ATI Notes for Maternal Newborn

Newborn vitals and labs ● RR - 30-60 in expected range ● HR - 110-160 ● BP 60-80 SBP / 40-50 DBP ● Temp - 36.5-37.5 (97.7F - 99.5 F) ● Length - 45-55cm (17.7-21.7 in) ● Weight - 2.5-4 kg (5.5lb - 8.8 lb) ● Blood g ...

Newborn vitals and labs ● RR - 30-60 in expected range ● HR - 110-160 ● BP 60-80 SBP / 40-50 DBP ● Temp - 36.5-37.5 (97.7F - 99.5 F) ● Length - 45-55cm (17.7-21.7 in) ● Weight - 2.5-4 kg (5.5lb - 8.8 lb) ● Blood glucose - 40 - 60 mg/dL(hypo when <40-50) ● Hgb - 14-24 g/dL ● RBC- 4.8-7.1 ● HCT - 44-64% ● Platelets - 150,000-300,00 ● Leukocytes - 9000 - 30,000 ● Bilirubin ○ 24 hours - 2-6 mg/dL ○ 48 hours - 6-7 mg/dL ○ 3-5 days- 4-6 mg/dL Expected maternal lab values ● ESR: 0-29 ● Cr: 0.5-0.11 ● BUN: 10-20 mg/dL ● HgB 10.5-11 ● Hct: 37-47 ● RBC: 4.2-5.4 ● WBC: 5,000 - 10,000 ● Fe: 60-160 mcg/dL ● Platelets: 150,000 - 450,000 ● Albumin: 3.5-5 ● Normal glucose level 70-110 mg/dL during pregnancy ● Na: 135-145 ● Calcium: 9.0-10 ● Cl: 98-106 ● Magnesium: 1.3 - 2.1 ● Urine specific gravity: 1.015-1.030 General ● Toxoplasmosis is teratogenic and asymptomatic ○ Syphilis, rubella are also teratogenic ● Rash is manifestation of rubella ● Allergies ○ Baker’s yeast contraindication for hepatitis B vaccine ○ Shellfish allergy CI to contrast dye (contains iodine) ○ Gelatin allergy CI to MMR vaccine ○ Egg allergy CI to influenza vaccine ● PKU, cystic fibrosis, sickle cell anemia are autosomal-recessive ● Use McRoberts maneuver to resolve shoulder dystocia ○ Flex knees apart and raise to abdomen which rotates the pubic bone anteriorly 1○ This releases anterior shoulder ○ Can also position patient on hands and knees to help rotate fetus from a posterior to anterior position for dystocia ● Indications for CS: abnormal FHR, malpresentation, HIV, active herpes, congenital anomalies ● Isotretinoin cream is used to treat acne and is teratogenic ● Graafian follicle expels ovum ● Frequent cough during pregnancy indicates cardiac decompensation, must be reported to provider ● Gastric bypass puts clients at risk for folate deficiency ● Sickle cell anemia iron levels are usually 6-8 ● In bladder distention, bladder sounds dull with percussion, uterus is above umbilicus, displaced to the right and fluctuates with palpation ● Pelvis shape ○ Gynecoid is well-rounded with a wide pubic arch, ideal for vaginal birth ○ Android, anthropoid, or platypelloid might have difficult with vaginal birth and may need CS ● Newborn with congenital diaphragmatic hernia will have a barrel-shaped chest ● Couvade syndrome is pregnancy like manifestations experienced by the expectant father - nausea, weight gain ● SSRI withdrawal includes irritability, agitation, tremors, diarrhea, vomiting ○ Fetus experiences hypoglycemia, lbw, tachycardia ● For DVT place on bed rest and use warm compresses ● Intrauterine pressure catheter is necessary to determine uterine contraction intensity and if they’re adequate for progression of labor ● Hispanic birth practices ○ Protect client’s head and feet from cold air ○ Delay bathing for 14 days following delivery ○ Bed rest for 3 days following delivery ○ Drink warm beverages following birth ● For a client with parvovirus, schedule ultrasound to detect fetal hydrops ● For maternal PKU, avoid foods high in protein Contraception ● Barrier methods: condoms, diaphragms ○ Client must be re-fitted by provider every 2 years for diaphragm or if they have a 20% weight change or have a full-term pregnancy or 2nd term abortion ○ When using diaphragm have to use spermicide for each act of coitus ○ Diaphragm must remain in place for 6 hours after sex ○ Can insert up to 6 hours before intercourse ● Hormonal methods (OCPs) ○ Side effects: chest pain, SOB, leg pain (DVT), headache/eye problems (stroke/HTN) ○ Want to pay attention to these side effects ○ If someone smokes, don’t recommend hormonal contraceptives (OCPs) ○ CI: hx of blood clots, stroke, cardiac problems, breast cancers, smoker, cholecystitis, HTN, migraines ○ Can’t use if on anticonvulsants, antifungals, and