Maternal-Newborn Nursing Exam Review, Exams of Nursing

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Maternit y Exam #1 Review Intro to Maternal-Newborn Nursing •KNOW THE DEFINITIONS • Types of families • Birth rate / mortality rates • EBP – interventions we do are based on evidence that it works • Beneficence, justice, etc •Nursing Practice Act • Standards of care each patient should get or better • Protect patients! • Scope of practice – what are you as an RN allowed to do etc. We can always work within these, and the hospital can better them, but never go outside of them. •HIPAA • Confidentiality • If not your patient no looking • No sharing to people who shouldn't know •Informed Consent • 18 years or older, not on medications that can alter thought processes (opioids), emancipated minor • Needs to know full risks and benefits as well as consequences not doing it. •Urinary Postpartum (cont) • Lactation • Urinary retention – watch for this – may not feel the need to void • Monitor output needs to void within 4 hrs pp •GI • Auscultate bowel sounds before massaging the fundus • Constipation • AMBULATION, fluids, fiber • Stool softeners •Skin • Cholasma - darkened pigmentation • Linea nigra • Striae – turn silvery •Immune • Hepititis B • If mom has hep B = baby gets hep B vaccine and Hep B immunoglobulin • If not just the vaccine • Rhogam within 72 hours after delivery of Rh+ baby • MMR shot if not immune • Avoid pregnancy for 1 month (4 weeks) • Should start right after delivery • Takes 3-5 days for milk to come in • Amount produced by frequent and amount of time infant suckles the breast • Prolactin = milk production • Oxytocin = milk secretion • Benefits • Immune, decreased SIDS, decreased incidence of allergies, bonding • Helps with involution, decrease PPH, increased expenditure of calories, decreased risk of OVA cancer, breast cancer • Episiotomy • Ice for first 24 hours • Sitz after that • Laceration • 3rd and 4th degree = no suppositories Maternal Adaptation •Taking In • 1-2 days PP • All about mom’s birthing story • Meet mom physiological needs •Taking Hold • Day 2 PP • Takes control of the baby’s care • Ready to learn about care of baby and herself •Letting Go • Mom lets go of old life and takes hold of being a mom • Aka buys a minivan Psychological Adaption •Baby Blues • 3-5 days PP • Changes in hormones • Normal! • Rest, taking time for themselves, getting out Postpartum Complications •The US is the only country where post partum death had increased due to hemorrhage •Hemorrhage • Early (first 24 hours) – think uterine atony • Late / Delayed (>24hrs - 6 weeks) – think retained placenta • Why hard to determine? • Higher blood levels before birth, changes in blood work will not be obvious • No specific levels to say this is hemorrhage • Reasons • Tone • Poor contraction of muscle, wrong placental placement, or something is inhibiting the muscle from contracting • Anesthesia, NSAIDS, nitrates, mag, etc • Infection, prolonged labor, bladder distension, over distension of the uterus. • Tissue – retained placenta • Trauma – laceration, c-section, rupture, hematoma • Clotting – preexisting issues •Know the risk Factors! Postpartum Hemorrhage •Signs of impending hemorrhage • Excessive bleeding (>2 pads in a 30-1hr) • Light headed, nausea, pale • Increased HR and RR, same BP or lower •How to intervene • Know who is at risk • Don’t over massage the fundus • Fundal massage, empty bladder, administer meds (oxytocin, etc) • Weigh the pads, good indication of how much she is losing • Frequent vitals •Infection / puerperal sepsis Postpartum Complications • Usually from normal bacteria – GBS, e. coli • C-sections higher risk than vaginal • Leading cause of maternal morbidity in the world • Prevent – handwashing, perineal care, etc • Signs • High temp, foul odor, etc • Endometritis – infection of the endometrium – foul odor, poor involution, normal sick symptoms, febrile • semi fowlers, and ambulation •Mastitis – infection of the breast • Usually due to poor infant latch • Painful, tender spot, with influenza like symptoms • Risks – poor latch, poor fitting bra or underwire bra, sore or cracked nipples, engorgement • Treatment • Good breastfeeding education • Feed more often • Bed rest during acute phase • The treatment is usually NEVER to stop breastfeeding. •UTI Menstrual Cycle •Secretion