NUR2633 Exam 2 Focused Review/– MCH – Study Guide Test 2: Module 3 ,4 and 5 (Labor, Postpartum and Newborn care)

NUR2633 Exam 2 Focused Review/– MCH – Study Guide Test 2: Module 3 ,4 and 5 (Labor, Postpartum and Newborn care) 1. Know the Stages and phases of labor including the physiological changes, the normal progression and the psychological impact to your patient. Know the labs that are essential to have for your patient prior to delivery of baby. Stages of labor First Stage- labor- variable Second stage- delivery of baby- up to 3 hours (2 without anesthesia) Pushing stage. Third Stage- delivery of placenta- 5-30 minutes Fourth Stage- Recovery 2 hours Within the first stage- we have 3 phases. 0-4cm- latent- most variable. Objective signs: cervical change, some effacement, communicative, contractions 8-10 min apart, mild contractions 4-8 cm- active- Intensity in contractions; bloody show- This is where we medicate mom.. 4-6 hours. Contractions are getting closer together and stronger. Membranes may rupture, contractions 2-5 min apart, more focused, less talking, risk to baby is greater, amount of perfusion to baby is less, baby can get hypoxic during long labor with progression 8-10 cm- transitional- rectal pressure- need to bear down and want to push- about 2 hours or less., may scream, writhe around in bed, will not feel any cervix around baby’s head Make sure mom is in a comfortable position and her surroundings are calm and inviting. Squatting or sitting is the best position. CBC, Hep, Rubella, HIV, Syphilis, Group B, Blood type, RH, drug screen, urine analysis 2. Know the reasons and the findings of each vaginal exam. Three pieces of information that we must get during a vaginal exam: Dilation (cervix is opening), station # of cm above the ischial spine is a negative number, below the ischial spine is a positive number, and effacement (from thick to thin)0 %-100% You can also get the presentation of the baby and feel is the membranes are intact. Vaginal exams are done at admission for baseline, when membranes rupture, and when she asks for pain meds, and when patient says she is ready to push. 3. Know the medications of labor and when to administer them. Pitocin- Promotes uterine contractions. Used to begin labor, augment labor and postpartum. We use 2 milliunits per minute which is equal to 6 ml per hour and it is titrated. Lactated Ringers. Every 20-30 minutes we move it up depending on the patient. Frequency of contractions no more than 2-3 minutes apart. Magnesium Sulfate- Preterm labor and pre-eclampsia Nubain and Stadol- Administer for Pain. Methergine (IM and PO after-contraindicated for hypertension) and Hemabate- Prevents hemorrhaging Cytotec- Causes uterine contractions. 4. Know the risks of rupturing membranes and what is the nursing intervention if this occurs spontaneously vs artificially. Infection is the biggest risk. Decrease the amounts of vaginal exams. Check the color and odor of the fluid as well when they ruptured. Baby should be delivered within 24 hours of ruptured membranes. 18 hours into ruptured membranes we administer antibiotics. AROM- Artificial rupture of membranes- fetal heart rate prior to AROM and after to determine if baby is in trouble or not. 5. Pain management – recognizing the risks and nursing interventions of regional anesthesia (epidurals/ spinal) (biggest risk to mom is hypotension – which causes fetal decelerations, so how do we prevent this?) Nubain and Stadol are systemic analgesics that is given during the active phase (peak of the contraction because there is less perfusion happening at that time so baby gets less of the meds). You do not want to give it to early or too late because then it all goes to the baby. Have Narcan in the warmer in case the baby does not have good APGAR score. 6. Preparation for epidural anesthesia also has to be considered as a nursing responsibility. Epidural (regional anesthesia)- Need consent from mom first, CBC w/ platelets, sit still, and give her About 1 liter of fluids. We give fluids to prevent hypotension. Client is placed supine after epidural, so we need to use a wedge under the right hip to decrease the pressure on the vena cava. NO PREGGO CAN LAY SUPINE DUE TO HYPOTENSION BECAUSE IT WILL PUT PRESSURE ON THE VENA CAVA. Vital signs every 5 minutes watching out for hypotension. 7. Know the reasons, risks and nursing interventions of the need for a C/section. This includes post-operative care. Also discuss the option for a VBAC and the criterion needed to start the discussion: incision is the priority. Pre-op Prep for a C-Section: Labs, foley, consent and awake to participate. Ambulate, give Pitocin if client is not progressing. Pitocin needs to be titrated, so we do not end up with a titanic contraction. Fetal hypoxia and uterine fatigue. We allow contractions to get 2-3 or 2-4 minutes apart. When do we do a C-section? Breech, transverse, placenta previa or abruption, prior C-section, baby is too big, cord prolapse, failure to descend, failure to dilate, non-reassuring fetal tracing, infection, herpetic lesion. Post Op for C-section: Vital signs, bleeding, LOC, locate fundus, urine output, No ambulating initially (SCD’s are on), pain management, peri care, listen to lungs/abdomen