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OB HESI STUDY GUIDE

Version 1
1. Basic nursing skills/safety/newborn radiant warmer temperature probe
If the infant does not remain w/the mother during the 1st 1-2 hours after birth, the
infant is placed under a radiant warmer or incubator until body temperature stabilizes
Skin temperature is used as the point of control maintained b/t 36 and 37
A thermistor probe (automatic sensor) is placed on the upper quadrant of the
abdomen immediately below the right or left costal margin
o Probe ensures detection of minor temperature changes before a dramatic
change in temperature develops
o Probe needs to be checked periodically to make sure it is in contact w/infants
skin
2. Med administration math
3. Med administration math
4. Antepartum contractions action
Frequent position changes
Encourage voiding minimum q2 hours
Encourage deep cleansing breaths
Provide pharmacological and non-pharmacological comfort measures
Provide maternal/fetal monitoring
Discourage pushing until fully dilated
5. Antepartum CST
Contraction stress test (CST) purpose is to identify the jeopardized fetus that is
stable at rest but showed evidence of compromise after stress. Woman is seated and
reclined (semi-Fowler). She is monitored electronically w/fetal ultrasound transducer
and uterine tocodynamometer. Tracing is observed for 10-20 minutes for baseline rate.
Two methods of the CST are the nipple-stimulation contraction test and the more
common oxytocin stimulated contraction test. If no late decelerations are observed w/
contractions, the findings are considered negative. Repetitive late decelerations (50%
or more of contractions) render a positive result
6. Antepartum fundal height action
Used as one indicator of fetal growth
Provides a gross estimate of the duration of pregnancy
o The height of the fundus in cm is approximately the same as the number of
weeks of gestation
Measurement is made from the upper border of the symphysis pubis to the upper
border of the fundus

Woman should have emptied her bladder and be lying supine with knees in flexed
position

7. Antepartum gestational HTN


Gestational HTN - the onset of HTN w/out proteinuria after week 20 of pregnancy
o Systolic > 140, diastolic > 90
HTN should be recorded on at least two separate occasions at least 4-6 hours apart
and within a 1-week period
Occurs more frequently in women w/multifetal pregnancies
Women w/gestational HTN have no evidence of preexisting HTN, and their BPs return
to normal levels within 6 weeks after giving birth
8. Antepartum indigestion third trimester
It is common for indigestion to start in the 3rd trimester d/t the growing baby pushing
the stomach upward toward the esophagus
o Relief measures
! Wait at least an hour after meals before lying down
! Eat several small meals, take your time
! Avoid foods that cause indigestion (fried/greasy foods)
! Avoid caeine/alcohol b/c they can aggravate indigestion
! Dont smoke
9. Antepartum - infertility drug therapy
Action is often directed at stimulating ovulation or enhancing ovulation so more
oocytes mature
M/C medications include: clomiphene citrate, hMG, FSH, hCG, and GnRH
o Prevalence of multiple pregnancies w/use of these meds is > 25%
10. Antepartum pregnancy weight gain
Maternal and fetal risks increase when mom is severely over or under weight
Underweight women are more likely to have preterm labor and to give birth to LBW
infants
Obesity increases likelihood of preeclampsia and gestational diabetes
Appropriate measure of evaluating weight gain is BMI
o <18.5 = underweight
o 18.5-24.9 = normal
o 25-29.9 = overweight
o 30 or > = obese
Pattern of weight gain
o 1st trimester average weight gain is 1-2kg
o Thereafter the recommended weight gain increases to about 0.5 kg/week for
an underweight woman and 0.4 kg/week for a woman of normal weight

The recommended weekly weight gain for overweight women during the 2nd
and 3rd trimester is 0.3 kg/week, and 0.2 kg for obese women

11. Antepartum smoking in pregnancy


Smoking is associated w/an increased frequency of preterm labor, PROM, abruption
placentae, Placenta Previa, and fetal death

Encourage women to quit or cut down if they smoke and to avoid second hand smoke

12. Antepartum supine hypotension


Supine hypotensive syndrome when lying flat, a decrease in systolic of >30mmHg d/
t suppression of the vena cava, causes faintness
o Common in the 2nd and 3rd trimester b/c of the increasing weight of the baby;
lying in the supine position can cause compression of the inferior vena cava
o Instruct client to use a side lying position with knees slightly flexed, and
change positions slowly
13. Antepartum triple screen
In the 2nd trimester, triple screening is available for fetuses w/Trisomy 21 and Trisomy
18
Screen is performed at 16-18 weeks
Measures the levels of 3 maternal serum markers; MSAFP, unconjugated estriol, and
hCG
o Fetus w/Trisomy 21 MSAFP and unconjugated estriol levels are low
o Low levels of in all 3 markers are associated w/Trisomy 18 (Edwards
syndrome)
14. Antepartum ultrasound at 20 weeks
Uses
o Establish/confirm dates
o Confirm viability
o Detect polyhdraminos/oligohydraminos
o Detect congenital anomalies
o Detect intrauterine growth restriction
o Assess placental placement
o Used for visualization during amniocentesis
15. Antepartum vaginal discharge pregnancy
Leukorrhea
o Hormonally stimulated cervix becomes hypertrophic and hyperactive,
producing abundant amount of mucus

Not preventable, do not douche, wear perineal pads, wipe from front to
back, report to PCP if accompanied by pruritus, foul odor, or change in
character or color
16. Antepartum Intrapartum UTI
UTIs are a common medical complication of pregnancy; about 20% of all pregnancies
Instruct women taking ABX to finish the entire course of meds, take meds on time and
around the clock so the medication levels remain constant
o Many women will develop a yeast infection while taking ABX b/c the ABX kills
normal flora. We should encourage them to include yogurt, cheese, or milk
containing active acidophilus while on their ABX regimen
UTI prevention
o Wipe from front to back
o Cotton crotch underwear
o Avoid tight-fitting clothes
o Limit time spent in damp exercise clothes
o Avoid bath salts/bubble baths
o Avoid colored/scented toilet tissue
o Dont wait to void
o Void before and after intercourse and before going to bed at night
o Drink at least 8 glasses of water daily
!

