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The Woman with an Intrapartum
27 Complication
MATCHING KEY TERMS
Match the term with the correct definition.
a. Delayed or difficult birth of the shoulders after the head has b. Premature separation of a normally implanted placenta d. Placenta that is abnormally adherent to the uterine muscle e. Medication to stop preterm or hypertonic labor contractions KEY CONCEPTS
1. What are three characteristics of effective uterine activity? 2. Complete the following table to compare the characteristics of hypotonic and hypertonic labor dysfunction.
Hypotonic Dysfunction
Hypertonic Dysfunction
3. What two measures may be used to stimulate labor that slows down after it is established? Copyright 2009, 2005, 2000 by Saunders, an imprint of Elsevier, Inc. All rights reserved. Chapter 27 The Woman with an Intrapartum Complication
4. What is the central principle of nursing actions when dysfunctional labor is a result of ineffective maternal pushing? 5. Why are upright positions good for women who have ineffective second-stage pushing? 6. List nursing measures to promote normal labor when maternal pushing is ineffective for each reason listed.
7. Why are upright maternal positions best to relieve persistent occiput posterior positions? 8. List four intrapartal problems that are more likely if a woman has a multifetal pregnancy.
9. What are the expected rates for dilation and fetal descent for the following? 10. List nursing measures for a woman having prolonged labor and for her fetus.
11. List nursing measures that may be used when a woman has precipitate labor.
Chapter 27 The Woman with an Intrapartum Complication
Copyright 2009, 2005, 2000 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
12. What factors may make a woman think her membranes have ruptured when they have not? 13. A client will be discharged with ruptured membranes at 32 weeks of gestation. Write a summary of client teaching 14. List side effects that may occur with beta-adrenergic drugs such as terbutaline. What drug should be available to reverse serious adverse effects of beta-adrenergic drugs, and what is its classification? 15. How do these drugs stop preterm labor? Give an example of each.
16. What are the primary nursing assessments related to each of these tocolytic drugs? Copyright 2009, 2005, 2000 by Saunders, an imprint of Elsevier, Inc. All rights reserved. Chapter 27 The Woman with an Intrapartum Complication
17. What are the two variations of prolapsed cord? 18. What are the two objectives if umbilical cord prolapse occurs or is suspected? 19. Describe three variations of uterine rupture.
20. Why is it important that the nurse not push on the uncontracted uterine fundus after birth? What is the correct 21. Why may amniotic fluid embolism result in disseminated intravascular coagulation? 22. If a pregnant woman suffers trauma, why should medical and nursing care focus on her stabilization before fetal 23. A woman at 32 weeks of gestation has had a car accident. Her vital signs are stable, and the fetal heart rate is 150 to 160 bpm. What should the nurse suspect if the woman’s uterus seems to be enlarging? What is the correct action? CRITICAL THINKING EXERCISES
1. During clinical practice, observe and discuss with nurses what measures they use for women having back labor.
2. Practice the positions listed for back labor so that you will be familiar with them during clinical practice.
3. If you had to be on bed rest for preterm labor, possibly for 6 weeks, what adjustments would you and your family have to make to achieve that recommendation? What would be the single most important obstacle to adhering to bed rest in your life? What type of quiet activities could you do while maintaining bed rest? Chapter 27 The Woman with an Intrapartum Complication
Copyright 2009, 2005, 2000 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
CASE STUDIES
Ann Craig is admitted at 33 weeks of gestation saying that she thinks her “water broke.” This is her fourth pregnancy. Two of her infants were preterm, born at 32 and 27 weeks of gestation, and she has had one elective abortion. She has had regular prenatal care since 6 weeks of gestation.
1. What are the most important additional assessments that the nurse should make? The nurse notes that a small amount of cloudy fluid is draining from Ann’s vagina. A nitrazine paper turns blue-black in color, and a fern test is positive. Maternal vital signs are temperature 37.2° C (99° F), pulse 86 bpm, respirations 22 breaths/min, blood pressure 132/80 mm Hg. The fetal heart rate is 162 to 170 bpm and has average variability. Ann occa-sionally has a contraction lasting 20 to 30 seconds.
