NSG374 Maternal Newborn Final Exam Study Guide 2022// 2023.

Critical Factors Affecting Labor and Birth ("5 P's"): · Passageway (birth canal: pelvis & soft tissues) · Passenger (fetus and placenta) · Powers (contractions) · Position (maternal) · Psychological response 2. Pelvic shape: o Gynecoid: favorable for vaginal delivery o Android: male-shaped, not favorable o Anthropoid: usually adequate, sunny side up o Platypelloid: not favorable 3. Passenger: Fetal Presentation: Cephalic (vertex) o Military o Brow o Face (see Figure 13.7) Breech o Frank o Full or complete o Footling or incomplete (see Figure 13.8) 4. Contractions - Mild IUCs: Feels like the tip of the nose to palapation 5. Contractions Moderate IUCs: Make the woman take notice but are ok. Feel like the tip of the chin 6. Contractions Strong IUCs: · Strong IUCs: Make her toes curl! Feel like the firm forehead 7. Physiologic Responses to Labor: Maternal: · Increased heart rate, cardiac output, blood pressure (during contractions) · Increased white blood cell count · Increased respiratory rate and oxygen consumption · Decreased gastric motility and food absorption · Decreased gastric emptying and gastric pH · Slight temperature elevation · Muscle aches/cramps · Increased BMR · Decreased blood glucose levels 1 / 35 8. Stages of Labor First stage: True labor to complete cervical dilatation (10 cm) Longest of all stages Three phases: Latent phase, Active phase, & Transition phase 2 / 35 9. second stage of labor: cervix 10 cm dilated to birth of baby 10. third stage of labor: birth of infant to placental separation o Placental separation o Placental expulsion 11. fourth stage of labor: 1 to 4 hours following delivery 12. Signs of Placental Separation: · The uterus rises upward · The umbilical cord lengthens · A sudden trickle of blood is released from the vaginal opening · The uterus changes its shape to globular 13. Spontaneous birth of the placenta occurs in one of two ways:: the fetal side (shiny gray side) presenting first - called Schultz mechanism or more com- monly called "shiny Schultz" the maternal side (red raw side) presenting first - termed Duncan mechanism or "dirty Duncan" 14. Maternal Assessment During Labor and Birth: · Maternal status (vital signs, pain, prenatal record review) · Vaginal examination (cervical dilation, effacement, membrane status, fetal de- scent and presentation) · Rupture of membranes · Uterine contractions (see Figure 14.2) · Leopold's maneuvers (see Nursing Procedure 14.1) 15. Leopold's Maneuver 1: What fetal part (head or buttocks) is located in the fundus (top of the uterus)? 16. Leopold's Maneuver 2: On which maternal side is the fetal back located? (Fetal heart tones are best auscultated through the back of the fetus.) 17. Leopold's Maneuver 3: What is the presenting part? 18. Leopold's Maneuver 4: Is the fetal head flexed and engaged in the pelvis 19. Guidelines for Assessing Fetal Heart Rate: · Initial 10 to 20 minute continu- ous FHR assessment on entry into labor/birth area · Completion of a prenatal and labor risk assessment on all clients · Intermittent auscultation every 30 minutes during active labor for low-risk women and every 15 minutes for high-risk women · During second stage of labor intermittent auscultation every 15 minutes for low-risk women and every 5 minutes for high-risk women