Select all that apply. Which assessment findings indicate to the nurse that the client is beginning the second stage of labor? She is extremely talkative and energetic and he has not observed her sleeping for more than an hour or two at a time. What is the priority nursing action for this client? Functional disorders of the pelvic floor such as pelvic organ prolapse and defecatory dysfunction represent a common health problem, especially in women.It is estimated that more than 15% of multiparous women (, 1) are affected by some sort of pelvic disorder and that 10%–20% of patients seek medical care in … "My contractions will increase in duration and intensity.". 1. Following examination, it is determined that her membranes are still intact and she is at a -2 station. Fundal massage is indicated; what should you do first? On the third day postpartum, which temperature is internationally defined as a postpartal infection? b)Place one hand over the symphysis pubis. The nurse reviews the client's prenatal record and discovers that she has had a positive group B streptococcus (GBS) laboratory report during her prenatal course. The nurse is creating a plan of care for a client experiencing dystocia and includes several nursing interventions in the plan. The nurse is required to administer the prescribed methylergonovine maleate intramuscularly to the client. She is currently 5 cm dilated. Risk for disuse syndrome is a nursing diagnosis associated with … A postpartal woman with a thrombophlebitis tells you that her leg is very painful. 1. About 10 days following birth, a new mother visits her physician with localized symptoms of redness, swelling, warmth, and a hard inflamed vessel in one leg. Following the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. Changing the client's position frequently 4. Turn the client onto her side and give oxygen by face mask at 8 to 10 L/min. The nurse prioritizes the plan and selects which nursing intervention as the highest priority? Netter's atlas of human anatomy [5th Edition] Download. Perform a vaginal examination every shift. dronabinol, nabilone, or nabiximols) may be useful in alleviating a wide variety of single or co-occurring symptoms often encountered in the palliative care setting. The nurse should monitor the client closely for the risk of uterine rupture if which occurred? Which maternal observation could indicate uterine inversion and require immediate intervention? 3. A labor room nurse is performing an assessment on a client in labor and notes that the fetal heart rate (FHR) is 158 beats/minute and regular. Which of the following medications would be contraindicated in her case? The health care provider prepares to perform an amniotomy. Your patient delivered six hours ago. A nurse using the 5T's tool will recognize which of the following as being a potential cause of postpartum hemorrhage? What is the most appropriate nursing action? What is one of them? The nurse collects a urine specimen for culture from a postpartum woman with a suspected urinary tract infection. Which of the following causes of the hemorrhage is most likely in this client? Which of the following assessments should you make prior to administering the medication? The nurse explains the purpose of effleurage to a client in early labor. Her uterus is still enlarged and soft, and lochial discharge is still present. Which situation should concern the nurse treating a postpartum client within a few days of delivery? When reviewing the client's history, the nurse notes she has a history of asthma. The nurse is monitoring a client in labor. … It might seem impossible to you that all custom-written essays, research papers, speeches, book reviews, and other custom task completed by our writers are both of high quality and cheap. Pale straw in color, with flecks of vernix. d)Blood loss in excess of 500 ml, occurring 24 hours to 6 weeks after delivery. A pregnant 39-week-gestation client arrives at the labor and delivery unit in active labor. Ce document a été rédigé par Emma Kahn et Vincent Reliquet à la demande de la Coordination Santé Libre dans le but d'éclairer l'opinion du groupe quant à la pertinence d'une vaccination anti-Covid dans les conditions actuelles, à l'aune de ce qui peut être décrit, connu et prévisible en Février… Call the health care provider (HCP) to obtain a prescription for intravenous antibiotic prophylaxis (IAP). A prenatal client with severe abdominal pain is admitted to the maternity unit. Continuous electronic fetal monitoring. The nurse has been working with a laboring client and notes that she has been pushing effectively for 1 hour. The nurse is reviewing true and false labor signs with a multiparous client. The nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse in a labor room is assisting with the vaginal delivery of a newborn infant. Explain to the client why a cesarean delivery is necessary. The nurse is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. The nurse should document these observations as signs of which condition? b)Interference with the maternal-newborn attachment process. d)Perform handwashing before breastfeeding. On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse should perform which procedure to assess the brachioradialis reflex? Este banco de palabras (español-inglés) de terminología del Seguro Social contiene palabras y expresiones comunes así como terminología técnica del Seguro Social. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. The nurse is caring for a client in labor who is receiving oxytocin by intravenous infusion to stimulate uterine contractions. The nurse assists the health care provider to perform an amniotomy on a client in labor. A 27-year-old G1, P1 woman arrives in the emergency department accompanied by her husband and new infant, crying, confused, and with possible hallucinations. Which of the following behaviors exhibited by a 4-hour postpartum woman requires further interventions by the nurse? The maternity nurse is caring for a client with abruptio placentae and is monitoring her for disseminated intravascular coagulation (DIC). After the spontaneous rupture of a laboring woman's membranes, the fetal heart rate drops to 85 beats/minute. The labor room nurse is performing the admission assessment and should suspect a diagnosis of placenta previa if which finding is noted? Which response is most appropriate initially? 4. (Select all that apply.). Her incision is red, warm, and very sensitive to touch, and she remains febrile despite antibiotic therapy. The nurse is reviewing the record of a client in the labor room and notes that the health care provider has documented that the fetal presenting part is at the -1 station. The nurse is caring for a client who is experiencing a precipitous labor and is waiting for the health care provider to arrive. Which statement, if made by the laboring client, most likely indicates that the client is in the second stage of labor? b)Her uterus is at the level of the umbilicus. A Hispanic woman who gave birth several hours ago is experiencing postpartum hemorrhage. Which of the following instructions would the nurse include in the teaching plan for a postpartum woman with mastitis? Fetal distress is occurring with a woman in labor. To ensure the best experience, please update your browser. When monitoring a postpartum client 2 hours after delivery, the nurse notices heavy bleeding with large clots. Evolution des crimes et délits enregistrés en France entre 2012 et 2019, statistiques détaillées au niveau national, départemental et jusqu'au service de police ou gendarmerie Associations : Subventions par mot dans les noms des associations At this point in the labor process, at least how often should the nurse assess and document the fetal heart rate? The client is experiencing uterine contractions every 2 minutes and she cries out in pain with each contraction. Which is the initial nursing action? Which assessment finding should the nurse expect to note if this condition is present? The client's contractions are every 5 minutes, with a duration of 40 seconds and of moderate intensity. Which of the following would the nurse be least likely to include? a)Symptoms include fever, chills, malaise, and localized breast tenderness. The nurse is administering magnesium sulfate to a client for preeclampsia at 34 weeks' gestation. Which assessment findings should the nurse expect to note? Which of the following is the most common cause of postpartum hemorrhage? What would be your best response? While assessing a postpartum woman, the nurse palpates a contracted uterus. Which action is most appropriate? What is the nurse's best interpretation of this client's behavior? Which complication is most likely responsible for a late postpartum hemorrhage? She has a history of postpartum hemorrhage with her previous births. A client arrives at a birthing center in active labor. Select all that apply. Select all that apply. In preparing for a class in teaching women and their partners, which of the following would be the most important to emphasize as helping to prevent postpartum complications? (Select all that apply.). The nurse should report which abnormal findings to the health care provider (HCP)? The nurse is performing an assessment of a client who is scheduled for a cesarean delivery at 39 weeks of gestation. When planning care for a postpartum patient, the nurse is aware the most common site for postpartum infection is which of the following? Which assessment on the third postpartal day would make you evaluate a woman as having uterine subinvolution? The nurse plans care, knowing that this identifies which category of decelerations? What is the priority nursing action? Select all that apply. A pregnant 39-week-gestation gravida 1, para 0 client arrives on the labor and delivery unit with signs and symptoms of active labor. Periodic, early decelerations that indicate fetal head compression. The nurse is caring for a client during the second stage of labor. The nurse is caring for a client in the active stage of labor. What is the initial nursing action? Which assessment finding indicates the need to contact the health care provider (HCP)? Which is the priority nursing intervention? The nurse is providing emergency measures to a client in labor who has been diagnosed with a prolapsed cord. c)Avoid over-the-counter (OTC) salicylates. The nurse has collected the following data on a client in labor. Notify the health care provider (HCP). The nurse determines that the client understands the signs of true labor if she makes which statement? The nurse is assessing the breast of a woman who is 1 month postpartum. a)A woman with diabetes who has delivered vaginally and develops tachycardia and a fever of 101.7 degrees on the third postpartum day. The nurse is preparing to care for a client in labor. 