NSG 210 Test 1: Labor and Delivery
milk ejection (milk letdown)
Oxytocin, when administered intranasally, stimulates the ________________________ reflex.
85%
Postpartum blues, or mild depression during the first 10 days after giving birth, affects up to ________% of women who give birth.
six
Postpartum urinary retention is defined as the inability to empty the bladder within _______ hours after a vaginal birth
dilation of the cervix
The nurse is monitoring a client in the first stage of labor. The nurse determines the client's uterine contractions are effective and progressing well based on which finding?
one fingerbreadth below the umbilicus
The nurse is observing a client who gave birth yesterday. Where should the nurse expect to find the top of the client's fundus?
pain originates from the cervix and lower uterine segment
The nurse is preparing an educational event for pregnant women on the topic of labor pain and birth. The nurse understands the need to include the origin of labor pain for each stage of labor. What information will the nurse present for the first stage of labor?
Wear a tight, supportive bra.
The nurse is preparing discharge for a client who plans to bottle-feed her infant. Which instruction should the nurse prioritize for this client in the discharge teaching?
uterine involution
The nurse should closely assess the woman for hemorrhage after giving birth by frequently assessing __________________
administrating a selective serotonin reuptake inhibitor
The nurse suspects that a mother who delivered her infant 2 weeks ago is experiencing postpartum depression. What is the first line of treatment for this client?
lightening
The process or time during late pregnancy when the fetal head begins to descend into the mother's pelvis, resulting in a lessening of pressure on the diaphragm
hCG (human chorionic gonadotropin)
The reason for a late postpartum hemorrhage is often retained placental fragments; if there are retained placental fragments, the serum ___________ levels will remain high.
expulsive stage
The second stage, the _______________________, begins when the cervix is completely dilated and ends with the birth of the newborn.
placental expulsion
The third stage, ___________________________, starts after the newborn is born and ends with the separation and birth of the placenta.
applying ice
Which intervention would be helpful to a bottle-feeding client who's experiencing hard or engorged breasts?
blood loss in excess of 500 ml, occurring at least 24 hours and up to 12 weeks after birth
Which measurement best describes delayed postpartum hemorrhage?
continuous labor support, hydrotherapy, hypnosis, ambulation and maternal position changes, transcutaneous electrical nerve stimulation (TENS), acupuncture and acupressure, attention focusing and imagery, therapeutic touch and massage, breathing techniques, and effleurage.
what are some nonpharmacologic measures to reduce pain while in labor?
sutures
allow for overlapping and changes in shape (molding) help identify position of the fetal head
longitudinal and transverse
what are the 2 positions in which a fetus can present it's fetal attitude?
- frequency - duration - intensity
what are the 3 parameters of uterine contractions?
increment (buildup of the contraction), acme (peak or highest intensity), and decrement (descent or relaxation of the uterine muscle fibers).
what are the 3 phases of a contraction
- occipitofrontal - occipitomental - suboccipitobregmatic - biparietal
what are the 4 diameters of the passenger in Child birth?
- O: occipital bone - M: mentum or face presentation - S: sacrum or breeched position - A: acromial process or shoulder presentation
what are the 4 landmark for fetal position and what do they stand for?
latent, active, and transition
what are the 4 phases of the first stage of labor?
- passageway (birth canal: pelvis and soft tissues) - passenger (fetus and placenta) - powers (contractions) - position (maternal) - Psychological response
what are the critical factors affecting labor and birth? (5 P's)
hydroxyzine (Vistaril), promethazine (Phenergan), or prochlorperazine (Compazine)
what are the names of the Ataractic (antiemetic) medications used as systemic analgesics during labor?
diazepam (Valium) or midazolam (Versed)
what are the names of the benzodiazepines used for pain relief related to systemic analgesics?
butorphanol (Stadol), nalbuphine (Nubain), meperidine (Demerol), morphine, or fentanyl (Sublimaze)
what are the names of the opioids used for pain relief during labor?
- periodic fetal heat rate accelerators and slight decelerations - decrease in circulation and perfusion - increase in arterial carbon dioxide pressure - decrease in fetal breathing movements - decrease in fetal oxygen pressure; decrease in partial pressure of oxygen
what are the physiologic fetal responses to labor?
