NSG 210 (exam 1)
Signs/symptoms of DIC
-hypovolemic (if bleeding internally) -Tachycardia -Cool -Clammy -Poor perfusion -Petechiae (watch for generalized petechiae that starts in trunk of back) -PTT may be higher than normal
If the newborn has an absent grimace, what APGAR score would you give for "grimace (reaction and reflex)"?
0
If the newborn has an absent pulse, what APGAR score would you give for "pulse (heart rate)"?
0
If the newborn is entirely blue/pale, what APGAR score would you give for "appearance (skin color)"?
0
If the newborn is limp, what APGAR score would you give for "activity (muscle tone)"?
0
If the newborns respirations are absent, what APGAR score would you give for "respiratory effort"?
0
The presenting part is at the level of the mother's ischial spines and is now "engaged" when the fetus is at what station?
0 station
If the newborn has a grimace, what APGAR score would you give for "grimace (reaction and reflex)"?
1
If the newborn has a pulse of less than 100/min, what APGAR score would you give for "pulse (heart rate)"?
1
If the newborn has a weak cry, what APGAR score would you give for "respiratory effort"?
1
If the newborn has blue arms and legs but a pink body, what APGAR score would you give for "appearance (skin color)"?
1
If the newborn has minor flexion, what APGAR score would you give for "activity (muscle tone)"?
1
What should the nurse do if the umbilical cord is protruding from the vagina?
Wrap the cord loosely in a sterile towel soaked with warm sterile normal saline
Lochia alba description
Yellow/white in color and occurs after lochia serosa and may last up to the 6th postpartum week / days 11-21 postpartum
Are frequent blood tests expected with administration of Warfarin?
Yes
Are post epidural headaches common?
Yes
Are small clots expected with Lochia rubra?
Yes
Does a slow trickle of blood from the vagina in a newly postpartum client require immediate investigation?
Yes
If placenta previa is present, should the doctor schedule a C-section before the onset of labor?
Yes
Is Misoprostol (Cytotec) safe to use for clients with hypertension?
Yes
Is immobility a risk factor for DVT?
Yes
Latent phase of labor
-0-3 cm -Mild to moderate contractions -Irregular
Active phase of labor
-4-7 cm -Moderate to strong contractions -Regular
Thrombolytics examples
-Alteplase (Activase) -Reteplase (Retavase) -Tenecteplase
DVT management
-Anticoagulation -Measure calf circumference bilaterally to provide a baseline for future comparison
AROM stands for what?
-Artificial rupture of membranes
Nifedipine action
-Calcium channel blocker -Used to delay delivery process for 24-48 hours
Indications for C-section
-Complete placenta previa -Breech presentation -Transverse lie -Placental abruption accompanied by nonreassuring fetal status -Active genital herpes -Umbilical cord prolapse -Arrest of descent or arrest of dilation -Nonreassuring fetal status -Previous classic incision -More than one previous cesarean birth -Benign, malignant tumors -Cervical cerclage
Late decelerations are due to
-Placental insufficiency -Impaired oxygen exchange
Clotting major complications
-Recurrent DVT -Pulmonary embolism
What are the signs/symptoms of placental abruption for the mother
-Severe abdominal pain -Rigid & tender uterus -Decrease in H&H and hypovolemic shock -Major dark red bleeding in uterus
Symptoms of DVTs depend on...
-Size -Location
Characteristics of a preterm newborn
-Skin is smooth, shiny, gooey (lots of vernix), translucent -Flat areolas -Club foot -Very smooth soles of the feet -Fused fingers or toes -Extremely flexible
What fetal lie would be a high risk for breech/C-section?
-Transverse (sideways) -Oblique (at an angle)
What are some causes of placental abruption?
-Trauma (motor vehicle accident, fall, blunt force trauma) -Multigravida -Hypertension -Stimulants (cocaine & smoking) -History of previous abruption
If epidural causes BP drop, what should the nurse do?
-Turn and lower head -Increase fluids -Oxygen
If late decelerations are noted, what should the nurse do?
-Turn patient to the side -Administer oxygen -Notify HCP
Local anesthesia (Lidocaine & Bupivacaine) actions
-Used to render specific portion of the body insensitive to pain -Interfere with nurve impulse transmission to specific areas of the body -Blocks signals at the nerve endings in the skin -Causes temporary numbing effects
Pitocin (oxytocin) is given after delivery of the fetus and the placenta to prevent _________ and __________
-Uterine atony -Postpartum hemorrhage
Clotting surgical interventions
-Venous thrombectomy (when thrombus lodges in femoral vein, removal necessary to prevent PE or gangrene, duration of effect varies among patients) -Filters (for recurrent thrombosis when anticoagulant therapy is contraindicated) -Vein ligation (to prevent clot extension into deep venous system)
During a vaginal exam, if the cervix is as thick as your finger, what % is effaced?
0%
If the newborn has a strong cry, what APGAR score would you give for "respiratory effort"?
2
Approximately _____lbs is lost during childbirth
12 lbs *fetus, placenta, amniotic fluid
How long can the latent stage last for the first pregnancy?
12-20 hours *encourage rest, shower, fluids (PO or IV)
During the first trimester (1-12 weeks) the normal fetal heart rate is ___-___ bpm
120-180 bpm
Which is the immediate nursing action when a client's membranes rupture spontaneously, releaseing clear, odorless fluid?
Assess the fetal heart rate
Six hours after a vaginal delivery the nurse notes the perineal pad is soaked and there is blood underneath the client's buttocks. Which action does the nurse take first?
Assess the fundus
Which is the priority nursing action when a client has an amniotomy performed to facilitate labor?
Assessing the fetal heart rate
Zero cm means that the baby is positioned in what way in the pelvis?
At the level of the ischial spines
APGAR score of 7-10 indicates ____ condition
Good
Change in the cervix is what kind of sign of labor?
Guarenteed
3rd trimester with right upper quadrant pain, nausea and vomiting are critical signs of what pregnancy condition?
HELLP syndrome
Treatment for hypovolemic shock
IV fluids
The presence of HCG in maternal blood is considered a _________ sign of pregnancy
Probable
Why is the Hep B vaccine given to newborns
Provides antibodies against Hep B
What is a major complication regarding DVT?
Pulmonary embolism
What is the complication for DVT
Pulmonary embolism
First recognition of fetal movements by the mother is called...
Quickening
Moderate variability is a REASSURING OR NONREASSURING fetal heart rate pattern?
Reassuring *Variability is the most important aspect of the FHR. It reflects the intactness of the fetal neurologic system, fetal oxygenation, and fetal oxygen reserve
What should you do if the APGAR of a newborn is 5?
Redo the APGAR every 5 minutes until the score is >7 or until 20 mins of life
Naloxone helps with reversal of what?
Respiratory distress
Naloxone action
Reverses respiratory depression secondary to opioid anesthetic
The nurse would anticipate administering Rho (D) immune globulin to the client with which laboratory values after delivery?
Rh negative and Coombs negative
If a newborn is Rh positive, and the mother is Rh negative, why would the baby receive an Rh-negative exchange transfusion?
The red blood cells will not be destroyed by maternal anti-Rh antibodies
Lochia rubra description
The reddish vaginal flow that occurs during the first 1-3 days after delivery
What should the nurses assess for immediately after an amniotomy?
Umbilical cord prolapse; assess the fetal heart rate for at least 1 full minute
Which alteration would the nurse recognize as a side effect of the epidural anesthetic?
Urinary retention
How should a client perform proper perineal care after an episiotomy?
Use a squeeze bottle with warm water to keep the site clean
How to reduce engorgement
Use ice packs after feeding and before the next feed
Prostaglandins action
Used to induce labor by softening/ripening the cervix and enhancing uterine muscle tone
Prior to discontinuing to IV oxytocin (Pitocin), which assessment is most important for the nurse to obtain?
Uterine firmness *It is most important to ensure that the uterus is contracting by assessing fundal firmness
This is where the placenta fails to detach from the uterine wall and pulls the uterus inside-out
Uterine inversion
Venous thrombi occurs where?
Where the vein is normal, but blood flow is very flow
What will contractions look like if a patient experiences placental abruption?
Contractions will be spaced out and FHR will have sharp drops
Variable decelerations are due to
Cord compression
Breastfeeding jaundice prevention strategies
-Frequent breastfeeding (every 2-3 hours) -Avoiding supplementation if newborn not dehydrated -Maternal lactation counseling
Late postpartum hemorrhage criteria
-From 24 hrs up to 6 weeks postpartum -Subinvolution of the uterus -Retained placental fragments
Uterine atony manifestations
-Fundus is difficult to locate -"Boggy" or soft feel to the fundus -Becomes firm when massaged -Excessive lochia and clots
Category 1 FHR indicates what?
-Good -Reassuring
What labs should be drawn for DIC?
D-dimer (expect fibrin levels to be high)
Blood stasis, altered coagulation, and localized vascular damage present in pregnancy can lead to what?
DVT
What is the first step to do for a hypoglycemic baby?
FEED the baby
Irregular contractions are characteristics of true or false labor?
False
By the 14th day after delivery, where should the fundus be palpated?
It should not be felt anymore
You know that this practice of consuming non-food substances, common to some cultures, is called
Pica
Lochia serosa description
Pink/brown in color following lochia rubra and occurs the 4th-10th day after delivery
A client in labor is having an indwelling urinary catheter inserted. Which action by the nurse would help prevent late decelerations of the fetal heart rate during this procedure?
Place a rolled towel under the client's right hip
Separation of a normally implanted placenta before the fetus is born
Placenta abruption
Uterine atony management
-Measures to contract the uterus -Provide fluid replacement
Engagement is represented when fetal head reaches station ____
Zero, 0
Physiological jaundice
it occurs within first two to four days and is considered normal
Amniotomy definition
Artificial rupture of membranes
Prolonged pregnancy is defined as
One that lasts longer than 42 weeks *Accurate calculation of the estimated date of delivery is essential
Stage four is considered to be the first ____ to ___ hours after delivery
One to two hours after delivery
first stage of labor and birth
Onset of true labor to complete dilatation
This hormone is responsible for milk ejection
Oxytocin
Pinkish-red blotches or diffuse mottling of the hands caused by an increase of estrogen is called ___________ and is considered an expected or unexpected finding?
