OB #2 and Final
Oxytocin
Common agent used for labor induction. At least 20 min of fetal monitoring is done to obtain baseline fetal heart, IV started. Risk for cesarean birth increase, uterus will be hyperstimulated, can lead to fetal distress and uterine rupture, water retention, hyponatremia, confusion or coma, CHF
A patient started on induction of labor at 37 weeks gestation, the provider orders a fetal fibronectin test. What is the purpose of this test?
Determine if a specific protein is present that is associated with readiness
When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive assessment that the uterine contractions are effective would be
Dilation of cervix
Methylphenidate
Stimulate the uterine muscle to contract
A woman 41 weeks gestation is admitted for induction of labor with IV Pitocin. The fetal monitor strip is noted to have contractions every 2 min lasting 60-90 sec. What is the highest priority intervention for the nurse?
Stop the IV Pitocin infusion.
Which type of pain is always associated with the first stage of labor?
Stretching of the cervix
A woman presents in advanced labor, and birth appears imminent. What is the most important and appropriate aspect of admission for this woman?
Taking her BP and determining whether clonus or edema is present.
Leoplod's maneuvers are =
go in and feel around the abdomen to try to determine where the baby's head, back, bottom, etc are.
Atony
lack of normal muscle tone
Fetal stations
measures the relationship of the presenting part of the fetus to the ischial spines of the mom
Jennifer has just received IV sedation. What must the nurse tell Jennifer to do?
Ambulate only with assistance from the nurse or caregiver
Fetal adaptation to labor
Placenta blood flow interrupted at the peak of each contraction. Healthy fetus: experience a slowly decreasing in pH, able to compensate and maintain HR WNL, labor stimulates surfactant production, maternal tissues helps clear the respiratory passageways of mucus, pressure on fetus may result in ecchymosis or edema. Vertex presentation: May cause formation of captu-succedaneum: swelling of the soft tissues of the head.
Fetal HR
110-160
Which woman are you most likely to have to prep for an episiotomy?
A multigravida with a history of heart problems, fetus is in vertex position
External version
A process of manipulating the position of the fetus while in utero, to try to turn the fetus to a cephalic presentation.
Leopold maneuver
Abdominal palpation of fetus, lie, attitude, helps nurse assess the position of the fetus to determine the optimal placement of the fetal monitoring transducer. Empty bladder beforehand, supine positioning
Susan is in labor with her second child. She knows that she will want a epidural anesthesia and she has already signed her consent form. What must the nurse do before Susan receives the epidural?
Administer a fluid bolus through the IV line to reduce the risk of hypotension.
A patient of 41 week gestation has been in labor for 18 hours and the fetus is now showing signs of distress. The anesthesiologist has recommended a general anesthetic, the patient can not have an epidural due to prior back surgery. The nurse should plan to administer which medication prior to taking the patient to the OR?
Antacid
Mother 's developmental stages
Attachment; Enduring emotional bond that develops between parent and infant (not automatic) Bonding: How new mother and father become acquainted with their newborn. Enface position: Mother interacts face to face with newborn Naming newborn: Calling newborn by name, maintaining eye contact and talking to newborn.
You asked to start external electronic fetal monitoring (EFM) for a primegravida who has been hospitalized because she is showing indications of going into labor. The baseline FHR fluctuate between 135 and 150. You noticed two instances in which the FHR reached 165 for 15 to 20 sec before settling back to the baseline rate. What should you do first?
Before reporting to the RN, determine the uterine contraction pattern
Marianne has been in labor for many hours and is becoming exhausted. Her fetus is showing increasing signs of distress, and the physician orders as a cesarean delivery. Marianne and her partner had their hearts set on natural childbirth. Although they attended childbirth classes, they focused on vaginal methods and are now distressed and unsure what to expect. What is the most important nursing intervention that you can provide at this point?
Briefly describe what they will experience during the procedure, explain each procedure as you perform it, and encourage Marianne's partner to participate whenever possible.
A woman requires induced labor. Which of the following should you consider to be the best indicator that induction can proceed?
Cervical length of 27 millimeters
Cesarean
Common if you have history of c-section, labor dystocia, failure to progress labor, nonreassurance, fetal malpresentation, such as breech. Less common: placenta previa (placenta covers the cervix), arruptio placentae (separation of placenta from uterus) CPD, fetal head cannot feed to the pelvis. Risk factors: Anesthesia RT complications, thrombolytic , embolic, wound complications. Risk for fetus: Inadverten delivery of a premature fetus, transient tachypnea.
