ch 23 CORNELL NOTES

List the medications used for induction of labor and how they are used:

Ripening:

• first try sweeping

• Prostaglandins (Prepidil, Cervidil): Inserted into posterior fornix of the vagina (by cervix), which changes the cervical consistency from firm to soft. Stays for 12hr

• Misoprostol: used off-label; req monitoring FHR & V/S

Contractions:

• Oxytocin (Pitocin): IV (can be stopped if hyperstim) to cx labor cxns after the cervix is ripe.

  • If ctx are <60-90s apart, decrease or stop oxytocin.

  • Mixed @ 10 IU in 1L LR, started at 1-2 mU/min, and gradually inc q30-60min.

What are the side effects of Oxytocin:

• Hyperstimulation of uterus (baby needs breaks in btwn cxns 60-90s; impairs with oxygenation)

• Extreme HoTN (peripheral vessel dilation)

• Water intoxication (Decreased urine flow) (preceded usually by headache + vomiting)

What is the nursing management of a patient on IV oxytocin?

• BP and HR q1hr

• Monitor uterine cxns & FHR consientiously

• Monitor I&Os (urine flow and water intoxication)

nursing interventions for uterine hyperstimulation?

1. Stop oxytocin

2. Ask pt to turn on left side to improve uterus blood flow

3. Administer IV fluid bolus to dilute level of oxytocin

4. O2 by mask 8-10L + terbutaline to relax uterus

What are the signs of uterine rupture?

(Most often in pts with previous c-section)

• Sudden, tearing pain during strong cxn

• Hemorrhage into abd & vag

• hypotensive shock (rapid weak pulse, falling BP, cool clammy skin)

• FH sounds fade → absent

How to manage uterus inversion?

• Stop oxytocin

• IV fluid (blood replacement, big needle)

• O₂

• CPR if HF

manage umbilical cord prolapse?

Always an emergency!!!

Management: relieve pressure on cord and preventing fetal anoxia

• Give O2 (10L by face mask) 

• Relieve compression 

• Put mama in Trendelenburg so baby can come off cord 

• hand into vagina to hold baby head off of cord 

• Rush pt to c-section 

• Tocolytic agent 

• Cover any exposed cord portion with sterile saline compress (prevent drying) 

nursing assessment during amnioinfusion?

• Infuse @ least amt for FHR w/o variable decelerations 

• Urge PT to lie in lat recumbent (prevent supine HoTN) 

• Continuously monitor FHR & contractions 

• Record temp q1hr (for infection) 

• Assess there is constant drainage from vag, otherwise can cx polyhydraminios

What are the risk factors that might make you suspect a Shoulder Dystocia?

• Patients w diabetes

• Multiparas

• Fetus BIG for gestational age

• Postdate/postterm pregnancies

• Suspected w prolonged second stage of labor or arrest of fetal descent

• turtle sign; fetal head moves past perineum, then retracts back

What is the nursing management of a shoulder dystocia?

• McRobert’s maneuver - have PT deeply flex thighs back to abdomen then rotate thigh laterally to make wide V to widen pelvic outlet 

• Suprapubic pressure - identify fetal back and stand on that side, apply downward lateral pressure to PT pubic bone to dislodge shoulder