Capstone Maternal OB focused review/pathology

positive contraction stress test

(Abnormal) A positive result is represented by late decelerations of FHR, with 50% or more of the contractions in the absence of hyperstimulation of the uterus.

primigravida

a client in their first pregnancy

Normal temperature of a Newborn

is 36.5° C to 37.5° C (97.7° F to 99.5° F), with 37° C (98.6° F) being average

Preterm Premature Rupture of Membranes (PPROM)

is the premature spontaneous rupture of membranes after 20 weeks of gestation and prior to 37 weeks of gestation.

negative contraction stress test

(Normal) A negative result is represented by no late decelerations of fetal heart rate (FHR).

Low platelet count

(less than 100,000/mm3 ), resulting in thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly disseminated intravascular coagulopathy

caput succedaneum

(localized swelling of the soft tissues of the scalp caused by pressure on the head during labor) is an expected finding that can be palpated as a soft edematous mass and can cross over the suture line. Caput succedaneum usually resolves in 3 to 4 days and does not require treatment. (23.4

oligohydramnios

(scant amount or absence of amniotic fluid) caused by any of the following ◯ Uteroplacental insufficiency ◯ Premature rupture of membranes ◯ 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

Dystocia

, or dysfunctional labor, is a difficult or abnormal labor related to the five P's of labor (passenger, passageway, powers, position, and psychologic response). ● Atypical uterine contraction patterns prevent the normal process of labor and its progression. Contractions can be hypotonic (weak, inefficient, or completely absent) or hypertonic (excessively frequent, uncoordinated, and of strong intensity with inadequate uterine relaxation) with failure to efface and dilate the cervix.

Fundal Massage

-Ask the client to lie on her back with her knees flexed. -Place a hand just above the client's symphysis pubis. -Position a hand around the top of the client's fundus. -Rotate the upper hand to massage the client's uterus -Use slight downward pressure to compress the client's fundus.

Medications for Chlamydia

-Doxycycline Used as a treatment, but contraindicated during pregnancy -Azithromycin or amoxicillin Prescribed during pregnancy -Erythromycin Administered to all infants following delivery. This is the medication of choice for ophthalmia neonatorum. This antibiotic is both bacteriostatic and bactericidal, and thus provides prophylaxis against Neisseria gonorrhoeae and chlamydia trachomatis.

What is the Rh factor? And why is important?

-The positive or negative sign next to the blood groups is known as the Rhesus (Rh) factor. The Rh factor is an inherited protein that can be found on the surface of the red blood cell. If your blood type is negative, then your blood cells lack the Rh protein. Although Rh positive is the most common blood type, having a Rh-negative typing does not indicate illness and usually doesn't affect your health -The Rh factor is one of the proteins on RBCs used to indicate whether the blood of two different people is compatible when mixed - such as blood of a mother and her baby at birth. It is routine and important that the Rh factor for a mother and unborn child be determined during pregnancy. If an expecting mother is Rh negative and her baby is RH is negative, there aren't usually any concerns. Conversely if the expecting mother is RH negative and her baby is Rh positive, the mother's blood might produce the anti-D antibodies. The effect of these antibodies on the development of the unborn child, who is Rh positive, are determined by many factors. There are medical interventions that can be taken under the supervision of a physician to protect the baby in utero

Intraventricular hemorrhage

-bleeding in or around the ventricles of the pre-matures baby's brain -The cause of intraventricular hemorrhage is a lack of oxygen to the brain, due to a difficult or traumatic birth, or from complications after delivery

Normal hemoglobin range for a newborn is

14-24g/dL

Mom comes in to emergency room, and she states baby is coming, how do you know she is in true labor?

1st stage of labor, dilated cervix to 10cm

moderately preterm labor

32-34 weeks

late preterm labor

34-36 weeks

a nurse is assessing a client who is 2 days postpartum. In which of the following locations should the nurse expect to locate the client's fundus?

3cm below umbilicus

adverse effects of epidural with mom

maternal hypotension, fetal bradycardia, inability to feel the urge to void, loss of the bearing down reflex, pallor, clammy skin, dizziness, lightheadedness, poor mentation

Nine-point Postpartum Assessment...BUBBLEHER

B- Breasts U- Uterus B- Bladder B- Bowel function L- Lochia E- Episiotomy H- Hemorrhoids E- Emotional Status R- Respiratory System

Chloasma/Melasma

A blotchy pigmentation of the skin on the face, is an expected finding during pregnancy usually fades away on its own a few months after delivery.

breech presentation

: Fetal heart tones should be assessed above the client's umbilicus in either the right- or left-upper quadrant of the abdomen.

betamethasone

: Releases enzymes that produce and release lung surfactant to stimulate lung maturity in a fetus

coarctation of the aorta pathophysiology

A narrowing of the lumen of the aorta, usually at or near the ductus arteriosus, that results in obstruction of blood flow from the ventricle

hydatidiform mole

A non viable pregnancy caused due to the growth of an abnormal fertilized egg or overgrowth of trophoblasts, the cells which normally develops into placenta within the uterus

Large patent ductus arteriosus pathophysiology

A noncyanotic heart defect in which the ductus arteriosus connecting the pulmonary artery and the aorta fails to close after birth

Vaginal birth after cesarean (VBAC)

A vaginal birth after cesarean birth is when the client delivers vaginally after having had a previous cesarean birth

developmental dysplasia of the hip pathophysiology

A variety of disorders resulting in abnormal development of the hip structures that can affect infants or children ● Acetabular dysplasia: delay in acetabular development (acetabular roof is shallow and oblique) ● Subluxation: incomplete dislocation of the hip ● Dislocation: femoral head does not have contact with the acetabulum

Lamaze method

A woman is physically and psychologically prepared through prenatal training in the use of controlled breathing to reduce pain during labor and coached by a partner to facilitate the process of natural childbirth Childbirth preparation methods- patterned breathing exercises) promote relaxation and pain management

Causes and complications for fetal bradycardia

AUSES/COMPLICATIONS ● Uteroplacental insufficiency ● Umbilical cord prolapse ● Maternal hypotension ● Prolonged umbilical cord compression ● Fetal congenital heart block ● Anesthetic medications ● Viral infection ● Maternal hypoglycemia ● Fetal heart failure ● Maternal hypothermia

Erythromycin

Administered to all infants following delivery. This is the medication of choice for ophthalmia neonatorum. This antibiotic is both bacteriostatic and bactericidal, and thus provides prophylaxis against Neisseria gonorrhoeae and Chlamydia trachomatis

Rh

All Rh-negative clients who have newborns who are Rh-positive must be given Rho(D) immune globulin administered IM within 72 hr of the newborn being born to suppress antibody formation in the mother. ● Test the client who receives both a live virus vaccine, such as the rubella vaccine, and Rho(D) immune globulin after 3 months to determine whether immunity to rubella has been developed.

Apgar scoring system

An Apgar score is assigned based on a quick review of systems that is completed at 1 and 5 min of life. This allows the nurse to rapidly assess extrauterine adaptation and intervene with appropriate nursing actions. ● 0 to 3 indicates severe distress ● 4 to 6 indicates moderate difficulty ● 7 to 10 indicates minimal or no difficulty with adjusting to extrauterine life

Necrotizing Enterocolitis (NEC)

An inflammatory disease of the gastrointestinal mucosa due to ischemia. It results in necrosis and perforation of the bowel. (Short‑gut syndrome can be the result secondary to removal of most or part of the small intestine due to necrosis.) Respiratory distress causes intestinal ischemia secondary to hypoxia

hypoglycemia in newborn

An initial drop in blood glucose after birth is a common occurrence due to the cessation of the maternal supply of glucose. ● Blood glucose levels are not usually assessed in healthy term newborns as they have adequate glycogen stores to compensate for this physiological change. ◯ A healthy term newborn can tolerate an initial decrease in their blood glucose level to as low as 30 mg/dL. ● Newborns who have risk factors for hypoglycemia should have a blood glucose level checked within the first hour after birth. This includes newborns who are preterm, small or large for gestational age, and newborns of diabetic clients. ◯ Interventions are indicated for at-risk newborns when their blood glucose levels are less than 40 to 45 mg/dL. ● Follow facility protocols regarding frequency of assessing blood glucose levels

nuchal cord

An umbilical cord that is wrapped around the fetus's neck.

Indications for an Induction of labor

Any condition in which augmentation or induction of labor is indicated. Elective induction for nonmedical indications must meet the criteria of at least 39 weeks of gestation. Elective inductions that do not meet recommended criteria can result in increased risk for infection, premature delivery, longer labor, and need for cesarean birth. CLIENT PRESENTATION ● Postterm pregnancy (greater than 42 weeks of gestation) ● Dystocia (prolonged, difficult labor) due to inadequate uterine contractions ● Prolonged rupture of membranes, which predisposes the client and fetus to risk of infection ● Intrauterine growth restriction ● Maternal medical complications ◯ Rh-isoimmunization ◯ Diabetes mellitus ◯ Pulmonary disease ◯ Gestational hypertension ● Fetal demise ● Chorioamnionitis

non-reactive stress test

Bad; may indicate fetus may be going into distress; should have acceleration of 15 bpm for 15 seconds, 2 times in 20 minutes

sensory stimulation strategies for nonpharmacological pain management for labor pain

Based on the gate-control theory to promote relaxation and pain relief ● Aromatherapy ● Breathing techniques ● Imagery ● Music ● Use of focal points ● Subdued lighting

nonpharmacological pain management: cutaneous stimulation strategies

Based on the gate-control theory to promote relaxation and pain relief ● Therapeutic touch and massage: back rubs and massage ● Walking ● Rocking ● Effleurage: Light, gentle circular stroking of the client's abdomen with the fingertips in rhythm with breathing during contractions ● Sacral counterpressure: Consistent pressure is applied by the support person using the heel of the hand or fist against the client's sacral area to counteract pain in the lower back ● Application of heat or cold ● Transcutaneous electrical nerve stimulation (TENS) therapy ● Hydrotherapy (whirlpool or shower) increases maternal endorphin levels ● Acupressure ● Frequent maternal position changes to promote relaxation and pain relief ◯ Semi-sitting ◯ Squatting (help stretch the perineum) ◯ Kneeling ◯ Kneeling and rocking back and forth ◯ Supine position only with the placement of a wedge under one of the client's hips to tilt the uterus and avoid supine hypotension syndrome

Client education on diaphragm care

Be properly fitted with a diaphragm by a provider. ● Replace every 2 years and refit for a 20% weight fluctuation, after abdominal or pelvic surgery, and after every pregnancy. ● The diaphragm requires proper insertion and removal. Prior to coitus, the diaphragm is inserted vaginally over the cervix with spermicidal jelly or cream that is applied to the cervical side of the dome and around the rim. The diaphragm can be inserted up to 6 hr before intercourse and must stay in place 6 hr after intercourse but for no more than 24 hr. ● Spermicide must be reapplied with each act of coitus. ● Empty the bladder prior to insertion of the diaphragm, to decrease pressure on the urethra. ● The diaphragm should be washed with mild soap and warm water after each use