17. Intrapartum back labor relief


Physiology
o

Exaggerated lumbar and cervicothoracic curves caused by change in center of


gravity d/t enlarging abdomen

Relief
o

Maintain good posture and body mechanics

Avoid fatigue

Wear low heeled shoes

Abdominal support may be useful

Conscious relaxation

Sleep on firm mattress

Apply local heat/ice

Get back rubs

Do pelvic tilt exercises

Rest

Condition will disappear 6-8 weeks after birth

18. Intrapartum chrioamnionitis


Chrioamnionitis bacterial infection of the amniotic cavity; occurs in 0.5-10% of
pregnancies
Usually diagnosed by maternal fever, maternal and fetal tachycardia, uterine
tenderness, and foul odor of amniotic fluid
M/C occurs after ROM/labor has begun
Risk factors
o Long labor
o Prolonged membrane rupture
o Multiple vaginal examinations
o Use of internal FHR and contraction monitoring
o Young maternal age
o Low socioeconomic status
o Null parity
o Preexisting infections of lower genital tract
Women w/chrioamnionitis are more likely to have dysfunctional labor; may need
cesarean
Neonatal risks include pneumonia, bacteremia, and sepsis
An association b/t chrioamnionitis and long-term neurologic development in the
newborn, including cerebral palsy, has been reported
To prevent maternal/neonatal complications, treat promptly w/IV broad spectrum ABX
o Ampicillin, penicillin, and gentamicin are used most often
19. Intrapartum food in labor
Ice chips and sips of clear liquids are the only oral intake recommended during labor
by the American society of anesthesiologists
Oer fluids and solid foods as ordered by PCP and desired by laboring women
o This provides hydration and calories; enhances positive emotional experience
and maternal control
Establish and maintain IV line as ordered
o This maintains hydration; provides venous access for medication
20. Intrapartum hyperventilation
Hyperventilation in pregnancy begins in the 1st trimester and increases 42% by term to
meet increased oxygen consumption needs
o The enlarging uterus pushes the diaphragm upward, reducing lung volume
! Compensation is necessary to meet increased ventilator demands

Hyperventilation, sometimes accompanied by respiratory alkalosis, can occur as pain


intensifies during labor and more rapid, shallow breathing techniques are used during
contractions

21. Intrapartum meconium stain decreased FHR


Meconium stained amniotic fluid indicates that the fetus has passed meconium before
birth
o Major risks associated w/meconium stained amniotic fluid is development of
meconium aspiration syndrome (MAS) in the newborn
! MAS causes severe form of aspiration pneumonia that occurs most
often in term/post term infants who have passed meconium in utero
! Decreased FHR is a clinical manifestation of meconium stained AF
o Emergency management of the newborn w/meconium stained amniotic fluid
! Prior to birth
Assess amniotic fluid
If stained, gather equipment and supplies necessary for
resuscitation before birth
Have at least one person capable of performing endotracheal
intubation on the baby present at birth
! Immediately after birth
Assess babys respiratory eorts, HR and muscle tone
Suction on the babys mouth and nose if baby has strong
respiratory eorts, good muscle tone, and a HR > 100bpm
Suction below the vocal cords w/ETT to remove any meconium
present before any spontaneous respirations have occurred or
assisted ventilation has been initiated if baby has depressed
respirations, decreased muscle tone, and a HR < 100 bpm
22. Intrapartum Pregnancy Induced HTN induction
The higher the BP, the more likely the woman is to be induced

In women w/severe gestational HTN, immediate birth is indicated (regardless of


gestational age) if signs of fetal stress, placental abruption, HELLP syndrome, oliguria,
pulmonary edema, eclampsia, or uncontrolled high BP develop

23. Intrapartum Pitocin hypersystolic (letanic) contractions


Signs
o More than 5 contractions in 10 minutes OR
o A series of single contractions lasting > 2 minutes OR
o Contractions of normal duration occurring within 1 minute of each other
Interventions w/normal FHR
o Reposition or maintain side-lying position
o Administer IV fluid bolus w/500 ml of LR
o If uterine activity has not returned to normal after 10 minutes, decrease
oxytocin do by at least half. If still not returned after another 10 minutes, d/c
oxytocin until fewer than 5 contractions occur in 10 minutes
Interventions w/abnormal FHR
o D/C oxytocin

o
o
o

Reposition or maintain side-lying position


Administer IV bolus w/500 ml of LR
Consider giving oxygen at 10L/min if above interventions dont resolve
abnormal FHR
o If no response, consider 0.25 mg terbutaline subcu according to facility
protocol
Resumption of oxytocin after resolution of tachysystole
o If infusion was d/c for < 20-30 minutes, resume at no more than one half the
rate that caused the tachysystole
o If infusion has been d/c for more than 30-40 minutes, resume at initial starting
dose

24. Intrapartum placenta previa


In Placenta Previa the placenta is implanted in the lower uterine segment such that it
completely or partially covers the cervix or is close enough to the cervix to cause
bleeding when the cervix dilates or the lower uterine segment eaces
Risk factors
o Hx of cesarean birth
o Advanced maternal age
o Multiparity
o Hx of prior suction curettage
o Smoking
Clinical manifestations
o Painless bright red vaginal bleeding during the 2nd or 3rd trimester
o Most cases diagnosed by ultrasound before significant vaginal bleeding
o Abdominal examination usually reveals a soft, relaxed, non-tender uterus w/
normal tone
o Presenting part of the fetus usually remains high b/c the placenta occupies the
lower uterine segment, thus fundal height is often > than expected for
gestational age
o B/c of the abnormality, fetal malpresentation (breech or transverse) is common
Complications
o Major one is hemorrhage
o Development of an abnormal placental attachment
o If bleeding cannot be controlled, hysterectomy may be necessary
o B/c most women w/placenta previa have cesarean birth, surgery related
trauma to structures adjacent to the uterus and anesthesia complications are
also possible
o Blood transfusion reactions
o Anemia
o Thrombophlebitis
o Infection
Diagnosis

All women w/vaginal bleeding after 20 weeks should be assumed to have a


placenta previa until proven otherwise
o Trans abdominal ultrasound to determine placental location
Management
o Expectant management observation and bed rest
o Active management (if woman is beyond 36 weeks or bleeding is excessive)
immediate cesarean birth is indicated
o If ultrasound confirms placenta previa, cesarean birth is indicated in all women

25. Intrapartum post term induction


Complications associated w/post-term pregnancy
o Macrosomia (BW > 4000g)
o Enlarging placenta w/increased areas of infarction which may aect its ability
to oxygenate the fetus
o Olygohydramnios potential for cord compression and resulting hypoxemia
o Meconium stained amniotic fluid, increased chance of meconium aspiration,
and low Apgar scores are other potential complications
B/c perinatal morbidity and mortality increase greatly after 42 weeks, most physicians
in the U.S. induce labor at 41 weeks
26. Intrapartum ruptured membranes
SROM occurs most commonly in the transition phase of the 1st stage of labor
PROM the spontaneous rupture of the amniotic sac and leakage of amniotic fluid
beginning before the onset of labor at any gestational age
Pre-term PROM rupture occurs before the completion of the 37th week
Most common maternal complication is choriamnionitis
Other less common maternal complications include placental abruptions, sepsis, and
death
Fetal complications are r/t intrauterine infection, cord prolapse, umbilical cord
compression associated w/oligohydramnios, and placental abruption

A sterile speculum examination and a Nitrazine (pH) and fern test can confirm that the
membranes have ruptured (procedure for test on p437)

27. Intrapartum stages of labor


1st stage of labor - onset of regular uterine contractions to full eacement and dilation
of cervix
o

Latent phase (through 3cm dilation) - progress in eacement w/little increase in


descent

Active phase (4-7cm dilation) - more rapid dilation and increased rate of
descent

Transition phase (8-10cm dilation) - same as active phase

2nd stage of labor - from the time the cervix is fully eaced and dilated to the birth of
the fetus
o
o

