Maternal Child Health
During the ___ and ___ trimesters, women should consume and extra ____kcal/day.
2nd and 3rd, 300
What supplement should vegetarians take? Why?
4 mg vit b12 because they are lacking due to lack of meat in diet
fetal bradycardia
<110
fetal tachycardia
>160 bpm
variability
Absent (none) Minimum (<5 bpm) Moderate (6-25) Marked (>25)
8 yr old well child check, question to ask regarding development
"do you have friends at school"
premonitory signs of labor
- Cervical changes - Lightening - Increased energy level - "Bloody show" - Braxton Hicks contractions - Spontaneous rupture of membranes
What are normal vital signs for children?
1 mo - 1 yr HR 100-190 awake, 90-160 resting RR 22-37 BP 72-104/37-56 T 35.8-38 (ear) 36.6-38 rectal 36.5-37.5 axillary O2 <92
What is normal FETAL heart rate range?
110-160 beats per minute
Normal baseline fetal heart rate
110-160 bpm
Physiological forces of labor
As pregnancy progresses, contractions gradually increase in intensity and frequency until, in labour, strong, synchronous, effective contractions occur. Changes in the structure of myometrial cells enable them to contract more strongly and to maintain this through labour. The initial changes are termed 'activation' 4 Stages of Labor First stage: Dilation of the cervix (mouth of the uterus) Second stage: Delivery of the baby. Third stage: Afterbirth where you push out the placenta. Fourth stage: Recovery.
Family Violence and Maltreatment (domestic violence, child abuse/neglect, munchausen syndrome by proxy)
Munchausen syndrome by proxy is a mental illness and a form of child abuse. The caretaker of a child, most often a mother, either makes up fake symptoms or causes real symptoms to make it look like the child is sick.
What is assessed in Apgar, how scored?
Newborn's 1) color, 2) heart rate, 3) reflexes, 4) muscle tone, and 5) respiration, each of which is given a score of 0, 1, or 2. CHRMR (Children have remarkable memory recall.)
Signs of Non-Reassuring Fetal Status
Non-reassuring fetal status is defined as abnormal fetal heart rate monitoring, including repeated fetal heart rate deceleration, fetal tachycardia, bradycardia, and late deceleration
Evidence Based Birth Slides (specifically Doula and diagnosing gestational diabetes)
Oral Glucose Tolerance Test (OGTT) TheOGTTmeasures blood glucose after you fast for at least 8 hours. First, a health care professional will draw your blood. Then you will drink the liquid containing glucose. You will need your blood drawn every hour for 2 to 3 hours for a doctor to diagnose gestational diabetes.
physiologic forces of labor
Primary Forces -- uterine contractions (frequency, duration, and intensity of uterine contractions as the fetus moves through the birth passage) Secondary Forces -- abdominal muscles used in pushing
most important step of screening a patient for physical abuse
ask patient when they are alone
monitoring of fetal heart rate
auscultation w Doppler electronic fetal monitoring (internal and external) normal baseline fetal heart rate (110-160)
Discuss listeria concerns
bacteria that poses threat to mom and baby found in refrigerated prepackaged foods (unpasteurized milk and dairy, deli meats, poultry, seafood To prevent: avoid soft cheeses, refrigerated smoked meats, hot dogs, lunch meats -- all unless cooked thoroughly
purpose of increased RBC in pregnancy
increase O2 delivery to cells
Car Seats, why rear-facing under 2?
infant rear-facing L low A anchors T tether C H children better support of head and neck
physiological forces of labor...
intensity of contractions duration of contractions freq of contractions
distinguishing factor of secondary amenorrhea...
menstruation that ceases after beginning
medication for an ectopic pregnancy that has not ruptured and no fetal heart tones are present
methotrexate
Childcare providers
must be licenses in state
during fourth stage of labor, which finding is indicative of not adapting during postpartum period?
palpation of boggy fundus
3rd stage of delivery
placental delivery, baby bonding with parents, photo op, record time b/w delivery and placental delivery (<30 min is n, more may require, any tearing repair manual evac)
Fetal/Newborn Implications of PROM
premature rupture of membranes How does PROM affect the baby? A significant risk of PPROM is that the baby is very likely to be born within a few days of the membrane rupture. Another major risk of PROM is development of a serious infection of the placental tissues called chorioamnionitis, which can be very dangerous for mother and baby.
folic acid is for...
