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37 Cards in this Set
- Front
- Back
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Butorphanol tartrate
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Reverses the analgesic effect of other opioids or narcotics in the woman’s body and precipitates withdrawal in drug-dependent individuals. For this reason, it is important to assess each woman’s history of narcotic drug use during the admission assessment; if she has been using drugs, she should not receive butorphanol. Most frequently given IV route, can be given IM. If administered IV recommended dose is 1-2mg (smaller dose is most frequently used). Onset is rapid. Peak 30-60min. Duration 3-4hrs. If IM, recommended dose is 1-2mg, 2mg is most usual dose. Onset is 10-15min, Peak 30-60min, Duration 3-4hrs. Common S/E Sedation, life-threatening reactions RESPIRATORY DEPRESSION in mother and fetus, Contraindications- Narcotic dependency, breastfeeding. Effects of butorphanol (Stadol) can be reversed with Narcan. Not a common S/E but urinary retention can occur, so nurse should frequently assess woman’s bladder for distention.
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Fentanyl-
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Narcotic agent. Used to treat pain. S/E urinary retention and delayed respiratory depression most frequently occurs with the use of morphine. One study examined women who had received fentanyl revealed interference with early breastfeeding, with higher dosages having more negative impact than lower dosages. A combination of opioids and a low dose of a local anesthetic agent achieve better pain control with reduced motor impairment.
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Lamaze Breathing
1st level |
Pattern-paced breathing with three levels. First level (slow paced)- Pattern begins and ends with a cleansing breath (in through the nose and out of pursed lips), slow breaths are taken, moving only the chest. The rate should be 6-9 breaths/min. or 2 breaths/15sec. the woman inhales as someone counts “one one thousand, two on thousand, three one thousand.” Exhalation begins and continues through the same count
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Lamaze Breathing
2nd level |
Pattern-paced breathing with three levels. Second level (modified paced)- Pattern begins and ends with a cleansing breath. Breaths are then taken in and out silently through the mouth at approximately 4 breaths/5sec. The jaw and entire body should be relaxed. Rate can be accelerated to 2-2 ½ breaths/sec. rhythm for the breaths can be counted out as “one and two and one and two and…” with the woman exhaling on the numbers and inhaling on “and.”
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Lamaze Breathing
3rd level |
Pattern-paced breathing with three levels. Third level (pattern paced)- Pattern begins and ends with a cleansing breath. All breaths ar rhythmical, in and out through the mouth. Exhalations are accompanied by a “hee” or “hoo” sound in a varying pattern, 2:1, which begins as 3:1 (hee hee hee hoo) and can change to 2:1 (hee hee hoo) of 1:1 (hee hoo) as the intensity of the contraction changes. The rate should not be more rapid than 2-2 ½ breaths/sec. The rhythm of the breaths would match a “one and two and…count.
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Butorphanol tartrate
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Reverses the analgesic effect of other opioids or narcotics in the woman’s body and precipitates withdrawal in drug-dependent individuals. For this reason, it is important to assess each woman’s history of narcotic drug use during the admission assessment; if she has been using drugs, she should not receive butorphanol. Most frequently given IV route, can be given IM. If administered IV recommended dose is 1-2mg (smaller dose is most frequently used). Onset is rapid. Peak 30-60min. Duration 3-4hrs. If IM, recommended dose is 1-2mg, 2mg is most usual dose. Onset is 10-15min, Peak 30-60min, Duration 3-4hrs. Common S/E Sedation, life-threatening reactions RESPIRATORY DEPRESSION in mother and fetus, Contraindications- Narcotic dependency, breastfeeding. Effects of butorphanol (Stadol) can be reversed with Narcan. Not a common S/E but urinary retention can occur, so nurse should frequently assess woman’s bladder for distention.
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Fentanyl-
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Narcotic agent. Used to treat pain. S/E urinary retention and delayed respiratory depression most frequently occurs with the use of morphine. One study examined women who had received fentanyl revealed interference with early breastfeeding, with higher dosages having more negative impact than lower dosages. A combination of opioids and a low dose of a local anesthetic agent achieve better pain control with reduced motor impairment.
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Lamaze Breathing
1st level |
Pattern-paced breathing with three levels. First level (slow paced)- Pattern begins and ends with a cleansing breath (in through the nose and out of pursed lips), slow breaths are taken, moving only the chest. The rate should be 6-9 breaths/min. or 2 breaths/15sec. the woman inhales as someone counts “one one thousand, two on thousand, three one thousand.” Exhalation begins and continues through the same count
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Lamaze Breathing
2nd level |
Pattern-paced breathing with three levels. Second level (modified paced)- Pattern begins and ends with a cleansing breath. Breaths are then taken in and out silently through the mouth at approximately 4 breaths/5sec. The jaw and entire body should be relaxed. Rate can be accelerated to 2-2 ½ breaths/sec. rhythm for the breaths can be counted out as “one and two and one and two and…” with the woman exhaling on the numbers and inhaling on “and.”