Body secreting the excess fluids from pregnancy
A client who is 3 days' postpartum calls the office and reports excessive night sweats. Which explanation should the nurse provide for the client?
IUPC
A device placed into the amniotic space during labor in order to measure the strength of uterine contractions.
clear, straw-colored fluid
A gravida 1 client is admitted in the active phase of stage 1 labor with the fetus in the LOA position. The nurse anticipates noting which finding when the membranes rupture?
progesterone
A hormone produced by the ovaries which acts with estrogen to bring about the menstral cycle.
the first step would be to massage the boggy fundus until it is firm to reduce the flow of blood.
A nurse assessing a postpartum client notices excessive bleeding. What should be the nurse's firstaction?
PE
A nurse is auscultating the lungs of a postpartum client and notices crackles and some dyspnea. The client's respiratory rate is 12 breaths/minute; she appears in some distress. What complication should the nurse suspect based on these data?
administration of platelet transfusions as prescribed
A nurse is caring for a client with idiopathic thrombocytopenic purpura (ITP). Which intervention should the nurse perform first?
push with contractions and rest in between them
A nurse is coaching a woman during the second stage of labor. Which action should the nurse encourage the client to do at this time
Educate the client on how to perform Kegel exercises.
A postpartum client is having difficulty stopping her urine stream. Which should the nurse do next?
venous duplex ultrasound of the right leg
A postpartum client who had a cesarean birth reports right calf pain to the nurse. The nurse observes that the client has nonpitting edema from her right knee to her foot. The nurse knows to prepare the client for which test first?
the pain radiates from the back to the front
A pregnant woman comes to the emergency department stating she thinks she is in labor. Which assessment finding concerning the pain will the nurse interpret as confirmation that this client is in true labor?
episiotomy
an ______________________ is an incision made in the perineum to enlarge the vaginal outlet and theoretically to shorten the second stage of labor. Alternative measures such as warm compresses and continual massage with oil have been successful in stretching the perineal area to prevent cutting it.
scant
assessing lochia: a 1- to 2-in lochia stain on the perineal pad or approximately a 10-mL loss
large or heavy
assessing lochia: a pad is saturated within 1 hour after changing it
light or small
assessing lochia: an approximately 4-in stain or a 10- to 25-mL loss
moderate
assessing lochia: an approximately 4-in stain or a 10- to 25-mL loss
second stage
begins with complete cervical dilation (10 cm) and effacement and ends with the birth of the newborn. this stage involves moving the fetus through the birth canal and out of the body. Contractions occur every 2 to 3 minutes, last 60 to 90 seconds, and are described as strong by palpation. the perineum bulges, and there is an increase in bloody show. The fetal head becomes apparent at the vaginal opening but disappears between contractions. When the top of the head no longer regresses between contractions, it is said to have crowned. may last up to 3 hours in a first labor and up to 2 hours in subsequent ones
fourth stage
begins with completion of the expulsion of the placenta and membranes and ends with the initial physiologic adjustment and stabilization of the mother (1 to 4 hours after birth). The focus during this stage is to monitor the mother closely to prevent hemorrhage, bladder distention, and venous thrombosis.
third stage
begins with the birth of the newborn and ends with the separation and birth of the placenta. consists of two phases: placental separation and placental expulsion.
- increased white blood cell count - increased heart rate, cardiac output, and blood pressure (during contractions) - increased respiratory rate and oxygen uptake - decreased gastric motility and food absorption - decreased gastric emptying and gastric pH - slight temperature elevation - muscle aches and cramps - increased basal metabolic rate - decreed blood glucose levels
what are the physiologic maternal responses to labor?
