Maternity Questions
Longitudinal Lie of baby
Parallel to mothers spine, can have vag birth
If new born assessments elicits Babinski Reflex this means
Stimulation of the newborn's immature neuromuscular system causes dorsiflexion of the big toe and fanning of the remaining toes (Babinski sign).
Three ways to help back pain during labor
*Pelvic rocking* eases tension in the muscles of the lumbar region. Lumbar pain during pregnancy results from the changes in posture as the uterus grows. *Forward tilting* eases tension in the muscles of the lumbar region. Lumbar pain during pregnancy results from the changes in posture as the uterus grows. Applying the heel of the hand to the laboring client's *sacral (pressure)* area (counterpressure) helps relieve the back discomfort that may result when a fetus is in the occiput posterior position.
PT's baseline BP is 92/70, protein in urine +1, possible mild preeclampsia concerns. what is the lowest her BP can be to have the RN concerned of Pre E.
122/85 because her systolic would increase by 30 mmHg and her diastolic by 15 mmHg
A client is found to have pelvic inflammatory disease, and the health care provider prescribes intravenous cefotetan 2 g twice a day. The instructions on the vial of cefotetan say to reconstitute 20 mL of diluent to yield 1 g/10.5 mL. How much solution (mL) should the nurse add to the 100-mL bag of 0.9% sodium chloride? Record your answer using a whole number. ___ mL
10.5 ml * 2 = 21 mL
Diabetic Mom Baby appearance
A red, puffy appearance of the face and neck is neonates born to diabetic mothers usually have this appearance.
Nursing Care required for Cervical Cancer PT with Radium Implant
Activity must be limited so the implant will not be dislodged. While the client is receiving therapy, alpha, beta, and gamma rays will be emitted; therefore the nurse should employ the principles of time and distance when providing care.
Abruptio Placenta
Uterine Tenderness and Fetal HR elevates due to Hypoxia, increase activity
At `10 weeks: Uterine anteflexion allows the uterine fundus to press on the urinary bladder,
causing urinary frequency.
Epidural Anasthesia RN Actions
A baseline vaginal examination is needed to determine the extent of cervical dilation and effacement. Before any procedure is implemented, the nurse should explain the procedure and answer any questions. Risk factors that contraindicate epidural anesthesia include antepartum hemorrhage, bleeding disorders, and allergy to the medication.
Newborn in Substance Abuse w/d
A nurse is assigned to care for an infant in the newborn nursery who was born 4 hours ago. Maternal substance abuse is strongly suspected. Which symptoms are seen in neonates demonstrating signs of drug withdrawal? Select all that apply. Tachypnea Exaggerated Moro reflex Restlessness and excessive activity Strong sucking and swallowing reflex In addition to these symptoms, an infant experiencing drug withdrawal has an uncoordinated sucking and swallowing reflex, muscle rigidity with increased muscle tone, and poor sleep patterns. Such infants are often difficult to console.
Post Partum Depression
ASSESSMENT • Listen actively and demonstrate a caring attitude because women may not volunteer unsolicited information about their depression. • Observe for signs of depression. • Ask appropriate questions to determine moods, appetite, sleep, energy and fatigue levels, and ability to concentrate. An example of how to initiate a conversation is, "Now that you have had your baby, how are things going for you?" • Use a screening tool to assess whether the depressive symptoms have progressed from postpartum blues to postpartum depression (PPD) (see text). • If depression is identified, ask if the mother has thought about hurting herself or the baby.
cervical cancer, the laboratory report reveals a stage 0 lesion. What does a nurse conclude about this client's stage of cancer? The lesion is carcinoma in situ. Stages of Cervical Cancer
According to the International Federation of Gynecology and Obstetrics, stage 0 is indicative of preinvasive cancer. When cancerous cells are completely confined within the epithelium of the cervix without stromal invasion, it is deemed stage 0 and called carcinoma in situ. Early stromal invasion is stage IA; there is minimal stromal invasion. Parametrial involvement, stage II, involves the area around the broad ligaments but not the pelvic wall; there is extension to the corpus of the uterus. Cancer confined to the cervix is classified as stage I.
