FCN Exam 2

What is the fourth stage of labor?

- Immediate postpartum - First 4 hours after birth - May experience -> Chills -> Afterpains -> Tired -> Assess for hemorrhage

Variability

-little changes in HR from baseline -happy baby=moving baby -normal

Regional anesthesia

-spinal nerve block used for c section -extended-release (lasts 12-24 hours)

What is an induce abortion?

Amount of blood depends on how many weeks and type/secureness of implantation

What is placenta previa?

It is a condition in which the placenta develops over and covers the cervix.

What is external cephalic version?

Manual maneuvering of baby to try to position from breech to vertex with flexed neck

Second stages of labor

Period from full dilation and cervical effacement to crowning and birth of infant

What would you infer if a mother had an abnormal lower abdominal contour during labor?

The mother has a full bladder

What is an amniotomy?

artificial rupture of the membranes (AROM), induces labor

Latent phase

contractions beginning (new moms come to hospital)

Third stage of labor

placental separation and Placental expulsion

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses an "arrested descent." The woman asks, "Why is this happening?" Which response is the best answer to this question?

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

What are alternative therapies that help with comfort and pain relief?

-Breathing, aromatherapy, reflexology, meditation, acupressure, acupuncture, larnaz theory, hydrotherapy -non pharmacologic pain management

What is a spontaneous abortion?

-Causes can be d/t abnormality in fetus or poor implantation -Sometimes the mom doesn't know she already passed the fetus in a blood clot -D & C sometimes necessary - Amount of blood depends on how many weeks and type/secureness of implantation

How would you describe an adolescent and their physically/cognitive challanges?

-Consider what interventions may be necessary -Increased education and increased monitoring may be necessary -Consider if they are victims of abuse

What are power problems in labor?

-Ineffective uterine force -dysfunctional labor and associated stages of labor

how would you describe an adolescent?

-Not emotionally or physically mature yet -May not have finished going through puberty -Physical complications d/t lack of appropriate nutrition

What is dysfunctional labor?

-Precipitate labor o Labor lasting less than 3 hours from start to finish -This is good for some women (veteran moms) but for some women it is very difficult on the body and psyche -Induction o Medications used to begin labor - Cervical ripening · -Lack of effacement thus induced with vaginal suppository - Pt must lay supine after for suppository to work Helps to soften and prepare cervix o Oxytocin · We make it naturally but this is artificial · Given to help w/ contractions

What are things nurses should ask about in a maternal exam?

-Previous deliveries (history tends to repeat itself) -Psych issues -Know about all previous pregnancies

Leopold Maneuvers

-abdominal assessment of fetal lie -monitors are placed (tocolytic monitor placed on fundus, FHR monitor placed on abdomen over fetus back)

What are causes of hemorrhage?

-abortion (spontaneous or induced_ -ectopic pregnancy -abruption placentae

What are reproductive changes during pregnancy?

-breasts (prepare for lactation, become enlarges, leak breast milk) -Lochia (vaginal discharge) -Uterus (need to palpate to monitor position)

decelerations

-decreased HR from baseline -not normal and not good -dangerous -reposition mom and apply oxygen -if continuous, increase pitocin and consider C-section

How does doula or coach aide in comfort and pain relief?

-helps mom relax -supportive person (not midwife) -backrubs, position change, breathing exercises

What are the leading complications of pregnancy?

-hemorrhage -thromboembolism -infection -hypertension of pregnancy -ectopic pregnancy

What can FHRs determine?

-if the baby is stressed -what the baby's recovery time is

What are signs and symptoms of hemorrhage?

-increased HR -low BP -lightheadedness -loss of consciousness -diaphoretic -pale

Narcotic analgesics (fentanyl preferred)

-intrathecal (traditional epidural) -Catheter in epidural space spine where narcs are given by PCA or slow release -platelet count check (to ensure patient wont bleed out) -ideally inserted at 3-5 cm dilation -removed after birth

What nursing care is involved in peripheral circulation?

