Labor and delivery 112

Question 1

THEORIES OF LABOR ONSET
(7)

Answer 1

1.) UTERINE DISTENTION & INCREASED PRESSURE

2.) OXYTOCIN STIMULATION -RELEASED BY PITUITARY AT TERM

3.) PROGESTERONE DECREASED/ESTROGEN INCREASES

• increases ABILITY OF UTERUS TO CONTRACT (PROGESTERONE MAINTAINS
  PREGNANCY, SO LOWER LEVELS STIMULATE LABOR.)

4.) PROSTAGLANDIN RELEASE - PRODUCED BY DECIDUAS, UMBILICAL
CORD, AND AMNION STIMULATES LABOR

5.) CERVICAL PRESSURE STIMULATES NERVE PLEXUS RELEASES
OXYTOCIN CAUSES CONTRACTIONS

6.) AGING PLACENTA-LIMITS ITSELF -MADE TO FUNCTION OPTIMALLY
FOR 41 WEEKS

7.) RISING CORTISOL LEVELS- INFLUENCES PROGESTERONE AND

Question 2

LABOR TRIGGERS ( maternal factors) (5)

Answer 2

1.) Uterine muscles stretched to threshold point–> release of prostaglandins and oxytocin that stimulate contractions
2.) increased pressure on the cervix stimulates nerve plexus –> release of oxytocin by the maternal pituitary gland
3.) increase in estrogen which enhanced myometrium to produce contractions
4.) progesterone (“pro-pregnancy hormone”) is functionally withdrawn allows estrogen to contract the uterus
5.) Oxytocin and Prostaglandins soften cervix and stimulate myometrial contractions

Question 2

Labor triggers ( fetal factors ) (2)

Answer 2

1.) Prostaglandin synthesis by the fetal membranes and the decidua stimulate contractions
2.) fetal cortisol increase- act on placenta, increase prostaglandins reduces progesterone all stimulate uterus to contact

Question 2

Components of Labor
5 “p” S

Answer 2

PASSENGER- fetus, size of the head,which is made to mold–> sutures and fontanels

PASSAGEWAY- mother’s physical capacity to deliver the infant

POWERS- 2 types involuntary and voluntary
strength of uterine muscle (contractions)
bearing down efforts (pushing)

POSITION OF MOTHER- Physiologically, it makes a difference in ability of the fetus to descend into the pelvis.
encourage woman to move around, ambulate, and change positions frequently, as long as it’s not medically contraindicated

PSYCHOLOGICAL- a woman’s psych can influence the progress of labor

Question 2

Myonetrium (2)

Answer 2

1.) Contracts and shortens during the first stage of labor

2.) has 2 segments
- upper (2/3) of the uterus (contracts to push the
fetus down)
- less muscular/more elastic lower segment of the
uterus and the cervix (1/3) (allows the cervix to
become thinner and pulled upward)

Question 2

UCs are responsible for the _________ and _________of the cervix in the first stage of labor.

Answer 2

1.) dilation (opening of the cervix)
2. )effacement (thinning and shortening of the cervix

Question 2

Frequency of contractions (4)

Answer 2

1.) UCs are rhythmic and intermittent

2.) Relaxation- Each contraction has a resting phase or uterine relaxation period that allows the uterine muscle a pause for rest

3.) Frequency- Time from the beginning of one contraction to the beginning of another. It is recorded in minutes (e.g., every 3 to 4 minutes).

4.) Duration- beginning of contraction to the end of the same contraction

Question 2

describe how blood flow works during contractions

Answer 2

Each contraction has a resting phase or uterine relaxation period that allows the uterine muscle a pause for rest. At term, the uteroplacental blood flow is estimated to be 500 to 750 mL/min. During a contraction, the blood flow is decreased in proportion to the strength of the contraction, decreasing the oxygen transfer from parent to fetus. Fetuses have multiple compensatory mechanisms to cope and usually are able to tolerate this stress (Turner etal., 2020). The period between contractions allows uteroplacental blood flow to be restored, the fetus to be reoxygenated, and waste to be removed.

