Chapter 14
Fetal position
Relationship of the presenting part to the maternal pelvis Written occiput or mentrum for cephalic, scapular acromion process (A) for breech
A nurse is caring for a client who has been administered an epidural block. Which should the nurse assess next?
Resting Respirations
At what time is the laboring client encouraged to push?
When the cervix is fully dilated
initiates cervical dilation
30 mmHG or higher
active labor intensity
50-80 mmHg
What is a late deceleration?
Starts after contraction Slow return to baseline Fetal hypoxia
The nurse determines that the fetal heart rate averages approximately 140 beats per minute over a 10-minute period. The nurse identifies this as:
baseline FHR.
A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage?
practicing effleurage on the abdomen
What is a FHR deceleration?
transient fall in the FHR
Vaginal fluid
Acidic
Fern Test
A tests used if the Nitrazine swab was inconclusive. The sample is obtained and looked at through a microscope. Look for fern pattern which indicates the presence of amniotic fluid.
Normal fetal heart rate
110-160 bpm
The nurse is preparing an educational event for pregnant women on the topic of labor pain and birth. The nurse understands the need to include the origin of labor pain for each stage of labor. What information will the nurse present for the first stage of labor?
Pain originates from the cervix and lower uterine segment.
A woman arrives in the labor and birth department and is panting and screaming "the baby is coming". What is the priority intervention by the nurse?
Quickly move the woman to a labor bed, and check the perineum. The woman is showing signs of advanced labor, possibly in transition or stage two. She needs to be managed as an imminent birth and taken directly to a room for vaginal assessment. Vital signs, medical/obstetrical history, and her room assignment can be taken care of later in the process.
A nurse is caring for woman in labor. The woman's membranes just ruptured. The nurse assesses the characteristics of the fluid. Which finding would the nurse identify as normal?
clear
The nurse is providing preoperative care for a client who will undergo a cesarean section. The nurse should
confirm that consent has been provided by the client.
The nurse is providing preoperative care for a client who will undergo a cesarean section. The nurse should:
confirm that consent has been provided by the client.
When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem?
prolonged decelerations Prolonged decelerations are associated with prolonged cord compression, abruptio placentae, cord prolapse, supine maternal position, maternal seizures, regional anesthesia, or uterine rupture. Variable decelerations are the most common deceleration pattern found. They are usually transient and correctable. Early decelerations are thought to be the result of fetal head compression. They are not indicative of fetal distress and do not require intervention. Fetal accelerations are transitory increases in FHR and provide evidence of fetal well-being.
What is a nursing intervention that helps prevent the most frequent side effect from epidural anesthesia in a pregnant client?
starting an IV and hanging IV fluids
Effacement
*0%: Cervical canal is 2cm long *50%: Cervical canal is 1cm long *100%: Cervical canal is obliterated
The nurse is assessing a new client who presents in early labor. The nurse determines the fetus has an acceptable heart rate if found within which range?
110 to 160 bpm
A gravida 1 client is admitted in the active phase of stage 1 labor with the fetus in the LOA position. The nurse anticipates noting which finding when the membranes rupture?
Clear to straw-colored
Psychological response
Clear, calm info Time - don't rush it Support Confidence Control - who's in the room How prepared is she?
Which intervention would be least effective in caring for a woman who is in the transition phase of labor?
encouraging the woman to ambulate
When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem?
prolonged decelerations
A client asks her nurse what effleurage means. After instruction is given, the nurse determines learning has taken place when the client states:
"Effleurage is light abdominal massage used to displace pain." Effleurage is a light abdominal massage used to keep the laboring woman's focus on the massage instead of the pain of labor.
The health care provider approves a labor plan which includes analgesia. The client questions how analgesia will help her pain during labor. Which answer is best?
"The analgesia will reduce the sensation of pain for a limited period of time."
The nurse is admitting a primigravida client who has just presented to the unit in early labor. Which response should the nurse prioritize to assist the client in remaining calm and cooperative during birth?
"The baby is coming. I'll explain what's happening and guide you."
An experienced nurse is mentoring a graduate nurse and critiquing the graduate's shift handoff. Which statement requires clarification?
"The client reports a pain level of 8. She has a low pain tolerance."
A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse?
"The injection is given in the space outside the spinal cord."
A woman asks the nurse if she can eat something during labor. Which response by the nurse would be best?
"You could have some hard candy to suck on." If women are kept NPO during labor, they can be administered anesthesia safely in an emergency. Stomach-emptying time is decreased.
A woman at 39 weeks gestation has been in labor for 8 hours and is asking how far she is dilated. She attended childbirth classes and is aware of the stages and phases of labor. She had a vaginal exam 30 minutes prior to her asking again. How should the nurse respond to her question?
"Your labor signs have not changed; we are looking for changes in your labor pattern before we check you again." "Your labor signs have not changed; we are looking for changes in your labor pattern before we check you again." The cervix must be assessed with a vaginal exam. The frequency of vaginal exams is based on the signs of changes in labor. The client has not demonstrated any changes in her labor pattern; the nurse should provide education on the reason for not checking her.
Dilation
*0cm: external cervical os is closed *5cm: external cervical os is halfway dilated *10cm: external cervical os is fully dilated and ready for birth passage.
Nalbuphine (Nubain)
*10-20mg IV* Causes less maternal nausea and vomiting. Causes decreased FHR variability, fetal bradycardia, and respiratory depression.
Diazepam (Valium)
*2-5mg IV* Is given to enhance pain relief of opioid and cause sedation. May be used to stop eclamptic seizures Decreases N/V Can cause newborn depression; therefore, lowest possible dose should be used.
Morphine
*2-5mg IV* Rapidly crosses the placenta, causes a decrease in FHR variability. Can cause maternal and neonatal CNS depression. Decrease uterine contractions.
