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Questions and Answers
What is an important reason to assess the mother's bladder during labor?
Which of the following fetal heart rate monitoring patterns indicates a potential issue with the placenta?
During the physical assessment, what should be monitored at least every 30 minutes?
What is a normal fetal heart rate range for a fetus during labor?
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Which assessment finding could indicate a risk for preeclampsia?
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What is the preferred fetal position during labor?
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What does the VEAL CHOP acronym help to assess during labor?
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What should be assessed first when the rupture of membranes occurs?
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Which of the following presentations is considered a risk during delivery?
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What should be done if fetal heart rate cannot be attained externally?
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What is the significance of checking the knee deep tendon reflexes (DTR) during labor?
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What color of amniotic fluid is considered normal?
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What is the average duration of labor for a primipara compared to a multipara?
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Which action may help a mother encourage a baby to turn into a more favorable position without anesthesia?
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What is a sign of potential infection after rupture of membranes?
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What interventions can be used to alleviate back pain when the fetal position is OP?
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What is required for pregnant women presenting with contractions at the ER?
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Which of the following accurately describes a characteristic of true labor?
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What should be administered to a patient with a positive Group Beta Strep test after their water breaks?
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What action should be taken if a woman is in false labor?
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Which of these is a sign that a woman should return to the hospital during labor?
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Why is consent for a C-section important?
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What does true labor require that false labor does not?
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What is the purpose of administering floras or tocolytics in labor management?
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What may indicate a need for surgical intervention during labor?
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What is a recommended nonpharmacological method of pain management during labor?
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What occurs if pushing starts too early before the cervix is fully dilated?
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What method should be avoided during the Second Stage of Labor due to its risk of decreasing perfusion?
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What is the maximum time allowed for the delivery of the placenta after birth?
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What indicates that the placenta is ready to be delivered?
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What is an important nursing intervention to manage the risk of infection during labor?
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What is a risk associated with administering IV narcotics within one hour of delivery?
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What should be assessed immediately after the placenta is delivered to prevent hemorrhage?
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What is the normal estimated blood loss for a vaginal delivery?
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What could happen if oxytocin is administered before the delivery of the placenta?
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Which is a contraindication for the administration of oxytocin?
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During the administration of anesthesia in labor, what is essential to prevent hypotension?
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What position should the patient be in to prevent hypotension during anesthesia?
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What is a potential sign of uterine atony after delivery?
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How long does the third stage of labor typically take for the delivery of the placenta?
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What should be monitored every 5 minutes during labor?
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What is a common intervention to address hypovolemia after delivery?
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Study Notes
Emergency Medical Treatment & Labor Act (EMTALA)
- All patients presenting to the ER must be treated and stabilized.
- Pregnant women in labor are considered unstable and require assessment and treatment regardless of insurance status.
- True labor involves progressive cervical change (dilation and effacement).
- False labor involves contractions without cervical change.
- Interventions for false labor: Rest, fluid bolus (1L LR), pain medication, tocolytics (terbutaline or ritodrine) to stop contractions.
- Return to hospital if contractions occur every 3 minutes, talking is painful between contractions, or water breaks.
Differentiating True vs. False Labor
- True labor: contractions intensify with position changes, located in lower back radiating to lower abdomen.
- False labor: contractions stop with position changes, located in the back of the abdomen above the umbilicus.
Rapid Review
- Obtain complete medical history, physical assessments, labs, consents, and review of birth plans.
- Understand Group Beta Strep: Swab at 36 weeks, IV antibiotics after water breaks (4 hours of coverage) protect the baby from infection.
- Consent for C-section: Obtain consent as delivery can become emergent.
- Birth plans: Respect mother's wishes within safety guidelines.
- Prioritize patient care based on triage information: immediate, next, third, fourth, and last to see.
First Stage of Labor
- Early phase: 0-5 cm dilation.
- Active phase: 6-10 cm dilation.
- Pain assessment: Review records, health history (G and P), gestational age, psychosocial assessment, appearance, support system, birth plan and expectations, cultural considerations.
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Physical assessment: Head-to-toe, including:
- Facial swelling, broken teeth, tonsils (assessing need for intubation).
- Cardiac assessment: BP between contractions every 30-60 minutes and 15-40 minutes in active labor.
- Respiratory assessment.
- Abnormal fetal heart tone: Umbilicus and above.
- Domestic violence screening.
- Urine for glucose, protein, and WBC.
- Check for leaking water: FHR COAT, fluid sample, ferning test, or pH test.
- Knees: DTR 1-2 normal, 3 brisk, 4 hyperlexia (preeclampsia).
