OB Final
positive signs of pregnancy
+ FHT by doppler Visualization of fetus on ultrasound Palpation of fetal movement by the examiner
What is the usual route and dose of methergine?
0.2 mg IM
The appropriate dose of vitamin K is _____. Why is vitamin K given to newborns?
0.5-1.0 mg To prevent bleeding because the immature newborn liver cannot yet synthesize vitamin K
The nurse is administering erythromycin ointment to a newborn. Select all of the following factors that apply: 1. The medication should be instilled in the lower conjunctival sac of each eye 2. The eyelids should be massaged gently to distribute the ointment 3. The medication must be given within the first hour or so after birth 4. The medication does not cause any discomfort to the infant 5. The medication can interfere with the baby's ability to focus
1, 2, 3, 5
List cultural beliefs related to newborn feeding:
1. Some women of Asian heritage breastfeed for first 1-2 years of life 2. People of Iranian heritage may breastfeed female babies longer than male babies 3. Some women of African ancestry may wean their babies after they begin to walk 4. Several cultures believe that colostrum is not healthy 5. Haitian mothers may believe that strong emotions spoil breast milk
List 5 minimal criteria for newborn discharge from the hospital
1. Stable VS for at least 12 hours 2. Urinated and passed at least 1 stool 3. Completed 2 successful feedings 4. No abnormalities on physical exam 5. Mother's knowledge, ability, and confidence are documented
Describe 3 methods nurses can use to assess that parents have understood postpartum teaching:
1. Teach back 2. Demonstration 3. Elicit questions
Identify recommended weight gains in pregnancy for the following conditions: 1. Underweight: _____ 2. Normal weight: _____ 3. Overweight: _______ 4. Obese: _______
1. Underweight: 28-40 lb 2. Normal weight: 25-35 lb 3. Overweight: 15-25 lb 4. Obese: 11-20 lb
A nurse is teaching about enhancing attachment to the newborn. He knows his teaching has been effective when the parents say: 1. "It will be a few weeks until my baby recognizes my voice" 2. "Eye contact is important in developing attachment" 3. "I should touch the baby as little as possible to minimize heat loss" 4. "I am not sure how to comfort the baby when she cries"
2. "Eye contact is important in developing attachment"
A nursery nurse is teaching the parents of an 8lb 4 oz formula fed baby about appropriate nutritional intake. How many ounces of formula should this baby have each day? 1. 5-18 2. 19-22 3. 24-28 4. 29-33
2. 19-22 Calculation: 20 kcalories in each 30 ml of formula (each 1 ounce). Baby needs approximately 50 kcalories (45.5 to 52.5) per pound of body weight per day. 50 kcalories X 8.25 pounds = 412 kcalories per day. Divide 412 kcalories by 20 (20 kcalories per ounce) = 20.6 ounces of formula per day.
At 6-12 hours postpartum, it is expected that the uterine fundus will be: 1. At the level of the symphysis pubis 2. At the level of the umbilicus 3. Midway between the umbilicus and symphysis pubis 4. 2 fingerbreadths below the umbilicus
2. At the level of the umbilicus
The nurse is performing an assessment on a breastfeeding dyad. The mother is holding the infant tucked under her arm with the infant's back and shoulders in her palm. The nurse documents this feeding position as: 1. Cradling 2. Football 3. Modified cradle 4. Side-lying
2. Football
A pregnant patient's first day of her last menstrual period was 6/14. What would be this patient's estimated date of birth?
3/21 To determine estimated date of birth, subtract 3 months and add 7 days from the first day of the patient's last menstrual period. For this patient, this would be 6 - 3 or 3 and 14 + 7 or 21. The estimated date of birth would be 3/21.
