L&D Exam 2
What is the lowest point of early deceleration?
-at the peak of the contraction
What is the procedure for a nonstress test (NST)
-before woman should void -baseline vitals are taken -HOB 45* -EFM applied to the abdomen -ultrasound transducer records FHR -Toco transducer records uterine activity -tracing occurs for 40 minutes
What is poor flexion/extension called?
-brow cephalic presentation
What is the risk of a pregnant woman being on O2?
-can lead to fetal brain damage if too much
What are cervical changes for a nullipara or primagravida?
-cervix has to efface first before dilation -cervix has to thin all the way out
how much is normal blood loss for a vaginal delivery?
<500 ml
What are the three signs of the placenta separating from the uterus?
-Gush of blood -uterus will rise slightly in the abdomen -Umbilical cord hangs out of the vaginal opening
When is an amnioinfusion indicated?
-Oligohydramnios (scant/absent amniotic fluid) -Fetal cord compression -indicated if thick meconium -severe repetitive variable decelerations -preterm labor -preterm rupture of membranes
What is step 3 of Leopold's Maneuver?
-Palpate the lower portion of the abdomen, above the pubic symphysis -determine head is at the pelvic inlet (ENGAGEMENT)
What are the variations of PASSENGER?
-Presentation -Attitude -Fetal lie -Position
Assessing a pregnant client in labor reveals that the client has not voided in the past 4 hours. What instruction will the nurse provide?
"It is important to try to urinate every 2 hours because you might not feel the urge." -During labor, pressure from the fetal head as it descends in the birth canal against the anterior bladder reduces bladder tone or the ability of the bladder to sense filling.
What is the fern test?
'fern-like' pattern of crystalized amniotic fluid and estrogen form when a specimen of cervical mucus is allowed to dry on a glass slide.
What is PASSAGE?
-the bony pelvis -Linea terminalis (pelvic brim) -true pelvis -false pelvis
What is the first stage of labor?
Begins with contractions and ends with full dilation
How are decelerations described?
By their relation to the onset and end of contraction
What is another word for labor mechinisms?
Cardinal movements
What are the variations of presentation?
Cephalic-vertex, military brow, face Breech-frank (buttocks), full, footling Shoulder-back, abdomen, transverse
What is the true definition of labor?
Cervical change
What can women have during labor?
Clear liquid and ice chips
A client received epidural anesthesia and developed a postdural puncture (spinal) headache. Which of the following should the nurse know about a postdural spinal headache?
The client should be encouraged to drink plenty of fluids. -A client with a postdural puncture (spinal) headache should be encouraged to drink plenty of fluids. Treatment of postdural spinal headache usually includes proper hydration. Sitting upright increases the severity of the headache. The headache is usually very severe. Without a treatment, it may last for days to weeks.
Which client outcome during the active phase labor is best?
The client will practice breathing techniques during contractions.
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?
The fetus is in the true pelvis and engaged.
What is placenta previa?
a problem during pregnancy when the placenta completely or partially covers the opening of the uterus (cervix)
What is chorionic villus sampling?
a test made in early pregnancy to detect congenital abnormalities in the fetus. A tiny tissue sample is taken from the villi of the chorion, which forms the fetal part of the placenta. -done through a transcervical approach or a transabdominal approach.
What is a nullipara?
a woman who has not given birth at more than 20 weeks gestation
What is a primigravida?
a woman who is pregnant for the first time
What is postmaturity?
long gestation >42 weeks
What is a tocodynamometer?
measures frequency and duration of contractions -a pressure transducer
The nurse is assessing a client in labor for pain and notes she is currently not doing well handling the increased pain. Which opioid can the nurse offer to the client to assist with pain control
meperidine
What is a parous or multigravida
multiple pregnancies 2 or more
Assessment reveals that the fetus of a client in labor is in the vertex presentation. The nurse determines that which part is presenting?
occiput
how many times can a provider try the vacuum extractor?
-3 tries/pulls -if fails all three a c-section is needed
what regulates the FHR?
-ANS (sympathetic and parasympathetic NS) - baroreceptors -chemoreceptors -adrenal gland -CNS
How does the procedure work for a CST?
-EFM -Oxytocin/nipple stimulation -three contractions in 10 minutes
What is a standard ultrasound
-general survey of fetus, placenta and amniotic fluid
What is fetal bradycardia a late sign of?
