Reference no: EM133341962
Questions:
1. A pregnant person with gestational diabetes (not well controlled) has a higher risk for a baby that is large for gestational age (LGA). Would you expect the baby's glucose levels to be high or low at birth, and why is this? They also can be at risk for respiratory distress and unstable temperatures. What can a nurse do to support breathing and temperature regulation?
2. At what gestational age is surfactant produced in-utero? What does surfactant do for an infant's lungs in terms of lung tissue ability to expand and contract?
3. Describe physiologic anemia in terms of why it occurs. During which trimester is it most common?
4. Compare and contrast the two congenital conditions: gastroschsis or omphalocele. Briefly describe what they are and provide at least 2 nursing considerations for each.
5. Name two possible causes of sepsis in an infant at birth, and at least 3 signs of sepsis in the infant.
6. Discuss the purpose for recommending folic acid to child-bearing persons. Name at least 3 foods rich in folic acid and 3 that have been fortified to include folic acid.
7. Please describe the flow of fetal blood from the placenta, through the fetal circulation, and back to the placenta. In your description, you should include where oxygenated vs. deoxygenated blood is located, as well as the 3 fetal shunts and which structures they bypass.
8. A 39-year-old G1P0 at 38 weeks 3 days arrives to OB triage from her provider's office after a BP reading of 149/90, and 5 pounds weight gain in the past week. She has no significant medical or surgical history. She denies blurry vision, N/V, SOB, and RUQ pain, but states she feels very "swollen" and has had a headache since yesterday which didn't go away after taking Tylenol. On admission to OB triage, her first set of VS is 156/95, 73, 18, 97.9. Upon examination, her lung sounds are clear bilaterally, hand grasp is strong bilaterally, DTRs 2+ bilaterally, clonus negative, and 3+ pitting edema of the lower extremities with generalized edema throughout. The FHR shows baseline of 140 BPM, moderate variability, accelerations, and no decelerations. The toco shows one UC in the first 30 minutes of monitoring. She states fetal movement is normal and denies vaginal bleeding and leaking of fluid. You page the provider and receive the following orders: serial BPs q 15 min, continuous FHR monitoring while in OB triage, and labs (chemistry panel, CBC, UPC). Lab results come back showing: Hgb 10.3, Hct 30.9, PLT 105,000, ALT 47, AST 52, UA 6.9, UPC .44. Since admission to OB triage, BPs have been: 150/93, 148/88, 140/79, 152/95.
The provider for the 39-year-old orders admission to L&D for induction of labor. What hypertensive disorder do you believe this patient has?
9. A 39-year-old G1P0 at 38 weeks 3 days arrives to OB triage from her provider's office after a BP reading of 149/90, and 5 pounds weight gain in the past week. She has no significant medical or surgical history. She denies blurry vision, N/V, SOB, and RUQ pain, but states she feels very "swollen" and has had a headache since yesterday which didn't go away after taking Tylenol. On admission to OB triage, her first set of VS is 156/95, 73, 18, 97.9. Upon examination, her lung sounds are clear bilaterally, hand grasp is strong bilaterally, DTRs 2+ bilaterally, clonus negative, and 3+ pitting edema of the lower extremities with generalized edema throughout. The FHR shows baseline of 140 BPM, moderate variability, accelerations, and no decelerations. The toco shows one UC in the first 30 minutes of monitoring. She states fetal movement is normal and denies vaginal bleeding and leaking of fluid. You page the provider and receive the following orders: serial BPs q 15 min, continuous FHR monitoring while in OB triage, and labs (chemistry panel, CBC, UPC). Lab results come back showing: Hgb 10.3, Hct 30.9, PLT 105,000, ALT 47, AST 52, UA 6.9, UPC .44. Since admission to OB triage, BPs have been: 150/93, 148/88, 140/79, 152/95.
Her SVE is 1/50%/-3, firm, and posterior. What is her Bishop score, and how do you anticipate her labor induction will begin (what potential methods/medications might be used to prepare her body for labor induction)?
