Labor and Delivery

Question 1

Amniotic fluid Functions

Answer 1

buoyancy, cushion, thermoregulation, protect umbilical cord, sterile environment

Question 2

What do you chart when the bag of fluid ruptures?

Answer 2

color, time, how it ruptured

Question 3

What does clear amniotic fluid mean?

Answer 3

normal fluids

Question 4

What is a sign of a small amount of meconium in fluid?

Answer 4

yellow/brown, thin liquid

Question 5

What is a sign of a large amount of meconium in fluid?

Answer 5

brown, green, thick, potentially chunky

Question 6

what is meconium?

Answer 6

baby poop, sterile

Question 7

What is the main concern of meconium in the amniotic fluid?

Answer 7

Aspiration during initial breath due to it sitting on the vocal cords

Question 8

What can cause meconium in the amniotic fluid?

Answer 8

Stress in utero

Question 9

What is the difference between SROM and AROM?

Answer 9

SROM (spontaneous rupture of membranes)
AROM (Artificial rupture of membranes)

Question 10

A patient presents with regular contractions that start from the back and wrap to the front. Her contractions get worse when walking and are becoming more frequent. Is she in labor?

Answer 10

Yes
She is in true labor

Question 11

A patient presents with irregular contractions in the lower abdomen and groin. They have not become more intense or more frequent. While walking she states her contractions feel less intense. Is she in labor?

Answer 11

No
she is in False Labor

Question 12

What is the purpose of the Nitrazine test?

Answer 12

pH test to determine if fluid is amniotic.
Blue strip= fluids

Question 13

What is seen through the microscope during a Fern Test?

Answer 13

If the fluids are amniotic, they will crystalize as they dry and form a fern shape.

Question 14

What is the purpose of the Amnisure test?

Answer 14

like a pregnancy test, shows either + or - for amniotic fluid

Question 15

What is a concern with a complete or partial rupture of bag of waters?

Answer 15

Infection
No longer sterile environment

Question 16

What is the first action when a bag of waters ruptures?

Answer 16

Pelvic exam to check for a prolapsed cord

Question 17

What is the main concern if an umbilical cord is prolapsed?

Answer 17

Unable to supply fetus with O2
Could wrap around fetus neck

Question 18

Is a cord prolapse considered a fetal emergency? What is the first step?

Answer 18

Yes, could result in fetal death, must go to OR/
Apply upward pressure with fingers on fetal head to relieve pressure off the cord. do not remove fingers.

Question 19

At what point is a fetal head considered engaged?

Answer 19

at a 0 station
There are no gaps between the head and the pelvis

Question 20

Asynclitism

Answer 20

When a fetal head is tilted to one side during labor

Question 21

What is the nursing diagnosis that is the top priority during cord compression?

Answer 21

Impaired Gas Exchange in the fetus

Question 22

Nursing interventions for impaired gas exchange during cord compression

Answer 22

-monitor fetal HR
- check cord
-bedrest
-reposition
-Give O2 to mom
-increase fluids
-stop Pitocin

Question 23

What is a priority nursing diagnosis for the mother during birth?

Answer 23

Risk for infection

Question 24

Nursing interventions for mom during risk for infection:

Answer 24

-maintain sterile field
-reduce # of times entering the vagina
-temp checks Q2
- hydration
-vitals
-assess fluid colors

Question 25

What is the most common pelvis type in women?

Answer 25

Gynecoid (80%)

Question 26

What are the three factors of pelvis size?

Answer 26

inlet, midplevis, outlet

Question 27

Inlet

Answer 27

upper rim "entrance to tunnel" side to side

Question 28

Outlet

Answer 28

tunnel exit

Question 29

Mid-Pelvis

Answer 29

tunnel itself front to back

Question 30

What is important to maintain during pelvic examinations?

Answer 30

consistency of examiner

Question 31

What is considered crowning?

Answer 31

a +4 station

Question 32

What does a + or - station mean?

Answer 32

- above 0 station + below 0 station any higher than -3 is floating

Question 33

What is fetal attitude?

