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40 Cards in this Set
- Front
- Back
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Considerations before meds |
Labor has to be definite Contractions regular & well established Active phase of stage 1, cervix dilated 4-5cm, avoid if less than 1 hr to delivery, IV meds given at beginning of each 3-5 contractions |
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Meds commonly used |
Nalbuphine (Nubain) Morphine Sedatives Fentanyl Stadol (butophanol, Meperidine (demerol) |
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FHR |
Baseline is the average during a 10 min period Normal: 110-160 Tachycardia: > 160 Bradycardia <110 Where baby is positioned can affect FHR |
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Methods for FRH |
Auscultation with doppler- determines fhr only externally Electronic fetal monitor- monitors fhr & uterine activity IUPC- internal, measures intensity of contractions |
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Early deceleration |
Head compression Uniform shape fhr> 100bpm U-shaped mirrors contractions Starts with contractions then goes away **no interventions will end when babies born |
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Late decelerations |
Bad sign if uncorrected and associated with tachycardia and loss of variability. uteroplacental insufficiency d/t supine hypotensive, uterine tachysystole, maternal htn, excessive oxytocin |
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Late decelerations cont |
U shaped, begins after peak of contraction, fhr returns to baseline after contraction ends **interventions: change maternal position (lateral), elevate legs (hypotension), inc IV fluid, assess for tachysystole, d/c oxytocin, give o2, |
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Variable decelerations |
Umbilical cord compression Irregular or "V" form, unpredictable not related to contractions at all, fhr <100bpm, quickly returns to baseline. **interventions: 1st! Manually elevate cord,change maternal position (knee chest), d/c oxytocin, 02, vaginal exam, possible amnioinfusion, notify DR |
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Dilation stage (latent) |
0-3cm dilation, 60-80% effacement, -5 to -2 station. Contractions mild-mod 5-30mins apart. Mom may state only backache ROM may occur, bloody show excited happy |
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Latent interventions |
Complete admission quickly Check fhr q2hrs bp tpr q2hrs, encourage activities, help mom understand labor process, start IV give enema ect, encourage to void at least q2h |
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Dilation stage (active phase) |
4-7cm dilated, 80-100% effacement, -1 to 0 station. Contractions mod to strong uterus firm. 3-5 mins apart, mom will be uncomfortable, malar flush, tachypnea, ROM may occur, tiredness less talkative |
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Active phase interventions |
Encourage abd or shallow breathing, check fhr q30-60mins, tpr q4hr, apply cool damp cloth on face, rub back, commend mom for her efforts, encourage void q2hrs, *medicate for pain, inform mom and dad of progress |
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Dilation stage (transition) |
8-10cm dilated, 100% effacement, 1+ to 4+ station Uterus very hard 2-3 mins apart, likely to experience n&v, pelvic and back discomfort, sweating, profuse dark bloody show, shaking leg cramps, very irritable, |
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Transition stage interventions |
Encourage relaxation between contractions, provide firm coaching, take deep breath & hold for nausea, breath into paper bag, assess fhr q15mins, if multi transfer to delivery room once 10cm, if primip mom will push until crowning |
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PROM |
Occurs > 24 hrs before labor begins. Risk of umbilical cord prolapse. **interventions: knee chest position, then c/s. Hrf infection (chorioamnionitis) Sterile exams, Possible IV antibiotics |
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Primary HYPERtonic dysfunction |
Poor force of contractions, effacement and dilation stop during latent phase. **intervention: rest 4-5 hours sedatives, demerol/morphine Terbutaline- Dec uterine tone if hypertonic uterus |
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Secondary HYPOtonic dysfunction |
Normal labor until mid-active phase Contractions ineffective or stop **interventions: Taylor sitting, amniotomy, oxytocin/pitocin, prostaglandin, c/s |
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Premature labor |
<38 weeks, fetal fibronectins assessed, presence between 24-34 weeks predicts labor. To halt labor use: terbutaline, indocin, magnesium sulfate Bethamethasone to hasten lung maturity |
