NUR 158, Ch 13, Labor and Birth process

Lightening can occur:

1. Primipara @ 2 weeks b4 labor 2. Multi: rt at labor

The nurse is measuring a contraction from the beginning of the increment to the end of the decrement for the same contraction. She would document this as which finding?

Duration Duration refers to how long a contraction lasts and is measured from the beginning of the increment to the end of the decrement for the same contraction. Intensity refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine catheter. Frequency refers to how often contractions occur and is measured from the increment of one contraction to the increment of the next contraction. The peak or acme of a contraction is the highest intensity of a contraction.

What can happen b4 the cervix is dilated?

Engagement, membrane rupture, and bloody show may all occur before the cervix has dilated.

Passenger

Fetus and Placenta

adverse effects of lorazepam

INC sedation

Psychological response

She should have clear info about procedures, Support, sense of mastery, trust in staff caring for her, Control over breathing, prepare for childbirth experiences

what is the best determination of effective ctx

dilation of cervix

A woman is told she has an anthropoid pelvis. This means her pelvis

is narrow transversely. Explanation: A gynecoid pelvis is the best shape for childbearing. An anthropoid pelvis is usually narrow. A "male" pelvis is termed an "android pelvis."

There are four essential components of labor. The first is the passageway. It is composed of the bony pelvis and soft tissues. What is one component of the passageway?

Cervix Explanation: The cervix and vagina are soft tissues that form the part of the passageway known as the birth canal.

The skull is the most important factor in relation to the labor and birth process. 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 Explanation: The cartilage between the bones allows the bones to overlap during labor, a process called molding that elongates the fetal skull thereby reducing the diameter of the head.

When teaching a group of nursing students about uterine contractions, which of the following would the instructor include as a typical feature?

Retracting of the lower segment Explanation: The nurse should identify retraction of the lower segment of the uterus as a feature of typical uterine contractions. As labor progresses the uterine contractions become stronger. The upper segment of the uterus contracts more actively than the lower segment. The lower segment retracts, pulling up the cervix. The upper segment thickens with time and the lower segment thins.

What are the signs that the 2nd stage has begun?

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.

A post delivery CBC has noted an elevated WBC count of 22,000/mm3. Which rationale is accurate regarding the elevated WBC count?

This is a normal variation due to stress of labor Explanation: An elevation of WBC up to 30,000mm/3 can be normal variation for any woman after delivery. This is related to the stress on her body from labor and delivery. Antibiotics are not indicated as this is a normal response to intense stress. The increase in WBC is not related to cesarean birth. Retesting would be wasteful as it is known that this is a normal response to any stress.

Passageway

birth canal

Powers

contractions

patho of braxton hicks ctx

help softening and ripen the cervix

Within the first hour after birth, the nurse would expect to find the woman's fundus:

At the level of the umbilicus Explanation: After birth, the fundus is located midline between the umbilicus and symphysis pubis but then slowly rises to the level of the umbilicus during the first hour after birth. Then the uterus contracts, approximately 1 cm (or fingerbreadth) each day after birth.

A nurse is performing a physical assessment of a woman in labor. As part of her assessment, she examines the outer and inner surfaces of her lips. What is the best rationale for this assessment?

Detection of herpes virus infection Explanation: Examine the outer and inner surfaces of her lips carefully to detect herpes lesions (pinpoint vesicles on an erythematous base). Report to her primary care provider if herpetic lesions are present anywhere because although oral lesions are invariably a type I herpes virus (common cold sores), type II (genital) herpes virus needs to be identified as this can be lethal to newborns; a woman primary health care provider may suggest the woman with oral herpes lesions take isolation precautions such as not kissing her newborn until the lesions crust. Be certain to palpate for enlargement of neck lymph nodes to detect the possibility of a respiratory infection. Inspect the mucous membrane of her mouth and the conjunctiva of her eyes for color to see if paleness suggests anemia. Auscultate the woman's lungs to be certain they are clear of rales.