-late fetal hypoxia
What is the psychosocial portion of the pain process?
-recognizing pain, interpreting it as painful, and reacting to that interpretation
What do external fetal monitors do?
-record how long contractions are and when the come -monitor FHR
What are POWERS?
-uterine contractions -maternal pushing efforts
What are the risks for amniocentesis
-you have to wait until 15-16 weeks to have it and can have little time to consider whether or not you want to terminate the pregnancy -risk of pregnancy loss -higher risk of pregnancy loss if done between 11-13 weeks -transfer of maternal and fetal blood may occur -may need RHOgam bc of blood comingling
What is the contraction cycle?
1. Increment 2. Acme 3. Decrement (then resting tone inbetween)
What are the three phases of the first stage of labor?
1. Latent 2. Active 3. Transition
What does fully dilated mean?
10 cm dilated
How many kicks should a woman get when doing a maternal assessment of fetal movement?`
10 kicks in 2 hours -can have something cold or sugary to get the baby moving -if they don't see an increase they should go to the hospital
When can a woman be electively induced for labor?
>=41 Weeks gestation
What is a reassuring finding to a CST?
A negative CST -no late decelerations -decreases in the FHR persist after the contraction ends
What is a nonreassuring outcome of a non-stress test?
A nonreactive nonstress test is nonreassuring -when tracing does not demonstrate the required characteristics of a reactive tracing in a 40minute period
What is a abnormal finding to a CST?
A positive CST -late decelerations with 50% or more of contractions in 10 minutes -can have less than 3 contractions in the 10 minutes
The nurse is documenting the length of time in the second stage of labor. Which data will the nurse use to complete the documentation?
Complete cervical dilation (dilatation) and time of fetal birth -The second stage of labor begins with complete cervical dilation (dilatation) of 10 cm and ends with delivery of the neonate.
What is full extension called?
Face cephalic presentation
Which consideration is a priority when caring for a mother with strong contractions 1 minute apart?
Fetal heart rate in relation to contractions
What is Leopold's maneuver?
It is used to determine the baby's position and know where to place the stethoscope.
The nurse assesses a client in labor and finds that the fetal long axis is longitudinal to the maternal long axis. How should the nurse document this finding?
Lie -The nurse is assessing fetal lie, the relationship of the fetal long axis to the maternal long axis. When the fetal long axis is longitudinal to the maternal long axis, the lie is said to be longitudinal.
What is moderate flexion called?
Military cephalic presentation
The skull is the most important factor in relation to the labor and birth processes. The fetal skull must be small enough to travel through the bony pelvis. What feature of the fetal skull helps to make this passage possible?
Molding -The cartilage between the bones allows the bones to overlap during labor, a process called molding that elongates the fetal skull, thereby reducing the diameter of the head.
The nurse is caring for a client who is sent to the obstetric unit for evaluation of fetal well-being. At which location is the nurse correct to place the tocodynamometer?
On the uterine fundus -the nurse is correct to place the tocodynamometer on the fundus with the sensor facing downward and then strap it securely to the abdomen.
A woman has been progressing through labor uneventfully until the occurrence of an intense contraction, when she then develops signs of umbilical cord compression. The health care provider can feel a portion of the cord in the vagina. Which emergency intervention should the nurse implement? Select all that apply.
Place a gloved hand in vagina and put upward pressure on presenting part to keep it off the cord. Position the woman in a knee-chest position. Apply oxygen mask at 10 L/min. Administer terbutaline, a tocolytic, as prescribed.
Which nursing action prevents a complication associated with the lithotomy position for the birth of the fetus?
Placing a wedge under the hips
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?
Practicing effleurage on the abdomen
what are concurrent maternal factors that indicate fetal diagnostic procedures?
Prepreg BMI <18.5 Prepreg BMI >25 -inadequate weight gain (&pattern) -excessive weight gain -use of illicit drugs, alcohol, tobacco, and nonprescribed drugs
What is the third stage of labor?
Starts with the delivery of the infant to the delivery of the placenta -lasts 5-20 min
What is the cardinal movement extension?
The 5th movement -the fetal head extends to get past the pubic symphysis -fetal head on the perineum
What is the cardinal movement of external rotation?
The 6th movement -when the baby is rotated to the optimal position -(occiput anterior left to right)
What is resting tone?
The amount of tone in the uterus between contractions Normal: 20-25 mmHg (with IUPC) When palpated: document as soft or adequate
At what stage of labor is nursing care most important?
