Nursing in Labor and Delivery Unit 4
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Questions and Answers

What does the acronym "LOP" refer to?

  • Left Sacrum Posterior
  • Left Occiput Transverse
  • Left Mentum Anterior
  • Left Occiput Posterior (correct)

    • Which of these positions typically results in a more challenging delivery because the baby's back of the head faces towards the mother's back, potentially leading to back pain and longer labor.

  • ROA
  • ROP (correct)
  • LOT
  • LMA

    • What does the abbreviation "LSA" represent regarding fetal positioning?

  • Left Shoulder Anterior
  • Left Mentum Anterior
  • Left Sacrum Anterior (correct)
  • Left Occiput Anterior

    • A baby in which position is facing the mother's left side with their chin tucked towards their chest?

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

    Which of these positions indicates the baby's back of the head is facing the mother's right side and pointing towards the front?

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

    Which of these positions signifies the baby's back of the head is directly positioned towards the mother's back?

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

    What does the acronym "LOT" represent regarding fetal positioning?

    <p>Left Occiput Transverse (C)</p> Signup and view all the answers

    Which of these positions is considered the most favorable for childbirth?

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

    What is the primary reason why uterine relaxation between contractions is essential for fetal oxygenation?

    <p>It allows for increased blood flow to the placenta. (B)</p> Signup and view all the answers

    Which of the following is a potential cause of fetal tachycardia?

    <p>Maternal fever (D), Maternal dehydration (A)</p> Signup and view all the answers

    What is the primary purpose of the tocodynamometer (TOCO) transducer?

    <p>To monitor duration and frequency of contractions (D)</p> Signup and view all the answers

    What are the smooth muscle adaptations that promote expulsion of the fetus during labor ?

    <p>Facilitates cervical dilation (A), Stretching of pelvic smooth muscle (B)</p> Signup and view all the answers

    What is somatic pain during labor? (Select all that apply)

    <p>Fetal head pressure in perineum (A), Experienced in the first stage of labor (B), Perineal tissue stretching (C)</p> Signup and view all the answers

    Which of the following is a nursing action that can be taken to address a client experiencing umbilical cord prolapse?

    <p>Positioning the client in a knee-chest position. (A)</p> Signup and view all the answers

    Which of the following is an example of a nursing intervention for a client experiencing incontinence during labor?

    <p>Offering absorbent pads (D)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of a Category II FHR tracing?

    <p>Uterine contractions exceeding 90 seconds in duration. (C)</p> Signup and view all the answers

    A nurse is caring for a postpartum client who is experiencing uterine atony. Which of the following interventions should the nurse prioritize?

    <p>Administering a dose of oxytocin (B)</p> Signup and view all the answers

    A nurse is assessing a postpartum client 24 hours after a vaginal delivery. Which of the following findings would indicate a potential complication?

    <p>Pulse rate of 100 beats per minute (D)</p> Signup and view all the answers

    A nurse is caring for a client who is receiving magnesium sulfate. Which of the following assessments should the nurse prioritize? (Select all that apply)

    <p>Maternal Respiratory Rate and Fetal HR Pattern (A), Patellar reflexes (B), Uterine activity and Urine output (C)</p> Signup and view all the answers

    A nurse is providing education to a client who is at risk for placental abruption. Which of the following factors should the nurse include in their teaching?

    <p>History of multiple pregnancies (B)</p> Signup and view all the answers

    A nurse is caring for a client who is 36 weeks pregnant and undergoing an external cephalic version. What action should the nurse take prior to the procedure?

    <p>Obtain a fetal heart rate tracing (A)</p> Signup and view all the answers

    A nurse is assessing a postpartum client's lochia. Which of the following findings would be considered normal 5 days after a vaginal delivery?

    <p>Lochia serosa, moderate amount of flow (B)</p> Signup and view all the answers

    Which of the following is a risk factor for postpartum hemorrhage?

    <p>History of a BMI greater than 40 (D)</p> Signup and view all the answers

    A nurse is caring for a postpartum client who is experiencing a boggy uterus. Which of the following interventions should the nurse implement?

    <p>Perform a fundal massage (B)</p> Signup and view all the answers

    Which of the following medication classes is primarily used for treating excessive vaginal bleeding?

