Chamberlain NR327 exam 2 study guide, Exams of Advanced Education

Download Chamberlain NR327 exam 2 study guide and more Exams Advanced Education in PDF only on Docsity!

Chamberlain NR327 exam 2 study guide

• Nr
• 2024/ - NR - Nr

normal fetal HR - correct answer ✔✔110-160 beat/min Accelerations in FHR - correct answer ✔✔■ Temporary increase - ■ Reassuring - no interventions Early decelerations - correct answer ✔✔■ Normal - no interventions, expected finding ■ Cause: compression of head on the pelvis Late deceleration: response after contraction - correct answer ✔✔■Non-reassuring - needs intervention ■ Interventions: side-lying position, fluids, d/c oxytocin, O2, notify the provider, palpate uterus for tachysystole ■ Cause: uteroplacental insufficiency Variable decelerations - correct answer ✔✔■ Requires intervention ■ Intervention: knee to chest position or side-side reposition, d/c oxytocin, O2, notify provider ■ Cause: cord compression VEAL CHOP MINE - correct answer ✔✔Menomic for decelerations ■ Variable Cord compression Move the patient ■ Early Head compression Identify labor progress ■ Accelearate Okay No action ■ Late Placental insufficiency Execute "STOP" (stop Pitocin, turn patient on side, O2 via face mask, plain IV fluid increased)

BUB(B)LE - correct answer ✔✔Bladder ■ Assess the bladder for distention and adequate emptying after efforts to void ■ Note the location and condition of the fundus , a full bladder tends to displace the uterus up and to the right ■ Be alert for signs of infection, including infrequent or insufficient voiding (less than 200 ml) BU(B)BLE - correct answer ✔✔Bowels and GI function ■ Spontaneous bowel movements may NOT occur for 2-3 days after giving birth b/c of a decrease in muscle tone in the intestines during labor ■ Normal patterns of bowel elimination usually return within 8-14 days after birth ■ Inspect the woman's abdomen for distention, auscultate for bowel sounds in all 4 quadrants, & palpate for tenderness ■ Ask the woman if she has had a bowel movement or has passed gas since giving birth Lochia rubra - correct answer ✔✔Rubra- red 1-3 days Reddish or red-brown vaginal discharge that occurs immediately after childbirth; composed mostly of blood. (COAT) Lochia serosa - correct answer ✔✔Serosa- pink 3-10 days Lochia alba - correct answer ✔✔Alba- white 10-14 days

Lochia Scant - correct answer ✔✔The amount of lochia on the perineal pad is described as follows: Scant: 1-2-inch lochia stain or approx. a 10 mL loss Lochia light - correct answer ✔✔The amount of lochia on perineal pad is described as follows: Light or small: an approx. 4-inch stain or a 10-25 mL loss Lochia moderate - correct answer ✔✔The amount of lochia on the perineal pad is described as follows: Moderate: a 4-6-inch stain w/ an estimated loss of 25-50 mL Lochia large or heavy - correct answer ✔✔The amount of lochia on the perineal pad is described as follows: Large or heavy: a pad is saturated within 1 hour after changing it BUBB(L)E - correct answer ✔✔Lochia ■ the postpartum vaginal discharge that typically continues for 4-6 weeks after childbirth ■Report any abnormal findings, such as heavy, bright-red lochia w/ large tissue fragments or a foul odor to the physician ■ Teach patient about frequent changing of perineal pads, continuous use of the peribottle, and proper handwashing before & after changing the pad

delivery H(E)R - correct answer ✔✔Emotion: emotional status ■ Be alert of mood swings, irritability, or crying episodes, which could show postpartum depression or psychosis ■ Remember cultural considerations ■ Edenberg's PPD screening HE(R) - correct answer ✔✔Rhogam ■ Administered 72 hours after birth to Rh negative moms who gave birth to Rh positive babies to prevent the formation of antibodies to protect future babies ■ Also, given at 28 weeks Postpartum Assessment - Lochia - correct answer ✔✔Lochia: ■ Red/rubra - 1-3 days ■ Pink/serosa - 3-10 days ■ White/alba - 10-14 days Postpartum Assessment - Timing's - correct answer ✔✔Assessments: ■ Every 15 min. during the 1 st hour ■ Every 30 min. during the 2 nd hour ■ Every 4 hours during the first 24 hours ■ Every 8 hours after the first 24 hours Postpartum Assessment Vitals - Temp - correct answer ✔✔Temp.:

■ May rise up to 38 °C (100.4 °F) - during the first 24 hours in some women due to dehydration ■ If temp. is above 38 °C (100.4 °F) at any time or an abnormal temp. after the first 24 hours may indicate infection & MUST be reported Postpartum Assessment Vitals - Pulse Rate - correct answer ✔✔Pulse rate: ■ Bradycardia may be noted due to changes in blood volume & cardiac output after delivery ■ Pulse usually stabilizes to pre-pregnancy levels within 10 days ■ Tachycardia in the postpartum woman can suggest anxiety, excitement, fatigue, pain, excessive blood loss, infection, or underlying cardiac problems Postpartum Assessment Vitals - BP - correct answer ✔✔Blood pressure: ■ Compare BP w/ client's usual range ■ Elevations in BP from baseline may suggest pregnancy-induced hypertension; decreases may suggest dehydration or excessive blood loss ■ Be alert for orthostatic hypotension Postpartum Assessment Vitals - Pain - correct answer ✔✔Pain

present (concerned about her health, infant condition, & ability to care for infant) ■ Demonstrate increased autonomy & independence by expressing strong interest Psychological adaptations: Letting-go - correct answer ✔✔Letting go: ■ The third phase occurs when the woman reestablishes relationships w/ other people ■ Begins to adapt to parenthood through her new roles ■ Becomes focused on moving forward by assuming the parental role by separating herself from the symbolic relationship she & her newborn had during pregnancy ■ Establishes a lifestyle that includes the infant Psychological adaptations: Role-attainment - correct answer ✔✔■ a process when mother forms an emotional relationship w/ infant over time ■ Commitment, mother attachment to unborn baby, & preparation for delivery & motherhood during pregnancy ■ Acquaintance/attachment to the infant, learning to care for the infant, & physical restoration during first 2-6 weeks following birth ■ Moving toward a new normal

■ Achievement of maternal identity through redefining self to incorporate motherhood (around 4 months). During this time mother feels self-confident & competent in her mothering roles & expresses love for & pleasure interacting w/ her infant Baby blues (1-10 days) - correct answer ✔✔characterized by mild depressive symptoms - mood swings, anger, anxiety, irritability, tearfulness (often for no reason) ■ the "blues" typically peak on postpartum 4 th & 5 th day, may last hours to days ■ usually resolves by day 10 w/o therapy

• nursing management: ■ encourage the mother to express her feelings to ease ■ be patient & understanding to her & family ■ suggest getting outside help w/ housework & infant care ■ provide telephone numbers that she can call when she's down ■ reassure patient that feelings are normal &; temporal postpartum depression - correct answer ✔✔usually occurs if symptoms of "baby blues" last longer than 6 weeks & seems to get worse

on face & extremities, massaging, palm contact on trunk, infant held close) Newborn response to attachment - correct answer ✔✔by cooing, grasping, smiling, & crying Positive attachment behaviors r/t parent - correct answer ✔✔direct eye contact, pointing out common features, speak positively Positive attachment behaviors r/t infant - correct answer ✔✔alert, strong grasp reflex, sucks well, enjoy being held close, follows parent's face Negative attachment behaviors r/t infant - correct answer ✔✔feed poorly cries for long periods, flat affect, stiffens body when held, doesn't pay attention to parent's faces Negative attachment behaviors r/t parent - correct answer ✔✔disappointment in infant, fails to "explore" infant, avoids caring for infant, negative self-concept, appears uninterested, call baby negative names (frog, monkey) Father bonding - correct answer ✔✔similar, but pace may differ ■ Attachment for fathers increased if they viewed caregiver role as important ■ Fathers also begin attachment behaviors during pregnancy

■ Becoming a father requires a man to build on experiences throughout childhood & adolescences Another family member - Bonding - correct answer ✔✔May view them as competition or fear that they will be replaced ■ Reassurance & attention from parents will help them feel loved & important ■ Expect regression (sucking thumb, bedwetting) ■ Encourage discussion about the infant ■ Arrange for child to see infant in the hospital ■ Show photos of baby growing in mommy's belly ■ Encourage others to pay attention to the older child when visiting Postpartum uterus - correct answer ✔✔The uterus returns to its normal size through a gradual process, which involves retrogressive changes that return it to its regular size Postpartum cervix - correct answer ✔✔Cervix returns to normal size 6 weeks after birth Postpartum endocrine changes - correct answer ✔✔Levels of circulating estrogen & progesterone drop rapidly when the placenta is delivered ■For non-lactating women, estrogen levels begin to increase 2 weeks after birth

