Compu-med Vocational Careers

Compu-med Vocational Careers

 

 

 

 

 

Blue-Print Unit exam 2

 

 

 

 

 

Exam 2 Blue Print COMPLETE

Bladder Hypotonia

Abdominal diastasis

After pains

Vaginal recovery:

· normal/abnormal findings

Cesarean recovery

· Risks, interventions, medications, education

Early maternal assessment (ALL body changes)

· Vital signs

· Body systems and adaptations/physiological changes

· BUBBLE-HE(B)

· Assessment of Lochia Flow

Phases associated with the Mothering Role

Deep Vein Thrombosis/thrombosis

· Medications/labs for meds

· Treatments

· Interventions

Postpartum Psychosocial (PPD/psychosis, blues)

· Medications/contraindications/interactions, interventions, etc

Postpartum hemorrhage

· Labs

· Medications to treat PPH

· Education

Hematomas

· signs & symptoms/ interventions, patient education,

Storing breastmilk/ breast pumping

Uterine Involution and how to document

REEDA Acronym: scoring

IPV: Economic, Isolation, emotional, threats

IPV: priority interventions for each type of abuse

Phases of IPV (honeymoon, tension, etc.)

Documenting IPV

Sexual assault treatments/ therapeutic communication

PMS vs. PMDD: signs and symptoms

PMD/PMDD patient education

Women at risk for PMS

Diseases that mimic PMS, how to rule it out

Menopause: effects/body changes/ treatment of symptoms

Fibrocystic changes

Benign breast tumor

Breast drainage

Breast self-examination

Breast screenings

Fine needle biopsy vs. core needle biopsy.

Breast cancer: cancer stage prognosis/ cancer survivorship plans/ diagnostics

 

 

REVIEW UNIT 2 EXAM

 

 

 

Bladder Hypotonia:

Occurs when your bladder muscles lose their ability to hold your urine.

 

You are not longer able to sense when your bladder is full or empty it completely, so it over fills and urine leaks out.

Is also called flaccid or hypotonic bladder.

Urinary retention can also result from bladder hypotonia after childbirth because the weight of the gravid uterus no longer limits bladder capacity.

Assess the maternal bladder (extremely important)

N.I: Kegel exercises.

 

Abdominal Diastasis:

Diastasis recti abdominal (abdominal separation) the separation between the two rectus abdominis muscles that can occur from pregnancy.

 

N.I: Nurses should teach them to maintain correct posture when performing activities such as lifting, carrying, and bathing the baby for at least 12 weeks after birth.

Performing modified sit-ups during this time is beneficial in helping to strengthen the abdominal muscles.

 

 

Afterpains:

Afterpains are intermittent uterine contractions that occur during the process of involution. Patients often describe the sensation as discomfort similar to menstrual cramps.

Also defined as belly cramps that a postpartum mother feels as her uterus shrinks back to its regular size after pregnancy.

 

Multiparas and patients with uterine overdistention (e.g., large baby, multifetal gestation, or hydramnios) are more likely to experience afterpains because of the continuous pattern of uterine relaxation and vigorous contractions.

 

Afterbirth pain is often severe for 2 to 3 days after childbirth

 

N.I: N.I for discomfort include assisting the patient into a prone position with a small pillow placed under her abdomen, initiating sitz baths (for warmth), encouraging ambulation, and administrating mild analgesics. Breastfeeding the NB.

Breastfeeding women should take pain medication approximately 30 minutes before nursing the baby to achieve maximum pain relief.

 

Vaginal Recovery:

· Normal/Abnormal findings

REEDA

Redness, Edema, Ecchymosis, Discharge, Approximation

 

Cesarean Recovery:

· Risks, Interventions, Medications, Education

 

Additional challenges faced by patients during recovery from a cesarean birth include recovery from the anesthesia, a need to cope with incisional and gas pain, and slow ambulation. Mother-infant bonding may be delayed, and patients are at an increased risk for hemorrhage, surgical wound infection, urinary tract infections (UTIs), and DVT.

 

Care of the patient after cesarean birth:

The nurse must complete the Breasts, Uterus, Bladder, Bowel, Lochia, and Episiotomy ( BUBBLE-HEB) Homan sign, Emotions, Bonding assessment.

· Recovery from anesthesia

· Abdominal Distension

· Urinary (retention/distension)

· Care of the cesarean Incision/Episiotomy

N.I: Perineal care. Clean, Front to back, Washing, Padding, Sitting, Change pad (3 to 4 hrs.) Ice Packs first 24 hrs. postpartum. Tucks, if Hemorrhoids. Sitz Baths relief pain and discomfort (24 to 48 hrs. postpartum) If bleeding occurs, notify the physician *PRIORYTY

 

Early Maternal Assessment:

Monitor for Infection/Hemorrhage

· Vital Signs: 1st 24hrs.

Temperature: 98.6 ~ 100.4 F

Pulse: 60~100 bpm Bradycardia is common

Blood Pressure: Consistent 120/80mmHg If High: Anxiety, HTN, Preeclampsia.

