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2360 Exam 2
| Question | Answer |
|---|---|
| Define oxygenation as a nursing concept. | Supplying cells with O₂ via ventilation, respiration, and perfusion. Nurses must detect alterations early to prevent complications. |
| Primary function of the lungs? Major structures? | Gas exchange. Upper airway (nose, pharynx, larynx); lower airway (trachea, bronchi, bronchioles, alveoli); lungs/pleura;diaphragm/intercostals. |
| Classic influenza cues you’re screening for? | Sudden onset Fever, Aches, Cough, Tired (fatigue). Droplet transmission; immunization prevents. |
| Oseltamivir key timing/teaching points. | Start within 48 hrs of symptoms; avoid within 48 hrs of vaccine and for 2 weeks after; can cause N/V/D—take with food. Active against A & B. |
| COVID-19 typical findings & basic diagnostics. | Fever, nonproductive cough, sore throat, anosmia; Dx with PCR (and CXR as indicated); vaccinate; symptomatic care. |
| Remdesivir pearls. | : Inhibits viral replication; bradycardia possible; vesicant, infuse 30–130 min; monitor for pulmonary improvement. Prevention > treatment. |
| Tocilizumab pearls. | : Lowers inflammatory response; neutropenia, SJS risk; infuse over 60 min alone (never push/bolus); aim for ↓ inflammation/↑ pulmonary function; monitor abd pain. |
| Paxlovid (nirmatrelvir/ritonavir) basics. | Inhibits viral replication; ≥12 years and >40 kg; renal dose-reduce; do not crush/chew; don’t double doses. |
| Unit learning emphasis for Oxygenation. | Apply A&P to assessment findings; differentiate independent vs collaborative interventions; prioritize care; create individualized goals; evaluate progress. |
| Bipolar I vs Bipolar II—core difference. | Bipolar I = at least one manic episode causing marked impairment/hospitalization. Bipolar II = hypomania + major depression, less dramatic elevation; judgment largely intact in hypomania. |
| Rapid cycling follow-up: A student notes “four mood episodes this year—two depressions, two hypomanias | Clarify/teach? That pattern suggests rapid cycling; assess med adherence, substance use, social stressors, and plan relapse prevention. |
| Mania safety first: A patient with Bipolar I is pacing, irritable, sleeping 2 h/night, and refusing meals | Priority nursing interventions? Safety + physiological needs: low-stim environment, hydration and high-calorie finger foods, promote rest, assess for aggression/SA risk; then meds/limits as ordered. |
| Flu window: A 24-year-old with sudden fever/aches/cough x 36 hrs asks about Tamiflu. They had a flu shot yesterday. | Best action? Do not start oseltamivir yet because it shouldn’t be taken within 48 hrs of vaccine; treat symptoms and reassess timing tomorrow. (Rationale: timing around vaccine matters; drug works best ≤48 hr after symptom onset as well.) |
| COVID therapy line: A 58-year-old COVID+ on room air is ordered remdesivir. The IV pump suggests a 20-min infusion | Your response? Change rate to 30–130 min and confirm central/peripheral suitability because remdesivir is a vesicant; monitor for bradycardia. |
| Inflammation control: A hypoxic COVID patient on steroids is now ordered tocilizumab. Pharmacy asks if it can piggyback with Zosyn to “save a line.” | Best reply? No—infuse tocilizumab alone over 60 minutes; never IV push/bolus; monitor ANC/skin for SJS signs and lung status. |
| Renal dosing check: The provider orders Paxlovid for a 70-kg 14-year-old with COVID and CKD (reduced GFR). | Priority nursing action? Verify reduced renal dose and teach no crushing/chewing, no double doses if one is missed. |
| Oxygenation goals: RSV bronchiolitis child shows ↑ WOB and O₂ sat 90–91% on room air. | First priorities? Escalate O₂ per protocol, position for ventilation, suction PRN, hydrate; set individualized outcomes (e.g., SpO₂ ≥ 94%, ↓ WOB) and evaluate response. |
