Unit 2: Maternal, Newborn, and Early Childhood

A nurse is observing a mother who is playing peek-a-boo with her 8-month-old child. The mother asks if this game has any developmental significance. The nurse should inform the mother that peek-a-boo helps develop which of the following concepts in the child?A. Hand-eye coordinationB. Sense of trustC. Object permanenceD. Egocentrism

C. Object permanenceObject permanence refers to the cognitive skill of knowing an object still exists even when it is out of sight. In discovering a hidden object while playing peek-a-boo, the infant experiences validation of this concept.

gestational complications Complications that may affect the baby Complications that may affect the woman: prevention

Complications that may affect the baby If POSITIVE for gestational diabetes, the baby may be at increased risk of: •Excessive birth weight. If the blood sugar level is higher than the standard range, it can cause the baby to grow too large. Very large babies — those who weigh 9 pounds or more — are more likely to become wedged in the birth canal, have birth injuries or need a C-section birth. •Early (preterm) birth. High blood sugar may increase the risk of early labor and delivery before the due date. Or early delivery may be recommended because the baby is large. •Serious breathing difficulties. Babies born early may experience respiratory distress syndrome — a condition that makes breathing difficult. •Low blood sugar (hypoglycemia). Sometimes babies have low blood sugar (hypoglycemia) shortly after birth. Severe episodes of hypoglycemia may cause seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal. •Obesity and type 2 diabetes later in life. Babies have a higher risk of developing obesity and type 2 diabetes later in life. •Stillbirth. Untreated gestational diabetes can result in a baby's death either before or shortly after birth. Complications that may affect the woman: Gestational diabetes may also increase the risk of: •High blood pressure and preeclampsia. Gestational diabetes raises the risk of high blood pressure, as well as preeclampsia — a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten both your life and your baby's life. •Having a surgical delivery (C-section). more likely to have a C-section if women have gestational diabetes. •Future diabetes. If a woman has gestational diabetes, it's more likely to get it again during a future pregnancy. Women also have a higher risk of developing type 2 diabetes as they age Prevention There are no guarantees when it comes to preventing gestational diabetes — but the more healthy habits that are adopted before pregnancy, the better. If a woman had gestational diabetes, these healthy choices may also reduce your risk of having it again in future pregnancies or developing type 2 diabetes in the future. •Eat healthy foods. Choose foods high in fiber and low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition. Watch portion sizes. •Keep active. Exercising before and during pregnancy can help protect you from developing gestational diabetes. Aim for 30 minutes of moderate activity on most days of the week. Take a brisk daily walk. Ride your bike. Swim laps. Short bursts of activity — such as parking further away from the store when you run errands or taking a short walk break — all add up. •Start pregnancy at a healthy weight. If planning to get pregnant, losing extra weight beforehand may help you have a healthier pregnancy. Focus on making lasting changes to your eating habits that can help you through pregnancy, such as eating more vegetables and fruits. •Don't gain more weight than recommended. Gaining some weight during pregnancy is typical and healthy. But gaining too much weight too quickly can increase the risk of gestational diabetes.

- Amniocentesis

is a procedure used to obtain amniotic fluid for genetic testing to determine fetal abnormalities or fetal lung maturity in the third trimester of pregnancy.

PPD meds 4

•Antidepressants - sertraline •Antipsychotics/Mood stabilizers - Lithium •Anxiolytics - contraindicated •Hormone therapy - brexanolone

Care of the Newborn During Transition

◦Maintaining the airway ◦Addressing distress ◦Taking vital signs ◦Every 30 minutes x 2 hours ◦Promoting thermoregulation ◦Skin-to-Skin, Delayed bathing ◦Addressing Vitamin D deficiency ◦Vitamin K (IM injection) ◦Preventing eye infection ◦Erythromycin ophthalmic ointment ◦Initiate the first feeding ◦Facilitate parent-newborn attachment/bonding

ADHD problems symptoms

●Problems related to: ○Decreased attention span ○Impulsiveness ○Increase motor activity ●Symptoms ○Difficulty completing tasks ○Fidgets constantly ○Frequently loud ○Interrupts other ○Sleep disturbances are common ○Strained social relationships ○Bullying at school and within the family

APGAR Scoring System

◦1 minute ◦5 minute ◦Score ranges from 0-10 ◦Acrocyanosis

newborn stools

◦First stool (meconium within 8-24 hours of life) ◦Transitional (thin brown to green) ◦Fecal (yellow or pasty green) ◦By day 2-3 of life = 10 per day ◦Soft in consistency

Neurological Function newborn

◦Partially flexed extremities (legs near abdomen) ◦Uncoordinated bilateral movements when awake, purposeless ◦Eye movement, alert ◦Cry is lusty and vigorous ◦Influenced by: ◦IUGR ◦Prenatal stress ◦OB medications ◦Acute fetal distress ◦Diabetes ◦Intrauterine drug exposure ◦Prematurity and low birth weight

A nurse is teaching a new mother how to use a bulb syringe to suction her newborn's secretions. Which of the following instructions should the nurse include?

Answer: Stop suctioning when the newborn's cry sounds clear.D. Stop suctioning when the newborn's cry sounds clear.The nurse should instruct the client to stop suctioning when the newborn's cry no longer sounds like it is coming through a bubble of fluid or mucus.

Recurrent decelerations

•Decelerations occur with > 50% of uterine contractions in any 20-minute segment.

chronic HTN

•History of HTN •Discovered during pregnancy prior to 20 weeks' gestation •Persists past 12 weeks postpartum

Hypertension in Pregnancy Disorder Management: Pre-Eclampsia in the Antepartum Period CHTN/GHTN

•Labetalol •Adjustments <20 weeks •Sodium restriction •Low-dose aspirin •Baseline labs (CBC, CMP) •NST •BPP •US

Fetal posistion

•Landmarks differ according to presentation (occiput, mentum, sacrum) •Photo displays occiput (vertex presentations) •Identify quadrant of maternal pelvis •Assessment: inspection, palpation of maternal abdomen and/or vaginal exam. •Occiput is the most common fetal presentation

Nutritional Changes in Pregnancy

•Maternal weight gain (25-35 lbs.) •Folic acid •Mercury (avoid) •Lactase deficiency •Foodborne illnesses (salmonella, listeriosis, Hepatitis E) •PICA

Maternal Systemic Response to Labor

▪CV -Stressed by contractions, pain, anxiety -Increase in cardiac output ▪Maternal position affects cardiac output ▪Blood pressure -SBP and DBP rise during contractions ▪Respiratory -Increase demand and consumption -Hyperventilation = respiratory alkalosis -Mild metabolic acidosis by end of first stage of labor ▪Compensated for by respiratory alkalosis ▪Quickly reverses in 4th stage of labor

At the completion of the Third Stage: Determine Blood Loss

▪Estimated blood loss (EBL) -Postpartum Hemorrhage (PPH) ▪Greater than 500 mL with VD ▪Greater than 1,000 mL after cesarean section

Assisted Birth Methods

▪Forceps -Neonatal and maternal risks ▪Vacuum -Application of suction to occiput of fetal head -Discontinue if more than three "pop-offs" occur -Common indication: prolonged second stage of labor or non-reassuring FHR -Preferred to forceps -Contraindications: true CPD, nonvertex presentations, maternal/fetal coagulation defects, suspected/known hydrocephalus, fetal scalp trauma

Musculature Changes in Pelvic Floor

▪Levator ani muscle, fascia of pelvic floor drawn rectum, vagina upward and forward with each contraction ▪As the fetal descends to pelvic floor: -Pressure on presenting part results in perineal structure thinning ▪Normal physiological anesthesia produced by decreased in blood supply to the area ▪Anus everts

episotomy

▪Surgical incision of perineal body to enlarge outlet ▪Mediolateral episiotomy preferred, if indicated ▪Regional or local anesthesia ▪Repair after birth of baby and placenta ▪Preventative measures to reduce the risk of lacerations or an episiotomy: -Perineal massage -Natural pushing -Side-lying pushing position -Warm compresses -Gradual expulsion of baby at time of birth

CP risk factors

●In utero risk factors ○Seizures ○Thyroid Disease ○Proteinuria ●Risk factors for delivery ○Breech delivery ○Tight and nuchal cords ○Shoulder dystocia ○Uterine rupture ○Placenta previa ○Fetal stress ○Hypoxia

- Cardiovascular changes in postpartum: - Maternal role attainment:

- Cardiovascular changes in postpartum: increase in CO may result in cardiovascular instability, usually stabilizes and returns to pre-pregnancy levels within 1 hour following birth, diuresis 2-5 days helps to decrease extracellular fluid results weight loss - Maternal role attainment: 4 stages: anticipatory stage occurs during pregnancy, formal stage begins when child is born, informal stage begins when women starts making own choices about mothering, personal stage women is comfortable with idea of herself as mother

in documentation, the following abbreviations are used:

- Right (R) or left (L) side of the maternal pelvis - The landmark of the fetal presenting part: occiput (O), mentum (M), sacrum (S), or acromion process (A) - Anterior (A), posterior (P), or transverse (T), depending on whether the landmark is in the front, back, or side of the pelvis.

3rd-4th stage WBC

- The third stage of labor begins with the birth of the baby and ends with delivery of the placenta, which should be completed within 30 minutes of the birth. - The fourth stage of labor is the time, from 1 to 4 hours after birth, during which physiologic readjustment of the mother's body begins - The WBC count increases to 25,000 to 30,000 cells/mm3cells/mm3 during labor and the early postpartum period.

- Ventricular septal defect: s/s 4

- Ventricular septal defect: consists of one or more holes in the ventricular septum and usually results in increased pulmonary blood flow. s/s: murmur, excessive sweating, fatigue, and tachypnea

Indications for use of forceps

-Nulliparity -Maternal age (35 and over) -Maternal height less than 150 cm (4'11") -Pregnancy weight gain >15 kg (33 lb) -Postdate gestation (41 weeks or more) -Epidural anesthesia -Infant presentation other than occipitoanterior -Presence of dystocia -Presence of midline episiotomy -Abnormal FHR tracing

A nurse providing teaching about promoting sleep with the parent of a 3-year-old toddler. Which of the following information should the nurse include?A. Follow a nightly routine and established bedtime.B. Encourage active play prior to bedtime.C. Let the child remain awake until tired enough to go to sleep.D. Reward the child with a food treat just prior to sleep if the child goes to bed on time.

A. Follow a nightly routine and established bedtime.Preschool-age children test limits. Consistency in approach to bedtime is very important. Bedtime is more likely to be pleasant for everyone if a routine is established and followed every night.

A nurse at a pediatric clinic is assessing a 5-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider?A. Head lags when pulled from a lying to a sitting positionB. Absence of startle and crawl reflexesC. Inability to pick up a rattle after dropping itD. Rolls from back to side

A. Head lags when pulled from a lying to a sitting positionAt the age of 5 months, the infant should have no head lag when pulled to a sitting position; therefore, the nurse should report this finding to the provider.

A nurse is teaching a postpartum client about steps the nurses will take to promote the security and safety of the client's newborn. Which of the following statements should the nurse make?

Answer: "Staff members who take care of your baby will be wearing a photo identification badge." D. "Staff members who take care of your baby will be wearing a photo identification badge."The nurse should instruct the client that all staff members that care for newborns are required to wear a photo identification badge so that the client will be reassured of the newborn's safety. Some units' staff members wear special badges or a specific color scrubs.

A nurse is teaching a new parent about newborn safety. Which of the following instructions should the nurse include in the teaching?

Answer: "You can share your room with your baby for the next few weeks." A. "You can share your room with your baby for the next few weeks."The nurse should recommend room-sharing during the first few weeks. This allows the parent to be readily available to the newborn and learn the newborn's cues. However, the nurse should instruct the parent to avoid placing the newborn in their bed as it increases the risk for sudden infant death syndrome.

A nurse is teaching a client who is at 36 weeks of gestation and has a prescription for a nonstress test. Which of the following statements should the nurse include in the teaching? Answer: "You will be offered orange juice to drink during the test."C. "You will be offered orange juice to drink during the test."A nonstress test is performed to measure fetal activity. Having the client drink orange juice, or another beverage high in glucose, will stimulate fetal movements during the procedure, helping to obtain results.

Answer: "You will be offered orange juice to drink during the test." C. "You will be offered orange juice to drink during the test."A nonstress test is performed to measure fetal activity. Having the client drink orange juice, or another beverage high in glucose, will stimulate fetal movements during the procedure, helping to obtain results.

A nurse is caring for a client who is in active labor and has had no cervical change in the last 4 hr. Which of the following statements should the nurse make?

Answer: "Your provider will insert an intrauterine pressure catheter to monitor the strength of your contractions." D. "Your provider will insert an intrauterine pressure catheter to monitor the strength of your contractions."Insertion of an intrauterine pressure catheter is necessary to determine uterine contraction intensity, frequency, and duration which will identify whether the contractions are adequate for progression of labor.

A nurse is performing a vaginal examination on a client who is in labor and observes the umbilical cord protruding from the vagina. After calling for assistance, which of the following actions should the nurse take next?

Answer: Apply internal upward pressure to the presenting part using two gloved fingers. B. Apply internal upward pressure to the presenting part using two gloved fingers.Using evidence-based practice, the first action the nurse should take is to apply internal upward pressure to the presenting part. Prolapse of the umbilical cord during labor can result in decreased perfusion to the fetus, which can lead to hypoxia. After calling for assistance, the nurse should relieve the compression on the umbilical cord by applying upward internal pressure on the presenting part with two gloved fingers. The nurse should not move their hand.

A nurse is assessing a client who gave birth vaginally 12 hr ago and palpates her uterus to the right above the unbilicus. Which of the following interventions should the nurse perform?

Answer: Assist the client to empty her bladder. C. Assist the client to empty her bladder.The nurse should assist the client to empty her bladder because the assessment findings indicate that the client's bladder is distended. This can prevent the uterus from contracting, resulting in increased vaginal bleeding or postpartum hemorrhage.

A nurse is caring for a client who is at 41 weeks of gestation and has a positive contraction stress test. For which of the following diagnostic tests should the nurse prepare the client?

Answer: Biophysical profile (BPP)C. Biophysical profile (BPP)The nurse should prepare the client for a BPP to further assess fetal well-being. A positive contraction stress test indicates there is potential uteroplacental insufficiency. A BPP uses a real time ultrasound to visualize physical and physiological characteristics of the fetus and observe for fetal biophysical responses to stimuli.

A nurse is assessing a newborn following a circumcision. Which of the following findings should the nurse identify as an indication that the newborn is experiencing pain?

Answer: Chin quivering B. Chin quiveringBehavioral responses to a newborn's pain include facial expressions such as chin quivering, grimacing, and furrowing of the brow.

A nurse is planning care for a client who is 2 hr postpartum. Which of the following interventions should the nurse plan to implement during the taking-hold phase of postpartum behavioral adjustment?

Answer: Demonstrate to the client how to perform a newborn bath. D. Demonstrate to the client how to perform a newborn bath.Demonstrating to the client how to perform a newborn bath occurs during the taking-hold phase. The new parent moves from being passively dependent to taking a stronger interest in her new role as a mother. She is now focusing on the care her newborn and acquiring parenting skills. The nurse should provide positive reinforcement during this phase to give the new parent confidence and promote maternal adjustment.

A nurse is preparing to administer oxytocin to a client who is postpartum. Which of the following findings is an indication for the administration of the medication? (SATA)

Answer: Flaccid uterus is correct. Oxytocin increases the contractility of the uterus.Excess vaginal bleeding is correct.Oxytocin enhances uterine contractility, decreasing vaginal bleeding.

A nurse is caring for a client who is pregnant and is at the end of her first trimester. The nurse should place the Doppler ultrasound stethoscope in which of the following locations to begin assessing for the fetal heart tones (FHT)?

Answer: Just above the symphysis pubis B. Just above the symphysis pubisAt the end of the first trimester of pregnancy, the client's uterus is approximately the size of a grapefruit and is positioned low in the pelvis slightly above the symphysis pubis. Therefore, the nurse should begin assessing for FHT just above the symphysis pubis.

A nurse is reviewing the medical record of a client who is postpartum and has preeclampsia. Which of the following laboratory results should the nurse report to the provider?

