CARE OF THE PARTURIENT

Question 1

1. LATENT PHASE
   ○ Cervical Dilation:

Answer 1

0 – 4 cm

Question 2

LATENT PHASE
○ Nature of Contraction:
Duration:
Interval:

Answer 2

< 30 secs

3 – 5 mins

Question 3

○ Length of Latent Phase

Answer 3

Primis – 6 hours
Multis – 4 – 5 hours

Question 4

1. LATENT PHASE
   ○ Attitude of mother:

Answer 4

feel comfortable, walking and sitting at this time

Question 5

Latent phase
Nursing Responsibilities:

Answer 5

1. Encourage walking - shorten 1st stage of labor
2. Encourage to void q 2 – 3 hrs. – full bladder inhibits contractions
3. Breathing – chest breathing

Question 6

Active Phase
○ Cervical Dilation:

Answer 6

: 4 – 7 cm

Question 7

ACTIVE PHASE
○ Nature of contractions:

Answer 7

Duration: 30 – 50 secs
Intensity: moderate to strong

Question 8

ACTIVE PHASE
○ Length of Active Phase:

Answer 8

Primis – 3 hours
Multis – 2 hours

Question 9

. ACTIVE PHASE
○ Attitude of mother:

Answer 9

prefer to stay in bed, withdraws from her environment and self – focused

Question 10

ACTIVE PHASE
Nursing Responsibilities:
CLue:
M
A
D
B

Answer 10

1. M – edications – have meds ready
2. A – ssessment include: vital signs, cervical dilation and effacement, fetal monitor, etc.
3. D – dry lips – oral care (ointment) dry linens
4. B – abdominal breathing

Question 11

. TRANSITION PHASE
○ Cervical Dilatation:

Answer 11

8 – 10 cm

Question 12

TRANSITION PHASE
○ Nature of Contractions:

Answer 12

Duration: 50 – 60 secs
]Interval: 2 -3 mins
]Intensity: moderate to strong

Question 13

Transition Phase:
○ Length of Transition Phase:

Answer 13

Primis – 1 hour (baby delivered within 10 contractions or 20 mins)
Multis – 30 mins (baby delivered within 10 contractions or 20 mins)

Question 14

TRANSITION PHASE
○ Attitude of mother

Answer 14

• feel discouraged, ask midwife/nurse repeatedly when labor will end, not in control of her emotions and sensations, irritated, may not want to be touched
  ○ There is an uncontrollable urge to push with contractions, a sign of impending second stage of labor. Profuse perspiration and distention of neck veins are seen.
  ○ Nausea and vomiting are a reflex reaction due to decreased gastric motility and absorption.

Question 15

TRANSITION PHASE
Nursing Responsibilities: RRE

Answer 15

1. Reassure woman that labor is nearing end & baby will be born soon
2. Reinforce breathing and relaxation techniques
3. Encourage fast-blow breathing to remove the urge to bear down
4. Emotional support

Question 16

SECOND STAGE or

Answer 16

EXPULSIVE STAGE

Question 17

SECOND STAGE – EXPULSIVE STAGE

MECHANISM OF LABOR:

Answer 17

EDFIEEE

 Engagement
 Descent
 Flexion
 Internal Rotation
 Extension
 External Rotation
 Expulsion

Question 18

entrance of the greatest biparietal diameter of the fetal head to the pelvic inlet

Answer 18

 Descent

Question 19

the chin of the fetus touches his chest enabling the smallest diameter (suboccipitobregmatic) to be presented to the pelvis for delivery

Answer 19

Flexion

Question 20

when the head reach the level of the ischial spine, it rotates from transverse diameter to AP diameter so that its largest diameter is presented to the largest diameter of the outlet. This movement allows the head to pass through the outlet.

Answer 20

 Internal Rotation

Question 21

the head of the fetus extend towards the vaginal opening. As the head extend, the chin is lifted and then it is born.

Answer 21

Extension

Question 22

when the head comes out, the shoulder which enters the pelvis in transverse position turns to anteroposterior position for it become in line with the anteroposterior diameter of the outlet & pass through the pelvis.

Answer 22

External Rotation

Question 23

when the head is born, the shoulder & the rest of the body follows without much difficulties.

Answer 23

Expulsion

Question 24

 Duration of Second Stage:

Answer 24

Primis – 50 mins
Multis – 20 mins

Question 25

2nd stage  Assessment:

Answer 25

monitor FHT q 15 mins in normal case and every 5 mins in high-risk cases if not yet delivered

Question 26

2nd stage  Transfer to the DR:

Answer 26

Primis – cervix fully dilated
Multis – cervix is 8 cm dilated

Question 27

Delivery Position used when forceps delivery & episiotomy are to be performed.

Answer 27

1. Lithotomy

Question 28

– head of the bed is 35 – 45˚ elevated, knees are flexed & feet flat on bed. This position facilitates the pushing effort of the mother.

Answer 28

2. Dorsal Recumbent

Question 29

indicated for woman with heart disease

Answer 29

3. Left Lateral Position

Question 30

Thirds stage or

Answer 30

PLACENTAL DELIVERY

Question 31

METHODS OF PLACENTAL SEPARATION:

Answer 31

1. Schultz Mechanism –if placenta separates first at its center and last at its edges, it tends to fold on itself like an umbrella and presents the fetal surface which is shiny (“Shiny” for Schultz); 80% of placentas separate in this manner.
2. Duncan Mechanism – if placenta separates first at its edges, it slides along the uterine surface and presents with the maternal surface which is raw, red, beefy, and irregular and “dirty” (“Dirty” for Duncan). Only about 20% of placentas separate this way.

Question 32

MANAGEMENT: Third stage

Answer 32

1. Watchful waiting.
2. Inject oxytocin (Methergine = 0.2 mg./ml. or Syntocinon = 10U/ml) IM to maintain uterine
3. Never leave the client unattended.
4. Oxygen & emergency equipment made available.

Question 33

b) Wait for signs of placental delivery

Answer 33

• Calkin’s sign
• Sudden gush of blood from vagina
• Lengthening of the cord

Question 34

uterus is firm, globular & rising to the level of umbilicus; earliest sign of placental separation

Answer 34

• Calkin’s sign

Question 35

c) Track the cord slowly, winding it around the clamp until the placenta spontaneously comes out, slowly rotating it so that no membranes are left inside the uterus, a method called

Answer 35

Brandt – Andrew’s maneuver.

Question 36

THE FOURTH STAGE or

Answer 36

PUERPERIUM

Question 37

4th stage MANAGEMENT:

Answer 37

1. Repair of lacerations

Question 38

CLASSIFICATION OF PERINEAL LACERATIONS
involves the vaginal mucous membranes and perineal skin

Answer 38

First degree

Question 39

CLASSIFICATION OF PERINEAL LACERATIONS
– involves not only the muscles, vaginal mucous membranes, and skin, but also the muscles.

Answer 39

2nd degree

Question 40

CLASSIFICATION OF PERINEAL LACERATIONS
involves not only the vaginal mucous membranes and skin, but also the external sphincter of the rectum

Answer 40

3rd degree

Question 41

CLASSIFICATION OF PERINEAL LACERATIONS
involves not only the external sphincter of the rectum, the muscles, vaginal mucous membranes, and skin, but also the m mucous membranes of the rectum.

Answer 41

4th degree