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34 Cards in this Set

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What does intrapartum mean?
During childbirth
What are the psychological factors to remember during the intrapartum period?
Stress Factors – Stress causes a reduction of myometrial activity (More stress = more pain), Comfort measures, Relaxation / breathing techniques, Reassurance and rapport
What is an episiotomy?
Incision in the perineal made during delivery to allow for more room for the baby to come out.
What are the types of episiotomies?
Midline or Mediolateral
What are the advantages and disadvantages of a midline episiotomy?
Advantages: Less blood loss, Less painful, Heals quickly Disadvantages: May extend to anus
What are the advantages and disadvantages of a medilateral episiotomy?
Advantages: More room
Disadvantages: More painful, More blood loss, Takes longer to heal
What is precipitate labor?
A labor that is completed in less than three hours. More common with the multiparous woman. Poses risk of trauma to the fetus as well as trauma to the maternal soft tissue.
What is the management for a patient in precipitate labor?
Early preparation for labor, Support the perineum in case of delivery
What is a laceration during delivery?
A natural tear in the vagina, skin, mucosa, fascia or muscle during labor. You will see a steady trickle of blood.
What is a first degree laceration during delivery?
Tear of: Perineal skin and vaginal mucosa.
What is a second degree laceration during delivery?
Tear of: Perineal skin, vaginal mucosa, fascia, muscle of the perineal body.
What is a third degree laceration during delivery?
Tear of: Perineal skin, vaginal mucosa, fascia, muscles of the perineal body involving the anal sphincter.
What is a fourth degree laceration during delivery?
Tear of: A third degree laceration but goes through the rectal mucosa.
What is a perineal hematoma?
A collection of blood in the subcutaneous layer of the perineal tissue. May feel like the patient may want to have a bowel movement. If pt states that she want to have a bowel movement, check site for hematoma.
It is characterized by: Purplish discolored area, Swelling, Feeling of presure or tightness
What is occiput posterior fetal position?
The most common position for a baby during labor is head down with the back of the head (occiput) facing the front of the mother (anterior). When the back of the head is facing the back of the mother (posterior) the baby’s position is called Occiput Posterior.
What are the symptoms of severe occiput posterior position? What is the nursing plan?
Severe back pain, Increased use of forcepts / vacuum, Increased risk of lacerations
What are the types of malpresentations? What is the treatment?
Types: Breech, Face, brow, Tranverse, Shoulder
Treatment: Manual rotation, External version, Cesarean section
What is macrosomia? What is the risk?
A Baby over 8 lbs 14 oz. The risk is Shoulder dystocia.
What is the nursing responsibility for macrosomia?
McRoberts Maneuver – push legs back of the mom as far as possible to make more room in the opening., Prep for a C-Section, Check infant for shoulder palsy and clavical after delivery – MD can break shoulder or clavical of baby.
What are the reasons for a c-section?
Malpresentation, Placenta previa or abruption, Fetal distress, Failure to progress – Dilation should be about 1 cm per hour., Prior uterine scar
What are the types of incisions for a c-section?
# 1: Classical / verticle (bellybutton to pubis) – the most contractile area is cut. Uterus may shred overtime. Back in the day, they used to limit C-sections to three children. # 2: Low transverse or pfannestiel (Bikini cut). The old scar is cut out on repeat c-sections.
What is the nursing responsibility for a patient undergoing a c-section?
Prepare client, Shave abdomen, Insert foley – to avoid filled bladder – prevents nicks during surgery, Preop meds – Bicitra 30 cc PO to reduce acid content, NPO during labor because it is not known if an emergency C-Sec may need to be performed. Ice chips only., Ask for allergies., Preop and postop teaching
What is a cord prolapse during labor?
Occurs when a loop of the umbilical cord gets in front of the presenting part. Sometimes just the act of the water breaking can wash out a part of the cord. Whenever water breaks, you must do a vaginal exam for check for cord compression and prolapse.
What is the nursing plan of action for a cord prolapse during labor?
Avoid compression – Put in finger and lift head to allow cord pressure relief., Trendelenberg position – or any position that will tilt the pelvis backwards to relieve pressure., Baby has 4 minutes of cut circulation before brain damage.
What is a dysfunctional labor?
An abnormal progress of dilation and/or descent of the presenting part.
What are the two types of dysfuctional labors? What is the treatment?
# 1: Hypertonia – Seen in early labor. Pain due to uterine muscle cell anoxia
# 2: Hypotonia – Seen in active labor. Caused by medication, epidural, over stretching or the uterus or malposition.
Treatment: Pitocin Augmentation
What is a uterine rupture?
May result frm VBAC (Vaginal birth after Cesarean), trauma, excess pitocin administration, fetal lie. When on Pitocin, contractions cannot be more than 2 minutes apart. Or else, the pt can have a “titanic” contraction and the uterus can rupture. If the uterine ruptures, a hysterectomy must be performed.
What are the symptoms of a uterine rupture? What is the treatment for uterine rupture?
Symptoms: Excrutiating pain, Cessation of contractions, Drastic decrease in fetal heart rate, May have bleeding
Treatment: Emergency cesarean
What is an amniotic fluid embolism?
Occurs when amniotic fluid gets into maternal circulation. More than 50% of the women that have this will not make it.
What are the symptoms of an amniotic fluid embolism? What is the treatment for an amniotic fluid embolism?
Symptoms: Respiratory distress – SOB, Cyanosis, Chest pain, Tachycardia, Acute hemorrhage
Treatment: Maintain oxygentation, Support CVS
What is Acretia?
Chorionic villi attach directly to the myometrium of the uterus. The placenta is embedded and they will have to go in an get it out. Can cause hemorrhage. If the bleeding does not stop, they must do a hysterectomy.
What is HELLP syndrome?
Hemolysis Elevated Liver enzymes Low Platelets

When a pt with HELLP syndrome is bleeding, will bleed more because of low platelets but will have an increase in clotting. It can cause DIC.
What is the treatment for HELLP syndrome?
Improve platelet count, Close observation, Prevent bruising or bleeding
What is DIC? What is the treatment for DIC?
Disseminated Intravascular Coagulation. Pregnant woman in a hypercoagular state. Overstimulation of the coagulation process triggered by underlying disease and vascular injury. So patient has bleeding but excessive clotting. Although it may look contraindicated, Heparin is given to the patient to prevent clots. Management by treating the underlying cause.