cervix
the _____________ thins through effacement to allow presenting part to descend into the vagina
fourth
the _________________ stage of labor occurs 1-4 hours following the delivery
occipital bone
the ____________________ represents a vertex presentation
anterior fontanelle
the famous "soft spot" of the newborn's head. It is a diamond-shaped space that measures from 1 to 4 cm. It remains open for 12 to 18 months after birth to allow for growth of the brain
dilation
the gradual opening of the cervix measured in centimeters from 0 to 10 cms
effacement
the gradual thinning, shortening, and drawing up of the cervix measured in percentages from 0%-100%
uterine involution
the return of the uterus to its normal size and former condition after delivery
1-2 days
the taking-in phase usually lasts _________________
Nitrazine test
this is a test of vaginal secretions if the client is uncertain whether the membranes have ruptured. Color will indicate whether amniotic fluid is present. Yellow = urine. Blue = Amniotic fluid.
uterine inversion
turning of the uterus inside out after birth of the fetus
anthropoid
usually adequate pelvic shape for vaginal delivery
Gap junctions are proteins that connect cell membranes and facilitate coordination of uterine contractions and myometrial stretching
what are gap junctions?
- cervical changes (cervical softening or possible cervical dilation) - lightening - increased energy level (nesting) - bloody show - Braxton Hicks contractions - spontaneous rupture of membranes
what are the premonitory signs of labor?
newborn respiratory depression, decreased alertness, inhibited sucking, and a delay in effective feeding
what are the side effects seen in a newborn when a client uses opioids as a systemic analgesic?
false pelvis
- above lines terminalis - upper flared parts of 2 iliac bones and concavities - wings of base of sacrum
true pelvis
- below lines terminalis - inlet - midpelvis - outlet (pelvic measurements)
cephalic fetal presentation
- cephalic - military - brow - face
between the umbilicus and the symphysis pubis.
1 to 2 hours after birth, the fundus is typically located ___________________
Avoid over-the-counter (OTC) salicylates.
A 29-year-old postpartum client is receiving anticoagulant therapy for deep venous thrombophlebitis. The nurse should include which instruction in her discharge teaching?
pudenal block
A __________________ is used for the second stage of labor, an episiotomy, or an operative vaginal birth with outlet forceps or vacuum extractor.
The nurse should encourage the client to change her pajamas to prevent chilling and reassure the client that it is normal to have postpartal diaphoresis.
A client who gave birth 5 days ago reports profuse sweating during the night. What should the nurse recommend to the client in this regard
fetal scalp stimulation or vibroacoustic stimulation.
An indirect method used to evaluate fetal oxygenation and acid-base balance to identify fetal hypoxia is _________________ or _________________
at the level of the umbilicus.
Approximately 6 to 12 hours after birth, the fundus is usually located ____________________
nitrous oxide
Inhaled nitrous oxide offers a safe and effective means of labor analgesia for many laboring women. __________________is known by most people as "laughing gas." For labor pain, half nitrous oxide gas (50%) is mixed with half oxygen (50%) and breathed through a mask or mouthpiece.
- the uterus rises upwards - the umbilical cord lengthens - a sudden trickle of blood is released from the vaginal opening - the uterus changes its shape to globular
what are the signs of placental separation?
primary (immediate or early) postpartum hemorrhage
Blood loss that occurs within 24 hours of birth is termed _________________________
myocardial depression
Bradycardia, hypotension, cyanosis, edema
Consistency, shape, and location
One of the primary assessments a nurse makes every day is for postpartum hemorrhage. What does the nurse assess the fundus for?
100
Cervical canal 0 cm in length would be described as ________% effaced.
50
Cervical canal 1 cm in length would be described as __________% effaced.
0
Cervical canal 2 cm in length would be described as _______% effaced.
an infection or a uterine hemorrhage.
Decreased blood pressure may suggest _______________ or _____________ postpartum
moderate lochia rubra
During the first hour following birth, the nurse should find ________________ with a fleshy odor.
increase decrease
During the last trimester of pregnancy, estrogen levels _______________ and progesterone levels _______________.
latent
Effacement of the cervix is from 0% to 40%. Contractions usually occur every 5 to 10 minutes, last 30 to 45 seconds, and are described as mild by palpation by the nurse. the cervix dilates slowly to approximately 6 cm. Women may remain at home during this phase, contacting their health care provider about the onset of labor.
FHR is below 110 bpm and lasts 10 minutes or longer
Fetal bradycardia occurs when _________________________
FHR greater than 160 bpm that lasts for 10 minutes or longer
Fetal tachycardia occurs when ____________________________
glucocorticoids, intravenous immunoglobulin, intravenous anti-RhoD, and platelet transfusions.
