OB Chapter 15-20

Early decelerations

FHR visually apparent, gradual decrease in and return to baseline FHR associated with UCs. It is thought to be caused by transient FETAL HEAD COMPRESSION and is considered a normal and benign finding.

Group care activities as much as possible.

Fatigue related to energy expenditure during labor and birth

A nulliparous woman who has just begun the second stage of her labor would most likely:

Feel tired yet relieved that the worst is over.

Predicting Spontaneous Preterm Labor and Birth

Fetal Fibronectin - if found in late second and early third trimester of pregnancy, there may be inflammation and an increased risk for labor. Not very accurate Cervical Length - cervical length less than 30mm more likely to lead to preterm labor

A woman who is gravida 3 para 2 enters the intrapartum unit. The most important nursing assessments are:

Fetal heart rate, maternal vital signs, and the woman's nearness to birth.

Length of Stay

Is dependent on: -Physical condition of the mother and newborn -Mental and emotional status of the mother -Social support at home -Educational needs for self-management -Financial constraints

In many hospitals new mothers are routinely presented with gift bags containing samples of infant formula. This practice:

Is inconsistent with the Baby Friendly Hospital Initiative. (Infant formula should not be given to mothers who are breastfeeding.)

In many hospitals new mothers are routinely presented with gift bags containing samples of infant formula. This practice:

Is inconsistent with the Baby Friendly Hospital Initiative.Infant formula should not be given to mothers who are breastfeeding.

how long do headaches last

1-3 days to several weeks and needs careful medical assessment

Causes of Tachycardia

Early fetal hypoexmia, fetal cardia arrhythmias, maternal fever, infection, parasympothalytic drugs, maternal hyperthyroidism, fetal anemia, drugs

Rupture of the Uterus

-Very serious obstetric injury -Most frequent cause: Scarred uterus as a result of previous cesarean births -Signs and symptoms Abnormal FHR tracing Loss of fetal station Abdominal pain Shock

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. The nurse's most appropriate response is to ask the woman:

"I'll warm the soup in the microwave for you."

A postpartum woman overhears the nurse tell the obstetrics clinician that she has a positive Homans sign and asks what it means. The nurse's best response is:

"You have calf pain when the nurse flexes your foot." (Discomfort in the calf with sharp dorsiflexion of the foot may indicate deep vein thrombosis.)

A postpartum woman overhears the nurse tell the obstetrics clinician that she has a positive Homans sign and asks what it means. The nurse's best response is:

"You have calf pain when the nurse flexes your foot."Discomfort in the calf with sharp dorsiflexion of the foot may indicate deep vein thrombosis.

Prolapsed Umbilical Cord

-When cord lies below presenting part of fetus -Contributing factors include: Long cord (longer than 100 cm) Malpresentation (breech) Transverse lie Unengaged presenting part

Causes of Preterm Labor and Birth

*Infections Iatrogenic pregnancy complications Sociodemographic factors

Mechanism of Birth

--Vertex presentation: Birth of head Ritgen maneuver Birth of shoulders Birth of body and extremities -Immediate assessment and care of the newborn:Reach around bab'ys head to check for umblical cord around neck- will strangle baby with continued pushing

Nurses play a critical role in educating parents regarding measures to prevent infant abduction. Which instructions contribute to infant safety and security?The mother should check the photo ID of any person who comes to her room

.Parents should use caution when posting photos of their infant on the Internet. The mom should request that a second staff member verify the identity of any questionable person.

Abnormal Labor Patterns

1) Prolonged latent phase 2) Protracted active phase dilation 3) Secondary arrest: no change 4) Protracted descent 5) Failure of descent Fetus at risk for hypoxia

Fourth Stage of Labor

1-2 hours after birth. Measure BP every 15 minutes for the first hour, as well as HR. Take temperature. Assess fundus, bladder, lochia, and perineum

how much does the funds decent every day

1 cm

Late decelerations: Interventions

1. Change maternal position (lateral) 2. Correct maternal hypotension by elevating legs 3. Increase rate of maintenance IV fluids 4. Palpate uterus to assess for tachysystole 5. Discontinue oxytocin if infusing 6. Administer O2, 8-10L/min by nonrebreather face mask 7. Notify physician or nurse-midwife 8. Consider internal monitoring for more accurate fetal and uterine assessment 9. Assist with birth (cesarean or vaginal assisted) if pattern cannot be corrected

Fetal Distress: Intervention

1. Place client in a lateral position 2. Administer O2, 8-10 L/min, via face mask 3. Discontinue oxytocin if infusing 4. Monitor maternal and fetal status **In the event of fetal distress, prepare the client for emergency cesarean delivery

Dystocia: causes in detail

1. fetus may be excessively large, malpositioned, or in an abnormal presentation 2. Contractions may be hypotonic or hypertonic -hypotonic--short, irregular, and weak - hypertonic--painful, occur frequently and are uncoordinated ** Can result in maternal dehydration, infection, fetal injury, or death.

Baseline FHR in normal range is:

110 to 160 beats/min, with no periodic changes and a moderate baseline variability

Second Trimester

13 weeks through 27 completed weeks

1 week post birth where is the fundus

4-5 finger breadths below the umbilicus

Under the Newborns' and Mothers' Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of

48 hours after a normal vaginal birth and for 96 hours after a cesarean birth. (The attending provider and the mother together can decide on an earlier discharge.)

fetal hypoxemia

A deficiency of oxygen in the arterial blood and associated with abnormal FHR patterns

Which collection of risk factors most likely would result in damaging lacerations including episiotomies ?

A first-time mother with reddish hair whose rapid labor was overseen by an obstetrician

Prolactin

A hormone secreted by the anterior pituitary that tarets the mammary glands stimulating them to produce breastmilk.

Indicated Preterm Birth

A means to resolve maternal or fetal risk

New parents express concern that because of the mother's emergency cesarean birth under general anesthesia, they did not have the opportunity to hold and bond with their daughter immediately after her birth. The nurse's response should convey to the parents that: A. Attachment, or bonding, is a process that occurs over time and does not require early contact. B. The time immediately after birth is a critical period for humans. C. Early contact is essential for optimum parent-infant relationships. D. They should just be happy that the infant is healthy.

A. Attachment, or bonding, is a process that occurs over time and does not require early contact.

Surgical Techniques

Can be vertical or transverse Transverse more common. Does not compromise entire uterine segment Vertical for breech birth; associated with higher risk of uterine rupture

Dystocia of Fetal Origin

Anomalies - gross ascites, large tumors, open NTD, and hydrocephalus CPD (cephalopelvic disproportion) - fetus cannot fit through the maternal pelvis to be born vaginally. Often related to macrosomia Malposition - most common is occipitoposterior position. Woman typically experiences severe back pain Malpresentation - breech is the most common form Multifetal pregnancy - higher risk for cerebral palsy

The nurse can help a father in his transition to parenthood by: A. Pointing out that the infant turned at the sound of his voice B. Encouraging him to go home to get some sleep C. Telling him to tape the infant's diaper a different way D. Suggesting that he let the infant sleep in the bassinet

A. Pointing out that the infant turned at the sound of his voice Infants respond to the sound of voices. Because attachment involves a reciprocal interchange, observing the interaction between parent and infant is very important.

In the United States, the en face position is preferred immediately after birth. Nurses can facilitate this process by all of these actions except: A. Washing both the infant's face and the mother's face B. Placing the infant on the mother's abdomen or breast with their heads on the same plane C. Dimming the lights D. Delaying the instillation of prophylactic antibiotic ointment in the infant's eyes

A. Washing both the infant's face and the mother's face To facilitate the position in which the parent's and infant's faces are approximately 8 inches apart on the same plane, allowing them to make eye contact, the nurse can place the infant at the proper height on the mother's body, dim the light so that the infant's eyes open, and delay putting ointment in the infant's eyes.

The nurse notes that a Vietnamese woman does not cuddle or interact with her newborn other than to feed him, change his diapers or soiled clothes, and put him to bed. In evaluating the woman's behavior with her infant, the nurse realizes that: A. What appears to be a lack of interest in the newborn is in fact the Vietnamese way of demonstrating intense love by attempting to ward off evil spirits. B. The woman is inexperienced in caring for newborns. C. The woman needs a referral to a social worker for further evaluation of her parenting behaviors once she goes home with the newborn. D. Extra time needs to be planned for assisting the woman in bonding with her newborn.

A. What appears to be a lack of interest in the newborn is in fact the Vietnamese way of demonstrating intense love by attempting to ward off evil spirits. The nurse may observe a Vietnamese woman who gives minimal care to her infant and refuses to cuddle or interact with her infant. The apparent lack of interest in the newborn is this cultural group's attempt to ward off evil spirits and actually reflects an intense love and concern for the infant.

Diastasis Recti Abdominis

Abdominal wall muscles separated. This is usually from oversdistention from a large fetus or multiple fetus.

Category III FHR

Abnormal. Immediate evaluation and prompt intervention necessary.

Accelerations

Abrupt increase above baseline rate that is at least 15 beats/min above the baseline and lasts 15 seconds or longer Before 32 weeks of gestation, the accel is 10/10

A patient whose cervix is dilated to 5 cm is considered to be in which phase of labor?

Active phase

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate?

Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours

Preterm Birth

Any birth that occurs before completion of 37 weeks or pregnancy

Orient the patient and family to the labor and birth unit.

Anxiety related to labor and the birthing process

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both of her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by:

Applying ice to the breasts for comfort

A parent who has a hearing impairment is presented with a number of challenges in parenting. Which nursing approaches are appropriate for working with hearing-impaired new parents

Ascertain whether the patient can read lips before teaching. Written messages aid in communication. Use devices that transform sound into light.

A parent who has a hearing impairment is presented with a number of challenges in parenting. Which nursing approaches are appropriate for working with hearing-impaired new parents?

Ascertain whether the patient can read lips before teaching. Written messages aid in communication. Use devices that transform sound into light.

Discharge instruction, or teaching the woman what she needs to know to care for herself and her newborn, officially begins:

At the time of admission to the nurse's unit.

____________________ is the process by which the parent and infant come to love and accept each other.

Attachment

Vacuum-Assisted Birth

Attachment of vacuum cup to fetal head, using negative pressure to assist birth of head Requirements: completely dilated cervix, engaged head, vertex presenation, ruptured membranes, no suspicion of CPD

Baseline FHR

Average during 10-minute segment, excluding periodic/episodic changes, periods of marked variability, segments of the baseline that differ by more than 25 beats per minute

3 kg/weeks

Average weight loss for new mothers after birth is

A tiered system of categorizing FHR has been recommended by regulatory agencies. Nurses, midwives, and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and understand the significance of each category. These categories include (Select all that apply): a. Reassuring. b. Category I. c. Category II. d. Nonreassuring. e. Category III.

B, C, E

Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that despite what folk wisdom might say: A. High-pitched voices irritate newborns. B. Infants can learn to distinguish their mother's voice from others soon after birth. C. All babies in the hospital smell alike. D. A mother's breast milk has no distinctive odor.

B. Infants can learn to distinguish their mother's voice from others soon after birth. Infants know the sound of their mother's voice early.

With regard to the adaptation of other family members, mainly siblings and grandparents, to the newborn, nurses should be aware that: A. Sibling rivalry cannot be dismissed as overblown psychobabble; negative feelings and behaviors can take a long time to blow over. B. Participation in preparation classes helps both siblings and grandparents. C. In the United States, paternal and maternal grandparents consider themselves of equal importance and status. D. Since 1990, the number of grandparents providing permanent care to their grandchildren has been declining.

B. Participation in preparation classes helps both siblings and grandparents. Preparing older siblings, as well as grandparents, helps with everyone's adaptation.

The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is: A. Tell the mother she must pay attention to her infant B. Show the mother how the infant initiates interaction and attends to her C. Demonstrate for the mother different positions for holding her infant while feeding D. Arrange for the mother to watch a video on parent-infant interaction

B. Show the mother how the infant initiates interaction and attends to her Pointing out the responsiveness of the infant is a positive strategy for facilitating parent-infant attachment.

Chorioamnionitis

Bacterial infection of the amniotic cavity Major cause of complications: occurs in 1-5% of term births and 25% of preterm births Diagnosed according to maternal fever, fetal tachycardia, uterine tenderness, and foul odor of amniotic fluid

Chorioamnionitis

Bacterial infection of the amniotic cavity (25% of preterm births) -maternal fever -fetal tachycardia -uterine tenderness -foul odor of amniotic fluid

Bradycardia

Baseline FHR less than 110 beats/min for 10 minutes or longer

Tachycardia

Baseline FHR more than 160 beats/min for 10 minutes or longer

According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR):

Before and after ambulation and rupture of membranes.

First Stage of Labor

Begins with onset of regular uterine contractions and ends with complete cervical effacement Latent phase: up to 3 cm Active phase: 4-7cm Transition phase: 8-10 cm

After they are born, a crying infant may be soothed by being held in a position in which the newborn can hear the mother's heartbeat. This phenomenon is known as:

Biorhythmicity.

True Milk

Bluish white mil with a skim milk appearance is known as

Oxytocin

Breastfeeding immediately after birth and in the early days postpartum increase the release of ________, which decreases blood loss and reduces risk for postpartum hemorrhage.

Lochia Rubra

Bright red, tends to clot, serosanguineous, becoming more serous and less bloody - last 1-3 days.

The baseline fetal heart rate (FHR) is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration. This is likely to be caused by which physiologic alteration (Select all that apply)? a. Spontaneous fetal movement b. Compression of the fetal head c. Placental abruption d. Cord around the baby's neck e. Maternal supine hypotension

C, E

Of the many factors that influence parental responses, nurses should be aware that all of these statements regarding age are true except: A. An adolescent mother's egocentricity and unmet developmental needs interfere with her ability to parent effectively. B. An adolescent mother is likely to use less verbal instruction, be less responsive, and interact less positively than other mothers. C. Adolescent mothers have a higher documented incidence of child abuse. D. Mothers older than 35 often deal with more stress related to work and career issues, as well as decreasing libido.

C. Adolescent mothers have a higher documented incidence of child abuse. Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counseling, but a higher incidence of child abuse is not one of them.

When assessing the relative advantages and disadvantages of internal and external electronic fetal monitoring, nurses comprehend that both:

Can be used during the antepartum and intrapartum periods.

The nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dad's chin. This woman's statement reflects: A. Mutuality B. Synchrony C. Claiming D. Reciprocity

C. Claiming Claiming refers to the process by which the child is identified in terms of likeness to other family members.

During a phone follow-up conversation with a woman who is 4 days postpartum, the woman tells the nurse, "I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!" The nurse would recognize that the woman is experiencing: A. Taking-in B. Postpartum depression (PPD) C. Postpartum blues D. Attachment difficulty

C. Postpartum blues During the PP blues, women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth PP day.

Varicella Vaccination

CDC reccommends prior to dc for postpartum women who have no immunity

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by:

Change in position.

Amniotic Fluid Embolism

Characterized by the sudden, acute onset of hypoxia, hypotension, cardiovascular collapse and coagulopathy. Risk factors include advanced age, minority race, placenta previa, preeclampsia, forceps-assisted birth. Poor outcomes for mother and fetus.

Cervical Ripening Methods

Chemical - PGE (Cervadil) successful in ripening cervix Mechanical & Physical - Balloon cath, which falls out at 3 cm; laminaria tents, membrane stripping; ambulation Alternative methods: blue cohosh & castor oil, acupuncture Amniotomy - artificial rupture of membranes

Colostrum

Cloudy yellowish fluid released from the breast the first few days after a female gives birth

Rupture of the Uterus

Complete or incomplete separation of the uterine tissue as a result of a tear in the wall of the uterus from the stress of labor. -Complete: Direct communication between the uterine and peritoneal cavities -Incomplete: Rupture into the peritoneum covering the uterus, but not into the peritoneal cavity

Spontaneous Preterm Birth

Comprises 75% of preterm births

The nurse caring for the postpartum woman understands that breast engorgement is caused by:

Congestion of veins and lymphatics.

Remaining fairly stable throughout the first and second stages

Duration

Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is the management of the environment. While providing routine mother-baby care, the nurse should ensure that: A. The baby is able to return to the nursery at night so that the new mother can sleep B. Routine times for care are established to reassure the parents C. The father should be encouraged to go home at night to prepare for mother-baby discharge D. An environment that fosters as much privacy as possible should be created

D. An environment that fosters as much privacy as possible should be created Care providers need to knock before gaining entry. Nursing care activities should be grouped.

When caring for a newly delivered woman, the nurse is aware that the best measure to prevent abdominal distention after a cesarean birth is:

Early and frequent ambulation.

After giving birth to a healthy infant boy, a primiparous woman, 16, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is "risk for impaired parenting related to deficient knowledge of newborn care." In planning for the woman's discharge, what should the nurse be certain to include in the plan of care? A. Tell the woman how to feed and bathe her infant B. Give the woman written information on bathing her infant C. Advise the woman that all mothers instinctively know how to care for their infants D. Provide time for the woman to bathe her infant after she views an infant bath demonstration

D. Provide time for the woman to bathe her infant after she views an infant bath demonstration Having the mother demonstrate infant care is a valuable method of assessing the client's understanding of her newly acquired knowledge, especially in this age group, because she may inadvertently neglect her child.

A 30-year-old multiparous woman has a boy who is 2 1/2 years old and now an infant girl. She tells the nurse, "I don't know how I'll ever manage both children when I get home." Which suggestion would best help this woman alleviate sibling rivalry? A. Tell the older child that he is a big boy now and should love his new sister B. Let the older child stay with his grandparents for the first 6 weeks to allow him to adjust to the newborn C. Ask friends and relatives not to bring gifts to the older sibling because you do not want to spoil him D. Realize that the regression in habits and behaviors in the older child is a typical reaction and that he needs extra love and attention at this time

D. Realize that the regression in habits and behaviors in the older child is a typical reaction and that he needs extra love and attention at this time The older child may regress in habits or behaviors (e.g., toileting and sleep habits) as a method of seeking attention. Parents need to distribute their attention in an equitable manner.