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

    What is a common risk factor associated with placenta accreta?

    <p>Previous cesarean delivery (A)</p> Signup and view all the answers

    Which of the following symptoms is NOT a manifestation of postpartum infection turning into sepsis?

    <p>Hyperactivity (D)</p> Signup and view all the answers

    Which risk factor significantly increases the likelihood of developing deep vein thrombosis in the postpartum period?

    <p>BMI greater than 35 (A)</p> Signup and view all the answers

    Which condition is characterized as a hereditary bleeding disorder that may increase the risk of postpartum hemorrhage?

    <p>Von Willebrand disease (C)</p> Signup and view all the answers

    Which of the following is a characteristic of an overt prolapsed cord?

    <p>The cord becomes compressed by the fetal presenting part (D)</p> Signup and view all the answers

    What is the priority intervention for a client experiencing moderate acute placental abruption?

    <p>Initiate IV access (C)</p> Signup and view all the answers

    What indicates shoulder dystocia during birth?

    <p>Fetal head emerges and then retracts (A)</p> Signup and view all the answers

    What happens during a uterine rupture?

    <p>The three muscular layers of the uterus tear apart (B)</p> Signup and view all the answers

    Which action is essential when caring for a client with chorioamnionitis?

    <p>Monitor fetal heart rate patterns (C)</p> Signup and view all the answers

    In a home birth, which of the following is a contraindication?

    <p>Multiple gestation pregnancies (A)</p> Signup and view all the answers

    What is the expected outcome after delayed cord clamping in newborns?

    <p>Higher blood volume and improved iron status (C)</p> Signup and view all the answers

    During a cesarean section, which pain management technique is most appropriate?

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

    What is the primary nursing action when a fetus is found to be in a transverse lie?

    <p>Contact the provider as this position may require intervention. (A)</p> Signup and view all the answers

    What is visceral pain during labor? (Select all that apply)

    <p>Uterine contractions (A), Cervical dilation (B), First stage of labor - Lower abdomen, back, legs (C)</p> Signup and view all the answers

    Flashcards

    Transverse Lie

    Fetus is positioned sideways in the uterus.

    Face Presentation

    Fetus's neck is extended with the face presenting during labor.

    5 P's of Labor

    Factors influencing labor: Passenger, Passageway, Powers, Position, Psychologic.

    Fetal Positioning

    Fetal positioning affects delivery; labels indicate orientation and attitude.

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    Labor Progression

    The pattern and stages through which labor develops.

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    Increased cardiac output

    An increase in the heart's ability to pump blood, promoting fetal oxygenation.

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    Dilation

    The widening or opening of the cervix during labor, indicating progress.

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    Effacement

    The thinning and shortening of the cervix as labor progresses.

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    Station

    The position of the fetus within the maternal pelvis related to the ischial spines.

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    Tocodynamometer (TOCO)

    A device used to monitor uterine contractions during labor.

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    Persistent fetal bradycardia

    A condition where the fetus has a heart rate less than 110 beats per minute.

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    Uterine relaxation

    The period between contractions, essential for fetal oxygenation.

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    Umbilical cord prolapse actions

    Nursing actions include repositioning, IV fluids, and oxygen to support fetus if cord slips out.

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    Uterotonics

    Medications used to reduce excessive vaginal bleeding post-delivery.

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    Complications of cord traction

    Risk of uterine inversion or tearing during the 3rd stage of labor.

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    Risk factors for postpartum hemorrhage

    Conditions like high BMI and previous hemorrhagic history increase risk after delivery.

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    Deep vein thrombosis postpartum

    Blood clots that can form in legs due to high BMI and diabetes after childbirth.

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    Postpartum infection & sepsis

    Sepsis can arise from infection in postpartum with symptoms like hypotension and tachycardia.

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    Nurse monitoring for magnesium sulfate

    Monitor FHR pattern, reflexes, respiratory rate, urine output, uterine activity.

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    External cephalic version

    Procedure to turn the fetus from breech to vertex position; involves understanding and preparation.

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    Risks for placental abruption

    Factors include gestational diabetes, abdominal trauma, low hemoglobin, and preeclampsia.

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    Postpartum fundal assessment

    Fundus should be firm and located between the pubis and umbilicus; decreases 1 cm per day postpartum.

