Procedures Chapter 19
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Prolapse and compression of the umbilical cord are teh primary risks of amniotomy. As fluid gushes out, the cord can become compressed between fetal presenting part and the woman's pelvis
The risk for infection is greater the longer membranes have been ruptured, especiall if more that 24 hours has elapsed
Labor may be induced if continuing the pregnancy is more hazardous to the maternal or fetal health that is the induction. Induction is not done if a maternal or fetal contraindication exists to labor or vaginal birth.
Oxytocin-or prostaglandin-stimulated uterine contractions may be hypertonic, decreasing placental perfusion
External version promotes vaginal birth by changing the fetal presentation from a breech or transverse lie to a cephalic lie. Internal version is sometimes used to change the presentation of the second twin after the birth of the first twin.
Giving birth over an intact perineum results in less blood loss, less pain and earlier resumption of comfortable intercourse postpartum. Therefore episiototmy should be done selectively rather than routinely to every woman
Trauma to maternal and fetal tissue is the primary risk associated with use of forceps or a vacuum extractor. Possible trauma to the mother includes vaginal wall laceration and hematoma. Trauma to the infant may include eccyhymoses lacerations, abrasions facial nerve injury and intracranial hemorrhage.
The preferred uterine incision for c-section birth is the low transverse incision because it is least likely to rupture in a subsequent pregnancy. The skin incision does not alway match the uterine incision and is unrealted to the risk of later uterine rupture.
Some women have feelings of quilt or inadequacy if they have a c-section. Therapeutic communication and sensitive family-centered care are essential to help them achieve a positive perception of their birth experience.
The preferred uterine incision for c-section birth is the low transverse incision because it is least likley to rupture in a subsequent pregnancy. The skin incision does not always match the uterine incision and is unrelated to the risk of later uterine rupture.
Newborn scalp edema caused by a vacuum extractor
Difficult or prolonged labor
Adverse condition resulting from treatment
Abnormally small quantity of amniotic fluid
List potential complications of amniotomy?
Prolapse of the umbilical cord, infection, and placental abruption
List nursing considerations necessary before and after an amniotomy?
Obtain baseline FHR before and compare FHR after procedure: assess temperature every 2 hours, keep woman clean and dry
List two nursing measures following the use of prostaglandin E2 to ripen the cervix and the rationale for each?
Observe the FHR for changes that occur with uterine contractions.
Assess for excessive contractions that can reduce fetal oxygen supply
Describe fetal and maternal nursing assessments associated with oxytocin infusion. What are signs of problems?
Assess teh FHR every 15 min during 1st stage labor and every 5 min during 2nd stage.
Problems include tachycardia (>150 to 160 bpm) bradycardia (<110 to 120 bpm), late decelerations and reduced FHR variabiltiy.
Assess uterine activity for contractions that are too frequent or too long or a uterus that does not relax for at least 60 sec between contractions.
Blood pressure and pulse identify changes from the baseline; tempreture assessment identifies infection that may occur with ruptured membranes.
Intake and output, assessment for headache, blurred vision, behavioral changes, increased blood pressure and resp, decreased pulses, rales, wheezing and coughing identify possible water intoxication. Postpartum hemorrhage may occur if an overstimulated uterus cannot contract effectively
List nursing interventions if fetal or maternal assessments are not reassuring when oxytocin induction or augmentation of labor is being done.
In addition to identifying the true cause of the nonreassuring assessments, interventions may include stopping and oxytocin infusion, increasing the rate of teh nonadditive infusio, positioning to avoid aortocaval compression, and giving oxygen by facemask. Internal monitoring may be initiated if not already in place. The physician may also order a tocolytic drug if uterine hyperactivity is the problem
Explain the purpose of aspect of care for the woman having external version? Nonstress test
A nonstress test evaluates placental function and apparent fetal health to avoid stressing a fetus that may already compramised
Explain the purpose of aspect of care for the woman having external version? Ultrasound
Ultrasound guides the version and helps monitor the FHR. It will also confirm fetal age and presentatoin and adequacy of amniotic fluid
Explain the purpose of aspect of care for the woman having external version? Tocolytic drug
A tocolytic drug relaxes the uterus to make the version easier to preform
Explain the purpose of aspect of care for the woman having external version? Rh immune globulin
Administer Rh immune globulin destroys fetal Rh-positive red blood cells that might stimulate anti-Rh antibodies in teh RH-negative woman. These may enter the mother's bloodstream because of tiny placental disruptions during the version.
