Labor and Delivery ATI Review

Stage 1 - Latent Phase

0–6 cm dilation, irregular contractions, teach breathing.

Stage 1 - Active Phase

6–10 cm dilation, stronger contractions, assess fetal heart rate.

Stage 2 - Pushing to Birth

Full dilation (10 cm) to delivery, encourage bearing down.

Stage 3 - Placenta Delivery

Delivery of newborn and placenta, usually 5-30 min.

Stage 4 - Recovery

1–4 hours postpartum, assess vital signs, promote bonding.

Normal Fetal Heart Rate (FHR)

Baseline 110–160 bpm.

Tachycardia in Fetus

FHR > 160 bpm for 10 min.

Bradycardia in Fetus

FHR < 110 bpm for 10 min.

Late Decelerations - First Action

Change to left lateral position.

Magnesium Sulfate Toxicity - Signs

RR <12/min, urine output <30 mL/hr, absent DTRs.

Antidote for Magnesium Toxicity

Calcium gluconate or calcium chloride.

Postpartum Hemorrhage (PPH) - Tone

1 cause is uterine atony; assess fundus.

Normal Lochia Timing

Rubra (red, days 1–3), serosa (pink-brown, days 4–10), alba (yellow-white, days 11+).

DVT - Signs

Unilateral leg pain, warmth, redness, swelling.

APGAR Score Interpretation - 0-3

Severe distress; require resuscitation.

APGAR Score Interpretation - 4-6

Moderate difficulty; stimulate and provide O₂.

Newborn Heart Rate Range

120–160 bpm.

Normal Newborn Temperature Range

97.7–99.5°F.

Vitamin K - Purpose

Prevents hemorrhagic disease in newborns.

New Ballard Score - Purpose

Estimates gestational age in first 48 hours.

Denial - Example

Client with lung cancer blames cold for cough.

Specific Plan + Access to Means

Highest risk factors for suicide.

Analyze Cues Questions

Identify clinical picture and infection based on symptoms.

Placenta Previa - Signs

Painless, bright red bleeding.

Abruption Placentae - Signs

Painful, dark red bleeding.

Normal Newborn Assessment - Milia

Pearly white spots that resolve spontaneously.

Normal Newborn Skin - Mongolian Spots

Blue-gray pigmentation on back or buttocks.

First Action in Preterm Labor

Identify contractions and timing.

Betamethasone - Purpose

Matures fetal lungs.

Monitoring Fundal Height

Measures approximate gestational age.

GTPAL - Definitions

G: Gravida, T: Term, P: Preterm, A: Abortions, L: Living children.

OCP Contraindications - List

History of DVT, stroke, uncontrolled hypertension.

Insulin - GDM Management

Preferred medication if diet fails.

Clinical Judgment - Step 1

Recognize cues from data.

Clinical Judgment - Step 3

Prioritize hypotheses by urgency.

Cocaine Use During Pregnancy - Complications

Vasoconstriction leading to abruptio placentae.

Meconium-Stained Amniotic Fluid - Vigorous Newborn

Routine assessment without intubation needed.

Meconium-Stained Amniotic Fluid - Non-Vigorous Newborn

Follow NRP resuscitation protocol.

Therapeutic Communication - Techniques

Use open-ended questions and active listening.

Non-Therapeutic Responses

Avoid false reassurance and 'why' questions.

Naegele's Rule - Calculation

First day of LMP minus 3 months plus 7 days.

Hypoglycemia Signs in Newborn

Jitteriness, weak cry, lethargy.

Labor Stages - Critical Indicator

Cervical dilation is the most important.

Phototherapy - Jaundice Risk Factors

Physiologic vs. pathologic jaundice definitions.

Tocolytics - Role in Preterm Labor

Suppress contractions to delay delivery.

Priority Nursing Actions Post Epidural

Assess for maternal hypotension.

Magnesium Sulfate Monitoring

Check BP, pulse, and urine output.

Cervical Changes Indicate Labor Progress

Dilation and effacement monitoring.

Vaginal Infections - BV Signs

Fishy odor and clue cells.

Vaginal Infections - Trichomonas Signs

Frothy yellow-green discharge.

Vaginal Infections - Candida Signs

Cottage cheese like discharge.

