What is the fourth stage of labor and when does it start?
Postpartum period- starts after the delivery of the placenta
What are the greatest risks during the postpartum period?
Hemorrhage
Shock
Infection
When is RH immune globulin (RhoGAM) administered to post partum women?
Administered 72 hours for women who are Rh-negative and gave birth to infants who are Rh-positive
This prevents sensitization to Rh in future pregnancies
What is included in the postpartum nursing assessment?
Monitoring vital signs
Assessing uterine firmness & location in relation to umbilicus
Uterine position in relation to midline (if deviated, assist mom in emptying bladder)
Amount of vaginal bleeding (lochia)
How often should vitals be monitored after delivery?
Every 15 min for the first hour
Every 30 minutes for second hour
Every 4-8 hr depending on remaining medication regimen
This occurs with contractions of the uterine smooth muscle, whereby the uterus returns to its pre-pregnant state
Involution
Defined as blood flow from the uterus during postpartum period
Lochia
This type of lochia is bright red in color, bloody consistency, fleshy odor, may contain small clots
Lochia rubra
This type of lochia is pinkish brown in color & serosanguineous consistency
Lochia serosa
This type of lochia is yellowish, white creamy color, fleshy odor
Lochia alba
When is colostrum present in the new mother’s breasts?
During pregnancy and 2-3 days immediately after birth
Defined as an infection in a milk duct of the breast with concurrent flulike symptoms
Mastitis
What are therapeutic and approved holding positions when breast feeding?
Cradle hold
Side-lying hold
Football hold
What does breast feeding cause the release of? What does this prevent?
Breast feeding causes the release of oxytocin which stimulates uterine contractions (will prevent hemorrhage)
What are normal lab values in the post partum period?
Increased Hct & Hgb up to 72 hours
Leukocytosis (WBC count up to 20,000-25,000 for the first 10-14 days, without presence of infection)
Increased coagulation factors
Increased fibrinogen
A medical condition during pregnancy defined as excessive nausea and vomiting that is prolonged past 12 weeks of gestation. Results in weight loss & electrolyte imbalance
Hyperemesis gravidarum
What are nursing responsibilities when caring for a patient diagnosed with hyperemesis gravidarum?
Monitor client’s I&O
Assess client’s skin turgor/mucous membranes
Monitor vital signs
Monitor client’s weight
Have client remain NPO for 24-48 hours
This medical condition occurs during pregnancy due to inadequacy in maternal iron stores and consuming insufficient amounts of dietary iron
Anemia
This medical condition is defined as an impaired tolerance to glucose with the first onset or recognition during pregnancy
Gestational diabetes mellitus
What is the ideal blood glucose level during pregnancy?
70-110mg/dL
What are the clinical manifestations of hypoglycemia?
Nervousness
Headache
Weakness
Irritability
Hunger
Blurred vision
Tingling of mouth/extremities
What are the clinical manifestations of hyperglycemia?
Thirst
Nausea
Abdominal pain
Frequent urination (diuresis)
Flushed dry skin
Fruity breath
What are the glucose levels that diagnostically, indicate gestational diabetes mellitus?
Blood glucose screening of 130-140mg/dL or greater, indicating 3-hr oral glucose test is indicated
This disorder begins after the 20th week of pregnancy where BP s elevated at 140/90 mm Hg or greater recorded at least twice, 4-6 hours apart within a 1 week period
Gestational hypertension (GH)
This disorder is defined as gestational hypertension with the addition of proteinuria greater than 1+
Mild preeclampsia
This disorder is defined as maternal BP of 160/100 mm Hg or greater, protenuria greater than 3+, oliguria, elevated Cr greater than 1.2mg/dLm visual disturbances, hyperreflexia, pulmonary/cardiac involvement, extensive peripheral edema, hepatic dysfunction & thrombocytopenia
Severe preeclampsia
This disorder is defined as severe preeclampsia symptoms along with the onset of seizure activity or coma
Eclampsia
This syndrome of pregnancy is a variant of gestational hypertension in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction
HELLP syndrome
H- hemolysis (anemia and jaundice)
EL- elevated liver enzymes (Elevated ALT/AST, nausea/vomiting)
LP- low platelets (thrombocytopenia, DIC)
What are antihypertensive medications that are approved to be taken during pregnancy?
