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77 Cards in this Set
- Front
- Back
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What should women be informed about during contractions?
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The possibility of not being admitted if they are 3 cm or less dilated
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What method can women use to relax during labor?
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A warm shower during the early stages of labor
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Why should warm baths be avoided?
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Because water immersion in early labor could prolong the labor process and increase the probability of oxytocin use to stimulate uterine contractions and epidural analgesia for pain reduction
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What is the top priority when the woman arrives at the perinatal unit?
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Assessment
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What are the urgent pregnancy problems?
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1. Labor
2. Decreased fetal movements 3. Rupture of membranes 4. Recent trauma |
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What is done for the woman upon admission in the perinatal unit?
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1. Change into the hospital gown
2. Placement of an admission band and an allergy band if applicable 3. Her belongings are put away or given to family members |
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When should questions be asked to the woman?
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In between contractions
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What pertinent perinatal data should be obtained?
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1. Age
2. Height and weight 3. General health status 4. Current medical conditions or allergies 5. Respiratory status 6. Previous surgical procedures 7. Any previous labor/birth experiences 8. Expected date of delivery/birth 9. Vital signs 10. Lab tests |
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What information is gathered about previous labor/birth experiences?
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1. Duration
2. Type of anesthesia used 3. Type of birth 4. Condition of newborn |
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What are the types of birth?
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1. Spontaneous vaginal
2. Forceps-assisted 3. Vacuum-assisted 4. Cesarean birth |
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What lab tests are conducted?
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1. Blood type and Rh factor of mother
2. CBC or partial blood cell count 3. The 50-g blood glucose test 4. Determination of the rubella titer 5. Serologic tests for syphilis 6. Hepatitis B surface antigen 7. Culture for GBS 8. Urinalysis |
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What is the woman asked to describe upon admission to the perinatal unit?
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1. Time and onset of contractions and progress in terms of frequency, duration, and intensity
2. Location and character of discomfort from contractions (e.g. back pain, suprapubic discomfort) 3. Persistence of contractions despite changes in maternal position and activity (e.g. walking or lying down) 4. Presence and character of vaginal discharge or show 5. The status of the amniotic membranes, such as gush or seepage of fluid |
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How is bloody or pink show distinguished from bleeding?
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The show is pink and sticky because of its mucoid nature. It is also scant to begin with and increases with effacement and dilation of the cervix.
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What other pertinent data must be gathered upon admission?
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1. Birth plan
2. Choice of infant feeding method 3. Type of pain management preferred 4. Name of PCP |
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What is the effect of allergic responses during labor?
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Swelling of the mucous membranes of the respiratory tract could interfere with breathing and the administration of inhalation anesthesia
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What psychosocial factors should be assessed?
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1. Verbal interactions
2. Body language 3. Perceptual ability 4. Discomfort level |
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What type of verbal interactions are assessed?
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1. Does the woman ask questions?
2. Can she ask for what she needs? 3. Does she talk to her support person(s)? 4. Does she talk freely to the nurse or only respond to questions? |
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What type of body language is assessed?
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1. Relaxed or tensed
2. Anxiety level 3. Body position 4. Eye contact 5. Level of activity and rest |
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What perceptual abilities are assessed?
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1. Language barrier
2. Comprehension |
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How is the comfort level assessed?
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Verbal and nonverbal cues of pain
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How might abuse survivors react?
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1. By fighting the labor process
2. React in panic or anger toward care providers 3. Taking control of everyone and everything 4. May surrender by being submissive and dependent 5. May retreat by mentally disassociating themselves from the sensations of labor and birth |
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How is the woman's sense of control during labor maintained?
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1. By explaining all procedures and why they are needed
2. Validating her needs and paying close attention to her requests 3. Proceeding at the woman's pace by waiting for her to give permission to touch her 4. Accepting her often extreme reactions to labor 5. Protecting her privacy |
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What are common concerns of women during labor?
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1. Will my baby be alright?
2. Will I be able to stand labor? 3. Will my labor be long? 4. How will I act? 5. Will I need medication? 6. Will it work for me? 7. Will my partner or someone be there to support me? |
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How can women feel empowered during labor?
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1. When they are given information they can understand and that show support to their efforts
2. Behave naturally and be able to "let go" 3. Be able to trust their own innate ability to give birth |
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What are some birth practices in different cultures?
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1. South Korea - stoic response to labor and pain; fathers usually not present
2. Japan - natural childbirth methods practiced; may labor silently; may eat during labor; father may be present 3. China - stoic response to pain; fathers not present; side-lying position 4. India - natural childbirth methods preferred; fathers not present; female relatives present 5. Iran - fathers not present; prefers female support and caregivers 6. Mexico - may be stoic until second stage of labor; may request pain relief; fathers and female relatives may be present 7. Laos - prefer squatting position; prefer female attendants; fathers may or may not be present |
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What cultural and religious preferences are assessed?
