Nursing Care of the Family During Labor and Birth (Chapter 16)

How long should mothers maintain bedrest after giving birth?

2 hours to prevent orthostatic hypotension

What station is crowning?

+5

Active labor contractions

3-5 min 45-60 sec

How long does the first stage of labor usually last?

Avg of 12 hours (from beginning of contractions to 10 cm dilation)

What do you need to monitor in stages 3&4?

BP, HR check for bleeding bc we're most worried about hemorrhage *Assess how many peri pads she's had to change*

What phase of the first stage of labor does the water break?

active phase

Most common fetal position

LOA

Second stage descent. What do you see?

bulging perineum increase in bloody show "crawfishing"

What should you watch out for if the baby's head is floating?

cord prolapse

How long does the transition phase last?

nullipara: 3 hours multi: 1 hour

What is the fundus?

top of uterus

What med do you give immediately after the placenta is delivered? Why?

pitocin helps prevent hemorrhage

Research shows that a round or peanut shaped birth ball during labor can:

-Reduce pain perception -Use gravity to facilitate labor -Enhance position changes -Work with cardinal movements -Shorten the length of labor -Reduce cesarean section rates

application of perineal pads after delivery (hesi)

place two on perineum do not touch inside of pad do apply from front to back, being careful not to drag pad across anus

For the labor nurse, care of the expectant mother begins with which situations? Select all that apply. The onset of progressive, regular contractions The bloody, or pink, show The spontaneous rupture of membranes Formulation of the woman's plan of care for labor Moderately painful contractions

progressive regular contractions bloody or pink show spontaneous ROM

What do you do when the baby is crowning?

put gentle counter pressure against the perineum. Do not allow rapid delivery over woman's perineum

CTX for transition phase

q 2-3 min 60-90 seconds long

When do you monitor VS for latent phase?

q 30-60 min *IN BETWEEN CONTRACTIONS* take BP between contractions in side lying position

How often should the mom use the bathroom? Why?

q2h A full bladder can impede labor progress

How often do you assess temp in latent phase

q4h *unless ROM, then q2h*

What will you see in a mother in the transitional phase?

rectal pressure urge to bear down bloody show loss of control

How will a mother in the transitional stage of labor act?

restless, frequent position changes fears being left alone exhaustion

What do you do when SSx of placental delivery occur?

tell the mother to push gently

When do you give eye prophylaxis to newborn?

you may delay eye prophylaxis and vaccinations until after the bonding period (can delay up to 1 hour)

How should you teach laboring mothers to breathe in active phase? Transition phase?

Patterned paced breathing Active: Slow in 2, 3, 4; out, 2, 3, 4 Transition: in/out 3:1 or 4:1 *Switch method regardless of phase of labor* *Breathing techniques, such as deep chest, accelerated, and cued, are not prescribed by the stage and phase of labor but by the discomfort level of the laboring woman. If coping is decreasing, switch to a new technique. *

What is the most significant finding in a urinalysis for a patient with preeclampsia? Protein Ketones Glucose Leukocytes

Protein Protein is a significant finding in a urinalysis for a patient diagnosed with preeclampsia. Normally protein should not be present in the urine. It is reflective of glomerular damage caused by hypertension in preeclampsia. Ketones are reflective of nutritional status. Glucose in the urine primarily occurs in the presence of elevated blood glucose. Leukocytes are present when there is inflammation or infection of urinary tract system.

Active: FHR assessment high risk and low risk. CTX assessment high risk and low risk

FHR and CTX assess q15 min for high risk and q30 min for low risk

Which test is performed to determine if membranes are ruptured? Urine analysis Fern test Leopold maneuvers Artificial rupture of membranes (AROM)

Fern Test In many instances, a sterile speculum examination and a Nitrazine (pH) and fern test are performed to confirm that fluid seepage is indeed amniotic fluid. A urine analysis should be performed on admission to labor and delivery. This test is used to identify the presence of glucose and protein. The nurse performs Leopold maneuvers to identify fetal lie, presenting part, and attitude. AROM is the procedure of artificially rupturing membranes, usually with a device known as an amnihook.

