How long should you leave a diaphragm in after intercourse?
6 hours
What type of lubricant is used with a diaphragm?
Water-based
... [Show More] lubricant
What should you do before inserting diaphragm?
Empty bladder
How often should a diaphragm be refitted?
Every 2 years
What are 2 reasons a diaphragm would need to be refitted?
--Client gains/loses 15lbs
--After full term pregnancy
Risk associated with Estrogen-Progestin oral contraceptives?
-increased risk of thrombosis
-CVD
-breast cancer
-poor liver function
Risk associated with Medroxyprogesterone (demo-Provera)?
Decreased bone-mineral density & Osteoporosis
When is an IUD contraindicated? (3)
1. non-monogamous women
2. no pregnancy hx
3. hx of pelvic inflammatory disease
When is Norelgestromin/ethinyl estrialdol (transdermal patch) contraindicated?
Hx of HTN or thromboembolism
What is Nagele's rule?
-take LMP date, subtract 3 months & add 7 days & add 1 year to obtain approximate due date (LMP: 3/15/16 = 12/22/17)
When is Rhogam given?
-anytime mother-fetal transfer of blood might occur
- (ie: mva's, amniocentesis, abd trauma, routinely at 28 weeks, post-partrum if mom is Rh- & baby is Rh+, & w/ each pregnancy/miscarriage).
How many weeks gestation is the Rubella titer given?
6 weeks.
At how many weeks is a 1 hour glucose tolerance test done?
28 weeks
At how many weeks is a GBS culture done?
36 weeks
How often is a urine dipstick done? & what is this testing for?
Done every visit to test for proteinuria.
What percent increase in blood flow occurs during pregnancy?
50%
What are 3 effects that occur during pregnancy d/t increased blood flow?
Increased RR & HR & workload on the heart.
How do you manage Hyperemesis?
-dry toast/crackers in am
-each a small snack w/ protein @ bedtime
-Don't eat fatty foods.
-Eat what sounds good instead of trying to eat all food groups.
What should you do if the patient becomes dehydrated?
1) Monitor/check kidney function tests
2) Assess / monitor for : increased BUN & Creatinine; decreased urine output, & weight loss.
What are risk factors for Abruptio placenta? (4)
1) HTN
2) Cocaine use
3) more than 1 fetus
4) polyhydramnios
How soon should you resume sexual activity after delivery?
6 weeks
What steps should you do when resuming sexual activity after delivery?
1) use water soluble lubrication (KY jelly)
2) use protection (ovulation can occur 1 month after delivery).
When should you first start breastfeeding after delivery?
Feed within 1 hour of delivery & then on demand
(usually 8-12 feedings/24hrs)
How should you treat engorgement?
Use Cabbage leaves
-(Warning: contain phytoestrogens which can decrease milk supply if used too often)
What do you use/treat sore nipples with?
Lanolin cream
What do you use for flat nipples?
Breast shells
s/s of mastitis? (4)
-fever
-unilateral breast tenderness
-chills
-body aches
s/s of candidiasis? (4)
-pink
-shiny nipples
-fine rash
-burning & stinging w/ feeding
How many additional calories should a woman eat every day when pregnant?
300 calories / day
How many additional calories should a woman eat per day, when breastfeeding?
400-500 / day
What should you use when bottle feeding?
a breast binder.
-no stimulation to breasts
When should you use oxytocin during labor? (2)
1) Induction
2) Augmentation of labor
When should you turn the oxytocin off?
-If client has prolonged OR late decelerations
What RN interventions should be done if there are prolonged OR late decelerations? (5)
1) turn pt to side
2) increase IV fluid
3) give O2 per face mask @ 10-15 L/min
4) stimulate fetal scalp if needed
5) may need to give terbutaline
What can STI's or any infection cause?
preterm labor
s/s of preterm labor? (4)
1) low back pain
2) diarrhea (could mean infection)
3) cramping
4) increased vaginal mucous
What meds can be given if preterm labor occurs?
