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READING QUESTIONS #3 What are appropriate nursing interventions for following OB complications: LABOR & BIRTH: Prolapsed umbilical cord: Risk factors: Rupture of amniotic membrane, abnormal fetal presentation, transverse lie (presenting part is not engaged, which leaves room for the cord to descend), SGA, unusually long umbilical cord, multifetal pregnancy, unengaged presenting part, and hydramnios or polyhydramnios. Physical assessment findings: visualization or palpation of the umbilical cord protruding from the uterus. FHS monitoring shows variable or prolonged deceleration, excessive fetal activity. Nursing care : Call for assistance immediately, notify the provider, reposition the patient to side- lying/ knee-chest/ or trendelenburg, continuous electronic monitoring of FHR, administer oxygen, initiate IV access, prepare for immediate vaginal birth, inform and educate client. Meconium-stained amniotic fluid (MSAF): Risk factors: After 38 weeks gestation, umbilical cord compression results in fetal hypoxia that stimulates the vagus nerve Physical assessment findings: The color can vary from green to black and consistency can vary from thick to thin. Often present in breech presentation, and might not indicate fetal hypoxia, present with no changes in FHR, stained fluid. Nursing care: Document fluid color and consistency. notify neonatal resuscitation team to be present at birth, follow designated suction protocol Fetal Distress : refers to signs before and after childbirth indicating that the fetus is not well. Fetal distress is present when: a. FHR below 110/min or above 160/min b. The FHR shows decreased or no variability c. There is fetal hyperactivity or no fetal activity Risk factors : Fetal anomalies, uterine anomalies, and complications of labor and birth Expected findings : Nonreassuring FHR pattern with decreased or no variability. Maternal/Fetal Nursing care : Monitor vital signs and FHR, position the client in a left side-lying reclining position with legs elevated, Administer 8-10 L of oxygen, discontinue oxytocin, prepare the client for emergency c-section, and increase IV fluid intake. You are the OB nurse caring for Betsy, who has just been admitted to L&D. As you perform Leopold’s, you
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discover Betsy’s baby is presenting breech. Which of the following complications should you be observant for? a. Precipitous delivery b. Premature rupture of membranes c. Postmaturity syndrome d. Prolapsed umbilical cord A nurse is caring for Roxanne who is currently 42 wks gestation and in active labor. Which of the following findings is her baby at risk for? a. Intrauterine growth restriction (IUGR) b. Hyperglycemia c. Meconium Aspiration d. Polyhydramnios A nurse is caring for Victoria in active labor. Her last cervical exam two hours ago was 3 cm/100% effaced/-2 station. Victoria suddenly states, “My water just broke!” The monitor reveals a FHR of 80-85/min and the nurse performs a vaginal exam noticing clear fluid and a pulsing loop of umbilical cord in the client’s vagina. Which of the following actions should the nurse perform first?
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  • Summer '19
  • Tina Gain
  • Obstetrics, Postpartum hemorrhage, Uterus

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