NUR 311A Exam 2

breastfeeding benefits

- allergies less likely to develop - maternal antibodies in breastmilk can prevent infections for baby - constipation less likely - unlikely to be contaminated, not affected by water supply - oxytocin release enhances involution of uterus - frequent, skin-to-skin contact enhances bonding - convenient: always available - economical

how does the nurse assure the safety of patients with alterations in sexuality across a variety of healthcare settings?

- building trusting relationship - ensuring HIPPA is in place and the environment is comfortable for the patient

what is meconium aspiration syndrome

- caused by infant's aspiration of meconium-stained amniotic fluid

gonorrhea collaborative therapy

- cefixime (suprax) 400 mg in single dose OR ceftriaxone (rocephin) 125 mg IM in a single dose - if chlamydial infection is not ruled out: Zpack 1 g in single dose or doxycycline 100mg BID x7 - patients who have uncomplicated gonorrhea and who are tx with any of the therapies above may not need to return to confirm they are cured - tx of sexual contacts - instruction of abstinence from sex and alcohol - re-examination if symptoms persist or recur after tx completion

newborn screening

- hearing screening - blood sample from heel stick tests (phenylketonuria, hypothyroidism, sickle cell disease, cystic fibrosis, and other conditions) - performed 24 hours after birth

plugged duct therapeutic management

- massage area followed by heat and continued breastfeeding using varied positions to help open ducts - plugged duct may progress to mastitis if not treated

high risk newborns

- pre-term - respiratory distress syndrome

breastfeeding recommended until

- recommended until 6-12 months

Upon examination, D.H. is 80% effaced and 4 cm dilated. The fetal heart rate (FHR) is 150 beats/min and regular. List the stages of labor. D.H. is in what stage of labor?

- she is in the first stage of labor, which lasts until complete dilation. - stage 2 lasts from dilation to birth - stage 3 is finished with placental delivery - stage 4 is 2 hours after delivery is complete

reproductive system changes postpartum - the cervix

- should feel firm by the end of the first week postpartum - external os is open about 1 cm which is a permanent change, slit like instead of round - the internal os closed

transient tachypnea of the newborn manifestations

- tachypnea - respiratory distress

following delivery, what assessments are important for the mother?

- take vitals - assess uterine function, position, and firmness - administer oxytocin IM or IV as ordered by physician - monitor and document lochia - document when the mother voids; assess for bladder distention - document perineal bruising or edema and status of the episiotomy, presence of hemorrhoids - document emotional status

if a pregnant woman is tested positive for group B steptococcus (GBS), what should be done?

- the woman would need to be treated with antibiotics (penicillin G or ampicillin) during labor - GBS can cause life-threatening respiratory, neurologic, and hematologic conditions for the newborn

urinary system postpartum

- urethra, bladder, and tissue around urinary meatus may be edematous and traumatized - bladder fills rapidly because of the diuresis that follows childbirth - stress incontinence

Changes in the body caused by pregnancy include relaxation of joints, alteration to center of gravity, faintness, and discomforts. These changes can lead to problems with coordination and balance. In teaching P.M. about safety during pregnancy, what will you include in your teaching?

- use good body mechanics and proper body alignment when lifting objects and when resting or sitting - use safety features on tools or vehicles - avoid activities requiring coordination, balance, and concentration or that can cause sudden jarring movements to the body - take rest periods

nipple pain solutions

- use warm water compress or massage breasts just before feedings and b/w feedings - begin each feeding with the less sore side first - vary position of the infant - nipple shields - breast cream, such as lanolin - expose the nipples to air between feeding to keep clothing from rubbing nipples

preterm infant with thermoregulation problems

- usually in radiant warmer or incubator - temp is monitored continuously by skin probe on infants abdomen - problems with thermoregulation are more significant in those of a preterm baby

patient education with an STI

- wash and urinate after sex - take antibiotics as prescribed - treat sex partners as well to prevent transmission - abstain from sex during tx and use condoms when activity is resumed - verbalize concerns - teach about s/s of complications and need to report problems - explain precautions: being monogamous, ask about sex hx, avoiding sex partners who use IV drugs, or have visible lesions, use condoms

You are the charge nurse working in labor and delivery at a local hospital. D.H. comes to the unit having contractions and feeling somewhat uncomfortable. You take her to the intake room to provide privacy, have her change into a gown, and ask her three initial questions to determine your next course of action, that is, whether to do a vaginal exam or to continue asking her more questions. D.H. has contractions 2 to 3 minutes apart and lasting 45 seconds. It is her third pregnancy (gravida 3, para 2002). Her bag of waters is intact at this time. She states that her due date is 2 days away. You determine that it is appropriate to ask for further information before a vaginal exam is done. What information do you need?

- when did your contractions begin? - when is your expected date of confinement, or due date? how many weeks' gestation are you? - do you have any allergies? - do you have any risk factors? - in addition, the nurse should note the gestational age of the fetus in relationship to the due date

P.M. comes to the obstetric (OB) clinic because she has missed two menstrual periods and thinks she might be pregnant. She states she is nauseated, especially in the morning, so she completed a home pregnancy test and it was positive. As the intake nurse in the clinic, you are responsible for gathering information before she sees the physician. What are the two most important questions to ask to determine possible pregnancy?

- when was the first day of her last menstrual period (LMP)? - when was the date of her last intercourse?

syphilis diagnosic testing

-hx and physical exam - dark-field microscopy - nontreponemal andor treponemal serologic testing - testing for other STDs (HIV, gonorrhea, chlamydia)

You are preparing to give the injection of vitamin K (AquaMEPHYTON). The order is to give 0.5 mg subcutaneously upon arrival to the nursery. The medication comes in a solution of 1 mg/0.5 mL. Calculate how much medication you will draw up into the syringe.

0.25 mL

The nurse has provided discharge instructions to a client who delivered a healthy newborn by cesarean delivery. Which statement made by the client indicates a need for further instruction? 1."I will begin abdominal exercises immediately." 2."I will notify my obstetrician if I develop a fever." 3."I will turn on my side and push up with my arms to get out of bed." 4."I will lift nothing heavier than my newborn baby for at least 2 weeks."

1 Rationale:A cesarean delivery requires an incision made through the abdominal wall and into the uterus. Abdominal exercises should not start immediately after abdominal surgery; the client should wait at least 3 to 4 weeks postoperatively to allow for healing of the incision. Options 2, 3, and 4 are appropriate instructions for the client after a cesarean delivery.

The nurse is assisting the primary health care provider to perform Leopold's maneuvers on a pregnant client. Which action should the nurse perform before the procedure? 1.Ask the client to urinate. 2.Ask the client to drink 8 oz of water. 3.Locate the fetal heart tones with a fetoscope. 4.Warm the sonogram gel before placing it on the client's abdomen.

1 Rationale:An empty bladder contributes to a woman's comfort during this examination. Drinking water to fill the bladder and warming sonogram gel may be performed before a sonography (ultrasound). Often Leopold's maneuvers are performed to aid the examiner in locating the fetal heart tones.

The nurse is administering magnesium sulfate to a client for preeclampsia at 34 weeks' gestation. What is the priority nursing action for this client? 1.Assess for signs and symptoms of labor. 2.Assess the client's temperature every 2 hours. 3.Schedule a daily ultrasound to assess fetal movement. 4.Schedule a nonstress test every 4 hours to assess fetal well-being.

1 Rationale:As a result of the sedative effect of the magnesium sulfate, the client may not perceive labor. This client is not at high risk for infection. Daily ultrasound exams are not necessary for this client. A nonstress test may be done, but not every 4 hours.

On assessment of a postpartum client, the nurse notes that the uterus feels soft and boggy. The nurse should take which initial action? 1.Massage the fundus. 2.Document the findings. 3.Contact the obstetrician. 4.Assist the client to ambulate.

1 Rationale:If the uterus is not contracted firmly (i.e., it is soft and boggy), the initial intervention is to massage the fundus until it is firm and to express clots that may have accumulated in the uterus. Documenting the findings is an appropriate action but is not the initial action. Contacting the obstetrician is not an initial action; however, the obstetrician would be contacted if the massage does not contract the uterus. Ambulating the client could be harmful and cause bleeding.

The nurse is assessing the fundus in a postpartum woman and notes that the uterus is soft and spongy and not firmly contracted. The nurse should prepare to implement which interventions? Select all that apply. 1.Massaging the uterus 2.Pushing gently on the uterus 3.Assisting the woman to urinate 4.Rechecking the uterus in 1 hour 5.Checking for a distended bladder 6.Calling the delivery room to schedule an abdominal hysterectomy

1, 3, 5 Rationale:If the uterus is soft and spongy and not firmly contracted, the initial nursing action is to massage the fundus gently until it is firm; this will express clots that may have accumulated in the uterus. If the uterus does not remain contracted as a result of massage, the problem may be a distended bladder, which lifts and displaces the uterus and prevents effective contraction of the uterine muscles. The nurse should then check for a distended bladder and assist the woman to urinate. Pushing on an uncontracted uterus could invert it, potentially causing massive hemorrhage and rapid shock. Waiting for 1 hour without intervention could result in excessive blood loss. The primary health care provider (PHCP) will need to be notified if uterine massage is not helpful. Pharmacological measures may be necessary to maintain firm contraction of the uterus. An abdominal hysterectomy may need to be performed for massive hemorrhage that is uncontrollable. The question presents no data indicating that hemorrhage is a problem. In addition, the nurse should not schedule an operative procedure.

Early recognition of preterm labor is essential to successfully implement interventions. The diagnosis of preterm labor is based on what three major diagnostic criteria?

1. gestational age between 20-37 weeks 2. presence of uterine activity (contractions) 3. progressive cervical change (e.g. cervical effacement of 80% or cervical dilation of 2 cm or greater)

The nurse is monitoring a client in labor who is receiving oxytocin and notes that the client is experiencing hypertonic uterine contractions. In order of priority, how should the nurse plan the actions to take? Arrange the actions in the order that they should be performed. All options must be used. Select the correct sequence number for each item. 1.Reposition the client. 2.Stop the oxytocin infusion. 3.Perform a vaginal examination. 4.Check the client's blood pressure. 5.Administer oxygen by face mask at 8 to 10 L/min. 6.Administer medication as prescribed to reduce uterine activity.

2, 1, 5, 3, 4, 6 Rationale:If uterine hypertonicity occurs, the nurse would immediately intervene to reduce uterine activity and increase fetal oxygenation. The nurse would stop the oxytocin infusion and increase the rate of the no additive solution, position the client in a side-lying position, and administer oxygen by face mask at 8 to 10 L/min. The nurse then would attempt to determine the cause of the uterine hypertonicity and perform a vaginal examination to check for a prolapsed cord. The nurse would check maternal blood pressure for the presence of hypertension or hypotension. The nurse stays with the client and contacts the primary health care provider (PHCP) as soon as possible (or asks another nurse to contact the PHCP) and then implements the PHCP's prescriptions, including the administration of medications to reduce uterine activity.

The nurse is interviewing a middle-aged woman with a history of fibrocystic disorder of the breasts. Which statements made by the client indicate a need for further teaching? Select all that apply. 1."I might experience pain in my underarm region." 2."My symptoms will decrease just before menstruation." 3."After I experience menopause, my symptoms may lessen." 4."Taking oral contraceptives now will increase my symptoms." 5."Upon self-breast examination, I may detect lumpiness in the upper, outer area of my breasts."

2, 4 Rationale:The nurse assesses the client with fibrocystic breast disorder for worsening symptoms (breast lumps, painful breasts extending into the underarm region, and possible nipple discharge) before the onset of menses. This is associated with cyclical hormonal changes. Taking oral contraceptive pills and experiencing menopause may also help to decrease the signs and symptoms of fibrocystic disease.

for a normal sized woman, average weight gain is 25-35 lbs. how does this translate weekly?

2.2-5.5 lb in the first trimester, and 1 lb per week after that until delivery

While waiting for laboratory results, you consider that if P.T. is experiencing preterm labor, she would receive antenatal glucocorticoids. How long do these drugs take to become effective?

24 hours after given IM

The nurse is caring for a client in active labor. Which nursing intervention would be the best method to prevent fetal heart rate (FHR) decelerations? 1.Prepare the client for a cesarean delivery. 2.Monitor the FHR every 30 minutes. 3.Encourage an upright or side-lying maternal position. 4.Increase the rate of the oxytocin infusion every 10 minutes.

3 Rationale:Side-lying and upright positions such as walking, standing, and squatting can improve venous return and encourage effective uterine activity. Many nursing actions are available to prevent FHR decelerations, without necessitating surgical intervention. Monitoring the FHR every 30 minutes will not prevent FHR decelerations. The nurse should discontinue an oxytocin infusion in the presence of FHR decelerations, thereby reducing uterine activity and increasing uteroplacental perfusion.

The nursing student is assigned to care for a client in the postpartum unit. The coassigned registered nurse asks the student to identify the most objective method to assess the amount of lochial flow in the client. Which statement, if made by the student, indicates an understanding of this method? 1. i can estimate the amount of blood loss by gauging the amount of staining on a perineal pad 2. i should ask the client to keep a record and document every time the perineal pad is changed 3. i should weigh the perineal pad before and after use and note the amount of time between each pad change 4. i can look at the perineal pad and gauge the amount of staining and relate it to the amount of time between pad changes

3 Rationale:To gather accurate data for comparison, the perineal pads must be weighed both before and after use. Once these weights are gathered, the amount of lochia flow can be accurately determined. Noting the time frame between pad changes and the number of pads used also is an important factor. Gauging the amount of staining does not provide accurate data. Asking the client to obtain the information also may not provide accurate data.

The nurse is assigned to care for a client who has chosen to formula-feed her infant. The nurse should plan to provide which instruction to the client? 1. apply a heating pad to breasts for comfort 2. wear a breast shield to correct nipple inversion 3. wear a supportive brassiere continuously for 72 hours 4. use the manual breast pump provided to express milk

3. Rationale:Wearing a supportive brassiere continuously for 72 hours postpartum will minimize breast engorgement. Any stimulation of the breasts (expression of milk, infant sucking) or increase in circulation (heating pad) will increase milk production or cause the blood vessels and lymphatics to engorge. Correction of nipple inversion will not be necessary if the mother chooses not to breast-feed her infant.

what is the average blood loss for a vaginal delivery?

500 mL

after delivery, cardiac output decreases and returns to pre-pregnancy levels by ___ to ___ weeks after delivery

6 to 12 weeks

As you monitor D.H., you observe for prolapse of the umbilical cord. Describe what this is and what can happen to the fetus if this occurs.

A prolapsed cord occurs when part of the umbilical cord lies below the presenting part of the fetus. Fetal hypoxia results from prolonged cord compression by the presenting part of the fetus. This can potentially lead to newborn asphyxia, neurologic brain injury, or death of the fetus.

How is transgender defined?

An adjective to describe a person who crosses or transcends culturally defined categories of gender.

What is genderqueer?

An identity label used by some people whose gender identity does not conform to one of the two categories of male or female.

An hour after admission, you recheck T.N.'s perineal pad and find that there is a very small amount of drainage on the pad. What will you do next? a. Ask T.N. to change her perineal pad. b. Check her perineal pad again in 1 hour. c.Check the pad underneath T.N.'s buttocks. d. Document the findings in T.N.'s medical record.

Answer: C When assessing for postpartum bleeding, it is important to check underneath the woman's buttocks. Blood may flow between the buttocks onto the linens under the mother, and excessive bleed- ing might go undetected if this area is not also checked.

what are the goals of antepartum care?

Answer: The objective of antepartum care is to ensure that pregnancy ends in the birth of a healthy infant without impairing the health of the mother. Ideally the first visit takes place before conception. Rationale: Good antepartum care begins before conception and continues on a regular basis thereafter.

a woman intending to get pregnant is advised to take a folic acid supplement. why is folic acid supplementation important before conception?

Answer: Woman are advised to consume 400 mcg to 800 mcg (0.4 mg to 0.8 mg) of folic acid daily for at least 1 month before conception and 2 to 3 months after conception. An intake of 600 mcg (0.6 mg) is recommended for the rest of pregnancy. Rationale: Folic acid is recommended to decrease the risk of neural tube defects. Women who have given birth previously to an infant with a neural tube defect should take 4 mg of folic acid daily during the 4 weeks before pregnancy and throughout the first trimester.

what are potential signs of magnesium sulfate toxicity? (select all that apply.) a. absent DTRs b. increased RR c. oliguria d. muscle rigidity e. severe hypotension

Answers: A, C, E Signs of magnesium sulfate toxicity include respiratory depression (rate less than 12 breaths/ min), absent DTRs, chest pain, severe hypotension, extreme muscle weakness, reduced urine output, and altered level of consciousness.

How should the nurse address a patient who is transgender?

Ask the patient how they would like to addressed and use that name along with their preferred pronouns.

Post-Partum Assessment (BUBBLE)

B-reasts U-terus B-owels B-ladder L-ochia E-pisiotomy/lateration/C-section incision H-oman's sign E-motional status

describe the usual diet used in treating gestational diabetes mellitus

Caloric intake recommendations should take into consideration the patient's activity level, prepreg- nancy weight, and weight gain to date. The usual prescription is 30 kcal/kg/day, based on a normal preconception weight. For obese women, the usual prescription is up to 25 kcal/kg/day, which trans- lates into 1500 to 2000 kcal/day for most women. To adequately control postprandial blood glucose levels, distribution of foods should include approximately 35% to 40% CHO, 20% to 25% protein, and 35% to 40% fat.

Determine the following EDD: Your patient had a normal period in February with first day of LMP on February 2, 2016.

EDD = 11/9/16

stomach changes during pregnancy

Elevated levels of progesterone relax all smooth muscle, decreasing gastrointestinal tone and motility.

figure out the woman's gravida and para Judy was pregnant with twin boys her first pregnancy and delivered them at 35 weeks. She had a miscarriage in her second pregnancy at 6 weeks. She then delivered a 40 week baby girl who was born stillborn for her third pregnancy. After genetics consult, she delivered a healthy baby girl at 38 weeks.

G4, P1 twins = 1 pregnancy

figure out the woman's gravida and para: Mrs. L. has been pregnant 4 times. She had a miscarriage at 8 weeks with her first pregnancy. She delivered a 34 week baby by cesarean section on her second pregnancy. That baby survived and is doing well. She had two more children, at 37 and 39 weeks who are also living.

