Maternal ati remediation PDF

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Remediation for missed ATI questions- useful for studying before you take the ATI...

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ATI remediation: Practice A: Establishing priorities:  Follow protocol  Airway, Breathing, Circulation  Warm baby(dry off/put hat on) because of Cold stress  Post circumcision—check for bleeding every 15 minutes  Preterm- cardiac and respiratory support Safety and Infection control: Accident/error/injury prevention: - Always compare mom/baby bracelets when returning/taking baby - Slats on crib should be less than 2.5” apart - Keep crib/bassinet away from window/blinds/drapes - Have all visitors wash hands before touching the newborn - Bracelet should be placed on baby immediately after birth on ankle and wrist, include: name, sex, date, date of birth, mothers hospital number Assessment and management of newborn complications 24 post procedure: - Substance abuse: CNS increased wakefulness, high pitch constant crying, hyperactive and increased Moro reflex, increased deep tendon reflexes, increased muscle tone, convulsions - Metabolic, vasomotor and respiratory findings- nasal congestion with flaring, frequent yawning, skin mottling, tachypnea greater than 60/min, sweating, temp greater than 37.2(99) - Nursing care: do neonatal abstinence scoring system assessment, elicit and assess reflexes, monitor ability to feed/digest, monitor fluids/electrolytes, turgor, mucous membranes, fontanels and I/O, - Phenobarbital (solfoton) anticonvulsant decreases CNS irritability/seizures for alcohol/opiod addiction - Swaddle to reduce self-stimulation, reduce external stimuli, small frequent feedings of high calorie formula—possibly gavage Ante/intra/postpartum and newborn care: Decelerations: -Early: FHR gradual decrease in and return to baseline FHR typically indicates compression of fetal head, it is a normal and benign find. Correspond to uterine contractions in first stage. - Late decelerations is due to uteroplacental deficiency, gradual decrease in and return to baseline associated with uterine contractions, starts after constration begins, returns to baseline after contraction ends. Repetitive late decels indicate fetal hypoxemia (placental perfusion decreased),  acidosis. - Late decels can be caused by maternal supine hypotensive, reposition mom -Variable- abrupt decrease in FHR, decreases more than 15bpm, lasts 15 seconds or more, returns to baseline in less than 2 minutes, “U” or “V” shape, occur because of

compression of umbilical cord, in first stage of labor, reposition mom, second stage, discourage mom from pushing - Immediately following ROM assess FHR for decelerations indicating fetal distress to make sure no umbilical cord prolapse, Discharge teaching: -assess what mom knows, support system, who will be home with her, what’s her readiness to learn? - wear well fitting bra for 72 hours after birth - emphasize importance of hand hygine for breastfeeding moms - cool compress between feedings if engorged - nonlactating, avoid breast stimulation and running warm water over breasts for a long time, engorged? Cold compress 15 on 45 off and cabbage. - nap when baby naps - no heavy lifting for 3 weeks Circumcision: --Do not bath via immersion until cord has completely fallen off -- Do not circumcise immediately because vitamin K is too low -- AAP does not recommend routine circumcision -- anesthesia is mandatory for all circumcsions --yelen, morgen, gomco-- inserts cone under foreskin and cuts, covers with petroleum gauze -- plastibell—goes between foreskin and glans, sutures tightly to foreskin, after 5-7 days plastibell drops off, no petroleum needed Fetal occiput posterior position: --Normal occiput presentation is vertex— --Internal roation, lateral anterior position as progresses from ischial spines to lower pelvis as passing through pelvis --Extension the fetal occiput passes under the symphysis pubis and then the head is deflected anteriorly and is born by extension of the chin away from the fetal chest. --If baby is facing Occiput posterior presentation—apply sacral counter pressure -- persistent occiput posterior prolongs labor and lots of back pain --baby is OPP, mom in active labor severe back pain—what position? Hands and knees Expected physical findings in newborn—  Weight- 2,500-4000 g  Length- 45-55cm(18-22”)  Head circumference- 32-36.8cm(12.6-14.5)  Chest circumfrence 30-33cm (12-13”) New ballard scale—rates infant on gestational age Rhogam:  administer RHO IM at 28 weeks gestation if Rh- Negative  RHO suppresses immune response to rH positive baby  RHO administered within 72 hours to Rh – mom who had + baby

 Kleihauer-betke test determines amount of fetal blood in maternal circulation, if a large fetomaternal transfusion is suspected. If 15mL or more of fetal blood is detected mom should receive and increased RhoGAM dose  Assess mom’s weight for needle length  NonPhamacological methods of minimizing pain: -Effleurage- lightly gentle, circular stroking of abdomen -gate control—concept that sensory nerve pathways can only handle limited number of sensations, alternate signals can be blocked and inhibit brain’s pain sensation -breathing methods—assess for tingling in fingers/lightheadedness could indicate blowing off too much co2 --sacral counter pressure—heel of hand against sacral= counter pressure --frequent position change assists in relaxation and pain relief Dosage calculations: oxytocin -assess site --monitor frequency duration/intensity of contractions Desired ------Have Need conversion? Medical Emergencies: Protruding umbilical cord: --Immediatel following ROM assess if cord prolapsed --FHR will be bradicardic (under 110 for 10+mins) -- d/c pitocin -- side lying position --administer o2 8-10 L/min --start an IV --administer tocolytic --notify provider Nitrazine paper: if ROM should be blue indicates fluid is alkaline Practice B: Herpes simplex: - cesarean if mom has active genital herpes outbreak - papanicolaou PAP test screens for herpes II, cervical cancer, hpv, - TORCH screening (toxoplasmosis, infections, rubella, cytomegalovirus and herpes) screens for infection capable of crossing placenta and adversely affecting fetal development - Spread by direct contact with oral/genital lesions, transmission to fetus is greatest during vaginal birth if the woman has active lesions - Obtain cultures from women who have hsv or are at or near term

