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HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed.
HESI OB / PEDI
COMPREHENSIVE STUDY REVIEW
Based on: Maternal-Child Nursing, 6th Ed. | Ashwill & McKinney | Elsevier
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1. CONCEPTION & PRENATAL DEVELOPMENT
Placenta Functions
- Gas exchange: O and CO transfer between mom and fetus₂ ₂
- Nutrient transport: glucose, amino acids, fatty acids to fetus
- Waste removal: fetal waste products removed via maternal circulation
- Hormone production: hCG, progesterone, estrogen, HPL
- Immune protection: passes IgG antibodies to fetus (passive immunity)
- Barrier: some protection against certain pathogens (NOT absolute) Amniotic Fluid Functions
- Protects fetus from trauma and temperature changes
- Allows fetal movement (musculoskeletal development)
- Fetal breathing/swallowing practice (lung/GI development)
- Normal volume: 800–1200 mL at term
Oligohydramnios Polyhydramnios
< 500 mL fluid (AFI < 5 cm) > 2000 mL fluid (AFI > 24 cm) Renal agenesis, urinary obstruction, IUGR, postdates GI obstruction, neural tube defects, maternal DM, fetal hydrops Fetal cord compression risk; variable decels Maternal respiratory distress, preterm labor, malpresentation Cord compression, fetal hypoxia Preterm labor, placental abruption, cord prolapse
2. ADAPTATIONS TO PREGNANCY
Signs of Pregnancy Presumptive (Subjective) Probable (Objective) Positive (Definitive) Amenorrhea Hegar's sign (softening of lower uterine segment) Fetal heart tones on auscultation
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed. Nausea/vomiting Goodell's sign (softening of cervix) Fetal movement felt by examiner Breast tenderness Chadwick's sign (bluish cervix/vagina) Visualization of fetus on ultrasound Fatigue + pregnancy test (hCG) Urinary frequency Ballottement Naegele's Rule
Calculating EDD
- Formula: First day of LMP − 3 months + 7 days + 1 year
- Example: LMP = July 10 → EDD = April 17 (next year)
- Normal gestation: 38–42 weeks; term = 40 weeks GTPAL Documentation Letter Stands For Example G Gravida – total pregnancies (including current)
G
T Term births (≥37 weeks) T P Preterm births (20–36 wks 6 days)
P
A Abortions/miscarriages (spontaneous or induced)
A
L Living children L Immunizations During Pregnancy
SAFE in Pregnancy AVOID in Pregnancy
Influenza (inactivated) Live vaccines (MMR, Varicella) Tdap (27–36 weeks, every pregnancy) Varicella vaccine COVID-19 (mRNA) HPV vaccine (defer until after delivery) Hepatitis B (if indicated) Rubella: give POSTPARTUM if non-immune
- ★ Rubella vaccine given AFTER delivery — never during pregnancy (live vaccine)
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed. Alpha-Fetoprotein (AFP) / Multiple-Marker Screening
HIGH AFP Levels LOW AFP Levels
Neural tube defects (spina bifida, anencephaly) Down syndrome (Trisomy 21) Multiple gestation Trisomy 18 (Edwards syndrome) Abdominal wall defects (gastroschisis, omphalocele) Gestational diabetes Fetal demise Incorrect gestational dating Quad Screen (15–20 weeks): AFP + hCG + Estriol + Inhibin-A Amniocentesis
Amniocentesis — KNOW THIS!
