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For a woman experiencing hypotonic contractions, what should be done initially?: Obtain an ultrasonic result

For a woman experiencing hypotonic contractions, what should be done initially?

A. Obtain an ultrasonic result
B. Infusion of oxytocin
C. Administration of analgesia
D. Amniotomy

Answer: A.

Initially, the nurse should obtain an ultrasonic confirmation ruling out a CPD or cephalopelvic disproportion. Thus, A is the best answer. Oxytocin is infused after the CPD is ruled out, because if CPD is present CS will be done. Analgesic administration will further decrease the intensity of uterine contractions as its inappropriate use is one of the reasons why hypotonic contractions occur. Amniotomy (artificial rupture of membrane) may be done after oxytocin is infused to speed up the labor.

Hypotonic Contractions: A Deeper Dive

Hypotonic contractions are a common labor complication where the uterine contractions are weak, infrequent, or ineffective in promoting cervical dilation and fetal descent. While the initial treatment often involves the administration of oxytocin, a more comprehensive understanding of this condition is essential for effective management.

Causes of Hypotonic Contractions:

Maternal Factors:

Overweight or obesity
Excessive fatigue or exhaustion
Excessive anxiety or fear
Use of certain medications (e.g., magnesium sulfate)

Fetal Factors:

Large fetal size
Fetal malposition
Fetal anomalies

Uterine Factors:

Uterine overdistension (e.g., multiple pregnancies)
Uterine scarring (e.g., from previous C-sections)

Other Factors:

Placental insufficiency
Amniotic fluid abnormalities

Additional Management Strategies:

While oxytocin is a primary treatment, other strategies may be considered, depending on the underlying cause and the progression of labor:

Supportive Measures:

Rest and relaxation
Hydration
Ambulation
Change of position

Amniotomy:

Artificially rupturing the amniotic sac can sometimes stimulate stronger contractions.

Analgesia:

Pain management can help reduce stress and anxiety, which may improve contractions.

Cesarean Section:

If labor fails to progress despite interventions, a cesarean section may be necessary to deliver the baby safely.

Monitoring and Evaluation:

Maternal and Fetal Monitoring:

Continuous fetal heart rate monitoring
Maternal vital signs
Contraction monitoring

Assessment of Progress:

Cervical dilation
Fetal descent
Amniotic fluid volume

Conclusion:

It's important to note that the management of hypotonic contractions should be individualized based on the specific circumstances of each patient. A healthcare provider will carefully assess the situation and recommend the most appropriate course of action.

The history of Mrs. Dela Cruz revealed that she is a multipara. When should the nurse transport the client from the labor room to the delivery room?

a- When the cervical dilatation is 8 cm.
b- When the cervical dilatation is 10 cm.
c- When the cervical dilatation is 9 cm.
d- When the client feels the urge to push.

Answer: A.

Multiparas are transported to the DR when the cervical dilatation is 7-8 cm because in multiparas dilatation may proceed before effacement is completed.

Effacement must occur at the end of dilatation, however, before the fetus can be safely pushed through the cervical canal; otherwise, cervical tearing could result.

Primiparas are transported to the DR when the cervical dilatation is 9-10 cm.

The decision to move a multipara client from the labor room to the delivery room depends on several factors, and there isn't a single definitive answer based solely on cervical dilatation.

Options details:

Here's a breakdown of the options you provided:

a. When the cervical dilatation is 8 cm:

This can be a valid criterion for some multiparas, especially those with a fast and efficient labor progression. However, it's not universally applicable, as some multiparas may dilate to 10 cm before experiencing the urge to push.

b. When the cervical dilatation is 10 cm:

This is often considered the standard for transferring primiparas (first-time mothers) to the delivery room. However, for multiparas, waiting until 10 cm might be unnecessarily long, especially if they're showing other signs of impending delivery.

c. When the cervical dilatation is 9 cm:

This falls in the middle of the previous options and could be a reasonable choice for some multiparas, but it's still not a definitive rule. Individual factors and labor progress play a significant role.

d. When the client feels the urge to push:

This is the most reliable indicator of readiness for delivery in multiparas. The urge to push arises due to the baby's descent and pressure on the cervix, regardless of the exact dilatation measurement.

Approach For Transferring:

Therefore, the best approach for transferring a multipara to the delivery room is a combination of factors:

- Cervical dilatation:

While not the sole indicator, reaching 8-9 cm can be a good starting point, but not a strict cut-off.

- Presence of the urge to push:

This is the most important sign of readiness, and waiting for it can be more efficient than focusing solely on dilatation.

