ATI Maternity - Summary Maternal & Newborn Nursing Lab PDF

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ATI MATERNITY Intro, Chap 1, Chap 2  Know that a pt must be refitted by the provider q2yrs for a diaphragm OR if they've gained >15lb (7kg) OR if they've had a full term pregnancy/2nd term abortion  When using a diaphragm, spermicide must be used for EACH act of coitus  Diaphragm must remain in place 6h after coitus (intercourse)  When using a hormonal method of contraception the S/E are chest pain, SOB, leg pain (possible clot), HA, eye problem, stroke, HTN  Hormonal contraception  blood clots!  If pt is a smoker, do not use hormonal oral contraceptive!  CONTRAINDICATION (oral pill): hx of blood clot/stroke/cardiac problem, breast/estrogen related cancers, smoker  Depo-Provera = injectable progestin o Can cause bone mineral density/loss of calcium o Make sure to have adequate Ca/vit D intake!  IUD can risk of pelvic inflammatory disease/uterine perforation/ectopic pregnancy o Monitor for change in string length (indicates IUD dislocation), foul-smelling vaginal discharge, pain with intercourse, fever, chills  Infertility = inability to conceive for at least 12mo o Sperm analysis (cost-effective; check men first) o Any test requiring dye in fallopian tube, make sure that the pt has no allergy to iodine/seafood Chap 3  Signs of Pregnancy (KNOW PRESUMPTIVE/POSITIVE; everything else probable) o Presumptive (signs can be explained other than pregnancy)  Amenorrhea, fatigue, cant sleep well, N/V, urinary frequency, breast changes, quickening o Probable  Abdominal enlargement, Hegar sign (softening/compressibility of uterus), Chadwick’s (bluish color of cervix), Goddell’s (softening of cervical tip), Bolutment (rebound of unengaged fetus), Braxton Hicks, + pregnancy test (HcG), fetal outline felt by examiner o Positive (no doubt; can feel/hear baby)  Fetal HR, US, can feel movement in uterus  Nagel’s Rule o Estimates due date based on LMP o EDD = LMP + 9mo + 1wk  GTPAL o G = gravidity (# of times pregnant; incl. current pregnancy) o T = term (# of term births; >38wks) o P = pre-term (# of preterm births; 130/140  OGTT (oral glucose tolerance test; requires fasting over night; no cafffeine/smoking; will take fasting glucose level, 100g oral glucose given, then test BS levels at 1h, 2h, 3h) Gestational HTN (NEED TO KNOW!) o CAUSE = vasospasm  poor tissue perfusion o After 20th week of pregnancy, if BP >140/90 recorded at least twice 4-6h apart, within 1wk = + Gestational HTN o No protein in urine Mild Pre-eclampsia o Same BP issue as Gestational HTN o +1 proteinuria Severe pre-eclampsia o BP > 160/100 o +3 proteinuria o >1.2 creatinine levels o HA, blurred vision, hyperreflexia, peripheral edema, epigastric pain Eclampsia o Severe pre-eclampsia + SEIZURES! o MEDS  Anti-convulsant (Magnesium Sulfate -prevents seizure)  Monitor for magnesium toxicity o S/S = reflex, urine output, RR, LOC, dysrhythmia o Antedote = calcium gluconate HELLP Syndrome o Hemolysis  anemia o Elevated liver enzymes (ALT, AST) o Low platelet suppress uterine contraction)  Betamethasone (steroid; help promote fetal lung maturity; “-sone”= steroid)

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After 37wks = full term labor PROM o Major cause of infx (esp if >24h since ROM and baby born) o Nitrazine paper test (blue = amniotic fluid; ROM not urine) o Ferning test (+ = ROM) o Placed on abx (infx = cause of PROM) o Betamethasone Changes that occur preceding labor o Back ache, slight weight loss 1-3lb, lightening (fetal head descends to true pelvis; feels like fetus dropped), contractions (in strength and regular), bloody show, energy burst, GI changes (N/V, indigestion), ROM o LABS  Group B Strep Test (if not performed at 36-37wks)  Urinalysis (check proteinuria, infx) Stages of Labor (NEED TO KNOW!) 1. Onset of labor  complete dilation of cervix (10cm) 1) Latent phase  0-3cm  mother is talkative, eager 2) Active phase  >3cm – 7cm  mother is restless, anxious, feelings of helplessness 3) Transition phase  >7cm – 10cm  mother has urge to push, rectal pressure 2. Fully dilated  birth of baby 3. Birth of baby  delivery of placenta 4. Delivery of placenta  mother’s VS returns to normal

Chap 12, 13, 16, 17  Non-pharmacological pain management o Eflourage (light, gentle circular stroking of client’s abdomen) o Sacral counter pressure (using heal of fist to push against sacral area to counteract back pain)  If patient gets sedative/opioid analgesic  risk of respiratory depression of newborn  Opioid analgesic  sedation, hypotension,variability of fetal HR  Epidural = lack of sensation at level at umbilicus to thighs o Need to be dilated >4cm o S/E = maternal hypotension, fetal bradycardia o Give IV fluid bolus to counteract maternal hypotension o Monitor for supine hypotension syndrome (d/t suppression of vena cava from lying flat on back  ensure that mother is not lying flat on back)  Spinal block = lack of sensation from nipples to feet o Used for C-section o S/E = maternal hypotension, fetal bradycardia, potential HA (d/t CSF leak)