A nurse practitioner is conducting an in-service education program for a group of nurses working in the labor and birth unit. The program is focusing on interpreting FHR patterns. The nurse practitioner determines that the teaching was successful when the group identifies which patterns as indicating abnormal fetal acid-base status? Select all that apply -fetal bradycardia -fetal tachycardia -sinusoidal pattern -recurrent late decelerations
-fetal bradycardia -sinusoidal pattern -recurrent late decelerations
The nurse assesses her client and notes that the fetus is at +1 station. The nurse interprets +1 station as indicating that the fetal presenting part is at
1cm below the ischial spine
A low-risk client is in the active phase of labor. The nurse evaluates the fetal monitor strip at 10:00 a.m. and notes the following: moderate variability, FHR in the 130s, occasional accelerations, and no decelerations. At what time should the nurse reevaluate the FHR?
1030
A low-risk client is in the active phase of labor. The nurse evaluates the fetal monitor strip at 10:00 a.m. and notes the following: moderate variability, FHR in the 130s, occasional accelerations, and no decelerations. At what time should the nurse reevaluate the FHR?
10:30 a.m.
The nurse tests the pH of fluid found on the vaginal exam and determines that the woman's membranes have ruptured based on which result?
6.5
The nurse tests the pH of fluid found on the vaginal exam and determines that the woman's membranes have ruptured based on which result?
6.5 Amniotic fluid is alkaline, so the membranes are probably ruptured if the pH ranges from 6.5 to 7.5.
pH of amniotic fluid
6.5-7.5
The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is:
7.15 or less.
The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is:
7.15 or less. In the hypoxic fetus, the pH will fall below 7.2, which is indicative of fetal distress.
A client states that "she thinks" her water has broken. Which best provides confirmation of the rupture of membranes?
A positive Nitrazine test
The nurse is assessing a laboring client and notes: 5 cm dilated, 80% effaced, zero station, contractions every 2 to 3 minutes, lasting 50 seconds, becoming increasingly uncomfortable, and apprehensive but appropriate and focused on breathing and relaxation. The nurse determines which nursing diagnosis is most appropriate for this client?
Acute pain related to uterine contractions
A pregnant patient received a narcotic analgesic 2 hours before delivery. The newborn is lethargic and difficult to arouse. What should the nurse prepare to do to help this newborn?
Administer naloxone hydrochloride.
A client in labor has requested the administration of narcotics to reduce pain. At 2 cm cervical dilatation, she says that she is managing the pain well at this point but does not want it to get ahead of her. What should the nurse do?
Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor.
Amniotic Fluid
Alkaline. Turns Nitrate Swab blue. If they have no ruptured the swab remains yellow to olive green.
Which statement is true regarding analgesia versus anesthesia?
Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area.
A primigravida client has just arrived in early labor and is showing signs of extreme anxiety over the birthing process. Why should the nurse prioritize helping the client relax?
Anxiety can slow down labor and decrease oxygen to the fetus
A primigravida client has just arrived in early labor and is showing signs of extreme anxiety over the birthing process. Why should the nurse prioritize helping the client relax?
Anxiety can slow down labor and decrease oxygen to the fetus.
Amniotomy
Artificial rupture of the membranes by an amnihook.
During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor?
Assess amount of cervical dilation. If vaginal bleeding is absent during admission assessment, the nurse should perform vaginal examination to assess the amount of cervical dilation. Hydration status is monitored as part of the physical examination. A urine specimen is obtained for urinalysis to obtain a baseline. Vital signs are monitored frequently throughout the maternal assessment.
As a woman enters the second stage of labor, her membranes spontaneously rupture. When this occurs, what would the nurse do next?
Assess fetal heart rate for fetal safety.
As a woman enters the second stage of labor, her membranes spontaneously rupture. When this occurs, what would the nurse do next?
Assess fetal heart rate for fetal safety. Rupture of the membranes may lead to a prolapsed cord. Assessment of FHR detects this.
The nurse is reviewing the medication administration record (MAR) of a client at 39 weeks' gestation and notes that she is ordered an opioid for pain relief. Which is an assessment priority after administering?
Assess fetal heart rate.
A client has been in labor for 10 hours and is 6 cm dilated. She has already expressed a desire to use nonpharmacologic pain management techniques. For the past hour, she has been lying in bed with her doula rubbing her back. Now, she has begun to moan loudly, grit her teeth, and bear down with each contraction. She rates her pain as 8 out of 10 with each contraction. What should the nurse do first?
Assess for labor progression.
contraction pattern every 15 minutes
Assess the contraction pattern every 15 minutes. The pattern will be similar to that found in the transition phase (i.e., contractions occur every two to three minutes, last 60 to 90 seconds, and are of strong intensity).
Priority Focus When Membranes Rupture
Assessing the FHR first to identify deceleration. Which may indicate Cord compression secondary to cord prolapse.
A nurse notes the digital readings of the electronic fetal monitor shows decreased beat-to-beat variability in a client who was just admitted to the unit. The nurse interprets this as indicating which system is mainly being affected in the fetus?
Central nervous system
The laboring client is on continuous fetal monitoring when the nurse notes a decrease in the fetal heart rate with variable deceleration to 75 bpm. What is the initial nursing intervention?
Change the position of the client. Variable decelerations often indicate a type of cord compression. The initial response is to change the position and try to release the cord compression. If this does not work, apply oxygen while using the call light to alert others. If this continues, her fluid status needs to be assessed before increasing her IV rate.
The nurse is assessing a woman in active labor. She notes a small mass above the symphysis pubis, rounded, distended, and nontender. What intervention should the nurse take next?
Check the chart for the last void. The most probable explanation of the mass is the bladder, which is full. The nurse should determine the last void by the client and offer to assist the client to void or prepare to catheterize the client to empty the bladder. This can be taken care of by the nurse. The client would not likely know if the mass was always present or not, given its location. If it were the uterus, it would be tender to the touch.
A nurse is caring for a client administered general anesthesia for an emergency cesarean birth. The nurse notes the client's uterus is relaxed upon massage. What would the nurse do next?
Continue to massage the client's fundus. The nurse should monitor the client for uterine relaxation. If this is noted, the nurse would continually massage the client's fundus until it no longer felt boggy.
The nursing instructor is preparing a class discussing the role of the nurse during the labor and birthing process. Which intervention should the instructor point out has the greatest effect on relieving anxiety for the client?
