Podcast
Questions and Answers
Postpartum administration of an IV drip of Pitocin is commonly used:
Postpartum administration of an IV drip of Pitocin is commonly used:
- To prevent postpartum fever
- To treat excessive postpartum bleeding
- To prevent excessive postpartum bleeding from occurring (correct)
- To increase the rate of postpartum milk production
Mastitis most commonly affects or occurs:
Mastitis most commonly affects or occurs:
- Right before a woman starts menstruating again
- When a woman wears a bra continuously
- In the first 3-5 days postpartum
- One breast rather than both simultaneously (correct)
The most common causes of postpartum bleeding include all of the following T's except:
The most common causes of postpartum bleeding include all of the following T's except:
- Tissue
- Thrombin
- Thalamus (correct)
- Tone
A woman with Von Willebrand's disease is at an increased risk for:
A woman with Von Willebrand's disease is at an increased risk for:
You are making a routine follow-up call to a woman who gave birth 6 days ago. She starts crying and says that she is exhausted, can't stop crying and doesn't want to get dressed. You tell her:
You are making a routine follow-up call to a woman who gave birth 6 days ago. She starts crying and says that she is exhausted, can't stop crying and doesn't want to get dressed. You tell her:
What defines zero station in childbirth?
What defines zero station in childbirth?
Which of the following should the nurse plan to include in the childbirth preparation class regarding the mechanisms of labor?
Which of the following should the nurse plan to include in the childbirth preparation class regarding the mechanisms of labor?
Which indicates that the second stage of labor is over?
Which indicates that the second stage of labor is over?
What will naloxone (Narcan) effectively reverse?
What will naloxone (Narcan) effectively reverse?
What is the most important assessment for the nurse to make immediately after dosing an epidural anesthetic?
What is the most important assessment for the nurse to make immediately after dosing an epidural anesthetic?
Which nursing action takes priority when a client in active labor spontaneously ruptures membranes?
Which nursing action takes priority when a client in active labor spontaneously ruptures membranes?
To help relieve lower-back pain during contractions, what may the nurse recommend to the husband?
To help relieve lower-back pain during contractions, what may the nurse recommend to the husband?
Why is spinal anesthesia more commonly used for cesarean sections than epidural anesthesia?
Why is spinal anesthesia more commonly used for cesarean sections than epidural anesthesia?
Use of an upright position for women in labor is associated with which outcome?
Use of an upright position for women in labor is associated with which outcome?
Which of the following is a sign of impending placental separation during the third stage of labor?
Which of the following is a sign of impending placental separation during the third stage of labor?
What essential equipment should be ready before administering epidural anesthesia?
What essential equipment should be ready before administering epidural anesthesia?
When is the best time for a woman to learn about pain relief strategies for labor?
When is the best time for a woman to learn about pain relief strategies for labor?
What should the nurse closely assess for in a woman with a continuous epidural infusion?
What should the nurse closely assess for in a woman with a continuous epidural infusion?
Which indicates bladder distention after a normal vaginal delivery?
Which indicates bladder distention after a normal vaginal delivery?
What type of lochia would the nurse expect to find on day one postpartum?
What type of lochia would the nurse expect to find on day one postpartum?
When are normal postpartum blues most likely to occur?
When are normal postpartum blues most likely to occur?
In which phase of postpartum psychological adaptation is a woman who feels, 'tired, sore, and hungry'?
In which phase of postpartum psychological adaptation is a woman who feels, 'tired, sore, and hungry'?
What is the most likely cause of a severe headache on postoperative day 2 after a cesarean section?
What is the most likely cause of a severe headache on postoperative day 2 after a cesarean section?
What assessment finding might be of concern 24 hours after a delivery?
What assessment finding might be of concern 24 hours after a delivery?
Which action should be reported after examination of a woman's bowels 36 hours postpartum?
Which action should be reported after examination of a woman's bowels 36 hours postpartum?
What is a normal finding conducive to breastfeeding on postpartum assessment of the breast?
What is a normal finding conducive to breastfeeding on postpartum assessment of the breast?
The postpartum drop in estrogen is likely to cause what effect?
The postpartum drop in estrogen is likely to cause what effect?
Why do levels of human chorionic somatomammotropin decrease after birth?
Why do levels of human chorionic somatomammotropin decrease after birth?
What should a nurse prioritize in a client with abnormal lochia findings after vaginal delivery?
What should a nurse prioritize in a client with abnormal lochia findings after vaginal delivery?
What is a primary complication to assess for in a multipara client post-delivery?
What is a primary complication to assess for in a multipara client post-delivery?
What do severe rectal pain and pressure suggest during perineal inspection?