G4, P3

calculate GTPAL: Judy was pregnant with twin boys her first pregnancy and delivered them at 35 weeks. She had a miscarriage in her second pregnancy at 6 weeks. She then delivered a 40 week baby girl who was born stillborn for her third pregnancy. After genetics consult, she delivered a healthy baby girl at 38 weeks.

G4, T2, P1, A1, L3

calculate GTPAL: Mrs. L. has been pregnant 4 times. She had a miscarriage at 8 weeks with her first pregnancy. She delivered a 34 week baby by cesarean section on her second pregnancy. That baby survived and is doing well. She had two more children, at 37 and 39 weeks who are also living.

G4, T2, P1, A1, L3

women with gestational diabetes mellitus cannot metabolize concentrated simple sugars without a sharp rise in blood glucose. name five examples of simple sugars you would teach a woman with GDM to limit

Glucose, honey, fructose, corn syrup, molasses, sucrose, regular soda, candies, fruit, fruit juice, milk, syrup, jams or jellies, sweet potatoes, beans, whole-wheat pasta, cakes, cookies—all desserts in general

what is gravida and para?

Gravida refers to a woman who is or has been pregnant regardless of the duration of the pregnancy. Para refers to the number of pregnancies that have ended at 20 or more weeks, regardless of whether the infant was born alive or was stillborn.

Baby H.'s mother asks you how she can keep her infant from catching a cold or some other type of infection. What is the most important measure to teach her?

Handwashing is the most important single measure in the prevention of neonatal infection. Baby H.'s mother should be taught to wash her hands before having contact with her baby. Inanimate objects should be cleaned with a bactericidal solution. Family or friends who are feeling ill or recently have been ill should not have contact with the infant.

What are common menopause symptoms?

Hot flushes, night sweats, and vaginal dryness

What is should a nurse who is caring for patient with ED, do if the patient has chest pain?

If they have taken a PDE-5 inhibitors in the last 24-48 hours all nitrates must be avoided. Call the HCP, report the use of PDE-5 inhibitors and expect an order for morphine to help stop the chest pain.

What are common causes of erectile dysfunction?

Inflammation of the prostate, urethra, or seminal vesicles Surgical procedures such as prostatectomy Pelvic fractures Lumbosacral injuries Vascular disease, including hypertension Chronic neurologic conditions, such as Parkinson disease or multiple sclerosis Endocrine disorders, such as diabetes mellitus (a major cause) or thyroid disorders Smoking and alcohol consumption Drugs, such as antihypertensives Poor overall health that prevents sexual intercourse

What teaching is important for men with erectile dysfunction and medication?

Instruct patients taking PDE-5 inhibitors to abstain from alcohol before sexual intercourse because it may impair the ability to have an erection. Common side effects of these drugs include dyspepsia (heartburn), headaches, facial flushing, and stuffy nose. If more than one pill a day is being taken, leg and back cramps, nausea, and vomiting also may occur. Teach men who take nitrates to avoid PDE-5 inhibitors because the vasodilation effects can cause a profound hypotension and reduce blood flow to vital organs. Teach patients to take the pill 1 hour before sexual intercourse.

what are afterpains

Intermittent uterine contractions after birth (post-partum). we see them significantly decrease by the 3rd day post-partum

first degree tear

Involves the superficial vaginal mucosa or perineal skin

What is erectile dysfunction (ED)?

Known as impotence, is the inability to achieve or maintain an erection for sexual intercourse.

What preventive health care is needed for MtF patients?

MtF patient requires prostate health care screenings like natal males.

Why is post-menopausal bleeding a problem?

Once a woman is postmenopausal, unplanned vaginal bleeding should always be investigated as soon as possible because it is highly suggestive of endometrial cancer.

According to the clinic protocol, you obtain the following for her prenatal record: CBC, blood type, urine for urinalysis (UA) (protein, glucose, blood), vital signs (VS), height, and weight. Next, the nurse-midwife does a physical examination, including a pelvic exam and confirms that P.M. is pregnant. P.M. has a gyne- coid pelvis by measurement, and the fetus is at approximately 6 weeks' gestation. what specimens are important to obtain when the pelvic examination is done?

Papanicolaou test (PAP) to screen for cervical intraepithelial neoplasia, herpes simplex type 2 (geni- tal herpes), and HPV (genital warts); cervical and vaginal smears for cytologic studies and diagnosis of chlamydia, gonorrhea, and group B streptococcus infections.

What are the symptoms of Chlamydia? What treatment is used?

Presence of symptoms, including vaginal or urethral discharge, dysuria (painful urination), pelvic pain, irregular bleeding The treatment of choice for chlamydia infections is azithromycin (Zithromax) 1 g orally in a single dose or doxycycline (Monodox, Doxy-Caps, Doxycin) 100 mg orally twice daily for 7 days.

what should you assess with a tear?

REEDA (redness, edema, ecchymosis, discharge, and approximation), swelling

Which predisposes the adolescent to feel an increased need for sleep?

Rapid physical growth

How are sexually transmitted infections spread? And how are they prevented?

STIs (HSV I and HSV II) can cause disease on the mouth or the genitals. They are prevented through contraceptive use. The only way to prevent STD or pregnancy 100% is through abstinence.

P.M. comes to the obstetric (OB) clinic because she has missed two menstrual periods and thinks she might be pregnant. She states she is nauseated, especially in the morning, so she completed a home pregnancy test and it was positive. As the intake nurse in the clinic, you are responsible for gathering information before she sees the physician. You ask whether she has ever been pregnant, and she tells you she has never been pregnant. How would you record this information?

She is gravida 1, para 0000.

What change in boys indicates the onset of puberty?

Testicular enlargement is the first change that signals puberty in boys; it usually occurs between the ages of 9 and 14 years during Tanner stage 2 development.

An adolescent tells the nurse that he has recently had homosexual feelings. What knowledge should the nurse's response be based on?

The adolescent should be encouraged to share his feelings and experiences.

Why are antiviral drugs used with genital herpes?

The drugs decrease the severity, promote healing, and decrease the frequency of recurrent outbreaks but do not cure the infection.

ureter changes during pregnancy

The flow of urine through the ureters is partially obstructed, particularly on the right side, causing the ureters and renal pelvis to dilate. The resulting stasis of urine allows additional time for bacteria to multiply and increases the risk of urinary tract infection during pregnancy.

Y.L. is instructed to monitor her fasting blood glucose first thing in the morning and 2 hours after every meal. What are the purposes of this request?

To assess the patient's glycemic control, help guide appropriate nutrition and exercise recommenda- tions, and assess the need for medication intervention.

What bacteria causes syphilis?

Treponema pallidum

what is GTPAL

Use of the GTPAL acronym allows a more complete description of pregnancy outcomes than use of gravida and para alone. G = stands for pregnancies or gravida T = term births or pregnancies delivered at 37 weeks of gestation or later P = preterm births (births between the 20th and 36th week of gestation) A = abortions (spontaneous or elected) L = living children

What teaching is important for the menopausal woman?

Using water-soluble lubricants, such as K-Y Liquid, Lubrin, Replens, or K-Y Silk-E to relieve vaginal dryness and dyspareunia. Discussing alternatives to estrogen, such as botanical preparations, if the woman does not want estrogen replacement therapy. The woman should discuss these with her health care provider because some have side or adverse effects or interactions with other drugs. Doing Kegel exercises to increase muscle tone around the vagina and urinary meatus to counteract the effects of genital atrophy. Drinking at least eight glasses of water a day to decrease the concentration of urine, to flush urine from the bladder, and to reduce bacterial growth, thereby preventing atrophic cystitis. Wiping from front to back after urination and defecation to reduce the transfer of bacteria from the anus to the urinary meatus and to help prevent cystitis at any age.

what is important to know about valcyclovir

Valcyclovir (Valtrex) is an antiviral medication that is used to treat HSV. This medication inhibits herpetic viral replication. A common side effect is a headache.

What is important for the nurse to remember when assessing a patient with syphilis?

Wear gloves while palpating any lesions because of the highly contagious treponemes that are present.

Y.L. asks whether having gestational diabetes will hurt her baby. How would you respond?

Women whose blood glucose levels are well controlled by diet are at low risk for fetal complications. These complications include stillbirth, spontaneous abortion, hydramnios, macrosomia, congenital anomalies, neonatal hypoglycemia and hyperbilirubinemia, and fetal or neonatal death. Though no standard recommendations have been formulated for fetal surveillance in pregnancies complicated by GDM, testing to identify fetal compromise can begin as early as 32 weeks of gestation, particularly if the woman has poor glycemic control. Surveillance testing often includes "kick counts," ultraso- nography for fetal growth and amniotic fluid volume, biophysical profile, nonstress test, contraction stress test, or amniocentesis for fetal lung maturity.

P.T. is a married 30-year-old gravida 4, para 1203 at 28 weeks' gestation. She arrives in the labor and deliv- ery unit at a level 2 hospital complaining of low back pain and frequency of urination. She states that she feels occasional uterine cramping and believes that her membranes have not ruptured. What actions would you take to help identify her underlying problem before calling the HCP?

actions to rule out preterm labor: - fundal height - leopold's maneuvers for fetal position - digital cervical examination to determine dilation, effacement, and station of presenting part - monitor fetal heart tones and contraction pattern with external monitors actions to rule out UTI: - obtain a clean-catch urine specimen and send for UA and C&S. obtain the specimen before connecting patient to the electronic uterine monitor - take vital signs

what is hyperbilirubinemia

aka jaundice, common for infants

As you assess the newborn, you observe for CNS depressant effects that might result because the mother received an opioid during labor. Opioid antagonists such as naloxone (Narcan) can promptly reverse the CNS depressant effects in the newborn, but when is naloxone contraindicated for an infant?

an opioid antagonist is contraindicated for an infant of an opioid-dependent woman because it may precipitate abstinence syndrome (withdrawal symptoms)

What is the hormone responsible for the growth of beard, mustache, and body hair in the male?

androgen

a mother is concerned that her newborn weighs less 3 days after birth, than what the baby weighed initially. what could you teach this mother about her baby?

babies may lose up to approximately 10% of their birth weight

is there an antidote for magnesium sulfate?

calcium gluconate (10 mL of a 10% solution or 1 g) given slow IV push by the physician to avoid dysrhythmias

increased progesterone can cause what symptom in a pregnant woman?

constipation

Baby H.'s mother asks you about cord care and circumcision care for her infant. What will you tell her?

cord care: wipe stump after each diaper change. watch for signs of infection (redness, swelling at base, purulent drainage). cord will fall off after 10-14 days. after the cord falls off, there will be a "raw" spot. keep area clean and dry circumcision: wash with warm water, pat dry, and apply petrolatum with each diaper change.

what virus causes encephalitis, esophagitis, retinitis, pneumonitis in immunocompromised pts

cytomegalovirus (CMV)

how does the nurse minimize complications of sexuality?

educating the patient on the ABCs of sexuality: abstinence, be monogamous, and condom use

cause of plugged ducts

exact cause unknown. predisposing factors could be: - engorgement - missed feedings - constricting bra

whats the difference between true and false labor contractions?

false labor contractions are called braxton hicks contractions, they come and go, and they begin in the abdomen and radiate to the back true labor contractions become more intense with walking or changing positions, become more regular with time and increase in intensity, frequency, and duration, and begin in the lower back and radiate to the lower portion of the abdomen

what is benign prostatic hyperplasia (BPH)

granular units in the prostate that undergo nodular tissue hyperplasia, resulting in enlargement of prostate glad - causes bladder outlet obstruction - common; exact cause cause unknown

J.F. progresses in labor, and, at 4-cm dilation, her membranes spontaneously rupture. The small amount of amniotic fluid is green. What does the green amniotic fluid indicate? what are the risks?

green amniotic fluid indicates that the fetus has had a bowel movement, known as meconium. risks include: - fetus has had some degree of stress - fetus will have to be closely monitored in labor - if meconium were swallowed, it could lead to serious respiratory distress - fetus may not tolerate labor well and is at higher risk for an emergency C-section

the location of the uterine fundus post-partum helps determine what?

helps determine whether involution of uterus is occurring normally

what virus causes hepatitis b

hepatitis B virus

what virus causes genital herpes

herpes simplex virus (HSV)

what virus causes genital warts or cervical cancer

human papilomavirus (HPV)

days 11-21 post-partum, what should the lochia look like?

lochia alba can last into the 6th week post partum should be less and less amounts should be a white cream, or light yellow color

Days 1-3 post birth, what should the lochia look like?

lochia rubra bloody, might have small clots, fleshy, earthy odor, red or red/brown

days 4-10 post-partum, what should the lochia look like?

lochia serosa decreased amount, serosanganous in color (brown tinged, more pink)

male reproductive problems can range from short term infections to

long term problems like cancer

T.N. delivered a healthy male infant 2 hours ago. She had a midline episiotomy. This is her sixth pregnancy. Before this delivery, she was para 4014. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit. You find a boggy fundus during your assessment. What corrective measures can be institued?

massage uterine fundus until firm. if it does not remain firm, additional oxytocin can be given, as ordered. assess for a full bladder, which can prevent the uterus from contracting normally.

How is Menopause defined

means "the end of menstruation," usually 2 consecutive months without menses.

what bacteria is responsible for gonorrhea

neisseria gonorroeae

age related differences to sexuality

o childhood (birth to 7 years) - baby boys get erections and baby girls exhibit increased vaginal lubrication, a result of genital congestion; infants of both sexes have been observed fondling their own genitals, a natural form of sexual expression and arousal; the quality of relationships during early childhood is instrumental in shaping sexual and emotional relationships later in life o preadolescence (8-12 years) - often a general social division of boys and girls into separate groups, and thus, sexual curiosity and learning occurs between children of the same sex; many children engage in masturbation during this stage o adolescence (13-19 years) - during adolescence, the physical changes associated with puberty become evident; during adolescence two developmental tasks present: learning to manage physical and emotional aspects of sexuality in order to form intimate relations and resolving the conflict between identity and role confusion; sexual identity is a sense of being attractive and being attracted to others (heterosexual, homosexual, bisexual, and transgendered) o adulthood (20 years and older) - two major developmental tasks for adults: learning to effectively communicate in intimate relationships and making informed decisions about sexual health, such as issues of family planning and prevention of sexually transmitted infections

hyperbilirubinemia (jaundice) therapeutic management

phototherapy

this reflex is similar to palmar grasp reflex. when the area below the toes is touched, the infants toes curl over the nurses finger what reflex is this

plantar grasp reflex

What is lochia?

postbirth uterine discharge

What is priapism?

prolonged erection

S/S a baby is cold:

restless, crying, increased flexion and activity (to help maintain heat), acrocyanosis. NOT shivering.

this reflex is important in feeding and is most often demonstrated when the infant is hungry. when the infant's cheek is touched near the mouth, the head turns toward the side that has been stroked. this response helps the infant find the nipple for feeding. the reflex occurs when either side of the mouth is touched. touching the cheeks on both sides at the same time confuses the infant what reflex is this

rooting reflex

any health issue that affects male reproductive system can affect the need for what

sexuality, elimination, and reproduction

What is an episiotomy?

surgical extension of the vaginal opening into the perineum during childbirth, to aid a difficult delivery and prevent rupture of tissues

reproductive system change postpartum - the vagina

takes 6-8 weeks for the vagina to complete involution and gain approx the same size and contour before pregnancy - edematous

the amount of lochia

teach moms that a pad that is saturated in an hour or less is a reason to call the physician

this reflex is elicited by stroking the lateral sole of the infant's foot from the heel forward and across the ball of the foot. this causes the toes to flare outwrd and the big toe to dorsiflex. what reflex is this?

the babinski reflex

What is the significance of misdiagnosing preterm labor?

the misdiagnosis of preterm labor can lead to the inappropriate use of pharmacologic agents that can be dangerous to the health of the woman, fetus, or both

this reflex is the most dramatic reflex. it occurs when the infant's head and trunk are allowed to drop back 30 degrees when the infant is in a slightly raised position. the infant's arms and legs extend and abduct, with the fingers fanning open and thumbs and forefingers forming a C position. the arms then return to their normally flexed state with an embracing motion. the legs may also extend and then flex what reflex is this

the moro reflex

A nurse-midwife has prescribed ferrous sulfate 325 mg daily to a patient. What teaching is important with this supplement?

the patient may be constipated and have darker colored stools. Take on an empty stomach and don't take with dairy. Take with water or juice. A patient with low iron or anemia can have the disease PICA, which is eating things that aren't typically edible, like ice, laundry detergent, etc.

this reflex refers to the posture assumed by newborns when in a supine position. the infant extends the arm and leg on the side to which the head is turned and flexes the extremities on the other side. this response is sometimes referred to as the fencing reflex because the infants position is similar to that of a person engaged in a fencing match what reflex is this

tonic neck reflex

Baby H.'s mother calls you to tell you that her baby seems too sleepy and not feeding well. What will your next action be?

use various techniques to try to stimulate the infant. if unsuccessful, you might want to check the baby's glucose level and notify the HCP

second degree tear

vaginal mucosa, the perineal skin, and deeper tissues like the fascia and muscles of the perineum

complex carbohydrates (CHO) do not cause a rapid rise in blood glucose when eaten in small amounts. identify five foods from this group.

whole grain breads, cereals, crackers, brown rice, potatoes, legumes, corn, peas, winter squash, yams

skin changes during pregnancy

· Circulation to the skin increases during pregnancy and encourages activity of the sweat and sebaceous glands. Pregnant women feel warmer and perspire more, particularly during the last trimester. Accelerated activity of the sebaceous glands fosters the development of acne. · Increased pigmentation from elevated estrogen, progesterone, and melanocyte-stimulating hormone · Areas of pigmentation include brownish patches, called melasma, chloasma, or the mask of pregnancy, over the forehead, cheeks, and nose. · The linea alba (the line that marks the longitudinal division of the midline of the abdomen) darkens to become the linea nigra. The nipples, areolae, and preexisting moles (nevi) become darker as pregnancy progresses.

breast changes during pregnancy

· During pregnancy, the breasts become highly vascular, and a delicate network of veins is often visible. · The nipples increase in size and become darker and more erect, and the areolae become larger and more pigmented. · In addition, a thick, yellowish fluid (colostrum) is present beginning at 12 to 16 weeks of pregnancy and can readily be expressed from the breasts by the third trimester.

kidney changes during pregnancy

· During pregnancy, the kidneys change in both size and shape because of dilation of the renal pelves, calyces, and ureters above the pelvic brim. The dilation is caused by (1) the effect of progesterone, which causes the ureters to become elongated and more distensible; and (2) compression of the ureters between the enlarging uterus and the bony pelvic brim.

mouth changes during pregnancy

· Elevated levels of estrogen cause hyperemia of the tissues of the mouth and gums, which may lead to gingivitis and bleeding gums. Some women develop severe vascular hypertrophy of the gums, which appear reddened and swollen and bleed easily. · Some women experience ptyalism (excessive salivation).

oxygen consumption during pregnancy

· Oxygen consumption increases by approximately 20% in pregnancy. · Half the oxygen is used by the uterus, fetus, and placenta. The rest is consumed by the breast tissue, and increased cardiac, renal, and respiratory maternal demands.

