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Questions and Answers
What does fetal lie refer to?
Which type of fetal presentation occurs in 96% of cases?
What is caput succedaneum?
What indicates a poor attitude in a breech presentation?
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Which of the following best describes a complete breech presentation?
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What is oligohydramnios associated with in a fetus?
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Which of the following correctly defines breech presentation?
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What classification falls under longitudinal lies?
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What typically begins at 10 cm of dilatation in the second stage of labor?
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Which change occurs in the contractions during the second stage of labor?
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What does the term 'crowning' refer to during the second stage of labor?
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How does a patient typically respond as the fetal head descends during labor?
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What is the first phase of the third stage of labor?
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What happens during placental separation?
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What may occur as the patient pushes during the second stage of labor?
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What is an effect of the descent of the fetus in the second stage of labor?
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What is the recommended nursing action if a patient is experiencing diaphoresis during labor?
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What is a potential physiological response in the urinary system during labor?
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Why is monitoring fluid balance important during labor?
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How does relaxin affect the musculoskeletal system during pregnancy?
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What nursing action is recommended for maintaining hydration during labor?
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What should be monitored due to the potential for increased body temperature during labor?
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What is a common response of the gastrointestinal system during labor?
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How often should the birthing parent be asked to void during labor?
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What is a common cultural preference that should be considered when caring for a patient post-delivery?
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How much does cardiac output increase from prelabor levels during labor?
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What is the average amount of blood loss at birth?
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Which condition requires additional precautions during labor and birth due to potential complications?
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What nursing action is recommended if epidural anesthesia is administered?
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What is the normal range for WBCs during labor compared to the usual levels?
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What is a potential risk associated with a pregnant patient having sexually transmitted infections?
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What is a potential consequence of hyperventilation during labor?
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Which family history element could indicate a need for specialized care during surgery?
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What percentage increase in total oxygen needs occurs during the second stage of labor?
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During a physical examination in labor, what should the initial assessment focus on?
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Which of the following symptoms may indicate an abnormal physiological response during labor?
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What symptom might pallor in a patient indicate during the assessment?
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Which assessment should be included in a pelvic examination during labor?
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What is an important step before conducting an HIV test?
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What finding may indicate a respiratory infection during a physical examination?
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Study Notes
Fetal Positioning
- Fetal malposition may occur due to oligohydramnios, reducing fetal movement space, or neurologic abnormalities leading to spasticity.
- Fetal lie describes how the long axis of the fetus aligns with the long axis of the mother's body.
- Longitudinal lie can be cephalic (head first) or breech (feet or buttocks first)
- Cephalic presentation occurs in approximately 96% of births, with the vertex being the ideal presenting part for effective cervical molding.
- Caput succedaneum, an edema on the fetal skull, can form during labor and helps identify the presenting part of the fetus.
- Breech presentation involves the buttocks or feet contacting the cervix.
- Complete Breech: Thighs are flexed; both buttocks and feet present.
Stages of Labor
-
Second Stage: Full dilatation and cervical effacement to infant birth
- Contractions: 2-3 minutes apart, lasting 60-75 seconds, with strong intensity.
- Pushing sensations become uncontrollable and may lead to momentary nausea or vomiting.
- As the fetal head descends, the perineum bulges and appears tense, and the anus may evert.
- Crowning occurs when the fetal scalp appears at the vaginal opening and increases in size.
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Third Stage: Placental Stage
- Begins with infant birth and ends with placental delivery.
- Two phases: Placental separation and placental expulsion.
- Placental separation causes bleeding on the maternal surface, aiding further separation from the attachment site.
- Patients may wish to take home the placenta for cultural reasons.
- Cord blood samples can be taken for future stem cell transplantation.
Maternal Physiological Effects of Labor
- Cardiovascular System:
- Cardiac output increases significantly.
- Blood pressure may rise due to contractions and pain response.
- Epidural anesthesia can cause hypotension.
- Monitor for hemorrhage and signs of pathology.
- Hematopoietic System:
- White blood cell count rises during labor.
- Monitor for signs of infection.
- Respiratory System:
- Increased respiratory rate due to cardiovascular activity.
- Total oxygen needs double during the second stage of labor.
- Monitor for hyperventilation.
- Temperature Regulation System:
- Body temperature may increase slightly.
- Diaphoresis (sweating) occurs to help with cooling.
- Monitor for signs of infection.
- Fluid Balance:
- Insensible water loss increases.
- Encourage fluid intake.
- Urinary System:
- Fetal head pressure reduces bladder tone.
- Encourage voiding every 2 hours.
- Musculoskeletal System:
- Relaxin secreted during pregnancy increases joint flexibility, allowing the pelvic joints to open during labor.
- Monitor for appropriate mobility and fall risks.
- GI System:
- Blood shunts to vital organs, reducing GI activity.
- Follow hospital protocols regarding oral intake.
Medical History Assessment
- Past Health History:
- Document any previous surgeries, heart diseases, diabetes, anemia, tuberculosis, kidney disease, hypertension, or sexually transmitted infections to ensure safe birthing practices.
- Assess risk for drug abuse or HIV exposure.
- Family Medical History:
- Inquire about inherited conditions such as cognitive challenges, heart disease, blood dyscrasia, diabetes, kidney disease, allergies, seizures, hearing loss, or malignant hyperthermia.
Physical Exam
- Overall Appearance:
- Assess for tiredness, paleness, illness, fear, edema, dehydration, and open lesions.
- Palpate neck lymph nodes for signs of respiratory infection.
- Inspect mucous membranes and conjunctiva for pallor indicating anemia.
- Examine teeth for caries or abscesses.
- Inspect lips for herpes lesions.
- Adapt further examination techniques based on labor stage and progression.
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Description
This quiz covers fetal positioning, including malpositions and presentations, as well as the stages of labor, specifically the second stage. Understand key concepts such as fetal lie, cephalic presentation, and the dynamics of labor contractions. Test your knowledge of these critical topics in obstetrics.
