PN Maternal Newborn Nursing Critical Thinking Safety and Infection Control 1.

What should the nurse teach the family about car seats?
The infant should always be in a rear-facing car seat from birth to 9.1 kg (20 lb) and 1 year of age. It is recommended to have the infant ride rear facing until he has reached the height and weight limit allowed by the manufacturer of the car seat.

2. What are signs and symptoms of abstinence withdrawal syndrome?

Frequent, small feedings of high-calorie formula may need gavage feedings. Elevating the infants head during and following feedings, and burping the infant well to reduce vomiting and aspiratin Trying various nipples to compensate for a poor suck reflex. Having suction available to reduce the risk for aspiration. For cocaine addicted infants, avoiding eye contact and using vertical rocking and a pacifier

Health Promotion and Maintenance 3. Contraception The nurse should provide client counseling on contraception and modification of risky sexual behaviors. Oral contraceptive effectiveness decreases when taking medications that affect liver enzymes such as anticonvulsants and some antibiotics. 4. What kind of birth control would be contraindicated for a breastfeeding mother? Pill is taken within 72 hr after unprotected coitus. Primary care provider or nurse will recommend an over-the-counter antiemetic to be taken 1 hr prior to each dose to counteract the side effects of nausea that can occur with high doses of estrogen and progestin. Advise the woman to be evaluated for pregnancy, if menstruation does not begin within 21 days. List at least two contraindications to diaphragm use. Diaphragms are inconvenient, interfere with spontaneity, and require Reapplication of spermicidal gel, cream, or foam with each act of coitus tobe effective. 5. When should a woman be refitted for her diaphragm? Diaphragm is not recommended for clients who have a history of toxic shock syndrome (TSS) or frequent, recurrent urinary tract infections. TSS is caused by a bacterial infection. Signs and symptoms include high fever, a faint feeling and drop in blood pressure, watery diarrhea,headache, and muscle aches. Proper handwashing aids in prevention of TSS as well as removingdiaphragm promptly at 6 hr following coitus. Antepartum 6. What is the definition of oligohydramnios? Oligohydramnios, which can lead to intrauterine fetal death, fetal cord compression, and intrauterine growth restriction (IUGR). 7. What is the definition of polihydramnios? Polyhydramnios, which can lead to fetal congenital anomalies and abnormal fetal presentation. 8. What is the purpose of the nonstress test (NST)? Heart rate to accelerate with fetal movement

The NST is interpreted as reactive if the FHR accelerates to 15 beats/min for at least 15 sec and occurs two or more times during a 20-min period. This assures that the placenta is adequately perfused and the fetus is well-oxygenated. How does the nurse determine the expected date of delivery or due date and what is this called? Ngeles rule take the first day of the last menstrual cycle, subtract3 months, and add 7 days and 1 year.Remember to take into account how many days there are in eachparticular month when adding 7 days. 9. Which foods contain large amounts of folic acid? Increasing protein intake is essential to basic growth. Also, increasing the intake offoods high in folic acid is crucial for neurological development and preventioof neural tube defects. Foods high in folic acid include leafy vegetables, dried peasand beans, seeds, and orange juice. Breads, cereals, and other grains are fortifiedwith folic acid. Physiological Adaptation 10. What are 3 physiological changes of pregnancy during the first trimester? Amenorrhea Nausea and vomiting Fatigue Urinary frequency Breast change Breast changes Breast tenderness may occur during the first trimester. The client should wear a bra that provides adequate support 11. Gestational diabetes is diagnosed with what test? Restricting dietary intake of calories and carbohydrates.Educating the client on monitoring blood glucose and diet management. Test for glucose tolerance 1 hr,2hr,3hr. 12. What are the risk factors from gestational diabetes? Maternal age older than 30 years. Obesity. Family history of diabetes. Previous delivery of a large or stillborn infant 13. At what point should the mother feel her baby kicking and what is this called? It is recommended that mothers count fetal activity 2 or 3 times aday for 60 min each time. Fetal movements of less than 3 in/hr or movements that cease entirely for 12 hrindicate a need for further evaluation. 14. List at least 5 dangers signs during pregnancy or symptoms the patient should always report to her provider Gush of fluid (rupture of amniotic membranes) Gush of fluid from the vagina (rupture of amniotic fluid) prior to 37 weeksgestation. Vaginal bleeding (placental problems such as abruption or previa). Abdominal pain (premature labor, abruptio placenta, or ectopic pregnancy). Persistent vomiting (hyperemesis gravidarum). Severe headaches (pregnancy-induced hypertension). Elevated temperature (infection, urinary tract infection). Dysuria (urinary tract infection 15. Fill in the blanks:

