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150 Cards in this Set
- Front
- Back
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What can anxiety and fear of the mom cause during l&d?
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ineffective labor
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What is dysfunctional labor?
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abnormal uterine contractins that prevent the normal progress of cervical dilation, effacement, or descent
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What are hypotonic contractions?
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less than 2 contractions in a 10 minute period
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When do hypotonic contractions usually occur?
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active phase
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What are the maternal effects of hypotonic contractions?
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risk of infection if ROM
PP hemorrhage exhaustion |
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What may be used to get hypotonic contractions back to normal?
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pitocin
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What are the fetal effects of hypotonic contractions?
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increased distress
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What can cause hypotonic contractions?
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CPD
breech transverse bowel or bladder distention |
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What may be done besides administering pitocin to get hypotonic contractions to normal?
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rupture membranes
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When do hypertonic contractions usually occur?
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latent phase
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What are hypertonic contractions?
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increased frequency of contractions w/o increased intensity
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What are the maternal effects of hypertonic contractions?
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exhausted, frustrated
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What are the fetal effects of hypertonic contractions?
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increased fetal distress
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What meds may be given to help rest with hypertonic contractions?
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stadol, epidural
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What should be r/o with hypertonic contractions?
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CPD and malpresentation
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What nursing care should be done with hypertonic contractions?
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ROM done
support and encouragement changing positions frequently |
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What causes ineffective contractions?
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uterus has more than 1 pacemaker
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What are ineffective contractions?
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may have one right after another and then nothing
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What are the maternal effects of ineffective contractions?
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exhaustion
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What are the fetal effects of ineffective contractions?
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stress d/t decreased O2
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What would be done to help ineffective contractions?
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pitocin, ROM
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What is a prolonged latent phase for a primip?
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20
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What is a prolonged latent phase for a multip?
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14
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What would you give for prolonged latent phase?
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stadol
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What can cause prolonged active phase?
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CPD, malpresentation
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What may be used monitor contractions during a prolonged active phase?
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intrauterine pressure cath
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What would be done if there were normal contractions w/o cervical change in a prolonged active phase?
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C/S
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What is prolonged descent?
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presenting part fails to descend into station
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What would you do for a prolonged descent?
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change positions, put on all fours if no epidural
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What is prolonged labor?
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labor that lasts more than 24 hours
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What can cause prolonged labor?
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CPD
malpresentation dysfunctional contractions over use of anesthesia cervical dystosia |
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What are the maternal effects of prolonged labor?
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exhaustion
risk for infection uterus is exhaustion can result in hemorrhage after delivery |
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What are the fetal effects of prolonged labor?
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increased fetal stress
prolapse cord odd shaped head |
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If CPD is causing a prolonged labor what should be done?
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C/S
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What should be monitored with prolonged labor?
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FHR a
contraction patterns accelerations deccelerations variability |
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How long should the second stage of labor take?
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no more than 2.3 hr
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What is arrest of descent?
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the baby was descending and now it has stopped
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How long must a woman push for to be considered an arrest of descent?
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1 hr
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What is failure of descent?
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baby never descend
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What do arrest descent and failure of descent result in?
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C/S
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What is precipitous labor?
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an intense, unusually short labor (less than 3 hours)
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What can cause a precipitous labor?
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multip
large pelvis small fetus previous hx improper use of pitocin |
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What are contractions like with precipitous labor?
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very strong
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What may be given to manage contractions during a precipitous labor?
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terbutaline
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What are the maternal effects of precipitous labor?
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risk for ruptured uterine d/t strong contractions
out of control b/c there's not enough time to get them comfortable pp hemorrhage lacerations of cervix and perineum |
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What are some fetal signs of precipitous labor?
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bradycardia
late decelerations deep variable decelerations |
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What is the fetal risk with precipitous labor?
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cerebral trauma
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What should the nurse not do during a precipitous labor?
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leave the bedside
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What is the fetal risk of a post-term pregnancy?
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placental insufficiency
respiratory distress of the newborn growth restriction of the fetus |
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Why might an amnioinfusion be done for a post-term pregnancy?