The nurse should report which of the following findings related to lochia as abnormal: 1. A musty odor 2. Mixed with a small amount of mucus 3. A moderate amount 4. A foul odor
4. A foul odor
A new mother is concerned about whether or not she can produce enough breastmilk. The nurse teaches the that the best indication her baby is receiving adequate nutrition is that the baby: 1. Is hungry and wants to eat every 2-3 hours 2. Sleeps for 4-6 hours between feedings 3. Gains 2 ounces per week 4. Has 6-8 wet diapers a day
4. Has 6-8 wet diapers a day
Which of the following behaviors indicates a need for further assessment of parent-infant bonding? 1. Calling the baby by name right away 2. Unwrapping and inspecting the baby 3. Seeking eye-contact with the baby 4. Waiting for the baby to vigorously cry before each feeding
4. Waiting for the baby to vigorously cry before each feeding
The nurse is conducting an initial prenatal assessment for a pregnant client. Which screenings should the nurse prepare the client for during this visit? Select all that apply. A. ABO and Rh typing B. HIV screening C. A urinalysis D. Complete blood count (CBC) E. Glucose tolerance test (GTT)
A, B, C, D ABO and Rh typing are drawn during the initial prenatal visit. An HIV screening is drawn during the initial prenatal visit. A urinalysis is conducted during the initial prenatal visit and for every subsequent prenatal visit A CBC is drawn during the initial prenatal visit Glucose is not done until SECOND trimester
Which of the following facilitates a neutral thermal environment? (Select all that apply.) A. Skin to skin contact between mother and baby B. Immediate drying C. Wrapping mother and baby in warm blankets D. Placing baby wrapped in blankets under the radiant warmer E. Maintaining a normal room temperature
A, B, C, E
A client who is having false labor most likely would have which of the following? (Select all that apply.) A. Pain in the abdomen that does not radiate B. Progressive cervical effacement and dilatation C. An increase in the intensity and frequency of contractions D. Contractions that lessen with rest and warm tub baths E. Contractions that do not intensify while walking
A, D, E True labor results in progressive dilation, increased intensity and frequency of contractions, and pain in the back that radiates to the abdomen. In true labor, contractions do not lessen with rest and warm tub baths. True labor contractions intensify while walking
A NICU nurse plans care for a preterm newborn that will provide opportunities for development. Which interventions support development in a preterm newborn in a NICU? Select all that apply. A. Dim the lights. B. Do not offer a pacifier. C. Place a blanket over the top portion of the incubator. D. Schedule care to cluster interventions E. Silence alarms quickly.
A, C, D, E Dimming the lights may encourage infants to open their eyes and be more responsive to their parents. Dimmer switches should be used to shield the baby's eyes from bright lights with blankets over the top portion of the incubator. Nursing care should be planned to decrease the number of times the baby is disturbed. Noise levels can be lowered by replacing alarms with lights or silencing alarms quickly.
A client is experiencing excessive bleeding immediately after the birth of her newborn. After speeding up the IV fluids containing oxytocin, with no noticeable decrease in the bleeding, the nurse should anticipate the physician requesting which medications? (Select all that apply.) A. Misoprostol B. Coumadin C. Nonsteroidal anti-inflammatory drugs D. Serotonin reuptake inhibitors (SSRIs) E. Methergine
A, E Misoprostol - commonly used rectally for postpartum hemorrhage Methergine is commonly used orally for postpartum hemorrhage
A glucose screening test would be done in the first trimester for which of the following patients? A. A woman with a pre-pregnant BMI of 40 B. A 15 year old pregnant with her first baby C. A woman who delivered her first baby at 32 weeks D. A woman who is pregnant with her 6th baby
A. A woman with a pre-pregnant BMI of 40 Early glucose screening is done for those at risk for pre-existing diabetes
A patient on the 2nd postpartum day reports that she was watching a youtube video about puppies and started to cry for no reason. She says she is thrilled with being a new Mom and loves her baby, but is worried that she might have postpartum depression. The nurse explains that the patient's episode of crying is typical of: A. Baby blues and should resolve on its own B. Postpartum depression and should be evaluated C. Anxiety and relaxation exercises might help D. Pre-existing depression and an antidepressant might be needed
A. Baby blues and should resolve on its own Baby blues is characterized by mood swings and episodes of crying in the first 2 weeks postpartum without other symptoms of depression. Baby blues is self-limiting and resolves without treatment. Mood swings in the early postpartum period may be associated with fatigue, physical discomfort, hormonal changes, and sleep deprivation.
