Nur 106 Module C part 2
What is the mechanical method for the Bishop Score
-Foli tip is placed in -inflate the balloon with Normal Saline -nurse tugs on it, which puts pressure on the cervix -when it eventually falls out, the pt is probably 3 cm
What are some interventions when a baby is breeched
-IV fluids are given -cover the abdomen with ultrasound jell -manually move baby
Risks for inductions
-Tachysystole uterine activity -uterine rupture -maternal water intoxication -chorioamnionitis -increase risk for c-section
What are things that need to be assessed in the active phase
-VS -cervix dilation -effacement -fetal monitor
What are some discomforts during the fourth stage of labor
-after birth pains -perineal discomforts
Nursing considerations for insufficient Bishop Score
-all consents signed -20-30 min. FHR baseline -IV access -Have pt empty their bladder -recumbent position for the first 30 min. -monitor continuously
Fetal Causes of dysfunctional labor
-anomalies -Cephalopelvic Disproportion (CPD) -Malposition -Multifetal pregnancy
The variables affecting labor: Psychological response
-anxiety -birth as and experience -support system
What are some risk factors for a breeched baby while being turned
-baby could get tangled up with the cord -abruption -irritates uterus
What are some non-pharmacologic interventions for pain control
-birthing ball -changing positions -walking around -the environment -thermal stimulation -acupressure -breathing techniques
Nursing considerations during infusion of Pitosin
-continuously assess FHR and contraction activity -decrease/discontinue for non-reassuring FHR pattern and/or tachysystole - may need to reduce the rate of infusion when in active labor (5-6 cm)
Pitocin: Maternal Assessment
-contraction pattern and uterine tone -VS and pain every 15-30 min. or with each dose change -strict I&O's for water intoxication
What are some true signs of labor
-contractions -discomfort -the cervix begins to dilate -the head begins to show
Nursing Considerations for Cytotec
-don't administer to pt's with uterine surgery -pharmacy has to prepare -continuous fetal monitoring -Pitocin may be administered 4 hrs. after last dose
What effect do pharmacologic management have on complications
-failure to progress -decrease BP -decrease FHR -illicit drug use
Prolonged labor
-greater than 18-24 hrs. -meds such as epidural -positioning (if mom's not changing positions)
Prolapsed Umbilical cord causes
-high station -small fetus -breech presentation -transverse lie -polyhydramnios
Nursing Interventions: non-reassuring (abnormal) FHR patterns
-identify cause -stop/reduce oxytocin -reposition -increase IV fluids -O2 by face mask -Vag. exams -VS -notify HCP
What are some adverse effects of excessive pain
-increase in uterine resting tone -reduces effectiveness of contractions -reduces blood flow to and from the placenta
What are some indications of an induced labor?
-intrauterine environment hostile to fetus -SROM at or near term -postterm -chorioamnionitis -hypertension -mild abruption -maternal conditions (diabetes, renal, heart,or pulmonary disease) -fetal death
If a pt has a classical incision, what can't the mom do?
