VN 34 Test 3 (sjvc intrapartum)

Question 1

1a. Explain what the “Bishop Score” is. (pg.218)

Answer 1

How the health care provider determines cervical readiness

Question 2

1b. What are the 5 bishop categories, and what do they indicate?(pg.218)

Answer 2

 Cervical consistency
 Position
 Dilation
 Effacement
 Fetal station

The higher the score the greater the chance that induction will be successful.

Bishop score of 6 or less indicates an “unripe,” or unfavorable cervix, and labor induction is less likely to be successful.

Question 3

2a. What does it mean to “ripen” a cervix? (pg.219)

Answer 3

A cervix that is favorable for induction/ to hasten cervical readiness

Question 4

2 b. List the mechanical methods of cervical ripening (pg.219, PP slide 4)

Answer 4

 Membrane stripping: inserts a gloved finger through the internal cervical os and sweeps the finger 360 degrees to separate the membranes from the lower uterine segment.
 Mechanical dilation of the cervix w/either a catheter or laminaria: The tip of the catheter is inserted through the cervix, and the balloon of the catheter is filled with 30 to 80 mL of sterile saline. inflated balloon rests between the internal cervical os and the amniotic sac.
>Laminaria (cervical dilators) : used to soften & dilate the cervix (made from the root of seaweed). Usually to induce abortion either therapeutic or elective for when the fetus has died in uteri.

Question 5

2c. List the pharmacological methods, which one can be administered both PO and vaginally? (pg.219)

Answer 5

 Prostaglandin E2 “Dinoprostone” (applied locally to the cervix, gel or vaginal inserts)
 Prostaglandin E1 “Misoprostol” (PO & vaginally)

Question 6

Describe an oxytocin induction. (pg.219)

Answer 6

A synthetic form of the posterior pituitary hormone that causes the uterus to contract, is the most common agent used for labor induction.

Question 7

b. What should the nurse do if hyperstimulation occurs? (pg.219)

Answer 7

 Monitor the fetal heart rate for signs of fetal distress.
 Provide comfort care
 Decrease environmental stimuli
>Encourage deep breathing
>Apply O2 if necessary

Question 8

4a. List the different types of assisted delivery (pg.220)

Answer 8

 Episiotomy (surgical incision made into the perineum to enlarge posterior part of vaginal opening)
 Vacuum- assisted delivery
 Forceps delivery

Question 9

5a. Name the indications for a cesarean delivery. (pg.223)

Answer 9

 Hx of previous cesarean (or other uterine incision)
 Labor dystocia (failure to progress in labor)
 Nonreassuring fetal status
 Fetal malpresentation (breech)
 Placenta previa
 Placenta abruption
 Cephalopelvic disproportion (fetal head too large to fit through pelvis)
 Active vaginal herpes lesions
 Prolapse of the umbilical cord
 Ruptured uterus

Question 10

5b. In which step of a cesarean would the LVN not participate? (pg.224)

Answer 10

 Postoperative care in the PACU
-We may care for woman after she has sufficiently recovered from anesthesia

Question 11

6a. When a client is having a planned cesarean section, what must the patient sign?

Answer 11

 Consent form

Question 12

6b. Can the paper work be signed ahead of time?

Answer 12

Yes

Question 13

7. Describe how the nurse can support her patient and the patient’s family in the event of an unplanned cesarean. (pg.232)

Answer 13

 Include the family in any explanations
 Through therapeutic communication, providing information, and a reassuring touch.
 Include the woman in conversations instead of talking to other staff as though the woman is not present.
 Encourage the woman to rest in-between contractions. During these rest periods, avoid conversations that are not related to the delivery
 A quiet room in-between contractions can help the woman rest and therefore better cope during the intervention or contractions.
 Explain procedures as you are doing them. Use short, nontechnical sentences. The woman’s anxiety may be elevated and she may not be able to process lengthy or detailed explanations. (Repeat info as needed)
 Explain what sensations she can expect to experience and what procedure to expect next.
 Be empathic. Acknowledge her feelings and let her know that these feelings are normal considering the situation with which she must cope.

