NURS 372 FINAL QUESTIONS & ANSWERS
What is attachment - Answers -Process by which a parent comes to love and accept a
child and a child comes to love and accept a parent
Developed and maintained through proximity and interaction
Nurses' role in attachment - Answers -Play important role in facilitating parenteral
attachment by heightening parental awareness of the infant's responses and ability to
communicate
Can help build confidence in parents
What is a PPH? - Answers -Loss of more than 500mls in vaginal birth, and 1000ml in
C-section
- And or any amount of blood that causes hemodynamic instability in the patient.
- Leading cause of maternal morbidity worldwide
- Occurs in 5% of all births
- Early/Acute means PPH occurs in first 24 hours
- Late/Secondary after 24 hours
PPH Prevention - Answers -Active Management in third stage of labor - Oxytocin after
delivery of anterior shoulder
- Consider delayed cord clamping
- Gentle cord traction
- Immediate fundal massage after birth
- If third stage of labor more than 30 mins, risk of PPH increases 6x.
4 t's of PPH - Answers -1) Tone
2) Trauma
3) Tissue
4) Thrombin
Tone RF's and Causes in PPH - Answers -Uterine Atony and hypotonia of uterus.
Leading cause of early PPH ~ 70%
- Overdistended uterus (macrosomia, multiples, polyhydramnios)
- High Parity
- Prolonged labor/oxytocin induced
- MgSO4 admin (due to vasodilating effects)
- Chorioamnionitis
Trauma RF's and Causes of PPH - Answers --Lacerations/tears/episiotomy
- Uterine rupture
- Hematomas
- Uterine inversion
,- Operative birth (ie C-section)
- Precipitous birth
Tissue RF's and Causes of PPH - Answers --Retained placenta fragments
-Placenta previa, accreta, increta, percreta
-Higher risk for infection
- Manual removal by OB
- Dilation and curettage (D & C)
- Hysterectomy (in severe cases of retained POC
Thrombin RF's and Causes of PPH - Answers -*Idiopathic Thrombocytopenic Purpura
(ITP) - Autoimmune disorder causing low platelets and antibodies.
*Von Willebrand's Disease - Deficiency in blood clotting proteins
*Disseminated Intravascular Coagulation (DIC) - Clotting ability is impaired, causing a
cascade of events which may lead to internal and external bleeding.
PPH Management - Answers -- 15 mins vitals and peri-area check for 2 hours after
birth.
- Eliminate Bladder Distension
- Rapid IV fluids
- Blood transfusion
- Oxygen administration
- If boggy uterus, fundal massage
- Bimanual compression of uterus
- Placental inspection, and exploration
- Ligation of arteries
- Uterine Tamponade (packing or balloon)
PPH Medications - Answers -*Oxytocin - Contracts uterus, decrease bleeding. No
Contraindications in PPH. Monitor for bleeding and tone.
*Misoprostol - Contracts uterus, contraindicated in allergies, monitor bleeding and tone.
*Hemabate (Carboprost) - Contracts uterus, avoid in severe asthma or HTN, check BP
and don't give if over 140/90
*Tranexemic Acid - Blood clotting and stopping prolonged bleeding. Contraindicated in
hx of blood clots or active anticoagulation, given in PPH for someone with bleeding
disorder.
Facilitating behaviours of parental attachment - Answers -§ Expresses pride infant
§ Views infant's behaviours and appearance in positive light
§ Hovers, maintains proximity
§ Touches, progresses from fingertip to fingertip to palms to encompassing contact
§ Talks, coos, sings to infant
§ Interprets infant's needs
Inhibiting behaviours of parental attachment - Answers -§ Expresses disappointment
, § Views infant's behaviours as deliberately uncooperative, negative comments about
appearance
§ Ignores the infant's presence, turns away from infant
§ Avoids, does not seek proximity, refuses to hold infant
§ Fails to move from fingertip to palmar contact
§ Handles roughly, hurries feedings
§ Makes no effort to interpret infant's needs or actions
Facilitating behaviours of infant attachment - Answers -§ Vocalization, crying when
hungry or wet
§ Easily consolable
§ Visually alert, eye-to-eye contact
§ Enjoys being cuddled
What provides diversity in transitioning to parenthood - Answers -o Age
- Young vs old(adolescent vs. >35 years)
o Social support network
o Culture
o Socioeconomic conditions
o Personal aspirations influence how parents respond
Phases of maternal postpartum adjustment - Answers -Dependent, taking in phase
Dependent, independent (talk hold phase)
Independent, letting go phase
Characteristics of Dependent, taking in phase - Answers -o First 24 hours (1-2 days)
o Focus is self and meeting basic needs
§ Reliance on others to meet needs for comfort, rest, closeness, and nourishment
§ Excited and talkative
§ Desire to review birth process
Characteristics of Dependent-Independent, Talk hold phase - Answers -o Day 2-3, lasts
10 days to several weeks
o Focus is on care of baby and competent mothering
§ Desire to take charge
§ Nurturing and acceptance by others still important
§ Eagerness to learn and practice (optimal teaching time)
§ Possible experience of postpartum blues
Characteristics of parenting with LGBTQ+ couples - Answers -- Possible challenges
include lack of family acceptance and support, public ignorance, and social invisibility
What is attachment - Answers -Process by which a parent comes to love and accept a
child and a child comes to love and accept a parent
Developed and maintained through proximity and interaction
Nurses' role in attachment - Answers -Play important role in facilitating parenteral
attachment by heightening parental awareness of the infant's responses and ability to
communicate
Can help build confidence in parents
What is a PPH? - Answers -Loss of more than 500mls in vaginal birth, and 1000ml in
C-section
- And or any amount of blood that causes hemodynamic instability in the patient.