Respirations: 12~20 per minute

Pain: “The Fifth Vital Sign”

Medications:

Stool softener, Laxative, Hemorrhoid Cream, NSAID.

 

Body system adaptations/physiological changes:

· Hematological and Metabolic System

500mL Blood Loss if Vaginal Childbirth 1gr / 1000mL Blood Loss if C/S 2gr

It is important for the nurse to remember that, as the body’s excess fluid is excreted, the hematocrit may rise because of hemoconcentration.

Maternal plasma volume decreases even further as a result of diuresis.

Circulating levels of estrogen and progesterone decrease dramatically after delivery of the placenta; human placental lactogen, cortisol, growth hormone, and insulinase, also fall.

maternal fatigue.

Patients who received epidural or spinal anesthesia may experience headaches, especially when they assume an upright position. After spinal or epidural anesthesia, headaches may result from the leakage of cerebrospinal fluid into the extradural space.

· Neurological

Fatigue, Discomfort, OXYTOCIN causes sleepiness.

· Renal System, Fluids and Electrolytes

Urinary output 3000mL in 24 hrs. Diuresis occurs after birth.

· Respiratory System

Resp system goes back to normal non-pregnancy state. Progesterone levels drop.

The immediate decrease in intra-abdominal pressure associated with the birth of the baby allows for increased expansion of the diaphragm and relief from the dyspnea usually associated with pregnancy.

· Integumentary System

Changes related to major alterations in hormones, alterations in pigmentation, connective and cutaneous tissue, hair, nails, secretory glands, and pruritus. Most pregnancy-related skin changes disappear completely during the postpartum period, although some, such as striae gravidarum (stretch marks), fade but may remain permanently.

· Cardiovascular System

Maternal cardiac output is significantly elevated above pre-labor levels for 1 to 2 hours postpartum and remains high for 48 hours postpartum. Returns to normal within 2~4 weeks after childbirth.

· Immune System

WBC slightly increased (25.000 count) during labor and birth and remains elevated during the early postpartum period, gradually returning to normal values within 4 to 7 days after childbirth. Rubella shot (MMR if titters are not immune) RhoGAM If Mom (-) and child (+)

· Ovulation

Menstruation usually resumes within 6 to 8 weeks after childbirth in women who are not breastfeeding.

Exclusively breastfeeding moms may not ovulate or menstruate for 3 or more months.

breastfeeding is not a reliable method of contraception.

· Gastrointestinal System

Bowels more active right after birth, mom may become hungry and thirsty . Constipation, a common nursing diagnosis for the postpartum patient, is associated with abdominal discomfort and decreased hunger.

· Musculoskeletal System

Diastasis recti abdominal: separation of the abdominal muscles. N.I Maintain correct posture when lifting, carrying and bathing the baby for at least 12 weeks after birth. Perform modified sit-ups to strength abdominal muscles.

 

BUBBLE HEB

BREAST: Engorgement

UTERUS: Fundal Heigh- Uterine Placement/ Consistency (Boggy/ Firm)

BOWEL: Gas passing, Constipation, Air can engage in arm (Early Ambulation)

BLADDER: Assess Catheter/Remove Urine color and amount

LOCHIA: COCA Color, Odor, Consistency, Amount.

EPISISOTOMY: Perineum, Hemorrhoids

REEDA Redness, Edema, Ecchymosis, Discharge, Approximation.

 

Homans Sign: Calf + Pushing test

Emotions: Affect, family interactions, Baby Blues

Bonding: Gazing, Enfolding, Interaction with the Newborn.

 

 

 

 

Assessment of Lochia Flow:

 

Scant: 1 inch 2.5cm

 

Light: 4inch 10cm

 

Moderate: 6inch 15cm

 

Heavy: Per Pad Saturated within 1hr.

 

Lochia Rubra: 3-4 days postpartum Dark bright red/ Menstrual odor/ Decreasing

 

Lochia Serosa: Up to 14th day postpartum pink, old blood, decrease amount

 

Lochia Alba: Up to 6 weeks postpartum White yellow creamy/light

 

Phases associated with the Mothering Role:

 

Rubin (1975) described three distinct phases that are associated with the woman’s assuming the mothering role. She labeled these phases:

“Taking-in,” (First 2 days)

“Taking-hold,” (2nd and 3rd day) and

“Letting-go” (2-6 weeks postpartum)

 

“Taking-in,” her birth experience in the first day or two after birth.

“Taking -hold,” Mom assumes care for herself and her infant. signs of bonding

“Letting-go,” Starts to focus on issues directly with herself and her newborn

 

DVT Deep Vein Thrombosis

Common during pregnancy

S & S: Depend on size

Unilateral Leg Pain

Positive Homan’s Sign

Calf Tenderness / Warm / Inflamed

Swelling / Maybe asymptomatic 50%

Pedal Pulse at +2

Developmental of Collateral Circulation

Degree of Vessel Occlusion

 

• Medications/labs for meds

ENOXAPARIN

LABS:

– D-dimer

– Basic Chemistry test

– PT and PTT

 

Thrombophlebitis = Thrombus + Inflammation

Describe inflammation

Typically occurs in CALFS

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