Maternal Newborn Exam One- ALL MATERIAL!

How does fetal circulation work?

1 vein brings oxygen and nutrients TO fetus while 2 arteries take fetal waste AWAY to placenta

Opioid analgesics

meperidine, fentanyl, nalbuphine Decrease perception of pain w/o loss of consciousness Given during early active labor IV route preferred r/t effectiveness of action

A tiny bit of blood goes to

the lungs just to help them grow

A nurse is preparing a client for intrauterine device (IUD) insertion. Which education will the nurse provide to the client?

"Checking the strings is recommended following insertion."

A client in her second trimester of pregnancy arrives at the health care facility for a routine follow-up visit. The nurse is required to educate the client so that the client knows what to expect during her second trimester. Which information should the nurse offer?

"You will experience quickening, and you will actually feel the baby."

A client gave birth to a child 3 hours ago and noticed a triangular-shaped gap in the bones at the back of the head of her newborn. The attending nurse informs the client that it is the posterior fontanel (fontanelle). The client is anxious to know when the posterior fontanel will close. Which time span is the normal duration for the closure of the posterior fontanel?

8 to 12 weeks

Heartburn Teaching

Avoid spicy, greasy and gas forming foods

Stage 3

Delivery of placenta Contractions- 5-30 minutes

Stage 4

Immediate PP recovery Contractions- 1-4 hours

Percutaneous Umbilical Blood Sampling

Obtains fetal blood from the umbilical cord by passing a fiber-optic scope into the amniotic sac

The nurse has administered erythromycin ointment to a newborn. What outcome indicates this nursing intervention has been effective?

The newborn does not contract ophthalmia neonatorum.

get iron from

fortified breakfast cereals, white beans, dark chocolate, soybeans, spinach

If WBCs are present in urine

infection

Quickening

slight fluttering movements of the fetus felt by the woman; usually between 16-20 weeks gestation

3rd trimester is

through 40 weeks

Precip labor Risk Factors

Multiparous client Oxytocin stimulation Hx of precipitous delivery

Prenatal Labs 11-20 weeks

not every woman is going to need this Genetic disorder screening and diagnostic tests

Monitor for diaper dermatitis

- Use zinc oxide based ointment

Uterine Rupture Management

Administer blood products if available Prepare for an immediate C-Section, possible hysterectomy

Ectoderm

CNS, PNS, skin, hair, nails, mammary glands

Epidural Block Placement

Curl up like a cat to create a C in the spine and open up the spaces Will run test doses- makes sure catheter is in correct place; watch HR Once the procedure is starting, watch BP very closely- every 15 minutes and every 2-3 minutes after If BP starts to drop and baby cannot tolerate it, then late decelerations will be present Mom may feel nauseous or dizzy

Passenger

Relationship between maternal longitudinal axis to fetal longitudinal axis

Cervix

junction of the uterus with the vagina- dilates during labor

Fetal movement is called quickening at

18-20 weeks

The licensed practical nurse is evaluating the tracings on the fetal heart monitor. The nurse is concerned that there is a change in the tracings. What should the LPN do first?

Assess and reposition the woman.

Analgesia Advantages

Can be given soon after requested Provides fast relief (usually w/in 5 minutes) movement/mobility still possible

Prolapsed Umbilical Cord Interventions

Get immediate assistance Insert two fingers, similar to a sterile vaginal exam and lift presenting part off the cord Position in knee to chest trendelenburg or side lying position with rolled towel under hips If you can see the cord, apply a warm, sterile saline soaked towel to prevent drying and maintain blood flow.

Other Teratogenic infections

HIV, Hep A/B, syphilis, parvovirus B19, varicella zoster

During a physical assessment of a newborn, the nurse observes bluish markings across the newborn's lower back. The nurse interprets this finding as:

Mongolian spots.

Fetal Heart Monitor

Monitors the baby's heart rate Will be located on the bottom of the mothers stomach because hopefully the baby is head down to get ready for delivery Will show readings on top of monitor

Tocodynamometer (pressure transducer) "Toco"

Monitors the mothers contractions Will be on the bottom on the monitor

A nurse is providing care to a pregnant woman in her first trimester who has come to the clinic for a follow-up visit. During the visit, the nurse teaches the woman about some of the changes that she will be experiencing during her pregnancy. Which information would the nurse include when describing changes in the breast?

Montgomery glands (Montgomery tubercles) become more prominent.

The nurse is assessing a pregnant client at 12 weeks' gestation and the client reports some new bumps on the dark part of her nipples. What is the best response from the nurse when questioned by the client as to what they are?

Montgomery glands (Montgomery tubercles); secrete lubricant for the nipples

Anaphylactoid Syndrome of Pregnancy Risk Factors

Multiple gestation Polyhydramnios IOL Clinical Manifestations Sudden chest pain SOB Bluish, grey coloration Coagulation failure Circulatory collapse High risk for DIC

Couvade Syndrome

Partner experiences physical symptoms such as nausea, vomiting, and back pain at the same degree or even more intensity as their partners. These symptoms apparently result from stress, anxiety and empathy for the pregnancy woman.

Women with Rh - blood should receive

RhoGAM immune globulin after procedure to protect future fertility

Anaphylactoid Syndrome of Pregnancy

Rupture in the amniotic sac accompanied by high intrauterine pressure causes infiltration of AF into maternal circulation. Can travel to and obstruct pulmonary vessels

TPAL

T- term births (greater than 37 weeks); defined by gestational age; twins, etc are still one pregnancy P-preterm births (viability at 20 weeks until 36.6 weeks) A- abortions (spontaneous or therapuetic); any loss of pregnancy L- # of living children; kids are counted as individuals now

Shoulder Dystocia Risks

Things that make for really big babies Maternal history of diabetes Multiparity Postdate pregnancy

Effacement

Thinning, shortening and drawing up of cervix Occurs during stage 1 of labor Measured in percentage 0 to 100% (complete)

Which statement is false regarding bathing the newborn?

To reduce the risk of heat loss, the bath should be performed by the nurse, not the parents, within 2 to 4 hours of birth.

During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first?

Turn the client on her left side.

Emergent C-section

Umbilical cord prolapse Placental abruption Severe fetal distress

Leopold Maneuvers

Use systematic observation and palpation to determine fetal position, presentation and lie Steps #1- fetal lie #2- fetal presentation #3- fetal engagement #4- fetal attitude

Pre/Post Ductal O2 Saturation Monitoring

Used to check in the ducts open as a fetus are closing Pre-ductal-right hand Post-ductal-either feet

Following delivery, a newborn has a large amount of mucus coming out of his mouth and nose. What would be the nurse's first action?

Using a bulb syringe, suction the mouth then the nose.

Advantages of a Epidural/Spinal Block

Very effective pain relief (might still feel pressure) Does not impact maternal mental status

Prolapsed Umbilical Cord Assessment

Visualization or palpation of umbilical cord FHR monitoring shows variables or prolonged deceleration

Once at the hospital

Vital signs are done Labor assessment Contractions Vaginal discharge Fetal assessment Gestational age Position Heart rate monitoring Prenatal record Labs like CBC, RPR/VDRL/HIV, UA, GBS

Analgesia

alleviates pain sensations, raises threshold for pain perception

Restless leg syndrome is

an uncontrollable urge to move the legs that occurs more often in women with iron deficiency

AROM

assisted rupture of membranes

Uterine Growth 20-22nd week

at umbilicus

The nurse is preparing the delivery room before the birth occurs. What supplies would the nurse have available to care for the newborn? Select all that apply. a. Glucose water b. Suction equipment c. Identification bands d. Ophthalmoscope e. Warmer bed

b, c, e

A pregnant client comes to the prenatal clinic complaining of urinary frequency and lower back pain on the right, stating that this has never happened before. An exam validates the diagnosis of pyelonephritis. Which factor would contribute to this condition?

decreased peristalsis of urinary tract

Fundus

dome of the uterus

Anesthesia

eliminates pain perceptions by interrupting nerve impulses to the brain

A nurse is preparing to auscultate the fetal heart rate of a pregnant woman at term admitted to the labor and birth suite. Assessment reveals that the fetus is in a cephalic presentation. At which area on the woman's body would the nurse best hear the sounds?

in the woman's lower abdominal quadrant

Which change in the musculoskeletal system would the nurse mention when teaching a group of pregnant women about the physiologic changes of pregnancy?

increased lordosis

soft, downy hair called

lanugo

The ductus venosus is

outside the heart and helps blood bypass the hepatic circulation to go back to the placenta

Uterine growth 12th week

palpable just above the symphysis pubis

P

para/parity # of pregnancies that reached 20 weeks or greater 22-25 weeks- age of viability for ATI

Lactation amenorrhea method (LAM)

safe method with a failure rate of 1-5% if infant is under 6 months of age, breastfeeding with no supplements and menses has not returned

Hegar's sign

softening in consistency of uterus, make uterus and cervix seem to be two separate regions- 6-12 weeks

SROM

spontaneous rupture of membranes

striae gravidarum

stretch marks

A young woman says she needs a temporary contraceptive but has a latex allergy. She mentions that she has a papillomavirus infection. Also, she says she is terrible about remembering to take pills. Which method should the nurse recommend?

transdermal contraception

FHR Variability Absent

undetectable; a flat line

Vaginal discharge

membranes; amniotic fluid is slightly alkaline

Oxytocin

necessary for labor contractions

The nurse is caring for a client whose fetus is noted to be in the position shown. For which fetal lie would the nurse provide client teaching?

Longitudinal

A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucus discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse?

"A one time discharge of bloody mucus in the toilet might have been your mucus plug."

A parent asks the nurse how to swaddle the newborn because the parent heard that it helps newborns calm down. Which statement will the nurse include in the teaching?

"Wrapping the newborn too tightly can impair breathing."

Heartburn in the

2nd and 3rd trimester

Human Placental Lactogen (hPL)

helps with making of breast milk; start of milk production

A client desires protection from unwanted pregnancies. However, the client does not enjoy sex when her partner wears a male condom. Also, the client experiences breast tenderness, headache, and nausea after taking oral contraceptive pills (OCPs). Which method would be the most likely choice for the couple to help them enhance their sexual experience as well as prevent any side effects?

transdermal contraceptive

Herpes simplex virus (HSV)

transmitted by direct contact with oral or gential lesions.

Labor usually begins between

37-42 weeks of pregnancy

FHR Variability

Fluctuations in baseline that are irregular in frequency and amplitude Indication of the nervous system development and function

Fetal Lie

How the baby lays in the mothers arms Does not tell us if it is head up or head down Want the baby to be vertical (longitudinal)- in line with moms spine

Get folic acid from

broccoli, brussel sprouts, leafy green veggies, peas, citrus fruits

The client is at 36 weeks' gestation. Which report requires immediate additional assessment by the nurse?