If the nurse finds the fundus soft, boggy, and displaced above and to the right of the umbilicus, what action should be take first?

First perform fundal massage; then have the client empty her bladder *full bladder is one of the most common reasons for uterine atony or hemorrhage in the first 24 hours after delivery*

Upon reviewing the laboratory reports of a pregnant patient, the nurse reports to the primary health care provider (PHP) that the patient has impaired nutrition. Which finding enabled the nurse to conclude this? Discoloration of the patient's urine specimen High specific gravity of the patient's urine specimen Presence of ketones in the patient's urine specimen Presence of leukocytes in the patient's urine specimen

The presence of ketones in the urine specimen indicates that the patient has impaired nutrition due to the presence of excess glucose in the blood. Abnormal levels of leukocytes, discoloration of urine, and abnormal specific gravity of the urine do not give information about nutrition. Abnormal levels of leukocytes indicate the presence of infection. Discoloration of the urine and high specific gravity of the urine indicate dehydration resulting from loss of fluids.

What is nitrazine paper used for?

Used for ROM to make sure the fluid is amniotic. It should turn blue/black

What is an episiotomy?

a surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues. *routine use has declined*

Active phase care

amniotomy (SROM, AROM) assess amniotic fluid -does it smell? (infection) -color?

For a woman in false labor, how would her cervix feel?

may be soft but with no significant change *posterior position* (hard to palpate)

What are contractions like in the latent phase?

mild, short q 30-45 min, 30-45 sec

How long does the third stage usually last?

5-30 minutes *The longer the stage, the higher the risk for hemorrhage/infection*

Degrees of tear for perineum

1st degree: only epidermis 2nd degree: dermis, muscle, and fascia 3rd degree: tear extend into anal sphincter 4rth degree: tear extends up the rectal mucosa *Tears cause pain and swelling. Avoid rectal manipulations*

The nurse is caring for a pregnant patient and suspects that the primary health care provider (PHP) would recommend a cesarean section. What could be the most probable reason for this? Increased maternal pulse rate Body mass index (BMI) is 32 kg/m 2 Elevated blood glucose levels High basal body temperature

A pregnant woman may have a higher risk of cesarean birth and cephalopelvic disproportion when the BMI is higher than 30 kg/m 2. It indicates that a weight gain of 16 kg or more results in a BMI above 30 kg/m 2. Therefore the nurse expects the patient to have cesarean birth because the patient's BMI is 32 (above 30) kg/m 2. Increased pulse rate, elevated blood glucose levels, and high temperature do not indicate the need for a cesarean section. These conditions are common during early labor and disappear after childbirth

When performing Leopold's maneuver, how can you tell if the baby is breeched or not?

Assess the fundus. If the fundus is soft, immovable, large, than a breech is indicated If the fundus is hard, movable, and small, then vertex indicated

What are the 8 priority assessments in the first hour after birth?

Fundal height, VS, lochia, bladder, perineum, return of sensation, bonding, comfort

Using Leopold's maneuver, how can you tell if the head is flexed?

If cephalic prominence is located on the same side as small parts, assume the head is flexed

Why is it important to ask mom what the color of the liquid was when her water broke?

If it's yellow-green, it's meconium-stained fluid which indicates fetal distress You want it to be clear

When is anesthesia/analgesia offered to a laboring mother?

In midactive phase of labor 1. If given too early, they may retard the progress of labor. 2. If given too late, narcotics increase the risk of neonatal respiratory depression

The nurse palpates the abdomen of a pregnant patient and reports that the fetus lies in longitudinal position with cephalic presentation. Which observation enabled the nurse to report about the fetal position? The presenting part has deeply descended in the pelvis. The cephalic prominence is on the same side as the back. The head is presenting to the true pelvis and is not engaged. The head feels round, firm, freely movable, and palpable by ballottement.

Leopold maneuvers (abdominal palpation) help identify the degree of descent into the pelvis of the presenting part in a pregnant patient. The head feels round, firm, freely movable, and palpable by ballottement when the fetus has a cephalic or breech presentation. Based on the descent of the presenting part, it may be difficult to infer the fetal position, as the presenting part can be head or buttock. The cephalic prominence on the same side as the back shows that the fetal head is extended and the face is the presenting part. This maneuver is not related to identification of fetal position. If the head is presenting to the true pelvis and is not engaged, then it determines the attitude of fetal head whether flexed or extended. It does not indicate the fetal position.

