ATI Maternal Newborn Proctored STUDY GUIDE 2021 docx(VERSION21 )(LATEST UPDATED GUIDE)(GRADED TO WORK 100 PERCENT)

ATI PROCTORED MATERNAL­NEWBORN NOTES PLACENTA PREVIA: abnormal implantation of placenta in
the lower uterine segment, near or over the cervix. Results in
SPONTANEOUS ABORTION: terminated before 20 weeks bleeding in the third trimester and the cervix begins to dilate
or weighs less than 500 grams and efface.
Risk factors Risk factors
 Chromosomal anomalies  Previous placenta previa
 Maternal illness, infection  Previous C/S (uterine scarring)
 AMA  > 35
 Trauma/injuries  multifetal gestation
 Anomalies of the fetus or placenta  multiple gestations or close pregnancies
 Antiphospholipid syndrome  smoking
Expected findings Expected findings
 Tenderness and backache  painless
 ROM  bright red bleeding (2nd or 3rd trimester)
 Dilation of cervix  fundal height bigger than normal
 Fever  fetus in breech, transverse, or oblique
 Signs and symptoms of hemorrhage  reassuring FHR
Diagnostics/therapeutic procedures  VS WNL
 Ultrasound  Decreasing urine output
 Cervical exam Labs
 D&E  Hb/Hct
 D&C  CBC
 Prostaglandins and oxytocin  Kleihauer­Betke test (detects fetal blood in maternal
Patient education circulation)
 Some vaginal discharge OK for 1­2 wk DX
 NO baths, tampons, or intercourse for 2 wk  US
 Fetal monitoring and assessment
ECTOPIC PREGNANCY Nursing
Risk factors  No vaginal exams
 Anything that compromises tubal patency  IV fluids
 STIs  O2 nearby
 IVF Patient ED
 Tubal surgery  Bed rest
 IUDs  Nothing in vagina
Expected findings
 Unilateral pain PLACENTA ABRUPTION: premature separation of
 Light period that is late placenta from uterus (>20 wk)
 Scant, dark red, brown vaginal spotting  DIC is associated with moderate or severe abruption
 6­8 wks after last normal menses Risk Factors
 referred shoulder pain  Maternal HPT
 SHOCK  Trauma
Labs  Cocaine
 Elevated hCG and progesterone will rule out ectopic  Previous
preg  Cigarette
DX/therapeutic procedures  PROM
 Transvaginal US  Multifetal preg
 CAUTION W/ VAGINAL EXAMS Expected findings
TX – rapid treatment necessary  Severe pain
 Medical management  Sudden onset of dark red bleeding
 If rupture has not occurred and tube  Uterine tenderness that can be diffuse
preservation is desired  Hypertonicity
 Methotrexate  Fetal distress
 Inhibits cell division, dissolves pregnancy  Hypovolemic shock S/SX
 Salpingostomy LABS
 Fixes the tube  Hb/Hct decreased
 Laproscopic salpingectomy  Coags decreased
 Removes the tube  Clotting defects (DIC)
 Cross and type match

,  Kleihauer­Betke  Short labors
 US  Pregnancy loss early weeks
 BPP  Advanced cervical dilation at early weeks
Nursing  DES exposure
 Immediate birth is the management  Congenital structure deformities
 IV fluids Expected findings
 O2 8­10 liters  Pink stained vaginal D/C
 Assess urinary output  ROM
 Uterine contractions w/ expulsion of fetus
VASA PREVIA: fetal umbilical vessels implant into the fetal DX/therapeutic procedures
membranes rather than the placenta  US
 Short cervix
CHAPTER 8 – INFECTIONS  Cervical funneling
HIV/AIDS  Effacement
 Passed from mother to fetus through placenta and  Prophylactic cervical cerclage
breastmilk  12­14 weeks
Expected findings  removed at 37 weeks
 Flu like symptoms Medications
 Fever  Tocolytics
 Lymphadenopathy D/C Education
 Diarrhea  Activity restriction
 Weight loss  Hydration
 Anemia  Avoid intercourse
Medications  Nothing into vagina
 Retrovir  Bed rest
 14 wk
 throughout preg HYPEREMESIS GRAVIDARUM: excessive N/V past 12
 before labor weeks prob r/t increase hCG
 delivery  5% weight loss from prepreg weight
 6 wk after delivery  electrolyte imbalance
Patient Education  acetonuria
 no breastfeeding  ketosis
 report to health department (provider) Risk factors
 younger than 30
TORCH Infections  history of migraines
 toxoplasmosis  first preg
 raw or uncooked meat  obese
 other (hepatitis)  gestational trophoblastic disease
 rubella  high levels of emotional stress
 cytomegalovirus  hyperthyroid
 droplet  DM
 HSV  GI Dx
 Passage through birth canal  HX of hyperemesis Gravidarum
Expected findings LABS
 T – similar to flu  UA: ketones acetones (breakdown of protein/fat)
 R – rash, lymphedema, fever, fetal consequences  Elevated urine specific gravity
 HSV – lesions and tender lymph nodes  Chem­7
Medications  Sodium, potassium, chloride decreased
 Antibiotics as RX  Metabolic acidosis
 Toxoplasmosis TX  Metabolic alkalosis
 Sulfonamides  Elevated liver enzymes
 Bilirubin
CERVICAL INSUFFICIENCY: expulsion of the products  Thyroid
of conception occurs  CBC
 Tissue changes Nursing
 Alteration in length of cervis  NPO for 24­48 hr
Risk factors Medications
 Cervical trauma HX  IV LR