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108 Cards in this Set

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WHAT ARE SOME PROBLEMS RELATED TO CHILDBIRTH
UTERINE DYSTOCIA
PRECIPITOUS LABOR
POST-TERM PREGNANCY
FETAL MALPOSITION OR MALPRESENTATION
MACROSOMIA
PLACENTAL, AMNIOTIC OR CORD PROBLEMS
DYSTOCIA
DIFFICULT LABOR R/T DYSFUNCTIONAL UTERINE CONTRACTIONS.
DESCRIBE THE CONTRACTIONS THAT OCCUR WITH DYSTOCIA
CONTRACTIONS THAT ARE UNCOORDINATED

IRREGULAR IN STRENGTH, TIMING OR BOTH
WHAT IS THE RESULT OF THE INEFFECTIVE UTERINE CONTRACTIONS THAT OCCUR WITH DYSTOCIA
INEFFECTIVE CERVICAL DILATION

PROLONGED LABOR
HYPERTONIC LABOR CONTRACTIONS

THE RESTING TONE OF THE MYOMETRIUM INCREASES OR DECREASES?
IINEFFECTIVE UTERINE CONTRACTIONS OF POOR QUALITY

OCCUR IN THE LATENT PHASE OF LABOR

THE RESTING TONE OF THE MYOMETRIUM INCREASES

CONTRACTIONS BECOME MORE FREQUENT, BUT INTENSITY MAY DECREASE

CONTRACTIONS ARE PAINFUL AND INEFFECTIVE IN DILATING AND EFFACING THE CERVIX

LEADS TO A PROLONGED LATENT PHASE
RISKS TO MOM WITH HYPERTONIC LABOR PATTERN
INCREASED DISCOMFORT
PHYSICALLY EXHAUSTED
EMOTIONALLY DISCOURAGED
DEHYDRATED
POOR COPING
RISKS TO FETUS WITH HYPERTONIC LABOR PATTERN
CEPHALOHEMATOMA
CAPUT SUCCEDANEUM
NON REASSURING FETAL STATUS
POOR BLOOD FLOW TO AND FROM PLACENTA (CAN LEAD TO ABRUPTION OF PLACENTA)
CLINICAL MANAGEMENT OF A PATIENT WITH HYPERTONIC LABOR
BED REST
SEDATION (PHENERGAN, STADOL)
AMNIOTOMY (ARTIFICIAL RUPTURE OF MEMBRANE)
PITOCIN
IV HYDRATION
HYPOTONIC LABOR
OCCURS AFTER LABOR HAS BEEN ESTABLISHED (USUALLY IN ACTIVE PHASE).

CHARACTERIZED BY FEWER THAN 2-3 CONTRACTIONS IN A 10 MINUTE PERIOD



CAN BE DUE TO MALPOSITION OF FETUS OR LARGE FETUS
RISKS TO MOM WITH HYPOTONIC LABOR PATTERN
EXHAUSTION
FATIGUE
POOR COPING
INFECTION (GREATEST RISK)
WHAT IS THE GREATEST RISK TO THE FETUS WITH HYPOTONIC LABOR?
INFECTION
CLINICAL MANAGEMENT OF HYPOTONIC LABOR PATTERN
ACTIVE MANAGEMENT OF LABOR WHICH INCLUDES:

AMNIOTOMY
TIMED CERVICAL EXAMS (DONE BETWEEN CONTRACTIONS)
AUGMENTED LABOR WITH PITOCIN
IV HYDRATION
CAREFUL MONITORING OF FETUS
EMOTIONAL SUPPORT
CAUSES OF HYPOTONIC LABOR
OVERSTRETCHED UTERUS FROM A TWIN GESTATION
LARGE FETUS
HYDRAMINIOS
GRAND MULTIPARITY
BLADDER OR BOWEL DISTENTION
CPD
IF MECONIUM IS PRESENT IN ANY CIRCUMSTANCES, WHAT IS THAT INDICATIVE OF?
FETAL DISTRESS
WHY SHOULD CERVICAL EXAMS BE LIMITED?
RISK OF INFECTION
PRECIPITOUS LABOR AND BIRTH
LABOR THAT LASTS LESS THAN 3 HOURS

