NM 704 EXAM 3 MODS 6-8 EXAM QUESTIONS AND ANSWERS
WITH COMPLETE SOLUTIONS VERIFIED
List and describe the components of an admission history and physical when a
woman is in labor.
Frequently encountered policy:
BP, pulse & R q 1 hr
Temp q 2-4 if normal and intact membranes, q 1-2 if abnormal/ROM
More frequently as indicated
Know the recommended frequency for the assessment of maternal vital signs in the first
stage of labor
Q 15-30
Review the recommendations for frequency of fetal heart rate assessment during labor.
Depends on woman's condition and midwife's ability to use other parameters for
evaluating progress. Routine SVE q 1-2 hrs not indicated.
Should generally be linked to your decision to intervene if no progress
Indicated:
To establish an informational baseline
Before deciding on the kind, amount and route of any medication
After SROM if prolapsed cord is suspected
Check for prolapsed cord when fetal heart rate decels don't resolve w/ the usual
maneuvers
,Review recommendation for the appropriate use of vaginal exams during the first stage
of labor.
Based on prevention of gastric content aspiration during general anesthesia, a
rare but serious s/e first described by Mendelson in 1946.
Be familiar with the history of the policy of withholding foods and oral fluids during labor.
No benefits or harms associated w/ oral intake during labor. Therefore there is no
justification for withholding fluids or foods in labor for women at low risk for
complications.
Know the current evidence regarding encouraging or withholding foods or oral fluids
during labor.
Actual or potential risk factors for each individual, not routine.
Can't tolerate oral fluid
Need meds (GBS+, pain meds, pit)
Prior to epidural prophylaxis for hypotension, and throughout for continued
volume expansion or medication for complications
List indications for IV access and/or IV fluids.
In the third trimester of pregnancy women exhibit a state of "accelerated
starvation" where a rapid rise in ketones and a concomitant fall in plasma
glucose. This process of accelerated lipolysis conserves glucose for the fetus.
Essentially ketosis is due to inadequate caloric intake. Also, ketosis can have
deleterious effects on uterine function.
Understand the significance of ketonuria to the laboring woman.
, Know the potential hazards of dextrose containing intravenous hydration to the
fetus and newborn
Tx of dystocia,
adjunct for IOL w/ medical indication
Amniotomy
Know the indications
Non vertex presentation
Head not engaged or well applied to cervix
Any contraindication to vaginal delivery
Amniotomy
contraindications
Be sure fetus is cephalic and engaged or well applied to cervix
Reassess cervix carefully to assess fetal station and ensure head well applied.
Keep fingers in cervix, gently disrupt membranes w/ amnihook, ideally during ctx
Take care to avoid scratching fetal head
Keep fingers in place during initial gush of fluid to ensure prolapsed cord doesn't
happen
Monitor FHT during and for a period of time after procedure.
Amniotomy
procedure for amniotomy.
Know the risks and benefits of routine amniotomy including:
effect on perception of pain
Didn't shorten first stage of labor
WITH COMPLETE SOLUTIONS VERIFIED
List and describe the components of an admission history and physical when a
woman is in labor.
Frequently encountered policy:
BP, pulse & R q 1 hr
Temp q 2-4 if normal and intact membranes, q 1-2 if abnormal/ROM
More frequently as indicated
Know the recommended frequency for the assessment of maternal vital signs in the first
stage of labor
Q 15-30
Review the recommendations for frequency of fetal heart rate assessment during labor.
Depends on woman's condition and midwife's ability to use other parameters for
evaluating progress. Routine SVE q 1-2 hrs not indicated.
Should generally be linked to your decision to intervene if no progress
Indicated:
To establish an informational baseline
Before deciding on the kind, amount and route of any medication
After SROM if prolapsed cord is suspected
Check for prolapsed cord when fetal heart rate decels don't resolve w/ the usual
maneuvers
,Review recommendation for the appropriate use of vaginal exams during the first stage
of labor.
Based on prevention of gastric content aspiration during general anesthesia, a
rare but serious s/e first described by Mendelson in 1946.
Be familiar with the history of the policy of withholding foods and oral fluids during labor.
No benefits or harms associated w/ oral intake during labor. Therefore there is no
justification for withholding fluids or foods in labor for women at low risk for
complications.
Know the current evidence regarding encouraging or withholding foods or oral fluids
during labor.
Actual or potential risk factors for each individual, not routine.
Can't tolerate oral fluid
Need meds (GBS+, pain meds, pit)
Prior to epidural prophylaxis for hypotension, and throughout for continued
volume expansion or medication for complications
List indications for IV access and/or IV fluids.
In the third trimester of pregnancy women exhibit a state of "accelerated
starvation" where a rapid rise in ketones and a concomitant fall in plasma
glucose. This process of accelerated lipolysis conserves glucose for the fetus.
Essentially ketosis is due to inadequate caloric intake. Also, ketosis can have
deleterious effects on uterine function.
Understand the significance of ketonuria to the laboring woman.
, Know the potential hazards of dextrose containing intravenous hydration to the
fetus and newborn
Tx of dystocia,
adjunct for IOL w/ medical indication
Amniotomy
Know the indications
Non vertex presentation
Head not engaged or well applied to cervix
Any contraindication to vaginal delivery
Amniotomy
contraindications
Be sure fetus is cephalic and engaged or well applied to cervix
Reassess cervix carefully to assess fetal station and ensure head well applied.
Keep fingers in cervix, gently disrupt membranes w/ amnihook, ideally during ctx
Take care to avoid scratching fetal head
Keep fingers in place during initial gush of fluid to ensure prolapsed cord doesn't
happen
Monitor FHT during and for a period of time after procedure.
Amniotomy
procedure for amniotomy.
Know the risks and benefits of routine amniotomy including:
effect on perception of pain
Didn't shorten first stage of labor