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if there is thick meconium to prevent aspiration at birth
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What would you monitor for with post-term pregnancy if the fetus passes meconium?
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aspiration
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What are the most common causes of a uterine rupture?
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mismanaged pitocin
instrumental delivery (forceps) seperation of scar of previous classic cesarean birth uterine trauma congenital uterine anomaly |
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What do uterine ruptures usually require?
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hysterectomy
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What are the s/s of uterine rupture?
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extreme pain that will not go away
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What is the maternal effect of uterine rupture?
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hemorrhage
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What are the fetal effects of uterine rupture?
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asphyxia
fetal death |
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What would the HR of the fetus do if there is uterine rupture?
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continuously decrease
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If you have an IUPC and there is a uterine rupture what would the IUPC show?
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no measurements will be shown
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What is required if there is a uterine rupture?
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C/S
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What is a uterine inversion?
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uterus completely or partly turns inside out
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When do uterine inversion usually occur?
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3rd stage of labor
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What can cause uterine inversion?
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uterine massage after delivery
pulling on umbilical cord to deliver placenta |
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What is an amniotic fluid embolism?
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amniotic fluid containing particles of vernix, hair, skin cells, or meconium enters maternal circulation
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What does amniotic fluid embolism cause?
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respiratory distress and circulatory collapse
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When would amniotic fluid embolism most frequently be seen with?
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abrupto
@ ROM after delivery of the placenta |
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What is a sign of amniotic fluid embolism?
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SOB
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What can amniotic fluid embolism cause?
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DIC and hemorrhage
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What can diagnose an amniotic fluid embolism?
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CT scan
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What would be given for an amniotic fluid embolism?
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02
plasma vitamin K |
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What labs would be checked with an amniotic fluid embolism?
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platelets
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What is a prolapsed cord?
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when cord lies below presenting part of fetus
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When does prolapsed cord usually happen?
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@ ROM
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What can contribute to prolapsed cord?
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long cord
malpresentation transverse lie unengaged presenting part |
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What is an occult prolapse of cord?
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descends with fetus but not past
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What would you do for a prolapse that isn't occult?
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release pressure from cord until in the OR
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Which prolapse would not be felt on a vaginal exam?
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occult
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What are the maternal risks for multiple gestation?
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PP hemorrhage b/c the uterus doesn't want to contract after labor
more uncomfortable PIH anemia PTL gestational diabetes |
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What are the fetal effects of multiple gestation?
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IUGR
prematurity |
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When would serial U/S start for multiple gestations?>
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28 wks
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What would you want to teach a multiple gestation mom?
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s/s of preterm labor
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Why would an U/S be kept in the room for multiple gestation?
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to look at presentation during labor
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How can you verify you're monitoring all fetuses in a multiple gestation?
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U/S
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Which breech can be delivered vaginally?
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frank
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What may be used to help deliver the head in a breech presentation?
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forceps
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What is at an increased risk for with breech delivery?
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lacerations
decapitation |
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What is a macrosomia baby?
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> 9.5 lbs
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Who commonly have macrosomial babies?
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diabetics
big people |
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What is used to estimate fetal weight?
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U/S
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What are the maternal effects of macrosomia?
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CPD
dysfunctional labor patterns pp hemorrhage |
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What are the fetal effects of macrosomia?
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cerebral trauma
shoulder dystosia fractured clavicle |
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What would you monitor for with macrosomia?
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CPD
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What could indicate CPD?
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early decelerations
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What is shoulder dystosia?
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head is born, but anterior shoulder cannot pass under pubic arch
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What are the maternal risks for shoulder dystosia?
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excessive blood loss
lacerations extension of episiotomy endometritis |
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What is the fetal risk with shoulder dystosia?
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decapitation
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What can be used to help shoulder dystosia?
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suprapubic pressure
McRoberts maneuver |
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What is the mazzanti technique of suprapubic pressure?
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pressure is applied directly posteriorly and laterally above the symphysis pubis
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What is the rubin technique of suprapubic pressure?
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pressure is applied obliquely posteriorly against the anterior shoulder
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What is McRoberts maneuver and when would it be used?
