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Nursing Care During Labor and Postpartum, Exams of General Surgery

A comprehensive overview of the nursing care and interventions required during the various stages of labor and the postpartum period. It covers topics such as the indications for labor induction, the stages of labor, the assessment and monitoring of the mother and fetus, the use of pharmacological and non-pharmacological pain management techniques, the management of postpartum complications, and the newborn's physical examination and vital signs. The document also addresses the factors that contribute to a positive birth experience, including the importance of clear communication, emotional support, and the mother's personal control over the birthing process. With its detailed information and evidence-based recommendations, this document could be a valuable resource for nursing students, new nurses, and experienced healthcare professionals working in the field of maternal-child health.

Typology: Exams

2024/2025

Available from 09/13/2024

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NSG222/ NSG 222 Exam 2: (New 2024/ 2025
Update) Family Nursing Review| Questions
and Verified Answers| 100% Correct| A
Grade Herzing
QUESTION
assessments during first stage of labor**
Answer:
- contractions (30-60 min during latent, 15-30 min during active)
- status of membranes
- fetal heart rate
- fetal position and station
- pain level
- encourage breathing techniques
- educate on importance of positioning
QUESTION
labs assessed during first stage of labor (if not already done)
Answer:
- urinalysis
- CBC
- syphilis
- HbsAg
- GBS
- HIV
- drug screen
QUESTION
What is the best position for the laboring mother?**
Answer:
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NSG222/ NSG 222 Exam 2: (New 2024/ 2025

Update) Family Nursing Review| Questions

and Verified Answers| 100% Correct| A

Grade– Herzing

QUESTION

assessments during first stage of labor** Answer:

  • contractions (30- 60 min during latent, 15 - 30 min during active)
  • status of membranes
  • fetal heart rate
  • fetal position and station
  • pain level
  • encourage breathing techniques
  • educate on importance of positioning

QUESTION

labs assessed during first stage of labor (if not already done) Answer:

  • urinalysis
  • CBC
  • syphilis
  • HbsAg
  • GBS
  • HIV
  • drug screen

QUESTION

What is the best position for the laboring mother?** Answer:

whatever is most comfortable for the mother, although research shows the upright position is best

QUESTION

transition phase of labor** Answer:

  • occurs during last part of active labor when mother is 8- 10 cm dilated
  • strong to very strong contractions every 2 - 3 min lasting 45 - 90 seconds
  • check FHR every 15 - 30 min
  • check mother's vital signs every 15 - 30 min
  • check temperature q4h (q2h if ROM)

QUESTION

indications for induction of labor with Oxytocin (Pitocin) Answer:

  • large fetus
  • gestational age greater than 42 weeks
  • maternal hypertension, diabetes, or lung disease
  • spontaneous rupture of membranes without start of labor

QUESTION

amniotomy Answer: artificial rupture of membranes

QUESTION

nursing interventions during 4th stage of labor** Answer:

  • support
  • prevent hemorrhage (fundal massage if needed)
  • small void amounts very fre- quently
  • uterus displaced to the right
  • bladder distention

QUESTION

diastasis recti Answer: separation of the abdominal muscles during pregnancy

QUESTION

contributing factors to postpartum diuresis** Answer:

  • large amounts of fluid given during labor
  • decreasing Oxytocin levels (antidiuretic)
  • retention of extra fluids during pregnancy
  • decreasing aldosterone

QUESTION

baby blues** Answer:

  • mild postpartum mood disorder (anxiety, irritability, mood swings)
  • normal response
  • develops 2 - 4 days after birth
  • peaks at 4 - 5 days after birth
  • resolves by day 10 after birth (with restorative sleep)

QUESTION

phases of maternal adaptation Answer: Phase 1: Taking-In - dependent behavior, 1 - 2 days

Phase 2: Taking-Hold - more independent but accepts help, needs reassurance, lasts several weeks Phase 3: Letting Go - recognizes baby as separate from herself, re-establishes relationships with others

QUESTION

assessment of postpartum woman Answer: B: breasts U: uterus B: bladder B: bowels L: lochia E: episiotomy/perineum E: extremities (signs of DVT or PE) E: emotional status

QUESTION

When are assessments done postpartum?** Answer:

  • first hour: every 15 minutes
  • second hour: every 30 minutes
  • first 24 hours: every 4 hours
  • after 24 hours: every 8 hours

QUESTION

normal vital signs postpartum Answer:

  • slight elevated temperature up to 100.4 for 24 hours
  • 60 - 80 bpm (puerperal bradycardia)
  • normal 12 - 20 respirations per minute
  • normal BP
  • pain level of 0 - 2/

QUESTION

when to call the medical provider after birth Answer:

  • soaking a peripad in less than 1 hour
  • redness of legs
  • edema
  • shortness of breath
  • dizziness
  • elevated temperature
  • feelings of harming herself or the baby

QUESTION

Coombs test Answer:

  • a test for the presence of anti-Rh factor antibodies in the blood
  • given to women who are Rh- to see if they have developed antibodies when baby is Rh+

QUESTION

when to call the pediatrician Answer:

  • signs of abdominal obstruction or infection
  • temperature <97.5 or >100.
  • excessive vomiting
  • distended abdomen
  • new pustules/blisters
  • runny nose
  • thrush

QUESTION

What 4 main changes occur for the newborn during the "golden hour?"

