Confirmatory of Pregnancy

Presumptive
*Symptoms (Subjective)
felt by the mother
Melasma

Positive Signs for pregnancy

-Confirmatory
Fetal Heart rate: obtained by doppler
Fetal Movement: felt by the examiner
Fetal Outline: by UTZ.

Naegele’s Rule (1st day of LMP)

Jan-Mar:+9months, +7days
Apri-December: -3 months, +7 days,+1 year

EArly Deceleration is caused by hEAD compression

begins and and w the contraction (FHR)
considered normal

Late Deceleration is caused by UteropLacental Insufficiency

begins after the onset of a contraction

Variable Deceleration is caused by cored compression

FHR TEST TO MOVEMENT

NONSTRESS TEST

FHR TEST TO CONTRACTION

STRESS TEST

EXERCISES
walking-best source of exercise
Squatting- to stretch the perineal muscle, to prevent laceration risk
Tailor siting- to stretch the perineal muscle.
Kegel Exercise- contraction of perineal muscle, “para ka pong nag pipigil ng ihi”. Purpose is to
strengthen her perineal muscle, interval:contract for 15 secs, relax for 10 secs. (30-80 repetition per
day).
Pelvic Rocking- to relieve back pain.
Preliminary Signs of labor Signs of Placental Seperation
1. Lightening (engagement) 1. Calkin’s Sign- uterus is firm and globular. it
relief of diaphragmatic pressure. means it is contracting. (Earliest sign)
Primipara: happens 1-2 weeks before labor 2. Lenghtening of the Umbilical Cord (most
multipara: happens on the day of labor definitive)
3. Sudden gush of blood
2. Ripening of the Cervix 4. Placenta is seen in the vaginal opening
cervix is as soft as a butter
release of epinephrine, release of energy Presentation of the Placenta
increase braxtons hicks 1. Schultz- Shining; Fetal Side; center seperates first
2. Duncan-Dirty; Maternal Side; edges seperates first
Labor and Birth
stages of labor Placental Expulsion
1st Stage; Stage of dilatation -placenta delivery by:
from the onset of contraction to the full cervical dilations. 1. Natural Bearing down of the mother.
divided into 3 phases: 2. Crede Maneuver- gentle pressure on a contracted
Latent uterus. Never applied to a non-contracted uterus or
dilatataion:0-3 it will lead to uterine inversion
duration:20-30 secs Nursing action
interval:q10 mins The nurse must inspect the placenta is complete.
Active retained placental fragment will lead to post partum
Dilatation:4-7 cm hemorrhage.
Duration40-60secs
Interval:q 5 mins Post Partum
Transition post partal period; 6 week period post childbirth
Dilatation8-10 cm Characterized by: involution process- reeturn to the
Duration:60-90 secs pre-pregnancy state of the reproductive organs.
Interval:q3mins Uterine Involution: accomplished by contraction. (1
Important parameter to assess: Dilatation cm per day)
*Nursing Considerations for each phase: First 24 hrs: must be umbilicus level.
Latent: Instruct the women to walk bcos this will further fundus should be palpable 1 cm below the umbilicus.
dilates the cervix Afterpain: Normal; Sensation of intermittent
Active: show of rupture of membrane occurs. cramping because of uterine contraction.
Transition: prepare for delivery.
the end of 1st stage: full dilatation and complete Psychological Phases by Reva Rubin (Post Partum)
effacement (shortening of the cervix) of the cervix. 1. Taking In:
measured by percentage. Internalizing the experience of being pregnant (1-3
days)
2nd Stage of Labor: Stage of Expulsion Passive, Dependent, self-centered and sensitive.
from full dilatation and complete effacement to the birth of 2.Taking Hold: taking the responsibilities of being a
the infant. new mom.
important event: Crowning strives to learn about how to be a mom. (3-9 days)
3. Letting Go: letting go of the former roles,
3rd Stage of Labor: Placental Stage embracing new roles.
from the birth of the infant to the delivery of the placenta.
divided into 2 phases

