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Labor (Exam 2)
| Question | Answer |
|---|---|
| Analgesia given too early.. | may prolong labor and depress fetus |
| Analgesia given too late.. | may causes neonatal respiratory depression w/ no benefit to mother |
| Safest form of anesthesia? | Local Infiltration |
| General Anesthesia | Used for emergency c section or vaginal birth - give just before birth to limit fetal exposure **risk of aspiration** |
| For moms given general.. | - place wedge under hip, tilt to side - give 30 ml of Bicitra before a c-section |
| Bicitra (SODIUM CITRATE-CITRIC ACID) | - Alkalizing agent that decreases acidity of gastric contents to minimize pneumonia if aspiration should occur |
| Regional Anesthesia | - temporary and reversible loss of sensation by injection of an agent into an area with direct contact to nervous tissue |
| Epidural Block | - given b/t contractions in L2-L5 - Marcaine or Xylocaine - Maternal hypotension possible - GOLD STANDARD FOR PAIN MANAGEMENT - Position on side with feet to chest for administration |
| Spinal Anesthesia | - may be used in low or midforceps & vacuum delivery - often used for c-sect -injected into l3-l5 Side effects: spinal headache, need a "blood patch" |
| Pudenal Block | - minor regional block that is effective & safe - given through vagina by placing local into the area of the pudenal nerve - use for spontaneous vaginal delivery Advantages: no neonatal respiratory depression |
| Paracervical block | - LA injected into lateral aspects of the cervix during active or transition phases -Monitor FHR for bradycardia |
| opoids | - Morphine has a depressive effect on fetus. - Meperidine (Demerol) has lesser impact on infant |
| Fentyl | - more potent but has a shorter duration of action than Morphine |
| Stadol & Nubain | - Stadol given if mom itches because of epidural - DO NOT GIVE WITH LATE DECELERATIONS |
| Precipitate labor | - Rapid labor less than 3 hours resulting in precipitous unattended birth/nurse attended - risk oh hemorrhage, & hypoxia to newborn |
| Pitocin drip too high.. | - may cause hypertonic uterine dyfunction |
| Tocolytic drugs.. | - prolong pregnancy for 2-7 days - Mg sulfate & nifedipine (Procardia) mg sulf antidote= calcium gluconate |
| Steroids are given.. | to assist with lung maturity |
| Postterm Labor | after 42 weeks - non stress test 2x weekly - daily fetal movement counts |
| Umbilical Cord Prolapse | - partial/ total occlusion of cord w/ rapid fetal demise - knee chest position (?? give o2 & place pt on left side??) |
| Uterine rupture | - onset marked by sudden fetal bradycardia |
| Amniotic fluid embolism | - respiratory distress in mother |
| Labor induction & augmentation | - Induction: stimulating contractions via medical or surgical means Augmentation: enhancing ineffective contractions after labor has begun (Pitocin) - cervical ripening to assist Pitocin |
| Amniofusion | - indications severe variable decelerations due to cord compression oligohydramnios thick meconium fluid preterm labor w/ premature rupture of membranes |
| Forceps/ Vacuum | uses: prolonged second stage of labor, non-reassuring FHR pattern, ect |
| Cesarean Birth | - classic or low transverse incision |
| Vaginal birth after c-sec (VBAC) | - Controversy related to risk of uterine rupture & hemorrhage |
| External monitoring | - ultrasound transducer placed over fetal back and detects movements of the fetal heart |
| Internal Monitoring | - inserted through cervix - must be 2 cm dilated |
| Baseline Heart rate | - average heart rate between contractions - Normal 120-160 - Tachycardia >160 - Bradycardia <120 or <110 in book |
| Nursing interventions for early deceleration | - perform vaginal exam |
| Baseline Variability | measure of interplay b/t sympathetic & parasympathetic nervous system |
| Short Term Variability | - change in rate between one fetal heart beat & the next - creates jaggedness or zig-zag - AKA beat to beat variability ONLY measured by internal electrode - Classified as present or absent |
| Long term Variability | - waviness or rhythmic fluctuations (cycles) - classified as absent, decreased, average, increased, marked |
| Most important aspect is LVT | - Even in presence of abnormal FHR, if variability is normal, fetus is NOT suffering from cerebra asphyxia -Occurs 2-6 times per minute |
| Causes of decreased variability | - hypoxia & acidosis - demerol, valium, vistaril that depress fetal CNS - Fetal sleep - fetus less than 32 weeks |
| causes of increase variability | - early/mild hypoxia - fetal stimulation - accoustic stimulation |
| Ominous sign | - decreasing variability that does not appear - associated w/ fetal sleep cycle or drugs |
| Accelerations | - transient increases in the FHR normally caused by fetal movements -sign of WELL-BEING |
| Non stress test | - accelerations w/ fetal movement form basis for nonstress test |
