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NUR4467 M3 Exam Latest Update
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NUR4467 M3 Exam LatestUpdate
What are the 5 factors that affect the labor process? - Answer - Passenger (fetus and
placenta)
- Passageway (birth canal)
- Powers (contractions)
- Position of the mother
- Psychological response
Explain the passenger factor
- What are the 5 factors that influence the passenger factor?
- What does each mean? - Answer - fetus and placenta
- determined by the size of the fetal head, fetal presentation, fetal lie, fetal attitude, and
fetal position (placenta also included also rarely causes issue except during placenta
previa)
- fetal head = Sutures and fontanels make the skull flexible to accommodate the infant
brain --> bones are not firmly united, slight overlapping, or molding of the shape of the
head, occurs during labor
- fetal presentation = part of the fetus that enters the pelvic inlet first and leads through
the birth canal during labor at term; either cephalic, breech, or shoulder
- fetal lie = Lie is the relation of the long axis (spine) of the fetus to the long axis (spine) of
the mother; either longitudinal (cephalic or breech) or transverse/horizontal/oblique
- fetal attitude = relation of the fetal body parts to one another
General flexion: characteristic posture (attitude) of fetus
- fetal position = the relationship of a reference point on the presenting part to the four
quadrants of the mother's pelvis
Explain the passageway factor - Answer - birth canal
- composed of the mother's rigid bony pelvis and the soft tissues of the cervix, the pelvic
floor, the vagina, and the introitus (the external opening to the vagina)
,- uterus composed of thick and muscular upper segment and a thin-walled, passive,
muscular lower segment w/ physiologic retraction ring separating them (lower wall
distends, upper wall thickens to accomodate)
- cervix effaces (thins) and dilates (opens) sufficiently to allow the first fetal portion to
descend into the vagina. As the fetus descends, the cervix is actually drawn upward and
over this first portion
- pelvic floor is a muscular layer that separates the pelvic cavity above from the perineal
space below. This structure helps the fetus rotate anteriorly as it passes through the
birth canal
What are the 4 basic pelvises? - Answer - Gynecoid (classic female; 50%) = round shape
- Android (resembling male; 23%) = heart shape
- Anthropoid (oval shaped, with a wider anteroposterior diameter; 24%) = oval shape
- platypelloid (flat pelvis; 3%) = flat shape
Explain the powers factor - Answer - contractions
- Primary powers = INVOLUNTARY uterine contractions - signal beginning of labor;
responsible for the effacement (shortening + thinning of cervix) and dilation of the cervix
and descent of the fetus
- Secondary powers = once the cervix has dilated, VOLUNTARY bearing-down efforts by
the woman augment the force of the involuntary contractions; no effect on cervical
dilation but important in expulsion of infant!
- Mother contracts diaphragm + abdominal muscles and pushes → increased
intraabdominal pressure that compresses the uterus on all sides and adds to the power
of the expulsive forces
Explain the position of the mother factor - Answer - Frequent changes in position relieve
fatigue, increase comfort, and improve circulation
Define labor - Answer refers to the process of moving the fetus, placenta, and
membranes out of the uterus and through the birth canal
What are signs preceding labor? (10) - Answer 1) Lightening or dropping
- In first-time pregnancies, the uterus sinks downward and forward about 2 weeks
before term, when the presenting part of the fetus (usually the fetal head) descends into
the true pelvis
2) return of urinary frequency (lightening relieves breathing, but causes more bladder
pressure)
3) Persistent low backache, sacroiliac distress
, 4) Stronger Braxton Hicks contractions (but irregular)
5) Weight loss of 0.5 to 1.5 kg (1 to 3 ½ pounds)
6) Surge of energy (aka nesting)
7) Cervical ripening
8) Inc vaginal discharge; bloody show (brownish or blood-tinged cervical mucus)
9) Membranes may rupture spontaneous
10) Less common = diarrhea, N/V indigestion
First Stage of Labor - Answer - last from the onset of regular uterine contractions to full
dilation of the cervix
- Latent (early) and active stages
--- Latent = effacement of cervix + little inc in descent (up to 3 cm dilation)
--- Active = rapid cervix dilation + inc rate of descent (begins at 6 cm, and ends with
complete cervical dilation at 10 cm)
How often do contractions occur in the latent stage of the first stage of labor? - Answer
every 15 to 30 minutes, are 15 to 30 seconds in duration, and are of mild intensity.
How often do contractions occur in the active stage of the first stage of labor? - Answer
every 3 to 5 minutes, are 30 to 60 seconds in duration, and are of moderate intensity ...
will gradually inc to every 2 to 3 minutes, are 45 to 90 seconds in duration, and are of
strong intensity.
How often do contractions occur in the second stage of labor? - Answer every 2 to 3
minutes, lasting 60 to 75 seconds, and are of strong intensity
Second Stage of Labor - Answer - lasts from the time the cervix is fully dilated to the
birth of the fetus
- Latent (passive fetal descent) phase and active pushing stage
--- Latent = urge to bear down not strong (fetus continues to descend passively + rotate
to an anterior position)
--- Active = strong urges to bear down (presenting part of fetus descends and presses
on stretch receptors of pelvic floor)
Third Stage of Labor - Answer - lasts from the birth of the fetus until the placenta is
delivered
- The placenta normally separates with the third or fourth strong uterine contraction
after the infant has been born. After it has separated, the placenta can be delivered with
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