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1. Value and meaning placed on the childbirth experience
2. View of childbirth as a wellness or illness experience and as a private or social event 3. Practices regarding diet, medications, activity, and emotional and physical support 4. Appropriate maternal and paternal behaviors 5. Birth companions - who they should be and what they should do 6. Views regarding the newborn and the newborn's care immediately after birth |
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What does the initial physical examination include?
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1. General systems assessment
2. Performance of Leopold maneuvers 3. Assessment of fetal status 4. Assessment of contractions 5. Vaginal assessment |
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What are the standard precautions during childbirth?
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1. Wash hands
2. Wear gloves 3. Wear face mask 4. Wear gown 5. Drape woman with sterile towels 6. Help woman put on appropriate coverings 7. Use appropriate method to suction newborn |
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What is done throughout labor?
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Accurate documentation, done as soon as possible after a procedure has been performed
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What is included in the general assessment?
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Assessment of heart, lungs, and skin
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What is the purpose of the Leopold maneuvers?
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1. Identify number of fetuses
2. Determine the presenting part, fetal lie, and fetal attitude 3. The degree of the presenting part's descent into the pelvis 4. The expected location of the PMI of the fetal heart rate on the woman's abdomen |
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When is the most common occurrence for umbilical cord prolapse?
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After rupture of membrane
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How are contractions described upon palpation?
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1. Mild
2. Moderate 3. Strong |
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What are mild contractions?
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Slightly tense fundus that is easy to indent with the fingertips
(feels like the tip of the nose) |
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What are moderate contractions?
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Firm fundus that is difficult to indent with fingertips
(feels like touching finger to chin) |
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What is a strong contraction?
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Rigid, boardlike fundus that is almost impossible to indent with fingertips
(feels like touching finger to forehead) |
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Is external electronic monitoring reliable for assessing intensity of uterine contractions?
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NO
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What is the most reliable way of assessing the intensity of uterine contractions?
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Internal electronic monitoring with an intrauterine pressure catheter (IUPC)
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When should a vaginal examination be performed?
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1. Upon admission
2. Significant change has occurred in uterine activity 3. On maternal perception of perineal pressure or the urge to bear down 4. Rupture of membranes 5. Variable decelerations of the FHR are noted |
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What is the purpose of a clean-catch urine specimen analysis?
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Assess hydration status, nutritional status, infection status, or status of possible complications such as preeclampsia shown by finding protein in urine
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When would a CBC be ordered?
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For women with a history of infection, anemia, gestational HTN, or other disorders
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Which positions during contractions are recommended to facilitate the rotation of the fetal occiput from the posterior to an anterior position?
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1. Squatting, because the position increases the pelvic diameter
2. A hand-and-knees ("all fours") position since gravity pulls the fetal back forward |
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What can be used to support a woman's body during labor and delivery?
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A birth ball (gymnastic ball)
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What should the labor rooms be like?
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Airy, clean, and homelike. The woman should feel safe in this environment and free to be herself and to use the comfort and relaxation measures she prefers.
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How can the nurse alleviate a woman's anxiety during labor?
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1. Communicating early
2. Explaining unfamiliar terms 3. Providing information and explanation without having her to ask and at a level she understands 4. Preparing her for sensations she will experience and procedures that will follow 5. Helping the woman achieve a satisfying birth experience |
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What does supportive and empathetic nursing care include?
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1. Helping the woman maintain control and participate to the extent she wishes in the birth of her infant
2. Providing continuity of care that is nonjudgmental and respectful of her cultural and religious values and beliefs 3. Meeting the woman's expected outcomes for her labor 4. Listening to the woman's concerns and encouraging her to express her feelings 5. Acting as the woman's advocate, supporting her decisions and respecting her choices as appropriate, and relating her wishes as needed to other health care providers 6. Helping the woman conserve her energy and cope effectively with her pain and discomfort by using a variety of comfort measures that are acceptable to her 7. Helping control the woman's discomfort 8. Acknowledging the woman's efforts during labor including her strength and courage, as well as those of her partner, and providing positive reinforcement 9. Protecting the woman's privacy, modesty, and dignity |
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What are the phases of stage two labor?
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1. Latent
2. Descent 3. Transition |
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What is the latent phase of stage two labor?
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Period of rest and relative calm
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What is the descent phase of stage two labor?
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Phase of active pushing characterized by strong urges to bear down as the reflex called Ferguson reflex is activated
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What is the Ferguson reflex?
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When the presenting part presses on the stretch receptors of the pelvic floor. At this point, the fetal station is usually +1, and the position is anterior.
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What is the transition phase of stage two labor?
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The presenting part is on the perineum, and bearing-down efforts are most effective for promoting birth. The woman may be more verbal about the pain she is experiencing; she may scream or swear and may act out of control.
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What factors influences the duration of the second stage of labor?
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1. Effectiveness of the primary and secondary powers of labor
2. The type and amount of analgesia or anesthesia used 3. The physical and emotional condition, position, activity level, parity, and pelvic adequacy of the laboring woman 4. The size, presentation, and position of the fetus 5. The nature and source of support the woman receives |
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What is the only objective sign that the second stage of labor has begun?