"I have been leaking clear, vaginal fluid."

- Gestational Age Classifications

- Preterm: <37 weeks - Late preterm: 34-36 weeks - Early term: 37-38 weeks - Term: 39-41 weeks - Post term: 42+ weeks

Common Newborn Complications

1. Establishing effective cardiorespiratory function is infant's greatest initial task 2. Main energy source=glucose; was provided by mother until birth 3. Large surface area: body weight ratio makes infants at higher risk for heat loss Cycle of newborn complications: respiratory distress-

The fetus should move around

10 times an hour; may have decreased movements if not receiving enough nutrients because of poor nutrition or placental insufficiency

Fetal movement can be felt by the mother at around

18-20 weeks and it will peak in intensity at 28-38 weeks

average weight gain

25-35 pounds; 3-5 in first trimester and 1 pound a week in the second and third.

Call provider if less than 10 movements in second hour

the fetus may be sleeping so lack of movements may not be serious, but it is an indication for further assessment

Supine hypotension

the mother lies down and then the baby moves up and presses on the vena cava

A woman in scrubs enters a mother's room while the nurse is completing an assessment. The woman states the doctor is in the nursery and has requested the infant be brought back for an examination. What will the nurse do?

Ask to see the woman' hospital identification badge.

Which complication occurs as a result of ineffective breathing patterns?

Hyperventilation

Insulin in pregnancy

Increase production but less effective response, making glucose more readily available for the fetus

General Pregnancy Discomfort

Ligament pains, backaches and leg cramps

A black couple are spending time with their newborn after the nurse brings the baby back from the transition nursery. The parents are horrified to note that their infant's buttocks appears bruised and demand to know what happened. The nurse should explain this is related to which factor?

Mongolian spots

A laboring mother requests that she be allowed to participate in "kangaroo care" following the birth. The nurse understands that this involves what action?

Placing the diapered newborn skin-to-skin with the mother and covering them both with a blanket.

Probable Signs

Provider sees/feels/says Positive pregnancy test- 4-12 weeks Goodell's sign Chadwick's sign Hegar's sign Abdominal enlargement- 14 weeks Ballottement- 16-28 weeks Braxton Hicks Contractions

Which statement is true regarding fetal and newborn senses?

The rooting reflex is an example that the newborn has a sense of touch.

Mesoderm

connective tissues, bone, cartilage, muscle, kidneys, ureters, reproductive system, heart, lymph and blood cells

The nurse is measuring a contraction from the beginning of the increment to the end of the decrement for the same contraction. The nurse would document this as which finding?

duration

When teaching a group of nursing students about the stages of labor, the nurse explains that softening, thinning, and shortening of the cervical canal occur during the first stage of labor. Which term is the nurse referring to in the explanation?

effacement

Braxton Hicks Contractions

false contractions that are painless, irregular and usually relieved with walking 16-18 week

N/V more in

first trimester and dies down as pregnancy progresses (usually)

Post term

greater than 40 weeks

Female condom

inserted into vagina and anchored by cervix Can be inserted before intercourse Cons- more expensive than male condoms, more bulky and difficult to use

Face masks are

preferred in pregnant laboring women

A nurse has just taught a client about the signs of true and false labor. Which client statement indicates an accurate understanding of this information

"False labor contractions usually occur in the abdomen."

When instructing a new mom on providing skin care to her newborn, which statement, made by the mother, indicates additional teaching is needed?

"I can use talc powders to prevent diaper rash."

A client calls the prenatal clinic and tells the nurse, "I think I am in labor." The nurse determines that the client is in true labor based on which client statement?

"I feel pressure in my vagina when I have the contraction."

A nurse is completing an informed consent on a client preparing for a tubal ligation. Which statement by the client would require the nurse to notify the health care provider?

"I will be able to have my third child in about a year from now."

After assessing a woman who has come to the clinic, the nurse suspects that the woman is experiencing abnormal uterine bleeding. Which statement by the client would support the nurse's suspicions?

"I've been having bleeding off and on that's irregular and sometimes heavy."

A woman who is about to be discharged after a vaginal birth notices a flea-like rash on her newborn's chest that consists of tiny red lesions all across the nipple line. What is the best response from the nurse when explaining this to the woman?

"It is a normal skin finding in a newborn."

The nurse working in a free health clinic assesses a 17-year-old client interested in contraceptives. Which statement by the client would indicate that female or male condoms would be the appropriate recommendation?

"Last year I was diagnosed with HPV."

A couple is deciding about contraceptive measures. The male partner has decided to undergo a vasectomy. After teaching the client about this procedure, which client statement indicates the need for additional teaching?

"Right after surgery, my semen will be sperm-free."

The nurse has provided information to a client about oral contraceptive pills (OCPs). Which statement by the client would indicate a need for further education?

"Some oral contraceptive pills protect against STIs."

A woman is diagnosed with primary dysmenorrhea and is prescribed ibuprofen as part of her treatment plan. When teaching the woman about using this medication, which instruction would be important for the nurse to emphasize?

"Start taking the medication when you first get your period."

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse?

"The hormones of pregnancy may cause anxiety or depression postpartum."

The nurse is assessing a male neonate in the presence of the parents and notes that the neonate has hypospadias. How should the nurse respond when questioned by the parents as to what this means?

"The opening of his urethra in located on the under surface of the tip of the penis."

A woman in labor has chosen to use hydrotherapy as a method of pain relief. Which statement by the woman would lead the nurse to suspect that the woman needs additional teaching?

"The temperature of the water should be at least 105℉ (40.5℃)."

The nurse is caring for a client who is a primigravida. Which statement is best to improve the client's psyche?

"You are doing a great job"

A nurse is performing a vaginal examination of a woman in the early stages of labor. The woman has been at 2 cm dilated for the past 2 hours, but effacement has progressed steadily. Which statement by the nurse would best encourage the client regarding her progress?

"You are still 2 cm dilated, but the cervix is thinning out nicely."

The nurse is caring for a client requesting oral contraceptives who has multiple sexual partners. The nurse recommends condoms to the client, but the client states, "I cannot use condoms because I am allergic to latex." Which response by the nurse is appropriate?

"You can still use condoms because they make latex-free condoms."

- Erythema toxicum

"baby acne", newborn rash d/t maternal hormones, appear and reappear on its own

- Cafe-au-lait spot

"birthmark", pigmentation marking, permanent

Presumptive Signs of pregnancy

"mom says I feel.." Amenorrhea Breast tenderness or fullness N/V Urinary frequency Uterine enlargement "bloating" Fatigue Quickening

Placenta

"organ of pregnancy"- provides blood, supply, nutrition, gas exchange and waste elimination for growing fetus

- Nevus flammeus

"port wine stain", altered pigmentation of the skin, more permanent

hCG

"pregnancy hormone"; allows for early detection

- Telangiectatic nevus

"stork bite", vascular marking underneath the skin

Coitus Interruptus

"withdrawal method" Con is that it is least effective, sperm are present in pre ejaculate fluid, no protection against STIs

Uterus

"womb" highly muscular, thick-walled, pear shaped organ situated between the bladder and rectum- where fetus develops

Uterus

"womb"- highly muscular, thick-walled, pear shaped organ situated between the bladder and rectum- where fetus develops

FHR Variability Marked

( greater than 25/min) crazy, line is all up and down

FHR Variability Minimal

(<5/min) no more than half a box

The client is being rushed into the labor and delivery unit. At which station would the nurse document the fetus immediately prior to birth?

+4

Newborn Assessment: Respiratory

- Count RR for 1 full minute - Normal breathing rate= 30-60 breaths per minute - Varies with activity, may be low as 20 breaths/min if in deep sleep, periods of apnea <10-15 seconds common, normal - Notes any signs of respiratory distress-grunting, flaring, retracting, tachypnea, cyanosis

Newborn Assessment

- First assessment done within 1 hour of birth, includes weights & measurements - Be flexible!! - Move from least invasive-

Formula

- Ready made vs. powdered - Check expiration date - Don't change without guidance from HCP - Prepared formula can be stored in refrigerator for 48 hrs - Discard any remaining milk left in bottle after feeding

To indicate that the infant is making a successful transition immediately after birth, the nurse checks the heart rate. The newborn is 4 hours old. Which rate would the nurse identify as a cause for concern?

108 beats/minute

Normal FHR range

110-160/min

Newborn Elimination

1st 24 hours of life: 1 wet, 1 dirty diaper 1st stool= meconium Progression: Day 2: 2 wet, 1 dirty Day 3: 3 wet, 1 dirty Day 4: 4 wet, 1 dirty Day 5+: 6-8 wet, 1 dirty every 24-48 hrs

A woman has opted to use medroxyprogesterone injections for birth control. The client receives the first injection today. The nurse instructs the woman to return to the clinic in how many months for the next injection?

3

Embryonic division

3 germ layers form and give way to body systems. Embryo stage lasts from implantation to 5-8 weeks gestation

Phase 2: Active Labor

3-5 hours Cerv. Change-4-7 cm Contractions-Stronger, q 3-5 min, lasting 40-60 secs

The nurse has completed assessing the blood glucose levels of several infants who are 24 hours old. Which result should the nurse prioritize for intervention?

30 mg/dL (1.67 mmol/L)

What is the expected range for respirations in a newborn?

30 to 60 breaths per minute

Phase 1: Latent Labor

6-12 hours Cerv. Change-0-3 cm Contractions-Mild, q 10 min, short (usually lasting 20-40 secs)

The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is:

7.15 or less.

Oxytocin and pitocin

A synthetic form of naturally occurring pituitary hormone Administered IV piggyback-allows for quick discontinuation resulting from uterine hyperstimulation Titrated by 1-2 mu/min every 30-60 minutes until adequate contraction pattern established Risks- uterine hypertonicity, sustained contractions, uterine rupture (w/ excessive dosage), fetal distress/bradycardia

A client in the latent phase of the first stage of labor is noted to be uncomfortable with intact membranes and mild contractions on assessment. The nurse should encourage the client to pursue which action?

Ambulation ad lib

The parents of a newborn male are questioning the nurse concerning the pros and cons of a circumcision. Which disadvantage should the nurse point out to these parents?

Anesthetic may not be effective during the procedure

Identify presence of periodic changes FHR monitoring

Are accelerations absent or present? Transitory increase in FHR above baseline, lasting less than 10 minutes Reassuring sign-no interventions

The nurse is caring for a newborn of a mother with human immunodeficiency virus (HIV). What is the priority for the nurse to complete following delivery?

Bathe the newborn thoroughly

Stage 3

Birth to placental delivery

Fetal presentation

Body part that will first contact the cervix, or be born first Cephalic "head down" or vertex Shoulder

Vacuum and Forceps

Both attach to the babies head and pull, mom at risk for lacerations, baby getting bruised and a possible hematoma Should only be used on a mom that has already had a baby before At risk for fetal facial paralysis

The nurse is teaching a prenatal class illustrating the steps that are used to keep families safe. The nurse determines the session is successful when the parents correctly choose which precaution to follow after the birth of their infant?