| Decelerations | - periodic decreases in FHR from the normal baseline |
| early decelerations | - decrease in FHR beginning at onset of a contraction and return to baseline by the end of contraction - caused by fetal head compression, usually benign |
| Late decelerations | - onset of deceleration occurs after onset of the contraction & is considered a non assuring pattern - occurs as result of uteroplacental insufficiency - results from decrease blood flow & o2 transfer **DISCONTINUE OXYTOCIN*** |
| Variable deceleration | - occurs if umbilical cord becomes compromised - fetal hypertension |
| Sinusoidal pattern | includes presence of LTV, absence of STV, and accelerations with fetal movements -associated w/ RH isoimmunization fetal anemia, chronic fetal bleed |
| Amnio-infusion | - installation of warm saline through intrauterine pressure catheter & may be used to recreate cushioning effect of the umbilical cord during contraction |
| Scalp Stimulation | - done by applying pressure w/ finger to the fetal scalp through dilated cervix - tactile response - assessment of acid-base balance |
| Acoustic stimulation | - sharp sound next to women's abdomen - used w/ nonstress test - used during labor to demonstrate fetus is reactive |
| Fetal blood sampling | - determine hypoxia - no pain - sample of capillary blood taken from fetus scalp **FETUS SHOULD NOT BE DELIVERED W/ VACUUM AFTER THIS TEST** |
| Ataratics: decrease n& v, anxiety, decrease narcotic requirements | - Vistaril (hydroxyzine) - Phenrgan (promethazien |
| Oxytocin | - plays important role in onset & maintenance of labor estrogen also increased myometrial sensitivity to oxytocin |
| Passageway | - relaxin & estrogen soften cartilage & increase strength & elasticity of pelvic organs - allows pelvic joints to seperate slighty |
| False pelvis | - shallow upper section of pelvic |
| true pelvis | - lower curved bony canal that includes the inlet, cavity, & outlet |
| Station | - relationship b/t ischial spines in the passage & the presenting part of the fetus - Ischial spines are at "station 0" |
| Wide suprapubic arches (gynecoid & platypelloid) | - allow for normal delivery * gynecoid most common |
| Narrow Arches (android & anthropoid) | - increase risks for forceps & c-section |
| Fontanels | points of intersection of membranous sutures |
| Anterior fontanel | - diamond shape |
| Posterior fontanel | - triangle shape |
| Fetal presentation can be determined by.. | locating the fontanel |
| Molding | overlapping of the fetal skull that helps the skull adapt to size & shape of the maternal pelvis - may take up to 3 days for effective molding to resolve |
| Fetal presentation | - refers to anatomic part that is either closest or in the canal |
| Fetal lie | - describes the relationship of the fetal long (head to toe) axis - in breech or cephalic presentation, lie is longitudinal - should presentation = transverse= unlikely vaginal birth |
| Oblique lie | - indicates the fetus is at a 45 degree angle to the maternal long axis & is unstable - often converts to longitudinal or transverse lie |
| Fetal attitude | - relationship of fetal body parts to one another |
| Typical fetal attitude.. | - flexion of the head wherein the chest rest on the sternum & arms and legs are flexed against the chest & back is bowed out |
| Largest diameter? | biparietal diameter @ 9.25 cm |
| fetal postion | - relationship of fetal presenting part to the left or right side of the maternal pelvis |
| 1st maneuver | - determine which fetal pole is present in fundal area |
| 2nd maeuver | - In a vertex/ breed presentation, one side will feel smooth & firm which indicates the back |
| 3rd maneuver | - fetal attitude can be determined in a cephalic presentation |
| 4th maneuver | - Dr will face clients feet to assess further fetal attitude |
| Primary powers | - uterine contractions are involuntary & generally independent of extrauterine control |
| Physiological retraction ring | - divides itself into two portions upper part thickens & lower segment thins out |
| Whats responsible for effacement and dilation of the cervix? | - uterine contractions |
| Effacement | shortening & thinning of the cervix - described in terms of % |
| Dilation | - widening of the cervical opening that occurs from myometrial contractions in labor - cervix is closed and then opens 10cm as labor advances |
| Cervix is no longer palpable when..? | - it is fully dilated & retracted |
| In primigravida.. | - effacement of the cervix begins before dilation |
| In multipara.. | - effacement & dilation progress together |
| Position | Lateral recumbent is most comfortable & best for fetal well being |
| First task of maternal role attainment.. | - mother seeks safe passage for herself & child during pregnancy |
| Early signs of labor | - lightening - 1-3 pound weight reduction - energy boost - false labor - bloody show - nesting |
