questions of labor and birth

The significance of episodic accelerations

Episodic accelerations are thought to be a sign of fetal well-being and adequate oxygen reserve.

Nursing care following amniotomy

Fetal heart rate is assessed immediately after amniotomy to detect any changes that may indicate cord compression or prolapse.

The nurse is caring for a client in labor. Which assessment findings indicate to the nurse that the client is be ginning these cond stage of labor?Select all that apply. 1. The contractions are regular. 2. The membranes have ruptured. 3. The cervix is dilated completely. 4. The client begins to expel clear vaginal fluid. 5. The spontaneous urge to push is initiated from perineal pressure.

269. 3, 5 Rationale: The second stage of labor begins when the cervix is dilated completely and ends with birth of the neonate. The woman has a strong urge to push in stage 2 from perineal pressure. Options 1,2,and 4 are not specific assessment findings of the second stage of labor and occur in stage 1.

The nurse is assisting a client undergoing induction of labor at 41 weeks of gestation. The client's contractions are moderate and occurring every 2 to 3 minutes, with a duration of 60 seconds. An internal fetal heart rate monitor is in place. The baseline fetal heart rate has been 120 to 122 beats/minute for the past hour. What is the priority nursing action? 1. Notify the health care provider. 2. Discontinue the infusion of oxytocin. 3. Place oxygen on at 8 to 10 L/minute via face mask. 4. Contact the client's primary support person(s)if not currently present.

282. 2 Rationale :The priority nursing action is to stop the infusion of oxytocin. Oxytocin can cause forceful uterine contractions and decrease oxygenation to the placenta, resulting in decreased variability. After stopping the oxytocin, the nurse should reposition the laboring mother. Notifying the health care provider, applying oxygen, and increasing the rate of the intravenous (IV) fluid (the solution without the oxytocin) are also actions that are indicated in this situation, but not the priority action. Contacting the client's primary support person(s) is not the priority action at this time. Test-Taking Strategy: Focus on the strategic word, priority. Focus on the data in the question and note the relationship of the words undergoing induction and the correct option. Also recall that physiological needs are prioritized over psychosocial needs.

umbilical cord compression

Variable decelerations occur if the umbilical cord becomes compressed, reducing blood flow between the placenta and the fetus

cesarean delivery of position

Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities. This leads to decreasing cardiac return,cardiac output, and blood flow to the uterus and subsequently the fetus. The best position to prevent this would be side-lying, with the uterus displaced off the abdominal vessels. Positioning for abdominal surgery necessitates a supine position, however; a wedge placed under the right hip provides displacement of the uterus.

late decelerations

Late decelerations are due to uteroplacental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions. Hypoxemiaresults; oxygen at 8 to 10 L/minute via face mask is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned onto her side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous oxytocin infusion is discontinued when a late deceleration is noted. The oxytocin would cause further hypoxemia because of increased uteroplacental insufficiency resulting from stimulation of contractions by this medication.

fetal station

Location of the presenting part in relation to the midpelvis or ischial spines; expressed as cm above or below the spines; station 0 is engaged, station -2 is 2 cm above the ischial spines 胎先露在坐骨耻上横指（-1）；坐骨棘下横指下（+1）表示。

The nurse in the labor room is caring for a client in the active stage of the firs tphase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action? 1. Administer oxygen via face mask. 2. Place the mother in a supine position. 3. Increase the rate of the oxytocin intravenous infusion. 4. Document the findings and continue to monitor the fetal patterns.

. 1 Rationale: Late decelerations are due to utero placental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions. Hypoxemia results; oxygen at 8 to 10 L/minute via face mask is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned onto her side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous oxytocin infusion is discontinued when a late deceleration is noted. The oxytocin would cause further hypoxemia because of increased utero placental insufficiency resulting from stimulation of contractions by this medication. Although the nurse would document the occurrence, option 4 would delay necessary treatment.