Terbutaline, Magnesium sulfate, and Betamethasone
What are 3 side effects of terbutaline?
1) HYPOkalemia
2) HYPERtension
3) HYPERgycemia
How often is Terbutaline given?
Terbutaline SQ q4hr
-IF pt goes home, Terbutaline PO q4hr
What does mg sulfate do?
relaxes smooth muscles
What should you check for when taking Mg sulfate?
-Check DTR (deep tendon reflexes) -- expect decrease but NOT absence
-Check RR (stop infusion if RR < 8-10)
What medication is given as a steroid to mature baby's lungs?
Betamethasone
-Given to mom IM before delivery.
When there is a rupture of membranes, what do you assess first?
FHR
-ensure there is no prolapsed cord
Things to check during postpartum?
-check fundus to assess for bleeding tendency (priority in 1st hour)
-Fundus should be firm, round & right @ umbilicus 2 hrs after delivery.
Where should the fundus be 2 hours after delivery, & what would it feel like?
1) Right @ umbilicus
2) Firm, round, & tight
Why would the fundus deviate to right & rise up above the umbilicus?
When the pt has a full bladder.
-have them go to the bathroom.
What is the frequency/length of time of normal contractions?
- q2-3 minutes lasting 45-60 seconds
What's a normal FHR ?
110-160/min
s/s of preeclampsia? (8)
1) low hct
2) low platelets
3) increased creatinine
4) proteinuria
5) HTN
6) headache
7) blurry vision
8) epigastric pain (LATE sign indicates liver damage)
What is a pt at an increased risk for d/t preeclampsia?
DIC
What med do you give as a seizure precaution?
Magnesium sulfate
What are seizure precautions? (3)
1) darkened cool room
2) side rails up x 4
3) padded bed rails
What should you do if a pt has a seizure? (5)
1) turn pt on their side
2) give O2
3) Monitor FHR
4) check contractions
5) give IV bolus
What should you have on hand incase of magnesium toxicity?
Calcium gluconate
What finding indicates a positive contraction stress test?
Late decelerations w/ at least 1/2 of contractions
What finding indicates a negative contraction stress test?
No late decels
How should a pt be positioned during a non-stress test (NST)?
Position mom in bed, semi-fowlers, tilted to right or left.
What indicates a "reactive" NST?
in 20 mins, there are at least 2 accelerations going 15 beats above baseline for 15 minutes
Non-reactive NST?
Opposite of reactive
What does a patient need to do during an NST?
Push button when feeling fetal movements.
How can you make a baby move during an NST?
1) Give mom a cold drink
2) Use acoustic stimulation
What is a biophysical profile (BPP)?
Combines NST w/ ultrasound to look @ status of infant (HR, muscle tone, breathing movements, gross body movements, amniotic fluid level)
What is a normal amniotic fluid level?
10 or higher
If a pt is unmedicated during labor, what can it lead to? & what should the RN help them to do?
1) Hyperventilation
2) breathing techniques
s/s of hyperventilation? (2)
1) numbness & tingling in fingers
2) light headed
Besides breathing techniques, what are other interventions that can be done during unmedicated labor? (5)
1) acupuncture / acupressure
2) music therapy
3)water therapy
4) effleurage (rhythmic rubbing of stomach)
5) counter-pressure to lower back
What are 3 ways to monitor fetus?
1) internal
2) external (majority have this type)
3) doppler
When is internal fetal monitoring done?
when there are 1) fetal problems 2) those w/ difficulty monitoring
What should the RN do before applying an external monitor?
Leopolds maneuver
What should be done for a pt who is having late decels? (5)
1) turn to side
2) elevate legs
3) increase IV
4) feel uterus for tachysystole
5) give O2 via face mask
What are a few normal changes that occur during pregnancy?
1) weight gian 25-35lbs (2-4 lbs in 1st trimester then 1lb/week for last 2 trimesters)
2) chloasma --brown blotches on face (temporary)
3) linea nigra -line that appears vertically midline of abdomen
4) striae gravidarum- stretch marks
How do you know when a woman is accepting these changes to her body?
