Term
| On what 3 criteria is diagnosis of preterm labor dependent? |
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Definition
# Gestational age between 20 and 37 weeks
# •Uterine activity (e.g., contractions)
# •Progressive cervical change (e.g., effacement of 80%, or cervical dilation of 2 cm or greater) |
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Term
| The pregnant woman at 30 weeks with an irritable uterus but no documented cervical change is what? |
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Definition
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Term
| What type of uterine activity is a s/s of preterm labor? |
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Definition
-Uterine contractions occurring every 10 minutes or more frequently and persisting for 1 hour or more.
-Uterine contractions may be painful or painless. |
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Term
| What types of discomfort are associated with preterm labor? |
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Definition
-Lower abdominal cramping similar to gas pains; may be accompanied by diarrhea.
-Dull, intermittent low back pain (below the waist)
-Painful, menstrual-like cramps
-Suprapubic pain or pressure
-Pelvic pressure or heaviness; feeling that the baby is pushing down.
-Urinary frequency |
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Term
| What characteristics of vaginal discharge are related to preterm labor? |
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Definition
-Change in character or increase in amount of usual discharge; thicker (mucoid) or thinner (watery), bloody, brown or colorless, increased amount, odor
-Rupture of amniotic membranes |
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Term
| What are 6 maternal contraindications to Tocolysis? |
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Definition
-Gestational hypertension (eclampsia)
-Active vaginal bleeding
-Intrauterine infection (chorioamnionitis)
-Cardiac disease
-Medical or obstetric condition that contraindicates continuation of pregnancy
-Cervical dilation greater than 6 cm. |
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Term
| What are 5 fetal contraindications to tocolysis? |
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Definition
-Estimated gestational age more than 34 wk.
-Fetal death
-Lethal fetal anomaly
-Acute fetal distress
-Chronic intrauterine growth restriction |
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Term
| What is the purpose of placing the woman on her side during tocolytic therapy? |
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Definition
| Enhances placental perfusion and reduces pressure on the cervix. |
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Term
| What should fluid intake be limited to for moms undergoing tocolytic therapy? |
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Definition
| 1500-2500ml/day, especially if a beta-adrenergic agonist or magnesium sulfate is being administered. |
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Term
| What is magnesium sulfate used for in preterm labor and what is its action? |
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Definition
| As a tocolytic. It is a CNS depressant that relaxes smooth muscles including the uterus. |
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Term
| How is Magnesium sulfate administered and by what route? |
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Definition
| Mix 40g in 1000ml IV solution and puggyback to primary infusion. Administer using a pump. |
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Term
| What is an electrolyte-related side effect of magnesium sulfate tocolytic therapy? |
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Definition
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Term
| What do you tell a mom who is experiencing hot flushes, sweating and dry mouth from Magnesium sulfate tocolytic therapy? |
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Definition
| Some reactions may subside when the loading dose is completed. |
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Term
| What are some intolerable adverse reactions to Magnesium sulfate tocolytic therapy? |
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Definition
-Resp rate less than 12
-Pulmonary edema
-Absent DTRs
-Chest pain
-Severe hypotension
-Altered LOC
-Extreme muscle weakness
-Urine output less than 25-30 ml/hr
-Serum Magnesium level of 10 mEq/L or greater. |
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Term
| What is the nurse's action if intolerable adverse reactions occur during Magnesium sulfate administration? |
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Definition
| Stop the infusion and notify the physician. |
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Term
| What must be on hand during Magnesium sulfate administration to reverse magnesium sulfate toxicity? |
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Definition
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Term
| A woman with which condition should never be given Magnesium sulfate? |
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Definition
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Term
| What does terbutaline (brethine) do and what is it used for? |
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Definition
| Relaxes smooth muscles, inhibits uterine activity, and causes bronchodilation. |
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Term
| How is Terbutaline (brethine) administered? |
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Definition
| Subcutaneous injection of 0.25 mg every 20 min to 3 hours (hold for HR greater than 120 beats/min) |
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Term
| What are some pulmonary maternal adverse effects of Beta-Adrenergic agonists (Betamimetics)? |
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Definition
| -SOB, couging, nasal stuffiness, tachypnea, pulmonary edema |
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Term
| What are some cardiac-related maternal adverse effects of Beta-Adrenergic agonists (Betamimetics)? |
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Definition
| Tachycardia, palpitations, skipped beats, myocardial ischemia, chest pain, hypotension. |
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Term
| What are some nursing considerations of Beta-Adrenergic agonists (Betamimetics)? |
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Definition
-Women should be screened with ECG before therapy begins; maternal heart disease, severe hypertension including preeclampsia, hyperthyroidism, and poorly controlled diabetes mellitus are contraindications.
