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Flashcards in Exam 2 Deck (45):
1

What is break through pain?

It is when the regular, scheduled medications are not working as well as they should and the patient is still having pain

2

Which phase of labor is the longest?

Latent Phase- Stage 1

3

What are signs of placental separation?

1- the uterus contracts and becomes globular and hard
2- gush of bright red blood
3-uterus rises in abd
4- Cord lengthening

4

Describe the medical model

focus on DELIVERY, more interventions with less times for natural processes. "abnormal until proven normal"

5

Describe the physiologic care model

focus is on the BIRTH. process as normal, natural and healthy, interventions only when it becomes dangerous

6

What is the practice evidence paradox?

When something is done in practice but doesn't make sense. caused but the tension between the two models of care

7

When you have a mother come to the hospital, what are your 3 options?

1- Send her home
2- Observe her- vitals with a 20min strip, walking and a vaginal exam after two hours
3- Admit her, hopefully in active phase

8

What are the three stages of Reva Rubin's maternal role attainment?

1- Taking in
2- Taking hold
3- Letting go

9

What happens during Taking-in? How long does it last?

This starts at the birth of baby and this can be for 24-48 hrs
the mother is thinking about herself, her pain, her friends and family and steps she should take.
Sometimes seems as though mother is not interested in baby, but this stage is normal

10

What happens during taking-hold? How long does it last?

Taking hold last up to several weeks, but does depend on family unit and mother. This is when the mother is questioning everything and wants to learn as much as she can, best time for postpartum teaching

11

What happens during Letting do?

Mother has learned how to integrate her baby into her life

12

What are the 6 lamaze birth practices?

1- let labor happen naturally
2- avoid any unnecessary medical interventions
3- try to avoid delivery on your back
4-bring someone with you who will be continuous support
5- walk and move around
6- keep baby with you

13

during which stage does the mother become exhausted, and many times fall asleep and have red cheeks

Transitional phase

14

What is a common phrase used by mothers when their baby has thrush?

"it feels like broken glass"

15

During the golden hour, what is the nurses role?

Vitals Q15mins
Fundal checks and massage
Lochia checks- hemorrhage

16

What are the three stages of breast-milk?

colostrum, fore-milk, hind-milk

17

What are the 4 main reasons for labor pain?

1- stretching of cervix and perineum
2- movement of ligaments
3- build up of lactic acid
4- Pulling apart of pelvis
(keep in mind emotional responses)

18

What are the 3 levels of pain management?

1- non-pharm
2- systemic
3- epidural

19

What are some examples of non- pharm pain management ?

movement, counter pressure, music, meditation, massage, shower, bath

20

What is used for systemic pain management ?

IV meds, dulls pain but does not remove it. Mother becomes a falls risk.
Does pass to baby.

21

What are the 4 Ps of Labor?

Passenger- fetus
Powers- contractions
Pelvis
Psyche- mother

22

What are the 4 Ps of preventable practice?

Physical environment
Permission
Practices
People

23

When would a pudendal block be used?

Episiotomy or laceration

24

What are the contraindications for an epidural?

Is it too late?
Spine abnormalities
anticuagulation therapy
known infection
Existing hypovolemia

25

The nurses role before an epidural is...?

Get baseline vitals of mom and baby
Vitals Q5 mins & BP/pulse/ O2
Should already have a IV in place
IV fluids
Contact anesthesia
Help position her
*have partner leave or sit down*

26

During an epidural the nurses role is to...?

Vitals Q1min
look for signs of nausea, vomiting= can be secondary to hypotension
Be a support for mom

27

after an epidural the nurses role is to?

EFM and Vitals on mom
Make sure mom is numb, and continues to be numb
Document all responses
Foley cath

28

What is a post- spinal headache?

Starts several hours after
may get worse with movement- orthostatic
may include neck and shoulders
check vitals
loss of CSF through puncture

29

What do you do if your patient has a post-spinal headache?

Best rest
Vitals
Hydrate
oral caffeine- or IV in some cases
oral analgesics

30

Pre-OP c-section, What is the RN's job?

ID patient
IV in place
IV antibiotics
Vitals
Include one family member for teachings
call neonatal provider and pediatrician
call anesthesia
GO WITH HER
Secure chart

31

During C-section, the RN does these

MONITOR
NEVER leave
make sure IV antibiotics are hung
Foley cath if not already done
Document all events
Get supplies
Prepare baby warmer
Plug in cauterizing device

32

The RN's role post-op c-section is...?

Vitals Q15mins
FHT
Lochia monitoring
IV patency
Pitocin
meds
Ice for perineum or incision
Blankets for warmth
Assist with breastfeeding
DOCUMENT
I&O

33

During Latent phase, how often do you check FHT?

Q1hr

34

During Active phase, how often do you check FHT?

Q30 mins

35

During 2nd stage, how often do you check FHT?

Q15mins for low risk

36

Always asses FHT after these events

Vaginal exam
ROM
Foley bulb for cervical ripening
Med admin
Fetal stimulation

37

When there are Variable decels, what do you do?

1 re-position
2 cut pit
3 O2
4 Lactated ringers
5 notify DR

38

When there are Late decels, what do you do?

1 Re-position
2 Bolus LR
3 cut pit
4 O2
5 Call DR

39

What is the 3 part nursing diagnosis statement?

1- Problem "patient at risk for ______
2-Etiology "Related to _____
3-Defining Characteristics "As evident by ____

40

What are the 4 Ts of Hemorrhage ?

Tone- uterine
Tissue- Retained placenta
Trauma- lacerations, rupture
cloTTing- Coagulopathy

41

What is wound dehiscence ?

Gap in sutures

42

What can cause Metritis?

c-section
PROM
Scalp electrodes

43

What are the symptoms of Metritis?

chills
Fever 101-104
abd/ uterine pain
30% increase in WBC
Malaise

44

What are the interventions for Metritis?

CBC
Cultures
Hygiene
IV antibiotics
Antipyretics
Drain abscess

45

What is paralytic Ileus?

Bowel blockage/ slowing

- is a post op complication- check for bowel sounds
- may be hard and distended
- pain, nausea, vomitting