Continuous labor support
A patient in labor is prescribed transcutaneous electrical nerve stimulation (TENS) to help with pain relief during labor. How should the nurse explain the process of pain relief with this method?
Counterirritation stimulation blocks pain from traveling to the spinal cord.
Cephalic presentation
Desire Vertex
Which primary symptom does the nurse identify as a potentially fatal complication of epidural or intrathecal anesthesia?
Difficulty breathing
The nurse is monitoring a client in the first stage of labor. The nurse determines the client's uterine contractions are effective and progressing well based on which finding?
Dilation of cervix
A nursing student is learning about intermittent fetal heart rate monitoring during labor. The student correctly chooses which of the following as used routinely for this procedure? (Select all that apply.)
Doppler fetoscope fetal monitor Intermittent fetal heart rate ascultation uses fetoscope, Doppler, or fetal monitor. An intrauterine pressure catheter is inserted into a pocket of amniotic fluid and is a continuous internal monitoring of contractions.
Causes of fetal tachycardia
Early fetal hypoxia, maternal fever, maternal dehydration, beta-sympathomimetic drugs, amnionitis, maternal hyperthyroidism, fetal anemia
Transcutaneous electrical nerve stimulation (TENS) reduces pain by which of the following mechanisms?
Electrical impulses are created that interfere with nerve transmission.
The nursing instructor is teaching a group of nursing students about the uniqueness of pain involved with the birthing process. The instructor determines the session is successful when the students correctly choose which pain factor to be related to psychosocial influences?
Fear of pain during labor
A nurse notes a pregnant woman has just entered the second stage of labor. Which interaction should the nurse prioritize at this time to assist the client?
Encourage the woman to push when a strong desire to do so is present.
While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents?
FHR fluctuates from 6-25 beats per minute.
How does a woman who feels in control of the situation during labor influence her pain?
Feelings of control are inversely related to the client's report of pain.
Moderate Intensity
Feels like the chin
Strong Intensity
Feels like the forehead
Mild Intensity
Feels like the tip of the nose.
Breech presentation
Frank breech OK
Assessment of Contractions
Frequency Duration Intensity Uterine resting tone.
Causes of fetal bradycardia
Late fetal hypoxia, maternal hypotension, prolonged umbilical cord compression, fetal arrhythmia, uterina hyperstimulation, abruptio placentae, uterine rupture, vagal stimulation, congenital heart block, maternal hypothermia
Butorphanol (Stadol)
Given IV Q 2-4 hr. Rapidly transferred across the placenta. Causes neonatal respiratory depression.
Normal Uterine Contractions
Have a contraction (systole) and relaxation (diastole) phase. Resembles a wave that moves downward to the cervix and upward to the fundus of the uterus. Puts enormous pressure on fetus, thins and dilates the cervix
A client is in active labor. Checking the EFM tracing, the nurse notes variables that are abnormal. What would be the nurse's first nursing intervention?
Help the woman change positions
During contractions, the electronic fetal monitor (EFM) shows variable V-shaped decelerations in the FHR lasting about 30 seconds with accelerations of about 5 bpm before and after each deceleration. Overshoot is absent, and the baseline FHR is within normal limits. What should the nurse do first?
Help the woman change positions. Changing positions is a first intervention to determine if this will improve the oxygen to the fetus. Supplemental oxygen should be maintained until the mother is stable. Placing the client on her side may increase the work of breathing. Pharmacological interventions are premature.
Which of the following supports why a preterm fetus usually is more affected by medication given at birth than a full-term fetus?
Inability of the immature liver to metabolize or inactivate drugs
The nurse is assisting a client through labor, monitoring her closely now that she has received an epidural. Which finding should the nurse prioritize to the anesthesiologist?
Inability to push
Prolonged Rupture of Membranes
Increases the risk for infection to the mother and fetus due to ascending vaginal organisms.
Green Fluid
Indicates the fetus has passed Meconium due to fetal hypoxia.
A nurse is teaching a couple about patterned breathing during their birth education. Which technique should the nurse suggest for slow-paced breathing?
Inhale slowly through nose and exhale through pursed lips.
The nurse is caring for a client who appears tense and apprehensive as labor progresses. Which nursing intervention is most helpful?
Initiate comfort measures
A pregnant client has opted for hydrotherapy for pain management during labor. Which measure should the nurse consider when assisting the client during the birthing process?
Initiate the technique only when the client is in active labor. The recommendation for initiating hydrotherapy is that women be in active labor (>5 cm dilated) to prevent the slowing of labor contractions secondary to muscular relaxation. Women are encouraged to stay in the bath or shower as long as they feel they are comfortable. The water temperature should not exceed body temperature. The woman's membranes can be intact or ruptured.
Local anesthetic we use during labor for specific areas?
Lidocaine
There are advantages and disadvantages to any kind of method used to control pain during labor and birth. What is an advantage of opioid administration?
It can be administered by the nurse.
Fetal lie
LIE: relationship to the pelvis - longitudinal or transverse
The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's:
LLQ
A nurse places an external fetal monitor on a woman in labor. Which instruction would be best to give her?
Lie on her side so she is comfortable. The best position for all women during labor is on their side.
The nurse is monitoring a client who has given birth and is now bonding with her infant. Which finding should the nurse prioritize and report immediately for intervention?
Maternal tachycardia and dropping blood pressure
The nurse is admitting a client in early labor and notes: FHR 120 bpm, blood pressure 126/84 mm Hg, temperature 98.8oF, contractions every 4 to 5 minutes lasting 30 seconds, and greenish-color fluid in the vaginal vault. Which finding should the nurse prioritize?
Meconium in the fluid
General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks?
Neonatal depression is possible
General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks?
Neonatal depression is possible.
Fundus palpation for contraction intensity
Nose-mild contraction Chin-moderate contraction Forehead-strong contraction
Continuous Labor Support
Offering a sustained presence to the laboring woman by providing emotional support, comfort measures, advocacy, information and advice and support for the partner.