-labor and vag. birth -can't be induced
What are the 3 phases in the first stage
-latent (early) -active -transitional
What are factors to consider in the second stage of labor
-maternal position and efforts -fetal size
What are some false signs of labor
-no head -thick cervix -irregular contractions
Contraindications that may need to be re-thought for inducing labor
-one or more previous low transverse c-section deliveries -breech presentation -over distention of the uterus -severe hypertension -fetal presenting part above the pelvic inlet -nonreassuring FHR patterns
Safety measure for Pitocin
-piggyback into primary lime at port closest to site -side-lying position to promote uterine blood flow -continuously assess FHR and uterine contractions
Intrapartum Emergencies
-placenta abnormalities (preveas and abruptions) -prolapsed umbilical cord -uterine rupture (previous uterine surgery) -uterine inversion
Contraindications for induced labor
-placenta previa or vasa previa -prolapsed umbilical cord -abnormal fetal presentation -active genital herpes -presenting part above the pelvic inlet -previous surgery on upper uterine segment -labor shouldn't be induces if the fetus is younger than 39 wks gestation unless a compelling reason exists
Intrapartum Complications
-possible intrauterine infection (fever) -Postterm pregnancy (beyond 42 wks)
What are risk of an amniotomy
-prolapse of the umbilical cord -infection -abruptio placentae
Uterine inversion causes
-pulling on cord -fundal pressure -placenta adherence -weak uterine wall
Nursing Considerations for Cervidil
-remove after 12 hr or w/ onset of labor or ROM -pt teaching -continuous fetal monitoring -may begin Pitocin 30-60 min. after removal
What are interventions for any pain medications (epidural and spinal block)
-reposition -increase IV fluids -Ephedrine -administer O2 -assess for fetal distress
Before turning off Pitocin what should the nurse do (interventions)
-repostion -give fluid bolus -give O2
Oxytocin (Pitocin)
-stimulates contractions -always given w/ an infusion pump -never given by gravity due to perfusion by gravity -starts w/ 1 ml/hr and then increases
Signs of Prolapsed Umbilical Cord
-sustained fetal bradycardia -variable deceleration
Dinoprostone (Cervidil)
-used as cervical ripening -has a 12 hr time release - can be removed (has a string attachment) -expensive
Misoprostol (Cytotec)
-used for induction -used to soften cervix -uterus contracts with high doses -can't be removed
Positions for prolapsed umbilical cord
-woman's hips higher than head to shift fetal presenting part toward the diaphragm -knee to chest (lets baby fall back into the abdomen and relieves pressure) -trendelenburge -vag. evaluation of the presenting part
how much is the women dilated in the latent phase
0-3 cm
After an amniotomy, how long does a nurse monitor the FHR for?
1 full minute
how long could the transitional phase last
1-2 hrs
how long does a spinal block last
2 hrs
how long could the latent phase last?
24 hrs
Predipitous labor
3hrs or less
how much is the women dilated in the active phase
4-7 cm
What scoring would be given if the cervix isn't ready (Bishop Score)
6 or less
how much is the women dilated in the transitional phase
8-10 cm
When do Braxton Hicks contractions occur?
@ 20 wks
What category is: Accelerations
Category 1 (reassuring)
What category is: Fetal heart rate baseline 140
Category 1 (reassuring)
What category is: Three accelerations in a 10 minute period
Category 1 (reassuring)
What category is: moderate variability
Category 1 (reassuring)
What category is: recovery to baseline following maternal position change
Category 1 (reassuring)
What category is: A positive CST
Category 2 (non-reassuring)
What category is: Baseline 135 with absent varibility
Category 2 (non-reassuring)
What category is: Baseline 180
Category 2 (non-reassuring)
What category is: Late deceleration with moderate variability
Category 2 (non-reassuring)
What category is: Late decelerations
Category 2 (non-reassuring)
What category is: Minimal or marked baseline variability
Category 2 (non-reassuring)
What category is: Tachycardia with absent variability
Category 2 (non-reassuring)
What category is: early deceleration with minimal variability
Category 2 (non-reassuring)
What category is: prolonged decelerations
Category 2 (non-reassuring)
What category is: Recurrent late deceleration with absent variability
Category 3 (non-reassuring)
What category is: Variable deceleration with absent variability
Category 3 (non-reassuring)
What are things to look at for a focused assessment on admission
FHR and maternal VS
If medications are given for a low scoring Bishop Score what needs to happen (r/t monitoring)
Fetal heart monitor need to be put on
What is the resting tone of a contraction?
It is the resting point after a contraction
What maneuver would be used to determine where a monitor goes for a baby?
Leopold's Maneuver
What is McRobert's Maneuver?
