Nursing Assessments in Labor and Delivery
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Questions and Answers

What characterizes the early phase of labor in terms of contractions?

  • Contractions are strong-very strong and q2-3 min apart
  • Contractions last longer than those in the active phase
  • Contractions peak quickly, similar to the active phase
  • Contractions are mild-moderate and q5-30 min apart (correct)

During the active phase of labor, which statement is true about effacement?

  • Effacement occurs intermittently with dilation
  • Effacement is primarily influenced by maternal mood
  • Effacement is not complete until delivery
  • Effacement is typically 100% complete (correct)

What behavioral change is typically observed during the active phase of labor?

  • The mother becomes irritable and preoccupied with herself (correct)
  • The mother is sociable and alert
  • The mother remains relaxed and open to instructions
  • The mother shows eagerness for labor progress

What is a common characteristic of contractions in the active phase of labor?

<p>Contractions last 60-90 seconds and occur every 2-3 minutes (B)</p> Signup and view all the answers

Which of the following is an example of a nursing intervention during the early phase of labor?

<p>Encouraging relaxation and emotional support (A)</p> Signup and view all the answers

What is the normal range for fetal heart rate at term?

<p>110-160 bpm (C)</p> Signup and view all the answers

Which of the following is a sign of placental separation during stage 3 of labor?

<p>Firmly contracting uterus (C)</p> Signup and view all the answers

What does the term 'Gravity' refer to in the GTPAL system?

<p>The number of pregnancies a woman has had (D)</p> Signup and view all the answers

Which statement about fetal heart rate variability is true?

<p>It is the normal irregularity of the cardiac rhythm. (B)</p> Signup and view all the answers

Which of the following is a positive sign of pregnancy?

<p>Fetal heart tones detected by ultrasound (D)</p> Signup and view all the answers

During labor, what does bradycardia refer to?

<p>Heart rate below 110 bpm for 10 minutes (C)</p> Signup and view all the answers

What is assessed to evaluate fetal wellbeing during labor?

<p>Fetal heart rate baseline and contraction characteristics (C)</p> Signup and view all the answers

At what gestational age is a baby considered preterm according to the GTPAL system?

<p>20-36.6 weeks (B)</p> Signup and view all the answers

Which of the following assessments is NOT part of the typical prenatal tests?

<p>Blood sugar test for diabetes (D)</p> Signup and view all the answers

Using Naegele’s Rule, how is the estimated due date (EDC) calculated?

<p>Add 9 months and 7 days to the last menstrual period (D)</p> Signup and view all the answers

What condition is characterized by hypertension with proteinuria that occurs after 20 weeks of gestation?

<p>Preeclampsia (C)</p> Signup and view all the answers

Which symptom is NOT considered a severe feature of preeclampsia?

<p>Increased placental perfusion (D)</p> Signup and view all the answers

Which drug is an antidote for magnesium sulfate toxicity?

<p>Calcium gluconate (B)</p> Signup and view all the answers

What is the primary goal of using Terbutaline in management?

<p>Stop preterm labor (A)</p> Signup and view all the answers

Which condition is characterized by seizures and is a severe complication of preeclampsia?

<p>Eclampsia (A)</p> Signup and view all the answers

Which of the following is a method to assess possible impaired liver function in a patient with severe features?

<p>CBC and metabolic panel (D)</p> Signup and view all the answers

What does RhoGam prevent in pregnancies where the mother is Rh- and the baby is Rh+?

<p>Maternal formation of anti-Rh antibodies (C)</p> Signup and view all the answers

Which is a common laboratory test performed to assess proteinuria in preeclampsia?

<p>Urine protein-to-creatinine ratio (C)</p> Signup and view all the answers

What role does Betamethasone play in managing pregnancies at risk for preterm birth?

<p>Stimulates fetal lung maturation (B)</p> Signup and view all the answers

What is a feature of HELLP syndrome?

<p>Laboratory involvement indicating severe preeclampsia (B)</p> Signup and view all the answers

What does a fetal heart rate (FHR) acceleration indicate?

