Maternal-Newborn Health Nursing Review Session 1.pptx

Maternal-Newborn Health Nursing

1. NRSG 4301 Maternal-Newborn Health Nursing Review Session 1

2. Kegel’s exercise is done by contracting and relaxing the muscles surrounding the vagina and anus in order to strengthen the perineal muscles and improve urine control (especially helpful among postpartum clients.) In normal pregnancy there is a higher demand for protein (body building foods), vitamins (especially vitamins A, B, C, folic acid) and minerals (especially iron, calcium, phosphorous, zinc, iodine, magnesium) because of the need of the growing fetus. 2

3. Carbon monoxide is one of the substances found in cigarette smoke. This substance diminishes the ability of the hemoglobin to bind with oxygen thus reducing the amount of oxygenated blood reaching the fetus. 3

4. Comparison of Caldwell- Moloy Pelvic Types 4 The gynecoid pelvis is most ideal for delivery. Other types include platypelloid (flat), anthropoid (apelike), and android ( malelike ).

5. Hydatidiform mole is characterized by the degeneration of the chorionic villi wherein the villi become vesicle-like. These vesicle-like substances when expelled per vagina and is a definite sign that the woman has hydatidiform mole. 5

6. A client who has had a hydatidiform mole removed should have regular checkups to rule out the presence of choriocarcinoma , which may complicate the client’s clinical picture. The client’s hCG levels are monitored for 1 year. During this time, she should be advised not to become pregnant because this would be reflected in rising hCG levels. 6

7. Rubella is caused by a virus and viruses have low molecular weight thus can pass through the placental barrier. Gonorrhea , candidiasis and moniliasis are conditions that can affect the fetus as it passes through the vaginal canal during the delivery process. A rubella vaccine shouldn’t be given to a pregnant woman. The vaccine can be administered after delivery, but the client should be instructed to avoid becoming pregnant for 3 months. 7

8. After the rupture of the bag of waters, the cord may also go with the water because of the pressure of the rupture and flow. If the cord goes out of the cervical opening, before the head is delivered (cephalic presentation), the head can compress on the cord causing fetal distress. Fetal distress can be detected through the fetal heart tone. Thus , it is essential to check the fetal heart rate right after rupture of bag to ensure that the cord is not being compressed by the fetal head. 8

9. In Rh incompatibility, an Rh(-) mother will produce antibodies against the fetal Rh (+) antigen which she may have gotten because of the mixing of maternal and fetal blood during labor and delivery. Giving her RhoGam after birth ( no longer than 72 hours ) will prevent her immune system from being permanently sensitized to Rh antigen . 9

10. On the first pregnancy, the mother still has no contact with Rh(+) blood thus it has not antibodies against Rh(+). After the first pregnancy, even if terminated into an abortion, there is already the possibility of mixing of maternal and fetal blood so this can trigger the maternal blood to produce antibodies against Rh(+) blood. 10

11. After chorionic villus sampling عينة من المشيمة and amniocentesis, instruct the client that if chills, fever, bleeding, leakage of fluid at the needle insertion site, decreased fetal movement, uterine contractions, or cramping occurs, she must notify the physician. Amniocentesis is needle aspiration of amniotic fluid. It’s usually performed at 15 to 17 weeks’ gestation to detect fetal abnormalities. 11

12. Induction is a deliberate initiation بدء متعمد of uterine contractions that stimulates labor. Such as oxytocin infusion is discontinued if uterine contraction frequency is less than 2 minutes or duration is longer than 90 seconds, or if fetal distress is noted. Amniotomy is artificial rupture of the membranes is performed by the obstetrician or nurse-midwife to stimulate labor, performed if the fetus is at 0 or a plus station, and increases the risk of prolapsed cord and infection. 12

13. Breast-feeding mothers may experience amenorrhea during the entire period of lactation so long as they are exclusively breast feeding. (Women may ovulate without menstruating, so breast-feeding should not be considered a form of birth control). A mother who breastfeeds exclusively and regularly during the first 6 months’ benefits from lactation amenorrhea. There is evidence to support the observation that the benefits of lactation amenorrhea lasts for 6 months provided the woman has not had her first menstruation since delivery of the baby. 13

14. Acrocyanosis is the term used to describe the baby’s skin color at birth when the soles and palms are bluish but the trunk is pinkish. 14

