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69 Cards in this Set

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What is uterine atony?
-atony: lack of muscle tone that results in failure of the uterine muscle fibers to contract firmly around the blood vessels when the placenta separates
Why is uterine atony a bad thing right after child birth?
-relaxed muscles allow rapid bleeding from the endometrial arteries at the placental site
-bleeding continues until uterine muscle fibers contract to stop the flow of blood
T/F: Retention of a large segment of the placenta does not allow the uterus to contract firmly & therefore can cause uterine atony.
Major sx of uterine atony include...
-a fundus that is difficult to locate
-a soft or boggy feel when the fundus is located
-a uterus that becomes firm as it is massaged but loses its tone when massage is stopped
-a fundus that is located above the expected levels which is at or near the umbilicus
-excessive lochia especially if it is bright red
-excessive clots expelled
T/F: if a peripad is saturated in an hour, a large amount of blood is considered to have been lost. Saturation in 15 mins represents an excessive loss of blood in the early PP period
T/F: Is a constant steady trickle of blood in the PP period just as dangerous as a large amount of blood flow over a set period of time?
What is the 1st intervention the RN should do when the utures is not firmly contracted?
-If the uterus is not firmly contracted the 1st intervention is to massage the fundus until it is firm & to express clots that may have accumulated in the uterus
How should the RN perform a fundal massage?
-One hand is placed just above the symphysis pubis to support the lower uterine segment while the other hand gently but firmly massages the fundus in a circular motion
How should the clots be expressed from the uterus after child birth?
-clots are expressed by applying firm but gentl pressre on the fundus in the direction of the vagina
Why is it critical for the uterus to be contracted firmly before expressing clots?
-It is critical that the uterus is contracted firmly before clots are expressed b/c pushing on a uncontracted uterus could invert the uterus & cause massive hemorrhage & rapid shock
(ati book) what are 2 things that could happen when uterine atony is not tx?
1. PP hemorrhage
2. uterine inversion
ssx of uterine atony (ati book)
-monitor for ssx of uterine atony:
-a uterus that is lrger than norm & boggy c possible lateral displacement on pelvic exam
-prolonged lochia discharge
-irregular or excessive bleeding
Assessments for uterine atony include (ati book)
-fundus (fundal height, consistancy & location)
-lochia (quality, color, & consistency)
What is Nagele's rule?
-it is a mathmatical way to figure out a mother's due date
-->take the 1st day of the last menstural period, subtract 3 months & add 7 days (& 1 year if it is applicable)
What is McDonald's method?
-a way to figure out gestational age
-measure the uterine fundal height in cm from the symphysis pubis to the top of the uterine fundus (btwn 18-30 wks of age
-the gestational age is estimated to be equal to the fundal height
How should a clt who is about to have a cesarean be positioned?
-positioning the clt in a supine position c a wedge under one hip to laterally tilt her & keep her off her vena cava & descending aorta
-this will help maintain optimal perfusion of oxygenated blood to the fetus during the procedure
What is the puropse of a fetal non-stress test?
-to monitor the response of the fetal HR to fetal movement
How does a non-stress test work?
-the mom pushes a button attached to the monitor whenever she feels a fetal movement that is noted on the paper tracing
What are the 2 out comes of a fetal non-stress test?
-NST reactive
-NST nonreactive
What does a reactive fetal non stress test mean?
-NST reactive: FHR accelerates to 15 beats/min for at least 15 sec & occurs 2 or more times during a 20 min period
What does a nonreactive fetal stress test mean?
-NST nonreactive: FHR does not accelerate adequately c fetal movement or no fetal movement occurs in 40 mins
--> further assessment such as contraction stres test or biophysical profile is indicated
What are some disadvantages of a fetal non-stress test?
-high rates of false nonreactive results c fetal movement response blunted by fetal sleep cycles, chronic tobacco smoking, meds, & fetal immaturity
How should the clt be positioned during a fetal nonstress test?
-clt should be in a reclining chair or in a semi-fowlers or left lateral position
During a NST, it is determined that the fetus is sleeping. What should the RN do to awaken the fetus?
