NUR 2513 Maternal Child Nursing Examination Blue Print – Exam 1_2020/2021 - Revised

NUR 2513 Maternal Child Nursing - 2020/2021 Examination Blue Print – Exam 1 Describe the Evolution and Trends of Maternal-Child Healthcare • Current trends influencing maternal-child healthcare o Women’s roles ▪ Maternal age is increasing over time and so is the maternal mortality rate ▪ Being more heard about what they want for their pregnancy ▪ Working during their pregnancy and afterwards ▪ More single families; women as single mothers make it difficult and stressful o Resources ▪ Education o Family dynamics ▪ Single moms ▪ Nuclear family ▪ Grandparents ▪ Foster/ adoptive parents ▪ Surrogates ▪ Incarceration ▪ Stepparents ▪ Aunts/ uncles ▪ Straight/ gay ▪ Nurses role is to provide neutral, compassionate care. ▪ Families are not as extended. As they used to be, so nurses need to fill those holes with support and resources o Advanced maternal age is 35 years old. Explain Potential Antepartum and Intrapartum Complications • IUGR o Intrauterine growth restriction o Failure to grow at the expected rate in the utero o S/S below average in weight, length, and head circumference; wasted appearance; poor skin turgor; sunken abdomen; small liver and dry umbilical cord o Measure fetal growth using fundal height o A condition in which a baby doesn't grow to normal weight during pregnancy. o Causes of intrauterine growth restriction vary but include placenta abnormalities, high blood pressure in the mother, infections, and smoking or alcohol abuse. o With this condition, a baby is born weighing less than 90 percent of other babies at the same gestational age. o Ultrasounds during pregnancy help monitor a baby's weight. • RH factor o Inherited protein found on red cells (rhesus factor) o RH positive means having it o Negative means not having it o RH typing determines the mothers blood type o Rh Screening: Rhogam given at 28-32 weeks gestation for Rh Negative gets Rhogam • Meconium aspiration o If meconium (fluid around baby) is inhaled by the baby, it can block air flow o Post term babies is most common at risk. • Gestational diabetes o Maternal glucose crosses placenta, but insulin does not o Fetus produces own insulin and pulls glucose from mother (hypoglycemic mom) o Newborn may be large; macrosomia o During 2nd and 3rd trimester, insulin needs increase (reason why they are diagnosed later stages of pregnancy) o (pregnancy induced) Glucose testing done between 20-26 weeks. Results should be between 60- 90mg/dL. Diabetes is managed by diet, but mother may need to turn to insulin if diet fails. Insulin does NOT cross the placenta. o Impairment in carbohydrate metabolism that first manifests during pregnancy o Fasting sugar above 140 or above. o Should not see glucose in urine or protein. 4 blood draw over 3 hours . if 2 of 4 are abnormal then she fails. Amniocentesis test for genetic issues, • Hyperemesis gravidarum o Really bad nausea and vomiting starts in the first trimester o Bad for electrolyte and fluid balance o Weight loss and dehydration o Encourage easy carbs like cereal and rice, liquids between meals, provide medications o What is the Nursing intervention? ▪ TPA (total perantal nutrition) stay until TPN ▪ IV fluids to replace lost fluid volume (containing Dextrose and Vitamins) ▪ Antiemetic (Zofran) ▪ NPO Status ▪ Bland Diets with HIGH protein, avoiding spicy or offending foods, eating crackers when they get up in the morning (don’t let the stomach be empty). ▪ Ginger capsules soothe stomach, and “Sea Bands” (acupressure bands) • Placenta previa o Improperly implanted placenta in the lower uterine segment near or over the internal cervical o Never do a vaginal assessment or any manipulation to the vagina. o Nursing assessment ▪ Bright red vaginal bleeding in last half of pregnancy ▪ Uterus is soft and relaxed ▪ Fundal height may be more than expected for gestational age o Nursing interventions ▪ Monitor VS, FHR, fetal activity, ultrasound ▪ NEVER do vaginal exams of any kind. We do not want to move the placenta ▪ Best rest with side lying position ▪ Monitor amount of bleeding ▪ IV fluids, blood products, or tocolytic medications o #1 = painless! Placenta sits on/near cervix, when cervix dilates it causes bleeding. Do not do physical exam on bleeding patient, as you don’t know if it is the placenta causing the bleeding and you can make it worse by examining her. - - -