Chapter 14 - Labor and delivery nursing management

A client is scheduled for a cesarean section under spinal anesthesia. After instruction is given by the anesthesiologist, the nurse determines the client has understood the instructions when the client states:

"I may end up with a severe headache from the spinal anesthesia." Cerebrospinal fluid (CSF) leakage from the needle insertion site and irritation caused by a small amount of air that enters at the injection site and shifts the pressure of the CSF causes strain on the cerebral meninges, initiating headache pain.

The nurse in an obstetric clinic is conducting client education with a group of expectant mothers. One young woman asks the nurse to tell the group what labor pain is like. What would be the nurse's best response?

"The pain of labor is unique and multidimensional. It originates from different places depending on what stage of labor you are in." Pain sensations associated with labor originate from different places, depending on the stage of labor.

Nuchal cord

*Called umbilical cord*

Maternal assessment during labor and birth

- Assess maternal vital signs, including temperature, blood pressure, pulse, respiration, and pain, which are primarily components of the physical exam and ongoing assessment - Also review the prenatal record to identify risk factors that may contribute to a decrease in uteroplacental circulation during labor. - 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. - Evaluate maternal pain and the effectiveness of pain management strategies at regular intervals during labor and birth.

Vaginal examination

- Digital vaginal exam at intervals of 4 hours for routine assessment & identification of a delay in active labor - The purpose of performing a vaginal examination is to assess the amount of cervical dilation, the percentage of cervical effacement, and the fetal membrane status and to gather information on presentation, position, station, degree of fetal head flexion, and presence of fetal skull swelling or molding

Each maneuver answers a question:

- Maneuver 1: What fetal part (head or buttocks) is located in the fundus (top of the uterus)? - Maneuver 2: On which material side is the fetal back located? (Fetal heart tones are auscultated through the back of the fetus) - Maneuver 3: What is the presenting part? - Maneuver 4: Is the fetal head flexed and engaged in the pelvis?

Uterine contractions during labor

-*Power of labor is uterine contractions* -Uterine contractions cause tension on the cervix, which leads to cervical dilation and thinning, which eventually forces the fetus through the birth canal. -Normal uterine contractions have a contraction (systole) and relaxation (diastole) phase. -The contraction resembles a wave, moving downward to the cervix and upward to the funds of the uterus. -Each contraction starts with a building up (increment), gradually reaching an acme (peak intensity), then letting down (decrement). Each contraction is followed by an interval of rest, then the next contraction begins. -During the acme (peak) of contraction, the entire uterus is contracting with the greatest intensity in the fundal area.

Analysis of amniotic fluid

-Amniotic fluid should be clear when the membranes rupture -Cloudy or foul smelling indicates an infection -Green may indicate the fetus has passed meconium secondary to transient hypoxia, prolonged pregnancy, cord compression, intrauterine growth restriction, maternal hypertension, diabetes, or chorioamnionitis ((however, green is considered normal if the fetus is in a breech presentation))

Fetal tachycardia

-Baseline FHR greater than 160 ppm and last 10 min or longer -fetal hypoxia, maternal fever, maternal dehydration, amnionitis, drugs (e.g., cocaine, amphetamines, nicotine), maternal hyperthyroidism, maternal anxiety, fetal anemia, prematurity, fetal infection, chronic hypoxemia, congenital anomalies, fetal heart failure, and fetal arrhythmias.

As the woman progresses through the first stage of labor, nursing interventions include:

-Encouraging the woman's partner to participate -Keeping the woman and her partner up to date on the progress of the labor -Orienting the woman and her partner to the labor and birth unit and explaining all of the birthing procedures -Providing clear fluids (e.g., ice chips) as needed or requested -Maintaining the woman's parenteral fluid intake at the prescribed rate if she has an IV -Initiating or encouraging comfort measures, such as backrubs, cool cloths to the forehead, frequent position changes, ambulation, showers, slow dancing, leaning over a birth ball, side-lying, or counterpressure on lower back

For low risk women, when should the FHR and contraction characteristics be assessed?

