ATI Maternity 2

In teaching parents to use a bulb syringe to suction an infant, the nurse should teach them to 1. Always suction the mouth before suctioning the nose 2. Insert the syringe into the sides of the mouth. 3. Use it only once a day.

1. Always suction the mouth before suctioning the nose 2. Insert the syringe into the sides of the mouth

Which temperature indicates the presence of postpartum infection? • 99.6° F in the first 48 hours • 100° F for 2 days postpartum • 100.4° F in the first 24 hours • 100.8° F on the second and third postpartum days

100.8° F on the second and third postpartum days

newborn HR

110 - 160/min

Newborn RR

30- 60/ min with short periods of apnea (<15 seconds) - apnea > 15 secs should be evaluated

Newborn Temp

36.5 C to 37.5 C (97.7 F to 99.5 F) axillary

Hyperbilirubinemia

5 - 7 mg/dl jaundice visible in the face then moves down the body Risk for acute bilirubin encephalopathy and kernicterus

Early postpartum hemorrhage is defined as a blood loss greater than _____ ml in the first _____ hours after _____ delivery • 500; 24; vaginal • 750; 24; vaginal • 1000; 48; cesarean • 1500; 48; cesarean

500; 24; vaginal

Newborn BP

60 to 80 mm Hg systolic and 40 to 50 mm Hg diastolic.

A postpartum client would be at increased risk for postpartum hemorrhage if she delivered a(n): (Look for the best answer) • 5 lb, 2 oz infant with outlet forceps. • 6.5 lb infant after a 2-hour labor. • 8 lb infant after an 23-hour labor. • 8 lb infant after a 12-hour labor.

8 lb infant after an 23-hour labor.

A nurse is caring for a client who is in labor and observes late decelerations on the electronic fetal monitor. Which of the following is the first action the nurse should take? A. Assist the client into the left-lateral position. B. Apply a fetal scalp electrode. C. Insert an IV catheter. D. Perform a vaginal exam.

A

A nurse is caring for a client in the third stage of labor. Which of the following findings indicate that placental separation? (Select all that apply.) A. Lengthening of the umbilical cord B. Swift gush of clear amniotic fluid C. Softening of the lower uterine segment D. Appearance of dark blood from the vagina E. Fundus firm upon palpation

A D E

neonatal abstinence syndrome

A cluster of physical signs exhibited by newborns exposed in utero to maternal use of substances such as heroin.

containment

A method of increasing comfort in infants by swaddling or other means to keep the extremities in a flexed position near the body.

kangaroo care

A method of providing skin-to-skin contact between infants and their parents.

A nurse is teaching a newly licensed nurse how to bathe a newborn and observes a bluish marking across the newborn's lower back. The nurse should include which of the following information in the teaching? A. "This is frequently seen in newborns who have dark skin." B. "This is a finding indicating hyperbilirubinemia." C. "This is a forceps mark from an operative delivery." D. "This is related to prolonged birth or trauma during delivery."

A. "This is frequently seen in newborns who have dark skin."

A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions every 3 to 5 min and becoming stronger. A vaginal exam reveals that the client's cervix is 3 cm dilated, 80% effaced, and -1 station. The client asks for pain medication. Which of the following actions should the nurse take? (Select all that apply.) A. Encourage use of patterned breathing techniques. B. Insert an indwelling urinary catheter. C. Administer opioid analgesic medication. D. Suggest application of cold. -mind over matter- forehead, wrists, behind her neck E. Provide ice chips. - not related to pain relief

A. Encourage use of patterned breathing techniques. C. Administer opioid analgesic medication. D. Suggest application of cold. -mind over matter- forehead, wrists, behind her neck

A nurse is providing care for a client who is in active labor. Her cervix is dilated to 5 cm, and her membranes are intact. Based on the use of external electronic fetal monitoring, the nurse notes a FHR of 115 to 125/min with occasional increases up to 150 to 155/min that last for 25 seconds, and have beat to beat variability of 20/min. There is no slowing of FHR from the baseline. The nurse should recognize that this client is exhibiting signs of which of the following? (Select all that apply.) A. Moderate variability B. FHR accelerations C. FHR decelerations D. Normal baseline FHR

AB D

DIC

AKA Comsumptive coagulopathy o Oozing from a puncture site or development of petechia may be initial clues of coagulopathy o May occur during pregnancy or immediate postpartum period

tracheoesophageal fistula

Abnormal connection between the esophagus and trachea.

bilirubin encephalopathy

Acute manifestation of bilirubin toxicity occurring in the first weeks after birth.

erythroblastosis fetalis

Agglutination and hemolysis of fetal erythrocytes caused by incompatibility between the maternal and fetal blood types, such as when the fetus is Rh-positive and the mother is Rh-negative.

postterm infant

An infant born after 42 weeks of gestation.

preterm infant

An infant born before the beginning of the 38th week of gestation. Also called premature infant.

late preterm infant

An infant born between 34 0/7 and 36 6/7 weeks of gestation.

extremely-low-birth-weight infant

An infant weighing 1000 g (2 lb, 3 oz) or less at birth.

very-low-birth-weight infant

An infant weighing 1500 g (3 lb, 5 oz) or less at birth.

low-birth-weight infant

An infant weighing less than 2500 g (5 lb, 8 oz) at birth.

large-for-gestational-age infant

An infant whose size is above the 90th percentile for gestational age.

small-for-gestational-age infant

An infant whose size is below the 10th percentile for gestational age.

