 So as OTC laxatives.

 Over-the-counter
Pincess Jovelyn Gutierez laxatives are also contraindicated unless
prescribed.
Discomforts during the First Trimester
 Avoid gas-forming foods. Advise the
There are a number of discomforts that can be felt during
woman to avoid gas-forming food to prevent
the first trimester. This is the time when the body is just
excessive flatulence.
starting to adjust to the pregnancy, and hormones are
still in chaos. The woman must be educated on how to Nausea, Vomiting, Pyrosis
ease these discomforts to help her adjust slowly. Nausea and vomiting are also one of the earliest
symptoms of pregnancy. Pyrosis or heartburn typically
Breast Tenderness
occurs when the woman ate a large meal.
Breast tenderness is one of the first symptoms that the
ADVERTISEMENTS
woman would notice in early pregnancy. The tenderness
 Small frequent feedings. Advise the woman
may vary between women; some hardly notice the
to take small, frequent meals and avoid
sensation at all.
greasy foods.
 Advise to wear a bra with a wide shoulder
 Upright position after. Encourage her to
strap. The support it gives helps ease the
keep in an upright position after meals to
tenderness.
avoid reflux.
 Dress warmly and avoid cold. She should
also dress warmly as exposure to cold Fatigue
increases the tenderness. Pregnant women experience fatigue mostly in early
 Get examined. Women who experience pregnancy because of increased metabolic
intense pain should have to examine the requirements.
presence of nipple fissures or breast abscess  Rest and sleep. Advise her to increase the
to rule out these conditions. amount of rest and sleep and to continue with
her normal nutrition intake.
Palmar Erythema
 Take short breaks. For women who still
Palmar erythema is the constant itching and redness of
work, advise her to take short breaks,
the palms but is not considered an allergy.
especially if her work involves being up and
Increased estrogen levels possibly cause the pruritus.
about the whole day.
Muscle Cramps
Muscle cramps are caused by decreased
serum calcium levels, increased phosphorus levels, or
interference in the circulation.
 Lie down. Advise the woman that when this
happens, she should lie on her back and
extend the affected leg while she keeps her
knee straight and dorsiflexes the foot.
 Magnesium citrate or aluminum
hydroxide gel. Magnesium citrate or
aluminum hydroxide gel is prescribed to
women who have frequent and unrelieved
muscle cramps.
 Raise those feet. The woman should elevate
her lower extremities frequently to promote
Palmar erythema. Image via thebileflow.wordpress.com circulation.
 No it’s not an allergy. Educate the woman
that she has not developed an allergy, and
this is normal during pregnancy.
 Calamine lotion to the rescue. To soothe
the itchiness, calamine lotion can be applied.
 Disappears naturally. Palmar erythema
would naturally disappear once the body has
adjusted to the increased estrogen levels.
Constipation
Constipation is caused by slow peristalsis due to the
pressure from the growing uterus.
 Increase fiber in the diet. Encourage the
woman to move her bowels regularly and
increase the fiber in her diet.
 Drink water. Advise her to drink at least 8
to 10 glasses of water every day. Hypotension
 Iron supplements. Educate her that iron
When the woman lies on her back and the uterus presses
supplements can cause constipation but need upon the vena cava, supine hypotension might occur,
not be stopped because it helps build up fetal impairing blood return to the heart.
 Sleep sideways. Advise woman to rest or
iron stores.
 Don’t use mineral oil. The use of mineral
sleep on her side, not on her back.
 Rise slowly. Encourage her to rise slowly
oil to relieve constipation is not advisable
because it absorbs the fat-soluble vitamins A, and dangle feet over the bed for a few
D, K, and E. minutes; avoid standing for extended
 Don’t use enemas. Enemas are also
periods.
prohibited as it may initiate labor. Varicosities
Varicosities are tortuous veins caused by the pressure of  Low heels. Advise the woman to wear shoes
the uterus to veins at the lower extremities. with low to moderate heels to reduce the
ADVERTISEMENTS amount of spinal curvature necessary to
 Raise legs. Advise the woman to rest in maintain an upright position.
Sim’s position or on the back with the legs  Warm compress. Backache can be relieved
raised against the wall. by applying local heat on the area.
 Don’t cross legs. Discourage sitting with  Body mechanics. Advise the woman to
legs crossed or knees bent and the use of squat rather than bend over to pick up
constrictive knee-high hose or garters. objects.
 Support stockings do wonders. The use of  Close to center of gravity. Advise the
elastic support stockings is advised to relieve woman to lift objects by holding them close
varicosities. to the body.
 Exercise and walk. Exercise is also
effective through taking walk breaks from Dyspnea
chores or from standing or sitting for too Dyspnea results from the pressure of the expanding
long. uterus on the diaphragm. Dyspnea is prominent
 Vitamin C helps. Vitamin C is also especially when the woman lies flat on the bed at night.
recommended to reduce varicosities for the ADVERTISEMENTS
formation of blood vessel collagen and  Proper sleeping position. Encourage the
endothelium. woman to sleep with her head and chest
elevated.
Hemorrhoids  Limit activities. Advise her to limit her
Hemorrhoids are varicosities of the rectal veins that activities during the day to prevent exertional
occur because of the pressure of the veins from the dyspnea.
weight of the uterus.
 Evacuate daily. Advise the woman to Ankle Edema
evacuate her bowels daily and resting on a Late in pregnancy, some women experience swelling of
Sim’s position. the ankles and feet. The edema is caused by general fluid
 Knee-chest position. Encourage the woman retention and reduced blood circulation in the lower
to assume a knee-chest position for 10-15 extremities.
minutes at the end of the day to relieve the  Watch out for proteinuria or
pressure on the rectal veins. eclampsia. Assess if the woman has
 Stool softener. If the woman already has hypertension or proteinuria to rule out
hemorrhoids, a stool softener would be eclampsia.
recommended.  Sleep on the left side.  Advise the woman to
 Relieving hemorrhoids. The pain of lie on her left side when resting or sleeping.
hemorrhoids could also be relieved by  Sit. Encourage her to sit half an hour in the
applying witch hazel or cold compresses to afternoon and in the evening with legs
external hemorrhoids. elevated and to avoid constrictive clothing.

Heart Palpitations Braxton Hicks Contraction

Heart palpitations may occur when upon sudden From the 8th to the 12th week of pregnancy, the uterus
movement the woman experiences bounding palpitation periodically contracts and relaxes, and this is termed as
of the heart. This is mainly due to circulatory Braxton Hicks contraction.
adjustments necessary to accommodate her increased  Give assurance. Assure the woman that
blood supply during pregnancy. these are not signs of early labor, but they
 Slow and steady. Advise the woman to can inform their healthcare provider about
move in slow, gradual movements to prevent them.
heart palpitations. A pregnant woman would always want reassurance that
her pregnancy is healthy. These discomforts may alarm
Frequent Urination her, especially if she knows little about the physiology of
The pressure of the uterus on the bladder causes frequent pregnancy, so it is the role of healthcare providers to
urination. Frequency occurs early in the pregnancy and guide her and be there for her whenever she needs them
late in the pregnancy. throughout the pregnancy.
 No fluid restriction. Advise the woman not
to restrict her fluids to diminish the How a Woman Responds to Pregnancy
frequency of urination, instead; caffeine Mood swings, grief, changes in sexual desires, and stress
intake should be diminished. are only some of the psychological changes that a
 Offer assurance. Assure the woman that pregnant woman experiences. The couple might
voiding frequently is a normal occurrence misinterpret these changes, so health education must be
during pregnancy. integrated in the care of the pregnant woman.
 Kegel’s exercises. Kegel’s exercise also ADVERTISEMENTS
helps to reduce the incident of stress
Grief
incontinence and helps regain the strength of
 Grief may arise from the realization that
urinary control and strengthens perineal
one’s roles would be changed permanently.
muscles for birth.
 A pregnant woman would be weaned off her
Discomforts during the Second and Third Trimester role as a dependent daughter, or as a happy-
The last trimesters of pregnancy also have their set of go-lucky girl, or a friend who is always
discomforts that you have to differentiate from available.
complications that might arise.  Even the partner would have to leave the
roles or the life he has been accustomed to as
Backache a man without a child to support.
Lumbar lordosis develops as pregnancy progresses to
maintain the balance. Mood Swings
  Also known as emotional lability, this  Despite the modern ages, there are still
psychological reaction can be caused by two groups who firmly believe in their culture’s
factors: hormonal changes or narcissism. explanations about birth complications and
 The comments that she had brushed off in the health care providers must respect this.
her nonpregnant state can now touch a nerve  Myths that surround the pregnancy should
or hurt her. always be respected, but the couple should
 Crying is a common manifestation of mood be educated properly regarding what could
swings, during and even after the pregnancy. be dangerous for the fetus’ health.
Changes in Sexual Desire Family Changes
 Women who are on the first trimester of  The environment where the woman grew
pregnancy experience a decrease in libido influences the way she would perceive her
mainly because of breast tenderness, nausea, pregnancy.
and fatigue.  Family culture and beliefs also affect a
 On the second trimester, sexual libido may woman’s perception of pregnancy.
rise because of increased blood flow to the  If she is loved as a child, she would have an
pelvic area that supplies the placenta. easy time accepting her pregnancy compared
 The third trimester might bring an increase to women who were neglected by her family
or decrease in sexual libido due to an during childhood.
increase in the abdominal size or difficulty in  A woman who has been told of disturbing
finding a comfortable position. stories about giving birth and pregnancy
 Estrogen increase may also affect sexual would view her own in a negative light,
libido as it may bring a loss of desire. while those who grew with beautiful birth
 The couple must be informed that these stories would more likely be excited for their
changes are normal to avoid pregnancy.
misunderstanding the woman’s attitude.  A positive attitude would only result from a
positive outcome and influence from the
Stress woman’s own family.
 Pregnancy is a major change in roles that
could cause stress. Individual Changes
 The stress that a pregnant woman feels might  Becoming a new mother is never an easy
affect her ability to decide. transition. The woman must first be able to
 The discomforts that she may feel could also cope with stress effectively, as this is a major
add up to the stress she is experiencing. concern during pregnancy.
 Assess whether the woman is in an abusive  She needs to have the ability to adapt
relationship as it may contribute further to effectively to any situation, especially if the
the stress. pregnancy is her first because there might be
a lot of new situations that would arise.
Introversion/Extroversion  Her ability to cope with a major change and
 Introversion refers to someone who focuses manage her temper would be put to a test
entirely on her own body and a common during motherhood.
manifestation during pregnancy.  The woman’s relationship with her partner
 Some pregnant women also manifest also affects her ability to accept her
extroversion, or acting more active, healthier pregnancy easily.
and more outgoing than before their  If she feels secure with her relationship with
pregnancy. the father of her child, she would have an
 Extroversion commonly happens to women easier time accepting her pregnancy as
who had a hard time conceiving and finally opposed to an unstable relationship where
hit jackpot. she feels insecure and may doubt the
decision of keeping the pregnancy.
Social Changes
 A woman who feels that the pregnancy may
 In the past, a pregnant woman is isolated
rob her of her looks, her freedom, a
from her family starting from visiting for
promotion, or her youth would need to have
prenatal consultation until the day of birth.
a strong support system so she could express
 She is isolated from her family and the baby
her feelings and unburden her chest.
a week after birth.
 The father’s acceptance of the pregnancy
 Today, having a support system for pregnant
also influences the woman’s ability to accept
women is highly encouraged, like bringing
the marriage.
along someone to accompany her during
 Utmost support from her husband would be
prenatal visits and allowing the husband to
very meaningful for the woman especially
be with the wife during birth if he chooses to.
during birth.
 Opinions on teenage pregnancy, late
pregnancies, and having the same sex parents The Psychological Tasks of Pregnancy
are now widely accepted compared to being Both the woman and her husband walk through a tangle
taboos in the past. of emotions during pregnancy. Accepting that a new life
would be born out of your blood is not as easy as others
Cultural Changes
may think. There are several stages that both should
 A pregnant woman’s culture and beliefs may
undergo, the psychological way.
also greatly affect the course of her
ADVERTISEMENTS
pregnancy.
 Assess if the woman and her partner have First Trimester: Accepting the Pregnancy
particular beliefs that might affect the way  The shock of learning about a new
the take care of the pregnancy so you can pregnancy is sometimes too heavy for a
integrate them in your plan of care. couple, so it is just proper for the both of
 them to spend some time recovering from Admission into labor room is only done when the patient
this major life-altering situation and avoid is in active labor.
overwhelming themselves at first.
 One of the most common reactions of a Stages of Labor
couple who would be having a baby for the The progress of cervical effacement, cervical dilatation,
first time is ambivalence, or feeling both and descent of fetal presenting part dictate stages of
pleased and unhappy about the pregnancy. labor. Here are the stages of labor and significant events
that mark their beginning and end:
Second Trimester: Accepting the Baby
 The woman and her partner will start to First Stage of Labor
merge into the role of novice parents as
second trimester closes in. As mentioned above, the first stage of labor is divided
 Emotions such as narcissism and into three sub-phases, namely: latent, active, and
introversion are commonly present at this transitional phases.
stage. Latent Phase
 Role playing and increased dreaming are
Latent (Preparatory) Phase starts from the onset of
activities that help the couple embrace their true labor contractions to 3 cm cervical dilatation. Here
roles as parents. are nursing responsibilities during this phase:
 At this stage, the woman and her partner
1. Assess patient’s psychological readiness.
must start to concentrate on what it will feel Provide continuous maternal support
like to be parents. (compared to usual care).
Third Trimester: Preparing for the Baby 2. Measure duration of latent phase. For
 The couple starts to grow impatient as birth nulliparas, it should not be more than 6

