Maternal Newborn and Women's Health: Key Concepts and Nursing Interventions, Exams of Nursing

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RN ATI Capstone Maternal Newborn and Women's Health Accurately Defined. Presumptive Signs of Pregnancy - ANSWER>>subjective amenorrhea, fatigue, n/v, urinary frequency, breast changes, quickening Probable Signs of Pregnancy - ANSWER>>objective cervical changes, Hegar's sign, Chadwick's sign, Goodell's sign, ballottment, braxton hick's contractions, positive pregnancy test Quickening - ANSWER>>slight fluttering movements of fetus felt by client, usually between 16-20 weeks Hegar's Sign - ANSWER>>softening of the lower uterine segment Chadwick's Sign - ANSWER>>bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion Goodell's Sign - ANSWER>>softening of the cervix Ballottement - ANSWER>>rebound of unengaged fetus Positive Signs of Pregnancy - ANSWER>>r/t presence of fetus fetal heart tones, visualization by ultrasound, fetal movement palpated by experienced examiner

First Trimester Symptoms - ANSWER>>n/v, breast tenderness, emotional lability, ambivalence towards pregnancy Second Trimester Symptoms - ANSWER>>slight reprieve from first trimester symptoms; renewed sense of energy Third Trimester Symptoms - ANSWER>>body prepares for childbirth; Braxton- Hicks; frequent urination; varicose veins; peripheral edema Nagele's Rule - ANSWER>>last menstrual period - 3 months + 7 days + 1 year Nonstress Test - ANSWER>>indications: assessing for wellbeing and an intact CNS during 3rd trimester, assessing fetus during a high-risk pregnancy interventions: seat client in reclining chair, semi-Fowler's or left lateral position with two belts and transducers on abdomen Reactive NST - ANSWER>>normal 2+ fetal heart rate accelerations within a 20 min period Nonreactive NST - ANSWER>>abnormal do contraction stress test or biophysical profile next Contraction Stress Test - ANSWER>>indications: nonreactive NST, high-risk pregnancies Negative CST - ANSWER>>normal

at least 3 uterine contractions in 10 mins w no late decelerations Positive CST - ANSWER>>abnormal late decelerations occur within 50% or more of contractions suggests uteroplacental insufficiency Biophysical Profile - ANSWER>>real-time US to visualize physiological characteristics of fetus assesses breathing, body movements, fetal HR, reactive FHR (NST), amniotic fluid volume RhoGAM - ANSWER>>give if mom is RH- When to Contact Provider in regards to Fetal Activity - ANSWER>>decreases or ceases entirely for 12 hrs Gravidity - ANSWER>># of pregnancies Parity - ANSWER>># of pregnancies that reach viability (20 weeks) GTPAL - ANSWER>>gravidity, term births (38 weeks), preterm births (20- 37 weeks), abortions/miscarriages, living children Teratogens - ANSWER>>warfarin, lithium, methimazole, phenytoin, tetracycline, antipsychotics, illegal drugs cigarettes & alcohol

thermal risks & radiation infections Group Beta Strep - ANSWER>>culture obtained around 35-36 weeks if positive - give IVPB penicillin during labor monitor newborn TORCH - ANSWER>>toxoplasmosis, other (hepatitis), rubella, cytomegalovirus, herpes TORCH Presentation - ANSWER>>flu-like symptoms, joint pain, rash, ocular findings Gestational Hypertension - ANSWER>>after 20 weeks 140/90 or more 2 separate times returns to baseline upon delivery Mild Preeclampsia - ANSWER>>same as GH but with proteinuria Severe Preeclampsia - ANSWER>>160/110 or more on 2 separate occasions proteinuria, oliguria, Cr elevated, cerebral or visual disturbance, hyperreflexia w/ ankle clonus, extensive edema, hepatic issues/ruq pain, thrombocytopenia, pulmonary/cardiac issues Eclampsia - ANSWER>>severe preeclampsia + seizure activity

