TEST PREVIEW: 316 Maternal Infant
Exam #1 Study Guide
Introduction to Maternity Nursing
Review AWHONN’s (Association for Women’s Health, Obstetrical and Neonatal Nurses) role in establishing
Standards of Care that influence nursing interventions
o Sets the STANDARDS OF CARE for maternity and gynecological nursing
Infant Mortality Rate
o Infant Mortality Rate: number of deaths of infants under 1 year of age per 1000 live births in a given
population
o Risk factors: infants born in multiple births, pre-term, infants born to unmarried mothers, teen mothers
or mothers 40+
o Top 5 causes of death: congenital malformations, show gestation, low birthweight, SIDS, maternal
complications and unintentional injuries
o Infant Mortality HP 2020 Goal: reduce fetal and infant deaths (MICH-1)
2007-2009 Baseline (per 2014 2020 Targe
1,000 live births + fetal
deaths)
20+ Weeks Gestation 6.2 6.0 5.6
Perinatal Period (28 Weeks 6.6 6.2 5.9
gestation- to 7+ days after
birth)
Review the Goals of Healthy People 2020
o Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death
o Achieve health equity, eliminate disparities, and improve the health of all groups
o Create social and physical environments that promote good health for all
o Promote quality of life, healthy development, and healthy behaviors across all life stages
Risk Factors: low birth weight, preterm birth, weight gain during pregnancy, infants put to sleep
on their backs
o Developmental Disabilities and Neural Tube Defects: developmental disabilities, spina bifida and other
neural tube defects, optimum folic acid
o Prenatal Substance Exposure: prenatal substance exposure, fetal alcohol syndrome, counseling and
interventions to prevent tobacco use
o Encourage increased breastfeeding, Newborn Screening & Service Systems: breastfeeding, newborn
bloodspot screening, sepsis among infants with Sickle Cell Disease, medical home care for children with
special health care needs, service systems for children with special health care needs
Reflect on the Nurse’s Role in Advocating for Patient Achievement
o Encourage Family-Centered Care: putting an emphasis on the family and family involvement throughout
the pregnancy, birth and PP period, is accepted and encouraged. Fathers are active participants in the
childbirth experience. Includes enabling and empowering the family to develop competence, confidence
and control over their own lives
Informed Consent
o Legal concept designed to allow patients to make intelligent decisions regarding their own healthcare
o Informed consent means that a patient, or legally designated decision maker, has granted permission for
a specific treatment or procedure based on full information about the treatment/procedure
o The patient is present the risks and benefits, probability of success and alternatives. The patient is also
told the consequences of not doing the procedure
o Nurse’s Role: to witness the patient’s signature, clarifying info that the MD has given and to determine
whether the patient understands the information given
, o Refusal of treatment, meds or procedure after information requires the patient to sign a form to release
the MD and agency from liability (example: Jehovah’s Witnesses refusal of blood transfusion or RhoGAM)
Postpartum Physiology and Nursing Care
Normal Expectations for BUBBLEHED Assessment (See Worksheet)
o Involution: rapid reduction in size of the uterus when the mother’s body returns to its pre-pregnant
state although it remains slightly larger than it was before the first pregnancy
o If the patient experiences PP uterine atony (failure of uterus to contract), IV oxytocin remains the first-line
drug for excessive bleeding related to the issue
o Puerperium: post-partum period, during which the woman readjusts, physically and psychologically from
pregnancy and birth. Lasts until 6 weeks or until the body has returned to a near non-pregnancy state
Normal Changes in Fundus after Delivery (Expectations)
o After pregnancy estrogen and progesterone decrease which causes autolysis: destruction of tissue, the
spongy layer of decidua (from the uterus) is shed off as lochia
o The placenta site heals through exfoliation and growth of endometrial tissue. Rather than scar tissue
formation, allowing future pregnancies. Exfoliation is one of the most important aspects of involution. If
the healing of the placental site left a fibrous scar, the area available for further implantation would be
limited, as would the number of possible pregnancies
o After birth, the top of the fundus remains at the level of the umbilicus for about half a day
o By 24 hours postpartum, the uterus is the same size it is at 20 weeks gestation
