Chapters 13, 14: Labor and Birth & Nursing management During Labor

Question 1

Describe Characteristics of false labor:

1. ) Timing
2. )Strength
3. )discomfort
4. )Activity
5. ) stay or go

Answer 1

1. ) timing is inconsistent
2. )generally weak, does not get stronger
3. )discomfort is in the front
4. )activity makes it better
5. ) stay at home

Question 2

Characteristics of true labor:

1. ) time
2. )strength
3. )discomfort
4. )activity
5. )stay or go

Answer 2

1. ) consistent
2. )gets stronger over time
3. ) starts from back moves to front
4. )activity does not make it go away
5. ) stay home until 5 minutes in between and lasts for 40 to 60 seconds

Question 3

Premonitory cervical changes

Answer 3

change in shape

becomes short and thin

Question 4

Describe cervical lightening

Answer 4

the fetus presenting part begins to descend. ease of breathing and gerd occurs but increase in back and pelvic pressure occur.
can occur 2 weeks before labor in a primapara individual

Question 5

1. ) bony prominence through which the feus must travel

2. )Three planes of location?

Answer 5

1. ) pelvis

2. ) inlet, mid pelvis(compresses lungs to expel fluid), outlet

Question 6

Factors affecting onset of labor

Answer 6

estrogen releases, prostaglandin sensitivity, progesterone reuptake

Question 7

Premonitory signs of labor

Answer 7

• cervical lightening
• increase in energy
• bloody show
• contractions
• pelvic and back pressure
• possible membrane rupture

Question 8

1. ) the largest and least compresible structure of the fetus
2. ) what do sutures do?
3. )what are the intersections of sutures?
4. ) which is the soft spot

Answer 8

1. ) Skull
2. ) Allow molding to achieve the smallest diameter
3. )fontanels
4. )anterior fontanel

Question 9

1.)critical factors that affect the process of labour (5 Ps)

Answer 9

1.) Passenger, passageway, powers, presentation, psychological response to pregnancy

Question 10

soft tissue passageway consists of what

Answer 10

pelvic floor muscle, cervix, vagina

Question 11

Describe the pelvic shapes

Answer 11

1. ) Gynecoid - True woman’s pelvis, most appropriate for birth
2. )anthropoid - found in men and non white women. elongated, longer from anterior to posterior than transverse
3. )android - funnel heart shaped. considered man’s pelvis. difficult rotation
4. ) platypeloid - unable to do vaginal birth

Question 12

1. ) most favourable fetal attitude
2. ) relationship between fetal long axis and maternal long axis? what is the most common
3. ) the other two types?

Answer 12

1. ) flexed position
2. )fetal lie: longitudinal
3. )would require cesarean birth if unable to reposition

Question 13

1. ) three main fetal presentations
2. ) variations of cephalic/ vertex
3. )challenges posed by breech presentation
4. )buttocks presents first, which presentation is this?
5. )fetus is cross legged, which presentation is this?
6. )one or two feet out, which presentation is this?

Answer 13

1. ) vertex, shoulder, breech
2. ) occiput, soldier, brow, and face
3. ) head can gat hung up, cord compression, inefficient molding and inefficient dilation
4. )Frank breech
5. )complete
6. )footling

Question 14

1. )Primary stimulus powering labor
2. )what is the purpose of contractions
3. ) identify and explain the 3 parameters of contractions

Answer 14

1. ) Contractions
2. )dilation and effacement
3. ) frequency (start of 1 to start of the next), duration, and intensity

Question 15

factors that affect a positive birth experience

Answer 15

trust in yourself
trust in care givers
support
pain management
preparedness
information

Question 16

fetal response to labour

Answer 16

can have increase or decrease in HR,
CO2 goes up
breathing, oxygenation goes down

Question 17

1. )Landmark for vertex
2. )landmark for face
3. )landmark for Breech
4. ) landmark for shoulder
5. ) occurs when the presenting part reaches the ostation
6. )refers to when presenting part hasn’t reached ostation
7. ) when would you expect this on a primagravida?

