seminar test 1

causes of late decels

****uteroplacental insufficiency -Maternal factors that decrease uteroplacental circulation like hhypotension, hypertension, uterine hyper stimulation -Conditions associated with decreased maternal oxygenation -Placental abnormalities -High risk-conditions of pregnancy

variable decels

- caused by cord compression - umbilical vein and then umbilical artery are compressed = abrupt deceleration -often seen during pushing -U,V, W in shape -Intervention - Reposition mother

attatchment

-Bidirectional—parent ↔ baby -Attachment behaviors

tachycardia -what is it -NA

-FHR > 160 for 10 minutes NA- take moms temp bc it tells you if mom is anxious, infections, brethren, or dehydrated Fetus could be expeirecing infection, premature, or hypoxic

early decels

-Fetal head compression during uterine compression -uniform shape and mirrors the contraction -Reassuring - no intervention needed/recheck cervix

preeclampsia

-Increase in BP after 20 weeks gestation -Proteinuria is present -Only known cure is birth of fetus and removal of placenta -If you do a urine dip theres protein in urine

Baseline FHR -normal -over 40 weeks

-Normal baseline - 110-160 BPM -FHRs 110-120 normal in fetuses over 40 weeks

NA for late decels

-Reposition/re-examine -Readjust/remove oxytocin -Re-hydrate -Re-oxygenate -Report -Record

bonding

-Unidirectional—parent → baby -Bonding behaviors

kick counts

-do after 28 weeks -after a meal -lay down for hour and want mom to have 4 movements -2 hours: 10 movements -if baby not moving that much teach to hydrate and eat a snack, if still though then come in for evaluation

frequency

-from start of one contraction to the start of the next -in minutes -round to 30 sec marks

NA for "afterbirth pain"

-give analgesics -positioning on abdomen with small pillow under pelvis

NA for tachysystole

-hydrate bc helps relax smooth muscle and helps contractions -breathine to slow down contractions and space them out

intrauterine pressure cath

-internal contraction monitor -gives most accurate reading of contractions and pressures inside uterus

Fetal scalp electrode

-internal fetal heart monitor -gives most accurate reading

mothers at higher risk for preeclampsia

-older mothers -younger mothers usually under 19 -mothers who are over weight -have diabetes -history of preeclampsia

duration

-start on contraction to the end -measured in seconds

late decels

-uteroplacental insufficiency -symmetric fall in the FHR, beginning at or after the peak of the contraction and returning to baseline AFTER the contraction is over -most severe

In fathers, the process is called engrossment

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23. Which patient should the nurse assess first? A. A patient that is two days post vaginal delivery with heavy red foul smelling lochia B. A patient that is going to be discharged today and has a scant amount of lochia that is pink to brown in color. C. A patient that is one day post vaginal delivery that has scant moderate lochia and the fundus is firm, midline and one finger breadth below the umbilicus D. A patient that is 12 hours post vaginal delivery with a fundus that is firm and midline at the umbilicus.

A. A patient that is two days post vaginal delivery with heavy red foul smelling lochia

24. While monitoring your patient's fetal strip, you notice that the fetal heart rate is at 165 BPM. What would this heart rate be documented as? A. Moderate tachycardia B. Moderate bradycardia C. Severe tachycardia D. Severe bradycardia

A. Moderate tachycardia

9. A client in the third stage of labor has experienced placental separation and expulsion. Why is it necessary for a nurse to massage the woman's uterus briefly until it is firm? A. To constrict uterine blood vessels. B. To provide comfort for the mom. C. It is not necessary. D. To make sure the uterus stays soft and boggy.

A. To constrict uterine blood vessels.

baseline variability

Absent- undetectable variability in baseline Minimal Variability - 0-5 BPM Moderate Variability - 6-25 BPM Marked Variability - change > 25 BPM ***do NOT evaluate during a contraction

17. When asked by the nurse what the etiology of variable decelerations are, the student nurse would be correct in stating: A) "It is a good sign and is associated with fetal head compression" B) "It is a sign of cord compression and the mother needs to be repositioned" C) "It is associated with uteroplacental insufficiency and occurs after the peak of the contraction" D) "It is an increase in fetal heart rate that is a reassuring sign of fetal wellbeing"

B) "It is a sign of cord compression and the mother needs to be repositioned"

7. The nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client's abdomen. After attachment of the monitor, the initial nursing assessment is which of the following? A. Determine the frequency of the contractions B. Assess the baseline fetal heart rate C. Determine the intensity of the contractions D. Identify the types of accelerations

B. Assess the baseline fetal heart rate

19. What procedure is TOP PRIORITY right before the surgeon starts the Cesarean? A. Do an In & Out Foley B. Monitor Fetal Tones C. cRNA checks for sensations of the patient D. Scrub Nurse puts betadine on patient

B. Monitor Fetal Tones

12. The nurse has been working with a laboring client and notes that she has been pushing effectively for 1 hour. What is the client's primary physiological need at this time? A. ambulation B. Rest between contractions C. change positions frequently D. consume oral food and fluids