Duration
Stages of Labor Start End
Nullipara Multipara
10-12 hr but
Full cervical 6-8 hrs but 2-12 hrs
First Stage True labor contractions 6-20 hrs is the
dilatation is the normal limit
normal limit
Onset of regularly perceived uterine
3 cm cervical
Latent phase contractions (mild contractions lasting 6 hrs 4.5 hrs
dilatation
20-40 sec)
Active Stronger uterine contractions lasting 40- 7 cm cervical
3 hrs 2 hrs
phase 60secs dilatation
Transitional Uterine contractions reaching their peak, 10 cm cervical
3 hrs 1.5-2 hrs
phase occurring every 2-3 minutes for 60-90 s dilatation
Infant birth <2 hrs 0.5-1 hrs
Second Stage Full cervical dilatation 3 hrs with
2 hrs with epidurals
epidurals
Placental
Third Stage Infant birth Maximum of 30 min.
delivery
nears. hours. On the other hand, for multiparas, it
 Preparations for the baby, both small and big, should be within 4.5 hours. Determine if
takes place during this stage. patient received anesthesia because it can
 The baby’s clothing and sleeping arrangements prolong latent phase. One of the most
are set and the couple is excited for his arrival. common cause of prolonged latent phase is
The transition of a woman from the start until the end of cephalopelvic disproportion (CPD) and it
the pregnancy is a big turning point for her and the requires cesarean birth.
people who surround her. Every single one of them must 3. Allow patient to be continually active.
be prepared physically, mentally and emotionally Upright maternal positions are recommended
because pregnancy is also considered a crisis in life; for women on the first stage of labor.
something that could turn your world upside down. Patients without pregnancy complications
can still walk around and make necessary
Admission Assessment birth preparations.
When a patient arrives at the labor floor, pertinent 4. Conduct interviews and filling in of forms
information about the pregnant woman’s health history (e.g. birth certificate) at this phase while the
is taken during admission. These include personal data patient experiences minimal discomfort and
(e.g. blood type, allergies, etc.), previous illness, has control over contraction pains.
pregnancy complications, preferences for labor and 5. Conduct health teaching on breastfeeding,
delivery, and childbirth preparations. Standard obstetric, newborn care, and effective bearing down
medical, and social history taking is also done. because during this time, patient’s anxiety is
In addition, the nurse assesses the following: vital signs, controlled and she is able to focus on nurse’s
physical exam, contraction pattern (frequency, interval, instructions.
duration, and intensity), intactness of membranes 6. Educate patient on different relaxation
through vaginal exam, and fetal well-being through fetal techniques. As early as this phase, encourage
heart rate, characteristic of amniotic fluid, and patient to begin alternative therapy of pain
contractions. The nurse performs Leopold’s maneuver to relief.
determine fetal presenting part, point of maximum
impulse, fetal descent and engagement.
 7. Ensure that the total number of internal Second Stage of Labor starts when cervical dilatation
examinations the woman receives in the reaches 10 cm and ends when the baby is delivered. At
entire course of labor is limited to 5 only. this stage, the patient feels an uncontrollable urge to
8. Ensure that birthing companion of choice is push. The patient may also experience
present all throughout the course of labor. temporary nausea together with increased restlessness
and shaking of extremities. The nurse at this stage must
Active Phase
coach quality pushing and support delivery.
Active Phase starts from 4 cm cervical dilatation to 7
Here are nursing care tips for this stage:
cm cervical dilatation. During this phase, contraction
1. Instruct patient on quality pushing. The
intensity is stronger, interval shortens, and duration
abdominal muscles must aid the involuntary
lengthens. This is where true discomfort is first felt by
uterine contractions to deliver the baby out.
the patient so she is dependent and her focus is on
2. Provide a quiet environment for the patient
herself. Here are nursing responsibilities in this phase:
to concentrate on bearing down.
1. Inform patient on the progress of her
3. Provide positive feedback as the patient
labor to lessen her anxiety and obtain her
pushes.
trust and cooperation.
4. Repeat doctor’s instructions. At this phase,
2. Start monitoring progress of labor with the
the patient barely hears the conversation
use of WHO partograph, 2-hour action line.
around the room because all her energy and
3. Encourage patient to be continually
thoughts are being directed toward giving
active to maximize the effect of uterine
birth.
contractions. Upright maternal positions are
5. Take note of the time of delivery and
recommended if tolerated.
proceed to initiate essential newborn care.
4. Assist patient in assuming her position of
Delayed cord clamping is recommended.
comfort. For those who can’t stay upright,
6. Assist in restrictive episiotomy for patients
left-side lying is recommended to avoid
who had vaginal births.
disruption in fetal oxygenation.
WHO do not recommend the following
5. Monitor maternal vital signs and fetal
interventions during delivery because they provide low
heart rate every 2 hours, or depending on
quality of evidence:
the doctor’s order.
1. Perineal massage
6. Anticipate patient needs (e.g. sponging face
2. Use of fundal pressure
with cool cloth, keeping bed clean and dry,
providing ice chips or lip balm) to promote Third Stage of Labor
comfort.
7. Determine when patient last voided because Third Stage of Labor or the placental stage starts from
a full bladder can hinder fast labor progress. birth of infant to delivery of placenta. It is divided into
8. Institute non-pharmacological pain measures two separate phases: placental separation and placental
(e.g. breathing exercises, distraction method, expulsion. Five minutes after delivery of baby, the uterus
imagery, music therapy, etc.) begins to contract again, and placenta starts to separate
Transition Phase from the contracting wall. Blood loss of 300-500 mL
Transition Phase starts from 8 cm cervical dilatation to occurs as a normal consequence of placental separation.
10 cm (full) cervical dilatation and full cervical Placenta sinks to the lower uterine segment or upper
effacement. During this time, patient may be exhausted vagina. The placenta is then expelled using gentle
and withdrawn or aggressive and restless. Patient’s urge traction on the cord.
to push is noticeable. Here are nursing Here are the signs of placental separation:
responsibilities in this phase: 1. Lengthening of umbilical cord
1. Inform patient on progress of her labor. 2. Sudden gush of vaginal blood
2. Assist patient with pant-blow breathing. 3. Change in the shape of uterus (globular in
3. Monitor maternal vital signs and fetal heart shape)
rate every 30 minutes -1 hour, or depending 4. Firm uterine contractions
on the doctor’s order. Contraction 5. Appearance of placenta in vaginal opening
monitoring is also continued. At this stage, here are the nursing care tips:
4. When perineal bulging is noticeable, prepare 1. Coach in relaxation for delivery of placenta.
for delivery. Check room temperature (25- 2. Congratulate on delivery of baby.
280C and free of air drafts). The nurse should 3. Encourage skin-to-skin contact to facilitate
also notify staff and prepare necessary bonding and early breastfeeding.
supplies and equipment, including 4. Ask patient whether placenta is important to
resuscitation machine. Lastly, perform them before it is destroyed. For those who
handwashing and double gloving. want to take it home, ensure that they
WHO do not recommend the following nursing understand and follow standard infection
interventions during labor because they have low precautions and hospital policy.
quality of evidence: 5. Administer prophylactic oxytocin as ordered.
ADVERTISEMENTS 6. Utilize controlled cord traction technique for
1. Routine perineal shaving placental expulsion.
2. Routine use of enema 7. Utilize absorbable synthetic suture materials
3. Admission cardiotocography (CTG) for low- (over chromic catgut) for primary repair of
risk women episiotomy or perineal lacerations.
4. Vaginal douching For immediate postpartum, the nurse checks the vital
5. Routine amniotomy for patients in signs and monitors for excessive bleeding. The first four
spontaneous labor hours after birth is sometimes referred to as the fourth
6. Massage and reflexology stage of labor because this is the most critical period
for the mother. The nurse is set to perform nursing
Second Stage of Labor interventions that would prevent the patient
from infection and hemorrhage. Also, they are being
reminded of the importance of breastfeeding,  Breast milk contains immunoglobulin
ambulation, and newborn care. A which binds viruses and bacteria so they
Here are WHO recommendations for immediate will not be absorbed from the gastrointestinal
postpartum: tract into the infant.
1. Early (<6 hours) resumption of feeding for  Lactoferrin, which is from the breast milk,
patients who have vaginal birth also interferes with the growth of pathogens.
2. Prophylactic antibiotics for women who  An enzyme from the breast milk,
sustained third to fourth degree of perineal the lysozyme, destroys bacteria by lysing
tear during delivery their cell membranes.
3. In healthy women who delivered vaginally to  Leukocytes in the breast milk provide
term infants, early postpartum discharge is protection against common respiratory
recommended. infections.
On the other hand, here are interventions not  Macrophages that
recommended during immediate postpartum: produce interferons protects against
1. Routine use of ice packs common viruses.
2. Oral methylergometrine for patients who  Lactobacillus bifidus in breast milk prevents
delivered vaginally colonization of pathogenic bacteria in the
Nursing care for women in labor is a routine that takes a gastrointestinal tract, reducing the incidence
while to fall into. After all, it is overwhelming for of diarrhea.
beginner nurses to do their responsibilities in front of a  Breast milk contains the ideal composition of
woman writhing in pain. However, the opportunity to electrolytes and minerals for infant growth.
protect women and the privilege of being a part of their  Rapid brain growth in the infants is achieved
positive pregnancy experience is rewarding. Read and because breast milk is high in lactose which
share this to your nurse friends because women’s and provides ready glucose.
children’s lives deserve only the best care.  Breast milk also contains linoleic acid which
is an essential fatty acid for skin integrity.
Breastfeeding and its Physiology  The levels of nutrients are enough to supply
Breast milk is agreed to be the most recommended the infant’s needs and also spare the infant’s
milk for newborns because of its benefits to both the kidneys from processing a high renal solute
mother and the newborn. What is the physiology of load of unused nutrients.
breastfeeding?  Breast milk is free from allergens, unlike
 Acinar cells or alveolar cells are responsible cow’s milk.
for the formation of breast milk.  Calcium is regulated better in newborns that
 Progesterone levels fall after the placenta is are breastfed.
delivered, leading to the stimulation of  Breastfeeding prevents excessive weight gain
prolactin. in infants.
 Prolactin stimulates the production of milk.
 On the fourth month of pregnancy, the acinar Advantages for the Mother
cells start producing colostrums, which is  Breastfeeding helps prevents breast cancer.
full of nutrients for the newborn.  Oxytocin aids in uterine involution as it
 Colostrum production continues for the first helps the uterus contract.
3 to 4 days after birth.  Breastfeeding empowers women because
 Transitional breast milk replaces only women can master it.
colostrums on the 2nd to 4th  Feeding and preparation time is greatly
 True or mature breast milk is produced on reduced.
the 10th  The bond between the mother and the baby is
 Milk flows through its reservoirs, the strengthened.
lactiferous sinuses, which are located behind
the nipple. Common Concerns in Breastfeeding
 Foremilk is the constantly forming milk. Some mothers may love breastfeeding their babies, but
 When the infant sucks at the breast, oxytocin there are others who are quite hesitant to do so. These
is released and the collecting sinuses of the are mainly due to some of their concerns during
mammary glands contract. breastfeeding, and examples of these concerns are as
 Milk is forced forward through the nipples, follows.
and this action is called the letdown reflex. Issue Intervention
 Let down reflex can be triggered by
thinking about the baby or whenever the The nurse s
mother hears a baby crying. The mother worries about the amount of milk adequate a
 After the letdown reflex, new milk or hind taken by the baby because she cannot see it. whether the
milk is formed, and it has higher fat than wetting the
foremilk. The infant does not suck well because of the
 Hind milk makes the infant grow more possible effect of analgesia during birth. The nurse
rapidly than foremilk. pattern of t
The infant also cannot suck well when it is not effect of an
 Oxytocin also helps in the contraction of the
hungry or was exhausted by crying from hunger.
uterus so that the woman will feel a small
tugging or cramping in the lower pelvis on The mother is worried because the infant’s stools
the first few days of breastfeeding. are loose and thin, but these are normal because Explain the
stools are normally lighter and looser for and also exa
Advantages of Breastfeeding breastfed babies.
Breastfeeding must also depend on the preference of The father feels shut out of the mother-baby
both the woman and her baby, so both of them could Advise the
relationship, so he does not participate in infant
enjoy the experience and gain benefits as well. infant aside
feeding.
Advantages for the Infant The mother has sore nipples because the nipples Assist the
 correctly and advise the findings
motherand at thethesame
to expose nippletime
to airavoids
were kept wet, so the infant cannot grip the entire between feedings. overexposing the newborn.
areola properly.  The most important assessment before
Advise the mother that she can apply aloe vera or vitamin E to
anything else is the respiratory assessment.
help heal the tissue.
 The newborn’s height and weight can
Encourage the infant to suck and advise
determine the motherand
their maturity to apply
establish
The engorgement of the mother’s breasts causes warm packs to breasts. baseline data of their height and weight.
a lymphatic filling as milk production begins. Instruct the mother  The to newborn
take a is warm
weighedshower
daily atbefore
exactly the
same time to note any abnormal
breastfeeding the infant to soften the breast tissue. weight loss
The mother does not want to breastfeed in public or gain.
Encourage the woman  to use discretion
Some to avoid tests
of the laboratory confrontation.
performed for
because some people make them uncomfortable.
newborns is the heel-stick test for blood
Assessment for Well-Being studies.
Assessment of the newborn immediately starts the  Glucose measurement is also possible
moment he or she is delivered, and there are a lot of through the heel-stick test to detect
standard assessments used to evaluate them rapidly. hypoglycemia.
 The newborns are also subjected to
Apgar Scoring behavioral capacity assessment where term
The Apgar scoring is done during the first 1 minute and newborns are physically active and
5 minutes of life. The heart rate, respiratory emotionally prepared to interact with the
rate, muscle tone, reflex irritability, and color are people around them than preterm newborns.
evaluated in an infant. Apgar score is the baseline for all
future observations. Care of the Newborn at Birth
 Newborn care is immediately done after birth
Indicator 0 1 2 in a separate space near the birthing area.
 Equipment such as radiant heat table, warm
blankets, resuscitation, eye care, suction,
A Activity Absent Flexed arms and legs
weighing scale and equipment for oxygen
administration are already prepared and
P Pulse Absent Below 100 bpm
ready to use.
 Newborn identification and registration is an
G Grimace Floppy Minimal response to stimulation
important step after the immediate newborn
care to avoid switching of babies or
A Appearance Blue; pale Pink body, blue extremities
kidnapping in the healthcare facility.
 An identification band is placed around the
R Respiration Absent Slow & irregular
newborn’s arm or leg which contains the
 Each parameter can have the highest score of mother’s hospital number, the mother’s full
two and the lowest is 0. name, sex, date, and time of infant’s birth.
 The scores of the five parameters are added  The newborn’s footprints are then taken and
to determine the status of the infant. kept for permanent identification.
Apgar scoring  The birth registration of the infant is taken
 0-3 points: the baby is serious danger and care of by the physician or nurse-midwife
need immediate resuscitation. who supervised in the delivery.
 4-6 points: the baby’s condition is guarded  The mother’s name, the father’s name, and
and may need more extensive clearing of the the infant’s name and birthdate, as well as
airway and supplementary oxygen. the place, are recorded.
 7-10 points: are considered good and in the  The newborn’s chart is also a mine of
best possible health. information when it comes to the newborn’s
welfare.
Respiratory Evaluation  Essential information such as the time of the
 With every newborn contact, respiratory infant’s birth, the Apgar score, eye care
evaluation is necessary because this is the given, immunizations, and the general
highest priority in newborn care. condition of the infant must be reflected on
 The Silverman and Andersen index can the chart.
assess respiratory distress and its varying
degrees. Care of the Newborn in the Postpartum Period
 There are five criteria to evaluate the  Newborn care varies among cultures and in
newborn: chest movement, intercostals some areas in the world.
retraction, xiphoid retraction, nares  During the initial feeding, a term newborn
dilatation, and expiratory grunt. could be fed immediately after birth while a
 The highest score for each criterion is 2, and formula-fed one should be fed at 2 to 4 hours
the lowest is 0. of age.
 The lowest overall score is 0, which indicates  Bathing is done an hour after birth to gently
that there is no respiratory distress. wash away the vernix caseosa, and this is
 A score of 4 to 6 shows moderate distress done daily.
and 7 to 10 indicates severe distress.  Areas such as the newborn’s face, skin folds,
 The scores of the Silverman and Andersen and diaper area are the areas that need
index are opposite the Apgar scoring. washing regularly.
 The nurse must supervise the bathing
Physical Examination together with the parents.
 Physical examination is done to detect any  The bath water must be pleasantly warm as
observable conditions and physical defects. well as the room to prevent chilling.
 This assessment is done quickly by the  Bathing should be before feeding and not
healthcare provider while noting important after it to prevent aspiration and vomiting.
  Equipment needed during bathing are a basin The system that will greatly feel the changes is the
of water, washcloth, soap, towel, diaper, a reproductive system. It includes the ovaries, uterus, and
clean shirt, and comb. vagina.
 Start bathing the infant from the cleanest  On the first trimester in the ovaries, the
area (the eyes) towards the dirtiest area (the corpus luteum starts to become active. By the
diaper area), and soap is never used for the second trimester, it begins to fade until the
baby’s face, only for the body. third trimester where it has already
 Do not soak the cord when you wash the skin disappeared.
around it.  The uterus increases in growth starting from
 Instruct the parents that the sleeping position the first trimester. On the second trimester,
of the infant must be flat on the back to the placenta is forming estrogen and
prevent SIDS, but never place a pacifier on progesterone.
the infant during sleep.  The vagina undergoes changes during the
 During diaper change, the area must be first trimester wherein a whitish discharge is
washed and dried well to prevent diaper rash. present. From the second until the third
 Petroleum jelly or a mild ointment is applied trimester, the whitish discharge increases in
on the buttocks to avoid accumulation of amount.
ammonia and remove meconium.  Amenorrhea also occurs, or the absence of
 Vaccination for Hepatitis B and Vitamin K menstruation.
administration is also essential in the  The cervix undergoes a more vascular and
postpartal period. edematous appearance owing to the
increased level of estrogen.
The Diagnosis of Pregnancy
Before a pregnancy is confirmed, the woman might see Breast Changes
small and big changes in her body that could help in  Breast changes start from the first trimester
determining if she is already pregnant.                               as the woman feels tenderness and fullness
of her breasts.
Presumptive Signs  As the pregnancy progresses, the breast size
Presumptive signs are signs that are least indicative of a increases a size or two, as the mammary
pregnancy. These changes can only be felt by the woman alveoli and fat deposits increase in size.
but cannot be documented by the healthcare provider.  The areola of the nipples become darker and
ADVERTISEMENTS its diameter increases.
 Breast changes (swollen), nausea and  The vascularity of the breast also increases,
vomiting, amenorrhea, frequent urination, as evidenced by the prominent blue veins
fatigue, uterine enlargement, quickening, over the surface.
linea nigra, melasma, and striae gravidarum  The Montgomery’s tubercles or the
are the presumptive signs of pregnancy. sebaceous glands of the areola protrudes and
 However, these signs may also denote other enlarges.
conditions that the body is undergoing.
Systemic Changes
Probable Signs After the changes that occurred mainly in the
Probable signs of pregnancy are objective and can be reproductive system of a pregnant woman, systemic
seen primarily by the healthcare provider. These can be changes will also start to occur in different body
taken through laboratory tests and home pregnancy tests systems.
by detect the presence of human chorionic ADVERTISEMENTS
gonadotropin in the blood or in the urine.
 Chadwick’s sign or a change in the color of Integumentary System
the vagina from pink to violet is a probable  The stretching of the abdomen causes rupture
sign of pregnancy. of the small segments of the connective layer
 Goodell’s sign is a probable sign that depicts of the skin.
a softening of the cervix.  Striae gravidarum or pinkish to reddish
 Hegar’s sign is the softening of the lower marks on the sides of the abdominal wall are
uterine segment. the result of the rupture.
 Ballottement is described as the rise of the  Linea nigra is a narrow, brown line that runs
fetus felt through the abdominal wall when from the symphysis pubis to the umbilicus
the uterine segment is tapped on a bimanual and separates the abdomen into right and left
examination. hemispheres.
 An evidence of a gestational sac found  Melasma or chloasma (mask of pregnancy)
during ultrasound is another probable sign. refers to the darkened areas on the cheeks or
 Braxton-Hicks contractions are periodic the nose that may appear during pregnancy.
uterine tightening and contractions.  Telangiectasis is red, branching spots that
 The fetal outline can also be now palpated by can be seen on the thighs. It is also called as
the examiner through the abdomen. vascular spiders.
 Palmar erythema also occurs because of the
Positive Signs increase in the estrogen level of the pregnant
There are only three positive signs of pregnancy that are woman.
documented by the health care providers.
ADVERTISEMENTS Respiratory System
 Evidence of a fetal outline on ultrasound.  A pregnant woman usually experiences
 With the use of a Doppler, an audible fetal stuffiness or marked congestion because of
heart rate is another positive sign. the increasing estrogen levels.
 The last is fetal movement felt by the  Shortness of breath is also a common
healthcare provider. discomfort of pregnancy as the pregnant
uterus pushes the diaphragm upward.
Reproductive System Changes
  The total oxygen consumption of a pregnant  Estrogen and progesterone aids in uterine
woman increases by 20%. and breast enlargement.
 Human placental lactogen increases glucose
Cardiovascular System levels to supplement the growing fetus.
 The blood pressure of the pregnant woman  Relaxin increases to soften the cervix and
decreases in the second trimester and then collagen of joints.
returns to its prepregnancy level on the third The changes in the physiologic status of a pregnant
trimester. woman are just one of the many phases of changes that
 The cardiac output increases 25% to 50%. occur during pregnancy. Most of these are normal, but
 Plasma volume also increases up to 3600 when the pregnant woman experiences an excessive
mL, marking the condition called manifestation of these signs, it would be best to consult
pseudoanemia early in the pregnancy. your healthcare provider.
 Heart rate also increases to 80 to 90 beats per
minute. Profile of the Newborn
 The blood volume increases up to 5,250 mL Newborns may look alike, but each has their own
during pregnancy. physical attributes and personalities. Some newborns are
fat and short while some are long and thin. There are
Gastrointestinal System newborns who never give a fuss whenever they are
 Nausea and vomiting is one of the first signs changed or cuddled, but some can cry in high decibels
of pregnancy that a woman feels. whenever you lift them from their cradles.
 Slower intestinal peristalsis occurs during the  The weight of newborns varies according to
second trimester of the pregnancy which their race, genetics, and nutritional factors.
causes heartburn, flatulence, and  To determine if the newborn’s weight is
constipation. appropriate for its gestational age, a neonatal
 Hemorrhoids also occur from the increased graph should be used in plotting the
pressure of the uterus on the veins in the newborn’s weight.
lower extremities.  Plotting the height and head circumference
Urinary System of the newborn also helps determine any
 The total body water of a pregnant woman disproportions.
increases up to 7.5 L for a more effective  The average birth weight for a mature female
placental exchange. newborn in the United States is 3.4kg or 7.5
 Even when the woman has an increased lbs, and for a mature male, the newborn is
urine output, her potassium levels are still 3.5 kg or 7.7 lbs.
adequate due to progesterone, which is  For all races, the normal weight is 2.5 kg or
potassium-sparing. 5.5 lbs.
 The bladder capacity increases to  The newborn loses 5% to 10% of its birth
accommodate 1,000 mL of urine during weight during the first few days of life, then
pregnancy. has 1 day of stable weight, and gains weight
 On the first trimester, the frequency of rapidly afterward.
urination already increases. By the last two  The newborn must gain 2 lbs per month for
weeks of pregnancy it reaches up to 10 to 12 the first six months of life.
times per day.   The average birth length of mature female
newborns is 53 cm or 20.9 inches. The
Skeletal System mature male newborn has an average birth
 By the 32nd week of pregnancy, the length of 54 cm or 21.3 inches.
symphysis pubis widens for 3 to 4 mm.  A mature newborn has a head circumference
 The center of gravity of a pregnant woman of 34 to 35 cm.
changes, and to make up for it she tends to  Head circumference is measured with a tape
stand straighter and taller than usual and with measure drawn across the center of the
the abdomen forward and the shoulders forehead and around the most prominent part
thrown back, the ‘pride of pregnancy’ or of the posterior head.
commonly ‘lordosis’ occurs.  The chest circumference in a mature
newborn is 2 cm less than the head
Endocrine System circumference.
 A slight enlargement in the thyroid and  Chest circumference is measured at the level
parathyroid gland increases the basal of the nipple using a tape measure.
metabolic rate of a pregnant woman and for
better consumption of calcium and vitamin Vital Statistics
D. Parameter Avera
 Thyroid hormone production increases.
 The insulin produced from the pancreas Weight 6.5 to
decreases early in the pregnancy, thereby Length 50 cm
increasing glucose available for the fetus.
 Increase in insulin occurs in the first Head circumference 33 to
trimester because estrogen, progesterone and 31
Chest circumference
HPL have insulin antagonistic properties. 2cm
 FSH and LH decreases causing anovulation. Abdominal circumference 31 to
 As the breasts are prepared for lactation,
prolactin increases in production. Vital signs
 The increase in melanocyte-stimulating Vital Sign Immediately At Birth
hormones causes increase in skin pigment.
 The human growth hormone increase to aid Temperature 36.5 to 37.2 Celsius
the fetus in growing. Pulse 180 beats/minute
 Respiration 80 breaths/minute  Pallor in newborns is a sign of anemia, and
the newborn must be watched closely for
Blood Pressure 80/46 mmHg
signs of blood in the stool or vomitus.
 Harlequin sign or when a newborn who is
Adjustment to Extrauterine Life
 The newborn’s color on the first 15 to 30
lying on his or her side appears red on the
dependent side and pale on the upper side
minutes of life is still acrocyanotic, and after
2 to 6 hours, there are quick color changes does not have a clinical significance.
 Vernix caseosa or the white cream cheese-
that may occur with movement or crying.
 The temperature within the first 15 to 30
like substance is washed away in the first
bath, but never rub harshly as it will only
minutes after birth falls from the intrauterine
temperature of 100.6⁰F or 38.1⁰C then come off gradually.
 Lanugo or the fine, downy hair that covers
stabilizes at 37.6⁰C after 2 to 6 hours.
 The rapid heart rate of as much as 180 BPM
the shoulders, arms and back of the newborn
would be rubbed away by the friction of the
on the first 15 to 30 minutes of life will have
wide swings in rate with activity as it slows bedding and clothes of the newborn.
 A white, pinpoint papule called milia can be
to 120-140 BPM.
 The newborn’s respirations are irregular in
found in some newborns, mainly on the
cheek or the bridge of the nose, and they
the first few minutes of life, then slows to
30-60 breaths per minute after 30 minutes disappear by 2 to 4 weeks of age.
and will become irregular again only during
activity.
 The newborn would be alert in the first 15 to
30 minutes of life, and later on, will alternate
between the sleeping and awakening phases.
 Just a few minutes after birth, the newborn
would respond to stimulation vigorously but
would be difficult to arouse while it is still
on a resting period until it becomes
responsive again 2 to 6 hours after birth.
 The bowel sounds can be heard after the first
15 minutes of life and becomes present
afterward.
 The fontanelles or the spaces or openings
Appearance of the Newborn
where the skull bones join are soft spots on
the newborn’s head.
o The anterior fontanelle is located
between the two parietal bones
and the two frontal bones which
gives it a diamond shape, and
normally closes at 12 to 18
months of age.
o The posterior fontanelle is
located at the junction of the
parietal bones and the occipital
bone and is triangular in shape,
and closes at the end of the
second month.
Newb  Newborns cry tearlessly until three months
orn Appearance of age when the lacrimal ducts mature.
 Increased concentration of red blood cells in  Birthmarks
newborns, and decreased amount of o Hemangiomas are vascular
subcutaneous fat gives them a ruddy tumors of the skin.
complexion. o Nevus flammeus are muscular
 In the first month, this ruddy complexion purple or dark red lesion.
slightly fades. Generally appear on the face and
 A pale and cyanotic newborn signifies that thighs.
she may have poor central nervous system o Strawberry hemangiomas—
control. elevated areas formed by
 A gray color in newborns may indicate
immature capillaries and
infection. endothelial cells.
 Acrocyanosis is normal in a newborn,
o Cavernous hemangiomas—
wherein the hands, feet, and lips are bluish in
these are dilated vascular spaces.
color.
o Mongolian spots—slate gray
 Central cyanosis, however, is a cause for
patches across the sacrum or
concern as this may indicate a decrease in
buttocks and consist of a
oxygenation.
collection of pigment cells.
 Jaundice appears on the second or third day
o Forceps marks—these are
of life as a result of the breakdown of fetal
circular or linear contusion
red blood cells.
matching the rim of the blade
 Early feeding to speed the passage of feces
forceps on the infant’s cheeks.
through the intestine and prevent
 Permanent eye color appears on the 3 rd to
reabsorption of bilirubin from the bowel may
12th month of age.
diminish physiologic jaundice.
  The newborn’s external ear is not yet fully  The woman should push the button of the
formed, and the top part of the external ear monitor whenever she feels the fetus move.
should be on a line drawn from the inner  Normally, when the fetus moves, the fetal
canthus to the outer canthus of the eye and heart should increase for about 15 beats per
back across the side of the head. minute and remain elevated for 15 seconds.
 The newborn’s nose tends to look large for  The nonstress test is done for 10 to 20
the face but the rest of the face will grow minutes.
more than the nose does.  The result is reactive if there are two
 The newborn’s mouth must open evenly accelerations of fetal heart rate lasting for 15
when he or she cries. seconds that occurs after movement.
 The result is non reactive if there are no fetal
Estimating Fetal Growth accelerations after a fetal movement, or there
is no fetal movement.
McDonald’s Rule
 If the nonstress test is nonreactive, a
 McDonald’s rule is the measurement of the
contraction stress test or biophysical profile
fundal height from the symphysis pubis.
will be scheduled.
 To measure, instruct the woman to lie supine
and start measuring from the symphysis Contraction Stress Testing
pubis to the uterine fundus.  In contraction stress testing, the fetal heart
 The distance between in centimeters depicts rate is assessed in conjunction with uterine
the week of gestation between the 20 th to the contractions.
31st weeks of pregnancy.  The woman is attached to an external uterine
 At 12 weeks, the uterine fundus should be at contraction and fetal heart rate monitor.
the level of the symphysis pubis.  The woman is instructed to roll a nipple
 At 20 weeks, the uterine fundus should be at between her fingers and thumb to produce
the level of the umbilicus. uterine contractions.
 At 36 weeks, the uterine fundus should be at  Within a 10-minute window, three
the level of the xiphoid process. contractions with a duration of 40 seconds or
longer must be present.
Fetal Movement
 The test is negative or normal if there are no
 Quickening or the first fetal movement that
decelerations in the fetal heart rate during
is felt by the mother usually starts at 18 to 20
contractions.
weeks of pregnancy.
 It is positive or abnormal if there is a late
 A healthy fetus moves at an average of at
deceleration at the end of a contraction and
least 10 times a day.
even after the contraction.
 In the Sandovsky method, to assess the fetal
movement, ask the woman to lie in a Ultrasonography
recumbent position after a meal and record  Ultrasonography measures the response of
the number of fetal movements within an sound waves against solid objects.
hour.  It can diagnose a pregnancy of 6 weeks’
 In every 10 minutes, the fetus normally gestation, confirm the presence, size, and
moves at least twice or 10 to 12 times in an location of the placenta, establish that the
hour. fetus is growing, detect any gross anomalies,
 If there is less than 10 movements in an hour, establish the fetal sex, and determine the
the woman should repeat the procedure for presentation and position of the fetus.
the next hour.  The woman has to have a full bladder at the
 The Cardiff method or the “Count-to-Ten” time of the procedure.
method, the woman records the time interval  Have the woman drink a full glass of water
between every 10 fetal movements she feels every 15 minutes 90 minutes before the
within 60 minutes. procedure until the start of the procedure.
 Ultrasonography is also used to predict fetal
Fetal Heart Rate
maturity by the measurement of the
Rhythm Strip Testing biparietal diameter of the fetal head.
 The normal fetal heart rate is 120 to 160  Placental grading can also be done through
beats per minute. ultrasound as 0 (12 to 24 weeks), 1 (30 to 32
 In rhythm strip testing, the fetal heart rate is weeks), 2 (36 weeks), and 3 (38 weeks).
assessed if a good baseline heart rate or a  The amount of amniotic fluid present can
degree of variability is present. also be detected through ultrasonography and
 The results are categorized as absent (none is also a way to estimate fetal health.
apparent), minimal (extremely small
Electrocardiography
fluctuations), moderate (a range of 6-25
 As early as the 11th week of pregnancy, fetal
beats per minute), and marked (range over 25
ECG can be recorded.
beats per minute).
 However, fetal ECG is inaccurate before the
 The rhythm strip testing is done as the
20th week as the fetal electrical conduction is
woman is asked to remain in a fixed position
still weak.
for 20 minutes.
Magnetic Resonance Imaging
Nonstress Test
 MRI does not have any harmful effects to
 In a nonstress testing, the response of the
both the mother and the fetus, and is now
fetal heart rate is measured in response to the
largely considered as one of the preferred
fetal movement.
fetal assessment techniques.
 The woman is attached to a fetal heart rate
 MRI can diagnose complications like ectopic
and uterine contraction monitor.
pregnancy and trophoblastic disease or H-
 mole because fetal movements could hide the provider’s orders is the key to a healthy and
findings later in pregnancy. safe pregnancy.