1. Select all that apply. b)"Postpartum depression develops gradually, appearing within the first 6 weeks.". On assessment, the nurse notes a slowing of the fetal heart rate and a loss of variability. The woman is complaining of a painful area on one breast with a red area. Shortly after receiving epidural anesthesia, a laboring woman's blood pressure drops to 95/43 mm Hg. The nurse is caring for a client who is receiving oxytocin for induction of labor and notes a nonreassuring fetal heart rate (FHR) pattern on the fetal monitor. A postpartum woman is diagnosed as having endometritis. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? c)Drop in estrogen and progesterone levels after birth. Introduction. The health care provider has prescribed an epidural block. a)Client's temperature remains below 100.4° F or 38° C orally. 1.Supine position with a wedge under the right hip. Which of the following nursing interventions would be appropriate to prevent thrombophlebitis? c)Ambulate the client as soon as her vital signs are stable. The nurse monitors the woman closely for which of the following adverse effects? Which of the following interventions should the nurse make in this case? In which time period would the nurse most likely expect a client who has delivered twins to experience late postpartum hemorrhage? The next day, she appears ill; fever is 102.9 degrees; WBC is 31,500 cells/mm3; blood cultures are negative. Providing comfort measures 3. On assessment, the nurse notes a slowing of the fetal heart rate and a loss of variability. During the intrapartum period, the nurse is caring for a client with sickle cell disease. A nurse is caring for a client in the postpartum period. The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount. An ultrasound is performed on a client with suspected abruptio placentae, and the results indicate that a placental abruption is present. The health care provider (HCP) has prescribed an intravenous (IV) infusion of oxytocin. Primary (immediate) postpartum hemorrhage is defined as excessive bleeding that occurs within the first 24 hours after delivery. Wrap the cord loosely in a sterile towel soaked with warm, sterile normal saline. 1. What is the most important aspect of post hospital care to teach her? One woman asks you about mastitis. The nurse is caring for a client in the transition phase of the first stage of labor. Which assessment finding should indicate to the nurse that the infusion needs to be discontinued? Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which of the following primary conditions? You tell him to bring her in right away, because you suspect Sylvia is suffering from what condition? Select all that apply. b) At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. Netter's atlas of human anatomy [5th Edition] Monitoring the mother's blood pressure. The nurse performs a vaginal assessment on a pregnant client in labor. Click on the image to indicate your answer. A 29-year-old postpartum client is receiving anticoagulant therapy for deep venous thrombophlebitis. Your first action would be to. c)"Postpartum depression develops gradually, appearing within the first 6 weeks.". Which of the following conditions would the nurse identify as necessitating the cautious administration of this drug? Select all that apply. When the infant's head crowns, what instruction should the nurse give the client? After teaching a local woman's group about postpartum affective disorders, which statement by the group indicates that the teaching was successful? The nurse is teaching a group of students about factors that place a pregnant woman at risk for infection in the postpartum period. The nurse is creating a plan of care for a pregnant client with a diagnosis of severe preeclampsia. A nurse is developing a plan of care for a client experiencing dystocia, and includes several nursing interventions in the plan. A client in labor is receiving oxytocin by intravenous infusion to stimulate uterine contractions. Which conditions are most likely associated with minimal variability? Turn the client on her side and administer oxygen by face mask at 8 to 10 L/min. b)The client feels empty since she delivered the neonate. Which maternal observation could indicate uterine inversion and require immediate intervention? Samantha delivered her fourth child after protracted and difficult labor during which oxytocin was used to augment her contractions. The nurse is caring for a client in labor and notes that minimal variability is present on a fetal heart rate (FHR) monitor strip. Comfort measures and medication fail to eliminate the pain, her pulse is rapid, and her blood pressure, hematocrit, and hemoglobin are low. The blood is a dark red. Which should be the nurse's first action? This documented finding indicates that the fetal presenting part is located at which area? Which action by the nurse should be implemented first? Which finding indicates that the rate of infusion needs to be decreased? The nurse is performing an assessment on a client diagnosed with placenta previa. Author Relationships With Industry and Other Entities…e365 Appendix 2. Which of the following is the most likely expected outcome that the nurse will identify for this patient related to this condition? An Rh-positive client vaginally delivers a 6-lb, 10-oz neonate after 17 hours of labor. The nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. Palpating the maternal radial pulse while listening to the FHR. The woman inquires as to why the nurse is waiting for a contraction to begin before she infuses the medication into the intravenous line. She complains of abdominal pain and a "bad smell" to her lochia. What is the priority nursing action? 