Women Health Exam 2 Test Map PDF

Labor- Chapter 16 What is the Emergency Medical Treatment & Labor Act (EMTALA)- Chapter 19 Narration 46 sec Anyone who shows up to the ER must be treated and stabilized. Pregnant women who present with contraction or may be in labor are considered unstable and must be assessed, stabilized, an...

Labor- Chapter 16 What is the Emergency Medical Treatment & Labor Act (EMTALA)- Chapter 19 Narration 46 sec Anyone who shows up to the ER must be treated and stabilized. Pregnant women who present with contraction or may be in labor are considered unstable and must be assessed, stabilized, and treated at the hospital regardless of ability to pay or have insurance. True labor (progressive cervical change) versus false labor (contractions with no progressive cervical change), and interventions: fluid, pain meds, rest, tocolytics/terbutaline Assessment: Let patients sit in the room comfortably or walk for an hour and recheck if cervix changes. True labor: is contraction with progressive cervical change such as dilation and effacement False labor: contraction with no cervical change o Interventions: rest, give bolus fluid 1L LR, pain meds, Tocolytic (stops uterine contraction) like tribuline → Monitor heart rate before administration, ritidrine to see if it stops contraction → send women home o Return to hospital if 3 minutes between contractions, hurts to talk between contraction, water break True labor False labor Intensity Regular, stronger, longer, closer together Irregular, becomes regular temporarily Position changes More intense Stops Location Lower back, radiating to lower abdomen Back of abdomen, above umbilicus Comfort measure Continued contraction Stops contractions Know all the history, physical assessments, labs, consents, and review of birth plans when they come in for labor on Rapid Review. Make sure you understand Group Beta Strep and the risks. Group Beta Test; Swab at 36 weeks → If positive → IV antibiotics after water breaks → 4 hours of coverage → protects baby from infections with sx ranging from Fever to death || if they don’t have group beta test start IV. Oral ABX not effective. Consent for C-section: Any delivery can turn and become emergent, so have this signed. Birth plans: do what mom wants within safety reason, epidural vs not, who cuts the cord, who is allowed in the room, some culture only allows female in the room. You must know the triage information from rapid review, who must you see immediately/emergency, who is next, who is third, who is fourth and who is last to see? Physical assessment of the women and fetus in labor, including urine dip on entry to the hospital- Chapter 18/19 The first stage of labor dilation includes two phases: Early 0-5 cm- Active 6-10 Pain assessment review record and health HX, G and P, Gestational age, psychosocial assessment, appearance and behavior, Support system, discuss birth plan and expectation, cultural considerations Physical head to toe assessment Head: facial swelling, broken tooth, tonsils, → in case of need for intubation Cardiac assessment: BP between contraction every 30-60 minutes, and 15-40 minutes during active labor respiratory assessment Abnormal position Heart tone umbilicus and above Get mom in bathroom to clear bladder {full bladder impedes labor progress} and ask about domestic violence Urine for glucose, protein, and WBC Is water broken or leaking? FHR COAT, get sample of fluid/ or ferning test/ pH test Knees: DTR 1-2 normal, 3 brisk 4 hyperlexia (preeclampsia) VS: HR 60-100, normal resp 12-20, BP less than 140/90 (increased BP signs of preeclampsia), o2 sat 95 percent. Check for DVT, measure and call provider Feet: clonus to check secondary reflex External fetal monitoring, US, o Fetal heart tone 110-160, normal variability of 6-25 beats o Bradycardia→ walking, caffeine, o Absent: brain damage o !! if fetal HR cannot be attained externally → must do internal monitoring, ROM is needed for internal monitoring risk of HIV, HEP B!! external monitoring is more accurate VEAL CHOP Variable Cord Comes at any time, can be Chage position to get pressure off Compression indication of Prolapsed Cord cord, increase fluid  Early Head Good, Baby is ready to come compression out Acceleration OK Good sign after 32 weeks Reactive non stress test 2(15x15) in 10–20-minute tracing Late Placental !!BAD!! Can indicate Turn off Pitocin, change mom’s insufficiency abruption, bleeding, Baby position, O2 mask, call the doctor isn’t getting blood Leopold maneuver: Malposition in Leopold: transverse: Breach || determine the orientation of the baby: 1- fundus- butt- move baby 2. Mid uterus- smooth portion, 3. Pelvis- large hard and round, 4- presenting part and head engaged 1- Fundus 2- Mid Uterus 3- Pelvic Presenting Part Cephalic (best Smooth Moveable Smooth portion Hard and round Head position) LOA is okay unmovable Breach Hard and round Soft, irregular (legs Legs or butt or but) Transverse Hard (back or Back or shoulder shoulder) o Preferred fetal position in labor - breech versus cephalic, vertex versus brow presentation- will not fit and cause damage to baby, Preferred position: cephalic, vertex (chin to chest), OA o OA- provides smallest diameter, preferred position o OP- Pressure and pain back pain, slows labor- mom will request pain meds, pressure can be felt with epidural, ▪ No anesthesia: Do lunges pelvic tilts if mom can move → encourage baby to turn ▪ With anesthesia: Turn mom side to side, Peanut ball- opens diameter and helps baby turn Rupture of membranes- What is the first assessment? - !! You always check the fetal heart tones FIRST when the water breaks!! Risk for cord compression COAT Color Odor Amount Time o Color: Normal: clear/straw color with white flecks  ▪abnormal*high risk if meconium staining and fetal distress- NICU must be at the delivery because there could