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Exam #2 - 2381
Labor and Birth Nursing Care
Question | Answer |
---|---|
How does fatigue affect the body? How should the nurse help prevent it? | it affects the body by using a lot of glucose which makes a person even more tired when there's low levels; have pt. drink and eat! only push when she feels need |
What is the single most reassuring thing to a mom in labor? | the nurse's presence! |
What is a possible action by the nurse to decrease anxiety in the mom AND dad? | give information! |
Should the patient come into the hospital right away when she suspects being in labor? | no! call if she wants to, come in if her water broke (prolapsed cord) but otherwise relax at home =) |
What's another term for "water breaks"? | SROM - spontaneous rupture of membrane |
What type of questions do you want to ask the mom on the phone if she says she's in labor? | why do you think you're in labor? what symptoms are you having? describe your symptoms? |
How can you tell amniotic fluid from vaginal secretions? | vaginal secretions are very acidic, whereas amniotic fluid is alkalotic |
What should you ask the mom about the color of the fluid if she thinks her water broke? | ask the mom what color it is (should be cloudy/clear) and ask if there is any color in it (if green, means there's meconium in it, baby's hypoxic) |
What's a "fern test" | to check leaking fluid under the microscope and see if it's crystallized and looks like a fern, if it is, it's amniotic fluid |
How do you know true labor from prodromal labor? | if contractions are consistent and increasingly painful (gradually getting worse), if it hurts to walk around, if pain starts in back, and cervical changes are noted = true labor |
What is the best indicator for the difference of prodromal labor and real labor? | CERVIX CHANGES! |
How can pain make labor progress? | endogenous pitocin is increased which dilates the cervix and effaces; endorphins are also released which can promote comfort |
What is the ultimate best position that a mom can be in during labor? | sitting upright! |
How should the nurse ask the mom questions throughout labor? and how should the nurse ask if she's coping good? | direct questions! use coping scale |
How should the nurse provide information to the mom and dad? Feedback? | thoroughly, throughout the whole process; continually praise the mom and dad and stay with the pt. |
Describe how you should validate the patient's pain. | acknowledge their level of pain but maybe remind them why they're having pain = labor =baby! |
In the first stage, phase I: latent phase, what are three things you need to determine? | risk factors, couple's wishes, and labor status (via contractions) |
In the latent phase, mom and dad need a lot of ________ and _________. | support and information |
The nurse in the latent phase, active phase, and transition is continually ___________. | assessing! |
What should the nurse check during the active phase of labor? 5 things | pain, VS, I&O, bladder, and hydration |
What should the nurse monitor in the active phase with the baby? | FHR during contractions |
What should the nurse monitor in the active phase with labor progress? | contractions, location of baby, cervical changes |
The nurse should also assess the need for help with coping (mom and dad), how? | asking them on a "coping scale" offer suggestions of pharmological or nonpharmalogical comfort measures if they haven't already expressed it |
What does dad need in the active phase? | his coping skills are tested, give them guidance on what to do, or a break |
Many people think the best comfort measure during active phase is...? | a warm bath! really progresses labor |
What types of things might help with the positioning of the baby during active phase? 2 | frequently changing positions or using the birthing ball |
During active phase, it's imporant to offer water frequently so they stay ______! | hydrated |
If there's too many people in the room talking to each other or watching TV - what is wrong with this situation? | focus should always be on mom! unless culturally contraindicated |
How do birthing balls help labor? | they separate the pelvis and it's impossible for perineal muscles to tense up |
What are some other "back labor" methods to use during active labor? 6 | tennis balls (massage), positioning on all fours, breathing, massage, imagery, hot packs |
Why is it so important for mom to try to relax when she can during labor? 4 | promotes oxygenation, reserves energy, so women can work "with" labor instead of "against", less discomfort |
How far along is the mom during the transition phase? | dilating to 8-10 cm - hard work! |
How does the nurse assess the mom during the transition phase? 8 | VS, hydration, bladder, medications or not?, uterine contractions, cervical changes, vaginal show, and behavior |
How does the nurse assess the baby during transition phase? | fetal descent and FHR |
Always, in each phase, assess the need for help with ___________! | coping |
What does dad need during the transition phase? | a hug! lol, normally dad is the brunt of all of the frustration coming from the mom and he needs to know that he is the "safe person" |
How often does frequency of assessment occur during the transition phase? | every 15-30 min! |
What type of comfort measures are good during the transition phase? How should you act with the mom? | breathing and relaxation are key here to prevent hyperventilation, massage, reassurance; you need to get right into the mom's face and sternly instruct her on things to do |
If mom has urge to push before fully dilated, what should the nurse do? | tell mom not yet b/c it will affect her cervix, tell her to focus on breathing more |
During the 2nd stage of labor, how can you get the baby to move if it's in an awkward position? | move the mom |
When should the mom push? | when she feels the urge to and she's dilated 10 cm |
What is REALLY IMPORTANT during the 2nd stage of labor? | HYDRATION |
What position are women more often comfortable with in pushing? | when they're squatting; toilet |
What type of temperature does the mom want now? what should you place on her perineum and what might you do to the perineum? | cool packs; warm packs and massage |
When things don't go acccording to plan in a labor, what is the FIRST THING A NURSE SHOULD DO?! | see if any nursing interventions will help, if so = do them, if not = get help! |
What should a nurse do if contractions slow down and are not effective? | get the mom up and moving around, or change position |
What should the nurse do when there's inadequate uterine relaxation? | needs medical intervention! get help |
What should the nurse do when baby's not happy, and HR decels? | maternal position change |
what happens when the pt. has increasingly discomfort? | keep trying new interventions! |
How should the nurse monitor the mom when having an epidural? 4 | watch the medication and how it can interfere with contractions, VS (esp. BP and RR), watch level of hydration and level of discomfort |
What should the nurse monitor with the baby during an epidural? | FHR and pattern |
What are some things that could go wrong with an epidural? 5 | hypotension, respiratory depression, non-reassuring fetal patterns, bladder distension, and suppression of labor progress |
What is the CIWA assessment? What are the 10 areas of assessment? | its an assessment of alcohol use; N&V, tremor, paroxysmal sweats, anxiety, and agitation tactile disturbances, auditory disturbances, visual disturbances, headache, orientation and clouding of sensation |
What are the two anti-anxiety drugs used to alcohol withdrawal syndrome? | ativan and librium |