Maternal Exam 2
MATERNAL Renal
+ 1 Proteinuria is normal during labor due to muscle breakdown from physical work of labor .
oliogohydramnios
-too little fluid
The fundus descends _____ every 24 hours .
1 to 2 cm ( 0.39 to 0.79 in )
Counter - pressure lifts the __1___ away from the __2__, which __3___ pain .
1. Fetal head 2. Sacral nerves 3. Decreases
Contractions described by __1__, __2__, and __3__.
1. frequency 2. duration 3. intensity
Labor maybe triggered by decrease level of __1___ and increased levels of __2__, __3__, and __4__.
1. progesterone 2. estrogen 3. prostaglandins 4. oxytocin
Which two types of attitudes may result in a c-section?
1.) complete extension= largest AP diameter ~13.5 cm 2.) partial extension
Newborn hemoglobin level expected reference range
14 to 24 g / dL
newborn platelet count expected reference range
150,000 to 300,000 / mm ^ 3 .
Lacerations
1st degree - skin 2nd degree - skin and muscle of perineal body 3rd degree anal sphincter muscle 4th degree anterior rectal wall
1st STAGE OF TRANSITION OF THE NEWBORN
1st period of reactivity -Awake and alert for up to 30 minutes after birth -HR 160-180 -Resp . irregular with rate between 60-80 bpm -Fine crackles can be auscultated in the lungs -Grunting , nasal flaring and retractions maybe present should cease within first hour after birth . -Bowel sounds are audible and meconium maybe passed
The fundus is approximately _____ below the level of the umbilicus at the end of the third stage of labor .
2 cm ( 0.79 in )
The nurse should titrate the dosage of oxytocin until the client has 1 contraction every ______.
2 to 3 minutes; One contraction every minute is an indication of uterine tachysystole
Newborn bilirubin expected reference range
2 to 6 mg / dL .
3rd STAGE OF TRANSITION OF THE NEWBORN
2nd period of reactivity -Occurs roughly between 2 to 8 hours after birth and lasts from 10 minutes to several hours in length . -Brief periods of tachycardia and tachypnea occur and are associated with increased muscle tone , changes in skin color and mucous production -Meconium is commonly passed now
When is fetal surfactant produced by?
32 weeks
When is the fetal GI system mature by?
36 weeks
Newborn serum glucose level expected reference range
40 to 60 mg / dL .
A nurse is teaching a prenatal class about pain management during labor . Which of the following statements should the nurse identify as an indication that the client understands the instructions ? A. " I can apply a heating pad to my back to relieve back pain . " B. " I can have a low spinal block to help with labor pain . " C. " I can have butorphanol every 2 hours during labor . " D. " My time limit for staying in the hydrotherapy tub is 30 minutes . "
A. " I can apply a heating pad to my back to relieve back pain . "
During birth about __A__ of fetal lung fluid is expelled , the remaining __B__ is reabsorbed through the interstitium and excreted through pulmonary circulation and lymphatic systems .
