ATI Maternal Newborn Focused Study guide PDF

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ATI Maternal Newborn Focused Study Guide 1. Assessment and Management of Newborn Complications: findings to report Substance Withdrawal  High-pitched cry, shrill cry; incessant crying; irritability, tremors, disturbed sleep pattern  Hypertonicity, convulsions  Hyperactivity with an increased moro reflex  Increased deep-tendon reflex  Increased muscle tone  Nasal congestion with flaring  Frequent yawning  Skin mottling  Retractions  Apnea  Tachypnea greater than 60/min (RR)  Sweating  Temperature greater than 99  Poor feeding  Regurgitation (projectile vomiting)  Diarrhea  Excessive uncoordinated constant sucking Hypoglycemia: serum glucose less than 40 mg/dl  Hypothermia  Flaccid muscle tone Dehydration  Urine output less than 1 mL/kg/hr  Urine specific gravity > 1.015  Weight loss, dry mucous membranes, absent skin turgor, depressed fontanel Overhydration  Urine output greater than 4 mL/kg/hr  Urine specific gravity less than 1.001  Edema, increased weight gain, crackles in lungs, intake greater than output  Nursing care and discharge teaching: car seat safety Harness should be snug and clip is at axillary level (not across neck or abdomen)  Infections: Treatment for Gonorrhea Administer Erythromycin to all infants following delivery  Ceftriaxone & azithromycin PO**  Report disease to health care department  Assessment of Fetal Well-Being: Contraindications for a Contraction Stress Test Placenta previa  Vasa previa  Preterm labor  Multiple gestations (twins)  Previous classic incision from a cesarean birth  Reduced cervical competence 2. Nutrition During Pregnancy: Educating a Client Who has heartburn  Eat small frequent meals (not allow tummy to get too full or too empty)  Sit up for 30 min after meals  Check provider prior to using OTC antacids

ATI Maternal Newborn Focused Study Guide 3. Contraception: Tubal Ligation)  Menstrual periods? contraception  Baby-Friendly Care: Responding to Clients Concerns About Sibling Adaptation Take sibling on a tour of the OB unit  Encourage parents to let sibling be one of the first to see infant  Provide a gift from the infant to give to sibling  Arrange for one parent to spend time with the sibling while the other parent is caring for the infant  Allow older siblings to help in providing care for the infant  Provide preschool aged siblings with a doll to care for  Medical Conditions: Laboratory Values to Report Hgb less than 11 mg/dl in 1st and 3rd trimester  Hgb less than 10.5 in 2nd trimester  Hct less than 3%  Positive blood glucose: 130/140 mg/dl or greater  BP greater than 140/90 or greater recorded on two different occasions at least 4 hours apart  Report proteinuria (gestational hypertension): mild +1; severe +3 & 160/110  Serum creatinine than 1.1 mg/dl  Platelet less than 100,000 4. Assessment of Fetal well-being: Complications Associated with an amniocentesis  Amniotic fluid emboli  Maternal or fetal hemorrhage  Fetomaternal hemorrhage with Rh isoimmunization  Maternal or fetal infection  Inadvertent fetal damage or anomalies involving limbs  Fetal death  Inadvertent maternal intestinal or bladder damage  Miscarriage or preterm labor  Premature rupture of membranes  Leakage of amniotic fluid 5. Newborn Assessment: Perform Focused Assessment of Newborn  6. Newborn Assessment: Perform Focused Assessment of Newborn

Apgar score 0-3 severe distress 4-6 moderate difficulty 7-10 minimal to no difficulty  Measure head circumference at greatest diameter (occipital to frontal): 32 to 37 cm  Measure chest circumference beginning at nipple line: 30 to 33 cm

