NUR 340 Exam 4

Grandparents-as-parent families

-Grandparents raising their grandchildren due to the inability or absence of the parents -May increase the risk for physical, financial, and emotional stress on older adults -May lead to confusion and emotional stress for child if biologic parents are in and out of child's life

Communal family

-Group of people living together to raise children and manage household; unrelated by blood or marriage -May face negative attitudes about their "different" lifestyle -Need to determine the decision-maker and caretaker of the children

Nuclear family

-Husband, wife, and children living in same household -May include natural or adopted children -Once considered the traditional family structure; now less common due to increased divorce rates and child rearing by unmarried persons

Factors that increase the risk of paternal PPD

-history of depression and/or anxiety -a low level of marital satisfaction -excessive financial stressors -a lack of significant other or partner's parental leave -the feeling that there is a great discrepancy between one's expectations of parenthood and its realities

Intervention for uterine atony

-massage and oxytocics

Clinical features of DIC

-petechiae -ecchymoses -bleeding gums -fever -hypotension -acidosis -hematomas -tachycardia -proteinuria -uncontrolled bleeding during birth -acute renal failure

Causes of subinvolution

-retained placental fragments -distended bladder -excessive maternal activity prohibiting proper recover -uterine myoma -infections

Health literacy

-the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions -includes the ability to understand instructions on prescription drug bottles, appointment slips, education brochures, health care provider's directions, consent forms, and the ability to negotiate complex health care systems

Family Centered Care

-the delivery of safe, satisfying, high-quality health care that focuses on and adapts to the physical and psychosocial needs of the family -based on mutual trust and collaboration between the woman, her family, and the health care provider

Mortality

-the incidence or number of individuals who have died over a specific period -presented as rates per 100,000 and is calculated from a sample of death certificates

Finding: Petechia or ecchymoses What's the cause?

-thrombocytapenia purpura *thrombin disorders in general

5 main causes of PPH

-uterine atony -retained placental fragments lacerations or hematoma thrombin (bleeding disorders) -uterine inversion caused by too much cord traction

Intimate partner violence

-violence in the home environment

Uterine inversion

-when the top of the uterus collapses into the inner cavity -due to excessive fundal pressure or pulling on the umbilical cord when the placenta is still firmly attached to the fundus after the infant has been born

Finding: Bleeding from IV site, incision site, gums and/or bladder What's the cause?

*thrombin disorders -DIC

Foster family

-A temporary family for children who are placed away from their parents to ensure their emotional and physical well-being -May include the foster family's children and other foster children in the home -Foster children are more likely to have unmet health needs and chronic health problems because they may have been in a variety of health systems.

Commuter family

-Adults in the family live and work apart for professional or financial reasons, often leaving the daily care of children to one parent. -Similar to single-parent family

Beneficence

Actively doing good

Finding: Firm midline uterus with stead stream or trickle of blood What's the cause?

Lacerations

Fidelity

keep promises

Contraindications for Cytotec (misoprostol)

allergy, active cardiovascular disease, pulmonary or hepatic disease

Measures to reduce your risk of bleeding

-Brush your teeth gently using a soft toothbrush. -Use an electric razor for shaving. -Avoid activities that could lead to injury, scrapes, bruising, or cuts. -Do not use any over-the-counter products containing aspirin or aspirin-like derivatives. -Avoid consuming alcohol. -Inform other health care providers about the use of anticoagulants, especially dentists.

Binuclear family

-Child who is a member of two families due to joint custody; parenting is considered a "joint venture" -Always works better when the interests of the child are put first and above the parents' needs and desires

Basic principles of family centered care

-Childbirth is considered a normal, healthy event in the life of a family. -Childbirth affects the entire family, and relationships will change. -Families are capable of making decisions about their own care if given adequate information and professional suppor

Nurses role in informed consent

1.Ensure consent form is complete 2.Can serve as a witness to signature 3.Determine whether patient understands what she is signing; ask pertinent questions 4.Usually, emancipated, competent minors can make decisions; In certain states, mature minors and emancipated minors may consent to their own health care and certain health care may be provided to adolescents without parental notification, including contraception, pregnancy counseling, prenatal care, testing and treatment of STIs and communicable diseases (including HIV), substance abuse and mental illness counseling and treatment, and health care required as a result of a crime-related injury

A woman presents to the clinic at 1-month postpartum and reports her left breast has a painful, reddened area. On assessment, the nurse discovers a localized red and warm area. The nurse predicts the client has developed which disorder? a. Mastitis b. Plugged milk duct c. Breast yeast d. Engorgement

A Mastitis usually occurs 2 to 3 weeks after birth and is noted to be unilateral. Assessment should reveal a localized reddened area that is warm and painful to palpation. The scenario described is not indicative of a plugged milk duct or engorgement. Yeast is not recognized to cause mastitis.