A. 1/3 B. 2/3
Newborns Resp rate should settle at ___A__ bpm with __B__ rate. Pauses should be no longer than 20 seconds
A. 30-60 B. irregular
A nurse in the labor and delivery suite is planning care for a group of 4 clients . Which of the following clients should the nurse see first ? A. A client who is in active labor and has late decelerations on the fetal heart monitor strip B. A client who is in transition and screaming and disturbing other clients C. A client who has epidural analgesia and is reporting breakthrough pain D. A client who has received an oxytocin infusion and is experiencing contractions every 2 min lasting 60 sec
A. A client who is in active labor and has late decelerations on the fetal heart monitor strip
A nurse is assisting with an amniotomy for a client who is in active labor . Which of the following actions should the nurse take ? A. Assess the fetal heart rate before and after the procedure B. Monitor the client's temperature every 4 hr after the procedure C. Medicate the client for pain 30 min prior to the procedure D. Perform cervical assessments every 2 hr after the procedure
A. Assess the fetal heart rate before and after the procedure
A nurse is reviewing the laboratory findings of a 24 - hour - old newborn . Which of the following findings should the nurse report to the provider ? A. Hemoglobin 12 g / dL B. Platelet count 200,000 / mm ^ 3 C. Total bilirubin 4 mg / dL D. Glucose 50 mg / dL
A. Hemoglobin 12 g / dL
A nurse is caring for a postpartum client 8 hr after delivery . Which of the following factors places the client at risk of uterine atony ? ( Select all that apply . ) A. Magnesium sulfate infusion B. Distended bladder C. Oxytocin infusion D. Prolonged labor E. Small for gestational age newborn
A. Magnesium sulfate infusion B. Distended bladder D. Prolonged labor
A nurse is providing care for a client who is in the second stage of labor . The fetal heart tracing indicates multiple variable decelerations . Which of the following actions should the nurse take ? A. Prepare an amnioinfusion B. Place the client in a supine position C. Administer oxygen 2 L / min via nasal cannula D. Give a glucocorticoid
A. Prepare an amnioinfusion
A nurse is caring for a client in the early stage of labor who has preeclampsia with severe features . Which of the following interventions should the nurse perform ? A. Assess the fetal heart rate and contractions hourly B. Encourage oral intake of clear , low - sodium fluids C. Instruct the client to ambulate during the early phase of labor D. Implement seizure precautions
D. Implement seizure precautions
A nurse is caring for a client who is in labor . A vaginal examination reveals the following findings : 2 cm , 50 % , +1 , right occiput anterior ( ROA ) . Based on this information , which of the following fetal positions should the nurse document in the medical record ? A. Transverse B. Breech C. Vertex D. Mentum
C. Vertex
FETAL Renal
Amniotic fluid made up of a large portion of fetal urine , thus amniotic fluid levels are indicative of fetal renal health . ( oliogohydramnios -too little fluid ) Placenta maintains fetal fluid and electrolyte balance during pregnancy , thus kidneys do not have to function for this purpose while in utero . Glomerular Filtration Rate ( GFR ) is low in the newborn Fetal kidneys do not concentrate urine well Newborns are very susceptible to over and dehydration issues
Nitrous Oxide
Analagesia -Self - inhaled - mixed with oxygen -Fewer complications for mom and baby than other analgesics but still some CNS depression
Spinal
Anesthesia -Used in C - sections because provide a higher area treated by anesthesia -Spinal complication risk increased over epidural because injection area is at level of spinal cord -Increased respiratory complications because of higher treatment area as well -Hypotension possible - treat with IVF bolus prior to administration -Check platelet levels prior to administration due to risk of bleeding
VARIABLE DECELERATION =???
CORD COMPRESSION
Blocks / Epidurals
Anesthesia -Used in vaginal births because provides a lower area treated by anesthesia -Can be titrated so that woman can feel pressure of push more effectively when needed -Many practitioners wait until 3 cms dilated to administer epidurals because feeling was that . epidural slowed or stalled labor progress if given too early in labor . Current research shows this to be untrue or questionable as labor progress slows in some patients but increases in others due to muscular relaxation . Thus , epidurals may be given in early labor .
