UWORLD NCLEX REVIEW MATERNAL & CHILD NURSING

UWORLD NCLEX REVIEW MATERNAL & CHILD NURSING Batch 14 12/18/17 STUDY GUIDE Supine hypotensive syndrome occurs when the weight of the abdominal contents compresses the vena cava causing decreased venous return to the heart. This results in low cardiac output (maternal hypotension) and reflex tachycardia. Manifestations include dizziness, pallor, and cold and clammy skin. The client should be immediately repositioned onto the right or left side until the symptoms subside. Prevention of this condition includes using a wedge under the client's hip while in a supine position. (Option 1) Decreased maternal cardiac output can result in decreased placental blood flow and fetal heart rate (FHR) abnormalities. FHR assessment also follows after the client is placed in the right or left lateral position. (Option 2) When supine hypotension is suspected, the client should first be placed in a lateral position. Blood pressure and pulse are checked to confirm the diagnosis. Assessing lung and heart sounds is not a priority. (Option 3) The HCP is notified after placing the client in a lateral position and completing the assessment. Fetal occiput posterior (OP) position is a common fetal malposition that occurs when the fetal occiput rotates and faces the mother's posterior or sacrum. OP fetal position can cause increased back pain or "back labor." Many fetuses in OP position during early labor spontaneously rotate to occiput anterior position (occiput facing the mother's anterior or pubis). The nurse or labor support person can apply counterpressure to the client's sacrum during contractions to help alleviate back pain associated with OP fetal positioning. Firm, continuous pressure is applied with a closed fist, heel of the hand, or other firm object (eg, tennis ball, back massager) (Option 1). (Option 2) Clients should be encouraged to change positions frequently (every 30-60 minutes) during labor to promote fetal rotation/descent and increase maternal comfort. Remaining in bed during early labor increases the risk for persistent fetal malposition and slows labor progression. (Option 3) Left lateral positioning is better for uteroplacental blood flow and fetal oxygenation than supine positioning when the client is resting in bed. However, it may not alleviate the client's back pain. (Option 4) Although epidural anesthesia can provide effective pain relief, it can limit client mobility and contribute to persistent fetal malposition. This client is also still in early labor and has not requested an epidural at this time. Precipitous birth occurs when the newborn is delivered ≤3 hours after the onset of contractions. In the event of precipitous labor, the nurse should be prepared to assist with the birth if the health care provider is unable to arrive in time. Immediately after the birth, the newborn should be dried and placed skin-to-skin on the mother's abdomen at uterine level to promote warmth; this prevents cold stress that can lead to newborn hypoglycemia or respiratory distress (Option 3). If the newborn is stable, the cord can be clamped and cut with sterile scissors after it has stopped pulsating or after the placenta has been expelled. (Option 1) The perineal area can be cleansed if needed once the placenta has been expelled. (Option 2) To avoid uterine inversion or cord avulsion (tearing or snapping), the nurse should not pull on the cord. Once placental separation occurs, signified by cord lengthening, a gush of blood, uterine cramping, and vaginal pressure, the mother can bear down gently to expel the placenta. (Option 4) Fundal massage is performed after expulsion of the placenta to increase uterine tone and decrease bleeding. The enlarging pregnant uterus should be just above the symphysis pubis at approximately 12 weeks gestation (Option 4). At 16 weeks gestation, the fundus is roughly halfway between the symphysis pubis and the umbilicus. It reaches the umbilicus at 20-22 weeks gestation and approaches the xiphoid process around 36 weeks gestation. At 38-40 weeks, the fetus engages into the maternal pelvis and the fundal height drops. After 20 weeks gestation, the fundal height, measured in centimeters from the symphysis pubis to the top of the fundus, correlates closely to the weeks of gestation. (Options 1, 2, and 3) At 12 weeks gestation, the uterine fundus should be just above the symphysis pubis Subjective, objective & positive signs of pregnancy Subjective (presumptive) Objective (probable) Positive (diagnostic) • Amenorrhea • Nausea & vomiting • Urinary frequency • Breast tenderness • Quickening • Excessive fatigue • Uterine & cervical changes o Goodell sign o Chadwick sign o Hegar sign o Uterine enlargement • Braxton Hicks contractions • Ballottement • Fetal outline palpation • Uterine &funicsouffle • Skin pigmentation changes o Chloasma o Linea nigra o Areola darkening • Striaegravidaru • Positive pregnancy tests • Fetal heartbeat heard with Doppler device • Fetal movement palpated by health care provider or visible fetal movements • Visualization of fetus by use of ultrasound Subjective (presumptive) signs of pregnancy are self-reported by a client. This client's symptoms could originate from pathologic causes (eg, urinary tract infection [UTI], sexually transmitted infection), but collectively these symptoms may be indicative of early pregnancy. Any client with possible signs/symptoms of early pregnancy should be asked about menstrual history (Option 3). (Option 1) Regular breast self-exams are an important part of breast self-awareness and may alert the client to early pathologic breast changes. However, breast tenderness is a common sign of early pregnancy, which should be ruled out first. (Option 2) Leukorrhea (ie, whitish, mucoid vaginal discharge) increases during pregnancy in response to rising hormone levels. The client should be questioned about color, odor, and consistency of discharge to rule out infection, but this response from the nurse does not address the larger picture. (Option 4) Increased urinary frequency may result from hyperglycemia, and clients with diabetes are at increased risk for infections (eg, UTI, yeast infection). Reviewing home blood sugar logs would help the nurse assess the client's level of glycemic control over time but would not address the complete picture of the client's acute symptoms. A child with a cleft palate (CP) is at risk for aspiration and inadequate nutrition due to eating and feeding difficulties. This is due to the infant's inability to create suction and pull milk or formula from the nipple. Until CP can be repaired, the following feeding strategies increase oral intake and decrease aspiration risk: • Hold the infant in an upright position, which promotes passage of formula into the stomach and decreases the risk of aspiration (Option 3). • Tilt the bottle so that the nipple is always filled with formula. Point down and away from the cleft. • Use special bottles and nipples, including cross-cut and preemie nipples and assisted delivery bottles. These devices allow formula to flow more freely, decreasing the need for the infant to create suction. Using a squeezable bottle allows the caregiver to apply pressure in rhythm with the infant's own sucking and swallowing (Option 5). • These infants swallow large amounts of air during feeding and so need to be burped more often to avoid stomach distension and regurgitation (Option 2). • Feeding slowly over 20–30 minutes reduces the risk of aspiration and promotes adequate intake of formula. • Feeding every 3–4 hours; more frequent feedings may be tiring for the infant and the mother. Some infants may need to be fed more frequently if they are not consuming adequate amounts of formula.