Labor and Birth, Care of Women with Complications during Labor and Delivery

passageway Shoulder Dystocia

Usually occurs when fetus is too large head comes out but shoulders won't Is an emergency Fetal chest cannot expand and the fetus needs to be able to breathe

A(n) _______________ is a narrow cone inserted into the cervix to ripen the cervix to increase uterine contractions.

laminaria A laminaria is a narrow cone inserted in the cervix that dilates and ripens the cervix as it absorbs water.

What should the nurse observe for after a version?

leaking amniotic fluid and for a pattern of contractions that may indicate labor has begun

types of uterine incisions

low transvers, low vertical, classic.

Uterine Incision

low transverse, low vertical, classic

episiotomy mediolateral

lower vaginal border toward moms right or left, enlarges opening more greater scarring, healing may cause painful intercourse

Problems with fetus fetal size

macrosomia, large fetus, weighs more than 4000g, may not fit through birth canal, can contribute to hypotonic labor dysfunction

cesarean secion risks

maternal r/t anesthesia, infection, hemorrhage, injury to urinary tract, blood clots, delayed intestinal peristalsis, respiratory compromise

prolonged labor can result in

maternal/newborn infection. maternal exhaustion, postpartum hemorrhage, greater anxiety and fear in ensuing pregnancy. subsequent labors can be anxious and fearful

hypertonic managemetn

mild sedation, tocolytic drugs, acceptance of womans discomfort and frustration, comfort measures.

Low Vertical

minimal blood loss, more likely to rupture during another birth

After admission nursing care consists of

monitor the laboring woman, helping the woman cope with labor, monitoring fetal heart rate, intermittent auscultation, continuous electronic fetal monitoring

Perineal Lacerations

non surgical rips or tears in the perineum that occur when the fetal head is born and an episiotomy is not performed First degree--- superficial Second degree-- deep tissue third degree-- anal spincter Fourth degree-- anal spincter into the rectal mucosa

Low Transverse

not likely to rupture during another birth, VBAC possible with this type

turbutline

relaxes smooth muscle. side effects - maternal and fetal tachycardia, hypoglycemia, hypokalemia, decreased blood pressure

Do NOT do Cesarean sections

Fetus is dead Too premuture to survive Mom has a bleeding disorder no clotting

The nurse is caring for a patient who is threatening preterm labor and has been given glucocorticoids. What is the purpose of glucocorticoid administration?

Increase fetal lung maturity.

What sign(s) of infection should the nurse assess for after an amniotomy? (Select all that apply.)

Increase of fetal heart rate (FHR) from 160 to 174 beats/minute

A(n) _______________ is a narrow cone inserted into the cervix to "ripen" the cervix to increase uterine contractions.

laminaria

The nurse is caring for a patient diagnosed with hypotonic labor dysfunction. What will the nurse expect when caring for this patient?

Use of frequent position changes

Which statement indicates a woman understands activity limitations for the management of preterm labor?

"I pack a picnic basket and put it next to the sofa so I do not have to get up for food during the day.

After the membranes have ruptured, the nurse should assess the fetal heart rate (FHR) for ________ minute(s).

1 The FHR is checked for 1 full minute to ensure that the infant is not in distress from cord compression resultant from the lost buoyancy.

Problems with the Pelvis and Soft Tissues

Bony pelvis Gynecoid pelvis most favorable for vaginal birth Soft tissue obstructions Most common is a full bladder

The nurse arrives at the start of a shift on the labor unit to find a census of four patients in active labor. Which laboring patient should the nurse attend to first?

35-year-old multigravida with history of precipitate birth

The nurse can anticipate that which of the following patients may be scheduled for induction of labor? A woman who is: 1. 38 weeks' gestation with fetus in transverse lie. 2. 40 weeks' gestation with fetal macrosomia. 3. 40 weeks' gestation with gestational hypertension. 4. 40 weeks' gestation with a fetal prolapsed cord.

40 weeks' gestation with gestational hypertension.

A frustrated patient in labor has been affected by decreased uterine muscle tone and reports, "My doctor won't induce my labor because of some silly score. He said I was a 4. What kind of magic number do I need?" What is the lowest Bishop score the patient should have prior to induction?

6

Precipitate Birth quick birth

A birth that is completed in less than 3 hours Labor begins abruptly and intensifies quickly Contractions may be frequent and intense May have uterine rupture, cervical lacerations, or hematoma

What is the major benefit of an amniotomy to augment or induce labor? A. Stimulate prostaglandin secretion B. Prevent umbilical cord compression C. Amniotomy is used to augment labor to stimulate prostaglandin secretion. D. Allow internal monitoring

A. Stimulate prostaglandin secretion Amniotomy can cause compression and prolapse. Amniotomy does allow for internal monitoring, but it is not the major benefit that helps augment labor.REF: Page 176

What is the major benefit of an amniotomy to augment or induce labor? a. Stimulate prostaglandin secretion b. Prevent umbilical cord compression c. Treat umbilical cord prolapse d. Allow internal monitoring

A. Stimulate prostaglandin secretion Amniotomy is used to augment labor to stimulate prostaglandin secretion. Amniotomy can cause compression and prolapse. Amniotomy does allow for internal monitoring, but it is not the major benefit that helps augment labor.REF: Page 176

What should the amniotic fluid look like?

Fluid should be clear, but it may contain bits of lanugo and have a mild odor;

Risks of Cesarean Birth for baby

Inadvertent preterm birth Respiratory problems because of delayed absorption of lung fluid Injury

How might the nurse instruct the patient to stimulate her nipples in an attempt to increase the quality of uterine contractions? (Select all that apply.)

Brush the nipples with a dry washcloth. Gently pull on the nipples Apply suction to the nipples with a breast pump.

When a woman is admitted to the labor and delivery unit, she tells the nurse that she is anxious about delivery, the welfare of her infant, and how quickly she will recover. How can anxiety affect labor?

By reducing blood flow to the uterus

What nursing care should be provided to a woman with a third-degree laceration immediately after delivery

Cold pack to the perineum

Amniotiomy

AROM - using sterile technique. Purpose is to stimulate contractions, enhance contractions, also done after incision in C/S. Done with amniohook during vaginal exam

induction/augmentation techniqu

AROM, cervical ripening agent - prostaglandin. Pitocin IV secondary into primary always on pump. continuous fetal monitoring. pharmacologic and nonpharmacological means.

When they Should do Cesarean Birth

Abnormal labor Inability of the fetus to pass through the mother's pelvis Maternal conditions such as GH or DM Active maternal herpes virus Previous surgery on the uterus Fetal compromise Placenta previa or abruptio placentae

Shoulder Dystocia care

After delivery, mother and infant need to be assessed for injuries Mother may have torn perineal tissue More at risk for uterine atony and postpartum hemorrhage Uterus does not contract well after birth Infant may have fractured clavicle

Safety Alert Cesarean

Although assessing the uterus after cesarean birth causes discomfort, it is important to do so regularly The woman can have a relaxed uterus that causes excessive blood loss, regardless of how she delivered her child

What nursing assessment should be reported immediately after an amniotomy?

Amniotic fluid is watery and pale green

Risks of Cesarean Birth for Mom

Anesthesia Respiratory complications Hemorrhage Blood clots Injury to urinary tract Delayed intestinal peristalsis Infection

Indications for an Episiotomy

Better control over where and how much the vaginal opening is enlarged An opening with a clean edge rather than the ragged opening of a tear Note: Hand job of the VJ massage and stretching exercises before labor may be an alternative to an episiotomy. The doula knows how to hand job ..

A ________ _________ is used to assess the status of the cervix in determining its response to induction.

Bishop score This score is the standard to assess the status of the cervix when determining readiness for induction.REF: Page 175

Using a diagram, the nurse demonstrates the sequence of the mechanisms of labor. Place the seven mechanisms of labor in sequential order. Put a comma and space between each answer choice (a, b, c, d, etc.) a. Extension b. Engagement c. Descent d. Flexion e. Expulsion f. Internal rotation g. External rotation

C, B, D, F, A, G, E The process by which a normal vaginal delivery is accomplished requires the infant to make the descent into the birth canal, engage, flex and internally rotate, and extend and externally rotate to be expelled.

Increased Anxiety during birth Psyche

Causes hormones to be released Epinephrine Cortisol Adrenocorticotropic Reduces contractility of the smooth muscle

Pharmacological ( Drug) Methods to Stimulate Contraction

Cervical ripening Prostaglandin - gel is applied to cervix because Oxytic drugs have no effect on the cervic Laminaria - narrow cone of a substance that absorbs water it is a osmotic dilator . Oxytocin induction /augmentation of labor Used to initiate or stimulate contractions Most commonly used method

A woman who is 33 weeks pregnant is admitted to the obstetric unit because her membranes ruptured spontaneously. What complication should the nurse closely assess for with this patient?

Chorioamnionitis

A woman in labor has excess amniotic fluid. She is in active labor and is not progressing because contractions are too weak to be effective. What does the nurse suspect is the cause of this ineffective labor? a. Ineffective maternal pushing because of fatigue b. Increased uterine muscle tone because of oxytocin use c. Decreased uterine muscle tone because of terbutaline (Brethine) use d. Decreased uterine muscle tone because of overdistention

D. Decreased uterine muscle tone because of overdistention A woman with decreased uterine muscle tone has contractions that are too weak to be effective during active labor. This is more likely to occur if the uterus is overdistended, such as with twins, a large fetus, or excess amniotic fluid (hydramnios). Uterine overdistention stretches the muscle fibers and thus reduces their ability to contract effectively.REF: Page 187

An obstetrician informs the nurse that the patient has a laceration that extends through the anal sphincter into the rectal mucosa. Based on the definition, what does the nurse document, per the physician, as the description of this laceration? a. First degree b. Second degree c. Third degree d. Fourth degree

D. Fourth degree Perineal lacerations are described by the amount of tissue involved. A fourth-degree laceration extends through the anal sphincter into the rectal mucosa.REF: Page 179

version is NOT done when

Disproportion between mother's pelvis and fetal size Abnormal uterine or pelvic size or shape Abnormal placental placement Previous cesarean birth with vertical uterine incision Active herpes virus infection Inadequate amniotic fluid Poor placental function Multifetal gestation Fetus can become entangled in umbilical cord

dysfunctional labor

Does not progress

What nursing intervention during labor can increase space in the woman's pelvis? 1. Promote adequate fluid intake. 2. Position her on the left side. 3. Assist her to take a shower. 4. Encourage regular urination.

Encourage regular urination

Nursing Care for Abnormal Fetal Presentation or Positions

Encourage woman to assume positions that favor fetal rotation and descent and reduce back pain Sitting, kneeling, or standing while leaning forward Rocking the pelvis back and forth while on hands and knees (encourages rotation) Side-lying Squatting (in second stage of labor) Lunging by placing one foot in a chair with the foot and knee pointed to that side Some of these are in lamaz

Which interventions could a nurse apply to help stimulate contractions? (Select all that apply.)

Encouraging the patient to sit upright Assisting the patient to ambulate Stimulating the nipples

Amniotomy nursing care

FHR for one minute after AROM. Assess color, odor, amount, time. Temperature every 2-4 hours. Promote comfort. Change bed pad often

Oxytocin is discontinured if

FHR is not within 110-160 beats per min Late decelerations and loss of variability the heart rate needs to rebound and contractions stop to refill the umbilical vein with Oxygen rich blood.

An infant is delivered with the use of forceps. What should the nurse assess for in the newborn?

Facial asymmetry

Precipitate Birth quick birth bad thing

Fetal oxygenation may be compromised Birth injury may occur from rapid passage through the birth canal Injuries can include Intracranial hemorrhage Nerve damage

_________ __________ _________explains how pain impulses reach the brain for interpretation and supports nonpharmacological methods of pain control.