The nurse is teaching the students in their obstetric rotation about fertilization. What processes must the sperm undergo before fertilization can occur? A. Capacitation and the acrosomal reaction B. Gametogenesis and capacitation C. Oogenesis and the acrosomal reaction D. Capacitation and ovulation
A. Capacitation and the acrosomal reaction capacitation - enabled to penetrate and fertilize egg acrosomal reaction - allows it to fuse with oocyte membrane
During the fourth stage of labor, the client's assessment includes a BP of 110/60, pulse 90, and the fundus is firm midline and halfway between the symphysis pubis and the umbilicus. What is the priority action of the nurse? A. Continue to monitor. B. Massage the fundus. C. Turn the client onto her left side. D. Place the bed in Trendelenburg position.
A. Continue to monitor. The client's assessment data are normal for the fourth stage of labor, so monitoring is the only action necessary. During the fourth stage of labor, the mother experiences a moderate drop in both systolic and diastolic blood pressure, increased pulse pressure, and moderate tachycardia.
Name the parts of the fetal skull:
A. Frontal suture B. Frontal bone C. Anterior fontanelle D. Parietal bone E. Parietal bone F. Posterior fontanelle G. Occipital bone
A client arrives in the labor and delivery unit and describes her contractions as occurring every 10-12 minutes, lasting 30 seconds. She is smiling and very excited about the possibility of being in labor. On exam, her cervix is dilated 2 cm, 100% effaced, and -2 station. What best describes this labor? A. Latent phase B. Transition phase C. Active phase D. Second phase
A. Latent phase In the early or latent phase of the first stage of labor, contractions are usually mild. The woman feels able to cope with the discomfort. The woman is often talkative and smiling and is eager to talk about herself and answer questions.
Which of the following tests has become a widely accepted method of evaluating fetal status? A. Nonstress test (NST) B. Nuchal translucency test C. Contraction stress test (CST) D. MSAFP test
A. Nonstress test (NST) The nonstress test (NST) has become a widely accepted method of evaluating fetal status. This test involves using an external electronic fetal monitor to obtain a tracing of the fetal heart rate (FHR) and observation of acceleration of the FHR with fetal movement.
The labor and delivery nurse is caring for a client whose labor is being induced due to fetal death in utero at 35 weeks' gestation. In planning intrapartum care for this client, which nursing diagnosis is most likely to be applied? A. Powerlessness B. Coping: Family, Readiness for Enhanced C. Urinary Elimination, Impaired D. Skin Integrity, Impaired
A. Powerlessness Powerlessness is commonly experienced by families who face fetal loss. Powerlessness is related to a sense of lack of control in the current situational crisis.
The nurse understands that the classic symptom of endometritis in a postpartum client is which of the following? A. Purulent, foul-smelling lochia B. Flank pain C. Breast is hot and swollen D. Decreased blood pressure
A. Purulent, foul-smelling lochia Assessment findings consistent with endometritis are foul-smelling lochia, fever, uterine tenderness on palpation, lower abdominal pain, tachycardia, and chills.
The nurse suspects that a client has developed a perineal hematoma. What assessment findings would lead the nurse to this conclusion? A. Tense tissues with severe pain B. Elevated temperature C. Facial petechiae D. Large, soft hemorrhoids
A. Tense tissues with severe pain Tenseness of tissues that overlie the hematoma is characteristic of perineal hematomas.
Four minutes after the birth of a baby, there is a sudden gush of blood from the mother's vagina, and about 8 inches of umbilical cord slides out. What action should the nurse take first? A. Watch for the emergence of the placenta. B. Place the client in a supine position. C. Prepare for the delivery of an undiagnosed twin. D. Place the client in McRoberts position.
A. Watch for the emergence of the placenta. Signs of placental separation usually appear around 5 minutes after birth of the infant, but can take up to 30 minutes to manifest. These signs are (1) a globular-shaped uterus, (2) a rise of the fundus in the abdomen, (3) a sudden gush or trickle of blood, and (4) further protrusion of the umbilical cord out of the vagina.
presumptive signs of pregnancy
Amenorrhea Nausea/vomiting Urinary frequency Breast tenderness Maternal perception of movement
You are doing discharge teaching for a new mother on her 2nd postpartum day. She looks confused when you begin to discuss resumption of activities. The patient tells you that her mother-in-law just told her that new mothers should have complete bedrest for 2 weeks. How would you respond?
