Chapter 8 nurising care of women with complications during labor and birth

The nurse notes that a woman's contractions during oxytocin induction of labor are every 2 minutes; the contractions last 95 seconds, and the uterus remains tense between contractions. What action is expected based on these assessments?

1. No action is expected; the contractions are normal.

2. The rate of oxytocin administration will be increased slightly.

3. Pain medication or an epidural block will be offered.

4. Infusion of oxytocin will be stopped.

4. Infusion of oxytocin will be stopped.

The nurse can anticipate that which of the following patients may be scheduled for induction of labor? A woman who is:

1. 38 weeks' gestation with fetus in transverse lie.

2. 40 weeks' gestation with fetal macrosomia.

3. 40 weeks' gestation with gestational hypertension.

4. 40 weeks' gestation with a fetal prolapsed cord.

3. 40 weeks' gestation with gestational hypertension.

A woman has an emergency cesarean delivery after the umbilical cord was found to be prolapsed. She repeatedly asks similar questions about what happened at birth. The nurse's interpretation of the woman's behavior is that she:

1. cannot accept that she did not have the type of delivery she planned.

2. is trying to understand her experience and move on with postpartum adaptation.

3. thinks the staff is not telling her the truth about what happened at birth.

4. is confused about events because the effects of the general anesthetic are persisting.

2. is trying to understand her experience and move on with postpartum adaptation.

What nursing intervention during labor can increase space in the woman's pelvis?

1. Promote adequate fluid intake.

2. Position her on the left side.

3. Assist her to take a shower.

4. Encourage regular urination.

4. Encourage regular urination.

A woman is being observed in the hospital because her membranes ruptured at 30 weeks gestation. While providing morning care, the nursing student notices that the draining fluid has a strong odor. The priority nursing action is to:

1. caution the woman to remain in bed until her physician visits.

2. ask the woman if she is having any more contractions than usual.

3. take the woman's temperature; report it and the fluid odor to the RN.

4. help to prepare the woman for an immediate cesarean delivery.

3. take the woman's temperature; report it and the fluid odor to the RN.

Following a vacuum extraction delivery, the nurse notices the newborn's head is not symmetrical with a chignon over the posterior fontanelle. The appropriate nursing action would be to:

a. apply cold compresses to the swollen area

b. notify the charge nurse or health care provider

c. document and continue routine observation

d. explain to the parents the swelling will resolve without treatment

c. document and continue routine observation

d. explain to the parents the swelling will resolve without treatment

An obstetrician informs the nurse that the patient has a laceration that extends through the anal sphincter into the rectal mucosa. Based on the definition, what does the nurse document, per the physician, as the description of this laceration?

a) First degree

b) Third degree

c) Second degree

d) Fourth degree

d) Fourth degree

A woman in labor has excess amniotic fluid. She is in active labor and is not progressing because contractions are too weak to be effective. What does the nurse suspect is the cause of this ineffective labor?

a) Decreased uterine muscle tone because of terbutaline use

b) Increased uterine muscle tone because of oxytocin use

c) Ineffective maternal pushing because of fatigue

d) Decreased uterine muscle tone because of overdistention

d) Decreased uterine muscle tone because of overdistention

What is the principal goal of nursing care during labor?

a) Preparation of the delivery room with needed supplies

b) Documenting the progression of the labor process

c) Promoting relaxation and helping the woman to conserve resources

d) Assisting the obstetrician to gown and glove

c) Promoting relaxation and helping the woman to conserve resources

What is the primary benefit of an amniotomy to augment or induce labor?

a) Stimulate prostaglandin secretion

b) Prevent umbilical cord compression

c) Treat umbilical cord prolapse

d) Allow internal monitoring

a) Stimulate prostaglandin secretion

Which statement indicates that an expectant mother understands the diagnosis of placenta previa?

a) "My doctor will monitor for rupture of membranes each week at my appointment."

b) "My doctor will not let my pregnancy go beyond my due date before he induces me."

c) "My baby will probably come early because of my condition."

d) "My doctor will not induce labor at any time during this pregnancy."

d) "My doctor will not induce labor at any time during this pregnancy."