Latent phase - fetus continues to descend passively d/t uterine contractions


Active phase - strong urges to bear down as fetus descends and presses on
the stretch
3rd stage of labor - from birth until the placenta is delivered

4th stage of labor - 1-4 hours after delivery of the placenta

28. Intrapartum transition


Transition phase - 8-10cm dilation
Marks the shift to the 2nd stage of labor; can last anywhere from a few minutes to
hours
Most intense stage of labor; strong contractions coming q2-3 minutes apart and
lasting a minute or more
During this phase there is more rapid dilation of the cervix and increased rate of
descent
Woman may feel the need to empty her bowel
29. Intrapartum variable decelerations action
Variable decelerations a visually abrupt decrease in FHR below the baseline. Occur
at any time during the uterine contraction phase
o Significance - occasional variables are no big deal, recurrent variable
decelerations on the other hand indicate repetitive disruption in the fetuss
oxygen supply d/t cord compression

Nursing interventions
o Change maternal position (side-lying, knee chest)
o Discontinue oxytocin if infusing
o Administer oxygen at 8-10 L/min by nonrebreather
o Notify PCP
o Assist w/vaginal examination to assess for cord prolapse
o Assist w/birth if pattern cannot be corrected

30. Newborn adequate milk supply


Tips for providing adequate milk to baby
o Avoid soaps and hard washing of the nipples b/c it can cause extreme
dryness/cracking and keep nipples dry b/t feedings
o Position baby so that their head, neck, and spine are aligned
o Appropriate nursing frequency adequate supply requires adequate demand
o Judge adequate supply on the babys weight gain, babys poop (should be
seedy, mustard colored), and babys aect after feeding
31. Newborn apnea at birth ventilate

Implemented if other methods of therapy cannot correct abnormalities in oxygenation


Indicated whenever blood gas values reveal the existence of severe hypoxemia or
severe hypercapnia (apnea w/bradycardia, ineective respiratory eort, shock,
asphyxia, infection, meconium aspiration syndrome, RDS, or congenital defects that
aect ventilation)
Dexamethasone may be administered to prevent chronic lung disease in ventilatordependent infants who are unlikely to survive w/out corticosteroids

32. Newborn asymmetric SGA


Usually results from placental or maternal problems that typically manifest in the late
2nd or the 3rd trimester. When the cause begins relatively late in gestation, organs and
tissues are not equally aected, resulting in asymmetric growth restriction
Common causes include
o Placental insuciency resulting from maternal disease
o Placental insuciency caused by multiple gestation
o Chronic maternal hypoxemia caused by pulmonary or cardiac disease
o Maternal malnutrition
An infant may also have asymmetric growth restriction and be small for gestational
age if the mother is a heavy user of opioids, cocaine, alcohol, and/or tobacco during
pregnancy
33. Newborn breastfeeding latch on
In preparation for latch during early feedings the mother should manually express a
few drops of colostrum and spread it over the nipple. This lubricates the nipple and
entices the baby to open the mouth
Present baby so that their mouth is directly in front of the nipple
Mother should support the babys neck and shoulders w/her hand and not push on
the occiput
The babys body is held in correct alignment (ears, shoulders, and hips are in a
straight line) during latch
In general, the babys mouth should cover the nipple and an areolar radius of about
2-3 cm
34. Newborn caput succedaneum
Caput succedaneum a generalized, easily identifiable edematous area of the scalp,
most commonly found on the occiput
This edematous swelling, present at birth, extends across suture lines and disappears
spontaneously within 3-4 days
Bruising of the scalp is often seen w/caput succedaneum
Causes
o W/vertex presentation the sustained pressure against the cervix results in
compression of local vessels, slowing venous return. The slowed venous return
causes an increase in tissue fluids within the skin of the scalp, and an
edematous swelling develops

Infants born w/vacuum assistance are usually born w/caput in area where the
cup was applied

35. Newborn cephalhematoma 1st action


Cephalhematoma a collection of blood b/t a skull bone and its periosteum
1st action
o ??? not sure what the 1st action is! The problem corrects itself!
o Can result from pressure during spontaneous birth, low forceps birth and
dicult forceps rotation and extraction
o A cephalhematoma appears several hours or the day after birth
o Its usually largest on the 2nd or 3rd day, by which time the bleeding stops
o Fullness of a cephalhematoma spontaneously resolves in 3-6 weeks
o Dont aspirate b/c of risk of infection
o As hematoma resolves, hemolysis of RBCs occurs, and jaundice can result
36. Newborn cephalhematoma complication
Complications
o Hyperbilirubin jaundice
o Infection
o Anemia
37. Newborn narcotic withdrawal
Nursing care
o Supportive therapy for fluid and electrolyte balance, nutrition, infection control,
and respiratory care
o Swaddling, holding, reducing stimuli, and feeding as necessary can be helpful
in easing withdrawal
o If cocaine addicted, position to avoid eye contact, swaddle infant, use vertical
rocking techniques, and us a pacifier to counter poor organizational response
to stimuli
o

Neonatal abstinence scoring system tool for assessing withdrawal symptoms


in newborns

Treatment
o When indicated, administer phenobarbital, diazepam or other meds per order
to decrease CNS irritability and control seizure activity
o Treatment may be needed for 2 weeks or more

38. Newborn newborn circumcision


Circumcision is a matter of parental choice
Circumcision is not performed immediately after birth b/c of the danger of cold stress
and decreased clotting factors, but its usually done before discharge

Feedings are usually withheld up to 2-3 hours before circumcision to prevent


vomiting and aspiration
o To prepare infant for the procedure, he is positioned in the restraint form, and
the penis is cleansed w/soap and water. Infant is draped for warmth and sterile
equipment is readied. Most commonly, the Yellen clamp or the plastibell device
is used
o Four types of anesthesia/analgesia are used ring block, dorsal penile nerve
block, topical anesthetic, and concentrated oral sucrose
o Oral acetaminophen may be administered after the procedure q4 hours
If bleeding occurs, the nurse applies gentle pressure w/folded sterile gauze
Educate parents about care of the circumcised infant
o Check for bleeding
o Observe for urination
o Keep area clean
o Check for infection
o Provide comfort
o Avoid prepackaged wipes b/c they have alcohol
o Wash penis gently w/water, if necessary, apply petroleum around the glans
after each diaper change
o Apply diaper so that it does not press on the circumcised area
Encourage parents to change the diaper at least q4 hours

39. Newborn respiratory distress oxygen saturation


Assess for cardinal signs of respiratory distress (nasal flaring, grunting, tachypnea,
central cyanosis, retractions)
Interventions
o Perform gestational age assessment
o Observe for signs of respiratory distress
o Monitor oxygenation by pulse oximetry
o Provide supplemental oxygen judiciously
o

Blood gas analysis RDS would reveal low oxygen and excessive acid

40. Newborn step reflex neonate


Hold infant vertically, allowing one foot to touch table surface
Infant will simulate walking, alternating flexion and extension of feet
Term infants walk on soles of their feet
Preterm infants walk on their toes
Step reflex is usually present for 3-4 weeks
41. Newborn T4 TSH newborn screen
Congenital hypothyroidism (low T4, elevated TSH)
Symptoms

