VN 34 Test 4 S.G (intrapartum)

Question 1

1. Know what the bishop score is (PP slide 4, pg.218)

Answer 1

How the health care provider determines cervical readiness
 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 2

2. Oxytocin nursing considerations (PP slide 4)

Answer 2

 Oxytocin use includes higher risk for cesarean delivery, hyperstimulation of the uterus w/possible uterine rupture, water retention & fetal distress
 Continuous fetal monitoring

Question 3

3. Gate control theory (PP slide 14)

Answer 3

Gate control is getting them distracted & mind focused on something else
 Massage & deep breathing

Question 4

4. Decelerations nursing considerations and causes (PP slide 5, NTK’s)

Answer 4

 FHR: 110-160
 Fetal distress: FHR below 110 or above 160 , no variability or little (put on left side, give O2, d/c oxytocin)
Early:
 Good
 Cause: baby’s head compressed on pelvis/soft tissue (mirror baby/contraction)
Late:
 Not good
 Cause: uteroplacental insufficiency
 No mirror, HR decrease
Variable:
 Not good
 Cause: cord compression
 HR all over

Question 5

5. Reasons for episiotomies (PP slide 21)

Answer 5

 Shoulder dystocia : head delivers but shoulders get caught in pelvic bone may need episiotomy
 LGA?

Question 6

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

Answer 6

 Full dilation of the cervix marks the beginning of the 2nd stage of labor
 Nurse should monitor length of contractions > 90 seconds poses increased risk of rupture
 Expected findings: bloody show, pelvic pressure, early decelerations

Question 7

7. Epidural anesthesia nursing considerations (PP slide 16)

Answer 7

 Pain relief during labor, if given too soon can prolong labor
 Hypotension is a priority!! (Get them on lateral side to get pressure off vena cava)
 Monitor VS

Question 8

8. Cervical ripening (pg.218, 219)

Answer 8

 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 9

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

Answer 9

 Increases HR & weaken contractions & increase maternal glucose
 Monitor potassium & glucose levels (report abnormal level)
 Potassium: 3.5- 5.0
 Glucose: 70-110mg/dL

Question 10

10. Admitted mom for preeclampsia nursing considerations (PP slide 6, pg.375,376)

Answer 10

 Monitor for s/s of eclampsia (seizure&coma) PRIORITY!!!
 Bed rest side lying
 Accurate BP, output
 Magnesium Sulfate is given to prevent seizures (have calcium gluconate @ bedside)
 Frequent monitoring of the mother & baby for worsening condition(report headache, visual changes & epigastric pain)
 Monitor blood pressure @ least every 4hrs for mild preeclampsia and more frequent for more severe disease
 Auscultate the lungs every 2hrs (may indicate developing of pulmonary edema)
 Weigh the woman daily on the same scale at the same time daily (report any sudden increase in weight)
 Check deep tendon reflexes & determine if clonus is present @ least once per shift
 Implement seizure precautions (quiet, non-stimulating environment, suction equipment @ bedside)

Question 11

11. Station, presentation, position, attitude (PP slide 11)

Answer 11

Station: position of the baby’s “presenting part” in relation to the ischial spines
 -1cm is above the ischial spine
 Negative cm means baby has not dropped or engaged
Presentation:
 Cephalic- FH will be below the umbilicus
 Breech-FH will be above umbilicus.
 Fetal sacrum could be in the right anterior quadrant
Position: right & left. Relation of the presenting part to the maternal pelvis. Posterior occiput can prolong labor. (right occipital anterior is the best position)
Attitude: fetal parts in relation to each other. (flexion is good, extension is bad)

Question 12

12. VBAC contraindications (PP slide 22)

Answer 12

 Hx of a classical uterine incision
 Placenta previa
 Previous uterine rupture

Question 13

13. PROM nursing considerations (PP slide 5)

Answer 13

 Monitor for infection: will be RX prophylactic abx
 Pelvic rest
 Fetal kick counts

Question 14

14. True labor (PP slide2)

Answer 14

 Burst of energy
 Results in a progressive effacement & dilation of the cervix

Question 15

15. Magnesium sulfate K,H,K (pg.377)

Answer 15

 Check for toxicity : hypotension, decreased RR, absent deep tendon reflexes, Altered LOC, urinary output.
 If woman dilated greater than 3-4cm cant have mag sulfate

Question 16

16. Prolapsed cord nursing considerations (PP slide 5)

Answer 16

 Place client in knee-chest or Trendelenburg
 Move the fetal presenting part of the cord w/two fingers
 Cover part w/warm sterile, saline-soaked towel
 Never push back in!!

Question 17

17. Ruptured uterus s/s (Pg.231)

Answer 17

 Maternal pain (abdomen, chest)
 Fetal bradycardia
 Signs of maternal shock (low BP, tachycardia)
 Unrelenting uterine contraction followed by a disorganized uterine pattern
 Reports by the woman of “popping sensation” in her abdomen
 Variable decelerations
 Increased fetal station felt upon vaginal examination (station is now -3 when it has been -1)
 Vaginal bleeding/increased bloody show
 Easily palpable fetal parts through the abdominal wall (uterine tenderness)

Question 18

18. Transition stage of labor (PP slide 19)

Answer 18

 Transition stage is the most intense phase of labor
 Assist the woman to rest between contractions & pant to avoid pushing until the cervix is fully dilated.
 Deep cleansing breaths before & after each contraction

Question 19

PTL NTK (PP slide 5)

Answer 19

 After 20 wks & before 37 wks
 Given mag sulfate & terbutaline