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91 Cards in this Set

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What mental health disorders commonly affect pregnany women?
Depression, bipolar disorder, anxiety, phobias, obsessive-compulsive disorder, posttraumatic stress disorder, and schizophrenia.
How are mental health disorders manifested in laboring clients?
Depression can reduce the woman's ability to concentrate or process information being provided. The labor process may feel overwhelming and she may feel hopeless. Women with bipolar disorder may experience depression, but if labor occurs during a manic phase, the woman may be hyperexcitable. Anxiety disorders may cause the woman to experience chest pain, shortness of breath, faintness, fear or even terror.
What background factors may contribute to an abnormal response to labor?
Factors such as age, marital and socioeconomic status, culture, methods of coping, support system, and understanding of the labor process contribute to the woman's psychologic resonse to labor.
Name some objective signs of a psychological disorder in labor:
The nurse remains alert to the woman's verbal and nonverbal behavioral responses to the pain and anxiety of labor. The woman who is to quiet and compliant, is disoriented, is agitated and seems uncooperative, or is experiencing acute anxiety symptoms may require further appraisal for psychologic disorders.
Name 4 possible nursing diagnoses for the client with a mental disorder:
Anxiety, Fear, Acute Pain, Ineffective Individual Coping.
What nursing interventions are important for the mental health client who is pregnant?
Nursing interventions center on providing support to the laboring woman and her partner and her family. The nurse's ability to help the woman and her partner cope is directly related the rapport they have established.
What are some anticipted outcomes of nursing care for the pregnant mental health client?
The woman: experiences a decrease in stress and increase in comfort, uses effective coping mechanisms to manage her stress and anxiety, is able to verbalize feelings about her labor and that the woman and her family's fear is decreased.
Name the characteristics of hypertonic labor:
In hypertonic patterns, ineffective uterine contractions of poor quality occur in the latent phase of labor, and the resting tone of the myometrium increases. The contractions are painful but ineffective in dilating and effacing the cervix, and a prolonged latent phase may result.
What are the implications of hypertonic labor?
Maternal risks are: increased discomfort due to unterine muscle cell anoxia, fatigue as the pattern continues and no labor progress results, stress on coping abilities, dehydration and increased incidence of infection if labor is prolonged. Fetal risks are: nonreassuring fetal status because contractions and increased resting tone interfere with the uteroplacental exchange and prolonged pressure on the fetal head which may result in cephalohematoma, caput succedaneum or excessive molding.
What is the intervention of hypertonic labor?
Management may include bed rest and sedation to promote relaxation and reduce pain. If patterns continue and develops into a prolonged latent phase, Pitocin infusion or amniotomy may be considered. These are only instituted after cephalopelvic disproportion (CPD) and fetal malpresentation are ruled out. If such is present, labor is not stimulated because vaginal birth is not possible and cesarean birth is performed.
What are the characteristics of hypotonic labor?
Characterized by fewer than two to three contractions in a 10-minute period.
What nursing interventions might be implemented in the client with a hypotonic labor pattern?
Nursing measures include frequent monitoring of contractions, maternal VS, and FHR. If amniotic membranes are ruptured, the nurse assesses for the presence of meconium, an intake and output record provides a way of determining hydration and dehydration, signs of infection should be monitored since the birth is prolonged and emotional support should be provided.
What nursing outcomes are the goals of care for the woman experiencing a hypotonic labor?
Anticipated outcomes of nursing care include the following: the woman maintains comfort during labor, the woman understands the type of labor pattern that is occurring and the treatment plan.
What is the definition of precipitous labor?
Labor that lasts less than 3 hours and results in rapid birth.
What are the contributing factors regarding precipitous labor?
Multiparity, large pelvis, previous precipitous labor, and a small fetus in a favorable position.
Are precipitous labor and precipitous birth the same thing?
No, precipitous birth is an unexpected, sudden, and often unattended birth.
What is the nursing plan for a precipitous labor?