Check the identification badge of any health care worker before releasing baby from room.

Rupture of Membranes

Commonly happens in active labor COAT : C→ color -Clear -Meconium- happens for two reasons- baby is term/post term or a preterm infant who have seen extreme stress-ex. growth restriction or mom was in a car accident -Light or thick -Bloody O--

The nurse is preparing discharge instructions for the parents of a male newborn who is to be circumcised before discharge. Which instruction should the nurse prioritize?

Cover the glans generously with petroleum jelly.

Vacuum

Cuplike suction device used to apply traction with contractions to assist in descent and birth of head Be sure to document if it pops off

The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting?

Darkened breast areolae

Which cardinal movement of delivery is the nurse correct to document by station?

Descent

The nurse is monitoring a client in the first stage of labor. The nurse determines the client's uterine contractions are effective and progressing well based on which finding?

Dilation (dilatation) of cervix

Precip labor Management

Do NOT leave patient unattended Do NOT attempt to stop delivery Encourage measures to control urge to push, delivery speed Pant with open mouth between contractions Lateral position to maximize blood flow Apply light pressure to perineal area and fetal head

A 3-hour old newborn is assessed and is tachypneic with a respiratory rate of 44. Heart rate is 168, temperature is 97.3°F (36.3°C) and blood glucose is 90. What is the first action the nurse should take?

Document normal findings.

Analgesia Disadvantages

Does not provide total relief May cause drowsiness, disorientation, nausea May cause neonatal respiratory depression Cannot give too close to birth or baby can come out with respiratory depression

Raw, red, irregular "dirty" placenta

Duncan, maternal side

The nurse cares for a pregnant client at the first prenatal visit and reviews expected changes that will occur during pregnancy. Which information will the nurse include in the education?

During pregnancy blood volume can increase by 40% to 50%.

N/V Teaching

Eat small frequent meals, drink plenty of fluids

Germ layers

Ectoderm, Mesoderm, Endoderm

A nurse is observing a new parent bottle feeding the newborn. The nurse notices that the newborn begins to get fussy during the feeding. Which action by the nurse would be appropriate?

Encourage the parent to burp the newborn to get rid of air.

What are small unopened or plugged sebaceous glands that occur in a newborn's mouth and gums?

Epstein pearls

Newborn Medications

Erythromycin aka "eyes" - Prevents ophthalmia neonatorum transmitted through descent in birth canal Vitamin K (Aquamephyton/phytonadione) aka "thighs" - Prevents hemorrhagic disorders - Administer 0.5 to 1 mg IM in vastus lateralis within 1 hr after birth Hepatitis B - Recommended by CDC to be administered to all newborns at birth, 2 months, and 6 months - Infants born to mothers infected with Hepatitis B also receive Hepatitis B immunoglobulin (HBiG) within 12 hours of birth

The school nurse is counseling a sexually active 16-year-old adolescent about the various forms of contraception. She is afraid of getting pregnant or contracting a sexually transmitted infection because her boyfriend refuses to use a condom. In answering the client's questions as to which option will be best suit her needs, which form should the nurse recommend?

Female Condom

Shoulder Dystocia Complications

Fetal fractured clavicle, brachial plexus injury, diaphragmatic paralysis Maternal baginal or cervical lacerations

The client in active labor overhears the nurse state the fetus is ROA. The nurse should explain this refers to which component when the client becomes concerned?

Fetal position

Identification & Safety

First priority after physiologic stability All infants are banded with 2 identification bracelets Infant Security Sensors, Code Words

Contractions

Frequency- beginning to beginning Tachysystole

The nurse is discussing the various positions for delivery with a client and her partner. The client mentions she would like a position which speeds up the process, decreases stress to her baby, and reduces the possibility of needing an episiotomy. Which positions should the nurse point out will best meet the client's desires?

Hands and knees

Supine Hypotension Teaching

Have pt lie in a side-lying position May also be said as put a wedge or pillow under hip or back

A 22-year-old client comes to the walk-in clinic complaining of fatigue, breast heaviness and extreme tenderness, and a clear vaginal discharge. What question would the nurse ask this client?

Have you been sexually active in the past 2 months?

Uterus "womb"

Highly muscular, thick-walled, pear shaped organ situated between the bladder and rectum

The nurse is preparing a newborn male for circumcision. During the assessment, the nurse notes the newborn has a hypospadias. Which action made by the nurse is best?

Inform the practitioner and cancel the procedure.

External monitoring

Intermittent Latent- q 30-60 min Active/transition- q 15-30 min Second- q 5-15 min Continuous

Precipitous Labor

Labor that lasts for 3 hours or less from onset of contractions to delivery

Male: vasectomy

Ligation of vas deferens through puncture wound in scrotum Sterility not achieved until all sperm is cleared (20 ejaculations); must use an alternate form of BC! Will need to get sperm counts checked Does not affect sperm production it just cannot travel 99.5% effective

Rubella education

MMR vaccine is contraindicated

McDonald's Rule

Measurement from notch of the pubic symphysis to top of uterine fundus as a woman lies supine centimeters=weeks gestation Accurate between 20-31 weeks Becomes inaccurate during the third trimester because the fetus is growing more in weight than in height during this time

When provider does things to force your body into labor Stripping membranes

Mechanically dilates cervix, which releases prostaglandins Separates membranes from lower uterine segment Mechanical dilation with a foley like device- only work if less than 3 cm dilated

Unplanned C-sec

NRFHT Cephalopelvic disproportion, lack of labor progression

Prenatal History

Need to know about any STIs and Tx because it is important to know for when it is time to deliver Know obstetric history (GTPAL) Social history- drug use (including marijuana), exercise habits, job/career Medical history or any pre-existing conditions Family history- any genetic disorders

The nurse is assessing a client who believes she is pregnant. The nurse points out a more definitive assessment is necessary due to which sign being considered a probable sign of pregnancy?

Positive home pregnancy test

The nurse is assessing a newborn by auscultating the heart and lungs. Which natural phenomenon will the nurse explain to the parents is happening in the cardiovascular system?

Pressure changes occur and result in closure of the ductus arteriosus.

Stage 2

Pushing & birth 30 min - 2 hours Contractions-q 3-5 minutes, 60-90 secs

Prolapsed Umbilical Cord Risk Factors

ROM (rupture of membranes) especially w/o engagement Small for gestational age (SGA) Polyhydramnios- too much amniotic fluid

Uterine Rupture

Rare, but life threatening emergency Seen in women who had a C-Section with their first birth and try to have a natural labor for the next birth : VBAC If the mother wants to labor for her second birth it depends on how her uterus was cut during the surgery

Just after birth, a newborn's axillary temperature is 94°F (34.4°C). What action would be most appropriate?

Rewarm the newborn gradually.

Internal Monitoring

Risk for infection No real need to be monitored internally ROM required

The new mother is holding her infant, speaking softly and gently stroking the baby's face. She giggles and asks the nurse why the baby turns toward her finger when she strokes the cheeks. The nurse should explain that this is which common newborn reflex?

Rooting

All barrier methods protect against

STIs

Progestin only mini pill

Safe for breastfeeding Action & use the same same as COC above May have more breakthrough, irregular vaginal bleeding

The nurse is caring for a new mother and newborn in a rooming-in unit and watches the mother put the infant in the bed, lying on her side, propped up with a pillow. The nurse should point out that this position can increase the risk of which situation?

Sudden infant death syndrome

The nurse is preparing to teach a client how to conduct the basal body temperature method to determine her fertile window. Which instruction should the nurse prioritize?

Temperature should be taken prior to any activity every morning.

A 1-day-old newborn is being examined by the nurse practitioner, who makes the following notation: face and sclera appear mildly jaundiced. What causes this finding?

The breakdown of RBCs release bilirubin, which the liver cannot excrete.

The nurse-midwife is performing a pelvic examination on a client who came to her following a positive home pregnancy test. The nurse checks the woman's cervix for the probable sign of pregnancy known as Goodell sign. Which description illustrates this alteration?

The cervix softens.

What assessment finding would suggest to the care team that the pregnant client has completed the first stage of labor?

The client's cervix is fully dilated.

The nurse is preparing new parents and their infant for discharge by answering questions and presenting basic discharge instruction. Which explanation should the nurse provide when questioned about the infant's yellow hue?

The tint is due to jaundice.

Prolapsed Umbilical Cord Complications

This compression results in decreased fetal circulation

The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. The mother will most likely experience which of the following at that time?

Urinary frequency

How to palpate

Use both hands Palpate smooth of back using palm of one hand and irregular small parts using palm of other hand Determine if presenting part is engaged by gently grasping lower segment of uterus between thumb and finger Cannot check head flexion without confirming presentation and position

The nurse prepares to give the first bath to a newborn and notes a white cheese-like substance on the skin. The nurse should document this as which substance?

Vernix

What measure(s) will the nurse implement to help ensure that a newborn is not misidentified in the hospital? Select all that apply. a. Place an identification band on both the mother and the newborn immediately after birth, before separating them. b. Keep the newborn with the parent 24 hours per day until discharge. c. Ask the parents to look at the newborn each time the newborn is brought to the room to be sure that the newborn is theirs. d. Have identifying data on the newborn's chart and compare information to that in the mother's chart. e. Obtain the newborn and the mother's thumbprint on the mother's chart.

a

The nurse has assessed several clients who have arrived for routine appointments. The nurse predicts the health care provider will prioritize a bone density scan for which client?

a 55-year-old white client who smokes and has family history of osteoporosis

A fundal height much greater then the standard suggests

a multiple pregnancy, a miscalculated due date, a large-for-gestational-age (LGA) infant, hydramnios (increased amniotic fluid volume), or possibly even gestational trophoblastic disease.

