chapter 8 maternal- not book

when is tyhe mucus plugh expelled

a week or 2 before labor begins

expulsin

birth occurse after derlivery the anterior and posterior shoulders

false labor

braxon hicks contractinos walk for an hour or 2 than vaginal exam to check the ceriix

descent -

decent-= dropping

4th stage

deilivery of placenta through 2-4 hr post off afterpains awake talkative excited

internal rotation

early of labortransverse poistion widest from side to side fetal head rotates 45 degrees to a anterior poistion

anthropoid pelvis

elongated in its deimensions roomy-anterior posterior transversis narrow

android pelvis

male pelvis heart shape 1/3 of white women and 16 percent of non white women have this large babies get stuck must be delivered ceerean

how to estimate the obstetric conjugate for pelvic dimenions

measure the diagnal conjugate \ than subtract 1.5 to 2 cm

vertex presentation

most favorable attitude of flexion

fetal skull

most important in relation to labor and birth cartilage overlap during birth called modling

military presentation

not flexed nor hyperextended

msot favoravle position for vaginal birth are

oa roa and loa

most important mesuremt for pelvic dimensions is

obsconjugate becuase this is the smallest diameter of the inlet through which the fetus must pass

how to abrevaite fetal position

r right l for left 2n dletters o for occupit f for fortum last part a for anterior p for posterior t for transferves

when the fetus has a score of - 4 station

recorded as floating and unengage not yet entered true pelvis

fetal attitide

refers to the relationship of teh fetal parts to one another

fetal presentation

refers to theforemost part of the fetus that enters the pevlic i

transition phase

8-10 cm 2-3 min 60-90 min strong most difficult resistg urge to push nausea vomiting iritability inability to relax feeling of loss of control

3 ways of fetal presentation

cepholic presentation feet or butt breach or shoulder shoudler presentation

soft tissues that form part of the passageway

cervix and vagina aka birth cannal

effacement 1st cervical change

cervix gets shorter and thinner recorded as a percentage when the length is 1 cm its 50 percenty when cervix is paper thin its 100 effecdd

2nd cervical change dilation

cervix opens measured in cm when dialated compeletey its 10 cm

2nd stage of labor

compelete 10 cm dilation 2-5 min d 60-90 min stron fetal decent woman should push when urge feels of being more in conrtol

passageway

consists with the womans bony pelvis and soft tissue of the cervix

bracton hicks

contractions that decrease in intensitiy with walking or change of positions

A pregnant woman comes to the emergency department because she thinks she is in labor. The nurse determines that the client is in true labor when assessment of contractions reveals which of the following? a) Occurring in an irregular pattern b) Lasting about 20 to 30 seconds c) Slowing when the woman changes position d) Radiating to the front of the abdomen from the back

d

Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines that this client is in: a) Active phase of the first stage b) Perineal phase of the second stage c) Transition phase of the first stage d) Latent phase of the first stage

d

The skull is the most important factor in relation to the labor and birth process. The fetal skull must be small enough to travel through the bony pelvis. What feature of the fetal skull helps to make this passage possible? a) Cephalohematoma b) Vertex presentation c) Caput succedaneum d) Moldin

d

There is no consensus of what actually happens to initiate the onset of labor. It is thought to be a combination of maternal and fetal factors that occur in such a way that labor begins. What is the term used to describe the way maternal and fetal factors interact to cause labor to begin? a) Pyramid effect b) Waterfall effect c) Pathway effect d) Cascade effect

d

Which of the following would indicate to the nurse that the placenta is separating? a) Umbilical cord shortens b) Fetal head at vaginal opening c) Mucous plug is expelled d) Uterus becomes globular

d

fetal lie

describes the postion of the long axis of teh fetus in relation to long axis of pregnant women logintudinal lie- whic the long axis of the fetus is parallel to the long axis transverse lie the long axis of the fetus is perpendicular to teh long axis of teh women oblique lie is between

perioarous women dilation

dilation and effacemnt happen together cervix dilates 1-2 cm several weeks before labor

flexion

head decends during labor when head meats soft tissue

what are the essential components of labor

passageway passanger power psyyche problem in any of these will negatively influce labor

powers

primary force of labor comes form

contractinos progestrone and parostaglandin

progestrone -inhibit contraction promote contractions is prostoglandin

pshyce

psychological

extension- wehn the fetus reaches the pubic arch it must extend under symphysis pubis

