2502 pre lab questions

Define gravidity and parity

Gravidity is the number of pregnancies.
Parity is the number of pregnancies in which the fetus(es) have reached viability; 20 weeks of gestation. The average range is 22-25 weeks of gestation

List 4 things that can be determined by Leopold’s maneuvers

o The number of fetuses
o The presenting part, fetal lie, fetal attitude
o The degree of the presenting part=s descent into the pelvis (i.e., engagement)
o The expected location of the point of maximal impulse( PMI) of the FHR on the patient’s abdomen

What is the color of normal amniotic fluid and name 2 deviation in color from
normal with rationale?

Normal: Pale, straw colored, and may contain flecks of vernix caseosa, lanugo & scalp hair.
Deviations:

• Greenish- brown color: Meconium in fluid from hypoxic episodes in fetus or post term gestation age

• Yellow-Stained fluid: Fetal hypoxia more than or at 36 hours before ROM (Rupture of membrane) , fetal hemolytic disease, intrauterine infection

• Port-wine colored: Bleeding associated with placenta abruption.

“During a postpartum assessment 1 hour after birth, a client’s fundus was no longer firm and her lochial flow had increased so that she saturated her perineal pad in less than one hour.”

What is the main cause of excessive bleeding after childbirth?

Uterine atony

“During a postpartum assessment 1 hour after birth, a client’s fundus was no longer firm and her lochial flow had increased so that she saturated her perineal pad in less than one hour.”

The client states that she experienced bladder distention after having her first child. What interventions can the nurse put in place to help prevent this complication?

• Have the patient empty their bladder spontaneously as soon as possible.

• Assist to the bathroom or onto a bedpan if unable to ambulate.

• Have patient listen to running water, place hands in warm water, or pouring water from sitz bath over the perineum may stimulate voiding. Voiding on sitz bath or assisting patient into shower may be effective.

• Administer analgesics if ordered and if unsuccessful, catheter will be needed to empty urine

“During a postpartum assessment 1 hour after birth, a client’s fundus was no longer firm and her lochial flow had increased so that she saturated her perineal pad in less than one hour.”

Which type of lochia would you expect the client to be experiencing at this point postpartum?

Lochia Rubra - immediately after birth, bright red with small clots, may be heavy for 1st 2 hours resembling a heavy menstrual period (Days 1 – 3)
Note: Tell Mom to be careful getting out of bed since blood can pool in the vagina and suddenly “gush” when standing

What does ‘OPQRSTUV’ stand for in pain assessment?

O- onset( e.g., “When did the pain start?”)
P-provocation/palliative factors( e.g., “What makes your pain better or worse?”)
Q- quality of pain( e.g., “Tell me what your pain feels like.”)
R- region/ radiation( e.g., “Show me everywhere your pain is.”)
S- severity( Use valid and appropriate pain rating scale)
T- timing( e.g., “Is pain constant, intermittent or a combination?” “Does it increase during specific times of day?” etc.)
U- understanding( e.g., “How is your pain affecting activities of daily living?”)
V-value( Are there any values or beliefs that patients have regarding pain?)

Discuss how often vital signs should be taken immediately following epidural insertion.

VS should be taken Q3-10 mins for the first 30 mins after insertion.

What are potential side effects from epidural anesthesia and analgesia that can impact both birth parent and newborn?

a. Birth parent : longer labor, increased need for oxytocin, inability to move , increase need for birth interventions, medication goes too high-resp depression, increased risk of fever, pruritus, fetal malposition, forceps vacuum, doesn’t respond to epidural and requires another form of analgesia, c/s. spinal anesthesia and risks associated with that. (pg414)
b. Fetus: no research available to show lasting effects on fetus/newborn but needs research to see effects on breastfeeding, because of increase incidence of maternal fever, newborn may be subjected unnecessarily to septic work up. (pg 416)

Why is it important to regularly check if client is voiding without difficulty while receiving epidural analgesia?

One of the possible complications of epidural analgesia is the increased risk of urinary retention, therefore it is important to check if client is voiding without difficulty

State the normal fetal heart rate (FHR) range and how this varies according to gestation.

110-160 bpm

What is the preferred method of fetal surveillance in healthy, low risk women in labor?

Intermittent Auscultation

How do you convert measurement from inches to centimeters and pounds and ounces to kilograms?

• The value of 1 inch is approximately equal to 2.54 centimeters. To convert inches to centimeter value, multiply the given inch value by 2.54.

• To convert pounds(lbs) to Kilograms(kgs) multiply the given lbs value by 0.454.