-Every 15-30 mins in active labor and every 5-15 mins while pushing, as well as before and after any digital vaginal examinations, membrane rupture, medication administered, and ambulation to the restroom

Assessment involves identifying the signs typical of the second stage of labor, including:

-Increase in apprehension or irritability -Spontaneous rupture of membranes -Sudden appearance of sweat on upper lip -Increase in blood-tinged show -Low grunting sounds from the woman -Complaints of rectal and perineal pressure -Beginning of involuntary bearing-down efforts

Guidlines for assessing fetal HR

-Initial 10- to 20-minute continuous FHR assessment on entry into labor/birth area -Completion of a prenatal and labor risk assessment on all clients -Intermittent auscultation every 30 minutes during active labor for a low-risk woman and every 15 minutes for a high-risk woman -During the second stage of labor, every 15 minutes for the low-risk woman and every 5 minutes for the high-risk woman and during the pushing stage

Assessing uterine contractions

-Measured by palpation of fundus & electronic monitoring. -Assessment of the contraction includes frequency, duration, intensity, and the uterine resting tone. -Uterine contractions with 30 mmHg or greater initiate cervical dilation. -During active labor, the intensity reaches 50-80 mmHg. -Resting tone is between 5-10 mmHg in early labor and between 12-18 mmHg in active labor. -To palpate the fundus, place the pads of your fingers on the fundus and describe how it feels: like the tip of the nose (mild), like the chin (moderate) or like the forehead (strong). -palpation of intensity is a subjective judgement; a descriptive term is assigned (mild, moderate, strong) -The 2nd method is electronic monitoring, either external or internal.

FHR Pattern Category 2

-Not predictive of abnormal fetal acid-base status, but requires evaluation and continued surveillance -Fetal tachycardia: >160 -Fetal bradycardia: <110 Absent baseline variability not accompanied by recurrent decelerations -Minimal or marked variability -Recurrent late decelerations with moderate baseline variability -Recurrent variable decelerations accompanied by minimal or moderate baseline variability; overshoots, or shoulders -Prolonged decelerations >2 min but <10 min

Fetal bradycardia

-Occurs when FHR is below 110 ppm and lasts 10 mins or longer. -Causes of fetal bradycardia might include fetal hypoxia, prolonged maternal hypoglycemia, fetal acidosis, administration of analgesic drugs to the mother, hypothermia, anesthetic agents (epidural), maternal hypotension, fetal hypothermia, prolonged umbilical cord compression, and fetal congenital heart block

Pudendal block

-Refers to the injection of a local anesthetic agent (bupivacine, ropivacaine) into the pudendal nerves near each ischial spine. It provides pain relief in the lower vagina, vulva, and perineum. -Used in the 2nd stage of labor, an episiotomy, or an operative vaginal birth with outlet forceps or vacuum extractor. It must be administered 15 mins before it would be needed to ensure full effect. -A transvaginal approach is used to inject an anesthetic agent at or near the pudendal nerve branch.

Baseline fetal heart rate

-The avg FHR that occurs during a 10 minute segment that excludes periodic or episodic rate changes (like tachy or bradycardia_ -It is assessed when the woman has no contractions and the fetus is not experiencing episodic FHR change -The NORMAL BASELINE is 110-160 ppm

Analysis of the FHR

-Used to determine fetal oxygen status -Fetoscope, Doppler device, or continuously with an electric fetal monitor applied externally or internally.

FHR location

-heard most clearly at the fetal back -in a cephalic presentation, best heard in the lower quadrants of the maternal abdomen -in a breech presentation, it is heard at or above the level of the maternal umbilicus -as labor progresses, FHR location changes as the fetus descends into the maternal pelvis for birthing process -to ensure the maternal HR is not confused with the fetal's HR, palpate the mom's radial pulse simultaneously while the FHR is being listened to at the abdomen -If the FHR is not found quickly, locating the fetal back by performing Leopold's maneuvers may help

FHR Pattern Category 1

-normal fetal acid-base status & does not require interventions -Baseline rate (110-160) -Present or absent accelerations -Present or absent early decelerations -Can be monitored with intermittent auscultation during labor

Fetal deceleration

-transient fall in FHR caused by stimulation of the parasympathetic nervous system. Decelerations are described by their shape and association to a uterine contraction. They are classified as early, late, and variable only

Fetal heart rate monitoring reveals baseline tachycardia in the fetus. Which rate would be most likely?

