Hypertension
Define persistent severe range blood pressures.
Two severe BP values (≥160 systolic OR ≥110 diastolic) more than 15 minutes and less than 60 minutes apart are considered persistent severe range blood pressures. BP values do not need to be consecutive.
What practice is included in the upcoming system fetal monitoring policy that may be a practice change for your hospital when initiating fetal monitoring?
Differentiate maternal heart rate (MHR) and FHR by applying maternal pulse oximetry sensor or using other continuous means of monitoring MHR (e.g., Toco MP). Periodically palpate maternal radial pulse to assist in excluding signal ambiguity (i.e., signal coincidence) in conjunction with vital sign / EFM devices.
Name 2 of the 3 criteria an infant must meet for a circumcision to be performed.
Maintains a temperature of at least 36.5ᵒC for two consecutive readings.
Physiologically stable.
At least 12 hours of age
True or False: PC.06.03.01 Reduce the likelihood of harm related to maternal severe hypertension/pre-eclampsia. The emergency dept is often where pt with symptoms or signs of severe hypertension present for care after delivery. For this reason education should be provided to staff and providers in emergency departments regardless of the hospitals ability to provide labor and delivery services.
True
An essential nursing skill performed and documented to ensure fluid balance in all patients is?
Intake & output
A patient has 2 severe range blood pressures at 12:00 and 12:30. The nurse starts to administer the Labetalol 20mg IV push at 12:44. What time should the nurse take the next blood pressure?
12:56 (2 minutes to administer Labetalol and BP is repeated 10 minutes later)
What 2 characteristics of an FHR tracing rule out fetal metabolic acidemia at the time of observation?
Moderate FHR baseline variability
FHR acceleration(s)
Local anesthetic must be given and how much time must lapse before proceeding?
No less than 5 minutes
Standard PC.06.01.01 Reduce the likelihood of harm related to maternal hemorrhage requires that staff complete an assessment using an evidenced-based tool for determining maternal hemorrhage on admission to Labor and Delivery and what other transition in care period?
On admission to postpartum
Often overlooked, at one hour of life, infants who are SGA, late preterm, or born of diabetic mothers might require the initiation of this important screening protocol.
Newborn blood glucose protocol
Your patient has 2 persistent severe range blood pressures and has a diagnosis of active asthma. Which IV push medication does the nurse anticipate the provider to order?
Hydralazine (active asthma and heart disease is a relative contraindication for Labetalol)
You have already determined that the signal source for this FHR tracing is fetal. What is the first thing to consider when trying to identify the etiology for this indeterminate baseline?
Presence of excessive uterine activity
How many hours post circumcision may infants by discharged per healthcare provider order?
At least two hours after circumcision
Provide role-specific education to all staff and providers who treat pregnant and postpartum patients about the organization’s hemorrhage procedure. At a minimum, education occurs at:
orientation, whenever changes to the processes or procedures occur, or every two years
Standardized IV tubing labels has been initiated for high alert medications across WHSL. What medications are associated with Yellow, Pink, and Green labels?
Yellow for Insulin
Pink for Pitocin
Green for Magnesium Sulfate
Your patient has a diagnosis of preeclampsia with new onset blood pressures of 140s/90s but does not have proteinuria. Name 3 of the 5 additional criteria needed to diagnose pre-eclampsia.
Thrombocytopenia (less than 100,000), renal insufficiency (serum creatinine concentrations greater than 1.1mg/dL or a doubling of serum creatinine concentration (in the absence of renal disease), impaired liver function (elevated liver transaminases to twice the normal concentration), pulmonary edema, new-onset headache unresponsive to medication and not accounted for by alternative diagnosis or visual symptoms
Describe a FHR Category II for EFM tracing.
Tracings are indeterminate and may represent a range of possibilities.
Infants are assessed for increased bleeding post circumcision at what 3 intervals?
immediately after the procedure
15 minutes after the procedure
1-hour post procedure
Education on hemorrhage is provided to patients (and their families including the designated support person whenever possible). At a minimum, education includes:
Signs and symptoms of postpartum hemorrhage during hospitalization that alert the patient to seek immediate care
Signs and symptoms of postpartum hemorrhage that alert the patient to seek immediate care
Arterial cord gases result as pH 7.01, pCO2 55, base deficit 17. The nurse would interpret this gas as:
Metabolic acidemia
Continued efforts to meet the PA AIM HTN bundles until treatment across all races/ethnicities for severe HTN is met & maintained at which percent?
75% or greater
What 2 pre-requisites must be established before a systematic assessment of an FHR tracing can be performed?
A continuous, good-quality tracing of the FHR and uterine activity
Verification that the FHR signal is fetal
Pain assessments are documented at what intervals?
before, during and after the procedure
Define the TJC measure PC-06
Unexpected complications in Term Newborns- intended to track moderate to severe adverse
Which medication cannot be administered to patients on maintenance opioid therapy?
Nubain /nalbuphine