The first stage
Which part of the uterus contracts actively?
The upper 2/3s
What is VBAC and TOLAC?
VBAC = Vaginal Birth After Cesarean & TOLAC = Trial of Labor After Cesarean
A client has opted to receive epidural anesthesia during labor. Which intervention should the nurse implement to reduce the risk of a significant complication associated with this type of pain management?
administration of 500 mL of IV Ringer's lactate -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.
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?
allowing the woman time to be alone -Positive support, not being alone, promotes a positive birth experience. Being alone can increase anxiety and fear, decreasing the woman's ability to cope.
Which action is a priority when caring for a client during the fourth stage of labor?
assessing the uterine fundus -During the fourth stage of labor, a priority is to assess the client's fundus to identify risk for postpartum hemorrhage.
When can chorionic villus sampling be performed?
between 10-12 weeks gestation
What is the best head position for the baby?
chin to chest -so crown comes out first
It is most likely that the practitioner would consider performing an amnioinfusion if the EFM tracing shows which of the following?
deep variable decelerations more than 60 bpm below the baseline with every contraction
What are medical condition indications for fetal diagnostic procedures?
preexisting DM or GDM (gestational DM) HTN Acute/nonacute infections ex. pyelonephritis STDs Severe anemia
What is the cardinal movement descent?
the 1st movement -the fetus moving through the birth canal -presenting part moves down
What is amnioinfusion?
when you reinfuse warm fluid into the uterus to mimic amniotic fluid -need strict I&Os
What could fetal tachycardia be an early sign of?
early fetal hypoxia
What does prolonged deceleration indicate?
-cord prolapse -maternal HTN -uterine hypertonia -associated with poor neonate outcome -pathological when crosses 2 contractions
What are decelerations in terms of FHR?
-deceleration of FHR caused by parasympathetic nervous system dominance -it has 4 types- early, late, variable, & prolonged
What is the Bishop score?
-dilation 0-3 (0cm-6cm) -effacement 0-3 (0-80% or more) -cervical consistency 0-2 (firm, medium, soft) -Cervical position 0-2 (Posterior, middle, anterior) *Higher the score # the more likely they are going to have a vaginal birth* -for prima greater than 7 - for multip greater than 5
What is the transition stage of labor
-dilation of 8-10 cm -100% effacement -contraction q/1-2 min lasting 60-90 sec -bloody show -urge to bear down -very intense contraction pain
What is the transition phase of labor indicated by?
-dilation of 8-10 cm -intense contractions -q 1-2 min -lasting 60-90 sec
Signs of hyperventilation
-dizziness -numbness -tingling -light-headed
What is lightening?
-drop of fetal presenting part
What is the increment part of the contraction cycle?
-period of increasing strength -starts out slowly -gradually builds in intensity
Contraindications of induction and augmentation of labor?
-placenta previa -abnormal fetal position
What occurs during the latent phase of labor?
-presenting part of the fetus is high -longer for primip-1-20 hrs -contraction q/5-10 min for 30-45 sec -irregular contractions -0-40% effacement -Cervix 0-3 cm dilated (feels like strong menstrual cramps)
What are the contraindications for a contraction stress test?
-preterm labor -women who are at risk for preterm labor -placenta previa -mult. pregnancy incompetent cervical os -preterm membrane rupture -hx of cesarean or uterine surgery
What is an episiotomy indicated?
-shoulder dystocia (shoulder is stuck) -vacuum or forceps-assisted births -face presentation -preterm fetus
nursing interventions for FHR decelerations
-stop Pitocin (oxytocin) -reposition woman (side laying/knee-chest position) -increase mainline IV rate -Notify provider -10 liters O2 nonrebreather mask -give Terbutaline sq (β₂ adrenergic receptor agonist)(relaxes uterine muscle) -if not working prepare for c-section
What occurs during the second stage of labor?
-sudden burst of energy -perineum flattens -bulging rectum and vagina -increase in pain -contractions q/2 min for 60-90 sex -increase in bloody show
What are non reassuring fetal vital signs?
-tachycardia >160 bpm over 10 min -Bradycardia <110 bpm over 10 min -Absent variability (no fluctuations) -Marked variability (>25 bmp/ all over the place) -Late deceleration- delayed onset of the decrease in FHR -Variable deceleration- if frequent (can be benign if not) -Prolonged deceleration-(pathologic when crosses 2 contractions)(associated w/poor neonate outcomes)
What is the PASSANGER?