RAPID DESCENT OF THE PRESENTING PART RESULTING IN BIRTH

UNEXPECTED, SUDDEN AND OFTEN UNATTENDED BIRTH
FACTORS THAT CONTRIBUTE TO PRECIPITOUS LABOR AND BIRTH
MULTIPARTITY

PREVIOUS PRECIP BIRTH

SMALL FETUS

LARGE PELVIS
RISKS OF PRECIPITOUS LABOR TO MOTHER
LOSS OF COPING ABILITIES

LACERATIONS

AMNIOTIC FLUID EMBOLISM

POSTPARTAL HEMORRHAGE

LACERATIONS OF CERVIX AND/OR PERINEUM
RISKS OF PRECIPITOUS LABOR TO FETUS
FETAL DISTRESS

POOR UTEROPLACENTAL PERFUSION

CEREBRAL TRAUMA

PNEUMOTHORAX (COMPRESSED CHEST WALL W/ PRESSURE)
NURSING CARE MANAGEMENT FOR A WOMAN IDENTIFIED AT RISK FOR PRECIPITOUS BIRTH
MONITOR CLOSELY THE LAST FEW WEEKS OF PREGNANCY

IF THE CERVIX BEGINS TO SOFTEN SHE MAY BE ADMITTED FOR INDUCTION

IN THE HOSPITAL SHE SHOULD BE MONITORED CLOSELY

KEEP AN EMERGENCY BIRTH PACK ON HAND

NURSE STAYS IN CONSTANT ATTENDANCE

PROVIDE COMFORT AND QUIET

BE ALERT TO DANGERS OF PITOCIN OVERDOSE

D/C PITOCIN IF ACCELERATED LABOR PATTERN OCCURS

TURN WOMAN ON L SIDE TO IMPROVE UTERINE PERFUSION

ADMINISTER O2

MONITOR FETUS FOR S/S HYPOXIA OR NONREASSURING FETAL STATUS
POST-TERM PREGNANCY
EXTENDING MORE THAN 42 WEEKS PAST THE FIRST DAY OF LMP
RISKS OF POSTTERM PREGNANCY TO MOM
LGA INFANT (MACROSOMIA)

INCREASED INCIDENCE OF FORCEPS-ASSISTED, VACUM ASSISTED, OR CESAREAN BIRTH

INCREASED PSYCHOLOGICAL STRESS

PROBABLE INDUCTION OR CS
WHAT IS THE MOST IMPORTANT FACTOR IN DETERMINING WHETHER OR NOT TO INDUCE
GESTATIONAL AGE OF INFANT.
AT WHAT WEEK IS THE PLACENTA REACHING ITS MAXIMUM FUNCTION
38
WHEN DOES THE PLACENTA STOP SUPPORTING THE FETUS
40 WEEKS
RISKS OF POSTTERM PREGNANCY TO FETUS
DECREASED PLACENTAL PERFUSION

FETAL DISTRESS

OLIGOHYDRAMNIOS

MECONIUM ASPIRATION

MACROSOMIA R/T HYPOTHERMIA AND HYPOGLYCEMIA
TYPES OF FETAL MALPRESENTATION OR MALPOSITION
OCCIPUT POSTERIOR (OCCURS 5% OF THE TIME)

BROW PRESENTATION (0.02%)

FACE PRESENTATION (<0.2%)

BREECH PRESENTATION (3-4%)

SHOULDER PRESENTATION TRANSVERSE LIE (0.3%)

COMPOUND PRESENTATION 90.5%)
TYPES OF BREECH

WHAT HAPPENS WHEN A FETUS IS IN BREECH PRESENTATION?
FRANK BREECH - BUTTOCKS PRESENT

COMPLETE BREECH - BUTTOCKS AND FEET PRESENT

FOOTLING BREECH - FEET PRESENT

BREECH GENERALLY RESULTS IN AN AUTOMATIC CS UNLESS LABOR HAS PROGRESSED TOO FAR.
MOST COMMON FETAL MALPOSITION
OCCIPUT POSTERIOR

THE HEAD IS DIRECTED TOWARD THE BACK OF THE MATERNAL PELVIS.