Palmar erythema; expected
Passage of birthing process
Pelvis
Which instruction would the nurse include when teaching episiotomy care?
Perform perineal care after toileting until healing occurs
If a woman gains more than 2 lbs in any 1 week, or more than 6 lbs in 1 month, _______________ should be expected
Preeclampsia
HELLP is a complication of __________ and ____________
Preeclampsia and DIC
"Flabby tone" is a characteristic of a full term or preterm newborn?
Preterm
"Hair all over body (lanugo)" is a characteristic of a full term or preterm newborn?
Preterm
"Minora and clitoris are still exposed" is a characteristic of a full term or preterm newborn?
Preterm
"Pinna has slow recoil, is soft, flat, and contains little cartilage" is a characteristic of a full term or preterm newborn?
Preterm
"Plantar creases are absent" is a characteristic of a full term or preterm newborn?
Preterm
"Shiny/translucent skin" is a characteristic of a full term or preterm newborn?
Preterm
"Without rouge" is a characteristic of a full term or preterm newborn?
Preterm
Describe preterm labor
Preterm labor is defined as contractions and cervical dilation between 20 and 36 weeks of gestation
What do you want to prevent when a patient is on oxytocin regarding contractions
Prevent the contractions from occuring too close together
During the first phase of labor, uterine contractions are the _____ force moving the fetus through the maternal pelvis
Primary force
True or false: constipation is common after childbirth
True
True or false: fetal tachycardia can also be an early sign of fetal hypoxia.
True
True or false: in breech presentations, the fetal buttocks or feet are the presenting part(s)
True
True or false: in shoulder presentations, the fetus lies transverse and the scapula is the presenting part
True
True or false: in the absence of vitamin K at birth, the infant is predisposed to bleeding problems
True
True or false: infants of mothers with hep B should receive hep B vaccine and immune globulin
True
True or false: it is possible for placenta previa to resolve on its own by the 3rd trimester due to it migrating away from the cervical opening
True
True or false: many newborns void immediately, most within 48 hours
True
True or false: milk, tea, coffee, and other caffeinated beverages should not be taken along with an iron supplement, since it decreases iron absorption
True
True or false: multiparas may experience engagement several weeks before onset of labor or during labor
True
True or false: perineal care consists of squirting warm water over the perineum after each voiding or bowel movement. The perineum is gently patted rather than wiped dry
True
True or false: placenta abruption can be partial, complete, or concealed
True
True or false: preexisting hypertension in pregnancy significantly increases the risk of preterm delivery and infant mortality
True
True or false: progesterone is not a biological marker of pregnancy, but increases in progesterone levels are critical for the maintenance of a pregnancy
True
True or false: rupture of the membranes before intrapartum treatment of GBS increases the chances that infection will ascend into the uterus
True
True or false: the nurse can delegate the mothers vital signs
True
True or false: the umbilical cord should have 1 vein and 2 arteries
True
True or false: the uterus should be midline after delivery and level with umbilicus
True
True or false: tocolytics can help stop preterm labor
True
True or false: vaginal exam must. be sterile if membranes have ruptured already
True
True or false: variable develerations can occur at any time during a contraction or in the absense of a contraction
True
True or false: vitamin K activates coagulation factors that are synthesized by the liver
True
True or false: vitamin K provides prophylaxis against hemorrhagic disease of the newborn
True
True or false: when newborns have growth spurts, they will want to nurse more often, and milk supply will increase
True
True or false: if tolerated, take the iron supplement on an empty stomach
True *Absorption is optimal when an iron supplement is taken on an empty stomach. Pregnant women taking iron supplements should be encouraged to take supplements on an empty stomach, provided gastrointestinal distress is not a problem.
True or false: the mother should awaken the baby at least every 3 hours during the day to feed
True (fully empty the breasts with each feeding (use a breast pump if needed))
Contractions every 5 minutes apart for 1 hour are an indication of true or false labor?
True labor
Signs and symptoms of postpartum infection
-Fever, chills -Pain or redness of wounds -Purulent wound drainage or wound edges not approximated -Tachycardia -Uterine subinvolution -Abnormal duration of lochia, foul odor -Elevated white blood cell count -Frequency or urgency of urination, dysuria, or hematuria -Suprapubic pain -Localized area of warmth, redness, or tenderness in the breasts -Body aches, general malaise
How should a normal fundus present?
-Firm -Midline -Level with the umbilicus
During the fourth stage of labor, how should the fundus feel/look?
-Firm -Midline -Two fingerbreadths below the umbilicus
The client delivered a baby 8 hours ago... the fundus is boggy and soft. Which interventions are most important?
-Firmly massage the fundus -Encourage the client to void -Administer Methergine per orders
Early postpartum hemorrhage (PPH) occurs when and how much blood loss?
-First 24 hours -Cumulative blood loss of 1000 mL or greater
For 3 consecutive late decelerations, should the nurse increase, decrease, or turn off Oxytocin (Pitocin)?
Turn off Oxytocin (Pitocin)
If late or variable decelerations occur, what should the nurse do?
Turn the patient
Babies may lose up to approximately __% of their birth weight
10%
How much is a pregnant clients heart rate expected to increase?
10-15 bpm
During a vaginal exam, if the cervix is paper thin, what % is effaced?
100%
Effacement is complete at ____%
100%
Ensure that the patient has ________ platelets before administration of epidural
100,000
PT normal range
11-12.5 seconds
An appropriate weight gain during pregnancy for someone who is obese should be __-__ pounds
11-20 lbs
Normal newborn heartrate
110-160
When are APGAR scores taken?
1 minute and 5 minutes of life
Too much bleeding is indicated if more than ____ pad(s) in _____ hour(s) is saturated
1 pad; 1 hour
Fetal bradycardia is a baseline FHR less than ___ bpm, and lasting more than __ minutes
110bpm, and lasting more than 10 minutes
For the first 12 hours after birth, the fundus should be __-__cm above the umbilicus
1-2cm
Menstrual cycle may not come back until about ___-___ years (depending on individual and if they're breastfeeding)
1-3 years *cannot use as contraception
In which order would paced breathing techniques be used as a client progresses through labor?
1. Cleansing breaths 2. Slow, deep breaths 3. Modified-paced breathing 4. Pant-blow 5. Slow, exhalation pushing
Sequence ofdisseminated intravascular coagulopathy
1. Endothelial damage, tissue factors (TFs), or toxins stimulate clotting cascade 2. Excess thrombin overwhelms natural anticoagulants 3. Widespread clotting in microvasculature 4. Thrombi and emboli impair tissue perfusion, leading to ischemia, infarction, necrosis 5. Clotting factors and platelets consumed faster than they can be replaced 6. Clotting activates fibrinolytic processes, which begin to break down clots 7. Fibrin degradation products are released, contributing to bleeding 8. Clotting factors are depleted, ability to form clots is lost, hemorrhage occurs
Thirty minutes after initiation of epidural anesthesia, the fetus is experiencing late decelerations. What is the correct sequence of nursing actions in order of priority?
1. Reposition the client on her side 2. Increase IV fluids 3. Reassess the fetal heart rate pattern 4. Notify the healthcare provider if late decelerations persist 5. Document interventions and related maternal/fetal responses
How to calculate delivery date?
1. Subtract 3 months from the first day of the last period 2. Add 7 days 3. Add 1 year
PT therapeutic range
1.5-2x (normal or control value)
PTT therapeutic range
1.5-2x (normal or control value)
A laboring client receiving epidural anesthesia has a sudden episode of severe nausea, and her skin becomes pale and clammy. Which would be the nurse's immediate action?
Turning the client on her side
______ days after childbirth, the fundus should no longer be palpable
14 days
What numbers are expected for variability?
15 and 15
An appropriate weight gain during pregnancy for someone who is overweight should be __-__ pounds
15-25 lbs
Normal platelet count
150,000-400,000
How is the location of the placenta assessed regarding placenta previa?
Ultrasound
Should Oxytocin (Pitocin) be discontinued if contractions are sustained over 2 minutes?
Yes
Should a person taking anticoagulants wear a medical alert bracelet?
Yes
Should a sacral dimple with a small skin tag be reported to the HCP?
Yes
The first stool usually occurs within ____-___ days postpartum. Normal patterns of bowel elimination usually resumes by ____-____ days after birth
2-3 days; 8-14 days
INR therapeutic range for Warfarin
2-3 seconds
__-__ pounds should be gained in the first trimester, then an average of one pound per week thereafter
2-5 lbs
The mother should experience fetal movements (quickening) by approximately _____ weeks of gestation
20 weeks
Should tight fitted clothes and stockings be avoided for clots?
Yes
True or false: should a foley catheter be placed if epidural is administered?
Yes
2 days after delivery, the fundus should be _____ finger breadths below the umbilicus
2 finger breadths
In primigravida, engagement occurs about _____ weeks before term
2 weeks
The INR therapeutic range for warfarin is ____ - ____
2-3
Can warfarin and heparin be administered together?
Yes and they SHOULD!
Repeat antibody screening for Rh is recommended at ___-___ weeks of gestation for unsensitized Rh-negative women
24-28 weeks
An appropriate weight gain during pregnancy for someone who is normal weight should be __-__ pounds
25-35 lbs
Is it normal to find minor bleeding in a female infants diaper?
Yes, due to the withdrawal/absent hormones from mother
An appropriate weight gain during pregnancy for someone who is underweight should be __-__ pounds
28-40 lbs
Rho(D) immune globulin is adminisitered during the _____th week of gestation
28th
Human chorionic gonadotropin (HCG) is present for ___-___ weeks postpartum
3-4 weeks
PTT normal range
30-40 seconds
Normal newborn respirations
30-60
Premature rupture is before _____ weeks
37 weeks
Which nursing action takes priority during the admission process to the birthing unit?
