Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
68wm6 p2 Spe Sit Lab
Special Situations in Labor and Delivery
| Question | Answer |
|---|---|
| Define amniotomy (aka AROM): | Artificial Rupture Of the Membranes (amniotic sac) by using a disposable plastic hook (Amnihook) |
| What is the purpose of an amniotomy? | usually performed in conjunction with induction and augmentation of labor and to allow internal electronic fetal monitoring |
| What are complications of an amniotomy? | *Prolapse of the umbilical cord *Infection *Abruptio placentae |
| What does green amniotic fluid indicate? | the fetus passed the first stool (meconium) |
| Bishop score > 8 indicates what? | vaginal birth more likely successful |
| When is labor induced? | Labor is induced if continuing the pregnancy is more hazardous for mom and fetus than delivery |
| What are contraindications to induce labor? | *Placenta previa, Vasa previa *Umbilical cord prolapsed *High station of the fetus *Active herpes *Abnormal size or structure of the mother’s pelvis *Abnormal fetal presentation *Previous classic cesarean incision |
| What are Induction / Augmentation Techniques to induce labor? | Amniotomy. Cervical Ripening |
| What are medical methods of cervical ripening? | *Prostaglandin gel (Prepidil) *Cytotec (Misoprostol |
| What is the mechanical method of cervical ripening? | Laminaria |
| What is the most commonly used drug in oxytocin induction? | Pitocin |
| What are the risks of Oxytocin induction/augmentation? | *Hypertonic uterine activity *Uterine rupture *Maternal water intoxication |
| When is oxytocin DCed or reduced during induction? | if the fetal heart rate is out of the normal range or if there are excessive uterine contractions |
| What drugs may be given to reduce uterine activity in the PT on oxytocin? | terbutaline and magnesium sulfate |
| During oxytocin induction, how often must B/P pulse and respirations be taken? | every 30-60 minutes |
| During oxytocin induction, how often must the temperature be taken? | every 2-4 hours |
| What is an External Cephalic Version (ECV)? | The care provider externally manipulates a breach baby into the proper postion through massage of the stomach/uterus |
| What is an Internal Version? | Reaching through the cervix to manipulate fetal position |
| What can be used in malpresentation of twin gestations to position fetus correctly for birth? | Internal Version |
| What are Version contraindications? | *Uterine malformations that limit the room available to perform the version and may be the reason for the abnormal fetal presentation *Previous C section with a vertical uterine incision *Disproportion between fetal size and maternal pelvic size |
| What may result from a Version of a fetus in a woman with a previous c-section with a verticle uterine incision? | May lead to uterine rupture |
| When is an External Cephalic Version (ECV) done? | Breach babies after 37 weeks of gestation |
| How is an ECV done? | *The procedure begins with nonstress test or biophysical profile. *Woman receives tocolytic medication (terbutaline) to relax uterus Using ultrasound to guide procedure, doctor pushes fetal butt upward outward, at same time pushes head toward pelvis |
| How long must a mother and fetus be observed after a version? | 1-2 hours |
| Leaking of vaginal fluid after a version may indicate what? | Ruptured membranes |
| What forceps are used to deliver fetal head during breach delivery? | Piper forceps |
| When are vacuum extractors contraindicated? | It is not used to deliver the fetus in a nonvertex presentation such as breech or face and also not used for very preterm fetus because the suction is more likely to injure the head |
| What are fetal indications for operative birth? | *Nonreassuring FHR patterns *Failure of the fetal presenting part to fully rotate and descend in the pelvis *Partial separation of the placenta |
| What are maternal indications for operative birth? | *Exhaustion *Inability to push effectively *Cardiac and pulmonary disease |
| When are cesarean births preferable? | if maternal and fetal conditions mandate a more rapid birth than can be done with forceps or vacuum and if the procedure would be too traumatic, or maternal CHF |
| How many times may a vacuum be applied during childbirth before the use of it is DCed? | Three |
| Where is the vacuum placed? | on the fetal head in the midline of the occiput |
| What may facial asymmetry indicate in the child born from operative birth? | injury to facial nerves |
| What is an episiotomy? | the surgical enlargement of the vagina during birth |
| What degree of laceration are usually uncomplicated and heal quickly? | 1st and 2nd degree |
| What degree of laceration extends to the rectal sphincter? | 3rd degree |
| What degree of laceration extends completely through the rectal sphincter? | 4th degree |
| What is the primary risk of episiotomy and laceration? Secondary? | infection, blood loss |
| How is an episiotomy done? | episiotomy is done with blunt-tipped scissors just before birth |
| What is the nursing interventions of a post-op episiotomy PT? | *Place cold packs on perineum to reduce pain, bruising and edema during the first 12-24 hours *Followed by perineal heat; this increases blood flow and promotes healing *Provide mild PO analgesics for pain management |
| What is hypotonic labor? | uterine contractions are too weak to be effective during labor |
| Who is hypotonic labor most likely to occur in? | women with an over-distended uterus |
| Tx of hypotonic labor | *The doctor may do an amniotomy *Augmentation of labor *IV or oral fluids |
| Nursing care of PT in hypotonic labor | *Give the laboring woman emotional support *Help patient with position change to promote comfort and enhance progress *Have patient walk, if allowed, to enhance contractions |
| What is hypertonic labor? | contractions that are frequent, cramp-like, and poorly coordinated |
| Tx of hypertonic labor | *Mild sedation to allow the woman to rest *Warm showers and baths promote relaxation and rest *Tocolytic drugs (terbutaline) may be ordered to reduce the high uterine resting tone |