Maternal Serum Alpha Fetoprotein Psychological Changes

AFP is found in the amniotic fluid and the maternal The changes that the woman undergoes are crucial
serum and is produced by the fetal liver. within the first 24 hours of postpartum, especially the
ADVERTISEMENTS psychological changes. These changes might affect the
 MSAFP levels start to increase at 11 weeks’ woman permanently if not given the appropriate
gestation and increases steadily until term. attention and care.
 The MSAFP level is abnormally high if there
is a spina bifida defect or abdominal defect. Taking-In Phase
 The MSAFP level is low if the fetus has a  The taking-in phase usually sets 1 to 2 days
chromosomal defect such as Down after delivery.
syndrome.  This is the time of reflection for the woman
 The MSAFP is assessed at the 15 th week of because within the 2 to 3 day period, the
pregnancy and can detect 85% to 90% of woman is passive.
neural tube defects and 80% of Down  The woman becomes dependent on her
syndrome. healthcare provider or support person with
some of the daily tasks and decision-making.
Amniocentesis  This dependence is mainly due to her
Amniocentesis is the aspiration of amniotic fluid from physical discomfort from hemorrhoids or the
the pregnant uterus for examination. after pains, from the uncertainty of how she
ADVERTISEMENTS could care for the newborn, and also from
 The test is typically done between the the extreme tiredness she feels that follows
14th and 16th weeks of pregnancy so that there childbirth.
is a generous amount of amniotic fluid  The woman prefers to talk about her
present. experiences during labor and birth and also
 Before the procedure, instruct the woman to her pregnancy.
void, and then place her on a supine position.  The taking-in phase provides time for the
 Fetal heart rate and uterine contraction woman to regain her physical strength and
monitors are attached to the woman, and organize her rambling thoughts about her
blood pressure and fetal heart rate are taken. new role.
 An ultrasound is performed first to determine  Encouraging the woman to talk about her
the position of the fetus and the location of a experiences during labor and birth would
pocket of amniotic fluid and the placenta. greatly help her adjust and let her incorporate
 Antiseptic solution is applied to the abdomen it into her new life.
and local anesthetic is injected.
 Inform the woman that she might feel Taking Hold Phase
pressure as the needle is introduced, but do  The taking hold phase starts 2 to 4 days after
not advise her to take a deep breath and hold delivery.
it in.  The woman starts to initiate actions on her
 About 15 mL of amniotic fluid is aspirated. own and making decisions without relying
 Amniotic fluid is analyzed for AFP, bilirubin on others.
determination, chromosome analysis, color,  Women who underwent anesthesia reach this
fetal fibronectin, inborn errors of phase only hours after her delivery.
metabolism, lecithin-sphingomyelin ratio,  She starts to focus on the newborn instead of
and phosphatidylglycerol and desaturated herself and begins to actively participate in
phosphatidylcholine. newborn care.
 Demonstrate newborn care to the mother and
Biophysical Profile watch her do a return demonstration of every
 The biophysical profile combines five procedure.
parameters into one assessment.  The woman still needs positive
 Fetal heart rate and breathing measure short- reinforcements despite the independence that
term central nervous system function. she is already showing because she might
 The amniotic fluid volume measures long- still feel insecure about the care of her child.
term adequacy of placental function.  Allow the woman to settle in gradually into
 The biophysical profile is more accurate than her new role while still at the hospital or
any other single assessment method. healthcare facility because making decisions
 The score ranges from 2-10, with 10 as the about the child’s welfare is a difficult part of
highest. motherhood.
 If the fetus has a score of 8 to 10, it is doing
well. Letting Go Phase
 During the letting go phase, the woman
 If the score is 6, this is considered
suspicious. finally accepts her new role and gives up her
 A score of 4 denotes that fetus might be in
old roles like being a childless woman or just
jeopardy. a mother of one child.
 This is the phase where postpartum
 The assessment is similar to that of an Apgar
scoring, and it is commonly called as fetal depression may set in.
 Readjustment of relationship is needed for an
Apgar.
Fetal assessment is just one of the many assessments that easy transition to this phase.
a pregnant woman must undergo to ensure the health of Physiological Changes
the fetus and even her own health. Undergoing these
tests can give comfort to the mother regarding the status
of her baby’s health, and compliance of her health care
Several body systems are also affected after the birth of
the newborn, and these changes may or may not be Circulatory System
noticed by the mother early during postpartum.  Blood volume returns to its prepregnancy
level by the first or second week of birth.
Reproductive System  A 4-point decrease in hematocrit and a 1-g
 Involution occurs during postpartum wherein decrease in hemoglobin occur with each 250
the reproductive organs return to their mL blood loss.
nonpregnant state.  Hematocrit levels reach its normal
 The area where the placenta was implanted is prepregnancy level 6 weeks after birth.
sealed off to avoid bleeding.  An increase in leukocytes and plasma
 The uterus returns to its prepregnant size. fibrinogen occurs in the first postpartum
 Involution occurs more quickly in women weeks as a defense mechanism against
who are well nourished and ambulate early infection and hemorrhage.
after birth.
 Contraction plays a very important role in Gastrointestinal System
the postpartum period for it allows the uterus  The woman will feel hungry and thirsty
to return to its former size quickly and also almost immediately after giving birth,
prevents hemorrhage.  Digestion and absorption are active again
 Lochia starts to appear as a bloody discharge after birth except for women who underwent
for the first 3 days after birth and is termed a caesarean section.
as lochia rubra.  Passage of stool may still be slow because of
 Lochia serosa or the brownish to pinkish the relaxin that is still present in the bowels.
discharge starts on the fourth day, and the  Bowel evacuation may still be difficult
amount of blood and tissue decreases. because of the pain of episiotomy.
 Lochia alba appears on the tenth day and the
Fertilization
discharge decreases and almost looks
colorless or whitish. It may last until the
Fertilization is the process wherein the ovum and the
third week after birth.
spermatozoa unite at the ampullary portion of the
 The cervix is soft and malleable immediately
fallopian tube, the usual site of fertilization.
after birth, but once contraction of the cervix
 A mature ovum can only be fertilized within
takes place it also returns to its prepregnant
24 to 48 hours after being released.
state.
 The functional life of the spermatozoa is
 At the end of seven days, the external os has
only 48 to 72 hours.
narrowed to the size of a pencil opening but
 The best time that fertilization would occur
appears slitlike or star shaped compared to
is 72 hours after sexual intercourse.
its round shape before childbirth occurred.
 The fertilized ovum is propelled along the
 The vagina returns to its prepregnant state
tube through the help of the peristaltic
through contractions after the entire
movements of the fallopian tube and the
postpartum period but remains slightly
tube’s cilia.
distended than before.
 The average time that the sperm can reach
 Kegel’s exercise helps return the strength
the cervix is within 90 seconds, and it can
and muscle tone of the vagina.
reach the outer fallopian tube within 5
 The labia minora and majora are still
minutes.
atrophic and soft after birth and would never
 If the ovum has already been penetrated by a
return to its prepregnant state.
spermatozoon, it changes its composition so
 The perineum is edematous and tender
that it becomes impermeable to other
immediately after birth.
spermatozoa.
Hormonal System  After penetration, the chromosomal materials
 As soon as the placenta is no longer present, of both the ovum and the spermatozoon
pregnancy hormones start to decrease. combine to form a zygote.
 hPL and hCG are insignificant by 24 hours.  Three factors determine the certainty of
 Progestin, estrone, and estradiol return to fertilization:
their prepregnancy levels a week after birth. o the maturation of both the sperm
 FSH remains low for 12 days and then starts and the ovum;
to increase to signal the start of a new o the ability of the sperm to reach
menstrual cycle. the ovum; and
o the ability of the sperm to
Urinary System penetrate the cell membrane and
 Immediately after birth, dieresis sets in to rid achieve fertilization.
the body the excess fluid that has
accumulated during pregnancy. Implantation
 On the second to fifth day after birth, the
urinary output of the woman increases to as  The migration of the zygote towards the
much as 3000 mL per day. uterus reaches 3 to 4 days, and it is propelled
 The woman’s abdomen must be assessed by the muscular contractions in the fallopian
frequently during the postpartum period to tube.
prevent damage to the bladder due to  Mitotic cell division or cleaving starts after
overdistention. 24 hours. The rate of cleaving is an average
 Urine may contain more nitrogen postpartum of one every 22 hours.
because of the increased activity of the  As the zygote reaches the uterus, it already
woman during labor. has 16 to 50 cell divisions, and it is now
 Lactose levels may be slightly elevated to called a morula because of its bumpy
prepare the body for breastfeeding. appearance.
  The morula floats freely along the body of
the uterus within 3 to 4 days, and it becomes
a blastocyst.
 The blastocyst attaches into the
endometrium, and this process is called
implantation, which occurs 8 to 10 days after
fertilization.
 Apposition, or the brushing of the blastocyst
against the endometrium, is the first part of
implantation.
 Adhesion occurs afterwards as the blastocyst
attaches to the surface of the endometrium,
then invasion, as it settles into the folds of
the endometrium.
 On the day of implantation, the woman may
experience a small amount of vaginal
spotting as the capillaries by the implanting ADVERTISEMENTS
blastocyst.  On the 11th or 12th day, the chorionic villi
 As implantation occurs, the zygote now start to form from the miniature villi that
becomes an embryo. protrude from a single layer of cells to start
the formation of placenta.
Fetal Structures  The chorionic villi have a central core and
fetal capillaries, and a double layer of
trophoblast cells.
Deciduas  The syncytial layer or the outer portion of the
two layers produces placental hormones such
as hPL, hCG, estrogen, and progesterone.
 The Langhans’ layer is the middle layer and
it protects the embryo and fetus from
infectious diseases. This layer appears to
function as early as 12 days’ gestation.
 The layer disappears on the 20 th to 24th week
of gestation, however, leaving the fetus more
susceptible to infections.
Placenta
The placenta, which is a Latin term for “pancake” for its
appearance came from the trophoblast tissues and has a
lot of functions that benefit the fetus.

ADVERTISEMENTS
 The uterine endometrium continues to
thicken because of the corpus luteum that is
influenced by hCG, and instead of sloughing
off in a usual menstrual cycle, it becomes the
deciduas.
 The deciduas are divided into three parts:
basalis, capsularis, and vera.
 The decidua basalis is the innermost portion
of the layer which rests directly under the
embryo.
 The decidua capsularis encapsulates the
trophoblast’s surface.
 The decidua vera becomes the remaining
portion of the uterine lining,and sheds as the
lochias.
 Eventually, the deciduas vera and capsularis
fuse because of the enlarging embryo.
It’s not just placenta it’s The Placenta.
Chorionic Villi  Nutrients such as glucose, amino acids,
vitamins, minerals, fatty acids, and water as
well as oxygen are transported through the
placenta from the maternal blood supply to
the fetus.
 Placental osmosis also plays an essential part
in maintaining the health of the fetus. it is
impermeable to a few harmful substances,
thereby it does not allow the crossing of
these substances towards the fetal blood
circulation.
 The syncytial layer produces various
hormones that benefit both the mother and
the fetus.
  The human chorionic gonadotropin is the
first placental hormone to be produced, and it
ensures that the corpus luteum would
continue to produce estrogen and
progesterone to support the pregnancy.
 Estrogen is also one of the hormones
produced by the syncytial cells and it aids in
the uterine growth and the development of
the mammary glands in preparation for
lactation.
 Progesterone is responsible for maintaining
the lining of the uterus during pregnancy. It
also reduces the contractility of the uterus to
prevent preterm labor.
 Human placental lactogen promotes
lactogenic properties and mammary growth
in preparation for the lactation of the mother.
Fetal
Amniotic Membranes Circulation
 The amnion and chorion compose the
umbilical cord which connects the embryo to
the chorionic villi of the placenta.
 The main function of the umbilical cord is
the transport of oxygen and nutrients from
the placenta to the fetus and the return of
waste products from the fetus to the placenta.
 The cord is made up of a gelatinous
mucopolysaccharide called Wharton’s
jelly that protects the vein and arteries from
trauma.
 The umbilical cord contains only one vein,
which carries blood from the placenta to the
fetus, and two arteries, which carries blood
from the fetus to the placenta.

Fetal Milestones
ADVERTISEMENTS
 The smooth portion of the chorionic villi
eventually becomes the chorionic membrane 4th Week of Gestation
which forms the sac that contains the  Spinal cord is formed and fused at the
amniotic fluid. midpoint.
 The amniotic membrane forms under the  Head folds forward and is prominent.
chorion, giving an appearance that seem like  The back is bent, which makes the head
they are only one membrane. almost touch the tail.
 The amniotic membrane is also responsible  A prominent bulge appears which would
for producing the amniotic fluid and the later form as the heart.
phospholipids that triggers the formation of  Lateral wings, the body, folds forward and
prostaglandins, the hormone that initiates fuse at midline.
uterine contractions.  Arms and legs are budlike structures.
 Eyes, ears, and nose are barely recognizable.
Amniotic Fluid
 The normal amount of amniotic fluid is 800 8th Week of Gestation
to 1000 mL.  Organogenesis is achieved and complete.
 The role of the amniotic fluid in the safety of  The heart already developed a septum and
the fetus is it protects the fetus from trauma valves and is beating rhythmically.
or pressure to the mother’s abdomen. It also  Arms and legs have developed.
regulates the temperature for the fetus and  Facial features are noticeable.
aids in muscular development allowing the  The genital starts to form but is not yet
fetus to move freely recognizable.
 The amniotic fluid also protects the umbilical  Fetal intestine is rapidly growing.
cord from trauma and pressure, thereby  Results of an ultrasound would show a
protecting the fetal oxygen supply. gestational sac which confirms pregnancy.
Umbilical Cord 12th Week of Gestation
 The toes and fingers already have nail beds.
 Faint fetal movements are starting.
 Early reflexes are present.
 Tooth buds are forming.
 Formation of bone ossification centers
initiate.
 The genital is already recognizable through
its appearance.
 Urine secretion begins but is not yet evident.
 Heartbeat could be detected by Doppler.
 children. The role of a mother starts not only during the
16th Week of Gestation time that the baby is born, but most especially when she
 An ordinary stethoscope could detect the decides that she wants to conceive an offspring.
fetus’ heart beat.
 Lanugo has started to form. Assessment
 The pancreas and liver are forming. The key to a successful individualized care plan is the
 Urine is present in the amniotic fluid. precise assessment and accurate obtaining of data. The
 Fetus starts to swallow the amniotic fluid. woman would be placed under observation
 Ultrasound could determine the sex of the during labor to monitor her progress and ensure a safe
fetus. delivery for her and the child.
 Assess for the signs of true labor. The signs
20th Week of Gestation of true labor are contractions that begin
 Mother could sense spontaneous fetal irregularly but progresses regularly and
movements. predictably, the pain is felt first at the lower
 There is hair formation on the head until the back and circles towards the abdomen,
eyebrows. continues to progress no matter what the
 The upper intestine contains meconium. woman’s activity level is, increases in
 Brown fat starts to form behind the kidneys, duration, frequency, and intensity and
sternum, and posterior neck. cervical dilation is already present.
 Vernix caseosa also starts to form and covers  Assess for the appearance of show, which
the skin. is blood mixed with mucus and would be
 Passive antibody transfer begins. present once the operculum or mucus plug is
 The sleep and activity patterns of the fetus expelled.
are evident.  Assess for the rupture of membranes. This
24th Week of Gestation is the scanty or sudden gush of clear fluid
 Lung surfactant begins to develop. from the vagina.
 Meconium is present at the rectum.  Assess for the engagement of the fetal
 Eyebrows and eyelashes are distinguishable. head. Engagement refers to the settling of
 Eyelids can now open. the presenting part into the pelvis at the level
 Pupils react to light. of the ischial spines.
 The fetus has reached the age of viability,  Assess for the station. Station is the
wherein they could survive externally if relationship of the presenting part to the level
cared for in a modern intensive facility. of the ischial spines.
 Responds to sudden sounds.  Assess for the effacement and dilatation of
the cervix. Effacement is the shortening and
28th Week of Gestation thinning of the cervical canal. In cervical
 Surfactant is demonstrated in the amniotic dilatation, the enlargement or widening of
fluid. the cervical canal is assessed.
 Alveoli are starting to mature.
 Testes descend into the scrotal sac. Diagnosis
 Retinal blood vessels start to form but are Main topic: Stages of Labor
highly susceptible to damage. During labor, a pregnant woman might encounter
difficulties that could affect her progress. These
32nd Week of Gestation conditions should be prevented to ensure a smooth labor
 Subcutaneous fat is deposited. period and eventually, a safe delivery.
 Fetus responds to sounds outside the ADVERTISEMENTS
mother’s body through movements.
 Active Moro reflex is present. First stage of labor
 Iron stores are starting to develop. This stage of labor is divided into three phases.
 Fingernails are starting to grow.  The latent phase starts during the onset of
true labor contractions until cervical
36th Week of Gestation dilatation.
 Depositions of iron, carbohydrate, calcium,  The active phase occurs when cervical
and glycogen stores are in the body. dilatation is at 4 to 7 cm and contractions last
 Additional subcutaneous fats are deposited. from 40 to 60 seconds with 3 to 5 minutes
 One or two creases are present at the sole of interval.
the foot.  The transition phase occurs when
 Lanugo starts to diminish. contractions reach their peak with intervals
 Some babies turn and assume a vertex of 2 to 3 minutes and dilatation of 8 to 10
presentation. cm.

