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Intrapartum-Zuck
| Question | Answer |
|---|---|
| Anesthesia | abolition of pain perception (with or without loss of consciousness) |
| Analgesia | alleviation of pain sensation or raising of pain |
| Pudendal block | anesthesia that eliminates pain in vagina, vulva and perineum, used episiotomy, birth and assisted birth |
| Local anethesia | used for perineal anesthesia for performing and repairing episiotomy |
| Epidural block | relief of pain from uterine contractions and birth by injection into the dura space |
| Spinal block | single dose injection into subarachnoid for pain control during birth, rather than labor |
| Narcan | drug that reverses the effects of opiods, prompt onset lasts 1-4hrs, metabolized liver |
| Tocolytic | medication used for relaxation of uterine muscles |
| Blood Patch | method to repair a tear in dura mater around spinal cord as a result of spinal anethesia |
| Glucocorticoid (Dexamethasone, Betamethasone) | medication used to stimulate fetal lung maturity, 24-34 weeks |
| Duramorph | addition to thecal anethesia to prolong pain relief, no narcotics for 18 hrs, monitor HR, RR, pulse ox q 30 min-1hr for 24hrs |
| Ritodrine (Yutopar) | Beta adrenergic agonist-IV to suppress contractions |
| Terbutaline (Brethine) | Beta adrenergic agonist-subq using syringe or pump, SE-tachy, dyspnea, hyperglycemia |
| Nifedipine (Procardia) | Ca channel blocker relax smooth muscle-sublingual then oral |
| Magnesium Sulfate | CNS depressant preterm labor-IV relax smooth muscle |
| Indomethacin | NSAID relaxes smooth muscles by prostaglandin inhibition, rectal or oral |
| Prostaglandin | used to ripen cervix or stimulate contractions |
| Dinoprostone (Cervidil) | vaginal insert posterior fornix of vagina-prostaglandin |
| Dinoprostone (Prepidil) | gel inserted cervix below internal os-prostaglandin |
| Oxytocin (Pitocin) | hormone used to stimulate uterine contractions to augment or induce labor |
| Laminaria tent | natural cervical dilator made from seaweed |
| Misoprostol (Cytotec) | oral tablet or intravaginal ripening agent |
| Baseline FHR | 110-160 beats/min during 10 minutes excluding periodic and episodic |
| Undetected variability | absence of expected irregular fluctuations in FHR |
| Bradycardia | FHR below 110/min longer than 10 min |
| Prolonged deceleration | decrease in FHR of 15/min below baseline lasts more than 10 min |
| Periodic changes | occur with contractions |
| Tachycardia | FHR above 160/min longer than 10 min |
| Variability | Exprected irregular fluctuations of baseline (2 or more/min) |
| Early deceleration | FHR decrease after onset of contraction-fetal head compression-GOOD |
| Late deceleration | FHR decrease after peak of contraction-UPI-Nonreassuring |
| Variable deceleration | FHR decrease any time during contraction-umbilical cord compression |
| Acceleration | increase FHR 15/min or more, last 15 sec but shorter than 2 min |
| Episodic | FHR changes not associated with contractions (movement etc) |
| Duration | start to finish of contraction |
| Frequency | peak to peak or start to start of contraction |
| Resting time | time between contractions |
| Acme | peak or intesity of contraction, mmHG, 35=mild, 50=mod, 75=strong |
| Normal resting tone | 8-15mmHG |
| Amniotomy | artificial rupture of membranes, check FHR, cord compression or prolapse |
| External version | External manipulation to turn fetus from unfavorable lie or presenting part, risks-cord compression, injury, placenta bleed, uterine tear/rupture, labor |
| Preterm labor | labor begins before 37-38 weeks |
| Hypotonic uterine dysfunction | results in less than adequate labor pattern |
| Amnioinfusion | intrauterine infusion to increase amount of fluid or flush, correct variable decels, need 30 min to increase fluid, risk of overdistention & increase tone |
| Sinusoidal FHR pattern | Related to severe fetal anemia, acidosis, hemorrhage, abruptio or hydrops fetalis, undulating, oscilating, waves, persistent & rounded, no variability |
| Cardiac changes with labor | Increase CO & PVR, stage 2 increase intrathoracic pressure & venous pressure, decrease venous return=fetal hypoxia |
| GI changes with labor | decrease motility, absorption, emptyingincrease nausea, belching with dilation |
| Meds used to treat GI issues during labor | Bicitra, Maalox, Reglan, Zantac |
| Urinary changes during labor | decrease tone, capacity, sensation of filling, proteinuria (affects progress & comfort) |
| Hemopoietic changes during labor | increase WBC (21-25), fibrinogendecrease coag time, blood sugar |
| Respiratory changes during labor | Increase O2 demand (stage 1=40%, stage 2=100%)hyperventilation |
| Fetal scalp pH | 7.25 and above=ok7.18 and below=deliver |
| Amniotic fluid normals | 1000ml, pale/straw color, no odor, watery, slightly alkaline |
| Best evaluation amniotic fluid | Ferning pattern, next nitrazine test |
| PURE | Position change q20,urinate q1-2hrs, relaxation, environment & encourage |
| Nubain | analgesia, caution with preterm, equal to morphine |
| Stadol | analgesia, CHECK RR, must be 10, potent, give begining of contraction |
| Stadol/Nubain adverse maternal effects | Resp depression, tachy, hypotension, bladder distention, mental changes, confusion, sedation |
| Stadol/Nubain adverse fetal effects | sinusoidal FHR, bradycardia, CNS depression |