Fetal Circulation
Can be affected by maternal position , uterine contractions , maternal blood pressure and umbilical cord blood flow Most healthy , term fetus can adapt to these stresses and compensate well
Fetal extension
Chin extended away from chest , extremities extended
Fetal flexion
Chin flexed to chest , extremities flexed into torso
Respiratory System Mechanical Factors
Clamping of the cord = rise in BP = increased circulation and lung perfusion -Changes in intrathoracic pressure due to chest compression during vaginal birth -Crying increases air distribution in the lungs and promotes alveoli expansion ; Positive pressure of crying helps keep alveoli open
COCHRAN RESEARCH
Cochrane Researchers found the first stage of labor was significantly shorter for women who walk around , stand up , kneel or sit up as opposed to lying down . These positions aid in fetal descent
Passenger
Consists of the fetus and the placenta
False Labor
Contractions -Occur irregularly or become regular only temporarily -Often stop with walking or position change -Can be felt in back or abdomen above navel -Can often be stopped through use of comfort measures Cervix ( by vaginal examination ) -May be soft but with no significant change in effacement or dilation or evidence of bloody show -Is often in posterior position Fetus -Presenting part is usually not engaged in pelvis
True Labor
Contractions -Occur regularly , becoming stronger , lasting longer , and occurring closer together -Become more intense with walking -Are usually felt in lower back , radiating to lower portion of abdomen -Continue despite use of comfort measures Cervix ( by vaginal examination ) -Shows progressive change ( softening , effacement , and dilation signaled by appearance of bloody show ) -Moves to an increasingly anterior position Fetus -Presenting part usually becomes engaged in pelvis , which results in increased ease of breathing ; at the same time , presenting part presses downward and compresses bladder , resulting in urinary frequency
A nurse is preparing to administer an IV infusion of oxytocin for labor induction to a client who is at 41 weeks of gestation . Which of the following actions should the nurse plan to take ? A. Administer the oxytocin with manual IV tubing B. Monitor the fetal heart rate every 15 minutes initially C. Begin the infusion at 10 milliunits / min D. Titrate the dosage until the client has 1 contraction every minute
B. Monitor the fetal heart rate every 15 minutes initially
A nurse is caring for a client who is in labor . The client asks the nurse , " Why are you pressing on my abdomen ? " Which of the following responses should the nurse make ? A. " I can determine your baby's heart rate . " B. " I can confirm that you have sufficient fluid around your baby . " C. " I can confirm that your baby moves with stimulation . " D. " I can determine the position of your baby . "
D. " I can determine the position of your baby . "
A nurse is preparing to administer meperidine hydrochloride to a client who is in labor . Which of the following statements should the nurse make to the client ? A. " This medication can cause your blood pressure to rise . " B. " This medication can cause dry mouth . " C. " This medication can cause you to urinate excessively . " D. " This medication can make you sleepy . "
D. " This medication can make you sleepy . "
A nurse is reviewing the laboratory values of a client who is pregnant and has a low progesterone level . Which of the following complications should the nurse expect ? A. Gestational diabetes B. Preterm labor C. Inadequate milk supply D. Inadequate uterine growth
B. Preterm labor
A nurse is assessing a client who is in the first stage of labor and has preeclampsia . Which of the following findings should the nurse expect ? A. Severe hypotension B. Proteinuria C. Elevated platelet count D. Seizures
B. Proteinuria
A nurse is reviewing the laboratory report for a client with suspected HELLP syndrome . Which of the following findings should the nurse report to the provider as an indication of this disorder ? A. Elevated hemoglobin B. Elevated creatinine clearance C. Elevated liver enzymes D. Elevated platelet count .