What is used to assess the status of the cervix in determining its response to induction?

a) Amniotomy

b) Apgar score

c) Bishop score

d) Prostaglandin secretion

c) Bishop score

Which are considered pharmacological methods to stimulate contractions? (Select all that apply.)

a) Prostaglandin gel

b) Oxytocin administration

c) Amniotomy

d) Nipple stimulation

e) Version

a) Prostaglandin gel

b) Oxytocin administration

amnioinfusion definition

insertion of fluid directly into uterus to provide a cushion for the umbilical cord after amniotic fluid is lost

induction of labor

intentional initiation of labor before it occurs naturally, more effective if cervical ripening is achieved before oxytocin is administered to stimulate contractions

augmentation of labor

stimulation of contractions after they started naturally

bishop score

greater then 6 may predict successful labor induction because of a ripe cervix

the nurse observes character of amniotic fluid and FHR when membranes have ruptured

fluid should be clear but may have mild odor and bits of lanugo, FHR should remain between 110-160

nurse observes fetal condition and character of contractions if

any methods to stimulate labor are used

dystocia definition

difficult labor which can be caused by abnormality of the power, passenger, passage or psyche of the woman

ways to promote normal labor

encouraging position changes, aiding relaxation, remind woman to empty her bladder

nursing care after episiotomy or perineal lacerations

cold applications, analgesics, wound assessment

nursing care after c-section

assess wound, indwelling catheter patency, IV flow, extra emotional support

nursing care after births involving instruments (forceps or vacuum extraction) and after abnormal labor and birth

observe maternal and newborn injuries or infections, (infection is the most common hazard after membranes rupture prematurely especially if theres a long interval before delivery)

nursing care when oxytocin is given to the woman in labor

check for s/s of increased uterine activity, monitor FHR Q15min during active labor and Q5min during transition phase

anaphylactoid syndrome

occurs when amniotic fluid enters the womans circulation

amnioinfusion

infusing liquid into amniotic sac

-dilutes meconium fluid

-variable decelerations more fluid helps move cord and keep it from compressing

-replaces cushion for umbilical cord

cephalopelvic disproportion/CPD

baby cant come out through vagina, need c-section, disproportion of moms cervix and fetus size

c-section with classic incision at risk for

uterine rupture

prostaglandin gel is used for

softening cervix

complications of augmentation of labor*

overstimulation of uterus, water intoxication, uterine rupture

fundus*

needs to be midline position, near umbilicus for height and firm

dystocia

difficult labor, primary nursing intervention check FHR, can cause shoulder dystocia (presenting part is shoulders, presenting part should be occiput for good delivery/vertex position)

hypertonic labor

uterus is overstimulated, contractions not effective, baby has low fetal oxygen, FHR decreases

presenting part of baby during delivery should be

occiput, anterior

power

contractions, moms pushing

passenger

size, presentation, position

ROP or LOP moms position

back labor, have pt sit, kneel or stand while leaning over

most common cause of soft tissue obstruction

full bladder

premature rupture at high risk for

chorioamnionitis

tocolytic therapy

stops uterine contractions

when getting mag sulfate mom feels

a warm flush

terbutaline

beta adrenergic, reduces smooth muscle, stops uterus from contracting/calms down contractions, causes tachycardia, if pulse is >120 hold med then try again and if its still >120 call doc, before giving check pulse

cord prolapse

Trendelenburg position

uterine rupture

pain in chest and between scapula or with inspiration means emergency situation

labor induction starts by

ripening of cervix using prostaglandin gel and pitocin/oxytocin

stimulate contractions by

using pitocin/oxytocin, helps start labor and augment labor

hypotonic labor give

pitocin/oxytocin

give pitocin/oxytocin after delivery to

contract uterus

augmentation pt is on

pitocin/oxytocin

artificial rupture of membranes/AROM is called

amniotomy which helps stimulate/enhance/start labor and contractions

amniotomy first check

FHR then check fluid for color (clear is normal, green is meconium)

amniotomy can cause

abruptio placentae

ruptured membranes assess

FHR

episiotomy

cut vagina, after sew back up for lacerations, ice the pt for first 12hrs then use warm sitz bath

forceps use

check facial symmetry of baby

vacuum extraction

baby gets cap on head, eventually goes away, baby can come out with cephalohematoma so check for that

c section needed when

mom has active herpes, mom has CPD, fetal compromise/distress, mom has PIH or diabetes

multifetal pregnancy

high risk for preterm labor, can cause dysfunctional labor

VBAC/vaginal birth after c-section

if you get pregnant again after having c-section, uterine scar will rupture

precipitate birth

delivery within 3hrs or less