Client education on mastitis

Breast hygiene can prevent and manage mastitis. ● Thoroughly wash hands prior to breastfeeding. ● Maintain cleanliness of breasts with frequent changes of breast pads. ● Allow nipples to air-dry. ● Proper infant positioning and latching-on techniques include both the nipple and the areola. Release the infant's grasp on the nipple prior to removing the infant from the breast. ● Completely empty the breasts with each feeding to prevent milk stasis, which provides a medium for bacterial growth. ● Use ice packs or warm packs on affected breasts for discomfort. ● Continue breastfeeding frequently (at least every 2 to 4 hr), especially on the affected side. ● Manually express breast milk or use a breast pump if breastfeeding is too painful. ● Breastfeed or pump frequently, emptying the affected side. ● Rest, take analgesics, and maintain fluid intake of at least 3,000 mL per day. ● Wear a well‑fitting bra for support. The bra should not have an underwire because that increases the risk for infection. ● Report redness and fever. ● Complete the entire course of antibiotics as prescribed -Use your fingers to release suction after feeding

Client education breast milk

Breast milk can be expressed using hand expression or a pump so the newborn can be fed using bottle or supplemental device. ◯ Breast pumps can be manual, electric, or battery-operated and pumped directly into a bottle or freezer bag. ◯ One or both breasts can be pumped, and suction is adjustable for comfort. ● Breast milk must be stored according to guidelines for proper containers, labeling, refrigerating, and freezing. ◯ Breast milk can be stored at room temperature under very clean conditions for up to 8 hr. It can be refrigerated in sterile bottles for use within 8 days, or can be frozen in sterile containers in the freezer compartment of a refrigerator for up to 6 months. Breast milk can be stored in a deep freezer for 12 months. ◯ Thawing the milk in the refrigerator for 24 hr is the best way to preserve the immunoglobulins present in it. It also can be thawed by holding the container under running lukewarm water or placing it in a container of lukewarm water. The bottle should be rotated often, but not shaken when thawing in this manner. ◯ Thawing by microwave is contraindicated because it destroys some of the immune factors and lysozymes contained in the milk. Microwave thawing also leads to the development of hot spots in the milk because of uneven heating, which can burn the newborn. ◯ Do not refreeze thawed milk. ◯ Unused portions of breast milk must be discarded after thawing or warming.

Client education on postpartum depression

CARE AFTER DISCHARGE ● Get plenty of rest and to nap when the infant sleeps. ● Remember the importance of taking time out for self. ● Schedule a follow-up visit prior to the traditional postpartum visit if at risk for developing postpartum depression. ● Consider community resources (La Leche League, community mental health centers). ● Seek counseling, and consider social agencies as indicated

Causes/Complications for fetal tachycardia

CAUSES/COMPLICATIONS ● Maternal infection, chorioamnionitis ● Fetal anemia ● Fetal cardiac dysrhythmias ● Maternal use of cocaine or methamphetamines ● Maternal dehydration ● Maternal or fetal infection ● Maternal hyperthyroidism

mentum presentation

Chin first Won't come out Needs C-Section

expected findings of premature rupture of membranes (PROM)

Client reports a gush or leakage of clear fluid from the vagina. PHYSICAL ASSESSMENT FINDINGS ● Presence of clear fluid Assess for a prolapsed umbilical cord. ● Abrupt FHR variable or prolonged deceleration ● Visible or palpable cord at the introitus

umbilical cord care

Cord clamp stays in place for 24 to 48 hr. ● Recommendations for cord care include cleaning the cord with water (using cleanser sparingly if needed to remove debris) during the initial bath of the newborn. ● Assess stump and base of cord for erythema, edema, and drainage with each diaper change. ● The newborn's diaper should be folded down and away from the umbilical stump. ● Bathing infant by submerging in water should not occur until the cord has fallen off. ● Most cords fall off within the first 10 to 14 days Hemorrhage Due to improper cord care or placement of clamp NURSING ACTIONS ● Ensure that the clamp is tight. If seepage of blood is noted, a second clamp should be applied. ● Notify the provider if bleeding continues

Cleft lip: nursing care plan (postoperative) — "CLEFT LIP"

Crying, minimize Logan bow Elbow restraints Feed with Brecht feeder Teach feeding techniques; two months of age (average age at repair) Liquid (sterile water), rinse after feeding Impaired feeding (no sucking) Position—never on abdomen

Hydatidiform signs and symptoms

Dark brown or reddish vaginal bleeding Severe nausea and vomiting Pelvic pain Anemia Hyperthyroidism High blood pressure

Lochia rubra (ruby is red)

Dark red color, bloody consistency, fleshy odor, can contain small clots, transient flow increases during breastfeeding and upon rising. Lasts 1 to 3 days after delivery.

client education for chlamydia and gonorrhea

Doxycycline might reduce the effectiveness of oral contraceptives. ● If continued sexual activity is desired, be aware of the sexually transmitted infection status of any sexual partners, and use a barrier contraceptive each time you have sex. ● All states have a reportable diseases list. Chlamydia is a commonly reported condition. It is the responsibility of the provider to report cases of these diseases to the local health department ● Take all medications as prescribed. ● Repeat the culture within 3 to 4 weeks to assess for medication effectiveness. ● There is a possibility of decreasing effectiveness of oral contraceptives. ● Adhere to safe sex practices (mutual monogamy; correct, consistent condom use)

Gastrointestinal discomfort taking non-steroidal anti-inflammatory drugs

Dyspepsia, abdominal pain, heartburn, nausea NURSING ACTIONS ● Damage to gastric mucosa can lead to gastrointestinal (GI) bleeding and perforation, especially with long-term use. ● Risk is increased in older adults, clients who smoke or have alcohol use disorder, and those who have a history of peptic ulcers or previous inability to tolerate NSAIDs. ● Observe for indications of GI bleeding (passage of black or dark-colored stools, severe abdominal pain, nausea, vomiting). ● Administer a proton pump inhibitor (omeprazole) or an H2 receptor antagonist (cimetidine) to decrease the risk of ulcer formation. ● Use prophylaxis agents (misoprostol). CLIENT EDUCATION ● Take medication with food or with an 8 oz glass of water or milk. ● Avoid alcohol.

Fetal tachycardia

FHR greater than 160/min for 10 min or more

Fetal bradycardia during labor

FHR less than 110/min for 10 min or more

infertility assessment for female and male

Female AGE: Age greater than 35 years can affect fertility. DURATION OF INFERTILITY: More than 1 year of coitus without contraceptives. For females older than 35 years or who have a known risk factor, the recommendation is for 6 months. MEDICAL HISTORY: Atypical secondary sexual characteristic, such as abnormal body fat distribution or hair growth, is indicative of an endocrine disorder. Assessment should include hormonal and adrenal gland disorders, as these can contribute to infertility. SURGICAL HISTORY: Particularly pelvic and abdominal procedures. OBSTETRIC HISTORY: Past episodes of spontaneous abortions. Other obstetric assessments should include an evaluation of hormone levels throughout the client's cycle. This can provide information about anovulation, amenorrhea, and premature ovarian failure. GYNECOLOGIC HISTORY: Abnormal uterine contours or any history of disorders that can contribute to the formation of scar tissue that can cause blockage of ovum or sperm. SEXUAL HISTORY: Intercourse frequency, number of partners across the lifespan, and any history of STIs. OCCUPATIONAL/ENVIRONMENTAL EXPOSURE RISK ASSESSMENT: Exposure to hazardous teratogenic materials in the home or at a place of employment. NUTRITION STATUS: Overweight or underweight. Nutritional deficiencies, such as anorexia, can contribute to infertility. SUBSTANCE USE: Alcohol, tobacco, heroin, methadone. Male MEDICAL HISTORY: Mumps, especially after adolescence; endocrine disorders; genetic disorders; and anomalies in the reproductive system. SEXUAL HISTORY: Intercourse frequency, and history of sexually transmitted infections. SUBSTANCE USE: Alcohol, tobacco, heroin, methadone. OCCUPATIONAL/ENVIRONMENTAL EXPOSURE RISK ASSESSMENT: Exposure to hazardous teratogenic materials in home or work environment, exposure of scrotum to high temperatures

diagnostic procedures for infertility female and male

Female PELVIC EXAMINATION: Assesses for uterine or vaginal anomalies. HORMONE ANALYSIS: Evaluates hypothalamic-pituitaryovarian axis to include blood prolactin, FSH, LH, estradiol, progesterone, and thyroid hormone levels. POSTCOITAL TEST: Evaluates coital technique and mucus secretions. ULTRASONOGRAPHY: A transvaginal or abdominal ultrasound procedure performed to visualize reproductive organs. HYSTEROSALPINGOGRAPHY: Outpatient radiological procedure in which dye is used to assess the patency of the fallopian tubes. Assess for history of allergies to iodine and seafood prior to beginning the procedure. HYSTEROSCOPY: A radiographic procedure in which the uterus is examined for defect, distortion, or scar tissue that can impair successful impregnation. LAPAROSCOPY: A procedure in which gas insufflation under general anesthesia is used to observe internal organs. Male SEMEN ANALYSIS: In 40% of couples who are infertile, inability to conceive is due to male infertility. This test is the first in an infertility workup because it is less expensive and less invasive than female infertility testing. It can need to be repeated. ULTRASONOGRAPHY: An ultrasound procedure is performed to visualize testes and abnormalities in the scrotum. A transrectal ultrasound is performed to assess the ejaculatory ducts, seminal vesicles, and vas deferens

Lightening

Fetal head descends into true pelvis about 14 days before labor; feeling that the fetus has "dropped"; easier breathing, but more pressure on bladder, resulting in urinary frequency; more pronounced in clients who are primigravida

vertex presentation

Fetal heart tones should be assessed below the client's umbilicus in either the right- or left-lower quadrant of the abdomen

nursing intervention for postpartum care/perineal care

For the first 2 weeks following delivery, clients will need to perform perineal hygiene as taught during the immediate postpartum period. This may include perineal water rinses following elimination using warm water or medicinal rinses, use of sitz baths, and comfort medications to the perineal and anal area. ● Cleanse the perineal area from front to back with warm water after each voiding and bowel movement. ● Blot perineal area from front to back. ● Remove and apply perineal pads from front to back.

Passive Immunity of a newborn

For the first few days after birth, the baby receives colostrum (early milk). Colostrum is secreted from the postpartum client's breasts during postpartum days 1 to 3. It contains immunoglobulin A (IgA), which provides passive immunity to the newborn.

What can occur as a result of elevated estrogen levels?

Gingivitis, nasal stuffiness, and epistaxis (nosebleed) causing increased vascularity and proliferation of connective tissue. The client should gently brush their teeth, observe good dental hygiene, use a humidifier, and use normal saline nose drops or spray

Head circumference (HC) of a newborn

HC range: 32 to 36.8 cm (12.5 to 15 inches)

Dystocia: general aspects (maternal)—"4P's" Powers Passageway Passenger Psych

Powers Passageway Passenger Psych

Severe preeclampsia

consists of blood pressure that is 160/110 mm Hg or greater, proteinuria greater than 3+, oliguria, elevated blood 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.

Expected findings for gestational diabetes mellitus

Hypoglycemia: nervousness, headache, weakness, irritability, hunger, blurred vision Hyperglycemia: polydipsia, polyphagia, polyuria, nausea, abdominal pain, flushed dry skin, fruity breath PHYSICAL ASSESSMENT FINDINGS ● Hypoglycemia ● Shaking ● Clammy pale skin ● Shallow respirations ● Rapid pulse ● Hyperglycemia ● Vomiting ● Excess weight gain during pregnancy

Expected findings for developmental dysplasia of the hip

INFANT ● Asymmetry and unequal number of skin folds on the posterior thigh ● Limited hip abduction ● Shortening of the femur ● Widened perineum ● Positive Ortolani test performed by provider (hip is reduced by abduction) ● Positive Barlow test performed by provider (hip is dislocated by adduction) CHILD ● One leg shorter than the other ● Walking on toes on one foot ● Walk with a limp

Fetal demise

If you don't feel baby move in the 6th month of pregnancy, what does that mean?

