For which reason would the nurse encourage a client to void during the first stage of labor quizlet?

The second stage of labor is the stage in which the infant is born.

This stage begins with full cervical dilation (10 cm) and complete effacement (100%) and ends with the baby's birth.

The force exerted by uterine contractions, gravity, and maternal bearing-down efforts facilitates achievement of the expected outcome of a spontaneous, uncomplicated vaginal birth.

The median duration of this stage of labor is 50 to 60 minutes in nulliparous clients and 20 to 30 minutes in multiparous clients.

During the second stage of labor, the infant is born; this stage begins with full cervical dilation (10 cm) and complete effacement (100%) and ends with the baby's birth. The force exerted by uterine contractions, gravity, and maternal bearing-down efforts facilitates achievement of the expected outcome of a spontaneous, uncomplicated vaginal birth. The median duration of second-stage labor is 50 to 60 minutes in nulliparous clients and 20 to 30 minutes in multiparous clients. In the first stage of labor, the birthing table is usually not set up for the nulliparous client, and the progress of labor is enhanced when a client changes her position frequently.

Modified-paced breathing

During the first phase of labor, as contractions increase in frequency and intensity, the patient must change breathing patterns to a modified-paced breathing technique. This breathing pattern is shallower and faster than the patient's normal rate of breathing, but should not exceed twice the resting respiratory rate. Slow-paced breathing is performed at approximately half the normal breathing rate and is initiated when the patient can no longer walk or talk through contractions. Patterned-paced breathing is suggested in the second phase of labor. It consists of panting breaths combined with soft blowing breaths at regular intervals. The patterns may vary, the 3:1 pattern is pant, pant, pant, blow and the 4:1 pattern is pant, pant, pant, pant, and blow.

◯ Provide teaching to the client and her partner about what to expect during labor and on implementing relaxation measures: breathing (deep cleansing breaths help divert focus away from contractions), effleurage (gentle circular stroking of the abdomen in rhythm with breathing during contractions), diversional activities (distraction, concentration on a focal point, or imagery).

◯ Encourage upright positions, application of warm/cold packs, ambulation, or hydrotherapy if not contraindicated to promote comfort.

◯ Encourage voiding every 2 hr.

■ During first stage, active phase of labor
☐ Provide client/fetal monitoring.
☐ Encourage frequent position changes.
☐ Encourage voiding at least every 2 hr.
☐ Encourage deep cleansing breaths before and after modified paced breathing.
☐ Encourage relaxation.
☐ Provide nonpharmacological comfort measures.
☐ Provide pharmacological pain relief as prescribed.

■ During first stage, transition phase of labor
☐ Continue to encourage voiding every 2 hr.
☐ Continue to monitor and support the client and fetus.
☐ Encourage a rapid pant-pant-blow breathing pattern if the client has not learned a particular breathing pattern.
☐ Discourage pushing efforts until the cervix is fully dilated.
☐ Listen for client statements expressing the need to have a bowel movement. This sensation
is a sign of complete dilation and fetal descent.
☐ Prepare the client for the birth.
☐ Observe for perineal bulging or crowning (appearance of the fetal head at the perineum).
☐ Encourage the client to begin bearing down with contractions once the cervix is fully dilated.

Multiparous, overweight, and has undergone a hysterectomy
Patients who have had multiple childbirths (multiparous) have a higher risk of urinary incontinence because of increased laxity of the pelvic floor muscles. An obese patient who has undergone a hysterectomy has a higher risk of developing urinary incontinence, because the hysterectomy can damage the nerve supply to the bladder. This, in turn, causes urinary incontinence. A patient who is nulliparous, is underweight, and has undergone colectomy is not at risk of urinary incontinence. Colectomy is the surgical removal of the colon and does not cause urinary incontinence. A patient who is nulliparous, is underweight, and has undergone splenectomy has a lower risk of developing urinary incontinence. Splenectomy is the surgical removal of the spleen and does not increase the risk of developing urinary incontinence. A patient who is primiparous, is underweight, and has undergone cholecystectomy has a lower risk of developing urinary incontinence. Cholecystectomy is the surgical removal of the gallbladder and does not cause urinary incontinence.

Retroperitoneal hematoma
Retroperitoneal hematoma is the accumulation of blood in the retroperitoneal space. It is caused by the rupture of the cesarean scar during labor. Retroperitoneal hematoma is characterized by such symptoms as persistent perineal pain, a feeling of pressure in the vagina, and shock. Therefore it is evident that the patient has this condition. Persistent perineal pain, a feeling of pressure in the vagina, and shock are not associated with rectocele, endometritis, or impaired lactation. Rectocele is the herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. Endometritis is characterized by fever, increased pulse rate, chills, anorexia, nausea, fatigue, pelvic pain, uterine tenderness, and foul-smelling lochia. Because the patient did not report these symptoms, the patient does not have endometritis. Perineal pain, a feeling of pressure in the vagina, and shock do not affect lactation, so the patient does not have impaired lactation.

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