Maternity Ch 19: Nursing Care of the Family During Labor and Birth

"31. _______________________________ "Letting down" of a contraction."

31. Decrement

"36. _______________________________ Period of rest between contractions."

36. Interval

"37. _______________________________ An involuntary urge to push in response to the Ferguson reflex."

37. Bearing-down effort

"28. _______________________________ The primary powers of labor that act involuntarily to expel the fetus and the placenta from the uterus."

"28. Uterine contractions"

"29. _______________________________ "Building up" of a contraction from its onset."

"29. Increment"

"30. _______________________________ The peak of a contraction with an intrauterine pressure less than 80 mm Hg."

"30. Acme "

"32. _______________________________ How often uterine contractions occur; the time that elapses from the beginning of one contraction to the beginning of the next contraction."

"32. Frequency "

"33. _______________________________ The strength of a contraction at its peak."

"33. Intensity "

"34. _______________________________ The time that elapses between the onset and the end of a contraction."

"34. Duration "

"35. _______________________________ The tension of the uterine muscle between contractions."

"35. Resting tone "

"47. A primigravida calls the hospital and tells a nurse on the labor unit that she knows she is in labor. The nurse's initial response is: A. "Tell me why you know that you are in labor." B. "How far do you live from the hospital?" C. "When is your expected date of birth?" D. "Have your membranes ruptured?""

"47. Choice A is correct; although choices B, C, and D are all important questions, the first question should gather information regarding whether or not the woman is in labor." A. "Tell me why you know that you are in labor."

"48. A woman's amniotic membranes have apparently ruptured. The nurse assesses the fluid to determine its character- istics and confirm membrane rupture. An expected assessment finding of membrane rupture is: A. pH 5.5 B. Absence of ferning C. Pale, clear fluid with white flecks D. Strong odor"

"48. Choice C is correct; pH of amniotic fluid is alkaline at 6.5 or higher, ferning is noted when examining fluid with a microscope, and the fluid is relatively odorless; a strong odor is strongly suggestive of in- fection; white flecks indicate vernix caseosa." C. Pale, clear fluid with white flecks

"49. When admitting a primigravida to the labor unit, the nurse observes for signs that indicate that the woman is in true labor and should be admitted. The nurse recognizes which of the following signs as indicative of true labor? (Circle all that apply.) A. Woman reports that her contractions seem stronger since she walked from the car to her room on the labor unit. B. Cervix feels soft and is 50% effaced. C. Woman perceives pain to be in her back or abdomen above the level of the navel. D. Fetus is engaged in the pelvis at zero station. E. Cervix is in the posterior position. F. Woman continues to feel her contractions intensify following a back rub and with use of effleurage."

"49. Choices A, B, D, and E are correct; pain of true labor is usually felt in the lower back radiating to the lower portion of the abdomen." A. Woman reports that her contractions seem stronger since she walked from the car to her room on the labor unit. B. Cervix feels soft and is 50% effaced. D. Fetus is engaged in the pelvis at zero station. E. Cervix is in the posterior position.

"5. The fourth stage of labor is considered to be the first _______________________________ after birth. During this stage the mother and newborn recover from the physical process of childbirth and get to know each other."

"5. 1 to 2 hours"

"50. A vaginal examination is performed on a multiparous woman who is in labor. The results of the examination were documented as 4 cm, 75%, 11, ROA. An accurate interpretation of these data is: A. Woman is in the latent phase of the first stage of labor B. Station is 1 cm above the ischial spines C. Presentation is cephalic D. Lie is transverse"

"50. Choice C is correct; O, or occiput, indicates a vertex presentation with the neck fully flexed and the occiput in the right anterior pelvic segment (R, A) of the woman's pelvis; the station is 2 cm below the ischial spines (12); the woman is in the active phase of labor, as indicated by 4 cm of dilation, and effacement is 75%; the lie is longitudinal because the head (cephalic/vertex) is presenting." C. Presentation is cephalic

"51. A physical care measure for a laboring woman that has been identified as unlikely to be beneficial and may even be harmful is: A. Allowing the laboring woman to drink fluids and eat light solids as tolerated B. Administering a Fleet enema at admission C. Ambulating periodically throughout labor as tolerated D. Using a whirlpool bath once active labor is established"

"51. Choice B is correct; research has indicated that enemas are not needed during labor; according to research findings, choices A, C, and D have all been found to be beneficial and safe during pregnancy." B. Administering a Fleet enema at admission

"6. _______________________________ Federal regulation enacted to ensure that pregnant women obtain the care they require during emergencies and when in labor regardless of their insurance status or ability to pay."

"6. Emergency Medical Treatment and Active Labor Act

"7. _______________________________ Graphic chart on which cervical dilation and station are plotted to assist in early identification of deviations from expected labor patterns."

