Practice Assessment- VATI RN Comprehensive Predictor Remediation .

1. Postpartum immunization recommendations for the mom: I learned postpartum moms should receive the MMR, Rho(D) immune globin, Varicella, and TDaP immunizations as quickly as possible in the postpartum period.  A client who has a titer of less than 1:8 is administered a subcutaneous injection of rubella vaccine or a measles, mumps, and rubella (MMR) vaccine during the postpartum period to protect a subsequent fetus from malformations. The client should not get pregnant for 1 month following the immunization.  All Rh-negative mothers who have newborns who are Rh-positive must be given Rho(D) immune globulin administered IM within 72 hours of the newborn being born to suppress antibody formation in the mother. Test the client who receives both the rubella vaccine and Rho(D) immune globulin after 3 months to determine whether immunity to rubella has been developed.  If the client has no immunity, varicella vaccine is administered before discharge. The client should not get pregnant for 1 month following the immunization. A second dose of vaccine is given at 4-8 weeks.  The TDaP (tetanus-diphtheria-acellular pertussis) vaccine is recommended for women who have not previously received it. Administer prior to discharge or as soon as possible in the postpartum period 2. Effective Breast Feeding for Newborns: I learned it is normal for breastfed newborns to have yellow stools which I previously assumed as an abnormal finding.  Newborns should be breastfed every 2-3 hours. Parents should awaken the newborn to feed at least every 3 hours during the day and at least every 4 hours during the night until the newborn is feeding well and gaining weight adequately. Breastfeeding should occur 8-12 times within a 24-hour window. Then, a feed-on-demand schedule can be followed.  Encourage the mother to breastfeed at least 15-20 min per breast to ensure that her newborn receives adequate fat and protein, which is richest in the breast milk as it empties the breast.  Avoid educating mothers regarding the duration of newborn feedings. Mothers should be instructed to evaluate when the newborn has completed the feeding, including slowing of newborn suckling, a softened breast, or sleeping. Both breasts should be offered to ensure that each breast receives equal stimulation and emptying.  Tell the mother how to tell if her newborn is receiving adequate feeding (gaining weight, voiding 6-8 diapers per day, and contentedness between feedings). Explain to the mother that the newborn can have loose, pale, and/or yellow stools during breastfeeding, and that this is normal.  If the newborn is spitting up, the newborn can have an allergy to dairy products. Determine the maternal intake of dairy products. The mother can need to This study source was downloaded by from CourseH on :09:41 GMT -06:00 eliminate dairy from her diet. Instruct her to consume other food sources high in calcium or calcium supplements. 3. Facture Casts Care: I learned to not use a hair dryer or heat source to dry the cast but to turn the client every 2 hours to facilitate airflow and enhance drying that way.  Plaster of Paris casts are heavy, not water-resistant, and can take 10-72 hours to dry. Synthetic fiberglass casts are light, water-resistant, and dry quickly (5-20 min). Prior to casting, the skin area should be observed for integrity, cleaned, and dried. Bony prominences should be padded to prevent skin breakdown. The provider then applies the casting material.  Elevate the cast above the level of the heart during the first 24-48 hours to prevent swelling. Also, apply ice for the first 24 hours to decrease swelling.  Turn and position the client every 2 hours so that dry air circulates around and under the cast for faster drying. This also will prevent pressure from changing the shape of the cast. Do not use heat lamps or warm hair dryers. 4. Nephrolithiasis Nutrition: I learned low K+ can contribute to calcium oxalate stone formation and to instruct the client to limit animal protein, excess sodium, alcohol, and caffeine use. I previously assumed these clients should decrease calcium intake.  Contributing factors include inadequate fluid intake, elevated urine pH, and excess excretion through the kidneys of oxalate, calcium, and uric acid.  Preventative Nutrition: excessive intake of protein, sodium, calcium, and oxalates (rhubarb, spinach, beets) can increase the risk of stone formation.  Therapeutic Nutrition: increasing fluid consumption is the primary intervention for the treatment and prevention of kidney stones. Daily fluid intake should be at least 1,500 mL to 3,000 mL. At least 8 to 12 oz (240 to 360 mL) of fluid, preferably water, should be consumed before bedtime because urine becomes more concentrated at night. Recommendation for calcium oxalate stone formation is to limit animal protein, excess sodium, alcohol, and caffeine use. Low potassium can contribute to calcium stone formation. Foods high in oxalates include spinach, rhubarb, beets, nuts, chocolate, tea, wheat bran, and strawberries, and should be limited in the diet. Avoid megadoses of vitamin C, which increase the amount of oxalate excreted. Recommendation for prevention of uric acid stones is to limit foods high in purines, which include lean meats, organ meats, whole grains, and legumes. This study source was downloaded by from CourseH on :09:41 GMT -06:00