VATI Reassessment Maternal Newborn Remediation FULL

VATI Reassessment Maternal Newborn Remediation FULL A single dose of azithromycin is an appropriate treatment for a chlamydial infection. An acceptable alternative is doxycycline twice a day for 7 days Rho (D) immunog ...

VATI Reassessment Maternal Newborn Remediation FULL A single dose of azithromycin is an appropriate treatment for a chlamydial infection. An acceptable alternative is doxycycline twice a day for 7 days Rho (D) immunoglobulin prevents the immune system of a client who is Rh negative from reacting to accidental exposure to fetal blood during pregnancy or delivery. If the client has another Rh-positive fetus in the future, these antibodies can destroy the blood cells of the fetus. Rho (D) immunoglobulin is administered routinely to Rh negative mothers at 28 weeks of gestation and following any pregnancy outcome (including birth or any planned or unintentional fetal loss). An indirect Coombs test determines the presence of Rh antibodies. If the client has Rh-negative blood, she does not produce Rh factor. Exposure to Rh positive blood, such as from a Rh factor positive fetus, could trigger the client to begin producing antibodies against Rh factor. These antibodies can cross the placenta and harm an Rh-positive fetus. A direct Coombs test measures the present of maternal antibodies in the newborn's blood. The nurse should monitor the client's respiratory status closely because the client is at risk for respiratory depression. During an infusion of magnesium sulfate, the nurse should monitor the respiratory rate every 5 min and every 15 min during maintenance infusion. Depending on the client's response to the medication, the provider will prescribe for the vital signs to be monitored every 30 to 60 min thereafter The nurse should evaluate the client's level of consciousness every hour. A hydatidiform mole is a rare tumor that forms inside the uterus at the beginning of a pregnancy and results in the over-production of tissue that would normally develop into the placenta. This tissue consists of fluid-filled vesicles. A rapidly enlarging uterus is a classic finding in clients who have a molar pregnancy. It is often accompanied by severe nausea and vomiting, elevated human chorionic gonadotropin levels, signs of hyperthyroidism, and early onset of preeclampsia. An L/S ratio of 2:1 is an indication of fetal lung maturity. Clients who are overweight, having a BMI of 25 to 29.9, should be advised that the recommended weight gain is 7 to 11.5 kg (15 to 25 lb). The pattern of weight gain is also important, with minimal gain in the first trimester. Shortly before labor, there is a decreased production of fetal lung fluid and a catecholamine surge that promotes fluid clearance from the lungs. Newborns born by cesarean, in which labor did not occur, can experience lung fluid retention, which leads to respiratory distress. The priority assessment when using the airway, breathing, circulation (ABC) approach to client care is to monitor the newborn for respiratory distress. Based on Maslow’s hierarchy of needs, the client's need for an adequate blood pressure to perfuse herself and her fetus is a physiological need that requires immediate intervention. Supine hypotension is a frequent cause of low blood pressure in clients who are pregnant. By turning the client on her side and retaking her blood pressure, the nurse is attempting to correct the low blood pressure and reassess. The client should avoid vaginal intercourse and the use of tampons for 2 weeks following discharge. Cephalopelvic disproportion is incorrect. Abdominal ultrasonography is used to identify cephalopelvic disproportion later in pregnancy. Rh incompatibility is incorrect. An indirect Coombs test is a screening tool for Rh incompatibility. Amniocentesis: Anomalies in fetal chromosomes is correct. Examination of amniotic fluid yields data about genetic anomalies, such as hemophilia and inborn metabolic disorders. Neural tube defects is correct. Examination of alpha fetoprotein levels in amniotic fluid confirms the presence of a neural tube defect, such as spina bifida. Fetal gender is correct. Karyotyping of fetal cells obtained from amniotic fluid permits the identification of fetal gender, which is important if an X-linked disorder is suspected in a male fetus. To elicit the Moro reflex, the nurse performs a sharp hand clap near the newborn and observes symmetric abduction and extension