If the father of the infant is Rh______postive____, and the mother is Rh____ngative______ and Coombs is ____indrect_________ an injection of RhoGAM will be administered _____28______ week and within ____72_________ hours of birth. 16. Rh incompatibility can cause symptoms ranging from very mild to fatal. In its mildest form, Rh incompatibility causes destruction of red blood cells. Rh incompatibility is almost completely preventable. Rh-negative clients require assistance with the performance of a Kleihauer-Betketest. The test detects the presence and amount of fetal blood in the maternalcirculation because manipulation can cause fetomaternal bleedin Complications of Pregnancy 17. List three signs of impending pregnancy induced hypertension (PIH) Abdominal pain, blurrey vision, reduced urine output, 18. The medication of choice to prevent seizures is _ magnesium sulfate ________ __________ 19. List at least 3 signs of magnesium sulfate toxicity Absence of patellar deep tendon reflexes. Urine output less than 30 mL/hr. Respirations less than 12/min. Decreased level of consciousness 1. Your client is experiencing a placental abruption. Which patients are at highest risk for placental abruptio? What are the signs and symptoms? Abruptio placenta is the premature separation of the placenta fromthe uterus, which can be a partial or complete detachment Vaginal bleeding, sharp abdominal pain, and tender rigid uterus. 2. Your client has placenta previa. What are the signs and symptoms? What are the appropriate nursing actions? Placenta previa occurs when the placenta abnormally implants in thelower segment of the uterus near or over the cervical os instead ofattaching to the fundus Painless bleeding as the cervix dilates 3. What are the 4 Ps of birth? Passenge, Passageway,Power, Position of laboring woman 4. How should the nurse assess uterine contractions? uterine contractions cause effacement and dilation of the cervix anddescent of the fetus. Involuntary urge to push and voluntary bearing down in thesecond stage helps in the expulsion of the fetus 5. List and describe the 4 stages of labor and 3 phases. First stage labor pain is an internal visceral pain that may be felt as back and leg pain. Pain is caused by: Dilation, effacement, and stretching of the cervix. Distention of the lower uterine segment. Contractions of the uterus with resultant uterine ischemia. Second stage labor pain with the event of fetal descent and expulsion is a localized somatic pain. Pain is caused by: Pressure and distention of the vagina and the perineum, described by the client as burning, splitting, and tearing. Pressure and pulling on the pelvic structures (ligaments, fallopian tubes, ovaries, bladder, and peritoneum). Lacerations of soft tissues (cervix, vagina, and perineum).