40th Week of Gestation Second stage of labor

 Fetus now kicks very actively and hard  This stage starts at full cervical dilatation
enough to cause discomfort. until the birth of the infant.
 The fetal hemoglobin is being converted to  The woman may experience an
adult hemoglobin. uncontrollable urge to push and bear down
 Vernix caseosa is fully formed. with every contraction.
 Fingernails extend to the fingertips.  Crowning or the appearance of the fetal
 The soles of the feet have creases that cover head on the vaginal opening occurs.
at least two-thirds of the surface.
The slow but sure development of the fetus inside a Third stage of labor
woman’s body should be monitored to ensure the  The third stage begins with the birth of the
delivery of a healthy and safe baby. Fetal development is infant until the delivery of the placenta.
a critical stage in a mother’s responsibility over her  The signs of placental expulsion are
lengthening of the umbilical cord, sudden
 gush of vaginal blood, changes in the shape  Client can express her preferences during
of the uterus and its firm contraction, and the labor.
appearance of the placenta at the vaginal  Client has the ability to understand the usual
opening. process of labor.
 Client reports that her environment is
Planning comfortable and secure.
With all the data gathered during assessment and  Client would be able to verbalize her feelings
through an accurate diagnosis, a care plan for the woman about her experiences during her labor
in labor would be made to aid her through her progress. period.
Care of a woman in the first stage of labor
ADVERTISEMENTS Induction and Augmentation of Labor
 Labor should be allowed to start naturally,
not artificially induced. Cervical Ripening
 The woman must also be allowed to move  Cervical ripening must be complete during
freely throughout the labor. Artificial early labor.
interventions should also be prohibited.  If there is no cervical ripening, there would
 Allow the woman to assume a non-supine be no dilatation and coordination of uterine
position for delivery. contractions.
 Upon delivery of the newborn, mother and  To determine whether the cervix is ripe,
child should be given unlimited opportunity Bishop established criteria for scoring the
for breastfeeding and bonding. cervix.
Care of a woman in the second stage of labor  If the woman’s score is 8 or greater, the
 During the second stage of labor, the place of cervix is already ready or birth and would
delivery of the woman must be prepared. respond to induction.
 The position of birth wherein the woman is  One of the ways to ripen the cervix is known
most comfortable must also be determined at as “stripping the membranes”, or separating
this stage. the membranes from the lower uterine
 Another important part is the promotion of segment manually using a gloved finger in
second stage effective pushing. the cervix.
 Perineal cleaning is also an integral part of  Complications that may arise from this
the second stage. procedure include bleeding due to undetected
Care of the woman in the third stage of labor low-lying placenta, inadvertent rupture of
 Placental delivery should be given focus at membranes, and infection when the
this stage. Once the placenta is delivered, membranes rupture.
oxytocin should be administered  Another method that is also considered is the
intramuscularly to promote uterine use of hygroscopic suppositories or
contractions. suppositories of seaweed that swell upon
 If there is episiotomy performed, perineal contact with cervical secretions.
repair should be integrated into the care plan.  These suppositories gradually and gently
urge dilatation.
Implementation  They are held in place by gauze sponges
Some interventions are implemented to give comfort and saturated with povidone iodine or an
safety for the mother during and after the labor period. antifungal cream.
These are essential in promoting the strength that the  The number of sponges and dilators should
mother would need during delivery. be documented accordingly to avoid leaving
ADVERTISEMENTS behind one of them inside the cervix.
 Encourage the client to void every 2 hours.  A more common method of speeding
 Observe and review the client’s breathing cervical ripening is the application of a
techniques. prostaglandin gel to the interior surface of
 Inform the client if c interventions are the cervix by a catheter or suppository, or to
necessary. the external surface by applying it to a
 Create a birth plan with the client so she diaphragm and then replacing it against the
could integrate her preferences in the care cervix.
plan.  Additional doses may be applied every six
 Provide ice chips, hard candies, or fluids to hours, but two or three doses are usually
relieve dry mouth. enough to achieve ripening.
 Provide a comfortable environment to aid in  Instruct the woman to remain in a side lying
the effective coping management of the position to avoid leakage of the medication.
client.  Continuously monitor the FHR at least every
 Allow the client to walk and move around 30 minutes after each complication.
freely during labor.  Side effects of this method include diarrhea,
 Do not intervene with the client during a fever, hypertension, and vomiting.
contraction to avoid disturbing her focus on  Oxytocin administration may also be started,
her technique. but that would be 6 to 12 hours after the last
prostaglandin dose.
Evaluation  Use prostaglandin with caution in women
After the labor has passed, delivery would commence with asthma, renal or cardiovascular disease,
immediately. And when the labor period for the woman or glaucoma.
has gone smoothly, a great chance for a safe and healthy  Women who underwent cesarean birth in the
delivery is within reach. past are contraindicated with prostaglandin
 Client should exhibit no signs of bladder method.
distention and have the ability to void every
2 hours. Induction of Labor by Oxytocin
 Client has a good to tolerable level of pain.
 Administration of oxytocin can initiate  Assure the woman that uterine contractions
contractions in a uterus in pregnancy term. in an induced labor are basically normal so
 Oxytocin is administered intravenously so she can use her breathing techniques
that when there is hyperstimulation, then it effectively.
could be quickly discontinued.  However, hyperbilirubinemia and jaundice in
 The effects happen immediately because the a newborn are possible because of induction
half-life of oxytocin is approximately 3 of labor with oxytocin.
minutes.  The infant should be observed closely for
 Oxytocin is usually mixed with Ringer’s these conditions during the first few days of
lactate, 10 units of oxytocin in 1000 mL of life.
Ringer’s lactate.
 The infusion could also be administered Augmentation by Oxytocin
piggyback to a maintenance IV solution, so  If labor contractions begin spontaneously but
that if the infusion would be discontinued, become weak, irregular, and ineffective,
the main IV line could still be maintained. augmentation of labor is required.
 The oxytocin solution must always be  Precautions for oxytocin administration are
attached to the port nearest to the woman so the same as for primary induction of labor.
that little solution remains in the tubing if it  The uterus may respond effectively to
is discontinued. oxytocin used as augmentation.
 Use of an infusion pump is recommended to  The drug should be increased in small
regulate the infusion rate and make sure that increments only and fetal heart sounds
the rate would not change even if the woman should be monitored during the procedure.
moves. The labor process is the gateway towards a safe delivery.
 Do not increase the rate without any further Once the woman has undergone labor, it is imminent
instructions because it can cause tetanic that delivery would follow suit. It is important for the
contractions. woman to have a smooth labor process for this is where
 Artificial rupture of membranes may be done she would be gathering her strength to deliver her
when cervical dilatation reaches 4 cm to precious bundle of joy.
further induce labor.
 Be aware of peripheral vessel dilatation, a EINC (ESSENTIAL INTRAPARTUM NEWBORN
side effect of oxytocin administration, which CARE)
can cause hypotension.  Prepare Decontamination solution
 Assess the woman’s pulse and blood o 1 part 5% chlorine bleach to 9 parts
pressure every 15 minutes to be certain of a water to make 0.5% chlorine solution
safe induction.  Prior to Woman’s Transfer to the DR
 Monitor uterine contractions and FHR  Ensure that mother is in her position of choice
accordingly. while in labor
 Contractions should occur no more often  (If in bed) Encourage left lateral
than every 2 minutes, should not be longer recumbent position or left sims position
than 70 seconds, and not stronger than 50  Ask mother if she wisher to eat/drink or void
mmHg.  If normal
 Stop the IV infusion if the contractions  Communicate with the mother – inform her of
become more frequent or longer in duration the progress of labor, give reassurance and
than the safe limits or if there are signs of encouragement
fetal distress.  Woman already in the DR
 Excessive stimulation of the uterus by  Preparing for delivery
oxytocin may lead to tonic uterine  Check temperature in DR area to be 25-28
contractions with fetal death or rupture of the degree Celsius eliminate air draf
uterus.  Ask mother if she is comfortable in semiupright
 In the event that hyperstimulation is not position (the default position of
stopped even if the infusion has been delivery table)
discontinued, a beta-adrenergic receptor drug  Prepare a clear, clean newborn
or magnesium sulfate may be prescribed to resuscitation area. Check the equipment if
decrease myometrial activity. clean, functional and within easy reach
 A complication of oxytocin infusion is water  Ensure the woman’s privacy.
intoxication because oxytocin has an  Remove all jewelry then wash hands
antidiuretic effect that results in decreased thoroughly observing the WHO 1-2-3-4-5
urine flow. procedure.
 Symptoms of water intoxication are  Arrange materials/supplies in a linear
headache and vomiting. sequence:
 Water intoxication in its most severe form  Gloves, dry linen, bonnet oxytocin
can cause seizures, coma, and even death injection
because of the large shift in interstitial tissue  Plastic clamp, instrument clamp,
fluid. scissors, 2 kidney basins
 Monitor the intake and output appropriately  After 1st breast feed – eye ointment,
and assess urine specific gravity to detect stethoscope to symbolize physical
fluid retention. examination, vitamin K, hepatitis B
 Limit the amount of IV fluid to 150 mL/hr and BCG vaccine (plus cotton balls,
by making sure that the main line is infusing etc.)
at a rate not greater than 2.5 mL/min.  Clean the perineum with antiseptic
 Induced labor tends to have shorter first solution
stage than the average unassisted labor.  Wash hands and put on 2 pairs of sterile
gloves aseptically (if same worker handles
perineum and cord).
 At the time of delivery decontaminate 2nd pair of gloves before
 Encourage the woman to push as desired disposal. Decontamination lasts for at least 10
 Drape the clean, dry linen over the mother’s minutes.
abdomen or arms in preparation for drying  Advise mother to maintain skin-to-skin
the baby. contact. Baby should be prone on mother’s
 Apply perineal support and do controlled chest/in between the breasts with head turn
delivery of the head. to one side.
 Perineal support and controlled delivery of  15-90 minutes
the head  Advise mother to observe for feeding cues
 Keep one hand on the head as it advances and cite examples of feeding cues.
during contractions while the other hand  Support mother instruct her on positioning
supports the perineum and attachment.
 During the delivery of the head,  Wait for FULL BREASTFEED to be completed
encourage woman to stop pushing and  Afer complete breastfeed, administer eye
breathe rapidly with mouth open. ointment, do thorough physical examination,
 Call out time of birth and sex of baby. do vitamin, hepatitis B and BCG injections.
 Inform the mother of outcome.  Vitamin K
 First 30 seconds  Dosage: 0.1 ml
 Thoroughly dry baby at least 30 seconds,  Route:
starting from the face and head, going down  IM
to the trunk and extremities while performing  Site: anterolateral aspect of the lef thigh –
a quick check for breathing. vastus lateralis muscle
 1-3 minutes  Hepatitis B
 Remove the wet cloth.  Dosage:
 Place baby in skin-to-skin contact on the  Route: IM
mother’s abdomen or chest  Site: anterolateral aspect of the right thigh –
 Cover baby with the dry cloth and the baby’s vastus lateralis muscle
head with a bonnet.  BCG
 Excluding a second baby by palpating the  Dosage: 0.5 ml
abdomen in preparation for giving  Route: Subcutaneous
OXCYTOCIN  Site: Right deltoid
 The circulating nurse gives IM oxytocin within  Crede’s Prophylaxis
one minute of baby’s birth.  Serves as prophylaxis for gonorrheal
 The immediate newborn care nurse removes conjunctivitis
first set of gloves and decontaminate them  Erythromycin ointment is more commonly
properly (in 0.5% chlorine solution for at least used today
10 minutes).  Instill or squeeze along the lower eyelid from
 Palpate umbilical cord to check for pulsations the inner canthus outward.
 Afer pulsations stops, clamp cord using the  Vitamin K injection
plastic clamp 2 cm from the base.  Given to all newborns to prevent bleeding
 Place the instrument clamp 5cm from the due to deficient clotting factor of vitamin
base. K
 Cut near plastic clamp (not midway).  Hepatitis B injection
 Perform the remaining steps of the Active  BCG injection
Management of the Third Stage of Labor (AMTSL):  Vital Measurements
 Wait for the strong uterine contractions then  Weigh in kilograms (N: 2.5 – 3.5 kg)
apply controlled cord traction and counter  Take temperature per rectum
traction on the uterus, continuing until  To measure your baby’s head circumference, a
placenta is delivered. nurse will wrap a flexible measuring tape
 Massage the uterus until it is firm around the broadest part of your baby’s
 Inspect vagina and perineum for lacerations/tears, forehead, just above the ears and at the
as necessary. midpoint of the back of the head. (N:33 –
Active Management of the Third Stage of Labor 35cm)
(AMTSL)  The chest circumference is measure at the
1. Administration of 10 IUM oxytocin IM within level of the nipple (N: 30-33cm)
one minute of delivery of the baby.  The abdominal circumference is measure just
2. Controlled cord traction with counter traction above the level of the umbilicus. (N: 29-33
(CCT with CT) on the uterus cm)
 If lacerations/tears/or episiotomy is present,  Measure the length from the heel in
repair is done recumbent position to the vertex of the head
 Prepare sterile syringe with needle (lidocaine (N: 45-55cm)
hydrochloride), tissue/thumb forceps,  Advised Optional/Delayed bathing.
scissors, sterile gauze, and suture (chromic 2/0  Advise breastfeeding per demand and about
catgut) danger signs for early referral
 Flush perineum clean the mother and apply  In the first hour, check baby’s breathing and color
perineal pad/napkin/cloth. and check mother’ vital signs and massage uterus
 Check the baby’s color and breathing; check every 15 minutes.
that mother is comfortable, uterus  In the second hour, check mother-baby dyad every
contracted. 30 minutes to 1 hour.
 Dispose of the placenta in a leak-proof  Complete all records
container or plastic bag. ESSENTIAL NEWBORN CARE
 Decontaminate (soaked in 0.5% chlorine 1. Immediate and thorough drying of the
solution) instruments before cleaning, newborn
2. Early Skin-to-skin contact between mother A pp client who delivered 2 days ago has developed
and newborn (atleast 6 hours) endometritis. Which charting entry would the nurse
3. Properly-timed cord clamping and cutting (1-3 expect to find in this client's chart - Cesarean birth
minutes afer pulsations stop) performed secondary to arrest of dilation (risk factors
4. Non-separation of the newborn from the include cesarean or operative vag birth, prolonged labor,
mother for early breastfeeding initiation and prolonged rupture of membranes, chorioamniotitis, and
rooming-in (breastfeed gives colostrum boost pp hemorrhage)
immunity of baby) A pp client states that she can't understand why she
doesn't enjoy being with her baby. What should the
Which of the following may be used to provide relief for nurse be most concerned about? - PP depression
perineal pain after a vaginal delivery? - Intermittent ice A mother who gave birth to a baby boy vaginally after
packs (vasoconstricts) Pitocin augmentation 2 weeks ago returns to the office
Which action may be recommended to soften engorged concerned b/c her flow has increased and is red but not
breasts prior to breastfeeding? - Applying warm foul smelling. The nurse supsects subinvolution. Which
compresses to breasts prior to nursing of the following can the nurse identify as a risk factor for
Which of the following should the nurse place in the PP this complication? - Abnormally adherent placenta,
client's bathroom to promote perineal care? - Peri-care history of leiomyomas, manual removal of the placenta
bottle The nurse is caring for a woman 8 hours after a vaginal
How many mls of fluid should a PP client drink a day to delivery. On assessment, the nurse finds the woman's
stay well hydrated? - 2000 ml fundus to be firm but she continues to have heavy
The nurse would be concerned if PP client has not vaginal bleeding. Which of the following would the
voided by which time period following delivery? - 6 nurse suspect? - A laceration
hours A PP client recovering from a DVT is being discharged.
Which instruction would the nurse provide to PP client What areas of teaching on self care and anticipatory
about getting out of bed for the first time? - Call for guidance should the nurse discuss with the client? -
assistance Increase the activity gradually, elevate the affected limb,
The rubella vaccine is contraindicated for which PP apply moist heat to the affected area
client? - HIV positive single parent During a home visit a client reports of a reddened,
Which of the following would be included in discharge swollen, and tender breast 10 days after delivery. Once
planning for contraception for a PP client? - Ensuring the this is confirmed on assessment, which of the following
client receives a prescription for choice, assessing the would the nurse advise? - These symptoms are
client's preference for contraception, providing info suggestive of an inflammatory or infectious process and
about client's choices, answering questions from client need immediate attention; the nurse should notify her
about methods health care provider
After discharge, how soon should the pp client schedule Postpartum depression occurs in approximately 19% of
a follow up visit with her provider? - 4-6 weeks postpartum clients. Assessment PP depression should
The nurse anticipates which of the following methods of begin prenatally. Of the following clients, which one
pain control for immediate postop c/s client? - Patient would be at risk for PP depression? - A primipara with a
controlled analgesia (PCA) med system history of depression and lack of supportive relationship
Which of the following strategies can the nurse use to A client is experiencing excessive bleeding immediately
promote ambulation in the c/s client? - Providing after the birth her newborn. __ fluids containing
encouragement to the mother, administering an analgesic oxytocin, with no noticeable decrease in the bleeding,
30 minutes prior to walking, using a folded sheet as an the nurse should expect the request of what medication?
abdominal splint - Methergine
Which strategy would the nurse suggest to promote The nurse is receiving shift report on several postpartum
bonding b/w the postpartum c/s client and her newborn? clients. Which of the following are at risk for pp
- Rooming in hemorrhage? - The client with polyhydramnios, the
You are preparing Mrs. Johnson's room for her PP client had a precipitous labor, the client had a forceps-
recovery. Which products will you ensure she has access assisted delivery
to for perineal care? - Peri bottle, anesthetic spray, and A client has just been diagnosed with mastitis. Which of
ice packs following the should the nurse suggest to the client? -
You are receiving report on Mrs. Hernandez, a PP client. Breastfeed from both breasts
You receive the following info: v/s are stable, The nurse is evaluating the nursing care provided to a
breastfeeding well, has positive bowel sounds, tolerated client with PP hemorrhage. Which would be included in
clear liquids well, and ambulated twice today. You the nurse's evaluation? - The client verbalizes a decrease
anticipate what order? - Regular diet in anxiety, maternal/newborn interaction has been
Mrs. Chang is a PP client who is rh neg. her new born is maintained, signs of PPH are detected and managed
rh positive. You anticipate which of the following effectively, the client verbalizes understanding of her
orders? - Administer RhoGam 300 mcg IM. condition
Mrs. Starnes is PP client who is complaining of The nurse is assessing a client for PP blues. Which of the
constipation. You review her medications and determine following feelings is shown in a client experiencing PP
what is responsible for her complaint of constipation? - blues? - Anxious, overwhelmed, fatigue, tearfulness
Tylenol #3 The nurse is assessing a pp client and finds the client's
What should the nurse include in the plan of care for a uterus to be boggy. What is an appropriate nursing
client with PP depression ? - Help facilitate bonding with action? - Massage the fundus until firm
the infant, use a depression scale to assess the client's The nurse is preparing to discharge a PP client and will
status, educate the client and family about signs of PP include info about teaching. Which signs of
depression, provide resources and referrals as needed thrombophlebitis must the nurse educate the client to
The nurse is making follow up calls to several pp clients. assess? - Local tenderness, heat, and swelling
Which client should the nurse schedule to be seen Sara is 34 yo client who delivered a 10 lb 8 oz female
immediately? - The client reports hearing voices talking infant with a vacuum assistance at 3 AM this morning.
about the baby During your PP assessment, you note that her heart rate
is 136 bpm and her blood pressure is 94/50. She states
that she has changed her peri-pad four times in the past Postpartum psychosis clients: - Rare and serious,
hour. You recognize an important component of your managed with hospitalization, psychiatric emergency,
assessment at this time is to do what? - To palpate the occurs second week postpartum
fundus (due to early PP hemorrhage occurring within the Clinical manifestations associated with PP depression
first 24 hours) include? - Anxiety, fatigue, difficulty sleeping
While assessing Sarah for possible sources of bleeding, Most common treatment for PP blues is what? - Rest and
you inspect the external genitalia for which of the supportive environment
following? - Lacerations of hematomas (especially since Your priority when assessing the client with PP
she had an instrument assisted birth) hemorrhage is what? - Fundal checks
Leah Wilson is a 28 yo woman who is 30 hours post Key factors in the nursing assessment in the client with a
cesarean section resulting in the delivery of a healthy 7 PP infection include? - Lab data, perineum, breasts and
lb 4 oz male infant. When performing your initial nipples- remember BUBBLEHE (except the "E" which
assessment, you note that she has an oral temperature of is emotional)
102.4 degrees. She is complaining of general weakness, Evaluation of the client with PP depression includes
malaise, and chills. She states that her vaginal draining what? - Positive maternal-newborn interaction
smells bad. The most common cause for these symptoms A mother who is bottle feeding her newborn asks to be
is what? - Endometritis (foul smelling lochia is a key discharged 24 hours post delivery because she has a 3
finding) year old at home. The hospital provides a complimentary
Sharon is a 36 yo client who is 4 days post normal visit from the home care nurse for a follow up. When
vaginal delivery of a healthy 8 lb 4 oz female infant. should the nurse schedule this visit to occur? - Within
During her initial follow up check she tells you that she 36-48 hours of discharge (If the mother and infant were
has been crying at times during the day and has no discharged from the hospital before 48 hours after birth,
appetite. She asks "what is wrong with me when I should the health care provider may have requested three home
be so happy right now? Your best response is that... - visits)
Postpartum blues is a temporary type of mild depression The home care nurse is visiting a mother who is breast
associated with changes in the hormones and the feeding. The nurse is teaching the mother how to prevent
adjustment to birth and motherhood complications. What should the mother be taught to
Eleanor is a 24 yo client who was diagnosed with PP prevent cracked nipples while she is feeding? - Wash the
hemorrhage related to a 4th degree laceration and nipples with water daily
retained products of conception. The active vaginal Which safety device is most appropriate for the nurse
bleeding is now controlled. You recognize that the most making home visits? - Cell phone
important component of her treatment will be which of At a home visit, the nurse assesses a neonate delivered
the following? - Administration of oxytocics (to promote vaginally at 42 weeks gestation 6 weeks ago. She finds
contractility of uterus and decrease ongoing blood loss) frequent hiccups, loose watery stool in diaper, red rash
PP hemorrhage is defined as blood loss of more than on face, and dry peeling skin. What warrants further
which amount after a vaginal birth? - 500 ml assessment? - Loose, watery stool in diaper
Risk factors for PP hemorrhage include? - Retained In preparation for discharge, the nurse discusses sexual
placental fragments, multiple gestation, prolonged labor, issues with a primiparious client who had a vag delivery
previous history of PP hemorrhage, operative vaginal with a midline episiotomy. What would the nurse
delivery with forceps or vacuum, precipitous labor, include as the most appropriate time for resuming sexual
uterine overdistention due to multiple gestation or intercourse? - After the PP follow up visit with HC
polyhydramnios, cesarean birth, general anesthesia, and provider
chorioamnioitis. A primiparous client who is bottle feeding her infant
Management of uterine atony includes? - Massaging the asks the nurse "when will menstrual cycle return?" the
fundus until firm, administration of uterine stimulants nurse says - It will probably return by 6-10 weeks
(oxytocin/methergine), monitoring for signs of Which statement about breastfeeding requires further
hypovolemia, administration of blood products if education? - As long as some of my nipple is in the
necessary baby's mouth, the baby will receive enough breast milk.
Late onset PP hemorrhage occurs 1-6 weeks PP and is A student nurse is shadowing a home health nurse for
most commonly associated with which? - Retained the day. The nurse talks about therapeutic relationships.
placental fragments What should she include? - Convey regard and respect
A puerperal (postpartum) infection is defined as which for the family by asking to be introduced to other family
of the following? - Fever of 100.4 or greater occurring members at the time of the visit, verbal and nonverbal
on 2 days within the first 10 days post-childbirth communication should be congruent, review the mother
Appropriate treatment for endometritis is what? - Broad and infant's history including and problems during
spectrum intravenous ABX continued until client is pregnancy, type of birth, problems during birth or
afebrile for 24 hours postpartum, infant feeding choices)
Risk factors associated with mastitis include? - Bacteria After instruction about episiotomy care, which
from mom's hands, a break in the nipple or areola, primiparous client statement indicates successful
failure to empty breasts completely teaching? - "I'll wipe the area from front to back using a
Treatment for mastitis includes? - Antibiotics, bed rest, blotting motion"
breast feeding A new mother asks the nurse about starting PP exercises.
Common clinical manifestations associated with UTI in What exercise would be most appropriate to include in
the postpartum client include? - Fever, burning on the nurse's instructions? - Flex the knees while supine,
urination, frequency then inhale deeply and exhale while contracting the
Risk factors associated with thrombophlebitis include? - abdominal muscles
Cesarean birth, hypercoagulability, multigestatonal birth While making a home visit to a primiparous client and
Postpartum blues clients: - Self-limiting, duration of 2 her 4 day old daughter, the nurse observes the mother
weeks, affects 70-80 percent of women, "baby blues" changing the infant's diaper. Before putting the new
Postpartum depression clients: - managed with diaper on, the mother begins to apply baby powder to the
medication, onset 4 weeks after birth, affects 19 percent infant's buttocks. Which statement about baby powder
of PP women, would the nurse make? - It may cause pneumonia to
develop.
A BF mother is visited by the home care nurse 2 weeks You are completing an assessment of maria during a PP
after delivery. The woman is febrile with flulike home visit. What will you assess to determine uterine
symptoms. Which statement regarding mastitis is involution in maria? - Fundal position (uterine involution
correct? - Symptoms include fever, chills, malaise, and is assessed by locating uterine fundal position)
localized breast tenderness. The client about to have a forceps delivery asks about
A primiparous client has been discharged from the what complications can occur. The nurse understands
hospital after delivering a 5 pound baby girl. How many that which of the following is complication of forceps
days PP should she expect the home care nurse to visit. - delivery? - Erb's palsy
3-6 days after discharge. The nurse is caring for a client who had a classical
A student nurse is shadowing a home health care nurse uterine incision for her c section. The nurse knows that
who is making PP visits. The student asks what is the the client understands implications for future
average length of stay in the hospital for a c section pregnancies that are secondary to her classical uterine
client. What is the correct response? - 3-4 days incision when the client makes which statement? - The
The home care nurse is assessing a new mother who risk of rupturing my uterus is too high for me to have
delivered 5 days ago. The mother has a temp of 100.9 any more babies.
what condition in a PP mother may cause a fever not A client is going to have a cephalic version at 38 weeks
caused by infection? - Breast engorgement gestation for a breech position. The nurse determines
A client who delivered by c section is having difficultly that the client has understanding of the procedure when
holding her infant comfortably in order to breastfeed. the client makes which of the following statements? -
She asks for assistance from the home care nurse. What "my baby will be turned in a head down position"
position for the infant would the nurse suggest to provide A client who has undergone a vacuum assisted birth asks
maximum comfort for the mother? - Football hold. the nurse how long the swelling on the infant's head will
The nurse encourages the use of which item when remain. What is the best response by the nurse. - 48-72
performing perineal care in the home setting after hours
delivery? - Peri bottle A client is going to have an external version for
Which topics are included in the discharge teaching for a transverse fetus and is concerned about the terbutaine
PP client? - S/S of illness, follow up instructions, she is about to receive the nurse explains that terbutaine
newborn care, maternal self care (tocolytic) is used to: - relax the uterus
The nurse is providing discharge teaching about The nurse is caring for a client who is scheduled for
newborn care to a mother. Which topics will be induction of labor. Which of the following conditions are
included? - Bathing, diapering, cord care, nutrition indications for labor? - Maternal pre-existing or
What areas are assessed during a PP home visit? - concurrent medical conditions(preeclampsia, diabetes),
Maternal self care, newborn care, infant feeding, parent- Infections, Postterm pregnancy, Premature rupture of
newborn bonding membranes (PROM), Fetal demise, Fetal compromise
Which steps are performed prior to making a postpartum (nonreassuring fetal heart tracing, intrauterine growth
home visit? - Reviewing infant history, making a previsit restriction), Oligohydramnios
phone call, notifying the family if running late, The HCP of a client 40 weeks gestation has ordered
reviewing maternal history cytotec for labor induction. The nurse should be aware
What is recommended to increase safety during a PP that cytotec will produce what change for this client? -
home visit? - Carrying a fully charged cell phone Cervical ripening
What are assessed during a newborn home visit? - The nurse is caring for a woman following a csection
Weight, reflexes, vital signs, nutritional status delivery with a low transverse incision. What are the
When completing a home visit, the nurse explains that a advantages of a low transverse uterine incision versus a
formula fed newborn will have which type of stool? - classical incision? - Less likely to rupture with
Darker yellow or borwn. (stools of breastfeed will subsequent pregnancies, involves less blood loss, less
appear mushy yellow or seedy) likely to cause bowel adhesions, easier to repair
What is the safest position for infant sleeping? - Back surgically.
The nurse assesses the abdominal incision of a PP client A laboring client at 39 weeks gestation has been pushing
who delivered by c section for? - Edema, approximation, for 2 hours. The nurse anticipates that the HCP will use
drainage, redness forceps to deliver. What criteria must be met to consider
The nurse encourages what prior to nursing when the forceps? - Adequate maternal anesthesia should be
mother experiences engorgement? - Expressing milk, provided, membranes must be ruptured, cervix must be
anti-inflammatory meds, warm compresses fully dilated.
Which nursing interventions are recommended for the A client is in the recovery room following a c section.
nursing mother who has sore nipples? - Instructing about She is stable and alert. Which of the following should be
proper positioning techniques, allowing nipples to air the nurse's focus of teaching at this time? - What to
dry b/w feedings, applying ice compresses prior to expect during the post partum period.
feedings, avoiding use of soap on nipples A G3P2 client presents at 38 weeks gestation with a
What is an important component to include when transverse lie. The nurse is preparing the client for an
terminating the nurse-client relationship during the last external version. Which client statement indicates that
home visit? - Reinforcing follow up care the client understands the procedure? - I will need to get
You are completing a PP home visit on Susan who an IV started for the procedure, I will have an ultrasound
delivered 4 days ago. When performing an assessment. done after the procedure, I will need a nonstress test
What finding would cause concern? - Pain in the leg or completed before the procedure, the procedure is
calf uncomfortable.
You receive a referral for a PP client named Michelle. A client at 37 weeks gestation is discharged after a
What is your initial action? - Review prenatal record. successful external cephalic version. What after care
Shaun is 4 days old and was circumcised in the hospital instructions would be important to discuss with the
prior to discharge. When performing a home visit, you client? - Monitor for uterine contractions, observe for
discuss the care of the circumcision site with his parents. excessive fetal movement
which is an appropriate statement to include? - A The HCP has performed an amniotomy on a client in
yellow-colored crust may develop as part of the healing labor. Which interventions by the nurse are indicated
process. when caring for this client during and immediately
following the procedure? - Assessment for prolapse of Which of the following is a common side effect
umbilical cord, assessment of the amount of amniotic associated with the use of vacuum extraction? - Swelling
fluid, assessment of the amniotic fluid color, assessment of the scalp
of fetal heart rate Why would you add a urinary catheter to the delivery
The nurse is caring for a client who will be having a c room table before a vaginal birth? - An empty bladder
section. Which of the following statements by the client provides more room on the pelvic floor
would cause the nurse to determine that the client does An external cephalic version (ECV) to change the
not understand what to expect during a c section position of the fetus is generally performed when? -
delivery? - I will receive a blood transfusion during After 36-37 weeks gestation
surgery. What is the success rate of an ECV? - 60%
The nurse in a prenatal care setting is caring for a Which of the following are required in order for a health
woman at 39 weeks gestation. The HCP is going to strip care provider to perform an external cephalic version? -
the client's amniotic membrane. The client asks the nurse Adequate amniotic fluid, singleton gestation, gestational
what this will do. What would be the best response by age of 36-37 weeks
the nurse? - Stripping the membranes releases Once the external cephalic version is completed, what is
prostaglandins that may help labor begin. your responsibility? - Monitoring maternal uterine
A laboring client at term is experiencing a prolonged activity and fetus status
second stage of labor. She has made no signs of progress
for more than 2 hours. The fetal scalp is visible between
contractions. The client says "I can't push any longer" 1. A postpartum nurse is preparing to care
the nurse notifies the HCP and anticipates what? - for a woman who has just delivered a healthy
Expect an instrument assisted delivery newborn infant. In the immediate
Mrs. Hernandez was admitted to the hospital in active
labor. She is 3 cm dilated and doctor performs an
postpartum period the nurse plans to take
amniotomy to release her amniotic fluid. What should the woman's vital signs:
you do? - Document the amniotic fluid's characteristics.
Mrs. Jeffries is a 250 pound woman with severe 2. Every 15 minutes during the first hour
preeclampsia. She is extremely agitated about her
impending labor. What would be the most appropriate and then every 30 minutes for the next two
topic for you to educate her on? - Her anesthesia options hours.
(talk about what can control her pain since she is
agitated, what will calm her down??) 2. A postpartum nurse is taking the vital
You are assisting a with a birth. Mom is 36 y/o who has
opted for an epidural. She has been pushing for over 4 signs of a woman who delivered a healthy
hours. She is exhausted, and her baby's head remains at newborn infant 4 hours ago. The nurse notes
the +3 station. The doctor has attempted a vacuum that the mother's temperature is 100.2*F.
extraction twice, but the suction cup has popped off
twice. What is the most likely next step? - A third Which of the following actions would be
attempt at vacuum (try vacuum three times, if failed all most appropriate?
three then c section) 4. Increase hydration by encouraging oral
Mom is 37 weeks gestation and her fetus is in a breech
presentation. She is undergoing an external cephalic fluids
version and is in extreme pain. Which of these 3. The nurse is assessing a client who is 6
statements best demonstrates her understanding of her hours PP after delivering a full-term healthy
options? - Stop the procedure.
Which of the following conditions would indicate that infant. The client complains to the nurse of
induction of labor is needed? - Preeclampsia, infection, feelings of faintness and dizziness. Which
fetal compromise of the following nursing actions would be
Which of the following pieces of information would you
use to determine how favorable the cervix is for
most appropriate?
induction? - The bishop score 2.Instruct the mother to request help
If you administered the ripening agents Cervidil and when getting out of bed
Prepidil, which of the following could you expect to be
4. A nurse is preparing to perform a fundal
associated with the drug? - Postpartum hemorrhage,
nonreassuring fetal status, uterine hyperstimulation assessment on a postpartum client. The
Which of the following is the most common c section initial nursing action in performing this
incision? - Low transverse
assessment is which of the following?
Before a woman undergoes a c section birth, you are
responsible for which of the following (what is the most Ask the mother to urinate and empty her
important)? - Supporting the woman and her partner bladder
In the recovery room following a c section birth, your
responsibilities include which of the following? -
Monitoring the woman's response to anesthesia,
monitoring maternal vital signs, assessing fundal height 5. The nurse is assessing the lochia on a 1
and firmness day PP patient. The nurse notes that the
What are mid forceps used for? - Between 0 and + 2 lochia is red and has a foul-smelling odor.
station
What are low forceps used for? - At + 2 station or lower The nurse determines that this assessment
What are outlet forceps used for? - At or on the finding is:
perineum and visible at the vaginal opening 2.Indicates the presence of infection
What is the maximum length of time a vacuum extractor
can be used without increasing the risk of injury to the
fetal scalp? - 10 minutes
6. When performing a PP assessment on a
client, the nurse notes the presence of clots 13. A nurse is monitoring a new mother in the
in the lochia. The nurse examines the clots PP period for signs of hemorrhage. Which of
and notes that they are larger than 1 cm. the following signs, if noted in the mother,
Which of the following nursing actions is would be an early sign of excessive blood
most appropriate? loss?
2. Notify the physician 2. An increase in the pulse from 88 to 102
BPM
7. A nurse in a PP unit is instructing a
mother regarding lochia and the amount of 14. A nurse is preparing to assess the
expected lochia drainage. The nurse uterine fundus of a client in the immediate
instructs the mother that the normal postpartum period. When the nurse locates
amount of lochia may vary but should never the fundus, she notes that the uterus feels
exceed the need for: soft and boggy. Which of the following
4. Eight peripads per day nursing interventions would be most
appropriate initially?
8. A PP nurse is providing instructions to a
woman after delivery of a healthy newborn 1. Massage the fundus until it is firm
infant. The nurse instructs the mother that
she should expect normal bowel elimination 15. A PP nurse is assessing a mother who
to return: delivered a healthy newborn infant by C-
2. 3 days PP section. The nurse is assessing for signs and
symptoms of superficial venous thrombosis.
9. Select all of the physiological maternal Which of the following signs or symptoms
changes that occur during the PP period. would the nurse note if superficial venous
thrombosis were present?
1.Cervical involution ceases immediately
3.Fundus begins to descend into the pelvis 1. Paleness of the calf area
after 24 hours 2. Enlarged, hardened veins
3. Coolness of the calf area
10. A nurse is caring for a PP woman who has 4. Palpable dorsalis pedis pulses
received epidural anesthesia and is
monitoring the woman for the presence of a 16. A nurse is providing instructions to a
vulva hematoma. Which of the following mother who has been diagnosed with
assessment findings would best indicate the mastitis. Which of the following statements
presence of a hematoma? if made by the mother indicates a need for
3.Changes in vital signs further teaching?