What do severe rectal pain and pressure suggest during perineal inspection?
Which findings indicate potential risks to breastfeeding post-delivery?
Which findings indicate potential risks to breastfeeding post-delivery?
Using the five-digit GTPAL system, select the correct description of her obstetric history.
Using the five-digit GTPAL system, select the correct description of her obstetric history.
Based on Nagele's rule, when is Ms. Hall's estimated date of delivery (EDD)?
Based on Nagele's rule, when is Ms. Hall's estimated date of delivery (EDD)?
Which sign/symptom is called a probable sign of pregnancy?
Which sign/symptom is called a probable sign of pregnancy?
As her pregnancy progresses, Ms. Thompson develops constipation. This is related to what underlying physiological gastrointestinal change?
As her pregnancy progresses, Ms. Thompson develops constipation. This is related to what underlying physiological gastrointestinal change?
To screen for neural tube defects in the fetus, Ms. Russell will probably undergo which test?
To screen for neural tube defects in the fetus, Ms. Russell will probably undergo which test?
What is the nurse's best response when a patient expresses uncertainty about readiness for a baby during her planned pregnancy?
What is the nurse's best response when a patient expresses uncertainty about readiness for a baby during her planned pregnancy?
What maternal changes related to pregnancy are usually called 'stretch marks'?
What maternal changes related to pregnancy are usually called 'stretch marks'?
What is your first action for a patient who is pale and diaphoretic, feeling dizzy and needing to vomit?
What is your first action for a patient who is pale and diaphoretic, feeling dizzy and needing to vomit?
Which of the following primigravid clients should you have the midwife visit first?
Which of the following primigravid clients should you have the midwife visit first?
According to her last menstrual period, a patient is 20 weeks gestation. Her fundal height measures 23 cms. This discrepancy may be accounted for by: (Select all that apply)
According to her last menstrual period, a patient is 20 weeks gestation. Her fundal height measures 23 cms. This discrepancy may be accounted for by: (Select all that apply)
Which immunizations can a pregnant woman receive? (Select all that apply)
Which immunizations can a pregnant woman receive? (Select all that apply)
For a postpartum patient with blood type A negative, what is the most important information the nurse must obtain regarding Rh immunoglobulin administration?
For a postpartum patient with blood type A negative, what is the most important information the nurse must obtain regarding Rh immunoglobulin administration?
How long is an ovum considered fertile after ovulation?
How long is an ovum considered fertile after ovulation?
What hormone does the placenta secrete?
What hormone does the placenta secrete?
Which statement about multiple births is true?
Which statement about multiple births is true?
Which of the following are known human teratogens? (Select all that apply)
Which of the following are known human teratogens? (Select all that apply)
What is the term used to describe the sperm head?
What is the term used to describe the sperm head?
What protects the baby's umbilical cord from being squashed?
What protects the baby's umbilical cord from being squashed?
Which statement demonstrates understanding of teratogens?
Which statement demonstrates understanding of teratogens?
What is it called when the umbilical cord wraps around the fetus's neck?
What is it called when the umbilical cord wraps around the fetus's neck?
The assessment finding that confirms true labor is:
The assessment finding that confirms true labor is:
Claire's contractions are coming about every 4 minutes and last about 45 seconds. Further examination shows: FHR 140 bpm; cervix 5 cm dilated; membranes intact. Claire is in what phase of labor?
Claire's contractions are coming about every 4 minutes and last about 45 seconds. Further examination shows: FHR 140 bpm; cervix 5 cm dilated; membranes intact. Claire is in what phase of labor?
Where is the fetal presenting part in relationship to the laboring woman's ischial spines if determined that the fetus is ROA at -1 station?
Where is the fetal presenting part in relationship to the laboring woman's ischial spines if determined that the fetus is ROA at -1 station?
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Study Notes
Obstetric History and Terminology
- GTPAL system: used to summarize obstetric history:
- G: Gravida (total pregnancies)
- T: Term deliveries (37 weeks and beyond)
- P: Preterm deliveries (before 37 weeks)
- A: Abortions (spontaneous or elective)
- L: Living children
- Ms. Hall's EDD calculated using Nagele's rule results in June 27.
Signs and Symptoms of Pregnancy
- Chadwick's sign (probable sign): bluish discoloration of cervix
- Presumptive signs (reported by the woman): amenorrhea, breast changes, urinary frequency
- Positive signs: fetal heart tones, movements felt by provider, ultrasound confirmation
Physiological Changes in Pregnancy
- Constipation occurs due to reduced intestinal motility.
- Stretch marks during pregnancy referred to as striae gravidarum.