During an assessment, the nurse is instructed to determine the position of the fetal head in a pregnant patient. What should the nurse do to determine whether the fetal head is flexed or extended? Palpate the fetal head with the palmar surface of the fingertips of the right hand. Identify the fetal part that occupies the fundus in the uterus of the pregnant patient. Palpate the smooth convex contour of the fetal back using the palmar surface of one hand. Grasp the lower pole of the uterus between the thumb and fingers, pressing in slightly.

Leopold maneuvers (abdominal palpation) help identify the degree of descent into the pelvis of the presenting part in a pregnant patient. Therefore the nurse should grasp the lower pole of the uterus between the thumb and fingers, pressing in slightly in order to determine whether the fetal head is flexed or extended. Identifying the fetal part that occupies the fundus of the patient helps to identify the fetal position. The fetal head is palpated with the palmar surface of the fingertips using both hands, but not with only the right hand to determine the cephalic prominence. Palpation of the smooth convex contour of the fetal back and irregularities using the palmar surface of one hand is not used to determine the attitude of the fetal head. This maneuver helps identify the feet, hands, and elbows of the fetus.

What does it mean when someone says the cervix has moved from posterior to anterior?

Near the time of labour and / or during prelabour and early labour, the cervix starts to move towards the front of the baby's head. This is known as either a 'central' or 'anterior cervix' (depending on how far forward it has moved), and can usually be easily felt by the caregiver if being examined.

What is an SVE and what do you do during this?

Sterile vaginal examination You examine: -Fetal presentation/position -Cervical dilation, effacement, position, consistency -fetal station *Performed before analgesia/anesthesia, to determine the progress of labor, to determine whether second stage pushing can begin*

The nurse is examining a newly admitted patient who is 39 weeks pregnant and notes that the patient is in the active phase of labor. Which symptoms does the nurse note to reach this conclusion? No evidence of uterine contractions (UCs) Mild uterine contractions (UCs) Strong uterine contractions (UCs) Moderate uterine contractions (UCs)

Strong Uterine Contractions Regular and strong UCs may occur in the active phase of labor. Absence of uterine contractions means that the labor has not started. Mild UCs can be observed during early labor. Mild to moderate UCs can be observed during the latent and active phases of labor.

The nurse observes that a pregnant patient is very reluctant to participate in the birthing process. Which interventions should the nurse follow to ensure fetal well-being? Select all that apply. Ask the patient to take deep breaths. Monitor the events of labor randomly. Encourage the patient to change positions. Suggest that the patient lie in the supine position. Suggest that the patient hold her breath for short periods.

The inability of a patient to actively participate in the birthing process indicates that the patient is at risk of ineffective individual coping. It may cause injury to the patient and the fetus. Therefore to promote fetal well-being and to prevent injuries to the patient, the nurse should adopt the methods to encourage the patient to actively participate in the birthing process. Hence the nurse should encourage the patient to change positions to facilitate the downward movement of the fetus. The nurse should ask the patient to take deep breaths for each contraction to increase oxygenation and gas exchange for the fetus. The nurse should also suggest that the patient hold her breath for short periods after exhalation to avoid fetal hypoxia. The nurse should monitor the events of labor constantly to prevent fetal death. The nurse cannot suggest that the patient lie in the supine position because the patient may feel discomfort lying in one position.

The primary health care provider (PHP) advised the nurse to assess the maternal temperature and vaginal discharge of a pregnant patient every 2 hours. What is the reason behind this advice? To evaluate fetal status To know the onset of labor To assess for potential risk for infection To prevent fetal hypertension

To assess for potential risk for infection When the membranes rupture, there is a possible risk of infection, as the microorganisms can ascend from the vagina to the uterus. Ruptured membranes can be assessed by monitoring the body temperature and vaginal discharge every 2 hours. The assessment is not used for knowing the onset of labor because it does not indicate the progress of labor. The fetal status is not known by the assessment of the temperature and vaginal show; it may be known by another procedure called Leopold maneuvers. This measure is not done to prevent fetal hypertension, because the maternal body temperature and vaginal discharge do not indicate fetal blood pressure.

