OB Exam 2
Baby starts at (-) station and gradually descends to
(+) station
Abstinence failure rate
0%
Normal INR
0.8-1.2
Fourth stage of labor
1-4 hours after delivery
Normal PT
11-12.5 sec
What is the normal fetal HR
110-160 bpm
Active stage of labor contractions last
45-60 seconds
Blood loss for vaginal birth
500 mL
How many wet diapers should newborn have per day
6-8
In transition, contractions last from
60-90 seconds
Bowels should be
Abdomen soft/nondistended. Normal bowel sounds x4 quadrants, passing flatus, no difficulty with BMs
Emotional State
Adequate mother/newborn attachment
When do fontanels close
Anterior at 18 months Posterior at 8-12 weeks
Apgar stands for
Appearance, Pulse, Grimace, Activity, and Respiration
Pain
Assess pain every 4 hours; admin pain meds when needed
Excessive bleeding is described as
Bleeding that soaks more than one pad per hour
Describe BUBBLEHE-P
Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy/incision, Homan's, Emotional, Pain
Mini-pill
Can be used during lactation
A nurse is caring for a client who is in active labor and notes late decelerations in the FHR. Which of the following actions should the nurse take first?
Change the client's position
A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is "not really sure if she is in labor or not." Which of the following should the nurse recognize as a sign of true labor?
Changes in the cervix
Homan's
Check for redness, warmth, to r/o blood clot
Variable deceleration =
Cord compression
Episiotomy/abdominal incision should be
Edges well approximated No drainage, warmth, redness or edema
Flexion
Fetal chin flexes downward onto chest
Internal Rotation
Fetal head rotates to fit diameter of pelvic cavity
Uterus should be
Firm fundus, midline, at or below level of umbilicus
Contractions like rollercoaster
First phase: Go up Second phase: Peak or acme Third phase: Let up (go down)
A nurse is caring for a client who is postpartum and received methylergonovine. Which of the following findings indicates that the medication was effective?
Fundus firm to palpation
If GBS positive
Give 2 doses of Penicillin before deliver
S/S of placental delivery
Globular shaped uterus rise of fundus in abdomen sudden gush or trickle of blood Further protrusion of umb. cord from vagina
Engagement
Greatest diameter of head passes through the pelvic inlet
Methergine is contraindicated in patients with
HTN
Early declerations =
Head compression
Apgar includes
Heart rate Resp effort Muscle tone Reflex irritability Color
What is intensity
How strong is contraction
GBS can cause
Infant respiratory distress
A nurse in a hospital is caring for a client who is at 38 weeks of gestation and has a large amount of painless, bright red vaginal bleeding. The client is placed on a fetal monitor indicating a regular fetal heart rate of 138/min and no uterine contractions. The client's vital signs are: blood pressure 98/52 mm Hg, heart rate 118/min, respiratory rate 24/min, and temperature 36.4° C (97.6° F). Which of the following is the priority nursing action?
Initiate IV access
what is precipitous labor
Labor that last three hours or less from the onset of contractions to the time of delivery
Stage one of labor has 3 parts
Latent, active, transition
Risk factors of precipitous labor
Lungs do not compress enough to remove fluid from lungs
Unrelieved vaginal bleeding that is not resolved by fundal massage will require?
Methergine
Descent
Movement of fetus through the birth canal
Diaphragm
Must be fitted by HCP
Accelerations =
OK
A nurse is caring for a client who is in active labor and notes late decelerations in the FHR. Which of the following actions should the nurse take first?
Obtain a 30 min electronic fetal monitoring (EFM) strip prior to induction
Extension
Occiput, brow and face emerge from vagina
Latent stage of labor is the
Onset of labor until 3 cm dilation
What is the most crucial postpartum assessment?
Palpating the uterus
Late decelerations =
Placental insufficiency (perfusion/decreased O2/blood supply)
A nurse on a labor unit is admitting a client who reports painful contractions. The nurse determines that the contractions have a duration of 1 min and a frequency of 3 min. The nurse obtains the following vital signs: fetal heart rate 130/min, maternal heart rate 128/min and maternal blood pressure 92/54 mm Hg. Which of the following is the priority action for the nurse to take?
Position with one hip elevated
A nurse is preparing to administer methylergonovine IM to a client who experienced a vaginal delivery. The nurse should explain to the client that the purpose of this medication is to prevent which of the following conditions?
Postpartum hemorrhage
Interventions for late decelerations
Reposition, side lying O2 non-rebreather DC Oxy/Run IV wide open Call HCP is not resolved Prepare for vaginal delivery is c-section
Key when giving oxytocin
See how baby and mom are doing
If pregnancy and need rubella vachcination, when is this given?
