NUR 211 OB

Variable Decel: What does it mean and how to treat it?

Cord compression; turn mother on side, increase IV fluids, call DR

The nurse should suspect puerperal infection when a client exhibits which of the following? a. temperature of 100.2 F b. WBC of 14,500 c. diaphoresis during the night d. malodorous lochial discharge

D

NO _____ for post party

Lovenox

Spontaenous ROM 24 hours ago, the fluid is clear, Fetal HR is 120 bpm with mod variability. What assessment should be made?

Maternal temp- could have infection; monitor 1-2 hrs

How to treat ectopic pregnancy if tube is ruptured?

Surgery

Endometritis:

infections; palpate for tenderness of uterus, fever, foul vaginal odor comes later, saturated pads; treat with many antibiotics

We want the uterus to return to normal size by how much?

1 cm a day (this is called involution) when it does not = subinvolution

Categories of Labor:

1. no intervention needed 2. things are changing; watch strip more carefully 3. Abnormal; recurrent late variables; dr is notified

Normal FHR?

110-160 bpm

Late Hemorrhage:

24 hours- 6 weeks

At 30 weeks you should how many kicks per hr?

4 in 1 hr

Contracting resting tone?

60 seconds

A multigravida at 30 weeks gestation with an obstetrical history of G3 P1011 is admitted to the labor unit. She is contracting every 5 minutes, with contraction duration of 40 seconds. Which of the comments by the client would be most informative regarding the etiology of the client's present condition? a. for the past day I have felt burning when I urinate b. I have a daughter who is 2 years old c. I jogged 1 1/2 miles this morning d. my miscarriage happened a year ago today

A

A nurse remarks to a client who has come to the clinic at 38 weeks gestation, "It looks like your face and hands are swollen." The client responds, "yes, you're right. Why do you ask?" the nurse's response is based on the fact that the changes may be causes by which of the following? a. altered globular filtration b. cardiac failure c. hepatic insufficiency d. altered splenic circumference

A

29 week gestation- antepartum unit with vaginal bleeding. To differentiate with Placenta Previa and Abruptio Placentae what should the nurse asses for?

Abdominal Pain

A client has just received carboprost because of uterine atony not controlled by IV oxytocin. For which of the following side effects of the med will the nurse monitor for? a. anasarca b. diarrhea c. hypertension d. palpitations

B - EXCESSIVE

A client at 42 weeks gestation has just had a 20 minute NST. Which of the following results would the nurse interpret as a reactive test? a. moderate fetal heart baseline variability b. maternal heart rate accelerations to 140 bpm lasting at least 20 seconds c. two fetal heart rate accellations of 15 bpm lasting at least 15 seconds d. absence of maternal premature ventricular contraction

C

Immediately prior to an amniotomy, the external fetal heart monitor tracing shows 145 bpm with moderate variability and early decelerations. Immediately following the procedure, the tracing shows a FHR of 120 bpm with a prolonged deceleration. A moderate amount of clear amniotic fluid is seen on the bed linens. The nurse concludes that which of the following has occurred? a. placental abruption b. eclampsia c. prolapsed cord d. succenturiate placenta

C

Patient has bogey uterus and lemon-sized clots, what med should be given?

Carbopost Tromethamine (hemabate)- cause severe diarrhea & contraindicated in asthma patients

Thick cervix?

Give Cytotec (mistoprolol) for cervical thinning; wait 4 hours to start Oxytocin

Baby with a transverse lie position?

NO Oxytocin

What meds is given for hemorrhage?

Uterotonic; Oxytocin, Methergine, Carbopost

When is Oxytocin/Pitocin infused?

after stage 3 of labor

UTI's:

burning or stinging when peeing; pat dry, peri bottle, stay hydrated

Internal Monitor

fetal scalp monitor electrode; can cause ROM

RN role in stage 3 of labor?

give Pitocin IV Pump

Prolonged labor complication?

higher risk for hemorrhage

Vacuum rule:

if it pops off 3 times; try another method

Nursing interventions for cord prolapse? (Polyhydraminos)

keep fingers in vagina until Dr says take out, knee to chest position to keep pressure off of cord, inserting a foley to raise the cord, give tokolytic (tubutemol) SubQ to stop contractions, dc Oxytocin; if baby's head is not well applied to cord it can slip around baby's head so mom is encouraged to be bed bound

Internal Monitor for contractions (IUCP)

lacerate or go straight through the placenta

Toko

measures contraction

Montevideo Units

measures from bottom to top of contraction; less than 200 units/10 mins = adequate labor

What to expect on fetal strip with eclampsia mother? What is appropriate action by nurse?

moderate variabilities & late decelerations pad the side rails & raise HOB

External Fetal Monitoring

monitors HR/ palpating for contraction

Tachysystole-

more than 5 contractions in 10 minutes; causes late decels

Hypertonic Contractions

no resting tone; last greater 90-110 seconds

Hypotonic Contractions

not strong enough to cause uterine contractions

Amino Infusion?

putting fluid back in the uterus, IUCP in place, warm NS

Early Hemorrhage:

within 24 hours of delivery

Magnesium:

therapeutic range 4-7 treatment for seziures assess for toxicity; change in LOC and absent DTR antidote: calcium gluconate

What is External Cephalic Version?

Moving/repositioning baby

Postpartum Hemmorage 4 T's:

Tone (soft bogey uterus Tissue Trauma/Lacerations T-thrombin

Mastitis:

red enlarged breasts- wash breast, cabbage leaves; infection from breastfeeding (treat w antibiotics)

UTI in pregnancy:

risk for preterm labor; prolonged decels

HELLP Syndrome

Hemolysis, Elevated liver Enzymes, Low platelets; pregnancy is hurting mom so instant delivery

Late Decels: LIONS

L- lay patient on side I- increase IV fluids O- oxygen administered and baby; dc Oxytocin N- notify DR S- surgery prep

How to treat ectopic pregnancy if tube is not ruptured?

Methotrexate

A client at 39 weeks gestation is admitted to the labor and delivery unit with vaginal warts from HPV. Which of the following action by the nurse is appropriate? a. notify the HCP for a surgical delivery b. follow standard infectious disease precautions c. notify the nursery of the imminent delivery of an infected neonate d. wear a mask whenever the perineum is exposed

B

A nurse is caring for the following 4 PP clients. Which clients should the nurse be prepared to monitor closely for signs of postpartum hemorrhage? SATA a. G1 P0100, delivered a fetal demise at 29 weeks b. G2 P2002, prolonged first stage of labor c. G2 P1011, vacuum assisted vaginal delivery d. G3 P3003, delivered vaginally at 42 weeks, 4lb oz neonate e. G4 P4004, with a retained placenta

B, C, E

BISHOP Score

Score for induction of labor; cervix dilation and softness , fetal position, effacement

Stages of Labor:

Stage 1: (true labor) starts with uterine contractions & cervix dilation- Early latent Phase-- relaxed contractions mild; 0-3cm Active Phase-- breathing techniques; 4-7cm Transition Phase-- cervix dilated 8-10cm; ready to push for baby Stage 2: Completely dilated/ prep pushing/ all 4's Stage 3: Baby and placenta delivers Stage 4: Postpartum phase-- massage fundus q15 mins first 1-2 hours; 4 week pp checkup or PRN