- Timing: 15–20 weeks (genetic); 3rd trimester for lung maturity
- Uses: chromosomal abnormalities, fetal lung maturity (L/S ratio ≥ 2:1 = mature)
- Prep: ultrasound guidance required; signed consent; empty bladder
- Risks: fetal injury, infection, preterm labor, Rh sensitization
- Post-procedure: monitor FHR & contractions; restrict activity 24 hrs
- Rh(-) mothers: give Rhogam after procedure Chorionic Villus Sampling (CVS)
- Timing: 10–12 weeks (EARLIER than amniocentesis)
- Purpose: chromosomal/genetic testing (does NOT test for NTDs)
- Advantage: earlier results than amniocentesis
- Risk: 1–2% pregnancy loss (slightly higher risk than amnio) Fetal Surveillance Tests Test Normal Result Nursing Notes NST (Non-Stress Test) REACTIVE: 2 accels of ≥ bpm for ≥15 sec in 20 min No prep needed; monitor 20– 40 min; no fasting CST/OCT (Contraction Stress NEGATIVE (no late decels with Nipple stim or Pitocin used; Test) contractions) = reassuring assess for hyperstim BPP (Biophysical Profile) 8 – 10/10 = normal; ≤4 = 5 parameters: NST + breathing, count-to- 10 method
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed.
5. GIVING BIRTH — LABOR True vs. False Labor
TRUE Labor FALSE Labor (Braxton-Hicks)
Regular contractions that INCREASE in frequency & intensity Irregular, do NOT increase in pattern Contractions DON'T go away with activity/position change Contractions often STOP with walking or rest Pain starts in BACK and radiates to FRONT Pain often in abdomen only Cervix DILATES and EFFACES No cervical change Stages of Labor Stage Phase/Description Key Points Stage 1 — Latent 0 – 6 cm dilation; longest stage Mild, irregular contractions; patient talkative; ambulation OK Stage 1 — Active 6 – 10 cm dilation; contractions q3–5 min More intense; epidural often requested here Stage 1 — Transition 8 – 10 cm; hardest part; contractions q2–3 min Very intense; patient may feel urge to push Stage 2 Pushing through delivery of baby Maternal pushing; crowning; monitor FHR closely Stage 3 Delivery of placenta (up to 30 min) Watch for signs: gush of blood, cord lengthening, uterus rises Stage 4 First 1–4 hours postpartum Fundal checks, vital signs, lochia assessment q15 min Amniotic Fluid — Color
Fluid Color Meaning / Action
Clear / slightly cloudy Normal Yellow-tinged May indicate Rh incompatibility or bilirubin Green (meconium-stained) Fetal distress; notify provider; NICU team at delivery Port-wine / dark red Possible abruptio placentae — EMERGENCY Foul odor (any color) Chorioamnionitis — infection — notify provider
Chorioamnionitis (Intraamniotic Infection)
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed.
6. FETAL HEART RATE SURVEILLANCE Normal FHR Parameters - Baseline FHR: 110–160 bpm - Contraction length: 45–90 seconds - Frequency: every 2–5 minutes - Duration of active labor contraction: typically 60–90 sec VEAL CHOP Mnemonic — FHR Patterns VEAL (Pattern) CHOP (Cause) Nursing Intervention V — Variable decel C — Cord compression Reposition (L or R lateral, kneechest), O , IVF, notify provider₂ E — Early decel H — Head compression Normal (vagal response to head compression); continue monitoring A — Accelerations O — Oxygenation (adequate) REASSURING — no action needed L — Late decel P — Placental insufficiency (^) EMERGENCY: O 10L mask, ₂ left lateral position, stop Pitocin, IVF bolus, notify MD, prepare C/S
Late Decelerations — Priority Interventions
- Turn patient to LEFT LATERAL position (relieve aortocaval compression)
- Stop oxytocin (Pitocin) immediately
- Oxygen 10 L/min via non-rebreather mask
- IV fluid bolus (increase perfusion)
- Notify provider — may need emergency C-section
- Prepare for possible intrauterine resuscitation 7. PAIN MANAGEMENT IN LABOR Non-Pharmacological Methods
- Gate Control Theory: stimulating large-diameter nerve fibers (touch, pressure, cold) 'closes the gate' to pain signals from smaller fibers
- Methods: massage, warm bath/shower, breathing techniques, TENS, position changes, birthing ball, hypnobirthing Pharmacological Methods Method Details Nursing Considerations