System that has the most change in the woman's body during pregnancy.
Cardiovascular: Total blood volume increases by 50%, making it necessary for the heart to pump harder and work more to accommodate this increase. Although the renal threshold is lowered, the major changes occur in the cardiovascular system. Changes in hormone levels occur, but they are not as profound as changes in the cardiovascular system. Pressure from the growing uterus can result in digestive discomfort and altered patterns of elimination, but these changes are not as significant as those in the cardiovascular system.
Predisposition of Osteoporosis
Cigarette smoking is a high-risk behavior associated with an increased incidence of osteoporosis in later life. Familial predisposition is considered a risk factor for the development of osteoporosis. Inadequate calcium intake during the premenopausal years is a risk factor for the development of osteoporosis after menopause.
Postterm Baby Appearance
Dry, peeling skin is related to decreased vernix and prolonged immersion in amniotic fluid. Abundant scalp hair and long fingernails are characteristics of postmaturity. These findings are typically noted in a term newborn who is 2 to 3 weeks old. Creases on the entire soles and palms are typical of full-term maturity;
Infant frequently regurgitates
Due to the cardiac sphincter of the newborn is not fully developed; if the stomach is too full, the feeding backs up through the sphincter and the infant regurgitates.
Post abortion or bleed prevention
Ergonovine (Ergotrate) is an oxytocic used in postpartum or postabortion hemorrhage. Carboprost (Hemabate) is a prostaglandin used to treat postpartum hemorrhage; it is also used to induce abortion.
Cervical Dilation 8cm, Mom ready to push an dfeels pressure, RN should
Help her take panting breaths (hee hee Hoo or shoe...shoe) This is the appropriate breathing technique for the transition phase; it prevents the client from pushing too early. The client is not fully dilated and is not ready to give birth.
Type 1 DM causes what to Prego
Increasing the risk of hypertensive states, The likelihood of gestational hypertension increases fourfold in the client with diabetes mellitus, probably because of a preexisting vascular disorder. Also Hydraminos, Polyhydraminos (more than 2000mL amniotic fluids
Within 12 hours if a newborn presents Jaundice we are to Report it to the HCP.
Jaundice occurring in the first 24 hours of life is pathological; it is associated with Rh or another blood incompatibility. Cephalhematoma is a collection of blood between the skull and periosteum that does not cross the suture line; it resolves within 6 weeks, and although it should be documented it does not require treatment. Erythema toxicum is newborn dermatitis, believed to be an inflammatory response. The rash is harmless, and although it should be documented it does not require treatment. Edematous genitalia, a response to maternal hormones, are common in newborns.
Tailor sitting and Kegel Exercise
Tailor: helps relax the muscles of the pelvic floor. Kegel : strengthen the muscles of the pelvic floor.
BP (should calculate) A client has a blood pressure of 90/50 mm Hg during her first visit to the prenatal clinic. On a subsequent visit, at 34 weeks' gestation, her blood pressure is 120/76 mm Hg. The nurse concludes that could have occurred because of: The possible development of preeclampsia
90/50 mm Hg at 34 weeks' gestation Now in third trimester, her blood pressure is 120/76 mm Hg. Normal for non pregnant but changed by 30 systolic and 26 diastolic. The nurse concludes that could have occurred because of: The possible development of preeclampsia an increase in systolic pressure of 30 mm Hg and diastolic pressure of 15 mm Hg warrants close observation for preeclampsia. The client's baseline blood pressure is low, suggesting that the increase in blood pressure is pregnancy related (i.e., gestational hypertension).
A client measuring at 18 weeks' gestation visits the prenatal clinic stating that she is still very nauseated and vomits frequently. Physical examination reveals a brown vaginal discharge and a blood pressure of 148/90 mm Hg. What condition does the nurse suspect the client is experiencing?