In follow-up appointments or visits with parents and their new baby, it is useful if the nurse can identify infant behaviors that can either facilitate or inhibit attachment. What is an inhibiting behavior? A. The infant cries only when hungry or wet. B. The infant's activity is somewhat predictable. C. The infant clings to the parents. D. The infant seeks attention from any adult in the room.

D. The infant seeks attention from any adult in the room. Parents want to be the focus of the infant's existence, just as the infant is the focus of their existence. Facilitating and inhibiting behaviors are behaviors that build or discourage bonding (attitudes); they do not reflect any value judgments on what might be healthy or unhealthy.

Which deceleration of the fetal heart rate would not require the nurse to change the maternal position? Early decelerations

Early decelerations and accelerations generally do not need any nursing intervention.

Abruptio Placentae: Assessment

Dark red vaginal bleeding. If the bleeding is high in the uterus or is minimal, there can be an absence of visible blood. Uterine pain or tenderness or both Uterine rigidity Severe abdominal pain Signs of fetal distress Signs of maternal shock if bleeding is excessive

Dysfunctional Labor (Dystocia)

Defined as long, difficult, or abnormal labor Caused by ineffective uterine contractions, alterations in pelvic structure, fetal causes, maternal position during labor and birth, psychologic response of the woman

Blood Volume

Depends on several factors: -Blood loss during childbirth -Amount of extravascular water mobilized and excreted -Pregnancy-induced hypervolemia allow most women to tolerate blood loss during child -Increase eliminated within first 2 weeks after birth, with return to nonpregnancy values by 6 months after delivery

Which description of the phases of the second stage of labor is accurate?

Descent phase: Significant increase in contractions, Ferguson reflux activated, average duration varied

Fetal Scalp Stimulation/Vibroacoustic Stimulation

Desired result is accel in FHR of at least 15 beats/min for 15 seconds Do not institute if FHR decels or bradycardia is present

Step 5

Determine dilation, presenting part, status of membranes, and characteristics of amniotic fluid.

Fetal Scalp Blood Sampling

Determines pH.

two to three

Episiotomies heal within _____ to _____ weeks.

Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3.5 to 4 minutes. The nurse would report this as:

First stage, active phase.

Variability

Fluctuations in the baseline FHR of two cycles per minute or greater Abnormal or indeterminate = absent or minimal variability Can be due to fetal hypoexmia and metabolic acidemia Moderate variability is considered normal Marked variability is unclear. Variations in sinusoidal pattern have been described in associated with chorioamnioitis, fetal sepsis, and narcotic analgesics

Caffeine

For CSF headaches, sometimes a beverage with _______ in it can bring relief.

24 to 36 hours

For non breastfeeding mothers, painful engorgement resolves and discomfort decreases approximately ______ to ______ hours after engorgement.

diapohoresis

For the first 2 to 3 nights after giving birth, and along with pospartal diuresis, a pregnant woman can profusely sweat; also known as _________.

For the labor nurse, care of the expectant mother begins with any or all of these situations, with the exception of:

Formulation of the woman's plan of care for labor.

Generally ranging from two to five contractions per 10 minutes of labor

Frequency

Normal Uterine Activity During Labor

Frequency of contractions Duration - between 45-80 seconds Strength - generally 40-70 mm Hg Resting tone - 10 mm Hg, should feel "soft" Relaxation time - 60 seconds in first stage, 45 seconds in second

Assessment of Uterine Contractions

Frequency: time between beginning of one contraction to the beginning of the following one Intensity: strength of contraction at its peak Duration: time that elapses between the onset and end of a contraction Resting tone: tension in the uterus between contractions Assessed by palpation or internal or external monitor

Maintenance of Uterine Tone

Fundal massage can cause temporary increase in the amount of vaginal bleeding seen as pooled blood leaves the uterus... clots can be expelled.

Leopold maneuvers would be an inappropriate method of assessment to determine:

Gender of the fetus.

Physical Examination

General systems assessment Vital signs Leopold maneuvers Assessment of FHR pattern (check FHR after ROM due to risk for cord prolapse)

Chinese Have an IUD inserted after the first child

Haitian take the placenta home to bury

On observing a woman on her first postpartum day sitting in bed while her newborn lies awake in the bassinet, the nurse should:

Hand the baby to the woman.

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. The nurse should be concerned that psychosocial outcomes are not being met if the woman:

Has not given the baby a name.

In the recovery room, if a woman is asked either to raise her legs off the bed or to flex her knees, place her feet flat on the bed, and raise her buttocks well off the bed, most likely she is being tested to see whether she:

Has recovered from epidural or spinal anesthesia. (If the numb or prickly sensations are gone from her legs after these movements, she has likely recovered from the epidural or spinal anesthesia.)

In the recovery room, if a woman is asked either to raise her legs off the bed or to flex her knees, place her feet flat on the bed, and raise her buttocks well off the bed, most likely she is being tested to see whether she:

Has recovered from epidural or spinal anesthesia.If the numb or prickly sensations are gone from her legs after these movements, she has likely recovered from the epidural or spinal anesthesia.

If a woman is at risk for thrombus and is not ready to ambulate, nurses may intervene by performing a number of interventions. Which intervention should the nurse avoid?

Having the patient sit in a chair.

Preventative Strategies for Preterm Birth

Health promotion and disease prevention Preconception counseling Interventions to prevent spontaneous preterm birth More research is needed Activity restriction: Limited work hours Restriction of sexual activity: Has not been shown to be effective Home care: Modified bed rest

Because the risk for childbirth complications may be revealed, nurses should know that the point of maximal intensity (PMI) of the fetal heart tone (FHT) is:

Heard lower and closer to the midline of the mother's abdomen as the fetus descends and rotates internally.

Causes of Bradycardia

Heart block, structural defects, viral infections, medications, fetal heart failure, maternal hypoglycemia, maternal hypothermia

What is an essential part of nursing care for the laboring woman?

Helping the woman manage the pain

Preterm Labor: risk factors

History of medical conditions Present and past obstetric problems *Infection--assess discharge for odor, change in character Social and environmental factors, including substance abuse Multifetal pregnancy, which contributes to overdistention of the uterus Anemia, which decreases oxygen supply to the uterus Age younger than 18 or first pregnancy and age older than 40 years

bleeding (hemorrhage)

I boggy uterus is associated with uterine ___________.

Procedure: Leopold Maneuvers

Identify fetal part that occupies the fundus Use palmar surface of one hand to identify the back and fetal parts Determine which fetal part is presenting over the inlet to the true pelvis Document

Pulmonary Edema

If a new mother cannot expel accumulated fluids during pregnancy, she can develop ________ _________.

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is:

It's normal to be anxious about labor. Let's discuss what makes you afraid."

The most critical nursing action in caring for the newborn immediately after birth is:

Keeping the newborn's airway clear. [The care given immediately after the birth focuses on assessing and stabilizing the newborn.]

The most critical nursing action in caring for the newborn immediately after birth is:

Keeping the newborn's airway clear.The care given immediately after the birth focuses on assessing and stabilizing the newborn.

Cesarean Birth: Indications

MATERNAL: -Specific cardiac disease (e.g. Marfan Syndrome, unstable CAD) -Specific respiratory disease (e.g. Guillain-Barre syndrome) -Conditions associated with increased intracranial pressure -Mechanical obstruction of the lower uterine segment (tumors, fibroids) -Mechanical vulvar obstruction (e.g. extensive condylomata) -History of previous cesarean birth FETAL: -Abnormal FHR or pattern -Malpresentation (e.g. breech or transverse lie) -Active maternal herpes lesions -Maternal HIV with viral load of more than 1000 copies/ml -Congenital anomalies MATERNAL-FETAL -Dysfunctional labor -Placental abruption -Placenta previa -Elective cesarean birth (maternal request)

Meconium aspiration syndrome (MAS)

Major risk associated with meconium-stained amniotic fluid in the newborn. It causes a severe form of aspiration pneumonia that occurs most often in term or postterm infants who have passed meconium in utero.

Abruptio Placentae: Postpartum

Monitor for signs of disseminated intravascular coagulation (DIC)

Hypotonic Uterine Inertia

More common type of uterine dysfunction Woman usually progresses into the active phase of first-stage of labor Woman may become exhausted and is at risk for infection. Rule out CPD and monitor FHR. If findings are normal, augmentation measures may be implemented.

Uterine tachysystole

More than 5 contractions in 10 minutes, averaged over a 30-minute window. Applies to both spontaneous and stimulated labor. See box pg 467 for emergency info

First Stage: Amniotic Membranes

Most commonly rupture during transition phase of labor. Rupture should be recorded

Rho immune globulin will be ordered postpartum if which situation occurs?

Mother Rh?2-, baby Rh+

Indications for Cesarean Birth

Mother: Marfan syndrome, CAD, respiratory disease, increased intracranial pressure, mechanical obstruction of lower uterine segment, mechnical vulvar obstruction, previous c-section Fetal: abnormal FHR, malpresentation, active herpes lesions, HIB with a viral load of more than 1000 copies, congenital abnormalities Matneral-Fetal: Dysfunctional labor, placental abruption, placenta previa, elective c-section

When the infant's behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics, this is called:Mutuality

Mutuality extends the concept of attachment to include this shared set of behaviors.

Proximity

NICU moms have harder time due to baby not in the same room.

The nurse caring for the woman in labor should understand that increased variability of the fetal heart rate may be caused by:Methamphetamines

Narcotics, barbiturates, and tranquilizers may be causes of decreased variability; methamphetamines may cause increased variability.

Ice; Secure Bra

Non breastfeeding mothers can reduce pain and discomfort by applying a _______ and wearing a ______ _______.

First Stage: Nursing Care

Offer general hygiene and encourage woman to wash hands. Change linens as needed. Women are only allowed clear liquids or ice during labor. Elimination: encourage voiding every 2 hours. Most women do not have bowel movements during labor Ambulation/positioning: encourage position change every 30-60 minutes if not done spontaneously

Extended Contact

Optimizes family-centered care Achieved through couplet care Family is encouraged to participate

Risk Factors for Dystocia

Overweight or short stature Advanced maternal age Infertility Uterine abnormalities Malpresentation and position of the fetus Cephalopelvic disproportion Uterine overstimulation with oxytocin Maternal fatigue, dehydration, and electrolyte imbalance, and fear Inappropriate timing of analgesic or anesthetic administration (Secondary powers) Abnormal uterine activity (hypertonic or primary dysfunctional labor, hypotonic or secondary uterine inertia)

Which statement regarding PPD is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis?

PPD can easily go undetected.

What is an expected characteristic of amniotic fluid?

Pale, straw color with small white particles

Care During C-Section

Pre-op: Assess cardiopulmonary status; blood work; assess VS and hydrate; provide emotional support Post-op: Assess recovery from effects of anesthesia and degree of pain. VS taken every 15 minutes for 1-2 hours. Oxytocin given to make sure uterus is firmly contracted. Monitor patient closely as she may be drowsy and at risk for falling asleep while holding her baby

Postterm pregnancy (postdate or prolonged pregnancy)

Pregnancy extends beyond the end of week 42 of gestation

Postterm Pregnancy

Pregnancy that extends beyond the end of 42 weeks gestation Clinical manifestations: maternal weight loss, decreased uterine size, meconium in amniotic fluid, and advanced bone maturation Maternal risks include dysfunctional labor, perineal injury due to macrosomia, hemorrhage and infection, interventions more likely to be necessary, fatigue and psychologic reactions Fetal risks include abnormal fetal growth, macrosomia, increased risk for birth injuries, aging placenta, oligohydramnios Care management: still controversial. Induce at 41 weeks gestation. Assess fetal well-being with BPP and NST

how to women tolerate considerable blood loss during birth?

Pregnancy-induced hypervolemia

The nurse thoroughly dries the infant immediately after birth primarily to:

Reduce heat loss from evaporation.

Reasons for Fetal Oxygen Supply

Reduction of blood flow through maternal vessels as result of hypertension and hypotension Reduction of oxygen content in maternal blood as a result of hemorrhage or severe anemia Alterations in fetal circulation with compression of umbilical cord Reduction in blood flow to intervillous space in placenta

Postanesthesia Recovery

Regardless of obstetric status, no woman should be discharged from recovery area until completely recovered from anesthesia

The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is to:

Show the mother how the infant initiates interaction and pays attention to her.

Low grade temperature

Sometimes new mothers can have a _____ _____ ______ which could be mistaken for an infection. This is actually due to the great stress and dehydrating effects of labor.

2 to 3 days

Spontaneous bowel evacuation may not occur for ____ to ____ days after childbirth.

Steps of Vaginal Exam

Step 1. Use sterile gloves and soluble gel for lubrication. Step 2. Position the woman to prevent supine hypotension. Step 3. Cleanse the perineum and vulva if necessary. Step 4. After obtaining permission, gently insert the index and middle fingers into the vagina. Step 5. Determine dilation, presenting part, status of membranes, and characteristics of amniotic fluid. Step 6. Explain findings to the patient. Step 7. Document findings and report to the provider.

After an emergency birth, the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity is to:

Stimulate the uterus to contract [Stimulation of the nipples through breastfeeding or manual stimulation causes the release of oxytocin and prevents maternal hemorrhage.]

After an emergency birth, the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity is to:

Stimulate the uterus to contract Stimulation of the nipples through breastfeeding or manual stimulation causes the release of oxytocin and prevents maternal hemorrhage.

The nurse expects to administer an oxytocic , Pitocin, Methergine to a woman after expulsion of her placenta to:

Stimulate uterine contraction.

The nurse expects to administer an oxytocic, Pitocin, Methergine to a woman after expulsion of her placenta to:

Stimulate uterine contraction.

Peaking at 40 to 70 mm Hg in the first stage of labor

Strength

Placenta Previa Assessment

Sudden onset of painless, bright red vaginal bleeding occurs in the last half of pregnancy. Uterus is soft, relaxed, and nontender Fundal height may be more than expected for gestational age *Vaginal exams are contraindicated if client is suspected of having or has a known placenta previa!

T or F: as lactation is established, a mass may form that can be distinguished from cancer by its position shift from day to day

TRUE

A nurse is observing a family. The mother is holding the baby she delivered less than 24 hours ago. Her husband is watching his wife and asking questions about newborn care.

The 4-year-old brother is punching his mother on the back. The nurse should: Realize that this is a normal family adjusting to family change.

A means of controlling the birth of the fetal head with a vertex presentation is:

The Ritgen maneuver. [The Ritgen maneuver extends the head during the actual birth and protects the perineum. Gentle, steady pressure against the fundus of the uterus facilitates vaginal birth.]

A means of controlling the birth of the fetal head with a vertex presentation is:

The Ritgen maneuver.The Ritgen maneuver extends the head during the actual birth and protects the perineum. Gentle, steady pressure against the fundus of the uterus facilitates vaginal birth.

500 to 1000 mL

The average blood loss for a cesarean birth is _______ to ______ mL.

300 mL to 500 mL

The average blood loss for a vaginal birth is ______ to ______ mL

Induction of labor

The chemical or mechanical initiation of uterine contractions before their spontaneous onset for the purpose of bringing about birth. Oxytocin and amniotomy (box 17-9) are the most common methods used in the US. For safety, elective induction should wait until 39 weeks gestation. Mechanical dilator--balloon catheter can be inserted through the intracervical canal to ripen and dilate the cervix.

The nurse recognizes that a woman is in true labor when she states:

The contractions in my uterus are getting stronger and closer together.

When using intermittent auscultation (IA) to assess uterine activity, the nurse should be cognizant that

The examiner's hand should be placed over the fundus before, during, and after contractions

Nurses alert to signs of the onset of the second stage of labor can be certain that this stage has begun when:

The nurse is unable to feel the cervix during a vaginal examination.The only certain objective sign that the second stage has begun is the inability to feel the cervix because it is fully dilated and effaced.

New parents express concern that, because of the mother's emergency cesarean birth under general anesthesia, they did not have the opportunity to hold and bond with their daughter immediately after her birth.

The nurse's response should convey to the parents that:Attachment, or bonding, is a process that occurs over time and does not require early contact.

A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged?

The woman leaves the infant on her bed while she takes a shower

A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged?

The woman leaves the infant on her bed while she takes a shower.

Lochia Serosa

This blood is pinkish or brown, serosanguineous consistency (thicker), fleshy odor. Occurs 4-10 days after delivery

The three tiered system of FHR tracings include Category I, II, and III. Category I is a normal tracing requiring no action. Category II FHR tracings are indeterminate.

This category includes tracings that do not meet Category I or III criteria. Category III tracings are abnormal and require immediate intervention.

Mechanism of Birth: Vertex Presentation

Three phases: 1) birth of the head, 2) birth of the shoulders, and 3) birth of the body and extremities

Cesarean Birth

Transabdominal incision of the uterus. Preserves life or health of mother and fetus

Version

Turning the fetus from one side to another External cephalic version - turns fetus from a breech or shoulder presentation to a vertex presentation. Terbulatine given to relax uterus Internal version - Physician inserts hand into uterus and changes presentation. Usually done to assist birth of second twin

When using intermittent auscultation (IA) for fetal heart rate, nurses should be aware that:

Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

Which maternal condition is considered a contraindication for the application of internal monitoring devices?

Unruptured membranes In order to apply internal monitoring devices, the membranes must be ruptured.

Step 1

Use sterile gloves and soluble gel for lubrication.

Electronic Fetal Heart Monitoring

Useful tool for visualizing FHR patterns on a monitor screen or printed tracing

Acquaintance

Uses touching, talking and exploring to become this with their infant immediately postpartum.

The nurse caring for a woman in labor understands that prolonged decelerations:

Usually are isolated events that end spontaneously.