Methyldopa (Aldomet)
Nifedipine (Adalat, Procardia)
Hydralazine (Apresoline, Nesopresol)
Labetalol (Normodyne)
AVOID ACE INHIBITORS & ARBs
What is an anticonvulsant medication used during pregnancy?
Magnesium sulfate
What are signs of magnesium sulfate toxicity?
Absence of patellar deep tendon reflexes
Urine output less than 30mL/hr
Respirations less than 12/min
Decreased LOC
Cardiac dysrhythmias
If magnesium sulfate toxicity is suspected, what is the priority nursing action?
Discontinue infusion & administer antidote CALCIUM GLUCONATE. Also, prepare to prevent respiratory/cardiac arrest
Including what vitamin in the diet will increase absorption of iron supplementation?
Vitamin C
This syndrome results from the chronic or periodic intake of alcohol during pregnancy; Alcohol is considered teratogenic
Fetal alcohol syndrome
Defined as a serum glucose level of less than 40mg/dL
Hypoglycemia in full term newborn
Defined as a serum glucose level of less than 25 mg/dL
Hypoglycemia in pre-term newborn
This syndrome is defined as surfactant deficiency in the lungs and is characterized by poor gas exchange and ventilatory failure
Respiratory distress syndrome (RDS)
Produced by the body, it is a phospholipid that assists in alveoli expansion & allows gas exchange to occur
Surfactant
What are assessment findings of respiratory distress syndrome in a newborn?
Tachypnea (greater than 60/min)
Nasal flaring
Expiratory grunting
Retractions (abdominal)
Labored breathing
Fine crackles upon auscultation
Cyanosis
What weeks gestation defines a pre-term newborn?
Between 20-37 weeks gestation
Defined as a newborn whose birth weight is at or below the 10th percentile and who has intrauterine growth restriction
SGA- Small for gestational age
Defined as a newborn who’s weight is above the 90th percentile or more than 8 lb 12 oz
LGA- large for gestational age
Defined as a newborn who is born after the completion of 42 weeks of gestation
Post-term infant
What do post-term infants have an increased risk for in utero?
Aspirating meconium
This disorder is a complication that can result from meconium aspiration; Ductus arteriosus & foramen ovale remain open
Persistent pulmonary hypertension of the newborn
Defined as an elevation of serum bilirubin levels resulting in jaundice (especially sclera and mucous membranes)
Hyperbilirubinemia (Hyperbili)
What can result from untreated hyperbilirubinemia of levels higher than 25 mg/dL?
Kernicterus (bilirubin encephalopathy)- caused by bilirubin depositing into brain cells
What is the treatment for hyperbili?
Phototherapy
What are nursing responsibilities when caring for a newborn receiving phototherapy?
Maintain eye mask over newborn’s eyes for protection of corneas and retinas
Keep newborn undressed, surgical mask placed over genitalia
Avoid motioning skin (can cause burns)
Remove newborn from phototherapy q4hr assessing accordingly
Reposition newborn q2hr
What are signs that phototherapy is working?
Bronze discoloration
Maculopapular skin rash
Dehydration
Elevated temperature
Congenital anomaly where there is failure of the lip or hard/soft palate to fuse
Cleft lip/palate
Congenital anomaly defined as failure of the esophagus to connect to the stomach
Tracheoesophageal atresia
Congenital anomaly common in newborns with Down syndrome, where first part of bowel has not developed and is not open; Contents of digestion are unable to pass; Requires surgery
Duodenal atresia
Congenital anomaly defined as the inability to metabolize the amino acid phenylalanine; Can result in mental retardation if left untreated
Phenylketonuria (PKU)
Congenital anomaly defined as instability to metabolize galactose into glucose; Can result in mental retardation if left untreated
Galactosemia
Congenital anomaly defined as neural tube defect in which the vertebral arch fails to close; Protrusion of meninges/spinal cord may be present
Spina bifida
Congenital anomaly defined as excessive spinal fluid accumulation in ventricles of brain causing the head to enlarge and fontanels to bulge; Sun-setting sign is common
Hydrocephalus (Water on brain)
Congenital anomaly defined as a non cyanotic heart defect where the ductus arteriosus connecting the pulmonary artery and the aorta fails to close after birth
Patent ductus arteriosus
What is an expected finding for an infant experiencing abstinence syndrome (withdraw from substance after birth)?
Continuous high-pitched cry
What are laboratory tests/metabolic screenings done after birth?