As we learn about what is best for moms and babies after birth, advice can change. Evidence suggests that bedrest increases the risk of blood clots. Although vigorous exercise or activity leading to over-exhaustion is discouraged in the first 2 weeks, walking and mild activities are encouraged to decrease the risk of blood clots, stimulate the appetite, decrease the risk of constipation, and aid in both mood and sleep.
The nurse is reviewing the process of fertilization with a group of high school students. Which structure should the nurse identify as the location where fertilization of the ovum occurs? A - ovary B - fallopian tube C - endometrium D - uterus
B Fertilization of the secondary oocyte by a spermatozoon usually occurs in the ampulla, which comprises the outer two thirds of the fallopian tube.
The community nurse is working with a group of women at a safety-net clinic for vulnerable populations. The women are all are formula-feeding their infants. Which statement indicates that the nurse's education session was effective? A. "The mixed formula can be left on the counter for a day." B. "I follow the instructions for mixing the powdered formula exactly." C. "I should use only soy-based formula for the first year." D. "It is okay to add more water to the formula to make it last longer."
B. "I follow the instructions for mixing the powdered formula exactly." Powdered formula is the least expensive type of formula. Parents will need to be briefed on safety precautions during formula preparation and they should be instructed to follow the directions on the formula package label precisely as written.
The nurse has completed a community education session on growth patterns of infants. Which statement by a participant indicates that additional teaching is needed? A. "Healthcare providers consider breastfeeding to be the 'gold standard' for neonatal nutrition." B. "Newborns should regain their birth weight by 1 week of age." C. "Breastfed and formula-fed babies have different growth rates." D. "Formula-fed infants regain their birth weight earlier than breastfed infant."
B. "Newborns should regain their birth weight by 1 week of age." Newborns should gain at least 10 g/kg/day and be back to birth weight no later than day 14 of life.
Which of the following changes in kidney functioning occurs during a normal pregnancy? A. Blood urea nitrogen values increase B. Glomerular filtration rate increases C. Renal plasma flow decreases D. Renal tubular reabsorption rate decreases
B. Glomerular filtration rate increases
The nurse is preparing a client for amniocentesis. Which statement would indicate that the client clearly understands the risks of amniocentesis? A. It could produce a congenital defect in my baby B. I might go into labor early C. The test could stunt my baby's growth D. Actually, there are no real risks to this procedure
B. I might go into labor early Amniocentesis has the potential to cause spontaneous abortion
One day after giving birth vaginally, a client develops painful vesicular lesions on her perineum and vulva. She is diagnosed with a primary herpes simplex 2 infection. What is the expected care for her neonate? A. Cultures of blood and CSF and serial chest x-rays every 12 hours. B. Intravenous acyclovir (Zovirax) and contact precautions. C. Meticulous hand washing and antibiotic eye ointment administration. D. Parental rooming-in and four intramuscular injections of penicillin.
B. Intravenous acyclovir (Zovirax) and contact precautions. Administering intravenous acyclovir (Zovirax) and contact precautions are appropriate measures for an infant at risk for developing herpes simplex 2 infection.
What VS needs to be taken prior to methergine administration? Why?
BP. Severe hypertension, vasoconstriction, and stroke may occur. Hypertension is a contraindication to methergine administration.
Akesha Smith is interested in breastfeeding her newborn daughter, but feels overwhelmed. She has a lot of questions and is uncertain how to begin. She states: "I have so many questions I wonder if I will ever know what to do." Formulate a nursing diagnosis that might apply to this patient:
Breastfeeding, ineffective, related to lack of maternal self-confidence as evidenced by questioning statements
A client who wants to use the vaginal sponge method of contraception shows that she understands the appropriate usage when she makes which statement? A. "I need to leave it in no longer than 6 hours." B. I need to add spermicidal cream prior to intercourse." C. "I need to moisten it with water prior to use." D. "I need to use a lubricant prior to insertion."
