maternal ob remediation

Prioritize care to a client in labor: fetal distress

- Monitor VS & FHR - Left-side lying reclining position w legs elevated - 8-10 L/min O2 via face mask - DC oxytocin (Pitocin) - Inc IV fluid rate (tx hypotension) - Prepare for emergency C-section

Prioritize care to a client in labor: amniotic fluid embolism

- 8-10 L/min O2 - Intubate & mechanical ventilation - Cardiopulmonary resuscitiation - IV fluids - Side lying w pelvis tilted at a 30 degree angle (to displace uterus) - Blood products (correct coagulation failure) - Indwelling catheter (measure hourly output) - Monitor mom & baby status - Prepare for emergency C-section

Client in labor & RN observes late decelerations on the electronic fetal monitor. 1st action of nurse

- Assist client in left-lateral position (inc uteroplacental perfusion)

Provide postpartum care & education: sex

- Avoid sex until laceration is healed & vaginal discharge has turned white (lochia alba) - Takes 2-4 weeks - OTC lubes may be needed during the 1st 6 weeks - Physiological reactions to sex may be slower & less intense for 1st 3 mo after birth

Prioritize care to a client in labor: prolapsed umbilical cord

- Call for assistance stat & notify MD - Use sterile gloved hand, insert 2 fingers into vagina & apply finger pressure on either side of cord to the fetal presenting part to elevate it off of the cord - Reposition client in knee to chest, Trendelenburg, or a side-lying position w rolled towel under client's hip - Apply warm, sterile, saline soaked towel to visible cord (prevent drying & to maintain BF) - Provide CONTINUOUS electronic monitoring of FHR for variable decelerations (indicate fetal asphysia & hypoxia) - Administer O2 at 8-10L/min via face mask (improve fetal O2) - Initiate IV access & administer IV fluid bolus - Prepare for C-section (if other meas fail) - Educate client

Provide postpartum care & education: danger signs to report to MD

- Chills or fever > 100.4 for 2 or more days - Change in vaginal discharge with inc amount, large clots, change to a previous lochia color, & a foul odor - Episiotomy, laceration, or incision pain that doesn't resolve with analgesics, foul-smelling drainage, redness, and/or edema - Pain or tenderness in abdominal or pelvic aresa that does not resolve with analgesics - Breasts with localized areas of pain & tenderness w redness & swelling - Urination with burning, pain, frequency, urgency (urine that's cloudy or had blood) for newborn -- Chills or fever > 100.4 for 2 or more days -forceful or frequent vomiting -diarrhea or dec BM and urination -GFR > 15 sec -poor feeding -jaundice -cyanosis -lethargy, inconsolable cryung, dfficulty waking, bleeding, drainage

Provide postpartum care & education: perineal care

- Cleanse front to back with warm water after each voiding & bm - Blot perineal area from front to back - Remove & apply perineal pads from front to back

Fetal assessment during labor: Leopold maneuvers RN

- Client empty bladder - Supine position w pillow under head & knees flexed slightly - Wedge under right hip (displace uterus & prevent supine hypotension)

Prioritize care to a client in labor: Rupture of uterus

- Client says "ripping", "tearing", sharp pain - IV fluids - Blood product transfusions - Prepare for C-section - Inform pt

Provide postpartum care & education: activity

- DONT perform housework w heavy lifting for at least 3 weeks. DONT lift anything heavier than the baby. - Avoid sitting for prolonged periods with legs crossed (to prevent thrombophlebitis) - Limit stair climbing for 1st few weeks - C-section clients wait until 4-6 week follow up visit before performing strenuous exercise, heavy lifting, or excessive stair climbing - DONT drive for 1st 2 weeks or while taking opioids for pain control

Prioritize care to a client in labor: meconium stained amniotic fluid

- Document color & consistency of stained amniotic fluid - Notify neonatal resuscitation team to be present at birth - Gather equip needed - Follow designated suction protocol - Assess neonate's RR, muscle tone, & HR - Suction mouth & nose (if RR strong, muscle tone good, & HR > 100) - Suction below vocal cords (endotracheal tube before spontaneous breaths occur if RR depressed, muscle tone dec, HR<100)

Prioritize care to a client in labor: Dystocia

- Dysfunctional (difficult) labor - r/t 5 powers of labor (passenger, passageway, powers, position, & psychologic response) - Apply fetal scalp electrode &/or intrauterine pressure catheter - Amniotomy (artificial rupture of membranes) - Encourage pt to regular void to empty bladder - Encourage position changes to aid in fetal descent or to open up the pelvic outlet (pt on hands & knees to help fetus to rotate from a post to ant position) - Encourage pt to ambulate, hydrotherapy (enhance progression of labor) - Apply counterpressure on sacral area (alleviate discomfort) - Assist pt to beneficial position for pushing & coach her about how to bear down with contractions - Prepare for a possible forceps-assisted, vacuum assisted, or C-section - Continue to monitor FHR in resp

Prioritize care to a client in labor: Fetal distress present when

- FHR < 110 or > 160 - FHR shows dec or no variability - Fetal hyperactivity or no fetal activity

pp nutrition and exercise

- Kegel exercises (regain pelvic floor muscles) - Pelvic tilt exercises (strengthen back muscles & relieve strain on lower back) -- Diet high in protein (tissue repair) - 2-3L of fluid each day

car safety

- Rear-facing car seat in the back seat, preferably in the middle (away from airbags & side impact) - Keep infants in rear facing car seats until age 2 or until the child reaches max ht & wt for the seat - Do not use a used or 2nd hand car seat -45 degress -harness at or just below the shoulder -retainer clip at axillae

Provide postpartum care & education: Breast care for those lactating

- Well fitting, supportive bra - Hand hygiene prior to breastfeeding - To relieve breast engorgement, have the pt completely empty her breasts at each feeding -Allow baby to nurse on demand, which would be about 10 times in 24 hours - Massage breast during feeding can help with emptying - Alternate breasts with each feeding - For breast engorgement, apply cool compress between and after feedings & warm compresses prior to - For flat or inverted nipples, suggest client roll the nipples between her fingers just before -sore nipples put breast milk on nipple and allow to dry and encourage fluids

Prenatal Care: Managing Constipation

-2nd and 3rd trimester -drink 2-3 L of fluids -Eat diet high in fiber -exercise regularly

UTI NI and RF

-3 L day of water -cranberry,prune juice for acidification of urine -acetaminophren -clean catch urine sample -abx(can BF while taking them) -c-section -epidural anesthesia -foleys -frequent pelvic exams -hx of UTI

normal expectations for b/b for NB

-3 stools per day or with each feed, less for bottle fed -urinate 6-8 times per day/wet diapers

Medical Conditions: Reportable Findings for a Client who Is Receiving Magnesium Sulfate

-Absence of patellar deep tendon reflexes -Urine output less than 30 mL/hr -Respirations less than 12/min -Decreased level of conciseness -Cardiac dysrhythmias magnesium sulfate can be given to a patient who is experiencing preeclampsia as a anticonvulsant and to lower blood pressure magnesium sulfate is a high risk drug and the patient must be monitored closely if any of these signs are noted: discontinue IV immediately, administer calcium gluconate, prepare for actions of cardiac or respiratory arrest

Medical Conditions: Priority Client to Assess (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 9)

-Always assess patient with preeclampsia or eclampsia first -Signs of preeclampsia: consists of blood pressure that is 160/110 mm Hg or greater, proteinuria greater than 3+, oliguria, elevated serum creatinine greater than 1.1 mg/dL, cerebral or visual disturbances (headache and blurred vision), hyperreflexia with possible ankle clonus, pulmonary or cardiac involvement, extensive peripheral edema, hepatic dysfunction, epigastric and right upper-quadrant pain, and thrombocytopenia -Signs of eclampsia: evere preeclampsia manifestations with the onset of seizure activity or coma. Eclampsia is usually preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentrations, which are warning signs of probable convulsions

Therapeutic Procedures to Assist with Labor and Delivery: Indications for Amnioinfusion (Active Learning Template - Therapeutic Procedure, RM MN RN 10.0 Chp 15)

-An amnioinfusion is indicated for cord compression -Oligohydramnios (scant amount or absence of amniotic fluid) caused by any of the following: Uteroplacental insufficiency, Premature rupture of membranes, or Postmaturity of the fetus -Fetal cord compression secondary to postmaturity of fetus (macrosomic, large body), which places the fetus at risk for variable deceleration from cord compression

Medical Conditions: Provide Care for Client Experiencing Preeclampsia (Chapter 9)

-Asses LOC -obtain pulse oximetry -monitor urine output and obtain a clean-catch urine sample to assess proteinuria -obtain daily weights -monitor vital signs -encourage lateral positioning -perform NST and daily kick counts -monitor I & O

Postpartum Disorders: Priority Intervention for Preeclampsia (Chapter 20)

-Assess clients LOC -establish baseline data -administer IV magnesium sulfate (antidote calcium) -monitor FHR tracing for rate, baseline variability and absence of late deceleration's -monitor vital signs 1. Assess the client's level of consciousness 2. Obtain pulse oximetry 3. Monitor urine output and obtain a clean-catch urine sample to assess for proteinuria 4. Obtain daily weights 5. Monitor vital signs 6. Encourage lateral positioning 7. Perform NST and daily kick counts as prescribed 8. Instruct the client to monitor I & O

Medical Conditions: Caring for Client who is Receiving Magnesium Sulfate

-Assess level of consciousness -Obtain pulse oximetry -Monitor urine output and obtain a clean-catch urine sample to assess for proteinuria -Obtain daily weights -Monitor vital signs (especially blood pressure) -Encourage lateral positioning -Perform NST and daily kid counts -Instruct the client to monitor I&O.

