Normal Contration Pattern
Frequency....
Duration...
Intensity...
Resting Tone...
-Contraction frequency every 2-3 minutes
-Duration is 60-90 seconds
-Intensity is 40-90 on IUPC
-Resting tone is 10-15 on IUPC
� < 5 contractions in 10 minutes over 30-minute window
Abnormal Contraction Pattern- Hypotonic, Interventions
-Weak, inefficient, or completely absent contractions
-administer Oxytocin, augment labor(helps strengthen contractions)
Abnormal Contraction Pattern- Hypertonic, Interventions(4), Med
-Excessively frequent, uncoordinated, and of strong intensity with inadequate uterine relaxation, can result in uteroplacental insufficiency leading to fetal hypoxia
-Maintain hydration, Promote rest/relaxation/comfort, Place in a left lateral position an
Perineal lacerations..
1st stage-
2nd stage-
3rd stage-
4th stage-
o First degree: through skin but doesn't involve muscle
o Second degree: extend through the skin and muscles into the perineum but not the anal sphincter
o Third degree: laceration extends through the skin, muscles, perineum, and external anal sphincter m
First stage of labor interventions(5)
-vaginal exam (dilation/effacement)
- monitor for ROM/vitals
-encourage frequent voiding
-teach breathing/relaxation
-frequent position changes, remain upright
If ROM,....(2)
put on FHR, & verify fluid with nitrazine paper(Should turn blue with a pH of 6.5-7.5)
2nd stage of labor interventions(full dilation to birth)....(3)
-monitor vitals & CTX
-rest b/w CTX
-cleanse perineum PRN/comfort measures
3rd stage of labor interventions(birth to placental expulsion).... (4)
-monitor vitals
-Administer oxytocics expulsion of the placenta to stimulate the uterus to contract & Administer analgesics
-clean perineum
-skin to skin contact/baby friendly activities
4th stage of labor interventions(placental expulsion until mom VS stable).... (4)
-assess maternal BP & vitals
-assess fundus, lochia, & episiotomy
-massage or administer oxytocics to prevent hemorrhage of fundus
-encourage bonding
Bishop Score(use...5)
-used to determine maternal readiness for labor by evaluating whether the cervix is favorable by rating the following
-Cervical dilation, Cervical effacement, Cervical consistency (firm, medium, soft), Cervical position (posterior, midposition, or anterio
Indications for Induction of Labor(4)
-Elective induction for nonmedical indications (must 39 weeks of gestation & Bishop score of >8 for multiparous client & >10 for nulliparous client)
-pregnancy >42 weeks of gestation, Dystocia due to inadequate uterine contractions: Prolonged, difficult l
Complications for Induction (3)
-Nonreassuring FHR(110-160)
-Loss of variability
-Late or prolonged decelerations
NURSE ACTION FOR COMPLICATION FOR INDUCTION(4)
-side-lying position
-increase the rate of IV fluid to 200 mL/hr / Administer O2
-Administer terbutaline(calms CTX)
-Monitor FHR/ Document responses to intervention, Prepare for emergency cesarean birth if unable to restore FHR
Pitocin:
essentials-4
Maintain dose if CTX...
DC dose if CTX...
-fetus must be engaged, piggybacked through a pump, assess vitals 30-60min & FHR/CTX 15min, I & Os
-Contraction frequency every 2-3 minutes, Duration is 60-90 seconds, Intensity is 40-90 on IUPC, Resting tone is 10-15 on IUPC, Dilation of 1 cm/hr, FHR is
Epidural block
use....
adverse effects....(4)
-Eliminates all the sensation all sensation from the level of the umbilicus to the thighs, relieving discomfort of uterine contractions, fetal descent and pressure and stretching of the perineum; 4cm dilated & active stage
-Maternal hypotension, Fetal Bra
Pudenal Block
use....
adverse effects...(2)
-Local anesthetic: lidocaine or bupivacaine, Transvaginal, no maternal or fetal systemic effects, Local anesthetic during delivery, episiotomy and episiotomy repair, Administer in late stage of labor 10-20min before delivery, For 2nd and 3rd stages of lab
FHR- normal=....
