MATERNITY HESI
1) Postpartum residual urine-palpate
-Assess bladder and urine output
• Palpate for spongy, full feeling over symphysis, check urge to void when bladder is
palpated
• Kegel exercises (promote retoning) increase the integrity of the introitus and
improve urine retention. Teach client to alternate contraction and relaxation of the
pubococcygeal muscles
• Should void within 4 hours of delivery. Suspect retention if voiding is frequent and
less than 100 mL per voiding
2) Vegetarian breast feeding
• Deficient in vitamin B 12, take supplements, multivitamins or drink soy milk 2-3
times a day
• Iron, protein, and calcium can also be low (eat beans, fruit, dark greens, eggs and
dairy, juice, cereal, yogurt and tofu)
• Medications or diets that promote weight loss not recommended for breast-
feeding mothers
3) Med administration- Pain control- deep breathing
•Breathing techniques, such as deep chest, accelerated, and cued, are not prescribed
by the stage and phase of labor but by the discomfort level of the laboring woman. If
coping is decreasing, switch to a new technique.
• Cleansing breath is a relaxed deep breath in through the nose and deep breath out
through the mouth. Used at the beginning and end of each contraction
•Slow paced breathing is initaiated when woman can no longer walk or talk through
contractions (optium oxygenation and relaxation) INCREASE
CONTRACTIONS=SHALLOW AND FAST BREATHING
•Patterned paced (pant-blow) suggested during transition phase
4) Antepartum- CST
-Contraction stress test (CST) or oxytocin challenge test (OCT)
• What is it? fetus is challenged with the stress of labor by the induction of uterine
contractions, the fetal response to physiologically decreased oxygen supply during
uterine contractions is noted. An unhealthy fetus will develop nonreassuring FHR
patterns in response to uterine contractions; late decelerations are indicative of UPI.
• Nursing care? Assess for contraindications: prematurity, placenta previa,
hydramnios, multiple gestation, and previous uterine classical scar, rupture of mem-
branes (ROM). Record a 20-minute baseline strip to determine fetal well-being
(reactivity) and presence or absence of contractions.
~To assess for fetal well-being, a recording of at least three contractions in 10
minutes must be obtained.
~If nipple stimulation is attempted, begin rolling both nipples if contractions do not
begin in 10 minutes. Proceed with oxytocin (Pitocin) infusion if unsuccessful with
nipple stimulation.
, ~A negative test suggests fetal well-being (i.e., no occurrence of late decelerations).
~Repetitive late decelerations (50% or more of contractions) render a positive
result! BAD
***HESI Hint • The danger of nipple stimulation lies in controlling the “dose” of
oxytocin delivered by the posterior pituitary. The chance of hyperstimulation or
tetany (contractions over 90 seconds or contractions with less than 30 seconds in
between) is increased***
5) Antepartum-Cytotec-pregnancy (Misoprostol)
•Drug that stimulates uterine pregnancy and manages postpartum hemorrhage
• Woman commonly have n/v and cramping after insertion (also used for abortion, if
it does not occur, misoprostol is repeated and vacuum aspiration is performed)
• Effects? Repeat until 3 or more contractions in 10 minutes/ Bishop score of 8 or
higher
• Considerations? Avoid giving w/ aluminum hydroxide and magniusm antacids, use
with caution in px with renal failure, monitor vaginal bleeding and uterine tone, have
woman void before, maintain supine or side-lying position for 30-40 minutes after
insertion, initatiet oxytocin for labor NO SOONER THAN 4 HOURS after last dose of
misoprostol.
6) Exercises-prepare for labor
•Teach woman to do pelvic tilt exercises, pelvic rocking exercises and breathing
exercises
7) False labor-confirm
• Often stop when walking or changing positions, can be felt in back or abdomen
above navel (no lower back pain), are irregular and presenting part not engaged in
pelvis
8) Kick count
• Client sits quietly or lies down on her side and counts fetal kicks as instructed
• Instruct the client to notify HCP if there are FEWER THAN 10 KICKS IN 2
CONSECUTIVE 2-HOUR PERIODS (fewer than 3 movements in one hour)
• Fetal movements that stop for 12 hours? Severely disturbed fetus, impending fetal
death= immediate delivery
• Important to remember that they may be reduced temporarily if woman taking
antidepressant meds, drinking alcohol, or smoking. They do not decrease as woman
nears term.
