NURS 131 Childbearing Study Notes

jasmine's version from 2016-05-04 02:17


Question Answer
A 30 year old woman with type 1 diabetes mellitus comes to the clinic for preconception care. What is the priority education for her at this time? The incidence of congenital anomalies is three times higher in the offspring of diabetic women. Good glycemic control during preconception and early pregnancy significantly reduces this risk and would be the highest priority message to this patient at this point (Focus: Prioritization)
Which task could be appropriately assigned to the unlicensed assistive personnel (UAP) working with you at the obstetric clinic? The UAP can check the blood pressure of this patient and report it to the RN. The RN would include this information in her full assessment of the patient, who may be showing signs of preeclampsia (Focus: Delegation)
You are working in the obstetric triage area, and several patients have just come in. which patient should you assess first? A multiparous patient in active labor with an urge to have a bowel movement will probably give birth imminently. She needs to be the first assessed, the provider must be notified immediately, and she must be moved to a safe location for the birth. She should not be allowed up to the bathroom at this time. The other patients all have needs requiring prompt assessment, but the imminent birth takes priority. Vaginal bleeding after intercourse could be due to cervical irritation or a vaginal infection, or could have a more serious cause such as placenta previa. This patient should be the second one assessed (Focus: Prioritization)
A 19 year old G1PO patient at 40 weeks’ gestation, who is in labor, is being treated with magnesium sulfate for seizure prophylaxis in preeclampsia. Which are priority assessments with this medication? Check deep tendon reflexes; Check the respiratory rate; Note the urine output. Rationale: Magnesium sulfate toxicity can cause fatal cardiovascular events and/or respiratory depression or arrest, so monitoring of respiratory rate is of utmost importance. The drug is excreted by the kidneys, and therefore monitoring for adequate urine output is essential. Deep tendon reflexes disappear when serum magnesium is reaching a toxic level. Vaginal bleeding is not associated with magnesium sulfate use. Calf pain can be a sign of a deep vein thrombosis, but is not associated with magnesium sulfate therapy (Focus: Prioritization)
Which action would best demonstrate evidence-based nursing practice in the care of a patient who is 1 day postpartum and reporting nipple soreness while breast feeding? It is recommended to avoid artificial nipples and pacifiers while establishing breast feeding unless medically indicated. Improper latch and position are common causes of nipple soreness and can be corrected with assessment and assistance to the mother. This practice supports the Perinatal Core Measure of increasing the percentage of newborns who are fed breast milk only (Focus: Prioritization)
A 24 year old G2P1 woman is being admitted in active labor at 39 weeks’ gestation. What prenatal data would be most important to know in your care of this patient at this time? The positive group B streptococci result requires immediate action. The provider must be notified and orders obtained for prompt antibiotic prophylaxis during labor to reduce the risk of mother-to-newborn transmission of group B streptococci. Intrapartum appropriate antibiotic treatment of the mother with group B streptococci supports the Perinatal Core Measure of reducing health care–acquired bloodstream infections in newborns (Focus: Prioritization)
You are working as a telephone triage nurse in the prenatal clinic. Which telephone call would require immediate notification of the provider? Leaking vaginal fluid at 34 weeks requires immediate attention, however, because it could indicate premature rupture of membranes with the risk of premature birth. An RN in a prenatal clinic can safely give telephone advice regarding nausea, vomiting, and pedal edema, which can be considered normal in pregnancy. The RN would assess the complaint, give the patient evidence-based advice, and define the circumstances under which the patient should call back. Vaginal itching at 20 weeks could be a yeast infection. Depending on clinic protocols, the RN could, after phone assessment, safely recommend an over-the-counter medication or arrange an office visit for the patient. (Focus: Prioritization)