110-160 with increase and decrease from baseline
Non-reassuring (4)
-Tachycardia: greater than 160/min for 1 minute or longer
-Bradycardia: FHR is less than 110/min for 1 minute or longer
-Absence of FHR variability
-Late decelerations/ Variable decelerations
Variability
definition...
absent...
minimal...
moderate...
marked...
-Fluctuations in the FHR baseline that are irregular in frequency and amplitude. Variability should be moderate.
-Absent variability=nonreassuring
-Minimal= less than or equal to 5
-Moderate= 6-25
-Marked=greater than 25
Accelerations- interventions,
Fetal Tachycardia, tachypnea interventions(3)
-No interventions are required
Fetal Tachycardia = FHR greater than 160 for 10 minutes or more
-Administer antipyretics, Administer oxygen, Administer IV fluids
Decelerations
-Brady + interventions(4)
-Decrease or loss of FHR variability intervention(2)
-early decels(1)
-late decels(6)
-variable decels(3)
-FHR less than 110 for 10 minutes or more
-Discontinue oxytocin, Assist to side-lying, Administer oxygen, Insert IV to maintain fluids
-stimulate scalp, left-lateral
-no interventions
-side-lying, IV fluids, DC oxytocin, Administer oxygen, Elevate legs, P
Category 1
-Baseline FHR
-Baseline FHR variability
-Accelerations
-decelerations
-Variable or late decelerations
predicts normal acid-base status
-Baseline FHR Between 110 - 160 BPM
-Baseline FHR variability moderate
-Accelerations: present or absent
-Early decelerations: present or absent
-Variable or late decelerations: absent
Category 2
-Baseline FHR
-Baseline FHR variability
-Accelerations
-decelerations
indeterminate
-tachy or brady
-minimal, absent, marked, baseline
-absense after fetal stimulation
-periodic or episodic, Prolonged FHR deceleration = or > 2 min but less than 10 min, Recurrent late/variable decelerations, Variable decelerations with overs
Category 3
(2)
predicts abnormal acid-base
-Sinusoidal pattern
-Absent baseline FHR variability with Recurrent variable/late decelerations, Bradycardia
Continuous Internal Fetal Monitoring
Patient Care(4)
-Ensure monitor functions properly, aseptic techniques,, Monitor maternal HR and temperature, Encourage frequent positioning
External fetal monitoring(Intermittent auscultation and uterine contraction palpation)
Indication-(5)
Patient Care-(3)
-Determine active labor, Rupture of membranes, Medication, Following vaginal examinations, Abnormal contractions
-Find the FHR & Count to determine baseline rate, Auscultate FHR before, during, and after contractions , Palpate fundus
External fetal monitoring(Continuous electronic fetal monitoring)
Indication-(6)
Patient Care-
-Multiple gestations, Oxytocin infusion, Bradycardia, Complications, Active labor, Fetal distress
-Use Leopold maneuver to find the FHR, Encourage frequent position changes
VEAL(name)
CHOP(cause)
MINE(management)
Variable Decels / Cord Compression / Move Client
Early Decels, Head Compression, ID labor progress
Accelerations, other(okay), no action needed
Late decels, placental insufficiency, execute action stat
C section Risk factors(8)
-Malpresentation, particularly breech position
-Cephalopelvic disproportion
-Non-reassuring FHT
-Placental abnormalities, Placenta previa, Abruptio placentae
-High risk pregnancy, multiple gestations
-Previous c/s birth
-Dystocia
-Umbilical cord prolapse
C section complications(maternal-7, fetal-2)
Maternal
-Aspiration
-Amniotic fluid pulmonary embolism
-Wound infection/Wound dehiscence
-Severe abdominal pain
-Thrombophlebitis/Hemorrhage
-UTI/Injuries to the bladder or bowel
-Anesthesia associated complications
Fetal
-Premature birth of fetus if ges
Prolapsed cord- how to recognize(4)
-client reports that she feels something coming through her vagina
-visualization or palpation of the umbilical cord protruding from the introitus