of LH and FSH stimulates immature follicles to start to mature •These follicles start secreting large amounts of estrogen (causing the endo lining to start to thicken) •Estrogen increases, LH rises, and progesterone increases •The LH spike mid-cycle causes ovulation leaving the corpus luteum •Progesterone then rises (thermogenic – aka rise in temp) suppressing LH and FSH •If not fertilized  corpus luteum degenerates and E and P drop and the cycle starts over. Reproductive Growth and Development •Sperm and Egg meet, you now have a baby! This usually occurs in the ampulla of the fallopian tube • Zygote/fetus secretes hCG • Embryo is highly susceptible to teratogens as it is laying down the roadmap for the body early on •Amniotic Fluid • Temp controlled • Cushions the fetus and protects from infection • Prevents the amnion from adhering to the fetus • Prevents cord compression •Umbilical cord – AVA, surrounded by Wharton's jelly •Placenta • Has a shelf life – forms from 3rd week to 8th month • Acts as the lungs, kidneys, liver, GI tracts for the fetus • Sends passive immunity to fetus from the mother • Secretes hCG, E, P, hPL A woman is menstruating. If hormonal studies were to be done at this time, which of the following hormonal levels would the nurse expect to see? 1. Both estrogen and progesterone high 2. Estrogen is high and progesterone is low 3. Estrogen is low and progesterone is high 4. Both estrogen and progesterone are low What is the hormone responsible for ovulation? LH What organs does the placenta replace? Corpus lutuem Prenatal Diagnostics •Glucose Tolerance (24 – 28 weeks) >140 needs further testing •Rhogam (28 weeks) •GBS (36 weeks) •Ultrasound • Abdominal vs transvaginal • Used to confirm pregnancy •Chorionic Villus Sampling (10-12 weeks) • Genetic testing, earliest one • Can cause fetal limb reduction, spontaneous abortion, Rh sensitization •MSAFP (16-18 weeks) • Blood test • Screens for neural tube defects •Amniocentesis (15 – 20 weeks) • Chromosomal abnormalities during 2nd trimester • Can be used again in 3rd trimester for fetal lung maturity • Lecithin : Sphingomyelin ration – 2:1 is accepted as mature lungs Non-Stress Test vs. Contraction Stress Test •Non-Stress Test • Mom is either in semifowlers or side lying • Nothing is added to induce “stress” • Mom pushes a button when she feels movement • Reactive – reacted to movement with increased HR •Baby moved and HR increased at least twice for 15bpm above baseline in 20 minutes •GOOD • Non-Reactive – HR did not increase with movement •Not good, but not horrible, as baby could be sleeping •They repeat this test, if still non-reactive they go to the contraction stress test •Contraction Stress Test • Stress is added – aka contractions to the uterus by pitocin or nipple stimulation • This is to see if the baby can handle vaginal birth • Positive CST •Decelerations were seen in HR • NOT GOOD • Negative CST •No decelerations seen •GOOD •Biophysical Profile • Usually done is they have a nonreactive NST or have other pregnancy risks like gest DM, HTN, PROM, etc • Done with information from NST and under ultrasound looking at the following 5 compenents •Fetal breathing movements •Gross Body movements ° Fetal tone ® Reactive fetal HR (NST) * Amniotic Fluid volume A woman comes into the office and states that her LMP was August 3rd. When would you tell her she might be due. A women who is A- delivers a baby who is AB-. Will she receive a rhogam shot after delivery? Why? No baby is not + A pregnant patient asks you how much alcohol she is allowed each week during pregnancy. What is your response? None! •Gravida = # of times pregnant GTPAL •T = # of pregnancies that were delivered >36 weeks (Term) •P = # of pregnancies that were delivered 22-36 weeks (Preterm) •A - # of pregnancies that resulted in abortion or miscarriage • Add these to P or T if during those times too •L - # of living children • ONLY TIME YOU ADD FOR MULTIPLES Determine the GTPAL: Ms. Z. has a 5-year old child who was full-term at birth. Since that time she has had an infant who was stillborn at 38 weeks and a spontaneous abortion that occurred at 13 weeks. She is currently 7 months pregnant. Ms. M. has had 3 pregnancies and is pregnant again. (At home, she has full-term twins and a child born at 36 weeks.) She also has had a fetus that spontaneously aborted at 10 weeks.