Ascultating the fetal heart
What does a boggy uterus indicate?
A non-contracting uterus that would be prone to hemorrhage
Tinnitus is indicative of toxicity of _______ and should be reported to the HCP
Aspirin
Active labor is between __-__cm dialated
4-7cm
During the active phase of stage one labor, the cervix is dilated __-__ cm, and the woman becomes more focused as contractions become more painful.
4-7cm
Blood glucose of ____ or more 1 hour after birth is expected
40 mg/dL or more
The PTT therapeutic range for someone on Heparin is _____ - _____
46-70 PTT
Another ____lbs is lost over the next 2 weeks postpartum (after initial 12 lbs)
9 lbs
The peak of pathophysiologic jaundice occurs at what hour?
96
Normal newborn temperature
97.7-99.5 F
D-dimer test normal range
<0.5 (220-500)
INR normal range
<1.1 seconds
To prevent thrombocytopenia, you should hold heparin subQ if platelets are <_______?
<100k
What is a good APGAR score?
>7
What is normal newborn weightloss during the first 3-4 days of life?
5-6%
During a vaginal exam, if the cervix is to your middle knuckle, what % is effaced?
50%
Lactating mothers can increase calorie intake by how much?
500 calories
Another ____ lbs is lost by 6 months post delivery
6 lbs
By ____ weeks, the uterus should be back to nonpregnant size
6 weeks
It takes __-__ weeks for the vagina to regain its nonpregnant size and contour
6-10 weeks
Many women return to approximately pre-pregnant weight by ___-___ weeks postpartum
6-8 weeks
Normal newborn blood pressure
60-80 mmHg/40-50 mmHg
DO NOT give antiplatelets if the hemoglobin is less than _______?
7
Notify the health care provider if the aPTT value is greater than _____ seconds
70 seconds
The transition phase of stage one labor occurs when the cervix is __-__ cm dilated
8-10cm
During a vaginal exam, if the cervix is halfway between the tip and your first knuckle, what % is effaced?
80%
Clotting definition
A complex coagulation process involving platelets, and clotting factors that work together to stop bleeding; vasoconstriction reduces blood flow and allows the clotting process to start. Platelets are activated and stick to the injured blood vessel to form a platelet plug. Next, clotting factors are activated and proceed in a coagulation cascade to the common final pathway where thrombin stimulates fibrinogen to form insoluble fibrin that stabilizes the clot
At -5 station, the presenting part of the fetus is ABOVE OR BELOW the level of the iliac crests at the pelvic inlet
ABOVE
Station of -1 to -5 indicates what?
Baby's head is above mom's ischial spine (baby is deeper inside the pelvis)
Station +1 to +5 indicates what?
Baby's head is crowning and coming out
Station 0 indicates what?
Baby's head is level with mom's ischial spine (head is engaged and ready for labor)
After the membranes have ruptured, clean the area to prevent what?
Bacteria getting into the lungs (embolism)
Extended fetus is good or bad?
Bad
Pathologic jaundice
Begins in the first 24 hours and may require treatment with phototherapy
Pathologic jaundice occurs when?
Begins in the first 24 hours of life
Stage three begins with _____ and ends with ______
Begins with delivery of the neonate and ends with explusion of the placenta
Stage one of labor begins with _____ and ends with _____
Begins with onset of contractions and ends with complete dilatation
Stage 1 of labor
Begins with onset of regular contractions and ENDS when cervix is completely effaced and dilated
Steroid/corticosteroid examples
Bethamethasone or dexamethasone
When should placenta previa babies be delivered?
Between 37-38 weeks *Should not wait until 40 weeks
The ___________ system is responsible for forming clots, whereas the _________ system is responsible for dissolving them
Coagulation; fibrinolytic
Second stage of labor and birth
Complete dilatation to birth of newborn
Oxytocin, misoprostol, and dinoprostone are all used to ______ labor in pregnancy clients?
Induce
What is the expected progression of lochial changes during the puerperium?
Rubra, serosa, alba
Bethamethasone action
Speeds up lung development in babies by increasing surfactant production
The doctor has written an order for a contraction stress test (CST). The presence of which condition would prompt the nurse to question the order?
Vaginal bleeding
With a heparin drip, what should be assessed 6 hours after initiation or making a change to the pump rate?
aPTT
Interventions for a newborn with hypoglycemia
-BREASTFEED -Keep infant warm
True or false: at the height of the contraction, you palpate to check intensity
True
Having a full bladder during labor can lead to...
A displaced uterus *Need to open passage for baby to pass
A fundus that is deviated to the right during the fourth stage of labor commonly is caused by ___________
A distended bladder
How long should you listen to an infants apical pulse?
A full minute
A bluish discoloration of the cervix and vaginal mucosa is observed. This is a sign of pregnancy and is documented as...
Chadwicks sign
Darkening of the face in the shape of a "mask." is normal and called
Chloasma
You know, that early deceleration is caused by:
Compression of the fetal head
Variable decelerations are caused by...
Compression of the umbilical cord
What is a common long term side effect of opioid analgesics?
Constipation
Tocotransducer is used for monitoring...
Contractions
What should you monitor during administration of Oxytocin (Pitocin)?
Contractions *Discontinue if contractions last longer than 60 seconds
Oral contraceptives are a known risk factor for...
DVT
Terbutaline action
Delays preterm labor momentarily (about 48 hours) to suppress preterm labor
Decrement phase of contraction
Descending or relaxation of the uterine muscle
Positive signs of pregnancy
Diagnostic confirmation such as fetal heartbeat and ultrasound
Opioid analgesics (agonist/antagonist) (Butorphanol & Nalbuphine) action
Manage moderate to severe pain
True or false: beginning prenatal vitamins prior to conception (when a pregnancy is planned) may prevent the nausea and vomiting sometimes experienced during early pregnancy
True
What does cephalic presentation mean?
Head is first/down
What can cause hypovolemic shock?
Hemorrhage *Excessive loss of blood
Capillary refill time of 4 seconds is an early sign of what?
Hemorrhagic shock
Protamine sulfate is the antidote for ______
Heparin and enoxaparin
During the second stage of labor, the woman uses what to propel the fetus through the pelvis?
Her voluntary pushing efforts
Plus five cm means that the baby is positioned in what way in the pelvis?
Higher in the pelvis
The nurse identifies a right cephalohematoma on an otherwise healthy 1-day-old newborn. Which would the nurse teach the parents at the time of discharge?
How to monitor their child for signs of jaundice
This hormone is produced by ____ cells of the placenta soon after implantation of a fertilized ovum and is a biologic marker of pregnancy
Human chorionic gonadotropin (HCG)
This term describes excessive vomiting and is a disorder of pregnancy that can cause dehydration
Hyperemesis gravidarum *Should be reported and treated promptly
If a baby weighs 4.5 grams or more, what do you expect to monitor for?
Hypoglycemia
Late decelerations suggest fetal ______, secondary to poor perfusion of the placenta
Hypoxia
How would you administer vitamin K to an infant?
IM in outer thigh
Why is low temperature expected for a newborn with hypoglycemia?
If the blood sugar is low, the metabolism slows down and the baby becomes cold
Which action will the nurse anticipate needing to take when a client develops hypotension immediately after receiving spinal anesthesia?
Increase IV flow rate
Methergine causes the BP to ______, so do not use for ____________ patients)
Increase; hypertensive *assess vital signs
Which is a potential cause of fetal tachycardia when a client is in active labor?
Increased maternal metabolism
If fever is above 100.4 after 24 hours of delivery, it is an indication of _________
Infection
Internal fetal monitoring is a high risk for what?
Infection
With ruptured membranes, theres an increase risk for ________
Infection *Notify provider as soon as membranes rupture
Aspirin and Clopidogrel (Plavix) action
Inhibits platelet adhesion
Antifibrinolytic drug (Tranexamic acid (Cyklokapron)) action
Inhibits the breakdown of fibrin (promotes clot formation)
When a boggy uterus is noted during the fourth stage of labor, and the uterus is midline, the nurse should...
Massage the uterus to promote contraction *The uterus should be massaged only until it is firm (overstimulation can result in uterine atony
When is subinvolution evident?
May not be evident until well after discharge *Nurses should teach the family signs and symtpoms that may need to be reported to the healthcare provider
True or false: bloody show can happen 3 days before labor, or right before
True
True or false: breastfed babies are not likely to have allergies to their mother's breast milk
True
True or false: breastfed babies experience fewer respiratory illnesses than formula-fed babies
True
True or false: breastfeeding is more economical
True
True or false: crackles (rales) indicate fluid in the lungs and are expected immediately after birth
True
True or false: duration, intensity, frequency of contractions increase as labor progresses
True
Contractions that become more regular as time goes by and increase in intensity, frequency, and duration characterize true or false labor?
True labor
Contractions that begin in the lower back and radiate to the lower portion of the abdomen characterize true or false labor?
True labor
Contractions that intensify with walking or position change characterize false or true labor?
True labor
In response to the occurrence of a late deceleration, which of the following actions should be carried out FIRST?
Turn the mother on her left side
Infants of mothers with _____ are at a risk for respiratory distress syndrome
Type 1 diabetes
If a clients blood type is O and she is Rh-positive, problems related to incompatibility may develop in her infant if the infant is which blood type?
Type A or B
When does HELLP syndrome occur?
Usually 3rd trimester *Can be seen in 2nd trimester
Breast milk jaundice
-Bilirubin level begins to rise after first week, as physiologic jaundice waning -Related to composition of breast milk -Temporary cessation of breastfeeding may be advised
Fentanyl action
-Binds to opiate receptors, producing analgesia -Treats moderate to severe acute pain -Treats chronic pain (cancer pain)
Morphine sulfate action
-Binds with opioid receptors; reduces sympathetic stimulation and reduces HR, cardiac work -Treats SEVERE pain -Treats BOTH acute and chronic pain
A cord blood sample is collected and sent to the lab to assess ___________ and _________
-Blood gases -pH
Disseminated intravascular coagulopathy diagnosis testing
-Blood testing -CBC and platelet count -Coagulation studies -Fibrin degradation products -Fibrin split products -Fibrinogen levels -D-dimer
Factor 10A inhibitors action
-Blood thinner -Treats and prevents blood clots in veins
Signs of true labor
-Bloody show -Water breaking -True labor contractions -Dilatation of cervix
What are risk factors for uterin atony
-Boggy uterus -Multigravida -Precipitous labor -Preterm contractions -Long term induction w/ oxytocin (hemorrhage) -Tocolytics
If mother denies breastfeeding, what should the nurse do?