<p>Fetal well-being (C)</p> Signup and view all the answers

What is the primary etiology of early decelerations in fetal heart rate?

<p>Fetal head compression (C)</p> Signup and view all the answers

Which of the following describes a late deceleration pattern?

<p>Gradual and uniform (A)</p> Signup and view all the answers

What is the recommended nursing intervention for variable decelerations?

<p>Change the mother's position to relieve cord compression (A)</p> Signup and view all the answers

What defines the duration of an FHR acceleration?

<p>Increase of 15 bpm for 15 seconds (B)</p> Signup and view all the answers

What is the most common cause of late decelerations?

<p>Uteroplacental insufficiency (C)</p> Signup and view all the answers

Which of the following is NOT a nursing intervention for late decelerations?

<p>Administer analgesics immediately (B)</p> Signup and view all the answers

How can minimal variability in FHR require intervention?

<p>It may precede fetal distress. (D)</p> Signup and view all the answers

Flashcards

GTPAL

A system used to record a woman's obstetric history. It stands for Gravida, Term, Preterm, Abortion, Living.

Gravida (G)

The number of pregnancies a woman has had, regardless of outcome.

Term (T)

The number of babies born at or beyond 37 weeks gestation.

Preterm (P)

The number of babies born between 20 and 36.6 weeks gestation.

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Naegele's Rule

A method for calculating the estimated date of confinement (EDC) or due date. It's calculated by adding 1 year, subtracting 3 months, and adding 7 days to the first day of the last menstrual period.

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Labor Stage 1

The longest stage of labor characterized by regular contractions that intensify and dilate the cervix.

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Labor Stage 2

The stage of labor marked by intense contractions and pushing, culminating in the delivery of the baby.

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Labor Stage 3

The delivery of the placenta following the birth of the baby.

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Labor Stage 4

The immediate postpartum period, where mother and infant are closely monitored for recovery and bonding.

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Fetal Heart Rate Baseline

The average fetal heart rate over a 10-minute period, typically ranging from 110 to 160 beats per minute.

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Fetal Fibronectin

A protein found in the cervix and fetal membranes. It is a marker for preterm labor, indicating a higher chance of delivering before 37 weeks.

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What is the primary focus of Stage 1 Labor?

To progress dilation and effacement of the cervix, while supporting the woman's physical and emotional well-being. It is a period of preparation for the baby's delivery.

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Active Phase of Labor

Marked by rapid dilation of the cervix from 6-10 cm, with strong contractions lasting 60-90 seconds, occurring every 2-3 minutes.

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What happens in Stage II Labor?

This is the pushing stage. It begins when the cervix is fully dilated (10 cm) and the mother feels the urge to push. It ends with the delivery of the baby.

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What is the primary focus of Stage III Labor?

Focus is on delivering the placenta after the baby is born. It involves ensuring the placenta comes out completely and the uterus contracts to prevent postpartum bleeding.

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FHR Baseline

The average fetal heart rate measured over a 10-minute period.

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Absent Variability

No fluctuations in fetal heart rate. This is a serious sign of fetal distress.

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Minimal Variability

Fetal heart rate fluctuates between 1-5 bpm. This indicates moderate fetal stress.

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Moderate Variability

Fetal heart rate fluctuates between 6-25 bpm. This is a reassuring sign of good fetal well-being.

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Marked Variability

Fetal heart rate fluctuates more than 25 bpm. This can indicate fetal stimulation or stress.

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Acceleration

A sudden increase in fetal heart rate of at least 15 bpm for 15 seconds or more.

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Early Deceleration

A gradual decrease in fetal heart rate that mirrors the contraction, caused by head compression.

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Late Deceleration

A gradual decrease in fetal heart rate that starts after the peak of the contraction, often caused by uteroplacental insufficiency.

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Gestational Hypertension

High blood pressure (BP) that develops during pregnancy for the first time, after 20 weeks gestation, with no proteinuria and resolves within 6 weeks postpartum.

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Preeclampsia

A serious pregnancy complication characterized by high BP and proteinuria (protein in urine) developing after 20 weeks gestation. It can also involve other severe features like impaired liver function, reduced platelet count, or visual disturbances.