For a woman in true labor, her cervix would feel like what?

it will have moved to anterior position (it'll be easy to palpate) shows progressive change

Phases within the first stage of labor

latent: 1-3 cm dilation active: 4-7 cm dilation transition: 8-10 cm dilation

SSx of placental separation

lengthening of cord, gush of blood, uterus changes to globular shape, placenta visible at vaginal opening

What positions should the mother be in for birth?

squatting, side-lying, high-fowler, lithotomy for pushing

If delivering in another room or setting:

1. Transfer multipara at 8 to 9 cm, +2 station 2. Transfer primigravida at 10 cm, with presenting part visible between contractions and during contractions

How long does the latent phase last in a nulliparous mother? Multiparous?

6 hours 4 hours

Using Leopold's maneuver, how can you help determine the degree of descent of the presenting part?

A ballotable or floating head can be rocked back and forth between the thumbs and fingers

Leopold's maneuvers (Hesi steps)

Description: abdominal palpations use to determine fetal presentation, lie, position, and engagement A. With client in supine position, place both cupped hands over fundus and palpate to determine whether breech (soft, immovable, large) or vertex (hard, movable, small) B. Place one hand firmly on side and palpate with other hand to determine presence of small parts or fetal back. (FHR is heard best through fetal back.) C. Facing client, grasp the area over the symphysis with the thumb and fingers and press to determine the degree of descent of the presenting part. (A ballotable or floating head can be rocked back and forth between the thumb and fingers.) D. Facing the client's feet, outline the fetal presenting part with the palmar surface of both hands to determine the degree and attitude of the fetus. (If cephalic prominence is located on the same side as small parts, assume the head is flexed.)

During the assessment, the nurse palpates the abdomen of a pregnant patient to identify the number of fetuses. Which actions should the nurse perform before conducting the assessment? Select all that apply. Help the patient change positions often. Ask the patient to empty the bladder completely. Place a small rolled towel under the patient's hip. Use running water to stimulate voiding of the patient. Suggest that the patient lie in the supine position with a pillow under her head.

Rationale Leopold maneuvers involve abdominal palpitation to identify the number of fetuses and expected location of the point of maximal impulse (PMI) of the fetal heart rate (FHR) on the patient's abdomen. Therefore the nurse should ask the patient to empty the bladder, as the maneuver can be painful if the bladder is full. The nurse can suggest that the patient lie in the supine position with one pillow under her head to make the patient feel comfortable. The nurse should place a small rolled towel under the patient's right or left hip to prevent supine hypotensive syndrome. The nurse should not ask the patient to change her positions frequently, as it may cause discomfort to the patient. Running water is used to stimulate voiding of the patient only when the patient has a problem of urinary elimination.

Shiny schultz vs. Dirty duncan

SS: side facing the baby "shiny and new like the baby" DD: side facing the mother "mother is dirty from labor"

The nurse observes that a pregnant patient has a blood glucose level of 180 mg/dL in early labor. Which prescription does the nurse expect to receive from the primary health care provider (PHP)? Lidocaine (Nervocaine) to the patient Ringer's lactate solution to the patient Hydromorphone (Dilaudid) to the patient Intravenous (IV) solution containing a small amount of dextrose

The blood glucose level of 180 mg/dL indicates that the patient has high blood glucose levels. Therefore the patient has to be administered an electrolyte solution without glucose to prevent the risk of fetal hyperglycemia and hyperinsulinism. Hence, the nurse would expect the PHP to prescribe Ringer's lactate solution to the patient, as it does not increase blood sugar levels. Lidocaine (Nervocaine) is an anesthetic preparation, which may be given during emergency. Hydromorphone (Dilaudid) is an opioid preparation and is not used in treating blood glucose levels in the body. IV solution containing a small amount of dextrose is administered to increase the fatty acid metabolism when the patient has ketosis. It is not useful to treat hyperglycemia.

