Maternity- Labor And Delivery Process Flashcards
Who does an intrapartum Nurse care for during each labor and delivery
The fetus mother and family unit
What are pre-monetary signs preceding labor
Back ache
weight loss
lightening
contractions
increase vaginal discharge or bloody show
energy burst
G.I. changes
Pre-monetary signs during labor of backache
Constant Low Dalbec a caused by pelvic muscle relaxation
How much weight should you lose during labor
0.5 to 1.5 kg weight loss
1-3 lbs
What is lightening
Fetal head descends to true pelvis about 14 days before labor
feeling like fetus has dropped
causes easier breathing
more pressure on bladder
more pronounced in first pregnancy
What are contractions
Irregular uterine contractions (Braxton Hicks) that eventually progress in strength and regularity
Premonitory signs of labor increase vaginal discharge or bloody show
Explosion of cervical mucus plug may occur
bloody tinged mucous plug from onset of dilation and effacement
What is an energy burst
Premonitory sign of labor
sometimes called nesting response
What G.I. changes can you have in the premonitory signs of labor
Nausea vomiting indigestion
less common
What is the first stage of labor consist of
The Latent stage
active phase
transition phase
What happens in the Latent stage of labor
Last 6 to 4 hours
cervical is dilated 0 to 3 cm
onset of contractions occur
mild to moderate irregular
occur 5 to 30 minutes and last 30 to 45 seconds
some dilation in effacement
woman is talkative and eager
What happens during the active phase of labor
3 to 2 hours
4 to 7 cm dilated
contractions more regular moderate strong
occur 3 to 5 minutes last 40 to 70 seconds rapid dilation in effacement
some fetal dissent
feeling helplessness with anxiety as contractions become stronger
What happens during the transition phase of labor
Last 20 to 40 minutes
dilated 8 to 10 cm
contractions very strong
occur 2 to 3 minutes less 45 to 90 seconds
complete dilation occurs
tired restless irritable states cannot continue
urge to push
most difficult part of the labor
What is the second stage of labor
Full dilation
contractions every 1 to 2 minutes
birth occurs
What happens during the third stage of labor
Delivery of the placenta

What is Schultz’s Presentation
Shiny fetal surface of placenta emerges first
What is Duncan presentation
Dull maternal surface of placenta emerges first
What is the fourth stage of labor
Maternal stabilization of vital signs
Return to homeostasis
What is cervical ripening
Cervix become soft opens and partially effaced
can begin to dilate
What happens during the rupture of membranes
The water breaks can initiate labor or occur any time during labor
Common during transition phase
How long after the rupture of membranes do you go into labor
Within 24 hours after rupture
if greater than 24 hours fetus can lead to infection
What should the nurse do immediately after a rupture of membranes
Assess the FHR for abrupt decelerations
indicative of fetal distress to rule out umbilical cord prolapse
What should the amniotic fluid look like
Watery clear and have a slight yellow tinge
No foul odor
alkaline between 6.5 to 7.5
What are the five “P” that affect in define labor process
Passenger (fetus + placenta)
passageway (birth canal)
powers (contractions)
position (of the woman)
physiological response
What is the passenger of labor
Fetus and placenta
What affects the ability of the fetus to navigate the birth canal
Fetal position
Fetal lie
fetal attitude
fetal presentation
What is the presentation of a fetus
The part of the fetus that is entering the pelvic inlet first 
What is the presentation of a fetus back of the head
occiput
What is the fetal position chin
Mentum
What is the fetal Presentation of the shoulder
Scapula
What is the fetus presentation of breech
Sacrum or feet
What is the fetus presentation for cephalic
Head down
What is the fetal lie
The relationship of maternal spine to the fetus spine
What is a transverse lie
Fetus spine is horizontal informs a right angle to the maternal spine
will not accommodate vaginal birth require a cesarean it fetus does not rotate
What is a Parallel or longitudinal lie
Fetal spine is parallel to maternal spine either cephalic or breech presentation
Breech presentation can require what
A cesarean birth
What is the fetal attitude
Relationship of fetal body parts to one another
What is Fetal flexion
Chin flex into chest extremities flexed into torso
What is fetal extension
Chin extended away from chest extremities extended
Fetopelvic or fetal position is what
The relationship of the presenting part of the fetus in reference to its directional position as it relates to one of the four maternal pelvic quadrants
What is the preferred fetal position
occiput
What does the first letter of reference in fetal position
The side of the maternal pelvis
right or left
What does the second letter reference in fetal position