4. When working in a free clinic for children, the nurse observes a mother with her 2 week infant. Which is the priority nursing action after this procedure? Assess the vagina and cervix with a gloved hand. The nurse ensures that the client receives adequate intravenous fluid intake and oxygen consumption to achieve which outcome? The nurse recognizes that these symptoms are associated with which condition? Which assessment findings are most likely associated with disseminated intravascular coagulation? Her fundus is firm, however, and her lochia is dark red and flowing in only moderate amounts; no pooling is evident. Document the findings and tell the mother that the pattern on the monitor indicates fetal well-being. The nurse is preparing to care for a client with hypertonic labor. Which assessment findings indicate the presence of concealed bleeding? Which of the following is least likely to be screened with this tool? a)Risk for fatigue related to chronic bleeding due to subinvolution. A woman in active labor has requested a regional anesthetic. After the client is transferred to the delivery room table, the nurse should place the client in which position? b)Dorsiflex her right foot and ask if she has pain in her calf. Methylergonovine is ordered for a woman experiencing postpartum hemorrhage. Mrs. M. and her infant are being discharged home after an unplanned cesarean delivery. Jerry, who is hypertensive and who received corticosteroids during pregnancy, delivered by cesarean and subsequently developed endometritis. Select all that apply. She calls you to her room complaining of pain "deep inside." The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. A nurse is caring for a client with a postpartum laceration. The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. 4. What is the major risk factor for a post-partum infection? The nurse is monitoring the client closely because concealed bleeding is suspected. A postpartal woman is developing a thrombophlebitis in her right leg. 1. Select all that apply. The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following actions would be most appropriate to relieve this pain? How should the nurse check for the major side effect associated with this type of regional anesthesia? Obtain equipment for a manual pelvic examination. c)Blood pressure, pulse, complaints of dizziness. The nurse in the labor room is caring for a client who is in the first stage of labor. The nurse assists in the vaginal delivery of a newborn infant. You are the nurse giving an educational presentation to the local Le Leche league chapter. What is the initial nursing action? It is discovered that a new mother has developed a puerperal infection. The nurse in the labor room is caring for a client in the active stage of the first phase of labor. The client's thought process is disoriented and she frequently indulges in obsessive concerns. c)Check for bladder distention, while encouraging the client to void. b)Absent verbalization about the birthing process. Which of the following would lead the nurse to suspect that a postpartum woman has developed metritis? • Atony of the uterus is defined as the failure of the uterus to contract adequately after the child is born. Which should be the nurse's initial action? The nurse prioritizes the plan and selects which nursing intervention as the highest priority? Monitoring fetal status 2. On the basis of these assessment findings, what is the appropriate nursing action? The nurse assists in the vaginal delivery of a newborn. The baseline fetal heart rate has been 120 to 122 beats/minute for the past hour. The nurse reviews the health care provider's prescriptions and should question which prescription? Which of the following instructions should the nurse offer the client as a caution when the client receives anticoagulation therapy? The majority of women who experience postpartal psychosis had no symptoms of mental illness before pregnancy. 4. Perineal inspection reveals a steady stream of bright-red blood trickling out of the vagina. When diagnosed with a deep vein thrombosis, the nurse knows the patient will be treated with which medication? Encourage an upright or side-lying maternal position. What is the priority nursing action? The nurse notes a local area on one breast, red and warm to touch. The client has been experiencing contractions that are short, irregular, and weak. What is the appropriate nursing action? Based on this finding, the nurse should prepare for which appropriate nursing action? The nurse is teaching a client with newly diagnosed mastitis about her condition. One of the fetuses is a breech presentation. The evidence thus far from some observational studies and clinical studies suggests that cannabis (limited evidence) and prescription cannabinoids (e.g. c)"Try applying warm compresses to your breasts to encourage the milk to be released.". Which assessment following an amniotomy should be conducted first? Your patient is showing signs and symptoms of a pulmonary embolism. Cheap paper writing service provides high-quality essays for affordable prices.
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