Maternity HESI HINTS
What does the BPP determine?
Fetal well being
HH 6
For many women, battering (emotional or physical abuse) begins during pregnancy. Women should be assessed for abuse in private, away from the male partner, by a nurse who is familiar with local resources and knows how to determine the safety of the client
Gentle counterpressure against the perineum during an emergency delivery prevents _____ and _____.
Maternal lacerations Fetal cerebral trauma
Name three maternal and three fetal complications of gestational diabetes.
Maternal: hypoglycemia, hypoerglycemia at birth, ketoacidosis Fetal: macrosomia, hypoglycemia at birth, fetal anomalies
HH 30
Meconium stained fluid is yellow-green or gold-yellow and may indicate fetal stress
HH 37
Never give Methergine or Hemabate to a client while she is in labor or before delivery of the placenta
HH 91
Nursing care during labor and delivery for a client with cardiac disease is focused on prevention of cardiac embarrassment, maintenance of uterine perfusion, and alleviation of anixety
In order to prevent problems with oxygenating the newborn, what parameters can the nurse observe?
PO2 50-90 SVO2 60-80
HH 3
Sperm live approximately 3 days (48-72 hours) and eggs live about 24 hours. A couple must avoid unprotected intercourse for several days before the anticipated ovulation and for 3 days after ovulation to prevent pregnancy.
HH 120
Watch a newborns Hct. It is difficult to oxygenate either an anemic newborn or a newborn with polycythemia
HH 101
When a pregnant women is admitted with a diagnosis of diabetes: -She is more prone to preeclampsia, hemorrhage, and infection -Most diabetic pregnancies are allowed to progress to term (38-40 weeks) as long as metabolic control is maintained and fetal growth is within standards
HH 84
When administering magnesium sulfate always have antidote available (calcium gluconate)
State three ways to identify the chronological age of a pregnancy (gestation).
10 lunar months, 9 calendar months consisting of three trimesters of 3 months each, 40 weeks, 280 days
FHR can be auscultated by Doppler at ____ weeks' gestation
10 to 12
HH 109
A nurse must be especially supportive of a postpartum client with infection because it usually implies isolation from newborn until organism is identified and treatment begun. Arrange phone calls to nursery and window viewing. Involve family, spouse, and significant others in teaching and encourage other family members to continue neonatal attachment activities
Prior to anesthesia for c-section delivery, the mother may be given an antacid or a gastric antisecretory drug. State the reasons these drugs are given.
Antacid buffers alkalize the stomach secretions. If aspiration occurs, less lung damage ensues. A antisecretory drug reduces gastric acid, reducing the risk for gastric aspiration
State four risk factors for or predisposing factors to postpartum hemorrhage
Dytocia or prolonged labor, overdistention of uterus, abruptio placentae, and infection
Identify three ways to determine the presence of congenital hip dislocation in the newborn
Hip click determination, asymmetric gluteal folds, unequal limb lengths
What are the major symptoms of preeclampsia?
Increase in BP of 30 mmHg systolic and 15 diastolic Proteinuria CNS disturbances
What are the cardinal symptoms of sepsis in a newborn?
Lethargy, temp instability, difficulty feeding, subtle color changes, subtle behavioral changes and hyperbilirubinemia
HH 25
Percutaneous umbilical blood sampling can be done during pregnancy under ultrasound for prenatal diagnosis and therapy. Hemoglobinpathies, clotting disorders, sepsis, and some other genetic testing can be done using this method
HH 111
Remember the risk for postpartum infections is higher in clients who experienced problems during pregnancy and who experienced trauma during labor and delivery
HH 52
Remember, RhoGAM is given to an RH negative mother who delivers a RH positive fetus and has negative indirect Coombs test. If the mother has a positive Coombs test, there is no need to give RhoGAM because the mother is already sensitized
HH 115
Risk factors for hemorrhage include dystocia, prolonged labor, overdistended uterus, abruptio placentae, infection
HH 1
The menstrual phase varies in length in each women
HH 18
When an amniocentesis is done in early pregnancy, the bladder must be full to help support the uterus and to help push the uterus up in the abdomen for easy access. When an amniocentesis is done in late pregnancy, the bladder must be empty so it will not be punctured
What is considered a good APGAR score?
7-10
HH 51
Client and family teaching is a common subject. Remember that when teaching the first step is to assess the clients level of knowledge and to identify their readiness to learn. Client teaching regarding lochia changes, perineal care, breastfeeding, and sore nipples are subjects that are commonly used
List the symptoms of a full bladder that might occur in the fourth stage of labor
Fundus above umbilicus, dextroverted, increased bleeding
Write one nursing diagnosis generated from the data pertinent to hyperbilirubinemia
Risk for injury related to predisposition of bilirubin for fat cells in brain
HH 48
Stop continuous infusion at end stage 1 labor during transition to increase effectiveness of pushing
Ovulation occurs how many day before the next menstrual cycle?
14 days
The hemodilution of pregnancy peaks at _____ weeks and results in a _____ in a woman's Hct.
28-32 weeks, decrease
During pregnancy a women should add ____ calories to her diet and drink ______ of milk per day
300, 3 cups
Normal blood glucose in term neonate is
40-80 mg/dL
A term newborn need to take in ____ calories per pound per day. After the initial weight loss is sustained, the newborn should gain ______ per day
50 1oz or 30grams
The newborn transitional period consists of the first ____ of life
6-8 hours
Normal fetal scalp pH in labor is _____, and values below _____ indicate true acidosis.
7.25 to 7.35, 7.2
The goal for diabetic management during labor is euglycemia. How is it defined?