of the arms, fanning of the fingers with the thumb and forefinger to form a C, and then a return to a relaxed flexion position. When a fetus is SGA, there is an increased risk for intrauterine hypoxia due to the presence of meconium in the amniotic fluid. The nurse should observe for meconium in respiratory secretions when suctioning the newborn at delivery. Newborns who are SGA are at risk for perinatal asphyxia due to the stress of labor and are often depressed. They require careful resuscitation and suctioning at delivery. Toxic shock syndrome, a severe disease caused by a toxin made by Staphylococcus aureus, is characterized by shock and multiple organ dysfunction. Approximately 50% of all cases involve menstruating women using highly absorbent tampons. This answer provides the client an option that allows for administration of pain medication but minimizes the effect it will have on the newborn while breastfeeding. Tocolytic medications, such as terbutaline, indomethacin, and nifedipine are used to relax the uterus in preterm labor. A client who is in preterm labor at 26 weeks of gestation is a candidate for tocolytic therapy. Painless, spontaneous vaginal bleeding might indicate that the client has placenta previa. Placenta previa is a condition in which the placenta is implanted low in the uterus, sometimes to the point of covering the cervical os. As the cervix effaces, the client begins to bleed. The ultrasound will show the location of the placenta and help to determine what sort of delivery the client requires and how emergent it is. By day 3 to 5, most clients who are breastfeeding begin to produce copious amounts of breast milk. Magnesium sulfate is typically administered to a client in preterm labor to achieve the tocolytic (uterine relaxation) effect. Magnesium sulfate depresses the function of the central nervous system, causing respiratory depression. Baseline assessment of respiratory status, checking the respiratory rate frequently, and reassessment of respiratory status with each change in dosage of magnesium sulfate is the primary focus when assessing the client. There is a narrow margin between what is considered a therapeutic dose and a toxic dose of magnesium sulfate. Hyperthermia in the newborn requires immediately intervention. Hyperthermia is typically caused by increased heat production related to sepsis or decreased heat loss. Clearing the airway of the infant is the first action the nurse should take immediately following delivery. Within 12 hr, the fundus should be palpable at the level of the umbilicus and then recede 1 to 2 cm each day. Within 12 hr, the fundus should be palpable at the level of the umbilicus and then recede 1 to 2 cm each day. A uterine fundus that is deviated to the right or left of the umbilicus indicates the client has a full bladder. The uterus would be palpated at a position between the umbilicus and symphysis pubis in a client who is approximately 1 week postpartum. Amenorrhea, a presumptive sign of pregnancy, is one of the first physiological indications of pregnancy that occurs by 4 weeks of gestation. Goodell's sign, a probable sign of pregnancy, is the next of physiological indications to occur. Goodell's sign is the softening of the cervix that typically occurs at 5 to 6 weeks of gestation. Quickening, the mother's perception of the first fetal movement, is a presumptive sign of pregnancy that typically occurs between 16 and 20 weeks of gestation. Lightening is the last of these physiological signs of pregnancy to occur. As the fetus descends into the pelvic cavity the fundal height decreases, which typically occurs between 38 and 40 weeks of gestation. ”I’ll expect the plastic ring to fall off by itself within a week” is a correct statement. With the Plastibell procedure, the plastic ring detaches in about 5 to 8 days. ”I’ll apply petroleum jelly to his penis with diaper changes” is an incorrect statement. With the Plastibell technique, no petroleum jelly is necessary. ”I’ll wash his penis with warm water and mild soap each day” is an incorrect statement. The client should not use soap or commercial cleansing wipes until the circumcision has healed, which takes at least 5 to 6 days. ”I’ll call the doctor if I see any bleeding” is a correct statement. The client should report any bleeding immediately. ”I’ll make sure his diaper is loose in the front” is a correct statement. Applying a loose diaper prevents pressure over the circumcision area.