The nurse is caring for a client who is sent to the obstetric unit for evaluation of fetal well-being. At which location is the nurse correct to place the tocodynamometer?
On the uterine fundus
Leopold maneuver sequence
Palpate the fundus, determine location of fetal back, palpate fetal part presenting at the inlet, palpate the cephalic prominence to identify attitude of head.
A nurse is auscultating the fetal heart rate of a woman in labor. To ensure that the nurse is assessing the FHR and not the mother's heart rate, which action would be most appropriate for the nurse to do?
Palpate the mother's radial pulse at the same time.
5 P's
Pelvis, passenger, power (dilation/effacement/station), position (maternal), psychological response
A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage?
Practicing effleurage on the abdomen
The nurse is preparing to administer an intradermal water injection to a client who is in labor. Which action should the nurse prioritize?
Prepare four 1 mL syringes of 0.05 to 0.1 mL sterile water using a 25 gauge needle.
The nursing instructor is teaching a group of nursing students about the various responsibilities of the labor and delivery medical team. The instructor determines the session is successful when the students correctly choose which function as the primary role of the LPN/LVN members of the team?
Provide care under the supervision of an RN.
To assess the frequency of a woman's labor contractions, the nurse would time:
The beginning of one contraction to the beginning of the next
Fentanyl has been administered to a client in labor. What assessment should the nurse prioritize?
Respiratory status
While waiting for the placenta to deliver during the third stage of labor the nurse must assess the new mother's vital signs every 15 minutes. What sign would indicate impending shock?
Tachycardia and a falling blood pressure
The nurse is admitting a client who appears to be in advanced labor with imminent birth. Which action should the nurse prioritize?
Take blood pressure and determine if clonus or edema are present.
Nitrazine Swab
Taken from the vagina to determine the membranes have ruptured. It determines the ph. Can be false positive if too much bloody show due to presence of blood.
What is amnioinfusion?
Technique where warmed sterile saline or LR is introduced into the uterus via an intrauterine pressure catheter. Used intrapartally to increase the volume of fluid in oligohydramnios to alleviate cord compression, or to dilute moderate to heavy meconium released in utero by a stressed fetus.
Fetal Attitude
The arrival at the outlet. Desire full flexion, but may also see transverse lie and longitudinal lie
What is FHR variability?
The beat-to-beat fluctuations in FHR that are irregular in amplitude and frequency
The client may spend the latent phase of the first stage of labor at home unless which occurs?
The client experiences a rupture of membranes
Fetal station
The descent and arrangement entering the bony pelvis Use fetal head: fontanels to find placement 0 = when presenting at level of spines -1 = 1cm above ischial spines =2 = 2cm below ischial spines
During labor, a pregnant patient's doula uses therapeutic touch and massage. Which outcome indicates that these approaches have been effective?
The patient is not requesting pain medication.
Purpose of doing a vaginal exam during labor
The purpose of performing a vaginal examination is to assess the amount of cervical dilation, the percentage of cervical effacement, and the fetal membrane status and to gather information on presentation, position, station, degree of fetal head flexion, and presence of fetal skull swelling or molding
Which signs signify that the second stage of labor has begun?
The urge to push occurs. Second stage of labor is the pushing stage; this is typically identified by the woman's urge to push or a feeling of needing to have a bowel movement. The emotional state may be altered due to pain and pressure. Contraction frequency is variable and not clearly indicative of a particular stage. The fetus can be at stage -1 for any length of time.
The nurse is aware that cord compression is not continuous when variable decelerations occur and that compression happens when which of the following takes place?
The uterus contracts and squeezes the cord against the fetus. Cord compression is not continuous when variable decelerations are occurring. The compression occurs when the uterus contracts and squeezes the cord against the fetus. It is relieved when the uterus relaxes between contractions. Prematurity and fetal sleep will cause decreased or absent variabilty.
Which assessment finding is most important as labor progresses?
The uterus relaxes completely between contractions.
The pain of labor is influenced by many factors. What is one of these factors?
The woman is prepared for labor and birth.
The nurse instructs the client about skin massage and the gate-control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods?
This is a technique to prevent the painful stimuli from entering the brain.
The laboring client who is at 3 cm dilation and 25% effaced is asking for analgesia. The nurse explains the analgesia usually is not administered prior to the establishment of the active phase. What is the appropriate rationale for this practice?
This may prolong labor and increase complications.
The nursing instructor is teaching the students the basics of the labor and delivery process. The instructor determines the session is successful when the students correctly choose which action will best help to prevent infections in their clients?
Thoroughly wash the hands before and after client contact.
What is the most important thing a nurse can do during labor and birth to prevent maternal and fetal infection?
Thoroughly wash the hands before and after client contact. The most important infection control technique in any health care setting is thoroughly washing hands on routine basis. Keeping the area clean is secondary, but is also important.
Purpose of Vaginal Examination
To assess the amount of cervical dilation, the percentage of cervical effacement and the fetal membrane status.
A nurse is preparing a patient for rhythm strip testing. She places the woman into a semi-Fowler's position. What is the appropriate rationale for this measure?
To prevent supine hypotension syndrome The term "rhythm strip testing" means assessment of the fetal heart rate for whether a good baseline rate and long- and short-term variability are present. For this, help a woman into a semi-Fowler's position (either in a comfortable lounge chair or on an examining table or bed with an elevated backrest) to prevent her uterus from compressing the vena cava and causing supine hypotension syndrome during the test. Placing her in this position does not decrease the heart rate of the fetus. It is not done to aid the woman as she pushes in labor, as she is not in labor yet. It is not done to prevent her from falling out of bed.
If the monitor pattern of uteroplacental insufficiency were present, which action would the nurse do first?
Turn her or ask her to turn to her side. The most common cause of uteroplacental insufficiency is compression of the vena cava; turning the woman to her side removes the compression.
A nurse caring for a pregnant client in labor observes that the fetal heart rate (FHR) is below 110 beats per minute. Which interventions should the nurse perform? Select all that apply.
Turn the client on her left side. Administer oxygen by mask. Assess client for underlying causes.
