OB Final Review

Methods of pain relief during labor

Nonpharmacologic and pharmacological

The four Ps of Labor

Power, passage, passenger, psyche

What methods are included in nonpharmacologic pain relief during labor?

Breathing techniques, position changes, hydrotherapy, massage.

What methods are included in pharmacological pain relief during labor?

IV opioids, epidural.

Most common pharmacologic pain relief during labor?

Epidural

What is an epidural?

Injection of medication into the epidural space.

What should be monitored for a laboring patient receiving an epidural?

BP

What may hypotension from an epidural result in?

Decreased placental perfusion

What is a common opioid given IV during labor?

Butorphanol

What can opioids given IV during labor cause?

Neonatal respiratory depression

V.E.A.L & C.H.O.P

Variable, early, accelerations, late & Cord compression, head compression, good, & placental insufficiency.

A variable pattern on a fetal monitoring strip indicates what?

Cord compression from the umbilical cord.

What nursing action is priority for a variable pattern on the fetal monitoring strip causing cord compression?

Reposition the patient.

What do early decelerations indicate?

Head compression, but a normal finding.

How are accelerations on a fetal monitoring strip interpreted?

Reassuring, baby is well oxygenated.

What do late decelerations indicate?

Placental insufficiency and a decreased oxygen supply to the fetus.

How should late decelerations been interpreted during labor?

Not reassuring, requiring immediate intervention.

What nursing actions are priority for late decelerations?

Reposition laboring patient, give oxygen, stop Pitocin, provide IV fluids.

What is priority during immediate care of the newborn?

Airway, breathing, temperature.

What does immediately drying the baby after birth prevent?

Evaporation heat loss.

Which method is often used to warm the baby?

Skin to skin

Which types of newborn fontanelles are there?

Anterior and posterior.

How does an anterior fontanelle look in a newborn?

Diamond shaped.

When does an anterior fontanelle in a newborn close?

Around 18 months old

Which newborn fontanelle closes sooner?

Posterior

How does a posterior newborn fontanelle look?

Triangular

What is breech presentation at risk for?

Cord prolapse

How are breech presentation baby's typically delivered?

C-section

What is breech presentation?

Presenting part is buttocks first.

What risk is associated with pitocin?

Tachysystole

What is tachysystole?

More than 5 contractions within 10 minutes.

What does tachysystole cause?

Decreased fetal oxygenation.

What interventions are associated with tachysystole?

Stop pitocin, oxygen, reposition, IV fluids.

How often should breastfed babies be fed?

Every two to three hours.

What are the signs of a good latch for a breastfeeding baby?

Audible swallowing, no pain.

What is important about formula feeding?

More scheduled feeding is required.

What should formula fed infants be monitored for?

Intolerance to formula.

What are the stages of labor?

Latent, Active and Transition

What is the latent stage of labor?

Dilation is slow, beginning stage.

What is the active stage of labor?

Fetal decent with rapid dilation.

What is the transition stage of labor?

Final stage of active labor, intense contractions.

Which labor phase has the most intense contractions?

The transition phase.

Which type of newborn heat loss is the most common?

Evaporation

What are the types of newborn heat loss?

Evaporation, conduction, convection, radiation.

What causes newborn heat loss from evaporation?

Wet skin, not drying baby.

What causes conduction heat loss in newborns?

Touch, like weighing on a cold scale.

What causes newborn heat loss from convection?

Cool air

What causes newborn heat loss from radiation?

Nearby cold, like windows.

Normal newborn heart rate

110-160

Normal respiratory rate for a newborn?

30-60

Normal temperature for a newborn

97.7-99.5

What are the signs of hypoglycemia?

Jitteriness, lethargic, poor feeding.

How is newborn hypoglycemia treated?

Feed immediately.

What happens if narcotics are given too close to delivery?

The newborn will have respiratory depression when born.

What does a 1st degree laceration involve?

The skin

What does a 2nd degree laceration involve?

Muscle

What does a 3rd degree laceration involve?

The anal sphincter

What does a 4th degree laceration involve?

The rectum

What is classified as a preterm infant?

37 weeks or below

What characteristics does a preterm infant have?

Poor temperature control from less body fat, respiratory issues, a weak suck.

What is classified as a post term infant?

42 weeks or more

What do post term infants have an increased risk for?

Meconium aspiration

What characteristic does a newborn with club foot have?

Inward turned foot

How is club foot treated?

Casting

What causes hydrocephalus?

Increased cerebrospinal fluid

What might a newborn with hydrocephalus be observed to have on assessment?

A bulging fontanelle and an enlarged head.

What causes the enlarged head in hydrocephalus?

The increase in CSF

What do infants with cleft palate have?

Difficult feedings requiring special bottles.

What causes jaundice in a newborn?

Increased bilirubin

How is jaundice treated in newborns?

Phototherapy

What nursing interventions are implemented for an infant with jaundice?

Eye protection, frequent turns, monitor bilirubin.

What does BUBBLE-HEE stand for?

Breasts, uterus, bladder, bowels, lochia, episiotomy, homan's sign (DVT), emotions, extremities, and temperature

What does REEDA stand for?

redness, edema, ecchymosis, discharge, approximation.

Lochia progression

rubra (red), serosa (pinkish/brown), alba (white)

when does rubra lochia occur

1-3 days PP

When does serosa lochia occur?

4-10 days PP

When does alba occur?

After serosa, typically day 10

What is abnormal PP bleeding?

Large clots, saturating pads quickly.

Frequency of contractions

Start to start

Duration of contractions

Start to end

Intensity of contractions

Strength

What do stronger and closer contractions indicate?

Progression of labor.

How is fetal lie defined?

The relationship of the fetal spine to the maternal spine.

Types of fetal lie

longitudinal and transverse

Which fetal lie is most common?

longitudinal

What are the characteristics of longitudinal fetal lie?

Baby is parallel to mother's spine, may be cephalic(head down) or breech.

Which fetal presentation is ideal for vaginal delivery?

Cephalic (head down)

What are the characteristics of transverse fetal lie?

Baby lays horizontally, may present shoulder first, usually requires a c section.

Which nursing priorities are indicated for fetal lie?

Leopold maneuver if indicated, ultrasound to confirm fetal lie position, monitor progression of labor.

Why is fetal monitoring used?

To evaluate fetal oxygenation and wellbeing.

Which type of fetal monitoring is used in low risk pregnancies?

Intermittent monitoring

What may minimal or absent variability indicate?

Hypoxia, sleep cycle, medications.

What are accelerations?

A temporary increase in heartbeat indicating fetal wellbeing.

What newborn medications are given?

Vitamin K, hepatitis B vaccine, and erythromycin eye ointment.

Why are newborns given vitamin K?

They are born with low vitamin K, needed for clotting.

Which newborn would be denied a circumcision procedure in most facilities?

The newborn who did not receive the vitamin K shot due to the clotting factor.

Which route is vitamin K given in newborns?

IM to the thigh

What does erythromycin eye ointment do?

Prevent eye infections from gonorrhea or chlamydia.

What are the maternal risks associated with general anesthesia?

Aspiration, respiratory depression, uterine relaxation, increased bleeding.

What newborn risks are associated with general anesthesia?

Respiratory depression and CNA depression