Chapter 13: Labor and delivery
The 5 P's in labor
-Passageway -passenger -position -powers -psych
Which nursing interventions should the nurse perform as part of prenatal education for the client to ensure a positive birth experience?
-provide the client clear information on procedures involves -encourage the client to have a sense of mastery and self control -encourage the client to have a position reaction to pregnancy
The first stage of labor is often a time of introspection, which information would guide the nurses planning of nursing care
A woman may spend time thinking about what is happening to her
During which time is the nurse correct to document the end of the third stage of labor?
At the time of the placental delivery (the beginning of the third stage is documented the time of birth)
What differentiates Braxon Hicks contractions from true labor?
Braxton Hicks contractions usually decrease in intensity with walking
The head is the presenting part; which fetal position
Cephalic or vertex
Cephalohematoma
Collection of blood under the scalp of a newborn
What sign marks the termination of the 1st stage of labor
Dilation of cervix diameter to 10 cm
What is crowing
Fetal had is at the vaginal opening and does not regress between contractions
Which nursing action is a priority when the fetus is at the 4+ station?
Have a bulb suction and infant warmer ready At the station +4, the fetus is being born.
What is the MOST important nursing assessment of the mother during the fourth stage of labor?
Hemorrhage -may occur from lacerations or retained placenta fragments
How do you measure the duration of a contraction
How long a contraction lasts and is measured from the beginning of the increment to the end of the decrement for the same contraction
Gynecoid pelvis
It is rounded in shape and allows ample room for the neonate to fit through the passageway
Which assessment finding indicates the client's fetus is in the transverse lie position
Long axis of the fetus is perpendicular to that of the client
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 (cartilage between the bones allow the bones to overlap during labor, a process called molding that elongates the fetal skull, reducing the diameter of the head)
What is restitution or external rotation
Occurs after the head is born and free of resistance.
Flexion
Occurs as the fetus encounters resistance from the soft tissues and muscles of the pelvic floor
What nursing intervention do women in the transition phase of labor need the most?
Positive reinforcement
Which action should the nurse encourage the client to do during the 2nd stage of labor?
Push with contractions & rest between them.
How do you measure the frequency of a contraction
Refers to how often contractions occur and is measured from the increment of one contraction to the increment of the next contraction
Caput succedaneum
Swelling of the soft tissue of the head
Which occurs as a result of contraction decrement?
The contraction intensity is decreasing. so, -blood flow to the fetus improves -FHR should return to baseline
What is descent
The downward movement of the fetal head until it is within the pelvic inlet
The nurse determines the client is experiencing fairly strong contractions at 12:05, 12:10, 12:15, and 12:20. what can the nurse conclude from these findings?
The frequency of contractions is every 5 minutes (changes in the cervix is necessary for active labor)
What is the peak or acme of a contraction
The highest intensity of a contraction
Engagement
The movement of the fetus into the pelvis from the upper uterus. this is the first cardinal movement of the fetus in preparation for the spontaneous vaginal delivery
The cervix and vaina are soft tissues that form
The passageway, known as birth canal
Extension
The state in which the fetal head is well flexed with the chin on the chest as the fetus travels through the birth canal
What is engagement
When the greatest transverse diameter of the head passes through the pelvic inlet
Documenting fetal position using abbreviations
first letter: "R" right or "L" left describes the side of the maternal pelvis toward which the presenting part is facing second letter: reference point "O" for occupy, "Fr" for frontum third letter: specifies whether the presenting part is facing the "A" anterior, "P" posterior or whether it is in a "T" transverse position
The nurse should instruct the woman to go to the health care facility based on the client's report of contractions that are:
occurring every 5 minutes. true labor contractions are usually felt in the lower back
Lightening
occurs when the fetal presenting part begins to descend into the maternal pelvis.
During the 2nd stage of labor, a woman is generally:
turning inward to concentrate on body sensations contractions are so unusual most women are unable to think of things other than what is happening inside their body
Which description is BEST when documenting an accurate client contraction
5 minutes apart and lasting 45 seconds
Hormone that is responsible for causing the pelvic connective tissue to become more relaxed and eslastic
Relaxin
Why is it important for the pauses to occur between contractions during labor
Restoration of blood flow to the uterus and placenta
The scapula of the fetus is the presenting part. the nurse interprets this finding as which fetal position?
Shoulder
Fetal lie
Term used to describe the position of the fetal long axis in relation to the long axis of the mother
Softening, thinning, and shortening of the cervical canal occurs during the 1st stage of labor
Term: Effacement
Frank breech position
The buttocks are presenting first with both legs extended up toward the face
Which client outcome during active and transitional labor is best?
The client will practice breathing techniques during contractions.