| Stadol/Nubain adverse neonate effects | resp depression (1-4 hrs), apnea, cyanosis, hypotonia, bradycardia, arrhythmias (Narcan given) |
| Narcan adverse effects | increase/decrease BP, increase HR, pain, irritable, crying, pul edema, abstinence syndrome |
| Analgesic/anesthesia complications fetus/neonate | CNS depression, hypoxia, lethargy, poor suck/swallow |
| Analgesic complications maternal | NV, decrease peristalsis, urine, CNS, BP alter, increase HR, ineffective, allergy, pruritus, delerium |
| General anethesia | used cesarean/sterilization, SE=allergy, NV, aspiration, alter BP, uterine atony (hemorrhage), urine retention, hypothermia, surgical comps) |
| #1 complication spinal/epidural anesthesia | Hypotension-prevent with bolus 500-1000ml LR |
| Medication treatment of hypotension during labor | Ephedrine |
| Nerve blocks | "caine" family, local or thecally, preservative to prolong, potentiators with cesarean |
| Nursing responsibilities with anesthesia | position of mom, monitor effects, contractions |
| Epidural dilation requirement | 3cm min, 4cm with nullipara |
| Potential complications spinal/epidural | shiver, NV, hypotension, inhibit bearing, allergy, ineffective, loss sensation, cramps, hypothermia, urine retention, uterine atony, hemmorhage, pruritus |
| Specific spinal complications | leakage of CSF, post dural puncture HA (give caffeine) |
| Fetal distress manifestations | abnormal FHR, meconium stained fluid with cephalic, hyperactivity |
| Short term variability | BTB, monitors compensation by babe with O2 changes, absent or present |
| Long term variability | cycles, 3-5/min |
| Tachycardia causes | early fetal hypoxia, prematurity, anemia, cardiac arrythmias, HF, mom drug use, anxiety, fever, hyperthyroid, pain mgmt meds |
| Tachycardia interventions | reposition, O2 @ 8-10L, increase mainline, antipyretics, calm, persist >1hr=deliver |
| Bradycardia causes | late fetal hypoxia, prolonged cord compression, acute fetal asphyxia, heart block, HYPO thermia, tension, glycemia, SE anesthia, positioning, contraction hyperstimulation (Pitocin) |
| Recurrent decelerations | occur with 50% contractions in 20min |
| Nadir | low point, usually occurs with peak of contraction |
| Shoulder humps | quick increase pre and post FHR changes=good |
| Intervention for nonreassuring | Intrauterine resuscitation-position, increase mainline, O2 @ 8-10L |
| Interventions for variable | check for cord, reposition, O2, amnioinfusion |
| Interventions for late | reposition, O2, increase mainline, turn off Pit, Monitor mom-BP:babe-FHR, deliver |
| Pseudosinusoidal | saw tooth, mod variability, caused pain meds |
| Saltatory | Marked variability >25bpm, unknown cause |
| 5 Ps of assessment | Personality, position, passenger, powers, passageway |
| Position | change q 20min, supine hypotensive syndrome |
| Presentation | cephalic, breech, shoulder, vertex |
| Lie | baby spine v. mom spine |
| attitude | flexion/extension |
| position | presenting part (right or left, part, location) |
| Amniotic Fluid Embolism | amniotic fluid into bloodstream (10%maternal mortality, 50% fetal) |
| Cord prolapse | emergency, SGA/SFD, premie, breech, transverse, RBOW, anmiotomy w/out engage |
| Cord prolapse interventions | position, bladder infusion, delivery |
| Nuchal cord (CAN) | cord around neck |
| Ferguson reflex | urge to push |
| O2 to babe begins decreasing at ____mmHG | 35 |
| Primary & Secondary powers | primary-contractions, secondary-pushing |
| Premature labor | after 20 weeks before 37 weeks |
| #1 cause premature labor | UTI- then dehydration, multifetal etc |
| Stop premature labor if | cervix <4cm or 50%, BOW intact, viable fetus, no maternal contraindications |
| dystocia | long, difficult labor |
| dysfunctional | abnormal contractions prevent normal progress |
| Hypertonic (Hyperstimulation) | painful but ineffective, increase rest tone >20mmHG, duration >90 sec, intensity >75-80mmHG: decrease rest <30 sec, frequency <2 min, coupling or tripling |
| Hypertonic interventions | O2, reposition, shut off Pit, increase mainline, tocolytic, amniotomy, calm |
| Hypotonic causes | fetal malposition, overdistention of uterus, pressure not high enough |
| Hypotonic interventions | rule out CPD/FPD or pelvic probs, amniotomy, stimulation |
| Precipitous labor | <3hrs |
| Induction | deliberate initiation of labor |
| Augmentation | stimulation or enhancement of contractions |
| Contraindications oxytocin | CPD, prolapse cord, transverse lie, nonreassuring status, placenta previa or vasa previa, prior classic uterine incision, active herpes infections |
| Indications oxytocin | suspect fetal jeopardy, dystocia, PROM, postterm, chorioamnionitis, maternal med probs, severe preeclampsia, fetal death, multipara w/precep lives far |
| Bishops score | cervical readiness, 9 or more more successful (13 total) |
| Oxytocin goal of therapy | 3 contractions in 10 minutes or 40-60 sec with good relax and no probs |
| Oxytocin Nursing mgmt | 1:1 ratio, dr present on site, EFM, max 20mu/min, start 1-2mu/min and increase q 15-30min, monitor cervix, contractions, VS, babe and h2O intoxication, max fluid 3000ml/24hr |
| Oxytocin SE | hyperstimulation, BP alterations, water intoxication, ineffective |
| Oxytocin SE fetus | nonreassuring HR or pattern, hypoxia |
| Oxytocin SE interventions | reposition, o2, increase mainline, turn of Pit, Notify dr |
Created by:
msivola
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