What is the primary risk associated with an amniotomy? • a.Maternal infection. b.Maternal hemorrhage. c.Prolapse of the umbilical cord. d.Separation of the placenta.

•ANS: C •When the membranes are ruptured, the umbilical cord may come downward with the flow of amniotic fluid and become trapped in front of the presenting part. Infection is a risk of amniotomy, but not the primary concern. Maternal hemorrhage and separation of the placenta are not associated with amniotomy.

•A 25-week pregnant woman is diagnosed with placenta previa. How should the nurse explain this condition?

•An implantation of the placenta in the lower uterus, near or covering the cervix.

•What therapeutic management should the nurse teach the woman with hyperemesis gravidarum that she can do at home?

•B-complex vitamins, Ginger has shown some benefit in reducing the episodes of vomiting, antiemetics such as Phenergan or Zofran

•What education should the nurse provide to the woman about how to manage her condition?

•Diet—decrease carbohydrates and eliminate simple sugars •Exercise •glucose level monitoring •Antepartum surveillance to identify fetal compromise may begin as early as 28 weeks of gestation if the woman has poor glycemic control or by 34 weeks in lower-risk women with GDM

if a woman reported her first day of her LMP to be November 25, 2016, her EDD would be?

11/25/16 - 3 months = 8/25/16 + 7 days = EDD= 9/1/17

Hepatitis B vaccine

- baby given first dose at hospital before discharge (within 12 hours of birth) - received other 2 doses at routine well-baby appointments

engorgement prevention

- breast feed infant every 2-3 hours day and night - do not give bottles during the day or not

infant of a diabetic mother, therapeutic management

- monitor bilirubin and blood glucose levels - feed newborn soon after birth (NG may be needed) - administer glucose intravenously to treat hypoglycemia

fourth degree tear

- most significant tear - extends through the anal sphincter and into the rectal mucosa

normal newborn eyes findings

- Eyes cross because of weak extraocular muscles - Ability to track and fixate momentarily - Eyelids often edematous as a result of pressure during the birth process and the effects of eye medication

normal newborn male genitalia findings

- Foreskin present - Scrotum may be edematous. - Meatus should be at tip of penis. - Testes should be descended

Care in the immediate postpartum period

- apply ice to perineum - sitz bath - perineal care after each voiding and bowel movement - anesthetic sprays decrease topical pain - analgesics for pain - promote bladder elimination - prevent thrombophlebitis

what are some of the major fetal developmental milestones throughout pregnancy that are often looked at as positive pregnancy signs?

- at 8 weeks gestation, fetal cardiac activity or body movement would be noted on an ultrasound. - at 19 weeks, palpation of fetal movement by an examiner

hyperbilirubinemia (jaundice) assessment

- assess for jaundice every 8 to 12 hours - as the skin blanches when the nurse presses on infants skin, a yellow color can be seen - begins at the head and moves down the body - golden or tan skin, white of the eyes turn yellow - becomes visible when serum bilirubin reaches 5-6 mg/dL

newborn care related to blood glucose

- assess for signs of hypoglycemia - perform screening tests for blood glucose according to agency policy - newborns are at risk for hypoglycemia so do not go long periods without feeding them

Decelerations occur in an early, variable, or late pattern. What is the significance of these patterns? State what the nurse should do for each type.

- Early decelerations are thought to be caused by fetal head compression and are considered a benign finding. - Variable decelerations typically indicate cord compression. Turn the patient's position and closely monitor. They typically occur during the transition phase of the first stage of labor and during the second stage of labor. - Late decelerations are considered to be more urgent because the fetus might be in distress. Persistent and repetitive late decelerations usually indicate fetal hypoxemia as a result of insufficient placental perfusion. This is monitored closely because it might indicate the need for an emergency cesarean delivery.

pharmacotherapy for patients experiencing alterations in sexual activity

- Antibiotics - infections of the reproductive tract are typically caused by STIs - Hormone replacement therapy - often used to treat the symptoms of menopause, most notably hot flashes and vaginal dryness - Phosphodiesterase-5 inhibitors (PDE-5) - sildenafil and vardenafil represent the first-line treatment for ED

APGAR

- Appearance (all pink, pink and blue, blue (pale) - Pulse (>100, <100, absent) - Grimace (cough, grimace, no response) - Activity (flexed, flaccid, limp) - Respirations (strong cry, weak cry, absent) - score 7-10: no interventions needed - score 4-6: gently stimulate by rubbing infant's back while administering oxygen - score 0-3: infant needs rescuscitation - scored 1 min after birth and 5 min after birth

normal newborn head findings

- Bones of the skull are not fused. - Sutures (connective tissue between the skull bones) are palpable and may be overlapping because of head molding - Sutures intersect at the fontanels - Molding is asymmetry of the head resulting from pressure in the birth canal; molding disappears in about 72 hours

cognitive-behavioral therapy for patients experiencing alterations in sexuality

- CBT and sexual counseling have proven effective in the treatment of sexual problems with psychological origins, including some cases of ED

Nursing interventions focus on monitoring the woman and fetus for growth and development; detect- ing potential complications; and teaching P.M. about nutrition, how to deal with common discomforts of pregnancy, and activities of self-care. A psychological assessment is done to determine P.M.'s feelings and attitudes regarding her pregnancy. How do attitudes, beliefs, and feelings affect pregnancy?

- Cultural and religious preferences might influence how she takes care of herself, how she views the pregnancy, how her partner responds to her and the pregnancy, and the importance of infant gender. - The following responses are normal unless the manifestations are extreme in either direction. Often they are related to hormonal influences on the body. --Ambivalence: mixed feelings even if the pregnancy was planned --Acceptance of the pregnancy --Introversion: the woman focuses on herself, dreams about the baby --Moodswings --Negative feelings about changes in body image

P.M. comes to the obstetric (OB) clinic because she has missed two menstrual periods and thinks she might be pregnant. She states she is nauseated, especially in the morning, so she completed a home pregnancy test and it was positive. As the intake nurse in the clinic, you are responsible for gathering information before she sees the physician. What additional information would be needed to complete the TPAL record?

- Gravida refers to the present pregnancy, para (from TPAL) refers to her past history. - TPAL is derived by asking about the number of term and preterm pregnancies, number of abortions before 20 weeks' gestation, and number of living children. The recording would be G1, Para 0000.

surgical procedures for patients experiencing alterations in sexuality

- Hysterectomy - surgical removal of the uterus and may be indicated for the following conditions: menorrhagia, pelvic pain from endometriosis, prolapse of the female reproductive organs, uterine fibroids, myomas, and cancer - Penile implant surgery - insertion of an inflatable device in the penis with a reservoir placed in the scrotum - Minor procedures - removal of genital lesions (e.g. warts or polyps) or incision and drainage for cysts or abscess

protecting the infant

- ID bands are placed on the mother, the infant, and the father - imprinted number or barcode is used to identify the mother and infant every time the infant is brought to the mother or partner - safety measures in place to prevent infant abduction

T.N. delivered a healthy male infant 2 hours ago. She had a midline episiotomy. This is her sixth pregnancy. Before this delivery, she was para 4014. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit. The patient complains of pain and discomfort in her perineal area. How will you respond?

- Inspect her perineum - apply ice bag to perineum, use topical anesthetic spray, and give pain medication as ordered - encourage sitz baths using cool water for the first 24 hours to decrease edema and warm sitz baths after 24 hours to promote circulation and healing

normal newborn female genitalia findings

- Labia may be swollen; clitoris may be enlarged. - (connective tissue between the skull bones) - Thick, white mucus discharge may be present .- Pseudomenstruation, caused by the withdrawal of the maternal hormone estrogen, is possible (blood-tinged mucus)

normal newborn nose findings

- Obligatory nose breathing - Occasional sneezing to remove secretions/obstructions

Syphilis treatment

- Penicillin G used to treat all but tertiary syphilis - confidential counseling and testing for HIV infection - repeat of nontreponemal tests at 6 and 12 months - examination of cerebrospinal fluid at 1 year if tx involves alternative antibiotics or if tx failure occurs

normal newborn skin findings

- Pinkish red (light-skinned newborn) to pinkish brown or pinkish yellow (dark-skinned newborn) - Vernix caseosa, a cheesy white substance, on entire body in preterm newborns, but is more prominent between folds closer to term; may be absent after 42 weeks of gestation - Lanugo, fine body hair, might be seen, especially on the back. - Milia, small white sebaceous glands, appear on the forehead, nose, and chin. - Dry, peeling skin - Acrocyanosis (peripheral cyanosis of hands and feet) is normal in the first few hours after birth and may be noted intermittently for the next 7 to 10 days - Birthmarks: -- Port-wine stain: Commonly appear on face. No fading with time. May require future surgery -- Mongolian spots Bluish black pigmentation. On lumbar dorsal area and buttocks. Common for babies with dark skin. Gradually fade during first and second years of life. -- Stork bites: blanch easily. More noticeable when baby crying. Disappear by 2-years-old

normal newborn abdomen findings

- Rounded, soft. - Bowel sounds present within first hour after birth - Meconium passed within 12-48 hr. Urine generally passed within 12-24 hr.

third degree tear

- SAME AS 2ND DEGREE: vaginal mucosa, the perineal skin, and deeper tissues like the fascia and muscles of the perineum - AND anal sphincter

normal newborn extremities/hips findings

- Should have full range of motion; symmetrical movements - Gluteal folds should be even - Ortolani's sign (A click or a popping sensation is felt when hips are abducted by examiner) and Barlow's sign (examiner can feel the femoral head move out of the acetabulum when he/she adducts the hips and applies gentle pressure down and back) are the two assessment tools for developmental hip dysplasia

normal newborn cord findings

- Should have three vessels—two arteries and one vein. - Small, thin cord may be associated with poor fetal growth.

T.N. delivered a healthy male infant 2 hours ago. She had a midline episiotomy. This is her sixth pregnancy. Before this delivery, she was para 4014. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit. What is important to note in the initial assessment?

- VS: BP might be low b/c of epidural, temp might be elevated b/c of exertion - fundal height and position - lochia: might be more profuse for a multigravida and if fundus feels boggy. should be rubra in color for the first few days - episiotomy: assess for swelling and discoloration - urinary output: void in 6-8 hours. encourage fluid intake and assess for UTI symptoms - bowel elimination: may be sluggish for a few days. stool softeners can be used, avoid straining - lower extremities: blood pooling or clots may occur. assess homan's sign by dorsiflexion of each foot and assessing for calf pain - breasts: warm packs or ice packs for tightness or tenderness - afterpains: the uterus is contracting - works harder after successive deliveries - emotional status: assess feelings post delivery. inquire about questions or concerns. remind her that self care is as important as caring for her infant

Baby H. was just born in a hospital that provides single-room maternity care (SRMC). SRMC allows the infant to remain with the parents after birth. The nurse will complete the physical assessment and observe for physiologic changes in the infant's transition from intrauterine to extrauterine life. The textbooks will tell you that the infant goes through an initial phase of reactivity 30 to 60 minutes after birth, then a sleep phase for 4 to 6 hours, then a second period of reactivity. You will see variations of the timing in actual practice. What care is specific to the first period of reactivity?

- apgar completed at 1 and 5 minutes - assess and monitor HR, RR, and color Q15-30 mins the first hour - maintain body temp, thoroughly dry infant, stabilize temp - maintain airway, suction with bulb syringe to remove secretions - facilitate mother and infant interaction - may delay eye prophylactics for first hour to facilitate parent-infant interaction through eye contact - weigh and measure infant - breast feeding can be initiated

flat or inverted nipple solutions

- breast shells in the bra helps the nipples protrude - just before beginning breast feeding, roll the nipple between thumb and forefinger to help it protrude - use breast pump before feedings - nipple shield to aid infant in latching on and to inverted nipples correctly

post partum integumentary system

- changes of pigmentation that occurred during pregnancy begin to disappear (melasma and linea nigra) - the straie gravidarum (stretch marks) fade to silvery lines but do not disappear - hair loss

newborn cord care

- clamp placed on baby's cord for 24 hours after birth - the cord becomes brownish black within 2 to 3 days and falls off within approx 10-14 days - evidence-based practice guidelines recommend cleaning umbilical cord with only water - assess cord for bleeding, purulent drainage, redness, or edema at the base

Once the transitional care and documentation are completed, the infant might be transferred to the normal newborn nursery if the hospital does not use SRMC. What ongoing care of newborn is this nurse responsible for?

- cleanliness - continued airway maintenance and suctioning - assess vitals Q4h - nutrition - warmth - circumcision care - education about circumcision care, cord care, and skin care

what is transient tachypnea of the newborn

- condition in which infant develops tachypnea soon after birth due to inadequate absorption of fetal lung fluid

You are the charge nurse working in labor and delivery at a local hospital. D.H. comes to the unit having contractions and feeling somewhat uncomfortable. You take her to the intake room to provide privacy, have her change into a gown, and ask her three initial questions to determine your next course of action, that is, whether to do a vaginal exam or to continue asking her more questions. What assessment should you make to gain further information from D.H.?

- contraction pattern: palpate abdomen for strength of contractions, frequency, and duration - cervical dilation and effacement, presentation, and position - amniotic membrane status - FHR: it is common to use a hand-held doppler; note rate and any slowing or acceleration - support systems and how she is coping with her contractions - VS - obtain a clean-catch urine specimen - draw blood for CBC and determine type and Rh factor

expected hormone changes to moms endocrine system

- decline in hormones: estrogen, progesterone, and human placental lactogen - human chorionic gonadotropin present for up to 3-4 weeks after birth - prolactin (stimulates milk secretion) returns to non-pregnant levels within 2 weeks if mother doesn't breastfeed

in a postpartum woman, a traumatized and edematous urethra, bladder, and tissue around the urinary meatus often causes what?

- diminished sensitivity to fluid pressure - many women have no sensation of needing to avoid even when their bladder is distended

chlamydia collaborative therapy

- doxycyline 100 mg BID x7 or Zpack in 1 g single dose - alternative regimen: erythromycin, ofloxacin, or levofloxacin - instruct abstinence for 7 days AFTER completing antibiotic - tx of all sex partners

newborn weight

- during the first few days after birth, infants commonly lose up to 10% of their body weight - infants usually regain the lost weight by 2 weeks of age - newborns have a small stomach capacity and may fall asleep before feeding adequately - capacity increases rapidly so that many infants take 2 to 3 oz by the end of the first week

reproductive system changes postpartum - the perineum

- edematous - can have lacerations: either tear or episiotomy

P.T.'s history reveals that she had one preterm delivery 4 years ago at 31 weeks' gestation. The infant girl was in the neonatal intensive care unit (NICU) for 3 weeks and discharged without sequelae. The second pre- term infant, a boy, was delivered 2 years ago at 35 weeks' gestation and spent 4 days in the hospital before discharge. She has no other risk factors for preterm labor. Vital signs are normal. Her vaginal examination was essentially within normal limits: cervix long, closed, and thick; membranes intact. Abdominal examina- tion revealed that the abdomen was nontender, with fundal height at 29 cm, fetus in a vertex presentation. while you are waiting for laboratory results, what therapeutic measures do you consider?

- encourage rest - hydration calms the uterus if there are mild contractions. give water - review external monitor strip, and assess for the presence of contractions. - if labor ensues, discuss with obstetric and pediatric staff about transferring P.T. to a level 3 hospital, which has a NICU

problems with breast feeding

- engorgement - nipple pain - flat or inverted nipples - plugged ducts

infant of diabetic mother, manifestations

- excessive size and weight - signs of hypoglycemia: twitching, apnea, difficulty feeding, lethargy, seizures, cyanosis - hyperbilirubinemia - signs of respiratory distress

list five risk factors for gestational diabetes mellitus

- family history of diabetes mellitus - personal hx of gestational diabetes mellitus - obesity or overweight - glucosuria - ethnicity: members of ethnic groups have higher prevalence - age over 25 years - hx of glucose intolerance outside of pregnancy - poor obstetric hx

benefits of babys vernix

- fights off germs - minimizes birth trauma - controls babys temperature - protects from macronium exposure - moisturizer

D.H. has her episiotomy repaired and the placenta delivered. What are the signs that the placenta has released from the uterine wall?

- firmly contracted uterus - uterus changes shape from a discoid to a globular ovoid shape - the cord lengthens - there is a sudden release of blood from vagina - finding of vaginal fullness on vaginal exam

at 8 weeks gestation, what nutritional teaching would you provide the patient?

- for any pregnant woman it is important to look at caloric intake, protein, calcium, and folic acid intake - eat small frequent meals to avoid N/V - eat dry toast or crackers before getting out of bed to prevent morning sickness - vitamin B6 and/or ginger capsules are sometimes recommended with N/V - starting pre-natal vitamins before conception may prevent N/V

other assessment findings in preterm infants

- fragile skin - newborn has poor suck and swallow reflexes - bowel sounds diminished - lanugo and vernix present - skin may appear jaundiced - at greater risk for infection - easily overstimulated - can have eye problems

preterm infant with respiratory problems: assessment

- have immature lungs - poorly developed cough reflex and narrow respiratory passages - infants born before surfactant production is adequate develop respiratory distress syndrome - respirations are irregular with periods of apnea

what psychosocial questions should you ask a pregnant mother at the beginning of pregnancy?

- how do you feel about being pregnant? - how does your husband/partner feel about being pregnant? - how do you feel about smoking cessation (if smoker)? - how are you and your husband/partner getting along?

P.T. is a married 30-year-old gravida 4, para 1203 at 28 weeks' gestation. She arrives in the labor and deliv- ery unit at a level 2 hospital complaining of low back pain and frequency of urination. She states that she feels occasional uterine cramping and believes that her membranes have not ruptured. You need additional information from P.T. to determine what you will do next. What important questions do you need to ask to differentiate what is going on with P.T.?