Gate control theory This theory has created a pain management option based on nerve pathways.REF: Page 159

Reasons why you should Indications for Labor Induction

Gestational hypertension - Ruptured membranes without spontaneous onset of labor Infection within the uterus Medical problems in the woman that worsen during pregnancy Fetal problems such as slowed growth, prolonged pregnancy, or incompatibility between fetal and maternal blood types Placental insufficiency Fetal death

Several hours after delivery the nurse finds a woman crying. The woman says repeatedly, "My baby is beautiful, but I was planning on a vaginal delivery. Instead I needed an emergency C-section." What is the most appropriate nursing diagnosis?

Grieving related to loss of expected birth experience

After several hours of labor, a nursing assessment reveals that a woman's cervix is 5 cm dilated but contractions are becoming shorter and less frequent. What is this labor pattern considered?

Hypotonic

The nurse notes that a woman's contractions during oxytocin induction of labor are every 2 minutes; the contractions last 95 seconds, and the uterus remains tense between contractions. What action is expected based on these assessments? 1. No action is expected; the contractions are normal. 2. The rate of oxytocin administration will be increased slightly. 3. Pain medication or an epidural block will be offered. 4. Infusion of oxytocin will be stopped.

Infusion of oxytocin will be stopped.

A woman is preparing for administration of a cervical ripening agent. What nursing actions will the nurse anticipate implementing? (Select all that apply.)

Insert IV. Record a baseline fetal heart rate. Explain procedure to patient

Version Two methods

Internal External The ideal position for the fetus in the period of time preceding the onset of labor is vertex. When the fetus is not in that position, the health care provider might be able to manually change the position of the fetus. turn the baby from breech to head down.

The ______________ ___________, also called the psychoprophylactic method, is the basis of most childbirth preparation classes in the United States.

Lamaze method The Lamaze method, also called the psychoprophylactic method, is the basis of most childbirth preparation classes in the United States.

The nurse may assist the health care provider in determining the fetal position and presentation by abdominal palpations called _____________________________ _____________________________.

Leopolds maneuver The nurse may assist the health care provider in determining the fetal position and presentation by abdominal palpations called Leopolds maneuver.

Most preferred Cesarean

Low transverse: not likely to rupture during another birth; VBAC possible with this type causes less blood loss.

uterine inversion treatment

MD will try to replace inverted uterus under general. anesthetic to cause uterine relaxation. after replaced oxytocin given to contract uterus and control bleeding. if no successful replacement then hysterectomy is necessary

passenger Fetal Size

Macrosomia—large fetus; weighs more than 4000 g (8.8 pounds) May not fit through birth canal Can contribute to hypotonic labor dysfunction

What are the rationales for labor induction? (Select all that apply.)

Maternal diabetes Placental insufficiency

Prolonged labor can cause

Maternal or newborn infection Maternal exhaustion Postpartum hemorrhage Greater anxiety and fear

The nurse is administering terbutaline (Brethine) to a pregnant woman to prevent preterm labor. The nurse would assess for which adverse effect?

Maternal tachycardia

Multifetal Pregnancy

May cause dysfunctional labor Uterine overdistention contributes to poor contraction quality Abnormal presentation or position of one or more fetuses interferes with labor mechanisms Often one fetus is delivered as cephalic and the second as breech, unless a version is done

Preterm Labor

Occurs after 20 weeks and before 37 weeks gestation Signs of impending PTL Maternal symptoms Risk Factors Patient education

The Psyche

Most common factors that can prolong labor Lack of analgesic control of excessive pain Absence of a support person or coach Immobility and restriction to bed Lack of ability to carry out cultural traditions

A pregnant woman's membranes ruptured prematurely at 34 weeks. She will be discharged to her home for the next few weeks. What would the nurse planning discharge instruction teach the woman to do?

Notify her obstetrician if she has a temperature above 37.8° C (100° F).

During a strenuous labor, the woman asks for some pain remedy for the sudden pain between her scapulae that seems to occur with every breath she takes. What is the best nursing action?

Notify the charge nurse immediately

Abnormal Duration of Labor Friedman's curve

Often used to graph the progress of cervical dilation and fetal descent Used as a guide to assess and manage the normal progress of labor

_____________________________ is a lower-than-normal amount of amniotic fluid.

Oligohydramnios

Amnioinfusion is done when these present

Oligohydramnios - less than 500 ml of amniotic fluid Umbilical cord compression-from lack of fluid Reduction of recurrent variable decelerations- added fluid to stop this for the FHR Dilution of meconium-stained amniotic fluid- babies fecal matter diluted. Replaces the "cushion" for the umbilical cord and relieves the variable decelerations

A pulsating structure is felt during a vaginal examination of a woman in labor. How would the nurse position the woman to prevent compression of a prolapsed cord?

On her back with her head lower than the rest of her body

Complications of Oxytocin Induction and Augmentation of Labor Most common is related to

Overstimulation of contractions = Fetal compromise from contractions being too long, too frequent, or too intense. Uterine rupture Water intoxication from Oxytocin Inhibits excretion of urine and promotes fluid retention

A labor dysfunction due to decreased uterine muscle tone occurs in a patient who is dilated to 5 cm with membranes intact. What action by the physician will the nurse anticipate?

Perform an amniotomy.

A woman is 37 weeks pregnant and questioning the nurse about possible induction of labor at term. What conditions would contraindicate labor induction? (Select all that apply.)

Placenta previa Prolapsed cord

Contraindications to Labor Induction in other words Labor is NOT induced

Placenta previa Umbilical cord prolapse Abnormal fetal presentation High station of the fetus Active herpes infection in the birth canal Abnormal size or structure of the mother's pelvis Previous classic cesarean incision

Induction/augmentation contraindications

Placenta précis, umbilical cord prolapse, abnormal fetal presentation, high station of fetus, active herpes, abnormal size or structure of moms pelvis. Previous classic cesarean

Abnormal Fetal Presentation or Position

Prevents the smallest diameter of the fetal head to pass through the smallest diameter of the pelvis breech, transverse,

Complications of Amniotomy

Prolapse of the umbilical cord Infection take womens temperature every 2 to 4 h is over 100.4 problem report to RN Abruptio placentae separation of placenta before

Amniotomy complication

Prolapsed umbilical cord, infection, abruption

precipitate labor nursing care

Promote fetal oxygen, mom cope with discomfort, to ply tic to decrease contractions, side lying and oxygen, pain control, narcs near time of birth, after birth assess mom and infant for signs of injury

What does the nurse explain is used to soften the cervix with a "cervical ripening" agent?

Prostaglandin gel insertion

Mom with neg Rh (Rh disease also known as Rhesus isoimmunisation)

Rh disease is generally preventable by treating the mother during pregnancy or soon after delivery with an intramuscular injection of anti-RhD immunoglobulin (Rho(D) immune globulin). The RhD protein is coded for by the RHD gene.

A woman is having a difficult labor because the fetus is presenting in the right occipital position (ROP). What position will the nurse promote to encourage fetal rotation and pain relief?

Sitting up and leaning forward on the over-bed table

Types of Incisions for Cesarean

Skin Vertical allows more room for a large fetus Transverse (a.k.a. Pfannenstiel) Uterine Low transverse: not likely to rupture during another birth; VBAC possible with this type Low vertical: minimal blood loss; more likely to rupture during another birth Classic: rarely used; more blood loss; most likely to rupture during another pregnancy

Premature Rupture of Membranes (PROM)

Spontaneous rupture of membranes at term, more than 1 hour before labor contractions begin Vaginal or cervical infection may cause PROM Diagnosis confirmed by Nitrazine paper test Looking for a "ferning" pattern from vaginal fluid placed on a slide and viewed under the microscope

The initial vaginal examination of a woman admitted to the labor unit reveals that the cervix is dilated 9 cm. The panicked woman begs the nurse, "Please give me something." What is the most appropriate pain relief intervention for a woman in precipitate labor?

Stay and breathe with her during contractions.

A woman 2 weeks past her expected delivery date is receiving an oxytocin infusion to induce labor and begins to have contractions every 90 seconds. What is the nurse's initial action?

Stop the oxytocin infusion.

A new mother is distressed and tearful about the elevated dome over her infant's posterior fontanelle. The nurse responds, "This condition will resolve itself in a few days." What is the cause?

The effect of the vacuum extractor

A student nurse questions the instructor regarding what alteration should be made for the assessment of the fundus of a new postoperative cesarean section patient. What is the best response?

The fundus is assessed by "walking" fingers from the side of the uterus to the midline.

Risks of Forceps or Vacuum Extraction

Trauma to maternal or fetal tissues Mother may have a laceration or hematoma in her vagina Infant may have bruising, facial or scalp lacerations or abrasions, cephalhematoma, or intracranial hemorrhage

Nursing Care in the Recovery Room from Cesarean

Vital signs to identify hemorrhage or shock IV site and rate of solution flow Fundus for firmness, height, and midline position Dressing for drainage Lochia for quantity, color, and presence of clots Urine output from the indwelling catheter

Nonpharmacological Methods to Stimulate Contractions

Walking- positional change pressure of moms spine Nipple stimulation of labor- this is the natural way of getting the pituitary gland to secrete oxytocin

A woman who is 24 weeks pregnant is placed on an intravenous infusion of magnesium sulfate. What side effect should the nurse inform the patient that she might experience?

Warm flush

What complications of overstimulation of uterine contractions may occur? (Select all that apply.)

Water intoxication Impaired placental exchange of oxygen and nutrients Uterine rupture

Powers of birth Ineffective Maternal Pushing

Woman may not understand which technique to use or fears tearing her perineal tissues Epidural or subarachnoid blocks may depress or eliminate the natural urge to push An exhausted woman may be unable to gather enough energy to push

Version

a method used to change fetal presentation

uterine rupture

a tear in the wall of the uterus.

Define dystocia.

a term used to describe a difficult labor, which can be caused by an abnormality of the power, passenger, passage, or psyche of the woman

A frustrated patient in labor has been affected by decreased uterine muscle tone and reports, My doctor wont induce my labor because of some silly score. He said I was a 4. What kind of magic number do I need? What is the lowest Bishop score the patient should have prior to induction? a. 6 b. 8 c. 10 d. 12

a. 6 The Bishop score evaluates the suitability of the patient for a vaginal delivery. A minimum score of 6 is recommended by the American Congress of Obstetricians and Gynecologists (ACOG).

What do late decelerations indicate? (Select all that apply.) a. A nonreassuring pattern b. Uteroplacental insufficiency c. Fetal heart depression d. Cord compression e. Head compression

a. A nonreassuring pattern b. Uteroplacental insufficiency c. Fetal heart depression This nonreassuring pattern indicates uteroplacental insufficiency and fetal heart compression. Prolonged decelerations indicate cord compression and early decelerations indicate head compressions.

The nurse observes on the fetal monitor a pattern of a 15-beat increase in the fetal heart rate that lasts 15 to 20 seconds. What does this pattern indicate? a. A well-oxygenated fetus b. Compression of the umbilical cord c. Compression of the fetal head d. Uteroplacental insufficiency

a. A well-oxygenated fetus Accelerations in the fetal heart rate suggest that the fetus is well oxygenated.

When a pregnant woman arrives at the labor suite, she tells the nurse that she wants to have an epidural for delivery. What is a contraindication to an epidural block? a. Abnormal clotting b. Previous cesarean delivery c. History of migraine headaches d. History of diabetes mellitus

a. Abnormal clotting An epidural block is not used if a woman has abnormal blood clotting.

The nurse is caring for a woman with epidural anesthesia for pain control during a vaginal delivery. A risk for injury related to epidural anesthesia has been identified by the nursing staff. What interventions are appropriate for the nurse to implement related to this diagnosis? (Select all that apply.) a. Assess leg movement and sensation before ambulating. b. Administer antibiotic as ordered. c. Observe for signs of impending birth. d. Provide sacral pressure as needed. e. Assess fetal position frequently.

a. Assess leg movement and sensation before ambulating. c. Observe for signs of impending birth. To prevent the risk for injury related to epidural anesthesia the nurse should asses for movement, sensation, and leg strength before ambulating, ambulate cautiously with an assistant, assist the woman to change positions regularly, and observe for signs that birth may be near: increase in bloody show, perineal bulging, and/or crowning.

