Maternity ATI
Succenturiate insertion of the cord vasa previa
Placenta has divided into two or more lobes and not one mass
Causes of bleeding during pregnancy- First trimester
SPONTANEOUS ABORTION: Vaginal bleeding, uterine cramping, and partial or complete expulsion of products of conception ECTOPIC PREGNANCY: Abrupt unilateral lower-quadrant abdominal pain with or without vaginal bleeding
Incomplete spontaneous abortion
Severe cramps, heavy, profuse bleeding, partial fetal tissue or placenta passed, cervical opening dilated with tissue in cervical canal or passage of tissue
The nurse is instructing a client who is taking an oral contraceptive about danger signs to report to her provider the nurse determines the client understands the teaching when the client states the need to report which of the following A. Reduced menstrual flow B. Breast tenderness C. Shortness of breath D. Headaches
Shortness of breath
Cervical cap and spermicide
Silicone rubber That fits snugly around the base of the cervix cervical caps come in three sizes and should be replaced every two years and re-fitted after any GYN surgery birth or any major weight fluctuation can be inserted up to six hours before intercourse and needs to be left in place at least six hours after intercourse but for no more than 48 hours at a time
Engagement
Occurs when the presenting part, usually biparietal (largest) diameter of the fetal head passes the pelvic inlet at the level of the ischial spines, referred to as station 0.
Matitis expected findings
Painful or tender localized hard mass and reddened area, usually on one breast, Chills, Fatigue, Axillary adenopathy in the affected side (enlarged tender axillary lymph nodes) with an area of inflammation that can be red, swollen, warm, and tender
Lochia serosa
Pinkish brown color and serosanguineous consistency. Lasts from approximately day 4 to day 10 after delivery.
Newborn vision
The newborn should be able to focus on objects 8 to 12 inches away from face. This is approximately the distance from the mother's face when the newborn is breastfeeding. The eyes are sensitive to light, so newborns prefer dim lighting. Pupils are reactive to light, and the blink reflex is easily stimulated. The newborn can track high‑contrast objects and prefers bright colors and patterns. Term newborns can see objects as far away as 2.5 feet. Within 2 to 3 months, they can discriminate colors.
Induction of labor is
the deliberate initiation of uterine contractions to stimulate labor before spontaneous onset to bring about the birth by chemical or mechanical means.
A cesarean birth is
the delivery of the fetus through a transabdominal incision of the uterus to preserve the life or health of the client and fetus when there is evidence of complications. Incisions are made horizontally into the lower segment of the uterus.
Instruct not to drive for
the first 2 weeks postpartum, or while taking opioids for pain control
Acme
the peak intensity of the contraction
Placenta previa occurs when
the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus. The abnormal implantation results in bleeding during the third trimester of pregnancy as the cervix begins to dilate and efface.
Encourage early demand breastfeeding for the client who is lactating, which will also stimulate
the production of natural oxytocin and help prevent uterine hemorrhage.
Physical changes of the breasts include
the secretion of colostrum, which occurs during pregnancy and 2 to 3 days immediately after birth. Milk is produced 3 to 5 days after the delivery of the newborn.
Augmentation of labor is
the stimulation of hypotonic contractions once labor has spontaneously begun, but progress is inadequate. Some providers favor active management of labor to establish effective labor with the aggressive use of oxytocin or rupture of membranes.
Lacerations that occur during labor and birth consist of
the tearing of soft tissues in the birth canal and adjacent structures including the cervical, vaginal, vulvar, perineal, and/or rectal areas.
A prolapsed umbilical cord occurs when
the umbilical cord is displaced, preceding the presenting part of the fetus, or protruding through the cervix. This results in cord compression and compromised fetal circulation.
Every 24 hr, the fundus should descend approximately
1 to 2 cm. It should be halfway between the symphysis pubis and the umbilicus by the sixth postpartum day.
Most cords fall off within the
10 to 14 days
Bradycardia is a FHR less than
10/min for 1 min or longer.
Iron-deficiency anemia Hgb less than
11 mg/dL in the first and third trimesters and less than 10.5 mg/dL in the second trimester
A normal, reassuring FHR is
110 to 160/min with increases and decreases from baseline.
Tachycardia is a FHR greater than
160/min for 1 min or longer.
Newborn Head should be
2 to 3 cm larger than chest circumference. If the head circumference is greater than or equal to 4 cm larger than the chest circumference, this can be an indication of hydrocephalus. If the head circumference is less than or equal to 32 cm, this can be an indication of microcephaly
The American Academy of Pediatrics recommends wellness checks at
2 to 5 days, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years, 2.5 years, 3 years, 4 years, and every year thereafter.
A more extensive physical exam is performed on the neonate within
24 hr of birth. Vital signs are obtained. A head‑to‑toe assessment is performed. Neurological and behavioral assessments are completed by eliciting reflexes and observing responses. Laboratory data is monitored
Cord clamp stays in place for
24 to 48 hr
Labor usually occurs within
24hr of the rupture of membranes Prolonged rupture of membranes greater than 24 hr before delivery of fetus can lead to an infection. Immediately following the rupture of membranes, a nurse should assess the FHR for abrupt decelerations, which are indicative of fetal distress to rule out umbilical cord prolapse.
The recommended iron intake for pregnant women is
27 mg/day
The newborn will then continue to pass stool
3 to 4 times a day depending on whether he is being breast‑ or bottle‑fed after the first 48hr
Prenatal vitamins typically contain
30 mg iron.
Moderate variability
6 to 25/min
They should void
6 to 8 times per 24 hr after day 4.
Motile sperm have been recovered from the uterus and oviducts as long as
60hrs after coitus (sex) but their ability to fertilize the ovum probably last no longer than 24 to 48 hours
Laparoscopy
A procedure in which gas insufflation under General Anesthesia is used to observe internal organs
External abdominal ultrasound
A safe, noninvasive, painless procedure whereby an ultrasound transducer is moved over the client's abdomen to obtain an image. An abdominal ultrasound is more useful after the first trimester when the gravid uterus is larger. The client should have a full bladder for the procedure.
Natural family planning fertility awareness-based methods include
Abstinence, coitus interruptus, calendar method, basal body temperature, and symptom based method based on cervical mucus
Birth by expulsion
After birth of the head and shoulders, the trunk of the neonate is born by flexing it toward the symphysis pubis.
When it comes to the clients needs pertaining to lifestyle choices remember to
Assess clients need and desire for contraception
Newborn eyes
Assess eyes for symmetry in size and shape. Each eye and the space between the eyes should equal one‑third the distance from the inner to the outer canthus of both eyes to rule out chromosomal bnormalities, such as Down syndrome. Eyes are usually blue or gray following birth
Low levels of AFP
Associated with chromosomal disorders (Down syndrome) or gestational trophoblastic disease (hydatidiform mole).
High levels of AFP are
Associated with neural tube defects, such as anencephaly (incomplete development of fetal skull and brain), spina bifida (open spine), or omphalocele (abdominal wall defect). High AFP levels also can be present with normal multifetal pregnancies.
activities that can enhance uterine involution
Breastfeeding, Early and frequent ambulation, Frequent voiding
How is the start of the fertile period Determined?
By subtracting 18 days from the number of days in the woman's shortest cycle
Hormonal methods of contraception include
Combined oral contraceptives progestin only pills emergency oral contraceptive transdermal contraceptive patch injectable progestins contraceptive vaginal ring implantable progestin intrauterine device
Rubella titer
Determines immunity to rubella.
Donor embryo or embryo adoption
Donated embryo is placed in the recipients uterus which is hormonal he prepared
Complications that can occur with infertility treatment
Ectopic pregnancy multiple gestation
Appropriate pain relief measures during vaginal birth
Epidural (block) analgesia, Epidural (block) anesthesia, Combined spinal‑epidural (CSE) analgesia, Nitrous oxide, Local infiltration anesthesia, Pudendal block, Spinal (block) anesthesia
Appropriate pain relief measures during cesarean birth
Epidural (block) anesthesia, Spinal (block) anesthesia, General anesthesia
Equipment for preforming circumcision
Gomco (Yellen) or Mogen clamp, or Plastibell device
Lab tests done when bleeding during pregnancy
Hgb and Hct, Clotting factors, WBC, Serum human chorionic gonadotropin
In Hyperemesis gravidarum a thyroid test can indicate
Hyperthyroidism
For women who have a history of early onset preeclampsia.
It is recommended that daily low dose aspirin therapy be initiated late in the first trimester
The first stage of labor consists of what 3 phases
Latent phase, Active phase, transition phase
Effleurage
Light, gentle circular stroking of the client's abdomen with the fingertips in rhythm with breathing during contractions
Anticonvulsant Medications
Magnesium sulfate Medication of choice for prophylaxis or treatment to lower blood pressure and depress the CNS.
Fourth stage of labor pain
Pain is caused by distention and stretching of the vagina and perineum incurred during the second stage with a splitting, burning, and tearing sensation.
When it comes to system specific assessments make sure to
Perform focused assessments
Initial Chest assessment
Point of maximal impulse location; ease of breathing; auscultation for heart rate and quality of tones; and respirations for crackles, wheezes, and equality of bilateral breath sounds
A nurse is caring for a client who is at 42 weeks of gestation and in active labor. Which of the following findings is the fetus is at risk for developing? A. Intrauterine growth restriction B. Hyperglycemia C. Meconium aspiration D. Polyhydramnios
Postterm neonates are at risk for aspiration of meconium.
Signs of pregnancy are classified into three groups
Presumptive probable and positive
Syphilis has three stages
Primary: Characterized by presence of a chancre Secondary: Characterized by skin rashes, such as a rash on the palms of hands and soles of feet Tertiary: Characterized by damage to internal organs including difficulty coordinating muscle movements and blindness
For basal body temperature when should the client measure their oral temperature
Prior to getting out of bed each morning to monitor ovulation
When preparing the client for oxytocin
Prior to the administration of oxytocin, it is essential that the nurse confirm that the fetus is engaged in the birth canal at a minimum of station 0. Use the infusion port closest to the client for administration. Oxytocin should be connected "piggyback" to the main IV line and administered via an infusion pump.
A nurse is caring for a client who has been in labor for 12 hr, and her membranes are intact. Then provider has decided to perform an amniotomy in an effort to facilitate the progress of labor. The nurse performs a vaginal examination to ensure which of the following prior to the performance of the amniotomy? A. Fetal engagement B. Fetal lie C. Fetal attitude D. Fetal position
Prior to the performance of an amniotomy, the amniotic membranes should have ruptured. It is also imperative that the fetus is engaged at 0 station and at the level of the maternal ischial spines to prevent prolapse of the umbilical cord.
In vitro fertilization embryo transfer IVF - ET
Procedure of collecting the woman's eggs from her ovaries fertilizing the eggs in the laboratory with sperm and transferring the embryo into her uterus
A nurse is caring for a newborn. Which of the following actions by the newborn indicates readiness to feed? A. Spits up clear mucus B. Attempts to place his hand in his mouth C. Turns his head toward sounds D. Lies quietly with his eyes open
Readiness‑to‑feed cues include then newborn making hand‑to‑mouth and hand‑to‑hand movements, sucking motions, rooting, and mouthing.
Ballottement
Rebound of unengaged
Hepatitis B immunization
Recommended to be administered to all newborns. Informed consent must be obtained. For newborns born to healthy women, recommended dosage schedule is at birth, 1 month, and 6 months.
An expected finding of Ectopic pregnancy is
Referred shoulder pain due to blood in the peritoneal cavity irritating the diaphragm or phrenic nerve after tubal rupture.
Toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes virus (TORCH) screening when indicated
Screening for a group of infections capable of crossing the placenta and adversely affecting fetal development.
Early deceleration of FHR
Slowing of FHR with start of contraction with return of FHR to baseline at end of contraction causes/complications: Compression of the fetal head resulting from uterine contraction, Uterine contractions, Vaginal exam, Fundal pressure. No intervention required
Contraceptive sponge
Small round polyurethane sponge containing spermicide it is designed to fit over the cervix and is one size fits all should be left in place for six hours after intercourse and provides protection for up to 24 hours
Hegars Sign
Softening and compressibility of lower uterus
Complete or total Placenta previa
The cervical os is completely covered by the placental attachment.
Postpartum discharge instruction should Include
The discussion of future contraceptive plans
Second period of reactivity
The newborn reawakens, becomes responsive again, and often gags and chokes on mucus that has accumulated in his mouth. This period usually occurs 2 to 8 hr after birth and can last 10 min to several hours.
During the initial prenatal visit
The nurse determines estimated date of birth obtains medical nursing history performance physical assessment for baseline obtains initial lab tests
exercise every day. D. Use proper body mechanics. E. Avoid constrictive clothing.
The pelvic rock or tilt exercise stretches the muscles of the lower back and helps relieve lower-back pain.The use of proper body mechanics prevents back injury due to the incorrect use of muscles when lifting.
Oxytocin
Uterine stimulant, Promotes uterine contractions
ReProductive system when pregnant
Uterus increases in size and changes shape and position ovulation and menses cease during pregnancy
Wound infection expected findings
Wound warmth, erythema, tenderness, pain, edema, seropurulent drainage, and wound dehiscence (separation of wound or incision edges) or evisceration (protrusion of internal contents through the separated wound edges) Temperature greater than 38° C (100.4° F) for 2 or more consecutive days
Lochia alba
Yellowish white creamy color, fleshy odor. Lasts from approximately day 11 up to 4 to 8 weeks postpartum.
Vaginal bleeding during pregnancy is always
abnormal and must be investigated to determine the cause. It can impair both the outcome of the pregnancy and the mother's life.
Cytomegalovirus manifests
asymptomatic or mononucleosis‑like manifestations
A hypertonic uterus
cannot be indented, even between contractions.
Indirect Coombs' test identifies
clients sensitized to Rh-positive blood.
Herpes simplex virus (HSV) is spread by
direct contact with oral or genital lesions. Transmission to the fetus is greatest during vaginal birth if the woman has active lesions.
Breastfeeding stimulates the release of
endogenous
Fourth degree Laceration
extends through skin, muscles, anal sphincter, and the anterior rectal wall.
Second degree Laceration
extends through the skin and muscles into the perineum but not the anal sphincter.
First degree Laceration
extends through the skin of the perineum and does not involve the muscles.
Marked variability
greater than 25/min
Pain, rather than noticeable bleeding, is the distinguishable clinical finding of
hematomas.
The greatest risks during the postpartum period are
hemorrhage, shock, and infection.
Methylergonovine, ergonovine, and carboprost can cause
hypertension.
Methotrexate
inhibits cell division and embryo enlargement, dissolving the pregnancy
Four-dimensional (4D)
like 3D but also shows fetal movements in a video
Apgar scoring 7 to 10 indicates
minimal or no difficulty with adjusting to extrauterine life
Apgar scoring 4 to 6 indicates
moderate difficulty
Indomethacin is prescribed for the client in
preterm labor.
Nifedipine is prescribed for the client in
preterm labor.
Use corticosteroids to treat
refractory hyperemesis gravidarum.
period beyond day 3, can indicate
retained placental fragments
Fontanels should be
soft and flat. Fontanels can bulge when the newborn cries, coughs, or vomits, and are flat when the newborn is quiet. Bulging fontanels can indicate increased intracranial pressure, infection, or hemorrhage. Depressed fontanels can indicate dehydration
Two-dimensional (2D)
standard medical scan; black, white, or shades of gray
Nontreponemal tests are often used for screening then treponemal tests to detect antibodies specific for
syphilis to confirm the diagnosis.
Increment
the beginning of the contraction as intensity is increasing
Dilation and curettage (D&C) is used when there is bleeding during pregnancy to
to dilate and scrape the uterine walls to remove uterine contents for inevitable and incomplete abortions.
A forceps-assisted birth consists of
using an instrument with two curved spoon-like blades to assist in the delivery of the fetal head. Traction is applied during contractions.
Exercise during pregnancy yields positive benefits and should consist of
30 min of moderate exercise (walking or swimming) daily if not medically or obstetrically contraindicated.
Average blood loss is
300 to 500 mL (10% of blood volume) in an uncomplicated vaginal delivery and 500 to 1,000 mL (15% to 30% of blood volume) for a cesarean birth)
Temperature stabilizes at
37° C (98.6° F) within 4 hr after birth if chilling is prevented.
Uterine size changes from
50-1000g or 0.1-2.2 lbs
Gestational carrier - embryo host
A couple completes the prices of IVF with the embryo place in another woman who will carry the pregnancy this is a contract agreement with the carrier having no genetic investment with the embryo
A nurse is reviewing a new prescription for ferrous sulfate with a client who is at 12 weeks of gestation. Which of the following statements by the client indicates understanding of the teaching? A. "I will take this pill with my breakfast." B. "I will take this medication with a glass of milk." C. "I plan to drink more orange juice while taking this pill." D. "I plan to add more calcium‑rich foods to my diet while taking this medication."
A diet with increased vitamin C improves the absorption of ferrous sulfate.
Indication for external cephalic version
A malpositioned fetus in a breech or transverse position after 36 weeks of gestation.
Hysteroscopy
A radiographic procedure in which the uterus is examined for signs of defect distortion or scar tissue that can impair successful impregnation
Primigravida:
A woman in her first pregnancy
Leopold maneuvers
Abdominal palpation of the number of fetuses, the fetal presenting part, lie, attitude, descent, and the probable location where fetal heart tones can be best auscultated on the woman's abdomen
Clinical findings of hypovolemic shock is an expected finding of
Abruptio placentae
Fetal lung maturity test PRESENCE OF PHOSPHATIDYLGLYCEROL (PG)
Absence of PG is associated with respiratory distress.
Monitor for signs of magnesium sulfate toxicity
Absence of patellar deep tendon reflexes, Urine output less than 30 mL/hr, Respirations less than 12/min, Decreased level of consciousness, Cardiac dysrhythmias
Apgar score 0 reveals
Absent heart rate and respiratory rate, flaccid muscle tone, no reflex irritability and blue pale color
For endometritis Clindamycin, Cephalosporins, penicillins, and gentamicin
Antibiotic, Treatment of bacterial infections, Educate the client to take all the medication as prescribed. Tell the client to notify the provider of the development of watery, bloody diarrhea. Tell the client to notify the provider if the client is breastfeeding.
Warfarin
Anticoagulant, Used for treatment of clots. It is administered orally and is continued by the client for approximately 3 months. Phytonadione, the warfarin antidote, should be readily available for prolonged clotting times. Monitor PT (1.5 to 2.5 times the control level of 11 to 12.5 seconds) and INR of 2 to 3.Instruct the client to watch for bleeding from the gums or nose, increased vaginal bleeding, blood in the urine, and frequent bruising. Instruct the client to use birth control to avoid pregnancy due to the teratogenic effects of warfarin. Oral contraceptives are contraindicated because of the increased risk for thrombosis.
Induction indicated with
Any condition in which augmentation or induction of labor is indicated. Elective induction for nonmedical indications must meet the criteria of at least 39 weeks of gestation and a Bishop score of greater than 8 for a multiparous client and greater than 10 for a nulliparous. Elective inductions that do not meet recommended criteria can result in increased risk for infection, premature delivery, longer labor, and need for cesarean birth.
Positive signs of pregnancy
Are those that can't be explained only by pregnancy such as fetal heart sounds visualization of fetus by ultrasound and fetal movement
Sensory stimulation strategies
Aromatherapy, Breathing techniques, Imagery, Music, Use of focal points, Subdued lighting
With Bulb Syringe
Aspirate mouth first, one nostril, then second nostril
Multiple Gestation
Assisted reproductive technology is associated with an increased incidence of multiple gestations this poses a risk for the mother and babies
A focused postpartum physical assessment should include assessing the client's
B: Breasts, U: Uterus (fundal height, uterine placement, and consistency), B: Bowel and GI function, B: Bladder function, L: Lochia (color, odor, consistency, and amount [COCA]), E: Episiotomy (edema, ecchymosis, approximation), Vital signs, to include pain assessment, Teaching needs
Calander method
Based on a record of menstrual cycle And ovulation probability. Based on this information intercourse is avoided to prevent pregnancy
Risks of withdrawal
Based on male partners control leakage of fluid that contain sperm prior to ejaculation can be deposited in the vagina and risk of pregnancy
The physiologic change preceding labor - the premonitory sign of contractions
Begin with irregular uterine contractions (Braxton Hicks) that eventually progress in strength and regularity
Term
Birth between the beginning of week 37 and prior to the end of 42 weeks of gestation.
European American tend to prefer
Birth is public concern; focus on technology; partner expected to be involved; provider seen as head of health care team
In the cardiovascular system during the postpartum period undergoes a decrease inblood volume related to
Blood loss during childbirth, Diaphoresis and diuresis of the excess fluid accumulated during the last part of the pregnancy
A nurse is providing care for a client who is diagnosed with a marginal abruptio placentae. The nurse is aware that which of the following findings are risk factors for developing the condition? (Select all that apply.) A. Fetal position B. Blunt abdominal trauma C. Cocaine use D. Maternal age E. Cigarette smoking
Blunt abdominal trauma, Cocaine use, Cigarette smoking
A nursing is caring for a client who is receiving IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if magnesium sulfate toxicity is suspected? A. Nifedipine B. Pyridoxine C. Ferrous sulfate D. Calcium gluconate
Calcium gluconate is the antidote for magnesium sulfate.
Fluconazole for candidasis
Can be prescribed as a single low dose, Topical therapies recommended for use in
Epidural block
Consists of a local anesthetic, bupivacaine, along with an analgesic, morphine or fentanyl, injected into the epidural space at the level of the fourth or fifth vertebrae. This eliminates all sensation from the level of the umbilicus to the thighs, relieving the discomfort of uterine contractions, fetal descent, and pressure and stretching of the perineum. It is administered when the client is in active labor and dilated to at least 4 cm. Continuous infusion or intermittent injections can be administered through an indwelling epidural catheter. Patient‑controlled epidural analgesia is a technique for labor analgesia and is a favored method of pain management for labor and birth. It is suitable for all stages of labor and types of birth and for repair of episiotomy and lacerations.
True labor
Contractions Can begin irregularly, but become regular in frequency, Stronger, last longer, and are more frequent, Felt in lower back, radiating to abdomen, Walking can increase contraction intensity, Continue despite comfort measures, cervix (assessed by vaginal exam), Progressive change in dilation and effacement, Moves to anterior position, Bloody show, Fetus: Presenting part engages in pelvis
Cradle hold
Cradle the newborn's head in the bend of the elbow. This permits eye‑to‑eye contact and is a good position for feeding.