If the woman has a history, an emergency birth pack is kept at hand. The nurse stays in constant attendance providing information and support before and after birth. To avoid possible precipitous labor and hyperstimulation of the uterus during Pitocin administration, the nurse should be alert to the dangers of Pitocin overdosage.
What are the anticipated outcomes of a precipitous labor?
The woman and her baby are closely monitored during labor and a safe birth occurs, the woman maintains optimal comfort.
Define post-term pregnancy:
One that extends more than 294 days or 42 weeks past the first day of the last menstrual period. Post term is different than post date (past the expected date of birth).
What are the possible maternal complications of post-term pregnancy?
Probable labor induction, increased risk for large-for-gestational-age (LGA), possible forceps/vacuum assisted births, and increased stress.
What are the possible fetal complications of post-term pregnancy?
Decreased perfusion from the placenta, oligohydramnios, and meconium aspiration.
What are the causes of persistent OP position (POP)?
Lack of rotation can be due to poor contractions, abnormal flexion of the head, incomplete rotation, inadequate maternal pushing efforts usually related to epidural anesthesia or a large fetus.
What are the implications of persistent OP postition?
Maternal risks include third or fourth degree perineal lacerations during birth and risk of extension of a midline episiotomoy.
What are the signs/symptoms/factors which suggest persistent OP position?
Complaints of intense back pain, a dysfunctional labor pattern, hypotonic labor, arrest of dilatation, or arrest of fetal descent.
What nursing interventions can help the client with persistent OP position?
Position changes can be tried to enhance rotation of OP or OT to OA. A knee-chest position provides a downward slant to the vaginal canal, directing the fetal head downward. A hands-and-knees position is often effective in rotating the fetus. In addition, the woman may try pelvic rocking and the support person may firmly stroke the abdomen. After the fetus has rotated, the woman lies in a Sims' position on the side opposite the fetal back.
What are the implications for a brow presentation?
Maternal implications of brow presentation include increased risk of longer labor due to ineffective concentration and slow or arrested fetal descent and cesarean birth if brow presentation persists.
What nursing interventions might be implemented in the client with a hypotonic labor pattern?
Nursing measures include frequent monitoring of contractions, maternal VS, and FHR. If amniotic membranes are ruptured, the nurse assesses for the presence of meconium, an intake and output record provides a way of determining hydration and dehydration, signs of infection should be monitored since the birth is prolonged and emotional support should be provided.
What nursing outcomes are the goals of care for the woman experiencing a hypotonic labor?
Anticipated outcomes of nursing care include the following: the woman maintains comfort during labor, the woman understands the type of labor pattern that is occurring and the treatment plan.
What is the definition of precipitous labor?
Labor that lasts less than 3 hours and results in rapid birth.
What are the contributing factors regarding precipitous labor?
Multiparity, large pelvis, previous precipitous labor, and a small fetus in a favorable position.
Are precipitous labor and precipitous birth the same thing?
No, precipitous birth is an unexpected, sudden, and often unattended birth.
What are the implications for a face presentation?
The fetal head is hyperextended. Maternal risks include increased risk for CPD and prolonged labor, risk of infection, and possible cesarean birth. Fetal-neonatal risks include cephalohematoma of the face, edema of the face and throat and pronounced molding of the head.
Discuss the ramifications for breech presentations:
Maternal implications are a likely cesarean birth. Fetal-neonatal implications include higher perinatal morbidity and mortality rates, increased risk of prolapsed cord, increased risk of cervical spinal cord injuries due to hyperextension of the fetal head during vaginal birth and increased risk of birth trauma.
What are the ramifications for a transverse lie presentation?
When a shoulder presentation is still evident at 37 completed weeks gestation, an external cephalic version is attempted, followed, if successful, by induction of labor.
What is fetal macrosomia?
Newborn weight of more than 4000g at birth.
What factors predispose a fetus to be macrosomia?
Male infants, offspring of large parents, diabetic women, mothers with a previous infant who weighted more than 4000g and in cases of grand multiparity and prolonged gestation.
What are the implications for fetal macrosomia?