Macrosomia
Condition that is diagnosed if the birth weight exceeds 4,500 g (9.9 lb) or the birth weight is greater than the 90th percentile for gestational age.
Uterine contractions; Powers
Contractions from os to fundus, cause cervix to efface (thin) dilate (open). -5 to + 5 cm. Each contraction should follow relaxation
A woman is experiencing back labor and complains of intense pain in the lower back. Which is the most effective nursing intervention to relieve this type of pain?
Counter pressure against the sacrum
A woman requires treatment to ripen her cervix, and you are discussing prostaglandins options with her. She has heard that an oral drug is available. You suggest that she ask her doctor about which of drug?
Cytotec
Precipitous delivery
Delivery that is unattended by the physician or nurse midwife
An infant, who was ROA in labor, has delivered and noted to have edema on his scalp along with ecchymosis. How does the nurse explain this to the parents?
Ecchymosis with edema on the scalp is where the infant was pushed out of the canal
Fetal molding
Elongation of the fetal skull to accommodate the birth canal.
The patient is G1 P0, in the second stage of labor and is at 2+ station and in anticipation of delivery within the hour. Her epidural did not work and she is begging for Demerol. Which is the most appropriate action by the nurse?
Encourage her through the contractions and explain not giving the Demerol
When completing a routine admission on the labor and delivery unit for induction of labor, after the admission information is collected, what is the next priority in planning care for the patient?
Fetal assessment
Fetal lightening
Fetal drop to pelvis
Pain relief during the vaginal birth
Epidural (block) analgesia Epidural (block) anesthesia Combined spinal epidural (CSE) analgesia Nitrous oxide Local infiltration anesthesia Pudendal block Spina (block) anesthesia
Pain relief during the second stage of labor
Epidural (block) analgesia Nitrous oxide Local infiltration anesthesia Nerve block analgesia and anesthesia Pudendal block Spinal (block) anesthesia
Pain relief for cesarean birth
Epidural (block) anesthesia Spinal (block) anesthesia General anesthesia
Facial presentation
Facial ecchymosis can be confused by cyanosis
The RN in labor and delivery documents the fetus as ROA. To what does this documentation refer for a fetus?
Fetal position
Which birthing position would you recommended to hasten delivery , enhance placental blood flow, decrease fetal stress, and reduce the possibility that an episiotomy will be required?
Hands and knees
Given a prepartum hemoglobin value of 14 gm/dL and hematocrit of 42 %, which postpartum measurements should you report to the RN?
Hemoglobin 9 gm/dL and hematocrit 34 percent in a woman who has given birth by cesarean.
You are preparing an injection of a narcotic to relieve a pregnant woman's pain. As you are about to give it, she asks you for a bedpan because she has to move her bowels, Your best action would be to
Hold the injection until you evaluate her labor progress
During which part of the birth process does the cardiac output increase to 80% above the pre-labor level
Immediately after birth
The nurse is assisting Monica through labor, monitoring her closely, now that she has received an epidural. The nurse would report which finding to the anesthesiologist?
Inability to push
The nurse is teaching a prenatal class the s/s of true labor. Identify the appropriate response by the class that shows an understanding of true labor contractions.
Increase even if I relax and take a shower
Fetal Late decelerations
Indicates uteroplacental insufficiency
Breasts after birth
Inspect the breasts and nipples for signs of engorgement, redness or cracks, palpate the nipple to determine if they are erect or inverted. The breasts should be soft during the first postpartum day and begin filling on the second and third day.
Sitz bath
Instruct to empty bladder Place the tubing in the allotted slot, and clamp the tubing. fill the bag with warm (102 to 105 f) water, hang it at a level of a few feet above the toilet. Unclamp the tubing and allow the water to fill the basin. Assist the woman to sit on the basin so that her perineum is submerged in the water Unclamp the tubing periodically Stay on for at lest 20 min
A woman is schedule to have a cesarean birth and you will be caring for her throughout the process. Your involvement in her care will be least intensive during which stage of this process?
Intraoperative
RhoGAM ( Rho(D)Immune globin)
Is given to an Rh negative mother who delivers an Rh-positive infant to prevent the formation of antibodies that may attack feature fetuses.
At which time during a woman's labor might the nurse assist with a pudendal block?