-Use cautiously if woman has controlled diabetes or migranes.
-Validate that woman is in PTL and is over 20 weeks and less than 35 weeks of gestation. |
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Term
| When would you discontinue the infusion and notify the physician with admin of Beta-Adrenergic agonists (Betamimetics)? |
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Definition
| -Maternal heart rate greater than 120 to 140 beats/min; a |
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Term
| What is the action of calcium channel blockers? |
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Definition
| Relaxes smooth muscles including the uterus by blocking calcium entry. |
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Term
| What medicine is contraindicated with Calcium channel blockers? |
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Definition
| Concurrent use with magnesium sulfate is contraindicated since it can cause severe hypotension. |
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Term
| What is the action of antenatal corticosteroid therapy with betamethasone, dexamethasone? |
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Definition
| Stimulates fetal lung maturation by promoting release of lung surfactant. |
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Term
| What is the indication for antenatal corticosteroid therapy? |
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Definition
| To prevent or reduce the severity of respiratory distress syndrome in preterm infants between 24 and 34 weeks gestation. |
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Term
| What are the adverse effects of antenatal corticosteroid therapy? |
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Definition
| Possible maternal infection, pulmonary edema (if given with beta adrenergic medications), may worsen maternal condition (diabetes, hypertension) |
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Term
| What types of activities should be promoted for a woman on bedrest? |
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Definition
| Those that have meaning, purpose, and value to the individual. |
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Term
| The Woman with PPROM should be taught what regarding self-care? |
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Definition
-Take your temperature and assess pulse every 4 hours when awake.
-Report temp of more than 38 degrees celsius.
-Remain on modified bed rest
-Insert nothing into the vagina
-Do not engage in sexual activity
-Assess for uterine contractions
-Do fetal movement counts daily
-Do not take tub baths
-Watch for foul-smelling vaginal discharge
-Wipe front to back after urinating or having a bowel movement
-Take antibiotics if prescribed; time frequency for around the clock administration; be sure to complete the entire course of treatment.
-See primary health care provider as scheduled. |
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Term
| What information should be taught to mom to help her assess fetal kick counts? |
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Definition
-Choose a time of day when you can sit or lie quietly
-choices for counting strategies are:
*starting at 9am, count the baby's movements until you have counted 10. If you have not counted 10 movements in 12 hours, notify your primary HC provider immediately.
*Count 4 movements, 3 times a day after meals. Most people count 4 movements in 1 hour. If you don't, then count for 1 more hour. If at the end of 2 hours, if you still haven't felt 4 movements, call your primary HC provider immediately. |
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Term
| When does hypertonic uterine dysfunction usually occur? |
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Definition
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Term
| What are some changes in pattern of progress that may be seen in hypertonic uterine dysfunction. |
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Definition
-Pain out of proportion to intensity of contraction.
-Pain out of proportion to effectiveness of contraction in effacing and dilating the cervix
-Contractions increase in frequenct
-Contractions uncoordinated
-Uterus is contracted between contractions. |
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Term
| What are the potential maternal effects of hypertonic uterine dysfunction? |
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Definition
-Loss of control related to intensity of pain and lack of progress.