• To convert ounces to kilograms; first convert ounces to pounds by dividing the weight in ounces by 16 , then convert from pounds to kg by multiplying the resulting weight in lbs by 0.454
  

What four conditions are essential for maintaining an adequate oxygen supply for neonates?

• A clear airway

• Effective establishment of respirations

• Adequate circulation, adequate perfusion , and effective cardiac function

• Adequate thermoregulation( exposure to cold stress increases oxygen and glucose needs)
  

What is the name of the tool commonly used today to determine gestational age?

New Ballard Score

What is the rationale and timing for administering vitamin K to a newborn baby?

Vitamin K promotes formation of clotting factors ( II, VII, IX, and X) in the liver. It is therefore used for prevention and treatment of hemorrhagic disease in the newborn( HDNB), as the newborn does not have the intestinal flora to produce this vitamin in the first week after birth. Vitamin K is given within 6 hours after birth following initial stabilization and appropriate parent -newborn interaction.

What is Physiological jaundice and when does it occur?

Physiological jaundice ( also called neonatal hyperbilirubinemia) occurs in approximately 60 % of full-term newborns and in 80% of preterm newborns. Physiological jaundice causes increased levels of bilirubin as a result of the diminished ability to conjugate and excrete an excess of bilirubin in the blood of the newborn. It usually occurs by the 2nd through 5th day of life.

What size catheter should be used for an adult?

The size used for adults is 14-16 French(Fr). Older persons or males with an enlarged prostrate may need a smaller size catheter( 12 to 14 Fr)

Should normal saline be used to inflate a urinary catheter balloon? Why or why not?

No; Normal saline can crystallize and render the balloon porous , resulting in balloon deflation and the risk of catheter loss.

A patient has pinned her urinary collection bag to the belt on her housecoat. What would you do and why?

You would pin the urine collection bag below the level of the bladder so that backflow of urine from the tubing into the bladder does not occur as it increases the possibility of infection.

How is a suprapubic catheter inserted?

Suprapubic catheters are inserted surgically into the bladder through the lower abdomen above the symphysis pubis. The procedure is performed by a physician under a local or general anesthesia and the catheter may be anchored in place with a suture.

List 4 types of enemas and their implications.

Tap Water ( Hypotonic enema): Do not repeat after first instillation because water toxicity or circulatory overload can develop

Physiological normal saline: Safest enema to administer. Infants and children can tolerate only this type because of their predisposition to fluid imbalance

Hypertonic solution( e.g. commercially prepared fleet enema): Useful for patients who cannot tolerate large volumes of fluid

Harris fluid edema: A return-flow enema that helps to expel intestinal gas.
Administer a small amount (100–200 mL) of enema solution into the patient's rectum and colon. Lower the enema container to allow the total volume of solution to low back. The repeated back-and-forth administration and return of the fluid reduces flatus and promotes return of peristalsis

Soapsuds edema (SSE): Pure castile soap added to either tap water or normal saline. Use only pure castile soap. The recommended ratio
of pure soap to solution is 5 mL (1 teaspoon) to 1 000 mL (1 quart) warm water or saline. Add soap to the enema bag after water is in place to reduce excessive suds.

Oil-retention enema: Oil-based solution. The colon absorbs a small volume,
which softens stool for easier evacuation.

Carminative solution: Relieves gaseous distension. Example: MGW solution,
which contains 30 mL of magnesium, 60 mL of glycerin,
and 90 mL of water.

What is baby- friendly initiative?

This initiative is a joint effort of the World Health Organization(WHO) and the United Nations Children’s Fund( UNICEF) that focuses on providing optimal clinical care for new mothers and their infants

Name 2 benefits of breastfeeding each for the mother and baby.

Benefits for the child:
• Reduces infant and child mortality
• Enhanced maturation of the gastrointestinal tract and immune factors
• Decreases the risk for gastroenteritis, celiac disease, chron’s disease, necrotizing enterocolitis, in preterm infants, obesity in childhood, adolescence and adulthood.
• Helps protect against otitis media, respiratory illnesses, urinary tract infections, bacteremia, and bacterial meningitis
• Lowes incidence of certain allergies
• Reduces death from SIDS
• May protect against childhood lymphoma , type1&2 diabetes mellitus
• Decreases risk of dental malocclusions
• May enhance cognitive development
• Pein relief for infants undergoing painful procedures

Benefits for Mother:
• Decreases postpartum bleeding and helps rapid involution of uterus
• Decreases risk of ovarian cancer, breast cancer, rheumatoid arthritis,
hypertension, hypercholesterolemia, cardiovascular disease, and type 2 diabetes mellitus.
• Helps in postpartum weight loss
• May protest against development of osteoporosis
• Delays return of menses
• Enhances bonding experiences
• Increases maternal role attainment
• May provide protection against perinatal mood disorders when breastfeeding difficulties are appropriately addressed.

