ATI Maternal Newborn Practice B Remediation PDF

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Remediation questions and answers for ATI practice B for maternal newborn....

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ATI Maternal Newborn Practice B Remediation Health Promotion and Maintenance Expected Physiological Changes During Pregnancy: Estimating Date of Birth Using Nägele's Rule (Active Learning Template - Basic Concept) When estimating the birth date of a newborn, Nagele’s rule can be used to approximately when the child will be born. To use this rule, take the first day of the last menstrual cycle of the patient, subtract three months, then add 7 days and 1 year. Take the number of days in each month into consideration. This will give a rough approximation as to when the baby is expected to be delivered. For example, if the start of the patient’s last menstrual cycle was on September 9th, the estimated due date would be June 16th. Nursing Care and Discharge Teaching: Teaching About Newborn Home Safety (Active Learning Template - Basic Concept) The nurse should instruct parents that the newborn should never be left alone with pets or other young children, or alone on a bed, couch, or table. Small objects should be left out of reach of newborns as they could easily choke. Newborns should sleep on a firm mattress lying on their backs the first few months of life and should not have pillows, toys, bumper pads, or loose blankets in the crib with them. There should not be more than 2 fingerbreadths between the mattress and the side of the crib. The crib should be placed away from the window to prevent radiation heat loss and should be kept away from heaters, radiators, and heat vents to prevent potential fires or hyperthermia. Nothing should be places around the newborns neck to prevent choking. Newborns should be kept away from cigarette smoke as secondhand inhalation can increase the potential for respiratory distress or illness. All visitors should be instructed to wash their hands before caring for the newborn to prevent spread of bacteria. The newborn should not be shaken, thrown up in the air or swung by their extremities. Pharmacological and Parenteral Therapies Medications Affecting Labor and Delivery: Evaluating Client Understanding About Terbutaline (Active Learning Template - Medication) Terbutaline is a Tocolytic that can be given to relax the smooth muscles of the uterus. This can be given to delay labor for up to 24 hours but not to prevent preterm labor. This medication can cause tachycardia, palpitations, chest pain, hypotension, hypokalemia, and hyperglycemia in the mother as well as tachycardia in the fetus. This medication should not be given in those with hepatic or renal diseases. Terbutaline can interact with MAOI, green teas and beta-blockers. Reduction of Risk Potential Assessment of Fetal Well-Being: Diagnostic Testing Following a Positive Contraction Stress Test (Active Learning Template - Therapeutic Procedure) Contraction stress tests are performed to evaluate how the FHR responds to contractions to determine how the fetus can handle the stress of labor. Nipple-stimulating and oxytocinstimulating tests can be performed.

Normally, this test should produce a negative result. This would mean that within a 10-minute period and three uterine contractions, there are no late decelerations of the FHR. If a positive result is produced, late decelerations are present in 50% or more of contractions suggesting uteroplacental insufficiency. Variable decelerations can be indicative of cord compression and early can be indicative of head compression. Labor may be induced or a cesarean me be performed. Fetal Assessment During Labor: Indications for Fetal Assessment Using Fetal Monitoring (Active Learning Template - Diagnostic Procedure) Continuous electrical fetal monitoring: used by securing an ultrasound transducer over the mother’s abdomen. Indications for the use of this device can include multiple gestations, oxytocin infusion, placenta previa, fetal bradycardia, maternal complications, intrauterine growth restrictions, post-date gestation, active labor, meconium-stained amniotic fluid, placental abruption, abnormal stress test results, abnormal contractions, or fetal distress. Continuous internal fetal monitoring: can be placed in the patient’s uterine cavity to monitor frequency, duration and intensity of contractions. Some indications of the use of this device can include early detection of abnormal FHR and an accurate assessment of variabilities, accurate measurements of uterine contractions, and this test allows for greater maternal movement while testing. Physiological Adaptation Fetal Assessment During Labor: Evaluating Interventions for a Client Who Has a Placenta Previa (Active Learning Template - System Disorder) Placental previa happens when the placenta abnormally implants to the lower portion of the uterus closer to the cervix than normal. This can result in bleeding during the third trimester as the mother gets closer to delivery. Complete placenta previa is when the cervix is completely covered by the placenta, incomplete is when the placenta partially covers the cervix, and marginal is when the placenta is not covering the cervix but is still lower than normal. Some findings that can be expected from placenta previa can include bright red vaginal bleeding, nontender uterus, greater than expected fundal height, abnormal fetal positioning, decreased urinary output (can be caused by bleeding). Laboratory tests should include H&H, CBC, blood type an Rh, coagulation studies, and KleihauerBetke test to detect fetal blood in maternal circulation. Diagnostics can include transabdominal or transvaginal ultrasound and fetal monitoring. Nurses should assess for s/s of bleeding, leakage or contractions, assess fundal height, and administer IV fluids, blood products or oxygen as needed. Nurses should not perform vaginal exams if placental previa is suspected as this can cause additional bleeding. The nurse should teach the patient to stay in bed as much as possible and to not insert anything into the vagina to prevent bleeding. Postpartum Disorders: Priority Intervention for a Client Experiencing Hypovolemic Shock (Active Learning Template - System Disorder) Hypovolemic shock can occur as a result of hemorrhage in postpartum women and is considered a medical emergency. Prompt treatment is necessary to prevent severe

complications. Treatment should be focused on restoring blood volume and eliminating the cause of hemorrhage. IV fluids and blood products can be administered to increase the patient’s circulating blood volume. Oxygen can also be administered to ensure adequate oxygen saturation and perfusion. Complications Related to the Labor Process: Priority Action to Take for a Protruding Umbilical Cord (Active Learning Template - Basic Concept) Prolapsed umbilical cord occurs when the cord is displaced and protrudes through the cervix before the fetus. When this occurs, visualization of the umbilical cord, FHR monitoring showing variable or prolonged decelerations, and excessive fetal movement followed by stillness (hypoxia) will be apparent. If this occurs, the nurse should not leave the patient and should call for assistance. The nurse should apply sterile gloves and insert them into the patient’s vagina to life the fetus’ head off of the cord. The patient should reposition to a knee-to-chest position with a rolled towel under either hip. A warm, sterile, saline-soaked towel should be placed on the cord to prevent drying. Continuous FHR monitoring should be initiated to monitor for decelerations. Oxygen should be administered at 8-10 l/min via facemask. IV fluids should be pushed. If the cervix is fully dilated, the patient should be prepared for an immediate vaginal birth.

Resources: Assessment Technologies Institute, LLC. (2014). Pn Maternal newborn nursing, Edition 9.0: Content mastery series review module.

E., H. N. J., McMichael, M., Johnson, J., DiStasi, A., Ball, B. S., Holman, H. C., … Kongable, L. (2016). Fundamentals for nursing: review module. ATI Nursing is a division of Assessment Technologies Institute....