intrapartum

Question 1

Advantages on FEM ultrasound

Answer 1

continuous graphic recording
Baseline, variability, changes in FHR
Noninvasive
Doesn’t require ROM
Nurse can place

Question 2

disadvantages to FEM ultrasound

Answer 2

Susceptible to interference with movement
Weak signal
Tracing may be difficult to interpret

Question 3

where should the ultrasound be placed to obtain the best reading?

Answer 3

Fetal shoulder area

Question 4

advantages of FEM with toco monitor

Answer 4

Noninvasive, easy to place
Intermittent use
Permanent continuous recording
Nurse can place and palpate contractions

Question 5

disadvantages of FEM with toco monitor

Answer 5

Nurse must compare to subjective data
belt may be uncomfortable
Mom may feel limited to move
Doesn’t measure intensity

Question 6

where should the Toco monitor be placed to get the best reading?

Answer 6

On the fundus

Question 7

Advantages of internal fetal scalp monitor

Answer 7

Clear tracings
Better information about variability
Nurse can place
Useful for overweight moms, due to increased Adipose tissue

Question 8

Disadvantages of fetal scalp monitor

Answer 8

infection, injury
Requires ROM, cervical dilation, invasive
Cannot be used in HIV positive moms

Question 9

advantages of IUPC

Answer 9

Pressure measurements for intensity/resting tone
Accurate timing of contractions
Permanent record of uterine activity

Question 10

Disadvantages of IUPC

Answer 10

ROM required with adequate dilation
Invasive
Risk for infection, uterine/personal injury
Provider places

Question 11

ways to test rupture of membranes

Answer 11

Nitrazine paper
Ferning test
Amnisure

Question 12

early decelerations

Answer 12

Caused by head compression
Mirrors inversely; contraction increases, HR decreases
Last 30 seconds
Occurs at zero station

Question 13

Late decelerations

Answer 13

due to uteroplacental insufficiency,
Hypo/hypertension, bleeding
Onset at peak of contraction

Question 14

variable decelerations

Answer 14

Due to cord compression
With or without contractions
Abrupt onset to Nadir

Question 15

Are intermittent variable decelerations normal?

Answer 15

Yes, physiologic labor response

Question 16

Nursing interventions for decelerations

Answer 16

change position
Oxygen
Turn oxytocin off
IVF. Bolus.
Lower HOB

Question 17

prolonged decelerations

Answer 17

Greater than or equal to two minutes for less than 10 minutes

Question 18

What is considered a baseline change?

Answer 18

Increase or decrease in heart rate for longer than 10 minutes

Question 19

sinusoidal pattern

Answer 19

Perfect waveform, category three
Indicates acidosis
Notify HCP, need to be delivered

Question 20

what is the best indication of fetal oxygenation?

Answer 20

Variability

Question 21

Absent variability

Answer 21

undetectable
In distress

Question 22

Minimal variability

Answer 22

<5 bpm
Can indicate sleep cycle, pain, medication, relaxation, magnesium sulfate

Question 23

moderate variability

Answer 23

6–25 bpm
Desired range

Question 24

Marked variability

Answer 24

> 25 bpm

Question 25

if the baby is tachycardic what is the next best nursing action?

Answer 25

Check the mothers temperature

Question 26

reassuring FHR

Answer 26

110–160 Long-term variability Appropriate accelerations

Question 27

non-reassuring FHR

Answer 27

Late decelerations Low variability Severe Brady/tachycardia Sinusoidal pattern Persistent variables

Question 28

nursing care for non-reassuring patterns

Answer 28

Change positions Turn off Pitocin Increase IVF Lower HOB Oxygen – 10 L nonrebreather Notify HCP and document Tocolytics, if contracting Delivery preparation

Question 29

Nursing Care first stage latent

Answer 29

anticipatory guidance Encourage ambulation VS Q1 hour Temp Q4/Q2 ROM FHR Q 30–60 minutes

Question 30

nursing Care, first stage active

Answer 30

Palpate contractions Q 15–30 minutes Vaginal exam Encourage voiding Q 1–2 hours IVF Auscultate, HR 15–30 minutes VS Q 15–30 minutes Change positions and pads

Question 31

nursing Care, first stage transition

Answer 31

Palpate contractions Q 15 minutes Sterile vaginal exam FHR 15–30 minutes assist with breathing Keep from pushing less than 10 cm * peanut ball good for epidural

Question 32

Comfort care first stage

Answer 32

clear fluids, ice chips Ambulation, Peri care Position changes Distraction, circular massage Firm pressure on back/sacrum Controlled breathing Hydrotherapy

Question 33

Nursing, Care, Second stage

Answer 33

sterile vaginal exam FHR Q 5– 15 minutes VS Q 30 minutes Assist with pushing and birth

Question 34

Comfort second stage

Answer 34

cool cloth Rest between contractions Assist into pushing position

Question 35

nursing Care third stage

Answer 35

Newborn care Provide stimulation and maintain warmth Apgar, newborn ID Facilitate kangaroo care Monitor for delivery of placenta

Question 36

nursing Care fourth stage

Answer 36

VS Q 15 minutes for first hour IVF. – Pitocin. Palpate fundus Q 15 minutes for first hour Assess vaginal bleeding Assist with feeding methods

Question 37

Comfort care fourth stage

Answer 37

Heated blanket Food/fluids, PRN Ice pack to perineum Pain, meds, PRN

Question 38

postpartum danger signs

Answer 38

Hypotension Tachycardia Uterine atony Excessive bleeding Hematoma

Question 39

discharge criteria

Answer 39

Stable vital signs, bleeding Nondistended bladder Firm fundus Report return of sensations from anesthesia