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The inability to feel the cervix during vaginal examination, indicating that the cervix is fully dilated and effaced
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What other signs suggest the onset of the second stage of labor?
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1. Sudden appearance of sweat on the upper lip
2. An episode of vomiting 3. Increased bloody show 4. Shaking of extremities 5. Increased restlessness; verbalization ("I can't go on") 6. Involuntary bearing-down efforts |
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What are the benefits of the upright position?
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1. Straighten the longitudinal axis of the birth canal and improve the alignment of the fetus for passage through the pelvis
2. Use of gravity to direct the fetal head toward the pelvic inlet, thereby facilitating descent 3. Enlarge pelvic dimensions and restrict the encroachment of the sacrum and coccyx into the pelvic outlet 4. Increase uteroplacental circulation, resulting in more intense, efficient uterine contractions 5. Enhance the woman's ability to bear down effectively, thereby minimizing maternal exhaustion |
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Which position has the highest episiotomy rate for nulliparas?
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Semi-recumbent
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Which position may reduce perineal trauma?
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The hands-and-knees ("all fours") position
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What should the nurse monitor the woman's breathing for?
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1. That she does not hold her breath for more than 5 to 7 seconds
2. She should ventilate her lungs fully by taking deep cleansing breaths before and after each contraction |
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What maternal benefits are associated with spontaneous pushing?
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1. Less perineal trauma
2. Less maternal fatigue 3. Fewer forceps- or vacuum-assisted births |
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What is the purpose of turning the woman onto her side?
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To reduce pressure of the uterus against the ascending vena cava and descending aorta, and oxygen can be administered by mask at 8 to 10 L/min
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What are the three phases of the spontaneous birth of a fetus in a vertex presentation?
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1. Birth of the head
2. Birth of the shoulders 3. Birth of the body and extremities |
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What is crowning?
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When the widest part of the head (the biparietal diameter) distends the vulva just before birth
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What is an episiotomy?
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Incision into the perineum to enlarge vaginal outlet
(it is done to minimize soft-tissue damage) |
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How is the perineum guarded during birth?
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1. Applying pressure against the rectum, drawing it downward to aid in flexing the head as the back of the neck catches under the symphysis pubis
2. Applying upward pressure from the coccygeal region 3. Assisting the mother with voluntary control of the bearing-down efforts by coaching her to pant while letting uterine forces expel the fetus |
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What is the purpose of guarding the perineum?
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1. Prevent fetal intracranial injury
2. Protect maternal tissues 3. Reduce postpartum perineal pain |
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What is fundal pressure?
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Application of gentle, steady pressure against the fundus of the uterus to facilitate the vaginal birth
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What is a first degree laceration?
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Laceration that extends through the skin and structures superficial to the muscles
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What is a second degree laceration?
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Laceration that extends through muscles of the perineal body
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What is a third degree laceration?
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Laceration that continues through the anal sphincter muscle
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What is a fourth degree laceration?
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Laceration that also involves the anterior rectal wall
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What risk factors are associate with perineal trauma?
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1. Nulliparity
2. Maternal position 3. Pelvic inadequacy 4. Fetal malpresentation and position 5. Large (macrosomic) infants 6. Use of instruments to facilitate birth 7. Prolonged second stage of labor 8. Fetal distress 9. Rapid labor in which there is insufficient time for the perineum to stretch |
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What happens after the birth of the fetus?
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Strong uterine contractions cause the placental site to shrink markedly. This causes the anchor villi to break and the placenta to separate from its attachments. Normally the first few strong contractions that occur 5 to 7 minutes after the baby's birth cause the placenta to be sheared away from the basal plate.
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What signs indicate placental separation?
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1. A firmly contracting fundus
2. A change in the uterus from a discoid to a globular shape 3. A sudden gush of dark blood from the introitus 4. Apparent lengthening of the umbilical cord as the placenta descends to the introitus 5. The finding of vaginal fullness (the placenta) on vaginal or rectal examination or of fetal membranes at the introitus |
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What does the nurse observe for after complete delivery of the placenta?
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1. Excessive blood loss
2. Alterations in vital signs 3. Pallor 4. Light-headedness 5. Restlessness 6. Decreased urinary output 7. Alteration in LOC and orientation |
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What are women with a history of cardiac disorders at increased risk for?
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1. Cardiac decompensation
2. Pulmonary edema as a result of the circulatory changes associated with the birth of the fetus and expulsion of the placenta |
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What is true labor?
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1. Contractions occur regularly, becoming stronger, lasting longer, and occurring closer together
2. Contractions become more intense with walking 3. Contractions are usually felt in the lower back, radiating to lower portion of abdomen 4. Cervix shows progressive change and moves to an increasingly anterior position 5. Fetal presenting part usually engaged in the pelvis; which results in an increased ease of breathing but also increasing urinary frequency |
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What is false labor?
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1. Contractions occur irregularly and STOP with walking or position change
2. Contractions can be felt in the back or above the navel 3. Cervix still in posterior position 4. Fetal presenting part not engaged in the pelvis |