Answer:

  • circulatory
  • respiratory
  • thermoregulation
  • maintain normal blood sugar

QUESTION

ductus arteriosus** Answer: a blood vessel in a fetus that bypasses pulmonary circu- lation by connecting the pulmonary artery directly to the ascending aorta, closes within a few hours after birth

QUESTION

phases of labor** Answer:

  • 1st Stage: 0 - 10cm (latent: 0 - 6cm dilation, active 6 - 10cm dilation)
  • 2nd Stage: from 10cm to birth of newborn (up to 3 hours)
  • 3rd Stage: separation and delivery of placenta (5-30 minutes)
  • 4th Stage: from placental delivery to stabilization of mother (1-4 hours after birth)

QUESTION

What is determined by vaginal examination during labor?** Answer:

  • cervical dilation
  • cervical effacement (thinning)
  • membranes intact/ruptured
  • fetal descent
  • fetal presentation

QUESTION

Nitrazine swab

QUESTION

fetal bradycardia Answer:

  • heartrate < 110 for more than 10 minutes
  • caused by epidural, hypoxia, or prolonged cord compression

QUESTION

fetal tachycardia Answer:

  • heartrate > 160 for more than 10 minutes
  • caused by asphyxia or stimulant use by mother

QUESTION

early decelerations - fetal heart rate Answer:

  • lowest point of deceleration mirrors peak of contraction
  • caused by compression of the head of the fetus
  • no intervention is necessary as this is a normal finding

QUESTION

variable decelerations - fetal heart rate Answer:

  • no correlation to contractions
  • caused by cord compression
  • shaped like u, v, w
  • implement LION (left side lying, IV fluids, oxygen & d/c Oxytocin, notify provider)

QUESTION

late decelerations - fetal heart rate** Answer:

  • decrease in fetal heartrate after con- traction
  • caused by insufficiency of placenta or uterus
  • implement LION (left side lying, IV fluids, oxygen & d/c Oxytocin, notify provider)

QUESTION

non-pharmacological interventions for labor** Answer:

  • hydrotherapy
  • ambulation/position change
  • acupuncture
  • imagery
  • effleurage (superficial stroking of abdomen)
  • massage
  • controlled breathing
  • heat therapy

QUESTION

pharmacological interventions for labor Answer:

  • opioids (decreases FHR)**
  • ataractics (decreases FHR)
  • benzodiazepines (CNS depression)

QUESTION

regional anesthesia during labor Answer:

  • epidural (continuous infusion in epidural space of "CAINE" & opioid)
  • spinal block (injected into subarachnoid space can be "CAINE" & opioid or just "CAINE")
  • patient-controlled epidural

Answer:

  • first stool of the newborn
  • greenish, black tarry stool
  • passed within 1st 12 - 24 hours of birth

QUESTION

physical exam of newborn Answer:

  • symmetric features
  • patency of nose, ears, rectum
  • genitalia normal
  • intact back
  • skin

QUESTION

newborn reflexes Answer:

  • rooting
  • sucking
  • palmar grasp
  • moro reflex (startle)
  • Babinski (spread toes when stroking from heel to toes)**

QUESTION

signs of problem with newborn Answer:

  • nasal flaring
  • grunting
  • cyanosis
  • abnormal respiratory rate <30 or >60)
  • abnormal heart rates (<110 or > 160)
  • abnormal size of baby

QUESTION

APGAR**

Answer:

  • Appearance (all pink, pink and blue, blue (pale))
  • Pulse (>100, <100, absent)
  • Grimace (cough, grimace, no response)
  • Activity (flexed, flaccid, limp)
  • Respirations (strong cry, weak cry, absent)

QUESTION

normal vital signs of newborn Answer:

  • temperature: 36.5° to 37.5° C (97.7° to 99.1° F) axillary
  • apical pulse: 110 to 160 bpm (100 bpm sleeping, 180 bpm crying)
  • respirations: 30 to 60 breaths/min

QUESTION

gestational age Answer:

  • preterm: <38 weeks
  • term: 38 - 42 weeks
  • postterm: >42 weeks
  • postmature: >42 weeks with signs of placental aging

QUESTION

skin variations in newborns Answer:

  • vernix: thick white coating
  • lanugo: fine hair
  • Mongolian spots: dark gray/purple spots

QUESTION

bottle feeding recommendations** Answer:

  • feed every 3 - 4 hours
  • feed for 30 minutes maximum
  • frequent burping
  • use semi-upright position
  • intake should be 1.5- 2 oz/lb of body weight

QUESTION

breast feeding recommendations Answer:

  • feed every 2 - 3 hours
  • nurse 10 - 20 minutes per side
  • milk is good for 4 hours at room temp
  • milk is good for 4 days in fridge
  • milk is good for 6 months in freezer

QUESTION

true labor** Answer:

  • contractions with regular intervals (predictable)
  • contractions gradually increase in frequency, duration, and intensity
  • nothing mother does stops or controls the contractions
  • contractions progress cervical dilation and thinning of cervix

QUESTION

false labor** Answer:

  • contractions with irregular intervals
  • change of position slows or stops contractions
  • contractions soften cervix but DO NOT cause cervical dilation

QUESTION

Factors affecting labor Answer:

  • presentation (part of fetus in pelvis first - cephalic, breech, or shoulder)
  • position (relationship of presenting part of fetus to the maternal pelvis - LOP, LOA, ROP, ROA)
  • station (presenting part of fetus compared to ischial spine - 4 to +4)

QUESTION

5 Ps of labor Answer:

  • passageway (birth canal)
  • passenger (fetus and placenta)
  • powers (contractions)
  • position (maternal)
  • psychological response

QUESTION

position of fetus (what letters mean) Answer: 1st letter - presenting part of fetus tilted to what side of the maternal pelvis (Right or Left) 2nd letter - presenting part of the fetus (Occiput, Sacrum, Scapula) 3rd letter - location of presenting part of fetus compared to maternal pelvis (Anterior or Posterior)

  • most common - LOP, LOA, ROP, ROA

QUESTION

Factors for a positive birth experience Answer:

  • provide clear information