DURING LABOR, 90-95% OF OP FETUSES ROTATE TO AN OCCIPUT-ANTERIOR POSITON.
CLINICAL MANAGMENT OF FETUS AND MOM WHEN MALPOSITION OCCURS
CLOSE MONITORING

POSITION CHANGES FOR MOTHER MAY HELP

POSSIBILITY OF EXTERNAL CEPHALIC VERSION

CAREFUL MONITORING OF FHT, AMNIOTIC FLUID, FETAL DISTRESS, CORD PROLAPSE, ESPECIALLY WITH BREECH

POSSIBILITY OF MIDLIINE EPISIOTOMY

FORCEPS MAY BE REQUIRED FOR POSTION CHANGE AND/OR DELIVERY

CS MAY BE REQUIRED
MACROSOMIA - WHAT IS THE WEIGHT
MORE THAN 4000G
INCIDENCE OF MACROSOMIA IS GREATER IN?
GENETIIC HISTORY

MALE INFANTS

IDM'S

PROLONGED GESTATION

GRAND MULTIPAROUS
WHAT IS THE MAJOR CAUSE OF CPD (CEPHALO-PELVIC DISPROPORTION)
MACROSOMIA
WHAT ARE SOME MEDICAL INTERVENTIONS FOR THE PATIENT WITH A MACROSOMIC INFANT?
IDENTIFY BEFORE ONSET OF LABOR

MONITOR FOR S/S DYSTOCIA

ASSISTED BIRTH OR CS MAY BE NECESSARY
RISKS TO MOTHER WITH MACROSOMIC FETUS
CPD

DYSFUNCTIONAL LABOR

PP HEMORRHAGE

LACERATIONS
RISKS TO MACROSOMIC FETUS
FETAL DISTRESS AND MECONIUM ASPIRATION

SHOULDER DYSTOCIA. ERBS PALSY

HYPOGLYCEMIA

HYPOTHERMIA
WHAT ARE SOME TYPES OF ASSISTED BIRTH
FORCEPS-ASSISTED

VACUUM ASISTED

VACUUM EXTRACTOR
CONDITIONS THAT MUST BE MET BEFORE FORCEPS AND VACUUM ASSISTED BIRTH CAN BE PERFORMED
FULLY DILATED CERVIX

ROM

+2 STATION

CEPHALIC PRESENTATION

NO CPD

EMPTY BLADDER (MAY BE GIVEN A CATH)

*WITH VAC, INTERMITTENT TRACTION IS APPLIED WITH CONTRACTIONS
CLINICAL MANAGEMENT WITH MACROSOMIC FETUS
CLOSE MONITORING DURING LABOR FOR EARLY DECELS, FETAL DESCENT

PROVIDE SUPPORT AND ENCOURAGEMENT FOR LABORING MOM AND PARTNER

MONITOR FOR POSTPARTAL COMPLICATIONS SUCH AS HEMORRHAGE RT UTERINE ATONY

ADMINISTER IV OXYTOCIN POST DELIVERY
NON-REASSURING FETAL STATUS
O2 SUPPLY IS INSUFFICIENT TO MEET THE NEEDS OF THE FETUS, THEREBY CAUSING HYPOXIA AND ACIDOSIS
CAUSES OF NON-REASSURING FETAL STATUS
CORD COMPRESSION

UTEROPLACENTAL INSUFFICIENCY
S/S OF NON-REASSURING FETAL STATUS
FETAL BRADYCARDIA

PERSISTANT LATE DECELS

PROLONGED OR VARIABLE DECELS WITHOUT A RETURN TO BASELINE

MECONIUM STAINED AMNIOTIC FLUID.
WHAT TYPE OF MONITORING MAY BE USED WHEN THERE IS NON-REASSURING FETAL STATUS
INTERNAL MONITORING
INTERVENTIONS R/T NON-REASSURING FETAL STATUS
DETERMINE CAUSE
CORRECT ANY MATERNAL HYPOTENSION
IV HYDRATION
STOP OXYTOCICS
OXYGEN VIA MASK IS ADMINISTERED TO MOM
EMOTIONAL SUPPORT
CS MAY BE NECESSARY
PLACENTA PREVIA
PLACENTA IS IMPLANTED IN LOWER PORTION OF UTERUS-COMPLETELY OR PARTIALLY COVERING THE CERVICAL OS