Answer: Platelets 50,000/mm3D. Platelets 50,000/mm3A platelet count of 50,000/mm3 is below the expected reference range, which can indicate disseminated intravascular coagulation. The nurse should report this result to the provider.

A nurse is calculating a client's expected date of birth using Nagele's rule. The client tells the nurse that her last menstrual cycle started on November 27th. Which of the following dates is the client's expected date of birth?

Answer: September 3rd A. September 3rdWhen using Nägele's rule to calculate the estimated date of birth for a client, the nurse should subtract 3 months from the first day of the client's last menstrual cycle and then add 7 days. November 27th minus 3 months equals August 27th. August 27th plus 7 days equals September 3rd.

A nurse is assessing a client who is at 30 weeks of gestation during a routine prenatal visit. Which of the following findings should the nurse report to the provider?

Answer: Swelling of the face A. Swelling of the faceSwelling of the face, sacral area, and fingers can indicate gestational hypertension or preeclampsia. Reduction in renal perfusion leads to sodium and water retention. Fluid moves out of the intravascular compartment into the tissues, causing edema.

Application of suction to occiput of fetal head •Surgical incision of perineal body to enlarge outlet

Application of suction to occiput of fetal head •The longer the duration, the more likely newborn is to have scalp injury •Discontinue if more than three "pop-offs" occur •Common indication is prolonged second stage of labor or nonreassuring FHR •Preferred to forceps in cases of suspected cephalopelvic disproportion (CPD) •Contraindications -True CPD -Nonvertex presentations -Maternal or suspected fetal coagulation defects -Known or suspected hydrocephalus -Fetal scalp trauma •Surgical incision of perineal body to enlarge outlet •Thought to decrease risk of lacerations of perineum, overstretching of perineal tissues -May actually increase risk of fourth-degree lacerations -Woman more likely to have anal sphincter tears -Perineal lacerations heal more quickly than deep perineal tears •Greater incidence of major perineal trauma if midline episiotomy done •American College of Obstetricians and Gynecologists (ACOG) discourages use of episiotomy when not indicated

A nurse is preparing to administer a liquid medication to an infant. Which of the following actions should the nurse take?A. Administer the medication while the infant is supine.B. Give the medication at the side of the infant's mouth.C. Add the medication to a full bottle of the infant's formula.D. Administer the medication slowly while holding the nares closed.

B. Give the medication at the side of the infant's mouth.When administering medications to an infant, a needleless oral syringe or medicine dropper is placed in the side of the mouth (buccal cavity alongside the tongue) to prevent gagging and aspiration.

A nurse is providing education to the parent of a toddler who is about to receive her first dose of the MMR (measles, mumps and rubella) immunization. Which of the following statements by the parent indicates an understanding of the teaching?A. "I am not going to let my child play with other children for 2 days."B. "I will need to return in 2 weeks for my child to receive the varicella immunization."C. "I can give my child acetaminophen for discomfort associated with the immunization."D. "My child might have some discharge from the injection site."

C. "I can give my child acetaminophen for discomfort associated with the immunization."Parents can give acetaminophen for minor discomforts such as low-grade fever and local tenderness resulting from the administration of the immunization.

A nurse is preparing to administer recommended immunizations to a 2-month-old infant. Which of the following immunizations should the nurse plan to administer?A. Human papillomavirus (HPV) and hepatitis AB. Measles, mumps, rubella (MMR) and tetanus, diphtheria, and acellular pertussis (TDaP)C. Haemophilus influenzae type B (Hib) and inactivated polio virus (IPV)D. Varicella (VAR) and live attenuated influenza vaccine (LAIV)

C. Haemophilus influenzae type B (Hib) and inactivated polio virus (IPV)The recommended immunizations for a 2-month-old infant include Hib and IPV. The Hib immunization series consists of 3 to 4 doses, depending on the immunization used, and at a minimum is administered at the ages of 2 months, 4 months, and 12 to 15 months. The IPV immunization series consists of 4 doses and is administered at the ages of 2 months, 4 months, 6 to 18 months, and 4 to 6 years.

gestational diabetes causes risk factors complications

Causes Researchers don't yet know why some women get gestational diabetes and others don't. Excess weight before pregnancy often plays a role. Usually, various hormones work to keep blood sugar levels in check. But during pregnancy, hormone levels change, making it harder for the body to process blood sugar efficiently. This makes blood sugar rise. Risk factors for gestational diabetes include: •Being overweight or obese •Not being physically active •Having prediabetes •Having had gestational diabetes during a previous pregnancy •Having polycystic ovary syndrome •Having an immediate family member with diabetes •Having previously delivered a baby weighing more than 9 pounds (4.1 kilograms) •Being of a certain race or ethnicity, such as Black, Hispanic, American Indian and Asian American Complications Gestational diabetes that's not carefully managed can lead to high blood sugar levels. High blood sugar can cause problems for you and your baby, including an increased likelihood of needing a surgery to deliver (C-section).

LATE DECELERATIONS

Clinical significance: Happens after contraction, deeper could cause prolonged Late decelerations are caused by uteroplacental insufficiency, which is a decrease in the blood flow to the placenta that reduces the amount of oxygen and nutrients transferred to the fetus. Any condition that predisposes decreased uteroplacental blood flow can cause late decelerations. Some triggering circumstances include low maternal blood pressure (i.e., hypotension) from the epidural analgesia, dehydration of the mother, anemia of the mother, rapid uterine contractions, placental abruption (i.e., the early separation of the placenta from the uterus before labor), and fetal hypoxia. Other causes: Excessive uterine contractionsMaternal hypotensionMaternal hypoxemia (asthma, pneumonia)Reduced placental exchange as in: Hypertensive disorders, Diabetes, IUGR , Abruption

common cause of perinatal loss things to do

Common Causes: Anemia, PIH, hemorrhage, placental insufficiencies, congenital/genetic abnormalities Maternal Risks: DIC (Disseminated Intravascular Coagulopathy), shock or sepsis, acute renal failure and severe cardiac complications including MI & CHF, and subsequent depression. Things the nurse can do: encourage the patient (family) to discuss their feelings, promote attachment and the creation of memories - encourage naming the infant, holding the infant should be facilitated when possible. Family may take pictures, make foot prints, create mementos. Visitation should be liberal and encourage support person to take a role at the bedside. Provide spiritual support, explain options and procedures for memorial service. Things to say: Be simple & straightforward and comfortable with sharing emotions. Actively listen to parents. It is ok to say "I don't know what to say exactly"; "I'm sorry", "I wish things would have ended differently", Encourage questions and answer honestly DO NOT SAY: "Things will get better", "Time will heal the pain", "You can always have more children", don't use medical jargon or avoid answering questions. Support Services: Hospice/Palliative Care, Perinatal Palliative Care, Parent Grief & Loss Groups

- Gestational diabetes mellitus (GDM) is

defined as a carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. It results from (1) an unidentified preexisting disease, (2) the unmasking of a compensated metabolic abnormality by the added stress of pregnancy, or (3) a direct consequence of the altered maternal metabolism stemming from changing hormonal levels.

A nurse is evaluating a 1-year-old for possible cerebral palsy. Which findings could be indicators of cerebral palsy? (Select all that apply.) qFrequent arching of the back qCrawling with three extremities qVocabulary limited to three words: mama, dada, and ball qPresence of the rooting reflex qNo demonstration of hand dominance

qFrequent arching of the back qCrawling with three extremities qPresence of the rooting reflex

stages of labor 1st (latent, active, transition) 2nd 3rd 4th

st stage: onset of true labor to complete dilation (10 cm) •Latent phase: beginning of regular contractions (usually mild, increase frequency, duration, intensity) •Cervix begins to dilate •Little or no fetal descent evident •Primigravida: averages 8.6 hours, typically does not exceed 20 hours •Multipara: averages 5.3 hours, typically does not exceed 14 hours •Active phase: •Anxiety, sense of need for energy, focus •Cervix dilates 6-8 cm •Fetal descent progressive •Contractions ore frequent, longer in duration, and increase in intensity •Transition phase: •Last part of first stage of labor •Awareness of need for energy, attention to be focus completely on task at hand •May be anxious, feel out of control, tired •Restless, frequent position changes •Strong contractions every 1.5-2 minutes; duration 60-90 seconds •Dilation approaches 10 cm - rectal pressure, uncontrollable desire to bear down, increased bloody show, ROM •May sleep between contractions •Support person may feel fatigues. Requires support. Feeling helpless Second stage: complete dilation to birth of neonate •Pushing (urge to push, bear down due to fetal presenting part reaches perineal floor) •UC: every 1.5 min, 60-90 seconds, strong on palpation •Perineum begins to bulge, flatten, move anteriorly (increasing severe pain and burning sensation as perineum distends) •Crowning: fetal head remains visible at vaginal introitus between contractions (birth imminent) •Psyche: may feel sense of purpose now that she can be actively involved, disconnected, nurse provides continuous labor support along with support person, may be forceful with staff, support persons, some do not feel overwhelming urge to push - nurse assists patient. Epidural - let's discuss. • Third stage: birth of neonate to delivery of placenta -Should be completed within 30 minutes of baby's birth •Placental separation -After baby is born, uterus contracts firmly -Placenta begins to separate -Membranes are last to separate •Placental delivery -Woman may bear down to aid -If this fails, gentle traction may be applied to cord while counterpressure exerted on lower uterine segment -Duncan mechanism: placenta separates from outer margins inward, presents with maternal surface delivering first -Schultz mechanism: placenta separates from inside to outer margins, delivered with fetal side presenting Fourth stage: •Period from 1 to 4 hours after birth during which physiologic readjustment of mother begins -Blood redistributed into venous beds -Moderate drop in systolic, diastolic blood pressure -Increased pulse pressure -Moderate tachycardia -Uterus remains contracted in midline of abdomen ▪Constricts vessels at site of placental implantation -Nausea, vomiting usually cease -Woman may be thirsty, hungry -Woman may have shaking chill -Bladder may be hypotonic ▪Can lead to urinary retention

severe manifestations of pre eclampsia

•BP > 160/110 mmHg •Persistent, debilitating headaches •Persistent RUQ pain (epigastric pain) •Serum creatinine > 1.1 mg/dL (or double the patient's baseline) •Platelets <100,000 •Elevated liver enzymes •Pulmonary edema •Visual distrubances •Altered mental status or seizure

biophysical profile 4

•Comprehensive assessment of fetus over a 30-minute period: •Fetal breathing movement •Fetal movement of body/limbs •Fetal tone •Amniotic fluid volume •FHR accelerations with activity (NST)

prenatal care first trimester second trimester third trimester

•Comprehensive history •Discussion of expected changes: •Normal symptoms •Nutrition •Exercise & more •Genetic testing •Prenatal labs •Pregnancy complications •Ultrasound •Screening for: •Gestational diabetes •Birth plan •Continued discussion on expectations •Planning for delivery •Continued discussion on expectations •Labor signs and symptoms •Monitor continued maternal and fetal well-being •Non-stress test, Biophysical profile

kick counts

•Daily after 28 weeks gestation •10 movements within a 2-hour period •Less than 10 movements in a 2-hour period - Notify HCP

Pre-eclampsia

•Diagnosed using the same criteria as GHTN •Accompanied by signs of end organ damage •Presence of proteinuria (2+ or greater on a urine dipstick) •Random protein/creatinine ratio of 0.3 or greater •0.3 gm of protein or greater in a 24-hour urine collection

Cerebral Palsy risk factors 5

•Disorder of movement and posture development •Caused by non-progressive lesion abnormality on fetal brain. •Manifestations are related to the location of injury in the brain •May have associated hearing, vision, communication, cognitive, and behavioral problems •Low birth weight •Placental abnormalities •Birth defects •Meconium aspiration •Birth asphyxia •Neonatal seizures •Respiratory distress syndrome •Postnatal causes include meningitis, encephalitis, and traumatic brain injury.

screening tools of PPD

•Edinburgh Postnatal Depression Scale •Postpartum Depression Screening Scale •Patient Health Questionnaire (PHQ) •Beck Depression Inventory II

Fetal Assessment

•Electronic monitoring of fetal heart rate -Methods of electronic monitoring ▪Ultrasound -Care must be taken to track fetal heart rate, not mother's ▪New ambulatory methods of external monitoring -Telemetry system -Some models can be worn in tub, can be submerged in water ▪Internal monitoring with internal spiral electrode -Membranes must be ruptured -Cervix at least 2 cm dilated -More effective, provides more accurate fetal tracing -Can injure fetus •Electronic monitoring of fetal heart rate -Baseline FHR ▪Average FHR rounded to increments 5 bpm ▪Normal FHR ranges 110-160 bpm ▪Wandering baseline: fluctuates between 120 and 160 bpm -Can be associated with neurologic impairment or preterminal event -Immediate intervention needed to enhance fetal oxygenation ▪Fetal tachycardia: sustained rate of ≥161 bpm -Marked tachycardia: ≥180 bpm ▪Fetal bradycardia: rate of <110 bpm during ≥10-minute period •Electronic monitoring of fetal heart rate -Arrythmias, dysrhythmias ▪Disturbances in FHR pattern related to structural abnormality or congenital heart disease -Variability ▪Measure of interplay between sympathetic, parasympathetic nervous systems ▪Reduced variability best predictor for determining fetal compromise ▪Absent variability that does not seem to be associated with fetal sleep cycle or administration of drugs is warning sign of nonreassuring fetal status -Accelerations ▪Transient increases in FHR normally caused by fetal movement ▪Often accompany uterine contractions Used as basis for nonstress tests •Electronic monitoring of fetal heart rate -Decelerations ▪Periodic decreases in FHR from baseline -Early: onset of uterine contraction -Late: caused by uteroplacental insufficiency -Variable: caused by umbilical cord compression ▪Sinusoidal pattern: absence of variability ▪Classified according to rate at which FHR leaves baseline -Abrupt: occur in <30 seconds -Variable: descend abruptly -Gradual: require ≥30 seconds to descend -Episodic: occur independently of uterine contractions -Periodic: occur with contractions -Prolonged: leave baseline for 2-10 minutes •Electronic monitoring of fetal heart rate -Evaluation of FHR tracings ▪Begin by looking at uterine contraction pattern -Determine uterine resting tone -Assess contraction frequency, duration, intensity ▪Evaluate FHR -Determine baseline -Determine FHR variability -Determine whether sinusoidal pattern is present -Determine whether periodic changes exist •Electronic monitoring of fetal heart rate -Evaluation of FHR tracings ▪Reassuring -Baseline rate of 110-160 bpm -Variability is moderate -Periodic patterns consist of accelerations with fetal movement, early decelerations may be present ▪Nonreassuring -Severe variable decelerations -Late decelerations of any magnitude -Absence of variability -Prolonged deceleration -Severe bradycardia -Nonreassuring patterns may require continuous monitoring •Electronic monitoring of fetal heart rate -Tracings categorized according to Three-Tier Fetal Heart Rate Interpretation System ▪Category I: normal -Strongly predictive of normal fetal acid-base status -No special action required ▪Category II: indeterminate -Not predictive of abnormal acid-base status -Require evaluation surveillance and reevaluation ▪Category III: abnormal -Predictive of abnormal fetal acid-base status -Require prompt evaluation -Important to provide information to laboring woman, interventions that will help her fetus

HTN disorders in pregnancy

•Gestational hypertension •Pre-eclampsia •Severe pre-eclampsia •Eclampsia •HELLP syndrome •Signs/Symptoms: severe, continuous headache, nausea, blurring of vision, flashes, dots in vision field, HTN, proteinuria, hyperreflexia •Diagnostics: CBC, CMP, 24 hour urine, UA, clotting factors •Management: labetalol, nifedipine, hydralazine, magnesium sulfate

Hypertension in Pregnancy Disorder Management: Pre-Eclampsia in the Antepartum Period preeclampsia

•Home care •Daily BP, Kick counts, modifications •Left lateral •S/S •Family support •Severity may require •Hospitalization •Seizure prophylaxis w/IV magnesium sulfate •Fetal monitoring •Maternal monitoring •Delivery •Anti-hypertensives (labetalol and hydralazine)

TACHYSYSTOLE cause 3 intervention 4

•Induction agents (oxytocin, misoprostol, etc.) •Prolonged labor •Pre-eclampsia •Smoking/alcohol/drug use Oligohydramnios: less fluid/ no amniotic fluid •Reposition mother •IVF bolus (Lactated Ringers) •Decrease or discontinue oxytocin •Obtain order for 0.25 mL Terbutalinesubcutaneously (do not use if patient has HTN) •If unresolved can lead to uterine rupture - EMEGENCY (hemorrhage, maternal and/or fetal death)

results from PPD

•Lower rates in breastfeeding •Disrupted maternal-infant bonding •Increased infant developmental delays •Challenges in meeting infant's needs/care •Longterm = child development impacted •Eating & behavioral problems due to insecure or disorganized attachment •Identify confusion, difficulty relating to others, learning difficulties, failure to thrive, and physical, emotional, and mental problems

Tests and procedures to diagnose preterm labor include: 4

•Pelvic exam. Your health care provider might evaluate the firmness and tenderness of your uterus and the baby's size and position. If your water hasn't broken and there's no concern that the placenta is covering the cervix (placenta previa), he or she might also do a pelvic exam to determine whether your cervix has begun to open. Your health care provider might also check for uterine bleeding. •Ultrasound. A transvaginal ultrasound might be used to measure the length of your cervix. An ultrasound might also be done to check for problems with the baby or placenta, confirm the baby's position, assess the volume of amniotic fluid, and estimate the baby's weight. •Uterine monitoring. Your health care provider might use a uterine monitor to measure the duration and spacing of your contractions. •Lab tests. Your health care provider might take a swab of your vaginal secretions to check for the presence of certain infections and fetal fibronectin (FFN)— a substance that acts like a glue between the fetal sac and the lining of the uterus and is discharged during labor. These results will be reviewed in combination with other risk factors. You'll also provide a urine sample, which will be tested for the presence of certain bacteria.