9) Morning sickness-ginger
Self management with morning sickness include: acupressure, ginger, vitaman B6
w/ doxylamine
1) Postpartum residual urine-palpate
-Assess bladder and urine output
• Palpate for spongy, full feeling over symphysis, check urge to void when bladder is
palpated
• Kegel exercises (promote retoning) increase the integrity of the introitus and
improve urine retention. Teach client to alternate contraction and relaxation of the
pubococcygeal muscles
• Should void within 4 hours of delivery. Suspect retention if voiding is frequent and
less than 100 mL per voiding
2) Vegetarian breast feeding
• Deficient in vitamin B 12, take supplements, multivitamins or drink soy milk 2-3
times a day
• Iron, protein, and calcium can also be low (eat beans, fruit, dark greens, eggs and
dairy, juice, cereal, yogurt and tofu)
• Medications or diets that promote weight loss not recommended for breast-
feeding mothers
3) Med administration- Pain control- deep breathing
•Breathing techniques, such as deep chest, accelerated, and cued, are not prescribed
by the stage and phase of labor but by the discomfort level of the laboring woman. If
coping is decreasing, switch to a new technique.
• Cleansing breath is a relaxed deep breath in through the nose and deep breath out
through the mouth. Used at the beginning and end of each contraction
•Slow paced breathing is initaiated when woman can no longer walk or talk through
contractions (optium oxygenation and relaxation) INCREASE
CONTRACTIONS=SHALLOW AND FAST BREATHING
•Patterned paced (pant-blow) suggested during transition phase
4) Antepartum- CST
-Contraction stress test (CST) or oxytocin challenge test (OCT)
• What is it? fetus is challenged with the stress of labor by the induction of uterine
contractions, the fetal response to physiologically decreased oxygen supply during
uterine contractions is noted. An unhealthy fetus will develop nonreassuring FHR
patterns in response to uterine contractions; late decelerations are indicative of UPI.
• Nursing care? Assess for contraindications: prematurity, placenta previa,
hydramnios, multiple gestation, and previous uterine classical scar, rupture of mem-
branes (ROM). Record a 20-minute baseline strip to determine fetal well-being
(reactivity) and presence or absence of contractions.
~To assess for fetal well-being, a recording of at least three contractions in 10
minutes must be obtained.
~If nipple stimulation is attempted, begin rolling both nipples if contractions do not
begin in 10 minutes. Proceed with oxytocin (Pitocin) infusion if unsuccessful with
nipple stimulation.
, ~A negative test suggests fetal well-being (i.e., no occurrence of late decelerations).
~Repetitive late decelerations (50% or more of contractions) render a positive
result! BAD
***HESI Hint • The danger of nipple stimulation lies in controlling the “dose” of
oxytocin delivered by the posterior pituitary. The chance of hyperstimulation or
tetany (contractions over 90 seconds or contractions with less than 30 seconds in
between) is increased***
5) Antepartum-Cytotec-pregnancy (Misoprostol)
•Drug that stimulates uterine pregnancy and manages postpartum hemorrhage
• Woman commonly have n/v and cramping after insertion (also used for abortion, if
it does not occur, misoprostol is repeated and vacuum aspiration is performed)
• Effects? Repeat until 3 or more contractions in 10 minutes/ Bishop score of 8 or
higher
• Considerations? Avoid giving w/ aluminum hydroxide and magniusm antacids, use
with caution in px with renal failure, monitor vaginal bleeding and uterine tone, have
woman void before, maintain supine or side-lying position for 30-40 minutes after
insertion, initatiet oxytocin for labor NO SOONER THAN 4 HOURS after last dose of
misoprostol.
6) Exercises-prepare for labor
•Teach woman to do pelvic tilt exercises, pelvic rocking exercises and breathing
exercises
7) False labor-confirm
• Often stop when walking or changing positions, can be felt in back or abdomen
above navel (no lower back pain), are irregular and presenting part not engaged in
pelvis
8) Kick count
• Client sits quietly or lies down on her side and counts fetal kicks as instructed
• Instruct the client to notify HCP if there are FEWER THAN 10 KICKS IN 2
CONSECUTIVE 2-HOUR PERIODS (fewer than 3 movements in one hour)
• Fetal movements that stop for 12 hours? Severely disturbed fetus, impending fetal
death= immediate delivery
• Important to remember that they may be reduced temporarily if woman taking
antidepressant meds, drinking alcohol, or smoking. They do not decrease as woman
nears term.
9) Morning sickness-ginger
Self management with morning sickness include: acupressure, ginger, vitaman B6
w/ doxylamine
