CNUR 303 - Lecture 1| QUESTIONS WITH VERIFIED ANSWERS 100% SOLVED| LATEST UPDATE
GUARANTEED PASS
Passageway - soft tissues •Cervix-effaces (thins) & dilates (opens)
•Pelvic floor-muscles assist
•Vagina becomes more stretchy, estrogen causes increase mucous, walls increase in vascularity
to become thickened and it lengthens
•Introitus
-perineal tissues softens and becomes stretchy
Cervical effacement and dilation Effacement is noted as a percentage and this is very
subjective
-100% effaced means the cervix is very short (image C)
Powers •Primary powers-Uterine muscles (contracting) which are responsible for:
•Effacement
•Dilation
•Ferguson reflex stimulates receptors on the pelvic floor to release oxytocin which helps make
strong contractions
•Secondary powers-"Pushing"
•Bearing-down efforts
Position-maternal •Affects woman's anatomical and physiological adaptations to labour
•Gravity-improve descent
•Upright-increase Cardiac Output
•Movement
,•Impacted by maternal or fetal position, culture
Psyche (psychological response) •Adverse effects: maternal fear and tension
•Anxiety-increase pain perception
•What must the HCP consider? who is their support system, what were her past experiences,
Process of labour •Movement of fetus, placenta, and membranes out of the uterus and
through the birth canal
-we talk about it in terms of mechanisms and stages
Signs preceding labour •Lightening or dropping of baby. When the presenting part moves
into the true pelvis and the fetus puts more pressure on the moms bladder causing her to have
to pee all the time
•Bloody show. Mucous that is brown or tinged. The cervix has shortened and thinned and
started to dilate, some of the tiny capillaries stretch and bleed a bit.
Stages of labour •First stage
•Second stage
•Third stage
•Fourth stage
-normal labour occurs at or near term with no maternal or fetal adverse effects with a vertex
cephalic presentaion
Seven cardinal movements of labor •Engagement
•Descent
•Flexion
•Internal rotation
,•Extension
•Restitution and external rotation
•Birth by expulsion
Physiological adaptation to labour •Fetal adaptation
•Changes occur in the following:
•Fetal heart rate: when the fetus moves, during a vaginal exam, fundal pressure
•Fetal circulation. Don't want mom to lay on back because it causes diminished blood flow, or
uterine contractions, maternal blood pressure and the umbilical cord. Sometimes the cord
doesn't have much whartons jelly which causes less protection for the cord.
•Fetal respiration. In utero, the lungs have fluid in them.
Labour assessment •Determination of true labour or pre-labour
•Contractions: are there any
•Cervix: is it efacing or dilating
•Fetus: what is it doing
•Admission to labour unit or can she return home?
Labour assessment admission data •Antenatal data and interview: any bloody show, any
contractions, any liquid from membranes rupturing, have you felt your baby move?
•Psychosocial factors
•Stress in labour
•Trans and gender-nonconforming persons
•Cultural factors
Labour assessment: physical examination •General systems assessment
•Vital signs
, •Leopold's manoeuvres helps us identify the number of fetus, the lie, attitude, presenting part
etc
•Assessment of fetal heart rate (FHR) and pattern
•Palpation of uterus: mild, moderate, strong
•Cervical effacement, dilation, fetal descent
•Vaginal examination: *no nursing students
Assessment of uterine cavity •Frequency
•Intensity
•Duration
•Resting tone
Lab and diagnostic test for assessment of labour -urine dip: checking for ketones (if mom is
dehydrated), protein (indicated by blood in urine possibly because of bloody show or that she
has a blood pressure concern that is affecting kidneys), glucose (diabetic), leukocytes (urinary
tract infection)
•Blood tests -not routine
•Assessment of amniotic membranes and fluid
•Signs of potential labour complications: blood pressure, temp, bleeding?