B. Rest between contractions

3. The nurse is caring for a client in labor who is receiving oxytocin (Pitocin) by intravenous infusion to stimulate uterine contractions. Which assessment finding should indicate to the nurse that the infusion needs to be discontinued? A. Increased urinary output B. fetal heart rate of 90 beats/min C. Three contractions occurring within a 10-minute period D. Adequate resting tone of the uterus palpated between contractions

B. fetal heart rate of 90 beats/min

14. A laboring mother has started to experience late decelerations during her contractions. Which of the following should the nurse do to help the mother's contractions? SELECT ALL THAT APPLY. A. Call the physician B. Reoxygenate C. Reposition D. Don't do anything E. Reduce pitocin F. Report and record

B. reoxygenate c. reposition e. reduce pitocin f. report and record

gestational hypertension

BP is 140/90 -no protein found in urine dip -occurs after 20 weeks

what to look for in bubble

Breats- any craking or drainage, inverted nipples Uterus- firm, consistency, location, relationship to umbilicus Bowel- bowel sounds (after c section or epidural can be hyperactive), want them to pass gas before leaving Bladder- voiding without difficulty, foley Lochia- bleeding after birth Epesiotomy- make sure no signs of edema or brusing

16. When assessing the uterus, the nurse notes that the fundus feels boggy. What is the priority intervention for the nurse? A) Call the physician immediately B) Elevate the mother's legs C) Massage the fundus until it feels firm D) Encourage the mother to void

C) Massage the fundus until it feels firm

2. Soon after delivery a neonate is admitted to the central nursery. The nursery nurse begins the initial assessment by A) auscultation bowel sounds B) determining chest circumference C) instructing the posture, color, and respiratory effort D) checking for identifying birthmarks

C) instructing the posture, color, and respiratory effort

1. When teaching umbilical cord care to a new mother, the nurse would include which information? A) apply peroxide to the cord with each diaper change. B) cover the cord with petroleum jelly after bathing. C) keep the cord dry and open to air D) wash the cord with soap and water each day during a tub bath.

C) keep the cord dry and open to air

15. While monitoring the baby, the nurse starts to see early delerations. The mother starts to look concerned and ask the nurse is there anything to worry about. What should be the nurse's response? A. "These are terrible and we need to get the baby out as soon as possible." B. " This just means that we need to call the physician so you can be checked." C. "These are good things. We are just going to continue to monitor you." D. " I really don't know what these mean. Let me check with another nurse."

C. "These are good things. We are just going to continue to monitor you."

5. The nurse is reviewing the record of a client in the labor room and notes that the health care provider has documented that the fetal presenting part is at the -1 station. This documented finding indicates that the fetal presenting part is located at which area? A. 1 inch below the coccyx B. 1 inch below the iliac crest C. 1 cm above the ischial spine D. 1 fingerbreadth below the symphysis pubis

C. 1 cm above the ischial spine -bc ischial spine is 0

8. A nurse notices that her patient is having variable decelerations. What could this be a sign of and what action should the nurse take first? A. Cord compression, immediate delivery. B. Head compression, immediate delivery. C. Cord compression, reposition patient. D. Head compression, reposition patient.

C. Cord compression, reposition patient.

22. What type of fetal heart rate monitor would the nurse expect to be in place if the fetal heart rate was difficult to obtain and every other method has failed? A. Tocotransducer B. Intrauterine Pressure Cather C. Fetal Scalp Electrode D. Fetal Monitor

C. Fetal Scalp Electrode

20. If an 8-hour postpartum mom has a soft uterus and it is 2 finger breaths above the umbilicus, what is the patient most at risk for? A. Fever B. Can't Void on her own C. Hemorrhage D. No Bonding with child

C. Hemmorhage

10. On assessment of a postpartum client, the nurse notes that the uterus feels soft and boggy. The nurse should take which initial action? A. Elevate the client's legs B. document the findings C. Massage the fundus until it is firm D. Push on the uterus to assist in expressing clots

C. Massage the fundus until it is firm

13. What action should the nurse take if she sees early decelerations on the fetal strip? A. Reposition mother B. Notify physician and prepare for C-section C. Nothing, this is normal D. Reoxygenate

C. Nothing, this is normal

21. A patient has been diagnosed with placenta previa. Which of these interventions is contraindicated for the patient's diagnosis? A. Monitor vital signs closely B. Prepare the patient physically and emotionally for a Caesarean section C. Sterile Vaginal Exam D. Start an IV access

C. Sterile Vaginal Exam

4. The nurse is caring for a client in labor. Which assessment finding indicates to the nurse that the client is beginning the second stage of labor? A. The contractions are regular. B. The membranes have ruptured. C. The cervix is dilated completely. D. The client begins to expel clear vaginal fluid.