Rupture of the Uterus

Usually caused by scarred uterus due to previous cesarean births S&S: Abnormal FHR tracing, loss of fetal station, abdominal pain, shock Increased risk due to multiple c-sections, no previous vaginal births, augmented or induced labor, multifetal gestation, macrosomia, infection, short interpregnancy interval Women with classic incisions are recommended not to attempt vaginal delivery

Hypertonic Uterine Dysfunction

Usually impacts first-time mothers Painful, frequent contractions that are ineffective in causing cervical dilation or effacement to progress Usually occur in latent phase in first-stage Women may be exhausted and express concern about a loss of control. Provide therapeutic rest with warm bath and analgesic

A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-pound, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, "I'm bleeding a lot." The most likely cause of postpartum hemorrhage in this woman is:

Uterine atony

Six

Uterus returns to its non pregnant state after _______ weeks.

Prolapsed Umbilical Cord

When cord lies below presenting part of fetus Contributing factors include long cord (more than 100cm), malpresentation (breech), transverse lie, unengaged presenting part Care management: examiner can hold cord off presenting part; modified Sim's position or Trendelnburg may keep pressure off presenting part

Lochia Alba

Whitish/yellowish discharge - lasts 10-14 days, may last 3-6 weeks and remain normal.

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding is: a) Little if any change b) Leakage of milk at let-down c) Swollen, warm and tender on palpation d) A few blisters and a bruise on each areola

a) Little if any change

When the infant's behavior and characteristics call forth a corresponding set of maternal behaviors and characteristics, this is called: a) Mutuality b) Bonding c) Claiming d) Acquaintance

a) Mutuality

When assessing a multiparous woman who has just given birth to an 8 pound boy, the nurse notes that the woman's fundus is firm and has become globular. A gush of dark red blood comes from her vagina. The nurse concludes that: a) The placenta has separated b) A cervical tear occurred during the birth c) The woman is beginning to hemorrhage d) Clots have formed in the upper uterine segment

a) The placenta has separated

The breasts of a bottle-feeding woman are engorged. The nurse should instruct her to: a) Wear a snug, supportive bra b) Allow warm water to soothe the breasts during a shower c) Express milk from breasts occasionally to relieve discomfort d) Place absorbent pads with plastic liners into her bra to absorb leakage

a) Wear a snug, supportive bra

The nurse caring for the laboring woman should understand that early decelerations are caused by: a. Altered fetal cerebral blood flow. b. Umbilical cord compression. c. Uteroplacental insufficiency. d. Spontaneous rupture of membranes.

a. Altered fetal cerebral blood flow.

The nurse providing care for the laboring woman comprehends that accelerations with fetal movement: a. Are reassuring. b. Are caused by umbilical cord compression. c. Warrant close observation. d. Are caused by uteroplacental insufficiency.

a. Are reassuring.

A laboring woman is lying in the supine position. The most appropriate nursing action at this time is to: a. Ask her to turn to one side. b. Elevate her feet and legs. c. Take her blood pressure. d. Determine whether fetal tachycardia is present.

a. Ask her to turn to one side.

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by: a. Change in position. b. Oxytocin administration. c. Regional anesthesia. d. Intravenous analgesic.

a. Change in position.

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse's first priority is to: a. Change the woman's position. b. Notify the care provider. c. Assist with amnioinfusion. d. Insert a scalp electrode.

a. Change the woman's position.

A normal uterine activity pattern in labor is characterized by: a. Contractions every 2 to 5 minutes. b. Contractions lasting about 2 minutes. c. Contractions about 1 minute apart. d. A contraction intensity of about 1000 mm Hg with relaxation at 50 mm Hg.

a. Contractions every 2 to 5 minutes.

Perinatal nurses are legally responsible for: a. Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes. b. Greeting the client on arrival, assessing her, and starting an intravenous line. c. Applying the external fetal monitor and notifying the care provider. d. Making sure that the woman is comfortable.

a. Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes.

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign that uterine contractions are effective would be: a. Dilation of the cervix. b.Descent of the fetus. c. Rupture of the amniotic membranes. d. Increase in bloody show.

a. Dilation of the cervix.

Which deceleration of the fetal heart rate would not require the nurse to change the maternal position? a. Early decelerations b. Late decelerations c. Variable decelerations d. It is always a good idea to change the woman's position.

a. Early decelerations

In assisting with the two factors that have an effect on fetal status (i.e., pushing and positioning), nurses should: a. Encourage the woman's cooperation in avoiding the supine position. b. Advise the woman to avoid the semi-Fowler position. c. Encourage the woman to hold her breath and tighten her abdominal muscles to produce a vaginal response. d. Instruct the woman to open her mouth and close her glottis, letting air escape after the push.

a. Encourage the woman's cooperation in avoiding the supine position.

Leopold maneuvers would be an inappropriate method of assessment to determine: a. Gender of the fetus. b. Number of fetuses. c. Fetal lie and attitude. d. Degree of the presenting part's descent into the pelvis.

a. Gender of the fetus.

What is an essential part of nursing care for the laboring woman? a. Helping the woman manage the pain b. Eliminating the pain associated with labor c. Sharing personal experiences regarding labor and delivery to decrease her anxiety d. Feeling comfortable with the predictable nature of intrapartum care

a. Helping the woman manage the pain

A pregnant woman is in her third trimester. She asks the nurse to explain how she can tell true labor from false labor. The nurse would explain that "true" labor contractions: a. Increase with activity such as ambulation. b. Decrease with activity. c. Are always accompanied by the rupture of the bag of waters. d. Alternate between a regular and an irregular pattern.

a. Increase with activity such as ambulation.

When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for _________________________ has increased. a. Intrauterine infection b. Hemorrhage c. Precipitous labor d. Supine hypotension

a. Intrauterine infection

The most critical nursing action in caring for the newborn immediately after birth is: a. Keeping the newborn's airway clear. b. Fostering parent-newborn attachment. c. Drying the newborn and wrapping the infant in a blanket. d. Administering eye drops and vitamin K.

a. Keeping the newborn's airway clear.

As the United States and Canada continue to become more culturally diverse, it is increasingly important for the nursing staff to recognize a wide range of varying cultural beliefs and practices. Nurses need to develop respect for these culturally diverse practices and learn to incorporate these into a mutually agreed on plan of care. Although it is common practice in the United States for the father of the baby to be present at the birth, in many societies this is not the case. When implementing care, the nurse would anticipate that a woman from which country would have the father of the baby in attendance? a. Mexico c. Iran b. China d. India

a. Mexico

The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is located: a. Over the uterine fundus. b. On the fetal scalp. c. Inside the uterus. d. Over the mother's lower abdomen.

a. Over the uterine fundus.

A means of controlling the birth of the fetal head with a vertex presentation is: a. The Ritgen maneuver. c. The lithotomy position. b. Fundal pressure. d. The De Lee apparatus.

a. The Ritgen maneuver.

When using intermittent auscultation (IA) to assess uterine activity, the nurse should be cognizant that: a. The examiner's hand should be placed over the fundus before, during, and after contractions. b. The frequency and duration of contractions is measured in seconds for consistency. c. Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together. d. The resting tone between contractions is described as either placid or turbulent.

a. The examiner's hand should be placed over the fundus before, during, and after contractions.

When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. The nurse concludes that: a. The placenta has separated. b. A cervical tear occurred during the birth. c. The woman is beginning to hemorrhage. d. Clots have formed in the upper uterine segment.

a. The placenta has separated.

Fetal well-being during labor is assessed by: a. The response of the fetal heart rate (FHR) to uterine contractions (UCs). b. Maternal pain control. c. Accelerations in the FHR. d. An FHR above 110 beats/min.

a. The response of the fetal heart rate (FHR) to uterine contractions (UCs).

With regard to a woman's intake and output during labor, nurses should be aware that: a. The tradition of restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia. b. Intravenous (IV) fluids usually are necessary to ensure that the laboring woman stays hydrated. c. Routine use of an enema empties the rectum and is very helpful for producing a clean, clear delivery. d. When a nulliparous woman experiences the urge to defecate, it often means birth will follow quickly.

a. The tradition of restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia.

Which maternal condition is considered a contraindication for the application of internal monitoring devices? a. Unruptured membranes b. Cervix dilated to 4 cm c. External monitors in current use d. Fetus with a known heart defect

a. Unruptured membranes

The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat: a. Variable decelerations. b. Late decelerations. c. Fetal bradycardia. d. Fetal tachycardia.

a. Variable decelerations.

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring

after the peak of the contraction. The nurse's first priority is to: Change the woman's position.Late decelerations may be caused by maternal supine hypotension syndrome.

Telemetry monitors

allow observation of the FHR and UC patterns by means of centrally located electronic display stations. These portable units permit the woman to walk around during electronic monitoring.

While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions

and returns to baseline before each contraction ends. The nurse should Document the finding in the client's record The FHR indicates early decelerations, which are not an ominous sign and do not require any intervention

Leakage of milk occurs and engorgement happens when ? Non breast feeding moms do what t or f. A few blisters and a bruise indicate problems with the breastfeeding techniques being used.

around day 2 or 4. do not express milk. lactation ceases within few days to week true.

ovulation occurs when

as early as 27 days in non lactating moms. up to 6 months in lactating moms. some women ovulate before their first menstrual period. first menses is heavier than normal

A woman gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is: a) Urinary tract infection b) Excessive uterine bleeding c) A ruptured bladder d) Bladder wall atony

b) Excessive uterine bleeding

Which test is performed to determine if membranes are ruptured? a) Urine analysis b) Fern test c) Leopold maneuvers d) AROM

b) Fern test

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is: a) Dont worry about it. You'll do fine b) It's normal to be anxious about labor. Let's discuss what makes you afraid c) Labor is scary to think about, but the actual experience isn't d) You may have an epidural. You won't feel anything

b) It's normal to be anxious about labor. Let's discuss what makes you afraid

The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action is to: a) Place her on a bedpan to empty her bladder b) Massage her fundus c) Call the physician d) Administer methylergonovine (Methergine), 0.2mg IM, which has been ordered prn

b) Massage her fundus

What statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth? a) My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter b) My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles c) I will not have a menstrual cycle for 6 months after childbirth d) My first menstrual cycle will be heavier than normal and then will be light for several months after

b) My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles

A woman who is gravida 3 para 2 enters the intrapartum unit. The most important nursing assessments are: a. Contraction pattern, amount of discomfort, and pregnancy history. b. Fetal heart rate, maternal vital signs, and the woman's nearness to birth. c. Identification of ruptured membranes, the woman's gravida and para, and her support person. d. Last food intake, when labor began, and cultural practices the couple desires.

b. Fetal heart rate, maternal vital signs, and the woman's nearness to birth.

Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3.5 to 4 minutes. The nurse would report this as: a. First stage, latent phase. b. First stage, active phase. c. First stage, transition phase. d. Second stage, latent phase.

b. First stage, active phase.

What correctly matches the type of deceleration with its likely cause? a. Early deceleration—umbilical cord compression b. Late deceleration—uteroplacental inefficiency c. Variable deceleration—head compression d. Prolonged deceleration—cause unknown

b. Late deceleration—uteroplacental inefficiency

Health care providers demonstrate a variety of reactions to lesbian couples including failure to acknowledge the "other mother's" role in pregnancy, birth, and parenting. Integration of the non-childbearing partner into care includes offering the same opportunities afforded male partners of heterosexual women. These include all except: a) Labor support b) Cutting the cord c) Rooming in during hospitalization d) Breastfeeding the infant

d) Breastfeeding the infant

For women who have a history of sexual abuse, a number of traumatic memories may be triggered during labor. The woman may fight the labor process and react with pain or anger. Alternately, she may become a passive player and emotionally absent herself from the process. The nurse is in a unique position of being able to assist the client to associate the sensations of labor with the process of childbirth and not the past abuse. The nurse can implement a number of care measures to help the client view the childbirth experience in a positive manner. Which intervention would be key for the nurse to use while providing care? a. Telling the client to relax and that it won't hurt much b. Limiting the number of procedures that invade her body c. Reassuring the client that as the nurse you know what is best d. Allowing unlimited care providers to be with the client

b. Limiting the number of procedures that invade her body

What is an expected characteristic of amniotic fluid? a. Deep yellow color b. Pale, straw color with small white particles c. Acidic result on a Nitrazine test d. Absence of ferning

b. Pale, straw color with small white particles

What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken. a. Call the provider, reposition the mother, and perform a vaginal examination. b. Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. c. Administer oxygen to the mother, increase IV fluid, and notify the care provider. d. Perform a vaginal examination, reposition the mother, and provide oxygen via face mask.

b. Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.

After an emergency birth, the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity is to: a. Facilitate maternal-newborn interaction. b. Stimulate the uterus to contract. c. Prevent neonatal hypoglycemia. d. Initiate the lactation cycle.

b. Stimulate the uterus to contract.

Nurses alert to signs of the onset of the second stage of labor can be certain that this stage has begun when: a. The woman has a sudden episode of vomiting. b. The nurse is unable to feel the cervix during a vaginal examination. c. Bloody show increases. d. The woman involuntarily bears down.

b. The nurse is unable to feel the cervix during a vaginal examination.

The primary difference between the labor of a nullipara and that of a multipara is the: a. Amount of cervical dilation. b. Total duration of labor. c. Level of pain experienced. d. Sequence of labor mechanisms.

b. Total duration of labor.

The nurse providing care for the laboring woman realizes that variable fetal heart rate (FHR) decelerations are caused by: a. Altered fetal cerebral blood flow. b. Umbilical cord compression. c. Uteroplacental insufficiency. d. Fetal hypoxemia.

b. Umbilical cord compression.

Why is continuous electronic fetal monitoring usually used when oxytocin is administered? a. The mother may become hypotensive. b. Uteroplacental exchange may be compromised. c. Maternal fluid volume deficit may occur. d. Fetal chemoreceptors are stimulated.

b. Uteroplacental exchange may be compromised.

Under which circumstance would it be unnecessary for the nurse to perform a vaginal examination? a. An admission to the hospital at the start of labor b. When accelerations of the fetal heart rate (FHR) are noted c. On maternal perception of perineal pressure or the urge to bear down d. When membranes rupture

b. When accelerations of the fetal heart rate (FHR) are noted

The nurse expects to administer an oxytocic (e.g., Pitocin, Methergine) to a woman after expulsion of her placenta to: a. Relieve pain. b.Stimulate uterine contraction. c.Prevent infection. d. Facilitate rest and relaxation.

b.Stimulate uterine contraction.

Bradycardia

baseline FHR less than 110 beats/min for 10 minutes or longer. True bradycardia occurs rarely and is not specifically related to fetal oxygenation. Bradycardia is often caused by some type of fetal cardiac problem...

Which description of the pases of the second stage of labor is accurate? a) Latent phase: feels sleepy, fetal station is 2+ to 4+, duration is 30 to 45 minutes b) Active phase: overwhelmingly strong contractions, Ferguson reflex activated, duration is 5 to 15 minutes c) Descent phase: significant increase in contractions, Ferguson reflex activated, average duration varies d) Transitional phase: woman "laboring down," fetal station is 0, duration is 15 minutes

c) Descent phase: significant increase in contractions, Ferguson reflex activated, average duration varies

Evidence-based care practices designed to support normal labor and birth recommend which practice during the immediate newborn period? a) The healthy newborn should be taken to the nursery for a complete assessment b) After drying, the infant should be given to the mother wrapped in a receiving blanker c) Encourage skin-to-skin contact of mother and baby d) The father or support persons should be encouraged to hold the infant while awaiting delivery of the placenta

c) Encourage skin-to-skin contact of mother and baby

Excessive blood loss after childbirth can have several causes; however, the most common is: a) Vaginal or vulvar hematomas b) Unrepaired lacerations of the vagina or cervix c) Failure of the uterine muscle to contract firmly d) Retained placental fragments

c) Failure of the uterine muscle to contract firmly

With regard to afterbirth pains, nurses should be aware that these pains are: a) Caused my mild, continual contractions for the duration of the postpartum period b) More common in first-time mothers c) More noticeable in births in which the uterus was overdistended d) Alleviated somewhat when the mother breastfeeds

c) More noticeable in births in which the uterus was overdistended

According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR): a. Every 15 minutes in the active phase of the first stage of labor in the absence of risk factors. b. Every 20 minutes in the second stage, regardless of whether risk factors are present. c. Before and after ambulation and rupture of membranes. d. More often in a woman's first pregnancy.

c. Before and after ambulation and rupture of membranes.

The nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates the woman's understanding of the instructions when she states, "True labor contractions will: a. Subside when I walk around." b. Cause discomfort over the top of my uterus." c. Continue and get stronger even if I relax and take a shower." d. Remain irregular but become stronger."

c. Continue and get stronger even if I relax and take a shower."

Which description of the phases of the second stage of labor is accurate? a. Latent phase: Feeling sleepy, fetal station 2+ to 4+, duration 30 to 45 minutes b. Active phase: Overwhelmingly strong contractions, Ferguson reflux activated, duration 5 to 15 minutes c. Descent phase: Significant increase in contractions, Ferguson reflux activated, average duration varied d. Transitional phase: Woman "laboring down," fetal station 0, duration 15 minutes

c. Descent phase: Significant increase in contractions, Ferguson reflux activated, average duration varied

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to 70 mm Hg and the resting tone range is 6 to 10 mm Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the nurse should: a. Notify the woman's primary health care provider immediately. b. Prepare to administer an oxytocic to stimulate uterine activity. c. Document the findings because they reflect the expected contraction pattern for the active phase of labor. d. Prepare the woman for the onset of the second stage of labor.

c. Document the findings because they reflect the expected contraction pattern for the active phase of labor.

Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions? a. Place the hand on the abdomen below the umbilicus and palpate uterine tone with the fingertips. b. Determine the frequency by timing from the end of one contraction to the end of the next contraction. c. Evaluate the intensity by pressing the fingertips into the uterine fundus. d. Assess uterine contractions every 30 minutes throughout the first stage of labor.

c. Evaluate the intensity by pressing the fingertips into the uterine fundus.