Preterm labor can affect any pregnancy. Many factors have been associated with an increased risk of preterm labor, however, including:

•Previous preterm labor or premature birth, particularly in the most recent pregnancy or in more than one previous pregnancy •Pregnancy with twins, triplets or other multiples •Shortened cervix •Problems with the uterus or placenta •Smoking cigarettes or using illicit drugs •Certain infections, particularly of the amniotic fluid and lower genital tract •Some chronic conditions, such as high blood pressure, diabetes, autoimmune disease and depression •Stressful life events, such as the death of a loved one •Too much amniotic fluid (polyhydramnios) •Vaginal bleeding during pregnancy •Presence of a fetal birth defect •An interval of less than 12 months — or of more than 59 months — between pregnancies •Age of mother, both young and older •Black, non-Hispanic race and ethnicity

pre term labor

•Risks •Signs/Symptoms •Diagnostics •Vaginal exam, ultrasound, uterine monitoring, lab testing (urine, FFN) •Management •Corticosteroids, tocolytics and magnesium sulfate

Prevention May not be able to prevent preterm labor — but there's much one can do to promote a healthy, full-term pregnancy. For example:

•Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby's health. Mention any signs or symptoms that concern you. If you have a history of preterm labor or develop signs or symptoms of preterm labor, you might need to see your health care provider more often during pregnancy. •Eat a healthy diet. Healthy pregnancy outcomes are generally associated with good nutrition. In addition, some research suggests that a diet high in polyunsaturated fatty acids (PUFAs) is associated with a lower risk of premature birth. PUFAs are found in nuts, seeds, fish and seed oils. •Avoid risky substances. If you smoke, quit. Ask your health care provider about a smoking cessation program. Illicit drugs are off-limits, too. •Consider pregnancy spacing. Some research suggests a link between pregnancies spaced less than six months apart, or more than 59 months apart, and an increased risk of premature birth. Consider talking to your health care provider about pregnancy spacing. •Be cautious when using assisted reproductive technology (ART). If planning to use ART to get pregnant, consider how many embryos will be transferred. Multiple pregnancies carry a higher risk of preterm labor. •Manage chronic conditions. Certain conditions, such as diabetes, high blood pressure and obesity, increase the risk of preterm labor. Work with the health care provider to keep any chronic conditions under control.

What assessment findings (cues) would you expect to find in a patient with PIH

•Severe headache •Swelling of face, hands, ankles •Weight gain •Vision changes •Elevated blood pressure •Chest pain •Shortness of breath (gasping or panting) •Nausea

pain management during labor

▪Analgesia and anesthesia -Given to decrease or eliminate pain during the birthing process ▪Non-pharmacological methods -Review information shared in clinical orientation ▪Pharmacological methods -IV narcotics - commonly used in active phase ▪Nubain (nalbuphine hydrochloride) -Contraindicated: patient with narcotic dependency/abuse as immediate withdrawal will occur = seizures ▪Stadol (butorphanol) -Regional analgesia/anesthesia ▪Epidural -Numb injection site with bupivacaine (Marcaine) or lidocaine (Xylocaine) -Fentanyl infusion -Side effects: hypotension

Nursing Care during Cervical Ripening

▪Assess maternal VS for baseline and routine VS per facility policy ▪Assess fetus for at least 20 minutes prior to starting cervical ripening ▪Bedrest for 30-60 minutes after placement of prostaglandin agent (left tilt) ▪Balloon catheters -Assess placement -No SVE -(Will involuntarily displace when cervix dilates to 4-5 cm) ▪Monitor contractions -Assess for tachysystole and FHR abnormalities ▪If occurs, turn woman to left side and O2 is administered ▪If tachysystole persist administration of a tocolytic agent (SC injection of 0.25 mg terbutaline)

mechanical methods

▪Balloon catheter (Foley bulb induction) ▪Advantages: lower cost than hormonal agents with similar efficacy, lower risk of experiencing side effects and tachysystole, reduce labor time ▪25-80 mL balloon is passed through the un-dilated cervix then inflated ▪Intermittent fetal monitoring acceptable

Cesarean Birth

▪Birth of newborn through an abdominal incision ▪Indications: -Malpresentations, placental abruption, active genital herpes, umbilical cord prolapse, non-reassuring FHR, previous classic incision, more than 1 previous cesarean, tumors, cervical cerclage, severe Rh isoimmunization, major congenital anomalies -Medical conditions (cardiac conditions, severe respiratory disease, CNS disorders, mechanical vaginal obstruction, maternal HIV infection, severe mental illness resulting in altered LOC) ▪Risk to neonate: respiratory problems ▪Extended LOS and increased complication risk in subsequent pregnancies ▪Increased maternal mortality and morbidity r/t increased risk of developing: -Infection, reactions to anesthesia, blood clots

Three-Tier FHR Interpretation

▪Category I -Normal -Strongly predictive of normal fetal acid-base status -No special action required (continue to monitor) ▪Category II -Indeterminate -No predictive of abnormal fetal acid-base status -Requires evaluation and interventions & re-evaluation ▪Category III -Abnormal -Predictive of abnormal fetal acid-base status -Require prompt intervention Category I. All of the following criteria must be present. Tracings meeting these criteria are predictive of normal fetal acid-base balance at the time of observation. Baseline rate: 110 to 160 bpm. Moderate baseline FHR variability. The classification of Category II tracings includes the following: bradycardia with variability, tachycardia, minimal variability, no variability with no recurrent decelerations, marked variability, absence of induced accelerations even after fetal stimulation, recurrent variable decelerations with minimal or moderate variability NICHD Category III (CIII) fetal heart rate tracing (FHR) is defined as having either sinusoidal pattern or absent to minimal baseline variability plus recurrent late decelerations, recurrent variable decelerations, or bradycardia.

Breech Classifications

▪Complete - fetal knees and hips are both flexed, thighs are on the abdomen. Buttock & feet are the presenting parts. ▪Frank - fetal hips are flexed, and the knees extended. Buttock is presenting part. ▪Footling - fetal hips and legs extended. Feet are presenting part. -Single -Double

Maternal Assessment

▪Comprehensive & ongoing ▪Assessment of uterine contractions (UC) -Pain level, external continuous monitoring (TOCO) or internal (IUPC) ▪TOCO positioned at fundus and records frequency and duration ▪IUPC provides a measurement of UC intensity -Commonly used in management of TOLAC* and high doses of oxytocin* -Contraindications: unknow origin of bleeding, placental abruption/previa, malpresentation, and chorioamnionitis -Risk for uterine perforation, placenta abruption, & prolapsed umbilical cord ▪Cervical assessment (dilation, effacement, & fetal station)

fetal presentation

▪Determined by the fetal lie and by the body part of the fetus that enters the pelvic passage. ▪Cephalic is the most common & desired presentation ▪Malpresentations -Breech -Shoulder -Face -Brow Cephalic presentation is the most common & further classified according to degree of flexion: Vertex: fetal head is completely flexed onto the chest, & the smallest diameter of the fetal head presents in maternal pelvis. Military: not flexed nor extended; top of head is the presenting part Brow: Fetal head is partially extended. The occipitomental diameter (the largest anteroposterior diameter) is presented to maternal pelvis, the siniput is the presenting part. Face: fetal head is hyperextended. Face is presenting part.

Relationship between Passage and Passenger

▪Engagement -Assess by vaginal exam -Primigravida ▪Within 2 weeks before term -Multiparas ▪Several weeks before onset of labor -Sagittal suture ▪Synclitic ▪Asynclitism ▪Station -Relationship of presenting part to line between ischial spines of maternal pelvis -Ischial spine is "0" station -Head higher = a negative # -Head lower = a positive # -During labor, presenting part should move progressively from negative station to a positive station -Failure to descend likely to result in cesarean section

Cervical Ripening

▪IOL may be necessary or beneficial ▪When a cervix is unfavorable, cervical ripening agents may be used: -Misoprostol (Cytotec) -Prostaglandin agents (Prepidil and Cervidil) -Mechanical methods ▪Balloon catheter

Myometrial Activity

▪In true labor: -Contraction shortens muscle -Exert a longitudinal traction on the cervix -Causes effacement ▪Contractions: -Stimulated by the hormone - oxytocin ▪Uterus: -Decreasing horizontal diameter -Causes straightening of fetal body ▪Upper part presses against fundus ▪Presenting part thrust down toward lower uterine segment, cervix -Longitudinal muscle fibers pulled up over presenting part

Misoprostol (Cytotec)

▪Initial dose 25 mcg -PO, SL, or vaginal insert ▪Followed by subsequent dosing every 3-6 hours (4 hours) ▪Oxytocin administration is recommended to start 4 hours after last dose ▪Continuous fetal monitoring ▪Contraindications: -Non-reassuring FHR tracing -Tachysystole ▪Moderate intensity

Nursing Care: THIRD STAGE

▪Maternal assessment -VS per facility (every 5 minutes) -Fundal (maintain tone and contraction pattern to deliver placenta) -Monitor for signs of placental separation -At delivery of placenta; PP oxytocin is initiated per facility guidelines (500 mL bolus followed by 125 mL/hour for total of 1 L) -Document time of placental delivery, EBL (QBL) ▪Average blood loss with SVD: 500 mL ▪Fetal assessment -Apgar score -VS/Physical Assessment ▪Respirations: 30-60, may be irregular ▪Apical pulse: 110-160 ▪Temperature above 97.8 less than 99.3 ▪Gestational age ▪Umbilical cord: 2 arteries and 1 vein -Immediate newborn care -Promote bonding Placental separation: uterus rises up in abdomen, uterine volume shrinks from contractions, creating a gush of blood vaginally as uterine contents are expelled, as the placenta separates and beginning to expel the umbilical cord protrudes further from the vagina and appears to lengthen.

Nursing Care: FIRST STAGE OF LABOR

▪Orient to environment, expected assessments, & procedures followed by comprehensive assessment (PPH risk) -VSS ▪Latent phase: Q1 hours (BP, HR, R), temperature every 4 hours (membranes intact) every 2 hours (ROM); UC every 30 minutes; FHR every 1 for low risk and 30 minutes for high risk ▪Active phase: VS same as latent phase, FHR every 30 minutes (LR); every 15 minutes (HR or non-reassuring FHR) ▪Transition phase: VS every 30 minutes, T same as latent phase, UC/FHR every 15 minutes ▪Encourage ambulation, unless contraindicated ▪Encourage to void Q2 hours ▪Monitor labor progress and fetal well-being ▪Provide ice chips and clear liquids ▪Teach, reinforce, and support the use of relaxation, visualization, and breathing techniques ▪Encourage rest between contractions ▪Document and updated HCP on status of woman & fetus ▪Evaluate: Is the woman able to cope? Is maternal-fetal well-being maintained?

Maternal Systemic Response to Labor (continued)

▪Renal -Increase in maternal renin level & activity and angiotensin level -Base of bladder pushed forward, upward when engagement occurs -Pressure from presenting part may impair blood, lymph drainage from base of bladder = edema ▪GI -Decreased motility, absorption of solid food -Prolonged gastric emptying time -Increased gastric volume ▪Immune -WBC increased to 25,000 - 30,o00 during labor, early PP period -Maternal blood glucose levels decrease -> decrease in insulin requirements ▪Pain -Cause of pain during labor ▪Physiologic process ▪Factors affecting response to pain (psyche/social)

Vaginal Birth after Cesarean (VBAC)

▪Supported as viable, safe alternative ▪All women who meet eligibility requirements should be offered trial of labor after cesarean (TOLAC) ▪ACOG guidelines for TOLAC candidates: -No contraindications for VB -One or two previous cesarean births, low transverse uterine incision -Clinically adequate pelvis -No other uterine scars -Surgeon available during active labor -Anesthesiologist available, if needed ▪Absolute risks of VBAC are small ▪Nursing care varies according to institutional protocols

Nursing Care: SECOND STAGE

▪VS every 5-15 minutes (BP, HR, P) ▪Palpate contractions ▪FHR every 15 min (LR); every 5 min for (HR) ▪Monitor for fetal descent, cardinal fetal movements and crowning ▪Position for pushing ▪Provide comfort measures ▪Empty bladder before pushing begins ▪Episiotomy may occur in this stage to enlarge opening if sign of fetal distress (medically indicated) ▪At time of birth, place baby immediately skin-to-skin with mother ▪Document: time of birth, gender, position, nuchal cord (if present) and medications administered

ADHD (Attention-Deficit/Hyperactivity Disorder) risk factors

●Classic Characteristics: ○Difficulty completing tasks that require focused concentration ○Hyperactivity ○Hyperkinesis (excessive movement) ○Impulsivity ●ADHD is often a missed diagnosis in the adolescent and adult ●Known Risk Factors ○Antisocial behavior ○Substance abuse ○Involvement in serious accidents ○Academic underachievement ○Low occupational success

CP patho/etio

●Congenital ○Occurs during fetal development, birth, and neonate period ●Acquired ○After the first 28 days of life ●Decrease in muscle tone ●Muscle stretch reflexes ●Postural reactions ●Primitive reflexes ●Seizures ●Mental retardation ●Hearing problems

ADHD etiology risk factors prevention

●Etiology ○Several Different mechanisms ○Exposure to high levels of lead ○Exposure to alcohol or tobacco smoke prenatally ○Preterm labor, impaired placental functioning, and impaired oxygenation ○Seizures and/or serious head injury ●Risk Factors ○Genetic Factors ○Environment ○Family Stress ○Poverty ○Poor Nutrition ●Prevention ○There is no way to prevent the development of ADHD ○Women during pregnancy should avoid ■Smoking ■Drugs ■Alcohol ■Prenatal care to avoid preterm labor

ADHD pharm

●Pharmacologic Therapy ○Most common approach ○Stimulants are primarily prescribed ○Non-stimulants, 3 have been approved by the FDA for children ○Decrease in impulsive behaviors are seen within the first 10 days ○All are Schedule II drugs ○Side effects ■Headache ■Insomnia ■Tachycardia ■Anorexia

Immediate Care of Newborn

◦Focus of care is to: ◦Maintain the airway ◦Supine ◦Bulb syringe ◦Promote thermoregulation ◦Skin-to-skin ◦Delayed bathing ◦Initiate first feeding ◦Breastfeeding - "Golden Hour" ◦Promote adequate hydration & nutrition ◦First stool and void expected within first 24 hours of life ◦Pseudo-menstruation ◦Promote bonding/attachment ◦Medication administration Nurses are also promoting skin integrity, promoting safety, and preventing complications. Kidney's reach maturity by 34-36 weeks of gestation First two days of life voids 2-6 times per day, expectation is newborn voids x 1 in the first 24 hours. Clear, yellow, odorless

newborn assessments

◦Immediately after birth ◦APGAR ◦First two hours of life ◦Skin-to-Skin ◦Breastfeeding ◦Nursery nurse assessment ◦Within 2 hours of birth and ongoing per facility policy ◦Prior to discharge ◦Healthcare provider will perform a comprehensive assessment

Care of the Newborn after Transition

◦Maintain cardiopulmonary function ◦Promote adequate hydration and nutrtion ◦Promoting skin integrity ◦Circumcision ◦Preventing complications ◦Promoting safety ◦Strenghening parent-newborn attachment/bonding

Diastasis recti abdominis

- Although the stretched abdominal wall appears loose and flabby, it responds to exercise within 2 to 3 months. However, the abdomen may fail to regain good tone and will remain flabby in the grand multipara, in the woman whose abdomen is overdistended, or in the woman with poor muscle tone before pregnancy. Diastasis recti abdominis (a separation of the abdominal muscle) may occur with pregnancy.

crowning cardinal movements

- Crowning occurs when the head no longer recedes and remains visible at the vaginal introitus between contractions; this means that birth is imminent. - The woman may feel some relief that the transition phase of the first stage is over, the birth is near, and she can push. Some women feel a sense of purpose now that they can be actively involved - or the fetus to pass through the birth canal, the fetal head and body must adjust to the passage by certain positional changes. These changes, called cardinal movements or mechanisms of labor

NST 2 beats

- Mom less than 32 weeks need to be 10 seconds by 10 beats-NST - Greater than 32 weeks 15 seconds by 15 beats-NST

- Postpartum blues - Potential reasons for postpartum blues include

- Postpartum blues, often referred to as "baby blues," are a common occurrence after childbirth and may affect up to 80% of women after giving birth. Symptoms include mood swings; feeling sad, anxious, or overwhelmed; crying spells (often for no reason); decreased appetite; and problems sleeping. - Potential reasons for postpartum blues include changing hormone levels, an unsupportive environment, and feelings of insecurity. If symptoms last beyond 10 to 14 days, the woman may need screening for postpartum depression.

