Chapter 13: Labor and delivery

The 5 P's in labor

-Passageway -passenger -position -powers -psych

Which nursing interventions should the nurse perform as part of prenatal education for the client to ensure a positive birth experience?

-provide the client clear information on procedures involves -encourage the client to have a sense of mastery and self control -encourage the client to have a position reaction to pregnancy

The first stage of labor is often a time of introspection, which information would guide the nurses planning of nursing care

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

During which time is the nurse correct to document the end of the third stage of labor?

At the time of the placental delivery (the beginning of the third stage is documented the time of birth)

What differentiates Braxon Hicks contractions from true labor?

Braxton Hicks contractions usually decrease in intensity with walking

The head is the presenting part; which fetal position

Cephalic or vertex

Cephalohematoma

Collection of blood under the scalp of a newborn

What sign marks the termination of the 1st stage of labor

Dilation of cervix diameter to 10 cm

What is crowing

Fetal had is at the vaginal opening and does not regress between contractions

Which nursing action is a priority when the fetus is at the 4+ station?

Have a bulb suction and infant warmer ready At the station +4, the fetus is being born.

What is the MOST important nursing assessment of the mother during the fourth stage of labor?

Hemorrhage -may occur from lacerations or retained placenta fragments

How do you measure the duration of a contraction

How long a contraction lasts and is measured from the beginning of the increment to the end of the decrement for the same contraction

Gynecoid pelvis

It is rounded in shape and allows ample room for the neonate to fit through the passageway

Which assessment finding indicates the client's fetus is in the transverse lie position

Long axis of the fetus is perpendicular to that of the client

The fetal skull must be small enough to travel through the bony pelvis, what feature of the fetal skull helps to make this passage possible

Molding (cartilage between the bones allow the bones to overlap during labor, a process called molding that elongates the fetal skull, reducing the diameter of the head)

What is restitution or external rotation

Occurs after the head is born and free of resistance.

Flexion

Occurs as the fetus encounters resistance from the soft tissues and muscles of the pelvic floor

What nursing intervention do women in the transition phase of labor need the most?

Positive reinforcement

Which action should the nurse encourage the client to do during the 2nd stage of labor?

Push with contractions & rest between them.

How do you measure the frequency of a contraction

Refers to how often contractions occur and is measured from the increment of one contraction to the increment of the next contraction

Caput succedaneum

Swelling of the soft tissue of the head

Which occurs as a result of contraction decrement?

The contraction intensity is decreasing. so, -blood flow to the fetus improves -FHR should return to baseline

What is descent

The downward movement of the fetal head until it is within the pelvic inlet

The nurse determines the client is experiencing fairly strong contractions at 12:05, 12:10, 12:15, and 12:20. what can the nurse conclude from these findings?

The frequency of contractions is every 5 minutes (changes in the cervix is necessary for active labor)

What is the peak or acme of a contraction

The highest intensity of a contraction

Engagement

The movement of the fetus into the pelvis from the upper uterus. this is the first cardinal movement of the fetus in preparation for the spontaneous vaginal delivery

The cervix and vaina are soft tissues that form

The passageway, known as birth canal

Extension

The state in which the fetal head is well flexed with the chin on the chest as the fetus travels through the birth canal

What is engagement

When the greatest transverse diameter of the head passes through the pelvic inlet

Documenting fetal position using abbreviations

first letter: "R" right or "L" left describes the side of the maternal pelvis toward which the presenting part is facing second letter: reference point "O" for occupy, "Fr" for frontum third letter: specifies whether the presenting part is facing the "A" anterior, "P" posterior or whether it is in a "T" transverse position

The nurse should instruct the woman to go to the health care facility based on the client's report of contractions that are:

occurring every 5 minutes. true labor contractions are usually felt in the lower back

Lightening

occurs when the fetal presenting part begins to descend into the maternal pelvis.

During the 2nd stage of labor, a woman is generally:

turning inward to concentrate on body sensations contractions are so unusual most women are unable to think of things other than what is happening inside their body

Which description is BEST when documenting an accurate client contraction

5 minutes apart and lasting 45 seconds

Hormone that is responsible for causing the pelvic connective tissue to become more relaxed and eslastic

Relaxin

Why is it important for the pauses to occur between contractions during labor

Restoration of blood flow to the uterus and placenta

The scapula of the fetus is the presenting part. the nurse interprets this finding as which fetal position?

Shoulder

Fetal lie

Term used to describe the position of the fetal long axis in relation to the long axis of the mother

Softening, thinning, and shortening of the cervical canal occurs during the 1st stage of labor

Term: Effacement

Frank breech position

The buttocks are presenting first with both legs extended up toward the face

Which client outcome during active and transitional labor is best?

The client will practice breathing techniques during contractions.