A nulliparous woman who has just begun the second stage of her labor would most likely: a. Experience a strong urge to bear down. b. Show perineal bulging. c. Feel tired yet relieved that the worst is over. d. Show an increase in bright red bloody show.

c. Feel tired yet relieved that the worst is over.

Because the risk for childbirth complications may be revealed, nurses should know that the point of maximal intensity (PMI) of the fetal heart tone (FHT) is: a. Usually directly over the fetal abdomen. b. In a vertex position heard above the mother's umbilicus. c. Heard lower and closer to the midline of the mother's abdomen as the fetus descends and rotates internally. d. In a breech position heard below the mother's umbilicus. ANS: C

c. Heard lower and closer to the midline of the mother's abdomen as the fetus descends and rotates internally.

The nurse caring for the woman in labor should understand that increased variability of the fetal heart rate may be caused by: a. Narcotics. b. Barbiturates. c. Methamphetamines. d. Tranquilizers.

c. Methamphetamines.

Fetal bradycardia is most common during: a. Intraamniotic infection. b. Fetal anemia. c. Prolonged umbilical cord compression. d. Tocolytic treatment using terbutaline.

c. Prolonged umbilical cord compression.

The nurse thoroughly dries the infant immediately after birth primarily to: a. Stimulate crying and lung expansion. b. Remove maternal blood from the skin surface. c. Reduce heat loss from evaporation. d. Increase blood supply to the hands and feet.

c. Reduce heat loss from evaporation.

woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely

correlated with these orders? The woman has an episiotomy.

It is paramount for the obstetric nurse to understand the regulatory procedures and criteria for admitting a woman to the hospital labor unit. Which guideline is an important legal requirement of maternity care? a. The patient is not considered to be in true labor (according to the Emergency Medical Treatment and Active Labor Act [EMTALA]) until a qualified health care provider says she is. b. The woman can have only her male partner or predesignated "doula" with her at assessment. c. The patient's weight gain is calculated to determine whether she is at greater risk for cephalopelvic disproportion (CPD) and cesarean birth. d. The nurse may exchange information about the patient with family members.

c. The patient's weight gain is calculated to determine whether she is at greater risk for cephalopelvic disproportion (CPD) and cesarean birth.

What is an advantage of external electronic fetal monitoring? a. The ultrasound transducer can accurately measure short-term variability and beat-to-beat changes in the fetal heart rate. b. The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions (UCs). c. The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor. d. Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions.

c. The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor.

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? a. The fetal head is felt at 0 station during vaginal examination. b. Bloody mucus discharge increases. c. The vulva bulges and encircles the fetal head. d. The membranes rupture during a contraction.

c. The vulva bulges and encircles the fetal head.

The nurse knows that the second stage of labor, the descent phase, has begun when: a. The amniotic membranes rupture. b. The cervix cannot be felt during a vaginal examination. c. The woman experiences a strong urge to bear down. d. The presenting part is below the ischial spines.

c. The woman experiences a strong urge to bear down.

The nurse caring for a woman in labor understands that prolonged decelerations: a. Are a continuing pattern of benign decelerations that do not require intervention. b. Constitute a baseline change when they last longer than 5 minutes. c. Usually are isolated events that end spontaneously. d. Require the usual fetal monitoring by the nurse.

c. Usually are isolated events that end spontaneously.

The nurse caring for the woman in labor should understand that maternal hypotension can result in: a. Early decelerations. b. Fetal dysrhythmias. c. Uteroplacental insufficiency. d. Spontaneous rupture of membranes.

c. Uteroplacental insufficiency.

The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are the result of: a. Altered cerebral blood flow. b. Umbilical cord compression. c. Uteroplacental insufficiency. d. Meconium fluid.

c. Uteroplacental insufficiency.

why does engorgement happen

congestion of veins and lymphatics NOT due to overproduction of milk

Two hours after giving birth a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm, at the umbilicus, and midline. Her lochia is moderate rubra with no clots. The nurse suspects: a) Bladder distention b) Uterine atony c) Constipation d) Hematoma formation

d) Hematoma formation

If a woman complains of back labor pain, the nurse might best suggest that she: a) Lie on her back for a while with her knees bent b) Do less walking around c) Take some deep, cleansing breaths d) Lean over a birth ball with her knees on the floor

d) Lean over a birth ball with her knees on the floor

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to: a) Begin an IV infusion of Ringer's lactate solution b) Assess the woman's vital signs c) Call the woman's primary health care provider d) Message the woman's fundus

d) Message the woman's fundus

Which finding would be a source of concern if noted during the assessment of a woman who is 12 hours' postpartum? a) Postural hypotension b) Temperature of 38 C c) Bradycardia- pulse rate of 55 beats/min d) Pain in left calf with dorsiflexion of left foot

d) Pain in left calf with dorsiflexion of left foot

Postbirth uterine/vaginal discharge, called lochia: a) Is similar to a light menstrual period for the first 6 to 12 hours b) Is usually greater after cesarean births c) Will usually decrease with ambulation and breastfeeding d) Should smell like normal menstrual flow unless an infection is present

d) Should smell like normal menstrual flow unless an infection is present

Perineal care is an important infection control measure. When evaluation a postpartum woman's perineal care technique, the nurse would recognize the need for further instruction if the woman: a) Uses soap and warm water to wash the vulva and perineum b) Washes from symphysis pubis back to the episiotomy c) Changes her perineal pad every 2 to 3 hours d) Uses the peribottle to rinse upward into her vagina

d) Uses the peribottle to rinse upward into her vagina

For the labor nurse, care of the expectant mother begins with any or all of these situations except: a) The onset of progressive, regular contractions b) The bloody, or pink, show c) The spontaneous rupture of membranes d) formulation of the woman's plan of care for labor

d) formulation of the woman's plan of care for labor

When a nulliparous woman telephones the hospital to report that she is in labor, the nurse initially should: a. Tell the woman to stay home until her membranes rupture. b. Emphasize that food and fluid intake should stop. c. Arrange for the woman to come to the hospital for labor evaluation. d. Ask the woman to describe why she believes she is in labor.

d. Ask the woman to describe why she believes she is in labor.

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse's initial response would be to: a. Prepare the woman for imminent birth. b. Notify the woman's primary health care provider. c. Document the characteristics of the fluid. d. Assess the fetal heart rate and pattern.

d. Assess the fetal heart rate and pattern.

When assessing the relative advantages and disadvantages of internal and external electronic fetal monitoring, nurses comprehend that both: a. Can be used when membranes are intact. b. Measure the frequency, duration, and intensity of uterine contractions. c. May need to rely on the woman to indicate when uterine activity (UA) is occurring. d. Can be used during the antepartum and intrapartum periods.

d. Can be used during the antepartum and intrapartum periods.

A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The fetal heart rate has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. The nurse should expect the woman to be: a. Admitted and prepared for a cesarean birth. b. Admitted for extended observation. c. Discharged home with a sedative. d. Discharged home to await the onset of true labor.

d. Discharged home to await the onset of true labor.

The nurse who performs vaginal examinations to assess a woman's progress in labor should: a. Perform an examination at least once every hour during the active phase of labor. b. Perform the examination with the woman in the supine position. c. Wear two clean gloves for each examination. d. Discuss the findings with the woman and her partner.

d. Discuss the findings with the woman and her partner.

While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should: a. Change the woman's position. b. Discontinue the oxytocin infusion. c. Insert an internal monitor. d. Document the finding in the client's record.

d. Document the finding in the client's record.

Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by: a. Maintaining normal maternal temperature. b. Preventing normal maternal hypoglycemia. c. Increasing the oxygen-carrying capacity of the maternal blood. d. Expanding maternal blood volume.

d. Expanding maternal blood volume.

The most common cause of decreased variability in the fetal heart rate (FHR) that lasts 30 minutes or less is: a. Altered cerebral blood flow. b. Fetal hypoxemia. c. Umbilical cord compression. d. Fetal sleep cycles.

d. Fetal sleep cycles.

For the labor nurse, care of the expectant mother begins with any or all of these situations, with the exception of: a. The onset of progressive, regular contractions. b. The bloody, or pink, show. c. The spontaneous rupture of membranes. d. Formulation of the woman's plan of care for labor.

d. Formulation of the woman's plan of care for labor.

As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with: a. Hypotension. c. Maternal drug use. b. Cord compression. d. Hypoxemia.

d. Hypoxemia.

Which fetal heart rate (FHR) finding would concern the nurse during labor? a. Accelerations with fetal movement b. Early decelerations c. An average FHR of 126 beats/min d. Late decelerations

d. Late decelerations

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take? a. Scream for help. b. Insert a Foley catheter. c. Start Pitocin. d. Notify the care provider immediately.

d. Notify the care provider immediately.

puerperium

period between the birth of the newborn and the return of the reproductive organs to their normal non pregnant state; fourth trimester of pregnancy

causes of headaches

post-partume preclampsia, stress and leakage of cerebrospinal fluid from epidural

A nurse may be called on to stimulate the fetal scalp: a.As part of fetal scalp blood sampling. b. In response to tocolysis. c. In preparation for fetal oxygen saturation monitoring. d. To elicit an acceleration in the fetal heart rate (FHR).

d. To elicit an acceleration in the fetal heart rate (FHR).

When using intermittent auscultation (IA) for fetal heart rate, nurses should be aware that: a. They can be expected to cover only two or three clients when IA is the primary method of fetal assessment. b. The best course is to use the descriptive terms associated with electronic fetal monitoring (EFM) when documenting results. c. If the heartbeat cannot be found immediately, a shift must be made to EFM. d. Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

d. Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

may not poop for 2-3 days. why?

decreased muscle tone in intestines during labor, prelabor diarrhea, lack of food, dehydration, fear, due to forceps use.

Variability of the FHR

described as irregular waves or fluctuations in the baseline FHR of two cycles per minute or greater. *Moderate variability is considered normal.

what happens after placental expulsion?

estrogen and progesterone levels decrease dramatically, triggering anatomic and physiologic changes.

nurse teaches a pregnant woman about the characteristics of true labor contractions. nurse evaluates the woman's understanding of the instructions when she states, "True labor contractions will Continue and get stronger even if I

relax and take a shower."They may become intense during walking and continue despite comfort measures. Typically true labor contractions are felt in the lower back, radiating to the lower portion of the abdomen

The most common causes of subinvolution,

retained placental fragments and infection.

Uterine Inversion: Assessment

-A depression in the fundal area of the uterus is notes -The interior of the uterus may be seen through the cervix or protruding through the vagina -The client has severe pain -Hemorrhage is evident -The client shows signs of shock

Rupture of the Uterus: Assessment

-Abdominal pain or tenderness -Chest pain -Contractions may stop or fail to progress -Rigid abdomen -Absent fetal heart rate -Signs of maternal shock -Fetus palpated outside the uterus (complete rupture)

Amniotic Fluid Embolism: Assessment

-Abrupt onset of respiratory distress and chest pain -Cyanosis -Fetal bradycardia and distress if delivery has not occurred at the time of the embolism

Amniotic Fluid Embolism

-Amniotic fluid containing particles of debris -Acute onset of hypotension, hypoxia, cardiovascular collapse, and coagulopathy -Maternal mortality to 61% or higher -Neonatal outcome is poor

GI System

-Appetite: Most new mothers are very hungry after recovery from analgesia, anesthesia, and fatigue -Bowel evacuation: Spontaneous bowel evacuation may not occur for 2 to 3 days after childbirth

Menstruation

-Approx 4 wks in non-lactating women, could go 6-9 months in those solely BF. -First period tends to be heavier than normal

Fourth Stage of Labor

-Assessment -Postanesthesia recovery -Care of the new mother -Care of the family

Components of Nursing Care

-Assist mother with rest and recovery after birth -Assessment of physiologic and psychologic adaptation -Prevention of complications -Education regarding self-management and infant care Support of mother and her partner during transition to parenthood

Prevention of Bladder Distention

-At risk due to urinary retension based on: epidural anesthesia vaginal or perineal lacerations episiotomy instrument assisted birth prolonged labor -Interventions based on woman emptying her bladder spontaneously asap.

Interaction

-Attachment facilitated by positive feedback

Chorioamnionitis

-Bacterial infection of the amniotic cavity -Major cause of complications -Clinical findings: Maternal fever Fetal tachycardia Uterine tenderness Foul odor of amniotic fluid

Labor

-Begins with first uterine contraction, continues with hard work during cervical dilation and birth, and ends as woman and family begin attachment process with infant -Nulliparous women seek admission during laten/early phase- first time mom's -Multiparous women do not usually come to hospital or birth center until active phase- women who have had babies before -True vs false labor—CTX's get longer, stronger and closer together, even when woman at rest

First Stage of Labor

-Begins with onset of regular uterine contractions -Ends with full cervical effacement and dilation -Three phases Latent phase: up to 3 cm of dilation Active phase: 4 to 7 cm of dilation Transition phase: 8 to 10 cm of dilation -End= 100% effacement and 10 cm dilated

Care Management

-Birth experience- may need to morn loss if it did not go as planned. -Maternal self image- reluctant to resume intercourse, poor body image -Adapttion- contuining to establish relationship, adapting to new roles. -Family structure- adjusts gradually, dealing with stress -Culture- influences behavior, should be incorporated when possible

Personal Aspirations

-Blocks plans of personal freedom or advancement in careers. -May result in indifference or neglect of the infant -May place impossibly high standards on infant

Lochia Ruba

-Blood and decidual and trophoblastic debris -Duration of 3 to 4 days

Breasts

-Breastfeeding mothers: Before lactation a yellowish fluid, colostrum, can be expressed from nipples. Breasts become fuller and heavier, estimate when milk comes in (72 to 96 hours after birth) Nonbreastfeeding mothers: Engorgement resolves spontaneously, and discomfort decreases within 24 to 36 hours

Assessment of Attachment Behaviors

-Careful observation of specific behaviors Formation of emotional bonds Skillful observation and intervening -Enhance parent-infant contact by increasing parent's awareness of infant responses Rooming-in: infant stays in the room with the mother.

Vaginal Exam

-Cervical effacement, dilation, fetal descent accomplished -Done less frequently esp if water is broken 2^ risk for infection

Adjustment for Couple

-Changes in relationship -Division of household and infant care responsibilities -Financial concerns -Balancing work/home/social activities -Changes in intimacy r/t baby

Becoming A Mother

-Characterized by dependent, dependent-independent, and interdependent behavior. -4 stages a- commitment, attachment to the unborn baby and preparation for deliver and motherhood during pregnancy. b- acquaintance/attachment to the infant, learning to care for the infant, and physical restoration during the first 2 to 6 weeks following birth. c- moving toward a new normal. d- achievement of maternal identity through redefining self to incorporate motherhood (around 4 months)

Integumentary System

-Chloasma of pregnancy usually disappears at end of pregnancy: Persists in 30% of women -Hyperpigmentation of areolae and linea nigra may not regress completely after childbirth -Some women will have permanent darker pigmentation of those areas -Stretch marks on breasts, abdomen, and thighs may fade but not disappear -Vascular abnormalities, spider angiomas, palmar erythema, and epulis regress with rapid decline in estrogens -Spider nevi persist indefinitely for some -Hair growth slows during the postpartum period: Some women experience significant hair loss

Dystocia

-Defined as long, difficult, or abnormal labor: Ineffective uterine contractions (powers) Alterations and pelvic structure (passage) Fetal causes (passenger) Maternal position during labor and birth Psychologic response of the woman

Low Birth Weight LBW

-Describes only birth weight: -2500 g or less -Easier to measure than preterm birth -Preterm birth is more dangerous

Socioeconomic Conditions

-Determine access to available resources. -May override desire for mothering infant -Effects parenting skills

Nonpharmacological Methods

-Distraction, imagery, hydrotherapy, therapeutic touch, relaxation, acupressure, aromatherapy, massage therapy, music therapy, TENS -Episiotomy or lacerations- lay on side and use pillow while sitting, ice pack, topical medication, dry heat, squeeze bottle, shower, tub bath, or sitz bath.

Visually Impaired Parent

-Does not have negative effect on parenting -Heightened sensitivity to other sensory output -Skepticism by health care professionals -Infant will need sensory input from other parent

Lesbian Couples

-Donor insemination -Adoption -Surrogate mother -Hide relationships due to homophobic responses -Role conflicts -Family/society stigmas

Abdomen

-During first 2 weeks abdominal wall remains relaxed -Woman has still-pregnant appearance -Return to prepregnancy state takes 6 weeks -Depends on previous tone, proper exercise, and amount of adipose tissue

Promotion of Ambulation

-Early intervention is associated with less risk of VTE -Encourage to ambulate frequently when stable -Watch out for orthostatic hypotension -Medications and ambulation -Prevention of VTE TEDS SCDs

Adolescent Parents

-Egocentricity and concrete thinking -Need strong support system -Difficulty accepting new roles and infant demands -Use less verbal interaction vs older parents -Emotional responses by father -Community resources

Induction of Labor

-Elective induction- fewer done due to insurance not paying. -Bishop score- determines if baby is ready to be induced, the higher the score the closer they are -39 weeks or greater

Father-Infant Relationship

-Engrossment- fathers absorption, preoccupation, and interest in infant. -Increased self-esteem -Less interpersonal and professional support compared with mothers and feel excluded from antenatal appointments and classes.