70-90
Normal newborn temp, heart rate, respiratory rate, blood pressure
97.7f-99.4f 110-160 30-60 80/50
HH 70
A client who is 30 weeks gestation call the health care provider because she is experiencing dark red vaginal bleeding. She is admitted to the emergency department, where the nurse determines the FHR to be 100. The clients abdomen is rigid and boardlike, and she is complaining of severe pain. What action should the nurse take first? First the nurse must use their knowledge base to differentiate between abruptio placentae and placenta previa. The nurse should immediately notify the health care provider and no abdominal or vaginal manipulation or exams should be done. Administer oxygen, monitor for bleeding at iv sites and gum because of the increased risk for DIC. Emergency cesarean section is required because uteroplacental perfusion to the fetus is being compromised by early separation of the placenta from the uterus
HH 23
A decrease in uteroplacental perfusion results in late decelerations, cord compression results in pattern of variable decelertions. Nursing interventions should include changing maternal position, continuing oxytoxin infusion, administering oxygen, notifying health care provider
HH 55
A detailed physical assessment is performed by the nurse or physician. Regardless of who performs the physical assessment the nurse must know normal vs abnormal variations in the newborn. Observations must be recorded and the physician notified regarding abnormalities
HH 40
A first degree tear involves only the dermis. A second degree tear involves dermis, muscle, A third degree tear extends into the anal spintcher A forth degree tear extends up the rectal Tears cause pain and swelling Avoid rectal simulations
HH 99
A higher incidence of fetal anomalies occurs in pregnant women with diabetes. Therefore fetal surveillance is important -Ultrasound examn -Alpha fetoprotein -Nonstress and contraction stress test
HH 108
A laparotomy of any kind, including cesarean birth, predisposes the client to postop paralytic ileus. When the bowel is manipulated during surgery, it ceases peristalsis, and this condition may persist. Symptoms include absent bowel sounds, abdominal distention, tympany on percussion, nausea, vomiting, obstipation. Early ambulation is an effective nursing intervention.
HH 42
APGAR score of 6 or lower at 5 minutes require an additional APGAR assessment at 10 minutes
List three symptoms of abruptio placentae and placenta previa
Abruptio: fetal distress, rigid boardline abdomen, pain, dark red or absent blood Previa: pain free, bright red blood, normal FHR, soft uterus
State the objective signs that signify ovulation.
Abundant, thin, clear cervical mucus; spinnbarkeit (egg white stretchiness) of cervical mucus; open cervical os; slight drop in body temp and then a 0.5-1 degree rise; ferning under a microscope
Name the four periodic changes of the FHR, their causes, and one nursing treatment for each.
Accelerations are caused by a burst of sympathetic activity, they are reassuring and require no treatment. Early decelerations are caused by head compression, they are benign and alert the nurse to monitor for labor progress and fetal descent. Variable decelerations are caused by cord compression, change of position should be tried first. Late decelerations are caused by UPI and should be treated by placing client of her side and administering oxygen.
HH 77
Acyclovir (used to treat herpes simplex) is NOT recommended during pregnancy
Name five maternal variables associated with diagnosis of a high-risk pregnancy.
Age (under 17 over 34 years old), parity (over 5), <3 months between pregnancies, diagnosis of preeclampsia diabetes, cardiac disease
HH 45
Agonist narcotic drug (morphine) produce narcosis and have higher risk for causing maternal and fetal respiratory depression. Antagonist drug have less respiratory depression but must be used with caution in mother with preexiting narcotic dependency because withdrawal symptoms occur immediately
HH 90
Although delivery is often described as the cure for preeclampsia, the client can convulse up to 48 hours after delivery
HH 78
Although metronidazole (flagyl) is the treatment of choice for some vaginal infections, its use is contraindicated in the first trimester of pregnancy, and it use during the second is controversial
HH 82
Although the toxic side effects of magnesium sulfate are well known and watched for, it is just as important to get serum blood levels of magnesium sulfate about 4 in order to prevent convulsions and to reach therapeutic range
State the normal psychosocial responses to pregnancy in the second trimester.
Ambivalence wanes and acceptance of pregnancy occurs, pregnancy becomes real, signs of maternal fetal bonding occur
HH 122
Antibiotic dosage is based on the neonates weight in kilograms. Peak and trough drug levels are drawn to evaluate whether therapeutic drug levels have been achieved. Closely monitor the neonate for adverse reactions of all drugs
HH 35
Application of Perineal pad after delivery -Place two on perineum -Do not touch inside of pad -Do apply from front to back, being careful not to drag pad across the anus
List three nursing interventions for neonate undergoing phototherapy
Apply opaque mask over eyes, leave diaper loose so stools and urine can be monitor but cover genitalia, turn every 2 hours, watch for dehydration
If meconium was passed in utero, what action must the nurse take in the delivery room?
Arrange for immediate endotracheal tube observation to determine the presence of meconium below the vocal cords
HH 11
As pregnancy advances, the uterus presses on abdominal vessels (vena cava and aorta). Teach the women that a left side lying position relieves supine hypotension and increases perfusion to uterus, placenta, and fetus
What is the major cause of maternal death when general anesthesia is administered?
Aspiration of gastric contents
What are the two best ways to test for correct placement of the gavage tube in the infants stomach?
Aspiration of stomach contents and ph testing, auscultation of an air bubble injection into the stomach
A client feels faint on the way to the bathroom. What nursing assessment should be made?
Assess BP sitting and lying, assess Hbg and Hct for anemia
What is the priority nursing action after spontaneous or AROM?
Assessment of the FHR
When is the screening test for PKU done?
At 2 to 3 days of life, or after enough breast milk or formula, usually after 24 hours, is ingested to allow for determination of body's ability to metabolize amino acid phenylalanine
HH 9
At approximately 28-32 weeks gestation, a plasma volume increase of 25%-40% occurs, resulting in normal hemodilution of pregnancy and Hct values of 32%-42%. High Hct values may look good, but in reality they represent a gestational hypertension disorder and a depleted vascular space
State the best way to administer IV drugs during labor.
At beginning of contraction, push a little medication in while uterine blood vessels are constricted, thereby reducing dose to the fetus
At 20 weeks gestation, the fundal height would be _____; the fetus would weigh about _____ and would look like _____.
At the umbilicus, 300-400grams, a baby- with hair, lanugo, and vernix, but without any subcutaneous fat
What information should be given to a client regarding resumption of sexual intercourse after delivery?
Avoid until postpartum exam, use water soluble jelly, expect slight discomfort due to vaginal changes
HH 105
Babies delivered abdominally miss out on the vaginal squeeze and are born with more fluid in their lungs, predisposing them to transient tachypnea and respiratory distress
HH 27
Be able to differentiate true labor from false labor *True labor* -Pain in lower back that radiates to abdomen -Contractions that intensify with ambulation -Pain accompanied by regular rhythmic contractions -Progressive cervical dilation and effacement *False labor* -Discomfort localized in abdomen -No lower back pain -Contractions decrease in intensity or frequency with ambulation
HH 53
Because Rh immune globulins suppress the immune system, the client who receives both RhoGAM and the rubella vaccine should be tested for rubella immunity at 3 months
HH 4
Because some women experience implantation bleed or spotting, they do not know they are pregnant
A baby is delivered blue, limp, and with a heart rate <100. The nurse dries the infant, suctions the oropharrynx and gently stimulates the infant while blowing O2 over the face. The infant still does not respond. What is the nest nursing action?
