maternal unit 4 exam

Delayed cord clamping increases the risk for this….. What would you assess with this issue

newborn hyperbilirubinemia with jaundice

Fetal adverse effects of maternal opioid use during labor (remember these can be given via epidural as well)

decreased fetal HR and variability, respiratory depression, and unexpected neurobehavior.

Newborn signs of respiratory distress

tachypnea, nasal flaring, grunting, chest wall retractions**

Potential Client Findings in Uterine Rupture

maternal–blood loss; fetal client–decreased variability in HR, late decelerations, fetal bradycardia, lack of fetal heart tones

Sign of coping well with labor

verbalizing they are coping well, focuses their concentration inward during the labor process

After the membranes have ruptured, how often do you assess the client’s temperature

check temp q2-4H

Critical Nursing Interventions During Acute Placental Abruption

minimize client activity, NPO status, verify informed consent, monitor FHR and maternal VS, resuscitate as indicated, initiate 2 large bore IV lines for IV access, insert indwelling urinary catether

Eye prophylaxis

prevents neonatal ophthalmia which increases risk for blindness if untreated.

How eye prophylaxis is done

(1) clean the eyes with sterile gauze and saline from inner to outer canthus; (2) apply 1-2cm ribbons of ointment to each eye’s conjunctival sac from inner to out canthus; (3) tip of medication tube should not touch any surfaces including newborn’s eyes; (4) 1 min after application, wipe excess medication away with sterile gauze (EXCEPTION

Findings associated with infection, what to monitor for

increased in respiration, change in LOC, fever

Have the client do this after delivery (painful and MUST be done)

fundal massage to help firm the fundus

If having a home birth, what should the client have quick access to if complications arise

a hospital; certified nurse-midwife/physician should be available to attend and assist

Main focus for incorporating cultural practices into labor and birth

as long as it is safe for maternal and fetal client and a certified individual is enacting the practice

Methods used in Relaxation and Breathing- what are they for

lower the client’s BP and breathing rate, allows the patient to feel more in control of their pain and labor process

Various ways to aid in the delivery of the placenta

active management to reduce risk of PPH (uterotonic medications; controlled cord traction; uterine massage); expectant (physiologic) management in low-risk births; allows placenta to deliver spontaneously

What to be assessing for during removal of an epidural

manifestation of infection; resistance or pain; catheter intactness; bleeding

What to do if a client that is having incontinence during labor and birth

use absorbent pads to manage incontinence

What to do if a prolapsed cord is found upon vaginal exam

a nurse or provider must keep their hand in place and attempt to elevate the presenting part away from the umbilical cord while nurse calls for assistance and the team prepares for emergency CS

What to do with the room temperature to prevent heat loss in the newborn

room temp is set to provide the newborn with a warm environment

Why an episiotomy would be performed

pt. Has an increased risk of perineal tear greater than a second degree or needs to happen d/t fetal distress

A client with this medical history should not receive hypnosis

medical hx. of mental health disorders, esp. psychosis /psychopathology

Fetal cardiovascular adaptation during labor

temporary ↓ FHR during contractions; blood shunted to brain/heart

Fetal respiratory adaptation

tolerates low O2; ↑ CO2 helps triggering breathing after birth

Fetal molding

overlapping of skull bones to fit through pelvis

Maternal cardiovascular changes in labor

↑ cardiac output; ↑ BP during contractions; ~500 mL blood loss

Maternal respiratory changes

↑ O2 demand, possible hyperventilation

Maternal GI changes

↓ motility, N/V, aspiration risk

Maternal urinary concern during labor

Full bladder can slow labor therefore encourage voiding

Common musculoskeletal complaint in labor

Back pain from fetal pressure

What are the cardinal movements of labor?

Fetal movements to pass through birth canal

Engagement

Fetal head enters pelvis inlet (0 station)

Descent

Downward movement of fetus through pelvis

Flexion

chin to chest = smaller head diameter

Internal rotation

head rotates to align with maternal pelvis

Extension

Head extends under pubic bone → delivered

External rotation (restitution)?

Head rotates to align with shoulders

Expulsion?

Shoulders and body delivered

Assessment Findings That Are Cues for Fetal Malpresentation (Breech Presentation)

heartbeat can be located by Doppler above the maternal umbilicus, palpation of fetal kicks in the lower abdomen; difficulty palpating a presenting part on sterile vaginal exam; palpation of fetal foot or buttocks near the maternal symphysis pubic; palpation of fetal head near the uterine fundus

Counterpressure is most helpful to whom

clients with back pain

Fetal tachycardia

Baseline FHR > 160 for greater than or equal to 10 minutes

Mild vs severe fetal tachycardia

161-180 bpm

Severe fetal tachycardia

greater than 180 bpm

Causes (fetal tachycardia)

maternal fever/ infection (chorioamnionitis)

General anesthesia causes this during birth and increases the risk for what?

decreased uterine tone; increased risk for postpartum hemorrhage

How previous experiences influence pain

↑ fear/anxiety → ↑ pain perception

How to document the cervical assessment in regards to the information on dilation, effacement and station (what format is it written in)

Dilation / Effacement / Station (e.g. 4 / 80 / -1)

In regards to contractions in labor, when does the fetus get oxygenation

between contractions

Know the 5 P’s of labor

Passenger, Passageway, Position, Psyche

Passenger

fetus (size, position, presentation)

Passageway

maternal pelvis & birth canal

Powers

uterine contractions + maternal pushing

Position

labor progress and fetal descent

Psyche

anxiety/fear can increase pain and slow labor

Late decelerations are considered to be a nonreassuring fetal heart rate patterns- what are some common intrauterine resuscitation interventions that would be performed

change maternal position (left lateral); O2 administration; IV fluid bolus; stop oxytocin; notify provider

Medical Requirements and Contraindications for a home birth

low-risk pregnancy; no maternal/fetal comorbidities; access to emergency care

Pathophysiology of preterm labor

Regular contractions and cervical changes before 37 weeks

Risks for Chorioamnionitis

prolonged rupture of membranes, multiple vaginal exams, infections

What acupressure does to the body

improves blood circulation, increases neurotransmitter secretion to decrease pain intensity during labor and birth; removes lactic acid produced during contractions, improves pain

What causes molding (elongation of the newborn’s head)

pressure of fetal head against maternal pelvis

What happens if the fetus is in the face presentation

head extended; difficulty for fetal head and neck to maneuver through the maternal pelvis d/t wide diameter; slower labor, failure to progress, need for a CS birth

What is a transverse lie

fetal positioned horizontally

What is a uterine rupture

tear in the uterine wall; considered an obstetrical emergency

What is an overt prolapsed umbilical cord

umbilical cord slips through the dilated cervix before the presenting part and becomes compressed by the fetal presenting part.

What is the “turtle sign” in shoulder dystocia head emerges then retracts against perineum

What the TOCO does

external device that measures uterine contractions

What type of analgesia is given for an emergency cesarean birth

spinal block

When an Operative Birth may be required

if patient has a contraindication for or difficulty with pushing efforts

Who usually gets a pudendal nerve block

client still pushing or after birth if a perineal repair is required

Is nitrous oxide sufficient for pain relief on its own

if the patient used nitrous oxide correctly, the need for other pharmacological pain management may decrease. It is blended with air or oxygen, inhaled through a mask.

Medication given if a client is having respiratory depression from opioids

Naloxone

Medication given to help with nausea and vomiting

ondansetron

Purpose of methylergonovine

uterotonic=prevents/treats PPH