OB exam 3

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How does clamping of cord initiate breathing

DROP in prostaglandin clamp cord

benefit of pacifier cons of pacifier

reduce SIDS nipple confusion *dont discourage pacifier use in a healthy baby who is bresatfeeding*

A baby is just delivered. Which of the following physiological changes is of highest priority?

respirations

what causes subinvolution

retained placental fragments infection

A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with "latch on" and recommends that the mother do which of the following?

rotate postitions each feed

immunizaitons to give mom upon discharge

rubella varicella Tdap maybe rhogam

time frame for PP blue

start 1-2 days PP --> 1-2 wks PP

list phases of maternal PP adjustment

taking in taking hold letting go

PPH with frank blood indicates

this is bright red - lacerations

how does mastitis rpesent

unilateral flu like symptoms

when does discharge teaching start

upon admission

PPH with dark red blood indicates

uterine atony or prolapse

what is this cause of PPH: nonpalpable uterus with pain

uterine inversion

vaccines given after 1st year of life

varicella and MMR

Immediately after delivery, a woman is shaking uncontrollably. Which of the following nursing actions is most appropriate?

warm blankets

when is Rhogam given

within 72 hrs PP

is HA pp normal?

yes but rule out HNT

Which of the following is the priority nursing action during the immediate postpartum period? 1. Palpate fundus. 2. Check pain level. 3. Perform pericare. 4. Assess breasts.

1. Palpate fundus.

name mechanical stimuli that initiates breathing

-compression of thorax -crying -*positive intrathoracic pressure*

describe dependent-independent taking hold phase

-focus on care of baby and competent mothering -asks Q -desire to take charge -need for nurturing and acceptance -eager to learn

describe dependent taking in phase

-focus on self -rely on others -exicted and talkative -want to talk about birth experience

risk factors of PP depression

-h/o of anxiety/depression -unintended pregnancy (preterm/twins, etc) -lack of social support -unmarried -stressful life events in previous yr -marital probs/violence o thyroid imbalance o DM o Mothers who underwent fertility tx o Complications in pregnancy, birth or breastfeeding o Preterm or ill babies o Multiparity o Low SES o Unintended pregnancy

nonpharm mx for episiotomy/laceration care

-peri bottle w warm water -wash with mild soap and warm water at least 1x per day and wash hands (no gloves) -lie on side -cool compress -shower -clean pad after using bathroom (sitz help w pain)

how long does lochia rubra last

1-3 days (4 is ok)

A client, G1 P0101, postpartum 1 day, is assessed. The nurse notes that the client's lochia rubra is moderate and her fundus is boggy 2 cm above the umbilicus and deviated to the right. Which of the following actions should the nurse take first?

1. MASSAGE 2. bathroom

when do we see lochia alba

10-14

BP when we should call Dr

140/90 on 2+ occassions at least 6 hrs apart --> preeclampsia

PPH if saturate pad within ___

15 min or an hr

how many ml of urine do we expect per void adn total in first few days PP for mom

150 ml/void 3000+ ml per day

when does baby get DTaP

2 months

when does baby get polio

2 months

baby gets MMR when?

2 y/o for rubella

A client who delivered a 3,900-gram baby vaginally over a right mediolateral episiotomy states, "How am I supposed to have a bowel movement? The stitches are right there!" Which of the following is the best response by the nurse? 1. "I will call the doctor to order a stool softener for you." 2. "Your stitches are actually far away from your rectal area." 3. "If you eat high-fiber foods and drink fluids you should have no problems." 4. "If you use your topical anesthetic on your stitches you will feel much less pain."

2. "Your stitches are actually far away from your rectal area."

A maternity nurse knows that obstetric clients are most at high risk for cardiovascular compromise during the one hour immediately following a delivery because of which of the following?

2. Excess blood volume from pregnancy is circulating in the woman's periphery. (high BP bc high volume)

when is dependent-independent taking hold phase

2/3rd day to 10+ days

how long does engorgement last if mom frequently BF

24 h

avg weight of baby

2500-4000

when does baby get Hep b

3 injections in forst 6 mo (1st in first month)

when breastfeeding dont give pacifier for how long?

3-4 weeks

what days do bilirubin normally peak

3-5

A primipara, 2 hours postpartum, requests that the nurse diaper her baby after a feeding because "I am so tired right now. I just want to have something to eat and take a nap." Based on this information, the nurse concludes that the woman is exhibiting signs of which of the following? 1. Social deprivation. 2. Child neglect. 3. Normal postpartum behavior. 4. Postpartum depression.