•Naegle's Rule

Add seven days to the first day of your LMP and then subtract three months

A nurse is caring for a client who is in labor and whose fetus is in the right occiput posterior position. The client is dilated to 8 cm and reports back pain. Which of the following actions should the nurse take?

Answer: Apply sacral counterpressure.A. Apply sacral counterpressure.The nurse should apply sacral counterpressure to assist in relieving back labor pain related to fetal posterior position.

A nurse is teaching a client who is at 35 weeks of gestation about manifestations of potential pregnancy complications to report to the provider. Which of the following manifestations should the nurse include?

Answer: Headache that is unrelieved by analgesiaC. Headache that is unrelieved by analgesiaA headache that is unrelieved by analgesia can indicate preeclampsia and should be reported to the provider.

A nurse is caring for an 18-year-old adolescent who is up-to-date on immunizations and is planning to attend college. The nurse should inform the client that he should receive which of the following immunizations prior to moving into a campus dormitory? A. Pneumococcal polysaccharide B. Meningococcal polysaccharide C. Rotavirus D. Herpes zoster

B. Meningococcal polysaccharideThe meningococcal polysaccharide immunization is used to prevent infection by certain groups of meningococcal bacteria. Meningococcal infection can cause life-threatening illnesses, such as meningococcal meningitis, which affects the brain, and meningococcemia, which affects the blood. Both of these conditions can be fatal. College freshmen, particularly those who live in dormitories, are at an increased risk for meningococcal disease relative to other persons their age. Therefore, the Centers for Disease Control and Prevention has issued a recommendation that all incoming college students receive the meningococcal immunization.

A nurse is assessing a 30-month-old toddler during a well-child visit. Which of the following findings requires further assessment by the nurse?A. Primary dentition is completeB. Unable to hop on one footC. Birth weight is tripledD. Able to state first and last name

C. Birth weight is tripledThe birth weight should triple by 12 months of age. By 30 months of age, the birth weight should be quadrupled.

A nurse is teaching a parent of a 12-month old child about development during the toddler years. Which of the following statements should the nurse include?A. "Your child should be referring to himself using the appropriate pronoun by 18 months of age."B. "A toddler's interest in looking at pictures occurs at 20 months of age."C. "A toddler should have daytime control of his bowel and bladder by 24 months of age."D. "Your child should be able to scribble spontaneously using a crayon at the age of 15 months."

D. "Your child should be able to scribble spontaneously using a crayon at the age of 15 months."The nurse should teach the parent that at the age of 15 months, the toddler should be able to scribble spontaneously, and at the age of 18 months, the toddler should be able to make strokes imitatively.

A nurse is caring for a 2-year-old child who has cystic fibrosis. The nurse is planning to take the child to the playroom. Which of the following activities would be appropriate for the child?A. Cutting figures from colored paperB. Drawing stick figures using crayonsC. Riding a tricycleD. Building towers of blocks

D. Building towers of blocksBuilding towers of blocks is an appropriate activity for a 2-year-old child. It promotes fine-motor development, and knocking blocks down provides a means of dealing with the stress of hospitalization.

Developmental Age Groups

Infancy (birth-1year) - require high level of care Toddler (1-3) - increased motor ability and independence Preschooler (3-6) - refines gross and fine motor skills School age (6-12) - entry into school, growth of intellectual skills, physical ability, and independence Adolescent (12-18)-mature cognitive thought, self-identity, peer influence.

Bishop scoring system:

The Bishop Score (also known as Pelvic Score) is the most commonly used method to rate the readiness of the cervix for induction of labor. The Bishop Score gives points to 5 measurements of the pelvic examination dilation, effacement of the cervix, station of the fetus, consistency of the cervix, and position of the cervix. An unfavorable cervix < 6. Cervical ripening agents are used to soften (prepare) the cervix for induction.

determine strip

as having either sinusoidal pattern or absent to minimal baseline variability plus recurrent late decelerations, recurrent variable decelerations, or bradycardia.

a nurse is giving pt an epidural for pain control what should they be monitoring for

monitor clients BP Q 5 min following first dose of epidural

Cogenital CP acquired CP

occurs develop fetal developed happens 28 days after life

Postpartum psychosis 6

· Agitation · Hyperactivity · Insomnia · Mood lability · Confusion · Irrationality · Difficulty remembering or concentrating · Delusions and hallucinations that tend to be related to the infant · Lithium or antipsychotics · Should be supervised at all times when caring for infant or other children · Support groups · Short-term institutionalization may be required

AROM PPROM

· This procedure is called amniotomy or artificial rupture of membranes (AROM). · When membrane rupture and leakage of amniotic fluid from the vagina occurs before 37 weeks of gestation, the term preterm premature rupture of membranes (PPROM)

Attention Deficit Disorder (ADD) & Attention Deficit Hyperactivity Disorder (ADHD) genetic symptoms diagnosing treatment nursing process

•ADD is a variation in central nervous system processing characterized by developmentally inappropriate behaviors and inattention. •When hyperactivity and impulsivity are added to the symptoms it is called ADHD. •More common in males than females, most often diagnosed in school age children around 2nd grade. •Symptoms often become more manageable with age and the individual learns coping mechanism to deal with them, but children do NOT just grow out of ADD/ADHD. •Genetics combined with environmental factors may be responsible for ADD/ADHD, also contributing is high levels of lead or mercury, prenatal exposure to alcohol and tobacco. •Neurotransmitters dopamine and norepinephrine may be in deficit along with slow brain maturation resulting in increased response to stimuli and decreased self-regulation causing inattention and impulsivity •Symptoms of ADHD inattention, hyperactivity and impulsivity are expressed through difficulty completing tasks, fidgets constantly, loud and disruptive behaviors, sleep disturbances which can lead to impaired socialization, anxiety, withdrawal, cognitive, and school issues. •When diagnosing ADD/ADHD it is imperative a thorough medical and mental health exam be conducted and appropriate screening tools be used. Anxiety and learning disabilities are often misdiagnosed as ADD/ADHD. Some medical conditions can cause similar symptoms and a complete physical exam should be conducted to rule out any neurological or other health impairment. Symptoms should be seen in multiple setting. (A minimum of two setting in which the symptoms appear is required for diagnosis) •Treatment includes environmental, behavioral, and pharmaceutical. •Environmental: decreased stimuli (clear desk, quiet room, tv/games off) •Behavioral - clear rules, limit setting, consistent consequences, structured routine. •Formalized behavioral therapy may include role playing, play therapy, CBT •Pharmaceutical: Stimulants (Ritalin, Concerta, Adderall) & Nonstimulants(atomoxetine) Know your meds! •Alternative therapies: Yoga, chiropractic, biofeedback, dietary intervention (eliminate process foods, sugar, aspartame, and yeast/ include foods rich in omega-3, iron, magnesium, zinc, B6) Herbs (melatonin, Echinacea, ginkgo biloba) •Nursing Process •Assess patients for S&S of ADD/ADHD, refer to appropriate healthcare professionals •Assess patients for medication knowledge, compliance, effectiveness (decreased in symptoms of inattention and impulsivity) and side effects (most common side effects include weight loss, trouble sleeping, and tachycardia) •Care planning for children with ADD/ADHD should include minimize environmental stimuli, behavior management plans, emotional support, promote self-esteem and identify community resources for child and their parents.

prolonged decelerations

•A decrease in FHR of > 15 beats per minute measured from the most recently determined baseline rate. The deceleration lasts >= 2 minutes but less than 10 minutes.

non stress test 4

•Adequate oxygenation and intact CNS •External electronic fetal monitor •Reactive or non-reactive •No reactive = at risk fetus •Reactive = 2 accelerations of FHR with movement 15 x 15 over 20 minutes

pre eclampsia risk factors

•History (personal or family) •CHTN •Kidney disease •Nulliparity •Diabetes •Coagulation disorders •Lupus •Obesity •Advanced maternal age (increased risk 40 or older) •Twins •New paternity

Intrapartum Management

•Induction of labor (IOL) •Magnesium sulfate (4-7) •Toxicity •Calcium gluconate •Epidural placement •Alternate pain management

Signs and symptoms of preterm labor include: complications

•Regular or frequent sensations of abdominal tightening (contractions) •Constant low, dull backache •A sensation of pelvic or lower abdominal pressure •Mild abdominal cramps •Vaginal spotting or light bleeding •Preterm rupture of membranes — in a gush or a continuous trickle of fluid after the membrane around the baby breaks or tears •A change in type of vaginal discharge — watery, mucus-like or bloody Complications Complications of preterm labor include delivering a preterm baby. This can pose a number of health concerns for the baby, such as low birth weight, breathing difficulties, underdeveloped organs and vision problems. Children who are born prematurely also have a higher risk of cerebral palsy, learning disabilities and behavioral problems.

normal newborns 7

•Respirations •30-60 bpm, irregular (60-70 immediately after birth) •No retractions or grunting •Apical pulse •110-160 bpm •Temperature •Above 36.5 C (97.8 F) •Skin color •Normal related to race/ethnicity •Acrocyanosis •Umbilical Cord •Two arteries, one vein •Gestational age •Term infants 37 -42 weeks of gestation •Sole creases •Creases that involve the heel

gestational diabetes

•Risks •Signs/Symptoms •Diagnostics •Screening begins between 24-28 weeks gestation (initial 1-hour glucose, follow-up 3-hour glucose •Management •Lifestyle modifications, glucose monitoring, and medication, if needed

The Fetus

•The Fetal Head •Sutures, fontanels allowing molding during birth •Size matters! •Fetal Attitude •Relation of fetal parts to one another •Normal attitude •Moderate flexion of head and flexion of arms into chest, and legs into abdomen •Fetal Lie •Relationship of cephalocaudal axis of fetus to cephalocaudal axis of woman •Longitudinal lie •Transverse horizontal lie •Fetal Presentation •Vertex (head-first)* •Breech •Shoulder •Face

uterine CONTRACTIONS

•Uterine Contractions •Uterine contractions are quantified as the number of contractions present in a 10-minute window, averaged over 30 minutes. •Normal: 5 or less contractions in 10 minutes, averaged over a 30-minute window. •Tachysystole: More than 5 contractions in 10 minutes, averaged over a 30-minute window. Applies to both spontaneous or stimulated labor. Tachysystole should always be qualified as to the presence or absence of associated FHR decelerations. •The terms hyperstimulation and hypercontractility are not defined and should no longer be used.

physiology of labor

▪Causes -Begins between 38-40 weeks -Exact cause is not clearly understood -Important aspects include: ▪Progesterone ▪Estrogen ▪Connective tissue

true/false labor

▪Contractions of true labor: -Produce progressive dilation, effacement of cervix -Regular -Increase in frequency, duration, intensity -Discomfort starts in back radiating around to abdomen ▪Not relieved by ambulation may intensify pain ▪Contractions of false labor: -No progressive cervical change -Irregular -Do not increase in frequency, duration, intensity -Occur in lower abdomen -Relieved by ambulation, change in position, PO fluids (water), warm shower/bath

Contraindications for IOL

▪Patient refusal ▪Placenta previa or vasa previa ▪Transverse fetal lie ▪Previous classical uterine incision ▪Active genital herpes infection ▪Umbilical cord prolapse ▪Absolute cephalopelvic disproportion (CPD)

Fetal Response to Labor

▪Persistent FHR changes may indicate changes in fetal well-being ▪Most fetuses are well equipped for the stress of labor ▪Initial assistance to the fetus is provided through the mother (position change, IVF, O2, etc.) ▪A more thorough discussion is in the section on fetal monitoring (refer to previous PPT provided during clinical orientation) •Heart rate -Early deceleration: fetal heart rate (FHR) decelerations as head pushes against cervix ▪Harmless in normal fetus •Acid-base status -Slow decrease in pH -More rapid decrease in pH during second stage of labor -As base deficit increases, fetal oxygen saturation drops by ~10% •Hemodynamic changes -Fetal BP acts as protective mechanism during anoxic periods caused by contracting uterus during labor -Fetal, placental reserves usually sufficient for safety of fetus

Prostaglandin Agents 2

▪Prepidil -0.5 mg dinoprostone) -Intracervical application ▪Cervidil -Intravaginal insert (posterior vagina) -2 cm square piece of cardboard -10 mg slow release dinoprostone over 12 hours (0.3 mg/hour) -Advantage: can be removed easily if an adverse reaction occurs RISK associated with prostaglandin agents: tachysystole, non-reassuring FHT, increase risk for PPH, & uterine rupture

POWERS: Physiologic Forces of Labor

▪Primary & secondary forces work together -Primary - uterine contractions -Secondary - use of abdominal muscles to push during second stage of labor (bearing down) ▪Contractions -Three phases of contractions (increment, acme, and decrement) -Described according to frequency, duration, and intensity

Autism risks prevention

○Down syndrome, fragile X syndrome, congenital rubella syndrome, and neurofibromatosis ○Family history ○Boys higher rate than girls ○Teratogens, such as valproic acid and thalidomide linked to ASD ○Advanced maternal age, however research is showing the age of both parents now ○Excellent prenatal care ○Folic acid ○Good health ○Discuss medications such as antiepileptics with doctor while pregnant ○Genetic counseling if there is a family history

Cerebral Palsy

●Cerebral palsy (CP) is a group of chronic conditions affecting body movements, coordination, and posture that results from a nonprogressive abnormality of the immature brain. ●Often a result of some type of insult to the developing brain of the fetus, neonate, or infant occuring in the later stages of pregnancy, during birth, or within the first 2 years of life. ●Can range from mild to severe ●May or may not include intellectual disability.

Signs of Impending Labor

▪Lightening (baby as dropped) ▪Braxton Hicks contractions ▪Cervical changes Bloody show ▪Rupture of membranes (ROM) -PROM -SROM -AROM -PPROM ▪Nesting -Preparing for baby -"Sudden burst of energy" ▪Other signs: -Weight loss -Diarrhea -Indigestion -N/V

A nurse is providing teaching to the parents of a 4-year-old child about fine motor development. Which of the following tasks should the nurse include in the teaching as an expected finding for this age group?A. Copies a circleB. Cuts foods using a table knifeC. Begins writing in cursiveD. Prints first and last name clearly

A. Copies a circleThe nurse should explain that copying a circle is a skill achieved by the age of 4 years.

A nurse is planning care for a client who is in labor and is having an amniotomy. Which of the following assessments should the nurse identify as the priority?

