RN VATI Maternal Newborn 2019 Study Guide (New) Maternal Newborn module reveiw, Exams of Nursing

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RN VATI Maternal Newborn 2019 Study Guide (New)

Maternal Newborn module reveiw

Nursing Care of the Acute and Chronically Ill Adult III (Hagerstown Community College)

RN VATI Maternal Newborn 66.7% Responding to a Client's Weight Gain During Pregnancy Should include dietary/dietician consult to help the patient. Planning Care for a Who Is Postpartum and Has Influenza Should keep the mom and newborn separated as mom is contagious. Checking Fundal Height Immediately after birth, the fundus should be firm, midline with the umbilicus, and approximately 2cm below the level of the umbilicus. At 12hrs postpartum the nurse should palpate the fundus at 1cm (0.4in) above the umbilicus. Every 24hrs the fundus should descend approximately 1-2cm (0.4-0.8in) It should be halfway between the symphysis pubis and the umbilicus by 6 days postpartum. Reporting Postpartum Complications Warm of one leg is an indicator of a possible DVT. The postpartum client is at greatest risk for a deep vein thrombosis that may lead to a pulmonary embolism. Identifying Risk Factors for Preeclampsia Although preeclampsia occurs primarily in first pregnancies, a woman who had preeclampsia in a previous pregnancy is seven times more likely to develop preeclampsia in a later pregnancy. Women with overweight or obesity are also more likely to have preeclampsia in more than one pregnancy. Women older than 40 are at higher risk. It tends to occur after 20 weeks of gestation. Signs and symptoms of preeclampsia include: proteinuria (>1+ dipstick urine protein or > mg/dL 24 hour urine protein, hypertension >140/90, two reading at least 4-6 hours apart), swelling in face, eyes, extremities, headaches, vision changes, etc. Identifying Contraindications for the Administration of Magnesium Sulfate Neuromuscular disease: use with extreme caution in patients with myasthenia gravis. Renal impairment: accumulation of magnesium may lead to magnesium intoxication. Immediately report signs of hypermagnesemia (confusion, slow movements, shortness of breath), Signs of hypocalcemia (muscle cramps, numbness). Identifying Medication for a Client Who Has a Hypersensitivity to Penicillin Tetracyclines (doxycycline), quinolones (ciprofloxacin), macrolides (clarithromycin), aminoglycosides (gentamicin) and glycopeptides (vancomycin) are all unrelated to penicillin’s and are safe to use in the penicillin allergic patient. Oral Glucose Tolerance Testing for a Client Who Is at 24 Weeks of Gestation Report dizziness during the test. Fasting before the test is necessary. Phenylketonuria Testing

A genetic disorder that causes central nervous system damage from toxic levels of the amino acid phenylalanine in the blood. All newborns are screened for this condition. A deficiency of the liver enzyme phenylalanine hydrolase, which is needed to convert phenylalanine to tyrosine. It is an autosomal recessive disorder. Phenylketonuria (PKU) clinical manifestations:

• • Digestive problems, feeding difficulties
• • Failure to thrive (growth failure)
• • Vomiting, and later progress to seizures
• • Musty odor in urine and severe intellectual disability
• • Older children have
• ~Eczema
• ~Hypertonia
• ~Hyperactive behavior
• ~Intellectual disability
• ~Hypopigmented hair, skin, and irises
• ~Commonly bizarre and schizoid behavior Assessment Findings for Hypoglycemia Expected range is between 30 and 60 mg/dL. Hypoglycemia is < 30 mg/dL during the first 3 days. If glucose levels are less than 25mg/dL in the first 4 hours; or less than 35mg/dL from 4 to 24 hrs, nurse should offer oral feedings to get blood glucose levels > 45 mg/dL.. IV dextrose can be given as well.
• ● Poor feeding
• ● Jitteriness/tremors
• ● Hypothermia
• ● Weak cry
• ● Lethargy
• ● Flaccid muscle tone
• ● Seizures/coma
• ● Irregular respirations
• ● Cyanosis
• ● Apnea Determining the Apgar Score The Apgar scoring system is divided into five categories. Each category receives a score of 0 to 2 points. At most, a child will receive an overall score of 10. However, a baby rarely scores a 10 in the first few moments of life. This is because most babies have blue hands or feet immediately after birth. A: Activity/muscle tone

