Chapter 5: Letitia Richford Cord Prolapse and Nonreassuring Fetal Status

Question 1

What are some components of preconception care?

health considerations

Answer 1

• chronic disease mgmt
• medications and herbals
• vaccines
• infectious diseases
• reproductive history (preg, sti, surgery)
• genetic conditions/family hx
• personal hx

Question 2

what are some components of preconception care?

behavioral considerations

Answer 2

• nutrition (folic acid, diet, exercise)
• contraception
• tobacco, alcohol, substance use
• family structure/personal relationships
• intimate partner violence
• environmental exposures or hazards

Question 3

inevitable abortion

Answer 3

• YES TO EVERYTHING
• vaginal bleeding and cramping
• cervix dilated

Question 4

threatened abortion

Answer 4

• vaginal bleeding
• NO cervical dilation

Question 5

missed abortion

Answer 5

• NO TO EVERYTHING
• preg no longer developing and not viable
• NO bleeding, cramping, cervical dilation

Question 6

septic abortion

Answer 6

• from intrauterine infection
• fever, chills, abd pain, bleeding, discharge, tachycardia, tachypnea

Question 7

incomplete abortion

Answer 7

• YES TO EVERYTHING
• vaginal bleeding, cramping, cervical dilation
• stuff remains in cervix or uterus

Question 8

RhoGam

why, when

Answer 8

• prevent mom’s antibodies from attacking baby
• 28 weeks to all mothers that are Rh-
• Postpartum if baby is Rh+ and mom Rh-

Question 9

Rhogam 50 ug dosage when

Answer 9

within 72 hr of abortion prior to 13 wks

Question 10

RhoGam 300 ug dosage when

Answer 10

• abortion after 13 wks
• 28 wks gestation
• within 72 hr of delivery
• within 72 hr of trauma or invasive procedure

Question 11

RhoGam dosage higher than 300 ug when

Answer 11

if mother’s exposure to Rh+ blood is higher than 15mL

Question 12

fetal movement kick counts methods

Answer 12

• 10 kicks/2 hr at rest
• 10 kicks/12hr normal activity
• 4 kicks/1 hr at rest
• 10 kicks/25 min if 22-26 wks
• 10 kicks/35 min if 37+ wks

Question 13

what does a birth plan include?

Answer 13

preferences at birth
* support person
* water breaks by self or assissted
* rest or walk
* intermittent or continuous fetal monitoring
* nonpharm or pharm pain mgmt
* breastfeed or formula
* circumcision or intact
* who cuts cord

Question 14

what should a client bring to the hospital?

Answer 14

• changes of maternity clothes
• massage stuff
• bluetooth speaker
• nursing bra
• mints
• socks
• travel toiletries
• nightgown
• phone charger

Question 15

reasurring fetal status

Answer 15

• 2 accelerations over 20 min
• no late/variable decelerations
• mod variability
• HR 110-160

Question 16

nonreassuring fetal status

Answer 16

• fetal bradycardia
• minimal or absent variability
• prolonged deceleration
• usually from lack of O2, cord prolapse

Question 17

nonreassuring fetal status interventions

Answer 17

• change maternal position (knee chest or trendelenburg)
• IV fluids increase
• O2
• turn off oxytocin
• sterile vaginal exam (if cord palpated, elevate presenting part off maternal pelvis, call for help)

If C-section delayed:
* keep cord moist
* maybe tocolytic like terbutaline
* fill bladder

Question 18

postoperative c-section orders (8)

Answer 18

• vitals: q15, q30, q1 hr, q4 hr, q8 hr
• fundus, lochia
• pain and analgesia
• incision care
• IV administration (oxytocin, fluids
• I&O
• activity
• serum testing and injection (kleihauser-belke for Rhogam)

Question 19

Milia

Answer 19

• little white bumps across face
• normal finding that resolves in few weeks and don’t hurt

Question 20

late preterm infant gest

Answer 20

34-36^6/7 weeks

Question 21

late preterm infant risks

Answer 21

• hypoglycemia
• hypothermia
• hyperbilirubinemia
• feeding problems
• respiratory issues (resp distress, tachypnea, pulmonary HTN)
• apnea

Question 22

late preterm infant assessments

Answer 22

• BG levels (norm 45-80 mg/dL)
• temperature (norm 97.7-99.32 F) and no baths until stable
• transcutaneous bilirubin
• latch and feeding
• resp assessment

Question 23

hypoglycemia in infants risk factors

Answer 23

• LGA or small for gestational age
• mother w gestational diabetes
• preterm infant
• stress at birth (cold stress, asphyxia)

Question 24

hypoglycemia signs in infants

Answer 24

• jitteriness
• high pitched cry
• breathing issues

Question 25

respiratory distress signs in infants

Answer 25

* nasal flaring * tachypnea * grunting * cyanosis * intercostal and subcostal retractions * seasaw breathing * A and B: apnea and bradycardia

Question 26

risk factors for hyperbilirubinemia

Answer 26

* prematurity * poor feeding * excessive breastfeeding * increased RBC production or breakdown * cold stress and acidosis * hemotoma * jaundice in first 24 hrs after birth * maternal ingestion diazepam, salicylates, sulfonamides

Question 27

delivery room newborn assessments (6)

Answer 27

* APGAR at 1 and 5 minutes * vital signs * measurements * sex determination * muscle tone * crying and breathing

Question 28

delivery room newborn interventions (4)

Answer 28

* erythromycin 0.5% ointment * vit k injection * breastfeeding attempt * blood glucose

Question 29

transitional period newborn assessments in first 4-6 h (6)

Answer 29

* temp 97.7-99.32 F * HR 120-160 bpm * pink and acrocyanosis color * tone * RR 40-60 breaths/min * BG 45-80 mg/dL

Question 30

after transition and until discharge newborn assessments (6)

Answer 30

* vitals q8 h * head to toe in 24 hrs * BG (45-80 mg/dL) * transcutaneous bilirubin or serum * breastfeeding latch/swallow/duration of feeding 2x/day * stool and void in first 24 hr

Question 31

predischarge newborn assessments

Answer 31

* BG after 24 hrs (norm 45-80 mg/dL) * pulse ox between 24-48 hrs * min 2 successful feeds * hearing test * vitals signs norm for at least 12 hrs * 1 void and stool within 12 hrs

Question 32

predischarge newborn interventions

Answer 32

* first hepB vaccine * follow up with pediatrician scheduled within 48 hr * car seat challenge test * educate to feed baby every 3 hours if preterm infant