WEEK 10: OB (CHAPTER 21 + 22)

4 T's of postpartum hemorrhage

T = tone --> altered uterine muscle tone T = tissue --> placental separation T = trauma --> lacerations and hematomas T= thrombin --> thromabosis helps prevent PPH by providing hemostasis

An Rh-positive client gives birth vaginally to a 6 lb, 10 oz (3,005 g) neonate after 17 hours of labor. Which condition puts this client at risk for infection? length of labor maternal Rh status method of birth size of the neonate

length of labor The prolonged length of labor places the mother at increased risk for developing an infection. The average size of the neonate, the vaginal birth, and Rh status of the client do not place this mother at increased risk.

A woman who gave birth to an infant 3 days ago has developed a uterine infection. She will be on antibiotics for 2 weeks. What is the priority education for this client? Encourage an oral intake of 2 to 3 liters per day. Keep the environment quiet to encourage rest. Change her perineal pads frequently. Take analgesics for uterine pain.

Encourage an oral intake of 2 to 3 liters per day. Many antibiotics are nephrotoxic, so the nurse would encourage liberal fluid intake each day to support a urinary output of at least 30 ml/hr.

What does the Bishop score assess? What score indicates successful vaginal birth? What score indicates that a cervical ripening method should be used prior to induction?

- Assesses the cervix is ripened - Identifies women who would most likely acheive a successful induction - Bishop score of 8 = successful vaginal birth - Bishop score of < 6 = cervical ripening method should be used

Maternal trauma from forceps / vacuum extractor

- lacerations of cervix / vagina / perineum - hematoma - extension of episiotomy incision into anus - hemorrhage - infection

What is the single most reliable predictor for preterm labor?

Cervical length measurement → measurement of closed portion of the cervix visualized during the transvaginal ultrasound short cervical length = 2.5 cm during mid trimester --> greater risk of preterm birth prior to 35 weeks gestation

Postpartum women possess an increased infection due to...

- tissue trauma during birth - vulnerability from placenta separation site - incision from cesarean section

The nurse is monitoring a client who is 5 hours postpartum and notes her perineal pad has become saturated in approximately 15 minutes. Which action should the nurse prioritize? Initiate Ringer's lactate infusion. Assess the woman's vital signs. Call the woman's health care provider. Assess the woman's fundus.

Assess the woman's fundus. The nurse should prioritize assessing the uterine fundus to eliminate it as a source of the bleeding. Assessing the vital signs would be the next step, especially if the massage is ineffective, to determine if the client is becoming unstable. The nurse would then alert the RN or health care provider about the increased bleeding and/or unstable vital signs.

A client's membranes rupture. The nurse observes the fetal heart rate drop from 156 to 110. The nurse inspects the client's perineum and sees a loop of umbilical cord. What is the nurse's priority concern in this situation? Decreased fetal oxygenation Increased risk for infection Increased risk for placental abruption Decreased strength of uterine contractions

Decreased fetal oxygenation When there is a cord prolapse the cord becomes compressed, blood flow is interrupted, and there is decreased oxygen available to the fetus resulting in fetal distress.

A nurse is assessing a client with postpartum hemorrhage; the client is presently on IV oxytocin. Which interventions should the nurse perform to evaluate the efficacy of the drug treatment? Select all that apply. Assess the client's uterine tone. Monitor the client's vital signs. Assess the client's skin turgor. Get a pad count. Assess deep tendon reflexes.

Assess the client's uterine tone. Monitor the client's vital signs. Get a pad count.

A postpartum woman is developing a thrombophlebitis in her right leg. Which assessments would the nurse make to detect this? Bend her knee, and palpate her calf for pain. Ask her to raise her foot and draw a circle. Blanch a toe, and count the seconds it takes to color again. Assess for pedal edema.

Assess for pedal edema. Calf swelling, erythema, warmth, tenderness, and pedal edema may be noted and are caused by an inflammatory process and obstruction of venous return.

The nurse is assessing a woman who had a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus? infection of episiotomy caput succedaneum perineal hematoma cervical lacerations

caput succedaneum

A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition? hemorrhage macrosomia infection dystocia

macrosomia Fetal risks associated with a prolonged pregnancy: - macrosomia - shoulder dystocia - brachial plexus injuries - low Apgar scores - postmaturity syndrome - cephalopelvic disproportion - uteroplacental insufficiency - meconium aspiration - intrauterine infection.