Maternal implications include increased risk of CPD, dysfunctional labor, soft tissue laceration, postpartal hemorrhage. Fetal-neonatal implications include meconium aspiration, asphyxia, shoulder dystocia and upper brachial plexus injury and fractured clavicles.
What are the nursing interventions for macrosomia?
What are some maternal/fetal postpartum complications?
The nurse assists in identifying women who are at risk for carrying a large fetus, a fetal monitor is applied as early decelerations could mean size disproportion at the bony inlet, the nurse provides support for the laboring woman, the nurse inspects macrosomic newborns after birth for cephalohematoma, Erb's Palsy and fractured clavicles, the fundus should be massaged because of the overstretching resulting in uterine atony. Maternal vital signs are closely monitored for deviation suggestive of shock.
What factors predispose a client to a multiple gestation?
Multiple gestation is in part due to advances in infertility treatments, common in African American women, women of greater age and parity and women who are tall and overweight.
Name some early indicators of multiple gestation:
During the prenatal period, visualization of two gestational sacs at 5 to 6 weeks, fundal height greater than expected for the length of gestation and auscultation of heart rates that differ by at least 10 beats per minute are most likely seen in multiple-gestation preganancies.
What are the possible complications of a multiple gestation?
The woman may experience UTI's, preeclampsia, preterm labor, and placenta previa. Complications during labor include abnormal fetal presentations, uterine dysfunction, prolapsed cord and hemorrhage at birth or shortly after. The perinatal mortality rate is 10 times greater for twins than a single fetus. Fetal problems include decreased intrauterine growth rate for each fetus, increased incidence of fetal anomalies increased risk of prematurity, abnormal presentations and an increase in cerebral palsy. Twins are more likely to have long-term diabilities when compared to children who were singleton births.
What clinical therapy is associated with twins/multiple gestation?
Prenatal visits are more frequent, women with multiple-gestation pregnancies need to understand the nutritional implications, assessment of fetal activity, the signs of preterm labor and the danger signs of pregnancy. Serial ultrasounds are used to assess the growth of each fetus, other testing may include NST, BPP and Doppler ultrasound to asses umbilical waveforms.
What prenatal education will be indicated for multiple gestation?
Diet, activity, planning resting periods, fetal activity assessment, signs of preterm labor, and danger signs of pregnancy.
What factors may indicate the need for cesarean section?
The presence of maternal complications such as placenta previa, abruptio placentae, or severe preeclampsia usually indicates the need for cesarean birth.
What nursing interventions are appropraite for the cesarean section/multiple gestation pregnancy?
FHR of the siblings is monitored continuously by electronic fetal monitor (EFM), the EFM now makes it possible to monitor the fetuses simultaneously. They are monitored up until the incision is made or throughout labor and vaginal birth. After birth the nurse must prepare to receive two or more newborns, this means duplicating everything including resuscitation equipment, radiant warmers and newborn identification and bracelets.
What are the FHR patterns that are considered non-reassuring?
Persistent late decelarations and prolonged decelerations.
What are the potential long-term sequalae of fetal hypoxia?
Oxygen deprivation leads to disorder of organism activity, change of metabolic processes. In different terms of pregnancy oxygen deprivation has different after-effects for fetus. On early terms it leads to appearance of congenital abnormalities, late development of embryo. On late terms of pregnancy oxygen deprivation leads to growth inhibition of fetus, its central nervous system damage (irreversible brain damage) or fetal demise may result.
Name some other signs of fetal distress:
Decreased fetal movement, late decelerations, variable decelerations. Another sign of non-reassuring fetal status is meconium-stained amniotic fluid.
What are some other assessment techniques for fetal distress?
Electronic fetal monitoring, fetal scalp stimulation test, fetal blood sampling and fetal arterial oxygen saturation (FSpO2) monitoring.
