NURS 551ATI Maternal Newborn Proctored Study Guide Latest Version

NURS 551ATI Maternal Newborn PrCh.1 Oral Contraceptves  Chest pain, SOB, leg pain (clot), headache, eye problems  Can cause blood clots  Hypertension  Do not use with smokers  Hx of blood clots, stroke, cardiac, breast or estrogen  Depro-provera calcium and vitamin D  IUD= increased risk of pelvic inflammatory disease, ectopic pregnancy o Change in string length, foul smell, fever/chills, pain with intercourse  notfy provider Ch.2 Infertlity  Inability for at least 12 months  Male frst (sperm analysis), then the woman (no hx of dye for test or seafood) Ch.3  Presumptve sign: things that can be explained by other means o Nausea, amenorrhea, N/V, Fatgue  Probable signs o Abdominal enlargements, Hagar sign, chad wicks sign, goodwill sign, ballotement, Braxton hick contractons, positve pregnancy test, fetal outline  Positve sign o FHR  Nagele’s rule: add 9 months and a week  GTPAl: Gravidity (# of tmes of pregnancy), Term births (38 weeks or more), Preterm births, Abortons/miscarriages, Living children Ch. 5 Nutriton During Pregnancy  Normal: 25-30 pounds  Overweight: 15-25 pounds  Underweight: 28-40 pounds  First trimester: no more than 2-4 pounds for entre trimesters.. then 1 lb/week  340 calories/day for second trimester…450 for third trimester (even during breasteeding)  Folic acid (dark leafy green veggies)  fetal neuro tube defects  2-3 L of water, limit amount of caffeine Ch.6 Assessment of Fetal Well being  Ultrasound  want bladder full **non-invasive**  When poking stomach  empty bladder (amniocenteses)  Biophysical profle: 0-10 score, 8-10 is normal o Reactve HR (0-2) o Breathing This study source was downloaded by from CourseH on :31:25 GMT -05:00 This study resource was shared via CourseH Body movement o Fetal tone o Amniotc fluid volume  Nonstress test: measures fetal well-being in last trimester, response to FHR to fetal movement; reactve if FHR accelerates; non reactve if no FHR acceleraton o YOU WANT REACTIVE  Contracton stress test o Want a contracton to occur  ocycotcin, nipple stmulaton; monitor FHR to see if deceleratons occur o You want late deceleratons  Amniocentesis o You want an empty bladder o AT 14 WEEKS o Levels of AFP (high  nuero tube defects; low down syndrome) o L/S rato: 2:1 rato is fetal lung maturity (2:5:1 or 3:1 for a client who has diabetes mellitus) o Complicatons: amniotc fluid emboli, hemorrhage, infecton  Chorionic callus sampling o Taking a piece of placenta o Can be done earlier to identfy abnormalites ( 11 WEEKS) Ch. 7 Bleeding During Pregnancy  Ectopic: Unilateral stabbing pain; Lower abdominal quadrant pain  Molar: bleeding that resembles prune juice  Placenta previa: lower segment of uterus instead of fundus; PAINLESS bright red during 2nd or 3rd trimester  may hemorrhage o Complete: cervical is completely covered by placental atachment o Partal o Incomplete  Abrupto placentae: sudden onset of intense localized pain with dark red vaginal bleeding Ch. 8 Infectons  Yeast infecton prety common Ch. 9 Medical Conditons  Incompetent cervix  cervical cerclage (placed at 12-14 weeks & removed at 37 weeks)  Hyperemesis: excessive N/V past 12 weeks; IV fluids, pyridoaxine (B6) administratons, antemetc meds (Zofran)  Iron defciency anemia: iron supplements with food rick in vitamin C (orange juice)  Gestatonal diabetes: higher risk for developing diabetes afer pregnancy, (will likely do biophysiol profle and non-stress test) This study source was downloaded by from CourseH on :31:25 GMT -05:00 This study resource was shared via CourseH Insulin to control sugar levels o Test b/w 24-28 wks  one-hour glucose (no fastng required) over 140 will proceed with next test OTGG (requires fastng) 3 hours  Gestatonal hypertension: caused by vasospasm  poor tssue perfusion o Afer 20 week; 0ber 140/90  positve o No protein in the urine o Mild preeclampsia: 1+ o Severe preeclampsia: 3+ o Eclampsia: seizures o HELLP syndrome: o Anthypertensive meds: methyldopa, nifedipine, hydralazine, labetalol o Magnesium!!  