o The fundus (top of uterus) descends 1-2 cm or 1-2 fingerbreadths every 24 hours. At 24 hours, the top of
the fundus should be one below the umbilicus (aka U/1)
o By 10-14 days postpartum the uterus has descended into the true pelvis
Fundus = 1 fingerbreadth above the umbilicus: 1/U
Fundus = at the level of the umbilicus: U/U
Fundus = 1 fingerbreadth below the umbilicus: U/1
o The fundus should be firm/hard and located midline to the umbilicus
o If fundus is found to be boggy (due to anesthesia) and above the umbilicus is associated with excessive
uterine bleeding. It gets firmer/harder when massaged: the massaging with help it bleed less
o If the fundus is midline but higher than expected, it is usually associated with clots within the uterus
o If you can’t find it (possibly due to a full bladder) it more than likely will be off to the right
o If the fundus is to the left or right of umbilicus patient will need to void then be reassessed for placement
Have the mom void and measure the uterus. If mom cannot void, straight-cath her
o Cramping is caused by involution of the uterus. Increases with greater number of pregnancies
o Breastfeeding also increases afterpains due to release of oxytocin hormone. May increase the speed of
the involution process
Expected Changes in Lochia
o Lochia determines state of healing of the placenta site, it should steadily decrease everyday
o Lochia Rubra: bright red, present for 1-3 days post-delivery, contains blood and decidual trophoblatric
debris (pieces of placenta), small nickel size clots are common when up and walking around
Length of rubra depends on breastfeeding practice and parity (# of pregnancies)
o Lochia Serosa: pink or brown, after 3-4 days post-partum consists of old blood serum, leukocytes, tissue
debris, last 10 days
o Lochia Alba: yellow to white, consists mostly of leukocytes decidua, epithelial cells, fat, mucus serum
bacteria, lasts 2-6 weeks after birth… think albino = white
o Variations on lochia: scant (1 inch of blood), light amount (4 inches of blood), moderate amount (6 inches
of blood) or heavy amount (saturated pad within 1 hour)
o When the lochia stops, the cervix is considered closed and the chances of infection decrease
o Patient Education
Sequence of changes (rubra, serosa, to alba)
Report large clots that are larger than a half dollar size or plum size
Exam #1 Study Guide
Introduction to Maternity Nursing
Review AWHONN’s (Association for Women’s Health, Obstetrical and Neonatal Nurses) role in establishing
Standards of Care that influence nursing interventions
o Sets the STANDARDS OF CARE for maternity and gynecological nursing
Infant Mortality Rate
o Infant Mortality Rate: number of deaths of infants under 1 year of age per 1000 live births in a given
population
o Risk factors: infants born in multiple births, pre-term, infants born to unmarried mothers, teen mothers
or mothers 40+
o Top 5 causes of death: congenital malformations, show gestation, low birthweight, SIDS, maternal
complications and unintentional injuries
o Infant Mortality HP 2020 Goal: reduce fetal and infant deaths (MICH-1)
2007-2009 Baseline (per 2014 2020 Targe
1,000 live births + fetal
deaths)
20+ Weeks Gestation 6.2 6.0 5.6
Perinatal Period (28 Weeks 6.6 6.2 5.9
gestation- to 7+ days after
birth)
Review the Goals of Healthy People 2020
o Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death
o Achieve health equity, eliminate disparities, and improve the health of all groups
o Create social and physical environments that promote good health for all
o Promote quality of life, healthy development, and healthy behaviors across all life stages
Risk Factors: low birth weight, preterm birth, weight gain during pregnancy, infants put to sleep
on their backs
o Developmental Disabilities and Neural Tube Defects: developmental disabilities, spina bifida and other
neural tube defects, optimum folic acid
o Prenatal Substance Exposure: prenatal substance exposure, fetal alcohol syndrome, counseling and
interventions to prevent tobacco use
o Encourage increased breastfeeding, Newborn Screening & Service Systems: breastfeeding, newborn
bloodspot screening, sepsis among infants with Sickle Cell Disease, medical home care for children with
special health care needs, service systems for children with special health care needs
Reflect on the Nurse’s Role in Advocating for Patient Achievement
o Encourage Family-Centered Care: putting an emphasis on the family and family involvement throughout
the pregnancy, birth and PP period, is accepted and encouraged. Fathers are active participants in the
childbirth experience. Includes enabling and empowering the family to develop competence, confidence
