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Exam #2 - 2381

Labor and Birth Nursing Care

QuestionAnswer
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
Created by: Megan Thompson Megan Thompson on 2009-09-24



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