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100 Cards in this Set
- Front
- Back
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A process of manipulating the position of the fetus while in utero is called what?
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version
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When is an external version done?
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when a fetus is breech or shoulder presentation near term. 37 weeks+
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What may the woman feel during an external version, and why would you stop the external version?
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uncomfortable and occasionally has to be stopped because of discomfort of the woman.
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Before a external version what should the woman do in preperation?
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empty her bladder
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What position should the woman be in during a external version?
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supine with a pillow or wedge under the right hip
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What should you record before and after an external version?
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vital signs
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After a external version what does the RN monitor, and for how long?
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the fetus for 30 minutes to an hour
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When is internal version done?
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to turn a second twin when she is breech
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How is an internal version done?
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physician inserts his fingers through the cervix and manually moves the fetus to turn.
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What is an elective induction?
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It is an induction of labor in which the physician and woman decide to end the pregnancy in the absence of a medical reason to do so.
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What can pitocin be administered intravenously for?
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to induce labor. it is a synthetic form of oxytocin. most common used.
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What reasons are legitimate medical reasons to induce labor?
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any condition that endangers the life of the woman or the fetus if the pregnancy were to continue. Such as; postdate pregnancy, premature rupture of membranes, chorioamnionitis, infection of the fetal membranes, pih, preeclampsia, severe intrauterine fetal growth restriction or diabetes mellitus or gestational diabetes.
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what is chorioamnionitis?
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infection of the fetal membranes
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What are some contraindications of labor induction?
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complete placenta previa, history of classical uterine incision, or more than two previous low transverse uterine incisions
Fetal disorders: hydrocephalus, fetal malpresentations, and fetal compromise. medical conditions: active genital herpes |
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What is the name for a cervix that is favorable for induction?
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ripe
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What is the bishop score?
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a method to determine cervical readiness.
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A bishop score of 5 or less means what?
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indicates an unripe or unfavorable cervix, and labor induction is less likely to be successful.
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Cervical length can be determined by what test? and explain the significance of cervical length.
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endovaginal ultrasound.
a cervix measuring 28mm or less is associated with a favorable induction rate, regardless of bishop score. |
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What is cervical length more commonly used to determine, rather than cervical ripeness?
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predictor of preterm labor risk
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How can you measure the maturity of a fetus' lungs? What score indicates fetal lung maturity?
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lecithin/sphingomyelin (L/S) ratio via amniocentesis.
2.0+ indicates maturity |
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What is membrane stripping? Explain it mother fucker!
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gloved finger through the interal cervical and sweeps the finger 360 degrees to separate the membranes from the lower uterine segment. Cervical ripening.
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What is a laminaria? What is it made from? How does it work?
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cervical dilator. Made from the root of seaweed. It is placed in the cervix, and works by absorbing moisture, which causes it to expand slowly. dilating the cervix. ripe nigga, ripe!
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Locally applied _________ have been found to be effective in preparing an unripe cervix for labor.
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prostaglandins
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What is the only substance approved by the US food and drug administration for prostaglandin cervical ripening?
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prostaglandin E2 gel or vaginal inserts (dinoprostone)
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Prostaglandin E2 gel is also called what?
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prepidil
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Prostaglandin E2 vaginal inserts are also called what?
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cervidil
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Where is a prostaglandin E2 vaginal insert placed?
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into the posterior fornix during a vaginal examination.
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If uterine _____ _________ occurs with cervidil inserted, what should you do?
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uterine hyperstimulation - remove via the string
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When having prostaglandin E2 inserted, what position should the patient be in after administration? for how long?
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recumbent position with a wedge under one hip, for at least 30 minutes.
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When is prostaglandin E2 usually administered?
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evening
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When is oxytocin induction administered after a prostaglandin E2 ripening?
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6-12 hours later
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What's another name for Prostaglandin E2?
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dinoprostone
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What's another name for prostaglandin E1?
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misoprostol - cytotec
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misoprostol is a ______ agent whose properties promote cervical ripening.
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antiulcer
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What is the ratio of misoprostol between vaginal insertion and oral?
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1:4 - meaning you have to take 4X the amount orally to equal the amount of only 1/4th the dosage vaginally.