A nurse caring for a pregnant client in labor observes that the fetal heart rate (FHR) is below 110 beats per minute. Which interventions should the nurse perform? Select all that apply.
Turn the client on her left side. Administer oxygen by mask. Assess client for underlying causes. The nurse should turn the client on her left side to increase placental perfusion, administer oxygen by mask to increase fetal oxygenation, and assess the client for any underlying contributing causes. The client's questions should not be ignored; instead, the client should be reassured that interventions are to effect FHR pattern change. A reduced IV rate would decrease intravascular volume, affecting the FHR further.
The nurse is caring for a client who prefers resting on her back during the labor process. To facilitate client wishes, which nursing action is required?
Utilize a wedge under one hip
What is VEAL CHOP?
Variable - Cord compression Early - Head Compression Acceleration - Okay Late - Placental insufficiency
What is a prolonged deceleration?
Visually apparent decrease in the FHR below baseline that lasts at least 2 minutes but less than 10.
What do we need to assess for the mother during labor?
Vital signs and a vaginal exam, along with health hx/prenatal record
Fetal presentation
What's coming to the outlet first - cephalic or breech
Preparation
Woman needs childbirth classes to help them cope with pain. Patients need to acquire skills to cope with labor discomfort. Don't have patient eat big meals, gastric motility and food absorption decrease --> she'll vomit
What is an early deceleration?
a deceleration that declines as the contractions starts but returns to Baseline before the contraction is over.
How can we assess FHR?
a fetoscope (a modified stethoscope attached to a headpiece) or a Doppler (ultrasound) device, or continuously with an electronic fetal monitor applied externally or internally
The expected fetal heart rate response in an active fetus is:
acceleration of at least 15 bpm for 15 seconds. A reassuring active fetal heart rate is a change in baseline by increase of 15 bpm for 15 seconds. This is a positive and reassuring periodic change in fetal heart rates as a response to fetal movement.
The nurse is reviewing the uterine contraction pattern and identifies the peak intensity, documenting this as which phase of the contraction?
acme
The nurse is reviewing the uterine contraction pattern and identifies the peak intensity, documenting this as which phase of the contraction?
acme The acme is the peak intensity of a contraction. The increment refers to the building up of the contraction. The decrement refers to the letting down of the contraction. Diastole refers to the relaxation phase of a contraction.
The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy?
acupressure
The nurse is assessing a laboring client and notes: 5 cm dilated, 80% effaced, zero station, contractions every 2 to 3 minutes, lasting 50 seconds, becoming increasingly uncomfortable, and apprehensive but appropriate and focused on breathing and relaxation. The nurse determines which nursing diagnosis is most appropriate for this client?
acute pain related to uterine contractions
The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next?
admin of O2 by mask
The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next?
administration of O2 mask
The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next?
administration of oxygen by mask
The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next?
administration of oxygen by mask The client should be administered oxygen by mask because the abnormal FHR pattern could be due to inadequate oxygen reserves in the fetus. Because the client is in preterm labor, it is not advisable to apply vibroacoustic stimulation, tactile stimulation, or fetal scalp stimulation.
A client in the latent phase of the first stage of labor is noted to be uncomfortable with intact membranes and mild contractions on assessment. The nurse should encourage the client to pursue which action?
ambulation ad lib
A client is in the first stage of labor, latent phase. Her membranes are intact, and her contractions are mild. Considering the client's condition and phase of labor, the nurse knows that which aid will facilitate labor?
ambulation ad lib To facilitate the first stage of labor, ambulation and movement will allow better fetal descent and help to speed the labor process. Bed rest will slow or stop the labor process. The client may use the bathroom as needed, but this does not affect labor rate. The client should remain mobile.
A primigravida client has just arrived in early labor and is showing signs of extreme anxiety over the birthing process. Why should the nurse prioritize helping the client relax?
anxiety can slow down labor and decrease oxygen to the fetus.
During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor?
assess amount of cervical dilation
key assessment during membrane rupture
assessing fetal heart rate (FHR) first to identify a deceleration, which might indicate cord compression secondary to cord prolapse.
in a breech position the fetal heart rate is best heard
at or above the level of the maternal umbilicus
The client and her partner have prepared for a natural birth and bring a picture of a sunset over the ocean with them. The nurse predicts they will be using which technique during labor?
attention focusing
Baseline FHR
average FHR range of 110-160 beats/min at term as assessed during a 10-minute period that excludes periodic and episodic changes and periods of marked variability Excludes accels/decels
The nurse determines that the fetal heart rate averages approximately 140 beats per minute over a 10-minute period. The nurse identifies this as:
baseline FHR. The baseline FHR averages 110 to 160 beats per minute over a 10-minute period. Fetal bradycardia occurs when the FHR is less than 110 beats per minute for 10 minutes or longer. Short-term variability is the beat-to-beat change in FHR. Baseline variability refers to the normal physiologic variations in the time intervals that elapse between each fetal heartbeat observed along the baseline in the absence of contractions, decelerations, and accelerations.
Normal color of amniotic fluid
clear
Which intervention has been demonstrated to reduce the release of catecholamines and anxiety, and has resulted in better birth outcomes for women?
continuous labor support Continuous labor support has been demonstrated to result in better labor outcomes in the current research. Continuous labor support is defined as caring for the labor patient by a nurse, doula, or primary support person who does not leave the client. Massage therapy is effective in that it engages gate control. Pharmacological interventions are useful but pose potential side effects to the mother and fetus. Hypnosis is less well understood.
A client is now in the second stage of labor. While doing the assessment, the nurse would gather what data at this time?
contraction pattern every 15 minutes Assess the contraction pattern every 15 minutes. The pattern will be similar to that found in the transition phase (i.e., contractions occur every two to three minutes, last 60 to 90 seconds, and are of strong intensity).
A client is now in the second stage of labor. While doing the assessment, the nurse would gather what data at this time?
contraction pattern every 15min.