Infections: Treatment for Gonorrhea

-Bacterial infection that is primarily spread by genital-to-gentital or oral-to-genital contact. -Treated with Ceftriaxone IM and azithromycin PO. -Identify and treat all partners -cefriaxone (Rocephin) IM and azithromycin (zithromax) PO for gonorrhea...one dose prescription, broad-spectrum antibiotics, bactericidal action -Instruct client to repeat culture to assess for medication effectiveness -Provide client education regarding disease transmission -Educate client regarding safe sex practices Ceftriaxone (Rocephin) IM and azithromycin (Zithromax) PO for gonorrhea One dose prescription Broad-spectrum antibiotic Bactericidal action Client education: instruct the client to take entire prescription as prescribed, to repeat the culture to assess for medication effectiveness, educate the client regarding safe sex practices

Complications Related to the Labor Process: Prioritize Care to the Client in Labor (Chapter 16-Basic learning concept

-Call for assistance immediately -Notify provider -Using a sterile glove, insert 2 fingers into vagina and apply pressure on either side of cord to fetal presenting part to relieve pressure -Reposition in high Trendelenberg or side-lying poition with rolled towel -apply warm sterile saline-soaked towel to visible cord -provide continuous FHR monitoring, check for late decels

Pain Management: Nonpharmacological Comfort Measures (Chapter 12)

-Childbirth preparation education (Lamaze), sensory and cutaneous strategies (aromatherapy, breathing techniques, imagery, music, use of focal points, subdued lighting, massage effleurage, sacral counterpressure, heat/cold therapy, hydrotherapy, acupressure -Frequent maternal position changes (semi-siting, squatting, kneeling, rocking, supine with placement of wedge)

Fetal Assessment During Labor: Monitoring Fetal Heart Rate (Chapter 13-Active learning template

-Continuous external fetal monitoring: secure ultrasound transducer over abdomen to determine PMI (record FHR pattern) -Tocotransducer: on fundus that records uterine contraction -Advantages: noninvasive, reduces risk for infection, membranes don't have to be ruptured, cervix does not need to be dilated -Disadvantages: contraction intensity is not measurable, quality of recording is affected by obesity and fetal position

Early Onset of Labor: Adverse Effects of Magnesium Sulfate (Active Learning Template - Medication, RM MN RN 10.0 Chp 10)

-Discontinue tocolytic therapy immediately if the client exhibits manifestations of pulmonary edema, which includes chest pain, shortness of breath, respiratory distress, audible wheezing and crackles, and a productive cough containing blood-tinged sputum -Monitor for magnesium sulfate toxicity, and discontinue for any of the following adverse effects: loss of deep tendon reflexes, urinary output less than 30 mL/hr, respiratory depression (less than 12/min), pulmonary edema, and chest pain -Administer calcium gluconate or calcium chloride as an antidote for magnesium sulfate toxicity

Nursing Care and Discharge Teaching: Newborn Hygiene (Chapter 26-Active learning template)

-Do not use lotions, oils, or powders, because they can alter a newborn's skin and provide a medium for bacterial growth or cause an allergic reaction -Diaper area should be kept clean and dry. Diapers should be changed frequently, and the perineal area cleaned with warm water or wiped and dried thoroughly -Hot water eater should be set at 40 degrees Celsius (120.2 F) or less -Room should be warm, and bath water should be at 36.6 to 37.2 C (98 to 99 F) -Use mile soap that does not contain hexachlorophene -do not bathe after feeding -assessment NB within 72 afterbirth -feed 8-12 times in 24 hrs (on demand or every 2-3 hrs), awaken to feed q 3hrs during day, q4hrs at night, bottle fed q 3-4 hrs -do not form a set schedule for feeding -wash clothes separately with mild detergent and hot water After the initial bath, the newborn's face, diaper area, and skin folds are cleansed daily. Complete bathing is performed 2 to 3 times a week using a mild soap that does not contain hexachlorophene. Teach the parents proper newborn bathing techniques by a demonstration. Bathing should be at the convenience of the parents, but not immediately after feeding to prevent spitting up and vomiting. Organize equipment so that the newborn is never unattended. Make sure the hot water is set at 49 C or 120C or less. Avoid drafts in the room, dry newborn right after bathing.

Prenatal Care: Prioritizing Client Assessment (Establishing Priorities)

-Education and assessment -For client's history, the nurse should ask about reproductive/obstetrical, medical, nutritional, family, psychosocial history and current health issues, medications, and exercise/lifestyle -The nurse should also ask about environmental risk factors and risk of abuse or if there is a history of it -Ask about birth plan -Initial prenatal: calculate due date, history, head to toe assessment, and labs -other visits: monitor mom's weight/vitals/edema, monitor fetal development (FHR/fundal measurement), provide education -Rh negative moms get RhO (D) immune globulin IM around 28 weeks -educate about first, second, and third trimesters - educate about common discomforts and danger signs! -danger signs: burning on urination, hyperemesis gravidarum,diarrhea, fever, abdominal cramps, gush of fluid from vagina, vaginal bleeding, decrease fetal movement, headaches, elevated temp, blurred vision, edema on face and hands, epigastric pain, signs of hyper or hypoglycemia.

Baby-Friendly Care: Therapeutic Communication Concerning Role Transition (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 18)

-Emphasize verbal and nonverbal communication skills between the client, caregivers, and the infant -Provide frequent praise, support, and reassurance to the client as she moves toward independence in caring for her infant and adjusting to her maternal role -Encourage continued support of grandparents and other family members -Encourage parents to express feelings, fears, and anxieties about caring for the infant

Nursing Care of Newborns: Security Planning (Security Plan)

-Hugs tags and identification bands -baby has two identifiers to prevent them from being given to wrong parents, switched or abducted -Newborn, mother, and mother's partner all have wristbands on that identify that they all belong together -these bands have permanent locks and must be cut off -the identification bands have the newborn's name, sex, date, and time of birth, and mother's health record number -one band on newborn's ankle and the other is on the wrist -mom's thumb prints and baby's footprints are also taken -each time the newborn is given to the parents, the identification band needs to be verified adjacent the mother's identification band -facility staff are wearing badges with photo identification on them -Newborn should not be given to anyone without a photo ID badge -Facilities are usually locked and staff permits exit and entrance

Nursing Care During Stages of Labor: Identifying the Need for Reassessment

-If there are late declarations, if baby is tachycardic or bradycardia each different stage of labor calls for different assessments of the mom stage one should focus on rupture of membranes, bladder distention, temperature, and FHR stage two should focus on BP, HR, and RR every 5-30 minutes, uterine contractions, pushing efforts by client, increase in bloody show, shaking of extremities stage three is focused on BP, HR, and RR every 15 min, clinical findings of seperation of placenta, vaginal fullness exam stage four should focus on assessing maternal vital signs to a steady state Reference: RN Maternal Newborn Nursing Ch. 14

Nutrition During Pregnancy: Teaching a Client Who Has Phenylketonuria (Active Learning Template - System Disorder, RM MN RN 10.0 Chp 5)

-It is important for the client to resume the PKU diet for at least 3 months prior to pregnancy and continue the diet throughout pregnancy. (The diet includes foods that are low in phenylalanine. Foods high in protein, such as fish, poultry, meat, eggs, nuts, and dairy products, must be avoided due to high phenylalanine levels. Aspartame, which contains phenylalanine, should be avoided by pregnant women who have PKU) -The client's blood phenylalanine levels are monitored during pregnancy -These interventions can prevent fetal complications such as mental retardation and behavioral problems

Contraception: Teaching About the Basal Body Temperature Method

-Measure oral temp prior to getting out of bed each morning to monitor ovulation -Temperature can drop slightly at the time of ovulation basal body temperature method can be a use of contraceptive temperature can drop slightly during time of ovulation patient should meauser oral temperature prior to getting out of bed each morning to monitor ovulation advantages include inexpensive, convenient, and no adverse side effects Reference: RN Maternal Newborn Nursing Ch. 1

Newborn Assessment: Eliciting Newborn Reflexes (Active Learning Template - Nursing Skill, RM MN RN 10.0 Chp 23)

-Moro reflex: Elicit by allowing the head and trunk of the newborn in a semisitting position to fall backward to an angle of at least 30°. The newborn will symmetrically extend and then abduct the arms at the elbows and fingers spread to form a "C" -Tonic neck reflex (fencer position): With newborn in supine, neutral position, examiner turns newborn's head quickly to one side. The newborn's arm and leg on that side extend and opposing arm and leg flex. -Babinski reflex: Elicit by stroking outer edge of sole of the foot, moving up toward toes. Toes will fan upward and out

Prenatal Care: Client Teaching About Managing Nausea and Vomiting (Ante/Intra/Postpartum and Newborn Care)

-N and V are common discomforts of pregnancy -might occur during first trimester -patient should try to avoid having an empty stomach -patient should avoid having spicy, greasy, or gas-forming foods -encourage fluid intake between meals -patient should eat crackers or dry toast 30 minutes to 1 hour before rising in the morning to relieve discomfort

Newborn Nutrition: Evaluating Teaching of Bottle Feeding (Chapter 25-Growth and Development)

-Newborn should be fed every 3 to 4 hours (awaken every 3 hours during the day and at least every 4 hours during the night) -use tap water to mix concentrated or powder formula -should not be placed in supine position because of risk of aspiration (held at 45 angle) -keep the nipple filled with formula to prevent newborn from swallowing air -place on back after feedings

Prenatal care: Assessing Fetal Heart Rate During Routine Prenatal Exams (Chapter 4-Nursing skills)