A client in her seventh week of the postpartum period is experiencing bouts of sadness and insomnia. The nurse suspects that the client may have developed postpartum depression. What signs or symptoms are indicative of postpartum depression? Select all that apply. a. decreased interest in life b. inability to concentrate c. bizarre behavior d. loss of confidence e. manifestations of mania

A, B, C The nurse should monitor the client for symptoms such as inability to concentrate, loss of confidence, and decreased interest in life to verify the presence of postpartum depression. Manifestations of mania and bizarre behavior are noted in clients with postpartum psychosis.

Autonomy

The individuals right to make a decision

Conditions associated with overdistention of uterus *Factors increasing risk for PPH

Tone: abnormalities of uterine contractions -Polyhydramnios -Multifetal gestation -Macrosomia

Conditions associated with uterine muscle exhaustion *Factors increasing risk for PPH

Tone: abnormalities of uterine contractions -Rapid labor -Prolonged labor -Oxytocin use

Manifestations of shock due to blood loss: Mild, mod. severe shock, blood loss percent, and the signs and symptoms

Mild: 20% -diaphoresis, inc. capillary refilling, cool extremities, maternal anxiety Moderate: 20-40% -Tachycardia, postural hypotension, oliguria Severe: >40% -hypotension, agitation/confusion, hemodynamic instability

Finding: Prolonged, uncontrolled uterine bleeding What's the cause?

Thrombin disorders

Conditions associated with pre-existing conditions *Factors increasing risk for PPH

Thrombin: coagulation abnormalities -Hereditary inheritance -Hemophilia -von Willebrand's disease -History of previous PPH -Acquired in pregnancy -Idiopathic thrombocytopenia purpura (ITP) -Bruising, elevated blood pressure -Disseminated intravascular coagulation (DIC)

What common risk factors for postpartum hemorrhage would the nurse note when assessing a laboring woman's history? (Select all that apply) a. Second stage of labor lasting 3½ hours b. Amniotic fluid index of 800 mL (27.1 oz) c. Singleton gestation d. Oxytocin induction of labor e. Estimate fetal eright 6 lb, 2 oz (2,778 g)

a, d Second stage of labor lasting 3½ hours, Oxytocin induction of labor

A low hemoglobin level in a postpartum woman could indicate which of the following? (Select all that apply) Hemodilution Polycythemia Anemia Dehydration Recent hemorrhage

a,c,e Hemodilution, Anemia, Recent hemorrhage Rationale:An abnormal, low hemoglobin level could indicate the following: anemia, recent hemorrhage, or hemodilution caused by fluid retention. Polycythemia and dehydration are possible causes for an abnormally high hemoglobin level.

The nurse is assessing a patient in the fourth stage of labor and notices that there is excessive vaginal bleeding. Which of the following drugs does the nurse know are used to control postpartum hemorrhage? (Select all that apply) a. Misoprostol (Cytotec) b. Magnesium sulfate c. Terbutaline sulfate d. Carboprost tromethamine (Hemabate) e. Methylergonovine maleate (Methergine) f. Oxytocin (Pitocin)

a,d,e,f Misoprostol (Cytotec), Carboprost tromethamine (Hemabate), Methylergonovine maleate (Methergine), Oxytocin (Pitocin)

Contraindications for Prostin E2 (dinoprostone)

active cardiac, pulmonary, renal, or hepatic disease

Confidentiality

the individuals right to privacy

Infant mortality rate

the number of deaths occurring in the first 12 months of life

The number one cause of postpartum hemorrhage is ___________________.

uterine atony

LGBT family

-Adults of the same sex living together with or without children -May face negative attitudes about their "different" lifestyle; are part of the American fabric. Two million children are being raised by LGBT parents. Public policy has not kept up with the changing reality of the American family.

Step- or blended family

-Adults with children from previous marriages or from the new marriage -May lead to family conflict due to different expectations on the part of the child and adults; they may have different views and practices related to child care and health

Signs and symptoms of mastitis

-Flu-like symptoms, including malaise, fever, and chills -Tender, hot, red, painful area on one breast -Inflammation of breast area -Breast tenderness -Cracking of skin around nipple or areola -Breast distention with milk

Common assessment findings associated with PPD

-Loss of pleasure or interest in life -Low mood, especially in the morning, sadness, tearfulness -Exhaustion that is not relieved by sleep -Feelings of guilt -Weight loss -Low energy -Irritability -Poor personal hygiene -Constipated -Preoccupied and unfocused -Indecisiveness -Diminished concentration -Anxiety -Despair -Compulsive thoughts -Loss of libido -Loss of confidence -Sleep difficulties (insomnia) -Loss of appetite -Bleak and pessimistic view of the future -Not responding to infant's cries or cues for attention -Social isolation, won't answer the door or the phone -Feelings of failure as a mother