Placental Hormones

-Expulsion of placenta results in dramatic decreases of placental-produced hormones -Decreases in chorionic somatomammotropin (hCS), estrogens, cortisol, and placental enzyme insulinase reverse effects of pregnancy -Estrogen and progesterone levels drop markedly

Parental Tasks and Responsibilities

-Fantasy vs actual child -Sex of baby different then suspected or wanted -Appearance of infant -BF helps mom feel like they are contributing to welfare of baby -Family support

Emergency Medical Treatment and Active Labor Act EMTALA

-Federal regulation enacted to ensure that woman receives emergency treatment or labor care -Nurses must be familiar with their responsibilities -Agencies must have policies and procedures in place to ensure compliance

Promotion of Nutrition

-Good appetite after birth -Prenetal vitamines until 6 weeks after birth -1800-2200 kcal/day

Shoulder Dystocia

-Head is born, but anterior shoulder cannot pass under pubic arch -Newborn is more likely to experience birth injuries -Brachial plexus -Maternal complications: Hemorrhage Rectal injuries

Care Management

-Helping parents cope with infant care -Role changes -Altered lifestyle -Change in family structure due to new baby -Anticipatory guidance

Promotion of Breastfeeding

-Ideal time 1 to 2 hours after childbirth -Baby-friendly hospitals mandate within 1 hour after birth.

Placental Site

-Immediately after the placenta and membranes are expelled, vascular constriction and thromboses reduce this to an irregular nodular area. -Regeneration not complete until usually 6 weeks after birth.

Transfer from Recovery Area

-In traditional setting, woman is moved to postpartum room after recovery -In labor, delivery, recovery, and postpartum (LDRP) setting, woman and infant remain together in room where birth occurred

Obesity

-Increasingly serious problem for pregnant women -Likely to begin their pregnancy with pre-existing conditions Hypertension Diabetes (usually type 2) -Increased risk of postdate pregnancy and complications -Nursing care has many challenges-- excessive weight will not allow uterus to contract--education to lose weight.

Meconium-Stained Amniotic Fluid

-Indicates that the fetus has passed the first stool before birth -Three possible reasons:stress, trauma, postdates, any periods of anoxia -Place of the infant at risk for meconium aspiration syndrome -Requires the team skilled in neonatal resuscitation

Vaginal Birth After Cesarean (VBAC)

-Indications for primary cesarean birth such as dystocia, breech presentation, or fetal distress often are nonrecurring -May be a candidate to attempt vaginal birth

Second Stage of Labor

-Infant is born -Begins with full cervical dilation (10 cm) -Complete effacement (100%) -Ends with baby's birth -Upper limits for duration of second stage-- 2 hrs nulli, 3 multi Two phases -Latent: relatively calm with passive descent of baby through birth canal -Descent: active pushing and urges to bear down

Culture

-Influences interaction with baby -All places importance on desiring and valuing children. -Influence parents interactions with HC professionals -Give perspective and meaning to child birth for parents.

Management of Inevitable Preterm Birth

-Labor progressed to cervical dilation of 4 cm likely to lead to inevitable preterm birth -Magnesium sulfate is given to reduce or prevent neonatal neurologic sequelae -Malpresentation is common -Neonatal resuscitation -Fetal and early neonatal loss

Precipitous Labor

-Labor that lasts less than 3 hours -Hypertonic uterine contractions -Complications: Placental abruption Uterine tachysystole Recent cocaine use

Perineal Trauma

-Lacerations Perineal lacerations Vaginal and urethral lacerations Cervical injuries -Episiotomy Routine use has declined

Pituitary Hormones and Ovarian Function

-Lactating and nonlactating women differ in timing of first ovulation and menstruation -70% of nonbreastfeeding mothers menstruate within first 12 weeks In breastfeeding women, return of ovulation depends on breastfeeding patterns -In nonlactating women, ovulation occurs as early as 27 days after birth

Parents >35 Years

-Less support -"sandwich generation" -Difficulty with intimacy -Work anxiey -Loss of control -Perimenopausal symptoms

Lochia Alba

-Leukocytes, decidua, epithelial cells, mucus, serum, and bacteria -Continues 2 to 6 weeks after birth

Intrauterine Fetal Demise: Assessment

-Loss of fetal movement -Absence of fetal heart tones -Disseminated intravascular coagulation (DIC) screen (monitor for coagulation abnormalities because DIC is a complication related to intrauterine fetal demise) -Low hemoglobin and hematocrit; low platelet count; prolonged bleeding and clotting time -Bleeding from puncture sites (could indicate DIC)

Prevention of Infection

-Maintaining a clean environment -Hand hygiene -Staff must follow protocol for colds, coughs, or skin infections -Perineal laceration and episiotomies.

Postterm Pregnancy, Labor, and Birth

-Maternal Risks: Dysfunctional labor Perineal injury due to macrosomia Hemorrhage and infection Interventions more likely to be necessary Fatigue and psychologic reactions -Fetal Risk:Abnormal fetal growth Macrosomia Increased risk for birth injuries Aging placenta Oligohydramnios

Preparing for Birth

-Maternal position- C position- pushes down uterus -Bearing-down efforts -FHR and pattern -Support of father or partner -Supplies, instruments, and equipment -Birth in delivery or birthing room

Preterm Premature Rupture of Membranes (PPROM)

-Membranes rupture before 37 weeks of gestation -Approximately 10% of all preterm births -Infection is a major risk factor -Pathologic weakening of the amniotic membranes Inflammation Stress from uterine contractions Other factors -Managed conservatively -Usually hospitalized

Immune System

-Mildly suppressed during pregnancy, the immune system returns to its prepregnant state -Rebound of the immune system can cause "flare-ups" of some conditions: Lupus erythematosus, Multiple sclerosis

Prevention of Excessive Bleeding

-Most frequent cause--- urine atony Nursing interventions: -Maintain good uterine tone and prevent bladder distention.

Grandparent Adaptation

-Most often associated with joy -May feel regret due to poor health or geographical distance -Grandparents are eager to help -Maternal grandmother is called on the most -Intergenerational relationships shift -Involvement dependent on cultural and familial factors

Hearing Impaired Parent

-Mother and partner establish an independent household -Technologic devices aid in parenting -Young children acquire sign language readily -Must get child into speech therapist ASAP

Amneohook

-Must be at least 2 cm dilated -If water breaks tey take nitrozene pH paper and dip in pool in vagina and want it to be basic -Fern test- take specimen under microscope- looks like fern pattern

Pharmacological Methods

-Non-opioid analgesics are the preffered pain mgmt in postpartum breastfeeding women because they do not alter maternal or infant alertness. -Breastfeeding concerns

Lochia Serosa

-Old blood, serum, leukocytes, and debris -Duration of 22 to 27 days

Promotion of Rest

-PPF- complex phenomenon affected by combinations of physiologic and psychologic and situational variable. -Fatigue likely to worsen over the first 6 weeks after birth. -Promote comfort measures

Transition to Parenthood

-Period of change and instability for all men and women Adoptive or biologic parents: different in bonding Married or single parents: no support vs support Lesbian or gay couples: stigmas, which partner is mom -Parenting is a process of role transition Requires cognitive, affective, and motor skill Infant's well-being and development depends on these components

Routine Lab Tests

-Physical assessment are preformed throughout hospitalization. -H&H to assess blood loss especially in c-section. -Clean catch- for sensitivity, especially if foley was inserted intra-partum. -Rh status- tests to preform possible tx

First Stage of Labor Assessment and Diagnosis

-Physical examination -General systems assessment -Vital signs -Leopold maneuvers- feel uterus to determine what position baby is in- try to determine if spine is down -Assessment of fetal heart rate (FHR) and pattern -Nursing Dx- 1-pain, 2- knowledge deficit

Third Stage of Labor

-Placental separation and expulsion -Firmly contracting fundus -Change in shape of uterus -Sudden gush of dark blood from introitus -Apparent lengthening of umbilical cord -Vaginal fullness

Vagina and Perineum

-Postpartum estrogen deprivation responsible for thinness of vaginal mucosa and absence of rugae -Vaginal rugae reappear within 3 weeks -Thickening of vaginal mucosa occurs with return of ovarian function -Dryness and coital discomfort, dyspareunia, may persist until return of ovarian function -Introitus is erythematous and edematous -Episiotomies heal within 2 to 3 weeks:May take 4 to 6 weeks to heal completely -Hemorrhoids (anal varicosities) are common and decrease within 6 weeks of childbirth

Contractions

-Postpartum hemostasis achieved by compression of intramyometrial blood vessels as uterine muscle contracts -Hormone oxytocin, released from pituitary gland, strengthens and coordinates these

Neurologic System

-Pregnancy-induced neurologic discomforts abate after birth Carpal tunnel syndrome is teased by reduced pressure -Postpartum headaches may be caused by gestational hypertension, stress, and leakage of cerebrospinal fluid into extradural space during placement of spinal anesthesia

Promotion of Normal Bowel Function

-Pregnant women at risk for constipation -Consume roughage, increase fluids, ambulate -Stool softeners and laxatives used

Social Support

-R/t positive adaptation by new parents -Quality better than quanity -Learn culturally valued practices -May help with household respinsibilities

Tdap

-Recommended for postpartum women who have not been vaccinated.

Cardiac Output

-Remains increased for 48 hours after birth -Increased stroke volume is caused by the return of blood to the maternal systemic circulation -Stroke volume, end-diastolic volume, and systemic vascular resistance remain elevated for 12 weeks after delivery

Musculoskeletal System

-Reversal of pregnancy adaptations -Joints are completely stabilized by 6 to 8 weeks after birth -New mother may notice permanent increase in shoe size

Infant-Parent Adjustment

-Rhythm: Alert state, Sleep wake patterns -Behavioral repertoires: Gazing, vocalizing, facial expressions -Body gestures:Responsivity, Smiling, cooing, en face

Follow Up

-Routine- women 6 week check up, baby 3 to 5 days. -Home visits-helps bridge gap, enhances BF, care referrals -Telephone F/U- used to reassess women's knowledge -Warm lines- consultation service, deals with less extreme emergencies. -Support groups- feels they are not alone -Community Resources- effective referral system

Discharge Teaching

-Self Mgmt- goal to be able to provide basic care for self and infant. -Rx meds- should make certain pt able to dispense meds appropriately

Couplet Care

-Sharing of duties between mother and nurse -Truly means that mothers and their newborns remain together as a "couplet" throughout their hospital stay and are cared for by the same nurse. -The philosophy is that mothers and their babies benefit from being a complete family unit immediately following birth.

Sibling Adaptation

-Siblings have to assume new positions within the family hierarchy -Reactions manifested in behavioral changes -Involvement in planning and care -Acquaintance behaviors (sibling rivalry)

Maternal Status

-Signs of potential problems Excessive blood loss Alteration in vital signs and consciousness -Care of placenta after delivery Cultural traditions

Cervix

-Soft immediately after birth -During the next 12 to 18 hours the cervix shortens, becomes firm, and regains prepregnant form -External os regains its prepregnancy appearance -Cervical os, dilated to 10 cm during labor, closes gradually

Promotion of Exercise

-Start gradually and progress. Abdominal exercise postponed until 4 weeks after birth -Kegel exercises

Augmentation of Labor

-Stimulation of uterine contractions after labor has started but progress is unsatisfactory -Implemented for management of hypotonic uterine dysfunction -Common methods Oxytocin infusion Amniotomy

Pelvic Muscular Support

-Supportive tissues of pelvic floor torn or stretched during childbirth -Require up to 6 months to regain tone -Kegel exercises encourage healing

Postpartum Period

-The interval between birth and return of reproductive organs to their nonpregnant state -Referred to as puerperium or fourth stage of pregnancy -Traditionally lasts 6 weeks, although this varies among women

Attachment

-The process by which a parent comes to love and accept a child and a child comes to love and accept a parent.

Involution Process

-The return of the uterus to a nonpregnant state following birth -Progresses rapidly -Fundus descends 1 to 2 cm every 24 hours 2 weeks after childbirth the uterus is no longer palpable -Returns to a nonpregnant state by 6 weeks -Occurs as a result of contractions

Cesarean Birth

-Transabdominal incision of uterus -Preserve life or health of mother and her fetus -Elective cesarean birth -Surgical techniques Vertical Transverse- most desirable -Monitor patient closely as she may be drowsy and at risk for falling asleep while holding her baby

Version

-Trying to move baby into position -External cephalic version -Internal version

Afterpains

-Uncomfortable cramping after birth -Usually resolves in 3-7 days. -More noticeable after births in which the uterus was overdistended. -Breastfeeding increases d/t release of oxytocin

Bonding

-Used interchangeably with attachment. - Developed and maintained by proximity and interaction with the infant through which the parents becomes acquainted with the infant and identifies the infant as an individual and claims the infant as a member of the family.

CV System

-VS: HR & BP return to nonpregnanct levels within a few days. R rate rapidly returns to nonpregnant levels after birth. -H&H: Drops moderately for 3-4 days, then begins to increase and reaches nonpregnanct levels by 8 weeks. -WBC: 10-12 days after birth values 20-25,000, can obscure dx of infection. -Clotting: increased during pregnancy & remain elevated in immediate puerperium.

Promotion of Normal Bladder Function

-Void spontaneously within 6 to 8 hours after vaginal birth -Volume of atleast 150mL at each void.

Lactation Suppression

-Wear well fitted sports bra of breast binder for at least 72 hours after birth. -Avoid stimulation -Ice packs for discomfort associated with engorgement. -Mild analgesic or antiinflamatory may be rx.

Postpartul Diuresis

-Within 12 hours women begin to diurese -Profuse diaphoresis often occurs at night for first 2 to 3 days

Frequency of Contractions

-how often CTX occur -beginning on 1 contraction to beginning of the next - count number of boxes from beginning to beggining

when does Kidney function return to normal

1 month after birth.

Variable decelerations: Interventions

1. Change maternal position (side-to-side, knee chest) 2. Discontinue oxytocin if infusing 3. Administer O2, 8-1- L/min by nonrebreather face mask 4. Notify physician or nurse-midwife 5. Assist with vaginal or speculum examination to assess for cord prolapse 6. Assist with amnioinfusion if ordered 7. Assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected

Prolapsed Umbilical Cord: Priority actions

1. Elevate the fetal presenting part that is lying on the cord by applying finger pressure with a gloved hand 2. Place client into extreme Trendelenburg's or modified Sims' position or a knee-chest position 3. Administer 02, 8-10L/min, by face mask 4. Monitor FHR and assess the fetus for hypoxia 5. Prepare to start IV fluids or increase the rate of administration of an existing solution 6. Prepare for immediate birth 7. Document the event, actions taken, client's response

Intrauterine Fetal Demise: Intervention

1. Encourage the client and her family to verbalize feelings; provide emotional support 2. Incorporate religious and cultural health care beliefs and practices in the plan of care 3. Allow the client choices relating to labor and delivery 4. Administer IV fluids, medications, and blood and blood products as prescribed if DIC occurs.

Amniotic Fluid Embolism: Intervention

1. Institute emergency measures to maintain life 2. Administer oxygen, 8-10L/min, by face mask or resuscitation bag delivering 100% oxygen 3. Prepare for intubation and mechanical ventilation 4. Position the client on her side 5. Administer IV fluids, blood products, and medications to correct coagulation failure 6. Monitor fetal status 7. Prepare for emergency delivery when the client is stabilized 8. Provide emotional support to the client, partner, and family

Rupture of the Uterus: Interventions

1. Monitor for and treat signs of shock (O2, IV fluids, blood products) 2. Prepare client for cesarean delivery (possible hysterectomy may be necessary) 3. Provide emotional support for the client and partner

Uterine Inversion: Interventions

1. Monitor for hemorrhage and signs of shock, and treat shock 2. Prepare the client for a return of the uterus to the correct position via the vagina; if unsuccessful, laparotomy with replacement to the correct position is done.

After childbirth, total blood volume declines by about how much?

16%, resulting in transient anemia.

uterus should not be palpable abdominally after how many weeks

2 weeks and should have returned to tis non pregnant location by 6 weeks post birth

laceration healing takes how long

2-3 weeks but can take 4-6 months

engorgement resolves spontaneously within? alleviating factors??

24-36 hours well fitted bra, ice packs, fresh cabbage leaves and mild analgesics nipple stimulation is avoided.

Low Birth Weight

2500 g or less. Easier to measure than preterm birth, which is more dangerous

Third Trimester

28 weeks through 40 completed weeks

Under the Newborns' and Mothers' Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of

48 hours after a normal vaginal birth and for 96 hours after a cesarean birth.The attending provider and the mother together can decide on an earlier discharge.

how long does it take for abdomen to return to non prego state?

6 weeks

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to

70 mm Hg and the resting tone range is 6 to 10 mm Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the nurse should:

when does "milk comes in" may feel warm, tender (swollen) and firm. may feel nodular or lumpy

72-96 hours

Late preterm birth

75% of all preterm births in the US. They occur between 34 and 36 weeks of gestation.

At 1 minute after birth, the nurse assesses the newborn to assign an Apgar score. The apical heart rate is 110 bpm, and the infant is crying vigorously with the limbs flexed. The infant's trunk is pink, but the hands and feet are blue. What is the correct Apgar score for this infant?

9 [1 point is deducted from the total score of 10 for the infant's blue hands and feet.]

Indicated Preterm Birth

A means to resolve maternal or fetal risk. Due to diabetes, CHTN, preeclampsia, obstetrical disorders, placental disorders, seizures, thromboembolism, HIV, obesity, advanced maternal age, fetal disorders

During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have:

A normal baseline heart rate.

When working with parents who have some form of sensory impairment, nurses should understand that Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact. is an inaccurate statement.

A number of electronic devices can turn sound into light flashes to help pick up a child's cry

The breasts of a bottle-feeding woman are engorged. The nurse should tell her to:

A snug, supportive bra limits milk production and reduces discomfort by supporting the tender breasts and limiting their movement. Cold packs reduce tenderness, whereas warmth would increase circulation, thereby increasing discomfort. Expressing milk results in continued milk production. Plastic liners keep the nipples and areola moist, leading to excoriation and cracking.

The most common cause of decreased variability in the fetal heart rate FHR that lasts 30 minutes or less is:Fetal sleep cycles

A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes

Women who have participated in childbirth education classes often bring a "birth bag" or "Lamaze bag" with them to the hospital. These items often assist in reducing stress and providing comfort measures. The nurse caring for women in labor should be aware of common items that a client may bring, including (Select all that apply): a. Rolling pin. b. Tennis balls. c. Pillow. d. Stuffed animal or photo. e. Candles.