C. "I need to moisten it with water prior to use." To activate the spermicide in the vaginal sponge, it must be moistened thoroughly with water.
A postpartum client calls the nursery to report that her newborn's umbilical cord stump is draining, and has a foul odor. What is the nurse's best response? A. "This is normal during healing." B. "Apply Betadine around the cord stump." C. "Take your newborn to the pediatrician." D. "Cover the cord stump with gauze."
C. "Take your newborn to the pediatrician." Parents should check each day for any odor, oozing of greenish yellow material, or reddened areas around the cord. They should report to the healthcare provider any signs of infection.
The prenatal clinic nurse is explaining test results to a client who has had an assessment for fetal well-being. Which statement indicates that the client understands the test results? A. "Because my contraction stress test was positive, we know that my baby will tolerate labor well." B. "The reactive nonstress test means that my baby is not growing because of a lack of oxygen." C. "The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby." D. "My biophysical profile score of 6 points to everything being normal and healthy for my baby."
C. "The normal Doppler velocimetry wave result indicates my placenta is getting enough blood to the baby." A decrease in fetal cardiac output or an increase in resistance of placental vessels will reduce umbilical artery blood flow. Doppler velocimetry is best used when intrauterine growth restriction is diagnosed; a normal result indicates that the baby is getting an adequate blood supply.
While completing the medical and surgical history during the initial prenatal visit, the 16-year-old primigravida interrupts with "Why are you asking me all these questions? What difference does it make?" Which statement would best answer the client's questions? A. "We ask these questions to make sure that our paperwork and records are complete and up to date." B. "We ask these questions to see whether you can have prenatal visits less often than most clients do." C. "We ask these questions to detect anything that happened in your past that might affect the pregnancy." D. "We ask these questions to look for any health problems in the past that might affect your parenting."
C. "We ask these questions to detect anything that happened in your past that might affect the pregnancy." The course of a pregnancy depends on a number of factors, including the past pregnancy history (if this is not a first pregnancy), pre-pregnancy health of the woman, presence of disease/illness states, family history, emotional status, and past healthcare.
A 15-year-old client has delivered a 22-week stillborn fetus. What does the nurse understand? A. Most teens have had a great deal of contact with death and loss and have an established method of coping. B. Teens tend to withhold emotions and need older adults with the same type of loss to help process the experience. C. Assisting the client might be difficult because of her mistrust of authority figures. D. Grieving a fetal loss manifests with very similar behaviors regardless of the age of the client.
C. Assisting the client might be difficult because of her mistrust of authority figures. Adolescents rely heavily on peer support and have a natural distrust of authority figures, which can make assisting them more difficult.
A 38-week newborn is found to be small for gestational age (SGA). Which nursing intervention should be included in the care of this newborn? A. Monitor for feeding difficulties. B. Monitor for signs of hyperglycemia. C. Maintain a warm environment. D. Assess for facial paralysis.
C. Maintain a warm environment. Hypothermia is a common complication in the SGA newborn; therefore, the newborn's environment must remain warm, to decrease heat loss.
The nurse has just assisted the father in bathing the newborn 2 hours after birth. The nurse explains that the newborn must remain in the radiant warmer. This is based on which assessment data? A. Heart rate 120 B. Respiratory rate 50 C. Temperature 96.8°F D. Temperature 99.6°F
C. Temperature 96.8°F The nurse rechecks the temperature after the bath and, if it is stable, dresses the newborn in a shirt, diaper, and cap; wraps the baby; and places the baby in an open crib at room temperature. If the baby's axillary temperature is below 36.5°C (97.7°F), the nurse returns the baby to the radiant warmer. The rewarming process should be gradual to prevent the possibility of hyperthermia.
A client had a cesarean birth 3 days ago. She has tenderness, localized heat, and redness of the left leg. She is afebrile. As a result of these symptoms, what would the nurse anticipate would be the next course of action? A. That the client would be encouraged to ambulate freely B. That the client would be given aspirin 650 mg by mouth C. That the client would be placed on bed rest D. That the client would be given Methergine IM
C. That the client would be placed on bed rest These symptoms indicate the presence of superficial thrombophlebitis. The treatment involves bed rest, elevation of the affected limb, analgesics, and use of elastic support hose.
