CH. 21

Nx mgmt to be done for dystocia?

-Promoting labor progress -Providing physical and emotional comfort -Promoting empowerment

Postterm pregnancy is how many weeks past gestation?

Past the end of 42weeks

Umbilical cord prolapse mgmt?

-Prompt recognition -Measures to relieve compression

Problems with passageway cause dystocia?

-Pelvic contraction -Obstructions in maternal birth canal

What is the contraction pattern for preterm labor?

4 contractions every 20 minutes or 8 contractions in 1 hr

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

5. Explanation: A Bishop score less than 6 usually indicates that a cervical ripening method should be used before labor induction. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN REQUIRING LABOR INDUCTION AND AUGMENTATION, p. 787.

VBAC important areas to focus on?

Consent, documentation, surveillance and readiness for emergnecy

Labor augmentation?

Enhancing ineffective contractions after labor has begun

Forceps or vacuum assisted birth?

Application of traction to fetal head For prolonged second stage of labor Nonreassuring FHR pattern Failure of presenting part to fully rotate and descend Limited sensation or inability to push effectively Presumed fetal jeopardy or fetal distress Maternal heart disease Acute pulmonary edema Intrapartum infection Maternal fatigue Infection

Placental abruption maintenance of maternal what?

Maternal cardiovascular status

Preterm labor is defined as what?

Regular uterine contractions with cervical effacement and dilation between 20 and 37 weeks gestation

Etiology of postterm labor is?

unknown

Postterm labor risks?

-C-section -dystocia -birth trauma -postpartum hemorrhage -infection

Postterm nx mgmt?

-Fetal surveillance -decision for labor induction -support -education -intrapartal care

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

Late decelerations Explanation: When the fetus is being deprived of oxygen the fetus will demonstrate late decelerations on the fetal monitoring strip. This is an indication the mother is in need of further assessment. Early decelerations are a normal finding. Variable decelerations usually coincide with cord compression. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN EXPERIENCING AN OBSTETRIC EMERGENCY, p. 797.

Labor induction and augmentation nx assessment?

Relative indications Gestational age determination Fetal status Maternal status Bishop score

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

magnesium sulfate Explanation: Magnesium sulfate is only given intravenously for preterm labor. Nifedipine and indomethacin are given orally for preterm labor. Betamethasone is given by intramuscular injection to help promote fetal lung maturity by stimulating surfactant production. It is not a tocolytic agent. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DRUG GUIDE 21.1 Medications Used with Preterm Labor, p. 781.

What lab tests can be done for preterm labor?

-CBC -UA -Amniotic fluid analysis -Fetal fibronectin -Cervical length via transvaginal ultrasound -salivary estriol -home uterine activity monitoring

Postterm nx assessment?

-Estimated DOB -daily fetal movement counts -nonstress tests twice weekly -amniotic fluid analysis -weekly cervical examinations -client understanding -anxiety -coping ability

A multipara woman is fully dilated and effaced and has been pushing for over 2 hours. The student nurse observing asks the nurse, "What is causing this to last so long?" Which response by the nurse would be the most accurate? "The fetal head and shoulders are too large to get through the canal." "The fetal head is in an abnormal position." "The fetus probably turned to a breech position at the last minute." "The woman's bladder is too full, so the fetus cannot descend."

"The fetal head is in an abnormal position." Explanation: A deceleration phase has become prolonged when it extends beyond 1 hour in a multipara. A prolonged deceleration phase most often results from abnormal fetal head position. Usually the size of the fetal head and shoulders have been measured via ultrasound and considered adequate to descend before labor. If the fetus turned to a breech position, a cesarean birth would have been scheduled. The woman's bladder can be emptied via catheter while she is in bed, so this should not be the problem. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 769.

Umbilical cord prolapse patho?

-Obstetric emergency that is partial or total occlusion of cord with rapid fetal deterioration

Problems with passenger?

-Occiput posterior position -Breech presentation -Multifetal pregnancy -Macrosomia and CPD -Structural abnormalities

A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used? 2 to 7 days 1 to 5 days 6 to 10 days 4 to 8 days

2 to 7 days Explanation: Tocolytic drugs may prolong the pregnancy for 2 to 7 days. During this time, steroids can be given to improve fetal lung maturity, and the woman can be transported to a tertiary care center. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, PRETERM LABOR, p. 780.

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

4,000 g to 4500 g Explanation: Macrosomia, in which a newborn weighs 4,000 to 4,500 g (8.1 to 9.9 lb) or more at birth, complicates approximately 10% of all pregnancies The excessive fetal size and abnormalities contribute to labor and birth dysfunctions. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, Diagnosis and Management of Common Problems Associated with Dystocia, pp. 772-773.

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

Abnormal position of the fetal head Explanation: Forceps are mechanical devices which can be used to help deliver the fetus. Although no longer used routinely they are still used in certain situations to assist with the birth. One of those situations is when the fetus is in an abnormal position and the health care provider attempts to reposition the fetus to facilitate birth. The use of forceps is not to lessen the mother's pain or to speed up the process. The use of forceps is not without risk of complications, include perineal lacerations and injury to the fetus if the forceps are not used correctly. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN REQUIRING BIRTH-RELATED PROCEDURES, p. 799.