Question 2

Contractions: Intensity (IUPC) (3)

Answer 2

1.) Strength of the contraction
2.) The intensity may be evaluated by palpation or with an intrauterine pressure catheter (IUPC) mm Hg
3.) UPC is an internal monitor placed in the uterus, that allows accurate measurement of strength, duration, and frequency of contractions

Question 2

contractions: palpating intensity (3)

Answer 2

1.) Mild: The uterine wall is easily indented during
contraction. It feels similar to the tip of a nose.

2.) Moderate: The uterine wall resists indentation during a contraction. It feels similar to a chin

3.) Strong: The uterine wall cannot be indented during a contraction. It feels similar to a forehead.

Question 2

The three phases of a contraction (3)

Answer 2

1.) Increment phase- the buildup of the contraction that begins in the fundus and spreads throughout the uterus, the longest part

2.) Acme phase- the peak of intensity but the shortest part of the contraction.

3.) Decrement phase- The relaxation of the uterine muscle.

Question 2

Ferguson reflex (2)

Answer 2

(1) urge to push
(2) is triggered, activating stretch receptors that send impulses to the hypothalamus, resulting in an acceleration of oxytocin release stimulating stronger contractions

Question 3

4 types of bony pelvis

Answer 3

1.) Gynecoid: most common, rounded shape, shallow pelvic cavity, short ischial spine (NL female)

2.) Android: Inlet is a triangle or heart-shaped with limited space in the posterior pelvis for accommodating the fetal head. narrow from the front prominent ischial spine. (NL male)

3.) Anthropoid: Inlet is oval shaped, with a narrower ­pubic arch, which is usually adequate for childbirth (ape-like)

4.) Platypelloid: The least common type found in about 3% of women. Has a flat inlet and a short anterior-posterior diameter, making childbirth more difficult (flat)

Question 3

passage: pelvic measurement

Answer 3

1.) Suprapubic arch >90% ok
2.) Diagonal conjugate > 11.5 cm for delivery
3.) Bi-ischial or intertuberous diameter >8cm

Question 4

active vs passive segments (soft tissue)

Answer 4

active- Fundus and Corpus
passive- Isthmus and cervix

Question 5

Fetal skull

Answer 5

1.) The largest portion of the fetus to come through the birth canal

2.) The head can mold, and change shape to fit the pelvis

3.) skull: two parietal bones, two temporal bones,
a frontal bone, and the occipital bone

4.) membranous spaces between bones are called cranial sutures

5.) Fontanels are called soft spots, they’re the intersections of these sutures

Question 6

Fetal presentation (3)

Answer 6

1.) Cephalic (head first)
2.) Breech (pelvis first)
3.) Shoulder (shoulder first)

Question 7

Cephalic presentations

Answer 7

1.) The presenting part Is the head
2.) 97% of all births
3.) vertex/occiput: the head is sharply flexed and the chin is touching the thorax
4.) Frontum/brown presentation: indicates partial extension of the neck with the brow as the presentation
5.) Face presentation: the neck is sharply extended and the back of the head (occiput) is arching to the fetal back

Question 8

Breech presentation ( 6 )

Answer 8

1.) The presenting part is the buttocks or feet
2.) 3% of all birth
4.) Complete breech: the knees are bent and buttocks and feet are close to the cervix, with the fetus cross-legged over the cervix 5-10% of breech fetuses are in this position
5.) Frank breech: complete flexion of thighs and legs, with feet adjacent to the head. at term, 50% to 70% of breech fetuses are in this position
6.) Incomplete/footling breech: extension of one or both thighs and legs so that one or both feet are presenting 10-40%

Question 9

Transverse/shoulder presentation

Answer 9

1.) The presenting part is usually the shoulder
2.) The reference point for transverse presentations is the acromion
3.) usually associated with a transverse lie

Question 10

Compound presentation

Answer 10

1.) An extremity prolapses along with the presenting part and both present together in the pelvis, occurs with 0.1% of labor
2.) often head with arm, doesn’t interfere with labor

Question 11

longitudinal vs transverse fetal lie

Answer 11

1.) longitudinal: vertex or breech
2.) transverse: shoulder
- cannot be delivered vaginally

Question 12

fetal position: R,L

Answer 12

ROA- Right occiput anterior
ROP- Right occiput posterior
LOA- Left occiput anterior
LOP- Left occiput posterior
LSA- left sacrum anterior

Question 13

a nurse in labor and delivery is caring for a client. Following delivery of the placenta, the nurse examines the umbilical cord. which of the following vessels should the nurse expect to observe in the umbilical cord?

