Labor and Delivery
A nurse sees a pregnant client at the clinic. The client is close to her due date. During the visit the nurse would emphasize that the client get evaluated quickly should her membranes rupture spontaneously based on the understanding of which possibility? 1 increased risk of infection 2 potential rapid birth of fetus 3 potential placenta previa 4 increased risk of breech presentation
1 After the amniotic sac has ruptured, the barrier to infection is gone, and an ascending infection is possible. In addition, there is a danger of cord prolapse. NOT 2 The spontaneous rupture does not hasten labor, although it might signal the beginning of labor. The client may have placenta previa with the membranes intact.
What assessment finding would suggest to the care team that the pregnant client has completed the first stage of labor? 1 The client's cervix is fully dilated. 2 The infant is born. 3 The client has contractions once every two minutes. 4 The client experiences her first full contraction.
1 The first stage of labor ends with the client's cervix being fully dilated at 10 cm. NOT 3.4. The onset of contractions signals the beginning of the first stage and 2 birth occurs at the end of the second stage.
The nurse is documenting the length of time in the second stage of labor. Which data will the nurse use to complete the documentation? 1 Admission time and time of fetal birth 2 Complete cervical dilation (dilatation) and time of fetal birth 3 Effacement time and time when contractions are regular 4 Time of mucus plug expulsion and full cervical dilation
2 The second stage of labor begins with complete cervical dilation (dilatation) of 10 cm and ends with delivery of the neonate.
Primigravida
A woman who is pregnant for the first time
Purpose of breathing patterns for labor
Breathing techniques are largely distraction techniques taught in birth classes and are well documented to decrease pain in labor.
Stages of Labor: 2
Childbirth reaches the second stage when the cervix is fully dilated to 10 cm. The second stage ends with the birth of the infant
The urge to push during labor is called the ________________.
Ferguson's reflex: the urge to push. This is generally caused by the baby being pressed onto the Ferguson Plexus of nerves, creating Ferguson's reflex
Labor
Labor is the process by which the fetus and the placenta leave the uterus
Leopold maneuvers help the nurse to determine
Leopold maneuvers help the nurse to determine the presentation, position, and lie of the fetus. The approximate weight and size of the fetus can be determined with ultrasound sonography or abdominal palpation.
Stages of Labor: 1
The first stage begins with the start of regular contractions that cause progressive changes to the cervix and ends when the cervix is dilated 10 cm.
Why is confidence during labor important?
When a mother feels confident in her ability to cope and finds ways to work with the contractions, the labor process is enhanced.
Gynecoid pelvis
categorized as a typical female pelvis (although only about half of all women have this type of pelvis); the rounded shape of the gynecoid inlet allows the fetus room to negotiate the dimensions of the bony passageway
When the cervix thins and shortens, it is known as ________________.
effacement
A(n) ________________ deceleration lasts longer than 2 minutes but less than 10 minutes.
prolonged
pelvic inlet (brim)
superior opening into the true pelvis from the abdominal cavity
Fetal lie
the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother
A nurse is caring for a client who has been administered an epidural block. Which should the nurse assess next? 1 respiratory rate 2 temperature 3 pulse 4 uterine contractions
1 The nurse must monitor for respiratory depression. Monitoring the client's respiratory rate will be the best indicator of respiratory depression.
transcutaneous electrical nerve stimulation (TENS)
Used for lower back pain, most effective in early labor Electrodes placed on the lower back provide a buzzing vibration that appears to improve pain tolerance
The most common fetal presentation, when the head is flexed with the chin toward the chest, is called ________________ presentation
Vertex
The nursing instructor is preparing a class discussing the role of the nurse during the labor and birthing process. Which intervention should the instructor point out has the greatest effect on relieving anxiety for the client? 1 Massage therapy 2 Continuous labor support 3 Pharmacologic pain management 4 Prenatal classes
2 Continuous labor support by a caring nurse or doula can help decrease a woman's anxiety during labor. Anxiety causes the release of catecholamines, which slow down the labor process. The continuous support helps keep the woman focused on what is important as well as provide necessary guidance and education as needed. NOT 1.3.4. The massage therapy, prenatal classes, and pharmacologic pain management are all tools that the nurse can use to help the woman.
