L&B 6b/Third stage of Labor/Nursing Interventions

Question 1

Third stage of Labor/Maternal Assessment/Vital Signs

1) How often?

Answer 1

1) BP, HR and RR q5mins

Hogan 164

Question 2

Third stage of Labor/Maternal Assessment/Uterine Fundus

The uterine fundus maintains ___1___ and ___2___ pattern to delivery placenta by ___3___ and ___4___ from uterine wall.

Answer 2

1) Uterine fundus maintains TONE
2) CONTRACTION pattern
3) Decreasing surface volume of uterus
4) Shearing placenta from uterine wall

(Hogan 165)

Question 3

Third stage of Labor/Maternal Assessment/ Placental separation s/s
Hints:
1)  abd
2) shrinks, gush
3) expelled
4)  umbilical cord
5)  Shape of uterus

NOTE: (London list this as 4 stage of labor pg 418)

Answer 3

1) Uterus rises upward in abd
2) Uterine volume shrinks from contractions, creating a gush/sudden trickle or spurt of blood vaginally
3) Uterine contents are expelled
4) During this process UMBILICAL CORD protrudes further from the vagina as the placenta moves downward the umbilical cord lengthens (? appears to lengthen)
5) Shape of uterus changes from flat (discoid) to round (globular).

(Hogan 165)

Question 4

Third stage of Labor/Fetal Assessment/Apgar Score

1) What does this assessment tell you?
2) How soon after birth is this done?
3) What are the five criteria?
4) What are the possible scores for each criteria?

NOTE: (London list this as 4 stage of labor pg 415)

Answer 4

1) Assess fetal status after birth
2) 1-5 mins after birth
3) Color, HR, Reflex irritability, muscle tone and respiratory effort
4) 0, 1, 2

(Hogan 165)

Question 5

Third stage of Labor/Fetal Assessment/Apgar scores of 8 or greater indicate?

NOTE: (London list this as 4 stage of labor pg 415)

Answer 5

Newborn needs minimal intervention (nasopharyngeal suction and oxygen near face)

(Hogan 165)

Question 6

Third stage of Labor/Fetal Assessment/Apgar score of 4 to 7 indicates? (3) possible interventions

NOTE: (London list this as 4 stage of labor pg 415)

Answer 6

Newborn needs intervention through

1) oropharyngeal suctioning
2) Tactile stimulation
3) oxygen administration

Question 7

Third stage of Labor/Fetal Assessment/Apgar scores of 3 or less indicates?

NOTE: (London list this as 4 stage of labor pg 415)

Answer 7

Need for resuscitation

Question 8

Third stage of Labor/Fetal Assessment/Respiration

Answer 8

Normally 30 to 60 may be irregular

Question 9

Third stage of Labor/Fetal Assessment/Apical pulse

Answer 9

110-160 maybe irregular and may increase to 180 transietly while crying

Question 10

Third stage of Labor/Fetal Assessment/Temperature

Answer 10

Skin temp above 97.8 F (36.5)

Question 11

Third stage of Labor/Fetal Assessment/Umbilical cord

Answer 11

Normally two arteries and one vein (note 1 artery with 1 vein can occur)

Question 12

Third stage of Labor/Fetal Assessment/Gestational age

Answer 12

Consistent with expected date of delivery

Question 13

Third stage of Labor/Fetal Assessment/Physical

Answer 13

Abbreviated exam to detect presence of visible congenital anomolies

Question 14

Third stage of Labor/Implementation and Collaborative Care

1) Mother
2) Immediate care of newborn (4)

Answer 14

1) Encourage rest/relax
2) Placing in a modified Trendelenburg position
3) Suctioning nose and oropharynx
4) Provide warmth
5) Begin attachment parent hold newborn

Question 15

Third stage of Labor/Documentation/Placenta
Hint:
1) Tick tock
2) How does it look?
3) Is it firm, loose/falling apart?
4) How did it separate from uterine wall?
5) Average blood loss?

NOTE: (London list this as 4 stage of labor pg 418)

Answer 15

1) Time of placenta delivery
2) Placenta appearance
3) Intactness of placenta
4) Mechanism of placental expulsion
5) Estimated delivery blood loss (average 250-500ml)

(Hogan 165)

Question 16

Third stage of Labor/Documentation/Placenta/Mechanism of expulsion
1) dirty Duncan mechanism of delivery

NOTE: (London list this as 4 stage of labor pg 418)

Answer 16

1) Placenta separates from edge progressing toward center and rough maternal side of placenta is visible

Question 17

Third stage of Labor/Documentation/Placenta/Mechanism of expulsion
1) shiny Schultz mechanism of delivery

NOTE: (London list this as 4 stage of labor pg 418)

Answer 17

1) Placenta separates from center progressing outward and membrane-covered fetal side of placenta is visible

Question 18

Third stage of Labor/Documentation/Medication

1) What med/agent is often used to assist with expulsion of placenta?

Answer 18

1) Oxytocic agent

Question 19

Third stage of Labor/Documentation/Cultrual disposal of Placenta

Answer 19

1) Assess and get biohazard bag? or container?

Question 20

Third stage of Labor/Evaluation Mother and newborn

Answer 20

Evaluate if mother and newborn experience a safe labor ad birth

Question 21

Third stage of Labor/Fetal Assessment/Apgar Score
 0 points
Color (Appearance)
HR
Reflex Irritability (Grimace)
Muscle Tone (Activity)
Respiratory Effort (Respirations)

Answer 21

0 points
Color (Appearance):  Blue, pale
HR:  Absent
Reflex Irritability (Grimace):  Absent
Muscle Tone (Activity):  Absent
Respiratory Effort (Respirations):  Absent

(Hogan 165)

Question 22

Third stage of Labor/Fetal Assessment/Apgar Score
1 points
Color (Appearance)
HR
Reflex Irritability (Grimace)
Muscle Tone (Activity)
Respiratory Effort (Respirations)

Answer 22

1 points
Color (Appearance): Blue extremities, pink body
HR: <100
Reflex Irritability (Grimace): Grimace
Muscle Tone (Activity): Some flexion of extremities
Respiratory Effort (Respirations): Slow irregular

Question 23

Third stage of Labor/Fetal Assessment/Apgar Score
2 points
Color (Appearance)
HR
Reflex Irritability (Grimace)
Muscle Tone (Activity)
Respiratory Effort (Respirations)

Answer 23

2 points
Color (Appearance): Completely pink
HR: >= 100
Reflex Irritability (Grimace): Vigorous cry
Muscle Tone (Activity): Active motion
Respiratory Effort (Respirations): Good cry

Question 24

Third stage of Labor/Maternal Assessment/ Placental separation while observing for s/s of placenta separation
palpate the uterus to check for ?

Answer 24

1) Ballooning caused by uterine relaxation and subsequent bleeding into uterine cavity.

Question 25

Third stage of Labor/Maternal Assessment/ Post-Placental separation

1) HCP inspects (2)
2) HCP repairs

Answer 25

1) Vagina and cervix of lacerations

2) lacerations and episiotomy repair

Question 26

Third stage of Labor/Newborn ID

Answer 26

1) Place on newborn’s wrist and ankle before leaving birthing room and parents receive their matching bands