The patient at term has a suspected small pelvis. The fetus has ...

[RYAN BANYAN]

The patient at term has a suspected small pelvis. The fetus has an estimated weight of 4200 g (9 pounds 4 ounces). Spontaneous labor has begun, and the patient is now at 6 cm.
 
  The nurse understands that the most important nursing action for this patient is to: 1. Assist the patient to squat during the second stage.
  2. Encourage oral fluids and carbohydrate intake.
  3. Assess the cervix for change every 8 hours.
  4. Inform the couple that labor might be prolonged.

Question 2

A new mother is concerned about spoiling her newborn. The home care nurse teaches the mother that:
 
  1. Newborns can be manipulative, so caution is advised.
  2. Meeting the infant's needs develops a trusting relationship.
  3. An infant who is rocked to sleep every night is being spoiled.
  4. Crying is good for babies, and letting them cry it out is advised.

[Mollythedog]

Answer to Question 1

1
Rationale 1: Squatting increases the diameter of the pelvic outlet, and might facilitate vaginal birth when cephalopelvic disproportion is a risk.
Rationale 2: A patient with a large fetus and a small pelvis has a higher-than-average chance of needing a cesarean. This patient should either be given only clear liquids or be NPO to reduce the risk of aspiration should a cesarean need to be performed.
Rationale 3: The cervix is normally assessed when the patient's labor status appears to have changed, or in order to determine whether cervical change is taking place. The cervix would be assessed more frequently if a patient were in the active phase of labor and cephalopelvic disproportion were a risk. Every 8 hours is too far apart.
Rationale 4: Although it is true that labor with a large fetus and a small pelvis could be prolonged, informing the couple of this fact is a psychosocial intervention. Physiologic interventions are a higher priority.

Answer to Question 2

2
Rationale 1: This would be inappropriate and incorrect advice.
Rationale 2: Picking babies up when they cry teaches them that adults are responsive to their needs. This helps build a sense of trust and security.
Rationale 3: This would be inappropriate and incorrect advice.
Rationale 4: This would be inappropriate and incorrect advice.