Final NUR242
Final Exam: Galen NUR 242 Med-Surg (Latest ):
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Postpartum hemorrhage risk factors - ANS -Grand multiparity (five or more)
-Over distention of the uterus (large baby, twins)
-Rapid or prolonged labor
-Retained placenta
-Placenta previa or previous placenta accrete or abruptio placentae
-Drugs (tocolytics, magnesium sulfate, general anesthesia, prolonged use of
oxytocin)
-Operative procedures (cesarean birth, vacuum extraction, forceps)
-Uterine fibroids
-History of PP hemorrhage
-Preeclampsia
-Coagulation defects
Final NUR242
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Final NUR242
Infection risk factors (postpartum) - ANS -Operative procedures (cesarean
birth, vacuum extraction, forceps)
-Multiple cervical examinations
-Prolonged labor
-Prolonged rupture of membranes
-Manual extraction of placenta or retained fragments
-Diabetes
-Catheterization
-Bacterial colonization of lower genital tract
Normal finding of fundal assessment - ANS -Fundus firmly contracted
-Remains contract after massaging
-Located at level of umbilicus/midline
Abnormal finding of fundal assessment - ANS -Soft and boggy (massage until
firm)
Final NUR242
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Final NUR242
-Soft after massaging (call HCP; give oxytocin; apply pressure to express
clots)
-Displaced from midline (empty bladder and reassess)
Lochia Rubra - ANS -1-3 days
-Bloody; small clots; fleshy earthy odor; red/brown
-Abnormal: large clots; saturated pads; foul odor
Lochia Serosa - ANS -4-10 days
-Pink or brown; serosanguineous
-Abnormal: too much; foul smell; continued/recurrent reddish color
Lochia Alba - ANS -11-21 days (even until 6 weeks PP)
-White, cream, or light yellow
-Abnormal: persistent lochia serosa; return to lochia rubra; foul odor
Signs of mild fluid volume deficit - ANS -Weight loss <5%
-Normal HR and BP
Final NUR242
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Final NUR242
-Normal skin turgor
-Cap refill: <2 seconds; moist membranes
-Fontanel (normal/flat); normal eyes
Signs of moderate fluid volume deficit - ANS -Weight loss 5-10%
-Normal/undetectable BP; increased HR
-Poor, prolonged skin recoil
-Cap refill: 2-3 seconds; dry membranes
-Fontanel (sunken); decreased tears
Signs of severe fluid volume deficit - ANS -Weight loss >10%
-Normal/undetectable BP; tachy/thready/brady
-Very poor skin turgor - tenting
-Cap refill: 3-4 seconds; parched membranes
-Fontanel (markedly sunken); no tears
Treatment for minimal fluid volume deficit - ANS -ORT not needed
-Age-appropriate diet
Final NUR242