OBSTERICS AND GYNECOLOGY
(NURS 242) ACTUAL EXAM NOTES
(all information you need to
pass)100% SIMPLIFIED AND
ACCURATE.
,Exam 3 – transition to parenthood
Pre-lecture activity
1. Uterine dystocia pg. 302 (lack of progressive cervical dilation, lack of descent of the fetal head,
or both)
a. Dystocia is difficult labor that is characterized by abnormally slow labor progress.
Abnormal labor results from abnormalities of the power, the passenger, or the passage.
The terms dystocia and failure to progress are both used to characterize an abnormally
long labor. However, this diagnosis is often mistakenly made before the woman has
entered the active phase of labor and, therefore, before adequate trial of labor.
Dystocia is the most common reason for primary cesarean sections. It is associated with
the same factors that influence normal labor.
i. Powers of labor (uterine contractions and maternal expulsive effort)
ii. Passenger (fetal presentation, position, or development)
iii. Passage (maternal bony pelvis or soft tissue)
b. Hypertonic (Pain management – morphine to help her relax – monitor FHR and mother’s
RR) have Narcan nearby.
i. Uncoordinated uterine activity. Contractions are frequent and painful but
ineffective in promoting dilation and effacement. When this occurs in early
labor, it may be referred to as prodromal labor. Women who experience
hypertonic uterine dysfunction are at risk for exhaustion related to prolonged
labor, and the fetus is at risk for fetal intolerance of labor and asphyxia related
to decreased placental profusion.
ii. Risk factors- nulliparous women are more subject to abnormal early labor.
iii. Assessment findings – painful, frequent UCs with inadequate uterine relaxation
b/w UCs with little cervical changes
1. May be category 2 or 3 FHR r/t prolonged labor and inadequate uterine
relaxation.
iv. Medical Management
1. Evaluate
a. Labor progress
b. Cause of labor dysfunction
2. Hydrate to improve uterine perfusion and coordination of UCs.
3. Provide pain management to allow the woman to sleep and prevent
exhaustion.
v. Nursing Actions
1. Promote rest = becomes effective when the woman sleeps for a period
of several hours and awakens in a normal labor pattern of active labor.
Methods used to promote uterine rest are
a. Administration of pain medication such as morphine as per
order to decrease labor contractions and allow the uterus to
rest.
b. Promotion of relaxation
i. Warm shower or tub bath
, ii. Quiet environment
iii. Minimal interruptions to allow for long period of sleep.
c. Hydrate the woman with IV and PO fluids if tolerated.
Dehydration can result in dysfunctional labor.
d. Assess FHR and UCs
e. Evaluate labor progress with a sterile vaginal exam.
f. Inform the woman and family of the progress of labor and
explain interventions.
g. Inform the care provider of the woman’s response and progress
in labor.
c. Hypotonic Uterine dysfunction – give oxytocin to get the mom to give birth.
i. When the pressure of the UC is insufficient to promote cervical dilation and
effacement. The woman makes normal progress during the latent phase of
labor, but during active labor the UCs become weaker and less effective for
cervical changes and labor progress. The woman is at risk for exhaustion and
infection related to the prolonged labor, and the fetus is at risk for fetal
intolerance of labor and asphyxia.
ii. R/F
1. Multiparous women often have more problems in the active phase.
2. Extreme fear may result in catecholamine release, interfering with
uterine contractility.
iii. Assessment findings
1. Decreased frequency, strength, and duration of UCs.
2. Little or no cervical change.
a. Less than 0.5 cm/hr progress in cervical dilation for a
primiparous woman in active labor
b. Less than 1 cm/hr progress in cervical dilation for a multiparous
woman in active labor
3. Increased fear and anxiety levels.
iv. Medical Management
1. Evaluate labor progression
2. Determine the cause of the dysfunction
3. Consider obstetrical interventions:
a. Augment labor with oxytocin
b. Perform amniotomy
c. Perform cesarean birth when other interventions have failed or
when there are signs of fetal intolerance of labor.
v. Nursing Actions
1. Assess uterine activity.
2. Assess maternal and fetal status.
3. Stimulate uterine activity to achieve a normal labor pattern using the
following methods:
a. Ambulate and change the position of the woman to promote
comfort and labor progress.