HELLP Syndrome - ANSWER>>H - hemolysis resulting in anemia & jaundice EL - elevated liver enzymes & epigastric pain/nausea LP - low platelets Placenta Previa - ANSWER>>placenta implants completely or partially over cervical os bright red vaginal bleeding, painless, do not do a vaginal exam Abruptio Placentae - ANSWER>>premature separation of the placenta from the uterine wall risk factors: cocaine, trauma, preeclampsia, multiparity dark red bleeding, board-like & tender abdomen, prepare for immediate C section 6 P's of Labor & Delivery - ANSWER>>psyche, powers, passenger, presentation, position, passageway Effacement - ANSWER>>shortening & thinning of cervix goal = 100% Dilation - ANSWER>>opening of cervix Station - ANSWER>>relationship of presenting part to maternal ischial spines that measures the degree of descent of fetus negative = above ischial spines 0 = at ischial spine positive = below ischial spines

Characteristics of False Labor - ANSWER>>Braxton Hick's (irregular & don't intensify) no significant change in dilation or effacement no bloody show fetus not engaged in pelvis Characteristics of True Labor - ANSWER>>contractions regular and increase in intensity, felt in lower back and radiate to abdomen dilation & effacement progress bloody show presenting part of fetus engaged in pelvis First Stage of Labor - ANSWER>>cervix dilates from 0-10 cm 3 stages - latent, active, transitional Latent Phase - ANSWER>>0-3 cm talkative & excited Active Phase - ANSWER>>4-7 cm anxious & in pain Transitional Phase - ANSWER>>8-10 cm nausea, vomiting, irritability

Second Stage - ANSWER>>pushing stage, dilation through delivery of baby Third Stage - ANSWER>>after delivery of baby through delivery of placenta Fourth Stage - ANSWER>>1-2 hr after delivery of placenta VEAL CHOP MINE - ANSWER>>variable - cord compression - move client early - head compression - identify labor progress acceleration - okay - nothing late - placental insufficiency - execute actions immediately Oxytocin - ANSWER>>stimulates uterine contractions monitor mom & baby, stop if late decelerations or tachysystole Methylergonivine Maleate - ANSWER>>stimulates uterine contractions AFTER delivery & treats pp hemorrhage Calcium Gluconate - ANSWER>>antidote for magnesium sulfate toxicity Terbutaline - ANSWER>>tocolytic used for preterm labor Indomethacin - ANSWER>>tocolytic for preterm labor Magnesium Sulfate - ANSWER>>treatment of seizures & tocolytic to prevent preterm labor

use infusion control device, flushing is normal, monitor vitals & eclampsia symptoms, fluid restriction, monitor for toxicity - no DTRs, low urine output, respirations < 12, decreased LOC, cardiac dysrhythmia Betamethasone - ANSWER>>prevents respiratory distress of newborn who is going to be delivered premature Misoprostol - ANSWER>>preinducition cervical ripening Drugs that Augment Labor - ANSWER>>oxytocin, misoprostol Drugs that Stop Premature Labor - ANSWER>>terbutaline, indomethacin, magnesium sulfate Drugs for PP Hemorrhage - ANSWER>>oxytocin, methylergonivine, carboprost tromethamine Epidural - ANSWER>>local anesthetic along with analgesic morphine or fentanyl injected into epidural space at level of 4th or 5th lumbar vertebrae Contraindications for Epidural - ANSWER>>maternal hypotension, coagulopathy, infection at injection site, increased ICP, maternal inability to cooperate Amniotomy - ANSWER>>artificial rupture of membranes to initiate or improve contractions - increased risk of complications

Indications for Induction - ANSWER>>maternal issues, fetal or placental issues, inadequate uterine contractions Contraindications for Induction - ANSWER>>cephalopelvic disproportion, nonreassuring FHR, placenta previa, prior uterine surgery, active genital herpes, HIV, cervical cancer Episiotomy - ANSWER>>incision made into perineum to enlarge the vaginal outlet during delivery monitor for pain & infection, encourage Kegels, apply ice packs, encourage sitz baths & educate about peri-care Nursing Interventions: Prolapsed Cord - ANSWER>>call for assistance, notify provider with a sterile-gloved hand - insert 2 fingers into vagina and apply pressure on either side of cord to the fetal presenting part to elevate it off cord knee-chest position or Trendelenburg positiong administer oxygen 8-10 per nonrebreather if cord is protruding - wrap it loosely in sterile saline-soaked towel closely monitor FHR prepare for immediate birth (can be vaginal or C) Nursing Interventions: Fetal Distress - ANSWER>>>Stop oxytocin

Administer oxygen 8-10L via not rebreather mask Turn onto left side Increase IV fluids