PLACENTA IS SUPPOSED TO BE IMPLANTED IN UPPER 2/3 OF FUNDUS
CAUSE OF PLACENTA PREVIA
UNKNOWN, BUT MORE FREQUENT IN MULTIPS AND WOMEN WITH PREVIOUS HX OF PP
WHAT IS AN INDICATOR OF PLACENTA PREVIA
BRIGHT RED VAGINAL BLEEDING IN LAST TRIMESTER
HOW IS PLACENTA PREVIA DX CONFIRMED
U/S USUALLY CONFIRMS

DO NOT DO A VAG EXAM BECAUSE IT COULD CAUSE HEMORRHAGE AND DISRUPT THE PLACENTA
TREATMENT FOR PATIENT WITH PLACENTA PREVIA
EMERGENCY DELIVERY VAGINALLY OR C/S

GENERALLY, IT'S DX VERY EARLY AND SOMETIMES IT CORRECTS ITSELF
WHAT CONDITIONS WILL INDICATE THAT A C/S IS NECESSARY IF PLACENTA PREVIA IS PRESENT
IF FETAL PRESENTING PART IS OBSTRUCTING BLOOD FLOW FROM PLACENTA DURING DESCENT
WHEN CAN PLACENTA PREVIA BE TREATED WITH MEDICATION
WHEN IT IS DISCOVERED BEFORE 37 WEEKS OR IF BLEEDING IS MINIMAL
WHAT IS THE GOAL FOR TREATMENT OF A PATIENT WITH PLACENTA PREVIA
DELAY DRUG TREATMENT UNTIL 37 WEEKS
BEDREST
NO RECTAL/VAGINAL EXAMS
MONITOR BLOOD LOSS, PAIN, UTERINE CONTRACTIONS
MONITOR FHR
MONITOR MATERNAL VS, H&H
IV'S, T & X MATCH, TRANSFUSE IF NECESSARY
NEWBORN IS MONITORED CLOSELY (ANTEPARTAL VISITS, U/S, BIOPHYSICAL PROFILE MORE FREQUENTLY)
PLACENTA ABRUPTIO
PREMATURE SEPERATION OF THE PLACENTA FROM THE UTERINE WALL PRIOR TO DELIVERY, CAUSING BLEEDING FROM THE UTERINE WALL.

MORE COMMON LATER IN PREGNANCY
HIGHEST INCIDENCE OF PLACENTA ABRUPTIO
WOMEN WITH:

HTN
PIH (PREG. INDUCED HTN)
HYDRAMINOS
MULTIPLE PREGNANCIES
AFTER AMNIOTOMY (CAUSES A SUDDEN CHANGE IN INTRAUTERINE PRESSURE)
TRAUMA
COCAINE ABUSE
PLACENTA ABRUPTIO CLASSIFICATIONS
CENTRAL

MARGINAL

COMPLETE
CENTRAL ABRUPTION
BLEEDING IN CENTER OF PLACENTA

CHARACTERIZED BY: CONCEALED BLEEDING AND RIGID ABDOMEN, SEVERE PAIN AND SHOCK
MARGINAL ABRUPTION
BLEEDING PASSES BETWEEN UTERINE WALL AND FETAL MEMBRANES

CHARACTERIZED BY: DARK BLEDING AND PAIN
COMPLETE ABRUPTION
MASSIVE VAG. BLEEDING, RIGID ABD., PROFOUND SHOCK, FETAL DISTRESS

TX: C/S STAT
WHAT IS THE MOST SIGNIFICANT SYMPTOM OF AN ABRUPTION
PAIN
WHEN A PATIENT IS SUFFERING FROM AN ABRUPTION, WHAT ARE GUIDELINES FOR CARE
MONITOR FHR FOR STRESS
U/S TO CONFIRM - NO VAG EXAM
EMERGENCY C/S
GIVE EMOTIONAL SUPPORT TO FAMILY (POSSIBILITY OF HYSTERECTOMY)
POOR PROGNOSIS FOR FETUS (1/3 DIE OF HYPOXIA)
MONITOR FOR DIC
WHAT VERY SERIOUS PROBLEM CAN OCCUR WITH AN ABRUPTION
A DIC (DISSIMINATED INTRAVASCULAR COAGULATION) CAN OCCUR.