Answer 33

flexion or extension

Question 34

What is occiput posterior?

Answer 34

"sunny side up" the occipital is facing the back of the mother can out pressure on the coccyx and sacrum

Question 35

What is the optimal position for the occipital during labor?

Answer 35

Occiput anterior

Question 36

Where would you place the fetal monitor when the fetal back is to the right and head up? head down?

Answer 36

up: above the belly button to the right down: below the belly button to the left

Question 37

What are the 5 P's of labor

Answer 37

1. psyche of the mother 2. position of the mother 3. passageway 4. passenger 5. powers

Question 38

Effacement

Answer 38

uterine wall takes up the cervix, thins from 0% to 100%

Question 39

Frank Breech

Answer 39

sacrum presents, hips flexed, legs extended, most common breech

Question 40

Footling Breech

Answer 40

Single or double footling, legs extended, one or both feet presenting

Question 41

Malpresentation

Answer 41

Shoulder transverse lie

Question 42

O: M: Sa: A:

Answer 42

Occiput Mentum Sacrum Acromian Process

Question 43

Leopold's First Maneuver

Answer 43

palpate over uterine fundus, determine fetal part the occupies the fundus

Question 44

Leopold's Second Maneuver

Answer 44

Palpate along sides of uterus, determine where the fetal back is

Question 45

Leopold's Third Maneuver

Answer 45

Palpate the lower portion of the abdomen above the pubis symphysis, determine fetal part entering pelvic inlet

Question 46

Leopold's Fourth Position

Answer 46

palpate with fingers towards patient feet, assess for flexion of fetal head

Question 47

Descent during labor

Answer 47

downward movement of the presenting fetal part in a transverse position measured in relation to the ischial spines

Question 48

Flexion during labor

Answer 48

pressure on the fetal head forces flexion tightly to chest

Question 49

Internal rotation during labor

Answer 49

1.fetal head enters pelvis transverse 2. head rotates from transverse to anterior 3. occiput just below symphysis pubis 4. shoulders are inline with transverse diameter of the pelvic inlet

Question 50

Extension

Answer 50

head is delivered as head pivots off maternal symphysis pubis, face emerges from vagina

Question 51

External Rotation during labor

Answer 51

shoulder rotation as the head externally rotates, the shoulders rotate anterior to posterior -anterior shoulder delivered first

Question 52

Expulsion

Answer 52

remainder of body is quickly delivered

Question 53

Primary Powers

Answer 53

Uterine contractions

Question 54

Secondary powers

Answer 54

Pushing

Question 55

1st Stage of Labor:

Answer 55

begins when labor starts, ends w/ cervix fully dilated

Question 56

2nd Stage of Labor:

Answer 56

begins w/ complete dilation , ends w/ delivery

Question 57

3rd Stage of Labor:

Answer 57

begins w/ fetus, ends w/ delivery of placenta

Question 58

4th Stage of Labor:

Answer 58

begins w/ delivery of placenta, ends w/ complete recovery

Question 59

1st Phase of Labor:

Answer 59

Latent: irregular, most comfortable

Question 60

3rd Phase of Labor:

Answer 60

Transition: worst, 8-10cm dilated, N,V, pressure, worst time to medicate

Question 61

2nd Phase of Labor:

Answer 61

Active: more regular and uncomfortable, best time to medicate

Question 62

Shiny vs. Not side of the placenta:

Answer 62

Shiny: baby side Not: mom side "dirty duncan, shiny shultze"

Question 63

Why shouldn't a mother push before she is fully dilated?

Answer 63

can cause the cervix to swell and prolong labor, can tear cervix

Question 64

How should you instruct a mother to push once fully dilated?

Answer 64

take deep breathe and hold once contraction starts, push while holding the breath for 30 seconds, aim for 3 pushes a contraction. Rest in-between contractions

Question 65

Why is the first 30 minutes after birth the best for feeding?

Answer 65

The baby is awake and will "newborn crawl"