quiz 3 (week 7 & 8)

Question 1

Cultural/Macrosystem Factors/Expectations

Answer 1

Cultural Attitudes
(Gender Role Expectations)
(Values Influencing the Medical System)
(Media Portrayals of Pregnancy & Birth)

Question 2

Family/Microsystem Factors

Answer 2

Caregiver
Family Support & Involvement
Partner Relationship and Partner as Parent
Community Support & Connection
Connection with Baby
Parenting
Breastfeeding
Baby’s Characteristics

Question 3

Individual Factors:

Answer 3

Attitudes and Expectations
Agency & Empowerment
Personal Wellbeing
Spirituality and Meaning
Labour & Delivery Experience
Preparation
Medical Concerns
Pain management
Staying Busy/Active

Question 4

Community Factors

Answer 4

Workplace Polices
Workplace experiences
Labour Environment
Healthcare Access & Nature of Care
(Practices in Maternal and Infant Care)
Preparation
Information
(Educational and Social Services for Perinatal Women)
Medical Interventions
Paternity Leave Policies

Question 5

perinatal mental heatlh influlences

Answer 5

Depression
Anxiety and stress
Trauma (present, or past)
Loss (grief and bereavement)
Body Image
Identity and relationship issues

Question 6

depression

Answer 6

DSM Criteria
Depressed mood or irritable most of the day
Decreased interest or pleasure Significant weight change(5%)or change in appetite
Change in sleep: Insomnia or hypersomnia
Change in activity: Psychomotor agitation or retardation
Fatigue or loss of energy
Guilt/worthlessness
Concentration
Suicidality

Question 7

Dystocia - Abnormal or difficult labour

Answer 7

Vast number of maternal and fetal factors

Problems with powers: hypertonic uterine dysfunction, hypotonic uterine dysfunction, precipitous labour

Problems with the passageway: abnormal pelvis, obstructions in maternal birth canal

Problems with psyche: psychological distress-Emotions such as fear, anxiety, helplessness, being alone, and weariness can lead to psychological stress, indirectly causing dystocia

Problems with passenger: occiput posterior position, breech presentation, multifetal pregnancy, macrosomia and CPD, structural abnormalities

Question 8

shoulder dystocia

Answer 8

Nursing Assessment
History of risk factors
Vital signs - temp
Uterine contractions
Fetal heart rate
Fetal position

Nursing Management
Ensure bladder is empty
Promoting labor progress Mc Robert’s Manoeuvre and suprapubic pressure
Providing physical and emotional comfort
Communication and empowerment

Question 9

umbilical cord prolapse

Answer 9

Pathophysiology: partial or total
occlusion of cord with rapid fetal
deterioration

Nursing Assessment
Continuous assessment of client and fetus

Nursing Management
Prevention-Aware of risk factors
Prompt recognition via FHR, vaginal exam
Measures to relieve compression of the cord
Expedite delivery (C Section)

Question 10

uterine rupture

Answer 10

uterus tears or breaks open
Nursing Assessment
Risk factors, onset marked by sudden fetal bradycardia, fetal parts felt really well, excruciating pain, signs of shock
Nursing Management
Preparation for urgent cesarean birth
Continuous maternal and fetal monitoring

Question 11

amniotic fluid embolism

Answer 11

Obstetric emergency
Sudden onset of hypotension, hypoxia,
coagulopathy due to breakage in barrier between maternal circulation and amniotic fluid

Nursing Assessment:
difficulty in breathing, hypotension, cyanosis, seizures, tachycardia, coagulation failure, DIC, pulmonary edema, uterine atony with subsequent hemorrhage, cardiac arrest
Nursing Management:
supportive measures to maintain oxygenation
hemodynamic function and to correct coagulopathy;
critical care monitoring

Question 12

forceps or vacuum assisted birth

Answer 12

Application of traction to fetal head with risk of tissue trauma to mother and newborn.

Indications:
Failure of presenting part to fully rotate and descend
Non reassuring FHR pattern
Presumed fetal jeopardy, limited sensation or inability to push effectively
Prolonged second stage of labour
Maternal fatigue
Maternal heart disease
Acute pulmonary edema

Question 13

cesarean birth

Answer 13

Classic or low transverse incision- Pfannenstiel
Major surgical procedure and accompanying risks
Nursing Assessment: history and physical examination for maternal and fetal indications

Question 14

Vaginal Birth After Cesarean (VBAC)

Answer 14

Controversy related to risk of uterine rupture and hemorrhage
Contraindications e.g. CPD, ↓2years since last section

**Special areas of focus: **
Consent
Continuous fetal heart surveillance
Readiness for emergency
Nurses as advocates for clients