11. A nurse is developing a plan of care for a 1. "I need to take antibiotics, and I should
PP woman with a small vulvar hematoma. The begin to feel better in 24-48 hours."
nurse includes which specific intervention in 2. "I can use analgesics to assist in
the plan during the first 12 hours following alleviating some of the discomfort."
the delivery of this client? 3. "I need to wear a supportive bra to
4.Prepare an ice pack for application to the relieve the discomfort."
area. 4. "I need to stop breastfeeding until this
condition resolves."
12. A new mother received epidural
anesthesia during labor and had a forceps 17. A PP client is being treated for DVT. The
delivery after pushing 2 hours. At 6 hours nurse understands that the client's
PP, her systolic blood pressure has dropped response to treatment will be evaluated by
20 points, her diastolic BP has dropped 10 regularly assessing the client for:
points, and her pulse is 120 beats per
minute. The client is anxious and restless. 3. Hematuria, ecchymosis, and epistaxis
On further assessment, a vulvar hematoma
is verified. After notifying the health care 18. A nurse performs an assessment on a
provider, the nurse immediately plans to: client who is 4 hours PP. The nurse notes
3. Prepare the client for surgery. that the client has cool, clammy skin and is
restless and excessively thirsty. The nurse
prepares immediately to: 1. Amount of lochia
2. Blood pressure
1. Assess for hypovolemia and notify the 3. Deep tendon reflexes
health care provider 4. Uterine tone
2. Begin hourly pad counts and reassure the
client 23. Methergine or pitocin are prescribed for
3. Begin fundal massage and start oxygen by a client with PP hemorrhage. Before
mask administering the medication(s), the nurse
4. Elevate the head of the bed and assess contacts the health provider who prescribed
vital signs the medication(s) in which of the following
conditions is documented in the client's
19. A nurse is assessing a client in the 4th medical history?
stage if labor and notes that the fundus is
firm but that bleeding is excessive. The 1. Peripheral vascular disease
initial nursing action would be which of the 2. Hypothyroidism
following? 3. Hypotension
4. Type 1 diabetes
1. Massage the fundus
2. Place the mother in the Trendelenburg's 24. Which of the following factors might
position result in a decreased supply of breast milk in
3. Notify the physician a PP mother?
4. Record the findings
1. Supplemental feedings with formula
20. A nurse is caring for a PP client with a 2. Maternal diet high in vitamin C
diagnosis of DVT who is receiving a 3. An alcoholic drink
continuous intravenous infusion of heparin 4. Frequent feedings
sodium. Which of the following laboratory
results will the nurse specifically review to 25. Which of the following interventions
determine if an effective and appropriate would be helpful to a breastfeeding mother
dose of the heparin is being delivered? who is experiencing engorged breasts?

1. Prothrombin time 1. Applying ice

2. Internationalized normalized ratio 2. Applying a breast binder
3. Activated partial thromboplastin time 3. Teaching how to express her breasts in a
4. Platelet count warm shower
4. Administering bromocriptine (Parlodel)
21. A nurse is preparing a list of self-care
instructions for a PP client who was 26. On completing a fundal assessment, the
diagnosed with mastitis. Select all nurse notes the fundus is situated on the
instructions that would be included on the client's left abdomen. Which of the
list. following actions is appropriate?