The presenting part of the fetus
occiput sacrum mentum or scapula
What does the third letter refrence in fetal position
The part of the maternal pelvis
anterior posterior or transverse
What is station
Measurement of fetal descent in CM with station 0 being the level of imaginary line of the ischial spine
What does a negative station mean
superior (above) to the ischial of spine
What does a postive station mean
Inferior (below) the ischial spine
What is the passageway of birth
The birth canal
size and shape must be adequate to allow the fetus to pass through
Cervix must dilate and efface in response to contractions
What is powers of birth
Uterine contractions which caused effacement and dilation
What is effacement
Shortening and thinning of the cervix
What is dilation
Enlargement or widening of the cervical opening and Canal
What is position of birth
Client should engage in frequent position changes during birth
whatever the maternal preference is
What helps aid in the fetal descent
Gravity
What is the physiological response of birth
Maternal stress tension and anxiety can produce physiological changes and impair progress of labor
What is a Leopold maneuver
Abdominal palpation of the fetal presenting part lie attitude descent and probable location where the fetal heart tones can be best auscultated
What is a Toko transducer
External electronic monitoring that is applied to the maternal abdomen over the fundus 
What does external electronic monitor
(Tocotransducer) 
Measures uterine activity
displays uterine contraction patterns
What is an external fetal monitor 
Transducer applied to the abdomen to assess FHR patterns during labor and birth
When do you obtain Group B streptococcus culture
Screen at 35 to 37 weeks
if results not available obtain culture at birth 
What does a postive Group B streptococcus culture mean
Start IV prophylactic antibiotic
What can a urinalysis in labor determine
Dehydration
ketonuria
proteinuria
glycosuria (implies gestational diabetes)
UTI (common in diabetes mellitus)
How often should you assess maternal vital signs
Check maternal temperature every two hours if membranes are ruptured
How do you assess uterine labor contractions
Placing a hand over the fundus to assess contraction frequency duration and intensity
What is frequency of a contraction
From the beginning of one contraction to the beginning of the next
What is duration of a contraction
Time between the beginning of a contraction to the end of the same contraction
What is intensity of a contraction
Strength of contraction at its peak described as mild moderate or strong
What is the resting tone of a uterine contraction
Tone of the uterine muscle in between contractions
What kind of contraction can reduce blood flow to the placenta resulting in fetal hypoxia and decreased FHR
 contraction duration (greater than 90 seconds ) or two frequent contractions (more than five and 10 minute periods) without suefficient time for uterine relaxation (less than 30 seconds)
What do you look for in a vaginal examination during labor
Cervical dilation and effacement
decent of fetus the birth canal
fetal position presenting part + lie membranes are intact or ruptured
What is the mechanism of labor in vertex presentation
The adaptations of the fetus makes as it progresses through the birth canal
What is engagement of labor
Occurs when the presenting part passes the pelvic inlet at the level of isheal spine station 0
What is the descent of labor
The process of the presenting part through the pelvis
What is flexion during labor
The fetal head meets resistance of the cervix pelvic wall
the head flexes bringing the chin close to the chest 
What is internal rotation of labor
The fetal occiput Ideally rotates to a lateral anterior position as it progresses from the ischeal spine to the lower pelvis
What is extension of labor
The fetus passes under the symphysis pubis where the head is deflected anteriorly and born
What is external rotation of labor
After the head is born it rotates to the position it occupied as it entered the pelvic inlet
What is birth by expulsion
After birth of head and shoulders the trunk of the neonate is born
What is the order that labor proceeds in
Engagement
descent
flexion
internal rotation
extension
external rotation
Birth by expulsion
How many times do we assess blood pressure and pulse after birth
Obtain blood pressure and pulse every 15 minutes after the first two hours of birth
When should be assessed temperature after birth
Temperature should be assessed every four hours for the first eight hours after birth and at least every eight hours
When should you assess the fundus in Lochia after birth
Every 15 minutes for the first hour
How can you prevent hemorrhage after birth
Massage the uterine fundus
Characteristics of true labor