Which nursing measure would be appropriate to prevent thrombophlebitis in the recovery period following a cesarean birth? • Roll a bath blanket and place it firmly behind the knees. • Limit oral intake of fluids for the first 24 hours. • Assist client in performing leg exercises every 2 hours. • Ambulate the client as soon as her vital signs are stable.

Assist client in performing leg exercises every 2 hours.

Why does a baby's heart rate fluctuate so much in pregnancy and labor?

Autonomic Nervous System o Baroreceptors o Chemoreceptors o CNS o Adrenal Glands- fight or flight

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. Which of the following actions should the nurse make? A. Assist the client to the bathroom. B. Prepare for an impending delivery. C. Prepare to remove a fecal impaction. D. Encourage the client to take deep, cleansing breaths.

B

A nurse is performing Leopold maneuvers on a client who is in labor. Which of the following techniques should the nurse use to identify the fetal lie? A. Apply palms of both hands to sides of uterus. B. Palpate the fundus of the uterus. C. Grasp lower uterine segment between thumb and fingers. D. Stand facing client's feet with fingertips outlining cephalic prominence.

B

A nurse is teaching a client about the benefits of internal fetal heart monitoring. Which of the following should statements the nurse include in the teaching? (Select all that apply.) A. "It is considered a noninvasive procedure." B. "It can detect abnormal fetal heart tones early." C. "It can determine the amount of amniotic fluid you have." D. "It allows for accurate readings with maternal movement." E. "It can measure uterine contraction intensity."

B D E

A nurse is caring for a newborn who was born at 38 weeks of gestation, weighs 3,200 g, and is in the 60th percentile for weight. Based on the weight and gestational age, the nurse should classify this neonate as which of the following? A. Low birth weight B. Appropriate for gestational age C. Small for gestational age D. Large for gestational age

B. Appropriate for gestational age

Sedatives

Barbituates o Pentobarbitals o Early latent phases- promote sleep, reduce anxiety o Unable to ambulate o Drowsiness

periventricular-intraventricular hemorrhage

Bleeding around and into the ventricles of the brain.

BUBBLE-HE

Breasts Uterus Bowel Bladder Lochia Episiotomy Homan (DVT) Education

A nurse is caring for a client and her partner during the second stage of labor. The client's partner asks the nurse to explain how he will know when crowning occurs. Which of the following responses should the nurse make? A. "The placenta will protrude from the vagina." B. "Your partner will report a decrease in the intensity of contractions." C. "The vaginal area will bulge as the baby's head appears." D. "Your partner will report less rectal pressure."

C

A nurse is caring for a client following the administration of an epidural block and is preparing to administer an IV fluid bolus. The client's partner asks about the purpose of the IV fluids. Which of the following is an appropriate response for the nurse to make? A. "It is needed to promote increased urine output." B. "It is needed to counteract respiratory depression." C. "It is needed to counteract hypotension." -almost universal that a patient receiving an epidural will have drops of blood pressure- Effedrine- vasoconstrict D. "It is needed to prevent oligohydramnios."

C. "It is needed to counteract hypotension." -almost universal that a patient receiving an epidural will have drops of blood pressure- Effedrine- vasoconstrict

A nurse is completing an assessment. Which of the following data indicate the newborn is adapting to extrauterine life? (Select all that apply.) A. Expiratory grunting B. Inspiratory nasal flaring C. Apnea for 10 second periods D. Obligatory nose breathing E. Crackles and wheezing

C. Apnea for 10 second periods D. Obligatory nose breathing

Apneic spells

Cessation of breathing for more than 20 seconds or accompanied by cyanosis or bradycardia.

periodic breathing

Cessation of breathing lasting 5 to 10 seconds followed by 10 to 15 seconds of rapid respirations without changes in color or heart rate.

kernicterus

Chronic and permanent result of bilirubin toxicity.

bronchopulmonary dysplasia

Chronic pulmonary condition in which damage to the infant's lungs requires prolonged dependence on supplemental oxygen. Also called chronic lung disease.

respiratory distress syndrome

Condition caused by insufficient production of surfactant in the lungs; results in ate-lectasis (collapse of the lung alveoli), hypoxia (decreased oxygen [O2] concentration), and hypercapnia (increased [CO2] concentration).

postmaturity syndrome

Condition in which a postterm infant shows characteristics indicative of poor placental functioning before birth. Also called dysmaturity syndrome.

retinopathy of prematurity

Condition in which damage to blood vessels may cause decreased vision or blindness.

esophageal atresia

Condition in which the esophagus is separated from the stomach and ends in a blind pouch. gastroschisis Protrusion of the intestines through a defect in the abdominal wall. The intestines are not covered by a peritoneal sac or skin.

