6.1d Fourth Stage of Labor

Question 1

4th Stage of Labor

Answer 1

• Starts with expulsion of placenta and lasts until patient is stable
• Includes the first 2 hours after birth for recovery

Question 2

Care Management

Answer 2

• Check BP and pulse every 15 minutes for 2 hours

- Temperature is checked every 4 hours for the first 8 hours

Question 3

Fundus Assessment

Answer 3

• Patient should have their knees flexed and head flat
• Cup hand and press firmly into abdomen below the umbilicus. Stabilize uterus at the symphysis pubis with opposite hand.
• Measure where the fundus is in relation to umbilicus using your fingers.
• Fundus should be firm and midline
• If fundus is not firm, massage it to expel any clots.
• Massage fundus until firm
• Apply pressure on fundus down towards vagina and assess amount/size of expelled clots

Question 4

Bladder Assessment

Answer 4

• Distended bladder is dull on percussion
• Uterus will be boggy, above the umbilicus, and on the right side
• Assist patient in voiding
• Record amount voided
• Catheterize if necessary
• Re-assess after patient has voided

Question 5

Lochia

Answer 5

• Observe perineal pads for lochia
• Determine amount, color, size, odor
• Observe for bleeding sources (episiotomy, lacerations)

Question 6

Perineum Assessment

Answer 6

• Assist patient to side laying and flex her leg up
• Lift butt and observe perineum
• Assess for erythema, edema, ecchymosis (bruising) drainage, and approximation (REEDA) at site of episiotomy or laceration repair.
• Assess for hemorrhoids

Question 7

Post anesthesia Recovery

Answer 7

• PAR score include activity, respiration, bp, LOC, and color
• Assessed every 15 minutes

Question 8

Care of New Mother

Answer 8

• Vaginal births without complications can have fluids and regular diet as soon as they want
• C-section births are restricted to clear liquid and ice chips

Question 9

Care of Family

Answer 9

• Encourage skin to skin contact
• Babies are wrapped in blankets and given a hat to prevent heat loss
• Many women want to breastfeed right away while infant is alert and to stimulate oxytocin production which helps prevent hemorrhage

Question 10

1st Step of Physical Examination

Answer 10

• General Systems Assessment (heart, lungs, skin)
• Presence of edema
• DTR
• Clonus
• VS
• Elevated BP should be re-assessed in 30 minutes after rest
• Weight

Question 11

Leopold Maneuvers Identifies

Answer 11

• Presenting Part
• Fetal Lie
• Fetal attitude
• Degree of pelvic descent
• Expected location of Maximal Intensity (PMI)

Question 12

FHR Monitor

Answer 12

• External fetal monitors need 20-30 minutes to establish a baseline for uterine activity and fetal heart rate. Patient cannot walk around during this time.

Question 13

Latent Phase Assessment

Answer 13

• BP, Pulse, RR, UA, FHR assessed every 30-60 minutes

- Temp assessed every 4 hours and then 2 hours after water breaks

Question 14

Labor Complications

Answer 14

• Uterine contractions longer than 90 seconds and close than 2 minutes apart
• Fetal bradycardia/tachycardia
• Minimal Variability
• Late, variable, prolonged FHR decelerations
• Irregular FHR
• Meconium stained or bloody amniotic fluid
• Bright red or dark foul smelling vaginal discharge
• Stoppage of dilation/effacement/decent
• Maternal temperature over 100