The nurse is caring for a pregnant patient during labor. What should the nurse do immediately after the child's birth? Ask the mother to hold the infant. Dry the infant and place in warm blanket. Record the Apgar scores after 30 minutes. Cut the umbilical cord 3.5 cm above the clamp.

The infant should be dried to prevent cold stress due to rapid loss of heat and then covered with a warm blanket. The Apgar score is to be recorded at 1 and 5 minutes after the birth of the infant. Recording it after 30 minutes may lead to failure in assessing the fetal signs. The cord should be cut at 2.5 cm above the placement of the clamp. A newborn may be very slippery to hold, and the mother may not be able to hold the baby due to fatigue. The infant can be given to the mother only after complete drying.

The laboratory reports of a pregnant patient revealed impaired placental perfusion. What position should the nurse suggest to the patient to enhance uteroplacental perfusion? Lateral position Upright position Hands-and-knees position Semirecumbent position

The lateral position, or side-lying position, promotes the uteroplacental perfusion and increases the fetal oxygen saturation. Therefore the nurse suggests the patient to lie in the lateral position. The upright and hands-and-knees positions help relieve backaches. Semirecumbent position is convenient for rendering care measures and for external fetal monitoring. The upright, hands-and-knees, and semirecumbent positions do not enhance uteroplacental perfusion.

A patient has given birth to a baby 1 hour ago. Which intervention should the nurse perform while caring for the patient? Massage the fundus if it is firm to expel any clots. Measure blood pressure every 30 minutes for 2 hours. Check the perineal pads and linen under the patient's buttocks. Access pulse rate and regularity every 30 minutes for 2 hours.

The nurse should check the perineal pads and linen under the patient's buttocks for lochia and note the color, odor, and size of the clots. This helps to detect the presence of intrauterine complication after birth. Blood pressure should be monitored every 15 minutes for 1 hour. This enables the nurse to assess the state of the patient and to prevent any complications. The fundus of the uterus should be massaged until it is firm and the clots are expelled. The pulse rate and regularity should be measured every 15 minutes for 1 hour.

A nurse is caring for a patient in the fourth stage of labor that has vaginally delivered an 8-lb, 6-oz. baby. The nurse notes the fundal height is at the umbilicus, the uterus is midline and firm, and there is a moderate amount of bright red bleeding noted on the pad and a continued vaginal trickling of bright red blood. What is the nurse's priority action? Catheterize the patient. Increase the rate of oxytocin. Notify the health care provider. Continue to massage the fundus.

The nurse's priority action is to notify the health care provider. The continued trickling of bright red blood in the presence of a uterus that is at the umbilicus, midline, and firm may be a vaginal or cervical laceration that will need to be repaired. Oxytocin is used to help the uterus contract and remain firm. A patient with a full bladder may present with additional uterine bleeding and will have a boggy uterus, which may indicate the need for a catheter. Continuing to massage the fundus will not stop the bleeding from the laceration; fundal massage is done to firm up the uterus.

A patient at 39 weeks gestation is admitted to labor and delivery reporting "leaking fluid and regular contractions." What is the nurse's priority action? Perform a vaginal exam. Perform a Leopold maneuver. Complete the admission assessment. Place the fetal monitor on the patient.

The nurse's priority action is to perform a Leopold maneuver to ascertain what fetal part is in the uterine fundus, the location of the fetal back, and the presenting part. Once the Leopold maneuver is performed, the fetal monitor can be correctly placed on the maternal abdomen at the point of maximal intensity (PMI), which is usually directly over the back. If delivery is not impending, the fetal heart rate is stable; the vaginal exam should be deferred until the status of the membranes can be determined. The admission assessment is completed when all of the information is obtained, including the physical assessment findings. The fetal monitor cannot be placed until the Leopold maneuver is performed.

