simulation

Question 1

temp

Answer 1

36.5-37.5 C (97.7-99.5 F)

Question 2

pulse

Answer 2

120-160

Question 3

respiration s

Answer 3

30-60

Question 4

intermittent uterine contractions that happen after birth

Answer 4

after pains

Question 5

If the uterus is contracted but there is excessive lochia, what type of injury is suspected?

Answer 5

laceration of the birth canal

Question 6

6 hazards of cold stress?

Answer 6

a. Increase oxygen needs
b. Decrease surfactant production
c. Respiratory distress
d. Hypoglycemia
e. Metabolic acidosis
f. Jaundice

Question 7

postpartum hemorrhage for vaginal birth

Answer 7

loss of 500 ml

Question 8

postpartum hemorrhage for c section

Answer 8

loss of 1000 ml

Question 9

when does late postpartum hemorrhage occur

Answer 9

24 hours and 6-12 weeks after birth.

Question 10

early postpartum hemorrhage occurs

Answer 10

during first hour after birth. Most often caused by uterine atony (a lack of tone)

Question 11

What is the first intervention in uterine atony?

Answer 11

Massage fundus until firm, and express the clots that may have accumulated in uterus

Question 12

earliest indication of hypovolemic shock?

Answer 12

Tachycardia, even the smallest increase in pulse should be noted

Question 13

Acute peripheral circulation failure resulting from loss of circulating blood volume.

Answer 13

hypovolemic shock

Question 14

Abnormally decreased volume of circulating fluid in the body

Answer 14

hypovolemia

Question 15

Where is the location of the uterus immediately after delivery?

Answer 15

Midway between the symphysis pubis and the umbilicus and midline of abdomen

Question 16

Within 12 hours after birth?

Answer 16

Fundus rises to level of umbilicus

Question 17

Each day thereafter until the 14th day?

Answer 17

Descends into abdominal cavity and cannot be palpated abdominally

Question 18

Why do some women have severe afterpains?

Answer 18

Most cases have multipara (multiple children) have more severe because of repeated stretching of uterus, primipara remains contract but may feel some afterpain – due to over distention of uterus or blood clots

Question 19

8 risk factors for post-partum hemorrhage.

Answer 19

a. Trauma to birth canal
b. Hematoma
c. Retention of placental fragment
d. Abnormalities of coagulation
e. DIC
f. Placenta prevera
g. Placenta accreta
h. Inversion of uterus
i. Someone who has multiple babies, LIKE MULTIPLE

Question 20

When assessing bladder elimination, explain the concern if a woman has frequent voids of less than 150 cc after birth?

Answer 20

This is known as urinary retention, mother is not emptying bladder all the way, mother’s fundus should be palpated to know how full bladder is

Question 21

Explain the procedure and risks of expressing clots from the uterus after birth.

Answer 21

Apply firm and gentle pressure on fundus in the direction of the vagina. Very important that the uterus is contracted firmly before attempt to express clots
Risk : pushing on uterus that is not contracted can invert the uterus and cause massive hemorrhage and shock

Question 22

If the uterus does not remain contracted or is displaced, what is the next step in dealing with uterine atony?

Answer 22

Assist the mother to urinate or put in catheter.

Question 23

Explain the procedure in replacing intravascular fluid volume.

Answer 23

Administer hall blood, packed RBC, normal saline and other plasma extenders are used, enough fluid should be given to maintain urinary output of 30 mL per hour, lactated ringers, whole blood

Question 24

When should lacerations of the birth canal be suspected?

Answer 24

If excessive uterine bleeding continued when the fundus is contracted firmly and is at expected location

Question 25

What is the most common cause of late post-partum hemorrhage?

Answer 25

subinvolution – delayed return of uterus to its not pregnant size and consistency

Question 26

How much blood loss can a pregnant or newly delivered woman tolerate

Answer 26

1500 – 2000 mL

Question 27

How does anemia impact the effect of blood loss in the pregnant or newly delivered woman?

Answer 27

Has less of a reserve for blood

Question 28

How is amount of blood loss estimated?

Answer 28

Weigh peri pads, linen savers, weigh linens

Question 29

Why would a woman who is hemorrhaging be temporarily rolled on her side?

Answer 29

Check underneath legs butt and back for lochia drainage

Question 30

Explain the differences in effacement in the parous woman and the woman who has not previously given birth.

Answer 30

Parous woman – thicker at point of time compared to nullipara, nullipara completes most cervical effacement early in the process of dilation

Question 31

Why are intermittent rather than continuous contractions in the laboring woman important to the fetus?

Answer 31

To allow fetal exchange of oxygen, nutrients, and waste products in the placenta during the period between the end of one contraction to the beginning of the next one.

Question 32

BP FOR prec

Answer 32

look up

Question 33

stimulates sustained contraction of the uterus and causes vasoconstriction

Answer 33

methylergonovine

Question 34

prevents hemorrhaging after labor

Answer 34

meth

Question 35

who do you not want to give the meth drug to

Answer 35

mom with hypertension, thrombophlebitis, CAD

Question 36

stimulates contractions of the uterus; used for treatment of postpartum hemorrhage caused by uterine atony

Answer 36

carboprost trome

Question 37

dont want to give carboprost trome to what patients

Answer 37

asthma, hypertension/hypotension, anemia, jaundice

Question 38

POST PARTUM hemorrhage

Answer 38

carboprost trome

Question 39

route for carboprost trome

Answer 39

IM ONLY

Question 40

route for Oxytocin/Pitocin

Answer 40

IV or IM

Question 41

route for meth

Answer 41

IM or PO

Question 42

side effects of carboprost Tromethamine/Hemabate

Answer 42

tachycardia, vomiting, diarrhea

Question 43

Occurs when bleeding into loose connective tissue occurs, while over lying tissue remains intact. Development as result of blood vessel injury and spontaneous deliveries, and deliveries where vacuum and forceps were used.