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Lamaze Breathing
3rd level |
Pattern-paced breathing with three levels. Third level (pattern paced)- Pattern begins and ends with a cleansing breath. All breaths ar rhythmical, in and out through the mouth. Exhalations are accompanied by a “hee” or “hoo” sound in a varying pattern, 2:1, which begins as 3:1 (hee hee hee hoo) and can change to 2:1 (hee hee hoo) of 1:1 (hee hoo) as the intensity of the contraction changes. The rate should not be more rapid than 2-2 ½ breaths/sec. The rhythm of the breaths would match a “one and two and…count.
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Lamaze Nursing considerations
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Hyperventilation may occur when a woman breathes very rapidly over a prolonged period of time. S/S of hyperventilation: tingling or numbness in the tip of nose, lips, fingers, or toes; dizziness; spots before the eyes; or spasms of the hands or feet. Encourage woman to slow her breathing rate and to take shallow breaths.
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Independent nursing action-meaning
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Any action nurses can perform on their own initiative without supervision (not so sure of this one).
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Oxytocin action
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(Pitocin) is a stimulatory effect on the smooth muscle of the uterus and blood vessels. Circulatory half-life of oxytocin is 3-5 minutes takes 40 min. for a particular dose of oxytocin to reach a steady-state plasma concentration. BP initially may decrease but after prolonged administration increase by 30% above the baseline. Oxytocin is used to induce labor at term and to augment uterine contractions in the first and second stages of labor. May be used immediately after birth to stimulate uterine contraction and thereby control uterine atony. For induction of labor: Add 10 units of Pitocin (1ml) to 1000 ml of IV solution. Using an infusion pump, administer IV, starting at 0.5-1 milliunit/min and increase by 1-2 miiliunits/min every 40-60 minutes.
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Oxytocin contraindications
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Severe preeclampsia-eclampsia, predisposition to uterin rupture, cephalopelvic disproportion, malpresentaton or malposition of the fetus, preterm infant
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Oxytocin Maternal/Fetal Side effects
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Abruptio placcentae, impaired uterine blood flow, leading to fetal hypoxia, rapid labor, leading to cervical lacerations, rapid labor and birth, leading to lacerations of cervix, vagina, or perineum, uterine atony; fetal trauma, uterine rupture, water intoxication
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Oxytocin: Nursing considerations
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Explain procedure, apply fetal monitor, the maximum rate is 40 milliunits/min, record oxytocin infusion rate in milliunits/min and ml/hr
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4th stage of labor Definition
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The period immediately following expulsion of the placenta, is also defined as lasting from 1 to 4 hours after the birth or until vital signs are stable
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4th stage of labor: Nursing responsibilities
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palpate uterus every 15min. for an hour until bleeding is within normal limits, after any perineal lacerations or an episiotomy the nurse can place clean absorbent pads beneath her and apply maternity pads or apply a cold pack to area, assist her as needed and change bed linens while mother is up, ensures that the mother and father or support person and newborn are given time to begin the attachment process, assess both maternal bleeding and newborn stabilization, assess mother’s BP 5-15min. intervals, P, firmness and position of fundus, and amount and character of vaginal blood flow every 15 minutes for the first 1-2 hrs. inspect the bloody vaginal discharge, lochia, for amount and chart it as minimal, moderate, or heavy, should be red.
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Pushing
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the nurse needs to instruct the woman to “push through the pain and burning.” The mothers tend to fight each contraction and any attempt of others to persuade them to push with contractions. Pushing involves the use of voluntary muscles, but it becomes involuntary when the pressure of the fetal head on the pelvic floor becomes intense. Delayed pushing appears to be better for the fetus and is a more naturalistic approach to the second stage of labor. Women should be supported in pushing in a manner that is desirable to them at a time when they feel the strongest urges to push.
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Hypercapnia: Definition
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increased fetal serum carbon dioxide
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Hypercapnia Causes
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May be caused by either maternal or fetal conditions. If mother has acidosis, the extra CO2 will be transferred to the fetus; also, if the umbilical cord becomes compressed or the placenta abrupts, fetal CO2 accumulates. As CO2 rises, pH drops. As a result, hypercapnia will come before acidosis.
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Hyperventilation definition:
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may occur when a woman breathes very rapidly over a prolonged period of time. RR rate greater than 20 breaths per min.
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Hyperventilation signs and symptoms
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tingling or numbness in the tip of nose, lips, fingers, or toes; dizziness; spots before the eyes; or spasms of the hands or feet.