Upon assessing the newborn's respirations, which finding would cause the nurse to notify the primary care provider?

a respiratory rate of 15 breaths per minute with nasal flaring

A client is beginning to take a combined oral contraceptive. Which of the following side effects will the nurse caution the client might be expected? Select all that apply. a. Nausea b. Breast tenderness c. Frequent urinary tract infections d. Headache e. Weight loss

a, b, d

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply. a. breast changes b. amenorrhea c. fetal heartbeat d. hydatidiform mole e. ultrasound pictures f. morning sickness

a, b, e

Which of the following changes, with highest priority, should the nurse teach a pregnant client to report to the health care provider as soon as possible?

abdominal pain coming and going during the third trimester

Variable Decelerations

abrupt decrease in FHR that varies in duration, intensity, and timing r/t contraction Abrupt decrease in HR with contractions Result of cord compression→ intervention necessary; roll mom Has a V or U shape

Placental separation

active bleeding on maternal surface of placenta with separation 5-30 minutes

A nurse is conducting an in-service program for staff nurses working in the labor and birth unit. The nurse is discussing ways to promote a positive birth outcome for the woman in labor. The nurse determines that additional teaching is necessary when the group identifies which measure?

allowing the woman time to be alone

Calcium and phosphorus are needs are increased during pregnancy because

an entire fetal skeleton must be built

A nurse is providing follow-up teaching to a client regarding the medically induced termination of her pregnancy. Which assessment finding should the nurse tell the client to report to the health care provider? Select all that apply. a. Mild cramping b. Severe depression or sadness c. Severe abdominal pain d. Vaginal bleeding of more than two pads per hour e. Oral temperature of 101.5°F (38.6℃)

b, c, d

A nurse is caring for a client in her fourth stage of labor. Which nursing assessments would indicate normal physiologic changes occurring during the fourth stage of labor? Select all that apply. a. Increase in the blood pressure b. Mild uterine cramping and shivering c. Decrease in the pulse rate d. Well-contracted uterus in the midline e. Decreased intra-abdominal pressure

b, c, e

GBS

bacteria that can live in the vaginal tract; only problem when you try to deliver vaginally; start screening for it around 36 weeks; tx with ampicillin

Prenatal Labs 1st Visit

blood and Rh factor, Hgb/Hct, STIs/disease titers, early maternal serum screen (determines gender) Urinalysis and urine culture

While performing a physical assessment of a newborn boy, the nurse notes diffuse edema of the soft tissues of his scalp that crosses suture lines. The nurse documents this finding as:

caput succedaneum.

Hormonal contraceptives

cause fluctuations in the normal menstrual cycle to suppress ovulation, thicken cervical mucus to block semen, and alter uterine decidua to prevent implantation Highly effective when taken correctly

A woman is to receive methotrexate and misoprostol to terminate a first-trimester pregnancy. When preparing the teaching plan for this client, the nurse understands that misoprostol works by:

causing uterine contractions to expel the uterine contents.

The nurse is teaching a primigravida who does not speak the dominant language. The nurse will teach about the most common type of fetal presentation. Which presentation will the nurse prepare?

cephalic presentation using preprinted materials in the client's language

True contractions will result in a

cervical change

A nurse is providing care to a pregnant woman in labor. The woman is in the first stage of labor. When describing this stage to the client, which event would the nurse identify as the major change occurring during this stage?

cervical dilation (dilatation)

Epidural Block

combination of local anesthetic and analgesic injected into epidural space, eliminating all sensation from umbilicus to thighs Preferred admin when pt is in active labor Can be patient controlled or intermittently to maintain level of comfort Stays in once placed

A nurse is conducting a class for a group of young adults at the health clinic about contraceptive options. The nurse determines that the teaching was successful when the group identifies which type as protective against sexually transmitted infections?

condom

After discussing various methods of contraception with a client and her partner, the nurse determines that the teaching was successful when they identify which contraceptive method as providing protection against sexually transmitted infections (STIs)?

condoms

The nurse places a warmed blanket on the scale when weighing a newborn to minimize heat loss via which mechanism?

conduction

Spinal Block

consists of local anesthetic injected into subarachnoid space, eliminating all sensation from nipples to feet Commonly used in C-Sections Goes in and comes out

Infections that can

cross the placenta and have teratogenic effects on the fetus

linea nigra

dark vertical line that runs down the stomach

Late Decelerations

decrease in FHR that starts after contraction, ends after contraction Offset from contraction Results of uteroplacental insufficiency, causing inadequate fetal oxygenation→ intervention necessary

Early Decelerations

decrease in FHR that starts with contractions, ends with contraction Mirror contraction; starts and ends with contraction Result of head compression→ no intervention

Chadwick's sign

deepened bluish-violet color of cervix- 6-8 weeks

Which assessment finding in the pregnant woman at 12 weeks' gestation should the nurse find most concerning? The inability to:

detect fetal heart sounds with a Doppler.

Kegel exercises not only strengthens urinary control but also

directly strengthens perineal muscles for birth

Basal Body Temp

drop just before, then spike in temp @ ovulation Pros- inexpensive, convenient Cons- variables can influence temp changes- no protection against STIs

Placental expulsion

either spontaneous delivery or gentle pressure/massage by PCP or manual extraction Placenta is inspected after delivery to make sure it is intact and no parts are retained. Expected blood loss: -300-500 mL for a vaginal delivery -800-1,000 mL for a C-Section

A woman is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and she has no real family support. The nurse's most therapeutic response would be to:

encourage her to identify someone that she can talk to and share the pregnancy experience.

Which intervention would be least effective in caring for a woman who is in the transition phase of labor?

encouraging the woman to ambulate

A nurse notes a pregnant woman has just entered the second stage of labor. Which interaction should the nurse prioritize at this time to assist the client?

encouraging the woman to push when she has a strong desire to do so

Hypertonic

excessively frequent, uncoordinated, strong intensity w/o adequate uterine relaxation Maintain hydration- keeps BP sufficient Internal monitoring can be initiated Lateral position to maximize blood flow Provide 8-10L oxygen via a face mask

The nurse is conducting an annual examination on a young female who reports her last menses was 2 months ago. The client insists she is not pregnant due to a negative home pregnancy test. Which assessment should the nurse use to assess confirm the pregnancy?

fetal heartbeat

Women should not restrict their fluid intake to diminish frequency of urination as

fluids are necessary to allow their blood volume to double

Contractions

frequency, duration, strength, cervical change

APGAR score

given at 1 and 5 minutes of life to assess infant's response to the extrauterine environment and any resuscitation measures provided by RN - Scores assigned at 1 and 5 minutes - If score is not 7 or above at 5 minutes, continue scoring q5 minutes for 20 minutes - Average score=8,9

Fetal blood Flow

goes through the right atrium and will hit the foramen ovale to be shunted to the aorta back to the placenta. If it does not go through the foramen ovale it will go down to the right ventricle and then the pulmonary artery into the ductus arteriosus that shunts blood away from the lungs into the aorta and to the umbilical artery that takes it to the placenta.

Prenatal Labs 36 weeks

group B streptococcus culture

- Strawberry hemangioma

group of capillaries right under the skin until they burst and go away

Estrogen

grows mammary glands to initiate breastfeeding and uterus to allow growth of fetus

The Apgar score is based on which 5 parameters?

heart rate, muscle tone, reflex irritability, respiratory effort, and color

The nurse is preparing an injection of a narcotic to relieve a pregnant woman's pain. As the nurse is about to give it, the client asks for a bedpan because she has to move her bowels. The nurse's best action would be to:

hold the injection until you evaluate her labor progress.

Nagele's Rule-

how the estimated delivery date (EDD) is calculated You get the date of the first day of the last menstrual period of the patient and subtract three months. And if the LMP date falls at April or before, then add a year An estimate- + or - of 2 weeks Will assume a 28 day cycle and not include leap year = G= gravida/gravidity # of pregnancies Including current pregnancy, miscarriages and abortions Does not get affected by outcome (live birth or stillborn) Twins and triplets still count as one pregnancy because they were one positive pregnancy test

When assessing a newborn 1 hour after birth, the nurse measures an axillary temperature of 95.8° F (35.4° C), an apical pulse of 114 beats per minute, and a respiratory rate of 60 breaths per minute. The nurse would identify which area as the priority?

hypothermia

Glycosuria

if persistent; diabetes

Cardiac Changes in Pregnancy

increase in cardiac output by 30-50% and blood volume by 30-45%, dizziness from dilation of vasculature, supine hypotension from compression of vena cava, dependent edema and varicosities, risk of thrombophlebitis from hypercoagulation Circulation to the uterus increases so much that toward the end of pregnancy 1/6th of the woman's blood supply is circulating through the uterus at any given time; uterine bleeding should always be regarded as serious bc it could lead to major blood loss

Thorax/Respiratory Changes in Pregnancy

increased AP diameter, change to costal respiratory pattern, increased tidal volume and O2 needs with decreased FRC, leading to dyspnea

A 28-year-old primigravida client with diabetes mellitus, in her first trimester, comes to the health care clinic for a routine visit. The client reports frequent episodes of sweating, giddiness, and confusion. What should the nurse tell the client about these experiences?

increased secretion of insulin occurs in the first trimester

Proteinuria

infection or Pre-Eclampsia

Ketonuria

insufficient food intake or vomiting

A nurse is assessing a pregnant woman and suspects that the woman may be experiencing pica. To help support this suspicion, the nurse evaluates the woman for signs and symptoms of which condition?

iron-deficiency anemia

A woman is using depot medroxyprogesterone acetate (Depo-Provera) as a method of birth control. Which side effect would the nurse most likely include as common?

irregular menstruation

Assessment of a pregnant client reveals that she is experiencing Braxton Hicks contractions. Which finding would support this assessment?

irregular pattern

Pulmonary vascular resistance (PVR) of the fetus

is high (High in lungs to keep blood out) the systemic vascular resistance (SVR) of the fetus=is low Blood is shunted away from the lungs through=foramen ovale and ductus arteriosus

An important factor to assess uterine growth at healthcare visits is

its constant, steady, and predictable increase in size.

Cervix

junction of the uterus with the vagina

The nurse measures a newborn's temperature immediately after birth and finds it to be 99°F (37.2°C). An hour later, it has dropped several degrees. The nurse understands that this heat loss can be explained in part by which factor in the newborn?

lack of subcutaneous fat

By the end of the 12th week of pregnancy, the uterus is

large enough that it can be palpated as a firm globe under the abdominal wall, just above the symphysis pubis.

Preterm

less than 37 weeks

Mother can do this at home,

lie on left side best after a meal Count and record # of movements felt in one hour If less than 10 drink soda/eat something sweet and try again

Endoderm

lining of pericardial, pleural and peritoneal cavities, resp tract and bladder and urethra

Musculoskeletal Changes in Pregnancy

lordosis of the spine, change in center of gravity (risk of falls)

Estrogen and progesterone

maintain the pregnancy; produced by placenta

Progesterone

maintains the endometrial lining of the uterus, lining needs to get thicker and raises estrogen levels

chloasma

mask of pregnancy-brown patches appear on face, also known as melasma

During labor, uterine contractions compress the uteroplacental arteries, temporarily stopping

maternal blood flow into the uterus and intervillous spaces of the placenta, decreasing fetal circulation and oxygenation

Fetal tachycardia can be caused by

maternal drugs, fever, anemia, hyperthyroidism, fetal hypoxia or arrhythmia.

Human Chorionic Gonadotropin (hCG)

measured in pregnancy tests; first hormone to be excreted-how you know a pregnancy has occurred

Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called?

melasma (chloasma)

Assessment of a newborn reveals tiny white pinpoint papules on a newborn's nose. The nurse documents this finding as:

milia.

