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NURS 242 Quiz 3 Exam: NURS 242 Quiz 3 (Final)
Questions & Answers
What are some nursing actions that are required prior to preforming a cervical Ripening? (Ans- Maternal Status - vital signs, underlying conditions, SVE, uterine contractions, obtain consent, IV access, ensure pt. voids Fetal well-being - electronic monitoring, non-stress test, possible biophysical profile What are the risks for using Pharmacological cervical ripening? (Ans- Uterine hyperstimulation Nonreassuring fetal heart rate List Nursing Care Items after insertion of a Cervical Ripening Agent has been applied (Ans- Assessment of FHR and uterine activity per institutional policies Patient must stay in bed in side lying position for 30-60 minutes after insertion
Be prepared to treat hyperstimulation What are some examples of Cervical Ripening Agents? (Ans- Prostaglandins: Cervidil insert Cytotec tablet Prepidil gel Cervidil (Dinoprostone) (Ans- is a tampon device that will be placed for 12 hours or until labor Will be on a continuous fetal heart monitor Side Effects: amniotic Fluid embolism , fever, back pain, headache, hypotension, d/n/v , Uterine rupture, UTI Contradictions: C - sections regardless of what kind of cut was made / don't give if mother is also on Oxytocin must wait 30 mins Someone with pulmonary, Hepatic or Renal issues Epilepsy, DM
Oxytocin (Ans- Medication used for induction and/or augmentation in women with a favorable cervix It is not effective as a cervical ripening agent Dosage: 30 units of oxytocin in 500 ml of Lactated Ringers resulting in an infusion rate of 1 mU/min = 1ml/hr *will be administered after ripening agent has been used Why do nurses do to manage Oxytocin? (Ans- changes the rate/dose from feedback from the baby's fetal heart tones Oxytocin Dosage (Ans- Titrate - starting at 1 - 2 mU/min every 30 - 60 minutes until adequate labor progress is achieved Oxytocin should be piggybacked into main IV line Once active labor is achieved, oxytocin should be discontinued What are the S&S of Uterine Hyperstimulation? (Ans- Uterine contraction >5 in 10 minutes Nonreassuring FHR
What are the Nursing interventions of Uterine Hyperstimulation? (Ans- Lateral position Discontinue oxytocin; increase main IV rate O2 by facemask Notify provider Prepare Terbutaline as ordered Continue to monitor Document What are some Nursing Care items when administering Oxytocin? (Ans- Stop oxytocin for 30 - 60 minutes and infuse an IV fluid bolus of Lactated Ringers if there is abnormal uterine activity (uterine tachysystole, low-intensity contractions, coupling or tripling of contractions) This allows oxytocin receptors to be sensitive to artificial oxytocin and produce uterine contractions that will progress labor
- has to be piggybacked into an IV What are some other methods used to help stimulate labor? (Ans- Membrane stripping
Effective for multiparous women with a favorable cervix Fetus must be vertex and well applied to cervix
- After rupture of membrane you must check temp every hour and CBC every 12 hours *Assess FHR immediately after rupture to ensure that the umbilical cord did not prolapse Assess maternal Common Facts about Transcervical Balloon Catheter. - Used for previous C-Section Moms (Ans- Requires direct visualization of the cervix A deflated Foley catheter, 14 - 26 french with a 30 ml balloon, is inserted into the extra-amniotic space, and then inflated above internal os with 30 - 80ml of sterile water Double balloon device also can be used distention stretching of the lower uterine segment and cervix Causes release of prostaglandins Balloon catheter usually falls out when the cervix begins to dilate What are the risks and Nursing interventions for a Transcervical Balloon Catheter? (Ans- Risks: Infection and cervical trauma
Nursing interventions: Document time of insertion Assess for rupture of membranes, bleeding, FHR and UC pattern, and vital signs Common facts about TOLAC / VBAC (Ans- 60 - 80% success rate Considerations Previous vaginal delivery? Type of incision? Reason for prior c-section? Contraindications Breech Infection (herpes) Vertical incision No prostaglandins!!! Nursing Care Management Close observation and assessment of patient and fetus
Shorten second stage of labor Risks (women) Lacerations / Extension of episiotomy / Hemorrhage / Bladder trauma Risks (Newborn) Cephalohematoma Nerve injuries Skin lacerations or bruising Skull fractures Intracranial hemorrhage What conditions are considered Obstetrical Emergencies? (Ans- Shoulder Dystocia Umbilical Cord Prolapse Uterine Rupture Define Shoulder Dystocia (Ans-