| Flu vs COVID triage: Two ED walk-ins—(A) sudden fever/aches/cough (12 hrs), (B) sore throat/anosmia x 4 days. | Who gets antivirals discussion now? Patient A (within oseltamivir window). Patient B focuses on testing and symptomatic care (consider COVID testing). |
| What are the three primary determinants of hemodynamics? | Cardiac Output (CO): Volume of blood pumped per minute (CO = HR × SV) Preload: Volume of blood returning to the heart (end-diastolic volume) Systemic Vascular Resistance (SVR): Resistance blood meets in systemic circulation |
| How does an increase in preload affect cardiac output? | ↑ Preload → ↑ Stroke Volume → ↑ Cardiac Output (to a point; excessive preload can cause heart failure). |
| How does systemic vascular resistance (SVR) influence blood pressure? | ↑ SVR → ↑ Afterload → ↑ Blood Pressure ↓ SVR → ↓ Afterload → ↓ Blood Pressure |
| What are the major adrenergic receptor types and their main effects? | α₁: Vasoconstriction → ↑ BP, pupil dilation α₂: Inhibits norepinephrine release → ↓ sympathetic outflow β₁: ↑ HR, ↑ contractility, ↑ renin release → ↑ CO β₂: Bronchodilation, vasodilation (skeletal muscle), uterine relaxation |
| Which tissues/organs are predominantly affected by β₁ activation? | Heart (β₁): ↑ HR (chronotropy), ↑ contractility (inotropy), ↑ conduction (dromotropy) → ↑ cardiac output → Symptoms: Palpitations, tachycardia, hypertension |
| What happens when β₂ receptors are activated? | Lungs: Bronchodilation → easier breathing Vessels (skeletal muscle): Vasodilation → ↓ SVR Uterus: Relaxation → prevents preterm labor |
| What is the prototype adrenergic (sympathomimetic) drug? | Epinephrine (Adrenalin) |
| What are the actions and uses of epinephrine? | Action: Nonselective agonist (α₁, β₁, β₂) → ↑ BP, ↑ HR, bronchodilation Use: Anaphylaxis, cardiac arrest, severe asthma, shock |
| Contraindications and adverse effects of epinephrine? | Contraindications: Hypertension, tachyarrhythmias, narrow-angle glaucoma Adverse Effects: Tachycardia, anxiety, tremor, hypertension, dysrhythmias |
| Nursing implications for adrenergic drugs (e.g., epinephrine)? | Monitor vitals, ECG, and urine output Assess IV site for extravasation Use lowest effective dose Educate about angina, tremors, anxiety For anaphylaxis, give IM in thigh and repeat if needed |
| What are the therapeutic effects of vasopressors? | ↑ BP and perfusion ↑ Cardiac output (depending on receptor targets) Maintain vital organ perfusion during shock |
| Adverse effects of vasopressors? | Hypertension Tachycardia or bradycardia Arrhythmias Peripheral ischemia (d/t vasoconstriction) Tissue necrosis if extravasation occurs |
| Nursing implications for vasopressor therapy? | Continuous cardiac & BP monitoring Use central line when possible Monitor extremities for perfusion Titrate dose per BP/CO goals Avoid abrupt discontinuation |
| Key nursing assessments for patients in shock? | Airway, Breathing, Circulation (ABCs) Level of consciousness Vitals (MAP > 65 mmHg) Urine output (> 30 mL/hr = adequate perfusion) |
| Nursing diagnoses in shock? | Ineffective tissue perfusion Decreased cardiac output Risk for impaired skin integrity Anxiety/fear related to condition |
| Evaluation of drug therapy for shock/hypotension? | BP and HR return to baseline Adequate urine output Warm, pink skin (improved perfusion) Mental status improved |
| Patient education priorities? | Avoid OTC/herbal meds without provider approval Maintain prenatal vitamins (especially folic acid) Report any drug exposure early in pregnancy Emphasize nonpharmacologic measures first when safe |
| Nursing diagnoses related to pregnancy pharmacology? | Knowledge deficit (drug effects during pregnancy/lactation) Risk for fetal injury Ineffective health maintenance |
| What is the prototype drug used to induce ovulation? | Clomiphene citrate (Clomid) — a selective estrogen receptor modulator (SERM) that stimulates ovulation by increasing FSH and LH secretion. |