-Exhaustion |
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Term
| What is the potential fetal effect of hypertonic uterine dysfunction. |
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Definition
| Fetal asphyxia with meconium aspiration. |
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Term
| What is the care management for hypertonic uterine dysfunction |
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Definition
-initiate therapeutic rest measures
-administer analgesic (ag, morphine, nalbuphine, meperidine) if membranes not ruptured or cephalopelvic disproportion not present
-Relieve pain to permit mother to rest
-Assist with measures to enhance rest and relaxation. |
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Term
| What are some causes of hypotonic uterine dysfunction? |
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Definition
| Cause may be pelvic contracture and fetal malposition, over distention of uterus (eg twins), or unknown (primary powers) |
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Term
| What are some changes in pattern of progress seen in hypotonic uterine dysfunction? |
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Definition
-Contractions decrease in frequency and intensity
-Uterus easily indentable even at peak of contraction.
-Uterus relaxed between contractions (normal) |
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Term
| What are the potential maternal effects in a woman with hypotonic uterine dysfunction |
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Definition
| Infection, exhaustion and psychologic trauma |
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Term
| What are 7 things that can be done to facilitate the rotation of the fetal head? |
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Definition
| Leteral abdominal stroking, Hands and knees position, squatting, pelvic rocking, stair climbing, lateral position (lay on side toward which the fetus should turn), and lunges |
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Term
| What are the signs uterine hyperstimulation with oxytocin has occurred? |
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Definition
-Uterine contractions lasting >90 sec and occurring more frequently
-Uterine resting tone >20 mmHg
-Nonreassuring fetal heart tones.
-Abnormal baseline (<110 or >160 bpm)
-Repeated late decelerations or prolonged decelerations. |
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Term
| What interventions can be done for a woman suspected of uterine hyperstimulation with oxytocin? |
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Definition
-Maintain woman in side-lying position
-Turn off oxytocin infusion; increase rate in maintenance IV infusion.
-Start administering oxygen by face mask
-Notify primary HC provider
-Prepare to administer terbutaline (brethine(, 0.25 mg subQ, if ordered to decrease uterine activity
-Continue monitoring FHR and pattern and uterine activity
-Document responses to actions. |
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Term
| What is the best position for administration of oxytocin for induction of labor? |
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Definition
| Side-lying or upright position. |
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Term
| What is the optimum intrauterine pressure during oxytocin delivery that lets the HC provider know to maintain dose? |
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Definition
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Term
| What is the optimal duration of uterine contractions during induction of labor with oxytocin that lets the HC provider know to continue the maintenance dose? |
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Definition
| duration of 60 to 90 seconds. |
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Term
| What is the ritgen maneuver? |
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Definition
| delivery of a child's head by pressure on the perineum while controlling the speed of delivery by pressure with the other hand on the head. |
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Term
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Definition
| asynclitismOblique presentation of the fetal head at the superior strait of the pelvis; the pelvic planes and those of the fetal head are not parallel. |
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Term
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Definition
| the relation of the fetal body parts to each other. |
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Term
| What is biparietal diameter? |
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Definition
| Largest transverse Diameter of the fetal head; extends from one parietal bone to the other. |
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Term
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Definition
| Vaginal discharge that originates in the cervix and consists of blood and mucus; increases as cervix dilates during labor.. |
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Term
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Definition
| Funneling of the internal cervical os |
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Term
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Definition
| cardinal movements of labor The mechanism of labor in a vertex presentation; includes engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and expulsion. |
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Term
| What is the ferguson reflex and why does it occur? |
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Definition
| Stretch receptors in the posterior vagina cause release of endogenous oxytocin that triggers the maternal urge to bear down, or the ferguson reflex |
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Term
| What is lightening and when does it occur? |
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Definition
| Between weeks 38 and 40, fundal height drops as the fetus begins to descend and engage in the pelvis (lightening) |
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Term
| What are the mechanisms of labor? |
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Definition
| in a vertex presentation; includes engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and expulsio |
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Term
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Definition
| a state of CNS depression in the newborn produced by an opioid. |
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Term
| Where does the spiral electrode attach? |
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Definition
| To the presenting part of the fetus. |