The anterior shoulder of the baby becomes impacted by the mother's pelvic rim First sign is retraction of the fetal head against the maternal perineum (Turtle Sign) Must delivery baby within 6 minutes before irreversible brain and organ damage occurs Risk Factors for Shoulder Dystocia (Ans- D - Diabetic mother O - Obesity of mother P - Post-term pregnancy & past hx. Of shoulder dystocia E - Excessive fetal weight > Fetal macrosomia ( a baby that weigh's more than 4,500 ) Maternal Diabetes History of Shoulder Dystocia Prolonged Second Stage of Labor Excessive Maternal weight Gain Unpredictable and Unpreventable What are the Risks Associated with Shoulder Dystocia
Define the Gaskin Maneuver (Ans- Assist the woman in a hands and knees position Position change and effects of gravity provides a safe and rapid delivery *Problem if mother had an epidural Define Cephalic Replacement (Ans- Last resort Provider returns fetal head to maternal pelvis and cesarean section is performed What are the nursing care items for a patient with Shoulder Dystocia (Ans- Explain situation to patient and family Request assistance Ensure neonatal resuscitation team is aware Be cognizant of time elapsing and inform provider Ensure a foot stool is being used for suprapubic pressure Define Umbilical Cord Prolapse (Ans- Occurs when the cord lies below the presenting part of the fetus Define Occult Cord (Ans- Occult cord is when the cord lies beside the baby - You will see deep variable decelerations in the heart rate
What are the Risk Factors for Umbilical Cord Prolapse? (Ans- Malpresentation Unengaged fetus Polyhydramnios - extra amniotic fluid Small or preterm fetus Mulitple gestation High Parity What would you find upon assessment of a Umbilical cord prolapse? (Ans- Sudden fetal bradycardia Variables decelerations Prolapse cord that my be felt with a SVE or visualized What nursing actions would you take during a Umbilical cord Prolapse? (Ans- Lift the presenting part off of the cord Request assistance Change maternal position (trendelenburg or knee chest position/ Gaskin Maneuver) Notify care provider Administer oxygen 10 L/min via mask IV fluid bolus
What are the risks to the baby if the mother has a Uterine Rupture? (Ans- Hypoxemia Neurologic depression Seizures Asphyxia Cerebral palsy Fetal acidosis Death What are the risks to the mother if the mother has a Uterine Rupture? (Ans- Hemorrhage Hysterectomy Hypovolemia Bowel laceration Injury to bladder What are some Assessment findings for a Uterine Rupture (Ans- FHR abnormality Fetal bradycardia Changes in uterine contraction pattern Vaginal bleeding
Loss of fetal station New onset of intense uterine pain What are some nursing Actions for a Uterine Rupture? (Ans- Understand signs and symptoms Request assistance Notify care provider immediately Prepare for emergency cesarean section Inform patient and family of situation List nursing care for a Uterine Rupture (Ans- First impressions are lasting ones. Provide emotional reassurance Explain grief stages/process Encourage & allow parents as much time with baby as needed Offer opportunities to hold, bathe, & dress Provide memory box, footprints, handprints, & photos Provide available grief literature Follow up with patient (phone call & card) What are the signs of forthcoming labor? (Ans- Lightening Braxton-Hicks
define Cephalic Presentation (Ans- The headfirst presentation that occurs in a normal birth Define "breech presentation" (Ans- when the baby's buttocks or both legs appear first during birth Define shoulder presentation (Ans- When the baby's shoulder appears first during birth What are the different types of Breech Presentation? (Ans- Complete Frank Footling Define Complete Breech (Ans- legs flexed on thighs, thighs flexed on abdomen and butt and toes are coming first Define Frank Breech (Ans- thighs flexed, legs extended
and butt is coming first Define Single Footing Breech (Ans- When one leg is stretched and the other is folded with thigh and knee bent What are the Physiologic forces of labor? (Ans- Uterus Contracting Must determine the frequency, duration, and strength of contractions to ensure uterus is contracting effectively in order to have a successful vaginal delivery What are the Psychological parts of labor? (Ans- Age Culture Support System Previous Experience Childbirth Preparation What items should be completed on initial Physical Assessment? (Ans- Monitoring fetal heart rate (FHR) and contraction pattern Vital signs
