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MATERNITY FINAL REVIEW
NAEGELE’S RULE
● -3mos + 1 week + 1 year or + 9mos + 1 week
● PRETERM: 20-37 wks ● TERM: 37-42 weeks, with 39-40 weeks considered ideal for the baby’s health. ● POSTTERM: after 42 wks
BREAST CARE:
● Ensure baby is latched on correctly(areola should be cover completely) ● Report signs of mastitis ( cracked/sore nipples, erythema, flu-like symptoms) ● Breastfeeding produces oxytocin which helps the uterus contract and prevents hemorrhaging Breast engorgement: ➔ Empty breast completely after each feeding ➔ Apply warm compresses prior feeding & apply cool compresses after feeding Breastfeeding produces oxytocin which helps the uterus contract and prevents hemorrhaging Suppression of lactation: ➔ Wear a supportive bra ➔ Avoid breast stimulation & warm water on breasts
Apply fresh cold cabbage leaves to breasts to help with breast engorgement/ suppression of lactation
WEIGHT:
● 6-9 lbs at birth
● 2x the weight by 6 mos.
● 3x the weight by 1 yr.
● 4x the weight by 2 ½ yr / 30 mos.
HEMORRHAGE
● Vaginally- 500 ml blood loss ● C-section- 1,000 ml blood loss LOCHIA ● Rubra: 1-4 after delivery, dark red ● Serosa: 4-9 days after delivery, pinkish brown ● Alba: 11 days to 8wks after delivery, whitish or yellowish ➔ Excessive = saturation of perineal pad within 15 min ★ Be sure to check for pooling of blood under the buttocks!!
FUNDUS ASSESSMENT
● 12 hrs after delivery, fundus should be firm, midline & approx at the level of the umbilicus ● Fundus descends ~ 1cm/day ● If the fundus is displaced, have the patient empty their bladder ● If the fundus is boggy(soft), gently massage massage until it’s form( this expels clots)
GESTATIONAL DIABETES MELLITUS(GDM)
Impaired glucose tolerance during pregnancy s/s: asymptomatic. polyuria( excessive urination), polydispsia( increased thirst)
● Tx: diet modification, exercise, blood glucose monitoring
● Hypoglycemia s/s: cold & clammy
● Hyperglycemia s/s: warm & dry, fruity breath odor
Complications for the baby: ● Macrosomia( a large baby):can lead to low blood sugar( hypoglycemia) , birth injuries( shoulder dystocia)
PREECLAMPSIA
s/s: headache, blurred vision, epigastric pain , proteinuria Tx: Magnesium sulfate- treats all type of eclampsia & HELLP syndrome* help bring down B/P but can affect Respirations Magnesium sulfate toxicity= Calcium Gluconate is the antidote
PLACENTA PREVIA
s/s: painless bright red bleeding ● Placenta Previa is Painless
Tx: Betamethasone
NEWBORN HEAT REGULATION ( THERMOREGULATION)
Balance between heat loss & heat production
NC: Dry newborn immediately after birth & after bathing Swaddle & place a hat on the infant
ULTRASOUND
Non-invasive
Transvaginal: 1st trimester for obese pt , DOES NOT require a full bladder Abdominal: most useful after 1st trimester. REQUIRE a full bladder
NONSTRESS TEST (NST)
Non- invasive test done in 3rd trimester to measure FHR response to fetal movement
PT:
● Mom pushes a button when she feels fetal movement ● If the fetus is sleeping, a vibroacoustic device may be used to awaken them BIOPHYSICAL PROFILE (BPP) Non-invasive assessment of fetal well-being using U/S and NST Overall score: 8-10 is normal. <8 is indicative of fetal hypoxia
CONTRACTION STRESS TEST (CST)
Invasive test to measure FHR response to contractions
PT: to induce contractions, nipple stimulation or oxytocin may be used. Negative: Normal. 3 contractions in 10 mins Positive: Abnormal. Late decelerations
INFANT NUTRITION
● Hunger cues: hand to mouth motions, sucking, rooting or mouthing.