-the fetus -the membranes -the placenta -(fetal positions and anatomic stuff affect labor)
What happens if a woman has a full bladder during labor?
-the fetus can't get into the pelvic inlet
Which parts of the uterus and cervix are passive with contractions?
-the lower 1/3 of the uterus -the cervix as a whole
What is a vibroacoustic stimulation test?
screening tool that uses auditory stimulation to assess fetal well-being with EFM when NST is nonreactive
What is the true pelvis?
space below the pelvic brim -pelvic Inlet -midpelvis -pelvic outlet
What is a specialized ultrasound?
specific-looks for abnormalities that may have been seen with the general survey or lab tests
The nurse is concerned that a pregnant client is developing polyhydramnios. What did the nurse assess in this client? Select all that apply.
tense uterus extreme shortness of breath difficulty hearing fetal heart rate uterus larger than expected for gestation week
What affects variability?
the 3 S's -sleep -sedation -sickness (CNS abnormalities)
what is the cervical os?
the opening in the cervix at each end of the endocervical canal
What is amniocentesis?
the sampling of amniotic fluid using a hollow needle inserted into the uterus, to screen for developmental abnormalities in a fetus. -done at 15-20 weeks gestation to find chromosome abnormalities. -can be used to see fetal conditions when a woman has Rh-positive blood -can be used to diagnose intrauterine infections -investigate amniotic fluid AFP
what is the gold standard to determine gestational age?
the ultrasound in the first trimester (transvaginal) -most accurate
A nurse is performing a physical assessment of a pregnant client at term who is in labor. The nurse assesses the client's fundal height, expecting to find it at which location?
the xiphoid process
What is effacement?
thinning and shortening of the cervix
What is external version?
to help manipulate the baby into the head down position
What are premonitory signs of labor?
-cervical changes (moves anteriorly) -nesting -Braxton Hicks -increased vaginal mucus secretion -energy spurt weight loss -bloody show
What is the latent phase of labor indicated by?
-cervix 0-3 cm dilated -contractions q/5-10 min -last 30-45 sec
What does variable deceleration indicate?
-cord compression -short umbilical cord -if they become prolonged or deeper the baby can become acidotic -Often associated with oligohydramnios w/wo ROM
The client is being rushed into the labor and delivery unit. At which station would the nurse document the fetus immediately prior to birth?
+4
What happens in the third stage of labor?
- the uterus contracts and separates the placenta from it
What is an android pelvis?
-"Male-shaped" pelvis -30% of women have this -not ideal for birth may need c-section
What is the active phase of labor indicated by?
-1.2 cm/hr dilation -dilation of 4-7cm
A woman is admitted to the labor and birthing suite. Vaginal examination reveals that the presenting part is approximately 2 cm above the ischial spines. The nurse documents this finding as:
-2 station. -----The ischial spines serve as landmarks and are designated as zero status. If the presenting part is palpated higher than the maternal ischial spines, a negative number is assigned. Therefore, the nurse would document the finding as -2 station. If the presenting part is below the ischial spines, then the station would be +2. Crowning refers to the appearance of the fetal head at the vaginal opening.
How much is normal blood loss for a c-section?
-800-1000 ml
What is a prolonged deceleration?
-A decrease in FHR that lasts at least 2 minutes but no longer than 10 minutes -a drop of 30 bpm or more -DOES NOT HAVE TO BE ASSOCIATED WITH A CONTRACTION
What is variable deceleration?
-Abrupt drop in FHR -on strip makes V, U, AND W shapes -DOES NOT HAVE TO BE WITH CONTRACTIONS -nonreassuring if occurs frequently
What are reassuring fetal vital signs?
-Accelerations -Minimal variability (<5 bpm) -Moderate variability (6-25 bpm) -Early deceleration (gradual decrease)
At which point along the birth canal must the fetal head extend for successful passage?
-At the level of the symphysis pubis
Position describing words
-Can be Right or Left -Occiput (O)-back of head -Mentum (M)- chin -Sacrum (S)- butt -Anterior (A)-pubic symphysis -Posterior (P)-sacrum -Transverse (T)
What are indications for a non-stress test?