Cold stress with the newborn

Ineffective thermoregulation can lead to hypoxia, acidosis, and hypoglycemia. Newborns who have respiratory distress are at a higher risk for hypothermia

chorioamnionitis

Infection of the amniotic sac signs and symptoms: maternal fever, tachycardia, increased uterine tenderness, and foul-smelling amniotic fluid

Precipitous labor

Labor that lasts 3 hours or less from onset of contractions to time of delivery

Late Decelerations

Late deceleration of FHR Slowing of FHR after contraction has started with return of FHR to baseline well after contraction has ended CAUSES/COMPLICATIONS ● Uteroplacental insufficiency causing inadequate fetal oxygenation ● Maternal hypotension, placenta previa, abruptio placentae, uterine tachysystole with oxytocin ● Preeclampsia ● Late- or post-term pregnancy ● Maternal diabetes mellitus

oxytocin contraindications/precautions

Maternal factors: Sepsis, an unripe cervix, active genital herpes, history of multiple births, history of uterine surgery Fetal factors: Immature lungs, cephalopelvic disproportion, fetal malpresentation, prolapsed umbilical cord, fetal distress, placental abnormalities, threatened spontaneous abortion

Adverse effect of epidural anesthesia

Maternal hypotension ◯ Fetal bradycardia ◯ Fever ◯ Itching ◯ Inability to feel the urge to void ◯ Urinary retention ◯ Loss of the bearing down reflex ● Decreased gastric emptying resulting in nausea and vomiting ● respiratory depression Allergic reaction and pruritus ● Elevated temperature, impaired placental perfusion

Maternal Phenylketonuria (PKU)

Maternal phenylketonuria (PKU) is a maternal genetic disease in which high levels of phenylalanine pose a danger to the fetus (intellectual disability, behavioral problems). ● 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 (fish, poultry, meat, eggs, nuts, dairy products) must be avoided due to high phenylalanine levels. Aspartame, which contains phenylalanine, should be avoided by pregnant clients who have PKU. ● The client's blood phenylalanine levels are monitored during pregnancy.

Anticonvulsant medications: Magnesium sulfate

Medication of choice for prophylaxis or treatment to depress the CNS and prevent seizures in the client who has eclampsia and severe preeclampsia

Nursing intervention for cold stress (hypothermia)

Monitor for manifestations of cold stress (skin pallor with mottling and cyanotic trunk; tachypnea). ● The newborn should be warmed slowly over a period of 2 to 4 hr. Correct hypoxia by administering oxygen. Correct acidosis and hypoglycemia.

Signs and symptoms of ductus arteriosus

Murmurs, abnormal heart rate or rhythm, breathlessness, and fatigue while feeding

What is the initial neurologic assessment for a newborn

Muscle tone and reflex reaction (Moro reflex); palpation for the presence and size of fontanels and sutures; assessment of fontanels for fullness or bulge

Common discomforts of pregnancy

Nausea and vomiting Breast tenderness Urinary frequency Urinary tract infections (UTIs) Fatigue Heartburn Constipation Hemorrhoids Backaches Shortness of breath Leg cramps Varicose veins and lower-extremity edema Gingivitis, nasal stuffiness, and epistaxis Braxton Hicks contractions, Supine hypotension

Bilirubin levels

Newborns 0.2 to 1.4 mg/dl

Nursing Intervention for Early decelerations of FHR

No intervention required

hypertonic uterine dysfunction

Nonproductive, uncoordinated, painful, uterine contractions during labor that are too frequent and too long in duration and do not allow for relaxation of the uterine muscle between contractions (uterine tetany).

Assess Baby-friendly care (parent-infant bonding)

Nursing assessments include noting the client's condition after birth, observing the maternal adaptation process, assessing maternal emotional readiness to care for the infant, and assessing how comfortable the client appears in providing infant care. ● Assess for behaviors that facilitate and indicate parent-infant bonding. ◯ Considers the infant a family member ◯ Holds the infant face-to-face (en face position), maintaining eye contact ◯ Assigns meaning to the infant's behavior and views this positively ◯ Identifies the infant's unique characteristics and relates them to those of other family members ◯ Names the infant, indicating bonding is occurring ◯ Touches the infant and maintains close physical proximity and contact ◯ Provides physical care for the infant (feeding, diapering) ◯ Responds to the infant's cries ◯ Smiles at, talks to, and sings to the infant ● Assess for behaviors that impair and indicate a lack of parent-infant bonding. ◯ Apathy when the infant cries ◯ Disgust when the infant voids, stools, or spits up ◯ Expresses disappointment in the infant ◯ Turns away from the infant ◯ Does not seek close physical proximity to the infant ◯ Does not talk about the infant's unique features ◯ Handles the infant roughly ◯ Ignores the infant entirely ◯ Does not include the infant in the family context ◯ Perceives infant behavior as uncooperative ● Assess for manifestations of mood swings, conflict about maternal role, or personal insecurity. ◯ Feelings of being "down" ◯ Feelings of inadequacy ◯ Feelings of anxiety ◯ Emotional lability with frequent crying ◯ Flat affect and being withdrawn ◯ Feeling unable to care for the infant

Nursing Intervention for neonatal abstinence syndrome

Nursing care for maternal substance use and neonatal effects or withdrawal include the following in addition to normal newborn care. ● Perform ongoing assessment of the newborn using the neonatal abstinence scoring system assessment, as prescribed. ● Elicit and assess the newborn's reflexes. ● Monitor the newborn's ability to feed and digest intake. Offer small frequent feedings. ● Swaddle the newborn with legs flexed. ● Offer non‑nutritive sucking. ● Monitor the newborn's fluids and electrolytes with skin turgor, mucous membranes, fontanels, daily weights, and I&O. ● Reduce environmental stimuli (decrease lights, lower noise level), avoid eye contact and talking during feedings, infants with NAS have difficulty processing multiple forms of stimulation and can quickly become frustrated.

Nursing considerations and ongoing care of amniotomy

ONGOING CARE ● Ensure that the presenting part of the fetus is engaged prior to an amniotomy to prevent cord prolapse. ● Monitor FHR prior to and immediately following AROM to assess for cord prolapse as evidenced by variable or late decelerations. ● Assess and document characteristics of amniotic fluid including color, odor, and consistency. INTERVENTIONS ● Document the time of rupture. ● Obtain temperature every 2 hr. ● Provide comfort measures (frequently changing pads, perineal cleansing).

Group B Steptococcus (GBS)

Obtain a vaginal/anal culture at 35 to 37 weeks of gestation to assess for GBS infection

Expected findings in Small for gestational age (SGA)

PHYSICAL ASSESSMENT FINDINGS ● Weight below 10th percentile ● Normal skull, but reduced body dimensions ● Hair is sparse on scalp ● Wide skull sutures from inadequate bone growth ● Dry, loose skin ● Decreased subcutaneous fat ● Decreased muscle mass, particularly over the cheeks and buttocks ● Thin, dry, yellow, and dull umbilical cord rather than gray, glistening, and moist ● Drawn abdomen rather than well‑rounded ● Respiratory distress and hypoxia ● Wide‑eyed and alert, which is attributed to prolonged fetal hypoxia ● Hypotonia ● Evidence of meconium aspiration ● Hypoglycemia ● Acrocyanosis

expected findings for hyperbilirubinemia

PHYSICAL ASSESSMENT FINDINGS ● Yellowish tint to skin, sclera, and mucous membranes. ● To verify jaundice, press the newborn's skin on the cheek or abdomen lightly with one finger. Then, release pressure, and observe the newborn's skin color for yellowish tint as the skin is blanched. ● Note the time of jaundice onset. ● Assess the underlying cause by reviewing the maternal prenatal, family, and newborn history. ● Hypoxia, hypothermia, hypoglycemia, and metabolic acidosis can occur as a result of hyperbilirubinemia and can increase the risk of brain damage.

Leopold maneuver considerations

PREPARATION OF THE CLIENT ● Ask the client to empty the bladder before beginning the assessment. ● Place the client in the supine position with a pillow under the head, and have both knees slightly flexed. ● Place a small, rolled towel under the client's right or left hip to displace the uterus off the major blood vessels to prevent supine hypotensive syndrome. ONGOING CARE ● Identify the fetal part occupying the fundus. The head should feel round, firm, and move freely. The breech should feel irregular and soft. This maneuver identifies the fetal lie (longitudinal or transverse) and presenting part (cephalic or breech). ● Locate and palpate the smooth contour of the fetal back using the palm of one hand and the irregular small parts of the hands, feet, and elbows using the palm of the other hand. This maneuver validates the presenting part. ● Determine the part that is presenting over the true pelvis inlet by gently grasping the lower segment of the uterus between the thumb and fingers. If the head is presenting and not engaged, determine whether the head is flexed or extended. This maneuver assists in identifying the descent of the presenting part into the pelvis. ● Face the client's feet and outline the fetal head using the palmar surface of the fingertips on both hands to palpate the cephalic prominence. If the cephalic prominence is on the same side as the small parts, the head is flexed with vertex presentation. If the cephalic prominence is on the same side as the back, the head is extended with a face presentation. This maneuver identifies the fetal attitude. INTERVENTIONS ● Auscultate the FHR post-maneuvers to assess the fetal tolerance to the procedure. ● Document the findings from the maneuvers.

Papanicolaou (Pap) test procedure

PREPROCEDURE NURSING ACTIONS ● Have the client empty the bladder. ● Place the client in the lithotomy position and drape appropriately. ● Explain to the client how the procedure will be carried out. ● Have all necessary equipment available (cervical scraping tools, glass slides, fixative, perineal pad). CLIENT EDUCATION ● Schedule the test when not menstruating. ● Use of vaginal medications, douching, or sexual intercourse within the past 24 hr can alter test results. INTRAPROCEDURE NURSING ACTIONS ● Remain with the client and provide support. ● Have ready the necessary equipment for the provider during procedure. ● Transfer specimens to slides and apply fixative to slides. POSTPROCEDURE NURSING ACTIONS: Provide perineal pads and tissues. CLIENT EDUCATION ● Minimal bleeding can occur from the cervix. ● Follow up with the provider if results are abnormal.

dysmenorrhea

Painful menstruation, is common in adolescents and young clients. In many clients, this pain is significantly decreased after the birth of a child or as the client becomes older

placenta Previa Signs and Symptoms

Painless, bright red vaginal bleeding during the second or third trimester ● Uterus soft, relaxed, and nontender with normal tone ● Fundal height greater than usually expected for gestational age ● Fetus in a breech, oblique, or transverse position ● Reassuring FHR ● Vital signs within normal limits ● Decreasing urinary output, which can be a better indicator of blood loss

Five P's

Passenger (fetus and placenta) Passageway (birth canal) Powers (contractions) Position of mother Psychologic response

Lochia serosa (rosa-meaning pink)

Pinkish brown color and serosanguineous consistency. Can contain small clots and leukocytes. Lasts from approximately day 4 to day 10 after delivery

Expected findings for postpartum blues

Postpartum blues ● Feelings of sadness ● Lack of appetite ● Sleep pattern disturbances ● Feeling of inadequacies ● Crying easily for no apparent reason ● Restlessness, insomnia, fatigue ● Headache ● Anxiety, anger, sadness PHYSICAL ASSESSMENT FINDINGS: Crying

polyhydramnios

Presence of excess amniotic fluid surrounding the unborn fetus. Expected finding: fetal gastrointestinal anomalies

The Uterus during Postpartum period

The uterus also rapidly decreases in size from approximately 1,000 g at the end of the third stage of labor to 60 to 80 g at 6 weeks postpartum with the fundal height steadily descending into the pelvis approximately one fingerbreadth (1 cm) per day. (17.1) ● At the end of the third stage of labor, the uterus should be palpable at midline and 2 cm below the umbilicus. ● 1 hr after delivery, the fundus (top portion of the uterus) should rise to the level of the umbilicus. ● Every 24 hr, the fundus should descend approximately 1 to 2 cm. It should be halfway between the symphysis pubis and the umbilicus by the sixth postpartum day. ● After about 2 weeks, the uterus should lie within the true pelvis and should not be palpable.