HIV protease inhibitors ● Depo-provera ○ Can cause decreased bone mineral density/loss of calcium ○ Make sure client has adequate calcium/vitamin D intake ● IUD 2○ Increase risk of PID ○ Can cause uterine perforation/ectopic pregnancy ○ Increases risk for ectopic pregnancy ○ Pay attention to change in string length, foul smelling discharge, pain with discharge, fever, chills ○ CI: menorrhagia, severe dysmenorrhea, history of ectopic pregnancy ● Levonorgestrel ○ Emergency contraception, inhibits ovulation ○ Must take within 72 hours after sexual intercourse Infertility ● Inability to conceive for at least 12 months ● Work up - start with guy/sperm analysis, then turn to women ● Tests with female - make sure woman doesn’t have allergy to iodine or seafood for tests with dye Maternal newborn nursing video 2 - Ch 3 Signs of pregnancy ● Presumptive signs ○ Things that can be explained by a reason other than pregnancy ○ Ex: amenorrhea, fatigue, n/v, urinary frequency, breast changes, fluttering in stomach ● Positive signs ○ Very distinct things ○ Ex: fetal heart signs, see baby with ultrasound, feel movement in uterus ● Probably signs ○ Signs that are in-between ○ Ex: abdominal enlargement, ■ Hegar's sign (softening/compressibility of uterus), ■ chadwick's sign (bluish color of the cervix), 6-8 weeks ■ goodell’s sign (softening of the cervical tip), 4 weeks ■ bolatment (rebound of unengaged fetus), ■ braxton-hicks, ■ positive pregnancy test (hormones could just be jacked up), ■ fetal outline felt by examiner, increased sensitivity of cervix ● Common physiological adaptation to pregnancy ○ Breast tenderness, larger and darker areolas ○ Spotting should be reported to provider ○ Increase in vaginal secretion (thin, white, odorless) ○ Dependent edema on the feet ○ Cardiovascular: increase in output (30-50%), blood volume (30-45%, and HR ○ Respiratory: oxygen needs increase, lung capacity decreases, RR increase ○ Cervical: becomes softer, blue/purple color ○ Skin: chloasma (brown patches on face, lines nigra, striae gravidarum ○ Will use new sexual positions for intercourse based on pregnancy weight change Naegele's rule ● Due date based on last menstrual cycle ● SUbtract three months, add 7 days ● Cathy's rule: add 9 months + 1 week 3GT- PAW acronym (florida power and light) ● Gravity - number of pregnancies ● Term births - 36 weeks and more ● Pre-term - less than 36 weeks ● Abortions and miscarriages ● Living children Maternal newborn nursing video 3 - Ch 5,6 Weight gain ● Normal - weight gain 25-35 pounds ● Overweight - 15-25 pounds ● Underweight - 28-40 pounds ● During 1st trimester shouldn’t gain more than 1-2kg (2-4 lbs) ● After 1st trimester, expect 1lb per week for last two trimesters Nutrition ● 340 extra calories per day second trimester ● 452 extra calories per day last trimester ● If breastfeeding, need 300-500 extra calories per day ● Folic acid: ○ Need 600 mcg a day ○ huge deal, prevents fetal neural tube defects ○ Dark green leafy vegetables, orange juice ● Increase protein intake to 71mg 2nd and 3rd trimester ● Drink 2-3L water per day ● Limit caffeine intake 300 mg per day ● Do not eat swordfish, shark, or other fishes ● No ETOH ● To prevent n/v: eat cool foods that are salty/tart and carbohydrates in morning Exercise ● Vigorous or strenuous activities limited to no longer than 20 minutes ● Should exercise 3 times per week for 30 minutes Pregnancy interventions ● Backpain ○ Pelvic tilt exercises, resting, sleeping on firm mattress ease back pain ○ Avoid lying on back (supine hypotension) ● UTIs ○ Avoid bubble baths ● Diagnostics during pregnancy ● Ultrasound (non-invasive) ○ Want bladder full, helps sound levels resonate ○ Have patient drink a quart of water prior ● Amniocentesis (invasive) ○ Empty bladder ● BPP ○ Score between 0-10 4■ 8-10 normal, healthy baby ○ Measures: ■ Reactive HR: reactive=2, non-reactive=0 ■ Breathing: 1 or more >30 seconds=2, absent or <30=0 ■ Body movements: 3 or more body/limb extensions return to flexsion=2, less than 3=0 ■ Fetal