OB

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Author:
amber1026
ID:
7863
Filename:
OB
Updated:
2010-02-28 17:29:08
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Test 2
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Description:
Alterations in Delivery form
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  1. indications for induction of labor
    history of rapid or silent labors, precipitate birthcoexisting medical disordersPROM (24 hr before labor)congenital anomalypostterm pregnacy with nonreactive NSTintrauterine fetal death
  2. nursing care for induction of labor
    amniotomy (breaking water)oxytocininternal fetal monitoring
  3. when performing assess?
    • "taco"
    • Time
    • Amount
    • Color
    • Odor
  4. dystocia
    abnormal labor pattern in which abnormalities occur with the power, the passenger, or the passage
  5. causes of dystocia
    • dysfunctional labor (or uterine ctx's)
    • alterations in passage
    • fetal causes
    • ineffective pushing
    • psychological responses
  6. dysfunctional labor (hypertonic)
    • usually occurs before 4cm dilation
    • most often in primipara, fearful, anxious
    • pain out of proportion to intensity and effectiveness
    • frequent, uncoordinated, poor resting tone
  7. potential maternal problems with hypertonic labor
    • maternall loss of control and fatigue
    • stress in coping abilities
    • dehydration and increased risk of infection if labor is prolonged
  8. potential fetal problems with hypertonic labor
    • fetal asphyxia
    • cephalhematoma, caput succedaneum, or excessive molding
  9. hypertonic nursing care
    provide comfort and supportsupportive measures (shower, position change, walking, mouth care, relaxation exercises and meds)education
  10. Hypotonic dysfunctional labor
    • usually occurs after 4cm dilation following normal latent/early active labor
    • causes may be CPD, malpresentation/position, overdistention of uterus
    • CTX's infrequent; normal resting tone
  11. potential maternal problems with Hypotonic labor
    maternal loss of control and exhaustion
  12. fetal problems with hyptonic labor
    infection of amniotic sac
  13. medical management of hypotonic labor
    rule out CPD
  14. nursing management for hypotonic labor
    • rest, analgesia if no CPD or ROM
    • often normal labor will resume after sleep or rest
  15. problems with powers include
    • abnormal patterns
    • lax abdominal wall
    • ineffectice pushing (secondary)
  16. abnormal patterns r/t problems with powers
    • prolonged latent
    • protracted active
    • secondary arrest
    • protracted descent, arrest of descent, failure of descent
    • precipitous labor
  17. lax abdominal wall
    - def
    - tx
    • displaces fetal head; prevents engagement
    • sculteus binder
  18. ineffective pushing
    - caused by
    - tx
    • anesthesia, exhaustion, malpresentation/position
    • may require forceps or vacuum extraction
  19. alterations in pelvic structure
    • pelvic dystocia
    • soft-tissue dystocia
  20. pelvic dystocia
    • pelive size and/or shape
    • midplane most common problem
  21. soft-tissue dystocia
    • any tissue other than bone that impedes descent
    • placenta previa, fibroids, adipose tissue
  22. fetal factors affecting normal labor
    • anomalies
    • CPD
    • malposition
    • malpresentation
    • multifetal pregnancy
    • shoulder dystocia
  23. postterm pregnancy - maternal risk
    • perineal damage due to the increased size of the fetus
    • maternal hemorrhage
    • cesarean birth
  24. postterm pregnancy - fetal risk
    • decrease in uterine-placental-fetal circulation (due to placental changes)
    • oligohydramnios
    • meconium staining
    • SGA or LGA
  25. precipitous labor
    labor and birth that last less than 3 hrs; hypertonic, tetanic CTX
  26. potential problems with precipitous labor
    • uterine rupture, abruptio placenta
    • post partal hemorrhage
    • fetal hypoxia and deathtrauma (laceration of cervix, vagina and perineum)
  27. what to do in shoulder dystocia
    • implement McRoberts maneuver
    • place woman's legs in exaggerated flexion into abdomen (apply suprapubic pressure - NEVER apply fundal pressure)
    • be prepared to place woman in knee chest or lateral position
  28. breech presentation (most common malpresentation)
    • frank
    • complete
    • incomplete
  29. frank breech presentation
    fetal thighs flexed at the hips, legs extended, feet close to face
  30. complete breech presentation
    fetal thighs and hips are flexed
  31. incomplete breech presentation
    one or both htighs are not flexed; knee, foot or feet is/are presenting part
  32. episiotomy
    - def
    - protects
    - types
    • surgical incision reduces possibility of laceration
    • portects fetal head from pressure exerted by resistant perineum
    • midline, mediolateral
  33. indications for forceps and vacuum assited birth
    • fetal distress
    • maternal needs
  34. criteria for forceps or vacuum assisted birth
    • engaged fetal head
    • ruptured membranes
    • full dilation
    • absence of CPD
    • anesthesia
    • empty bladder
  35. types of forcep/vacuum assisted birth
    • low-outlet
    • vacuum
  36. criteria for vaginal breech delivery
    • frank or complete breech withouth hyperextension of the head
    • fetal weight less than 3500gms
    • adequate pelvic size
    • gestational age of 36-42 wks
    • experienced birth attendant and pediactric support
  37. crieria for c-section
    • absence of labor when fetal status requires prompt delivery
    • premature fetus whose condition requires minimal stress
    • previous hx of perinatal death or child with birth injury
    • inadequate pelvis
  38. problems with cord
    • cord prolapse
    • congenital of absence with artery (associated with other anomalies)
    • abnormal insertions
    • abnormal lengths
  39. abnormal cord length
    - short
    - long
    • umbilical hernias, abruption, cord rupture
    • transient variables, true knots
  40. cord prolapse
    - types
    - factors that increase risk
    occult, in front of head, complete

