NU 345A Maternity Study Guide Maternity Vitamin K Why is it given after delivery to a newborn? Where and how is it administer? What are the ratification if you don’t administer vitamin K? Umbilical Cord Care (Post delive
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NU 345A Maternity Study Guide Maternity Vitamin K Why is it given after delivery to a newborn? Where and how is it administer? What are the ratification if you don’t administer vitamin K? Umbilical Cord Care (Post delivery) What does this entail/ What are your responsibilities as a nurse ?. What are the things you need to assess when checking a cord? Obstetrical Intrapartum Emergency What are the things you need to remember when dealing with a prolapse? What are the interventions needed to take Newborn Jaundice Difference physiologic and pathologic ? Difference in severity ? How are they treated differently ? Explain the condition to parents. Premature delivery interventions What are the things we can do to try to give this baby respiratory success? ● Positioning ● The prone position is used for preterm infants because it decreases breathing effort and increases oxygenation ● corticosteroids Feeding the Newborn Breast vs bottle What are the important things (heating?) Fetal Surveillance in Labor What causes Early Decelerations? What causes Late Decelerations? What causes Variable Decelerations? Fetal Intrauterine Resuscitation Category I- All good Category II- Monitor Category III- Houston… we have a problem ???? (hypoxia) ???? (hypoxia) ??? How to provide oxygen to baby in utero? Steps to provide during hypoxia Phases and Stages of Labor ● Latent labor, also called early labor. ● Active labor. ● Transition labor. ● Type 1 Diabetes Difference between too much insulin or hyperglycemic attack? Nursing intervention based on the presented symptoms Hyperglycemia Diabetes Warning Signs in Pregnancy What warning signs we should be educating on each trimester Newborn Assessment Intrauterine to extrauterine life Sucking and rooting reflex EXPECTED FINDING: Elicit by stroking the cheek or edge of mouth. Newborn turns the head toward the side that is touched and starts to suck. EXPECTED AGE: Usually disappears after 3 to 4 months but can persist up to 1 year Palmar grasp EXPECTED FINDING: Elicit by placing examiner’s finger in palm of newborn’s hand. The newborn’s fingers curl around examiner’s fingers. EXPECTED AGE: Lessens by 3 to 4 months Plantar grasp EXPECTED FINDING: Elicit by placing examiner’s finger at base of newborn’s toes. The newborn responds by curling toes downward. EXPECTED AGE: Birth to 8 months Moro reflex EXPECTED FINDING: Elicit by allowing the head and trunk of the newborn in a semisitting position to fall backward to an angle of at least 30°. The newborn will symmetrically extend and then abduct the arms at the elbows and fingers spread to form a “C.” EXPECTED AGE: Birth to 6 months Tonic neck reflex (fencer position) Babinski reflex Stepping EXPECTED FINDING: Elicit by holding the newborn upright with feet touching a flat surface. The newborn responds with stepping movements. EXPECTED AGE: Birth to 4 weeks Birth trauma - rule out HPV Aware done. How to educate? SROM (Spontaneous rupture of membrane) What does the nurse do immediately after a woman's water breaks ? Tetralogy of Fallot Serious cardiac condition diagnose soon after delivery? What do we need to be aware ? What are the nursing intervention? RDS: Resp distress system Signs and symptoms Condition caused by insufficient production of surfactant in the lungs; results in atelectasis (collapse of the lung alveoli), hypoxia (decreased oxygen [O2] concentration), and hypercapnia (increased [CO2] concentration). ● Fetal hyperinsulinemia retards cortisol production, which is necessary for the synthesis of surfactant needed to keep the newborn's alveoli open after birth, thereby increasing the risk for respiratory distress syndrome. ● Reduced lung fluid clearance and delayed thinning of lung connective tissue may also play a part, although other authorities believe that gestational age is the primary determinant of whether an infant will have respiratory distress syndrome. ● Respiratory distress syndrome is more likely to occur if the mother's glycemic control is poor, because wide fluctuations in her insulin and glucose levels have slowed lung maturation ● Tests of fetal lung maturity will be done before elective delivery of the fetus by induction or scheduled cesarean if questions about maturity exist.