For the woman with idiopathic thrombocytopenic purpura, expect to administer _____________________, __________________, ___________________, and ___________________. Prepare the woman for a splenectomy if the bleeding tissues do not respond to medical management.
-Ruptured membranes -Cervical dilation of at least 2 cm -Presenting fetal part low enough to allow placement of the scalp electrode -Skilled practitioner available to insert spiral electrode
Four specific criteria must be met for internal fetal monitoring to be used. ____________, ______________, _____________, and ______________
naloxone (Narcan)
Opioids given close to the time of birth can cause CNS depression in the newborn, necessitating the administration of ____________________ to reverse the depressant effects of the opioids.
maternal positioning (semi-Fowler position), IV hydration, and supplemental oxygen
Hypotension and associated FHR changes are managed with _______________, _________________, and _______________________
4-6
If a woman has not voided within _____________ hours after giving birth, catheterization may be needed because a full bladder interferes with uterine contraction and may lead to hemorrhage.
a full bladder as the cause.
If the fundus is displaced to the right of the midline, suspect ______________________
Encourage the woman to use ice packs, to wear a snug, supportive bra 24 hours a day, and to take mild analgesics such as acetaminophen.
If the woman is bottle-feeding, explain that breast engorgement is a self-limiting phenomenon that disappears as increasing estrogen levels suppress milk formation. If the woman's breasts become engorged in this situation, what should the nurse encourage the patient to do?
contact the health care provider because the client may have experienced a postpartum hemorrhage that went unreported or undetected. The health care provider will decide what measures to take.
If there is a significant drop in a postpartum mother's H & H, the nurse should _____________________
this is normal
In recording a postpartum mother's urinary output, the nurse notes that she is voiding between 150 and 200 mL with each hourly void. How would the nurse interpret this finding?
umbilical cord blood analysis and fetal scalp stimulation
In situations suggesting the possibility of fetal compromise, such as category II or III FHR patterns, further ancillary testing such ________________________ and _____________________________ may be used to validate the FHR findings and assist in planning interventions.
letting-go phase
In the __________________ phase, the third phase of maternal adaptation, the woman reestablishes relationships with other people. She adapts to parenthood in her new role as a mother. She assumes the responsibility and care of the newborn with a bit more confidence (Jordan et al., 2019). The focus of this phase is to move forward by assuming the parental role and to separate herself from the symbiotic relationship that she and her newborn had during pregnancy. She establishes a lifestyle that includes the infant. The mother relinquishes the fantasy infant and accepts the real one.
lateral positioning of the mother, increasing the intravenous (IV) fluid rate to improve maternal circulation, administering oxygen at 8 to 10 L/min by mask, considering internal fetal monitoring, documenting findings, and reporting to the health care provider.
Interventions to improve uteroplacental blood flow and perfusion through the umbilical cord include _______________________________________
the level of the umbilicus.
It has been 8 hours since a woman gave birth vaginally to a healthy newborn. When assessing the woman's fundus, the nurse would expect to find it at:
Lochia serosa
It is pinkish brown and is expelled 3 to 10 days postpartum. primarily contains leukocytes, decidual tissue, red blood cells, and serous fluid. second stage in lochia evolution postpartum
dilation, expulsive, placental, and restorative
Labor is typically divided into four stages: dilation, expulsive, placental, and restorative
effleurage
Light, continuous-stroking massage movement applied with fingers and palms in a slow and rhythmic manner.
when there are more than 25 beats of fluctuation in the FHR baseline.
Marked variability occurs when _______________________
Rh-negative Rh-positive
Mothers who are _______________ and have given birth to an infant who is ______________ should receive an injection of Rh immunoglobulin within 72 hours after birth to prevent a sensitization reaction in the Rh-negative woman who received Rh-positive blood cells during the birthing process.
1 cm per day
Normally, the fundus progresses downward at a rate of ____________ per day after childbirth and should be nonpalpable by 10 to 14 days postpartum. By day 14, the uterus has descended below the rim of the symphysis pubis and is no longer palpable
up and to the right.
