Women's Ch. 14 Ricci: Essentials of Maternity, Newborn, and Women's Health Nursing, Fifth Edition well answered

Maternal Assessment During Labor & Birth - ANSWERSMaternal status: -Vital signs -Pain (0-10) -Vaginal examination for baseline ---Cervical dilation ---Effacement ---Membrane status-can take pH in area with nitrozene paper to test for true amniotic fluid ---Fetal descent ---Presentation -Uterine contractions -Leopold's maneuvers First Stage of Labor: Admission Assessment - ANSWERSFetal assessment Lab studies Routine: urinalysis, CBC, blood type, Rh factor PRN: Syphilis, HbsAg screening, GBS, HIV (with woman's consent), and possible drug screening if not included in prenatal history Assessment of psychological status - ANSWERS• If there is no vaginal bleeding on admission, a vaginal examination is performed to assess cervical dilation, after which it is monitored periodically as necessary to identify progress. Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations ). LWW. Kindle Edition. - ANSWERS• Also review the prenatal record to identify risk factors that may contribute to a decrease in uteroplacental circulation during labor. Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations ). LWW. Kindle Edition. Where are the ischial spines - ANSWERSblunted prominences at the midpelvis. Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations ). LWW. Kindle Edition. - ANSWERSWhen membranes rupture, the priority focus should be on assessing fetal heart rate (FHR) first to identify a deceleration, which might indicate cord compression secondary to cord prolapse. Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations ). LWW. Kindle Edition. - ANSWERSSigns of intrauterine infection to be alert for include maternal fever, fetal and maternal tachycardia, foul odor of vaginal discharge, and an increase in white blood cell count. Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations ). LWW. Kindle Edition. what color will the nitrazine yellow dye swab be with amniotic fluid? - ANSWERSBlue; amniotic fluid as basic; vaginal fluid is acidic and turns in yellow. What state is the uterus in during the acme of a contraction? - ANSWERSAt the acme (peak) of the contraction, the entire uterus is contracting, with the greatest intensity in the fundal area. The relaxation phase follows and occurs simultaneously throughout the uterus. Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations ). LWW. Kindle Edition. - ANSWERSTo confirm that membranes have ruptured, a sample of fluid is taken from the vagina via a nitrazine yellow dye swab to determine the fluid's pH. Vaginal fluid is acidic, whereas amniotic fluid is alkaline and turns a nitrazine swab blue. Where does the nurse palpate the uterus to determine strength of contractions? - ANSWERSThe fundus. To palpate the fundus for contraction intensity, place the pads of your fingers on the fundus Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations 17336-17337). LWW. Kindle Edition. What are Leopold's maneuvers? - ANSWERSPerforming Leopold's Maneuvers Purpose: To Determine Fetal Presentation, Position, and Lie Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations ). LWW. Kindle Edition. - ANSWERSPerform the first maneuver to determine presentation. a. Facing the woman's head, place both hands on the abdomen to determine fetal position in the uterine fundus. b. Feel for the buttocks, which will feel soft and irregular (indicates vertex presentation); feel for the head, which will feel hard, smooth, and round (indicates a breech presentation). Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations ). LWW. Kindle Edition. - ANSWERSComplete the second maneuver to determine position. a. While still facing the woman, move hands down the lateral sides of the abdomen to palpate on which side the back is located (feels hard and smooth). b. Continue to palpate to determine on which side the limbs are located (irregular nodules with kicking and movement). - ANSWERSPerform the third maneuver to confirm presentation. a. Move hands down the sides of the abdomen to grasp the lower uterine segment and palpate the area just above the symphysis pubis. b. Place thumb and fingers of one hand apart and grasp the presenting part by bringing fingers together. c. Feel for the presenting part. If the presenting part is the head, it will be round, firm, and ballottable; if it is the buttocks, it will feel soft and irregular. - ANSWERSPerform the fourth maneuver to determine attitude. a. Turn to face the client's feet and use the tips of the first three fingers of each hand to palpate the abdomen. b. Move fingers toward each other while applying downward pressure in the direction of the symphysis pubis. If you palpate a hard area on the side opposite the fetal back, the fetus is in flexion, because you have palpated the chin. If the hard area is on the same side as the back, the fetus is in extension, because the area palpated is the occiput. Also, note how your hands move. If the hands move together easily, the fetal head is not descended into the woman's pelvic inlet. If the hands do not move together and stop because of resistance, the fetal head is engaged into the woman's pelvic inlet (Walker & Sabrosa, 2014). Fetal Assessment During Labor & Birth-Amniotic Fluid Analysis: - ANSWERSClear: Normal Cloudy, foul smelling: Infection Green tinged: Fetal meconium (stress occurred) Fetal Assessment During Labor & Birth-Fetal Heart Rate Monitoring: - ANSWERSHand-held Intermittent Continuous EFM(used with Pitocin, epidural) External Internal (with obese pts, fetal distress) - ANSWERSThe object of FHR monitoring is to reduce the mortality/morbidity by ensuring that all fetal hypoxic insults are identified in time to allow removal or alteration of the reason for it, or to enable a safe birth of the fetus before irreversible asphyxia damage occurs (Hastings, 2015). Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations 17396-17398). LWW. Kindle Edition. How can fetal heart rate be measured externally? - ANSWERSHandheld Doppler device Fetal Assessment During Labor & Birth- Fetal Heart Rate Patterns: - ANSWERSFetal Heart Rate Patterns: Baseline Average rate that occurs over a 10 min segment Normal=110-160 bpm Baseline Variability Minimal/Absent Moderate Marked Periodic Baseline Changes Accelerations Decelerations Early Variable Late Artifact - ANSWERSThe FHR is heard most clearly at the fetal back. Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Location 17443). LWW. Kindle Edition. Fetal Heart Rate Patterns: - ANSWERS-Baseline --Average rate that occurs over a 10 min segment --Normal=110-160 bpm --It is assessed when the woman has no contractions and the fetus is not experiencing episodic FHR changes. ---Fetal bradycardia occurs when the FHR is below 110 bpm and lasts 10 minutes or longer- can be normal or bad Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations ). LWW. Kindle Edition. -Baseline Variability (variability during labor is GOOD) --Minimal/Absent (0-5 beat change/min.) --Moderate (This is BEST) --Marked -Periodic Baseline Changes --Accelerations --Decelerations ---Early ---Variable Late Artifact Nonpharmacologic measures for pain control - ANSWERSNonpharmacologic measures may include continuous labor support, hydrotherapy, hypnosis, ambulation and maternal position changes, transcutaneous electrical nerve stimulation (TENS), acupuncture and acupressure, attention focusing and imagery, therapeutic touch and massage, breathing techniques, and effleurage. Most of these methods are based on the gate control theory of pain, which proposes that local physical stimulation can interfere with pain stimuli by closing a hypothetical gate in the spinal cord, thus blocking pain signals from reaching the brain. Make sure mom knows what is available to her! Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations ). LWW. Kindle Edition. Doula's /Support Person's Role - ANSWERSContinuous encouragement, praise - makes a very big difference to mom! - ANSWERSMoving during labor is better than lying down butorphanol (Stadol) nalbuphine (Nubain) - ANSWERSStadol and Nubain are the IV drugs most often given during labor. These drugs also cause nausea Most important SE of opioids - ANSWERSRespiratory depression for mom and baby -Can only give before 8 cm because after it will affect baby Epidural is infused intermittently or continuously? - ANSWERSMost often continuously through IV Why is a 500-1000 ml fluid bolus given right before epidural? - ANSWERSEpidural causes hypotension What med is injected prior to epidural? - ANSWERSLidocaine - it burns for a few seconds, but is the worst part of the epidural procedural! Local infiltration for: - ANSWERSlidocaine injection for episiotomy or laceration Pudendal nerve block (nerve inside vaginal wall that causes a lot of pain) - ANSWERSepisiotomy or surgical delivery Spinal/Intrathecal normally used only for: - ANSWERSC-section General anesthesia used when? - ANSWERSEmergency C-section or some reason the mom can't take epi Why provide anticipatory info for mom and support? - ANSWERS1st time moms have often never been in hospital before due to being healthy! First stage of labor: phone assessment - ANSWERSEstimated date of birth Fetal movement; frequency in past few days Other premonitory signs of labor experienced Parity, gravida, and previous childbirth experiences Time frame in previous labors Characteristics of contractions Bloody show and membrane status (whether ruptured or intact) Presence of supportive adult in household or if she is alone She should then call her provider who will probably want to assess First stage of labor: eat? - ANSWERSNo, just in case a C-section needs done Vitals assessment - ANSWERSQ 60 min during latent phase (drive V6L when you want to be Loud) Vitals assessment - ANSWERSQ 30 min active and transition (drive V3AT V3 All other Times) How often document contractions during phases - ANSWERSLatent phase: Q 30-60 min Active phase: Q 15-30 min Transition: Q 15 min How often document fetal HR during phases - ANSWERSLatent phase: Q 30-60 min Active phase: Q 15-30 min Transition: none When the membranes rupture, the nurse should assess: - ANSWERSFetal heart rate Fluid color, odor, amount 2nd Stage Nursing Management - ANSWERSNewest research says don't hold breath while bearing down, but we'll see it in MUSC Vaginal exams during labor - ANSWERSAs infrequently as possible to avoid infection When to push? - ANSWERSBest to wait to push until latest possible time to conserve mom's energy and perineum Why does nurse dry baby right after birth? - ANSWERSWarms, stimulation, put with mom skin to skin or heat source if mom can't. What is APGAR score and when is it taken? - ANSWERS1 minute and 5 minutes after birth: 1 min. average = 8; 5 min. average = 9 (color is the one taken off most often) Assess the newborn by assigning an Apgar score at 1 and 5 minutes. The Apgar score assesses five parameters scored 0, 1, or 2 (1) heart rate (absent, slow, or fast), (2)respiratory effort (absent, weak cry, or good strong yell), (3) muscle tone (limp, or lively and active), (4) response to irritation stimulus, and (5) color—that evaluate a newborn's cardiorespiratory adaptation after birth. The parameters are arranged from the most important (heart rate) to the least important (color). The newborn is assigned a score of 0 to 2 in each of the five parameters. The purpose of the Apgar assessment is to evaluate the physiologic status of the newborn; see Chapter 18 for additional information on Apgar scoring. Ricci, Susan. Essentials of Maternity, Newborn, and Women's Health Nursing (Kindle Locations ). LWW. Kindle Edition. Why is pitocin given right after delivery of placenta if not during? - ANSWERSTo reduce risk of uterine hemorrhage. Also massage uterus to reduce 4th stage - recovery stage- lasts - ANSWERSfor about 4 hours after birth. Watch for bleeding, promote family bonding, take vitals Q15 1st hour, then Q 30 next hour Why is having an empty bladder important after delivery? - ANSWERSBladder must empty or fundus will become boggy vs firm. VEAL CHOP-which relates to fetal heart rate. - ANSWERSVariable decels => Cord compression (usually a change in mother's position helps) Early decels => Head compression (decels mirror the contractions; this is not a sign of fetal problems) Accelerations => OK/O2 (baby is well oxygenated-this is good) Late decels => Placental utero insufficiency (this is bad and means there is decreased perfusion of blood/oxygen/nutrients to the baby).