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed. Epidural Most common; continuous or bolus; local anesthetic + opioid in epidural space Prep: 500–1000 mL IV bolus; monitor BP q5 min × 20 min; assess motor/sensory block Epidural Medications Bupivacaine (local anesthetic) + fentanyl or morphine (opioid) Watch for: hypotension, itching, urinary retention, respiratory depression Spinal Block Single injection into subarachnoid space; used for C-section Rapid onset; monitor for hypotension and spinal headache Local Infiltration Lidocaine injected into perineum for repair of laceration/episiotomy Short duration; minimal systemic effects Pudendal Block Local anesthetic to pudendal nerve via transvaginal route 2nd stage or repair; blocks perineum and lower vagina General Anesthesia Used for emergency C-section when epidural unavailable Risk of aspiration; require NPO; sodium citrate given pre-op
- ⚠ Epidural hypotension: most common side effect — treat with left lateral position + IV fluids ± ephedrine/phenylephrine
- ⚠ Spinal headache (post-dural puncture): worse when upright, better lying flat; treat with blood **patch
- OB PROCEDURES Amniotomy (AROM)**
Amniotomy — Key Nursing Actions
- Monitor FHR BEFORE and IMMEDIATELY AFTER to detect cord prolapse
- Note: color, odor, amount of fluid — document time
- How to tell amniotic fluid from urine: Nitrazine paper turns BLUE (alkaline) with amniotic fluid; fern pattern on microscopy
- Risk: cord prolapse, infection (chorioamnionitis) Induction / Augmentation of Labor — Oxytocin (Pitocin)
- Induction = starting labor; Augmentation = stimulating sluggish labor
- Start at lowest dose; titrate per protocol
- STOP Pitocin if: hyperstimulation (>5 contractions/10 min), late decels, sustained FHR changes, tachysystole
Oxytocin Contraindications
- Cephalopelvic disproportion (CPD)
- Malpresentation (transverse lie, footling breech)
- Placenta previa or vasa previa
- Prior classical uterine incision (high risk of rupture)
- Active genital herpes
- Non-reassuring FHR patterns Bishop Score
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed.
Pre-Op Nursing Checklist
- Informed consent obtained
- NPO status confirmed (8 hrs for solids, 2 hrs for clear liquids)
- IV access (large bore) — IV fluids running
- Foley catheter insertion (after regional anesthesia)
- Abdominal/pubic hair clipped (not shaved)
- Antacid prophylaxis (sodium citrate/Bicitra) to reduce aspiration risk
- Baseline VS; O saturation monitoring₂
- Fetal monitoring until transfer to OR
- Remove nail polish, jewelry, dentures
- Compression stockings (DVT prevention) 9. NEWBORN ADAPTATION, ASSESSMENT & FEEDING Thermoregulation
4 Types of Heat Loss — Newborns
- EVAPORATION: wet skin loses heat (dry newborn immediately at birth)
- CONDUCTION: heat lost to cooler surfaces (warm blankets, warm scale)
- CONVECTION: heat lost to cool air currents (keep away from vents/AC)
- RADIATION: heat lost to cooler objects nearby (keep away from cold walls/windows) • Cold stress → hypoglycemia → metabolic acidosis Newborn Vital Signs — Normal Ranges Parameter Normal Range Action if Abnormal Heart Rate 110 – 160 bpm < 100 or > 160: assess, stimulate, notify provider Respiratory Rate 30 – 60 breaths/min < 30 or > 60: assess for distress, O as needed₂ Temperature 97.7–99.5°F (36.5–37.5°C) Hypothermia: warm; Fever: assess for infection Blood glucose > 45 mg/dL (first 4 hrs) / > 50 mg/dL after Hypoglycemia: early feed or dextrose gel O saturation (after 10 min)₂ ≥ 95% Supplemental O ; continuous ₂ monitoring Heel Stick — Best Method
Heel Stick Technique
- Best site: lateral heel (avoid center and posterior — nerve/vessel damage risk)
- Warm heel 5–10 min before to increase blood flow
- Wipe away FIRST drop of blood (diluted with interstitial fluid)
- Do NOT squeeze excessively — causes hemolysis → false result
- Apply pressure with gauze after; do not apply bandage (aspiration risk) Jaundice
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed.
