fetal assessment
VEAL CHOP stands for what
variables cord
earlies head
accelerations ok
lates placenta
Your patient just received an epidural 12 minutes ago. You walk out to the nurses station to sit and chart and see increasingly worse late decelerations.
a)what is causing the lates
b) priority to fix the lates
a) hypotension from epidural
b)
Which newborn infant would the nursery nurse assess first?
1. The 3 hour old newborn who weighs 6lbs 2oz
2. the 4 hour newborn delivered at 42 weeks gestation
3. the 6 hour newborn who is 18 inches long
4. the 8 hour newborn who was born at 40 weeks gestation with meconium stained fluid upon SROM
What is the 42 week gestation newborn
1. normal weight
2. delivered at 42 weeks is postmature & is at risk for hypoglycemia and hypothermia because the placenta begins to deteriorate after 40 weeks and sub q fat is utilized to support the infants life
3. 18 is shorter than most, but no
4. 40 weeks is normal, meconium at 8 hours no longer a problem in this answer choice
Decreased DTR's
oliguria
impaired respirations
sweating & flushing of the skin
lethargy progressing to coma as the toxicity increases
probably need lab work drawn to monitor for
can help you if you have PIH...........
what am I?
Hypermagnesemia
You are monitoring lab results for clients on the postpartum unit. Which client would warrant intervention by Ms. Helen first?
1. The client who had a vaginal delivery and who has a white blood cell count of 22,000 mm3.
2. The client who had a C-section who has a serum potassium level of 5.2 mEq/L.
3. The client with preeclampsia who has a platelet count of 100,000 mm3.
4. The client with gestational diabetes who has a serum glucose level of 146 mg/dL.
What is the low platelets.
1. the white blood cell count rises normally during labor and postpartum—up to 25,000 mm3
2. The serum potassium level is within normal limits, 3.5 to 5.5 mEq/L
3. HELLP syndrome is a group of symptoms that occur in pregnant women who have hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP), which occurs in women who are severely preeclamptic and eclamptic. Normal platelet count is 150,000 to 450,000, so this client’s platelet count requires immediate intervention.
4. This glucose level is elevated, but since the client had gestational diabetes this blood glucose level does not require immediate intervention.
A patient walks into the OB triage unit you happened to be floated to for this exact moment. She is 39 weeks and SROM approx 30 minutes before arrival. You put on the fetal monitors and toco. You notice the fetal heart rate baseline is 100, minimal variability, no accelerations, and contractions every 1-3 minutes. You are the only nurse on the whole floor and have no help, but you are a great nurse and can handle it.
BTW-after you do all the interventions in the correct order, the fetal heart rate returns to a category I strip.
What order would you do the following nursing interventions & why?
administer terbutaline 0.25mg
notify the provider
position client in side lying position
apply o2 via face mask
monitor FHR & uterine contractions
start an IV & run the fluid as fast as it can go
1. Position the client in side-lying position to increase uteroplacental perfusion
2. Apply o2 by face mask
3. start IV & run the fluid as fast as it can go
4. administer terbutaline 0.25mg to diminish uterine activity
5. monitor FHR & uterine contractions
6. notify provider
I can happen because the fetus is in a transverse lie.
Polyhydramnios can make me more likely.
Sometimes I participate in jump rope
I can result in an emergency c-section
Sometimes I like a smaller fetus
I like to have fun when the fetus is -4 station.
What am I?
prolapsed umbilical cord
Umbilical cord becomes displaced in front of the presenting part of the fetus or protruding in front of the cervix. Results in cord compression and compromised fetal circulation.
Which newborn should the charge nurse in the nursery assign to the licensed practical nurse (LPN)?
1. The 4 hour newborn who was born at 42 weeks
2. the 8 hour newborn who is jittery and irritable
3. the 18 hour newborn whose mother was addicted to heroin
4. the 8 hour newborn who was born vaginally after 2 hours of pushing
what is the newborn that was pushed out for 2 hours
1. postmature = possible complications = RN
2. hypoglycemia = RN
3. withdrawls = RN
4. stable = LPN
which priority intervention should the nurse implement for the 38 week gestation client who is receiving epidural anesthesia?
1. place the client in the fetal position
2. assess the clients respiratory rate
3. pre-hydrate the client with IV fluid
4. ensure the client has been NPO for 4 hours
what is check the clients respiratory rate
1. the client should be in this position but breathing is a little more important
2. if the anesthesia ascends the spinal cord, the client will quit breathing and therefore this is the priority
3. the client should be pre-hydrated to avoid hypotension, but airway is more important first
4. NPO important for general....not epidural
You transfer your patient to the postpartum unit. She had an uneventful delivery except baby had to be extracted with a vacuum. Upon assessment, you assess which of the following to determine the patient has a cervical laceration?