Hgb & Hct (if prescribed)
Blood glucose
Newborn genetic screening done by heelstick
PKU (phenylalanine) testing
Hearing screening
How does a nurse go about getting a heel stick blood specimen from a newborn?
Warm newborns heel to increase circulation
Cleanse area with appropriate antiseptic, allow for drying
Spring activated lancet used on outer aspect of heel
After puncture, apply pressure with gauze until bleeding stops
Cuddle/comfort newborn after completion of procedure to promote feelings of safety
How is the newborn identified after birth?
Using two identifiers; Arm band is applied immediately after birth to both mom and father baby to prevent newborn from being given to wrong parents
How should newborns be positioned during sleep to prevent SIDS?
Supine “safe sleep”
How might stools of breast fed newborns appear?
Yellow and seedy
What is mandatory post birth to prevent opthalmia neconatorum?
Erythromycin (Roycin) – Prophylactic eye care
What organisms is opthalmia neconatorum caused by?
Neisseria gonorrhoeae or Chlaymdia trachomatis – can cause blindness if left untreated
Why is vitamin K administered to newborn within 1 hour after birth?
To prevent hemorrhagic disorders; Because vitamin K into produced in the GI tract of the newborn until day 8, it is administered at birth
How should you care an infant while umbilical cord is healing?
Keep clean and dry to prevent infection
What type of bathing should be avoided while umbilical cord is still healing?
Bathing infant by submersion in water; Should be avoided until cord has fallen off
If an infant is not dried completely at birth, by what mechanism will the infant lose heat?
Evaporation – loss of heat that occurs when a liquid is converted to a vapor
What does performing Leopold’s maneuvers determine?
Number of fetuses
Presenting part (cephalic/breech
Fetal lie (longitudinal/transverse)
Fetal attitude
Degree of descent into mom’s pelvis
Location of PMI – fetal back
How and in what order are contractions rated?
Frequency, Duration, Intensity
What is a normal fetal heart rate (FHR)?
110-160bpm with increases/decreases from baseline
What are advantages of external fetal monitoring?
Noninvasive- reduces risk for infection
Membranes do not have to be punctured
Cervix does not have to be dilated
What are disadvantages of external fetal monitoring?
Contraction intensity is not measurable
Requires frequent repositioning of client
Quality of recording is affected by client obesity/fetal position
Defined as FHR less than 110/min
Fetal bradycardia
What are nursing interventions required when FHR is 110bpm or less?
Discontinue oxytocin
Assist client to side-lying position
Administer o2 at 8-10L/min
Insert IV catheter w/tocolytic medication
Notify provider
Defined as FHR greater than 160 bpm for 10 min or more
Fetal tachycardia
What are nursing interventions required when FHR is 160bpm or more?
Administer prescribed antipyretics for maternal fever (if present)
Administer o2 by mask at 8-10 L/min
Administer IV fluid bolus
What nursing intervention is required for early decelerations of FHR?
No intervention required – expected finding
Cause: Compression of fetal head resulting from uterine contraction
What are late decelerations of FHR caused by?
Uteroplacental insufficiency causing inadequate fetal oxygenation
What are nursing interventions required for late decelerations of FHR?
Place client in side-lying position
Insert IV catheter and increase fluids
Discontinue oxytocin if being infused
Administer o2 by mask 8-10 L/min
Notify provider
Prepare for emergency c-section or assisted vaginal birth
What are variable decelerations of FHR caused by?
Umbilical cord compression, prolapsed cord, nuchal cord or oligohydramnios
What are nursing interventions required for variable decelerations of FHR?
Reposition client from side to side or into knee-chest
Discontinue oxytocin if being infused
Administer o2 by mask 8-10 L/min
Perform/assist with vaginal exam
Assist with amnioinfusion if prescribed
What are some advantages of internal fetal monitoring?
Early detection of abnormal FHR suggesting fetal distress
Accurate assessment of FHR variability
Accurate assessment of uterine contraction intensity
Allows greater maternal freedom
What are some disadvantages of internal fetal monitoring?
Membranes must be ruptured- can introduce infection
Cervix must be dilated to a minimum of 2-3cm
Presenting part must descent to place electrode
Specially trained personnel must do procedure
A nurse is caring for a client in the third stage of labor. What findings indicate that placental separation has occurred?