164 bpm A fetal heart rate of 164 beats per minute (bpm) indicates fetal tachycardia. The normal range of FHR is between 120 and 160 bpm. When the FHR is above 160 bpm, it should be considered as fetal tachycardia. Therefore, a FHR of 164 beats per minute is considered tachycardia.

A woman is admitted to the labor and birthing suite. Vaginal examination reveals that the presenting part is approximately 2 cm above the ischial spines. The nurse documents this finding as:

2 station

Assessment: vital signs (BP, pulse, respiration)

2nd stage: Every 5-15 min 3rd stage: Every 15 min 4th stage: Every 15 min

Assessment: FHR

2nd stage: Every 5-15 min by Doppler or continuously by EFM 3rd stage: Apgar scoring 1 and 5 min 4th stage: Newborn- complete head-to-head assessment; vital signs every 15 min until stable

Assessment: Contractions/uterus

2nd stage: Palpate every one 3rd stage: Observe for placental separation 4th stage: Palpating for firmness and position every 15 min for first hour

Assessment: Bearing down/pushing

2nd: Assist with every effort 3rd: None 4th: None

Behavior/psychosocial

2nd: Observe every 15 mins: cooperative, focus is on work of pushing newborn out 3rd: Observe every 15 mins: often feelings of relief after hearing newborn crying: calmer 4th: Observe every 15 mins: usually excited, talkative, awake; needs to hold newborn, be close, and inspect body

Vaginal discharge

2nd: observe for signs of descent - bulging of perineum, crowning 3rd: Assess bleeding after expulsion 4th: Assess every 15 min with fundus firmness

Fetoscope

A modified stethoscope attached to a headpiece. Use for intermittent FHR monitoring involving auscultation via fetoscope.

How to confirm that membranes have ruptured

A sample of fluid is taken from the vagina with a nitramine yellow dye swab to determine the fluid's pH. Vaginal fluid is acidic, where amniotic fluid is alkaline and turns the swab blue. (A false positive result can occur if women are experiencing a large amount of bloody show, because blood is alkaline) The membranes are intact if the swab remains yellow-olive green with a pH of 5-6. If the swab turns blue-green to a deep blue with a pH of 6.5-7.5 the membranes have ruptured.

A client in the latent phase of the first stage of labor is noted to be uncomfortable with intact membranes and mild contractions on assessment. The nurse should encourage the client to pursue which action?

Ambulation ad lib To facilitate the first stage of labor, ambulation and movement will allow better fetal descent and help to speed the labor process. Bed rest will slow or stop the labor process. The client may use the bathroom as needed, but this does not affect labor rate. The client should remain mobile.

Which statement is true regarding analgesia versus anesthesia?

Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area. Systemic analgesia should be used with caution near the time of birth because it can cause respiratory depression, in addition to decreased FHR variability. Hypotension is a common side effect of regional anesthesia.

The labor nurse reports to the nurse on the oncoming shift, "The woman in labor room 2 is handling her pain very well. She smiles whenever I go in to talk to her, and she doesn't complain at all!" What assessment by the oncoming labor nurse would best reveal if the off-going labor nurse's observations were correct?

Asking the woman to describe her pain and rate it on a scale of 0-10 It is important to be nonjudgmental when assisting a woman to cope with pain. Some nurses feel strongly that a woman should have a "natural" childbirth without medication. Other nurses do not understand why any woman would want to "suffer" through labor without an epidural. In both situations, the nurse is in danger of not providing the support that the laboring woman needs and deserves. Rarely is there a completely pain-free labor. Even when a woman plans for an epidural, she frequently reports severe pain before the epidural is administered. Caregivers commonly underrate the severity of pain when compared with the woman's ratings

The nurse is reviewing the medication administration record (MAR) of a client at 39 weeks' gestation and notes that she is ordered an opioid for pain relief. Which is an assessment priority after administering?

Assess FHR After administering an opioid to a laboring mother, the priority is to assess the impact on the fetus. Opioid administration can cross the placental barrier with symptoms including assessing heart rate and variability. After birth, there may be a decrease in alertness. Maternal factors of a decreased blood pressure, constipation and dry month are of a lower priority.