-Bottle feed infant -Avoid stimulation of the breasts
Opioid analgesics (agonist/antagonist) examples
-Butorphanol -Nalbuphine
Magnesium sulfate action
-CNS depressant and relaxes smooth muscles (uterus) -Reduces seizure risks in women with preeclampsia -Decreases uterine muscle contractions
Signs/symptoms of DVT
-Calf pain and cramping -One sided leg swelling -Warm, red leg -Shortness of breath and chest pain (NOTIFY HCP)
Indomethacin action
-Nonsteroidal anti-inflammatory agent (NSAID) -Inhibits production of prostaglandins which contribute to uterine contractions -Delays preterm labor before 31 weeks gestation
Anticoagulants examples
-Warfarin -Enoxaparin -Heparin -Direct thrombin inhibitors
Medical conditions that warrant C-section
-Cardiac conditions -Severe respiratory disease -Central nervous system (CNS) disorders that increase intracranial pressure -Mechanical vaginal obstruction -HIV infection in the mother -Severe mental illness resulting in altered state of consciousness
Pushing before the cervix is fully dilated could cause...
-Cervical edema -Tissue damage
"Active management" interventions for placenta previa
-Cesarean birth -Monitor maternal and fetal status -Continuous EFM -Best rest w/ IV -Monitor for bleeding
Indications to tell postpartum patient to call provider
-Change in temperature -Change in BP -Pink color blood changes to bright red
Late deceleration interventions
-Change to lateral side position -Start IV or increase rate -Stop oxytocin -Oxygen w/ face mask *if does not work, notify provider
Signs/symptoms of HELLP syndrome
-Nausea/vomiting/indigestion with **pain AFTER eating** *****Cardinal Sign: Epigastric Pain****** -Low platelets -Elevated enzymes -High blood pressure and protein in the urine (but not always present)*
Why do newborns need vitamin K shots right after birth?
-Newborns are unable to synthesize vitamin K due to absence of intestinal flora at birth -Vitamin K is needed to prevent bleeding problems in the early neonatal period
Interventions for an umbilical cord prolapse
-Call for assistance -Insert sterile gloved hand to relieve compression -Reposition mother (knee-chest position or Trendelenburg position) -Wrap cord loosely with a sterile towel or gauze soaked with sterile normal saline if protruding -Prepare for emergency C section
"Expectant management" interventions for placenta previa
-Assess for bleeding -Monitor for signs of preterm labor -Magnesium sulphate -Home care (if stable) -No vaginal or rectal exam -Pelvic rest -Type and screen to allow for immediate crossmatch -Antenatal corticosteroids if <34 weeks
Which assessments would be completed before administering uterine stimulants to induce labor?
-Assess the cervix to ensure readiness for labor induction -Assess the mother's pulse rate -Assess contractions and document -Assess fetal heart rate and document
What should be assessed before administering a uterine stimulant?
-BP -Pulse -RR
Station advances from -____ to +____ as the presenting part of the fetus descends through the pelvis
-5 to +5
Transition phase of labor?
-8-10 cm -Strong to very strong contractions
Deep vein thrombosis (DVT) definition
-A blood clot in a deep vein, most often an extremity -Inflammation of a vein that is often accompanied by the formation of a clot
Problems of the psyche of labor
-A perceived threat caused by fear, pain, or one's situation -Stress response of fight or flight
Umbilical cord prolapse
-A prolapsed umbilical cord slips down after the membranes rupture and becomes compressed between the fetus and pelvis *Prompt delivery of the fetus remains a priority
Signs of postpartum hemorrhage
-A uterus that does not contract or does not remain contracted -Large gush or slow, steady trickle, ooze, or dribble of blood from the vagina -Saturation of one peripad over 15 minutes -Severe, unrelieved perineal or rectal pain -Tachycardia
Clinical manifestations of uterine rupture
-Abdominal pain and tenderness -Chest pain or pain in the shoulder area -Hypovolemic shock -Abnormal fetal heart rate patterns -Absent fetal heart sounds -Cessation of contractions -Palpation of the fetus outside of the uterus
Cord blood analysis in cases of...
-Abnormal FHR patterns -Meconium-stained amniotic fluid -Newborn depressed at birth -Apgar score <7 at 5 minutes of age
Clotting symptoms
-Aching pain in affected extremity, especially when walking -Possible tenderness, warmth, erythema -Cyanosis, edema of affected extremity -Palpable cord along affected vein (RARE) *May differ greatly in severity *Primarily caused by inflammatory process
Newborns who have not voided within 48 hours should be assessed for...
-Adequacy of fluid intake -Bladder distention -Restlessness and symptoms of pain
What care should the nurse provide to a newborn delivered 1 hour ago during the transitional period?
-Administer IM vitamin K -Encourage skin-to-skin contact with mother -Perform a gestational assessment -Administer Hep B vaccine
What priority nursing interventions would be implemented for maternal hypotension secondary to regional anesthesia and analesgia?
-Administer oxygen -Place the woman in a lateral position -Increase IV fluids
Transitional milk
-After 30-72 hours of colostrum production -More copious than colostrum -Contains more fat, lactose, water-soluble vitamins, calories
If placental abruption is present, what should the nurse prepare for?
-Anticipate emergent C section -Apply continuous external fetal monitoring -IV access and draw blood -Bed rest -Tocolytics -Monitor for signs of hypovolemic shock, pallor, tachycardia, hypotension
Interventions for DVT
-Anticoagulants -Ambulation or leg exercises -Elevation w/ pillows -No tight clothes -Compression stockings *DO NOT sit patient up in 90 degree angle (difficult for blood to circulate
Psyche of birthing process
-Anxiety -Fear -Fatigue *Decreases a woman's ability to cope with pain in labor
Antiplatelet drugs examples
-Aspirin -Clopidogrel (Plavix)
Disseminated intravascular coagulopathy implementation (promotion of effective tissue perfusion)
-Assess extremity pulses, warmth, capillary refill -Monitor LOC, mental status -Carefully reposition at least every 2 hours -Discourage leg crossing, do not elevate knees with pillow -Minimize use of tape on skin
Clotting interventions
-Clean affected leg and foot daily -Use egg-crate mattress or sheepskin on bed -Encourage frequent position changes (at least every 2 hours) -Encourage increased fluid, dietary fiber intake -Encourage early ambulation as allowed, assist as needed -Low-molecular-weight heparins (LMWH) -Oral anticoagulation -Elevating foot of bed, knees slightly flexed (above heart level) -Leg exercises -Intermittent pneumatic compression devices -Elastic stockings
Methylergonovine (Methergine) action
-Controls postpartum bleeding, hemorrhage, and atony -Prevents/treats excessive bleeding after childbirth
Acute disseminated intravascular coagulopathy is characterized by:
-Develops rapidly over hours/days -Must be treated immediately
Chronic disseminated intravascular coagulopathy is characterized by:
-Develops slowly over weeks/months -Lasts longer, not typically diagnosed as quickly -Causes excessive clotting but usually not bleeding -Patients with cancerous tumors, aortic aneurysms commonly affected
What criteria must be met in order to perform internal monitoring?
-Dilatated at least 2cm -Membranes must be ruptured
Disseminated intravascular coagulopathy (definition)
-Disruption of hemostasis characterized by widespread intravascular clotting and bleeding -Ranges from mild to acute and life-threatening
Interventions for disseminated intravascular coagulation
-Draw coagulation tests, fibrinogen, and platelet count -Administer blood products, volume expanders, and oxygen -Monitor for bleeding (IV sites, ears, nose etc.)
Postpartum hemorrhage interventions
-Early recognition is critical -First step is evaluation of contractility of uterus -Firm massage of fundus -Minimizing blood loss -Check for bladder distention -Laboratory studies -Administer fluids and medications
Nursing interventions to reduce pain related to decreased venous flow
-Elevate the affected leg -Apply a warm compress
Interventions for mother who is constipated after birth
-Encourage woman to maintain high fluid intake -Dietary sources of fiber may be helpful
If a mother states that she cannot do it anymore (labor), the nurse should do what?
-Evaluate the labor pattern and determine what factors are obstructing the labor process -Determine what factors are obstructing the labor process -Continue to monitor fetal and maternal well-being -Reassess the four Ps
What are the two main concerns regarding abruptio placentae?
-Excessive bleeding -Fetal hypoxia
Maternal outcomes due to placenta previa
-Excessive bleeding -Hysterectomy -Trauma -Blood transfusion
What are interventions for a breech baby?
-External cephalic version (ECV) -C-section
Constipation postpartum can be caused by...
-Fear due to episiotomy and tearing -Increase in progesterone
Opioid analgesics (agonists) examples
-Fentanyl -Morphine sulfate
Indications for labor induction and augmentation
-Fetal compromise (intrauterine growth restriction, Rh incompatibility) -Spontaneous rupture of membranes near term -Postterm pregnancy -Chorioamnionitis -Hypertension associated with pregnancy -Maternal medical conditions -Diabetes mellitus -PROM -Chorioamnionitis -Mild abruptio placentae -Intrauterine fetal demise -Isoimmunization -Oligohydramnios -Nonreassuring fetal status, nonreassuring antepartum testing
Meconium-stained fluid indicates what?
-Fetal distress -Hypoxia -Aspiration risk
Late decelerations indicate what?