preventing neural tube defects
expected S/E of PCA pump
pruritis urinary retention nausea
what happens during 2nd stage of delivery
pushing
nursing intervention for accelerations
reassuring normal sign, lasts for 15+ secs and peaks 15+ beats/min
nursing intervention for variable deceleration
reposition mother to knee-chest position to get baby's head off the chord, or use 2 fingers to lift baby's head off the chord until further interventions required
Nursing actions for non-reassuring fetal heart rate pattern
reposition pt maternal VS IV bolus of at least 500 ml cervical exam maternal O2 DC pitocin
Life-threatening reaction to all labor analgesics
respiratory depression in all (cardio and resp depression/bronchoconstriction in newborn w Fentanyl) (muscle rigidity, esp in resp muscles w Fentanyl)
TORCH infection with vaccine...
rubella
a patient for physical abuse safety concerns for.... toddler - ______ school age - ______ adolescents - ______
safety concerns for.... toddler - fall school age - bike safety adolescents - seatbelt safety
if glucose is 140 for 1hr glucose test...
schedule the pt to come back for a 3 hr test
symptom a newly pregnant woman should report
sharp one-sided abdominal pain
nursing intervention for early decels
sign that baby is descending into pelvis, monitor as needed
what assessments are you doing on baby in the first few hours and days of life?
stool, intake, latch, temp regulation, jaundice, diaper count, reflexes, glucose
High mercury fish to avoid are
swordfish, shark, tilefish, mackerel
why is it important for families to choose licensed daycare providers
the state regulates safety protocols are followed at licensed daycares
what is not true of a doula...
they are medical professionals (this is false) true... employed by hospital supportive during birth help w laboring positions
rationale for infant client with a congenital heart defect to likely have poor weight gain...
they burn more calories than they take in
a woman is admitted with a fever and a rash begins to develop desquamation of skin on hands and feet. what disease does this show based on these s/s
toxic shock syndrome
Optimal weight gain is _________.
underweight woman 28-40 lbs (12.5-18 kg) normal weight 25-35 lbs (11.5-16 kg) overweight 15-25 lbs (7-11.5 kg) obese 11-20 lbs (6-9.1 kg)
Interventions you might do for a baby with a low Apgar score
warm blanket, suction, O2, rescue breaths
assessment the nurse should do to try to identify if mom is hemorrhaging
weigh and count pads
When is pregnancy considered "ended"?
when placenta delivered
how to know if a child is ready to move from a 5-point harness to a booster seat
where the seat belt lands on the child's chest
late decels
worrisome sign, reposition mother, give IV fluids, anticipate DCing or decreasing ocytocin, or administering tocolytic to decrease contractions
chord prolapse
A cord prolapse is when an unborn baby's umbilical cord slips through the cervix and into the vagina after a mother's water breaks and before the baby descends into the birth canal. During delivery, the prolapsed cord can become compressed by baby's body.
Doula
A doula is a professional labor assistant who provides physical and emotional support to you and your partner during pregnancy, childbirth and the postpartum period. For instance, a doula might offer: Attention to physical comfort through techniques such as touch and massage and assistance with breathing
Method of inducing labor
A gel or vaginal insert of prostaglandin is inserted into the vagina or a tablet is given by mouth. This is typically done overnight in the hospital to make the cervix "ripe" (soft, thinned out) for delivery. Administered alone, prostaglandin may induce labor or may be used before giving oxytocin.
Ectopic Pregnancy and Methotrexate (handout posted)
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus. An ectopic pregnancy most often occurs in a fallopian tube, which carries eggs from the ovaries to the uterus. This type of ectopic pregnancy is called a tubal pregnancy The most common drug used to treat ectopic pregnancy is methotrexate. This drug stops cells from growing, which ends the pregnancy. The pregnancy then is absorbed by the body over 4-6 weeks. This does not require the removal of the fallopian tube.
Optimal weight gain during pregnancy depends on_______ and her _______.
BMI and prepregnant nutritional state
Placenta Previa tx
Bed rest is recommended. A cesarean section is often needed. Possible blood transfusion.
Labor readiness, how to assess?