During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor?

Assess amount of cervical dilation If vaginal bleeding is absent during admission assessment, the nurse should perform vaginal examination to assess the amount of cervical dilation. Hydration status is monitored as part of the physical examination. A urine specimen is obtained for urinalysis to obtain a baseline. Vital signs are monitored frequently throughout the maternal assessment.

Assessing the FHR

Assess and document fetal status at least every 30 minutes. Record the baseline FHR every 30 minutes and evaluate the fetal monitor tracing for abnormal patterns. Variability should be present, except for brief periods of fetal sleep or when the mother receives narcotics or other selected medications, and no late decelerations should be present. Accelerations of the FHR are normal.

Which of the following is a priority when caring for a woman during the fourth stage of labor?

Assessing the uterine fundus

A pregnant woman admitted to the labor and birth suite undergoes rapid HIV testing and is found to be HIV-positive. Which of the following would the nurse expect to include when developing a plan of care for this women? (Select all that apply.)

Avoidance of scalp electrodes for fetal monitoring Refraining from obtaining fetal scalp blood for pH testing Administering zidovudine at the onset of labor

When applying the ultrasound transducers for continuous external electronic fetal monitoring, at which location would the nurse place the transducer to record the FHR?

Between the umbilicus and the symphysis pubis

A client states, I think my waters broke! I felt this gush of fluid between my legs. The nurse tests the fluid with Nitrazine paper and confirms membrane rupture if the paper turns:

Blue

How can you reduce the need for episiotomy?

By squatting and apply pressure evenly distributed to the perineum

A woman in labor is to receive continuous internal electronic fetal monitoring. The nurse reviews the woman's medical record to ensure which of the following as being required? **Maybe?**

Cervical dilation of 2 cm or more

A clients membranes spontaneously ruptured, as evidenced by a gush of clear fluid with a contraction. Which of the following would the nurse do next?

Check the fetal heart rate When the fetal membranes rupture, spontaneously or artificially, assess the FHR and check the amniotic fluid for color, odor, and amount. Assess the FHR intermittently or continuously via electronic monitoring. During the latent phase of labor, assess the FHR every 30 to 60 minutes; in the active phase, assess FHR at least every 15 to 30 minutes.

A nurse is assisting with the delivery of a newborn. The fetal head has just emerged. Which of the following would be done next?

Checking for the cord around the neck

Which of the following would be most appropriate for the nurse to suggest about pushing to a woman in the second stage of labor

Choose whatever method you feel most comfortable with for pushing

The nurse notes persistent early decelerations on the fetal monitoring strip. Which of the following would the nurse do next?

Continue to monitor the FHR because this pattern is benign

The nursing instructor is preparing a class discussing the role of the nurse during the labor and birthing process. Which intervention should the instructor point out has the greatest effect on relieving anxiety for the client?

Continuous labor support by a caring nurse or doula can help decrease a woman's anxiety during labor. Anxiety causes the release of catecholamines, which slow down the labor process. The continuous support helps keep the woman focused on what is important as well as provide necessary guidance and education as needed. The massage therapy, prenatal classes, and pharmacologic pain management are all tools that the nurse can use to help the woman.

Artifact

Describes irregular variation or the absence of the FHR on the fetal monitor record that result from mechanical limitations of the monitor or electrical interference. (If a monitor picks up transmission from a truck driver, etc)

A 39-week-gestation client presents to the labor and birth unit reporting abdominal pain. What should the nurse do first?

Determine if the client is in true or false labor When a nurse first comes in contact with a pregnant client, it is important to first ascertain whether the woman is in true or false labor. Information regarding the number of pregnancies or history of drug allergy is not important criteria for admitting the client. The healthcare provider should be notified once the nurse knows the client's current status.

Effacement & dilation are used to assess cervical changes as follows:

Effacement -0% cervical canal is 2cm long -50% cervical canal is 1 cm long -100% cervical canal is obliterated Dilation: -0 cm: external cervical os is closed -5 cm: external cervical os is halfway dilated -10 cm: external os is fully dilated & ready for birth passage

A woman in early labor is using a variety of techniques to cope with her pain. When the nurse enters the room she notes that the woman is making light, circling movements with her fingertips across her abdomen. What technique is she using?