Signs and symptoms of Metritis

-Lower abdominal tenderness or pain on one or both sides -Temperature elevation (>38º C) -Foul-smelling lochia -Anorexia -Nausea -Fatigue and lethargy -Leukocytosis and elevated sedimentation rate

Sings of bleeding to notify HCP with

-Nosebleeds -Bleeding from the gums or mouth -Black tarry stools -Brown "coffee grounds" vomitus -Red to brown speckled mucus from a cough -Oozing at incision, episiotomy site, cut, or scrape -Pink, red, or brown-tinged urine -Bruises, "black and blue marks" -Increased lochia discharge (from present level)

Extended family

-Nuclear family and grandparents, cousins, aunts, and uncles -Need to identify the decision-maker and primary caretaker of the children -Popular in some cultures, such as Hispanic and Asian cultures

Single-parent family

-One parent is responsible for care of children. -May result from death, divorce, desertion, birth outside marriage, or adoption. -These families are likely to face challenges because of economic, social, and personal restraints; one person serves as the homemaker, caregiver, and financial provider.

General risk factors that could predispose a woman to depression

-Poor coping skills -First pregnancy -Low self-esteem -Numerous life stressors -History of abuse -Mood swings and emotional stress -Previous psychological problems or a family history of psychiatric disorders -Substance abuse -Limited or lack of social support network

Factors placing woman at risk for postpartum infection

-Prolonged (>18 to 24 hours) premature rupture of membranes (removes the barrier of amniotic fluid so bacteria can ascend) -Cesarean birth (allows bacterial entry due to break in protective skin barrier) -Urinary catheterization (could allow entry of bacteria into bladder due to break in aseptic technique) -Regional anesthesia that decreases perception of need to void (causes urinary stasis and increases risk of urinary tract infection) -Staff attending to woman are ill (promotes droplet infection from personnel) -Compromised health status, such as anemia, obesity, smoking, drug abuse (reduces the body's immune system and decreases ability to fight infection) -Pre-existing colonization of lower genital tract with bacterial vaginosis, Chlamydia trachomatis, group B streptococci, S. aureus, and E. coli (allows microbes to ascend) -Retained placental fragments (provides medium for bacterial growth) -Manual removal of a retained placenta (causes trauma to the lining of the uterus and thus opens up sites for bacterial invasion) -Insertion of fetal scalp electrode or intrauterine pressure catheters for internal fetal monitoring during labor (provides entry into uterine cavity) -Instrument-assisted childbirth, such as forceps or vacuum extraction (increases risk of trauma to genital tract, which provides bacteria access to grow) -Trauma to the genital tract, such as episiotomy or lacerations (provides a portal of entry for bacteria) -Prolonged labor with frequent vaginal examinations to check progress (allows time for bacteria to multiply and increases potential exposure to microorganisms or trauma) -Poor nutritional status (reduces body's ability to repair tissue) -Gestational diabetes (decreases body's healing ability and provides higher glucose levels on skin and in urine, which encourages bacterial growth) -Break in aseptic technique during surgery or birthing process (allows entry of bacteria)

Signs of postpartum depression

-Restless -Worthless -Guilty -Hopeless -Moody -Sad -Overwhelmed -Loss of enjoyment -Low energy level -Loss of libido The new mother may also: -Cry a lot -Exhibit a lack of energy and motivation -Be unable to make decisions or focus -Lose her memory -Experience a lack of pleasure -Have changes in, sleep, or weight -Show a lack of concern for herself -Withdraw from friends and family -Have pains in her body that do not subside -Feel negatively toward her baby -Appetite disturbances -Feelings of isolation from others -Lack interest in her baby -Worry about hurting the baby -Act detached toward others and infant -Have recurrent thoughts of suicide and death

Nursing Standards

-Standards 1 - VI Use of nursing process (ADOPIE) -Standards VII - XV •Quality of practice (quality and safety improvement) •Maintains education & competencies •Evaluates own practice •Ethical actions & decision-making •Maintaining collegial, professional relationships •Collaboration & Communication •Research (generates/integrates evidence into care) •Use of resources & technology (safety, effectiveness, cost) •Leadership (role model, change agent, consultant, mentor)

Key elements of informed consent

-The decision maker must be of legal age in that state, with full civil rights, and must be competent (have the ability to make the decision). -Information is presented in a manner that is simple, concise, and appropriate to the level of education and language of the individual responsible for making the decision. -The decision must be voluntary, without coercion or force or under duress. -There must be a witness to the process of informed consent. -The witness must sign the consent form.

