Nursing Care L&D

Question 1

What are the 4 processes of Labor

Answer 1

Powers (contractions)
Passenger (fetus)
Passage (pelvis)
Maternal Psyche

Question 2

2 types of powers

Answer 2

primary (provided by uterine muscle)

secondary (Maternal bearing down efforts. Ferguson’s reflex)

Question 3

What is Ferguson’s reflex?

Answer 3

Spontaneous urge to push when presenting part reaches the pelvic floor

Question 4

3 Characteristics of Contractions

Answer 4

Coordinated
Involuntary
Intermittent

Question 5

Powers consists of

Answer 5

dilation (0-10) - widening/enlargement of cervix conclusive sign that contractions are effective
effacement (0-100%) - shortening/thinning of cervix

Question 6

Fetal Head (Passenger) composed of…

Answer 6

Sutures(Frontal/Coronal/Sagittal/Lambdoid)
Bones (Frontal/Parietal/Occipital)
Fontanels (anterior/posterior)

Question 7

Fetal Head Diameters

Answer 7

Biparital - 9.5cm

Suboccipitobregmatic - 9.5cm (anterior/posterior)

Question 8

Components (Passenger)

Answer 8

Fetal Lie (longitudinal or transverse - relationship of fetus's long axis to that of its mother)
Attitude (relationship of fetal body parts to each other - NORM=flexion "c" shape)
Presentation (body part entering pelvis 1st - cephalic=vertex, breech=frank,complete,footling, shoulder)

Question 9

Position (Passenger)

Answer 9

Reference point of fetal presenting part in the pelvis
Cephalic - occiput or vertex (ROA=right occiput anterior)
Breech presentation - sacrum (LSP=left sacrum posterior)
Shoulder presentation - scapula
OA - direct occiput anterior, neither right or left

Question 10

Pelvis (Passage)

Answer 10

True - Inlet, Mid-pelvis, Outlet

False - No impact on birthing process

Question 11

True Pelvis - Inlet

Answer 11

Anterior/Posterior Diameters
Diagonal Conjugate (>=11.5cm)
Obstetric Conjugate (1.5-2cm< diagonal)
True Conjugate (1.5cm< diagonal)

Question 12

True Pelvis - Mid-pelvis

Answer 12

Level of Ischial Spine

Transverse diameter - 10.5cm

Question 13

True Pelvis - Outlet

Answer 13

Outlet - Level of the ischial tuberosities

Transverse diameter - >=8cm

Question 14

Pelvic Shapes - Passage

Answer 14

Gynecoid - BEST
Android - Male type pelvis - heart shaped
Anthropoid
Platypelloid

Question 15

Maternal Psyche

Answer 15

Past OB hx
Cultural Values
Current pregnancy experience
Psychological responses

Question 16

Theories of Labor Onset

Answer 16

Estrogen/Progesterone - levels regulate chg in oxytocin, progesterone decreases towards end of preg.
Oxytocin - uterus becomes more sensitive to oxy at term, rises during 2nd stage of labor
Prostoglandins - increase in prostoglandins in amniotic fluid & fetal membranes
Fetal Endocrine - with maturation, fetal adrenals secrete corticosteroids & fetal oxytocin, trigger mechanisms ldg to labor

Question 17

Factors affecting Labor

Answer 17

Maternal position
Current pregnancy experience
Past pregnancy experience
Culture

Question 18

Pain Mgmt (pharmacological)

Answer 18

IV Meds:
Morphine
Nubain
Stadol
Phenergan
*Fetus is also treated*

Question 19

Pain is both visceral and musculoskeletal T or F

Answer 19

True

Question 20

3 Types of Anesthesia

Answer 20

Regional - epidural, sub-arachnoid block * risk=maternal hypo-tension*
Local - perineal local block (for episiotomy)/pudendal block (forceps delivery) does nothing to relieve labor pain
General - emergency c-sections - chemically induced coma risk for aspiration/bld=maternal - respirator distress in newborn