...

and obstetric conjugate that measures what is adeuqte

11 cm

The first stage of labor is often a time of introspection. In light of this, which of the following would guide your planning of nursing care? a) A woman will rarely speak or laugh during this period. b) A woman should be left entirely alone during this period. c) A woman may spend time thinking about what is happening to her. d) No nursing care is needed to be done during this time.

A woman may spend time thinking about what is happening to her

A young woman recently gave birth to a healthy 7 lb, 6 oz baby girl. There were no complications during the birth, and the mother appears to be well. Which of the following should the nurse do to assess this client's psychological state after the pregnancy? a) Quiz the client on her knowledge of current events to make sure she is lucid b) Ask her about her family history related to mental illness c) Refer the client to a psychologist who specializes in postpartum depression d) Encourage the client to talk about her birthing experience with the nurse and others

Encourage the client to talk about her birthing experience with the nurse and others

The nurse is reviewing the laboratory tests results of a client in labor. Which of the following would the nurse consider a normal finding? a) Decreased plasma fibrinogen levels b) Increased blood glucose levels c) Increased blood coagulation time d) Increased white blood cell count

Increased white blood cell count

The woman has just delivered a healthy baby boy, but the placenta has not yet delivered. What stage of labor does this scenario represent? a) First b) Second c) Fourth d) Third

Third

A client has not received any medication during her labor. She is having frequent contractions every 1 to 2 minutes and has become irritable with her coach and no longer will allow the nurse to palpate her fundus during contractions. Her cervix is 8 cm dilated and 90% effaced. The nurse interprets these findings as indicating: a) Active phase of the first stage of labor b) Transition phase of the first stage of labor c) Latent phase of the first stage of labor d) Pelvic phase of the second stage of labor

b

A nurse performs an initial assessment of a laboring woman and reports the following findings to the primary care provider: fetal heart rate is 152 bpm, cervix is 100% effaced and 5 cm dilated, membranes are intact, and presenting part is well applied to the cervix and at -1 station. The nurse recognizes that the client is in which stage of labor? a) Third b) First, active c) Second d) First, laten

b

When measuring the diagonal conjugate of a woman's pelvis, the distance between which of the following anatomic landmarks would be used? a) Interior surface of the sacral prominence and the posterior surface of the symphysis pubis b) Anterior surface of the sacral prominence and the anterior surface of the symphysis pubis c) Medial surface of the ischial tuberosities d) Posterior surface of sacrum and the axis of the ischial tuberosities

b

3rd stage of labor

birth through deilivery soghns of placental sepration gushof blood lengthening of umbilcal cord fundus globualr ask about infant

nesting urge

burst of engery to clean 24-48 hrs before labor

A multigravid patient has been in labor for several hours and is becoming anxious and distressed with the intensity of her frequent contractions. The nurse observes moderate bloody show and performs a vaginal examination to assess the progress of labor. The cervix is 9 cm dilated. The nurse knows that the patient is in which of the following phases of labor? a) Latent phase. b) Early phase. c) Transition phase. d) Active phase.