Name the nursing interventions for fetal distress:
Medical Interventions:
Intrauterine resuscitation(corrective measures used to optimize the oxygen exchange within the maternal-fetal circulation), should be started without delay when ominous FHR patterns are detected. Treatment centers on improving the blood flow to the fetus by correcting maternal hypotension, decreasing intensity and frequency of contractions if present, providing IV fluids as needed, administering oxygen and gathering further information about fetal status. Fetal response to intrauterine resuscitation measures dictates subsequent actions.
Define Abruptio Placena:
Premature separation of a normally implanted placenta from the uterine wall. Premature separation is considered a catastrophic even because of the severity of the resulting hemorrhage.
What are some predisposing factors for abruption?
The cause is largely unknown. Theories have been proposed relating its occurrence to decreased blood flow to the placenta through the sinuses during the last trimester. Other suggestive factors include excessive intrauterine pressure caused by hydramnios or multiple-gestation pregnancy, maternal hypertension, smoking, ETOH use, increased maternal age and parity, trauma, domestic violence and abuse, nonvertex presentation, and sudden changes in intrauterie pressure.
Name three types of abruption:
Marginal (separates from the edges), Central (centrally separated), and Complete (massive vaginal bleeding is seen in the presence of total separation).
What are the implications of an abruption?
As a result of the damage to the uterine wall and the retroplacental clotting with central abruption, large amounts of thromboplastin are released into the maternal blood supply. This thromboplastin in turn triggers the development of DIC (disseminated intravascular coagulation) and resultant hypofibrinogenemia. Fibrinogen levels which are ordinarily elevated in pregnancy, may drop in minutes to the point at which blood will no longer coagulate. Postpartal problems depend in large part on the severity of the intrapartal bleeding, coagulation defects (DIC), hypofibrinogenemia and time between separation and birth.
What are the fetal implications of Abruptio placentae?
What fators might increase the fetuses risk or outcome?
Perinatal mortality ranges from 25% to 35%. In severe cases, in which most of the placenta is separated, the infant mortality rate is 100%. In less severe separation, fetal outcome depends on the level of time to delivery. The rate of survival is highest in fetuses who are delivered within 20 minutes of initial separation. The most serious complications in the newborn arise from preterm labor, anemia and hypoxia. If fetal hypoxia progresses unchecked, irreversible brain damage or fetal demise may result.
What are the clinical therapies for an abruption?
Because of the risk of DIC, evaluating the results of coagulation tests is imperative. After establishing the diagnosis, immediate priorities are maintaining the cardiovascular status of the mother and developing a plan for the birth of the fetus. The birth method selected depends on the condition of the woman/fetus. In many circumstances, cesarean birth will be the safest option. If the separation is mild and the pregnancy is near term, labor may be induced and the fetus born vaginally with as little trauma as possible. The hypovolemia that accompanies severe abruptio placentae is life threatening. If the fetus is alive, emergency cesarean section is the method of choice. Central venous pressure (CVP) monitoring may be needed to evaluate IV fluid replacement. Lab tests are done... H&H and coagulation status. Packed red blood cells or whole blood may be given to maintain hematocrit.
Discuss the appropriate nursing care plan for the client with abruptio placentae:
Electronic monitoring of the uterine contractions and resting tone between contractions provides information about the labor pattern and effectiveess of the Pitocin induction. Since uterine resting tone is frequently increased with abruptio placentae, it must be evaluated frequently for further increase. Abdominal girth measurements may be ordered hourly. Another method of evaluating uterine size, which increases as more bleeding occurs at the site of abruption, involves placing a mark at the top of the uterine fundus; the distance from the symphis pubis to the mark may be measured hourly. Overdistention of the uterus can lead to a ruptured uterus, another life-threatening complication.
What is Placenta Previa?
The placenta is implanted in the lower uterine segment rather than the upper portion of the uterus. This implantation may be on a portion of the lower uterine segment or over the internal cervical os. As the lower uterine segment contracts and dilates in the later weeks of pregnancy, the placental villi are torn from the uterine wall, thus exposing the uterine sinuses at the placental site.
Name the different types of previa:
Total (the internal os is completely covered).
Partial (the internal os is partially covered).
Marginal (the edge of the lower uterine segment in close proximity to but not covering the os).
