During the first stage of labor, gastrointestinal motility and absorption of solid foods are

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NR 331 Maternal Child Nursing Care- Chapter 13-16 Uncomplicated Labor & Delivery

• The nurse is caring for a patient in the first stage of labor. What maternal physiologic

changes does the nurse expect?1 Decrease in absorption of solid food 2 Increase in systolic and diastolic pressures 3 Increase in nausea and vomiting sensation 4 Increase in cardiac output by 30% to 50%

Answer 1 During the first stage of labor, gastrointestinal motility and absorption of solid foods are decreased, and stomach-emptying time is slowed down. Only systolic blood pressure increases during uterine contractions in the first stage of labor. Systolic and diastolic pressures increase during contractions in the second stage of labor and return to baseline levels between contractions. Nausea and vomiting sensations may occur during the transition from first stage to second stage of labor. In the first stage of labor, the cardiac output increases by 10% to 15%.Cardiac output increases by 30% to 50% only at the end of the first stage of labor and not in the first stage.

• What are the common signs that are observed in the days preceding labor? Select all that

apply.1 Persistent low backache 2 Sudden increase in lethargy 3 Blood-tinged cervical mucus 4 Increase in weight up to 1.5 kg 5 Profuse vaginal mucus

Answer

1, 3, 5

Common signs that precede labor include persistent low backache and sacroiliac distress as a

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result of relaxation of the pelvic joints. Brownish or blood-tinged cervical mucus may be passed.The vaginal mucus becomes more profuse in response to the extreme congestion of the vaginal mucous membranes. In the days preceding labor, women generally have a sudden surge of energy. They also experience a loss of 0.5 to 1.5 kg in weight. This is caused by water loss resulting from electrolyte shifts that in turn are produced by changes in estrogen and progesterone levels.

• Nurses can advise their patients that which of these signs precede labor? Select all that

apply.1 A return of urinary frequency as a result of increased bladder pressure 2 Persistent low backache from relaxed pelvic joints 3 Stronger and more frequent uterine (Braxton Hicks) contractions 4 A decline in energy, as the body stores up for labor 5 Uterus sinks downward and forward in first-time pregnancies

Answer

1, 2, 3

After lightening, a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor , women often expe- rience persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Before the onset of labor, it is common for Braxton Hicks contractions to increase in both frequency and strength.Bloody show may be passed. A surge of energy is a phenomenon that is common in the days preceding labor. In first-time pregnancies, the uterus sinks downward and forward about 2 weeks before term.

• During the vaginal examination of a laboring patient, the nurse analyzes that the fetus is in the

right occiput anterior (ROA) position at -1 station. What is the position of the lowermost portion of the fetal presenting part?1

• cm above the ischial spine. 2
• cm above the ischial spine. 3

at the level of the ischial spine. 4

• cm below the ischial spine.

Answer 2

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When the lowermost portion of the presenting part is 1 cm above the ischial spine, it is noted as being minus (-)1. When positioned 2 cm above the ischial spine, it is -2 station. At the level of the spines the station is referred to as 0 (zero). When the presenting part is 1 cm below the spines, the station is said to be plus (+)1.

• What are the factors that speed up the dilation of the cervix? Select all that apply.

1

Strong uterine contractions 2 Scarring of the cervix 3 Pressure by amniotic fluid 4 Prior infection of the cervix 5 Force by fetal presenting part

Answer

1, 3, 5

Dilation of the cervix occurs by the drawing upward of the musculofibrous com- ponents of the cervix, which are, in turn, caused by strong uterine contractions. Pressure exerted by the amniotic fluid while the membranes are intact or by the force applied by the presenting part can promote cervical dilation. Scarring of the cervix may occur following a surgery. Prior infection or surgery may slow cervical dilation.

• Nurses can help their patients by keeping them informed about the distinc- tive stages of

labor. What description of the phases of the first stage of labor is accurate?1 Latent

Answer mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours 2 Active

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Answer moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours 3 Lull

Answer no contractions; dilation stable; duration of 20 to 60 minutes 4 Transition

Answer very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours

Answer 2 The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours. The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours.No official "lull" phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes.

• The nurse is caring for a patient who is in the third trimester of pregnancy. The patient

reports pain in the pelvic joints. What does the nurse recognize as

the cause of the pain? 1 There is relaxation of the pelvic joints. 2 There is decreased mobility of the ligaments. 3 The joint of the symphysis pubis is narrowing. 4 The pelvis may not support vaginal birth.