● Breastfed: after 6 mos, infants need iron-fortified cereal/foods
● Formula-fed: need iron-fortified formula for the first year of life, solid foods introduced around 4-6 mo and one at a time to rule out allergies
NEWBORN DEHYDRATION
● Sunken Fontanelle: appear sunken/depressed ● Dry mouth or lips ● Fewer wet diapers
UMBILICAL CORD CARE ( two arteries & one vein) ● Keep cord dry( sponge baths until cord falls off) ● Fold diaper under cord ● Monitor for infection (malodor, purulent drainage, moist/red cord)
PROLAPSED UMBILICAL CORD
- Call for assistance( MEDICAL EMERGENCY)
- Position mom knee chest or in trendelenburg( lay down and feet above level of heart
- Place a saline soaked towel over protruding umbilical cord
VACCINES
2 mo : B DR HIP 4 mo: DR HIP 6 mo : B DR HIP 12-18 mo: MAD HPV 4-6 yrs: Very DIM 11-12 yrs: Tada men have HPV
INFLUENZA after 6 mos & need a booster 1 month after
RHOGAM VACCINE
If mom its Rh -,administer Rh immune globulin at 28 weeks & within 72hrs of delivery if baby its Rh+
VACCINE SAFE IN PREGNANCY
● Flu, Tdap, RSV, and COVID-
FOLIC ACID
crucial for neurological development and for prevention of neural tube defects
HOW TO CHECK FETAL LUNGS MATURITY
Amniocentesis: Used to identify chromosomal abnormalities, neural tube defects, Rh incompatibility & fetal lung maturity
Performed between 15-18 wks gestation, empty bladder beforehand
⬆AFP = Neural tube defects ⬇ AFP= Down syndrome
MATERNAL TEACHING FOR UNPLEASANT SIDE EFFECTS
N/V: eat crackers before getting out of the bed in the morning, esta small/frequent meals & bland foods. Hemorrhoids: use warm sitz baths & witch hazel pads.Avoid straining during bowel movements
MILESTONES AGE PLAY APPROPRIATE
Birth-1: colorful pictures board books 1-3: push and pull toys 3-6: dress up clothes 6-12: board games
HOSPITALIZATION BASED ON AGE
● Encourage parental presence & participation for younger children ● Allow choices when possible ● Use therapeutic play techniques for younger children( a teddy to demonstrate procedures) ● Allow children to touch medical equipment ● Encourage peer interactions/wear street clothes for school age children and adolescents ● Perform painful procedures in a treatment room so the child’s room is a pain free site ● Put child in a room with kids who have similar conditions ● Keep babies near nurse stations
LARYNGOTRACHEOBRONCHITIS
s/s: Barking cough
LUMBAR PUNCTURE EDUCATION (POSITION)
● Pre-procedure: On their side in a fetal position or stretched over a table while sitting ( so back is arched)
● Pro-procedure: lay fat for several hours
PAVLEK HARNESS
● Gently massage under straps ● Place diaper under straps ● Assess skin frequently 2-3/day ● Avoid lotions/powders ● Do not adjust the harness yourself
INTRACRANIAL PRESSURE( ICP)
● Irritability ● Bulging fontanelle ● High-pitched cry ● ⬇ LOC
SEIZURE PRECAUTIONS AND CARE
● Seizure precautions: pad side rails, suction/oxygen equipment at bedside
● During seizure:
➔ Turn patient to side ➔ Do not put anything in the patient's mouth ➔ Do not restrain patient ➔ Loosen restrictive clothing ➔ Note onset & during of seizure
HYPERTROPHIC PYLORIC STENOSIS
projectile vomiting, olive-shaped mass (RUQ) Tx: pyloromyotomy
NURSE INTERVENTIONS FOR DIARRHEA & VOMITING
Tx: Oral rehydration solution, IV fluids/electrolytes HOW TO DX ICP
APPENDICITIS
s/s: RLQ pain(McBurney’s point) ● Monitor for rupture( sudden relief of pain)
OTITIS MEDIA
s/s: ear pain, irritability, fever, fluid drainage, and hearing difficulty
CLEFT LIP
Opening in the upper lip Feeding: use nipple with wide base, squeeze cheeks together during feeding
CLEFT PALATE
Opening in roof of the mouth Feeding: upright position, one way flow bottle & burp infant frequently
POST-OP: utilize elbow immobilizers to protect the site
NEPHROTIC SYNDROME
s/s: frothy urine & periorbital edema Monitor I&Os, daily weight & abdominal girth
ACUTE GLOMERULONEPHRITIS (AGN)
Common in school age children s/s: periobital edema, brown(cola-colored) urine , oliguria and hypertension Strict I&Os, Daily weight.
MED ORAL ROUTE
● Determine ability to swallow pills ● Hold infant in semi upright/reclining ● Provide atraumatic (if able to, mix with applesauce) ● Flavor medications
CAR SEAT
Rear facing until 2 yrs. Front facing over 2 yrs.
INFANT REFLEXES
SUCKING BIRTH TO 4 MO
INFANT BEINGS TO SUCK WHEN LIPS
ARE TOUCHED
BABINSKI REFLEX - BIRTH TO 1 YR
INFANT’S TOES FAN UPWARD AND OUT
WHEN THE SOLE OF THE FOOT IS
STROKED.
STEPPING - BIRTH TO 4 WKS
INFANT MAKES STEPPING
MOVEMENTS WHEN FEET ARE
TOUCHING A FLAT SURFACE
ROOTING - BIRTH TO 4 MO/ 2 MOS
INFANT TURNS HEAD AND OPENS
MOUTH WHEN CHEEK OR MOUTH ARE
STROKED
MORO/STARTLE BIRTH TO 6 MO
INFANT EXTENDS ARMS AND LEGS
THEN PULLS THEM IN TOWARD THE
BODY WITH A BRIEF CRY IN
RESPONSE TO A SENSATION OF
FALLING, LOUD NOISE OR SUDDEN
MOVEMENT