DIC - A LARGE AMOUNT OF THROMBOPLASTIN IS RELEASED INTO MATERNAL BLOOD SUPPLY DUE TO DAMAGE TO UTERINE WALL CAUSED BY ABRUPTION. THE THROMBOPLASTIN CAUSES DEVELOPMENT OF DIC AND HYPOFIBRINOGENEMIA (LOW FIBRIN). AS A RESULT THE BLOOD WILL NO LONGER COAGULATE AND HEMORRHAGE AND HEMORRHAGIC SHOCK COULD OCCUR. IF NOT CORRECTED QUICKLY, IT COULD BE FATAL TO MOM.
PROLAPSED CORD
CORD COMPRESSION CAUSES FETAL HYPOXIA (INCREASED VARIABLITY AND/OR INTENSE DECELS WITH CONTRACTIONS)
INTERVENTIONS REQUIRED FOR PROLAPSED CORD
IMMEDIATE INTERVENTION REQUIRED
BEDREST AFTER ROM (HEAD SHOULD BE ENGAGED BEFORE ROM)
WATCH FOR S/S OF FETAL DISTRESS
LATE DECELS, INCREASING VARIABILITY
EMERGENCY CARE FOR PROLAPSED CORD
O2
FHM
MANUAL DECOMPRESSION (FINGERS IN VAG TO RELIEVE PRESSURE AND WATCH MONITOR TO SEE IF YOU ARE RELIEVING COMPRESSION)
KNEE-CHEST POSTION FOR MOM
CS
AMNIOTIC FLUID COMPLICATIONS
POLYHYDRAMINOS
OLIGOHYDRAMNIOS
AMNIOTIC FLUID EMBOLISM
NORMAL AMOUNT OF AMNIOTIC FLUID
800-1000 ML @ 36-37 WEEKS
POLYHYDRAMNIOS
MORE THAN 2000 ML OF FLUID

MOST COMMON IN DIABETIC MOM

INCREASED RISK OF C/S BIRTHS

MAY BE CHRONIC OR ACUTE

ASSOCIATED WITH MATERNAL DIABETES, RH SENSITIZATION AND MULTIPLE PREG.

ASSOCIATED WITH FETAL MALFORMATIONS AND PRETERM BIRTHS

PROLAPSE CORD CAN OCCUR
OLIGOHYDRAMNIOS IS ASSOCIATED WITH WHAT?
ASSOCIATED WITH POSTMATURITY, PLACENTAL INSUFFICIENCY, FETAL MALFORMATION, ESPECIALLY RENAL.
MANAGEMENT OF POLYHYDRAMNIOS
U/S AND AMNIOCENTESIS USED TO MANAGE (FLUID CAN BE DRAWN OUT WITH AMNIOCENTESIS)
MANAGEMENT OF OLIGOHYDRAMNIOS
CLOSE MONITORING OF FETUS VIA BPP, SERIAL U/S, NST

AMNIOFUSION MAY BE PERFORMED AFTER ROM (ADDING NORMAL SALINE TO INCREASE AMNIOTIC FLUID)
AMNIOTIC FLUID EMBOLISM
DIRE EMERGENCY (ONLY 40% RECOVER FROM ACUTE PHASE)

TEAR IN AMNION COMBINED WITH CONTRACTIONS CAUSES FLUID TO SEAP INTO MATERNAL CIRCULATION. FLUID CAN TRAVEL TO LUNGS AND CAUSE A SUDDEN ONSET OF RESPIRATORY DISTRESS

