NUR 325 Exam 1 Study Guide with Questions and Correct Answers
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Course
NUR 325
Institution
NUR 325
Name and describe the 5 'P's that influence labor Powers, Passage, Passenger, Psyche, & Position
O Contractions are involuntary smooth muscle contractions that efface and dilate the cervix O Pushing is the voluntary action to propel the fetus down through the pelvis Powers are contractions and pus...
NUR 325 Exam 1 Study Guide with
Questions and Correct Answers
Name and describe the 5 'P's that influence labor ✅Powers, Passage, Passenger,
Psyche, & Position
O Contractions are involuntary smooth muscle contractions that efface and dilate the
cervix
O Pushing is the voluntary action to propel the fetus down through the pelvis ✅Powers
are contractions and pushing
O Favorable for vaginal birth: gynecoid & anthropoid
O Cm/%/- or + (Station: relationship of fetus presenting part to the maternal ischial
spine) ✅Passage: The bony pelvis and the soft tissue which includes the cervix
muscles, ligaments, & fascia
O Sutures of the head can cross each other to get the baby out
O Lie: orientation of the fetus to the mother's spine
O Attitude: fetus's body parts to one another
O Presentation: fetal part coming out first
- Cephalic or vertex: head first
- Transverse lie: Acromion first
- Complete breech: Buttocks first, legs crossed
- Frank breech: Buttocks first, body doubled
- Footling breech: Foot/feet first ✅Passenger: Molding helps the fetus exit
1st letter: side of maternal body (R or L)
o 2nd letter: Presenting part
§ (O) Occiput
§ (S) Sacrum
§ (A) Acromium
§ (B) Brow
o 3rd letter: Position of the presenting part
§ (A) Anterior
§ (P) Posterior
§ (T) Transvers ✅Positions: Relationship of the presenting part of the pelvis
o Anxiety can increase pain perception and activate stress hormones
§ Ex: Catecholamines from the adrenal glands which can inhibit UCs and blood flow to
the placenta
o Observe for rapid breathing, tremors, frowning, grimacing, clenched teeth, crying,
thrashing, increased HR, & respirations ✅Psyche
,Describe the physiology of labor ✅- Estrogen stimulates uterine muscle UCs
- Connective tissue loosens softening, thinning, & opening of the cervix
- Muscles of upper uterine segment shorten
thinning, flattening, and forward movement of cervix
- Progesterone relaxation of smooth muscle
- Fetal head pressure cervical dilatio
Discuss the premonitory signs of labor ✅- "Dropping" often happens 2-3 weeks before
labor and it feels like everything drops down to your waist.
- Braxton-Hicks Contractions: happen with increasing intensity and frequency
- Sign of false labor
- Weight loss (1-3 lbs): can happen 2-3 days before labor
- Bloody Show (mucus with blood) or loss of mucous plugs
- SROM
- Burst of energy, also known as nestin
Differentiate between false and true labor. ✅FALSE
- Irregular contractions, contraction lessen with walking and relaxation, no change in
position of the fetus, pain in groin or abdomen.
TRUE
- Regular contractions that are closer together and stronger, pain starts in lower back
and radiates to the abdomen, contractions do not stop with walking or rest, the cervix
will thin and dilate, fetus moves lower
Compare and contrast the physiologic and psychologic changes occurring in each of the
stages of labor ✅First stage: Dilation
- Starts with true labor
- Ends with complete dilation (10 cm) and 100% effacement
- Primip: 6-18 hours (can be 2-24 hours)
- Multip: 2-10 hours (can be longer)
- 3 phases
- 1. Latent phase
- From onset-3 cm dilation
- Fetal station: -5 to 0
- UCs mild, infrequent but increasing to every 5-30 minutes, duration 30-45
- Discomfort like menstrual cramps
- Women tend to be sociable, excited & cooperative, some feel apprehension
- 2. Active phase
- 4-7 cm dilation
- ~75% effacement
- Fetal station often "0"
- UCs q3-4 mins & moderate-strong
- Women become less sociable, begin to turn inward, still cooperative, request
analgesia
- Transition phase
- 8 cm - complete dilation
, - Complete effacement
- Fetal station: 1+ - 2+
- UCs q 2 mins
- UC duration 60-90 seconds
- Intense pain
- Behavior change:
- Inwardly focused
- Easily agitated
- Needs help focus on breathing
- May cry out, scream, lose control
- Difficult to satisfy
- May be hostile to significant others and care givers
2nd stage of labor ✅Second stage: Pushing & Delivery
- Pushing
- Lasts 5 minutes to 2 hours
- Primip: 50 mins
- Multip: 20 mins
- Mom feels the urge to push with UCs
- Women regain control; tired, but excited
- Pushing with abdominal muscles aids in moving fetus through birth canal
- Tissues of vaginal wall thin and stretch to accomodate fetus
- Muscles of pelvic floor stretch
- Too rapid stretching can cause tears of vaginal wall +/or perineum
- Episiotomy is performed to prevent uncontrolled tearing of perineum
- Delivery
- As head emerges, mouth and nose are suctioned to prevent aspiration and clear
airway
- Check for a nuchal cord (umbilical cord wrapped around baby's neck)
- Deliver body by pulling down then up
- Cord is cut when pulsating stops
- Put newborn immediately to chest
- APGAR score at 1 and 5 minutes
3rd stage of labor ✅Third stage: Delivery of placenta
- May last 5-30 minutes
- If 30 mins has passed without delivery, intervention is needed (manual extraction or
D&C)
- No traction should be put on cord
- Detach or prolapse cord &/or invert uterus
- Administer pitocin after placenta delivers
- ATI describes 4th stage of labor as also being the delivery of the placenta. They group
delivery of placenta in 3rd and 4th.
- Signs of placental separation from the uterus
- Uterus rises anteriorly and abdomen takes on an oval (globular) shape
- Small gush of blood precedes expulsion
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