Chapter 17; Labor and Birth Complications Perry;Maternal Child Nursing Care, 6th Edition

Chapter 17; Labor and Birth Complications Perry;Maternal Child Nursing Care, 6th Edition

• In planning for home care of a woman with preterm labor, which concern must the nurse

address?

• Nursing assessments will be different from those done in the hospital setting.
• Restricted activity and medications will be necessary to prevent recurrence of preterm labor.
• Prolonged bed rest may cause negative physiologic effects.

d. Home health care providers will be necessary. - answerANS: C

Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged after birth recovery. Nursing assessments will differ somewhat from those performed in the acute care setting, but this is not the concern that needs to be addressed. Restricted activity and medication may prevent preterm labor, but not in all women. In addition, the plan of care is individualized to meet the needs of each woman.Many women will receive home health nurse visits, but care is individualized for each woman.

• The nurse providing care for a woman with preterm labor who is receiving terbutaline would

include which intervention to identify side effects of the drug?

• Assessing deep tendon reflexes (DTRs)
• Assessing for chest discomfort and palpitations
• Assessing for bradycardia

d. Assessing for hypoglycemia - answerANS: B

Terbutaline is a 2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. Signs of cardiopulmonary decompensation would include chest pain and palpitations.Assessing DTRs would not address these concerns. 2-Adrenergic agonist drugs cause tachycardia, not bradycardia. The metabolic effect leads to hyperglycemia, not hypoglycemia.

• In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what

finding would alert the nurse to possible side effects?

• Urine output of 160 mL in 4 hours

• Deep tendon reflexes 2+ and no clonus
• Respiratory rate of 16 breaths/min

d. Serum magnesium level of 10 mg/dL - answerANS: D

The therapeutic range for magnesium sulfate management is 5 to 8 mg/dL. A serum magnesium level of 10 mg/dL could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress. Urine output of 160 mL in 4 hours, deep tendon reflexes 2+ with no clonus, and respiratory rate of 16 breaths/min are normal findings.

• A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone

intramuscularly. The purpose of this pharmacologic treatment is to:

• stimulate fetal surfactant production.
• reduce maternal and fetal tachycardia associated with ritodrine administration.
• suppress uterine contractions.
• maintain adequate maternal respiratory effort and ventilation during magnesium sulfate

therapy. - answerANS: A

Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. Inderal would be given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy

• A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing

preterm labor. What finding indicates that preterm labor is occurring?

• Estriol is not found in maternal saliva.
• Irregular, mild uterine contractions are occurring every 12 to 15 minutes.
• Fetal fibronectin is present in vaginal secretions.

d. The cervix is effacing and dilated to 2 cm. - answerANS: D

Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth.Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could

predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor such as cervical changes.

• A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and

says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor?

• She is exhibiting hypotonic uterine dysfunction.
• She is experiencing a normal latent stage.
• She is exhibiting hypertonic uterine dysfunction.

d. She is experiencing pelvic dystocia. - answerANS: C

Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, often are anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress. With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor; then the contractions become weak and inefficient or stop altogether. The contraction pattern seen in this woman signifies hypertonic uterine activity. Typically uterine activity in this phase occurs at 4- to 5-minute intervals lasting 30 to 45 seconds. Pelvic dystocia can occur whenever contractures of the pelvic diameters reduce the capacity of the bony pelvis, including the inlet, midpelvis, outlet, or any combination of these planes.

• Which assessment is least likely to be associated with a breech presentation?
• Meconium-stained amniotic fluid
• Fetal heart tones heard at or above the maternal umbilicus
• Preterm labor and birth

d. Postterm gestation - answerANS: D

Postterm gestation is not likely to be seen with a breech presentation. The presence of meconium in a breech presentation may result from pressure on the fetal wall as it traverses the birth canal.Fetal heart tones heard at the level of the umbilical level of the mother are a typical finding in a breech presentation because the fetal back would be located in the upper abdominal area. Breech presentations often occur in preterm births.

• A woman is having her first child. She has been in labor for 15 hours. Two hours ago her vaginal

examination revealed the cervix to be dilated to 5 cm and 100?faced, and the presenting part was at station 0. Five minutes ago her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description?

• Prolonged latent phase
• Protracted active phase
• Arrest of active phase

d. Protracted descent - answerANS: C

With an arrest of the active phase, the progress of labor has stopped. This patient has not had any anticipated cervical change, thus indicating an arrest of labor. In the nulliparous woman a prolonged latent phase typically would last more than 20 hours. A protracted active phase, the first or second stage of labor, would be prolonged (slow dilation). With protracted descent, the fetus would fail to descend at an anticipated rate during the deceleration phase and second stage of labor.

• In evaluating the effectiveness of oxytocin induction, the nurse would expect:
• contractions lasting 80 to 90 seconds, 2 to 3 minutes apart.
• the intensity of contractions to be at least 110 to 130 mm Hg.
• labor to progress at least 2 cm/hr dilation.
• At least 30 mU/min of oxytocin will be needed to achieve cervical dilation. - answerANS: A

The goal of induction of labor would be to produce contractions that occur every 2 to 3 minutes and last 60 to 90 seconds. The intensity of the contractions should be 80 to 90 mm Hg by intrauterine pressure catheter. Cervical dilation of 1 cm/hr in the active phase of labor would be the goal in an oxytocin induction. The dose is increased by 1 to 2 mU/min at intervals of 30 to 60 minutes until the desired contraction pattern is achieved. Doses are increased up to a maximum of 20 to 40 mU/min.

• A pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord is suspected.

What intervention would be the top priority?

• Placing the woman in the knee-chest position.
• Covering the cord in sterile gauze soaked in saline.
• Preparing the woman for a cesarean birth.