The nurse is teaching a prenatal class the signs and symptoms of true labor. Identify the appropriate response by the class that shows an understanding of true labor contractions.

Increase even if I relax and take a shower. Explanation: True labor contractions do not stop; they continue and strengthen, as well as increase in frequency. If the contractions subside while taking a shower or relaxing, then they are not labor contractions. The discomfort over the top of the uterus is normal for full term pregnancy.

Factors that affect the process of labor/birth:

Passageway Passenger Powers Position Psychological response

Positions

she should move around

Assessment reveals that a woman's cervix is approximately 1 cm in length. The nurse would document this as:

50% effaced Explanation: A cervix 1 cm in length is described as 50% effaced. A cervix that measures approximately 2 cm in length is described as 0% effaced. A cervix 1/2 cm in length would be described as 75% effaced. A cervix 0 cm in length would be described as 100% effaced.

true contractions

*Begin irregularly but become regular and predictable • Felt first in lower back and sweep around to the abdomen in a wave • Increase in duration, frequency, and intensity

The order of labor?

1. cervix dilates 2 cm 2. fully effaced 3. fetus descend 4. crowning 5. placental sep 6. placental expulsion

Spontaneous Rupture of Membrane

1. infection 2. prolapsed cord if engagement has not occured (entrance of largest diameter of the fetal presenting part, usually the fetal head, into smallest diameter of maternal pelvis

engagement occurs

1. prima: 2 weeks b4 term 2. several weeks b4 onset of labor or not until labor begins

A nurse is educating a group of nursing students about the molding of the fetal skull during the birth process. Which of the following would the nurse include as the usual cause of molding?

Poorly ossified cranial vault Explanation: Molding is an adaptive process in which there is overriding and movement of the bones of the cranial vault to adapt to the maternal pelvis. The poorly ossified bones of the cranial vault, along with loosely attached membranous attachments, allow for the process of molding in the fetal skull. The bones of the face and the base of the skull are completely ossified and united. Hence they cannot allow for movement or overriding. The membranous attachments are loosely bound to the cranial vault and not tightly, which allows for molding of the fetal skull.

A client in the third stage of labor has experienced placental seperation and expulsion. Why is it necessary for a nurse to massage the woman's uterus briefly until it is firm?

To constrict the uterine blood vessels Explanation: The nurse must massage the client's uterus briefly after placental expulsion to constrict the uterine blood vessels and minimize the possibility of hemorrhage. Massaging the client's uterus will not lessen the chances of conducting an episiotomy. In addition, an episiotomy, if required, is conducted in the second stage of labor, not the third. The client's uterus may appear boggy only in the fourth stage of labor, not in the third stage. Ensuring that all sections of the placenta are present and that no piece is left attached to the uterine wall is confirmed through a placental examination after expulsion.

A woman is in the second stage of labor and is crowning. Which diameter of the fetal skull, which is the smallest, should align with the anteroposterior diameter of the mother's pelvis, which is the narrowest diameter at the pelvic inlet?

Transverse (biparietal) Explanation: The anteroposterior diameter of the pelvis, a space approximately 11 cm wide, is the narrowest diameter at the pelvic inlet so the best presentation for birth is when the fetus presents a transverse (biparietal) diameter (the narrowest fetal head diameter, at 9.25 cm) to this.

A nurse is performing a vaginal examination of a woman in the early stages of labor. The woman has been at 2 cm dilated for the past 2 hours, but effacement has progressed steadily. Which of the following should the nurse do to best encourage the client regarding her progress?

correct response: Say, "you are still 2 cm dilated, but the cervix is thinning out nicely." Explanation: Women are anxious to have frequent reports during labor, to reassure them everything is progressing well. If giving a progress report, remember most women are aware of the word dilatation but not effacement. Just saying, "no further dilatation", therefore, is a depressing report. "You're not dilated a lot more, but a lot of thinning is happening and that's just as important" is the same report given in a positive manner.

Gynecoid

round shape, dull ischial spine and wide arch