One hour postdelivery the nurse notes the new mother has saturated three perineal pads. What is the most appropriate nursing action? a. Check the fundus for position and firmness. b. Report to the doctor immediately. c. Change the pads and chart the time. d. Time how long it takes to soak one pad.

a. Check the fundus for position and firmness. Increased lochia may indicate hemorrhage. The fundus should be assessed for firmness. One pad an hour is an acceptable rate for immediate postdelivery.

How does the pain of childbirth differ from other types of pain? (Select all that apply.) a. Childbirth pain is part of a normal process. b. Childbirth pain seldom needs narcotic relief. c. Position changes relieve pain and facilitate delivery. d. Childbirth pain declines following birth. e. Childbirth pain is self-limited.

a. Childbirth pain is part of a normal process. c. Position changes relieve pain and facilitate delivery. d. Childbirth pain declines following birth. e. Childbirth pain is self-limited. Childbirth pain differs from other types of pain because it is part of a normal, natural, and expected process, can be relieved by change of position, declines immediately following birth, and is self-limiting. Childbirth pain requires pharmacological management with narcotics in many cases.

A woman who is 33 weeks pregnant is admitted to the obstetric unit because her membranes ruptured spontaneously. What complication should the nurse closely assess for with this patient? a. Chorioamnionitis b. Hemorrhage c. Hypotension d. Amniotic fluid embolism

a. Chorioamnionitis Infection of the amniotic sac, called chorioamnionitis, may cause prematurely ruptured membranes, or it may be a consequence of rupture because the barrier to the uterine cavity is broken.

Which are nonpharmacological forms of pain control? Select all that apply. a. Diversion b. Epidural c. Breathing techniques d. Effleurage e. Sacral pressure

a. Diversion c. Breathing techniques d. Effleurage e. Sacral pressure Skin stimulation such as effleurage, diversion and distraction, sacral pressure, and breathing techniques are all examples of nonpharmacological pain control methods that can be used during labor. Epidural is a type of regional anesthesia that requires use of medications for effectiveness of pain control.REF: Page 160

Which interventions could a nurse apply to help stimulate contractions? (Select all that apply.) a. Encouraging the patient to sit upright b. Assisting the patient to ambulate c. Stimulating the nipples d. Offering emotional support e. Allowing the patient to vent frustration

a. Encouraging the patient to sit upright b. Assisting the patient to ambulate c. Stimulating the nipples Sitting upright, ambulating, and stimulating the nipples may encourage progression of labor. Offering emotional support and allowing patient to vent frustration are supportive to the patient but do not stimulate more effective labor.

What chemical substance(s) produced in the body acts as a natural pain reliever? a. Endorphins b. Morphine c. Codeine d. Atropine

a. Endorphins Endorphins are natural body substances that are similar to morphine and may explain why laboring women need smaller doses of analgesia.

What does meconium-stained amniotic fluid indicate when the infant is in a vertex presentation? a. Fetal distress b. Fetal maturity c. Intact gastrointestinal tract d. Dehydration in the mother

a. Fetal distress Green-stained amniotic fluid means that the fetus passed the first stool before birth, and it is an indicator of fetal compromise.

The husband of a woman in labor asks, What does it mean when the baby is at minus 1 station? After giving an explanation, what statement by the husband indicates that teaching was effective? a. Fetal head is above the ischial spines. b. Fetal head is below the ischial spines. c. Fetal head is engaged in the mothers pelvis. d. Fetal head is visible at the perineum.

a. Fetal head is above the ischial spines. Station describes the level of the presenting part in the pelvis. It is estimated in centimeters from the level of the ischial spines. Minus stations are above the ischial spines.

The physician performs an amniotomy on a laboring woman. What will be the nurses priority assessment immediately following this procedure? a. Fetal heart rate b. Fluid amount c. Maternal blood pressure d. Deep tendon reflexes

a. Fetal heart rate The FHR should be assessed for at least 1 full minute after the membranes rupture and must be recorded and reported. Marked slowing of the rate or variable decelerations suggests that the fetal umbilical cord may have descended with the fluid gush and is being compressed. Fluid amount should be assessed and recorded but is not the top priority. Maternal blood pressure and deep tendon reflexes are not appropriate assessments following rupture of membranes.

What would the nurse expect a normal finding to be during assessment of the fundus of the uterus every 15 minutes during the fourth stage of labor? a. Firm and at the umbilicus b. Soft and deviated to the left c. Firm and deviated to the right d. Soft to touch, but firm with massage

a. Firm and at the umbilicus During the fourth stage, recovery of labor, the uterus is normally found firmly contracted at or below the umbilicus level. Deviation to the right can indicate a full bladder. A boggy or soft uterus can indicate a potential complication. The uterus is not usually found deviated to the left.REF: Page 145

What breathing techniques would the nurse teach the prenatal patient to help her focus during labor in order to reduce pain? (Select all that apply.) a. First stage breathing b. Abdominal breathing c. Fourth stage breathing d. Modified pace breathing e. Patterned paced breathing

a. First stage breathing b. Abdominal breathing d. Modified pace breathing e. Patterned paced breathing First stage breathing includes the techniques of modified pace breathing and patterned paced breathing, which are types of abdominal breathing techniques. These patterns of breathing will help a woman in labor to focus and reduce pain perception. The fourth stage of labor is the womans recovery stage and does not require a breathing technique.

What signs of respiratory distress in the neonate should be reported immediately? Select all that apply. a. Grunting respirations b. Flaring of the nostrils c. Heart rate above 110 beats/min d. Cyanosis of the hands and feet e. Respiratory rate higher that 60 breaths/min

a. Grunting respirations b. Flaring of the nostrils e. Respiratory rate higher that 60 breaths/min Some signs of respiratory distress that should be immediately reported include grunting respirations, persistent cyanosis (other than hands and feet), flaring of the nostrils, retractions, sustained respiratory rate higher than 60 breaths/min, and sustained heart rate greater than 160 beats/min or less than 110 beats/min.REF: Page 151

What is the most appropriate nursing action to take when a laboring woman hyperventilates? a. Help her breathe into her cupped hands. b. Place her flat on her back. c. Initiate oxygen at 2 liters via mask. d. Notify the doctor.

a. Help her breathe into her cupped hands. Measures to combat hyperventilation include breathing into cupped hands or a paper bag or holding breath for a few seconds. All of these techniques decrease PCO2.

What are the advantages of a freestanding birth center? (Select all that apply.) a. Home-like setting b. Designed for high-risk pregnancies c. Lower costs d. Attended by certified obstetricians e. Immediate emergency access

a. Home-like setting c. Lower costs Advantages of a freestanding birth center include a homelike setting and lower costs because the center does not require expensive departments such as emergency or critical care. Freestanding birth centers are not designed for high-risk patients, are not attended by certified obstetricians, and do not have immediate emergency access.

A woman requests a pudendal block to manage her labor pain. What statement by the woman indicates a need for further explanation about the pudendal block? a. Im having a contraction. Can I get the pudendal block now? b. Ill get the pudendal block right before I deliver. c. The nurse midwife will insert the needles into my vagina. d. It takes a few minutes after the medicine is administered to make me feel numb.

a. Im having a contraction. Can I get the pudendal block now? The pudendal block does not block pain from contractions and is given just before birth.

magnesium sulfate

antidote: calcium gluconate. continuous IV. monitor levels. toxicity -cardiorespiratory depression , hyporeflexia, fetus watch drowsiness, may need resuscitation

Which is a sign of impending labor? a. Increased vaginal discharge b. Baby dropping c. Increased libido d. Diarrhea

a. Increased vaginal discharge Braxton Hicks contractions (increasing in intensity), increased discharge, and bloody show are always signs of impending labor. Diarrhea is not a sign of impending labor.REF: Page 126

What typical types of classes are available to help expectant parents prepare for parenthood? (Select all that apply.) a. Infant care b. Breastfeeding c. Gestational diabetes d. Sources of financial aid e. Yoga

a. Infant care b. Breastfeeding c. Gestational diabetes Prenatal classes include such topics as infant care, breastfeeding, gestational diabetes, exercising, and sibling and grandparent preparation. Yoga and financial information are not traditional content for prenatal instruction.

A woman is preparing for administration of a cervical ripening agent. What nursing actions will the nurse anticipate implementing? (Select all that apply.) a. Insert IV. b. Record a baseline fetal heart rate. c. Explain procedure to patient. d. Instruct patient to ambulate immediately afterward. e. Ensure a tocolytic is available.

a. Insert IV. b. Record a baseline fetal heart rate. c. Explain procedure to patient. The cervical ripening procedure should be explained to the woman and her family. A fetal heart rate baseline is recorded. An intravenous (IV) line with saline or heparin sodium (Hep-Lock) may be placed in case uterine tachysystole (hyperstimulation) occurs and IV tocolytics (drugs that reduce uterine contractions) are needed. After insertion of the prostaglandin gel, the woman remains on bed rest for 1 to 2 hours and is monitored for uterine contractions. Vital signs and fetal heart rate are also recorded.

A woman is 7 cm dilated, and her contractions are 3 minutes apart. When she begins cursing at her birthing coach and the nurse, what does the nurse assess as the most likely explanation for the womans change in behavior? a. Labor has progressed to the transition phase. b. She lacked adequate preparation for the labor experience. c. The woman would benefit from a different form of analgesia. d. The contractions have increased from mild to moderate intensity.

a. Labor has progressed to the transition phase. If a woman suddenly loses control and becomes irritable, suspect that she has progressed to the transition stage of labor.

The nurse is administering terbutaline (Brethine) to a pregnant woman to prevent preterm labor. The nurse would assess for which adverse effect? a. Maternal tachycardia b. Maternal hypertension c. Fetal bradycardia d. Fetal hypokalemia

a. Maternal tachycardia Maternal tachycardia is the common negative side effect of terbutaline, which should be corrected with a dose of propranolol.

An 18-year-old primigravida is 4 cm dilated and her contractions are 5 minutes apart. She received little prenatal care and had no childbirth preparation. She is crying loudly and shouting, Please give me something for the pain. I cant take the pain! What is the priority nursing diagnosis? a. Pain related to uterine contractions b. Knowledge deficit related to the birth experience c. Ineffective coping related to inadequate preparation for labor d. Risk for injury related to lack of prenatal care

a. Pain related to uterine contractions The most important issue for this woman, at this time, is effective pain management.

A labor dysfunction due to decreased uterine muscle tone occurs in a patient who is dilated to 5 cm with membranes intact. What action by the physician will the nurse anticipate? a. Perform an amniotomy. b. Initiate tocolytic drugs. c. Order a sedative for the patient. d. Plan to do an emergency cesarean section.

a. Perform an amniotomy. Medical treatment for hypotonic labor dysfunction includes an amniotomy as the first remedy if the membranes are intact.

How should the nurse intervene to relieve perineal bruising and edema following delivery? a. Place an ice pack on the area for 12 hours. b. Place a warm pack on the perineal area for 24 hours. c. Administer aspirin to relieve inflammation. d. Change the perineal pad frequently.

a. Place an ice pack on the area for 12 hours. An ice pack can be placed on the mothers perineum to reduce bruising and edema for 12 hours followed by a warm pack after the first 12 to 24 hours after delivery.