A nurse is caring for a client who has disseminated intravascular coagulation (DIC). Which of the following antepartum complications should the nurse understand is a risk factor for this condition? A. Preeclampsia B. Thrombophlebitis C. Placenta previa D. Hyperemesis gravidarum
DIC can occur secondary in a client who has preeclampsia.
Cesarean birth doubles the risk of
DVT
Linea Negra
Dark line of pigmentation from the umbilicus extending to the pubic area
A nurse is caring for a client who is pregnant and is to undergo a contraction stress test (CST). Which of the following findings are indications for this procedure? (Select all that apply.) A. Decreased fetal movement B. Intrauterine growth restriction (IUGR) C. Postmaturity D. Placenta previa E. Amniotic fluid emboli
Decreased fetal movement, Intrauterine growth restriction (IUGR), and Postmaturity
Chadwick sign
Deep in violet bluish color of cervix and vaginal mucosa
Ensuring hydration is important when avoiding preterm labor because
Dehydration stimulates the pituitary gland to secrete an antidiuretic hormone and oxytocin. Preventing dehydration prevents the release of oxytocin, which stimulates uterine contractions.
CBC with differential, Hgb, and Hct:
Detects infection and anemia.
Therapeutic donor insemination
Donor sperm is used to inseminate a woman
Levels higher than the expected reference range of hCG and inhibin A indicates a risk for
Down syndrome.
Lower levels than the expected reference range of estriol can indicate a risk for
Down syndrome.
electronic fetal monitoring
During latent phase: every 30 to 60 min, During active phase: every 15 to 30 min, During second stage: every 5 to 15 min
A nurse is taking a newborn to a mother following a circumcision. Which of the following actions should the nurse take for security purposes? A. Ask the mother to state her full name. B. Look at the name on the newborn's bassinet. C. Match the mother's identification band with the newborn's band. D. Compare name on the bassinet and room number
Each time the newborn is taken to the mother, the mother's identification band should be verified against the newborn's identification band.
Advantages of Continuous internal fetal monitoring
Early detection of abnormal FHR patterns suggestive of fetal distress. Accurate assessment of FHR variability. Accurate measurement of uterine contraction intensity. Allows greater maternal freedom of movement because tracing is not affected by fetal activity, maternal position changes, or obesity.
A nurse is giving instructions to a mother about how to breastfeed her newborn. Which of the following actions by the mother indicates understanding of the teaching? A. The mother places a few drops of water on her nipple before feeding. B. The mother gently removes her nipple from the infant's mouth to break the suction. C. When she is ready to breastfeed, the mother gently strokes the newborn's neck with her finger. D. When latched on, the infant's nose, cheek, and chin are touching the breast.
Effective latching‑on includes the infant's nose, cheek and chin touching the mother's breast
Appropriate pain relief measures during the second stage of labor
Epidural (block) analgesia, Nitrous oxide, Local infiltration, anesthesia, Nerve block analgesia and anesthesia, Pudendal block, Spinal (block) anesthesia
A nurse is discussing risks factors for urinary tract infections with a newly licensed nurse. Which of the following conditions should the nurse include in the teaching? (Select all that apply). A. Epidural anesthesia B. Urinary bladder catheterization C. Frequent pelvic examinations D. History of UTIs E. Vaginal birth
Epidural anesthesia, Urinary bladder catheterization, Frequent pelvic examinations, History of UTIs
A nurse is completing a newborn assessment and observes small white nodules on the roof of the newborn's mouth. This finding is a characteristic of which of the following conditions? A. Mongolian spots B. Milia spots C. Erythema toxicum D. Epstein's pearls
Epstein's pearls are small white nodules that appear on the roof of a newborn's mouth.
Frequency of contractions
Established from the beginning of one contraction to the beginning of the next
Hormone analysis
Evaluate hypothalamus pituitary ovarian access to include serum prolactin FSH LH estradiol progesterone and thyroid hormones
Postcoital Test
Evaluates coital technique and mucus secretions
you are having these feelings." B. "It is normal to have these feelings during the first few months of pregnancy." C. "You should be happy that you are going to bring new life into the world." D. "I am going to make an appointment with the counselor for you to discuss these thoughts."
Feelings of ambivalence about pregnancy are normal during the first trimester.
Nonreassuring FHR patterns are associated with fetal hypoxia and include the following
Fetal bradycardia, Fetal tachycardia, Absence of FHR variability, Late decelerations, Variable decelerations
A nurse is reviewing findings of a client's biophysical profile (BPP). The nurse should expect which of the following variables to be included in this test? (Select all that apply.) A. Fetal weight B. Fetal breathing movement C. Fetal tone D. Fetal Position E. Amniotic fluid volume
Fetal breathing movement Fetal tone Amniotic fluid volume
Second Stage of labor
Full dilation Progresses to intense contractions every 1 to 2 min Pushing results in birth of fetus. this stage can last for a primigravida 30min to 2 hrs for a Multigravida 5 to 30 min
Yellowish‑green vaginal discharge is noted in females with
Gonorrhea
Intrauterine growth restriction (IUGR)
Growth rate does not meet expected norms.
A nurse is caring for a client who is in active labor and reports severe back pain. During assessment, the fetus is noted to be in the occiput posterior position. Which of the following maternal positions should the nurse suggest to the client to facilitate normal labor progress? A. Hands and knees B. Lithotomy C. Trendelenburg D. Supine with a rolled towel under one hip
Having the client assume a position on her hands and knees can help the fetus rotate from a posterior to an anterior position.
Hepatitis B screen
Identifies carriers of hepatitis B
Instruct the client to adhere to and maintain the following during pregnancy.
Increase calories: An increase of 340 calories/day is recommended during the second trimester. An increase of 462 calories/day is recommended during the third trimester. If the client s breastfeeding during the postpartum period, additional caloric intake is advised.Increasing protein intake is essential to basic growth. Iron supplements are often added to the prenatal plan to facilitate an increase of the maternal RBC mass. Calcium, which is important to a developing fetus, is involved in bone and teeth formation.Fluid. Limit caffeine. It is recommended that women abstain from alcohol consumption during pregnancy.
Gastrointestinal system and bowel function postpardum physical changes
Increased appetite following delivery, Constipation with bowel evacuation delayed until 2 to 3 days after birth, Hemorrhoids
It is expected that the clients heart changes in size and shape with resulting cardiac hyper trophy to accommodate
Increased blood volume and increase cardiac output heart sounds also change
Intrauterine pressure catheter
Insert a solid, sterile, water-filled intrauterine pressure catheter inside the uterus to measure intrauterine pressure. Displays uterine contraction patterns on monitor Requires the membranes to be ruptured and the cervix to be sufficiently dilated
A nurse is teaching a client who is breastfeeding and has mastitis. Which of the following responses should the nurse make? A. "Limit the amount of time the infant nurses on each breast." B. "Nurse the infant only on the unaffected breast until resolved." C. "Completely empty each breast at each feeding or use a pump." D. "Wear a tight‑fitting bra until lactation has ceased."
Instruct the client to completely empty each breast at each feeding to prevent milk stasis, which provides a medium for bacterial growth.
First stage of labor pain is
Internal visceral pain that can be felt as back and leg pain. This is caused by Dilation, effacement, and stretching of the cervix Distention of the lower segment of the uterus Contractions of the uterus with resultant uterine ischemia
Assisted reproductive technologies include
Intrauterine insemination, in vitro fertilization embryo transfer, gamete intrafallopian transfer, donor oocyte, donor embryo-embryo adoption, gestational carrier-embryo host, surrogate mother, therapeutic donor insemination
A nurse is caring for a client who is pregnant and states that her last menstrual period was April 1 which of the following is the clients estimated delivery date A. January 8 B. January 15 C. February 8 D. February 15
January 8 because April -3 months is January +7 days would be the eighth
A nurse in an antepartum clinic is assessing a client who has a TORCH infection. Which of the following findings should the nurse expect? (Select all that apply.) A. Joint pain B. Malaise C. Rash D. Urinary frequency E. Tender lymph nodes
Joint pain, Malaise, Rash, Tender lymph nodes
A nurse is providing discharge instructions to a postpartum client following a cesarean birth. The client reports leaking urine every time she sneezes or coughs. Which of the following interventions should the nurse suggest? A. Sit‑ups B. Pelvic tilt exercises C. Kegel exercises D. Abdominal crunches
Kegel exercises consist of the voluntary contraction and relaxation of the pubococcygeus muscle to strengthen the pelvic muscles, which will assist the client in decreasing urinary stress incontinence that occurs with sneezing and coughing.
A nurse is caring for a client in the third stage of labor. Which of the following findings indicate that placental separation? (Select all that apply.) A. Lengthening of the umbilical cord B. Swift gush of clear amniotic fluid C. Softening of the lower uterine segment D. Appearance of dark blood from the vagina E. Fundus firm upon palpation
Lengthening of the umbilical cord, Appearance of dark blood from the vagina, Fundus firm upon palpation
Three stages of lochia
Lochia rubra, Lochia serosa, and Lochia alba
Conduction
Loss of body heat resulting from direct contact with a cooler surface. Preheat a radiant warmer, warm a stethoscope and other instruments, and pad a scale before weighing the newborn. The newborn should be placed directly on the mother's chest and covered with a warm blanket
Meconium-stained amniotic fluid
Meconium passage in the amniotic fluid during the antepartum period prior to the start of labor is typically not associated with an unfavorable fetal outcome. The fetus has had an episode of loss of sphincter control, allowing meconium to pass into amniotic fluid.
Male infertility assessment includes
Medical history sexual history of substance abuse occupational environmental exposure risk assessment
Antihypertensive medications
Methyldopa, Nifedipine, Hydralazine, Labetalol, Avoid ACE inhibitors and angiotensin II
Asian American tend to prefer
Might prefer mother to be present; partner not an active participant; labor in silence; cesarean birth undesirable
For Ongoing prenatal visits
Monitor weight blood pressure and urine for glucose protein and leukocytes, presence of edema fetal development and provide education for self-care
In an uneventful pregnancy prenatal visits are scheduled
Monthly for weeks 16 through 28 and every two weeks from week 29 to 36 and every week from 36 weeks until birth
Higher levels of hCG can indicate
Multifetal pregnancy Ectopic pregnancy hydatidiform mole for a genetic abnormalities such as down syndrome
Intitial newborn assessment of Neurologic
Muscle tone and reflex reaction (Moro reflex); palpation for the presence and size of fontanels and sutures; assessment of fontanels for fullness or bulge
Methods of contraception include
Natural family planning, barrier hormonal and intrauterine methods, and surgical procedures
common discomforts of pregnancy
Nausea and vomiting Breast tenderness Urinary frequency Urinary tract infections (UTIs) Fatigue Heartburn Constipation Hemorrhoids Backaches Shortness of breath Leg cramps Varicose veins and lower-extremity edema Gingivitis, nasal stuffiness, and epistaxis Braxton Hicks contractions, Supine hypotension
A client who is at 7 weeks of gestation is experiencing nausea and vomiting in the morning. Which of the following information should the nurse include in the teaching? A. Eat crackers or plain toast before getting out of bed. B. Awaken during the night to eat a snack. C. Skip breakfast and eat lunch after nausea has subsided. D. Eat a large evening meal.
Nausea and vomiting during the first trimester might be relieved by eating crackers or plain toast 30 to 60 min prior to rising in the morning.
Newborn Taste
Newborns can taste and prefer sweet to salty, sour, or bitter.
Gamete intrafallopian transfer
Oocytes are retrieved and immediately placed with prepared Motile sperm both our place together into a thin flexible to catheter the gametes are then injected into the fallopian tubes using a surgical procedure called laparoscopy
Appropriate pain relief measures during the first stage of labor
Opioid agonist analgesics, Opioid agonist‑antagonist analgesics, Epidural (block) analgesia, Combined spinal‑epidural (CSE) analgesia, Nitrous oxide
A nurse is performing Leopold maneuvers on a client who is in labor. Which of the following techniques should the nurse use to identify the fetal lie? A. Apply palms of both hands to sides of uterus. B. Palpate the fundus of the uterus. C. Grasp lower uterine segment between thumb and fingers. D. Stand facing client's feet with fingertips outlining cephalic prominence.
Palpating the fundus of the uterus identifies the fetal part that is present, indicating the fetal lie (longitudinal or transverse)
Blood pressure cuff 2.5 cm wide used for newborn assessment
Palpation or electronicmethod. Blood pressure can be done in all four extremities if evaluating the newborn for cardiac problems.
A nurse on the postpartum unit is caring for four clients. Which of the following clients should the nurse recognize as the greatest risk for development of a postpartum infection? A. A client who experienced a precipitous labor less than 3 hr in duration B. A client who had premature rupture of membranes and prolonged labor C. A client who delivered a large for gestational age infant D. A client who had a boggy uterus that was not well‑contracted
Premature rupture of membranes with prolonged labor poses the greatest risk for developing a postpartum infection because the birth canal was open, allowing pathogens to enter
Intrauterine insemination
Procedure use the place prepared sperm in the uterus at time of ovulation
Erythromycin
Prophylactic eye care is the mandatory instillation of antibiotic ointment into the eyes to prevent ophthalmia neonatorum, Application can be delayed for 1 hr after birth to facilitate baby‑friendly activities during the first period of newborn reactivity.
For Ante/Intra/Postpartum and Newborn care it is important to
Provide prenatal care and education
Other causes of bleeding during pregnancy include
RECURRENT PREMATURE DILATION OF THE CERVIX: Painless bleeding with cervical dilation leading to fetal expulsion PRETERM LABOR: Pink-stained vaginal discharge, uterine contractions becoming regular, cervical dilation and effacement HYDATIDIFORM MOLE: Benign proliferative growth of the placental trophoblast
General anesthesia
Rarely used for vaginal or cesarean births when there are no complications present. It is used only in the event of a delivery complication or emergency when there is a contraindication to nerve block analgesia or anesthesia. General anesthesia produces unconsciousness.
Regional blocks
Regional blocks are most commonly used and consist of pudendal, epidural, spinal, and paracervical nerve block.
Attitude
Relationship of fetal body parts to one another
Implantable progestin
Requires a minor surgical procedure to sub dermal he implant and remove a single rod containing etonogestrel On the inner side of the upper aspect of the arm this provides affective continuous contraception for three years and is reversible
A nurse is caring for client who had no prenatal care, is Rhnegative, and will undergo an external version at 37 weeks of gestation. Which of the following medication should the nurse plan to administer prior to the version? A. Prostaglandin gel B. Magnesium sulfate C. Rho(D) immune globulin D. Oxytocin
Rho(D) immune globulin is administered to an Rh negative client at 28 weeks of gestation. Because this client had no prenatal care, it should be given prior to the version to prevent isoimmunization.
Intitial newborn assessment of abdomen
Rounded abdomen and umbilical cord with one vein and two arteries
Syphilis is an
STI caused by the bacterium Treponema pallidum. It can have long‑term complications if not adequately treated.
Football hold
Support half of the newborn's body in the holder's forearm with the newborn's head and neck resting in the palm of the hand. This is a good position for breastfeeding and when shampooing the newborn's hair.
Venereal disease research laboratory (VDRL)
Syphilis screening mandated by law.
External fetal monitoring (EFM)
T ransducer applied to the abdomen of the client to assess FHR patterns during labor and birth
Amniocentesis
The aspiration of amniotic fluid for analysis by insertion of a needle transabdominally into a client's uterus and amniotic sac under direct ultrasound guidance locating the placenta and determining the position of the fetus. It may be performed after 14 weeks of gestation.
A nurse is reviewing breastfeeding positions with the mother of a newborn. Which of the following positions should the nurse discuss? A. Over‑the‑shoulder B. Supine C. Chin‑supported D. Cradle
The cradle position for breastfeeding includes the mother laying the newborn across her forearm with her hand supporting the lower back and buttocks.
Extension
The fetal occiput passes under the symphysis pubis, and then the head is deflected anteriorly and is born by extension of the chin away from the fetal chest.
A nurse in a prenatal clinic is caring for four clients. Which of the following clients' weight gain should the nurse report to the provider? A. 1.8 kg (4 lb) weight gain and is in her first trimester B. 3.6 kg (8 lb) weight gain and is in her first trimester C. 6.8 kg (15 lb) weight gain and is in her second trimester D. 11.3 kg (25 lb) weight gain and is in her third trimester
The nurse should be concerned about this client because she has exceeded the expected 3- to 4-lb weight gain of a client in the first trimester.
A nurse is caring for a client who has postpartum psychosis. Which of the following actions is the nurse's priority? A. Reinforce the need to take antipsychotics as prescribed. B. Ask the client if she has thoughts of harming herself or her infant. C. Monitor the infant for indications of failure to thrive. D. Review the client's medical record for a history of bipolar disorder.
The nurse should identify that the greatest risk to the client and her infant is self‑harm or harm directed toward the infant. Therefore, the priority action the nurse should take is to directly ask the client if she has thoughts of self‑harm, suicide, or harming the infant.
Endocrine system when pregnant
The placenta becomes an endocrine organ that produces large amounts of HCG progesterone estrogen human placental lactogen and prostaglandins hormones are very active during pregnancy and function to maintain pregnancy and prepare the body for delivery
Descent
The progress of the presenting part (preferably the occiput) through the pelvis. Measured by station during a vaginal examination as either negative (-) station measured in centimeters if superior to station 0 and not yet engaged, or positive (+) station measured in centimeters if inferior to station 0.
Newborn habituation
This is a protective mechanism whereby the newborn becomes accustomed to environmental stimuli. Response to a constant or repetitive stimulus is decreased. This allows the newborn to select stimuli that promotes continued learning, avoiding overload.
Duration of contractions
Time between the beginning of a contraction to the end of that same contraction
A nurse is assessing a postpartum client for fundal height, location, and consistency. The fundus is noted to be displaced laterally to the right, and there is uterine atony. The nurse should identify which of the following conditions as the cause of the uterine atony? A. Poor involution B. Urinary retention C. Hemorrhage D. Infection
Urinary retention can result in a distention of the bladder. A distended bladder can cause uterine atony and lateral displacement from the midline, usually to the right.
A nurse is caring for a client who is pregnant and reviewing signs of complications the client should promptly report to the provider. Which of the following complications should the nurse include in the teaching? A. Vaginal bleeding B. Swelling of the ankles C. Heartburn after eating D. Lightheadedness when lying on back
Vaginal bleeding indicates a potential complication of the placenta such as placenta previa. The nurse should instruct the client to notify the provider immediately.
Female condom
Vaginal sheath made of nitrile a non-latex synthetic rubber with flexible rings on both ends
Accelerations
Variable transitory increase in the FHR above baseline. Causes/complications: Healthy fetal/placental exchange, Intact fetal central nervous system (CNS) response to
The nursing assessment and prenatal care includes obtaining information about
You're productive in OB history medical history nutritional history family history current medications psychosocial history any environmental exposures current exercise and lifestyle and abuse history or risk
For genital warts and Condyloma acuminata, options include
a client‑applied cream, such as imiquimod, or a provider‑administered therapy, such as trichloroacetic acid application.
Human chorionic gonadotropin (hCG):
a hormone produced by the placenta
Thrombophlebitis refers to
a thrombus that is associated with inflammation.
Rh-negative clients require a Kleihauer-Betke test to detect for the presence and amount of fetal blood in the maternal circulation because
a version can cause fetomaternal bleeding. If more than 15 mL fetal blood is present, Rho(D) immune globulin must be administered to suppress the maternal immune response to fetal Rh-positive blood.
microcephaly
abnormally small head
Loss of 5% to 10% of weight
after birth (regain 10 to 14 days after birth)
Uncomfortable uterine cramping is referred to as
afterpains.
Instruct the client who is taking methotrexate to avoid
alcohol consumption and vitamins containing folic acid to prevent a toxic response to the medication and protect herself from sun exposure
For HIV positive clients which procedures should be avoided
amniocentesis and episiotomy should be avoided due to the risk of maternal blood exposure.Use of internal fetal monitors, vacuum extraction, and forceps during labor should be avoided due to the risk of fetal bleeding.
Women who are breastfeeding require
an additional 450 to 500 calories per day to support adequate nutrition.
Decreased progesterone After delivery of the placenta results in
an increase in muscle tone throughout the body.
Core temperature varies within newborns, but it should be kept at
approximately 36.5 to 37° C 97.7 to 98.6° F.
Telangiectatic nevi (stork bites)
are flat pink or red marks that easily blanch and are found on the back of the neck, nose, upper eyelids, and middle of the forehead. They usually fade by the second year of life.
Vaginal and rectal cultures for GBS
are performed at 35 to 37 weeks of gestation.
Mothers should not preform housework for
at least 3 weeks. Do not lift anything heavier than the infant.
GBS is a
bacterial infection that can be passed to a fetus during labor and delivery.
With Meconium-stained amniotic fluid the color
can vary black to greenish, yellow, or brown, though meconium-stained amniotic fluid is often green. Consistency can be thin or thick
More cases of congenital syphilis are reported in the U.S. than
cases of perinatal HIV infection.
In Hyperemesis gravidarum Use antiemetic medications (ondansetron, metoclopramide)
cautiously for uncontrollable nausea and vomiting.
True labor leads to
cervical dilation and effacement.
Unexpected medical conditions that can occur during pregnancy include
cervical insufficiency, hyperemesis gravidarum, anemia, gestational diabetes mellitus, and gestational hypertension.
Sites of wound infections include
cesarean incisions, episiotomies, lacerations, and any trauma wounds present in the birth canal following labor and birth.
HPV is the most
common STI some types can cause genital warts (also known as Condyloma acuminata) and cancers. It is spread through oral, vaginal, and anal sex (most commonly vaginal or anal routes). When large,widespread, or occluding the birth canal, genital warts can complicate a vaginal delivery. Therefore, a cesarean section can be recommended
Absent or undetectable variability
considered nonreassuring
Recurrent spontaneous abortion
cramps vary, bleeding varies, tissue is passed, cervical opening is usually dialated.
Septic spontaneous abortion
cramps vary, bleeding varies; malodorous discharge, variation of tissue passing, cervical opening usually dilated
In nonlactating women, prolactin
declines and reaches the prepregnant level by the third week postpartum. Ovulation occurs 27 to 75 days after birth. Menses resume by 4 to 6 weeks postpartum.
An ultrasound allows for
early diagnosis of complications, permits earlier interventions, and thereby decreases neonatal and maternal morbidity and mortality.
