WF Module 9 and 10 - Women and Families Quiz #3 PDF

lOMoARcPSD|47951355 WF Module 9 and 10 - Women and Families Quiz #3 Nursing With Women And Families (Northeastern University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by...

lOMoARcPSD|47951355 WF Module 9 and 10 - Women and Families Quiz #3 Nursing With Women And Families (Northeastern University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Ebony Whitworth ([email protected])  lOMoARcPSD|47951355 Module 9/10- Labor and Delivery 5 Ps of labor: 1. Powers (contraction)  Purpose = dilate cervix and aid in expulsion  Originate in fundus.  Measured by frequency and duration. o Rest b/w contraction is allowing O2 to fetus  Intensity: Mild, moderate, strong o Can also use an IUPC. MUST HAVE RUPTURE MEMBRANES FOR IUPC.  Mild (70 mmHg) 2. Passageway (Route the fetus must travel)  Maternal Pelvis  Maternal soft tissue – cervix o Cervix needs to be “ripe.”  Effacement vs dilation  Gynecoid is true female pelvis and about 50% women have/ slightly oval.  Anthropoid – egg shape and narrow sides – difficulty for labor  Platypelloid- narrow and oval  Android – true male pelvis, heart shape.  Fetal head must rotate.  Bishop score – likelihood of a woman entering labor naturally. o Low score – not expected to go into labor vs a high score. 3. Passenger  Fetal attitude (MC flexion of legs/arms) vs fetal lie (long axis of mom’s spine and fetus, longitudinal.)  90% cephalic position  Breech (3-4 %) o High risk for cord prolapse  Shoulder (transverse) – not optimal for vaginal delivery! 4. Position (maternal pelvis position)  Station relation of presenting part to maternal pelvis.  Zero station= presenting part engaged in pelvis level of the ischial spines  3 Letters o Direction presenting part faces Either Left or Right and its MOM’s L or R o Presenting part Downloaded by Ebony Whitworth ([email protected])  lOMoARcPSD|47951355  O = occiput (most common fetal head is flexed)  M= mentum (chin, fetal head is extended)  Sa= Sacrum (breech presentation)  A= Acromium process (transverse presentation) o Relationship to pelvis  A = anterior  P= posterior  T=transverse o MC position is LOA  Leopold Maneuvers o Done to determine fetal presentation and position o Four maneuvers:  1st maneuver: superior surface of fundus  2nd maneuver: each side of uterus  3rd maneuver: suprapubic area  4th maneuver: fetal attitude and extension (only if in cephalic presentation) 5. (Psyche)  Psyche experience influenced by: o Parity o Age o Culture o Coping mechanisms o Relaxation mechanisms o Emotional factors o Other discomforts o Length of labor o Intensity of labor o Maternal positions o Fetal position Nursing Assessment of Laboring Client  Maternal Assessment:  Focused assessment to determine condition of mother/baby o Maternal:  Vital signs  Uterine activity  Bladder status / I&O  Bloody show/ bleeding  Membrane status (nitrazine, amnisure, fern test)  Response to labor  Maternal discomfort  Cultural needs o Fetal Assessment:  Fetal presentation and station  Fetal heart rate  Fetal Gestation and Growth  Maternal History o Allergies Downloaded by Ebony Whitworth ([email protected])  lOMoARcPSD|47951355 o Current or recent medications o Pregnancy History  Previous pregnancies (GTPAL)  Type of delivery/c-section  Complications  Maternal testing/ prenatal labs o Blood type/ Rh o Hematocrit/ hemoglobin o Group Beta Strep (prophylactic antibiotics if positive) o Hepatitis B o HIV (antiviral meds if positive) o Ultrasonography o Nonstress tests Fetal Assessment during labor: external EFM and Internal EFM o Fetal heart tracing  Baseline HR  Variable  Accelerations  Periodic changes (declarations)  Occurs in response to contractions and fetal movement. Short term changes in rate rather than baseline. Laat 1-2 minutes.  Accelerations  Early Decelerations (head compression) o “mirror image” o Pressure on fetal skull, must do nursing interventions.  Late (placental insufficiency) o Indicates fetal hypoxia  Variable (cord compression) o Occurring during anytime of contraction o Secondary to cord compression Downloaded by Ebony Whitworth ([email protected])  lOMoARcPSD|47951355  FHT Categories Category I - normal no intervention required. Category II- indeterminate requires evaluation and continued monitoring. Category III - Predictive of abnormal fetus acid base status requires prompt evaluation and interventions. Labor and Delivery Initiation of Labor factors:  Uterine stretching (release of prostaglandins)  Oxytocin release  Decrease progesterone.  Increase prostaglandin secretion.  