- Other signs of impending delivery:

These may include increased frequency and intensity of contractions, bloody show, and fetal descent.

Ultimately, the decision of when to transfer a multipara should be made by the healthcare provider in consultation with the client, considering the specific circumstances and labor progress.

Remember:

individual cases may vary, and this information should not be used as a substitute for professional medical advice.

Mrs. Dela Cruz’s has contractions growing stronger which lasts for 40-60 seconds and occur approximately every 3-5 minutes.

The doctor is about to perform an IE, the nurse expects that the client’s cervical dilatation will be:

a- 0-3 cm
b- 4-7 cm
c- 8-10 cm
d- 11-13 cm

Answer: B.

The nurse would expect that the client’s cervical dilatation is 4-7 cm as the contraction duration and interval is noted for clients who are in the active phase of the first stage of labor.

The maximum cervical dilatation is 10 cm, thus, letter D should be eliminated first. The first stage of labor (stage of dilatation) is divided into three phases.

Latent phase – 0-3 cm cervical dilatation; contractions are short and mild lasting 20-40 seconds and occurring approximately every 5-10 minutes.
Active phase – 4-7 cm cervical dilatation; contractions grow stronger, lasting 40-60 seconds and occur at approximately every 3-5 minutes.
Transition phase – 8-10 cm cervical dilatation; contractions reach their peak of intensity, occurring every 2-3 minutes with a duration of 60-90 seconds.

Based on the information provided, the most likely cervical dilatation for Mrs. Dela Cruz would be: b. 4-7 cm

Here's the reasoning:

- Contraction strength and duration:

Contractions lasting 40-60 seconds and occurring every 3-5 minutes are indicative of the active phase of labor. During this phase, the cervix dilates from 4 to 7 cm.

- Friedman's score:

A scoring system called Friedman's score can be used to estimate cervical dilatation based on contraction frequency and duration. In this case, the score would be around 80-90, which also points to a dilatation of 4-7 cm.

Therefore, while options a and c are possible in the active phase, they are less likely based on the specific details provided. Options d and e are unlikely as they represent more advanced stages of labor that typically have stronger and more frequent contractions.

It's important to remember that cervical dilatation can vary depending on individual factors and progress throughout labor. This information should be used for educational purposes only and not as a substitute for professional medical advice.

Jessa, 17 years old, is bleeding between periods of less than two weeks.

This condition is an abnormality in the menstrual cycle known as:

a. Metrorrhagia.
b. Menorrhagia.
c. Amenorrhea.
d. Dysmenorrheal.

Answer: A

Abnormalities of Menstruation:

Amenorrhea – absence of menstrual flow.
Dysmenorrhea – painful menstruation.
Oligomenorrhea – scanty menstruation.
Menorrhagia -excessive menstrual bleeding.
Metrorrhagia – bleeding between periods of less than 2 weeks.

Mrs. Donna asked the nurse, when a fetal heart starts beating.

The nurse correctly responded by stating:

a. 3 weeks AOG
b. 8 weeks AOG
c. 12 weeks AOG
d. 20 weeks AOG

Situation: Mrs. Dela Cruz is in labor and is brought to the emergency room with a ruptured bag of water.

Answer: A.

Fetal heart starts beating at 3 weeks AOG. The heart at this time is consisting of two parallel tubes. By 8 weeks AOG, fetal heartbeat can be detected with an ultrasound. During 12 weeks AOG, the fetal heart rate is audible with a Doppler apparatus. A fetal heart beat is detectable with fetoscope by the 20th week AOG. (Source: Foundations of Maternal-Newborn Nursing by Murray and McKinney/Saunders 4th Ed.)

The most important nursing consideration in a postpartal woman with a hypotonic contraction is:

a. Assessment for infection
b. Assessment for bleeding
c. Assessment for FHR
d. Assessment for woman’s coping mechanism

Situation:

Bleeding during pregnancy is a serious case and should be managed immediately.

Answer: B.

During the postpartum period, the uterus should be palpated and lochia should be assessed because contractions after birth may also be hypotonic that will result to bleeding.

An important landmark of the pelvis that determines the distance of the descent of the head is known as.. Ischial spines

An important landmark of the pelvis that determines the distance of the descent of the head is known as:

a- Linea terminalis
b- Sacrum
c- Ischial spines
d- Ischial tuberosities

Answer: C.
Ischial spines are the point of reference in determining the station (relationship of the fetal presenting part to the ischial spines).

When the fetal head is at the level of the ischial spines the station is zero. When it is 1 cm above the ischial spines it is -1 and if 1 cm below the ischial spines it is +1.
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The ischial or promontory tuberosity of the ischium is a bony bulge of the ischium, the lower part of the coxal bone.