15. The Apgar score is used to assess the newborn’s vital functions. It’s obtained at 1 minute and 5 minutes after delivery (and may be repeated later if the score is and remains low.) The score is based on respiratory effort, heart rate, muscle tone, reflex irritability, and color. An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate distress, and 0 to 3 indicates severe fetal distress which requires resuscitation. 15

16. The Apgar Scoring System 16

17. Cold stress causes oxygen consumption and energy to be diverted from maintaining normal brain cell function and cardiac function, resulting in serious metabolic and physiological conditions. The phases of newborn instability occur during the first 6 to 8 hours after birth and are known as the transition period between intrauterine and extrauterine existence. These phases include the first period of reactivity, period of decreased responsiveness, and second period of reactivity. 17

18. Intrauterine device (IUD) prevents pregnancy by not allowing the fertilized ovum from implanting on the endometrium. Some IUDs have copper added to it which is spermicidal. It is not a barrier since the sperms can readily pass through and fertilize an ovum at the fallopian tube. If mother is breastfeeding, the progesterone only type is the best because estrogen can affect lactation. 18

19. If a client who’s taking a hormonal contraceptive misses a dose, she should take the pill as soon as she remembers or take two at the next scheduled interval and continue with the normal schedule. If a client who’s taking a hormonal contraceptive misses two consecutive doses, she should double the dose for 2 days and then resume her normal schedule. She also should use an additional birth control method for 1 week. 19

20. Clients who have hypertension, thrombophlebitis, obesity, or a family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives. The 3 parameters measured/monitored which will indicate that the woman has ovulated are- temperature increase of about 0.2-0.4 degrees centigrade, softness of the cervix and cervical mucus that looks like the white of an egg which makes the woman feel “wet”. 20

21. Chloasma , the mask of pregnancy, is pigmentation of a circumscribed area of skin (usually over the bridge of the nose and cheeks) that occurs in some pregnant women. It may also be called melasma . Thyroid enlargement and increased basal body metabolism are common occurrences during pregnancy. With advanced maternal age, a common genetic problem is Down syndrome . 21

22. Teenage mothers are more likely to have low-birth-weight neonates because they seek prenatal care late in pregnancy (as a result of denial) and are more likely than older mothers to have nutritional deficiencies from “fad diets.” بدعة الحميات 22

23. A pregnant woman with sickle cell anemia needs supplemental iron to maintain iron stores and enhance the oxygen-carrying capacity of the blood by increasing the hemoglobin. Any vaginal bleeding during pregnancy should be considered a complication until proven otherwise. 23

24. A pregnant client can avoid constipation and hemorrhoids by adding fiber to her diet. A pregnant client should take folic acid because this nutrient is required for rapid cell division and it lessens the risk of the fetus developing a neural tube defect. Calcium deficiency and lack of proper exercise can cause leg cramps during pregnancy. 24

25. Ideally, breast self-examination should be performed about 1 week after the onset of menses because hormonal influences on breast tissue are at a low ebb at this time.   The client should perform breast self-examination on the same day each month only if she has stopped menstruating (e.g., menopause). 25

26. The nurse should instruct the client to take a mild analgesic, such as ibuprofen, if menstrual pain or “cramps” are present. 26

27. The classic triad of symptoms of preeclampsia are hypertension, edema, and proteinuria. Additional symptoms of severe preeclampsia include hyperreflexia, cerebral and vision disturbances, and epigastric pain. Blood pressure readings of 160 mmHg systolic and 100mmHg diastolic on two separate occasions and oliguria (urine output less than 500 ml in 24 hours), proteinuria, 3+ to 4+ or more than 5 gm in a 24-hour sample are indicatives of severe preeclampsia. 27

28. In a pregnant client, preeclampsia may progress to eclampsia, which is characterized by seizures and may lead to coma. 28

29. Management of severe preeclampsia include: bed rest high-protein, moderate-sodium diet treatment with magnesium sulfate corticosteroids fluid and electrolyte replacement antihypertensive therapy 29

30. Q: A pregnant client at 32 weeks’ gestation has mild preeclampsia. She is discharged home with instructions to remain on bed rest. She should also be instructed to call her physician if she experiences which of the following symptoms? Select all that apply. Headache. Increased urine output. Blurred vision. Difficulty sleeping. Epigastric pain. Severe nausea and vomiting. 1 , 3 , 5 , and 6 30

