NM 704 Exam 3 - Accurate Answers To All Questions
Know the recommended frequency for the assessment of maternal vital signs
in the first stage of labor Right Ans - BP, pulse, respirations: q 1 hour
Temp: q 2 to 4 hours when normal and membranes intact
OR 1 to 2 hours in the temp is abnormal and membranes have ruptured
Review the recommendations for frequency of fetal heart rate assessment
during labor Right Ans - Continuous: No comp - q 15 min; comp - q 5 min
Intermittent: Acog - q 5 min; ACNM - Q 15 min before pushing, q 5 min during
pushing; AWHONN - Q 5 - 15 min
Review recommendation for the appropriate use of vaginal exams during the
first stage of labor Right Ans - Consider why and when: will it change your
management in any way?
Be familiar with the HISTORY of the policy of withholding foods and oral fluids
during labor Right Ans - 1918 - DeLee warned that food must be
encouraged throughout labor to avoid general weakness, delayed labor, and
serious postpartum hemorrhage
1946 - Mendelson identified aspiration of stomach contents as the cause of
post-aspiration pneumonia and subsequent maternal mortality d/t delay in
gastric emptying and increased gastric acidity
**the practice of feeding women in labor was deemed clinically unsound and
NPO policies were introduced
Know the CURRENT evidence regarding encouraging or withholding food or
oral fluids during labor Right Ans - ASA currently recommends oral intake
of modest clear liquids for uncomplicated pts and case-by-case determination
for high risk
Prolonged fasting can lead to ketosis, however no association has been shown
between ketosis and poor outcomes and the relationship is unclear
Prolonged fasting in labor has shown no increased risk for aspiration
Aspiration is more related to general anesthesia rather than regional which is
more commonly used today
,List indications for IV access and/or IV fluids Right Ans - Should be based
on actual or potential risk factors for each individual
Need for increased hydration
Potential oxytocin administration, abx administration
For pre-epidural fluids or in case of med administration for emergency
Understand the significance of ketonuria to the laboring woman Right Ans
- Occurs as a result of fat catabolism when glycogen scores are used up
May have deleterious effects on uterine function
No differences in duration of labor, augmentation of labor, cesarean sections,
or Apgar scores
Understand the potential hazards of dextrose containing intravenous
hydration to the fetus and newborn Right Ans - In large doses can cause
fetal lactic acidosis and newborn jaundice and hypoglycemia
Know the disadvantages of a supine maternal position in labor Right Ans -
Supine hypotension
May lead to an illusion of cephalopelvic disproportion d/t reduced pelvic
diameter
Impedes rotation from OP or OT to OA
Requires pushing against gravity
Places fetus in unfavorable drive angle in relation to pelvis
Causes contractions to become more frequent, more painful, and less effective
Know the impact of squatting and "hands on knees" positions on pelvic
dimensions Right Ans - The sagittal outlet and interspinous diameter are
significantly greater than when supine; women who are taller, younger, and
parous had greater increases
List different positions and movements for labor and indicate their proposed
benefit Right Ans - Side-lying
Standing/leaning forward
Kneeling
, Squatting
Pelvic rocking
Lunging
Walking/stairs
Slow dancing
Abdominal stroking/lifting
Pelvic press
Discuss assessment and management strategies for a fetus suspected or
known to be in a posterior position Right Ans - Assessment: Leopold's
Maneuvers, digital exam, location of FHT, ultrasound is gold standard
although not always perfect
Management: Teach and encourage woman to move around and use different
techniques to use gravity and pelvic shape to change position of fetus, confirm
with ultrasound and do not assume that back pain = OP or that no back pain
with stalled labor is not OP, Provide continuous labor support, rotate fetal
head manually or digitally
Know the indications, contraindications, and procedure for amniotomy
Right Ans - Indications: May be used for treatment for dystocia or as an
adjunct for women who have clear indication for induction
Contraindications:
Procedure: Ensure cephalic presentation, disrupt membrane during cxn, leave
fingers in place to ensure prolapsed cord does not occur
Know the risks and benefits of amniotomy Right Ans - Effect on perception
of pain: Can lead to an increase in perception of pain
Labor duration: Does not shorten
Fetal and neonatal status: Cod compression with FHR decels; cord prolapse
Rates of analgesia use:
Cesarean section: Increased risk
Know about the use of hydrotherapy in labor Right Ans - Use of analgesia:
Significant reduction in the use of epidural/spinal analgesia
Reported maternal pain: Higher pain scores in those not using water
Know the recommended frequency for the assessment of maternal vital signs
in the first stage of labor Right Ans - BP, pulse, respirations: q 1 hour
Temp: q 2 to 4 hours when normal and membranes intact
OR 1 to 2 hours in the temp is abnormal and membranes have ruptured
Review the recommendations for frequency of fetal heart rate assessment
during labor Right Ans - Continuous: No comp - q 15 min; comp - q 5 min
Intermittent: Acog - q 5 min; ACNM - Q 15 min before pushing, q 5 min during
pushing; AWHONN - Q 5 - 15 min
Review recommendation for the appropriate use of vaginal exams during the
first stage of labor Right Ans - Consider why and when: will it change your
management in any way?