3. Normal postpartum behavior. (taking in phase)

nurse should ntofy HCP if Hct drops below

30%

NORMAL Hct for PP woman

35-45 (ANYTHING BELOW 30 IS A CONCERN)

when do we see lochia serosa

4-10

It has just been discovered that a newborn is missing from the maternity unit. The nursing staff should be watchful for which of the following individuals? 1. A middle-aged male. 2. An underweight female. 3. Pro-life advocate. 4. Visitor of the same race.

4. Visitor of the same race.

do we suction nose or mouth first

mouth!

when can pt exercise

6 wk

time frame for PP depression

6-12 months PP (can start wk 4)

normal pulse ox for baby

95+

should mom take supplements when BF

no

food restrictions when breast feeding

none

drugs that will cause PPH

oxytocin magnesium sulfate

S/S of DVT

pain warmth redness edema

when to do physical portion of ballard

ASAP (NM is not ASAP just within 24h)

CI of methargine

HTN & heart conditions & preeclampsia

how much drop in Hct and Hgb is expected to be seen after birth

Hct: 2% Hgb: 0.5

you CAN breastfeed if you have which virus

Hepatitis (HIV is CI)

IS PP BLUES A RISK FACTOR FOR PP DEPREESION

NOOOO!!!!

benefits of BF for mom (6)

PP depression PP blood loss DM heart disease obesity *reproductive cancers*

how to prevent evaporation when baby warm

WDS

sensory stimuli that initiates breathing

WDS lights temp change noise nose and mouth suctioning

can baby come out of phototherapy?

YES for like 30 min to feed & mom to hold

when does baby get varicella

after 1 y/o

caution of prostaglandin R2 (dinoprostone) if hx of

asthma HTN/hypotension

hemabate CI if

asthma (or HTN) hx

what to tell mom after getting MMR

avoid pregnancy for 28 days

BUBBLE-E

breast uterus bladder bowel lochia episiotomy emotional state

best non-hormonal BC

breast feeding

how to manage/prevent engorgement

breastfeed Q2-3h warm compress before ice pack/cabbage after

which type of birth increases risk of DVT

c section

checmical stimuli to initiate breathing

cessation of placental BF

what is suspected if continuous bleeding w/o cause

coagulopathy --> give factor VIII

air draft is what kind of heat loss

convection

The nurse should warn a client who is about to receive Methergine (ergonovine) of which of the following side effects?

cramping (BC IT CONTRACTS UTERUS)

which position for BF uses pillow

cross cradle

when do we normally see engorgement

day 3-5

if mom had anesthesia encourage

deep breathing

tachycardia indicates

dehydration infection PPH

what phase is mom dealing with physical and emotional change

dependent-independent taking hold phase

what phase is mom in during PP blues

dependent-independent taking hold phase

what is baby wearing in phototherapy

diaper adn eye shield

SE of misoprostol

diarrhea --> increase fluids

what is indicative of PPH

drop of 10% in hct (MAKE SURE TO CALCULATE 10% NOT SUBTRACT 10)

what causes hematoma

episiotomy or forceps birth

what is expected in active alert state of baby

expressing hunger and frustration

when is dependent taking in phase

first 24-48 hrs

when is fundus at level fo umbilicus

first 24h

births putting mom at risk for PPH

forceps c-section

focus of interdependent letting-go-phase

forward movement of family as a unit -mom allows family involvement -reassure relationship and sex w partner

The nurse informs a postpartum woman that which of the following is the reason ibuprofen (Advil) is especially effective for afterbirth pains?

has anti-prostaglandin effects

what is this cause of PPH: "my butt is hurting"

hematoma

smacking, lickign lips and opening & closing mouth indicates

hunger

where is bulb syringe kept

in crib always

cephalohematoma puts baby at risk for

jaundice

what is this cause of PPH: Uterus is firm and well contracted but constant trickle or frank (bright red blood) bleeding

laceration

causes of genital tract laceration

large baby operative birth fast birth abnormal presentation

body surface in baby vs adult

larger in baby (little skin exposed is a lot for a baby)

what is it called when milk flow starts

let down reflex

what to give to pt if subinvolution of uterus

methargine

temp indicating infection in mom baby?

mom: >100.4º+ baby: >100º


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