-Fetal hypoxia -Placental insufficiency
Indications for episiotomy
-Fetal shoulder dystocia -Forceps- or vacuum-assisted birth -Fetus in occiput posterior position
Problems of the passenger of labor
-Fetal size -Macrosomia -Shoulder dystocia -Abnormal fetal presentation or position -Multi-fetal pregnancy -Fetal anomalies
Signs associated with intrapartum infection
-Fetal tachycardia (greater than 160 bpm) -Maternal fever (38°C or 100.4°F) -Foul- or strong-smelling amniotic fluid -Cloudy or yellow amniotic fluid
Which characteristics are scored on a biophysical profile?
-Fetal tone -Fetal movement -Amniotic fluid index -Fetal breathing movements
Passenger of birthing process
-Fetus -Membranes -Placenta
"Expectant management" criteria for placenta abruption
-Fetus <34 weeks gestation -Both mother and fetus are stable
Early postpartum hemorrhage criteria
-First 24 hrs postpartum -Cumulative blood loss of 1000mL or greater
Apgar scoring 0, 1, or 2 for each of the following...
-Heart rate -Respiratory effort -Muscle tone -Reflex irritability -Skin color
Causes of pathologic jaundice
-Hemolytic disease -Trauma -Blood incompatibility -Instrument delivery (forceps, vacuum, etc) -Excessive blood destruction (the liver cannot break it down) *Anything that will cause hemolysis
Risk factors for disseminated intravascular coagulopathy risk factors
-Hemolytic reactions to blood transfusions -Bacterial or fungal blood infections -Large hemangioma -Certain types of leukemia, pancreatitis, liver disease -Recent surgery or anesthesia -Severe tissue damage -Pregnancy complications -Sepsis -Trauma
Side effects of oxytocin
-Hypertension -Frequent/intense contractions
Disseminated intravascular coagulopathy implementation (manage pain)
-Identifying etiology of pain is important -Handle extremities gently -Apply cool compress to painful joints
"Active management" criteria for placenta abruption
-If the fetus is term -Bleeding is moderate or severe -If mother or fetus is in jeopardy
"Active management" interventions for placenta abruption
-Immediate birth -Large bore IV line -Monitor vital signs -Continuous EFM -Laboratory studies (hematocrit, H&G, clotting studies) -Indwelling catheter -Fluid replacement -Blood administration -Vaginal birth may be feasible -Labor induction and augmentation -Monitor mother and fetus for any sign of compromise -Provide emotional support -C section may be necessary **(NOT to be attempted in severe bleeding or uncorrected coagulopathy
Colostrum
-Immediately available to baby at birth -Provides all nutrition required until mother's milk becomes more abundant
Placenta previa characteristics
-Implantation of the placenta in the lower uterus -Can be near or completely over internal cervical os
What is oxytocin used for?
-Induction of labor -Augmentation of labor *Helps with contractions
Problems of the powers of labor
-Ineffective contractions -Uterine overdistention - hydramnios -Hypotonic labor dysfunction -Hypertonic labor dysfunction -Ineffective maternal pushing
Antiplatelet drug (aspirin, clopidogrel) action
-Inhibits platelet aggregation/adhesion (inhibits clot formation)
How would the nurse educate the mother on breaking newborns suction when breastfeeding?
-Insert a finger into the corner of the newborns mouth before removing them from the breast
Assessment techniques to determine fetal position
-Inspection, palpation of maternal abdomen -Vaginal examination
Complications of a prolonged pregnancy
-Insufficiency of placental function -Meconium aspiration -Dysfunctional labor due to continued fetal growth
Perineal trauma management
-Involves repairing the trauma before excessive blood loss occurs -Visualization of lacerations may be difficult
Signs of hypoglycemia in newborn
-Jitteriness, tremors -Poor muscle tone -Sweating -Tachypnea -Grunting -Cyanosis -Apnea -Diaphoresis -Low temperature -Poor suck -High-pitched cry -Lethargy -Irritability -Seizures, coma
Clotting diagnostic tests
-Laboratory studies (D-dimer, prothrombin time (PT), partial thromboplastin time (PTT), activated partial thromboplastin time (aPTT), bleeding time, platelet count -Duplex venous ultrasonography -Plethysmography -MRI -Ascending contrast venography
What are the 3 phases of first stage of labor?
-Latent -Active -Transition
What should the nurse suggest for a mother complaining of back labor pain?
-Lean over a birth ball with her knees on the floor -Counter pressure against sacrum
Signs/symptoms of hypoglycemia in a newborn
-Less than 40 mg/dL -Shaking, sweating and irritable -Lethargy -High-pitched or weak cry -Seizures
Local anesthesia examples
-Lidocaine -Bupivacaine
Premonitory signs of labor
-Lighening -Braxton hicks contractions -Rupture of membranes -Sudden burst of energy (usually 24-48 hours before labor) -Weight loss, diarrhea, indigestion, nausea, vomiting
Signs of a distended bladder
-Location of fundus above baseline level -Fundus displaced from midline -Excessive lochia -Bladder discomfort -Bulge of bladder above symphysis -Frequent voiding of less than 150mL
Signs and symptoms of hypoglycemia in a newborn
-Low temperature -Lethargic -Poor feeding (give glucose IV)
Which assessments and interventions are necessary once an epidural catheter has been inserted?
-Maintain IV fluid administration -Have oxygen available in case of hypotension -Check the bladder for distention every 2 hours -Monitor fetal heart rate and labor progress per hospital protocol
Postpartum hemorrhage define
-Major cause of maternal mortality and morbidity -Life threatening with little warning -Dark blood is probably of venous origin such as superficial laceration of the birth canal -Bright blood is arterial and can indicate deep laceration of the cervix
Fetal outcomes due to placenta previa
-Malpresentation -Preterm birth -Fetal anemia -Congenital anomalies
3 classifications of placenta previa
-Marginal -Partial -Total
Risk factors for placenta abruption
-Maternal hypertension (most profound) -Cocain use (due to vascular disruption in the placental bed -Blunt external abdominal trauma (MVAs) -Cigarette smoking -Previous abortion -Multiple gestation -Acquired thrombophlebitis
Grade 1 classification of placenta abruption
-Mild -10-20% separation -<500mL blood loss
Postpartum blues/baby blues definition and when does it occur?
-Mild depression -Begins in the first week postpartum, but should not last longer than 2 weeks
When cervix is unfavorable, cervical ripening agents may be used such as...
-Misoprostol (Cytotec) -Formulations of prostaglandin E2 -Mechanical methods -Balloon catheter to encourage dilatation
Grade 2 classification of placenta abruption
-Moderate -20-50% separation -1000-1500mL blood loss
Category 2 FHR indicates what?
-Moderate -Monitor patient
What are risk factors for hypoglycemia in an infant?
-Mom with diabetes -Hypothermia -Sepsis
Interventions for HELLP
-Monitor blood pressure -Promote safety of mother and baby
"Expectant management" interventions for placenta abruption
-Monitor for abruption -Fetal well-being (NST, BPP, IUGR) -Corticosteroids given for fetal lung maturity
Disseminated intravascular coagulopathy implementation (monitor gas exchange)
-Monitor oxygen saturation continuously -Place in Fowler or high-fowler position -Maintain bedrest -Encourage deep breathing, effective coughing -Use nasotracheal suctioning with caution -Administer analgesics, antianxiety drugs, as needed
Indications for use of forceps
-Nulliparity -Maternal age (35 and over) -Maternal height less than 150 cm (4'11") -Pregnancy weight gain >15 kg (33 lb) -Postdate gestation (41 weeks or more) -Epidural anesthesia -Infant presentation other than occipitoanterior -Presence of dystocia -Presence of midline episiotomy -Abnormal FHR tracing
What are the worst fetal positions?
-OP (occiput posterior (left or right)) -OT (occiput transverse (left or right))
Breastfeeding jaundice
-Occurs during first few days of life in breastfed newborns -Appears to be related to inadequate fluid intake, not milk composition
Signs and symtpoms of infection postpartum
-Odor -Irregular bleeding/color (change from light pink to bright red) -Rise in temperature (above 100.4) -Signs of DVT
Amniotomy purpose
-Often done in conjunction with induction of labor -Enables internal electronic fetal monitoring
Predisposing factors (postpartum hemorrhage)
-Overdistention of the uterus (multiple gestation, large infant, hydramnios) -Multiparity (>5) -Rapid or prolonged labor -Placenta previa -Previous placenta accreta -Abruptio placentae -Drugs (prolonged oxytocin, prostaglandins, tocolyticcs, magnesium sulfate) -Use of forceps or vacuum extractor -Cesarean birth -Uterine leiomyomas (fibroids) -Previous postpartum hemorrhage or uterine surgery -General anesthesia -Preeclampsia -Clotting/coagulation disorders/DIC
Uterine stimulant examples
-Oxytocin (Pitocin) -Methylergonovine (Methergine) -Misoprostol (Cytotec) -Prostaglandins (Dinanrostone) (Prostin E 2, Servidil, Prepidil)
Medications that can cause postpartum hemorrhage
-Oxytocin (prolonged) -Tocolytics -Magnesium sulfate
Anticoagulants (Warfarin, Enoxaparin, Heparin, and Direct thrombin inhibitor) action
-PREVENTS formation of a clot -PREVENTING GROWTH of existing clots *CANNOT get rid of a preexisting clot
Which interventions are included in the immediate care plan of a postpartum client with a fourth-degree laceration?
-Pain management with oral analgesics -Assessment of the site every 15 minutes -Application of an ice pack for 20 minute intervals
Clinical manifestations of placenta previa
-Painless bright red vaginal bleeding (2nd or 3rd trimester) *due to stretching and thinning of the lower uterine segment -Initial bleeding may be small -Abdomen is soft, relaxed, and nontender -Fundal height higher than expected -Presenting part of the fetus is usually high (because placenta occupies the lower uterine segment) -Fetal malpresentation is common -Maternal vitals and fetal HR may be normal
Problems of the passage of labor
-Pelvis -Maternal soft tissue obstructions
What would the nurse plan to instruct the client regarding the effectiveness of the block?
