Labor Complications

Question 1

What is the definition of a Hypertonic Labor Pattern?

a) More than 5 contractions in 10 minutes averaged over 30 minutes
b) Contractions of normal duration occurring every 2 to 3 minutes
c) Contractions with a duration of 80 to 90 sections

Answer 1

a

Question 2

What is the definition of a prolapsed cord?
a)The cord is wrapped around the fetal neck
b) The cord is wrapped around the fetal body
c) The cord is in front of the fetal presenting part
d) Any time you see variable decelerations of the fetal monitor

Answer 2

C

Question 3

a)Which Uterine Incision will allow for a Vaginal Delivery After Cesarean (VBAC)
a) Lower Vertical Incision
b) Upper Vertical Incision
c) Upper Transverse Incision
d) Lower Transverse Incision

Answer 3

D

Question 4

a)Who should seen first?
b) Why?
c) Then what to do next?

Answer 4

a) Rosa
Regular contractions
G3 P2
b) Uterine rupture
c) Immediately Call the OB Physician

Question 5

Uterine rupture
a) signs and symptoms
b) nursing action

Answer 5

a)
Pale skin (dec BP)
Diaphoretic (sweating heavily)
Severe lower abdominal pain

Spontaneous tearing
Fetus being expelled into the peritoneal cavity

b)
O2
IV Fluids
Continuous fetal monitoring
Prepare for immediate C-Section

Question 6

Joy at the labor room
The fetal heart monitor
Rate: 145
Variability: moderate
Decelerations: None

What Category is this?

Answer 6

Category 1
-Fetus is stable
-No interventions are required

Joy can come off the monitor and walk around for a short time

Question 7

What are category 2 and 3?

Answer 7

2: Tachycardia or bradycardia
We don’t really know what is going on

3: Inadequate perfusion

Question 8

What can we tell the mom who lost a baby?

Answer 8

Prepare a memory box
Provide privacy but stay close to address any needs
Consider cultural factors
Ask want to hold?
Dress, or take pictures of the baby?

They may worry that their wished are strange or wrong.
Reassure them that there is no right or wrong.

Question 9

Rosa delivered a baby girl via C-section
Now she is at recovery room
What monitoring should we perform?

Answer 9

1 Monitor Bleeding

#2 Monitor Pain

Monitor VS
Monitor return of sensation
Monitor urine output

Question 10

How will the fetal monitoring change once Pitocin is initiated?

Answer 10

Fetal heart monitoring is continuous during Pitocin administration

Question 11

If this pattern, what should we do?

Answer 11

Decrease the Pitocin

Question 12

After Dec Pitocin
Uerine activity levels out at about 4-5 contractions in a 10 minute window.
Is this appropriate?

Answer 12

Yes
because a Hypertonic is more than 5 contractions in 10 minutes

Question 13

a) fetal heart tracing. What do you see?
b) What does this indicate?
c) What do you do?

Answer 13

a) late decelerations.
b) decreased placental perfusion.
c) Intrauterine resuscitation

Question 14

What is intrauterine resuscitation?

Answer 14

Turning off the Pitocin!
Help the patient roll to her side
Give O2 by face mask
IV bolus

Question 15

Now the provider ruptures membranes
placing internal monitors to assess the fetal heart rate better

As soon as the membranes rupture you know that you must what?

Answer 15

Assess the fetal heart rate

Question 16

When the membranes rupture you see green tinged amniotic fluid.
This is most likely caused by what?

Answer 16

Stress on the fetus
meconium

Question 17

Side effects of an epidural on placental perfusion?

Since the fetus is already showing signs of poor perfusion, what would you do to help ensure adequate perfusion?

Answer 17

Dec the patient’s blood pressure which would decrease placental perfusion

IV bolus

Question 18

Now that Joy is completely dilated and begins to push.
She pushes for 2 hours and has made some progress but it has been a long day and Joy is tired. The provider states that he can help her with a vacuum.
What is the action for this?

Answer 18

Ensure that the bladder is empty to prevent injury
Gather all necessary equipment

Question 19

The provider applies the vacuum to guide out the fetal head.
While he is doing that, what is your responsibility as the nurse?

Answer 19

Monitor the fetal heart tracing
Keep track of the time and the events taking place
Support the patient

Question 20

a very large head finally emerges
but shoulders cannot be deliver

Joy was gestational diabetes, so problem is…..
and what do you do?

Answer 20

Macrosomia leading to a Shoulder Dystocia

Perform McRoberts
Keep track of the time
Monitor the fetal heart rate

Question 21

What is McRoberts?

Answer 21

Opens up the pelvic outlet to make more space for the shoulder
McRoberts works and the fetal shoulder is freed after less than a minute.

Question 22

Due to operative vaginal delivery and the macrosomic baby
Joy has suffered a 3rd degree laceration.

3rd degree?

Answer 22

The perineal muscle down through the external anal sphincter.

Question 23

Joy has very sore cervical \
Her baby is at NICU for the time being for glucose monitoring and a potential broken clavicle.

What does this experience put her at risk for in the postpartum period?

Answer 23

Postpartum Hemorrhage
Infection
Problems with bonding
Postpartum depression

Question 24

A new nurse is caring for a client who is in the first stage of labor. The nurse observes the umbilical cord protruding from the vagina. Which of the following interventions would require further teaching?

a) Place the patient in knee- chest position
b) Turn the patient to her left side to improve perfusion
c) Push up on the presenting part with a gloved hand
d) Elevate the patient hips while pulling the emergency light

Answer 24

b

Question 25

The nurse educates the patient on what to expect with operative vaginal delivery. What statement by the patient indicates that teaching was effective? SATA

a) “You will need to ensure that my bladder is empty first.”
b) “The doctor is going to pull the baby out so I can just relax.”
c) “The baby will be out soon so we can take off the monitors.”
d) “I will still need to push down whenever I feel contractions.”

Answer 25

a,d