ATI Maternal Newborn Focused Study Guide                                     

Measure abdominal circumference above umbilicus: Weight 2500 to 4000; LBW under 2500 g Term 37-42 weeks Length: 45 to 55 cm One vein, 2arteries Moro reflex New Ballard scale: assesses neuromuscular and physical maturity RR: 30-60 Heart rate 110-160 (AP assessed for full minute) BP: 60 to 80 systolic & 40 to 50 diastolic 60/40 or 80/50 Temperature 97.7 to 99.5F axillary Under 97.7F can cause acidosis to occur Milia: small raised white spots on nose, chin and forehead (disappear without treatment) Mongolian spots: parents are aware and document (normal) Telangiectatic nevi (stork bites): flat pink or red marks on back neck, nose, upper eyelids, middle of forehead (fade by 2nd year of life) Nervus flammeus: purple or red (does not blanch or disappear) Erythema toxicum: pink rash appears on body during first 3 weeks (no treatment necessary) Head should be 2 to 3 cm larger than chest circumference (4cm+ indicates hydrocephalus); head circumference less than or equal to 32 cm indicates microcephaly Caput succedaneum: swelling of soft tissues of scalp form pressure on head during labor: resolves in 3 to 4 days Anterior fontanel should be palpated and 5cm on average and diamond shape Posterior fontanel is smaller and triangle shaped Fontanels should be soft and flat Fontanels can bulge when newborn cries, coughs or vomits, but flat when quiet Bulging fontanels = ICP, infection or hemorrhage Depressed fontanels = dehydration Sutures should be palpable, separated and can be overlapping (molding: from head compression during labor) Eyes are usually blue or gray following birth Pupillary and red flex are present; eyeball mvmt will demonstrate random, jerky movements Ears: inner to other canthus of newborn eyes. Should be even; ears that are low set = down syndrome Nose: mucus present , but no drainage; obligate nose breathers Mouth: saliva should be scant; excessive saliva indicates tracheoesophageal fistula Epstein’s pearls: small white cysts found on the gums and at junction of soft and hard palates is normal Protruding tongue = down syndrome Gray-white patches on tongue and gums indicate thrush Neck: short, thick, skin folds and NO webbing Absence of head control indicate prematurity or down syndrome Chest: barrel-shaped, respirations are primarily diaphragmatic, clavicle intact

ATI Maternal Newborn Focused Study Guide Breast nodules can be 3 to 10 mm Bowel sounds present 1 to 2 hours following birth Vaginal blood tinged discharge in female newborn is normal (from maternal pregnancy hormones)  Urine should be passed within 24 hours after birth  Uric acid crystals will produce rust color in urine in first couple days of life  NO click when abducting hips  Gluteal fold should be symmetrical  Spine: straight, flat, midline and easily flexed  Sucking and rooting reflex: 3/4months to 1 year  Palmar grasp: lessons by 4 months  Plantar grasp: birth to 8 months  Moro reflex: birth to 6 monthshold newborn in a semi-sitting position then allow head and trunk to fall backward  Tonic neck reflex: birth to 4 months  Stepping: birth to 4 weeks  Newborn focuses objects 8 to 12 inches away from face  Eyes sensitive to light: prefer dim light  2-3 months they can discriminate colors  newborn turn toward general direction of sound startle relflex: make loud noise above infant’s head  Newborn prefer sweet (can recognize mom’s smell)  Hgb: 14 to 24  Plateletes: 150-300,000  Hct: 44-64%  Glucose 40 to 60  RBC count: 4.8 to 7,000,000  Bilirubin: 24 hours 2 to 648 hours: 6 to 73 to 5 days: 4 to 6  Leukocytes: 9,000 to 30,000  Respiratory distress: grunting & nasal flaring  Infection in lungs: crackles and wheezing  Extrauterine life: inspiratory nasal flaring, apnea for 10 second periods 7. Assessment and Management of Newborn Complications: Phototherapy for hyperbilirubinemia Risk factors:  Increased RBC production or breakdown  Rh or ABO incompatibility  Decreased liver function  Oxytocin during labor  Maternal ingestion of diazepam, salicylates or sulfonamides close to birth  Maternal diabetes  Neonatal hyperthyroidism  Ecchymosis or hemangioma  Prematurity Lab tests:  Monitor bilirubuin every 4 hours until level returns to normal***  Assess maternal newborn and newborn blood type to determine whether there is ABO incompatibility. This occurs if newborn has blood type A or B, and mother is type O  Review Hgb and Hct   