Patient Assessments and Interventions
- Hypotension symptoms should prompt immediate left lateral positioning for patient comfort and safety.
- Significant symptoms in early pregnancy, such as inability to keep fluids down, necessitate priority assessment by healthcare provider.
Laboratory and Screening Tests
- Maternal Serum Alpha-fetoprotein (MSAFP): primary test to screen for neural tube defects.
- Immunizations during pregnancy include inactive flu vaccine, Tdap, and recombinant Hep B.
Newborn and Maternal Concerns
- Understanding Rh immunoglobulin: critical if the newborn's Rh factor is positive for the mother with Rh-negative blood type.
- Teratogenic risks highest in the first 8 weeks of pregnancy, involving various factors including infections and environmental exposures.
Labor and Delivery
- Indicators of true labor include cervical dilation changes during assessment; dilation from 2 cm to 4 cm confirms active labor.
- Fetal position terminology:
- ROA: right occiput anterior
- Station measures the fetal presenting part’s relationship to the ischial spines.
Mechanisms of Labor
- Cardinal movements of labor: engagement, descent, flexion, internal rotation, extension, external rotation, expulsion.
- The second stage of labor concludes with the complete birth of the baby.
Fertility Considerations
- Ova remain fertile approximately 24 hours post-ovulation, crucial for couples practicing natural family planning.### Naloxone and Maternal Respiratory Depression
- Naloxone (Narcan) reverses respiratory depression caused by opiates like morphine sulfate (MSO4) by blocking their effects on the brain.
- It is ineffective against anesthetic agents, barbiturates, and tranquilizers.
Epidural Anesthetic Administration
- Immediate assessment after epidural administration should focus on maternal blood pressure due to the risk of hypotension.
- Maternal perfusion is crucial for both maternal and fetal health.
Spontaneous Rupture of Membranes
- The priority nursing action after membranes rupture is to assess the fetal heart rate (FHR).
- Monitoring FHR ensures fetal perfusion following the rupture.
Managing Back Pain in Labor
- Counterpressure applied to the lower back during contractions offers significant relief for back pain.
- Supporting legs or changing positions during labor may not provide immediate pain relief from contractions.
Spinal vs. Epidural Anesthesia
- Spinal anesthesia is preferred for cesarean sections as it has a quicker setup compared to epidurals, though it lasts shorter.
- An epidural provides longer-lasting pain relief but with a more involved setup.
Labor Positioning
- Upright positions during labor are associated with a shortened first stage of labor.
- Utilizing gravity may decrease the duration of the third stage of labor.
Signs of Placental Separation
- Umbilical cord lengthening is a key sign of impending placental separation.
- A small gush of blood can also indicate separation.
Preparation for Epidural Placement
- Required equipment before an epidural includes a blood pressure monitor, IV access with fluids, and provisions for oxygen and suction.
- Monitoring for hypotension is essential after the procedure.
Learning Pain Relief Strategies
- Expectant mothers should learn pain relief strategies during prenatal visits or classes for optimal preparation.
- Early education facilitates better retention compared to learning in labor.
Post Epidural Assessment
- After a continuous epidural infusion, monitor for bladder distention as patients may lose the urge to urinate.
- Signs of fatigue, such as drowsiness, are common but less critical than urinary retention.
Lochia Assessments
- Lochia rubra is expected one day postpartum, transitioning to serosa and then alba.
- Uterus deviated to the right and above the umbilicus can indicate bladder distention.
Postpartum Psychological Phases
- "Taking in" phase focuses on the mother’s personal needs and processing her birth experience.
- Postpartum blues typically manifest 3-5 days after delivery.
Maternal Assessment and Complications
- A severe headache post-spinal anesthesia suggests potential spinal fluid leakage (postdural puncture headache).
- Uterine atony is a primary concern after a complicated delivery.
Postpartum Pain and Complications
- Severe rectal pain may indicate a vaginal hematoma, especially if accompanied by perineal pain.
- Common causes of postpartum bleeding are the four T's: Tone, Tissue, Thrombin, and Trauma.
Breastfeeding Considerations
- Everted nipples are conducive to breastfeeding, while flat or inverted nipples may complicate latching.
- Engorgement can be managed by frequent nursing; tight bras or limited nursing time are ineffective.
Hormonal Changes and WBC Count
- Decreased estrogen after birth can lead to vaginal tissue atrophy.
- Elevated white blood cell counts are expected postpartum due to labor and delivery stressors.
Support and Communication
- During follow-up calls, recognizing signs of postpartum blues and reassuring the mother about its normalcy can provide emotional support.
- Assessing available help and support networks is crucial for managing postpartum mental health.
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