NUR 222

NURS 222 Exam Pain Management in Labor & Fetal Heart Assessment - Correct Answer-Day 7 : Pain Management in Labor & Fetal Heart Assessment Comfort - Correct Answer-Support (physical and emotional) Environment Non-pharmacologic management Childbirth preparation Relaxation and Breathing Effleurage and counter pressure Touch and massage Heat/Cold Application Hydrotherapy Aromatherapy Music Effleurage - Correct Answer-Light, continuous-stroking massage movement applied with fingers and palms in a slow and rhythmic manner. Counterpressure - Correct Answer-Pressure applied to the sacral area of the back during uterine contractions Lamaze breathing - Correct Answer-controlled, slow, deep breathing technique also known as conscious breathing. in combination with support from nurses or loved ones — it reduces labor pain and helps people relax, both physically and mentally. Pharmacological Pain Management - Correct Answer-Use of narcotics in labor Regional analgesia/anesthesia Pudendal Spinal Epidural (can be used as a PCA) Paracervical/local anesthesia General anesthesia What is cricoid pressure? Why is it done? Cricoid Pressure - Correct Answer-Pressure on the cricoid cartilage; applied to occlude the esophagus to inhibit gastric distention and regurgitation of vomitus in the unconscious patient. Allows ET tube to flow into right spot. Contraction Assessment - Correct Answer-- Frequency How far apart? Beginning of 1 to the beginning of the next. - Duration How long from beginning of 1 to the end? - Strength Palpate fundus to feel how strong uterus is contracting Strong contraction won't indent uterine wall -Resting Tone Period in between contractions Resting tone in between contractions Fetal Heart Rate - Correct Answer-Describe auscultation of fetal heart rate - Doppler - Electronic Fetal Monitoring (EFM) -- External/Internal Monitoring Baseline Fetal Heart Rate - Correct Answer-Average FHR rounded to the nearest 5 bpm over a 10 minute period. Fetal Tachycardia - Correct Answer-Greater than 160 bpm. - Usually related to an increase in temperature. Fetal Bradycardia - Correct Answer-Less than 110 bpm for greater than 10 minutes. Short-term variability (STV) - Correct Answer-change in fetal heart rate from one beat to the next. Absent Variability - Correct Answer-amplitude is undetectable Minimal Variability - Correct Answer-Change in less than 5 bpm Moderate Variability - Correct Answer-Babies heart rate staying within 6-25 bpm. **This is what we are looking for** Marked Variability - Correct Answer-Greater than 25 bpm. Fight or Flight. Baby is very excited/stimulated. Accelerations - Correct Answer-FHR goes up related to fetal movement. Up 15 bpm & up for 15 seconds. Decelerations - Correct Answer-Early, Late, Variable, Early Decelerations - Correct Answer-Head Compression Onset: prior to/early in contraction Lowest level: at or before midpoint of the contraction Typically consistent Late Decelerations - Correct Answer-Placental Insufficiency Onset: late in contraction Lowest level: after midpoint of contraction Become consistent & tend to get worse Variable Decelerations - Correct Answer-Cord Compression Onset: anytime -- not related to a contraction at all Prolonged Decelerations - Correct Answer-Decrease in FHR of at least 15bpm below baseline lasting 2-10 minutes Nursing Actions related to Decelerations - Correct Answer-Change position Oxygen Turn off Oxytocin Increase IV fluids Vaginal exam Prepare for emergency Delivery Keep client and family informed VEAL // CHOP - Correct Answer-V - Variable Deceleration E - Early Deceleration A - Acceleration L - Late Decelerate C - Cord Compression H - Head Compression O - Ok! P - Placental Insufficiency Amnioinfusion - Correct Answer-introduction of a solution into the amniotic sac; -Relieve cord compression (variable decels) -Flush out/Thin out Meconium Meconium - Correct Answer-Babies first bowel movement in utero. Thick, green, tarry The patient presents with placental abruption. What type of deceleration does the nurse expect to see? - Correct Answer-Late Deceleration Day 8 : Childbirth Complications - Correct Answer-Day 8 : Childbirth Complications Pre-Term Pregnancy - Correct Answer-Occurs between 20-37 weeks gestation. Late preterm: 34-36 weeks - once in active labor (4-7 cm dilated), it's difficult to stop the process Pre-Term Pregnancy Management Prevention Early Recognition & Diagnosis Lifestyle Modifications - Correct Answer-Prevention - Suppression of uterine activity Early Recognition & Diagnosis - Risk factors: multiples, infections Lifestyle Modifications - House arrest, Bed rest, Admit to Ante-partum unit Pre-Term Pregnancy: Suppression of Uterine Activity - Correct Answer-Tocolytic Therapy Review Med Guide pg 421-422 -Magnesium Sulfate (CNS depressant) -Indocin -Procardia Pre-Term Pregnancy: Promotion of Fetal Lung Maturity - Correct Answer-Review Med Guid pg 423 - Lungs developed @ 39 weeks gestation - Drugs used to stimulate fetal lung maturity - Betamethasone -Dexamethasone Pre-mature rupture of membranes (PROM) - Correct Answer-Spontaneous rupture of the amniotic sac and leakage of amniotic fluid before the onset of labor at any gestational age. - Fever, Flu like symptoms - **Avoid frequent vaginal exams (limit bacteria/infection)** Chorioamnionitis Endometritis Post-term Pregnancy - Correct Answer-Extends more than 294 days or 42 weeks past the LMP Risks - Decreased placental perfusion (late decelerations) - Overweight baby (extra 6 lbs) - Meconium aspiration - Oligohydramnios Dystocia - Correct Answer-Labor that has gone & stops. Malpresentation - Correct Answer-Brow presentation Face presentation Breech Transverse Compound Macrosomia - Correct Answer-large-bodied baby commonly seen in diabetic pregnancies Greater then 4000g (8lbs 13oz) Multiple Gestation - Correct Answer-presence of more than one embryo developing in the uterus during pregnancy Prolapsed Cord - Correct Answer-Umbilical cord comes out before the baby Expect to see variable decelerations Push baby back up into uterus to prevent cord compression Must go back to operating room Amniotic Fluid Embolism - Correct Answer-An extremely rare, life-threatening condition that occurs when amniotic fluid and fetal cells enter the pregnant woman's pulmonary and circulatory system through the placenta via the umbilical veins, causing an exaggerated allergic response from the woman's body - After delivery baby does just fine - MOM complains of cyanotic, chest pain, tachycardic, BP bottoms out - Usually results in Maternal Death Hydramnios (polyhydramnios) - Correct Answer-Greater than 2000 mL of fluid in the amniotic sax Oligohydramnios - Correct Answer-too little amniotic fluid Meconium Stained Amniotic Fluid - Correct Answer-Meconium passage in the amniotic fluid during the antepartum period prior to the start of labor is typically not associated with an unfavorable fetal outcome. The fetus has had an episode of loss of sphincter control, allowing meconium to pass into amniotic fluid. Shoulder Dystocia - Correct Answer-Head is delivered but shoulders become impacted above mother's symphysis pubis. Try to open pelvis as much as possible. A 28-year-old G3P2002 is in labor at 39 weeks of gestation. The client has been in the second stage of labor for 3 hours. Upon reviewing the client's health record, the nurse notes the following findings: 1. Small amounts of bloody show during vaginal exam 2. History of gestational diabetes 3. History of genital herpes