-if there are no fetal movements (fetal sleeping), vibroacoustic stimulation (sound source, usually laryngeal stimulator) may be activiated for 3 sec on the maternal abdomen over the fetal head to awaken a sleeping fetus
During a NST, a nonreactive stress test is concluded. Vibroacoustic stimulation as the next step has not worked as well. The RN has notified the MD. What should the RN be prepared to implement next?
-the RN should anticipate CST or a BPP
How is hypogycemia defined in an term infant & perterm infant?
-TERM: serum glucose level of <40mg/dL
-PRETERM: serum glucose level of <25mg/dL
Untreated hypoglycemia can result in...
-mental retardation
ssx of hypoglycemia in an infant...
-poor feeding
-jitteriness, tremors
-weak shrill cry
-flaccid muscle tone
When assessing an infant for hypoglycemia, the RN should....
-monitor BG level closely
-monitoring IV if unable to orally feed
-monitoring for ssx of hypoglycemia
-monitoring VS & temp
What are some RN interventions to assess hypoglycemia in an infant?
-obtaining blood per heel stick for glucose monitoring
-frequent oral &/or gavage feeding or continous parenteral nutrition is provided early after birth to tx hypoglycemia (untx can lead to seizures, brain damage, & death)
In true labor, the contractions are...
-regular frequency
-stronger, last longer, & are more frequent
-felt in lower back, radiating to abdomen
-walking can increase contraction intensity
-contractions continue despite comfort measures
In true labor, the cervix...
-progressive change in dilation & effacement
-moves to anterior portion
-bloody show
In true labor, the fetus...
-presenting part engages in pelvis
In false labor the contractions...
-painless, irregular frequency, & intermittent
-decrease in frequency, duration, & intensity c walking or position changes
-felt in lower back or abd above the umbilicus
-often stop c comfort measures such as oral hydration
In false labor, the cervix...
-no significant change in dilation or effacement
-often remains in posterior position
-no significant bloody show
In false labor, the fetus...
-presenting part is NOT engaged in the pelvis
After child birth, the taking in phase begins...
-the taking in phase begins immediately following birth lasting a few hours to a couple of days.
-characteristics: passive dependent behavior & relying on others to meet needs for comfort, rest, closeness, & nourishment
-the clt focuses on her own needs & is concerned about the overall health of her NB
-she is excited & talkative, repeatedly reviewing the labor & birth experience
How should the RN help faciliate bonding between mom & baby?
-faciliate the bonding process by placing the infant skin-to-skin c the mom soon after birth in an en-face position
What ways should the RN encourage the parents to bond c the baby?
-encourage the parents to bond c the baby through cuddling, feeding, diapering, & inspect the infant
-provide a quiet & private environment that enhances the family bonding process
What should the RN say to the mother during the "taking hold" phase after childbirth?
-the RN should provide frequent praise, support & reassurance to the mother as she moves toward independence in care of the NB & adjusts to the maternal role
-encourage the mother (&other parent) to discuss their feelings, fears, & anxieties about caring for their NB
At what age do toddlers delvelop gender?
-3 years of age
T/F: toddlers appreciate the usefulness of various body parts
T/F: growth slows considerable during toddlerhood.
what is the average weight of a 2 year old?
-12 kg
T/F: head cirumference slows in the toddle years, and is usually equal to chest cirumference by 1-2 years.
-chest circumference continues to increase & exceeds the head circumference during the toddle years
T/F: after the 2nd year the chest circumference exceeds the abd measurement which in addition to the growth of the lower extremities, gives the child a taller leaner appearance.
-True, however the toddler retains a squat "pot-bellied" appearance b/c of less well-developed abd musculature & short legs
-legs retain a slightly bowed or curved appearance during the 2nd year from the toddlers weight & relatively lrg trunk
What is a program adolescents go through that attempts to keep them away from drugs & alcohol?
-DARE (drug abuse resistance education)
What is the teaching in regards to sexual experimentation for adolescents?
-Abstinence is highly recommended
-if sexual activity is occuring, the use of birth control is recommended
What should the RN teach the adolescent clt in regards to STDs?
