labor and delivery
What is the priority nursing action for recurrent variable decelerations on the fetal monitor?
Reposition the client—usually into a side-lying or knee-chest position—to relieve cord compression.
Which common skin change during pregnancy is triggered by melanocyte-stimulating hormone?
Chloasma (“mask of pregnancy”)—darkening over cheeks and forehead due to increased melanin.
How many vessels should a normal umbilical cord contain, and what should you assess if abnormal?
2 arteries and 1 vein (AVA). If fewer, assess for renal or cardiac anomalies.
What VS changes are expected in the first 24 hours postpartum?
Slight bradycardia (50–70 bpm), mild temp elevation (up to 100.4°F), stable BP.
What hormone causes the let-down reflex during breastfeeding?
Oxytocin.
List 3 key features that distinguish true labor from false labor.
True labor includes: (1) Regular, increasing contractions, (2) Cervical dilation, and (3) Pain radiating to back/abdomen that intensifies with walking.
A pregnant client presents with painless bright red vaginal bleeding. The uterus is soft and nontender. What is suspected?
A newborn is jittery and has a BG of 36 mg/dL. What is your immediate nursing action?
Feed the infant immediately (breast or formula); if symptoms persist or BG doesn’t rise, initiate IV glucose.
What are 3 signs of placental separation during the third stage of labor?
(1) Gush of blood, (2) Lengthening of umbilical cord, (3) Fundus rises and becomes firm.
Calculate the GTPAL: Currently pregnant at 12 weeks, 2 term births, 1 preterm, 1 abortion, 3 living children.
G5 T2 P1 A1 L3
Why must the nurse ensure the bladder is emptied during labor, and what are the consequences if not?
A full bladder displaces the uterus and can impede fetal descent, leading to prolonged labor or ineffective contractions.
What conditions are contraindicated in a client receiving methylergonovine?
Preeclampsia and hypertension - increases stroke/seizure risk
Name three hallmark signs of respiratory distress in the newborn.
Nasal flaring, grunting, intercostal or subcostal retractions.
What care is appropriate for a 4th-degree laceration postpartum?
Ice packs (first 24 hrs), sitz baths (after 24 hrs), stool softeners, peri care, high fiber diet, pain control, infection monitoring.
Explain how to teach fetal kick counts and what an abnormal result might mean.
Count 10 movements in 2 hours or 4 in 1 hour. Fewer = possible fetal hypoxia or demise → instruct to rest, drink cold fluids, recheck, and call provider if still low.
What stage and phase of labor is likely when a patient is 8 cm dilated, shaky, nauseous, and says "I can’t do this"?
This is the active phase of the first stage—typically 8–10 cm—marked by intense contractions and emotional distress.
What are the hallmark signs and nursing priorities for HELLP syndrome?
Hemolysis, elevated liver enzymes, low platelets; monitor for RUQ pain, epigastric tenderness, worsening labs—anticipate delivery and magnesium sulfate.
Differentiate between caput succedaneum and cephalohematoma.
Caput = crosses sutures, soft, present at birth.
Cephalohematoma = firm, doesn’t cross sutures, appears hours later, ↑ jaundice risk.
A postpartum client has fever >100.4°F, foul lochia, and severe lower pain. What is suspected?
Endometritis—infection of uterine lining. Requires antibiotics and monitoring for sepsis
Which reflex is demonstrated when stroking the newborn’s cheek?
Rooting reflex
What is the full chain of priority interventions for a prolapsed umbilical cord?
Call for help → Insert sterile gloved hand to lift presenting part → Position client in knee-chest or Trendelenburg → Administer oxygen → Discontinue oxytocin → Prepare for emergency cesarean.
Why is amniotic fluid embolism (anaphylactoid syndrome of pregnancy) life-threatening, and how is it managed?
It causes sudden cardiopulmonary collapse and DIC. Management includes emergency delivery, intubation, oxygen, CPR, blood products, and ICU support.
What are complications of neonatal polycythemia, and how is it managed?
Risks: thrombosis, hypoglycemia, hyperbilirubinemia, stroke. Management: monitor Hct, glucose, hydration, consider partial exchange transfusion.
How does postpartum psychosis differ from postpartum depression?
Psychosis = hallucinations, delusions, bizarre behavior, rapid onset (within 2 weeks), medical emergency requiring hospitalization.
Why is vitamin K given to newborns, and what risk is present if declined?
Prevents VKDB (Vitamin K Deficiency Bleeding). Newborns lack gut flora to synthesize clotting factors—risk for life-threatening bleeding, including intracranial.