What is the principal goal of nursing care during labor? a. Promoting relaxation and helping the woman to conserve resources b. Preparation of the delivery room with needed supplies c. Assisting the obstetrician to gown and glove d. Documenting the labor process

a. Promoting relaxation and helping the woman to conserve resources c. Assisting the obstetrician to gow

version nursing care

assist, observe mom and fetus 1-2 hours after, baseline vitals and EFM before and after. assess for vaginal leaking

infant signs of infection

axillary temp under 97 or over 100. lethargy or irritability, poor feeding, not "looking right"

Which are considered pharmacological methods to stimulate contractions? Select all that apply. a. Prostaglandin gel b. Amniotomy c. Oxytocin administration d. Nipple stimulation e. Version

a. Prostaglandin gel c. Oxytocin administration Cervical ripening using prostaglandin gel and oxytocin administration (IV) are considered pharmacological methods to stimulate contractions. Amniotomy is the artificial rupture of membranes by using a sterile sharp instrument and can stimulate contractions but is not considered pharmacological. Stimulation of the nipples causes natural secretion of oxytocin and is a nonpharmacological method to stimulate contractions. Version is a method of changing the fetal presentation, usually from breech to cephalic.REF: Pages 175-176

What does the nurse explain is used to soften the cervix with a cervical ripening agent? a. Prostaglandin gel insertion b. Intravenous oxytocin c. Warm saline douches d. Nipple stimulation

a. Prostaglandin gel insertion Prostaglandin gel is inserted in the cervix and the woman remains in bed for 1 to 2 hours, being monitored for uterine contractions.

While caring for an Arab woman in labor, the nurse should provide cultural sensitivity through which interventions? (Select all that apply.) a. Provide for extreme modesty. b. Assign a male caregiver. c. Arrange for the husband/partner to participate in labor. d. Provide adequate pain control. e. Respect protective amulets.

a. Provide for extreme modesty. d. Provide adequate pain control. e. Respect protective amulets. Arab women are extremely modest, usually have a low pain tolerance, and wear various protective and religious amulets. The husband is in attendance but not as a participant. Arabs prefer female caregivers. If a male is in attendance, then the husband will remain in the room as long as the male is there.

A nurse instructs a womans labor coach to comfort her by firmly pressing on her lower back. What is this technique? a. Sacral pressure b. Distraction c. Effleurage d. Conscious relaxation

a. Sacral pressure Sacral pressure refers to firm pressure against the lower back to relieve some of the pain of back labor.

Which are nonpharmacological forms of pain relief? (Select all that apply.) a. Skin stimulation b. Diversion and distraction c. Breathing techniques d. Exercise e. Yoga

a. Skin stimulation b. Diversion and distraction c. Breathing techniques Skin stimulation, diversion and distraction, and breathing techniques are the bases of nonpharmacological pain control. Although exercise and practices such as yoga and Pilates are beneficial, they are not means of pain control.

A woman 2 weeks past her expected delivery date is receiving an oxytocin infusion to induce labor and begins to have contractions every 90 seconds. What is the nurses initial action? a. Stop the oxytocin infusion. b. Continue the infusion and report the findings to the physician. c. Turn her on her left side and reassess the contractions. d. Administer oxygen by mask.

a. Stop the oxytocin infusion. Oxytocin is discontinued if signs of fetal compromise or excessive uterine contractions occur.

What is a potential adverse effect of pudendal block? a. Vaginal hematoma b. Maternal hypotension c. Fetal deoxygenation d. Spinal headache

a. Vaginal hematoma The pudendal block has few adverse effects if the woman is not allergic to the drug. A vaginal hematoma (collection of blood within the tissues) sometimes occurs. An abscess may develop, but this is not common.REF: Page 167

Vaginal examination reveals the presenting part is the infants head, which is well flexed on the chest. What is this presentation? a. Vertex b. Military c. Brow d. Face

a. Vertex In the vertex presentation, the fetal head is the presenting part. The head is fully flexed on the chest.

What complications of overstimulation of uterine contractions may occur? (Select all that apply.) a. Water intoxication b. Impaired placental exchange of oxygen and nutrients c. Increased blood pressure d. Convulsions e. Uterine rupture

a. Water intoxication b. Impaired placental exchange of oxygen and nutrients e. Uterine rupture The most common complications are impaired placental exchange and uterine rupture, but water intoxication can occur due to fluid retention.

Indications for Cesarean Birth

abnormal labor, inability of the fetus to pass through the mother';s pelvis, maternal conditions such as GH or DM, active maternal herpes virus, previous surgery on the uterus, fetal compromise, placenta previa or abruptio placentae

Evaluating fetal heart rate patterns

accelerations, early deceleration, variable deceleration, late decelerations

Risk Factors for Dysfunctional Labor

advanced maternal age, obesity, overdistention of uterus, abnormal presentation, cephalopelvic disproportion, overstimulation of the uterus, maternal fatigue, dehydration, fear, lack of analgesic assistance

prolonged pregnancy risks

aging placenta delivers o2 and nutrients to fetus less efficiently. fetus may lose weight. skin may begin to peel. meconium aspiration syndrome. psychologically feels pregnancy will never end. if 42 weeks then induce.

Nursing Tips

although assessing the uterus after cesarean birth causes discomfort, it is important to do so regularly, the woman can have a relaxed uterus that causes excessive blood loss, regardless of how her child was delivered

After an amniotomy, the umbilical cord becomes compressed. The nurse prepares the patient for an instillation of a bolus of warm sterile saline into the uterus, which is called ____________________.

amnioinfusion

hypotonic management

amniotmy, oxytocin augmentation, adequate hydration, nondrug stimulation, position changes and encouragement.

Laminaria

an alternative to cervical ripening by swelling inside the cervix

Risks of Cesarean BIrth for mother

anesthesia, respiratory complications, hemorrhage, blood clots, injury to urinary tract, delayed intestinal peristalsis, infection

sequence of events in cesarean birth

anesthesia, scrubbed and draped - incision. AROM, amniotic fluid suctioned. reaches into uterus to lift out fetal head or buttocks. infant airway/warmth, placenta scooped out and assessed. uterine cavity

Which statement made by an expectant mother demonstrates understanding of the significant risks of home delivery? a. "I know I will have access to the technology that monitors my well-being." b. "I know that there will be a delay in emergency care if there is a complication." c. "The physician will only come to my home if I have a complication." d. "The midwife can perform most emergency procedures at home."

b. "I know that there will be a delay in emergency care if there is a complication." Mothers will not have access to technology at home. Most physicians will not come to the home for medical care. Most emergency procedures can only be performed in the hospital per standard of care. It is important that this mother understands that there will be a delay, creating significant risk, if there is a complication.REF: Page 116

The nurse is instructing a Lamaze class on abdominal breathing and tells a patient that her baseline respiratory rate is 22 breaths per minute. What should be the patients rate while performing slow breathing? a. 9 b. 11 c. 15 d. 20

b. 11 The range of respirations should be no lower than half of the base rate and no more rapid than double the base rate.

What is the purpose of the administration of Vitamin K (AquaMephyton) to a newborn? a. Cord healing b. Blood clotting c. Respiratory status d. Infection prevention

b. Blood clotting Vitamin K (AquaMephyton) is required by the newborn to assist in blood clotting. A newborn lacks vitamin K at birth because of a sterile gastrointestinal tract. Newborns receive a single dose of vitamin K into the vastus lateralis muscle before leaving the delivery room, usually at age 1 hour.REF: Page 153

What assessment should be taken immediately after the anesthesiologist administers an epidural block to a laboring woman? a. Bladder for distention b. Blood pressure c. Sensation in the lower extremities d. Intravenous fluid flow rate

b. Blood pressure Blood pressure is checked every 5 minutes when the epidural block is first begun. Bladder assessment is also important but not an initial assessment.

How might the nurse instruct the patient to stimulate her nipples in an attempt to increase the quality of uterine contractions? (Select all that apply.) a. Place a warm, moist washcloth over the breast. b. Brush the nipples with a dry washcloth. c. Gently pull on the nipples. d. Apply suction to the nipples with a breast pump. e. Press the palms of her hands down on her breasts.

b. Brush the nipples with a dry washcloth. c. Gently pull on the nipples. d. Apply suction to the nipples with a breast pump. Brushing nipples with a dry washcloth, gently pulling nipples, and applying suction with a breast pump are all effective methods of nipple stimulation, which will increase the quality of uterine contractions.

The nurse is caring for a patient who is not certain if she is in true labor. How might the nurse attempt to stimulate cervical effacement and intensify contractions in the patient? a. By offering the patient warm fluids to drink b. By helping the patient to ambulate in the room c. By seating the patient upright in a straight-back chair d. By positioning the patient on her right side

b. By helping the patient to ambulate in the room

When a woman is admitted to the labor and delivery unit, she tells the nurse that she is anxious about delivery, the welfare of her infant, and how quickly she will recover. How can anxiety affect labor? a. By decreasing a womans pain sensitivity b. By reducing blood flow to the uterus c. By increasing the ability to tolerate pain d. By enhancing maternal pushing through greater muscle tension

b. By reducing blood flow to the uterus Excessive anxiety reduces uterine blood flow, making uterine contractions less effective, and creates muscle tension that counteracts the expulsion powers of contractions.

What is a registered nurse who has advanced training in anesthetic administration known as? a. Certified Registered Nurse Anesthesiologist b. Certified Registered Nurse Anesthetist c. Certified Registered Nurse Analgesist d. Certified Registered Nurse Assistant

b. Certified Registered Nurse Anesthetist A certified registered nurse anesthetist (CRNA) is a registered nurse who has advanced training in anesthetic administration.REF: Page 164

The nurse coaches the primigravida not to bear down until the cervix is completely dilated. What may premature bearing down cause? a. Increased use of oxygen b. Cervical laceration c. Uterine rupture d. Compression of the cord

b. Cervical laceration Bearing down against a cervix that is not dilated can cause edema and laceration to the cervix.

What nursing care should be provided to a woman with a third-degree laceration immediately after delivery? a. Warm compresses to the perineum b. Cold pack to the perineum c. Warm sitz bath d. Elevation of hips to prevent edema

b. Cold pack to the perineum Ice is applied to the perineum to reduce bruising and edema.

The physician has ordered Fentanyl (Sublimaze) for a woman in labor and has asked the nurse to provide patient education. What will the nurse include in the educational plan? (Select all that apply.) a. Onset is slow. b. Duration is short. c. Administration is by mouth. d. No known side effects. e. It is not the same drug as sufentanil.

b. Duration is short. e. It is not the same drug as sufentanil. Fentanyl has a rapid onset and short duration of action. Fentanyl, sufentanil, and alfentanil are not the same drugs. Fentanyl can cause respiratory depression but less than meperidine. It is not administered by mouth.

What would the nurse guide a labor coach to do to comfort a woman tensing her muscles with contractions? a. Offer warm liquids to the patient. b. Encourage the patient to pant. c. Engage the patient in conversation. d. Assist the patient to the knee-chest position.

b. Encourage the patient to pant. Panting relaxes the abdominal wall and distracts the patient. It would not be helpful to offer fluids or to attempt conversation during contractions. Walking intensifies contractions.

What marks the end of the third stage of labor? a. Full cervical dilation b. Expulsion of the placenta and membranes c. Birth of the infant d. Engagement of the head

b. Expulsion of the placenta and membranes The third stage of labor extends from the birth of the infant until the placenta is detached and expelled.

The nurse is caring for a laboring patient who is not reporting pain. What sign would alert the nurse of the need for pain relief? a. Frequently asking for ice chips b. Facial grimacing c. Changing positions in bed d. Covering her face with her hands

b. Facial grimacing Facial grimacing may be an indicator of unexpressed pain.

It is determined that the presenting part of the fetus is the buttocks. At delivery the fetuss hips are flexed and the knees are extended. How would the nurse record this presentation? a. Complete breech b. Frank breech c. Double footling d. Buttocks presentation

b. Frank breech When a fetus presents in a frank breech position, the legs are flexed at the hips and extend toward the shoulders.