ATI Maternal Newborn Focused Study Guide A direct Coomb’s test reveals the presence of antibody coated (sensitized) Rh-positive RBCs in newborn  Check electrolyte levels for dehydration from phototherapy ● Nursing Care: Obs e r v et h es ki na n dmu c o u sme mb r a n e sf orj a u n di c e .Mo ni t orv i t a ls i g ns . Se tu p p h o t o t h e r a p yi fpr e s c r i be d .◯ Ma i n t a i na ne y ema s ko v e rt h en e wb o r n ’ se y e sf orp r o t e c t i o no fc o r ne a sa nd r e t i n a s .◯ Ke e pt h en e wbo r nu n d r e s s e d .Fo rama l en e wb or n ,as u r g i c a lma s ks ho u l db ep l a c e d( l i k eabi ki n i ) o v e rt h eg e ni t a l i at op r e v e ntpo s s i b l et e s t i c u l a rd a ma g ef r omh e a ta ndl i g h twa v e s .Bes ur et or e mo v et h eme t a l ◯ s t r i pf r o mt h ema s kt opr e v e n tb u r n i n g . Av o i da pp l yi n gl o t i o n so ro i n t me n t st ot h es ki nb e c a u s et he ya b s o r b h e a ta n dc a nc a u s ebu r n s .◯ Re mo v et hen e wb o r nf r o mp h o t o t he r a p ye v e r y4h r ,a ndu n ma s kt h en e wb or n ’ s ◯ e y e s ,c h e c ki n gf o ri n fla mma t i o no ri n j u r y R .e p o s i t i o nt hene wb or ne v e r y2h rt oe x p o s ea l lo ft heb o d y ◯C s u r f a c e st ot h ep h o t o t h e r a p yl i g h t sa n dp r e v e n tpr e s s u r es o r e s . h e c kt h el a mpe n e r g ywi t hap h o t o me t e rp e r ● ◯ f a c i l i t yp r o t o c o l .T ur not h ep h o t o t h e r a p yl i g h t sb e f o r ed r a wi n gb l o odf o rt e s t i n g .Ob s e r v et h en e wbo r nf o r ◯ ◯ Ma e ffe c t so fp h o t o t h e r a p y . Br o n z ed i s c o l o r a t i o n :n o tas e r i ou sc omp l i c a t i on c u l op a p u l a rs ki nr a s h :n o ta ◯D s e r i o usc o mpl i c a t i o n◯ De v e l o p me n to fp r e s s u r ea r e a s e h y d r a t i on :p o o rs ki nt u r g or , d r ymuc o u sme mb r a ne s , ◯ ● d e c r e a s e dur i n a r yo u t p u t El e v a t e dt e mp e r a t ur e En c o u r a g et h ep a r e n t st oh o l da n di n t e r a c twi t ht h en e wbo r n ● wh e np ho t o t he r a p yl i g h t sa r eo ff . Mo n i t o re l i mi n a t i ona n dd a i l ywe i g h t s , wa t c h i n gf o re v i de n c eo f ● C d e h y d r a t i o n . h e c kt h en e wbo r n ’ sa x i l l a r yt e mp e r a t u r ee v e r y4h rd u r i n gph o t o t h e r a p yb e c a us et e mp e r a t ur e ● c a nb e c omee l e v a t e d . Fe e dt h en e wb or ne a r l ya n df r e q u e nt l y ,e v e r y3t o4h r . Th i swi l lp r o mo t eb i l i r u b i n e x c r e t i oni nt h es t o ol s .● En c o u r a g ec o n t i n u e db r e a s t f e e d i n go ft hen e wb o r n .Su p p l e me n t a t i o nwi t hf o r mu l a ● ● ma ybep r e s c r i be d .Ma i n t a i na d e q u a t eflu i di nt a k et op r e v e n td e h y d r a t i o n . Re a s s u r et h ep a r e n t st ha tmo s t n e wbo r n se x p e r i e n c es o med e gr e eo fj a u n di c e .● Ex p l a i nh y p e r b i l i r ub i ne mi a , i t sc a u s e s ,d i a g n o s t i ct e s t s ,a n d ● ● t r e a t me n tt op a r e n t s . Ex p l a i nt h a tt h ene wbo r n ’ ss t o olc o n t a i n ss o meb i l et ha twi l lb el o o s ea n dgr e e n . Admi n i s t e ra ne x c h a n g et r a n s f u s i o nf o rn e wb or n swh oa r ea tr i s kf ork e r n i c t e r u s .  Phot o t he r a p y :t h ene wb o r n ’ sbi l i r u bi ns h ou ds t a r tt ode c r e a s ewi t hi n4t o6h ou r sa f t e rt r e a t me nt 

8. Medical Conditions: Caring for a client who has hyperemesis Gravidarum  ● Monitor I&O.  ● Assess skin turgor and mucous membranes.  ● Monitor vital signs.  ● Monitor weight.  ● Have the client remain NPO for 24 to 48 hr.  ● Give the client IV lactated Ringer’s for hydration.  ● Give pyridoxine (vitamin B6) and other vitamin supplements as tolerated. American Congress of Obstetricians and Gynecologists recommend the use of pyridoxine alone or in combination with doxylamine as the initial medication management because these medications are considered both safe and effective.  ● Use antiemetic medications (ondansetron, metoclopramide) cautiously for uncontrollable nausea and vomiting.  ● Use corticosteroids to treat refractory hyperemesis gravidarum.  Advance the client to clear liquids after 24 hr if no vomiting.  Advance the client’s diet as tolerated, with frequent small meals. Start with dry toast, crackers, or cereal; then move to a soft diet; and nally to a normal diet as tolerated.  In severe cases, or if vomiting returns, enteral nutrition per feeding tube or total parental nutrition can be considered.  Prenatal Care: Auscultating for Fetal Heart Rate