Amnioinfusion What is it? What is the indication?

technique of introducing warmed, sterile, normal saline or LR solution into the uterus transcervically though an intrauterine pressure catheter to increase volume of fluid when oligohydramnios is present servere variable declerations due to cord compression, oligohydramnios due to placental insufficiency, post maturity, ROM, preterm labor w/ premature ROM, and thick meconium fluid

Newborn trauma from forceps / vacuum extractor

- facial nerve injury - cephalhematoma - caput succedaneum - ecchymoses - facial and scalp lacerations

postpartum woman is developing thrombophlebitis in her right leg. Which assessment should the nurse no longer use to assess for thrombophlebitis? Assess for redness and warmth. Ask about increased pain with weight bearing. Ask if she has pain or tenderness in the lower extremities. Dorsiflex her right foot and ask if she has pain in her calf.

Dorsiflex her right foot and ask if she has pain in her calf. A positive Homans sign (pain in the upper calf upon dorsiflexion) is not a definitive diagnostic sign as it is insensitive and nonspecific and is no longer recommended as an indicator of DVT. That is because calf pain can also be caused by other conditions.

A woman receiving an oxytocin infusion for labor induction develops contractions that occur every minute and last 75 seconds. Uterine resting tone remains at 20 mm Hg. Which action would be most appropriate? Slow the oxytocin infusion to the initial rate. Continue to monitor contractions and fetal heart rate. Stop the infusion immediately. Notify the birth attendant.

Stop the infusion immediately. The woman is exhibiting signs of uterine hyperstimulation, which necessitate stopping the oxytocin infusion immediately to prevent further complications. Once the infusion is stopped, the nurse should notify the birth attendant and continue to monitor the woman's contractions and fetal heart rate.

What postpartum client should the nurse monitor most closely for signs of a postpartum infection? a client who had a nonelective cesarean birth a primiparous client who had a vaginal birth a client who had an 8-hour labor a client who conceived following fertility treatments

a client who had a nonelective cesarean birth The major risk factor for postpartum infection is a nonelective cesarean birth. Antepartum risk factors include history of infection; history of chronic conditions, such as diabetes, anemia, or poor nutrition; infections of the genital tract; smoking; and obesity.

Which intervention would be helpful to a client who is bottle feeding her infant and experiencing hard, engorged breasts? applying ice restricting fluids applying warm compresses administering bromocriptine

applying ice Women who do not breastfeed often experience moderate to severe engorgement and breast pain when no treatment is applied. Ice promotes comfort by decreasing blood flow (vasoconstriction), numbing the area, and discouraging further letdown of milk.

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 With hypotonic uterine contractions... - the number of contractions is unusually infrequent (not more than two or three occurring in a 10-minute period) - resting tone of the uterus remains less than 10 mm Hg - strength of contractions does not rise above 25 mm Hg.

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? blood pressure of 130/88 mm Hg active genital herpes infection decreased urine output uterine hypertonicity

uterine hypertonicity Aminoinfusion contraindications: - vaginal bleeding of unkown origin - umbilical cord prolapse - amnionitis - uterine hypertonicity - severe fetal distress

The nurse cared for a client who gave birth. The duration of labor from the onset of contractions until the birth of the baby was 2 hours. How will the nurse document the client's labor in the health record? Precipitous labor Prolonged labor Prodromal labor False Labor

Precipitous labor A labor that is less than 3 hours in duration is a precipitous labor. Prolonged labor, also known as failure to progress, occurs when labor lasts for approximately 20 hours or more in a first-time mother.

A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's first action would be to: administer oxygen by mask. increase her intravenous fluid infusion rate. put firm pressure on the fundus of her uterus. tell the woman to take short, catchy breaths.

administer oxygen by mask. An amniotic embolism quickly becomes a pulmonary embolism. The woman needs oxygen to compensate for the sudden blockage of blood flow through her lungs

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." The nurse will teach the postterm client to monitor fetal movements daily to help determine if the fetus is experiencing distress.

The nurse is monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding? well coordinated. poor in quality. brief. erratic.

erratic Hypertonic contractions occur when the uterus never fully relaxes between contractions, making the contractions erratic and poorly coordinated because more than one uterine pacemaker is sending signals for contraction.

The nurse is caring for several women in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply. "I am sad because I am not spending as much time with my toddler now that my newborn is here." "Sometimes I get tired of being with only the newborn, so I call my mom and sister to come visit." "The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."