A tender uterus and foul-smelling lochia can indicate
endometritis.
hydrocephalus
excessive cerebral fluid within the brain cavity surrounding the brain
Palmar grasp
expected finding Elicit by placing examiner's finger in palm of newborn's hand. The newborn's fingers curl around examiner's fingers. expected age Lessens by 3 to 4 months
newborn Abnormal breath sounds
expiratory grunting, crackles, and wheezes
Gain of 110 to 200 g/week for
first 3 months
Fetal heart rate baseline variability is described as
fluctuations in the FHR baseline that are irregular in frequency and amplitude. Expected variability should be moderate variability. Classification of variability is as follows.
Pregnant women should Avoid the use of
hot tubs or saunas.
Exogenous oxytocin can be administered postpartum to
improve the quality of the uterine contractions. A firm and contracted uterus prevents excessive bleeding and hemorrhage.
Postpartum blues can occur
in approximately 50% to 85% of women during the first few days after birth and generally continues for up to 10 days.
It is important NOT to give the vitamin K and the hepatitis B injections
in the same thigh. Sites should be alternated.
Iron-deficiency anemia occurs during pregnancy due to
inadequacy in maternal iron stores and consuming insufficient amounts of dietary iron.
An episiotomy is an
incision made into the perineum to enlarge the vaginal opening to facilitate birth and minimize soft tissue damage.
If maternal iron deficiency anemia is present
increased dosages of 60 to 120 mg/day can be required.
Maternal phenylketonuria (PKU)
is a maternal genetic disease in which high levels of phenylalanine pose a danger to the fetus.
Goal of cord care
is to prevent or decrease risk for infection and hemorrhage.
Spontaneous abortion
is when a pregnancy is terminated before 20 weeks of gestation (the point of fetal viability) or a fetal weight less than 500 g.
Precipitous labor is defined as
labor that lasts 3 hr or less from the onset of contractions to the time of delivery.
Assessment in the first stage - FHR monitoring (normal range 110 to 160/min)
latent phase - every 30 to 60 min active phase - every 15 to 30 min transitional phase - every 15 to 30 min
Interdependent Phase of maternal role attainment
letting‑go phase Focus on family as a unit Resumption of role (intimate partner, individual)
Caput succedaneum
localized swelling of the soft tissues of the scalp caused by pressure on the head during labor. is an expected finding that can be palpated as a soft edematous mass and can cross over the suture line. Caput succedaneum usually resolves in 3 to 4 days and does not require treatment.
Intermittent auscultation of the FHR is a
low‑technology method that can be performed during labor using a hand‑held Doppler ultrasound device, ultrasound stethoscope, or fetoscope to assess FHR.
Coagulation defect, such as disseminated intravascular coagulopathy (DIC), is often associated with
moderate to severe abruption.
Hispanics tend to prefer
mother to be present rather than partner
Multiparous client Can
move through the stages of labor more rapidly
Gestational hypertensive disease and chronic hypertension can
occur simultaneously
Incomplete Uterine rupture
occurs with dehiscence at the site of a prior scar (cesarean birth, surgical intervention). Internal bleeding might not be present.
Gestational hypertensive diseases are associated with
placental abruption, kidney failure, hepatic rupture, preterm birth, and fetal and maternal death.
Threatened spontaneous abortion
possible mild cramps, spotting to moderate bleeding, no tissue passed, closed cervical opening
Inform the client that a cesarean birth will be needed for subsequent pregnancies
post Uterine inversion
Urinary tract infections (UTIs) are a common
postpartum infection secondary to bladder trauma incurred during the delivery or a break in aseptic technique during bladder catheterization. A potential complication of a UTI is the progression to pyelonephritis with permanent kidney damage leading to kidney failure
Vasospasm contributing to poor tissue perfusion is the underlying mechanism for the manifestations of
pregnancy hypertensive disorders.
Ultrasound is a
procedure lasting approximately 20 min that consists of high-frequency sound waves used to visualize internal organs and tissues by producing a real‑time, three-dimensional image of the developing fetus and maternal structures (fetal heart rate [FHR], pelvic anatomy)
Gestational trophoblastic disease (GTD) is the
proliferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid-filled, and takes on the appearance of grape-like clusters. The embryo fails to develop beyond a primitive state and these structures are associated with choriocarcinoma, which is a rapidly metastasizing malignancy. Two types of molar growths are identified by chromosomal analysis.
Butorphanol and nalbuphine
provide pain relief without causing significant respiratory depression in the mother or fetus. Both IM and IV routes are used.Crosses the placental barrier. If given to the mother too close to the time of delivery, opioid analgesics can cause respiratory depression in the neonate.
Newborn Normal heart rate
ranges from 110 to 160/min with brief fluctuations above and below this range depending on activity level (crying, sleeping). Apical pulse rate is assessed for 1 full minute, preferably when the newborn is sleeping. The pediatric stethoscope head is placed on the fourth or fifth intercostal space at the left midclavicular line over the apex of the newborn's heart. Heart murmurs are documented and reported.
Encourage the client to increase her oral fluid intake postpardum to
replace fluids lost at delivery and to prevent or correct dehydration
newborn Tachypnea
respirations greater than or equal to 60/min
newborn Bradypnea
respirations less than or equal to 30/min
HIV is a
retrovirus that attacks and causes destruction of T lymphocytes. It causes immunosuppression in a client. HIV is transmitted from the mother to a neonate perinatally through the placenta and postnatally through the breast milk.
In Hyperemesis gravidarum Chemistry profile
reveals possible electrolyte imbalances
Naloxone, an opioid antagonist, should be readily available for
reversal of opioid‑induced respiratory depression.
Decreased placental enzyme insulinase After delivery of the placenta results in
reversal of the diabetogenic effects of pregnancy, which lowers blood glucose levels immediately in the puerperium.
Apgar scoring and a brief physical exam is done immediately following birth to
rule out abnormalities.
diastasis recti
separation of the rectus muscle from 2 to 4 cm. It usually resolves within 6 weeks.
Newborn Blood pressure
should be 60 to 80 mm Hg systolic and 40 to 50 mm Hg diastolic.
Newborn Bowel sounds
should be present 1 to 2 hr following birth.
Failure to thrive is
slow weight gain. A newborn usually falls below the 5th percentile on the growth chart.
Milia
small raised white spots on the nose, chin, and forehead can be present. These spots disappear spontaneously without treatment parents should not squeeze the spots.
Thrombophlebitis of the lower extremities can be of
superficial or deep veins, which are most often of the femoral, saphenous, or popliteal veins. The postpartum client is at greatest risk for a deep‑vein thrombosis (DVT) that can lead to a pulmonary embolism.
Dependent‑independent Phase of maternal role attainment
taking‑hold phase Begins on day 2 or 3 Lasts 10 days to several weeks Focus on baby care and improving caregiving competency Want to take charge but need acceptance from others Want to learn and practice Dealing with physical and emotional discomforts, can experience "baby blues"
Uterine atony results from
the inability of the uterine muscle to contract adequately after birth. This can lead to postpartum hemorrhage.
For clients who are Rh-negative and not sensitized
the indirect Coombs' test is repeated between 24 and 28 weeks of gestation.
The physiologic change preceding labor - the premonitory sign of Assessment of amniotic fluid is completed once
the membranes rupture Should be watery, clear, and pale- to straw-yellow in color. Odor should not be foul. Volume is between 500 and 1,200 mL. Use nitrazine paper to confirm that amniotic fluid is present. Amniotic fluid is alkaline: Nitrazine paper is deep blue, indicating pH of 6.5 to 7.5. Urine is slightly acidic: Nitrazine paper remains yellow.
Current recommendations for fetal monitoring include a
three-tier fetal heart rate interpretation system.
Encourage a diet high in protein to promote
tissue healing.
Examination of the cervix is used when there is bleeding during pregnancy to
to observe whether it is opened or closed.
Hypertonic contractions do not contribute
to the progression of labor (cervical effacement, dilation, and fetal descent). and can can result in uteroplacental insufficiency leading to fetal hypoxia.
For Cervical Insufficiency administer
tocolytics prophylactically to inhibit uterine contractions.
External cephalic version is an
ultrasound-guided handson procedure to externally manipulate the fetus into a cephalic lie done at 36 to 37 weeks gestation in a hospital setting. There is a high risk of placental abruption, umbilical cord compression, and emergent cesarean birth with this procedure. Contraindications to performing a version include uterine anomalies, previous cesarean birth, cephalopelvic disproportion, placenta previa, multifetal gestation, and oligohydramnios.
Preterm labor is
uterine contractions and cervical changes that occur between 20 and 37 weeks of gestation.
Postpardum Physiological maternal changes consist of
uterine involution; lochia flow; cervical involution; decrease in vaginal distention; alteration in ovarian function and menstruation; and cardiovascular, urinary tract, breast, and gastrointestinal tract changes.
Newborn Respiratory rate
varies from 30 to 60 breaths/min with short periods of apnea (less than 15 seconds) occurring most frequently during the rapid eye movement sleep cycle. Periods of apnea lasting longer than 15 seconds should be evaluated. Crackles and wheezing are manifestations of fluid or infection in the lungs. Grunting and nasal flaring are clinical findings of respiratory distress.
Serum hCG analysis following molar pregnancy to be done
weekly for 3 weeks, then monthly for 6 months up to 1 year to detect GTD.
Administer subcutaneous injection of terbutaline
when hyperstimulation occurs
After 2 weeks, the uterus should lie
within the true pelvis and should not be palpable
Bulb syringe
Used for suctioning excess mucus from the mouth and nose.
Nagele's rule
Used to calculate delivery date, take the first day of the woman's last menstrual cycle subtract three months then add seven days and one year adjusting for the year as necessary
Stethoscope with a pediatric headused for newborn assessment
Used to evaluate heart rate, breath sounds, and bowel sounds.
Axillary thermometer used in newborn assessment
Used to monitor temperature and prevent hypothermia. Rectal temperatures are avoided because they can injure the delicate rectal mucosa; an initial rectal temperature can be obtained to evaluate for anal abnormalities.
Postpardum Physical changes of the musculoskeletal system involve
a reversal of the musculoskeletal adaptations that occurred during pregnancy. By 6 to 8 weeks after birth: The joints return to their prepregnant state and are completely restabilized. The feet, however, can remain permanently increased in size. Muscle tone begins to be restored throughout the body with the removal of progesterone's effect following delivery of the placenta. The rectus abdominis muscles of the abdomen and the pubococcygeus muscle tone are restored following placental expulsion and return to the prepregnant state about 6 weeks postpartum.
H in HELLP refers to hemolysis which results in
anemia and jaundice
Solids are not introduced until
6 months of age. If introduced too early, food allergies can develop
Nifedipine
A calcium channel blocker that is used to suppress contractions by inhibiting calcium from entering smooth muscles. Monitor for headache, flushing, dizziness, and nausea. These usually are related to orthostatic hypotension that occurs with administration. Should not be administered concurrent with magnesium sulfate, or concurrent or immediately following a beta2-adrenergic agonist. Instruct the client to slowly change positions from supine to upright, and to sit until dizziness disappears. Tell the client to maintain adequate hydration to counter hypotension.
A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea and vomiting and scant, prune-colored discharge. She has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect? A. Hyperemesis gravidarum B. Threatened abortion C. Hydatidiform mole D. Preterm labor
A client who has a hydatidiform mole exhibits increased fundal height that is inconsistent with the week of gestation, and excessive nausea and vomiting due to elevated hCG levels. Scant, dark discharge occurs in the second trimester.
A nurse is caring for a client who is in the first stage of labor and is encouraging the client to void every 2 hr. Which of the following statements should the nurse make? A. "A full bladder increases the risk for fetal trauma." B. "A full bladder increases the risk for bladder infections." C. "A distended bladder will be traumatized by frequent pelvic exams." D. "A distended bladder reduces pelvic space needed for birth."
A distended bladder reduces pelvic space, impedes fetal descent, and places the bladder at risk for trauma during the labor process.
Lower blood levels of hCG might suggest
A miscarriage or ectopic pregnancy
Urine should be passed within
24 hr after birth Uric acid crystals will produce a rust color in the urine the first couple of days of life.
Postpartum infections are complications that can occur up to
28 days following childbirth, or a spontaneous or induced abortion
Abstinence
Abstaining from having sexual intercourse illuminates the possibility of sperm entering the vagina.
What is the most effective method of birth control
Abstinence
Transvaginal ultrasound
An invasive procedure in which a probe is inserted vaginally to allow for a more accurate evaluation. An advantage of this procedure is that it does not require a full bladder.
Which medications can cause false positive or false negative pregnancy results
Anticonvulsants diuretics and tranquilizers
Physiologic changes preceding labor - premonitory signs include
Backache, weight loss, Lightening, contractions, increased vaginal discharge or bloody show, energy burst, GI changes, Cervical ripening, Rupture of membranes, Assessment of amniotic fluid
A single dose of what is given with PROM at 24 to 31 weeks of gestation to reduce the risk of perinatal mortality, respiratory distress syndrome, and other morbidities
Betamethasone
Blood Pressure
Blood pressure measurements are within pre-pregnancy range during first trimester systolic light or no increase from pre-pregnancy levels diastolic slight decrease is around 24 to 32 weeks will gradually return to pre-pregnancy level by the end of the pregnancy
Gestational diabetes mellitus increases risk to the fetus of
spontaneous abortion, related to poor glycemic control Infections (urinary and vaginal), related to increased glucose in the urine and decreased resistance because of altered carbohydrate metabolism Hydramnios, which can cause overdistention of the uterus, premature rupture of membranes, preterm labor, and hemorrhage Ketoacidosis from diabetogenic effect of pregnancy (increased insulin resistance), untreated hyperglycemia, or inappropriate insulin dosing Hypoglycemia, caused by overdosing in insulin, skipped or late meals, or increased exercise Hyperglycemia, which can cause excessive fetal growth (macrosomia)
Biophysical profile (BPP) uses a
real-time ultrasound to visualize physical and physiological characteristics of the fetus and observe for fetal biophysical responses to stimuli. It combines FHR monitoring (nonstress test) and fetal ultrasound.
An amniotomy is the
artificial rupture of the amniotic membranes (AROM) by the provider using an Amnihook or other sharp instrument. Labor typically begins within 12 hr after the membranes rupture and can decrease the duration of labor by up to 2 hr. The client is at an increased risk for cord prolapse or infection.
Vital signs are checked in the following sequence for newborns
respirations, heart rate, blood pressure, and temperature. The nurse observes the respiratory rate first before the newborn becomes active or agitated by use of the stethoscope, thermometer, and/or blood pressure cuff.
EL in HELLP refers to elevated liver enzymes results in
elevated alanine aminotransferase ALT or aspartate transaminase AST, epigastric pain, nausea and vomitting
In lactating women, the serum prolactin levels remain
elevated and suppress ovulation. The return of ovulation is influenced by breastfeeding frequency, the length of each feeding, and the use of supplementation. The infant's suck is also believed to affect prolactin levels. Length of time to the first postpartum ovulation is approximately 6 months.
Pharmacological anesthesia
eliminates pain perceptions by interrupting the nerve impulses to the brain.
Uterine infection is also referred to as
endometritis is an infection of the uterine lining or endometrium. It is the most frequently occurring puerperal infection. Endometritis usually begins on the second to fifth postpartum day, generally starting as a localized infection at the placental attachment site and spreading to include the entire uterine endometrium.
Continued flow of lochia serosa or alba beyond the normal length of time can indicate
endometritis, especially if it is accompanied by fever, pain, or abdominal tenderness.
Babinski reflex
expected finding Elicit by stroking outer edge of sole of the foot, moving up toward toes. Toes will fan upward and out. expected age birth to 1 year
Sucking and rooting reflex
expected finding Elicit by stroking the cheek or edge of mouth. Newborn turns the head toward the side that is touched and starts to suck. expected age Usually disappears after 3 to 4 months but can persist up to 1 year
A mediolateral episiotomy
extends from the vaginal outlet posterolateral, either to the left or right of the midline, and is used when posterior extension is likely. Third-degree laceration can occur. Blood loss is greater, and the repair is more difficult and painful. Local anesthetic is administered to the perineum prior to the incision.
A median (midline) episiotomy
extends from the vaginal outlet toward the rectum, and is the most commonly used. Effective, Easily repaired, Generally least painful, Associated with a higher incidence of third- and fourth-degree lacerations
Gestational hypertension (GH) , which begins after the 20th week of pregnancy, describes
hypertensive disorders of pregnancy whereby the woman has an elevated blood pressure at 140/90 mm Hg or greater recorded on two different occasions, at least 4 hr. apart. There is no proteinuria. The presence of edema is no longer considered in the definition of hypertensive disease of pregnancy. Blood pressure returns to baseline by 6 weeks postpartum.
Oxytocin stimulation can lead to
hypertonic uterine contractions.
Feedings can be started
immediately following birth. Breastfeeding is initiated as soon as possible after birth as part of baby‑friendly initiatives. Formula feeding usually is started at about 2 to 4 hr of age. A few sips of sterile water can be given to assess sucking and swallowing reflexes and ensure that there are no anomalies, such as a tracheoesophageal fistula, prior to initiating formula. The newborn is fed on demand, which is normally every 3 to 4 hr for bottle‑fed newborns and more frequently for breastfed newborns.
Vaginal blood‑tinged discharge can occur
in female newborns, which is caused by maternal pregnancy hormones. This is an expected finding
D&C recommended if oxytocics are
ineffective in expelling the placental fragments.
An amnioinfusion of normal saline or lactated Ringer's is
instilled into the amniotic cavity through a transcervical catheter introduced into the uterus to supplement the amount of amniotic fluid. The instillation reduces the severity of variable decelerations caused by cord compression.
Cervical Dilation for a Multigravida
is 1.5 cm an hr
Cervical Dilation for a primigravida
is 1cm an hr
Vasa Previa
is a condition when the fetal umbilical vessels implant into the fetal membranes rather than the placenta. There are variations of vasa previa.Velamentous insertion of the cord Succenturiate insertion of the cord Battledore insertion of the cord
Candidiasis, also known as vulvovaginal candidiasis or yeast infection,
is a fungal infection caused by Candida albicans. It is the second most common type of vaginal infection in the U.S., All women who have symptoms should be tested.
Erythema toxicum (erythema neonatorum)
is a pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks. This is frequently referred to as newborn rash. No treatment is required.
Cervical insufficiency (premature cervical dilatation)
is a variable condition whereby expulsion of the products of conception occurs. It is thought to be related to tissue changes and alterations in the length of the cervix.
HELLP syndrome
is a variant of GH in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction. HELLP syndrome is diagnosed by laboratory tests, not clinically.
Chorioamnionitis
is an infection of the amniotic membranes.
Eclampsia
is severe preeclampsia manifestations with the onset of seizure activity or coma. Eclampsia is usually preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentrations, which are warning signs of probable convulsions.
Posterior fontanel
is smaller than anterior fontanel and triangle‑shaped
Neisseria gonorrhoeae
is the causative agent of gonorrhea.
Percutaneous umbilical blood sampling, commonly called cordocentesis
is the most common method used for fetaln blood sampling and transfusion. This procedure obtains fetal blood from the umbilical cord by passing a finegauge, fiber-optic scope (fetoscope) into the amniotic sac using the amniocentesis technique. The needle is advanced into the umbilical cord under ultrasound guidance, and blood is aspirated from the umbilical vein. Blood studies from the cordocentesis can consist of: Kleihauer Betke test that ensures that fetal blood was obtained, CBC count with differential, Indirect Coombs' test for Rh antibodies, Karyotyping (visualization of chromosomes), Blood gases
Abruptio placentae
is the premature separation of the placenta from the uterus, which can be a partial or complete detachment. This separation occurs after 20 weeks of gestation, which is usually in the third trimester. It has significant maternal and fetal morbidity and mortality and is a leading cause of maternal death.
Rubella symptoms
joint and muscle pain
The client is at risk for hemorrhage or infection due to a
laceration or hematoma.
Assessment in the first stage - Contraction monitoring
latent phase - every 30 to 60 min active phase - every 15 to 30 min transitional phase - every 10 to 15 min
Assessment in the first stage - Blood pressure, pulse, and respiration measurements
latent phase - every 30 to 60 min active phase - every 30 min transitional phase - every 15 to 30 min
Types of abortion are clinically classified according to
manifestations and whether the products of conception are partially or completely retained or expulsed
Three-dimensional (3D)
multiple pictures at once; almost as clear as a photograph; images look more lifelike than standard ultrasound images
newborn Respiratory distress
nasal flaring, retractions, grunting, gasping, and labored breathing
Missed Spontaneous abortion
no cramps, no bleeding with brownish discharge, no tissue passed, prolonged retention of tissue, closed cervical opening
Assess the lochia flow for
normal color, amount, and consistency. Lochia typically trickles from the vaginal opening but flows more steadily during uterine contractions
The mother should Plan at least
one daily rest period; rest when the infant naps.
Herpes simplex infection symptoms consisting of
painful blisters and tender lymph nodes
Continuous internal fetal monitoring with a scalp electrode is
performed by attaching a small spiral electrode to the presenting part of the fetus to monitor the FHR. The electrode wires are then attached to a leg plate that is placed on the client's thigh and then attached to the fetal monitor.
Clients who have had a cesarean birth should wait until the 4‑ to 6‑week follow‑up visit before
performing strenuous exercise, heavy lifting, or excessive stair climbing.
With GTD serum level hCG is
persistently high compared with expected decline after weeks 10 to 12 of pregnancy.
Lochia is
post-birth uterine discharge that contains blood, mucus, and uterine tissue.
Methylergonovine is prescribed for the client experiencing
postpartum hemorrhage.
Paternal transition to fatherhood consists of a
predictable three‑stage process during the first few weeks of transition. Expectations and intentions: The father desires to be deeply and emotionally connected with the infant. Confronting reality: The father discovers that his expectations might not be met. Commonly expressed emotions include feeling sad, frustrated, and jealous. He embraces the need to be actively involved in parenting. Creating the role of the involved father: The father decides to become actively involved in the care of the infant. Reaping rewards: Rewards include infant smiles and a sense of completeness and meaning.
Toxoplasmosis, other infections (e.g., hepatitis), rubella virus, cytomegalovirus, and herpes simplex virus are known collectively as
TORCH, which is a group of infections that can negatively affect a woman who is pregnant. These infections can cross the placenta and have teratogenic effects on the fetus. TORCH does not include all the major infections that present risks to the mother and fetus.
