Module 5 Objectives - First Half (Exam 2) 2

Question 1

Signs of placental separation

Answer 1

1. Umbilical cord lengthens
2. Sudden trickle or spurt of blood appears
3. Uterus changes from discoid to globular shape
4. Uterus rises in the abdomen as the placenta settles in the lower uterine segment

Question 2

Total acceptable blood loss during vaginal delivery, recovery, and early puerperium

Answer 2

500mL Vaginal

1000 mL or 1L C-section

Question 3

Therapeutic effect of oxytocic medication administration during the fourth state of labor and delivery

Answer 3

Stimulates the uterus to promote sustained uterine contractions after birth and to reduce the incidence of postpartum hemorrhage

Question 4

Gate Control Theory of pain management during the intrapartal period

Question 5

Nalbuphine (Nubain)

Answer 5

Analgesic, High Alert Medication

Decreases perception of pain

• 10mg IV q 3-4 hours PRN
• Slow push, direct IV
• Maternal drowsing between contractions
• Readily crosses placental border
• Giving this medication during the latent phase may slow labor
• Administer with start of contraction to decrease transfer to placenta
• Potential indication for neonatal Narcan (respiratory depression)

Question 6

Naloxone (Narcan)

Answer 6

Narcotic antagonist

Question 7

Position Changes

Answer 7

First Stage - Standing, Sitting Upright, Sitting, Leaning forward with Support, Semi-sitting, Side-lying, Kneeling, Leaning forward with Support

Second Stage- Hands and Knees, Squatting, Semisitting, Side-Lying chin to chest and pulls on flexed knee

Relieve Sacral Pressure: Standing, Sitting leaning forward with support, Kneeling leaning forward with support, Hands and Knees,

Question 8

Hydrotherapy

Answer 8

1. Use of shower, tub bath, whirlpool bath
2. Water therapy supplements any relaxation technique
3. Buoyancy supports body and equalizes pressure on the body and aids in muscle relazation
4. Fluid shifts reduce edema and excess fluid is excreted by kidneys
5. Infections may be a concern
6. Do not use in latent phase; use it in active phase

Question 9

Relaxation Techniques

Answer 9

1. Reduce bright lights and uncomfortable temperatures
2. Mask noise
3. Reduce anxiety and fear (give choices, info, and refer to patient by name)
4. Progressive Relaxtion (contracts and then releases specific muscle groups until all muscles are relaxed)
5. Neuromuscular dissociation (learn to relax all muscles other than those that are working)
6. Touch relaxation (in response to partner’s touch)
7. Relaxation against pain (partner deliberately causes mild pain and the woman learns to relax despite the pain)
8. Self-Massage
9. Massage by others
10. Counterpressure (sacral pressure)
11. Touch
12. Thermal stimulation (warmth, cold)
13. Acupressure

Question 10

Placed or patterned breathing techniques

Answer 10

1. First-Stage Breathing always has cleansing breath in beginning and end of contraction
2. Slow Paced breathing
   
   1. Slow, deep breathing that causes relaxation
   2. Mouth or nose
   3. Should be used as long as possible during labor as it promotes relaxation and oxygenation
3. Modified Paced Breathing
   
   1. Used when slow breathing is no longer effective
   2. Chest breathing at a faster rate
   3. More shallow than slow-pacedbreathing but oxygen level is the same
   4. Focus is release of tension
4. Patterned-Paced Breathing
   
   1. Pant-Blow
   2. Number of breaths before the blow may remain constant or may change in a pattern
5. Breathing to prevent pushing
   
   1. Blowing prevents closure of the glottis and breath-holding
   2. Blows repeatedly using short puffs when the urge to push is strong

Question 11

Maternal assessmentdata epidural anesthesia

Question 12

Fetal assessment data epidural anesthesia

Question 13

Neonatal assessment data epidural anesthesia

Question 14

Tissue Ischemia

Answer 14

The blood supply to the uterus decreases during contractions, leading to tissue hypoxia and anaerobic metabolism which causes PAIN

Question 15

Cervical Dilation (pain)

Answer 15

Dilation and stretching of the cervix and lower uterus causes PAIN

Question 16

Pressure and pulling on pelvic structures (pain)

Answer 16

Pressure and pulling on pelvic structures and ligaments such as the fallopian tubes, ovaries, bladder, and peritoneum. Visceral pain (referred pain). May feel it in back and legs

Question 17

Distention of the Vagina and Perineum (pain)

Answer 17

Distention of the vagina and perineum occurs with fetal descent, especially during second stage labor and causes PAIN. May describe sensation as burning, tearing, or splitting (somatic pain)