Bishop readiness score: Dilation of the cervix. This means how far your cervix has opened in centimeters. Effacement of the cervix. This means how thin your cervix is. It is normally about 3 centimeters long. It gradually becomes thinner as labor progresses. Consistency of the cervix. This means whether your cervix feels soft or firm. Women who have had previous pregnancies usually have a softer cervix. The cervix softens before labor. Position of the cervix. As the baby descends into the pelvis, the cervix — the doorway to the uterus — moves forward with the head and the uterus. Fetal station. This is how far up the birth canal the baby's head is. Usually, before labor begins, the baby's head moves from -5 (high up and not yet in the pelvis) to station 0 (where the baby's head is firmly in the pelvis). During labor the baby moves through the vaginal canal until the head is clearly visible (+5) and the baby is about to be delivered. If Bishop score is high, it means that there's a greater chance that an induction will be successful for you. If your score is 8 or above, it's a good indication that spontaneous labor would start soon. If an induction becomes necessary, it's likely to be successful. If score is between 6 and 7, then it's unlikely that labor will be starting soon. An induction may or may not be successful.
What is lochia made of?
Blood. The tissue lining of your uterus. Amniotic fluid. Bacteria and microorganisms. Any leftover fetal membranes. Cervical mucus.
What is chorioamnionitis?
Chorioamnionitis is a bacterial infection that occurs before or during labor. The name refers to the membranes surrounding the fetus: the "chorion" (outer membrane) and the "amnion" (fluid-filled sac). The condition occurs when bacteria infect the chorion, amnion, and amniotic fluid around the fetus.
which medication is given to induce ovulation in a woman experiencing infertility?
Clomid
Colic (interventions)
Colic is frequent, prolonged and intense crying or fussiness in a healthy infant. Colic can be particularly frustrating for parents because the baby's distress occurs for no apparent reason and no amount of consoling seems to bring any relief. These episodes often occur in the evening, when parents themselves are often tired. Episodes of colic usually peak when an infant is about 6 weeks old and decline significantly after 3 to 4 months of age. While the excessive crying will resolve with time, managing colic adds significant stress to caring for your newborn child. Symptoms Babies have been known to fuss and cry, especially during the first three months of life. The range for what's considered typical crying is difficult to pin down. In general, colic is defined as crying for three or more hours a day, three or more days a week, for three or more weeks. Features of colic may include the following: Intense crying that may seem more like screaming or an expression of pain Crying for no apparent reason, unlike crying to express hunger or the need for a diaper change Extreme fussiness even after crying has diminished Predictable timing, with episodes often occurring in the evening Facial discoloring, such as skin flushing or blushing Body tension, such as pulled up or stiffened legs, stiffened arms, clenched fists, arched back, or tense abdomen Sometimes there is relief in symptoms after the infant passes gas or has a bowel movement. Gas is likely the result of swallowed air during prolonged crying.
Congenital Heart Defects
Congenital heart defects (CHDs) are conditions that are present at birth and can affect the structure of a baby's heart and the way it works. They are the most common type of birth defect. As medical care and treatment have advanced, infants with congenital heart defects are living longer and healthier lives. The most common type of heart defect is a ventricular septal defect (VSD). What is the most common heart murmur in babies? The most common type of heart murmur is called functional or innocent. An innocent heart murmur is the sound of blood moving through a normal, healthy heart in a normal way.
stages of labor
First stage -Latent phase (dilation 1-4 cm, contractions q 10-20 min, lasting 15-20 sec) -Active phase (dilation 4-7 cm, contractions q 2-3 min, lasting 40-60 sec) -Transition phase (dilation 8-10 cm, contractions q 2 min, lasting 60-75 sec) Second stage (complete) Third stage Fourth stage
Your sleeping 6 month patient has vitals of BP 70/65 HR 190 RR 28 Temp 98.6 F/ 37 C are any abnormal?
HR 190 Normal range 1 mo-1 year 100-190 (awake), 90-160 (sleeping) 1-2 year old 98-140 (awake), 80-120 (sleeping)
Certified Nurse Midwife
Educated in the two disciplines of nursing and midwifery Prepared to manage independently the care of women at low risk for complications during pregnancy, birth, and the postpartum period, as well as the care of healthy newborns. So what types of patients would NOT be appropriate for a CNM?
What are childhood developmental norms?
Erikson's stages Infancy - Basic trust versus mistrust. Toddler - Autonomy versus shame and doubt. Preschool-age - Initiative versus guilt. School-age - Industry versus inferiority. Adolescence - Identity versus identity confusion. Young adulthood - Intimacy versus isolation. general milestones birth to 1 likes to cuddle, follows objects, comforted by touch 2-3 holds rattles, side to back, hold her head partially 4-6 grasps objects at will, manipulates objects, supports weight when held standing 8-10 pincer grasp, crawl, pulls body by arms 10-12 shape sorter, stands alone, sit from standing 0-1 solitary play 2-3 parallel play (associate dramatic) 5-6 cooperative What is an example of associative play? Playing dress-up, using the same playground equipment, or sharing a play kitchen are good examples of associative play activities; each child has their own focus but may be talking to each other and using the same toys to carry that out.