-Nonstress test: most widely used antepartum evaluation of fetal well-being performed during the third trimester -NST interpreted as reactive if FHR is normal baseline rate with moderate variability, accelerates to 15 BPM forat least 15 seconds and occurs two or more times during a 20 min period

Therapeutic Procedures to Assist with Labor and Delivery: Labor Induction Using Oxytocin

-Obtain client's informed consent -Baseline date needs to be obtained before cervical-repining agents are used -The nurse may initiate oxytocin 6-12 hrs after the administration of the prostaglandin -Before oxytocin is administered, it is essential that the nurse conform that the fetus is engaged in the birth canal at minimum station of 0. -After oxytocin is administered, assessment should be done ever 30-60 minutes. -Monitor FHR and contraction pattern every 15 min and with every change in dose. -Assess fluid intake and urinary output -A Bishop score should be obtained prior to induction

Contraception: Contraindications for Thrombophlebitis (Chapter 1)

-Oral contraceptive pill -Do not massage area -limited movement (often on bedrest) -avoid placing knees in sharply flexed position

labs for DIC and ITP

-PT prolonged -platelets: dec -fibrinogen dec d-dimer: inc -fibrin split product_ inc NI: -splenectomy for ITP if no response to medical mgmt -hysterectomy for DIC -monitor UOP, may need foley for DIC: o2, fluid volume replacement, vasoactive meds, utertonic agents

Labor and Delivery Process: Teaching Findings of False Labor

-Painless, irregular frequency, and intermittent contractions -Contractions decrease in frequency, duration, and intensity with walking or position changes -Contractions are felt in lower back or abdomen above umbilicus -Contractions often stop with sleep or comfort measures such as oral hydration or emptying of the bladder -The cervix has no significant changes in dilation or effacement -The cervix often remains in posterior position -The cervix has no bloody show -The presenting part of the fetus is not engaged in the pelvis.

Fetal Assessment During Labor: Late Decelerations in Fetal Heart Rate

-Place client in side-lying position -Insert IV and increase rate of infusion -Discontinue oxytocin -Administer O2 by mask at 8-10 L/min via nonrebreather face mask -Elevate client's legs -notify provider, prepare for assisted vaginal birth or c-section. -Defintion: Slowing of FHR after contraction has started with return to FHR to baseline well after contraction has ended. -Can be caused by: Uteroplacentral insufficiency causing inadequate fetal oxygenation, maternal hypotension, placenta prevue, abrupt placentae, uterine hyper stimulation with oxytocin, preeclampsia, post-term pregnancy, maternal diabetes mellitus.

Assessment and Management of Newborn Complications: Findings for Hypoglycemia (Active Learning Template - System Disorder, RM MN RN 10.0 Chp 27)

-Poor feeding,Jitteriness/tremors, Hypothermia, Diaphoresis, Weak cry -Lethargy, Flaccid muscle tone, Seizures/coma -Irregular respirations, Cyanosis, Apnea

Expected Physiological Changes During Pregnancy: Presumptive Signs of Pregnancy

-Presumptive Signs of Pregnancy are changes that the women experiences -subjective symptoms or objective signs -signs could also be related to things other than pregnancy, such as peristalsis, infections, stress) -they include..... ---amenorrhea (absence of menstruation) ---fatigue ---nausea and vomiting ---urinary frequency ---breast changes (darkened areolae, enlarged montgomery's glands) ---quickening (slight fluttering movements of the fetus felt by a woman, usually between 16-20 weeks of gestation) ---uterine enlargement

Infections: Caring for a Newborn Whose Mother has HIV (Chapter 8-Active learning template)q

-Provide counseling prior to and after testing -Refer client for a mental health consultation, legal assistance, and financial resources -administer antiviral prophylaxis, triple-drug antiviral, or highly active antiretroviral therapy (HAART) as prescribed -encourage vaccination against hepatitis B, pneumococcal infection, Haemophilius influenzae type B and viral influenza -Infant should be bathed after birth before remaining with mother

Assessment of Fetal Well-Being: Teaching About RhoGAM

-RhoGAM is giving to Rh- moms at 28 weeks gestation, or after an amniocentesis, and then after delivery -Protects mom against baby's blood of baby is Rh+

Prenatal Care: Reportable Laboratory Findings

-Rubella -Hep B -HIV

Pain Management: Evaluating a Client's Understanding of Pain Management (Chapter 12)

-Teach client about techniques to promote pain management -patterned breathing and progressive relaxation techniques

Nursing Care and Discharge Teaching: Teaching About Newborn Home Safety (Home Safety)

-The baby should never be left unattended with pets or small children -keep small objects out of reach -Do not leave a newborn alone on bed, couch, or table because they could fall off -educate about safe sleep (alone, on back, firm surface ) -do not put anything around the baby's neck -Crib safety--including being placed on an inner wall for temperature regulation. -make sure smoke detectors are working in your home -be within arms reach when baby is placed on a higher surface -avoid smoke exposure -infection control with hand washing -Do not toss the baby in the air or swing him/her by their extremities -provide community resources

Prenatal Care: Auscultating for Fetal Heart Rate (Active Learning Template - Nursing Skill, RM MN RN 10.0 Chp 4)

-The heartbeat can be heard by Doppler late in the first trimester -Listen at the midline, right above the symphysis pubis, by holding the Doppler firmly on the abdomen -FHR can be detected at early appointments by ultrasound

Nursing Care of Newborns: Ensure Identification of Newborns

-The newborn, mother, and mother's partner are identified by plastic identification wristbands with permanent locks that must be cut to be removed. -Identification bands include the newborn's name, sex, date, and time of birth, and mother's health record number. -The newborn has one band placed on the ankle and one on the wrist. -In addition, the newborn's footprints and the mother's thumb prints are taken. The above information is also included with the footprint sheet. -Each time the newborn is given to the parents, the identification band should be verified against the mother's identification band. -sensor device on ID band or cord clamp that sounds alarm when infant is removed from facility

Newborn Assessment: Obtaining Infant's Measurements (Chapter 23)

-Weight: 2500-4000g -Length: 45-55cm (18-22in) -Head circumference: 32-36.8cm (12.6-14.5in) -Chest circumference: 30-33cm (12-13 in) -measure crown to heel of foot for length -measure head circumference at greatest diameter (occipital to frontal) -measure chest beginning at nipple line -measure abdomen above umbilicus

Nursing Care During Stages of Labor: Priority Assessment Following an Amniotomy (Potential for Complications from Surgical Procedures and Health Alterations)

-artificial ROM -used to induce labor -labor usually begins 12 hours after AROM --Priorities -reassess the FHR and pattern--look for signs of cord prolapse evidenced by variable or late decelerations -record time of procedure -assess color, odor, and consistency of fluid -assess how mom is tolerating it -assess women's temperature every 2 hours -look for signs of infection

gestational age

-assessment performed within first 48 hrs ballard scale: -measures neuromuscular and physical maturity -pg 156 -AGA: wt is between 10 and 90th % -LBW: 2500 g or less -term: 37-42 weeks -postmature: after 42 but evidence of placental insufficiency

FTT

-below 5th % -massage breast during feeding and evaluate latch -if spitting up, baby might have allergy and mom may need to eliminate dairy from diet

Postpartum Disorders: Identifying Risks Factors for Postpartum Hemorrhage

-blood loss of 500(vag)-1000ml (c-section) ***RIP PAM Retained placental fragments (indicated by uterine atony, subinvolution, or inversion of the uterus). risk factors for postpartum hemorrhage include: uterine atony, overdistended uterus, previous history of uterine atony, prolonged labo, high parity, ruptured uterus, complications during pregnancy, precipitous delivery, magnesium sulfate therapy during labor, lacertations and hematomas, inversion of uterus, retained placental fragments, subinvolution of the uterus, and coagulopathies findings: -boggy -blood clots bigger than a quarter -pad saturation in less than 15 min -tachy, HOTN -oliguria -pale clammy skin

Newborn Nutrition: Safe Handling of Breast Milk

-breastfeeding should occur 8-12 times per q 24hr -colostrum till day 3, contains iga(reduces risk of infection, -Breast milk can be stored at room temperature under very clean conditions for up to 8hrs -It can be refrigerated in sterile bottles for use within 8 days, or can be frozen in fertile containers in the freezer compartment of fridge for up to 6 months. Can be stored in a deep freezer for 12 months. -Thawing the milk in the fridge for 24hrs in the best way to preserve the immunoglobulins present in it. It can also be thawed by running lukewarm water over it. -Do not thaw in microwave -Do not refreeze thawed milk -Used portions of breast milk must be discarded -wt loss 5-10% after rebirth, regain 10-14 days -gain of 110-200g/week for first 3 mo -100-140ml/kg/24 hrs, first 3 mo 110, 3-6mo dec 100(20 kcal/oz) -40-50% carbs, 15% fats -2.25-4 g/kg/day of protein -400 IU vit d per day -adequate iron for BF babies up to 6mo, after 6 mo iron-fortified cereal, for bottle fed should have iron fortified until 12mo -fluoride supplements after 6mo -solid foods not introduced until 6mo, or allergies can develop

Newborn Assessment: Assigning Apgar Score (Chapter 23)

-brief physical exam done immediately following birth to rule out abnormalities (1 and 5 min of life) scoring: -0-3= severe distress -4-6= moderate distress -7-10= no distress components: -heart rate- absent (0), less than 100 (1) >100 (2) RR- Absent (0), slow, weak cry (1), good cry (2) Muscle tone- flaccid (0), some flexion(1), well-flexed(2) Reflex irr. - none (0), grimace(1), cry (2) color- blue, pale (0), acrocyanosis(1), pink(2)

mandatory screening for NB

-capillary heel stick done 24 hrs after birth, requires formula or breast milk for 24 hrs prior to heelstick, if d/c before 24 hrs do test in 1-2 weeks -PKU: leads to retardation, tx in first 2 mo of life can prevent htis -serum bili prior to d/c -hearing screening(mandated in most states)

