L and D 4 Flashcards
What medication is used for induction or augmentation
- Usually patients are induced with cytotec and then augmented with Pitocin later (after cervix ripens).
- induced with Pitocin and later augmented with rupture of membranes
- The intervention that is first implemented is the method of induction and the second thing and everything after that is the augmented intervention.
What is meant by uterine tachysystole
When the uterus is contracting too much tachysystole (less than 2 minutes apart and lasting 90 sec.)
- fetus-not receiving adequate oxygenation between contractions -> non-reassuring fetal heart tones
- mother-risk for uterine rupture, too tired to push/deliver
What is the objective when using oxytocin (Pitocin)?
create contractions that are strong enough that they will lead to cervical dilation and eventually delivery.
What are the side effects of using this oxytocin? -5
tachysystole, non-reassuring fetal heart tones (hypoxia), uterine rupture, water intoxication, fetal death.
What are some major nursing responsibilities with oxytocin-3
Continuously assess fetal heart tones (category I, II, III), adjust Pitocin drip according to the heart tones and contractions, palpate uterus resting tone between contractions (should be soft between contractions).
Amniotomy (AROM) ~ Artificial rupture of membranes
when the physician ruptures the patients amniotic sac
- increase cervical dilation and the body will release oxytocin which will increase contractions
- speed up the time of delivery.
- Increased risk for prolapsed cord when water breaks (rupture of membranes).
RN responsibilities with AROM-3
pull necessary supplies (amniotic hook, physician’s sterile gloves, place chucks pad under patient, and extra towels) and prepare patient for the procedure (educate and offer a restroom break before).
-most important responsibility=> assess fetal heart tones before, during, and after the procedure for reassuring strip.
Amnioinfusion
fluid infusion to gravity into the uterus via the intrauterine pressure catheter (IUPS)
-sometimes used when oligohydramnios is present, patient has been ruptured a long time and there are non-reassuring fetal heart tones (variables usually due to cord compression).
Amnioinfusion RN responsibilities
monitor the amount of fluid infused and also the amount of fluid that leaks back out (do not want to over distend the uterus ->uterine rupture) and monitor fetal heart tones.
Episiotomy
when the physician creates a perineal incision to increase room for delivery
-intervention should only be used when needed (baby is not fitting during delivery) and not used as a routine procedure with every vaginal birth.
Episiotomy RN responsibilities
ensure that the labor table is set up correctly with all needed supplies and assist during the procedure per physician’s request (hold a leg, anticipate need for sutures post-delivery, anticipate a large baby and possible dystocia, need for NRP, increased risk for postpartum hemorrhage, increased risk for a larger tear, infection).
Assistive births; Forceps or vacuum assisted
mother is too tired/exhausted to push and deliver and the infant is becoming unstable (non-reassuring fetal heart tones) and needs to be delivered now
- close to a vaginal delivery and would prefer that over a cesarean
- physician pulls fetus out during the contraction and with the mother pushing at the same time.
Assistive births; Forceps or vacuum assisted RN responsibilities-6
- anticipate a shoulder dystocia, possible stat cesarean section if this is unsuccessful, need for NRP (baby),
- assess for clavicle fracture (baby), assess fetal head for bleeding/bruises/skin integrity, and increased risk for hemorrhage (maternal).
How does nursing care differentiate for the woman who has experienced a cesarean birth-5
- will recover in PACU for 2 hrs post-delivery before being transported to her postpartum room
- recovery is pretty much the same as for a vaginal birth except there is a surgical incision to assess (bleeding and later also risk for infection/dehisced), vital signs are more frequently, and pain management is different (IV narcotics).
- If the patient had general anesthesia then pain management is more of a focus (feel everything immediately) and airway management may be relevant at first.
- The postpartum nurse will include the surgical site in her assessment but will still include fundal assessments.
- Important to educate patient of how to best care for herself (deep breathing, ambulate, splint when laughing/coughing/repositioning) and why we do what we do (fundal assessments)
What are the type of skin incisions
- low transverse incision is recommended but during an emergency there is not enough time
- vertical incision, AKA classical incision
- higher increased risk for uterine rupture with future pregnancies compared to low transverse incision
- any type of uterine trauma/surgery is at increased risk for uterine rupture