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Severe Features of Preeclampsia

These are signs of worsening preeclampsia, requiring prompt medical intervention. They include BP ≥160 systolic or ≥110 diastolic, cerebral or visual changes, impaired liver function, progressive renal insufficiency, and low platelet count.

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Eclampsia

Preeclampsia that progresses to seizures or coma in the mother.

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Superimposed Preeclampsia/Eclampsia

Happens when a woman with chronic hypertension (high BP before pregnancy) develops preeclampsia or eclampsia.

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HELLP Syndrome

A severe form of preeclampsia involving hemolysis (destruction of red blood cells), elevated liver enzymes, and low platelet count.

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What is the pathological basis of preeclampsia?

Preeclampsia is characterized by inadequate vascular remodeling in the placenta leading to decreased placental perfusion and hypoxia. This triggers endothelial cell dysfunction and increased permeability resulting in vasospasm and generalized increased peripheral resistance, causing high BP.

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Magnesium Sulfate (MgSO4)

This medication is given to prevent seizures in women with preeclampsia or eclampsia. It also acts as a tocolytic (to stop contractions) in preterm labor.

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Betamethasone/Dexamethasone

Corticosteroids given to pregnant women at risk for preterm birth to stimulate fetal lung maturation and promote surfactant production for the baby's lungs.

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Nifedipine

A calcium channel blocker used as a tocolytic (to stop contractions) and to lower blood pressure in preeclampsia.

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Study Notes

Exam Review

  • Review materials thoroughly to succeed in exams.
  • Plan ahead for effective studying.
  • Avoid procrastination and prioritize studying early.

GTPAL

  • Gravity: Number of times pregnant.
  • Term: Number of babies born after 37 weeks.
  • Preterm: Number of babies born, 20-36.6 weeks gestation.
  • Abortion: Number of spontaneous or therapeutic abortions.
  • Living: Number of living children.

EDC/Due Date-Naegele's Rule

  • Information not provided.

Sarah's Due Date and History

  • Sarah is pregnant for the fifth time.
  • Current pregnancy is 8 weeks (3/15/2024 LMP).
  • History includes:
    • 10-week miscarriage
    • 32-week vaginal delivery
    • 34-week vaginal delivery
    • 37-week vaginal delivery

Stages of Pregnancy (Presumptive, Probable, Positive)

  • Presumptive: Symptoms suggestive of pregnancy (e.g., breast changes, nausea).
  • Probable: More objective signs of pregnancy (e.g., Goodell's sign, Chadwick's sign, Hegar's sign).
  • Positive: Definitive signs of pregnancy (e.g., visualization of fetus by real-time ultrasound, fetal heart tones, visualization by x-ray).

Prenatal Visits and Tests

  • Frequency of prenatal visits.
  • Assessments performed during prenatal visits.
  • Common discomforts during pregnancy.
  • Danger signs to watch out for.
  • Education provided during prenatal visits.
  • Fundal height measurements.
  • Amniocentesis
  • Kick counts.
  • Fetal Fibronectin
  • Amnisure.
  • NST, CST, BPP

Low-Risk Antepartum Client Visits

  • A low-risk client visits her obstetrician/midwife weekly in the last month of pregnancy.

Positive CST in a 37-Week Client

  • A positive CST indicates the fetus is well-oxygenated.
  • It doesn't necessarily mean an induction of labor is imminent or that the placenta isn't perfusing correctly.
  • More data is needed to infer possible problems in the uterine function.

Stages of Labor: Stage 1

  • Contractions cause effacement and dilation.
  • Labor is an involuntary power
  • Two phases: early and active stages

Stages of Labor: Stage 2

  • Contractions and pushing; delivery of the infant
  • Involuntary and voluntary powers
  • Pushing (gentle vs. forceful); positions
  • Assessments: uterus, bleeding, perineum

Stages of Labor: Stage 3

  • Delivery of the placenta
  • Signs of placental separation (e.g., firmly contracting uterus, sudden gush of dark blood).
  • Lengthening of umbilical cord
  • Vaginal fullness.

