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ATI Maternal Newborn > Ch. 11: Labor and Delivery Process > Flashcards

Ch. 11: Labor and Delivery Process Flashcards

1
Q

What are some of the premonitory signs of labor (physiologic signs that precede labor)?

A
  • Backache
  • Weight loss (1-3 lbs)
  • Lightening
  • Contractions
  • Bloody show
  • Energy burst (nesting)
  • ROM
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2
Q

Labor usually occurs within _____ of the ROM

A

24 hours

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3
Q

What can prolonged ROM greater than 24 hours before delivery of a fetus lead to?

A

Infection

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4
Q

Why should a nurse assess FHR immediately following the ROM?

A

A nurse should assess FHR for abrupt decels, which are indicative of fetal stress to rule out umbilical cord prolapse

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5
Q

Once the ROM has occurred, an assessment of amniotic fluid is completed. What are normal, expected characteristics of amniotic fluid?

A
  • Watery, clear, and pale to straw yellow in color
  • Odor should not be foul
  • Volume between 500-1200 mL
  • Nitrazine paper should turn deep blue indicating a pH of 6.5-7.5
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6
Q

There are 5 P’s that affect and define the labor and birth process. What are the 5 Ps?

A
  1. Passenger
  2. Passageway
  3. Powers
  4. Position
  5. Psychological response
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7
Q

5P: Passenger. What is the passenger(s)?

A

Fetus and placenta

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8
Q

5Ps: Passenger

What all affects the ability of the fetus to navigate the birth canal?

A
  • Size of fetal head
  • Fetal presentation
  • Lie
  • Attitude
  • Position
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9
Q

5Ps: Things that affect the passenger

The part of the fetus that is entering the pelvic inlet first. It can be the back of the head (occiput), chin (mentum), shoulder (scapula), or breech (sacrum or feet)

A

Presentation

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10
Q

5Ps: Things that affect the passenger

The relationship of the maternal longitudinal axis (spine) to the fetal longitudinal axis (spine)

A

Lie

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11
Q

5Ps: Things that affect the passenger

What are the 2 types of lies?

A

Transverse and parallel/longitudinal

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12
Q

5Ps: Things that affect the passenger

What type of lie is this?

Fetal long axis is horizontal and forms a right angle to maternal axis and will not accommodate vaginal birth

A

Transverse

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13
Q

5Ps: Things that affect the passenger

What is the presentation of transverse lie?

A

Shoulder

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14
Q

5Ps: Things that affect the passenger

What type of lie is this?

Fetal long axis is parallel to maternal long axis

A

Parallel/longitudinal

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15
Q

5Ps: Things that affect the passenger

What is the presentation of the parallel/longitudinal lie?

A

Cephalic or breech (breech may require a c-section)

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16
Q

5Ps: Things that affect the passenger

Relationship of fetal body parts to one another

A

Attitude

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17
Q

5Ps: Things that affect the passenger

What are the two types of attitudes and describe

A

Fetal flexion: chin flexed to chest, extremities flexed into torso

Fetal extension: Chin extended away from chest, extremities extended

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18
Q

5Ps: Things that affect the passenger

The relationship of the presenting part of the fetus (sacrum, meantime, or occiput) in reference to its directional position as it relates to one of the 4 maternal pelvic quadrants. How is this labeled?

A

Fetal position (fetopelvic)

  • Right or left side of maternal pelvis= R or L
  • Presenting part of fetus= O for occiput, S for sacrum, M for mentum, or Sc for scapula
  • Part of maternal pelvis= A (anterior), P (posterior), T (transverse)
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19
Q

5Ps: Passageway

The birth canal is composed of the bony pelvis, cervix, pelvic floor, vagina, and vaginal opening. The size and shape of the bony pelvis must be adequate to allow the fetus to pass through. The cervix must ___ and ____ in response to contractions and fetal descent

A

Dilate and efface

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20
Q

5Ps: What P is this?

Uterine contractions cause effacement and dilation of the cervix and descent of the fetus. Involuntary urge to push and voluntary bearing down in the second stage of labor helps in the expulsion of the fetus

A

Powers

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21
Q

5Ps: Position

Why should the client engage in frequent position changes?

A

To increase comfort, relieve fatigue, and promote circulation

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22
Q

5Ps: Psychological response

What can produce physiological changes that impair the progress of labor?

A

Maternal stress, tension, and anxiety

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23
Q

Abdominal palpation of the number of fetuses, the fetal presenting part, lie, attitude, descent, and the probable location where fetal heart tones may be best auscultated on the woman’s abdomen

A

Leopold maneuvers

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24
Q

Separate transducer applied to the maternal abdomen over the fundus that measures uterine activity

A

External electronic monitoring (tocotransducer)

25
Q

Transducer applied to the abdomen of the client to assess FHR patterns during labor and birth

A

External fetal monitoring (EFM)

26
Q

When do we get culture for group B strep?