Effleurage Effleurage is a form of touch that involves light circular fingertip movements on the abdomen and is a technique the woman can use in early labor. The theory is that light touch stimulates the nerve pathways to the brain and keeps them busy, thereby blocking the pain sensation

A woman has just entered the second stage of labor. The nurse would focus care on which of the following?

Encouraging the woman to push when she has a strong desire to do so

When planning the care of a woman in the active phase of labor, the nurse would anticipate assessing the fetal heart rate at which interval?

Every 15-30 mins

The nurse is performing Leopolds maneuvers to determine fetal presentation, position, and lie. Which action would the nurse do first?

Feel for the fetal buttocks or head while palpating the abdomen

What is the most common etiology of fetal injury and death that can be prevented by optimal fetal surveillance during labor and early interventions?

Fetal hypoxia

A nurse palpates a woman's fundus to determine contraction intensity. Which of the following would be most appropriate for the nurse to use for palpation?

Finger pads

A nurse is completing the assessment of a woman admitted to the labor and birth suite. Which of the following would the nurse expect to include as part of the physical assessment? (Select all that apply.)

Fundal height measurement, membrane status, contraction pattern

Which type of anesthesia is anticipated when the delivery of the fetus must be done quickly due to an emergency situation?

General This is reserved for emergencies in which the fetus must be delivered immediately to save the life of the fetus, mother, or both. Regional anesthesia provides pain relief during labor and birth. Local anesthesia is typically a short-acting anesthesia used to numb the perineum.

Fetal baseline variability

Irregular fluctuations in the baseline feel HR, which is measured as the amplitude of the peak to trough in bpm. variability is one of the most important characteristics of the FHR. Variability is described in four categories as follows: fluctuation range undetectable fluctuation range observed at <5 bpm fluctuation range from 6 to 25 bpm fluctuation range >25 bpm

Episiotomy

Is an incision made in the perineum to enlarge the vaginal outlet and theoretically to shorten the second stage of labor. Alternative measures such as warm compresses and continual massage with oil have been successful in stretching the perineal area to prevent cutting it. The midline episiotomy has been the most commonly used one in the United States because it can be easily repaired and causes the least amount of pain. The application of warmed compresses and/or intrapartum perineal massage is associated with a decrease in trauma to the perineal area and reduced the need for an episiotomy.

What is leopard's maneuvers

Method for determining the presentation, position, and lie of the fetus through the use of specific four steps. Involves inspection and palpation of the maternal abdomen as a screening assessment for malpresentation. A longitudinal lie is expected, and the presentation can be cephalic, breech, or shoulder.

When palpating the fundus during a contraction, the nurse notes that it feels like a chin. The nurse interprets this finding as indicating which type of contraction?

Moderate

A nurse is assessing a woman after birth and notes a second-degree laceration. The nurse interprets this as indicating that the tear extends through which of the following?

Muscles of perineal body

The client is requesting information on the various pain medication management techniques that are available so she can decide which option she would like to choose for her impending birth. While gathering together the information, the nurse would indicate which technique as becoming very popular and effective?

Neuraxial analgesia/anesthesia This is the administration of analgesic or anesthetic agents, either continuously or intermittently, into the epidural or intrathecal space to relieve pain. Neuraxial analgesia does not interfere with the progress or outcome of labor. This technique involving minimal motor blockade has become more popular. The most important complication associated with systemic analgesics is respiration depression. Systemic analgesia and regional analgesia/anesthesia have become less common due to their potential complications.

When assessing fetal heart rate, the nurse finds a heart rate of 175 bpm, accompanied by a decrease in variability and late decelerations. Which of the following would the nurse do next?

Notify HCP

Interventions for category 3 Patterns:

Notify the health care provider about the pattern and obtain further orders, making sure to document all interventions and their effects on the FHR pattern. Discontinue oxytocin or other uterotonic agent as dictated by the facility's protocol, if it is being administered. Turn the client on her left or right lateral, knee-chest, or hands and knees to increase placental perfusion or relieve cord compression. Administer oxygen via nonrebreather face mask to increase fetal oxygenation. Increase the intravenous fluid rate to improve intravascular volume and correct maternal hypotension. Assess the client for any underlying contributing causes. Provide reassurance that interventions are to effect pattern change. Modify pushing in the second stage of labor to improve fetal oxygenation. Document any and all interventions and any changes in FHR patterns. Prepare for an expeditious surgical birth if the pattern is not corrected in 30 minutes.