Heat loss

Conduction- cold stethoscope, cold table Convection- the air vent in the room- cover their head Radiation- closer they are to warmer lights, the hotter they will be

A nurse in labor and delivery is planning care for a newly admitted client who reports she is in labor and has been having vaginal bleeding for 2 weeks. Which of the following should the nurse include in the plan of care? A. Inspect the introitus for a prolapsed cord. B. Perform a test to identify the ferning pattern. C. Monitor station of the presenting part. D. Defer vaginal examinations.

D

A nurse is caring for a client who is in the first stage of labor and is encouraging the client to void every 2 hr. Which of the following statements should the nurse make? A. "A full bladder increases the risk for fetal trauma." B. "A full bladder increases the risk for bladder infections." C. "A distended bladder will be traumatized by frequent pelvic exams." D. "A distended bladder reduces pelvic space needed for birth."

D

A nurse is reviewing the electronic monitor tracing of a client who is in active labor. The nurse should know that a fetus receives more oxygen when which of the following appears on the tracing? A. Peak of the uterine contraction B. Moderate variability C. FHR acceleration D. Relaxation between uterine contractions

D

If nonsurgical treatment for subinvolution is ineffective, which surgical procedure is appropriate to correct the cause of this condition? • Hysterectomy • Laparoscopy • Laparotomy • D&C

D&C

A nurse is completing a newborn assessment and observes small white nodules on the roof of the newborn's mouth. This finding is a characteristic of which of the following conditions? A. Mongolian spots- looks like a bruise on the buttocks or the shoulders B. Milia spots- look like whiteheads on the nose C. Erythema toxicum- looks acne- normal D. Epstein's pearls

D. Epstein's pearls

A nurse is assessing the reflexes of a newborn. In checking for the Moro reflex, the nurse should perform which of the following? A. Hold the newborn vertically under arms and allow one foot to touch table. B. Stimulate the pads of the newborn's hands with stroking or massage. C. Stimulate the soles of the newborn's feet on the outer lateral surface of each foot. D. Hold the newborn in a semi sitting position, then allow the newborn's head and trunk to fall backward

D. Hold the newborn in a semi sitting position, then allow the newborn's head and trunk to fall backward

A nurse is caring for a client who is using patterned breathing during labor. The client reports numbness and tingling of the fingers. Which of the following actions should the nurse take? A. Administer oxygen via nasal cannula at 2 L/min. B. Apply a warm blanket. C. Assist the client to a side-lying position. D. Place an oxygen mask over the client's nose and mouth

D. Place an oxygen mask over the client's nose and mouth

spina bifida

Defective closure of the bony spine that encloses the spinal cord; a type of neural tube defect.

Lochia

Discharge- slough off heavy to light

intrauterine growth restriction

Failure of a fetus to grow as expected for gestational age.

Although circumcision continues to be a controversial procedure, many parents in the United States elect to have this surgery performed on their newborn sons. It is believed that newborns do not feel pain; therefore, this is the optimum time for the procedure to be done and no anesthesia is required • true • false

False

To assess fundal contraction 6 hours after cesarean delivery, the nurse should • Gently palpate, applying the same technique used for vaginal deliveries. • Place hands on both sides of the abdomen and press downward • Rely on assessment of lochial flow rather than palpating the fundus.

Gently palpate, applying the same technique used for vaginal deliveries

corrected age

Gestational age that a preterm infant would be if still in utero; the chronologic age minus the number of weeks the infant was born prematurely. Also may be called developmental age.

hydrops fetalis

Heart failure and generalized edema in the fetus secondary to severe anemia resulting from destruction of erythrocytes.

Macrosomia

Infant birth weight above the 90th percentile for gestation age. Some sources use more than 4000 g (8 lb, 13 oz) or 4500 g (9 lb, 15 oz).

A mother with mastitis is concerned about breast-feeding while she has an active infection. The nurse should explain that the • Infant is protected from infection by immunoglobulins in the breast milk. • Infant is not susceptible to the organisms that cause mastitis • Organisms that cause mastitis are not passed to the milk. • Organisms will be inactivated by gastric acid.

Infant is protected from infection by immunoglobulins in the breast milk

Thrombophlebitis

Inflammatory changes in the vessel wall generally accompany by thrombus formation

Which measure may prevent mastitis in a breastfeeding mother? • Initiating early and frequent feedings • Nursing the infant for 5 minutes on each breast • Wearing a tight-fitting bra • Applying ice packs prior to feeding

Initiating early and frequent feedings

asphyxia

Insufficient oxygen and excess carbon dioxide in the blood and tissues.

parenteral nutrition

Intravenous infusion of all nutrients known to be needed for metabolism and growth.

