Chapter 21: Nursing Management of Labor and Birth at Risk

Put the client in bed immediately, call for help, and lift the presenting part of the fetus off the cord.

A G3P2 woman at 39 weeks' gestation presents highly agitated, reporting something "came out" when her membranes just ruptured. Which action should the nurse prioritize after noting the umbilical cord is hanging out of the vagina? Place the client in Trendelenburg position and gently attempt to reinsert the cord. Put the client in bed immediately, call for help, and lift the presenting part of the fetus off the cord. Contact the health care provider and prepare the client for an emergent vaginal birth. With the client in lithotomy position, hold her legs and sharply flex them toward her shoulders.

Perineal tearing The immediate risk of a precipitous delivery is perineal tearing, because the tissue does not have time to stretch naturally. Vaginal stretching has occurred as the fetus descended to the perineum. Bladder incontinence and pelvic floor relaxation are potential long-term consequences of a precipitous birth, but they are not the immediate concern.

After only 45 minutes of labor, the client feels the urge to push. She pushes once and the baby's head is visible. With the next push, the head emerges. What is the immediate risk when the head is delivered too fast? Perineal tearing Bladder incontinence Pelvic floor relaxation Vaginal stretching

Depressed deep tendon reflexes

A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize? depressed deep tendon reflexes elevated blood glucose tachypnea bradycardia

Use a fist to apply counter pressure to the lower back.

A nurse is assessing a full-term client in labor and determines the fetus is occiput posterior. The client states that all her discomfort is in her lower back. What intervention can the nurse provide that will help alleviate this discomfort? Place the client supine with the head of bed elevated 30 degrees. Apply a warm washcloth to the lower back. Have the health care provider administer a pudendal block. Use a fist to apply counterpressure to the lower back.

birth is unlikely within the 2 next weeks. Rationale: Fetal fibronectin is a protein that helps the placenta and fetal membranes adhere to the uterus during pregnancy. A negative result (absence of fetal fibronectin) is a reliable indicator that delivery is unlikely within 2 weeks following the test. It does not diagnose infection.

A nurse working with a woman in preterm labor receives a telephone report for the fetal fibronectin test done 10 hours ago. The report indicates an absence of the protein, which the nurse knows indicates: no infection is present. birth is likely within the next 2 weeks. birth is unlikely within the 2 next weeks. infection is present.

The incidence is increasing. The nurse should tell the client that the incidence of multiple gestation is rising primarily as a result of ovarian stimulation and in vitro fertilization and an increased number of women giving birth at older ages.

A pregnant woman at her first office visit tells the nurse, "I hope I have twins. It seems like all my friends have had twins lately!" What should the nurse tell the client about multiple births at this time? The incidence is decreasing. The incidence is increasing. People giving birth at younger ages is resulting in more twins. Incidence of twins is consistently approximately 1 in 100 conceptions.

administer oxygen by mask.

A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's first action would be to: tell the woman to take short, catchy breaths. administer oxygen by mask. put firm pressure on the fundus of her uterus. increase her intravenous fluid infusion rate.

Cord compression Oligohydramnios and meconium staining of the amniotic fluid are common complications of post-term pregnancy. Oligohydramnios increases the incidence of cord compression, which can lead to fetal distress during labor.

A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is post-term and has oligohydramnios. What does this increase the risk of during birth? Shoulder dystocia Macrosomia Cord compression Fetal hydrocephalus

applying counterpressure to the back Counterpressure applied to the lower back with a fisted hand sometimes helps the woman cope with "back labor" associated with occiput-posterior positioning. The others are not recommended or used techniques for a woman in labor with back pain.

A woman whose fetus is in the occiput posterior position is experiencing increased back pain. Which is the best way for the nurse to help alleviate this back pain? applying ice to the back applying counterpressure to the back performing acupuncture on the back applying a heating pad to the back

Pain relief measures Intense back pain is associated with persistent occiput posterior position. Therefore, a priority is to provide pain relief measures. Position changes that can promote fetal head rotation are important after the nurse institutes pain relief measures. Additionally, the woman's ability to cooperate and participate in these position changes is enhanced when she is experiencing less pain. Immediate cesarean birth is not indicated unless there is evidence of fetal distress. Oxytocin would add to the woman's already high level of pain.