A, B, C, D

Lifestyle Modifications

Activity restriction, including bed rest and limited work. Most recommend modified bed rest Restriction of sexual activity has not shown to be effective Home care with modified bed rest, such as smaller, more frequent meals and activities

When caring for a newly delivered woman, the nurse is aware that the best measure to prevent abdominal distention after a cesarean birth is:Early and frequent ambulation.

Activity will aid the movement of accumulated gas in the gastrointestinal tract

Instruct the patient and partner in the use of specific relaxation techniques.

Acute pain related to contractions

Of the many factors that influence parental responses, nurses should be conscious of negative stereotypes that apply to specific patient populations. Which response could be an inappropriate stereotype of adolescent mothers?

Adolescent mothers have a higher documented incidence of child abuse.

Dehydrate

After birth, a new mother is often very hungry and thirsty. Encourage the new mother to stay away from caffeine products because they can _________ her.

Step 4

After obtaining permission, gently insert the index and middle fingers into the vagina.

A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge. As you prepare her for discharge, she begins to cry. Your initial action should be to

Allow her time to express her feelings.

A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge. As you prepare her for discharge, she begins to cry. Your initial action should be to:

Allow her time to express her feelings.

Newborns' and Mothers' Health Protection Act of 1996

Allows for a minimum of 48 hours stay after a vaginal birth and 96 hours after cesarean birth

The nurse caring for the laboring woman should understand that early decelerations are caused by:

Altered fetal cerebral blood flow.Early decelerations are the fetus's response to fetal head compression

Criteria for Discharge

American Academy of Pediatrics recommendations: -Should be to sufficient length to identify early problems and determine that the mother and family are prepares and able to care for the neonate at home. -The health of the mother and newborn should be stable. -The mother should be able and confident to provide care for her infant. -There should be adequate support sysems in place and access to follow up care.

The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat:Variable decelerations

Amnioinfusion is used during labor either to dilute meconium-stained amniotic fluid or to supplement the amount of amniotic fluid to reduce the severity of variable decelerations caused by cord compression

Amniotic Fluid Embolism

Amniotic fluid embolism is the escape of amniotic fluid into the maternal circulation. The debris-containing amniotic fluid deposits in the pulmonary arterioles and is usually fatal to the mother.

Spontaneous Preterm Birth

An early initiation of the labor process Comprises 75% of preterm births

Concerning the third stage of labor, nurses should be aware that:

An expectant or active approach to managing this stage of labor reduces the risk of complications.

Placenta Previa

An improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Management depends on the classification of the placenta previa and gestational age of the fetus. Risk of HEAVY BLEEDING and SHOCK

fetal hypoxia

An inadequate supply of oxygen at the cellular level that can cause metabolic acidosis, and occurs if fetal hypoxemia is uncorrected.

Shoulder dystocia

An uncommon obstetric emergency that increases the risk for fetal and maternal morbidity and mortality during the attempt to accomplish birth vaginally. It is a condition in which the head is born but the anterior shoulder cannot pass under the pubic arch.

First Stage: Labs and Tests

Analysis of urine specimen: provides info on hydration status, nutritional status, infection status, and complications such as preeclampsia Blood tests: Hematocrit, CBC, blood type, rH status Other tests: GBS

Promotion of Fetal Lung Maturity

Antenatal glucocoritcoids given to stimulant surfactant production Optimal benefits occur within the first 24 hours

Promotion of Fetal Lung Maturity

Antenatal glucocorticoids :NIH recommends for all women at risk for preterm Not indicated if: Cord prolapse- cord out first Chorioamnionitis- infection of linning of the uterus Abruptio placentae- placenta out first

Preterm Birth

Any birth that occurs before completion of 37 weeks of pregnancy

Preterm birth

Any birth that occurs before the completion of 37 weeks of pregnancy, regardless of birth weight. Complications related to preterm birth account for more newborn and infant deaths than any other cause.

In documenting labor experiences, nurses should know that a uterine contraction is described according to all these characteristics except:

Appearance shape and height

A laboring woman is lying in the supine position. The most appropriate nursing action at this time is to:

Ask her to turn to one side

When a nulliparous woman telephones the hospital to report that she is in labor, the nurse initially should:

Ask the woman to describe why she believes she is in labor.

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse's initial response would be to:

Assess the fetal heart rate and pattern.

Uterine resting tone

Assessed with the Intrauterine Pressure Catheter (IUPC) 10 mm Hg

Third Stage of Labor

Assessment: firmly contracting fundus, sudden gush of dark blood, lengthening of umbilcal cord Physical assessment: BP, HR, and R every 15 minutes. Assess for placental separation and amount of bleeding. Apgar assessment at 1 and 5 min after birth. Interventions: Assist to bear down to facilitate expulsion of separated placenta. Encourage bonding and breastfeeding

The best way for the nurse to promote and support the maternal-infant bonding process is to:

Assist the family with rooming-in.

To promote bonding and attachment immediately after delivery, the most important nursing intervention is to:

Assist the mother in assuming an en face position with her newborn

Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?

Assist the patient in emptying her bladder.

Care Management: PROM

At term, birth is the best option. Labor will likely be induced. For preterm PROM, woman is managed conservatively. Hospitalized to prolong pregnancy unless infection, vaginal bleeding, placental abruption is present.

Many first-time parents do not plan on their parents' help immediately after the newborn arrives. What statement by the nurse is the most appropriate when counseling new parents about the involvement of grandparents? A. "You should tell your parents to leave you alone." B. "Grandparents can help you with parenting skills and also help preserve family traditions." C. "Grandparent involvement can be very disruptive to the family." D. "They are getting old. You should let them be involved while they can."

B. "Grandparents can help you with parenting skills and also help preserve family traditions."

Umbilical Cord Acid-Base Determination

Blood withdrawn from artery and vein. Arterial values reflect fetal condition, whereas umbilical vein values indicate placental function Perform cesarean birth for fetal compromise, low 5-minute apgar score, severe IUGR, abnormal FHR, multifetal gestation

Fetal bradycardia is most common during:Prolonged umbilical cord compression.Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death

Bradycardia can result from placental transfer of drugs, prolonged compression of the umbilical cord, maternal hypothermia, and maternal hypotension.

The nurse caring for the postpartum woman understands that breast engorgement is caused by:Congestion of veins and lymphatics.

Breast engorgement is caused by the temporary congestion of veins and lymphatics

With regard to parents' early and extended contact with their infant and the relationships built, nurses should be aware that: A. Immediate contact is essential for the parent-child relationship. B. Skin-to-skin contact is preferable to contact with the body totally wrapped in a blanket. C. Extended contact is especially important for adolescents and low-income women because they are at risk for parenting inadequacies. D. Mothers need to take precedence over their partners and other family matters.

C. Extended contact is especially important for adolescents and low-income women because they are at risk for parenting inadequacies. Nurses should encourage any activity that optimizes family extended contact.

Preterm Labor

Cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy

Preterm labor

Cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy.

The nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dad's chin. This woman's statement reflects:Claiming.

Claiming refers to the process by which the child is identified in terms of likeness to other family members

Step 3

Cleanse the perineum and vulva if necessary.

False Labor

Contractions: occur irregularly or become regular only temporarily; often stop with walking or position change; can be stopped through use of comfort measures Cervix: may be soft but with no significant change; is often in posterior position Fetus: presenting part is not engaged

True Labor

Contractions: occur regularly, becoming stronger, lasting longer, and occurring closer together; become more tense with walking; are usually felt in lower back; continue despite use of comfort measures Cervix: shows progressive change; moves to an increasingly anterior position Fetus: presenting part engaged in pelvis, which results in increased ease of breathing but causes urinary frequency

Pelvic Dystocia

Contractures of pelvic diameters that reduce capacity of bony pelvis, inlet, midpelvis, or outlet

Perinatal nurses are legally responsible for:

Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes

Afterpains

Cramping pain after childbirth caused by alternating relaxation and contraction of uterine muscles; occur intermittently for approximately 2 or 3 days after birth and that result from contractile efforts of the uterus to return to its normal involuted condition

After birth, a crying infant may be soothed by being held in a position in which the newborn can hear the mother's heartbeat. This phenomenon is known as: A. Entrainment B. Reciprocity C. Synchrony D. Biorhythmicity

D. Biorhythmicity The newborn is in rhythm with the mother. The infant develops a personal biorhythm with the parents' help over time.

Dystocia (Dysfunctional Labor)

Difficult labor that is prolonged or more painful. Occurs because of problems caused by uterine contractions (powers), the fetus (passenger), or the bones and tissues of the maternal pelvis (passage).

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign that uterine contractions are effective would be:

Dilation of the cervix.

A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The fetal heart rate has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. The nurse should expect the woman to be:

Discharged home to await the onset of true labor.

The nurse who performs vaginal examinations to assess a woman's progress in labor should:

Discuss the findings with the woman and her partner.

Step 7

Document findings and report to the provider.

Elective Cesarean Birth

Due to fear or pain of childbirth Risks: high rates of endometriosis, blood transfusion, and venous thrombosis; longer hospital stay; greater complications in subsequent pregnancies Should not be performed unless gestational age is 39+

In assisting with the two factors that have an effect on fetal status pushing and positioning , nurses should:

Encourage the woman's cooperation in avoiding the supine position.

Patient Family and Teaching

Encourage woman to maintain a side-lying or semi-fowler's position with a lateral tilt Encourage woman to keep her mouth and glottis open as she pushes

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include:

Encouraging the woman to try various upright positions, including squatting and standing.

The nurse providing care for the laboring woman comprehends that accelerations with fetal movement:Are reassuring.

Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal well-being

Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions?

Evaluate the intensity by pressing the fingertips into the uterine fundus.

First Stage of Labor Nursing Care

Evidence-based practice Physical care measures General hygiene Nutrient and intravenous intake-typically don't give them a lot of food- peristalsis slows down Elimination- encourage frequent urination- bladder can hinder birthing process Ambulation and positioning- ambulate until water broke

Dystocia: Assessment

Excessive abdominal pain Abnormal contraction pattern Fetal distress Maternal or fetal tachycardia Lack of progress in labor

Urethra and Bladder

Excessive bleeding can occur because of displacement of the uterus if bladder is full

Bladder

Excessive bleeding can occur because of the displacement of the uterus if the ________ is full.

The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is:

Excessive uterine bleeding.

Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by:

Expanding maternal blood volume.Filling the mother's vascular system makes more blood available to perfuse the placenta and may correct hypotension

Step 6

Explain findings to the patient.

With regard to parents' early and extended contact with their infant and the relationships built, nurses should be aware that:

Extended contact is especially important for adolescents and low-income women because they are at risk for parenting inadequacies.

Fetal Distress: Assessment

FHR < 110 bpm, or >160 bpm Meconium-stained amniotic fluid Fetal hyperactivity Progressive decrease in baseline variability Severe variable decelerations Late decelerations

Fetal Monitoring Standards of Care

FHR tracings evaluated every 30 minutes during the first stage of labor and every 15 minutes during the second stage. Report abnormalities to doctor

FHR Patterns

Fetal well-being measures by response of FHR to uterine contractions Reassuring patterns are baseline of 110-160 w/ no periodic changes and a moderate baseline variability In preterm infant, baseline may be higher

First Trimester

First day of LMP through 12 completed weeks (3 months)

Early Recognition of Preterm Birth

Gestational age between 20 and 37 weeks Uterine activity (contractions) Progressive cervical change Effacement of 80% Cervical dilation of 2 cm or greater

Early Recognition and Diagnosis of Preterm Labor

Gestational age between 20 and 37 weeks Uterine activity (contractions) Progressive cervical change (effacement of 80% or cervical dilation 2 cm or greater)

Many first-time parents do not plan on their parents' help immediately after the newborn arrives. What statement by the nurse is the most appropriate when counseling new parents about the involvement of grandparents?

Grandparents can help you with parenting skills and also help preserve family traditions."

Which breastfeeding patient is most likely to have severe afterbirth pains and request a narcotic analgesic?

Gravida 5, para 5

Shoulder Dystocia

Head is born but anterior shoulder cannot pass under pubic arch Newborn is likely to experience injuries such as brachial plexus Mother at risk for postpartum hemorrhage and rectal injuries McRoberts manuever used to free shoulder. Apply suprapubic pressure. Do not apply fundal pressure.

Risk for Spontaneous Preterm Birth

History of spontaneous preterm birth African-American race Genital tract infections Multifetal gestation Second trimester bleeding Low prepregnancy weight

Risk Factors for Spontaneous Preterm Birth

History of spontaneous preterm birth, African-American race, GI tract infections, multifetal gestation, second trimester bleeding, low prepregnancy weight

Oxytocin (Pitocin)

Hormone normally produced by posterior pituitary gland that stimulates uterine contractions Used to induced labor or augment a labor progressing slowly because of inadequate contractions High alert medication - hazards include placental abruption, uterine rupture, hemorrhage, infection

As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with:

Hypoxemia.Nonreassuring heart rate patterns are associated with fetal hypoxemia

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase

IV fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take?Notify the physcian

Rubella Vaccination

If woman is not immune, vaccination is recommended

Soft

Immediately after birth, the palpated cervix is _________.

A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. This activity indicates that the nurse is trying to:

Improve the accuracy of blood loss estimation, which usually is a subjective assessment.

In a variation of rooming-in, called couplet care, the mother and infant share a room, and the mother shares the care of the infant with:The nurse.

In couplet care the mother shares a room with the newborn and shares infant care with a nurse educated in maternity and infant care.

Induction of Labor

In elective induction, cervix is ripened using prostaglandins or intracervical insertion of balloon catheter Increased risk for c-section, neonatal morbidity, and cost Should not be induced until 39 weeks Bishop score used to evaluate inducibility. Score of 8+ indicates cervix is soft and induction is usually successful

During the taking-hold phase the mother assumes responsibility for her own care and shifts her attention to the infant

In the taking-in phase the mother is primarily focused on her own needs.

A new father states, "I know nothing about babies," but he seems to be interested in learning. This is an ideal opportunity for the nurse to:

Include him in teaching sessions.

Nursing Interventions

Includes periodic assessments to detect: -Deviations from the normal changes, -Measures to relieve discomfort or pain, -Safety measures to prevent injury or infection, -Teaching and counseling to promote competence in self-management. ALSO -Orientation to unit and security precautions

A pregnant woman is in her third trimester. She asks the nurse to explain how she can tell true labor from false labor. The nurse would explain that "true" labor contractions:

Increase with activity such as ambulation.

Category II FHR

Indeterminate. Require continued observation.

Meconium-Stained Amniotic Fluid

Indicates fetus has passed first stool before birth Due to: 1) normal physiologic function that occurs with maturity, 2) result of hypoxia-induced peristalsis and sphincter relaxation, 3) sequel to umbilical cord compression-induced vagal stimulation in mature fetuses Risk of meconium aspiration syndrome

Second Stage of Labor

Infant is born. Begins will full cervical dilation (10cm), complete effacement (100%) and ends with baby's birth. 50-60 minutes in nulliparous women and 20-30 in multiparous women Composed of 2 phases: latent and descent Assessment is continuous

Which concerns about parenthood are often expressed by visually impaired mothers

Infant safety Transportation Missing out visually Needing extra time for parenting activities to

Which concerns about parenthood are often expressed by visually impaired mothers?

Infant safety Transportation Missing out visually Needing extra time for parenting activities to

Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom may say:

Infants can learn to distinguish their mother's voice from others soon after birth.

Causes of Spontaneous Preterm Labor

Infections, including periodontal disease Bleeding at the site of placental implantation

Amnioinfusion

Infusion of room-temperature isotonic fluid into uterine cavity. Relieves variable decels by preventing cord compression UC should be monitored during the procedure

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse could try is:

Inserting a sterile catheter.

Late decelerations are almost always caused by uteroplacental insufficiency.

Insufficiency is caused by uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption.

Promotion of Comfort

Interventions are intended to eliminate pain sensations entirely or reduce it to a tolerable level that allows the woman to care for her baby. -many causes of pain -pain can be cultural -lack of objective does not mean there is no pain (cultural)

Muslim countries Will not eat pork or pork products

Korean or other South East Asian countries Prefer not to give babies colostrum

Fetal Response

Labor is a physiologic stress for fetus Fetal oxygen must be maintained during labor to prevent fetal compromise

Precipitous Labor and Delivery

Labor lasting less than 3 hours *Stay with client at all times; do not try to keep the fetus from being delivered. You may need to deliver baby if doctor doesn't arrive in time! Complications: placental abruption, uterine tachysystole, recent cocaine use

Precipitous Labor

Labor that last less than 3 hours May result from hypertonic uterine contractions May lead to placental abruption, uterine tachysystole, and recent cocaine use Fetal complications lead to shoulder dystocia and hypoxia

Which fetal heart rate (FHR) finding would concern the nurse during labor? Late decelerations

Late decelerations are caused by uteroplacental insufficiency and are associated with fetal hypoxemia. They are considered ominous if persistent and uncorrected.

What correctly matches the type of deceleration with its likely cause?

Late deceleration—uteroplacental inefficiency

If a woman complains of back labor pain, the nurse could best suggest that she:

Lean over a birth ball with her knees on the floor.

During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby?

Letting go

During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby?

Letting go [During the taking-hold phase the mother assumes responsibility for her own care and shifts her attention to the infant. In the taking-in phase the mother is primarily focused on her own needs.]

Obesity

Likely to begin pregnancy with pre-existing conditions, such as HTN and diabetes Increased risk of postdate pregnancy and complications, such as blood clots

For women who have a history of sexual abuse, a number of traumatic memories may be triggered during labor. The woman may fight the labor process and react with pain or anger. Alternately, she may become a passive player and emotionally absent herself from the process. The nurse is in a unique position of being able to assist the client to associate the sensations of labor with the process of childbirth and not the past abuse. The nurse can implement a number of care measures to help the client view the childbirth experience in a positive manner. Which intervention would be key for the nurse to use while providing care?