Fetal macrosomia
A situation in which a fetus is large, usually defined as weighing more than 4,500 grams or almost 9 pounds AKA "large for gestational age." Fetus (the developing, unborn infant inside the uterus)
Breech presentation
Birth position in which the buttocks, feet, or knees emerge first
Contraction intensity
Intensity refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine pressure catheter. Measured as mild, moderate, strong
Acme
The highest intensity of a contraction.
Stages of Labor: 1 Phase 1 (Latent)
The latent phase of the first stage of labor is the period during which the cervix progressively dilates from 0 - 3 cm. Longest stage of labor lasting an average of 12 hours for a primigravida and 8 hours for multigravidas Contractions are mild to palpation (women can typically talk through them) Latent phase is can be a period of excitement due to long-anticipated immanent birth, whereas for others it may be a period of anxiety. Contractions last 30 - 40s and may be as close together as q3 min or as far apart as q30 min. Contractions may feel like menstrual cramps and may be accompanied by a low backache.
________________ variability occurs when there is an amplitude of 6 to 25 beats per minute in the fetal heart rate.
moderate
Fetal presentation
Manner in which the fetus enters the birth canal.
Variable decelerations
Most common deceleration pattern found. They are usually transient and correctable.
Fetal position
Relationship of the landmark on the presenting fetal part to the front, sides, or back of the maternal pelvis.
Stages of Labor: 4
The fourth stage of labor begins with the birth of the placenta and ends after 4 hours or when the mother becomes clinically stable.
Accelerations in FHR
Transient increase in FHR (15x15)
Assessment reveals that the fetus of a client in labor is in the vertex presentation. The nurse determines that which part is presenting? 1 shoulders 2 occiput 3 brow 4 buttocks
2 With a vertex presentation, a type of cephalic presentation, the fetal presenting part is the occiput. NOT 1 The shoulders are the presenting part when the fetus is in a shoulder presentation. 3 The brow or sinciput is the presenting part when a fetus is in a brow presentation. The buttocks are the presenting part when a fetus is in a breech presentation.
Which nursing action is required before a client in labor receives an epidural? 1 giving a fluid bolus of 500 ml 2 checking for maternal pupil dilation 3 testing maternal reflexes 4 observing maternal gait
1 The chief concern with epidural anesthesia is its tendency to cause hypotension because of its blocking effect on the sympathetic nerve fibers in the epidural space. One of the major adverse effects of epidural administration is hypotension. Therefore, a 500-1,000 ml fluid bolus is usually administered (before the anesthetic is administered) to help prevent hypotension in the client who wishes to receive an epidural for pain relief. NOT 2.3.4. Checking maternal reflexes, pupil response, and gait aren't necessary.
A nurse places an external fetal monitor on a woman in labor. Which instruction would be best to give her? 1 Lie supine so the tracing does not show a shadow. 2 Avoid flexing her knees so her abdomen is not tense. 3 Lie on her side so she is comfortable. 4 Avoid using her call bell to reduce interference.
3 The best position for all women during labor is on their side.
The community health nurse is conducting a presentation on labor and delivery. When illustrating the birth process, the nurse should point out "0 station" refers to which sign? 1 "This is just a way of determining your progress in labor." 2 "This indicates that you start labor within the next 24 hours." 3 "This means +1 and the baby is entering the true pelvis." 4 "The presenting part is at the true pelvis and is engaged."
4 0 station is when the fetus is engaged in the pelvis, or has dropped. This is an encouraging sign for the client. NOT 1.2. This sign is indicative that labor may be beginning, but there is no set time frame regarding when it will start. Labor has not started yet, 3 The fetus has not begun to move out of the uterus.