C. Elevated liver enzymes
A nurse is caring for a client who is in the latent phase of labor and is experiencing low back pain . Which of the following actions should the nurse take ? A. Instruct the client to pant during contractions B. Position the client supine with legs elevated C. Encourage the client to soak in a warm bath D. Apply pressure to the client's sacral area during contractions
D. Apply pressure to the client's sacral area during contractions
A nurse is creating a plan of care for a client who is in the active stage of labor and expresses a desire to use nonpharmacological methods of pain relief . Which of the following interventions should the nurse include ? A. Encourage the client to listen to music B. Instruct the client how to use informational biofeedback C. Ask the client to reconsider using a regional anesthetic D. Assist the client into a warm shower
D. Assist the client into a warm shower
A nurse is caring for a client who is at 39 weeks gestation and in active labor . Which of the following actions should the nurse include in the plan of care ? A. Keep all 4 side rails up while the client is in bed B. Monitor the fetal heart rate every hour C. Insert an indwelling urinary catheter D. Check the cervix prior to analgesic administration
D. Check the cervix prior to analgesic administration
A nurse is caring for a client who is in labor . Which of the following methods will determine the frequency of the client's contractions ? A. Palpating the firmness of the uterus during a contraction B. Calculating the time from the end of each contraction to the beginning of the next C. Measuring the time from the beginning of a contraction to the end of that same contraction D. Evaluating the time from the beginning of a contraction to the beginning of the next contraction
D. Evaluating the time from the beginning of a contraction to the beginning of the next contraction
A nurse is caring for a client labor who has an epidural for pain relief . Which of the following is a complication of the epidural block ? A. Nausea and vomiting B. Tachycardia C. Hypotension D. Respiratory depression
C. Hypotension
A nurse is caring for a client in the latent stage of labor who is reporting a pain level of 4 on a scale of 1 to 10. Which of the following actions should the nurse take ? A. Encourage the client to use hydrotherapy B. Teach the client biofeedback to control labor pain C. Lead the client in relaxation breathing techniques D. Administer a benzodiazepine medication
C. Lead the client in relaxation breathing techniques
Mood changes during stages of labor
Euphoric- early 1st stage Serious - mid and late 1st stage Amnesia between contractions of 2nd stage Elation and fatigue with 3rd and 4th stage
Assess after ROM
Fetal Heart Rate - Due to possibility of cord prolapse . Fluid appearance / significance : -Clear to slightly yellowish- Normal - Small amount blood , mucous and vernix - ok -Blood - tinged - May indicate problem -Meconium stained - May indicate problem -Odor = Infection Time - Want to deliver with 24 hours of rupture , if possible , to decrease risk of infection Amount of fluid - Roughly 1000ml at term
Transverse Lie
Fetal long axis is horizontal , forms a right angle to maternal axis , and will not accommodate vaginal birth . The shoulder is the presenting part and can require delivery by cesarean birth if the fetus does not rotate spontaneously .
Parallel or longitudinal Lie
Fetal long axis is parallel to maternal long axis , either a cephalic or breech presentation . Breech presentation can require a cesarean birth .
Platypelloid pelvis
Flat Shape
POSITIONING OF THE Woman In Labor
Frequent changes in the first stage of labor should be encouraged to relieve fatigue , increase comfort and improve circulation During Second stage of labor affected by physician and maternal preference , fetal and maternal condition , and environment
FETAL Hepatic
Glycogen main source of energy stored in liver / higher level than adults at term Iron stored in liver at term should be adequate for first 5 months of life Fetal liver doesn't have to clear bilirubin because the placenta does much of this work . Therefore fetal blood is shunted away from the liver and to the placenta and the fetal liver doesn't have adequate supplies of enzymes present to conjugate bilirubin = predisposes newborn to hyperbilirubinemia after birth
EARLY DECELERATION =???
HEAD COMPRESSION
IF THERE WERE A PROLAPSED CORD ??
IF occurs : Relieve pressure on cord , Cover with sterile gauze / saline , Knee chest / Trendelenburg
Primary Powers
Involuntary Uterine Contractions - Cause dilation , effacement and fetal decent Body of uterus - Start at the top of uterus ( fundus ) and work down in wave like motion
_______ is the return of the uterus to its normal pre - pregnancy state , which occurs after the delivery of the placenta
Involution
Forth Stage
Lasts about 2 hours after delivery of the placenta - recovery . period - homeostasis returns - Time of heightened assessment for complications
Third Stage
Lasts from birth of the Fetus until birth of the placenta
Second Stage of Labor
Lasts from full cervical dilation to birth of the fetus
Presentation will affect
Length & difficulty of labor Method of delivery
Duration
Length of the contraction from beginning to end of one contraction
Signs preceding labor
Lightening - Dropping of fetus into true pelvis - gradual - Occurs in primaparas about 2 weeks prior to term - May not occur in Multiparas until labor occurs . Respiratory relaxation - less congestion and ease of breathing returns due to lightening Backache - Due to lightening Urinary Frequency - Due to lightening Braxton Hicks Contractions - Strong , frequent but irregular contractions that do not cause dilation Increased vaginal discharge and bloody show - vaginal congestion and passing of mucous plug Cervical Ripening / Softening- may have some effacement and dilation Surge of Energy - Nesting Loss of 0.5-1.5 kgs maternal weight due to fluid shifts- cause a change in estrogen and progesterone levels . Possible Rupture of Membranes - Active labor doesn't always follow
Glomerular Filtration Rate ( GFR ) is ____ in the newborn
Low
Psychological response
Maternal stress , tension , and anxiety can produce physiological changes that impair the progress of labor .