Being oxygenation by bag and mask at 30-50 breaths per minute. If heart rate is <60, start cardiac massage at 120 events per minute. Assist health care provider in setting up for intubation procedure.
HH 2
Between ovulation and the beginning of the next menstrual cycle, there are usually exactly 14 days. In other words, ovulation occurs 14 days before the next menstrual cycle
List the symptoms of hyperbilirubinemia in the neonate
Bilirubin levels rise 5mg/day, jaundice, dark urine, anemia, high RBC count, dark stool
Which women experiences afterpains more that others?
Breastfeeding, multiparas and women who experienced overdistention of the uterus
HH 31
Breathing techniques, such as deep chest, accelerated, and cued, are not prescribed by the stage and phase of labor but by the discomfort level of the laboring women. If coping in decreasing, switch to a new technique
During the physical examination of the newborn, the nurse notes the cry is shrill, high pitched, and weak. What are the possible causes?
CNS anomalies, brain damage, hypoglycemia, drug withdrawal
In order to prevent rickets in the preterm newborn, what supplements are given?
Calcium and vitamin D
List three signs of positive bonding between parents and newborn
Calling infant by name, exploring newborn head to toe, using en face position
State the advantage of CVS over amniocentesis.
Can be done between 8-12 weeks gestation Results are returned within 1 week. . Allows for decision about termination while still in the 1st trimester
The nurse anticipates which newborns will be at greater risk for problems in the transitional period. State three factors that predispose to respiratory depression in the newborn
Cesarean section delivery, magnesium sulfate given to mother in labor, asphyxia or fetal distress during labor
HH 61
Circumcision has become controversial because there is no real medical indication for the procedure, and it does cause trauma and pain to the newborn. It was once thought to decrease the incidence of penile and cervical cancer, but some researchers say this is unfounded
HH 72
Client with abruptio placentae or placenta previa should undergo NO abdominal or vaginal manipulation -No Leopold maneuvers -No vaginal exams -No rectal exams, enemas, suppositories -No internal monitoring
HH 67
Clients with prior traumatic delivery, history of D&C, and multiple abortions and daughters of DES mothers may experience miscarriage or preterm labor related to incompetent cervix. The cervix may be surgically repaired prior to pregnancy, or during. A cerclage is placed around the cervix to constrict the interanal os. The cerclage may be removed prior to labor if labor is planned or left in place if cesarean birth is planned
HH 94
Coumadin may NOT be taken during pregnancy due to its ability to cross the placenta and affect the fetus. Heparin is the drug of choice, it doesnt cross the placenta
If the first day of a womens last normal menstrual period was May 28. what is the EBD using Nagele rule?
Count back 3 months and add 7 days, March 7
What interventions should the nurse implement to prevent further CNS irritability in the preeclampsia client?
Darken room, limit visitors, maintain close 1:1 nurse to client ratio, place in private room, plan nursing interventions all at the same time so client is disturbed as little as possible
What specific information should the nurse include when teaching about HPV detection and treatment?
Detection of dry wartlike growths on vulva or rectum. Need for pap smear in the prenatal period. Treatment with podophyllin cant be used during pregnancy. Gardasil immunization for females 9-30 years of age
HH 33
Determine cervical dilation before allowing client to push. Cervix should be completely dilated (10cm) before the client beings pushing. If pushing states to early, the cervix can become edematous and never fully dilated
Nurses often weigh diapers in order to determine exact urine output in the high-risk neonate. Explain this procedure.
Diaper is weighed in grams before being applied to infant. Diaper is weighed after infant has wet it. Each gram of added weight is calculated and recorded as 1ml of urine
What contraceptive technique is recommended for diabetic women?
Diaphragm with spermicide, clients should avoid birth control pills, which contain estrogen and IUDs which are an infection risk
HH 71
Disseminated intravascular coagulation (DIC) is a syndrome of abnormal clotting that is systematic and pathologic. Large amounts of clotting factors, especially fibrinogen, are depleted, causing widespread external and internal bleeding. DIC if related to fetal demise, infection, sepsis, pregnany induced hypertension, abruptio placentae.
HH 65
Do NOT feed a newborn when they respiratory rate is over 60. Inform the physician and anticipate gavage feedings in order to prevent further energy utilization and possible aspiration
HH 41
Do NOT wait until 1 minute APGAR is assigned to being resuscitation of compromised neonate
HH 124
Drugs used to treat neonatal infections can be ototoxic and nephrotoxic. Close monitoring of therapeutic levels and observation for side effects are required
HH 107
Due to exploration and cleansing of the uterus just after delivery of the placenta, the amount of lochia may be scant in the recovery room. However pooling of vagina and uterus while on bed rest may result in blood running down the clients leg when she first ambulates. Cesarean birth clients have the same lochial change, placental site healing, and aseptic needs as do vaginal birth clients
HH 114
During medical emergencies such as bleeding episodes, clients need calm, direct explanations and assurance that all is being done that can be done. If possible allow support person at bedside
HH 81
Dystocia frequently requires the use of oxytocin for augmentation or induction of labor. Uterine tetany is a harmful complication and careful monitoring is required. The desired effect is contractions every 2-3 minutes with duration of contractions no longer than 90 seconds. Continuously monitor FHR and uterine resting tone. If tetany occurs, turn off oxytocin, turn client to side lying position, administer oxygen. Check output (should be 100ml/4 hours). Oxytocins most important side effect is its antidiuretic effect, which can cause water intoxication. Using IV fluids containing electrolytes decreases the risk for wate intoxication
HH 19
Early decelerations, caused head compression and fetal descent, usually occur between 4- 7 cm and in the second stage of labor. Check for labor progress if early decelerations are noted
State three nursing interventions during forcep delivery
Ensure empty bladder, ausccultate FHR before application, during process, and between traction periods, observe for maternal lacerations, and newborn cerebral or facial trauma
HH 103
Estrogen- containing birth control pills affect glucose metabolism by increasing resistance to insulin. Use of an intrauterine device may be associated with an increased risk for infection in these already vulnerable women
How often should the nurse check the fundus during the fourth stage of labor?
Every 15 minutes for 1 hour and every 30 minutes for 2 hours if normal
State the most important action to take when a cord prolapse is determined.
Examiner should position mother to relieve pressure on the cord or push the presenting part off the cord with fingers until emergency delivery is accomplished
What is a reactive nonstress test?
FHR acceleration of 15 for 15 seconds in response to fetal movement
What is the most important indicator of fetal autonomic nervous system integrity and health?
