Chapter 17.docx

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Chapter 17 1. The nurse is caring for laboring patients. Which women are experiencing problems related to a critical factor of labor? Select all that apply. 1. Primip at 7 cm, fetus in military attitude 3. Primip at 4 cm, fetus with macrocephaly due to hydrocephalus 4. Multip at 6 cm, fetus at −2 station, mild contractions 5. Primip at 5 cm, fetal presenting part is right shoulder Correct Answer: 1,3,4,5 Rationale 1: Attitude refers to the relationship of the fetal parts to one another. Military attitude is an unflexed neck; normal fetal attitude is flexion of the neck. Military attitude creates a larger diameter of the head fitting through the pelvis. This patient is experiencing a problem between the maternal pelvis and the presenting part. Rationale 2: Lie refers to the relationship between the cephalocaudal axis of the mother to the cephalocaudal axis of the fetal body; longitudinal lie is normal. Rationale 3: Hydrocephalus can lead to macrocephaly, or an abnormally large head. Macrocephalic babies might not fit through the bony pelvis and could require birth by cesarean. This patient is experiencing a problem between the maternal pelvis and the presenting part. Rationale 4: Station refers to how low in the pelvis the baby’s presenting part is; −2 station is high in the pelvis. Contractions should be strong to cause fetal descent and cervical dilation. Mild contractions will not move the baby down or open the cervix. This patient is experiencing a problem between the maternal pelvis and the presenting part. Rationale 5: The presenting part is the fetal part coming through the cervix. The occiput or back of the baby’s head is the most common and most effective presenting part. A shoulder presentation cannot deliver vaginally and will require a cesarean birth. This patient is experiencing a problem between the maternal pelvis and the presenting part. 2. The charge nurse has received a shift change report. Which patient requires immediate intervention? 4. Primip at 3 cm screaming in fear because her mother died during childbirth Rationale 4: This patient is most likely fearful that she will die during labor if her mother died during childbirth. It is very rare to die during childbirth in developing countries. The extreme fear this patient is experiencing could stimulate the fight-or-flight mechanism and hormone cascade, which can significantly
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