-
Risk factors for shoulder dystocia.
- abnormal pelvic anatomy
- gestational diabetes
- post date pregnancy
- macrosomia
- assisted vaginal delivery
- protracted active phase of first stage
- protracted second stage
-
Nursing actions for shoulder dystocia.
- McRoberts maneuver
- Suprapubic pressure
- Woods Screw maneuver
- epesiotomy
- fracture clavicle
- Zavanelli maneuver
-
What is McRoberts maneuver?
hyperflexing of mom's legs tightly to abdomen
-
What is Woods Screw Maneuver?
- anterior shoulder is pushed twd baby's chest;
- posterior shoulder is pushed twd baby's back, making baby's head somewhat face mom's rectum.
-
When is the Woods Screw Maneuver performed?
only after the McRoberts maneuver and applying subrapubic pressure
-
What is Zanelli maneuver?
pushing back the head into the birth canal in anticipation of a c-section
-
Nursing care before c-section surgery.
- monitor maternal vs & fetal HR
- ensure patent IV site
- NPO
- preop meds (bicitra, antibiotics)
- Foley
- prepare abdomen
- assist with spinal placement
- position woman on operating table
-
Nursing care after a c-section surgery.
- Care for normal newborn
- monitor vs
- check surg dressing
- palpate fundus/check lochia
- I's & O's
- oxytocin & pain meds
-
What is abruptio placentae?
premature separation of placenta after 20 weeks but prior to delivery
-
Characteristics of abruptio placentae.
- dark red vag bleeding (port wine)
- firm or rock hard contractions & uterine tendernes
- uterine contraction pattern
- uterus may turn blue from blood invading myometrium (Couvelaire uterus)
- retroplacental clotting & damage to uterine wall
- large amts of thromboplastin are released into bld supply
-
What does abruptio placentae usually lead to?
hysterectomy (uterus does not contract well)
-
What can abruptio placentae trigger?
DIC & hypofibrinogenemia
-
Associated RF for abruptio placentae.
- HTN, preeclampsia
- abdominal trauma
- smoking
- cocaine use
- multiple gestation
- sudden decompression of uterus
- maternal age >35 or <20 yrs
- chorioamnionitis
-
Nursing care of abruptio placentae.
- Assess FHR for loss of variabilit &/or late decels
- large bor IV cath for bld admin
- supp O2
- type & cross for 2 units
- assess for hypovolemia & shock
-
What is placenta previa?
placenta is improperly implanted in the lower uterine segment; excessive bld loss from placental separation from lower uterine segment
-
Onset of placenta previa vs abrutptio placentae.
quiet & sneaky; sudden & stormy
-
Definition of HypERtonic labor.
- More than 5 contractions in 10 min OR
- any contraction lasting > 2 min
-
What can hypertonic labor lead to?
- uterine rupture
- placental abruption
- fetal distress/fetal death
- emergency c-section
-
What is precipitous labor?
extremely rapid dilation & effacement of < 3 hrsPrimagravidas: 5cm or > per hour;Multiparas: 10cm per hour
-
Characteristics of pathological jaundice.
- Jaundice within first 24 hours of life
- Total serum bilirubin > 12.9 mg/dL in term infant
- Total serum bilirubin > 15 mg/dL in preterm infant
- Jaundice lasting >1 week in term & 2 wks preterm
-
Main cause of pathological jaundice.
hemolytic disease (mom Rh -, baby Rh +
-
What is transplacental transfer?
transmitted to fetus through placenta (ex. syphillis)
-
What is ascending infection?
ascends into uterus from prolonged ROM
-
What is intrapartal exposure?
Exposure during birth (ex-herpex simplex)
-
What is horizontal transmission of infection in a neonate?
nosocomial
-
What three things put the infant at great risks for acquiring an infection?
-
Signs of PDA.
- Increased O2 needs
- Increased ventilatory settings
- Acidosis
- Hypotension
- heart murmur upper left sternal border
- apnea & bradypnea
- bounding pulses
-
Nursing Axns for PDA.
- Vent support
- monitor I & O; restrict fluid
- prepare family for poss surgery
- give diuretics as ordered
-
Assessment findings for IVH
- bradycardia w/ O2 desat
- hypotonia
- metabolic acidosis
- full/tense anterior fontanel
- seizures
- decreased LOC
- sudden change in condition
-
Nursing action for IVH
- reduce stress by maintaining dark, quiet environment
- admin blood SLOWLY to minimize fluctuations in BP (in a syringe over 4 hrs)
-
S/S of hypoglycemia in an IDM.
- usually w/in 1-2 hrs following delivery;
- tremors
- cyanosis
- apnea
- temperature instability
- poor feeding
- hypotonia
- seizures in severe cases
-
For IDMs, BGL should be checked how often?
(p.899)
- hourly during first 4 hrs of life;
- q 4 hrs til risk period (48 hrs) has passed
- *capillary or venous blood samples*
-
Gestational diabetes is diagnosed of two or more of the following are met or exceeded:
- fasting 95 mg/dL
- 1 hr 180
- 2 hr 155
- 3 hr 140
-
Meds for gest diabetes.
- glyburide
- injectable insulin
-
How is fetal status assessed when mom has gestational diabetes?
- daily kick counts
- nonstress tests beginning at 32 weeks
- ultrasound at 18-20 weeks and again at 28 weeks to monitor fetal growth
|
|