| What pregnancy-associated changes affect drug pharmacokinetics? | ↑ Blood volume and cardiac output → diluted plasma drug levels. ↑ Renal blood flow → ↑ drug excretion. ↓ GI motility → altered absorption. ↑ Body fat → ↑ volume of distribution for lipid-soluble drugs. ↓ Albumin → ↑ free drug fraction. |
| Examples of herbs to avoid in pregnancy? | Black cohosh: May stimulate uterus. Blue cohosh: Toxic to fetus. Dong quai: Uterine stimulant. Ginkgo/bilberry/garlic: ↑ bleeding risk. Kava, valerian: CNS depressants. |
| How are common pregnancy symptoms managed pharmacologically? | Nausea/vomiting: Vitamin B6, doxylamine, ginger. Heartburn: Antacids, sucralfate. Constipation: Bulk laxatives, docusate. Pain: Acetaminophen preferred. Infections: Use pregnancy-safe antibiotics (e.g., penicillins, cephalosporins). |
| Oxytocin adverse effects and nursing implications? | Adverse: Uterine hyperstimulation, fetal distress, water intoxication, uterine rupture. Nursing: Monitor FHR, uterine tone, contractions, I&O, and BP closely. |
| What are common drug classes used during labor/delivery? | Oxytocics: Stimulate contractions. Analgesics: e.g., opioids (butorphanol, fentanyl). Regional anesthetics: e.g., epidural (bupivacaine). Corticosteroids: Betamethasone to mature fetal lungs in preterm labor. |
| Nursing diagnoses related to pregnancy pharmacology? | Knowledge deficit (drug effects during pregnancy/lactation) Risk for fetal injury Ineffective health maintenance |
| Phentermine — action? | Centrally acts in the hypothalamus to suppress appetite by increasing release of norepinephrine and dopamine → reduces hunger sensation. |
| Phentermine — therapeutic use? | Short-term management of obesity (with diet, exercise, behavioral modification); typically for patients with BMI ≥30 or ≥27 with comorbidities (e.g., diabetes, hypertension). |
| Phentermine — adverse effects? | CNS stimulation: insomnia, restlessness, dizziness Cardiovascular: hypertension, tachycardia, palpitations Dry mouth, constipation, euphoria, dependence potential |
| Phentermine — contraindications? | Cardiovascular disease (HTN, arrhythmias) Hyperthyroidism, glaucoma History of drug abuse Pregnancy/lactation Use with MAO inhibitors |
| Phentermine — nursing implications? | Monitor BP, HR, weight, and mood changes Take early in day to prevent insomnia Avoid alcohol, caffeine, other stimulants Use short-term only (≤12 weeks) Teach about balanced diet and exercise |
| Prototype lipase inhibitor | Orlistat (Xenical, Alli) |
| Orlistat — action? | Inhibits pancreatic and gastric lipases, preventing the breakdown and absorption of about 30% of dietary fats → fats excreted in feces. |
| Orlistat — adverse effects? | GI: oily spotting, flatulence with discharge, fecal urgency, steatorrhea, diarrhea Fat-soluble vitamin deficiency (A, D, E, K) Rare liver injury |
| Orlistat — contraindications? | Chronic malabsorption syndrome Cholestasis Pregnancy Caution with cyclosporine or levothyroxine (separate by ≥4 hrs) |
| Orlistat — nursing implications? | Give with meals containing fat or up to 1 hr after Take multivitamin 2 hrs before or after dose Monitor weight, liver function, bowel patterns Teach to follow low-fat diet to reduce GI side effects |
| Prototype GLP-1 receptor agonist for obesity? | Liraglutide (Saxenda, Victoza) |
| Liraglutide — adverse effects? | Nausea, vomiting, diarrhea, constipation Headache, dizziness Pancreatitis (rare but serious) Hypoglycemia (especially with other antidiabetics) Gallbladder disease Injection-site reactions |
| Nursing assessment for overweight/obesity? | BMI, waist circumference, vital signs Current medications and health history (CVD, diabetes) Diet, activity level, and emotional factors Motivation and readiness to change |
| Nursing diagnoses for patients with obesity? | Imbalanced nutrition: more than body requirements Risk for low self-esteem Sedentary lifestyle Knowledge deficit (weight loss and medication use) |