In providing and teaching cord care, which principle is important 1. Cord care is done only to control bleeding 2. Alcohol is the only agent used for cord care 3. Keeping the cord dry will decrease bacterial growth

Keeping the cord dry will decrease bacterial growth

A sign of thrombophlebitis is: • Visible varicose veins. • Positive Homans' sign. • Local tenderness, heat, and swelling. • Pedal edema in the affected leg.

Local tenderness, heat, and swelling

transcutaneous oxygen monitoring

Method of continuous noninvasive measurement of oxygen in the blood by transducers attached to the skin.

Which instruction should be included in the discharge teaching plan to assist the client in recognizing early signs of complications? • Palpate the fundus daily to ensure that it is soft. • Notify the physician of any increase in the amount of lochia or a return to bright red bleeding. • Report any decrease in the amount of brownish red lochia • The passage of clots as large as an orange can be expected.

Notify the physician of any increase in the amount of lochia or a return to bright red bleeding

enteral feeding

Nutrients supplied to the gastrointestinal tract orally or by feeding tube.

meconium aspiration syndrome

Obstruction and air trapping caused by meconium in the infant's lungs, which may lead to severe respiratory distress.

omphalocele

Protrusion of the intestines into the base of the umbilical cord. The intestines are covered by a peritoneal sac.

myelomeningocele

Protrusion of the meninges and spinal cord through a defect in the vertebrae; a form of neural tube defect.

Meningocele

Protrusion of the meninges through a defect in the vertebrae; a form of neural tube defect.

Newborn bradypnea

RR < 30/min

Newborn Tachypnea

RR > 60/min

The purpose of state-required newborn screening is to • Keep the state records updated. • Document the number of births. • Recognize and treat newborn disorders early.

Recognize and treat newborn disorders early.

Lochia rubra

Red, present 1-2 days after birth

noncompliance

Resistance of the lungs and thorax to distention with air during respirations.

Nipple feeding readiness

Rooting ➢ Sucking on gavage tube, finger, or pacifier ➢ Ability to tolerate holding ➢ Respiratory rate <60 breaths per minute ➢ Presence of gag reflex ➢ ***Speech Pathology will assist you with teaching the newborn how to suck appropriately

A nurse is caring for a client who is in active labor. The client reports lower-back pain. The nurse suspects that this pain is related to a persistent occiput posterior fetal position. Which of the following nonpharmacological nursing interventions should the nurse recommend to the client? A. Abdominal effleurage B. Sacral counterpressure C. Showering if not contraindicated D. Back rub and massage

Sacral counterpressure

necrotizing enterocolitis

Serious inflammatory condition of the intestines.

ABGAR

Severe distress 0-3 Moderate distress 4-6 Minimal to no difficulty 7-10 HR 0 - absent 1 - slow, < 100/min 2 - > 100/min RR 0 - absent 1 - slow, weak cry 2 - good cry Muscle tone 0 - flaccid 1 - some flexion 2 - well-flexed Reflex 0 - none 1 - Grimase 2 - cry Color 0 - blue, pale 1 - pink body, acrocyanosis 2- completely pink

compliance

Stretchability or elasticity of the lungs and thorax that allows distention without resistance during respirations.

persistent pulmonary hypertension

Vasoconstriction of the infant's pulmonary vessels after birth; may result in right-to-left shunting of blood flow through the ductus arteriosus, the foramen ovale, or both.

minimal enteral nutrition

Very small feedings designed to help the gastrointestinal tract mature. Also called trophic feedings.

Epidural & spinal regional analgesics

What are they? o Block pain receptors Adverse Effects o Decrease gastric emptying time- n/v o Inhibits bowel and bladder sensation- do not automatically put in a foley catheter, want to put her on the bed pain o MOST COMMON- drop in mothers BP o Tachycardia or bradycardia o hyperthermia Client Education o Ongoing o Bed rest, move side to side with assistance o Dizziness can occur Nursing Actions o Look for signs of hypotension o Fetal compromise- effedrine- increase fetal HR o VS every 2 minutes for the first 15 minutes, every 5 mins for the next hour

Meconium-stained fluid

a sign of fetal distress • Any/All of the complications discussed can at any time lead to meconium if the fetus is struggling to obtain enough oxygen • The problem with Meconium Stained Fluid is the effects at the time of extra-uterine transition.....we DO NOT WANT MECONIUM to penetrate the bronchioles leading to the alveoli of the newborns lungs leading to MECONIUM ASPIRATION. This causes initially a mechanical blockage of air trying to reach the alveoli & eventuall to infection which, is very difficult for newborns to regualte and fight. • Thick meconium stained fluid-pea soup

Cephalohematoma

accommodation of blood, DOES NOT CROSS THE SUTURE LINE can lead to jaundice, increased bilirubin levels, and bleeding

Fourth- degree laceration

all the way through, skin, muscles, anal sphincter, and anterior rectal wall.

