NUR 221 Final Exam

Risk factors for Jaundice

Brusing Sibling with Jaundice Hemo Disorder Tramatic Birth Not feeding

after delivery the fondus should feel like?

firm at belly button midline goes down once CM a day

What is the Ballard score?

A simplified score for assessment of fetal maturation of newborns. (six neuromuscular signs, six physical signs)

Prolapse Cord and what to do

Call for help, Lifts whatever part is being compressed, change position (mothers)

Misoprostol (Cytotec)

Contracts the uterus give rectally, sublingual or PO

interventions for Postpartum Hem

massage fondus top and bottom. (always hold bottom) Bolus

Jaundice in the first 24 hours is

typically Patho and it could be because of sepsis and blood incompatibility

Methylergonovine

contraindicated in clients with significant cardiovascular disease, peripheral vascular disease, hypertension, preeclampsia, or eclampsia.

Rh factor

presence or lack of antigens on the surface of red blood cells, which causes a reaction between Rh-positive blood and Rh-negative blood this affects the second baby

Premature Rupture of membranes

- first thing check FHR - Check time of Rupture - Monitor signs of infection (check color and smell of amniotic fluid) -Limit vaginal exams - if mom is in preterm labor give tocolytics

Drug Exposed infant

- high pitched crying - irritability - loose stool - temp instability - test called neonate abstentions syndrome (NAS) will determine how sever the withdrawl is

Non-stress test

- reactive is good - Favorable results- 2 or more FHR accelerations of 15 beats lasting 15 seconds in a 20 minute period - Test checks for fetal well being

Fetal dimise or loss

-Ask if they want to hold the baby -make memory box -take pictures -religious preferences -talk about the infant

What does a newborn screen check

-Genetic screening -has to be done 24 hours after birth or before discharge -mandated -heel stick -will not get results right away they will be mailed to you

Newborn complications of RH issoimunization/ABO incompatibility

-Jaundice -anemic -hydro fetalis -Erythroblastosis fetalis

Methylergonovine (Methergine)

Acts directly on the uterine muscle to stimulate forceful contractions. Used for postpartum hemorrhage. Precautions/interactions: use with extreme caution in clients with hypertension, preeclampsia, heart disease, venoatrial shunts, mitral valve stenosis, sepsis, or hepatic or renal impairment. Side effects: potential vasoconstriction, hypertension, headache. Interventions: continuously monitor BP, assess uterine bleeding, and uterine tone.

The nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which sign, if noted, would be an early sign of excessive blood loss?

An increase in the pulse rate from 88 to 102 beats per minute. During the fourth stage of labor, the maternal blood pressure, pulse, and respiration should be checked every 15 minutes during the first hour. An increasing pulse is an early sign of excessive blood loss because the heart pumps faster to compensate for reduced blood volume.

What is TORCH syndrome?

Group of infections that BABIES acquire in UTERO or at birth or postnatally T= Toxoplasmosis O= Other (HBV, Parvovirus, HIV, West Nile Virus) R= Rubella C= CMV infection H= Herpes simplex

Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority assessment?

Methylergonovine, an ergot alkaloid, is used to prevent or control postpartum hemorrhage by contracting the uterus. Methylergonovine causes continuous uterine contractions and may elevate the blood pressure. A priority assessment before the administration of the medication is to check the blood pressure. The obstetrician needs to be notified if hypertension is present.

The nurse is preparing to care for a newborn receiving phototherapy. Which interventions should be included in the plan of care? Select all that apply.

Monitor skin temperature closely. Reposition the newborn every 2 hours. Cover the newborn's eyes with eye shields or patches.

Risk factors for postpartum hemorrhages

Multi-gestation, Trauma, Retained Placenta Pieces, Magsulfate (not allowing the fondus to cramp back down), Chorio, and Oxytocin (Due to uterus cramping down too fast)

The nurse in a labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. What is the firstnursing action with this finding?

Place the client in Trendelenburg's position.

A postpartum client is attempting to breast-feed for the first time. The nurse notes that the client has inverted nipples. What nursing action should the nurse take to assist the client in breast-feeding the newborn infant?

Provide breast shells and assist the mother with using a breast pump before each feeding to make the nipples easier for the newborn infant to grasp.

did you know

Urine output is a good way to measure organ perfusion

RhoGAM

Used to prevent an immune response to Rh positive blood in people with an Rh negative blood type

what is the number one cause of postpartum hemorrhages

Uterine Atony

Coombs test

a test for the presence of anti-Rh factor antibodies in the blood (this is often given to pregnant women that are Rh- to see if they will mount an immune response against the blood of their fetus)

Hemabate (Carboprost)

do not give if you have asthma! o Uterine Contraction / prevention of bleeding - smooth muscle contraction use with caution on woman who have a history of:liver heart lungs disease. asthma hypertension diabetes or uterine scarring

what is the process of normal clotting?

Coagulation Process and Fibralinic

s/s of postpartum hemorrhage

-increase or change in lochial pattern (large clots) -uterine atony -blood clots larger than a quarter -perineal pad saturated in 15 minutes or less -constant oozing, trickling, or frank flow of bright red blood from the vagina -tachycardia and hypotension -skin pale, cool, and clammy with loss of turgor and pale mucous membranes -oliguria

Safety Protocols in maternity ward

-matching wrist -don't leave baby alone -alarms -Parents should ask for photo idea if they find anything suspicious about a person

Symptoms of newborn congenital heart disease

-mumurs -around the lips cyanosis -good pulse on top extremities and weak pulses on lower extremites -color changes when feeding or crying

Factors that increase risk of maternal fetal blood incompatability

ABO blood types Mom is RH negative Pre pregnancy blood transfer Multi-pregnancy

What is uterine atony?

Failure of the uterus to "cramp down" and tighten after delivery

Hemorrahge medication for postpartum mom

Hemabate methylergine oxtocin cytotec

ABO incompatibility

Mother's blood type is O Infant's blood type is A, B, or AB It affects any pregnancy

Nuchal Folds

can be a sign of downs or turner syndrome

post partum hemorrhage is defined as

500 ml for vaginal to include delivery blood loss and 1,000 ml for c-section to include delivery blood loss