(BPP for LS Ratio) GTPAL Gravida: # of pregnancies Term: number of pregnancies at 40 weeks Preterm: number of pregnancies before 40 weeks Abortions: number of abortions, miscarriages, fetal demises Living: number of currently living children Proper Latch Signs of proper latch? a proper latch where the baby pulls the areola towards the back of the throat. You may ask….does it hurt the mother to breastfeed? The answer is….not if the baby latches on correctly. If the baby only grabs the tip of the areola, it is painful and the baby should be gently released from the breast to start the process again. Harder with inverted nipple Paternal influence on Sperm Quality: How to enhance quality of sperm? ● Quantity. ● Movement. ● Structure (morphology)., Sperm highly affected by marijuana smoking pot more than once a week can lower sperm count by a third Epidural Anesthesia: Epidural: Anesthesia: Probable Signs of Pregnancy: Presumptive/Probable: Positive Signs Assessing the Bladder Why is it important to assess in labor? Why is it important to assess after delivery? Congenital Neonatal Cardiac Anomalies What the anomaly is? Abnormal intrauterine development of an organ or structure. ● non-invasive prenatal testing (NIPT) has the potential to be a highly effective screening method for major CA in a clinical setting. ● Because of the increased risk for congenital anomalies or fetal death, surveillance should begin early for women with preexisting diabetes, ideally with preconception care to bring her diabetes into the best control. ● Folate deficiency is associated with increased risk of spontaneous abortion, abruptio placentae, and fetal anomalies. Know Where the anomaly is How does it affect neonatal cardiac circulation? Contraception: Barrier methods of birth control (Block) Percentages of effectiveness for each method Combination estrogen/progesterone Pill: 99.9% if used effectively Prevents ovulation- (vasoconstricts) (rings, patches,implants, transdermal) Forget pill: take moment you remember and then take one thats due Skip 2 pills: stop pack, get period and use back-up form of birth control Depo injection- progesterone only 15 lb weight gain 3 year maximum useage Condoms: 80% Can break, degrade, expire Abstinence:100% Sex is bad if you have sex you will get STD’s and die Diaphragm:60% Great option if pt cant be on pill or hormone replacement Need to be fitted for it Do not use petrolium or silicone lubes (degrade plastic) Place prior to intercourse- cannot remove for 6 hours after last intercourse to avoid pregnancy ATI- gain or loose 15 lbs need to be re-fitted IUD: Mechanical barrier to implantation Copper and merana 99.9% Does not prevent conception Up to 10 yrs Could cause scarring→ infertility or infection associated with PID→ scarring Multiple sex partners- bad option PIH Assessment: ● Begins after the 20th week of pregnancy, describes hypertensive disorders of pregnancy whereby the woman has an elevated blood pressure at 140/90 mm Hg or greater recorded on two different occasions, at least 4 hr. Apart. ● There is no proteinuria. Urine output (normal/not) ● The presence of edema is no longer considered in the definition of hypertensive disease of pregnancy. ● Blood pressure returns to baseline by 6 weeks postpartum. Labor Assessment: Frequency: Timed from the beginning of one contraction to the beginning of the next. This determines how often a woman is contracting. Duration: This determines how long each contraction lasts. Timed from the beginning of one contraction to the end of that same contraction. Intensity: With external monitoring: determined by palpating the fundus of the uterus for mild, moderate, or strong contractions. When and IUPC is inserted, uterine contraction strength can be measured numerically. Signs of Labor Contractions coming every five minutes for at least an hour, despite walking and hydration. Any signs of leaking a fluid that does not smell like urine indicating a possible rupture of the bag of waters. Progressing Labor Contractions will become stronger, and more effective by causing dilatation and effacement, with the production of a bloody show. How are they assessed? External fetal monitor: Frequency and duration Internal fetal monitor: Intensity (measured numerically) APGAR When is it preformed? 1min, 5min, 10min Maximum Points :10 Seizures in pregnant women
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