Asymptomatic at birth; mental and motor delays, short stature, coarse, dry skin
and hair, hoarse cry, constipation
Diagnosis
o Heelstick - blood spot T4 or TSH or both can be used in neonatal screening for
CH
Treatment
o Maintain L-thyroxine levels in upper half of normal range
o Periodic bone age to monitor growth

42. Postpartum breast engorgement relief


Use of cold (ice packs, gel packs, cold compresses) after breastfeeding (15-20 min
on-45 min o)
Chilled cabbage leaves washed, chilled in fridge, and placed over breasts
Warmth (shower, warm compress) before breastfeeding
Anti-inflammatory medications - ibuprofen
Breast massage
Pumping

If not breast feeding encourage snug, support bra b/c it limits milk production and
decreases discomfort

43. Postpartum cervical laceration


Cervical injuries occur when the cervix retracts over the advancing fetal head
These lacerations occur at the lateral angles of the external os; most are shallow and
bleeding is minimal
Larger lacerations may extend into the lower uterine segment; serious bleeding may
occur
Extensive lacerations may follow attempts to enlarge the cervical opening artificially or
to deliver the fetus before full dilation is achieved
44. Postpartum fundal massage explain boggy
Fundus (either firm or boggy {spongy})
o If firm, measure it measure the distance from the top of the symphysis pubis
to the top of the uterine funds w/centimeter tape measure
o If not firm, massage it place hands appropriately so as not to lose the uterus.
With upper hand, firmly apply pressure downward toward vagina and observe
for amount and size of expelled clots
45. Postpartum hemorrhage postpartum
PPH the loss of more than 500ml of blood after vaginal birth and 1000ml after
cesarean
Signs of PPH use of > 1 perineal pad per hour
Causes
o Over distended uterus

o Previous hx of uterine atony


o High parity
o Prolonged labor, oxytocin-induced labor
o Trauma during labor and birth
o Unrepaired lacerations of the birth canal
o Ruptured uterus
o Inversion of the uterus
o Placenta accrete, increta, percreta
o Coagulation disorders
o Placental abruption, placenta previa
Management
o 1st step is to evaluate the contractility of the uterus
! If hypotonic, eorts are made to increase contractility and minimize
blood loss
o Initial management of PPH is firm massage of the fundus
o Expression of any clots, elimination of any bladder distention, and continuous
IV infusion of 10-40 units of oxytocin in 1000 ml of LR/NS are also primary
interventions
! If uterus fails to respond to oxytocin, Ergotrate or Methergine may be
given IM
o Rapid administration of crystalloid solutions or blood/blood products or both
will be needed to restore the womans intravascular volume
o Oxygen by nonrebreather
o Indwelling urinary catheter to monitor urine output
o CBC w/platelet count, fibrinogen, PT and PTT

46. Postpartum IDDM insulin needs PP


During the 1st 24 hours, insulin requirements decrease substantially b/c the major
source of insulin resistance, the placenta, has been removed
Insulin requirements in breastfeeding women may be one half of pre-pregnancy levels
b/c of the carbohydrate used in human milk production
o Also, glucose levels are lower in breastfeeding women
47. Postpartum postpartum hematoma
PP hematoma localized collection of blood in loose connective skin beneath external
gentalia
Causes
o Trauma during spontaneous delivery
o Trauma during operative vaginal delivery
o Inadequate suturing of an episiotomy
o Dicult/prolonged 2nd stage of labor
Clinical manifestations
o Complaints of pressure and pain

o Discolored skin that is tight, full feeling and painful to touch


o Decrease of absence of lochia flow if vagina is impeded
Management
o Small hematomas heal on their own
o Large hematomas may require evacuation of the blood and ligation of the
bleeding vessel
Complications
o Hypovolemic shock
o Anemia, infection
o Increased postpartum recovery time
o Sepsis
o Dyspareunia
Nursing interventions/patient education
o Inspect perineal for signs of hematoma periodically postpartum
o Monitor VS to evaluate for signs of shock
o Relieve pain ice bag, mild analgesia, position for comfort, catheterize if
unable to void, teach balanced diet w/food high in iron

48. Postpartum postpartum infection


PP infection presence of fever of 38 or more on 2 successive days of the 1st 10
postpartum days
Endometriosis is the m/c cause
o Other common PP infections include wound infections, mastitis, UTIs, and
respiratory tract infections
Risk factors
o Women who have concurrent medical or immunosuppressive conditions
o Cesarean or operative vaginal birth
o Prolonged rupture of membranes
o Prolonged labor
o Internal maternal or fetal monitoring
Management and care
o CBC, venous blood cultures, and uterine tissue cultures
o Good maternal perineal hygiene w/ good hand washing
o Strict adherence by all health care workers to aseptic techniques during
childbirth
o Management of endometriosis is broad spectrum ABX and supportive care,
including hydration, rest, and pain relief
o Nursing measures include assess lochia, VS, and changes in womans
condition, comfort measures (cool compress, warm blankets, perineal care,
and sitz baths)
o Teaching about side eects of therapy, prevention of spread of infection, s/s of
worsening condition, and adherence to treatment plan and need for follow up
care

49. Postpartum postpartum monitor LGA SVD


SGA the nurse should monitor blood glucose levels as the priority
LGA the nurse should assess for hypoglycemia and trauma (palpate clavicles for
fracture)
50. Postpartum postpartum advanced maternal age
More likely to have preexisting conditions HTN and diabetes
Increased incidence of antepartum hemorrhage, malpresentation, operational vaginal
delivery, cesarean delivery, and fetal death
At risk for LBW baby, preterm delivery, placenta previa
51. Postpartum postpartum WBC
Due to the inflammation, pain, and the stress of birth, neutrophils are increased and
are responsible for a marked increase in the white blood cell count during the
postpartum period
White blood cell counts may increase to levels as high as 30,000/mm3
o B/c of this normal increase, it is important monitor patients closely for
indications of infection
52. Postpartum PP fatigue therapeutic communication
Fatigue is common in the postpartum period and involves physiologic as well as
psychological components
PPF may be associated w/long labors, cesarean birth, infant care demands, anemia,
infection, or thyroid dysfunction, physical discomfort (lack of sleep),
PPF is a risk factor for postpartum depression
Interventions are planned to meet the womans individual needs for sleep and rest
while in hospital
o Back rubs, medication for sleep, side-lying position for breastfeeding mothers
53. Antepartum tay sachs
Prenatal diagnosis of tay sachs (genetic) via chorionic villus sampling and amniotic
fluid testing
o Amniocentesis is possible after week 14 amniotic fluid withdrawn into a
syringe
o CVS can be performed in the 1st or 2nd trimester tissue specimen take from
the fetal portion of the placenta
! Accomplished transcervically or transabdominally
54. Postpartum teaching involution
Involution the return of the uterus to a non-pregnant state
o Begins immediately after birth of the placenta w/UC; extends for 6 weeks after
delivery
o Teach woman about fundal massage to stimulate UC
55. Mental health/maternity anxiety/communications/antepartum emergency delivery
Women who experience emergency child birth are more likely to have high anxiety