- how long ago did the uterine cramping begin? - point to location - what type of pain is it? sharp or dull? continuous or intermittent? - has there been any vaginal bleeding? - does she feel any lower pelvic pressure? - how long has she had the low back pain? - her parity indicates she had two previous preterm deliveries. at what gestational age were the infants born, were there any complications, and what was her treatment to try to stop her contractions? - does she have any risk factors contributing to preterm labor: low prepregnancy weight, low weight gain during pregnancy, smoking, substance abuse, chronic health problems? UTI questions: - has she had a fever? - how long has she had urinary frequency? - is there any blood or cloudiness in urine? - has she ever had a UTI during one of her other pregnancies? - has she had any infections during this pregnancy?

You are the charge nurse working in labor and delivery at a local hospital. D.H. comes to the unit having contractions and feeling somewhat uncomfortable. You take her to the intake room to provide privacy, have her change into a gown, and ask her three initial questions to determine your next course of action, that is, whether to do a vaginal exam or to continue asking her more questions. What three initial questions will you ask and why?

- how often are your contractions (timed from the beginning of one to the beginning of the next), and how long do they last? labor might be progressing rapidly if contractions are close together and last for a long time - which pregnancy is this or you? first pregnancy labor usually lasts longer - has your water broken? labor progresses more rapidly after the membranes rupture

chlamydia diagnostic tests

- hx and physical exam - nucleic acid amplification test (NAAT) to detect chlamydia - direct fluorescent antibody (DFA) test for chlamydia - enzyme immunoassay (EIA) for chlamydia antigen - testing for other STDs (gonorrhea, HIV, syphilis), - culture for chlamydia

genital herpes dx tests

- hx and physical exam - viral isolation by tissue culture - antibody assay for specific HSV viral type

newborn care related to thermoregulation

- immediately after birth place baby on mother's chest or abdomen to provide warmth from skin to skin contact - dry the wet infant quickly with warm towels to prevent heat evaporation - put hat on baby's head and wrap body in blanket or sleep sack - perform initial assessment under radiant warmer - postpone bath for several hours

What would be done if you noted that D.H. had a prolapsed cord?

- immediately call for help and notify HCP - glove the examining hand and insert two fingers into the vagina and to the cervix. exert upward pressure - place woman into extreme Trendelenburg's or modified Sims' or knee-chest position - administer oxygen to the woman by mask at 8-10 L/min until birth is accomplished - if cord is protruding, wrap loosely in sterile towel saturated with warm, sterile solution - explain to woman what is happening and the plan - closely monitor fetal HR - ensure IV is functional, start IV if one is not in place - prepare for immediate vaginal birth if cervix is fully dilated

After discharge, it is important for Baby H. to receive follow-up care. What should you teach the mother to help her understand the importance of regular visits?

- immunizations: the schedule for immunizations should be reviewed with the parents. stress importance of immunizations to decrease infants risk of developing certain diseases. - growth and development: these are recorded at each visit and compared to standard norms. if any child falls outside of the norm, early interventions can be implemented to minimize potential problems

newborn skin care

- infant receives bath to remove blood and amniotic fluid as soon as temperature is stable - removing vernix not necessary - teach parents that babies do not need daily baths at home - change diaper often - meconium (first stool) is very thick, sticky, and difficult to remove from skin

vitamin K injection

- infants are deficient in clotting factors - given vitamin K to prevent vitamin K deficiency bleeding - IM injection given within the the first hour after birth

physiologic post-partum changes

- involution of uterus: descent of uterine fundus, afterpains, lochia

what instructions are important to include in the administration of iron?

- iron absorption is enhanced when vitamin C is increased - citrus fruits and juices, tomatoes, melons and strawberries are all high in vitamin C - absorption is optimal when taken on empty stomach - milk should NOT be taken along with iron supplementation - tea, coffee, and caffeinated beverages decrease absorption

prenatal drug exposure manifestations

- irritability - tremors - hyperactivity - hypertonicity - respiratory distress - vomiting - high pitched cry - sneezing - fever - diarrhea - excessive sweating - poor feeding - extreme sucking of fists - seizurs

plugged duct manifestatiosn

- localized edema - warmth - redness - tenderness - hard area may be palpated - tiny white area may be present on the nipple

prenatal drug exposure therapeutic management

- managing complication common to drug-exposed infants - administration of oral morphine or methadone - swaddle the newborn - place the newborn in a quiet room and reduce stimulation - NG feedings may be necessary due to poor feeding - refer mother to tx for substance abuse

meconium aspiration syndrome manifestations

- mild to severe respiratory distress are present at birth - a barrel-shaped chest from hyperinflation in severe cases - nails, skin, and cord may be stained with meconium

gastrointestinal system postpartum

- mother is hungry and thirsty, r/t energy expended during birth - constipation common - stool softeners and laxatives used frequently - first stool occurs within 2-3 days postpartum

Post Partum: Musculoskeletal

- muscle fatigue and aches the first couple of days after vaginal childbirth - ligaments and cartilage of the pelvis begin to return to pre-pregnancy positions - abdominal muscles weak, soft, and flabby

describe some of the physiological signs of pregnancy

- not having a period - presence of human chorionic gonadrotropin (HCG) hormone - nausea with occasional vomiting, particularly early in the AM - always tired - breasts feel heavier and more sensitive - frequent and urgent urination, nocturia - nipples will darken and become more erectile - blood vessels will become visible at the skin surface due to increased blood flow - striae gravidium may appear - liquid may be expressed from nipples as pregnancy advances (16 weeks+)

risk factors for benign prostatic hyperplasia (BPH)

- obesity - diabetes mellitus - hormone supplementation - lack of physical activity

The sleep phase and second reactive phase might occur in the SRMC or in the nursery. Identify eight assessments or tasks that the nurse needs to do during the transitional care period.

- observe for choking on mucus that is normally present - monitor VS - assess infants ability to feed - assess glucose level - measure height, weight, and head and chest circumference - erythromycin ointment - vitamin K - hepatitis vaccine - physical assessment - bathe baby - note any voiding or stool and document - document findings

what is the mother at risk for when the bladder fills rapidly due to diuresis that follows childbirth?

- overdistention of the bladder - incomplete emptying of the bladder - retention of residual urine

expected ovulation changes in moms endocrine system

- ovulation resumes as early as 3 weeks postpartum - 40-45% of non-nursing mothers resume menstruation at 6-8 weeks after childbirth, 75% by 12 weeks, and all within 6 months - menses while breastfeeding may resume as early as 8 weeks or as late as 18 months

transient tachypnea of the newborn therapeutic management

- oxygen - NG feedings while the respiratory rate is high to prevent aspiration and conserve energy

preterm infant with respiratory problems: nursing care

- oxygen may need to be given by oxygen hood, nasal cannula, or ventilator - CPAP may be necessary to improve expansion of lungs - suction secretions

respiratory distress syndrome therapeutic management

- oxygen, CPAP, or mechanical ventilation - surfactant replacement therapy can be instilled into the infant's trachea

Care after Cesarean Birth:

- pain management - assess for respiratory depression - assess for paralytic ileus (rare) - assess for surgical dressing or incision

T.N. delivered a healthy male infant 2 hours ago. She had a midline episiotomy. This is her sixth pregnancy. Before this delivery, she was para 4014. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit. T.N.'s condition is stable and you prepare to provide patient teaching. What patient teaching is vital after delivery?

- perineum care: wipe front to back, wash perineum with warm water using a squirt bottle, apply anesthetic ointment or spray, change peri-pads frequently, wash hands before and after care - fluids: rehydration and prevent constipation - ambulation: early movement to prevent blood clots and constipation - feeding - danger signs: excessive bleeding and S/S of infection (fever over 100.4 degrees, chills, redness of breast or incision, foul-smelling discharge) - postpartum exercises: kegel exercises to strengthen perineal muscles - sexual activity: without contraception, it is possible to get pregnant again shortly after delivery. discuss options - rest: important for health, encourage and limit visitors

newborn circumcision care

- petroleum jelly over the circumcision site to prevent diaper from sticking, small piece of gauze may be placed over area - diaper attached loosely to prevent pressure - frequently assess area for bleeding during the first few hours after procedure - edema from circumcision can cause difficulty voiding, mother is to notify physician if baby has not voided in 6-8 hours after circumcision

The decelerations stop, and the remainder of the labor is uneventful; D.H. has an episiotomy to allow more room for the infant to emerge and delivers a male infant. what is involved in the immediate care of the newborn?

- place infant under warming light, provide suction to clear airway - assess and record apgar score at 1 and 5 mins after birth - dry infant and wrap in warm blankets - maintain clear airway - place correct wrist and ankle IDs on infant and mother

nipple pain prevention

- position baby at breast with enough of the areola in the mouth that the nipple is not compressed between the babys gums - vary the position of the baby to change pressure on the nipple - do not use soap on the nipples b/c it removes protected oils and causes drying - if breast pods are used for leaking milk, remove them when they become wet to prevent skin irritation

P.T. is a married 30-year-old gravida 4, para 1203 at 28 weeks' gestation. She arrives in the labor and deliv- ery unit at a level 2 hospital complaining of low back pain and frequency of urination. She states that she feels occasional uterine cramping and believes that her membranes have not ruptured. You are the charge nurse and admit P.T. Based on the information you have been given, identify the two most likely diagnoses for P.T.

- preterm labor - UTI

erythromycin ointment

- prophylactic eye treatment to help with neonatal conjunctivitis in case the mother is infected with gonorrhea - given to every baby within first hour after birth

Upon examination, D.H. is 80% effaced and 4 cm dilated. The fetal heart rate (FHR) is 150 beats/min and regular. She is admitted to a labor and delivery room on the unit. What nursing measures should be done at this time?

- put D.H. in bed. fetal and contraction monitors are placed on her abdomen. contractions and FHR are recorded every 30 minutes. if her labor is augmented with IV drugs, the recording is every 15 minutes. - answer questions she might have - teaching is vital. help D.H. with relaxation and breathing techniques

engorgement solutions

- reduce edema and pain by applying cold packs to the breasts b/w feedings - application of cool cabbage leaves - just before feedings, apply heat with compresses or take a shower to stimulate milk flow - massage breasts before and during feedings to stimulate let-down reflex - if the areolae are engorged, making it hard for the baby to latch on, express a little milk by hand - feed more often: every 1.5-2 hours - wear a well-fitting bra for support during the day and at night for comfort

As the nurse, you know that assessment and teaching are vital in the prenatal period to ensure a positive outcome. What information is important to include at every visit and at specific times during the pregnancy?

- regular prenatal visits are scheduled Q4 weeks until 28 weeks' gestation, Q2 weeks until 30-36 weeks, and every week from 37 weeks to delivery - fundal height measured to estimate fetal growth - vital signs - deep tendon reflexes: hyperreflexia may indicate pre-eclampsia - assess for edema in the face, hands, legs, and feet - check for urine glucose and protein - addressing any discomfort that patient might have - stress need for adequate fluid intake (2 L daily - 8 glasses)

manifestations of respiratory distress syndrome

- respiratory distress - pallor and cyanosis - hypothermia - poor muscle tone

how often should a woman have prenatal visits?

- return regularly even if there are no complications - go to clinic every 4 weeks until 28 weeks - then go to clinic every 2 weeks until 36 weeks - then go to clinic weekly until delivery

what is respiratory distress syndrome

- serious lung disorder caused by immaturity and inability to produce surfactant resulting in hypoxia and acidosis

When caring for a woman with symptoms of preterm labor, it is important to question the woman about whether she has symptoms when she is engaged in certain activities that might require lifestyle modifications. What activities should you assess for?

- sexual activity - riding long distances without being able to stretch legs or stand - carrying heavy loads or carrying a child often - standing more than 50% of her day - hard physical work - being unable to stop and rest when tired - climbing stairs - limited or no assistance with household work and caring for other children

reasons for formula feeding

- some women are embarrased by breast feeding - woman's partner or family/friends may not be supportive of breast feeding - woman may be on medication that would make breast feeding harmful - woman has medical condition that would make breast feeding harmful - baby has medical condition that makes breast feeding difficult - mother and baby have difficulty with breast feeding techniques - may have difficulty breast feeding when returning to work or school

meconium aspiration syndrome therapeutic management

- suctioning infant as soon as the head is born does not reduce the incidence of MAS - in infants with depressed respirations and insufficient muscle tone or HR below 100 bpm, an endotracheal tube is used to remove as much meconium as possible - some infants only need warmed, humidifed oxygen, while others require extensive respiratory support with mechanical ventilation

P.M. asks the nurse about what should be reported to her doctor. List at least six of the "danger signs of pregnancy."

- sudden gush of fluid from vagina - abdominal pain - temperature above 101.7 - dizziness, blurred vision - persistent vomiting - severe headahce - edema in the hands, face, legs, and feet - convulsions - oliguria - dysuria (UTI) - absence of fetal movement after initial fetal movement is felt (approx 20 weeks)

T.N. delivered a healthy male infant 2 hours ago. She had a midline episiotomy. This is her sixth pregnancy. Before this delivery, she was para 4014. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit. T.N tells you that she must go back to work in 6 weeks and is not sure she can continue breast feeding. what options are available to her?

- the advantages of breastfeeding for babies are well understood, but there are several advantages for new mothers as well. it is less expensive and less time-consuming b/c no prep of formulation is needed - assure her that she can continue breast feeding. pumps are available - breast milk can be frozen and given to baby in bottle while at work - babies can be brought to the workplace for feeding if appropriate - if she wants to stop breast feeding, she can begin decreasing the number of breast feedings by one (and increase the number of bottle feedings) - obtain a consultation with lactation consultant

Baby H.'s mother has decided to breastfeed her infant. She asks for assistance. Identify six important points to include in your teaching plan.

- try to initiate as soon as feasible after birth - you need to wipe your hands after every diaper change, after changing peri-pad, and before touching your breasts - choose a comfortable position for yourself and your infant with the infants head slightly elevated - compress the breast behind the areola and have baby directly in front of nipple to latch on easily - baby needs to be awake and alert - initial fluid is colostrum. very nutritious and rich in immunoglobulins that help protect baby from disease - feed baby Q2-3 during the day and as the baby awakens at night but at least Q4 hours the first few weeks of life - breast milk works on the principle of supply and demand

Two hours later, the laboratory results indicate a urinary tract infection. The contraction monitor indicates infrequent, mild contractions. Her physician discharges her to home on an antibiotic for the UTI. What follow-up measures should be considered in providing P.T. discharge instructions?

- what is her nutritional status? is she taking time to eat a balanced diet? - is she drinking enough fluids? stress importance of consuming at least 2 L (8 glasses of fluid daily) - caffeine is a diuretic and should be avoided - avoid bubble bath or bath oils and scented toilet paper b/c it can irritate the urethra - urinate before and after sex - assess understanding of when and how to take antibiotic if she has problems - review S/S of preterm labor an risk factors - she should be seen by HCP again within 1 week

Naegel's rule can be used to calculate the estimated delivery date. why is it important to have an estimated due date?

- will determine what types of changes the mother will see/feel - will determine what milestones the fetus should be reaching throughout the pregnancy

pre-term infant

-born before 37 weeks gestation - appearance: frail and weak, decreased muscle tone, limp extremities, lack subcutaneous fat, thin skin appears red and translucent - behavior: exhausted from noise and routine activities, cry may be weak

gonorrhea diagnostic tests

-hx and physical exam - gram stain smear - culture for neisseria gonorrhoeae - nucleic acid amplification test (NAAT) to detect N. gonorrhoeae - testing for other STDs (syphilis, HIV, chlamydia)

P.M. comes to the obstetric (OB) clinic because she has missed two menstrual periods and thinks she might be pregnant. She states she is nauseated, especially in the morning, so she completed a home pregnancy test and it was positive. As the intake nurse in the clinic, you are responsible for gathering information before she sees the physician. It is important to complete the intake interview. What categories will you address with P.M.?

-s/s she had - current ad past gynecologic hx - contraceptive hx - current and past medical hx - allergies - medications, including herbs - social and occupational hx - hx of physical abuse - vaccinations - partners hx - risk factors (substance use, age less than 20 or over 25, pre-existing medical conditions) - nutrition hx - discomforts or concerns

On March 10, the nurse performed an initial assessment on a client admitted to the labor and delivery unit for "rule out labor." The client has not received prenatal care but is certain that the first day of her last menstrual period (LMP) was July 7 the previous year. The nurse plans care based on which interpretation? 1.The client is possibly in preterm labor. 2.The fetus may not be viable at delivery. 3.The client may require labor augmentation. 4.The fetus is at high risk for shoulder dystocia.

1 Rationale:According to Naegele's rule, by subtracting 3 months and adding 7 days and 1 year to this client's LMP the nurse can determine that her estimated date of delivery (EDD) is April 14. This client is in the labor and delivery unit to be evaluated for the presence of labor more than 1 month before her EDD; therefore, she is possibly in preterm labor. Viability is said to occur between the 22nd and 25th weeks of gestation. This fetus is approximately 4 weeks before term. If this client truly is in labor, the primary health care provider's plan would be to try to stop the labor in order to prevent delivery at this early stage in the pregnancy. This would eliminate option 3, labor augmentation. Because of the typical 36-week gestational size of a fetus, 2200 to 2900 g, there would be no risk for a difficult shoulder delivery.

The client is being seen at 24 weeks' gestation at the prenatal clinic. At her last routine visit, the fundus was located at the umbilicus. Today, the fundus is measured and found to be 23 cm. How should the nurse interpret this finding? 1. fundus is at the appropriate level 2. fundus is larger than expected height 3. fundus is smaller than expected height 4. growth pattern indicates intrauterine growth restriction (IUGR)

1 Rationale:At the previous routine visit at 20 weeks' gestation, the fundus was located at the umbilicus. For each subsequent week after 20 weeks, fundal height should increase by approximately 1 cm/week. At 24 weeks' gestation, the appropriate fundal height would be 24 cm plus or minus 2 cm. By 36 weeks' gestation, the fundus reaches its highest level at the xiphoid process.

During a prenatal visit, the nurse is explaining dietary management to a client with preexisting diabetes mellitus. The nurse determines that teaching has been effective if the client makes which statement? 1."Diet and insulin needs change during pregnancy." 2."I will plan my diet based on the results of urine glucose testing." 3."I will need to eat 600 more calories every day because I am pregnant." 4."I can continue with the same diet as before pregnancy, as long as it is well balanced."