| Nursing interventions for pharmacologic obesity therapy? | Reinforce lifestyle modification as first-line therapy Monitor weight loss trends and side effects Evaluate for vitamin deficiencies (esp. with orlistat) Teach proper administration and adverse symptom reporting |
| A 29-year-old with BMI 33 and irregular menses wants pregnancy. What’s your first-line counseling + test focus? | : Weight reduction + timed intercourse education; evaluate for ovulatory disorder (e.g., prolactin/TSH, mid-luteal progesterone). Consider clomiphene or letrozole if anovulatory. |
| A 36-year-old couple, 8 months trying. When is work-up indicated? | For ≥35 years, start evaluation after 6 months; include semen analysis and ovulation assessment; discuss ART options (IUI/IVF/ICSI) when indicated. |
| Teaching point to reduce modifiable infertility risks? | Stop smoking, limit alcohol, optimize weight, manage diabetes, avoid gonadotoxic meds where possible. |
| : 8 wks, cramping + bleeding, cervix closed. Likely dx and immediate tests? | : Threatened abortion; quantify β-hCG, pelvic US, Rh status; RhIg if Rh– with bleeding. |
| 7 wks, unilateral pain + spotting, hCG not doubling, empty uterus on US. Next step? | : Ectopic pregnancy—if stable and criteria met, methotrexate; if unstable/contraindicated, laparoscopic surgery |
| Marked N/V, very high hCG, “snowstorm” US, vaginal bleeding. Priority education? | GTD (molar)—evacuation + hCG surveillance and reliable contraception during follow-up. |
| Painless 2nd-trimester dilation with prior losses. Intervention? | Cervical cerclage with pre/post-procedure teaching. |
| 30 wks, painless bright-red bleeding. What must you avoid and what to do? | Suspect placenta previa—NO digital exam; stabilize, fetal monitoring, ultrasound, pelvic rest. |
| 36 wks, painful bleeding, firm tender uterus, non-reassuring FHR. Priority? | Placental abruption—ABC, IV access, labs, continuous EFM; prepare for urgent birth. |
| Placental abruption—ABC, IV access, labs, continuous EFM; prepare for urgent birth. | Severe preeclampsia/HELLP: admit, seizure precautions, IV magnesium (monitor DTR/RR; calcium gluconate at bedside), control BP (labetalol/hydralazine), plan delivery when stabilized. |
| On Mg infusion, RR 10/min, absent DTRs. Action? | Stop Mg, notify provider, give calcium gluconate, airway/SpO₂ support. |
| Seizure in a preeclamptic pt. First three actions? | Airway/position, MgSO₄ bolus, control BP; then plan delivery. |
| Polyhydramnios at 32 wks (GDM). Two key risks to anticipate intrapartum? | Cord prolapse and malpresentation; prepare controlled AROM, continuous EFM |
| Oligohydramnios intrapartum with recurrent variables. Nursing action? | Amnioinfusion per protocol; reposition; O₂; stop oxytocin if running. |
| Infertility Risk factors | Ovulatory (PCOS, thyroid, hyperprolactinemia, low/high BMI, intense exercise, stress) • Tubal/uterine (PID/STD hx, endometriosis, fibroids/adhesions, anomalies) • Male (abnormal semen analysis, varicocele, tobacco/alcohol/drugs, heat, anabolic steroids) |
| infertility Treatment Options | Anovulation: weight optimization; treat thyroid/prolactin; ovulation induction (letrozole or clomiphene) • PCOS: lifestyle + consider metformin + letrozole first■line for ovulation • Tubal factor: surgical correction vs IVF; endometriosis: laparoscopy ± |
| infertility Nurse considerations | Preconception counseling: folic acid, vaccines, STI screen, optimize chronic diseases • Teach timed intercourse/ovulation tracking; med side effects & monitoring (watch OHSS) • Psychosocial support, cultural sensitivity, cost/access resources, grief sup |
| Factors That Make Pregnancy High■Risk | Maternal: extremes of age, low/high BMI, low SES, IPV, substance use; chronic disease (HTN, diabetes, cardiac, renal, autoimmune); prior PTB or multiple C■sections; thrombophilia • Pregnancy related: multiples, placenta previa/accreta spectrum, oligo/po |