and control over their own lives
Informed Consent
o Legal concept designed to allow patients to make intelligent decisions regarding their own healthcare
o Informed consent means that a patient, or legally designated decision maker, has granted permission for
a specific treatment or procedure based on full information about the treatment/procedure
o The patient is present the risks and benefits, probability of success and alternatives. The patient is also
told the consequences of not doing the procedure
o Nurse’s Role: to witness the patient’s signature, clarifying info that the MD has given and to determine
whether the patient understands the information given
, o Refusal of treatment, meds or procedure after information requires the patient to sign a form to release
the MD and agency from liability (example: Jehovah’s Witnesses refusal of blood transfusion or RhoGAM)
Postpartum Physiology and Nursing Care
Normal Expectations for BUBBLEHED Assessment (See Worksheet)
o Involution: rapid reduction in size of the uterus when the mother’s body returns to its pre-pregnant
state although it remains slightly larger than it was before the first pregnancy
o If the patient experiences PP uterine atony (failure of uterus to contract), IV oxytocin remains the first-line
drug for excessive bleeding related to the issue
o Puerperium: post-partum period, during which the woman readjusts, physically and psychologically from
pregnancy and birth. Lasts until 6 weeks or until the body has returned to a near non-pregnancy state
Normal Changes in Fundus after Delivery (Expectations)
o After pregnancy estrogen and progesterone decrease which causes autolysis: destruction of tissue, the
spongy layer of decidua (from the uterus) is shed off as lochia
o The placenta site heals through exfoliation and growth of endometrial tissue. Rather than scar tissue
formation, allowing future pregnancies. Exfoliation is one of the most important aspects of involution. If
the healing of the placental site left a fibrous scar, the area available for further implantation would be
limited, as would the number of possible pregnancies
o After birth, the top of the fundus remains at the level of the umbilicus for about half a day
o By 24 hours postpartum, the uterus is the same size it is at 20 weeks gestation
o The fundus (top of uterus) descends 1-2 cm or 1-2 fingerbreadths every 24 hours. At 24 hours, the top of
the fundus should be one below the umbilicus (aka U/1)
o By 10-14 days postpartum the uterus has descended into the true pelvis
Fundus = 1 fingerbreadth above the umbilicus: 1/U
Fundus = at the level of the umbilicus: U/U
Fundus = 1 fingerbreadth below the umbilicus: U/1
o The fundus should be firm/hard and located midline to the umbilicus
o If fundus is found to be boggy (due to anesthesia) and above the umbilicus is associated with excessive
uterine bleeding. It gets firmer/harder when massaged: the massaging with help it bleed less
o If the fundus is midline but higher than expected, it is usually associated with clots within the uterus
o If you can’t find it (possibly due to a full bladder) it more than likely will be off to the right
o If the fundus is to the left or right of umbilicus patient will need to void then be reassessed for placement
Have the mom void and measure the uterus. If mom cannot void, straight-cath her
o Cramping is caused by involution of the uterus. Increases with greater number of pregnancies
o Breastfeeding also increases afterpains due to release of oxytocin hormone. May increase the speed of
the involution process
Expected Changes in Lochia
o Lochia determines state of healing of the placenta site, it should steadily decrease everyday
o Lochia Rubra: bright red, present for 1-3 days post-delivery, contains blood and decidual trophoblatric
debris (pieces of placenta), small nickel size clots are common when up and walking around
Length of rubra depends on breastfeeding practice and parity (# of pregnancies)
o Lochia Serosa: pink or brown, after 3-4 days post-partum consists of old blood serum, leukocytes, tissue
debris, last 10 days
o Lochia Alba: yellow to white, consists mostly of leukocytes decidua, epithelial cells, fat, mucus serum
bacteria, lasts 2-6 weeks after birth… think albino = white
o Variations on lochia: scant (1 inch of blood), light amount (4 inches of blood), moderate amount (6 inches
of blood) or heavy amount (saturated pad within 1 hour)
o When the lochia stops, the cervix is considered closed and the chances of infection decrease
o Patient Education
Sequence of changes (rubra, serosa, to alba)
Report large clots that are larger than a half dollar size or plum size