FETAL Gastrointestinal
Mature 36 weeks Difficulty digesting starches and Fats Meconium Should pass within 24 hours after birth Malformations cause Polyhydramnios ( too much amniotic fluid ) as the fetus doesn't swallow and recycle the fluid
Biishial diameter
Measured between ischial tuberosities ( > 8 cm is considered adequate )
Station
Measurement of fetal descent in centimeters with station 0 being at the level of an imaginary line at the level of the ischial spines , minus stations superior to the ischial spines , and plus stations inferior to the ischial spines .
A ______ position indicates that the fetus has fully extended the head and is presenting with the chin .
Mentum
Stadol / Nubain
Narcotic / Opioid Agonist - Antagonist Analgesic -Treat pain with less nausea side effects -Confusion can be long lasting -Less resp . depression than Demerol or Fentanyl -Cause withdrawal symptoms in opioid dependent mothers
Demerol
Narcotic / Opioid Agonist Analgesic -Inexpensive -Effects baby for 1-3 days after administration - Narcan doesn't work well as metabolites cross placenta
Fentanyl
Narcotic / Opioid Agonist Analgesic -Shorter and faster acting - Need frequent or PCA dosing -Fewer fetal side effects and less sedation and nausea than Demerol -More expensive than Demerol
Fetal Heart Rate ( FHR )
Normal term FHR is 110-160 bpm Temporary acceleration and slight decelerations can be expected during labor in response to fetal movement , vaginal examination , fundal pressure , uterine contractions , abdominal palpation , and fetal head compression .
ACCELERATION=???
OKAY
First Stage of Labor
Onset of regular uterine contractions to full dilation of the cervix . Longest Stage of Labor
Anthropoid pelvis
Oval Shape
LATE DECELERATION=???
PLACENTAL INSUFFICIENCY
Fetal Presentation
Part of the Fetus that enters the pelvic inlet and is closest to the cervix -Cephalic or Vertex presentation ( occiput / head or mentum / chin = fetal part closest to cervix ) -Breech ( sacrum / buttocks / feet - fetal part closest to cervix ) -Shoulder ( scapula - fetal part closest to the cervix )
2nd STAGE OF TRANSITION OF THE NEWBORN
Period of decreased responsiveness -After the first period of reactivity - newborn sleeps or has markedly decreased activity . Lasts for 60-100 minutes -HR at baseline 100-120 bpm -Infant is pink - acrocyanosis is still normal -Resp . rapid and shallow but unlabored . Rate up to 60 bpm -Bowel sounds are audible and peristalsis maybe seen on abd . Wall .