"The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider." Postpartum psychosis is a serious and emergent condition in which the new mother has lost touch with reality and needs immediate psychiatric intervention. S/S = mood lability, delusional beliefs, hallucinations, disorganized thinking - mother will be tearful, confused, and preoccupied with feelings of guit and worthlessness

What criteria must be met to use forceps / vacuum extractor?

- ROM - complete cervix dilation - engaged fetus vertex - adequate maternal pelvis size

What are the indications for forceps/vacuum extracter?

- prolonged second stage of labor - distressed FHR pattern - failure of present part to fully rotate + descend in pelvis - limited sensation and inability to push effectively due to anesthesia - presumed fetal jeopardy / fetal distress - maternal heart disease - acute pulmonary edema - intrapartum infection - maternal fatigue - infection

What are the S/S of preterm labor?

-change or increase in vaginal discharge - pelvic pressure - low, dull backache - menstrual-like cramps - feeling of pelvic pressure or fullness -GI upset - general sense of discomfort or unease - heaviness or aching in the thighs; uterine contractions, with or without pain - more than six contractions per hour - intestinal cramping, with or without diarrhea - persistent contractions.

Amnioinfusion is used to change the relationship of uterus, placenta, cord and fetus to improve ________________ and _______________ oxygenation

Amnioinfusion is used to change the relationship of uterus, placenta, cord and fetus to improve placental and fetal oxygenation

A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client? Place the woman in Trendelenburg position. Assess fetal heart sounds. Administer amnioinfusion. Administer oxygen at 10 L/min by face mask.

Assess fetal heart sounds. Rationale: To rule out cord prolapse, always assess fetal heart sounds immediately after rupture of the membranes whether this occurs spontaneously or by amniotomy, as the fetal heart rate will be unusually slow or a variable deceleration pattern will become apparent when cord prolapse has occurred. The other answers refer to therapeutic interventions to implement once cord prolapse has been confirmed.

Six hours after birth, a client's first void is 70 ml. What is the nurse's next action? Assess for residual urine. Assess for a urinary tract infection. Assess for perineal hematoma. Assess for dehydration.

Assess for residual urine. Given the small volume voided, the nurse would assess for residual urine. Clients experience diuresis after birth; therefore, a large volume of urine is expected.

Upon assessment, the nurse notes a postpartum client has increased vaginal bleeding. The client had a forceps birth that resulted in lacerations 4 hours ago. What should the nurse do next? Assess for uterine contractions. Change the client's peri-pad. Obtain the client's vital signs. Have the client void.

Assess for uterine contractions. The nurse needs to identify whether the bleeding is from lacerations or uterine atony. This can be done by looking for a well-contracted uterus with bright-red vaginal bleeding. Lacerations commonly occur during forceps birth. In subinvolution of the uterus, there is inadequate contraction, resulting in bleeding. A boggy uterus with vaginal bleeding is seen in uterine atony. Once the nurse knows the cause of the bleeding, the condition can be treated.

The nurse is caring for a mother within the first four hours after a cesarean birth. Which nursing intervention would be most appropriate to prevent thrombophlebitis in the mother? Roll a bath blanket or towel and place it firmly behind the knees. Limit oral intake of fluids for the first 24 hours to prevent nausea. Assist client in performing leg exercises every 2 hours. Ambulate the client as soon as her vital signs are stable.

Assist client in performing leg exercises every 2 hours. The best prevention for thrombophlebitis is ambulation as soon as possible after recovery. Ambulation requires blood movement throughout the cardiovascular system, decreasing thrombophlebitis risks. Placing a bath blanket behind the knees interrupts circulation and could cause a thrombus. Fluids are encouraged not limited. Leg exercises may put strain on the abdominal incision.

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 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.

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. - 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.

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. 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.

A client presents to the clinic with her 3-week-old infant reporting general flu-like symptoms and a painful right breast. Assessment reveals temperature 101°8F (38.8°C) and the right breast nipple with a movable mass that is red and warm. Which instruction should the nurse prioritize for this client? Complete the full course of antibiotic prescribed, even if you begin to feel better. Use NSAIDs, warm showers, and warm compresses to relieve discomfort. Breastfeed or otherwise empty your breasts at least every 3 hours. Increase your fluid intake to ensure that you will continue to produce adequate milk.

Complete the full course of antibiotic prescribed, even if you begin to feel better. Mastitis is an infection of the breast tissue with common reports of general flu-like symptoms that occur suddenly, along with tenderness, pain, and heaviness in the breast. Inspection reveals erythema and edema in an area localized to one breast, commonly in a pie-shaped wedge. The area is warm and moves or compresses on palpation. Nursing care focuses on supporting continued breastfeeding, preventing milk stasis and administering antibiotics for a full 10 to 14 days. The woman should empty her breasts every 1.5 to 2 hours to help prevent milk stasis and the spread of the mastitis.

A client is diagnosed with a postpartum infection. The nurse is most correct to provide which instruction? Change the perineal pad every 3 to 4 hours to decrease the uterine infection. Drink plenty of fluids to decrease a bladder infection. Apply ice to the perineum to decrease pain of a perineal infection. Finish all antibiotics to decrease a genital tract infection.

Finish all antibiotics to decrease a genital tract infection. A postpartum infection is an infection of the genital tract after delivery through the first 6 weeks postpartum. It is most important to include finishing all antibiotics in nursing instructions.

The nurse is preparing to talk to a group of pregnant women about elective induction and why it is not highly recommended. Which statements should she include in her presentation? Select all that apply. It significantly increases the admissions to the neonatal ICU. It significantly increases the risk of cesarean birth. It significantly increases the weight of the newborn. It significantly increases the use of epidural analgesia. It significantly increases instrumented birth.

It significantly increases the risk of cesarean birth. It significantly increases instrumented birth. It significantly increases the use of epidural analgesia. It significantly increases the admissions to the neonatal ICU. Evidence is compelling that elective induction of labor significantly increases the risk of cesarean birth, instrumented birth, use of epidural analgesia, and neonatal ICU admissions. Increased birth weight is not a factor.

A 26-year-old primigravida has brought her doula to the birthing center for support during her labor and birth. The doula has been helping her through the past 16 hours of labor. The laboring woman is now 6 cm dilated. She continues to report severe pain in her back with each contraction. The client finds it comforting when her doula uses the ball of her hand to put counterpressure on her lower back. What is the likely cause of the woman's back pain? A. Breech presentation B. Occiput posterior position C. Fetal macrosomia D. Nongynecoid pelvis

Occiput posterior position A labor complicated by occiput posterior position is usually prolonged and characterized by maternal perception of increased intensity of back discomfort. The lay term for this type of labor is "back labor."

A woman presents at Labor and Delivery very upset. She reports that she has not felt her baby moving for the last 6 hours. The nurse listens for a fetal heart rate and cannot find a heartbeat. An ultrasound confirms fetal death and labor induction is started. What intervention by the nurse would be appropriate for this mother at this time? Explain to her that there was probably something wrong with the infant and that is why it died. Offer to take pictures and footprints of the infant once it is delivered. Call the hospital chaplain to talk to the parents. Recommend that she not hold the infant after it is delivered so as to not upset her more.

Offer to take pictures and footprints of the infant once it is delivered. When parents are faced with a fetal death, they need comfort and support without being intrusive. Taking pictures, footprints and gathering other mementos are very important in helping the family deal with the death. The mother is encouraged to hold the infant after delivery and name it. Telling the parents that the infant was probably defective is hurtful and not supportive to them. Calling the hospital chaplain is something that can be offered but should not be done without the parent's approval.

A G3P2 woman at 39 weeks' gestation presents highly agitated, reporting something "came out" when her membranes just ruptured. Which action should the nurse prioritize after noting the umbilical cord is hanging out of the vagina? Put the client in bed immediately, call for help, and lift the presenting part of the fetus off the cord. With the client in lithotomy position, hold her legs and sharply flex them toward her shoulders. Place the client in Trendelenburg position and gently attempt to reinsert the cord. Contact the health care provider and prepare the client for an emergent vaginal birth.

Put the client in bed immediately, call for help, and lift the presenting part of the fetus off the cord. The nurse must put the woman in a bed immediately, while calling for help, and holding the presenting part of the fetus off the cord to ensure its safety. Umbilical cord prolapse occurs when the umbilical cord slips down in front of the presenting part, which can result in the presenting part compressing the cord, cutting off oxygen and nutrients to the baby, and the baby is at risk of death. This is an emergency. C SECTION

A woman arrives at the office for her 4-week postpartum visit. Her uterus is still enlarged and soft, and lochial discharge is still present. Which nursing diagnosis is most likely for this client? Risk for fatigue related to chronic bleeding due to subinvolution Risk for infection related to microorganism invasion of episiotomy Risk for impaired breastfeeding related to development of mastitis Ineffective peripheral tissue perfusion related to interference with circulation secondary to development of thrombophlebitis

Risk for fatigue related to chronic bleeding due to subinvolution Subinvolution is incomplete return of the uterus to its prepregnant size and shape. With subinvolution, at a 4- or 6-week postpartal visit, the uterus is still enlarged and soft. Lochial discharge usually is still present. The symptoms in the scenario are closest to those of subinvolution.

What is the first and most reliable symptom of uterine rupture?

Sudden fetal distress Other symptoms: - acute + continuous abdominal pain w/ or w/o epidural - vaginal bleeding - hematuria - irregular abdominal wall contour - loss of sensation in the fetal presenting part - hypovolemic shock

The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? The most common pathogen is group A streptococcus (GAS). A breast abscess is a common complication of mastitis. Mastitis usually develops in both breasts of a breastfeeding client. Symptoms include fever, chills, malaise, and localized breast tenderness.

Symptoms include fever, chills, malaise, and localized breast tenderness. Mastitis is an infection of the breast characterized by flu-like symptoms, along with redness and tenderness in the breast. The most common causative agent is Staphylococcus aureus. Breast abscess is rarely a complication of mastitis if the client continues to empty the affected breast. Mastitis usually occurs in one breast, not bilaterally.

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. 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.

There are several women in active labor on the unit. Which woman is at highest risk for developing hypotonic contractions and therefore will need frequent nursing assessments? a 21-year-old primipara woman who does not have a support person with her and is very anxious a 17-year-old primipara requesting more pain medication every 15 to 30 minutes (and not receiving it) even though there is an epidural catheter in place that is working effectively a G4P3 client who is having twins and wants to experience a "natural birth" a 37-year-old G2P1 woman being induced whose last ultrasound at 36 weeks' gestation showed oligohydramnios

a G4P3 client who is having twins and wants to experience a "natural birth" Hypotonic contractions occur during the active phase of labor and tend to occur after the administration of analgesia in a uterus that is overstretched by a multiple gestation or polyhydramnios, or in a uterus that is lax from grand multiparty.

The nurse suspects that a mother who delivered her infant 2 weeks ago is experiencing postpartum depression. What is the first line of treatment for this client? scheduling electroconvulsive therapy administrating a selective serotonin reuptake inhibitor talking to the client and reassuring her that she will feel better soon telling the client that she has no need to be depressed

administrating a selective serotonin reuptake inhibitor Selective serotonin reuptake inhibitors are the first-line drugs for postpartum depression and will help the new mother cope with the stresses of motherhood. They are also safe for breastfeeding mothers. Electroconvulsive therapy is used on women who are not responsive to medications. Minimizing the importance of the depression is counterproductive and not supportive of the mother.

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 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.

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 nullipara pendulous abdomen preterm birth

diabetes Shoulder dystocia is most apt to occur in women with diabetes, in multiparas, and in postdate pregnancies. Shoulder Dystocia Risk factors - Maternal obesity - Maternal weight gain - Maternal diabetes - Macrosomic infant - Post dated pregnancy - Short stature - Epidural

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 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.

uterine subinvolution

incomplete involution of the uterus or failure to return to its normal size and condition after birth

A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is: longer length of labor. increased number of overall pregnancies. increasing birth weight. poor quality of prenatal care.

increasing birth weight. Shoulder dystocia is the obstruction of fetal descent and birth by the axis of the fetal shoulders after the fetal head has emerged. The incidence of shoulder dystocia is increasing because of increasing birth weights, with reports of it in as many as 2% of vaginal births. Risk factors - Maternal obesity - Maternal weight gain - Maternal diabetes - Macrosomic infant - Post dated pregnancy - Short stature - Epidural

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

lack of cervical dilation past 2 cm

A nursing student correctly identifies the most desirable position to promote an easy birth as which position? breech occiput anterior face and brow shoulder dystocia

occiput anterior Any presentation other than occiput anterior or a slight variation of the fetal position or size increases the probability of dystocia.

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 preeclampsia premature rupture of membranes placental abruption

placental abruption 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. Fetal demise risk factors/causes: - postterm pregnancy - renal disease - substance abuse - infection - hypertension - advanced maternal age - multiple gestation - Rh disease - uterine rupture - diabetes - congenital anomalies - obesity - smoking - cord accident - abruption - blunt trauma - premature rupture of membranes - hemorrhage

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 A semi-Fowler position or a squatting, kneeling position will be most effective for pushing and may speed descent.

The most common cause of postpartum hemorrhage is ______________ __________

uterine atony failure of the uterus to contract and retract after brith

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 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. Urgent delivery by cesarean birth is usually indicated