Examples of Category II fetal heart rate tracings contain any of the following:
Tachycardia Bradycardia not accompanied by absent baseline variabilityMinimal baseline variability Absent baseline variability not accompanied by recurrent decelerations Marked baseline variabilityProlonged fetal heart rate deceleration equal or greater than 2 min but less than 10 min Recurrent late decelerations with moderate baseline variability Recurrent variable decelerations with minimal or moderate baseline variability Variable decelerations with additional characteristics, including "overshoots," "shoulders," or slow return to baseline fetal heart rate Absence of induced accelerations after fetal stimulation
Position
The client should engage in frequent position changes during labor to increase comfort, relieve fatigue, and promote circulation. Position during the second stage is determined by maternal preference, provider preference, and the condition of the mother and the fetus.Gravity can aid in the fetal descent in upright, sitting, kneeling, and squatting positions
A nurse is providing discharge teaching to the parents of a newborn regarding circumcision care. Which of the following statements made by a parent indicates an understanding of the teaching? A. "His circumcision will heal within a couple of days." B. "I should remove the yellow mucus that will form." C. "I will clean his penis with each diaper change." D. "I will give him a tub bath within a couple of days."
The penis should be cleaned with warm water with each diaper change.
By 36 weeks the top of the uterus in the fundus will reach
The xiphoid process, which can cause shortness of breath as a uterus pushes against the diaphragm
Five P's
There are five factors that affect and define the labor and birth process: passenger - fetus and placenta, passageway - birth canal, powers - contractions, position - of the woman, and psychological response
A nurse is in prenatal clinic is caring for a client who is pregnant and experiencing episodes of maternal hypotension the client asked the nurse what causes these episodes which of the following responses should the nurse make A. This is due to an increase in blood volume B. This is due to pressure from the uterus on the diaphragm C. This is due to the weight of the uterus on the vena cava D. This is due to increased cardiac output
This is due to the weight of the uterus on the vena cava
Yellow‑green, frothy vaginal discharge with foul odor manifests in women with
Trichomoniasis
Fetal flexion (attitude)
Chin flexed to chest, extremities flexed into torso
Skin changes that occur are
Chloasma, linea negra, striae gravidarum
A nurse is assessing a client who has postpartum depression. The nurse should expect which of the following findings? (Select all that apply.) A. Paranoia that her infant will be harmed B. Concerns about lack of income to pay bills C. Anxiety about assuming a new role as a mother D. Rapid decline in estrogen and progesterone E. Feeling of inadequacy with the new role as a mother
Concerns about lack of income to pay bills, Anxiety about assuming a new role as a mother, Rapid decline in estrogen and progesterone, Feeling of inadequacy with the new role as a mother
Sacral counterpressure
Consistent pressure is applied by the support person using the heel of the hand or fist against the client's sacral area to counteract pain in the lower back
Spinal anesthesia (block)
Consists of a local anesthetic that is injected into the subarachnoid space into the spinal fluid at the third, fourth, or fifth lumbar interspace. This can be done alone or in combination with an analgesic such as fentanyl. The spinal block eliminates all sensations from the level of the nipples to the feet. It is commonly used for cesarean births. A low spinal block can be used for a vaginal birth, but it is not used for labor. A spinal block is administered in the late second stage or before cesarean birth.
Pudendal block
Consists of a local anesthetic, such as lidocaine or bupivacaine, administered transvaginally into the space in front of the pudendal nerve. This type of block has no maternal or fetal systemic effects, but it does provide local anesthesia to the perineum, vulva, and rectal areas during delivery, episiotomy, and episiotomy repair. It is administered during the late second stage of labor 10 to 20 min before delivery, providing analgesia prior to spontaneous expulsion of the fetus or forceps-assisted or vacuum-assisted birth. It is suitable during the second and third stages of labor and for repair of episiotomy and lacerations.
Nipple-stimulated contraction test
Consists of a woman lightly brushing her palm across her nipple for 2 min, which causes the pituitary gland to release endogenous oxytocin, and then stopping the nipple stimulation when a contraction begins. The same process is repeated after a 5-min rest period.
Passenger
Consists of the fetus and the placenta. The size of the fetal head, fetal presentation, fetal lie, fetal attitude, and fetal position affect the ability of the fetus to navigate the birth canal. The placenta can be considered a passenger because it also must pass through the canal
Epidural and spinal regional analgesia
Consists of using analgesics such as fentanyl and sufentanil, which are short-acting opioids that are administered as a motor block into the epidural or intrathecal space without anesthesia. These opioids produce regional analgesia, providing rapid pain relief while still allowing the client to sense contractions and maintain the ability to bear down
The physiologic change preceding labor - the premonitory sign of backache is
Constant low, dull backache caused by pelvic muscle relaxation
Contraceptive vaginal ring
Contains etonogestrel and ethinyl estradiol that is delivered at continuous levels vaginallydoes not have to be fitted can cause blood clots hypertension stroke and heart attack
Four basic ways to hold the newborn
Cradle hold, Upright position, Football hold, Colic hold
A nurse is caring for a client and her partner during the second stage of labor. The client's partner asks the nurse to explain how he will know when crowning occurs. Which of the following responses should the nurse make? A. "The placenta will protrude from the vagina." B. "Your partner will report a decrease in the intensity of contractions." C. "The vaginal area will bulge as the baby's head appears." D. "Your partner will report less rectal pressure."
Crowning is bulging of the perineum and the appearance of the fetal head.
Fourth Stage of labor
Delivery of placenta Maternal stabilization of vital signs Achievement of vital sign homeostasis Lochia scant to moderate rubra. can last 1 to 4 hrs
Third Stage of labor
Delivery of the neonate Placental separation and expulsion Schultze presentation: shiny fetal surface of placenta emerges first Duncan presentation: dull maternal surface of placenta emerges first. this stage can last 5 to 30 min
HIV
Detects HIV infection (the Centers for Disease Control and Prevention and the American Congress of Obstetricians and Gynecologists recommend testing all clients who are pregnant unless the client refuses testing).
Vaginal/cervical culture
Detects streptococcus β-hemolytic, bacterial vaginosis, or sexually transmitted infections (gonorrhea and chlamydia).
Blood type, Rh factor, and presence of irregular antibodies
Determines the risk for maternal-fetal blood incompatibility (erythroblastosis fetalis) or neonatal hyperbilirubinemia.
Newborn expected lab values
Hgb: 14 to 24 g/dL, Platelets: 150,000 to 300,000/mm3, Hct: 44% to 64%, Glucose: 40 to 60 mg/dL, RBC count: 4.8 x 106 to 7.1 x 106, Bilirubin, 24 hr: 2 to 6mg/dL, 48 hr: 6 to 7 mg/dL, 3 to 5 days: 4 to 6 mg/dL, Leukocytes: 9,000 to 30,000/mm3
Urinalysis with microscopic examination of pH, specific gravity, color, sediment, protein, glucose, albumin, RBCs, WBCs, casts, acetone, and human chorionic gonadotropin
Identifies pregnancy, diabetes mellitus, gestational hypertension, renal disease, and infection.
During Developmental stages and transitions remember to
Identify expected body image changes associated with the clients developmental age
When it comes to what the client needs to adapt to physiologically with alterations in body systems make sure to
Identify signs of potential prenatal complications
If magnesium toxicity is suspected
Immediately discontinue infusion. Administer antidote calcium gluconate or calcium chloride. Prepare for actions to prevent respiratory or cardiac arrest.
A nurse is teaching a client about potential adverse affects of implantable progestins which of the following adverse effects of the nurse include select all that apply A. Tinnitus B. Irregular vaginal bleeding C. Weight gain D. Breast changes E. Gingival hyperplasia
Irregular vaginal bleeding we game and brush changes are all potential adverse effects
A nurse in the clinic is caring for a client who is to be seen by the provider for a post operative appointment following a salpingectomy due to an ectopic pregnancy which of the following statements by the client requires clarification A. It is good to know that I won't have a tubal pregnancy in the future B. The doctor said that this surgery can affect my ability to get pregnant again C. I understand that one of my fallopian tubes had to be removed D. Ovulation can still occur because my ovaries were not affected
It is good to know that I won't have a tubal pregnancy in the future after the first tubal pregnancy they are at a greater risk of reoccurrence
During ambulation to the bathroom, a postpartum client experiences a gush of dark red blood that soon stops. On assessment, a nurse finds the uterus to be firm, midline, and at the level of the umbilicus. Which of the following findings should the nurse interpret this data as being? A. Evidence of a possible vaginal hematoma B. An indication of a cervical or perineal laceration C. A normal postural discharge of lochia D. Abnormally excessive lochia rubra flow
Lochia typically trickles from the vaginal opening but flows more steadily during uterine contractions. Massaging the uterus or ambulation can result in a gush of lochia with the expression of clots and dark blood that has been pooled in the vagina, but it should soon decrease back to a trickle of bright red lochia in the early puerperium.
Evaporation
Loss of heat as surface liquid is converted to vapor. Gently rub the newborn dry with a warm sterile blanket (adhering to standard precautions) immediately after delivery. If thermoregulation is unstable, postpone the initial bath until the newborn's skin temperature is 36.5° C (97.7° F). When bathing, expose only one body part at a time, washing and drying thoroughly.
Barrier methods are
Male condom female condom diaphragm and spermicide cervical cap and spermicide contraceptive sponge
40% of couples who are infertile inability to conceive is due to
Male infertility
If complete abstinence is maintained there are
No risks
Therapeutic procedures for infertility include
Non-medical therapy and alternative measures medical therapy assisted reproductive technologies
Advantages of continuous electronic fetal monitoring
Noninvasive and reduces risk for infection. Membranes do not have to be ruptured. Cervix does not have to be dilated. Placement of transducers can be performed by the nurse. Provides permanent record of FHR and uterine contraction tracing.
Gravidity
Number of pregnancies
Parity
Number of pregnancies in which the fetus or fetuses reach 20 weeks of pregnancy not the number of fetuses parity is not affected whether the fetus is stillborn or alive
preparation for pregnancy and birth during the first trimester
Physical and psychosocial changes, Common discomforts of pregnancy and measures to, provide relief, Lifestyle: exercise, stress, nutrition, sexual health,dental care, over-the-counter and prescription medications, tobacco, alcohol, substance use, and STIs (encourage safe sexual practices), Possible complications and indications to report (preterm labor), Fetal growth and development, Prenatal exercise, Expected laboratory testing
Colic hold
Place the newborn face‑down along the holder's forearm with the hand firmly between the newborn's legs. The newborn's cheek should be by the holder's elbow on the outside. The newborn should be able to see the ground, and the holder's arm should be close to the body, using it to brace and steady the newborn. This is a good position for quieting a fussy newborn.
Continuous internal fetal monitoring can be used in conjunction with
an intrauterine pressure catheter (IUPC)
A nurse educator on the postpartum unit is reviewing risk factors for postpartum hemorrhage with a group of nurses. Which of the following factors should the nurse include in the teaching? (Select all that apply.) A. Precipitous delivery B. Obesity C. Inversion of the uterus D. Oligohydramnios E. Retained placental fragments
Precipitous delivery, Inversion of the uterus, Retained placental fragments
Goodell's sign
Softening of cervical tip
A nurse is caring for a client who has mastitis. Which of the following is the typical causative agent of mastitis? A. Staphylococcus aureus B. Chlamydia trachomatis C. Klebsiella pneumonia D. Clostridium perfringens
Staphylococcus aureus, Escherichia coli, and streptococcus are usually the infecting agents that enter the breast due to sore or cracked nipples, which results in mastitis.
Ectopic pregnancy is the second most frequent cause of
bleeding in early pregnancy and a leading cause of infertility.
Third degree Laceration
extends through the skin, muscles, perineum, and external anal sphincter muscle.
There are three types of ultrasound
external abdominal, transvaginal, and Doppler.
Placenta previa is Classified into three types
dependent on the degree to which the cervical os is covered by the placenta. Complete/total, Incomplete Partial, Marginal/low-lying
Perineal lacerations are defined in terms of
depth.
Minimal variability
detectable but equal to or less than 5/min
Ultrasound is used when there is bleeding during pregnancy to
determine the presence of a viable or dead fetus, or partial or complete products of conception within the uterine cavity.
Newborn Normal temperature range
is 36.5° C to 37.5° C (97.7° F to 99.5° F) axillary. The newborn is at risk for hypothermia and hyperthermia until thermoregulation (ability to produce heat and maintain normal body temperature) stabilizes. If the newborn becomes chilled (cold stress), oxygen demands can increase and acidosis can occur.
Mild preeclampsia
is GH with the addition of proteinuria of greater than or equal to 1+. Report of transient headaches might occur along with episodes of irritability. Edema can be present.
Disseminated intravascular coagulation (DIC)
is a coagulopathy in which clotting and anticlotting mechanisms occur at the same time. The client is at risk for both internal and external bleeding, as well as damage to organs resulting from ischemia caused by microclots. can occur secondary to other complications
Rapid treatment for ectopic pregnancy includes
medical management, methotrexate, Salpingostomy, Laparoscopic salpingectomy
The immediate postpartum period following birth is a time of increased risk for all women for
micro‑organisms entering the reproductive tract and migrating into the blood and other parts of the body, which can result in life‑threatening septicemia.
Complete spontaneous abortion
mild cramps, minimal bleeding, complete expulsion of uterine contents, closed with no tissue in cervical canal
A gestational age assessment is performed
on newborns within the first 48 hr following birth. Neonatal morbidity and mortality are related to gestational age and birth weight. The gestational age assessment involves taking measurements of the newborn and the use of the New Ballard Scale. This scale provides an estimation of gestational age and a baseline to assess growth and development.
Dependent Phase of maternal role attainment
taking‑in phase, First 24 to 48 hr, Focus on meeting personal needs, Rely on others for assistance, Excited, talkative, Need to review birth experience with others
A nurse is caring for a client in active labor. When last examined 2 hr ago, the client's cervix was 3 cm dilated, 100% effaced, membranes intact, and the fetus was at a -2 station. The client suddenly states "My water broke." The monitor reveals a FHR of 80 to 85/min, and the nurse performs a vaginal examination, noticing clear fluid and a pulsing loop of umbilical cord in the client's vagina. Which of the following actions should the nurse perform first? A. Place the client in the Trendelenburg position. B. Apply pressure to the presenting part with her fingers. C. Administer oxygen at 10 L/min via a face mask. D. Call for assistance.
According to evidenced-based practice, the nurse should first call for assistance.
A nurse is reviewing discharge teaching with a client who has a urinary tract infection. Which of the following statements by the client indicates understanding of the teaching? (Select all that apply.) A. "I will perform peri care and apply a perineal pad in a back‑to‑front direction." B. "I will drink cranberry and prune juices to make my urine more acidic." C. "I will drink large amounts of fluids to flush the bacteria from my urinary tract." D. "I will go back to breastfeeding after I have finished taking the antibiotic." E. "I will take Tylenol for any discomfort.
Acidification of urine inhibits bacterial multiplication, Increased fluid intake can help to flush the bacteria from the urinary tract, Acetaminophen is taken to reduce discomfort and pain associated with a urinary tract infection.
Management of a client who is in preterm labor includes focusing on stopping uterine contractions by
Activity restriction, Ensuring hydration, Identifying and treating an infection, Monitor FHR and contraction pattern
Vitamin K (phytonadione)
Administered to prevent hemorrhagic disorders. Vitamin K is not produced in the gastrointestinal tract of the newborn until around day 7. Vitamin K is produced in the colon by bacteria that forms once formula or breast milk is introduced into the gut of the newborn. Administer 0.5 to 1 mg intramuscularly into the vastus lateralis (where muscle development is adequate) within 1 hr after birth.
A nurse is caring for a client who is 2 days postpartum. The client states, "My 4‑year old son was toilet trained and now he is frequently wetting himself." Which of the following statements should the nurse provide to the client? A. "Your son was probably not ready for toilet training and should wear training pants." B. "Your son is showing an adverse sibling response." C. "Your son may need counseling." D. "You should try sending your son to preschool to resolve the behavior."
Adverse responses by a sibling to a new infant can include regression in toileting habits
External rotation (restitution)
After the head is born, it rotates to the position it occupied as it entered the pelvic inlet (restitution) in alignment with the fetal body and completes a quarter turn to face transverse as the anterior shoulder passes under the symphysis.
Female infertility assessment should include
Age, duration of infertility, medical history surgical history OB history GYN history sexual history occupational and environmental exposure risk assessment weight and substance use
Gestational trophoblastic disease (GTD) Complete mole
All genetic material is paternally derived. The ovum has no genetic material, or the material is inactive. The complete mole contains no fetus, placenta, amniotic membranes, or fluid. There is no placenta to receive maternal blood. Hemorrhage into the uterine cavity occurs, and vaginal bleeding results. Approximately 20% of complete moles progress toward a choriocarcinoma.
Category I of the three tier system
All of the following are included in the fetal heart rate tracing: Baseline fetal heart rate of 110 to 160/min Baseline fetal heart rate variability: moderate Accelerations: present or absent Early decelerations: present or absent Variable or late decelerations: absent
Oxytocin-stimulated contraction test
Also known as an oxytocin challenge test (OCT), it is used if nipple stimulation fails and consists of the IV administration of oxytocin to induce uterine contractions.
Thrombolytic therapy to break up blood clots may be prescribed such as
Alteplase, streptokinase: Similar side effects and contraindications as anticoagulants.
Ampicillin
Ampicillin is an antibiotic used to treat infection. It is commonly used to treat chorioamnionitis. Obtain vaginal, urine, and blood cultures prior to administration of antibiotic.
Serum and urine test provide
An accurate assessment for the presence of human chorionic gonadotropin HCG production and can start as early as a day of implantation and can be detected as early as 7 to 8 days after conception
Anaphylactoid syndrome of pregnancy (amniotic fluid embolism)
An amniotic fluid embolism occurs when there is a rupture in the amniotic sac or maternal uterine veins accompanied by high intrauterine pressure that causes infiltration of the amniotic fluid into the maternal circulation. The amniotic fluid then travels to and obstructs pulmonary vessels and causes respiratory distress and circulatory collapse. It can occur during labor, birth, or within 30 min following birth. Meconium-stained amniotic fluid or fluid containing particulate matter can cause devastating maternal damage because it readily clogs the pulmonary veins completely. Serious coagulation problems, such as disseminated intravascular coagulopathy (DIC), can occur.
A nurse is admitting a client who is in labor and has HIV. Which of the following interventions should the nurse identify as contraindicated for this client? (Select all that apply.) A. Episiotomy B. Oxytocin infusion C. Forceps D. Cesarean birth E. Internal fetal monitoring
An episiotomy should be avoided for a client who is HIV‑positive due to the risk of maternal blood exposure.The use of forceps during delivery should be avoided due to the risk of fetal bleeding.Internal fetal monitoring should be avoided due to the risk of fetal bleeding.
Infertility is defined as
And inability to conceive despite engaging in unprotected sexual intercourse for a prolonged period of time or at least 12 months
Heparin
Anticoagulant, Given IV to prevent formation of other clots and to prevent enlargement of the existing clot. Initially, IV heparin is administered by continuous infusion for 3 to 5 days with doses adjusted according to coagulation studies. Protamine sulfate, the heparin antidote, should be readily available to counteract the development of heparin‑induced antiplatelet antibodies. Monitor aPTT (1.5 to 2.5 times the control level of 30 to 40 seconds). Instruct the client to report bleeding from the gums or nose, increased vaginal bleeding, blood in the urine, and frequent bruising
Retrovir
Antiretroviral agent, Nucleoside reverse transcriptase inhibitor. Administer retrovir at 14 weeks of gestation, throughout the pregnancy, and before the onset of labor or cesarean birth. Administer retrovir to the infant at delivery and for 6 weeks following birth.
Bishop score indicated in
Any condition in which augmentation or induction of labor is indicated a client at 39 weeks of gestation should be greater than 8 for a multiparous client and greater than 10 for a nulliparous client as an indicator of readiness for labor induction.
A nurse on the postpartum unit is performing a physical assessment of a client who is being admitted with a suspected deep‑vein thrombosis (DVT). Which of the following clinical findings should the nurse expect? (Select all that apply.) A. Calf tenderness to palpation B. Mottling of the affected extremity C. Elevated temperature D. Area of warmth E. Report of nausea
Calf tenderness to palpation, Elevated temperature, and Area of warmth
Ondansetron and metoclopramide
Can control nausea and anxiety. They do not relieve pain and are used as an adjunct with opioids
Cardiovascular system when pregnant
Cardiac output increases 30 to 50% and blood volume increases 30 to 45 at term to meet the greater metabolic means heart rate increases during pregnancy beginning around week five and reaches a peek 10 to 15 per minute above pre-pregnancy rate around 32 weeks gestation
Category II of three tier system
Category II tracings include all fetal heart rate tracings not categorized as Category I or Category III.
A nurse is caring for a client who has gonorrhea. Which of the following medications should the nurse anticipate the provider will prescribe? A. Ceftriaxone B. Fluconazole C. Metronidazole D. Zidovudine
Ceftriaxone IM or doxycycline orally for 7 days is prescribed for the treatment of gonorrhea.
Maternal precipitous labor complications
Cervical, vaginal, or perineal lacerations, Resultant tissue trauma secondary to rapid birth, Uterine rupture, Amniotic fluid embolism, Postpartum hemorrhage
Presumptive signs of pregnancy are
Changes that a woman experiences that make her think that she might be pregnant these changes might be subjective symptoms or objective signs signs also might be a result of physiological factors other than pregnancy examples are amenorrhea fatigue nausea vomiting urinary frequency breast changes such as darkened areola enlarged Montgomery glands, quickening which is slight fluttering movements of the fetus felt by a woman usually between 16 to 20 weeks and uterine enlargement
Probable signs of pregnancy are
Changes that make The examiner suspect a woman is pregnant primarily related to physical changes of the uterus signs can because by physiological factors other than pregnancy examples of probable signs are abdominal enlargement Hegar's sign Chadwick sign goodell's sign ballottement Braxton Hicks contractions positive pregnancy test and fetal outline
A nurse educator in the labor and delivery unit is reviewing the use of chemical agents to promote cervical ripening with a group of newly hired nurses. Which of the following statements by a nurse indicates understanding of the teaching? A. "They are administered in an oral form." B. "They act by absorbing fluid from tissues." C. "They promote dilation of the os." D. "They include an amniotomy."
Chemical agents that promote cervical ripening include medications administered in oral form.