-Perineal pain will not be felt -The bearing-down reflex will be diminished
During the transition phase, women who do NOT receive epidural will experience...
-Physical shaking -Reluctant to be touched -Amnesia between contractions -Diaphoresis
What medications ripen the cervix?
-Pitocin -Prostaglandins -Prepadil -Misoprostol
Causes and risks for disseminated intravascular coagulation
-Placental abruption -Stillbirth (intrauterine fetal demise)
Four components of the birthing process
-Powers -Passage -Passenger -Psyche
Disseminated intravascular coagulopathy can lead to...
-Preeclampsia -Fetal death -Amniotic fluid embolism -Septic abortion -Placental abruption (degree of separation correlates with severity of DIC) -HELLP syndrome Hemolysis (H( Elevated Liver enzymes (EL) Low Platelet (LP)
HELLP syndrome is often a complication of what?
-Preeclampsia, most often related to severe preeclampsia
PROM stands for what? and occurs when?
-Premature rupture of membranes -Occurs before onset of labor
Mature milk
-Present by 2 weeks postpartum -Contains 13% solids, 87% water -Solids: carbohydrates, proteins, fats -Despite thin appearance, provides baby with all necessary nutrients
PPROM stands for what? and occurs when?
-Preterm premature rupture of membranes -Occurs before 37 weeks of gestation
Direct thrombin inhibitors actions
-Prevents blood clots -Bind directly to thrombin -Used to prevent arterial and venous thrombosis or DVT
Tranexamic acid (Cyklokapron) action
-Prevents the formation of plasmin from plasminogen -Prevents and controls excessive bleeding that results from surgery or overactivity of fibrinolytic system
Risk factors for placenta previa
-Previous cesarean birth -Advance maternal age (35-40 years of age) -Multiparity -Prior suction curettage (induced abortion or miscarriage) -Multiple gestation -Placenta previa in previous pregnancy
Amniotomy risks
-Prolapse and compression of the umbilical cord -The risk for infection increases the longer the membranes have been ruptured (chorioamnionitis). -Abruptio placentae
Signs/symptoms of subinvolution
-Prolonged discharge of lochia -Irregular or excessive uterine bleeding -Profuse hemorrhage -Pelvic pain -Backache -Fatigue -Persistent malaise
During the vaginal exam, if you see the cord, what can you do?
-Put the mom in trendelesnburg position -Put the mom in knee to chest position -Put your hand on babys head and lift it off of the cord
What are the best fetal positions?
-ROA (right occiput anterior) -LOA (left occiput anterior)
What are immediate assessments for a newborn?
-RR -HR -Suctioning -Stimulation -ID bands -APGAR
Disseminated intravascular coagulopathy assessment (observation and patient interview)
-Recent medical history -Blood transfusions, trauma -Current pregnancy, recent abortion -Known malignancies -History of abnormal bleeding -Exposure to infectious diseases -Nosebleeds, bleeding gums, bruising, or ecchymosis
If APGAR score is less than 7 at 5 minutes...
-Repeat scoring every 5 minutes up to 20 minutes -Resuscitative measures may be needed
Disseminated intravascular coagulopathy treatment
-Replacement of blood, blood products -Use of anticoagulants -Supportive care -Management of major obstetric bleeding similar to that of trauma patients
Interventions for late decelerations
-Reposition mom to side lying -Oxygen via facemask -Alert the HCP -Discontinue oxytocin -IV fluids *Prepare for C section if late decelerations persist
Variable deceleration interventions
-Reposition the mom on lateral side -Oxygen *if does not work = notify the physician amnio infusion
Methods of heat production for newborns
-Restlessness and crying -Flexion and increased activity -Metabolism rises -Vasoconstriction -Nonshivering thermogenesis (brown fat)
Factors that increase the risk for prolapsed umbilical cord
-Ruptured membranes -Fetal presenting part at high station -Fetus that poorly fits pelvic inlet because of small size or abnormal presentation -Excessive volume of amniotic fluid (hydramnios)
Causes/risk factors for placenta previa are...
-Scar tissue -Previous C-section -Previous abortion -Previous uterine surgery -Maternal age 35 or older -Smoking
Grade 3 classification of placenta abruption
-Severe ->50% separation ->1500mL blood loss
Peri-care for pain management should consist of what?
-Sitz bath -Ice packs -Opioids & NSAIDS Laxatives and stool softeners (prevent constipation)
Newborn characteristics leading to heat loss
-Skin with little subcutaneous (white) fat -Blood vessels close to the surface -Large skin surface
Category 3 FHR indicates what?
-Something is wrong -Non-reassuring
SROM stands for what? and occurs when?
-Spontaneous rupture of membranes -Occurs at height of intense contraction
Peri-care for cleaning should consist of what?
-Squeeze bottle with warm water -Wipe front to back -Blot perineum dry
Oxytocin (Pitocin) action
-Stimulates or improves uterine contractions -Controls postpartum bleeding and hemorrhage -Induces labor -Completes an incomplete abortion
Signs and symptoms of placenta abruption
-Sudden onset of intense localized uterine pain -Uterine tenderness and contractions -Uterine hyperactivity -increasing uterine resting tone -Coagulopathy -Increase in fundal height (concealed hemorrhage) -Hard, board-like abdomen -High uterine basline tone on electronic monitoring strip -Persistent abdominal pain -Systemic signs of early hemorrhage (tachycardia [maternal and fetal], low blood pressure, restlessness) -Persistent late deceleration in fetal heart rate or decreasing baseline variability -Vaginal bleeding can be slight or absent
If a patient is adament about pushing before the cervix is fully dialated, what should the nurse do?
-Tell the patient to pant through contractions -Help the patient assume the knee-chest position if the urge to push is uncontrollable
Tocolytics examples
-Terbutaline -Indomethacin -Nifedipine
Lightening
-The sensation of the fetus moving from high in the abdomen to low in the birth canal -Baby dropping
Clotting (pharmacology)
-Thrombolytic drugs to accelerate clot lysis -NSAIDs to reduce inflammation in veins, provide symptom relief -Anticoagulants (heparin, warfarin, LMWH, direct thrombin inhibitors, factor Xa inhibitors)
Interventions for uterine inversion
-Tocolytics (terbutaline or magnesium sulfate) -Provider repositions the uterus -Oxytocin (AFTER uterus has been repositioned) -IV fluids and blood products
Placenta previa diagnosis tests
-Transabdominal ultrasound examination (standard diagnosis) -Transvaginal ultrasound (determines accurate determination of placenta location)
If feeding the newborn does not help decreasing jaundice, what should be done next?
-Use phototherapy (cover infants eyes to protect) *Assess for dehydration (check skin and diaper)
Misoprostol (Cytotec) action
-Used for postpartum hemorrhaging -Cervical ripening
RhoGAM shot action
-Used to prevent a condition called (Rh) incompatability -Stops the mothers blood from making antibodies that attack Rh+ blood cells
Powers of birthing process
-Uterine contractions -Maternal pushing
The two powers of labor
-Uterine contractions -Maternal pushing efforts
How can engagement be determined?
-Vaginal examination -Leopold maneuver
Thrombus formation
-Vascular damage stimulated clotting cascade -Thrombus propagates in direction of blood flow, triggering inflammatory response -Thrombus first floats within a vein, pieces break loose, travel through circulation as emboli
Disseminated intravascular coagulopathy assessment (physical examination)
-Vital signs -Heart, breath sounds -Skin color, temperature condition (examine for petechiae, purpura) -Abdominal assessment
The nurse identifies three contractions lasting 80-90 seconds and less than 2 minutes apart in a client receiving a piggyback infusion of oxytocin to augment labor. What is the correct order of priority for the nursing actions that would be taken?
1. Titrate the piggyback infusion 2. Check the fetal heart rate 3. Determine whether the contractions have diminished 4. Notify the primary healthcare provider 5. Administer oxygen by face mask 6. Document the responses of the client and fetus
If the newborn cries and pulls away, what APGAR score would you give for "grimace (reaction and reflex)"?
2
If the newborn has a pulse over 100/min, what APGAR score would you give for "pulse (heart rate)"?
2
If the newborn has active flexion and extension, what APGAR score would you give for "activity (muscle tone)"?
2
If the newborn is completely pink, what APGAR score would you give for "appearance (skin color)"?
2
Minimal sensation in lower extremities due to epidural anestesia results in a risk for what?
A risk for injury
Subinvolution (definition)
A slower than expected return of the uterus to its nonpregnant size and consistency *Can be due to retention of placental fragments or pelvic infection
Poor weight gain during the first trimester is associated with an increased risk of __________________
A small for gestational age (SGA) infant *If the poor weight gain occurs in the last half of pregnancy, theres an increased risk for preterm delivery
Sudden vaginal bleeding and increased uterine tone without relaxation between contractions is indicative of which complication?
Abruptio placentae; assess the fetal heart rate, uterine activity, and blood pressure
Landmark for shoulder presentations
Acromion process of scapula
This is the best method for the nurse to use to obtain immediate assistance at the bedside
Activate the priority call light from the bedside *ALWAYS stay with the client
Treatment for Aspirin toxicity
Activated charcoal
The patient is in bed and need assitance with pain during which phase of labor?
Active labor
Breathing techniques are in full swing, 4-7cm dilated, and 100% effaced occur during which phase of labor?
Active phase
An indirect Coombs' test is performed on a pregnant Rh negative client to predict fetal risk for which disorder?
Acute hemolytic anemia
How can constipation be prevented while taking opioid analgesics?
Adequake fluid and fiber intake
If a Rh negative client experiences a miscarriage at 10 weeks' gestation, which action would the nurse anticipate regarding the administration of Rho(D) immune globulin?
Administration of one intramuscular microdose of Rho(D) immune globulin
Preterm labor begins after the ____th week but prior to the end of the ____th week of gestation
After 20th week, but prior to the end of the 37th week of gestation
Physiologic jaundice occurs
After 24 hours of life
When should you hear bowel sounds in a baby?