Lengthening of the umbilical cord
Appearance of dark blood from the vagina
Fundus is firm upon palpation (due to uterus contracting)
A nurse is caring for a client who is in the transition phase of labor and reports that she needs to have a bowel movement with the peak of contractions. What is the appropriate nursing intervention?
Prepare for an impending delivery- the urge to have a bowel movement indicates fetal descent and complete dilation
A nurse is caring for a client who is in the first stage of labor and encourages the client to void every 2 hours. Why is this important?
Distended, full bladder reduces pelvic space needed for birth & impedes fetal descent
Signs that a woman may have that make her think that she is pregnant. Including: Amenorrhea, fatigue, nausea/vomiting, breast changes, uterine enlargement
Presumptive signs of pregnancy
What are examples of presumptive signs of pregnancy?
Amenorrhea (Absent period)
Fatigue
Nausea/vomiting (Morning sickness)
Breast changes (Darkening of aerola)
Uterine enlargement
Quickening
Signs that make the medical examiner suspect a woman is pregnant
Probable signs of pregnancy
What are examples of probable signs of pregnancy?
Abdominal enlargement
Hegar’s sign (softening of lower uterus)
Chadwick’s sign (Deepened violet-blue color of cervix/vaginal mucosa
Goodell’s sign (softening of cervical tip
Braxton hicks contractions
Positive pregnancy test (Testing for hcg)
What are examples of positive signs of pregnancy?
Fetal heart sounds
Visualization of fetus by ultrasound
Fetal movement palpated by experienced examiner
What do at-home pregnancy tests detect in urine?
hCG- human chorionic gonadotropin
What do higher levels of hCG indicate?
Multifetal pregnancy
Ectopic pregnancy
Genetic abnormality- Down syndrome
What do lower levels of hCG indicate?
Possible misscarriage
How do you determine an estimated delivery date using Nagele’s rule?
Take the first day of the woman’s LMP, subtract 3 months, add 7 days and add 1 year
Defined as the number of pregnancies
Gravidity
Defined as a woman in her first pregnancy
Primagravida
Defined as a woman who has had two or more pregnancies
Multigravida
Defined as the number of pregnancies in which the fetus or fetuses reach viability (20 weeks) regardless of whether the fetus is born alive
Parity
What does the GTPAL acronym stand for?
Gravidity
Term births (38+ weeks)
Preterm births
Abortions/miscarriages
Living children
What is supine hypotension syndrome?
Pressure of the uterus on the vena cava, decreasing venous blood flow to the heart
What is chloasma?
Pigmentation increases on the face, normal during pregnancy
What is line nigra?
Dark line of pigmentation from the umbilicus extending to the pubic area
Approximately how long should a mother spend breastfeeding on each breast?
15-20 minutes per breast & 30-40 minutes total feeding
Before a circumcision is performed, what does a nurse need to assess?
History of bleeding tendencies in family (hemophilia, clotting disorders)
Hypospadias/epispadias
Ambiguous genitalia (have both male/female characteristics)
Illness/infection
Post a circumcision, what does a nurse need to assess?
Bleeding q15min for first hour & a1hr for 12 hours
Assess for first voiding by newborn post procedure
What is recommended exercise type and amount of time during pregnancy?
Exercise during pregnancy yields positive benefits and should consist of 30 minutes moderate exercise (walking/swimming)
For the expectant mother experiencing nausea/vomiting, what should the nurse recommend when it comes to eating in the morning?
Eat crackers or plain toast before getting out of bed
How is an apgar score made?
Perfect score: 10
5 categories, each worth points each
Categories: HR, RR, Muscle tone, Reflex irritability, Color
How many veins/arteries should the umbilical cord have?
1 vein 2 arteries
What are expected ranges of physical assessments found in newborn?
Weight- 2500-4000 grams
Length- 18-22 in
Head circumference- 12.6-14.5 in
Chest circumference- 12-13 in
What are small white nodules on the roof of the newborns mouth (may or may not be present)
Epstein’s pearls
What nursing interventions are recommended when introducing a new infant to other siblings?
Let sibling be the first one to see new infant
Provide a ‘gift’ from the infant to give the sibling
Arrange for one parent to spend time with sibling while other parent cares for infant
Allow older sibling to help in providing care for infant
What are examples of non pharmacological pain management during labor?
Aromatherapy
Breathing techniques
Guided imagery
Music
Subdued lighting
Back massage/effleurage
Sacral counter pressure
Heat/cold therapy
Hydrotherapy
Frequent position changes
Defined as light, gentle stroking of the client’s abdomen with the fingertips in rhythm with breathing during contractions
Effleurage
What is the purpose of bethamethasone (Celestone) administration during pre-term labor?