"7. Partogram"

"8. _______________________________ Trained and experienced female labor attendant who provides a continuous one-on-one caring presence throughout the labor and birth of the woman she is attending."

"8. Doula"

"9. _______________________________ Traditional labor position in which the woman lies on her back with her legs raised in stirrups."

"9. Lithotomy"

"Appearance of fetal intestinal contents in the amniotic fluid, giving it a greenish color."

10. P P. Meconium staining

"Prolonged holding of breath while bearing down (closed-glottis pushing)."

11. F F. Valsalva maneuver

"Burning sensation of acute pain as vagina stretches and crowning occurs."

12. G G. Ring of fire

"Artificial rupture of membranes (AROM, ARM)."

13. J J. Amniotomy

"Occurs when widest part of the head (biparietal diameter) distends the vulva just before birth."

14. H H. Crowning

"Incision into perineum to enlarge the vaginal outlet."

15. B B. Episiotomy

"Test to determine if membranes have ruptured by assessing pH of the fluid."

16. M M. Nitrazine test

"Technique used to control birth of fetal head and protect perineal musculature."

17. A A. Modified Ritgen maneuver

"Method of breathing during bearing-down efforts characterized by a strong expiratory grunt or groan."

18. Q Q. Open-glottis pushing

"Expulsion of placenta with fetal side emerging first."

19. E E. Shultz mechanism

"Cord encircles the fetal neck."

20. K K. Nuchal cord

"Method used to palpate fetus through abdomen."

21. N N. Leopold maneuvers

"Occurs when pressure of presenting part against pelvic floor stretch receptors results in a woman's perception of an urge to bear down."

22. D D. Ferguson reflex

"Frondlike crystalline pattern created by amniotic fluid when it is placed on a glass slide."

23. O O. Ferning

"Classification of medication that stimulates the uterus to contract (a uterotonic)."

24. C C. Oxytocic

"Expulsion of placenta with maternal surface emerging first."

25. I I. Duncan mechanism

"Application of a gentle yet steady force with hands pressed against the uterus."

26. R R. Fundal pressure

"Protrusion of umbilical cord in advance of the presenting part."

27. L L. Prolapse of umbilical cord

"2. During the latent phase of the first stage of labor the cervix dilates up to _______________________________ cm in approximately _______________________________ to _______________________________ hours. Cervical dilation progresses from _______________________________ to _______________________________ cm in about ________ _______________________ to _______________________________ hours during the active phase of the first stage of labor. The duration of the transition phase is approximately _______________________________ to ___________ ____________________ minutes and the cervix dilates from _______________________________ to _______________ ________________ cm."

During the latent phase of the first stage of labor the cervix dilates up to 3 cm in approximately 6 to 8 hours. Cervical dilation progresses from 4 to 7 cm in about 3 to 6 hours during the active phase of the first stage of labor. The duration of the transition phase is approximately 20 to 40 minutes and the cervix dilates from 8 to 10 cm.

"1. The first stage of labor begins with the onset of _______________________________ and ends with complete cervical _______________________________ and _______________________________. A blood-tinged mucous discharge (bloody show) from the vagina usually indicates the passage of the _______________________________."

The first stage of labor begins with the onset of uterine contractions and ends with complete cervical effacement and dilation. A blood-tinged mucous discharge (bloody show) from the vagina usually indicates the passage of the mucous plug."

"3. The second stage of labor is the stage in which the _______________________________. It begins with full cervical _______________________________ and complete _______________________________. It ends with the ___________ ____________________. This stage is divided into the _______________________________ phase, a period of rest and calm (laboring down), and the phase of _______________________________ (descent). The only certain objective sign that the second stage has begun is the inability to feel the _______________________________ during a vaginal examination."

The second stage of labor is the stage in which the infant is born. It begins with full cervical dilation and complete effacement. It ends with the baby's birth. This stage is divided into the latent phase, a period of rest and calm (laboring down), and the phase of active pushing (descent). The only certain objective sign that the second stage has begun is the inability to feel the cervix during a vaginal examination.

"4. The third stage of labor lasts from the _____________ until the______________________________. Detachment of the placenta from the wall of the uterus or separation is indicated by a firmly contracting __________ _____________________, change in the shape of the uterus from _______________________________ to ___________ ____________________, a sudden _______________________________ from the introitus, apparent _______________ ________________, and the finding of _______________________________ or of _______________________________ at the introitus."

The third stage of labor lasts from the Birth of the baby until the placenta is expelled. Detachment of the placenta from the wall of the uterus or separation is indicated by a firmly contracting fundus, change in the shape of the uterus from discoid to globular ovoid, a sudden gush of dark blood from the introitus, apparent lengthening of umbilical cord, and the finding of vaginal fullness or of fetal membranes at the introitus.