A

36-37 weeks

27
Q

We do a clean catch urine sample for a urinalysis to check for things.

  1. How do we check hydration from it?
  2. How do we check nutritional status?
  3. What is indicative of gest. HTN?
  4. What does bacterial count tell us?
A
  1. Hydration status: Specific gravity
  2. Nutritional status: Ketones
  3. Proteinuria indicative of gest. HTN
  4. Bacterial count tells if there is UTI
28
Q

If membranes are ruptured how often do we check maternal temp?

A

q1-2 hr

29
Q

We assess FHR to determine fetal well being. This can be done by EFM or spiral electrode that is applied to fetal scalp. Prior to electrode placement, what 2 things must occur?

A

Cervical dilation and ROM

30
Q

Established from the beginning of one contraction to the beginning of the next

A

Frequency

31
Q

The time between the beginning of a contraction to the end of the same contraction

A

Duration

32
Q

Strength of the contraction at its peak described as mild, moderate, or strong

A

Intensity

33
Q

Tone of the uterine muscle in between contractions

A

Resting tone

34
Q

What if there is not enough time for uterine relaxation (less than 30 seconds)…what can result?

A

Fetal hypoxia and decreased FHR

35
Q

What can measure intrauterine pressure?

A

Intrauterine pressure catheter

36
Q

True or false labor?

Cervix moves to anterior position

A

True

37
Q

True or false labor?

Presenting part of the fetus is not engaged in pelvis

A

False

38
Q

True or false labor?

Cervix has bloody show

A

True

39
Q

True or false labor?

There is no bloody show

A

False

40
Q

True or false labor?

Contractions aretronger, last longer, and are more frequent

A

True

41
Q

True or false labor?

Fetus presenting part is engaged in pelvis

A

True

42
Q

True or false labor?

Contractions are felt in lower back, radiating to abdomen

A

True

43
Q

True or false labor?

Contractions are painless, irregular in frequency, and intermittent

A

False

44
Q

True or false labor?

Walking can increase contraction intensity

A

True

45
Q

True or false labor?

Contractions decrease in frequency, duration, and intensity with walking or position changes

A

False

46
Q

True or false labor?

Cervix remains in posterior position

A

False

47
Q

True or false labor?

Contractions may begin irregularly, but become regular in frequency

A

True

48
Q

True or false labor?

Contractions felt in lower back or abdomen above umbilicus

A

False

49
Q

True or false labor?

Cervix has progressive change in dilation and effacement

A

True

50
Q

True or false labor?

Contractions often stop with sleep or comfort measures like oral hydration or emptying the bladder

A

False

51
Q

True or false labor?

Cervix has no significant change in dilation or effacement

A

False

52
Q

True or false labor?

Contractions continue despite comfort measures

A

True

53
Q

The adaptations the fetus makes as it progresses through the birth canal during the birthing process

A

Mechanism of labor

54
Q

What are the 7 mechanisms of labor?

A 
Engagement
Descent
Flexion
Internal rotation
Extension
Restitution and external rotation
Expulsion
55
Q 
A nurse in the L&D unit receives a phone call from a client who reports that her contractions started about 2 hours ago, did not go away when she had 2 glasses of water and rested, and became stronger since she started walking. Her contractions occur every 10 min and last about 30 sec. She hasn't had any fluid leak from her vagina. However, she saw some blood when she wiped after voiding. Based on this report, the nurse should recognize that the client is experiencing
A. Braxton Hicks
B. ROM
C. Fetal descent
D. True contractions
A

D

56
Q

A nurse in L&D unit is caring for a client in labor and applies an external fetal monitor and tocotransducer. The FHR is around 140/min. Contractions are every 8 min and 30-40 seconds in duration. The nurse performs a vag exam and finds the cervix is 2 cm dilated and 50% effaced, and the fetus is at a -2 station. Which of the following stages and phases of labor is this client experiencing?

A. First stage, latent
B. First stage, active
C. First stage, transition
D. Second stage

A

A

57
Q

A client experiences a large gush of fluid from her vagina while walking in the hallway of the birthing unit. The nurses first action after establishing that the fluid is amniotic fluid should be to

A. Assess AF for meconium
B. Monitor FHR for distress
C. Dry client and make her comfortable
D. Monitor clients UC

A

B

58
Q

A nurse in L&D is completing admission history for a client who is at 39 weeks of gestation. The client repots that she has been leaking fluid from her vagina for 2 days. The nurse knows that this client is at risk for

A. Cord prolapse
B. Infection
C. Postpartum hemorrhage
D. Hydramnios

A

B

59
Q

A nurse is caring for a client who is in active labor and becomes nauseous and vomits. The client is very irritable and feels the urge to have a BM. She states, “I have had enough. I can’t do this anymore. I want to go home right now.” The nurse knows that these signs indicate the client is in the

A. Second stage of labor
B. Fourth stage of labor
C. Transition stage of labor
D. Latent phase of labor

A

C

ATI Maternal Newborn (13 decks)

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