COURSE TASK 3

NCMA219

LECTURE
MOMBREROS, Allyssa Jae ORENDAIN, Gregoria Grezhane PEROS, Rica Mae G.
1. ROSEANN IS SCHEDULED FOR AUGMENTATION OF LABOR WITH

OXYTOCIN. WHAT FACTORS WOULD YOU ENSURE ARE IN PLACE

BEFORE AUGMENTATION IS BEGUN?

2
ANSWER:
Augmentation of labor is the process of stimulating the uterus to increase the frequency, duration, and intensity of
contractions after the onset of spontaneous labor. It is commonly used to treat labor that has been delayed when the
assessment or the cause is poor uterine contractions, and potentially prevent cesarean section.
According to Agency of Healthcare and Research Quality these are the factors or the assessment you need to verify
before augmentation is begun:
·It is important to verify and document absence of contraindications for use of oxytocin for induction or augmentation.

Contraindications include:
o Gestational age less than 39 completed weeks that does not have medication indication for induction.
o Fetal macrosomia (estimated fetal weight >4500 grams).
o Placenta or vasa previa.
o Transverse lie or other malpresentation.
o Cord prolapse
o Prior classical uterine incision or previous transfundal uterine surgery.
o Active genital herpes.
1. Verifying and
o Pelvic structural deformities.
documenting
o Invasive cervical carcinoma.
indications for use
·Verify and document that a competent physician is available to perform a cesarean delivery.

·Verify and document the evidence of medical indication for induction or augmentation, gestational age, discussion of

risks and benefits of oxytocin use versus nonuse with the patient and her family. Here are some examples:
o Hypertensive disorders of pregnancy.
o Chorioamnionitis.
o Maternal medical condition severe intrauterine fetal growth retardation.
o Pregnancy exceeding 41 completed weeks.
o Premature spontaneous rupture of membranes with absence of contractions.
ANSWER:
Augmentation of labor is the process of stimulating the uterus to increase the frequency, duration, and intensity of
contractions after the onset of spontaneous labor. It is commonly used to treat labor that has been delayed when the
assessment or the cause is poor uterine contractions, and potentially prevent cesarean section.
According to Agency of Healthcare and Research Quality these are the factors or the assessment you need to verify
before augmentation is begun:

·Document gestational dating and discussion with patient of risks and benefits of elective induction, with consideration

to parity and cervical status for inductions that are scheduled for women at greater than 39 completed weeks without

a medical indication
1. Verifying and

documenting
·It has been 36 weeks since a positive serum or urine human chorionic gonadotropin (HCG) pregnancy test.
indications for use

·Verify and document Bishop score (inductions only). (see the table on the next page)


Feature Modified Bishop Score

0 1 2 3

Dilation (cm) <1 1-2 3-4 >4

<1
Length (cm) or
>4 2-4 1-2
>80
Effacement (%) 0-30 40-50 60-70

Station -3 -2 -1 or 0 +1 or +2

Consistency Firm Medium Soft -

Position Posterior Midposition Anterior -

ANSWER:
Augmentation of labor is the process of stimulating the uterus to increase the frequency, duration, and intensity of
contractions after the onset of spontaneous labor. It is commonly used to treat labor that has been delayed when the
assessment or the cause is poor uterine contractions, and potentially prevent cesarean section.
According to Agency of Healthcare and Research Quality these are the factors or the assessment you need to verify
before augmentation is begun:

2. Assessment

·Assess a 20-minute electronic fetal monitoring EFM tracing strip prior to the administration of oxytocin.

·Assess fetal presentation and station (fetal descent) prior to the administration of oxytocin.

Fetal Assessment ·During oxytocin infusion titration, assess fetal heart rate (FHR), contraction pattern, and intensity every 15

minutes.

Once an adequate contraction pattern is reached, assess FHR and contraction pattern and intensity every 30

minutes.
ANSWER:
Augmentation of labor is the process of stimulating the uterus to increase the frequency, duration, and intensity of
contractions after the onset of spontaneous labor. It is commonly used to treat labor that has been delayed when the
assessment or the cause is poor uterine contractions, and potentially prevent cesarean section.
According to Agency of Healthcare and Research Quality these are the factors or the assessment you need to verify
before augmentation is begun:

2. Assessment

·Assess the cervical status prior to the administration of oxytocin, note for: Effacement, Dilation, Removal of

cervical ripening devices.

·Assess blood pressure, pulse, respiratory rate every hour.