Contractions begin irregularly but become Regular and frequent stronger less longer and are more frequent walking can increase contraction intensity progression in dilation in effacement
Characteristics of false labor
Painless irregular contractions decrease in frequency and intensity with walking stop with sleep or emptying bladder
no significant change in dilation or effacement
A client calls the providers office and reports having contractions for two hours that increase with activity and did not decrease with rest and hydration the client denies leaking of vaginal fluid but did notice blood when wiping after voiding which of the following manifestations of the client experiencing
Braxton Hicks contractions
rupture of membranes
fetal decent
true contractions
True contractions
A nurse is caring for a client having contractions every eight minutes that are 30 to 40 seconds in duration the client cervix is 2 cm dilated 50% effaced in the fetus is at -2 station with an FHR around 140 which of the following stages and phases of labor is this client experiencing
First stage latent phase
first stage active face
first stage transition phase
2nd stage of labor
First stage latent phase 
A nurse is caring for a client who is 40 weeks of gestation and reports having a large gush of fluid from the vagina while walking from the bathroom which of the following action should the nurse take first
Examine the amniotic fluid for meconium
check the FHR
dry the client and make them comfortable
apply a tocotransducer
Check the FHR
A nurse is completing an admission assessment for a client who is 39 weeks of gestation and reports fluid leaking from the vagina for two days which of the following conditions is the client at risk for developing
Cord prolapse
infection
postpartum hemorrhage
Hydramnios
Infection
A nurse is caring for a client who is an active labor irritable and reports urge to have a bowel movement the client vomits and states I’ve had enough I can’t do this anymore which of the following stages of labor is the client experiencing
Second stage
fourth stage
transition phase
latent phase
Transition phase
Is pain subjective or objective
Subjective Everyone’s is unique
What is the first consideration when planning pain management
Safety of the mother and fetus
What kind of pain happens in the first stage of labor
Internal visceral pain felt in back and leg
Caused by dilation effacement and contractions
What kind of pain occurs in the second stage of labor
Pain that occurs with fetal dissent and
expulsion
feels like pulling burning splitting and tearing
What kind of pain occurs in the third stage of labor
Pain with expulsion of placenta similar to first stage
caused by contractions and pulling
What causes pain in the fourth stage of labor
Caused by dissension in stretching of the vagina feels like splitting burning and tearing
What should the nurse look for that can affect the clients pain management
Cultural beliefs and behaviors
What slows the progression of labor
Fear tension and anxiety
What are indications of pain
Crying moaning screaming
increase blood pressure
tachycardia
hyperventilation
vomiting
What is the Gate- Control Theory of pain?
Sensory nerve pathways that pain sensations use to travel to the brain will allow only a limited number of sensations to travel at any given time
By sending alternate signals through these pathways the pain signals can be blocked
What do you do if your patient is hyper ventilating
Have client breathe into a paper bag or cup hands
What are sensory stimulation strategies for nonpharmacological pain relief
Aromatherapy
breathing
music
What are cutaneous stimulation strategies for nonpharmacological pain techniques
Back massage
walking
application of heat or cold
shower
acupuncture
What is effleurage
Play gentle circular stroking of the clients abdomen with fingertips and rhythm with breathing during contractions
What is sacral counterpressure
Consistent pressure is applied by the support person using the heel of the hand or fest against the client sacral area to counteract pain in the lower back
 Are sedatives used for pain management
Not typically because cause respiratory depression
should not be administered if birth is anticipated within 12 hours
What Opioid is used as a pain relief that does not cause significant respiratory depression in mother or fetus
butorphanol and nalbuphine
What should be readily available to reverse opioid induced respiratory depression
 naloxone
What does metoclopramide do
Control nausea and anxiety
does not relieve pain
What is a pudendal block 
Local anesthetic that is administered transvaginal
has no maternal or fetal systematic affects
provides anesthesia to the perineum vulva and rectum 
When do you give a pudenal block
During the late second stage of labor 10 to 20 minutes before delivery
What is an epidural block
Illuminate pain from the Level Of the umbilicus to the thighs relieving the discomfort of uterine contractions
