Unit 2 Exam Review PDF

 Unit 2 Exam Review Chapter 6: 1. True vs. False Labor (Pg 137) - True labor: involves regular, painful contractions that increase in intensity and result in cervical dilation. - False labor: Braxton Hicks involves irregular, often painless contractions...

 Unit 2 Exam Review Chapter 6: 1. True vs. False Labor (Pg 137) - True labor: involves regular, painful contractions that increase in intensity and result in cervical dilation. - False labor: Braxton Hicks involves irregular, often painless contractions that do not lead to cervical changes. 2. When to Go to the Hospital for Labor (Pg 134) - Go to the hospital when contractions are regular, strong, - Prit mom ( 1st time mom) : go to the hospital when you have contractions 5 mins apart for 1 hour - Multi Mom (multiple mom) : go to the hospital when you have contractions 10 mins apart for 1 hour or if there is vaginal bleeding, the water breaks, or the baby is moving less than usual. 3. Station 0, +1, +2 (Pg 132, Picture on Pg 134) - Station 0 means the baby’s head is at the ischial spines (engaged). Station +1 or +2 indicates the baby is descending further down the birth canal, closer to delivery. 4. Ischial Spine (Station 0): a. - The ischial spines are used as a reference point in labor to determine how far the baby has descended into the pelvis. Station 0 means the baby’s head is aligned with these spines and is considered engaged, signaling that labor is progressing. - Plus (positive numbers) he is coming out (crowning) - Negative numbers are above the ischia spine and isn’t engaged in the birth canal - Every time we have an contraction its pushing down and heart rate might drop - Make sure there is a rest in between the contractions if not he is staying squeezed and the heart rate is decreasing Ischial Tuberosity- Sitting bone Chapter 7: 4. Betamethasone Use (Pg 143) - Betamethasone is a steroid given to pregnant women at risk of early delivery to help the baby’s lungs develop faster. It is usually given between 24 and 34 weeks of pregnancy. The goal is to reduce the risk of breathing problems and other complications in preterm babies. 5. VEAL CHOP and Interventions (Pg 143) - VEAL CHOP is a mnemonic to remember fetal heart rate patterns and their causes: - V: Variable decelerations - C: Cord compression - E: Early decelerations - H: Head compression - A: Accelerations - O: Okay (normal) - L: Late decelerations - P: Placental insufficiency - Interventions include repositioning the mother, providing oxygen, and increasing IV fluids. Interventions for VEAL CHOP: - Variable decelerations → Cord compression: - Intervention: Reposition the mother (e.g., move her to her side) to relieve pressure on the cord. Consider amnioinfusion if needed. - Early decelerations → Head compression: - Intervention: This is typically benign and expected during labor. No intervention is usually needed. - Accelerations → Okay (normal finding): - Intervention: No intervention required; this indicates a healthy baby. - Late decelerations → Placental insufficiency: - Intervention: Reposition the mother (usually to her left side), provide oxygen, stop oxytocin if it’s being used, and increase IV fluids to improve placental perfusion. 6. Meconium-Stained Fluid (p. 144): - This occurs when the fetus passes stool into the amniotic fluid. It can indicate fetal distress and increase the risk of respiratory issues if aspirated.  · Fetal Accelerations and Decelerations “VEAL CHOP” o Variable Deceleration = Cord Compression - D – cells : drop heart rate - Cord is being compressed ( any thing associated with the cord) - Deep U V W pattern o Early Deceleration = Head Compression - Looks like a smiley face - Always comes with a contraction -I o Acceleration = Okay !! - Has a jump in the heart rate but it goes back to baseline o Late Deceleration = Placental Insufficiency - The placenta is not working correctly so recovery is sluggish - Dropping after the contraction is finished · Management of Decels & Nursing Response to Monitor Patterns o Implement Position Changes : lay patient on their left side ot alleviate pressure o Administer Oxygen : 10 L nonrebreather o Administer IV Fluid Bolus : Lactated Ringers solution to increase perfusion, increase cardiac output and placental perfusion o Amnioinfusion (only for Variable Decels) : Saline or LR – to replace the fluid she doesn’t have 7. Stages of Labor (Pgs 155-156) - First stage: Cervical dilation from 0-10cm. This stage is divided into the latent, active, and transition phases. - Second stage: Delivery of the baby. - Third stage: Delivery of the placenta. - Fourth stage: Immediate postpartum recovery. Concern in the 4th Stage of Labor: - The 4th stage of labor is the immediate postpartum period, where the primary concern is the risk of hemorrhage (excessive bleeding). Monitoring uterine firmness and bleeding, as well as vital signs, is crucial. 