Question 14

8. What is a VBAC and when is it contraindicated? (pg.231)

Answer 14

(Vaginal birth after cesarean)

 When a woman has a classical uterine incision from a previous cesarean delivery
 Placenta previa
 Hx of previous uterine rupture
 Lack of facilities or equipment to perform an immediate emergency cesarean

Question 15

9a. Describe the signs and symptoms of a uterine rupture. (pg.231, box 11-3)

Answer 15

 Dramatic onset of fetal bradycardia or deep variable decelerations
 Reports by the woman of a “popping” sensation in her abdomen
 Excessive maternal pain (can be referred pain, such as to the chest)
 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

Question 16

9b. In the event of uterine rupture, what is the treatment of choice? (pg.397)

Answer 16

 Immediate cesarean delivery

Question 17

10a. List the causes of labor dysfunction. (pg.385)

Answer 17

 Problems w/the uterus (uterine dysfunction)
 Maternal pelvis (cephalopelvic disproportion)
 Situations involving the fetus (fetal malposition)

Question 18

10b. What are the treatment for hypertonic and hypotonic labor? (pg.386)

Answer 18

 Hypertonic treatment is to decrease or shut off the oxytocin infusion
 Hypotonic labor: Augmentation w/oxytocin, if hypotonic labor causes fetal heart rate to drop PCP may order tocolytic. (substance that relaxes uterine muscle)

Question 19

11. List the options of interventions for a safe delivery of a client whom presents with a breech presentation and for a transverse lie. (pg.387)

Answer 19

Breech presentation
 Most health care providers prefer to do a cesarean birth without labor or attempting a vaginal delivery.
 External cephalic version (manipulating the position of the fetus while in utero)

Transverse Lie
 The health care provider will either use external cephalic version to try to turn the fetus to a cephalic presentation or deliver the fetus by cesarean.

Question 20

12a. What is the priority for the woman with premature rupture of membranes? (pg.388, flashcard 79)

Answer 20

 Prepare for birth
 Labor induction if birth doesn’t begin on its own
 Monitor for infection?

Question 21

12B. Describe the management of preterm PROM, including fetal surveillance. (pg.388)

Answer 21

 If there are signs of infection, such as elevated maternal temperature; maternal tachycardia; cloudy, foul-smelling amniotic fluid; and uterine tenderness, the health care provider obtains cultures, starts antibiotics, and facilitates delivery regardless of gestational age.
 Prophylactic antibiotics (usually ampicillin and erythromycin) may be ordered for preterm PROM.
 For preterm PROM between 24 & 34 weeks, intramuscular corticosteroids are given to the mother to reduce the risk of neonatal respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis
 Fetal surveillance is done at least daily. Generally, the woman performs kick counts after every meal. Daily nonstress tests may also be ordered. Frequent ultrasound examinations to measure the amount of amniotic fluid and fetal growth are also done.

Question 22

13. What are the guidelines for the patient who is not in true labor? (Pg.157)

Answer 22

 After the initial assessment by the health care provider, the woman may be instructed to walk for an hour or two. Then, a vaginal examination is repeated to determine any cervical changes.
 If the contractions become stronger, more regular, or if other signs of true labor occur, such as rupture of membranes (“bag of waters breaks”) or presence of bloody show (mucous vaginal discharge that is pink or brown tinged which occurs as the blood vessels in the cervix start to rupture as effacement and dilation are beginning).

Question 23

14.What is the significance of a fetal fibronectin test and cervical length? (pg.389)

Answer 23

 Examinations used to diagnose PTL include evaluation of contraction frequency, fetal fibronectin test, and measurement of cervical length.
 Short cervical length w/a positive fetal fribronectin test indicates that the woman has an increased chance of delivering prematurely

Question 24

15. What are the signs and symptoms for preterm labor?

Answer 24

Signs & Symptoms: (pg.389)
The definitive diagnosis of PTL is made when uterine contractions result in cervical change.
 Uterine contractions (may be painless)
 Pelvic pressure
 Menstrual-like cramps
 Vaginal pain
 Low, dull backache accompanied by vaginal discharge & bleeding
 Membranes may be intact or ruptured

Question 25

15b. Treatment for PTL

Answer 25

 Tocolytics - often buy enough time to allow for corticosteroid injections to help mature the fetal lungs, treatment of group B streptococcal infections, if present, or to allow transfer to a facility with a higher level of neonatal intensive care.
 Another treatment is for weekly progesterone to be administered to the pregnant woman with a history of preterm delivery or short cervix