-Decreased fetal movement -DM -connective tissue disease -IUGR (intrauterine growth restriction) -hyperthyroidism -Rh disease -HTN -Renal disease -sickle cell disease -suspected postmaturity -3rd trimester bleeding
What is late deceleration?
-Delayed Onset of decrease in FHR -occurs during contraction -at the PEAK of the contraction HR goes down -nonreassuring
What are the 5 parameters of a biophysical profile?
-FHR (done with NST) -Fetal breathing movements -Gross Fetal Movements -Fetal Muscle tone -Amniotic fluid volume
What are the 4 major factors that interact during birth?
-Powers -Passage -Passenger -Psyche
contraindications for vaginal operative birth
-Severe fetal compromise -high fetal station -cephalopelvic disproportion -acute maternal conditions
What is step 4 of Leopold's maneuver?
-Stand facing pt's feet -slide hands down on either side of the lower pelvis -determine if the fetal head is flexed and how far distended in the pelvis
What is the fourth stage of labor?
-The recovery stage -1-2 hours after the delivery of the placenta -STARTS THE POSTPARTUM PERIOD
Version contraindications
-Uterine malformations -Previous cesarean birth -Placenta abnormalities -Third-trimester bleeding -Fetal size >4000 g -Cephalopelvic disproportion -Multifetal gestation -cord around fetal neck -placenta previa -Oligohydramnios -Intrauterine growth restriction -Uteroplacental insufficiency -Engagement of the fetal head into the pelvis
When is a score of 8-10 for a biophysical profile considered not normal?
-When oligohydramnios is present <500 ml
what is a contraction stress test (CST)
-a CST records the response of the FHR to stress by induced uterine contractions (sees of baby will tolerate labor) -can be done when NST is nonreactive -sometimes the initial test for fetal well being-
What is a platypelloid pelvis?
-a flat pelvis -5% of women have this -not favorable for birth
What are somethings to know about the administration of oxytocin?
-always connected to the closest port to the patient -start slow -increase gradually -watch FHR, uterine activity, and fetal heart patterns -always secondary to a piggyback isotonic
What are the risks for a vibroacoustic stimulation test
-appears to be safe for a fetus's hearing at 33 weeks
What is Percutaneous Umbilical Blood Sampling? (PUBS)
-aspiration of fetal blood from the umbilical cord right where it connects to the placenta -uses a high res ultrasound to guide the needle -RHOgam is given to RH-negative women
What are indications for a cesarean birth?
-dystocia -cephalopelvic disproportion -HTN -maternal disease -active genital herpes -tolac -vertical cesarean incision -removal of fibroid tumors -persistent nonreassuring FHR patterns -fetal malpresentations -hemorrhagic conditions
What is the scoring for a biophysical profile?
-each parameter contributes 0 or 2 points -can never score a 1 (all or nothing) -a score of 8-10 is considered normal results (UNLESS OLIGOHYDRAMNIOS IS PRESENT) -10 is the highest and the perfect score -8/8 may be scored if FHR is not looked at
What are cervical changes for a parous or multigravida?
-effacement and dilation occur together -thicker cervix than nullipara at any point during labor -cervix does have to thin out all the way
Which intervention would be least effective in caring for a clinet who is in the active phase of labor?
-encouraging the client to ambulate
What are the risks associated with PUBS?
-fetal bradycardia (usually shortterm) -rupture of membranes and preterm labor -production of clots -can cut the umbilical cord
Which parameters of the biophysical profile are done by real-time ultrasonography?
-fetal breathing movements -gross fetal movements -fetal muscle tone -amniotic fluid volume
c-section contraindications
-fetal death -immature fetus -maternal coagulation defects -HIV?
What is attitude for the passenger?
-fetal head flexed or extended
What are the three goals of a antepartum fetal surveillance test?
-fetal well-being as accurate as possible -reduce perinatal morbidity and mortality -to guide medical interventions
What is an unsatisfactory CST result?
-fewer than 3 contractions in 10 minutes -or tracing could not be completed
What is early deceleration?
-gradual decrease in FHR that starts at the beginning of the contraction and returns to baseline at the end. -in response to head compression which can occur during a sterile vaginal exam, contractions, fundal pressure, and the second stage of labor. It's NORMAL -reassuring, benign -Will look like a mirror image of the contraction lines -Just occurs during labor
What is a gynecoid pelvis?
-ideal pelvic shape for birth -50% of women have this shape
What are the pros for a CST?