Be familiar with the HISTORY of the policy of withholding foods and oral fluids
during labor Right Ans - 1918 - DeLee warned that food must be
encouraged throughout labor to avoid general weakness, delayed labor, and
serious postpartum hemorrhage
1946 - Mendelson identified aspiration of stomach contents as the cause of
post-aspiration pneumonia and subsequent maternal mortality d/t delay in
gastric emptying and increased gastric acidity
**the practice of feeding women in labor was deemed clinically unsound and
NPO policies were introduced
Know the CURRENT evidence regarding encouraging or withholding food or
oral fluids during labor Right Ans - ASA currently recommends oral intake
of modest clear liquids for uncomplicated pts and case-by-case determination
for high risk
Prolonged fasting can lead to ketosis, however no association has been shown
between ketosis and poor outcomes and the relationship is unclear
Prolonged fasting in labor has shown no increased risk for aspiration
Aspiration is more related to general anesthesia rather than regional which is
more commonly used today
,List indications for IV access and/or IV fluids Right Ans - Should be based
on actual or potential risk factors for each individual
Need for increased hydration
Potential oxytocin administration, abx administration
For pre-epidural fluids or in case of med administration for emergency
Understand the significance of ketonuria to the laboring woman Right Ans
- Occurs as a result of fat catabolism when glycogen scores are used up
May have deleterious effects on uterine function
No differences in duration of labor, augmentation of labor, cesarean sections,
or Apgar scores
Understand the potential hazards of dextrose containing intravenous
hydration to the fetus and newborn Right Ans - In large doses can cause
fetal lactic acidosis and newborn jaundice and hypoglycemia
Know the disadvantages of a supine maternal position in labor Right Ans -
Supine hypotension
May lead to an illusion of cephalopelvic disproportion d/t reduced pelvic
diameter
Impedes rotation from OP or OT to OA
Requires pushing against gravity
Places fetus in unfavorable drive angle in relation to pelvis
Causes contractions to become more frequent, more painful, and less effective
Know the impact of squatting and "hands on knees" positions on pelvic
dimensions Right Ans - The sagittal outlet and interspinous diameter are
significantly greater than when supine; women who are taller, younger, and
parous had greater increases
List different positions and movements for labor and indicate their proposed
benefit Right Ans - Side-lying
Standing/leaning forward
Kneeling
, Squatting
Pelvic rocking
Lunging
Walking/stairs
Slow dancing
Abdominal stroking/lifting
Pelvic press
Discuss assessment and management strategies for a fetus suspected or
known to be in a posterior position Right Ans - Assessment: Leopold's
Maneuvers, digital exam, location of FHT, ultrasound is gold standard
although not always perfect
Management: Teach and encourage woman to move around and use different
techniques to use gravity and pelvic shape to change position of fetus, confirm
with ultrasound and do not assume that back pain = OP or that no back pain
with stalled labor is not OP, Provide continuous labor support, rotate fetal
head manually or digitally
Know the indications, contraindications, and procedure for amniotomy
Right Ans - Indications: May be used for treatment for dystocia or as an
adjunct for women who have clear indication for induction
Contraindications:
Procedure: Ensure cephalic presentation, disrupt membrane during cxn, leave
fingers in place to ensure prolapsed cord does not occur
Know the risks and benefits of amniotomy Right Ans - Effect on perception
of pain: Can lead to an increase in perception of pain
Labor duration: Does not shorten
Fetal and neonatal status: Cod compression with FHR decels; cord prolapse
Rates of analgesia use:
Cesarean section: Increased risk
Know about the use of hydrotherapy in labor Right Ans - Use of analgesia:
Significant reduction in the use of epidural/spinal analgesia
Reported maternal pain: Higher pain scores in those not using water