A nurses in a prenatal clinic caring for a patient who is on the first trimester of pregnancy the clients health record includes this data: G3 T1 P0 A1 L1 how should the nurse interpret this information select all that apply A. Client has delivered newborn at term B. Client has experienced no preterm labor C. Client has been through active labor D. Client has two prior pregnancies E. Client has one living child
Client has delivered one new born at term client has experienced no preterm labor client has been through active labor client has two prior pregnancies and client has one living child
Administer intrapartum antibiotic prophylaxis to the following clients
Client who has GBS bacteriuria during current pregnancy Client who has a GBS‑positive screening during current pregnancy, Client who has unknown GBS status who is delivering at less than 37 weeks of gestation, Client who has maternal fever of 38° C (100.4° F), Client who has rupture of membranes for 18 hr or longer
A nurse is conducting a home visit for a client who is 1 week postpartum and breastfeeding. The client reports breast engorgement. Which of the following recommendations should the nurse make? A. "Apply cold compresses between feedings." B. "Take a warm shower right after feedings." C. "Apply breast milk to the nipples and allow them to air dry." D. "Use the various infant positions for feedings."
Cold compresses applied to the breasts after the feedings can help with breast engorgement.
Transdermal contraceptive patch
Contains norelgestromin (progesterone) and ethical estradiol, which is delivered at continuous levels through the skin into subcutaneous tissue apply the patch the same day of the week for three weeks with no application on the fourth week it maintains consistent blood levels of hormones avoid the liver metabolism because it's not absorbed in the G.I. tract
The physiologic change preceding labor - the premonitory sign of weight loss is
0.5 to 1.5 kg (1 to 3.5 lb) weight loss
In blood values, coagulation factors, and fibrinogen levels during the puerperium
Hematocrit levels drop moderately for 3 to 4 days then begin to increase and reach nonpregnant levels by 8 weeks postpartum. During the first 4 to 7 days after birth, WBC values between 20,000 and 25,000mm are common. Coagulation factors and fibrinogen levels increase during pregnancy and remain elevated for 2 to 3 weeks postpartum. Hypercoagulability predisposes the postpartum client to thrombus formation and thromboembolism.
Initial lab tests for prenatal visit include
Hemoglobin he Metacritic wbc blood type and RH rubella titer your analysis renal function test Pap test cervical cultures HIV antibody hepatitis B surface antigen toxoplasmosis and RPR or VDRL
Combined oral contraceptives
Hormonal contraception containing estrogen and progestin which acts by suppressing ovulation thickening the cervical mucus to block semen and altering the uterine decidua to prevent implantation. Requires prescription and follow up appointments must be used consistently to be effective can increase the risk of thromboembolism stroke heart attack hypertension gallbladder disease and liver tumor. exacerbates conditions affected by fluid retention such as migraine epilepsy asthma kidney or heart disease. Oral contraceptive effectiveness decreases when taking medications that affect liver enzymes such as anti-convulsant and some antibiotics
Splenectomy: may be performed by the provider if
ITP does not respond to medical management
PPD (tuberculosis screening), chest x-ray after 20 weeks of gestation with PPD test
Identifies exposure to tuberculosis.
One-hour glucose tolerance (oral ingestion or IV administration of concentrated glucose with venous sample taken 1 hr later [fasting not necessary])
Identifies hyperglycemia; done at initial visit for at‑risk clients and at 24 to 28 weeks of gestation for all pregnant women (greater than 140 mg/dL requires follow up).
Production of hCG begins with
Implantation peaks at about 60 to 70 days of geStation the declines until around 100 to 130 days of pregnancy and then gradually increases until term
Measurement of fundal height
In centimeters from the symphysis pubis to the top of the uterine fundus between 18 and 32 weeks approximates the gestational age
A nurse in the labor and delivery unit is caring for a client in labor and applies an external fetal monitor and tocotransducer. The FHR is around 140/min. Contractions are occurring every 8 min and 30 to 40 seconds in duration. The nurse performs a vaginal exam and finds the cervix is 2 cm dilated, 50% effaced, and the fetus is at a -2 station. Which of the following stages and phases of labor is this client experiencing? A. First stage, latent phase B. First stage, active phase C. First stage, transition phase D. Second stage of labor
In stage 1, latent phase, the cervix dilates from 0 to 3 cm, and contraction duration ranges from 30 to 45 seconds.
A nurse is caring for a client who is in labor and experiencing incomplete uterine relaxation between hypertonic contractions. The nurse should identify that this contraction pattern increases the risk for which of the following complications? A. Prolonged labor B. Reduced fetal oxygen supply C. Delayed cervical dilation D. Increased maternal stress
Inadequate uterine relaxation results in reduced oxygen supply to the fetus.
Cervical insufficiency expected findings
Increase in pelvic pressure or urge to push Pink-stained vaginal discharge or bleeding Possible gush of fluid (rupture of membranes) Uterine contractions with the expulsion of the fetus Postoperative (cerclage) monitoring for uterine contractions, rupture of membranes, and signs of infection
Negative CST (NORMAL FINDING)
Indicated if within a 10-min period, with three uterine contractions, there are no late decelerations of the FHR.
Positive CST (ABNORMAL FINDING)
Indicated with persistent and consistent late decelerations with 50% or more of the contractions. This is suggestive of uteroplacental insufficiency. Variable deceleration can indicate cord compression, and early decelerations can indicate fetal head compression. Based on these findings, the provider may determine to induce labor or perform a cesarean birth.
Indomethacin
Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that suppresses preterm labor by blocking the production of prostaglandins. This inhibition of prostaglandins suppresses uterine contractions. Monitor the client closely. Discontinue tocolytic therapy immediately if the client exhibits manifestations of pulmonary edema, which include chest pain, shortness of breath, respiratory distress, audible wheezing and crackles, and a productive cough containing blood-tinged sputum. Indomethacin treatment should not exceed 48 hr. Indomethacin should only be used if gestational age is less than 32 weeks of gestation. Monitor for postpartum hemorrhage related to reduced platelet aggregation.
Prenatal care dramatically reduces
Infant and maternal morbidity and mortality rates my early detection and treatment of potential problems
A major risk of PROM and PPROM for the client and the fetus is
Infection
Gate control theory of pain
Based on the concept that the sensory nerve pathways that pain sensations use to travel to the brain will allow only a limited number of sensations to travel at any given time. By sending alternate signals through these pathways, the pain signals can be blocked from ascending the neurological pathway and inhibit the brain's perception and sensation of pain.
Radiation
Loss of heat from the body surface to a cooler solid surface that is close to, but not in direct contact. Keep the newborn and examining tables away from windows and air conditioners. Bathing can begin once the newborn's temperature has stabilized to at least 36.5° C (97.7° F). A complete sponge bath should be given within the first 1 to 2 hr after birth under a radiant heat source to prevent heat loss. If necessary, the first bath will be postponed until thermoregulation stabilizes.
preparation for pregnancy and birth during the second trimester
Benefits of breastfeeding, Common discomforts and relief measures, Lifestyle: sex and pregnancy, rest and relaxation, posture, body mechanics, clothing, seat belt safety and travel, Fetal movement, Complications (preterm labor, gestational hypertension, gestational diabetes mellitus, premature rupture of membranes) Preparation for childbirth and childbirth education classes, Review of birthing methods, Development of a birth plan (verbal or written agreement about what client wishes during labor and delivery)
A nurse in labor and delivery is providing care for a client who is in preterm labor at 32 weeks of gestation. Which of the following medications should the nurse anticipate the provider will prescribe to hasten fetal lung maturity? A. Calcium gluconate B. Indomethacin C. Nifedipine D. Betamethasone
Betamethasone is a glucocorticoid given to clients in preterm labor to hasten surfactant production.
A nurse is providing care for a client who is at 32 weeks of gestation and who has a placenta previa. The nurse notes that the client is actively bleeding. Which of the following types of medications should the nurse anticipate the provider will prescribe? A. Betamethasone B. Indomethacin C. Nifedipine D. Methylergonovine
Betamethasone is given to promote lung maturity if delivery is anticipated.
Surgical sterilization for females
Bilateral tubal ligation a surgical procedure consisting of several rooms and or burning or blocking the fallopian tube's to prevent fertilization this is permanent considered irreversible
Musculoskeletal system when pregnant
Body alterations and weight increase necessitate an Adjustment in posture pelvic joints relax
Postmature
Born after the completion of 42 weeks of gestation with evidence of placental insufficiency.
A nurse is reviewing formula preparation with parents who plan to bottle‑feed their newborn. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Use a disinfectant wipe to clean the lid of the formula can. B. Store prepared formula in the refrigerator for up to 72 hr. C. Place used bottles in the dishwasher. D. Check the nipple for appropriate flow of formula. E. Use tap water to dilute concentrated formula.
Bottles can be placed in a dishwasher or washed by hand in hot soapy water using a good bottle brush. The flow of formula from the nipple should be checked to determine that it is not too fast or too slow. Tap water is used to mix concentrated or powder formula. If the water is from a questionable source, it should be boiled first.
Lochia rubra
Bright red color, bloody consistency, fleshy odor, can contain small clots, transient flow increases during breastfeeding and upon rising. Lasts 1 to 3 days after delivery.
Ceftriaxone IM and azithromycin PO used for gonorrhea
Broad‑spectrum antibiotic; bactericidal action
Equipment for newborn assessment
Bulb syringe, Stethoscope with a pediatric head, Axillary thermometer, Blood pressure cuff 2.5 cm wide, Scale with protective cover in place, Tape measure in centimeters, Clean gloves
First trimester danger signs
Burning on urination (infection), Severe vomiting (hyperemesis gravidarum), Fever or chills (infection), Abdominal cramping and/or vaginal bleeding (miscarriage, ectopic pregnancy)
How is the end of the fertile period established
By subtracting 11 days from the number of days of the longest cycle
Surgical intervention (hysterectomy) for
DIC: performed by the provider as indicated
Obtain swab of vaginal secretions for fetal fibronectin between
24 and 34 weeks of gestation. This protein can be found in vaginal secretions and can be related to inflammation of the placenta that can lead to preterm birth. This test is used to determine preterm labor.
A nurse is caring for a client who is in labor. The nurse should identify that which of the following infections can be treated during labor or immediately following birth? (Select all that apply.) A. Gonorrhea B. Chlamydia C. HIV D. Group B streptococcus beta‑hemolytic E. TORCH infection
Erythromycin is administered to the infant immediately following delivery to prevent Neisseria gonorrhoeae. Erythromycin is administered to the infant immediately following delivery to prevent Chlamydia trachomatis. Retrovir is prescribed to a client in labor who is HIV‑positive. Penicillin G or ampicillin may be prescribed to treat positive GBS.
A newborn was not dried completely after birth. Which of the following mechanisms should the nurse understand causes heat loss? A. Conduction B. Convection C. Evaporation D. Radiation
Evaporation is the loss of heat that occurs when a liquid is converted to a vapor. In a newborn, heat loss by evaporation occurs as a result of vaporization of the moisture from the skin
Braxton hicks contractions
False contractions that are painless irregular and usually relieved by walking
Newborn Hearing
Hearing is similar to that of an adult once the amniotic fluid drains from the ears. Newborns exhibit selective listening to familiar voices and rhythms of intrauterine life. The newborn turns toward the general direction of a sound.
Apgar score 2 reveals
Heart rate Greater than 100/min, Respiratory Rate Good cry, muscle tone Well‑flexed, reflex irritability cry, color completely pink
Apgar score 1 reveals
Heart rate Slow, less than 100/min, Respiratory rate Slow, weak cry, muscle tone Some flexion of extremities, reflex irritability Grimace, color Pink body, cyanotic hands and feet (acrocyanosis)
A nurse is teaching a client about the benefits of internal fetal heart monitoring. Which of the following should statements the nurse include in the teaching? (Select all that apply.) A. "It is considered a noninvasive procedure." B. "It can detect abnormal fetal heart tones early." C. "It can determine the amount of amniotic fluid you have." D. "It allows for accurate readings with maternal movement." E. "It can measure uterine contraction intensity."
A benefit of internal fetal monitoring is that it can detect abnormal fetal heart tones early. A benefit of internal fetal monitoring is that it allows for accurate readings with maternal movement which external monitoring needs adjusting when the client moves. A benefit of internal fetal monitoring is that it can measure uterine contraction intensity which external monitoring cannot.
A nurse in an OB clinic is teaching a client about using an IUD for contraception which of the following statements by the client indicates an understanding of the teaching A. And IUD should be replaced annually during a pelvic exam B. I cannot get an IUD until after I've had a child C. I should expect intermittent abdominal pain while the IUD is in place D. A change in the string length of my IUD should be reported
A change in the string length of my IUD should be reported because this can indicate expulsion
IUD intrauterine device
A chemically active T shaped device that is inserted through the cervix and placed in the uterus by the provider releases a chemical substance that damages sperm in transit to the uterine tubes and prevents the fertilization the most effective contraceptive methods of preventing pregnancy are the long-acting reversible contraceptive LARC methods implant and IUDs. IUDs can be used by Nulliparous and multiparous women. The device must be monitored monthly by client after menstruation to ensure the presidents of the small string that hangs from the device into the upper part of the vagina to rule out migration or expulsion of the device there is a copper IUD option that does not use hormones
A nurse in the clinic is caring for a group of female clients who are being evaluated for infertility which of the following clients to the nurse anticipate the provider will refer to a genetic counselor A. A client who sister has alopecia B. A client whose partner has Von Williebrand Disease C. A client who has an allergy to sulfa D. A client who had rubella three months
A client whose partner has von Willebrand disease
A nurse is caring for a client who has a diagnosis of ruptured ectopic pregnancy. Which of the following findings is seen with this condition? A. No alteration in menses B. Transvaginal ultrasound indicating a fetus in the uterus C. Serum progesterone greater than the expected reference range D. Report of severe shoulder pain
A client's report of severe shoulder pain is a finding associated with a ruptured ectopic pregnancy due to the presence of blood in the abdominal cavity, which irritates the diaphragm and phrenic nerve.
Magnesium sulfate
A commonly used tocolytic that relaxes the smooth muscle of the uterus and thus inhibits uterine activity by suppressing contractions. Contraindications for tocolysis include active vaginal bleeding, dilation of the cervix greater than 6 cm, chorioamnionitis, greater than 34 weeks of gestation, and acute fetal distress. Administer calcium gluconate or calcium chloride as an antidote for magnesium sulfate toxicity.
Diaphragm and spermicide
A dome shaped cup with a flexible rim made of silicone that fits snuggly over the cervix with spermicidal cream or gel placed into the dome and around the rim diaphragms are available in different sizes so a fitting is required
A nurse is reviewing the electronic monitor tracing of a client who is in active labor. The nurse should know that a fetus receives more oxygen when which of the following appears on the tracing? A. Peak of the uterine contraction B. Moderate variability C. FHR acceleration D. Relaxation between uterine contractions
A fetus is most oxygenated during the relaxation period between contractions. During contractions, the arteries to the uteroplacental intervillous spaces are compressed, resulting in a decrease in fetal circulation and oxygenation.
Betamethasone
A glucocorticoid that is administered IM in two injections 24 hr apart, and requires 24 hr to be effective. The therapeutic action is to enhance fetal lung maturity and surfactant production in fetuses between 24 to 34 weeks gestation.Administer the medication deep into the gluteal muscle 24 and 48 hr prior to birth of a preterm neonate. Monitor the client and neonate for pulmonary edema by assessing lung sounds. Monitor for maternal and neonate hyperglycemia. Monitor the neonate for heart rate changes.
New Ballard Scale
A newborn maturity rating scale that assesses neuromuscular and physical maturity Each individual assessment parameter displays at least six ranges of development along a continuum. Each range of development within an assessment is assigned a number value from ‑1 to 5. The totals are added to give a maturity rating in weeks gestation (e.g., a score of 35 indicates 38 weeks of gestation).
Doppler ultrasound blood flow analysis
A noninvasive external ultrasound method to study the maternal-fetal blood flow by measuring the velocity at which RBCs travel in the uterine and fetal vessels using a handheld ultrasound device that reflects sound waves from a moving target. It is especially useful in fetal intrauterine growth restriction (IUGR) and poor placental perfusion, and as an adjunct in pregnancies at risk because of hypertension, diabetes mellitus, multiple fetuses, or preterm labor.
A nurse is caring for a client who is admitted to the labor and delivery unit. With the use of Leopold maneuvers, it is noted that the fetus is in a breech presentation. For which of the following possible complications should the nurse observe? A. Precipitous labor B. Premature rupture of membranes C. Postmaturity syndrome D. Prolapsed umbilical cord
A prolapsed umbilical cord is a potential complication for a fetus in a breech presentation
A nurse is caring for a client who is in the second stage of labor. The client's labor has been progressing, and she is expected to deliver vaginally in 20 min. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that which of the following types of regional anesthetic block is to be administered? A. Pudendal B. Epidural C. Spinal D. Paracervical
A pudendal block is a transvaginal injection of local anesthetic that anesthetizes the perineal area for the episiotomy and repair, and the expulsion of the fetus.
A nurse is caring for a client who is postpartum. The nurse should identify which of the following findings as an early indicator of hypovolemia caused by hemorrhage? A. Increasing pulse and decreasing blood pressure B. Dizziness and increasing respiratory rate C. Cool, clammy skin, and pale mucous membranes D. Altered mental status and level of consciousness
A rising pulse rate and decreasing blood pressure are often the first indications of inadequate blood volume.
A nurse is completing postpartum discharge teaching to a client who had no immunity to varicella and was given varicella vaccine. Which of the following statements by the client indicates understanding of the teaching? A. "I will need to use contraception for 3 months before considering pregnancy." B. "I need a second vaccination at my postpartum visit." C. "I was given the vaccine because my baby is O-positive." D. "I will be tested in 3 months to see if I have developed immunity
A second varicella immunization is needed at 4 to 8 weeks following delivery by clients who had no history of immunity
A nurse is caring for a client who is 1 hr postpartum following a vaginal birth and experiencing uncontrollable shaking. The nurse should understand that the shaking is due to which of the following factors? (Select all that apply.) A. Change in body fluids B. Metabolic effort of labor C. Diaphoresis D. Decrease in body temperature
A shift in body fluids during the first 2 hr puerperium can cause a postpartum chill. The work of labor can cause a postpartum chill during the first 2 hr puerperium.
A nurse is providing discharge instructions for a client. At 4 weeks postpartum, the client should contact her provider for which of the following client findings? A. Scant, nonodorous white vaginal discharge B. Uterine cramping during breastfeeding C. Sore nipple with cracks and fissures D. Decreased response with sexual activity
A sore nipple that has cracks and fissures is an indication of mastitis.
A nurse is caring for a client who is in preterm labor and is scheduled to undergo an amniocentesis. The nurse should evaluate which of the following tests to assess fetal lung maturity? A. Alpha-fetoprotein (AFP) B. Lecithin/sphingomyelin (L/S) ratio C. Kleihauer-Betke test D. Indirect Coombs' test
A test of the L/S ratio is done as a part of an amniocentesis to determine fetal lung maturity.
Male condom
A thin rubber sheath a man wears on his penis during sexual intercourse As a contraceptive or as protection against infection male condoms can be made of latex rubber polyurethane or natural membrane condom should be placed on an erect penis leaving an empty space at the tip for sperm reservoir
A nurse in a health clinic is reviewing contraceptive use with a group of adolescent clients which of the following statements by that I don't listen reflects an understanding of the teaching A. A water-soluble lubricant should be used with condoms B. A diaphragm should be removed two hours after intercourse C. Oral contraceptives can worsen a case of acne D. A contraceptive patch is replaced once a month
A water-soluble lubricant should be used with condoms
Surrogate mother
A woman is inseminated with semen and carries the fetus until birth
Multigravida:
A woman who has had two or more pregnancies
Collecting newborn blood samples
Heel stick blood samples are obtained by the nurse, who dons clean gloves. Warm the newborn's heel first to increase circulation. Cleanse the area with an appropriate antiseptic, and allow for drying. A spring‑activated lancet is used so that the skin incision is made quickly and painlessly. The outer aspect of the heel should be used, and the lancet should go no deeper than 2.4 mm to prevent necrotizing osteochondritis resulting from penetration of bone with the lancet. Apply pressure with dry gauze (do not use alcohol because it will cause bleeding to continue) until bleeding stops, and cover with an adhesive bandage. Cuddle and comfort the newborn when the procedure is completed to reassure the newborn and promote feelings of safety.
Tape measure in centimeters used in a newborn assessment
Measure from crown to heel of foot for length. Measure head circumference at greatest diameter (occipital to frontal). Measure chest circumference beginning at the nipple line, and abdominal circumference above the umbilicus.
Station
Measurement of fetal descent in centimeters with station 0 being at the level of an imaginary line at the level of the ischial spines, minus stations superior to the ischial spines, and plus stations inferior to the ischial spines.
Decrease or loss of irregular fluctuations in the baseline of the FHRCauses/complications:
Medications that depress the CNS, such as narcotics, barbiturates, tranquilizers, or general anesthetics, Fetal hypoxemia and metabolic acidemia, Fetal sleep cycle (minimal variability sleep cycles usually do not last longer than 30 min), Congenital abnormalities.
Injectable Progrstins
Medroxyprogesterone is an intramuscular or subcutaneous injection given to a female client every 11 to 13 weeks start of injection should be during the first five days of a clients menstrual cycle and every 11 to 13 weeks thereafter maintain adequate intake of calcium and vitamin Dreturn to fertility can be delayed as long as up to 18 months after discontinuation should only be used as long-term method of birth control more than two years if other birth-control methods are in adequate
Disadvantages of Continuous internal fetal monitoring
Membranes must have ruptured to use internal monitoring. Cervix must be adequately dilated to a minimum of 2 to 3 cm. Presenting part must have descended to place electrode. Potential risk of injury to fetus if electrode is not properly applied. A provider, nurse practitioner/midwife, or specially trained registered nurse must perform this procedure. Potential risk of infection to the client and the fetus.
Mastitis risk factors
Milk stasis from a blocked duct Nipple trauma and cracked or fissured nipples Poor breastfeeding technique with improper latching of the infant onto the breast, which can lead to sore and cracked nipples Decrease in breastfeeding frequency due to supplementation with bottle feeding Poor hygiene and inadequate handwashing when handling perineal pads and touching the breasts
A nurse is teaching a newly licensed nurse how to bathe a newborn and observes a bluish marking across the newborn's lower back. The nurse should include which of the following information in the teaching? A. "This is frequently seen in newborns who have dark skin." B. "This is a finding indicating hyperbilirubinemia." C. "This is a forceps mark from an operative delivery." D. "This is related to prolonged birth or trauma during delivery."
Mongolian spots are commonly found over the lumbosacral area of newborns who have dark skin and are of African American, Asian, or Native American origin.