What are the fetal implications of Abruptio placentae?
What fators might increase the fetuses risk or outcome?
Perinatal mortality ranges from 25% to 35%. In severe cases, in which most of the placenta is separated, the infant mortality rate is 100%. In less severe separation, fetal outome depends on the level of time to delivery. The rate of survival is highest in fetuses who are delivered within 20 minutes of initial separation. The most serious complications in the newborn arise from preterm labor, anemia and hypoxia. If fetal hypoxia progresses unchecked, irreversible brain damage or fetal demise may result.
What are the clinical therapies for an abruption?
Because of the risk of DIC, evaluating the results of coagulation tests is imperative. After establishing the diagnosis, immediate priorities are maintaining the cardiovascular status of the mother and developing a plan for the birth of the fetus. The birth method selected depends on the condition of the woman/fetus. In many circumstances, cesarean birth will be the safest option. If the separation is mild and the pregnancy is near term, labor may be induced and the betus born vaginally with as little trauma as possible. The hypovolemia that accompanies severe abruptio placentae is life threatening. If the fetus is alive, emergency cesarean section is the method of choice. Central venous pressure (CVP) monitoring may be needed to evaluate IV fluid replacement. Lab tests are done... H&H and coagulation status. Packed red blood cells or whole blood may be given to maintain hematocrit.
Discuss the appropriate nursing care plan for the client with abruptio placentae:
Electronic monitoring of the uterine contractions and resting tone between contractions provides information about the labor pattern and effectiveness of the Pitocin induction. Since uterine resting tone is frequently increased with abruptio placentae, it must be evaluated frequently for further increase. Abdominal girth measurements may be ordered hourly. Another method of evaluating uterine size, which increases as more bleeding occurs at the site of abruption, involves placing a mark at the top of the uterine fundus; the distance from the symphis pubis to the mark may be measured hourly. Overdistention of the uterus can lead to a ruptured uterus, another life-threatening complication.
What is Placenta Previa?
The placenta is implanted in the lower uterine segment rather than the upper portion of the uterus. This implantation may be on a portion of the lower uterine segment or over the internal cervical os. As the lower uterine segment contracts and dilates in the later weeks of pregnancy, the placental villi are torn from the uterine wall, thus exposing the uterine sinuses at the placental site.
Name the different types of previa:
Total (the internal os is completely covered).
Partial (the internal os is partially covered).
Marginal (the edge of the lower uterine segment in close proximity to but not covering the os).
What risk factors might preced a previa?
Women with previous history of placenta previa have an increased risk of developing another previa in future pregnancies. Other factors include multiparity, increasing age, placenta accreta (abnormally firm attachment of the placenta to the uterine wall), defective development of blood vessels in the decidua, a large placenta, smoking and cocaine use, previous cesarean section or abortion and male fetus.
What are the implications of a previa for mother and fetus?
The prognosis for the fetus depends on the extent of placenta previa. In cases of a marginal previa or a low-lying placenta, the woman may be allowed to labor. FHR monitoring is imperative when the woman is admitted, particularly if a vaginal birth is anticipated, because the presenting part may obstruct the flow of blood from the placenta or umbilical cord. If nonreassuring fetal status occurs, cesarean birth is indicated. Women who are diagnosed with a complete or partial previa will undergo a cesarean birth since the risk of intrapartum hemorrhage is high. After birth, blood sampling should be done to determine whether the intrauterine bleeding episodes of the woman have caused anemia in the newborn.
Discuss different management strategies for placenta previa:
The goal of medical care is to identify the cause of bleeding and to provide treament that will ensure mature birth of the newborn. If the pregnancy is less than 37' weeks gestation, expectant management is employed to delay birth until about 37 weeks to allow the fetus to mature.
Expectant management involves stringent regulation of the following:
Bed rest w/bathroom privileges as long as the woman is not bleeding, no vaginal exams, monitoring for blood loss, pain and uterine contractility, evaluating FHR with and external fetal monitor, monitoring maternal vital signs, complete laboratory evaluation(H&H, Rh factor and UA), IV Lactated Ringers, two units of crossmatched blod available for transfusion.
