Birth Risk 2

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Birth Risk 2
2015-03-06 21:25:27


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  1. Preterm Labor
    • Sometimes symptoms are vague
    • all about education what they need to do and pay attention to your body.

    • contractions and cervical changes between 20-37 weeks
    • this is risk
    • potential membranes will come out and you will rupture
    • 12% born premare
    • more premature you are the less developed your brain is.
  2. Preterm Labor Assessment
    • Risk factors
    • - have they had this before
    • - issues with incompetent cervix
    • Subtle
    • - pelvic pressure
    • - low dull backaches
    • - cramping
    • - achiness in thigh
    • - diarrehea intestinal cramps
    • (anything that is persistent and consistent notify MD)
    • if u are in labor this will not go away
    • vaginal discharge- cervical change
    • premature preterm rupture of membranes- cervical dilation and effacement
    • (at risk for infection)
    • lab or diagnostic (monitoring): fetal fibronectin (swap sterile- protein our body releases when we are in labor), cervical length via transvaginal u/, home uterine activity monitoring
  3. Preterm Therapeutic management
    • Tocolytics: turn of the contraction
    • corticosteriods: help the babies lung mature. (premature stiff lungs, help with lung complient..but won't mature- helps with intubated/oxygenated them)
    • antibiotic: for group b strep (use this to treat prophalytically)
    • 1 dose of steriods q 24hr (two doses before she delivers)
    • assess mom
  4. Tocolytic Therapy
    • Mg Sulfate: to stop contractions, CNS depressant smooth muscles relaxant (difference why we are picking this drug- preclam and preterm)
    • Indomethacin: prostagladins inhibitor (to stop contractions
    • Nifedipine (procardia, calcium channel blocker) inhibits movements into cell which in esessence inhibits uterine activity
    • this is use for pt with heart disease- could have the same effect. could effect their bp or pulse (so good assessments)
  5. Betamethasone (celestone)
    • promotes fetal lung maturity by stimulating surfactant production
    • but does not produce enough surfactant but makes it easier (esp at 24w)
    • - admin in two doses IM 24hr apart
    • - drugs required at least 24hrs prior to delivery to be effective
    • - after 34 weeks u would not get this drug
    • - monitor for for maternal infection or pulmonary edema, hyperglycemia (steriods effects your immune system and if u are DM will incre bs)
    • - monitor neonate for heart rate changes, pulmonary edema, hyperglycemia
  6. Preterm nursing management
    • Monitor
    • - VS, I&O, bedrest on left (don't want walking around to promote contractions, FHR, limit vag exams
    • - ensuring hydration
    • - identify and treat any infections (alot of females come in preterm with UTI, if u have bacteria in bladder it could stimulate your uterus)
    • - id any contraindications for meds ordered
    • - monitor for adverse reaction to meds
    • client education
    • pyshcological support
  7. Postterm labor
    • pregnancy continuing past end of 42 w gestation
    • Dx: gestational age (early u/s best indication of dates)
    • fetal risk: placental aging, aminotic fluid decre (not to have decel), dry/cracked skin
    • mom risk: baby can keep growing bigger, issue with delivery
    • therap mana: assess mom, how to get her into labor (best avenue)
  8. Postterm labor risk assessment management
    • Mom risk dystocia, possible c-section
    • fetal risk: related placental insufficiency, meconium aspiration (stressed)
    • assessment: estimated date of birth, cervical exam, fetal movements, non stress test twice a week, amniotic fluid analysis
    • management: fetal survelliance, decision for induction, support, education
  9. Postterm labor
    providing care during the intrapartum period
    • continously assess and monitor FHR
    • monitor mom hydration status
    • assess amniotic fluid characteristics
    • - report meconium stained fluid immediately
    • provide support, pressence, information and encouragement
  10. Labor induction and Augmentation
    • Labor induction: stimulating contraction via medical or surgically needs
    • Augmentation: enhances effective contractions after labor has begun (if contractions have stopped so add oxytocin)
    • Cervical rippening
    • indications for inductions/augmentation (hypotonic)
    • Bishop Score
  11. Bishop score
    • >8 successful labor (cervix is ripped)
    • <6 cervix isnt ripped we need that cervix to be thin before you give oxytocin
  12. Cervical Rippening
    • Non Pharm
    • - breast stimulation
    • - sex- prostagladins
    • - walking
    • - castor (it makes u go to bathroom)
    • - change position
    • - spicy food

    • Mechanical
    • - foley cathether- insert foley inflate balloon pull pressure and this helps to thin the cervix

    • Pharm
    • - prepidil (cervidil) (tampon to help open), Cytotec (misoprostol) (small capsule u insert in vag)- have to sign a consent in case the have an adverse effect

    • Surgical
    • - rupture membranes (head engaged)

  13. AROM- surgical
    • explain procedure
    • monitor FHR before during and after procedure
    • observe/record color, amount, odor, time, cervical status, mom temp
    • take temp q 1hr
    • monitor onset of contraction
    • stripping of membranes
  14. Pharm agents cervical rippening
    • Prostagladins: dinoprosterone (cervidil insert; prepidil gel)
    • Misoprostol (cytotec)- synthesis PGE1
    • - informed consent- cause used for stomach issues- not FDA approved to use for rippening
    • - adverse: labor
    • - initiate oxytocin for labor induction at least 4 hrs after the last med was given
    • Nursing implications:
    • maintain IV access, emotional support, pain med, assess efface and dilation, uterine contractions, VS, FHR pattern), monitor for side effects, tocolytic available
  15. Oxytocin
    • used for labor artificial induction and augmentation- titrating med
    • advantages:
    • - short half life (1-5 mins) gets out of system quick once we turn it off
    • - generally well tolerated

