Exam 2

Question 1

What is break through pain?

Answer 1

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

Question 2

Which phase of labor is the longest?

Answer 2

Latent Phase- Stage 1

Question 3

What are signs of placental separation?

Answer 3

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

Question 4

Describe the medical model

Answer 4

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

Question 5

Describe the physiologic care model

Answer 5

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

Question 6

What is the practice evidence paradox?

Answer 6

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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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

Question 11

What happens during Letting do?

Answer 11

Mother has learned how to integrate her baby into her life

Question 12

What are the 6 lamaze birth practices?

Answer 12

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

Question 13

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

Answer 13

Transitional phase

Question 14

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

Answer 14

“it feels like broken glass”

Question 15

During the golden hour, what is the nurses role?

Answer 15

Vitals Q15mins
Fundal checks and massage
Lochia checks- hemorrhage

Question 16

What are the three stages of breast-milk?

Answer 16

colostrum, fore-milk, hind-milk

Question 17

What are the 4 main reasons for labor pain?

Answer 17

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)

Question 18

What are the 3 levels of pain management?

Answer 18

1- non-pharm
2- systemic
3- epidural

Question 19

What are some examples of non- pharm pain management ?

Answer 19

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

Question 20

What is used for systemic pain management ?

Answer 20

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

Question 21

What are the 4 Ps of Labor?

Answer 21

Passenger- fetus
Powers- contractions
Pelvis
Psyche- mother

Question 22

What are the 4 Ps of preventable practice?

Answer 22

Physical environment
Permission
Practices
People

Question 23

When would a pudendal block be used?

Answer 23

Episiotomy or laceration

Question 24

What are the contraindications for an epidural?

Answer 24

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

Question 25

The nurses role before an epidural is...?

Answer 25

``` 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* ```

Question 26

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

Answer 26

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

Question 27

after an epidural the nurses role is to?

Answer 27

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

Question 28

What is a post- spinal headache?

Answer 28

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

Question 29

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

Answer 29

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

Question 30

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

Answer 30

``` 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 ```

Question 31

During C-section, the RN does these

Answer 31

``` 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 ```

Question 32

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

Answer 32

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

Question 33

During Latent phase, how often do you check FHT?

Answer 33

Q1hr

Question 34

During Active phase, how often do you check FHT?

Answer 34

Q30 mins

Question 35

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

Answer 35

Q15mins for low risk

Question 36

Always asses FHT after these events

Answer 36

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

Question 37

When there are Variable decels, what do you do?

Answer 37

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

Question 38

When there are Late decels, what do you do?

Answer 38

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

Question 39

What is the 3 part nursing diagnosis statement?

Answer 39

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

Question 40

What are the 4 Ts of Hemorrhage ?

Answer 40

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

Question 41

What is wound dehiscence ?

Answer 41

Gap in sutures

Question 42

What can cause Metritis?

Answer 42

c-section PROM Scalp electrodes

Question 43

What are the symptoms of Metritis?

Answer 43

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

Question 44

What are the interventions for Metritis?

Answer 44

``` CBC Cultures Hygiene IV antibiotics Antipyretics Drain abscess ```

Question 45

What is paralytic Ileus?

Answer 45

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