• 0 points: limp or floppy
• 1 point: limbs flexed
• 2 points: active movement P: Pulse/heart rate
• 0 points: absent
• 1 point: less than 100 beats per minute
• 2 points: greater than 100 beats per minute G: Grimace (response to stimulation, such as suctioning the baby’s nose)
• 0 points: absent
• 1 point: facial movement/grimace with stimulation
• 2 points: cough or sneeze, cry and withdrawal of foot with stimulation A: Appearance (color)
• 0 points: blue, bluish-gray, or pale all over
• 1 point: body pink but extremities blue
• 2 points: pink all over R: Respiration/breathing
• 0 points: absent
• 1 point: irregular, weak crying
• 2 points: good, strong cry Expected Findings Following an External Cephalic Version What are some adverse outcomes from ECV (risks)? Heart rate abnormalities, Abruption, umbilical cord prolapse, rupture of membranes, stillbirth and feto-maternal hemorrhage (the more serious complications occur less than 1% of the time. Actions to Assist with an Amniocentesis
• Place in left lateral tilt position by placing wedge under left hip. Actions to Take Following a Cesarean Birth Immediate Postoperative Care (PACU) Nursing Actions
• • estimate blood loss (1 g=1 cc)
• • monitor I&O
• • active warming measures
• • newborn care, assessments & vaccinations First 24 Hours After Birth (Nursing Actions)
• • assess pain (use pharmacological & non-pharmacological methods to relieve then reassess pain)

• • monitor sensation
• • monitor for side effects from intrathecal morphine (puritus, nausea/vomiting, urinary retention, respiratory depression)
• • monitor for complications of anesthesia (postpartum hemorrhage, seizures, neurological deficits)
• • auscultate lungs
• • assess fundus & lochia
• • assess abdominal dressing
• • assess for paralytic ileus
• • monitor I&O
• • assist mother into comfortable position to feed newborn & help with care
• • emotional support Nursing Actions for a Newborn Who Has Hyperbilirubinemia
• Reassure parents that most neonates experience some degree of jaundice.
• Keep emergency equipment available when transfusing blood.
• Administer IVIG if hyperbilirubinemia is the result of blood-group isoimmunization.
• Anticipate the need for phototherapy, and prepare equipment for the treatment, if necessary.
• During phototherapy:
• Provide meticulous skin care.
• Expose as much of the neonate's skin to the lights as possible; have the neonate naked except for a diaper.
• Turn the neonate frequently.
• Shield the neonate's eyes to prevent damage to the retinas; remove the shields to allow eye contact with the parents when out of the lights, such as during feeding.
• Ensure that the neonate is positioned at a proper distance from the light source, usually 18" (46 cm) above the neonate's crib.
• Provide meticulous skin care.
• Expose as much of the neonate's skin to the lights as possible; have the neonate naked except for a diaper.
• Turn the neonate frequently.
• Shield the neonate's eyes to prevent damage to the retinas; remove the shields to allow eye contact with the parents when out of the lights, such as during feeding.
• Ensure that the neonate is positioned at a proper distance from the light source, usually 18" (46 cm) above the neonate's crib.
• Provide fluids as ordered.
• Obtain daily weights.
• Obtain specimens for laboratory testing, including serial serum bilirubin levels.
• Give Rho(D) immune globulin (human) to an Rh-negative mother after amniocentesis, during the third trimester, following delivery, or following a spontaneous or elective abortion to prevent hemolytic disease in subsequent neonates.

Predisposing Factors for Postpartum Infection Vaginal delivery assisted or otherwise. Cesarean section. The risk of infection is higher if the surgical procedure is performed after labor sets in. Prolonged labor. Internal examination of fetus during pregnancy. Vaginal examinations during pregnancy. Expected Findings for a Client Who Has Hyperemesis Gravidarum Persistent nausea and vomiting with complete inability to retain food and fluids. Patient also has significant weight loss of 5% pregnancy weight. Dehydration, electrolyte and acid/base imbalance and psychological factors. Dehydration: Dry tongue, dry mucous membranes, decreased turgor (elasticity) of skin. Scant/concentrated urine also known as ketosis and acetonuria. Medical Conditions: Priority Action for Client with Severe Preeclampsia A client who has progressed from preeclampsia to eclampsia requires delivery as soon as possible. Magnesium sulfate: This is a prophylactic treatment for clients with preeclampsia to prevent seizures. Liver inflammation: RUQ pain in pregnant clients with signs of preeclampsia is most often caused by liver inflammation. Management of Hypoglycemia for Newborns Who Are Small for Gestational Age Hypoglycemia often occurs in the early hours and days of life because of a lack of adequate glycogen synthesis and thus decreased glycogen stores and must be treated quickly with IV glucose. Newborn Assessment: Priority Action for Newborn Who Is Limp and Cyanotic Stabilize the body temperature or clear airway as indicated, administer oxygen, and if needed, prepare for resuscitation.