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OB chapter 15 and 16

OB chapter 15 and 16 study guide

preterm labor gestation less than 36 weeks; contractions every 5 to 10 minutes lasting for at least 30 seconds and persisting for more than 1 hour; dilation more than 2.5 cm and 75% effaced
reasons for IV fluids in preterm labor to increase vascular volume and prevent dehydration; prevents oxytocin from being released
ritodrine and corticosteroids cause a risk for? fluid overload and pulmonary edema
betamethasone used to reduce respiratory distress in newborn; needs to be given to the mother at least 24 to 48 hours before the birth of the newborn who is less than 34 weeks’ gestation
nursing implications related to tocolytic therapy report 120 bpm or greater and BP less than 90/40 mm Hg; monitor oxygen levels
complications of PROM infection; compression of the umbilical cord; prolapsed cord
hypertonic uterine dysfunction a labor with uterine contractions of poor quality that are painful, out of proportion to their intensity, do not cause cervical dilation or effacement, and are usually uncoordinated and frequent
management of cephalopelvic disproportion external cephalic version; cesarean birth
complications of breech position fetal descent is slow; cord prolapsed occurs more often; risk of postpartum hemorrhage is also increased
relation to abnormal fetal presentations associated with preterm birth, multiple gestation, congenital anomalies, placenta previa, and multiparity
amniotomy indications vertex must be engaged; fetal heart rate should be monitored; the character, odor, and color of the amniotic fluid should be documented
1st responsibility after amniotomy monitor fetal heart rate
overstimulation of contractions due to pitocin contractions longer than 90 seconds, intervals less than 60 seconds, and nonreassuring fetal heart rates
what can hyperstimulation with use of pitocin lead to? uteroplacental insufficiency, fetal compromise, uterine rupture, and a very rapid labor with potential uterine or cervical lacerations
When do you turn it off, slow it down discontinue immediately and contact PHCP if uterine hyperstimulation or nonreassuring fetal heart rate occurs
Four degrees of laceration 1st:extends through skin into mucous membrane; 2nd extends farther, reaching the muscles of the perineal body; 3rd the anal sphincter muscles and muscles of the perineum are torn; 4th reaches into the anal sphincter muscles and anterior wall of the rectum
fetal complication from forceps and vacuum bruising and edema; potential cephalhematoma, intracranial hemorrhage, scalp lacerations, subdural hematoma, and with forceps, possible paralysis of a facial nerve
risks of rapid deliveries fetal hypoxia, fetal intracranial hemorrhage; maternal cervical, vaginal, or perineal lacerations
1st action to take for a prolapsed cord place woman’s hips higher than her head; knee chest, Trendelenburg, or side-lying with hips elevated on pillows
what infections require c-sections active herpes viral infection
why is a foley inserted before a c-section inserted to keep the bladder empty during surgery, which reduces the risk of injury to the bladder when the incisions are made
disadvantage of general anesthesia in a c-section it crosses the placental barrier, newborn may need vigorous resuscitation
c-sections and the future of being able to deliver vaginally with next pregnancy one previous c-section; adequacy of pelvis; available facilities for a c-section within 30 minutes; provision of EFM; availability of IV access
priority nursing diagnosis with giving pitocin hyperstimulation or nonreassuring fetal heart rates
when to review pre/post-op procedures with pt do even if they’ve had a c-section before
Bishop scale and induction the American College of Obstetricians and Gynecologists has recommended that a Bishop score of 6 or more is necessary to predict a successful outcome of labor induction
risk of hemorrhage after delivering twins the woman is more likely to hemorrhage because of overdistention of the uterus
classification of infants is based on? gestational ages and birth weights
small for gestational age (SGA) below the 10th percentile
large for gestational age (LGA) above the 90th percentile
LGA and postterm infants are prone to? meconium aspiration; appearing thin with loose, dry skin; at risk for hypoxia, hypoglycemia, polycythemia, cold stress, and asphyxia
characteristics of preterm infant skin is wrinkled and delicate and usually covered with lanugo; has few creases on the sole of the foot; is thin, and has prominent fontanelles and suture lines; cry is weak; body appears limp and is in extension
scarf sign maneuver in the term newborn the elbow cannot be drawn past the midline of the body; the elbow easily passes the midline of the body of a preterm newborn
inefficient thermogenesis is prone to which type of infant preterm
too high of O2 can damage what on an infant? vision; retinopathy of prematurity causes vasoconstriction in the vessels of the retina
gavage feeding techniques for newborn connect syringe; verify; connect barrel and pinch; pour 1-3 ml SW for patency; pinch; pour formula or milk into barrel; release pinching of the tube and allow fluid to flow by gravity; stimulate newborn; flush with SW; pinch tube; remove syringe
reasons for premie being high risk for respiratory distress surfactant deficiency
necrotizing enterocolitis (NEC) an acute inflammatory process of the bowel; episodes of asphyxia may reduce the circulation, causing ischemia and necrosis in areas of the bowel; feeding precedes onset of symptoms; occult blood
intraventricular hemorrhage a common type of intracranial hemorrhage; bulging fontanelles and seizure activity is seen
parents of NICU patients encourage parents to still touch and hold infant in NICU if allowed
generalized signs of NEC distention of the abdomen with increased amount residual feeding; diminished or absent bowel sounds, diarrhea, and occult blood
why premies are more likely to develop hyperbilirubinemia poor clearance of bilirubin in the liver and reduced fluid intake can inhibit the removal of bilirubin in the intestine; also cold stress releases free fatty acids which displace bilirubin from albumin-binding sites
signs of neonatal pain facial grimaces; cry; increased respiration and heart rate; increased movement of extremities; increased state of arousal
overhydration signs in premies urinary output greater than 3 ml/kg/hr; urine specific gravity less than 1.001; edema; increased weight gain; rales; intake greater than output
kangaroo care skin-to-skin contact of the newborn onto the parent’s chest; has evidence-based positive effects on newborn oxygenation, thermoregulation, and stabilization of vital signs, in addition to fostering the bonding process
symmetric and asymmetric growth symmetric: interference with growth occurs early in pregnancy, all parts of the body are small; asymmetric: growth interference begins later in pregnancy, newborn weight is below normal, but length and head circumference is normal
patent ductus arteriosis congenital heart disease resulting when the opening between the pulmonary artery and the aorta does not close after birth
respiratory distress syndrome inability of newborn, especially preterm newborn, to maintain adequate respiratory effort, resulting from insufficient surfactant in the lungs
retinopathy of prematurity retinal damage and blindness in the preterm neonate resulting from exposure to high oxygen concentrations; also known as retrolental fibroplasia
bronchopulmonary dysplasia pulmonary condition affecting preterm newborns who have had respiratory failure and have been oxygen dependent for several days
intraventricular hemorrhage bleeding within the ventricles of the brain
necrotizing enterocolitis acute inflammation of the bowel that leads to necrosis
Created by: laotracuata