Note the location and condition of the fundus; a full bladder tends to displace the uterus ________________
stool softener
Regardless of the type of delivery, most women experience decreased bowel tone and sluggish bowels for several days after birth. Decreased peristalsis occurs in response to analgesics, surgery, diminished intra-abdominal pressure, a low-fiber diet, insufficient fluid intake, and diminished muscle tone. In addition, women with episiotomies, perineal lacerations, or hemorrhoids may fear pain or damage to the perineum with the first bowel movement and may attempt to delay it. Subsequently, constipation is a common problem during the postpartum period. A ____________________ can be prescribed for this reason.
maternal fever, fetal and maternal tachycardia, foul odor of vaginal discharge, and an increase in white blood cell count.
Signs of intrauterine infection to be alert for include_________________, ___________________, _________________, and ___________________
nesting
Some women report a sudden increase in energy before labor. This is sometimes referred to as _____________________
antiemetic (Ataractics)
The __________________ group of medications is used in combination with an opioid to decrease nausea and vomiting and lessen anxiety.
Peurperium
The ___________________ period refers to the first 6 weeks after delivery.
taking-in phase
The ___________________ phase is the time immediately after birth when the client needs sleep, depends on others to meet her needs, and relives the events surrounding the birth process. This phase is characterized by dependent behavior. During the first 24 to 48 hours after giving birth, mothers often assume a passive role in meeting their own basic needs for food, fluids, and rest, allowing the nurse to make decisions for them concerning activities and care. They spend time recounting their labor experience to others. Such actions help the mother integrate the birth experience into reality; the pregnancy is over and the newborn is now a unique individual, separate from herself. When interacting with the newborn, new mothers spend time claiming the newborn and touching them, commonly identifying specific features in the newborn, such as "he has my nose" or "his fingers are long like his father's"
taking-hold phase
The ______________________ phase, the second phase of maternal adaptation, is characterized by dependent and independent maternal behavior. This phase typically starts on the second to third day postpartum and may last several weeks. She will be particularly concerned about her health, the infant's condition, and her ability to care for them. She demonstrates increased autonomy and mastery of her own body's functioning, and a desire to take charge with support and help from others. She will show independence by caring for herself and learning to care for her newborn, but she still requires assurance that she is doing well as a mother. She expresses a strong interest in caring for the infant by herself.
supine
The best position for a complete assessment of the uterus is __________________
A semi-Fowler position encourages lochia to drain so it will not become stagnant and cause further infection.
The nurse is caring for a postpartum woman who is diagnosed with endometritis. Which position should the nurse encourage the client to maintain?
lochia alba
The discharge is creamy white or light brown and consists of leukocytes, decidual tissue, and reduced fluid content. It occurs from days 10 to 14 but can last 3 to 6 weeks postpartum in some women and still be considered normal. final stage in lochia evolution postpartum
restorative
The fourth stage, the ____________________ or immediate postpartum period, lasts from 1 to 4 hours after birth
6.5-7.5
The membranes are probably ruptured if the nitrazine swab turns a blue-green to deep blue with pH ranging from _________ to __________
uterine atony
The most common cause of PPH is _________________; failure of the uterus to contract and retract after birth.
S. aureus
The most common cause of mastitis is _____________________ , transmitted from the neonate's mouth.
respiratory depression
The most important complication associated with the use of Systemic analgesics is ___________________________. Therefore, requiring careful monitoring
administer oxygen mask
The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next?
if blood pressure is lower than 140/90 mm Hg hypertension is a contraindication of methylergonovine
The nurse is administering methylergonovine 0.2 mg to a postpartum client with uterine subinvolution. Which assessment will the nurse need to make prior to administering the medication?
meperidine
The nurse is assessing a client in labor for pain and notes she is currently not doing well handling the increased pain. Which opioid can the nurse offer to the client to assist with pain control?
the fetus is in the true pelvis and is engaged
The nurse is caring for a client at 39 weeks' gestation who is noted to be at 0 station. What would be the appropriate documentation by the nurse?
7.15 or less.