MAY OCCUR AFTER PRECIPITOUS BIRTH

HIGHER INCIDENCE IN PREECLAMPSIA

S/S CHEST PAIN,DYSPNEA,CYANOSIS,FROTHY SPUTUM,TACHYCARDIA,HYPOTENSION, MASSIVE HEMORRHAGE
WHAT ARE THE INDICATIONS THAT A C SECTION MAY NEED TO BE PERFORMED
COMPLETE PLACENTA PREVIA
CPD (CEPHALOPELVIC DISPROPROTION - FETUS LARGER THAN PELVIC DIAMETERS)
ABRUPTIO PLACENTA
ACTIVE GENITAL HERPES
UMBILICAL CORD PROLAPSE
FAILURE TO PROGRESS IN LABOR
FETAL DISTRESS
TYPES OF SKIN INCISIONS FOR A C/S
TRANSVERSE-MADE ACROSS THE LOWEST AND NARROWEST PART OF THE ABD. ONCE HEALED IT'S ALMOST INVISIBLE. LIMITATIONS OF THIS TYPE IS THAT IT DOES NOT ALLOW FOR EXTENSION OF THE INCISION IF NEEDED

VERTICAL-MADE BETWEEN THE NAVEL AND THE SYMPHYSIS PUBIS. THIS TYPE IS QUICKER AND PREFERRED IN CASES OF NON-REASSURING FETAL STATUS WHEN RAPID BIRTH IS INDICATED, WITH PRETERM OR MACROSOMIC INFANTS, OR WHEN THE WOMAN IS OBESE.

TRANSVERSE REQUIRES MORE TIME TO MAKE AND HEAL, SO IF TIME IS OF THE ESSENCE, THE PHYSICIAN MAY DO A VERTICAL.
RISKS OF CS
INCREASED RISK OF BLEEDING
INCREASED RISK OF BLOOD CLOTS
INCREASED RISK OF INFECTION
RISK OF PLACENTA PREVIA IN SUBSEQUENT PREG.
RISK OF ABRUPTIO PLACENTAE IN SUBSEQUENT PREG.
INCREASE IN FETAL DEMISE
INCREASE IN NEONATAL RESPIRATORY DISTRESS
GUIDELINES FOR C/S CARE
PROVIDE SUPPORT FOR PARENTS
VERTICAL VS HORIZONTAL INCISION
VS, WOUND CARE, MONITOR LOCHIA
ANALGESIA
MONITOR FOR HYPOTENSION
MONITOR URINE OUTPUT, COLOR, QUALITY (THEY SHOULD GET 125 ML OF FLUID/HR, SO THEY SHOULD HAVE CLEAR,YELLOW URINE)
WHAT CRITERIA SHOULD BE MET BEFORE A VBAC - VAGINAL BIRTH AFTER CECAREAN
PT AGREES WITH VBAC
PREVIOUS TRANSVERSE INCISION
BENIGN POSTOP COURSE
CURRENT COURSE IN UNCOMPLICATED
RISK OF UTERINE RUPTURE
WHAT ARE SOME PROCEEDURES THAT MAY BE PERFORMED TO ASSIST IN BIRTH OF AN INFANT
VERSION
AMNIOTOMY
CERVICAL RIPENING
LABOR INDUCTION
AMNIO INFUSION
EPISIOTOMY
FORCEPS-ASSISTED BIRTH
VACUUM ASISTED BIRTH
C/S
VBAC
VERSION

EXTERNAL VERSION
TURNIING OF THE FETUS

EXTERNAL CEPHALIC VERSION-FETUS CHANGED FROM BREECH TO CEPHALIC EXTERNALLY. PT. IS GIVEN TERBUTALINE TO RELAX UTERUS AND U/S IS USED TO GUIDE. WAIT UNTIL 36 WEEKS GIVE NST RIGHT AFTER
CERVICAL RIPENING
PROSTAGLANDIN PLACED ON THE CERVIX TO ALLOW FOR CX SOFTENING