-FHR monitoring shows variable or prolonged deceleration
-excessive fetal activity followed by cessation of
Prolapsed cord- priority intervention(5)
-call for help, hold cord
-Reposition the client in a knee-chest, Trendelenburg, or a side-lying position with a rolled towel under the client's right or left hip to relieve pressure on the cord
-apply warm saline towel to cord to prevent drying; apply fl
Indications for amnioinfusion...(2)
-Oligohydramnios caused by.... Uteroplacental insufficiency..... PROM.... Post maturity of the fetus
-Fetal cord compression secondary to post maturity of fetus (macrosomic, large body), which places the fetus at risk for variable deceleration from cord c
Dystocia
dysfunctional labor, does not progress in dilation, effacement, or detal descent
Shoulder dystocia
presenting part stuck on pubic bone, use McRoberts
McRoberts Maneuver
lithotomy position with legs flexed to chest to maximize pelvic outlet
Interventions for shoulder dystocia(7)
-McRoberts position
-Fetal scalp monitor or IUPC
-Have the client empty bladder
-Encourage position changes to aid fetal descent or to open pelvic outlet
-Ambulation enhance progression of labor
-Relaxation techniques hydrotherapy, counter-pressure
-Possi
Fetal distress- bradycardia...interventions(5)
-monitor vitals and FHR
-left side lying reclining position with legs elevated
-administer 8-10L/min of oxygen via a face mask
-discontinue oxytocin if being administered & increase IV fluid rate to treat hypotension if indicated
-prepare the client for a
Fetal Distress- Nuchal Cord(3)
-Take finger and loop into the cord and take it off of the baby's neck
-Make sure there is no pressure on that cord-May need to rush in for a c section
BUBBLEHEB
B: BREASTS
U: UTERUS
B: BLADDER
B: BOWEL MOVEMENT
L: LOCHIA
E: EPISIOTOMY
H: HOMANS (THINK DVT*)
E: EMOTIONAL STATE OF MOTHER
B: BONDING
BREASTS(4, +breast problem causes-3, prevention-2, treatment-3)
-Colostrum is produced after birth and 2-3 days and milk is produced on days 3-5 after
-Lactating (breastfeeding) or Non-lactating (bottlefeeding)
-Nipples.....cracked, bleeding, inverted, flat
-Engorgement....tenderness and heat
-Causes
Delayed or infreq
UTERUS-(4)
-Supine position after voiding
-Assess level of fundus fingerbreadths
o Firm or boggy?; LOCATION(see sim prep)
? Boggy = Massage teach self-massage
? Should be firm
-Oxytocin, methergine
-C-section assess and massage if necessary
BOWEL-(4)
-Bowel sound return of function
-Constipation sluggish due to low progesterone
o Fear to have BM
o Encourage fluids, fiber, ambulate
o Stool softeners, NO enemas
-Hemorrhoids..... witch hazel pads
-Postop - c-section or BTL need to pass gas before eating
BLADDER(5)
-Risk for distension trauma, meds, anesthesia, catheterization
-Empty bladder q 2 - 3 hours after vaginal delivery or catheter removal
o Periurethral edema = difficult voiding
-Full bladder.... uterine atony hemorrhage
o Diuresis full bladder
-Monitor for
LOCHIA(4)
-Can pool in the vagina
-Color
o Rubra: bright red (1-3 days)
o Serosa: dark red/pink (4-10 days)
o Alba: white (11 days to 4-8 weeks)
? Return to rubra subinvolution
Massaging the uterus or ambulation can result in a gush of lochia with the expression of
EPISIOSTOMY-(4)
-Sims position
-REEDDA
o Redness, edema, ecchymosis (discoloration), discharges, drainage, approximation
o Ice packs, dermoplast spray, sitz bath
o Pain medication acetaminophen, hydrocodone
-Hemorrhoids
-Teaching
o Hygiene, comfort measures, hand washing
HOMANS(Lower extremities)-(3)
-Risk for thrombophlebitis.... DVT
o Hypercoagulability, anemia, trauma, surgery, obesity, childbirth
-Diagnostic LEVD
o SCD's, early ambulation
o Antiebolism hose if bed rest
� Heparin therapy with DVT
o Warfarin CI with breast feeding!