A 39-week-gestation client presents to the labor and birth unit reporting abdominal pain. What should the nurse do first?
determine if the client is in true or false labor.
fourth maneuver
determines fetal attitude (flexion or extensions) use tips of 3 fingers to palpate the abdomen, finger tips facing downwards.
third maneuver
determines presentation palpate area above pubis symphisis
The nurse explains Leopold's maneuvers to a pregnant client. For which purposes are these maneuvers performed? Select all that apply.
determining the presentation of the fetus determining the position of the fetus determining the lie of the fetus Leopold maneuvers help the nurse to determine the presentation, position, and lie of the fetus. The approximate weight and size of the fetus can be determined with ultrasound sonography or abdominal palpation.
What are Leopold maneuvers for?
determining the presentation, position, and lie of the fetus through the use of four specific steps
When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive assessment that uterine contractions are effective would be:
dilatation of cervix. The best determination of effective contractions is dilation of the cervix. Engagement, membrane rupture, and bloody show may all occur before the cervix has dilated.
A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as:
effleurage
A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency?
every 15 minutes During the first hour of the fourth stage of labor, the nurse would assess the woman's fundus every 15 minutes and then every 30 minutes for the next hour.
When planning the care of a woman in the active phase of labor, the nurse would anticipate assessing the fetal heart rate at which interval?
every 15 to 30 minutes During the active phase of labor, FHR is monitored every 15 to 30 minutes. FHR is assessed every 30 to 60 minutes during the latent phase of labor. The woman's temperature is typically assessed every 4 hours during the first stage of labor and every 2 hours after ruptured membranes. Blood pressure, pulse, and respirations are assessed every hour during the latent phase and every 30 minutes during the active and transition phases. Contractions are assessed every 30 to 60 minutes during the latent phase, every 15 to 30 minutes during the active phase, and every 15 minutes during transition.
A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency?
every 15min
The nurse is assessing the laboring client to determine fetal oxygenation status. What indirect assessment method will the nurse likely use?
external electronic fetal monitoring Analysis of the FHR using external electronic fetal monitoring is one of the primary evaluation tools used to determine fetal oxygen status indirectly. Fetal pulse oximetry measures fetal oxygen saturation directly and in real time. It is used with electronic fetal monitoring as an adjunct method of assessment when the FHR pattern is abnormal or inconclusive. Fetal scalp blood is obtained to measure the pH. The fetal position can be determined through ultrasonography or abdominal palpation but is not indicative of fetal oxygenation.
As a woman enters the second stage of labor, which would the nurse expect to assess?
feelings of being frightened by the change in contractions
A pregnant client in her 32nd week of gestation has been admitted to a health care center reporting decreased fetal movement. What should the nurse determine first before placing the fetoscope on the woman's abdomen, so as to auscultate the fetal heart sounds?
fetal back The nurse assessing the client should first determine the fetal back before placing the fetoscope on the client's abdomen. The fetal back is determined first because it is through the back that the heart signals are best transmitted. During labor, the fetal heart rate should be assessed to check for any variations indicating distress. Fetal heart rate is auscultated by placing a fetoscope on the client's abdomen in the area of the fetal back. Determining the fetal head, shoulders, and the buttocks would be of no help in localizing the heart sounds.
If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which pattern would the nurse anticipate seeing on the monitor?
fetal heart rate declining late with contractions and remaining depressed
If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which pattern would the nurse anticipate seeing on the monitor?
fetal heart rate declining late with contractions and remaining depressed Lack of blood supply to the fetus because of poor placental filling prevents the fetal heart rate from recovering immediately following a contraction.
A nurse is monitoring a fetal heart rate (FHR) pattern on her client in labor. The earlier baseline FHR was 140. The FHR now is 168. The nurse knows that which factors can affect changes in the FHR? Select all that apply.
fetal movement fetal distress maternal fever An increase in the FHR from baseline can mean that there is some type of fetal distress. This can happen with a maternal fever also. Narcotics may affect the heart rate variability but not the baseline FHR. Fetal movement can cause an increase in FHR, and utero-placental insufficiency can cause late decelerations in the FHR.
The nurse is admitting a client who is in early labor. After determining that the birth is not imminent, which assessment should the nurse perform next?
fetal status
when does the fetal membrane typically rupture?
first stage of labor
A pregnant client with a history of spinal injury is being prepared for a cesarean birth. Which method of anesthesia is to be administered to the client?
general anesthesia General anesthesia is administered in emergency cesarean births. Local anesthetic is injected into the superficial perineal nerves to numb the perineal area generally before an episiotomy. Although an epidural block is used in cesarean births, it is contraindicated in clients with spinal injury. Regional anesthesia is contraindicated in cesarean births.
A client is being admitted to labor and birth. When admitting an obstetric client in early labor, the first intervention by the nurse is:
good rapport is established with the client and significant other. On admission the client and her family need to establish a rapport with their caregiver. If the client is stable and there is no immediate need, rapport should be established over actions that can be taken care of later.
In providing culturally competent care to a laboring woman, which is a priority?
identify how the client expresses labor pain.
The labor and delivery nurse knows that internal monitoring during labor is an invasive technique. She correctly identifies an increase in the risk of which of the following for both mother and fetus if this is done?
infection Because internal monitoring techniques are invasive, both the woman and the fetus can become ill with infection. Internal methods should be used only when the benefit clearly outweighs the risk.
The nurse is monitoring a client's uterine contractions. Which factors should the nurse assess to monitor uterine contraction? Select all that apply.
intensity of contractions frequency of contractions uterine resting tone The nurse should assess the frequency of contractions, intensity of contractions, and uterine resting tone to monitor uterine contractions. Monitoring changes in temperature and blood pressure is part of the general physical examination and does not help to monitor uterine contraction.
What is an epidural?
is a numbing medicine given by injection (shot) in the back. It numbs or causes a loss of feeling in the lower half your body. This lessens the pain of contractions during childbirth
A nurse recommends to a client in labor to try concentrating intently on a photo of her family as a means of managing pain. The woman looks skeptical and asks, "How would that stop my pain?" Which explanation should the nurse give?
it distracts you from the sensations of pain.