·Assess intake and output every 4 hours.

Maternal Assessment
·Monitor for signs of uterine hypertonus, tachysystole, and uterine rupture: tachysystole (more than five

contractions in a 10-minute window, averaged over 30 minutes):

o Uterine hypertonus (resting tone greater than 20mmHg; verify with internal monitor).
o Abdominal rigidity and pain.
o Hypotension.
o Tachycardia.
o Vaginal bleeding.
ANSWER:
Augmentation of labor is the process of stimulating the uterus to increase the frequency, duration, and intensity of
contractions after the onset of spontaneous labor. It is commonly used to treat labor that has been delayed when the
assessment or the cause is poor uterine contractions, and potentially prevent cesarean section.
According to Agency of Healthcare and Research Quality these are the factors or the assessment you need to verify
before augmentation is begun:

2. Assessment

·Monitor for signs of water intoxication:

o Headache.
o Nausea and vomiting.
Maternal Assessment
o Confusion.
o Decreased urine output (<30mL/hr).
o Hypotension.
Tachycardia, cardiac arrhythmias.
ANSWER:
Augmentation of labor is the process of stimulating the uterus to increase the frequency, duration, and intensity of
contractions after the onset of spontaneous labor. It is commonly used to treat labor that has been delayed when the
assessment or the cause is poor uterine contractions, and potentially prevent cesarean section.
According to Agency of Healthcare and Research Quality these are the factors or the assessment you need to verify
before augmentation is begun:
Provider Notification Parameters:
·Tachysystole (more than five contractions within 10 minutes, averaged over a 30-minute window).
·Contractions lasting 2 minutes or more.
·Contractions of normal duration occurring within 1 minute of one another.
·Insufficient return of uterine resting tone between contractions or via palpation.
·Intraamniotic pressure above 25 mmHg between contractions via intrauterine pressure catheter.

3, Provider notification

Standing Orders for Response to Complications:

parameters and

For tachysystole, the following should be implemented as standing physician orders so that nurses can implement on

standing orders for

time:
response to

complications For Category I FHR pattern and tachysystole:

·Turn patient to left (preferable) or right lateral position.
·Increase maintenance IV rate or administer 500 cc LR IV bolus.

Note: Consider any fluid restrictions the patient may have.

If uterine activity does not return to normal after 10 minutes, decrease the oxytocin rate by at least half; if uterine

activity has not returned to normal after 10 more minutes, discontinue the oxytocin until uterine activity is less than five

contractions in 10 minutes.
ANSWER:
Augmentation of labor is the process of stimulating the uterus to increase the frequency, duration, and intensity of
contractions after the onset of spontaneous labor. It is commonly used to treat labor that has been delayed when the
assessment or the cause is poor uterine contractions, and potentially prevent cesarean section.
According to Agency of Healthcare and Research Quality these are the factors or the assessment you need to verify
before augmentation is begun:

For Category II and III FHR and tachysystole:

3, Provider notification
·Discontinue oxytocin.
parameters and
·Turn patient to left (preferable) or right lateral position.
standing orders for
·Increase maintenance IV rate or administer 500 cc LR IV bolus.
response to

complications Note: Consider any fluid restrictions the patient may have.
Administer oxygen at 8 to 15 L/min. via nonrebreather face mask if the first interventions do not resolve the abnormal

FHR pattern. Discontinue oxygen as soon as possible. If no response, administer terbutaline 0.25 mg SC.
ANSWER:
Augmentation of labor is the process of stimulating the uterus to increase the frequency, duration, and intensity of
contractions after the onset of spontaneous labor. It is commonly used to treat labor that has been delayed when the
assessment or the cause is poor uterine contractions, and potentially prevent cesarean section.
According to Agency of Healthcare and Research Quality these are the factors or the assessment you need to verify
before augmentation is begun:

·Explain to the patient the oxytocin procedure, mobility or diet restrictions if any, availability of wireless fetal

monitoring, and expected results

·Explain the signs of uterine hypertonus or tachysystole and water intoxication to the patient/caregiver
4. Patient comfort and

education ·Ask the patient to rate her comfort level at periodic intervals

·Promote comfort to the patient by using positioning, breathing and relaxation exercises, and medication if needed

Assess the need for increased analgesia or epidural anesthesia

2. THE BABY OF MRS. P IS IN OCCIPITO-POSTERIOR POSITION. SHE IS

EXPERIENCING SEVERE BACK PAIN. WHAT ACTIONS COULD HER

HUSBAND TAKE TO HELP RELIEVE HIS WIFE’S PAIN CAUSED BY THIS

POSTERIOR FETAL POSITION?