-Educate about si
EMOTIONAL STATUS-(3)
-Taking in=first 24 hours
-Taking hold =assumes responsibility
o Rests when baby rests
o Fatigue = anxiety and depression
-Attitude toward infant support system
o Adolescent mother
o Mother relinquishing infant
BONDING-(5)
-Family centered care
o Rooming in
-Assess interaction with infant between parents, siblings
o Include cultural practices
-Supportive care
-Assess knowledge level of mother and significant other
-Praise support with newborn care
Labs-Rubella(3)
-< 1:8 titer = nonimmune (cannot get pregnant for 1 month after vaccine)
-Will need to get rubella vaccine before she goes home
-Prevent from getting rubella mesels
Labs- Rh factor(2)
-Must receive RhoGAM in 72 hrs of delivery to prevent sensitization in future pregnancies
-IM Received a dose at 28 weeks
LABS- HEP B(1)
- if mother infected then infant must have vaccine and immune globulin within 12 hrs
Labs-CBC(2)
-H/H decrease = normal
-elevated WBC to 25,000 nl 10 - 14 days
-WBC counts up to 30,000 may occur early postpartum
(Treat symptoms not lab values)
Labs-Vitals(5)
-Temperature up to 100 may be due to dehydration or exertion in the first 24 hours
-Afebrile after 24 hours, breast feeding can increase temp
-BP wnl, may decrease initially
oIncreased BP may indicate PIH
-Pulse rate may decrease to 50 - 70
oIncreased HR
Maternal role attainment/transition - Phases..... dependent(5)
taking in phase"
-First 24-48 hr
-Focus on meeting personal needs
-Rely on others for assistance
-Excited, talkative
-Need to review birth experience with others
Maternal role attainment/transition - Phases..... dependent/independent (4)
taking hold phase"
-Begins on day 2 or 3, Lasts 10 days to several weeks
-Focus baby care and improving caregiving competency
-Want to take charge but need acceptance from others, Want to learn and practice
-Dealing with physical and emotional discomfort
Maternal role attainment/transition - Phases.... interdependent (2)
Letting go phase"
-Focus on family as a unit
-Resumption of role (intimate partner, individual)
Paternal Bonding(3)
-The father has skin-to-skin contact, holds the infant, and maintains eye-to-eye contact with the infant
-The father observes the infant for features similar to his own to validate his claim of the infant
-The father talks, sings, and reads to the infant
Sibling Bonding(4)
-take tour of OB unit
-let them be first one to see infant
-provide gift/doll to care for
-spend time with sibling
Methergine-
Contra-1
effects/indications-2
side effects-3
contra: HTN
expected effects: used for hemorrhage
side effects: hypertension, N/V, headache
Magnesium Sulfate
-use(2)
-side effects(3)
-toxicity(5)
-interventions(3)
-stop CTX, treatment of seizures
-flushing, hot, sedation
-absense of deep tendon reflex, urinary output less than 30, respirations less than 12, decreased LOC, dysrhythmias
-DC,administer calcium, prepare to prevent respiratory/cardiac arrest
Pain Assessment(4)
-PQRST, questions, nonverbal cues
-Anxiety/fear- muscle tension-slows labor
-Cultural beliefs-ASK
-Evaluate- verbal/nonverbal cues
Endometritis-
sites(3)
Expected finding(7)
Treatment(2)
-infection of the uterine lining or endometrium
Most frequently occurring puerperal infection
Usually begins on the 2nd-5th postpartum day, generally starting as a localized infection at the placental attachment site and spreading to include uterine endom
Mastitis-
expected findings(5)
An infection of the breast involving interlobular CT and is usually unilateral
Can progress to an abscess if untreated
Occurs most commonly in mothers breastfeeding for the first time and well after establishment of milk flow, which is usually 6 weeks aft
UTI-
expected findings(5)
treatment(3)
A common postpartum infection secondary to bladder trauma incurred during the delivery or a break in aseptic technique during bladder catheterization
Expected Findings:
-Reports of urgency, frequency, dysuria, and discomfort in pelvic areas
-Fever/ Chills
Vulvovaginitis-
types(2)
risks(4)
expected findings(2)
treatment(2)
-Two types most pertinent: yeast infections, bacterial vaginosis.