After they begin to feed
This is a deadly condition that occurs when amniotic fluid inside the uterus leaks out and enters the mother's bloodstream, leading to very high risk for mortality in both the mother and baby. It occurs most often during delivery or in the immediate recovery period
Amniotic fluid embolism
What is an acceleration?
An abrupt increase in fetal heart rate above the baseline of 15 beats/min for 15 seconds
Physiologic anemia of pregnancy/hemodilution of pregnancy
An increase in plasma volume in excess of an increase in red blood cells
What does an extended fetus indicate?
CNS problems
What must be present before the nurse initiates internal fetal monitoring?
Cervical dilatation of at least 2cm and ruptured membranes
This fontanel usually closes in 18 months
Anterior fontanel
If sepsis is the cause of DIC, what should the treatment be?
Antibiotics
If the mother is colonized with GBS or becomes high risk for GBS infection, what would she be treated with?
Antibiotics (penicillin G or ampicillin
_________ are used for prevention of growth of EXISTING clots
Anticoagulants
Treatment for clotting
Anticoagulation (heparin is preferred)
What medication should be given for patients with DVT?
Anticoagulatns
If malpresentations cannot be altered, __________ is generally required
Cesarean birth
What are the priority nursing actions to address the mothers needs related to the repair of a 4th degree perineal laceration?
Apply perineal ice packs consistently for the first 24-48 hours (prevents hematoma and provides comfort)
Third stage of labor and birth
Birth of newborn to delivery of placenta
Most common cause of displaced fundus
Bladder distention
Why is there is a high incidence of urinary retention after epidural anesthesia?
Blockage of the nerves to the bladder is the last to be reversed with epidural anesthesia
Epidural can cause a sharp drop in _____
Blood pressure
A ______ uterus is not good, and a ______ uterus is good
Boggy; firm
These types of contractions disappear with walking or position change and do not dilate the cervix
Braxton hicks contractions/false labor contractions
Which action is the physiological mechanism of phototherapy?
Breaks down the bilirubin into a conjugated form
Thrombolytics (Alteplase (Activase), Reteplase (Retavase), and Tenecteplase) action
Breaks down/dissolves CLOTS
Increment phase of contraction
Buildup of the contraction that begins in the fundus and spreads throughout the uterus
This is severe bleeding inside and outside the mother's body. As the body uses up all clotting factors and platelets; it makes little clots all over the body
Disseminated intravascular coagulation
Which is the nurse's priority assessment for a client in the fourth stage of labor?
Distention of the bladder
When can mothers receive epidural?
During the active stage of labor (3cm+)
When is the best time for the nurse to teach simple breating and relaxation techniques to a client in labor?
During the latent phase of the first stage of labor
Continue to monitor patient if ________ decelerations occur
Early
The client is relaxed and contractions are mild during which phase of labor?
Early/latent phase
Shortening and thinning of the cervix is called
Effacing
What hormone causes itching and a reddened appearance of the hands and feet?
Estrogen
Remind the woman to empty her bladder at least every ____ hours
Every 2 hours *Catheterization is sometimes needed
How often should prenatal visits occur?
Every four weeks until 28 weeks, every two weeks until 36 weeks, then weekly until delivery *Visits increase because the risk of complications associated with pregnancy increases as pregnancy advances
Which is the initial nursing action when a pregnant patient requests something for pain?
Examine the client's cervix for dilation and effacement
True or false: the nurse can delegate education
FALSE; nurses must perform this task
True or false: wheezes, stridor, or persistent crackles after the first few hours after birth are normal
False
True or false: when breastfeeding, you should clean breasts with soap and water
False *Soap should be avoided as it can cause dryness and lead to cracking
Contractions that begin in the abdomen and radiate to the back characterize false or true labor?
False labor
Discomfort of TRUE OR FALSE LABOR contractions may be relieved by ambulation, changing positions, drinking a lot of water, taking a warm shower or tub bath
False labor
Heparin has a ______ onset and lasts ______
Fast; shorter period of time
Early decelerations are due to
Fetal head compression
Crowning definition
Fetal head remains visible at vaginal os between contractions *Birth is imminent
Ultrasound transducer is used for monitoring...
Fetal heart rate
What should you assess before administering prostaglandins?
Fetal heartrate
Meconium (fetal stool) is normally passed after delivery of the fetus, but it may be passed before delivery, in response to _______________ and ____________
Fetal hypoxia and relaxation of the anal sphincter
Acceptance of the biologic fact of pregnancy characterizes the ____ trimester
First; the pregnant woman needs to acknowledge "I am pregnant" as she accepts the immediate reality of the pregnancy itself
Duration of a contraction is measured
From the beginning of one to the end of the same contraction
A uterus that is displaced to the right would suggest a...
Full bladder
"Ear should be stiff and firm" is a characteristic of a full term or preterm newborn?
Full term
"Pinna: fast recoil" is a characteristic of a full term or preterm newborn?
Full term
"Scrotum will have rouge" is a characteristic of a full term or preterm newborn?
Full term
"Testicles are descended" is a characteristic of a full term or preterm newborn?
Full term
"Well flexed tone" is a characteristic of a full term or preterm newborn?
Full term
Plantar creases covering 2/3 of the sole of foot and well defined nipples with raised areola are consistent findings with an infant born preterm or full term?
Full term
Accelerations indicate good or bad oxygenation for the baby?
Good
Fully flexed fetus is good or bad?
Good
What will the abdomen feel like with placental abruption?
Hard and firm
Immediately after delivery, a sudden gush of blood from the vagina accompanied by an apparent lengthening of the umbilical cord is to be expected. It generally indicates that the placenta...
Has seperated form the wall of the uterus and will soon be expelled
Pitocin (oxytocin) is a hormone that causes...
Intermittent uterine contractions
The term that describes the expected gradual reduction in size of the uterus after delivery as it contracts to return to normal size is...
Involution
What process is being described? -Begins immediately after expulsion of the placenta -Progresses rapidly during the next few days after birth -The return of the uterus to a nonpregnant state after birth
Involution
Press and release to asses for yellow blanching is detecting what?
Jaundice
Encourage leg exercises and ambulation (compression stockings) in labor to...
Keep blood flowing *DO NOT ambulate immediately, start with leg exercises
Lochia should become ______ in color and amount with each passing postpartum day
LIGHTER
Fourth stage of labor and birth
Lasts 1-4 hours after delivery
The patient can still walk around during which phase of labor?
Latent phase
What position is best for administration of epidural?
Lateral arch or sitting and bending over
What landmark should the newborns heart rate be assessed at?
Left side, below the nippe (4th intercostal space)
A dark line down the middle of the skin on the abdomen is called...
Linea nigra
The vaginal discharge that occurs during the postpartum period (puerperium), which and consists of blood, tissue, and mucous, is called...
Lochia
This term describes the discharge after birth from the sloughing off of the inner lining of the uterus
Lochia
Contractions will become ________ and ________ frequent as labor progresses through the active portion of the first stage of labor
Longer; more frequent
What fetal lie is best for vaginal delivery?
Longitudinal lie (mother and baby body are parallel)
"Partial" classification of placenta previa
Lower border of placenta is within 3cm of internal cervical os but does not fully cover it
Minus five cm means that the baby is positioned in what way in the pelvis?
Lower in the pelvis
Why would the nurse instruct a pregnant woman in labor that she must avoid lying on her back?
Lying in the supine position causes decreased placental perfusion
Anticonvulsants/antidysrhythmic examples
Magnesium sulfate
Calcium gluconate is the antidote for _________
Magnesium sulfate
How would you accurately measure contraction frequency?
Measure the time from the beginning of one contraction to the beginning of the next
RoGAM
Medication given to mothers pregnant, who are Rh-, with their second child -Prevents mothers body from developing antibodies and attacking the fetus
What should you avoid if you're taking factor 10A inhibitors?
Medications that increase bleeding *Aspirin
Increase secretion of __________ causes pigmentation changes to the skin, including chloasma (mask of pregnancy)
Melanotropin
Landmark for face presentations
Mentum
This medication can be given for moderate postpartum hemorrhage
Methergine
Do not give this drug to clients with hypertension (preeclampsia and pre-existing hypertension)
Methylergonovine (Methergine)
Do not use this drug before the delivery of the placenta
Methylergonovine (Methergine)
This medication can be given vaginally to stop hemorrhaging *Check FHR before administration
Misoprostol
The correct term for the cone shape of a vaginally-delivered infant's head is called...
Molding
What should the nurse do if the infant is crying, skin is mottled, and hands are shaking?
Monitor the blood glucose level
Which factor in a client's history would suggest a risk for preterm labor?
Multiple urinary tract infections
Opioid analgesics (antagonists) examples
Naloxone
Vitamin B6 and/or ginger capsules are sometimes recommended when _____ is a problem during pregnancy
Nausea *Acupuncture and acupressure are effective non-pharmacological measures for relief of nausea
Rise in human chorionic gonadotropin early in pregnancy causes what symptoms?
Nausea and vomiting (morning sickness)
If presenting part of fetus is higher, the number is NEGATIVE OR POSITIVE?
Negative
RhoGAM is not necessary if the infant is Rh ________ (negative or positive)
Negative
Nasal flaring and costal/sternal retractions indicate what in the newborn?
Neonatal distress
Do local anesthesia (Lidocaine & Bupivacaine) cause loss of consciousness?
No
Should you avoid vitamin K while taking factor 10A inhibitors or warfarin?
No *No need to decrease, increase, or avoid vitamin K (keep it consistent)
If a client with placenta previa is actively bleeding, should the baby be delivered?
No, control/manage bleeding first
Should a client patient recieve warfarin?
No, pregnancy is contraindication of warfarin
What is the tool used to determine delivery date
Nägele's rule
Probable signs of pregnancy
Objective data such as cervical changes
Landmark for vertex presentations
Occiput
________ _______ is the most common fetal presentation
Occiput anterior
Patients should be instructed to change positions slowly to prevent possible orthostatic hypotension when taking what drug?