1.) two veins and one artery
2.) one artery and one vein
3.) two arteries and one vein
4.) two arteries and two veins

Answer 13

3.) Two arteries and one vein
- the vein carried the oxygenated, nutrient-rich blood from the placenta to the fetus, and the two arteries returned the blood to the placenta

Question 14

A nurse is assessing a client who is in active labor and notes that the presenting part is at 0 station. which of the following is the correct interpretation of this clinical finding?

1.) The fetal head is in the left occiput posterior position

2.) the largest fetal diameter has passed through the pelvic outlet

3.) the posterior fontanel is palpable

4.) the lowermost portion of the fetus is at the level of the ischial spines

Answer 14

4.) the lowermost portion of the fetus is at the level of the ischial spines

• the presenting part is at 0 station when its lowermost portion is at the level of an imaginary line drawn between the client’s ischial spines. levels above the ischial spines are negative values: -1,-2,-3, levels below the ischial spines are positive values +1,+2,+3

Question 15

The nurse is caring for a client who was admitted to the maternity unit at 38 weeks of gestation and who is experiencing polyhydramnios. The nurse should understand that this diagnosis means which of the following ?

1.) client is carrying more than one fetus

2.) there is an elevated level of alpha- fetoprotein in the amniotic fluid

3.) an excessive amount of amniotic fluid is present

4.) the fetus is likely to have a congenital anomaly, be growth restricted, or demonstrate fetal distress during labor

Answer 15

3.) an excessive amount of amniotic fluid is present

• an excess of amniotic fluid is defined as amniotic fluid pockets of >8 cm or an amniotic fluid index of greater than 25. polyhydramnios or hydramnios is associated with neural tube defects, obstructions of the fetal gastrointestinal tract, multiple fetususes, and fetal hydrops.

Question 16

polyhydraminios

Answer 16

Polyhydramnios is a condition during pregnancy where there is an excessive accumulation of amniotic fluid around the fetus. This can occur for various reasons, such as fetal abnormalities, maternal diabetes, or twin pregnancies

Question 17

A nurse is admitting a client who has a diagnosis of preterm labor. the nurse anticipates a prescription by the provider for which of the following medications? (select all that apply)

1.) Methylergonovine
2.) prostaglandin E2
3.) Oxytocin
4.) Magnesium sulfate
5.) indomethacin

Answer 17

correct answers: Indomethacin and Magnesium sulfate

1.) Methylergonovine is incorrect. Methylergonovine promotes uterine contractions to manage postpartum hemorrhage.

2.) Prostaglandin E2 is incorrect. Prostaglandin E2 is used to stimulate cervical ripening and hasten (go faster) the onset of labor.

3.) Oxytocin is incorrect. It’s used to induce and augment (increase) labor

4.) Magnesium sulfate is correct. Magnesium sulfate is a tocolytic and stops contractions in clients experiencing preterm labor

5.) Indomethacin is correct. Indomethacin is used to relax uterine smooth muscles and suppress uterine activity in clients who have a diagnosis of preterm labor.

Question 18

A nurse on the labor and delivery unit is caring for a patient who is having induction of labor with oxytocin administered through a secondary IV line. Uterine contractions occur every 2 min, last 90 sec, and are strong to palpation. the baseline fetal heart rate is 150/min, with uniform decelerations beginning at the peak of the contraction and return to baseline after the contraction is over. which of the following actions should the nurse take?

1.) decrease the rate of infusion of the maintenance IV solution

2.) discontinue the infusion of the IV oxytocin

3.) increase the rate of infusion if the IV oxytocin

4.) Slow the client’s rate of breathing

Answer 18

answer is 2

1.) decrease the rate of infusion of the maintenance IV solution
- Increasing the rate of infusion of the maintenance IV solution is an appropriate action to take when late decelerations occur.

2.) discontinue the infusion of the IV oxytocin
- Discontinue the oxytocin infusion immediately if a client is experiencing late decelerations due to uterine hyperstimulation.