ATI Maternal Newborn Focused Study Guide Therapeutic Procedures to Assist with Labor and Delivery: Indications for Amnioinfusion 9. Contraception: Client Teaching About Birth Control Methods  Diaphragm (putting in order for placement of a diaphragm) A client should be properly fitted with a diaphragm by a provider. Replaced every 2 years and refitted for a 20% weight fluctuation, after abdominal or pelvic surgery, and after every pregnancy. Requires proper insertion and removal. Prior to coitus, the diaphragm is inserted vaginally over the cervix with spermicidal jelly or cream that is applied to the cervical side of the dome and around the rim. The diaphragm can be inserted up to 6 hr before intercourse and must stayin place 6 hr after intercourse but for no more than 24 hr. Spermicide must be reapplied with each act of coitus. A client should empty her bladder prior to insertion of the diaphragm. Diaphragm should be washed with mild soap and warm water after each use 

Getting Your Diaphragm Ready Before you put the diaphragm in your vagina, put about one tablespoon of spermicidal gel or cream in the cup (see picture below). Smear some of the gel around the rim of the diaphragm. Do not use petroleum jelly or oil-based vaginal creams (such as Monistat). These can make tiny holes in the diaphragm.

Inserting Your Diaphragm You can put your diaphragm in while you are lying down, squatting, or standing with one leg up on a chair. Your legs need to be fairly wide open. Bending your knees can help. Once you're in position, follow these steps:  Use one hand to fold the diaphragm in half with the dome pointing down (see picture below). Hold your vagina open with your other hand.  Put the diaphragm into your vagina, aiming for your tailbone (see picture below). Push the diaphragm as far back into your vagina as you can.  Use one finger to push the front rim of the diaphragm up behind your pubic bone, aiming for your belly button.

Checking Placement of Your Diaphragm With your finger, feel for your cervix through the dome of the diaphragm. The cervix will feel firm, but not bony. It feels a bit like the tip of your nose. If the diaphragm does not cover your cervix or if you cannot feel your cervix at all, the dome is not in the right place. This means that you need to remove the diaphragm, put more spermicidal gel on it, and insert it again. The diaphragm should not fall out when you cough, squat down, sit on the toilet, or walk around. If your diaphragm stays in place when you do these things, the front rim is most likely in the right place above the pubic bone (see picture below).

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Contraception: Counseling About Sterilization

ATI Maternal Newborn Focused Study Guide Contraception: Tubal Ligation Pain Management: Monitoring a Client Following a Pudendal Nerve Block 11.Expected Physiological Changes During Pregnancy: Reportable Laboratory Findings 12.Nursing Care and Discharge Teaching: Education for Plastibell Circumcision 13.Medical Conditions: Evaluation of Third Trimester Complications 14. Pain Management: Intervention for Hypotension Following Epidural Placement  15. Complications Related to the Labor Process: Nursing Action for Shoulder Dystocia __________________________________________________________________________________  

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Prenatal care: Rubella Titer Determines immunity to Rubella (test after 3 months for Rubella immunity) AssessmentandManagementofNewbor nCompl i cat i ons:Cocai neUseDi sor der

Medical Conditions: Caring for a client who has severe preeclampsia  Assess vital signs & Assess for presence of edema on face, fingers and upper extremities  Pad railing  Check blood pressure (avoid talking to patient)  Administer medications per order  Check deep tendon reflex (Homan’s reflex)  Dim the room  Perform NST and daily kick counts  Encourage bed rest and lateral positioning  Promote diversional activities: e.g., T, visit from friends and family, gentle exercise  Avoid foods high in sodium; avoid alcohol & limit caffeine  Drink 6-8 8 ounce glasses of water a day

ATI Maternal Newborn Focused Study Guide  

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Bleeding during pregnancy: Client teaching for ectopic pregnancy  Avoid alcohol and folic acid with methotrexate (toxic  Advise to protect herself from sun exposure  STD Early       

onset of labor: teaching regarding terbutaline “This medication will stop my contraction Limit physical activity to conserve strength Increase iron and protein intake to promote the rebuilding of RBC volume Notify provider if tachycardia, palpitations, chest pain, hypotension (less than 90/60), heart rate greater than 120/130/min, chest pain, pulmonary edema, cardiac arrhythmias Avoid beta blockers Terbutaline is administered SUB-Q Notify provider if contractions persist or increase in frequency or duration

Assessment and Management of Newborn Complications: Clinical Manifestations of a Macrosomic Newborn  Crease on one hand  “Your baby will have excess body fat”  Weight above 90th percentile (4,000 g; 8 lb, 13oz)  Shoulder dystocia, clavicle fracture, asphyxia (body deprived of oxygen)  Polycythemia (high RBCs causing blood to be too thick)  Erb-Duchenne paralysis d/t birth trauma  Large head: plump full faced (cushiongoid appearance); increased sub-q fat

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**Hypoxia including tachypnea (RR 60+), retractions, cyanosis, nasal flaring, grunting Sluggishness, hypotonic muscles, and hypoactivity Tremors form hypocalcemia Hypoglycemia: Blood glucose drops to 30 mg/dl the first 1 to 2 hours following birth (less than 40 mg/dl) Respiratory distress form immature lungs or meconium aspiration

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