Answer: Temperature B. TemperatureThe greatest risk for a client following amniotomy is infection. Therefore, the nurse should identify that the priority assessment is the client's temperature.

Adaptations to Extrauterine Life:

1. Initiation of respirations - Review the A&P of the iniiation of respirations, factors that inhibit initial respirations, oxygen transport, maintaining respiratory function - Diaphramagmic, shallow and irregular in depth and rhythm with 5-15 second pauses - Greater than a 20 second pause is classified as abnormal (apnea - further evaluation) - Nose breathers Can breath orally, nasal obstructions can cause fetal distress. Bulb syringe - keep nose and throat clear.

A nurse is caring for a client who has preeclampsia and is receiving a continuous infusion of magnesium sulfate IV. Which of the following actions should the nurse take?

Answer: The nurse should have calcium gluconate readily available B. Have calcium gluconate readily available.The nurse should have calcium gluconate readily available to prevent cardiac or respiratory arrest in the event the client experiences magnesium toxicity.

What are the signs and symptoms of ADHD? List the side effects of Ritalin How should parents deal with behavioral issues in a child with ADHD? List the three treatment areas for ADHD and an example of each

1.Inattentiveness, Impulsivity, and Hyperactivity 2.Common SE: Loss of appetite, weight loss, trouble sleeping, tachycardia (concerning SE to report to physician: allergic reaction, vision changes, extreme restlessness or agitation, hallucinating (seeing, hearing, or feeling things that are not there) A.Follow up question: What would the nurse assess for to evaluate the effectiveness of Ritalin? Answer: ability to sit still for longer periods of time, decrease in impulsive and inattentive symptoms, increased ability to concentrate) 3.Parents need to be supportive and find resources to help them deal with the behaviors of their children particularly when they feel overwhelmed. They should set clear limits and consistent rules, create routines, praise positive behaviors, and enforce consistent consequences. Preventative strategies can include scheduled physical activity before needing to concentrate (i.e. play outside, then do homework), decrease environmental stimuli (quiet room to study). 4.Environmental, behavioral, pharmaceutical

A nurse is assessing a 6-month-old infant at a well-child visit. Which of the following findings indicates the need for further assessment?A. Grabs feet and pulls them to her mouthB. Posterior fontanel is closedC. Legs remain crossed and extended when supineD. Birth weight has doubled

C. Legs remain crossed and extended when supineLegs crossed and extended when supine is an unexpected finding and requires further assessment. At 6 months of age, the legs flex at the knees when the infant is supine. Crossed and extended legs when supine is a finding associated with cerebral palsy.

Recognizing Risk Factors Related to Postpartum Depression

•Personal or family history of depression •Lack of social/emotional support •Unintended Pregnancy •Pregnancy Complication •Poor relationship quality •History of Physical or Emotional Abuse •Socioeconomic Challenges •Life stressors, Anxiety

gestational HTN

•Pregnancy-induced hypertension •> 20 weeks' gestation •BP > 140/90 on at least two occassions 6 hours apart

A patient in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the patient regarding management of care. Which statement, if made by the patient, indicates a need for further education? •A. "I will maintain strict bedrest throughout the remainder of the pregnancy." •B. "I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding." •C. "I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." •D. "I will watch for the evidence of the passage of tissue."

A

A nurse is planning care for a 10-month-old infant who has suspected failure to thrive (FTT). Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)A. Observe the parents' actions when feeding the child.B. Maintain a detailed record of food and fluid intake.C. Follow the child's cues as to when food and fluids are provided.D. Sit beside the child's high chair when feeding the child.E. Play music videos during scheduled meal times.

A. Observe the parents' actions when feeding the child. B. Maintain a detailed record of food and fluid intake. Inappropriate feeding techniques and meal patterns provided by parents can contribute to a child's growth failure.A nutritional goal for the child who has suspected FTT is to correct nutritional deficiencies, which can be identified by recording all food and fluid intake.

accelerations

Abrupt increase from baseline (onset to peak <30 seconds) 32 weeks and beyond = 15 X 15 Less than 32 weeks = 10 X 10 Prolonged acceleration: Increase in heart rate lasts for 2 to 10 minutes. The absence of accelerations for more than 80 minutes correlates with increased neonatal morbidity. Fetal scalp stimulation can be used to induce accelerations. There is about a 50% chance of acidosis in the fetus who fails to respond to stimulation in the presence of a non-reassuring pattern. This technique should not be used to verify the absence of acidemia during a deceleration of the FHR since there is insufficient literature to support its use during a deceleration.

meds ADHD

Amphetamine-dextroamphetamine (Adderall) Dexmethylphenidate (Focalin) Methylphenidate (Ritalin, Concerta) ●Teach patients and parents about side effects such as headaches, insomnia, and anorexia. ●Monitor patients growth while on this medication. ●Ask about a "drug holiday" on weekends and school breaks. ●Potential for abuse: Some children will sell the drug at school.

A nurse is teaching a client who is at 24 weeks of gestation regarding a 1-hr glucose tolerance test. Which of the following statements should the nurse include in the teaching?

Answer: "A blood glucose of 130 to 140 is considered a positive screening result."C. "A blood glucose of 130 to 140 is considered a positive screening result."The nurse should instruct the client that a blood glucose level of 130 to 140 mg/dL is considered a positive screening. If the client receives a positive result, she will need to undergo a 3-hr glucose tolerance test to confirm if she has gestational diabetes mellitus.

A nurse is caring for a client who is in labor and reports increasing rectal pressure. She is experiencing contractions 2 to 3 min apart, each lasting 80 to 90 seconds, and a vaginal examination reveals that her cervix is dilated to 9 cm. The nurse should identify that the client is in which of the following phases of labor?

Answer: Transition A. ActiveThe active phase of labor is characterized by a cervical dilatation of 4 to 7 cm and contractions every 3 to 5 min, each lasting 40 to 70 seconds. B. TransitionThe nurse should identify that the client is in the transition phase of labor. This phase is characterized by a cervical dilatation of 8 to 10 cm and contractions every 2 to 3 min, each lasting 45 to 90 seconds. C. LatentThe latent phase of labor is characterized by cervical dilation of 0 to 3 cm and contractions every 5 to 30 min, each lasting 30 to 45 seconds. D. DescentThe descent phase of labor is characterized by active pushing with contractions every 1 to 2 min, each lasting for 90 seconds.

A nurse is performing a physical assessment on a 6-month-old infant. Which of the following reflexes should the nurse expect to find?A. SteppingB. BabinskiC. ExtrusionD. Moro

B. BaninskiThe Babinski reflex, which is elicited by stroking the bottom of the foot and causing the toes to fan and the big toe to dorsiflex, should be present until the age of 1 year. Persistence of neonatal reflexes might indicate neurological deficits.

A nurse is assessing a 9-month-old infant during a well-child visit. Which of the following findings indicates that the infant has a developmental delay? A. Creeps on hands and knees B. Inability to vocalize vowel sounds C. Uses crude pincer grasp D. Stands by holding onto support

B. Inability to vocalize vowel sounds The infant should begin vocalizing vowel sounds at the age of 7 months, and by the age of 10 months, be able to say at least one word.

A nurse in a pediatric clinic is assessing a toddler at a well-child visit. Which of the following actions should the nurse take?A. Perform the assessment in a head to toe sequence.B. Minimize physical contact with the child initially.C. Explain procedures using medical terminology.D. Stop the assessment if the child becomes uncooperative.

B. Minimize physical contact with the child initially.The nurse should initially minimize physical contact with the toddler, and then progress from the least traumatic to the most traumatic procedures.

nurse is assessing a 3-year-old child who is 1 day postoperative following a tonsillectomy. Which of the following methods should the nurse use to determine if the child is experiencing pain?A. Ask the parents.B. Use the FACES scale.C. Use the numeric rating scale.D. Check the child's temperature.

B. Use the FACES scale.Pain is a subjective experience even for a 3-year-old child. The FACES scale can be used to accurately determine the presence of pain in children as young as 3 years of age.

PP and Newborn Assessment (bonding)

Baby: Poor wt gain Poor growth Childhood illnesses Increased infant mortality Social development impaired

A 26 year old female presents to the clinic. States her last menstrual period was on 10/4/2022 and reports this is her fourth pregnancy with 2 living children born at 34 weeks and 38 weeks gestation and a miscarriage at 8 weeks. The nurse documents the obstetrical history in the electronic medical record as follows: •A. LMP 06/11/2023, G4, P2, T1, P1, A1, L2 •B. LMP 07/11/2023, G4, P3, T1, P1, A1, L2 •C. LMP 07/11/2023, G4, P2, T1, P1, A1, L2 •D. LMP 06/11/2023, G4, P3, T2, P1, A0, L2

C

A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present? •A. Painless, bright red bleeding •B. Absence of abdominal pain •C. Uterine tenderness/pain •D. A soft abdomen

C

A pregnant patient has a nonstress test performed. The results showed the baby had 4 fetal heart rate accelerations of at least 15 beats/min that lasted 15 seconds from start to finish in association with fetal movement for 20 minutes. The results of this would be documented as: • A. Negative Contraction Stress Test • B. Nonreactive Nonstress Test • C. Reactive Nonstress Test • D. Positive Contraction Stress Test

C

A nurse is teaching the parent of an infant about home safety. Which of the following information should the nurse include? (Select all that apply.)A. Use a wheeled infant walker.B. Place soft pillows around the edge of the infant's crib.C. Position the car seat so it is rear-facing.D. Secure a safety gate at the top and bottom of the stairs.E. Maintain the water heater temperature at 49° C (120° F).

C. Position the car seat so it is rear-facing. D. Secure a safety gate at the top and bottom of the stairs. E. Maintain the water heater temperature at 49° C (120°) Infants and children should remain in the rear-facing position when in a car seat until the age of 2 years or until they reach the recommended height and weight per the manufacturer's guidelinesAs the infant begins to crawl and becomes more mobile, the risk of falls increases.To prevent a burn injury, the temperature of the water heater should not exceed 49° C (120° F).

A nurse is reviewing a new prescription for iron supplements with a patient who is 12 weeks gestation. Which of the following beverages should the nurse instruct the patient to take with the iron supplement? •A. 8 oz. water •B. 8 oz. coffee or tea •C. 4 oz. lactose-free low fat milk •D. 4. oz. orange juice

D

A nurse is caring for a preschool-age child who is dying. Which of the following findings is an age-appropriate reaction to death by the child? (Select all that apply.)A. The child views death as similar to sleep.B. The child is interested in what happens to his body after death.C. The child recognizes that death is permanent.D. The child believes his thoughts can cause death.E. The child thinks death is a punishment.

D. The child believes his thoughts can cause death .E. The child thinks death is a punishment. Preschool-age children believe that their thoughts and wishes can make things happen since they are egocentric. This is one reason why the death of a family member can be very difficult for a child at this age.Preschool-age children sometimes believe that death is the result of guilt or punishment due to something they have done, said, or thought.

induction of labor

Diabetes mellitus -Renal disease -Preeclampsia-eclampsia -Chronic pulmonary disease -PROM -Chorioamnionitis -Postterm gestation > 42 weeks -Mild abruptio placentae -Intrauterine fetal demise -Intrauterine growth restriction (IUGR) -Isoimmunization -Oligohydramnios -Nonreassuring fetal status, nonreassuring antepartum testing

CP Hypotonia Hypertonia, rigidity, spasticity Athetosis Ataxia Hemiplegia Diplegia Quadriplegia

Hypotonia Floppiness, increase ROM of joints, diminished reflex response Hypertonia, rigidity, spasticity Tense, tight muscles Uncoordinated awkward, stiff movements, scissoring or scrossing of the legs, exaggerated reflex reactions Athetosis Constant involuntary writhing motions that are more severe distally Ataxia Poor muscle control during voluntary movement, poor balance Hemiplegia Involvement of one side of the body, with the upper extremities being more dysfunctional than the lower extremities Diplegia Involvement of all extremities, but the lower extremities are more affected than the upper, usually spastic Quadriplegia Involvement of all extremities with the arms in flexion and legs in extension

magnesium toxicity

IOL 37 weeks or sooner if mother or fetus risks outweigh the benefits of extending pregnancy Mg toxicity: ***loss of tendon reflexes SOB, abnormal lung sounds, decreased O2 SAT, oligura/decreased UOP (less than 30 mL/hr) Pt may feel flushed, weak, or nauseated (not signs of toxicity)

indications ceasarian •Uterine incisions

Indications -Complete placenta previa -Breech presentation -Transverse lie -Placental abruption accompanied by nonreassuring fetal status -Active genital herpes -Umbilical cord prolapse -Arrest of descent or arrest of dilation -Nonreassuring fetal status -Previous classic incision -More than one previous cesarean birth -Benign, malignant tumors -Cervical cerclage Lower uterine segment transverse ▪Most commonly used -Lower uterine segment vertical incision ▪Preferred for multiple gestation, abnormal presentation, placenta previa, nonreassuring fetal status, preterm fetus, macrosomic fetus -Classic incision

infants safety

Infants should sleep on their backs No blankets or stuffed animals in the crib No crib bumpers Correct dosing for Tylenol and Motrin - many pediatric offices give this information out at the child's 2 months well visit. Babies younger than 6 months old should only take Tylenol for a fever. Infants should be in rear-facing carseats. If they have the anchor capability then it should be used Babies should not sleep for prolonged periods in a carseat Remember tummy time with babies Educate parents on not putting puffy coats or blankets on baby and then harness. Parents can use a light coat under the harness or place a blanket over baby once they are harnessed in. Discuss turning hot water heaters down and water safety with babie

A nurse is caring for a client following an amniocentesis at 18 weeks of gestation. Which of the following findings should the nurse report to the provider as a potential complication?

Leakage of fluid from the vagina B. Leakage of fluid from the vaginaLeakage of fluid from the vagina could indicate premature leakage of amniotic fluid and should be reported to the provider.

nursing process CP nutritional status limited weight bearing developmental delays safety parental involvement baclofen pump sx

Nutritional Status •Children with CP need require high-calorie diet related to feeding difficulties. •Muscle coordination for swallowing, spasticity or hypotonia place the child at risk for aspiration. •Provide small amount of soft food, use large padded utensils. •Pay particular attention to fluid intake to prevent dehydration, fiber to prevent constipation. •Child may need gastrostomy tube to obtain adequate nutrition and fluids. Limited Weight Bearing •In addition to impaired growth of muscle and bone related to spasticity, contractures may develop causing scoliosis •Nutritional deficits in conjunction with limited weight bearing activities results in greater risk of osteoporosis and fractures. •The nurse needs to promote physical mobility and proper body alignment while preserving skin integrity. •ROM, stretching of the muscles, massage, positioning, splints/braces, adaptive devices Developmental Delays & Maximizing Level of Independence •Remember many children with CP are physically, but not intellectually impaired. •Use appropriate terminology, involve patient in their care as appropriate for age and developmental level. •Promote a positive self-image and independence. •Use adaptive technology to assist in communication, eating, mobility, etc. Safety •Assess safety needs •Safety belts should be worn in strollers and wheelchairs •Adaptive car seats may be needed for proper body position •Children with chronic seizures may need to wear helmets to protect from further injury. •Gait/mobility issues Parental involvement •Bonding •Education •Medications (baclofen, anti-seizure medications) •Dental care (disease process & side effects of medications) •Emotional support / Support groups •Address financial needs / burdens •Community Resources - next slide will look at some of the collaborative resources and continued care needs of a child with CP Intrathecal Baclofen Pump •Baclofen can be given orally or intrathecally. Oral forms do not cross the blood/brain barrier effectively and must be administered in much higher dosages than intrathecal routes. •Gaba B activist that diminishes spasticity and has muscle relaxant properties •Peak effect is 4 hours after administration so signs of overdose may be delayed (signs of overdose: decreased LOC, seizure, difficulty breathing, hypothermia, flaccidity) •After implantation of intrathecal device the nurse must observe for signs of infection, leaking CSF •After several months the patient become dependent on baclofen and will experience severe withdrawal symptoms if the pump malfunctions. Early withdrawal symptoms include: lightheadedness, itching, low BP, tingling, return of spasticity. •Education regarding pump, caution with MRI - the strong magnet will stop the pump briefly, but it should resume function upon completion, refill of medication every 1-6 months, device battery is good for 5-7 years. Surgery •Orthopedic surgery to improve function including joint stabilization, Achilles tendon lengthening, hamstring release, or dorsal rhizotomy (afferent fiber cutting to reduce spasticity)

peripartum postpartum psychosis

Peripartum Depression: SEVERE depression that occurs in pregnancy or within the 1st year of giving birth Postpartum Depression: mood swings, feeling sad, feeling anxious/overwhelmed, crying spells for no reason, decreased appetite, and sleep disturbances. Postpartum Psychosis: Agitation, hyperactivity, insomnia, mood lability, confusion, irrationality, difficulty concentrating or remembering, delusions and hallucinations that tend to be r/t infant.

play therapy visual guided imagery hyponosis cognitive behavior therapy

Play therapy - observable actions assist in cognitive learning, problem solving, and creativity Art Therapy Visual Guided Imagery - uses child's own imagination and positive thinking to reduce stress and anxiety Hypnosis - children are often more suggestible than adults and hypnosis has been effective in managing phobias and pain. Cognitive Behavior Therapy - a combination therapy that includes teaching children how their brain (cognition) works providing understanding that assists them in having control over their experiences and how they respond to situations through new thinking patterns and alternative reactions. It also involves response conditioning to alter inappropriate behaviors. Positive reinforcement of desired behaviors helps a child replace maladaptive behaviors with appropriate ones. It is important to include anyone involved in the care of the child including parents, grandparents, siblings, teachers, nurses, etc to provide consistent feedback.

fetal lie

Refers to the relationship of the spinal column (cephalocaudal) axis of fetus and of the woman.