| Causes of Bleeding — Early vs Late | Threatened/inevitable/incomplete/complete abortion • Ectopic pregnancy • Molar pregnancy (GTD) • Cervical causes (polyps, cervicitis) |
| Causes of Bleeding Late | Placenta previa (painless, bright red) • Placental abruption (painful, rigid uterus) • Vasa previa (fetal blood after ROM) • Uterine rupture (usually in labor) |
| ) Nursing Assessment & Management for Bleeding | Assessment • ABCs; vitals & trends; quantify bleeding; pain pattern; uterine tone/contractions; fetal status • Gestational age; Rh type; trauma/infection history; Labs: CBC, type & screen/cross, coag panel; ultrasound; hCG (1st trimester) |
| Management by scenario | Placenta previa: NO digital exams; pelvic rest; IV access; continuous EFM; plan delivery if unstable • Abruption: two large■bore IVs; type & cross; EFM; oxygen; correct hypovolemia/coagulopathy; prepare urgent birth • Ectopic: stabilize; methotrexate i |
| Management by scenario | GTD: uterine evacuation; serial hCG surveillance; reliable contraception • Give Rh(D) immune globulin if Rh■negative with bleeding |
| Plans of Care — High■Risk Pregnancy (Framework)1 | Nursing Dx: Risk for decreased fetal perfusion; Maternal injury; Anxiety; Knowledge deficit • Goals: stable maternal hemodynamics; reassuring fetal status; infection prevention; patient knows warning signs |
| Plans of Care — High■Risk Pregnancy (Framework)2 | • Interventions: condition■specific care; fetal surveillance (kick counts, NST, BPP); med adherence; escalation criteria • Evaluation: vitals/labs stable; fetal testing appropriate; patient teaches back danger signs |
| Conditions with Negative Effects During Pregnancy 1 | Hypertensive disorders (gestational HTN, preeclampsia/eclampsia, HELLP) • Diabetes (pre■gestational/GDM) • Infections (GBS, UTI/pyelo, STIs, chorioamnionitis) |
| Conditions with Negative Effects During Pregnancy 2 | Thyroid disease, anemia, autoimmune (SLE, APS) • Substance use, psychosocial risks, IPV • Hyperemesis gravidarum; placental disorders (previa/accreta, abruption); oligo/polyhydramnios |
| Dystocia — Risk Factors 1 | Power: hypotonic/hypertonic activity; uterine fatigue; excessive/insufficient oxytocin • Passenger: OP/OT malposition, asynclitism, macrosomia, anomalies |
| Dystocia — Risk Factors 2 | Passage: contracted pelvis; full bladder/bowel; soft tissue obstruction • Psyche/position: anxiety, exhaustion, supine positioning • Iatrogenic: early AROM; induction without readiness |
| Dysfunctional Labor Patterns — Major Problems 1 | Prolonged latent phase; arrest of dilation/descent • Hypertonic labor: frequent, uncoordinated, painful contractions with minimal progress |
| Dysfunctional Labor Patterns — Major Problems 2 | Hypotonic labor: weak/infrequent contractions after active phase onset • Precipitate labor: very fast labor → maternal lacerations, fetal distress |
| Plans of Care — Dysfunctional Labor 1 | Hypertonic: therapeutic rest (analgesia/sedation), hydration, positioning, reduce anxiety; avoid unnecessary oxytocin • Hypotonic: rule out CPD/malposition; empty bladder; amniotomy if appropriate; start/adjust oxytocin per protocol; peanut ball/positi |
| Plans of Care — Dysfunctional Labor 2 | OP malposition: hands■knees, lunges, side■lying with peanut ball, counter■pressure; anticipate longer second stage • All: document progress; monitor for infection (prolonged ROM); fetal tolerance; analgesia/anesthesia support |
| ) Plan of Care — Preterm Labor (PTL) 1 | • Assess/triage: contractions + cervical change (20–36■⁄■ wks); fetal fibronectin; cervical length by TVUS • Med bundle: betamethasone 24–34 wks (consider up to 36■⁄■ if risk); short■term tocolysis (nifedipine; |
| ) Plan of Care — Preterm Labor (PTL)2 | indomethacin <32 wks; terbutaline select); MgSO■ for neuroprotection if <32 wks; GBS prophylaxis if indicated • Nursing: IV access; hydration as ordered; infection screen (UTI/BV); limit vaginal exams; education on fetal movement and return precautions |