4 T's and causes of postpartum hemorrhage

-Tone: uterine atony, distended bladder -Tissue: retained placenta and clots; uterine subinvolution -Trauma: lacerations, hematoma, inversion, rupture -Thrombin: coagulopathy (pre-existing or acquired)

Aspects that can lead to PPD

-Unresolved feelings about the pregnancy -Fatigue after delivery from lack of sleep or broken sleep -Feelings of being less attractive -Inadequate assistance from partner -Lack of social support network -History of sexual or physical abuse -Unemployment or financial insecurity -Doubts about the ability to be a good mother -Stress from changes in work and home routines -Loss of freedom and old identity

Signs and symptoms of UTI

-Urgency -Frequency -Dysuria -Flank pain -Low-grade fever -Urinary retention -Hematuria -Urine positive for nitrates -Cloudy urine with strong odor

Signs and symptoms of wound infection

-Weeping serosanguineous or purulent drainage -Separation of or unapproximated wound edges -Edema -Erythema -Tenderness -Discomfort at the site -Maternal fever -Elevated white blood cell count

Adolescent families

-Young parents who are still mastering the developmental tasks of their childhood -Are at greater risk for health problems in pregnancy and delivery; more likely to have premature infants, which then leads to risk of subsequent health and developmental problems -Probably still need support from their family related to financial, emotional, and school issues

Complications associated with DIC

-abruptio placentae -amniotic fluid embolism -intrauterine fetal death with prolonged retention of the fetus -acute fatty liver of pregnancy -severe preeclampsia -HELLP syndrome -septicemia -postpartum hemorrhage

Post partum hemorrhage

-bleeding of more than 500 mL after vaginal deliver -bleeding of more than 1000 mL after C-section

Metritis

-infection of endometrium, decidua, and adjacent myometrium -can result in parametritits or septic pelvic thrombophlebitis

Maternal mortality ratio

-the annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy. -It is reported as a ratio of deaths per 100,000 live births, for a specified year.

A nurse is assigned to a patient who was just admitted to the postpartum unit after a vaginal delivery. The nurse notes on the initial assessment that the patient's fundus is boggy at the umbilicus and that a grapefruit-sized blood clot expelled from her vagina. In what order would the nurse undertake the following actions (first, second, third, fourth, and fifth)? 1) Obtain a set of vital signs every 5 to 10 minutes 2) Assess intravenous (IV) access for patency and flow of IV fluids 3) Put on the call light for assistance 4) Place Peri-Pads on the scale to weigh estimated blood loss 5) Perform fundal massage using both hands

1) Put on the call light for assistance 2) Perform fundal massage using both hands 3) Assess intravenous (IV) access for patency and flow of IV fluids 4) Place Peri-Pads on the scale to weigh estimated blood loss 5) Obtain a set of vital signs every 5 to 10 minutes First, seek assistance from available staff so that multiple measures can be readily implemented. Second, the assessment indicates that the uterus is atonic; therefore, the next action is directed at resolving the cause—by massaging the fundus. Third, a patent IV line is needed to administer medication, such as oxytocin. Fourth, all Peri-Pads or soiled linen should be weighed on the scale to accurately assess blood loss. The fifth and final action is to obtain the patient's vital signs to determine the effect of the blood loss.

The nurse is caring for several women in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply. a. "The newborn is not really mine emotionally, since I was never pregnant and do not have children." b. "Sometimes I get tired of being with only the newborn, so I call my mom and sister to come visit." c. "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider." d. "I am sad because I am not spending as much time with my toddler now that my newborn is here." e. "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts."

A, C, E Postpartum psychosis is a serious and emergent condition in which the new mother has lost touch with reality and needs immediate psychiatric intervention. Visual hallucinations such as seeing the newborn's thoughts projected on her phone is a sign of postpartum psychosis. Denying the pregnancy or that the newborn is hers is a sign of postpartum psychosis. The delusion that her milk is poisoned is a sign of postpartum psychosis. Being concerned about time with the toddler is a sign of postpartum blues or possibly depression. Reaching out for family to visit is a positive coping skill.

A client is diagnosed with a postpartum infection. The nurse is most correct to provide which instruction? a. Change the perineal pad every 3 to 4 hours to decrease the uterine infection. b. Finish all antibiotics to decrease a genital tract infection. c. Apply ice to the perineum to decrease pain of a perineal infection. d. Drink plenty of fluids to decrease a bladder infection.

B A postpartum infection is an infection of the genital tract after delivery through the first 6 weeks postpartum. It is most important to include finishing all antibiotics in nursing instructions. Endometritis is an infection of the mucous membrane or endometrium of the uterus. Cystitis is an infection of the bladder. Infection of the perineum or episiotomy is a localized infection and not inclusive of the entire genital tract.

Which situation should concern the nurse treating a postpartum client within a few days of birth? a. The client would like to watch the nurse give the baby her first bath. b. The client is nervous about taking the baby home. c. The client feels empty since she gave birth to the neonate. d. The client would like the nurse to take her baby to the nursery so she can sleep.