| Lightening | - descent of fetus & uterus into the pelvic cavity 2-3 weeks before onset of labor |
| Braxton hicks contractions | - produce no cervical change |
| bloody show | - thick tenacious mucus forms inside cervical canal to act as protective barrier - as cervix begins to soften & dilate, mucus plug is expelled 24-48 hours before labor begins |
| Nesting occurs | 24-48 hours prior to labor |
| 1st stage of labor | longest in duration - begins w/ reg. contractions & ends when cervix is completely dilated |
| latent stage | - begins with onset of contractions - 15-20 mins apart lasting 20-30 secs - begins w/ little or no dilation and ends w/ cervix dilated 3 - 4 cm |
| Active phase | - 3 - 4 cm dilated & ends when she is 8 cm dilated - contractions q 2-3 mins lasting 60 seconds apart - pain relief requested |
| trasnition stage | - contractions q 1.5 - 2 mins lasting 60-90 seconds |
| 2nd stage of labor | - begins when cervix is completely dilated 7 effaced and ends when fetus is expelled - AKA pushing stage |
| Crowning | - point at which the fetal head is visible at the vulvar opening - birth is imminent - Lithotomy most common position for this stage |
| Descent | - progression of fetal head into the pelvis |
| flexion | - occurs when fetal head meets resistance from the pelvic floor and walls as well as the cervix causing head to flex w/ chin against fetal chest |
| internal rotation | - rotation of head from occiput transverse to occiput anterior |
| extension | - passing of fetal head under symphysis pubis |
| Restitution | - after birth of the head, head turns to realign w/ shoulder |
| external rotation | - rotation of shoulders so they are in an anteroposterior position |
| expulsion | - birth of entire body |
| 3rd stage of labor | - begins as soon as fetus is delivered & ends when placenta is delivered - after expulsion of fetus, uterus contracts q 3-4 mins - within 10-15 minutes of baby, placenta is expelled |
| schultz | fetal side |
| Duncan | uterine side |
| 4th stage of labor | first hour after delivery |
| Labor induction | - stimulation of uterine contractions before spontaneous onset of labor for the purpose of accomplishing delivery - most common reason is post term gestation |
| Bishop Score | - score of 6 or more = likelihood of successful induction - 13 point scoring scale |
| Cytotec (Misoprostol) | - synthetic prostaglandin administration orally / vaginally to produce contractions - side effects: hypertonic contractions, elevated resting tone **25-50 mg dose** |
| Pitocin (Oxytocin) **ALWAYS 2NDARY MEDICATION) | - helps induce labor, continue labor, or control bleeding after delivery. - produced naturally by the posterior pituitary gland and stimulates contraction of uterus - diluted w/ 10 units in 1 liter of isotonic solution |
| Pitocin continued.. | - DOES NOT cross placenta |
| Pitocin SIDE EFFECTS | - FHR decelerations - uterine hyperstimulation - uterine rupture - hypotension - diuresis (H20 intoxication) |
| Stripping of membranes | - assists w/ spontaneous labor - placing finger through cervical & sweeping in a circular motion |
| Aminiotomy | - artificial rupture of membrane - performed early in labor for urgent induction - (preeclampsia) - |
| Spontaneous rupture of membranes | - CHECK FHR first!!! |
| Outlet forceps | when head is crowning |
| low forceps | when head is at +2 station or lower but NOT crowning |
| Traction of forceps.. | only applied during contractions |
| Supine hypotension syndrome | - decreases cardiac output & stroke volume - heavy uterus can cause vena cava compression - MOTHER SHOULD LIE ON HER SIDE OR BACK W/ UTERUS TILTED TO ONE SIDE |
| PMI.. | - slightly more to the left |
| IV site | 18-20 gauge - need 1000 cc LR or D5wLR |
| Nitrazine paper | yellow paper turns blue when in contact w/ amniotic fluid |
| Fern Test | - amniotic fluid dries into a fernlike pattern on the microscope |
| DTR OF 3+ INNDICATES.. | - Clonus associated w/ preeclampsia |
| Test for clonus | - knee is supported in a partially flexed position while nurse applies sharp dorsiflexion to the foot |
| Hemoglobin below 11 or hematocrit below 32% relfects.. | anemia or hemmorhage |
| If a woman has an epidural does she need a cath?? | YES |
| Episiotomy | - surgical cut at opening of vagina during child birth * midline- cut from vagina directly toward anus * mediolateral- cut from vagina at an angle off to one side of the anus |
| Brethine | - for preterm labor & uterine hyperstimulation - prevents and slows contractions of the uterus |
| Amnisure test | - test for premature rupture of membrane |
| Apgar Score | - 0,1,2 for Activity, pulse, grimace. appearance, & respiration - 10 is best possible score |
| fetal station +5 | - fetal head fills vaginal canal, right before birth |
| amount of blood lost in vaginal birth | - 500 ml |
| amount of blood lost in csection | 1000 |
Created by:
KristinL
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