External electronic monitoring (tocotransducer)

Separate transducer applied to the maternal abdomen over the fundus that measures uterine activity ◯ Displays uterine contraction patterns ◯ Easily applied by the nurse but must be repositioned with maternal movement to ensure proper placemen

Early decelerations of FHR

Slowing of FHR at the start of contraction with return of FHR to baseline at end of contraction CAUSES/COMPLICATIONS ● Compression of the fetal head resulting from uterine contraction ● Uterine contractions ● Vaginal exam ● Fundal pressure NURSING INTERVENTIONS: No intervention required.

What is the Naegele's rule and how is it calculated? What is this also known as?

Take the first day of the client's last menstrual cycle, subtract 3mths, and then add 7 days and 1 year, adjusting for the year as necessary. Expected date of delivery (EDD)

Fetal Doppler

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.

your in a labor and delivery unit, and the mom has a rapidly progressing labor-and the baby is coming, but mom is not fully dilated. what are the risks that are involved with baby coming too soon, and mom not fully dilatated? and what do you do.

The risk that happens with baby is head compression, brain damage, and ICP. Nursing intervention: Put on sterile gloves, and stick 2 fingers in vagina and push baby back.

TORCH infections

Toxoplasmosis, other infections (hepatitis), rubella virus, cytomegalovirus, and herpes simplex virus (HSV) are known collectively as TORCH, which is a group of infections that can negatively affect a client who is pregnant. These infections can cross the placenta and have teratogenic effects on the fetus. TORCH does not include all the major infections that present risks to the mother and fetus. ● Rubella can cause fetal consequences (miscarriage, congenital anomalies, death). ● HSV can cause miscarriage, preterm labor, and intrauterine growth restriction.

Variable deceleration of FHR

Transitory, abrupt slowing of FHR 15/min or more below baseline for at least 15 seconds, variable in duration, intensity, and timing in relation to uterine contraction CAUSES/COMPLICATIONS ● Umbilical cord compression ● Short cord ● Prolapsed cord ● Nuchal cord (around fetal neck)

Hydatidiform mole treatment

Treatment involves dilation and curettage (D and C) procedure, to remove the abnormal tissue growth from the uterus.

The normal umbilical cord contains how many arteries? How many veins?

Two arteries and one vein (AVA)

Papanicolaou (Pap) test

Used as a screening tool for cervical cancer, herpes simplex type 2, and/or human papillomavirus.

oxytocin

Uterine stimulants increase the strength, frequency, and length of uterine contractions

contraction stress test

a stress test used to evaluate the ability of the fetus to tolerate the stress of labor and delivery stimulate the nipple, give oxytocin -notice in 3 contractions in a span of 10 minutes, no late decelerations

VEAL CHOP

Variable decels => Cord compression (usually a change in mother's position helps) Early decels => Head compression (decels mirror the contractions; this is not a sign of fetal problems) Accelerations => O2 (baby is well oxygenated-this is good) Late decels => Placental utero insufficiency (this is bad and means there is decreased perfusion of blood/oxygen/nutrients to the baby).

lochia alba (meaning white)

Yellowish white creamy color, fleshy odor. Can consist of mucus and leukocytes. Lasts from approximately day 10 up to 8 weeks postpartum

multigravida

a client who has had two or more pregnancies

nulligravida

a client who has never been pregnant

Chlamydia

a is a bacterial infection caused by Chlamydia trachomatis and is the most commonly reported STI in American women. ● The infection can be difficult to diagnose because the client rarely has manifestations. If chlamydia is left untreated in females, it can lead to pelvic inflammatory disease (PID), which can cause infertility and ectopic pregnancy. ● The Centers for Disease Control and Prevention (CDC) recommends yearly screening of all sexually active females younger than 25 years, as well as older females who have risk factors (new or multiple partners). All pregnant clients should be screened at the first prenatal visit and rescreened in the third trimester if younger than 25 years and/or at high risk. ● If not treated during pregnancy, chlamydia can cause premature rupture of membranes, preterm labor, and postpartum endometritis. ● If transmitted to the neonate, it can cause conjunctivitis and pneumonia after delivery.

Postmature infant

a newborn after the completion of 42 weeks of gestation.

lordosis

abnormal anterior curvature of the lumbar spine (sway-back condition) common during pregnancy and toddler years

microcephaly

abnormally small head indicating fused cranial sutures or prenatal infection with rubella, toxoplasmosis, or cytomegalovirus normal range is 32 to 36.8cm for a newborn

abstinence

abstaining from having a sexual intercourse eliminates the possibility of sperm entering the vagina.

expected findings for endometritis

anorexia ● Pelvic pain ● Chills ● Fatigue ● Loss of appetite fever physical findings: ◯ Uterine tenderness and enlargement ◯ Dark, profuse lochia ◯ Lochia that is either malodorous or purulent ◯ Temperature greater than 38° C (100.4° F) ◯ Tachycardia

how to treat mastitis

antibiotics

Complete miscarriage

all fetal tissue passed, cervix closed, mild cramping, small amount of bleeding

probable signs of pregnancy

are changes that make the examiner suspect a client is pregnant (primarily related to physical changes of the uterus). Signs can be caused by physiological factors other than pregnancy (pelvic congestion, tumors). ● Abdominal enlargement related to changes in uterine size, shape, and position ● Hegar's sign: softening and compressibility of lower uterus ● Chadwick's sign: deepened violet-bluish color of cervix and vaginal mucosa ● Goodell's sign: softening of cervical tip ● Ballottement: rebound of unengaged fetus ● Braxton Hicks contractions: false contractions that are painless, irregular, and usually relieved by walking ● Positive pregnancy test ● Fetal outline felt by examiner

Presumptive signs of pregnancy

are changes that the client experiences that make them think that they might be pregnant. These changes might be subjective manifestations or objective findings. Signs also might be a result of physiological factors other than pregnancy (peristalsis, infections, stress). ● Amenorrhea ● Fatigue ● Nausea and vomiting ● Urinary frequency ● Breast changes: darkened areolae, enlarged Montgomery's glands ● Quickening: slight fluttering movements of the fetus felt by the client, usually between 16 to 20 weeks of gestation ● Uterine enlargement

Iron supplements

are often added to the prenatal plan to facilitate an increase of the maternal RBC mass. Iron is best absorbed between meals and when given with a source of vitamin C. Milk and caffeine interfere with the absorption of iron supplements. Food sources of iron include beef liver, red meats, fish, poultry, dried peas and beans, and fortified cereals and breads. A stool softener might need to be added to decrease constipation experienced with iron supplements.

*Fetal Station - 0 Station*

at the ischial spine

preterm newborn

birth occurs after 20 weeks of gestation and before completion of 37 weeks of gestation

Leopold maneuver

consist of performing external palpations of the maternal uterus through the abdominal wall to determine the following. ● Presenting part, fetal lie, and fetal attitude ● Degree of descent of the presenting part into the pelvis ● Location of the fetus's back to assess for fetal heart tones ◯ Vertex presentation: Fetal heart tones should be assessed below the client's umbilicus in either the right- or left-lower quadrant of the abdomen. ◯ Breech presentation: Fetal heart tones should be assessed above the client's umbilicus in either the right- or left-upper quadrant of the abdomen

risk associated with amniotomy

d-Intra-amniotic infection -umbilical cord prolapse when presenting part is not engaged -bleeding from undiagnosed placental abnormality -severe variable decelerations

linea nigra

dark line of pigmentation from the umbilicus extending to the pubic area

nursing intervention for vibroacoustic stimulation

event marker each time they feel the fetus move. ● If there are no fetal movements (fetus sleeping), vibroacoustic stimulation (sound source, usually laryngeal stimulator) can be activated for 3 seconds on the maternal abdomen over the fetal head to awaken the sleeping fetus

expected findings of a congenital diaphragmatic hernia in newborn

exhibit a barrel-shaped chest as the abdominal organs have shifted into the chest cavity

meconium aspiration

fetal aspiration of amniotic fluid containing meconium (the dark green substance forming the first feces of a newborn infant)

continuous electronic fetal monitoring

g is accomplished by securing an ultrasound transducer over the client's abdomen, which records the FHR pattern, and a tocotransducer on the fundus that records the uterine contractions. Determination of variability

*gait control theory* when a mom's in labor-non-pharmacological measures-distracts them

heat, cold, massage, tens unit, counterpressure, hydrotherapy

Dinoprostone gel (Prepidil) misoprostol gel

help with cervical ripening CHEMICAL AGENTS based on prostaglandins are used to soften and thin the cervix. They can be in the form of oral medication or vaginal suppositories/gels

What is a disadvantage of an NST?

include a high rate of false nonreactive results with the fetal movement response blunted by sleep cycles of the fetus, fetal immaturity, maternal medications, and nicotine use disorder.

Vacuum-assisted birth

involves the use of a cuplike suction device that is attached to the fetal head. Traction is applied during contractions to assist in the descent and birth of the head, after which, the vacuum cup is released and removed preceding delivery of the fetal body. Follow recommendations by the manufacturer for product use to ensure safety.

Pre-eclampsia

is GH with the addition of proteinuria of greater than or equal to 1+. Report of transient headaches might occur along with episodes of irritability. Edema can be present.

Cephalohematoma

is a collection of blood between the periosteum and the skull bone that it covers. It does not cross the suture line. It results from trauma during birth such as pressure of the fetal head against the maternal pelvis in a prolonged difficult labor or forceps delivery. It appears in the first 1 to 2 days after birth and resolves in 2 to 8 weeks. (23.5)

HELLP syndrome

is a variant of GH in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction. HELLP syndrome is diagnosed by laboratory tests, not clinically

hyperbilirubinemia

is an elevation of serum bilirubin levels resulting in jaundice. Jaundice normally appears on the head (especially the sclera and mucous membranes), and then progresses down the thorax, abdomen, and extremities

Gestational Diabetes mellitus

is an impaired tolerance to glucose with the first onset or recognition during pregnancy. The ideal blood glucose level during pregnancy should range between 60 and 99 mg/ dL before meals or fasting, and less than or equal to 120 mg/dL 2 hr after meals. ● Findings of diabetes mellitus can disappear a few weeks following delivery. However, approximately 50% of clients will develop type II diabetes mellitus later in life

episiotomy

is an incision made into the perineum to enlarge the vaginal opening to facilitate birth and minimize soft tissue damage.

Mastitis

is an infection of the breast involving the interlobular connective tissue and is usually unilateral. Mastitis can progress to an abscess if untreated. ● It can occur as early as the seventh postpartum day. It usually occurs during the first 6 weeks of breastfeeding but can occur at any time during breastfeeding. ● Staphylococcus aureus is usually the infecting organism

Endometritis (uterine infection)

is an infection of the uterine lining or endometrium. It is the most frequently occurring puerperal infection.