Just before delivery
Precipitous labor
Labor that last less than 3 hours from the start of uterine contractions to birth. Complication from tissue damage such as lacerations of the cervix, vaginal wall and perineum, and bruising or other trauma to the infant from rapid descent. (Abnormal)
The nurse is working with a patient in labor. She is happy and cheerful, and states she is "ready to see her baby." What stage or phase of labor would she anticipate the patient to be in right now?
Latent phase
Newer methods of pain control are under investigation, one under study is the use of intradermal water injection. Where is the water injected for pain control in labor?
Lower back
Effleurage
Massage strokes, non pharmacologic relief of labor pain
Methods of cervical ripening
Mechanical methods Prostaglandins Membrane stripping, Inserting a catheter into a cervix and inflating the balloon, cervical dilators (laminaria)
The mechanical method most used for cervical ripening is what?
Membrane stripping
Jane S is gravida 1, in the active phase of stage 1 labor. The fetal position is LOA. When Jane's membranes rupture, the nurse should expect to see.
Moderate amount of clear to straw colored fluid
Which lochia pattern should you report immediately to the RN ?
Moderate lochia serosa on day 4 postpartum, increasing in volume and changing to rubra on day 5
Perineum
Never fully returns to pregravid, kegel exercise, lactation can lead to vaginal dryness/dysperunia
Proper feeding postpartum
Non breastfeeding: Decrease caloric intake by 300 kcal/day which should equal her pregnancy calorie intake level. Lactating woman: Add an additional 200 kcal above the pregnancy requirement of 300 Kcal/day, for a total of 500 Kcal above pregnancy calorie requirements.
fetal variable decelerations
Occur at any point during a contraction. Jagged erratic shape, suddenly drops from baseline and recovers, resembles U, V, W. Indicates umbilical cord compression, becomes apparent at delivery, when umbilical cord is wrapped around a body part, such as (neck) nuchal cord
Pain relief during first stage of labor
Opioid agonist analgesics Opioid agonist antagonist Epidural (block) analgesia Combined spinal epidural (CSE) analgesia Nitrous oxide
Opioids are often used in labor for pharmacologic pain management. A patient in the transition phase of labor is requesting fentanyl (Sublimaze) for pain. How should the nurse respond to her request?
Pain medication given now might cause the baby to have slow respirations and is not recommended. lets try to focus and breathe
Engorgement
Painful swelling of breast tissue as a result of rapid increase in milk production and venous congestion causing interstitial tissue edema; impaired milk flow results in accumulation of milk in breasts; most often occurs between the third and fifth postpartum days
Joanne has been in labor for 5 hours. Earlier there was a gradual increase of FHR baseline with variables. but Joanne has changed positions several times and now the fetus shows no signs of hypoxia. Joanne's cervix is almost completely effaced and dilated to 8 cm. However, the labor graph indicates that the fetus has stopped descending. What should you do first?
Palpate the area just above the symphysis pubis
Fetal presentation
Part of the fetus enters the pelvic inlet Head-cephalic-presentation Feet or buttocks- breech presentation shoulder-shoulder presentation Right occiput anterior (ROA) Best Way Left occiput anterior (LOA) Right occiput posterior (ROP)
Lecithin/spingomyelin
Perform of gestation is less than 37 weeks In the event of of a rupture membranes For preterm labor Complications indicating a cesarean birth Amniotic fluid is tested to determine if fetal lungs are mature Determine whether the fetus should be delivered immediately or if requires more time in utero with the administration of glucocorticoids to promote fetal lung maturity. 2:1 Ratio indicates fetal lung maturity 2, 5:1 or 3:1 client with DM
Fundus checks
Performed 1 hour after delivery Woman lying supine, palpate the fundus, note the position of the uterus to determine tone, position, size. It should be not boggy, located in the midline, and at the appropriate height in relation to the umbilicus, depending on what hour or day it is after delivery
Episiotomy
Performed when baby's shoulders are stuck in birth canal, shoulder dystocia, head will not rotate from occipital posterior, fetus in breech presentation.
Induction of labor
Physician and woman choose to induce labor without medical cause. Result in long interventions, longer labors, higher cost, possible cesarean
Nancy has presented in the early phase of labor. She is experiencing abdominal pain and show signs of growing anxiety about the pain. What is the best pain management technique the nurse can suggest at this stage?