Therapeutic mgmt for labor induction?

Cervical ripening (Bishop score) Herbal agents Castor oil, hot baths, enemas Sexual intercourse w/ breast stimulation Mechanical methods and surgical methods Pharmacological agents Oxytocin

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

Look for late decelerations on monitor, which is associated with fetal anoxia. Explanation: A danger of hypertonic contractions is that the lack of relaxation between contractions may not allow optimal uterine artery filling; this can lead to fetal anoxia early in the latent phase of labor. Applying a uterine and a fetal external monitor will help identify that the resting phase between contractions is adequate and that the FHR is not showing late deceleration. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, TABLE 21.1 Diagnosis and Management of Common Problems Associated with Dystocia, p. 770.

Shoulder dystocia is a true medical emergency that can cause fetal demise because the baby cannot be born. Stuck in the birth canal, the infant cannot take its first breath. Which maneuver is first attempted to deliver an infant with shoulder dystocia? McDonald maneuver McGeorge maneuver McRoberts maneuver McRonald maneuver

McRoberts maneuver Explanation: McRoberts maneuver is an intervention that is frequently successful in cases of shoulder dystocia, and it is often tried first. McRoberts requires the assistance of two individuals. Two nurses are ideal; however, a support person or a technician can serve as the second assistant. With the woman in lithotomy position, each nurse holds one leg and sharply flexes the leg toward the woman's shoulders. This opens the pelvis to its widest diameters and allows the anterior shoulder to deliver in almost half of the cases. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, TABLE 21.1 Diagnosis and Management of Common Problems Associated with Dystocia (continued), p. 773.

What is one of the most common obstetric complications?

Preterm labor

Placental abruption cure?

Prompt delivery of fetus (c-sec if fetus is still alive and vaginal if fetal demise)

Labor Induction?

Stimulating contractions via medical or surgical means

Amniotic fluid embolism onsent?

Sudden onset of hypotension Hypoxia Coagulopathy due to breakage in barrier between maternal circulation and amniotic fluid

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

Use McRoberts maneuver. Explanation: McRoberts maneuver intervention is used with a large baby who may have shoulder dystocia and requires assistance. The legs are sharply flexed by a support person or nurse, and the movement will help to open the pelvis to the widest diameter possible. Zavanelli maneuver is performed when the practitioner pushes the fetal head back in the birth canal and performs an emergency cesarean birth. Fundal pressure is contraindicated with shoulder dystocia. It is outside the scope of practice for the LPN to attempt birth of the fetus by pushing one of the fetus' shoulders in a clockwise or counterclockwise motion. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, TABLE 21.1 Diagnosis and Management of Common Problems Associated with Dystocia (continued), p. 773.

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

Uterine rupture Explanation: The client with any prior history of uterus surgery is at increased risk for a uterine rupture. A falling blood pressure and increasing pulse is a sign of hemorrhage, and in this client a uterine rupture needs to be a first consideration. The scenario does not indicate a hypertonic uterus, a placenta previa, or umbilical cord compression. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN EXPERIENCING AN OBSTETRIC EMERGENCY, p. 797.

After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical? breast stimulation amniotomy laminaria prostaglandin

amniotomy Explanation: Amniotomy is considered a surgical method of cervical ripening. Breast stimulation is considered a nonpharmacologic method for ripening the cervix. Laminaria is a hygroscopic dilator that mechanically causes cervical ripening. Prostaglandins are pharmacologic methods for cervical ripening. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN REQUIRING LABOR INDUCTION AND AUGMENTATION, p. 788.

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

birth is unlikely within the 2 next weeks. Explanation: Fetal fibronectin is a protein that helps the placenta and fetal membranes adhere to the uterus during pregnancy. A negative result (absence of fetal fibronectin) is a reliable indicator that birth is unlikely within 2 weeks following the test. It does not diagnose infection. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, PRETERM LABOR, p. 782.

A 16-year-old client has been in the active phase of labor for 14 hours. An ultrasound reveals that the likely cause of delay in dilation (dilatation) is cephalopelvic disproportion. Which intervention should the nurse most expect in this case? cesarean birth administration of oxytocin administration of morphine sulfate darkening room lights and decreasing noise and stimulation

cesarean birth Explanation: If the cause of the delay in dilation (dilatation) is fetal malposition or cephalopelvic disproportion (CPD), cesarean birth may be necessary. Oxytocin would be administered to augment labor only if CPD were ruled out. Administration of morphine sulfate (an analgesic) and darkening room lights and decreasing noise and stimulation are used in the management of a prolonged latent phase caused by hypertonic contractions. These measures would not help in the case of CPD. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, pp. 777-778.

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

contractions most forceful in the middle of uterus rather than the fundus Explanation: Contractions that are more forceful in the midsection of the uterus rather than in the fundus suggest hypertonic uterine dysfunction. Reports of severe back pain are associated with a persistent occiput posterior position due to the pressure of the fetal head on the woman's sacrum and coccyx. Cervical dilation (dilatation) that has not progressed past 2 cm is associated with dysfunctional labor. A breech position is one in which the fetal presenting part is the buttocks or feet. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, TABLE 21.1 Diagnosis and Management of Common Problems Associated with Dystocia, p. 770.

