Childbearing Family Exam #2-Study Guide

★ Cord prolapse: ○ when the umbilical cord is displaced, preceding the presenting part of the fetus, or protruding through the cervix. ○ This results in cord compression and compromised fetal circulation. ○ Expected findings ■ Client may report 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 decels ■ Excessive fetal movement followed by cessation; suggestive of severe fetal hypoxia. ○ Risk Factors ■ Rupture of amniotic membranes ■ Abnormal fetal presentation ■ Transverse lie: presenting part not engaged, leaving room for the cord to descend ■ Small for gestational age fetus ■ Unusually long cord ■ Multifetal pregnancy ■ Hydramnios or polyhydramnios ○ NURSING INTERVENTIONS ■ Call for assistance immediately/ notify provider ■ Use sterile gloved hand, insert 2 fingers into vagina, apply pressure on either side of the cord to the fetal presenting part to elevate it off of the cord. ■ Reposition the client in a knee-chest, trendelenburg, or side lying position with a rolled towel under the clients right hip to relieve pressure on the cord. ■ Apply a warm, sterile, saline soaked towel to the visible cord to prevent drying and maintain blood flow. ■ Continuous FHR monitoring for decels-which indicate fetal asphyxia/hypoxia ■ Give O2 @ 8-10L/min via face mask to improve fetal oxygenation 1 ■ Initiate IV access, and give IV bolus ■ Prep for immediate vag birth if cervix if fully dilated, or C-section if not. ■ Keep mom and partner informed and educated about interventions. Late decelerations-causes, interventions ○ Slowing of FHR after contraction has started with the return of FHR to baseline well after contraction has ended. ○ Nadir occurs after the peak of the contractions ○ CAUSES/COMPLICATIONS: uteroplacental insufficiency causing inadequate fetal oxygenation, maternal hypotension, placenta previa, abruptio placentae (DIC: too many clots to actually clot the blood), uterine hyperstimulation w/oxytocin, preeclampsia, late or post term pregnancy, maternal diabetes mellitus. ○ NURSING INTERVENTIONS: ■ Place client in side lying position ■ Insert IV cath and increase rate of fluid ■ Discontinue oxytocin if being used ■ Elevate the clients legs, lower head ■ Administer oxygen @ 8-10 L/min via nonrebreather face mask ■ Notify provider ■ Prepare for assisted vag birth or C-section ■ UNCOIL (change position, oxygen-rarely, Oxytocin off, IV fluids, Lower head) Fetal position how to access, what each station means (i.e. -1, 0, +1, etc.) ○ Refers to the relationship of the landmark on the presenting fetal part to the anterior, posterior, or R/L of the maternal pelvis. ○ Right or left side of the MOTHER ○ Fetal presenting part ■ Occiput ■ Mentum (fetal chin) ■ Sacrum ■ Acromion Process (scapula) ○ Anterior, Posterior or Transverse depending on whether the landmark is in the front, back or side of the pelvis. ○ OP: baby looking at pussy ○ OA: baby looking at ass.