Physiologic Jaundice Pathologic Jaundice
Appears AFTER 24 hours of life Appears WITHIN 24 hours of life Peaks day 3–5 in term; 5–7 in preterm Rises rapidly (>5 mg/dL/day) Due to RBC breakdown + immature liver Due to Rh/ABO incompatibility, sepsis, liver disease Treatment: phototherapy, hydration, feeding Treatment: phototherapy, possible exchange transfusion Eye shields required during phototherapy Monitor bilirubin levels closely q4–8h Caput Succedaneum vs. Cephalohematoma
Caput Succedaneum Cephalohematoma
Edema of SCALP soft tissue Subperiosteal blood collection Crosses suture lines Does NOT cross suture lines Present at BIRTH; resolves in 1–3 days Appears 12–24 hrs after birth; resolves in weeks No special treatment needed Monitor bilirubin (RBC breakdown → jaundice risk) Caused by: vaginal delivery pressure, vacuum Caused by: prolonged/difficult delivery, forceps/vacuum Newborn Reflexes Reflex How to Elicit Normal Response Moro (startle) Sudden noise or head drop Arms out, then embrace; disappears 4–6 months Rooting Stroke cheek near mouth Turns toward stimulus; helps with feeding Sucking Touch roof of mouth Strong rhythmic sucking; helps with feeding Babinski Stroke sole of foot heel to toe Toes fan out upward (plantar extension) — normal in infants Grasp (palmar) Press finger into palm Fingers close tightly; disappears 3–4 months Stepping Hold upright, feet on surface Stepping motions; disappears 1 – 2 months Initial Medications
Vitamin K (Phytonadione) Erythromycin Eye Ointment
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed.
10. FAMILY PLANNING Contraception Methods Method Mechanism Key Teaching Points Combined OCP Suppresses ovulation; thickens cervical mucus Take same time daily; no smoking if >35 yrs (DVT risk); can start day 1 of period or Sunday Progestin-only pill (Mini-pill) Thickens cervical mucus; suppresses ovulation inconsistently Take at SAME time daily (3-hr window); safe while breastfeeding IUD (Mirena/Liletta) Progestin — thins endometrium; prevents implantation Lasts 5–8 yrs; check strings monthly; can cause amenorrhea IUD (Copper/Paragard) Spermicidal copper ions; prevents fertilization Lasts 10+ yrs; heavier periods; can use as emergency contraception within 5 days Depo-Provera (injection) Prevents ovulation; every 13 weeks Bone density loss with longterm use; takes up to 18 months for fertility return Condoms (male) Barrier; prevents sperm from reaching egg Only method that ALSO prevents STIs; use with spermicide for best efficacy Diaphragm/cervical cap Barrier; used with spermicide Insert up to 6 hrs before; leave in 6 hrs after; not for STI protection NFP/FAM Avoid intercourse during fertile window Requires training; multiple indicators; high failure rate typical use Emergency Contraception (Plan B) High-dose progestin delays/prevents ovulation Take within 72 hrs (up to 120 hrs); OTC; does NOT cause abortion Tubal ligation Surgical; permanent sterilization Irreversible; counsel thoroughly; risk of ectopic if failure
- ★ Breastfeeding as contraception (LAM): requires exclusive breastfeeding, no menstruation returned, baby < 6 months — only then is it ~98% effective
- ⚠ **Combined OCPs are CONTRAINDICATED while breastfeeding (estrogen suppresses milk production). Use progestin-only or non-hormonal methods.