What interventions should a nurse expect to implement after an epidural block is placed? a. Fluid bolus of 500 bcc b. Frequent monitoring of blood pressure c. Frequent administration of medications for nausea d. Frequent assessment of temperature

b. Frequent monitoring of blood pressure The fluid bolus is usually given prior to the epidural. One of the frequent adverse reactions of an epidural is hypotension, which can cause fetal hypoxia. Medications for nausea are not usually needed if blood pressure is maintained. Temperature is monitored but because of rupture of membranes is not an assessment related to epidural block.REF: Page 168

After several hours of labor, a nursing assessment reveals that a womans cervix is 5 cm dilated but contractions are becoming shorter and less frequent. What is this labor pattern considered? a. Normal b. Hypotonic c. Hypertonic d. False

b. Hypotonic The woman with labor dysfunction related to decreased uterine muscle tone begins labor normally, but contractions diminish after the active phase.

Which statement indicates a woman understands activity limitations for the management of preterm labor? a. After my shower in the morning, I do the laundry and straighten up the house; then I rest. b. I pack a picnic basket and put it next to the sofa so I do not have to get up for food during the day. c. I have a 2-year-old to care for, but I try to rest as much as I can. d. I get really bored at home, so I go to the shopping mall for just a little while.

b. I pack a picnic basket and put it next to the sofa so I do not have to get up for food during the day. Lengthy activity restrictions are often needed to prevent preterm birth. The nurse can help the woman identify ways to organize necessary activities and maximize rest.

The nurse is caring for a patient who is threatening preterm labor and has been given glucocorticoids. What is the purpose of glucocorticoid administration? a. Prevent infection. b. Increase fetal lung maturity. c. Increase blood flow from placenta. d. Relax the cervix.

b. Increase fetal lung maturity. Glucocorticoids assist with improving the lung maturity of a fetus that is preterm.

What sign(s) of infection should the nurse assess for after an amniotomy? (Select all that apply.) a. Oral temperature of 37 C (99.8 F) b. Increase of fetal heart rate (FHR) from 160 to 174 beats/minute c. Flecks of vernix in the amniotic fluid d. Low back pain e. Edematous labia

b. Increase of fetal heart rate (FHR) from 160 to 174 beats/minute Increase in the FHR above 160 beats/minute frequently precedes a womans temperature elevation. All the other options are normal findings for late pregnancy.

A pregnant womans membranes ruptured prematurely at 34 weeks. She will be discharged to her home for the next few weeks. What would the nurse planning discharge instruction teach the woman to do? a. Report any increase in fetal activity. b. Notify her obstetrician if she has a temperature above 37.8 C (100 F). c. Massage her breasts to promote uterine relaxation. d. Rest in a side-lying Trendelenburg position with hips elevated.

b. Notify her obstetrician if she has a temperature above 37.8 C (100 F). For the woman with premature rupture of membranes (PROM) who is not having labor induced right away, teaching combines information about infection and preterm labor. The woman should monitor her temperature and report a temperature greater than 37.8 C (100 F).

During a strenuous labor, the woman asks for some pain remedy for the sudden pain between her scapulae that seems to occur with every breath she takes. What is the best nursing action? a. Give the pain remedy. b. Notify the charge nurse immediately. c. Turn the patient to her back and flex her knees. d. Suggest that the coach give her a back rub.

b. Notify the charge nurse immediately. Sudden pain between the scapulae during a strenuous labor is an indicator of uterine rupture. This should be reported immediately.

Which position(s) and exercise(s) will the nurse teach as beneficial in combating discomfort in the later stages of pregnancy? (Select all that apply.) a. Leg lifts b. Pelvic rock c. Tailor sitting d. Sit-ups e. Shoulder curling

b. Pelvic rock c. Tailor sitting e. Shoulder curling Pelvic rock, tailor sitting, and shoulder curling are beneficial to the muscles that will have to adapt to the extra weight and changed posture of later pregnancy. Leg lifts and sit-ups are not beneficial because they both increase intraabdominal pressure.

A woman is 37 weeks pregnant and questioning the nurse about possible induction of labor at term. What conditions would contraindicate labor induction? (Select all that apply.) a. Maternal gynecoid pelvis b. Placenta previa c. Horizontal cesarean incision d. Prolapsed cord e. Gestational diabetes

b. Placenta previa d. Prolapsed cord Labor induction is contraindicated with placenta previa or a prolapsed umbilical cord. Gynecoid pelvis is the most favorable shape for vaginal delivery. Induction can be attempted as a VBAC after a horizontal cesarean incision but is contraindicated with a classic (vertical) incision. Gestational diabetes is not a contraindication for labor induction.

What is the Dick-Read method of childbirth preparation based on? a. Mild sedation throughout labor b. Relaxation techniques c. Skin stimulation d. Deep massage

b. Relaxation techniques The Dick-Read method depends on the use of relaxation techniques to reduce the discomforts of labor.

When caring for the laboring patient, the nurse determines that the fetus is located in the right occiput posterior (ROA). What will the nurse anticipate? a. Urinary retention b. Severe lower back pain c. A shorter labor process d. Nausea

b. Severe lower back pain If the fetal occiput is in a posterior pelvic quadrant, each contraction pushes it against the mothers sacrum, resulting in persistent and poorly relieved back pain (back labor). Labor is often longer with this fetal position.

Overstimulation of contraction

fetal compromise, uterine rupture

The nurse observes the patient bearing down with contractions and crying out, The baby is coming! What is the best nursing intervention? a. Find the physician. b. Stay with the woman and use the call bell to get help. c. Send the womans partner to locate a registered nurse. d. Assist with deep breathing to slow the labor process.

b. Stay with the woman and use the call bell to get help. If birth appears to be imminent, the nurse should not leave the woman and should summon help with the call bell.

A student nurse questions the instructor regarding what alteration should be made for the assessment of the fundus of a new postoperative cesarean section patient. What is the best response? a. The fundus is not assessed until the second postoperative day. b. The fundus is assessed by walking fingers from the side of the uterus to the midline. c. The fundus is assessed only if large clots appear in lochia. d. The fundus is assessed only once every shift.

b. The fundus is assessed by walking fingers from the side of the uterus to the midline. Assessment of the fundus following a cesarean section is done as usual, but using especially gentle fundal massage.

The nurse is providing a conference on nonpharmacological pain control methods. What major advantages of nonpharmacological pain control methods will the nurse include in the presentation? (Select all that apply.) a. They sedate the mother. b. They do not slow labor. c. They do not dull the excitement of the birth experience. d. They do not have the potential to cause allergic reactions. e. They do not have to be delayed until labor is well established.

b. They do not slow labor. c. They do not dull the excitement of the birth experience. d. They do not have the potential to cause allergic reactions. e. They do not have to be delayed until labor is well established. All the options mentioned are benefits of nonpharmacological pain control methods with the exception of sedating the mother.

What is the least amount of sensation that one perceives as pain? a. Tolerance b. Threshold c. Level d. Abatement

b. Threshold Pain threshold is the least amount of sensation that one perceives as pain. Thresholds are different for each individual.

A woman in labor will receive general anesthesia prior to cesarean section. The nurse reminds the patient that food and fluids need to be restricted for several hours prior to delivery. What will this prevent? a. Nausea and vomiting b. Vomiting and aspiration c. Abdominal cramping d. Intestinal obstruction

b. Vomiting and aspiration The major adverse effect of general anesthesia is aspiration of stomach contents.

Indications for an episiotomy

better control over where and how much the vaginal opening is enlarged, an opening with a clean edge rather than the ragged edges of a tear, perineal massage and stretching exercises before labor may be an alternative to an episiotomy

episiotomy indications

better control. an opening with a clean edge rather than the ragged opening of a tear. risk of infection. done with blunt tipped scissors before birth.

A nursing student is observing prenatal exams in the office setting. The health care provider informs the student that the fetal position is LSA. The student interprets this as a ____________________ presentation.

breech LSA is the abbreviation for Left Sacrum Anterior. This is a breech presentation.

Which statement indicates that an expectant mother understands the diagnosis of placenta previa? a. "My doctor will not let my pregnancy go beyond my due date before he induces me." b. "My doctor will monitor for rupture of membranes each week at my appointment." c. "My doctor will not induce labor at any time during this pregnancy." d. "My baby will probably come early because of my condition."

c. "My doctor will not induce labor at any time during this pregnancy." The physician will not induce a patient with this diagnosis. Rupture of membranes is not a primary risk for this complication. This diagnosis does not have a high correlation with preterm births.REF: Page 175

The nurse arrives at the start of a shift on the labor unit to find a census of four patients in active labor. Which laboring patient should the nurse attend to first? a. 18-year-old primigravida with a fetal breech presentation b. 25-year-old multigravida with history of previous cesarean section c. 35-year-old multigravida with history of precipitate birth d. 16-year-old primigravida with a twin pregnancy

c. 35-year-old multigravida with history of precipitate birth A precipitate birth is completed in less than 3 hours. Labor often begins abruptly and intensifies quickly, rather than having a more subtle onset and gradual progression. Contractions may be frequent and intense, often from the onset. If the womans tissues do not yield easily to the powerful contractions, she may have uterine rupture, cervical lacerations, or hematoma. Fetal breech presentation, history of cesarean section, and multifetal pregnancy have associated risk factors, but not as immediate as precipitate birth.

What nursing assessment should be reported immediately after an amniotomy? a. Fetal heart rate is regular at 154 beats/min. b. Amniotic fluid is clear with flecks of vernix. c. Amniotic fluid is watery and pale green. d. Maternal temperature is 37.8 C.

c. Amniotic fluid is watery and pale green. Amniotic fluid should be clear. Green fluid indicates the fetus has passed meconium, which is associated with fetal compromise.

cesarean contraindications

fetal death or too premature to survive, if mom has abnormal blood clotting.

What is the most important nursing intervention during the fourth stage of labor? a. Monitor the frequency and intensity of contractions. b. Provide comfort measures. c. Assess for hemorrhage. d. Promote bonding.

c. Assess for hemorrhage. Immediately after giving birth, every woman is assessed for signs of hemorrhage.

A woman who is 6 cm dilated has the urge to push. What will the nurse instruct the woman to do during the contraction? a. Use slow-paced breathing. b. Hold her breath and push. c. Blow in short breaths. d. Use rapid-paced breathing.

c. Blow in short breaths. If a laboring woman feels the urge to push before the cervix is fully dilated, then she is taught to blow in short breaths to avoid bearing down.

Which childbirth method was originally called "husband-coached childbirth" and was the first to include the father as an integral part of labor? a. Lamaze b. Dick-Read c. Bradley d. Gate control

c. Bradley The Bradley method was originally called "husband-coached childbirth" and was the first to include the father as an integral part of labor. It emphasizes slow abdominal breathing and relaxation techniques. The Lamaze method uses mental techniques that condition the woman to respond to contraction with relaxation rather than tension. The Dick-Read method believes that fear contributes to tension, which results in pain. Methods include education and relaxation techniques to interrupt the pain cycle.REF: Page 161

What contraction duration and interval does the nurse recognize could result in fetal compromise? a. Duration shorter than 30 seconds, interval longer than 75 seconds b. Duration shorter than 90 seconds, interval longer than 120 seconds c. Duration longer than 90 seconds, interval shorter than 60 seconds d. Duration longer than 60 seconds, interval shorter than 90 seconds

c. Duration longer than 90 seconds, interval shorter than 60 seconds Persistent contraction durations longer than 90 seconds or contraction intervals less than 60 seconds may reduce fetal oxygen supply.

An infant is delivered with the use of forceps. What should the nurse assess for in the newborn? a. Loss of hair from contact with forceps b. Sacral hematoma c. Facial asymmetry d. Shoulder dislocation

c. Facial asymmetry Pressure from forceps may injure the infants facial nerve, which is evidenced by facial asymmetry.