Phenergan / Reglan
Reglan works better for nausea prevention / treatment but impairs analgesia of opioids
Attitude
Relationship of fetal body parts to one another
Fetal Respiration
Respiration is initiated immediately after birth by various methods : Fetal lung fluid is cleared from the airway during passage through the maternal birth canal during labor and vaginal birth ( Squeezing of fetal chest and abdomen new research says = minor role ) . Fetal oxygen pressure ( Po2 ) decreases . Arterial carbon dioxide pressure ( Pco2 ) increases . Arterial pH decreases . Bicarbonate level decreases . Fetal respiratory movements decrease during labor
Longitudinal lie ( vertical lie )
Result in Cephalic or breech presentation
Horizontal lie ( transverse lie )
Result in shoulder presentation - must have C - section - vaginal birth not possible
Partial Extension
Results in Brow Presentation -Uncommon -Head pushed back slightly -Difficult birth due to large AP diameter ( Occipitomental ) -May result in C - Section is AP diameter too large to pass through pelvis
Complete Extension
Results in a face presentation -Rare and abnormal -Head and neck are hyperextended and the occiput touches the fetus's upper back -Very difficult birth as largest AP diameter presents ( Submentobregmatic ) 12 13.5cm -Diameter of fetal skull is commonly too large to pass through the pelvis - 15-20 % require C - section
ROT
Right occiput transverse
FETAL STATION
Station: relationship of presenting part to maternal ischial spines + station - 1 cm or greater below level of ischial spines 0 station - at level of ischial spines ( Engaged ) - station - 1cm or greater above level of ischial spines ( Floating )
Intensity
Strength of the contraction at its peak
FETAL Respiratory
Surfactant adequately produced by 32 weeks The placenta is responsible for oxygenation
Passageway
The birth canal that is composed of the bony pelvis , cervix , pelvic floor , vagina , and introitus ( vaginal opening )
Position
The client should engage in frequent position changes during labor to increase comfort , relieve fatigue , and promote circulation . Position during the second stage is determined by maternal preference , provider preference , and the condition of the mother and the fetus .
FETAL Neurologic
The fetal neurologic system begins to develop early in the womb ( week 3 ) and continues to mature long after birth , thus it is susceptible to damage throughout pregnancy and delivery . Damage to neuro system at any stage of development can have lasting effects on fetus and newborn . Term newborn brain is 1/4th the size of adult brain
Presentation
The part of the fetus that is entering the pelvic inlet first and leads through the birth canal during labor . It can be the back of the head ( occiput ) , chin ( mentum ) , shoulder ( scapula ) , or breech ( sacrum or feet ) .
Lie
The relationship of the maternal longitudinal axis ( spine ) to the fetal longitudinal axis ( spine )
Fetopelvic or fetal position
The relationship of the presenting part of the fetus ( sacrum , mentum , or occiput ) , preferably the occiput , in reference to its directional position as it relates to one of the four maternal pelvic quadrants . It is labeled with three letters (R/L, O/S/M/Sc, A/P/T)
FETAL Immunologic
The term newborn can fight infection but not as effectively as an older child The fetus doesn't make IgA but it is present in breast milk - which provides passive immunity
FETAL Endocrine
Thyroid gland develops early in the womb ( week 3-4 ) . Maternal Thyroxine doesn't cross the placenta well , so fetus typically produces thyroid hormones . A fetus that doesn't produce thyroid hormones will be born with congenital hypothyroidism which results in severe intellectual disability ; thus this is screened for in newborn screening after birth before discharge form hospital . Fetal insulin is produced in the pancreas near week 20 of development . Maternal hyperglycemia will produce fetal hyperglycemia and hyperinsulinemia and will result in a large ( macrosomic ) fetus with underdeveloped lung maturation . This places the newborn at risk for hypoglycemia and respiratory distress at birth .
4 T's -Causes of Postpartum Hemorrhage
Tone - altered uterine muscle tone Tissue - retained placental fragments Trauma - Lacerations *** ( firm fundus with continuous trickle of blood without clots ) , hematomas , Uterine inversion Thrombosis- disorders that interfere with clot formation
Gate Control Theory of Pain Control
Using distraction techniques such as massage or stroking , music , focal points , and imagery reduces or completely blocks the capacity of nerve pathways to transmit pain -These distractions are thought to work by closing down a hypothetic gate in the spinal cord , thus preventing pain signals from reaching the brain . The perception of pain is thereby diminished .