The nurse is preparing an educational event for pregnant women on the topic of labor pain and birth. The nurse understands the need to include the origin of labor pain for each stage of labor. What information will the nurse present for the first stage of labor?

Pain originates from the cervix and lower uterine segment. Pain sensations associated with labor originate from different places depending on the stage of labor. During the first stage of labor, the stretching required to efface and dilate the cervix stimulates pain receptors in the cervix and lower uterine segment.

A woman's amniotic fluid is noted to be cloudy. The nurse interprets this finding as which of the following?

Possible infection

A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage?

Practicing effleurage on the abdomen In early labor, the less medication use the better; allow use of nonpharmacologic management and control the pain with effleurage. Sitting in a warm pool of water is relaxing and may lessen the pain, but it does not control the pain. Sedatives are not indicated as they may slow the birthing process. Opioids should be limited as they too may slow the progression of labor.

What is the expected norm during labor?

Progressive fetal descent (-5 to +4) Moving downward from the negative stations to zero station to the positive stations.

A client arrives at a health care facility in the latent phase of the first stage of labor. Which intervention should the nurse implement?

Provide emotional and physical support. The nurse should provide emotional and physical support. When pain exceeds the client's threshold for coping, she may require pharmacologic measures to facilitate pain relief. Cesarean birth is not indicated during the latent phase of labor, so the nurse need not assist in preparation for it. Clients receiving epidural anesthesia generally should be in the active phase of the first stage of labor with cervical dilation of 4 to 5 cm, so there is no need to assist in providing epidural anesthesia. Naloxone may be used to reverse the effects of both maternal and neonatal respiratory depression following the administration of narcotic agents for pain relief.

The injection of a local anesthetic to block specific nerve pathways is referred to as:

Regional-block Regional-block anesthesia successfully blocks pain sensation in a designated body part.

A woman in labor received an opioid close to the time of birth. The nurse would assess the newborn for which of the following?

Respiratory depression

After teaching a group of students about fetal heart rate patterns, the instructor determines the need for additional teaching when the students identify which of the following as indicating normal fetal acidbase status? (Select all that apply.)

Sinusoidal pattern, recurrent variable decelerations, absence of late decelerations

A nurse is providing care to a woman during the third stage of labor. Which of the following would alert the nurse that the placenta is separating? (Select all that apply.)

Sudden gush of dark blood from the vagina

What signs would indicate impending shock?

Tachycardia and a falling blood pressure. During the 3rd stage of labor, a nurse is required to monitor the mother's vital signs atlas every 15 minutes.

Periodic baseline changes of FHR

Temporary, recurrent changes made in response to a stimulus such as a contraction. The FHR can demonstrate patterns of acceleration or deceleration in response to most stimuli

Cervical Dilation and Effacement

The amount of cervical dilation (opening) and the degree of cervical effacement (thinning) are key areas assessed during the vaginal examination as the cervix is palpated with the gloved index finger.

The nurse is monitoring a client in the first stage of labor. The nurse determines the client's uterine contractions are effective and progressing well based on which finding?

The best determination of effective contractions is dilation of the cervix. Engagement, membrane rupture, and bloody show may all occur before the cervix has dilated.

Rupture of membranes

The membranes will be felt as a soft bulge that is more prominent during a contraction. When membranes rupture the priority focus should be on assessing fetal heart rate first to identify a deceleration, which might indicate cord compression secondary to cord prolapse.

A woman in labor has chosen to use hydrotherapy as a method of pain relief. Which statement by the woman would lead the nurse to suspect that the woman needs additional teaching?

The temperature of the water should be atlas 105 F

Fetal Descent & presenting part

The vaginal exam can also determine fetal descent (station) and presenting part. During the vaginal examination, the gloved index finger is used to palpate the fetal skull through the opened cervix or the buttocks in the case of a breech presentation. The ischial spines serve as landmarks and have been designated as zero station.

