When a pregnant patient has undiagnosed vaginal bleeding, vaginal examination should be avoided until ultrasonography rules out placenta previa.
After delivery, the first nursing action is to establish the neonate’s airway.
Nursing interventions for a patient with placenta previa include positioning the patient on her left side for maximum fetal perfusion, monitoring fetal heart tones, and administering I.V. fluids and oxygen, as ordered.
The specific gravity of a neonate’s urine is 1.003 to 1.030. A lower specific gravity suggests overhydration; a higher one suggests dehydration.
The neonatal period extends from birth to day 28. It’s also called the first 4 weeks or first month of life.
A woman who is breast-feeding should rub a mild emollient cream or a few drops of breast milk (or colostrum) on the nipples after each feeding. She should let the breasts air-dry to prevent them from cracking.
Breast-feeding mothers should increase their fluid intake to 2½ to 3 qt (2,500 to 3,000 ml) daily.
After feeding an infant with a cleft lip or palate, the nurse should rinse the infant’s mouth with sterile water.
The nurse instills erythromycin in a neonate’s eyes primarily to prevent blindness caused by gonorrhea or chlamydia.
Human immunodeficiency virus (HIV) has been cultured in breast milk and can be transmitted by an HIV-positive mother who breast-feeds her infant.
A fever in the first 24 hours postpartum is most likely caused by dehydration rather than infection.
Preterm neonates or neonates who can’t maintain a skin temperature of at least 97.6° F (36.4° C) should receive care in an incubator (Isolette) or a radiant warmer. In a radiant warmer, a heat-sensitive probe taped to the neonate’s skin activates the heater unit automatically to maintain the desired temperature.
During labor, the resting phase between contractions is at least 30 seconds.
Lochia rubra is the vaginal discharge of almost pure blood that occurs during the first few days after childbirth.
Lochia serosa is the serous vaginal discharge that occurs 4 to 7 days after childbirth.
Lochia alba is the vaginal discharge of decreased blood and increased leukocytes that’s the final stage of lochia. It occurs 7 to 10 days after childbirth.
Colostrum, the precursor of milk, is the first secretion from the breasts after delivery.
The length of the uterus increases from 2½” (6.3 cm) before pregnancy to 12½” (32 cm) at term.
To estimate the true conjugate (the smallest inlet measurement of the pelvis), deduct 1.5 cm from the diagonal conjugate (usually 12 cm). A true conjugate of 10.5 cm enables the fetal head (usually 10 cm) to pass.
The smallest outlet measurement of the pelvis is the intertuberous diameter, which is the transverse diameter between the ischial tuberosities.
Electronic fetal monitoring is used to assess fetal well-being during labor. If compromised fetal status is suspected, fetal blood pH may be evaluated by obtaining a scalp sample.
In an emergency delivery, enough pressure should be applied to the emerging fetus’s head to guide the descent and prevent a rapid change in pressure within the molded fetal skull.
After delivery, a multiparous woman is more susceptible to bleeding than a primiparous woman because her uterine muscles may be overstretched and may not contract efficiently.
Neonates who are delivered by cesarean birth have a higher incidence of respiratory distress syndrome.
The nurse should suggest ambulation to a postpartum patient who has gas pain and flatulence.
Massaging the uterus helps to stimulate contractions after the placenta is delivered.
When providing phototherapy to a neonate, the nurse should cover the neonate’s eyes and genital area.
The narcotic antagonist naloxone (Narcan) may be given to a neonate to correct respiratory depression caused by narcotic administration to the mother during labor.
In a neonate, symptoms of respiratory distress syndrome include expiratory grunting or whining, sandpaper breath sounds, and seesaw retractions.
Cerebral palsy presents as asymmetrical movement, irritability, and excessive, feeble crying in a long, thin infant.
The nurse should assess a breech-birth neonate for hydrocephalus, hematomas, fractures, and other anomalies caused by birth trauma.
When a patient is admitted to the unit in active labor, the nurse’s first action is to listen for fetal heart tones.
In a neonate, long, brittle fingernails are a sign of postmaturity.
Desquamation (skin peeling) is common in postmature neonates.
A mother should allow her infant to breast-feed until the infant is satisfied. The time may vary from 5 to 20 minutes.
Nitrazine paper is used to test the pH of vaginal discharge to determine the presence of amniotic fluid.
A pregnant patient normally gains 2 to 5 lb (1 to 2.5 kg) during the first trimester and slightly less than 1 lb (0.5 kg) per week during the last two trimesters.
Neonatal jaundice in the first 24 hours after birth is known as pathological jaundice and is a sign of erythroblastosis fetalis.
A classic difference between abruptio placentae and placenta previa is the degree of pain. Abruptio placentae causes pain, whereas placenta previa causes painless bleeding.
Because a major role of the placenta is to function as a fetal lung, any condition that interrupts normal blood flow to or from the placenta increases fetal partial pressure of arterial carbon dioxide and decreases fetal pH.
Precipitate labor lasts for approximately 3 hours and ends with delivery of the neonate.
Methylergonovine (Methergine) is an oxytocic agent used to prevent and treat postpartum hemorrhage caused by uterine atony or subinvolution.
As emergency treatment for excessive uterine bleeding, 0.2 mg of methylergonovine (Methergine) is injected I.V. over 1 minute while the patient’s blood pressure and uterine contractions are monitored.
Braxton Hicks contractions are usually felt in the abdomen and don’t cause cervical change. True labor contractions are felt in the front of the abdomen and back and lead to progressive cervical dilation and effacement.
The average birth weight of neonates born to mothers who smoke is 6 oz (170 g) less than that of neonates born to nonsmoking mothers.
Culdoscopy is visualization of the pelvic organs through the posterior vaginal fornix.
The nurse should teach a pregnant vegetarian to obtain protein from alternative sources, such as nuts, soybeans, and legumes.
The nurse should instruct a pregnant patient to take only prescribed prenatal vitamins because over-the-counter high-potency vitamins may harm the fetus.
High-sodium foods can cause fluid retention, especially in pregnant patients.
A pregnant patient can avoid constipation and hemorrhoids by adding fiber to her diet.