Placental Seperation
Extension of Placenal Seperation: Shortest:1mins
Longest: 30 mins is considered normal.
 OB POST TEST
1. The hormone responsible for the development of the ovum during the menstrual cycle is
-FOLLICLE STIMULATING HORMONE
2. Which hormones are responsible for the thickening of the uterine lining?
-ESTROGEN, PROGESTERONE
3. The nurse documents the fact that patient Liz typically has a menstrual cycle of 34 days. If she had coitus on days 8, 10 and 20 of her
last cycle. Which is the day on which she most likely conceived?
-DAY 20
4. Liz asks, how much longer her nurse will refer to the baby inside her as an embryo. To ensure team members use terms consistently, the
nurse would want them to know the conceptus is classified as an embryo at what time?
-From implantation until 5 to 8 weeks
5. Jully tells the nurse she has developed painful hemorrhoids. She admits that she is embarrassed to discuss this problem but acknowledges
that it needs to be addressed. The best advice to give her would be which of the following?
-USE COLD COMPRESS TO RELIEVE PAIN
6. Jully has done some online research about the ankle edema that she typically experiences by the end of each day. Which statement by
her would reveal that she has read accurate information about the cause of this?
-“I'll rest with my feet elevated to take pressure off my leg veins."
7. What psychological task is important for the woman to complete during the first trimester of her pregnancy?
- ACCEPTING PREGNANCY
8. Laura did a urine pregnancy test but was surprised to learn a positive result is not a sure sign of pregnancy. She asks what a positive sign
would be. The nurse should cite what finding?
- FETAL HEART RATE
9. The nurse is reviewing danger signs of pregnancy with her patient. Which of following would the nurse tell her to report if it should
occur?
-She gains more than 3 Ib a week at fourth month of her pregnancy, IT SHOULD BE 1LB PER WEEK ONLY
10. The nurse assesses Celeste Bailey's uterine contractions and the FHR. Which of the following would the nurse document as a late
deceleration?
-The FHR decreased after the start of a contraction.
11. Elena asks the nurse which type of exercise is best to strengthen her perineal muscles in anticipation of birth. Which of the following
recommendations is safest and most effective?
-KEGEL EXERCISE
12. Celeste didn't recognize for over an hour that she was in labor. During her prenatal education, Celeste should have been taught to
recognize which sign of true labor?
-"Show" or release of the cervical mucus plug
13. Celeste is anxious for her placenta to deliver. What is the best nursing action for Celeste?
-d. Assure her that a placenta loosens quickly so the waiting time will not be long.
14. The nurse determines which of the following actions will support woman's transition into a postpartal taking-hold phase?
-Help her to give her new baby a bath.
15. All of the following observations would suggest that placental separation is occurring, except
-Maternal blood pressure stops
16. Which type of contractions signal true labor?
-Contractions that achieve cervical dilatation
17. A pregnant client is making her first Antepartum visit. She has a 2-year old son born at 40 weeks, a 5- year old daughter born at 38
week and she had a spontaneous abortion 3 years ago at 10 weeks. The nurse would note her OB history as
-G4P2
18. The nurse is aware than an adaptation of pregnancy is an increased blood supply to the pelvic region that results in a purplish
discoloration of the vaginal mucosa. which is known as:
-Chadwick's sign
19. When involved in prenatal teaching. the nurse should advise the clients that an increase in vaginal secretions during pregnancy is called
leukorrhea and is caused by increased:
-Production of estrogen
20. At a prenatal visit at 36 weeks' gestation. a client complains of discomfort with irregularly occurring contractions. The nurse instructs
the client to:
-Walk around until they subside
21. The nurse teaches a pregnant woman to avoid lying on her back. The nurse has based this statement on the knowledge that the supine
position can:
-Cause decreased placental perfusion
22. The pituitary hormone that stimulates the secretion of milk from the mammary glands is:
-Prolactin
23. Nurse Kira knows that “Show” and spontaneous Rupture of membrane commonly occurs during during what phase of the first stage
of labor?
-Active
24. Which of the following behaviors characterizes the Postpartum mother in the taking in phase?
-Passive and dependant
25. During the 4th postpartum day, which of the following observations about the client would the nurse be most likely to make as she is in
the taking-hold phase?
-The client appears interested in learning about neonatal care