NM704 Exam 4 - Accurate Answers To All Questions VS Frequency in the Second Stage Right Ans - You'll take BP between contractions. It'll be about 10 mm/Hg higher in this stage than in the first stage.Bladder Emptying During the Second Stage Right Ans - People should be voiding frequently. You may need to remind them, as the urge may be diminished. You may need to cath a person if they have an epidural.Fetal Monitoring in the Second Stage Right Ans - For EFM it's Q15 barring complications (then it'd be Q5).For IA, it depends on whose guidelines you follow. ACOG says Q15, ACNM says Q5.
Second Stage Definition Right Ans - Two Definitions:
- when the cervix is completely dilated (10cm)
- When there is a spontaneous urge to push
Prolonged Second Stage Definition Right Ans - More than 2 hours of pushing in multiparous people and more than 3 hours of pushing in nulliparous people Spontaneous Pushing Right Ans - Usually results in 5 to 6 bearing-down efforts per contraction for 3 - 10 seconds each. Pushing will often occur during an exhalation, with an open mouth and glottis. This will usually be accompanied by grunting or low groaning. The birthing person controls when and for how long to push Coached Pushing Right Ans - Bearing-down efforts begin when the clinician assesses full dilation and pushing is directed with instructions from a nurse or clinician for when to push and for how long. This usually results in 3 pushes per contraction with a duration of 8 to 10 seconds each. Pushing occurs while the person is holding their breath; silence is encouraged and often results in a valsalva maneuver 1 / 2
Closed-Glottis Pushing Associations Right Ans - - Decreased fetal oxygenation
- Increased perineal trauma
- Impaired PP pelvic function
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Supine and Lithotomy Pushing Position Right Ans - Associated with uterine pressure on the vena cava, parental hypotension, decreased uterine perfusion, and variant fetal heart rate patterns Rounded Back Pushing Position Right Ans - The uterus and fetal presenting part are better aligned with the pelvis Leaning Forward & Upright Pushing Position Right Ans - Increases the angle between the uterus and the spine, thereby directing the fetal presenting part toward the larger posterior segment of the pelvis Changing Pushing Position Frequently Right Ans - Promotes changes in pelvic diameters, which can aid in the fetus finding the "best fit" while moving through the pelvis.Episiotomy Indications Right Ans - To shorten the second stage because of prolonged fetal heart rate decels or another fetal heart rate pattern suggestive of acidemia Third Stage of Labor Definition Right Ans - The time between the baby being born and placental separation and birth. Usually lasts less than 10 minutes but can last up to 30.Risks of Prolonged Third Stage Right Ans - PPH if the third stage lasts longer than 20 minutes. 30 minutes without placental expulsion is considered a prolonged third stage Placental Separation Right Ans - Contractions constrict blood vessels that supply the placenta, resulting in hemostasis. There's an abrupt decrease in the size of the uterine cavity following birth of the baby. With each contraction, the placental implantation surface area decreases without a change in placental size, causing the placenta to buckle and separate from the decidua.