The fetus of a woman in labor is determined to be in a persistent occiput posterior position. Which intervention would the nurse prioritize? Side-lying position Pain relief measures Immediate cesarean birth Oxytocin administration

Prepare to assist with external version.

The nurse is assessing a multipara woman who presents to the hospital after approximately 2 hours of labor and notes the fetus is in a transverse lie. After notifying the RN and primary care provider, which action should the LPN prioritize? Assist with nitrazine and fern tests. Include a set of piper forceps when the table is prepped. Apply pressure to the woman's lower back with a fisted hand. Prepare to assist with external version.

continuing to monitor maternal and fetal status

Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound? continuing to monitor maternal and fetal status noting the space at the maternal umbilicus applying suprapubic pressure against the fetal back auscultating the fetal heart rate at the level of the umbilicus

brachial plexus assessment

A fetus is experiencing shoulder dystocia during birth. The nurse would place priority on performing which fetal assessment postbirth? assess for cleft palate monitor for a cardiac anomaly extensive lacerations brachial plexus assessment

Magnesium sulfate Magnesium sulfate is only given intravenously for preterm labor. Nifedipine and indomethacin are given orally for preterm labor. Terbutaline is given intravenously during the initial period and then switched to the oral route for maintenance.

A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer? betamethasone nifedipine indomethacin magnesium sulfate

5.

A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: 7. 5. 9. 6.

reports of severe back pain

After assessing a client's progress of labor, the nurse suspects the fetus is in a persistent occiput posterior position. Which finding would lead the nurse to suspect this condition? fetal buttocks as the presenting part contractions most forceful in the middle of uterus rather than the fundus reports of severe back pain lack of cervical dilation (dilatation) past 2 cm

Use McRoberts maneuver.

The nurse is assisting with a G2P1, 24-year-old client who has experienced an uneventful pregnancy and is now progressing well through labor. Which action should be prioritized after noting the fetal head has retracted into the vagina after emerging? Attempt to push in one of the fetus's shoulders. Use Zavanelli maneuver. Use McRoberts maneuver. Apply pressure to the fundus.

45 ml urine output in 2 hours The nurse knows a placental abruption places the client at high risk of hemorrhage. A decreased urine output indicates decreased perfusion from blood loss. The hematocrit, hemoglobin, and platelet counts are all within expected levels.

The nurse is caring for a client after experiencing a placental abruption (abruptio placentae). Which finding is the priority to report to the health care provider? 45 ml urine output in 2 hours hematocrit of 36% (0.36) hemoglobin of 13 g/dl (130 g/L) platelet count of 150,000 mm3

Potential lacerations and bleeding

When caring for a client requiring a forceps-assisted birth, the nurse would be alert for: damage to the maternal tissues. increased risk for uterine rupture. potential lacerations and bleeding. increased risk for cord entanglement.

Uterine rupture

A G2P1 woman is in labor attempting a VBAC, when she suddenly complains of light-headedness and dizziness. An increase in pulse and decrease in blood pressure is noted as a change from the vital signs obtained 15 minutes prior. The nurse should investigate further for additional signs or symptoms of which complication? Placenta previa Hypertonic uterus Uterine rupture Umbilical cord compression

corticosteroids Corticosteroids are given to help reduce or prevent the frequency and severity of respiratory distress syndrome in preterm infants delivered between 24 and 34 weeks' gestation. Medications most commonly used for tocolysis include magnesium sulfate, indomethacin, and nifedipine.

A client at 32 weeks' gestation has been admitted to the labor and birth unit with preterm labor. Which medication would the nurse be likely to administer to reduce the risk of complications in the preterm newborn? corticosteroids indomethacin nifedipine magnesium sulfate

macrosomia Fetal risks associated with a prolonged pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome, cephalopelvic disproportion, uteroplacental insufficiency, meconium aspiration, and intrauterine infection. Amniotic fluid volume begins to decline by 40 weeks of gestation, possibly leading to oligohydramnios. Hemorrhage, infection, and dystocia are risk to the mother not the fetus.