| What may lead to ineffective maternal pushing? | *The woman does not understand which technique to use *The woman is afraid of tearing *Regional anesthesia may reduce the natural urge to push |
| Nursing care of PT demonstrating ineffective maternal pushing | *Main focus is to coach the woman and teach her the proper pushing techniques *If the woman cannot feel her contractions the nurse must tell the patient when to push *Reduce anxiety |
| What is macrosomia? | a large fetus, generally weighing over 4000 gm (8.8 pounds) |
| What fetal position may cause intense back and leg pain in the woman? | Occiput posterior |
| Dysfunctional labor in a multifetal pregnancy may be due to what common causes? | *Uterine overdistension --> hypotonic labor *Abnormal presentation of one or all of the fetuses |
| What is hydrocephalus? | fluid collection on the brain, causes enlargement of the fetal head |
| What is spina bifida? | hernial protrusion of the meninges of the spinal cord. Hernial sac contains CSF and sometimes nervous tissue |
| What pelvic shape is the most common and most favorable for vaginal birth, the pelvis inlet is round? | Gynecoid |
| What pelvic shape is the anteroposterior diameter is equal to or greater than the transverse diameter. Not favorable for vaginal delivery? | Anthropoid |
| What pelvic shape is the male type pelvis and not favorable for vaginal delivery? | Android |
| What pelvic shape has a shortened anteroposterior diameter and a flattened, oval, transverse shape. Not favorable for vaginal delivery? | Platypelloid |
| What are the four basic pelvis shapes? | *Gynecoid *Anthropoid *Android *Platypelloid |
| What is the most common soft tissue obstruction during labor? | Full bladder |
| What are forms of maternal soft tissue obstruction? | *Full bladder most common *Fibroids *Cervical scar tissue |
| What is the average rate of cervical dilation? | 1.2 cm/hr for a woman having her first baby, and 1.5 cm/hr for a woman that has had a baby previously |
| Prolongued labor increases the risks of what? | *Maternal or fetal infection *Maternal exhaustion *Postpartum hemorrhage |
| What are the complications of PROM? | *Chorioamnionitis: infection of the amniotic sac *Chance for infections greatly increased after 24 hours |
| What is the Tx of preterm labor? | *Bed rest and hydration *Urinalysis is done to detect UTIs *Tocolytic drugs may be given to inhibit contractions *Ritodrine (Yutopar) *Because of the side effects of Ritodrine, other drugs are given to inhibit contractions |
| In the PT suffering preterm labor, what is given to speed fetal lung maturation? | *Steroid drugs to increase fetal lung maturity *Dexamethasone and betamethasone. |
| What is prolongued pregnancy? | Pregnancy that lasts longer than 42 weeks |
| What are the risks of prolongued pregnancy? | *inefficient placental delivery of nutrients and oxygen. *Fetus may lose weight or skin may peel *Meconium may be expelled in amniotic fluid *Low blood sugar likely at birth *If placenta functioning inefficiently fetus will not tolerate labor well |
| What is a prolapsed umbilical cord? | the cord slips downward after the membranes rupture, subjecting it to compression between the fetus and pelvis |
| What is a complete prolapsed umbilical cord? | the cord can be seen protruding from the vagina |
| What is an occult prolapsed umbilical cord? | the cord is compressed between the fetal presenting part and pelvis but cannot be seen or felt during vaginal exam |
| What increases the risk of prolapsed umbilical cord? | *Fetus is high in the pelvis when the membranes rupture *Very small fetus *Abnormal presentation (breech) *Hydramnios |
| Tx of prolapsed umbilical cord | *Displace the fetus upward to stop the compression *The baby is usually delivered by cesarean section |
| In the event of a prolapsed umbilical cord, how is the fetus displaced? | *Knee-chest position *Trendelenburg *The nurse or doctor may push the fetus upward from the vagina |
| What is complete uterine rupture? | a direct communication between the uterine and peritoneal cavities |
| What is incomplete uterine rupture? | a rupture into the peritoneum covering the uterus or into the broad ligament but not the peritoneal cavity |
| What is uterine dehiscence? | a partial separation of an old uterine scar. Little or no bleeding may occur. No signs or symptoms may exist and the rupture may be found incidentally during a subsequent C section or other abdominal surgery |
| What can cause uterine ruptures? | *Previous surgery on the uterus *Many previous births *Intense contraction, as with use of Pitocin *Blunt abdominal trauma |
| S/Sx of uterine rupture: | *Asymptomatic *Shock *Abdominal pain *Pain in the chest *Cessation of contractions *Abnormal or absent fetal heart rates *Palpation of fetus outside uterus |
| What surgery may need to be done in the case of a large uterine rupture? | Hysterectomy |
| What is uterine inversion? | occurs when the uterus completely or partly turns inside out, usually during the 3rd stage of labor. Is uncommon but potentially fatal |
| What can cause uterine inversion? | *Fundal pressure during birth *Pulling on the umbilical cord before the placenta detaches from the uterine wall *Fundal pressure on an incompletely contracted uterus after birth |
| What drug is used to cause the uterus to contract and reduce bleeding? | Pitocin |
| What is necessary if the replacement of an inverted uterus is unsuccessful? | Hysterectomy |
| What is an amniotic fluid embolism? | when amniotic fluid, with its particles such as vernix, fetal hair, and sometimes meconium, enters the maternal circulation and obstructs pulmonary vessels |
| What adverse effect of an amniotic fluid embolism occurs early and what can it lead to? | Failure of the right ventricle occurs early and can lead to hypoxemia, depressed cardiac function, and circulatory collapse |
| What is a boggy uterus? | A uterus that is not firm or contracted. |
| What must be done if the umbilical cord is wrapped too tightly over the infants neck for it to be slipped over? | It must be clamped in two places and cut. |
Created by:
Shanejqb
Popular Nursing sets