A primigravida client at 38 weeks' gestation calls the clinic and reports, "My baby is lower and it is more difficult to walk." Which response should the nurse prioritize? 1 "The baby has dropped into the pelvis; your body and baby are getting ready for labor in the next few weeks." 2 "This is not normal unless you are in active labor; come to the hospital and be checked." 3 "That is something we expect with a second or third baby, but because it is your first, you need to be checked." 4 "The baby moved down into the pelvis; this means you will be in labor within 24 hours, so wait for contractions then come to the hospital."
1 The baby can drop into the pelvis, an event termed lightening, and can happen for up to 2 weeks before the woman goes into labor. This is normal and does not require intervention.
The nurse notes that the fetal head is at the vaginal opening and does not regress between contractions. The nurse interprets this finding as which process? 1 engagement 2 descent 3 restitution 4 crowning
4 Crowning occurs when the top of the fetal head appears at the vaginal orifice and no longer regresses between contractions. NOT 1 Engagement occurs when the greatest transverse diameter of the head passes through the pelvic inlet. 2 Descent is the downward movement of the fetal head until it is within the pelvic inlet. 3 Restitution or external rotation occurs after the head is born and free of resistance. It untwists, causing the occiput to move about 45 degrees back to its original left or right position.
Assessment of a pregnant woman reveals that the presenting part of the fetus is at the level of the maternal ischial spines. The nurse documents this as which station? A -2 B -1 C 0 D +1
C. Station refers to the relationship of the presenting part to the level of the maternal pelvic ischial spines. Fetal station is measured in centimeters and is referred to as a minus or plus, depending on its location above or below the ischial spines. When the presenting part is at the level of the maternal ischial spines, the fetus is at 0 station. NOT A.B. When the presenting part is above the ischial spines, the distance is recorded as minus stations. D. When the presenting part is below the ischial spines, the distance is recorded as plus stations.
During labor, progressive fetal descent occurs. What is the range and how is it numbered?
Progressive fetal descent (-5 to +4) is the expected norm during labor, moving downward from the negative stations to zero station to the positive stations in a timely manner.
Prolonged decelerations
These decelerations are an abrupt FHR decreases of at least 15 bpm from baseline that last longer than 2 minutes but less than 10 minutes; fatal
The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy? 1 acupressure 2 acupuncture 3 effleurage 4 biofeedback
1 Acupressure is the application of pressure or massage at designated susceptible body points. A common point used for a woman in labor is Co4, which is located between the first finger and thumb on the back of the hand. Women may report their contractions feel lighter when a support person holds and squeezes their hand because the support person is accidentally triggering this point. NOT 2 Acupuncture involves insertion of needles into the same body points. 3 Effleurage, the technique of gentle abdominal massage often taught with Lamaze in preparation for birth classes, is a classic example of therapeutic touch. 4 Biofeedback is based on the belief that people have control and can regulate internal events such as heart rate and pain responses.
The nurse is assessing the laboring client to determine fetal oxygenation status. What indirect assessment method will the nurse likely use? 1 external electronic fetal monitoring 2 fetal blood pH 3 fetal oxygen saturation 4 fetal position
1 Analysis of the FHR using external electronic fetal monitoring is one of the primary evaluation tools used to determine fetal oxygen status indirectly. NOT 3 Fetal pulse oximetry measures fetal oxygen saturation directly and in real time. It is used with electronic fetal monitoring as an adjunct method of assessment when the FHR pattern is abnormal or inconclusive. 2 Fetal scalp blood is obtained to measure the pH. 4 The fetal position can be determined through ultrasonography or abdominal palpation but is not indicative of fetal oxygenation
A client has opted to receive epidural anesthesia during labor. Which of the following interventions should the nurse implement to reduce the risk of a significant complication associated with this type of pain management? 1 administration of 500 mL of IV Ringer's lactate 2 administration of 1000 mL of IV glucose solution 3 move the woman into a supine position 4 administration of aspirin
1 Hypotension risk can be reduced by being certain a woman is well hydrated with 500 to 1000 mL of IV fluid, such as Ringer's lactate, before the anesthetic is administered. NOT 2 Ringer's lactate is preferable to a glucose solution because too much maternal glucose can cause hyperglycemia with rebound hypoglycemia in the newborn. 3 Be certain a woman does not lie supine but remains on her side after an epidural block, to help prevent supine hypotension syndrome. 4 Be sure to caution women not to take acetylsalicylic acid (aspirin) for pain in labor as aspirin interferes with blood coagulation, increasing the risk for bleeding in the newborn or herself.