A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition? macrosomia dystocia hemorrhage infection

uterine rupture

A woman in active labor with a history of two previous cesarean births is being monitored frequently as she tries to have a vaginal birth. Suddenly, the woman grabs the nurse's hand and states, "Something inside me is tearing." The nurse notes her blood pressure is 80/50 mm Hg, pulse rate is 130 bpm and weak, the skin is cool and clammy, and the fetal monitor shows bradycardia. The nurse activates the code team because the nurse suspects the client may be experiencing which complication? uterine rupture compression on the inferior vena cava an amniotic embolism to the lungs an undiagnosed abdominal aorta aneurysm

Check for a full bladder. A full bladder can interfere with the progress of labor, so the nurse must be sure that the client has emptied her bladder.

Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider? Make sure the epidural medication is turned down. Assess vital signs every 30 minutes. Check for a full bladder. Make sure the client is lying on her left side.

1 cm/hour for cervical dilation

The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule? 2 cm/hour for cervical dilation 1/2 cm/hour for cervical dilation 1 cm/hour for cervical dilation 1/4 cm/hour for cervical dilation

placental abruption The most common cause of fetal death after a trauma is placental abruption (abruptio placentae), where the placenta separates from the uterus, and the fetus is not able to survive. Genetic abnormalities typically cause spontaneous abortion (miscarriage) in the first trimester. Trauma does not cause preeclampsia (which is related to various issues in the mother) nor does trauma usually cause PROM.

The nurse is admitting a client at 23 weeks' gestation in preparation for induction and delivery after it was determined the fetus had died secondary to trauma. When asked by the client to explain what went wrong, the nurse can point out which potential cause for this loss? placental abruption premature rupture of membranes genetic abnormality preeclampsia

caput succedaneum Caput succedaneum is a complication that may occur in the newborn of a woman who had a forceps-assisted birth. Maternal complications include tissue trauma such as lacerations of the cervix, vagina, and perineum; hematoma; extension of episiotomy into the anus; hemorrhage; and infection.

The nurse is assessing a woman who had a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus? perineal hematoma caput succedaneum infection of episiotomy cervical lacerations

Sudden shortness of breath Sudden shortness of breath can be a sign of amniotic fluid embolism and requires emergent intervention. This can occur suddenly during labor or immediately after. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension. It must be reported to the care team so proper interventions may be taken. Other symptoms can include hypotension, cyanosis, hypoxemia, uterine atony, seizures, tachycardia, coagulation failure, DIC, and pulmonary edema.

The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team? Unrelieved pain Sudden shortness of breath Bradypnea Bradycardia

Abnormal position of the fetal head Forceps are mechanical devices which can be used to help deliver the fetus. Although no longer used routinely they are still used in certain situations to assist with the birth. One of those situations is when the fetus is in an abnormal position and the health care provider attempts to reposition the fetus to facilitate birth. The use of forceps is not to lessen the mother's pain or to speed up the process. The use of forceps is not without risk of complications, include perineal lacerations and injury to the fetus if the forceps are not used correctly.

The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth? The fetus is descending too slowly Reduce risk of complications To lessen the mother's pain Abnormal position of the fetal head

"Continue to monitor fetal movements daily."

The nurse provides education to a postterm pregnant client. What information will the nurse include to assist in early identification of potential problems? "Monitor your bowel movements for constipation." "Be sure to measure 24-hour urine output daily." "Increase your fluid intake to prevent dehydration." "Continue to monitor fetal movements daily."

contractions most forceful in the middle of uterus rather than the fundus Contractions that are more forceful in the midsection of the uterus rather than in the fundus suggest hypertonic uterine dysfunction. Reports of severe back pain are associated with a persistent occiput posterior position due to the pressure of the fetal head on the woman's sacrum and coccyx. Cervical dilation (dilatation) that has not progressed past 2 cm is associated with dysfunctional labor. A breech position is one in which the fetal presenting part is the buttocks or feet.

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction? fetal buttocks as the presenting part contractions most forceful in the middle of uterus rather than the fundus lack of cervical dilation past 2 cm reports of severe back pain

4,000 g to 4500 g Macrosomia, in which a newborn weighs 4,000 to 4,500 g (8.1 to 9.9 lb) or more at birth, complicates approximately 10% of all pregnancies The excessive fetal size and abnormalities contribute to labor and birth dysfunctions

The health care provider has determined that the source of dystocia for a woman is related to the fetus size. The nurse understands that macrosomia would indicate the fetus would weigh: 3,500 g to 4000 g 2500 to 3000 g 3,000 g to 3500 g 4,000 g to 4500 g

Cervix dilates 1 cm per hour.