The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is:
- cervix - pelvic floor muscles - vagina
what are the soft tissues of the passageway for child birth?
umbilical cord blood analysis
This test is considered a good indicator of fetal oxygenation and acid-base condition at birth. The normal mean pH value range is 7.2 to 7.3. The pH values are useful for planning interventions for the newborn born with low 5-minute Apgar scores, severe fetal growth restriction (FGR), category II and III patterns during labor, umbilical cord prolapse, uterine rupture, maternal fever, placental abruption, meconium-stained amniotic fluid, and post-term births
palpate the mother's radial pulse while listening to the FHR
To ensure that the nurse is assessing the FHR and not the mother's heart rate, which action would be most appropriate for the nurse to do?
30
Uterine contractions of an intensity of _________ mm Hg or greater promote cervical dilation.
- uterine stretch - progesterone withdrawal - increased oxytocin sensitivity - increased release of prostaglandins
What are the 4 factors that influence the onset of labor?
combined spinal-epidural (CSE) analgesia
When compared with traditional epidural or spinal analgesia, which often keeps the woman lying in bed, _________________________ allows her to ambulate ("walking epidural").
assessing fetal heart rate (FHR) first to identify a deceleration, which might indicate cord compression secondary to cord prolapse.
When membranes rupture, the priority focus should be on ___________________________
Help the mother initiate breastfeeding within 30 minutes of birth. Encourage breastfeeding of the newborn infant on demand. Place baby in uninterrupted skin-to-skin contact (kangaroo care) with the mother.
When teaching the new mother about breastfeeding, the nurse is correct when providing what instructions?
uterine subinvolution
Which complication is most likely responsible for a late postpartum hemorrhage?
supplemental breastfeedings with formula
Which factor might result in a decreased supply of breast milk in a postpartum client?
acromial process
_____________ means that the baby has a shoulder representation
contractions
________________ thin and dilate the cervix
Lochia rubra
_________________ is a deep-red mixture of mucus, tissue debris, and blood that occurs for the first 3 to 4 days after birth. As uterine bleeding subsides, it becomes paler and more serous. first stage in lochia postpartum
Reciprocity
__________________ is the process by which the infant's abilities and behaviors elicit parental responses (i.e., the smile by the infant gets a smile and kiss in return).
epidural
___________________ analgesia for labor and birth involves the injection of a local anesthetic agent (e.g., lidocaine or bupivacaine) and an opioid analgesic agent (e.g., morphine or fentanyl) into the lumbar epidural space. A small catheter is then passed through the epidural needle to provide continuous access to the epidural space for maintenance of analgesia throughout labor and birth
benzodiazepines
___________________ are used for minor tranquilizing and sedative effects. Diazepam (Valium) is also given IV to stop seizures resulting from eclampsia. It can be administered to calm a woman who feels out of control, thereby enabling her to relax enough so that she can participate effectively during her labor process rather than fighting against it. Lorazepam (Ativan) can also be used for its tranquilizing effect, but increased sedation is experienced with this medication. Midazolam (Versed), also given IV, produces good amnesia but no analgesia. It is most commonly used as an adjunct for anesthesia. Diazepam and midazolam cause CNS depression for both the woman and the newborn.
diuresis (increased production of urine)
___________________ is the most likely reason for the weight loss during the first postpartum week.
floating
_____________________ is when engagement has not occurred because the presenting part is freely movable above the pelvic inlet.
late decelerations
_______________________ are associated with uteroplacental insufficiency, which occurs when blood flow within the intervillous space is decreased to the extent that fetal hypoxia or myocardial depression exists
early decelerations
________________________ are thought to be a result of fetal head compression that results in a reflex vagal response with a resultant slowing of the FHR during uterine contractions.
effleurage
_________________________ is a light, stroking, superficial touch of the abdomen, in rhythm with breathing during contractions. It is used as a relaxation and distraction technique from discomfort. External fetal monitor belts may interfere with the ability to accomplish this. Massage works as a form of pain relief by increasing the production of endorphins in the body. Endorphins reduce the transmission of signals between nerve cells and thus lower the perception of pain.
prolonged decelerations
__________________________ are abrupt FHR declines of at least 15 bpm that last longer than 2 minutes but less than 10 minutes The rate usually drops to less than 90 bpm. Many factors are associated with this pattern, including prolonged cord compression, abruptio placenta, cord prolapse, supine maternal position, vaginal examination, fetal blood sampling, maternal seizures, regional anesthesia, or uterine rupture
Regional analgesia/anesthesia
_____________________________ provides pain relief without loss of consciousness. It involves the use of local anesthetic agents with or without added opioids to bring about pain relief or numbness through the drug's effects on the spinal cord and nerve roots.