The nurse should remain w/the woman and let her express her fears
o Explanations to reduce her fear can be eective
o Avoid belittling their fears; dont tell them not to worry
Interventions
o Assess level of anxiety
o Remain w/patient as much as possible
o Elicit patients feelings about surgery
o Explain preoperative and postoperative procedures
o Reduce unnecessary stimuli

Version 2
1. Nutrition/newborn/postpartum vegetarian breast feeding
Choose foods high in iron, protein, and calcium
o Iron - dried beans and peas, lentils, whole-grain products, dark leafy green
vegetables, and dried fruit
o Protein eggs and dairy products, soy products and meat substitutes,
legumes, lentils, nuts, and seeds
o Calcium dairy products, juices, cereals, soy milk, soy yogurt, and tofu
Supplements; B12 and in some cases Vitamin D
2. Med administration intrapartum pain control deep breathing
Breathing techniques provide distraction, thereby reducing the perception of pain
All patterns begin w/a deep, relaxing, cleansing breath to greet the contraction and
end w/another deep breath to gently blow the contraction away.
Slow paced breathing is initiated when the woman can no longer walk or talk through
contractions
o Aids in relaxation and provides optimum oxygenation
o As contractions increase in frequency and intensity, a shallower and faster than
normal rate of breathing should be tried
Patterned paced (pant-blow) breathing is suggested during the transition phase
3. Med administration math ml/hr
4. Med administration math
5. Med administration/newborn/legal/ethical immunize NB
Rubella/varicella
o Informed consent for rubella and varicella vaccination in the PP period includes
information about possible side eects and the risk of teratogenic eects.
o Women must understand that they must practice contraception to prevent
pregnancy for 1 month after being vaccinated
Rh Immune Globulin, RhoGAM
o Obtain informed consent (per protocol), explain procedure, purpose, and
possible side eects
o Verify correct dosage and confirm lot number and womans identity before
injection w/another RN
HB
o Parental consent must be obtained before administration
6. Antepartum 2nd trimester no fetal movement
If woman is concerned about lack of fetal movement she can perform a daily fetal
movement count aka kick count
o Woman should count kicks a few times a day for periods of 60 minutes

Fewer than 3 fetal movements within 1 hour warrants further evaluation by a


NST or CST, BPP, or a combination of these
Fetal movements that cease entirely for 12 hours (fetal alarm signal)
o This sign points to a severely disturbed fetus and indicates impending
intrauterine fetal death
o Such a development is indication for immediate delivery of the fetus, provided
it is viable

7. Antepartum false labor confirm


False labor
o Irregular and unpredictable contractions
! Often stop w/walking or position change
! Can be felt in the back or abdomen above the navel
! Can often be stopped through the use of comfort measures
o Cervix may be soft but w/no significant change in eacement or dilation or
evidence of bloody show
o Fetus presenting part is usually not engaged in the pelvis
8. Antepartum fetal position
Fetal position is the relationship of a reference point on the presenting part (occiput,
sacrum, mentum [chin], or sinciput [deflexed vertex])
Position is denoted by a 3 part abbreviation
o 1st letter denotes the location of the presenting part in the right (R) or left (L)
side of the mothers pelvis
o 2nd letter stands for the specific presenting part of the fetus, O occiput, S
sacrum, M mentum, and Sc scapula
o 3rd letter stands for location of the presenting part in relation to the anterior (A),
posterior (P), or transverse (T) portion of the maternal pelvis
! Example ROA occiput is the presenting part and is located in the
right anterior quadrant of the maternal pelvis
9. Antepartum last trimester UTI
In the 3rd trimester, UTIs are more serious b/c of the potential for developing a kidney
infection
o The bladder loses tone during pregnancy. This leads to diculty emptying the
bladder which makes the bladder more prone to reflux (urine flow back up the
ureters toward the kidney)
o The growing uterus puts extra pressure on the urinary tract. This may block
urine drainage from the bladder, leading to back flow of urine up the ureters
toward the kidney
10. Antepartum mag sulfate toxicity
Mag sulfate is the drug of choice in the prevention and treatment of seizure activity
caused by severe preeclampsia or eclampsia

If renal function declines, all of the magnesium sulfate will not be adequately excreted
resulting in magnesium toxicity
Symptoms of mild toxicity
o Lethargy
o Muscle weakness
o Decreased or absent DTRs
o Double vision
o Slurred speech
Symptoms of increasing toxicity
o Maternal hypotension
o Bradycardia
o Bradypnea
o Cardiac arrest
If magnesium toxicity is suspected
o D/C magnesium infusion immediately
o Give calcium gluconate or calcium chloride IV

11. Antepartum pregnancy changes


12. Antepartum pregnancy positive sign
Positive signs of pregnancy those signs only attributable to the presence of the fetus
o Hearing fetal heart tones
o Visualization of the fetus
o Palpating fetal movements
13. Antepartum Rh isoimmunization risk
Rh incompatibility (isoimmunization) occurs when an Rh-negative mother has an Rhpositive fetus who inherits the dominant Rh-positive gene from the father
Genetic risk factor
o If the mother is Rh negative and the father is Rh positive and homozygous for
the Rh factor, all the ospring will be Rh positive
o If the father is heterozygous for the Rh factor, there is a 50% chance that each
infant born of the union will be Rh positive
Usually women become sensitized in their 1st pregnancy w/Rh positive fetus but do
not produce enough antibodies to cause lysis of fetal blood cells
o During subsequent pregnancies however, antibodies form in response to
repeated contact w/the antigen from the fetal blood, and lysis of fetal RBCs
results
! Severe Rh incompatibility results in marked fetal hemolytic anemia b/c
the fetal erythrocytes are destroyed by maternal Rh positive antibodies

Multiple gestation, placental abruption, placenta previa, manual removal of the


placenta, and cesarean birth increase the risk of isoimmunization

14. Antepartum STDs pregnancy


Chlamydia
o Maternal eects PROM, preterm labor, PP endometritis
o Fetal eects LBW
o Treatment
! ABX
! Ok during pregnancy
Gonorrhea
o Maternal eects miscarriage, preterm labor, PROM, amniotic infection
syndrome, choriamnionitis, PP endometritis, PP sepsis
o Fetal eects preterm birth, IUGR
o Treatment
! ABX
Herpes simplex virus
o Maternal eects intrauterine infection (rare)
o Fetal eects congenial infection (rare)
o Treatment
! Acyclovir (or some version thereof)
HPV
o Maternal eects dystocia (dicult birth) from large lesion, excessive bleeding
from lesions after birth trauma
o Fetal eects none known
o Treatment
! Pregnant and lactating women cryotherapy
! Non pregnant women prodofilox (topical)
Syphilis
o Maternal eects miscarriage, preterm labor
o Fetal eects IUGR, preterm birth, still birth, congenital infection
o

Treatment
!