To identify the frequency of contractions, the nurse would do which of the following? A. Time from the beginning of the contraction to the peak of the same contraction. B. Palpate for the strength of the contraction at its peak. C. Time between the beginning of one contraction and the beginning of the next contraction. D. Start timing from the beginning of one contraction to the completion of the same contraction.
C. Time between the beginning of one contraction and the beginning of the next contraction. The frequency of contractions is measured from the beginning of one contraction to the beginning of the next contraction.
A nurse is explaining to the nursing student why evaluation of the perineal area for the postpartum patient needs to be conducted in a side-lying position. The nurse explains that the side-lying position facilitates: A. Comfort B. Decreased pressure on sutures C. Visualization D. Assessment of infection
C. Visualization In order to get good visualization of the perineal area, the patient must be in the side lying position, and the buttocks need to be separated.
Identify the causes of the following in pregnancy: Urinary frequency
Caused by direct pressure of the uterus on the bladder
Identify these early pregnancy signs: Blue purple color of the cervix
Chadwick
probable signs of pregnancy
Chadwick Goodell Hegar Positive pregnancy test Uterine enlargement Braxton-hicks contractions
What is the definition of pica? What is the most important nutritional concern with pica?
Craving and eating of non-nutritive, non-food substances. The most important and common problem with pica is iron deficiency anemia.
A woman at 28 weeks' gestation is asked to keep a fetal activity record and to bring the results with her to her next clinic visit. One week later, she calls the clinic and anxiously tells the nurse that she has not felt the baby move for more than 30 minutes. Which of the following would be the nurse's most appropriate initial comment? A. "When did you eat last?" B. "Have you been smoking?" C. "You need to come to the clinic right away for further evaluation." D. "Your baby might be asleep."
D. "Your baby might be asleep." Lack of fetal activity for 30 minutes typically is insignificant. Movement varies considerably, but most women feel fetal movement at least 10 times in 3 hours.
Of all the clients who have been scheduled to have a biophysical profile, the nurse should check with the physician to clarify the order for which client? A. A gravida with intrauterine growth restriction B. A gravida who complains of decreased fetal movement for 2 days C. A gravida who is post-term D. A gravida with mild hypotension of pregnancy
D. A gravida with mild hypotension of pregnancy The biophysical profile is used when there is a risk of placental and/or fetal compromise. The gravida with mild hypotension will need to be monitored more closely throughout the pregnancy, but is not a candidate at present for a biophysical profile.
Which of the following is a sign of dehydration in the newborn? A. Light colored, concentrated urine B. Slow, weak pulse C. Soft, loose stools D. Depressed fontanelles
D. Depressed fontanelles Depressed fontanelles are a sign of dehydration in the newborn.
The nurse is creating a poster for pregnant mothers. Which description of fetal development should the nurse include? A. Four primary germ layers form from the blastocyst. B. After fertilization, the cells only become larger for several weeks. C. The embryonic stage is from fertilization until 5 months. D. Most organs are formed by 8 weeks after fertilization.
D. Most organs are formed by 8 weeks after fertilization. Most organs are formed during the embryonic stage, which lasts from the 15th day after fertilization until the end of the 8th week after conception.
The nurse prepares to admit to the nursery a newborn whose mother had meconium-stained amniotic fluid. The nurse knows this newborn might be at risk for which of the following? A. Anemia B. Jaundice within the first 24 hours C. Imperforate anus D. Respiratory distress
D. Respiratory distress The presence of meconium in the amniotic fluid indicates that the fetus may be suffering from asphyxia. Meconium-stained newborns or newborns who have aspirated particulate meconium often have respiratory depression at birth and require resuscitation to establish adequate respiratory effort.