Cerebral palsy manifestation 5

Spastic - increased muscle tone through joints leading to contractures; exaggerated deep tendon reflexes, positive Babinski Dyskinetic-Athetosis - muscle tone abnormalities affecting the entire body, difficulty with fine, purposeful movements, tremors, slow involuntary writhing motions . Dyskinetic-Dystonia - involuntary sustained muscle contractions that lead to sustained or intermittent exaggerated and distorted posturing, twisting, or repetitive movements. Rigid muscles when awake; normal or decreased muscle tone when asleep Ataxic - abnormalities of voluntary movement involving balance and position of trunk and limbs, difficulty maintaining posture, wide-base unsteady gait. Difficulty controlling hand and arm movements. Increased or decreased muscle tone, hypotonia in first couple of years. Mixed - No dominant motor pattern; ma have mild spasticity, dystonia, and/or athetoid movement.

A nurse is preparing to perform Leopold maneuvers for a client. Identify the sequence the nurse should follow. (Move the steps into the box on the right, placing them in order of performance. Use all the steps.)

The first step the nurse should take when performing Leopold maneuvers is to palpate the client's fundus to identify the fetal part .Second, the nurse should determine the location of the fetal back. Third, the nurse should palpate for the fetal part presenting at the inlet. Finally, the nurse should palpate the cephalic prominence to identify the attitude of the head

Newborns may have problems clearing the fluid in the lungs and beginning respiration for a variety of reasons:

The lymphatic system may be underdeveloped, thus decreasing the rate at which the fluid is absorbed from the lungs.

Normal vs tachysystole

Top: 5 UC in 20 minutes Bottom: 13 UC in 20 minutes

T/F Symptoms of Autism may be seen as early as 12-24 months old It is important for the nurse to include home rituals in the care of an autistic child

True: The most common age of diagnosis is 8 years old and it's more common in males than females, symptoms can appear as early as 12-24 months. First signs are often brought to the pediatricians attention near the age of 3. Children with ASD often exhibit stereotypy (rigid, machine-like movements), stimming (repetitive behaviors like arm flapping, rocking, spinning), communication difficulties including echolalia (repeating back words), and an abnormal response to stimuli (aversion to touch, loud noises, or bright light). True: Children with ASD prefer routines and rituals (same schedules day to day, lining up objects, eating only certain foods). A nurse should be aware of a child's routine, behaviors, coping mechanisms, and rituals and address them as they are able in the plan of care for the child. This includes stabilizing environmental stimuli, enhanced communication, maintaining a safe environment, providing supportive care and anticipatory guidance, and connecting parents with community resources.

what med should babies only be given to 6 months

Tylenol based on weight not age

V C E H A O L P

VEAL Variable decelerations Early decelerations Accelerations Late decelerations CHOP Cord compression Head compression OK Placental insufficiency MINE Move mother Intervention Not Necessary No intervention needed Evaluate the why: •Reposition mother •Fluid bolus (LR) •Stop oxytocin (Pitocin) •Apply oxygen via non-rebreather mask @ 10 L/min •C/S may be possible

contributing factors of PPD

•Emotional letdown •Physical discomfort •Sleep deprivation/fatigue •Anxiety about caring for baby •History of depression •Severe PMS

15 months-2.5 years fine/gross motor skills

- 15 months gross motor skills: walks without help - 15 months fine motor skills: uses cup well; builds a tower of two blocks - 18 months gross motor skills: runs clumsy, throws a ball overhand, pulls and pushes toy - 18 months fine motor skills: manages spoon without rotation, turns page in book, build tower 3-4 blocks - 2 years gross motor skills: walking up and down stairs by placing both feet on each step - 2 years fine motor skills: builds a tower 6-7 blocks - 2.5 years gross motor skills: jumps across the floor and off a chair or step using both feet, takes few steps on tip toe - 2.5 years fine motor skills: draw circles, has good hand coordination

blood loss during sx unable to receive epidural minimal variability 2 How to prepare with epidural: 5 hypoglycemia how often to do bubble assessment

- 500 ml of blood loss during vaginal delivery - Unable receive epidural if platelets less than 100,000 - Minimal variability: cause baby become sleepy, do not start Pitocin on a reactive strip - How to prepare with epidural: platelets, consents, stage of labor (anytime they want), shaking-shift of hormones, hypotension-amphedren - Cold baby cause hypoglycemia, put hat on and swaddle - Bubble assessment checked every 15mins

Severe features of preeclampsia include any or all of the following: 7

- BP greater than or equal to 160/110 mmHg - Persistent or debilitating headache - Persistent right upper quadrant or epigastric pain - Serum creatinine greater than 1.1 mg/dL or double the patient's baseline - Platelet count less than 100,000/microliter - Liver enzymes elevated to at least twice the upper limit of normal - Pulmonary edema

- BUBBLE HE: - Abdominal changes in post partum: - During pregnancy

- BUBBLE HE: breast, uterus, bladder, bowel, lochia, episiotomy, hemorrhoids, emotions - Abdominal changes in post partum: uterine ligaments stretched require time to recover, stretched abdominal walls responds to exercise 2-3 months, diastasis recti abdomini: separation of abdominal muscles- may occur with pregnancy, responds well to exercise - During pregnancy: increased levels of estrogen stimulate breast duct proliferation, elevated progesterone levels promote development of lobules, prolactin arises, lactation suppressed by elevated progesterone, progesterone levels fall once placenta expelled

cerebral palsy s/s

- CP can cause abnormal perception and sensation; visual, hearing, and speech impairments - Cerebral palsy s/s: gagging or choking poor suck reflex, poor head control, rigid posture, asymmetric crawl, toe walking, arching back, spastic (pyramidal)-hypertonicity muscle tightness increased deep tendon reflexes poor control motion, athetold: involuntary jerking movements, dystonic: slow twisting movements, ataxia: wide based gait and difficulty with coordination -

language with autism 4

- Communication difficulties or delays in speech and language are common and are often the first symptoms that lead to diagnosis. Absence of babbling and other communication by 1 year of age, absence of two-word phrases by 2 years, and deterioration of previous language skills are characteristic of autism. Language acquisition, including verbal and nonverbal communication patterns, such as eye contact, will vary based on the severity of the disorder. - · Engaging in echolalia (a compulsive parroting of a word or phrase just spoken by another) - · Repeating questions rather than answering them - · Being fascinated with rhythmic, repetitive songs and verses.

cystic fibrosis CF s/s blood speciman sweat chloride test meds

- Cystic fibrosis: is a respiratory disorder that results from inheriting a mutated gene. Characterized by mucus glands that secrete an increase in the quantity of thick mucus leads to mechanical obstruction - CF symptoms: early s/s-wheezing, dry nonproductive cough; dyspnea, cough, obstructive emphysema; barrel shape chest, clubbing finger; large frothy bulky greasy stools (steatorrhea), distend abdomen/thin legs-infants, defiency of fat soluble vitamins - Blood specimen: defiency of fat soluble vitamins (A,D,E,K) - Sweat chloride test: child must be well hydrated to ensure accurate test results, confirm CF chloride greater than 40 - Administer pancreatic enzymes within 30 min of eating a meal or snack- pancrealipase treats pancreatic insuffiency - Cerebral palsy: is a nonprogressive impairment of motor function, especially of muscle control, coordination, and posture

fetal bradycardia fetal tachycardia early decel late decel

- Fetal bradycardia: umbilical cord prolapse, maternal hypotension/hypoglycemia/hypothermia, and anesthetic meds - Fetal tachycardia: maternal dehydration, maternal or fetal infection, fetal cardiac dysthymias - Early deceleration FHR: uterine contractions, vaginal exam, fundal exam - Late decelerations FHR:maternal hypotension, placenta previa, abruptio placenta, uteroplacental insuffiency; place side lying position, d/c oxytocin, administer oxygen

fetal lie fetal presentation malpresentation engagement station

- Fetal lie refers to the relationship of the cephalocaudal (spinal column) axis of the fetus to the cephalocaudal axis of the woman. The fetus may assume either a longitudinal (vertical) lie or a transverse horizontal lie. - Fetal presentation is determined by fetal lie and by the body part of the fetus that enters the pelvic passage first. - Breech and shoulder presentations are called malpresentations because they are associated with difficulties during labor. - Engagement of the presenting part occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet. - Station refers to the relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis.

stages of labor

- First stage of labor: Latent phase: 0-3cm, irregular mild to moderate, frequency 5 to 30 min, duration 30 to 45 seconds Active phase: 4 to 7cm, contractions more regular moderate to strong, frequency 3 to 5 min, duration 40 - 70 seconds Transition phase: contractions strong to very strong, frequency 2-3 min, duration 45-90 seconds - Second stage: full dilation - Third stage: delivery of baby - Fourth stage: delivery of placenta

frequency duration intensity

- Frequency refers to the time between the beginning of one contraction and the beginning of the next contraction. Duration is measured from the beginning of a contraction to the completion of that same contraction. Intensity refers to the strength of the contraction during acme. - When the cervix is completely dilated and the fetus has descended enough to stimulate the maternal urge to push, the mother's abdominal muscles contract as she bears down. Bearing down assists the expulsion of the fetus and placenta. -

GTPAL FHT

- GTPAL: gravidity, term births (37 wks), preterm birth (viability to 37 wks), abortions/miscarriage, living children - FHT: 110-160

Clinical Characteristics of Cerebral Palsy - Clinical Characteristics - Definitions 7

- Hypotonia - Floppiness, increased range of motion of joints, diminished reflex response - - Hypertonia, rigidity, spasticity- - Tense, tight muscles - Uncoordinated, awkward, stiff movements; scissoring or crossing of the legs; exaggerated reflex reactions - - Athetosis - Constant involuntary writhing motions that are more severe distally - - Ataxia - Poor muscle control during voluntary movement, poor balance - - Hemiplegia - Involvement of one side of the body, with the upper extremities being more dysfunctional than the lower extremities - - Diplegia - Involvement of all extremities, but the lower extremities are more affected than the upper, usually spastic - - Quadriplegia - Involvement of all extremities with the arms in flexion and legs in extension -

- Stage - Age - Primary Task Erikson stages 5

- Infancy - Birth-18 months - Trust versus mistrust - Development of basic trust and sense of security - Lack of trust, sense of fear - - Early childhood - 18 months-3 years - Autonomy versus shame and doubt - Basic awareness of independence; sense of autonomy and self-control - Self-doubt, sense of helplessness, heightened dependence on caregivers - - Late childhood - 3-5 years - Initiative versus guilt - Emergence of basic sense of self-guidance and self-discipline - Impaired self-initiative, insecurity regarding leadership ability - - School age - 6-12 years - Industry versus inferiority - Confidence in ability to attain goals, initial formation of identity apart from nuclear family, successful peer group integration - Sense of incompetence, low self-esteem, difficulty integrating into peer groups - - Adolescence - 12-20 years - Identity versus role confusion - Formation of strong sense of identity as an individual and as a member of society, identification of personal and occupational goals - Role confusion, social alienation, potential substance misuse or abuse, potential development of antisocial personality disorder

infant head circumference language nutrition immunizations injury prevention

- Infant head circumference: 33 to 35 cm - Infant length: 48 to 53 cm, weight: 6 to 9 lb - 6 to 8 teeth abrupt by the end of the first age - Language development: turns head to the sound of a rattle by 3 months, laughs and squeal by 4 months, makes single vowel sounds by 2 months, says three to five words by the age of 1 year - Immunizations: birth-hepatitis B, 2 months: DTap, RV, IPV, Hib, PCV - Nutrition: new foods should be introduced one at a time over 5-7 day period; vegetable and fruits should be introduced at 6-8 month - Injury prevention: hold the infant for feedings do not prop bottle, small objects that become lodged in the throat (grapes coins candy), hot water should be less than 120 F

The AAP recommends the following for safe infant sleeping: 6

- Infants should always be placed on their back for sleeping until 1 year of age. Side sleeping is not safe. - Breastfeeding is recommended because it is associated with a reduced risk of SIDS. - Infants should sleep in the same bedroom as their parents, close to the parents' bed, but not in the bed, for at least their first 6 months, and preferably for their first year. They should sleep on a separate surface designed for infants. - There should be no soft objects in the infant's sleep area—no pillows, soft toys, quilts, comforters, sheepskins, crib bumpers, or loose bedding such as blankets. - Offer a pacifier at naptime and bedtime, but there is no need to replace it if it falls out. - Avoid exposure to smoke, alcohol, and illicit drugs during pregnancy and after birth. - Dress infants appropriately for the environment—avoid overheating, and especially avoid covering the face and head of the infant.

nullipara multipara cervical dilation

- Nullipara - <20 hr<20 hr in most cases LP - 1.1-3.8 hr AP - 1-3.2 hr TP - ≤3 hr≤3 hr may be longer than 3 hr with epidural anesthesia 2nd - - Multipara - <14 hr<14 hr in most cases LP - 0.9-3.2 hr AP - 0.6-2 hr TP - <1 hr<1 hr hr, may be as much as 2 hr with epidural 2nd - - Cervical dilation - 0-6 cm LP - 6-8 cm AP - 8-10 cm TP

- Placenta previa: - Aburptio placenta:

- Placenta previa: placenta abnormally implants in the lower segment of the uterus near or over cervix; s/s painless bright red vaginal bleeding, uterus soft relaxed nontender, fundal height greater than expected - Aburptio placenta: premature separation of the placenta from the uterus, s/s sudden onset of intense localized uterine pain , area of uterine tenderness, fetal distress

-preeclampsia/eclampsia -preeclampsia s/s

- Preeclampsia is defined according to the same criteria as gestational HTN, accompanied by signs of end organ damage. Eclampsia is preeclampsia with the presence of seizures. Preeclampsia superimposed onto chronic HTN - early signs of preeclampsia include high BP and evidence of protein in the urine. Additional symptoms include swelling of the face, eyes, or hands and sudden weight gain of more than 0.9 kg (2 lb) per week. hese include persistent headache, right-sided abdominal or shoulder pain, irritability, decreased urine output, nausea and vomiting, and vision changes.

identify possible factors that can contribute to the blues: 3

- Pregnancy complications and other obstetric issues (such as gestational diabetes) - Depression prior to or during pregnancy, or episodes of postpartum depression with previous births - Maternal age (both adolescent and advanced maternal age put the woman at greater risk).