The nurse is monitoring the electronic fetal heart rate monitor and notes the following: variable V-shaped decelerations in the fetal heart rate (FH)R lasting about 30 seconds, accelerations of about 5 beats/min before and after each deceleration, no overshoot, and baseline FHR within normal limits. Which response should the nurse prioritize? 1 Help the woman change positions. 2 Discontinue supplemental oxygen. 3 Encourage pushing with contractions during second stage of labor. 4 Start an oxytocic infusion and decrease the rate of IV fluids.
1 The electronic fetal heart rate monitor reading is associated with cord compression. Changing to a different position is a first intervention to determine if this will improve the oxygen to the fetus. NOT 2 Supplemental oxygen should be maintained until the mother is stable. 4 Pharmacologic interventions are premature. 3 The nurse should modify pushing in the second stage of labor to improve fetal oxygenation.
A client in labor has requested the administration of opioids to reduce pain. At 2 cm cervical dilation (dilatation), she says that she is managing the pain well at this point but does not want it to get ahead of her. What should the nurse do? 1 Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor. 2 Agree with the client, and administer the drug immediately to keep the pain manageable. 3 Explain to the client that opioids should only be administered an hour or less before birth. 4 Refuse to administer opioids because they can develop dependency in the client and the fetus.
1 The timing of administration of opioids in labor is especially important as, if given too early (before 3 cm cervical dilatation), they tend to slow labor. If given close to birth, because the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered in the fetus for 2 to 3 hours after maternal administration. For this reason, opioids are preferably given when the mother is more than 3 hours away from birth. This allows the peak action of the drug in the fetus to have passed by the time of birth.
A nurse is auscultating the fetal heart rate of a woman in labor. To ensure that the nurse is assessing the FHR and not the mother's heart rate, which action would be most appropriate for the nurse to do? 1 Palpate the mother's radial pulse at the same time. 2 Ask the woman to hold her breath while assessing the FHR. 3 Have the woman lie completely flat on her back while auscultating. 4 Instruct the woman to bend her knees and flex her hips.
1 To ensure that the maternal heart rate is not confused with the FHR, palpate the client's radial pulse simultaneously while the FHR is being auscultated through the abdomen. NOT 2 Having the woman hold her breath would be inappropriate and possibly dangerous. 3.4. Lying flat or bending the knees and flexing the hips would have no effect on determining if the heart rate being assessed is of the fetus or the mother.
A nurse is performing a vaginal examination of a woman in the early stages of labor. The woman has been at 2 cm dilated for the past 2 hours, but effacement has progressed steadily. Which statement by the nurse would best encourage the client regarding her progress? 1 "You are still 2 cm dilated, but the cervix is thinning out nicely." 2 "There has been no further dilation (dilatation); effacement is progressing." 3 "You haven't dilated any further, but hang in there; it will happen eventually." 4 Don't mention anything to the client yet; wait for further dilation (dilatation) to occur.
1 Women are anxious to have frequent reports during labor, to reassure them everything is progressing well. If giving a progress report, the nurse should remember most women are aware of the word dilation (dilatation) but not effacement. "You're not dilated a lot more, but a lot of thinning is happening, and that's just as important" is the same report given in a positive manner. Just saying, "no further dilation (dilatation)" is a depressing report.
During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor? 1 Monitor vital signs. 2 Assess the amount of cervical dilation (dilatation). 3 Obtain urine specimen for urinalysis. 4 Monitor hydration status.
2 If vaginal bleeding is absent during admission assessment, the nurse should perform vaginal examination to assess the amount of cervical dilation (dilatation). NOT 4 Hydration status is monitored as part of the physical examination. 3 A urine specimen is obtained for urinalysis to obtain a baseline. 1 Vital signs are monitored frequently throughout the maternal assessment.