1. continuous lochia flow and a flaccid uterus
2. report of increasing pain and pressure in the perineal area
3. slow trickle of bright red vaginal bleeding and a firm fundus
4. gush of rubra lochia when the uterus is massaged
what is a slow trickle of bright red vaginal bleeding
& firm fundus=laceration
flaccid uterus=bleeding probably from uterus
pain in perineal area = vulvar hematoma
thats good
The laboring patient shows late decelerations on the fetal monitor. After placing the client in the left lateral position the late's continue, which intervention should Ms. Glada implement first?
1. Call the doctor
2. encourage the patient to take slow deep breaths during contractions
3. decrease the pitocin
4. prepare for an immediate delivery of the fetus
what is call the doctor!
the fetus is in distress and after increasing blood supply by placing the client in the left lateral position, Ms. Glada needs to contact the obstetrician for immediate C-section.
2. Panting during contractions will help prevent the client from pushing but it is not the first intervention. This client needs immediate evaluation by an obstetrician.
3. stop it
4. The nurse needs to prepare for immediate delivery of the fetus but not prior to contacting the obstetrician. The nurse cannot perform a C-section.
What am I?
placental abruption.
Increase the index of suspicion:
Exam: uterine tenderness, contractions/irritability, fetal distress
Increase risk of abruption:
HTN, AMA, multiparous, smoking/cocaine use, previous, abd trauma, premature rupture of membranes
Which client would the newborn nursery nurse assess first after receiving shift report?
1. the newborn who has chignon
2. the newborn with caput succedaneum
3. the newborn who has a cephalohematoma
4. the newborn who has port wine stain
what is a cephalohematoma
1. newborn scalp edema created by vacuum extraction and should resolve
2. happens because of pressure of the fetal head on the mothers cervix and should resolve
3. this happens when there is bleeding between the periosteum and the skull from pressure during birth. the firm swelling is not present at birth but develops within the first 24-48 hours--bleeding baby = bad
4. nah
You are teaching a patient experiencing age-related vaginal atrophy and is taking estradiol cream. Which of the following statements should the nurse include in the teaching?
1. use the medication daily
2. apply the medication externally
3. It has fewer systemic effects than oral estrogen
4. medicine can increase your risk of bone loss
what is fewer system effects than oral estrogen
since applied internally = fewer system effects
should be applied 1-3 days per week
can decrease the risk of postmenopausal bone loss
Who have a HIV positive patient and currently work in Canada. What should you do when the baby is born?
select all that apply
1. encourage mother not to breastfeed
2. administer hep b vaccine
3. implement contact precautions when providing care for the infant
4. collect a cord blood specimen to rest for the presence of HIV in the infant
what is do not breastfeed and administer all vaccines
why? infants who are exposed to HIV should recieve all vaccines.
IN the US & Canada, breastfeeding should be avoided by mothers who are HIV positive
the nurse should use standard precautions when caring for the newborn
to test newborn for HIV-need their actual blood--not cord blood -maternal antibodies will be present in the cord blood
1. atrial septal defect
2. renal agenesis
c. spina bifida
d. hyrocephalus
what is renal agenesis
oligo is a amniotic fluid volume less than 300mL during the 3rd trimester. Happens when there is a renal system dysfunction or obstructive uropathy. Something wrong with the fetal kidneys will cause oligo or poly
cardiac fetal abnomalities will not cause issues with amniotic fluid
neural tube defects do not cause amniotic fluid issues
hydrocephalus does not affect the volume of the amniotic fluid
A patient walks in with the complaint "my stomach started hurting pretty suddenly about 15 minutes ago when I fell down doing a cartwheel". She had a c-section 2 years prior. Upon assessment you notice her abdomen is 3 times bigger than you would expect for her gestation. Upon palpation, the fetus appears to be in the woman's breast & not pelvis. As you are doing her assessment she starts experiencing bleeding & you do......
what is your priority action at this time?
risk factors: uterine trauma due to accident or surgery (previous c section), overdistention of the uterus (polyhydramnios), hyperstimulation either spontaneous or oxytocin, external or internal version
Expected findings: client reports "ripping" pain, loss of fetal station (baby goes up to Oklahoma and not in the gulf)
manifestations: tachypenea, hypotension, pallor, cool slimly skin
Which statement indicates to the postpartum nurse the discharge teaching to the first time mother is effective?