C A client experiencing postpartum blues may say she feels empty now that the infant is no longer in her uterus. She may also verbalize that she feels unprotected now. The other options are considered normal and would not be cause for concern. Many first-time mothers are nervous about caring for their neonates by themselves after discharge. New mothers may want a demonstration before doing a task themselves. A client may want to get some uninterrupted sleep, so she may ask that the neonate be taken to the nursery.

A fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition? a. uterine subinvolution b. uterine contraction c. uterine atony d. uterine prolapse

C Fundal massage is performed for uterine atony, which is failure of the uterus to contract and retract after birth. The nurse would place the gloved dominant hand on the fundus and the gloved nondominant hand on the area just above the symphysis pubis. Using a circular motion, the nurse massages the fundus with the dominant hand. Then the nurse checks for firmness and, if firm, applies gentle downward pressure to express clots that may have accumulated. Finally, the nurse assists the woman with perineal care and applying a new perineal pad.

The nurse is assisting with a birth, and the client has just delivered the placenta. Suddenly, bright red blood gushes from the vagina. The nurse recognizes that which occurrence is the most likely cause of this postpartum hemorrhage? a. Uterine atony b. Retained placental fragments c. A cervical laceration d. Disseminated intravascular coagulation

C Lacerations of the cervix are usually found on the sides of the cervix, near the branches of the uterine artery. If the artery is torn, the blood loss may be so great that blood gushes from the vaginal opening. Because this is arterial bleeding, it is brighter red than the venous blood lost with uterine atony. Fortunately, this bleeding ordinarily occurs immediately after detachment of the placenta, when the primary care provider is still in attendance. Uterine atony, or relaxation of the uterus, is the most frequent cause of postpartum hemorrhage; it tends to occur most often in Asian or Hispanic woman. Conditions that contribute to uterine atony include having received deep anesthesia or analgesia and a prior history of postpartum hemorrhage. Disseminated intravascular coagulation is typically associated with premature separation of the placenta, a missed early miscarriage, or fetal death, none of which is evident in this scenario. A retained placental fragment is possible, but there is no evidence for this in the scenario.

The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? a. Mastitis usually develops in both breasts of a breastfeeding client. b. A breast abscess is a common complication of mastitis. c. Symptoms include fever, chills, malaise, and localized breast tenderness. d. The most common pathogen is group A streptococcus (GAS).

C Mastitis is an infection of the breast characterized by flu-like symptoms, along with redness and tenderness in the breast. The most common causative agent is Staphylococcus aureus. Breast abscess is rarely a complication of mastitis if the client continues to empty the affected breast. Mastitis usually occurs in one breast, not bilaterally.

The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? a. 1000 mL b. 750 mL c. 500 mL d. 300 mL

C Postpartum hemorrhage is defined as a cumulative blood loss greater than 500 mL after a vaginal birth and greater than 1,000 mL after a cesarean birth, with signs and symptoms of hypovolemia within 24 hours of the birth process.

The nurse is caring for four postpartum client, monitoring them for postpartum infection. Which client is the priority due to current vital signs suggesting a postpartum infection? a. Client 35 hours postpartum with a temperature of 99.6°F (37.5°C) b. Client 25 hours postpartum with a temperature of 99.2°F (37.3°C) c. Client 20 hours postpartum with a temperature of 102.4°F (39.1°C) d. Client 30 hours postpartum with a temperature of 100.4°F (38°C)

D Postpartum infection is defined as a fever of 100.4°F (38°C) or higher after the first 24 hours after childbirth, occurring on at least 2 of the first 10 days after birth, exclusive of the first 24 hours. Of the clients listed, the client at 30 hours postpartum with a temperature of 100.4°F (38°C) should be monitored for postpartum infection.

Finding: displaced soft and boggy uterus What's the cause?

Distended bladder

Thrombosis

Formation of a blood clot

Factors that influence health in childbearing family

Genetics, Gender Race Socioeconomic status Homelessness Violence Culture Nutrition Lifestyle choices Environment Stress & Coping

Finding: Bulging area under skin surface What's the cause?

Hematoma

Morbidity

Indicates a disease state or condition

Stillbirth

Loss of fetus after 20 weeks of pregnancy

Signs and symptoms of PE

Main •Sudden shortness of breath •Severe chest pain Other S & S •Tachypnea •Tachycardia •Hypotension •Syncope •Jugular vein distention •Decreased oxygen saturation •Cardiac arrythmias •Change of mental status

Accountability

Taking responsibility for ones actions

Cultural competence

The ability to apply knowledge about a client's culture so that care meets the family's needs

Which of the following factors in a postpartum woman's history would lead the nurse to monitor the woman closely for an infection? a. Hemoglobin of 12 mg/dL b. Manually extracted placenta c. Labor of 10 hours length d. Multiparity of 5 pregnancies

The correct response is "B" since manual removal of a placenta increases the risk for infection since the uterus was entered and traumatized during the procedure. This extraction places her at high risk for a subsequent infection. Response "A" is incorrect since hemoglobin of 12 mg/dL is within normal limits and indicates she is not anemic, which would be a risk factor for infection. Response "C" is incorrect since 10 hours would not be considered a prolonged labor span. A labor longer than 24 hours would place her at increased risk for a postpartum infection, especially if the membranes were ruptured all that time. Response "D" would not place her at increased risk for infection, but instead for a postpartum hemorrhage.

