Proctored RN Maternal Newborn

1. Infections: Indications for Cesarean Birth- Mothers who are infected with HSV have the possibility of having a miscarriage, preterm labor or ectopic pregnancy. A cesarean section is recommended for all women who have active genital herpes lesions or early outbreak. 2. Infections: Treatment for Gonorrhea- Medications used for patients have gonorrhea includes Ceftriaxone IM and azithromycin PO which are broad spectrum antibiotics. They cause bactericidal action. 3. Expected Physiological Changes During Pregnancy: Patients go through a lot of different physical changes during pregnancy. During the first semester changes will not be so obvious. During the third trimester patient’s abdomen will be enlarged. She will feel back and leg discomfort as well as lethargic. Skin will change as well, stretch marks will become more noticeable and hyperpigmentation will be darker in some areas of the body. 4. Labor and Delivery Process- Caring for a patient who is in second stage of labor, usually the patient will be fully dilated, Intense contractions will be felt every 1 to 2 minutes. Pushing will result in birth during the second stage. 5. Nursing Care and Discharge Teaching: Complications to report. Patients need to be taught that they need to report an infected cord. They cannot bathe a newborn with a circumcision. Teach how to use premoistened towelettes to clean the penis. Teach how to prevent falls, suffocation, strangulation, and burns. Also report any bleedings right away. 6. Therapeutic Procedures to Assist with Labor and Delivery: Indications for Amniofusion-Patients who normally get amniofusion will be patients who have oligohydramnios caused by either uteroplacental insufficiency or premature rupture of membranes. This will be done to supplement the amount of amniotic fluid. 7. Therapeutic Procedures to Assist with Labor and Delivery: Indications for discontinuing oxytocin- Discontinue oxytocin if uterine hyperstimulation occurs. This will be contractions more often than every 2 min or contractions that last 90 seconds. Also if there is no relaxation of uterus between contractions. 8. Expected Physiological Changes During Pregnancy: Quickening means slight fluttering movements of the fetus felt by a woman usually between 16 to 20 weeks of gestation. 9. Newborn assessment: Eliciting Newborn Reflexes- Sucking and rooting reflex is tested by stroking the cheek or the edge of the mouth. Palmar grasp examine finger’s in palm of newborn’s hand. Plantar grasp place nurses finger at base of newborn’s toes, the newborn responds by curling toes. Moro reflex position newborn to fall backward in an angle of at least 30 degrees, the newborn will extend and then abduct his arms. Tonic neck flex newborn turns head to one side then the other while being in a supine position. Babinski reflex performed by stroking outer edge of the foot moving up towards the toes. Toes will eventually fan out. Stepping is done by holding baby in an upright position on a flat surface newborn will respond by stepping. 10. Prenatal Care: Rubella Titer: It determines immunity to rubella. The virus affects the developing organs and the baby may be born with serious disabilities for instance the congenital rubella syndrome. There are many complications of congenital rubella syndrome including cataracts, deafness, heart, lung and brain abnormalities. Having rubella infection in the first three months of pregnancy also increases the risk of having a miscarriage. 11. Contraception Client Teaching About Birth Control Methods: Cervical cap and spermicide are silicone rubber cap that fits snugly around the base of the cervix they come in three sizes. Can be inserted up to 6 hours before intercourse and needs to be left inside for at least 6 hours after intercourse, but no more than 48 hours at a time. Needs to be replaced every 2 years and refitted after gynecological surgery, birth or any major weight fluctuation. Make sure to have patients wash is with mild soap and warm water after each use. 12. Contraception Counseling about Sterilization-Transcervical sterilization is the insertion of small flexible agents through the vagina and cervix into the fallopian tubes. This scars the tubes preventing conception. Examination is done after 3 months to make sure fallopian tubes are blocked. Birth control will need to be used for the first three months until confirmation of blocked fallopian tubes occurs. Patient will see changes in the menstrual cycle as well. 13. Contraception Tubal Ligation:Surgical methods include burning or blocking the fallopian tubes to prevent fertilization. Can be done withing 24 to 48 hours after giving birth. Ectopic pregnancies can occur. Risk for infection, hemorrhage or trauma. Not reversible. 14. Pain management:Comfort Measures to Sacral Pain During Labor- Therapeutic touch and massage such as back rubs can be used. Walking around the park. Rocking on a chair watching tv. Effleurage which is light gentle circular stroking of the patient’s abdomen with the fingertips in rhythm. Also sacral counterpressure which is pressure used from the heel of the hand or fist against the sacral area. 15. Pain Management:Nursing actions to reduce pain-Butorphanol and nalbuphine both provide pain relief without causing significant respiratory depression in the mother or fetus. They can both be administered either by IM or IV. .............................................................................................CONTINUE