Betamethasone is a glucocorticoid that is given to clients in preterm labor to hasten surfactant production in the infant
What does the biophysical profile (BPP) measure?
Physical/physiological characteristics of the fetus & fetus response to stimuli
What does the BPP (biophysical profile) measure?
Reactive/nonreactive FHR
Fetal breathing patterns
Gross body movements
Fetal tone
Qualitative amniotic fluid volume
This type of stress test consists of a woman brushing her palm across her nipple for 2 minutes, which causes the pituitary to release endogenous oxytocin
Nipple stimulated CST (Contraction stress test)
Defined as the aspiration of amniotic fluid for analysis by insertion of a needle transabdnominally into a client’s uterus and amniotic sac under direct ultrasound guidance
Amniocentesis
High levels of what protein (examined during an amniocentesis) is associated with neural tube defects?
Alpha-fetoprotein (AFP)
What are low levels of Alpha-fetoprotein (AFP) associated with?
Down Syndrome
What are high levels of Alpha-fetoprotein (AFP) associated with?
Neutal tube defects
What are nursing responsibilities following an amniocentesis?
Monitor vital signs, FHR, uterine contractions for 30 minutes following procedure
Have client rest for 30 minutes
Administer Rh immune globulin (RhoGAM) to the client if she is Rh-negative to protect against Rh isoimmunization (If fetus has different Rh)
This type of diagnostic procedure is an assessment of a portion of the developing placenta (chorionic villi) which is aspirated through a thin sterile catheter or syringe through the abdominal wall
Chorionic villi sampling
A nurse is caring for a client who is in preterm labor and is scheduled to undergo an amniocentesis to assess fetal lung maturity. What is the test for fetal lung maturity during an amniocentesis?
Lecithin/sphingomyelin (L/S) ratio
What is an acoustic vibration device & why is it used during a non stress test (NST)?
It is a vibrato device that is used to awaken a fetus from sleeping
What are some contraindications for oxytocin therapy during labor?
Sepsis
Unripe cervix
Genital herpes
History of multiple births
Uterine surgery
What is terbutaline (Brethine) used for?
To stop uterine contractions- causes uterine smooth muscle relaxation
Defined as the artificial rupture of membranes (AROM) by provider using an Amnihook or other sharp instrument
Amniotomy
Defined as scant amount or absence of amniotic fluid
Oligohydramnios
This type of delivery assistance involves using a cup like suction device that is attached to the head
Vacuum-assisted delivery
This type of assisted birth is using an instrument with two curved spoon like blades to assist in the delivery of the fetal head
Forceps-assisted birth
Defined as an incision made into the perineum to enlarge the vaginal opening to facilitate delivery and minimize soft tissue damage
Episiotomy
What are indications for cesarean birth?
Malpresentation (breech)
Fetal distress
Placental abnormalities
High risk pregnancy (HIV+, Hypertensive disorders, diabetes mellitus, active genital herpes lesions)
Previous c-section
Multiple gestations
Umbilical cord prolapse
What are nursing responsibilities after a c-section?
Monitor for bleeding (internal, external)
Assess lochia
Monitor I&O
Monitor vitals
Give pain medication as prescribed
Encourage ambulation to prevent thrombus
Assess client for UTI
When is an amnioinfusion indicated?
Oligohydraminios (scant/absent amniotic fluid)
Fetal cord compression
What is the recommended weight gain during pregnancy?
11.2-15.9 kg or (25-35 lbs)
What is the recommended daily increase in caloric intake during the second trimester? Third trimester?
2nd: 340 calorie increase
3rd: 452 calorie increase
What are examples of foods high in folic acid?
Leafy vegetables
Dried peas & beans
Seeds
Orange juice
Breads/cereals/grains
What is the recommended amount of folic acid that should be taken DURING pregnancy?
600 mcg
How can HIV possibly be transmitted to the fetus?
Perinatally through the placenta and postnatally through the breast milk
What procedures should be avoided for mom’s HIV+?
Amniocentesis and episiotomy- risk of maternal blood exposure to newborn
Defined as a bacterial infection that can be passed to the fetus during labor and delivery
Group B Streptococcus, beta hemolytic (GBS)
What can a group b strep infection lead to during pregnancy/delivery?