10. A 39-year-old G1P0 at 38 weeks 3 days arrives to OB triage from her provider's office after a BP reading of 149/90, and 5 pounds weight gain in the past week. She has no significant medical or surgical history. She denies blurry vision, N/V, SOB, and RUQ pain, but states she feels very "swollen" and has had a headache since yesterday which didn't go away after taking Tylenol. On admission to OB triage, her first set of VS is 156/95, 73, 18, 97.9. Upon examination, her lung sounds are clear bilaterally, hand grasp is strong bilaterally, DTRs 2+ bilaterally, clonus negative, and 3+ pitting edema of the lower extremities with generalized edema throughout. The FHR shows baseline of 140 BPM, moderate variability, accelerations, and no decelerations. The toco shows one UC in the first 30 minutes of monitoring. She states fetal movement is normal and denies vaginal bleeding and leaking of fluid. You page the provider and receive the following orders: serial BPs q 15 min, continuous FHR monitoring while in OB triage, and labs (chemistry panel, CBC, UPC). Lab results come back showing: Hgb 10.3, Hct 30.9, PLT 105,000, ALT 47, AST 52, UA 6.9, UPC .44. Since admission to OB triage, BPs have been: 150/93, 148/88, 140/79, 152/95.
The provider orders magnesium sulfate infusion for preeclampsia. One hour after this medication is started, you notice the following FHR tracing. How would you interpret this tracing (include contraction frequency and duration, FHR baseline, variability, presence of accelerations/decelerations and interpretation into Category 1, 2, or 3)?
11. A 39-year-old G1P0 at 38 weeks 3 days arrives to OB triage from her provider's office after a BP reading of 149/90, and 5 pounds weight gain in the past week. She has no significant medical or surgical history. She denies blurry vision, N/V, SOB, and RUQ pain, but states she feels very "swollen" and has had a headache since yesterday which didn't go away after taking Tylenol. On admission to OB triage, her first set of VS is 156/95, 73, 18, 97.9. Upon examination, her lung sounds are clear bilaterally, hand grasp is strong bilaterally, DTRs 2+ bilaterally, clonus negative, and 3+ pitting edema of the lower extremities with generalized edema throughout. The FHR shows baseline of 140 BPM, moderate variability, accelerations, and no decelerations. The toco shows one UC in the first 30 minutes of monitoring. She states fetal movement is normal and denies vaginal bleeding and leaking of fluid. You page the provider and receive the following orders: serial BPs q 15 min, continuous FHR monitoring while in OB triage, and labs (chemistry panel, CBC, UPC). Lab results come back showing: Hgb 10.3, Hct 30.9, PLT 105,000, ALT 47, AST 52, UA 6.9, UPC .44. Since admission to OB triage, BPs have been: 150/93, 148/88, 140/79, 152/95.
After AROM for clear fluid 12 hours after admission, the patient reports pain with contractions at 8/10 and requests an epidural. What interventions will be anticipated before beginning epidural anesthesia?
12. A 31-year-old patient who is G3P1011 presents for IOL at 39.0 weeks of gestation for Type 1 DM with history of shoulder dystocia with her first delivery. Her diabetes is managed using an insulin pump which she has had since she was a teenager. Her prenatal labs are: A+, Antibody negative, GBS +, all others negative/non-reactive and rubella immune. Her admission blood glucose reading is 80. Her insulin pump is shut off and the nurse begins hourly blood glucose checks and IV insulin as ordered by the OB provider. Her last baby was born at 39 weeks 6 days of gestation, weighed 4410 grams (9 pounds, 12 ounces), and she experienced a shoulder dystocia during birth. That child has no long-term consequences as a result of the shoulder dystocia. This fetus has an estimated weight of 4150 grams. She has an uncomplicated labor and 10 hours after her IOL was started, she reports rectal pressure. She is found to be 10/100/+2 station and the provider is paged to come for pushing phase and birth.
Knowing the history of her prior birth, how should the nurse prepare for birth?
13. A 31-year-old patient who is G3P1011 presents for IOL at 39.0 weeks of gestation for Type 1 DM with history of shoulder dystocia with her first delivery. Her diabetes is managed using an insulin pump which she has had since she was a teenager. Her prenatal labs are: A+, Antibody negative, GBS +, all others negative/non-reactive and rubella immune. Her admission blood glucose reading is 80. Her insulin pump is shut off and the nurse begins hourly blood glucose checks and IV insulin as ordered by the OB provider. Her last baby was born at 39 weeks 6 days of gestation, weighed 4410 grams (9 pounds, 12 ounces), and she experienced a shoulder dystocia during birth. That child has no long-term consequences as a result of the shoulder dystocia. This fetus has an estimated weight of 4150 grams. She has an uncomplicated labor and 10 hours after her IOL was started, she reports rectal pressure. She is found to be 10/100/+2 station and the provider is paged to come for pushing phase and birth.