Penicillin

If allergic to penicillin, Tetracycline or Doxycycline

15. Antepartum Supine hypotension


Physiology induced by pressure of gravid uterus on ascending vena cava when
woman is supine; reduces uteroplacental and renal perfusion
S/S pallor, dizziness, faintness, breathlessness, tachycardia, nausea, clammy skin,
sweating
Nursing intervention position woman in side-lying position until her s/s subside and
vital signs stabilize WNL
16. Antepartum tocolyctic treatment preterm labor (p787-789)

Tocolytics are medications given to arrest labor after uterine contraction and cervical
change have occurred
o Magnesium sulfate is the most commonly used tocolytic agent b/c maternal/
fetal adverse reactions are less common that w/beta-adrenergic agonists
o Beta-adrenergic agonists (terbutaline - m/c) were widely used in the past
o Calcium channel blockers (Nifedipine) oral administration, low incidence of
maternal and fetal side eects; use is increasing

17. Antepartum TPAL


TPAL system of summarizing patients obstetric hx

T- term births, P - preterm births, A - abortions, L - living children

18. Intrapartum abdominal trauma


Blunt abdominal trauma m/c result of motor vehicle crash but may also result from
battering or falls
o All pregnant victims should be carefully evaluated form s/s of placental
abruption after even minor blunt abdominal trauma
! s/s of placental abruption include uterine tenderness/pain, uterine
irritability, uterine contractions, vaginal bleeding, leaking of amniotic
fluid, or change in FHR characteristics
Penetrating abdominal trauma m/c result of bullet wounds, then stab wounds
o Fetus is more vulnerable to serious injury than is the mom b/c the enlarged
uterus protects other maternal organs
19. Intrapartum anesthesia
Anesthesia complete pain relief and motor block
o Local perineal infiltration anesthesia may be used when an episiotomy is to be
performed or when lacerations must be sutured after birth in a woman who
does not have regional anesthesia
! Epinephrine is usually added to the solution to localize and intensify the
eect and to prevent excessive bleeding
o Spinal anesthesia contains either a local anesthetic alone or in combination w/
an opioid agonist; injected into the subarachnoid space.
! Use of this technique is for both elective and emergent cesarean births
! Low spinal anesthesia may be used for vaginal birth , but is not suitable
for labor
! Interventions and care prior to and during epidural administration
! Prior to the block
! Assist PHP/ACP w/education and obtaining consent
! Assess VS, hydration status, labor progress and FHR and
pattern
! Start IV line and infuse a bolus (Ringers/NS) if ordered

Obtain lab results (Hct/Hgb)


Assess pain using pain scale
Assist woman to void
During initiation of the block
! Assist woman to assume/maintain proper position
! Verbally guide woman through the procedure
! Assist ACP w/documenting VS, time/dose of meds
! VS (especially BP) and FHR
! Have oxygen/suction ready
! Monitor for signs of local anesthetic toxicity as test dose
is administered
!
!
!

20. Intrapartum AROM equipment


Amnihook or other sharp instrument is inserted through the vagina and cervix
o PCP inserts it alongside the fingers and then hooks and tears the membranes
21. Intrapartum atropine preop- CS (found nothing in the book about this)
Atropine has been used to reduce gastric secretions before a cesarean section
22. Intrapartum bladder
Adequate bladder care during labor can reduce the incidence of bladder distention
thus reducing the risk for PPH
o Nursing interventions
! Encourage women to void q2hr
! If bladder is palpable and patient cannot void, catheterize
! Women w/epidural or spinal analgesia should have a Foley
23. Intrapartum delivery parking lot
Highest priority intervention is to put the infant to the breast; this will help contract the
uterus and prevent PPH
24. Intrapartum epidural BP
After epidural is initiated, the woman should be positioned on her side so the uterus
does not compress the ascending vena cava and descending aorta, which can impair
venous return and reduce CO and BP
o Alternate the womans position from side to side every hour
Oxygen should be available if hypotension occurs despite maintenance of hydration
w/IV fluids and displacement of uterus to the side
Ephedrine or phenylephrine (vasopressor used to increase maternal BP) and increased
IV fluid infusion may be needed
25. Intrapartum fetal tachycardia
Definition FHR 160/bpm lasting > 10 minutes
Possible causes
o Early sign of fetal hypoxemia
o Fetal cardiac arrhythmias

o Maternal fever
o Maternal or fetal infection
o Parasympatholytic drugs (atropine)
o sympathomimetic drugs (terbutaline)
o Maternal hyperthyroidism
o Fetal anemia
o Drugs (caeine, cocaine, methamphetamines)
Clinical significance
o Tachycardia is abnormal when associated w/late decelerations, severe variable
decelerations, or absent variability
Nursing interventions
o Depend on cause: reduce maternal fever w/antipyretics and cooling measures;
O2 at 8-10 L/min by nonrebreather may be of some value

26. Intrapartum impending delivery


Signs of labor
o Eacement
o Dilation
o Mucus plug is passed
o Bloody show
o Surge of energy
o SROM
o Weight loss
27. Intrapartum Placenta Previa s/s
Painless bright red vaginal bleeding; initially a small amount and stops as clots form
VS may be normal b/c pregnant women can lose up to 40% of blood volume w/out
showing signs of shock
FHR is normal
Abdominal examination usually reveals soft, relaxed, non-tender uterus w/normal tone
Presenting part of fetus high, not engaged b/c placenta occupies the lower uterine
segment, thus fundal height is often greater than expected for gestational age
Fetal malpresentation (breech, transverse, oblique) is common
28. Intrapartum variable deceleration action
Nursing interventions
o Change maternal position
o Discontinue oxytocin if infusing
o Administer oxygen at 8-10L/min by nonrebreather
o Notify MD/midwife
o Assist w/vaginal or speculum examination to assess for cord prolapse
o Assist w/amnioinfusion if ordered
o Assist w/birth if pattern cannot be corrected

29. Newborn Apgar scoring


Evaluations are made at 1 and 5 minutes after birth
Scores of 0-3 indicate severe distress, 4-6 indicate moderate diculty, 7-10 indicate
minimal/no diculty
HR


Absent (0)

Slow <100 (1)

>100 (2)
Respiratory eort
Absent (0)

Slow, weak cry (1)
Good cry (2)
Muscle tone
Flaccid (0)

Some flexion (1)

Well flexed (2)
Reflex irritability
No response (0)

Grimace (1)

Cry (2)
Color

Blue, pale (0)
Body pink/ext blue (1)