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

corticosteroids Explanation: Corticosteroids are given to help reduce or prevent the frequency and severity of respiratory distress syndrome in preterm infants delivered between 24 and 34 weeks' gestation. Medications most commonly used for tocolysis include magnesium sulfate, indomethacin, and nifedipine. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, PRETERM LABOR, p. 780.

A client in the active phase of labor is diagnosed as having a protracted labor pattern. Which pattern would the nurse assess as indicative of a protracted labor pattern? arrest of the descent of the fetal head prolonged deceleration phase secondary arrest of cervical dilation (dilatation) delayed descent of the fetal head

delayed descent of the fetal head Explanation: Protraction disorders are characterized by delayed descent of the fetal head and delayed cervical dilation (dilatation). Prolonged deceleration phase, secondary arrest of cervical dilation, and arrest of the descent of the fetal head are characteristics of arrest disorder and not of protraction disorder. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 769.

A client at 38 weeks' gestation has an ultrasound performed at a routine office visit and learns that her fetus has not moved out of a breech position. Which intervention does the nurse anticipate for this client? external cephalic version trial labor forceps birth vacuum extraction

external cephalic version Explanation: External cephalic version is the turning of a fetus from a breech to a cephalic position before birth. It may be done as early as 34 to 35 weeks, although the usual time is 37 to 38 weeks of pregnancy. A trial birth is performed when a woman has a borderline (just adequate) inlet measurement and the fetal lie and position are good and involves allowing labor to take its normal course as long as descent of the presenting part and dilation (dilatation) of the cervix continue to occur. Forceps, which are not commonly used anymore, and vacuum extraction are used to facilitate birth when other complications are present, but they would be less likely to be used with a fetus in breech position. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 775.

A nurse is caring for an antenatal mother diagnosed with umbilical cord prolapse. For which condition should the nurse monitor the fetus? fetal hypoxia preeclampsia coagulation defects placental pathology

fetal hypoxia Explanation: The nurse should monitor for fetal hypoxia in cases of umbilical cord prolapse. Because this is the fetus's only lifeline, fetal perfusion deteriorates rapidly. Complete occlusion renders the fetus helpless and oxygen deprived. Preeclampsia, coagulation defects, and placental pathology are not risks associated with umbilical cord prolapse. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN EXPERIENCING AN OBSTETRIC EMERGENCY, p. 796.

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

hospitalization, tocolytic, and corticosteroids Explanation: At 31 weeks' gestation, the goal would be to maintain the pregnancy as long as possible if the mother and fetus are tolerating the continuation of the pregnancy. Stopping the contractions and placing the client in the hospital allows for monitoring in a safe place if the woman continues and gives birth. Administration of corticosteroids may help to develop the lungs and prepare for early preterm birth. Sending the woman home is contraindicated in the scenario described. An emergency cesarean birth is not indicated at this time. Monitoring fetal movement (kick) counts is typically done with a postterm pregnancy. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, PRETERM LABOR, p. 780.

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

placental abruption Explanation: The most common cause of fetal death after a trauma is placental abruption (abruptio placentae), where the placenta separates from the uterus, and the fetus is not able to survive. Genetic abnormalities typically cause spontaneous abortion (miscarriage) in the first trimester. Trauma does not cause preeclampsia (which is related to various issues in the mother) nor does trauma usually cause PROM. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN EXPERIENCING AN OBSTETRIC EMERGENCY, p. 797.

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

tomorrow at 1400 Explanation: Betamethasone is given as two intramuscular injections, given 24 hours apart. Because the woman got her first dose at 1400 today, then her second dose would be given at 1400 tomorrow. Corticosteroids given to the mother in preterm labor can help prevent or reduce the frequency and severity of respiratory distress syndrome in premature infants delivered between 24 and 34 weeks' gestation. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DRUG GUIDE 21.1 Medications Used with Preterm Labor, p. 781.

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

uterine rupture Explanation: If a uterus should rupture, the woman experiences a sudden, severe pain during a strong labor contraction, which she may report as a "tearing" sensation. Because the uterus at the end of pregnancy is such a vascular organ, uterine rupture is an immediate emergency. Signs of hypotensive shock begin, including a rapid, weak pulse, falling blood pressure, cold and clammy skin, and dilation of the nostrils from air starvation. Fetal heart sounds fade and then are absent. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, VAGINAL BIRTH AFTER CESAREAN, p. 793.

A woman in labor with a history of drug and alcohol addiction and no prenatal care has arrived in the emergency department in active labor with cervix 5 cm dilated. An ultrasound shows the fetus in a breech presentation. As a nurse prepares to care for this woman, which assessments indicate the fetus is in distress and needs immediate help to survive? Select all that apply. meconium staining noted on fluid seeping from vagina variable deceleration FHR pattern noted on monitor premature rupture of membranes with yellow-green color fluid that smells foul fetal heart rate decreasing into the 80s minimal movement as the fetus descends into the pelvic opening

variable deceleration FHR pattern noted on monitor fetal heart rate decreasing into the 80s Explanation: Variable deceleration fetal heart rate pattern noted on the monitor signifies a possible prolapsed cord. Low fetal heart rate can be a sign of hypoxia. Meconium staining occurs because of cervical pressure on the buttocks and rectum, not because of fetal anoxia, so it is not a sign of fetal distress. It is normal for the fetus to slow in movement as it makes its way through the birth canal. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN EXPERIENCING AN OBSTETRIC EMERGENCY, p. 795.

