Editing Maternal and Newborn Nursing – RN Flashcards (section)

== Intrapartum ==

;True labor versus false labor: the deciding criterion
:'''Cervical change.''' True labor produces progressive dilation and effacement with regular contractions that intensify, are felt in the back radiating forward, and are not relieved by rest or walking. False labor is irregular, felt in the abdomen, and is relieved by position change or hydration.

;Fetal station
:The relationship of the presenting part to the maternal ischial spines. 0 station means the presenting part is at the spines and is engaged; negative numbers are above, positive numbers are below, in centimeters.

;The most important single indicator of fetal oxygenation on the monitor
:'''Baseline variability.''' Moderate variability (6 to 25 bpm) is reassuring and strongly predicts the absence of metabolic acidemia. Absent or minimal variability with recurrent decelerations is the ominous combination. Fetal sleep, opioids, and magnesium can reduce variability without hypoxia.

;VEAL CHOP
:'''V'''ariable deceleration = '''C'''ord compression; '''E'''arly deceleration = '''H'''ead compression; '''A'''cceleration = '''O'''K; '''L'''ate deceleration = '''P'''lacental (uteroplacental) insufficiency. Late decelerations are gradual, begin after the contraction starts, and return after it ends.

;Category III tracing: definition and response
:Absent variability with recurrent late decelerations, recurrent variable decelerations, or bradycardia, '''or''' a sinusoidal pattern. Response: lateral repositioning, stop oxytocin, IV fluid bolus, oxygen per protocol, vaginal exam to rule out prolapse, correct hypotension, notify the provider, and prepare for expedited birth.

;Tachysystole and the nurse's independent action
:More than 5 contractions in 10 minutes averaged over 30 minutes. The nurse '''independently decreases or stops the oxytocin infusion''', repositions the client, and gives a fluid bolus; terbutaline may be ordered for uterine relaxation.

;Cord prolapse management, including what is never done
:Call for help, insert a gloved hand and elevate the presenting part off the cord, place the client knee-chest or in steep Trendelenburg or exaggerated Sims, stop oxytocin, give oxygen, keep an exposed cord moist with warm sterile saline gauze, and prepare for emergency cesarean birth. '''Never attempt to replace the cord into the uterus.''' The hand stays in place until delivery.

;Shoulder dystocia: what to do and what is contraindicated
:'''McRoberts maneuver''' (sharp hyperflexion of the maternal thighs onto the abdomen) plus '''suprapubic pressure'''. '''Fundal pressure is contraindicated''' because it worsens impaction and risks uterine rupture. Anticipate postpartum hemorrhage and assess the newborn for brachial plexus injury and clavicle fracture.

;Classic presentation of uterine rupture
:Sudden severe tearing abdominal pain, loss of fetal station or a suddenly abnormal or absent fetal heart tracing, cessation of contractions, and signs of hypovolemic shock. Highest risk with a prior classical uterine incision. Immediate surgical delivery is required.

;Most common serious complication of epidural analgesia and the nursing response
:'''Maternal hypotension''' with reduced uteroplacental perfusion and fetal heart rate changes. Response: IV fluid bolus per protocol, lateral positioning, oxygen, and a vasopressor such as ephedrine or phenylephrine as ordered. Also monitor for urinary retention, fever, pruritus, and fall risk from motor blockade.