be !!aspiration!! of the meconium plug and the neonate may not be able to breathe, time (do not want to exceed 24 hrs- begin IV antibiotics at 18 hrs) o Odor: normal: no odor o Amount: may vary by patient, regardless document the amount o Time: Need to start ABX 18- 24 hours after ROM, Hourly temp after ROM, monitor FHR, Tachycardia and temp elevation = infection Understand the labor portogram. Multiparas deliver faster than primiparas. What is the average duration of labor for a primipara versus a multipara- Page 387 chart in the book The labor curve addresses the trees/rocks or the highway. If you are a first-time mom- it will be slower, if you are a multipara, it is faster. If you are not laboring in the expected timeline as referenced above, the baby may be too big or malposition. This may indicate a need for surgical intervention. Maternal labor nursing intervention including voiding, breathing techniques and hyperventilation (cup hands and rebreathe), ice chips, linen changes, and options for analgesia and anesthesia Do what mother wants regarding pain: nonpharmacological pain management: Hydrotherapy, ambulation, dance, massage, breathing technique- slow deep breathe Hyperventilation → too much oxygen in body → tingling finger light head → Cup hands to increase CO2 in body Ice chips and light soups → risk for emergency surgery for everyone in labor Frequent bladder voiding, Continuous change in Lenin due to leaking fluid Give mom options on pain management If mom, ask for IV meds → screen for use of narcotics → IV administration w/i 1 hour of delivery → risk of using Narcan for baby → baby seizures Know contraindication for epidural  The cervix should be completely dilated (10 cm) before the client begins pushing. If pushing starts too early, the cervix can become edematous and never fully dilate → soft tissue dystocia Limit cervical exam due to high risk of infection. The Second Stage of Labor is pushing and delivery of the fetus. open glottis: Preferred pushing with open airway, closed glottis pushing: Valsalva, vasovagal→ decreased perfusion → deliver less oxygen to mom and baby Set up a delivery table, including bulb syringe, cord clamp, and sterile supplies. Perform perineal cleansing. Make sure the client and support person can visualize delivery if they desire. If siblings are present, make sure they are closely attended to by a support person explaining that their mom is all right. Record the exact delivery time (complete delivery of the baby). Push with contractions and rest between. This stage can be from one push up to three hours. The Third Stage of Labor is the delivery of the placenta. Must happen within 20-30 minutes. If longer might indicates excreta or retained placenta → pregnancy hormone is still secreting → risk of hemorrhage How do you know placenta is coming out? Uterus will rise, cord will lengthen, gush of blood, followed by the placenta Inspect to see if all the placenta is out. Once placenta comes out → estrogen level falls drastically → Oxytocin is released → some hospitals administer a bolus of oxytocin → decrease bleeding Evaluate uterus is at umbilical or lower, check if bladder is empty How do you know when the placenta has separated? Make sure the uterus is firm after the delivery- Give oxytocin ASAP to prevent bleeding What is the sequela if oxytocin is given before the delivery of the placenta? May be harder to get placenta out Know normal estimated blood loss for a vaginal and a C-section delivery. < 500 for vaginal loss or have consent Contra: platelet under 100k due to bleed risk, previous spinal surgery, CNS disorder, MRSA legioin, Allergy to -caine, Must be in active labor 3-4 cm Call anesthesia and preload patient with 1-2 L of LR or NS --> to avoid Hypotension which can lead to LATE decel and placental abruption During: Position: Mad Cat like position (DR JBT holding DR H), Metallic taste, monitor HR and FHR, assist in holding patient, slight tilt not sitting up, make sure it’s not going up to diaphragm or going to butt. Have significant other sitting down they can pss out Ongoing: Hypotension: lateral position, Fluid, vasopressor to Assess FHR every 5 minutes, keep bladder empty, assess pain relief, women should feel pressure but not pain Post: spinal leak- headaches, take BP, blue tube to know end of epidural,  General anesthesia Monitor VS and FRH, Emergency, drugs to decrease gastric acid, uterine Atony: uterus don’t shrink Second stage: pushing, palpate bladder (no obstruction), ROM - FHR and Coat with temp, teach mom to push then cleansing breath, 3 10 second interval, Docs can only use forceps and vacuum Record time of delivery, Third stage of labor 5-15 minutes to delivery of placenta, document when placenta comes out o Gushes of blood → followed by the placenta Pitocin bolus after placental delivery to stop bleeding and shrink placenta Monitor VS 15 min, Over 30 minutes then surgical removal Massage uterus to make sure its firm Blood loss less than 500 for vaginal, 1k for c section Skin to skin with mom or dad Dr repairs tears, ice pad 4th stage of labor Make sure MOM don’t bleed to death o Dystocia, over distention, long labor, short labor, old placenta, hemorrhage, Signs of Bleeding → if pt soak pad, Assess for hypovolemic sx If fundus needs to be firm, soft and spongy = bleeding, Breast feed in 1-2 hours, Preterm labor No contractions or contractions less than 2 per 5-minute period Steroids for fetal lung development, Mag sul (neural fetal protection), or terbutaline (contraindications: not over 110-120) Post date Baby too big, Hypertonic uterine dysfunction: fluids Hypotonic: Pitocin, Shoulder dystocia: turtle, McRoberts, suprapubic pressure, woods (corkscrew) maneuver Prolapsed cord: call for assistant, examine, push on presenting part, prevent pressure, lateral recumbent, Amniotic fluid embolism: anaphylaxis