does not remove pressure sensation
When do you give an epidural block
In active labor and dilated to at least 4 cm
Nursing actions for an epidural block
Please Patient into sitting or side lying position 
assessed for orthostatic hypotension
What is a spinal block
Local anesthetic that Eliminates all sensations from the level of the nipples to the feet
common in cesarean births
When do you give a spinal block
Before cesarean birth
What is an adverse reaction of a spinal block
 potential headache from leakage of cerebral spinal fluid
 important nursing action for spinal block
Assessed maternal vital signs every 10 minutes
When is general anesthesia used in labor
Rarely used only if there’s a delivery complication or emergency patient
has nothing by mouth maintain airway
check for decreased uterine in town
A nurse is caring for a client who is 40 weeks of gestation and is experiencing contractions every 3 to 5 minutes and becoming stronger a vaginal exam reveals the client service is 3 cm dilated 80% effaced and -1 station the client asked for pain medication which of the following action should the nurse take (select)
Encourage use of pattern breathing techniques
insert indwelling urinary catheter administer opioid analgesics medication suggest application of cold
provide ice chips
Encourage use of pattern breathing techniques
administer opioid analgesic medication
suggest application of cold
A nurse is caring for a client who is an active labor the client reports lower back pain the nurse suspects that this pain is related to a persistent occiput Posterior fetal position which of the following Nonpharmacological nursing intervention should the nurse recommend to the client
Abdominal effeurage
Sacral counter pressure
Showering if not contraindicated
Back rub and massage

Sacral counter pressure
A nurse is caring for a client following administration of an epidural block and is preparing to administer an IV fluid bolus the clients partner asked about the purpose of the IV fluids which of the following statements should the nurse make
It is needed to promote increase urine output
it is needed to counteract respiratory depression
it is needed to counteract hypotension 
it is needed to prevent oligohydramnios 
It is needed to counteract hypotension
A nurse is caring for a client who is in the second stage of labor the clients labor has been progressing and a vaginal delivery is expected in 20 minutes the provider is preparing to administer lidocaine for pain relief and perform an episiotomy The nurse should know that which of the following types of regional anesthetic black should be administered
Pudendal
Epidural
Spinal
Paracervixal 
Pudendal
A nurse is caring for a client who is using pattern breathing during labor of the client reports numbness and tingling of the fingers which of the following action should the nurse take
Administer oxygen via nasal cannula a 2 L per minute
apply a warm blanket
assist the client to side lying position place in oxygen mask over the clients nose and mouth
Place an oxygen mask over the clients nose and mouth
How frequent are contractions in the Latent phase 
5 to 30 minutes
How long do contractions last in the latent phase 
30 to 45 seconds
How dilated are you in the latent phase 
0-3 cm
How frequent are your contractions in the active face
3 to 5 minutes
How long do your contractions last in the active face
40 to 70 seconds
How dilated are you in the active phase
4 to 7 cm
How frequent are contractions in the transition phase
2 to 3 minutes
How long do contractions last in the transition phase
45 to 90 seconds
How dilated are you in the transition phase
Completely dilated
When do you avoid vaginal examination
In the presence of vaginal bleeding or until placenta previa or abruptio are ruled out
What is the most important indicator of the progress of labor
Cervical dilation
What is crowning
Appearance of presenting part, fetal head at the perineum
If there is a suspected rupture of membranes what do you first assess
FHR
Why do you perform a bladder palpation on a regular basis
To prevent bladder distention which can impede Fido descent through the birth canal
How often should you encourage voiding
During the active phase
Every two hours 
What does it mean when the client expresses they need to have a bowel movement
This sensation is a finding of complete dilation and fetal dissent 
prepare the client for birth
How often should you monitor vital signs in the latent phase 
Every 30 to 60 minutes
How often should you monitor vital signs in the active and transitional
Every 15 to 30 minutes
How often should you monitor contractions in The transition phase
Every 10 to 15 min
What is first-degree Peroneal lacerations
Laceration extends through the skin of the perineum and does not involve the muscle
What is second-degree lacerations
