MCN: Stages of Labor

Question 1

2 important events that take place during the first stage of labor

Answer 1

1. cervical dilatation
2. effacement

Question 2

Phases of dilatation:

Answer 2

1. Latent Phase
2. Active
3. Transition

Question 3

Cervical dilatation in latent phase.

Answer 3

0-3 cm

Question 4

Duration of labor in latent phase.

Answer 4

15-30 seconds

Question 5

Heart disease in pregnancy

Answer 5

Gravido-Cardiac

Question 6

Nursing intervention in gravido cardiac

Answer 6

Put weight in mother’s abdomen after delivery.

Question 7

Frequency of labor in the latent phase.

Answer 7

10 minutes

Question 8

Interval of the labor in latent phase.

Answer 8

Every 5-10 minutes

Question 9

Description of labor in latent phase.

Answer 9

Mild regular contractions described as menstrual cramp.

Question 10

Length of latent phase in prima and multi.

Answer 10

Primi- 6 hours
Multi- 4-5 hours

Question 11

Maternal behavior in latent phase:

Answer 11

1. talkative
2. alert
3. less anxious
4. excited and happy
5. in control

Question 12

General nursing care in latent phase:

Answer 12

1. rapport
2. breathing technique
3. provide needed info
4. encourage participation
5. facilitate position of comfort
6. encourage ambulation
7. offer ice chips
8. voiding 1-2 hours

Question 13

Discomfort present in latent phase:

Answer 13

1. backache
2. abdominal cramps

Question 14

These will retard the progress of labor.

Answer 14

Full bladder and full bowel

Question 15

Possible nursing diagnosis in latent phase:

Answer 15

1. anxiety
2. ineffective breathing pattern
3. pain
4. knowledge deficit

Question 16

When do you take BP and FHT in the latent phase?

Answer 16

midway between contraction

Question 17

Abnormal FHT suggests:

Answer 17

Fetal distress

Question 18

Signs and symptoms of fetal distress

Answer 18

a. bradycardia
b. tachycardia
c. meconium stained in non breech
d. fetal trashing

Question 19

NPO (nothing by mouth) is implemented in the latent phase because:

Answer 19

a. digestion delayed during labor
b. full stomach interfere with proper bearing down
c. may vomit and cause aspiration

Question 20

Contraindication of enema

Answer 20

1. vaginal bleeding
2. abnormal fetal presentation/position
3. ruptured BOW
4. crowning
5. premature labor

Question 21

Purposes of doing enema

Answer 21

1. Full bowel hinders the progress of labor
2. expulsion of feces during 2nd stage predispose to infixation
3. full bowel predispose postpartum discomfort
4. allows more room for the descend of the fetal head in the pelvis

Question 22

Nursing care on the dilation phase (latent phase)

Answer 22

1. hospital admission
2. assessment
3. monitoring and evaluation
4. emotional support
5. health teaching

Question 23

What are the things to be monitored and evaluated in the 1st stage of labor.

Answer 23

a. uterine contraction
b. BP
c. FHT

Question 24

Health teachings in the 1st stage of labor