Premature rupture of membranes (PROM) is best
Premature rupture of membranes (PROM) is best defined as rupture of the amniotic sac and leakage of fluid that occurs before 37 weeks of gestation. leakage of fluid at least 1 hour before the onset of labor regardless of gestational age is performed in the physician’s office in order to induce labor. is artificially performed in order to augment labor. A macrosomic infant is born after a difficult vacuum-assisted delivery which included a 2 ½ minute episode of shoulder dystocia requiring McRoberts maneuver and suprapubic pressure. After stabilization, the infant is assessed and weighed. Vital signs are stable, there is no evidence of brachial plexus injury or fractures. The birth weight is 4650 gm. The nurse’s most appropriate action is to: leave the infant in the room with the mother. monitor blood glucose levels and observe closely for signs of hypoglycemia. perform a gestational age assessment to determine if the infant is large for gestational age. take the infant immediately to the nursery. A perinatal nurse assesses the skin condition of a 3 hour old newborn. Her assessment notes a yellow coloration of the skin, sclera, and oral mucous membranes. What condition is most likely the cause of these signs and/or symptoms? Breastmilk jaundice Hypoglycemic jaundice Pathologic jaundice Physiologic jaundice Polycythemic anemia of the newborn The nurse providing care for a woman with preterm labor on terbutaline would include which of the following interventions to identify side effects of the drug? Assess for bradycardia deep tendon reflexes dyspnea and crackles hypoglycemia Which of the following are possible causative factors for subinvolution of the uterus? (Select all that apply) Endometritis Fibroids Retained placental tissue Urinary tract infection Respiratory characteristics of the premature infant include: (Select all that apply) Decreased number of functioning alveoli. Greater collapsibility of respiratory tract. Increased calcification of the thorax. Increased surfactant production. Contraindications for induction of labor include: (Select all that apply) Abnormal fetal position Placental abnormalities Postdate pregnancy Pregnancy-induced hypertension Which of the following are common assessment findings of post-mature neonates? (Select all that apply) Abundant vernix caseosa Dry and peeling skin Hypoglycemia Thin, wasted appearance According to Pressler (2008), birth injuries fall into two (2) major categories: those produced by the _______________ and those produced by _ A patient, 28 weeks gestation and diagnosed with mild preeclampsia, has agreed to a plan of care including modified activity and twice daily recording of fetal movements. This information is used primarily to: Assess the growth of the fetus. Determine fetal status / well being. Evaluate the duration of fetal sleep cycles. Relieve anxiety. Now 35 weeks gestation, the patient’s condition has become more pronounced. She is admitted to Labor and Delivery for magnesium therapy x 24 hours prior to induction. In planning the patient’s care, the two primary goals should be: Improve reflex irritability and maintain cardiac output. Increase kidney perfusion thus limiting kidney damage. Lessen edema and reduce blood pressure. Prevent seizures and deliver the infant safely. The patient has been receiving Magnesium Sulfate, 2 gms / hr, IVPB, for the past four hours. The nurse assesses the patient and documents as follows: Nursing Notes 5/3/12 @ 1500 Pt resting quietly in bed; awakened easily for assessment. BP 156/92, R18, DTR’s 1+; Urine output > 30 mL per hour; FHT’s stable and reactive. Pt denies s/s of PIH, s/s ROM, s/s labor. Abdomen soft, non-tender to palpation ———- CCrider, RNC Based on this assessment, what nursing action should be implemented? Continue the magnesium sulfate as ordered, reassess in one hour. Discontinue the magnesium and rehydrate with Lactated Ringers. Give a 4 gm bolus of magnesium immediately. Increase the magnesium sulfate to 3 gms per hour and reassess in one hour. Induction of labor is started 24 hours after the initiation of magnesium therapy. The nurse is aware that the combination of magnesium and pitocin Increases the occurrence of dysfunctional labor. Increases the patient’s likelihood of needing an emergency c-section. Necessitates the use of fetal scalp electrode (ISE) and intrauterine pressure catheter (IUPC). Will increase the patient’s BP necessitating early placement of the epidural. SCENARIO CONTINUES ON NEXT PAGE CONTINUED FROM THE PREVIOUS PAGE The nurse reviews the patient’s laboratory result which reveals a falling hematocrit, a significantly elevated AST/ALT, and a platelet count of 63000. The nurse notifies the physician because the lab results are indicative of Disseminated Intravascular Coagulopathy Eclampsia HELLP syndrome Idiopathic thrombocytopenia The physician has written orders for the patient, now status post emergency cesarean section, to remain on magnesium sulfate for 24 – 48 hours post-delivery. Knowing that magnesium will increase the patient’s risk for postpartum hemorrhage, the nurse would question which one of the following orders? Medication / Dosage / Frequency / Route 07:00 – 18:59 19:00 – 06:59 A carboprost (Hemabate) 250 mcg x one dose Medication / Dosage / Frequency / Route 07:00 – 18:59 19:00 – 06:59 B methylergonovine maleate (Methergine) 0.2 mg IM x one dose Medication / Dosage / Frequency / Route 07:00 – 18:59 19:00 – 06:59 C misoprostol (Cytotec) 400 mcg per rectum x one dose Medication / Dosage / Frequency / Route 07:00 – 18:59 19:00 – 06:59 D oxytocin (Pitocin) 20 units in LR 1000 mL to run at 125 mL/hr x 24 hrs The nurse identifies which of the following as a positive patient outcome? (Select all that apply) Increase in serum creatinine Increase in serum protein Resolution of oliguria Resolution of thrombocytopenia
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