A nurse is caring for a client who is at 42 weeks of gestation and is admitted to the labor and delivery unit. During an ultrasound, it is noted that the fetus is large for gestational age. The nurse reviews the prescription from the provider to begin an amnioinfusion. Which of the following conditions should the nurse plan to prepare an amnioinfusion? (Select all that apply.) A. Oligohydramnios B. Hydramnios C. Fetal cord compression D. Hydration E. Fetal immaturity
Oligohydramnios is an indication for an amnioinfusion because inadequate amniotic fluid can contribute to intrauterine growth restriction of the fetus, restrict fetal movement, and cause fetal distress during labor. Oligohydramnios results in fetal cord compression, which decreases fetal oxygenation. Amnioinfusion prevents cord compression.
A nurse is preparing to administer prophylactic eye ointment to a newborn to prevent ophthalmia neonatorum. Which of the following medications should the nurse anticipate administering? A. Ofloxacin B. Nystatin C. Erythromycin D. Ceftriaxone
One medication of choice for ophthalmia neonatorum is erythromycin ophthalmic ointment 0.5%. This antibiotic provides prophylaxis against Neisseria gonorrhoeae and Chlamydia trachomatis.
Opioid analgesics
Opioid analgesics such as meperidine hydrochloride, fentanyl, butorphanol, and nalbuphine act in the CNS to decrease the perception of pain without the loss of consciousness. The client can receive opioid analgesics IM or IV, but the IV route is recommended during labor because the action is quicker. These are usually given during the early part of active labor.
Progestin-Only Pills (Minipills)
Oral Progestins that provide the same action of combined oral contraceptives. Must take pill at the same time every day has fewer adverse effects when compared with a combined oral contraceptive safe to take while breast-feeding
A nurse is reviewing a new prescription for iron supplements with a client who is in the 8th week of gestation and has iron deficiency anemia. Which of the following beverages should the nurse instruct the client to take the iron supplements with? A. Ice water B. Low-fat or whole milk C. Tea or coffee D. Orange juice
Orange juice contains vitamin C, which aids in the absorption of iron.
Hysterosalpingography
Outpatient radiological procedure in which dyes used to assess the patency of the fallopian tube's assess for history of allergies to iodine and seafood prior to beginning the procedure
Medical therapy for infertility
Ovarian stimulation medications are prescribed to stimulate the ovary to produce follicles medications given are clomiphene letrozole. Other medication used to support ovulation is metformin
Ectopic Pregnancy
Ovum implants in the fallopian tube's or abdominal cavity due to the presence of endometrial tissue as the open increases in size fallopian tube can rupture and extensive bleeding occurs resulting in surgical removal of the damage tube if ectopic pregnancy is identified prior to rupture of the two surgical removal of the products of conception maybe performed or methotrexate is prescribed to dissolve the pregnancy. Client faces a Increased risk of reoccurrence of an ectopic pregnancy and infertility
A nurse is caring for a client who is receiving oxytocin for induction of labor and has an intrauterine pressure catheter (IUPC) placed to monitor uterine contractions. For which of the following contraction patterns should the nurse discontinue the infusion of oxytocin? A. Frequency of every 2 min B. Duration of 90 to 120 seconds C. Intensity of 60 to 90 mm Hg D. Resting tone of 15 mm Hg
Oxytocin is discontinued if uterine hyperstimulation occurs with contraction duration longer than 90 seconds.
Causes of bleeding during pregnancy - Third Trimester
PLACENTA PREVIA: Painless vaginal bleeding ABRUPTIO PLACENTAE: Vaginal bleeding, sharp abdominal pain, and tender rigid uterus VASA PREVIA: Fetal vessels are implanted into the membranes rather than the placenta.
Expected hematoma findings
Pain Pressure sensation in rectum (urge to defecate) or vagina Difficulty voidingBulging, bluish mass or area of red‑purple discoloration on vulva, perineum, or rectum
Second stage of labor pain is
Pain that is somatic and occurs with fetal descent and expulsion. This pain is caused by Pressure and distention of the vagina and the perineum, described by the client as "burning," "splitting," and "tearing" Pressure and pulling on the pelvic structures (ligaments, fallopian tubes, ovaries, bladder, and peritoneum) Lacerations of soft tissues (cervix, vagina, and perineum)
Third stage of labor pain is
Pain with the expulsion of the placenta is similar to the pain experienced during the first stage. This pain is caused by Uterine contractions Pressure and pulling of pelvic structures
Endometritis expected findings
Pelvic pain, Chills, Fatigue, Loss of appetiteUterine tenderness and enlargement, Dark, profuse lochia, Lochia that is either malodorous or purulent, Temperature greater than 38° C (100.4° F), typically on the third to fourth postpartum day, Tachycardia
A nurse is completing an assessment. Which of the following data indicate the newborn is adapting to extrauterine life? (Select all that apply.) A. Expiratory grunting B. Inspiratory nasal flaring C. Apnea for 10‑second periods D. Obligatory nose breathing E. Crackles and wheezing
Periods of apnea lasting less than 15 seconds are an expected finding. Newborns are obligatory nose breathers.
A nurse is caring for a newborn immediately following a circumcision using a Gomco procedure. Which of the following actions should the nurse implement? A. Apply Gelfoam powder to the site. B. Place the newborn in the prone position. C. Apply petroleum gauze to the site. D. Avoid changing the diaper until the first voiding.
Petroleum gauze is applied to the site for 24 hr to prevent the skin edges from sticking to the diaper.
A nurse is reviewing postpartum nutrition needs with a group of new mothers who are breastfeeding their newborns. Which of the following statements by a member of the group indicates an understanding of the teaching? A. "I am glad I can have my morning coffee." B. "I should take folic acid to increase my milk supply." C. "I will continue adding 330 calories per day to my diet." D. "I will continue my calcium supplements because I don't like milk."
Postpartum women who are at risk for inadequate dietary calcium should continue taking calcium supplements during lactation.
New ballard scale neuromuscular maturity
Posture ranging from fully extended to fully flexed (0 to 4). Square window formation with the neonate's wrist (‑1 to 4). Arm recoil, where the neonate's arm is passively extended and spontaneously returns to flexion (0 to 4). Popliteal angle, which is the degree of the angle to which the newborn's knees can extend (‑1 to 5). Scarf sign, which is crossing the neonate's arm over the chest (‑1 to 4). Heel to ear, which is how far the neonate's heels reach to her ears (‑1 to 4).
Azithromycin or amoxicillin
Prescribed during pregnancy, Broad‑spectrum antibiotic, Bactericidal action, Administer erythromycin to all infants following delivery. This is the medication of choice for ophthalmia neonatorum. This antibiotic is both bacteriostatic and bactericidal, and thus provides prophylaxis against Neisseria gonorrhoeae and Chlamydia trachomatis.
A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? (Select all that apply.) A. Respirations less than 12/min B. Urinary output less than 30 mL/hr C. Hyperreflexic deep‑tendon reflexes D. Decreased level of consciousness E. Flushing and sweating
Respirations less than 12/min, Urinary output less than 30 mL/hr, Decreased level of consciousness
A nurse in labor and delivery unit is completing an admission assessment for a client who is at 39 weeks of gestation. The client reports that she has been leaking fluid from her vagina for 2 days. Which of the following conditions is the client at risk for developing? A. Cord prolapse B. Infection C. Postpartum hemorrhage D. Hydramnios
Rupture of membranes for longer than 24 hr prior to delivery increases the risk that infectious organisms will enter the vagina and then eventually into the uterus.
Trichomoniasis is a
STI caused by the protozoan parasite Trichomonas vaginalis. It can be spread penis‑to‑vagina or vagina‑to‑vagina. If trichomoniasis is left untreated in women, it can lead to PID, which can cause infertility. All women who have clinical findings should be tested. Pregnant women who have trichomoniasis are more likely to have preterm delivery and babies with low birth weight (less than 5.5 lb).
A nurse is caring for a client who is in active labor. The client reports lower-back pain. The nurse suspects that this pain is related to a persistent occiput posterior fetal position. Which of the following nonpharmacological nursing interventions should the nurse recommend to the client? A. Abdominal effleurage B. Sacral counterpressure C. Showering if not contraindicated D. Back rub and massage
Sacral counterpressure to the lower back relieves the pressure exerted on the pelvis and spinal nerves by the fetus.
Lochia amount is assessed by the quantity of saturation on the perineal pad as being
Scant: less than 2.5 cm, Light: 2.5 to 10 cm, Moderate: more than 10 cm, Heavy: one pad saturated within 2 hr, Excessive blood loss: one pad saturated in 15 min or less, or pooling of blood under buttocks
Active Phase
Second phase of the first stage of labor from 4cm to 7cm dilated. Contractions More regular, moderate to strong Frequency: 3 to 5 min Duration: 40 to 70 seconds. Rapid dilation and effacement Some fetal descent Feelings of helplessness Anxiety and restlessness increase as contractions become stronger. Can last for a primigravida 3hr and for a multigravida 2hr
Sedatives (barbiturates)
Sedatives such as secobarbital pentobarbital and phenobarbital are not typically used during birth, but they can be used during the early or latent phase of labor to relieve anxiety and induce sleep
Expected laceration findings
Sensation of oozing or trickling of blood Excessive rubra lochia (with or without clots) Vaginal bleeding even though the uterus is firm and contracted Continuous slow trickle of bright red blood from vagina, laceration, episiotomy
External electronic monitoring (tocotransducer)
Separate transducer applied to the maternal abdomen over the fundus that measures uterine activity Displays uterine contraction patterns Easily applied by the nurse but must be repositioned with maternal movement to ensure proper placement
Category III of the three tier system fetal heart rate tracings include
Sinusoidal pattern, Absent baseline fetal heart rate variability and any of the following. Recurrent variable decelerations, Recurrent late decelerations, Bradycardia
Newborn Initial external assessment includes
Skin color, peeling, birthmarks, foot creases, breast tissue, nasal patency, and meconium staining (can indicate fetal hypoxia)
New ballard scale Physical Maturity
Skin texture, ranging from sticky and transparent, to leathery, c racked, a nd w rinkled (‑1 to 5). Lanugo presence and amount, ranging from none, sparse, abundant, thinning, bald, or mostly bald (‑1 to 4). Plantar surface creases, ranging from less than 40 mm to creases over the entire sole (‑1 to 4). Breast tissue amount, ranging from imperceptible, to full areola with a 5 to 10 mm bud (‑1 to 4). Eyes and ears for amount of eye opening and ear cartilage present (‑1 to 4). Genitalia development, ranging from flat smooth scrotum to pendulous testes with deep rugae for males (‑1 to 4), and prominent clitoris with flat labia to the labia majora covering the labia minora and clitoris for females (‑1 to 4).
Late deceleration of FHR
Slowing of FHR after contraction has started with return of FHR to baseline well after contraction has ended. causes/complications: Uteroplacental insufficiency causing inadequate fetal oxygenation, Maternal hypotension, placenta previa, abruptio, placentae, uterine hyperstimulation with oxytocin, Preeclampsia, Late- or post-term pregnancy, Maternal diabetes mellitus
Chromosomal abnormalities account for 50% of
Spontaneous abortions
The physiologic change preceding labor - the premonitory sign of Rupture of membranes is
Spontaneous rupture of membranes can initiate labor or can occur anytime during labor, most commonly during the transition phase.
Contraception refers to
Strategies or devices used to reduce the risk of fertilization or implantation in an attempt to prevent pregnancy
Intensity of contractions
Strength of the contraction at its peak, described as mild (slightly tense, like pressing finger to tip of nose), moderate (firm, like pressing finger to chin), or strong (rigid, like pressing finger to forehead)
Striae Gravidarum
Stretch marks most notably found on the abdomen and thighs
Basal body temperature
Temperature can drop slightly at the time of ovulation this can be used to facilitate conception or be used as natural contraceptive
Fetal distress is present when
The FHR is below 110/min or above 160/min. The FHR shows decreased or no variability. There is fetal hyperactivity or no fetal activity.
A nurse is assessing the reflexes of a newborn. In checking for the Moro reflex, the nurse should perform which of the following? A. Hold the newborn vertically under arms and allow one foot to touch table. B. Stimulate the pads of the newborn's hands with stroking or massage. C. Stimulate the soles of the newborn's feet on the outer lateral surface of each foot. D. Hold the newborn in a semi‑sitting position, then allow the newborn's head and trunk to fall backward
The Moro reflex is elicited by holding the newborn in a semi‑sitting position and then allowing the head and trunk to fall backward.
Spinnbarkeit sign
The ability for the cervical mucus to stretch between the fingers
A nurse is caring for a client who is pregnant and undergoing a nonstress test. The client asks why the nurse is using an acoustic vibration device. Which of the following responses should the nurse make? A. "It is used to stimulate uterine contractions." B. "It will decrease the incidence of uterine contractions." C. "It lulls the fetus to sleep." D. "It awakens a sleeping fetus."
The acoustic vibration device is activated for 3 seconds on the maternal abdomen over the fetal head to awaken a sleeping fetus.
Mechanism of labor in vertex presentation
The adaptations the fetus makes as it progresses through the birth canal during the birthing process, engagment, descent, flexion, internal rotation, extention, external rotation - restitution, Birth by explusion.
Passageway
The birth canal that is composed of the bony pelvis, cervix, pelvic floor, vagina, and introitus (vaginal opening). The size and shape of the bony pelvis must be adequate to allow the fetus to pass through it. The cervix must dilate and efface in response to contractions and fetal descent.
Incomplete or partial Placenta previa
The cervical os is only partially covered by the placental attachment.
A nurse is performing a fundal assessment for a client who is 2 days postpartum and observes the perineal pad for lochia. She notes the pad to be saturated approximately 12 cm with lochia that is bright red and contains small clots. Which of the following findings should the nurse document? A. Moderate lochia rubra B. Excessive blood loss C. Light lochia rubra D. Scant lochia serosa
The client has moderate lochia rubra containing small clots, which is an expected finding for the second day postpartum.
A nurse is caring for a client who is using patterned breathing during labor. The client reports numbness and tingling of the fingers. Which of the following actions should the nurse take? A. Administer oxygen via nasal cannula at 2 L/min. B. Apply a warm blanket. C. Assist the client to a side-lying position. D. Place an oxygen mask over the client's nose and mouth.
The client is experiencing hyperventilation caused by low serum levels of PCO2. Placing an oxygen mask over the client's nose and mouth or having the client breathe into a paper bag will reduce the intake of oxygen, allowing the PCO2 to rise and alleviate the numbness and tingling.
A nurse is providing care to four clients on the postpartum unit. Which of the following clients is at greatest risk for developing a postpartum infection? A. A client who has an episiotomy that is erythematous and has extended into a third‑degree laceration B. A client who does not wash her hands between perineal care and breastfeeding C. A client who is not breastfeeding and is using measures to suppress lactation D. A client who has a cesarean incision that is well‑approximated with no drainage
The client who does not wash her hands between perineal care and breastfeeding is at an increased risk for developing mastitis. Therefore, she is most at risk for developing a postpartum infection.
A nurse is teaching a client who is pregnant about the amniocentesis procedure. Which of the following statements should the nurse include in the teaching? A. "You will lay on your right side during the procedure." B. "You should not eat anything for 24 hours prior to the procedure." C. "You should empty your bladder prior to the procedure." D. "The test is done to determine gestational age."
The client's bladder should be empty ton avoid an inadvertent puncture during the procedure.
Internal rotation
The fetal occiput ideally rotates to a lateral anterior position as it progresses from the ischial spines to the lower pelvis in a corkscrew motion to pass through the pelvis.
A client experiences a large gush of fluid from her vagina while walking in the hallway of the birthing unit. Which of the following actions should the nurse take first? A. Check the amniotic fluid for meconium. B. Monitor FHR for distress. C. Dry the client and make her comfortable. D. Monitor uterine contractions
The greatest risk to the client and fetus is umbilical cord prolapse, leading to fetal distress following rupture of membranes. The first action by the nurse is to monitor the FHR for clinical findings of distress.
A nurse is caring for a client who is in labor and observes late decelerations on the electronic fetal monitor. Which of the following is the first action the nurse should take? A. Assist the client into the left-lateral position. B. Apply a fetal scalp electrode. C. Insert an IV catheter. D. Perform a vaginal exam.
The greatest risk to the fetus during late decelerations is uteroplacental insufficiency. The initial nursing action should be to place the client into the leftlateral position to increase uteroplacental perfusion.
A nurse is caring for a newborn immediately following birth. Which of the following nursing interventions is the highest priority? A. Initiating breastfeeding B. Performing the initial bath C. Giving a vitamin K injection D. Covering the newborn's head with a cap
The greatest risk to the newborn is cold stress. Therefore the highest priority intervention is to prevent heat loss. Covering the newborn's head with a cap prevents cold stress due to excessive evaporative heat loss
Transcervical Sterilization
The insertion of smalls flexible agents through the vagina and cervix into the fallopian tube's this results in the development of scar tissue in the tubes preventing conception examination must be done after three months to ensure fallopian tube's are blocked not reversible
A nursecaring for a couple who is being evaluated for infertility which of the following statements by the nurse indicates understanding of the infertility assessment process A. You will need to see a genetic counselor as a part of the assessment B. It is usually the woman who is having trouble so the man doesn't have to be involved C. The man is the easiest to assess and the provider will usually begin there D. Think about adopting first because there are many babies that need good homes
The man is the easiest to assess and the provider will usually begin there
Emergency oral contraceptive
The morning after pill that prevents fertilization from taking place pill is taken within 72 hours after unprotected coitus. This is not to be taken on a regular basisContra indicated if a client is pregnant or has undiagnosed abnormal vaginal bleeding
First period of reactivity
The newborn is alert, exhibits exploring activity, makes sucking sounds, and has a rapid heart rate and respiratory rate. Heart rate can be as high as 160 to 180/min, but will stabilize at a baseline of 100 to 120/min during a period that lasts 30 min after birth.
A nurse is reviewing car seat safety with the parents of a newborn. Which of the following instructions should the nurse include in the teaching regarding car seat position? A. Front seat, rear‑facing B. Front seat, forward‑facing C. Back seat, rear‑facing D. Back seat, forward‑facing
The newborn should be restrained in a car seat in a rear‑facing position in the back seat until 2 years of age.
Period of relative inactivity
The newborn will become quiet and begin to rest and sleep. The heart rate and respirations will decrease, and this period will last from 60 to 100 min after birth.
A nurse is teaching a group of new parents about proper techniques for bottle feeding. Which of the following instructions should the nurse provide? A. Burp the newborn at the end of the feeding. B. Hold the newborn close in a supine position. C. Keep the nipple full of formula throughout the feeding. D. Refrigerate any unused formula.
The nipple should always be kept full of formula to prevent the newborn from sucking in air during the feeding
A nurse is providing discharge teaching for a nonlactating client. Which of the following instructions should the nurse include in the teaching? A. "Wear a supportive bra continuously for the first 72 hours." B. "Pump your breast every 4 hours to relieve discomfort." C. "Use breast shells throughout the day to decrease milk supply." D. "Apply warm compresses until milk suppression occurs."
The nurse should instruct the client to wear a well‑fitting support bra continuously for the first 72 hr.
A nurse on the postpartum unit is planning care for a client who has thrombophlebitis. Which of the following nursing interventions should the nurse include in the plan of care? A. Apply cold compresses to the affected extremity. B. Massage the affected extremity. C. Allow the client to ambulate. D. Measure leg circumferences.
The nurse should plan to measure the circumference of the leg to assess for changes in the client's condition.
A client in the early postpartum period is very excited and talkative. She is repeatedly telling the nurse every detail of her labor and birth. Because the client will not stop talking, the nurse is having difficulty completing the postpartum assessments. Which of the following action should the nurse take? A. Come back later when the client is more cooperative. B. Give the client time to express her feelings. C. Tell the client she needs to be quiet so the assessment can be completed. D. Redirect the client's focus so that she will become quiet.
The nurse should recognize that the client in is the taking‑in phase, which begins immediately following birth and lasts a few hours to a couple of days.
A nurse in the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states she missed one menstrual cycle and cannot be pregnant because she has an intrauterine device. The nurse should suspect which of the following? A. Missed abortion B. Ectopic pregnancy C. Severe preeclampsia D. Hydatidiform mole
Manifestations of an ectopic pregnancy include unilateral lower quadrant pain with or without bleeding. Use of an IUD is a risk factor associated with this condition.
A nurse is caring for a client following the administration of an epidural block and is preparing to administer an IV fluid bolus. The client's partner asks about the purpose of the IV fluids. Which of the following is an appropriate response for the nurse to make? A. "It is needed to promote increased urine output." B. "It is needed to counteract respiratory depression." C. "It is needed to counteract hypotension." D. "It is needed to prevent oligohydramnios."
Maternal hypotension can occur following an epidural block and can be offset by administering an IV fluid bolus.
Respiratory system while pregnant
Maternal oxygen needs increased during the last trimester the size of the chest my enlarge allowing for Lung in expansion as the uterus pushes upward respiratory rate increases and total lung capacity decreases
Psychological response
Maternal stress, tension, and anxiety can produce physiological changes that impair the progress of labor
Genetic counseling
Maybe recommended by the provider if there's a family history of birth defects or the client has sickle cell trait or sickle cell anemia or is older than 35
A nurse is providing care for a client who is in active labor. Her cervix is dilated to 5 cm, and her membranes are intact. Based on the use of external electronic fetal monitoring, the nurse notes a FHR of 115 to 125/min with occasional increases up to 150 to 155/min that last for 25 seconds, and have beat‑to‑beat variability of 20/min. There is no slowing of FHR from the baseline. The nurse should recognize that this client is exhibiting signs of which of the following? (Select all that apply.) A. Moderate variability B. FHR accelerations C. FHR decelerations D. Normal baseline FHR E. Fetal tachycardia
There is moderate variability of 20/ min (6 to 25/min is expected reference range). FHR accelerations are present with increases up to 150 to 155/min lasting for 25 seconds. There is a normal baseline FHR of 115 to 125/min falls within the expected reference range of 110 to 160/min.
Candidiasis expected finding
Thick, creamy, white, cottage cheese‑like vaginal‑discharge
Transition Phase
Third phase of the first stage of labor from 8cm to 10 cm dilated, Contractions Strong to very strong, Frequency: 2 to 3 min, Duration: 45 to 90 seconds, complete dilated is achieved. Tired, restless, and irritable Feeling out of control, client often states, "cannot continue" Can have nausea and vomiting Urge to push Increased rectal pressure and feelings of needing to have a bowel movement Increased bloody show Most difficult part of labor. can last 20 to 40 min
A nurse is caring for a client who is 1 day postpartum. The nurse is assessing for maternal adaptation and mother‑infant bonding. Which of the following behaviors by the client indicates a need for the nurse to intervene? (Select all that apply.) A. Demonstrates apathy when the infant cries B. Touches the infant and maintains close physical proximity C. Views the infant's behavior as uncooperative during diaper changing D. Identifies and relates infant's characteristics to those of family members E. Interprets the infant's behavior as meaningful and a way of expressing needs
This behavior demonstrates a lack of interest in the infant and impaired maternal‑infant bonding. A client's view of her infant as being uncooperative during diaper changing is a sign of impaired maternal‑infant bonding.