A patient is admitted to the labor and delivery unit. Upon examination, she is found to be dilated 3 cm. The nurse notes that the woman is having contractions that last about 45 seconds and are about 5 minutes apart. Based on this information, in which phase of labor is this patient?
latent phase Contractions during the latent phase of labor are typically 5 to 10 minutes apart and last 30 to 45 seconds. The cervix is dilated 1 to 3 cm, and effacement begins.
The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's:
left lower quadrant.
The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's:
left lower quadrant. The best position to auscultate fetal heart tones in on the fetus back. In this position, the best place for the FHR monitor is on the left lower quadrant.
A nurse is required to obtain the fetal heart rate (FHR) for a pregnant client. If the presentation is cephalic, which maternal site should the nurse monitor to hear the FHR clearly?
lower quadrant of the maternal abdomen In a cephalic presentation, the FHR is best heard in the lower quadrant of the maternal abdomen. In a breech presentation, it is heard at or above the level of the maternal umbilicus.
Adverse effects of an epidural
maternal hypotension, fetal bradycardia, inability to feel the urge to void, loss of the bearing down reflex, prolonged 2nd stage, catheter migration (respiratory distress if it goes up), maternal fever, hot spots, bladder distention
green amniotic fluid
may indicate that the fetus has passed meconium secondary to transient hypoxia, prolonged pregnancy, cord compression, intrauterine growth restriction (IUGR), maternal hypertension, diabetes, or chorioamnionitis normal if baby is in breech position = meconium
The nurse notes that a client's amniotic fluid is green when the membranes rupture. What finding would the nurse document?
meconium in the amniotic sac Green tinted fluid with ROM is indicative of meconium in the amniotic sac, or the infant having a bowel movement in utero. Infection would be shown by pus or cloudy fluid. Umbilical cord prolapse occurs when pressure on the cord stops the flow of oxygen to the fetus. Amniotic embolism results when amniotic fluid enters circulation.
The nurse is assessing a client in labor for pain and notes she is currently not doing well handling the increased pain. Which opioid can the nurse offer to the client to assist with pain control?
meperidine
leopold maneuveurs
method for determining the presentation, position, and lie of the fetus through the use of four specific steps. -a longtiudinal lie is expected -position can be cephalic, breech, or shoulder. Maneuver 1: What fetal part (head or buttocks) is located in the fundus (top of the uterus)? Maneuver 2: On which maternal side is the fetal back located? (Fetal heart tones are best auscultated through the back of the fetus.) Maneuver 3: What is the presenting part? Maneuver 4: Is the fetal head flexed and engaged in the pelvis?
goal of FHR monitoring
mortality and morbidity by ensuring that all fetal hypoxic insults are identified in time to allow removal or alteration of the reason for them, or to enable a safe birth of the fetus before irreversible asphyxia damage occurs
second manuever
move hands down the lateral sides of the abdomen to palpate on which side the back is located (feels hard and smooth). continue to determine where limbs are locates
A client has asked that an opioid be kept on standby in case she needs it for pain control. As a precaution, the nurse will also have which of medication readily available to reverse the effects of that opioid?
naloxone
A nurse is auscultating the fetal heart rate of a woman in labor. To ensure that the nurse is assessing the FHR and not the mother's heart rate, which action would be most appropriate for the nurse to do?
palpate the mothers radial pulse at the same time
A patient who is in her 9th month of pregnancy comes to the emergency department and reports that bright red blood is coming from her vagina. She denies having any pain. What needs to be ruled out before a vaginal examination can be performed?
placenta previa Vaginal examinations should never be done if the woman presents with bright red painless bleeding until placenta previa is ruled out. The other options would not be concerns at this time based on the findings.
t or f: During intermittent auscultation to establish a baseline, the FHR is assessed for a full minute after a contraction. From then on, unless there is a problem, listening for 30 seconds and multiplying the value by two is sufficient.
true
A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency?
q15min
uterine contraction
resembles a wave, moving downward to cervix and upward towards uterus
A nurse is caring for a client who has been administered an epidural block. Which should the nurse assess next?
respiratory rate
A nurse is caring for a client who has been administered an epidural block. Which should the nurse assess next?
respiratory rate The nurse must monitor for respiratory depression. Monitoring the client's respiratory rate will be the best indicator of respiratory depression.
Labor
rhythmic, regular contractions (5 min) with cervical change Heart rate increases 10-20bmp, RR increase CO increases 12-31% first stage, 50% second stage BP increases up to 35% WBC count increases as muscle is getting damaged
A pregnant client requires administration of an epidural block for management of pain during labor. For which conditions should the nurse check the client before administering the epidural block? Select all that apply.
spinal abnormality hypovolemia coagulation defects The nurse should check for any abnormality of the spine, hypovolemia, or coagulation defects in the client. An epidural is contraindicated in women with these conditions. Varicose veins and skin rashes or bruises are not contraindications for an epidural block. They are contraindications for massage used for pain relief during labor.
A nurse is providing care to a woman during the third stage of labor. Which finding would alert the nurse that the placenta is separating?
sudden gush of dark blood from the vagina Signs that the placenta is separating including a firmly contracting uterus, a change in uterine shape from discoid to globular ovoid, a sudden gush of dark blood from the vaginal opening, and lengthening of the umbilical cord protruding from the vagina.
While waiting for the placenta to deliver during the third stage of labor the nurse must assess the new mother's vital signs every 15 minutes. What sign would indicate impending shock?
tachycardia and a falling blood pressure Monitor the woman's vital signs at least every 15 minutes during the third stage of labor. Tachycardia and a falling blood pressure are signs of impending shock; the nurse should immediately report these signs.
A woman presents in advanced labor, and birth appears imminent. What is the most important and appropriate aspect of admission for this woman?
taking her blood pressure and determining whether clonus or edema is present In advanced labor the most important assessments must be completed first. The assessment for signs or symptoms of preeclampsia must be assessed first. The history can be obtained after the birth of the baby or if labor slows down. Plans for the newborn can be figured out later. Blood tests can be run as soon as a sample can be taken from the mother.
To assess the frequency of a woman's labor contractions, the nurse would time:
the beginning of one contraction to the beginning of the next.