Limiting the number of procedures that invade her body

implement a number of care measures to help the client view the childbirth experience in a positive manner. Which intervention would be key for the nurse to use while providing care?

Limiting the number of procedures that invade her body

Intermittent Auscultation (IA)

Listening to fetal heart sounds at periodic intervals to assess FHR.

Intermittent Auscultation

Listening to fetal heart sounds at periodic intervals to listen to FHR Can be performed with DeLee-Hillis fetoscope, Pinard stethoscope, Doppler ultrasound

Postbirth uterine/vaginal discharge, called lochia:

Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after cesarean births. Lochia usually increases with ambulation and breastfeeding. An offensive odor usually indicates an infection.

The postpartum woman who continually repeats the story of her labor, delivery, and recovery experience is:

Making the birth experience "real." [Reliving the birth experience makes the event real and helps the mother realize that the pregnancy is over and that the infant is born and is now a separate individual.]

The postpartum woman who continually repeats the story of her labor, delivery, and recovery experience is:

Making the birth experience "real." Reliving the birth experience makes the event real and helps the mother realize that the pregnancy is over and that the infant is born and is now a separate individual.

Forceps-Assisted Birth

Maternal indications: prolonged second stage of labor or need to shorten second stage. Fetal indications: abnormal FHR tracing, arrest of rotation, extraction of head in breech position Woman's cervix must be fully dilated and bladder should be empty. Membranes must be ruptured

Electronic Fetal Monitoring (EFM)

Maternal obesity, occiput posterior position, and anterior attachment of placenta can cause weak or absent signals External monitoring: FHR is measured by the ultrasound transducer while uterine activity is measured by tocotransducer. Must be notified if woman changes position. Internal monitoring: More accurate monitoring that is not impacted my mother's movement or size. Spiral electrode is attached to presenting part. IUPC measures frequency, duration, intensity, and uterine resting tone

Adverse Effects of Bed Rest

Maternal: weigh loss, muscle wasting, bone demineralization, decreased cardiac output, cardiac deconditioning, alteration in bowel function, sleep disturbance, prolonged postpartum recovery Boredom, loneliness, reduced stress

Decelerations

May be benign or abnormal. FHR decelerations are categorized as early, late, variable, or prolonged.

Early Contact

May facilitate attachment process Skin to skin immediately after birth

Tocolytics

Medications given to arrest labor after uterine contractions and cervical change have occurred. (Magnesium sulfate, Terbutaline -- read pg 447) Antenatal glucocorticoids--administered between 24 and 34 weeks gestation--single course; optimal benefits occur within the first 24 hours--promotion of fetal lung maturity

When implementing care, the nurse would anticipate that a woman from which country would have the father of the baby in attendance?

Mexico

Early decelerations: Interventions

None required. Just document

Fetal Compromise

Nonreassuring/abnormal RHF patterns are associated with fetal hypoexemia If uncorrected, can lead to fetal hypoxia

Category I FHR

Normal

Care Management

Nulliparous women seek admission during latent phase Multiparous women do not usually come to hospital or birth center until active phase

Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to mother the mother. Specifically this expression refers to:

Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood.

Trial of Labor (TOL)

Observation of a woman and fetus (4-6 hours) to assess safety of vaginal birth Woman is evaluated for active labor and VS and FHR are monitored

Trial of Labor (TOL)

Observation of a woman and her fetus for a specified length of time to assess safety of vaginal birth

Preterm Labor

Occurs after the 20th week but before the 37th week of gestation. *Focus on stopping the labor

Postmaturity syndrome

Occurs in about 20% of neonates born after postterm pregnancies. This syndrome is characterized by dry, cracked, peeling skin; long nails; meconium staining of skin, nails, and umbilical cord; and perhaps loss of subcutaneous fat and muscle mass.

Supine Hypotension (Vena Cava Syndrome)

Occurs when the venous return to the heart is impaired by the weight of the uterus on the vena cava. The syndrome results in partial occlusion of the vena cava and aorta and in reduced cardiac return, cardiac output, and blood pressure. *To prevent supine hypotension, avoid the supine position; position the client by placing a pillow or wedge under the client's hop to displace the gravid uterus off the vena cava.

Placental Explusion

Occurs within 15 minutes of baby's birth. If it has not been completed w/in 30 minutes, the placenta is considered to be retained.

Montevideo Units

Part of internal monitoring Calculated by subtracting the baseline uterine pressure from the peak contraction. Spontaneous labor begins when MVUs are between 80 and 120.

With regard to the adaptation of other family members, mainly siblings and grandparents, to the newborn, nurses should be aware that:

Participation in preparation classes helps both siblings and grandparents.Preparing older siblings and grandparents helps everyone to adapt.

Alterations in Pelvic Structure

Pelvic Dystocia - contractures of pelvic diameters that reduce capacity of bony pelvis, inlet, midpelvis, or outlet Soft tissue dystocia - results from obstruction of birth passage by an anatomic abnormality other than bony pelvis (such as placenta previa, uterine fibroids, full bladder or rectum, etc.)

Assessment: Admission to Hospital

Perform general systems assessment and take VS Check status of membranes (Nitrazine or Fern test can determine if ruptured) Review birth plan

Second Stage: Latent

Period of relative calm with baby descending through birth canal Fetus rotates to anterior position

Changes in FHR

Periodic changes occur with UCs Episodic not associated with UCs

Postpartum Blues

Pink period- heightened joy and feelings of well being, followed by the blue period. -Emotionally labile and often cry easily for no apparent reason. -S&S- depression, let-down feeling, restlessness, fatigue, insomnia, headache, anxiety, sadness, and anger. -PPF- increases risk for depression symptoms. -Fathers may experience -May go undetected due to embarrassment, guilt, and fatigue

Placental Abnormalities

Placenta accreta is an abnormally adherent placenta; placenta increta occurs when the placenta penetrates the uterine muscle itself; placenta percreta occurs when the placenta goes all the way through the uterus *May cause hemorrhage immediately after birth because the placenta does not separate cleanly.

The nurse can help a father in his transition to parenthood by:

Pointing out that the infant turned at the sound of his voice.

Dysfunctional Labor

Position of woman - can enhance or slow fetal descent Psychologic responses - hormones and neurotransmitters released in response to stress can cause dystocia

Step 2

Position the woman to prevent supine hypotension.

Second Stage: Preparing for Birth

Position: no one position exists. Lithomy, supine, semirecumbent are most popular in the West Bearing-down efforts: Encourage women to push when they feel like pushing. Monitor woman's breathing so she does not hold her breath. Amnesia between contractions also occurs during this stage FHR & Pattern: Encourage position change and 10L/min of oxygen if FHR drops

Lochia

Post birth discharge

Headaches

Postpartum _________ can be caused by gestational hypertension, stress, leakage of CSF into the extradural space during placement of spinal anesthesia.

Postpartal overdistention of the bladder and urinary retention can lead to which complications?

Postpartum hemorrhage and urinary tract infection (Incomplete emptying and overdistention of the bladder can lead to urinary tract infection. Overdistention of the bladder displaces the uterus and prevents contraction of the uterine muscle, leading to postpartum hemorrhage.)

Abruptio Placentae

Premature separation of the placenta from the uterine wall after the 20th week of gestation and before the fetus is delivered.

First Stage of Labor Admission Data

Prenatal data-- if any Interview-last meal, last bm, drink, smoke, drugs Psychosocial factors-who is her support Stress in labor-expectations, subside any fears Cultural factors-vegan diet, no men in the room

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding would be:

Presence of soft, nontender colostrum. 72-96 hours: "milk comes in" may feel warm, tender (swollen) and firm. may feel nodular or lumpy

Prevention

Programs aimed at health promotion and disease prevention to encourage healthy lifestyles Preconception counseling (ex. smoking cessation) Interventions such as progesterone supplementation

Abnormal Labor Patterns

Prolonged latent phase Protracted active phase dilation Secondary arrest Protracted descent Failure of descent

Involution

Rapid reduction in size of uterus and return to prepregnant state; begins immediately after birth of placenta

A nurse is observing a family. The mother is holding the baby she delivered less than 24 hours ago. Her husband is watching his wife and asking questions about newborn care. The 4-year-old brother is punching his mother on the back. The nurse should:

Realize that this is a normal family adjusting to family change.

A man calls the nurse's station and states that his wife, who delivered 2 days ago, is happy one minute and crying the next. The man says, "She was never like this before the baby was born." The nurse's initial response could be to:

Reassure him that this behavior is normal.

Premature Rupture of the Membranes (PROM)

Refers to spontaneous rupture of the amniotic membranes and leakage of amniotic fluid before the onset of labor at any gestational age. When rupture happens before term and delivery will be delayed, INFECTION is a risk. (labor is likely to be induced)

Tocolytic Therapy

Relaxation of the uterus using various drugs. Improves blood flow through uterus. Terbutaline (Brethine) usually given subQ

Commonly 45 seconds or more in the second stage of labor

Relaxation time

What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken.

Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.

Average of 10 mm Hg

Resting tone

Soft Tissue Dystocia

Results from obstruction of birth passage by an anatomic abnormality other than bony pelvis

Claiming Process

Revealed by maternal comments such as, "Daniel held him close and said, 'He's the image of his father,' but i found one part like me-his toes are shaped like mine."

First Stage: Vaginal Assessment

Reveals whether woman is in true labor Perform only when indicated due to stress on woman

Rh Isoimmunization

Rh immune globulin should be given within 72 hours for R-negative women who deliver an Rh-positive infant

Continue to provide comfort measures and minimize distractions.

Risk for impaired individual coping

Encourage frequent voiding and catheterize if necessary.

Risk for impaired urinary elimination

Women who have participated in childbirth education classes often bring a "birth bag" or "Lamaze bag" with them to the hospital. These items often assist in reducing stress and providing comfort measures. The nurse caring for women in labor should be aware of common items that a client may bring, including:

Rolling pin. Tennis balls. Pillow. Stuffed animal or photo. ?????????

The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse best interpret these data?

Rubella vaccine should be given

Premature Rupture of Membranes (PROM)

Rupture of amniotic sac and leakage of amniotic fluid beginning at least 1 hour before onset of labor at any gestational age Membranes rupture before 37 weeks of gestation. Approximately 10% of all preterm births Infection is a major risk factor Due to pathologic weakening of the amniotic membranes caused by inflammation, stress from uterine contractions, or factors that increase intrauterine pressure

nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment?

Seldom makes eye contact with her son

Augmentation of Labor

Stimulation of uterine contractions after labor has started but progress is unsatisfactory Implemented for hypotonic uterine dysfunction Usually includes oxytocin infusion and amniotomy

ambulate

The best way to prevent a susceptible mother from a thrombus is to _________!

The nurse recognizes that a woman is in true labor when she states:

The contractions in my uterus are getting stronger and closer together."Regular, strong contractions with the presence of cervical change indicate that the woman is experiencing true labor.

With regard to afterbirth pains, nurses should be aware that these pains are:

The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations, which persist throughout the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. A large baby or multiple babies overdistend the uterus and this accounts for afterbirth pains. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

To assess uterine activity (UA) by palpation:

The examiner should keep his fingertips placed over the fundus before, during, and after contractions. -Contraction intensity - described as mild, moderate, or strong -Contraction duration - measured in seconds, from beginning to end of contraction -Frequency of contractions - measured in minutes, from beginning of one contraction to the beginning of the next.

Subinvolution

The failure of uterus to return to nonpregnant state

Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3.5 to 4 minutes. The nurse would report this as:First stage, active phase.

The first stage, active phase of maternal progress indicates that the woman is in the active phase of the first stage of labor.

massage

The first step after birth concerning the uterus is to __________.

Mutuality

The infants behaviors and characteristics elicit a corresponding set of maternal behaviors and characteristics.

A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-pound, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, "I'm bleeding a lot."

The most likely cause of postpartum hemorrhage in this woman is: Uterine atony.

Nurses play a critical role in educating parents regarding measures to prevent infant abduction. Which instructions contribute to infant safety and security?

The mother should check the photo ID of any person who comes to her room

Document the findings because they reflect the expected contraction pattern for the active phase of labor.

The nurse is responsible for monitoring the uterine contractions to ascertain whether they are powerful and frequent enough to accomplish the work of expelling the fetus and the placenta.

Nurses alert to signs of the onset of the second stage of labor can be certain that this stage has begun when:

The nurse is unable to feel the cervix during a vaginal examination. [The only certain objective sign that the second stage has begun is the inability to feel the cervix because it is fully dilated and effaced.]

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to:Massage the woman's fundus.

The nurse should assess the uterus for atony. Uterine tone must be established to prevent excessive blood loss. The nurse may begin an IV infusion to restore circulatory volume, but this would not be the first action.

During a phone follow-up conversation with a woman who is 4 days' postpartum, the woman tells the nurse, "I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!"

The nurse would recognize that the woman is experiencing:During the PP blues women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth PP day.

In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. Which one is a facilitating behavior?

The parents hover around the infant, directing attention to and pointing at the infant.

It is paramount for the obstetric nurse to understand the regulatory procedures and criteria for admitting a woman to the hospital labor unit. Which guideline is an important legal requirement of maternity care?

The patient's weight gain is calculated to determine whether she is at greater risk for cephalopelvic disproportion (CPD) and cesarean birth.

When assessing a multiparous woman who has just given birth to an 8 lb boy, nurse notes that the woman's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. nurse concludes that:

The placenta has separated.

The mother-baby nurse is able to recognize reciprocal attachment behavior. This refers to:

The positive feedback an infant exhibits toward parents during the attachment process. [Reciprocal attachment applies to feedback behavior and is not unidirectional.]

The mother-baby nurse is able to recognize reciprocal attachment behavior. This refers to:

The positive feedback an infant exhibits toward parents during the attachment process.Reciprocal attachment applies to feedback behavior and is not unidirectional.

Ovulation

The release of prolactin in breastfeeding women causes a decrease in estrogen and progesterone, thus extending the time until

Fetal well-being during labor is assessed by

The response of the fetal heart rate to uterine contractions

Augmentation of labor

The stimulation of uterine contractions after labor has started spontaneously but progress is unsatisfactory. It is implemented for the management of hypotonic uterine dysfunction. Common methods include oxytocin infusion and amniotomy. Noninvasive methods--emptying the bladder, ambulation and position changes, relaxation measures, nourishment and hydration, hydrotherapy

What is an advantage of external electronic fetal monitoring?

The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor.

The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is located: Over the uterine fundus

The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur.

With regard to a woman's intake and output during labor, nurses should be aware that:

The tradition of restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia.

Prolapsed Umbilical Cord

The umbilical cord is displaced between the presenting part and the amnion or protruding through the cervix, causing compression of the cord and compromising fetal circulation. FETAL HYPOXIA.

how long does it take for restoration or healing times with vagina, hemorrhoids, episiotomies.

The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth. Hemorrhoids can take 6 weeks to decrease in size. Most episiotomies take 2 to 3 weeks to heal.

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign that uterine contractions are effective would be:Dilation of the cervix.

The vaginal examination reveals whether the woman is in true labor

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth?

The vulva bulges and encircles the fetal head.

The nurse knows that the second stage of labor, the descent phase, has begun when:

The woman experiences a strong urge to bear down.

A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders?

The woman has an episiotomy.

Puerperium

Time period from the birth of the newborn to the return of the organs to their nonpregnant state. (4th Trimester)

A nurse may be called on to stimulate the fetal scalp:

To elicit an acceleration in the fetal heart rate (FHR).The scalp can be stimulated using digital pressure during a vaginal examination

Preinduction of labor--given prior to Oxytocin

To ripen (soften) the cervix, causing it to begin to dilate and efface. -Prostaglandin E1 (Misoprostol/Cytotec) -Prostaglandin E2 (Dinoprostone/Cervidil insert, Prepidil Gel)

Suppression of Uterine Activity

Tocolytics are given to arrest labor after uterine contractions and cervical change have occurred Mag sulfate inhibits uterine contractions and decrease intracellular calcium levels Terbutaline used as tocolytics but have side effects, including tachycardia and hyperglycemia. Should not be used in women with preeclampsia, diabetes, hyperthyroidism, and migraines. Beta2 agonist Indomethacin - NSAID suppresses preterm labor by blocking production of prostaglandins

Suppression of UA

Tocolytics:Magnesium sulfate, terbutaline, indomethacin.

The primary difference between the labor of a nullipara and that of a multipara is the:

Total duration of labor.

Placenta Previa: 3 Classifications

Total: The internal cervical os is covered entirely by the placenta when the cervix is dilated fully Partial: The lower border of the placenta is within 3 cm of the internal cervical os, but does not fully cover it. Marginal: The placenta is implanted in the lower uterus, but its lower border is more than 3 cm from the internal cervical os.

Communication Between Parent and Infant

Touch- used extensively by parents as a means of becoming acquainted. Vary with cultural groups. Eye contact- cultural, en face, dimming lights Voice-respond to higher pitched voices, can distinguish moms Odor- moms scent, breastmilk Entrainment-move in time with the structure of adult speech Biorythmicity- ex heartbeat, can soothe infant Reciprocity- type of movement or behavior that provides observer with cues. Synchrony- "fit" between baby cues and parents response.

Excessive blood loss after childbirth can have several causes; the most common is:Failure of the uterine muscle to contract firmly.

Uterine atony can best be thwarted by maintaining good uterine tone and preventing bladder distention

Why is continuous electronic fetal monitoring usually used when oxytocin is administered?

Uteroplacental exchange may be compromised.The uterus may contract more firmly, and the resting tone may be increased with oxytocin use

The nurse caring for the woman in labor should understand that maternal hypotension can result in:

Uteroplacental insufficiency.Low maternal blood pressure reduces placental blood flow during uterine contractions and results in fetal hypoxemia.