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Amniotic fluid embolism intervention |
CPR, fluid resuscitation, 02, left laying side if still pregnant |
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Stress testing |
Determines fetal ability to tolerate labor. |
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Non stress test |
Evaluates ,changes in fhr with fetal movement. Normal= reactive, inc of 15bmp with activity in a 20 min period. Abnormal= non reactive, <15 bmp increase with 15 mins of fetal activity |
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Contraction stress test |
Natural contractions are stimulated with small doses of oxytocin. Normal= neg, no deceleration Abnormal= pos, late deceleration 50% off the time May occur because of placenta previa, abruptio placenta, PROM, incompetent cervix |
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Presumptive signs |
**Reported by the patient Amenorrhea 4 weeks since LMP N&V morning sickness Fatigue Breastfeeding changes, pain tingling Frequent urination Quickening: 16-18wks primip, 14-16 wks multip |
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Probable signs |
Observed by examiner Abdominal distention about 12 weeks Uterine changes hegars sign-softening of lower uterine segment. Vaginal/cervical changes Inc secretions, mucous plug formation. Chadwicks Sign- bluish color of vagina. Goodells sign- softening of tip of cervix. Braxton hicks contractions, ballottement, pos preg |
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Positive signs |
Presence of fetus, fetal heart tones audible by 10wks, funic souffle, uterine souffle palpation of fetal parts, ultrasound |
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Estimated date of birth |
First day LMP - 3 months + 7 days Add one year If LMP> March 24th |
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Threatened abortion |
Cervix NOT dilated, only half abort |
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Inevitable abortion |
Cervix IS dilated, termination is not preventable |
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Imminent abortion |
Strong uterine contractions |
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Incomplete abortion |
Some products of conception passed, some retianed. Cervix IS dilated, bleeding, severe cramps |
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Habitual/recurrent abortions |
Cerclage/shirod Kar procedure, Can stay in place until delievery |
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Missed abortion |
Mom may still look preg, still has to deliver. Fetus dies in utero, retained. Weight loss, diuresis, neg preg test, need to prevent sepsis, DIC |
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Ectopic pregnancy |
Any gestation outside of uterine cavity, #1 reason for mortality in moms. S&S: missed 1 menses, lower abd pain usually 1 sided, referred shoulder pain, sharp pain, abdomen distended firm and board like |
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Ectopic pregnancy treatment |
Laparotomy, remove tube and remainder of products Laparoscopy, tube opened embryo removed |
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Hydatidiform mole |
Complete: ovum has no chromosomes, inactivated nucleus Partial: 2 sperm fertilize 1 ovum Dark brown/bright red bleeding 6-8wks after missed period, uterine size> gest age, s&s of gest HTN before 24 weeks, diffuse snowstorm on ultrasound |
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Hydatidiform mole treatments |
Large bore IV, VS, labs, D&C, hysterectomy, contraception for 1 yr HRF choriocarcinoma, cont pitocin IV for 24 hrs after sugery. High levels of HCG may indicate this |
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Placenta previa |
Placenta completely or partially covers cervix. Spont abortion or hemorrhage may occur in second half of pregnancy S&S: painless bright red bleeding after 24 wks, uterus soft & Vs normal. Look for findings r/t shock |
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Abruptio placenta |
Placenta separates after 20 weeks, Painful dark bleeding, board like abdomen, fhr low or absent HTN is biggest risk factor, drugs, alc, trauma, polyhydraminos, Can cause: severe bruising of uterine muscles, DIC, hepatitis, hypovolemic shock, fetal& mom death |
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Biophysical profile |
8/10 is reassuring 6/10 may indicate need for delivery 4/10 means delivery is recommended 2/10 or less prompts imm delivery! |
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Veal chop mine |
V-variable E-early A-acceleration L- late C-cord compress H- head compress O-ok no prob P- placental insufficiency M-move mom I-investigate N-nothinf E-emergency |