Completely
pink (2)
30. Newborn circumcision care
Wash hands before touching
Check for bleeding
o If bleeding occurs, apply gentle pressure
Observe for urination
o Infant should have 2-6 wet diapers in a 24 hour period the 1st day, then at least
6-8 24 hours to 3-4 days
Keep area clean
o Change diaper at least q4hr
o Wash penis gently w/warm water to remove urine and feces; apply petroleum
jelly to glans w/each diaper change
o Dont wash penis w/soap until circumcision is healed (5-6 days)
o Apply diaper loosely Cleanse genitals daily and after voiding or defecating
Check for infection
o Glans penis is dark red after circumcision, and then becomes covered w/yellow
exudate in 24 hrs, which is normal and lasts 2-3 days. Do not remove it
o Redness, swelling, discharge, aor odor indicates infection
Provide comfort
o Handle the area gently
o Provide extra holding, feeding, and opportunities for nonnutritive sucking for a
day or tow
31. Newborn gavage feed residual
In gavage feeding, breast milk or formula is given to the infant through a NG tube or
OG tube
o Can be done either intermittently or continuously
! Volume of the continuous feedings is recorded hourly, and the residual
gastric aspirate is measured q2-4 hr
Aspirates of < one hour volume can be refed to the infant
! For intermittent feedings, residuals of < 50% of the previous feeding
can be refed to the infant to prevent loss of electrolytes

Feeding is usually stopped if the residual is > 50% of the feeding or if


residuals are increasing

32. Newborn heat loss radiation


Radiation loss of heat from the body surface to a cooler solid surface that is close
to, but not in direct contact
o The nurse should keep the newborn and examining tables away from windows
and air conditioners
33. Newborn hematoma bilirubin
Trauma during birth vacuum assisted birth, forceps
! A cephalhematoma can result
As the hematoma resolves, hemolysis of RBCs occurs, levels of
bilirubin in the blood rise and jaundice results
!

No treatment is normally required

Phototherapy for babies with significant jaundice

34. Newborn newborn respiration


Once respirations are established, breaths are shallow and irregular, ranging from
30-60 breaths/minute, with pauses lasting < 20 seconds
o Apneic periods > 20 seconds are indicative of a pathologic process and should
be further evaluated
Newborns are nose breathers
Newborns are abdominal breathers
Signs of respiratory distress
o Nasal flaring
o Intercostal/subcostal retractions
o Grunting w/respirations
o Tachypnea
o Changes in infants color
35. Newborn newborn nursing care
Apgar scoring @ 1 and 5 minutes after birth
Physical assessment
Neurologic assessment
Gestational age assessment
Airway maintenance
Maintaining adequate oxygen supply
Maintaining body temperature
Eye/vitamin k prophylaxis
Umbilical cord care
Promoting parent-infant attachment
36. Newborn phototherapy home

Candidates for home therapy include healthy and active infants w/no signs/symptoms
of complications
Fiber optic bilirubin blankets are often used
Home care nurse assesses infants response to therapy via weight, feeding, output,
and temperature stability

37. Postpartum attachment


P 507-8
38. Postpartum breast assessment
Size/shape
Abnormalities, reddened areas, or engorgement
Presence of breast fullness d/t milk presence
Nipples for cracks, fissures, soreness, or inversion
Little change the 1st day; colostrum is present and may leak
39. Postpartum breast engorgement treatment
Instruct mother to feed every 2 hours; softening at least 1 breast and pumping the
other (to soften it)
Ice packs/gel packs, cold compresses after BF (15-20 minutes on, 45 minutes o)
Chilled cabbage leaves reduce swelling
Warm compresses, warm showers before BF
NSAIDS
Breast massage
Pumping
If bottle feeding, suggest a snug support bra b/c it limits milk production and reduces
discomfort
40. Postpartum home delivery Rh negative
Mom has 72 hours to get the Rhogam shot if baby is +
Midwife can give the shot
Babys cord blood is used to determine Rh status
41. Postpartum post epidural headache
Spinal headache is much more likely to occur when the dura is accidentally punctured
during administration of the epidural

Leakage of CSF from the site of puncture of the dura mater is thought to be the major
causative factor in postdural puncture headache
Assuming an upright position triggers or intensifies the headache
Assuming a supine position provides relief
Headache usually begins within 2 days of puncture and may persist for days/weeks

42. Postpartum postpartum assess


In addition to VS, physical assessment of the PP woman includes BUBBLE-HE

B Breasts
! Size/shape
! Abnormalities, reddened areas, or engorgement
! Presence of breast fullness d/t milk presence
! Nipples for cracks, fissures, soreness, or inversion
! Little change the 1st day; colostrum is present and may leak
U Uterus
! Palpate for firmness
! Location of fundus; normal finding in 1st 24 hours is midline at level of
umbilicus, involutes 1cm/day
B Bowel
! Bowel sounds in all 4 quadrants should be active in all quadrants
! Bowel movement (by day 2 or 3 after birth is normal)
B Bladder
! Ability to void spontaneously
! Distention
! Pain/burning during urination
! Does pt. feel like she is emptying bladder completely?
L Lochia/legs
! Lochia
Color of lochia
o Day 1-3; nubra (dark red)
o Day 4-10; serosa (brownish red/pink)
o After day 10; alba (yellowish white)
Amount; scant to moderate - > 1 pad/hr indicates PPH
Clots anything > 1cm is abnormal
Odor foul may indicate infections
! Legs
Deep tendon reflexes 1+ to 2+
Peripheral edema can you see/feel ankle bones?
E Episiotomy/laceration/Perineum
! Episiotomy/laceration
Edges approximated
! Perineum
Redness, edema, ecchymosis, and discharge
Level of pain
H Hemorrhoids
! If present; should be soft and pink
! Takes up to 6 weeks to decrease in size
E Energy level/emotions
! Able to care for self/infant; able to sleep
! Exited, happy, interested or involved in infant care

43. Postpartum postpartum rubella immunization


Rubella vaccine
o Women who have not had rubella or who are serologically not immune, a
subcu injection of rubella vaccine is recommended in PP to prevent possibility
of contracting rubella in future pregnancies
o B/c virus is shed in urine and other body fluids, vaccine should not be given if
mother or other household members are immunocompromised
o BF mother can be vaccinated
o Requires informed consent; including information about possible s/e and risk
of teratogenic eects
o Women must practice contraception to prevent pregnancy for 1 month after
being vaccinated
o M/c side eects are fever, lymphadenopathy, and arthralgia
44. Postpartum spinal headache blood patch
Leakage of CSF from the site of puncture of the dura mater is thought to be the major
causative factor in postdural puncture headache (PDPH), aka spinal headache
Treatment w/blood patch is considered if headache is severe or debilitating or does
not resolve after conservative management

Epidural blood patch the womans blood is injected slowly into the lumbar epidural
space, creating a clot that patches the tear or hole in the dura mater
Blood patch is nearly complication free

45. Antepartum diabetes


Specific assessments to assess the eects of the diabetes, specifically retinopathy,
nephropathy, peripheral and autonomic neuropathy, peripheral vascular, and cardiac
involvement
In addition to baseline laboratory tests, renal function may be assessed w/a 24 hour
urine collection for total protein excretion and creatinine clearance
Urinalysis and culture to assess for the presence of a UTI (more common in diabetics)
Glycosylated hemoglobin A1c provides a measure of glycemic control over the last
4-6 weeks
o Hgb A1c > 6 indicate elevated glucose levels
Fasting glucose levels may be assessed during antepartum visits
Euglycemia is the goal of treatment
o Glucose levels in the range of 65-90 mg/dl before meals
o Glucose levels in the range of 130-140 mg/dl after meals
Woman should wear a medical identification bracelet
Prenatal visits more often; 1st/2nd trimester q 1-2 weeks, 3rd trimester once/twice
each week
46. Intrapartum herpes