A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage? 1 Immersing the client in warm water in a pool or hot tub 2 Practicing effleurage on the abdomen 3 Administering a sedative such as secobarbital or pentobarbital 4 Administering an opioid such as meperidine or fentanyl
2 In early labor, the less medication use the better; allow use of nonpharmacologic management and control the pain with effleurage. NOT 1 Sitting in a warm pool of water is relaxing and may lessen the pain, but it does not control the pain. 3 Sedatives are not indicated as they may slow the birthing process. 4 Opioids should be limited as they too may slow the progression of labor.
When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem? 1 variable decelerations 2 prolonged decelerations 3 early decelerations 4 accelerations
2 Prolonged decelerations are associated with prolonged cord compression, placental abruption (abruptio placentae), cord prolapse, supine maternal position, maternal seizures, regional anesthesia, or uterine rupture. NOT 1 Variable decelerations are the most common deceleration pattern found. They are usually transient and correctable. 3 Early decelerations are thought to be the result of fetal head compression. They are not indicative of fetal distress and do not require intervention. 4 Fetal accelerations are transitory increases in FHR and provide evidence of fetal well-being.
A nurse is monitoring the fetal heart rate (FHR) of a client in labor using an electronic fetal monitor. The reading shows a late deceleration. Which intervention will the nurse implement? 1 Encourage the Valsalva maneuver. 2 Change maternal position to side-lying position. 3 Administer exogenous oxytocin. 4 Place the client in the lithotomy position.
2 To intervene with late decelerations, the nurse will change maternal position to a side-lying posture. Late deceleration in the fetus indicates insufficient uteroplacental perfusion. Changing the maternal position improves the maternal venous return. Attempts should be made to increase the uteroplacental perfusion and fetal circulation. NOT 1.3. Administering oxytocin and encouraging Valsalva maneuver (extended breath holding) may augment the uteroplacental insufficiency. In late deceleration, the nurse should administer oxygen through a nasal cannula and discontinue administration of oxytocin. 4 Placing the client in the lithotomy position contributes to poor placental circulation.
A 26-year-old primigravida has brought her doula to the birthing center for support during her labor and birth. The doula has been helping her through the past 16 hours of labor. The laboring woman is now 6 cm dilated. She continues to report severe pain in her back with each contraction. The client finds it comforting when her doula uses the ball of her hand to put counterpressure on her lower back. What is the likely cause of the woman's back pain? 1 Breech presentation 2 Fetal macrosomia 3 Occiput posterior position 4 Nongynecoid pelvis
3 A labor complicated by occiput posterior position is usually prolonged and characterized by the maternal perception of increased intensity of back discomfort. The lay term for this type of labor is "back labor." Occiput posterior position is when the fetus faces the mother's front. In this case, lower back pain may persist between contractions as the fetal head pushes against the maternal sacrum.
Which intervention would be least effective in caring for a woman who is in the transition phase of labor? 1 having the client breathe with contractions 2 providing one-to-one support 3 encouraging the woman to ambulate 4 urging her to focus on one contraction at a time
3 Although ambulating is beneficial during early and possibly even active labor, the strong and frequent contractions experienced and the urge to bear down may make ambulating quite difficult. NOT 1.4. During transition, women should continue to breathe with contractions and focus on one contraction at a time. 2 Providing one-to-one support at this time helps the woman cope with the events of this phase, as well as help her maintain a sense of control over the situation.
The client and her partner have prepared for a natural birth and bring a picture of a sunset over the ocean with them. The nurse predicts they will be using which technique during labor? 1 Patterned birthing 2 Water therapy 3 Attention focusing 4 Hypnosis
3 Attention focusing is the use of an object or picture or image for the woman to reflect and focus on (internally or externally) during labor to distract her from the labor pain. NOT 4 Hypnosis is a psychological state. 2 Water therapy involves the woman sitting in water to relax. 1 Patterned breathing involves the woman controlling her breathing patterns during contractions and "breathing through" them to help control the pain. The attention focusing, patterned breathing, water therapy, and hypnosis are all variations of relaxation which may be used by the client during the birthing process.
