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At which week of gestation does placental transport of substances to and from the fetus begin?
5 weeks
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Women taking minipill (or progestin-only OC) have a higher incidence of what condition (nursesmust teach client about s/s)
Tubal and ectopic pregancies
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What is the classic sign of uterine retention and overflow?
- Varying urge to urinate with an average output of 100mL
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Does a client who had episiotomy at risk for blood loss? Also, what complication is the client at high risk of?
Blood loss is usually minimal when episotomy is performed.
Prolonged dysparenunia (painful intercourse) may occur if infxn interferes w/ healing at episotomy site
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What is the approximate time that the blastocyst spends travelling to the uterus for implantation?
7 days
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When a pt comes and tells nurse she believs her membranes have ruptured, nurse must ask what important question?
When did you feel that it has ruptured?
To identify time elapsed b/c risk of perinatal infxn increases with membrane rupture and onset of contractions
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Describe a best suggestion for breast pumping to relieve breast engorgement
Each breast should be pumped for at least 10 min every 3-4hrs. Do it at night only if you're awake. Not necessary to wake up and pump, rest is important
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When given oxytocin for slow-progressed labor, how would contractions feel like after administration?
Oxytocin causes stronger, more uncomfortable contractions, and will peak more abruptly
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After amniocentesis is performed (apprx 20 min), what is an important action nurse must do first if pt. O- ?
- Administer RhoGAM to prevent maternal sensitization.
- Must be given after any invasive procedures
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What is the primary cause of constipation during pregnancy?
Reduced inestinal motility
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What BG level is considered hypoglycemia in neonate?
< 40mg/dl
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Chest compressions for neonate should be initiated if HR falls below which rate?
Below 60 beats/min
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Which conditions place the client at risk for DIC?
Any conditions that may trigger clotting factors to deplete:
Intrauterine fetal death, abruptio placentae, septic shock, amniotic fluid embolism
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Guidelines for cleft lip/palate neonate
They can't grasp a niple securely, may swallow a large amount of air during feeding. FREQUENT BURPING THE BABY
- DO NOT use spoons
- DO NOT place nipple in cleft palace
- Feed in upright position to reduce risk of aspiration
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What to teach the client to promote comfort when client c/o perineal discomfort when sitting?
Should contract buttocks beore sitting or rising
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Fever during or after the first 24 hours of postpartum is normal?
Fever during 24 hours pp is body's normal response to delivery
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How is temp seen in neonate suspected of having an infxn?
- Decreased (temperature instability)
- Skin becomes ashen or mottled
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When should you expect to hear fetal heart tones using Doppler ultrasound? When w/ a stethoscope?
As early as 11th week for Doppler ultrasound
Heart tones w/ a stethoscope may be heard between 17-20 weeks' gestation
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Pt. w/ ectopic pregnancy should Not ___________ anything pending surgery.
*hint: verb. Usually an order before surgery
EAT OR DRINK
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Describe the components of a biophysical profile (BPP) -- an ultrasound assessment of the fetus's well-being
NST, fetal tone, fetal breathing, quantity of amniotic fluid
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Define Perinatologist
An obstetrical subspecialist concerned with the care of the mother and fetus at higher-than-normal risk for complications.
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When can a primigravid detect fetal movements (quickening)?
Between 18-20 weeks.
*after 20 weeks, the fetus continues to gain weight steadily, the lungs start to produce surfactant, the brain is grossly formed, and myelination of the spinal cord begins
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Cleft lip feeding device
Bulb syringe with rubber tip
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What complications should we monitor for a client after a cerclage for cervix incompetence
Inserting a cerclage, a suture around the cervix, is an invasive procedure to the uterus. Spontaneous ROM, infnx, active and regular contractions indicating preterm labor, or active bleeding from suture may occur. Suture is removed during the third trimester of pregnancy
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What is the primary reason for putting breast-feeding neonates to the breast immediately after birth?
Breast-feeding neonates immediately after birth ESTABLISHES A LEARNED RESPONSE
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Which complication is common in neonates who received prolonged mechanical ventilation?