Amniotic fluid nx assessment?

Difficulty breathing Hypotension Cyanosis Seizures Tachycardia Coagulation failure DIC Pulmonary edema Uterine atony w/ subsequent hemorrhage ARDS Cardiac arrest

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

Check for a full bladder. Explanation: A full bladder can interfere with the progress of labor, so the nurse must be sure that the client has emptied her bladder. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 777.

Amnioinfusion nx mgmt?

Teaching Maternal and fetal assessment Preparing for possible csection

What nursing assessments can be done for dystocia?

-History of risk factors -Maternal frame of mind -Vital signs -Uterine contractions -Fetal heart rate, fetal position

Uterine rupture nx assessments?

Risk factors Onset of sudden fetal distress

Amniotic fluid nx mgmt?

Supportive measures to maintain oxygenation and hemodynamic function Correct coagulopathy Critical care monitoring

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

hypotonic contractions Explanation: With hypotonic uterine contractions, the number of contractions is unusually infrequent (not more than two or three occurring in a 10-minute period). The resting tone of the uterus remains less than 10 mm Hg, and the strength of contractions does not rise above 25 mm Hg. Hypertonic uterine contractions are marked by an increase in resting tone to more than 15 mm Hg. However, the intensity of the contraction may be no stronger than that associated with hypotonic contractions. In contrast to hypotonic contractions, these occur frequently and are most commonly seen in the latent phase of labor. Uncoordinated contractions can occur so closely together they can interfere with the blood supply to the placenta. Because they occur so erratically, such as one on top of another and then a long period without any, it may be difficult for a woman to rest between contractions or to breath effectively with contractions. Braxton Hicks contractions are sporadic contractions that occur in pregnancy before the onset of true labor. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 769.

IUFD nx mgmt?

-Assisting with grieving process -Referrals

Placental abruption mgmt is dependent on what?

-Gestational age -Extent of hemorrhage -Maternal-fetal oxygenation perfusion

What problems with powers cause dystocia?

-Hypertonic uterine dysfunction -Hypotonic uterine dysfunction -Protracted disorders -Arrest disorders -Precipitate labor

Intrauterine fetal demise nx assessments?

-Inability to obtain fetal heart sounds -Ultrasound to confirm absence of fetal activity -Labor induction

Postterm fetal risks?

-Macrosomnia -Shoulder dystocia -brachial plexus injuries -low apgar score -postmaturity syndrome -cephalopelvic disproportion

Labor induction and augmentation nc mgmt?

Oxytocin Pain relief and support

Risk factors for dystocia?

Epidural analgesia/excessive analgesia Multiple gestation Polydramnios Maternal exhaustion Ineffective maternal pushing technique Occiput posterior position Longer first stage of labor* Nulliparity Short maternal stature* Fetal birth weight over 8.8 lb.* Shoulder dystocia Abnormal fetal presentation* Fetal anomalies Maternal age over 35 years High caffeine intake Increased BMI Gestational age over 41 weeks Chorioamnionitis Ineffective uterine contractions High fetal station at complete cervical dilation*

Uterine rupture nx mgmt?

-Prepare for urgent c-sec -Continuous maternal and fetal monitoring

Umbilical cord prolapse assessments?

-Prevention -Risk factors -Continuous assessment of client and fetus

During a shoulder dystocia emergency, what action(s) does the nurse implement to prevent fetal hypoxia? Select all that apply. Assist with maneuvers. Keep time. Document events in the record. Lower the head of the bed. Administer oxytocin to increase the contractions.

Assist with maneuvers. Keep time. Document events in the record. Lower the head of the bed. Explanation: The nurse will assist with the maneuvers used to facilitate birth of the shoulders. The nurse also keeps time, by calling out how much time has passed, since the head was delivered. The fetus needs to be completely birthed within 5 minutes to minimize the risk of hypoxia. Documentation of the events taking place, including the use of maneuvers and maternal and fetal response, is another nursing responsibility. The head of the bed needs to be lowered to a flat position to increase the effectiveness of McRoberts maneuver and to give the health care provider the maximum space to birth the shoulders. Oxytocin is not administered in this situation. The shoulders are stuck, and making the contractions stronger will not resolve the problem but will increase fetal distress. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, FETAL ASSESSMENT DURING LABOR AND BIRTH, p. 480.

Intrauterine fetal demise cause?

Numerous cause

Placental abruption definition?

Obstetric emergency with premature separation

Uterine rupture is what?

Obstetric emergency with sudden fetal bradycardia is marked as the onset

A client in labor is to undergo an external version for fetal malpresentation. When preparing the client for this procedure, which action(s) is appropriate? Select all that apply. Tell the client not to urinate before the procedure. Obtain the client's vital signs. Gather baseline data on the pregnant client and fetus. Review relaxation techniques with the client. Position the client on the left side for the procedure.