8.Interventions for Hypovolemic Shock or Postpartum Hemorrhage (Pg 247-248): (**FIRST SIGN TACHYCARDIA) - If a mother is experiencing hypovolemic shock or postpartum hemorrhage, interventions include: a. - Massaging the uterus to promote contraction and reduce bleeding. b. - Administering uterotonic medications to help the uterus contract. c. - Providing IV fluids and possibly blood transfusions to maintain blood pressure and replace lost fluids. d. Monitoring vital signs and oxygen levels closely. 9. Late Signs of Hemorrhage (between 24hrs-6 weeks postpartum) - A late sign of hemorrhage includes signs of shock, such as pale, clammy skin, rapid breathing, and a weak, fast pulse. Thirsty pink/white then turns RED BLEEDING *** RISK OF HEMORRHAGING** 10.Placenta Previa (p. 94-95): - Placenta previa presents with **painless bright red vaginal bleeding**. The placenta covers part or all of the cervix. - Abruptio placenta involves painful, dark vaginal bleeding due to premature placental detachment. 11. Cervical Ripening Agents (p. 183): - Prostaglandins: help soften the cervix in preparation for dilation and effacement. They are not used in women with a previous C-section due to the risk of uterine rupture. - Dinoprostone (Cervidil, Prepidil): A synthetic form of prostaglandin E2, available as a gel or vaginal insert. - Misoprostol (Cytotec): A synthetic prostaglandin E1 analog, also used off-label for cervical ripening and labor induction. 12. Preterm Labor Interventions (p. 202): - Activity limitations, such as bed rest, may be recommended to reduce the risk of preterm labor. Chapter 8: 13.Thrombophlebitis Signs and Symptoms (Pg 220) - Symptoms include pain, tenderness, swelling, redness, warmth over the affected vein, and possibly a positive Homan's sign (pain in the calf upon dorsiflexion of the foot). (If pain then its a DVT/Blood clots) (Report to provider) 14. Therapeutic Communication After Delivery - Be supportive and provide information to new mothers. Avoid being dismissive and encourage them to share their feelings and concerns. 15. Mastitis and Nursing Care (Pgs 255-256) (2-3 weeks post-until end of breastfeeding) - Mastitis is an infection of the breast tissue, leading to pain, swelling, warmth, and redness. Nursing care includes ensuring the breast is emptied with each feeding or pumping session, applying warm compresses, and managing pain and inflammation. Mothers can usually continue breastfeeding or pumping. 16. Breastfeeding with Mastitis - Mothers can continue breastfeeding. It’s important to empty the milk ducts properly to prevent worsening the condition. Pumping= Dumping with Mastitis Treatment: Antibiotics, Mild Analgesic, Continue to feed baby 17. Standard Care When Weaning from Breastfeeding (Pg 240) - Gradual weaning is recommended to prevent engorgement and mastitis. Mothers should slowly reduce breastfeeding sessions and introduce formula or other appropriate foods. Eliminate Feedings Gradually: Remove one feeding at a time, starting with the least important feeding and waiting several days before eliminating another. The last feeding to eliminate should be the baby’s favorite, often the morning or bedtime feeding. Omit daytime feeding first Comfort Nursing: Be prepared for the baby to seek comfort nursing if they are tired, ill, or uncomfortable. Abrupt Weaning: If you must wean suddenly, you may experience breast engorgement. To relieve discomfort, use a supportive bra, ice packs, analgesics, or cabbage leaves. Avoid breast pumping to help decrease milk supply. 18. Postpartum Hemorrhage Assessment (p. 247-248): - Watch for signs such as heavy bleeding, decreased blood pressure, and increased heart rate. Interventions include fundal massage and administration of uterotonic drugs. 19. Soft Uterine Fundus (Pg 247) - A soft or boggy uterine fundus indicates uterine atony, which can lead to postpartum hemorrhage. The uterus should be massaged to help it firm up. 20. Uterine Atony (p. 249): (Collection of blood within uterus) - This is the failure of the uterus to contract, which can lead to postpartum hemorrhage. It is treated with fundal massage and medications such as oxytocin. Cause: Over-distention, retained placental fragments, prolonged labor or use of of drugs during labor that relaxes uterus. · Nursing Care Immediately After Birth - Care of mother : Observing for hemorrhage / Vital Signs / Skin color / location and firmness of uterine fundus / Lochia / Assess Pain - Promoting comfort by : keeping mom warn and dry and using ice packs to help reduce swelling and bruising Chapter 9: 21. Identifying the Baby (Pgs 158-159) - Ensure that the mother’s and baby’s ID bands match to prevent mix-ups. 22. Caloric Intake During Lactation - Lactating mothers typically need an additional 500 calories per day to support milk production. 