Which nursing action has the highest priority for a patient in the second stage of labor? a. Check the fetal position. b. Administer pain medication. c. Help the mother push effectively. d. Prepare the mother to breastfeed on the delivery table.

c. Help the mother push effectively. The second stage of labor is the pushing stage. The nurse should help the mother push effectively. The mother cannot breastfeed in the second stage of labor. Checking fetal position is not the highest priority during the second stage of labor. Pain medication should not be administered in the second stage because it will cause a lethargic neonate and possibly depress the newborn's respirations.REF: Page 144

What is the best nursing action to implement when late decelerations occur? a. Reposition the patient to supine b. Decrease flow of intravenous (IV) fluids c. Increase oxygen to 10 L/minute d. Prepare to increase oxytocin drip

c. Increase oxygen to 10 L/minute The major objective of care for late decelerations is to increase maternal oxygen. IV fluids are increased to increase placental perfusion, oxytocin drips are stopped, and the patient is positioned to prevent supine hypotension.

A nurse is teaching a childbirth preparation class. The group is discussing individual expression of labor pain. What statement is accurate about a patients expression of pain? a. It reduces the patients perception of pain. b. It is intensified by the vertex position of the fetus. c. It is influenced by culture. d. It can be completely controlled by nonpharmacological techniques.

c. It is influenced by culture. Culture influences how women feel about birth and what is an acceptable response to pain.

A woman in the transition phase of labor requests a narcotic analgesic medication for pain relief. What should the nurse explain regarding giving a narcotic analgesic medication at this stage of labor? a. It can cause medication given at later stages to be ineffective. b. It will have no complications for the mother or infant. c. It may result in respiratory depression to the newborn. d. It will speed up labor and increase pain.

c. It may result in respiratory depression to the newborn. The risk of narcotic analgesics is that they cross the placenta and can cause fetal respiratory depression.

Which narcotic antagonist is used to reverse narcotic-induced respiratory depression? a. Hydroxyzine (Vistaril) b. Phenobarbital c. Naloxone (Narcan) d. Nitrous oxide

c. Naloxone (Narcan) Naloxone (Narcan) is used to reverse respiratory depression caused by narcotics.

A pulsating structure is felt during a vaginal examination of a woman in labor. How would the nurse position the woman to prevent compression of a prolapsed cord? a. On her right side with knees flexed b. On her left side with a pillow placed between her legs c. On her back with her head lower than the rest of her body d. Supine with her legs elevated and bent at the knee

c. On her back with her head lower than the rest of her body The Trendelenburg (head down) position displaces the fetus upward to stop compression of the prolapsed cord.

What is the function of contractions during the second stage of labor? a. Align the infant into the proper position for delivery b. Dilate and efface the cervix c. Push the infant out of the mothers body d. Separate the placenta from the uterine wall

c. Push the infant out of the mothers body The contractions push the infant out of the mothers body as the second stage of labor ends with the birth of the infant.

While caring for a laboring woman, the nurse notices a pattern of variable decelerations in fetal heart rate with uterine contractions. What is the nurses initial action? a. Stop the oxytocin infusion. b. Increase the intravenous flow rate. c. Reposition the woman on her side. d. Start oxygen via nasal cannula.

c. Reposition the woman on her side. Repositioning the woman is the first response to a pattern of variable decelerations. If the decelerations continue, then oxygen should be administered and/or the flow rate of oxygen should be increased.

The initial vaginal examination of a woman admitted to the labor unit reveals that the cervix is dilated 9 cm. The panicked woman begs the nurse, Please give me something. What is the most appropriate pain relief intervention for a woman in precipitate labor? a. Get an order for an intravenous narcotic. b. Notify the anesthesiologist for an epidural block. c. Stay and breathe with her during contractions. d. Tell her to bear with it because she is close to delivery.

c. Stay and breathe with her during contractions. The nurse would stay with the woman experiencing precipitate labor and breathe with her during contractions to help the woman focus and cope with each contraction.

Why is the relaxation phase between contractions important? a. The laboring woman needs to rest. b. The uterine muscles fatigue without relaxation. c. The contractions can interfere with fetal oxygenation. d. The infant progresses toward delivery at these times.

c. The contractions can interfere with fetal oxygenation. Blood flow from the mother into the placenta gradually decreases during contractions. During the interval between contractions, the placenta refills with oxygenated blood for the fetus.

What is the nurse primarily concerned about maintaining in the initial care of the newborn? a. Fluid intake b. Feeding schedule c. Thermoregulation d. Parental bonding

c. Thermoregulation Thermoregulation is necessary to keep heat loss minimal and oxygen consumption low. Hypothermia can cause cold stress, which leads to hypoxia.

The nurse is caring for a woman in the first stage of labor. What will the nurse remind the patient about contractions during this stage of labor? a. They get the infant positioned for delivery. b. They push the infant into the vagina. c. They dilate and efface the cervix. d. They get the mother prepared for true labor.

c. They dilate and efface the cervix. The first stage of labor describes the time from the onset of labor until full dilation of the cervix.

A woman who is 24 weeks pregnant is placed on an intravenous infusion of magnesium sulfate. What side effect should the nurse inform the patient that she might experience? a. Nausea and vomiting b. Headache c. Warm flush d. Urinary frequency

c. Warm flush Magnesium sulfate is the drug of choice for initiating therapy to stop labor. The patient will notice a warm flush with the initiation of the drug.

While discussing labor and delivery during a prenatal visit, a primigravida asks the nurse when she should go to the hospital. What is the nurses most informative response? a. When you feel increased fetal movement b. When contractions are 10 minutes apart c. When membranes have ruptured d. When abdominal or groin discomfort occurs

c. When membranes have ruptured Ruptured membranes are an indication that the woman should go to the hospital or birthing center.

Nipple stimulation

causes the pituitary gland to secrete natural oxytocin

infection of amniotic sac

chorioamnionitis. may cause PROM. risk of infection if 18 hour or more. GBS associated with PROM and PPROm

A(n) ________ incision is rarely used for cesarean birth because it involves more blood loss and is the most likely of the three types to rupture during another pregnancy.

classic This is true of a classic incision. However, it may be the only choice if the fetus is in a transverse lie or if there is scarring or a placenta previa in the lower anterior uterus.REF: Page 182

episiotomy/laceration nursing care

cold packs after 12-24 hours then warmth in form of heat packs or sitz bath. mild oral analgesics sufficient for pain management. monitor for infection, hematoma, diet

Nursing measures to promote comfort in a woman who has an episiotomy or laceration

coldpacks, heatpacks, oral analgesics

Describe nursing care after episiotomy or perineal lacerations.

comfort measures such as cold applications, analgesics, and wound assessment

nursing care hypo/hypertonic

comfort, emotional support, position changes, encourage walking, nipple stimulation

precipitate labor

complete in less than 3 hours. begin abruptly and intensifies quickly contractions frequent and intense from onset. if soft tissues do not yield to powerful contractions then uterine rupture, cervical lacerations or hematoma. contractions can compromise fetal oxygen, rapid passage can cause intracranial hemorrhage, nerve damage

post partum uterine rupture signs

continuous bleeding of brighter red blood. rising pulse and falling blood pressure

hypertonic

contraction are poorly coordinated, frequent and painful. resting tone between contractions is tense. more likely during latent phase.

symptoms of preterm labor

contractions either uncomfortable or painless. menstrual like cramps. constant low backache. pelvic pressure or feeling baby is pushing down. change in vaginal discharge. abdominal cramps with or without diarrhea. pain or discomfort in vulva or thighs. "just feeling bad"

hypotonic

contractions weak and ineffective. occurs during active phase. more likely with overdistended uterus or multipara

Episiotomy

controlled surgical enlargement of teh baginal opening during birth

When 3 to 4 cm of the fetal head is visible at the vaginal opening, this is known as ________.

crowning This is the definition of crowning.REF: Page 145

Why should the nurse encourage the mother to void during the fourth stage of labor? a. A full bladder could interfere with cervical dilation. b. A full bladder could obstruct progress of the infant through the birth canal. c. A full bladder could obstruct the passage of the placenta. d. A full bladder could predispose the mother to uterine hemorrhage.

d. A full bladder could predispose the mother to uterine hemorrhage. A full bladder immediately after birth can cause excessive bleeding because it pushes the uterus upward and interferes with contractions.

What is the most appropriate statement from the nurse when coaching the laboring woman with a fully dilated cervix to push? a. At the beginning of a contraction, hold your breath and push for 10 seconds. b. Take a deep breath and push between contractions. c. Begin pushing when a contraction starts and continue for the duration of the contraction. d. At the beginning of a contraction, take two deep breaths and push with the second exhalation.

d. At the beginning of a contraction, take two deep breaths and push with the second exhalation. When the cervix is fully dilated, the woman should take a deep breath and exhale at the beginning of a contraction, and then take another deep breath and push while exhaling.

A woman in labor has had an epidural block for pain relief. The nurse will be assessing carefully for what associated side effect of this type of regional anesthesia? a. Reduced fetal heart rate b. Long, intense contractions c. Sudden leg cramps d. Bladder distention

d. Bladder distention A side effect of an epidural block is urine retention because the anesthesia interferes with the womans ability to have an urge to void. The patient may have to be catheterized.

A laboring patient requests hot and cold applications be applied to her abdomen for pain control. How will this intervention act to control pain? a. By increasing endorphin production b. By facilitating effacement and dilation c. By producing increasing pain tolerance d. By stimulation of large nerve fibers

d. By stimulation of large nerve fibers The gate control theory explains how pain impulses reach the brain for interpretation. It supports several nonpharmacological methods of pain control. According to this theory, pain is transmitted through small-diameter nerve fibers. However, the stimulation of large-diameter nerve fibers temporarily interferes with the conduction of impulses through small-diameter fibers. Techniques to stimulate large-diameter fibers and close the gate to painful impulses include massage, palm and fingertip pressure, and heat and cold applications.

Several hours after delivery the nurse finds a woman crying. The woman says repeatedly, My baby is beautiful, but I was planning on a vaginal delivery. Instead I needed an emergency C-section. What is the most appropriate nursing diagnosis? a. Anxiety related to the development of postpartum complications b. Ineffective individual coping related to unfamiliarity with procedures c. Risk for ineffective parenting related to emergency cesarean section d. Grieving related to loss of expected birth experience

d. Grieving related to loss of expected birth experience Women who have cesarean births usually need greater support than those who have vaginal births. They may feel grief, guilt, or anger because the expected course of birth did not occur.

Several hours into labor, a woman complains of dizziness, numbness, and tingling of her hands and mouth. What does the nurse recognize these symptoms signify? a. Hypertension b. Anxiety c. Anoxia d. Hyperventilation

d. Hyperventilation Hyperventilation is sometimes a problem if a woman is breathing rapidly.

The nurse is preparing a teaching plan for a woman receiving a subarachnoid block before delivery. What nursing action will be included in this plan to prevent the associated side effect of this type of anesthesia? a. Restrict oral fluids. b. Keep legs flexed. c. Walk with assistance as soon as possible. d. Lie flat for several hours.

d. Lie flat for several hours. The woman would be advised to remain flat for several hours after the block to decrease the chance of postspinal headache.

After amniotomy, which observation should be reported immediately

fetal heart rate of 95 bpm

The nurse who encourages the gate control theory of pain control would advise a woman in labor and her partner to use which nonpharmacological method of pain management? a. Slow abdominal breathing b. Guided relaxation c. Listening to music d. Massage

d. Massage According to the gate control theory, stimulating large-diameter nerve fibers temporarily interferes with conduction of impulses through small-diameter fibers. Massage is a technique that stimulates large-diameter fibers and closes the gate.

What are the rationales for labor induction? (Select all that apply.) a. Placenta previa b. Prolapse of cord c. High station of fetus d. Maternal diabetes e. Placental insufficiency

d. Maternal diabetes e. Placental insufficiency Maternal diabetes and placental insufficiency are rationales for induction. The other options are contraindications for labor induction.