Obtain the client's vital signs. Gather baseline data on the pregnant client and fetus. Review relaxation techniques with the client. Explanation: Prior to the procedure it is important to monitor the client and the fetus to obtain baseline data. A nonstress test (NST) or biophysical profile (BPP) is done along with fetal heart rate evaluation. The pregnant client's vital signs are also taken. The client should empty the bladder. The client should be positioned supine with a pillow or wedge under one hip.

A client is admitted to the health care facility. The fetus has a gestational age of 42 weeks and is suspected to have cephalopelvic disproportion. Which should the nurse do next? Place the client in lithotomy position for birth. Administer oxytocin intravenously at 4 mU/minute. Perform artificial rupture of membranes. Prepare the client for a cesarean birth.

Prepare the client for a cesarean birth. Explanation: Cephalopelvic disproportion is associated with postterm pregnancy. This client will not be able to vaginally give birth and should be prepared for a cesarean birth. Lithotomy position, artificial rupture of membranes, and oxytocin are interventions for a vaginal birth. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, POST-TERM PREGNANCY, p. 785.

Labor induction/augmentation indications?

Prolonged gestation Prolonged premature rupture of membranes Gestational hypertension Cardiac disease Renal disease Chorioamnionitis Dystocia IUFD Isoimmunization DIabetes

A nurse is caring for a client who is scheduled to undergo an amnioinfusion. The nurse would question this prescription if which finding is noted upon client assessment? uterine hypertonicity active genital herpes infection blood pressure of 130/88 mm Hg decreased urine output

uterine hypertonicity Explanation: The nurse should ensure that the client does not have uterine hypertonicity to confirm that amnioinfusion is not contraindicated. Other factors that enforce contraindication of amnioinfusion include vaginal bleeding of unknown origin, umbilical cord prolapse, amnionitis, and severe fetal distress. Active genital herpes infection is a condition that enforces contraindication of labor induction rather than amnioinfusion. Urine output and blood pressure do not determine a client's ability to receive an amnioinfusion. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 769.

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

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." Explanation: Arrest of labor results when no descent has occurred for 2 hours in a nullipara or 1 hour in a multipara. The most likely cause for arrest of descent during the second stage is CPD. Rest should allow the uterine contractions to be more efficient. The hormones secreted during pregnancy allow ligaments to soften so bones can shift to allow birth. Ultrasound would have previously been diagnosed prior to the onset of labor. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 769.

Therapeutic mgmt for preterm labor?

-Risk prediction -Tocolytic drugs prolong pregnancy for 2-7 days while corticosteroids are used to mature the fetal lungs -Abx prophylaxis for women with group B streptococcus

Amnioinfusion indications?

-Severe variable decelerations due to cord compression -Oligohydramnios due to placental insufficiency -Postmaturity or rupture of membranes -Preterm labor with premature rupture of membranes -Thick meconium fluid

A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is postterm and has oligohydramnios. What does this increase the risk of during birth? fetal hydrocephalus macrosomia cord compression shoulder dystocia

cord compression Explanation: Oligohydramnios and meconium staining of the amniotic fluid are common complications of postterm pregnancy. Oligohydramnios increases the incidence of cord compression, which can lead to fetal distress during labor. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, POST-TERM PREGNANCY, p. 785.

The nurse is assisting a primipara in the second stage of labor. The mother has been pushing now for almost 3 hours. The nurse should anticipate planning for: an operative delivery. augmentation with oxytocin. an increase in the epidural medication. a variation in pushing technique.

an operative delivery. Explanation: In the second stage of labor, allowing pushing for at least 3 hours for first births and at least 2 hours for second births is recommended prior to surgical interventions. Extra time may be given for individual circumstances, including epidural anesthesia. Increasing or decreasing the epidural medication will not help. Changes in position or variations in pushing technique are unlikely to be of benefit in facilitating a more rapid birth. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN REQUIRING BIRTH-RELATED PROCEDURES, p. 799.

A woman has been in active labor for over 20 hours, and the nurses are discussing this case with the health care provider. The nurses know to assess this woman for which potential complication from a prolonged labor? Select all that apply. bleeding tendencies to the point of hemorrhage premature rupture of membranes maternal postpartal infection exhaustion exaggerated pain

bleeding tendencies to the point of hemorrhage maternal postpartal infection Explanation: The risk of maternal postpartum infection, hemorrhage, and infant mortality is higher in women who have a prolonged labor than in those who do not. Therefore, it is vital to recognize and prevent dysfunctional labor to the greatest extent possible. In active labor, it is likely the membranes have already ruptured. Exhaustion occurs following labor and is not specific to prolonged labor. All labor results in pain, not just prolonged labor. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 768.

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

diabetes Explanation: Shoulder dystocia is most apt to occur in women with diabetes, in multiparas, and in postdate pregnancies. A pendulous abdomen is associated with the transverse lie fetal position not with shoulder dystocia. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, TABLE 21.1 Diagnosis and Management of Common Problems Associated with Dystocia (continued), p. 773.

A primigravida at 28 weeks' gestation comes to the clinic for a checkup. She tells the nurse that her mother gave birth to both of her children prematurely, and she is afraid that the same will happen to her. Which risk factors associated with preterm birth would the nurse discuss with the client? Select all that apply. history of previous preterm birth current multiple gestation pregnancy large-for-gestational-age fetus uterine or cervical abnormalities previous cesarean birth

history of previous preterm birth current multiple gestation pregnancy uterine or cervical abnormalities Explanation: The top three risk factors for premature birth are history of previous preterm birth, current multiple gestation pregnancy, and uterine or cervical abnormalities. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, VAGINAL BIRTH AFTER CESAREAN, p. 792.