Laceration extends through the skin in the muscle into the perineum but not the anal sphincter
What is third-degree perineum Laceration
Laceration extends through the skin muscle perineum an external anal sphincter to the muscle
What is fourth-degree peroneal laceration
Laceration extends through the skin muscle in anal sphincter and anterior rectal wall
How often should you check vitalsigns in the second stage of labor
Every 5 to 30 minutes
How often should you check the fetal heart rate in the second stage of labor
Every 5 to 15 minutes
How often should you check vital signs in the third stage of labor
Every 15 minutes
What are the clinical findings in the third stage of labor
Placenta separated from the uterus indicated by
fundus firming
umbilical cord appears to lengthen placenta descends
 why do you administer oxytocics In the third stage of labor
Simulate the uterus to contract and those preventing hemorrhage
When do you check vital signs in the fourth stage of labor
Every 15 minutes for the first two hours
G A nurse is caring for a client and partner during the second stage of labor the client‘s partner asks the nurse to explain how to know when crowning occurs which of the following responses should the nurse make
The placenta will protrude from the vagina
your partner will report a decrease in the intensity of contractions
the vagina area will bulge in your babies head will appear
your partner will report less rectal pressure
The vagina area will bulge as the babies head appears
The nurse is caring for a client who is in the transition phase of labor and reports that they need to have a bowel movement with the peak of contractions which of the following action should the nurse make
Assist the client to the bathroom
prepare for in pending delivery
prepare to remove a fecal impaction encourage the client to take deep cleansing breaths
Prepare For an impending delivery
A nurse is caring for a client in the third stage of labor which of the following findings indicates placenta separation (select)
Lengthening of the umbilical cord
swift gush of clear amniotic fluid
softening of the lower uterine segment appearance of dark blood from the vagina
fundus firm upon palpation
Lengthening of the umbilical cord appearance of dark blood from the vagina
fundus firm upon palpation
A nurse is planning care for a newly admitted client who reports I am in labor and I have been having virginal bleeding for two weeks which of the following should the nurse include in the plan of care
Inspect the introutis For a prolapsed cord
perform a test to identify the ferning pattern
monitor station of presenting part
defer vaginal examination
Defer Vaginal examination’s
A nurse is caring for a client who is in the first stage of labor and is encouraging the client to avoid every two hours which of the following statements should the nurse make
A full bladder increases the risk for fetal trauma
a full bladder increases the risk for bladder infections
a distended bladder will traumatized by the frequent pelvic exams
a distended bladder reduce his pelvic space needed for birth
Distended bladder reduces pelvic space needed for birth
What is external cephalic version
Hands on procedure to externally manipulate the fetus into cephalic lie
Performed at 37 to 38 weeks
high risk of placenta abruption, umbilical cord compression, emergency c- section
What is the indication for external cephalic version
Why does it happen
A male position feet is in a breach or transverse position in late gestation
When do you give Rho{D}
28 weeks gestation
What should you monitor and external cephalic version
Monitor FHR patterns for bradycardia decelerations or decrease fetal activity
What is Bishop score
A score use to determine maternal readiness for labor by evaluating whether the cervix is favorable 
How do you determine Bishop score
You rate
cervical dilation
cervical effacement
cervical consistency
cervical position
station Of presenting part
When do you use Bishop score
In any condition which augmentation or induction of labor is indicated
What is a good Bishop score
A score of eight or more is indicative of successful induction
client must be 39 weeks
What is cervical ripening
Increases cervical readiness for labor through Promotion of cervical softening dilation and effacement
When do you use Cervical ripening
In any condition which argumentation or induction of labor is indicated
Failure of the cervix dilate and efface failure of labor to progress
Should you avoid before or after cervical Ripening
Void prior to the procedure
If client becomes tachysystole What medication do you administer
Subcutaneous terbutaline 
If fetal goes into fetal distress during surgical ripening what do you do
Position the client on left side
What is induction of labor
Deliberate initiation of uterine contractions to stimulate labor before spontaneous onset to bring about birth by chemical or mechanical means