-if it is reassuring we know the fetus is okay for at least one week -a + CST gives the physician time to figure out which other tests they can do and how to help the fetus -minimally invasive
Signs of false labor
-inconsistent contractions -Discomfort is only annoying -no cervical changes
what are accelerations in terms of FHR?
-increase in FHR above baseline >15 bpm that last >15 seconds --when a nurse looks at a 20 min strip they should see 2 accelerations -they are reassuring
Signs of true labor
-increased contractions & discomfort -Cervical changes-progressive effacement and dilation
What does late deceleration indicate?
-indicates placental insufficiency -ominous when repetitive and can't be fixed -may have to deliver the baby a different way -nonreassuring
What is an antepartum fetal surveillance stress test?
-it observes the FHR response to movement -(sees if FHR goes up when fetus moves
How long does a reassuring biophysical profile say the baby is fine?
-it only lets you know that the fetus is okay for 1 week at least
What physical factors affect pain tolerance?
-labor intensity -cervical readiness -fetal position -pelvic readiness -fatigue and hunger -caregiver interventions
risks for vaginal operative birth
-lacerations -hematomas -fetal risks- lacerations nerve injuries, bruising, cephalohematoma, surgical hemorrhage, seizures, death, encephalopathy, intracranial hemorrhage
Why is pregnancy and labor a hypercoagulable state?
-levels of clotting factors are elevated -notably fibrinogen -also still high after delivery -woman is at risk for DVTs
What is the position of the PASSENGER?
-location of fixed reference point on the presenting part in relation to the 4 quads of the maternal pelvis
what are the risks of chorionic villus sampling?
-loss of pregnancy -more than two attempts of CVS or bleeding before the procedure increases pregnancy loss risk -some reports of limb reduction defects
Operative vaginal birth indications
-maternal exhaustion or cardiac condition -fetal nonreassuring HR patterns -fetal head not coming out
What types of episiotomies are there?
-midline/median -mediolateral
What is the active phase of labor?
-more rapid dilation and descent -dilation 1.2 cm/hr to 4-7 cm -40-80% effacement -contractions are 2-5 min for 40-60 sec (more painful & regular)
What are the requirements for Internal fetal monitoring?
-need to have rupture of membranes (ROM) -presenting part needs to be down -cervical dilation of at least 3 cm is needed
What is an anthropoid pelvis?
-oval shaped, with a wider anteroposterior diameter -25% of women have this shape -second best pelvic shape for birth
What is step 2 of Leopald's maneuver?
-palpate sides of the abdomen -determine whether the back is to left or right -the side is in relation to the maternal side
What is step 1 of Leopold's maneuver?
-palpate upper abdomen -determine head or butt
What is the acme part of the contraction cycle?
-period during which the contraction is MOST intense -Peak of contraction
What is the decrement portion of the contraction cycle?
-period of decreasing intensity -when the uterus relaxes -intensity subsides more quickly than the increment portion of the cycle
What are the disadvantages to a nonstress test?
-they have a High false-positive ratio -there has to be additional testing done for a nonreactive nonstress test -only shows a small window of time of how the baby is doing
What are the cons of a CST
-time consuming -expensive -requires women to do self-breast stimulation -oxytocin must be given carefully (can cause hyperstimulation) -requires a lot of precision
What are sources of pain during child birth?
-tissue ischemia due to lack of blood supply to the uterus -cervical dilation as it stretches and the uterus lowers -pressure and pulling on the pelvic structures-can show as referred pain in the legs and back -distention of the vagina and perineum, may feel like burning, tearing- due to fetus descending-somatic pain
Why would an amniocentesis be used in the 3rd trimester
-to determine fetal lung maturity for inducement (looks at lung surfactant lecithin/sphingomyelin L/S) (L/S ratio is >2) -tests for fetal hemolytic disease -checks fetal bilirubin concentration (Rh sensitized)
Why may PUBS be used?
-to treat a severely anemic fetus and transfuse blood -to diagnose fetal coagulopathies, hemoglobinopathies, hemophilias, and congenital infections
What are fetal risks to a c-section?
-transient tachypnea -persistent pulmonary HTN -traumatic injury -lung immaturity
What are indications for induction and augmentation of labor?
-unhealthy fetal environment -cervical ripening -post dates
What is complete flexion called?