| Nursing Management — Induction/Augmentation 1 | Verify indication and gestational age; obtain Bishop score • Cervical ripening when unfavorable (dinoprostone, misoprostol, balloon) • Oxytocin: low start, careful titration; continuous EFM; watch for tachysystole (≥5 contractions/10 min) |
| Nursing Management — Induction/Augmentation 2 | • If non■reassuring FHR or tachysystole: POISON — Position change, Oxytocin off, IV bolus, assess BP/sterile exam, O■ as ordered, Notify; consider tocolysis • Pain plan; bladder care; clear documentation of dosing/response |
| Obstetric Emergencies — Do■First Actions 1 | Shoulder dystocia: McRoberts + suprapubic pressure; no fundal pressure; prepare additional maneuvers; neonatal assessment • Cord prolapse: call help; elevate presenting part with gloved hand; knee■chest/Trendelenburg; warm sterile gauze if exposed; O■; |
| Obstetric Emergencies — Do■First Actions 2 | • Uterine rupture: sudden pain, loss of station, abnormal FHR → rapid response, emergent laparotomy • Amniotic fluid embolism: hypoxia/hypotension/DIC → airway/oxygenation (likely intubation), vasopressors, blood products, treat atony, ICU |
| Obstetric Emergencies — Do■First Actions 3 | PPH: follow 4 Ts algorithm and uterotonic sequence (see Section 13)• Cord prolapse: call help; elevate presenting part with gloved hand; knee■chest/Trendelenburg; warm sterile gauze if exposed; O■; prepare for stat cesarean |
| 13) Postpartum Complications — Risks, Assessment, Prevention, Management 1 | Postpartum hemorrhage (PPH) • Risks: overdistension, prolonged/precipitate labor, chorio, MgSO■, operative birth, previa/accreta, prior PPH, anemia |
| 13) Postpartum Complications — Risks, Assessment, Prevention, Management 2 | • Assess: tone, trauma, tissue, thrombin (4 Ts); vitals; quantify blood loss; fundal tone/height • Prevent: active third stage (oxytocin); risk stratification; avoid overdistension; correct anemia |
| 13) Postpartum Complications — Risks, Assessment, Prevention, Management 3 | • Manage: fundal massage → empty bladder → IV access + oxytocin → add uterotonics (methylergonovine—avoid HTN; carboprost—avoid asthma; misoprostol); TXA; tamponade/IR/OR if refractory |
| 13) Postpartum Complications — Risks, Assessment, Prevention, Management 4 Infection • VTE • Mood 1 | Endometritis: fever, uterine tenderness, foul lochia → broad■spectrum IV antibiotics • Mastitis: continue breastfeeding, warm compresses, antibiotics; hand hygiene |
| 13) Postpartum Complications — Risks, Assessment, Prevention, Management 4 Infection • VTE • Mood 2 | VTE: risks include cesarean, immobility, obesity, thrombophilia; prevent with early ambulation, SCDs, anticoagulation per risk • Mood: screen with EPDS; differentiate blues vs depression vs psychosis; ensure safety and referral pathways |
| ) Plans of Care — Bring It All Together-) Preeclampsia with Severe Features (34 wks) 1 | • Dx: Risk for decreased maternal/fetal perfusion; Risk for injury; Anxiety • Goals: BP <160/110; no seizures; reassuring NST/BPP; patient knows warning signs • Interventions: seizure precautions; MgSO■ (monitor DTR/RR/urine; calcium gluconate bedside); |
| ) Plans of Care — Bring It All Together-) Preeclampsia with Severe Features (34 wks) 2 | antihypertensives; I&O;/daily weights; labs (CBC/platelets, LFTs, Cr); fetal surveillance; plan delivery when stabilized; education • Evaluation: stable BP; no neuro symptoms; reassuring fetal testing; labs trending appropriately |
| ) Plans of Care — Bring It All Together-) Dysfunctional Labor — Hypotonic Pattern 1 | Dx: Ineffective uterine perfusion; Risk for infection; Acute pain • Goals: adequate contraction pattern; progressive dilation/descent; no infection/fetal distress |
| ) Plans of Care — Bring It All Together-) Dysfunctional Labor — Hypotonic Pattern 2 | • Interventions: empty bladder; position/peanut ball; consider AROM; oxytocin per protocol; limit exams; monitor temp/FHR; analgesia support • Evaluation: regular contractions; cervical change ≥1–2 cm in 2–4 h; stable maternal/fetal status |
