Exam 2 ch 27 & 28

Question 1

Where should the level of the fundus be 12 hrs after delivery?

Answer 1

to the umbilicus

Question 2

What type if lochia is found immediately following delivery, during the 1st week after delivery, during weeks 3-8.?

Answer 2

Immediately: lochia rubra
1st week: lochia serose
3-8 weeks: lochia alba

Question 3

What is the 1st secretion from the breasts called? What are its characteristics and what does it supply to the baby?

Answer 3

Colostrum-rich in protein, calories, antibodies, and lymphocytes

Question 4

How long does it normally take to regain prepregnancy weight without dieting after delivery?

Answer 4

Normally achieved 6-8 weeks if there wasn’t excessive weight gain

Question 5

What causes engorgement?

Answer 5

Result of venous and lymphatic stasis that occurs during lactation

Question 6

How do you treat engorgement for the breastfeeding mom and how do you suppress the milk supply for a non-breastfeeding mom?

Answer 6

Treat engorgement: Keep breast feeding and use cabbage leafs

Suppress supply: don’t breastfeed/ pump and wear a bra that provides adequate compression and ice

Question 7

Know normal expected vital signs for the postpartum mom. (hint: pulse maybe slow and a temperature of up to 100.2F is considered normal)

Answer 7

T: 100.4
P: bradycardia 50-70 BPM
R:WNL
B/P: orthostatic hypotension

Question 8

What is the recommended diet and caloric intake for the breastfeeding mom?

Answer 8

Increase calorie intake by 300-500/day and drink 2-3L of fluids/day

Question 9

Know what the normal postpartum assessment of the fundus and bleeding is?

Answer 9

Needs to contract and remain contracted, firm, and midline. when you do your assessment small trickles are normal.

Severe bleeding= uterus not contracting properly at placental site. If it doesn’t full hysterectomy will be preformed. remember to check under the buttocks for bleeding during assessments.

Question 10

What is the proper procedure for assessing the fundus after birth? Where should the nurse’s hands be?

Answer 10

Pt should empty bladder first. One hand on syphisis pubis for support, the other hand on fundus. Feel to see if firm and contracted, if boggy massage. look for bleeding

Question 11

What safety measures does the nurse initiate regarding bathing and the postpartum pt?

Answer 11

Pt fall risk bc of orthostatic hypotension

Question 12

A pt is afraid to have a BM because of her episiotomy. what interventions are appropriate for this pt?

Answer 12

assess her fear. have her bulk up her diet (fiber), laxative/suppositories, pain control, prune juice, walking, stay hydrated, sitz bath.

Question 13

What safety measures does the nurse implement when ambulating the post-cecarean delivery pt for the first time?

Answer 13

Dangle legs before getting out of bed. Stay with her for the first time getting out of bed and for her first shower (heat can mess with B/P)

Question 14

Know what normal “taking in” response looks like. (hint: mother may want the baby to go to the nursery so she can rest)

Answer 14

New mother may be passive for the first day or two; needs supportive care. Mood swings are common, due to stress, fatigue, rapid hormonal changes.

Question 15

Know normal and abnormal findings on the 1st postpartum day?

Answer 15

BUBBLEHE

-Breasts: abnormal- Engorged, painful, cracks
-Uterus: normal-cramping during breastfeeding; Abnormal- soft/boggy, severe bleeding
-Bowel and GI- Normal to be scared of pain, BM usually in 2-3 days
-Bladder: abnormal to retain; could hinder uterus from contracting all the way
-Lochia: Normal to be bright red then darken and slow/taper off for the first 8 week.
Abnormal- Sudden gushing, pooling under buttocks,
-Episiotomy: normal sewn edges together; abnormal- edges separating, infection, allergic reaction to stitches
-homans sign- Abnormal: pain in calf when foot is dorsal flexed
-emotional state: not a crazy

Question 16

What are the immediate priorities of care for a newborn?