Spinal anesthesia
a ___________________ is frequently used for elective and emergent cesarean births.
sinusoidal FHR pattern
a ______________________ is described as having a visually apparent smooth, sinewave-like undulating pattern in the FHR baseline with a cycle frequency of 3 to 5 bpm that persists for more than 20 minutes. It is attributed to a derangement of CNS control of FHR and occurs when a severe degree of hypoxia secondary to fetal anemia and hypovolemia is present. It is always considered a category III pattern, and to correct it, a fetal intrauterine transfusion would be needed. It indicates the fetus is in marked jeopardy
cephalohematoma
a collection of blood between the periosteum and the bone that occurs several hours after birth. It does not cross suture lines and is generally reabsorbed over the next 6 to 8 weeks
uterine subinvolution
a condition in which the uterus returns to its prepregnancy shape and size at a rate that is slower than expected (usually the result of retained placental fragments or an infection)
Leopold's Maneuver
a method of abdominal palpation used to determine fetal position or placement within the uterus
nulliparous
a woman who has never given birth
primigravida
a woman who is pregnant for the first time
Bonding in the maternal-newborn world is the attachment process that occurs between a mother and her newborn infant. This is how the mother and infant become engaged with each other and is the foundation for the relationship. Bonding is a process and not a single event.
describe bonding
Rupture of membranes with loss of amniotic fluid prior to the onset of labor is termed prelabor rupture of membranes
describe premature rupture of membranes
placental separation
detaching from uterine wall
dystocia
difficult labor
linea terminalis
division of false and true pelvis
Heart rate increases by 10 to 20 bpm. Cardiac output increases by 12% to 31% during the first stage of labor and by 50% during the second stage of labor. Blood pressure increases by up to 35 mm Hg during uterine contractions in all labor stages. The white blood cell count increases to 25,000 to 30,000 cells/mm3 perhaps as a result of tissue trauma. Respiratory rate increases and more oxygen is consumed related to the increase in metabolism. Gastric motility and food absorption decrease, which may increase the risk of nausea and vomiting during the transition stage of labor. Gastric emptying and gastric pH decrease, increasing the risk of vomiting with aspiration. Temperature rises slightly, possibly due to an increase in muscle activity. Muscular aches and cramps occur as a result of stress on the musculoskeletal system. Basal metabolic rate increases and blood glucose levels decrease because of the stress of labor
during labor, maternal physiologic responses include:
caput succedaneum
edema of the scalp at the presenting part. This swelling crosses suture lines and disappears within 3 to 4 days
active
encompasses the time from an increase in the rate of cervical dilation until completion of cervical dilation. Cervical dilation begins to occur more rapidly and predictably until it reaches 10 cm and cervical dilation and effacement are complete. The fetus descends farther in the pelvis. Contractions become more frequent (every 2 to 5 minutes) and increase in duration (45 to 60 seconds).
breech presentation
fetal presentation showing Frank, full or complete, and footling or incomplete
gravida 1
first pregnancy
- 15 contractions - 4 minutes apart
if you are in true labor, how many contractions do you have per hour? How often are contractions?
decreased
in pregnancy, Vaginal acidity is ___________________ due to the presence of amniotic fluid, blood, and lochia, all of which are alkaline. An alkaline environment encourages the growth of bacteria.
uterine atony
inability of the uterus to contract effectively
Fontanels
intersections of sutures; help in identifying position of fetal head in molding
fetal skull
largest and least compressible structure
posterior fontanelle
located at the back of the fetal head; it is triangular. This one closes within 8 to 12 weeks after birth and on average, measures 1 to 2 cm at its widest diameter
android
male pelvic shape, not favorable
multiparous
multiple pregnancies
floating
no engagement; presenting part freely movable about pelvic inlet
platypelloid
non-favorable pelvis shape for vaginal delivery
first stage
out of the 3 stages of labor, which is the longest?
