NORCET 3 - 2022 (Shif…: Which instruction given by the nurse to a woman in first stage of labour Except?

NORCET 3 - 2022 (Shift-1)

Obstetrics & Gynaecology

Medium

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

The question asks for an inappropriate instruction for the first stage of labor due to the keyword 'Except'.
Pushing is the primary action of the second stage of labor, which begins only after the cervix is fully dilated to 10 cm.
Instructing a woman to push before full cervical dilation is incorrect and can lead to complications like cervical edema, lacerations, maternal exhaustion, and fetal distress.
Therefore, telling a woman to 'Push during contractions' is the instruction that should NOT be given during the first stage of labor.

Option A: This is a correct and recommended instruction. Ambulation and changing positions can help manage pain, utilize gravity to aid fetal descent, and may shorten the duration of labor. Alternating with rest helps conserve energy.
Option B: This is a correct and recommended instruction. The left lateral position prevents supine hypotension (aortocaval compression) by shifting the weight of the uterus off the major blood vessels, which ensures adequate blood flow to the placenta and fetus.
Option C: This is a correct and essential instruction. The nurse must actively coach the woman to avoid pushing before the cervix is fully dilated to prevent complications. Breathing techniques like panting or blowing are taught to manage the urge to push.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing management during the first stage of labor to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary responsibility during the first stage of labor is to ensure maternal and fetal safety while promoting labor progress. Giving the correct instructions is a critical part of this role.
Incorrectly instructing a patient to push prematurely can turn a normal labor into a complicated one, increasing the risk of operative delivery (forceps, vacuum, or cesarean) and causing preventable injury to both mother and baby.
Patient safety is paramount. Understanding the physiological process of each labor stage allows the nurse to provide evidence-based guidance that prevents harm.

How to Approach the Question

First, identify the core of the question. It asks about nursing instructions during the 'first stage of labor'.
Next, notice the keyword 'Except'. This signals that you are looking for the option that is an incorrect or inappropriate instruction for the given situation. Three options will be correct actions, and one will be the incorrect action.
Recall the characteristics of the first stage of labor: it begins with the onset of regular contractions and ends with full cervical dilation (10 cm). The primary maternal activities are coping with contractions through breathing, relaxation, and position changes.
Evaluate each option against the known principles of first-stage labor management:
Option A (Ambulate and rest): Is this appropriate? Yes, mobility and rest are encouraged.
Option B (Lie left lateral): Is this appropriate? Yes, it prevents supine hypotension.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 25-43

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 38-46