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WVC Obsteric Procedu
wvc Nursing Care During Obstertric Procedures chpt 20
| Question | Answer |
|---|---|
| Amniotomy | Artificial rupture of the amniotic sac. Usually done in conjunction with induction or stimulation of labor, or to permit electronic fetal monitoring. |
| What are three risks associated with amniotomy? | Prolapse of the umbilical cord, obstructing blood flow to and from the placenta & reducing fetal gas exchange. INFECTION, and abruptio placentae. |
| This can occur if the uterus is distended when the membranes rupture. A large area of placental disruption reduces fetal oxygenation, nutrition and waste disposal. | Abruptio placentae, premature separation of normally implanted placenta. One of the 3 risks assoc. with amniotomy. |
| In what case would an amniotomy be deferred? | If the fetus presenting part is high or if the presentation is not cephalic. The risk for prolapsed cord is greater in this situation b/c there is more room for the cord to slip down. |
| What procedures would a nurse perform prior to the amniotomy? | Establish a baseline fetal heart rate and pattern at least 20 to 30 minutes prior to the procedure. |
| While monitoring FHR you see deep or prolonged variable decelerations that occur during contractions, or persistent bradycardia is present after contractions, what can be suspected? | The cord may be compressed, causing fetal distress. |
| In addition to fetal heart rate monitoring after an amniotomy, a nurse should also assess what? | Temperature should be assessed every 2 hours after an amniotomy. Anything greater than 100.4 f should be reported. |
| What are the 8 indications that labor should be induced? | A hostile intrauterine environment, spontaneous rupture of the membranes w/o onset of labor, postterm pregnancy, inflammation of the amniotic sac, hypotention reducing FBF, abruptio placentae, severe maternal medical conditions and fetal death. |
| What drug is used to augment labor when the contractions are insufficient? | Oxytocin |
| This condition is a contradiction to induction of labor. It is the abnormal implantation of the placenta in the lower uterus. | placenta preva can result in hemorrhage during labor, so labor would not be induced. |
| This contradiction to labor exists when the umbilical cord vessels branch over the amniotic sac rather than inserting into the placenta. | Vasa previa can cause fetal hemorrhage if the membranes rupture and labor is induced. |
| This condition indicates an immediate cesarean section is necessary. | Umbilical cord prolapse. |
| What is cephalopelvic disproportion? | A fetal head size that is too large to fit through the maternal pelvis at birth. |
| This condition is usually caused by bacterial or viral infections that cause inflammation of the amniotic sac. | chorioamniontitis , also called amniontitis. |
| A difficult or prolonged labor, often associated with abnormal uterine activity and cephalopelvic disproportion | Dystocia. |
| A surgical incision of the perineum to enlarge the vaginal opening. | episiotomy |
| This is when the umbilical cord is around the fetal neck | nuchal cord |
| Abnormally small quantity of amniotic fluid (less than 500 ml at term) | oligohydramnios |
| Edema caused to the newborn's scalp created by a vacuum extractor | chignon |
| What are the major risks associated with induction and augmentation of labor? | Uterine hyperstimulation resulting in fetal distress, uterine rupture, maternal water intoxication caused by oxytocin's antidiuretic effects and a greater risk for chorioamnionitis. |
| What are the 5 factors to estimating cervical readiness for labor according to the Bishop Scoring System? | Dilation, effacement, fetal station, cervical consistency, and cervical position. |
| What 2 drugs are given to facilitate cervical ripening? | Prostaglandin and misoprostol (Cytotec unlabeled use) |
| How does a mechanical method of cervical ripening work? | A common method involves placement of hydrophilic inserts into the cervical canal, where they absorb water and expand, gradually dilating the cervix. |
| A woman's uterus becomes more sensitive to oxytocin as labor progresses. During what stage of labor can the rate of infusion gradually be reduced? | During the active stage of labor, usually when the woman is between 5-6 cm dilated. After the membranes rupture, it maybe stopped or reduced. |
| Oxytocin stimulates uterine contractions. Hypertonic contractions can have what effect on the fetus? | Hypertonic contractions can reduce placental blood flow and therefore reduce exchange of fetal oxygen and waste products. |
| What does a HYPERTONIC contraction mean? | A contraction that is too strong and causes fetal distress. |
| Prior to induction or augmentation of labor the nurse determines whether FHR and patterns are reassuring. How often is the FHR charted during the 1st and 2nd stage of labor. | FHR is charted at least every 15 minutes during the 1st stage of labor and every 5 minutes during the 2nd stage of labor. |
| During induction/augmentation of labor the nurse recognizes nonreassuring patterns or hypertonic contractions. What steps can she take to reduce uterine activity and increase fetal oxygenation? | Reducting or stopping the oxytocin, keeping the woman on her side to prevent aortocaval compression & increase fetal blood flow, giving 100% oxygen via snug facemask. |
| What drug may the doctor order to reduce uterine activity during induction/augmentation of labor? | Terbutaline can be given to quickly stop the uterine hyperstimulation. |
| The nurse observes the uterine activity and monitors what three things? | Contractions are assessed for frequency, duration and intensity. |
| During the administration of oxytocin, how often is the mother's baseline BP & pulse taken? | Every 30 minutes or when the oxytocin level is increased. |
| If a woman has received oxytocin for an extended period of time, she runs the risk for postpartum hemorrhage. What should a nurse look for to identify this condition? | The uterine muscle becomes fatigued and doesn't contract effectively to compress vessels at the placental site. This is manifested by a SOFT FUNDUS & AN EXCESSIVE AMOUNT OF LOCIA, USUALLY WITH LARGE CLOTS. |
| What are two methods used to change fetal presentation? | External cephalic version and internal version. |
| What is an operative vaginal birth? | One in which the physician applies traction to the fetal head during birth with a vacuum extractor or forceps, to aid the woman's expulsive efforts. |
| What are the 3 types of uterine incisions made for a cesarean? | Low transverse, low vertical and classic, a vertical incision into the upper uterus. |
| What is the preferred surgical uterine incision for a cesarean? | low transverse uterine incision is the preferred unless there is a complication. |
| Two incisions are made. One in the abdominal wall and one in the uterine wall. What are the 2 in the abdominal wall called? | A midline vertical incision between the umbilicus and the symphysis or a Pfannenstiel incision, just above the symphysis. |
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