1. Take the prescribed antibiotics until the 1. Ask the client to empty her bladder
soreness subsides. 2. Straight catheterize the client
2. Wear supportive bra immediately
3. Avoid decompression of the breasts by 3. Call the client's health provider for
breastfeeding or breast pump direction
4. Rest during the acute phase 4. Straight catheterize the client for half
5. Continue to breastfeed if the breasts are of her uterine volume
not too sore.
27. The nurse is about the give a Type 2
22. Methergine or pitocin is prescribed for a diabetic her insulin before breakfast on her
woman to treat PP hemorrhage. Before first day postpartum. Which of the following
administration of these medications, the answers best describes insulin requirements
priority nursing assessment is to check the: immediately postpartum?
1. Lower than during her pregnancy 33. What type of milk is present in the
2. Higher than during her pregnancy breasts 7 to 10 days PP?
3. Lower than before she became pregnant
4. Higher than before she became pregnant 1. Colostrum
2. Hind milk
28. Which of the following findings would be 3. Mature milk
expected when assessing the postpartum 4. Transitional milk
client?
34. Which of the following complications is
1. Fundus 1 cm above the umbilicus 1 hour most likely responsible for a delayed
postpartum postpartum hemorrhage?
2. Fundus 1 cm above the umbilicus on
postpartum day 3 1. Cervical laceration
3. Fundus palpable in the abdomen at 2 2. Clotting deficiency
weeks postpartum 3. Perineal laceration
4. Fundus slightly to the right; 2 cm above 4. Uterine subinvolution
umbilicus on postpartum day 2
35. Before giving a PP client the rubella
29. A client is complaining of painful vaccine, which of the following facts should
contractions, or afterpains, on postpartum the nurse include in client teaching?
day 2. Which of the following conditions
could increase the severity of afterpains? 1. The vaccine is safe in clients with egg
allergies
1. Bottle-feeding 2. Breast-feeding isn't compatible with the
2. Diabetes vaccine
3. Multiple gestation 3. Transient arthralgia and rash are common
4. Primiparity adverse effects
4. The client should avoid getting pregnant
30. On which of the postpartum days can the for 3 months after the vaccine because the
client expect lochia serosa? vaccine has teratogenic effects

1. Days 3 and 4 PP 36. Which of the following changes best

2. Days 3 to 10 PP described the insulin needs of a client with
3. Days 10-14 PP type 1 diabetes who has just delivered an
4. Days 14 to 42 PP infant vaginally without complications?

31. Which of the following behaviors 1. Increase

characterizes the PP mother in the taking in 2. Decrease
phase? 3. Remain the same as before pregnancy
4. Remain the same as during pregnancy
1. Passive and dependant
2. Striving for independence and autonomy 37. Which of the following responses is most
3. Curious and interested in care of the baby appropriate for a mother with diabetes who
4. Exhibiting maximum readiness for new wants to breastfeed her infant but is
learning concerned about the effects of
breastfeeding on her health?
32. Which of the following complications
may be indicated by continuous seepage of 1. Mothers with diabetes who breast-feed
blood from the vagina of a PP client, when have a hard time controlling their insulin
palpation of the uterus reveals a firm uterus needs
1 cm below the umbilicus? 2. Mothers with diabetes shouldn't
breastfeed because of potential
1. Retained placental fragments complications
2. Urinary tract infection 3. Mothers with diabetes shouldn't
3. Cervical laceration breastfeed; insulin requirements are
4. Uterine atony doubled.
4. Mothers with diabetes may breastfeed; pitocin is ordered. The nurse understands
insulin requirements may decrease from that this is indicated for this client because:
breastfeeding.
1. She had a precipitate birth
38. On the first PP night, a client requests 2. This was an extramural birth
that her baby be sent back to the nursery 3. Retained placental fragments must be
so she can get some sleep. The client is most expelled
likely in which of the following phases? 4. Multigravida's are at increased risk for
uterine atony.
1. Depression phase
2. Letting-go phase 44. As part of the postpartum assessment,
3. Taking-hold phase the nurse examines the breasts of a
4. Taking-in phase primiparous breastfeeding woman who is one
day postpartum. An expected finding would
39. Which of the following physiological be:
responses is considered normal in the early
postpartum period? 1. Soft, non-tender; colostrum is present
2. Leakage of milk at let down
1. Urinary urgency and dysuria 3. Swollen, warm, and tender upon palpation
2. Rapid diuresis 4. A few blisters and a bruise on each areola
3. Decrease in blood pressure
4. Increase motility of the GI system 45. Following the birth of her baby, a woman
expresses concern about the weight she
40. During the 3rd PP day, which of the gained during pregnancy & how quickly she
following observations about the client would can lose it now that the baby is born. The
the nurse be most likely to make? nurse, in describing the expected pattern of
weight loss, shld begin by telling her that:
1. The client appears interested in learning
about neonatal care 1.Return to prepregnant weight is usually
2. The client talks a lot about her birth achieved by the end of the postpartum
experience period
3. The client sleeps whenever the neonate 2.Fluid loss from diuresis, diaphoresis, and
isn't present bleeding accounts for about a 3 pound
4. The client requests help in choosing a weight loss
name for the neonate. 3.The expected weight loss immediately
after birth averages about 11 to 13 pounds
41. Which of the following circumstances is 4.Lactation will inhibit weight loss since
most likely to cause uterine atony and lead caloric intake must increase to support milk
to PP hemorrhage? production

1. Hypertension 46. Which of the following findings would be

2. Cervical and vaginal tears a source of concern if noted during the
3. Urine retention assessment of a woman who is 12 hours
4. Endometritis postpartum?

42. Which type of lochia should the nurse 1. Postural hypotension

expect to find in a client 2 days PP? 2. Temperature of 100.4°F
3. Bradycardia — pulse rate of 55 BPM
1. Foul-smelling
4. Pain in left calf with dorsiflexion of left
2. Lochia serosa
foot
3. Lochia alba
4. Lochia rubra 47. The nurse examines a woman one hour
after birth. The woman's fundus is boggy,
43. After expulsion of the placenta in a
midline, and 1 cm below the umbilicus. Her
client who has six living children, an infusion
lochial flow is profuse, with two plum-sized
of lactated ringer's solution with 10 units of
clots. The nurse's initial action would be to:
 2.Exhibit a reduced attention span, limiting
1. Place her on a bedpan to empty her readiness to learn
bladder 3.Vacillate between the desire to have her
2. Massage her fundus own nurturing needs met and the need to
3. Call the physician take charge of her own care and that of her
4. Administer Methergine 0.2 mg IM which newborn
has been ordered prn 4.Have reestablished her role as a
spouse/partner
48. When performing a postpartum check,
the nurse should: 52. Four hours after a difficult labor and
birth, a primiparous woman refuses to feed
1.Assist the woman into a lateral position her baby, stating that she is too tired and
with upper leg flexed forward to facilitate just wants to sleep. The nurse should:
the examination of her perineum
2.Assist the woman into a supine position 1.Tell the woman she can rest after she
with her arms above her head and her legs feeds her baby
extended for the examination of her 2.Recognize this as a behavior of the taking-
abdomen hold stage
3.Instruct the woman to avoid urinating just 3.Record the behavior as ineffective
before the examination since a full bladder maternal-newborn attachment
will facilitate fundal palpation 4.Take the baby back to the nursery,
4.Wash hands and put on sterile gloves reassuring the woman that her rest is a
before beginning the check priority at this time
 
49. Perineal care is an important infection 53. Parents can facilitate the adjustment of
control measure. When evaluating a their other children to a new baby by:
postpartum woman's perineal care technique,
the nurse would recognize the need for 1.Having the children choose or make a gift
further instruction if the woman: to give to the new baby upon its arrival home
2.Emphasizing activities that keep the new
1.Uses soap and warm water to wash the baby and other children together
vulva and perineum 3.Having the mother carry the new baby into
2.Washes from symphysis pubis back to the home so she can show the other children
episiotomy the new baby
3.Changes her perineal pad every 2 - 3 hours 4.Reducing stress on other children by
4.Uses the peribottle to rinse upward into limiting their involvement in the care of the
her vagina new baby

50. Which measure would be least effective 54. A primiparous woman is in the taking-in
in preventing postpartum hemorrhage? stage of psychosocial recovery and
adjustment following birth. The nurse,
1. Administer Methergine 0.2 mg every 6
recognizing the needs of women during this
hours for 4 doses as ordered
stage, should:
2.Encourage the woman to void every 2 hours
3.Massage the fundus every hour for the 1.Foster an active role in the baby's care
first 24 hours following birth 2.Provide time for the mother to reflect on
4.Teach the woman the importance of rest the events of and her behavior during
and nutrition to enhance healing childbirth
3.Recognize the woman's limited attention
51. When making a visit to the home of a
span by giving her written materials to read
postpartum woman one week after birth, the
when she gets home rather than doing a
nurse should recognize that the woman
teaching session now
would characteristically:
4.Promote maternal independence by
1.Express a strong need to review events and encouraging her to meet her own hygiene and
her behavior during the process of labor and comfort needs
How is Labor a clinical diagnosis? - -Painful uterine
birth contractions
-Progressive cervical effacement and dilation What is the leading indication for induction of labor? -
-A bloody show Gestational HTN or PIH
What is a bloody show? - Bloody discharge What is the cut off for post-term delivery? - 42 weeks
What are the two major functions of uterine -significant increase in amniotic fluid
contractions? - Dilate the cervix What is a cervical ripening agent? - Prostaglandins
Push the fetus through the birth canal -Misoprostol
What are the three mechanical variables that decide the -Makes cervix get softer
fetus's ability to be delivered? - The Powers What does membrane stripping accomplish? - Increases
The Passenger prostaglandin release
The Passage What do you use for mechanical dilation? - Foley bulb
how do you qualitatively assess contractions? - with or without oxytocin
-Observation of the mother and palpation of the fundus With the bishop score? - Predics likelihood of successful
of the uterus induction
-External tocodynamometry (toco) What bishop scores are favorable for successful
-Number of contractions in an average 10 minute induction? - Greater than or equal to 6
window, intensity and duration of the contractions What is a major contraindication to induced labor? -
How do you quantitatively assess contractions? - ICUP Prior classical c-section
-most precise What are indications for operative vaginal delivery? -
What is the definition of adequate labor? - (no Head is engaged and fully dilated
consensus) -suspicion of immediate or potential fetal compromise
3-5 contractions in 10 minutes What is shoulder dystocia? - Delivery that requires
IUCP= 200-250 montevideo units additional maneuvers following failure of gentle
what are the fetal variables that influence labor? - Size downward traction of the fetal head to effect delivery of
Lie the shoudlers
Presentation What is the most common treatment for shoulder
Position dystocia? - McRobert's Maneuver
Station -Dorsiflexion of the hips against the abdomen
What is the definition of macrosomia? - 4500g What is the most common episiotomy technique? -
What is the normal lie in delivery? - longitudinal Midline
What is the vortex presentation? - Headfirst (most -Easy to perform and repair
common) -Less pain postpartum
What is the breech presentation? - ass first What are the four P's that make up the process of labor
What is external cephalic version? - Application of and birth? - powers
pressure to the mother's abdomen to turn the fetus passage
-prevent breech passenger
When is ECV done? - After 36 weeks? psyche
What is station? - Where the head is in relation to ischial Other than the 4 P's of labor and birth, what are some
spine/pubis other "p" words that influence it also? - perparation
When is the station 0? - When the head is at the head of position
ischial spine professional help
What is android pelvis? - Heart shaped place
-Man Like procedures
-Difficult people
What is the ideal pelvic shape for delivery? - Gynecoid Forces that cause the cervix to open and that propel the
What is engagement? - Passage of widest diameter of fetus downward through the b irth canal. - powers of
presenting part to below the plane of the pelvis labor-uterine contractions and the mother's pushing
What is descent? - Downward passage of presenting part What are the primary powers of labor during the first
through the pelvis stages of labor, from onset to full dilation? - uterine
What does flexion do? - Decreases the diameter of the contractions
head Uterine contractions are _______ _______ muscle
What is internal rotation? - Rotation of presenting part contractions. - involuntary, smooth
What is the first stage of labor? - Onset of labor to full What are some things that influence the intensity and
dilation effectrivemenss of a woman's contractions? - walking
What is the second stage of labor? - Interval between full drugs
dilation (10cm) and delivery maternal anxiety
What is the third stage of labor? - Time from delivery to vaginal examinations
expulsion of placenta What are the purpose of uterine contractions? - to cause
What is the latent phase of labor? - First part of first the cervix to efface (thin) and dilate (open) to allow the
stage of labor fetus to descend into the birth canal.
-Regular contractions Contractions push the fetus ________ as the cervix is
-No cervical dilation pulled _________, causing the cervix to become thinner
What is the active phase? - 3-4cm of cervical dilation and shorter. - downward
What ist he most common parenteral pain management upward
PCA? - Fentanyl How is effacement determined? - by vaginal exam
What is the maternal risk with fentanyl? - Aspiration (touch), using percentage to indicate how much it has
Respiratory depression effaced from the original cervical length.
Do epidurals increase the risk of c-section? - No, but How is dilation of the cervix determined? - with vaginal
may slow down labor exam (touch), described in centimeters
How do you treat respiratory depression caused by What is considered full dilation? - 10 cm
fentanyl in neonates? - Narcan What are the 3 phases of contractions? - increment
What is dystocia? - Slow, abnormal progression of labor peak, or acme
What is the leading indication of primary c-section? - decrement
Dystocia of labor
The period of time when contractions are increasing in The level of the presenting part (usually the head) in the
strength - increment pelvis. - station
the period of greatest contraction strength - peak or acme How is station estimated? - in cm's from the livel of the
the period of decreaseing strength of contractions - schial spines in the mom's pelvis
decrement Where is zero at in the stations? - the ischial spine of the
How are contractions described? - frequency mom's pelvis
duration Where are minus stations located? - above the ischial
interval spines
intensity Where are plus stations located? - below the ischial
The elapsed time from the beginning of one contraction spines
until the beginning of the next contraction - frequency the positional changes that allow the fetus to fit through
How is frequency noted? - in minutes and fractions of the pelvis with the least resistance. - mechanisms of
minutes labor (cardinal movements)
When should you report frequency of contractions to the What is the last cardinal movement (or mechanism of
HCP? - when they are occurring more often than every 2 labor)? - placenta is expelled and uterus contracts
minutes What do stations tell us? - how the baby is progressing
Why should contractions occurs more often than every 2 down the birth canal
minutes be reported to the doctor? - they may be What does intrapartum care of the fetus include? -
reducing fetal oxygen supply assessment of FHR
the elapsed time from the beginning of a contraction assessment of amniotic fluid for meconium
until the end of the same contraction. - duration What does electric fetal monitoring record continuously?
How is durating noted? - in seconds - fetal heart rate
When should the duration of contractions be reported to contraction patterns
the doctor? - If they are lasting longer than 90 seconds, What type of monitoring promotes walking during
because it may reduce fetal oxygen supply. labor? - intermittent monitoring
The approximate strength of the contraction - intensity How often are FHR and contractions monitored if using
How is intensity noted? - mild, moderate, strong intermittent monitoring? - every 30-60 minutes
This intensity of contraction is when the fundus is easily If internal EFM is done, what is required first? -
indented with the finger. feels similar to the tip of a nose. membranes have ruptured
- mild contraction cervix dilated to 1-2 cm for device insertion
This intensity of contraction is when teh fundus can be If internal EFM is done, where is the probe attached to
indented with figers but with more difficulty, fundus the baby? - the presenting part of the fetus
feels similar to the chin - moderate contractions What are the two types of EFM? - fluid filled catheter
This intensity of contraction is when the fundus cannot connected to pressure sensitive device, and solid catheter
readily be indented with the figer, and it feels harder, with a pressure sensor in it's tip.
similar to the forehead. - firm contractions What is used for external fetal heart monitoring? -
The amount of time the uterus relaxes between doppler transducer (uses sound waves)
contractions. - interval How are contractions measured externally? - a
With each contractions, blood flow from the mother to tocotransducer wiht a pressure sensitive button over the
placenta decreases, but resumes during the __________. fundus
- interval What should the baseline fetal heart rate be? - 110 bpm-
When should length of interval be reported to the 160bpm for at least 2 minutes
doctor? - persistent contraction intervals shorter than 60 This describes fluctuation or constant changes in the
seconds may reduce fetal oxygen supply baseline fetal heart rate within a 10 minute window -
What 3 instances during contractions should be reported baseline variability
to the doctor? - contractions more frequent than every 2 temporary, abrupt rate increases of at least 15 beats per
minutes minute above the baseline FHR that last less than 30
lasting longer than 90 seconds seconds. - accelerations
having intervals shorter than 60 seconds What kind of pattern do accelerations show? - a
When does a woman start pushing? - When dilated to 10 reassuring pattern
When does the mom feel a strong urge to push or bear When is acceleration considered prolonged? - when it
down? - When the cervix is fully dilated and the fetus lasts 2-10 minutes
starts to descend If an acceleration lasts longer than 10 minutes, what is it
What can eliminate the natural urge to push? - considered to be? - a baseline fetal heart rate change
exhaustion Temporary, gradual rate decreases during contractions,
epidural anesthesia where the FHR always returns to the baseline reate by
If a woman is feeling a premature urge to push (before the end of the contractions. - early decelerations
cervix is fully dilated), what might the problem be? - the When is the peak of deceleration? - at the peak of the
fetus is pushing against the rectum contraction
What are some problems that can occur from anxiety and What kind of pattern are early decelerations? - a
fear during the birth process? - greater pain reassuring pattern
inhibit labor progress abrupt decreases of 15 beats per minute below the
reduce blood flow to the fetus baseline, lasting 15 seconds to 2 miuntes. They begin
What is the bag of waters called? - amniotic sac and end abruptly, and do not exhibit a consistent pattern.
What is more likely to occur if many hours elapse - variable decelerations
between rupture of the membranes and birth? - infection what do variable decelerations suggest? - the umbilical
(because the amniotic sac seal the uterine cavity against cord is being compressed, often because it is around the
organisms from the vagina. fetal neck, or insufficient amniontic fluid to cushin the
Why should a woman go right to the hospital when her cord.
amniotic sac ruptures? - 1. infection is more likely This is when the umbilical cord is around the baby's
2. the umbilical cord may slip down and become neck in uetero - nuchal cord
compressed between the mom's pelvis and the fetal When should you call the doctor related to variable
presenting part decel? - fhr decreases to 70 bpm
decrease lasts longer than 60 seconds nipple stimulation
What are the nonreassuring patterns? - tachycardia when the baby's head is too big to fit thru the birth canal
bradycardia - cephalopelvic disproportion
decreased or absent variability What does ROM stand for? and SROM and AROM? -
late decel rupture of membranes
variable decel spontaneous rupture of membranes
FHR decelerations that being AFTER the beginning of artificial rupture of membranes
the contractions and do not return to the baseline until What is the age of viability? - 20 weeks
after the contraction ends - late deceleration what is considered a "term" baby? - 37-38 weeks
What does late decelrations suggest? - placenta not A pregnancy that did not go on past 20 weeks - abortion
delievering enough o2 to the fetus The number of pregnancies a woman has had - gravida
What is it called when the placenta is not delivering A woman who has never been pregnant - nulligravida
enough o2 to the fetus? - uteroplacental insufficiency a woman who is pregnant for the first time -
What is usually the first nursing response to variable primagravida
decel (a nonreassuring pattern) - respositioning the a woman who has been pregnant before - multigravida
woman to relieve pressure on the umbilical cord and a woman who has given birth to one or more children
improve blood flow through it. who reached the age of viability - para
What can be done to infuse fluid into the amniotic a woman who has given birth to her first child past the
cavity? - amniofusion point of viability - primipara
What things can be done about late decels? - a woman who has given birth to 2 or more children past
repositioning the point of viability - multipara
giving o2 at 8-10L via face mask prenatal age of the developing fetus calculated from the
increasing IV fluid to expand blood volume first day of a womans LMP - gestational age
stopping pitocin Nageles rule to determine the estimated date of delivery
preparing to give tocolytic drugs to stop contractions - determine the first day of the LNMP
a procedure to artificially rupture amniotic membrane - count backward 3 months
amniotomy add 7 days
What is recorded when the bag of waters is broken? - the word ______ indicates the number of pregnancies.
color The word _____ indicates the outcome of the
odor pregnancies. Para increases ONLY when a woman
amount of fluid delivers at at least 20 weeks. - gravida
What is the normal color of amniotic fluid? - clear with para
possible white flecks of vernix in it If a fetus is aborted spontaneously before 20 weeks it is
What does green amniotic fluid mean? - fetus has passed considered to be: - pre-term
meconium Recommended schedule for prenatal visits in an
How is amniotic fluid volume estimated? - scant uncomplicated pregnancy - conception-28 weeks:
moderate (500 mL) q4weeks
Large (1000 mL) 29-36 weeks: q2weeks
What might cloudy or yellow amniotic fulid with an 37 weeks to birth: every week
offensive odor indicate? - infection A nurse in the delivery room is assisting with the
What test can be performed if it is unclear if a woman's delivery of a newborn infant. After the delivery of the
membranes have ruptured? - nitrazine test, fern test newborn, the nurse assists in delivering the placenta.
Amniotic fluid is ________ and turns pH paper dark Which observation would indicate that the placenta
blue green or dark blue. - alkaline has separated from the uterine wall and is ready for
This is a test to see if membranes ruptured where
amniotic fluid is spread on a microscope slide and delivery? 
viewed under the microscope to see if the cyrstals in the
fluid look like tiny fern leaves - fern test 1. A soft and boggy uterus - Given
What would you suspect if a woman loses control and
2. Maternal complaints of severe uterine
becomes irritable? - she has progressed to the transition
phase of labor cramping
what is a VBAC? - vaginal birth after cesarean 3. Changes in the shape of the uterus
What is the main concern with VBAC? - the uterine scar 4. The umbilical cord shortens in length
will rupture and disrupt the placental blood flow and and changes in color
cause hemmorrhage
What are the four stages of labor? - dilation and A nurse in the postpartum unit is caring for a client
effacement who has just delivered a newborn infant following a
expulsion of the fetus pregnancy with placenta previa. The nurse reviews
expulsion of placenta the plan of care and prepares to monitor the client for
recovery which of the following risks associated with placenta
What are the 3 phases of the dilation and effacement
stage? - latent phase (1-4) previa? 
active phase (4-7)
transition phase (7-10)
1. Infection
In what phase of labor does the woman start pushing? -
second stage-expulsion of fetus 2. Chronic hypertension
What stages of labor fall into the immediate postpartum 3. Hemorrhage - Given
period? - third and fourth stage 4. Disseminated intravascular coagulation
how long does the fourth stage of labor (recovery) last? -
1-4 hours after expelling placenta or until the mom is A nurse is assessing a pregnant client in the 2nd
physiolocially stable trimester of pregnancy who was admitted to the
What 2 non-medical things can be done to stimulate maternity unit with a suspected diagnosis of abruptio
labor contractions via oxytocin? - orgasm placentae. Which of the following assessment findings
would the nurse expect to note if this condition is Which of the following nursing actions is most

present?  appropriate? 

