Obstetrics 1st Stage of Labor Assessment

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Questions and Answers

What is the primary focus of nursing management during the first stage of labor?

Ensuring constant fetal monitoring

Assessing maternal pain and vital signs (correct)

Preventing maternal fatigue

Providing medication for pain relief

Which action is NOT a component of nursing management in the first stage of labor?

Room environment adjustment

Performing a vaginal examination immediately (correct)

Providing emotional support

Nutritional counseling

What should nurses evaluate to manage maternal pain effectively during labor?

Maternal vital signs and pain management effectiveness (correct)

The patient's previous pain thresholds

Fetal heart rate patterns primarily

The family's influence on pain experience

Why is advocacy considered important in nursing management during labor?

To respect the mother's decisions and preferences Signup and view all the answers

What is the role of the partograph in the first stage of labor?

To track progress of labor and identify abnormalities Signup and view all the answers

Which of the following components should NOT be part of the full history taken during the first labor stage?

Details about the mother's diet Signup and view all the answers

What should be assessed if there is no vaginal bleeding upon admission during the first stage of labor?

Cervical dilation Signup and view all the answers

Which comfort measure is recommended during the first stage of labor?

Frequent position changes Signup and view all the answers

What is the appropriate timeframe for the delivery of the placenta after the infant's birth?

Within 5 to 30 minutes Signup and view all the answers

Which sign indicates placental separation during the third stage of labor?

Change in shape of the uterus Signup and view all the answers

What is an essential observation during the fourth stage of labor?

Assessing for postpartum hemorrhage Signup and view all the answers

What is the main purpose of administering oxytocin after placental expulsion?

To ensure uterine retraction Signup and view all the answers

What should be assessed regarding the bladder during the fourth stage of labor?

It should be empty to allow uterine contraction Signup and view all the answers

What is the significance of checking the fetal neck once the fetal head has emerged?

To check for umbilical cord wrapping Signup and view all the answers

During the management of the second stage of labor, which method of pushing is generally encouraged?

Delay pushing with spontaneous efforts Signup and view all the answers

What should be done to the placenta after delivery to ensure its completeness?

Examine for completeness and anomalies Signup and view all the answers

Which of the following is NOT part of the abdominal examination during the first stage of labor?

Cervical dilatation measurement Signup and view all the answers

What is the purpose of assessing amniotic fluid after rupture of membranes?

Identify if it is clear, meconium stained, or blood stained Signup and view all the answers

Which of the following is a recommended non-pharmacologic intervention during the first stage of labor?

Hydrotherapy Signup and view all the answers

What key element should be monitored continuously during the second stage of labor?

Fetal heart rate Signup and view all the answers

Which assessment is NOT performed on the fetus during labor management with a partograph?

Maternal position changes Signup and view all the answers

In the context of labor management, what does 'continuous coaching and support' refer to?

Ongoing emotional and physical encouragement during delivery Signup and view all the answers

What is the main concern when membranes are ruptured during labor?

Infection risk and cord prolapse Signup and view all the answers

Study Notes

Examination Findings

Assess for pallor, edema, and abdominal scars.

Management of 1st Stage of Labor - Assessment

Abdominal examination includes checking fetal presentation, position, engagement, and auscultating the fetal heart.
Monitor uterine contractions during the assessment.
Pelvic examination to evaluate cervical dilatation (in cms) and effacement (in %), membrane status (intact or ruptured), and amniotic fluid characteristics post rupture (clear, meconium stained, or blood stained).
Determine the presenting part's position and station.

Investigations

Conduct urine tests for protein, sugar, and ketones.
Blood tests include Complete Blood Count (CBC), Random Blood Sugar (RBS), blood grouping, and cross-matching for high-risk patients.

Management of 1st Stage of Labor - Preparation and Care

Recommend light nutrition such as frozen berries, dried fruit, jelly, and water.
Support continuous labor support techniques including hydrotherapy, ambulation, slow-dancing, and changes in maternal position.
Implement therapeutic touch, massage, breathing techniques, and encourage bladder emptying every 1-2 hours.
Prioritize non-pharmacologic interventions before pharmacologic ones.

Management of 1st Stage of Labor - Partograph

Assess fetus condition using Fetal Heart Rate (FHR) monitored by Doppler or CTG, as well as amniotic fluid status.
Monitor labor progress through cervical dilatation and contractions.
Evaluate maternal condition, including medications (e.g., oxytocin), intravenous fluids, and vital signs.

Management of 2nd Stage of Labor

Conduct delivery preparation with continuous coaching and support, and ongoing assessment of FHR.
Allow maternal choice for labor positions ranging from lithotomy to side-lying or kneeling.
Cleanse perineum with antiseptic solution and create a sterile field around the vagina.

Nursing Management of Labor Objectives

Expect students to understand the appropriate nursing management for each labor stage.
Recognize the labor and birthing process as a transformative experience for women.
Emphasize the necessity for nurses to be respectful, available, supportive, and professional.

Management of 1st Stage of Labor - Nursing Interventions

Conduct a full maternal history including obstetric history, current pregnancy details, and labor progression.
Monitor vital signs and pain as primary components of physical examination.
Identify risk factors affecting uteroplacental circulation during labor.

Management of 2nd Stage of Labor - Observation

Observe maternal, fetal, and uterine conditions with vital signs and progress monitored hourly or every 30 minutes.

Management of 2nd Stage of Labor - Conduct of Delivery

Delay pushing and encourage spontaneous (non-directed) pushing.
Perform episiotomy if indicated.
After fetal head emerges, check for cord around the neck; ensure adequate suctioning of the baby’s mouth and nose.
Promote skin-to-skin contact and encourage breastfeeding post-delivery.

Management of 3rd Stage of Labor

Deliver placenta within 5 to 30 minutes post-infant delivery. Signs of separation include cord lengthening, shape change of the uterus, and vaginal bleeding.
Examine placenta, membranes, and umbilical cord for completeness and anomalies; check for perineum, vulval outlet, and vaginal lacerations.

Management of 4th Stage of Labor

Observe the two hours post-delivery as a critical period for postpartum hemorrhage risks.
Monitor bleeding, blood pressure, and pulse every 15 minutes.
Ensure uterus is firm and bladder is empty to aid uterine retraction.

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Description

This quiz covers the critical examination findings and management strategies during the first stage of labor. Topics include abdominal and pelvic assessments, necessary investigations, and care preparations for patients. Test your knowledge on effective labor management techniques.