During their experience in labor & delivery, a group of nursing students are observing a woman who is having uncoordinated contractions where the monitor shows some contractions close together, followed by a long period without any contractions. The nurse asks the students, "Which medication may help to stimulate a more effective, consistent pattern of contractions?" Which medication would be considered the best answer? morphine sulfate betamethasone terbutaline oxytocin

oxytocin Explanation: Oxytocin administration may be helpful in uncoordinated labor to stimulate a more effective and consistent pattern of contractions with a better, lower resting tone. Morphine sulfate is an IV opioid for pain. Betamethasone is given to help hasten lung maturity. Terbutaline is a tocolytic medication given to stop or slow preterm labor. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN REQUIRING LABOR INDUCTION AND AUGMENTATION, p. 789.

A 19-year-old nulliparous woman is in early labor with erratic contractions. An assessment notes that she is remaining at 3 cm. There is also a concern that the uterus is not fully relaxing between contractions. The nurse suspects which complication? reduced oxygen to the fetus ruptured uterus cephalopelvic disproportion precipitate labor

reduced oxygen to the fetus Explanation: Hypertonic uterine dysfunction occurs when the uterus never fully relaxes between contractions. Placental perfusion becomes compromised, thereby reducing oxygen to the fetus. This occurs in early labor and affects nulliparous women more than multiparous women. A ruptured uterus is a potential complication; however, hypoxia to the fetus would occur first. Cephalopelvic disproportion is usually associated with hypotonic uterine dysfunction. Precipitate labor is one that is completed in less than 3 hours from the start of contractions to birth. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 769.

A woman in active labor has just had her membranes ruptured to speed up labor. The nurse is concerned the woman is experiencing a prolapse of the umbilical cord when the nurse notices which pattern on the fetal heart monitor? variable deceleration pattern fetal heart rate (FHR) increase to 200 beats/min early deceleration with each contraction late deceleration with late recovery following contraction

variable deceleration pattern Explanation: Umbilical cord prolapse can be seen after the membranes have ruptured, when the FHR is displaying a sudden variable deceleration FHR pattern on a fetal monitor. It is not uncommon for FHR to increase following a procedure. Early deceleration with each contraction is seen when the fetal head is being compressed through the pelvic opening. Late deceleration with late recovery following contraction is associated with uteroplacental insufficiency (UPI). Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN EXPERIENCING AN OBSTETRIC EMERGENCY, p. 796.

A nurse assesses a client in labor and suspects dysfunctional labor (hypotonic uterine dysfunction). The woman's membranes have ruptured and fetopelvic disproportion is ruled out. Which intervention would the nurse expect to include in the plan of care for this client? administering oxytocin preparing the woman for an amniotomy encouraging the woman to assume a hands-and-knees position providing a comfortable environment with dim lighting

administering oxytocin Explanation: Oxytocin would be appropriate for the woman experiencing dysfunctional labor (hypotonic uterine dysfunction). Comfort measures minimize the woman's stress and promote relaxation so that she can work more effectively with the forces of labor. An amniotomy may be used if the membranes were intact. It may also be used with hypotonic uterine dysfunction to augment labor. A hands-and-knees position helps to promote fetal head rotation with a persistent occiput posterior position. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN REQUIRING LABOR INDUCTION AND AUGMENTATION, p. 787.

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

had previous lower abdominal incision Explanation: The choice of a vaginal or repeat cesarean birth can be offered to women who have had a lower abdominal incision. Contraindications to VBAC include a prior classic uterine incision, prior transfundal uterine surgery, uterine scar other than low-transverse ("bikini cut") cesarean scar, contracted pelvis, and inadequate staff at the facility if an emergency cesarean birth is required. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, VAGINAL BIRTH AFTER CESAREAN, p. 792.

A laboring client has been pushing without delivering the fetal shoulders. The primary care provider determines the fetus is experiencing shoulder dystocia. What intervention can the nurse assist with to help with the birth? positioning the woman prone McRoberts maneuver fundal pressure Lamaze position

McRoberts maneuver Explanation: The McRoberts maneuver is frequently successful and often tried first. It requires assistance from two people. Two nurses place the client in the lithotomy position, while each holds a leg and sharply flexes the leg toward the woman's shoulders. This opens the pelvis to its widest diameters and allows the anterior shoulder to deliver in almost half of the cases. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, TABLE 21.1 Diagnosis and Management of Common Problems Associated with Dystocia (continued), p. 773.

The nurse is receiving shift handoff for a client with dystocia. Which nursing interventions are most appropriate in the plan of care? Select all that apply. Bed rest in the side-lying position Nipple stimulation Administration of an enema Administration of a tocolytic Emotional support

Nipple stimulation Administration of an enema Emotional support Explanation: Dystocia is said to exist when the progress of labor deviates from normal and is slow. Hypotonic uterine contractions are a common cause. Nursing interventions include ambulation in the hall, nipple stimulation for oxytocin release, use of an enema, and, as always, emotional support of the client. Administration of a tocolytic suppresses uterine contractions and the labor process. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 769.