Pathologic Jaundice - Risk Indicators

Appears within 24 hours of birth.

Preterm Labor - Signs

Uterine contractions, pelvic pressure.

Hypoglycemia Screening - At-Risk Newborns

Check glucose within first hour.

Emergency C-Section - Indications

Nonreassuring FHR or maternal shock.

Preeclampsia - Fluid/Electrolyte Monitoring

Report urine output <30 mL/hr.

Zidovudine - Administration to Newborn

Given at delivery and for 6 weeks.

Magnesium Sulfate - Must Know Aspects

Monitor deep-tendon reflexes (DTRs).

Respiratory Complications in Hypoglycemia

Can lead to apnea in severe cases.

Meconium Aspiration - Risk Assessment

Assess for need of neonatal resuscitation.

Fundal Height Measurement - First Trimester

Not typically utilized until later gestation.

Postpartum Hemorrhage Immediate Action

Vigorous fundal massage plus oxytocin.

OCP Effectiveness - Drug Interactions

Less effective with anticonvulsants or rifampin.

Assessment of Cervical Changes - Best Resource

Ultrasound for placental position.

Breastfeeding While HIV Positive - Recommendation

Not recommended in the US.

Cocaine Neurobehavioral Effects on Newborn

Irritability and CNS signs present.

Clinical Judgment Framework - Step 5

Implement nursing interventions correctly.

Abdominal Ultrasound - Teaching Importance

Ensure client understands relaxation during procedure.

Prenatal Lab Values - Key Tests

CBC and HIV are standard initial tests.

Oxygen Use in Severe Bleeding

8-10 L/min via face mask for positioning.

Breastfeeding Contraceptive - Minipill

Safe for breastfeeding women.

Normal Newborn Vitals - Assessment

Check heart, respiration, and temperature ranges.

Newborn Assessment - HEP B Vaccine Schedule

Administer first dose within 24 hours.

Temperature Instability in Newborns - Report Concern

Assess for infection or other causes.

Labor Stages - Overview

Latent, Active, Pushing, and Recovery phases.

Risk for Infection During Labor

Assess maternal and fetal risk factors.

Magnesium Sulfate Adverse Effects - Common

Flushing and sedation are normal side effects.

Aglow of Newborn Photography

Capture moments immediately post-delivery.

Cesarean Birth Indications - Key Factors

Maternal or fetal distress prompts surgical intervention.

Changes in Maternal Vital Signs - After Delivery

Assessing for hypotension and other risks.

Neonatal Heparin Therapy - Monitoring Parameters

Regular lab work for safety.

Reliable Communication Techniques - Key Talks

Use age-appropriate dialogue when discussing care.

Erythromycin Ointment - Newborns

Given to prevent ophthalmia neonatorum.

Epidural Placement - Important Pre-procedure Steps

Ensure hydration and baseline assessment are completed.

High-Risk Pregnancy Factors - List Examples

Diabetes, hypertension, and previous preterm birth.

Nursing Role in Preterm Labor - Key Actions

Monitor contractions and perform patient education.

Newborn Reflexes - Key to Assessment

Monitor for normal and abnormal reflexes.

Maternal Injury from Trauma - Assessment Focus

Assess for shock and injury severity.

Substance Abuse Effects - On Newborn Health

Impact of maternal drug use on fetal development.

CPR for Newborns - Guidelines to Follow

Neonatal life support practices adhere to strict protocols.

Cervical Competence Assessment - Risk Indicators

Monitor cervical length in high-risk pregnancies.

Magnesium Sulfate - Clinical Indications

Used for preeclampsia and seizure prevention.

Antibiotic Implications in Pregnancy - Key Considerations

Choosing safe options during labor.

Labor Induction Techniques - Overview

Understanding pharmacological and mechanical methods.

Medications Contraindicated in Pregnancy

Identify and avoid prior to delivery.

Maternal Mental Health - Assessment Techniques

Utilizing standardized screening tools.

Antidepressant Use - Assessment Focus During Pregnancy

Monitor risks and benefits for mother and fetus.

Neonatal vs Maternal Monitoring - Differentiating Factors

Focus on unique parameters for both patient types.

Maternity Care - Best Practice Recommendations

Integrative model incorporating family values.

Birth Plan Development - Key Components

Identify preferences and concerns for delivery.