OB quiz 3

Question 1

Pain and discomfort experienced during labor have two neurologic origins:

Answer 1

Visceral and somatic

Question 2

Visceral

Answer 2

From cervical changes, distention of lower uterine segment, and uterine ischemia.

Question 3

Referred pain

Answer 3

Originated in uterus radiates to abdominal wall, lumbosacral area of back, iliac crest, gluteal area, and down thighs

Question 4

Somatic pain

Answer 4

Intense, sharp, burning, well localized

Question 5

Emotional expressions of suffering often seen

Answer 5

• Increased anxiety
• Crying, groaning, gesturing, writhing
• Cultural expression of pain varies

Question 6

Factors influencing pain response

Answer 6

Physiologic factors, culture, anxiety, previous experience, gate-control theory of pain, comfort, support, environment

Question 7

A Doula

Answer 7

Someone who stays with you during labor, that is trained to support the mom. (Doesn’t mean you don’t have a support person). They are not a nurse/midwife.

Question 8

Breathing techniques

Answer 8

Very controlled, deep breath in through your nose, then slowly out of your mouth like blowing out a candle.

Question 9

Effleurage

Answer 9

A light touch

Question 10

counter pressure

Answer 10

fist/tennis balls pressing into pt’s back.

Question 11

Relaxing and breathing techniques

Answer 11

• Acupressure and acupuncture
• Application of heat and cold
• touch and massage
• Hypnosis
• Biofeedback (doing a great job!)
• Aromatherapy
• Intradermal block

Question 12

Systemic analgesia

Answer 12

• Opioid (narcotic) agonist analgesics
• Opioid agonist-antagonist analgesics
• Opioid antagonists

Question 13

Pudendal nerve block

Answer 13

Take a giant needle, insert into pudendal nerve (which innervates the uterus). Very painful, but was very effective. Pt died before from one because her BP went too low.

Question 14

Disadvantages of a spinal anesthesia

Answer 14

• Marked hypotension
• Impaired placental perfusion
• Ineffective breathing patterns

Question 15

Effects of epidural block on neonate

Answer 15

Little or no lasting effects on the neonate

Question 16

Nitrous oxide for analgesia

Answer 16

Self-administered via face mask

Question 17

General anesthesia

Answer 17

• Used rarely for vaginal births
• Used infrequently for elective cesarean section
• May be necessary if indications necessitate a rapid birth

Question 18

A woman is in labor if…

Answer 18

There is cervical change and regular contractions.

Question 19

Latent phase

Answer 19

Up to 3 cm of dilation

Question 20

Active phase

Answer 20

4-7 cm of dilation

Question 21

Transition

Answer 21

8-10 cm of dilation

Question 22

True Labor

Answer 22

contractions are regular

Question 23

Emergency Medical Treatment and Active Labor Act (EMTALA)

Answer 23

Cannot turn away people in imminent labor or if they’re in active labor. If they are not in labor yet, can send them to another hospital.

Question 24

Fist stage of labor- Assessment

Answer 24

• Determination of true or false labor by:
• Contractions (put monitor on)
• Fetus (Check heart tones, check for accelerations/decelerations, look at variability)
• Cervix (check for ruptured membranes)
• Prenatal data
• Interview
• Psychosocial factors
• Women with a history of sexual abuse
• Stress in labor
• Cultural factors
• Vital signs

Question 25

Assessment of uterine contractions

Answer 25

• Frequency- beginning of one contraction to another
• Intensity-how high it goes on the strip
• Duration-swoop upward to swoop downward its about a minute long
• Resting tone-stright flat line when at rest
• Cervical effacement, dilation,
• Fetal descent: -5 to +5

Question 26

Assessment-Laboratory & Diagnostic tests

Answer 26

• Analysis of urine specimen
• Blood tests
• Assessment of amniotic membranes and fluid.

Question 27

Plan of care and interventions

Answer 27

• General hygiene
• Nutrient and Fluid intake
• Elimination- I & Os, straight cath
• Ambulation & Positioning

Question 28

Second stage of labor

Answer 28

• 50 min for nulliparous

- 30 min for multiparas

Question 29

Second stage of labor-Latent

Answer 29

Relatively calm with passive descent of baby through birth canal

Question 30

Second stage of labor-Descent

Answer 30

Active pushing and urges to bear down

Question 31

Second stage of labor-Transition

Answer 31

Presenting part is on perineum, and bearing-down efforts are most effective from promoting birth

Question 32

Vertex presentation

Answer 32

Birth of head
Birth of shoulders
Birth of body & extremities

Question 33

Third stage of labor

Answer 33

Placental separation and expulsion

Question 34

Placental separation & expulsion

Answer 34

• Firmly contracting fundus
• Change in shape of uterus
• Sudden gush of dark blood from introits
• Apparent lengthening of umbilical cord
• Vaginal fullness
• Provider examines placenta and membranes for intactness

Question 35

Number one goal in 4th stage of labor

Answer 35

Make sure baby is breathing.