1 Rationale:The diet for a pregnant client with diabetes mellitus is individualized to allow for increased fetal and metabolic requirements, with consideration of such factors as prepregnancy weight and dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and insulin therapy. Dietary management during diabetic pregnancy must be based on blood, not urine, glucose changes. An increase of 600 calories a day is not required. Diet and insulin needs change during the pregnancy in direct correlation to hormonal changes and energy needs. In the second and third trimesters, insulin needs increase.

The nurse is creating a plan of care for a client experiencing dystocia and includes several nursing interventions in the plan. The nurse prioritizes the plan and selects which nursing intervention as the highest priority? 1.Monitoring fetal status 2.Providing comfort measures 3.Changing the client's position frequently 4.Keeping the significant other informed of the progress of the labor

1 Rationale:The priority in the plan of care should include the intervention that addresses the physiological integrity of the fetus. Although providing comfort measures, changing the client's position frequently, and keeping the significant other informed of the progress of the labor are components of the plan of care, fetal status is the priority.

The nurse is monitoring a client in labor whose membranes ruptured spontaneously. What is the initial nursing action? 1. determine the fetal heart rate 2. provide peripads for the client 3. take the clients blood pressure 4. note the amount, color, and odor of the amniotic fluid

1 Rationale:When the membranes rupture in the birth setting, the nurse immediately assesses the fetal heart rate to detect changes associated with prolapse or compression of the umbilical cord. Taking the blood pressure and noting the characteristics of the amniotic fluid are also appropriate actions but are not the initial actions in this situation. The nurse may assist the client in cleaning, changing clothing, and providing peripads, but determining the fetal heart rate is the initial action.

The nursing instructor asks a nursing student to explain the characteristics of the amniotic fluid. The student responds correctly by explaining which as characteristics of amniotic fluid? Select all that apply. 1.Allows for fetal movement 2.Surrounds, cushions, and protects the fetus 3.Maintains the body temperature of the fetus 4.Can be used to measure fetal kidney function 5.Prevents large particles such as bacteria from passing to the fetus 6.Provides an exchange of nutrients and waste products between the mother and the fetus

1, 2, 3, 4 Rationale:The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely and maintains the body temperature of the fetus. In addition, the amniotic fluid contains urine from the fetus and can be used to assess fetal kidney function. The placenta prevents large particles such as bacteria from passing to the fetus and provides an exchange of nutrients and waste products between the mother and the fetus.

The nursing instructor asks a nursing student to explain the characteristics of the amniotic fluid. The student responds correctly by explaining which as characteristics of amniotic fluid? Select all that apply. 1. allows for fetal movement 2. surrounds, cushions, and protects the fetus 3. maintains the body temperature of the fetus 4. can be used to measure fetal kidney function 5. prevents large particles such as bacteria from passing to the fetus 6. provides an exchange of nutrients and waste products between the mother and the fetus

1, 2, 3, 4 Rationale:The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely and maintains the body temperature of the fetus. In addition, the amniotic fluid contains urine from the fetus and can be used to assess fetal kidney function. The placenta prevents large particles such as bacteria from passing to the fetus and provides an exchange of nutrients and waste products between the mother and the fetus.

The nurse is providing postpartum instructions to a client who will be breast-feeding her newborn. The nurse determines that the client has understood the instructions if she makes which statements? Select all that apply. 1. I should wear a bra that provides support 2. drinking alcohol can affect my milk supply 3. the use of caffeine can decrease my milk supply 4. i will start my estrogen birth control pills as soon as i get home 5. i know if my breasts get engorged, i will limit my breast-feeding and supplement the baby 6. i plan on having bottled water available in the refrigerator so i can get additional fluids easily

1, 2, 3, 6 Rationale:The postpartum client should wear a bra that is well fitted and supportive. Common causes of decreased milk supply include formula use; inadequate rest or diet; smoking by the mother or others in the home; and use of caffeine, alcohol, or medications. Breast-feeding clients should increase their daily fluid intake; having bottled water available indicates that the postpartum client understands the importance of increasing fluids. If engorgement occurs, the client should not limit breast-feeding but should breast-feed frequently. Oral contraceptives containing estrogen are not recommended for breast-feeding mothers.

A postpartum care unit nurse is reviewing the records of 5 new mothers admitted to the unit. The nurse determines that which mother is most likely at risk for developing a puerperal infection? Select all that apply. 1. a mother who had 10 vaginal exams during labor 2. a mother with a history of previous puerperal infections 3. a mother who gave birth vaginally to a 3200-gram infant 4. a mother who experienced prolonged rupture of the membranes 5. a mother who experienced the expected outcome with delivery of the placenta

1, 2, 4 Rationale:Risk factors associated with puerperal infection include a history of previous puerperal infections, cesarean births, trauma, prolonged rupture of the membranes, prolonged labor, multiple vaginal exams, and retained placental fragments.

A client calls the primary health care provider's office to schedule an appointment because she has missed 2 menstrual cycles and has always been very regular. The client receives an appointment for the next day. The nurse should expect which findings to be present at this prenatal visit if the client is pregnant? Select all that apply. 1.Chadwick's sign 2.Vertex presentation 3.Positive pregnancy test 4.Fetal heart rate audible by fetoscope 5.Fetal movement detectable by the mother

1, 3 Rationale:Having missed 2 menstrual cycles with a normal history, the client is at approximately 8 weeks' gestation. Hormonal changes lead to vascular congestion in the cervix and vagina. The tissues have an appearance of looking "blue," and this change is identified by the term Chadwick's sign. In early pregnancy, human chorionic gonadotropin (hCG) is produced by trophoblastic cells that surround the developing embryo. This hormone is responsible for a positive pregnancy test. The pregnancy is not advanced significantly enough to be able to determine a presentation. Fetal heart rate is not audible by fetoscope until approximately 20 weeks. The earliest a mother experiences fetal movement is approximately 14 weeks.

The nurse is reviewing the record of a client who has just been told that her pregnancy test is positive. The primary health care provider has documented the presence of first trimester pregnancy signs. Which signs should the nurse anticipate as being present during this time frame? Select all that apply. 1.Hegar's sign 2.Babinski's sign 3.Ortolani's sign 4.Goodell's sign 5.Chadwick's sign

1, 4, 5 Rationale:In the early weeks of pregnancy, the uterus and cervix undergo physical changes. The uterine isthmus softens (Hegar's sign); the cervix becomes softer as a result of pelvic vasoconstriction, causing Goodell's sign; and the cervix and vagina become vasocongested, which gives a blue appearance and is known as Chadwick's sign. Babinski's sign is related to neurological integrity. Ortolani's sign is related to the presence of hip dysplasia.

The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication? Select all that apply 1.Flushing 2.Hypertension 3.Increased urine output 4.Depressed respirations 5.Extreme muscle weakness 6.Hyperactive deep tendon reflexes

1, 4, 5 Rationale:Magnesium sulfate is a central nervous system depressant and relaxes smooth muscle, including the uterus. It is used to halt preterm labor contractions and is used for preeclamptic clients to prevent seizures. Adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.

what is the average blood loss for a cesarean birth?

1000 mL

A pregnant client in the first trimester calls the nurse at a health care clinic and reports that she has noticed a thin, colorless vaginal drainage. The nurse should make which statement to the client? 1."Come to the clinic immediately." 2."The vaginal discharge may be bothersome, but is a normal occurrence." 3."Report to the emergency department at the maternity center immediately." 4."Use tampons if the discharge is bothersome, but be sure to change the tampons every 2 hours."

2 Rationale:Leukorrhea begins during the first trimester. Many clients notice a thin, colorless, or yellow vaginal discharge throughout pregnancy. Some clients become distressed about this condition, but it does not require that the client report to the health care clinic or emergency department immediately. If vaginal discharge is profuse, the client may use panty liners, but she should not wear tampons because of the risk of infection. If the client uses panty liners, she should change them frequently.

A couple comes to the family planning clinic and asks about sterilization procedures. Which question by the nurse should determine whether this method of family planning would be most appropriate? 1."Have you ever had surgery?" 2."Do you plan to have any other children?" 3."Do either of you have diabetes mellitus?" 4."Do either of you have problems with high blood pressure?"

2 Rationale:Sterilization is a method of contraception for couples who have completed their families. It should be considered a permanent end to fertility, because reversal surgery is not always successful. The nurse would ask the couple about their plans for having children in the future. Options 1, 3, and 4 are unrelated to this procedure.

A pregnant client in the prenatal clinic is scheduled for a biophysical profile (BPP). The client asks the nurse what this test involves. The nurse should make which appropriate response? 1."This test measures your ability to tolerate the pregnancy." 2."This test measures amniotic fluid volume and fetal activity." 3."This test measures your cardiac status and ability to tolerate labor." 4."This test measures only the amount of amniotic fluid present in the uterus."

2 Rationale:The BPP assesses 5 parameters of fetal activity: fetal heart rate, fetal breathing movements, gross fetal movements, fetal tone, and amniotic fluid volume. In a BPP, each of the 5 parameters contributes 0 to 2 points, with a score of 8 considered normal and a score of 10 perfect. Results are available immediately. A BPP test deals with fetal, not maternal, well-being. Options 1 and 3 relate to maternal well-being. Amniotic fluid measurement is only 1 component of the BPP test.

The nurse has collected the following data on a client in labor. The fetal heart rate (FHR) is 154 beats/min and is regular, and contractions have moderate intensity, occur every 5 minutes, and have a duration of 35 seconds. Using this information, what is the appropriate action for the nurse to take? 1. prepare for imminent delivery 2. continue to monitor the client 3. report the FHR to the anesthesiologist on call 4. report the findings to the primary health care provider

2 Rationale:The data collected by the nurse are within normal limits and require no further action on the part of the nurse other than continued monitoring. The FHR is normally 110 to 160 beats/min. Signs of potential complications of labor include contractions consistently lasting 90 seconds or longer; contractions consistently occurring 2 minutes or less apart; fetal bradycardia, tachycardia, or persistently decreased variability; and irregular FHR. There are no data to indicate that delivery is imminent and no data to support contacting the anesthesiologist or PHCP.

The nurse caring for a client with a diagnosis of subinvolution should recognize which conditions as causes of this diagnosis? Select all that apply. 1.Afterpains 2.Uterine infection 3.Increased estrogen levels 4.Increased progesterone levels 5.Retained placental fragments from delivery

2, 5 Rationale:Infections and retained placental fragments are the primary causes of subinvolution. When either of these processes is present, the uterus has difficulty contracting. The presence of afterpains is an expected finding following delivery. Hormonal levels are not causes of subinvolution

The nurse is caring for a 25-year-old client who will undergo bilateral orchidectomy for testicular cancer. Which statement by the nurse would be helpful in exploring the client's concerns about loss of reproductive ability? 1. "you must be sad that you wont be able to have children after surgery" 2. "can you share with me any concerns about how this surgery will affect you in the future?" 3. "has the surgeon told you that you will not be able to have children?" 4. "do you feel that the surgeon has told you all you need to know about the upcoming surgery?"

2. Rationale:One of the most helpful approaches in exploring client concerns is to use open-ended questions. These tend to elicit more descriptive responses on the part of the client. Option 1 imposes the nurse's opinion on the client and does not value the client's perspective. Options 3 and 4 are closed-ended questions that may be answered with a "yes" or "no" response.

Which newborn is most at risk for a brachial plexus injury? 1. a term infant with a history of forceps-assisted delivery 2. a term infant delivered via primary cesarean section for malpresentation 3. a large for gestational age infant with a history of shoulder dystocia at delivery 4. a 36-week preterm infant delivered vaginally after preterm rupture of membranes

3 Rationale:Brachial plexus injuries, a fractured clavicle, or a fractured humerus are all possible risks during a delivery of an infant with shoulder dystocia and must be considered during the immediate newborn assessment. Stretching or pulling away of the shoulder from the head may occur during a difficult delivery such as one involving shoulder dystocia. This positioning may cause damage to the upper plexus. Larger infants are more likely to be involved in a delivery in which inadequate space is a concern.

The nurse is collecting data from a client who is at 32 weeks' gestation. The nurse measures the fundal height in centimeters and expects the findings to be how many centimeters (cm)? 1. 22 cm 2. 28 cm 3. 32 cm 4. 40 cm

3 Rationale:From 22 weeks until term, the fundal height measured in centimeters is roughly plus or minus 2 cm of the gestational age of the fetus in weeks. If the fundal height exceeds weeks of gestation, additional assessment is necessary to investigate the cause for the unexpected uterine size. If an unexpected increase in uterine size is present, it may be that the estimated date of delivery is incorrect and the pregnancy is more advanced than previously thought. If the estimated date of delivery is correct, it may be possible that more than 1 fetus is present.

The nurse is providing nutritional counseling to a new mother who is breast-feeding her newborn. The nurse should instruct the client that her calorie needs should increase by approximately how many calories a day? 1. 100 2. 300 3. 500 4. 1000

3 Rationale:If the client is breast-feeding, her calorie needs increase by approximately 500 calories/day. The client should also be instructed on the need for increased fluids and the need for prenatal vitamins and iron supplements.

The result of a biophysical profile (BPP) of a 28-year-old client at 36 weeks' gestation after the ultrasound components is 8. Based on this result, the nurse should take which action? 1.Prepare the client for labor induction. 2.Notify the primary health care provider (PHCP). 3.Place the fetal heart monitor on the client in order to do a nonstress test (NST). 4.Provide the client with information regarding warning signs and symptoms of pregnancy and discharge her to home.

3 Rationale:The BPP includes 5 components, one of which is an NST. Each of these components allows the practitioners to assess if the central nervous system is fully functional and that the fetus is not hypoxemic. Four components are included in the ultrasound portion of the profile in addition to an NST: fetal breathing movements, fetal movements, fetal tone, and amniotic fluid index. Each of the 5 components is given a score of either 2 or 0. Zero indicates an abnormal result, and a 2 indicates a normal result. After the ultrasound components, the client's BPP is 8 out of 8 possible points. This indicates fetal well-being, but there is a need to complete the BPP by obtaining an NST. Notifying the PHCP can be eliminated because the BPP result thus far is normal. Labor induction can be eliminated because the client's gestational age is not term and the BPP reveals no abnormalities or the need for induction. To complete a BPP, an NST must be done; therefore, it is inappropriate to send the client home at this point in her care, so eliminate option 4.

A pregnant 39-week-gestation gravida 1, para 0 client arrives on the labor and delivery unit with signs and symptoms of active labor. The nurse reviews the client's prenatal record and discovers that she has had a positive group B streptococcus (GBS) laboratory report during her prenatal course. After performing a cervical exam, the nurse confirms that the cervix is dilated 6 cm and 90% effaced. Which should be the nurse's first action? 1.Provide the client with instructions on how to push. 2.Prepare the labor room and the client for an imminent delivery. 3.Call the primary health care provider (PHCP) to obtain a prescription for intravenous antibiotic prophylaxis (IAP). 4.Call the PHCP to the labor and delivery unit to perform a delivery.

3 Rationale:The client evidences progression toward delivery because the cervix is dilated 6 cm and the signs and symptoms of active labor are present. Because the client has had a positive GBS result during pregnancy, her neonate is at risk for becoming infected with GBS via vertical transmission during birth. GBS poses a significant risk for infant morbidity and mortality. To decrease this risk, it is recommended that IAP be administered during labor. Providing the client with instructions on pushing is not appropriate at a time when she does not need to use this information; thus, this is not a priority. The client is not close to complete dilation; therefore, the PHCP is not required for delivery at this time.

The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement by the student indicates an understanding of the ductus venosus? 1."It connects the pulmonary artery to the aorta." 2."It is an opening between the right and left atria." 3."It connects the umbilical vein to the inferior vena cava." 4."It connects the umbilical artery to the inferior vena cava."

3 Rationale:The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery.

The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement by the student indicates an understanding of the ductus venosus? 1."It connects the pulmonary artery to the aorta." 2."It is an opening between the right and left atria." 3."It connects the umbilical vein to the inferior vena cava." 4."It connects the umbilical artery to the inferior vena cava."

3 Rationale:The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery.

A primary health care provider has prescribed transvaginal ultrasonography for a client in the first trimester of pregnancy, and the client asks the nurse about the procedure. How should the nurse respond to the client? 1."The procedure takes about 2 hours." 2."It will be necessary to drink 1 to 2 quarts (1 to 2 liters) of water before the examination." 3."The probe that will be inserted into the vagina will be covered with a disposable cover and coated with a gel." 4."Gel is spread over the abdomen, and a round disk transducer will be moved over the abdomen to obtain the picture."

3 Rationale:Transvaginal ultrasonography allows clear visibility of the uterus, gestational sac, embryo, and deep pelvic structures, such as the ovaries and fallopian tubes. The client is placed in a lithotomy position and a transvaginal probe, encased in a disposable cover and coated with a gel that provides lubrication and promotes conductivity, is inserted into the vagina. The client may feel more comfortable if she is allowed to insert the probe. The procedure takes about 10 to 15 minutes. Options 2 and 4 identify components of abdominal ultrasound.

a post partum woman's fundus has descended by 3 cm. how many days post-partum is the mother

3 days out 1 day = 1 cm descent 4 cm is when the fundus is in the pelvic cavity and cannot be palpated abdominally

A client arrives at a birthing center in active labor. After examination, it is determined that her membranes are still intact and she is at a −2 station. The primary health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcomes of the amniotomy? Select all that apply. 1.Less pressure on her cervix 2.Decreased number of contractions 3.Increased efficiency of contractions 4.The need for increased maternal blood pressure monitoring 5.The need for frequent fetal heart rate monitoring to detect the presence of a prolapsed cord

3, 5 Rationale:Amniotomy (artificial rupture of the membranes) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the progress begins to slow. Rupturing of the membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions. Increased monitoring of maternal blood pressure is unnecessary after this procedure. The fetal heart rate needs to be monitored frequently, as there is an increased likelihood of a prolapsed cord with ruptured membranes and a high presenting part.

The nurse is teaching a pregnant client about the physiological effects and hormonal changes that occur during pregnancy. The client asks the nurse about the role of estrogen in pregnancy. Which responses should the nurse give the client about the role of estrogen? Select all that apply. 1.It maintains and relaxes the uterine lining for implantation. 2.It stimulates metabolism of glucose and converts the glucose to fat. 3.It increases the blood flow to mucous membranes and causes them to swell and soften. 4.It prevents the involution of the corpus luteum and maintains the production of progesterone until the placenta is formed. 5.It stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation.

