Labor & Delivery Complications
What is the first action you should take in response to a prolapsed umbilical cord?
CALL FOR ASSISTANCE FIRST.
What do you always check to ensure safety and security between infants and their caregivers?
Identification bracelets! Mom and infant have matching bracelets.
In the context of maternal-newborn nursing, what is the greatest risk factor for a DVT?
Cesarean section (C/S) = double the risk.
What are the three priority newborn medications?
Erythromycin optic ointment, Vitamin K injection, and Hepatitis B injection.
What kind of newborn is at the highest risk for developing hypoglycemia?
Large for Gestational Age (LGA)
What are three nursing actions in response to fetal distress?
- Left side-lying position
- O2 via NRB
- D/C oxytocin if indicated
Other: continuous maternal VS/FHR, ^ IVF, emergency C/S if no improvement.
How often should you check maternal BP/pulse after birth?
Q 15 minutes for the first 2 hours.
What are the 4 T's for postpartum hemorrhage?
TONE (uterine atony)
TISSUE (placental fragments)
TRAUMA (inversion of the uterus)
THROMBIN (DIC, ITP)
A- Activity
P - Pulse
G - Grimace
A - Appearance
R - Respirations
What is the main difference between physiologic jaundice and pathological jaundice in a newborn?
Pathological jaundice occurs within the first 24 hours of life and requires intervention. Physiologic jaundice occurs after 24 hours of life and is considered benign.
What complication is the fetus at risk for in the context of hypertonic uterine contractions?
Fetal asphyxia (reduced fetal oxygen supply)
"CF 1/U" denotes the relative position and firmness of the fundus. It translates to meaning the fundus is firm and positioned 1 fingerbreadth above the umbilicus.
What are some S/S of endometritis and what medication will you give?
- Pelvic pain!
- Flu-like symptoms, fever
- Dark profuse malodorous lochia
RX = clindamycin (antibiotic)
What angle should a newborn car seat be placed at and where should the retainer clip be secured?
45-degree angle and secured at the armpit level of the newborn.
Name three nursing interventions related to the provision of phototherapy for newborns.
- Place an eye mask on the baby
- Keep baby undressed (diaper on)
- Reposition baby q 2 hrs.
Other: monitor for dehydration, frequent feedings, remove baby q 4 hrs.
In what position will you place mom if the fetus is in a posterior position to rotate to an interior position?
Hands and Knees position
What does BUBBLE-LE stand for as an acronym related to postpartum assessment?
B - Breasts
U - Uterus
B - Bladder function
B - Bowel & GI function
L - Lochia
E - Epistomy/laceration
L - Lower extremities (S/S DVT)
E - Emotions
What organism is most often responsible for mastitis?
S. aureus
A newborn presents with transparent skin, abundant lanugo, and no plantar surface creases. According to the New Ballard Scale, this newborn would likely be classified as...
Premature
What is the name of the two conditions related to the urethra that are contraindications for circumcision?
Hypospadias and Epispadias.
Hypospadias (urethra @ wrong anatomical location on boys)
Epispadias (undeveloped urethra, urine exits from abnormal location)
What is another name for Anaphylactoid Syndrome, what does it mean, and what is one associated complication?
Also known as an Amniotic Fluid Embolism, it is the infiltration of amniotic fluid to maternal circulation and an associated complication is DIC.
What is Homan's Sign and what complication does a positive Homan's Sign suggest?
Pain in the calf muscle when the foot is dorsiflexed while the knee is extended. Positive Homan's Sign suggests a DVT.
Name five medications given to manage PPH, beginning with the first line uterotonic.
First Line = Pitocin (Oxytocin)
Methylergonovine (Methergine)
Hemabate (Carboprost)
Cytotec (Misoprostol)
Tranexamic Acid
What is the time frame for performing a heel stick blood sample on a newborn and what is the purpose of this test?
A newborn has an elevated BP with bounding pulses in the arms and decreased BP in the legs with cool skin. What CHD are these findings associated with?