A nurse is caring for a newborn who was born at 38 weeks of gestation, weighs 3,200 g, and is in the 60th percentile for weight. Based on the weight and gestational age, the nurse should classify this neonate as which of the following? A. Low birth weight B. Appropriate for gestational age C. Small for gestational age D. Large for gestational age
This newborn is classified as appropriate for gestational age because the weight is between the 10th and 90th percentile.
Terbutaline used for uterus inversion
Tocolytic, To relax the uterus prior to the provider's attempt at replacement of the uterus into the uterine cavity and uterus repositioning, Avoid aggressive fundal massage.
Resting tone of uterine contractions
Tone of the uterine muscle in between contractions. A prolonged contraction duration (greater than 90 seconds) or too frequent contractions (more than five in a 10-min period) without sufficient time for uterine relaxation (less than 30 seconds) in between can reduce blood flow to the placenta. This can result in fetal hypoxia and decreased FHR.
Variable deceleration of FHR
Transitory, abrupt slowing of FHR less than 110/min, variable in duration, intensity, and timing in relation to uterine contraction). Causes/complications: Umbilical cord compression, Short cord, Prolapsed cord, Nuchal cord (around fetal neck)
A nurse in the labor and delivery unit receives a phone call from a client who reports that her contractions started about 2 hr ago, did not go away when she had two glasses of water and rested, and became stronger since she started walking. Her contractions occur every 10 min and last about 30 seconds. She hasn't had any fluid leak from her vagina. However, she saw some blood when she wiped after voiding. Based on this report, which of the following clinical findings should the nurse recognize that the client is experiencing? A. Braxton Hicks contractions B. Rupture of membranes C. Fetal descent D. True contractions
True contractions do not go away with hydration or walking. They are regular in frequency, duration, and intensity and become stronger with walking.
A majority of birth defects occur between
Two and eight weeks gestation
A nurse is caring for a client who reports indications of preterm labor. Which of the following findings are risk factors of this condition? (Select all that apply). A. Urinary tract infection B. Multifetal pregnancy C. Oligohydramnios D. Diabetes mellitus E. Uterine abnormalities
Urinary tract infection, Multifetal pregnancy, Diabetes mellitus, Uterine abnormalities
Papanicolaou (Pap) test
Used as a screening tool for cervical cancer, herpes simplex type 2, and/or human papillomavirus.
Three-hour glucose tolerance (fasting overnight prior to oral ingestion or IV administration of concentrated glucose with a venous sample taken 1, 2, and 3 hr later)
Used in clients who have elevated 1-hr glucose test as a screening tool for diabetes mellitus. A diagnosis of gestational diabetes requires two elevated blood-glucose readings.
Iron dextran
Used in the treatment of iron-deficiency anemia when oral iron supplements cannot be tolerated by the client who is pregnant.
What kind of lubricants should be used with latex condoms to avoid condom breakage
Water-soluble lubricant
Appropriate for gestational age (AGA)
Weight is between the 10th and 90th percentile.
Large for gestational age (LGA)
Weight is greater than the 90th percentile.
Small for gestational age (SGA)
Weight is less than the 10th percentile.
Low birth weight (LBW)
Weight of 2,500 g or less at birth.
Expected newborn initial reference ranges
Weight: 2,500 to 4,000 g (5.5 to 8.8 lb) Length: 45 to 55 cm (18 to 22 in) Head circumference: 32 to 36.8 cm (12.6 to 14.5 in) Chest circumference: 30 to 33 cm (12 to 13 in)
A birth plan consists of
What a clients goals are for the birthing process
Newborn ears
When examining the placement of ears, draw an imaginary line through the inner to the outer canthus of the newborn's eye. The eye should be even with the upper tip of the pinna of the newborn's ear. Ears that are low‑set can indicate a chromosome abnormality, such as Down syndrome, or a kidney disorder. Cartilage should be firm and well formed. Lack of cartilage indicates prematurity. The newborn should respond to voices and other sounds. Inspect ears for skin tags.
Flexion
When the fetal head meets resistance of the cervix, pelvic wall, or pelvic floor. The head flexes, bringing the chin close to the chest, presenting a smaller diameter to pass through the pelvis
A nurse in the clinic received a phone call from a client who believes she is pregnant and would like to be tested in the clinic to go from her pregnancy which of the following information should the nurse provide to the client A. You should wait until four weeks after conception to be tested B. You should be off any medications for 24 hours prior to the test C. You should collect urine from the first morning void D. You should be NPO for at least eight hours prior to the test
You should collect urine from the first morning void
I nurses in the clinic and teaching a client about her new prescription for Medroxyprogesterone which of the following information should the nurse include in the teaching select all that apply A. Weight loss can occur B. You are protected against STIs C. You should increase your intake of calcium D. You should avoid taking antibiotics E. Irregular vaginal spotting can occur
You should increase your intake of calcium because intake of calcium and vitamin D is necessary to prevent loss of bone density which can occur with this medication and irregular vaginal spotting can occur
A nurse is assessing a postpartum client who is exhibiting tearfulness, insomnia, lack of appetite, and a feeling of letdown. Which of the following conditions are associated with these clinical findings? A. Postpartum fatigue B. Postpartum psychosis C. Letting‑go phase D. Postpartum blues
`Postpartum blues are characterized by tearfulness, insomnia, lack of appetite, and feeling let‑down.
Gestational diabetes mellitus (GDM) is
an impaired tolerance to glucose with the first onset or recognition during pregnancy. The ideal blood glucose level during pregnancy should range between 70 and 110 mg/dL. Symptoms of diabetes mellitus can disappear a few weeks following delivery. However, approximately 50% of women will develop Type II diabetes mellitus within 5 years.
Pregnant women should Consume
at least 8 to 10 glasses (2.3 L) of water each day.
Prostaglandins and oxytocin is used when there is bleeding during pregnancy to
augment or induce uterine contractions and expulse the products of conception
Educate the client on taking these precautions when on anticoagulants
avoid taking aspirin or ibuprofen (increases bleeding tendencies).use an electric razor for shaving.avoid alcohol use (inhibits warfarin).brush teeth gently using a soft toothbrush. avoid rubbing or massaging legs. avoid periods of prolonged sitting or crossing legs.
After delivery of the placenta, hormones (estrogen, progesterone, and placental enzyme insulinase)
decrease, thus resulting in decreased blood glucose, estrogen, and progesterone levels.
A Bishop score is used to
determine maternal readiness for labor by evaluating whether the cervix is favorable by rating the following: Cervical dilation, Cervical effacement, Cervical consistency (firm, medium, or soft), Cervical position (posterior, midposition, or anterior), Station of presenting part, The five factors are assigned a numerical value of 0 to 3, and the total score is calculated.
Dystocia, or dysfunctional labor, is a
difficult or abnormal labor related to the five P's of labor (passenger, passageway, powers, position, and psychologic response) Atypical uterine contraction patterns prevent the normal process of labor and its progression. Contractions can be hypotonic (weak, inefficient, or completely absent) or hypertonic (excessively frequent, uncoordinated, and of strong intensity with inadequate uterine relaxation) with failure to efface and dilate the cervix.
Dilation and evacuation (D&E) is used when there is bleeding during pregnancy to
dilate and evacuate uterine contents after 16 weeks of gestation.
Nonreactive NST is a test that
does not demonstrate at least two qualifying accelerations in a 20-min window. If this is so, a further assessment, such as a contraction stress test (CST) or BPP, is indicated.
Cytomegalovirus (member of herpes virus family) is transmitted by
droplet infection from person to person, a virus found in semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and blood latent virus can be reactivated and cause disease to the fetus in utero or during passage through the birth canal.
The three shunts that, functionally close during a newborn's transition to extrauterine life with the flow of oxygenated blood in the lungs and readjustment of atrial blood pressure in the heart are
ductus arteriosus, ductus venosus, and foramen ovale
Hyperemesis gravidarum is
excessive nausea and vomiting (possibly related to elevated hCG levels) that is prolonged past 12 weeks of gestation and results in a 5% weight loss from prepregnancy weight, electrolyte imbalance, acetonuria, and ketosis.There is a risk to the fetus for intrauterine growth restriction or preterm birth if the condition persists
Moro reflex
expected finding Elicit by allowing the head and trunk of the newborn in a semisitting position to fall backward to an angle of at least 30°. The newborn will symmetrically extend and then abduct the arms at the elbows and fingers spread to form a "C." expected age birth to 6 months
Stepping
expected finding Elicit by holding the newborn upright with feet touching a flat surface. The newborn responds with stepping movements. expected age birth to 4 weeks
Plantar grasp
expected finding Elicit by placing examiner's finger at base of newborn's toes. The newborn responds by curling toes downward. expected age birth to 8 months
Tonic neck reflex (fencer position)
expected finding With newborn in supine, neutral position, examiner turns newborn's head quickly to one side. The newborn's arm and leg on that side extend and opposing arm and leg flex. expected age birth to 3 to 4 months
Chlamydia is a
bacterial infection caused by Chlamydia trachomatis and is the most commonly reported STI in American women. Chlamydia can be difficult to diagnose because it is often asymptomatic. If chlamydia is left untreated in women, it can lead to pelvic inflammatory disease (PID), which can cause infertility.
Recommended weight gain during pregnancy
based on a single pregnancy, is usually 11.3 to 15.9 kg (25 to 35 lb). The general rule is that clients should gain 1 to 2 kg (2.2 to 4.4 lb) during the first trimester and after that approximately 0.4 kg (1 lb) per week for the last two trimesters. Underweight women are advised to gain 28 to 40 lb; overweight women, 15 to 25 lb.
Decreased estrogen After delivery of the placenta is associated with
breast engorgement, diaphoresis (profuse perspiration), and diuresis (increased formation and excretion of urine) of excess extracellular fluid accumulated during pregnancy. It diminishes vaginal lubrication. Local dryness and intercourse discomfort can persist until ovarian function returns and menstruation resumes.
Cervical ripening by various methods increases
cervical readiness for labor through promotion of cervical softening, dilation, and effacement it can eliminate the need for oxytocin administration to induce labor, lower the dosage of oxytocin needed and promote a more successful induction.
Hypertensive disease in pregnancy is divided into
clinical subsets of the disease based on end-organ effects and progresses along a continuum from mild gestational hypertension; mild and severe preeclampsia; eclampsia; and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.
Idiopathic thrombocytopenic purpura (ITP) is a
coagulopathy that is an autoimmune disorder in which the life span of platelets is decreased by antiplatelet antibodies. This can result in severe hemorrhage following a cesarean birth or lacerations. genetic in origin
A hematoma is a
collection of 250 to 500 mL of clotted blood within tissues that can appear as a bulging bluish mass. Hematomas can occur in the pelvic region or higher in the vagina or broad ligament
Severe preeclampsia
consists of blood pressure that is 160/110 mm Hg or greater, proteinuria greater than 3+, oliguria, elevated serum creatinine greater than 1.1 mg/dL, cerebral or visual disturbances (headache and blurred vision), hyperreflexia with possible ankle clonus, pulmonary or cardiac involvement, extensive peripheral edema, hepatic dysfunction, epigastric and right upper‑quadrant pain, and thrombocytopenia.
Toxoplasmosis is caused by
consumption of raw or undercooked meat or handling cat feces. Manifestations are similar to influenza or lymphadenopathy.
Rubella (German measles) is
contracted through children who have rashes or neonates who are born to women who had rubella during pregnancy
Physical changes of the uterus include involution of the uterus. Involution occurs with
contractions of the uterine smooth muscle, whereby the uterus returns to its prepregnant state. The uterus also rapidly decreases in size from approximately 1 kg (2.2 lb) to 60 to 80 g at 6 weeks with the fundal height steadily descending into the pelvis approximately one fingerbreadth (1 cm) per day.
False labor
contractions, Painless, irregular frequency, and intermittent, Decrease in frequency, duration, and intensity, with walking or position changes, Felt in lower back or abdomen above umbilicus, Often stop with sleep or comfort measures such as oral hydration or emptying of the bladder cervix (assessed by vaginal exam) No significant change in dilation or effacement Often remains in posterior position No significant bloody show fetus: Presenting part is not engaged in pelvis
Nevus flammeus (port wine stain)
is a capillary angioma below the surface of the skin that is purple or red, varies in size and shape, is commonly seen on the face, and does not blanch or disappear.
Cephalohematoma
is a collection of blood between the periosteum and the skull bone that it covers. It does not cross the suture line. It results from trauma during birth such as pressure of the fetal head against the maternal pelvis in a prolonged difficult labor or forceps delivery. It appears in the first 1 to 2 days after birth and resolves in 2 to 3 weeks.
home uterine activity monitoring (HUAM)
is a uterine contraction monitor that can be used by the client at home. HUAM is not considered to be effective in preventing preterm labor.
Chorionic villus sampling (CVS)
is assessment of a portion of the developing placenta (chorionic villi), which is aspirated through a thin sterile catheter or syringe inserted through the abdominal wall or intravaginally through the cervix under ultrasound guidance. CVS is a first-trimester alternative to amniocentesis with one of its advantages being an earlier diagnosis of any abnormalities. CVS is ideally performed at 10 to 13 weeks of gestation.
Salpingostomy for ectopic pregnancies
is done to salvage the fallopian tube if not ruptured.
A hypotonic uterus
is easily indentable, even at peak of contractions.
Preterm premature rupture of membranes (PPROM)
is the premature spontaneous rupture of membranes after 20 weeks of gestation and prior to 37 weeks of gestation.
Premature rupture of membranes (PROM)
is the spontaneous rupture of the amniotic membranes 1 hr or more prior to the onset of true labor. For most women, PROM signifies the onset of true labor if gestational duration is at term.
Prophylactic cervical cerclage
is the surgical reinforcement of the cervix with a heavy ligature that is placed submucosally around the cervix to strengthen it and prevent premature cervical dilation. Best results occur if this is done at 12 to 14 weeks of gestation. The cerclage is removed at 37 weeks of gestation or when spontaneous labor occurs.
Inversion of the uterus
is the turning inside out of the uterus and can be partial or complete. Uterine inversion is an emergency situation that can result in postpartum hemorrhage and requires immediate intervention
If BV is left untreated
it can increase a woman's chances of developing PID, which can lead to infertility. All women who have manifestations should be tested.Treatment is especially important for pregnant women. BV is associated with preterm labor and babies with low birth weight (less than 5.5 lb).
Gonorrhea is a bacterial infection that is
primarily spread by genital‑to‑genital contact. However, it also can be spread by 012anal‑to‑genital or oral‑to‑genital contact. It can also be transmitted to a newborn during delivery. With gonorrhea Women are frequently asymptomatic. If gonorrhea is left untreated in women, it can lead to PID, which can cause infertility.
Maternal serum alpha-fetoprotein (MSAFP)
screening occurs between 15 to 22 weeks of gestation. Used to rule out Down syndrome (low level) and neural tube defects (high level). The provider might decide to use a more reliable indicator and opt for the Quad screen instead of the MSAFP at 16 to 18 weeks of gestation. This includes AFP, inhibin-A, a combination analysis of human chorionic gonadotropin, and estriol.
Nonstress test (NST) is
the most widely used technique for antepartum evaluation of fetal well-being performed during the third trimester. It is a noninvasive procedure that monitors response of the FHR to fetal movement.
Subinvolution is when
the uterus remains enlarged with continued lochial discharge and can result in postpartum hemorrhage.
Inform the parents that newborns cry when
they are hungry, overstimulated, wet, cold, hot, tired, bored, or need to be burped. Assure the mother that, in time, she will learn what her newborn's cry means. Instruct the mother not to feed her newborn every time he cries. Overfeeding can lead to stomach aches and diarrhea. After checking the newborn, it is okay to let her cry for short periods of time.
LP in HELLP refers to Low Platelets less than 100,000 resulting in
thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly disseminated intravascular coagulopathy
Postpartum chill, which occurs in the first 2 hr puerperium, is an
uncontrollable shaking chill immediately following birth. Postpartum chill is possibly related to a nervous system response, vasomotor changes, a shift in fluids, and/or the work of labor. This is a normal occurrence unless accompanied by an elevated temperature. Provide warm blankets and fluids. Assure client that these chills are a self-limiting, common occurrence that will last only a short while.
Every newborn should be seen and examined at the doctor's office within
72 hr (2 to 3 days) after discharge from the hospital
A nurse manager is reviewing ways to prevent a TORCH infection during pregnancy with a group of newly licensed nurses. Which of the following statements by a nurse indicates understanding of the teaching? A. "Obtain an immunization against rubella early in pregnancy." B. "Seek prophylactic treatment if cytomegalovirus is detected during pregnancy." C. "A woman should avoid crowded places during pregnancy." D. "A woman should avoid consuming undercooked meat while pregnant."
"A woman should avoid consuming undercooked meat while pregnant."
The physiologic change preceding labor - the premonitory sign of energy burst is sometimes called
"nesting" response
Laparoscopic salpingectomy for ectopic pregnancies
(removal of the tube) is performed when the tube has ruptured.
BPP Total score findings
8 TO 10: normal, low risk of chronic fetal asphyxia 4 TO 6: abnormal, suspect chronic fetal asphyxia LESS THAN 4: abnormal, strongly suspect chronic fetal asphyxia
conduct a pain assessment on the newborn every
8 to 12 hr and following painful procedures
Fetal lung maturity tests LECITHIN/SPHINGOMYELIN (L/S) RATIO
A 2:1 ratio indicates fetal lung maturity (2.5:1 or 3:1 for a c lient who has diabetes mellitus)
Bacterial vaginosis
A bacterial infection most commonly caused by Haemophilus vaginalis or Gardnerella vaginalis. It is the most common vaginal infection in women 15 to 44 years of age. It cannot be related to sexual activity.
High-risk pregnancy: Quad marker screening
A blood test that ascertains information about the likelihood of fetal birth defects. It does not diagnose the actual defect. It can be performed instead of the maternal serum AFP yielding more reliable findings. Includes testing for: hCG, AFP, Estriol, and Inhibin A. Preferred at 16 to 18 weeks gestation
Pulmonary embolus is
An embolus which occurs when fragments or an entire clot dislodges and moves into circulation. A pulmonary embolism is a complication of DVT that occurs if the embolus moves into the pulmonary artery or one of its branches and lodges in a lung, occluding the vessel and obstructing blood flow to the lungs. Acute pulmonary embolus is an emergent situation
Preterm or premature
Born prior to the completion of 37 weeks of gestation.
In preparation for pregnancy and birth third trimester
Childbirth preparation, Fetal movement/kick counts to ascertain fetal well‑being, Diagnostic testing for fetal well-being (nonstress test, biophysical profile, ultrasound, and contraction stress test).
Latent Phase
First phase of First stage of labor from 0cm dilated to 3cm dilated, it is the onset of labor. Contractions Irregular, mild to moderate, Frequency: 5 to 30 min, Duration: 30 to 45 seconds. Some dilation and effacement Talkative and eager. can last for a primigravida 6hr and multigravida 4hr
Pregnancy test urine sample should be
First-voided morning specimens
Infertility diagnostic procedures for females include
Pelvic exam, hormone analysis, postcoital test, ultrasonography, hysterosalpingography hysteroscopy and laparoscopy
Convection
Flow of heat from the body surface to cooler environmental air. Place the bassinet out of the direct line of a fan or air conditioning vent, swaddle the newborn in a blanket, and keep the head covered. Any procedure done with the newborn uncovered should be performed under a radiant heat source. Keep ambient temperature of the nursery or mother's room at 22 to 26° C (72 to 78° F).
Puerperal infections expected findings
Flu‑like clinical findings, such as body aches, chills, fever, and malaise Anorexia and nausea Elevated temperature of at least 38° C (100.4° F) for 2 or more consecutive days Tachycardia
A nurse is reviewing care of the umbilical cord with the parent of a newborn. Which of the following instructions should the nurse include in the teaching? A. Cover the cord with a small gauze square. B. Trickle clean water over the cord with each diaper change. C. Apply hydrogen peroxide to the cord twice a day. D. Keep the diaper folded below the cord.
Folding the diaper below the cord prevents urine from the diaper penetrating the cord site.
Symptom-based method using cervical mucus
Following ovulation the cervical mucus becomes thin and flexible under the influence of estrogen and progesterone to allow for sperm viability and motility the ability for the mucus to stretch between the fingers is the greatest during ovulation, this method a woman examines mucus from the last day of menstrual cycle to determine ovulation
A nurse is reviewing the health record of a client who is pregnant the provider indicated the client exhibits probable signs of pregnancy which of the following findings should the nurse expect select all that apply A. Quickening B. Ballottement C. Montgomery's glands D. Chadwick sign E. Quickening
Goodells sign Chadwick sign ballottement
Causes of bleeding during pregnancy - Second trimester
GESTATIONAL TROPHOBLASTIC DISEASE: Uterine size increasing abnormally fast, abnormally high levels of hCG , nausea and increased emesis, no fetus present on ultrasound, and scant or profuse dark brown or red vaginal bleeding
GTPAL
Gravity Term birth 38 weeks or more Preterm births from viability up to 37 weeks Abortion/miscarriages prior to viability Living children
Gestational trophoblastic disease (GTD) partial mole
Genetic material is derived both maternally and paternally. A normal ovum is fertilized by two sperm or one sperm in which meiosis or chromosome reduction and division did not occur. A partial mole often contains abnormal embryonic or fetal parts, an amniotic sac, and fetal blood, but congenital anomalies are present. Approximately 6% of partial moles progress toward a choriocarcinoma.
Hydatidiform mole
Gestational trophoblastic disease which is a group of rare tumors that involve abnormal growth of cells inside a woman's uterus. GTD does not develop from cells of the uterus like cervical cancer or endometrial (uterine lining) cancer do. Instead, these tumors start in the cells that would normally develop into the placenta during pregnancy.
A nurse in a prenatal clinic is providing education to a client who is in the 8th week of gestation. The client states that she does not like milk. Which of the following foods should the nurse recommend as a good source of calcium? A. Dark green leafy vegetables B. Deep red or orange vegetables C. White breads and rice D. Meat, poultry, and fish
Good sources of calcium for bone and teeth formation include low-oxalate, dark green leafy vegetables, such as kale, artichokes, and turnip greens.