FHR variability
Neonates who are sick are prone to receive too much stimulation in form of invasive procedures and handling and too little developmentally appropriate stimulation and affection. How might such an infant respond?
Failure to thrive, absence of crying
HH 12
Fetal well being is determined by pressing fundal height, fetal heart tones and rate, fetal movement, and uterine activity (contractions). Changes in FHR are the first and most important indicators of compromised blood flow to the fetus, these changes require action. Remember the normal FHR is 110-150
HH 38
Full bladder is one of the most common reasons for uterine atony or hemorrhage in the first 24 hours after delivery. If the nurse finds the fundus soft, boggy, and displaced above and to the right of the umbilicus, what action should be taken first? First, perform fundal massage, then have the client empty her bladder. Recheck the fundus every 15 minutes for 1 hour, then every 30 minutes for 2 hours
What immediate nursing actions should be taken when a postpartum hemorrhage is detected?
Fundal massage, notify health care provider if massage doesnt firm fundus, count pads to estimate blood loss, assess and record vital signs, increase iv fluids, and administer O2
What are the common side effects of antibiotic used to treat puerperal infection?
GI adverse reactions: nausea, vomiting, diarrhea, cramping. Hypersensitivity reactions: rashes, urticaria and hives
Why are PO medications avoided in labor?
Gastric activity slows or stops in labor, decreasing absorption from PO route; it may cause vomiting
HH 17
Gestational age is best determined by an early sonogram rather than a later one
When should the postpartum dose of oxytocin be administered and why?
Give immediately after placenta is delivered to prevent postpartum hemorrhage and atony
HH 34
Give oxytocin after the placenta is delivered because the drug will cause the uterus to contract. If the oxytocic drug is administered before the placenta is delivered, it may result in a retained placenta, which predisposes the client to hemorrhage and infection
HH 98
Glucose screen Client dose NOT have to fast for this test. 50g of glucose is given and blood is drawn after 1 hour. If the blood glucose is greater than 140, a 3 hour glucose tolerance test is done
A small for gestational age newborn is identified as one who
Has a weight below the tenth percentile for estimated weeks of gestation
A breastfeeding mother complains of very tender nipples. What nursing actions should be taken?
Have her demonstrate infant position on breast. Leave bra open to air dry nipples for 15 minutes three times daily, express colostrum and rub on nipples
List three necessary nursing actions prior to an ultrasound exam in the first trimester of pregnancy
Having client fill bladder, do not allow client to void position client in supine and with uterine wedge
HH 10
Hgb and Hct data can be used to evaulate nutritional status Example, A 22 year old primigravida at 12 weeks gestation has a Hgb of 9.6 and Hct of 31%. She has gained 3lbs during the first trimester. A weight gain of 2-4Lbs during the first trimester is recommended, and this client is anemic. Supplemental iron and a diet higher in iron are needed. Food high in iron -Fish and red meats -Cereals and yellow vegetables -Green leafy vegetables and citrus fruits -Egg yolks and dried fruits
HH 83
Hold next dose of magnesium sulfate and notify health care provider if any toxic symptoms occur (<12 respirations/min, urine output <100/4hours, absent DTR, magnesium sulfate serum level >8)
What complications are associated with TPN?
Hyperglycemia, electrolyte imbalance, dehydration, and infection
HH 32
Hyperventilation results in respiratory alkalosis that is caused by blowing off too much COs Symptoms include -Dizziness -Tingling of fingers -Stiff mouth Have a women breath into her cupped hands or a paper bag in order to rebreathe CO2
What is the danger associated with regional blocks?
Hypotension resulting from vasodilation below the block, which pools blood in the periphery, reducing venous return
HH 62
Hypothermia leads to depletion of glucose and therefore to the use of brown fat for energy. This results in ketoacidosis and possible shock. Prevent by keeping neonate warm
Name four causes of decreased FHR variability
Hypoxia, acidosis, drugs, fetal sleep
HH 43
IV administration of analgesic is preferred to IM administration for a client in labor because the onset and peak occur more quickly and the duration of the drug is shorter. It is important ot know the following IV: -onset 5 minutes -peak 30 minutes -duration 1 hour IM: -onset 30 minutes -peak 1-3 hours -duration 4-6 hours
To promote comfort, what nursing interventions are used for third degree episiotomy that extends into the anal sphincter?
Ice pack, witch hazel compresses, no rectal manipulation
HH 68
If HCG levels no not dimish choriocarcinoma may develop. Pregnancy may mask the signs and symptoms of choriocarcioma
When may a VBAC be considered by a woman with a previous c-section?
If a low uterine transverse incision was performed and can be documented and if the original complication does not recur, such as CPD
HH 104
If a women is medicated, the responsible adult accompanying her must sign the necessary consent forms. State laws differ as to the acceptability of a friend signing the consent form rather than relative
Identify two reasons to without anesthesia and analgesia until the midactive phase of stage 1 labor
If analgesia are given too early, they can retard labor, if given to late they can cause fetal distress
HH 20
If cord prolapse is detected, the examiner should position the mother to relieve pressure on the cord (knee to chest) or push the presenting part off the cord until immediate cesarean delivery can be accomplished
HH 29
If infants head is floating, watch for cord prolapse
HH 39
If narcotic analgesics are given, raise side rails and place the call with within reach. Instruct client not to get out of bed or ambulate without assistance. Caution client about drowsiness as a side effect
HH 112
In most cases, a mother who is on antibiotic therapy can continue to breastfeed unless the health care provider things the neonate is at risk for sepsis by maternal contact. Sulfa drugs are used cautiously in lactating mothers because they can be transferred in breast milk
HH 96
In severe cases of hyperemesis gravidarum, the health care provider may prescribe antihistamines, vitamin b6, or phenothiazines to relieve nausea. The provider may also prescribe Reglan to increase the rate at which the stomach moves food into the intestines or antacid to absorb stomach acid and help prevent acid reflux
HH 16
In some states, screening for neural tube defects by testing either maternal serum alpha fetoprotein levels or amniotic fluid AFP levels are mandated by state law. This screening test is highly associated with both false positives and false negatives
What factors places the postpartum client at risk for thromboembolism?
Increased clotting factors
What factors does a nurse look for in determining a newborns, what supplements are given?
Infant has good suck, has coordinated suck swallow, takes less than 20 minutes to feed, gains 20-30 g/day
List four nursing interventions to enhance family and parent adjustment to a high risk newborn
Initiate early visitation at ICU. Provide daily information to family. Encourage participation in support group for parents. Encourage all attempts at caregiving.