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    Lab values post vaginal birth

    Expect hemodilution; WBCs can increase to 25,000; gradual increase in hemoglobin and hematocrit afterward.

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    Cervical changes postpartum

    The cervix heals within weeks, and the external os becomes a transverse slit.

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    Lochia description on a pad

    Lochia varies: scant, light, moderate, heavy; colors change from dark red to yellow.

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    ROA

    Right Occiput Anterior position, where the baby's back is against the mother's right side.

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    LOA

    Left Occiput Anterior position, where the baby's back is against the mother's left side.

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    ROP

    Right Occiput Posterior position, where the baby's back is against the mother's right side, but facing her spine.

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    LOP

    Left Occiput Posterior position, where the baby's back is against the mother's left side, but facing her spine.

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    ROT

    Right Occiput Transverse position, where the baby is positioned sideways with the head pointing to the right.

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    LOT

    Left Occiput Transverse position, where the baby is positioned sideways with the head pointing to the left.

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    RMA

    Right Mentum Anterior position, where the baby's chin is down and positioned on the right side.

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    LMA

    Left Mentum Anterior position, where the baby's chin is down and positioned on the left side.

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    Non-pharmacological techniques for back pain

    Methods like physical therapy, heat application, and exercise to alleviate back pain without medication.

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    Antagonist for opioid pain medication

    A medication that blocks the effects of opioids, such as naloxone, used in cases of overdose.

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    Pain management for perineal lacerations

    Options include ice packs, sitz baths, and topical anesthetics to ease discomfort after delivery.

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    Complications of epidural

    Potential issues include headache, infection, nerve damage, or puncture of the spinal cord.

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    Signs of respiratory distress in newborn

    Indicators include grunting, nasal flaring, and retractions of the chest wall.

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    Turtle sign

    A clinical indicator of shoulder dystocia where the fetal head emerges and then retracts.

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    Characteristics of overt prolapsed cord

    The cord slips through a dilated cervix and gets compressed by the fetal presenting part.

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    Leopold's maneuvers

    A series of abdominal palpations used to determine fetal position, such as breech presentation.

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    Study Notes

    Unit 4 Labor

    • Review nursing actions for a transverse fetal lie: Contact provider
    • Labor progression with face presentation: Face presentation fetal neck extension, labor may progress slower than anticipated
    • Five Ps of labor:
      • Passenger: Directly relates to the fetus
      • Passage: Refers to maternal pelvis and surrounding soft tissues
      • Powers: Maternal efforts during labor, including pushing
      • Position: Maternal position
      • Psyche: Emotional state of the client
    • Review fetal positioning and labels for each position (Right, Left, Occiput, Mentum, Anterior, Posterior, Transverse). (See table/chart for complete list)

    Rupture of Membranes

    • Rupture of membranes usually happens before contractions begin.

    Maternal Physiological Adaptations

    • Increased cardiac output promotes fetal oxygenation (increased stroke volume and heart rate).

    Elevated WBC Count in Labor

    • Elevated white blood cell count warrants monitoring of temperature.

    Incontinence During Labor

    • Absorbent pads for incontinence.

    Elongated Newborn Heads

    • Molding: Spaces between the fetal skull bones allow the fetal head to change shape, including elongated shapes.

    Dilation, Effacement, and Station in Labor

    • Dilation: Widening of the cervix.
    • Effacement: Thinning and shortening of the cervix.
    • Station: Fetal position within the maternal pelvis relative to the ischial spines.

    Tocodynamometer Troubleshooting

    • If the tocodynamometer is not recording accurately, notify the provider.

    Late Decelerations on Fetal Monitor

    • Reposition the client to a left lateral position.
    • If no recovery to baseline, emergent birth is necessary.

    Persistent Fetal Bradycardia

    • If persistent fetal bradycardia occurs after intervention, notify the provider.

    Fetal Tachycardia Causes

    • Potential causes include maternal fever, and maternal dehydration.

    Sinusoidal Fetal Heart Pattern

    • Intrauterine resuscitation (increase fetal oxygenation) is necessary.

    Category II FHR Tracing Characteristics

    • Bradycardia
    • Minimal baseline variability
    • Prolonged decelerations
    • Variable or late decelerations with minimal or moderate baseline variability.