PREPIDIL, CERVIDIL, MISOPROSTOL (CYTOTEC)
CONTRAINDICATIONS TO USING CERVICAL GEL
MATERNAL ASTHMA
SCAR TISSUE IN UTERUS
BLEEDING
PLACENTA PREVIA
FETAL DISTRESS
2ND MOST IMPORTANT FACTOR IN DETERMINING WHETHER OR NOT TO INDUCE LABOR
CERVICAL RIPENING
DEFINE INDUCTION
STIMULATION OF UTERINE CONTRACTIONS BEFORE THE SPONTANEOUS ONSET OF LABOR, WITH OR WITHOUT RUPTURED FETAL MEMBRANES, FOR THE PURPOSE OF ACCOMPLISHING BIRTH.
BEFORE INDUCTION IS ATTEMPTED, WHAT MUST BE ASSESSED TO INDICATE THAT BOTH MOM AND FETUS ARE READY FOR INDUCTION?
GESTATIONAL AGE
CERVICAL READINESS
COMMON INDICATIONS FOR INDUCTION
DM
PREECLAMPSIA
PROM
HISTORY OF PRECIPITOUS BIRTH
POSTTERM GESTATION
ABRUPTIO PLACENTA W/O INDICATION OF NONREASSURING FETAL STATUS
IUGR
CONTRAINDICATIONS OF INDUCTION
FETAL MATURITY
CLIENT REFUSAL
UNSTABLE CONDITION OF MOM OR FETUS
NURSING MANAGEMENT OF PATIENT INDUCED WITH OXYTOCIN
PIGGYBACK INTO LOWEST PART OF PORT OF LR

GOAL: ACHIEVE STABLE CONTR. Q 2-3 MINUTES, LASTING 40-60 SEC.

D/C FOR FETAL DISTRESS, CONTR. MORE FREQ. THAN Q2 MIN, DURATION OF CONTR. EXCEEDS 60 SEC, INSUFFICIENT RELAXATION OF UTERUS B/T CONTR.

RISKS: UTERINE RUPTURE,RAPID LABOR AND BIRTH, WATER INTOXICATION
S/S OF H20 INTOXICATION ASSOCIATED WITH OXYTOCIN USE
SEEING SPOTS
INCREASED BP
TACHYCARDIA
EPISIOTOMY/EPISIORHAPPHY INDICATIONS
THOUGHT TO MINMIZE LACERATIONS

MACROSOMIA
FORCEPS ASSISTED DELIVERY
WHAT ARE SOME TIPS TO HELP REDUCE INCIDENCE OF ROUTINE EPISIOTOMIES
KEGEL EXERCISES
PERINEAL MASSAGE
AVOID LITHOTOMY POSITION
SIDE-LYING FOR PUSHING
WARM COMPRESSES

IF A WOMAN HAS GOOD PELVIC TONE, STRETCHABILITY OF PERINEUM, AND LESS USE OF SEDATIVES/NARCOTICS DURING LABOR, THESE FACTORS MAY ALSO PREVENT EPIS.
POST-EPISIOTOMY TREATMENT
ICE PACKS
TUCKS
EPIFOAM
WITCH HAZEL PADS
AMERICAINE SPRAY
ANALGESICS
ANTIINFLAMMATORY MEDS
SITZ BATHS
STOOL SOFTENERS
GOOD HYGEINE (VERY IMPT)
PERINEAL LACERATIONS AND LEVELS
TEARING TO THE PERINEAL, VAGINAL WALL CERVIX, AND LOWER UTERINE SEGMENT DURING CHILDBIRTH.

1ST DEGREE-EXTENDS THROUGH SKIN
2ND DEGREE-EXTENDS THROUGH MUSCLE
3RD DEGREE-EXTENDS TO ANUS
4TH DEGREE-EXTENDS INTO RECTAL WALL
WHAT ARE SOME POSTPARTUM COMPLICATIONS
POSTANESTHETIC PROBLEMS
PP HEMORRHAGE
PP INFECTIONS
PP CARDIOMYOPATHY
PP THROMBOSIS
PP ECLAMPSIA
PP PPSYCHOSIS
PUERPERIUM PERIOD
PERIOD OF 42 DAYS FOLLOWING CHILDBIRTH AND EXPULSION OF PLACENTA AND MEMBRANES.