FHR Variability Expected finding

moderate (6-25/min)

Abstinence

most effective method of BC; no risk of STIs but requires self control

The 3 hour test

mother is given the same glucose drink and her blood is drawn three times in the span of these hours. 2 elevated readings indicated gestational diabetes.

The nurse completes the initial assessment of a newborn. Which finding would lead the nurse to suspect that the newborn is experiencing difficulty with oxygenation?

nasal flaring

Natural Family Planning

no protection against STIs if having intercourse with these

get calcium from

orange juice, milk, yogurt, cheese, dark green leafy veggies, dried peas and beans

Fetal growth

organogenesis begins and proceeds in cephalocaudal direction

All individuals who use wheelchairs need to

periodically press on the armrests with their hands and raise their butt off the seat of the wheelchair to help prevent pressure ulcers; danger of ulcers increases with pregnancy because of the added weight

The Ballard scoring system evaluates newborns on which two factors?

physical maturity and neuromuscular maturity

What oxygenates the fetus?

placenta

Endocrine Changes in Pregnancy

placenta produces pregnancy hormones (hCG, progesterone, estrogen and prostaglandins), adrenal glands increase in cortisol and aldosterone production; increased insulin resistance

In a client's seventh month of pregnancy, she reports feeling "dizzy, like I'm going to pass out, when I lie down flat on my back." The nurse explains that this is due to:

pressure of the gravid uterus on the vena cava.

A maternity nurse is aware that the fetal head is the presenting part in complete extension position. Which type of birth should the maternity nurse anticipate?

prolonged labor and possible cesarean birth

Umbilical Cord

provides circulatory pathway to connect fetus to placenta

A new mother reports that her newborn often spits up after feeding. Assessment reveals regurgitation. Which factor would the nurse integrate into the response?

relaxed cardiac sphincter

When explaining how a newborn adapts to extrauterine life, the nurse would describe which body systems as undergoing the most rapid changes?

respiratory and cardiovascular

Shiny, glistening placenta

schultz, fetal side

Neurological Changes in Pregnancy

sciatic nerve pain, dizziness, lightheadedness, syncope with supine hypotension

Goodell's sign

softening of cervical tip- 5 weeks

A nurse is providing care to a woman during the third stage of labor. Which finding would alert the nurse that the placenta is separating?

sudden gush of dark blood from the vagina

Changes in Pregnancy Breasts

tenderness, tingling, enlargement, darkening of the areola/nipple, prominence of superficial veins, expression of colostrum

A fundal measurement much less than standard suggests

the fetus is failing to thrive, the pregnancy length was miscalculated, or an anomaly interfering with growth has developed

Skin Changes in Pregnancy

there is an increased pigmentation causing linea nigra, chloasma, and striae gravidarum

A couple has chosen fertility awareness as their method of contraception. The nurse explains that the unsafe period for them during the menstrual cycle would be at which time?

three days before and three days after ovulation

1st trimester is

through week 12

2nd trimester is

through week 24

Sedatives (barbiturates)

to relieve anxiety, induce sleep Restrict to latent labor

Fundus

top of the uterus

CMV

transmitted through semen, cervical/vaginal secretions, breast milk, urine, feces, blood

Pudendal Block

transvaginal injection into the space in front of the pudendal nerve Provides relief to perineum, vulva and rectal areas during delivery and repair Administered during late stage 2 for pain relief and stage 3 for pain relief r/t repair

The nurse is assessing a primigravida woman at a routine prenatal visit. Which assessment finding is reinforcing to the client that she is definitely pregnant?

ultrasound picture of her fetus

deoxygenated blood carried by

umbilical arteries back to placenta

Oxygenated blood carried by

umbilical vein to the baby

General Anesthesia

unconscious loss of sensation Used for emergency delivery via C-Section when nerve block anesthesia is a CI or time prohibits nerve block establishment

Fertilization

union of ovum and spermatozoon in fallopian tube, forming zygote

Caution women to not wait but void as often as necessary, as

urine stasis can lead to infection

- Neonates covered in white, cheesy substance called

vernix caseosa

Hypotonic

weak, inefficient, absent Managed by giving oxytocin Internal monitoring can be initiated Position changes to allow fetal rotation Prepare for assisted delivery; possible C-Section

Amniotic membranes/sac "bag of water"

what the fetus is enclosed in

- Milia

white spots, clogged sebaceous glands

Prenatal Labs 24-28 weeks

will revisit with complications Will take the glucose tolerance test The 3 hour test

Calendar method

woman calculates fertile period based on menstrual cycle Pros: inexpensive, most useful if combined with basal body temp or cervical mucus method Cons: requires accurate record keeping & regular cycles, requires abstinence during fertile period, no protection against STIs

Uterine Growth 36th week

xiphoid process

**Check for engagement before

you rupture a mother's membranes Goal is to relieve the pressure until the baby is born!!

Implantation

zygote migrates to the uterus, dividing many times to form a blastocyst, finally settling into the endometrial wall. Occurs 8-10 days after fertilization

A new mother asks the nurse why her newborn must get a vitamin K injection. Which response made by the nurse is best?

"Newborns need vitamin K to prevent hemorrhage. They cannot produce it themselves right after birth because of the lack of normal flora in their intestines."

The mother calls the nurse to check her baby after noting the right side of the body is dark red while the left side of the baby is pale. Which question to the mother should the nurse prioritize when assessing the situation?

"Was the baby recently crying?"

When to Call the Pediatrician Newborn

- Rectal temperature less than 97 or greater than 100.4 - Poor feeding - Frequent or projectile vomiting - Diarrhea or decreased bowel movements - Decreased urination - Labored breathing or apnea (

Fetal heart rate monitoring reveals baseline tachycardia in the fetus. Which rate would be most likely?

164 beats per minute

Fatigue and shortness of breath common in

1st and 3rd Always evaluate SOB to make sure it is normal

A pregnant woman can experience various emotions in pregnancy similar to the stages of grief but for pregnancy

1st trimester- accept pregnancy 2nd trimester- accept fetus 3rd trimester- prepare for baby and end of pregnancy

C section incisions

2 incisions- external and uterine Lower transverse incision is better for VBAC Do not need to labor if mom has a vertical incision

A urinalysis is done on a client in her third trimester. Which result would be considered abnormal?

2+ Protein in urine

How long is the neonatal period for a newborn?

28 days

The nurse obtains a human chorionic gonadotropin (hCG) level from a woman who thinks that she is pregnant. Which result would the nurse identify as a positive pregnancy result?

32 mIU/mL (32 IU/L)

Weight & Measurement Classifications

AGA (appropriate for gestational age):10-90th percentile LGA (large for gestational age): greater than 90th percentile SGA (small for gestational age): <10th percentile - IUGR (intrauterine growth restriction): <3% LBW (low birth weight): <2500g - VLBW (very low birth weight): <1500g - ELBW (extra low birth weight): <1000g

A woman at 38 weeks' gestation is in labor and oxytocin is prescribed to augment her labor. When preparing to administer this medication, what action by the nurse would be appropriate?

Administer the medication piggybacked into a primary IV line using a pump.

A client who delivered her baby 3 months ago is seen in the clinic and tells the nurse that she and her husband have yet to resume a sexual relationship. The nurse notes that no contraception is currently being used. What is the most appropriate nursing diagnosis for this client?

Altered sexual pattern related to fear of pregnancy

Transdermal Patch

Applied to SQ tissue of butt, abd, upper arm or torso Replace on same day of the week x3 weeks, no application on 4th week Decreases risk of forgetting to take pill Less effective in obese women Same AE as OCs Avoids liver metabolism

Toxoplasmosis teaching

Avoid raw foods, ensure food is cooked properly Use gloves when gardening Avoid contact with cat litter

Premonitory Signs

Backache Weight loss Lightening "dropped"- baby starts to engage Increased vaginal discharge, bloody show Energy burst "nesting" Gastrointestinal changes- body will clean itself out; diarrhea Rupture of membranes (ROM) Cervical ripening- stretchy and pliable Contractions (braxton hicks)

Which documentation in the health record is most correct for the third stage of labor?

Begins with the time of delivery of the fetus and ends with the time of the delivery of the placenta.

A nurse is caring for an infant with an elevated bilirubin level who is under phototherapy. What evaluation data would best indicate that the newborn's jaundice is improving?

Bilirubin level went from 15 to 11.

A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize?

Blood is trapped in the vena cava in a supine position.

The nurse notices that there is no vitamin K administration recorded on a newborn's medical record upon arrival to the newborn nursery. What would be the nurse's first action?

Call the Labor and Delivery nurse who cared for the newborn to inquire about why the medication was not documented.

Positive Signs

Can ONLY be explained by pregnancy Fetal heart tones, visualization of fetus on ultrasound, fetal movement

Elective termination of pregnancy

Can be ended medically or surgically Abortion means any loss of pregnancy

CMV Education

Can cause severe neurologic changes or eye damage, hearing impairment or chronic liver disease Because a woman has almost no symptoms, she may not even be aware she contracted an infection

The nurse explains the hospital's home visitation program for new families after discharge from the hospital. Which information will the nurse include regarding this program?

Caregivers can demonstrate competency in caring for the infant and ask questions.

Stage 1 (approx. 12 hours)

Cervical opening (dilation) & thinning (effacement)

Precip labor Complications

Cervical, vaginal or perineal lacerations Postpartum hemorrhage d/t forceful delivery resulting in lacerations, premature placental separation Fetal hypoxia Subdural hemorrhage d/t rapid release of pressure on head

There are four essential components of labor. The first is the passageway. It is composed of the bony pelvis and soft tissues. What is one component of the passageway?

Cervix

The nurse is documenting the length of time in the second stage of labor. Which data will the nurse use to complete the documentation?

Complete cervical dilation (dilatation) and time of fetal birth

Types of breech

Complete- baby looks exactly like it should but it is sitting up Footling- one foot is hanging out Frank- legs folded up next to head

Male condom

Cons- high rate of noncompliance, must be applied when erect, can rupture/leak

Diaphragm & spermicide

Cons- requires prescription & visit to the provider, interferes with spontaneity, removed within 6 hours, no protection against STIs, must be inserted correctly to be effective, requires re-fit every 2 yrs

The nurse cares for a pregnant client in labor and determines the fetus is in the right occiput anterior (ROA) position. Which action by the nurse is best?

Continue to monitor the progress of labor

Fetal Attitude

Degree of flexion a fetus assumes during labor or the relation of the fetal parts to each other Flexion of the neck Want baby tucked in chin to chest Face presentation is not compatible with vaginal delivery Vertex

The nurse notices while holding him upright that a 1-day-old newborn has a significantly indented anterior fontanelle. She immediately brings it to the attention of the physician. What does this finding most likely indicate?