CI for OCP

-cholecystitis -HTN -thrombophelbitis -migraines

Ante/Intra/Postpartum and Newborn Care Nursing Care of Newborns: Preventing Diaper Rash (RN QSEN - Patient-centered Care, Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 24)

-clean and dry -change q 4 hrs

Assessment of Fetal Well-Being: Planning for Diagnostic Testing After a Positive Contraction Stress Test (Diagnostic Tests)

-contaction stress test uses nipple-stimulation or oxytocin to stimulate contractions -iv fluids -negative is normal finding which means there are no late decelerations of the FHR during the procedure -positive is an abnormal finding --means that there is persistent and consistent late decelerations with 50% or more of the contractions -suggest uteroplacental insufficiency -variable decelerations may mean that the cord is compressed -early decelerations can indicate fetal head compression -provider may induce labor or do a c-section -a complication would be a preterm labor.. but benefits of having a preterm baby are greater than the risks at this point

Therapeutic Procedures to Assist with Labor and Delivery: Vacuum-Assisted Delivery (Chapter 15)

-cuplike suction device attached to fetal head, traction is applied -indications: maternal exhaustion and ineffective pushing efforts, fetal distress during second stage of labor -Conditions for use: vertex presentation, absence of cephalopelvic disproportion, ROM -Risks: lacerations, subdural hematoma, cephalohematoma, maternal lacerations to cervix, vagina and perineum 1. Provide client and partner with support and education regarding procedure. 2. Assist client to lithotomy position and allow for sufficient traction of the vacuum cup when it is applied to fetal head. 3. Assess and record FHR before and during vacuum assistance. 4. Assess for bladder distention, and catheterize if necessary. 5. Prepare for a forceps-assisted birth if a vacuum-assisted birth is not successful. 6. Alert postpartum care providers that vacuum assistance was used. 7. Observe neonate for lacerations, cephalohematoma, or subdural hematoma after delivery. 8. Check the neonate for caput succedaneum (normal occurrence and should resolve within 24 hours)

extrauterine life

-cutting of the umbilical cord is the most critical adjustment because the baby establishes respiratory function as it takes its first breaths and the shunts close

ways to help involution

-early ambulation -frequent voiding -breastfeeding

Nursing Care of Newborns: Teaching About Universal Newborn Screening (Laboratory Values)

-educate parents on purpose--looks for genetic diseases that can result in severe health issues--allows for early detection -nurse can explain procedures to patient -24 newborn bundle -newborn hearing screening -CCHD -collection of specimens by heelstick, venipuncture or urine -capillary heel stick done 24 hrs after birth, requires formula or breast milk for 24 hrs prior to heelstick, if d/c before 24 hrs do test in 1-2 weeks educate on normal lab values: --hemoglobin 14-24 g/dl --hematocrit 44-64% --RBC 4.8 x 10^6 to 7.1 x 10^6/ul --platelets 150,000 to 300,000 mm3 --wbc 9000- 30,000 --bilirubin at 24 hours should be 2-6, 48 hours: 6-7, 3-5 days: 4-6 -glucose: 40-60

Postpartum Physiological Adaptations: Identifying a Contraindication for a Prescription (Adverse Effects/Contraindications/Side Effects/Interactions)

-enemas and suppository should not be prescribed for patients with third or fourth degree perineal lacerations -ferrous sulfate can be prescribed to supply iron to the body to help produce more RBCs but it a contraindication for it is lactation.

Fetal Assessment During Labor: Identifying the Steps of Leopold Maneuvers (Ante/Intra/Postpartum and Newborn Care)

-external palpations of the maternal uterus through the abdominal wall to determine: --number of fetuses --presenting part, fetal lie, and fetal attitude --degree of decent of the presenting part into the pelvis --location of the fetus's back to assess for fetal heart tones -Steps: ---identify fetal part in fundus ---fetal lie (longitudinal or transverse and presentation (vertex or breech) ---head should feel round, firm, and moveable if the baby is in vertex ---fundus will feels soft if its breech ---distinguish back from arms and legs (back will feel long and smooth and arms and legs will feel lumpy) ---identify the descent of the fetus into the pelvis--what is presenting part and what is the attitude of it (flexed or extended) ---face the client's feet and outline the fetal head using the palmar surgical of the fingertips to palpate cephalic prominence. -can also use FHR post-maeuvesr to assess the fetal tolerance to the procedure -DOCUMENT

Nursing Care of Newborns: Assessing Pain (Pharmacological Pain Management)

-facilities usually have their own protocol for assessing infant pain -newborn may cry, whimper, and groan -facial expressions: grimace, chin quivering, eyes tightly closed -body: limb withdrawal, thrashing, flaccidity, fist clenching -change in sleep-wake cycles, feeing, activity, and fussiness -heart rate and BP increases -rapid and shallow respirations -pharmacologic management: --local anesthesia for circumcision and test tube insertion --topical anesthesia for circumcision, lumbar puncture, venipuncture, and heal sticks --non-opioid analgesia is for mild-moderate pain from inflammatory conditions --morphine and fentanyl are most widely used opioid analgesics other: epidural infusion, local and regional nerve blocks, and intra-dermal or topical anesthetics

Grief, Loss, and Palliative Care: Caring for a Client Who Has Experienced a Fetal Death (Grief and Loss)

-fetal death is defined by being death before birth but after 20 weeks gestation -perinatal palliative care (a model used when fetal death or stillbirth is expected) -provide supportive interventions -understand their feelings and the meaning of that pregnancy -understand cultural aspects that influence the meaning of loss -determine her social support network once she is to return home -assist with arrangements for newborn -understand common reactions to grief because the patient you are caring for may process grief differently

findings to report pp

-fever of 100.3 for 2 or more days -redness, tenderness or pain in breasts, incision pain, abdomen, pelvis, calves, -UTI

Postpartum Infections: Assessing Laboratory Values (Ante/Intra/Postpartum and Newborn Care)

-fever over 100.4*F or higher for 2 consecutive days during the first 10 days postpartum are a sign of infection -Test:::: ----blood, intracervical, or intrauterine bacterial cultures to see what type of organism is causing the infection ----elevated white blood cells (leukocytosis) ----red blood cell sedimentation rate is increased ----also look for signs of abeam with RBC count

16. Complications of the Newborn: Hypoglycemia Pg. 245

-findings: RD, hypotonia, poor feeding, hypothermia • Hypoglycemia is a serum glucose level of less than 40 mg/dL for term newborns occurring in the first 3 days of life and less than 25 mg/dL for preterm newborns. • Untreated hypoglycemia can result in seizures, brain damage, and/or death.

formula

-for concentrated formula: shake b4 opening, adn wash the lid with hot soapy water -tap water -45 degrees, semi upright -burp after every 1/2 oz -keep nipple ful -can be refrigerated up to 48 hours -always hold bottle, never prop -discard after or any unused -evaluate flow

non breast feeders

-form fitted bra 1st 72 hours -cool compresses 15 min on and 45 off for breast engorgement -cold cabbage leaves -avoid warm water over breasts and breast stimlation

Infections: Nursing Action for a Client Who Has Parvovirus B19 (Fifth Disease) (Standard Precautions/Transmission-Based Precautions/Surgical Asepsis )

-has definable facial characteristics -closely monitor fetus to see if there is a development of fetal hydrops (abnormal accumulation of fluid-severe) -monitor this by ultrasounds -treat anemia by intrauterine transfusion -educate patient on risks -infection can result in miscarriage, fetal anemia, hydrop fetalis, IUGR, or stillbirth

distinguish hematoma from laceration

-hematomas are painful

Postpartum Disorders: Priority Intervention for a Client Experiencing Hypovolemic Shock (Alterations in Body Systems)

-hemorrhage can lead to this -emergency situation -vigorous treatment -restore circulating blood volume and eliminate the cause of the hemorrhage -need to establish venous access--preferably with large IV catheter -get help and equipment -start IV infusion for standing orders -maintain patient's airways -administer oxygen -continuously monitor status

PE findings

-hypotension -inc temo -hypoxia -distended neck bbeins -heart murmurs -hemoptysis -tachypnea -dyspnea -pleuritic chest pain -apprehension ni: -semi fowlers and o2 -alteplase, streptokinse, hep, warfarin

Nursing Care of Newborns: Priority Action Following Delivery (Aging Process)

-immediate assessments and care for newborn -APGAR at 1 minute and 5 minutes -record exact timing -baby is directly placed onto mother's chest if there are no complications (once it is dried) -cover baby with warm blanket for temperature regulation -cord is cut after 1 minute -focus is on the stabilization of the newborn -multiple nurses available. -watch for signs of distress in newborn -maintain patent airway, supporting respiratory effort, and preventing cold stress -bath is given within 1-2 hrs of delivery -gloves worn until bath is given -BF immediately after birth, formula 2-4 hrs so given few sips of sterile water to assess reflwxes -fed q 3-4 hrs for bottle fed and more often for BF

Medical Conditions: Providing Discharge Teaching to a Client Who Had Gestational Diabetes Mellitus (Health Promotion/Disease Prevention)

-increase risks to fetus include spontaneous abortion, infections, hydramnios, ketoacidosis, hypoglycemia and/or hyperglycemia -managed with only diet and exercise unless glucose levels are persistently high then they might consider insulin -instruct patient to perform daily kick counts -educate about diet, including standard diabetic diet and restricted carb intake. -provide resources about dietary counseling -educate about exercise -instruct client about self-adminstration of insulin if applicable -educate about the need of postpartum lab testing to include OGTT and blood glucose levels