Fetal positions
Frank breech is when the baby's legs are folded flat up against his head and his bottom is closest to the birth canal The most common and safest combination consists of the following: Head first (called vertex or cephalic presentation) Facing rearward. Face and body angled toward the right or left. Neck bent forward. Chin tucked in. Arms folded across the chest. Occiput anterior (OA) The best fetal position for your baby to be shortly before birth is feet up, head down, facing your back, with their back resting against your belly. Occiput posterior (OP) Breech position. Oblique position. Transverse position.
Apgar scores
How is Apgar score for newborn used? The Apgar score is a test given to newborns soon after birth. This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed. The test is usually given twice: once at 1 minute after birth, and again at 5 minutes after birth. Heart rate: 0 - No heart rate 1 - Fewer than 100 beats per minute indicates that the baby is not very responsive. 2 - More than 100 beats per minute indicates that the baby is vigorous. Respiration: 0 - Not breathing 1 - Weak cry-may sound like whimpering or grunting 2 - Good, strong cry Muscle tone: 0 - Limp 1 - Some flexing (bending) of arms and legs 2 - Active motion Reflex response: 0 - No response to airways being stimulated 1 - Grimace during stimulation 2 - Grimace and cough or sneeze during stimulation Color: 0 - The baby's entire body is blue or pale 1 - Good color in body but with blue hands or feet 2 - Completely pink or good color
Disadvantages of epidurals
Most common complication is maternal hypotension May slow labor progress and fetal descent Less effective pushing efforts (decreased sensation) Increase in other interventions (vacuum, forceps, cesarean)
Group B Strep
In women, GBS most often is found in the vagina and rectum. This means that GBS can pass from a pregnant woman to her fetus during labor. This is rare and happens to 1 or 2 babies out of 100 when the mother does not receive treatment with antibiotics during labor. The chance of a newborn getting sick is much lower when the mother receives treatment.
Infertility
Infertility is defined as not getting pregnant after 1 year of having regular sexual intercourse without using birth control. If you are older than 35, an evaluation is recommended after 6 months of trying. TX: ovulation stimulation, gonadotrophins, surgery to open blocked tubes, for endometriosis
IUGR
Intrauterine Growth Retardation A condition in which a baby doesn't grow to normal weight during pregnancy. Causes of intrauterine growth restriction vary but include placenta abnormalities, high blood pressure in the mother, infections, and smoking or alcohol abuse. With this condition, a baby is born weighing less than 90 percent of other babies at the same gestational age. Ultrasounds during pregnancy help monitor a baby's weight. Depending on the results, the baby may need to be delivered early
a child whose repeatedly brought to the ED for vomiting but s/s seem to disappear when a caregiver is present may be indicative of.
Munchausen syndrome by proxy
Shoulder dystocia risk factors
MOM Extreme heavy bleeding after giving birth (postpartum hemorrhage). Severe tearing of the area between your vagina and anus (perineum). Rectovaginal fistula: A rectovaginal fistula is an abnormal connection between your vagina and rectum. BABY If shoulder dystocia is not properly identified and overcome, a baby can potentially die or suffer serious brain damage from oxygen deprivation. As a result, OB/GYNs have a very limited window of time to act in response to shoulder dystocia
Placenta Previa
Placenta previa occurs when a baby's placenta partially or totally covers the mother's cervix — the outlet for the uterus. Placenta previa can cause severe bleeding during pregnancy and delivery. With placenta previa, pt might bleed throughout your pregnancy and during your delivery. PV is rare.
How does estrogen and progesterone affect the cardiovascular system of a pregnant woman?