Third stage labor pain with the expelling of the placenta is similar to the

pain experienced during the first stage. Pain is caused by: Uterine contractions. Pressure and pulling of pelvic structures. Fourth stage pain is caused by: Distention and stretching of the vagina and perineum incurred during the second stage with a splitting, burning, and tearing sensation. 6. What is the most common adverse effect of epidural administration? Adverse effects of an epidural block include: Maternal hypotension. Fetal bradycardia. Inability to feel the urge to void. Loss of the bearing down reflex 7. Briefly describe: early decelerations, late decelerations, variable decelerations and what nursing actions should be taken. Early deceleration of FHR (slowing of FHR with start of contraction with return of FHR to baseline at end of contraction)\Compression of the fetal ,head resulting from uterine ,contraction,Vaginal exam,Fundal pressure. Late deceleration of FHR (slowing of FHR after contraction has started with return of FHR to baseline well after contraction has ended) Change the client to a sidelying position.Administer oxygen 8 to 10 L/min per mask.Start an IV line if not in place or increase the IV rate Variable deceleration of FHR (transitory, abrupt slowing of FHR <110 beats/min, variable in duration, intensity, and timing in relation to uterine contraction. 8. What is the purpose of an amnioinfusion? Amnioinfusion of normal saline or lactated Ringers solution as prescribed isinstilled into the amniotic cavity through a transcervical catheter introduced intothe uterus to supplement the amount of amniotic fluid. The instillation will reduceseverity of variable decelerations caused by cord compression or dilute meconiumstained amniotic fluid 9. What are some of the fetal risks related to a vacuum assisted delivery? Cephalohematoma. Scalp lacerations. Subdural hematoma of the neonate. Maternal lacerations to the cervix, vagina, or perineum 10. List at least 2 risk factors for cord prolapsed. Rupture of amniotic membranes (ROM)It is necessary to check FHR immediately following rupture ofmembranes. Abnormal fetal presentation.Any presentation other than vertex (occiput is the presenting part)Transverse lie

Postpartum Nursing Care

11. At what rate should uterine involution occur? Administering oxytocics intramuscularly or intravenously as prescribed after the placenta is delivered to promote uterine contractions and to prevent hemorrhage. 12. What is lochia is called immediately after birth, 34 days following birth and 10 days after birth? Lochia rubra bright red color, bloody consistency, fleshy odor, may contain small clots, transient flow increase during breastfeeding and upon rising. Lasts 1 to 3 days after delivery. Lochia serosa pinkish brown color, serosanguineous consistency, contains old blood, serum, leukocytes, and tissue debris. Lasts from approximately day 4 to day 10 after delivery. Lochia alba yellowish, white creamy color, fleshy odor, contains leukocytes, decidua, epithelial cells, mucus, serum, and bacteria. Lasts from approximately day 11 up to and beyond 6 weeks postpartum. 13. The patients fundus is deviated to the left of the umbilicus. What is the most likely reason? Preventing uterine inversion by the avoidance of strong pulls on the umbilical cord unless the placenta has definitely separated. 14. A client is experiencing uterine atony. What do you expect to see? What are your actions? Uterine atony is a hypotonic uterus that is not firm and is described as boggy. The inability of the uterine myometrium to contract and stay contracted around the open blood vessels of the uteroplacental implantation site is the most common cause of postpartum hemorrhage. 15. What would you teach a bottle feeding mother about reducing the symptoms of breast engorgement? For breast engorgement, use cool compresses between feedings and use warm compresses or a warm shower to the breasts prior to breastfeeding to increase milk flow and letdown reflex 16. What should the nurse teach the client about resuming sexual activity following childbirth? Teach the client to avoid sexual intercourse until the episiotomy/ laceration is healed and vaginal discharge has turned white (lochia alba). This usually takes 2 to 4 weeks or until the client is seen by herprimary care provider/midwife. 17. List at least 5 factors would increase the risk for postpartum infection. Monitor for signs and symptoms of all puerperal infections, which include: Elevated temperature of at least 38 C (100 F) for two or more consecutive days. Flu-like symptoms such as body aches, chills, fever, and malaise. Tachycardia and an increased pulse rate. Anorexia and nausea. 18. List the 4 most common types of postpartum hemorrhage. Pain is the distinguishable symptom of hematomas rather than noticeable bleeding. Postpartum lacerations and hematomas can result in postpartum hemorrhage or infection of the laceration 19. List at least 4 risk factors for postpartum hemorrhage. Uterine atony. Complications during pregnancy (e.g., placenta previa, abruptio placenta). Precipitous delivery. Administration of magnesium sulfate therapy during labor. Lacerationi. Inversion of uterus