A 25-year-old primigravida is at 20 weeks' gestation. The nurse takes her vital signs and notifies the healthcare provider immediately because of which finding? A.Pulse 88/minute B. Temperature 37.4°C (99.3°F) C. Blood pressure 122/78 mmHg D. Rhonchi in both bases
D. Rhonchi in both bases Any abnormal breath sounds should be reported to the healthcare provider.
The nurse is reviewing preconception questionnaires in charts. Which couple are the most likely candidates for preconceptual genetic counseling? A. Single 32-year-old woman is using donor sperm B. Wife and husband are both 29 years old, first baby for husband, wife has a normal 4-year-old C. Wife is 30 years old, husband is 31 years old D. Wife's family has a history of hemophilia
D. Wife's family has a history of hemophilia For families in which the woman is a known or possible carrier of an X-linked disorder, such as hemophilia, the risk of having an affected male fetus is 25%.
Describe the physiologic changes that result in the following maternal vital sign changes immediately postpartum: Decrease in pulse
Decreased cardiac strain, decreased blood volume, and increased stroke volume
Identify the causes of the following in pregnancy: Heartburn
Displacement of stomach and GI organs by enlarged uterus
Why is there a tendency towards increased nasal stuffiness and epistaxis during pregnancy? What are some relief measures for this? (p.271)
Elevated estrogen levels cause edema of the nasal mucosa leading to nasal stuffiness. Because of the increased blood volume, small capillaries are fuller than usual and prone to bleed more easily, leading to an increased risk of epistaxis. Relief measures include cold air vaporizers and saline nose spray or drops. Nasal strips that open the nasal passages can also be helpful.
what information would you give to Ms. Smith about breastfeeding related to the following issues: Latching on
Elicit the rooting reflex. When infant opens mouth wide, draw baby close to breast and insert nipple deeply into mouth
A nurse is conducting a home postpartum visit. The mother says that she is surprised that it is no longer recommended to put alcohol on the baby's cord. How should the nurse respond?
Evidence indicates that there is no difference in infection rates between applying antiseptics like alcohol and just cleaning and drying the cord with water. Applying antiseptics also delayed cord separation, so we no longer recommend applying alcohol or any antiseptics.
Describe the physiologic changes that result in the following maternal vital sign changes immediately postpartum: Increase in temperature
Exertion and dehydration of labor. May also occur after milk comes in.
Why is the postpartum woman at risk for postpartum bladder over-distention and urinary tract infection?
Increased bladder capacity, swelling and bruising of tissues around the urethra, decreased sensitivity to fluid pressure, and decreased sensitivity of bladder filling. If there has been spinal or epidural anesthesia, neural signals to the bladder are decreased, and they are more susceptible to bladder over-distension. Oxytocin given postpartum has an antidiuretic effect, and results in rapid bladder filling once oxytocin is discontinued. Urinary output postpartum increases in the first 12-24 hours. Increased urine output with decreased emptying and increased risk of over-distension increases the possibility of urinary stasis and urinary tract infection.
Identify the causes of the following in pregnancy: Hemorrhoids
Increased pressure of the uterus on the veins of the rectum interferes with circulation and makes them more prone to have varicosities (hemorrhoids). This risk is increased with the constipation that is common in pregnancy.
While working in the nursery, you notice that baby Melanie, age 5 hours, has turned blue. Closer inspection reveals a large amount of frothy mucus in her mouth. What is the nursing diagnosis for this situation?
Ineffective respiration related to airway obstruction as evidenced by excess mucus
what information would you give to Ms. Smith about breastfeeding related to the following issues: Breaking suction before removing the baby from the breast
Insert finger between side of baby's mouth and the breast to break the suction
Your patient is 4 hours post cesarean delivery. She has a PCA pump for pain relief. Her husband tells you that he is worried that she will press the pump control too often and give herself an overdose of narcotics. How do you respond?
It is not possible for patients to overdose with a PCA pump, because the maximum dose is pre-set, and there is a "lock-out" feature that prevents further medication from going to the patient if the maximum dose has already been dispensed.
A woman's LMP is 5/5/18. Using Naegle's rule, calculate her EDD - month, day, and year (p. 242):
February 12, 2019
What are the guidelines for storing expressed breast milk In the freezer?
Fresh milk can be stored for 3-4 months
What are the guidelines for storing expressed breast milk in the fridge?