Nurses in the United States working in maternity services need to have knowledge of a variety of cultures and be culturally competent in caring for women and their families because: a. All members of a specific culture are homogenous. b. Physiological differences exist among different cultures. c. Care can be individualized for different cultural preferences. d. Nondominant cultural groups are made up of new immigrants.

The correct response is "C" because every culture has numerous differences, values, traditions, and ways they wish to receive health care. Nurses working with diverse populations must have knowledge of these variations to meet the needs of each client. "A" is an incorrect response because people are individuals within each culture, thus they are not all the same within that same culture; "B" is an incorrect response because human physiology is not based on culture, but rather genetics and environment; and "D" is an incorrect response because minority cultures in the United States are not all new immigrants, as many have been born in the United States and lived here all of their lives.

Which of the following findings would lead the nurse to suspect that a woman is developing a postpartum complication? a. Moderate lochia rubra for the first 24 hours b. Clear lung sounds upon auscultation c. Temperature of 100° F d. Chest pain experienced when ambulating

The correct response is "D" as this may suggest a pulmonary embolism and the health care provider needs to be notified immediately. Response "A" is incorrect since this is a normal finding for a postpartum woman. Response "B" is incorrect since lung sounds that are clear are a normal finding. Response "C" is incorrect since a postpartum infection would produce a temperature of 101°F or higher. This temperature may indicate mild dehydration and encouraging fluids will reduce it.

A postpartum woman reports hearing voices and says, "The voices are telling me to do bad things to my baby." The clinic nurse interprets these findings as suggesting postpartum: a. Psychosis b. Anxiety disorder c. Depression d. Blues

The correct response is A. Psychotic persons tend to lose touch with reality and frequently attempt to harm themselves or others. This behavior may occur when a woman experiences postpartum psychosis. Anxiety typically does not induce hallucinations or cause a person to want to harm herself or others. Depression involves feelings of sadness rather than hallucinations or thoughts of harming herself or others. Feeling "down," but not to the extreme of wanting to harm herself or her newborn, is suggestive of postpartum blues.

Client advocacy, utilization management, and coordination of care describe which of the following? a. Primary nursing care b. Case management c. Family-centered care d. Patient-focused care

The correct response is B because all three items make up the core values of case management. Case management is a collaborative process of assessment, planning, application, coordination, follow-up, and evaluation of the options and services required to meet an individual's health needs through communication and available resources to promote quality cost-effective results. Primary care does focus on the client, but not on utilization management. Family-centered care focuses on the family members to meet their needs, not just the client's needs. Client-focused care does not consider utilization management, only the coordination of care for that specific client.

The nurse is preparing a class about homelessness. Which factors contribute to homelessness? Select all that apply. a. Decrease in the number of people living in poverty b. Unemployment c. Exposure to abuse or neglect d. Cutbacks in public welfare programs e. Establishment of community crisis centers

The correct response is B, C, and D. Factors contributing to homelessness include economic factors such as the increase in poverty, lack of affordable housing, decreases in availability of rent subsidies, unemployment, and cutbacks in public welfare programs. Personal crises such as divorce, domestic violence, and substance abuse also are factors. Deinstitutionalization of the mentally ill has played a major role, especially without the development of community centers and homes to assist these individuals during times of crisis.

While assessing a postpartum multiparous woman, the nurse detects a boggy uterus midline 2 cm above the umbilicus. Which intervention would be the priority? a. Assessing vital signs immediately b. Measuring her next urinary output c. Massaging her fundus d. Notifying the woman's obstetrician

The correct response is C. A boggy uterus that is midline and above the umbilicus suggests that the uterus is not contracting properly. Therefore, the nurse should massage the fundus to aid in stimulating the uterine muscles to contract. In addition, the nurse should assess the client's lochia. Vital signs are taken once fundal massage has been initiated. Monitoring uterine output is important to evaluate the woman's fluid balance, but this would have no effect at all on alleviating the current situation. Since the uterus is midline, it is unlikely that a full bladder is the cause. Notifying the woman's obstetrician would be necessary if fundal massage did not alleviate the problem.