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Hyperventilation Nursing considerations
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Encourage woman to slow her breathing rate and to take shallow breaths. Breathing into a mask or her hands causes re- breathing of CO2.
Possibly admin oxygen |
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Imminent birth
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When delivery could happen at any moment. Imminent birth is when the mother has regular contractions at 1-2 min. intervals and has an urge to push or bear down or when crowning or the top of the baby’s head/breech presentation visible at the vulva, or when her water breaks. These are all signs of imminent birth.
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First Stage Labor nursing care
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Straight cath prn if bladder distended, if regional block administered monitor BP, FHR, sensation per protocol, provide continuing status reports to CNM/physician, perform sterile vaginal examination as indicated.
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Second and third stage nursing care
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Indwelling cath or straight cath prn if bladder distended, continue monitoring VS, FHR, and sensation if regional block has been given. Fourth stage ns care- Straight cath if bladder distended, monitor return of motor ability and sensation if regional block has been given, weigh perineal pads if lochia flow greater than 1 saturated pad in 15min, presence of boggy uterus and close; decrease BP, increase P
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Teaching electronic fetal monitoring
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teach patients that if their positions become uncomfortable to tell the nurse so that they may be repositioned. If doing external monitoring, tell patients what to expect, such as the coolness of the gel and pressure from the transducer. If using internal monitoring, warn mainly of what to expect in terms of pain. Before and as the procedure takes place, let the patient know what you are doing and provide room for questions.
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Meconium stained amniotic fluid
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Increases maternal psychologic stress due to fear for baby. Fetal-neonatal implications: increase risk of fetal asphyxia, increase risk of meconium aspiration, increase risk of pneumonia due to aspiration of meconium
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Early decelerations/cause, ns care
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Is when the baby is moving down the birth canal, starts and ends with contraction, cause is head compression, are reassuring that the baby is healthy unless they are seen with a lack of descent of the fetal head into the pelvis.
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Late decelerations/cause, ns care
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Are not reassuring, do not end when contraction is over, cause is uteroplacental insufficiency or abruption placenta. NS care if Pitocin is running turn it off first and then reposition the pt. If Pitocin is not running then first ns action is to reposition the women and increase IV fluids.
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Variable decelerations/cause, ns care
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Cause due to cord compression, re position the woman. Look like a W wave on the FHR in relation to the contractions
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Internal FH monitoring
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uses a fetal scalp electrode (FSE), a fine spiral wire. The FSE is the most precise method of monitoring because it is a direct ECG of the FHR and produces the most accurate FHR tracing. The FSE is attached to the fetus during a vaginal exam. The FHR is then recorded on graph paper. For the spiral electrode to be inserted, the cervix must be dilated at least 2 cm, the presenting fetal part must be accessible by vaginal examination, and the membranes must be ruptured. FSE is attached to the presenting part, being careful not to apply it to the face, suture lines, fontanelles, cervix, or perineum if the fetus is in a breech position. Fetal scalp monitoring provides an instantaneous and clear picture of FHR (much better than external monitoring).
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Internal FH monitoring contraindications
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This method involves an actual puncture into the scalp of the fetal head, so use should be avoided if at all possible, especially when dealing with clients with known maternal infections such as HepB, HIV, or group B streptococcus. Also avoid in preterm infants because of risk of ventricular hemorrhage.
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External FH monitoring
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using an ultrasound (US) transducer. The US transducer is placed on abdomen over fetal back. We determine where the fetal back is using Leopold’s maneuvers. Also, place transducer where the pulse is the loudest and use an elastic belt to hold it in place. Next, a water-soluble gel is applied to bottom of transducer. This helps conduct the heart sounds so we can hear it more easily. The image is recorded onto graph paper. Interference by other moving parts is usually minimized, but every once in a while the maternal heart beat is also picked up and must be distinguished from the fetal pulse by comparing the signal with the maternal pulse.
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External Vs. Internal
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Internal more accurate, but can cause complications.
External: It’s better than internal monitoring because it is non-invasive and doesn’t require ROM (rupture of membranes) or cervical dilation. However, the tracings may be hard to interpret and sketchy. |
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Nitrazine
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this is a test to determine if ROM has occurred. This test relies on the fact that amniotic fluid is more alkaline than vaginal secretions. Any fluid leaking from the vaginal introitus is checked with nitrazine paper. The paper will turn to a blue-green or blue color if membranes have ruptured. However, false-positives can occur if the fluids are contaminated with urine, semen, 50% or more of blood in the specimen, or anti-septic cleansers and soap because these are also alkaline. If there is copious fluid leakage from the vaginal introitus, the diagnosis of PROM/PPROM is considered confirmed.
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