to prevent seizures (monitor mg toxicity  no reflexes, low urine output, low level of consciousness, low resp)  Magnesium toxicity  calcium gluconate (antdote) Ch. 10 Early onset of Labor  Preterm labor: 20-37 weeks o Swab of vaginal secretons (fetal fbronectn) o Administer nifdepine (calcium channel blocker) block calcium to suppress contractons o Magnesium sulfate- relax smooth muscle (watch for mg toxicity) o Indomethacin o Betamethasone (steroids) promote fetal lung maturity  Premature rupture of membrane o Nitrazine paper test (should turn blue) *yellow would be just urine* o Positve ferning test to conduct on amniotc fluid to verify rupture o May put on an antobiotc (infecton can cause rupture) (betamethasone) Ch.11 Labor and Delivery Processes  Back ache, weight loss (1-3 lbs), lightening (fetal to pelvis), contractons (Braxton hicks), increased vaginal discharge or bloody show, energy burst, GI changes  Labs: Group B streptococcus, urinalysis  Stages of labor: o Onset-complete dilaton (10 cm):  Latent: irregular (mild-moderate); every 5-30 min lastng 30-45 sec  Actve: regular (moderate-strong); every 3-5 min lastng 40-70 sec  Transiton: (strong-very strong); every 2-3 min lastng 45-90 sec (feeling of needing to poop) o Fully dilates-birth: o Birth-delivery of placenta: o Delivery to placenta-normal vital signs: This study source was downloaded by from CourseH on :31:25 GMT -05:00 This study resource was shared via CourseHCh. 12 Pain management  Efeurage: light gentle circular stroking of the clients abdomen with fngertps in rhythm with breathing during contractons (cutaneous stmulaton)  Resp. depression, decreased FHR, hypotension, sedaton with opioid or sedatve  Epidural: lack of sensatons from umbilicus to thighs; dilated to 4cm or aboce; AE: hypotension fetal bradycardia, (IV bolus to counteract) avoid supine hypotension **do not lay on back Ch. 13 Fetal Assessment During Labor  110-160 BPM; want moderate variability (NO LATE DECELERATIONS) **early ones are ok  Fetal bradycardia (due to epidural)  disco oxytocin, place on side, provide oxygen  Fetal tachycardia (over 160) maternal infecton (antpyretc and oxygen)  Late declaraton (uteral placental insufciency): side lying positon, increase fluid, admin oxygen, disco oxytocin  Variable deceleratons (umbilical cord compression): repositon clients side to side, knee chest positon Ch. 16 Complicatons related to labor process  Prolapsed umbilical cord: displaced preceding the presentng part of the fetus or through the cervix o Use a sterile-gloved hand, insert two fngers into the vagina and apply fnger pressure on either side of the cord to the fetal presentng part to elevate it off the cord o Repositon in a knee-chest, Trendelenburg or a side lying positon with a rolled towel under the clients right or lef hip to relive the cord o Apply warm sterile saline soaked towel to the visible cord Ch.17 Postpartum physiological adaptons  RhoGaM admin 72 hours afer giving birth who are RH neg and baby is RH positve to prevent issues with next pregnancy  Fundus o 3rd stage of labor: palpable at midline and 2cm below to halfway b/w umbilicus and symphysis pubis o 12 hr postpartum: 1 cm above umbilicus o Every 24 hours afer should descend 1-2 cm o 6 post partum  halfway o By 10 day you shouldn’t be able to palpate  Lochia: discharge afer birth o Rubra  bright red color, some clot (1-3 days) o Serosa  pinkish brown color (4-10 days) o Alba  yellowish white creamy discharge with flush order (4-8 weeks) This study source was downloaded by from CourseH on :31:25 GMT -05:00 This study resource was shared via CourseH Ice packs at perineum for frst 24 to 48 hr, sitz baths at 100-104 degrees at least 2x a day  Milk 2-3 days afer birth (before that is the colostrum)  Uterine atony: retaining urine (uterine to be displaced) o Have her go to the bathroom Ch. 18 Baby friendly Care  Phases of maternal role atainment o Dependent (taking in); 24-48 hr o Dependent-independent (taking-hold); 2-3 days o Interdependent (letng-go) Ch. 19 Discharge Teaching  Breast engorgement  cold/warm compresses b/w feedings, warm shower prior to breasteeding (increase milk flow and promote the let down reflex)  For non lactng patents  fresh cold cabbage leaves Ch.20 Postpartum Disorders  Deep vein thrombosis: unilateral swelling in legs; postpartum at higher risk  Pulmonary embolism: chest pain, difculty breathing  Postpartum hemorrhage: Uterine atony, retained placenta fragments; increase change in lochia patern o Meds: oxytocin (uterine stmulant), methylergonovine , misoprostol o Uterine atony  Massage fundus Ch. 21 Postpartum infectons  Mastts: infectons in breast; painful or tender localized