    • disadvantage:
    • - uterine hyperstimulation (no resting tone) leading to fetal compromised/impaired oxygenation
    • - antidiurectic affect- decre urine flow that may lead to water intoxication
    • Symptoms- headache and vomiting- retain alot of water could mess with brain- assess VS bp can go up
    • IV pump should be in the room just in case it is needed
  16. oxytocins how to administer
    • Admin IV infusion via pump, piggyback to main line at the closet port to patient according to policy
    • incre dose to establish adequate labor pattern
    • - esta labor pattern of contraction q 2-3mins lasting 40-60 with resting after
    • - uterine intensity 40-90mm/HG IUPC
    • - usual max dose 20-40/min IV
    • - physician readily available during infusion
    • provide emotional support
    • empty bladder q 2hrs
  17. Nursing consideration for oxytocin admin
    • continously monitor FHR and uterine contractions
    • - document q 15mins
    • - observe for tetanic (BIG) contraction or hyperstimulation (incr intensity of belly)
    • - observe for non reassuring FHR
    • - mom BP, P q 15mins and document
    • - HTN more common, hypotension means water intoxicity- pressing on brainstem no common)
    • monitor I&O
    • limit IV fluids to 150ml/hr
    • discontinue for any fetal or maternal distress
  18. Nursing consideration cont oxy
    • abnormal fetal hr < 110 or >160
    • - loss of variablity late decel, persistent bradycardia
    • discontinue oxytocin
    • reposition to side lying position
    • incre IV fluids
    • admins oxygen via face mask 10L
    • perform vag exam
    • notify MD
  19. issues with oxtocin
    nausea, hypertonic, fetal brady/tachycardia, headache, hypotension etc
  20. look at pump question on
    page 20
  21. Intrauterine fetal demise
    • numerous causes: advance aging, RH sentization, abruptions, PROM, prolong pregnancy, knots in cord, DM, HTN
    • devasting effects on family and staff
    • nursing assessment
    • - inability to obtain fetal heart sounds
    • - u/s to confirmed absence of fetal activity
    • - labor induction
    • Nx management: assist with grieving process, referral
    • education if baby is not moving
  22. Umbillical cord prolapse
    • not good
    • occult hidden inside the uterus and baby should be lying on it
    • or it could be ahead of the presenting part (vag canel/vag)
    • if cord comes out before the baby then the baby doesnt have oxygen
    • think of next step: get mother on all fours to get baby of the cord or u may have to put hand up vag to hold baby's head during surgery in OR
  23. cord prolapse pathophysiology
    • partial or total occlusion of cord with rapid fetal deterioration
    • fetus will die if this cord compression is not relieved
    • complete occulsion causes fetal oxygen deprivation
    • when the presenting part does not fully occupy the pelvic inlet, prolapse is more likely to occur
  24. cord prolapse assessment
    • prevention; risk factors ROM FHR
    • signs of prolapse
    • - rupture of membrane with a sudden variable decel
    • - cord prolapse leads to immediate cord compression
    • - to rule out cord prolapse always assess fetal heart sounds immediately after rupture of membrane
    • - cord maybe visual in the vulva or palpated( feel pulsation) during vag exam
    • -
  25. cord prolapse management
    • assist with measures to relieve compression
    • sterile gloved hand into the vagina and holds the presenting part off the umbilical cord
    • change position to modify sims (w/hips raised), trendelenburg, or knee chest position
    • apply sterile saline soaked towel to cord
    • monitor FHR, maintain bedrest
    • O2 at 8-10ml/ face mask
    • prepare for c-section
  26. Placental Abruption
    • OB emergency- premature separation of the placenta from the uterus
    • risk factors: HTN, preclam, DM, seizure,smoked, drug use, issue with uterine rupture
    • identify bleeding, FHR, mom VS (good assessments)
    • management: depends on gestational age, extent of hemorrage, maternal-fetal oxygenation perfusion
    • maintenance of maternal CV status
    • prompt delivery of fetus
    • c-section if fetus still alive, vag birth is fetus is demise
    • large amount of bleed means baby is not getting any O2
  27. Uterine rupture assessment
    • a partial or complete tear in the uterine muscle. be careful with tiration with giving pitocin
    • Assessment:
    • risk factors: prior surgery, prior uterine scars, previous c-section (window fine thin layer of tissue)
    • onset fetal distress
    • contractions may stop, severe tearing, buring, stabbing, fetal parts papable thru abdomen, fetal monitoring changes, could have a huge bleed, this is a medical emergency
    • signs of hypovolemic shock
    • nx management:
    • prep for urgent c-section
    • continous maternal and fetal monitoring
    • mom can lose baby and uterus
  28. Amniotic fluid embolism
    • OB emergency. seeing during labor or after
    • what happens is products from the baby- vernix, skin hair, or meconium enters mom systemic circulation in embolism form and could obstruct the pulmonary vessels causing respiratory distress and circulatory collapse

    • doesn't always have a good outcome.
    • disruption of the barrier between mom and fetal circulation
    • mom presents with sudden onset, hypotension, hypoxia, restless, coagulation due to the breakage in barrierĀ  between mom circulation and amniotic fluid DIC
  29. Amniotic Fluid embolism assessment
    • 50% survivoral rate
    • difficulty breathing (SOB), discomfort in chest, hypotension, cyanosis, seizures, tachycardia, coagulation failure, DIC, pulmonary edema, uterine atony w/subsequent bleeding, ARDS (acute respiratory distress symptom), cardiac arrest

    • management:
    • supportive measures to support oxygenation and hemodynamic function and correct coagulopathy, critical care monitoring