-adolescent should undergo external genitalia exams, pap smears, & cervical & urethral cultures (specific to genders)
-rectal & oral cultures may need to be taken
-counsle the adolescent about risk taking behaviors & their exposure to STDs (AIDs, hepatitis, ect)
-teach that the use of condoms will decrease the risk of STDs
T/F: Identification of pregnant teens should be done to ensure that nutrition & support is offered to promote the health of the teen & fetus.
-following infant delivery, education should be given to prevent future pregnancies
What are some ways the RN can teach the adolescent about injury prevention?
-encourage attendance of drivers ed courses; emphasize the need for compliance c seat belt
-teach the dangers of drinking/substance abuse & driving (MADD)
-insist on helmet use c bikes, motorcycles, skateboards, roller blades, & snowboards
-screen for substance abuse
-teach the adolescence not to swim alone
-teach proper use of sporting equipment
-some age appropriate activities:
*non-violent video games
*non-violent music
*caring for a pet
*career training programs
*social events
What are male condoms?
-a thin flexible sheath worn on the penis during intercourse to prevent semen from entering the uterus
How should a RN instruct the clt on wearing a male condom?
-man places condom on his erect penis, leaving an empty space at the tip for a sperm reservoir
-following ejaculation, the man withdraws his penis from the woman's vagina while holding condom rim to prevent any semen spillage to vulva or vaginal area
-may be used in conjunction c spermicidal gel or cream to increase effectiveness
-only water soluble lubricants should be used c latex condoms to avoid condom breakage
What are some prodromal ssx of anaphylaxis?
-uneasiness, impending doom, restlessness, irritability, severe anxiety, HA, dizziness, parethesia, disorentation
-cutaneous sx are most common initial sx. child c/o feeling warm, angioedema most noticable in eyelids, lips, tongue, hands, feet & genitalia
What are some ssx of anaphylaxis?
-cutaneous manifestations are often followed by bronchiolar constriction (narrowing of the airway, dilated pulmonary circulation causes pulmonary edema & hemorrhages & there is often life threatening laryngeal edema
What should the RN teach the parents of a child who just recieved an immunization in case the child has an anaphylatic reaction outside the office?
-instruct parents to call 911 & to keep the child calm until help arrives
What is an adverse effect of measles vaccination?
-teach parents to observe for bleeding
-instruct the parents to call the PCP if bleeding, bruising, or red dot-like rash occurs
What are the 2 forms of isolation in regards to the older adult population?
1. isolation by choice; the result of a desire not to interact c others
2. may be a response to conditions that inhibit the ability or the opportunity to interact c others
T/F: when the older adult is isolated, they are increased risk of vulnerability.
-True; vulnerability increases in the absence of the support of other adults as may occur c the loss of work role or relocation to unfamiliar surroundings
What are some pysiologic factors that can contribute to an older adults isolation?
-impaired hearing, diminished vision, & reduced mobility all contribute to reduced interaction c others & isolation
T/F: the lose of the ability to drive may limit older adult's ability to live independently as well as contributing to isolation.
What are some reasons that older adults chose isolating themselves?
-some older adults withdraw b/c of feelings of rejection
-older adults see themselves as unattractive & reject b/c of changes in their personal appearance due to normal aging
How can nurses assist lonely older adults to rebuild social networks & reverse patterns of isolation?
-outreach programs
-meals on wheels
-socialization needs
-daily telephone calls by volunteers
-need for activities such as outings
Spinal cord injuries involve losses of...
-motor function
-sensory function
-control of elimination
T/F: the level of cord involved dictates the consequences of spinal cord injury
--> for ex: injury at C3 to C5 poses a great risk for impaired spontaneous ventilation b/c of proximity of the phrenic nerve
losing function in 4 extermities after a spinal cord injury is called...
Losing function in the 2 lower extremities after a spinal cord injury is called...
Tetraplegia is a spinal cord injury affecting what parts of the spinal cord?
Paraplegia is a spinal cord injury affecting which parts of the spinal cord?