Mom's legs are pulled back as far as possible to open up the pelvis
What type of diet is a pt on when having a c-section
NPO
In the transitional phase, what can women not be given
No medication
What medication would NOT be given if the Bishop Score was a 6 or less
Oxytocin
What is the first stage of labor called
The stage of cervical dilation
Doctors put a standing order for what medication? and what does it do?
Tubertaline (Brethine), it given if there is too many contractions
What does the station of the baby tell a nurse?
Where the baby's head is sitting in relation to mom's pelvis
If a shoulder dystocia cannot be corrected, what can happen?
a C-section may be performed
Ruptured uterus is what
a medical emergancy
A pt has a classical incision, what will she not be able to do?
a pt can't do a vag delivery or labor
Variable deceleration are which of the following: -gradual -abrupt -periodic -episodic
abrupt and episodic
A (VEAL CHOP)
acceleration
The primary goal of intrapartum fetal surveillance is to enable clinicians to asses what?
adequacy of fetal oxygenation during labor
The third stage of labor begins immediately
after the fetus is born and ends when the placenta is delivered
What is the key to recovery?
ambulation (movement)
What type of medication should be given if a pt has Polynefritus
antibiotics
A (PAIN)
anticipated
Amniotomy
artificial rupture of membranes and it allows for more pressure and it allows for the cervix to dilate more
A (MAD) (active phase)
assess and anticipate physical needs
Signs of uterine inversion
bleeding, toned up
How is Cytotec administered?
can be taken by mouth or placed near the cervix
What type of diet is a pt on when having a vaginal delivery
clear liquid diet
After an amniotomy what should bedocumented
color clarity amount odor time VS
The second stage of labor begins with
complete cervical dilation and ends with delivery of fetus
Pitocin: Fetal Assessment
continuously or intermittent fetal heart tracing (document q 5-30 min.)
During the second stage of labor the pt should push along with what?
contractions
C (VEAL CHOP)
cord compression
What is the most common cause of fetal insufficiency?
cord compression
Signs and symptoms for Cytotec
cramping and bleeding for 24 hrs
Shoulder Dystocia
delayed or difficult birth of the fetal shoulders after the head is born
D (TIRED) (transitional phase)
discomfort
D (MAD) (active phase)
dry lips and dry linens
When does lightening occur in pregnancy?
during early labor
E (VEAL CHOP)
early
What type of deceleration is this: due to head compression
early
What type of deceleration is this: early onset
early
What type of deceleration is this: Uniform shape
early and late
What type of deceleration is this: usually within normal heart range
early and late
E (TIRED) (transitional phase)
encourage/ praise
The variables affecting labor: Passenger
fetal head, variations on the passager position
What can cause the fundus to be inverted (uterine inversion)
firm massage pressure
When is a spinal block most commonly use
for a scheduled c-section
What does a nurse need to look at when a contraction happens?
frequency, duration, and resting tone
Where are Braxton Hicks felt?
from the sides
Where are real contractions felt?
from the top of the uterus
Early deceleration are which of the following: -gradual -abrupt -periodic -episodic
gradual and periodic
Late deceleration are which of the following: -gradual -abrupt -periodic -episodic
gradual and periodic
What scoring would indicate that the cervix is soft and ready, using the Bishop Score
greater than 7-9
H (VEAL CHOP)
head compression
Continue to give Pitocin after birth to prevent what
hemorrhage
Both prolonged and prefipitous labor are at an increased risk for what?
hemorrhages
what can placenta complications could lead to?
hysterectomy
With an amniotomy what is the mother at an increase risk for
infection
After 18 hrs ago, a ROM is performed and mom is in active labor, what is she at an increase risk for and what are nurses worried about
infection and sepsis
I (TIRED) (transitional phase)
informed progress
I (PAIN)
intermittent
What happens to a pt's BP when given a spinal block
it decreases
How does local infiltration anesthesia work
it numbs the perineal area for any laccerations
L (VEAL CHOP)
late
What type of deceleration is this: Late onset
late
What type of deceleration is this: due to uteroplacental insufficiency
late
What type of deceleration is this: may be altered with maternal
late and variable
What type of deceleration is this: may be associated with fetal acidosis
late and variable
What is given in a pudendal block?