Shortly after giving birth
Expulsion
Shoulders and body quickly follow to delivery
External Rotation
Shoulders enter pelvis, turning head to one side
Soon after delivery, the mother may appear primarily concerned with herself. This is known as the?
Taking in phase
A nurse is assessing a client who is in active labor and notes that the presenting part is at 0 station. Which of the following is the correct interpretation of this clinical finding?
The lowermost portion of the fetus is at the level of the ischial spines
Second stage of labor is
The period after cervix is dilated to 10 cm until baby is delivered
What do uterotonics do
Tone the uterus
There are several causes of postpartum hemorrhage, list them:
Uncontracted uterus Injury to the birth canal Large infant/twins Excessive amniotic fluid Prolonged/precipitous labor
What is Bishop Score
Used to determine cervical readiness
A nurse is caring for a client who is in the first stage of labor, undergoing external fetal monitoring, and receiving IV fluid. The nurse observes variable decelerations in the fetal heart rate on the monitor strip. Which of the following is a correct interpretation of this finding?
Variable decelerations are due to umbilical cord compression
A nurse is providing education to a client who is in labor and has a prescription for a continuous IV infusion of oxytocin. Which of the information should the nurse include?
Your contractions will become stronger and more frequent
Ischial spine marks what station
Zero
Condom is considered what method
barrier
Most important nursing action is to
check the FHR
Why give vitamin K
clotting
Third stage of labor is
delivery of placenta
The immediate postpartum period of fourth stage of labor lasts from the delivery of the placenta to the
first 4 hours after labor
What are the signs that the placenta is about to be delivered?
globular shaped abdomen lengthening of the cord
Variable declerations position
knee to chest
Scant lochia
less than 1 inch
light lochia
less than 4 inches
Labor induction
no contractions
REEDA
redness, edema, ecchymosis, drainage, approximation
heavy lochia
saturated pad w/i one hour
The APGAR scoring system is useful in determining:
status of overall condition.
Involution
uterus reducing to pre pregnancy size
labor augmentation
when spontaneous labor stops
When to give vitamin K
within one hour of birth
Is Oxytocin piggybacked?
yes
What is frequency
Time between the beginning of one contraction and the beginning of the next contraction
What is duration
Time of beginning of contraction to end of same contraction
4 T's of PPH
Tone Tissue Trauma Thrombin disorder
A nurse is caring for a client who is in labor and has an external fetal monitor. The nurse observes late decelerations on the monitor strip and interprets them as indicating which of the following?
Uteroplacental insufficiency
What is dystocia
difficult labor or failure to progress
moderate lochia
less than 6 inches
Breasts should be
normal, soft, no cracking or bleeding nipples, erect nipples for breast feeding
where to give vitamin K
vastus lateralis
A nurse is caring for a client who is at 39 weeks of gestation and is in active labor. The nurse locates the fetal heart tones above the client's umbilicus at midline. The nurse should suspect that the fetus is in which of the following positions?
Frank breech
Bladder should be
Nondistended and nonpalpable; voiding clear/yellow
What are some risks/concerns for the mother in the postpartum period
Postpartum hemorrhage Infection Preeclampsia/eclampsia
5 P's of labor
Powers (contractions) Passageway (birth canal) Passenger (fetus) Psychological response Position
Lochia
Rubra (dark red) up to 4 days Serosa (pinkish/brown) 4-10 days Alba (whitish/yellow) 10-28 days
A nurse is admitting a client who is at 38 weeks of gestation and is in the first stage of labor. Which of the following assessment findings should the nurse report to the provider first?
Continuous contraction lasting 2 minutes
Blood loss for C-section
1000 mL
Give Rhogam at
28 weeks gestation and 72 hours after birth
Active stage of labor continues from
3 cm until 7 cm dilation
Active stage of labor, how long between contractions
3-5 minutes
In transition, time between contractions is
30 seconds to 2 minutes
In latent stage of labor contractions last
30-45 seconds
A postpartum patient should void ______________ ml/voiding
300-400 mL
When to check mother for GBS status
36-37 weeks gestation
In latent stage of labor how many minutes between contractions
5-30 minutes
A nurse is caring for a newborn and calculating the Apgar score. At 1 min after delivery, the following findings are noted: heart rate of 110/min; slow, weak cry; some flexion of extremities; grimace in response to suctioning of the nares; body pink in color with blue extremities. Calculate the newborn's Apgar score. Answer the number only.
6
Transition phase of labor continues from
7 cm - 10 cm
Normal temperature:
97.9-99F axillary