Dosage Calculation: Calculating Dose of Hepatitis B Immune Globulin for a Newborn (Dosage Calculation)

-information for immunization --infants get their first dose as infants --completes over a period of 6 months (at birth, 1 month, and 6 months) --given as an injection --usually 0.5ml for a newborn dosage --know how many mLs you need to draw up --know how to do dosage calculations based on information given in the question --it is recommended to be administered to all newborns --informed consent must be obtained -info about immune globulin --know how to do dosage calculations based on info given in the question --for moms who are infected with hep B, the hep B immunoglobulin and the hep B vaccine is given within 12 hours of birth --vaccine is then given at 1 month, 2 months, and 12 months

Early Onset of Labor: Expected Outcomes of Betamethasone (Expected Actions/Outcomes)

-it is a glucocorticoid that is administered IM in two injections that are 24 hours apart -administer medication deep into the gluteal muscle 24 and 48 hours prior to birth of preterm neonate -monitor the client and neonate for pulmonary edema by assessing lung sounds -monitor for maternal and neonate hyperglycemia -monitor the neonate for heart rate change -educate client about the signs of pulmonary edema -these include...chest pain, SOB, and crackles -Expected outcome: there will be an increase in surfactant production for preterm baby -therapeutic action is to enhance fetal lung maturity and surfactant production in fetuses between 24-36 weeks.

downs indications

-low set ears -protruding tongue -absence of head control (could also be prematurity)

NI for pp hemorrhage

-massage fundus -foley(assess for distention) -maintain IV fluids with isotonic solutions (0.9% nacl or LR) -colloid volume expanders (albumin -packed RBC and FFP -elevate legs 20-30 degrees -o2 at 2-3 l NC -limit PA -inc iron and protein and take iron with vitamin C

mastitis

-milk stasis from a blocked duct -normally staph a -6 weeks after delivery -poor hand hygiene between handline perineal pads and breast feeding -findings: unilateral pain, localized hard mass, chills fatigue, -axillary adenopathy NI: -good hand hygiene prior to BF -allow nipples to air dry -teach proper latch techniques(nipple and areola) -completely empty breasts -ice or warm packs -BF q 2-4 hours, especially on affected side -start BF with unaffected side first, for letdown reflex -3 l day water

Assessment and Management of Newborn Complications: Monitor Newborn Receiving Phototherapy (Chapter 27)

-monitor skin and mucous membranes for jaundice -monitor vital signs -maintain eye mask and undressed except for males cover genitalia -Avoid oils or lotions -remove every 4 hours, reposition every 2 hours -turn off before drawing blood -bronze discoloration and macupapular rash- not a serious complication

Newborn Assessment: Eliciting Newborn Reflexes (Chapter 23)

-moro, stepping, crawling, deep tendon, babinski, pull-to-sit, magnet, sucking, startle -should happen automatically -if not intact, could be an indicator of further complications

early decels

-no NI necessary

circumcision

-no bottle feeding 3 hrs prior, BF is fine -petroleum jelly -avoid tight gauze -no tub baths until circumcision is healed -do not remove exudate -provide gentle pressure with sterile gauze -swaddle and feed after procedure

Health Promotion and Maintenance (22 items) Ante/Intra/Postpartum and Newborn Care (12 items)

-no heavy lifting for 3 weeks (nothing heavier than the infant) -avoid prolonged sitting with legs crossed -limit stair climbing for first few weeks pp -for c-section: wait 4-6 weeks until follow up for ^^ -no driving for 2 weeks -2-3l/day -high protein -nonlactating: 1800-2200kcal/day -lactating: inc 330, 450-550 per day, inc calcium. -kegel and pelvic tilt -no sex 2-4 weeks or until d/c turned white -can't take OCP for weeks pp if lactating -menses returns in 3 mo or until cessation of BF for lactating -nonlactating: menses returns in 4-10 weeks

jaundice in newborn

-none on first day -may appear on third day but dec spontaneously

Therapeutic Procedures to Assist with Labor and Delivery: Caring For a Client Who Is Experiencing Hypotonic Uterine Dysfunction (Alterations in Body Systems)

-normal progress into active labor but then contractions are week and not effective -caring for this client involves ruling out CPD (cephalopelvic disproportion), assessing FHR, assessing amniotic fluid if applicable, and assess maternal well-being -may use intrauterine pressure catheter to evaluate contractions more accurately -may encourage patient to walk around, sit in whirlpool or shower, and stimulate nipples. -can also infuse oxytocin -also may ROM

uterine atony

-only express clots when uterus is contracted otherwise you will cause hemorrhage -ensure bladder is empty -if massaging doesn't make it firm prepare for surgical intervention

Postpartum Disorders: Indications for Administration of Oxytocin (Ante/Intra/Postpartum and Newborn Care)

-oxytocin is a uterine stimulant and promotes uterine contractions -can be used for postpartum hemorrhage -signs of postpartum hemorrhage are boggy uterus (or uterine atony), blood clots larger than a quarter, saturate pad in 15 minutes or less, constant flow from vagina, tachycardia and hypotension, skin pale, cool, and clammy with loss of turbot and pale mucous membranes -nursing considerations for oxytocin: assess uterine tone and vaginal bleeding and monitor for adverse reactions of water intoxication, such as lightheadedness, N/V/H and malaise. these reactions can progress to cerebral edam with seizures, coma, and death

nursing care of NB

-periods of reactivity: 1st: b-30 min, sucking sounds, exploring, high RR and HR 2nd: rest, sleep lasts 60-100 3rd:2-8hrs, gags, chokes from mucus in mouth -pain assessment q 8-12 hrs following painful procedures -weigh daily at same time

Labor and Deliver Processes: Providing Prenatal Education (Ante/Intra/Postpartum and Newborn Care)

-physiological changes that typically come before labor: backache, weight loss, lightening, contractions, increased vaginal discharge or bloody show, energy burst, gastrointestinal changes(N/V/indigestion), cervical ripening, rupture of membranes -tell patient that amniotic fluid should be watery, clear, and pale-to straw-yellow in color. it should also have no odor -educate throughout labor and delivery process and procedures

Medical Conditions: Priority Action for a Client Who Is Having a Seizure (Accident/Error/Injury Prevention)

-position patient on side to prevent aspiration, -call for assistance -make sure the patient does not hurt herself while seizure is going on -monitor FHR to see how fetus is reacting to seizure -wait for seizure to pass

Pain Management: Caring for a Client Who Is in Labor (Non-Pharmacological Comfort Interventions)

-reduces fear, anxiety, and tension -remind them about what what they learned in childbirth education class if applicable -nurse needs to assess for signs of hyperventilation -can use aromatherapy, breathing techniques, imagery, music, use of focal points, subdued lighting -therapeutic touch and massage -walking or rocking -light circular strokes around abdomen -sacral counter pressure -apply hot or cold compress -transcutaneous electrical nerve stimulation -can get in whirlpool or shower -acupressure -encourage frequent position changes -nurse should teach the patient about these techniques and promote them for pain management

prevent hypothermia in NB

-skin-skin contact for 1-2 hrs after birth to maintain skin temp, if not put under warmer to prevent hypothermia and assess q hr until stable -keep head covered and swaddled -aviud fan or airconditioning vent -if uncovered, any condition, must be under warmer -keep room at 22-26c, 72-78F -when bathing only expose one body part at a time -keep away from windows or air conditioners -temp stabilizes at 98.6 within 4 hr after birth if chilling is prevented -thermoregulation: metabolize brown fat to star warm -conduction: direct contact with cool surface -convection: flow of body heat from body to cooler air (air vent, fan) -evaporation -radiation: loss of body heat d/t cooler surface that is close to but not in direct contact(window)s

Nursing Care of Newborns: Steps for Bathing a Newborn (Ante/Intra/Postpartum and Newborn Care)

-temperature must be stable and at least 36.5 degrees celsius -complete sponge bath should be given within first hour or two after birth under radiant heat source to prevent heat loss -if temperature is not stable than they have to wait -steps of bath: --make sure supplies are ready --never leave baby alone --test temperature of water with hand (remember that temp can change throughout the bath) --begin with washing baby's face with water--no soap --clean eyes inside to outside --clean ears and nose --wash body with really soapy water --wash genital area last --wrap the newborn up when washing the hair --use football hold when washing hair --use soap and water on the head and massage

Assessment of Fetal Well-Being: Teaching About Rho(D) Immune Globulin (Medication Administration)

-there is an issue with compatibility when mom is RH- because baby could be RH+ -Amniocentesis is a way to analyze the amniotic fluid -Rho (D) immune globulin is administered if mom is rh- for precautionary measures -patient may have allergic reaction so patient must be educated on signs -cord blood is collected if mom is type O or RH neg

Fetal Assessment During Labor: Applying an External Transducer (Ante/Intra/Postpartum and Newborn Care)

-transducer is put on abdomen and continuously records the FHR pattern -there is also a tocotransducer on the funds that records the uterine contractions -indications for this: multiple gestations, oxytocin infusion, placenta previa, fetal bradycardia, maternal complications, intrauterine growth restriction, post-date gestation, active labor, meconium-stained amniotic fluid, abruptio placenta: suspected or actual, abnormal non-stress test or contraction stress test, abnormal uterine contractions, and fetal distress - prep: use leopold maneuvers to correctly place the tranduscer....auscultate FHR using listening device and palpate the fundus to identify uterine activity for proper placement -ongoing care: provide education on why they are used and what the result are -encourage frequent position changes -can easily be disconnected if patient wants to use the bathroom or walk around