Powers
Uterine contractions cause effacement ( shortening and thinning of the cervix ) during the first stage of labor and dilation of the cervix ( enlargement or widening of the cervical opening and canal ) that occurs once labor has begun and the fetus is descending . Involuntary urge to push and voluntary bearing down in the second stage of labor helps in the expulsion of the fetus .
Hemorrhage can occur from
Uterus -Failure to contract -Retention of placental fragments Hematoma Cervical Lacerations / Vaginal Tears Bladder Distention Other Causes
Fetal Presentation Assessed via
Vaginal exam Abdominal Inspection / Palpation ( Leopold's Maneuvers ) Sonogram ( U / S ) Auscultation of FHR
Secondary Powers
Voluntary contraction of diaphragm and abdominal muscles through . maternal effort - Urge to bear down / pushing Do not effect dilation but important to increase intra - abdominal pressure and expel infant from uterus .
When should meconium first be passed?
Within 24 hours after birth
Does a fetus produce thyroid hormones?
Yes
A nurse is caring for a client who is in active labor and receiving an oxytocin infusion . The nurse notes tachysystole with a Category 1 fetal heart rate tracing . Which of the following actions should the nurse take ? A. Discontinue oxytocin infusion and apply oxygen B. Increase oxytocin infusion rate by 2 mu / min C. Administer terbutaline 0.25 mg subcutaneously D. Reposition the client in a side - lying position and continue to monitor
D. Reposition the client in a side - lying position and continue to monitor
A nurse at a clinic is preparing to teach the process of involution to a group of antenatal clients . Which of the following information should the nurse provide ? A. The fundus is approximately 2 cm ( 0.79 in ) above the level of the umbilicus at the end of the third stage of labor . B. The fundus is approximately 3 cm ( 1.18 in ) above the umbilicus within 12 hours after delivery . C. The fundus is located halfway between the umbilicus and mons pubis on the sixth day postpartum . D. The fundus is not palpable abdominally at 2 weeks postpartum .
D. The fundus is not palpable abdominally at 2 weeks postpartum .
A nurse is assessing a client who is suspected of having hyperemesis gravidarum . Which of the following laboratory tests should the nurse check first ? A. Complete blood count B. Liver enzymes C. Bilirubin level D. Urine ketones
D. Urine ketones
Valsalva maneuver should be _____
DISCOURAGED causes fetal hypoxia- Reversed with deep breathing and 02
Fetal Attitude
Degree of flexion or relationship of fetal body parts to one another
A ______ position indicates that the fetus is upright in the uterus and is presenting with the buttocks or feet .
breech
immediately after birth Fetal Arterial pH ____
decreases
immediately after birth Fetal Bicarbonate level ___
decreases
immediately after birth Fetal oxygen pressure ( Po2 ) ____
decreases
What predisposes newborn to hyperbilirubinemia after birth?
fetal liver doesn't have adequate supplies of enzymes present to conjugate bilirubin
Amniotic fluid is made up of a large portion of ____
fetal urine
FHR Variability
fluctuations in the baseline FHR that are irregular in amplitude and frequency not including acceleration or decelerations . -Measured between contractions . -Measured from peak to trough of single cycle . Interprets health of neurologic to cardiac system of fetus . Absent : amplitude range undetectable Minimal : < or to 5bpm Moderate : 6 to 25 bpm ( preferred ) Marked : > 25 bpm
Nausea and belching are a reflex response to _____
full cervical dilation
Supine hypotension
great risk because of ascending vena cava and descending aorta compression . If uterus is particularly large , this increases the risk . Multifetal pregnancy , polyhydramnios , anxiety , pain and some meds increase supine hypotension risk . Reversed with position change to side , fluids and O2 if necessary
HELLP
hemolysis ( H ) elevated liver enzymes ( EL ) low platelet count ( LP ) This syndrome is a severe form of preeclampsia .