Answer 43

hematomas

Question 44

symptoms of hematomas

Answer 44

deep severe unrelieved pains and feelings of pressure that are not relieved by usual methods, tachycardia, decreased BP.

Question 45

hematoma treatment

Answer 45

small hematomas reabsorb naturally, large hematomas may require incision, evacuation of clots, and location/ligation of bleeding vessels

Question 46

pharm therapeutic management when late post-partum hemorrhage occurs

Answer 46

oxytocin, methergine, prostaglandins

Question 47

therapeutic management when late post-partum hemorrhage occurs

Answer 47

If bleeding continues or reoccurs, dilation and stretching of cervical OS2 permits suctioning or scraping of the walls of the uterus may be necessary to remove fragments.

Question 48

Explain the cause of increased respiratory rate, skin pallor, decreased blood pressure, anxiety and confusion in the hemorrhaging woman.

Answer 48

Decrease in BP due to decrease in circulating blood volume, respiratory rate increases as woman becomes more anxious in attempts to take in more oxygen, vasoconstriction in skin which cause pallor

Question 49

nursing care during a hemorrhage

Answer 49

``` vital signs and pulse assessment of fundus and lochia uterine massage oxygen administration iv fluids blood administration meds urine catheter position notify Doc family support ```

Question 50

explain the benefit and procedure of modified Trendelenburg positioning

Answer 50

Legs are elevated 10-30 degerees to increase blood return from the legs, head is elevated, trunk is horizontal

Question 51

most common cause of subinvolution

Answer 51

delay ??

Question 52

nullipara advice to these laboring women about coming to the hospital

Answer 52

contractions are 5 minutes apart lasting 1 minute for 1 hour

Question 53

multi para advice to these laboring women about coming to the hospital

Answer 53

contractions are 10 minutes apart lasting one minute for one hour

Question 54

womans whose bag has possibly broken advice to these laboring women about coming to the hospital

Answer 54

come in; could be trickle or gush of fluid

Question 55

what other patient should you suggest to come into the hospital

Answer 55

women with bright red bleeding

Question 56

where does the transducer go

Answer 56

on the fetal back

Question 57

Continuous headache, drowsiness, mental confusion, blurred/double vision, numbness/tingling in feet, epigastric pain, decreased urine output

Answer 57

hypertension and preclampsia

Question 58

Impaired liver function, pulmonary edema, renal insufficiency, and death to baby and mom.

Answer 58

complications with preclampsia

Question 59

cure for preclampsia

Answer 59

deliver the baby

Question 60

Reduce activity, BP monitoring, go to doctor, monitor weight, urine collection to test for protein, increase kick counts, diet should have proteins and calories.

Answer 60

regular interventions for preclampsia

Question 61

severe preclampsia

Answer 61

bed rest in lateral position, calm environment, antihypertensive meds.

Question 62

numbers for preclampsia ??

Answer 62

dont know

Question 63

treats preeclampsia and hypertension; contraindications include heart block, impaired renal func, respiratory distress, myocardial damage

Answer 63

magnesium sulfate

Question 64

treats preeclampsia and hypertension; less maternal tachycardia, contraindicated for patients with asthma, CHF, or heart disease, associated with hypoglycemia and small for gestational aged infants

Answer 64

labitol

Question 65

antidote for magnesium sulfate

Answer 65

calcium gluconate

Question 66

nursing interventions for patient on magnesium sulfate

Answer 66

monitor lungs for pulmonary edema and respiratory rate

Question 67

treats preeclampsia and hypertension; higher doses associated with maternal hypotension, headaches and fetal distress

Answer 67

Hydrolizide

Question 68

prevent eclampsia.

Answer 68

Early and regular prenatal care, close attention to weight, monitor BP, urinary protein analysis, low does aspirin, calcium and magnesium supplements, and a salt restricted diet

Question 69

BUBBLEHE

Answer 69

``` breasts uterus bladder bowel lochia EPISITOMY/INCISION HEMMORHOIDS/HOMAN’S SIGN EMOTIONAL STATUS ```

Question 70

preeclampsia blood pressure levels

Answer 70

140/90

Question 71

Where is the Doppler ultrasound transducer placed?

Answer 71

On the fetal back: monitoring the fetal heart rate.

Question 72

normal is bloody small cloths, earthy odor, fleshly, dark red or red brown -Abnormal:really large clots, foul odor

Answer 72

Lochia Rubra

Question 73

day 3-10 Decreased amount of blood- pink or brown tinged | -Abnormal: excessive amount, foul smell, dark deep red color

Answer 73

lochia serosa

Question 74

day 10-14 white creamy light yellow color | Abnormal: red foul odor, discharge is continuous

Answer 74

lochia albia

Question 75

What does REEDA mean?

Answer 75

``` REEDA for someone who has had an episiotomy (cut) or a laceration. Redness Edema Ecchymosis Discharge Approximation ```

Question 76

How do we do a bubblehe assessment on a postpartum mother?

Answer 76

Breast - check nipples, wearing supportive bra Uterus - palpate fundus Bladder - pain or burning with urination Bowel - passing gas, bowel movement, listen to bowel sounds Lochia - how much they have been bleeding, color Edema - check stitches for REEDA, education on peri bottle Hommen’s sign/hemorrhoids - hommen’s sign is patient has history of DVT Education/emotion - overall mood and bonding with infant, signs of baby blues

Question 77

breast fed infants should have how many stools per day

Answer 77

4 stools

Question 78

formula fed infants should have how many stools per day

Answer 78

1-3 stools