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Term
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Definition
| An artificial rupture of membranes which can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if progress begins to slow. |
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Term
| What is the 1st part that enters through the pelvic inlet called? |
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Definition
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Term
| What is a major problem with epidurals? |
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Definition
| They prolong the second stage of labor. |
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Term
| What are reassuring FHR patterns characterized as? |
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Definition
A a baseline FHR in the normal range of 110 to 160 BPM with no periodic decelerations and a moderate baseline variabilirt
-Accelerations with fetal movement |
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Term
| What is a normal uterine activity pattern in labor characterized by? |
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Definition
Contractions occurring every 2 to 5 nin and lasting less than 90 second. They should be moderate to strong in intensity, as evidenced by palpation;
-30 seconds or more should elapse between the end of one contraction and the beginning of the next;
-Between contractions, uterine relaxation should be dectected by palpation or by an average intrauterine pressure of 15 mm Hg or less. |
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Term
| Fetal bradycardia <110 bpm for >10 min, she should? |
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Definition
| Notify primary HC provider. |
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Term
| Fetal tachycardia >160 bpm for >10 min in term pregnancy, she should? |
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Definition
| Change maternal position and discontinue oxytocin if infusing. |
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Term
| Irregular FHR, abnormal sinus rhythm shown by internal monitor, we should? |
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Definition
| Increase IV fluid rate, if fluid being infused per protocol order and administer oxygen at 8 to 10 l/min by snug face mask. |
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Term
| Persistent decrease in baseline FHR variability without an identified cause, we should? |
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Definition
| Check maternal temp for elevation and start an IV line if one is not in place. |
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Term
| Late, severe, variable and prolonged deceleration patterns, we should? |
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Definition
| Assist with amnioinfusion if ordered. |
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Term
| Absence of FHR, we should? |
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Definition
| Stimulate fetal scalp or use sound stimulation. |
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Term
| Intrauterine pressure >75mm Gh shown by intrauterine pressure catheter monitoring. . .this is a sign of what and what should be done? |
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Definition
| Sign of inadequate uterine relaxation, and we should notify the HC provider and discontinue oxytocin if infusing. |
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Term
| Contractions consistently lasting >90 seconds. . .What do we do? |
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Definition
| Change woman to a side-lying position. |
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Term
| Contraction interval is less than 2 minutes, what interventions are appropriate? |
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Definition
| Administer O2 at 8 to 10L/min by snug face mask, start an IV line if one is not in place, palpate and evaluate contractions, give tocolytics as ordered. |
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Term
| Vaginal bleeding (bright red, dark red, or in an amount in excess of that expected during normal cervical dilation, what do we do? |
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Definition
| Notify Doc, anticipate emergency (stat cesarean birth |
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Term
| Continuous vaginal bleeding with FHR changes |
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Definition
| DO NOT perform vaginal exam |
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Term
| foul Smelling amniotic fluid, what do we do? |
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Definition
| This indicates infection...notify HC provider. |
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Term
| Maternal temp >38 degrees C in the presence of adequate hydration (straw-colored urine), what do we do? |
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Definition
| Start an IV line if one is not in place. |
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Term
| Fetal tachycardia >160 beats/min for >10 min. |
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Definition
| Assist with or perform collection of catheterized urine specimin and amniotic fluid sample and send to the lab for urinalysis and cultures. |
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Term
| Fetal bradycardia with variable deceleration during uterine contraction, what do we do? |
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Definition
| Call for assistance and have someone notify the primary HC provider immediately. |
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Term
| Woman reports reports feeling the cord after membranes rupture, what do we do? |
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Definition
| Glove examining hand and insert two fingers into the vagina to the cervix, with one finger on either side of the cord or both fingers to one side, exert upward pressure against the presenting part to relieve compression of the cord. Place a rolled towel under the hip. Place woman in extreme trendelenburg position or modified sims position, or knee to chest position. Wrap cord loosely in a sterile towel saturated with warm, sterily normal saline if the cord is protruding from the vagina. Administer O2 at 8 to 10 L/min by face mask until birth is accomplished. Start IV fluids or increase existing drip rate. Continue to monitor FHR by internal fetal scalp electrode, if possible. Don't attempt to place cord back into cervix (only a retard would do something like this). Prepare for immediate birth (vaginal or cesarean) |
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