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NUR113 Test 3
Intrapartum
| Question | Answer |
|---|---|
| Daily fetal movement counts | can be done anytime to monitor condition of fetus. <3 = investigate |
| fetal Heart activity US | 6-7 weeks to confirm condition of the heart, see chambers |
| gestational age US | 6-40 weeks, if uncertain of age d/t bleeding, BC, LMP |
| Fluid Volume US | anytime to measure Fluid volume. Oligo or hydramnios |
| Dopplar Blood flow analysis | 16-18 weeks, studies blood flow in high risk pregs d/t age, DM, GD, sickle cell, smoker. Persistent high ratios when should be low = IUGR |
| Fetal growth US | 20-30 weeks d/t poor maternal wt gain from drug use, GD, GM, or multis |
| Fetal anatomy US | 18-40 weeks, to detect anomalies, will influence how and where birth has to take place |
| placental structure US | 3rd tri to check growth and placement of placenta. Ca deposits = NO fxn or perfusion d/t hardening |
| Biophysical profile | 28wks - birth, assess fetus and environment. Most accurate indicator of impending fetal demise b.c gives overall look at enviro |
| amniocentesis | after 16 weeks, for age >35, hx of chromosonal abnormalities, to detect genetic prob, fetal maturity, fetal hemolytic disease, or meconium and check for stress on fetus |
| chorionic villus sampling | 10-12 weeks, age >35, genetic abnormalities, family hx, Tissue sample with genetic make up of fetus |
| AFP or alpha- fetoprotein | 15-22 weeks,neural tube defects; produced by fetal liver should increase with age. If decreased or low = downs |
| triple marker test | 10 weeks, contains: afp, estriol, hcg, more definitive of trisomies than just afp |
| coombs | done anytime to check for rh factor |
| non stress test | anytime. f response to norm stimuli. 90% f moves associated c acels. reactive: 2 or > acels or FHR 15b/m or > associated c q f move. Non-reac: BAD, no acels or FHS < 15b/m lasting 15 sec or > |
| Contraction stress test | 3rd tri when preterm stimulate contraction by oxytocin or nip stim. neg= want, no late decels c min 3 contractions c/n 10 m period. Positive: persistant late decels occuring c over 1/2 of all contractions |
| latent phase stage 1 | duration 0-3cm, last 6-8h, contraction mild-mod q 3-30 m, last 20-40 sec, assess q hr, smiling, talkative |
| active phase stage 1 | duration 4-8cm, last 3-6h, cont mod-strong, q 2-3 min, last 40-60 sec, assess q 30 min, decreased coping ability |
| when is epidural administered | active phase of stage 1 when dilated 4-5 cm |
| transition phase stage 1 | duration 8-10 cm, last 20-40 min, contractions strong, q 1.5-2 min, last 60-90 sec, assess q 15 m, hates life, increased anxiety |
| in labor woman states she feels a pressure on her rectum and feels the need to bear down what do you do first | check her and see how dilated and effaced she is to determine phase and stage of labor |
| labor stage 2 | duration, cervix can't be assessed 10 cm dilated, 100% effaced, +4 to be born, baby is born assess q 5 min, sense of purpose, quiet focused |
| labor stage 3 | duration few min to 1 hr after birth, evidence placenta delivered, assess q 15 min, fundal massages, relieved |
| labor stage 4 | duration up to 2 hours after birth, hormones, fluid volume and COP re-reg, tired, milk in |
| Normal labor | completed c/n 24 h, single F presents vertex, no comps exist, mom at or near term |
| retained placenta | > 30 min after birth, excessive bleeding, manual removal, if fails then D&C |
| placenta accreta | villi attached to myometrium, placenta fails to seperate, may lead to hysterectomy |
| management of amniotic fluid embolism | O2, intubation and vent, CPR, position on side, IV fluids, blood transfusion, foley, emergency birth. C-section to save baby |
| amniotic fluid embolism | occurs when there are particles of debris(vernix, hair, skin, cells) that enter the maternal circulation and obstructs pulmonary vessels |
| what causes amniotic fluid embolism to occur | tear in amniotic sac or intrauterine pressure that will allow fluid to enter circulation at any time |
| normally with an amniotic fluid embolism death ensues, but if it doesn't what type of probs are suspected | coagulations and DIC |
| prolapsed umbilical cord | occurs when the cord lies below the presenting part of the fetus. Occult=hidden, can feel. frank=visible |
| reasons for prolapsed cord | long umblicial cord, malpresentation(breech), transverse lie, unengaged presenting part |
| Signs of prolapsed cord | bradycardia with variable decels during contraction, may feel or see the cord |
| if prompt care is not given in prolapsed cord what will the result be for fetus | hypoxia |
| care for prolapsed cord | nurse climbs on bed with pt, fingers into vagina to push baby up off cord, trendeleberg position assumed, or sims with knees to chest, admin O2, section asap! |
| when can vaginal birth be attempted with prolapsed cord | cervix dilated and pelvis adequate |
| placenta previa | placenta is implanted in lower uterine segment or over internal cervical os |
| complete previa | cervix dilated and os covered |
| marginal previa | edge of placenta extends 2-3 cm over os |
| low lying previa | placenta implanted in lower uterine segment but doesn't reach os |