The nurse plays a major role in assessing the progress of labor. The nurse integrates understanding of the typical rule for monitoring labor progress. Which finding would the nurse correlate with this rule? cervix dilates 1 cm per hour fetus descends 1 cm per hour cervix dilates 2 cm per hour fetus descends 2 cm per hour

has previous lower abdominal incision The choice of a vaginal or repeat cesarean birth can be offered to women who had a lower abdominal incision. Contraindications to BVAC include a prior classic uterine incision, prior transfundal uterine surgery, uterine scar other than low-transverse cesarean scar, contracted pelvis, and inadequate staff of facility if an emergency cesarean birth is required.

A client has arrived to the birthing center in labor, requesting a VBAC. After reading the client's previous history, the nurse anticipates that the client would be a good candidate based on which finding? had previous lower abdominal incision had prior transfundal uterine surgery had prior classic uterine incision has a contracted pelvis

less than 3 hours

A nursing student has learned that precipitous labor is when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This means the labor will be completed in which span of time? less than 5 hours less than 3 hours less than 8 hours less than 4 hours

Look for late decelerations on monitor, which is associated with fetal anoxia.

A woman in labor is having very intense contractions with a resting uterine tone >20 mm Hg. The woman is screaming out every time she has a contraction. What is the highest priority fetal assessment the health care provider should focus on at this time? Look for late decelerations on monitor, which is associated with fetal anoxia. Monitor heart rate for tachycardia. Monitor fetal blood pressure for signs of shock (low BP, high FHR). Monitor fetal movements to ensure they are neurologically intact.

providing a comfortable environment with dim lighting

A woman is experiencing dystocia that appears related to psyche problems. Which intervention would be most appropriate for the nurse to initiate? encouraging the women to change positions frequently administering oxytocin preparing the woman for an amniotomy providing a comfortable environment with dim lighting

Turn off the oxytocin.

Hypertonic labor is labor that is characterized by short, irregular contractions without complete relaxation of the uterine wall in between contractions. Hypertonic labor can be caused by an increased sensitivity to oxytocin. What would the nurse do for a client who is in hypertonic labor because of oxytocin augmentation? Turn off the oxytocin. Increase the oxytocin. Turn off the methotrexate. Increase the methotrexate.

erratic. Hypertonic contractions occur when the uterus never fully relaxes between contractions, making the contractions erratic and poorly coordinated because more than one uterine pacemaker is sending signals for contraction. Hypotonic uterine contractions are poor in quality, brief, and lack sufficient intensity to dilate and efface the cervix.

The nurse is monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding? erratic. well coordinated. poor in quality. brief.

The myometrium becomes sensitive from the lack of relaxation and anoxia of uterine cells. Hypertonic contractions cause uterine cell anoxia, which is painful.

Which statement describes why hypertonic contractions tend to become very painful? More than one contraction may begin at the same time, as receptor points in the myometrium act independently of each other. The myometrium becomes sensitive from the lack of relaxation and anoxia of uterine cells. The number of uterine contractions is very low or infrequent. There is an increase in the length of labor because so many contractions are needed to achieve cervical dilation (dilatation).

diabetes Shoulder dystocia is most apt to occur in women with diabetes, in multiparas, and in postdate pregnancies. A pendulous abdomen is associated with the transverse lie fetal position not with shoulder dystocia.

A client is giving birth when shoulder dystocia occurs in the fetus. The nurse recognizes that which condition in the client is likely to increase the risk for shoulder dystocia? pendulous abdomen diabetes preterm birth nullipara

hypotonic contractions With hypotonic uterine contractions, the number of contractions is unusually infrequent (not more than two or three occurring in a 10-minute period). The resting tone of the uterus remains less than 10 mm Hg, and the strength of contractions does not rise above 25 mm Hg. Hypertonic uterine contractions are marked by an increase in resting tone to more than 15 mm Hg. However, the intensity of the contraction may be no stronger than that associated with hypotonic contractions. In contrast to hypotonic contractions, these occur frequently and are most commonly seen in the latent phase of labor. Uncoordinated contractions can occur so closely together they can interfere with the blood supply to the placenta. Because they occur so erratically, such as one on top of another and then a long period without any, it may be difficult for a woman to rest between contractions or to breath effectively with contractions. Braxton Hicks contractions are sporadic contractions that occur in pregnancy before the onset of true labor.