Testing if its amniotic fluid -ferning: take amniotic fluid, put it on the slide and let it dry and
let physician to view it under microscope
-test strip: dip it in fluid and its very alkaline and it will turn it a dark blue
Labour: plan of care •Standards of care
•Physical nursing care during labour
•General hygiene
GUARANTEED PASS
Passageway - soft tissues •Cervix-effaces (thins) & dilates (opens)
•Pelvic floor-muscles assist
•Vagina becomes more stretchy, estrogen causes increase mucous, walls increase in vascularity
to become thickened and it lengthens
•Introitus
-perineal tissues softens and becomes stretchy
Cervical effacement and dilation Effacement is noted as a percentage and this is very
subjective
-100% effaced means the cervix is very short (image C)
Powers •Primary powers-Uterine muscles (contracting) which are responsible for:
•Effacement
•Dilation
•Ferguson reflex stimulates receptors on the pelvic floor to release oxytocin which helps make
strong contractions
•Secondary powers-"Pushing"
•Bearing-down efforts
Position-maternal •Affects woman's anatomical and physiological adaptations to labour
•Gravity-improve descent
•Upright-increase Cardiac Output
•Movement
,•Impacted by maternal or fetal position, culture
Psyche (psychological response) •Adverse effects: maternal fear and tension
•Anxiety-increase pain perception
•What must the HCP consider? who is their support system, what were her past experiences,
Process of labour •Movement of fetus, placenta, and membranes out of the uterus and
through the birth canal
-we talk about it in terms of mechanisms and stages
Signs preceding labour •Lightening or dropping of baby. When the presenting part moves
into the true pelvis and the fetus puts more pressure on the moms bladder causing her to have
to pee all the time
•Bloody show. Mucous that is brown or tinged. The cervix has shortened and thinned and
started to dilate, some of the tiny capillaries stretch and bleed a bit.
Stages of labour •First stage
•Second stage
•Third stage
•Fourth stage
-normal labour occurs at or near term with no maternal or fetal adverse effects with a vertex
cephalic presentaion
Seven cardinal movements of labor •Engagement
•Descent
•Flexion
•Internal rotation
,•Extension
•Restitution and external rotation
•Birth by expulsion
Physiological adaptation to labour •Fetal adaptation
•Changes occur in the following:
•Fetal heart rate: when the fetus moves, during a vaginal exam, fundal pressure
•Fetal circulation. Don't want mom to lay on back because it causes diminished blood flow, or
uterine contractions, maternal blood pressure and the umbilical cord. Sometimes the cord
doesn't have much whartons jelly which causes less protection for the cord.
•Fetal respiration. In utero, the lungs have fluid in them.
Labour assessment •Determination of true labour or pre-labour
•Contractions: are there any
•Cervix: is it efacing or dilating
•Fetus: what is it doing
•Admission to labour unit or can she return home?
Labour assessment admission data •Antenatal data and interview: any bloody show, any
contractions, any liquid from membranes rupturing, have you felt your baby move?
•Psychosocial factors
•Stress in labour
•Trans and gender-nonconforming persons
•Cultural factors
Labour assessment: physical examination •General systems assessment
•Vital signs
, •Leopold's manoeuvres helps us identify the number of fetus, the lie, attitude, presenting part
etc
•Assessment of fetal heart rate (FHR) and pattern
•Palpation of uterus: mild, moderate, strong
•Cervical effacement, dilation, fetal descent
•Vaginal examination: *no nursing students
Assessment of uterine cavity •Frequency
•Intensity
•Duration
•Resting tone
Lab and diagnostic test for assessment of labour -urine dip: checking for ketones (if mom is
dehydrated), protein (indicated by blood in urine possibly because of bloody show or that she
has a blood pressure concern that is affecting kidneys), glucose (diabetic), leukocytes (urinary
tract infection)
•Blood tests -not routine
•Assessment of amniotic membranes and fluid
•Signs of potential labour complications: blood pressure, temp, bleeding?
Testing if its amniotic fluid -ferning: take amniotic fluid, put it on the slide and let it dry and
let physician to view it under microscope
-test strip: dip it in fluid and its very alkaline and it will turn it a dark blue
Labour: plan of care •Standards of care
•Physical nursing care during labour
•General hygiene