23. Immediate Newborn Care (Pg 157) -After establishing an airway, the next most important step is to ensure (the baby is warm) thermoregulation to prevent hypothermia. Think ABCs o Maintaining Thermoregulation - Regulate temperature / skin to skin / drying baby off / make sure baby is breathing - Low temp. can cause low sugar Hypoglycemia and respiratory distress - Normal respirations for baby = 30 – 60 min - Normal temperature for baby = 36.5 – 37.5 C ( 97.9 – 99.7 F) - Normal blood loss : 500 ml vaginal delivery & 1000 C – Section 24. VBAC (Vaginal Birth After Cesarean) Concerns (Pg 150) - After a cesarean section, the primary concern with a vaginal birth is the risk of uterine rupture, which requires careful monitoring. 25. Apgar Score (Pg 158) - The Apgar score assesses a newborn’s health at 1 and 5 minutes after birth. It checks five criteria: i. heart rate, ii. respiration, iii. muscle tone, iv. reflex response, v. skin color. b. Each criterion is scored from 0 to 2, with a total score of i. 7-10 being considered normal, ii. 4-6 fairly low, and iii. 3 and below critically low. 26. Signs of Hypoglycemia in Newborns (p. 229): - Hypoglycemia in newborns is defined as a blood glucose level less than 40 mg/dL in term infant Preterm less than 35 mg/dL. - Symptoms include jitteriness, poor muscle tone, sweating, respiratory difficulty, low temperature, poor suck, high pitch cry, lethargy, and cyanosis seizures. The normal blood glucose range for a newborn baby between 40 to 60 mg/dL within the first few hours after birth and 50 to 90 mg/dL after the first day of life. Tachycardia = first sign of Hypoglycemia Chapter 10: 27. Baby Blues, Postpartum Depression, Postpartum Psychosis (Pg 256) - Baby Blues: Common, mild mood swings, feeling sad, anxious, or overwhelmed, usually starting a few days after birth and resolving within two weeks. Postpartum Depression: (starts to see 4 weeks after birth) More intense and longer-lasting than baby blues. Symptoms include severe mood swings, difficulty bonding with the baby, withdrawal from family and friends, and thoughts of harming oneself or the baby. **She do not wants to harm herself or baby but scared she will.** Postpartum Psychosis: - A rare but severe mental health emergency that can include hallucinations, delusions, paranoia, and confusion. This condition requires immediate medical treatment. **Thoughts of killing herself and her baby.** 28. Ensuring Baby Is Getting Enough to Eat (Pg 225) - To ensure a baby is well-fed, check if the baby is urinating and passing stools regularly. A baby should have about 6 to 8 wet diapers a day, which indicates proper hydration and that the baby is getting enough milk. Is baby happy ? 29. Preventing Thrombophlebitis After Surgery or Birth (Pg 247) - To prevent thrombophlebitis (blood clot in a vein), encourage early ambulation (walking), use compression stockings or devices, and ensure proper hydration. For women who had surgery, prophylactic (preventive) anticoagulant medication might be given. No pillow behind the knees. 30. Types of Formula Preparations (Pg 240) - There are different types of formula: ( feed every 3-4 hours) Ready-to-Feed Formula: No need to add water; it’s ready to use straight from the container. Concentrated Liquid Formula: Mix one part concentrated formula with one part water. Boiling water isn’t necessary unless its safety is uncertain. Avoid using well water, spring water, or mineral water due to potential mineral content. Powdered Formula: Add the recommended scoops of powder to measured water. Sterilization is only necessary if the water quality is questionable. 31. Childbirth vs. Other Pain (Pg 166) - Childbirth pain is unique due to its association with the rhythmic contractions of labor, which have a specific purpose in delivering the baby. If you see Infection it is NOT Puerperal Sepsis on EXAM***** 32. Stimulating Contractions - Contractions can be stimulated by walking, sitting up, nipple stimulation (which releases oxytocin (Induces labor), or administering synthetic oxytocin. Increased Contractions During Breastfeeding: This is due to the release of oxytocin during breastfeeding, which also causes uterine contractions (afterpains) and helps the uterus return to its pre-pregnancy size. 33. Epidural Side Effects (p. 252): - Side effects include urinary retention and hypotension. Hypotension can affect blood flow to the baby, making it a priority concern. 34. Meconium-Stained Fluid and Prolapsed Cord (p. 144): - Meconium in the amniotic fluid can indicate fetal distress. A prolapsed cord, where the umbilical cord slips out before the baby, requires immediate action, such as repositioning the mother to relieve pressure on the cord. 35. Rubella Vaccine (MMR): - The MMR vaccine is given postpartum to women who are not immune to rubella. It is not administered during pregnancy due to the risk to the fetus. Give after labor if mom hasn’t Already.