PROM (premature rupture of membranes)
Preterm labor and delivery
Chorioamniotitis
Infections of urinary tract
Maternal sepsis
Defined as terminated pregnancy before 20 weeks of gestation or fetal weight less than 500 g
Spontaneous abortion
What are nursing actions for a client bleeding during pregnancy?
Assess color/amount of bleeding
Maintain client on bed rest
Avoid vaginal exams
Administer meds/blood products as prescribed
Defined as the abnormal implantation of a fertilized ovum outside of the uterine cavity, usually in the fallopian tube, which can result in a tubal rupture causing a fatal hemorrhage
Ectopic pregnancy
This occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus
Placenta previa
Defined as the premature separation of the placenta from the uterus, which can be partial or complete detachment
Abruptio placenta
What are risk factors associated with abrupt placenta?
Maternal HTN
Blunt abdominal trauma
Cocaine use
Cigarette smoking
Refers to a thrombus that is associated with inflammation, occurs postpartum
Thrombophlebitis
If a client reports leg pain & tenderness, what should the nurse suspect?
Possible DVT
What are nursing responsibilities when educating client about preventing thrombophlebitis?
Maintain antiembolism stockings until ambulation established
Perform active/passive ROM if on bed rest
Avoid prolonged periods of standing, sitting or immobility
Have client elevate legs when sitting
Maintain adequate fluid intake
Tell client to discontinue smoking
What are nursing responsibilities when caring for a patient with thrombophlebitis?
Encourage rest
Facilitate bed rest
DO NOT massage affected area to prevent thrombus from dislodging and becoming an embolus
Administer analgesics (NSAIDs)
Administer anticoagulants for DVT
When administering IV heparin, what lab value should the nurse particularly monitor?
apTT
What is the antidote for PO warfarin?
Vitamin K
When administering PO warfarin, what lab value should the nurse particularly monitor?
PT and INR
Defined as a coagulopathy that is an autoimmune disorder in which the life span of platelets is decreased by anti platelet antibodies
Idiopathic thrombocytopenic purpura (ITP)
Defined as a coagulopathy in which clotting and anticlotting mechanisms occur at the same time
Disseminated intravascular coagulation (DIC)
Defined as more than 500mL blood loss after a vaginal birth or more than 1000 mL blood loss after a cesarean birth
Postpartum hemorrhage
What are nursing responsibilities if post partum hemorrhage is suspected?
Monitor vital signs
Assess for source of bleeding
Assess bladder for distention
Maintain/initiate IV fluids to replace blood loss
Provide o2 at 2-3 L/min via NC
Elevate client’s legs to increase venous return
What is methylergonovine (Methergine) used for?
Controls postpartum hemorrhage
What drugs control postpartum hemorrhage?
Methylergonovine (Methergine)
Misoprostol (Cytotec)
Carboprost tromethamine (Hemabate)
Defined as inability of the uterine muscle to contract adequately after birth
Uterine atony
Defined as when the uterus remains enlarged with continued local discharge and may result in a post partum hemorrhage
Subinvolution of the uterus
Defined as turning inside out of the uterus and may be partial or complete
Inversion of the uterus
Defined when fragments of the placenta remain in the uterus and prevents the uterus from contracting, which can lead to uterine atony or subinvolution
Retained placenta
What is the earliest indication of hypovolemia caused by hemorrhage?
Increasing pulse and decrease BP
What are clinical findings found with suspected DVT?
Calf tenderness to palpation
Swelling of the extremity
Elevated temperature
Area of warmth
This occurs when the umbilical cord is displaced, preceding the presenting part of the fetus or protruding through the cervix
Prolapsed umbilical cord
What are immediate nursing responsibilities when prolapse of umbilical cord is suspected?
CALL FOR ASSISTANCE
Notify provider
Use a sterile gloved hand, insert 2 fingers into vagina & provide pressure on either side of the cord to the fetal presenting part
Apply warm/sterile saline soaked towel to visible cord to prevent drying
Monitor FHR variabilities
Administer o2 at 8-10L/min via face mask
Prepare for c-section if other measures fail
Educate client of current situation
Defined as difficult or abnormal labor related to the 5 powers of labor (Passenger, passageway, powers, position & psychologic response)
Dystocia (dysfunctional labor)
Defined as labor that lasts 2 hours or less from the onset of contractions to the time of delivery
Precipitous labor
What is the first action required by the nurse right after delivery of infant?