Folic Acid

is crucial for neurologic development and the prevention of fetal neural tube defects. Folate found naturally in foods is converted to folic acid. Foods high in folate include leafy vegetables, dried peas and beans, seeds, and orange juice. Breads, cereals, and other grains are fortified with folic acid. The March of Dimes recommends that clients who wish to become pregnant and clients of childbearing age take 400 mcg of folic acid and clients who become pregnant take 600 mcg of folic acid.

Calcium

which is important to a developing fetus, is involved in bone and teeth formation. Sources of calcium include milk, calcium-fortified soy milk, fortified orange juice, nuts, legumes, and dark green leafy vegetables. Daily recommendation is 1,000 mg/day for pregnant and nonpregnant clients 19 to 50 years of age, and 1,300 mg/day for those under 19 years of age.

hyperemesis gravidarum

is excessive nausea and vomiting (possibly related to elevated hCG levels) that is prolonged past 16 weeks of gestation or that is excessive and causes weight loss, dehydration, nutritional deficiencies, electrolyte imbalances, and ketonuria. ● There is a risk to the fetus for intrauterine growth restriction, small for gestational age, or preterm birth if the condition persists.-the presence of ketones supports the diagnosis

Lochia

is post-birth uterine discharge that contains blood, mucus, and uterine tissue. The amount of lochia is similar to a heavy menstrual period about 2 hr after delivery, then decreases gradually at a consistent rate.

eclampsia

is severe preeclampsia manifestations with the onset of seizure activity or coma. Eclampsia is usually preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentration, which are warning manifestations of probable convulsions.

ectopic pregnancy

is the abnormal implantation of a fertilized ovum outside of the uterine cavity usually in the fallopian tube, which can result in a tubal rupture causing a fatal hemorrhage. It is the second most frequent cause of bleeding in early pregnancy and a leading cause of infertility.

amniotomy

is the artificial rupture of the amniotic membranes (AROM) by the provider using a hook, clamp, or other sharp instrument. ● Labor typically begins within 12 hr after the membranes rupture and can decrease the duration of labor by up to 2 hr. ● The client is at an increased risk for cord prolapse or infection.

Gonorrhea

is the causative agent of gonorrhea. Gonorrhea is a bacterial infection that is primarily spread by genital-to-genital contact. However, it also can be spread by anal-to-genital or oral-to-genital contact. It can also be transmitted to a newborn during delivery. ● Females frequently have no manifestations. If gonorrhea is left untreated in females, it can cause tubal scarring and can lead to PID, which can cause infertility. ● The CDC recommends yearly screening for all sexually active females younger than 25 years as well as older females who have risk factors (new or multiple sex partners). All pregnant clients at risk should be screened at the first prenatal visit and rescreened in the third trimester if at continued high risk. ● If left untreated, the neonate experiences ophthalmia neonatorum, which can cause blindness

induction of labor

is the deliberate initiation of uterine contractions to stimulate labor before spontaneous onset to bring about the birth by chemical or mechanical means. METHODS ● Mechanical or chemical approaches ● Administration of IV oxytocin ● Nipple stimulation to trigger the release of endogenous oxytocin

cesarean birth

is the delivery of the fetus through a transabdominal incision of the uterus to preserve the life or health of the client and fetus when there is evidence of complications. ● Incisions are made vertically and horizontally into the lower segment of the uterus. Horizontal is the optimal incision

Nonstress test (NST)

is the most widely used technique for antepartum evaluation of fetal well-being performed during the third trimester. It is a noninvasive procedure that monitors response of the FHR to fetal movement. A Doppler transducer (used to monitor FHR) and a tocotransducer (used to monitor uterine contractions) are attached externally to a client's abdomen to obtain tracing strips. The client pushes a button attached to the monitor whenever they feel a fetal movement, which is then noted on the tracing. This allows a nurse to assess the FHR in relationship to the fetal movement

abruptio placentae

is the premature separation of the placenta from the uterus, which can be a partial or complete detachment. This separation occurs after 20 weeks of gestation, which is usually in the third trimester. It has significant maternal and fetal morbidity and mortality and is a leading cause of maternal death

Premature Rupture of Membranes (PROM) Pathophysiology

is the spontaneous rupture of the amniotic membranes prior to the onset of true labor. For most clients, PROM signifies the onset of true labor if gestational duration is at term

Prophylactic cervical cerclage

is the surgical reinforcement of the cervix with a heavy ligature that is placed submucosally around the cervix to strengthen it and prevent premature cervical dilation. Best results occur if this is done at 12 to 14 weeks of gestation. The cerclage is removed at 36 weeks of gestation or when spontaneous labor occurs.

Bishop score

is used to determine maternal readiness for labor by evaluating whether the cervix is favorable by rating the following. ◯ Cervical dilation ◯ Cervical effacement ◯ Cervical consistency (firm, medium, or soft) ◯ Cervical position (posterior, midposition, or anterior) ◯ Station of presenting part ● The five factors are assigned a numerical value of 0 to 3, and the total score is calculated.

preterm labor

is uterine contractions and cervical changes that occur between 20 and 36 weeks and 6 days of gestation. P

pruritis gravidarum

itching during pregnancy without the presence of a rash

Trisomy 21 (Down Syndrome) pathophysiology

which is the most common trisomic abnormality with 47 chromosomes in each cell

very preterm labor

less than 32 weeks

The Mcroberts maneuver

lithotomy position with legs flexed to chest to maximize pelvic outlet (helps relieve shoulder dystocia)

fetal lie: transverse

long axis of fetus is perpendicular to long axis of mother

oral contraceptives

mimics the properties of natural hormones, except they provide constant, rather than the normal fluctuating, levels of these hormones. As a result, secretion of FSH and LH is suppressed. In addition, the progesterone in oral contraceptives promotes a production of thick cervical mucus, which provides a barrier to the passage of sperm.

What medications would you give for a boggy uterus?

misoprostol, oxytocin, methylergonovine, carboprost

What is uterine tetany?

non-productive, uncoordinated, painful, contractions during labor that are too frequent and too long in duration and do not allow for relations of the uterine muscle between contractions? contractions that last longer than 60 seconds, if persistent may indicated that the uterus is contracted for excessive periods of time, contributing to fetal stress. nursing intervention: turn them to the side

brow presentation (cephalic)

o Fetal head is partially extended o Longest diameter is presenting

Vertex presentation (cephalic)

o Most common o Fetal head is fully flexed o Most favorable because the smallest diameter is presenting "Crown of the Head"

supine hypotension

occurs when a client lies on their back and the weight of the gravid uterus compresses the vena cava. This reduces blood supply to the fetus. The client might experience feelings of lightheadedness and faintness. Teach the client to lie in a side-lying or semi-sitting position with the knees slightly flexed

Placenta Previa (Placenta first)

occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus.

prolapsed umbilical cord

occurs when the umbilical cord is displaced, preceding the presenting part of the fetus, or protruding through the cervix. This results in cord compression and compromises fetal circulation

amniotic fluid embolism

occurs when there is a rupture in the amniotic sac or maternal uterine veins accompanied by high intrauterine pressure that causes infiltration of the amniotic fluid into the maternal circulation. The amniotic fluid then travels to and obstructs pulmonary vessels and causes respiratory distress and circulatory collapse. It can occur during labor, birth, or within 30 min following birth. ● Meconium-stained amniotic fluid or fluid containing particulate matter can cause devastating maternal damage because it readily clogs the pulmonary veins completely. ● Serious coagulation problems, such as disseminated intravascular coagulopathy (DIC), can occur.

intermittent auscultation

of the FHR is a low-technology method that can be performed during labor using a hand-held Doppler ultrasound device, ultrasound stethoscope, or fetoscope to assess FHR. In conjunction, palpation of contractions at the fundus for frequency, intensity, duration, and resting tone is used to evaluate fetal well-being. During labor, uterine contractions compress the uteroplacental arteries, temporarily stopping maternal blood flow into the uterus and intervillous spaces of the placenta, decreasing fetal circulation and oxygenation. Circulation to the uterus and placenta resumes during uterine relaxation between contractions. For low-risk labor and delivery, this procedure allows the client freedom of movement and can be done at home or a birthing center. Guidelines for intermittent auscultation or continuous electronic fetal monitoring ● During latent phase: every 30 to 60 min ● During active phase: every 15 to 30 min ● During second stage: every 5 to 15 min

Incomplete miscarriage

some, but not all, of the products of conception have been passed; retained products may be part of the fetus, placenta or membranes

occiput posterior

presentation is when the fetal occiput is directed toward the posterior maternal pelvis rather than the anterior pelvis. position prolongs labor and the client reports greater back pain as the fetus presses against the maternal sacrum (squat during contractions)

vernix caseosa

protective, thick, cheesy covering) amounts vary, with more present in creases and skin folds

adverse effects of betamethasone

pulmonary edema, chest pain, shortness of breath, and crackles

Missed Miscarriage/Abortion

refers to a pregnancy in which the fetus has died but the products of conception are retained in utero for up to several weeks. It may be diagnosed by ultrasonic examination after the uterus stops increasing in size or even decreases in size. There may be no bleeding or cramping, and the cervical os remains closed.

contraception

refers to strategies or devices used to reduce the risk of fertilization or implantation in an attempt to prevent pregnancy other general uses for oral contraceptives may include decreasing frequency of hormone-induced migraine headaches, stabilizing regularity of the menses, and reducing a woman's risk for disorders such as uterine and ovarian cancers, PID, benign breast disease, and ovarian cysts.

manifestations of impending birth (when you have not had prenatal care, ready to have baby)

sitting on one buttock, making grunting sounds, bulging of the perineum, bearing down during contractions

Quickening

slight fluttering movements of the fetus felt by the client, usually between 16 to 20 weeks of gestati

striae gravidarum

stretch marks most notably found on the abdomen and thighs

Adverse effect of terbutaline

tachycardia, angina, tremors, palpitations, nervousness, dysrhythmias, chest discomfort

Inevitable miscarriage

the cervical os is open, but the products of conception have not been expelled

Fetal lie: longitudinal

the long axis of fetus is parallel to long axis of the mother:

Signs and symptoms of coarctation of the aorta

● Elevated blood pressure in the arms ● Bounding pulses in the upper extremities ● Decreased blood pressure in the lower extremities ● Cool skin of lower extremities ● Weak or absent femoral pulses ● Heart failure in infants ● Dizziness, headaches, fainting, or nosebleeds in older children

involution of the uterus

the uterus returns to its normal nonpregnant size immediately following delivery

Fetal movement/kick counts

to ascertain fetal well-being: A client should be instructed to count and record fetal movements or kicks daily. There are several different methods to complete kick counts. ◯ One method: Clients should count fetal activity two or three times a day for 2 hr after meals or bedtime. Fetal movements of less than 3 per hr or movements that cease entirely for 12 hr indicate a need for further evaluation. ● Diagnostic testing for fetal well-being (nonstress test, biophysical profile, ultrasound, and contraction stress test)

Fetal lie: oblique

unstable line is diagonal and most declare themselves longitudinal lie of transverse lie if transverse can't be born vaginally

Biophysical Profile (BPP)

uses a real-time ultrasound to visualize physical and physiological characteristics of the fetus and observe for fetal biophysical responses to stimuli. It combines FHR monitoring (nonstress test) and fetal ultrasound.