The tuberosity of the ischium is located in the upper and posterior portion of the ischium branch and, together with the tip of the coccyx, forms the lower opening of the pelvis.

When an individual sits, body weight often falls on the ischial tuberosity.
This ischial promontory is palpable in the middle gluteal region, at the same height as the greater trochanter of the femur.

Divisions:
The ischial tuberosity is divided into two portions, a lower, rustic and somewhat triangular portion and an upper, smooth and quadrilateral portion.

+ The lower portion is subdivided by a longitudinal crest that crosses the lower half from the base to the apex of the rough triangle that forms this lower portion.

This crest divides this region into two:
- the outer half, the furthest from the midline of the body, provides the insertion point of the muscle Adductor major of the thigh;
- the inner half gives insertion to the greater or sacrotuberous sacrocytic ligament.

+ The upper portion is subdivided into two areas by an oblique crest that runs from top to bottom:
- the semimembranous muscle part of the upper and outer half;
- In the lower and inner half the long head of the crice and semitendinosus biceps is inserted.

Pathologies:
Ischial tuberosity is one of the pressure points in the prostrate patient that causes the appearance of pressure ulcers.

Violent trauma to the gluteal region can cause fracture of the ischial tuberosity.

The nurse assisted Mrs. Donna to a dorsal recumbent position and is about to assess the fetal heart rate (FHR).. Doppler apparatus

The nurse assisted Mrs. Donna to a dorsal recumbent position and is about to assess the fetal heart rate (FHR). Which of the following apparatus should the nurse use in auscultating for the FHR?
a- Doppler apparatus
b- Fetoscope
c- Ultrasound
d- Stethoscope

Answer: A.
Mrs. Donna’s gestational age is 16 weeks (4 months). During this time, the fetal heart rate is audible with a Doppler apparatus. A fetal heart beat can be detected with a Doppler apparatus starting at 12 weeks AOG. By 8 weeks AOG, fetal heartbeat can be detected with an ultrasound. A fetal heart beat is detectable with fetoscope by the 20th week AOG. (Source: Foundations of Maternal-Newborn Nursing by Murray and McKinney/Saunders 4th Ed).
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Invented by Edward H. Hon1 in 1958, a Doppler fetal monitor or Doppler heart rate monitor is a handheld / portable ultrasound transducer used to detect a fetus's heartbeat during prenatal care. Use the Doppler effect to provide an audible heartbeat simulation. Some models also show heart rate in beats per minute. The use of this monitor is sometimes known as Doppler auscultation.
A fetal Doppler monitor provides information about the fetus similar to the information provided by a fetal stethoscope. An advantage of the fetal Doppler monitor over a fetal (non-electronic) acoustic stethoscope is the production of sounds; which allows people, apart from the user, to listen to the beats. A disadvantage is its complexity and cost, and its low reliability for an electronic device.
Originally created for use by health professionals, their personal use is now becoming popular.

Fetal Heart Rate:
DopplerSonographyBloodFlowDiagram-de.svg
Beginning in the fifth (5) week the fetus's heart will accelerate at a rate of 3.3 beats per day for the next month.
The heart of the fetus begins to beat at approximately the same rate as that of the mother, which is 80 to 85 bpm. The fetal heart rate for weeks 5 through 9 is illustrated below, assuming an initial heart rate of 80:
- Week 5 starts at 80 and ends at 103 bpm
- Week 6 starts at 103 and ends at 126 bpm
- Week 7 starts at 126 and ends at 149 bpm
- Week 8 starts at 149 and ends at 172 bpm
- At week 9 fetal beats tend to beat within the range of 148 to 160 bpm.
The fetal heart rate will begin to decrease and will generally drop to position within the range of 110 to 160 bpm for week 12.2

Gender Prediction:
The evidence indicates that there is no relationship between the fetal heart rate and the gender of the fetus, therefore the heart rate cannot be used as a reliable predictor of the fetus gender.

Types of Dopplers:
Dopplers for home or hospital use differ in the following:

- Manufacturers:
Among the most popular manufacturers we have Nicolet, Huntleigh and Summit Doppler.

- Probe type:
waterproof or not. Waterproof probes are used in water births.

- Frequency:
2 or 3 MHz probes. It is advisable to use a 3 MHz probe to detect the heart rate at the beginning of pregnancy (8-10 weeks gestation). A 2 MHz probe is recommended for pregnant and overweight women.

