Mom & Baby (Intrapartum)

Late decelerations

A decrease in fetal heart rate begins at the end of the contraction and doesn't return to baseline until the contraction is over. Late decelerations are associated with uteroplacental insufficiency, shock, or fetal metabolic acidosis.

Gestational hypertension

A high blood pressure (like 146/90) may indicate this problem. This reduces blood flow to the placenta and can cause intrauterine growth restriction and other problems that make the fetus less able to tolerate the stress of labor.

A client in active labor reveals meconium-stained amniotic fluid and fetal heart sounds in the upper right quadrant. What is the most likely cause of this situation?

Breech position.

Fetal reaction to amniotomy

Check the fetal heart rate for bradycardia. After a client has an amniotomy, the nurse should ensure that the cord is not prolapsed, and that the fetus tolerated the procedure well. The most effective way to do this is to check the fetal heart rate.

What will contractions be like for a laboring client who is started on oxytocin?

Contractions will be stronger and more uncomfortable and will peak more abruptly.

HELLP syndrome

Hemolysis, elevated liver enzymes, an low platelet count.

Adverse reaction (maternal and fetal) to epidural anesthetic

Hypotensive crisis, which is characterized by maternal hypotension, and fetal and maternal bradycardia (not tachycardia).

Why must the nurse monitor the client's fluid intake and output closely during oxytocin administration?

Oxytocin causes water intoxication. Prolonged oxytocin infusion may cause severe water intoxication, leading to seizures, coma, and death.

a client who is attempting a trial of labor (attempt a vaginal birth after cesarean) has contractions that are 1.5 minutes apart with a duration 75 to 90 seconds. The client reports a "sharp, tearing" pain, and the electronic fetal monitor is no longer recording contractions. What is the priority nursing action?

Prepare for an emergency cesarean birth as a sharp, tearing pain along with absence of contractions on the EFM indicate a uterine rupture, which is an extreme emergency.

A nurse notes an FHR of 190 beats/min. The client states her baby has been extremely active. Uterine contractions are strong, occurring every 3 to 4 minutes and lasting 40 to 60 seconds. Which piece of data would indicate fetal hypoxia?

excessive fetal activity and fetal tachycardia

Reiki as an alternative therapy during intrapartum period

This is considered energy from light touch. Reiki is based on the principle that energy from hands being placed lightly on or at a distance from the body can be used to heal.

What fetal monitoring reading suggests umbilical cord compression?

Variable decelerations are decreases in fetal heart rate that aren't related to the timing of contractions. Characteristic of umbilical cord compression, variable decelerations generally occur as drops of 10 to 60 beats/minute below the baseline.

A primigravid client has just completed a difficult, forceps-assisted birth of a 9-lb (4.08-Kg) neonate. Her labor was unusually long and required oxytocin augmentation. The nurse who's caring for her should stay alert for uterine...

atony A large fetus, extended labor, stimulation with oxytocin, and traumatic birth commonly are associated with this development, which may lead to postpartum hemorrhage.

A client in labor is attached to an electronic fetal monitor (EFM). Which finding by an EFM indicates adequate uteroplacental and fetal perfusion?

fetal heart rate variability within 5 to 10 beats/minute Fetal heart rate variability most reliably indicates uteroplacental and fetal perfusion; an average variability of 5 to 10 beats per minute is considered normal.

The nurse is caring for a client at 36 weeks' gestation with a temperature of 101.2°F (38.4°C). Examination indicates that the client is leaking amniotic fluid. What is the nurse's priority concern based on these findings?

intrauterine infection Premature membrane rupture creates an open port for intrauterine infection, indicated by an elevated temperature.

After the client's death, the nursing staff displays many emotions. With whom should the nurse-manager consult to help the staff cope with this unexpected death?

Chaplain, because his educational background includes strategies for handling grief

Laboring client with genital herpes

In this situation, cesarean birth helps avoid infection transmission to the neonate, which would occur during a vaginal birth.

Sign that placental detachment is occurring

An abrupt lengthening of the cord.