-mom is at high risk for DVT dur to 50% higher blood volume especially due to c-section -perform DVT assessment (assess legs/calves for warmth, redness, and pain to touch) -Interventions (ambulation, SCDs, lovenox injections)

General anesthesia

-not routine -used in emergency c-sections and/or if not enough time to give spinal nerve block (have to work quick after given) -increased complications (respiratory compromised baby)

Bonding

-nurses need to monitor for signs of poor bonding by either parent -keep culture in mind -refer to SW if needed

What is trail labor?

-see how well mom pushes before actually pushing

What are passage problems?

-trial labor -externam cephalic version -forceps birth -Vacuum extraction

What are passenger problems?

-umbilical cord prolapse -multiple gestation -problems with fetal positioning

What to asses when the membrane as ruptured (water broke)?

-when did it occur -amount -color -odor

What is Preclampsia & eclampsia?

Definition: disorder of pregnancy characterized by triad of hypertension, proteinuria, and edema with vasospasm as a cause · Proteinuria d/t spilling of proteins into urine · Edema d/t fluid is going into the third space and not into cells appropriately

What nursing care is involved in uterine involution?

Fundal massage frequently to prevent uterine atony (boggy uterus)

A woman has arrived at the birthing center in labor, requesting a VBAC. The nurse knows that she would be a good candidate after reading the woman's previous history based on which finding?

Has previous lower abdominal incision

Sonography

If needed, can use ultrasound to determine the positioning of the baby

what are the side effects of oxytocin?

If too much it causes a hyperstimulated uterus which stalls labor and the baby and mom could have low O2

What are pharmacologic measures that help with comfort and pain relief?

Narcotic analgesics (fentanyl preferred because it has a quick half life) -regional anesthesia -local anesthesia -General anesthesia -Nitrous oxide (aka walking epidural)

The nurse educator explains that several factors are involved with the "powers" that can cause dystocia. One factor is dysfunction that occurs when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This is known as which term?

Precipitous labor (Labor lasting less than 3 hours from start to finish)

What is a hemorrhage?

Profuse bleeding can happen quickly d/t increased vasculature of the area

The nurse is caring for a woman in active labor. Which assessment finding should the nurse prioritize and report?

Sudden shortness of breath

What is the biggest concern when meconium is found in amniotic fluid?

The baby asperating

The nurse is correct to instruct the client in active labor on which type of patterned breathing?

Transitioning breaths from "slow, deep breaths to quicker short breaths" at the contraction peak.

A nurse is reviewing a journal article on the causes of postpartum hemorrhage. Which condition would the nurse most likely find as the most common cause?

Uterine atony (boggy uterus)

what does primigravida mean?

a woman who is pregnant for the first time

Why is baseline FHR important?

assess baseline HR and establish then monitor for variations from baseline

Active phase

contractions increase and dilation begins (veteran moms come to hospital)

A women is giving birth when shoulder dystocia occurs in the fetus. The nurse recognizes that which condition in the woman is likely to increase the risk for shoulder dystocia?

diabetes

Transition phase

dilation and effacement complete -Mom can have chills, nausea, vomiting

Maternal exam assessment

history, physical, Leopold maneuvers, rupture of membranes, vaginal exam, sonography

what are the side effects of magnesium sulfate?

hypotension and bradycardia

Why do nurses monitor FHR and uterine contraction correlation?

it shows the HR response to uterine contractions -shows if baby needs to be reposition or how it is handling the contractions

What is more alarming to a labor nurse, early decelerations or late decelerations?

late decelerations

First Stages of labor

latent phase active phase transition phase

What is hypovolemic shock?

loss of too much blood/fluid in the body

What terminology would the nurse use to document a newborn who weighs 4,000 grams (8.13 lb) or more at birth?

macrosomia (large) -worry about these women delivering because the baby is larger and has potential for should dystocia

A nursing student working with a woman in preterm labor and correctly identifies which medication as being used to relax the smooth muscles of the uterus and for seizure prophylaxis and treatment in women with preeclampsia?