Describe the maternal changes that characterize the transition phase of labor.
Irritability and unwillingness to be touched, but doesnt want to be left alone, nausea, vomiting, and hiccupping
List the symptoms of neonatal narcotic withdrawal
Irritability, hyperactivity, high-pitched cry, frantic sucking, coarse flapping tremors, and poor feeding
NEC results from _____ and is manifested by _____, ischemia/hypoxia results in _____.
Ischemic hypoxia, abdominal distention, sepsis, and lack of absportion form intestine Injury to the intestinal mucosa
The nurse notes a swelling over the back part of the newborn's head. Is this a normal newborn variation?
It depends on the finding, It if crosses suture lines and is caput, it is normal. If it does not cross suture line, it is a cephalohematoma with bleeding.
HH 57
It is difficult to differentiate between caput seccedaneum (edmea under the scalp) and cephalohematoma (blood under the periosteum). The caput crosses suture lines and is usually present at birth, whereas the cephalohematoma does NOT cross the suture lines and manifests a few hours after birth. The danger of cephalohematoma is increased hyperbilirubinemia due to excess RBC breakdown
HH 15
It is recommended that pregnant women consume the equivalent of 3 cups of milk or yogurt per day. They will ensure that the daily calcium needs are met and help to alleviate the occurrence of leg cramps
Why is regular insulin used in labor?
It is short-acting, predictable, can be infused IV, and can be discontinued quickly if needed.
HH 102
It is useful to discontinue long acting insulin administration on the day before delivery is planned because insulin requirements are less during labor and drop precipitously after delivery
What is the danger to the newborn of heat loss in the first few hours?
It leads to depletion of glucose, body begins to use brown fat for energy, producing ketones and causing ketoacidosis and shock
HH 28
Its important to know the normal findings for a client in labor -Normal FHR 110-160 -Normal maternal bp <140/90 -Normal maternal pulse <100 -Normal maternal temp <100.4f -Slight elevation in temp may occur because of dehydration and the work of labor. Anything higher indicates infection and must be reported immediately
Physiologic jaundice in the newborn occurs and is caused by
Jaundice occurs at 2-3 days after delivery and is caused by immature livers inability to keep up with the bilirubin production resulting from normal RBC destruction
HH 117
Jitteriness is a clinical manifestation of hypoglycemia and hypocalcemia. Laboratory analysis is indicated to differentiate between the two
List three nursing interventions to ease the discomfort of afterpains
Keep bladder empty, provide warm blanket for abdomen, administer analgesics prescribed
What is the most important determinant of fetal maturity for extrauterine survival?
L/S ratio (lung maturity, lung surfactant development)
HH 127
Lab tests measure total and direct bilirubin levels. Dangerous bilirubin is the unconjugated, indirect type, which is measured by subtracting the direct from the total bilirubin
HH 21
Late decelerations indicate UPI and are associated with conditions such as postmaturity, preeclampsia, diabetes, cardiac disease, and abruptio placentae
What are the two most difficult times to control the pregnant diabetes?
Late in the third trimester and in postpartum period, insulin needs drop sharply
List the major CNS danger signals that occur in the neonate.
Lethargy, high pitched cry, litteriness, seizures, and bulging fontanels
List five signs and symptoms new parents should be taught to report immediately to a doctor or clinic.
Lethargy, temp >100f, vomiting, green stool, refusal of two feeds in a row
List five prodromal signs of labor the nurse might teach the client.
Lightening, braxton hicks contractions, increased bloody show, loss of mucous plug, burst of energy, and nesting behavior
HH 5
Look for signs of maternal-fetal bonding during pregnancy For example, talking to the fetus in utero, massaging abdomen, and nicknaming the fetus are all healthy psychosocial activities
What symptoms are common to most newborns with down syndrome?
Low set ears, simian crease on palm, protruding tongue, brushfield spots in iris, epicanthal folds
What instructions should the nurse give the woman with a threatened abortion?
Maintain strict bed rest for 24-48 hours, avoid sexual intercourse for 2 weeks
HH 128
Maintenance of hydration is crucial for all infants. A preterm infant is already at risk for fluid and electrolyte imbalances caused by increased body surface area resulting from extended body positioning and larger body area in relation to body weight. Phototherapy treatment for hyperbilirubinemia increases the risk for dehydration
What are the major goals of nursing care related to pregnancy induced hypertension with preeclampsia?
Maintenance of uteroplacental perfusion, prevention of seizures, prevention of complications such as HELLP syndrome, DIC, and abruption -To prevent seizures by decreasing CNS irritability -CNS depression -Calcium gluconate - Reduce urinary ouput, reduce respiratory rate, decreased reflexes
List four nursing actions for the second stage of labor.
Make sure cervix is completely dilated before pushing is allowed, assess FHR with each contraction, teach woman to hold breath for no longer than 10 seconds, teach pushing techniques
HH 113
Many times mastitis can be confused with a blocked milk sinus, which is treated b nursing closer to the lump and by rotating the baby on the breast. Breastfeeding is not contraindicated for women with mastitis unless pus is in the breast milk or the antibiotic of choice is harmful to the infant. If either of these occurs, milk production can still be fostered by manual expression
What actions can the nurse take to assist in preventing postpartum hemorrhage?
Massage the fundus and keep bladder empty
How should a nurse determine the length of a tube needed for the oral gavage feeding of a newborn?
Measure from the bridge of the nose to the earlobe and then to a point halfway between the xiphoid and umbilicus
What are the nursing actions for endometritis and parametritis?
Measures to promote lochia drainage, antipyretic measures, administration of analgesics and antibiotics as prescribed, increase of fluids, with attention to high protein and high vitamin c diet
HH 79
Medications usually recommended for a nonpregnant client with a STD may be contraindicated for the pregnant client because of the effects on the fetus
HH 36
Methergine is NOT given to clients with hypertension because of its vasocontrictive action. Pitocin is given with caution to those with hypertesion
What characteristics would the nurse expect to see in a neonate with fetal alcohol syndrome?
Microcephaly, strabismus, growth retardation, short palpebral fissures, maxillary hypoplasia, abnormal palmar creases, irregular hair, whorls, poor suck, cleft lip, cleft palate, small teeth
What special actions should the nurse take during the intrapartum period if preterm labor is unable to be arrested?
Monitor FHR continuously and limit drugs that cross placental barriers so as to prevent fetal dspression or further compromise
State three priority nursing actions in the postdelivery period for the client with preeclampsia
Monitor for sings of blood loss, continue to assess BP and DTRs every 4 hours, monitor for uterine atony
All pregnant women should be taught preterm labor recognition. Describe the warning symptoms of preterm labor.