The nurse is assessing a pregnant patient who presents with uterine contractions, which become intense as the patient walks. The nurse provides comfort measures; however, the contractions continue to radiate from the patient's lower back to her abdomen. What further findings does the nurse expect in the patient? Select all that apply. Dilation of the cervix Increased urinary frequency Posterior position of the cervix Presenting part of fetus not engaged in pelvis No evidence of bloody show on vaginal examination

The patient has signs that she is going into true labor, and therefore the nurse expects cervical dilation. The patient will also exhibit increased urinary frequency as the presenting part of the fetus compresses the bladder. False labor, not true labor, is characterized by posterior positioning of the cervix. The presenting part of the fetus is generally not engaged in the pelvis in false labor, not true labor. There is no evidence of bloody show on vaginal examination of a patient who presents with false labor.

The nurse is caring for a patient in labor whose cervix is dilated to 10 cm and who is exhibiting copious amounts of bloody mucus show. What behavior does the nurse anticipate finding in this patient? Select all that apply. The patient expresses the need to defecate. The patient finds it difficult to follow instructions. The patient readily listens to the nurse's instructions. The patient doubts her ability to continue with the labor. The patient expresses the need to have a caretaker at her bedside.

The patient in labor is dilated by 10 cm and exhibits copious amounts of bloody mucus show. These findings indicate that the patient is in the transition phase of the first stage of labor. In the transition phase, the patient experiences pressure on the anus and therefore feels the need to defecate. The patient may also express doubts about her ability to continue with the labor in this phase. The patient in the active stage of labor who is dilated by 4 to 7 cm finds it difficult to follow the nurse's instructions as the strength of the contractions begins to increase. In the latent phase of the first stage of labor, the patient is able to listen readily to the nurse's instructions because the contractions are mild. The patient feels the need for companionship and encouragement during the active stage of labor.

During the assessment of a 38-week pregnant patient, the nurse finds that the patient is experiencing false labor. After reviewing the medical history, the nurse finds that the patient had rapid labor during the previous pregnancy. What would be the most suitable nursing action? Admit the patient to a latent labor room immediately. Suggest that the patient rest at home until the labor progresses. Inform the patient that cervical dilation of 5 cm indicates true labor. Suggest that the patient take a cold shower to prevent uterine contractions (UCs).

The patient who is in false labor should be asked to wait until true labor begins. However, if the medical reports of the patient indicate that the patient had rapid labor during the previous pregnancies, then the patient must be admitted in the latent labor room. This helps prevent complications during the labor. The patient should not be instructed to return home for the progression of the labor, because there is a history of rapid labor. Generally, dilation of up to 3 cm indicates true labor. Patients with false labor usually find warm showers to be soothing, not cold ones.

Upon assessment, the nurse suspects that a pregnant patient has potential complications during the early phase of labor. Which signs in the patient correspond to the nurse's suspicion? Select all that apply. Temperature of 36.5 o C Intrauterine pressure of 85 mm Hg Uterine contractions lasting for 92 seconds UCs lasting for 40 seconds Relaxation between UCs lasting for 25 seconds

The pregnant patient is likely to have potential complications during the early phase of labor if the UCs last more than 90 seconds. Long UCs can compromise the fetal perfusion. An intrauterine pressure of above 80 mm Hg and relaxation between the UCs lasting less than 30 seconds indicate impaired fetal perfusion. The temperature of 36.5 o C and UCs lasting for 40 seconds are not the signs of potential complications during early labor. The temperature above 38 o C and UCs lasting more than 40 seconds indicate potential complications during the early phase of labor.

The nurse observes that a pregnant patient has uterine contractions (UCs) for the duration of 80 seconds with a frequency of 2 minutes, and the cervical dilation is found to be 7 cm. What other assessments should the nurse conduct for the patient in such a situation? Select all that apply. Observing changes in the mood and energy every 30 minutes Recording maternal blood pressure and pulse every 60 minutes Recording maternal blood pressure and pulse every 15 minutes Assessing uterine activity (UA) and vaginal show every 10 minutes Assessing UA and vaginal show every 30 minutes

UCs, for a duration of 80 seconds and a frequency of 2 minutes, combined with cervical dilation of 7 cm, indicate that the patient is in the transition phase of labor. Therefore the nurse has to assess the UA and vaginal show every 10 to 15 minutes. During the transition phase, the nurse should assess the maternal blood pressure and pulse every 15 to 30 minutes. This helps to prevent infections and maternal hypertension. The assessment of UA and vaginal show every 30 to 60 minutes should be done in the latent phase, but not in transition phase. During the latent phase, the changes in mood and energy levels are assessed every 30 minutes. During the transition phase, the patient has rapid mood swings, so the nurse should assess the mood of the patient every 5 minutes to prevent anxiety and stress. Assessing the patient's blood pressure every 60 minutes may not be helpful in preventing risk to the fetus.

