NM704 Exam 4 - Accurate Answers To All Questions
VS Frequency in the Second Stage Right Ans - You'll take BP between
contractions. It'll be about 10 mm/Hg higher in this stage than in the first
stage.
Bladder Emptying During the Second Stage Right Ans - People should be
voiding frequently. You may need to remind them, as the urge may be
diminished. You may need to cath a person if they have an epidural.
Fetal Monitoring in the Second Stage Right Ans - For EFM it's Q15 barring
complications (then it'd be Q5).
For IA, it depends on whose guidelines you follow. ACOG says Q15, ACNM says
Q5.
Second Stage Definition Right Ans - Two Definitions:
- when the cervix is completely dilated (10cm)
- When there is a spontaneous urge to push
Prolonged Second Stage Definition Right Ans - More than 2 hours of
pushing in multiparous people and more than 3 hours of pushing in
nulliparous people
Spontaneous Pushing Right Ans - Usually results in 5 to 6 bearing-down
efforts per contraction for 3 - 10 seconds each. Pushing will often occur during
an exhalation, with an open mouth and glottis. This will usually be
accompanied by grunting or low groaning. The birthing person controls when
and for how long to push
Coached Pushing Right Ans - Bearing-down efforts begin when the clinician
assesses full dilation and pushing is directed with instructions from a nurse or
clinician for when to push and for how long. This usually results in 3 pushes
per contraction with a duration of 8 to 10 seconds each. Pushing occurs while
the person is holding their breath; silence is encouraged and often results in a
valsalva maneuver
, Closed-Glottis Pushing Associations Right Ans - - Decreased fetal
oxygenation
- Increased perineal trauma
- Impaired PP pelvic function
Supine and Lithotomy Pushing Position Right Ans - Associated with uterine
pressure on the vena cava, parental hypotension, decreased uterine perfusion,
and variant fetal heart rate patterns
Rounded Back Pushing Position Right Ans - The uterus and fetal presenting
part are better aligned with the pelvis
Leaning Forward & Upright Pushing Position Right Ans - Increases the
angle between the uterus and the spine, thereby directing the fetal presenting
part toward the larger posterior segment of the pelvis
Changing Pushing Position Frequently Right Ans - Promotes changes in
pelvic diameters, which can aid in the fetus finding the "best fit" while moving
through the pelvis.
Episiotomy Indications Right Ans - To shorten the second stage because of
prolonged fetal heart rate decels or another fetal heart rate pattern suggestive
of acidemia
Third Stage of Labor Definition Right Ans - The time between the baby
being born and placental separation and birth. Usually lasts less than 10
minutes but can last up to 30.
Risks of Prolonged Third Stage Right Ans - PPH if the third stage lasts
longer than 20 minutes. 30 minutes without placental expulsion is considered
a prolonged third stage
Placental Separation Right Ans - Contractions constrict blood vessels that
supply the placenta, resulting in hemostasis. There's an abrupt decrease in the
size of the uterine cavity following birth of the baby. With each contraction,
the placental implantation surface area decreases without a change in
placental size, causing the placenta to buckle and separate from the decidua.
VS Frequency in the Second Stage Right Ans - You'll take BP between
contractions. It'll be about 10 mm/Hg higher in this stage than in the first
stage.
Bladder Emptying During the Second Stage Right Ans - People should be
voiding frequently. You may need to remind them, as the urge may be
diminished. You may need to cath a person if they have an epidural.
Fetal Monitoring in the Second Stage Right Ans - For EFM it's Q15 barring
complications (then it'd be Q5).
For IA, it depends on whose guidelines you follow. ACOG says Q15, ACNM says
Q5.
Second Stage Definition Right Ans - Two Definitions:
- when the cervix is completely dilated (10cm)
- When there is a spontaneous urge to push
Prolonged Second Stage Definition Right Ans - More than 2 hours of
pushing in multiparous people and more than 3 hours of pushing in
nulliparous people
Spontaneous Pushing Right Ans - Usually results in 5 to 6 bearing-down
efforts per contraction for 3 - 10 seconds each. Pushing will often occur during
an exhalation, with an open mouth and glottis. This will usually be
accompanied by grunting or low groaning. The birthing person controls when
and for how long to push
Coached Pushing Right Ans - Bearing-down efforts begin when the clinician
assesses full dilation and pushing is directed with instructions from a nurse or
clinician for when to push and for how long. This usually results in 3 pushes
per contraction with a duration of 8 to 10 seconds each. Pushing occurs while
the person is holding their breath; silence is encouraged and often results in a
valsalva maneuver
, Closed-Glottis Pushing Associations Right Ans - - Decreased fetal
oxygenation
- Increased perineal trauma
- Impaired PP pelvic function
Supine and Lithotomy Pushing Position Right Ans - Associated with uterine
pressure on the vena cava, parental hypotension, decreased uterine perfusion,
and variant fetal heart rate patterns
Rounded Back Pushing Position Right Ans - The uterus and fetal presenting
part are better aligned with the pelvis
Leaning Forward & Upright Pushing Position Right Ans - Increases the
angle between the uterus and the spine, thereby directing the fetal presenting
part toward the larger posterior segment of the pelvis
Changing Pushing Position Frequently Right Ans - Promotes changes in
pelvic diameters, which can aid in the fetus finding the "best fit" while moving
through the pelvis.
Episiotomy Indications Right Ans - To shorten the second stage because of
prolonged fetal heart rate decels or another fetal heart rate pattern suggestive
of acidemia
Third Stage of Labor Definition Right Ans - The time between the baby
being born and placental separation and birth. Usually lasts less than 10
minutes but can last up to 30.
Risks of Prolonged Third Stage Right Ans - PPH if the third stage lasts
longer than 20 minutes. 30 minutes without placental expulsion is considered
a prolonged third stage
Placental Separation Right Ans - Contractions constrict blood vessels that
supply the placenta, resulting in hemostasis. There's an abrupt decrease in the
size of the uterine cavity following birth of the baby. With each contraction,
the placental implantation surface area decreases without a change in
placental size, causing the placenta to buckle and separate from the decidua.