The nurse is caring for a client experiencing a prolonged second stage of labor. The nurse would place priority on preparing the client for which intervention? a forceps and vacuum-assisted birth a precipitous birth artificial rupture of membranes a cesarean birth

a forceps and vacuum-assisted birth Explanation: A forceps-and-vacuum-assisted birth is required for the client having a prolonged second stage of labor. The client may require a cesarean birth if the fetus cannot be delivered with assistance. A precipitous birth occurs when the entire labor and birth process occurs very quickly. Artificial rupture of membranes is done during the first stage of labor. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN REQUIRING BIRTH-RELATED PROCEDURES, p. 799.

A multipara woman is experiencing a prolonged descent while trying to rest and increase her fluid intake. The nurse suggests that she change position. Which position(s) will be effective for pushing to speed up the descent? Select all that apply. supine with knees pulled up to chest semi-Fowler position lithotomy position squatting position standing, leaning against a door frame

semi-Fowler position squatting position Explanation: A semi-Fowler position or a squatting, kneeling position will be most effective for pushing and may speed descent. The other positions will not help speed the descent. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, TABLE 21.1 Diagnosis and Management of Common Problems Associated with Dystocia, p. 771.

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

"Continue to monitor fetal movements daily." Explanation: The nurse will teach the postterm client to monitor fetal movements (kick counts) daily to help determine if the fetus is experiencing distress. A 24-hour urine is needed for postterm clients; however, this is not collected daily. Although all pregnant clients should avoid dehydration, there is no indication this client needs to increase her fluid intake and this will not help identify potential problems. Monitoring bowel movements for constipation is not needed. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, POST-TERM PREGNANCY, p. 785.

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

"Maybe dimming the lights or some soft music will help you relax a bit." "I will keep you updated often on how you and your baby are doing." "Things are moving along but sometimes it can take a little longer." Explanation: The client is experiencing problems with the psyche. The nurse should provide emotional support to the client and family. Comfort measures such as dimming the lights or putting on soft music can promote relaxation and help the client's body work more effectively with the forces of labor. Keeping the client updated about her status and that of her fetus can provide reassurance and encouragement. Explanations about labor and what to expect can help empower the client and help her cope. The nurse should provide continuous presence to allay anxiety. Pain medication is needed to reduce anxiety and stress. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 777.

A client who is in labor presents with shoulder dystocia of the fetus. Which is an important nursing intervention? Assist with positioning the woman in squatting position. Assess for reports of intense back pain in first stage of labor. Anticipate possible use of forceps to rotate the fetus to anterior position at birth. Assess for prolonged second stage of labor with arrest of labor.

Assist with positioning the woman in squatting position. Explanation: The nurse caring for the client in labor with shoulder dystocia of the fetus should assist with positioning the client in squatting position. The client can also be helped into the hands and knees position or lateral recumbent position for birth, to free the shoulders. Assessing for report of intense back pain in first stage of labor, anticipating possible use of forceps to rotate to anterior position at birth, and assessing for prolonged second stage of labor with arrest of labor are important interventions when caring for a client with persistent occiput posterior position of fetus. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, TABLE 21.1 Diagnosis and Management of Common Problems Associated with Dystocia (continued), p. 773.

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

Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min. Explanation: Hyperstimulation is usually defined as five or more contractions in a 10-minute period or contractions lasting more than 2 minutes in duration or occurring within 60 seconds of each other. The surest method to relieve hyperstimulation is to immediately discontinue the oxytocin infusion. The rate should not be increased by more than 2 milliunits at a time. When the infusion is administered, the oxytocin solution should be "piggybacked" to a maintenance IV solution such as Ringer's lactate and the piggyback added to the main infusion at the port closest to the woman. Infusions are usually begun at a rate of 1 to 2 milliunits/min. If there is no response, the infusion is gradually increased every 30 to 60 minutes by small increments of 1 to 2 milliunits/min until contractions begin. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN REQUIRING LABOR INDUCTION AND AUGMENTATION, p. 792.

A woman arrives in the L & D unit in the beginning early phase with her contractions 5 to 8 minutes apart and dilated 1 cm. Thirty minutes later the nurse finds the woman in hard, active labor and 8 cm dilated. The nurse calls for assistance, prepares for a precipitate birth, and monitors the woman for which priority assessment caused by a rapid birth? Assess bladder for fullness. Check perineal area frequently for bleeding. Assess the woman's breathing and intervene if necessary. Assess and administer pain medication as needed.

Check perineal area frequently for bleeding. Explanation: Precipitous dilation (dilatation) is cervical dilation that occurs at a rate of 5 cm or more per hour in a primipara or 10 cm or more per hour in a multipara. Contractions can be so forceful they lead to premature separation of the placenta or lacerations of the perineum, placing the woman at risk for hemorrhage. The other interventions are appropriate, but the priority is assessing for bleeding/hemorrhage. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, DYSTOCIA, p. 769.