20. What are the signs and symptoms of postpartum depression? What are the risk factors? What are your interventions? Postpartum depression occurs in approximately 50 to 80% of women during the first few days after birth and generally continues for up to 10 days. It is characterized by tearfulness, insomnia, lack of appetite, and feeling of letdown. The mother may experience an intense fear and/or anxiety, anger, and inability to cope with the slightest problems and become despondent 21. Risk factors: Feelings of guilt and inadequacies. Irritability. Lack of appetite and weight loss. Persistent feelings of sadness and intense mood swings. Flat affect. Ambivalence toward infant and family 22. How would you describe postpartum psychosis? What are your interventions? Identifying the source of the bleeding. Assisting the primary care provider with repair procedures. Treating small vulvar hematomas with the application of ice packs. Encouraging sitz baths. Encouraging cleansing of the perineal area with a water bottle filled with warm tap water after voiding and defecation 23. What are the signs and symptoms of a perineal hematoma? Operative vaginal birth (e.g., forceps-assisted, vacuum assisted birth). Precipitate birth. Cephalopelvic disproportion.Size (macrosomic infant) and abnormal presentation or position of the fetus. Prolonged pressure of the fetal head on the vaginal mucosa. Previous scarring of the maternal birth canal from infection, injury, or operatio Newborn nursing care 24. Describe: average for gestational age (AGA): large for gestational age (LGA): small for gestational age (SGA) Small for gestational age= Babies are born with low birth weight or below the 10th percentile. Neonate may be premature or postmature Fetus doesnt receive required nutrition to support growth. Chromosomal abnormalities and intrauterine infection can cause SGA . 25. Factors that can cause SGA are: Advanced diabetes Age older than 35 Drug use Gestational hypertension Smoking Large for gestational age= Birth weight at or above the 90th percentile Large babies are subjected to an overproduction of growth hormone in utero. Male neonates are larger than female neonate. Immature reflexes

26. What are circumcisions not done immediately following birth? Phimosis. Phimosis means that the foreskin is too tight to be pulled back over the head of the penis. If it is pulled back and then not pulled forward again, the head of the penis may swell and become very painful. Many boys cannot move the foreskin all the way back until they reach 10 years of age or older. By the time boys are into puberty, they should be able to pull the foreskin back and forth easily. Therefore, most young boys do not need circumcision just because the foreskin will not pull back. In some cases, however, the foreskin is so tight that urine collects inside of it and balloons out every time they urinate. These boys need to be circumcised. Birth defects of the penis. When the penis is severely bent, the skin is attached to the skin of the scrotum, or the opening is in the wrong place, surgery should be performed to correct the problem, and circumcision is usually performed at the same time. Balanitis. Some boys get episodes of swelling and redness of the head of thepenis, sometimes affecting the entire penis. These are infections that can be easily treated. However, if the problem recurs, circumcision is sometimes recommended. Urinary tract infections. Some evidence suggests that uncircumcised boys are more likely to get urinary tract infections. After the first year of life these infections are rare and tend to be mild when they occur. 27. What are Mongolian spots?
The Mongolian spot is a congenital developmental condition exclusively involving the skin. Its blue spots usually occur on the sacral area. The blue color is caused by melanocytes.

28. What is the fine downy hair on a newborns back called? Lanugo 29. When the newborns cheek is stroked she turns her head in the direction of the stroke. What is this reflex called? Root reflex 30. What 2 prophylactic medications do all newborns receive in the first hour of life? silver nitrate solution for Ophthalmia Neonatorum Erythromycin Ointment for Chlamydia Infections 31. A newborn has hyperbilirubinemia and is receiving phototherapy why? Hyperbilirubinemia is an elevation of serum bilirubin levels resulting in jaundice. Jaundice normally appears in a cephalocaudal manner, first being noticed in the head (especially the sclera and mucous membranes), and then progresses down the thorax, abdomen, and extremities. A mask should be placed over the newborn eyes to prevent injury from the light. 32. What are 3 possible complications of this therapy? How do you prevent these complications? Maculopapular skin rash, not a serious complication Development of pressure areas Dehydration (e.g., poor skin turgor, dry mucous membranes, decreased urinary output Phototherpy can result dehydration.which will result in decreased urinary output. 33. Explain the complications of cold stressing a neonate. Explain how you would promote thermoregulation with this infant to prevent complications.

Providing thermoregulation in an incubator to avoid cold stress. Ensure thermoregulation (neutral thermal environment) to maintain the premature infants body temperature.