Cortisol release (inhibit progesterone and increase prostaglandin)  Placental aging True Definition of Labor: 1) Presence of regular phasic uterine contraction increasing in frequency and intensity 2) Progressive cervical effacement and dilation of cervix Signs of Impending Labor: Downloaded by Ebony Whitworth ([email protected])  lOMoARcPSD|47951355  Lightening  Increased vaginal discharge.  Increase energy.  GI symptoms (NV, diarrhea)  Cervical change  Bloody show  Rupture of membranes  Lower back pain  Weight loss  Uterine contraction True Labor False Labor -Regular contractions -Irregular contraction -Contractions Progresses to a pattern -No regular pattern - Discomfort begins in back and radiates to the -Discomfort in lower abdomen and groin abdomen -Show is not present - Contraction continue, despite moving or - Does not cause cervical change changing position -Contractions might stop when you walk or rest - Sedation does not diminish contraction pattern -Sedation will stop or decrease contractions - Causes cervical changes - Show usually present First Stage of Labor:  Early labor (latent phase)  Active phase  Transition phase Second Stage of Labor:  Descent and expulsion of fetus o From full dilation to birth of baby o Adds voluntary efforts. o Overwhelming urge to push. o Increase feeling of control o Pressure feeling (“baby is coming”) Third Stage of Labor  Expulsion of placenta o Detaches about 5-10mins after birth – up to 30mins. o Signs it is occurring:  Uterus becomes smalls.  Blood gushes  Cord lengthens. Fourth Stage of Labor  Immediate postpartum o First 4hours after birth o May experience – chills, afterpains, tired o Assess for hemorrhage. Downloaded by Ebony Whitworth ([email protected])  lOMoARcPSD|47951355 Pain Management  Tissue anoxia  Stretching (dilation) of cervix  Pressure on pelvic floor  Nonpharmacological o Cutaneous stimulation strategies o Sensory stimulation o Cognitive strategies  Pharmacological o Analgesia- partial or full relief of painful sensation using medication that decreases or alters the perception of pain. o Anesthesia- partial or complete loss of sensation w/ or w/out loss if consciousness. o Systemic -IV, IM,inhalation  Can slow down labor and can affect fetus.  Opioid analgesics: morphine and meperidine or fentanyl, stadol, nubain  Inhalation: nitrous oxide  Tranquilizers: Vistaril, Phenergan o Regional administration- epidural, spinals, combined spinal epidural.  Epidural: watch for hypotension  Spinal: risk for spinal headache  General anesthesia: potential fetal distress o Local nerve blocks- pudendal and paracervical block Module 10- Complications of labor Complication of Labor o Preterm baby @ increased risk for serious complications o Preterm birth= born before 37 weeks o Preterm labor  Regular uterine contractions occurring b/w 20-37wk gestation accompanied by one or more of the following: progressive cervical change and cervical effacement >80% OR dilation 1cm o Risk factors:  Spontaneous or iatrogenic  4 pathways:  Intrauterine infection/inflammation  Decidual hemorrhage  Excessive uterine stretch (multiple polyhydramnios)  Maternal or fetal stress  Demographic risk  Medical risk in current or predating pregnancy  Environmental/behavioral/psychosocial risk Biochemical Markers: o Fetal fibronectin-fFn produce during pregnancy. Acts as a biological glue, attaching the fetal sac to the uterine lining.  Cannot be detected b/w 24-34 wk. of pregnancy. Warning Signs Downloaded by Ebony Whitworth ([email protected])  lOMoARcPSD|47951355 o Uterine cramping o Backache o Pressure in pelvis o Increase or change in vaginal discharge o Abdominal cramping o Change in fetal movement Management of Preterm Labor o Assess for infection/clean catch urinalysis- treat the infection o Restricting activity o Ensuring hydration o Tocolysis-administration of medication to stop contractions.  MAIN GOAL= stop labor long enough to get corticosteroid on board to promote fetal lung maturity.  Contraindication for tocolysis:  Severe HTN or preeclampsia  Evidence of fetal compromise  Fetal death  Fetal anomaly incompatible with life  Fetal lungs are mature  Drugs:  Beta-adrenergic agonist – Terbutaline o MOA: promotes smooth ms relaxation. Can be given IM or SUBQ. No better than mag for PTL; higher incidence of maternal side effects o AE: maternal tachy, pulmonary edema, fetal tachy, hyperglycemia,kypokalemia, hypotension, cardiac insufficiency, arrhythmia, myocardial ischemia, maternal death  Magnesium sulfate o MOA: prevents reflux of Ca into myometrial cells causing uterine relaxation-CNS depressant. Most commonly used for neuroprotection. o AE: loss of DTR, mental status change/LOC, respiratory depression, pulmonary edema, profound hypotension, cardiac arrhythmia o Antidote: Calcium gluconate 1gm IV over 3mins.  