Maternal infection w/HSV-2 can have adverse eects on both mother and fetus
o Viremia (virus in the blood) occurs during the primary infection
o Primary infections during 1st trimester are associated w/increased miscarriage
rates
Most severe complication of HSV is neonatal herpes, potentially fatal/severely
disabling disease
No known cure
Antiviral meds to partially control symptoms include acyclovir, Val acyclovir, and
famciclovir
o Safety of these antivirals has not been established; however may be used to
reduce the symptoms if benefits to the woman outweigh the potential harm to
the fetus

47. Newborn heel-stick - best method


Warming the heel before the sample is taken is often helpful (heat 5-10 minutes helps
dilate vessels)
o Cloth soaked w/warm water and wrapped loosely around foot provides
warming
Nurse cleanses area w/appropriate skin antiseptic, restrains the infants foot w/free
hand, and then punctures the site (automatic puncture device causes less pain and
requires fewer punctures)
Heel stick - outer aspect of heel and should penetrate no deeper than 2.4 mm
After specimen is collected, pressure should be applied w/dry gauze; site is then
covered w/bandage
48. Newborn hip dysplasia Ortolanis maneuver
Hip integrity is assessed using the Barlow test and the Ortolani maneuver
o For the Barlow test, the hip is flexed to 90 and adducted followed by gentle
downward pushing of the femoral head, if hip can be dislocated, the femoral
head moves out of the acetabulum and examiner feels a clunk
o The hip is then checked to determine if the femoral head can be returned to the
acetabulum using the Ortolani test; as the hip is abducted and upward
leverage is applied, a dislocated hip will return to the acetabulum with a clunk


49. Newborn thrush
Oral candidiasis is characterized by white plaques on the oral mucosa, gums, and
tongue
Infants who are sick, debilitated, or receiving ABX are more susceptible to thrush
Interventions
o Maintenance of scrupulous cleanliness to prevent reinfection
o Careful hand hygiene
o Proper cleanliness of equipment and environment
Infant is treated w topical application of 1 ml Nystatin over surface of oral cavity four
times a day
o To prevent relapse therapy should be continued for at least 2 days after lesions
disappear
If infant is BF, the mother is also treated w/topical antifungal preparation such as
Nystatin applied to the nipples
50. Antepartum teaching childbirth education
Health promotion
o The nurse should stress healthy behaviors that promote the health of the
pregnant woman and her fetus
Preparation for pregnancy and birth
o Nurses should provide anticipatory teaching about physical/emotional
changes, danger s/s to report, various birthing options
o Use a variety of educational methods, such as pamphlets and videos, and
have the client verbalize and demonstrate learned topics
Common discomforts of pregnancy
o P 354-5
Danger signs to report
o Gush of fluid from the vagina (rupture of amniotic fluid) prior to 37 weeks
gestation
o Vaginal bleeding (placental problems such as abruption or previa)

o
o
o
o
o
o
o
o
o
o
o
o
o

Abdominal pain (premature labor, abruptio placenta, or ectopic pregnancy)


Changes in fetal activity (decreased fetal movement may indicate fetal distress)
Persistent vomiting (hyperemesis gravidarum)
Severe headaches (pregnancy-induced hypertension)
Elevated temperature (infection)
Dysuria (urinary tract infection)
Blurred vision (pregnancy-induced hypertension)
Edema of face and hands (pregnancy-induced hypertension)
Epigastric pain (pregnancy-induced hypertension)
Concurrent occurrence of flushed dry skin, fruity breath, rapid breathing,
Increased thirst and urination, and headache (hyperglycemia)
Concurrent occurrence of clammy pale skin, weakness, tremors, irritability, and
lightheadedness (hypoglycemia)
Signs of preterm labor

51. Postpartum cultural blood transfusion


52. Postpartum discharge teaching
Self-management topics
o Perineal care
o Breast care
o Nutrition
o Rest/sleep/exercise
o Family planning
o Sexual intercourse/contraception
o Medications
S/S of potential complications to report
o Chills or fever greater than 38 C (100.4 F) for 2 or more days
o Change in vaginal discharge with increased amount, large clots, change to a
previous
o lochia color such as bright red bleeding, and a foul odor
o Normal lochia flow pattern shows
! Bright red vaginal drainage for 2 to 3 days.
! Blood-tinged serous vaginal drainage from days 4 to 10.
! White vaginal discharge from day 11 to 6 weeks.
o Episiotomy, laceration, or incision pain, that does not resolve with analgesics,
foul smelling drainage, redness, and/or edema
o Pain/tenderness in the abdominal or pelvic areas that does not resolve with
analgesics
o Breast(s) with localized areas of pain and tenderness with redness and swelling
and/or nipples with cracks or fissures
o Calves with localized pain and tenderness, redness, and swelling. A lower
extremity with either areas of redness and warmth or coolness and paleness

Urination with burning, pain, frequency, urgency; urine that is cloudy or has
blood
Psychosocial problems
o Postpartum depression is when the client feels apathy toward the infant,
cannot provide self- or infant-care, or has feelings that she might hurt herself or
her infant
Follow up
o The client should be discharged with an appointment set for a postpartum
follow-up visit or a number to call and schedule an appointment
o Following a vaginal delivery the follow up visit should take place in 6 weeks
o Following a cesarean birth the visit should take place in 2 weeks

53. Abuse/newborn cocaine exposure


Cocaine crosses the placenta and is found in breast milk
Cocaine is a recognized cause of placental abruption
Neonatal eects
o Prematurity
o SGA
o Placental or cerebral infarctions
o Hyperactivity
o Dicult to console
o Increased risk for SIDS
o Hypersensitivity to noise and external stimuli
o Reduction in verbal reasoning
54. Mental health/maternity depress/grief/intrapartum still birth
There is an early period of acute distress and shock followed by a period of intense
grief that includes emotional, cognitive, behavioral, and physical responses
Parents reach the phase of reorganization when they return to their usual level of
functioning in society
Parental grief can extend for months to years
Phase of acute distress
o Shock
o Numbness
o Intense crying
o Depression
Phase of intense grief
o Loneliness
o Guilt
o Anger, resentment, bitterness, irritability
o Fear/anxiety
o Disorganization diculties w/cognitive processing
o Sadness/depression
o Physical symptoms

Reorganization phase
o Search for meaning
o Reduction of distress
o Reentering normal life activities w/more enthusiasm
o Can make plans, including discussion about another pregnancy

55. Mental health/maternity depress/grief/postpartum PP depression assess


Be an active listener and demonstrate a caring attitude b/c women may not volunteer
unsolicited information about their depression
Observe for signs of depression
Ask appropriate questions to determine moods, appetite, sleep, energy, and fatigue
levels, and ability to concentrate
Use a screening tool to assess whether the depressive symptoms have progressed
from PP blues to PP depression
If depression is identified, ask if the mother has thought about hurting herself or the
baby