Question 15

managing a non reassuring FHR pattern

Answer 15

Make sure patient has a wedge (not on back)
Change patient’s position
Adjust FHR transducer/check maternal pulse
Start Oxygen
Reassure the client and family
If oxytocin is in progress, turn it off and speed up the IV to reduce the effects of the oxytocin
Call for help

Question 16

onset of labour factors involved

Answer 16

Labor begins when the forces favoring the continuation of pregnancy are overcome by the forces that want it to end
Hormone Changes
↑ fetal adrenal gland activity - production of glucocorticoids so ↓ progesterone and uterus easily stimulated
↓progesterone and ↑ estrogen
Release of ↑prostaglandins
Mechanical factors
Stretching, pressure, irritation of the uterus and cervix – leads to release of ↑ oxytocin and it is more sensitive to Oxytocin

Question 17

signs preceding labour

Answer 17

Lightening
Urinary frequency
↑ Braxton-Hicks
Weight loss ~3 lbs
Surge of energy “nesting”
Backache
↑ vaginal discharge
Bloody show
Rupture of Membranes
Contractions

Question 18

true labour vs pre/early labour

Answer 18

TRUE
Contractions – ↑ frequency, duration, & intensity
May ↑ with activity
Discomfort- lower back sweeps around , across thighs
Cervix – Effacement and dilation
May have bloody show

PRE-Labor or Early Labor
Contractions: Inconsistent – do not ↑
No Δ with Activity ↓ when resting
Discomfort is in lower abdomen
Cervix – no change
Not usual to have bloody show

Question 19

Critical Factors Affecting Labour and Birth (“5 Ps”)

Answer 19

Passageway (birth canal: bony pelvis & soft tissues)
Passenger (fetus and placenta)
Powers (contractions)
Position (maternal)
Psychological maternal response to labour

Question 20

Five Additional Factors Affecting the Labour Process

Answer 20

Philosophy (low-tech, high-touch)
Partners (support caregivers)
Patience (natural timing)
Patient preparation (childbirth knowledge base)
Pain control (comfort measures)

Question 21

landmarks on baby

Answer 21

Occipital bone (0): Vertex presentation
Chin (mentum [M]): Face presentation
Buttocks (sacrum [S]): Breech

Question 22

powers primary vs seconadry

Answer 22

Primary - Nature of the contractions
Secondary – amniotic fluid and maternal bearing down efforts

Question 23

cardinal movements of labour

Answer 23

Engagement
Descent with Flexion
Internal rotation
Extension-sweeps perineum
Restitution and External rotation
Shoulders rotate
Expulsion of body

Question 24

first stage of labour

Answer 24

First stage (8-12 hrs) longest of 3 stages Start of true labor till complete cervical dilatation-10 cm
Latent phase up to 3 cm
Active phase 3- 8cm
Transition phase 8-10cm

Question 25

second stage of labour

Answer 25

cervix 10 cm dilated to birth of baby

Question 26

third stage of labour

Answer 26

birth of infant to placental expulsion

Question 27

fourth stage of labour

Answer 27

1-4 hours following delivery

Question 28

Pharmacological Agents of Pain Relief.

Answer 28

Sedatives/anti-emetics-
Morphine & Gravol - IM
Local Anesthesia- Lidocaine
Pudendal Block- Lidocaine
Regional anesthesia
Neuraxial analgesia/anesthesia techniques: continuous, intermittent –(Epidural, Spinal)

Question 29

Nursing Management of a client -Epidural

Answer 29

This is a sterile procedure (cap and mask)
Client must have an iv, a doctor’s order
Epidural information sheet - shared with client and client consent must be obtained
Position the client (C) and ask her to remain still
Provide the anesthesiologist with correct medication (bupivacaine and fentanyl) and set up epidural pump
Obtain baseline vitals and position client with a wedge
Perform hourly sensory, motor, respiration and blood pressure checks
Insert a foley catheter
Restrict intake to clear fluids only

Question 30

narcotics in labour

Answer 30

If woman has had narcotics within 4 hours of birth
Keep antidote ready for baby
Naloxone Hydrochloride (Narcan)
.1mg per Kg body weight
i.e. – .3mg IM

Question 31

Oxytocin for 
Induction or Augmentation of labour

Answer 31

Normal reassuring fetal heart tracing is a requirement
Continuous fetal and uterine monitoring
Dose increased every 30 mins in a safe manner
Start with 1 milli unit and a max of 20 milli units per minute unless the obstetrician permits a higher dose
5-6 strong contractions per 10 minutes with a good resting tone is desirable

Question 32

Signs of Placental Separation

Answer 32

The uterus rises upward
The umbilical cord lengthens
A sudden trickle of blood is released from the vaginal opening
The uterus changes its shape to globular