Assessment and Management of Newborn Complications: Manifestations of Exposure to Selective Serotonin Reuptake Inhibitors (Chemical and Other Dependencies/Substance Use Disorder)

-typically SSRIs are in the B or C pregnancy risk category -SSRIs could potentially lead to intrauterine fetal demise and miscarriage -they can also result in physical malformations -newborn may have pulmonary hypertension -newborn may experiences neonatal adaptation syndrome -withdrawal is associated with respiratory failure that required short-term support -newborn may experience seizures in the first 2 weeks of life -can also be associated with cardiac defects, specifically septal defects

endometritis

-uterine tenderness and enlargement -dark profuse lochia -lochia that is either malodorous or purulent -fever of 100.4 for 2 or more days -tachycardia meds: clindamycin, cephalosporins, penicillins, gentamicin -notify provider of watery diarrhea or BF

Assessment of Fetal Well-Being: Nonstress Test (Diagnostic Tests)

-widely used to see fetal wellbeing, during third trimester, takes 20-40 minutes -offered OJ for sleeping baby -noninvasive -potential diagnoses: assess for intact CNS, ruling out fetal death with patients who have diabetes mellitus -client presses button when she feels her fetus move -sound can usually be a stimulator if the baby isn't moving very much -monitor for 20 minutes -interpretation: --want reactive non-stress test which means there was at least 2 accelerations --nonreactive is abnormal and more testing would be done--including CST or BPP

tx for preterm labor

6. terbutaline (Brethine) and mag sulfate- tx for preterm labor

SAFETY AND INFECTION CONTROL: mom with HIV

5. HIV testing is recommended in the third trimester for clients who are at increased risk. amniocentesis and episiotomy should be avoided due to the risk of maternal blood exposure. Internal fetal monitors, vacuum extraction, and forceps during labor should be avoided due to the risk of fetal bleeding. administration of injections and blood testing should not take place until the first bath is given to the newborn.

Nursing Care of the Client During the Postpartum Period: Expected Findings (Active Learning Template - Basic Concept, RM MN PN 9.0 Chp 12)

A fundus located to the right of the midline often indicates a full bladder.

Ante/Intra/Postpartum and Newborn Care Therapeutic Procedures to Assist with Labor and Delivery: Indications for Discontinuing Oxytocin (RN QSEN - Safety , Active Learning Template - Medication, RM MN RN 10.0 Chp 15)

AE: -water intoxication: n/v/ha, MALAISE, light headedness which can progress to cerebral edema

Prenatal Care: Assessing Medication Contraindications for a Client who is at 6 Weeks of Gestation

Avoid all over-the-counter medications, supplements, an prescription medications unless the provider who is supervising her care has knowledge of this practice

Postpartum Physiological Adaptations: Priority Nursing Assessment Following a Cesarean Birth (Ante/Intra/Postpartum and Newborn Care)

B: breasts (nipples) U: uterus (fundal height, uterine placement, and consistency) B: bowel and GI function B: bladder function L: lochia (color, odor, consistency, and amount) E: episiotomy (edema, ecchymosis, approximation) Assess vitals!--blood pressure and pulse are checked at least every 15 minutes for the first 2 hours after birth and temperature should be assessed every 4 hours for the first 8 hours after birth and then at least every 8hr. -Specifically for c-section moms: ---need to make sure incision is still intact ---Foley catheter will be taken out after 12 hours ---Q4hr vitals and assessment for the first 24 hours ---Respirations every hour for first 24 hours ---take out IV 24 hours after delivery

breast feeding adv

BF adv: promotes rapid brain growth d/t large amts of lactose, provides protein and nitrogen -dec risk for GI infections, celiac, asthma, LRTI, SIDS, obesity, DM, AML/ALL, otitis media -dec risk for pp hemoragem, ovarian and breast CA, dm, HTN, HLD, CV, disease, RA -RED HC COSTS, ENV BURDEN, LESS EXPENSIVE -skin to skin and feed within 30 of birth -express colostrum on nipple to entice newborn -explain cramps are normal during BF -tickle lower lip with nipple, include areola in latch (nose,cheeks, chin will be touching breast) -15-20 min per breast -8-12 x day -use breast that you stopped with in last feeding for next one -put finger inside mouth prior to removing him from breast -only BF for 2-3weeks, to not cause confusion -loose pale yellow stools normal -offer referral for BF support groups or contact lactation consultant -ready to feed whenL: mouthing, sucking, rooting, hand to mouth or hand-hand mvmt

Nursing care and discharge teaching: antimicrobial agents and the umbilical cord (Ch. 26)

Before discharge, the cord clamp is removed. Prevent cord infection by keeping the cord dry, and keep the top of the diaper folded underneath it. Sponge baths are given until the cord falls off, which occurs around 10 to 14 days after birth. Tub bathing and submersion can follow. Cord infection can result if cord is not kept clean and dry. Monitor for symptoms of a cord that is moist and red, has a foul odor, or purulent discharge. Notify the provider immediately if findings of cord infection are present. Before discharge, the cord clamp is removed. Prevent cord infection by keeping the cord dry, and keep the top of the diaper folded underneath it. Sponge baths are given until the cord falls off, which occurs around 10 to 14 days after birth. Tub bathing and submersion can follow. Cord infection can result if cord is not kept clean and dry. Monitor for symptoms of a cord that is moist and red, has a foul odor, or purulent discharge. Notify the provider immediately if findings of cord infection are present.

Early Onset of Labor: Expected Outcomes of a Glucocorticoid

Betamethasone -Two IM injections 24hr apart, required 24 hrs to be effective. -Enhances fetal lung maturity between 24-34 weeks -Monitor client for pulmonary edema -Monitor maternal and neonate for hyperglycemia -Monitor neonate for heart rate changes

Managing Client Care: Delegation to assistive personnel (Chapter 1)`

Clerical duties -Selected care tasks such as ambulation, feeding, mouth care, and bathing -Data gathering such as intake and output and vital signs

Postpartum Physiological Adaptions: Interventions for a Client Who has Bladder Distention

Catheterize of necessary for bladder distention if the client is unable to void to ensure complete emptying of the bladder and allow uterine involution. the urinary system can face distress during labor and delivery urinary retention secondary to loss of bladder elasticity and tone and/or loss of bladder sensation a distended bladder as a result of urinary retention can cause uterine atony and displacement to one side, usually to the right encourage the patient to empty her bladder every 2-3 hours assess bladder elimination pattern Reference: RN Maternal Newborn Nursing Ch. 17

c-section doubles the risk of

DVT -found with US, CT, MRI ni: -prevention: elevate legs when sitting, early ambulation pp to prevent,2-3l/day, avoid crossing legs, no smoking, teds until able to ambulate, active and passive ROM if bed rest longer thn 8 hrs -NI: -bed rest and elevation of legs above the heart(no pillows under knees) -warm,moist compresses -TEDS -no aspirin or ibuprofen, use electric razor, no alcohol -NSAIDS and anticoagulants(heparin-aptt 1.5-2x, 30-40 sec), warfarin (PT: ^, 11-12.5 sec and INR of 2-3) -no massaging -measure leg circumferences -

Contraception: Diaphragm Education

Definition: A dome-shaped silicone cup that fits snugly over the cervix. -Client should be properly fitted -Replaced every 2 years -Refitted after 20% weight fluctuation, after abdominal or pelvic surgery, an after pregnancy -Can be inserted up to 6 hours before intercourse. Must stay in place for at least 6 hours after intercourse, but for not more than 24 hours. -Patient should empty bladder before insertion -Wash with soap and water after use

Medical Conditions: Providing Teaching for a Client who has Hypermesis Gravidarum

Discharge Instructions: -Client can have clear liquids after 24hr if no vomiting -Frequent, small meals. Try toast, crackers, cereal. Then move to soft diet and finally to a normal diet.

Baby-Friendly Care: Phases of Maternal Postpartum Adjustment

During the first 2-6 weeks after birth, the client goes through a period of acquaintance with her newborn, as well as physical restoration. During this time she also focuses on completely caring for new newborn. -Finally, the act of achieving maternal identity is accomplished around 4 months following birth. -These stages can overlap, and are variable based on maternal, infant, and the environmental factors. Phases of Maternal Role Attainment: Taking-In Phase: -First 24-48 hrs -Excited, talkative, -Focus on meeting personal needs Taking-Hold Phase: -Days 2-3 -Focus on baby care and improving caregiving competency -Want to learn and practice -Can experience "baby blues" Letting-Go Phase: -Focus on family as a unit -Resumption of role (intimate partner, individual)

Fetal assessment during labor: Leopold maneuvers descriptioN

External palpations of the uterus through the abdominal wall to determine: - # fetuses - Presenting part, fetal lie, & fetal attitude - Degree of descent of presenting part into pelvis - Expected location of the point of max impulse

Assessment and Management of Newborn Complications: Assessing an Infant who is Large for Gestation Age

Expected findings: -Weight above 90th percentile -Large head -plump and full-faced -Manifestations of hypoxia including tachypnea, recreations, cyanosis, nasal flaring, and grunting -Birth trauma -Sluggishness, hypotonic muscles, hyperactivity -Tremors from hypocalcemia -Hypoglycemia -Respiratory distress from immature lungs or meconium aspiration Findings of increased intracranial pressure: dilated pupils, vomiting, bulging fontanels, high-pitched cry Lab tests: -Blood glucose to monitor for hypoglycemia -ABGs -CBC -Chest x-ray

Infections: Identifying Potential Complications

Expected findings: -fever -diarrhea and weight loss -lymphadenopathy and rash -anemia

Medical Conditions: Evaluating Laboratory Findings for a Client Who Has Preeclampsia

H: Hemolysis, resulting in anemia and jaundice EL: Elvated liver enzymes LP: Low platelets lab values assessed in patients suspected to have preeclampsia: liver enzymes, serum creatinine, BUN, uric acid, magnesium which indicate renal function decreases; CBC; clotting studies; chemistry profile abnormal findings are seen in: elevated liver enzymes, increased creatinine, increased plasma uric acid, thrombocytopenia, decreased Hgb, hyperbilirubinemia Reference: RN Maternal Newborn Nursing Ch. 9

Prenatal Care: Expected Changes During the Second Trimester

Heartburn, constipation, hemorrhoids, backaches, varicose veins and lower-extremity edema, gingivitis, nasal stuffiness, epistaxis, braxton hicks contractions, supine hypotension.