Dry the newborn
To facilitate feeding and correct latching on, how should the mother hold the infant?
“Tummy to tummy”
What type of deceleration requires IMMEDIATE nursing assessment?
Prolonged decelerations- may result in fetal death if there is no response to intrauterine resuscitation
What should the nurse instruct the new parents regarding bathing the newborn?
Avoid bathing the new infant daily because it can cause dryness and alters the acid mantle of the newborn’s skin
What should the temperature of the water approximately be to prevent injury to newborns?
36.6-37.2 (98-99F)
If a client tests positive for a 1-hour glucose tolerance test, what test will confirm/deny a diagnosis of gestational diabetes?
3-hr glucose tolerance test
What is the main clinical finding that indicates magnesium sulfate toxicity?
Absence of deep tendon reflexes
How long should a child be back facing in car seat while riding in a vehicle?
Until age 2
What is unilateral breast pain a symptom of?
Mastitis
What are traditional hispanic practices post partum?
Protecting the newborn’s head/feet from cold air; Delaying bath for 14 days following delivery; Bed rest for mom for 3 days & drinking warm beverages following birth
What is irritability during phototherapy a sign of?
Acute bilirubin and encephalopathy
When should oxytocin be administered?
Flaccid uterus
Excess vaginal bleeding
To enhance contractions
What should an expectant mother do after exercising?
Side-lie for 10 minutes to promote circulation to fetus
At what minutes are apgar scores taken?
1 & 5 minutes
What does a feeling of tightness following an amniocentesis indicate?
Onset of uterine contractions
What does dull, intermittent back pain indicate?
Preterm labor, needs to be reported to provider
What is a non-pharmacological method for lactation suppression?
Cabbage leaves:
Plant sterols and salicylates from cabbage leaves can help relieve swelling
What are sub-sternal retractions in a newborn a sign of?
Respiratory distress
During the immediate postpartum period, what is the new mom at greatest risk for?
Post partum hemorrhage
What does a mom’s subjective report of “tingling fingers” during labor indicate?
Hyperventilation
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a nurse is planning care for a newborn who has hyperbilirubinemia and is to receive phototherapy
ob maternity quizlet
A patient has received oxytocin to augment pregnancy. What is a contraindication?
A.
There are none
B.
Late decelerations
C.
Prolonged active phase of labor
D.
Cessation of uterine dilation
E.
All of the above
Suppose a patient is in premature labor and is receiving MGSO4 2 g I V, what finding should you report to the provider?
A.
RR of 16/min
B.
Patient states having hot flashes
C.
Absent deep tendon reflexes
D.
There is nothing you need to worry about with this medication
E.
All the above
Patient is tensing at the onset of a contraction. What can you tell her regarding breathing techniques.
A.
When a contraction comes bear down and push
B.
Take a cleansing breath in
C.
Use patterned breathing
D.
Breath however you want to
E.
All of the above
You are taking care of a patient having amniocentesis done what is the appropriate action for you to take prior to procedure?
A.
Assess fetal movement
B.
Pat patient on belly and tell her everything is looking great
C.
Assess for nausea and vomiting in patient
D.
Assess fetal heart rate
E.
I have no clue how to answer this question
At a prenatal clinic a patient comes in and says she is 2 weeks late for her period and thinks she may be pregnant. What would you tell this patient?
A.
If you have been sexually active and you didn’t wrap it before you tapped it, you are probably pregnant
B.
Well because your period is late you should go home and take a pregnancy test and come back with the results
C.
I am going to go ahead and give you a pregnancy test here so we can determine if you are or not
D.
Have you noticed that your abdomen has enlarged in the past two weeks
E.
Sometimes there are other causes for a skipped or missed period, what is you typical cycle like
You are caring for a patient in labor, patient reports she is having increased rectal pressure. Her vaginal exam shows that her cervix is 8-9 cm dilated, her contractions are 2-3min apart and they last for about 80-90 seconds. You realize that the client is in _.
A.
Labor
B.
Transition phase
C.
Third stage
D.
First stage
E.
Active phase
In teaching newborn care, in discharging patient and family the highest priority is:
A.
Instruction on how to suction with a bulb syringe
B.
Swaddling
C.
Feeding
D.
Diapering
E.
Not really my problem what they do when they get home with the baby
You have four patients in antepartum all with preeclampsia. Which patient requires further assessment?