C. The cervix is dilated completely.

6. While monitoring your full-term labor patient, you notice persistent variable decelerations. Your first intervention for maximizing fetal oxygentation is to A. Discontinue Pitocin B. Change maternal position C. Administer oxygen

C. administer oxygen

bradycardia -causes for mom -fetal causes

Causes for mom: mag sulfate, other drugs, moms position Fetal causes: post term, laying on cord, hypoxic environment

18. A woman contracting every 3 min x 60 seconds, suddenly develops an amniotic fluid embolism. Which of the following signs/symptoms would the nurse observe? A. Sudden gush of fluid from the vagina B. Intense and unrelenting uterine pain C. Precipitous dilation and expulsion of the fetus D. Chest pain with dyspnea and cyanosis

D. Chest pain with dyspnea and cyanosis

bradycardia

FHR below 110-120 for at least 10 minutes -rates less than 95 are almost always pathologic

placement of uterus -immediately after birth -six to twelve hours after

Immediately after birth - midline between symphysis pubis and umbilicus 6-12 hours after birth - rises to level of the umbilicus

stages of touch

Initial: touches with fingertips Second: more comfortable with role - hand strokes head or body of neonate Final: holding in arms, bringing close to body

c section post care- first 24 hours

Medical management Anesthesia management - May have continual pain relief through epidural, PCA and PRNs Nursing care - assess for blood loss, I&O, warming

c section post care- 24 hours before discharge

Medical management - dressing removed Nursing care - assess pain and monitor for S/SX of hemorrhage, infection, diet, urination, ability to provide self and infant care, bowel sounds, and ambulation.

menstruation for non breastfeeding vs breastfeeding -and what to teach pt

Nonbreastfeeding -Reoccurs 7-9 weeks -First ovulation by 4th cycle Breastfeeding -3 or more months -Reduces risk of pregnancy no sex and tampons for six weeks

pros and cons of continuous monitoring

Pro of continuous- know whats going on with baby Cons- mom is strapped down

pros and cons of intermittent monitoring

Pros of intermittent monitoring- more flexibility during labor Down side- don't always know whats going on with baby

REEDA scale

Redness, edema, echimosis, drainage, approximation

lochia colors

Rubra - dark red, occurs in 1st 3-4 days -Bloody with small clots, scant - moderate, increases with breastfeeding, fleshy odor Serosa - pink to brown, occurs 4th -10th day -scant, increases with activity, fleshy odor Alba - white or creamy - 1-2 more weeks -Scant fleshy odor

vital signs after delivery

Should remain stable BP increase - Preeclampsia? Temp - normal to have elevation to 100.4 WBC - normal elevation after delivery - up to 30,000/ml HCT - may increase with hemoconcentration, decrease with blood loss

when should pt void after delivery

Should void within 1st 4-6 hours after delivery - then every 4-6 hours

rubins theory -taking in -taking hold -letting go

Taking- In - first day or two period of dependency -need for therapeutic sleep and nutrition need to resolve the labor experience Taking Hold - second or third day after birth -woman becomes more independent assumes the role of care giver focus on the future Letting Go - fluid change to motherhood role -Complete incorporation

maternal attatchment behaviors

Touch -Fingertips to palms to enfolding Vision - in face position Voice - greets newborn, high-pitched voice Hearing - responds to sounds emitted by the newborn

c section post care- immediately after

assess blood loss, fundus, vitals, I&O, keep warm, bonding

risk factors for delayed bonding

baby in NICU, when baby gets shipped off and the baby and mom are in separate places

not normal alba

bright red bleeding (s/sx late hemorrhage)

positive bonding

call baby by name, breastfeeding attachment, cuddling being close, introducing to family

discharge teaching

call dr if- increased temp over 100.5, abdominal pain, warm breasts or tender nodule if had c section don't drive for 2 weeks teach parents signs, symptoms in infant that indicate possible problems

how to manage preeclampsia

closely monitor mom low sodium diets medication- antihypertensive put on magnesium sulfate if the BP is high enough

not normal serosa

continuation of rubra after day 4, heavy saturating pads q 15min

Anaphylactic Syndrome (Amniotic fluid embolism)

embolism forms when the amniotic fluid that contains fetal cells, lanugo, and vernix enters the maternal vascular system and results in cardio-respiratory collapse -SOB -If they survive= risk for brain trauma -Preeeclampsia causes this bc pressure and so much protien in urine -C sections cause high risk

postpartum diuresis

first 12-24 hours

acceleration show what

good fetal HR

signs of preeclampsia

high BP edema blurred vision dizzy

pain relief of perineum

ice packs for the first 24 hours Warm sitz baths after 24 hours Oral or topical pain medications

preeclampsia: risk for baby

preterm delivery, resp issues, intrauterine growth restriction, still birth

teaching for a non breastfeeding mom

really tight bra to help leakage, take cooler showers and not let warm water hit breasts, wrap with ace bandage

not normal rubra

rubra: foul odor, large clots, heavy, saturating pads q 15 mins, placental fragments present