The loss of excess fluid accumulated during the last part of the pregnancy
occurs within the first 2 to 3 days post-delivery.
The physiologic change preceding labor - the premonitory sign of lightening is when
Fetal head descends into true pelvis about 14 days before labor; feeling that the fetus has "dropped"; easier breathing, but more pressure on bladder, resulting in urinary frequency; more pronounced in clients who are primigravida
Breech presentation
Fetal heart tones should be assessed above the mother's umbilicus in either the right- or left-upper quadrant of the abdomen.
Vertex presentation
Fetal heart tones should be assessed below the mother's umbilicus in either the right- or left-lower quadrant of the abdomen.
Fetal precipitous labor complications
Fetal hypoxia due to hypertonic contractions or umbilical cord around fetal neck, Fetal intracranial hemorrhage due to head trauma from rapid birth
Transverse lie
Fetal long axis is horizontal, forms a right angle to maternal axis, and will not accommodate vaginal birth. The shoulder is the presenting part and can require delivery by cesarean birth if the fetus does not rotate spontaneously.
Parallel or longitudinal lie
Fetal long axis is parallel to maternal long axis, either a cephalic or breech presentation. Breech presentation can require a cesarean birth.
Renal system when pregnant
Fill Traciann rate increases secondary to the influence of pregnancy hormones and an increase in blood volume and metabolic demands the amount of urine produced remains the same urinary frequency is common during pregnancy
The physiologic change preceding labor - the premonitory sign of Increased vaginal discharge or bloody show
Expulsion of the cervical mucus plug may occur. Brownish or blood‑tinged mucus plug resulting from the onset of cervical dilation and effacement.
Fetal tachycardia
FHR greater than 160/min for 10 min or more. Causes/complications: Maternal infection, chorioamnionitis, Fetal anemia, Fetal cardiac dysrhythmias, Maternal use of cocaine or methamphetamines, Maternal dehydration, Maternal or fetal infection, Maternal hyperthyroidism
Fetal bradycardia
FHR less than 110/min for 10 min or more. Causes/complications: Uteroplacental insufficiency, Umbilical cord prolapse, Maternal hypotension, Prolonged umbilical cord compression, Fetal congenital heart block, Anesthetic medications, Viral infection, Maternal hypoglycemia, Fetal heart failure, Maternal hypothermia. Discontinue oxytocin if being administered. Assist the client to a side-lying position., Administer oxygen, Administer a tocolytic medication as prescribed and maintenance fluid notify provider
A nurse is caring for a postpartum client who delivered her third infant 2 days ago. The nurse recognizes that which of the following findings are suggestive of postpartum depression? (Select all that apply.) A. Fatigue B. Insomnia C. Euphoria D. Flat affect E. Delusions
Fatigue, Insomnia, Flat affect
Viability
The point in time when an infant has the capacity to survive outside the uterus there is not a specific week of gestation however infants born between 22 and 25 weeks are considered on the threshold of viability
Primipara:
Has completed one pregnancy to stage of viability
Multipara:
Has completed two or more pregnancies two stage of viability
In Hyperemesis gravidarum a CBC will reveal
Hct concentration is elevated because inability to retain fluid results in hemoconcentration.
Upright position
Hold the newborn upright, and face him toward the holder while supporting his head, upper back, and buttocks.
A nurse is reviewing contraindications for circumcision with a newly hired nurse. Which of the following conditions are contraindications? (Select all that apply.) A. Hypospadias B. Hydrocele C. Family history of hemophilia D. Hyperbilirubinemia E. Epispadias
Hypospadias involves a defect in the location of the urethral opening and is a contraindication to circumcision. A family history of hemophilia is a contraindication for circumcision. Epispadias involves a defect in the location of the urethral opening and is a contraindication to circumcision.
For Hypertonic contractions
Maintain hydration. Promote rest and relaxation, and provide comfort measures between contractions. Place the client in a lateral position, and provide oxygen by mask. Oxytocin is not administered
Inevitable spontaneous abortion
Moderate cramps, mild to severe bleeding, no tissue passed, Cervical opening dilated with membranes or tissue bulging at cervix.
Group B Streptococcus (GBS)
Obtain a vaginal/anal culture at 35 to 37 weeks of gestation to assess for GBS infection.
Scale with protective cover in place for newborn assessment
Scale should be at 0; weight should include pounds, ounces, and grams.
For infertility diagnostic procedures for men include
Semen analysis and ultrasound
Oxytocics include
oxytocin, methylergonovine, and carboprost. Misoprostol, a prostaglandin, also may be administered
Apgar scoring 0 to 3 indicates
severe distress
A vacuum-assisted birth involves
the use of a cuplike suction device that is attached to the fetal head. Traction is applied during contractions to assist in the descent and birth of the head, after which, the vacuum cup is released and removed preceding delivery of the fetal body.
Coagulopathies are suspected when
the usual measures to stimulate uterine contractions fail to stop vaginal bleeding.
Complete Uterine rupture involves
the uterine wall, peritoneal cavity, and/or broad ligament. Internal bleeding is present.
Lactating and nonlactating women differ in
the timing of the first ovulation and the resumption of menstruation.
Types of abortions include
threatened, inevitable, incomplete, complete, and missed.
The human ovum can be fertilized no later than
12 to 24 hours after ovulation
Battledore insertion of the cord vasa previa
A marginal insertion, Increased risk of fetal hemorrhage
Chloasma
An increase of pigmentation on the face
Postterm (postdate)
Born after the completion of 42 weeks of gestation.
A nurse is teaching a client who is at 6 weeks of gestation about common discomforts of pregnancy. Which of the following findings should the nurse include in the teaching? (Select all that apply.) A. Breast tenderness B. Urinary frequency C. Epistaxis D. Dysuria E. Epigastric pain
Breast tenderness, Urinary frequency, Epistaxis
Newborn chest should be
Chest should be barrel‑shaped Nipples should be prominent, well formed, and symmetrical
Fetal extension (attitude)
Chin extended away from chest, extremities extended
Heat loss occurs by four mechanisms
Conduction, Convection:, Evaporation, Radiation.
Velamentous insertion of the cord vasa previa
Cord vessels begin in the branch at the membranes and then course to the placenta
Phases of maternal role attainment are
Dependent, Dependent-Independent, and Interdependent
If needed RhO(D) immune globulin is administered
IM around 28 weeks gestation when clients are Rh-negative
Hgb electrophoresis:
Identifies hemoglobinopathies (sickle cell anemia and thalassemia).
Each uterine contraction is comprised of
Increment, Acme, Decrement
Newborn Smell
Newborns have a highly developed sense of smell, prefer sweet smells, and can recognize the mother's smell.
Nullipara
No pregnancy beyond the stage of viability
Fetopelvic or fetal position Right - R or left - L
The first letter references either the side of the maternal pelvis.
Presentation
The part of the fetus that is entering the pelvic inlet first and leads through the birth canal during labor. It can be the back of the head (occiput), chin (mentum), shoulder (scapula), or breech (sacrum or feet).
Coitus interruptus withdrawal
The withdrawal of penis from vagina prior to ejaculation
Carboprost tromethamine
Uterine stimulant, Controls postpartum hemorrhage
Misoprostol
Uterine stimulant, Controls postpartum hemorrhage
Nulligravida:
Woman who has never been pregnant
It is expected with GTD to have
Excessive vomiting (hyperemesis gravidarum) due to elevated hCG levels
Newborn touch
Newborns should respond to tactile messages of pain and touch. The mouth is the area most sensitive to touch in the newborn.
A nurse concludes that the father of an infant is not showing positive signs of parent‑infant bonding. He appears very anxious and nervous when the infant's mother asks him to bring her the infant. Which of the following actions should the nurse use to promote father‑infant bonding? A. Hand the father the infant, and suggest that he change the diaper. B. Ask the father why he is so anxious and nervous. C. Tell the father that he will grow accustomed to the infant. D. Provide education about infant care when the father is present.
Nursing interventions to promote paternal bonding include providing education about infant care and encouraging the father to take a hands‑on approach
Non-medical therapy an alternative measures for infertility include
Nutritional and dietary changes exercise yoga and stress management herbal medications only if prescribed an acupuncture
A nurse is caring for a client who is at 14 weeks of gestation and has hyperemesis gravidarum. The nurse should identify that which of the following are risk factors for the client? (Select all that apply.) A. Obesity B. Multifetal pregnancy C. Maternal age greater than 40 D. Migraine headache E. Oligohydramnios
Obesity, Multifetal pregnancy, Migraine headache
A nurse in an in fertility clinic is providing care to a couple who has been unable to conceive for 18 months which of the following data should be included in the assessment A. Occupation B. Menstrual history C. History of falls D. Childhood infectious diseases E. Recent blood transfusions
Occupation menstrual history and childhood infectious diseases
Anesthesia is required for circumcision. Types of anesthesia include
a ring block, dorsal‑penile nerve block, topical anesthetic (eutectic mixture of local anesthetics), and concentrated oral sucrose. Nonpharmacologic methods, such as swaddling and nonnutritive sucking can be used to enhance pain management
With Cervical insufficiency an ultrasound can show
a short cervix (less than 25 mm in length), presence of cervical funneling (beaking), or effacement of the cervical os indicates reduced cervical competence.
Pain is
a subjective and individual experience, and each client's response to the pain of labor is unique. Safety for the mother and fetus must be the first consideration of the nurse when planning pain management measures
The establishment of respiratory function with
the cutting of the umbilical cord is the most critical extrauterine adjustment as air inflates the lungs with the first breath.
Decrement
the decline of the contraction intensity as the contraction is ending
Circulatory changes after birth occur with
the expulsion of the placenta and the cutting of the umbilical cord as a newborn begins breathing independently.
An intrapartum nurse should care for three clients during each labor and delivery
the fetus, mother, and family unit
Postpartum psychosis develops within
the first 2 to 3 weeks of the postpartum period. Clients who have a history of bipolar disorder are at a higher risk. Clinical findings are severe and can include confusion, disorientation, hallucinations, delusions, obsessive behaviors, and paranoia. The client might attempt to harm herself or her infant.
Methylergonovine
Uterine stimulant, Controls postpartum hemorrhage, do not administer to clients with hypertension or heart disease
Oxytocin and misoprostol can cause
hypotension
AFP Alpha-fetoprotein (AFP) level for fetal abnormalities can be measured from the amniotic fluid between
15 and 20 weeks (16 to 18 weeks of gestation is ideal) and can be used to assess for neural tube defects in the fetus or chromosomal disorders.
Newborns sleep approximately
16 to 19 hr/day with periods of wakefulness gradually increasing. Newborns are positioned supine, "safe sleep," to decrease the incidence of sudden infant death syndrome (SIDS).
Mongolian spots
(bluish purple spots of pigmentation) are commonly noted on the shoulders, back, and buttocks. These spots are frequently present on newborns who have dark skin. Be sure the parents are aware of Mongolian spots, and document location and presence.
When it comes to nonpharmacological comfort interventions
Assess the clients need for alternative and or complementary therapy
Donor oocyte
Donated eggs are collected from a donor by an IVF procedure the eggs are inseminated the embryos are placed in a recipients uterus prior to implantation the recipient undergoes hormonal therapy to prepare the uterus
Second and third trimester danger signs
Gush of fluid from the vagina (rupture of amniotic fluid) prior to 37 weeks of gestation, Vaginal bleeding (placental problems such as abruption or previa) Abdominal pain (premature labor, abruptio placentae, or ectopic pregnancy), Changes in fetal activity (decreased fetal movement might indicate fetal distress) Persistent vomiting (hyperemesis gravidarum), Severe headaches (gestational hypertension), Elevated temperature (infection), Dysuria (urinary tract infection), Blurred vision (gestational hypertension), Edema of face and hands (gestational hypertension), Epigastric pain (gestational hypertension), Concurrent occurrence of flushed dry skin, fruity breath, rapid breathing, increased thirst and urination, and headache (hyperglycemia), Concurrent occurrence of clammy pale skin, weakness, tremors, irritability, and lightheadedness (hypoglycemia).
With reduction of risk potential use diagnostic tests to
Monitor maternal and fetal results
Potential for complications of diagnostic tests and treatments and procedures make sure to
Monitor the client for signs of bleeding
Gastrointestinal system when pregnant
Nausea and vomiting might occur due to hormonal changes and or an increase of pressure within the abdominal cavity as the pregnant client stomach and intestines are displeased with in the abdomen constipation might occur due to increased transit time of food through the G.I. tract and thus increased water absorption
A nurse in a clinic is teaching a client of childbearing age about recommended folic acid supplements. Which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency? A. Iron deficiency anemia B. Poor bone formation C. Macrosomic fetus D. Neural tube defects
Neural tube defects are caused by folic acid deficiency. Food sources of folic acid include fresh green leafy vegetables, liver, peanuts, cereals, and whole grain breads.
Marginal or low-lying Placenta previa
The placenta is attached in the lower uterine segment but does not reach the cervical os.
Retained placenta
The placenta or fragments of the placenta remain in the uterus and prevents the uterus from contracting, which can lead to uterine atony or subinvolution.
A nurse is caring for a client who has suspected hyperemesis gravidarum and is reviewing the client's laboratory reports. Which of the following findings is a manifestation of this condition? A. Hgb 12.2 g/dL B. Urine ketones present C. Alanine aminotransferase 20 IU/L D. Serum glucose 114 mg/dL
The presence of ketones in the urine is associated with the breakdown of proteins and fats that occurs in a client who has hyperemesis gravidarum.
Lie
The relationship of the maternal longitudinal axis (spine) to the fetal longitudinal axis (spine)
Fetopelvic or fetal position
The relationship of the presenting part of the fetus (sacrum, mentum, or occiput), preferably the occiput, in reference to its directional position as it relates to one of the four maternal pelvic quadrants. It is labeled with three letters.
Fetopelvic or fetal position Occiput - O, sacrum - S, mentum - M, or scapula - Sc
The second letter references the presenting part of the fetus.
Fetopelvic or fetal position Anterior - A, posterior - P, or transverse - T
The third letter references the part of the maternal pelvis.
A nurse is caring for a client who is in active labor and becomes nauseous and vomits. The client is very irritable and feels the urge to have a bowel movement. She states, "I've had enough. I can't do this anymore. I want to go home right now." Which of the following stages of labor is the client experiencing?
The transition phase of labor occurs when the client becomes irritable, feels rectal pressure similar to the need to have a bowel movement, and can become nauseous with emesis.
A nurse is caring for a client who is in the transition phase of labor and reports that she needs to have a bowel movement with the peak of contractions. Which of the following actions should the nurse make? A. Assist the client to the bathroom. B. Prepare for an impending delivery. C. Prepare to remove a fecal impaction. D. Encourage the client to take deep, cleansing breaths
The urge to have a bowel movement indicates fetal descent and complete dilation. Preparing for an imminent delivery is appropriate
Postpardum Urinary system and bladder function
The urinary system can show evidence of the following. Urinary retention secondary to loss of bladder elasticity and tone and/or loss of bladder sensation resulting from trauma, medications, or anesthesia. A distended bladder as a result of urinary retention can cause uterine atony and displacement to one side, usually to the right. The ability of the uterus to contract is also lessened. Postpartal diuresis with increased urinary output begins within 12 hr of delivery.
A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions every 3 to 5 min and becoming stronger. A vaginal exam reveals that the client's cervix is 3 cm dilated, 80% effaced, and -1 station. The client asks for pain medication. Which of the following actions should the nurse take? (Select all that apply.) A. Encourage use of patterned breathing techniques. B. Insert an indwelling urinary catheter. C. Administer opioid analgesic medication. D. Suggest application of cold. E. Provide ice chips.
The use of patterned breathing techniques can assist with pain management at this time. An opioid analgesic can be safely administered at this time. The use of a nonpharmacological approach, such as the application of cold, is an appropriate intervention at this time.
Powers
Uterine contractions cause effacement (shortening and thinning of the cervix) during the first stage of labor and dilation of the cervix (enlargement or widening of the cervical opening and canal) that occurs once labor has begun and the fetus is descending. Involuntary urge to push and voluntary bearing down in the second stage of labor helps in the expulsion of the fetus
A nurse in labor and delivery is planning care for a newly admitted client who reports she is in labor and has been having vaginal bleeding for 2 weeks. Which of the following should the nurse include in the plan of care? A. Inspect the introitus for a prolapsed cord. B. Perform a test to identify the ferning pattern. C. Monitor station of the presenting part. D. Defer vaginal examinations
Vaginal examinations should not be performed until placenta previa or abruptio placentae has been ruled out as the cause of vaginal bleeding.
Surgical sterilization for men
Vasectomy a surgical procedure consisting of ligation and severance of the vas deferens. This is permanent. Reversal is possible but not always successful
A nurse is preparing to administer a vitamin K (phytonadione)injection to a newborn. Which of the following responses should the nurse make to the newborn's mother regarding why this medication is given? A. "It assists with blood clotting." B. "It promotes maturation of the bowel." C. "It is a preventative vaccine." D. "It provides immunity."
Vitamin K is deficient in a newborn because the colon is sterile. Until bacteria are present to stimulate vitamin K production, the newborn is at risk for hemorrhagic disease.
Adjustments to extrauterine life occur as
a newborn's respiratory and circulatory systems are required to rapidly adjust to life outside of the uterus.
Assess episiotomy and lacerations for approximation, drainage, quantity, and quality. A bright red trickle of blood from the episiotomy site in the early postpartum period is
a normal finding
Fever of 38° C (100.4° F) or higher for 2 consecutive days during the first 10 days of the postpartum period is indicative of
a postpartum infection and requires further investigation. The infection can be present in the bladder, uterus, wound, or breast of a postpartum client. The major complication of puerperal infection is septicemia.
Alpha-fetoprotein (AFP):
a protein produced by the fetus
Estriol:
a protein produced by the fetus and placenta
Inhibin A:
a protein produced by the ovaries and placenta
An Apgar score is assigned based on
a quick review of systems that is completed at 1 and 5 min of life. This allows the nurse to rapidly assess extrauterine adaptation and intervene with appropriate nursing actions.
Changes in fetal heart rate patterns are categorized as
episodic or periodic changes. Episodic changes are not associated with uterine contractions, and periodic changes occur with uterine contractions. These changes include accelerations and decelerations
African Americans tend to prefer
female family members for support
Native American tend to prefer
female nursing personnel; family involved in birth; use of herbs during labor; squatting position for birth
Immediately after delivery, the fundus should be
firm, midline with the umbilicus, and approximately at the level of the umbilicus. At 12 hr postpartum, the fundus may be palpated at 1 cm above the umbilicus.
Penicillin G or ampicillin are most commonly prescribed
for GBS Administer penicillin 5 million units initially IV bolus, followed by 2.5 million units intermittent IV bolus every 4 hr. The client may receive ampicillin 2 g IV initially, followed by 1 g every 4 hr. Bactericidal antibiotic is used to destroy the GBS.
In Hyperemesis gravidarum urinalysis is use to evaluate
for ketones and acetones (breakdown of protein and fat) is the most important initial laboratory test: Elevated urine specific gravity
Mastitis is an
infection of the breast involving the interlobular connective tissue and is usually unilateral. Mastitis can progress to an abscess if untreated. It occurs most commonly in mothers breastfeeding for the first time and well after the establishment of milk flow, which is usually 6 weeks after delivery. Staphylococcus aureus is usually the infecting organism
The method and frequency of fetal surveillance during labor will vary and depend on
maternal/ fetal risk factors as well as the preference of the facility, provider, and client.
Antidepressants
may be prescribed by the provider if indicated.
Antipsychotics and mood stabilizers
may be prescribed for clients who have postpartum psychosis.
The physiologic change preceding labor - the premonitory sign of GI changes are less common but include
nausea, vomiting, and indigestion
Anterior fontanel should be
palpated and approximately 5 cm on average and diamond shaped.
Assess uterine labor contraction characteristics by
palpation, placing a hand over the fundus to assess contraction frequency, duration, intensity and resting tone of uterine contractions or by the use of external or internal monitoring
The postpartum period, also known as the
puerperium, includes physiological and psychological adjustments. This period is the interval between birth and the return of the reproductive organs to their normal nonpregnant state. Although traditionally this has been considered to last 6 weeks, this timeframe varies among women.
Uterine Rupture is a
rare but life-threatening obstetric injury.
Postpartum hemorrhage is considered to occur if
the client loses more than 500 mL blood after a vaginal birth or more than 1,000 mL blood after a cesarean birth. Two complications that can occur following postpartum hemorrhage include hypovolemic shock and anemia.
Postpartum blues is characterized by
tearfulness, insomnia, lack of appetite, and a feeling of letdown. A mother can experience an intense fear, anxiety, anger, and inability to cope with the slightest problems and become despondent. Postpartum blues typically resolves in 10 days without intervention.
Iron-deficiency anemia Hct less
than 3%
American Academy of Pediatrics and American Congress of Obstetricians and Gynecologists recommend
that blood pressure and pulse be assessed at least every 15 min for the first 2 hr after birth, and that temperature be assessed every 4 hr for the first 8 hr after birth and then at least every 8 hr.
The NST is interpreted as reactive if
the FHR is a normal baseline rate with moderate variability, accelerates at least 15/min (10/min prior to 32 weeks) for at least 15 seconds (10 seconds prior to 32 weeks) and occurs two or more times during a 20-min period
The Kleihauer-Betke test determines
the amount of fetal blood in maternal circulation if a large fetomaternal transfusion is suspected. If 15 mL or more of fetal blood is detected, the mother should receive an increased Rho(D) immune globulin dose
The physiologic change preceding labor - the premonitory sign of cervical ripening is
when the Cervix becomes soft (opens) and partially effaced, and can begin to dilate
A vaginal birth after cesarean birth VBAC is
when the client delivers vaginally after having had a previous cesarean birth.
Fetal tachycardia
which is a prolonged increase in the FHR greater than 160/min can indicate infection, is frequently associated with preterm labor.
BPP assesses fetal well-being by measuring five variables
with a score of 2 for each normal finding, and 0 for each abnormal finding for each variable: FHR Fetal breathing movements Gross body movements Fetal tone Qualitative amniotic fluid volume
Meconium should be passed
within 24 to 48 hr after birth
Postpartum depression occurs
within 6 months of delivery and is characterized by persistent feelings of sadness and intense mood swings. It occurs in 10% to 15% of new mothers and usually does not resolve without intervention. It is similar to nonpostpartum mood disorders.
Rho(D) immune globulin is administered
within 72 hr to women who are Rh-negative and gave birth to infants who are Rh-positive to prevent sensitization in future pregnancies.