Engorgement - correct answer ✔✔Swelling of the breasts resulting from increased blood flow, edema, and the presence of milk can be alleviated by frequent feedings, at least every 2 to 3 hours. Instruct mother can be alleviated by frequent feedings, at least every 2 to 3 hours. Wear supportive bra 24 hours a day Non-breastfeeding mothers - correct answer ✔✔In the non-breastfeeding woman let her know that engorgement is self-limiting and lactation will begin to disappear as estrogen levels increase and suppress milk formation. Wearing a snug bra and ice packs and help with the symptoms ■ Engorgement resolves in 24 to 36 hours after milk comes in ■ Estrogen levels begin to increase 2 weeks after delivery Breastfeeding contraindications - correct answer ✔✔■ HIV ■ Street Drugs ■ Chemotherapy Drugs ■ Herpes Simplex ■ Untreated TB ■ Galactosemia T or F - Breastfeeding makes the breasts sag - correct answer ✔✔False Pregnancy, heredity, & aging cause the breasts to sag, NOT breastfeeding T or F - A mother needs to clean her nipples before breastfeeding - correct answer ✔✔False

■ The nipple area has natural protective oils to keep it germ free ■ Soap & alcohol irritate the nipples & should be avoided ■ Mothers only need to rinse the breasts w/ water once a day T or F - Breastfeeding can help a mother shed baby weight & allows your body to recover from pregnancy & childbirth more quickly - correct answer ✔✔True ■ Moms who breastfeed burn about 300-500 extra calories a day ■ Breastfeeding also releases hormones that trigger your uterus to return to its pre-baby size & weight faster T or F - Women who smoke should NOT breastfeed - correct answer ✔✔False ■ All women are encouraged to stop smoking or at least cut down ■ It is better for the baby if the mother smokes & breastfeeds than it is if the mother smokes & does not breastfeed ■ Second-hand smoke is considered worse for the baby T or F - Breastfeeding can be painful to mothers - correct answer ✔✔False ■Breastfeeding should not hurt ■ Soreness happens when the baby is incorrectly positioned or latching on

Breastfeeding Nutirtion - correct answer ✔✔■ 4 servings of Fruits and Vegetables ■ 4-5 servings of milk ■ 12 or more servings Bread, Pasta, Cereal ■ 7 servings Meat, Poultry, Fish, Eggs ■ 5 servings Fats, Oils, and Sweets ■ Lower intake of saturated fats, trans fat, & cholesterol newborn hypothermia - correct answer ✔✔■ Normal temp. range for infant: 97.7 °F- 99.7 °F s/s: ■ temp. less than 97.7 °F (36.5 °C) ■ cyanosis ■ increased RR ■Assess temperature q30 min for the first 2 hours then q8 hours until discharge Predispositions to heat loss - correct answer ✔✔■ Thin skin ■ Lack of shivering ability ■ Lack of subcutaneous fat ■ Little ability to conserve heat ■ Inability to communicate hot or cold Hypothermia nursing interventions - correct answer ✔✔■ Monitor for cyanotic trunk, depressed respirations ■ Warm infant slowly over a period of 2-4 hours in a radiant warmer - Preferred method: skin-to-skin

■ Check temp. every hour until stable ■ All exams & assessment should be performed under radiant warmer or during skin-to-skin

• correct answer ✔✔■ Performed within the first 48 hours following birth ■ Take measurements &use the Ballard Scale o Ballard Gestational Age Tool ■ Provides estimation of gestational age ■ Baseline for growth & development ■ Neuromuscular Maturity ■ 6 ranges ■ assigned # value from -1 to 5 Appropriate for Gestational Age (AGA) - correct answer ✔✔Weight, length, and head circumference are between the 10th and 90th percentiles for gestational age. Small for Gestational Age (SGA) - correct answer ✔✔weight is less than the 10 th percentile Large for Gestational Age (LGA) - correct answer ✔✔weight is greater than the 90th percentile Low Birth Weight (LBW) - correct answer ✔✔a birth weight of less than 5.5 pounds Term - correct answer ✔✔37-42 weeks of gestation Preterm or premature - correct answer ✔✔birth prior to 37 weeks