| risk factors for previa | previous previa, previous section, induced abortion r/t endometrial scaring, multi gestation, closely spaced pregs, age >35, male fetus, smoking, cocaine |
| S&S of previa | painless vaginal bleeding after 24 weeks |
| Plan of care for previas | transabd US, pelvic rest (no cervical checks, no sex), term, in labor=section, <36wks, no labor=rest, IVFs and PRBCs, monitor FHRs. partial/mariginal may attempt vag birth |
| abruptio placentae | premature sep of placenta from implantation site |
| marginal abruptio | placenta separates at edges, blood passes btwn fetal membranes and uterine wall, vag bleeding |
| central abruptio | placenta seps centrally, blood trapped, concealed bleeding |
| complete abruptio | total sep, massive vag bleed |
| S&S of abruptio placentae | intense sudden pain` |
| risk factors for abruptio | PIH, cocaine, blunt trauma, smoking, poor nutrition, previous abruptio |
| Treatment for abruptio placenta depends on what | severity and type, amt blood loss, fetal maturity and status. Mild=management implemented, FHR monitoring started, corticosteroids(lung mat), rh status |
| in cases of moderate to severe separation of placenta d/t abruptio what should be done and why | section with hysterectomy because of hypoxia to uterus and inability to contract, women are always hospitilzed with abruptio d/t possible sep and hemorrhage |
| plan of care for abruptio | hospitalized bed rest, assess fetal lungs, vag birth if no distress, or dead fetus |
| rupture of the uterus | most common cause is sep of scar from previous section, uterine trauma, congenital uterine anomaly. rare and serious |
| complete rupture of uterus | extends through the uterine wall into peritoneal cavity, sudden sharp abd pain with signs of hypovolemic shock |
| incomplete rupture of uterus | extends into the perineum but not into the cavity, bleeding usually internal |
| rupture of the uterus may be caused by | contractions, overdistended uterus (multifetus), oxytocin (stop immed), ext and internal version, difficult forceps delivery |
| management of rupture of uterus | no use of oxytocin, lap and delivery of fetus, PRBCs, hysterectomy, and fluids |
| S&S of rupture of uterus | fainting, v, and tenderness, hypotonic uterine contractions, and lack of progress. fetal heart tones may be lost |
| A woman is interested in having a VBAC, vag birth after section what risk would you inform her of | risk of tearing previous incision and uterus during labor, hemorrhage and infant death. To decrease risk avoid prostaglandins and inducing |
| A classic incision for c-section puts you at increased risk for what | increased risk for uterine rupture in subsequent incisions and labor, rarely used now |
| reasons for section birth | CPD or malpresentation, Fetal distress, cord prolapse, dysfxnal labor, multi gestation, birth canal obstruction, previous section |
| During a version, what med should be admined and why | terbutaline to relax the uterus |
| Before a version can be done, what 3 things have to occur | 36 weeks , reactive non-stress test, breech or not engaged |
| pelvic dystocia | contractures of the pelvis diameters that reduce the capacity of the bony pelvis |
| soft tissue dystocia | obstruction of the passageway such as in placenta previa or a fibroid |
| causes of pelvic dystocia | congenital, deformities, immaturity, android/platyploid may cause CPD |
| along with soft tissue dystocia that obstructs the passage way, what anatomical part may also be a problem | full bladder or rectum |
| If labor continues when dystocia is present and the fetus can't descend, what can result | necrosis of the maternal soft tissue from head pressure, fistulas of other structures from the vagina |
| hypertonic labor patterns | ineffective contractions in causing cervical dilation or effacement |
| hypotonic labor patterns | initial progress is normal, but then contractions become weak, inefficient or stop all together |
| A first time mother is having hypertonic contractions, what should you do to improve her contractions | change position to left side lying, encourage rest, soothing environment, warm tub |
| You have a pt laboring with hypotonic contractions what should you do to encourage her contractions to come back strong | encourage freq voiding, monitor for infection, support |
| Pitocin is known to hyperstimulate the uterus, the puts the it at risk for what | uterine rupture and decreased placental perfusion |
| You have a pt on pitocin, what should you monitor mom and baby for | MOM: BP and P changes, hypertonicity of uterus;BABY: FHR and rhythm |
| you have a pt on pitocin and are monitoring her contractions closely, when her contractions are what you should stop pitocin | lasting >90 sec or <2 min apart and with Fetal pattern of late decels |
| early decels are indicative of what | head compression |
| Late decels indicative of what | placental insufficiency |
| variable decels indicaive of what | cord compression |
| NON reactive non stress test is | NOT GOOD |
| You know that periodic changes from baseline mean what | normal, occuring with uterine contractions |
| you know that episodic changes from baseline mean what | not associated with uterine contractions |
Created by:
caseyrn2be
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