Evidence shows that postpartum depression is caused by: • Hormonal Changes • An imbalance of brain chemicals • Stress • Lack of sleep

an imbalance of brain chemicals

The Centers for Disease Control and Prevention (CDC) recommends the use of personal protective equipment when the nurse is likely to come into contact with • Any client at any time. • Any body fluids. • Blood and blood products.

any body fluids

Hypovolemic shock

decreased BP increase HR

Polycythemia

defined as a central venous hematocrit (Hct) level of greater than 65%, is a relatively common disorder. The primary concern with polycythemia is related to hyperviscosity and its associated complications.[1] Blood viscosity increases exponentially as the Hct level rises above 42%. This associated hyperviscosity is thought to contribute to the symptom complex observed in approximately one half of infants with polycythemia. However, only 47% of infants with polycythemia have hyperviscosity, and only 24% of infants with hyperviscosity have a diagnosis of polycythemia. • Retrieved from: http://emedicine.medscape.com/article/976319-overview#showall

HELLP

diagnosed by laboratory tests, not clinically. • H: Hemolysis resulting in anemia and jaundice • EL: Elevated liver enzymes resulting in elevated alanine aminotransferase (ALT) or aspartate transaminase (AST), epigastric pain, and nausea and Vomiting • LP: Low platelets (less than 100,000/mm3), resulting in thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly disseminated intravascular coagulopathy (DIC)

The client who is being treated for endometritis is placed in the Fowler position because it: • Promotes comfort and rest. • Facilitates drainage of lochia. • Prevents spread of infection to the urinary tract. • Decreases tension on the reproductive organs.

facilitates drainage of lochia

SVT

generally involves the saphenous venous system and is confined to the lower leg.

Low-lying placenta

implanted in lower segment in proximity to the os

DVT

involve veins from the foot to the iliofemoral region. It is a major concern because it predisposes to PE Most often b/w days 10 to 20 postpartum

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests: • Uterine atony. • Lacerations of the genital tract. • Perineal hematoma. • Infection of the uterus.

lacerations of the genital tract

Intrauterine pressure catheter

measures strength of contractions

Second- degree laceration

muscle involvement but no anal sphincter

Third-degree laceration

muscle involvement, perineum, and external anal sphincter muscle involved

Cervix postpartum

needs to close NOTHING IN THE VAGINA FOR 6 WEEKS

First- degree laceration

no muscle involvement

Caput succedaneum

normal finding, crosses the suture line, fluid build up, the bones overlap to accommodate- molding, it will go away in a few days to a few weeks

Magnesium Toxicity

o Absence of patellar deep tendon reflexes o Urine output less than 30 mL/hr o Respirations less than 12/min • STOP the magnesium sulfate and administer anecdote calcium gluconate • Call for help! o Decreased level of consciousness o Cardiac dysrhythmias

Opiod Analgesics

o Demerol, fentanyl, (statol, nubaine- opiod-like, less sedation) • Adverse Effects o Decrease variability in babies HR o Sedation o Lowers ability of patient to • Client Education o Change the way you perceive the pain o Crosses Placental barrier • Nursing Actions o NEVER administer pain medication unless you do a vaginal exam first o NEVER give during transition phase of labor o Narcan should be available- fetal or maternal respiratory depression anecdote

Magnesium Toxicity interventions

o Immediately discontinue infusion. o Administer antidote calcium gluconate or calcium chloride. o Prepare for actions to prevent respiratory or cardiac arrest

Cold Stress

o Ineffective thermoregulation can lead to hypoxia, acidosis,and hypoglycemia. Newborns who have respiratory distress are at a higher risk for hypothermia. • NURSING ACTIONS o Monitor for manifestations of cold stress (cyanotic trunk, depressed respirations). o The newborn should be warmed slowly over a period of 2 to 4 hr. Correct hypoxia by administering oxygen. o Correct acidosis and hypoglycemia

Diastasis recti

o May separate from the efforts of pushing or pregnancy o May require follow-up, possible surgery o Intestines behind the abdomen can protrude o If intestines become restricted can cause necrosis

FHR Variability

o Moderate variability- healthy- 6 to 25 beats o Absent- flat line- sign of hypoxia o Minimal- 1 to 5 beats o Marked- >30 beats

Hypoglycemia nurse action

o Monitor for jitteriness; twitching; a weak, high pitched cry; irregular respiratory effort; cyanosis; lethargy; eye rolling; seizures; and a blood glucose level less than 40 mg/dL by heel stick. o Have the mother breastfeed immediately or give donor breast milk or formula to elevate blood glucose levels. Brain damage can result if brain cells are depleted of glucose.