1. Absence of abdominal pain 1. Continue monitoring the fetal heart rate

2. Painless, bright red vaginal bleeding 2. Encourage the client’s coach to continue
3. Uterine tenderness/pain - Given to encourage breathing exercises
4. A soft abdomen 3. Notify the physician or nurse mid-wife -
Given
A nurse is admitting a pregnant client to the labor 4. Encourage the client to continue
room and attaches an external electronic fetal monitor pushing with each contraction
to the client’s abdomen. After attachment of the
monitor, the initial nursing assessment is which of the
A nurse is performing an assessment of a client who
is scheduled for a cesarean delivery. Which
following?  assessment finding would indicate a need to contact

1. Determining the frequency of the the physician? 

contractions
2. Identifying the types of accelerations - 1. Hemoglobin of 11.0 g/dL
Given 2. Maternal pulse rate of 85 beats per
3. Assessing the baseline fetal heart rate minute
4. Determining the intensity of the 3. White blood cell count of 12,000
contractions 4. Fetal heart rate of 180 beats per minute

A nurse is caring for a client in labor who is receiving A maternity nurse is preparing to care for a pregnant
Pitocin by IV infusion to stimulate uterine client in labor who will be delivering twins. The nurse
contractions. Which assessment finding would monitors the fetal heart rates by placing the external
indicate to the nurse that the infusion needs to be
fetal monitor: 
discontinued? 
1. So that one fetus is monitored for a 15-
1. Three contractions occurring within a minute period followed by a 15 minute
10-minute period fetal monitoring period for the second
2. Adequate resting tone of the uterus fetus
palpated between contractions 2. Over the fetus that is most posterior to
3. Increased urinary output - Given the mothers abdomen
4. A fetal heart rate of 90 beats per minute 3. Over the fetus that is most anterior to
the mothers abdomen
A nurse is monitoring a client in labor. The nurse
4. So that each fetal heart rate is
suspects umbilical cord compression if which of the
following is noted on the external monitor tracing
monitored separately

during a contraction?  A client arrives at a birthing center in active labor. Her

membranes are still intact, and the nurse-midwife
prepares to perform an amniotomy. A nurse who is
1. Early decelerations assisting the nurse-midwife explains to the client that
2. Variable decelerations
3. Short-term variability - Given after this procedure, she will most likely have: 
4. Late decelerations
1. Less pressure on her cervix
A nurse in the labor room is preparing to care for a 2. Decreased number of contractions
client with hypertonic uterine dysfunction. The nurse
3. Increased efficiency of contractions
is told that the client is experiencing uncoordinated
contractions that are erratic in their frequency,
4. The need for increased maternal blood
duration, and intensity. The priority nursing pressure monitoring