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shoulder dystosia
pull legs as far to abdomen as possible allowing the sacrum to flatten |
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What is pelvic dystosia?
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contractures of pelvic diameter that reduce the capacity of the bony pelvis, intet, midpelvis, or outlet
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What is soft-tissue dystocia?
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results from obstruction of the birth passage by an anatomic abnormality other than the bony pelvis
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What can cuase a soft-tissue dystocia?
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placenta previa
uterine thyroid full bladder or rectum fatty tissue |
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What is used for cervical ripening?
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cytotec
PO or vaginally 25-50 mcg |
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Why is cyotec preferred to be given vaginally?
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b/c it can be flushed out of the vagina
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What can be used to induce labor?
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amniotomy
oxytocin |
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What is bishops scale?
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looks at components of cervix to see if its favorable
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What are some reasons there would be a medical induction?
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PIH
gestational diabetes post-term |
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What are some contraindications for an induced labor?
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refusal
CPD active herpes virus placenta previa known malpresentation other than frank breech |
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When does labor begin after an amniotomy?
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12 hrs
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What do you want the fetus to be before you do an amniotomy?
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engaged
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What are the disadvantages of an amniotomy?
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risk for infection
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What is the goal of oxytocin infusion?
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contractions 2-3 min apart lasting at least 60 sec
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How is oxytocin given for induction?
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IV
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What is oxytocin started as for indcution?
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0.5-2mu/min
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What do you increase oxytocin to for induction every 15-60 min?
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0.5-2mu/min
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What is the risk for administering oxytocin?
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hyperstimulation leading to fetal distress
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What would you monitor for with oxytocin administration?
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fetal distress
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What is oligohydraminos?
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< 500 ml between 32 and 36 wks
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What is thought to be the cause of oligohydraminos?
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renal issues
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How is amniotic fluid measured?
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in pockets by U/S
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What can oligohydramnios cause?
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hypoxia
dysfunctional labor patterns |
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What is hydramnios?
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exceeding 2 liters between 32 and 36 wks
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What can hydramnios cause?
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PTL
malformations malpresentation |
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Why might have pt with hydramnios have SOB?
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increased size of uterus puts pressure on diaphragm
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Why would you measure fundal height with a pt with hydraminos?
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determine when to withdrawal fluid
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What would you monitor for with a pt with hydramnios?
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PTL
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Why would you want to deliver a IUFD asap?
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to prevent DIC
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How does DIC occur in IUFD?
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thromboplasma is released after death and gets into maternal circulation and sets off DIC
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How long could it take for DIC to occur after IUFD?
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1 wk
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How can you confirm an IUFD?
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U/S
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What should be documented on a forceps delivery?
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when applied and when removed
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When would forceps not be used?
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known CPD
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What is there an increased risk for with forceps delivery?
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laceration
fetal bruising |
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What maternal indications would call for forceps delivery?
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shorten second stage in even of dystocia
compensate for deficient explusive efforts reverse a dangerous condition |
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What fetal indications would call for forceps delivery?
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distress or certain abnormal presentations
arrest of rotation delivery of head in a breech presentation |
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When would a vacuum not be used>?
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preterm baby b/c of cerebral vessels
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What should you document about a vacuum delivery?
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applied, anytime it comes off and reapplied
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When can a vacuum be used?
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vertex presentation
ruptured membranes absence of CPD |
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What is tachycardia of a fetus?
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> 160 for 10 min
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What is bradycardia of a fetus?
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< 120 for 10 min
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What is absent variablity?
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0-3 BPM
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What is minimal variablity?
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< 5 BPM
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What is moderate variability?
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6-25 BPM
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What could you do for absent variability?>
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give fluids
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What could cause a scheduled C/S?
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CPD
previous C/S breech active herpes |
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What should be done post op for a C/S?
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assessment
VS lab studies teaching consent prep for surgery preop meds support preson |
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What is a classic C/S?
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vertical incisions of skin and uterus
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What is a low cervical C/S?
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horizontal incision of skin, vertical incision of uterus or horizontal incisions of skin and uterus
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Which type of C/S would be used in an emergency situation?
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vertical
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What type of C/S contraindicates vaginal deliveries?
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vertical
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