NUR 221 Exam 2 Questions with Complete
Solutions
assessment of neonatal pain • Neonatal Infant Pain Scale (NIPS) (Lawrence, Alcock,
McGrath, et al., 1993) • Premature Infant Pain Profile (PIPP) (Stevens, Johnston, Petryshen, et
al., 1996) • Neonatal Pain Agitation and Sedation Scale (NPASS) (Hummel, Puchalski, Creech,
et al., 2008) • CRIES (Krechel & Bildner, 1995) (Table 23.5)
Non pharmacological treatment of neonatal pain swaddling, tucking, pacifier, oral sucrose
with or without a pacifier, skin to skin contact with mom, breastfeeding and breast milk, oral,
visual, auditory distractions, sensorial saturation (speaking softly, gently massaging face,
providing oral sucrose on the tongue).
Pharmacological treatment of neonatal pain Local anesthesia is routinely used during
procedures such as circumcision. Topical anesthesia is used for circumcision, lumbar puncture,
venipuncture, and heelsticks. Nonopioid analgesia (oral liquid acetaminophen) is effective for
mild to moderate pain from inflammatory conditions. Morphine and fentanyl are the most widely
used opioid analgesics for pharmacologic management of neonatal pain. Continuous or bolus IV
infusion of opioids provides effective and safe pain control. Other methods for managing
neonatal pain are epidural infusion, local and regional nerve blocks, and intradermal or topical
anesthetics (Gardner et al., 2016).
,Nonstress test (NST) for antepartum evaluation of fetal well being performed during third
trimester. noninvasive test that monitors the fhr to fetal movement. a doppler transducer(used to
monitor the fhr) and a tocotransducer(used to monitor uterine contractions) are attached
externally to a client's abdomen to obtain tracing strips. client pushes a button when she feels the
fetus move.
Findings in the first stage of labor considered to last from the onset of regular uterine
contractions to full dilation of the cervix. Commonly the onset of labor is difficult to establish
because the woman may be admitted to the labor unit just before birth and the beginning of labor
may be only an estimate. The first stage is much longer than the second and third combined.
However, great variability is the rule, the first stage of labor is now divided into only two phases,
latent (early) and active (Kilpatrick & Garrison, 2017). During the latent phase, there is more
progress in effacement of the cervix and little increase in descent. During the active phase, there
is more rapid dilation of the cervix and increased rate of descent of the presenting part.
Reactive NST two accelerations in a 20 min period. 15bpm above baseline lasting for 15
seconds or longer
Non reactive NST NO fetal heart rate accelerations of accelerations less than 15 beats/min
or lasting less than 15 seconds throughout any fetal movement during the testing period;
, if the test does not meet reactive criteria listed above after 40 min the test is considered non-
reactive
fetal physiological adaptation to labor FHR-temporary accelerations and slight early
decelerations of the FHR can be expected in response to spontaneous fetal movement, vaginal
examination, fundal pressure, uterine contractions, abdominal palpation, and fetal head
compression. Stresses to the uterofetoplacental unit result in characteristic FHR patterns (see
Chapter 15 for further discussion).
Real time Ultrasound look for 4 things
1. fetal breathing movements (chest moves in and out) at least 1 episode that lasts 30 seconds in
a 30 min period.
2. Fetal movement- atleast 3 trunk or limb movements in 30 minutes.
3. Fetal tone-atleast 1 episode in 30 mins
4. amniotic fluid index AFI- looking for pockets of amniotic fluid intrauterine.
fetal physiological adaptation to labor Fetal Circulation- Fetal circulation can be affected
by many factors, including maternal position, uterine contractions, blood pressure, and umbilical
cord blood flow. Uterine contractions during labor tend to decrease circulation through the spiral
Solutions
assessment of neonatal pain • Neonatal Infant Pain Scale (NIPS) (Lawrence, Alcock,
McGrath, et al., 1993) • Premature Infant Pain Profile (PIPP) (Stevens, Johnston, Petryshen, et
al., 1996) • Neonatal Pain Agitation and Sedation Scale (NPASS) (Hummel, Puchalski, Creech,
et al., 2008) • CRIES (Krechel & Bildner, 1995) (Table 23.5)
Non pharmacological treatment of neonatal pain swaddling, tucking, pacifier, oral sucrose
with or without a pacifier, skin to skin contact with mom, breastfeeding and breast milk, oral,
visual, auditory distractions, sensorial saturation (speaking softly, gently massaging face,
providing oral sucrose on the tongue).
Pharmacological treatment of neonatal pain Local anesthesia is routinely used during
procedures such as circumcision. Topical anesthesia is used for circumcision, lumbar puncture,
venipuncture, and heelsticks. Nonopioid analgesia (oral liquid acetaminophen) is effective for
mild to moderate pain from inflammatory conditions. Morphine and fentanyl are the most widely
used opioid analgesics for pharmacologic management of neonatal pain. Continuous or bolus IV
infusion of opioids provides effective and safe pain control. Other methods for managing
neonatal pain are epidural infusion, local and regional nerve blocks, and intradermal or topical
anesthetics (Gardner et al., 2016).
,Nonstress test (NST) for antepartum evaluation of fetal well being performed during third
trimester. noninvasive test that monitors the fhr to fetal movement. a doppler transducer(used to
monitor the fhr) and a tocotransducer(used to monitor uterine contractions) are attached
externally to a client's abdomen to obtain tracing strips. client pushes a button when she feels the
fetus move.
Findings in the first stage of labor considered to last from the onset of regular uterine
contractions to full dilation of the cervix. Commonly the onset of labor is difficult to establish
because the woman may be admitted to the labor unit just before birth and the beginning of labor
may be only an estimate. The first stage is much longer than the second and third combined.
However, great variability is the rule, the first stage of labor is now divided into only two phases,
latent (early) and active (Kilpatrick & Garrison, 2017). During the latent phase, there is more
progress in effacement of the cervix and little increase in descent. During the active phase, there
is more rapid dilation of the cervix and increased rate of descent of the presenting part.
Reactive NST two accelerations in a 20 min period. 15bpm above baseline lasting for 15
seconds or longer
Non reactive NST NO fetal heart rate accelerations of accelerations less than 15 beats/min
or lasting less than 15 seconds throughout any fetal movement during the testing period;
, if the test does not meet reactive criteria listed above after 40 min the test is considered non-
reactive
fetal physiological adaptation to labor FHR-temporary accelerations and slight early
decelerations of the FHR can be expected in response to spontaneous fetal movement, vaginal
examination, fundal pressure, uterine contractions, abdominal palpation, and fetal head
compression. Stresses to the uterofetoplacental unit result in characteristic FHR patterns (see
Chapter 15 for further discussion).
Real time Ultrasound look for 4 things
1. fetal breathing movements (chest moves in and out) at least 1 episode that lasts 30 seconds in
a 30 min period.
2. Fetal movement- atleast 3 trunk or limb movements in 30 minutes.
3. Fetal tone-atleast 1 episode in 30 mins
4. amniotic fluid index AFI- looking for pockets of amniotic fluid intrauterine.
fetal physiological adaptation to labor Fetal Circulation- Fetal circulation can be affected
by many factors, including maternal position, uterine contractions, blood pressure, and umbilical
cord blood flow. Uterine contractions during labor tend to decrease circulation through the spiral