    • presenting part at high station
    • small fetal size or abnormal presentation
    • hydramnios
  41. interventions for cord prolapse
    • relieve pressure on cord
    • - push head off cord
    • - knee chest position
    • - elevate hips

    • deliver expediently
    • - C-section
    • - vaginally
  42. problems with membranes and fluid
    • chorioamnionitis
    • fluid imbalance (poly and oligohydramnios)
    • amniotic embolism/anaphalactoid syndrome
  43. chorioamnionitis
    - def
    - s&s (report promptly)
    - interventions
    • infection of membranes and fluid
    • fetal tachycardia, maternal fever, amniotic fluid abnormalities
    • medical and nursing care depends on Sx, maternal and fetal response
  44. hydramnios (polyhydramnios)
    - def
    - cause
    - 2 types
    - s&S
    - result in
    • over 2000 ml
    • cause unknown, associated with fetal anomalies - may be associated with increased placental function
    • chronic and acute
    • SOB, LE edema d/t VC compression
    • fetal anomalies, preterm birth
  45. management of polyhydramnios
    - if severe or symptomatic
    - tx:
    • hospitalization
    • Arom, indomethacin
  46. arom
    - def
    - risk
    • needle amniotomy, amniocentesis
    • abruption, prolapsed cord,
  47. indomethacin used to
    decrease fetal urine output = <amniotic fluid
  48. oligohydramnios
    - def
    - risks
    - causes
    • less than normal fluid; AFI of <500cc (measure on US)
    • risks of skin, muskuloskeletal abnormalities, pulmonary hypoplasia
    • reduced cushioning effect during labor may lead to cord compression
  49. Pregnancy induced hypertension
    - occurance
    - manifestations
    • occurs in 5-8% of all pregnancies (most common hypertensive disorder in pregnancy/second leading cause of maternal death)
    • preeclampsia and eclampsia
  50. preeclampsia
    • defined as increase BP after 20 wks gestation accompanied by proteinuria
    • 140/90 or diff of 15 from norm
  51. eclampsia
    occurance of a seizure in a woman with preeclampsia who has no other cause for a seizure
  52. maternal risks with pregnancy induced HTN
    - can impact?
    - CNS changes include
    - intracerebral hemorrhage
    • most organ systems, causing serious complications
    • hyperreflexia, headache, eclamptic seizure
    • rare complication, but is the most common cause of death in women with severe preeclampsia and eclampsia
  53. fetal risks with HTN
    • preterm birth (15% of all preterm births are a result of preeclampsia)
    • small for gest age
    • placental abruption
    • may be over sedated at birth d/t maternal meds
    • may have hypermagnesmia d/t maternal tx w/ mag sulfate
  54. nursing care for PIH
    • urine dipsticks for protein q shift
    • blood pressure eval q 1-4 hrs
    • daily weight
    • bed rest
    • corticosteroids
    • anticonvulsants
    • assess deep tendon reflexes and clonus
    • assess for HA, blurred vision and epigastric pain
    • if on mag sulfate chek urine output q 1 hr (should be more than 30cc/hr)
  55. first sign of mag toxicity
    decrease DTR
  56. changes in fetal heart rate baseline:
    - fetal tachycardia
    - fetal bradychardia
    baseline greater than 160 bpm for at least a 10 min period