3.) increase the rate of infusion if the IV oxytocin
- increasing the rate of the oxytocin infusion can result in fetal distress due to uterine hyperstimulation.

4.) oxygen should be administered at a rate of8 to qo L/min when late deceleration occur due to uterine hyperstimulation

Question 19

A nurse is caring for a client who is in the first stage of labor, undergoing external fetal monitoring, and receiving IV fluid. The nurse observes variable decelerations in the fetal heart rate on the monitor strip. which of the following is a correct interpretation of this finding?

1.) variable deceleration are due to umbilical cord compression

2.) Variable decelerations are caused by uteroplacental insufficiency.

3.) Variable decelerations are a result of the administration of IV narcotic analgesics

4.) Variable decelerations are related to fetal head compression.

Answer 19

correct answer: 1

1.) variable deceleration are due to umbilical cord compression
- variable decelerations are decreases in the fetal Heart rate with an abrupt onset, Followed by a gradual return to baseline. variable decelerations coincide with umbilical cord compression, which decreases the oxygen supply to the fetus

2.) Variable decelerations are caused by uteroplacental insufficiency.
- uteroplacental insufficiency produces late decelerations, which indicate fetal hypoxemia

3.) Variable decelerations are a result of the administration of IV narcotic analgesics

• the administration of narcotic analgesic can result in decreased variability, which is observed as irregular waves or fluctuations in the baseline fetal heart rate

4.) Variable decelerations are related to fetal head compression.

• Fetal head compression causes early decelerations, which are a gradual decrease in fetal heart rate with a return to baseline during a uterine contraction

Question 20

A nurse on a labor unit is admitting a client who reports painful contractions. the nurse determines that the contractions have a duration of 1 min and a frequency of 3 min. The nurse obtains the following vital signs: fetal heart rate 130/min, maternal heart rate 128/min and maternal blood pressure 92/54 mm Hg. which of the following is the priority action for the nurse to take?

1.) Notify the provider of the findings
2.) position the client with one hip elevated
3.) ask the client of she needs pain medication

Answer 20

answer is 2

1.) Notify the provider of the findings
- calling the provider may be appropriate; however, this is not the priority intervention

2.) position the client with one hip elevated
- Based on Maslow’s hierarchy of needs, the client’s need for an adequate blood pressure to perfuse herself and her fetus is a physiological need that requires immediate intervention. Supine hypotension is a frequent cause of low blood pressure in clients who are pregnant. By turning the client on her side and retaking her blood pressure, the nurse is attempting to correct the low blood pressure and reassess.

3.) ask the client of she needs pain medication
-The client’s comfort should be addressed; however, this is not the priority intervention.

4.) Have the client void
- The client should be encouraged to empty her bladder every 2 hr during labor; however, this is not the priority intervention.

Question 21

A nurse is admitting a client who is at 37 weeks of gestation and has severe gestational hypertension. which of the following actions should the nurse expect to implement? (select all that apply)

1) Administer magnesium sulfate IV
2.) provide a dark, quiet environment.
3.) ensure that calcium gluconate is readily available
4.) assess respiratory rate q4
5.) evaluate neurological status q8

Answer 21

answer: 123

1) Administer magnesium sulfate IV
- Magnesium sulfate IV is given as a tocolytic medication for preterm labor to relax smooth muscle of the uterus and as a treatment for preeclampsia. The underlying pathophysiology of preeclampsia is vasospasm. The nurse should closely monitor the client for signs of magnesium toxicity, such as loss of patellar reflexes, respiratory depression, cardiac arrhythmias, cardiac arrest, urinary retention, and serum magnesium levels higher than 8 mEq/L.

2.) provide a dark, quiet environment.
- A dark, quiet environment helps to decrease CNS stimulation, which minimizes the risk of seizures.

3.) ensure that calcium gluconate is readily available
- Calcium gluconate is the antidote for magnesium sulfate and should be readily available when administering magnesium sulfate. The nurse should be prepared to administer the medication in response to manifestations of magnesium toxicity, such as depressed respirations, oliguria, sudden drop in BP, loss of deep-tendon reflexes, and fetal distress.