3, 5 Rationale:Estrogen is a very important hormone of pregnancy. It is responsible for vasocongestion of the mucous membranes. Estrogen stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation. Progesterone maintains the uterine lining for implantation and relaxes all smooth muscle. Human placental lactogen stimulates the metabolism of glucose and converts the glucose to fat; it is antagonistic to insulin. Human chorionic gonadotropin prevents involution of the corpus luteum and maintains the production of progesterone until the placenta is formed.

Which purposes of placental functioning should the nurse include in a prenatal class? Select all that apply. 1. it cushions and protects the baby 2. it maintains the temperature of the baby 3. it is the way the baby gets food and oxygen 4. it prevents all antibodies and viruses from passing to the baby 5. it provides an exchange of nutrients and waste products between the mother and developing fetus

3, 5 Rationale:The placenta provides an exchange of oxygen, nutrients, and waste products between the mother and the fetus. The amniotic fluid surrounds, cushions, and protects the fetus and maintains the body temperature of the fetus. Nutrients, medications, antibodies, and viruses can pass through the placenta.

A pregnant client being admitted to the labor room tells the nurse that she felt a large gush of fluid before arriving at the hospital. The nurse performs an assessment on the client and notes that the fetal heart rate is 90 beats/minute and that the umbilical cord is protruding from the vagina. What is the appropriate nursing action? 1. place the woman in a high-Fowler's position 2. palpate and evaluate contractions while administering a tocolytic 3. wrap the cord loosely in a sterile towel saturated with warm, sterile normal saline 4. start an intravenous (IV) line with fluids to be administered at a keep-vein-open (KVO) rate only

3. Rationale:When an umbilical cord is protruding, nursing actions are immediately directed at reducing cord compression and facilitating delivery of the fetus. The cord is wrapped loosely in a sterile towel saturated with warm normal saline to prevent it from drying out and becoming compressed. The client is placed in an extreme Trendelenburg's or modified Sims' position or knee-chest position to reduce compression. A tocolytic is used for inadequate uterine relaxation. IV solutions are administered at a rate greater than a KVO rate.

A pregnant client is admitted in labor. The nursing assessment reveals that the client's hemoglobin and hematocrit levels are low, indicating anemia. What should the nurse observe for following the client's labor? 1.Anxiety 2.Hot flashes 3.Low self-esteem 4.Postpartum infection

4 Rationale:Anemic women have a greater likelihood of cardiac decompensation during labor, postpartum infection, and poor wound healing. Anemia does not specifically present a risk for hot flashes. Anxiety and low self-esteem are unrelated to physiological integrity.

The nurse in a delivery room is assessing a client immediately after delivery of the placenta. Which maternal observation could indicate uterine inversion and require immediate intervention? 1.Chest pain 2.A rigid abdomen 3.A soft and boggy uterus 4.Complaints of severe abdominal pain

4 Rationale:Signs of uterine inversion include a depression in the fundal area, visualization of the interior of the uterus through the cervix or vagina, severe abdominal pain, hemorrhage, and shock. Chest pain and a rigid abdomen are signs of a ruptured uterus. A soft and boggy uterus indicates that the muscle is not contracting.

A prenatal client with vaginal bleeding is being admitted to the labor unit. The labor room nurse is performing the admission assessment and should suspect a diagnosis of placenta previa if which finding is noted? 1.Back pain 2.Abdominal pain 3.Painful vaginal bleeding 4.Painless vaginal bleeding

4 Rationale:The classic sign of placenta previa is the sudden onset of painless vaginal bleeding. Painful vaginal bleeding, abdominal pain, and back pain identify signs and symptoms of abruptio placentae.

A client arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. The client tells the nurse that a home pregnancy test was positive but that she began to have mild cramps and is now having moderate vaginal bleeding. On physical examination of the client, it is noted that she has a dilated cervix. Which statement, if made by the client, indicates that the client is interpreting the situation correctly? 1."I will need to remain on bed rest for 2 weeks." 2."I will need to take a full course of antibiotic treatment." 3."I will need to take tocolytic medication to halt the labor process." 4."I will need to prepare myself and my family for the loss of this pregnancy."

4 Rationale:The client is experiencing a spontaneous abortion (miscarriage), which cannot be prevented and will terminate her pregnancy. Bed rest will not reverse this process.

The nurse is reviewing true and false labor signs with a multiparous client. The nurse determines that the client understands the signs of true labor if she makes which statement? 1."I won't be in labor until my baby drops." 2."My contractions will be felt in my abdominal area." 3."My contractions will not be as painful if I walk around." 4."My contractions will increase in duration and intensity."

4 Rationale:True labor is present when contractions increase in duration and intensity. Lightening or dropping leads to engagement (presenting part reaches the level of the ischial spine) and occurs when the fetus descends into the pelvis about 2 weeks before delivery. Contractions felt in the abdominal area and contractions that ease with walking are signs of false labor.

A pregnant client admitted to the labor room arrived with a fetal heart rate (FHR) of 94 beats/minute and the umbilical cord protruding from the vagina. The client tells the nurse that her "water broke" before coming to the hospital. What is the appropriate nursing action? 1.Sit the client in a high-Fowler's position. 2.Call the pharmacy for a tocolytic medication. 3.Get intravenous (IV) therapy equipment and solution from the storage area. 4.Wrap the cord loosely in a sterile towel soaked with warm, sterile normal saline.

4 Rationale:When an umbilical cord is protruding, the cord must be protected from drying out and becoming compressed. Wrapping the cord with a sterile, saline-soaked towel will help accomplish this. The nurse must also help reduce compression of the cord by placing the client in an extreme Trendelenburg's or modified Sims' position. The primary health care provider is also notified immediately. A tocolytic would be used if the client had inadequate uterine relaxation. IV solutions may be administered but are not the priority item with the information given

The clinic nurse is performing an assessment on a client who is 6 days postpartum. When assessing involution, the nurse expects the uterine fundus to be located at which area? Click on the image to indicate your answer. 1. furthest away, line 10, above belly button 2. line 8, under belly button 3. line 6, midway 4. line 4, closest

4 Rationale:Within 12 hours after delivery, the fundus may be approximately 1 cm above the umbilicus. Involution progresses rapidly during the next few days after delivery, decreasing approximately 1 cm per day. By the sixth postpartum day, the fundus normally is located 6 cm below the 12 hours after delivery location. in class we have been taught that 1 day postpartum = 1 cm, day 2 = 2 cm, day 3 = 3 cm, etc.

A clinic nurse is explaining to a client the changes in the integumentary system that occur during pregnancy and should tell the client that which change may persist after she gives birth? 1. epulis 2. chloasma 3. telangiectasia 4. striae gravidarum

4. Rationale:Striae gravidarum, or stretch marks, reflect separation within the underlying connective tissue of the skin. After birth they usually fade, although they never disappear completely. Options 1, 2, and 3 are incorrect. An epulis is a red, raised nodule on the gums that bleeds easily. Chloasma, or mask of pregnancy, is a blotchy, browning hyperpigmentation of the skin over the cheeks, nose, and forehead and is especially noticed in dark-complexioned pregnant women. Chloasma usually fades after the birth. Telangiectasias, or vascular "spiders," are tiny star-shaped or branch-shaped, slightly raised, and pulsating end arterioles usually found on the neck, thorax, face, and arms. They occur as a result of elevated levels of circulating estrogen. The spiders usually disappear after delivery.

A laboring woman is lying in the supine position. What is the most appropriate nursing action? a.Ask her to turn to one side. b.Elevate her feet and legs. c.Take her blood pressure. d.Determine whether there is fetal tachycardia.

ANS: A The woman's supine position may cause the heavy uterus to compress her inferior vena cava, reducing blood return to her heart and reducing placental blood flow. This problem is relieved by having her turn onto her side. Elevating her legs will not relieve the pressure from the inferior vena cava. This position may produce hypotension in the woman, but the action should be to prevent this from happening, not to assess for the problem. If the woman is allowed to stay in the supine position, and blood flow to the placental is reduced significantly, fetal tachycardia may occur. The most appropriate nursing action is to prevent this from occurring by turning the woman to her side.

During the meeting with the dietitian, Y.L. gives a diet history that is high in noodles and rice with little protein. She informs the dietitian she is lactose intolerant but can have dairy products occasionally in small portions. is it important that Y.L. take a calcium supplement along with her prenatal vitamins?

Adequate amounts of calcium during pregnancy are necessary to calcify fetal bones and teeth. Women of Y.L.'s age normally need 1000 mg/day of dietary calcium intake. Being pregnant does not increase the need for calcium. The dietitian will evaluate Y.L.'s normal diet. If it provides less than 1000 mg/day, the dietitian might recommend either a change in foods that Y.L. eats or a calcium supplement, whichever best suits Y.L.'s needs.

While waiting for laboratory results, you consider that if P.T. is experiencing preterm labor, she would receive antenatal glucocorticoids. What is the rationale for the administration of antenatal glucocorticoids for preterm labor? a. to accelerate fetal lung maturity b. to stop uterine contractions c. to soften the cervix d. to prevent maternal infection

Answer: A Antenatal glucocorticoids such as dexamethasone and betamethasone are given to accelerate fetal lung maturity and thereby prevent or reduce the severity of respiratory distress syndrome in preterm infants between 24 and 34 weeks of gestation. However, this is an unlabeled use because the U.S. Food and Drug Administration has not approved these medications for this use. The other options are not correct.

what is a reproductive life plan?

Answer: A reproductive life plan addresses the woman's desired number and spacing of pregnancies. Such a plan helps women make changes that help improve birth outcomes. Rationale: Chronic conditions such as asthma, obesity, diabetes, or hypothyroidism should be addressed before pregnancy occurs.

Although D.H. continues to use alternative therapies for discomfort, she asks for pain medication and receives a dose of meperidine (Demerol). Three hours later, D.H. is lying on her back, and during contrac- tions you notice a few late decelerations of the FHR. You stay with D.H. to monitor her and her fetus and immediately call for someone to notify the PCP. put these actions in order of priority: a. discontinue the oxytocin infusion b. turn D.H. onto her left side and elevate her legs c. increase the rate of the maintenance IV fluids d. administer oxygen at 8-10 L/min by facemask

Answer: A. 3; B. 1; C. 2; D. 4 Late decelerations of FHR might indicate fetal distress. At the first sign of these, the mother should be turned to her left side (or right side if she has been lying on her left side), with her legs elevated to reduce maternal hypotension. The maintenance (not medication infusions) IV rate should be increased, and, if oxytocin is infusing, it should be discontinued. Oxygen should be administered. Stay with the patient to monitor her and the fetus, and have someone immediately notify the PCP.

the laboratory also performs a Coombs' test on Baby H. what is the purpose of the Coombs' test? a. it is done to identify the infants blood type b. it tests for damage to the RBCs from maternal antibodies c. it checks the RBCs for anemia d. it is a test for immunity to the hepatitis virus

Answer: B A positive Coombs' test means the mother has formed antibodies that coat and damage the infant's RBCs. As the infant's RBCs rupture, the bilirubin rises and is deposited in the infant's brain, which could cause retardation.

The nurse reviews the hospital security guidelines with T.N. The nurse points out that her baby has a special identification bracelet that matches a bracelet worn by T.N. and reviews other security procedures. Which statement by T.N. indicates a need for more teaching? a. "If I have a question about someone's identity, I can ask about it." b. "If someone comes to take my baby for an exam, that person will usually carry my baby to the exam room." c."Nursesonthisunitallwearthesamepurpleuniforms." d. "Each staff member who takes my baby somewhere should have a picture identification badge."

Answer: B It is essential to teach new parents about importance of checking the identity of any person who comes into the room to remove the baby. Picture identification badges should be checked, and often unit staff members will wear matching uniforms. If a baby is to be taken to another location from the mother's room, the baby is usually wheeled in a bassinet, not carried in a staff member's arms.

you realize that Baby H.'s mother need information about safety issues before being discharged. After reviewing safety issues, which statement by Baby H.'s mother indicates that she needs further instruction? a. "I have a car seat and will use it for my baby every time we use the car" b. "I can leave him on the infant table for just a few moments while he is a newborn" c. "I will not drink hot coffee while holding my baby" d. "I will check the bath water temperature before bathing him"

Answer: B People commonly believe infants cannot fall off of beds or tables. Although it is not common, they are capable of rolling off surfaces from birth. Never leave an infant or child unattended on a bed or other elevated surface. She must have a car seat to transport her baby from the hospital to home. She needs to be taught how to install the seat and restrain her infant correctly. Accidents are the number one killer of chil- dren of all ages, and prevention is age-specific. Parents should be taught correct car safety for chil- dren of all ages. Never drink hot liquids or smoke while holding an infant. Always check the temperature of the water before putting the baby in the bath water.

what types of assessments are performed at the preconception visit?

Answer: During a preconception visit, the health care provider obtains a complete history and physical examination. The woman is assessed for health problems (such as diabetes, hypertension, or sexually transmitted infections [STDs]), harmful habits (such as use of alcohol or drugs), or social problems (such as intimate partner violence) that might unfavorably affect pregnancy. Screening for rubella, varicella, and hepatitis B is performed, and the vaccines are given if indicated. Rationale: The preconception visit includes a complete history and physical examination to determine potential risks to the mother and fetus and obtain baseline data for a plan of care. If problems are discovered, intervention may be started immediately to avoid complications or worsening of the woman's condition or situation because of pregnancy. The woman should be instructed to wait at least 1 month after receiving rubella and varicella vaccines before conceiving.

True or False: A phenylketonuria (PKU) blood test can be done any time before an infant is discharged to home. If false, explain your rationale.

Answer: False PKU results from a deficiency of the enzyme phenylalanine dehydrogenase. Without this enzyme, the infant will not be able to digest certain proteins properly. Left undetected, these proteins build up in the body and can cause mental retardation. The test for PKU is not reliable until the newborn has ingested an adequate amount of the amino acid phenylalanine. The initial ingestion of milk needs to be documented and the test performed at least 24 hours after that time.

why is a preconception visit important?

Answer: Preconception is important to identify problems that might harm the mother or infant once pregnancy occurs and to provide education to help achieve a healthy pregnancy. Rationale: The early weeks of pregnancy are particularly important because during that time the fetal organs are forming and are especially sensitive to harm. Many women do not begin prenatal care until after this sensitive period, and injury may already have transpired.

As you assess both the mother and the fetus during the active stage of labor, you will look for abnormalities. Which of these are potential abnormalities during labor? (Select all that apply.) a. unusual bleeding b. brown or greenish amniotic fluid c. contractions that last 40 to 70 seconds d. sudden, severe pain e. increased maternal fatigue

Answers: A, B, D Abnormalities that might occur during labor include unusual bleeding, amniotic fluid that is brown or greenish in color, absence of fetal movement or decelerations (slowing) of the FHR, any sudden severe pain, and difficulty breathing. Contractions that last for 40 to 70 seconds are expected during the active stage of labor; contractions that last for 90 seconds or longer might indicate a com- plication. Increased maternal fatigue is expected as labor progresses.

P.M asks you whether there are any foods that she should avoid while pregnant. She lists some of her favorite foods. Which foods, if any, should she avoid eating while she is pregnant? (select all that apply) a. hot dogs b. sushi c. yogurt d. deli meat e. cheddar cheese

Answers: A, B, D Food safety issues: Listeria organisms can cause miscarriages and stillbirths; contamination may be found in soft cheeses (cheddar cheese is a hard cheese), hot dogs, and deli meats. Toxoplasmosis has been linked to undercooked poultry and meat. Methylmercury and polychlorinated biphenyls (known as PCBs) found in some fish are harmful to the developing fetus; pregnant mothers should not eat shark, swordfish, king mackerel, or tilefish; they should avoid raw fish and seafood. Twelve ounces of cooked fish weekly is acceptable from these varieties: shellfish, wild-caught salmon, canned light tuna, smaller ocean fish, or farm-raised catfish or salmon.

After her examination, P.M. states that she is worried because her sister had an ectopic pregnancy and had to have surgery. She asks you, "What are the signs of an ectopic pregnancy?" Which of these are correct? (Select all that apply.) a. fullness and tenderness in her abdomen, near the ovaries b. pain, either unilateral, bilateral, or diffuse over the abdomen c. nausea d. dark red or brown vaginal bleeding e. increased fatigue

Answers: A, B, D Signs and symptoms of an ectopic pregnancy include adnexal fullness and tenderness; tender- ness that progresses to a colicky pain when the tube stretches; pain which is unilateral, bilateral, or diffuse over the abdomen; and dark red or brown abnormal vaginal bleeding. If the ectopic preg- nancy ruptures, pain increases. Referred shoulder pain can occur from diaphragmatic irritation caused by blood in the peritoneal cavity. The patient might exhibit signs of shock related to the amount of bleeding within the abdominal cavity. Nausea and increased fatigue might occur with normal pregnancies.

Which of these situations are considered contraindications to antenatal glucocorticoids when a woman is in preterm labor? (select all that apply) a. cord prolapse b. chorioamnionitis c. presence of twin fetuses d. cervical dilation of 2.5 cm e. abruptio placentae

Answers: A, B, E Antenatal glucocorticoids are contraindicated if there is medical indication for immediate delivery, such as cord prolapse, chorioamnionitis, or abruptio placentae.

D.H. states that she is feeling discomfort and asks you whether there is alternative therapy available before taking medication. List at least four alternative methods to assist D.H. with controlling her discomfort.

Change positions to promote comfort; use pillows, imagery, and visualization; conscious breathing to enhance relaxation; music, therapeutic (or healing) touch, acupressure over pressure sites, massage therapy, hypnosis, application of heat or cold to areas of discomfort.

A sexually active adolescent asks the school nurse about prevention of sexually transmitted infection. What is the most appropriate recommendation by the nurse?

Condoms provide the best available barrier to the organisms that cause STDs

What is gender dysphoria?

Emotional or psychological distress caused by an incongruence between one's natal (birth) sex and gender identity.

calculate EDD, G/P, and GTPAL Leslie N. has always wanted a big family. She had twins at 37 weeks who survived. Then she delivered triplets at 34 weeks who survived and then one baby at 40 weeks. She is pregnant "for the last time!" Her first day of her LMP was on November 30, 2016.