1. “I should contact my baby’s doctor if she refuses two or more feedings of breast milk.”
2. “My baby will have green liquid stools for at least 1 month after I take her home.”
3. “I must administer AquaMephyton elixir with formula to my daughter.”
4. “If my daughter has thick, yellow-colored stool I will call her doctor.”
what is calling the doctor if the baby wont eat
Refusal of two or more feedings indicates the infant has a problem that requires the mother notify the healthcare provider. This indicates the mother understands the discharge teaching.
2. Green liquid stools indicate a problem and require the mother notify the healthcare provider.
3. AquaMephyton (vitamin K) is administered intramuscularly to the infant in the newborn nursery to prevent the infant from bleeding because the gastrointestinal tract is sterile when the infant is born and requires bacteria to synthesize vitamin K from the food eaten by the infant.
4. The infant will have meconium stool for a few weeks after being born, so the mother should not notify the healthcare provider.
tell me everything you know about ergotamine
Only use when needed to avoid a dependence on
not safe during pregnancy because can stimulate uterine contractions-------teach clients who are trying to become or might be preggo not to use it
used for migraines
experiencing tingling in fingers or toes should call doc STAT because is a s/s of toxicity
s/s of withdrawl can cause ha, n/v, restlessness
When taking care of a newborn, which of the following should you report to the provider and why?
[more than one answer may be correct...or maybe only one..or maybe none....maybe all....you pick]
1. hemoglobin 12
2. platelet 130,000
3. total bilirubin 6.8
4. glucose 65
what is all the things you will tell the doctor
according to ATI
normal hemoglobin 14-24
normal platelet 150000-300000
normal total bilirubin 2-6
normal glucose 40-60
Your patient is in active labor and you increased the oxytocin approx. 15 minutes ago. You notice tachysystole with a category I strip. What are you going to do?
1. discontinue the oxytocin infusion & apply oxygen
2. continue to monitor the contractions and fetal heart rate
3. prepare to administer terbutaline
4. move the client from high fowlers to a different position & continue to monitor the patient
what is move the cilent to a different position and continue to monitor
category 1 tracing is good and expected finding and does not represent fetal distress. changing positions will help increase uteroplacental perfusion and ocntinue to monitor the tracing for another 10-15 minutes to determine if tachysystole resolves
d/c infusion & o2 if cat 2 or 3 strip
do something--dont just stand there
terb for cat 2 or 3 or if have tried allllllll interventions and cannot resolve tachysystole & variability starts to decrease and .......
Your patient walks in. Says she is 38 weeks pregnant and has had some vaginal bleeding. You assess one of the following things and determine the bleeding is either coming from a placenta previa or a placental abruption. Which one of these things did you assess?
1. uterine tone
2. fetal heart rate
3. blood pressure, respirations, heart rate, temperature, amniotic fluid index upon ultrasound
4. amount of bleeding
what is uterine tone
placenta previa = uterus relaxed, soft, painless
placenta abruption = uterus firm, board like, lots of pain
You are assessing your newborn patient and realize he/she is at risk for hyperbilirubinemia. What of the following maternal conditions do you see in the electronic health record that raises your "nurse sense" for hyperbilirubinemia?
1. placenta previa
2. multiple gestation
3. infection
4. anemia
what is infection
choose someone to answer the powerpoint question
You are about to administer oxytocin to your patient, but realize your patient down below has a contraindication for the medication. Who is your patient?
1. patient with prolonged rupture of membranes for 49 hours at 38 weeks gestation
2. patient whose fetus diagnosed with intrauterine growth restriction and gestational hypertension
3. a patient who is 42 weeks with meconium present with SROM
4. patient with active genital herpes
what is the active genital herpes
Baby is at risk for acquiring the infection while passing through the birth canal.
1. need to get that baby out
2. need to get that baby out
3. need to get that baby out
Name all the cranial nerves and how you examine each
1. olfactory-have them smell
2. optic-test vision acuity and visual fields
3. oculomotor-pupil reaction to light
4. trochlear-test for downward and inward movment of the eye
5. trigeminal-jaw movements & sensations on the face & neck-ask pt to clentch jaw while you palpate the jaw muslces
6. abducens-lateral movement of eyes-test ocular movement in all directions
7. facial-raise eyebrows, smile, show teeth, puff out cheeks
8. acoustic-test hearing ability
9. glossopharyngeal-pharyngeal movment and swallowing-ask pt to say ah and have pt yawn to observe upward movement of the soft palate
10. vagus-ask pt to swallow and speak
11. accessory-ask pt to shrug shoulders
12. hypoglossal-protrude tongue-push tongue against cheeck