31. Hydralazine acts to lower blood pressure by peripheral dilation without interfering with placental circulation. One of the most common side effects of the drug is tachycardia. After an eclamptic seizure, the client is at risk for abruptio placentae due to severe vasoconstriction resulting in hemorrhage into the decidua basalis. 31

32. Placenta previa is abnormally low implantation of the placenta so that it encroaches on or covers the cervical os . Nursing interventions for a client with placenta previa include positioning the client on her left side for a maximum fetal perfusion, monitoring fetal heart tones, and administering I.V. fluids and oxygen, as ordered. 32

33. In placenta previa , bleeding is painless and seldom fatal on the first occasion, but it becomes heavier with each subsequent episode. When a pregnant client has undiagnosed vaginal bleeding, vaginal examination should be avoided until ultrasonagraphy rules out placenta previa . 33

34. Abruptio placenta is premature separation of a normally implanted placenta. It may be partial or complete, and usually causes abdominal pain, vaginal bleeding, and a boardlike abdomen. Abruptio placenta is manifested by a board-like abdomen and non-reassuring fetal heart rate tracing. 34

35. The classic difference between abruptio placenta and placenta previa is the degree of pain. Abruptio placenta causes pain, whereas placenta previa causes painless bleeding. 35

36. Meconium is a material that collects in the fetus’s intestines and forms the neonate’s first feces, which are black and tarry. The presence of meconium in the amniotic fluid during labor indicates possible fetal distress and the need to evaluate the newborn for meconium aspiration. 36

37. During fetal heart rate monitoring, variable decelerations indicate compression or prolapse of the umbilical cord. 37

38. If a fetus has late decelerations (a sign of fetal hypoxia), the nurse should instruct the mother to lie on her left side and then administer 8 to 10 L of oxygen per minute by mask. The nurse should notify the physician. The side-lying position removes pressure on the inferior vena cava. A nonstress test is considered reactive (negative) if two or more fetal heart rate accelerations of 15 beats/minute above baseline occur in 20 minutes . 38

39. The first action to take when a loop of the umbilical cord is seen protruding from a woman in labor is to place the client in a Trendelenburg or knee-chest position. During delivery, if the umbilical cord can’t be loosened and slipped from around the neonate’s neck, it should be clamped with two clamps and cut between the clamps. Prepare to ventilate the newborn as he’s being born. 39

40. To exclude infection chances, the nurse should assess for foul smelling in patients with a rupture in membrane. Methylergonovine ( Methergine ) is an oxytocic agent used to prevent and treat postpartum hemorrhage caused by uterine atony or subinvolution . At emergency treatment for excessive uterine bleeding, 0.2 mg of methylergonovine ( Methergine ) is injected I.V. over 1 minute while the client’s blood pressure and uterine contractions are monitored. 40

41. After a stillbirth, the parents should be allowed to hold the newborn to help them come to terms with their loss. A fever in the first 24 hours postpartum is most likely caused by dehydration rather than infection. 41

42. Colostrums , the precursor of milk, is the first secretion from the breasts after delivery . Colostrum contains large numbers of antibodies called "secretory immunoglobulin" (IgA) that help protect the mucous membranes in the throat, lungs, and intestines of the infant. 42

43. In a normal delivery and for the first 24 hours postpartum, a total blood loss not exceeding 500 ml is considered normal. A client who has postpartum hemorrhage caused by uterine atony should be given oxytocin a prescribed. Uterine atony is failure of the uterus to remain firmly contracted. The major cause of uterine atony is a full bladder. 43

44. Hot compresses can help to relieve breast tenderness after breast-feeding. 44

45. Lochia rubra is the vaginal discharge of almost pure blood that occurs during the first few days after childbirth. Lochia serosa is the serous vaginal discharge that occurs 4 to 7 days after childbirth. Lochia alba is the vaginal discharge of decreased blood and increased leukocytes that’s the final stage of lochia. It occurs 7 to 10 days after childbirth . 45

46. Immediately after delivery of the placenta, the nurse would expect to palpate the fundus halfway between the umbilicus and the symphysis pubis. Within 2 hours postpartum, the fundus should be palpated at the level of umbilicus. The fundus remains at this level or may rise slightly above the umbilicus for approximately 12 hours. After the first 12 hours, the fundus should decrease one fingerbreadth (1 cm) per day in size. By the ninth or tenth day, the fundus usually is no longer palpable. 46