In addition to age, infant and maternal risk factors associated with an increased incidence of SIDS include the following (Carolan, 2018; U.S. National Library of Medicine, 2020b). 8

- Preterm and low birth weight - Race: Most common in American Indians and Alaska Natives, followed by non-Hispanic Blacks, non-Hispanic whites, Hispanics, and Asian or Pacific Islanders - Sex: More common in boys than in girls - Sleeping in a prone or side-lying position - Exposure to environmental tobacco smoke or mother who smoked during pregnancy - Overheating (e.g., overdressing, too many bed covers) - Bed sharing, especially with people who smoke or are under the influence of alcohol or drugs - Loose bedding: Use of pillows, comforters, quilts, and blankets - Sleeping on soft surfaces such as waterbeds, sofas, pillows, or with stuffed toys.

skin changes Rh factor - Maternal serum alpha fetoprotein (MSAFP): - Common discomfort of pregnancy: - Nonstress test:

- Skin changes: chloasma: increase of pigmentation of the face, linea nigra: dark line pigmentation, striae gravidarum: stretch marks - Rh factor: indirect combs test identifies client sensitized to Rh positive blood - Maternal serum alpha fetoprotein (MSAFP):screening occurs at 15-22 wks, used to rule out down syndrome - Common discomfort of pregnancy: SOB, leg cramps, varicose veins and lower extremity edema, nasal stuffiness and nosebleed(elevated estrogen), braxton hicks - Nonstress test: is the most widely used technique for antepartum evaluation of fetal well being performed

stages of milk 3

- Stages of human milk: colostrum: immediately available to baby at birth, provides all nutrition required until mothers milk becomes more abundant - Transitional milk: after 30-72 hours of colostrum production, more copious colostrum - Mature milk: presents by 2 weeks of postpartum

latent phase active phase transition phase second stage

- The latent (or prodromal) phase starts with the beginning of regular contractions, which are usually mild. The woman feels able to cope with the discomfort. She may be relieved that labor has finally started and that the end of pregnancy has come. - hey may start as mild contractions lasting 20 seconds with a frequency of 10 to 20 minutes and progress to moderate ones lasting 30 to 40 seconds with a frequency of 5 to 7 minutes - When the woman enters the early active phase, her anxiety and her sense of the need for energy and focus tend to increase as she senses the intensification of contractions and pain. She may begin to fear a loss of control or may feel the need to "really work and focus" on the contractions. - During this phase, the cervix dilates from approximately 6 to 8 cm (1.6 to 2.8 in.). Fetal descent is progressive, and the rate of cervical dilation most often increases. During the active phase, contractions become more frequent and longer in duration, and they increase in intensity. By the end of the active phase, contractions may have a frequency of 2 to 5 minutes, a duration of 40 to 60 seconds, and strong intensity. - The transition phase is the last part of the first stage of labor. When the woman enters the transition phase, she may demonstrate an acute awareness of the need for her energy and attention to be completely focused on the task at hand. - During the transition phase, contractions have a frequency of approximately every 1.5 to 2 minutes, a duration of 60 to 90 seconds, and strong intensity. The transition phase does not usually last longer than 3 hours for nulliparas or longer than 1 hour for multiparas - The second stage of labor begins with complete cervical dilation and ends with birth of the baby. For primigravidas, the second stage should be completed within 3 to 4 hours after the cervix becomes fully dilated; for multiparas, the second stage should be complete in 2 to 3 hours. Contractions continue with a frequency of about every 15 to 30 minutes, a duration of up to 90 seconds, and strong intensity

attention-deficit disorder (ADD) risk factors Symptoms of ADHD 3

- The term attention-deficit disorder (ADD) is sometimes used to describe individuals who experience the inattentiveness and difficulty concentrating related to ADHD - Multiple risk factors for ADHD have been identified. Maternal factors, such as smoking cigarettes and drinking alcohol during pregnancy, increase the risk of ADHD in offspring - Symptoms of ADHD can range from mild to severe. The child has difficulty completing tasks, fidgets constantly, is frequently loud, and interrupts others. Sleep disturbances are common. Because of these behaviors, the child often has difficulty developing and maintaining social relationships and may be shunned or teased by other children. - Women should avoid smoking, drugs, and alcohol during pregnancy to reduce the risk of ADHD and other disorders in their children. - ADHD has three clusters of symptoms, (inattentive, hyperactive, and impulsive)

- autism spectrum disorder (ASD) 3

- autism spectrum disorder (ASD) characteristically demonstrates impaired communication and social interaction patterns and the presence of repetitive, restrictive behaviors - The core characteristics of autism fall into two developmental areas and usually manifest by the time the child is 3 years old: (1) social interaction and communication and (2) restrictive and repetitive behaviors. - Children with ASD have difficulties with social interactions, communication, and restrictive, repetitive behaviors. Social interactions are always complex and involve perceptions of the other individual as well as social behaviors.

- Cephalohematoma - Capet succedaneum - Erythromycin ophthalmic ointment - Vitamin K (IM injection)

- minor condition that occurs during the birth process. Pressure on the fetal head ruptures small blood vessels when the head is compressed against the maternal pelvis during labor or pressure from forceps or a vacuum extractor used to assist the birth -swelling of the scalp in a newborn. It is most often brought on by pressure from the uterus or vaginal wall during a head-first -antibiotics have made it possible to treat pregnant people who have sexually transmitted infections as well as any infants who contract bacterial ON—making blindness highly unlikely in countries where mothers have access to screening and treatment during pregnancy. Also today, gonorrhea has been replaced by chlamydia—another sexually transmitted infection— - provides protection against bleeding that could occur because of low levels of this essential vitamin.

- sudden unexpected infant death (SUID) Three factors that occur simultaneously lead to SIDS: 3

- sudden unexpected infant death (SUID), the most common causes include sudden infant death syndrome, unknown causes, and accidental suffocation and strangulation in bed. 1. The infant must have a vulnerability, an abnormality in the brainstem, which controls respiratory and autonomic responses to stressors during sleep. 2. Significant stressors that contribute to SIDS must be present, such as prone (face-down) or side sleeping and bed sharing. When infants are in the prone or side-lying positions, the brainstem abnormality compromises their protective reflexes, such as arousal and head turning, against asphyxia. 3. Infants must be in a critical developmental period within the first 6 months of life.

fetal monitoring

Fetal heart rate monitoring is the process of checking the condition of the fetus during antepartum care (as needed) and intrapartum by monitoring the fetus's heart rate with special equipment.

- Fetal attitude

refers to the relation of the fetal parts to one another, including flexion or extension of the fetal body and extremities.

A number of factors can delay or impair lactogenesis. Maternal factors include the following (Janke, 2014): 5

· Cesarean birth · Postpartum hemorrhage · Type 1 diabetes · Untreated hypothyroidism · Obesity · Polycystic ovary syndrome · Retained placenta fragments · Vitamin B6B6 deficiency

Mechanisms of labor. 5

A, Descent (This occurs because of four forces: (1) pressure of the amniotic fluid, (2) direct pressure of the uterine fundus on the breech, (3) contraction of the abdominal muscles, and (4) extension and straightening of the fetal body.). B, Flexion (This occurs as the fetal head descends and meets resistance from the soft tissues of the pelvis,). C, Internal rotation (The fetal head must rotate to fit the diameter of the pelvic cavity, which is widest in the anteroposterior diameter). D, Extension. (The resistance of the pelvic floor and the mechanical movement of the vulva opening anteriorly and forward assist with extension of the fetal head as it passes under the symphysis pubis.) E, External rotation. (As the shoulders rotate to the anteroposterior position in the pelvis, the head turns farther to one side (external rotation).)

EARLY DECELERATIONS

Clinical significance: head compression (Late stages labor commonly seen as baby engages into the pelvis); mirrors the contraction approaching delivery associates with head compression OR Strong contractions; monitor closely as this could lead to decreased oxygenation for fetus.

- Gestational hypertension: - Preeclampsia: - Severe preeclampsia: - Eclampsia: - HELLP syndrome:

- Gestational hypertension: begins after the 20th week of pregnancy BP higher than 140/90 - Preeclampsia: proteinuria or greater than 1+, reports headache or edema - Severe preeclampsia: 160/110 BP higher, proteinuria 3+, oliguria, headache, blurred vision, hyperreflexia possible ankle clonus, and edema - Eclampsia: severe preeclampsia with seizure activity - HELLP syndrome: hematologic conditions coexist with severe preclampsia; H: hemolysis, EL: elevated liver enzymes, LP: low platelets

1st-4th stage

- - The first stage begins with the onset of true labor and ends when the cervix is completely dilated at 10 cm and the mother has the urge to push. The second stage begins with urge to push in the setting of complete dilation and ends with the birth of the newborn. The third stage begins with the birth of the newborn and ends with the delivery of the placenta. - First Stage - Latent Phase - Active Phase - Transition Phase - Second Stage - Labor

- Presumptive signs: - Probable signs: - Positive signs:

- Presumptive signs: amenorrhea, fatigue, N/V, urine frequency, breast changes, and quickening (slight fluttering movement; usually at 16-20 weeks) - Probable signs: abdominal enlargement, hegars sign (softening of lower uterus), Chadwick's sign (deepened violet bluish color of cervix), goodell sign (softening of the cervix, Braxton hick's contraction, and positive pregnancy test - Positive signs: fetal heart sounds, visualization of fetus by ultrasound, and fetal movement

lochia, which is classified according to its appearance and contents. These classifications are lochia rubra, lochia serosa, and lochia alba.

- The uterus rids itself of the debris remaining after birth through a discharge called lochia, which is classified according to its appearance and contents. These classifications are lochia rubra, lochia serosa, and lochia alba. - Lochia rubra is dark red. It occurs for the first 1-3 days and contains epithelial cells, erythrocytes, leukocytes, shreds of decidua, and occasionally fetal meconium, lanugo, and vernix. Clotting is often the result of blood pooling in the upper portion of the vagina. - Lochia serosa is a pinkish color. It occurs from approximately day 3 until day 10. - This final discharge, termed lochia alba (from the Latin word for white), is composed primarily of leukocytes, decidual cells, epithelial cells, fat, cervical mucus, cholesterol crystals, and bacteria. Patients should be instructed to call their doctor if they notice bright red bleeding beyond 4 to 5 days postpartum or a return to bright red bleeding after it had previously ceased

their risk factors may include 4

- having a previous baby die of SIDS, sleeping arrangements (e.g., sleeping with parents in their beds or with other siblings), and sleeping on a soft mattress surrounded with blankets and loose bedding. Parents or older children may accidentally roll on to the baby, suppressing their drive to breathe, and loose bedding (e.g., blankets) may obstruct air flow if the baby gets entrapped in the linens, resulting in an unexpected death.

- Maternal role attainment (MRA) Maternal role attainment often occurs in four stages (Mercer, 1995):

-is the process by which a woman learns mothering behaviors and becomes comfortable with her identity as a mother. 1. The anticipatory stage occurs during pregnancy. The woman looks to role models, especially her own mother, for examples of how to mother. 2. The formal stage begins when the child is born. The woman is still influenced by the guidance of others and tries to act as she believes others expect her to act. 3. The informal stage begins when the mother starts making her own choices about mothering. The woman begins to develop her own style of mothering and finds ways of functioning that work well for her. 4. The personal stage is the final stage of maternal role attainment. When the woman reaches this stage, she is comfortable with the notion of herself as "mother."

The biophysical profile is a comprehensive assessment of five biophysical variables over a 30-minute period: 5

1. Fetal breathing movement 2. Fetal movements of body or limbs 3. Fetal tone (extension and flexion of extremities) 4. Amniotic fluid volume (visualized as pockets of fluid around the fetus) 5. FHR accelerations with activity (reactive NST).

Each contraction has three phases:

1. Increment: the building up of the contraction (the longest phase) 2. Acme: the peak of the contraction 3. Decrement: the letting up of the contraction.

Variable decelerations

variable decelerations are the most common type of fetal deceleration. They typically occur during the first and second stages of labor (i.e., the initial contractions and dilation of the cervix leading to the delivery of the infant, respectively) and vary in shape, duration, and intensity. They often resemble the letter "U," "V" or "W" and may not have a constant relationship with uterine contractions.; cord compression could cause this

gross 5/fine motor skills 5 1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months

GROSS 1 month-holds head lag 6-rolls back to front 7-full weight on feet 8-sits unsupported 12-sits down from standing FINE 4- grasp object with both hands 6-holds bottle 10-grasp bottle with one hand 11-place object in container 12-builds two block tower/turn page

Complications may occur before or during labor and birth that interfere with adequate lung expansion; thus, the decrease in pulmonary vascular resistance fails to occur, resulting in decreased pulmonary blood flow. These complications include the following: 4

Inadequate compression of the chest wall in very small newborns (SGA or very low birth weight) because of immature muscular development The absence of chest wall compression in a neonate born by cesarean delivery, although this compression can be externally applied by skilled HCPs as they deliver the newborn from the uterus Respiratory depression because of maternal analgesia or anesthesia agents Aspiration of amniotic fluid, meconium, or blood.

stages of piaget theory

Sensorimotor phase Birth-2 years Stage 1: Use of reflexes Birth-1 month Uses reflexes: sucking, rooting, grasping. Stage 2: Primary circular reaction 1-4 months Infant responds reflexively. Objects are extension of self. Stage 3: Secondary circular reaction 4-8 months Awareness of environment grows. Changes in the environment are actively made as infant recognizes cause and effect. Stage 4: Coordination of secondary schemata 8-12 months Intentional behavior occurs. Object permanence begins. Stage 5: Tertiary circular reaction 12-18 months Toddlers discover new goals and ways to attain goals. Rituals are important. Stage 6: Mental combinations 18-24 months Language gives toddlers a new tool to use. Preoperational phase 2-7 years Young children think by using words as symbols. Everything is significant and relates to "me." They explore the environment. Language development is rapid. Words are associated with objects. As children get older, egocentric thinking diminishes. They think of one idea at a time. Words express thoughts. Concrete operational phase 7-11 years Children solve concrete problems, begin to understand relationships such as size, understand right and left, and recognize various viewpoints. Formal operational phase 11 years and up Children use rational thinking. Reasoning is deductive and futuristic.

- Major depressive disorder with peripartum onset is

very similar to major depression, and both disorders have nearly the same symptomatology. Peripartum depression presents as a combination of depressed mood, loss of interest, loss of pleasure, sleep and appetite disturbance, impaired concentration, psychomotor disturbance, fatigue, feelings of guilt or worthlessness, and suicidal thoughts

variability pt 2 5

Variability is the single most important indicator of adequate oxygenation of the fetus. Moderate variability is concerned normal. Variability is the single most important indicator of adequate oxygenation of the fetus. Moderate variability is concerned normal. Absent variability is a sign of fetal compromise. Etiologies of decreased variability: Fetal metabolic acidosis, CNS depressants, fetal sleep cycles, congenital anomalies, prematurity, fetal tachycardia, preexisting neurologic abnormality, normal, betamethasone. Marked variability may be caused by an increased sympathetic response related to a stressful intrapartum event, such as cord compression or meconium. Absent variability is a sign of fetal compromise.

Vernix caseosa Lanugo Mottling Harlequin sign Jaundice

Vernix caseosa is a white, cheesy substance normally found on newborns. It is absorbed within 24 hours after birth. Vernix is abundant on preterm babies and absent on postterm newborns. Lanugo (fine hair) is seen on preterm newborns, especially on the shoulders, foreheads, backs, and cheeks. Desquamation of the skin is seen in postterm newborns. Mottling (lacy pattern of dilated blood vessels under the skin) occurs as a result of general circulation fluctuations. It may last several hours to several weeks, or it may come and go periodically Harlequin sign color change is occasionally noted: A deep red color develops over one side of the newborn's body while the other side remains pale, so the skin resembles a clown's suit. Jaundice is yellow pigmentation of body tissues caused by the presence of bile pigments. It is first detectable on the face (where skin overlies cartilage) and the mucous membranes of the mouth, and it has a head-to-toe progression

People with CF can have a variety of symptoms, including: 5

Very salty-tasting skin Persistent coughing, at times with phlegm Frequent lung infections including pneumonia or bronchitis Wheezing or shortness of breath Poor growth or weight gain in spite of a good appetite

· nonstress test (NST),

a widely used method of evaluating fetal status, may be used alone or as part of a more comprehensive diagnostic assessment called a biophysical profile. The NST is based on the knowledge that when the fetus has adequate oxygenation and an intact CNS, accelerations of the FHR occur with fetal movement.