(NURS 242) ACTUAL EXAM NOTES
(all information you need to
pass)100% SIMPLIFIED AND
ACCURATE.
,Exam 3 – transition to parenthood
Pre-lecture activity
1. Uterine dystocia pg. 302 (lack of progressive cervical dilation, lack of descent of the fetal head,
or both)
a. Dystocia is difficult labor that is characterized by abnormally slow labor progress.
Abnormal labor results from abnormalities of the power, the passenger, or the passage.
The terms dystocia and failure to progress are both used to characterize an abnormally
long labor. However, this diagnosis is often mistakenly made before the woman has
entered the active phase of labor and, therefore, before adequate trial of labor.
Dystocia is the most common reason for primary cesarean sections. It is associated with
the same factors that influence normal labor.
i. Powers of labor (uterine contractions and maternal expulsive effort)
ii. Passenger (fetal presentation, position, or development)
iii. Passage (maternal bony pelvis or soft tissue)
b. Hypertonic (Pain management – morphine to help her relax – monitor FHR and mother’s
RR) have Narcan nearby.
i. Uncoordinated uterine activity. Contractions are frequent and painful but
ineffective in promoting dilation and effacement. When this occurs in early
labor, it may be referred to as prodromal labor. Women who experience
hypertonic uterine dysfunction are at risk for exhaustion related to prolonged
labor, and the fetus is at risk for fetal intolerance of labor and asphyxia related
to decreased placental profusion.
ii. Risk factors- nulliparous women are more subject to abnormal early labor.
iii. Assessment findings – painful, frequent UCs with inadequate uterine relaxation
b/w UCs with little cervical changes
1. May be category 2 or 3 FHR r/t prolonged labor and inadequate uterine
relaxation.
iv. Medical Management
1. Evaluate
a. Labor progress
b. Cause of labor dysfunction
2. Hydrate to improve uterine perfusion and coordination of UCs.
3. Provide pain management to allow the woman to sleep and prevent
exhaustion.
v. Nursing Actions
1. Promote rest = becomes effective when the woman sleeps for a period
of several hours and awakens in a normal labor pattern of active labor.
Methods used to promote uterine rest are
a. Administration of pain medication such as morphine as per
order to decrease labor contractions and allow the uterus to
rest.
b. Promotion of relaxation
i. Warm shower or tub bath
, ii. Quiet environment
iii. Minimal interruptions to allow for long period of sleep.
c. Hydrate the woman with IV and PO fluids if tolerated.
Dehydration can result in dysfunctional labor.
d. Assess FHR and UCs
e. Evaluate labor progress with a sterile vaginal exam.
f. Inform the woman and family of the progress of labor and
explain interventions.
g. Inform the care provider of the woman’s response and progress
in labor.
c. Hypotonic Uterine dysfunction – give oxytocin to get the mom to give birth.
i. When the pressure of the UC is insufficient to promote cervical dilation and
effacement. The woman makes normal progress during the latent phase of
labor, but during active labor the UCs become weaker and less effective for
cervical changes and labor progress. The woman is at risk for exhaustion and
infection related to the prolonged labor, and the fetus is at risk for fetal
intolerance of labor and asphyxia.
ii. R/F
1. Multiparous women often have more problems in the active phase.
2. Extreme fear may result in catecholamine release, interfering with
uterine contractility.
iii. Assessment findings
1. Decreased frequency, strength, and duration of UCs.
2. Little or no cervical change.
a. Less than 0.5 cm/hr progress in cervical dilation for a
primiparous woman in active labor
b. Less than 1 cm/hr progress in cervical dilation for a multiparous
woman in active labor
3. Increased fear and anxiety levels.
iv. Medical Management
1. Evaluate labor progression
2. Determine the cause of the dysfunction
3. Consider obstetrical interventions:
a. Augment labor with oxytocin
b. Perform amniotomy
c. Perform cesarean birth when other interventions have failed or
when there are signs of fetal intolerance of labor.
v. Nursing Actions
1. Assess uterine activity.
2. Assess maternal and fetal status.
3. Stimulate uterine activity to achieve a normal labor pattern using the
following methods:
a. Ambulate and change the position of the woman to promote
comfort and labor progress.
