OB Emergencies
This is the priority nursing action for a prolapsed cord.
Lift the presenting part off the cord.
This is the most common cause of preterm labor
Infection
Tocolytic that causes tachycardia. Do not use for more than ~24 hours. Used to stop contractions in preterm and term labor.
Terbutaline (Brethine)
Causes painless, bright-red vaginal bleeding. Contraindication to vaginal delivery.
Placenta previa
fetal monitoring is a nursing priority during and after amniotomy because...
umbilical cord compression or prolapse is a risk with rupture of membranes
Nursing actions for shoulder dystocia
1. Call for help
2. As directed by provider, perform McRobert's maneuver and/or apply suprapubic pressure.
Appropriate nursing actions for client with signs/symptoms of hypotension after epidural
Stay with patient, supine or Trendelenburg (with hip tilt), monitor FHR and VS, IVF bolus if needed, administer vaspressor (ephedrine), notify provider
Given to mother in preterm labor to help mature fetal lungs. Requires subsequent dosing over 48 hours.
Betamethasone or Dexamethasone
this is why one-year delay of pregnancy is recommended after a molar pregnancy
surveillance for tumor growth (gestational trophoblastic neoplasia) includes monitoring hCG levels. elevated levels associated with pregnancy could prevent recognition and proper treatment of disease.
A pregnant client reports to the ER with pelvic pain and vaginal bleeding. An ultrasound is performed to determine the location of the fetus because...
a ruptured ectopic pregnancy has a high incidence of maternal mortality
sign/symptoms of placental abruption
abdominal pain, vaginal bleeding, hard abdomen, FHR decels, shock
What are common causes of placental abruption?
Contraindications to amniotomy
contraindications to vaginal delivery (malpresentation, placental previa, preterm unless medically necessary, active herpes lesions, etc), fetal head not engaged in the pelvis (above 0 station)
Given as titrated infusion to induce or augment labor. Also given as bolus for first line prevention/treatment for postpartum hemorrhage.
Oxytocin (Pitocin)
most common cause of intrauterine growth restriction
chronic poor placental perfusion
nursing recommendation for client complaint of no fetal movement when performing daily fetal movement counts
present to office or hospital for non-stress test
nursing actions for intrauterine resuscitation
turn patient to left side, IVF bolus, supplementary O2 if needed, notify provider, treat underlying issue (stop pitocin, give ephedrine, check vaginal exam and respond appropriately)
Post-term fetal/newborn complications
poor placental perfusion, meconium aspiration, birth injuries d/t macrosomia, oligohydramnios
Given for neuroprotection for mother in preeclampsia and for fetus in preterm labor.
Magnesium sulfate
this is the reason asymptomatic bacteriuria is treated during pregnancy
~1/3 of these cases develop into pyelonephritis, requiring hospital admission with fetal monitoring and 48 hours of IV antibiotics. pyelonephritis in pregnancy is associated with preterm birth and maternal sepsis.
nursing action for nonreactive NST after 20 minutes
prolong for another 20 minutes and try vibroacoustic stimulation or other nursing actions to wake fetus
appropriate nursing actions for eclamptic seizure
stay with patient, call for help, protect patient from injury, ensure oxygen and suction are available to use after seizure, monitor VS, FHR, and LOC after seizure
Major risk for trial of labor/vaginal birth after cesarean
uterine rupture
Calcium channel blocker used to reduce blood pressure in preeclamptic patients and as a tocolytic in preterm labor. Side effects include tachycardia and hypotension.
Nifedipine (Procardia)
most common cause of anemia in pregnancy
iron deficiency
greatest risk associated with prolonged rupture of membranes
infection (chorioamnionitis)