Postpartum Physiological Adaptions: Assessment Findings of a Vaginal Hematoma

If patient has a hematoma, she will feel pressure, but not pain

Prioritize care to a client in labor: Precipitous labor

Labor lasting < 3 hr - Dont leave pt unattended - Encourage pt to pant btw contractions (control the urge to push) - Side lying position (optimize uteroplacental perfusion & fetal O2) - Prepare for ROM upon crowning (fetal head visible at perineum) if not already rupture - Do not attempt to stop delivery - Control rapid delivery by applying light pressure to perineal area & fetal head (gently press upward) - Suction mucus from mouth to nose - Deliver anterior should located under symphysis pubis. Next posterior shoulder. Then allow the rest to slip out - Assess for complications

NOT SAFE DUROING PREG- VACC

MMR

Contraception: Contraindicated Method for Osteoporosis

Medroxyprogesterone is an intramuscular or sub-q injection given to a female client every 11 to 13 weeks. -First injection should be during the first 5 days of period. In postpartum, 5 days after delivery. -Maintain adequate intake of calcium and vitamin D. -Very effective -Adverse effects: decrease in bone mineral density, weight gain, depression (contraindicated for osteoporosis pt.) -Return to fertility can be a long as 18 months after discontinuation

Prenatal Care: Priority Intervention for a Client who has Depression (Chapter 4)

NI: -ask the client if she has thoughts of self-harm, suicide, or harming her infant, provide for the safety of the infant -monitor interactions between the client and her infant -monitor client's mood and affect -reinforce that feeling down in pp is normal and self-limiting - -pp blues: normally resolves in 10 days without intervention pp depression: -requires intervention for resolution -occurs within 6 mo of delivery Emotional lability: unpredictable mood changes and increased irritability (due to hormonal changes -feeling of ambivalence towards pregnancy (normal early in pregnancy...should resolve in third trimester)

Nutrition During Pregnancy: Identify Signs of Potential Prenatal Complicati

Nausea, constipation, maternal phenylketonuria, diabetes mellitus

Greater risk for developing a puerperal infection

Not washing hands between perineal care & breastfeeding findings: -fever of 100.4 for 2 days -tachycardia -flu-like s/s -anorexia or nausea NI: -aseptic technique -maintain IV -admin IV abx (penicillins or cephalosporins) -diet high in protein

Assessment and Management of Newborn Complications: Assessing a Newborn Who is 24 Hr Old

Obtain blood by heel stick for glucose monitoring. Glucose should be over 40 mg/dL. -warm heel -stick outer aspect of heal

Early Onset of Labor: Rupture of Membranes

PROM is the spontaneous rupture of the amniotic membranes 1 hr of more prior to the onset of true labor

While performing Leopold maneuvers the nurse should use which technique to identify the fetal lie?

Palpate the fundus of the uterus

Prenatal Care: Safe Immunizations During Pregnancy

Pregnant patients should get the flu shot

Provide postpartum care & education: follow up visit

Pt should be discharged with an appt set for a postpartum follow-up visit - Or a # to call & schedule an appt - Vaginal: in 4-6 weeks - C-section: in 2 weeks

A fetus receives more oxygen when ______ appears on the tracing:

Relaxation btw uterine contractions

Complications Related to the Labor Process: Nursing Action for a Nuchal Cord

Slip cord over baby's head if it is loose enough

Unexpected Response to Therapies (2 items) Oxygen and Inhalation Therapy: Need for Suctioning (RM NCC RN 9.0 Chp 16, Active Learning Template - Basic Concept)

Routine suctioning of the mouth first, then the nasal passages with a bulb syringe, is done to remove excess mucus in the respiratory tract. 1. Compress bulb before insertion into one side of the mouth. 2. Avoid center of the mouth to prevent stimulating gag reflex. 3. Aspirate mouth first, one nostril, then second nostril. -if suctioning doesn't work, use back blows or chest thrusts -c-section infants are more susceptible to fluid accumulation

Assessment and Management of Newborn Complications: Findings for Hypoglycemia (Chapter 27)

Serum glucose less than 40 mg/dl -Bilirubin levels increase more than 0.5 mg/dl/hr, peaks at greater than 13 mg/dl or is associated with anemia or hepatosplenomegaly -Kernicterus: bilirubin levels at or higher than 25 mg/dl

Therapeutic procedures to assist with labor and delivery: caring for a client whose fetus has a posterior presentation (Ch. 15)

Suggest hands and knees position to facilitate rotation of the fetus from a posterior position to an anterior position.

Medical Conditions: Hypermesis Gravidarum

Urinalysis for ketones and acetones (breakdown of PR and fat) is the most important lab test -Chemistry profile -Thyroid test -CBC hyperemesis graviderum is excessive nausea and vomiting that is prolonged past 12 weeks gestation results in 5% weight losts from prepregnancy weight risk factors: maternal age younger than 30, history or migraines, obesity, first rpegnancy, diabetes, GI disorders, or family history of hyperemesis monitor patient I&O, assess skin turgor, weight and vital signs Reference: RN Maternal Newborn Nursing Ch. 9

Nursing Care and Discharge Teaching: Care Seat Safety for Premature Newborn

Use an approved rear-facing car seat in the back seat, preferably in the middle (away from airbags) to transport newborn. Keep infants in rear-facing car seats until age 2 or until the child reaches the maximum night and weight for the seat. Premature babies need to have a car seat test in the hospital prior to discharge.

Assessment of Fetal Well-Being: Oxytocin-Stimulated Contraction Test

Used to induce uterine contractions -Contraindicated for placenta previa, vasa previa, preterm labor, multiple gestations, previous classic incisions for c-section, reduced cervical competence -Can be difficult to stop and may lead to preterm labor -Negative results is a normal finding -Postive result is an abnormal finding

Newborn Assessment: Expected Physical Findings of a Newborn (Developmental Stages and Transitions)

Weight - 2,500 to 4,000 g (5lb 8oz - 8lb 13oz) -Length - 45 to 55 cm (18 to 22 in) -Head circumference - 32 to 36.8 cm (12.6 to 14.5 in) -Chest circumference - 30 to 33 cm (12 to 13 in) -Respirations are 30-60 with short periods of apnea(<15 sec) -HR is 110-160 (assess apical for 1 full min when sleeping) -blood pressure (not routine) 60-80/40-50 mmHg -temperature is 36.5-37.5(97.7-99.5) -should have moderate flexing -skin may have normal deviations but skin color should be pink or acrocyanotic with no jaundice present on first day, turgor is present, skin is dry soft and smooth -desquamation few days after birth in term babies -vernix present, more in creases -lanugo -sleep 16-19hr/day normal findings deviations: -milia (do nto squeeze) -mongolian spots(more common on dark skinned) -telangiectatic nevi(stork bites)- flat red marks that blanch, fade by 2nd year of life -nevus flammeus(port wine): capillary angioma does not blanch or disappear -erythema toxicum: (e neonatorum) appears during first 3 weeks, doesn't need tx, newborn rash Normal Assessment Findings for Head: -Should be 2-3 cm larger than chest. -fontanels should be soft and flat, can bulge when cry or cough -depressed fontanels- dehydration - Anterior fontanel should be palpated and approximately 5 cm on average and diamond shaped. - Posterior fontanel is smaller and triangle-shaped. Should be soft and flat. -sutures should be palpable and separated,Molding of sutures is normal. -caput succedaneum- soft edematous mass that crosses suture lines and resolves in 3-4 days and no tx necessary -cephalohematoma: doesn't cross suture line, appears in first 2 days and resolves in 2-3 weeks -eyes are usually blue or gray following birth -each and and the space betweens the eyes should equal 1/3 the distance form the inner to outer canthus of both eyes to rule out downs --random, jerky eye ball movements -obligate nose breathers, do not open mouth until 3 weeks old -epsteins pearls- small white cysts found on gums, disappear in a few weeks -BS present 1-2 after birth -meconium should be passed within 24-48 hrs after birth -vaginal blood tinged discharge can occur -hymenal tag should be present -urine should be passed in first 24 hrs -soles over 2/3 of feet -no click heard when abducting the hips reflexes: -sucking/rooting: disappears after 3-4 mo(can last up to 1 yr) -palmar grasp: same ^^ -plantar: birth -8mo -moro: extend and abduct fingers form a "c"; birth-6mo -tonic neck(fencer): turns head, arm and leg on that side extend and opposing arm and leg flex , b-3mo -babinski: positive/normal: toes fan upward and out -stepping: birth--4weeks senses: -touch: mouth is most sensitive -prefer sweet over salty -vision: 8-12 inches from face(approx same distance when BF) -prefer bright colors

weight gain requires

alternate sex positions

follow up for vag and c-section

c: 2weeks -vag: 4-6 weeks

Postpartum Physiological Adaptions: Nursing Action for Vaginal Bleeding Following a Cesarean Birth

lochia is normal following birth whether it is vaginally or cesarean lochia rubra - bright red, seen 1-3 days after delivery. this is a normal finding it is important for a nurse to mark amount and color of blood, and whether or not clots are formed excessing amounts of blood can be an indication of cervical or vaginal tearing Reference: RN Maternal Newborn Nursing Ch. 17

postpartum disorders: contraindications to methylergonovine

methylergonovine is used as a uterine stimulant -it is helpful in controlling postpartum hemorrhages -DO NOT administer to clients who have hypertension monitor for adverse reactions, including HTN, nausea, vomiting, and headache Reference: RN Maternal Newborn Nursing Ch. 20