During labor, a pregnant patient's doula uses therapeutic touch and massage. Which outcome indicates that these approaches have been effective?
the patient is not requesting pain medication
The nurse is caring for a client who has been in labor for the past 8 hours. The nurse determines that the client has transitioned into the second stage of labor based on which sign?
the urge to push occurs
A nurse is preparing a patient for rhythm strip testing. She places the woman into a semi-Fowler's position. What is the appropriate rationale for this measure?
to prevent supine hypotension syndrome
A nursing student is studying labor and delivery and has learned that the first stage of labor consists of which of the following phases? (Select all that apply.)
transition active latent The first stage of labor includes three phases: latent, active, and transition.
t or f: If the hands do not move together and stop because of resistance, the fetal head is engaged into the woman's pelvic inlet
true
While caring for a woman in labor, the nurse notes that the fetal heart monitor demonstrates late decelerations. The most common cause for their occurrence is:
uteroplacental insufficiency. Late decelerations are associated with uteroplacental insufficiency. They typically indicate decreased blood flow to the uterus during the contractions. Maternal hypotension and fatigue would not be observed on the fetal heart monitor. Cord compression would be marked by fetal tachycardia.
Adverse effects of opioids
• nausea and vomiting • drowsiness • Itching • constipation RESPIRATORY DEPRESSION
What is a spinal block?
injection of a local agent into the subarachnoid space, similar to an epidural. Mainly used for scheduled c/s
Promethazine (Phenergan)
*25-50mg IV* Is used for antiemetic effect when combined with opioids. Causes sedation and reduces apprehension. May contribute to maternal hypotension and neonatal depression.
Meperidine (Demerol)
*25-75mg IV* Can cause CNS depression Decreases fetal variability
Prochlorperazine (Compazine)
*5-10mg IV or IM* Frequently given with morphine sulfate for sleep during prolonged latent phase; counteracts the nausea that opioids can produce.
Hydroxyzine (Vistaril)
*50-100 mg IM* Does not relieve pain but reduces anxiety and potentiates opioid analgesic effects; can not be given IV is used to decrease N/V
Fentanyl (Sublimaze)
*50-100mcg IV Or Epidurally Can cause maternal Hypotension, Maternal and fetal respiratory depression. Rapidly crosses the placenta.
A G3 P2 with no apparent risk factors presents to the labor-and-delivery suite in early labor. She refuses the fetal monitor, stating she delivered her second baby at home without a monitor and everything went well. What is the nurse's best response?
A few minutes on the monitor will ensure the baby is doing well and then the baby can then be monitored intermittently.
The nurse is preparing a birthing care plan for a pregnant client. Which factor should the nurse prioritize to achieve adequate pain relief during the birthing process?
Client priorities and preferences are incorporated into the plan.
A nurse is teaching a couple about patterned breathing during their birth education. Which technique should the nurse suggest for slow-paced breathing?
Inhale slowly through nose and exhale through pursed lips. For slow-paced breathing, the nurse should instruct the woman to inhale slowly through her nose and exhale through pursed lips. In shallow or modified-pace breathing, the woman should inhale and exhale through her mouth at a rate of 4 breaths every 5 seconds. In pattern-paced breathing, the breathing is punctuated every few breaths by a forceful exhalation through pursed lips. Holding the breath for 5 seconds after every three breaths is not recommended in any of the three levels of patterned breathing.
When teaching the pregnant patient about self-medicating for pain during labor, why did the nurse instruct the patient to avoid taking acetylsalicylic acid?
interference with blood coagulation with increased risk of bleeding in mother or infant.
What is the normally accepted fetal heart rate range?
110-160 bpm The standard acceptable fetal heart rate baseline is the range of 110-160 beats per minute. Sustained heart rates above or below the norm are cause for concern.
Stages of Labor
1: onset -> 10cm dilated 2: 10cm -> baby 3: baby -> placenta 4: placenta -> 2-4hrs PP, depending on facility
Sources of Discomfort
*Tissue Ischemia (tissue hypoxia, uterus) *Cervical Dilation *Pelvic Structures *Distention of the Vagina
A client is in the active phase of labor. She is a low-risk client. The nurse evaluates the fetal monitor strip at 10:00 a.m. Moderate variability is present. The FHR is in the 130s with occasional accelerations, no decelerations. At what time does the nurse need to reevaluate the FHR?
10:30 a.m. Assess and document fetal status at least every 30 minutes. Record the baseline FHR every 30 minutes and evaluate the fetal monitor tracing for abnormal patterns. Variability should be present, except for brief periods of fetal sleep or when the mother receives narcotics or other selected medications, and no late decelerations should be present. Accelerations of the FHR are normal.
A nurse practitioner is conducting an in-service education program for a group of nurses working in the labor and birth unit. The program is focusing on interpreting FHR patterns. The nurse practitioner determines that the teaching was successful when the group identifies which patterns as indicating abnormal fetal acid-base status? Select all that apply.
fetal bradycardia sinusoidal pattern recurrent late decelerations
If the monitor pattern of uteroplacental insufficiency were present, which action would the nurse do first?
Turn her or ask her to turn to her side
The spouse of a pregnant patient is concerned about the risk of paralysis from an epidural block being used during labor. How should the nurse respond to the spouse's concern?
"The injection is given in the space outside the spinal cord."
A client in the first stage of labor is admitted to a health care center. The nurse caring for the client instructs her to rock on a birth ball. The nurse informs her that this causes the release of certain natural substances, which reduces the pain. To which substance is the nurse referring?
endorphins The nurse is referring to the release of endorphins, which are natural analgesic substances released by the movement of the client on the birth ball. The nurse should encourage the client to rock or sit on the birth ball. This causes the release of endorphins. The client's movement on the birth ball does not produce prostaglandins, progesterone, or relaxin. Prostaglandins are local hormones that bring about smooth muscle contractions in the uterus. Progesterone is a hormone involved in maintaining pregnancy. Relaxin is a hormone that causes backache during pregnancy by acting on the pelvic joints.