A hydatidiform mole, in which chorionic villi degenerate into grapelike vesicles, is the cause of these signs and symptoms. Choriocarcinoma is a sequel to a hydatidiform mole; the blood level of human chorionic gonadotropin (hCG) is monitored for 1 year after removal of the mole. If the level of hCG blood decreases to the expected range and remains there for 1 year, the client may safely plan another pregnancy.
Ruptured tube pregnancy
Any blood from the rupture will accumulate, causing phrenic nerve irritation and pain. Shoulder pain is not a response to anxiety; it is a typical symptom of phrenic nerve irritation.
LOA position expect FHR
Fetal heart sounds will be in the left lower quadrant if the fetus is in the left occiput anterior position.
RSA Position expected HR
Fetal heart sounds will be in the right upper quadrant if the fetus is in the right sacrum anterior position.
Rheumatic Heart Disease Prego needs additional supplements of what?
Folic Acid and Iron Because pregnant women with heart disease are more likely to have anemia, there may be an additional need for iron and also for folic acid.
Induce Labor Meds
Oxytocin (Pitocin) is an oxytocic that triggers or augments uterine contractions; it is used for labor induction. Misoprostol (Cytotec) is a prostaglandin used for cervical ripening and labor induction. Dinoprostone (Prepidil) is used for cervical ripening to induce labor and is also used to induce abortion.
Mom presents with painless vaginal bleed, at 9 months what should the nurse do
Placing the client in the semi-Fowler position forces the heavy uterus to put pressure on the blood vessels at the site of the separating placenta, controlling bleeding to some extent.
Family Planning and not wanting to get pregnant if mucous methods shows
The cervical mucus is clear and stretchable (spinnbarkeit) at ovulation because of maximal estrogen stimulation. Clear, thick cervical mucus occurs after ovulation has occurred. Yellow, thin cervical mucus = infection
Funic Souffle
The funic souffle is the sound of blood rushing through the fetal umbilical cord and is therefore the same rate as the fetal heart rate.
LSA position expect HR where
The left sacrum anterior position indicates that the fetus is in a breech presentation and the head is in the fundus; fetal heart sounds are best heard in the *left upper quadrant.*
Erbs Palsy
The nerves that are stretched take about 3 months to recover from the trauma sustained during birth. Passive range-of-motion exercise and intermittent splinting performed by a trained family member will help facilitate recovery Surgery is needed if avulision of nerves occurs
Mittelschmerz is
pain that sometimes occurs at the time of ovulation when the ovum erupts from the follicle. The pain is mild, cyclic, and characteristic of mittelschmerz
Preterm Baby Appearance
preterm newborns have few sole and palm creases. Vernix is found on a newborn at about 38 weeks' gestation
Infant with A spasm of the pyloric valve would show what sign
projectile vomiting, not by regurgitation.
factor identified by the nurse in a client's history places the client at increased risk for breast cancer?
Advanced age at the time of a first child's birth is one of the risk factors for malignancy of the breast because of prolonged exposure to unopposed estrogen. Hesi Rational Chart Woman's age • Number of first-degree relatives affected • Age of woman at menarche • Age of woman at first live birth • Number of breast biopsies • History of atypical hyperplasia in biopsy specimens
Promote Parent Infant attachment
Keep new family together immediately. A sensitive period occurs during the first few hours of life that is important in the promotion of parent-infant attachment, although for some parents it may take longer to develop attachment behaviors. Encouraging rooming-in is helpful because it increases the amount of contact between the parents and the newborn; however, this contact occurs after the first few critical hours.
A nurse is assessing several postpartum clients. Which conditions increase the risk for postpartum hemorrhage? Select all that apply.
Twin birth Overdistended bladder Retained placental fragments Overdistention of the uterus may lead to delayed or inadequate uterine contractions. An overdistended bladder may inhibit uterine contractions. Retained placental fragments inhibit uterine contractions.