- POSTPARTUM CARE**
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed. BUBBLE-HE Assessment
BUBBLE-HE Focused Assessment
- B — Breasts: engorgement, nipple soreness, mastitis signs
- U — Uterus: location, firmness, height (should descend 1 cm/day)
- B — Bladder: void within 6 hrs; signs of UTI; urinary retention common post-epidural
- B — Bowel: bowel sounds; first BM expected day 2–3; stool softeners routine
- L — Lochia: amount, color, odor (Rubra → Serosa → Alba)
- E — Episiotomy/laceration: REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation)
- H — Homan's sign/legs: DVT assessment; calf tenderness, warmth, edema
- E — Emotional: bonding, mood, support, signs of PPD Lochia Progression Type Timing Description Lochia Rubra Day 1– 3 Bright red; heavy; fleshy odor — NORMAL Lochia Serosa Day 4– 10 Pink/brown; moderate; serosanguineous Lochia Alba Day 11–6 weeks Yellowish-white; light; minimal
- ⚠ Report: bright red lochia after serosa stage, foul odor, clots > golf ball, saturation of pad in < 1 hr Postpartum Immunizations
Rubella Vaccine Rhogam
Given if titer < 1:8 (non-immune) Given at 28 weeks AND within 72 hrs after delivery Administered postpartum (not during pregnancy — live vaccine) ONLY if mom is Rh(-) AND baby is Rh(+) Wait 28 days before conceiving again 300 mcg IM injection; no blood bank form needed routinely Counsel: avoid pregnancy 1 month Also given after miscarriage, amnio, CVS, trauma Postpartum Blues vs. Depression
PP Blues (Baby Blues) Postpartum Depression (PPD)
Days 1–5 postpartum; peaks day 3– 5 Onset: within first year, often weeks postpartum Mild mood swings, tearfulness, irritability Persistent sadness, hopelessness, inability to cope Self-limiting; resolves < 2 weeks Requires treatment: therapy + antidepressants
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed. Leading preventable cause of intellectual disability Signs of NAS: high-pitched cry, tremors, poor feeding, seizures, diarrhea Treatment: supportive; no cure for FAS Treatment: swaddle, quiet environment, breastfeeding, medication if needed (morphine/methadone) Intimate Partner Violence (IPV)
- Universal screening at every prenatal visit
- Screen ALONE — never with partner present
- Abuse can escalate during pregnancy (abuser may target abdomen)
- Risks: low birth weight, preterm birth, placental abruption, miscarriage
- Nursing: document injuries, provide resources, mandatory reporting per state law, safety planning 13. HIGH-RISK NEWBORN Late Preterm Infant (34–36 6/7 weeks)
- LOOKS term but has immature systems: feeding problems, respiratory issues, temperature instability, hypoglycemia, jaundice
- Nursing: monitor glucose, weight, temperature; support breastfeeding; watch for respiratory distress Respiratory Distress — Signs
Signs of Respiratory Distress (Silverman-Andersen)
- Tachypnea > 60 breaths/min
- Grunting (audible expiratory grunt)
- Nasal flaring
- Retractions: subcostal, intercostal, suprasternal
- Cyanosis (central)
- O saturation < 95%₂ RDS vs. TTN
RDS (Respiratory Distress Syndrome) TTN (Transient Tachypnea of the
Newborn)
Preterm infants (< 34 weeks most common) Term or near-term infants (especially C-section) Cause: surfactant deficiency → alveolar collapse Cause: retained fetal lung fluid (not cleared by birth canal squeeze) Surfactant replacement therapy (Survanta, Calfactant) Self-resolving: usually clears in 24–72 hours Prevention: betamethasone to mom before 34 wks delivery Treatment: supportive O , monitoring, feeding ₂ support Requires mechanical ventilation possibly (^) Usually only needs supplemental O₂
- ⚠ Betamethasone: given to mom 24–48 hrs before anticipated preterm birth (< 34 weeks) to accelerate fetal lung maturity (surfactant production). Priority indication = RDS prevention.