When she makes positive comments
What is shoulder dystocia?
Condition in which the baby's shoulders are unable to pass through the pubis symphis, once the head passes through.
What is McRobert's position?
(Done w/ shoulder dystocia)
-hyperflexing the mother's legs tightly up to her abdomen. Allows for suprapubic pressure
-allows for rotation of the pelvis and facilitating the release of the fetal shoulder
What should you never do during shoulder dystocia?
1) Fundal pressure -- bc it could rupture the uterus!
What should you do when there is a prolapsed cord?
1) notify MD
2) place pt in Trendelenberg (OR hands & knees position)
3) keep examining hand on fetal head while pushing head off cord
4) wrap cord in wet sterile saline gauze
What does this acronym stand for?
V C M
E H I
A O N
L P E
Variable Cord comp. Move pt/reposition
Early Head comp. Initiate labor progress
Accreted Ok No action needed
Late Placental insuff. Execute orders STAT
What does this acronym stand for?
T
B
I
D
O
D
Turn pt
B
I
D
O2
Delivery
What will the pt feel with a vaginal hematoma?
Pressure in the vagina
What is a pt w/ a vaginal hematoma at risk for?
Hemorrhage
What are RN interventions for vaginal hematoma?
1) apply ice packs to perineum
2) Observe hematoma to check for increased size
What condition causes "destruction of platelets by antibodies"?
Idiopathic thrombocytopenia purpura
What is someone w/ Idiopathic thrombocytopenia purpura at risk for?
Hemorrhaging
What is the desired fetal position for delivery?
LOA (left occiput anterior) or ROA (right occiput anterior)
If a baby is occiput posterior position, what will the mother feel?
Back pain
OP position, what can be done to help the mother?
-put pressure on lower back
-have mother get in hands & knees position to relieve pain & help fetus rotate.
At what times are Apgar scores done? & what 5 things does it assess?
1) 1 min & 5 min
2) color, tone, HR, Resp effort, reflexes (worth 2 points each)
When discharging a newborn, how soon do they need to see their physician?
in 2 weeks
At what intervals does a PKU screen need to be done?
after 24 hours & then again at 2 weeks
How do you do a PKU test?
Obtain blood by heel stick on sides of heel (not center).
-use "spring-loaded blade" =more precise & goes in more shallowly
-warm heel to bleed better
-swaddle infant & give pacifier to soothe & decrease pain
What should you do to provide security to the newborn?
verify ID on mom & baby whenever you bring baby to the room & then on baby again when you re-enter the nursery.
What are newborn meds?
-Vitamin K (helps w/ clotting)
-Hep B vaccine
-Erythromycin ointment (prevents ophthalmia neonatorum caused by gonorrhead &/or clamydia)
How soon do you give a newborn meds?
w/in 2 hrs after birth (usually right after)
-Vit K & erythromycin are given by state law
-Hep B requires parental consent.
What's included in a NB assessment?
1) Head circumference: just above ears & around head
2) chest circumference: @ nipple line
3) Length: with legs pulled straight
4) weight: no clothes or diaper on
5) Term NB will have breast engorgement w/ breast buds 6-10mm, overlapping suture lines, lanugo on shoulders & back, large diamondd shape anterior fontanel, & small triangle shaped posterior fontanel.
What is should be included for parents discharge teaching when going home w/ a newborn?
1) water heater no higher than 120 degrees F
2) Crib slats no more than 2-3/8 inches apart, nothing in crib w/ baby (no large blankets/stuffed animals)
3) place car seat or bouncer on floor when infant is inside
4) car seat installed in back seat facing backward, 45 degree angle, shoulders & head supported.
What indicates that a baby is "SGA"
< 10th percentile
What are SGA babies at risk for?
1) temp instability
2)feeding difficulties
3) respiratory distress. [Show Less]