A woman refuses to have an epidural block because she does not want to have a postdural puncture (spinal) headache after birth. What would be the nurse's best response? 1 "The anesthesiologist will do her best to avoid this." 2 "The pain relief offered will compensate for the discomfort afterward." 3 "Spinal headache is not a usual complication of epidural blocks." 4 "Your health care provider knows what is best for you."
3 Because epidural anesthesia does not enter the cerebral spinal fluid space, it is unlikely to cause a "spinal headache."
A nurse is conducting an in-service program for staff nurses working in the labor and birth unit. The nurse is discussing ways to promote a positive birth outcome for the woman in labor. The nurse determines that additional teaching is necessary when the group identifies which measure? 1 promoting the woman's feelings of control 2 providing clear information about procedures 3 allowing the woman time to be alone 4 encouraging the woman to use relaxation techniques
3 Being alone can increase anxiety and fear, decreasing the woman's ability to cope. Positive support, not being alone, promotes a positive birth experience. NOT 1 Feelings of control promote self-confidence and self-esteem, which in turn help the woman to cope with the challenges of labor. 2 Information about procedures reduces anxiety about the unknown and fosters cooperation and self-confidence in her abilities to deal with labor. Catecholamines are secreted in response to anxiety and fear and can inhibit uterine blood flow and placental perfusion. 4 Relaxation techniques can help to reduce anxiety and fear, in turn decreasing the secretion of catecholamines and ultimately improving the woman's ability to cope with labor.
A nurse is providing care to a woman in labor. After assessment of the fetus, the nurse documents the fetal lie. Which term would the nurse use? 1 flexion 2 extension 3 longitudinal 4 cephalic
3 Fetal lie refers to the relationships of the long axis (spine) of the fetus to the long axis (spine) of the mother. There are three primary lies: longitudinal, oblique, and transverse. NOT 1.2. Flexion and extension are terms used to describe fetal attitude. 4. Cephalic is a term used to describe fetal presentation.
Which assessment finding is most important as labor progresses? 1 The client is remaining in control of emotions. 2 Labor is completed within 18 hours. 3 The uterus relaxes completely between contractions. 4 The pulse and respirations rise with the work of labor.
3 It is most important that the uterus relaxes completely between contractions. If not, sufficient blood flow to the placenta and oxygen to the fetus may be interrupted. Also, uterine rupture can occur. NOT 1 It is appropriate for the client to remain in control of emotions. The nurse and support person provide emotional support as needed. 2 There is no time frame for labor to be completed. 4 It is normal for the pulse and respiratory rates to increase with the work of labor.
The nurse is reviewing the signs of labor with a client entering the last phase of the third trimester of pregnancy. What should the nurse include as an indication that the labor is beginning? 1 excessive fatigue and headache 2 sharp, right-sided abdominal pain 3 sudden gush of clear fluid from the vagina 4 an increased pulse rate and upper abdominal pain
3 Labor may begin with rupture of the membranes, experienced either as a sudden gush or as scanty, slow seeping of clear fluid from the vagina. NOT 1.2.4. Excessive fatigue, headache, abdominal pain, or increased pulse rate are not indications that labor is beginning.
The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next? 1 application of vibroacoustic stimulation 2 tactile stimulation 3 administration of oxygen by mask 4 fetal scalp stimulation
3 The client should be administered oxygen by mask because the abnormal FHR pattern could be due to inadequate oxygen reserves in the fetus. NOT 1.2.4. Because the client is in preterm labor, it is not advisable to apply vibroacoustic stimulation, tactile stimulation, or fetal scalp stimulation.
