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30 Cards in this Set

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Emergency Delivery

rapid, uncontrolled delivery is a nonsterile or unassisted delivery that can be managed w/out complications to mother or fetus

Emergency Delivery



Nursing Assessment

-bulging perineum


-woman screaming that the baby is coming


-presenting part visible at introitus

Emergency Delivery




Nursing Plans

-do NOT leave client alone


-get precipitous delivery basin from ER or closet if birth is occuring in labor room


-place clean towel under buttocks


-have client use hee-blow or blow blow breathing to slow expulsion of head over perineum

Emergency Delivery



If amnion is present

rupture with fingers or clean implement when head crowns

Emergency Delivery




To Prevent fetus from popping over the perineum, which can lacerate tissue and cause fetal cerebral trauma

Apply gentle counterpressure against presenting part

Emergency Delivery




Check for cord around neck and remove if loose; cut if tight




Deliver ___ first by gently pressing DOWNWARD under symphysis

anterior shoulder first




Then, apply UPWARD pressure over perineum to deliver posterior shoulder

Deliver entire body, holding baby slightly ___ position to facilitate mucus drainage

head down

Emergency Delivery




Suction baby with ____ quickly, mouth and nares.




Dry infant and cover with blanket or towel.



bulb syringe

Emergency Delivery




Clamp cord in 2 places, and cut in between. If sterile supplies are not available, leave in tact.




Do not ___ the cord

milk

Emergency Delivery



When signs of placental separation are seen (gush of blood, lengthening of cord), ask woman to :

gently push placenta out

Emergency Delivery




Where do you place the baby to contract the uterus?

to mother's breast

C-Section




Complications

-anesthesia complications


-usual abdom surgery complications


-sepsis


-thromboemobolism


-injury to urinary tract

C-sections



The rate of c-section births is more than ___ in the US and increasing.




Vag birth after c-section is decreasing due to complications after the procedure

30%

C-sections




Assessment

-elective or repeat c-section birth scheduled


-emergency c-section birth performed to prevent harm to mother/fetus

C-sections




Nursing care Before c-section

-encourage couple to attend c-section birth class


-if emergency c-section is necessary, obtain informed consent***


-inform anesthesiologist of need for preoperative assessment


-assist with anesthesia, usually epidural


-shave abdomen from xiphoid to 1/4 way down thigh, including pubic area


-insert foley

C-sections




Admin preop meds

-usually because fetus is in utero, no analgesia or sedative is prescribed preop




-client may receive antacid to alkalize stomach contents or a drug such as histamine receptor antagonist ,, which is a gastric antisecretory drug that reduces the production of gastric secretions

C-sections




Obtain lab studies

-type and crossmatch for 2 units packed RBCS, CBC, and chemistry




obtain urinalysis

C-sections




Interventions

Have client remove dentures, contact lenses, rings, and fingernail polish. Notify nursery, neonatologist, and ped of impending c-section




Allow presence of support person in operative suite

C-sections




Intraoperative care




Before abdom preperation:

-place wedge under one hip to displace uterus laterally


-keep client warm with blankets


-monitor and doc fetal heart tones continously

C-sections




Intraoperative Care

-apply grounding pad to leg


-perform abdom scrub


-perform circulating nurse duties per institutional protocol


-if client is awake, assess and meet psychosocial needs

After c-section

-receive complete birth report, including the type of uterine incision performed


-fundal height and consistency assessment may be difficult due to abdom bandage abdom pain


-assess temp every hr in recovery room, then every 4 hrs for 24 hrs, then every 8 hrs


-assess HR, resp, breath sounds, bowel sounds, and SaO2


-begin I&O assessment every 8 hrs



After c-section, admin pain med:

-PCA and postoperative epidural analgesia with morphine sulfate, fentanyl citrate

After c-section, to prevent respiratory complications

-demonstrate splinting of abdom


-coughing


-deep breathing


-incentive spirometer




due to stasis of lung secretions

C-section




Maintain aseptic technique to prevent sepsis

-teach handwashing


-assess incisional healing every 8 hrs


-perform scrupulous perineaum care and pad changes


-assess lochia for foul odor

If woman is medicated, who signs the necessary consent forms?

responsible adult accompanying her,




per state law

Babies delivered abdominally miss out on the vaginal squeeze and are born with more fluid in their lungs, predisposing them to ____ and resp distress

transient tachypnea

The ______ incision results in less postop pain, less bleeding, and fewer incidents of ruptured uterus.

low transverse uterine incision

The ____ incision of the uterus may involve part of the fundus, resulting in more postop pain, more bleeding, and increased change of uterine rupture

classical vertical incision

How do c-section lochia changes, placental site healing, and aseptic needs compare to vaginal clients?





They are the same.




Amount of lochia may be scant due to the exploration and cleaning of the uterus just after delivery of the placenta.

A lapartomy of any kind, including c-section birth, predisposes the client to postoperative _______.




What intervention is necessary?

paralystic ileus
When the bowel is manipulated during surgery, it ceases peristalsis, and this condition may persist. (absent bowel sounds, abdom distention, n/v, tymphany on percussion)
early ambulation