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o Higher incidence of bladder/uterine atony Norm fetal HR = 110-160/min o Want moderate variability!  Accelerations = ok  Early decelerations = compression of fetal head during contraction = ok  Late decelerations = uterine placental insufficiency = lack of fetal oxygenation = bad!  1st place mother into side-lying position, increase fluids, D/C oxytocin, administer oxygen  Variable deceleration = umbilical cord compression  Reposition client (side-to-side, knee-chest), D/C oxytocin, administer oxygen  fetal bradycardia (d/t anesthetic meds) = D/C oxytocin, place pt on side, give more oxygen  fetal tachycardia (can be a sign of maternal infx) = give antipyretics, oxygen

Chap 16  umbilical cord compression/prolapsed cord (cord is protruding through cervix d/t fetal head compression) o emergency! o Using sterile gloved hand, insert 2 fingers into vagina, place finger on either side of cord, lift head from cord to stop compression o Reposition client knee-chest or Trendelenburg o Use warm, sterile saline soaked towel on visible cord to prevent cord drying up  Rhogam o Should be administered within 72h after giving birth to mother Rh-, baby Rh+ to prevent issues with NEXT pregnancy  Fundal height o Immediate after delivery = firm, midline fundus @ level of umbilicus o 12h postpartum = fundus may go up 1cm above umbilicus o every 24h after that = fundus should descend 1-2cm/day  by day 6 postpartum = halfway between umbilicus and symphysis pubis  by day 10 postpartum = fundus should not be able to be palpated Chap 17  Lochia = discharge after women gives birth o Lochia rubra = bright red bleeding (day 1-3 postpartum)  May see clots, should not be excessive  Should NOT saturate pad within 15min  Extending past 3 days = concern about atony o Lochia serosa = serosanguineous consistency, pink-ish brown (day 4-10) o Lochia alba = whitish creamy (day 11-6wks postpartum) o May have fleshy odor o Any excessive spurting of bright red blood = ABNORMAL!  Pain management after birth

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o Sitz bath, ice packs on perineum pain/discomfort Milk starts to come in 2-3 days after birth o Before = colostrum = thicker, yellow consistency  Full of nutrients! Good for baby to get! Average blood loss during vaginal birth = 500mL Average blood loss during cesarean birth = 1000mL Uterine atony (bladder distention  uterus displacement) o Tx = Have patient void Rh- mom, Rh+ baby  Rhogam within 72h birth to prevent antibody formation, which can impact baby of subsequent pregnancies

Chap 18  Phases of Maternal Role Attainment 1. Dependent – Taking In phase  1st 24-48h after birth  mum eager to talk about birth experience; relies on others for assistance (still in hospital) 2. Dependent – Independent – Taking Hold phase  Begins day 2-3 up to next couple weeks  Mum focused on baby care, practicing skills/learning how to take care of baby 3. Inter-dependent – Letting Go phase  Not all about baby care  Resuming role as partner, individual (focus turns more towards other aspects of life too)  Discharge Teaching – Breast Engorgement o Cold compress/tight bra between feedings  most important if mother is NOT planning to breastfeed baby o Warm compress/warm shower PRIOR to breast feeding – helps milk flow o Cold, fresh cabbage leaves on breast or mild analgesics alleviates symptoms Chap 20 – Postpartum Disorders  DVT o S/S = unilateral area of swelling, warmth, redness; calf tenderness  Pulmonary Embolism o S/S = chest pain, difficulty breathing  Postpartum Hemorrhage o Lochia rubra lasting longer/excessive bleeding  CAUSE = retained placental fragments, uterine atony  Make sure that mother’s bladder is emptied, monitor pads, monitor for HR/BP (d/t blood loss), massage fundus  MEDS (for postpartum hemorrhage/uterine atony)  Oxytocin/Pitocin (uterine stimulant; will help to contract uterus to return to normal size)  Methylergonovine (Methergine; uterine stimulant – helps uterus to contract  blood loss)

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 Misoprostol (uterine stimulant) Mastitis o Infection in breast o S/S = painful/tender localized red mass, reddened area on one breast, flu-like symptoms (chill, fatigue) o Prevention = make sure to wash hands prior to breast feeding, keep breasts clean, air-dry nipples, make sure the baby is sucking on entire nipple/areola

Chap 22 – Postpartum Depression  Postpartum blues (can last up to 10 days) o S/S = tearfulness, insomnia, lack of appetite, feeling of let down o If extend >10 days or S/S more severe, monitor for PPD  PPD (occurs within 6mo of delivery) o S/S = persistent feelings of sadness, intense mood swings  Postpartum psychosis o Common with mums with hx of bipolar disorders o S/S = disorientation, hallucination, obsessive behavior, paranoia Chap 23 – Newborn Assessment  APGAR Score (0-10) o 7-10 = good! No distress o 4-6 = moderate distress o 100 = 2; HR...