Fetal Complications
What is one of the primary reasons a pre-term baby suffers respiratory distress?
Lack of surfactant production
This is caused by overstretching of the uterus. (due to multi-fetal pregnancy, high parity, polyhydraminos, traumatic birth, mag sulfate, rapid or prolonged labor, use of oxytocin)
What is uterine atony?
What sign is revealing the fetus is undergoing appropriate oxygenation from the fetal strip?
Variability
Nurse Julia plans to instruct the postpartum client about methods to prevent breast engorgement.
What should she include in the teaching?
To prevent engorgement, the client should provide frequent feedings to the infant
Warm compresses (do not use ice as this will dry up the milk)
A patient with Pre-E may exhibit what symptoms:
High blood pressure, proteinuria, headache, and visual changes, brisk reflexes.
What is the priority action when the fundus is boggy during a postpartum assessment?
Massage the fundus
A client who is admitted to L&D has the following findings: G2P1, estimated 40 weeks gestation, contractions 2 mins apart, lasting 45 seconds, +4 station. What is the nurse's priority at this time:
Preparing the client for an immediate delivery
What are some important teaching points for a patient who has placenta previa?
Encourage bed rest
Avoid vaginal exams & sexual intercourse
Monitor bleeding
What is a positive sign of pregnancy?
Fetal heartbeat
When assessing the FHR tracing, the nurse becomes concerned about the FHR pattern. In response to loss of variability, the nurse repositions the client to her left side and administers oxygen. These actions will likely improve what condition?
Fetal hypoxia
What meds may be given to a patient who is having PPH? (postpartum hemorrhage)
What are contraindications?
Pitocin
Methergine (not for HTN)
Hemabate (not for Asthma)
What method is used to determine the LMP:
Nagele's Rule- subtract 3 months, add 7 days
(Keep in mind the months that have 30 days etc.)
After 3 days of breast-feeding, a patient reports nipple soreness. To relieve this discomfort, the nurse should instruct the patient to:
Make sure baby is getting latched on correctly, wear a good supportive bra, make sure the nipples are everted, ointment, (Lanolin) warm compresses, warm shower, tea bags etc.
What does TORCH stand for?
Toxoplasmosis- clients need to have someone else handle cat feces/litter
Other-gonorrhea, syphilis (copper palms), varicella, hep B, HPV, HIV
Rubella- German measles
Cytomegalovirus
Herpes Simplex
Each disease can be teratogenic, cross placenta, effect on fetus depends on developmental stage at time of exposure
What 5 areas are evaluated in an APGAR?
How often are these evaluated?
How are these scored?
APGAR: Appearance (skin color), pulse (heart rate), grimace (reflexes), activity (muscle tone) and respiration (breathing effort).
Scored: 0-2, 1 min and 5 min
What are signs that a client may be suffering from postpartum depression? (PPD)
Overwhelming feelings
Overly tired for more than two weeks
Feelings of anxiety/hopelessness
A pregnant woman is close to giving birth. Examination of the FHR is 90bpm. What is the best action of the nurse?
Re-position the client and make sure the FHR is being picked up correctly.
Contact the HCP. FHR should be 110bpm minimum
After teaching a pregnant woman who is in labor about the purpose of the episiotomy, what purpose stated by the client would indicate to the nurse that teaching was effective:
Episiotomy prevents the perineum from tearing.
Name at least 1 fetal heart pattern on a fetal strip indicates fetal distress?
Late decel
What are the different newborn reflexes?
Moro (Startle reflex)
Babinski (along the side of the foot, toes fan out)
Plantar and grasp reflexes
Rooting/ sucking reflex
Tonic neck: resembling a fencing position
A Rh-negative mother who has given birth to a Rh-positive infant and has no evidence of sensitization, what should be administered:
Rh immune globulin (Rhogam) within 72 hours of delivery.
What are some side effects for an Epidural?
Low blood pressure, headaches, and infections.
Nausea and vomiting can also occur
What is priority teaching for a patient taking oral contraceptives?
An alternate method of birth control is needed when taking medications like anticonvulsants, antifungals, St. Johns Wort etc.
Also, a condom (barrier) needs to be used to prevent STIs.
What vaccines are contraindicated during pregnancy?
Varicella (chicken-pox)
MMR