When managing the care of a patient in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. What do these measures include? Encouraging the woman to try various upright positions, including squatting and standing Telling the woman to start pushing as soon as her cervix is fully dilated Continuing an epidural anesthetic so that pain is reduced and the woman can relax Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction

Upright positions and squatting may enhance the progress of fetal descent. Many factors dictate when a woman will begin pushing. Complete cervical dilation is necessary, but it is only one factor. If the fetal head is still in a higher pelvic station, the physician or midwife may allow the woman to "labor down" (allowing more time for fetal descent, thereby reducing the amount of pushing needed) if she is able. The epidural may mask the sensations and muscle control needed for the woman to push effectively. Closed-glottic breathing may trigger the Valsalva maneuver, which increases intrathoracic and cardiovascular pressure, reducing cardiac output and inhibiting perfusion of the uterus and placenta. In addition, holding the breath for longer than 5 to 7 seconds diminishes the perfusion of oxygen across the placenta, resulting in fetal hypoxia.

What are lochia?

discharge fluid after birth moderate red small clots <2-3 cm (NO LARGE CLOTS. if you see large, think hemorrhage)

How does the mother act during the latent phase?

excited, talkative, smiling able to cope well with pain anxious, but able to express feelings Partner is feeling excited

Latent phase assessment of contractions high risk and low risk

high risk q 30 min low risk q 60 min

Latent phase assessment of FHR high risk and low risk

high risk q 30 min low risk q 60 min *before, during, and after ctx*

On interacting with the partner of a pregnant patient, the nurse suggests that the partner soothe the patient's forehead, palms of her hands, and soles of her feet. What patient observation could be the possible reason for such advice to the partner? Hyperesthesia Flushing of cheeks Bladder distension Postural hypotension

hyperesthesia The pregnant patient becomes more sensitive to touch as the labor progresses. This condition is called hyperesthesia. Soothing the surfaces of the body where hair does not grow can reduce this sensitivity. These areas include the patient's forehead, palms of the hands, and soles of the feet. Flushed cheeks appear in the active phase of first-stage labor. The cheeks appear to be normal in the later phase. Soothing the patient's forehead does not reduce flushing of the patient's cheeks. The advice of soothing the patient's forehead, palms of the hands, and soles of the feet is not a suitable intervention to reduce bladder distention in the patient. Additionally, postural hypotension is not resolved by soothing the patient; it is reduced by placing a pillow under the patient's hips.

When is a placenta considered retained?

if it stays in there > 30 minutes after delivery

How will a mother act in the active phase of labor?

increased anxiety fears loss of control sense of helplessness *less anxiety with constant support*

Shivering of newborn infant indicates what?

indicates hypoglycemia not hypothermia

What are you looking for when you do a urine analysis on a pregnant woman?

looking for high protein or high sugar in urine high protein could indication preeeclampsia, or if BP is normal could be from infection (UTI) high sugar may suggest gestational diabetes

During the transition phase, what do you need to keep in mind when the mother wants to bear down?

make sure she's fully dilated before she bears down If she bears down too early, her cervix could swell and then never fully dilate Do SVE to assess progress

When should laboring women be allowed to ambulate?

only if the FHR is within a normal range and if the fetus is engaged (zero station). *If the fetus is not engaged, there is an increased risk that a prolapsed cord will occur*

Where is FHR best heard?

over fetal back (that's why it would be best for them to be in OA position)

VS assessment for active labor high risk and low risk

q 15 for high risk q 30 for low risk *in between contractions*

SSx of distress in a newborn

retractions tachypnea dusky color grunt flaring nares

What do you suspect if fundus is firm and bright red blood continues to trickle?

suspect undetected laceration *always check perineal pad AND under buttocks*