Methylergonovine

uterine stimulants increase the strength, frequency, and length of uterine contractions. -contracts the uterus and is used for emergency intervention for serious postpartum hemorrhage

Gestational hypertension (GH)

which begins after the 20th week of pregnancy, describes hypertensive disorders of pregnancy whereby the client has an elevated blood pressure at 140/90 mm Hg or greater recorded on two different occasions, at least 4 hr apart. There is no proteinuria. The presence of edema is no longer considered in the definition of hypertensive disease of pregnancy. Blood pressure returns to baseline by 12 weeks postpartum.

Intrauterine pressure catheter

which is a solid or fluid-filled transducer placed inside the client's uterine cavity to monitor the frequency, duration, and intensity of contractions.

postpartum diuresis

• Increases urinary output • Increased respiratory loss of fluids • Increased perspiration with nocturnal diaphoretic episodes (might need to change linens). Drop in hormones, specifically Estrogen, causes. Reassure that it's normal.

For cleft palate or cleft lip and palate

■ Position the infant upright while cradling the head during feeding. ■ Use a specialized bottle with a one-way valve and a specially cut nipple. ■ Burp the infant frequently. ■ Syringe feeding can be necessary for the infant who is unsuccessful with other methods.

expected findings for ovarian cancer

● Abdominal pain or swelling ● Abdominal discomfort (dyspepsia, indigestion, gas, distention) ● Abdominal mass ● Urinary frequency ● Unexpected weight loss ● Vaginal bleeding ● Urinary frequency or incontinence

Black cohosh

● Acts as an estrogen substitute ● Treats manifestations of menopause ● Mechanism of action is unknown ADVERSE EFFECTS AND PRECAUTIONS ● GI distress, lightheadedness, headache, rash, weight gain ● Avoid taking during pregnancy, especially the first two trimesters of pregnancy. ● Limit use to no longer than 6 months due to lack of information regarding long-term effect INTERACTIONS ● Increases effects of antihypertensive medications ● Can increase effect of estrogen medications ● Increases hypoglycemia in clients taking insulin or other medications for diabetes NURSING ADMINISTRATION: Question clients who take antihypertensives, insulin, or hypoglycemic agents, or clients who might be pregnant about possible use of black cohosh.

Nursing intervention for betamethasone

● Administer betamethasone 12 mg IM for two doses 24 hr apart. ● Ideally, administer at least 24 hr (but not more than 7 days) before delivery. ● Administer deep IM using ventral gluteal or vastus lateralis muscle. ● Monitor for maternal hyperglycemia. ● Assess the preterm infant's lung sounds

Nursing Intervention experiencing hemorrhage during postpartum care

● Administer oxytocics intramuscularly or IV after the placenta is delivered to promote uterine contractions and to prevent hemorrhage. ◯ Oxytocics include oxytocin, methylergonovine, and carboprost. Misoprostol, a prostaglandin, also can be administered. ● Monitor for adverse effects of medications. ◯ Oxytocin and misoprostol can cause hypotension. ◯ Methylergonovine, ergonovine, and carboprost can cause hypertension. ● Encourage early breastfeeding for a client who is lactating. This will stimulate the production of natural oxytocin and prevent hemorrhage. ● Encourage emptying of the bladder to prevent possible uterine displacement and atony Give oxygen as 2L/min via nasal cannula

Nursing interventions for fetal tachycardia

● Administer prescribed antipyretics for maternal fever, if present. ● Administer oxygen by mask at 10 L/min via nonrebreather face mask. ● Administer IV fluid bolus

Risk factors for Ovarian Cancer

● Age greater than 40 years; risk increases with age ● Nulliparity or first pregnancy after 30 years of age ● Family history of ovarian, breast, or genetic mutation for hereditary nonpolyposis colon cancer (HNPCC) ● BRCA1 or BRCA2 gene mutations ● Diabetes mellitus ● Early menarche/late menopause ● Endometriosis ● High-fat diet ● Infertility ● Older adult clients following surgery for cancer

Medications for postpartum depression

● Antidepressants can be prescribed by the provider if indicated. ● Antipsychotics and mood stabilizers can be prescribed for clients who have postpartum psychosis

Nursing Intervention for fourth stage of labor

● Assess maternal blood pressure and pulse every 15 min for the first 2 hr and determine the temperature at the beginning of the recovery period, then assess every 4 hr for the first 8 hr after birth, then at least every 8 hr. ● Assess fundus and lochia every 15 min for the first hour and then according to facility protocol. ● Massage the uterine fundus and/or administer oxytocics to maintain uterine tone and to prevent hemorrhage. ● Encourage voiding to prevent bladder distention. ● Assess episiotomy or laceration repair for erythema. ● Promote an opportunity for parental-newborn bonding. ● After they have had a chance to bond with their baby and eat, most new mothers are ready for a nap or at least a quiet period of rest

laceration and hematoma nursing intervention

● Assess pain. ● Visually or manually inspect the vulva, perineum, and rectum for lacerations and/or hematomas. ● Evaluate lochia. ● Continue to assess vital signs and hemodynamic status. ● Attempt to identify the source of the bleeding. ● Assist the provider with repair procedures. ● Use ice packs to treat small hematomas. ● Administer pain medication. ● Encourage sitz baths and frequent perineal hygiene (perineal bottle)

Preterm newborn expected findings

● Ballard assessment showing a physical and neurological assessment totaling less than 37 weeks of gestation ● Periodic breathing consisting of 5‑ to 10‑second respiratory pauses, followed by 10‑ to 15‑second compensatory rapid respirations ● Manifestations of increased respiratory effort and/ or respiratory distress including nasal flaring or retractions of the chest wall during inspirations, expiratory grunting, and tachypnea ● Apnea: a pause in respirations 20 seconds or greater ● Low birth weight ● Minimal subcutaneous fat deposits ● Head that is large in comparison with the body, and small fontanels ● Wrinkled features with abundance of lanugo covering back, forearms, forehead, and sides of face, and few or no creases on soles of feet ● Skull and rib cage that feel soft ● Eyes closed if the newborn is born at 22 to 24 weeks of gestation

risks/contraindications for having IUD

● Best used by clients in a monogamous relationship due to the risks of STIs ● Can cause irregular menstrual bleeding ● Risk of bacterial vaginosis, PID, uterine perforation, or uterine expulsion ● Must be removed in the event of pregnancy ● This method can increase the risk of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy and can be expelled

Risk factors for developmental dysplasia of the hip (DDH)

● Birth order (firstborn) ● Female gender ● Family history ● Breech intrauterine position ● Delivery type ● Joint stability ● Oligohydramnios ● Large for gestational age

Respiratory complications of newborn

● Bradypnea: respirations less than or equal to 30/min ● Tachypnea: respirations greater than or equal to 60/min ● Abnormal breath sounds: expiratory grunting, crackles, wheezes ● Respiratory distress: nasal flaring, retractions, grunting, gasping, labored breathing, central cyanosis

Nursing Intervention for prolapsed umbilical cord

● Call for assistance immediately. ● Do not leave the client. ● Notify the provider. ● Using a sterile-gloved hand, insert two fingers into the vagina, and apply finger pressure on either side of the cord to the fetal presenting part to elevate it off of the cord. Stay in this position until the delivery of the baby. ● Reposition the client in a knee-chest, Trendelenburg, or a side-lying position with a rolled towel under the client's right or left hip to relieve pressure on the cord. ● Apply a warm, sterile, saline-soaked towel to the visible cord to prevent drying and to maintain blood flow. ● Provide continuous electronic monitoring of FHR for variable decelerations, which indicate fetal asphyxia and hypoxia. ● Administer oxygen at 8 to 10 L/min via a face mask to improve fetal oxygenation. ● Initiate IV access and administer IV fluid bolus. ● Prepare for an immediate vaginal birth if cervix is fully dilated or cesarean section if it is not. ● Inform and educate the client and their partner about the interventions

Risks/possible complications/contraindications for people taking oral contraceptives

● Clients who have a history of thromboembolic disorders, stroke, heart attack, coronary artery disease, gallbladder disease, cirrhosis or liver tumor, headache with focal neurologic findings, uncontrolled hypertension, diabetes mellitus with vascular involvement, breast or estrogenrelated cancers, pregnancy, lactating, less than 6 weeks postpartum, or smoking (if over 35 years of age) are advised not to take oral contraceptive medications. ● Oral contraceptive effectiveness decreases when taking medications that affect liver enzymes (anticonvulsants, antifungals, some antibiotics)

Risk Factors: (SGA) small for gestational age

● Congenital or chromosomal anomalies ● Maternal infections, disease, or malnutrition ● Gestational hypertension and/or diabetes ● Maternal smoking, drug, or alcohol use ● Multiple gestations ● Placental factors (small placenta, placenta previa, decreased placental perfusion) ● Fetal congenital infections (rubella, toxoplasmosis)

During transition phase of labor (First Stage) Nursing Intervention

● Continue to encourage voiding every 2 hr. ● Continue to monitor and support the client and fetus. ● Encourage a rapid pant-pant-blow breathing pattern if the client has not learned a particular breathing pattern. ● Discourage pushing efforts until the cervix is fully dilated. ● Listen for client statements expressing the need to have a bowel movement. This sensation is a finding of complete dilation and fetal descent. ● Prepare the client for the birth. ● Observe for perineal bulging or crowning (appearance of the fetal head at the perineum). ● Encourage the client to begin bearing down with contractions once the cervix is fully dilated. ● *Some references only recognize two phases in the first stage of labor: latent (0 to 5 cm) and active (6 to 10 cm).

Nursing interventions for fetal bradycardia

● Discontinue oxytocin if being administered. ● Assist the client to a side-lying position. ● Administer oxygen by mask at 10 L/min via nonrebreather face mask. ● Insert an IV catheter if one is not in place and administer maintenance IV fluids. ● Administer a tocolytic medication. ● Notify the provider

Moro reflex

● EXPECTED FINDING: 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." ● EXPECTED AGE: Complete response can be seen until 8 weeks, body jerk only until 8 to 18 weeks, and then absent by 6 months

palmar grasp

● EXPECTED FINDING: Elicit by placing examiner's finger in palm of newborn's hand. The newborn's fingers curl around examiner's fingers. ● EXPECTED AGE: Lessens by 3 to 4 months

sucking and rooting reflex

● EXPECTED FINDING: Elicit by stroking the cheek or edge of mouth. Newborn turns the head toward the side that is touched and starts to suck. ● EXPECTED AGE: Usually disappears after 3 to 4 months but can persist up to 1 year

Tonic neck reflex (fencer position)

● EXPECTED FINDING: 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. ● EXPECTED AGE: Birth to 3 to 4 months

Nursing interventions for baby friendly care (parent-infant bonding)

● Facilitate the bonding process by placing the infant skin-to-skin or in the en face position with the client immediately after birth. ● Promote rooming-in as a quiet and private environment that enhances the family bonding process. ● Promote early initiation of breastfeeding, and encourage the client to recognize infant readiness cues. Offer assistance as needed. ● Teach the client about infant care to facilitate bonding as the client's confidence improves. ● Encourage parents to bond with the infant through cuddling, bathing, feeding, diapering, and watching the infant. ● Provide frequent praise, support, and reassurance to the client as they move toward independence in caring for the infant and adjusting to their parental role. ● Encourage parents to express feelings, fears, and anxieties about caring for the infant

expected findings for postpartum depression

● Feelings of guilt and inadequacies ● Irritability ● Anxiety ● Fatigue persisting beyond a reasonable amount of time ● Feeling of loss ● Lack of appetite ● Persistent feelings of sadness ● Intense mood swings ● Sleep pattern disturbances PHYSICAL ASSESSMENT FINDINGS ● Crying ● Weight loss ● Flat affect ● Irritability ● Rejection of the infant ● Severe anxiety and panic attack

positive signs of pregnancy

● Fetal heart sounds ● Visualization of fetus by ultrasound ● Fetal movement palpated by an experienced examiner

Medications to give for hyperemesis gravidarum

● Give IV lactated Ringer's for hydration. ● Give pyridoxine (vitamin B6) and other vitamin supplements as tolerated. American College of Obstetricians and Gynecologists recommend the use of pyridoxine alone or in combination with doxylamine as the initial medication management because these medications are considered both safe and effective. ● Use antiemetic medications (metoclopramide) cautiously for uncontrollable nausea and vomiting. ● Use corticosteroids to treat refractory hyperemesis gravidarum.

