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NUR113 Test 3

Intrapartum

QuestionAnswer
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