c

What term is used to describe the position of the fetal long axis in relation to the long axis of the mother? a) Fetal position b) Fetal presentation c) Fetal lie d) Fetal attitude

c

fetus neck is extended and the face is visible

cephalic presentation

fetal position

determined by comparing teh relationship of arbitrarily deteremed referecnce point on the presenting part of the fetus to the quadranst of teh maternal pelvis

when fetus settles into teh true pevlis at level of ischial it is said

enageged

pelvic shapes

gynecoid anthropoiid platypelliod android

fetal station

referse to teh relationship of present part of the fetus to ischial spines of the pevlis when widdened part of the diamater of present part is at the level of the ischial spines the situation is zero if above the ishcial its negative number minus if below positive

signs labor is approching

ripeening of cervix and effacement dilation of cer ix softening

cardinal movement

the positinoing and movemnt through passageconnal

the portion of the pelvis below the linea terminalis is the

true pelvis is the bony passageway through which the fetus must pass during delivery

pubic arch should be what measurment

90 degrees

Which of the following would alert the nurse that the client is in the transition phase of labor? a) Reduction of rectal pressure b) Beginning urge to bear down c) Decrease in the bloody show d) Enthusiasm in the client

Beginning urge to bear down

There are four essential components of labor. The first is the passageway. It is composed of the bony pelvis and soft tissues. What is one component of the passageway? a) Cervix b) Uterus c) False pelvis d) Perineum

Cervix

After teaching a group of students about the maternal bony pelvis, which statement by the group indicates that the teaching was successful? a) The pelvic outlet is associated with the true pelvis. b) The false pelvis lies below the imaginary linea terminalis. c) The false pelvis is the passageway through which the fetus travels. d) The bony pelvis plays a lesser role during labor than soft tissue.

The pelvic outlet is associated with the true pelvis.

diagnoal conjugate pelvic demensions

extends from the symphysis pubis to gteh sacral promontory

the flared upper portion of the bony pelvis is

false pevlis this is not part of the bony passageway

passenger

fetus fetal skull fetal lie fetal presentation fetal attitude fetal poistion fetal station

bony pelvis

forms the rigid passageway through which the fetus must navigate to deliver vaginally

engagemnet

inital decnet of the fetal head 2 weeks before lavor

onset of labor

what is triggering labor to begin cascade effects

anticipitory sign of labor

2 weeks before labor settle into pevlice ciaity sense that baby has dropped lightyening

latent phase

4 cm 5-10 min duration 30-45 sec intensity mild irregualr conrtactino thinning excited talkative

active phase

4-8cm 3-5 min 40-60 sec moderate to strong regular contaction women is focused on conractions fetal decent

platlypelloid pelvis

last common flat in dimeniosn with naranterior posterior diameter wide transcverse must have cesearn

The obstetrician is examining a woman who is in early labor to determine the positioning of the fetus. The nurse knows that which of the following fetal attitudes would be the most advantageous for birth? a) Chin in moderately flexed military position b) Head flexed forward so much that the chin touches the sternum c) Fetus in complete extension with back arched d) Fetus in partial extension with brow presenting to birth canal

Head flexed forward so much that the chin touches the sternum

Question: Put the following events of labor in correct order: 1 2 3 4 5 6 Cervix becomes fully effaced The cervix dilates to 2 cm Crowning occurs Fetus begins descent Placental separation Placental expulsion

The cervix dilates to 2 cm Cervix becomes fully effaced Fetus begins descent Crowning occurs Placental separation Placental expulsion

documneting contraction 3 discritors

frequencey = how often... beggining of one conrtaction to the next duration- how long from the beggining=contratcion from start to finsih and intensity-strength of contraction -by palpating the fundus at the peak of contraction

each involuntary uterine contraction is composed of 3 phases

increment -build up contractions longest phase acme =peak decrement=letting up phase relaxes guraually

true pelivs landmarks

inlet-entrance to the true pelvis midpelvis and outlet exit point s

gynecoid pelvis

is most favorable rounded shape of gyncoid inlet typical pelvis

practioner takes measure menst of teh midpelvis at teh level of what

ischial spines

A client is in the transitional phase of labor. Which of the following would the nurse most likely find? Select all that apply.

• Strong desire to push • Irritability with restlessness