Marginal abruptio placentae

o Placenta separates at its edges o Blood passes between fetal membranes and uterine wall o Blood escapes vaginally

Central aburptio placentae

o Placenta separates centrally o Blood trapped between placenta and uterine wall o Concealed bleeding, no vaginal bleeding

Complete abruptio placentae

o Total separation o Massive vaginal bleeding

Newborn Dehydration

o Urine output <1 mL/kg/hr o Urine specific gravity >1.02 o Weight loss greater than expected o Dry skin and mucous membranes o Sunken anterior fontanel o Poor tissue turgor o Blood: elevated sodium, protein, and hematocrit levels o Hypotension

Newborn overhydration

o Urine output >3 mL/kg/hr o Urine specific gravity <1.001 o Edema o Weight gain greater than expected o Bulging fontanels o Blood: decreased sodium, protein, and hematocrit levels o Moist breath sounds o Difficulty breathing

Hematoma

o Very firm, hot to touch, almost purple or dark red pocket of fluid o Externally on the labia o < 5 cm- 1st intervention is notify the physician and apply Ice o > 5 cm- surgical intervention, notify provider immediately

A white blood cell (WBC) count of 35,000 cells/mm3 on the morning of the first postpartum day indicates • Possible infection. • Normal WBC limit. • Serious infection. • Suspicion of sexually transmitted disease.

possible infection

PE

potentially fatal complication that occurs when the pulmonary artery is obstructed by a blood clot that was swept into circulation from a vein or by amniotic fluid

A nurse is caring for a client who is in the second stage of labor. The client's labor has been progressing, and sheis expected to deliver vaginally in 20 min. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that which of the following types of regional anesthetic block is to be administered? A. Pudendal B. Epidural C. Spinal D. Paracervical

pudendal

Involution

return to pre-pregnancy state roughly the size of her closed fist (in a matter of 6 weeks)

Macrosomia

risk for trauma during birth, including fracture of the clavicles from shoulder dystocia, cephalhematoma, and facial nerve and brachial plexus injury. • Strict control of the mother's blood glucose level, especially during the third trimester, reduces the incidence of macrosomia. • Hypoglycemia of the newborn may occur after birth when the supply of glucose from the mother is no longer available but the infant's high insulin production continues. It occurs in more than 50% of macrosomic infants

Marginal placenta previa

the edge of the os is covered

Total placenta previa

the internal os is completely covered

Partial placenta previa

the internal os is partially covered

Variable Decelerations

• Abrupt drop n FHR V-like shape • Onset to nadir= <30 seconds • Cause: cord compression • Action: Change position

preeclampsia interventions

• Assess level of consciousness. • Obtain pulse oximetry. • Monitor urine output, and obtain a clean-catch urine sample to assess for proteinuria. • Obtain daily weights. • Monitor vital signs with careful attention to blood pressure measurement (e.g., using proper size cuff and avoiding talking to client during measurement). • Encourage lateral positioning. • Constant fetal monitoring • Perform NST and daily kick counts. • Instruct the client to monitor I&O

Placenta Previa Interventions

• Bed rest with bathroom privileges while not bleeding • NO vaginal exams • Monitor blood loss, pain, uterine contractility • Evaluate FHR with EFM • Monitor maternal vital signs • Laboratory evaluation o Hemoglobin/hematocrit o Rh factor o Urinalysis • IV fluid (lactated Ringer's solution) • Two units of crossmatched blood available

GHTN

• Begins after the 20th week of pregnancy, describes hypertensive disorders of pregnancy whereby the woman has an elevated blood pressure at 140/90 mm Hg or greater recorded on two different occasions, at least 4 hr. apart. • +20 systolic or +15 diastolic- GHTN • There is no proteinuria • The presence of edema is no longer considered in the definition of hypertensive disease of pregnancy. • Blood pressure returns to baseline by 6 weeks postpartum.

Early Decelerations

• Decelerations mirror the contractions • Cause: head compression • Action: Monitor

If rubella vaccine is indicated for a postpartum client, instructions to the client should include

• Drinking plenty of fluids to prevent fever. • The recommendation to stop breast-feeding for 24 hours after the injection • An explanation of the risks of becoming pregnant within 28 days following injection. o NOTHING IN THE VAGINA FOR 6 WEEKS o Potential for malformation of a new pregnancy

Newborn Hemorrhage

• Due to improper cord care or placement of clamp • NURSING ACTIONS o Ensure that the clamp is tight. If seepage of blood is noted, a second clamp should be applied. o Notify the provider if bleeding continues.