Dehydration

A nurse is performing a physical assessment of a woman in labor. As part of her assessment, she examines the outer and inner surfaces of her lips. What is the best rationale for this assessment?

Detection of herpes virus infection

Dystocia (dysfunctional labor)

Difficult or abnormal labor r/t 4 P's, resulting in failure to dilate, efface, descend or ineffective pushing Atypical uterine contractions

Pushing- Stage 2

Educate on open vs closed glottis pushing Facilitate positioning open pelvic outlet Allor for perineal stretching if possible Prep perineal area per hospital protocol Prepare for lacerations/episiotomy

Prenatal Visit Schedule

Every 4 weeks through 2nd semester Every 2 weeks from 28-36 weeks Every week from 36 weeks-delivery

During a vaginal exam, the nurse notes that the lower uterine segment is softened. The nurse documents this finding as:

Hegar sign.

A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem?

Hemorrhoids

The nurse is explaining to new parents the various vaccinations their newborn will receive before being discharged home. Which immunization should the nurse teach the parents about that will help decrease the incidence of hepatic disease later in life?

Hep B

Fetal Distress Management

Identify the cause Increase IV fluid for hypotension (if ordered) Left side lying position to maximize blood flow Provide 8-10 L via facemask Discontinue oxytocin if it is being administered Prepare for assisted delivery, possible C-Section

Infection Control

Immune system not yet functional - IgG transferred through placenta, IgA transferred in breast milk HAND WASHING!!!! Individual patient supplies No sick visitors Caregivers: - Flu shot - Tdap shot (pertussis protection) - No smoking/ secondhand smoke

A client is requesting information on the various available contraceptives. When explaining a vaginal spermicide, which information should the nurse prioritize?

Insert the product by applicator in the vagina prior to intercourse.

A newborn's cord begins to bleed 1 day following birth. What measures would the nurse take to address this problem?

Inspect the clamp to insure that it is tightly closed and applied correctly.

A patient asks the nurse if a cervical cap is better than a diaphragm for contraception. What is the advantage of a cervical cap?

It can be left in place longer.

Amniotic fluid

Keeps the baby from being squished and helps develop fetal muscle tone. Regulates fetus's temperature Fetus swallows fluid to develop lungs and kidneys.

Pregnant women can get the flu and Tdap shot during pregnancy, but cannot get the

MMR, Varicella, Zoster, poliomyelitis or HPV vaccine

Planned C-sec

Malpresentation Multiple gestation High risk pregnancy Moms choice

Disadvantages of a Epidural/Spinal Block

Maternal hypotension which can lead to fetal distress Urinary catheter r/t inability to feel urge to void Will decrease mobility, ability to bear down for delivery

Shoulder Dystocia Interventions

McRoberts maneuver→ flex thighs sharply to abdomen to widen pelvic outlet Suprapubic pressure→ helps shoulder to escape from beneath the symphysis pubis

The nurse is conducting an assessment on a newborn and witnesses a startled response with the extension of the arms and legs. The nurse should document this as which response?

Moro

Non-Stress Test

Non-invasive procedure to measure the response of the fetal HR to fetal movement to identify fetal CNS status during third semester Mother is connected to fetal HR monitor and toco Monitor for 20 min Mother pushes button every time she feels movement A reactive result- 2 accelerations of fetal heart rate, which is 15 bpm above baseline lasting for 15 sec after movement; non-reactive if no acceleration occur with the fetal movements Fetal HR should increase approximately 15 beats/min and remain elevated for 15 seconds

Shoulder Dystocia

Occurs at second stage of labor when fetal head is born but shoulders are too broad to enter and/or be born through the pelvic outlet

Contraction Stress Test- CST

Performed after non-reactive NST to determine how the fetus will tolerate the stress of labor Contractions induced via nipple stimulation or pitocin Need three contractions in 10 minute period, lasting 40-60 sec Use caution! Ensure preterm labor does not begin Monitor for uterine hyperstimulation (contractions longer than 90 sec or greater than 5 contractions in 10 minutes Mother connected to FHR monitor and TOCO Negative CST- (should not see any late decelerations of FHR); What we want to see Positive CST- (persistent and consistent late decels with 50% or more contractions) suggests uteroplacental insufficiency→ consider delivery

A nurse is coaching a woman during the second stage of labor. Which action should the nurse encourage the client to do at this time?

Push with contractions and rest between them.

The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence?

Quickening

According to Brazelton's Neonatal Behavioral Assessment Scale, a newborn would be in what state if the eyes are open and looking at people nearby, and the newborn has minimal activity or body movement?

Quiet alert

Combined Oral contraceptives "the pill"

Requires prescription Take at same time every day Must use backup method if more than 2 doses missed Antibiotics can interfere with the pill!!- decrease effectiveness Major risks for thromboembolism, stroke, heart attack and HTN, especially if a smoker,

Female: tubal ligation

Severance and cauterization of fallopian tubes Can be done immediately after childbirth 99.5% effective

A pregnant client at 33 weeks' gestation is in the office for a routine visit. She lies down on her back and while the nurse is listening for fetal heart tones, the client tells the nurse that she feels lightheaded; her blood pressure is 82/58 mm Hg. What is the most likely explanation for this problem?

She is experiencing supine hypotension syndrome

Epidural/spinal regional analgesia

Short acting opioids administered as motor block into epidural, intrathecal space w/e anesthesia Provides rapid pain relief, maintains client's sense of contractions and ability to bear down Knocks out receptors

Intrauterine pressure catheter (IUPC)

Solid or fluid filled transducer that sits next to the infant inside the uterine cavity Used for assessment of contractions, administration of amnioinfusion Long, thin, flexible plastic tube Can look great on external, but not good internally and vice versa If it goes too far it could rupture placenta

The nurse is assessing a 1-month-old male infant during a routine examination at a family health center. Which method does the nurse use to test for Babinski's sign?

Stroke the bottom of the foot to determine if there's fanning and dorsiflexion of the big toe

Implantable progestin rod (implanon, nexplanon)

Subdermally implanted into upper aspect of arm Effective, continuous for up to 3 years Safe for breastfeeding More rapid return to fertility after removal Must avoid trauma to insertion site

The nurse is assessing a 2-hour-old newborn and notes that the infant has irregular patterns of breathing rate, depth, and rhythm. Which is the best action made by the nurse?

Taking no action because these are normal findings in a newborn

A heel stick blood glucose on a 6-hour-old newborn is 44 but the venous blood sample shows a glucose of 89. What could cause this discrepancy?

The bedside glucometer is not calibrated for newborns.

A 24-year-old primigravida client at 39 weeks' gestation presents to the OB unit concerned she is in labor. Which assessment findings will lead the nurse to determine the client is in true labor?

The client reports back pain, and the cervix is effacing and dilating.

Herpes Teaching

The first time a woman contracts an HSV infection, systemic involvement occurs. This virus spreads into the bloodstream (viremia) and, if a woman is pregnant, can cross the placenta to a fetus, thus posing substantial fetal risk. If genital lesions are present at time of birth, a fetus may contract the virus from direct exposure during birth. For this reason, a c section is indicated Acyclovir or valacyclovir can both be safely administered to women who develop lesions during pregnancy as well as to their newborns at birth. Given prophylactically at 36 weeks until birth to prevent lesions

A couple is considering vasectomy as a contraception option. However, the husband is nervous about how such a procedure would affect his sexual functioning. Which information should the nurse mention to the man?

The man will still have full erection capacity.

glucose tolerance test

This test is run by giving the mother a 50g oral glucose load (drink) followed by a timed blood draw; usually the 1-hour test and if the result is greater than 140 then the mother is referred to the 3 hour test

False contractions

Tighten portions of the uterus Don't usually cause back pressure Don't last longer over time Don't become stronger over time Don't grow closer together Often stopped with comfort measures, such as hydration or emptying of bladder

What important information should the nurse give a client about the use of a diaphragm during menstruation?

Toxic shock syndrome is possible.

Accelerations- absent or present?

Transitory increase in FHR at least 15 above baseline lasting at least 15 seconds but less than 10 minutes Reassuring sign-no interventions As contraction comes→ acceleration comes

Toxoplasmosis

Transmitted through contact w/ undercooked meats, contaminated soil and cat feces

Forceps

Two curved spoon like blades used to apply traction with contractions to assist in descent and birth of head

Tests for fetal well being

Ultrasound, non-stress test, contraction stress test, biophysical profile (BPP)

Biophysical Profile "BPP"

Utilizes ultrasound & NST to identify 5 parameters (w/ each parameter receiving a score of 0-2) to assess fetal well being Five parameters that are utilized are fetal HR, fetal breathing movements, gross body movements, fetal tone and amniotic fluid index 10 is the highest score, each parameter is 2 points 8-10: fetus is doing well 6 is suspicious 4 or less denotes the fetus is potentially in jeopardy Most accurate way to determine fetal well-being in a single assessment May be done as often as daily during a high-risk pregnancy

The nurse is caring for a newborn with a mother who has a positive hepatitis B surface antigen (HBsAg) test. Which of the following can the nurse expect the newborn to receive? Select all that apply. a. Hepatitis B immune globulin b. Hepatitis A vaccination c. Intravenous immune globulin G d. Hepatitis B vaccination

a, d

A client prescribed a combined oral contraceptive (COC) has presented for a routine visit. Which finding if reported by the client upon assessment should the nurse prioritize?

abdominal pain

A nurse is meeting with a group of pregnant clients who are in their last trimester to teach them the signs that may indicate they are going into labor. The nurse determines the session is successful after the clients correctly choose which signs as an indication of starting labor? Select all that apply. a. constipation b. bloody show c. lightening d. weight gain e. backache

b,c,e

The nurse is teaching a young couple who desire to start their family the various methods for determining fertility. After discovering the woman regularly travels internationally for work, deals with a lot of job anxiety, and frequently uses an electric blanket at home, the nurse will discourage the use of which method?

basal body temperature method

The nurse is admitting a 10-pound (4.5-kg) newborn to the nursery. What is important for the nurse to monitor during the transition period?

blood sugar

- Mongolian spot

bluish, black altered pigmentation, will not blanch, fades away

A nurse is conducting a parenting class on infant skin care. What information should the nurse include when preparing materials on the characteristics of the skin of infants? Select all that apply. a. The epidermis is thicker than in adults. b. Sweat glands are fully functioning at birth. c. Substances are easily absorbed. d. It is thinner and more fragile than an adult's e. Skin is less susceptible to the sun.

c, d

Cervical Mucus method (billings method)

cervical mucus becomes thin, watery and transparent and stretches between fingers (spinnbarkeit sign) Pros- requires self evaluation and can be very accurate especially while breastfeeding, beginning menopause, and planning a desired pregnancy Cons- no protection against STIs

During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called?

couvade syndrome

Reproductive Changes in Pregnancy

growth of the uterus, darkening of cervical and vaginal membranes from increased vasculature, cervix softens and mucus plug develops; vaginal pH increases

The nurse is discussing the insulin needs of a primiparous client with diabetes who has been using insulin for the past few years. The nurse informs the client that her insulin needs will increase during pregnancy based on the nurse's understanding that the placenta produces:

hPL, which deceases the effectiveness of insulin.