Pregnancy is associated with vasodilation of the systemic vasculature and the maternal kidneys. The systemic vasodilation of pregnancy occurs as early as at 5 weeks and therefore precedes full placentation and the complete development of the uteroplacental circulation.2 In the first trimester, there is a substantial decrease in peripheral vascular resistance, which decreases to a nadir during the middle of the second trimester with a subsequent plateau or slight increase for the remainder of the pregnancy3 (Figure 1). The decrease is ≈35% to 40% of baseline. Systemic vascular resistance increases to near-prepregnancy levels postpartum,4 and by 2 weeks after delivery, maternal hemodynamics have largely returned to nonpregnant levels.5 Increased vascular distensibility, or compliance, has been observed in normal human pregnancy starting in the first trimester.6 Systemic vascular resistance increases to near-prepregnancy levels postpartum.4 Vasodilation of the kidneys results in a 50% increase in renal plasma flow and glomerular filtration rates by the end of the first trimester. This results in decreases in serum creatinine, urea, and uric acid values
Advantages of epidurals
Relieves discomfort during labor Results in less fetal adverse effects than IV analgesia Allows woman to rest and regain energy for labor
Rh Alloimmunization
Rh alloimmunization in pregnancy develops when the maternal red blood cells (RBCs) lacking the Rh antigen (RhD negative) are exposed to RhD positive RBCs through the placenta leading to the activation of the maternal immune system The dose at 28 weeks is fixed for all pregnant women BUT The Kleihauer-Betke (KB) test = used to determine required dose of Rhogham *POST BIRTH*. Given to Rh(-) mothers The 2nd dose is dependent on the KB test and needs to be altered accordingly in order to prevent hemolysis.
postpartum hemorrhage nursing intervention
Save all perineal pads used during bleeding and weigh them to determine the amount of blood loss. Place the woman in a side lying position to make sure that no blood is pooling underneath her. Assess lochia frequently to determine if the amount discharged is still within the normal limits. What is the first line management of postpartum hemorrhage? Oxytocin (Pitocin) is the first choice for prevention of postpartum hemorrhage because it is as effective or more effective than ergot alkaloids or prostaglandins and has fewer side effects
Should pregnant women eat fish? what to avoid?
Some ok, avoid high mercury like tilefish, shark, makerel
Analgesics used during labor:
Stadol Nubain Demerol Fentanyl
Possible SE of analgesics given during labor
Stadol (sedation, sweaty, clammy, N&V) Nubain (sedation, dizzy, faint, hypo/hypertension) Demerol (pruritis, dizzy, sedation, nausea, constipation) Fentanyl (bradycardia, hypotension, N&V, respiratory depression)
define lochia serosa vs lochia rubra, discuss the 3 stages of lochia
Stage 1 Lochia Rubra Dark or bright red blood. Lasts for three to four days. Flows like a heavy period. Small clots are normal. Mild, period-like cramping. Stage 2 Lochia Serosa Pinkish brown discharge that's less bloody looking. Thinner and more watery than lochia rubra. Lasts for four to 12 days. Flow is moderate. Less clotting or no clots. Stage 3 Yellowish white discharge. Little to no blood. Light flow or spotting. Lasts from about 12 days to six weeks. No clots.
TORCH infections—focus on what distinguishes them from one another
TORCH is an acronym for a group of diseases that cause congenital (present at birth) conditions if a fetus is exposed to them in the uterus. TORCH stands for: toxoplasmosis other (such as syphilis, varicella, mumps, parvovirus, and HIV) rubella cytomegalovirus herpes simplex What causes these in utero TORCH infections? A baby contracts a TORCH infection in the uterus when the mother catches the infectious disease and carries it through her bloodstream to the baby. The developing fetus is especially vulnerable to illness because its immune system is not yet strong enough to permanently fight off infection. Since a baby in utero cannot completely get rid of an infection, the disease remains in the body and can prevent the child's vulnerable organs from developing correctly.
