CNUR 303| QUESTIONS WITH VERIFIED ANSWERS 100% SOLVED| LATEST UPDATE
GUARANTEED PASS
Nursing care with epidural Positioning of patient for procedure
Support patient
Assist Anesthetist
Post epidural Monitoring:
» Vital Signs
» FHR
» Dermatomes
Manage any hemodynamic concerns
Spinal Anesthetic » Local anesthetic injected directly into spinal canal
» Used most commonly in cesarean section
» Very quick onset
Approx. 4 hours
General anesthetic used in emergencies
» Intubation may be difficult
» Risk of aspiration
» Increased pain postoperatively
» Consider PCA after
Bishops score Determines readiness for labor
Cervidil A medication used to ripen the cervix before induction.
,Oxytocin/Syntocinon/Pitocin Given IV according to protocol
30 units/500ml NS hung as secondary line
Used for induction & augmentation of labor
Half-life 5-12 minutes; Steady state plasma concentration 40 min
Chemically similar to ADH (antidiuretic hormone, so prolonged use may lead to urinary
retention)
Released by the posterior pituitary gland
Risk of oxytocin Increased risk of PPH d/t uterine fatigue
Continue in postpartum period - uterus is reliant on oxytocin to contract, so it may go limp and
hemorrhage
Monitor for S&S of PPH
Oxytocin titration NOW EVERYBODY has the same dose regulation (1mu/min and up max
2mu/min q30m)
Labour dystocia than 4 hours of active labor with less than 0.5cm of dilation/hour
Or
>1 hour of active pushing with no descent of presenting part
Risk factors of labour dystocia o High BMI
o Short Stature
o AMA (advanced maternal age)
o Infertility difficulites
o Prior EVC
o Uterine abnormalities
,o Malpresenation
o CPD
o Maternal fatigue, dehydration, electrolyte imbalance
o Inappropriate use/timing of analgesic
Normal contrations: start at top of uterus and squeeze down
hypertonic contractions o Midsection contracts with more force than the fundus
OR
o Contraction is not synchronized
hypotonic contractions o No basal tone
o Insufficient intensity
o Fails to dilate the cervix
o May be due to:
§ Uterine over distention
§ Fetal malposition
Precipitous labor <3 hours of labour to delivery
Perineal tissue
Rapid fetal descent
Complications:
- Location
- Laceration
- Hemorrhage
- Newborn bruising d/t rapid decent into pelvis
, types of breech Frank: bum down, feet up
Complete: crisscross apple sauce
(can try vaginal)
Footling/double footling: foot or feet first
(cesarian)
shoulder dystocia Head is delivered but shoulders become impacted above mother's
symphysis pubis.
shoulder dystocia risk factors Macrosomia
Previous SD
Arrested descent in labor
Prolonged labor
Post-term pregnancy (>40wks)
Maternal obesity
Maternal diabetic - poorly controlled- leads to macrosomnia
Short maternal stature
Operative vaginal delivery
Types of umbilical cord prolapse o Occult/Hidden: Alongside the presenting part
o Overt: Precedes the fetus and can be seen protruding from the maternal vagina or introitus
Assessing uterine activity Frequency: how often are contractions (§ Normal is ≤ 5
contractions in 10 minutes averaged over a 30 minute period)
GUARANTEED PASS
Nursing care with epidural Positioning of patient for procedure
Support patient
Assist Anesthetist
Post epidural Monitoring:
» Vital Signs
» FHR
» Dermatomes
Manage any hemodynamic concerns
Spinal Anesthetic » Local anesthetic injected directly into spinal canal
» Used most commonly in cesarean section
» Very quick onset
Approx. 4 hours
General anesthetic used in emergencies
» Intubation may be difficult
» Risk of aspiration
» Increased pain postoperatively
» Consider PCA after
Bishops score Determines readiness for labor
Cervidil A medication used to ripen the cervix before induction.
,Oxytocin/Syntocinon/Pitocin Given IV according to protocol
30 units/500ml NS hung as secondary line
Used for induction & augmentation of labor
Half-life 5-12 minutes; Steady state plasma concentration 40 min
Chemically similar to ADH (antidiuretic hormone, so prolonged use may lead to urinary
retention)
Released by the posterior pituitary gland
Risk of oxytocin Increased risk of PPH d/t uterine fatigue
Continue in postpartum period - uterus is reliant on oxytocin to contract, so it may go limp and
hemorrhage
Monitor for S&S of PPH
Oxytocin titration NOW EVERYBODY has the same dose regulation (1mu/min and up max
2mu/min q30m)
Labour dystocia than 4 hours of active labor with less than 0.5cm of dilation/hour
Or
>1 hour of active pushing with no descent of presenting part
Risk factors of labour dystocia o High BMI
o Short Stature
o AMA (advanced maternal age)
o Infertility difficulites
o Prior EVC
o Uterine abnormalities
,o Malpresenation
o CPD
o Maternal fatigue, dehydration, electrolyte imbalance
o Inappropriate use/timing of analgesic
Normal contrations: start at top of uterus and squeeze down
hypertonic contractions o Midsection contracts with more force than the fundus
OR
o Contraction is not synchronized
hypotonic contractions o No basal tone
o Insufficient intensity
o Fails to dilate the cervix
o May be due to:
§ Uterine over distention
§ Fetal malposition
Precipitous labor <3 hours of labour to delivery
Perineal tissue
Rapid fetal descent
Complications:
- Location
- Laceration
- Hemorrhage
- Newborn bruising d/t rapid decent into pelvis
, types of breech Frank: bum down, feet up
Complete: crisscross apple sauce
(can try vaginal)
Footling/double footling: foot or feet first
(cesarian)
shoulder dystocia Head is delivered but shoulders become impacted above mother's
symphysis pubis.
shoulder dystocia risk factors Macrosomia
Previous SD
Arrested descent in labor
Prolonged labor
Post-term pregnancy (>40wks)
Maternal obesity
Maternal diabetic - poorly controlled- leads to macrosomnia
Short maternal stature
Operative vaginal delivery
Types of umbilical cord prolapse o Occult/Hidden: Alongside the presenting part
o Overt: Precedes the fetus and can be seen protruding from the maternal vagina or introitus
Assessing uterine activity Frequency: how often are contractions (§ Normal is ≤ 5
contractions in 10 minutes averaged over a 30 minute period)