Which of the following would the nurse expect to include in the plan of care for a woman with mastitis who is receiving antibiotic therapy? a. Stop breast-feeding and apply lanolin b. Administer analgesics and bind both breasts c. Apply warm or cold compresses and administer analgesics d. Remove the nursing bra and expose the breast to fresh air

The correct response is C. Applying compresses and giving analgesics would be helpful in providing comfort to the woman with painful breasts. Treatment for mastitis encourages frequent breast-feeding to empty the breasts. Lanolin applied to the breasts will have little impact on mastitis other than to keep them moist. Binding both breasts will not bring relief; in fact, it could cause additional discomfort. Emptying the breasts frequently through breast-feeding would be helpful. Although wearing a nursing bra will help support the heavy breasts and fresh air is helpful to prevent cracked nipples, these are ineffective once mastitis develops.

A postpartum mother appears very pale and states she is bleeding heavily. The nurse should first: a. Call the client's health care provider immediately. b. Immediately set up an intravenous infusion of magnesium sulfate. c. Assess the fundus and ask her about her voiding status. d. Reassure the mother that this is a normal finding after childbirth.

The correct response is C. It is important to assess the situation before intervening. In addition, checking the bladder status and emptying a full bladder will correct uterine displacement so that effective contractions to stop bleeding can occur. Assessment of the situation is needed before the nurse can notify the health care provider. At this point, the nurse has no facts to report about the client's condition. Magnesium sulfate would relax the uterus and increase bleeding. Pallor and heavy bleeding are not normal findings during the postpartum period.

Which factor would most likely be responsible for a pregnant women's failure to receive adequate prenatal care in the United States? a. Belief that it is not necessary in a normal pregnancy b. Use of denial to cope with pregnancy c. Lack of health insurance to cover expenses d. Inability to trust traditional medical practices

The correct response is C. Lack of adequate health insurance is a major barrier to receiving adequate prenatal care. Of the millions of Americans who have no health insurance, the majority are women. Without health insurance, many have limited options to procure prenatal care. Statistics will demonstrate the better outcomes with prenatal care, and most women would want to have medical supervision for a better outcome. Most women seek care early in the pregnancy, except for teenagers who hide or are unaware of their pregnancy. The majority of women receive quality prenatal care and the outcome is positive. The mistrust of traditional medical practices may play a role in some women from different cultures since they differ in their own cultural health practices.

When implementing the plan of care for a multigravida postpartum woman who gave birth just a few hours ago, the nurse vigilantly monitors the client for which complication? a. Deep venous thrombosis b. Postpartum psychosis c. Uterine infection d. Postpartum hemorrhage

The correct response is D. Hemorrhage is possible if the uterus cannot contract and clamp down on the vessels to reduce bleeding. When the placenta is expelled, open vessels are then exposed and the risk of hemorrhage is great. Thrombophlebitis typically is manifested later in the postpartum period rather than within the first few hours after birth. Infection usually is manifested 24 to 48 hours after birth, not within the first few hours.

Methergine has been ordered for a postpartum woman because of excessive bleeding. The nurse should question this order if which of the following is present? a. Mild abdominal cramping b. Tender inflamed breasts c. Pulse rate of 68 beats per minute d. Blood pressure of 158/96 mm Hg

The correct response is D. Methergine can cause hypertension. Therefore, if the woman's blood pressure was already elevated, the nurse would need to question the order for the drug. Typically if methergine is ordered, her lochia flow would be increased, not minimal. Methergine is not used to treat mastitis, which would be evidenced by tender, inflamed breasts. A pulse rate of 68 beats per minute is not an unusual finding and would not be a reason to question the order.

When caring for an adolescent, in which instance must the nurse share information with the parents, no matter which state care is provided in? a. Pregnancy counseling b. Depression c. Contraception d. Tuberculosis

The correct response is D. Pregnancy, contraception, and mental illness treatment are provided in many states to adolescents without parental involvement. Those laws do not include the provision of care for communicable diseases such as tuberculosis, which would require parental consent and notification.

When preparing a presentation for a local woman's group on women's health problems, what would the nurse include as the number one cause of mortality for women in the United States? a. Breast cancer b. Childbirth complications c. Injury resulting from violence d. Heart disease

The correct response is D. The number one cause of mortality in women is heart disease, accounting for more than one half million deaths per year. Most women, however, believe that breast cancer is their number one concern. The mortality rate pales in comparison to that for cardiovascular deaths. Approximately 350 deaths occur secondary to childbirth complications. Statistics for injury resulting from violence would be much less when compared with the number of women who die annually from heart disease.