Answer 16

APGAR
Vital signs: R:30-60 (w/ brief apnea), P:120-160BPM, B/P: 60-80/40-50mmHg, axillary temp:97.6-98.6, skin color/ appearance pinkish with blue hands and feet (acrocyanois)
Complete head-toe

Question 17

Where is acrocyanosis considered normal on the newborn?

Answer 17

hands and feet

Question 18

What should the nurse do and why, if the baby is jaundiced within the first 24 hours?

Answer 18

Lamp bed with eye protection???

Question 19

Know descriptions of lanugo and vernix caseosa.

Answer 19

Lanugo- soft downy hair covering baby

Vernix caseosa- yellowish- white cheese like protective coating covering baby

Question 20

State law requires certain newborn diagnostic tests to detect inborn errors of metabolism. What tests do these typically include?

Answer 20

???

Question 21

When assessing a newborn’s head, what findings might indicate a chromosomal disorder?

Answer 21

Flattened nose, un-proportionate facial features

Question 22

Why is vitamin K given to a newborn?

Answer 22

Babies aren’t born with something that can clot their blood

Question 23

Know how to teach a mother about care of the circumcised baby.

Answer 23

keep clean and assess for bleeding; sterile petroleum gauze

Question 24

Recognize normal and abnormal assessment findings of the newborn. Think about cry, posture, eyes, ears, acrocyanosis, etc.

Answer 24

Cry- normal
posture- spine straight, with out curves, weak neck, arms and legs usually flexed against body,
Eyes- eyelids maybe edematous, strabismus, nystagmatisum, and near sighted are normal, assess for PERRLA
Ears- upper insertion of pinna should be even with the outer canthus
Acrocyanosis- Normal for hands and feet

Question 25

What do a normal breastfed baby’s stool look like?

Answer 25

pale yellow, paste like, sweet smell

Question 26

Know the following newborn reflexes and be able to explain them to the parents.

Answer 26

Moro: Startle w/ sudden jarring or change in equilibrium
Tonic neck: When infants head is quickly turned to one side; arm and leg of same side will extend, and the opposite arm and leg will flex (resembles fencing stance)
Babinski: When sole of foot is stroked along side, toes will fan out.
Rooting: When side of cheek is stroked, infant will turn head toward the stoke to feed
Sucking: putting something in infants mouth (pacifier, bottle, boob, finger,

Question 27

Know the key points to give when teaching parents about bathing infants.

Answer 27

keep body covered when washing their hair. keep water war, NOT hot, don’t get umbilical cord wet, don’t leave baby alone in water, always keep at least one hand on the baby

Question 28

Know expected medical and nursing interventions for the pt with hyperemesis gravidarum

Answer 28

???

Eat small meal though out the day, don’t drink while you eat, stay hydrated, take prescribed antiemetics

Question 29

Know the difference between monozygotic and dizygotic twins.

Answer 29

Monozygotic- 1 egg and 1 sperm that split into 2 at a crutial time

Dizygotic- 2 eggs and 2 sperm

Question 30

Know the expected medical and nursing interventions for the pt with ectopic pregnancy.

Answer 30

???
talk about how they are feeling, fears, procedure, etc
Medical procedure will depend on where it attached. Can be a D&C or they might have to remove the fallopian tube

Question 31

Know the danger signals of pregnancy.

Answer 31

Edema, rapid weight gain, visual disturbances, bleeding, upper ABD pain, decreased fetal movement

Question 32

Know the difference in s/s of placenta previa and abruption placentae.

Answer 32

Abruption- sudden/severe fundal pain, dark red blood

Previa- painless, bleeding, BRB (??)

Question 33

How would you position the pregnant woman to optimize uterine-placental perfusion?

Answer 33

left lateral

Question 34

Know the classic s/s of preeclampsia

Answer 34

rapid weight gain, edem, visual disturbances, proteinuria,

Question 35

Know how to teach the pregnant pt how to avoid toxoplasmosis.

Answer 35

Avoid cat feces and raw meat

Question 36

What is the biggest danger to the developing fetus when the mother has diabetes mellitus?

Answer 36

hypoglycemia