Notify the provider Perform fetal scalp stimulation or vibroacoustic stimulation per protocol Main Goal/Risks of PP Period - ANSWER>>goal = prevent hemorrhage risks = hemorrhage, shock, infection Colostrum - ANSWER>>transitions to milk 48 - 96 hrs after delivery, very high nutrition Advantages to Breast Feeding - ANSWER>>sucking stimulates uterine contractions,

promotes involution, and increases milk production actively supports baby's immune system (IgA) Nursing Interventions: Engorgement (non-lactating) - ANSWER>>avoid nipple stimulation, cold compress, pain meds, supportive bra Nursing Interventions: Engorgement (lactating) - ANSWER>>manually express some milk to facilitate latch, frequent feeding or pumping (every 2-3 hrs), warm shower, breast massage, supportive bra, apply cold compresses or cabbage leaves in between feedings Uterine Involution - ANSWER>>good firm, fundus near umbilicus after delivery, descends 1 cm per day, breastfeeding helps it and full bladder is bad Uterine Subinvolution - ANSWER>>bad - it is not firming up

massage, frequent voiding, give oxytocin Endometritis - ANSWER>>begins 2nd-5th day PP more common after C pelvic pain, uterine tenderness, foul smelling or profuse lochia, fever, tachycardia, elevated WBC and ESR Mastitis - ANSWER>>usually unilateral, occurs 2-4 weeks after delivery chills, fever, malaise, local breast tenderness & erythema Initial Care of Newborn - ANSWER>>1. ABCs

2. thermoregulation (dry baby)
3. cord - should be 2 arteries & 1 vein, clamp it
4. APGAR APGAR - ANSWER>>2 is best heart rate, respiratory effort, muscle tone, reflex irritability, color 0 APGAR - ANSWER>>absent HR, no cry, flaccid muscle tone, no reflex, blue/pale 1 APGAR - ANSWER>>slow HR, slow & weak cry, some flexion of extremities, grimaces, pink w blue extremities Newborn HR - ANSWER>>100- 160

Newborn Respirations - ANSWER>>40- 60 Newborn Temperature - ANSWER>>37 degrees celsius Newborn BP - ANSWER>>60-80 / 40- 50 Newborn Head Circumference - ANSWER>>should be 2-3 cm greater than chest Use of Bulb Syringe - ANSWER>>suction mouth before nose Circumcision Care - ANSWER>>change diaper q 4 hrs, clean penis w warm water, for clamp procedures - apply petroleum jelly with each diaper change for 24 hrs, expect yellowish mucus over glans by day 2 and do not wash it off, don't clean w alcohol, will heal within 2 weeks Nursing Interventions: Drug/Alcohol Withdrawal in Newborns - ANSWER>>NAS score, assess reflexes, monitor ability to feed, monitor fluid/electrolytes, skin turgor, fontanelles, I&Os, observe behavior, maintain IV, reduce external stimuli, small & frequent feedings w/ high calorie foods, have suction immediately available Signs of Hypoglycemia - ANSWER>>poor feeding, jitteriness, hypothermia, diaphoresis, weak cry, lethargy, flaccid muscle tone, seizures/coma Nursing Interventions: Hypoglycemia - ANSWER>>heel stick w/in 2 hrs of birth, frequent oral feedings, monitor closely, monitor IV if baby can't orally feed

Physiologic Jaundice - ANSWER>>benign, caused by breakdown of fetal RBCs, excessive bruising, and liver immaturity appears after 24hrs Pathologic Jaundice - ANSWER>>indicates underlying disease - usually due to blood group compatibility between mom&baby or infection appears before 24hrs Nursing Interventions: Phototherapy - ANSWER>>eye mask, undressed (cover male genitals), avoid lotions or ointments, remove baby q 4 hrs, reposition q 2 hrs to expose all surfaces, turn off lights before drawing blood, temp q 4 hrs Points to Remember - ANSWER>>-never good to be late (late decels = bad)

• absent variability (straight line0 on on FHR monitor is bad
• never place laboring client flat on back
• unexplained pain is not good
• never provide fundal pressure with shoulder dytocia
• tachycardia = hemorrhage
• quick onset epigastric pain = seizure aura
• give oxygen 8-10 l/min through nonrebreather
• never do vaginal exam if there is unexplained bleeding
• if the client is bleeding there needs to be IV access
• unstable clients should be close to nurse's station