lidocane
What are some risk factors when dealing with and epidural or spinal block
maternal hypotension bladder distention (empty bladder)
M (MAD) (active phase)
medication
Cephalopelvic Disproportion (CPD)
mom's pelvis and baby's head do not match
Tachysystole
more than 5 contractions in 10 minutes
Which intervention by mom is most important during the active phase?
movement
An increase secretion of ______________ __________________, can also stimulate the laboring process
natural oxytocin
What is phenergan used for
nausea
N (PAIN)
normal
O (VEAL CHOP)
okay
Where would a nurse put a monitor on a fetus?
on the fetus's back
What is the most common adjunctive drug
phenergan
When contractions are going well, but they are not strong enough, what is the pt given
pitocin
P (VEAL CHOP)
placenta insufficiency
P (PAIN)
purposeful
How often does a nurse take a temperature after an amniotomy
q1-2 hrs.
what is the length and duration of contractions in the transitional phase
q2-3 min. and for 45-90 sec. duration
what is the length and duration of contractions in the active phase?
q3-5 min. and for 30-60 sec. duration
Bishop Score
ratings of the readiness of the cervix
R (TIRED) (transitional phase)
restless
Applying suprapubic pressure allows for what (in shoulder dystocia)
rolls the shoulder in -may cause fractured clavicle or humerus fracture
During the transitional phase, what is one thing the nurse needs to teach?
short, panting breaths
Pitocin is given to do what?
speed up the contractions
What 2 systems are responsible for "fight or flight"?
sympathetic and paprasympathetic
A pt can get _______________ when pitocin is given
tachysystole
Who does general anesthesia most affect
the baby
Braxton Hicks do not change what
the cervix
Cervical ripening is a sign for what
the cervix is changing to become softer, and the dilation process starts
the fourth stage of labor begins after
the delivery of the placenta and continues for 1-4 hrs after delivery
If anything happens to mom, what should a nurse assess
the fetal heart rate
If the mom does not have adequate blood flow, what will happen to the fetus?
the fetus won't be perfused well
Prostaglandins stimulate what
the laboring process
The stage of cervical dilation begins with:
the onset of regular contractions and ends with complete dilation
What is the third phase of labor called
the placental stage
With an epidural, a pt should still fill....
the pressure of the baby
Management of prolapsed umbilical cord
the priority is to relieve pressure on the umbilical cord to improve blood flow through it until deliver
Variables are common during which stage in labor?
the pushing stage
What is the fourth stage of labor called
the recovery stage/ maternal homeostatic stabilization stage
Cervical Ripening
the softening of the cervix
What is the second stage of labor called
the stage of expulsion
effacement
the thickness of the cervix
Systemic drugs for labor act on what
the whole nervous system
What are some maternal behaviors of the fourth stage of labor
tired and excited
T (TIRED) (transitional phase)
tires
What is the purpose of using Ephedrine after an epidural
to bring up BP
polyhydramnios
too much amniotic fluid
Hypo/hypertonic uterine dysfunction
too much or too little contractions
The variables affecting labor: Passage
true pelvis is most important
If pt is contracting well what should the nurse do if pt is on pitocin
turn pitocin down
The variable affecting labor: Powers (what is needed)
uterine contractions and maternal pushing efforts
Fight or flight is how you get what?
variability
V (VEAL CHOP)
variable
What type of deceleration is this: due to cord compression
variable
What type of deceleration is this: variable onset
variable
What is engagement
when the baby drops into the pelvis, and happens during active labor
lightning
when the baby falls in the pelvic area, and the mom can finally breath again
When is a version not done
with PTL
Can a pt develop kidney stones when pregnant
yes