Leopolds maneuver during labor: --abdominal palpation of number of fetus, presenting part, lie, attitude, descent, and the probable location where the fetal heart tones may be auscultated on the woman’s abdomen -- Leopolds maneuvers assist in identifying best location for fetal heart tones, PMI is optimal over fetal back -- Empty bladder prior --Supine with wedge under right hip -- Count FHR 30-60 seconds to determine baseline -- Ausculate during a contraction for 30seconds Family dynamics: --provide frequent, praise, support, reassurance to the mother as she moves toward independence in caring for her infant and adjusting to her maternal role -- encourage mom/parents express feelings, fears, anxieties -- Paternal adaption—Expectations(preconvieved ideas), Reality(discovers expectations might not be met, jealousy, sadness, frustration), Transition to mastery(becomes actively involved -- three stages of father infant bonding: making a commitment, being connected, making room for infant(modifies life Gestational Diabetes: --Impaired tolerance with the first onset or recognition during pregnancy. The ideal blood glucose level during pregnancy should fall between 70-110 -- Symptoms disappear a few weeks following delivery, 50% mom will develop DM within 5 years. -- Increase risk to fetus: spontaneous abortion, infections, hydramnios(overdistention of uterus—PROMpreterm labor hemorrhage), ketoacidosis because increased insulin resistance, -- Assess if pt is hypo/hyperglycemic --Glucola screening test/1hr glucose tolerance test (50g oral glucose load, followed by plasma glucose analysis preformed at 24-28 weeks) positive result is 140mg/dL or greater= additional testing with 3hr glucose tolerance test -- 3 hour glucose tolerence test(overnight fasting, avoid caffeine, abstience from smoking for 12 hr prior) 100 g glucose load given, serum levels at 1,2,3, hrs post. -- most oral hypoglycemic agents are contraindicated for gestational DM, Diagnostic tests: --Biophysical profile, real time ultrasound visualize physical and physiological characteristics of fetus and observe for fetal biophysical responses to stimuli --BPP asses fetal well being based on 5 elements (2pts each): reactive fhr, fetal breathing movements, 1 episode of 30 seconds in 30 minutes, gross body movement(3 body/limb extension and returning to flexion within 30 minutes), fetal tone(1 episode of extension with return to flexion), amniotic fluid volume(1 pocket of fluid measuring 1cmin 2 perpendicular planes) score of 8-10 normal under 4 is abnormal

--Nonstress test (NST)—evaluates fetal well being in third trimester, noninvasive monitors response of the FHR to fetal movement. A Doppler monitors FHR and tocotransducer, monitor contractions, pt pushes button whenever baby moves -used assess for intact fetal CNS -ruling out the risk for fetal death in clients of have DM, used twice a week or until after 28 weeks gestation -- Contraction stress test, stimulate nipples for 2-3 minutes cause pituitary gland to release oxytocin and then stopping the nipple stimulation when contraction begins repeated after a 5 min rest period. - stimulates contractions(which decrease placental blood flow) and analyze FHR in conjuction with contractions. Hyperstimulation (contraction longer than 90 seconds and more frequent that 2 minutes) should be avoided. -Can use pitocin if nipple stimulation fails. - negative CST is a normal finding. If within a 10 min period 3 uterine contractions and no late decels --Amniocentesis—insert needle into uterus with ultrasound guidance, perform after 14 weeks, do for previous chromosomal anomaly’s, parent has chromosomal anomally, hx of neural tube defects, lung maturity assessment. --Alpha fetaoprotein measured from amniotic fluid at 16-18 weeks assess for neural tube defects or chromosomal disorders. High levels= neural tube effects Low= chromosomal defects Interpretation lab values: (Neonate) --Hgb 14-24 g/dL --Hct 44-64% -- RBC 4,800-7,100,000/mm^3 --Leukocytes 9,000-30,000 -- platelets 150,000-300,000/mm3 --Glucose 40-60mg/dL --Bilirubin: 0-6 mg/dL day 1, 8 mg/dL or less on day 2, 12 mg/dL or less day 3 Hyperbillirubinemia: --Jaundice present in the head -- physiologic jaundice—benign appears after 24 hours --pathologic—underlying disease appears before 24 hours -- Kernicterus (Encephalopathy) can result if untreated and levels are 25mg/dL or higher --monitor billi levels every 4 hours, -- check for ABO incapabitability (if mom is O and baby, a/b) -- use mask during phototherapy Hemodynamics: Epidural: --given during active stage, first stage, of labor -- keep side reails up afterwards, pt may be dizzy -- nausea and vomiting frequent because reduce gastric emptying --respiratory depression

--hypotension Postpartum infections: -- can occur 28 days postpartum, fever of 100.4 for 2 consecutive days in initial 10 days postpartum indictive of infection -- uterine infection = endometritis, most frequent puerperal infection --mastitis – infection in breast because of blocked duct -- tx Endometritis with clindamycin(cleocin) antibiotic, notify if water, bloody stool develops --UTI, obtain clean catch sample, encourage to increase fluid intake to 3,000 mL/day --UTI cranberry juice will acidify tract and inhibit bacterial growth...