L&D/Third Stage of Labor/Nursing Interventions

Question 1

Third stage of Labor/Maternal Assessment/Vital Signs1) How often?

Answer 1

1) BP, HR and RR q5mins(Hogan 164)

Question 2

Third stage of Labor/Maternal Assessment/Uterine FundusThe 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 pattern3) Decreasing surface volume of uterus4) Shearing placenta from uterine wall(Hogan 165)

Question 3

Third stage of Labor/Maternal Assessment/ Placental separation s/sHints:1) abd2) shrinks, gush3) expelled4) umbilical cord5) Shape of uterusNOTE: (London list this as 4 stage of labor pg 418)

Answer 3

1) Uterus rises upward in abd2) Uterine volume shrinks from contractions, creating a gush/sudden trickle or spurt of blood vaginally3) Uterine contents are expelled4) 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 Score1) 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 birth2) 1-5 mins after birth3) Color, HR, Reflex irritability, muscle tone and respiratory effort4) 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 interventionsNOTE: (London list this as 4 stage of labor pg 415)

Answer 6

Newborn needs intervention through 1) oropharyngeal suctioning2) Tactile stimulation3) 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 Care1) Mother2) Immediate care of newborn (4)

Answer 14

1) Encourage rest/relax2) Placing in a modified Trendelenburg position3) Suctioning nose and oropharynx4) Provide warmth5) Begin attachment parent hold newborn

Question 15

Third stage of Labor/Documentation/PlacentaHint:1) Tick tock2) 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 delivery2) Placenta appearance3) Intactness of placenta4) Mechanism of placental expulsion5) Estimated delivery blood loss (average 250-500ml)(Hogan 165)

Question 16

Third stage of Labor/Documentation/Placenta/Mechanism of expulsion1) dirty Duncan mechanism of deliveryNOTE: (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 expulsion1) shiny Schultz mechanism of deliveryNOTE: (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/Medication1) 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 pointsColor (Appearance)HRReflex Irritability (Grimace)Muscle Tone (Activity)Respiratory Effort (Respirations)

Answer 21

0 pointsColor (Appearance): Blue, paleHR: AbsentReflex Irritability (Grimace): AbsentMuscle Tone (Activity): AbsentRespiratory Effort (Respirations): Absent(Hogan 165)

Question 22

Third stage of Labor/Fetal Assessment/Apgar Score1 pointsColor (Appearance)HRReflex Irritability (Grimace)Muscle Tone (Activity)Respiratory Effort (Respirations)

Answer 22

1 pointsColor (Appearance): Blue extremities, pink bodyHR: <100Reflex Irritability (Grimace): GrimaceMuscle Tone (Activity): Some flexion of extremitiesRespiratory Effort (Respirations): Slow irregular

Question 23

Third stage of Labor/Fetal Assessment/Apgar Score2 pointsColor (Appearance)HRReflex Irritability (Grimace)Muscle Tone (Activity)Respiratory Effort (Respirations)

Answer 23

2 pointsColor (Appearance): Completely pinkHR: >= 100Reflex Irritability (Grimace): Vigorous cryMuscle Tone (Activity): Active motionRespiratory Effort (Respirations): Good cry

Question 24

Third stage of Labor/Maternal Assessment/ Placental separation while observing for s/s of placenta separationpalpate 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 separation1) HCP inspects (2)2) HCP repairs

Answer 25

1) Vagina and cervix of lacerations2) 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