What are some important nursing interventions regarding placenta previa?
Assessment of the woman with placenta previa must be ongoing to prevent or treat complications that are potentially lethal to the mother and fetus. Painless, bright-red vaginal bleeding is the most accurate diagnostic sign of previa. As a result of the placement of the placenta, the fetal presenting part is often unengaged and transverse lie is common. The nurse assesses blood loss, pain and uterine contractility both subjectively and objectively. Maternal vital signs and the results of blood and urine tests provide additional data about the woman's condition. FHR is evaluated with continuous external fetal monitoring. The nurse should also observe and verigy the family's ability to cope with the anxiety associated with an unknown outcome.
What is prolapsed cord and what are the implications?
Results when the umbilical cord precedes the fetal presenting part. Although a prolapsed cord does not directly precipitate physical alterations in the woman, her immediate concern for the baby created enormous stress. Compression of the cord results in decreased blood flow and leads to nonreassuring fetal status. If labor is underway, the cord is compressed further with each contraction. If the pressure on the cord is not relieved, the fetus will die.
Name some abnormal umbilical cord anatomical features:
There are four: succenturiate, circumvallate, battledore, velamentous insertion.
What is an amniotic fluid embolus?
In the presence of a small tear in the amnion or chorion high in the uterus, a small amount of amniotic fluid may leak into the chorionic plate and enter the maternal system as an amniotic fluid embolism.
What are the signs and symptoms of an amniotic fluid embolism?
Sudden onset of respiratory distress, circulatory collapse, acute hemorrhage, and cor pulmonale as the embolism blocks the vessels of the lungs. She exhibits dysnea and cyanosis leading to hemorrhagic shock and coma. Birth must be facilitated immediately to obtain a live fetus.
What are the nursing interventions for an amniotic fluid embolism?
In the absence of a physician/CNM, the nurse administers oxygen under positive pressure until medical help arrives. An IV line is wuickly established. If respiratory and cardiac arrest occurs, CPR is initiated immediatley. The nurse readies the equipment necessary for blood transfusion and for the insertion of the CVP (central venous pressure) line. As the blood volume is replaced, using fresh whole blood to provide clotting factors, the CVP is monitored freqently. In the presence of cor pulmonale, fluid overload could easily occur.
What is polyhydramnios?
Also called hydramnios, occurs when there is more than 2000 mL of amniotic fluid.
What conditions are associated with polyhydramnios?
Exact cause is unknown but in 20% of cases it is associated with major congenital anomalies.
Hydramnios is associated with maternal disorders such as diaetes and Rh sensitization and with multiple-gestation pregnancies.
What are the maternal implications of hydramnios?
When the amount of amniotic fluid is 3000mL or more, the woman experiences shortness of breath and edema in the lower extremities from compression of the vena cava.
What happens if the amniotic fluid is removed due to hydramnios?
If the amniotic fluid is removed rapidly before birth, abruptio placentae can result from too sudden a change in the size of the uterus. Because of overdistention of the uterine muscles, uterine dysfunction can occur in the intrapartal period, and the incidence of postpartal hemorrhage increases.
What are the nursing considerations for the client with hydramnios?
Hydramnios should be suspected when the fundal height increases out or proportion to the gestational age. On sonography, large spaces can be identified between the fetus and the uterine wall. When amniocentesis is performed, it is vital to maintain a sterile technique to prevent infection. If the fetus has been diagnosed with a congenital defect in utero or is born with a defect, the family needs psychologic support. Often the nurse collaborate with social services.
What are the fetal implications for hydramnios?
Fetal malformations and preterm birth are common thus the perinatal mortality rate is fairly high. Prolapse cord can occur when the membranes rupture and the incidence of malpresentations also increases.
What is Oligohydramnios?
Amniotic fluid is severely reduced and concentrated.
What conditions are associated with Oligohydramnios?
