Test 4

Question 1

1. Know what the bishop score is(slide 4)

Answer 1

• Cervical consistency
• Position
• Dilation
• Effacement
• Fetal station

Question 2

2. Oxytocin nursing considerations(Slide 4)

Answer 2

Complications associated with the use of oxytocin include:

• Higher risk for cesarean delivery
• Hyper stimulation of the uterus with possible; uterine rupture
• Water retention
• Fetal distress

Question 3

3. Gate control theory(slide 14)

Answer 3

Nonpharmacologic Intervention (Relaxation technique):

• Massage
- Deep breathing
- Keep their mind distracted

Question 4

4. Decelerations nursing considerations and causes (NTK during class)

FH normal range, Early, Late and Variable

Answer 4

• FH: 110-160

• Early: GOOD
o Baby head compressed in pelvis
o Mirror baby FH with contractions

• Late: NOT GOOD
o Uteroplacental Insufficiency
o Not mirror
o Heart rate decrease after contraction

• Variable: NOT GOOD
o Cord compression
o All over the place

Question 5

5. Reasons for episiotomies (Slide 21)

Answer 5

• Shoulder dystocia: (head delivers by shoulder stuck this is an emergency)

Question 6

6. Nursing considerations during the second stage of labor and concerns (slide 20)

Answer 6

• Nurse should monitor length of contractions greater than 90 second poses

• Concerns: increase risk of rupture
- bloody shows, early deceleration and pelvic pressure

Question 7

7. Epidural anesthesia nursing considerations(Slide 16)

Answer 7

• Epidural anesthesia: pain relief during labor. If given too soon can prolong labor

• Complications:
o Hypotension-placed client in a lateral position *priority

Question 8

8. Cervical ripening: define and types

Answer 8

• Define: A cervical readiness

• Membrane Stripping:
o The health care provider inserts a gloved finger through the internal cervical os and sweeps the finger 360 degrees to separate the membranes from the lower uterine segment

• Dilation of the cervix by the health care provider using a catheter:
o The tip of the catheter is inserted through the cervix, and the ballon of the catheter is filled with 30 to 80 mL of sterile saline. The inflated ballon rests between the internal cervical os and the amniotic sac.

• Laminaria (or cervical dilators):
o Are used to soften and dilate the cervix, usually to induce abortion either therapeutic or elective or to induce labor when the fetus has died in utero. (Made from the root of seaweed)

Question 9

9. Terbutaline K,H,K (page 391)

Answer 9

• Increase Heart Rate
• Weaken contractions
• Monitor serum potassium (3.5-5.0)
• Monitor glucose (70-110) level can be elevated
• Report if abnormal level

Question 10

10. Admitted mom for preeclampsia nursing considerations (page 376)

Answer 10

• Magnesium Sulfate given to prevent seizures
• Monitor for s/s of eclampsia-priority
o Seizure
o Coma

• The woman and fetus require frequent monitoring for symptoms of worsening condition (headache, visual changes and epigastric pain)
• Monitor blood pressure at least every 4 hours
• Auscultate the lungs every 2 hours (can indicate Pulomanry edema)
• Weigh the woman daily on the same scale at the same time of day while she is wearing the same amount of clothing.
• Check deep tendon reflexes and determine if clonus is present at least once per shift
• Implement seizure precaution. Keep the environment quiet and nonstimulating because bright lights and loud noises could precipitate a seizure

Question 11

11. Station, presentation, position, attitude (see slide) (Slide 11)

Answer 11

• Presentions:
o Cephalic-FH will be below umbilicus
o Breech-FH will be above umbilicus
o Fetal sacrum could be in the right anterior quadrants

• Position:
o Right and left. Relation of the presenting part to the maternal pelvis.
o Posterior occipital can prolong labor (Right/Anterior occipital is the best)

• Attitude:
o Fetal parts in relation to each other
o Flexion is good, extension is bad

• Station:
o Position of the baby’s “Presenting part” in relation to the ischial spines in the pelvis
o 1 cm above the ischial spine and negative means the baby has not drop or engaged

Question 12

12. VBAC contraindications (Slide 22)

Answer 12

• History of a classical uterine incision
• Placenta previa
• A previous uterine rupture

Question 13

13. PROM nursing considerations(Slide 5)

Answer 13

premature rupture of membranes

• Monitor for Infection will be treated with prophylactic antibiotics)
• Pelvic rest
• Fetal kick counts

Question 14

14. True labor (Slide 2)

Answer 14

• Sign: burst of energy
• True labor results In progressive effacement and dilation of the cervix

Question 15

15. Magnesium sulfate K,H,K (slide 6)

Answer 15

• Dilated greater than 3-4cm, they can’t have magnesium sulfate
• Antidote: calcium gluconate

• Check for toxicity:
o Hypotension
o Decreased respiratory rate
o Absent deep tendon reflexes
o Altered LOC

Question 16

16. Prolapsed cord nursing considerations (Slide 5)

Answer 16

• Place client in knee-chest or Trendelenburg
• Move the fetal presenting part off the cord with two finger
• Cover part with warm, sterile, saline-soaked towel
• Never pushing back in

Question 17

17. Ruptured uterus s/s (page 397 & 231)

Answer 17

• A nonreassuring fetal heart rate pattern
• Fetal bradycardia or deep variable decelerations
• Reports by the woman of a “popping” sensation in her abdomen
• Excessive maternal pain to the chest, abdomen, shoulder, back)
• Unrelenting uterine contraction followed by a disorganized uterine pattern
• Increased fetal station felt upon vaginal examination (e.g., station is now −3 when it has been −1)
• Vaginal bleeding or increased bloody show
• Easily palpable fetal parts through the abdominal wall
• Signs of maternal shock (falling BP and rising pulse)

Question 18

18. Transition stage of labor(Slide 19)

Answer 18

• The transition phase is the most Intense phase of labor
• Assist the woman to rest between contractions and pant to avoid pushing until rage cervix is fully dilated
• Deep cleansing breaths before and after each contraction

Question 19

19. Preterm labor (Slide 5)

Answer 19

• After 20 weeks and before 37 weeks
• Give Magnesium Sulfate & Terbutaline