L & D
This is the normal FHR range
110-160 bpm
This is the 1st line agent for PPH
Pitocin
The expected fundal height the day after delivery
1-2 cm or fingerbreadths below umbilicus
and
midline
1st thing you will do if PP blood loss seems excessive
assess uterine contractility
massage if boggy
Which sign would you see if there was a shoulder dystocia?
turtle sign
The most critical nursing action in caring for the newborn immediately after birth is:
keep airway clear
This is a contraindication for methylergonovine (Methergine)
HTN
Name the pinkish brown vaginal discharge day 4-10 after delivery
Serosa
PPH is defined as:
S&S of hypovolemia
and/or
______ml or more blood loss
1000 or more
How many weeks gestation should she be before an elective induction or c-section?
at least 39 wks
This is the priority assessment when ROM occurs.
Assessing FHR
Name 1 prostaglandin used to ripen the cervix
misoprostol (Cytotec)
dinoprostone (Cervidil)
This is what you will have mom do if you assess her fundus and it is higher than what you'd expect and/or not midline
void
If the mom has excessive PP bleeding and her fundus is firm, what would you anticipate is the cause of her bleeding?
Possibly:
lacerations, hematoma
placental tissue
clotting d/o
When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign that uterine contractions are effective would be:
cervical dilation
Define the 1st stage, active phase of labor
(dilation and contraction frequency)
begins at 6 cm
typically contracting every 2-3 min
When does a postpartum mom get Rhogam? Explain.
Rh incompatibility:
Mom is Rh- and baby is Rh+
Within 72 hrs after delivery
Mom is not sensitized (didn't develop antibodies)
Mom should report if
she is saturating a pad within ___ hr
and/or
passing clots the size of an ____
1 hr or less
egg (golf ball) or larger
Name 1 example of a 2nd line agent that you will give mom if she has excessive PP blood loss
*uterotonic/uterotocic meds
misoprostol (Cytotec)
methyergonovine (Methergine)
hemabate (Carboprost)
What is a major risk for TOLAC?
How would you know it occurred?
*TOLAC= trial of labor after cesarean
Uterine rupture
Late decels
This is a mnemonic used to remember and interpret FHR patterns.
Write it out on the board and explain what each letter stands for.
Variable decels r/t Cord compression
Early decels r/t Head compression
Accels decels r/t Ok (good)
Late decels r/t Placental/utero insufficiency
Preterm labor:
Tocolytics- give indication and 1 example
Glucocorticoids- give indication and 1 example
Magnesium Sulfate- indication
Tocolytics- mag sulfate, nifedipine, terbutaline, indocin. Slows down contractions to buy time for...
GCs-Betamethasone and dexamethasone for fetal lung maturity (stimulates surfactant) *34wks or less
Mag- neuroprotection (protects against CP) *34 wks or less
This is the mnemonic used for mom's postpartum assessment.
Write it out on the board and explain what each letter represents
B= breasts
U= uterus
B= bladder
B= bowels
L=lochia
E= episiotomy/lacerations/or incision (any cut or tear)
E= emotions
Name the 4 most common causes of PPH (*hint: 4 Ts)
and
Which T is the most common?
Tone- uterine atony (most common)
Trauma (laceration, hematoma, inversion, rupture)
Tissue (placental fragment, adherent/invasive placenta)
Thrombosis (coagulopathy/clotting disorder)
What is the mnemonic for shoulder dystocia interventions?
50% of all cases are resolved by which 2 interventions?
H- call for help
E- episiotomy
L- legs (McRoberts maneuver) ********
P- pressure (suprapubic pressure) ********
E- enter maneuvers
R- remove posterior arm
R- roll pt