Placenta Previa main symptom
The main symptom is bright red vaginal bleeding without pain during the second half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Toxic Shock
Toxic shock syndrome is a rare, life-threatening complication of certain types of bacterial infections. Often toxic shock syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria, but the condition may also be caused by toxins produced by group A streptococcus (strep) bacteria. Toxic shock syndrome can affect anyone, including men, children and postmenopausal women. Risk factors for toxic shock syndrome include skin wounds, surgery, and the use of tampons and other devices, such as menstrual cups, contraceptive sponges or diaphragms. S/S A sudden high fever Low blood pressure Vomiting or diarrhea A rash resembling a sunburn, particularly on your palms and soles Confusion Muscle aches Redness of your eyes, mouth and throat Seizures Headaches Causes Most commonly, Staphylococcus aureus (staph) bacteria cause toxic shock syndrome. The syndrome can also be caused by group A streptococcus (strep) bacteria. Risk factors Toxic shock syndrome can affect anyone. About half the cases of toxic shock syndrome associated with staphylococci bacteria occur in women of menstruating age; the rest occur in older women, men and children. Streptococcal toxic shock syndrome occurs in people of all ages. Toxic shock syndrome has been associated with: Having cuts or burns on your skin Having had recent surgery Using contraceptive sponges, diaphragms, superabsorbent tampons or menstrual cups Having a viral infection, such as the flu or chickenpox Complications Toxic shock syndrome can progress rapidly. Complications may include: Shock Renal failure Death Prevention
fetal heart tones -- interventions:
Variable decelerations Chord compression Early decelerations Head compression Accelerations Ok, may need O2 Late decelerations Placental insufficiency VEAL CHOP
Bradycardia r/t hypoxia, Chronic Hypoxemia
Why does hypoxia cause bradycardia in infants? As a result, hypoxia triggers a vagal response and slows the heart. Infants and small children have a cardiac output that is rate dependent. Bradycardia significantly lowers cardiac output and oxygen delivery; hypoxia and hypercarbia worsen
appropriate intervention during labor for a woman who tested positive for group B strep at 35 wks
administer IV antibiotics during labor
appropriate intervention for baby with APGAR of 4..
administer oxygen and place on warming table
What are the positive signs of pregnancy?
and HR US (see and hear heart beat)
preferred fetal positioning
anterior occuput
when to check glucose for a pregnant woman...
between 24-28 wks
common sign of child abuse...
bite marks
most concerning long-term effect of hyperbilirubinemia in newborn
brain damage
What are presumptive signs of pregnancy?
breasts hurt late period
what the nurse should NEVER do when walking a family to the car for discharge
buckle their child in the car seat safely
disadvantage to epidurals...
can slow labor progress and fetal descent
lactose intolerance in pregnant women
can take OTC enzyme tabs or drops, cooked or fermented dairy may be ok
true indication of labor
cervical dilation
what assessment of a newborn upon the cut cord would likely warrant attention
circumoral cyanosis
Cultural Assessment of a pregnant woman/couple
consider religion, working moms/stay at home moms, cultural preferences w placenta, chord, meds, who holds baby first, etc
What are potential SEs of pain medication?
constipation, tolerance, addiction, lower RR, drowsy
infant locomotion on hands and knees (discussed with Exam 1 content, slide placed in Final Exam Module)
crawling - 6-7 months creeping (belly off floor) - 9 months pulls to stand - 10 months walk with assist - age 11 months walk alone - age 12 months
SANE nursing priority (sexual assault nurse examiner)
creating a safe environment for the patient
decelerations
early -- head compression variable -- chord compression late -- placental insufficiency prolonged -- (>2 min + >15 bpm decel)
Mom assessment
expect firm fundus, if not, massage to help firm up, breast feed helps firm uterus BUBBLE: (breasts, uterus, bowel, bladder, lochia, episiotomy) incision: (check for redness, erythemia, blood, approximation (REBA)
Nutrients and supplements needed during pregnancy
folate to prevent spina bidifa prenatal vits
induction methods
foley bulb stripping membranes administering pitocin
rhogam medication for...
for Rh- mom and Rh+ baby given at 28 wks given 1-3 days postpartum
Discuss Salmonella concerns
from raw eggs, avoid raw or lightly cooked eggs, cake batter, homemade ice cream, etc.
4th stage of labor: recovery
fundal assessment (height, firmness), baby bonding, blood loss, breast feeding, check HR, BP when checking fundus
What are age appropriate accident prevention steps?
gates, car seats, locks, latches, outlet covers
a 1-year-old is admitted for RSV is having retractions. mom calls out in concern. what finding is most concerning
heart rate of 68 not concerning... glucose of 90 BP of 92/54 mild intercostal retraction
what torch infection is Tx with acyclovir
herpes
unexpected S/E of a PCA pump...
hypertension
Does lochia have a foul smell?
no, can smell like mentrual blood, or musty, metallic, sour, stale
When is induction indicated?
not before 39 weeks, at 41-42
pregnancy test
objective/probable
an order we should question for placenta previa
obtain equipment for a vaginal exam
a pt is admitted with a trach. which of the following should be at bedside
one trach a size smaller one trach the same size
nursing role in teaching school-age kids about bullying
teach kids to promptly report what they experience or see happening
which assessment would let the nurse know there may be retainment of placental fragments
temp
What are probable signs of pregnancy?
test is pos