A laboring woman is receiving oxytocin IV to augment her labor and 2 hours later begins having contractions every 2 minutes lasting 60 to 90 seconds each with little, if any, rest time in between the contractions. At this time, which interventions would be the priority for the nurse caring for this client? Select all that apply. Administer betamethasone to mature the fetal lungs. Ask the woman to drink 32 ounces (1 L) of water. Discontinue the oxytocin infusion. Administer an IV bolus of fluids. Apply oxygen to the woman via mask at 8 to 10 L/min.

Discontinue the oxytocin infusion. Administer an IV bolus of fluids. Apply oxygen to the woman via mask at 8 to 10 L/min. Explanation: The danger of hyperstimulation is that a fetus needs 60 to 90 seconds between contractions in order to receive adequate oxygenation from placenta blood vessels. Hyperstimulation is usually defined as five or more contractions in a 10-minute period or contractions lasting more than 2 minutes in duration or occurring within 60 seconds of each other. Several interventions such as asking the woman to turn onto her left side to improve blood flow to the uterus, administering an IV fluid bolus to dilute the level of oxytocin in the maternal blood stream, and administering oxygen by mask at 8 to 10 L are all helpful interventions for hyperstimulation. The surest method to relieve hyperstimulation is to immediately discontinue the oxytocin infusion. The lungs should be mature if a woman is undergoing induction. Drinking water takes too long to be absorbed and dilute the blood stream, so IV fluids are best. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN REQUIRING LABOR INDUCTION AND AUGMENTATION, p. 789.

The nurse assesses that a fetus is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment? Shorter dilation (dilatation) stage of labor Experience of additional back pain Need to have the baby manually rotated Necessity for vacuum extraction for birth

Experience of additional back pain Explanation: Most women whose fetus is in a posterior position experience back pain while in labor. Pressure against the back by a support person often reduces this type of pain. An occiput posterior position does not make for a shorter (dilation) dilatation stage of labor. OP position does not indicate the need to have the baby manually rotated, nor does it indicate a necessity for a vacuum extraction birth. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, TABLE 21.1 Diagnosis and Management of Common Problems Associated with Dystocia, p. 771.

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

Prepare the client for a cesarean birth. Explanation: The findings are consistent with uterine rupture. An abrupt change in the fetal heart rate pattern is often the most significant finding associated with uterine rupture. Others are reports of pain in the abdomen, shoulder, or back in a laboring woman who had previous effective pain relief from epidural anesthesia. Falling blood pressure and rising pulse may be associated with hypovolemia caused by occult bleeding. The treatment is immediate cesarean birth. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, VAGINAL BIRTH AFTER CESAREAN, pp. 792-793.

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

Prepare to assist with external version. Explanation: Transverse lie is a fetal malposition and is a cause for labor dystocia. The fetus would need to be turned to the occipital position using external version or be born via cesarean birth. Piper forceps are used in the birth of a fetus that is in the breech position. Nitrazine and fern tests are done to assess if amniotic fluid is leaking from the sac into the vagina. Counterpressure applied to the lower back with a fisted hand sometimes helps the woman to cope with the "back labor" that is characteristic of occiput posterior (OP) positioning. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, TABLE 21.1 Diagnosis and Management of Common Problems Associated with Dystocia (continued), p. 773.

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

Severe variable decelerations occur and are due to cord compression. Explanation: Indications for amnioinfusion include severe variable decelerations resulting from cord compression, oligohydramnios (decreased amniotic fluid), postmaturity, preterm labor with rupture of the membranes, and thick meconium fluid. Failure of the fetal presenting part to rotate fully; descent in the pelvis; abnormal fetal heart rate patterns or acute pulmonary edema; and compromised maternal pushing sensations from anesthesia are indications for forceps-assisted birth, and not for amniofusion. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, POST-TERM PREGNANCY, p. 786.

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

Sudden shortness of breath Explanation: Sudden shortness of breath can be a sign of amniotic fluid embolism and requires emergent intervention. This can occur suddenly during labor or immediately after. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension. It must be reported to the care team so proper interventions may be taken. Other symptoms can include hypotension, cyanosis, hypoxemia, uterine atony, seizures, tachycardia, coagulation failure, DIC, and pulmonary edema. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN EXPERIENCING AN OBSTETRIC EMERGENCY, p. 798.

The nurse notes the fetal heart rate has slowed in a woman in labor at 8 cm dilation (dilatation). Assessment reveals a prolapsed umbilical cord. Which action should the nurse prioritize? Turn client to her left side. Place client in a knee-chest position. Use fingers to press upward on the presenting part. Prep for immediate cesarean delivery.

Use fingers to press upward on the presenting part. Explanation: If the woman presents with a visible prolapse of the cord, quickly place her in bed and gently palpate the cord for pulsations to verify fetal viability. Then use fingers to press upward on the presenting part. Continue to hold the presenting part of the cord until delivery of the infant. If you discover the condition and are unable to call for help, place the client in knee-chest position, call for help, and then continue to intervene as previously described. Keeping the pressure of the fetus off the cord improves fetal circulation. Replacing the cord could knot it; allowing it to dry would constrict cord blood vessels. Turning the woman to the left side is not the intervention of choice. Another nurse will be helping prepare this client for immediate cesarean delivery. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 21: Nursing Management of Labor and Birth at Risk, WOMEN EXPERIENCING AN OBSTETRIC EMERGENCY, p. 795.