Birth

Question 1

What are some other signs of impending labor? 今にも起こりそうな

Answer 1

Burst of energy (nesting)
Lighting(Baby drops into the pelvis 骨盤)
Weight loss
GI upset
Leg cramps
Water broke
Pelvic pressure

Question 2

What are we looking for on the NST?

Answer 2

A normal baseline and 2 accelerations of 15 beats, lasting 15 seconds in a 20 min period.

Question 3

a) baseline?
b) variability?
c) Accelerations?

Answer 3

The baby is currently well perfused because:
There is a normal baseline - 145
Moderate variability with 6 to 25 beats of variation
Accelerations are present; No decelerations

Question 4

Latent phase

a) dilation cm?
b) duration?
c) frequency?

Answer 4

a) 0cm-3cm
b) 30-45secs
c) 5-30mins

Question 5

Active phase?

a) dilation cm?
b) duration?
c) frequency?

Answer 5

a) 4-7cm
b) 40-70secs
c) 3-5 mins

Question 6

Transition

a) dilation cm?
b) duration?
c) frequency?

Answer 6

a) 8-10cm (full)
b) 45-90secs
c) 2-3mins

Question 7

Second stage is?

Answer 7

Full dilation to birth

Question 8

Third stage is?

Answer 8

Birth to deliver placenta

Question 9

Fourth stage is?

Answer 9

Deliver of placenta to hemostasis
2 hours post-delivery of the placenta

Question 10

What does the acronym VEAL CHOP pertain to?

Answer 10

Assessment of changes in the Fetal Heart Rate

Question 11

The complications to assess for in ALL women during labor are? 3

Answer 11

Bleeding
Infection
Decreased Fetal Perfusion

Question 12

How can we measure the strength of her contractions?

Answer 12

Palpation

Question 13

What is the only definite way to tell if a patient is in true labor?

Answer 13

Cervix is changing
頸部

Question 14

Can we send mom who has false labor home?

Answer 14

No, we need to check the fetal heart rate and perform an NST.

Question 15

Non-pharmacologic Pain Management
Cutaneous

example?

Answer 15

Massage
Heat or Cold packs
Rocking or Walking
Sacral counterpressure
(heal of hand to massage mom’s sacrum)
Acupressure

Question 16

Non-pharmacologic Pain Management
Relaxation

example?

Answer 16

Non-touching aromatherapy
Music
Breathing
Imagery

Question 17

a) Kelly’s baby is “-2” so that means
b) If Kelly’s baby was “+2” what would that mean?

Answer 17

a) Kelly’s baby is 2 cm above the ischial spines
b) The baby is 2 cm below the ischial spines

Question 18

Tammy is afraid to get an epidural and wants to know if you can just give her something through her IV.

What can you tell her about systemic forms of pharmacologic pain relief?

Answer 18

IV Medications cross the placenta and may cause respiratory distress in the baby after delivery requiring Naloxone (Narcan). Therefore, we won’t administer any if you are close to delivery.

Question 19

What form of pain relief is the epidural?
Is it systemic of regional?

Answer 19

Regional - which doesn’t enter the blood stream and doesn’t cross the placenta.

Question 20

Which of the five process of labor may be affected at this stage? after epidural

Answer 20

Position - the patient will still need to move during labor so the nurse will have to help her change
position every couple of hours

Passenger - The epidural causes hypotension which can affect fetal perfusion

Question 21

The provider decides to breaks Kelly’s water.
After the membranes are ruptured what is the first thing you do?

Answer 21

Assess the Fetal Heart rate

Question 22

What is this?

Answer 22

Leopold’s Maneuvers
-determine the position of the fetus

Question 23

Kelly is very anxious to see if she can start pushing and wants to know why you are not checking her cervix as frequently. (after water brake)

What can you tell her?

Answer 23

I want to limit your exams, so I don’t introduce an infection now that your water is broken.

Question 24

Kelly states that she feels like she need to have a bowel movement.
Should you check her cervix now?

Answer 24

Yes!

Question 25

C/C/+2 This means that Kelly is in what stage of labor?

Answer 25

Second Stage

Question 26

a) Later stage of labor, what pharmacological pain relief is available? (for the lower vaginal and perineal area) b) Any risk?

Answer 26

a) The pudendal block b) no risk from hypotension it does not enter the blood stream and therefore does not affect the baby, like the IV medications Unfortunately, it can’t be re-dosed like the epidural or IV medication

Question 27

What is this position called?

Answer 27

**The occiput anterior position**. This is the best position for the fetal head to exit the pelvis.

Question 28

What is this position?