The nurse providing care for the laboring woman should understand that late fetal heart rate decelerations are the result of:

Uteroplacental insufficiency.Uteroplacental insufficiency would result in late decelerations in the FHR

Uterine Inversion

Uterus completely or partly turns inside out. This can occur during delivery or after delivery of the placenta. Risk factors: fundal implantation of the placenta, manual extraction of the placenta, short umbilical cord, uterine atony, leiomyomas, and abnormally adherent placental tissue.

Lochia

Vaginal discharge during the puerperium consisting of blood, tissue and mucus.

Ice; Sitz bath

Vaginal edema can be a painful byproduct of giving birth. It can be relieved with ________ or soaking in a ________ _________.

The nurse providing care for the laboring woman realizes that variable fetal heart rate decelerations are caused by:Umbilical cord compression.

Variable decelerations can occur any time during the uterine contracting phase and are caused by compression of the umbilical cord.

Variable decelerations

Visually abrupt decrease in FHR below baseline of 15 beats or more, lasting 15 seconds and returning to baseline in less than 2 minutes from the time of onset, which can occur at any time during a contraction as a result of UMBILICAL CORD COMPRESSION. On fetal monitor tracing, appearance has a U, V, or W shape. *Occurs in approx. 50% of all labors and usually are transient and correctable

Prolonged deceleration

Visually apparent decrease in the FHR of 15 beats/min or more below the baseline, which lasts more than 2 minutes but less than 10 minutes.

Late decelerations

Visually apparent gradual decrease in and return to baseline FHR in response to uteroplacental insufficiency resulting in TRANSIENT DISRUPTION of OXYGEN TRANSFER to the FETUS; lowest point occurs after the peak of the contraction and baseline rate is not usually regained until the uterine contraction is over. *considered ominous if persistent and uncorrected

In the United States the en face position is preferred immediately after birth. Nurses can facilitate this process by all of these actions except:

Washing both the infant's face and the mother's face.

At 1 minute after birth, the nurse assesses the newborn to assign an Apgar score. The apical heart rate is 110 bpm, and the infant is crying vigorously with the limbs flexed. The infant's trunk is pink, but the hands and feet are blue.

What is the correct Apgar score for this infant? The Apgar score is 9 because 1 point is deducted from the total score of 10 for the infant's blue hands and feet.

Under which circumstance would it be unnecessary for the nurse to perform a vaginal examination?

When accelerations of the fetal heart rate (FHR) are noted [An accelerated FHR is a positive sign; however, variable decelerations merit a vaginal examination]

Under which circumstance would it be unnecessary for the nurse to perform a vaginal examination?

When accelerations of the fetal heart rate (FHR) are noted An accelerated FHR is a positive sign; however, variable decelerations merit a vaginal examination

Redness, Edema, Echomosis (bruising), Drainage, Approximation

When checking an episiotomy, use the mnemonic REEDA. This stands for:

Management of Inevitable Preterm Birth

When labor progressed to cervical dilation of 4 cm or more Mag sulfate given to reduce to prevent neonatal neurologic sequelae Malpresentation is common

When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for Intrauterine infection has increased

When the membranes rupture, microorganisms from the vagina can ascend into the amniotic sac and cause chorioamnionitis and placentitis.

Second Stage: Descent

Woman has strong urge to bear down due to the Ferguson reflex Stimulation of oxytocin from pituitary gland provokes stronger uterine contractoins

Vaginal Birth After Cesarean (VBAC)

Woman who has had a c-section with a low transverse incision can have VBAC

As relates to rubella and Rh issues, nurses should be aware that:

Women should be warned that the rubella vaccination is teratogenic, and that they must avoid pregnancy for 1 month after vaccination.

Breast feeding

___________ can increase afterpains because the uterus is stimulated to contract due to the release of oxytocin.

Fetal fibronectin

a biochemical marker used as a diagnostic test for preterm labor. It is a glycoprotein "glue" found in plasma and produced during fetal life. Fetal fibronectin normally appears in cervical and vaginal secretions early in pregnancy and then again in late pregnancy. Often the test is used to predict who will NOT go into preterm labor because preterm labor is very unlikely to occur in women with a negative result.

Baby-friendly hospitals mandate their infants be put to breast within the first _______ after birth. a) 1 hour b) 30 minutes c) 2 hours d) 4 hours

a) 1 hour

When performing a vaginal examinations on laboring women, the nurse should be guided by what principle? a) Cleanse the vulva and perineum before and after the examination as needed b) Wear a clean glove lubricated with tap water and reduce discomfort c) Perform the examination every hour during the active phase of the first stage of labor d) Perform an examination immediately if active bleeding is present

a) Cleanse the vulva and perineum before and after the examination as needed

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

a) Encouraging the woman to try various upright positions, including squatting and standing

Parents can facilitate the adjustment of their other children to a new baby by: a) Having children at home choose or make a gift to give the new baby on his or her arrival home b) Emphasizing activities that keep the new baby and other children together c) Having the mother carry the new baby into the home so she can show the other children the baby d) Reducing stress on the other children by limiting their involvement and care of the new baby

a) Having children at home choose or make a gift to give the new baby on his or her arrival home

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

a. Encouraging the woman to try various upright positions, including squatting and standing.

Which description of postpartum restoration or healing times is accurate? a) The cervix shortens, becomes firm, and returns to form within a month postpartum b) Rugae reappear within 3 to 4 weeks c) Most episiotomies healh within a week d) Hermorrhoids usually decrease in size within 2 weeks of childbirth

b) Rugae reappear within 3 to 4 weeks

The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, does the nurse identify as a possible maladaptive behavior regarding parent-infant attachment? a) Talks and coos to her son b) Seldom makes eye contact with her son c) Cuddles her son close to her d) Tell visitors how well her son is feeding

b) Seldom makes eye contact with her son

In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviours that can either facilitate or inhibit attachment. What is a facilitating behavior? a) The parents have difficulty naming the infant b) The parents hover around the infant, directing attention to and pointment at the infant c) The parents make no effort to interpret the actions or needs of the infant d) The parents do not move from fingertip touch to palmar contact and holding

b) The parents hover around the infant, directing attention to and pointment at the infant Hovering over the infant, as well as obviously paying attention to the baby, is a facilitating behavior.

When working with parents who have some form of sensory impairment, nurses should realize that all of these statements are true except: a) One of the major difficulties visually impaired parents experience is the skepticism of health care professionals b) Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact c) The best approach for the nurse is to assess the parents' capabilities rather than focusing on their disabilities d) Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information

b) Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact Other sensory output can be provided by the parent, other people can participate, and other coping devices can be used.

Vaginal examinations should be performed by the nurse under all these circumstances except: a) An admission to the hospital at the start of labor b) When accelerations of the fetal heart rate (FHR) are noted c) On maternal perception of perineal pressure or the urge to bear down d) When membranes ruptured

b) When accelerations of the fetal heart rate (FHR) are noted

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is: a. "Don't worry about it. You'll do fine." b. "It's normal to be anxious about labor. Let's discuss what makes you afraid." c. "Labor is scary to think about, but the actual experience isn't." d. "You can have an epidural. You won't feel anything."

b. "It's normal to be anxious about labor. Let's discuss what makes you afraid."

A new client and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the baby's heart rate should be. Your best response is: a. "Don't worry about that machine; that's my job." b. "The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor." c. "The top line graphs the baby's heart rate, and the bottom line lets me know how strong the contractions are." d. "Your doctor will explain all of that later."

b. "The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor."

During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have: a. Bradycardia. b. A normal baseline heart rate. c. Tachycardia. d. Hypoxia.

b. A normal baseline heart rate.

A patient whose cervix is dilated to 5 cm is considered to be in which phase of labor? a. Latent phase b. Active phase c. Second stage d. Third stage

b. Active phase

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? a. Latent: Mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours b. Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours c. Lull: No contractions; dilation stable; duration of 20 to 60 minutes d. Transition: Very strong but irregular contractions; 8- to 10-cm dilation; duration of 1 to 2 hours

b. Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours

Concerning the third stage of labor, nurses should be aware that: a. The placenta eventually detaches itself from a flaccid uterus. b. An expectant or active approach to managing this stage of labor reduces the risk of complications. c. It is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface. d. The major risk for women during the third stage is a rapid heart rate.

b. An expectant or active approach to managing this stage of labor reduces the risk of complications.

how much lochia is typically discharged with in the first 2 hours after birth?

be similar to the amount during a heavy menstrual period.

with in 12 hours p birth why do moms have profuse diaphoresis (especially @ night) for the first 2-3 days ??

being to lose excess tissue fluid

what decreases the urge to void

birth induced trauma, increased bladder capacity and the effects of anesthesia

Overdistension causes what?

bleeding, susceptible to infection and impedes normal voiding

With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that: a) Kidney function returns to normal a few days after birth b) Diastasis recti abdominis is a common condition that alters the voiding reflex c) Fluid loss through perspiration and increased urinary output accoun for a weight loss of more than 2kg during the puerperium d) With adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth

c) Fluid loss through perspiration and increased urinary output accoun for a weight loss of more than 2kg during the puerperium

The early postpartum period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Fatigue compounds these issues. Although the baby blues are a common occurrence in the postpartum period, about one-half million women in America experience a more severe syndrome known as postpartum depression (PPD). Which statement regarding PPD is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis? a) PPD symptoms are consistently severe b) This syndrome affects only new members c) PPD can easily go undetected d) Only mental health professionals should teach new parents about this condition

c) PPD can easily go undetected

A nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates her understanding of the instructions when the woman states: a) True labor contractions will subside when I walked around b) True labor contractions will cause discomfort over the top of my uterus c) True labor contractions will continue and get stronger even if I relax and take a shower d) True labor contractions will remain irregular but become stronger

c) True labor contractions will continue and get stronger even if I relax and take a shower

While making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically: a) Express a strong need to review the events and her behavior during the process of labor and birth b) Exhibit a reduced attention span, limiting readiness to learn c) Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn d) Have reestablished her role as a spouse or partner

c) Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn

The nurse recognizes that a woman is in true labor when she states: a. "I passed some thick, pink mucus when I urinated this morning." b. "My bag of waters just broke." c. "The contractions in my uterus are getting stronger and closer together." d. "My baby dropped, and I have to urinate more frequently now."

c. "The contractions in my uterus are getting stronger and closer together."

At 1 minute after birth, the nurse assesses the newborn to assign an Apgar score. The apical heart rate is 110 bpm, and the infant is crying vigorously with the limbs flexed. The infant's trunk is pink, but the hands and feet are blue. What is the correct Apgar score for this infant? a. 7 b. 8 c. 9 d. 10

c. 9

In a variation of rooming-in, called couplet care, the mother and infant share a room and the mother shares the care of the infant with: a) The father of the infant b) Her mother (the infant's grandmother) c) Her eldest daughter (the infant's sister) d) the nurse

d) the nurse

In documenting labor experiences, nurses should know that a uterine contraction is described according to all these characteristics except: a. Frequency (how often contractions occur). b. Intensity (the strength of the contraction at its peak). c. Resting tone (the tension in the uterine muscle). d. Appearance (shape and height).

d. Appearance (shape and height).

If a woman complains of back labor pain, the nurse could best suggest that she: a. Lie on her back for a while with her knees bent. b. Do less walking around. c. Take some deep, cleansing breaths. d. Lean over a birth ball with her knees on the floor.

d. Lean over a birth ball with her knees on the floor.

Which collection of risk factors most likely would result in damaging lacerations (including episiotomies)? a. A dark-skinned woman who has had more than one pregnancy, who is going through prolonged second-stage labor, and who is attended by a midwife b. A reddish-haired mother of two who is going through a breech birth c. A dark-skinned, first-time mother who is going through a long labor d. A first-time mother with reddish hair whose rapid labor was overseen by an obstetrician

d. A first-time mother with reddish hair whose rapid labor was overseen by an obstetrician

Accelerations of the FHR

defined as a visually apparent, abrupt (onset to peak less than 30 seconds) increase in FHR above the baseline rate. The peak is at least 15 beats/min above the baseline, and the acceleration lasts 15 seconds or more, with the return to baseline less than 2 minutes from the beginning of the acceleration. *Accelerations are considered an indication of fetal well-being representing fetal alertness or arousal states.

A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The fetal heart rate has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical

dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. The nurse should expect the woman to be:Discharged home to await the onset of true labor.

decrease in voiding may result in what?

distention in bladder. which then pushes the uterus up and to the side and prevents uterus from contracting firmly.... which causes bleeding

For women who have a history of sexual abuse, a number of traumatic memories may be triggered during labor. The woman may fight the labor process and react with pain or anger. Alternately, she may become a passive player and

emotionally absent herself from the process The nurse is in a unique position of being able to assist the client to associate the sensations of labor with the process of childbirth and not the past abuse. The nurse can

The baseline fetal heart rate (FHR) is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is

evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration. is likely to be caused by which physiologic alteration. Compression of the fetal head Maternal supine hypotension

The nurse notes that a Vietnamese woman does not cuddle or interact with her newborn other than to feed him, change his diapers or soiled clothes, and put him to bed.

evaluating the woman's behavior with her infant, the nurse realizes that:What appears to be a lack of interest in the newborn is in fact the Vietnamese way of demonstrating intense love by attempting to ward off evil spirits.

subinvolution

failure of the uterus to reduce to its normal size and condition after pregnancy

Changes in the maternal immune system during the postpartum period account for the profuse diaphoresis that new mothers experience.

false

Women who have participated in childbirth education classes often bring a "birth bag" or "Lamaze bag" with them to the hospital. These items often assist in reducing stress and providing comfort measures. The nurse caring

for women in labor should be aware of common items that a client may bring, including Rolling pin.Tennis balls.Pillow.Stuffed animal or photo.

Duration of Contractions

how long each ctx is

Postpartal Diuresis

increased production of urine that occurs in the pospartum period to rid the body of fluid retained during pregnancy

Postpartal overdistention of the bladder and urinary retention can lead to which complications?Postpartum hemorrhage and urinary tract

infection Incomplete emptying and overdistention of the bladder can lead to urinary tract infection. Overdistention of the bladder displaces the uterus and prevents contraction of the uterine muscle, leading to postpartum hemorrhage

Amnioinfusion

infusion of room-temperature isotonic fluid (usually normal saline or lactated Ringer's solution) into the uterine cavity if the volume of amniotic fluid is low. The purpose is to relieve intermittent umbilical cord compression that results in variable decelerations and transient fetal hypoxemia by restoring the amniotic fluid volume to a normal or near-normal level.

hemorriods s&s when will they decrease?

itching discomfort and bleeding. decrease in size 6 wks after child birth

If suckling is never begun or discontinued what happens

lactation ceases within a few days to a week

pelvic relaxation

lengthening and weakening of the facial supports of pelvic structure

nadir

lowest point of the deceleration.

The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor."

normal uterine activity pattern in labor is characterized by:Contractions every 2 to 5 minutes.Contractions normally occur every 2 to 5 minutes and last less than 90 seconds with about 30 seconds in between

After giving birth to a healthy infant boy, a primiparous woman, 16 years old, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is Risk for impaired parenting related to deficient knowledge

of newborn care. In planning for the woman's discharge, what should the nurse be certain to include in the plan of care? Provide time for the patient to bathe her infant after she views an infant bath demonstration

A new client and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing

on the graph, referring to the EFM strip. He wants to know what the baby's heart rate should be. Your best response is:

Homans Sign

pain in calf upon dorsiflexion of foot and may indicated thrombophlebitis

diastasis recti abordominis

separation of the two rectus muscles along the median line of the abdominal wall

Contraction Intensity

strength at its peak: mild, moderate, or strong-- nose, chin, forhead

Resting Tone

tension in muscles between CTX- make sure uterus is resting- so it can re take oxygen

asphyxia

term used when fetal hypoxia results in metabolic acidosis

Baseline FHR

the average rate during a 10-minute segment that excludes periodic or episodic changes, periods of marked variability, and segments of the baseline that differ by more than 25 beats/min. There must be at least 2 minutes of interpretable baseline data in a 10-minute segment of tracing to determine the baseline FHR.

Tachycardia

the baseline FHR greater than 160 beats/min for 10 minutes or longer. It can be considered an early sign of fetal hypoxemia, especially when associated with late decelerations and minimal or absent variability.

In a variation of rooming-in, called couplet care, the mother and infant share a room, and the mother shares the care of the infant with:

the nurse

Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is management of the environment. While providing routine mother-baby care,

the nurse should ensure that: An environment that fosters as much privacy as possible should be created.

autolysis

the self-destruction of excess hypertrophied tissue caused by the decrease in hormone levels post pregnancy

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming

the soup so that his wife can eat it. The nurse's most appropriate response is to ask the woman: "I'll warm the soup in the microwave for you."

When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that:

the woman's risk for intrauterine infection has increased. [When the membranes rupture, microorganisms from the vagina can ascend into the amniotic sac and cause chorioamnionitis and placentitis.]

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both of her breasts are swollen, warm, and tender on palpation. The woman should be advised that

this condition can best be treated by: Applying ice to the breasts for comfort.

with in 12 hours post birth where should the funds be

to the level of the umbilicus or slightly above or below

pre induced hypervolemia during pregnancy (increase in blood flow) helps with what

tolerate considerable blood loss during birth 500 ml during bag birth 1000 ml during c-section

Although all other joints return to their normal prepregnancy state, those in the parous woman's feet do not. The new mother may notice a permanent increase in her shoe size.

true

A tiered system of categorizing FHR has been recommended by regulatory agencies. Nurses, midwives, and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and

understand the significance of each category. These categories include Category I. Category II. Nonreassuring.

suppportive tissues of the pelvic floor are torn and stretched during birth and take how long to regain tone? what helps with this?

up to 6 months. kegel exercises help strengthen perineal muscles (important to help prevent pelvic relaxation)

what should women expect their menstrual cycle? what will the flow be like?

will return to my prepregnant volume within three or four cycles." She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles.