Intrapartum Period

After explaining about the second stage of labor, which client statement would indicate to the nurse that the client understands the information discussed?

"I should try to push with each contraction." - The second stage of labor begins with complete cervical dilation and ends with childbirth. During this time, the client is encouraged to push with each contraction. Throughout labor, the client's blood pressure should remain within normal limits. The membranes often rupture in the second stage of labor, but they also may rupture earlier—in some instances, even before labor begins. However, the fluid should not have a foul odor, which is indicative of an infectious process. Contractions can be strong and painful in the first stage of labor as well as the second stage.

At 6 cm dilation, a client in labor receives a lumbar epidural for pain control. Which nursing diagnosis is most appropriate?

Altered tissue perfusion related to effects of anesthesia - A disadvantage of lumbar epidural is the risk for hypotension, which can lead to altered tissue perfusion. Epidurals are associated with longer labor and hypothermia, not rapid delivery and hyperthermia. Any pain the client experiences wouldn't be directly related to the wearing off of anesthesia.

The nurse is caring for a client in labor and notes late decelerations on the external fetal monitoring strip. Which of the following actions will the nurse include in the client's plan of care? all that apply

Change the client's position Contact the healthcare provider Administer oxygen to the client - Late decelerations are caused by placental insufficiency and need to have an active response. Increasing the pitocin would cause the fetus to have further placental insufficiency. Discontinuing the external fetal heart monitor would be inappropriate as the fetus needs intervention. Calling the healthcare provider would be necessary for a change in the plan of care. Application of oxygen to the client would help facilitate further oxygenation of the fetus. Changing the client's position may help alleviate the decelerations if they are caused by hypotension and will help determine if the decelerations are truly late

During labor, a client's cervix fails to dilate progressively, despite her uncomfortable uterine contractions. To augment labor, the physician orders oxytocin. When preparing the client for oxytocin administration, the nurse describes the contractions the client is likely to feel when she starts to receive the drug. Which description is accurate?

Contractions will be stronger and more uncomfortable and will peak more abruptly. - Oxytocin administration causes stronger, more uncomfortable contractions, which peak more abruptly than spontaneous contractions.

A nurse is caring for a client with mild active bleeding from placenta previa. Which assessment factor indicates that an emergency cesarean birth may be necessary?

Fetal heart rate of 80 beats/minute - A drop in fetal heart rate signals fetal distress and may indicate the need for a cesarean birth to prevent neonatal death. Maternal blood pressure, pulse rate, respiratory rate, intake and output, and description of vaginal bleeding are all important assessment factors; however, changes in these factors don't always necessitate the delivery of the neonate.

A 19-year-old primigravid client at 38 weeks' gestation is 7 cm dilated, and the presenting part is at +1 station. The client tells the nurse, "I need to push!" What should the nurse do next?

Instruct the client to use a pant-blow pattern of breathing. - Pushing during the first stage of labor, when the urge is felt but the cervix is not completely dilated, may produce cervical swelling, making labor more difficult. The client should be encouraged to use a pant-blow (or blow-blow) pattern of breathing to help overcome the urge to push. The McDonald procedure is used for cervical cerclage for an incompetent cervix and is inappropriate here. Increasing the rate of oxygen and intravenous fluids will not alleviate the pressure that the client is feeling. The client should not push even if she feels the urge to do so because this may result in cervical edema at 7-cm dilation.

The nurse is caring for a pregnant client. The nurse notes hypotension and a nonreassuring fetal heart tracing. Which of the following would the nurse include in the client's plan of care?

Position the client on her left side The supine position causes compression of the client's aorta and inferior vena cava by the fetus. The compression, in turn, inhibits maternal circulation. The appropriate intervention would be to position the client on her left side. If that did not work, calling the healthcare provider would be the next option. Because the client is already hypotensive, having the client empty out their bladder would not be an appropriate option. Having the client hold her breath would make the hypotension worse.

The nurse is working with four clients on the obstetrical unit. Which client will be the highest priority for a cesarean section?

client at 38 weeks' gestation with active herpes lesions -The nurse is working with four clients on the obstetrical unit. Which client will be the highest priority for a cesarean section?

A 19-year-old primigravida at 38 weeks' gestation, in active labor for the past 8 hours, is admitted to the hospital accompanied by her mother. On admission, the client's cervix is 5 cm dilated, her blood pressure is 120/84 mm Hg, and she is breathing rapidly, feeling dizzy and light-headed. The nurse determines that the client is most likely experiencing effects of which factor?

hyperventilation - When a client is hyperventilating during labor, she is eliminating more carbon dioxide than usual. As a result, she becomes light-headed or dizzy. Being light-headed or dizzy is not correlated with rapid cervical dilation. The client's problems are not related to an elevated blood pressure. Being light-headed or dizzy is not correlated to excitement about the labor process.

The nurse is caring for a client in active labor. As the nurse is evaluating the waveform below, identify the area of concern that suggests umbilical cord compression.

the end of the u shape - 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.