HELLP syndrome stands for

● H: Hemolysis resulting in anemia and jaundice ● EL: Elevated liver enzymes resulting in elevated alanine aminotransferase (ALT) or aspartate transaminase (AST), epigastric pain, and nausea and vomiting ● LP: Low platelets (less than 100,000/mm3 ), resulting in thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly disseminated intravascular coagulopathy

expected laboratory values in newborn assessment

● Hgb: 14 to 24 g/dL ● Platelets: 150,000 to 300,000/mm3 ● Hct: 44% to 64% ● Glucose: greater than 40 to 45 mg/dL ● RBC count: 4.8 x 106 to 7.1 x 106 ● Bilirubin ◯ 24 hr: 2 to 6mg/dL ◯ 48 hr: 6 to 7 mg/dL ◯ 3 to 5 days: 4 to 6 mg/dL ● WBC count: 9,000 to 30,000/mm

Risk factors for postpartum depression

● Hormonal changes with a rapid decline in estrogen and progesterone levels ● Individual socioeconomic factors ● Decreased social support system ● Anxiety about assuming new role as a parent ● Unintended pregnancy ● History of previous depressive disorder ● Low self-esteem ● History of partner violence ● Medical conditions (thyroid imbalance, diabetes, infertility) ● Complications with breastfeeding ● Parent of multiples

Risk factors for hyperbilirubinemia

● Increased RBC production or breakdown ● Rh or ABO incompatibility ● Decreased liver function ● Maternal ingestion of diazepam, salicylates, or sulfonamides close to birth ● Maternal diabetes ● Oxytocin during labor ● Neonatal hyperthyroidism ● Ecchymosis or hemangioma ● Cephalohematomas ● Prematurity

motor vehicle injury

● Infant-only and convertible infant-toddler car seats are available. ● Infants and toddlers remain in a rear-facing car seat until the age of 2 years or the height recommended by the manufacturer. ● The safest area for infants and children is the backseat of the car. ● Do not place rear-facing car seats in the front seat of vehicles with passenger airbags. ● Infants should not be left in parked cars.

Risk factors for Premature rupture of membranes

● Infection ● Prior preterm birth ● Shortening of the cervix ● Second/third trimester bleeding. ● Pulmonary or connective tissue disorders ● Low BMI ● Copper or ascorbic acid deficiencies ● Tobacco or substance use

Gestational diabetes mellitus increased risk to fetus

● Macrosomia, birth trauma, electrolyte imbalances, and neonatal hypoglycemia ● Infections (urinary and vaginal), related to increased glucose in the urine and decreased resistance because of altered carbohydrate metabolism ● Hydramnios, which can cause overdistention of the uterus, placental abruption, preterm labor, and postpartum hemorrhage ● Ketoacidosis from diabetogenic effect of pregnancy (increased insulin resistance), untreated hyperglycemia, or inappropriate insulin dosing ● Hypoglycemia, caused by overdosing in insulin, skipped or late meals, or increased exercise ● Hyperglycemia, which can cause excessive fetal growth (macrosomia)

risk factors of abruptio placentae

● Maternal hypertension (chronic or gestational) ● Blunt external abdominal trauma (motor-vehicle crash, maternal battering) ● Cocaine use resulting in vasoconstriction ● Previous incidents of abruptio placentae ● Cigarette smoking or other nicotine use ● Premature rupture of membranes ● Multifetal pregnancy

What causes mastitis?

● Milk stasis, which can be caused by a blocked duct, engorgement, or a bra with an underwire ● Nipple trauma and cracked or fissured nipples ● Poor breastfeeding technique with improper latching of the infant onto the breast, which can lead to sore and cracked nipples ● Decrease in breastfeeding frequency due to supplementation with bottle feeding ● Contamination of breasts due to poor hygiene

Nursing intervention for Post procedure of a cesarean

● Monitor for evidence of infection and excessive bleeding at the incision site. ● Assess the uterine fundus for firmness or tenderness. ● Assess the lochia for amount and characteristics. A tender uterus and foul-smelling lochia can indicate endometritis. ● Assess for productive cough or chills, which could be a manifestation of pneumonia. ● Assess for indications of thrombophlebitis, which include tenderness, pain, and heat on palpation. ● Monitor I&O. ● Monitor vital signs per protocol. ● Provide pain relief and antiemetics as prescribed. ● Encourage the client to turn, cough, and deep breathe to prevent pulmonary complications. ● Encourage splinting of the incision with pillows. ● Encourage ambulation to prevent thrombus formation. ● Assess the client for burning and pain on urination, which could be suggestive of a urinary tract infection

nursing intervention for hypoglycemia in a newborn

● Monitor for manifestations of hypoglycemia (jitteriness, tremors, weak or high pitched cry, decreased tone, poor feeding, apnea, respiratory distress, low temperature, seizures, a blood glucose of less than 40 to 45 mg/dL). ● Initiate feedings with breastmilk or formula in clinically stable newborns to maintain or increase blood glucose levels. ● Continue to monitor blood glucose levels and feed every 2 to 3 hr for at least the first 24 hr of life, in at-risk newborns and those who have demonstrated hypoglycemia, as per facility protocol. ● Skin-to-skin contact will promote breastfeeding and thermoregulation to stabilize blood sugar levels.

Nursing intervention for postpartum depression

● Monitor interactions between the client and their infant. Encourage bonding activities. ● Monitor the client's mood and affect. ● Reinforce that feeling down in the postpartum period is normal and self-limiting. Encourage the client to notify the provider if the condition persists. ● Encourage the client to communicate feelings, validate and address personal conflicts, and reinforce personal power and autonomy. ● Reinforce the importance of compliance with any prescribed medication regimen. ● Contact a community resource to schedule a follow-up visit after discharge for clients who are at high risk for postpartum depression. ● Ask the client if they have thoughts of self-harm, suicide, or harming their infant. Provide for the safety of the infant and client as the priority of care

care of newborn after discharge

● Newborn infants should be placed in an federally approved car seat at a 45 degree angle to prevent slumping and airway obstruction. The car seat is placed rear facing in the rear seat of the vehicle and secured using the safety belt. The shoulder harnesses are placed in the slots at or below the level of the infant's shoulders. The harness should be snug and the retainer clip placed at the level of the infant's armpits. ● Instruct parents that their newborn will require a checkup by a provider within 72 hr of discharge. This is especially important for breastfed newborns to evaluate weight and hydration status

Nursing Care for premature rupture of membranes

● Nursing management depends on gestational duration, if there is evidence of infection, or an indication of fetal or maternal compromise. ● Prepare for birth if indicated. ● Obtain vaginal/rectal cultures for streptococcus betahemolytic. ● Obtain vaginal cultures for chlamydia and Neisseria gonorrhoeae. ● Limit vaginal exams. ● Provide reassurance to reduce anxiety. ● Assess vital signs every 2 hr. Notify the provider of a temperature greater than 38º C (100º F). ● Monitor FHR and uterine contractions. ● Encourage hydration. ● Obtain a CBC. ● Anticipate a prescription for 7-day course of broad spectrum antibiotics. assess the odor of the amniotic fluid

Risk factors for gestational diabetes mellitus

● Obesity ● Hypertension ● Glycosuria ● Maternal age older than 25 years ● Family history of diabetes mellitus ● Previous delivery of an infant that was large or stillborn

nursing interventions for ovarian cancer

● Observe for urinary retention and difficulty voiding. ● Assess bowel sounds. Paralytic ileus can occur due to manipulation of the bowel during surgery. ● Discuss sexuality, surgically induced menopause, and other self-image issues with the client.

ovarian cancer

● Ovarian cancers are epithelial tumors that grow on the surface of the ovaries. ● The tumors grow quickly and are often bilateral. ● Metastases frequently occur before the primary ovarian malignancy is diagnosed. There is a high recurrence rate of ovarian cancer, after which it is treatable but not curable. ● Ovarian cancer is the leading cause of death from female reproductive cancers. ● The exact etiology of ovarian cancer is unknown. However, the more times a woman ovulates in her lifetime seems to be a risk factor because ovarian cancer is more prevalent in females who have early menarche, late-onset menopause, nulliparity, and those who use infertility agents.

Expected Findings of Mastitis

● Painful or tender localized hard mass and reddened area, usually on one breast ● Influenza-like manifestations (chills, fever, headache, body ache) ● Fatigue Physical Findings: Axillary adenopathy in the affected side (enlarged tender axillary lymph nodes) with an area of inflammation that can be red, swollen, warm, and tender

Client education for premature rupture of membranes

● Perform daily fetal kick counts and to notify the nurse of uterine contractions. ● Adhere to bed rest with bathroom privileges. ● Depending on gestational age, treatment is conservative, and hospitalization can prolong pregnancy while monitoring for risk factors (infection, vaginal bleeding, fetal complications). ● Adhere to limited activity with bathroom privileges. ● Hydrate. ● Conduct a self-assessment for uterine contractions. ● Record daily kick counts for fetal movement. ● Monitor for foul-smelling vaginal discharge. ● Refrain from inserting anything into the vagina. ● Abstain from intercourse. ● Avoid tub baths. ● Wipe the perineal area from front to back after voiding and fecal elimination. ● Take temperature every 4 hr when awake and report a temperature that is greater than 38° C (100° F).

Client education for gestational diabetes mellitus

● Perform daily kick counts. ● Adhere to the appropriate diet, including standard diabetic diet and restricted carbohydrate intake. Dietary counseling by a registered dietitian should occur. ● Exercise. ● Perform self-administration of insulin. ● Understand the need for postpartum laboratory testing to include OGTT and blood glucose levels

Nursing Intervention for late deceleration of FHR

● Place client in side-lying position. ● Insert an IV catheter if not in place and increase rate of IV fluid administration. ● Discontinue oxytocin if being infused. ● Administer oxygen by mask at 8 to 10 L/min via nonrebreather face mask. ● Elevate the client's legs. ● Notify the provider. ● Prepare for an assisted vaginal birth or cesarean birth.

