Maternal/Newborn ATI Final REVIEW

Maternal/Newborn ATI Final REVIEW What is the fourth stage of labor and when does it start? Postpartum period- starts after the delivery of the placenta What are the greatest risks during the postpartum period? Hemorrhage Shock Infection When is RH immune globulin (RhoGAM) administered to post partum women? Administered 72 hours for women who are Rh-negative and gave birth to infants who are Rh-positive This prevents sensitization to Rh in future pregnancies What is included in the postpartum nursing assessment? Monitoring vital signs Assessing uterine firmness & location in relation to umbilicus Uterine position in relation to midline (if deviated, assist mom in emptying bladder) Amount of vaginal bleeding (lochia) How often should vitals be monitored after delivery? Every 15 min for the first hour Every 30 minutes for second hour Every 4-8 hr depending on remaining medication regimen This occurs with contractions of the uterine smooth muscle, whereby the uterus returns to its pre-pregnant state Involution Defined as blood flow from the uterus during postpartum period Lochia This type of lochia is bright red in color, bloody consistency, fleshy odor, may contain small clots Lochia rubra This type of lochia is pinkish brown in color & serosanguineous consistency Lochia serosa This type of lochia is yellowish, white creamy color, fleshy odor Lochia alba When is colostrum present in the new mother's breasts? During pregnancy and 2-3 days immediately after birth Defined as an infection in a milk duct of the breast with concurrent flulike symptoms Mastitis What are therapeutic and approved holding positions when breast feeding? Cradle hold Side-lying hold Football hold What does breast feeding cause the release of? What does this prevent? Breast feeding causes the release of oxytocin which stimulates uterine contractions (will prevent hemorrhage) What are normal lab values in the post partum period? Increased Hct & Hgb up to 72 hours Leukocytosis (WBC count up to 20,000-25,000 for the first 10-14 days, without presence of infection) Increased coagulation factors Increased fibrinogen A medical condition during pregnancy defined as excessive nausea and vomiting that is prolonged past 12 weeks of gestation. Results in weight loss & electrolyte imbalance Hyperemesis gravidarum What are nursing responsibilities when caring for a patient diagnosed with hyperemesis gravidarum? Monitor client's I&O Assess client's skin turgor/mucous membranes Monitor vital signs Monitor client's weight Have client remain NPO for 24-48 hours This medical condition occurs during pregnancy due to inadequacy in maternal iron stores and consuming insufficient amounts of dietary iron Anemia This medical condition is defined as an impaired tolerance to glucose with the first onset or recognition during pregnancy Gestational diabetes mellitus What is the ideal blood glucose level during pregnancy? 70-110mg/dL What are the clinical manifestations of hypoglycemia? Nervousness Headache Weakness Irritability Hunger Blurred vision Tingling of mouth/extremities What are the clinical manifestations of hyperglycemia? Thirst Nausea Abdominal pain Frequent urination (diuresis) Flushed dry skin Fruity breath What are the glucose levels that diagnostically, indicate gestational diabetes mellitus? Blood glucose screening of 130-140mg/dL or greater, indicating 3-hr oral glucose test is indicated This disorder begins after the 20th week of pregnancy where BP s elevated at 140/90 mm Hg or greater recorded at least twice, 4-6 hours apart within a 1 week period Gestational hypertension (GH) This disorder is defined as gestational hypertension with the addition of proteinuria greater than 1+ Mild preeclampsia This disorder is defined as maternal BP of 160/100 mm Hg or greater, protenuria greater than 3+, oliguria, elevated Cr greater than 1.2mg/dLm visual disturbances, hyperreflexia, pulmonary/cardiac involvement, extensive peripheral edema, hepatic dysfunction & thrombocytopenia Severe preeclampsia This disorder is defined as severe preeclampsia symptoms along with the onset of seizure activity or coma Eclampsia This syndrome of pregnancy is a variant of gestational hypertension in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction HELLP syndrome H- hemolysis (anemia and jaundice) EL- elevated liver enzymes (Elevated ALT/AST, nausea/vomiting) LP- low platelets (thrombocytopenia, DIC) What are antihypertensive medications that are approved to be taken during pregnancy? Methyldopa (Aldomet) Nifedipine (Adalat, Procardia) Hydralazine (Apresoline, Nesopresol) Labetalol (Normodyne) AVOID ACE INHIBITORS & ARBs What is an anticonvulsant medication used during pregnancy? Magnesium sulfate What are signs of magnesium sulfate toxicity? Absence of patellar deep tendon reflexes Urine output less than 30mL/hr Respirations less than 12/min Decreased LOC Cardiac dysrhythmias If magnesium sulfate toxicity is suspected, what is the priority nursing action? Discontinue infusion & administer antidote CALCIUM GLUCONATE. Also, prepare to prevent respiratory/cardiac arrest Including what vitamin in the diet will increase absorption of iron supplementation? Vitamin C This syndrome results from the chronic or periodic intake of alcohol during pregnancy; Alcohol is considered teratogenic Fetal alcohol syndrome Defined as a serum glucose level of less than 40mg/dL Hypoglycemia in full term newborn Defined as a serum glucose level of less than 25 mg/dL Hypoglycemia in pre-term newborn This syndrome is defined as surfactant deficiency in the lungs and is characterized by poor gas exchange and ventilatory failure Respiratory distress syndrome (RDS) Produced by the body, it is a phospholipid that assists in alveoli expansion & allows gas exchange to occur Surfactant What are assessment findings of respiratory distress syndrome in a newborn? Tachypnea (greater than 60/min) Nasal flaring Expiratory grunting Retractions (abdominal) Labored breathing Fine crackles upon auscultation Cyanosis What weeks gestation defines a pre-term newborn? Between 20-37 weeks gestation Defined as a newborn whose birth weight is at or below the 10th percentile and who has intrauterine growth restriction SGA- Small for gestational age Defined as a newborn who's weight is above the 90th percentile or more than 8 lb 12 oz LGA- large for gestational age Defined as a newborn who is born after the completion of 42 weeks of gestation Post-term infant What do post-term infants have an increased risk for in utero? Aspirating meconium This disorder is a complication that can result from meconium aspiration; Ductus arteriosus & foramen ovale remain open Persistent pulmonary hypertension of the newborn Defined as an elevation of serum bilirubin levels resulting in jaundice (especially sclera and mucous membranes) Hyperbilirubinemia (Hyperbili) What can result from untreated hyperbilirubinemia of levels higher than 25 mg/dL? Kernicterus (bilirubin encephalopathy)- caused by bilirubin depositing into brain cells What is the treatment for hyperbili? Phototherapy What are nursing responsibilities when caring for a newborn receiving phototherapy? Maintain eye mask over newborn's eyes for protection of corneas and retinas Keep newborn undressed, surgical mask placed over genitalia Avoid motioning skin (can cause burns)