Moro reflex

• EXPECTED FINDING: Elicit by allowing the head and trunk of the newborn in a semi-sitting position to fall backward to an angle of at least 30°. The newborn will symmetrically extend and then abduct the arms at the elbows and fingers spread to form a "C." • EXPECTED AGE: Birth to 6 months

Stepping

• EXPECTED FINDING: Elicit by holding the newborn upright with feet touching a flat surface. The newborn responds with stepping movements. • EXPECTED AGE: Birth to 4 weeks

Plantar Grasp

• EXPECTED FINDING: Elicit by placing examiner's finger at base of newborn's toes. The newborn responds by curling toes downward. • EXPECTED AGE: Birth to 8 months

Palmar Grasp

• EXPECTED FINDING: Elicit by placing examiner's finger in palm of newborn's hand. The newborn's fingers curl around examiner's fingers. • EXPECTED AGE: Lessens by 3 to 4 months

Babinski reflex

• EXPECTED FINDING: Elicit by stroking outer edge of sole of the foot, moving up toward toes. Toes will fan upward and out. (23.6) • EXPECTED AGE: Birth to 1 year • Opposite of an adult

Sucking and rooting reflex

• EXPECTED FINDING: Elicit by stroking the cheek or edge of mouth. Newborn turns the head toward the side that is touched and starts to suck. • EXPECTED AGE: Usually disappears after 3 to 4 months but can persist up to 1 year

Tonic neck reflex (fencer position)

• EXPECTED FINDING: With newborn in supine, neutral position, examiner turns newborn's head quickly to one side. The newborn's arm and leg on that side extend and opposing arm and leg flex. • EXPECTED AGE: Birth to 3 to 4 months

Cesarean interventions

• First 24 hours o Pain relief o Overcoming effects of immobility o Providing comfort • After 24 hours o Resuming normal activities o Assisting mother with infant feeding o Preventing abdominal distention

Mild Preeclampsia

• Gestational Hypertension + • Proteinuria of greater than or equal to 1+ proteinuria. • Report of transient headaches might occur along with episodes of irritability. • Edema can be present. • HA, irritability

Late Decelerations

• Gradual drop in FHR • Onset to nadir >30 seconds • Cause: uteroplacental insufficiency • Action: turn patient/ O2/ call for help • TURN OFF PITOCIN • Baby is not getting oxygen because the placenta is not doing its job • Interuterine resuscitation- give more fluid to push more O2 to the baby

Newborn fetal distress

• Grunting, intracostal flaring, and nasal flaring

Hypertonic uterine dysfunction

• Hyperstimulated • A rise in resting tone- the time between contractions does not come to a full rest- too much ocytoxiin • Intervention- decrease amount of oxytocin by half o If that doesn't work turn off oxytocin o And provide uteral resuscititon Left side, oxygen, Isotonic solution - 500 mL, empty bladder, call for help

Intrauterine Growth Restriction

• Infants affected with IUGR have higher perinatal morbidity and mortality rates than infants who are not growth restricted. • Death may occur from asphyxia before or during labor because of poor placental functioning. • IUGR affects up to 8% of pregnancies (Brozanski & Bogen, 2007). • SGA infants are more likely to experience fetal distress and asphyxia. • Problems tend to be greatest in infants who are preterm in addition to being SGA. • Increased risk of o Low Apgar scores, meconium aspiration, and polycythemia o Hypoglycemia o inadequate thermoregulation o These infants often are small throughout their lives.

Internal fetal scalp electrode

• Invasive procedure • Used if we are concerned about hypoxia

First Stage Interventions

• Leopold's • vaginal exam • encourage slow-paced breathing • depending on phase of labor intervene accordingly • verify rupture of membranes with nitrazine paper (turns blue, pH 6.5 to 7.5) • fetal fibronectin- Ferning- indicative of rupture of membranes

Polycythemia symptoms

• Lethargy • Irritability • Jitteriness • Tremors • Seizures • Cerebrovascular accidents • Respiratory distress • Cyanosis • Apnea

Hypotonic uterine dysfunction

• Macrosomic • Cannot get baby to descend • Lack of labor progress • Cesarean delivery

Post Date complications

• Macrosomic • Placenta gets old o as time goes by reduced placenta perfusion, o calcifications- become hardened, o Limited blood supply o Placental insufficiency o Late decels o US used to grade placenta • GDM complication- calcification of placenta- occurs after 37-38 weeks, hardly ever let them get to term

postpartum hemorrhage interventions

• Massage soft and boggy uterus • Weigh perineal pads • Maintain vascular access o 18 gage or bigger • Observe for signs of anemia o H&H • Monitor urinary output • Allow adequate rest o Bed rest • Administer medications (uterine stimulants, analgesics) o #1 OXYTOCIN- free fall, no more baby, vastis lateralis muscle o #2 METHERGINE- vasoconstrictor • CONTRA: HTN, Chronic or PIHTN o #3 hemabate- • directly into the uterus during cesarean delivery • DIARRHEA • Teach self-care o Massage fundus

PROM

• No longer have a nice barrier to protect baby from infection • Oxytocin increases • Want baby born within 24 hours • If baby is premature we want to keep them inside as long as possible as long as there are no infections o Antibiotics o Bedrest o Topolitics- terbutaline • We hope the bag will reseal • If not hopefully it gives us enough time to give the baby betamethasone to increase lung function