A pregnant woman arrives at the emergency department (ED) and reports she is in labor. After a thorough examination and diagnostic testing, it is determined to be false (prodromal) labor. What signs and symptoms would lead the nurse to suspect false (prodromal) labor? (Select all that apply.) a. Leaking of vaginal fluid b. Contractions intensify with ambulation c. Pink spotting d. Painless tightening of abdominal muscles e. Cervix thick and not effaced

d. Painless tightening of abdominal muscles e. Cervix thick and not effaced Painless tightening of abdominal muscles (Braxton-Hicks contractions) and cervix thick and not effaced lend to the determination of false (prodromal) labor. Leaking of vaginal fluid may indicate rupture of membranes and is a sign of true labor. Contractions that intensify with ambulation and pink spotting (bloody show) are signs of true labor.

At a prenatal visit, a primigravida asks the nurse how she will know her labor has started. The nurse knows that what indicates the beginning of true labor? a. Contractions that are relieved by walking b. Discomfort in the abdomen and groin c. A decrease in vaginal discharge d. Regular contractions becoming more frequent and intense

d. Regular contractions becoming more frequent and intense In true labor, contractions gradually develop a regular pattern and become more frequent, longer, and more intense.

The nurse formulates a nursing diagnosis for a woman in the fourth stage of labor. What is the most appropriate nursing diagnosis? a. Pain related to increasing frequency and intensity of contractions. b. Fear related to the probable need for cesarean delivery. c. Dysuria related to prolonged labor and decreased intake. d. Risk for injury related to hemorrhage.

d. Risk for injury related to hemorrhage. In the fourth stage of labor, a priority nursing action is identifying and preventing hemorrhage.

A woman is having a difficult labor because the fetus is presenting in the right occipital position (ROP). What position will the nurse promote to encourage fetal rotation and pain relief? a. Prone with legs supported and give her a back massage b. Supine with legs bent at the knee c. Standing with support d. Sitting up and leaning forward on the over-bed table

d. Sitting up and leaning forward on the over-bed table A position that favors fetal rotation and descent and that is helpful for the woman with back labor is to sit or kneel leaning forward on a support.

At what point during the labor process does the health care provider know that the second stage of labor has begun? a. The fetus is at +1 station. b. The placenta is delivered. c. The woman feels the urge to push. d. The cervix is fully dilated at 10 cm.

d. The cervix is fully dilated at 10 cm. Stage 2 is from full dilation of the cervix until birth of the fetus. Pushing before full dilation can be dangerous to the fetus and exhausting to the mother.The +1 station is too high. Delivery of the placenta is stage 3.REF: Page 144

A new mother is distressed and tearful about the elevated dome over her infants posterior fontanelle. The nurse responds, This condition will resolve itself in a few days. What is the cause? a. Prolonged pressure against the partially dilated cervix b. Small leak of fluid through the posterior fontanelle c. Pressure of the forceps during delivery d. The effect of the vacuum extractor

d. The effect of the vacuum extractor The chignon is due to the effect of the vacuum extractor and will disappear in a few days.

A woman reports that she thinks her membranes have ruptured. The physician performs a nitrazine paper test and the nurse observes the strip paper to be deep blue in color. What is the significance of this assessment? a. The woman is at risk for placenta previa. b. The woman is in the active phase of labor. c. The fluid is acidic and is most likely urine. d. The fluid is alkaline and most likely amniotic fluid.

d. The fluid is alkaline and most likely amniotic fluid. A blue-green or deep blue color of the nitrazine paper indicates the fluid is alkaline and most likely amniotic fluid. A yellow to yellow-green color of the strip paper indicates the fluid is acidic and is most likely urine. The nitrazine paper test does not indicate stage of labor nor can it identify placenta previa.REF: Page 137

At 1 and 5 minutes of life, a newborns Apgar score is 9. What does the nurse understand that a score of 9 indicates? a. The newborn will require resuscitation. b. The newborn may have physical disabilities. c. The newborn will have above average intelligence. d. The newborn is in stable condition.

d. The newborn is in stable condition. Apgar scoring is a system for evaluating the infants need for resuscitation at birth. Five categories are evaluated on a scale from 0 to 2, with the highest score being 10. A score of 9 indicates that the newborn is stable.

What does the nurse note when measuring the frequency of a laboring womans contractions? a. How long the patient states the contractions last b. The time between the end of one contraction and the beginning of the next c. The time between the beginning and the end of one contraction d. The time between the beginning of one contraction and the beginning of the next

d. The time between the beginning of one contraction and the beginning of the next The frequency of contractions is the elapsed time from the beginning of one contraction to the beginning of the next contraction.

A patient who received an epidural block asks why her blood pressure is taken so often. What is the nurses best response to explain the frequent blood pressure assessments? a. They ensure that unsafe levels of hypertension do not occur. b. They help assess for the need for further pain relief. c. They monitor the progress of labor. d. They ensure adequate placental perfusion.

d. They ensure adequate placental perfusion. The hypotension that accompanies an epidural block may cause inadequate perfusion of the placenta, leading to fetal hypoxia.

The nurse is caring for a patient diagnosed with hypotonic labor dysfunction. What will the nurse expect when caring for this patient? a. Elevated uterine resting tone b. Painful and poorly coordinated contractions c. Implementation of fluid restriction d. Use of frequent position changes

d. Use of frequent position changes A woman with hypotonic labor dysfunction will be encouraged to change position frequently to enhance contractions. With hypotonic labor uterine resting tone is decreased and IV fluids are increased. Painful and poorly coordinated contractions occur with hypertonic labor.

A pregnant woman, gravida 2, para 1, tells the nurse she desires a VBAC (vaginal birth after cesarean section) with this pregnancy. What is the primary concern regarding complications for this patient during labor and birth? a. Eclampsia b. Placental abruption c. Congestive heart failure d. Uterine rupture

d. Uterine rupture Nursing care for women who plan to have a VBAC is similar to that for women who have had no cesarean births. The main concern is that the uterine scar will rupture, which can disrupt the placental blood flow and cause hemorrhage. Observation for signs of uterine rupture should be part of the nursing care for all laboring women, regardless of whether they have had a previous cesarean birth.

Dystocia

difficult labor

First stage

dilation and effacement (4-6 hours)

prolapsed cord medical management

displace fetus upward to stop compression against pelvis. maternal position such as knee chest or Trendelenburg. placing mom in side lying with hips elevated on pillows. experienced MD may push fetus upward. 02 and tocolytic may be given. deliver by quickest means possible.

Risks and contraindications of version

disproportion between mother's pelvis and fetal size, abnormal uterine or pelvis size or shape, abnormal placental placement, previosu cesarean birth with vertical uterine incision, active herpes virus infection, inadequate amniotic fluid, poor placental function, multifetal festation, fetus can become entangled in umbilical cord

external technique

do after 37 weeks, before labor onset, determine fetal status

Nursing care of early pregnancy bleeding disorders

document amount and character of bleeding, save anything that looks like clots or tissue for evaluation by a pathologist, perineal pad count with estimated amount of blood per apd, such as 50%, monitor vs, if actively bleeding, woman should be kept NPO in case surgical intervention is needed

Following a vacuum extraction delivery, the nurse notices the newborn's head is not symmetrical with a chignon over the posterior fontanelle. The appropriate nursing action would be to: (Select all that apply) a. apply cold compresses to the swollen area b. notify the charge nurse or health care provider c. document and continue routine observation d. explain to the parents the swelling will resolve without treatment

document and continue routine observation, explain to the parents the swelling will resolve without treatment

Dysfunctional labor

does not progress

abnormal labor

dysfunction labor, dystocia - difficult labor, abnormality in 4 P's.

Abnormal Labor

dysfunctional labor, dystocia

The massage technique that stimulates the large-diameter fibers in order to block impulses from the small-diameter fibers is ____________________.

effleurage Effleurage stimulates the large-diameter fibers and blocks the pain impulses from the small-diameter fibers.

internal technique

emergency, during vaginal birth of twins or with inadequate fetal position

To facilitate delivery when using forceps you should

empty moms bladder

What nursing measures can promote a normal labor?

encouraging position changes, aiding relaxation, and reminding the woman to empty her bladder

The release of __________ during labor may explain why women often need smaller doses of an analgesic or anesthetic than might be expected in a similarly painful experience.

endorphins Endorphins are natural body substances similar to morphine. Endorphin levels increase during pregnancy and peak during labor.REF: Page 160

version risks

entangled umbilical cord, tear, uterine contractions

Bishop's Scoring System

evaluates the cervical response to induction procedures, the higher the score the more successful labor induction

Hydramnios

excessive amniotic fluid

4th degree laceration

extends through the anal sphincter into the rectal mucosa

Two methods of version

external and internal

Observe for complications after amniotomy

fetal heart rate outside normal range 110-160, suggest umbilical cord prolapse, color, odor and characteristics of amniotic fluid, woman's temp., green fluid may indicate that the fetus has passed a meconium stool

uterine rupture treatmetn

fetus living or blood loss excessive c/s. hysterectomy. careful monitoring of oxytocin, notify MD if any signs, emotional support

episiotomy median (midline)

from lower vaginal border toward anus, easier to repair and heals neatly, if extends more likely to go to sphincter

speeding fetal lung maturation

gestation between 24 and 34 weeks. dexamethasone and betamethasone may repeat in one week if birth not occurred.

Indications for labor induction

gestational hypertension, ruptured membranes without spontaneous onset of labor, infection within the uterus, medical problems in the woman that worsen during pregnancy, fetal problems, placental insufficiency, fetal death

Cesarean Birth currently 27.6%

healthy people 2020 wants to reduce Cesarean sections to 15 %.

Oxytocin (Pitocin)

high alert infusion. both mother and fetus must be observed closely for adverse reactions. infusion secondary line always pump. adjustment of rate dependent on response of patient and fetus. continuous fetal monitoring. record FHR.

Oxytocin

hormone secreted by the posterior pituitary gland (trade name Pitocin) too much Oxytocin can lead to hypoxia if contraction last longer then 90 seconds and / or more then 5 contractions in 10 minutes.

Supporting the partner by teaching partner

how laobr pains affect the woman's behavior/attitude, how to adapt responses to the woman's behavior, what to expect in his/her own emotionoal responses, the effects of epidural analgesia

Induction of labor is more effective if:

if cervical ripening is achieved before oxytocin is administered to stimulate contractions

prolapsed cord risk factors

if fetus doesn not completely fill the space in the pelvis or if fluid pressure is great when the membranes rupture - fetus high in pelvis when rupture - very small fetus - abnormal presentation - hydramnios

Prostaglandin

in a gel or vaginal insert is applied before labor induction to soften the cervix

Cephalopelvic Disproportion

inability of the fetus to fit through the pelvis

Risks of Cesarean Birth for Neonate

inadvertent preterm birth, respiratory problems because of delayed absortion of lung fluid, injury

cesarean risks for newborn

inadvertent preterm birth, respiratoy problems due to delayed absorption of lung fluid, injury such as laceration or bruising

Induction Vs Augmentation of labor

induction is the intentional initiation of labor before it occurrs naturally. Augmentation- is the stimulation of contractions after the have begun naturally.

What is the most common hazard after membranes rupture prematurely?

infection

Water intoxication

inhibits excretion of urine and promotes fluid retention

forceps

instruments with curved blades that fit around fetal head without unduly compressing it, may also use for c/s

version

internal or external. change fetal presentation. after 37 weeks, before labor onset, ultrasound prior. Non stress test. biophysical profile.

2nd degree laceration

involves baginal mucosa, perineal skin and deeper tissues of teh perineum

Induction

is the initiation of labor before it begins naturally

Augmentation

is the stimulation of contractions after they have begun naturally

A woman has an emergency cesarean delivery after the umbilical cord was found to be prolapsed. She repeatedly asks similar questions about what happened at birth. The nurse's interpretation of the woman's behavior is that she: 1. cannot accept that she did not have the type of delivery she planned. 2. is trying to understand her experience and move on with postpartum adaptation. 3. thinks the staff is not telling her the truth about what happened at birth. 4. is confused about events because the effects of the general anesthetic are

is trying to understand her experience and move on with postpartum adaptation.