    Tocodynamometer (TOCO) Transducer Purpose

    • Provides information related to the duration and frequency of contractions.

    Uterine Contractions & Fetal Oxygenation

    • Uterine relaxation between contractions is essential to ensure fetal oxygenation.

    Smooth Muscle Adaptations for Labor

    • Stretching of pelvic smooth muscle facilitates cervical dilation, promoting fetal expulsion.

    Umbilical Cord Prolapse Care

    • Repositioning, IV fluids, oxygen, discontinue uterotonic medications.
    • If the problem persists after interventions, notify the provider.

    Unit 4 Pain Management

    • Somatic vs. visceral pain during Labor
      • Visceral: Uterine contraction, Cervical dilation (lower abdomen, back, legs)
      • Somatic: Fetal head pressure in perineum, stretching of pelvic muscles (perineal tissue stretching)
    • Cultural practices influence pain: Cultural beliefs, and practices affect pain relief.
    • Anxiety & Pain: Anxiety, and perceived pain are influenced by the patient's support system, emotional state, and anxiety level.
    • Coping Mechanisms in perception of pain positive Coping: Moaning, Rhythmic movements, breathing, relaxed between contractions
    • Non-Pharmacological Techniques: Positioning (Maternal satisfaction), ambulation, high-Fowler's, squatting.
    • Non-Pharmacological Techniques for Anxiety/Psychosis: Support/coping mechanisms.

    Unit 4 Birth

    • Contraindications to home births: High-risk pregnancies are contraindicated, and safety/ quick access to a hospital are necessary.

    Episiotomy Rationale

    • An episiotomy is a bedside surgical procedure that can be used to speed up the process when fetal distress is present.

    Hypothermia in Newborns

    • Maintain body/room temperature, dry with towel, put on a hat
    • Monitor temperature.

    Delayed Cord Clamping Findings

    • Increased hemoglobin and iron stores
    • Increased risk of jaundice

    Lochia Measurement

    • Measure lochia from birth through 24 hours and track amount via a gram scale weight on pads.

    Newborn Respiratory Distress Signs

    • Cyanosis around the mouth
    • Nasal flaring and grunting

    Newborn Eye Prophylaxis

    • Erythromycin 0.9% ophthalmic ointment within 1 hour following birth to prevent neonatal ophthalmia.
    • Clean newborn's eyes with medication for 1 minute before wiping away excess.

    Overt Cord Prolapse

    • Cord slips through the dilated cervix and becomes compressed by the fetal presenting part. A potentially life-threatening event requiring immediate intervention.

    Unit 3 Postpartum Period Complications

    • Risk factors for Postpartum Hemorrhage: Uterine atony, retained placenta, lacerations.
    • Medications for Excessive Vaginal Bleeding: Uterotonics (oxytocin, misoprostol, tranexamic acid, methylergonovine).
    • Complications of Umbilical Cord Traction: (not included)
    • Placenta Accreta Risk Factors: Primigravida, history of endometriosis, uterine atony, uterine fibroids, smoking, maternal age >35 years.
    • Postpartum Hemorrhage Leading to Shock Risk factors/Comorbidities: History of hemorrhage, BMI > 40
    • Deep Vein Thrombosis Risk Factors/Comorbidities: BMI > 35, Pre-Existing Diabetes
    • Diagnostic testing for suspicion of deep vein thrombosis in the leg.
    • Postpartum Infection (turning into sepsis): Symptoms include hypotension, hypoxia, hypothermia, tachycardia
    • Non-Pharmacological therapies for mastitis: Cold compresses
    • Bleeding Disorders for Postpartum Hemorrhage Risk: Hemophilia, Anti-coagulation, von Willebrand disease (hereditary bleeding disorder)
    • Maternal bleeding and hypotension: Physician Orders.
    • Priority medication for immune thrombocytopenia purpura: Oral corticosteroids, Tranexamic acid (for bleeding).

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    Maternal, Newborn, and Women's Health Test #3 Study Guide PDF

    Description

    This quiz covers key concepts related to Unit 4 on Labor, including nursing actions for fetal positioning, the five Ps of labor, and maternal physiological adaptations. It also reviews the implications of membrane rupture and elevated WBC counts during labor. Test your knowledge and understanding of these essential nursing actions in labor and delivery.

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