hard mass and reddened area usually on one breast; Chills, fatgue o Enlarged tender axillary lymph nodes with an area of inflammaton that can be red, swollen, warm and tender  Hygiene: wash hands prior to breasteed, air dry nipples, baby taking nipple and areola area when feedings, breast empted during each feeding to prevent mastts Ch.22 Postpartum depression  Blues: tearfulness, lack of appette  Depression: within 6 mo of delivery,  Psychosis: hx of bipolar disease, hallucinatons, obsessive behavior, paranoia Ch. 23 Newborn assessment  APGAR (0-2) total of 10; 0-3 severe distress; 4-6 moderate difculty; 7-10 minimal to no difculty o Heart Rate=- greater than 100/min is 2 o Resp rate o Muscle tone This study source was downloaded by from CourseH on :31:25 GMT -05:00 This study resource was shared via CourseH Reflex- grimace is a 1 o Color- completely pink is 2  New Ballard Scale- newborn maturity scale (neuromuscular and physical maturity) o Neuromuscular: square window, arm recoil, scarf sign, popliteal angle, heel to ear **they should be well flexed o Physical:  Preterm: thinner skin, stcky skin, lanugo, flat smooth scrotum, flat labia  Full term: thicker, plantar creases, breast tssue (5-10 mm breast buds)  Late term: wrinkle, leather skin  Normal deviatons o Milia: raised white spots o Mongolian spots: bluish purple spots  Head o Should be 2-3 cm larger than chest circumference o Anterior (diamond shape) and posterior fontanel (smaller and triangle shape) present o Caput succedaneum o Cephalohematoma  Eyes are blue at grey at frst  Grey white patches on tongue indicate thrush a fungal infecton (Candidiasis)  Reflexes o Sucking rootng reflex o Palmar grasp o Plantar grasp o Moro reflex o Tonic neck (fencer positon) o Babinski reflex o Stepping Ch. 24 Nursing Care of Newborn  Thermoregulaton o Conducton o Convecton o Evaporaton: drying newborn off o Radiaton  Meconium- should be passed afer 24 hours afer birth (abnormal if it doesn’t happen)  Erythromycin ointment in eye to (gonorrhea, chlamydia)  Vitamin K  needed to prevent hemorrhaging untl they start producing their own  Hep B  at birth, 1 mo, 6 mo  Hypoglycemia (jitery, twitching, weak high pitched vcy, cyanosis, lethargy, seizures, under 40 glucose level, irregular resp) This study source was downloaded by from CourseH on :31:25 GMT -05:00 This study resource was shared via CourseHCh. 25 Newborn nutriton  Lose 5-10% body weight afer birth  Breast feeding o Decrease risk of SIDS o First food introduced – iron o Start right afer birth (uterine cramps  release of oxytocin) o 15-20 min per breast (try to empty breast with each feeding) o Best indicator if they are eatng right is based on diaper (6-8 diapers per day) o Stored at room temp for up to 8 hours, refrigerated must be used within 8 days, If frozen up to 6 mo, deep freezer, 12 mo. o Thaw milk in refrigerator o DO NOT microwave milk o DO NOT refreeze thaw milk o Used portons should be discarded (DO NOT use again) o Formula up to 48 hours Ch. 26 Nursing Care and Discharge teaching  Place baby on back (to prevent SIDS)  Newborns sleep 17 hours out of 24  Cord care o Keep dry and above diaper o Give sponge baths only untl it comes off (10-14 days afer birth) o Makes sure it is NOT moist or red, foul odor, purulent drainage  Circumcision Care o Petroleum jelly o DO NOT wash yellowish mucus off o Give baby acetaminophen  Car safety o Rear end facing o Middle back seat untl age 2 Ch. 27 New born complicatons  Hypoglycemia (less than 40)  Preterm: resp distress, bronchopulmonary dysplasia, aspiraton, apnea,  Macrosonic newborn: born to mom with diabetes, hypoxia, hypoglycemia, hypocalcemia (tremors)  Post term: cracked, leather skin, long hair and nails  Hyperbilirubinemia o Jaundice (monitor tme it set in) o Kernicterus (untreated) o Phototherapy  primary treatment (greater than 15)  Eye mask over baby This study source was downloaded by from CourseH on :31:25 GMT -05:00 This study resource was shared via CourseH Keep newborn undress  Cover genital  Avoid applying loton  Remove from phototherapy every 4 hours and check eyes  Repositon every 2 hours  Bronze/rash is not serious  Monitor dehydraton!!! (sunken fontanel); check diaper (feed frequently) This study source was downloaded by from CourseH on :31:25 GMT -05:00 This study resource was shared via CourseH Powered by TCPDF ()octored Study Guide