After birth of the fetal head, the provider has difficulty delivering the shoulders and announces there is a shoulder dystocia. What is the correct next step for the nurse to take?
14. A 31-year-old patient who is G3P1011 presents for IOL at 39.0 weeks of gestation for Type 1 DM with history of shoulder dystocia with her first delivery. Her diabetes is managed using an insulin pump which she has had since she was a teenager. Her prenatal labs are: A+, Antibody negative, GBS +, all others negative/non-reactive and rubella immune. Her admission blood glucose reading is 80. Her insulin pump is shut off and the nurse begins hourly blood glucose checks and IV insulin as ordered by the OB provider. Her last baby was born at 39 weeks 6 days of gestation, weighed 4410 grams (9 pounds, 12 ounces), and she experienced a shoulder dystocia during birth. That child has no long-term consequences as a result of the shoulder dystocia. This fetus has an estimated weight of 4150 grams. She has an uncomplicated labor and 10 hours after her IOL was started, she reports rectal pressure. She is found to be 10/100/+2 station and the provider is paged to come for pushing phase and birth.
After a 1 minute 30 second shoulder dystocia, a baby girl is delivered and evaluated by the pediatric team. Her APGARS are 7 and 9 and she is moving all extremities. The pediatric team leaves the newborn in the care of the L&D team. The newborn weighs 4300 grams (9 pounds, 8 ounces). Describe in one sentence why this newborn is at increased risk for hypoglycemia after birth?
15. A 31-year-old patient who is G3P1011 presents for IOL at 39.0 weeks of gestation for Type 1 DM with history of shoulder dystocia with her first delivery. Her diabetes is managed using an insulin pump which she has had since she was a teenager. Her prenatal labs are: A+, Antibody negative, GBS +, all others negative/non-reactive and rubella immune. Her admission blood glucose reading is 80. Her insulin pump is shut off and the nurse begins hourly blood glucose checks and IV insulin as ordered by the OB provider. Her last baby was born at 39 weeks 6 days of gestation, weighed 4410 grams (9 pounds, 12 ounces), and she experienced a shoulder dystocia during birth. That child has no long-term consequences as a result of the shoulder dystocia. This fetus has an estimated weight of 4150 grams. She has an uncomplicated labor and 10 hours after her IOL was started, she reports rectal pressure. She is found to be 10/100/+2 station and the provider is paged to come for pushing phase and birth.
At the time of birth, the mother was receiving insulin at 2.2 units/hour via infusion pump. Following birth of the newborn and placenta, what rate of insulin will she receive?
16. A 31-year-old patient who is G3P1011 presents for IOL at 39.0 weeks of gestation for Type 1 DM with history of shoulder dystocia with her first delivery. Her diabetes is managed using an insulin pump which she has had since she was a teenager. Her prenatal labs are: A+, Antibody negative, GBS +, all others negative/non-reactive and rubella immune. Her admission blood glucose reading is 80. Her insulin pump is shut off and the nurse begins hourly blood glucose checks and IV insulin as ordered by the OB provider. Her last baby was born at 39 weeks 6 days of gestation, weighed 4410 grams (9 pounds, 12 ounces), and she experienced a shoulder dystocia during birth. That child has no long-term consequences as a result of the shoulder dystocia. This fetus has an estimated weight of 4150 grams. She has an uncomplicated labor and 10 hours after her IOL was started, she reports rectal pressure. She is found to be 10/100/+2 station and the provider is paged to come for pushing phase and birth.
This woman is at increased risk for PPH. Name one risk factor for PPH as well as interventions the nurse will take to decrease risk of hemorrhage.
17. Please list: a) 3 contraindications to use of combined oral contraceptive (COC) pills, and b) 3 pieces of education you would offer a patient who has a new prescription for COCs.
18.Please compare and contrast placenta previa vs. placental abruption. You should discuss differences in etiology, symptoms/presentation, risk factors, and list one nursing intervention for each condition.