Conditions associated with retained blood clots *Factors increasing risk for PPH

Tissue: retained in uterus -atonic uterus

Conditions associated with products of conception *Factors increasing risk for PPH

Tissue: retained uterus -complete placenta at birth

Conditions associated with uterine infection *Factors increasing risk for PPH

Tone: abnormalities of uterine contractions -maternal fever -prolonged rupture of membranes

Conditions associated with Uterine inversion *Factors increasing risk for PPH

Trauma: of the genital tract -forceful pulling when the placenta is not separated yet; traction on the cord when the uterus is not contracted

Condition associated with laceration extensions *Factors increasing risk for PPH

Trauma: of the genital tract -malposition of the fetus -previous uterine surgery

Conditions associated with lacerations (anywhere) *Factors increasing risk for PPH

Trauma: of the genital tract -precipitate birth -operative birth

Define postpartum infection

a fever of 100.4° F (38° C) or higher after the first 24 hours after childbirth, occurring on at least 2 of the first 10 days after birth, exclusive of the first 24 hours

Culture

a view of the world and a set of traditions that are used by a specific social group and are transmitted to the next generation

Capacity

ability to understand alternatives and consequences of treatment and choose the best option

The provider has ordered a Foley catheter be placed in a postpartum woman who has lost 1,000 mL (33.8 oz) of blood after a difficult vaginal delivery. What are the main reasons for an indwelling catheter in this situation? (Select all that apply) a. To prevent urinary incontinence following birth b. To ensure accurate urinary output measurements c. To prevent displacement of the uterus d. To minimize the risk of infection e. To decrease the risk of injury due to falls

b,c To ensure accurate urinary output measurements, To prevent displacement of the uterus The primary reasons to implement a Foley catheter with an episode of postpartum hemorrhage are to empty the bladder to prevent displacement of the uterus and to monitor output accurately. This intervention is to prevent further blood loss that could lead to hemovolemic shock, a life-threatening event. Keeping the patient at bed rest to prevent falls is not a therapeutic intervention. The risk of infection is higher with the insertion of an indwelling urinary catheter, and the placement of a Foley catheter would not prevent incontinence following birth.

Major obstetric hemorrhage

blood loss of more than 1500-2500 mL or bleeding that required more than 5 units of transfused blood

Delayed postpartum hemorrhage

blood loss that occurs 24 hours to 12 weeks after birth

Intervention for thrombin (bleeding disorders)

blood products

Contraindications for Hemabate

contraindicated with asthma due to risk of bronchial spasm

Nonmaleficence

do no harm

Intervention for retained placental tissue

evacuation and oxytocicis

Interventions for uterine inversion caused by too much cord traction

gentle replacement of uterus and oxytocics

Contraindications for methergine

if the woman is hypertensive, do not administer

Parametritis

infection within the uterine serosa and broad ligaments, including ovaries and fallopian tubes

Contraindications for Pitocin

never give undiluted as a bolus injection intravenously

Primary postpartum hemorrhage

occurs in the first 24 hours after delivery

Finding: Dark red bleeding mixed with clots What's the cause?

placenta fragments remaining

A nurse is caring for a client in the postpartum period. When observing the client's condition, the nurse notices that the client tends to speak incoherently. The client's thought process is disoriented, and she frequently indulges in obsessive concerns. The nurse notes that the client has difficulty in relaxing and sleeping. The nurse interprets these findings as suggesting which condition?

postpartum psychosis The client's signs and symptoms suggest that the client has developed postpartum psychosis. Postpartum psychosis is characterized by clients exhibiting suspicious and incoherent behavior, confusion, irrational statements, and obsessive concerns about the baby's health and welfare. Delusions, specific to the infant, are present. Sudden terror and a sense of impending doom are characteristic of postpartum panic disorders. Postpartum depression is characterized by a client feeling that her life is rapidly tumbling out of control. The client thinks of herself as an incompetent parent. Emotional swings, crying easily—often for no reason—and feelings of restlessness, fatigue, difficulty sleeping, headache, anxiety, loss of appetite, decreased ability to concentrate, irritability, sadness, and anger are common findings are characteristic of postpartum blues.

Intervention for lacerations or hematoma

surgical repair

Veracity

telling the truth

Cultural competence

the ability to apply knowledge about a client's culture so that the health care provided can be adapted to meet his or her needs

Neonatal mortality rate

the number of infant deaths occurring in the first 28 days of life per 1,000 live births

Fetal mortality rate

the spontaneous intrauterine death of a fetus at any time during pregnancy per 1,000 live births

Bacteria responsible for pelvic infections

those that normally reside in the bowel, vagina, perineum, and cervix, such as E. coli, Klebsiella pneumoniae, or G. vaginalis

Justice

treating everyone equally and fairly

SIgns and symptoms of DVT

•Calf swelling; one larger then the other •Redness around affected area •Warmth to touch •Tenderness •*Pedal Edema; may have edema without a DVT -positive Homan's signs is not a definitive diagnosis

Common bacterial casues of UTI

•E. Coli, Klebsiella, Proteous, Enterobacter

Barriers that affect health in childbearing families

•Finances •Transportation •Language/Culture •Low Health Literacy •Health Care Delivery System

Signs and symptoms of hemorrhagic shock with PPH

•Pale color and clammy skin •Tachycardia •Decrease in blood pressure •Anxiety and confusion •Decreased capillary refill •Place pulse ox •Decreased urinary output (late sign)