Evaluating client understanding of newborn safety Suction mouth then nose

suction mouth then nose routine suctioning of the mouth and nasal cavity is common with newborns suction mouth first then nose this is done to remove excess mucus from respiratory tract steps to use: 1. compress bulb before insertion into one side of the mouth 2. avoid center of mouth bc of gag reflex 3. aspirate mouth first, then one nostril then other nostril Reference: RN Maternal Newborn Nursing Ch. 24

Medical Conditions: Adverse Effects of Magnesium Sulfate

☐ Absence of patellar deep-tendon reflexes (knee) ☐ Urine output less than 30 mL/hr ☐ Respirations less than 12/min ☐ Decreased level of consciousness ☐ Cardiac dysrhythmias

T/F: the membranes must be ruptured prior to insertion of an internal electrode or intrauterine pressure catheter

t

client education and discharge teaching: teachin a new mother to bottle feed

when not breastfeeding, where a well-fitting, supportive bra continuously for first 72 hours, avoid breast stimulation or running warm water over breasts, apply cold compresses to help with breast engorgement Reference: RN Maternal Newborn Nursing Ch. 19

postpartum disorders: priority action for ineffective pain relief

with pain, it is important to attempt nonpharmacological treatments to relieve pain these treatments could be effleurage, music therapy, hydrotherapy, massage, postition changes, hypnosis, biofeedback if these dont work, pharmacological pain management may be used this includes: sedatives, opiod analgesics, epidural and spinal analgesia, regional blocks, or general anesthesia Reference: RN Maternal Newborn Nursing Ch. 12

9. Nursing care of the client during the postpardum period: Education regarding rubella vaccination Pg. 159

• A client who has a titer of less that 1:8 is administered a subcutaneous injection of rubella vaccine or an meals, mumps, and rubella vaccine during the postpartum period to protect a subsequent fetus from malformations. Clients should not get pregnant for 4 weeks following the vaccination.

14. Prenatal Care: RhoGAM Injection Pg. 23

• Administer RhoGAM injection around 28 weeks of gestation for clients who are Rh-negative.

4. Care of the postpartum client: epistomy care Pg. 154

• Apply ice packs to the client's perineum for the first 24 to 48 hours to reduce edema and provide anesthetic effect. • Encourage sitz baths at a temperature of 38-40 degrees at least twice a day. • Administer analgesia as prescribed for pain and discomfort. • Apply topical anesthetics to the client's perineal area as needed or witch hazel compress to the rectal area.

13. Early Onset of Labor: pharmacological therapy Pg. 104

• Brethine- beta-adrenegic agonist that relaxes uterine smooth muscle by stimulating beta2 receptors in the smooth muscle fibers to inhibit uterine activity. • Magnesium Sulfate- relaxes the smooth muscle of the uterus and thus inhibits uterine activity by suppressing contractions. • Indocin- is a nonsteroidal anti-inflammatory drug that suppresses preterm labor by blocking the production of prostaglandins. This inhibition of prostaglandins suppresses uterine contractions.

20. Fetal assessment during labor: priority intervention for spontaneous rupture of membrane Pg. 107

• Check vital signs every 4 hours. • Obtain vaginal, urine, and blood cultures prior to administration of antibiotics. • Monitor FHR and uterine contractions. • Monitor for signs and symptoms of infection.

21. Prenatal care: reinforcing teaching regarding heartburn Pg. 25

• Eat small frequent meals • Sit up for 30 mins after meals. • Check with the provider prior to using any over the counter antacids.

8. Newborn Assessment: Postmaturity Pg. 196

• Head to toe examination of newborn within 24 hours. • An APGAR score obtained. • Obtain vital signs in following sequence: respirations, heart rate, blood pressure, and temperature. • Obtain measurements. (length and weight)

6. Nursing care of the newborn: Reinforcing teaching about elimination Pg. 221

• Inform patents that newborns should have 6 to 8 wet diapers a day with adequate feedings and may have 3 to 4 stools per day. • Instruct parents to keep the newborns diaper area clean and dry. Recommend changing the newborns diaper frequently and cleaning the perineal are with warm water or wipes and drying thoroughly to prevent skin breakdown. Apply barrier cream if skin becomes irritated.

17. Prenatal Care: Reinforcing client teaching about laboratory testing Pg. 23

• Instruct clients to avoid all over the counter medications, supplements, and prescription medications unless prescribed by the provider. • Instruct clients to watch for signs of potential complications and to repost occurrence to provider. • Explain importance of regular follow up to include monthly prenatal visits for the first seven months, then every two weeks during the eighth month, and every week during the last month.

19. Complications of Pregnancy: Nursing Interventions Pg. 103

• Instruct clients to remain on bed rest with bathroom privileges. • Encourage clients to rest in the left lateral position to increase blood flow to the uterus and decrease uterine activity. • Tell clients to avoid sexual intercourse. • Ensure hydration. • Monitor FHR and contraction pattern.

10. Nutrition during pregnancy: vitamin and mineral intake Pg. 57

• Iron should be increased from 18 to 27mg for pregnant women. • Folate should be increased from 400 to 600mcg for pregnant women. • Vitamin B12 should be increased from 2.4 to 2.6mcg for pregnant women

2. Nursing care of the Newborn: Newborn Safety Pg. 224

• Keep small objects out of reach of newborns. • Provide a firm mattress for newborns to sleep on. Never put pillows, large floppy toys, or loose plastic sheeting in crib. , bumper pads • The space between the mattress and sides of the crib should be less than two fingerbreasths. • The slats on the crib should be no more than 2.5 inches apart. -placed on an inner wall not next to a window -check smoke detectors monthly -keeep away from heaters -everyone should wash hands befoe handling newborn

5. Nursing care of the newborn: cord care Pg. 221

• Keep the cord dry and keep the top of the diaper folded underneath it. -do not cover with gauze -water should not be applied to cord • Avoid submerging newborns in water until the cord falls off around 10 to 14 days after birth. Give sponge baths until the cord falls off. • Report any foul smelling, purulent drainage, or redness at the cord site to the provider. - Observe for any bleeding from cord - Ensure that the cord is clamped securely to prevent hemorrhage -Cord clamp is removed -Prevent infection by keeping cord dry and keep the top of diaper folded underneath -Sponge baths are given until cord falls off (around 10-14 days postpartum) -Cord infection can result if cord is not kept clean and dry -Monitor symptoms: moist and red, foul odor, purulent discharge (notify provider)

7. Prenatal care: Monitoring fetal heart tones Pg. 44

• Obtain a baseline FHR, fetal movement, and contractions for 10 to 20 min and document.

12. Newborn Assessment: priority findings Pg. 197

• Obtain measurements. (length and weight) • Obtain vital signs in the following sequence: respirations, heart rate, blood pressure, and temperature. • Obtain an APGAR score. • Head to toe

1. Complications of the Newborn: Use of phototherapy Lights Pg. 244

• Place an eye mask over the newborns eyes after they are gently closed to protect the corneas and retinas. • Avoid applying lotions or ointments to newborns because they absorb heat and can cause burns. • Turn off the phototherapy lights before drawing blood for testing. • Remove newborns every 2 hours to expose all of the body surfaces to the phototherapy lights and prevent pressure sores.

11. Contraception: use of oral contraceptives during lactation Pg. 8

• Progestin-only oral contraceptives are safe to take while breastfeeding • Have fewer side effects when compared to a combination of oral birth control pills. - Begin contraceptions upon resumption of sex - Pregnancy can occur with breastfeeding even though menses has not returned - Menses in nonlactating client- resumes in 4-10 wks - Menses in lactating client- resumes in 3 mo

15. Clinical Disorders: Reporting Critical finding during gestation Pg. 85

• Reports of nausea and vomiting past 12 weeks of gestation-hyperemesis gravidarum • Fatigue, irritability, cravings to ingest materials that are not food- Anemia • Hypertension, nausea, vomiting- preeclampsia

3. Assessment of Fetal well-being: nonstress test Pg. 42

• Seat the client in a reclining chair or place in a semi-flowers or left lateral position. • Perform Leopold's maneuvers to locate the fetal back. • Apply conduction gel to the ultrasound transducer. • Secure a Doppler transducer to the client's abdomen over the fetal back to record the FHR pattern. Nonstress Test: most widely used antepartum evaluation of fetal well-being performed during the third trimester. The NST is interpreted as reactive if the FHR is a normal baseline rate with moderate variability, accelerates to 15 beats/min for at least 15 seconds and occurs two or more times during a 20 minute period.

18. Clinical Disorders: Abnormal findings Pg. 83

• Unexpected medical conditions include incompetent cervix, hyperemesis gravidarum, anemia, gestational diabetes, gestational hypertension, preeclampsia, and heart disease.

22. Bleeding during pregnancy: Abruptio Placentae Pg. 65

• Uterine pain with vaginal bleeding • Fetal distress • Vaginal bleeding • Board like tender abdomen -most common cause for DIC