In which newborn should the nurse suspect hypoglycemia?

newborn with a heart rate of 60 after a prolonged deceleration in utero

The nurse is meeting with a 36-year-old client who wishes to begin using contraceptives. The client reports being in a long-term, monogamous relationship, runs 2 miles per day, and smokes a pack of cigarettes each day. Which method will the nurse be least likely to suggest to the client?

oral contraceptive pills (OCPs)

Prior to discharging a 24-hour-old newborn, the nurse assesses the newborn's respiratory status. What would the nurse expect to assess?

respiratory rate 45 breaths/minute, irregular

Abdomen/GI/Renal Changes in Pregnancy

stretching and separation of abd muscles. Displacement of organs from enlarging uterus, decreased gastric motility and muscle tone causing constipation and gastric reflux, increased caloric needs, morning sickness, increase in GFR, urinary frequency

HEENT Changes in Pregnancy

swelling/bleeding of gums, nasal stuffiness, nose bleeds

Two exceptions to the rule that deformities usually occur in early embryonic life are the effects caused by the organisms of

syphilis and toxoplasmosis. Can cause abnormalities in organs that were originally formed normally.

Skin assessment is

the same as in adults-assess each body surface and note any irregularities; check for temperature, moisture, turgor, and edema - Note any cyanosis, pallor, plethora-overly red appearance, or jaundice; also note petechiae or bruising caused by traumatic birth

A nurse is instructing a client on birth control methods. The client asks about the cervical mucus method. When should the nurse tell the client she is fertile in relation to her mucus?

when it is thin, watery, and copious

A labor nurse is caring for a client who is 7 cm dilated, 100% effaced, at a +1 station, and has a face presentation on examination. The nurse knows that teaching was understood when the birth partner makes which statement?

"Our baby will come out face first."

A nurse is teaching a newborn's caregivers how to change a diaper correctly. Which statement by the caregiver best indicates the nurse's teaching was effective?

"We will fold down the front of her diaper under the umbilical cord until it falls off."

Newborn Assessment: Cardiac

- Auscultate apical pulse rate for 30-60 seconds; located at 4th ICS until 7 years - Normal HR=110-160 beats/min - Newborns transition from fetal to neonate circulation during 1st 24-48 hours of life - Murmurs commonly heard, always follow up - Auscultate same 5 precordial points with diaphragm & bell - Acrocyanosis- blue, purplish extremities with pink trunk - Check capillary refill over sternum

Newborn Assessment: Neurological

- LOC assessed via alertness, purposeful movement, response to stimuli, ability to console, and quality of cry - High-pitched cry is indicative of neurological impairment - Primitive reflexes: - rooting/sucking - Grasp - moro/startle - Tonic neck/fencing - Babinski - stepping

Anaphylactoid Syndrome of Pregnancy Management

Administer oxygen via face mask at 8-10 L/min Anticipate intubation, mechanical ventilation Prepare for a C-Section STAT Perform CPR (may be ineffective): -Requires two person effort -Displace uterus to left side to reduce pressure on thoracic side -Administer IV fluid, blood products Assume transfer to an ICU

Which nursing action has a negative effect on fetal descent?

Administering narcotic pain medication

Amniocentesis

Aspiration of amniotic fluid via transabdominal needle, guided by ultrasound Administer RhoGAM after procedure for Rh negative mothers Done after 24 weeks (16-18 ideal) Needs an empty bladder

Braxton Hicks contractions are termed "practice contractions" and occur throughout pregnancy. When the woman's body is getting ready to go into labor, it begins to show anticipatory signs of impending labor. Among these signs are Braxton Hicks contractions that are more frequent and stronger in intensity. What differentiates Braxton Hicks contractions from true labor?

Braxton Hicks contractions usually decrease in intensity with walking.

Fetal Distress

FHR baseline below 110/min or above 160/min FHR shows decreased or no variability Fetal hyperactivity, no fetal activity, or presence of non reassuring fetal heart tones

Injectable progestin (Depo-Provera)

Given IM q 11-13 weeks (4 per year) Safe for breastfeeding Decreased risk of uterine cancer if used long term Need adequate intake of calcium and vit D May cause weight gain Return to fertility may be delayed up to 18 months after discontinuation

Vaginal Ring (nuvaring)

Inserted vaginally once a month, remains in place for 3 weeks, removed for one week before new ring inserted Does not require fit Can be removed for up to 3 hours w/o compromising effectiveness, but removal is not required for intercourse Avoids liver metabolism

Intrauterine devices T shaped devices inserted into uterus

Most effective contraceptive Hormonal brands- 3-5 yrs Copper IUD- 10 years Easily reversible, immediate return to fertility Safe for breastfeeding Monitored monthly by presence of strings in upper vagina Increased risk for PID and other pelvic infections, uterine perforation, ectopic pregnancy

Prolapsed Umbilical Cord

Occurs when the umbilical cord is displaced, preceding the presenting part of the fetus or protruding through the cervix

Dilation

Opening of the cervix- occurs during stage 1 of labor Measured from 0 (closed) to 10 cm (complete)

Station (engagement)

Position of the presenting part, usually the infant's head, in relation to the ischial spines of the pelvis Occurs during stage 1 and stage 2 of labor Measured in cm -5 is floating, 0 is engaged and in line with the ischial spines, and +5 is crowning Crowning- fetal scalp appears though vaginal opening

Blood is shunted away from the liver through

ductus venosus

Newborn Assessment: EENT

- Eyes- newborn vision is limited; note condition of sclera, conjunctiva, eyelid abnormalities, and any drainage; check PERRL and red reflex - Ears- note even placement; may lack cartilage if less than 39 weeks; hearing test usually performed prior to d/c from hospital - Nose- check for nostril patency because infants are obligate nose breathers - Mouth- check that lips and palate are intact; check for sucking ability; check frenulum (thin attached under the tongue), presence of any neonatal teeth (need to be pulled) - Neck-palpate clavicles to ensure no fractures

Common Abductor profile

- Female of child-bearing age who recently lost a baby/pregnancy or who is unable to conceive - "Appears" pregnant - Visits nursery/maternity units at more than 1 hospital - May ask detailed questions about unit procedures, layout of floor, where babies are located - Familiar with hospital staff routines - Will wear scrubs to impersonate hospital staff

Newborn Assessment: Head

- Head/face- palpate fontanels and sutures; loof for symmetric facial features - Head circumference should be 2-3 cm larger than chest - Note any depression or bulging of fontanels - Note any swelling, bruising, or bulging of scalp/skull, forcep marks - Caput Succedaneum vs. molding vs. cephalohematoma *KNOW DIFF

New Ballard Scale

- Used to determine/confirm gestational age - Displays 6 ranges of development along continuum of neuromuscular & physical maturity

Determine FHR baseline

Average HR over 10 minute period, excluding accelerations, decelerations and marked variability (the up and down of baseline) **requires a stable line greater than or equal to 2 minutes Want to get baseline from stable looking segment, between contractions if possible Each dark line is a minute and each box is 10 seconds Should be reported as a single number, not a range

Tell pregnant mother to

Avoid soaking in hot tubs Seek dental care, but avoid x-rays if possible (There is a strong correlation between poor oral health and preterm birth) May have lower sex drive initially; sex is safe as long as woman is comfortable and there is no complications -Sex on the expected due date does not initiate labor -Orgasm does not initiate preterm labor -Sex does not cause rupture of the membranes Moderate exercise is healthy; 3 times weekly for 30 minutes; walk daily; yoga and swimming are good exercises Sleep on side, not back Travel restriction to disease prone areas, travel usually okay until 36 weeks Avoid any OTC meds unless instructed by provider Nutrition: Recommended To increase diet by an additional 300 calories a day during pregnancy. Diet should also be high in folic acid, iron and calcium; increase fluid intake to 8-10 glasses a day; limit caffeine

Cervical cap & spermicide

Pros- can be left in place up to 48 hours because no pressure placed on vaginal walls or urethra Cons- dislodge more readily than diaphragm, requires re-fit every 2 yrs Refit needs to be done if a change in weight, pregnancy, or any pelvic surgery occurs

A nurse is explaining to a group of new parents about the changes that occur in the neonate to sustain extrauterine life, describing the cardiac and respiratory systems as undergoing the most changes. Which information would the nurse integrate into the explanation to support this description?

Pulmonary vascular resistance (PVR) is decreased as lungs begin to function.

Position

Relationship of presenting part to specific quadrant and side of woman's pelvis to determine fetal orientation Usually have to get the second letter first First letter: right or left? In relation to maternal pelvis If baby is facing the spine it is anterior Second letter: fetal landmark, Occiput Third letter: Anterior, posterior or transverse

A nurse is conducting education classes at the local high school on reproductive life planning. Which would be appropriate for the nurse to implement during the teaching? Select all that apply. a. Encouragement of abstinence b. Various religious viewpoints c. Her personal opinion on abortion d. Sexually transmitted infection statistics e. Proper condom application

a, d, e

A woman who is using an intrauterine system for contraception comes to the clinic. When assessing the woman, which finding(s) would alert the nurse to a possible complication? Select all that apply. a. oral temperature of 101°F (38.3°C) b. absence of pain with intercourse c. menstrual flow lighter and shorter d. string length shorter than on initial visit e. reports of abdominal pain

a, d, e

Hyperbilirubinemia (Jaundice)

- Bilirubin is waste product of RBC breakdown - 2 types of jaundice: - Physiologic- appears AFTER 1st 24 hours of life - Pathologic- appears BEFORE 1st 24 hours of life - Results in discoloration of skin and sclera, elevated serum bilirubin levels, dehydration, poor feeding - Treatment: - Early screening - HYDRATE - Phototherapy - If pathologic, may need exchange transfusion (rare) - At risk for jaundice symptoms: Jaundice in 1st 24 hrs, A family history, Unrecognized hemolysis, Non-optimal feeding, Deficiency in G-6-PD, Infection, Cephalohematoma/bruising, and Ethnic variations

Newborn Normal Vital Signs

- Heart rate=110-160 bpm - Respiratory rate= 30-60 breaths/min, irregular - Temp- rectal is most accurate - Goal range= 97.7-99.5/36.5-37.5 - BP- systolic 60-80 mmHg; diastolic 40-50 mmHg - Vitals checked at birth q30 min x 2, q1 hr, then q8

