Labor and Delivery Archer

What slows down contractions?

tocolytics

tocolytics examples

terbutaline

and

magnesium sulfate

oxytotics does what

stimulate contractions

oxytocin is what?

oxytotics

terbutaline indications

preterm labor

is also used as a resuce medication for astham

terbutaline: monitor

HR of mom and baby when used in labor

monitor fetal heart monitor strips closely

blood glucose

and EKG

terbutaline can cause

Hypokalemia,

HTN,

hyperglycemia

CNS overstimulation (vs will go uo so do frequent VS)

magnesium sulfate indidcations

Hypomagnesemia

torsade de point

pre-eclampsia

preterm labor

seizures

asthma exacerbation

magnesium sulfate considerations

Give IV Slowly (can cause over sedation)

monitor for hypermagnesemia

monitor for hypermagnesemia

confusion

dizziness

weakness

decreased reflexes -> turn down of off

Oxytocin indications

induction of labor

and

post post part hemorage

oxytocin considerations

monitor contractions

monitor fetus reponse

warn mother contractions will be more painful

oxytocin monitor

BP

HR

glucose

K

mentus

chin first in birth cancal

sacral

butt bound in birth cancal

occiput

back part of the skull(we want this)

determinign the position of the baby

right or left

what is presenting

how they are lying

what is the best position for birthing

ROA or LOA

at isichial spine

0 station

negative - further up in beith cancal

positive station - mom is ready to start pushing

variability

fluctuation in the fetal heart rate

Acceleration

a speeding up of the fetal heart rate

deceleration

a slowing down of the fetal heart rate

reassuring

the baby looks healthy

HR for fetus

110-160

Absent variability

bad

Doesn't go up or down

Marked variability

can be either bad or good

moderate variability

A reassuring sign

decelerations

early

variable

late

early decelerations

Head pressed on. This is ok.

VEAL CHOP

V- Variable C- Cord Comphression

E- Early Decels H- Head Compression

A- Accelerations O - OK

L-Late Decels P - Placenta

variable deceleration

cord compression

late decelerations

Bad (placental insufficiency)

LION

Non reassuring fetal heart rate

LION PIT

Lay the mother on her LEFT side

Increase IV fluids

Oxygen

Notify the healthcare provider

PIT: discontinue pitocin

Placenta previa

Major symptom is PAINLESS bright red bleeding

placenta is covering the cervix

placenta previa assess

bleeding:

pad count to determine the amount

clot

color

placenta previa what is used to confirm diagnosis

ultra sound

This will determine the type of previa

Transvaginal ultrasound is

safe in placenta previa

Nursing interventions for placenta previa

never ever perform a vaginal exam if you suspect this_> can break placenta and cause more hemmoraage

would never want to irritate the placenta

monitor fetus

bed rest: minimize blood loss

c-section indicated in most cases

1 gram

1 mL of blood loss

Abruptio placentae

premature separation of the placenta from the uterine wall (placenta is in the right place)

abruptio placenta s/s

causes massive amount of painful bleeding (dark red )

incomplete abruptio placenta

causes internal bleeding

blood backs up behind the placenta

complete abruptio placenta

causes massive external bleeding

very painful

abruptio placenta assessment

Board like abdomen ( due to internal bleeding)

rigid uterus

hypotension

maternal tachycardia

fetal brady cardia

abruptio placentae intervention

-Monitor for fetal distress

-Monitor maternal bleeding

-monitor fundal height

-keep the BP up with IVF and or blood product

-prepare for delivery- most likely C-section

prolapsed cord

umblical cord slips out

during delivery the prolapsed cord can become compressed by the presenting part of the fetus which cuts off oxygen to the fetus

do cervical exam or visual

pulsing tissue

prolapsed cord interventions

elevate the presenting part of the fetus off of the prolapse cord

keep your hand on the baby's head lifting it up and call for help

administer oxygen

wrap cord in sterile moist towel

prolapsed cord position

knees to chest position- open the pelvis

trandelenburg- let gravity shift the baby off the cord

what not to do with patient who has a prolapsed cord

never attempt to push the cord back in

postpartum hemorrhage risk factor

-twins or triplets

-macrosomia fetus

-preeclampsia

-prolonged labor

-precipitous labor

-use of forceps or vacuum during delivery

-placenta previa

-abruptio placenta

Boggy uterus

This is a uterus that is not contracting to clamp down on the blood vessels

INDICATES BLEED

The fundus will feel soft instead of hard as it should

hemorrhage blood loss

-PPH client are saturating pad every 15 minutes

-puddle of blood in the bed

-if they try to stand up for the first time there could be a huge gush of blood

hemorrhage interventions

fundal massage- every 15 minutes at a minimum

meds:

oxytocin

methylergonovine

blood product

Methylergonovine (Methergine)

Acts directly on the uterine muscle to stimulate forceful contractions. Used for postpartum hemorrhage.