Pregnancy and Labor
Most notable in the second trimester and beyond, a state of hemodilution caused by a disproportionate increase of plasma vs RBCs causing a decrease in hemoglobin and hematocrit values.
Physiologic Anemia
A postpartum client calls the clinic asking about being tearful, irritable, and having difficulty coping with her new baby. What education should the nurse provide?
May be baby blues, but if symptoms worsen or last longer than 2 weeks, may need treated for postpartum depression.
Non-shivering thermogenesis causes vasoconstriction, decreasing oxygen to the tissues. Anaerobic glycolysis increases, decreasing pH, leading to metabolic acidosis. S/S: Respiratory distress, hypoglycemia, weak cry, jitteriness, hypotonia, and lethargy.
Cold Stress
A client states she keeps dribbling urine even after she has just used the bathroom and she doesn't feel like she needs to void. What should be assessed?
Rupture of membranes
With normal involution, how long after delivery should the fundus no longer be able to be palpated abdominally?
2 weeks postpartum
The newborn exhibits the following symptoms: Respiratory distress, weak cry, jitteriness, hypotonia, and lethargy. The baby's temp is 96.9 F. What is a priority?
Assess blood sugar
A client with an average BMI asks what is normal weight gain during pregnancy.
1-4 lbs in first trimester, 0.5 - 1 pound per week after for a total of 25 - 35 pounds.
A postpartum client is experiencing a severe headache when upright that improves when she lies down. Upon further assessment, the nurse finds the client had an epidural. What should the nurse anticipate?
Post-epidural headache. Notify anesthesia and prepare for a blood patch.
If the newborn is not skin-to-skin, the infant may be placed under a radiant warmer. The infant’s skin temperature is used as the point of control in a warmer with a servo-controlled mechanism. The servo controller adjusts the temperature of the warmer to maintain the infant’s skin temperature within the preset range. Where should the temperature probe be placed?
The automatic sensor probe is usually placed on the upper quadrant of the abdomen immediately below the right or left costal margin (never over a bone).
Which fetal heart deceleration requires immediate intervention?
Late decelerations
Math!!
Order: 4milliunits/minute to help promote an effective contraction pattern. Available: Lactated Ringer’s 1000mL with oxytocin 20 units. The nurse should program the infusion pump to deliver how many mL/hour?
12 mL/hr
What is a priority action if a newborn begins to spit up?
Sit the baby up and burp them.
What patient teaching is important with iron supplements?
Do not take with calcium, tea, or coffee, Stools may be black or dark green, may be taken at bedtime if stomach discomfort occurs
Math!!
Order: magnesium sulfate 6 grams intravenously to be infused over 20 minutes for a client with preterm labor. The IV bag contains magnesium sulfate 20 grams in dextrose 5% in water 500 mL. How many mL/hour should the nurse set the infusion pump?
450 mL/hr
Math!!
Order: Infuse Regular Insulin at 6 units/hr. Supplied: Regular Insulin 125 units in 250 mL NS. What will you set the infusion pump at (mL/hr)?
12 mL/hr