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How often can a dose of misoprostol be repeated?
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4 - 6 hours
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What's an amniotomy/
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artificial rupture of membranes (AROM)
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artificial rupture of membranes will cause the body to release what hormone, which enhances labor?
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prostaglandins
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What is the common protocol of oxytocin in regards to units placed per Xml of IV fluid?
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10 units of oxytocin in 1,000ml of IV fluid.
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The dose of oxytocin is usually titrated up by _ to _ milliunits every __ to __ minutes until an adequate contaction pattern is obtained.
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1 to 2 milliunits
15 to 20 minutes |
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What leads to contractions that occur one after the other without a sufficient rest period inbetween? which can lead to fetal distress and even uterine rupture.
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uterine hyperstimulation
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Explain water intoxication in regards to oxytocin.
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because oxytocin is a posterior pituitary hormone, it is chemically related to antidiuretic hormone. can have an antidiuretic affect.
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What are Sx of water intoxication?
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hyponatremia, confusion, convulsions, or coma, congestive heart failure, and death.
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What is amnioinfusion?
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the infusion of sterile fluid into the uterine cavity during labor done to relieve persistent deep variable decelerations associated with cord compression or to dilute thick meconium-stained amniotic fluid in an effort to decrease morbidity and mortality from meconium aspiration syndrome.
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What prereqs are needed for amnioinfusion?
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ruptured membranes and adequate cervical dilation to allow introduction of the intrauterine pressure catheter into the uterus.
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What fluid should you never use with amnioinfusion?
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dextrose solution
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What temperature should the fluid be for an amnioinfusion and why?
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warmed using a blood warmer when the fetus is preterm. term fetus can handle room temperature.
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what are the contraindications for amnioinfusion?
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placenta previa, abruptio placentae, multiple gestation, malpresentation of the fetus, absent/diminished fetal heart rate or other signs of distress, fetal anomalies incompatible with life, uterine anomalies, and chorioamnionitis.
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what are the possible complications of amnioinfusion?
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polyhydramnios from trapped amniotic fluid, high intrauterine pressure readings, placental abruption, chorioamnionitis, and problems caused by solution temperatures.
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after administration of amnioinfusion, what should you notify the physician immediately about?
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no return of fluid at all.
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What situations will an episiotomy be indicated?
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baby's shoulders are truck
head will not rotate from an occiput-posterior position breech forceps or vacuum is used to shorten the second stage of labor |
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What are methods to minimize the need for an episiotomy?
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kegels
using natural pushing techniques - particularly in side laying position patience |
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what's another name for a median episiotomy?
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midline
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What does a median episiotomy cut?
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from the fourchette straight down into the true perineum
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What is a mediolateral episiotomy?
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2 cuts which are angled to the right and left of the pernieum
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Outlet forceps are applies when?
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when the fetal head can be seen at the introitus.
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low forceps are applied when?
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when the station is equal to or greater than +2, but the head is not yet showing on the perineum.
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When midforceps used?
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when the fetal head is well engaged but still relatively high in the pelvis.
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Midforceps are most often used to assist the fetus to rotate to a ..... position?
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anterior
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What are signs of trauma by use of forceps or vacuum?
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cephalhematoma, retinal hemorrhage, bruising, edema, exaggerated caput (chignon), forceps mark, and transient facial paralysis.
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What should you reassure the parents after they see marks on their baby from the forceps?
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That the marks are exaggerated and will go away within a few days.
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What does the word cesarean come from?
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The word caedere, meaning "to cut"
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What are the four major indications for cesarean birth?
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history of previous cesarean
labor distocia (difficulty labor) fetal distress breech presentation |
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Other than the 4 most common indications for a cesarean birth, what are some other reasons?
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placenta precia (placenta covers the cervix), abruptio placentae (placenta separates from the uterus before brith), cephalopelvic disproportion, active genital herpes, prolapsed umbilical cord, and ruptured uterus.
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what maternal complications can arise during a c section?
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laceration of the uterine artery, bladder, ureter, or bowel; hemorrhage requiring transfusion; and hysterectomy.
