When managing the care of a woman in the second stage of labor, ...

[iveyjurea]

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include:
 
  a. Encouraging the woman to try various upright positions, including squatting and standing.
  b. Telling the woman to start pushing as soon as her cervix is fully dilated.
  c. Continuing an epidural anesthetic so pain is reduced and the woman can relax.
  d. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction.

Question 2

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse's initial response would be to:
 
  a. Prepare the woman for imminent birth.
  b. Notify the woman's primary health care provider.
  c. Document the characteristics of the fluid.
  d. Assess the fetal heart rate and pattern.

[jjorrostieta]

Answer to Question 1

ANS: A
Upright positions and squatting both may enhance the progress of fetal descent. Many factors dictate when a woman will begin pushing. Complete cervical dilation is necessary, but it is only one factor. If the fetal head is still in a higher pelvic station, the physician or midwife may allow the woman to labor down (allowing more time for fetal descent, thereby reducing the amount of pushing needed) if the woman is able. The epidural may mask the sensations and muscle control needed for the woman to push effectively. Closed glottic breathing may trigger the Valsalva maneuver, which increases intrathoracic and cardiovascular pressures, reducing cardiac output and inhibiting perfusion of the uterus and placenta. In addition, holding the breath for longer than 5 to 7 seconds diminishes the perfusion of oxygen across the placenta and results in fetal hypoxia.

Answer to Question 2

ANS: D
The umbilical cord may prolapse when the membranes rupture. The fetal heart rate and pattern should be monitored closely for several minutes immediately after ROM to ascertain fetal well-being, and the findings should be documented. Rupture of membranes (ROM) may increase the intensity and frequency of the uterine contractions, but it does not indicate that birth is imminent. The nurse may notify the primary care provider after ROM occurs and fetal well-being and the response to ROM have been assessed. The nurse's priority is to assess fetal well-being. The nurse should document the characteristics of the amniotic fluid, but the initial response is to assess fetal well-being and the response to ROM.

[iveyjurea]

TYSM

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