The nurse is reviewing the record of a client in the labor room and notes that the health care provider has documented that the fetal presenting part is at the -1 station. This documented finding indicates that the fetal presenting part is located at which area? Refer to figure.1. 1 2. 2 3. 3 4. 4

. 3 Rationale: Station is the measurement of the progress of descent in centimeters above or below the midplane from the presenting part to the is chial spine. It is measured in centimeters, and noted as a negative number above the line and as a positive number below the line. At the negative 1 (-1) station, the fetal presenting part is 1 cm above the ischial spine. Option 1 is at the negative 5 (-5) station and the fetal presenting part is 5 cm above the ischial spine. Option 2 is at the negative 2 (-2) station and the fetal presenting part is 2 cm above the is chial spine.Option 4 is at the positive3 (+3) and the fetal presenting part is 3 cm below the is chial spine. Test-Taking Strategy:Recalling that station is measured in centimeters and uses the ischial spineas are ferencepoint will assist in answering this question. Focus on the data in the question and note the location of the is chial spine, and that the stations range from -5 cmto+5 cm above or below this referencepoint. Review: Stations of the presenting part

The nurse is performing an assessment of a client who is scheduled for cesarean and elivery at 39weeks of gestation. Which assessment finding indicates the need to contact the health care provider (HCP)? 1. Hemoglobin of 11 g/dL (110 mmol/L) 2. Fetal heart rate of 180 beats/minute 3. Maternal pulse rate of 85 beats/minute 4. White blood cell count of 12,000 mm3 (12.0Â109/L)

2 Rationale: A normal fetal heat rate is 110to160 beats/minute. A fetal heart rate of 180 beats/minute could indicate fetal distress and would warrant immediate notification of the HCP.By full term,a normal maternal hemoglobin range is 11 - 13 g/dL (110 - 130 mmol/L)because of the hemodilution caused by an increase in plasma volume during pregnancy.The maternal pulse rate during pregnancy increases 10to15beats/minute over prepregnancy readings to facilitate increased cardiac output, oxygen transport, and kidney filtration. White blood cell counts in a normal pregnancy begin to increase in the second trimester and peak in the third trimester, with a normal range of 11,000 to 15,000 mm3 (11 to 15 Â 109/L), up to 18,000 mm3 (18 Â 109/L). During the immediate postpartum period, the white blood cell count may be 25,000 to 30,000 mm3 (25 to 30 Â 109/L) because of increased leukocytosis that occurs during delivery. Test-Taking Strategy: Focus on the subject, normal assessment and laboratory findings and those that indicate the need to contact the HCP. Knowledge regarding the normal and abnormal findings in a pregnant client and fetus will direct you to the correct option.

The nurse is caring for a client in labor. Which assessment findings indicate to the nurse that the client is beginning the second stage of labor?Select all that apply. 1. The contractions are regular. 2. The membranes have ruptured. 3. The cervix is dilated completely. 4. The client begins to expel clear vaginal fluid. 5. The spontaneous urge to push is initiated from perineal pressure.

3, 5 Rationale: The second stage of labor begins when the cervix is dilated completely and ends with birth of the neonate. The woman has a strong urge to push in stage 2 from perineal pressure. Options 1 ,2,and 4 are not specific assessment findings of the second stage of labor and occur in stage 1.

Normal and abnormal laboratory findings and normal fetal heart rate

:Anormal fetal heart rate is 110to160 beats/minute.A fetal heart rate of 180 beats/minute could indicate fetal distress and would warrant immediate notification of the HCP. By full term,a normal maternal hemoglobin range is 11 - 13 g/dL (110 - 130 mmol/L)because of the hemodilution caused by an increase in plasma volume during pregnancy .The maternal pulse rate during pregnancy increases 10 to 15 beats/minute over prepregnancy readings to facilitate increased cardiac output, oxygen transport, and kidney filtration. White blood cell counts in a normal pregnancy begin to increase in the second trimester and peak in the third trimester, with a normal range of 11,000 to 15,000 mm3 (11 to 15 Â 109/L), up to 18,000 mm3 (18 Â 109/L). During the immediate postpartum period, the white blood cell count may be 25,000 to 30,000 mm3 (25 to 30 Â 109/L) because of increased leukocytosis that occurs during delivery.

related to external fetal monitoring

Assessing the baseline fetal heart rate is important so that abnormal variations of the baseline rate can be identified if they occur.

Stations of the presenting part

Station is the measurement of the progress of descent in centimeters above or below the midplane from the presenting part to the ischial spine. It is measured in centimeters, and noted as a negative number above the line and as a positive number below the line. At the negative 1 (-1) station, the fetal presenting part is 1 cm above the is chial spine. Option 1 is at the negative 5 (-5) station and the fetal presenting part is 5 cm above the is chial spine. Option 2 is at the negative 2 (-2) station and the fetal presenting part is 2 cm above the is chial spine.Option 4 is at the positive3 (+3) and the fetal presenting part is 3 cm below the ischial spine. 胎先露在坐骨耻上横指（-1）；坐骨棘下横指下（+1）表示。