More than 5 contractions per hour, cramps, low dull backache, pelvic pressure, change in vaginal discharge
HH 14
Most providers prescribe prenatal vitamins to ensure that the client receives and adequate intake of vitamins. However, only the health care provider can prescribe prenatal vitamins. It is the nurses responsibility to teach about proper diet and about taking prescribed vitamins as they have prescribed by the health care provider
Hypotension commonly occurs after the laboring client receives a regional block. What is one of the first signs the nurse might observe?
Nausea
Name the major discomforts of the first trimester and one suggestion for amelioration of each
Nausea and vomiting, crackers before rising, fatigue, Rest periods and naps and 7-8 hours of sleep at night
List the symptoms of water intoxication resulting form the effect of Pitocin (oxytocin) on the ADH.
Nausea, vomiting, headache, hypotension
State two ways to determine whether the membranes have truly ruptured.
Nitrazine testing: paper turns dark blue or back Demonstration of fluid ferning under microscope
Are psychoprophylactic breathing techniques prescribed for use according to the stage and phase of labor?
No clients should use these techniques according to their discomfort level and should change techniques when one in no longer working for relaxtion
A women on Orinase (oral hypoglycemia) asks the nurse if she can continue this medication during pregnancy. How should the nurse respond?
No oral hypoglycemia medication are teratogenic to the fetus. Insulin will be needed
Does insulin cross the placenta breast barrier?
No therefore insulin dependent women may breastfeed
May women with a positive HIV antibody try to breastfeed?
No, HIV has been found in breast milk
Is one ultrasound examination useful in determining the presence of IUGR?
No, serial measurements are needed to determine IUGR
Must women diagnosed with mastitis stop breastfeeding?
No, women who stop breastfeeding abruptly may make the situation worse by increasing congestion and engorgement providing further media for bacterial growth. Client may have to discontinue breastfeeding if pus is present or if antibiotic contraindicated for neonate
HH 93
Normal diuresis, which occurs with the postpartum period, can pose serious problems to the new mother with cardiac disease because of the increased cardiac output
HH 50
Normal leukocytosis of pregnancy averages 12,000-15,000. During the first 10 to 12 days postdelivery values of 25,000 are common. Elevated WBC and normal elevated ESR may confuse interpretation of acute postpartal infections.
State three principles pertinent to counseling and teaching a pregnant adolescent
Nurse must establish trust and rapport before counseling and teaching begin. Adolescents do not respond to an authoritarian approach. Consider the developmental task of identity and social and individual intimacy
Describe the schedule of prenatal visits for a low-risk pregnant woman
Once every 4 weeks until 28 weeks, every 2 week from 28-36 weeks then once a week until delivery
State four risk factors for or predisposing factors to postpartum infection.
Operative delivery, intrauterine manipulation, anemia or poor physical health, traumatic delivery, and hemorrhage
HH 100
Oral hypoglycemics are not taken during pregnancy because of the potential teratogenic effects on the fetus. Insulin is used for therapeutic management
What are the symptoms of hypovolemic shock?
Pallor, clammy skin, tachycardia, lightheadedness, and hypotension
Client who have had a cesarean section are prone to what postop complications?
Paralytic ileus, infection, thromboembolism, respiratory complications, and impaired maternal infant bonding
HH 63
Physiologic jaundice occurs at 2-3 days of life. If it occurs before 24 hours or persists beyond 7 days it becomes pathologic. Physiologic occurs because of the immature livers normal inability to keep up with the RBC destruction and to bind bilirubin. Remember unconjuated bilirubin is the culprit
The nurse records a temp below 97f on admission of the newborn. What action should the nurse be taking?
Place newborn in isolette or under radiant warmer and attach a temp skin probe to regulate temp. Double wrap newborn if no isolette or warmer is available. Watch for signs of hypothermia and hypoglycemia
A premature baby is born and develops hypothermia. State the major nursing interventions to treat hypothermia.
Place under radiant warmer or incubator with temo skin probe over liver. Warm all items touching newborn. Place plastic wrap over neonate
HH 74
Podophyllin, which is usually used to treat HPV, is contraindicated in pregnancy because it is associated with fetal death, preterm labor, and cervical carcinoma.
What interventions can the nurse implement to maintain cardiac perfusion in laboring cardiac client?
Position the client in a semi or high fowler, prevent Vasalva maneuvers, position client in side laying position for regional anesthesia, avoid stirrups because of possible popliteal vein compression and decreased venous return
Should the normal newborn have a positive or negative Babinski reflex?
Positive until 12-18 months
HH 59
Postnatally, the fetal structures of foramen ovale, ductus arteriosus, and ductus venous should close. Those that do not, cardiac and pulmonary compromise will develop
HH 54
Postpartum blues are usually normal, especially 5-7 days after delivery (unexplained tearfulness, feeling down, having decreased appetite). Encourage use of support persons to help wiht housework for the first 2 postpartum weeks. Refer to community resources
HH 8
Practice calculating EBD. If the first day of a womans last normal menstrual period was October 17, what is her EBD, using Nagele rule? July 24, count back 3 months and add 7 days. (Always give Feb 28 days)
HH 7
Practice determining the gravidity and parity. A women who is 6 weeks pregnant has the following -She has a healthy 2 year old daughter -She had a miscarriage at 10 weeks -She had an elective abortion at 6 weeks, 5 years earlier -With this pregnancy, she is gravida 4, para 1 (1 delivery after 20 weeks) -GTPAL is 4-1-0-2-1
List three conditions clients with diabetes are more prone to develop
Preeclampsia, hydramnios, infection
List the factors predisposing a woman to preterm labor
Preeclamspia, IUGR, CPD, STD, anemia
IVH is more common in _____ and results in symptoms of _____.
Premature neonates and VLBW babies Increased ICP
Describe the discharge counseling for a woman after hydatidiform mole exacuation by D&C.
Prevent pregnancy for 1 year, return to clinic or MD for montly HCG levels for 1 year, postop D&C instructions
HH 46
Pudendal block and subarachnoid block are used only in second stage of labor. Peridual and epidural black may be used in all stages of labor
How does the nurse differentiate the symptomatology of cystitis from that pyelonephritis?
Pyelonephritis has the same symptoms as cystitis (dysuria, frequency, urgency) with addition of flank pain, fever, pain at costovertebral angle
What conditions make oxygenation of the newborn more difficult?