fetal engagement
presenting part reaching 0 station
- Notify the health care provider about the pattern and obtain further orders, making sure to document all interventions and their effects on the FHR pattern. -Discontinue oxytocin or other uterotonic agent as dictated by the facility's protocol if it is being administered. -Turn the client on her left or right lateral, knee-chest, or hands and knees to increase placental perfusion or relieve cord compression. -Administer oxygen via nonrebreather face mask to increase fetal oxygenation. -Increase the IV fluid rate to improve intravascular volume and correct maternal hypotension. -Assess the client for any underlying contributing causes. -Provide reassurance that interventions are to effect pattern change. -Modify pushing in the second stage of labor to improve fetal oxygenation. -Document any and all interventions and any changes in FHR patterns. -Prepare for an expeditious surgical birth if the pattern is not corrected in 30 minutes.
recurrent late decelerations and recurrent variable decelerations are considered to be "abnormal FHR patterns". list your nursing interventions for this occurrence
buttocks
the _____________ landmark represents a breeched position
The woman with endometritis typically looks ill and commonly develops a fever of 100.4°F (38°C) or higher (more commonly 101°F [38.3°C], possibly as high as 104°F [40° C]) on the third to fourth postpartum day. The rise in temperature at this specific time is the most significant finding. The woman exhibits tachycardia, typically a rise in pulse rate of 10 beats per minute for each rise in temperature of one degree. In addition, the woman may report chills, anorexia, and general malaise. She also may report abdominal cramping and pain, including strong afterpains. Fundal assessment reveals uterine subinvolution and tenderness. Lochia typically increases in amount and is dark, purulent, and foul-smelling. However, with certain microorganisms, her lochia may be scant or absent.
what are typical symptoms of endometritis?
anxiety can slow the laboring process and decrease fetal oxygen supply
what does anxiety in a laboring mother do to the process of labor
chin
what does the term "mentum" refer to?
- psychological - spiritual - psychosocial - cultural - environmental
what factors influence pain during labor and birth?
longitudinal fetal lie
what fetal position does this image represent
transverse fetal lie
what fetal position does this image represent
The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix.
what is a hypotonic pregnancy?
the birth of the infant and placental separation
what is involved in the third stage of labor?
a positive nitrazine test
what is the best way to confirm the patient's rupture of membranes?
Gynecoid
what is the favored pelvic shape for vaginal delivery?
providing a comfortable environment with dim lighting
what is the most appropriate nursing intervention for a patient with dystocia related to psyche problems
LOA followed by ROA
what is the most favorable fetal positioning for a vaginal birth?
Fetal movement can be stimulated with a vibroacoustic stimulator (artificial larynx) applied to the woman's lower abdomen and turned on for 3 to 5 seconds to produce sound and vibration or by placing a gloved finger on the fetal scalp and applying firm pressure. A well-oxygenated fetus will respond when stimulated (tactile or by noise) by moving in conjunction with an acceleration of 15 bpm above the baseline heart rate that lasts at least 15 seconds. This FHR acceleration reflects a pH of more than 7 and a fetus with an intact CNS.
what is the process of vibroacoustic stimulation?
Inhale slowly through nose and exhale through pursed lips.
what is the proper technique for slow-paced breathing while in labor?
fever
what reported finding is the most significant finding related to the suspected diagnosis of endometritis?
prolactin
which hormone that is responsible for milk production?
involution
which process results in the return of nonpregnant size and function of the female organs?
afterpains
women who have had several babies prior to this delivery often experience __________________ which is where the uterus is contracting and relaxing at intervals.
placental expulsion
• continued uterine contractions cause the placenta to be expelled within 2 to 30 minutes • After the placenta is expelled, the uterus is massaged briefly by the attending physician or midwife until it is firm so that uterine blood vessels constrict, minimizing the possibility of hemorrhage. • *Normal blood loss is approximately 500 mL for a vaginal birth and 1,000 mL for a cesarean birth*