Answer 17

1. ) Occiput (O)
2. )Mentum (M)
3. ) Sacrum (S)
4. ) Acromion (A)
5. )fetal engagement
6. ) floating
7. ) can occur 2 weeks prior to labor

Question 18

cardinal movements of labor

1. ) downward movement of presenting part
2. )when vertex meets resistance from cervix. pelvis wall, and floor?
3. )first rotation
4. ) and then?
5. ) rotation back to original?
6. ) exit?

Answer 18

1. ) decent
2. )flexion
3. ) internal rotation
4. )extension
5. )external rotation
6. ) expulsion

Question 19

what happens in the first stage of labour

Answer 19

frequent contractions are achieved: dilation and effacement occur

Question 20

describe latent phase of 1st stage

Answer 20

1. ) dilation ends at 3 cm and effacement ends at 40%
2. ) contractions are 5-10 min in between lasting from 30 to 45 seconds
3. ) woman can speak during contraction

Question 21

1. ) what does it mean if the nurse can indent the fundus during a contraction?
2. ) describe active phase of first stage of labor

Answer 21

1. ) it is considered a mild contraction
2. ) dilation from 4 - 7 cm and effacement from 40 - 80 %. Contractions are 2 - 5 min in between lasting 45 to 60 seconds. the woman in more inwardly focused

Question 22

Describe transition phase of the first stage

Answer 22

dilation ends at 10 cm and effacment ends at 100%. Contractions are now 1-2 min in between lasting 60 to 90 seconds

Question 23

1. ) what happens in the 2nd stage of labor
2. ) what happens in the 3rd stage of labor
3. ) what is normal blood loss

Answer 23

1. ) start at 10 cm dilation and ends with birth of the fetus
2. ) starts at birth of the fetus and ends with birth of the placenta
3. ) 500 ml vaginal birth. 1000 ml cesarean birth

Question 24

describe 4th stage of labor

2.) sings of placental separation?

Answer 24

this is when the mother is stabilized

2.) umbilical cord elongation, trickle of dark blood

Question 25

1. ) Maternal assessment during labor and birth 2. ) what is the purpose of vaginal exam 3. ) What is the priority when membranes rupture 4. ) how would you determine membrane rupture

Answer 25

1. ) assess vital signs and vaginal exam 2. ) check for dilation, effacement, presenting part 3. ) check FHR, assess how long the membrane has ruptured ( prolonged membrane rupture increases risk for infection) 4. ) nitrazine test (blue means rupture)

Question 26

1. )primary powers of labor | 2. ) how is this monitored?

Answer 26

1. ) contraction | 2. )external monitoring device, internal monitoring device

Question 27

Method to determine presentation, position, and lie of fetus. explain the process

Answer 27

1.) Leopold's maneuver 2.)Maneuver 1 determines which part is at the fundus Maneuver 2 determines which side the back is at maneuver 3 determines which part is the presenting part Maneuver 4 determines the extent of fetal engagement

Question 28

What do you do when amniotic fluid is stained green

Answer 28

prep suction and possible resuscitation

Question 29

1. ) how to assess Baseline FHR | 2. ) what is considered normal FHR

Answer 29

1. ) assess when mum is not contracting and baby is not moving 2. ) 110 to 160

Question 30

Category I fetal pattern Category II Category III

Answer 30

1. ) predictive of normal pattern, no interventions 2. ) require assessment and monitoring, no interventions 3. ) interventions are warranted

Question 31

temporary and recurrent baseline changes

Answer 31

periodic baseline changes

Question 32

1.) fluctuations of FHR baseline

Answer 32

variabilit

Question 33

1 Absent variability 2. ) minimal variabiltiy 3. ) normal varibility 4. )marked varibility

Answer 33

1. ) no change 2. )<5 3. ) 6 - 25 4. ) >25

Question 34

AKA laughing gas

Answer 34

nitrous oxide

Question 35

opioids

Answer 35

1. ) nalbuphine 2. )butorphanol 3. )meperidine 4. )fentanyl

Question 36

Provides pain relief without loss of consciousness 1. ) where in the spinal cord? 2. ) contraindications for epidurals 3. ) when is epidural given 4. ) what is the advantage of combined spinal epidural

Answer 36

regional anesthesia 1. ) below t8 or t10 2. ) spinal injury or history of surgery, bleeding disorders or anticoagulant therapy 3. ) 5 cm dilation 4. ) spinal epidural offers use of legs