List 3 newborn feeding- readiness cues.

• Common newborn feeding cues are:

• Hand-to-mouth or hand-to -hand movements

• Sucking motions

• Rooting reflex- infant moves toward whatever touches the area around the mouth and attempts to suck.

• Mouthing

• Flexed arms and legs with clenched fists held over chest and tummy( sometimes called hunger posture)

What is colostrum and what are its benefits for the baby?

The milk consumed by the newborn in the first few days is called Colostrum. It is a clear, yellowish fluid rich in antibodies and higher in protein but lower in fat than mature milk
Benefits:
• Enhances baby’s immune system
• High protein level of colostrum facilitates binding of bilirubin and may help
prevent jaundice
• The laxative action of colostrum promotes early passage of meconium and helps in the establishment of normal lactobacillus bifidus flora in the newborn’s digestive tract.

What forms of infant formula are available?

• Ready -to feed( No water needed)
• Liquid concentrate ( needs to be mixed with sterilized water)
• Powder( needs to be mixed with sterilized water)

List 2 principles of surgical asepsis

• All items used within a sterile field must be sterile.
• A sterile barrier that has been permeated by punctures, tears, or moisture must be considered contaminated.
• Once a sterile package is opened, a 2.5-cm (1-inch) border around the edges is considered unsterile.
• Tables draped as part of a sterile field are considered sterile only at table level.
• If there is any question or doubt about the sterility of an item, the item is
considered to be unsterile.
• Sterile contacting sterile equals sterile; sterile contacting unsterile equals
unsterile. Movement around and in the sterile field must not compromise or
contaminate the field.
• A sterile object or field out of the range of vision or an object held below a
person's waist is contaminated.
• A sterile object or field becomes contaminated by prolonged exposure to air; stay organized and complete any procedure as soon as possible

When are sutures / staples normally removed? Is this a sterile procedure?

• Sutures and staples generally are removed within 7 to 14 days after surgery if healing is adequate. Retention sutures usually remain in place 14 to 21 days.
• Yes, suture/ staples removal is a sterile procedure and requires sterile supplies.

Why are retention sutures sometimes used to close an incision?

Retention sutures link underlying fat and muscle tissue and give added support to an obese or slow healing patient

When is the most likely time for wound dehiscence or evisceration to occur?

Wound dehiscence or evisceration is most likely to occur 3 to 11 days after surgery.

What assessments should you make prior to carrying out suture / staple removal?

Inspect incision for healing ridge and skin integrity of suture line for uniform closure of wound edges, normal colour ,absence of drainage and absence of inflammation

Mrs. A is a thirty-five-year-old divorced woman who is in the pre-admission clinic. She is scheduled to have a hysterectomy in one week to relieve pain and bleeding from endometriosis. During the interview, Mrs. A tells the nurse that she has always wanted to have a child, and now she knows this will never be possible.
Identify three nursing diagnoses for Mrs. A

Anxiety
Pain ( due to endometriosis)
Anticipatory Grieving
Fatigue ( Due to bleeding)
Knowledge deficit ( related to surgery/medical condition/post-surgery expectations )

What is atelectasis?

It is the collapse( complete or partial) of alveoli in the lungs

What are normal SpO2 levels for adults and newborns?

• Normal oxygen saturation levels for both adults and newborns : 95-100%.

• Critical saturation levels constituting clinical emergency is less than 90%.

What safety precautions must be instituted for the client who is receiving oxygen therapy?

Some of the safety precautions are;
o Oxygen supports combustion.
o Secure oxygen cylinders.
o Check oxygen levels.
o Avoid smoking, open flames, matches, and lighters.
o Eliminate sparks by ensuring electrical equipment( e.g., razor, radio, TV) is in good working condition and grounded.
o When electrical appliances are in use turn off oxygen.
o Locate the closest fire extinguisher.
o Use only water-based lubricants. Avoid oil-based products( Vaseline) that are flammable and can ignite spontaneously in the presence of oxygen

What flow rate of oxygen may require a patient to receive humidification?

High flow rates ( e.g., >40% or >4 Liters)