2. What data from the aforementioned assessments are most relevant? 3. What is the main judgment you would make from these data? What is the basis for that judgment? 4. Would you perform a vaginal examination at this point? Why or why not? Shawna is an 18-year-old primigravida admitted to the birth center at 27 weeks of gestation in probable preterm labor. Her membranes are intact. The physician writes these orders: ● NPO except ice chips● Complete blood count● Catheterize urine for routine analysis and culture and sensitivity● IV fluids: Ringer’s lactate at 200 ml/hr for 1 hour, then 125 ml/hr● Routine fetal monitoring and maternal vital signs 5. Which of these orders has priority? Why? 6. What position is appropriate for Shawna? Why? Shawna will receive magnesium sulfate for tocolysis.
7. What nursing observations are essential related to magnesium sulfate? Why? Contractions stop, and Shawna will begin taking oral terbutaline before she is discharged.
8. What teaching is appropriate related to home use of this drug? Copyright 2009, 2005, 2000 by Saunders, an imprint of Elsevier, Inc. All rights reserved. Chapter 27 The Woman with an Intrapartum Complication
9. What additional teaching is important before Shawna is discharged? REVIEW QUESTIONS
1. A woman is having hypotonic labor and is very frus- 6. A woman is fully dilated, and the fetal station is 0. The trated because this is her third trip to the birth center. fetus is in a right occiput posterior position. Choose What nursing measure is most appropriate for her? the optimal maternal position for pushing.
c. Offer her a warm shower or bath.
d. Reassure her that her problem is common.
2. A woman has shoulder dystocia when giving birth. 7. A woman is having very rapid labor with her fourth child. What nursing measure is most appropriate to b. application of suprapubic pressure.
a. Offer meperidine (Demerol) when she reaches d. turning to a hands-and-knees position.
b. Keep her in an upright position until full cervical 3. While in bed, a good position for the woman laboring c. Avoid vaginal examinations during the peak of a d. Coach her to use breathing techniques with each 8. Choose the nursing assessment that most clearly 4. Choose the primary nursing measure to promote fetal a. Remind the woman to empty her bladder every c. Maternal temperature of 37.8° C (100° F) b. Assist fetal head rotation while doing a vaginal 9. A woman telephones the labor unit and says she has c. Have the woman push at least three times with been having back discomfort all day. She is at 32 weeks of gestation. The nurse should tell the woman d. Promote intake of glucose-containing fluids during a. is having discomfort that is typical of late pregnancy.
b. should come to the hospital if she has increased 5. An infant weighing 8 pounds 10 ounces is born vagi- nally. Shoulder dystocia occurred at birth. Because of c. can increase her fluid intake to reduce Braxton- this problem, the nurse should assess the infant for a. head swelling that does not extend beyond the d. should come to the hospital for further evaluation.
b. inward turning of the feet and/or legs.
c. creaking sensation when the clavicles are palpated.
d. limited abduction of one or both hips.
Chapter 27 The Woman with an Intrapartum Complication
Copyright 2009, 2005, 2000 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
10. A woman is receiving magnesium sulfate to stop pre- 12. A woman telephones the labor unit saying that she term labor. The essential nursing assessment related has recent onset of pain between her shoulder blades that is worse when she breathes in. The nurse should a. for frequency and duration of uterine contractions.
a. ask her whether she has had a recent upper respira- b. hourly vital signs, heart sounds, and lung sounds.
c. for presence of fetal movements with contractions.
b. explain that the growing fetus reduces space to d. vaginal examination for cervical dilation, efface- c. have her palpate her uterus for frequent contractions.
d. tell her that she should come to the hospital 11. A few minutes after a woman’s membranes rupture during labor, the fetal heart rate drops from an aver-age of 140 bpm to 75 to 80 bpm. The nurse should 13. Choose the nursing assessment that most clearly a. call via telephone the physician and report the b. assess for other signs that indicate chorio amnionitis.
c. perform a vaginal examination and palpate for d. insert an indwelling catheter to keep the bladder Copyright 2009, 2005, 2000 by Saunders, an imprint of Elsevier, Inc. All rights reserved. Chapter 27 The Woman with an Intrapartum Complication

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