RDS: alveolar prematurity and lack of surfactant, anemia, polycythemia
What are the two major complications of O2 toxicity?
RLF and BPD
HH 89
Rarely are antihypertensive drugs used in a preeclampsia client. They are given only in the event of diastolic BP about 110. The drug of choice if hydralazine
HH 49
Regional block anesthesia and fetal presentation -Internal rotation is harder to achieve when the pelvic floor is relaxed by anesthesia, this results in a persistent occiput posterior position of the fetus, -Monitor fetal position, remember the mother cant tell you she has back pain, which is a cardinal sign of persistent posterior fetal position -Regional blocks, especially epidural and caudal blocks, commonly result in assisted delivery because of the inability to push effectively during the second stage of labor
HH 125
Renal immaturity in a preterm infant makes the monitoring of the administration of IV fluids and drug therapy crucial. Closely monitor BUN and creatinine levels when administering the mycin antibiotic to treat infections in neonate
HH 95
Research has found that infection by H pylori is another possible causative factor in hyperemesis. Other pregnancy and nonpregnant risk factors for hyperemesis gravidarum include first pregnancy, multiple fetuses, age under 24, history of this condition with other pregnancies, obesity, high fat diet
Hyperventilation often occurs in the laboring client, What results from hyperventilation, and what should the nurse take to relieve the condition?
Respiratory alkalosis occurs, it is caused by blowing off CO2 and is relieved by breathing into a paper bag or cupped hands
What does the Silverman-Anderson index measure?
Respiratory difficulty
List the risk factors for hyperbilirubemia
Rh incompatibility, ABO incompatibility, prematurity, sepsis, perinatal asphyxia
HH 76
Rubella is teratogenic to the fetus during the first trimester, causing congenital heart disease, cataracts, or both. All women should have their titers check during pregnancy. If the womans titers are low, should be receive the vaccine after delivery and be intrusted not to get pregnant within 3 months. Breastfeeding mothers may take the vaccine
HH 123
Sepsis can be indicated by both a temp increase and temp decrease
Three days postpartum, a lactating mother has full, warm, taut, tender breasts. What nursing actions should be taken?
She is engorged, have newborn suckle frequently, take measures to increase milk flow: warm water, breast massage, supportive bra
HH 92
Should these clients experience preterm labor, the use of beta adrenergic agent such as Terbutaline is contraindicated because of the risk for MI
Name the three most common complications of amniocentesis
Spontaneous abortion, fetal injury, infection
What are the signs of endometritis?
Subinvolution (boggy, high uterus), lochia returning to rubra with possible foul smell, temp 100.4f or higher, unfundal tenderness
HH 56
Suction the mouth first then the nose. Stimulating the nares can initiate inspiration, which could cause aspiration of mucus in the oral pharynx
HH 69
Suspect ectopic pregnancy in any women of childbearing age who is presenting at an emergency room, clinic, or office with unilateral or bilateral abdominal pain. Most are misdiagnosed as appendicitis
What is the major side effect of beta adrenergic tocolytic drugs?
Tachycardia
HH 85
Tachycardia is the major side effect of tocolytic drugs which are beta adrenergic agents, such as terbutaline. They are used to stop preterm labor. Teach the client to take her pulse prior to administration and to withhold medication if pulse is not within the prescribed parameters (>120-140). If administration is via a continuous pump, teach the client to monitor pulse periodically
List the symptoms of cardiac compensation in a laboring client with cardiac disease.
Tachycardia, tachypnea, dry cough, rales in lung bases, dyspnea, and orthopnea
State five symptom
Tachypnea, dusky color, flaring nares, retractions, grunting
A women has decided to take birth control pills as her contraceptive method. What should she do if she misses taking the pill for 2 consecutive days?
Take two pills for 2 days and use an alternative form of birth control
HH 13
Teach clients to report immediately any of the following danger signs. Early intervention can optimize maternal and fetal outcome. Possible indications of Preeclampsia and exlampsia are: -Visual distrubances -Swelling of face, fingers, and sacrum -Severe, continuous headache -Persistent vomiting -Epigastric pain -Fluid discharge or bleeding from vagina (anything other than normal leukorrhea) -Change in fetal movement or increaesd FHR Infection signs include: -Chills -Temperature over 100.4f -Dysuria -Pain in abdomen
HH 66
Teach parents to take infants temp both axillary and rectal. Axillary is recommended but some pediatricians request rectal temp. -Axillary place under the infants arm hold in place for 5 minutes -Rectal: needs blunt need, insert 1/4-1/2 inch and hold for 5 minutes.
Upon admission to the postpartum room, 3 hours after delivery, a client has a temp of 99.5f. What nursing actions are required?
Temp is probably elevated due to dehyration and work of labor, force fluids and retake temp in one hour, notify physician if above 100.4f
What is the most common complication of oxytocin augmentation or induction of labor? List three actions the nurse should take if such a complication occurs?
Tetany. Turn off Pitocin. Turn pregnant woman onto side. Administer O2
HH 73
Tetracycline is contraindicated in pregnancy because it darkens the teeth of the newborn
HH 24
The danger of nipple stimulation flies in controlling the dose of oxytocin delivered by the posterior pituitary. The chance of hyperstimulation or tetany (contractions over 90 seconds or contractions with less than 30 seconds in between) is increased
HH 47
The first sign of a blocks effectiveness is usually warmth and tingling in the ball of the foot or the big toe
What are the dangers of the nipple stimulation stress test?
The inability to control oxytocin dosage and the chance of tetany/hyperstimulation
What maternal position provides optimum fetal and placental perfusion during pregnancy?
The knee chest position, but the ideal position of comfort for the mother, which supports the fetal, maternal, and placental perfusion is the side laying position (removes pressure from the abdominal vessels)
HH 119
The lower the score on the SilvermanAnderson index of respiratory distress, the better the respiratory status of the neonate. A score of 10 indicates the newborn is in severe respiratory distress. This is the exact opposite of the method used for APGAR scoring
HH 88
The major goal of nursing care for a client with preeclampsia is to maintain uteroplacental perfusion and prevent seizures. This requires the administration of magnesium sulfate. Withhold administration of magnesium sulfate if signs of toxicity exist.