| ) Plans of Care — Bring It All Together Preterm Labor (31 wks)1 | Dx: Risk for preterm birth; Anxiety; Knowledge deficit • Goals: delay birth 48 h for steroids; stable maternal/fetal status; patient teaches back plan.Interventions: IV access; labs/urine; betamethasone; tocolytic; MgSO■ |
| ) Plans of Care — Bring It All Together Preterm Labor (31 wks)2 | (<32 wks); GBS prophylaxis PRN; pelvic rest; limit exams; education on fetal movement and danger signs • Evaluation: no cervical progression; reassuring FHR; meds given; patient demonstrates understanding |
| Plans of Care — Bring It All Together Immediate PPH 1 | • Dx: Risk for deficient fluid volume; Risk for shock; Anxiety • Goals: firm midline fundus; stable vitals; bleeding within expected range |
| Plans of Care — Bring It All Together Immediate PPH 2 | Interventions: massage → empty bladder → oxytocin → additional uterotonics per contraindications; TXA; quantify blood loss; warm fluids/blood products per protocol; reassess q5–15 min • Evaluation: firm fundus; reduced bleeding; stable hemodynamics |
| A Category III tracing with recurrent late decelerations should trigger which sequence first? | POISON: lateral position, stop oxytocin, IV bolus, assess, O₂, notify |
| Tachysystole is defined as: | ≥5 contractions/10 min |
| Painless, bright‑red bleeding at 32 weeks suggests: | Placenta previa |
| Painful bleeding with a firm, tender uterus and fetal distress suggests: | Placental abruption |
| First‑line tocolytic to buy 48 h for steroids in a stable 30‑week PTL: | Nifedipine |
| Indomethacin as a tocolytic should generally be avoided after: | 32 weeks |
| Magnesium sulfate toxicity is suspected when: | RR 10, absent DTRs, oliguria |
| The antidote for magnesium toxicity is: | Calcium gluconate |
| Most common cause of primary PPH is: | Uterine atony |
| After massage and emptying bladder, persistent atony is treated next with: | Oxytocin infusion |
| Methylergonovine is contraindicated in: | Hypertension |
| Carboprost should be avoided in: | Asthma |
| Rh‑negative patient with first‑trimester bleeding should receive: | Rh(D) immune globulin |
| Best immediate action for shoulder dystocia: | McRoberts and suprapubic pressure |
| Cord prolapse priority: | Elevate presenting part |
| For preterm fetal neuroprotection (<32 wks), give: | Magnesium sulfate |
| A Category I strip includes: | Baseline 140 with moderate variability and no recurrent decels |
| Variable decelerations are most consistent with: | Cord compression |
| Biggest risk combination for placenta accreta spectrum: | Placenta previa with prior cesarean |
| Misoprostol for ripening is generally avoided in patients with: | Prior cesarean/uterine surgery |
| Define AGA, SGA, LGA. | AGA = 10th–90th %tile; SGA <10th %tile; LGA >90th %tile for GA. |
| : Define LBW, VLBW, ELBW. | LBW <2500 g; VLBW <1500 g; ELBW <1000 g. |
| Q: What is fetal growth restriction (FGR)? | Birthweight <3rd %tile or multiple measures <10th %tile and/or prenatal diagnosis; can be symmetric or asymmetric. |
| Q: Common SGA/FGR neonatal problems? | Perinatal asphyxia, thermoregulation difficulty, hypoglycemia, polycythemia, meconium aspiration |
| Q: LGA/macrosomia—top maternal risk factors? | Diabetes, maternal obesity/excess weight gain, maternal LGA history. |
| Q: LGA neonatal risks you must monitor for? | Birth injury, asphyxia/resp distress, hypoglycemia, polycythemia, hyperbilirubinemia. |
| Q: First-hours glucose plan for at-risk LGA/SGA infants? | BG within 30 min of birth and hourly; early on-demand feeds; dextrose gel PRN. |
| Q: Preterm systems most at risk (quick list)? | Thermoregulation, infection/immunity, neuro (PVH/IVH), nutrition/glucose, hematologic, perfusion/PDA, ROP, RDS/BPD, NEC. |