Question 26

16a. Describe the potential side effects when a patient is on Magnesium Sulfate or Terbutaline, while baby is still inside. (pg.390)

Answer 26

 Terbutaline:
Mother:
Tachycardia, palpitations, anxiety, hypokalemia, hyperglycemia, hypotension, and hyperglycemia

Baby:
Tachycardia, hyperglycemia

 Magnesium Sulfate:
Mother:
At toxic levels: Respiratory depression, tetany, paralysis, profound hypotension, cardiac arrest
Baby:
nonreactive NST, decreased fetal breathing movements

Question 27

16b. Describe potential side effects on mom when on Magnesium Sulfate after baby has been born. (pg.390)

Answer 27

 Altered LOC
 Decreased respirations
 Decreased deep tendon reflex
 High risk of toxicity

Question 28

16c. What condition necessitates mom to be on magnesium Sulfate after delivery? (pg.193,375)

Answer 28

 Prevention & treatment of eclamptic seizures

Question 29

17. What are some very important actions of the nurse in the postpartum period of an intrauterine fetal death, also known as fetal demise? (pg.394)

Answer 29

 Allow the woman and her family space to comfort one another, but do not avoid her.
 Offer to call a pastor or other spiritual leader. Be sure to determine whether the woman would like any religious sacraments or rituals.
 Be sure that mementos are collected. Collect a lock of hair, footprints, and other reminders of the baby.
 Take pictures as dictated by institutional policy. Pictures are usually taken even if the woman refuses them.

Question 30

18a. Describe what shoulder dystocia is. (Pg.395)

Answer 30

the fetal head delivers, but the shoulders become stuck in the bony pelvis, preventing delivery of the body.

Question 31

18b. Signs & Symptoms and Treatment of shoulder dystocia: (Pg.395)

Answer 31

 The “turtle sign” is the classic sign that alerts the birth attendant to the probability of shoulder dystocia. (The fetal head delivers, but then retracts similar to a turtle)

Treatment:
 McRoberts Maneuver - With the woman in lithotomy position, each nurse holds one leg and sharply flexes the leg toward the woman’s shoulders.
 Suprapubic pressure - one nurse can use a fist to apply suprapubic pressure. This will sometimes dislodge the impacted shoulder.
>Zavanelli Maneuver: intentionally breaking fetus clavicle to dislodge or putting arm in the vagina and trying to push one of the shoulders counterclockwise/clockwise.

Question 32

19. Describe the treatment for an umbilical cord prolapse. (pg.396)

Answer 32

 Immediate cesarean delivery is the treatment of choice to save the fetus’s life.
 The examiner who discovers the condition should push upward on the presenting part with the fingers to move the fetus away from the cord.
 Emptying the bladder with an indwelling catheter is another method that can temporarily relieve cord compression while the woman is prepared for delivery.

Question 33

20. Name the signs of a uterine rupture. (pg.397)

Answer 33

 A nonreassuring fetal heart rate pattern
 Other signs are complaints of pain in the abdomen, shoulder, or back in a laboring woman who had previously efficient pain relief from epidural anesthesia
 Falling blood pressure and rising pulse may be associated with hypovolemia caused by occult bleeding.
 A vaginal examination may demonstrate a higher fetal station than was present previously.
 There may or may not be changes in the contraction pattern

Question 34

4b. In which situations would an assisted delivery be necessary? (pg.220, flashcard 76)

Answer 34

 The mother becomes tired and stops pushing effectively
 Prolonged second stage of labor
 The baby’s shoulders are stuck in the birth canal after the head is born (shoulder dystocia).
 The head will not rotate from an occiput posterior position (persistent occiput posterior).
 The fetus is in a breech presentation.
 Instruments (forceps or vacuum) are being used to shorten the second stage of labor.

Question 35

Cardiac output is at its’ highest at what stage of labor? Freebie

Answer 35

Immediately after birth

Question 36

Guidelines for food/drink during the labor process.

Answer 36

NPO or moderate amounts of liquid

Question 37

Which presentation is most common and least common?

Question 38

What are the Four P’s of labor?(pg.165)

Answer 38

> Passageway
Passenger
Powers
Psyche