Fresh milk can be stored for up to 8 days. Thawed frozen milk can be stored for 24 hours
Identify these early pregnancy signs: Softening of the cervix
Goodell
Which vaccines are contraindicated during pregnancy (p. 281)?
HPV vaccination LAIV flu vaccine MMR Varicella Zoster (Shingles)
Identify these early pregnancy signs: Softening of the cervical-uterine isthmus
Hegar
How do you explain this weight loss to the parents?
Newborns lose up to 10% of their body weight soon after birth. The primary mechanism is a shift of fluid from intracellular to extracellular spaces. We expect them to regain their birth weight within 2 weeks.
Lisa comes into the office for her first prenatal visit at 6 weeks of pregnancy. Her husband asks if Lisa can continue to have an occasional glass of wine throughout her pregnancy. What is your response (p.284)?
No safe level of alcohol use during pregnancy has been identified, and it is recommended that pregnant women completely abstain from alcohol use.
what information would you give to Ms. Smith about breastfeeding related to the following issues: Frequency of feeding
On demand. May do cluster feedings. 8-12 feedings a day, no longer than 5 hours between feeds.
During a home visit, the parents ask how they will know if their baby is ill. What are some cues that a newborn needs to be evaluated?
Poor feeding, abdominal distension, apnea, irritability, lethargy
Describe the physiologic changes that result in the following maternal vital sign changes immediately postpartum: Increase in BP
Post-exertion rise. May also be related to oxytocin and vasopressor medications.
How is a postpartum home visit different from a community health home visit?
Postpartum visits are for a limited, specific purpose, and will typically be only for 1 visit. Community health home visits are generally extended over time, and can cover a range of issues
The nurse weighed a breastfeeding newborn at 72 hours after birth. His weight dropped from 3800 grams to 3600 grams. What is the appropriate nursing action?
Record the weight in the chart
List 4 conditions that can increase the risk of a negative pregnancy outcome and the potential negative outcome (pages 231-233)
Risk Factor & Potential Outcome 1. Multiparity --> Antepartum or Postpartum hemorrhage 2. Smoking --> HTN, IUGR, etc. 3. Thyroid disorder --> Infertility, SAB 4. UTI --> Preterm labor and birth
While working in the nursery, you notice that baby Melanie, age 5 hours, has turned blue. Closer inspection reveals a large amount of frothy mucus in her mouth. What are the immediate nursing interventions?
Suction the baby, stimulate and give oxygen. If no immediate response, call for help
Why should women avoid lying flat on their backs from the late 2nd trimester of pregnancy until after they have the baby?
To avoid maternal hypotension caused by compression of the vena cava between the uterus and the spine
What is the most appropriate injection site for vitamin K?
Vastus lateralis
Butoconazole is for:
Vulvovaginal candidiasis
what information would you give to Ms. Smith about breastfeeding related to the following issues: Methods for encouraging the baby to breastfeed
Watch for cues, unwrap the baby, walk fingers up back, sing or talk to baby
Irregular pigmentation on cheeks, forehead, and nose ("mask of pregnancy")
chloasma (melasma)
List 3 antepartum conditions that may compromise the infant in utero
chronic hypertension diabetes substance use infections (including Hep B, HIV, Group B strep, etc.) cardiac conditions
A 3200 gram male infant is born via spontaneous vaginal birth. His Apgars at birth are 9 at 1 minute and 9 at 5 minutes. His mother is anxious to hold him and start breastfeeding. What nursing actions will help maintain thermoregulation in this newborn?
dry quickly put a hat on the baby encourage skin to skin cover both Mom and baby
What if his mother was undergoing an extensive post-birth repair and was not available to hold the baby - what nursing actions would then be used to help maintain thermoregulation?
dry quickly put a hat on the baby give the baby to the father to do skin to skin or place the baby in the radiant warmer on warmed blankets but undressed apply skin temperature sensors if in the warmer.
line of darker pigmentation extending from pubis to the umbilicus
linea nigra
small, bright red, vascular elevations of skin often on chest, arms, legs, and neck
spider nevi
wavy, irregular, reddish streaks on abdomen, breasts, or thighs (stretch marks)
striae gravidarum