Sim Lab

Question 1

What constitutes the First Stage of Labor?

Answer 1

Initial Assessment

• contact (usually phone): health history, prenatal record, birth plan
• inquire about fetal movement, EDB, bloody show, membrane status, characteristics of contractions, other s/s of labor, GP, previous childbirth experiences
• determine: True vs False LAbor
• do they have support

Question 2

what is EDB?

Answer 2

estimated date of birth

Question 3

what is gravida? parity?

Answer 3

gravida - how many times pregnant

parity - number of greater than 20 weeks (so miscarriages still a part of this)

Question 4

How do you determine between true and false labor?

Answer 4

• examination of cervix
  True: will change cervix
  False: won’t change cervix

Question 5

How do you perform an initial, physical assessment for someone in labor?

Answer 5

General Assessment

• head 2 toe and vitals (pain)
• Leopold’s maneuver
• vaginal examination for baseline
• amniotic membrane status: know when water broke b/c want to have labor at least 24 hours after it breaks
• uterine contraction
• FHR and pattern

Question 6

What is Leopold’s maneuver?

Answer 6

• palpation to try and figure out how the baby is positioned in the belly, look up how to do
  butt: more point
  head: round ball

***most babies are head first

Question 7

what is the top of the uterus called?

Answer 7

the fundus

Question 8

Describe the vaginal examination for baseline during labor

Answer 8

2 fingers with lube through vaginal opening

• need to assess THICKNESS of cervix and how far DILATED it is (2 most important thing)
• also assess how far down the fetus has descended

Question 9

What is the range of dilation when doing a vaginal examination during labor?

Answer 9

0-10 cm

Question 10

How to rate fetal descent?

Answer 10

-3,-2,-1,0,+1,+2,+3 where positive numbers are further down means the labor will be shorter rather than longer

Question 11

how do you check if it’s fluid from amniotic sac and not urine when water breaks?

Answer 11

nitrozine test, vaginal fluid pH is acidic where amniotic fluid is alkaline, use pH strip and see if it turns blue

(sometimes use amnisure, special q tip insert in vagina leave in for a minute and when you take it out put it in a solution and lab tests it)

Question 12

What do you need to assess with uterine contractions?

Answer 12

• frequency: measure start of one contraction to start of next contraction
• intensity: how strong contraction is
• duration
• resting tone

Question 13

What is the FHR and what do you need to to know about it?

Answer 13

fetal heart rate
- either reassuring or non-reassuring: look at contractions and how baby's reacting to them, good = reassuring
normal HR (measured over 10 min): 110-160
- determine variability (Minimal, moderate, marked): marked variability could mean baby's being pressed, mom has moved etc; there will also be periodic baseline changes (bad is minimal variability with late deceleration baseline changes)

Question 14

Do you have to get the woman’s consent to test for HIV?

Answer 14

yes

Question 15

what is a really important genital swab to do on a pregnant woman about to give birth?

Answer 15

for strep B

Question 16

What are the non-pharm methods for pain management

Answer 16

1) Continuous Labor Support: someone in room for them
(biggest one)
2) Hydrotherapy: relaxation/buoyancy, vasodilation
3) Ambulation and position changes (definitely NOT flat on back)
4) Acupuncture
5) Attention Focusing and Imagery (eye contact’s important)
6) Therapeutic Touch/Massage
7) Breathing Techniques

Question 17

What is Nursing Management during Second Stage of Labor

Answer 17

Delivery

• cleanse perineal area/vulva b/c from here on out always leaking fluid
• birth assist includes suctioning of newborn, holding legs, umbilical cord clamping
• immediate care of newborn

Question 18

What entails immediate care of the newborn?

Answer 18

1) Drying/Stimulation
2) Apgar score
3) Identification
4) Hugs band: alarm band
5) measure baby/brith statistics

Question 19

What is the third stage of labor

Answer 19

Placenta discarded

• assess for trauma, episiotomy, lacerations
• usually separates within 10 minutes

Interventions

• instruct to push
• admin oxytocin PRN
• apply ice to perineum if vaginal delivery

Question 20

What’s the Fourth Stage of Labor?

Answer 20

• first 4 hours after delivery

- vital signs, fundus, perineal area, comfort level, lochia, bladder status

Question 21

What is lochia?

Answer 21

description of fluid coming from uterus

Question 22

What is bladder status indicative of after labor?

Answer 22

recovery status of mother

Question 23

Why should a mother not lay on her side? (or is it her back?)

Answer 23

• supine vena cava syndrome

if have to tilt, better to be on left side

Question 24

For whihc babies are phototherapy lights used for?

Answer 24

• babies with elevated bilirubin

Question 25

If you have a baby that’s high or low birthweight, what’s an important second assessment to do?

Answer 25

blood glucose test

Question 26

What’s the respiration rate for the newborn?

Answer 26

30-60 breaths/min

Question 27

what is it called when baby’s trunk and face are pink but extremities are blue?

Answer 27

acrocyanosis

Question 28

How do you perform a PKU?

Answer 28

heel stick, do it on the outer edges