-vertex cephalic presentation
What is a normal FHR
110-160 bpm -fluctuates slightly from 5-15 bpm -recorded over a 10-minute time frame -excludes variability of at least 25 bpm above baseline
transvaginal ultrasounds
1st trimester ultrasounds are always transvaginal
The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is:
7.15 or less
What is a suspicious finding for a CST?
A eqiuvocal CST (Tachystole) -intermittent late decelerations and sig variable decelerations -SUDDEN DECREASE IN FHR THAT QUICKLY GO BACK TO BASELINE -Presence of contractions that occur more frequently than every 2 minutes or last longer than 90 seconds in the presence of late decelerations. Requires repeat testing on the following day. CAN ALSO BE A HYPERSTIMULATION FINDING
What is a reassuring outcome to a non-stress test?
A reactive nonstress test is reassuring --is when at least 2 fetal heart accelerations with or w/o the mother detecting them in a 20-minute period --at least 15 beats per min above baseline and --last 15 seconds from baseline to baseline
The nurse is analyzing the readout on the EFM and determines the FHR pattern is normal based on which recording?
Acceleration of at least 15 bpm for 15 seconds -A normal active fetal heart rate is a change in baseline by increase of 15 bpm for 15 seconds. This is a positive and normal periodic change in fetal heart rates as a response to fetal movement. Normal variability is noted to occur within 6 to 25 bpm from the baseline FHR. There should be no decelerations.
What is the second stage of labor?
Begins with full dilation and ends with delivery -avg time for primip 2-3 hrs -avg time for multip 20 min
The nurse is monitoring a laboring client with continuous fetal monitoring and notes a decrease in FHR with variable deceleration to 75 bpm. Which intervention should the nurse prioritize?
Change the position of the client -Variable decelerations often indicate a type of cord compression. The initial response is to change the position and try to release the cord compression. If this does not work, apply oxygen while using the call light to alert others. If this continues, her fluid status needs to be assessed before increasing her IV rate.
A gravida 1 client is admitted in the active phase of stage 1 labor with the fetus in the LOA position. The nurse anticipates noting which finding when the membranes rupture?
Clear to straw-colored fluid -The infant is in the correct position, and the client has been in labor. The expectation would be for normal amniotic fluid presentation of clear to straw-colored fluid. If there is blood, then the uterus is bleeding and there is an extreme emergency. If the fluid is greenish, there is meconium in the fluid. Cloudy, white fluid may indicate an infection is present.
When do effacement and dilation occur?
Concurrently during labor at different rates
What are characteristics of contractions?
Coordinated Frequency Duration Intensity
The client is experiencing back labor and reporting intense pain in the lower back. The nurse should point out which intervention will be effective at this point?
Counterpressure against the sacrum
Which cardinal movement of delivery is the nurse correct to document by station?
Descent -Descent is documented by station, which is the relationship of the fetal presenting part to the maternal ischial spines. Descent continues throughout labor until the fetus reaches the fetal station of +4.
What is the bishop score used for?
Determining cervical favorability for labor induction
The nurse is monitoring a client in the first stage of labor. The nurse determines the client's uterine contractions are effective and progressing well based on which finding?
Dilation of the cervix
What is effleurage?
Effleurage is a type of self-massage that focuses on your abdomen. The idea is to help interrupt the pain response so you won't feel as much pain as you would otherwise. During effleurage, you use circular, rhythmic stroking movements with the palm of your hand to lightly massage your abdomen
What are obstetric factors that indicate fetal diagnostic procedures
Hydramnios >2000ml oligohydramnios <500 ml previous infants >4000 g birth weight decrease in fetal movement/absence of fetal movement malpresentation of the fetus multifetal preg hx of low birth weight grand multiparity postmaturity >42 weeks preterm labor 20-38weeks discordant not knowing gestational age previous fetal lose previous birth of an infant with congenital abnormalities
The nurse is assisting a client through labor, monitoring her closely now that she has received an epidural. Which finding should the nurse prioritize to the anesthesiologist?
Inability to push
When caring for a client in the third stage of labor, the nurse notices that the expulsion of the placenta has not occurred within 5 minutes after birth of the infant. What should the nurse do?
Nothing. Normal time for stage three is 5 to 30 minutes.
A 32-year-old woman presents to the labor and birth suite in active labor. She is multigravida, relaxed, and talking with her husband. When examined by the nurse, the fetus is found to be in a cephalic presentation. His occiput is facing toward the front and slightly to the right of the mother's pelvis, and he is exhibiting a flexed attitude. How does the nurse document the position of the fetus?