- Heart rate display:
some Dopplers automatically show heart rate; others require that the heart rate be counted and timed by the doctor.
The use of “Sonicaid” as a common term to refer to a fetal Doppler monitor originated from the products of Sonicaid Ltd, a company located in West Sussex in the United Kingdom. Sonicaid products include the D205 / 206 portable fetal dopplers and the FM2 / 3/4 series of fetal monitors. The company was acquired by Oxford Intruments in 1987 to form Oxford Sonicaid. In 2006 the products and the Sonicaid brand was acquired by the British group Huntleigh Healthcare.

Uses of the adult Doppler fetal monitor:
Using a continuous 2 MHz Doppler, similar to that used in obstetrics for auscultation of fetal beats, it is possible to auscultate valvular movements and blood flows in the adult heart. This technique, recently developed by Mc Loughlin MJ and Mc Loughlin S, allows to explore undetectable phenomena to classical auscultation with a stethoscope and has demonstrated a superior sensitivity in the diagnosis of aortic valvulopathies and alterations in the diastolic relaxation of the left ventricle.
Because the physical basis of Doppler auscultation differs from those of the classic stethoscope, it has been suggested that both methods can be supplemented by improving the diagnostic yield of the cardiovascular physical exam.

A woman in labor is diagnosed with abruption placenta.. Cigarette smoking

A woman in labor is diagnosed with abruption placenta. The nurse would expect which findings in the client’s history that may contribute to the occurrence of the complication?
a. Age of 24 years old
b. Cigarette smoking
c. Sleeping 8 hours per night
d. Sitting for long period

Answer: B.
Predisposing factors for abruptio placenta:
• Advanced maternal age
• Short-umbilical cord
• Chronic hypertensive disease
• PIH
• Direct trauma
• Vasoconstriction from cocaine or cigarette use.

Continued bleeding may result to fetal distress.. Fetal bradycardia. tachycardia

Continued bleeding may result to fetal distress. The nurse knows that the fetus is being compromised when she observed or note which of the following:
a. Fetal tachycardia
b. Fetal bradycardia
c. Fetal thrashing
d. All of the above

Answer: D.
Signs of fetal distress include: tachycardia, bradycardia, fetal thrashing and meconium-stained amniotic fluid.

For the nurse to distinguish that the bleeding of the patient is placenta previa or abruption placenta.. Whether there was accompanying pain

For the nurse to distinguish that the bleeding of the patient is placenta previa or abruption placenta. what should she ask the woman?
a. Whether there was accompanying pain
b. What she has done for bleeding
c. Estimation of blood loss
d. All of the above

Answer: A.
placenta previa presents bleeding without pain whilst the bleeding in abruptio placenta is painful.

In caring for a client diagnosed with placenta previa.. Performing a pelvic examination

In caring for a client diagnosed with placenta previa, the nurse should avoid which of the following?
a. Inspecting the perineum
b. Performing a Kleihauer-Betke test
c. Performing a pelvic examination
d. All of the above

Answer: C.
Never attempt a pelvic or rectal examination with painless bleeding late in pregnancy because any agitation of the cervix when there is placenta previa may initiate massive hemorrhage, possibly fatal to both the mother and the fetus.
The perineum should be assessed or observed or inspected for bleeding by looking over the perenial pads. An Apt or Kleihauer-Betke test (test strip procedures) can be used to detect whether the blood is of fetal or maternal origin.

Mrs. Diane is diagnosed with Placenta Previa. The main difference with the bleeding in placenta previa and abruption placenta is that placenta previa has.. Bright-red blood

Mrs. Diane is diagnosed with Placenta Previa. The main difference with the bleeding in placenta previa and abruption placenta is that placenta previa has:
a. Painful bleeding
b. Rigid abdomen
c. Bright-red blood
d. Blood filled with clots

Answer: C.
In placenta previa the bleeding that occurs is abrupt, painless, bright-red and sudden to frighten a woman. With abruption placenta, the bleeding is painful, the abdomen is rigid or board-like and the blood is dark-red or filled with clots.

The client’s uterine contractions are hypotonic. The nurses top priority with hypotonic contractions during the intrapartal period is.. Infection control

The client’s uterine contractions are hypotonic. The nurses top priority with hypotonic contractions during the intrapartal period is:
a. Pain relief
b. Psychological support
c. Monitoring the lochia for possible bleeding
d. Infection control

Answer: D.
When the contractions are hypotonic, the length of labor is increased. When the cervix is dilated for a long period of time, both the uterus and fetus are at greater risk of infection. Hypotonic contractions are not exceedingly painful because of their lack of intensity. Monitoring of bleeding through evaluation of lochia is done during the postpartum period not the intrapartum period.