Nursing Interventions for Induction of labor

● Prepare the client for cervical ripening. ◯ Obtain the client's informed consent form. ◯ If cervical-ripening agents are used, baseline data on fetal and maternal well-being should be obtained. ◯ Monitor FHR and uterine activity after administration of cervical-ripening agents. ◯ Notify the provider of uterine tachysystole or fetal distress. ● Prepare the client for misoprostol administration. ◯ Misoprostol is a tablet inserted vaginally to ripen the cervix. ◯ Encourage the client to void prior to the procedure. ● Prepare the client for oxytocin administration. ◯ Prior to the administration of oxytocin, it is essential that the nurse confirm that the fetus is engaged in the birth canal at a minimum of station 0. ◯ Initiate oxytocin no sooner than 4 hr after the administration of misoprostol, and 6 to 12 hr after dinoprostone gel instillation or removal of a dinoprostone insert. ◯ Use the infusion port closest to the client for administration. Oxytocin should be connected to the main IV line and administered as an intermittent IV bolus via an infusion pump. ◯ An intrauterine pressure catheter (IUPC) can be used to monitor frequency, duration, and intensity of contractions. ◯ When oxytocin is administered, assessments include maternal blood pressure, pulse, and respirations every 30 to 60 min and with every change in dose. ◯ Monitor the FHR and contraction pattern every 15 min in the first stage of labor, every 5 min in the second stage of labor, and with every change in dose. ◯ Assess fluid intake and urinary output. ◯ A Bishop score rating should be obtained prior to starting any labor induction protocol

What do nurses do before administering an analgesic during labor?

● Prior to administering analgesic medication, verify that labor is well established by performing a vaginal exam. ● Administer antiemetics as prescribed. ● Monitor maternal vital signs, uterine contraction pattern, and continuous FHR monitoring. Assess maternal vital signs and fetal heart rate and pattern and documented before and after administration of opioids for pain relief. ● Assess for adverse reactions (difficulty breathing) and be prepared to administer antidotes whenever medications are administered

expected findings for postpartum psychosis

● Pronounced sadness ● Disorientation ● Confusion ● Paranoia PHYSICAL ASSESSMENT FINDINGS: Behaviors indicating hallucinations or delusional thoughts of self-harm or harming the infant

Nursing Intervention for gonorrhea

● Provide client education regarding disease transmission. ● Identify and treat all sexual partners. ● Administer erythromycin to all infants following delivery. This is the medication of choice for ophthalmia neonatorum. This antibiotic is both bacteriostatic and bactericidal, and thus provides prophylaxis against Neisseria gonorrhoeae and Chlamydia trachomatis. ● All states have a reportable diseases list. Gonorrhea is a commonly reported condition. It is the responsibility of the provider to report cases of these diseases to the local health department

Nursing action during the active phase of labor

● Provide client/fetal monitoring. ● Encourage frequent position changes. ● Encourage voiding at least every 2 hr. ● Encourage deep cleansing breaths before and after modified paced breathing. ● Encourage relaxation. ● Provide nonpharmacological comfort measures. ● Provide pharmacological pain relief as prescribed

Hepatitis B immunization Nursing intervention

● Recommended to be administered to all newborns. ● Informed consent must be obtained. ● For newborns born to healthy clients, recommended dosage schedule is at birth, 1 month, and 6 months. ● For parents infected with hepatitis B, hepatitis B immunoglobulin and the hepatitis B vaccine is given within 12 hr of birth. The hepatitis B vaccine is given alone at 1 month, 2 months, and 12 months. ! It is important NOT to give the vitamin K and the hepatitis B injections in the same thigh.

Nursing Intervention for variable deceleration of FHR

● Reposition client from side to side or into knee-chest. ● Discontinue oxytocin if being infused. ● Administer oxygen by mask at 8 to 10 L/min via nonrebreather face mask. ● Perform or assist with a vaginal examination. ● Assist with an amnioinfusion if prescribed.

small for gestational age Newborn

● SGA describes a newborn whose birth weight is at or below the 10th percentile and who has intrauterine growth restriction. ● Common complications of newborns who are SGA are perinatal asphyxia, meconium aspiration, hypoglycemia, polycythemia, and instability of body temperature

Expected findings for down syndrome

● Separated sagittal suture ● Enlarged anterior fontanel ● Small round head ● Flattened forehead ● Upward, outward slant to eyes ● Small nose with depressed nasal bridge (saddle nose) ● Small ears with short pinna ● Epicanthal folds observed in ocular area ● High-arched narrow palate ● Protruding tongue ● Short, broad neck ● Shortened rib cage ● Possible congenital heart defect ● Protruding abdomen ● Incurved fifth finger (clinodactyly) ● Broad, short feet and hands with stubby toes and fingers ● Transverse palmar crease ● Large space between big and second toes with plantar crease ● Short stature ● Hyperflexibility, muscle weakness, and hypotonia ● Dry skin that cracks easily

Pre-eclampsia/eclampsia expected findings

● Severe continuous headache ● Nausea ● Blurring of vision ● Flashes of lights or dots before the eyes PHYSICAL ASSESSMENT FINDINGS ● Hypertension ● Proteinuria ● Periorbital, facial, hand, and abdominal edema ● Pitting edema of lower extremities ● Vomiting ● Oliguria ● Hyperreflexia ● Scotoma ● Epigastric pain ● Right upper quadrant pain ● Dyspnea ● Diminished breath sounds ● Seizures ● Jaundice ● Manifestations of progression of hypertensive disease with indications of worsening liver involvement, kidney failure, worsening hypertension, cerebral involvement, and developing coagulopathies

HELLP syndrome signs and symptoms

● Severe continuous headache ● Nausea ● Blurring of vision ● Flashes of lights or dots before the eyes Physical Findings: ● Hypertension ● Proteinuria ● Periorbital, facial, hand, and abdominal edema ● Pitting edema of lower extremities ● Vomiting ● Oliguria ● Hyperreflexia ● Scotoma ● Epigastric pain ● Right upper quadrant pain ● Dyspnea ● Diminished breath sounds ● Seizures ● Jaundice ● Manifestations of progression of hypertensive disease with indications of worsening liver involvement, kidney failure, worsening hypertension, cerebral involvement, and developing coagulopathies

Expected findings for abruptio placentae

● Sudden onset of intense localized uterine pain with dark red vaginal bleeding ● Area of uterine tenderness can be localized or diffuse over uterus and boardlike ● Contractions with hypertonicity ● Fetal distress ● Clinical findings of hypovolemic shock

bathing newborn/client education

● Teach the parents proper newborn bathing techniques by a demonstration. Have the parents return the demonstration. ● After the initial bath, the newborn's face, diaper area, and skin folds are cleansed daily. Complete bathing is performed two to three times per week using a mild soap. CLIENT EDUCATION ● Bathing by immersion is not done until the newborn's umbilical cord has fallen off and the circumcision has healed, if applicable. Wash the area around the cord, taking care not to get the cord wet. Move from the cleanest to dirtiest part of the newborn's body, beginning with the eyes, face, and head; proceed to the chest, arms, and legs; and wash the groin area last. ● Bathing should take place at the convenience of the parents, but not immediately after feeding to prevent spitting up and vomiting. ● Organize all equipment so that the newborn is not left unattended. Never leave the newborn alone in the tub or sink. ● Make sure the hot water heater is set at 49° C (120.2° F) or less. The room should be warm, and the bath water should be 38° C (100.4° F). Test water for comfort with your elbow prior to bathing the newborn. ● Avoid drafts or chilling of the newborn. Expose only the body part being bathed, and dry the newborn thoroughly to prevent chilling and heat loss. ● Clean the newborn's eyes using a clean portion of the wash cloth. Use clear water to clean each eye, moving from the inner to the outer canthus. ● Each area of the newborn's body should be washed, rinsed, and dried, with no soap left on the skin. ● Wrap the newborn in a towel, and swaddle them in a football hold to shampoo the head. Rinse shampoo from the newborn's head, and dry to avoid chilling. ● To cleanse an uncircumcised penis, wash with soap and water and rinse the penis. The foreskin should not be forced back or constriction can result. ● To cleanse a circumcised penis, use warm water. Do not use soap until the circumcision is healed. ● Wash the vulva by wiping from front to back to prevent contamination of the vagina or urethra from rectal bacteria. ● Applying a fragrance-free, hypoallergenic, moisturizing emollient immediately after bathing can help prevent dry skin

Risk factors for down syndrome

● The cause is unclear but might be multicausal in nature. ● Maternal age greater than 35 years ● Paternal age greater than 55 years

expected findings in an ectopic pregnancy

● Unilateral stabbing pain and tenderness in the lowerabdominal quadrant ● Menses that is delayed (1 to 2 weeks), lighter than usual, or irregular ● Scant, dark red, or brown vaginal spotting 6 to 8 weeks after last normal menses; red, vaginal bleeding if rupture has occurred ● Referred shoulder pain due to blood in the peritoneal cavity irritating the diaphragm or phrenic nerve after tubal rupture ● Findings of hemorrhage and shock (hypotension, tachycardia, pallor, dizziness) if a large amount of bleeding has occurred

magnesium sulfate nursing actions

● Use an infusion control device to maintain a regular flow rate. ● Monitor blood pressure, pulse, respiratory rate, deeptendon reflexes, level of consciousness, urinary output (indwelling urinary catheter for accuracy), presence of headache, visual disturbances, epigastric pain, uterine contractions, and fetal heart rate and activity. ● Monitor for manifestations of magnesium sulfate toxicity. ◯ Absence of patellar deep tendon reflexes ◯ Urine output less than 30 mL/hr ◯ Respirations less than 12/min ◯ Decreased level of consciousness ◯ Cardiac dysrhythmias ● If magnesium toxicity is suspected: ◯ Immediately discontinue infusion. ◯ Administer antidote calcium gluconate or calcium chloride. ◯ Prepare for actions to prevent respiratory or cardiac arrest.

nursing intervention for administration of magnesium sulfate for severe preeclampsia and eclampsia

● Use an infusion control device to maintain a regular flow rate. ● Monitor blood pressure, pulse, respiratory rate, deeptendon reflexes, level of consciousness, urinary output (indwelling urinary catheter for accuracy), presence of headache, visual disturbances, epigastric pain, uterine contractions, and fetal heart rate and activity. ● Monitor for manifestations of magnesium sulfate toxicity. ◯ Absence of patellar deep tendon reflexes ◯ Urine output less than 30 mL/hr ◯ Respirations less than 12/min ◯ Decreased level of consciousness ◯ Cardiac dysrhythmias ● If magnesium toxicity is suspected: ◯ Immediately discontinue infusion. ◯ Administer antidote calcium gluconate or calcium chloride. ◯ Prepare for actions to prevent respiratory or cardiac arrest.

Expected findings of postmature infant

● Wasted appearance, thin with loose skin, having lost some of the subcutaneous fat ● Peeling, cracked, and dry skin; leathery from decreased protection of vernix and amniotic fluid ● Long, thin body ● Meconium staining of fingernails and umbilical cord ● Hair and nails can be long ● Alertness similar to a 2‑week‑old newborn ● Difficulty establishing respirations secondary to meconium aspiration ● Hypoglycemia due to insufficient stores of glycogen ● Clinical findings of cold stress ● Neurological manifestations that become apparent with the development of fine motor skills ● Macrosomia

small gestational age (SGA) expected findings

● Weight below 10th percentile ● Normal skull, but reduced body dimensions ● Hair is sparse on scalp ● Wide skull sutures from inadequate bone growth ● Dry, loose skin ● Decreased subcutaneous fat ● Decreased muscle mass, particularly over the cheeks and buttocks ● Thin, dry, yellow, and dull umbilical cord rather than gray, glistening, and moist ● Drawn abdomen rather than well‑rounded ● Respiratory distress and hypoxia ● Wide‑eyed and alert, which is attributed to prolonged fetal hypoxia ● Hypotonia ● Evidence of meconium aspiration ● Hypoglycemia ● Acrocyanosis