At what time is the laboring client encouraged to push? 1 When the nurse wants the client to push 2 When the health care provider has arrived 3 When the cervix is fully dilated 4 When the fetal head can be seen
3 To avoid birth trauma, the client is not encouraged to push until the cervix is fully dilated. This is determined on vaginal exam. Once it is noted, there is no need to wait until the fetal head can be seen. The urge to push may be present without full cervix dilation. Labor is not stopped until the health care provider arrives. A nurse can deliver the fetus.
The client in active labor overhears the nurse state the fetus is ROA. The nurse should explain this refers to which component when the client becomes concerned? 1 Fetal station 2 Fetal attitude 3 Fetal position 4 Fetal size
3 When documenting the ROA (right occipital anterior), this is the right occiput anterior or the relationship of the fetal position to the mother using the maternal pelvis as the point of reference. NOT 1 Fetal station refers to the relationship of the presenting part of the fetus to the ischial spines of the pelvis. 2 Fetal attitude refers to the relationship of the fetal parts to one another. 4 Fetal size refers the actual size of the developing fetus.
The nurse is caring for a client at 39 weeks' gestation who is noted to be at 0 station. The nurse is correct to document which? 1 The client is fully effaced. 2 The fetus is floating high in the pelvis. 3 The fetus is in the true pelvis and engaged. 4 The fetus has descended down the birth canal.
3 When the fetus is at a 0 (zero) station, it is at the level of the ischial spines and said to be engaged. NOT 1 Determining the station does not mean that the client's cervix is fully effaced. 2 If the fetus is floating high in the pelvis, its station is noted as a negative number. 4 Descending into the pelvis or birth canal is documented as a positive number.
A pregnant client is admitted to a maternity clinic after experiencing contractions. The assigned nurse observes that the client experiences pauses between contractions. The nurse knows that which event marks the importance of the pauses between contractions during labor? 1 effacement and dilation (dilatation) of the cervix 2 shortening of the upper uterine segment 3 reduction in length of the cervical canal 4 restoration of blood flow to uterus and placenta
4 The pauses between contractions during labor are important because they allow the restoration of blood flow to the uterus and the placenta. NOT 1.2.3. Shortening of the upper uterine segment, reduction in length of the cervical canal, and effacement and dilation (dilatation) of the cervix are other processes that occur during uterine contractions. (normally, the cervix is closed, firm, and elongated 3.5 and 4 cm)
Valsalva maneuver
A breathing method that may slow your heart when it's beating too fast. To do it, you breathe out strongly through your mouth while holding your nose tightly closed. This creates a forceful strain that can trigger your heart to react and go back into normal rhythm
Doula
A caregiver who provides continuous physical, emotional, and educational support for the mother before, during, and after childbirth.
placenta previa
A condition in which the placenta partially or wholly blocks the neck of the uterus, thus interfering with normal delivery of a baby.
Vertex presentation (cephalic)
A delivery in which the head of the newborn comes out first.
Effleurage
A form of light, patterned touch over the abdomen, thigh, or chest May be irritating later in labor as a greater sensitivity to touch is experienced
Stages of Labor: 1 Phase 2 (Active)
Period which the cervix progressively dilates from 3 to 7 cm. Last about 5 hrs in a primiparous patient and 2 - 3 hrs in a multiparous patient. Contractions are moderately strong to palpation and last 30 - 45s Contractions are more frequent in this phase, coming q3 - 5 min. Women may be more focused than they were during the latent phase and may at times become anxious and restless.
Effacement
The cervix thins out and becomes softer and shorter. It's measured in percentages from 0 to 100 percent
Stages of Labor: 1 Phase 3 (Transition)
The final period of cervical dilation and typically lasts < 2 hrs. Contractions are strong and close together, a new one starting every 1-2 min and lasting 40-60s each. Women may feel out of control, irritable, uncooperative, exhausted, or dependent. Some women experience NV, and perspiration may be noted on the upper lip and forehead. Increase in bloody vaginal discharge is typical. Delivery preparation begins at this time. If the woman's membranes have not already ruptured by this point, the provider will likely perform an amniotomy, or artificial rupture of the membranes.
Stages of Labor: 3
The third stage of labor starts when the neonate is born and ends with the birth of the placenta.