Postpartum Hemorrhage

• Number one cause- uterine atony- failure to contract, vessels are open and not constricted o Easiest intervention- fundal massage- irritate the hell out of the uterus o Naturally the body will release oxytocin and begin to contract • Early postpartum hemorrhage (Within first few hours or withing first 24 hours) o Uterine atony (most common reason) o Trauma • Late postpartum hemorrhage (after 24 hours)

Late Postpartum hemorrhage

• Occurs from 24 hours to 6 weeks after birth • Causes: subinvolution of placental site or retention of placental fragments • Methergine Cessation- bleeding starts because of pieces of conception

Early postpartum Hemorrhage

• Occurs in the first 24 hours after birth • Causes: uterine atony; lacerations of vaginal and cervical areas; retained placental fragments; vulvar, vaginal, or pelvic hematomas,;uterine inversion

Care in immediate postpartum period

• Providing comfort measures o Cramping- ibuprofen- no clotting issues o Pain meds- episiotomy, cesarean • Promoting bladder elimination o Encourage her to avoid every 2 hours o Prevents hemorrhage and bladder infections • Providing fluid and food o Must have the presents of bowel sounds in all 4 quadrants • Preventing thrombophlebitis

Mastitis

• Rapid or insidious onset of fever • Chills • Headache • Flu-like muscle aches and malaise • Warm, reddened, painful area of the breast • Erythema and swelling are present in the upper outer quadrant of the breast. Axillary lymph nodes are often enlarged and tender. The segmental anatomy of the breast accounts for the demarcated, often V-shaped wedge of inflammation.

Shoulder dystocia

• Result of large baby or small pelvis • Macrosomic babies • GDM • Head passes 0 station • Shoulder gets stuck underneath synthesis pubis • Provider cannot pull too hard- causes nerve damage • Nurse interventions- pushing the knee back and away from the body, suprapubic pressure, trying ot pop the shoulder under the synthesis pubic • Possible shoulder fracture • Comp= fetal demise, brachial palsy

Eclampsia

• Severe preeclampsia manifestations with the onset of seizure activity or coma. • Eclampsia is usually preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentrations =warning signs of probable/impending convulsions/seizures.

Neonatal resuscitation

• The interdisciplinary team is vital in responding quickly to Neonatal Crisis. • Here is a link to a 2 week old newborn's experience with NRP. • The procedure you are seeing is called an Intraosseous Infusion

Cytomegalovirus

• Transplacental, during birth, in breast milk • Most asymptomatic at birth. LBW,† IUGR, enlarged liver and spleen, CNS abnormalities, jaundice, intellectual disability, hearing loss, purpura, blindness, microcephaly, and seizures. May have no signs for months or years. • Diagnosed by urine or pharyngeal culture. May shed virus in saliva and urine for months or years. No effective drug therapy.

expected ranges

• Weight: 2,500 to 4,000 g (5.5 to 8.8 lb) • Length: 45 to 55 cm (18 to 22 in) • Head circumference: 32 to 36.8 cm (12.6 to 14.5 in) • Chest circumference: 30 to 33 cm (12 to 13 in)

Risk Factors for postpartum hemorrhage

• because of forcep use • because of precipitous delivery • because of prolonged labor • because of fetal size

Severe preeclampsia

• consists of blood pressure that is 160/110 mm Hg or greater • proteinuria greater than 3+, oliguria • elevated serum creatinine greater than 1.1 mg/dL • cerebral or visual disturbances (headache and blurred vision) o edema reaching the level of the brain o impending seizure • hyperreflexia with possible ankle clonus • pulmonary or cardiac involvement o pulmonary edema, rails • extensive peripheral edema • hepatic dysfunction, epigastric and right upper quadrant pain o hepatic dysfunction • thrombocytopenia • cascade of complications- DIC, and HELLP

Third Stage Interventions

• delivery of the placenta • vital signs every 15 minutes • as soon as the placenta is delivered, administer Pitocin IV • Apgar scores performed on the neonate • massage the fundus after delivery of placenta every few minutes • promote bonding- skin to skin if possible • encourage breast-feeding

Second Stage Interventions

• wait until the patient is 10 cm • more frequent monitoring needed • one-to-one nursing ratio • increase bloody show • prepare and assess for possible perineal laceration or episiotomy • promote rest between contractions • comfort measures such as cold compresses • notify the nursery of imminent delivery • assure all neonatal equipment is ready for delivery

Adverse signs during nipple feeding

➢ Tachycardia ➢ Bradycardia ➢ Increased respiratory rate Nasal flaring ➢ Markedly decreased oxygen saturation level ➢ Cyanosis, pallor ➢ Apnea ➢ Choking, Coughing Gagging, regurgitation ➢ Falling asleep early in the feeding ➢ Feeding time longer than 20 to 30 minutes