When do you induce labor
At least 39 weeks
dystocia (prolonged difficult labor) due to inadequate uterine contractions
Prolong ruptured membranes
Should you void prior to induction of labor
Yes void prior to the procedure
Where does the fetus have to be engaged prior to the administration of oxytocin in the induction of labor
Fetus has to be engaged in the birth canal at minimum of station 0
 What is the desired contraction pattern in induction of labor
Contraction frequency of 2 to 3 minutes contraction duration of 80 to 90 seconds contraction intensity of 40 to 90
What should you do if the contraction pattern is greater than desired outcome in induction of labor (tachsytole)
Discontinue oxytocin
What is argumentation of labor
Simulation of hypotonic contractions once lever has spontaneously begun but progress is inadequate
What is amniotomy 
Artificial rupture of amnionic membranes by provider using hook clamp or other sharp instruments
How soon after an amniotomy should labor begin
12 hours
What is the client at risk for after receiving an amniotomy
Cord prolapse or infection
Why would you give an amniotomy
Labor progression is too slow
What must Happen before and amniotomy
Presenting part of the fetus is engaged to prevent cord prolapse
What should you monitor right after an amniotomy
Fetal heart rate
After in amniotomy what vital sign is important
Temperature check every two hours
What is an amnioinfusion
Normal Celine or lactated ringers is instilled into the Amniotic cavity through transcervical catheter
Used to supplement the amount of amniotic fluid
What does an amnio infusion reduce
The severity of variable to celebration caused by a cord compression
Why would you give an amnioinfusion
Oligohydramnios (scant amount or absence of amniotic fluid)
Fetal cord compression 
What must happen before you can give an amnioinfusion
Membranes must have rupture to perform
What is a vacuum assisted delivery
Using a couple like suction device that is attached to the fetal head traction is applied during contractions to assist in the descent in birds of the head after the vacuum is released and removed proceeding delivery of the fetal body
Why would you need a vacuum assisted delivery
Maternal exhaustion and ineffective pushing efforts fetal distress during second stage
generally not used to assess birth before 34 weeks
What is Caput
succedaneum
Swelling of the scalp in a newborn that usually disappears within 3 to 5 days caused by vacuum assisted delivery
What is forceps assisted birth
Using an instrument with two curve spoon like blades to assist the delivery of a fetal head
traction is applied during contractions
Why would you use forceps assisted birth
Prolong second stage of labor need to shorten duration fetal distress
Abnormal presentation
Breech position require delivery of the head
 Must what must happen before forceps assistant birth
Bladder empty
fetuses engage
membranes have ruptured
Fetal heart rate decreases during forceps assisted birth what do you do
Forceps are removed and reapply
What is a Episiotomy
Incision me to the perineum to enlarge the vaginal opening to facilitate birth and minimize soft tissue damage
What is the median midline episiotomy
Laceration from vaginal outlet toward rectum most commonly use
easily repaired
What is the medial lateral episiotomy
Laceration extends from vaginal outlet posterolateral either to the left or the right
Blood loss is greater
repair more difficult
What is a cesarean birth
Delivery of the fetus through the transabdominal incision of the uterus to preserve the life or health of client
when there is evidence of complications
What should you encourage after a C-section
Splitting of the incision with pillows and ambulation
What can tender uterus and foul smelling lochia indicate
Endometriosis
What is a vaginal birth after cesarean
Client delivers vaginally after having a previous cesarean birth
Why would you have a vaginal birth after cesarean
If a client has cesarean due to dysfunctional labor fridge presentation or abnormal FHR which are all considered non-recurring events
A nurse is caring for a client who is 42 weeks of gestation and is having an ultrasound for which of the following conditions should the nurse plan for an amnioinfusion (select)
oligohydramnios
Hydramnios
Fetal cord compression
hydration
fetal immaturity
Oligohydramnios
Fetal cord compression
A nurse is caring for a client who has been in labor for 12 hours with intact membranes the nurse performs a vaginal examination to ensure which of the following prior to the performance of the Amniotomy
Fetal engagement
fetal lie
fetal attitude
fetal position
Fetal engagement
A nurse is caring for a client who has had no prenatal care is Rh negative and will undergo an external version at 38 weeks of gestation which of the following medication should the nurse plan to administer prior to the version?