A nurse is evaluating a 1-year-old for possible cerebral palsy. Which findings could be indicators of cerebral palsy? (Select all that apply.)a. Presence of the rooting reflexb. No demonstration of hand dominancec. Vocabulary limited to three words: "mama," "dada," and "ball"d. Frequent arching of the back e. Crawling with three extremities

a, d, and e (Feedback: Persistent newborn reflexes, such as the rooting reflex, could be an indication of cerebral palsy. The rooting reflex would usually go away by 4 months old. The crawling child should use all four extremities to crawl, not just two or three. Hand predominance could indicate a weakness on one side if evident before the preschool years. A child arching his back or having an abnormal posture could indicate cerebral palsy. It is normal for a 1-year-old to know 1-4 words.)

- Physiologic changes preceding labor: 5 - Assessment of amniotic fluid: 5 Ps station leopold maneuvers

backache, lightening (feeling fetus has dropped), bloody show (cervical mucus plug may occur), energy burst(nesting), rupture of membranes (labor usually occurs 24 hours later) - Assessment of amniotic fluid: should be watery, clear; use nitrazine to confirm amniotic fluid; ph 6.5-7.5 - 5 P's: passenger (fetus and placenta), passageway (birth canal), powers (contraction), position (of the women), psychological response - Station: measurement of fetal descent in centimeters with station 0 being level of an imaginary line - Leopold maneuvers: abdominal palpitation of the fetal presenting part, lie, attitude, descent

- A fetal movement record is a - The transvaginal procedure can be

noninvasive technique that enables the pregnant woman to monitor and record movements easily and without expense. accomplished with an empty bladder, and most women do not feel discomfort during the exam.

- Gestational hypertension

occurs in the second half of pregnancy in a previously normotensive mother. The diagnosis is made when the patient has a BP greater than or equal to 140/90 mmHg on at least two occasions that are at least 6 hours apart after 20 weeks' gestation

Five factors influence the progress of labor:

the birth passage (true pelvis, which forms the bony canal through which the fetus must pass), the fetus (fetal head, attitude, lie, and presentation are critical to the outcome of labor), the relationship between birth passage and fetus (When assessing the relationship between the birth passage and the presenting part of the fetal body, the nurse considers the engagement of the fetus, the location (or station) of the fetal presenting part in the birth passage in relation to the ischial spine, and the fetal position to one of the four quadrants of the maternal pelvis), physiologic forces of labor (Birth of the fetus, fetal membranes, and placenta occurs through the work of primary and secondary forces. Uterine muscular contractions that occur in the first stage of labor are the primary force.), and psychologic considerations (The final critical factor is the parents' psychosocial readiness, including their fears, anxieties, birth fantasies, excitement level, feelings of joy and anticipation, and level of social support.) five Ps: passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response.

- Preeclampsia is distinguished from chronic or gestational HTN by

the presence of these abnormal findings: proteinuria, defined as 2+2+ or greater on a urine dipstick; random urine protein/creatinine ratio of 0.3 or greater; or 0.3 gram of protein or greater in a 24-hour urine collection.

Ultrasound testing can be of benefit in the following ways: 3

· Early identification of pregnancy. Pregnancy may be detected as early as the fifth or sixth week after the LMP by assessing the gestational sac and the presence of a FHR after 6 weeks of gestation. · Observation of fetal heartbeat and fetal breathing movements. Fetal breathing movements have been observed as early as 11 weeks of gestation. · Identification of more than one embryo or fetus. Comparison of the biparietal diameter of the fetal head, head circumference, abdominal circumference, and femur length to assess growth patterns.

· APGAR-Sign 5 · Score · 0 · 1 · 2

· Heart rate · Absent · Slow—below 100 beats/min · Above 100 beats/min · · Respiratory effort · Absent · Slow—irregular · Good crying · Muscle tone · Flaccid · Some flexion of extremities · Active motion · · Reflex irritability · None · Grimace · Vigorous cry · · Color · Pale blue · Body pink, blue extremities · Completely pink

APGAR

· Heart rate is auscultated or palpated at the junction of the umbilical cord and skin. This is the most important assessment. A newborn heart rate of less than 100 beats/min indicates the need for immediate resuscitation. · Respiratory effort is the second most important Apgar assessment. Complete absence of respirations is termed apnea. A vigorous cry indicates adequate respirations. · Muscle tone is determined by evaluating the degree of flexion and resistance to straightening of the extremities. A normal newborn's elbows and hips are flexed, with the knees positioned up toward the abdomen. · Reflex irritability is evaluated by stroking the baby's back along the spine or by flicking the soles of the feet. A cry merits a full score of 2. A grimace is given 1 point, and no response is scored as 0. · Skin color is inspected for cyanosis and pallor. Generally, newborns have blue extremities with a pink body, which merits a score of 1.

The advantages of the NST include the following: 3 The disadvantages of the NST include the following: 2

· It is quick to perform, permits easy interpretation, and is inexpensive. · It can be done in an office or clinic setting. · It is a noninvasive procedure. · There are no known side effects. · It is sometimes difficult to obtain a suitable tracing. · The woman has to remain relatively still for at least 20 minutes.

However, with increased downward pressure of the presenting part, the woman may notice the following: 5

· Leg cramps or pains caused by pressure on the nerves that course through the obturator foramen in the pelvis · Increased pelvic pressure · Increased urinary frequency · Increased venous stasis, leading to edema in the lower extremities · Increased vaginal secretions resulting from congestion of the vaginal mucous membranes.

Postpartum blues 5

· Mood swings · Feeling sad · Feeling anxious or overwhelmed · Crying spells for no reason · Decreased appetite · Problems sleeping · May occur in the first days following birth; usually resolves without treatment within 3 to 14 days

During her prenatal visits, the mother is instructed to call her HCP if any of the following occur: 4

· Rupture of membranes · Regular, frequent uterine contractions (nulliparas, 5 minutes apart for 1 hour; multiparas, 6 to 8 minutes apart for 1 hour) · Any vaginal bleeding · Decreased fetal movement.

Peripartum depression 3

· Severe depression that occurs during pregnancy or within the first year of giving birth, with increased incidence at about the fourth week postpartum, just before menses resumes, and upon weaning · Antidepressants may be prescribed cautiously following a risk-benefit analysis with the individual patient based on patient clinical characteristics and personal history. · Support groups · Assistance with care of the newborn, taking care to promote self-confidence in mothering · Mental health counseling · Assistance with building self-esteem and self-confidence in mothering skills

active acquired immunity passive acquired immunity

· When the pregnant woman forms antibodies in response to illness or immunization, this process is called active-acquired immunity. When IgG antibodies are transferred from the pregnant woman to the fetus in utero, passive-acquired immunity results because the fetus does not produce the antibodies.

meconium pseudomestruation

· meconium (their first stool) within 8 to 24 hours of life and almost always within 48 hours. Meconium is formed in utero from the amniotic fluid and its constituents, intestinal secretions, and shed mucosal cells. It is recognized by its thick, tarry-black or dark green appearance · . Blood or whitish discharge may occasionally be observed on the diapers of female newborns; this pseudomenstruation is related to the withdrawal of maternal hormones. Males who are circumcised may have bloody spotting following the procedure. In the absence of apparent causes for bleeding, the HCP should be notified

- With the possible exception of the first 24 hours after birth,

· the woman should be afebrile during the postpartum period. A maternal temperature of up to 38°C (100.4°F) may occur after childbirth as a result of the exertion and dehydration of labor. An increase in temperature to between 37.8 and 39°C (100 and 102.2°F) may also occur during the first 24 hours after the mother's milk comes in

WHAT IS a Reactivity?- NST

•An increase of 15 BPM above baseline for 15 second duration (from baseline to baseline) twice in a 20-minute period - fetuses 32 weeks or greater •Premature fetuses often do not meet criteria for reactivity. Less than 32 weeks, presence of 10 X 10 •Reactivity (a term used in antenatal testing) interchangeably with reassuring •If not reactive reposition-left side, perfusion, have anything eat or drink

Variability

•Fluctuations in the baseline •Grades of fluctuation are based on amplitude range (peak to trough): •Absent = undetectable •Minimal = 5 or less BPM •Moderate = 6-26 BPM •Marked = > 25 BMP

normal baseline rate

•Normal fetal heartrate (110-160 bpm)

HELLP syndrome

- Accompanying severe epigastric pain may indicate hepatic involvement, which is commonly associated with HELLP syndrome. The characteristics of HELLP are hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP).

- Amniotomy: - Induction of labor methods: - Episiotomy: - Prolapsed cord: - Meconium stained amniotic fluid:

- Amniotomy: artificial rupture by the provider using a hook or clamp; labor typically begins in 12 hours - Induction of labor methods: mechanical or chemical approaches, adm IVoxytocin, nipple stimulation - Episiotomy: is an incision made into the perineum to enlarge the vaginal opening - Prolapsed cord: when the umbilical cord is displaced preceding the part of the fetus; notify dr., reposistion, apply two fingers into the vagina apply finger pressure on either side of the cord and do not move your hand until you are in OR; medical emergency - Meconium stained amniotic fluid: meconium passage of the amniotic fluid, amniotic fluid is green or black - Newborn stool: First stool (meconium within 8-24 hours of life) - Transitional (thin brown to green)

hall mark manifestation in CF pt sweat test

- An increased level of chloride in the sweat is a hallmark manifestation and is one basis for diagnosis of CF. As a result of increased mucus viscosity, clinical manifestations of CF also commonly include respiratory problems, such as a chronic cough and susceptibility to infection. - The sweat test, which is typically administered twice, measures the amount of salt in the baby's sweat and is most effective for a CF diagnosis; a high level of salt confirms the diagnosis

- Magnesium sulfate: - Betamethasone:

- Magnesium sulfate: meds choice for prophylaxis or treatment to prevent seizures who has eclampsia or severe preeclampsia and relax smooth muscle inhibit uterine activity suppressing contractions; mag toxicity: absence of patellar deep tendon reflexes, output less than 30, respiration 12; toxicity administer calcium gluconate - Betamethasone: glucocorticoid administered IM in two injections, 24 hour apart, requires to be effective. Enhance fetal lung maturity.

tests during pregnancy 3

- RPR: syphilis - Group B strep 38 wks vaginal swab, positive need antibiotic when delivery can cause blindness, infection, sepsis - Varicella/rubella cannot receive when pregnant because of live virus

Signs and symptoms of impending labor include 5

lightening(Lightening describes the effects that occur when the fetus begins to settle into the pelvic inlet (engagement)), Braxton Hicks contractions (irregular, intermittent contractions that occur throughout a pregnancy), changes to the cervix (This softening of the cervix is called ripening.), -Misoprostol,cervedil bloody show (cervical secretions accumulate in the cervical canal to form a barrier called a mucus plug. With softening and effacement of the cervix, the mucus plug is often expelled, resulting in a small amount of blood loss from the exposed cervical capillaries. The resulting pink-tinged secretions are called bloody show.), membrane rupture(amniotic membranes rupture before the onset of labor. After membranes rupture, 90% of women will experience spontaneous labor within 24 hours/ Spontaneous rupture of membranes (SROM) generally occurs at the height of an intense contraction with a gush of the fluid out of the vagina.), and a sudden burst of energy (Some women report a sudden burst of energy approximately 24 to 48 hours before labor. This often finds expression in nesting behaviors.)

milk production colostrum

- Once the placenta is expelled at birth, progesterone levels fall, and the inhibition is removed, triggering milk production. This occurs whether the mother has breast stimulation or not. If breast stimulation is not occurring by the third or fourth day, however, prolactin levels begin to drop. By 7 to 14 days postpartum, prolactin levels in nonlactating women will be back to pre-pregnancy levels, and milk production will cease - Colostrum is the initial milk that begins to be secreted during midpregnancy and that is immediately available to the baby at birth. It provides the newborn with all the nutrition required until the mother's milk becomes more abundant in a few days.

- Infant reflexes 7

- Sucking and rooting: the infant turns their head toward the side that is touched and starts to suck (birth to 4 months) - Palmar grasp: the infant grasps the object (birth to 4 months) - Plantar grasp: the infant toes curl downward (birth to 8 months) - Moro reflex: infant's arms and legs symmetrically extend then abduct while fingers spread to form a C (birth to 4 months) - Tonic neck reflex: the infant extends arm and legs on that side and flexes the arm and leg on the opposite side (birth to 3 or 4 months) - Babinski reflex: the infant toes fan upward and downward (birth to year) - Stepping reflex: the infant makes stepping movement (birth to 4 weeks)

- Cystic fibrosis (CF) is an 3

- Cystic fibrosis (CF) is an inherited disorder that affects the secretory glands, particularly the glands that are responsible for secreting mucus, digestive enzymes, and sweat. - CF involves cellular entry of too much salt and not enough water. This causes the production of thick, sticky mucus that obstructs ducts and passageways within the body, including the airways - Genetic screening can be done using blood or a saliva sample to assess an individual's carrier status. Genetic screening is recommended for individuals who have a personal or family history of CF.

newborns 5

- Newborns pulse rate: birth to 4 weeks-110-160, infant 1 to 12 months-90 to 160, toddler 1 to 2 years 80 to 140 - Newborns respiration birth to 4 weeks 30 to 60, infant 1 to 12 months 25 to 30 - Head: fontanels should be flat, posterior fontanel usually closes by 8 weeks of age, anterior fontanels usually closes between 12 and 18 months of age - Newborn - 4 weeks BP: 64/41 - Infant 1 month to 12 months: 85/50 - Breasts newborns: breasts enlarged during first few days

sutures fontanels effacement

- The sutures of the fetal skull are membranous spaces between the cranial bones. The intersections of these sutures are called fontanels. Cranial sutures allow molding of the fetal head during birth and help the clinician to identify the position of the fetal head during vaginal examination. - . Effacement is thinning of the cervix as it is drawn upward into the uterine side walls. The cervix changes progressively from a long, thick structure to a structure that is tissue-paper thin

involution uterine atony

- The term involution describes the rapid reduction in size of the uterus and the return of the uterus to a nonpregnant state. - A fundus that is above the umbilicus and is boggy (feels soft and spongy rather than firm and well contracted) is associated with excessive uterine bleeding. As blood collects and forms clots within the uterus, the fundus rises, interrupting firm contractions of the uterus and exacerbating uterine atony

Each day, people with CF complete a combination of the following therapies: 4

Airway clearance to help loosen and get rid of the thick mucus that can build up in the lungs. Inhaled medicines to open the airways or thin the mucus. These are liquid medicines that are made into a mist or aerosol and then inhaled through a nebulizer and include antibiotics to fight lung infections and therapies to help keep the airways clear. Pancreatic enzyme supplement capsules to improve the absorption of vital nutrients. These supplements are taken with every meal and most snacks. People with CF also usually take multivitamins. An individualized fitness plan to help improve energy, lung function, and overall health CFTR modulators to target the underlying defect in the CFTR protein. Because different mutations cause different defects in the protein, the medications that have been developed so far are effective only in people with specific mutations.

Milia Telangiectatic nevi (stork bites) Congenital dermal melanocytosis Nevus flammeus (port-wine stain) . Nevus vasculosus (strawberry mark) Epstein pearls Thrush

Milia (exposed sebaceous glands) appear as raised white spots on the face, especially across the nose Telangiectatic nevi (stork bites) appear as pale pink or red spots and are frequently found on the eyelids, nose, lower occipital bone, and nape of the neck. Congenital dermal melanocytosis, sometimes referred to in the literature as Mongolian spots, refers to bluish-black or gray-blue pigmentation on the dorsal area and the buttocks Nevus flammeus (port-wine stain) is a capillary angioma directly below the epidermis. It is a nonelevated, sharply demarcated, red-to-purple area of dense capillaries. In newborns of African descent, it may appear as a purple-black stain. . Nevus vasculosus (strawberry mark) is a capillary hemangioma. It consists of newly formed and enlarged capillaries in the dermal and subdermal layers. Epstein pearls (small, glistening, white specks [keratin-containing cysts] that feel hard to the touch) are often present. They usually disappear in a few weeks and are of no significance. Thrush may appear as white patches that look like milk curds adhering to the mucous membranes, and bleeding may occur when patches are removed.