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NUR4445 The Newborn Test With Complete Solution
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NUR4445 The Newborn TestWith Complete Solution
What are the 9 different parts of the post partum assessment? - Answer BUBBLEHEB:
Breasts
Uterus
Bowel
Bladder
Lochia
Episiotomy
Homan's Sign/Hemorrhoid's
Emotional status
Bonding
Normal (3) vs abnormal findings in the breasts post partum - Answer · Normal findings
- Soft, symmetrical everted nipples
- Colostrum present
- No cracking or bleeding
· Abnormal findings
- Inverted nipples
Normal vs abnormal findings in the uterus post partum - Answer · Normal findings
- Fundus is firm at the umbilicus
· Abnormal findings
- Fundus is boggy
What must the patient do before an examination of the uterus? - Answer void
Normal findings in the bowels post partum (2) - Answer - Abdomen is soft and
non-distended
,- Bowel sounds present in all four quadrants (sluggish/hypoactive)
Normal (2) vs abnormal findings in the bladder post partum - Answer · Normal findings
- Non-distended and non-palpable
- Voiding without difficulty
· Abnormal findings
- Urine retention
Normal lochia post partum (3) - Answer - Moderate amount of lochia rubra (dark red)
- Small clots
- No more than 500 mL (moderate)
Normal (3) vs abnormal findings in an episiotomy - Answer · Normal findings
- Mild edema
- Tears or episiotomy are intact and well-approximated
- REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation)
· Abnormal findings
- infection
What do we educate the mother about regarding an episiotomy? What do we avoid
doing? - Answer Educate about calf pain but do not do homan's sign
What are normal findings regarding hemorrhoids post partum? What position do we put
patient in to assess? - Answer - Rectum intact with small hemorrhoids that are
non-tender
- Put patient in Sim's position to assess
What should emotional status look like post partum? - Answer Tired, still taking it all in
Normal (2) vs abnormal (2) findings regarding bonding post partum - Answer · Normal
findings
- Good attachment and bonding
- Admiring the baby
· Abnormal findings
- Anything that leads to mal-parenting can lead to bad attachment
- Ex: really long labor could cause bonding issues
, What are common post partum maternal concerns/tasks (5)? - Answer 1. Restoring
physical condition
2. Developing competence in caring/meeting needs of baby
3. Establishing a relationship with baby
4. Adapting to altered lifestyle and family structure
5. Some new mothers have little to no experience and feel overwhelmed
What education do we give to the mother while assessing her (7)? - Answer o Breast
care
o Breast milk production
o Let-down reflex
o Breast self-examination
o Abdominal tightening exercises
o Physical and anatomic changes
o Danger signs to report
What are common post partum discomforts (6)? - Answer o Perineal pain
o Hemorrhoids
o Afterbirth pains
o Muscle discomfort
o Sweating
o Nipple soreness (breastfeeding)
What are some nursing interventions for post partum perineal pain (4)? - Answer - Sitz
baths and topical agents for perineum
- Ice within first 24 hours only
- Positioning, ambulation
- analgesics
What are some nursing interventions for post partum hemorrhoids (4)? - Answer - Sitz
baths
- topical anesthetic ointments, rectal suppositories, or witch-hazel pads
- Assume side-lying position when possible and avoid prolonged sitting
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