A client has been in labor for 10 hours, with contractions occurring consistently about 5 minutes apart. The resting tone of the uterus remains at about 9 mm Hg, and the strength of the contractions averages 21 mm Hg. The nurse recognizes which condition in this client? hypotonic contractions Braxton Hicks contractions uncoordinated contractions hypertonic contractions

transverse lie

A client with a pendulous abdomen and uterine fibroids (uterine myomas) has just begun labor and arrived at the hospital. After examining the client, the primary care provider informs the nurse that the fetus appears to be malpositioned in the uterus. Which fetal position or presentation should the nurse most expect in this woman? anterior fetal position transverse lie cephalic presentation occipitoposterior position

Assess fetal heart sounds.

A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client? Administer oxygen at 10 L/min by face mask. Place the woman in Trendelenburg position. Assess fetal heart sounds. Administer amnioinfusion.

the 41-year-old client who conceived by in vitro fertilization The nurse should assess infertility treatment as a contributor to increased probability of multiple gestations. Multiple gestations do not occur with an adolescent birth; instead, chances of multiple gestations are known to increase due to the increasing number of women giving birth at older ages.

A nurse is assessing the following antenatal clients. Which client is at highest risk for having a multiple gestation? the 38-year-old client whose spouse is a triplet the 19-year-old client diagnosed with polycystic ovary syndrome the 27-year-old client who gave birth to twins 2 years ago the 41-year-old client who conceived by in vitro fertilization

Avoid any discussion of the situation with the couple.

A nurse is providing care to a couple who have experienced intrauterine fetal demise. Which action would be least effective in assisting a couple at this time? Give the parents a lock of the infant's hair. Assist the family in making arrangements for their stillborn infant. Allow the couple to spend as much time as they want with their stillborn infant. Avoid any discussion of the situation with the couple.

increasing birth weight

A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is: increased number of overall pregnancies. increasing birth weight. longer length of labor. poor quality of prenatal care.

breech presentation Breech presentation is when the fetal buttocks present first rather than the head. Face and brow presentation has complete extension of the fetal head. Brow presentation is when the fetal head is between full extension and full flexion so that the largest fetal skull diameter presents to the pelvis. Persistent occiput posterior position is the engagement of fetal head in the left or right occiputo-transverse position with the occiput rotating posteriorly rather than into the more favorable occiput anterior position. Normal presentation is head first or occiput anterior.

A nursing student correctly identifies the problem of fetal buttocks instead of the head presenting first as which type of presentation? face and brow presentation normal presentation persistent occiput posterior presentation breech presentation

tomorrow at 1400 Betamethasone is given as two intramuscular injections, given 24 hours apart. Because the woman got her first dose at 1400 today, then her second dose would be given at 1400 tomorrow. Corticosteroids given to the mother in preterm labor can help prevent or reduce the frequency and severity of respiratory distress syndrome in premature infants delivered between 24 and 34 weeks' gestation. Betamethasone (Celestone) is an antenatal glucocorticoid that is given intramuscularly (IM) to pregnant women between 24 and 34 weeks' gestation. It is administered to prevent morbidity and mortality associated with preterm labor due to respiratory distress syndrome. Therefore the nurse should administer the drug in two doses with a time interval of 24 hours because optimal fetal benefits start 24 hours after the first injection. The drug cannot be administered orally because it may impair the absorption of the drug; therefore the drug must be given only through the IM injection route. Increased doses of insulin are administered only if the patient has a history of well-controlled blood sugar levels. The drug causes increased blood glucose levels and increased white blood cells (WBCs) but not blood platelet levels. Therefore it is not useful to assess the blood platelet levels in the patient after the drug is administered.