Fundal Height
The uterus rises gradually to the level of the umbilicus at around 22 to 24 weeks' gestation. A fundus just over the symphysis suggests a 10-12 week pregnancy. Fundal height of 9 inches (18 cm) suggests a 16- to 18-week pregnancy. Fundal height of 14 inches (28 cm) suggests a 28-week pregnancy.
Oxytocin pt is monitored for
Water Intoxication
What can swallowing air while suckling cause
cramping or colic.
clomiphene citrate (Clomid)
Tx Anovulatry Cycle Report Nausea Vomiting to HCP because it is a Category X drug and this may mean you are prego. common s/e Weight gain, blurred vision, and hot flashes
Assessment During her sixth month of pregnancy, a woman visits the prenatal clinic for the first time. As part of the initial assessment a complete blood count and urinalysis are performed. Which laboratory finding should alert the nurse to the need for further assessment? 1 Hemoglobin of 10 g/dL 2 Urine specific gravity of 1.020 3 Glucose level of 1+ in the urine 4 White blood cell count of 9,000/mm3
This hemoglobin reading suggests a true anemia. The lowest hemoglobin resulting from physiologic anemia of pregnancy is 12 g/dL; this anemia occurs because the plasma volume increases to a greater extent than the red blood cells during pregnancy. A white blood cell count of 9,000/mm3 is within the expected range of 5,000 to 10,000/mm3; it may increase to 15,000/mm3 during the second half of pregnancy. A urine specific gravity of 1.020 is within the expected range of 1.010 to 1.030. A 1+ urine glucose level is not unusual during pregnancy because of the lowered renal threshold for glucose during pregnancy; if it increases to 2+, further investigation for diabetes should be undertaken.
A client with a history of three spontaneous abortions is now at 16 weeks' gestation and attending the high-risk prenatal clinic. She expresses concerns about remaining at home during this pregnancy. Which questions will elicit responses most helpful to the nurse developing the client's plan of care? Select all that apply. 1 "Do you have a support system available to help you?" 2 "Have you been told about the status of your pregnancy?" 3 Do you know the causes related to spontaneous abortions?" 4 "Are you aware of how a healthy lifestyle affects a pregnancy?" 5 "What are the characteristics of an impending spontaneous abortion?"
The availability of support persons is important when the client is deciding how to try to maintain the pregnancy. Knowing the status of her pregnancy is helpful to the nurse planning her care. If the status is not known, the nurse can correct any misconceptions and assist the client in focusing on reality while helping ease her anxiety. Think of their anxiety! The causes of spontaneous abortion are not always known; theoretic knowledge of the causes will not help the client maintain her pregnancy. Questions about the interrelationship of lifestyle and a healthy pregnancy may add to the client's anxiety; they are not relevant at this time. Questioning the client's knowledge of an impending spontaneous abortion may add to the client's anxiety; after three abortions the client probably knows what to expect before there is a spontaneous abortion.
A preterm infant, born at 30 weeks' gestation, is receiving an intravenous electrolyte solution at a rate of 20 mL/hr by way of an umbilical arterial line. At the hourly intake measurement, the nurse observes that 40 mL has infused in the past hour. What is the nurse's first intervention? 1 Taking the vital signs 2 Comparing the intake with the output 3 Checking the practitioner's prescriptions 4 Slowing the infusion rate to half of the prescribed rate
The priority is assessing the infant for circulatory overload; changes in the vital signs may indicate a problem that must be addressed quickly. Comparing the intake and output record wastes valuable time that should be spent assessing the infant's response. Checking the practitioner's prescription wastes valuable time that should be spent assessing the infant's response. After the infant's response is assessed, an adjustment of the IV rate may be prescribed.
Stages of Syphillis
This is the description of a chancre (An indurated painless nodule on the vulva that is draining), which is the initial sign of syphilis. Secondary Stage: Flat wartlike plaques around the vagina and anus are condylomata, which are typical of the secondary stage of syphilis. Glistening patches in the mouth covered with a yellow exudate are typical of the secondary stage of systemic involvement, which occurs from 2 to 4 years after the disappearance of the chancre. A maculopapular rash on the palms and soles.