Practicing effleurage on the abdomen
Nonpharmacologic Pain Management
Provide sense of control over childbirth Try a variety of methods and seek alternatives, including pharmacologic methods, if measured used is not effective
Fetal position
Relationship of the landmark on the presenting fetal part to the front, sides, or back of the maternal pelvis.
Involution
Return of the uterus to a nonpregnant state after birth uterine contractions leads to involution. Immediately after the placenta delivers, the uterus contracts inward, a process that seals off blood vessels at the former site of the placenta.
Lochia
Rubra; Dark Red 3 to 4 days Serosa; Pinkish brown 4 to 10 days Alba: whitish yellow 10 to 28 days
A woman in latent labor for the past 12 hours is requesting medication to help her rest. What medication should the provider prescribe?
Secobarbital (Seconal)
Dilation
Second cervical change during normal labor, measured in 10 cm. Normally a primiparous woman experiences effacement before dilation.
In preparing for the actual birth, which fetal position presentation would a nurse be least likely to find?
Shoulder
Effacement
Softening and shortening of the cervix during labor
Augmentation of labor
Something added to labor in order to improve it. AROM, IV oxytocin, tocolytic (relaxes the uterine muscle, vacuum extractor or forceps.
Fetal Early decelerations
Spontaneous elevation of FHR above the baseline by at least 15 bpm for 15 sec, consider to be reassuring
Regional anesthesia
Temporary interruption of nerve conduction, is produced by injecting an anesthetic solution near the nerves to be blocked.
A patient is being sent to the labor and delivery unit for cervical ripening over night followed by induction of labor the next morning. She is asking "what is cervical ripening?" How should the nurse respond?
The cervix needs to be soft and thinning to be induced for labor, this helps soften prepare it for labor
Labor can be indicated by the following?
The patient complains of back pain and the cervix is effacing and dilating
What the term 0 station means?
The presenting part is a true pelvis and is engaged
Fetal engaged
The presenting part of the fetus has settled into the true pelvis at the level of the ischial spines
Fetal station
The relationship of the presenting part of a fetus to the ischial spine.
The laboring patient who is at 3cm dilation and 25% effaced is asking for analgesia. The nurse explains the analgesia is usually not administered prior to the establishment of the active phase. Identify the appropriate rationale for this practice.
This may prolong labor and increase complications
Early deceleration are benign periodic changes. True/ false
True
A woman arrives at labor and delivery with contractions q2-3 min lasting 30-45 sec reporting that she "thinks my water broke". On exam the RN notes the presenting part is difficult to determine. What intervention should the LPN anticipate?
Use of an ultrasound to determine position.
While caring for a woman in labor the fetal heart rate monitor demonstrates late decelerations. The most common cause for this occurrence is
Uteroplacental insufficiency
The provider is admitting a patient to ripen her cervix for induction of labor. The order is for prostaglandin E2. The nurse preparing to administer the medication via which route?
Vaginal
A woman at 39 weeks gestation has been in labor for 8 hours and is asking how far she is dilated, she attended child birth classes and is aware of the stages of labor and phases of labor. She had a vaginal exam 30 min prior to her asking again. How should the nurse respond to her question?
Your labor signs have not changed; we are looking for changes in your labor pattern before we check you again
False labor
a set of temporary contractions of the uterus that resemble the start of labor
Labor dystocia
an abnormal progression of labor, occurs because of malfunction in or more of the four P's of labor. Passageway; pelvis too small Passenger: fetus malpositioned Powers: Insufficient urine contractions Psyche: Woman may fight contractions
Amniotomy
artificial rupture of membranes (AROM)
Dystocia
difficult labor
Epidural/analgesia/anesthesia
provides more effective pain relief than opioids - often completely eliminates the pain sensation - a 500-2000 mL fluid bolus is required before these meds are administered to reduce the risk of hypotension
Fetal attitude
relationship of fetal parts to one another Flexion (ovoid shape) most favorable for vaginal delivery Military (no flexion or extension) Brown or frontum (partial extension) Face (full extension)
Fetal lie
relationship of the long axis of the fetus to the long axis of the mother
Lightening
the sensation of the fetus moving from high in the abdomen to low in the birth canal
Colostrum
thin, milky fluid secreted by the breast during pregnancy and during the first days after birth before lactation begins
Breech presentation
when the baby's buttocks or both legs appear first during birth, ecchymosis may be seen in the buttocks.