HH 110
The most common iatrogenic cause of a UTI is urinary catheterization. Encourage clients to void frequently and not ignore the urge. IV antibiotics are usually administered to clients with pyelonephritis
HH 26
The most important determinant of fetal maturity for extrauterine survival is the lung maturity, lung surfactant ratio
HH 80
The outcome of adolescent pregnancy depends on the prenatal care. Nutrition is a key factor because the adolescents physioloic needs for growth are already higher, and the additional stress of pregnancy only increases those needs
HH 106
The preferable low transverse uterine incision usually results in less postop pain, less bleeding, and fewer incidents of ruptured uterus. The classical vertical incision of the uterus may involve part of the fundus, resulting in more postop pain, more bleeding and increased chance of uterine rupture
Why does the newborn need vitamin K in the first hour after birth?
The sterile gut at delivery lacks intestinal bacteria necessary for the synthesis of vitamin k, vitamin k is needed in the clotting cascade to prevent hemorrhagic disorders
Define cervical effacement
The taking up of the lower cervical segment into the upper segment, the shortening of the cervix expressed into percentages from 0%-100% or complete effacement
HH 58
The umbilical cord should always be checked at birth. It should contain three vessels, one vein which is oxygentated blood to the fetus, and two arteries, which carry unoxygenated blood back to the placenta. This is the opposite of normal circulation in the adult. Cord abnormalities usually indicate cardiovasular or renal anomalies
HH 87
The uterus is the most sensitive to become tetanic at the beginning of the infusion. The client must ALWAYS be attended and contractions monitored. Contractions should last no longer than 90seconds to prevent fetal hypoxia
HH 60
These neurologic reflexes are transient and disappear usually within the first year of life. In the pediatric client, prolonged presence of these reflexes can indicate CNS defects.
What should the fundal height be at 3 days postpartum for a woman who has had a vaginal delivery?
Three fingerbreadths/cm below the umbilicus
Where is the FHR best heard?
Through the fetal back in vertex, OA positions
HH 121
To PO2 should be maintained between 50-90 mmHG. PO2 <50 signifies hypoxia. PO2 >90 signifies oxygen toxicity problems
HH 126
To assess for skin jaundice, apply pressure with thumb over bony prominence to blanch skin. After thumb is removed, the area will look yellow before normal skin color reappears. The best areas for assessment are the nose, forehead, and sternum. In dark skinned infants observe congunctival sac and oral musosa
HH 118
To avoid metabolic problems brought on by cold stress, the first step and number one priority in managing the newborn is to prevent loss of body heat, that is followed by ABCs. Neonates produce heat by nonshivering thermogenesis, which involves burning of brown fat. The neonate is easily stressed by hypothermia and develops acidosis as a result of hypoxia. Prevent chilling. If an infant is cold, the first signs exhibited are prolonged acrocyanosis, skin mottling, tachycardia, and tachypnea. If an infant is cold stressed, warm slowly over 2-4 hours because rapid warming may produce apnea. A neonate needs glucose, he or or she has little glycogen storage and needs to be fed
Why are serum or amniotic AFP levels done prenatally?
To determine whether AFP levels are elevated, which may indicate the presence of neural tube defects, or whether they are low, which may indicate trisomy 21
HH 64
To evaluate exact urine output, weigh dry diaper before applying. Weigh the wet diaper after infant has voided. Calculate and record each gram of added weight as 1 ml urine
What is the purpose of eye prophylaxis in the newborn?
To prevent opthalmia neonatorum, which results from exposure to gonorrhea in the vagina
State three principles relative to the pattern of weight gain in pregnancy.
Total gain should be average 25-35 lbs. Gain should be consistent throughout pregnancy. An average of 1lb/week should gained in the second and third trimester
HH 75
Toxoplasmosis is usually related to exposure of cats, gardening, or eating raw meat
HH 44
Tranquilizers such as phenergan and vistaril are used in labor as analgesic potentiating drugs to decrease the amount of narcotic needed to decrease maternal anxiety
How is true labor discriminated from false labor?
True labor: regular, rhythmic contractions that intensify with ambulation, pain in the abdomen sweeping around from the back, and cervical changes False labor: irregular rhythm, abdominal pain (not in back) that decreases with ambulation
State three actions the nurse should take when hypotension occurs in a laboring client.
Turn client to left side, administer o2, increase speed of iv infusion
When is preterm labor able to be arrested?
UTI, overdistention of uterus, diabetes, preeclampsia, cardiac disease, placenta previa, psychosocial factors such as stress
A women asks why she is urinating so much in the postpartum period. The nurse bases the response on what information
Up to 3000ml per day can be voided because of the reduction in the 40% plasma volume increase during pregnancy
When should a laboring client be examined vaginally?
Vaginal exams should be done prior to analgesia and anesthesia to rule out cord prolapse, to determine labor progress if it is questioned, and to determine when pushing can begin
Identify the nursing plans and interventions for a woman hospitalized with hyperemesis gravidarum
Weight daily, check urine ketone three times a day, give progressive diet, check FHR every 8 hours, monitor for electrolyte imbalance
HH 116
What immediate nursing actions should be taken when a postpartum hemorrhage is detected? -Perform fundal massage -Notify health care provider if fundus does not become firm -Count pads to estimate blood loss -Assess and record vital signs -Increase IV fluids -Administer oxytocin infusion as prescribed
HH 22
When decelerations patterns (late or variable) are associated with decreased or absent variability and tachycardia, the situation is ominous (potentially disastrous) and require immediate intervention and fetal assessment
When is it dangerous to administer butorphanol (Stadol), an agonist/antagonist narcotic?
When the client is an undiagnosed drug abuser of narcotics, it can cause immediate withdrawal
When should the nurse hold the dose of magnesium sulfate and call the physician?
When the clients respirations are <12, DTRs are absent, or urine output is <100ml/4hrs
What nursing interventions are used to enhance maternal infant bonding during the fourth stage of labor?
Withhold eye prophylaxis for up to 1 hour, perform newborn admission and routine procedures in room with parents, encourage breastfeeding, darken room for encourage newborn to open eyes
HH 97
Women who suffer from hyperemesis gravidarum are often deficient in thiamin, riboflavin, vitamin b6, vitamin a, and retinol binding proteins
HH 86
Women with previous uterine scars are prone to uterine rupture, especially if oxytocin or forceps are used. If a women complains of sharp pain accompanied by the abrupt cessation of contractions, suspect uterine rupture, MEDICAL EMERGENCY. Immediate surgical delivery is indicated to save the fetus and the mother
List three signs of placental
gush of blood, lengthening of cord, and globular shape of uterus
How is the fourth stage of labor defined?
the first 1-4 hours after delivery of the placenta
What is the cause of preeclampsia?
the underlinging pathphisiology appears to be generalized vasospans with increased peripheral resistance and vascular damage