    baseline less than 110 bpm for at least a 10 min period
  57. Which comment made by a client would indicate the client's ability for safe care during the last trimester of pregnancy with mild preeclampsia?
    The client state "I will:
    A. report any SOB to my MD
    B. report any HA or blurr vision to MD
    C. limit my fluid intake after 3 pm
    D. limit my salt intake during this time
    B
  58. non-reassuring FHR pattern
    • severe variable deccelerations
    • late deccelerations of any magnitude
    • absence of variability, bradycardia (70 or less)
    • prolonged decceleration lasting 2 min but less than 10 min
  59. severe variable deccelerations consist of
    FHR below 70 lasting 30-45 sec accompanied by a rising baseline or decreasing variability
  60. interventions for non-reassuring tracing
    • document and report findings accurately and promptly to MD
    • continuous monitroing of mom/fetus
    • change position
    • provide O2
    • increase IV fluids
    • provide information to mom/family
    • admin tocolytic if ordered
    • prepare for immediate delivery
  61. variable deccelerations
    - occurance
    - d/t?
    • occur anytime withing the ctx
    • due to cord compression
  62. with variale decceleration you should do what first

    if that doesn't work?
    • change position to move fetus off of chord
    • 1. give O2, 2. give fluid, 3. amnion fusion
  63. interventions for variable decelerations
    • d/c pitocin
    • change position
    • perform vag exam
    • O2 per face mask
    • amnionfusion
    • if uncorrected, deliver
  64. late decelerations
    - occurance
    - d/t
    • occur after the beginning, peak, and end of ctx
    • due to placental insufficiency
  65. late deceleration interventions
    - FIRST
    - SECOND
    - then...
    • D/C pitocin
    • put in side lying position
    • give O2
    • maintain or increase IV fluids
    • if hypotensive, correct
    • fetal pH sampling
  66. early decelerations
    - occurance
    - d/t
    • simultaneously with ctx
    • vagal nerve stimulation caused by the fetal head
  67. interventions for early decelerations
    position change
  68. shock associated with pregnancy related complications
    • hypvolemic
    • septic
    • cardiogenic
    • neurogenic
  69. hypvolemic shock
    - def
    - d/t
    loss of volume

    • ectopic pregnancy
    • previa and abruption
    • uterine rupture
    • PP hemorrhage
    • obsteteric surgery
  70. septic shock
    - def
    - caused by
    decreased blood vessel function

    • infection
    • toxin
  71. cardiogenic shock
    - def
    - caused by
    decrease pump function

    • cardiac tamponade
    • PE
    • thrombophlebitis
  72. neurogenic shock
    - def
    - caused by
    overwhelmed neuro regulatory capacity

    • uterine inversion
    • electroyte imbalance
    • drug toxicity
    • aspiratino
  73. S/S hypovolemic shock
    • tachypnea, tachycardia, weak thready pulse
    • hypotn
    • increased cap refill (>4 sec)
    • oliguria (<30cc/hr)
    • cool, clammy skin
    • pallor, peripheral cyanosis
    • hypothermia
    • anxiety, restlessness, thirst, feeling chilled, disorientation
  74. S/S of Septic shock
    • tachycardia; hyperdynamic pulse
    • tachypnea, resp alkalosis
    • hypotn
    • cerebral ischemia
    • polyuria
    • hyperthermia (early)
    • palpitations, faintness, apprehension, stupor, disorientation
  75. OB emergency interventions
    • large bore IV
    • O2 admin
    • floey cath
    • admin of blood, blood products, tx coaglopathy, DIC
    • promote fetal/newborn well-being
    • prepare, assist with emergency delivery
    • assess, monitor for changes, fluid overload
    • CPR if necessary w/n 4 min

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