Dysfunctional labor may be caused by which of the following.. Overdistention of the uterus

Dysfunctional labor may be caused by which of the following?
a. Excessive or too early analgesia administration
b. Exhausted mother
c. Overdistention of the uterus
d. All of the above

Answer: D.
Dysfunctional Labor is caused by the ff:
• Inappropriate use of analgesia
• Pelvic bone contraction that has narrowed the pelvic diameter so that a client can’t pass (e.g. in a client with rickets)
• Poor fetal position
• Extension rather then extension of the fetal head
• Overdistention of the uterus
• Cervical rigidity
• Presence of a full rectum or bladder
• Mother becoming exhausted from labor
• Primigravid status.

Uterine contractions can occur because of the interplay of the contractile enzyme adenosine triphosphate and the influence some hormones.. Prolactin

Uterine contractions can occur because of the interplay of the contractile enzyme adenosine triphosphate and the influence some hormones. Which of the following least likely contributes to the occurrence of uterine contractions?
a. Oxytocin
b. Estrogen
c. Prolactin
d. All of the above

Answer: C.
Prolactin is the hormone that produces milk in mammary glands. Uterine contractions can occur because of the interplay of the contractile enzyme adenosine triphosphate and the influence some hormones and major electrolytes which are the following:
• Calcium
• Sodium
• Potassium
• Specific contractile proteins (actin and myosin)
• Epinephrine and norepinephrine
• Oxytocin
• Estrogen and progesterone
• Prostaglandins.

Monitoring contractions is very important during labor. To monitor uterine contractions.. Spread the fingers lightly over the fundus to monitor the contraction

Monitoring contractions is very important during labor. To monitor uterine contractions, what should the nurse do?
a. Observe for the client’s facial expression to know that the contraction has started or stopped.
b. Instruct the client take note of the duration of her contractions.
c. Offer ice chips to the woman.
d. Spread the fingers lightly over the fundus to monitor the contraction.

Answer: D.
The nurse should spread his/her fingers lightly over the fundus to monitor the uterine contractions.

The doctor informed the woman that she is on station -1.. Your baby is still floating or ballotable

The doctor informed the woman that she is on station -1. Mrs. Dela Cruz asked the nurse, what does a station -1 means, the most appropriate response of the nurse is:
a. “It means that engagement has already occurred.”
b. “The presenting part of your baby is at the entrance of the true pelvis or the largest diameter of the presenting part into the true pelvis.”
c. “Your baby is still floating or “ballotable”
d. “The presenting part of your baby is at the vulvar ring of your reproductive organ.”

Answer: C.
Station -1 means that the fetal presenting part is above the level of the ischial spines. Letter A is wrong because engagement is described as Station 0. Letter B is incorrect because the statement of nurse is describing the occurrence of engagement that is again station 0. Prior to engagement the fetus is said to be "floating" or ballottable, thus letter C is the best option. Letter D, is describing crowning which is described as Station +3 or +4.

The nurse’s initial action once the bag of water has ruptured is.. Put the client to the bed immediately

The nurse’s initial action once the bag of water has ruptured is:
a. Take the fetal heart tones
b. Put the client to the bed immediately
c. Perform an IE
d. Take the woman’s temperature

Answer: B.
The keyword is INITIAL ACTION. The important consideration before answering the question is to take a look at the situation. SITUATION: THE WOMAN IS IN THE Emergency Room or is seeking admission.
A woman in labor seeking admission to the hospital (in the ER) and saying that her BOW has ruptured should BE PUT TO BED IMMEDIATELY and the fetal heart tones taken consequently. If a woman in the Labor Room says that her membranes have ruptured, the initial nursing action is to take the fetal heart tone.

Psychological and emotional responses of pregnant women differ. However, general emotional response has been noted during pregnancy based on their gestational age

Psychological and emotional responses of pregnant women differ. However, general emotional response has been noted during pregnancy based on their gestational age. Mrs. Donna will most likely have which emotional response towards her pregnancy?
a. Presents denial disbelief and sometimes repression.
b. Has personal identification of the baby and realistic plans for future of the child.
c. Fantasizes the appearance of the baby.
d. Verbalizes fear of death during childbirth.

Answer: C.
The client is in her second trimester of pregnancy (16 weeks AOG or 4 months), thus, she perceived the baby as a separate entity. Presenting denial and disbelief and sometime repression is the psychological/emotional response of a pregnant woman on her first trimester. Identifying the fetus and setting realistic plans for the child’s future is noted during the third trimester of pregnancy. It is during this time also that the woman verbalizes fear of death.