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What is the most common post-op complication of c section?
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infection - 2 common are uterus and the surgical wound. Others: uti, sepsis, pneumonia, postpartum hemorrhage, thrombophlebitis, etc.
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What does a baby being born c section not get that a baby gets during a vaginal delivery?
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lung compression to excrete secretions accumulated in the lungs.
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What is another name for a pfannenstiel's incision?
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bikini cut - low transverse incision
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What incision extends through the body of the uterus to the fundus?
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classical incision
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When is a classical incision used?
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emergencies where the fetus needs to be removed immediately or is unusually large
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What are the negative aspects to a classical incision?
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bleeding is more likely, higher risk for abdominal infection and the highest risk for uterine rupture in subsequent pregnancies.
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What are the negatives to a low cervical vertical incision?
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carries higher risk of maternal injury, and higher risk of uterine rupture.
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what is the preferred incision for a csection?
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low cervical transverse incision
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What incision carried the lowest risk of uterine rupture, is easier to repair, and is least likely to cause adhesions?
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low cervical transverse incision
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When does the intraoperative phase begin?
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once the woman enters the OR
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What position is a client put in before epidural is used?
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sitting position with her legs dangling to one side, or she may be placed in the side lying position. back must be in a C shape during placement.
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What position is the patient put in after epidural and foley catheter is inserted?
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supine with a wedge under one hip.
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post epidural what is the center of attention toward the fetus?
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fetal heart rate - for at least 1 minute
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When is the baby taken to the mother after delivery?
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when it is breathing well and the skin color is pink, he is double wrapped in prewarmed blankets, a cap is placed on his head, then he is ready to go.
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An IV is placed in the preoperative holding area and will remain in place for how long after the procedure?
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24 hours
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How often should a woman, after a csection, turn cough and deep breathe?
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every 1 to 2 hours
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Why is early ambulation after csection recommended?
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to decrease the pain and distention of gas and to decrease risks associated with major surgery, such as respiratory complications, infection, thrombophlebitis, etc.
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What does gas build up respond best to?
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ambulation and simethicone.
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What is incisional pain best treated with?
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narcotics nigga!
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What is uterine cramping best treated with?
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nonsteroidal anti-inflammatory drugs
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What hold of the baby during breast feeding will lessen the pressure on the incision?
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football hold
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How long should the patient be NPO before csection?
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8 hours
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What medication can be given before csection delivery, besides anesthesia?
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antacid such as Bicitra 30mL to reduce the risk of aspiration while the woman is under the effects of anesthesia.
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What gauge is the catheter used for an IV?
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large bore - 18-gauge or lower.
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During pre-op, what laboratory studies are done?
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CBC, blood type & screen, electrolytes.
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How much blood do they retain preoperatively and why?
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at least 2 units of blood. in the event of an emergency.
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What should the clients urinary output be in post-op?
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at least 30cc/hour
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What must be evaluated and recorded along with vital signs post-op?
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condition of the fundus
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Because during a csection the surgeon thoroughly cleans the inside of the uterus, what should you notice with the lochia?
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should be less lochia present than a regular vaginal delivery. moderate lochia after csection is a possible sign of postpartum hemorrhage
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What must a woman have to be able to have a trial of labor for a woman who has had a previous csection?
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adequate pelvis, no precious uterine ruptures, personnel and facilities available to perform an immediate csection, and no more than two previous low transverse uterine scars. Also the ability to do a csection within 18 minutes.
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The risk for uterine rupture during VBAC is much higher when a ________ incision was previously done on the uterus; therefor VBAC is contraindicated in someone with this incision.
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classical
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Can a woman have a VBAC if she has had a single uterine rupture previously?
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hell no mother fucker!
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What are the signs of uterine rupture?
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dramatic onset of fetal bradycardia
reports by the woman of "popping" in the abd excessive maternal pain unrelenting uterine contraction followed by a disorganized uterine pattern increased fetal station felt upon vaginal exam easily palpable fetal parts through abd wall signs of maternal shock |
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Does a LVN take care of a woman laboring who has a history of previous csection?
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nope. Out of the scope of practice.
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what is another name for postpartum period?
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puerperium
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