EDD = August 6, 2017 G4, P3 G4, T2, P1, A0, L6

calculate the EDD, G/P, and GTPAL Courtney L. is currently pregnant. She thinks her first day of her LMP was on January 16, 2015. She had an elective abortion when she was 18 years old. At the age of 26 she delivered a boy at 42 weeks' gestation, but he died of SIDS at the age of 6 months. She became pregnant again soon after this occurred and had a 36-week girl who is now 3 years old.

EDD = october 23, 2015 G4, P2 G4, T1, P1, A1, L1

why is medical nutrition therapy for a woman with gestational diabetes mellitus higher in fat and protein?

Fats provide the essential fatty acids needed for fetal brain development. Fats should be distrib- uted as less than 33% from saturated, less than 33% from polyunsaturated, and the balance from monounsaturated sources. The normal recommended protein allowance for a woman is 0.8 g/kg of body weight/day. During pregnancy, an additional 10 g/day of protein is required for adequate fetal growth and to support metabolic changes in the mother.

According to the clinic protocol, you obtain the following for her prenatal record: CBC, blood type, urine for urinalysis (UA) (protein, glucose, blood), vital signs (VS), height, and weight. Next, the nurse-midwife does a physical examination, including a pelvic exam and confirms that P.M. is pregnant. P.M. has a gynecoid pelvis by measurement, and the fetus is at approximately 6 weeks' gestation. Vital signs: BP: 116/74 mm Hg HR: 88 bmp RR: 16 breaths/min Temp: 98.9 Do any of these vital signs cause concern? What should you do?

No. these results fall within normal ranges. continue to monitor with each prenatal visit, and document

According to the clinic protocol, you obtain the following for her prenatal record: CBC, blood type, urine for urinalysis (UA) (protein, glucose, blood), vital signs (VS), height, and weight. Next, the nurse-midwife does a physical examination, including a pelvic exam and confirms that P.M. is pregnant. P.M. has a gynecoid pelvis by measurement, and the fetus is at approximately 6 weeks' gestation. P.M. tells you that the date of her last menstrual period (LMP) was February 2. How would you calculate her due date? what is her due date?

Pregnancy lasts about 9 calendar months or 10 lunar months (40 weeks). All dates are calculated by taking the first day of the LMP, counting back 3 months, and adding 7 days. Or, add 7 days to the LMP and count forward 9 months. For an LMP of February 2, the due date would be November 9.

Thermoregulation

Process of maintaining an internal temperature within a tolerable range.

During a woman's 38-week prenatal visit, the nurse assesses the fetal heart rate to be 180 beats/minute. What might the nurse suspect as the most likely cause of this tachycardia? 1.Maternal infection 2.Gestational hypertension 3.Gestational diabetes mellitus 4.Consumption of recent high-sugar snack

Rationale:The fetal heart rate depends on gestational age and ranges from 160 to 170 beats/minute in the first trimester but slows with fetal growth to approximately 110 to 160 beats/minute near or at term. Near or at term, if the fetal heart rate is less than 110 beats/minute or more than 160 beats/minute with the uterus at rest, the fetus may be in distress. A fetal heart rate of 180 beats/minute indicates tachycardia and could indicate intrauterine infection and fetal distress. Gestational hypertension, gestational diabetes, and consuming a high-sugar diet may affect the fetal heart rate but are not the most likely causes.

What woman can not have hormonal therapy after menopause?

Some women do not qualify for hormone therapy, for example, women who have breast cancer or blood coagulation disorders.

What teaching is needed for oral Antibiotic Therapy for Sexually Transmitted Diseases?

Take your medicine for the number of times a day it is prescribed and until it is completed. Your sexual partner must be treated if you have a sexually transmitted disease (STD). Expedited partner therapy is one way to ensure partners are treated. Be sure to return for your follow-up appointment after completing your antibiotic treatment. Call if you have any questions or concerns. Do not have sex until after you and your partner complete your antibiotic therapy. This should be at least 7 days, even if treatment is one dose. Drink at least 8 to 10 glasses of fluid a day to help heal your infection, while taking your antibiotics. Do not take antacids containing calcium, magnesium, or aluminum, such as Tums, Maalox, or Mylanta, with your antibiotics. They may decrease the effectiveness of the antibiotic. Take your antibiotics on an empty stomach unless your health care provider instructs you to take them with food.

When discussing sex and sexual activities with adolescents, what approach should the nurse use?

The nurse should provide accurate and complete information that is presented with correct terminology.

What is Expedited partner therapy (EPT)?

The practice of treating sexual partners of patients diagnosed with chlamydia infection or gonorrhea by providing prescriptions or medication to the patient, which they can take to their partner(s), without the health care provider examining the partner(s)

Y.L. is instructed to complete ketone testing using the first-voided urine in the morning. What is the rationale for this request?

The presence of urine ketones indicates nocturnal starvation because of inadequate food intake as a bedtime snack but can also signify the need for bedtime insulin. During pregnancy, there is an increased tendency to catabolize fat and spare amino acids and glucose for the developing fetus. There is evidence to suggest that elevated ketone levels might decrease psychomotor skills and lower IQ scores in the fetus.

P.M. asks, "Is a vaginal exam done at every visit?" What is your response? explain.

a vaginal exam is not done after the initial visit until the final weeks of gestation because it can stimulate vaginal contractions or cause possible infection. the vaginal exam is unnecessary because it does not offer vital information that cannot be obtained from other sources.

You are working as an RN in a large women's clinic. Y.L., a 28-year-old Asian woman, arrives for her regu- larly scheduled obstetric appointment. She is in her 26th week of pregnancy and is a primigravida. After examining the patient, the nurse-midwife tells you to schedule Y.L. for a glucose challenge test. You review Y.L.'s chart and note she is 5 feet, 3 inches and weighs 143 pounds; her prepregnancy body mass index (BMI) is 25. Her father has type 2 diabetes mellitus (DM), and both paternal grandparents had type 2 DM. You enter the room to talk to Y.L. when is a glucose challenge test performed?

a 75-g oral glucose tolerance test is performed between 24-28 weeks' gestation for all women not known to have diabetes

According to the clinic protocol, you obtain the following for her prenatal record: CBC, blood type, urine for urinalysis (UA) (protein, glucose, blood), vital signs (VS), height, and weight. Next, the nurse-midwife does a physical examination, including a pelvic exam and confirms that P.M. is pregnant. P.M. has a gynecoid pelvis by measurement, and the fetus is at approximately 6 weeks' gestation. What is the significance of a gynecoid pelvis?

a gynecoid pelvis means the bony pelvis is adequate for the fetus to pass through without difficulty

•What treatment will she receive if the fallopian tube is intact and has NOT ruptured?

•Medication—methotrexate—inhibits cell division (growth) in the embryo. Surgical treatment may be needed if methotrexate treatment fails or if the woman shows a high risk of tubal rupture-- to salvage the tube for future pregnancies. The tube is opened with a fine linear incision, the products of conception are removed

How does the nurse assess for risk factors, and for alterations in sexual well-being and sexually transmitted disease?

· Adolescent sexuality includes considering critical factors that may influence their behavior: socioeconomic status, family structure, future perspectives for education, and lived experiences · There exists an underlying assumption that individuals with disabilities are asexual and have no need of sexual fulfillment. All people, including those with disabilities, are entitled to move toward both sexual and social maturity in the same manner. · Those for increased risk for negative sequelae are adults who have recently separated from their partner because of death or divorce. These adults begin dating and suddenly have several new and unknown sexual partners. · Gay, lesbian, and bisexual youths have been found to engage in more high-risk sexual practices

what is important to know about newborn safety?

· Baths can lower the newborns temperature, so it's important to know what their core temperature is prior to a bath · The newborn should not sleep in the same bed with the mother, the newborn should sleep in its crib · The baby should be wrapped in a dry blanket for warmth and with a cap to their head as protection · Only plain water is used on the baby until 4 days old, because soaps, ointments, powders, lotions, and baby wipes can disrupt the acid mantle on the skin and provide a medium for bacterial growth · Use of powders places the infant at risk for fine particle aspiration

what health habits and types of medications are evaluated at the preconception visit?

made if necessary. Use of complementary or alternative therapies is also addressed. An initial weight is recorded to establish a baseline for evaluation of weight gain throughout pregnancy. Other important assessments include smoking, alcohol and recreational drug usage. Rationale: Medications that might be teratogenic can be changed to less harmful drugs. Some complementary or alternative therapies that are safe at other times may be harmful during pregnancy. Women who are obese can obtain help to lose weight before conceiving. Obesity during pregnancy increases the incidence of hypertensive disorders, gestational diabetes, postpartum hemorrhage, poor labor progression, cesarean delivery, anesthesia complications, wound infection, and birth of large-for-gestational-age infants. Smoking, alcohol and recreational drug usage are all harmful to the fetus.

hair changes during pregnancy

· Because fewer follicles are in the resting phase, hair grows more rapidly and less hair falls out during pregnancy.

flat or inverted nipple prevention

none, you're born that way

etiologies of male sexual disorders

o Men can experience sexual dysfunction r/t sexual desire (libido), arousal, and pain o The two widely recognized conditions are erectile dysfunction and ejaculatory disorders o ED is an inability to develop or maintain an erection of the penis during sexual activity o Ejaculatory dysfunction is characterized by reduced or absent semen volume, which may be the result of a psychological condition, a medical condition, a medication, or a surgery.

primary preventions for patients experiencing alternations in sexuality

o Patient education, counseling and referral are essential o Focused areas of discussion including abstinence, contraception, safer sex practices, STIs, healthy relationships and community resources

etiologies of female sexual disorders

o SD may involve many physiological factors (diabetes, neuropathy, paralysis, and hormones) o The majority of research and clinical trials on SD in women have focused on psychological causes (stress, anxiety, depression, and anger) o The condition of SD includes the medical diagnoses of hyposexual activity disorder, sexual aversion disorder, sexual arousal disorder, orgasmic disorder, sexual pain disorder, and persistent genital arousal disorder

secondary prevention for patients experiencing alterations in sexuality

o Screening for STIs o Screening for Intimate Partner Violence

what are plugged ducts

occlusion of milk duct

this reflex occurs when the infants palm is toughed near the base of the fingers. the hand closes into a tight fist. the grasp reflex may be weak or absent if the infant has injury to the nerves of the arm. what reflex is this

palmar grasp reflex

postural changes during pregnancy

· Begin in the second trimester, when the hormones estrogen and progesterone initiate increased mobility of the pelvic ligaments. This facilitates passage of the fetus through the pelvis at the time of birth. · At 28 to 30 weeks, the pelvic symphysis separates. Relaxation of the pelvic joints creates pelvic instability, and the woman may assume a wide stance and the waddling gait of pregnancy to compensate for a changing center of gravity. · During the third trimester, as the uterus increases in size, the expectant mother leans backward to maintain her balance. This posture creates a progressive lordosis, or curvature of the lower spine, and may lead to backache.

this reflex occurs when infants are held upright with their feet touching a solid surface. they lift one foot and then the other, giving the appearance that they are trying to walk what reflex is this

stepping reflex

this reflex is essential to normal life. when the mouth of palate is touched by the nipple or a finger, the infant begins to suck. the sucking reflex is assessed for its presence and strength. feeding difficulties may be related to problems in the infants ability to suck and to coordinate sucking with swallowing and breathing. what reflex is this

sucking reflex

by day 14 post-partum, the uterus should or should not be palpated anymore?

the uterus should not be able to be palpated anymore

what are infants at risk for heat loss

their skin is thin, blood vessels are close to the surface, and there is little subcutaneous fat to provide a barrier to loss of heat

A serum magnesium level is drawn, and the results show 7.8 mEq/L. Does this result need to be reported to the physician? If so, what would you prepare to do?

therapeutic range for magnesium level is between 4-7.5 mEq/L. the result of 7.8 is too high and must be reported. magnesium sulfate infusion will be reduced or discontinued.

Medical nutrition therapy is the primary treatment for the management of GDM. Because treatment must begin immediately, you call the dietitian to come see Y.L. You also schedule Y.L. to meet with other mem- bers of the DM management team later in the week. what is the goal of medical nutrition therapy?

to control post-prandial blood glucose levels and maintain euglycemia

You are working as an RN in a large women's clinic. Y.L., a 28-year-old Asian woman, arrives for her regu- larly scheduled obstetric appointment. She is in her 26th week of pregnancy and is a primigravida. After examining the patient, the nurse-midwife tells you to schedule Y.L. for a glucose challenge test. You review Y.L.'s chart and note she is 5 feet, 3 inches and weighs 143 pounds; her prepregnancy body mass index (BMI) is 25. Her father has type 2 diabetes mellitus (DM), and both paternal grandparents had type 2 DM. You enter the room to talk to Y.L. what is the purpose of a glucose challenge test?

to screen for gestational diabetes mellitus (GDM)

How is the concept of sexuality defined?

· Central aspect of being human throughout life encompasses sex, gender identities, and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction · Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles, and relationships. · While sexuality can include all of these dimensions, not all of them are always experienced or expressed. · Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, legal, historical, religious, and spiritual factors

will a woman with HSV be able to have a baby

yes. a c-section will reduce the risk of fetal transmission of HSV

cervix changes during pregnancy

· Estrogen causes hyperemia (congestion with blood) of the cervix, resulting in the characteristic bluish purple color that extends to include the vagina and labia. This discoloration, referred to as Chadwick's sign, is one of the earliest signs of pregnancy. · Collagen fibers in the connective tissue of the cervix decrease, causing the cervix to soften. Before pregnancy, the cervix has a consistency similar to that of the tip of the nose. After conception, the cervix feels more like the lips or earlobe. The cervical softening is referred to as Goodell's sign. · The mucus plugs the cervical canal and blocks the ascent of bacteria from the vagina into the uterus during pregnancy

what are the initial assessments of a newborn?

· Inspect the infants back for possible neurological defects · The APGAR score should be identified · Umbilical cord inspection (need 2 arteries and 2 veins - if only one of each, notify HCP) · Molded head · Temperature · Bowel movement within the first 72 hours (obstruction would be suspected) · If natal teeth are present (notify HCP - could cause aspiration) · If any skin abnormalities or tags are present (notify HCP)

what is a PKU screen and why is it done before discharge?

· PKU screen is a neonatal screening that detects if there is a problem in converting the protein phenylalanine. If present, it can lead to mental retardation if not found and treated early. · This will be collected by puncturing the lateral heel after warming and collecting blood samples on the designated lab form

what are the consequences of sexual disorders

· Physiological consequences à unfulfilled sexual desire, unsatisfactory sexual responses, pain, STI infection as a result of a sexual encounter, inability to create a pregnancy, and complications with pregnancies · Psychological consequences à problems with relationship, low self-esteem, anxiety, and depression

Uterus changes during pregnancy

· Prepregnancy, it weighs up to 70 g (2.5 oz) and has a capacity of approximately 10 mL. By the end of a normal pregnancy, the uterus weighs approximately 1100 to 1200 g (2.4 to 2.6 lb) and has a capacity of approximately 5000 mL. · By 12 weeks of gestation, the fundus (top of the uterus) can be palpated above the symphysis pubis. It is located at the umbilicus by 20 weeks' gestation. The fundus reaches its highest level at the xiphoid process at 36 weeks. Because it pushes against the diaphragm, many expectant mothers experience shortness of breath. By 40 weeks, the fetal head descends into the pelvic cavity and the uterus sinks to a lower level. This descent of the fetal head is called lightening because it reduces pressure on the diaphragm and makes breathing easier. · Throughout pregnancy, the uterus undergoes irregular contractions called Braxton Hicks contractions. During the first two trimesters, contractions are infrequent and less noticeable. During the third trimester, contractions occur more frequently and may cause some discomfort. They are called false labor when they are mistaken for the onset of early labor.

connective tissue changes during pregnancy

· Striae gravidarum or "stretch marks" appear as slightly depressed pink to purple streaks on the abdomen, breasts, and buttocks. Striae fade to white or silvery lines but do not disappear after childbirth.

heart sound changes during pregnancy

· The changes are first heard between 12 and 20 weeks and regress during the first week after childbirth. The most common variations in heart sounds include splitting of the first heart sound and a third heart sound. A systolic murmur is found in 95% of pregnant women.

small and large intestine changes during pregnancy

· The emptying time of the intestines is increased, allowing more time for nutrient absorption. Calcium, amino acids, iron, glucose, sodium, and chloride are better absorbed during pregnancy, but absorption of some of the B vitamins is reduced. Decreased motility in the large intestine allows time for more water to be absorbed, leading to constipation. Hemorrhoids may be caused or exacerbated by constipation if the expectant mother must strain to have bowel movements.

physical respiratory changes during pregnancy

· The enlarging uterus lifts the diaphragm by approximately 4 cm. · The ribs flare, the substernal angle widens, and the thoracic circumference increases. These changes result from relaxation of the ligaments around the ribs. Breathing becomes more thoracic than abdominal, adding to the dyspnea many women experience.

cardiac output changes during pregnancy

· The expanded blood volume of pregnancy causes an increase in cardiac output—the amount of blood ejected from the heart each minute. Cardiac output rises up to 50%. Cardiac output is most efficient when the woman is lying in the lateral position and least efficient in the supine position.

heart position changes during pregnancy

· The heart is pushed upward and toward the left as the uterus elevates the diaphragm during the third trimester. As a result of the change in position, the locations for auscultating heart sounds may be shifted upward and laterally in late pregnancy.

esophagus changes during pregnancy

· The lower esophageal sphincter tone decreases during pregnancy, primarily because of the effect of progesterone on the smooth muscles. The relaxation of the esophageal sphincter and upward displacement of the stomach allow reflux of acidic stomach contents into the esophagus and produces.

bladder changes during pregnancy

· The woman experiences frequency of urination throughout pregnancy. Although uterine expansion within the pelvis is one cause of these urinary changes, frequency begins before the uterus is big enough to exert pressure on the bladder. Hormonal influences and the increased blood volume may play a significant role in urinary frequency. · Many women experience stress or urge incontinence that begins at any time during pregnancy and continues until after delivery. Nocturia is also common.

blood volume changes during pregnancy

· Total blood volume increases by as much as 45%.

what is important to know about the administration of vitamin K in the newborn?