| Preterm oxygenation cues to act on? | Grunting, tachypnea, apnea, retractions, nasal flaring, central cyanosis; HR 120–140 (quiet), RR 30–60 norms. |
| Safe SpO₂ range to reduce ROP risk? | Avoid extremes; keep roughly 88–95% as ordered; prevent large swings |
| Thermoregulation: target axillary temp & cold stress cues? | 97.7–99.5°F; cold stress → RD, central cyanosis, hypoglycemia, lethargy, weak cry, apnea, acidosis. |
| Preterm nutrition priorities in first 24 h? | Early oral or gavage feeds as tolerated (IV glucose if not), frequent BGs, maintain temp, monitor weight, non-nutritive sucking |
| Late-onset sepsis (≥7 days) cues in newborn? | Apnea, RD, hypotonia, lethargy, poor feeding, temp instability, hypotension, tachycardia. |
| Infection prevention pillars for preterm? | Skin-to-skin, reduce skin breakdown/tape, strict line care & precautions, limit exposures/jewelry. |
| Neonatal pain assessment tools (examples)? | FLACC, PAC, CRIES, NIPS; correlate with VS/cry/movement. |
| Non-pharm neonatal pain interventions? | Swaddling, non-nutritive sucking, breastfeeding, kangaroo care, oral sucrose, massage, rocking. |
| Family coping—two nursing actions that improve self-efficacy? | Frequent updates/involvement in care + guided participation (positioning, skin-to-skin). |
| Discharge criteria for preterm infant (high-level)? | Physiologic stability, family ready for care, community supports arranged, outpatient provider secured. |
| Differentiate caput succedaneum vs cephalohematoma. | Caput: soft tissue edema, crosses sutures, present at birth, resolves in days. Cephalohematoma: subperiosteal blood, does not cross sutures, appears hours after birth, resolves in 2–3 weeks. |
| Physiologic vs pathologic jaundice—timing red flag? | Pathologic: within first 24 h or TSB rise >5 mg/dL/day or TSB >95th %tile. |
| Lab to confirm hemolytic disease in jaundiced neonate? | Direct Coombs (positive = sensitized RBCs). |
| Phototherapy—3 nursing priorities. | Eye protection (overhead lights), frequent feeds with strict I/O and weight, turn infant q2h; expect frequent loose green stools. |
| When is exchange transfusion considered? | Failure of phototherapy or confirmed hemolytic disease with dangerous TSB. |
| Infant of diabetic mother (IDM)—common early issue & action? | Hypoglycemia → early frequent feeds, thermoregulation, close BG monitoring. |
| : Substance exposure—two syndromes to know? | FASD (facial features, growth, CNS dysfunction); NOWS (opioid withdrawal: CNS, respiratory, GI symptoms). |
| : First-line management for NOWS? | Non-pharmacologic (swaddle, quiet room, on-demand feeds, caregiver presence); meds (morphine/methadone/buprenorphine) if needed. |
| : RDS classic findings & CXR description? | Tachypnea, retractions, nasal flaring, grunting, cyanosis; CXR “ground-glass” with under-expansion. |
| RDS management—what are you anticipating? | Supportive care: exogenous surfactant, CPAP/PEEP, mechanical ventilation PRN in NICU. |
| Meconium Aspiration—key pathophys triad? | Airway obstruction, surfactant dysfunction, hypoxia/pneumonitis. |
| Meconium Aspiration—assessment clues? | Meconium-stained fluid, RD after birth, barrel-shaped chest, coarse crackles; CXR patchy infiltrates, hyperaeration. |
| Current practice at delivery for meconium-stained fluid? | Do not delay birth for routine suctioning; neonatal team evaluates/ treats after birth. |
| NEC—two major risk factors to recognize? | Prematurity and gut immaturity; others: formula feeding, intestinal ischemia. |
| Polycythemia in FGR—hallmark lab and signs? | Hct >65% / Hgb >20; ruddy skin, abdominal distension, vomiting, poor feeding. |
| Teaching point for parents of preterm infant on oxygen targeting? | Keep O₂ within prescribed range; avoid low (<88) or high (>95) saturations to reduce ROP risk. |
| Preterm thermoregulation teaching for home transition? | Skin-to-skin, cap on head, avoid over-/under-heating, monitor feeding/wet diapers closely. |
Created by:
Anmag002