*NURSING > Summary > HESI NCLEX HESI HELP UPDATED VERSION (All)

HESI NCLEX HESI HELP UPDATED VERSION

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o Anesthetic Blocks ▪ Pudendal block = decreases pain in perineum and vagina – no help with contraction pain ▪ Epidural block = T10-S5 • Blocks all pain • First sign = warmth or tingling in ball of foot or big toe ▪ Regional blocks often result in forceps or vacuum assisted births because they affect the mother’s ability to push effectively o Tears ▪ 1st degree – Dermis ▪ 2nd degree – mm/fascia ▪ 3rd degree – anal sphincter ▪ 4th degree – rectum o Placenta ▪ Abruptio Placenta = dark red bleeding with rigid, board-like abdomen ▪ Placenta Previa = painless bright red bleeding ▪ Placenta Separation • Lengthening of cord outside of vagina, gush of blood, full feeling in vagina • Give oxytocin after placenta is out – NOT BEFORE ▪ Schultz Presentation = shiny side outside (fetal side of placenta) • Postpartum o Postpartum VS Schedule ▪ Every 15 min for 1 hr ▪ Every 30 min for next 2 hrs ▪ Every hour for the next 2-6 hrs ▪ Then every 4 hrs o BM for mom within 3 days = normal o Lochia ▪ No more than 4-8 pads/day and no clots >1cm ▪ Fleshy smell is normal ▪ Foul smell = infection o Massage boggy uterus to encourage involution – empty bladder ASAP ▪ May need to catheterize ▪ Full bladder can lead to uterine atony and hemorrhage o DIC – Tx with Heparin (safe in pregnancy) – fetal demise, abruptio placenta, infection o WBC counts are elevated up to 25,000 for about 10 days post-partum o C-section can lead to paralytic ileus – early ambulation helps o Postpartum infection common in problem pregnancies – anemia, DM, traumatic birth o Postpartum Hemorrhage = leading cause of maternal death. ▪ Risk factors include: dystocia, prolonged labor, overdistended uterus, abruptio placenta, infection ▪ Tx includes: fundal massage, count pads, VS, IV fluids, oxytocin, notify physician • Newborn o Babies born without vaginal squeeze more likely to have respiratory difficulty initially o APGAR = HR, RR, mm tone, reflect irritability, color ▪ 1 and 5 minutes ▪ 7-10 = Good; 4-6 = moderate resuscitative efforts; 1-3 mostly dead o Eye care = E-mycin + Silver nitrate – for gonorrhea o Rho(D) immune globulin (RhoGAM) is given to Rh- mothers who deliver Rh+ children ▪ Not given is mom has a positive Coombs test – she already has developed antibodies…. Too late o Caput Succedaneum = edema under scalp – crosses suture line

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