- Leading cause of maternal morbidity worldwide
- Occurs in 5% of all births
- Early/Acute means PPH occurs in first 24 hours
- Late/Secondary after 24 hours
PPH Prevention - Answers -Active Management in third stage of labor - Oxytocin after
delivery of anterior shoulder
- Consider delayed cord clamping
- Gentle cord traction
- Immediate fundal massage after birth
- If third stage of labor more than 30 mins, risk of PPH increases 6x.
4 t's of PPH - Answers -1) Tone
2) Trauma
3) Tissue
4) Thrombin
Tone RF's and Causes in PPH - Answers -Uterine Atony and hypotonia of uterus.
Leading cause of early PPH ~ 70%
- Overdistended uterus (macrosomia, multiples, polyhydramnios)
- High Parity
- Prolonged labor/oxytocin induced
- MgSO4 admin (due to vasodilating effects)
- Chorioamnionitis
Trauma RF's and Causes of PPH - Answers --Lacerations/tears/episiotomy
- Uterine rupture
- Hematomas
- Uterine inversion
,- Operative birth (ie C-section)
- Precipitous birth
Tissue RF's and Causes of PPH - Answers --Retained placenta fragments
-Placenta previa, accreta, increta, percreta
-Higher risk for infection
- Manual removal by OB
- Dilation and curettage (D & C)
- Hysterectomy (in severe cases of retained POC
Thrombin RF's and Causes of PPH - Answers -*Idiopathic Thrombocytopenic Purpura
(ITP) - Autoimmune disorder causing low platelets and antibodies.
*Von Willebrand's Disease - Deficiency in blood clotting proteins
*Disseminated Intravascular Coagulation (DIC) - Clotting ability is impaired, causing a
cascade of events which may lead to internal and external bleeding.
PPH Management - Answers -- 15 mins vitals and peri-area check for 2 hours after
birth.
- Eliminate Bladder Distension
- Rapid IV fluids
- Blood transfusion
- Oxygen administration
- If boggy uterus, fundal massage
- Bimanual compression of uterus
- Placental inspection, and exploration
- Ligation of arteries
- Uterine Tamponade (packing or balloon)
PPH Medications - Answers -*Oxytocin - Contracts uterus, decrease bleeding. No
Contraindications in PPH. Monitor for bleeding and tone.
*Misoprostol - Contracts uterus, contraindicated in allergies, monitor bleeding and tone.
*Hemabate (Carboprost) - Contracts uterus, avoid in severe asthma or HTN, check BP
and don't give if over 140/90
*Tranexemic Acid - Blood clotting and stopping prolonged bleeding. Contraindicated in
hx of blood clots or active anticoagulation, given in PPH for someone with bleeding
disorder.
Facilitating behaviours of parental attachment - Answers -§ Expresses pride infant
§ Views infant's behaviours and appearance in positive light
§ Hovers, maintains proximity
§ Touches, progresses from fingertip to fingertip to palms to encompassing contact
§ Talks, coos, sings to infant
§ Interprets infant's needs
Inhibiting behaviours of parental attachment - Answers -§ Expresses disappointment
, § Views infant's behaviours as deliberately uncooperative, negative comments about
appearance
§ Ignores the infant's presence, turns away from infant
§ Avoids, does not seek proximity, refuses to hold infant
§ Fails to move from fingertip to palmar contact
§ Handles roughly, hurries feedings
§ Makes no effort to interpret infant's needs or actions
Facilitating behaviours of infant attachment - Answers -§ Vocalization, crying when
hungry or wet
§ Easily consolable
§ Visually alert, eye-to-eye contact
§ Enjoys being cuddled
What provides diversity in transitioning to parenthood - Answers -o Age
- Young vs old(adolescent vs. >35 years)
o Social support network
o Culture
o Socioeconomic conditions
o Personal aspirations influence how parents respond
Phases of maternal postpartum adjustment - Answers -Dependent, taking in phase
Dependent, independent (talk hold phase)
Independent, letting go phase
Characteristics of Dependent, taking in phase - Answers -o First 24 hours (1-2 days)
o Focus is self and meeting basic needs
§ Reliance on others to meet needs for comfort, rest, closeness, and nourishment
§ Excited and talkative
§ Desire to review birth process
Characteristics of Dependent-Independent, Talk hold phase - Answers -o Day 2-3, lasts
10 days to several weeks
o Focus is on care of baby and competent mothering
§ Desire to take charge
§ Nurturing and acceptance by others still important
§ Eagerness to learn and practice (optimal teaching time)
§ Possible experience of postpartum blues
Characteristics of parenting with LGBTQ+ couples - Answers -- Possible challenges
include lack of family acceptance and support, public ignorance, and social invisibility