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed. Growth Classification Classification Definition Risks SGA — Symmetric Weight, length, AND head circumference all < 10th %ile Early insult; chromosomal, infection; poor long-term prognosis SGA — Asymmetric Weight < 10th %ile; length and FOC NORMAL Late insult (PIH, placental insufficiency); better prognosis LGA Weight > 90th %ile Maternal DM; birth trauma Neonatal Abstinence Syndrome (NAS)
NAS Signs & Management
- Signs: high-pitched cry, hypertonicity, tremors, poor sucking, vomiting, diarrhea, sneezing, seizures
- Scoring: Finnegan Neonatal Abstinence Scoring Tool (FNAST)
- Environment: quiet, dim room; swaddle; decrease stimulation; frequent small feedings
- Breastfeeding encouraged (unless HIV+ or active drug use) — helps decrease NAS severity • Medications if severe: oral morphine or methadone per protocol Necrotizing Enterocolitis (NEC)
NEC — Recognize and Act Fast!
- Signs: abdominal distension, bilious vomiting, bloody stools, absent bowel sounds, temperature instability
- At-risk: preterm infants, formula-fed infants
- Action: NPO immediately, NG tube to low intermittent suction, IV fluids, antibiotics, surgery if bowel perforated
- Prevention: breast milk feeding is protective Retinopathy of Prematurity (ROP)
- Caused by: high O levels → abnormal vessel growth in retina₂
- Prevention: maintain O sat 90–95% in preterm infants (avoid > 95%)₂
- Monitoring: ophthalmologic exams in all premature infants
- Treatment: laser therapy or anti-VEGF injections 14. COMPLICATIONS OF PREGNANCY Hemorrhagic Conditions Condition Key Signs Management Spontaneous Abortion (Miscarriage) Vaginal bleeding, cramping, passage of tissue; hCG declining Expectant/medical/surgical (D&C); Rhogam if Rh(-) (shoulder dystocia), hypoglycemia, C-section
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed.
Magnesium Sulfate — MUST KNOW!
- Uses: (1) Prevent/treat seizures in pre-eclampsia; (2) Tocolysis (stop preterm labor)
- Therapeutic level: 4–7 mEq/L (seizure prevention) / 6–8 mEq/L (tocolysis)
- SIGNS OF TOXICITY: loss of DTRs (first sign!), respiratory rate < 12, urinary output < 30 mL/hr, flushing, somnolence, respiratory arrest
- Nursing: check DTRs q1-2h, monitor RR and UO hourly, have CALCIUM GLUCONATE at bedside (antidote)
- ANTIDOTE: Calcium gluconate 1 g IV push (push slowly over 3 minutes)
- ⚠ STOP MgSO and give calcium gluconate if: RR < 12, absent DTRs, O sat falling ₄ ₂ Diabetes in Pregnancy Trimester Insulin Needs Rationale 1st Trimester DECREASED need (risk of hypoglycemia) hCG has mild insulin-like effect; nausea → less food intake 2nd & 3rd Trimester INCREASED need (insulin resistance rises) hPL and other placental hormones cause insulin resistance Postpartum DECREASED need sharply (back to pre-pregnancy) Placenta delivered → antiinsulin hormones gone; monitor closely
Glucose Challenge Test (GCT) Oral Glucose Tolerance Test (OGTT)
Done at 24–28 weeks for screening Done if GCT is abnormal; DIAGNOSTIC NO FASTING REQUIRED FASTING REQUIRED (8–14 hours NPO) 50g oral glucose; 1-hr blood glucose 100g oral glucose; blood drawn fasting, 1hr, 2hr, 3hr Abnormal: ≥140 mg/dL (some use 130) GDM if 2+ values exceed thresholds (CarpenterCoustan or NDDG) Infections During Pregnancy Infection Risk to Baby Management HIV Vertical transmission during ART during pregnancy; C- birth/breastfeeding section if VL > 1000; no breastfeeding Herpes (HSV) Neonatal herpes if active outbreak at birth C-section if active lesions or prodrome; acyclovir from 36 wks Group B Strep (GBS) Neonatal sepsis, meningitis, pneumonia Screen all at 35–37 weeks; IV penicillin G in labor if positive
HESI OB/PEDI Study Review | Maternal-Child Nursing 6th Ed.
- ★ GBS + mother: give IV Penicillin G in labor (NOT postpartum). If penicillin allergic: clindamycin or cefazolin per sensitivities