tone: 1 or more extensions return to flexion=2, lack of or absent movement=0 ■ Amniotic fluid volume: 1 pocket >2cm in 2 perpendicular planes=2, absent or <2cm pockets=0 ○ Mother will be delivered if score of 4 or lower or at 36 weeks ga with a score of 6 ● NST ○ Non-invasive ○ Measures fetal well-being in last trimester of pregnancy ○ MEasures response of fetal HR to fetal movement and uterine contractions ■ Frequency - evaluating time from beginning of one contraction to the next ■ Duration - length from beginning to end of contraction ○ Considered reactive (normal) if fetal HR accelerates during movement - positive ○ Non-reactive if FHR (not-normal) does not accelerate adequately - negative ○ Fetal heart rate should increase 15 bpm while fetus moves and remain increased for 15 seconds ○ Orange juice before test promotes fetal movement ○ Use vibroacoustic stimulation on abdomen for 3 sec if no fetal movement detected ○ Considered non-reactive after 40 minutes of continuous monitoring with no accelerations in FHR Other diagnostics ● Contraction stress test ○ Bring contractions through oxytocin/pitocin/nipple stimulate ○ Late decelerations are never good ○ If no late decelerations - negative test result (GOOD) ■ No late deceleration of FHR with 3 contractions in 10 min. Period ○ If late decelerations - positive test result (BAD) ■ Late deceleration present in 50% or more of contractions, indicative of uteroplacental insufficiency ○ Can send women into preterm labor ● Amniocentesis ○ Want empty bladder ○ Tests genetic fluid for fetal genetic abnormalities ○ Done around 14 weeks GA ○ Ultrasound done first to locate pocket of fluid ○ Testing for levels of AFP, alphafoto protein ■ If AFP high, associated with neural tube defects ■ If AFP low, associated with chromosomal disorders - down syndrome ■ This test is done around 15-22 weeks ○ Tests for LS ratio ■ Leucotin sphingomyelin ■ Tests for fetal lung maturity ○ Risks: amniotic fluid emboli, hemorrhaging, infection, leaking of fluid, rupture of membranes, miscarriage ○ Might cause uterine cramping or mild discomfort ○ Asses fetal heart tones and uterine tone prior to and throughout procedure to establish a baseline 5○ Priority After: monitor FHR ○ After procedure administer Rhogham for Rh-negative moms, encourage rest and plenty of fluids for 24 hours ○ Complications: amniotic fluid emboli, hemorrhage, infection, leakage of amniotic fluid, PROM, miscarriage ● Corianc viliv sampling (CVS) - alternative to amniocentesis ○ 10-12 weeks GA ○ Take tiny piece of placenta and test that ○ Advantage: done earlier ○ Complications: PROM, miscarriage ● Kleinheur-Betke test ○ Used to determine the amount of fetal blood circulating in the maternal blood when there is a risk of Rh-isoimmunization ● Cordiocentesis ○ Used to identify fetal blood type and RBC when there is a risk of isoimmune hemolytic anemia ● Intermittent auscultation ○ Does NOT determine variability, need continuous FHR monitoring ○ Can determine baseline ○ Can reveal auditory accelerations and decelerations ○ Nurse should palpate and count the maternal pulse while listening to the fetal heart rate to validate findings and distinguish maternal pulse from the fetal heart ○ Establish baseline fetal heart rate by counting for 30-60 seconds after each contraction ○ Listening device should be placed over the fetal back ● Kick count ○ Daily fetal movement count (DFMC) ○ Before bedtime or after meals for 2 hours or until 10 movements are counted ○ Or client can count all movements in a 12 hour period ○ Can be done once a day but should be for 60 minutes ● Bishop score ○ Indicates cervial favorability for labor inducibility by assessing cervical dilation, effacement, station, consistency, position ○ Score of 8 or more favors successful induction ○ Dinoprostone - a cervical ripening agent, used for scores less than 8 Other tests before labor ● Strep B ○ Done at 35-37 weeks ○ Provide penicillin intrapartum ○ If status unknown, fever >38 degrees C, or ROM > 18 hours give antibiotics ● Urinalysis ○ Check for protein in urine ● Indirect Coombs: ○ Determines if mother is Rh negative or positive ○ For negative, repeat at 24-28 weeks ○ Administer rhogam for negative at 28 weeks Contractions 6● True ○ Beginning irregular then become predictable ○ Will continue regardless of activity ○ Become stronger with walking and more reg with a change in activity ○ Frequency and duration increases ○ Begin in lower back and spread to abdomen ■ Lower abdomen ● False ○ Begin and remain irregular ○ Will go away if client walks or goes to sleep ○ Will not increase in frequency or duration ○ Begin in abdomen and stay in abdomen and groin area ■ Upper abdomen ● Tachysystole ○ Contractions lasting longer than 2 minutes or 5 contractions in 10 minutes ○ Leads to fetal hypoxia ○ Apply facemask at 10L ○ Turn in side lying position before discontinuing oxytocin and see if that resolves External cephalic version ● Provider attempts to turn around fetus externally ● Receives tocolytic prior to allow uterus to relax ● This is high-risk procedure and is performed in hospital setting ● High risk of umbilical cord compression or placental abruption ● Administer Rhogham after ● FHR monitored continuously because fetus at risk of bradycardia and variable decelerations ● Nurse monitors FHR 60 minutes following procedure Ectopic pregnancy ● Ovum implanted outside uterus, usually in fallopian tube ○ Usually result of scarring caused by previous tubal infection or surgery ● S/S: unilateral stabbing pain and tenderness in LLQ or RLQ of abdomen, vaginal spotting/bleeding, referred shoulder pain with tubal rupture ● Fallopian tube can burst ● Procedure:Salpingostomy ● Risk factors: PID Molar pregnancy (hydatidiform mole)- Gestational Trophoblastic Disease ● Proliferation and degeneration of trophoblastic villi in placenta ● Grape-like clusters ● Vaginal discharge is usually dark brown ● S/S: bleeding that resembles prune juice, abnormally high hCG levels ● Increased incidence of melanoma ● With hydatidiform moles pregnancy must be avoided for 1 year ● hCG should be obtained following evacuation of mole and then weekly until levels are normal for 3 weeks. Then every 4 weeks for the next 6-10 months ● Can cause HTN Spontaneous abortion ● termination of pregnancy before 20 weeks ● Threatened: spotting, no tissue passed, cervix closed 7● Inevitable: mild to severe bleeding, no tissue passed, dilated cervix ● Incomplete: severe bleeding, partial fetal tissue passed, dilated cervix ● Complete: minimal bleeding, complete uterine contents passed, closed cervix ● Procedures: dilation and curettage (D&C), administration of prostaglandins and oxytocin for inevitable or incomplete abortion Placenta previa ● Placenta abnormally implants in lower segment of uterus by uterus ● Complete, incomplete or partial ○ Complete: cervix completely covered by placental attachment ○ incomplete/partial: partially covered ○ Marginal/low-lying: placenta attached to lower uterus, but does not cover the cervical os ● S/S: ​painless​ bright red vaginal bleeding during 2nd/3rd trimester ● Mothers measure slightly larger because fetus is higher in uterus ● Fundal height can be larger ● Abdomen and uterus is soft and non-tender ● Do not perform vaginal exams Abruptio placenta ● Premature separation of placenta from uterus ● High rate of fetal and maternal mortality ● Sudden onset of intense and localized uterine pain with dark red blood ● Rigid abdomen ● Firm board-like uterus (uterine hypertonicity) TORCH ● Often causes flu-like symptoms ● Toxoplasmosis: r/t consumption of raw or undercooked meat, handling of cat feces (cook meats thoroughly, don’t touch cat litter) ● Other: Hepatis A and B, syphilis, mumps ● Rubella (German Measles): vaccine CI during pregnancy ● Cytomegalovirus: member of the HSV family transmitted via droplet ● HSV: transmission to baby can occur during vaginal birth if mom has active lesions ::::::::::::::::::::::::::::::::::::::::CONTENT CONTINUED IN THE ATTACHMENT:::::::::::::::::::::::::::::::::::::::::::::::::::