VATI Maternal Newborn Remediation

A nurse has provided education to a client who has a new prescription for Nifedipine. What statements by the client would indicate they understand the instructions? Swallow the tablet or capsule whole and do not crush, chew, or break it. Take the extended-release tablet on an empty stomach A nurse is caring for a client being discharged following admission for hyperemesis gravidarum. What dietary instructions should the nurse provide to the client? Advance the patients diet as tolerated with frequent small meals. Start with dry toast, crackers, or cereal; them move to a soft diet; and finally to a normal diet as tolerated. For nausea, eat small amounts frequently to avoid large meals that distend the stomach and avoid fried, fatty, and spicy foods. Ginger and herbal tea might also be helpful. A nurse is caring for a laboring client. Identify and differentiate the type of pain in the first stage and the second stage of labor. The first stage involves internal visceral pain that can be felt as back and leg pain, whereas the second stage includes pain that is somatic and occurs with fetal descent and expulsion. Identify three (3) adverse effects of terbutaline that can be a complication to the laboring client. The provider should be notified of a HR greater than 130/min, chest pain, cardiac arrhythmias, myocardial infarction, BP less than 90/60, or pulmonary edema. These are all adverse effects and the prescription will likely be discontinued by the provider if the patient can’t tolerate the adverse effects. Nice work on your Maternal newborn remediation! This is a specialty area, so sometimes a little tricky if we don’t have a lot of experience in this clinical setting. For Maternal Newborn, make sure you are comfortable with the normal physiological changes of pregnancy, the stages of labor, potential complications of pregnancy, how to tell true vs false labor, complications during labor and delivery, postpartum care, and newborn assessment/complications. There are also specific meds used in the labor and delivery process you need to be familiar with. Here are some general test taking tips for you. When a question is about priorities, choose the least restrictive or least invasive option available. Another strategy is that acute problems take priority over chronic problems that the client might have. Other test taking strategies that you can utilize are looking at early versus late signs and symptoms. Pay close attention to the time elapsed. It is important to note that the client who is closer to the time when they were at highest risk, means they are at highest risk for complications. For example, a client who is recently post-operative is highest risk for complications than the client you may have had surgery one week ago. Also remember to pick the most complete answer. These test taking strategies will help you as you move forward in answering questions related to priority. Here is some additional information for you: Do you know Oral contraceptives: Signs of potential problems—"ACHES" Abdominal Pain-blood clot in the pelvis or liver, vomiting, cramping, weakness Chest Pain-blood clot in the lung or heart vessels, heart attack, angina, chest or heart pain, left arm and shoulder pain, coughing and shortness of breath Headaches-stroke, blurred vision, spots, zigzag lines, weakness, difficulty speaking, sudden intellectual impairment Eye Problems-Stroke or retinal vein thrombosis, complete or partial loss of vision Severe Leg Pain-Inflammation and blood clots in leg, swelling, heat or redness, tenderness in leg How do you feel about Complication of severe pre-eclampsia—"HELLP" syndrome? HELLPsyndrome is a life-threatening pregnancy complication usually considered to be a variant of preeclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth. H (hemolysis, which is the breaking down of red blood cells) EL (elevated liver enzymes) LP (low platelet count) HELLP syndrome can be difficult to diagnose, especially when high blood pressure and protein in the urine aren't present. Its symptoms are sometimes mistaken for gastritis, flu, acute hepatitis, gall bladder disease, or other conditions. The global mortality rate of HELLP syndrome has been reported to be as high as 25%. That's why it's critical for expecting mothers to be aware of the condition and its symptoms so they can receive early diagnosis and treatment. The physical symptoms of HELLP Syndrome may seem at first like preeclampsia. Pregnant women developing HELLP syndrome have reported experiencing one or more of these symptoms:    Headache Nausea/vomiting/indigestion with pain after eating Abdominal or chest tenderness and upper right upper side pain (from liver distention)     Shoulder pain or pain when breathing deeply Bleeding Changes in vision Swelling Signs to look for include:   High blood pressure Protein in the urine The most common reasons for mothers to become critically ill or die are liver rupture or stroke (cerebral edema or cerebral hemorrhage). These can usually be prevented when caught in time. If you or someone you know has any of these symptoms, please see a healthcare provider immediately. Newborn assessment components—"APGAR"      Appearance Pulse Grimace Activity Respiratory effort VEAL CHOP–which relates to fetal heart rate.     Variable decels => Cord compression (usually a change in mother’s position helps) Early decels => Head compression (decels mirror the contractions; this is not a sign of fetal problems) Accelerations => O2 (baby is well oxygenated–this is good) Late decels => Placental utero insufficiency (this is bad and means there is decreased perfusion of blood/oxygen/nutrients to the baby). Placenta Previa versus Placenta Abruptio Category Placenta Previa Abruptio Placenta Problem Low implantation of the placenta Premature separation of the placenta Incidence It occurs in approximately It occurs in about 10% of pregnancies and is 5 in every 1000 the most common cause of perinatal death. pregnancies Risk Factors  Increased parity  High parity     Advanced maternal age Past cesarean births Past uterine curettage Multiple gestation        Advanced maternal age A short umbilical cord Chronic hypertensive disease Pregnancy-induced hypertension Direct trauma Vasoconstriction from cigarette use Thrombic conditions that lead to thrombosis such as autoimmune antibodies Bleeding Always present May or may not be present Color of blood in bleeding episodes Bright red Dark red Pain during Painless bleeding Sharp, stabbing pain Managemen t    Place the woman immediately on bed rest in a side-lying position. Weight perineal pads. NEVER attempt a pelvic or rectal examination because it may initiate massive blood loss.       Fluid replacement Oxygen by mask Monitor FHR Keep the woman in a lateral position DO NOT perform any vaginal or pelvic examinations or give enema Pregnancy must be terminated because the fetus cannot obtain adequate oxygen and nutrients. If birth does not seem imminent, cesarean birth is method of choice for delivery.