A pregnant client at 28 weeks' gestation in preterm labor has received a dose of betamethasone IM today at 1400. The client is scheduled to receive a second dose. At which time would the nurse expect to administer that dose? tomorrow at 0800 tomorrow at 1400 tomorrow at 1800 tomorrow at 1200 today at 2200

"Maybe dimming the lights or some soft music will help you relax a bit." "I will keep you updated often on how you and your baby are doing." "Things are moving along but sometimes it can take a little longer." The client is experiencing problems with the psyche. The nurse should provide emotional support to the client and family. Comfort measures such as dimming the lights or putting on soft music can promote relaxation and help the client's body work more effectively with the forces of labor. Keeping the client updated about her status and that of her fetus can provide reassurance and encouragement. Explanations about labor and what to expect can help empower the client and help her cope. The nurse should provide continuous presence to allay anxiety. Pain medication is needed to reduce anxiety and stress.

A pregnant client's labor has been progressing slower than normal. The client is visibly anxious and tense, telling the nurse, "I am so worried about what is going to happen. And I am so tired and feel so helpless." Other underlying issues that may be contributing to the client's slow labor progress have been ruled out. Which response(s) by the nurse would be appropriate? Select all that apply. "Let me leave you alone for a little while so you can get some rest." "Maybe dimming the lights or some soft music will help you relax a bit." "Things are moving along but sometimes it can take a little longer." "I will have to stop giving you pain medicine because it is slowing your labor." "I will keep you updated often on how you and your baby are doing."

Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis

A shoulder dystocia situation is called in room 4. The nurse enters the room to help and the health care provider says to the nurse, "McRoberts maneuver." What does the nurse do next? Push the fetal head back into the uterus and prepare the client for cesarean birth Move the client into a hands-and-knees position, to straighten the sacral curve and release the posterior shoulder Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis Apply downward pressure above the pubic bone of the client, in an attempt to rotate the anterior shoulder

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." Arrest of labor results when no descent has occurred for 2 hours in a nullipara or 1 hour in a multipara. The most likely cause for arrest of descent during the second stage is CPD. Rest should allow the uterine contractions to be more efficient. The hormones secreted during pregnancy allow ligaments to soften so bones can shift to allow birth. Ultrasound would have previously been diagnosed prior to the onset of labor.

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses "arrest of labor." The woman asks, "Why is this happening?" Which response is the best answer to this question? "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." "Maybe your baby has developed hydrocephaly and the head is too swollen." "It is likely that your body has not secreted enough hormones to soften the ligaments so your pelvic bones can shift to allow birth of the baby." "Maybe your uterus is just tired and needs a rest."

The parents are beginning to demonstrate positive grieving behaviors. An evaluation of proposed outcomes may reveal unhappiness because not every woman who experiences a deviation from the normal in labor and birth will be able to give birth to a healthy child. Some infants will die. outcome achievement might include the client begins positive grieving behaviors [touching, counting toes/fingers, etc.] in response to loss of newborn. The other statements are probably accurate but are not written like outcome statements.

A woman in active labor suddenly experiences a sharp, excruciating low abdominal pain, which the nurse suspects may be a uterine rupture since the shape of the abdomen has changed. The nurse calls a code, and a cesarean birth is performed stat, but the infant does not survive the trauma. A few hours later, after the woman has stabilized, she asks to hold and touch her infant, and the nurse arranges this. Later, the nurse's documentation should include which outcome statement? The parents continue to mourn the loss of their infant. The parents are beginning to demonstrate positive grieving behaviors. The parents are exhibiting dysfunctional coping mechanisms related to the death of their newborn. The parents just cannot believe their perfect infant died.

Hospitalization, tocolytic therapy, and IM corticosteroids At 31 weeks gestation, the goal would be to maintain the pregnancy as long as possible if the mother and fetus are tolerating continuation of the pregnancy. Stopping the contractions and placing the patient in the hospital allow for monitoring and a safe place if the woman continues and delivers. Administration of corticosteroids may help to develop the lungs and prepare for early preterm delivery. Sending the woman home is contraindicated in the scenario described. An emergency cesarean section is not indicated at this time. Monitoring fetal kick counts is typically done with a post-term pregnancy.