magnesium sulfate

What to asses during vaginal exam?

make sure there is a safe passage of fetus

Internal monitoring

monitor screwed into babys forehead

External monitoring

monitors placed on belly to monitor FHR and contractions

What is a ectopic pregnancy?

o Attachment outside uterine cavity -Usually fallopian tube o Typically, not viable o Increased complications o If in fallopian tube, it can rupture leading to bleeding and abdominal pain -Sometimes this is repairable, sometimes not

Why is MAGNESIUM SULFATE given to pregnant women?

o Medication used for preeclampsia o Medication used to stop/slow preterm labor -It is a cardiac medication thus need to monitor effects on heart -Smooth muscle relaxant

What is abruption placentae?

o Premature placental separation o Sharp, abrupt pain o Intense bleeding

Why is oxytocin used in pregnant women?

o Used to induce uterine contractions and begin a mom's labor o Also used after birth to continue contracting the uterus so that it clamps down to prevent hemorrhaging

Why is fentanyl used in pregnant women?

o Used to manage pain o Opioid, narcotic analgesic

What are medications used during labor?

o magnesium sulfate o Oxytocin o Fentanyl

Local anesthesia

pedendal block (vagina and perineum numbing with lidocaine)

The nurse is monitoring a woman in labor who is having a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The woman reports severe pain in her abdomen and shoulder. What should the nurse prepare to do?

prepare the woman for a cesarean birth (most likely the mom is hemorrhaging)

A woman having contractions comes to the emergency department. She tells the nurse that she is at 34 weeks' gestation. The nurse examines her and finds that she is already effaced and dilated 2 cm. What is this woman demonstrating?

preterm labor

what are some side effects of fentanyl?

respiratory distress and low heart rate

What is hyperemesis gravidarum?

severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus

When assessing a postpartum woman who was diagnosed with a cervical laceration that has been repaired, what sign should the nurse report as a possible development of hypovolemic shock?

weak and rapid pulse (because the body is trying to push the blood to the vital organs)

What is a vacuum extraction birth?

· "small plunger" · Suction on baby's head and pull with contraction · Risk of causing trauma to baby's head

What are the problems with fetal positioning, presentation or size?

· Breech presentation (Feet/butt first, c-section safest) · Macrosomia -Big big baby usually seen w/ gestational diabetic mom, 10+ lbs, Risky to delivery vaginally, Sometimes an OB will induce if baby is getting too large · Shoulder dystocia -Usually w/ macrosomia -Shoulders get caught on pelvis -Baby crowns then gets sucked back in (turtling) - Medical emergency · OB will pull pull pull · Baby might fracture clavicle

What are the problems associated with multiple gestation?

· Increased risks with multiple fetuses · Assessment: Leopold maneuver and ultrasounds · Safest to deliver C-section in OR -First baby could be born and second one has more room to flip around and have bad positioning - First baby could be born and second one is emergency C-section -It is safer to just be in the OR

What is ineffective uterine force?

· Ineffective contractions · Not enough fetal descent

What is a forceps birth?

· Large "salad tongs" · Used in emergencies or if mom is exhausted and baby NEEDS to come out ASAP · Pull out with contraction · Risk of causing trauma to baby's head and/or nerve damage

what are the classifications of preeclampsia?

· Mild preeclampsia o Increased BP (specifically diastolyic) o Small amount of proteinuria · Severe preeclampsia o Increased proteinuria o Increased BP o Increased edema (pitting, facial) · Eclampsia o Increased edema leading to cerebral edema and seizures (Can lead to fetal death d/t maternal circulatory collapse) · Lack of O2 to baby

What are interventions to monitor with preeclampsia?

· Monitor regularly at office visits · Antihypertensive medications

What happens with an umbilical cord prolapse?

· Umbilical cord is slipping under fetus and gets pinched with ROM · Usually seen w/ breech presentation · Assessment: umbilical cord is visualized in vagina before baby · Medical emergency --> prepare for c-section