intervention would be to:  A nurse is caring for a client in labor and prepares to
auscultate the fetal heart rate by using a Doppler
1. Monitor the Pitocin infusion closely ultrasound device. The nurse most accurately
determines that the fetal heart sounds are heard
2. Prepare the client for an amniotomy
3. Promote ambulation every 30 minutes - by: 
Given
4. Provide pain relief measures 1. Placing the diaphragm of the Doppler on
the mother abdomen
A nurse is monitoring a client in active labor and
2. Noting if the heart rate is greater than
notes that the client is having contractions every 3
minutes that last 45 seconds. The nurse notes that
140 BPM
the fetal heart rate between contractions is 100 BPM. 3. Palpating the maternal radial pulse while
listening to the fetal heart rate
 4. Performing Leopold’s maneuvers first to A nurse is reviewing the record of a client in the labor
determine the location of the fetal heart room and notes that the nurse midwife has
documented that the fetus is at -1 station. The nurse
A pregnant client is admitted to the labor room. An
assessment is performed, and the nurse notes that determines that the fetal presenting part is: 
the client’s hemoglobin and hematocrit levels are low,
indicating anemia. The nurse determines that the 1. 1 fingerbreadth below the symphysis
pubis
client is at risk for which of the following?  2. 1 inch below the coccyx
3. 1 cm above the ischial spine
1. Hemorrhage 4. 1 inch below the iliac crest
2. Low self-esteem
3. A loud mouth A nurse is beginning to care for a client in labor. The
4. Postpartum infections physician has prescribed an IV infusion of Pitocin. The
nurse ensures that which of the following is
A nurse is developing a plan of care for a client
experiencing dystocia and includes several nursing implemented before initiating the infusion? 
interventions in the plan of care. The nurse prioritizes
the plan of care and selects which of the following 1. Placing a code cart at the client’s
bedside
nursing interventions as the highest priority?  2. Continuous electronic fetal monitoring
3. Placing the client on complete bed rest
1. Providing comfort measures 4. An IV infusion of antibiotics
2. Keeping the significant other informed
of the progress of the labor A maternity nurse is caring for a client with abruptio
3. Changing the client’s position frequently placenta and is monitoring the client for disseminated
4. Monitoring fetal heart rate intravascular coagulopathy. Which assessment finding
is least likely to be associated with disseminated
A client in labor is transported to the delivery room
and is prepared for a cesarean delivery. The client is intravascular coagulation? 
transferred to the delivery room table, and the nurse
1. Swelling of the calf in one leg
places the client in the:  2. Decreased platelet count
3. Prolonged clotting times
1. Semi-Fowler position with a pillow under 4. Petechiae, oozing from injection sites,
the knees and hematuria
2. Trendelenburg’s position with the legs in
stirrups A nurse is assigned to care for a client with hypotonic
3. Supine position with a wedge under the uterine dysfunction and signs of a slowing labor. The
right hip nurse is reviewing the physician’s orders and would
4. Prone position with the legs separated expect to note which of the following prescribed
and elevated
treatments for this condition? 
A nurse is caring for a client in the second stage of
labor. The client is experiencing uterine contractions 1. Administration of a tocolytic medication
every 2 minutes and cries out in pain with each 2. Increased hydration
contraction. The nurse recognizes this behavior 3. Medication that will provide sedation
4. Oxytocin (Pitocin) infusion
as: 
A nurse explains the purpose of effleurage to a client
1. Fear of losing control in early labor. The nurse tells the client that
2. Exhaustion
3. Involuntary grunting effleurage is: 
4. Valsalva’s maneuver
1. The application of pressure to the
A nurse is caring for a client in labor. The nurse sacrum to relieve a backache
determines that the client is beginning in the 2nd 2. Performed to stimulate uterine activity
stage of labor when which of the following by contracting a specific muscle group
while other parts of the body rest
assessments is noted?  3. A form of biofeedback to enhance
bearing down efforts during delivery
1. The cervix is dilated completely 4. Light stroking of the abdomen to
2. The membranes have ruptured facilitate relaxation during labor and
3. The client begins to expel clear vaginal provide tactile stimulation to the fetus
fluid
4. The contractions are regular A nurse in the labor room is caring for a client in the
active phases of labor. The nurse is assessing the
fetal patterns and notes a late deceleration on the
monitor strip. The most appropriate nursing action is little snack before getting out of bed,
ginger ale, B6, avoid antiemetics)
to:  8. What causes nasal stuffiness and
epistaxis? what is recommended? -
1. Administer oxygen via face mask estrogen causes swelling
2. Increase the rate of pitocin IV infusion 9. recommended: cool air vaporizer and
3. Place the mother in the supine position saline nose drops
4. Document the findings and continue to 10. What causes fatigue in the first
monitor the fetal patterns trimester? - progesterone relaxes and
causes fatigue as well as the weight of
A nurse assists in the vaginal delivery of a newborn the baby
infant. After the delivery, the nurse observes the 11. what are causes of urinary frequency? -
umbilical cord lengthen and a spurt of blood from the uterus puts weight on uterus, increased
vagina. The nurse documents these observations as estrogen levels, hCg
12. *kegel exercises, empty bladder often,
signs of:  keep water intake high
13. What is Leukorrhea, what causes it and
1. Placental separation what is important education for women?
2. Placenta previa - Increased vaginal discharge (clear or
3. Hematoma whitish) that is normal d/t the increase in
4. Uterine atony estrogen.
14. it is important to tell her the yeast
A nurse in the labor room is performing a vaginal infections are curdy white discharge with
assessment on a pregnant client in labor. The nurse pain and itchiness= should wear cotton
notes the presence of the umbilical cord protruding underwear and eat yogurt
from the vagina. Which of the following would be the
15. What are common discomforts
associated with the second and third
initial nursing action? 
trimester? - 1.) pyrosis (heartburn):
16. 2.) ankle edema
1. Call the delivery room to notify the staff
17. 3.) varicose veins
that the client will be transported
18. 4.) flatulence
immediately 19. 5.) hemorrhoids
2. Find the closest telephone and stat page 20. 6.) constipation:
the physician 21. 7.) backache
3. Gently push the cord into the vagina 22. 8.) leg cramps
4. Place the client in Trendelenburg’s 23. 9.) fainting
position 24. 10.) SOB
25. 11.) difficulty sleeping
A nurse is caring for a client in labor and is monitoring 26. 12.) round ligament pain
the fetal heart rate patterns. The nurse notes the 27. 13.) carpal tunnel syndrome
presence of episodic accelerations on the electronic 28. What should you avoid to help with
fetal monitor tracing. Which of the following actions is
heartburn? - avoid fried food overeating
and lying down after a meal
most appropriate? 
29. What are some tx options for
hemorrhoids? - OTC preparations, ice
1. Notify the physician or nurse mid-wife of
packs, topical agenst, reinsert
the findings.
hemorrhoid
2. Take the mothers vital signs and tell the 30. What will help with constipation and
mother that bed rest is required to what should you absolutely avoid? -
conserve oxygen. Use: stool softener, increase fibers,
3. Document the findings and tell the prune juic
mother that the monitor indicates fetal 31. DO NOT take laxatives
well-being 32. what is round ligament pain and can be
4. Reposition the mother and check the used to help improve the pain? - it is
monitor for changes in the fetal tracing intense grabbing groin pain
5. What are common discomforts present 33. use heating pad and pull knees to
during the first trimester? - N/V, Nasal abdomen
stuffiness and epistaxis, fatigue, urinary 34. What health education do you give in
frequency breast tnederness, ptyalism, regards to fetal activity monitoring? -
leukorrhea start monitor at 28 weeks, once you feel
6. When does the N/V start and stop? - the baby moving for the first time you
starts week 2, ends 14th week should feel it every day from there on,
7. What are causes of the N/V during the should be 4-10 kicks/hr (recommended
first trimester? - hcg hormone, increased to count after a meal bc it makes the
metabolism, sensitivity to odors baby more active)
(recommended: avoid triggers, eat a 35. Are there restrictions with traveling? - no
36. What are some exercises to help with near the junction of the body of the
back pain and supporting organs? - uterus and cervix
back strain: pelvic tilt 65. What is macDonald's sign? - ease in the
37. increase elasticity and support pelvic flexing the body of the uterus against the
organs: kegels cervix
38. Can pregnant women receive 66. What is ballottement? - passive fetal
vaccinations? - Only DEAD, no live movement ellicited by pushing up
viruses! against the cervix, pushing the fetal
39. when are teratogenic substance the body up and then it falls back and the
most harmful? - during the first trimester examiner feels a rebound.
40. What are complications of smoking in a 67. What is couvade? - father observes
pregnancy? - LBW, abortion, PROM, certain rituals to ensure a safe
preterm birth, SIDS pregnancy
41. what is the definition of subjective A nursing student is preparing a prenatal class
changes? - 9presumptive changes): on the process of fetal circulation. The nursing
symptoms reported by teh women instructor asks the student specifically to
42. **not proof of pregnancy describe the process through the umbilical cord.
Which of the following statements from the
43. what are some examples of subjective
student is correct? - "The two arteries in the
changes? - amenorrhea, breast umbilical cord carry deoxygenated blood &
tenderness, morning sickness, fatigue, waste products away from the fetus to the
quickening (18-20wks), urinary placenta."
frequency A nursing student is assigned to care for a client
44. What is the definition of objective in labor. A nursing instructor asks the student to
changes? - (probable changes): describe fetal circulation, specifically the ductus
symptoms observed by a health care venous. The nursing instructor determines that
provider the student understands fetal circulation if the
45. ** not proof of pregnancy student states that the ductus venous: - Connects
46. What are some objective the umbilical vein to the inferior vena cava.
A pregnant client tells the clinic nurse that she
changes/signs? - -Chadwick's sign:
wants to know the sex of her baby as soon as it
bluish/purplish coloring can be determined. The nurse understands that
47. -Goodell's sign: softening cervix he client should be able to find out at 12 weeks'
48. -Hegar's sign: softening uterine isthmus gestation because by the end of the twelfth
(6-8wks) week: - The sex of the fetus can be determined
49. -McDonald's sign: body of uterus eases by the appearance of the external genitalia.
agains cervix A nurse is performing as assessment on a client
50. -Ballotment: push fetal body up and as it who is at 38 weeks' gestation & notes that the
falls back the examiner feels a rebound fetal heart rate is 174 beats/min. On the basis of
51. -Ladin's sign: soft spot anteriorly in the this finding, the appropriate nursing action is to:
middle of the uterus near the junction of - Notify the physician.
A nurse is conducting a prenatal class on the
the bdoy of the uterus and cervix
female reproductive system. When a client in the
52. what are positive proofs of pregnancy? - class asks why the fertilized ovum stays in the
-Ultrasound (4-5wks) fallopian tube for 3 days, the nurse responds that
53. -FHR (doppler @10-12wks) (fetoscope the reason for this is that it: - Promotes the
@17-20wks) fertilized ovum's normal implantation in the top
54. -birth portion of the uterus.
55. -fetal movement felt by examiner (after A nursing instructor is reviewing the menstrual
20wks) cycle with a nursing student who will be
56. What are the four psychologic tasks that conducting a prenatal teaching session. The
go through the mother's mind in instructor asks the student to describe the
preparation for the baby? - 1. safety follicle-stimulating hormone (FSH) & the
luteinizing hormone (LH). The student
57. 2. acceptance
accurately responds by stating that: - FSH & LH
58. 3. "binding in", "come to terms" are released from the anterior pituitary gland.
59. 4. Give (of self) A couple comes to the family planning clinic &
60. What is mitleiden? - the father asks about sterilization procedures. Which
experiencing similar symptoms and question by the nurse would determine if this
cravings to the mother method of family planning would be
61. What is Goodell's sign? - softening of appropriate? - "Do you plan to have any other
the cervix children?"
62. What is Chadwicks sign? - eep red- A nurse should explain which of the following
purple or bluish coloration of the mucous to a pregnant client found to have a gynecoid
membranes of the cervix, vagina and pelvis? - That her type of pelvis is the most
favorable for labor & birth.
vulva d/t increased vasocongestion of
A nurse explains some of the purposes of the
the pelvic vessels placenta to a client during a prenatal visit. The
63. What is Hegar's sign? - softening of the nurse determines that the client understands
isthmus of the uterus (occurs at 6-8wks) some of these purposes when the client states
64. What is Ladin's sign? - a soft spot that the placenta: - Is the way the baby gets food
anteriorly in the middle of the uterus & oxygen.
A nursing instructor asks a nursing student to list A nurse is providing instructions to a pregnant
the functions of the amniotic fluid. The student client who is scheduled for an amniocentesis.
responds correctly by stating that which of the The nurse tells the client that: - An informed
following are functions of amniotic fluid: - * consent needs to be signed before the procedure.
Allows for fetal movement A pregnant client in the first trimester calls nurse
* Is a measure of kidney function at a health care clinic & reports that she has
* Surrounds, cushions, & protects the fetus. noticed a thin, colorless vaginal drainage. The
* Maintains the body temperature of the fetus. nurse should make which assessment to the
A nurse is performing an assessment of a client? - "The vaginal discharge may be
pregnant client who is at 28 weeks of gestation. bothersome, but is a normal occurrence."
The nurse measures the fundal height in A nurse has performed a non-stress test on a
centimeters & expects the finding to be which of pregnant client & is reviewing the fetal monitor
the following? - 30 cm strip. The nurse interprets the test as reactive &
A nurse is collecting data during an admission understands that this indicates: - Normal
assessment of a client who is pregnant with findings
twins. The client has a healthy 5-year-old child A non-stress test is performed on a client who is
who was delivered at 38 weeks & tells the nurse pregnant, & the results of the test indicate non-
that she does not have a Hx of any type of reactive findings. The physician prescribes a
abortion or fetal demise. The nurse would contraction stress test, & the results are
document the GTPAL for this client as - G=2, documented as negative. A nurse interprets the
T=1, P=0, A=0, L=1 finding of the contraction stress test as
A pregnant client is seen in a health care clinic indicating: - A normal test result.
for a regular prenatal visit. The client tells the A pregnant client tells a nurse that she has been
nurse that she is experiencing irregular craving "unusual foods." The nurse gathers
contractions, & the nurse determines that she is additional assessment data from the client &
experiencing Braxton Hicks contractions. Based discovers that the client has been ingesting daily
on this finding, which nursing action is amounts of white clay dirt from her backyard.
appropriate? - Inform the client that these Laboratory studies are performed on the client.
contractions are common & may occur The nurse reviews the results * determines that
throughout the pregnancy. which of the following indicates a physiological
A nurse is providing instructions to a pregnant consequence of the client's practice? -
client with genital herpes about the measures Hemoglobin 9.1 g/dL
that are needed to protect the fetus. The nurse A pregnant client asks a nurse about the types of
tells the client that: - A cesarean section will be exercises that are allowable during pregnancy.
necessary if vaginal lesions are present at the The nurse should instruct the client that the
time of labor. safest exercise to engage in is which of the
A nurse is reviewing the record of a client who following? - Swimming
has just been told that a pregnancy test is A physician has prescribed transvaginal ultra-
positive. The physician has documented the sonography for a client in the 1st trimester of
presence of Goodell's sign. The nurse determines pregnancy & the client asks a nurse about the
that this sign indicates: - A softening of the procedure. The nurse tells the client that: - The
cervix. probe that will be inserted into the vagina will be
A client arrives at the clinic for the first prenatal covered with a disposable cover & coated with a
assessment. The client tells a nurse that the first gel.
day of her last menstrual period was Oct. 19, A clinic nurse has instructed a pregnant client in
2012. Using Nagele's rule, the nurse determines measures to prevent varicose veins during
the estimated date of confinement is: - July 26, pregnancy. Which statement by the client
2013 indicates a need for further instructions? - "I
A nurse-midwife is assessing a pregnant client should wear knee-high hose, but I should not
for the presence of ballottement. To make this leave them on longer than 8 hours."
determination, the nurse-midwife does which of A pregnant client calls a clinic & tells a nurse
the following? - Initiates a gentle upward tap on that she is experiencing leg cramps that awaken
the cervix. her at night. To provide relief from the leg
A pregnant client asks a nurse in the clinic when cramps, the nurse tells the client the following: -
she will be able to begin to feel the fetus move. "Bend your foot toward your body while
The nurse responds by telling the mother that extending the knee when the cramps occur."
fetal movements will be noted between which of A clinic nurse is providing instructions to a
the following weeks of gestation? - 16 & 20 pregnant client regarding measures that assist in
A nurse is performing as assessment of a alleviating heartburn. Which statement by the
primigravida who is being evaluated in a clinic client indicates an understanding of the
during her second trimester of pregnancy. Which instructions? - "I should avoid eating foods that
of the following indicates an abnormal physical produce gas, such as beans & some vegetables,
finding that necessitates further testing? - Fetal & fatty foods such as deep-dried chicken."
heart rate of 180 beats / min A nurse in a health care clinic is instructing a
A nurse is assisting in performing an assessment pregnant client how to perform "kick counts."
on a client who suspects that she is pregnant & Which statement by the client indicates a need
is checking the client for probable signs of for further instructions? - "I need to lie flat on
pregnancy. Which of the following are probable my back to perform the procedure."
signs of pregnancy. - * Ballotement A nurse is providing instructions regarding
* Chadwicks sign treatment if hemorrhoids to a client who is in the
* Uterine enlargement second trimester of pregnancy. Which statement
* Braxton Hick's contractions/ by the client indicates a need for further
instruction? - "I should apply hear packs to the pregnancy. The nurse determines that teaching is
hemorrhoids to help the hemorrhoids shrink." needed if the client makes which statement? - "I
A nurse providing instructions to a client in the will need to increase my insulin dosage during
first trimester of pregnancy regarding measures the first 3 months of pregnancy."
to assist in reducing breast tenderness. The nurse A pregnant client reports to a health care clinic,
tells the client to: - Wash the breasts with warm complaining of loss of appetite, weight loss, &
water & keep them dry. fatigue. After assessment of the client,
A nurse is describing cardiovascular system tuberculosis is suspected. A sputum culture is
changes that occur during pregnancy to a client obtained & identifies Mycobacterium
& understands that which finding would be tuberculosis. The nurse provides instructions to
normal for a client in the 2nd trimester? - the client regarding therapeutic management of
Increase in pulse rate. the tuberculosis & the nurse tells the client that:
A rubella titer result of a 1-day postpartum client - Isoniazid (INH) plus rifampin (Rifadin) will be
is less than 1:8, & a rubella virus vaccine is required for 9 months.
prescribed to be administered before discharge. A nurse is providing instructions to a maternity
The nurse provides which information t the client with a history of cardiac disease regarding
client about the vaccine? - * Pregnancy needs to appropriate dietary measures. Which statement,
be avoided for 1 to 3 months. if made by the client, indicates an understanding
* The vaccine is administered by the of the information provided by the nurse? - "I
subcutaneous route. should drink adequate fluids & increase my
* A hypersensitivity reaction can occur if the intake of high-fiber foods."
client has an allergy to eggs. A clinic nurse is performing a psychosocial
* Exposure to immuno-suppressed individuals assessment of a client who has been told that she
needs to be avoided. is pregnant. Which assessment finding indicates
A nurse is providing instructions to a pregnant to the nurse that the client is at high risk for
client with human immunodeficiency virus contracting HIV? - A client who has a history of
(HIV) infection regarding care to the newborn intravenous drug use.
infant after delivery. The client asks the nurse A nurse in a maternity unit is providing
about the feeding options that are available. The emotional support to a client and her husband
best response by the nurse is: - "You will need to who are preparing to be discharged from the
bottle-feed the newborn infant." hospital after the birth of a dead fetus. Which
A home care nurse visits a pregnant client who statement made by the client indicates a
has a diagnosis of mild preeclampsia. Which component of the normal grieving process? -
assessment finding indicates a worsening of the "We want to attend a support group."
preeclampsia & the need to notify the physician? A nurse evaluates the ability of a hepatitis B-
- The client complains of a headache & blurred positive mother to provide safe bottle-feeding to
vision. her infant during postpartum hospitalization.
A stillborn infant was delivered in the birthing Which maternal action best exemplifies the
suite a few hours ago. After the delivery, the mother's knowledge of potential disease
family remained together, holding & touching transmission to the infant? - The mother washes
the infant. Which statement by the nurse would & dries her hands before & after self-care of the
further assist the family in their initial period of perineum & asks for a pair of gloves before
grief? - "What can I do for you?" feeding.
A nurse implements a teaching plan for a A home care nurse is monitoring a pregnant
pregnant client who is newly diagnosed with client with gestational hypertension who is at
gestational diabetes mellitus. Which statement risk for preeclampsia. At each home care visit,
made by the client indicates a need for further the nurse assesses the client for which classic
teaching? - "I should avoid exercise because of signs of preeclampsia? - * Proteinuria
the negative effects on insulin production." * Hypertension
A pregnant client in the last trimester has been * Generalized Edema
admitted to the hospital with a diagnosis of A nurse is caring for a client in labor. The nurse
severe preeclampsia. A nurse monitors for determines that the client is beginning the
complications associated with the diagnosis & second stage of labor when which of the
assesses the client for: - Evidence of bleeding, following assessments is noted? - The cervix is
such as in gums, petechiae, & purpura. dilated completely.
A nurse in a maternity unit is reviewing the A nurse in the labor room is caring or a client in
records of the clients on the unit. Which client the active stage of labor. The nurse is assessing
would the nurse identify as being at the greatest the fetal patterns and notes a late deceleration.on
risk for developing disseminated intravascular the monitor strip. The appropriate nursing action
coagulation (DIC)? - A gravida II who has just is to: - Administer oxygen via face mask.
been diagnosed with dead fetus syndrome A nurse is performing an assessment of a client
A client in the 1st trimester of pregnancy arrives who is scheduled for a cesarean delivery. Which
at a health care clinic & reports that she has been assessment finding would indicate a need to
experiencing vaginal bleeding. A threatened contact the physician? - Fetal heart rateof 180
abortion is suspected, & the nurse instructs the beats/min
client regarding management of care. Which A nurse is reviewing the record of a client in the
statement made by the client indicates a need for labor room & notes that the nurse-midwife has
further instructions? - "I will maintain strict documented that the fetus is at - 1 station. The
bedrest throughout the remainder of the nurse determines that the fetal presenting part is:
pregnancy." - 1cm above the ischial spine
The nurse is assessing a pregnant client with A client arrives at a birthing center in active
type I diabetes mellitus about her understanding labor. Her membranes are still intact, & the
regarding changing insulin needs during nurse-midwife prepares to perform an
amniotomy. A nurse who is assisting the nurse- note if this condition is present? - Uterine
midwife explains to the client tat after this tenderness
procedure, she will most likely have: - Increased A maternity nurse is preparing for the admission
efficiency of contractions of a client in the third trimester of pregnancy
A nurse is monitoring a client in labor. The who is experiencing vaginal bleeding & has a
nurse suspects umbilical cord compression if suspected diagnosis of placenta previa. The
which of the following is noted on the external nurse reviews the physician's prescriptions &
monitor tracing during a contraction? - Variable would question which prescription? - Obtain
Decelerations equipment for a manual pelvic examination.
A client in labor is transported to the delivery ***(Nothing needs to go inside)
room and prepared for a cesarean delivery. After An ultrasound is performed on a client at term
the client is transferred to the delivery room gestation who is experiencing moderate vaginal
table, a nurse places her in: - Supine position bleeding. The results of the ultrasound indicate
with a wedge under the right hip. that abruptio placentae is present. Based on
***(this helps keep the baby off of the vena these findings, the nurse would prepare the
cava). client for: - Delivery of the fetus
A nurse has provided discharge instructions to a A nurse is performing an initial assessment on a
client who delivered a healthy infant by cesarean client who has just been told that a pregnancy
delivery. Which statement made by the client test is positive. Which assessment finding would
indicates a need for further instructinos? - "I will indicate that the client is at risk for preterm
begin abdominal exercises immediately." labor? - The client has a history of cardiac
A nurse is monitoring a client in active labor & disease.
notes that the client is having contractions every A nurse is monitoring a client who is in the
3 minutes that last 45 seconds. The nurse notes active stage of labor. The client has been
that the fetal heart rate between contractions is experiencing contractions that are short,
100 beats/min. Which of the following nursing irregular, & weak. The nurse documents that the
actions is appropriate? - Notify the physcian or client is experiencing which type of labor
nurse-midwife. dystocia? - Hypotonic
***(The HR is too slow). After a preciptious delivery, a nurse notes that
A nurse is caring for a client in labor & is the new mother is passive & only touches her
monitoring the fetal heart rate patterns. The newborn infant briefly with her fingertips. The
nurse notes the presence of episodic nurse should do which of the following to help
accelerations on the electronic fetal monitor the woman process what has happened? -
tracing. Which of the following actions is Support the mother in her reaction to the
appropriate? - Document the findings & tell the newborn infant.
mother that the patter on the monitor indicates A nurse in a labor room is monitoring a client
fetal well-being. with dysfunctional labor signs of fetal or
A nurse is admitting a pregnant client to the maternal compromise. Which of the following
labor room & attaches an external electronic assessment findings would alert the nurse to a
fetal monitor to the client's abdomen. After compromise? - Persistent non-reassuring fetal
attachment of the electronic fetal monitor, the heart rate.
initial nursing assessment is which of the A nurse in a labor room is preparing to care for a
following? - Assess the baseline fetal heart rate. client with hypotonic uterine contractions. The
A nurse is reviewing true & false labor signs nurse is told that he client is experiencing
with a multiparous client. The nurse determines uncoordinated contractions that are erratic in
that the client understands the signs of true labor their frequency, duration, & intensity. The
if she makes which statement? - "My priority nursing intervention in caring for the
contractions will increase in duration & client is to: - Provide pain relief measures.
intensity." A nurse is reviewing the physician's
After an amniotomy has been performed, a nurse prescriptions for a client admitted for premature
should first assess: - The fetal heart rate pattern. rupture of the membranes. Gestational age of the
A client in labor has been pushing effectively for fetus is determined to be 37 weeks. Which
1 hour. A nurse determines that the client's physician's prescription should the nurse
primary physiological need at this time is to: - question? - Perform a vaginal examination every
Rest between contractions. shift.
A nurse is monitoring a client in labor who is A nurse has developed a plan of care for a client
receiving oxytocin (Pitocin) and notes that the experiencing dystocia & includes several
client is experiencing hypertonic uterine nursing interventions in the plan of care. The
contractions. List in order of priority the actions nurse prioritizes the plan of care & selects which
that the nurse takes. - 1. Stop the oxytocin intervention as the highest priority? - Monitoring
infusion. the fetal heart rate.
2. Reposition the client. Fetal distress is occurring with a laboring client.
3. Administer oxygen by face mask at 8 to 10 As the nurse prepares the client for a cesarean
L/min. birth, what other intervention should be
4. Perform a vaginal examination. performed? - Administer oxygen, 8 to 10 L/min,
5. Check the client's blood pressure. via face mask.
6. Administer medication as prescribed to reduce A nurse in the postpartum unit is caring for a
uterine activity. client who has just delivered a newborn infant
A nurse is assessing a pregnant client in the following a pregnancy with a placenta previa.
second trimester of pregnancy who was admitted The nurse reviews the plan of care & prepares to
to the maternity unit with a suspected diagnosis monitor the client for which risk associated with
of abruptio placentae. Which of the following placenta previa? - Hemorrhage.
assessment findings would the nurse expect to
A nurse in a labor room is performing a vaginal A nurse is monitoring a client in the immediate
assessment on a pregnant client in labor. The postpartum period for signs of hemorrhage.
nurse notes the presence of the umbilical cord Which of the following sign, if noted, would be
protruding from the vagina. Which of the an early sign of excessive blood loss? - An
following is an initial nursing action? - Place the increase in the pulse rate from 88 to 102
client in Trendelenburg's position. beats/min.
A nurse is performing an assessment on a client A nurse is preparing to assess the uterine fundus
diagnosed with placenta previa. Which of these of a client in the immediate postpartum period.
assessment findings would the nurse expect to When the nurse locates the fundus, she notes
note? - *Bright red vaginal bleeding that the uterus feels soft & boggy. Which
*Soft, relaxed, non-tender uterus nursing intervention would be appropriate
*Fundal height may be greater than expected for initially? - Massage the fundus until it's firm.
gestational age. A nurse is providing instructions about measures
A postpartum nurse is taking the vital signs of a to prevent postpartum mastitis to a client who is
client who delivered a healthy infant 4 hours breast-feeding her newborn. Which of the
ago. The nurse notes that the client's temperature following, if stated by the client, would indicate
is 100.2 F. Which of the following actions a need for further instructions? - "I should wash
would be appropriate? - Increase hydration by my nipples daily with soap & water."
encouraging oral fluids. A postpartum nurse is assessing a client who
***(Dehydration could be the cause) delivered a healthy infant by cesarean section for
A nurse is assessing a client who is 6 hours signs & symptoms of superficial venous
postpartum after delivering a full-term health thrombosis. Which of the following signs or
infant. The client complains to the nurse of symptoms would the nurse note if superficial
feelings of faintness & dizziness. Which nursing venous thrombosis were present? - Enlarged,
action would b most appropriate? - Instruct the hardened veins.
client to request help when getting out of bed. A client in a postpartum unit complains of
A postpartum nurse is providing instructions to a sudden sharp chest pain & dyspnea. The nurse
client after delivery of a healthy infant. The notes that the client is tachycardic & the
nurse instructs the client that she should expect respiratory rate is elevated. The nurse suspects a
normal bowel elimination to return. - 3 days pulmonary embolism. Which of the following
postpartum would be the initial nursing action? - Administer
A nurse is planning care for a postpartum client oxygen, 8 to 10 L/min, by face mask.
who had a vaginal delivery 2 hours ago. The A nurse is assessing a client in the fourth stage
client had a mid-line episiotomy & has several of labor & notes that the fundus is firm, but that
hemorrhoids. What is the primary nursing bleeding is excessive. Which of the following
diagnosis for this client? - Acute pain would be the initial nursing action? - Notify the
A nurse is monitoring the amount of lochia physician.
drainage in a client who is 2 hours postpartum & A nurse is preparing to care for four assigned
notes that the client has saturated a perineal pad clients. Which client is at highest risk for
in 1 hour. The nurse reports the amount of hemorrhage? - A multiparous client who
lochial flow as: - Heavy delivered a large fetus after oxytocin (Pitocin)
A nurse is teaching a postpartum client about induction.
breast-feeding. Which of the following A postpartum client is diagnosed with cystitis.
instructions should the nurse include? - The diet The nurse plans for which priority nursing
should include additional fluids. intervention in the care of the client? -
A nurse is preparing to perform a fundal Encouraging fluid intake.
assessment on a postpartum client. The initial A nurse is monitoring a postpartum client who
nursing action in performing this assessment is received epidural anesthesia for delivery for the
which of the following? - Ask the client to presence of a vulvar hematoma. Which of the
urinate & empty her bladder. following assessment findings would best
A nurse is caring for four 1-day postpartum indicate the presence of hematoma? - Changes in
clients. Which client has an abnormal finding vital signs.
that would require further intervention? - The A nurse is developing a plan of care for a
client with lochia that is red & has a foul- pospartum client with a small vulvar hematoma.
smelling odor. The nurse includes which specific intervention
When performing a postpartum assessment on a in the plan during the first 12 hours after
client, a nurse notes the presence of clots in the delivery? - Prepare an ice pack for application to
lochia. The nurse examines the clots & notes the area.
that they are larger than 1cm. Which nursing A nurse is preparing a list of self-care
action is appropriate? - Notify the physician. instructions for a postpartum client who was
*( Clots that are larger than 1 cm, are big!) diagnosed with mastitis. Which of the following
A nurse is providing postpartum instructions to a instructions would be included on the list? - *
client who will be breast-feeding her newborn. Wear a supportive bra.
The nurse determines that the client has * Rest during the acute phase.
understood the instructions if she makes which * Maintain a fluid intake of at least 3000mL.
of the following statements? - * "I should wear a * Continue to breast-feed if the breasts are not
bra that provides support." too sore.
* "Drinking alcohol can affect my milk supply." A nurse in a delivery room is assisting with the
* "The use of caffeine can decrease my milk delivery of a newborn. After delivery, the nurse
supply." prepares to prevent heat loss in the newborn
* "I plan on having bottled water available in the resulting fro evaporation by: - Drying the infant
refrigerator so I can get additional fluids easily." with a warm blanket.
The mother of a newborn calls a clinic & reports The nurse is preparing to care for a newborn
to a nurse that when cleaning the umbilical cord, receiving phototherapy. Which interventions are
the mother noticed that the cord was moist & appropriate? - * Monitor skin temperature
that discharge was present. The appropriate closely.
nursing instruction to the mother is which of the * Reposition the newborn every 2 hours.
following? - Bring the infant to the clinic. * Cover the newborn's eyes with eye shields or
*(Infection) patches.
A nurse in a newborn nursery receives a A nurse is caring for a client who is receiving
telephone call to prepare for the admission of a oxytocin (Pitocin) to induce labor. The nurse
43-week gestation newborn with Apgar scores discontinues the oxytocin infusion if which of
of 1 & 4. In planning for admission of this the following is noted on assessment of the
newborn, the nurse's highest priority should be client? - Uterine hyperstimulation
to: - Connect the resuscitation bag to the oxygen *V *C
outlet. EH
A nurse is assessing a newborn infant after AO
circumcision & notes that the circumcised area LP
is red with a small amount of bloody drainage. A pregnant client is receiving magnesium sulfate
Which of the following nursing actions is for the management of preeclampsia. A nurse
appropriate? - Document the findings. determines that e client is experiencing toxicity
A nurse in a newborn nursery is monitoring a from the medication if which of the following is
preterm newborn for respiratory distress noted on assessment? - Respiration's of 10
syndrome. Which assessment signs noted in the breaths/min
newborn would alert the nurse to the possibility Methylergonovine (Methergine) is prescribed
of this syndrome? - Tachypnea & retractions for a client with postpartum hemorrhage. Before
A postpartum nurse is providing instructions to administering the medication, a nurse contacts
the mother of a newborn with the health care provider who prescribed the
hyperbilirubinemia who is being breast-fed. The medication if which condition is documented in
nurse provides which appropriate instruction to the client's medical history? - Peripheral
he mother? - Continue to breast-feed every 2 to vascular disease
4 hours. *(can cause a blood clot)
A nurse is assessing a newborn who was born to A nursing instructor asks a nursing student to
a mother who is addicted to drugs. Which describe the procedure for administering
assessment finding would the nurse expect to erythromycin ointment to the eyes of a newborn.
note during the assessment of this newborn? - The instructor determines that the student needs
Incessant crying. to research this procedure further if the student
A nurse notes hypotonia, irritability, & a poor states that: - "I will flush the eyes after instilling
sucking reflex in a full-term newborn on the ointment."
admission to the nursery. The nurse suspects A client in preterm labor (31 weeks) who is
fetal alcohol syndrome & is aware that which dilated to 4 cm has been started on magnesium
additional sign would be consistent with fetal sulfate & contractions have stopped. If the
alcohol syndrome. - Abnormal palmar creases. client's labor can be inhibited for the next 48
A nurse is preparing a plan of care for a newborn hours, what medication does the nurse anticipate
with fetal alcohol syndrome. The nurse should will be prescribed? - Betamethasone
include which priority intervention in the plan of Methylergonovine (Methergine) is prescribed
care? - Monitor he newborn's response to for a woman to treat postpartum hemorrhage.
feedings & weight gain pattern. Before administration of methylergonovine, the
A nurse administers erythromycin ointment priority nursing assessment is to check the: -
(0.5%) to the eyes of a newborn & the mother Blood pressure
asks the nurse why this is performed. The nurse A nurse is preparing to administer beractant
explains to the mother that this is routinely done (Survanta) to a premature infant who has
to: - Prevent opthalmia neonatum from respiratory distress syndrome. The nurse plans to
occurring after delivery in a newborn with an administer the medication by which of the
untreated gonococcal infections. following routes? - Intratracheal
A nurse prepares to administer a vitamin K An opioid analgesic is administered to a client in
injection to a newborn, & the mother asks the labor. The nurse assigned to care for the client
nurse why her infant needs the injection. The ensures that which medication is readily
best response by the nurse would be: - available if respiratory depression occurs? -
"Newborns are deficient in vitamin K, & the Naloxone (Narcan)
injection prevents your newborn from bleeding." Rho(D) immune globulin (RhoGAM) is
A nurse develops a plan of care for a woman prescribed for a client after delivery and the
with HIV infection & her newborn. The nurse nurse provides information to the client about
includes which intervention in the plan of care? - the purpose of the medication. The nurse
Maintaining standard precautions at all times determines that the woman understands the
while caring for the newborn. purpose of the medication if the woman states
A nurse is planning care for a newborn of a that it will protect her next baby from which of
diabetic mother. A priority nursing diagnosis for the following? - Being affected by Rh
this infant is: - Risk for Injury related to low incompatibility.
blood glucose levels. A nurse is monitoring a client in preterm labor
The nurse determines that a new mother who is receiving intravenous magnesium sulfate.
understands the teaching about prevention of The nurse monitors for which adverse reactions
newborn abduction is she states: - "I will ask the of this medication? - * Flushing
nurse to attend to my infant if I am napping & * Depressed respiration's
my husband is not here." *Extreme muscle weakness