ROA (right occiput anterior)
A pregnant woman comes to the emergency department stating she thinks she is in labor. Which assessment finding concerning the pain will the nurse interpret as confirmation that this client is in true labor?
Radiates from the back to the front
What is the cardinal movement of Engagement?
The 2nd movement -fetal presentation reaches 0 station (at ischial spines)
What is the cardinal movement flexion?
The 3rd movement -ensures the smallest part of the fetal presenting part enters the pelvis
What is the cardinal movement internal rotation?
The 4th movement -fetus head rotates to try and fit through the pelvis to get to the outlet
What is the false pelvis?
The upper portion above the pelvic brim or inlet.
How many cardinal movements are there?
There are 7 cardinal movements -Descent -Engagement -Flexion -Internal rotation -Extension -External rotation -expulsion
A client has just given birth to a healthy baby boy, but the placenta has not yet delivered. What stage of labor does this scenario represent?
Third -Stage three begins with the birth of the baby and ends with delivery of the placenta.
A nurse is caring for a client who has had a cesarean birth with general anesthesia. The nurse would assess the woman closely for which possible complication?
Uterine Atony
Which of the following is not a physiologic basis for painful contractions during labor
Uterine and cervical blood vessels dilate, increasing blood flow and causing hypoxia in the muscle fibers. -During labor uterine and cervical blood vessels constrict, reducing blood flow and causing anoxia in the muscle fibers.
Which procedure is contraindicated in an antepartum client with bright red, painless bleeding?
Vaginal examination -A vaginal examination is contraindicated in a client with bright red vaginal bleeding until placenta previa is ruled out
At what time is the laboring client encouraged to push?
When the cervix is fully dilated
A young woman presents at the emergency department reporting lower abdominal cramping and spotting at 12 weeks' gestation. The primary care provider performs a pelvic examination and finds that the cervix is closed. What does the care provider suspect is the cause of the cramps and spotting?
a threatened abortion -
What is a limited ultrasound?
addresses a specific concern ex. to see the presentation, if the water broke (fluid level), to see if there is cardiac activity, for external version, help with amniocentesis, for twin vaginal delivery
What is an amniotomy?
artificial rupture of membranes -sterile procedure -risk of infection
At what dilation do people typically vomit?
at 7 cm
What is hydramnios?
excessive amniotic fluid >2000 mL
What is fetal lie?
fetal spine in relation to the maternal spine -want longitudinal and parallel
Which cardinal movement allows the fetus to travel through the birth canal most efficiently?
flexion
A nurse is caring for a client in her fourth stage of labor. Which nursing action(s) is essential during the fourth stage of labor? Select all that apply.
fundal assessment every 15 minutes assessment of bleeding for expulsion of placental fragments
A client in labor with epidural analgesia is fully dilated and preparing to push. The nurse palpates a smooth, firm, oval bulge in the suprapubic area. What action should the nurse take first?
have the pt attempt to void
The nurse is reviewing the laboratory test results of a client in labor. Which finding would the nurse consider normal?
increased white blood cell count
What does variability mean in terms of FHR
irregular fluctuations in the baseline FHR of 2 cycles per minute or greater -assess over a 10 minute period
What is the cardinal movement expulsion?
it is the 7th and last movement -when the provider gets the shoulders of the baby out of the vagina
Things to know about external version?
only done after 37 weeks -have 18 or 20 gg IV site -nonstress test before and after -consent form -may get epidural
What is fetal presentation?
part of the fetus that first enters the pelvis
How would you describe a transverse lie?
perpendicular mother and fetal spines
What is the physiologic component to the pain process?
reception by sensory nerves and transmission to the CNS
what is a fetal scalp electrode (FSE)?
records baby's EKG
What is an intrauterine pressure catheter? (IUPC)
records the frequency, duration, and intensity of contractions
What does discordant mean?
unequal fetal growth of twins
what is an ultrasound or doppler
used for FHR -placed on baby's back
What is internal fetal monitoring
uses two long thin catheter electrodes which are inserted through the woman's cervix into the uterus; the amniotic fluid membrane (or sac) surrounding the fetus must be broken or ruptured; the cervix must be dilated at least 1-2 cm; used for high risk pregnancies when more accurate monitoring is necessary