GENERATIVE ORGANS USUALLY RETURN TO NORMAL DURING THIS TIME
HOW LONG DOES INVOLUTION USUALLY TAKE
6 WEEKS
WHAT ARE SOME PP PROBLEMS RELATED TO ANESTHESIA
RESPIRATORY PROBLEMS
HYPOTENSION
HEADACHE (SPINAL HEADACHE)
DVT (HUGE PROB., IF + HOMANS SIGN, BED REST UNTIL DVT RULED OUT)
BLADDER ATONY
PP HEMORRHAGE CAUSES
UTERINE ATONY (MOST COMMON CAUSE)
LACERATION/EPISIOTOMY
RETAINED PLACENTAL FRAGMENTS
HEMATOMAS
UTERINE INVERSION
COAGULATION DISORDERS OR LOW PLATELETS
EARLY PP HEMORRHAGE
OCCURS IN 1ST 24 HOURS AFTER BIRTH

CAUSES:
ABSENCE OF UTERINE CONTRACTIONS WHICH LEADS TO SIGNIFICANT BLOOD LOSS

LACEERATIONS OF GENITAL TRACT OR EPISIOTOMY

RETAINED PLAC. FRAGMENTS

VULVAR, VAG, OR SUBPERIOTONEAL HEMATOMAS

UTERINE INVERSION

COAGULATION DISORDERS
LATE PP HEMORRHAGE
24 HOURS TO 6 WEEK AFTER BIRTH

SUBINVOLUTION

RETAINED PLACENTAL FRAGMENTS (MOST COMMON CAUSE OF PP HEM)

FUNDAL HEIGHT FAILS TO REDUCE APPROPRIATELY
UTERINE ATONY
MOST COMMON CAUSE OF PP HEM.

RELAXATION OF UTERUS CAUSED BY:

OVERDISTENTION OF UTERUS
RAPID OR PROLONGED LABOR
OXYTOCIN AUGMENTATION
GRAND MULTIPARITY
DRUGS THAT RELAX UTERUS
FIBROIDS
WHAT IS A GOOD INDICATOR THAT PP HEM. MAY BE OCCURING
MORE THAN 4 SATURATED PADS/HOUR
NURSING CARE FOR PP HEM
DETERMINE CAUSE
ASSESS FUNDUS, LOCHIA, BLADD, V/S
HAVE PT VOID (REGIONAL ANESTHETICS REDUCE BLADD TONE)
MASSAGE BOGGY FUNDUS (MAY NEED OXYTOCICS-PITOCIN,METHERGINE)
PELVIC EXAM (LOOK FOR LACERATIONS/REPAIR)
MAY NEED D AND C FOR RETAINED PLACENTA
PP THROMBOEMBOLYTIC DISEASE
THROMBOUS FORMATION IN A SUPERFICIAL OR DEEP VEIN, USUALLY IN LEGS. IT CAN LEAD TO PULMONARY EMBOLUS
RISK FACTORS OF THROMBOEMBOLYTIC DISEASE

S/S
HX OF DVT

EDEMA
LOW-GRADE CHILLS
PAIN POSSIBLY DX IMPENDENCE OF PLETHYSMOGRAPHY
TX FOR THROMBOEMBOLYTIC DISEASE
STRICT BED REST
TEDS
IV HEP AND WARAFIN FOR 2-6 MONTHS
POSSIBLY ANTIBIOTIC THERAPY
UTI PP - WHY ARE PP MOMS AT INCREASED RISK AND WHAT ARE SOME CAUSES
INCREASED RISK DUE TO NORMAL POSTPARTAL DIURESIS
INCREASED BLADD CAPACITY
DECREASED BLADD SENSITIVITY FROM STRETCHING/TRAUMA
INHIBITED CONTROL OF BLADD FOLLOWING GEN/REG ANESTHESIA
CONTAMINATION FROM CATH
MASTITIS
INFECTION OF BREAST CONNECTIVE TISSUE THAT OCCURS PRIMARILY IN LACTATING WOMEN

USUALLY PRESENTS AFTER 1 WEEK PP

USUALLY ONLY 1 BREAST AFFECTED
S/S MASTITIS
TENDER, RED, SWOLLEN BREAST
HOT BREAST
FEVER AND ACUTE ILLNESS

TX: ANTIBIOTICS, CONTINUE BREAST FEEDING OR PUMPING, WARM COMPRESSESS, ANAGLGESICS
PP MOOD DISORDER
OCCURS 50-80% OF NEW MOMS
BABY BLUES
PP PSYCHOSIS
PP DEPRESSION