Answer 28

**That is the occiput posterior position.** This is much harder to deliver. The second stage will likely take longer.

Question 29

The provider delivers the rest of the body, suctions the mouth and nose, then dries the baby and places the baby on Kelly’s abdomen. What stage of labor is Kelly in now?

Answer 29

The third stage of labor

Question 30

The placenta slides out of the vagina. What stage of labor is Kelly in now?

Answer 30

The fourth stage

Question 31

Now that the placenta has separated, Kelly is a risk for??

Answer 31

Hemorrhage

Question 32

What interventions should be implemented by fourth stage?

Answer 32

Oxytocics medication Pitocin(contract the uterus) Assess fundus every 15 mins /(ensure that it is firm, and her lochia isn’t too heavy) If her fundus is not firm, fundal massage is needed

Question 33

What are some benefits of skin-to-skin?

Answer 33

Bonding Breastfeeding Thermoregulation for baby Glucose control for baby Breastfeeding (leads to increased uterine tone and decreases bleeding for Kelly)

Question 34

What are the 5 P?

Answer 34

Passenger Passageway Powers Position of mother Psychologic response

Question 35

What are the passenger factor?

Answer 35

Size of fetal head Fetal presentation Fetal position Fetal lie Fetal attitude

Question 36

Question 37

Question 38

Position Why do they need to frequent changes in position?

Answer 38

Relieve fatigue Increase comfort Improve circulation

Question 39

Normal Psychologic Response Latent Labor

Answer 39

Excited Some apprehension Pain controlled fairly well able to follow directions

Question 40

Normal Psychologic Response Active Labor

Answer 40

More serious Attention is inward Some difficulty following directions

Question 41

Normal Psychologic Response Transition

Answer 41

Fearful Irritable doubt about ability to continue

Question 42

Question 43

Fetal adaptation, 3 changes occur in

Answer 43

Fetal heart rate Fetal circulation Fetal respiration

Question 44

What are the innervation when late and variable decelerations?

Answer 44

**LIOON** Left lying IV fluid Oxygen Stop oxytocin Notify provider

Question 45

The nurse locates the fetal heart tones in the patient’s RUQ. The nurse should suspect that the fetus is in which of the following positions? * A – Cephalic * B – Transverse * C – Posterior * D – Breech

Answer 45

D

Question 46

A nurse is caring for a client who was just admitted at 39 weeks of gestation and in active labor. Which of the following actions should the nurse include in the patient’s plan on care? * A – Keep four side rails up while the client is in bed. * B – Monitor the fetal heart rate (FHR) every hour. * C – Check the cervix prior to analgesic administration. * D – Insert an indwelling urinary catheter.

Answer 46

C

Question 47

What is the Braxton Hicks Contraction?

Answer 47

Irregular in frequency, less intense and usually go away if you change positions

Question 48

What is the sing for preceding labor?

Answer 48

Weight loss Lightening Braxton Hicks contractions Nesting

Question 49

What can we make for general comfort while moms have pain?

Answer 49

Patient is dry Bladder empty Room appropriate temp Question answer

Question 50

Nursing care first stage?

Answer 50

Perform Leopold maneuvers Perform a vaginal examination Assessments related possible rupture of membrane Suspected-- FHR

Question 51

Nursing care in active phase?

Answer 51

Monitor FHR Encourage frequent position change Encourage voiding Encourage relaxation Provide pharmacological pain relief

Question 52

Nursing care during Transition phase?

Answer 52

Monitor FHR Encourage voiding Encourage breathing control Encourage bearing down once cervix fully dilated

Question 53

What Is Crowning?

Answer 53

When you can see the top of your baby's head through the opening of your vagina

Question 54

Transition phase and mom need to have bowel movement. What nurse should do?

Answer 54

Prepare for an impending deliver 差し迫った urge bowel movement indicate fetal descent 下降

Question 55

What is the sing for placenta separation?

Answer 55

Lengthening of the umblical cord Appearance of dark blood from the vagina Fundus firm upon palpation

Question 56

The patient has vaginal bleeding for 2weeks. What should nurse do?

Answer 56

Defer vaginal exam 延期する

Question 57

Why do we encourage to mom to void every 2hours during labor?

Answer 57

A distended bladder reduces pelvic space needed for birth

Question 58

a) Effacement? b) Dilation?

Answer 58

a) Thinning/stretching of the cervix 90-100%) b) How wide opening cervix (0-10cm)

Question 59

a) Epidural cause what? b) Intervention?

Answer 59

a) Maternal hypotension b) Administer IV fluids Position change