47. The fundus of a postpartum client is massaged to stimulate contraction of the uterus and prevent hemorrhage. 47

48. Plastic nipple shield may cause nipples dryness as a result of preventing air circulation (air drying).   The nurse should instruct the postpartum woman not to use soap with breast to prevent dryness. The normal menstruation retuned back after the delivery by around 6 to 10 weeks. 48

49. After delivery, the first nursing action is to establish the newborn’s airway. The first immunization for a newborn is the hepatitis B vaccine, which is administered in the nursery shortly after birth. 49

50. To prevent ophthalmia neonatorum (a severe eye infection caused by maternal gonorrhea), the nurse may administer one of three drugs, as prescribed, in the neonate’s eyes: tetracycline, silver nitrate, or erythromycin. 50

51. The first 12 hours after delivery are part of taking-in phase of maternal postpartum adjustment, which typically lasts from 1 to 3 days. During the taking-in phase, the client is primarily concerned with her own needs.   After the first 1 to 3 days postpartum, the client is in the taking-hold phase and can focus more on the needs of the neonate. 51

52. Respiratory distress syndrome (hyaline membrane disease) develops in premature infants because their pulmonary alveoli lack surfactant. In a neonate, symptoms of respiratory distress syndrome include expiratory grunting or whining, sandpaper breath sounds, and seesaw retractions. Neonates who are delivered by cesarean birth have a higher incidence of respiratory distress syndrome. The opioid antagonist naloxone ( Narcan ) may be given to a neonate to correct respiratory depression caused by narcotic administration to the mother during labor. 52

53. When teaching parents to provide umbilical cord care, the nurse should teach them to clean the umbilical area with a cotton ball saturated with alcohol after every diaper change to prevent infection and promote drying. Infants of diabetic mothers are susceptible to macrosomia as a result of increased insulin production in the fetus. 53

54. The diamond-shaped anterior fontanel usually closes between ages 12 and 18 months. The triangular posterior fontanel usually closes by age 2 to 3 months. 54

55. Q: The nurse has detected repetitive variable decelerations in the fetal heart rate. What should the nurse do first? Give the laboring client oxygen via nasal cannula. Reposition the client onto her left side. Prepare the room and client for imminent delivery. Start a large-bore IV of lactated Ringer’s solution. 55

56. Q: A client who is 32 weeks pregnant is being monitored in the antepartum unit for pregnancy-induced hypertension . She suddenly complains of continuous abdominal pain and vaginal bleeding . Which of the following nursing interventions should be included in the care of this client? Select all that apply. Evaluate maternal vital signs. Prepare for vaginal delivery. Reassure the client that she’ll be able to continue the pregnancy. Auscultate fetal heart tones. Monitor the amount of vaginal bleeding. Monitor intake and output. 1 , 4 , 5 , and 6 56

57. Q: A mother with a history of varicose veins has just delivered her first baby. A nurse suspects that the mother has developed a pulmonary embolus . Which of the data below would lead to this nursing judgment? Select all that apply. Sudden dyspnea. Chills, fever. Diaphoresis. Hypertension. Confusion. 1 , 3 , and 5 57

58. Q: In planning care with a pregnant woman, the nurse needs to consider that normal cardiovascular adaptations to pregnancy include? A (30–50) % increase volume. A decrease in sedimentation rate. A gradual increase in blood pressure. An immediate increase in hematocrit. 58

59. Q: Which of the following pregnant clients will be at risk for toxoplasmosis ? Select all that apply: A pregnant client who eat raw meat. A pregnant client handling cat litter of infected cats. A pregnant client gardening and cultivating soil exposed to cat feces. A pregnant client with low rubella titer. A pregnant client who have undergone external radiation. A pregnant client with draining, painful vesicles in the external genitalia. 1 , 2 , and 3 59

60. Q: A client is in her early months of pregnancy and complains about morning sickness . Which of the following recommendation might you make to her? Nothing will alleviate it, and you must do your best to accept it. Eat a dry carbohydrate, such as crackers, before arising. Take large quantities of fluids with meals. Eat three meals per day and avoid eating between meals. 60

61. Q: A client is preparing to take a Sitz bath for the first time. The nurse will: discourage the client from taking a Sitz bath. check on the client after the Sitz bath. place a call bell well within reach and check on the client frequently. allow the client privacy during the Sitz bath time. 61

62. Q: The nurse determines the fundus of a postpartum client to be boggy . Initially, the nurse should: document the findings. massage gently and reassess. catheterize the client. call the physician immediately. 62