Prostaglandin gel
Magnesium sulfate
Rho(D)
Oxytocin
Rho(D)
A nurse is caring for a client who is receiving oxytocin for indication of labor and has interuterine pressure catheter placed to monitor uterine contractions for which of the following contraction pattern should the nurse discontinue infusion of oxytocin
Frequency of every two minutes
duration of 90 to 120 seconds
intensity of 60 to 90
resting tone of 15
Duration of 90 to 120
A nurse educator in labor and delivery unit is reviewing the use of chemical agents to promote cervical ripening with a group of newly licensed nurses which of the following statements by the nurse indicates understanding of the teaching
They are tablets administered vaginally
they act by absorbing fluid from tissue
they promote dilation of the os
they include amniotomy
They are tablets administered vaginally
What is a prolapse umbilical cord
Occurs when the umbilical cord is displaced preceding the presenting part of the fetus or protruding through the cervix
What are some risk factors of a prolapsed umbilical cord
Rupture of amniotic membranes
abnormal fetal presentation
transverse lie
unusually long umbilical cord
small gestation
What would you find if a client had prolapse umbilical cord
Client reports they’re feeling something coming through the vagina
What do you do if a client has a prolapsed umbilical cord
Call for assistance immediately
do not leave
insert two fingers into the vagina and apply pressure to the cord reposition client to side
What can a prolapse umbilical cord mean for the fetus
Prolonged deceleration severe hypoxia
If a patient has a prolapse umbilical cord what should you prepare for
Immediate vaginal birth if cervix is fully dilated or C-section
What is meconium stained amniotic fluid
 poop in the amniotic fluid
What would you find if your patient has meconium stained amniotic fluid
Green thick amniotic fluid
Often presented in breech 
 What should you do during labor for a fetus inmeconium stand amniotic fluid
Have neonate and recitation team ready suction mouth and nose using bulb syringe if respiratory efforts are strong
if weak suction
What is fetal distress
FHR below 110 or above 160
What position should you put the client and if there is fetal distress
Left side lying position
What is dystocia
Dysfunctional labor it is difficult or abnormal labor related to the five p
What is hypotonic uterine contractions
Weak
inefficient or
completely absent
What is hypertonic uterine contractions
Excessively frequent
uncoordinated
strong intensity with inadequate uterine relaxation
What does a hypotonic uterus look like
Easily indentable at peak of contractions
What does a hypertonic uterus look like
Cannot be indented even between contractions
What position of the fetus prolongs labor
Occiput posterior
What is precipitous labor 
Labor that last three hours or less from the onset of contractions to the time of delivery
What do you do if the court is around the fetal neck during labor
Attempt to gently slip it over the head
What is uterine rupture
Complete rupture involves the uterine wall peritoneal cavity and broad ligament internal bleeding present
Life threatening
 what will a patient feel when they’re uterus ruptured
Ripping or tearing sharp pain uterine tenderness
What are they at risk for in uterine rupture
Hypovolemic shock
what is anaphylactoid syndrome of pregnancy
Amniotic fluid embolism
Occurs when there is a rupture in the amniotic sac accompanied by high intrauterine pressure that causes infiltration of the amniotic fluid into maternal circulation
What kind of anaphylactoid syndrome deadly
Meconium stained Amniotic fluid circulating in the blood
 patient needs what if anaphylactoid syndrome occurs
Emergency C-section
A nurse is caring for a client who is in labor and experiencing incomplete uterine relaxation between hypertonic contractions the nurse should identify this contraction pattern increases the risk of which of the following complications
Prolong labor
reduced fetal oxygen supply
delayed cervical dilation
increase maternal and stress
Reduced fetal oxygen supply
A nurse is caring for a client who is an active labor and reports severe back pain during assessment the fetus is noted to be in the occiput posterior position which of the following maternal position should the nurse suggest to the client to Facilitate normal labor progress 
Hands and knees
lithotomy
Trendelenburg
supine with a roll towel under one hip
Hands and knees
A nurse is caring for a client who is in labor with the use of Leopold maneuvers it is noted that the fetus is in breech position for which of the following possible complications should the nurse observe
precipitous labor
Premature rupture of membranes postmaturity syndrome
prolapsed umbilical cord
Prolapsed umbilical cord
A nurse is caring for a client who is 42 weeks of gestation and an active labor which of the following findings is the fetus at risk for developing
Intrauterine growth restriction
Hyperglycemia
meconium aspiration
polyhydranios
Meconium aspiration
A nurse is caring for a client and active labor when last examined two hours ago the clients cervix was 3 cm dilated 100% effaced membranes intact and the fetus was added negative to station the client suddenly states my water broke the motto revealed an FHR of 80 to 85 per minute the nurse performs a vaginal examination noticing clear fluid in a pushing loop of umbilical cord in the clients vagina which of the following action should the nurse perform first
Play slickline and Trendelenburg position apply pressure to the presenting part with the fingers
Administer oxygen at 10 L per minute via facemask
initiate IV fluid
Apply pressure to the presenting part with the fingers