Meperidine hydrochloride possible adverse effects
hypotension , confusion , sedation , headaches , respiratory depression , constipation , and urinary retention
immediately after birth Fetal Arterial carbon dioxide pressure ( Pco2 ) ____
increases
LOA
left occiput anterior
LOP
left occiput posterior
LOT
left occiput transverse
Occipitofrontal
little if any flexion of fetal head 12 cm
Dilation
opening , enlargement or widening of external cervical os - Expressed in cms ( 0 cms - 10 cms ) - 10cms is full dilation - promoted by contractions and pressure of fetal presenting part
panting during contractions
prevents pushing or bearing down before the cervix is completely dilated during the transition phase of labor
The use of hydrotherapy during the latent phase of labor can ____ the labor process .
prolong
amniotic fluid levels are indicative of fetal ____ health
renal
ROA
right occiput anterior
ROP
right occiput posterior
Effacement
shortening and thinning of internal cervical os - expressed in percentages ( 0 % -100 % ) - Cervix is normally 2-3 cm long and 1cm thick - Effacement occurs first in primparas before dilation ; Dilation and Effacement occur together in subsequent labors .
Suboccipitobregmatic
smallest presenting part when head flexed- greatest flexion as chin rests on chest 9.5 cm
Frequency
time from beginning of one contraction to the beginning of the next
Polyhydramnios
too much amniotic fluid; caused by malformations im fetal GI tract
A _____ position indicates that the fetus is lying horizontally in the pelvis and is presenting with a shoulder .
transverse
Biparietal
transverse diameter with greatest width of fetal head 9.25 cm
Fetal insulin is produced in the pancreas near week _____ of development
week 20
Submentobregmatic
when fetal head is hyperextended - largest diameter of presenting part 13.5 cm
Occipitomental
when the fetal head is extended- large diameter 13.5 cm
Outlet
where fetus " exits " birth canal -Transverse diameter is smallest diameter of outlet : ( LARGEST DIAMETER OF INLET )
Inlet
where fetus enters birth canal Anterior / posterior ( A / P ) diameter is smallest diameter of inlet ( LARGEST DIAMETER OF OUTLET )
Complete Flexion
" fetal position " - head tucked down onto chest , chin touching sternum -MOST COMMON Fetal Attitude= Results in a vertex ( top of the head ) presentation -Ideal fetal attitude for birth because the fetus occupies as little space as possible in the uterus -Easiest birth because the smallest AP diameter ( Suboccipitobregmatic ) of the fetal skull is presented to pass through the pelvis first
Moderate Flexion
" military position " - head slightly flexed but chin doesn't touch chest -Usually results in a sinciput ( forehead ) presentation -Many fetuses assume this position early in labor but then convert to complete flexion as labor progresses -Usually not a difficult birth as the second smallest AP diameter ( Occipitofrontal ) of the fetal skull is presented to pass through the pelvis first
Gynecoid pelvis
" normal " female - Round Shape
Android pelvis-
" normal " male - Heart Shaped
A nurse is teaching a prenatal class about nonpharmacological comfort measures during labor . Which of the following statements should the nurse identify as an indication that the instructions have been understood ? A. " I can have my partner apply counterpressure to my upper abdomen . " B. " My baby will be monitored with a Doppler device during hydrotherapy . " C. " I can have the nurse apply acupressure to my lower abdomen . " D. " My TENS unit will not help with lower back pain during early labor . "
B. " My baby will be monitored with a Doppler device during hydrotherapy . "
A nurse is caring for a client in active labor who has meconium staining of the amniotic fluid . The nurse notes a reassuring fetal heart rate ( FHR ) tracing from the external fetal monitor . Which of the following actions should the nurse perform ? A. Prepare the client for an ultrasound examination B. Prepare the client for an emergency cesarean birth C. Prepare equipment needed for newborn resuscitation D. Perform endotracheal suctioning as soon as the fetal head is delivered
C. Prepare equipment needed for newborn resuscitation
The nurse should administer oxytocin with _______ to ensure accurate flow rate delivery .
an infusion pump