Hypotonic

labor begins normally, but diminishes during active phase, more likely to occur if uterus is over distended, stretches the muscle fibers and reduces their ability to contract effectively

Compare nursing care for a C/S birth vs. a vaginal birth.

nursing care after cesarean birth is similar to care after vaginal birth with the addition of assessing the wound, indwelling catheter patency, and IV flow *the woman and her partner may need extra emotional support after cesarean birth

Describe the nursing care after births involving instruments (forceps or vacuum extraction).

observations for maternal and newborn injuries or infections

preterm labor

occurs after 20 weeks and before 38. results - immaturity of newborn. often begins with vague symptoms. early PTL usually does not begin like labor at term.

amniotic fluid embolism

occurs when amniotic fluid with particles enters womans circulation and obstructs small blood vessels in her lungs. more likely to occur during very strong labor because fluid is pushed into small blood vessels that rupture as cervix dilates. characterized by abrupt onset of hypotension, respiratory distress and coagulation abnormalities.

Amnioinfusion

oligohydramnios, umbilical cord compression, reduction of recurrent variable decelerations, dilution of meconium-stained amniotic fluid, replaces the cushion for the umbilical cord and relieves the variable decelerations

Use of Forceps and suctioning are

only temporary facial or head dis-formation remember the soft spot the fontanels allow the fetal skull to be compressed slightly during birth and also allow for brain to not get damaged.

Complications of oxytocin induction and augmentaiotn of labor

overstimulation of contraction, water intoxication

The amount of pain a person is willing to endure is referred to as ______________ ______________.

pain tolerance Pain tolerance is the amount of pain a person is willing to endure. Pain threshold is the point at which pain is perceived. Pain threshold is relatively consistent from person to person, but pain tolerance differs greatly.

What types of methods can be used to stimulate labor?

pharmacological, non-pharmacological, or mechanical methods

Contraindications to labor induction

placenta previa, umbilical cord prolapse, abnormal fetal presentation, high station of the fetus, active herpes infection in the birth canal, abnormal size or structure of teh mother's pelvis, previous classic cesarean incision

The nurse explains that the four Ps of the birth process are __________, __________, __________, and __________.

powers, passenger, passage, psyche The four interrelated components of the process of labor and birth, called the four Ps, are powers, passenger, passage, and psyche.

PROM

premature rupture of membranes. rupture at term

PPROM

preterm premature rupture of membranes. ROM before 38 weeks with or without uterine contractions

Reasons for an Episiotomy

prevent impaired sexual functioning later on in life, reduce the severity of perineal lacerations, reduce post-delivery pain and medication use

Abnormal fetal presentation or position

prevents the smallest diameter of the fetal head from passing through the smallest diameter of the pelvis, fetus does not pass easily, interferes with most efficient mechanisms of labor, can cause cord compression, may require external version

intrapartum antibiotics

previous infant with GBS. birth before 37 weeks. maternal fever during labor. membranes ruptured 18 hours or more.

Amniotomy Complications

prolapse of the umbilical cord, infection and abruptio placentae

Which is the most appropriate nursing care for the woman having hypertonic labor

promote rest and provide general comfort measures

Cervical Ripening

prostaglandin, laminaria

Forceps Extraction

provides traction and roation tot he fetal head when the mother's pushing efforts are insufficient to accomoplish a safe delivery, help the physician extract the fetal head throught he incision during a cesarean birth

Classic

rarely used, moreblood loss, most likely to rupture during another pregnancy

forceps/vacuum nursing care

ready equipment including catheter, ice for afterwards. assess for vaginal hematoma (sever and poorly relieved pelvic or rectal pain. assess infant head. check infants facial nerve

Post-abortion teaching

report increased bleeding, take temp every 8 hours for 3 days, take an oral iron supplement if prescribed, resume sexual activity as recommended by the health care provider, return to health care provider at the recommended time for a checkup and contraception information, pregnancy can occur before the first menstrual period returns after the abortion procedure

After the pregnant woman is admitted to the labor suite, the nurse assesses the position of the infant as ROA; this means that the infants head is _________ __________ _________.

right occiput anterior Right occiput anterior means that the infants right occiput is toward the anterior aspect of the mothers body.

If the sacrum of the fetus in a breech presentation is in the mother's right posterior pelvis, it is described as __________ ____________ ________.

right sacrum posterior The first word refers to what side of the mom's pelvis the presenting part is facing, the second is the fetal reference point (occiput for vertex presentations, mentum for face, and sacrum for breech), and the third references the front (anterior) or back (posterior) of the mother's pelvis. If the fetus is neither anterior nor posterior, then it is transverse.REF: Page 124

3rd degree laceration

same as second degree, also involves anal sphincter

uterine rupture characteristics

shock dues to bleeding in to abdomen. pain in chest between scapulae or with inspiration, cessation of contractions. abnormal or absent fetal heart rate, palpation of fetus outside uterus because fetus is pushed through torn are.

When oxytocin is given to the woman in labor, what should the nurse be aware of?

signs and symptoms of increased uterine activity

Types of Incisions

skin and uterine

prolapsed umbilical cord

slips downward in pelvis after membranes rupture. complete - visible at vagina opening. palpated - cord cannot be seen but felt as pulsating structure on vag exam. occult - prolapse is hidden, not seen or felt.

prostaglandin

soften cervix for labor induction. Gel/vaginal insert. monitor FHR. bedrest. usually in place 6-12 hours. complications - diarrhea, uterine hyperstimulation

Types of abortion

spontaneous, induced

Walking

stimulates contractions, eases pressure of the fetus on the mother's back, adds gravity to the downward force of contraction

oxytocin reaction nursing

stop oxytocin, increase non medicated IV, change patient position, give oxygen via face mask. notify MD. may require a tocolytic to reduce uterine contractions

A Bishop score greater than 6 may predict what?

successful labor induction because of a "ripe cervix"

vacuum extractor

suction applied to fetal head, can use with c/s, cannot be used in breech or all variations of cephalic, does not take up room in pelvis.

1st degree laceration

superficial vaginal mucosa or perineal skin

cesarean section

surgical delivery through abdominal and uterine incision. indications - abnormal labor, CPD, PIH, diabetes, active herpes, previous surgery on uterus, fetal compromise, placenta previa, abruptio placenta

A woman is being observed in the hospital because her membranes ruptured at 30 weeks gestation. While providing morning care, the nursing student notices that the draining fluid has a strong odor. The priority nursing action is to: 1. caution the woman to remain in bed until her physician visits. 2. ask the woman if she is having any more contractions than usual. 3. take the woman's temperature; report it and the fluid odor to the RN. 4. help to prepare the woman for an immediate cesarean delivery.

take the woman's temperature; report it and the fluid odor to the RN.

mothers signs for infection

temp 100.4 or more, foul smelling, cloudy or yellowish amniotic fluid, foul odored vaginal drainage after birth

stopping preterm labor - tocolytic drugs

terbutaline (brethine), magnesium sulfate. indomethacin (Indocin). nifedipine (Procardia)

Amniotomy

the artificial rupture of membranes, done to stimulate or enhance contractions, stimulates prostaglandin secretion

What should the nurse observe when the membranes are ruptured?

the character of the amniotic fluid and fetal heart rate

If methods to stimulate labor are used, what should the nurse observe?

the fetal condition and character of contractions

When oxytocin is given to the woman in labor, what should the nurse monitor?

the fetal heart rate every 15 minutes during active labor and every 5 minutes during the transition phase

What is an amnioinfusion?

the insertion of fluid directly into the uterus to provide a cushion for the umbilical cord after amniotic fluid is lost

An amnioinfusion is

the instillation of fluids into the uterus by means of an intrauterine-pressure catheter (IUPC). it can be done with a bolus or a continueous infusion

What is induction of labor?

the intentional initiation of labor before it occurs naturally

What is augmentation of labor?

the stimulation of contractions after they started naturally

Cesarean Birth

the surgical delivery of the fetus through incisions in the mother's abdomen and uterus

Induced

therapeutic, elective

Types of spontaneous abortion

threatened, inevitable, incomplete, complete, missed, recurrent

laceration

torn, ragged-edged wound uncontrolled tear

uterine inversion nursing care

tow IV lines, assess uterus every 15 minutes for firmness and deviation from midline. amount of vaginal bleeding. catheter assessment if applicable. NPO until stable. emotional support.

risk of foreceps/vacuum

trauma to fetal or maternal tissues, mom may have laceration or hematoma, infant may have bruising, lacerations or abrasion cephalohematoma or intracranial hemorrhage. vacuum causes harmless area of circular edema on infants scalp (chignon)

Risks for Forceps and Vacuum Extraction

trauma to maternal or fetal issues, mother may have a laceration or hematoma in her vagina, infant may have bruising, facial or scalp lacerations or abrasions, cephalhematoma or intracranial hemorrhage

uterine inversion

turning of the uterus inside out after birth of the fetus. rapid onset of schodk is common. can occur during fundal massage.

Lacerations

uncontrolled tear of the tissues that results in a jagged wound

indications for foreceps or vaccum extraction

used if exhausted, cardiac/pulmonary disorders, decreased FHR, placental problems. contraindication - cannot substitute for c/s, fetus high in pelvis, too large for pelvis

Oxytocin induction and the augmentaiton of labor

used to initiate or stimulate contractions, monst commonly used method

Vacuum Extraction

uses suction applied to the fetal head so the physician can assist the mother's expulsive efforts, used only with occiput presentation

Effects of Hormones Released because of anxiety

using glucose the uterus needs for energy Diverts blood from the uterus Increases tension of pelvic muscles; can impede fetal descent Increases perception of pain

Hypertonic

usually occurs during the latent pahse of labor, characterized by contractions that are frequent, cramplike and poorly coordinated, painful, but nonproductive, uterus is tense, even between contractiosn, which leads to reduced blood fow to the placenta

Shoulder Dystocia

usually occurs when fetus is too large, is an emergency, fetal chest cannot expand and the fetus needs to be able to breathe, after delivery, mother and infant need to be assessed for injuries, mother may have torn perineal tissue, more at riskf or uterine atony and postpartum hemorrhage, uterus does not contract well after birth, infant may ahve fractured clavicle

Benefit of Augmentation

usually requires less total oxytocin than induction, uterus is more sensitive to the drug when labor has already begun

Cesarean and assessments

uterine fundus hights and feel if it is firm or bogy if bogy message. vital signs every 15 minutes for first 1 to 2 hours Do NOT let the uterus relax make sure it is contracting to pull back down toward normal size.

Skin Incision

vertical allows more room for a large fetus, transverse

Monitor and helping with woman cope with labor

vital signs and contractions, progress of labor and response to labor, intake and output, teaching, providing encouragement

Nursing Care in the Recovery Room

vital signs to identify hemorrhage or shock, IV site and rate of solution flow, fundus for firmness, height and midline position, dressing for drainage, lochia for quantity, color and presence of clots, urine output from the indwelling catheter

cesarean recovery room

vital signs, oxygen, IV fluids, fundus check, dressing, lochia, urine output, cough and deep breathing, splint, PCA or narcotics

non pharm ways to stimulate contractions

walking, positions, nipple stimulation. complications - overstimulation nd can cause fetal compromise and uterine rupture

oxytocin complications

water intoxication - inhibits excretion of urine, promotes fluid retention. most noted post partum - fetal distress, FHR outside range, late decelerations. loss of variability, uterine hyperstimulation.

Nursing Tips to observe after amniotomy

wet underpads and linens after the membranes rupture, change them

When does anaphylactoid syndrome occur?

when amniotic fluid enters the woman's circulation

Cesarean Section Birth

woman may need more emotional support, emotional care of the partner and family is essential

Ineffective Maternal Pushing

woman may not understand which technique to use or may fear tearing her perineal tissues, epidural or subarachnoid blocks may depress or eliminate the natural urge to push, an exhausted woman may be unablle to gather enough energy to push