4.) assess respiratory rate q4
- The nurse should monitor the client’s respiratory status closely because the client is at risk for respiratory depression. During an infusion of magnesium sulfate, the nurse should monitor the respiratory rate every 5 min and every 15 min during maintenance infusion. Depending on the client’s response to the medication, the provider will prescribe for the vital signs to be monitored every 30 to 60 min thereafter.
5.) evaluate neurological status q8
- The nurse should evaluate the client’s level of consciousness every hour.

Question 22

What is Nagele’s rule?

Answer 22

Expected date of delivery

First day of Last Menstrual period - 3 months+ 7 days

Antepartum Slide 7

Question 22

What hormone is a at home pregnancy test, testing for?
- what do we health teach
- what kind of sign is it

Answer 22

Human Chorionic Gonadotropin (HCG)
- First Am urine to get most accurate results. And that they can be inaccurate due to Improper collection, Medications, Hormone-producing tumors.
- Probable sign

Question 23

At a mother’s last antepartum appointment she was noted with a BP of 148/98 and Proteinuria. What is she at HRF, and what should she be health taught?

Answer 23

-HRF pre-eclampsia
- HT monitoring of CNS changes ( headache, visual symptoms)
- possible meds
- activity restriction

Question 24

The result from increased venous pressure.
Bonus how would you treat it?

Answer 24

• Varicosities
• support hose
• avoid prolonged sitting/standing
• avoid crossing legs.

Question 25

How many extra calories should pregnant woman be eating to support a baby inutero?

Answer 25

• 300/day
• 3rd trimester 450/day

Question 26

Nursing care of placenta previa, and abruptio placenta includes

Answer 26

• obtain HX
• Last vaginal exam/Ultrasound results
• vital signs
• lab tests as ordered
• Monitoring fetal HR
• Assess uterine tone/contractions

Question 27

Uterine distention, oxytocin stimulation, and prostaglandin release are all theories of_______?

Answer 27

Labor onset

Question 28

A soon to be mother’s cervix is softening, shortening, and thinning. What is this called?

Answer 28

effacement

Question 29

In the transition phase when a mother gets to 10cm of dilation what reflex is inhibited?

Answer 29

Ferguson
- baby’s head stretches cervix and feedbacks on pituitary, pituitary secretes oxytocin into blood and travels to uterine muscle, oxytocin stimulates uterine contractions and pushes baby down stretching servix further, the cycle repeats

Question 30

A woman has entered labor and their cervix is fully dilated, when health teaching a mom about her Voluntary Expulsive efforts which option is the best to tell her?

A. Push until you cant anymore then breath!
B. Push for 6-8 seconds, then exhale. 4 times per contraction.
C. Push as long as you can and hold your breath to keep you diaphragm out of the way, then breath and repeat per contraction.

Answer 30

B. Push for 6-8 seconds, then exhale. 4 times per contraction.

Question 31

During your admission assesment the fetal HR is 148 on average over a 10 minute period. What is this considered and what is you nursing intervention if there are any?

Answer 31

Normal, none.

Tachy=>160

Brady=>110

Question 32

Umbilical cord compression, Nuchal/short/prolapsed knot between the pelvis and fetus are examples of_____? What are you interventions if there are any?

Answer 32

• Change maternal position to Lateral
• D/C oxytocin
• O2
• vaginal exam

Question 33

Probable signs of pregnancy are ….?

Answer 33

Observed by examiner, but may be attributed to other causes.

Question 34

Amenorrhea, Nausea/Vomiting, and Fatigue are all _______ signs?

Answer 34

Presumptive

Question 35

Bleeding, infection, and pain are all_______

Answer 35

warning signs to report to the MD

Question 36

A baby is born with anomalies and less than 300 mL of amniotic fluid what is this called?

Answer 36

Oligohydramnios

Question 37

Cravings, Pica, Pagophagia are all examples of_____

Answer 37

Nutritional problems for pregnant woman.

Question 38

A Mom has been determined to have an Ectopic Pregnancy what treatments are used for these?

Answer 38

• Laparotomy
• Laparoscopy
• Methotrexate

Question 39

A mom was given an epidural, her BP read 94/54 prior to the epidural her BP was 138/86. What is your action?

Answer 39

Notify Anesthesiologist/ Nurse