Ca Channel Blockers- Nifedipine/Procardia o MOA: smooth muscle relaxer, potent vasodilator o AE: hypotension, flushing, HA, tachycardia, nausea, dizziness, palpitations  Prostaglandin inhibitors –Indomethacin o MOA: powerful anti-inflammatory that inhibits prostaglandin and readily crosses the placenta. Often used w/ Mag. Shown effective in prolonging pregnancy 48-72hrs. o AE: risk of fetal ductus arteriosus closed early if administered after the 32 wk. o Promotion of fetal lung maturity  Betamethasone o Prevention- Progesterone Downloaded by Ebony Whitworth ([email protected])  lOMoARcPSD|47951355 o Reduces preterm birth in a select population. Previous preterm and singleton gestation. o Not supported for use in multiple gestation Nursing Care in PTL: o Management of a client who is in preterm labor includes focusing on stopping uterine contractions. o Activity restriction o Strict bed rest has been found to have adverse effects such as pulmonary edema and VTE o Encourage the client to rest in the left lateral position to increase blood flow to the uterus and decrease uterine activity. o Avoid sexual intercourse. o Ensuring hydration -Dehydration stimulates the pituitary gland to secrete an antidiuretic hormone and oxytocin. o Preventing dehydration prevents the release of oxytocin, which stimulates uterine contraction o Identifying and treating an infection o Have the client report any vaginal discharge, noting color, consistency, and odor. o Monitor vital signs and temperature. o Chorioamnionitis should be suspected with the occurrence of elevated temperature and tachycardia. o Monitor FHR and contraction pattern. o Fetal tachycardia, a prolonged increase in the FHR greater than 160/min may indicate infection, which is frequently associated with preterm labor Complications of Labor  Dystocia is an abnormal,long, or difficult labor or delivery. (5 P’s) o Powers = uterine contraction that do not produce progressive cervical dilation, effacement, and decent of the presenting part. Contractions are quantified as number of contractions presented in a 10min window, averaged over 30min.  Hypotonic contractions ( arrest of dilation/descent) - amniotomy or oxytocin augmentation if no CPD.  Tachysystole- labor pattern definition: >5 uterine contraction in 10min over 30min, with less than 60seconds of relaxation.  Potential complication = fetal deoxygenation and uterine rupture.  Ineffective pushing o Passenger and Position  Malposition – posterior position (mom complains of back pain)  Malpresenation o Passageway  Cephalopelvic disproportion- occurs when fetal head is larger than maternal pelvic diameter. Downloaded by Ebony Whitworth ([email protected])  lOMoARcPSD|47951355  Lack of fetal descent in presence of strong contraction  Labor usually prolonged  Shoulder dystocia  Dystocia Assistance o Forceps o Vaccum extractions  Caput succedaneum  Cephalohematoma  Intracranil hemorrhage  Labor Enhancer o Pitocin – stimulates contractions  Induction vs augmentation  AE: increasing contraction, resting tone, HR. Decreases BP , and increase ICP  FETAL RISK:  Fetal hypoxia  Uterine rupture  Placental abruption  Postpartum hemorrhage  Fetal hypotension o Medically necessary o CAUTION:  Fetal distress  Orematurity  Over-distension of uterus  C-Section o Performed because of factors related to mother, fetus, and other. o Pfannestiel incision MC ; Classic incision increases risk of uterine rupture in subsequence pregnancies and labor o Post-Op Nursing Care:  Pain  RR  I&O  Incision  Bowel function  Circulation  Psychologial response  Intrapartum Emergencies o Shoulder dystocia  Impactation of anterior fetal shoulder behind maternal pubis symphysis  Risk factors:  Fetal macrosmia  Maternal DM  Maternal obesity  Previous shoulder dystocia o Cord prolapse  Obstetric emergency that occurs when umbilical cord drops down alongside or infront of the presenting part of the fetus. Downloaded by Ebony Whitworth ([email protected])  lOMoARcPSD|47951355 Fetal circulation can be reduced or cutt off compeletly causing physiological effects for the fetus.  Nursing Care:  Place in trendelenberg or knee-chest position ( #1 GET THE PRESSURE OFF THE CORD)  Elevate with sterile gloved hand  If cord is visible, handling should be avoided covered with warm,sterile, saline soaked gauze o Amniotic embolism  Escape of amniotic fluid into the maternal circulation – usually enters maternal circulation through sinus at placental site  Usually fatal to the mother- amnio fluid contain debris, lanugo, vernix, meconium  SSX:  Dyspnea  Chest pain  Cyanosis  Shock  Therapeutic intervention:  Deliver the baby  Provide cardiovascular and respiratory support to mom Downloaded by Ebony Whitworth ([email protected])