Newborn Feeding & Nutrition

- Initiate feeding in 1st 30-60 minutes of life - Continue feeding "on demand"- look for cues: mouth opening, looking around, rooting, crying (last sign) - Breastmilk/formula should be the ONLY source of nutrition for babies until 6 months of age (unless otherwise directed by a HCP) - Exclusively or partially BF babies need 400 IU Vitamin D supplement per day; BF mothers who are vegan should give their infants B12 supplementation - Minerals: content of BM and formula adequate for minerals except iron and fluoride - Iron more easily absorbed from BM: all commercial formulas have iron added - Fluoride supplement indicated for newborns not receiving fluoridated water after 6 months of age

Newborn Discharge Teaching

- Most of the teaching you provide to parents is the same information I have just told you!!! - Topics to include: - Feeding & Elimination - General Care: diapering, dressing, cord care, bulb syringe suction, rectal temperature - Circumcision care if indicated - Sleep, positioning - Bathing - Comfort care: swaddling, quieting techniques - Safety: smoking, car seat, child-proofing the home - Wellness exams (usually within 2-5 days of discharge, again at 2 weeks) - When to call pediatrician

Newborn Assessment: Musculoskeletal

- Observe spontaneous movements in all extremities - Tone/flexion will vary with gestational age - Check for polydactyly/syndactyly - Check that spine is straight, intact without dimples, tufts of hair, or obvious spinal cord defects - Check hips for congenital dislocation 1. Ortolani maneuver=OUT, abduct hips 2. Barlow maneuver=BACK, adduct hips

Circumcision

- Personal choice based on religious, cultural, or social traditions - Benefits of circumcision: - Easier hygiene - Decreased risk of UTIs, STIs, HIV, and penile cancer - Contraindications: hypospadias - Anesthesia options: local anesthetic, EMLA topical cream - Nursing actions: - Ensure signed consent and order present - Gather equipment, set up sterile field, position infant - Administer medications as prescribed - Assist with procedure - Post procedure assessment

Breastmilk

- Rule of "5s"-5 hours after pump before the milk spoils/expires, 5 months in the freezer - How do I know my baby is getting enough breastmilk?? Baby has 6-8 wet diapers/day, weight gain (0.5-1 oz per week), satisfied/sleeping between feedings, breast fill empty

Newborn Hypoglycemia

- S/S of hypoglycemia: jittery/twitching**, can look like seizure-if you put pressure and they don't stop twitching it's a seizure - Infants at risk - IDM - SGA/LGA, late pre-term, post-term - Nursing interventions- take blood sugar, feed, and last resort is dextrose bolus

Newborn Respiratory Distress

- S/S of respiratory distress: grunting, retracting, tachypnea, cyanosi, flaring of nostrils - Infants at risk: - C-section - IDM - SGA/late pre-terms - Congenital anomalies - Nursing interventions: clear the airway with bulb syringe, use bag mask if needed

Phototherapy

- Undress infants down to diaper only for maximum body surface exposure - Cover eyes - Keep lights within 10-12 inches of infant - Reposition frequently to allow all surfaces light exposure - Do not use lotions - Remove eye mask and allow brief periods of parent interaction during feedings, diaper changes; check for any pressure ulcers - Check total serum bilirubin levels regularly**

Newborn Diagnostic & Lab Procedures

- Use capillary sample from heel prick: stick in outer aspect of heel - Required Newborn Labs: - ABO/Rh if maternal Type O or Rh- - Direct Coombs Test-performed on infant's blood to look for any foreign antibodies adhered to blood cells - Glucose, Hgb/Hct, CBC as indicated - O2 Sat Screening - Metabolic screen-aka "PKU" - Bilirubin level - Hearing screen

Circumcision Care

- Use regular water to clean site with each diaper change - With Mogen or Gomco procedures, apple vaseline to glans with each dapper change to prevent penis from sticking to diaper - No tub baths until circumcision is healed (7-10 days) - Yellow exudate can form over/under - Assess for signs of complications/infection - Use regular water to wipe

A fetus is assessed at 2 cm above the ischial spines. How would the nurse document the fetal station?

-2

A woman is admitted to the labor and birthing suite. Vaginal examination reveals that the presenting part is approximately 2 cm above the ischial spines. The nurse documents this finding as:

-2 station.

Physiologic Adaptation to Birth....IS REALLY HARD WORK!

1. Respiratory effort initiated via tactile, thermal, chemical, and mechanical stimuli 2. Opening pressure of 40-70 mmHg required to inflate lungs with first breath 3. Alveoli overcome surface tension (with help of surfactant) and exchange fetal lung fluid for air/O2 4. Pulmonary vascular resistance decreases and systemic vascular resistance increases, closing fetal shunts and establishing neonatal circulation *happens simultaneously within the first few seconds 5. Brown fat is metabolized to help regulate body temperature (requires glucose) 6. Fluid/electrolyte balance, acid-base balance, and glucose homeostasis regulated by adequate nutritional intake 7. Assess infant for regulation of waste elimination 8. Promote parent-infant bonding

The nurse is assessing a pregnant woman who has just completed her first trimester. The woman's BMI was 27 prior to becoming pregnant. Her prepregnancy weight was 175 lb (79.4 kg). On reviewing the woman's medical record, which measurement would the nurse determine as appropriate weight gain for the woman during her first trimester?

177 lb (80.3 kg)

Newborn Bathing & Skin Care

1st bath in initial 2-4 hours of life - Delayed bathing for infants at risk - HIV + mother= immediate - Temperature & VS stable - Move from clean to dirty At home: cleanse skin folds daily, full bath every 2-3 days Sponge bath only until umbilical cord stump falls off (7-10 days), circumcision site healed Umbilical cord care - "Dry" cord care - Cord should be free of drainage/redness/odor Skin care for rashes/dryness - Baby lotions only

Chorionic Villi Sampling

1st trimester alternative to amniocentesis Placental cells aspirated through the abdominal wall or transvaginally through ultrasound guidance Needs a full bladder

A 17-year-old client arrives for an annual examination and reports no changes since the last exam; however, the nurse assesses a positive Chadwick sign, slightly enlarged uterus, and subsequent positive urine pregnancy test. Which task should the nurse prioritize to assist this client who is denying any possibility that she is pregnant?

Accepting the pregnancy

A nurse is receiving a client from the postanesthesia unit to the recovery unit at the ambulatory surgery center. The client just had a laparoscopic tubal ligation. Which is the nurse's priority assessment?

Bleeding

A newborn's vital signs are documented by the nurse and are as follows: HR 144, RR- 36, BP- 128/78, and T- 98.6℉ (37℃). Which finding would be concerning to the nurse?

Blood Pressure

The nurse is assessing a woman at 37 weeks' gestation who has presented with possible signs of labor. The nurse determines the membranes have ruptured based on which color of the Nitrazine paper?

Blue

The nurse walks into a client's room and notes a small fan blowing on the mother as she holds her infant. The nurse should explain this can result in the infant losing body heat based on which mechanism?

Convection

The newborn has been placed in skin-to-skin contact with his mother. A blanket covers all of his body except his head. His hair is still wet with amniotic fluid, etc. What is the most likely type of heat loss this baby may experience?

Evaporative

True Contractions

Eventually tighten entire uterus Usually cause pressure on lower back &/or lower abdomen Last longer over time (duration) Become stronger over time (intensity) Grow closer together (frequency) Don't stop &/or intensity increases with walking, position changes

Ultrasound

External, transvaginal or doppler Allows for early dx of complications, early intervention Used to: confirm + date pregnancy, verify preg location, detect fetal cardiac activity, measure fetal growth, detect fetal anomalies, measure amniotic fluid index, determine fetal position, measure cervical length (cervical insufficiency)

Pregnant women should call the provider immediately if the client experiences any of the following S/S

Gush of fluid from the vagina (greater than 37 weeks) Vaginal bleeding, severe abd cramping decreased/no fetal movement Persistent vomiting Severe HA, blurry vision, edema of the hands or face, epigastric pain Signs of any infection or illness

A client at 16 weeks' gestation comes to the office for a routine exam. At what location within the abdomen would the nurse anticipate the uterus to be found?

Halfway between the symphysis pubis and the umbilicus

The LPN assists the RN while performing the Ortolani maneuver on a newborn. When asked by the mother the reason for this maneuver, which is the best response from the nurse?

Hip for dislocation

Spinal Headache

Leakage of CSF at the puncture site, resulting in debilitating headache that impacts mother's ability to bond, transition after birth Usually occurs in association with spinal block, but can occasionally occur results from epidural procedure Exacerbated by movement, sitting and/or standing; minimally improved by lying down Administer caffeine, IV fluids, oral analgesics for resolution Can put mom through epidural again and instead draw blood and readminister and inject that blood and hopefully seal the leakage and level out the CSF (blood patch)

The nurse enters the room and notes the infant is in its bed sleeping, close to the outside window. Which action should the nurse prioritize?

Move the infant away from the window.

Emergency oral contraceptives "plan B pills"

Must be taken w/in 72 hours of unprotected intercourse Can be purchased OTC; no age minimum Evaluate for pregnancy if menstruation does not begin w/in 21 days Will not terminate an already established pregnancy

A pregnant woman with a fetus in the cephalic presentation is in the latent phase of the first stage of labor. Her membranes rupture spontaneously. The fluid is green in color. Which action by the nurse would be appropriate?

Notify the health care provider about possible meconium.

What is the first action taken by a nurse caring for a newborn with suspected hypoglycemia?

Perform a heel stick to obtain a blood sample for testing for glucose level.

A young newly married woman comes to the clinic and asks about ways to prevent pregnancy. When the nurse begins to talk about oral contraceptives, the client says that her religion does not allow oral contraceptives. What can the nurse recommend for this client?

Rhythm method

Uterine Rupture Clinical Manifestations

Sensation of ripping, tearing or sharp pain Non reassuring fetal heart tones→ absent, minimal variability Change in uterine shape Cessation of contractions Hypovolemic shock- tachypnea, hypotension, pallor, clammy skin

The nursing instructor is teaching students about normal changes of pregnancy. The instructor talks about diastasis recti. What is the instructor presenting?

Separation of the muscles of the abdominal wall

The client pushes and the baby's head emerges. External rotation begins, but the baby's chin is drawn back just inside the vagina. The nurse recognizes that additional providers are needed in the delivery room. What emergency protocol does the nurse call?

Shoulder dystocia

Fetal Scalp electrode

Small spiral electrode that attracts to the presenting part to monitor FHR Electrode is secured to the mother's thigh and plugged into the monitor Use landmarks on a baby's head and do a single twist that is said to feel like a finger stick Danger for misplacement or infection Nurses can place it- need extra training

The nurse identifies from a client's prenatal record that she has a documented gynecoid pelvis. Upon the client entering the labor and delivery department, which nursing action is best?

Take no extra measures; prepare for a standard labor.