Exact cause is unknown, is is found however in cases of postmaturity, with IUGR secondary to placental insufficiency, and in fetal coditions assoctiated with mahor renal malformations, including renal aplasia with dysplastic kidneys and obstructive lesions of the lower urinary tract.
What nursing interventions are associated with Oligohydramnios?
Continuous fetal monitoring, the nurse evaluates the EFM tracing for the presence of variable decelerations or other nonreassuring signs. If variable decelerations are noted, the woman's position can be changed and the physician/CNM notified. After the birth, the newborn is evaluated for signs of congenital anomalies, pulmonary hypoplasia (incomplete development of lung tissue)and postmaturity.
What is CPD or cephalopelvic disproportion?
The birth passage includes the maternal bony pelvis, beginnins at the pelvic inlet and ending at the pelvic outlet, and the maternal soft tissues within these anatomic areas. A contracture (narrowing diameter) in any of the described areas can result in CPD.
What are the clinical problems associated with CPD?
Labor is prolonged in the presence of CPD, membrane rupture can result from the force of the unequally distributed contractions being exerted on the fetal membranes, in obstructive labor, in which the fetus cannot descend, uterine rupture can occur. With delayed descent, necrosis of maternal soft tissues acan result from pressure exerted by the fetal head.
What are the appropriate nursinng interventions for CPD?
The adequacy of the maternal pelvis should be assessed both during and before labor. The size of the fetus and its presentation, position and lie must also be considered. The nurse keeps the couple informed of what is happening if CPD is suspected. Nursing actions during the trial of labor (TOL) include assessing the cervical dilatation and fetal descent more frequently. Both contractions and the fetus should be monitored continuously. Any signs of nonreassuring fetal status are reported to the physician/CNM immediately.
Discuss the labor characteristics which may indicate CPD:
When labor is prolonged, cervical dilitation and effacement are slow and engagement of the presenting part is delayed.
Define the degrees of laceration:
First-degree is limited to the fourchette, perineal skin and vaginal mucous membrane, Second-degree involves the perineal skin, vaginal mucous membrane, underlying fascia and muscles of the perineal body and may extend upward on both sides of the vagina, third-degree extends through the perineal skin, vaginal muscous membranes, and perineal body and involves the anal sphincter and may extend up the anterior wall of the rectum, fourth-degree is the same as third but extends through the rectal mucosa to the lumen of the rectum; it may be called third-degree laceration with a rectal wall extension.
Discuss appropriate nursing interventions based on the degree of laceration:
Perineal massage has been found to reduce the risk of tear. If the mother has a tear (or an episiotomy, or both) that requires stitches, a local anesthetic will first be injected directly into the areas that need numbing. Or, if she has an extensive tear, she may get a pudendal block — an injection of a local anesthetic into the walls of the vagina, which bathes the pudendal nerve and numbs the entire genital area. Then the practitioner will stitch the patient up, layer by layer.
Afterward, the mother can be educated to apply ice packs to the area for the next 12 hours or so. Pain medication will be given and sex should be avoided until healed properly.
Discuss some of the possible causes of fetal demise:
The cause may be unknown, or it may result from any of a number of physiologi maladaptations including preeclampsia or eclampsia, abruptio placentae, placenta previa, diabetes, congenital anomalies, renal disease, cord accidents, fetal growth restriction, and alloimmunization. In developing countries, infection plays a significant role in fetal deaths.
What are the signs of a fetal demise?
Cessation of fetal movement reported by the mother to the nurse is frequently the first indication of fetal death. It is followed by a gradual decrease in the signs and symptoms of pregnancy. Fetal heart tones are absent, and fetal movement is no longer palpable.
What are the medical/nursing interventions for fetal demise?
Being caring and supportive is essential. Open communication between the mother, her partner, and the healthcare team members contribute to a realistic understanding of the medical condition and its associated treatments. Most facilities have an established protocol to follow in the event of perinatal death. The family needs to be prepared for the birth and viewing. Facilitating the family's grief work is a critical nursing intervention. Counseling and community services should be discussed as possible resources as well.