-associated with an increased risk: preterm birth and a low-birth-weight baby, preterm premature rupture of the membranes (PPROM), uterine infection, second-trimester miscarriage.
-Thick, w
Gonorrhea
Risks(5)
Infant care(4)
treatment(1)
-Increased risk endometritis after delivery - also miscarriage, amniotic fluid infection, preterm PROM, preterm labor
-Can be passed to newborn during labor and delivery affecting newborns eyes.
-Antibiotic eye ointment/drops is required for ALL newborns
PP Blues(period)
definition
Expected findings(6)
-first days - 10 days
-Definition: Tearfulness, insomnia, lack of appetite and feeling of letdown
-Feelings of sadness/lack of appetite
-Sleep pattern disturbances restless
- insomnia, fatigue,
-Feeling of inadequacies
-Crying easily for no reason, --Head
PP depression(period)
definition
Expected findings(7)
-within 6 months
-Definition: Persistent feelings of sadness and intense mood swings, Rapid decline of estrogen and progesterone
-feelings of guilt/loss/ sadness
-Irritability
- fatigue beyond reasonable amount of time
-Financial inadequacy
-Intense mood
self-care, postop care - when to call the doctor(8)
-Chills or fever: greater than 100.4 degrees for 2 or more days
-Change in vaginal discharge: with increased amount, arge clots, change to a previous lochia color, such as bright red bleeding and foul odor
(Normal: rubra (dark red drainage for 1-3 days; s
Basal Body Temp Method...definition
education-(1)
advantages(3)
disadvantages(2)
-Temperature drops slightly at the time of ovulation
o Education
-Measure oral temperature prior to getting out of bed each morning
o Advantages
-Inexpensive, convenient and no adverse effects
o Disadvantages
-Reliability influenced by stress, fatigue, il
Diaphragm
education-(3)
advantages(1)
disadvantages(3)
Contras(3)
-Dome-shaped cup fits over the cervix with spermicidal cream/gel placed into the dome and around the rim
Education
-Must be properly fitted by a doctor with a diaphragm, Replaced every 2 years, refitted with 20% weight fluctuation/surgery
-Advantage woman
Combined Oral Contraceptives:
education-(1)
advantages(10)
disadvantages(3)
-Contain estrogen and progestin, which acts by suppressing ovulation, thickening the cervical mucus to block semen, and altering the uterine decidua to prevent implantation
Advantages:
-Highly effective if taken correctly and consistently
-Non-contracepti
Progestin-only pills
advantages(2)
disadvantages(4)
Oral progestins that provide the same action as combined oral contraceptives
Advantages:
-Fewer adverse effects when compared with a combined oral contraceptive
-Considered safe to take while breastfeeding
Disadvantages:
-Less effective in suppressing ovu
Contraceptive vaginal ring
advantages(3)
disadvantages(4)
Contains etonogestrel (combo of both) and ethinyl estradiol (estrogen) that is delivered at continuous levels vaginally
Advantages:
-Does no have to be fitted
-Decreases the risk of forgetting to take the pill
-Vaginal route of delivery increases bioavail
Implantable progestin
advantages(4)
disadvantages(3)
Requires a minor surgical procedure to subdermally implant and remove a single rod containing etonogestrel on the inner side of the upper aspect of the arm
Advantages:
-Effective continuous contraception for 3 years
-Can be inserted immediately after abor
Female Sterilization (bilateral tubal ligation)
Procedure
Advantages-3
disadvantages-3
risks-1
A surgical procedure consisting of severance and or burning or blocking the fallopian tubes to prevent fertilization
Procedure:
The cutting, burning, or blocking of the fallopian tubes to prevent the ovum from being fertilized by the sperm
Advantages:
-Pe
Male sterilization (vasectomy)
Procedure
client education(2)
advantages(3)
disadvantages(3)
A surgical procedure consisting of ligation and severance of the vas deferens
Procedure:
The cutting of the vas deferens in the male as a form of permanent sterilization. Reinforce the need for alternate forms of birth control for approximately 20 ejacula