Opioid analgesics
Postpartum hemorrhage is characterized as bleeding over ______ mL and can occur for up to ______ weeks postpartum
Over 1000 mL; 2 weeks postpartum
This is a hormone from posterial pituitary; stop this drug if contractions are too frequent and long
Oxytocin
Which drug is used for treating a client with severe postpartum bleeding?
Oxytocin
Hyperbilirubinemia is known as what kind of jaundice?
Pathologic jaundice
This type of jaundice occurs within the first 12-24 hours
Pathologic jaundice
Acme phase of contraction
Peak of intensity
A client who had tocolytic therapy for preterm labor is being discharged. Which instruction would the nurse include in the teaching plan?
Pelvic rest
Why do people with DIC need heparin?
People with DIC have multiple micro-emboli/fibrin split floating around so they require heparin to consume the fibrin split products *Heparin stops the micro clots from turning into bigger clots
"Bleeding and formation of a hematoma on the maternal side of the placenta" and "bleeding may be visible or concealed" describes what complication?
Placenta abruption
This term describes a placenta that attaches to the uterus too firmly
Placenta accreta
"Total" classification of placenta previa
Placenta completely covers internal cervical os
It is called _____ when there is poor perfusion to baby when there's a prolonged pregnancy (40+ weeks)
Placenta degeneration
"Marginal" classification of placenta previa
Placenta is implanted in lower uterus, but its lower border is >3cm from internal cervical os
Painless, bright red vaginal bleeding is indicative of what condition?
Placenta previa
This is the abnormal implantation of the placenta over the cervix either completely or partially at the bottom of the uterus
Placenta previa
A deadly condition where the placenta prematurely detaches from the uterine wall while the baby is still inside
Placental abruption
Enoxaparin labs to monitor
Platelet count *HOLD for <100K *NOT aPTT or INR
When presenting part of fetus has passed ischial spines, the station number is NEGATIVE OR POSITIVE?
Positive
This is a severe headache that can occur after epidural anesthesia
Postdural puncture headache
This fontanel usually closes in 2 months
Posterior fontanel
Back pain would suggest that the fetus was in a _____ position, which would make labor more difficult
Posterior position
This occurs postpartum, lasts 10 days or less, and resolves on its own
Postpartum blues
This occurs postpartum, lasts 2 weeks or more, onset withing 4 weeks after delivery, and requires interventions
Postpartum depression
Often unrecognized until profound symptoms
Postpartum hemorrhage
Overdistention of the uterus, like a multifetal pregnancy is a risk factor for which complication?
Postpartum hemorrhage
Perineal trauma may cause...
Postpartum hemorrhage
Twin birth, overdistended bladder, and retained placental fragments put the client at a higher risk for what?
Postpartum hemorrhage
This occurs postpartum, occurs within 2-3 weeks of delivery, requires immediate interventions, and has extremely debilitating signs
Postpartum psychosis
Presumptive signs of pregnancy
Subjective data the women report to the HCP *"My breasts hurt"
Erythromycin ophthalmic ointment is applied to the newborn's eyes to...
Protect the infant from gonorrheal or chlamydial infection
This jaundice is caused by malfunction of the liver where it cannot function at the maximum (cannot break down bilirubin)
Psychologic jaundice
Which fetal heart tracing during labor can most likely result in fetal hypoxia and metabolic acidosis?
Recurrent late decelerations
Clotting (managing pain)
Regularly assess location, characteristics, level of pain using pain scale (report increasing pain, changes in location, characteristics) *sudden chest pain is emergency -Measure calf, thigh diameter -Apply warm, moist heat to affected extremity -Maintain bedrest as ordered
What does see-saw breathing in an infant indicate?
Respiratory distress
Who is RhoGAM given to?
Rh negative mothers who are expecting an Rh positive baby and who are not already sensitized
The nurse is planning to administer Rh immune globulin. Which situation would require the administration of this medication?
Rh-negative woman who has had an amniocentesis
Make sure the cervix is ______ in order to start induction of labor
Ripe
Blood pressure RISES OR FALLS during contractions?
Rises
What is the risk associated with taking factor 10A inhibitors?
Risk for neurological impairment *Can cause brain bleed
Landmark for breech presentations
Sacrum
Assessing the perineum for bulging is an action performed during which stage of labor?
Second stage
The cervix is fully dilated and the neonate is born in which stage of labor?
Second stage
Acceptance of the fetus as distinct and separate from herself is a developmental task of the _____ trimester of pregnancy
Second;. it is facilitated by quickening (the mother's perception of fetal movement)
Which is a sensory simulation strategy a laboring client can use as a nonpharmacological strategy for pain management?
Selecting a focal point and beginning breathing techniques
A client with a history of a congential heart defect should be placed in which position?
Semi-fowler; permits maximal chest expansion for ventilation
What position should a client be placed after given epidural ?
Side lying to prevent vena cava syndrome
When on anticoagulants, what should you notify the HCP about?
Signs of bleeding (black tarry stools, hematuria, epistaxis (nose bleed), petechiae on chest, easy bruising)
Arterial thrombi occurs where?
Sites of arterial plaque rupture
Warfarin has a _______ onset, and lasts ______
Slow; long
Stage 4 of labor
Starts with delivery of the placenta ends with vital sign normalization (usually 2 hours postpartum)
Stage 2 of labor
Starts with full dilation and ends with the birth of the baby
Stage 3 of labor
Starts with the birth of the baby, to the delivery of the placenta
After the placenta has been expelled, the nurse starts a Pitocin (oxytocin) drip. Pitocin (oxytocin) is administered at this time to:
Stimulate uterine contractions
Which is the nurse's responsibility when a client's labor is being stimulated with an oxytocin?
Stopping the infusion if contractions become hypertonic
Medical term for stretch marks
Striae
When the process of involution does not occur properly, ____________ occurs and can cause postpartum hemorrhage
Subinvolution
Which position would the nurse teach the client to avoid when she experiences back pain during labor?
Supine position
Maternal dehydration or hyperthyroidism may also cause fetal _______________
Tachycardia
What tool is frequently used to determine gestational age based on neuromuscular and physical characteristics?
The New Ballard Score
Why is hypoglycemia a concern for the infant if mother has diabetes?
The baby was getting free sugar from the mother all throughout pregnancy, so when birthed, the baby is overproducing insulin but doesnt have the source of sugar anymore
How would the nurse best explain the probable cause of jaundice to the parents of a 3-day-old newborn?
The body is slow to get rid of the fetal red blood cells that have been destroyed
After 6 hours in labor, a client is dilated 5cm and at a -1 station. In the next hour her contractions gradually become irregular and more uncomfortable. Which possiblitily would the nurse immediately consider?
The client has a full bladder
How is HELLP syndrome resolved?
The delivery of the placenta *HELLP syndrome is progressive until the placenta is delivered
What does a longitudinal lie mean?
The fetus is lying parallel to the woman's spine; vaginal birth is possible
What maternal position does not impede maternal circulation and promotes placental perfusion
The left lateral position
Oxytocin (Pitocin) should be piggybacked into what?
The main IV fluids
When the umbilical cord looks longer and there's more blood coming out, what is probably happening?
The placenta has detached from the uterus
Why are brakston hick contractions not concerning?
They do not change/affect the cervix
Preparing for the birth and parenting of the yet unborn child is a developmental task of the _____ trimester of pregnancy
Third; during this stage, the pregnant woman moves psychologically from " I am going to have a baby" to "I am going to be a mother."
This medication can ONLY be given through compressible sites like a peripheral IV
Thrombolytics
What is the only way oxytocin can be administered?
Through a pump
Why should mothers be encouraged to urinate frequently?
To avoid pulmonary edema
Beta adrenergic medications are called ______
Tocolytics
Indomethacin is used to delay preterm labor and is apart of which class of medication?
Tocolytics
Antifibrinolytic examples
Tranexamic acid (Cyklokapron)
More profuse bloody show and uncontrollable shaking of the legs occur in the ________ phase of the first stage of labor
Transition phase
Nausea and vomiting occur in the __________ phase of the first stage of labor
Transition phase
Restlessness, flushed, irritable, and nausea are all symptoms of which phase of the first stage of labor?
Transition phase
The cervix dilates to 8-10cm, contractions are strong and close, and 100% effaced indicates which phase of labor?
Transition phase
Vomiting, bloody mucous, and urge to have a bowel movement are expected during which phase of the first stage of labor?
Transition phase
Shoulder presentation is also called...
Transverse lie
What should the patient avoid while taking anticoagulants?
Trauma/bleeding (flossing, razors, contact sports, alcohol mouth wash, hard brushing)
True or fals: lochia is discharge from uterus of debris remaining after childbirth
True
True or false: Aspirin should not be given to children
True
True or false: DVTs can form during pregnancy due to the hypercoagulable state of pregnancy
True
True or false: a full bladder may inhibit the progress of labor
True
True or false: abouve 1/2 of DVTs are asymptomatic
True
True or false: an increase in contractions may be noted during breast-feeding
True
True or false: an overdistended urinary bladder prevents the uterus from contracting after birth; may result in hemorrhage
True
After a vaginal birth a client complains of vagina feeling full and heavy and the pain in it and in the rectum is excruciating... which problem would the nurse suspect is the cause of the pain?
Vaginal hematoma
What foods should be encourgaed when iron supplements are prescribed?
Vitamin C (citrus fruits and juices, tomatoes, melons, and strawberries)
Pain, edema, jaundice, erythema, and hemolysis are adverse effects of which newborn medication?
Vitamin K
This medication is given to an infant because their clotting factors are not fully developed yet
Vitamin K
What medication prevents infants from getting hemorrhagic disease?
Vitamin K
Vitamin K is the antidote for _______
Warfarin
_________ works by inhibiting vitamin K synthesis by bacteria in the gastrointestinal tract, inhibiting production of clotting factors
Warfarin
What is a pulmonary embolism?
When clots or fragments break loose and travel to pulmonary circulation (lungs)
Engagement occurs when?
When the largest diameter of presenting part reaches or passes through pelvic inlet