2
Answer:
During pregnancy, the body also produces the hormone relaxin, which helps prepare the body for childbirth. One
of the effects of relaxin is the loosening of ligaments throughout the body, making pregnant women less stable and
more prone to injury, especially in their backs.

Here are some ways to help ease her wife back pain:
·Sit in ergonomic chairs with supportive backs or put a small pillow at the small of your back. And try to sit up
straight.

·Stand up straight. Resist the urge to push your belly far forward.

·Apply a warm towel, warm water bottle, or heating pad on the lowest setting.

·Wear an abdominal support garment or maternity pants with wide elastic bands that fit under the belly.

·Get a firm mattress or put a board between your mattress and box spring.

·Sleep on your side, with at least one knee bent. Try using a pregnancy pillow to make sleeping more comfortable.
Or put a pillow between your knees and another under your belly.

·Ask your doctor about recommended stretching exercises and if any low impact exercises are safe for you —
regular exercise can help with back pain.
Answer:
·Get a gentle pregnancy massage if your doctor says it is OKAY.

·Do not take any medications without checking with your doctor first.

·Remind not to lift anything that weighs more than a few pounds. If you have to pick up something heavy (or a small
someone), make sure to lift correctly.

·Do not bend down at the waist; instead, bend at your knees, squat down, and lift with your legs, not your back.

·Do not sit or stand for long periods. If you cannot get around it, use a box or stool to prop up one foot when standing or
both feet when sitting. If you must stand for a long time, make sure to take frequent breaks.

·Back pain also can be a sign of something else, like labor starting or a urinary tract infection. If you have any questions
or concerns, severe pain, pain that isn't getting better, or additional symptoms, they must immediately contact their
doctor.
 3. AFTER RUPTURE OF THE MOTHER’S MEMBRANES, THE FETAL MONITOR SHOWS

VARIABLE DECELERATIONS. ON INSPECTION, YOU ARE ABLE TO SEE THE UMBILICAL

CORD AT THE VAGINAL OPENING. YOU ARE AWARE THAT THIS IS A FETAL EMERGENCY.

IN ORDER OF PRIORITY, WHAT WOULD BE YOUR BEST ACTIONS?

2
Answer:
Umbilical Cord prolapse is the descent of the umbilical cord into the vagina ahead of the fetal presenting part with
resulting compression of the cord between the presenting part and the maternal pelvis causing loss of oxygen to the
fetus. Most common cause is premature rupture of membranes. It also occurs in about 1 of 1000 births.

·Notify the physician immediately and prepare for emergency cesarian birth.

·The client with prolapsed cord should be treated by helping the client elevate her hips to minimize pressure on the cord.

·Knee-chest face-down or steep Trendelenburg position uses gravity to shift the fetus out of the pelvis.

·A gloved hand in the vagina pushes the fetus upward and off the cord.

·Evaluate FHR periodically especially right after the rupture of membranes and again in 5 to 10 mins.
o The fetus may have an abnormal fetal heart rate known as bradycardia or a heart rate of less than 120 beats per
minute.

·It is an emergency situation and cesarean section is usually the route of delivery.
Answer:

·If the client is dilated, vaginal delivery is the most emergent route. Encourage the client to push
and assist with delivery as follows.
o Lower the head of the bed and elevate the client's hips with a pillow or place the client in a
knee-chest position.
o Constantly asses the cord pulsations.
o Wrap the cord gently with gauze soaked in sterile normal saline solution.
·If solved immediately, there may be no permanent injury. The longer the delay, the greater the
chance of complications.
SOURCES:
https://www.ncbi.nlm.nih.gov/books/NBK258881/
https://www.ahrq.gov/hai/tools/perinatal-care/modules/strategies/medication/tool-safe-oxytocin.html
https://my.clevelandclinic.org/health/diseases/12345-umbilical-cord-prolapse?

fbclid=IwAR01YPPdSGDvt47eOExZ2buePZiX0tYWYFhl94hWShKWb4caaf5H-eGXWiQ
https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-notes/cord-prolapse/?

fbclid=IwAR0AB_WTEprzxImbPzAxE9m_w6YVSsJVZ-

f4RH3J5E18WwHXjnXIujPSS6k#:~:text=The%20client%20with%20a%20prolapsed,B%2C%20and%20D%20are%20incorrect