Stages of Labor: Stage 4

  • Assessments for bonding behaviors and infant feeding
  • Immediate postpartum observation.

Nursing Interventions for Stage 1 of Labor

  • Information about specific nursing interventions is not given.

Nursing Interventions for Stage 3 of Labor

  • Information about specific nursing interventions is not given.

Fetal Heart Rate Assessment during Labor

  • Aspects of fetal heart rate assessed to determine fetal well-being.

Fetal Heart Rate Baseline, Variability, and Changes

  • Baseline heart rate normal range (term).
  • Bradycardia: Fetal heart rate below normal range.
  • Tachycardia: Fetal heart rate above normal range.
  • Variability: Normal irregularity of the heartbeat.
  • Absent, minimal, moderate, marked categories for variability.
  • Accelerations (common with fetal movement, indicative of fetal well-being).
  • Decelerations (early, late, variable, prolonged)
    • Etiologies and causes Nursing interventions during decelerations.

VEAL CHOP MINE Mnemonic

  • A mnemonic used to help remember fetal heart rate patterns and their possible causes:
    • Variable decelerations = Cord compression
    • Early decelerations = Head compression
    • Accelerations = Okay
    • Late decelerations = Placenta insufficieny

Fetal Tracing Characteristics

  • Information provided isn't sufficient to determine characteristic traits.

Causes of Fetal Monitoring Tracing

  • Information provided isn't sufficient to determine possible causes.

High Risk: Preterm Labor

  • Risk factors: changes in vaginal discharge, pelvic pressure, dull backache, and uterine tightening.
  • Nursing implications: monitoring contractions and cervical change; to identify danger signs.

High Risk: Hypertension in Pregnancy

  • Various conditions characterized by elevated blood pressure during pregnancy are categorized.

Preeclampsia: Pathology

  • Inadequate vascular remodeling
  • Decreased placental perfusion and hypoxia
  • Vasospasm
  • Increased peripheral resistance and blood pressure
  • Increased endothelial cell permeability.
  • Intravascular protein and fluid loss
  • Decreased tissue perfusion in all organs
  • Reduced plasma volume.

Severe Preeclampsia Features and Interventions

  • BP (blood pressure) criteria.
  • Cerebral and visual changes.
  • Severe headaches.
  • Impaired liver function (epigastric pain).
  • Progressive renal insufficiency (oliguria).
  • Pulmonary edema.
  • Thrombocytopenia.

Patient with Severe Preeclampsia

  • Presence of protein in urine and elevated blood pressure with swelling in legs are indicative of a potentially severe preeclampsia case.
  • Platelet count below 90,000 is a critical parameter.

High-Risk Conditions: Placenta Previa & Placental Abruption

  • Information provided isn't sufficient to determine the conditions.

Postpartum Assessment

  • Comprehensive postpartum assessments include breasts, uterus, bladder, bowel, lochia, episiotomy/lacerations, hemorrhoids, and emotional status.

Postpartum Hemorrhage and Uterine Atony

  • Excessive blood loss (>1000ml) after childbirth, frequently related to uterine atony.
  • Predisposing factors and assessments to determine the reason for the blood loss.

Newborn Complications

  • Prematurity (definition, complications, assessments)
  • Respiratory distress syndrome (RDS)
  • Transient tachypnea of the newborn (TTN)
  • Birth trauma (caput and cephalhematoma, infections, NAS).
  • Blood sugar issues (hypoglycemia).
  • Risk factors, assessments, and interventions for each.

Newborn Swelling

  • Report finding to the medical provider.

Newborn Heat Loss

  • Drying a newborn prevents evaporation heat loss.

Newborn Bathing

  • Information provided isn't sufficient to form teaching points.

Medications and Considerations

  • Information about medications and their usage.
  • Side effects for some of the pregnancy medications are provided.

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Description

This quiz covers key concepts related to the stages of labor, including contractions, fetal heart rate, and the GTPAL system. Test your knowledge on nursing interventions, signs of pregnancy, and fetal wellbeing assessments. Perfect for nursing students and professionals preparing for labor and delivery scenarios.

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