A.
BP 144/90 mmHg
B.
Don’t really care, i have been working for 12 hours and i’m tired and ready to go home
C.
Proteinura less than 0.3 g in 24 hour
D.
Deep tendon reflexes +4
E.
All of the above
You have just admitted a patient into L&D, client says ‘my water just broke”. what is your priority intervention?
A.
Make sure she didn’t get anyting on your shoes or scrubs
B.
Clean up mess
C.
Assess amniotic fluid
D.
Check cervical dilation
E.
Monitor fetus’ heart rate
In the fourth stage of labor patient is experiencing hemorrhage, what is the second step you would do for the patient?
A.
Assess bladder
B.
Massage fundus
C.
Give pitocin
D.
Give MGSO4
In the fourth stage of labor patient is experiencing hemorrhage, what is the last thing you would do?
A.
Give pitocin
B.
Assess bladder
C.
Give MGSO4
D.
Massage fundus
You are caring for a patient who is 18 weeks her MSAFP is high. What is the appropriate action?
A.
Offer grief counseling
B.
Request ultrasound
C.
Tell patient and family that they are having a baby with Down Syndrome and ask how would they like to proceed with pregnancy
D.
Obtain prescription of narcotic drugs so they can deal with what may come
E.
Uh what the hell are we talking about in this question?
A fetal anomaly associated with oligohydraminos is __.
A.
Cardiac issues
B.
Reproductive issues
C.
GI issues
D.
Renal issues
E.
Neurological issues
Your patient is in active labor, she said she has had bright red bleeding since contractions started. when you are monitoring her VS at frequent intervals. What are you assessing for?
A.
Pain
B.
Hemorrhage
C.
Hypertension
D.
How much time i can waste before my shift is over
The patient is diagnosed with a hydatidiform mole. What should you expect?
A.
Dark browinsh vaginal discharge
B.
Dont know because i don’t even know what that is
C.
Decreased urine output
D.
Subnormal maternal temperature
E.
All of the above
Inactive labor the fetal heart rate decrease from 166/min to 100/min after the acme of contractions. the heart rate then returns to baseline when the contraction is finished. What should you document?
A.
Early deceleratoins
B.
Nothing because i don’t do documenting
C.
Fetal bradycardia
D.
Late decelerations
E.
Variable declerations
A positive pregnancy can be determined by __.
A.
Enlarge abdomen
B.
Amenorrrhea
C.
Fetal movement felt by physician
D.
Chadwicks sign
E.
Pregnancy test
Your patient is HIV positive, what should you include in her care plan?
A.
Nothing, i don’t care to do a plan
B.
Explain blood test during pregnancy
C.
Importance of taking medication daily
D.
That she will be isolated from everyone including baby after delivery
E.
All the above
Your patient has abruption placenta, what should you be assessing for in her lab results?
A.
Prolonged partial thromboplastin time
B.
Decrease clotting time
C.
Increased platelet count
D.
I have not a clue
E.
Right now i wished melissa would die for making up this quiz
Themain distinction between abprutio placenta and placenta previa is
A.
Maternal hypotension
B.
Decreased hemorrhage
C.
Abdominal pain
D.
Who cares
E.
All of the above
To verify a patient’s pregnancy blood and urine are checked for the presence of what?
A.
Alcohol
B.
HCG
C.
Estrogen
D.
Progesteron
E.
Narcan
LMP was July 8th. When is EDB?
A.
Novemeber 15th
B.
April 15th
C.
Ocotober 1st
D.
October 15th
E.
April 3rd
One hour after administering Pitocin to your patient her contractions were 90-100 seconds and 1-2 min apart. what needs to happen?
A.
Discontinue pitocin
B.
Increase infusion
C.
Decrease/slow down infusion
D.
Add other drugs to her regimen
E.
Nothing she will be just fine
A patient is on MGSO4 IV for PIH her BP=162/112mm/Hg, RR=32/min, HR=90 deep tendon reflex is +4. What other assessment should you immediately report?
A.
RR= 16/min
B.
BP went from 162/112 to 132/62
C.
Urninary output is 20 mL/hr
D.
Deep tendon reflex is +2
E.
I have not a clue
What is the best sleeping position for a pregnant patient with PIH?
A.
Trendelenburg
B.
Upside down
C.
Supine
D.
Left side-lying
E.
Semi-fowlers