· Vitamin K is given to the newborn to prevent and/or treat hemorrhagic disease o This vitamin does not cross the placenta and there is very little in breast milk o Supplemental vitamin K should be given to newborns to help clot the blood

Which occurrence is associated with cervical dilation and effacement? a.Bloody show b.False labor c.Lightening d.Bladder distention

•ANS: A As the cervix begins to soften, dilate, and efface, expulsion of the mucus plug that sealed the cervix during pregnancy occurs. This causes rupture of small cervical capillaries. Cervical dilation and effacement do not occur with false labor. Lightening is the descent of the fetus toward the pelvic inlet before labor. Bladder distension occurs when the bladder is emptied frequently (not emptying bladder all of the way). It may slow down the decent of the fetus during labor

supine hypotension during pregnancy

· When the pregnant woman is in the supine position, particularly during the second half of pregnancy, the weight of the pregnant uterus partially occludes the vena cava and the aorta. The occlusion may impede return of blood from the lower extremities and reduce cardiac return, cardiac output, and blood pressure. Collateral circulation developed in pregnancy generally allows blood flow from the legs and pelvis to return to the heart when the woman is in a supine position. · However, some women develop supine hypotensive syndrome. Symptoms include faintness, lightheadedness, dizziness, nausea, and agitation. Some may experience syncope, a brief lapse in consciousness. Blood flow through the placenta also decreases if the woman remains in the supine position for a prolonged period, which could cause fetal hypoxia. · Turning to a lateral recumbent position alleviates the pressure on the blood vessels and quickly corrects supine hypotension. Women should be advised to rest in a side-lying position to prevent supine hypotension. If they must lie in a supine position for any reason, a 217wedge or pillow under either hip is effective in decreasing supine hypotension.

•A woman who is 22 weeks pregnant is at risk for gestational diabetes. She has heard people talking about this before, but never quite understood it. How would you describe this condition to her?

•A carbohydrate intolerance of variable severity that develops or is first recognized during pregnancy.

Which assessment finding would convince the nurse to "hold" the next dose of magnesium sulfate? • a.Absence of deep tendon reflexes b.Urinary output of 100 mL total for the previous 2 hours c.Respiratory rate of 14 breaths/minute d.Decrease in blood pressure from 160/100 to 140/85

•ANS: A •Because absence of deep tendon reflexes is a sign of magnesium toxicity, the next scheduled dose should not be administered. Calcium gluconate is the antidote that should be administered. An hourly output of less than 30 mL could indicate toxicity. A respiratory rate of less than 12 breaths/min could indicate toxicity. Decrease in blood pressure is an expected side effect of magnesium sulfate.

How does the placenta allow for exchange of oxygen, nutrients, and waste products between the mother and fetus? a.Contact between maternal blood and fetal capillaries within the chorionic villi b.Interaction of maternal and fetal pH levels within the endometrial vessels. c.A mixture of maternal and fetal blood within the intervillous spaces. d.Passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries.

•ANS: A •Fetal capillaries within the chorionic villi are bathed with oxygen and nutrient-rich maternal blood within the intervillous spaces. The nutrients and oxygen from mom's blood are pulled through placenta to go into baby's blood. •The endometrial vessels are part of the uterus. There is no interaction with fetal blood at this point. Maternal and fetal blood do not normally mix. Maternal carbon dioxide does not enter into the fetal circulation.

Both members of an expectant couple are carriers for phenylketonuria (PKU), an autosomal recessive disorder. In counseling them about the risk to their unborn child, you should tell them that: • a.The child has a 25% chance of being affected. b.The child will be a carrier, like the parents. c.The child has a 50% chance of being affected. d.One out of four of their children will be affected.

•ANS: AEach child born to a couple who carries an autosomal recessive trait has a 25% chance of having the disorder, because the child receives either a normal or an abnormal gene from each parent. If one member of the couple has the autosomal recessive disorder, all of their children will be carriers; if both parents are carriers, each child has a 50% chance of being a carrier. Each child has the identical odds of being affected; because both parents are carriers, each child has a 25% chance of being affected, a 50% chance of being a carrier, and a 25% chance of not having the gene transmitted.

A pregnant woman with a BMI of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's best response would be to tell the woman that she should gain approximately: a.1 pound per week throughout the pregnancy. b.3.5 pounds during the first trimester, then 1 pound each week until the end of the pregnancy. c.1 pound a week during the first two trimesters, then 2 pounds per week during the third trimester. d.A total of 25 to 35 pounds.

•ANS: B •A BMI of 22 represents a normal weight. Therefore a total weight gain for pregnancy would be about 25 to 35 lb, or about 3.5 lb in the first trimester and about 1 lb per week during the second and third trimesters. 1 lb per week is too much weight gain for a pregnant woman of normal BMI. The weight gain pattern in answer C does not meet the recommendations. A total weight gain of 25 to 35 lbs is technically right but does not answer the woman's question usefully.

Which intervention may be most helpful for the client experiencing most of her labor pain in her back? a.Lying supine with head slightly elevated b.Having the support person apply firm pressure to the sacrum c.Sitting upright with the legs straight d.Having the nurse massage the upper back during a contraction

•ANS: B •Firm pressure against the sacrum, not the upper back, may be helpful in relieving the discomfort associated with back labor. Ambulation and an upright position are positions that make contractions more efficient and less painful.

Which finding in the urine analysis of a pregnant woman is considered a variation of normal? a.Proteinuria b.Glucosuria c.Bacteria in the urine d.Ketones in the urine

•ANS: B •Small amounts of glucose may indicate "physiologic spilling." The presence of protein could indicate kidney disease or preeclampsia. •Bacteria in the urine are associated with urinary tract infections. An increase in ketones indicates that the client is exercising too strenuously or has an inadequate fluid and food intake.

What is the pregnant woman most motivated to learn about during the first trimester? a.Fetal development. b.Impact of a new baby on family members. c.Measures to reduce nausea and fatigue so that she can feel better. d.Location of childbirth preparation and breastfeeding classes.

•ANS: C •During the first trimester, a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy. •Fetal development is a concern during the second trimester when the pregnancy seems more real. The impact of a new baby on the family would be appropriate topics for the second trimester, when the fetus becomes "real" as its movements are felt and its heartbeat is heard. Motivation to learn about childbirth techniques and breastfeeding is greatest for most women during the third trimester, as the reality of impending birth and becoming a parent is accepted.

What is the most important nursing intervention after the injection of epidural anesthesia? • a.Monitoring urinary output. b.Monitoring contractions. c.Monitoring maternal blood pressure. d.Monitoring intravenous infusion rate.

•ANS: C •Epidural anesthesia may produce maternal hypotension due to vasodilation. The mother is prone to bladder distention and this needs to be monitored. However, this does not become a problem until 1 to 3 hours later. Continuing monitoring of the contractions is important because they may be altered by the epidural. However, this is not the most important nursing intervention after the epidural is administered. The intravenous infusion needs to be maintained before, during, and after the epidural. However, it is not the most important nursing intervention at this point.

The nurse notes a pattern of late decelerations on the fetal monitor. What is the most appropriate action? a.Continue observation of this reassuring pattern. b.Notify the physician or nurse-midwife. c.Give the woman oxygen by face mask. d.Place the woman in a Trendelenburg position.

•ANS: C •Late decelerations are associated with reduced placental perfusion. Giving the laboring woman oxygen increases the oxygen saturation in her blood, making more oxygen available to the fetus. Late decelerations are not a reassuring pattern; interventions are needed. Nursing interventions should be initiated before notifying the health care provider. The Trendelenburg position will not increase the placental perfusion.

Which diagnostic test evaluates the effect of fetal movement on fetal heart activity? a.Contraction Stress Test b.Sonography c.Biophysical profile d.Fetal Non Stress Test

•ANS: D •An Non Stress Test evaluates the ability of the fetal heart to accelerate either spontaneously or in association with fetal movement. CST evaluates the fetal reaction to contractions. Sonographic examinations visualize the fetus and are done for various reasons. The biophysical profile evaluates fetal status using many variables. The Fetal Non-Stress test is a simple, non-invasive test performed in pregnancies over 28 weeks gestation. The test is named "non-stress" because no stress is placed on the fetus during the test.

•What therapeutic management will the nurse expect if the woman has mild preeclampsia and the doctor chooses to continue her treatment outpatient?

•Activity is usually restricted, although full bed rest is not required. The woman will most likely need to stop working for the duration of home management, although computer-based work may be possible. •The woman should keep a record of fetal movements, also called a "kick count". She should report a significant decrease in movements or absence of movement •Blood pressure should be checked two to four times per day •Daily weight each morning •A urine dipstick test for protein •Diet: fluid restriction and low salt

•The nurse knows that if the woman's preeclampsia becomes severe, she will be hospitalized. What will be included in the woman's plan of care?

•Bed rest, reduce external stimuli (lights, noise) that might precipitate a seizure •Magnesium sulfate prevents seizure and reduces blood pressure. (Magnesium is not an antihypertensive medication, but it relaxes smooth muscle, including the uterus, and thus reduces vasoconstriction) •Antihypertensive medications--If the woman's systolic blood pressure is ≥160 mm Hg, the risk for stroke or congestive heart failure is higher. Hydralazine is commonly used. •Delivery may be necessary, even if the gestation is less than 34 weeks, because of disease severity.

•The nurse knows that one type of abruptio placentae is concealed hemorrhage. What is this and what are the signs/symptoms?

•Bleeding that occurs behind the placenta while the margins remain intact. •Signs/symptoms: Increase in fundal height; Hard, board-like abdomen; Persistent abdominal pain; Systemic signs of early hemorrhage (tachycardia [maternal and fetal], falling blood pressure, restlessness); Persistent late deceleration in fetal heart rate; Vaginal bleeding can be slight or absent

•The last topic presented in the workshop is Group B Streptococcus Infection. Where does this bacterium colonize in the pregnant woman? The student nurse learns that preterm rupture of membranes and preterm birth can occur due to Group B Streptococcus Infection. What other complications/infections can occur for the neonate? What is the diagnostic testing (and when is it performed), and what is the prevention and treatment for infants?

•Colonizes the rectum, vagina, cervix, and urethra •Neonatal complications: Sepsis, pneumonia, and meningitis are the primary neonatal infections in early onset GBS disease •Diagnosis of the mother is done via vaginal and rectal cultures at 35 to 37 weeks' gestation. •Antibiotics such as penicillin prescribed for the mother during labor and birth; intravenous antibiotics prescribed for infected infants.

•The nurse will suspect that the doctor will order conservative inpatient management if the woman with abruptio placentae meets what list of criteria? And for what reasons will the doctors consider immediate cesarean birth of the baby? And what are the nursing considerations and treatment for each?

•Conservative Inpatient: (RARE, usually c-section is needed) If the abruption is mild and the fetus is less than 34 weeks of gestation, shows no signs of distress, and if bleeding is minimal. ** bed rest and may include administration of magnesium sulfate to decrease uterine activity (relaxes smooth muscles) •Immediate c-section: If signs of fetal compromise are present or the woman or her fetus exhibit signs of excessive bleeding, either obvious or concealed. ** Intensive monitoring of both the woman and the fetus is essential because rapid deterioration of either can occur. One or more large-gauge IV lines should be placed for replacement of fluid and blood.

•What signs/symptoms does the nurse expect to see when she assesses the woman with hypertension during pregnancy today?

•Deep tendon reflexes (DTRs) may be very brisk (hyperreflexia).Generalized edema-- Edema may be present in the lower legs, and in the hands and face. Edema may be so massive that the woman's appearance is distorted. •Symptom of worsening condition (risk for eclampsia): continuous headache, drowsiness, or mental confusion (indicate poor cerebral perfusion and may be precursors of generalized seizures), Visual disturbances--blurred or double vision or spots before the eyes, epigastric pain or "upset stomach,"—particularly ominous, may indicate distention of the hepatic capsule and often warn that a seizure is imminent.

•What are maternal and fetal complications associated with gestational diabetes?

•Fetal: macrosomia, neonatal hypoglycemia, respiratory distress, preterm labor, premature rupture of membranes, preterm birth, and birth injury •Maternal: Hypertension, preeclampsia, urinary tract infections, and birth injury to maternal tissues

•What other simple recommendations about food can the nurse suggest to the woman with hyperemesis gravidarum to reduce nausea and vomiting?

•Food portions should be small •Eliminate foods with strong odors •Lowfat foods and easily digested carbohydrates, such as fruit, breads, cereals, rice, and pasta •Sitting upright after meals reduces gastric reflux

•How is this diagnosis (preeclampsia) different than gestational hypertension?

•Gestational hypertension is blood pressure elevation detected first time after mid-pregnancy without proteinuria.

•A nurse is reviewing the physician's notes for a patient who is 24 weeks pregnant and scheduled for an appointment today. She has a diagnosis of preeclampsia. What findings does the nurse expect when she takes the woman's blood pressure and obtains a 24-hour urine collection or random urine dipstick evaluation?

•High blood pressure--Systolic blood pressure ≥140 mm Hg (occurring after 20 weeks of pregnancy); significant proteinuria

•A 24-year-old woman schedules an appointment with her physician, because she is experiencing abdominal pain. She is diagnosed with an ectopic pregnancy. How should the nurse explain this condition to the woman and what other manifestations might she be experiencing?

•It is an implantation of a fertilized ovum in an area outside the uterine cavity, usually the fallopian tube. •Manifestations: Missed menstrual period, abdominal and pelvic pain, vaginal "spotting" or light bleeding, may have positive urine pregnancy test.

•What are the nursing considerations that the nurse caring for the patient with an ectopic pregnancy should include in her plan of care?

•Nursing care focuses on preventing or identifying hypovolemic shock, controlling pain, and providing psychological support for the woman who experiences an ectopic pregnancy. •The nurse must explain the importance of communicating to the healthcare team worsening symptoms that suggest tubal rupture (pelvic, shoulder, or neck pain; dizziness or faintness; increased vaginal bleeding).

•The nurse will suspect that the doctor will allow the woman with placenta previa to continue with outpatient treatment if she meets what list of criteria? And for what reasons would the doctors consider immediate cesarean birth of the baby?

•Outpatient: The woman is clinically stable, with no evidence of active bleeding; The woman can maintain bed rest at home; Home is within a reasonable distance from the hospital; Emergency transportation is available 24 hours a day. •Immediate c-section: Fetus is greater than 36 weeks of gestation & lungs are mature. Immediate delivery of an immature fetus may be necessary if bleeding is excessive and does not stop, the woman's cardiovascular status is unstable, or there are signs of fetal compromise.

•An expectant mother is Rh-negative and the father is Rh-positive. The nurse assessing the patient during her obstetrical appointment knows that this can cause Rh incompatibility between the mother and baby. How would the nurse explain the pathophysiology of this condition to the mother? Also, how would she explain what causes maternal and fetal blood to mix during pregnancy?

•People who are Rh-positive have the Rh antigen on their red blood cells, whereas people who are Rh-negative do not. When blood from a person who is Rh-positive enters the bloodstream of a person who is Rh-negative, the body reacts as it would to any foreign substance: It develops antibodies to destroy the invading antigen. •Theoretically, no mixing of fetal and maternal blood occurs during pregnancy. But in reality, small placental accidents can allow a drop or two of fetal blood to enter the maternal circulation and initiate the production of antibodies to destroy the Rh-positive blood cells (sensitization or isoimmunization). •Sensitization can also occur during a spontaneous or elective abortion or during antepartum procedures such as amniocentesis and chorionic villus sampling. Most exposure of maternal blood to fetal blood occurs during the third stage of labor, when active exchange of fetal and maternal blood can occur as the placenta separates.

•The nurse explains to the patient that preeclampsia can progress to become eclampsia. How should the nurse describe this condition to the patient?

•Progression to eclampsia with generalized seizures that cannot be attributed to other causes.

•Obstetrical units have protocols that address routine assessments when magnesium is being administered. What signs/symptoms of magnesium toxicity should the nurse watch for? The nurse should respond with what nursing interventions if patient develops magnesium toxicity?

•S/s of magnesium toxicity: Respiratory rate less than 14 breaths per minute, Maternal pulse oximeter reading lower than 95%, Absence of DTRs, Sweating/flushing, Confusion, lethargy, slurring of speech, drowsiness, disorientation, Hypotension •Treatment: Discontinue magnesium and notify the physician for signs of magnesium toxicity. Magnesium toxicity can be reversed by slow IV administration of calcium gluconate.

•A women with vaginal bleeding was seen at her physician's office. She was diagnosed with abruptio placentae. How should the nurse explain this condition to the woman, and what other symptoms is she mostly likely experiencing (there are 5 classic signs/symptoms)?

•Separation of a normally implanted placenta before the fetus is born; occurs when there is bleeding and formation of a hematoma on the maternal side of the placenta (cause of hematoma formation is unknown). •1. Abdominal and low back pain, often described as aching or dull 2. Frequent low-intensity contractions 3. High uterine resting tone = uterus not resting between contractions 4. Uterine tenderness 5. Vaginal bleeding

•The patient most likely came for her appointment today because of what classic sign of placenta previa? And what is the cause of this symptom?

•The classic sign = sudden onset of painless uterine bleeding in the latter half of pregnancy. •Bleeding occurs when the placental villi are torn from the uterine wall, resulting in hemorrhage from the uterine vessels. Bleeding may be scanty or profuse, and it may cease spontaneously, only to recur later. Bleeding may not occur until labor starts, when cervical changes disrupt placental attachment.

•f her fallopian tube does rupture, what treatment will she receive?

•The goal of therapeutic management is to control the bleeding and prevent hypovolemic shock. When the woman's cardiovascular status is stable, a surgery is performed to remove the affected tube and ligate bleeding vessels.

•This is the mother's first child. Most likely, will her baby be affected by this condition? What treatment can the mother receive to prevent complications with subsequent babies? And when should she receive this treatment?

•The woman's first Rh-positive child is usually unaffected because maternal antibodies are formed after the birth of the infant. •Subsequent Rh-positive fetuses can be affected, however, unless the mother receives an IM injection Rho(D) immune globulin (RhoGAM) to prevent antibody formation after the birth of each Rh-positive infant. •Administer RHOgam: • At 28 weeks of pregnancy• If baby is Rh-positive-- within 72 hours after delivery • Within 72 hours following the termination of a pregnancy of 13 weeks gestation or more •One microdose within 72 hours following the termination of a pregnancy of less than 13 weeks gestation.

•A woman is experiencing persistent, uncontrollable vomiting that began in the third week of her pregnancy. She was diagnosed with hyperemesis gravidarum. Medical intervention is necessary to prevent which potential complications?

•Weight loss, dehydration, and alkalosis from loss of hydrochloric acid in the gastric fluids