At 31 weeks' gestation, a 37-year-old woman with a history of preterm birth reports cramps, vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Assessment reveals cervix 2.1 cm long; fetal fibronectin in cervical secretions, and cervix dilated 3 to 4 cm. Which interactions should the nurse prepare to assist with? bed rest and hydration at home careful monitoring of fetal movement (kick) counts an emergency cesarean birth hospitalization, tocolytic, and corticosteroids

Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min. Hyperstimulation is usually defined as five or more contractions in a 10-minute period or contractions lasting more than 2 minutes in duration or occurring within 60 seconds of each other. The surest method to relieve hyperstimulation is to immediately discontinue the oxytocin infusion. The rate should not be increased by more than 2 milliunits at a time. When the infusion is administered, the oxytocin solution should be "piggybacked" to a maintenance IV solution such as Ringer's lactate and the piggyback added to the main infusion at the port closest to the woman. Infusions are usually begun at a rate of 1 to 2 milliunits/min. If there is no response, the infusion is gradually increased every 30 to 60 minutes by small increments of 1 to 2 milliunits/min until contractions begin.

The nurse in a busy L & D unit is caring for a woman beginning induction via oxytocin drip. Which prescription should the nurse question with regard to titrating the infusion upward for adequate contractions? After one hour, titrate the infusion upward by 1 to 2 mu/min until contractions are adequate. Start oxytocin drip, piggyback to main IV line to port closest to client. Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min. Discontinue infusion if contractions are every 2 minutes lasting 60 to 90 seconds each.

Late decelerations When the fetus is being deprived of oxygen the fetus will demonstrate late decelerations on the fetal monitoring strip. This is an indication the mother is in need of further assessment. Early decelerations are a normal finding. Variable decelerations usually coincide with cord compression.

The nurse is caring for a client suspected to have a uterine rupture. The nurse predicts the fetal monitor will exhibit which pattern if this is true? Late decelerations Early decelerations Variable decelerations Mild decelerations

Prepare the client for a cesarean birth. The findings are consistent with uterine rupture. An abrupt change in the fetal heart rate pattern is often the most significant finding associated with uterine rupture. Others are reports of pain in the abdomen, shoulder, or back in a laboring woman who had previous effective pain relief from epidural anesthesia. Falling blood pressure and rising pulse may be associated with hypovolemia caused by occult bleeding. The treatment is immediate cesarean birth.

The nurse is monitoring a client in labor who has had a previous cesarean section and is trying a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The client reports severe pain in her abdomen and shoulder. What should the nurse prepare to do? Turn the client on her left side. Place the client in a knee-chest position. Bolus the client with another dose of medication through the epidural. Prepare the client for a cesarean birth.

It significantly increases the risk of cesarean birth. It significantly increases instrumented birth. It significantly increases the use of epidural analgesia. It significantly increases the admissions to the neonatal ICU. Evidence is compelling that elective induction of labor significantly increases the risk of cesarean birth, instrumented birth, use of epidural analgesia, and neonatal ICU admissions. Increased birth weight is not a factor.

The nurse is preparing to talk to a group of pregnant women about elective induction and why it is not highly recommended. Which statements should she include in her presentation? Select all that apply. It significantly increases the weight of the newborn. It significantly increases the admissions to the neonatal ICU. It significantly increases the risk of cesarean birth. It significantly increases instrumented birth. It significantly increases the use of epidural analgesia.

Severe variable decelerations occur and are due to cord compression. R:Indications for amnioinfusion include severe variable decelerations resulting from cord compression, oligohydramnios (decreased amniotic fluid), postmaturity, preterm labor with rupture of the membranes, and thick meconium fluid. Failure of the fetal presenting part to rotate fully, descend in the pelvis, abnormal fetal heart rate patterns or acute pulmonary edema, and compromised maternal pushing sensations from anesthesia are indications for forceps-assisted birth, and not for amniofusion.

The nurse would prepare a client for amnioinfusion when which action occurs? Severe variable decelerations occur and are due to cord compression. Fetal presenting part fails to rotate fully and descend in the pelvis. Maternal pushing is compromised due to anesthesia. The fetus shows abnormal fetal heart rate patterns.

"Dystocia is diagnosed after labor has progressed for a time." Nursing management of the woman with dystocia, regardless of etiology, requires patience. The nurse needs to provide physical and emotional support to the patient and family. Dystocia is diagnosed not at the start of labor, but rather after it has progressed for a time.

The nursing student demonstrates an understanding of dystocia with which statement? "Dystocia is not diagnosed until after the delivery." "Dystocia is diagnosed at the start of labor." "Dystocia is diagnosed after labor has progressed for a time." "Dystocia cannot be diagnosed until just before delivery."