- VS: HR 60-100, normal resp 12-20, BP under 140/90, O2 sat 95%.
- DVT assessment and measurements.
- Feet: Clonus to assess secondary reflex.
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Fetal monitoring: External (US or external fetal monitoring) and internal (if needed for accurate FHR).
- Normal fetal heart tone: 110-160 bpm with variability of 6-25 beats.
- Bradycardia: Possible causes include walking, caffeine.
- Absent variability: Potential brain damage.
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VEAL CHOP
- Variable decelerations: Cord compression. Interventions include changing position to relieve pressure and increasing fluids.
- Early decelerations: Head compression. A good sign indicating baby's readiness for delivery.
- Accelerations: OK. A good sign after 32 weeks.
- Late decelerations: Placental insufficiency. Interventions include stopping Pitocin, changing mom's position, O2 mask, calling the doctor.
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Leopold Maneuver: Determines baby's position and orientation to the pelvis (cephalic, breech, transverse).
- Preferred fetal position: Cephalic, vertex (chin to chest), OA.
- OP position: Pressure and back pain, may slow labor. Interventions include pelvic tilts, lunges, side-to-side turning, Peanut ball.
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Rupture of membranes (ROM): Check fetal heart tones first to assess for potential cord compression.
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COAT:
- Color: Normal: Clear/straw color with white flecks. Abnormal: Meconium staining (indicates fetal distress) requires NICU presence at delivery due to aspiration risk.
- Odor: Normal: No odor.
- Amount: Variable and documented.
- Time: Start ABX 18-24 hours after ROM. Monitor FHR, hourly temperature (tachycardia and fever indicate infection).
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COAT:
Labor Progress
- Multiparas deliver faster than primiparas.
- Labor curve: Reflects expected labor progression for primiparas and multiparas.
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Maternal labor nursing interventions:
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Pain management:
- Nonpharmacological: Hydrotherapy, ambulation, massage, breathing techniques, slow deep breaths.
- Pharmacological: IV medications, screen for narcotic use, IV administration within 1 hour before delivery, Narcan for baby if needed.
- Hyperventilation: Cup hands to increase CO2.
- Ice chips and light soups: Risk for emergency surgery.
- Voiding frequently.
- Linen changes due to fluid leaks.
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Pain management:
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Epidural: Contraindications include platelet count under 100,000 (bleeding risk), previous spinal surgery, CNS disorders, MRSA legion, allergy to -caine.
- Should be administered during active labor (3-4cm dilated).
- Preload with 1-2L LR or NS to prevent hypotension.
Second Stage of Labor
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Pushing: Begins after full dilation (10 cm) and ends with delivery.
- Open glottis pushing: Preferred method with an open airway.
- Closed glottis pushing: Valsalva maneuver (not recommended due to decreased perfusion).
- Delivery preparation: Set up delivery table with bulb syringe, cord clamp, sterile supplies, and ensure visualization for parents.
- Pushing technique: Push with contractions and rest between. Duration can vary from 1 push to 3 hours.
Third Stage of Labor
- Delivery of the placenta: Must occur within 20-30 minutes. Delay indicates potential excreta or retained placenta, increasing the risk of hemorrhage.
- Signs of placental separation: Uterus rises, cord lengthens, gush of blood.
- Placenta inspection: Ensure complete removal.
- Oxytocin administration: After placenta delivery to decrease bleeding and shrink the uterus.
- Uterus assessment: Firmness and bladder status.
Fourth Stage of Labor
- Focus on maternal well-being: Monitor for bleeding and hypovolemic symptoms.
- Uterus check: Firmness (soft and spongy uterus indicates bleeding).
- Breastfeeding: Encourage within 1-2 hours after delivery.
Complications and Interventions
- Preterm labor: Contractions less than 2 per 5-minute period. Interventions include steroids for fetal lung development, magnesium sulfate for fetal neural protection, and terbutaline (contraindications: HR over 110-120).
- Post-dates: Baby may be too big.
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Uterine dysfunction:
- Hypertonic: Fluids.
- Hypotonic: Pitocin.
- Shoulder dystocia: Turtle sign, McRoberts maneuver, suprapubic pressure, Woods maneuver.
- Prolapsed cord: Call for assistance, examine, push on presenting part, lateral recumbent position.
- Amniotic fluid embolism: Anaphylaxis.
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Description
Test your understanding of the Emergency Medical Treatment and Labor Act (EMTALA) and its implications for patient care in emergency situations. This quiz covers the differentiation between true and false labor, treatment protocols, and essential assessments needed by healthcare providers.
