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Risk factors for shoulder dystocia.
- abnormal pelvic anatomy
- gestational diabetes
- post date pregnancy
- assisted vaginal delivery
- protracted active phase of first stage
- protracted second stage
Nursing actions for shoulder dystocia.
- McRoberts maneuver
- Suprapubic pressure
- Woods Screw maneuver
- fracture clavicle
- Zavanelli maneuver
What is McRoberts maneuver?
hyperflexing of mom's legs tightly to abdomen
What is Woods Screw Maneuver?
- anterior shoulder is pushed twd baby's chest;
- posterior shoulder is pushed twd baby's back, making baby's head somewhat face mom's rectum.
When is the Woods Screw Maneuver performed?
only after the McRoberts maneuver and applying subrapubic pressure
What is Zanelli maneuver?
pushing back the head into the birth canal in anticipation of a c-section
Nursing care before c-section surgery.
- monitor maternal vs & fetal HR
- ensure patent IV site
- preop meds (bicitra, antibiotics)
- prepare abdomen
- assist with spinal placement
- position woman on operating table
Nursing care after a c-section surgery.
- Care for normal newborn
- monitor vs
- check surg dressing
- palpate fundus/check lochia
- I's & O's
- oxytocin & pain meds
What is abruptio placentae?
premature separation of placenta after 20 weeks but prior to delivery
Characteristics of abruptio placentae.
- dark red vag bleeding (port wine)
- firm or rock hard contractions & uterine tendernes
- uterine contraction pattern
- uterus may turn blue from blood invading myometrium (Couvelaire uterus)
- retroplacental clotting & damage to uterine wall
- large amts of thromboplastin are released into bld supply
What does abruptio placentae usually lead to?
hysterectomy (uterus does not contract well)
What can abruptio placentae trigger?
DIC & hypofibrinogenemia
Associated RF for abruptio placentae.
- HTN, preeclampsia
- abdominal trauma
- cocaine use
- multiple gestation
- sudden decompression of uterus
- maternal age >35 or <20 yrs
Nursing care of abruptio placentae.
- Assess FHR for loss of variabilit &/or late decels
- large bor IV cath for bld admin
- supp O2
- type & cross for 2 units
- assess for hypovolemia & shock
What is placenta previa?
placenta is improperly implanted in the lower uterine segment; excessive bld loss from placental separation from lower uterine segment
Onset of placenta previa vs abrutptio placentae.
quiet & sneaky; sudden & stormy
Definition of HypERtonic labor.
- More than 5 contractions in 10 min OR
- any contraction lasting > 2 min
What can hypertonic labor lead to?
- uterine rupture
- placental abruption
- fetal distress/fetal death
- emergency c-section
What is precipitous labor?
extremely rapid dilation & effacement of < 3 hrsPrimagravidas: 5cm or > per hour;Multiparas: 10cm per hour
Characteristics of pathological jaundice.
- Jaundice within first 24 hours of life
- Total serum bilirubin > 12.9 mg/dL in term infant
- Total serum bilirubin > 15 mg/dL in preterm infant
- Jaundice lasting >1 week in term & 2 wks preterm
Main cause of pathological jaundice.
hemolytic disease (mom Rh -, baby Rh +
What is transplacental transfer?
transmitted to fetus through placenta (ex. syphillis)
What is ascending infection?
ascends into uterus from prolonged ROM
What is intrapartal exposure?
Exposure during birth (ex-herpex simplex)
What is horizontal transmission of infection in a neonate?
What three things put the infant at great risks for acquiring an infection?
Signs of PDA.
- Increased O2 needs
- Increased ventilatory settings
- heart murmur upper left sternal border
- apnea & bradypnea
- bounding pulses
Nursing Axns for PDA.
- Vent support
- monitor I & O; restrict fluid
- prepare family for poss surgery
- give diuretics as ordered
Assessment findings for IVH
- bradycardia w/ O2 desat
- metabolic acidosis
- full/tense anterior fontanel
- decreased LOC
- sudden change in condition
Nursing action for IVH
- reduce stress by maintaining dark, quiet environment
- admin blood SLOWLY to minimize fluctuations in BP (in a syringe over 4 hrs)
S/S of hypoglycemia in an IDM.
- usually w/in 1-2 hrs following delivery;
- temperature instability
- poor feeding
- seizures in severe cases
For IDMs, BGL should be checked how often?
- hourly during first 4 hrs of life;
- q 4 hrs til risk period (48 hrs) has passed
- *capillary or venous blood samples*
Gestational diabetes is diagnosed of two or more of the following are met or exceeded:
- fasting 95 mg/dL
- 1 hr 180
- 2 hr 155
- 3 hr 140
Meds for gest diabetes.
- injectable insulin
How is fetal status assessed when mom has gestational diabetes?
- daily kick counts
- nonstress tests beginning at 32 weeks
- ultrasound at 18-20 weeks and again at 28 weeks to monitor fetal growth