Explain the purpose of aspect of care for the woman having external version? Uterine activity monitoring
Uterine activity monitoring identifies persistent contractions that may herald the onset of labor
Describe nursing care associated with a foceps-or vacuum extractor-assisted birth. What is the rationale for each?
Add a catheter to the delivery table to empty the mothers bladder, making more room for the insturment-assisted birth. postpartum observe for truama usually lacerations (bright red bleeding with a firm fundus). Cold packs to the perineal area limit bruising and edema. Observe for reddening, mild bruising, or small lacerations where forceps were applied. A chingnon is typical if a vacuum extractor is used. Explain that these minor problems usually quickly. Facial asymmetry, usually seen when crying suggests nerve damage that resolves more slowly
Describe techniques that may reduce the need for an episiotomy
Upright positon with pushing, delay pushing until the urge is felt, use of open-glottis technique with pushing; daily perineal massage during the last 3 weeks of pregnancy
Explain why c-section is not necessarily easy for the newborn?
The infant may be born preterm if a c-section is scheduled. Absorption of lung fluid may be delayed, resulting in transient tachypnea. Injury can occur, such laceration or bruising
Explain the rationale for the intervention associated with c-section? Medication such as famotidine administered
to reduce gastric secretions
Explain the rationale for the intervention associated with c-section? Placing a wedge under one hip
Wedge under hip avoids aortocaval compression by the heavy uterus
Explain the rationale for the intervention associated with c-section? Complete blood cell count, coagulation studies, blood type, and crossmatch
These tests identify reserve to tolerate blood loss, risk for poor blood clotting to control hemorrhage, and blood type for possible transfusion and enable caregivers to prepare blood to be immediatel ready if the need for transfusion arises
Explain the rationale for the intervention associated with c-section? Antibiotic
Reduces risk for postpartum infection
Explain the rationale for the intervention associated with c-section? indwelling catheter
Keeps bladder out of the way of uterine incision
After the physician performs an amniotomy, the fluid is dark green with a mild odor and the FHR is 130 to 140 bpm. The most appropriate nusing care is to?
Monitor the fetus more closely for nonreassuring signs
The correct setup for oxytocin inductoin of labor is?
Oxytocin is given as a secondary infusion and is controlled by an infusion pump.
A method to prepare the cervix for induction of labor the following day is?
THe nursing assessment finding that is most likely to occur with hypertonic uterine contractions?
A) foul smelling amniotic fluid
B) contraction interval of 90- seconds
C) Fetal heart rate of 80-100bpm
D) Maternal pulse of 80 to 90 bpm
C) fetal heart rate of 80-100 bpm
A woman has external version to change her fetus positon from breech to cephalic. Choose the postprocedure nursing observation that would indicate she should not be released to go home.
A) FHR is 135 to 145 bpm with average varibility
B) Occasional mild brief contractions occur
C) Maternal temp is 99.2 and pulse is 90 bpm
D) Vaginal discharge is a pale and watery fluid
D) vaginal discharge is a pale and watery fluid
Parents of a newborn with a forceps-assisted vaginal birth ask about small reddened areas on the infants cheeks. The nurse should tell them that the areas?
are temporary and will disappear
A urinary catherter should be readily availible when a woman has a forceps-assisted birth because?
A full bladder reduces available room in the pelvis
During recovery period after low forceps birth with a median episiotomy, the nurse should?
Apply cold packs to the perineal area promptly
Choose correct preoperative teaching before planned c-section?
A) oral intake will be limited to clear fluids for 12 hours before surgery
B) IV fluids are usually continued for 2 days after birth
C) the woman will be asked to take deep breaths and cough regularly after birth.
D) The nurse will help her ambulate to the restroom to urinate within 4 hours.
The best method to prevent hemorrhage after c-section is to?
Assess the uterine fundus regularly for firmness
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