Bronchopulmonary dysplasia: chronic lung condition caused by lung tissue damage that's characterized by inflammation, exudate, scarring, fibrosis and emphysema; usually occurs in immature infants treated for RDS with mechanical ventilation and supplemental oxygen
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Signs that neonate is in the second period of reactivity
Ruddy skin, thick oral secretions, labile HR, irregular RR
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BPP evaluates fetal health by assessing 5 variables:
1. Fetal breathing movements
2. Gross body movements
3. Fetal tone
4. Reactive fetal heart rate
5. Qualitative amniotic fluid vol.
SCORE
Normal: 2 pts; abnorma: 0
- 8-10 normal
- <6 risk for asphyxia & premature birth. Warranted investigation.
BPP may be repeated if score isn't within normal limits
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What teachings should be given to a client with mastitis?
- * Massage the affected area gently DURING breast-feeding
- * Breast feed at least every 2-3 HOURS
- * WARM, WET WASHCLOTH to her breast BFORE each feeding
- * AVOID wearing a BRASSIERE when breastfeeding
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Describe the normal weight patter in the neonate first few days after birth
Neonates lose approximately 10% of their birth weight during the first 3-4 days, b/c of loss of excess extracellular fluid and meconium and limited oral intake.
- Return to birth weight should occur within 10 days after birth
- Normal birth weights range from 6-9 lbs
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What should you do if you miss 3 or more OC pills in a row?
Discard the pack, use an alternative contraceptive method until period begins, and start a new pack on a regular schedule
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Which complication in neonate is commonly associated with renal malformations in neonate?
Renal malfromations include renal aplasia, dysplastic kidenys, and obstructive lesions of the lower urinary tract
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Typical assessment findings for a postterm neonate
- Abundant subcutaneous fat
- Long silky hair
- Absent vernix caseosa
- Dry, cracked skin
- Long nails
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Appropriate interventions for a client with fourth degree laceration vagina
- KEGEL's exercise
- Cold applications
- Sitz baths
*Perineal pads would do little to reduce pain or promote perineal healing (DUH MIMI)
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1-hour glucose tolerance test is recommended for all pregnant women between 24-28 weeks, but the test should be performed toward the end of the first trimester if the client has a history of what?
- * glycosuria
- * previously unexplained fetal loss
- * family h/o diabetes
- * previous LGA neonate
- * Obesity
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When is the triple screen blood study offered and what does it detect?
15- 20 weeks
Detect chromosomal abnormalities
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What info should a nurse document on a patient with direct fetal scalp electrodes
- *Time of the fetal scalp electrode placement
- *Name of the physician who applied the electrodes
- *FHR
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Findings that indicate that the neoate developed hemolytic disease (A+ positive baby from an O- mom)
Signs of kernicterus
RH and ABO incompatibility -- develop severe jaundice as a result of rising bilirubin. If bilirubin is high enough to cross BBB (usually 20 mg & higher), neonate is at serious risk for neurologic impairment caused by permanent cell damage.
Other findings: lethargy or irritability, poor feeding patterns, including vomitting, weight loss of > 10%
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It's difficult to awaken a neonate 3 hours after birth because he/she is progressing into the sleep cycle.
During this period, the neonate shows minimal response to external stimuli
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Periods of neonatal reactivity are characterized by what behaviors?
Alertness & attentiveness (usually 6-8 hours after birth)
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Describe the stages of neonate reactivity
1st period of reactivity: During the first 30 minutes after birth, your infant will be very alert, may cry vigorously, may suck greedily on his fist, and will appear very interested in his environment. Your infant's eyes will probably be open, will have a vigorous suck reflex at this time, creating a great opportunity for you to breastfeed.
Second stage of the first reactive period: which generally lasts 2 to 4 hours. Your baby will enter a state of sleep and relative calmness.
Second period of reactivity: begins when your baby awakens from his deep sleep.
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Describe post interventions for neonates whose mothers have the following conditions:
A. Mother rhas hep B infxn
B. Mother has cytomegaloviru (CMV) infxn
C. Mother has gonnorhea
D. Mother has HIV
- A. Mother should receive hep B immunoglobulin within 12 hours of birth
- B. Neonate may be treated with IV antivirals. DOES NOT NEED strict isolation
- C. Eye prophylaxis w/ abx for neonate
- D. Contact isolation for neonate
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Engorged breasts should not have breast binder to support breasts
Binding causes vasoconstriction which will diminish milk supply
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