The nurse instructs the client about skin massage and the gate control theory of pain. Which statement would be appropriate for the nurse to include for the client understanding of the nonpharmacologic pain relief methods?

These methods are a technique to prevent the painful stimuli from entering the brain. Gate-control delivers the pain stimuli from the pain site by replacing with a comfort stimuli in a new location. Gate control does not need to be applied directly to the site of the pain. Anxiety heightens painful feelings, gating blocks the flow of painful stimuli to the sensory centers in the brain

.A nurse is explaining the use of therapeutic touch as a pain relief measure during labor. Which of the following would the nurse include in the explanation?

This technique redirects energy fields that lead to pain

After describing continuous internal electronic fetal monitoring to a laboring woman and her partner, which of the following would indicate the need for additional teaching?

Unfortunately, I'm going to have to stay quite still in bed while it is in place.

Electric fetal monitoring (EFM)

Uses a machine to produce continuous tracing of the FHR. A sound is produced with each heartbeat and a graphic record of the FHR pattern is produced. The primary objective of EFM is to provide info about fetal oxygenation and prevent fatal injury that could result from impaired fetal oxygenation during labor; detect FHR changes early before they are prolonged.

A nurse is reviewing the fetal heart rate pattern and observes abrupt decreases in FHR below the baseline, appearing as a U-shape. The nurse interprets these changes as reflecting which of the following?

Variable decelerations

Which position would be most appropriate for the nurse to suggest as a comfort measure to a woman who is in the first stage of labor? (Select all that apply.)

Walking with a support person, straddling with forward leaning over a chair, rocking back and forth with foot on chair

A nurse is describing the different types of regional analgesia and anesthesia for labor to a group of pregnant women. Which statement by the group indicates that the teaching was successful?

We can get up and walk around after receiving combined spinalepidural analgesia.

Assessment parameters of the FHR include:

baseline FHR and variability, presence of accelerations, periodic or episodic decelerations, and changes or trends of FHR pattern over time.

If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which pattern would the nurse anticipate seeing on the monitor?

fetal heart rate declining late with contractions and remaining depressed Lack of blood supply to the fetus because of poor placental filling prevents the fetal heart rate from recovering immediately following a contraction.

FHR Pattern Category 3

predictive of abnormal fetal acid-base status at the time of observation and requires prompt evaluation and interventions, such as giving maternal oxygen, changing maternal position, discontinuing labor augmentation medication, and or treating maternal hypotension -Fetal bradycardia: <110 -Recurrent late decelerations -Recurrent variable decelerations-declining or absent -Sinusoidal pattern (smooth, undulating baseline)

Variable decelerations

present as visually apparent abrupt decreases in FHR below baseline and have an unpredictable shape on the FHR baseline, possibly demonstrating no consistent relationship to uterine contractions. The shape of variable decelerations may be U, V, or W, or they may not resemble other patterns.usually occur abruptly with quick deceleration. They are the most common deceleration pattern found in the laboring woman and are usually transient and correctable

Fetal acceleration

transitory abrupt increases in the FHR above the baseline that last <30 seconds from onset to peak. They are associated with sympathetic nervous stimulation. They are visually apparent, with elevations of FHR of more than 15 bpm above the baseline, and their duration is >15 seconds, but less than 2 minutes They are generally considered reassuring and require no interventions. Accelerations denote fetal movement and fetal well-being and are the basis for nonstress testing.

Early decelerations

visually apparent, usually symmetrical, and characterized by a gradual decrease in the FHR in which the nadir (lowest point) occurs at the peak of the contraction. They rarely decrease more than 30 to 40 bpm below the baseline. Typically, the onset, nadir, and recovery of the deceleration occur at the same time as the onset, peak, and recovery of the contraction. They are most often seen during the active stage of any normal labor, during pushing, crowning, or vacuum extraction

Late decelerations

visually apparent, usually symmetrical, transitory decreases in FHR that occur after the peak of the contraction. The FHR does not return to baseline levels until well after the contraction has ended. Delayed timing of the deceleration occurs, with the nadir of the uterine contraction. Late decelerations are associated with uteroplacental insufficiency, which occurs when blood flow within the intervillous space is decreased to the extent that fetal hypoxia or myocardial depression exist