(Option 2) The client had 2 preterm births, indicated by the P2 portion of the GTPAL notation. The client's term birth is indicated by the T1 portion of the GTPAL notation (Option 1). This client (G5T1P2A1L2) has been pregnant 5 times (G5) had 1 term birth (T1), 2 preterm births (P2), and 1 abortion (A1) and has 2 currently living children (L2). Other labor admission interventions include application of external fetal monitoring and performance of a nitrazine pH test to determine if membranes have ruptured.ġ. Educational objective: Vaginal examinations of the laboring client with ruptured membranes should be performed using a sterile glove to decrease the risk of infection (eg, chorioamnionitis) to the client and fetus. However, there is no evidence to support NPO status of low-risk laboring clients, and most clients benefit from hydration provided by oral clear liquids during labor. (Option 4) Hospital policy, provider preference, and the client risk profile will dictate appropriate oral intake during labor. These maneuvers assist the nurse in locating the fetal back for optimal placement of the ultrasound transducer for external fetal heart monitoring. (Option 3) Leopold maneuvers help determine fetal presentation and involve systematic palpation of the client's abdomen. A yellow, olive-yellow, or olive green color indicates a negative result and suggests that membranes are intact. A blue-green, blue-gray, or deep blue color indicates a positive result and probable rupture of membranes. (Option 1) A nitrazine pH test strip inserted into the vagina can differentiate between amniotic fluid, which is alkaline, and vaginal fluid, which is acidic. Use of nonsterile gloves and instruments during vaginal examinations increases the risk of infection in the laboring client or fetus (eg, chorioamnionitis). The nurse should use a sterile glove during vaginal examination in the presence of ruptured membranes to prevent infection. This client is at term and in active labor.Ģ. If the FHR tracing does not improve, a right-side position may be attempted (Option 2) Administering oxygen at 8-10 L/min via nonrebreather face mask to promote fetal oxygenation (Option 1) Giving prescribed IV bolus of lactated Ringer solution or normal saline to improve placental perfusion, especially during maternal hypotension Notifying the health care provider (Option 4) (Option 5) Nitrazine pH tests are used to detect leaking amniotic fluid, most often if premature (prelabor) rupture of membranes is suspected. Nursing actions to improve fetal perfusion and oxygenation include: Discontinuing uterotonics (eg, oxytocin ) to reduce uterine activity (Option 3) Changing maternal position to the left side to relieve compression of the inferior vena cava. Chronic uteroplacental insufficiency (eg, intrauterine growth restriction, preeclampsia, diabetes) may also cause late decelerations. Late decelerations indicate impaired fetal oxygenation associated with decreased uteroplacental perfusion (eg, due to maternal hypotension after epidural placement or uterine tachysystole). A late deceleration is a decrease in FHR that begins after a contraction, reaches its lowest point (nadir) after the contraction peak, and then gradually returns to baseline.

1,2,3,4 The mnemonic VEAL CHOP may help nurses recall causes of fetal heart rate (FHR) changes noted on monitor tracings.

Amniotic fluid test strip