NUR 2633 Maternal Child Health Final Work Sheet 2023/2024

NUR 2633 Maternal Child Health 1. Dysmenorrhea – a common complaint with women – what are the non-pharmacological and pharmacological treatments. NSAID’s (Motrin, Naproxen, Alive), heating pad, rest, increase calcium, increase fluids, decrease red meat, alcohol, smoking drugs, exercise. 2. Obstetrical issues – pregnancy risks - Know Naegle’s Rule – to establish gestational age ovulation occurs in the middle of the cycle, stress can affect cycle, as well as high exercise, pregnancy, medications, drugs, hormones, obesity. Add 1 year, subtract 3 months, add 7 days. Pregnancy risks smoking, alcohol drinking, obesity, diabetes, drug use, hypertension, poor nutrition, eating disorders ALL affect pregnancy. EDD can also be measured by fundal height (Ex. Fundal height is measuring at umbilicus = 20 weeks) 3. Fetal assessment 3 things baby is okay – fetal heart tones (audible at 10-12 weeks), movement (16-18 weeks for multiparis, 18-20 for prima gravida), fundal height (12-14 weeks, at the symphysis pubis, umbilicus is 20 weeks) 4. Poor nutrition, drugs, HTN, DM are all issues of placental perfusion – what will the fetal result be – IUGR is the result, how do we identify IUGR? Smaller fundus. Uncontrolled diabetes = large baby, larger fundal height, baby can have hypoglycemia after birth, birth injuries and respiratory immaturity 5. Does the placenta provide nutrition? – no it provides for gas exchange, baby gets oxygen. 6. Anemia becomes a problem in pregnancy – can you discuss the maternal and fetal risks – low hemoglobin = low oxygen, baby with low oxygen means less movement. Iron ingestion can cause GI upset, tarry stools, constipation (increase fluids, fiber, stool softeners and exercise) 7. Hyperemesis – excessive vomiting that exceeds more than 3 months, at risk for fluid and electrolyte imbalance, manage by IV fluids and antiemetics (Zofran), small frequent meals, avoid trigger foods, carb snack 8. Hypertension – preeclampsia has specific symptoms – please know these as well as treatment modalities and nursing interventions – keep in mind Magnesium Sulfate nursing interventions – headaches, blurry vision, epigastric pain, bloated, edema, high BP, protein in the urine. Manage by bed rest, dim the lights, Mag sulfate 4g maintenance over 20-30 minutes’ bolus, maintenance 2g. Seizure precautions, and monitor baby, left side lying. For Mag watch for mag toxicity and respiratory depression, check for urine output, and deep tendon reflexes, vitals every hour. Lungs if have to deliver baby, use Betamethasone to help with lung maturity. No bolus fluids in preeclampsia. 9. Pre- term labor – define it; signs and symptoms, treatment modalities and nursing interventions – pelvic pressure, cramping, contractions, baby drop, lower back pain, increase urine output and vaginal discharge. Can be caused by dehydration or infection. Put on monitor, GIVE FLUIDS (Bolus Lactated ringers), FFN test before vaginal exam, LABOR IS NOT LABOR WITHOUT CERVICAL CHANGE. 2CM OR 80% effaced, start aggressively managing pre term labor with terbutaline (Causes maternal tachycardia, watch heart rate), if unsuccessful go to mag sulfate and use betamethasone. 10. Diabetes Mellitus – Type 1, Type 2 and Gestational DM all have issues that are common to all and specific to each. Note the concerns specific to each, management and fetal surveillance – type 1 concerned with cardiac, skeletal and CNS in baby, woman requires less insulin 1st trimester because of basal metabolic rate is increased, then needs progress over 2nd/3rd trimester. Monitor closely, babies at risk for sudden fetal demise, have mom monitor # of fetal movements. Type 2 concerned with controlling sugars, control by diet, and hypoglycemic/macrosomic baby. Gestational DM, same interventions as type 2 DM. 11. Define Macrosomia – and what are the risks – large baby, larger fundal height, baby can have hypoglycemia after birth, birth injuries and respiratory immaturity 12. What is an NST, and a BPP for whom would you recommend these tests? – Non stress test, to ensure fetal well being, if non reactive move to BPP, if BPP scores from 6-8 keep monitoring, if less that 6 start to think about delivering, hostile uterine environment. 13. Amniocentesis: when and for what reason? – taking fluids from the amniotic sac, checking for chromosomal anomalies, checking lung maturity. 14. Amniotic fluid surrounds the baby and has 5 functions – oligiohydramnios means? Polyhydramnios- what are you thinking? Temperature, cord and baby cushioning, allows free movement of baby, lubricant, lung development. Oligohydramnios is too little fluid poly is too much. Poly identifies with fundal height more than what it should be. 15. It is all about the placenta and perfusion – how do promote perfusion to the placenta, and what can interfere? (any disease or substance that interferes with vascular perfusion: HTN, DM, smoking, drugs, poor nutrition, etc.) – left side lying. 16. Know fetal heart rate monitoring – 5 parts and what does each tell you. (ie: accelerations are always positive, healthy babies) – baseline, variability, accelerations, decelerations and maternal activity. 17. Variability 3 parts – moderate, minimal, absent. Minimal can be sleeping, decreased perfusion, dehydration, mom hasn’t eaten in awhile, medications, DO NOT AUTOMATICALLY THINK DELIVERY. 18. Accelerations – always good (: 19. Decelerations 3 types – early (head compression), variable (cord compression), late (placental insufficiency) Interventions: reposition mom, O2, fluids, stop Pitocin, prolonged (perfusion issue, hypotension from epidural induction, continue fluids) 20. Know Normal Fetal heart rate, when movement occurs, and when you can palpate fundal height and begin measuring with a tape measure – 110-160. 21. If there is a non reassuring Fetal Heart rate – what are the nursing interventions? Change moms position, fluids... 22. Epidural anesthesia is common place, what needs to be completed before an epidural can be placed? What are the risks to mother and then to baby with epidural? - 23. Labor is a progression – we recognize change with behavioral and physiological changes. Vaginal exams are means to measure progress – do you understand what you are examining and what it means? Example – 5cm, 90%, -2 (what does this mean 5cm dilated, 90% effaced, -2 above ischial spines) – Labor stages: latent, active (4cm-8cm in 4-6 hours, contractions 2-3 minutes apart, watch for tachysystole) and transition (placental delivery, gush of blood 5-30 minutes, pressure, full feeling, and globular uterus, cord lengthens, MAKE SURE PLACENTA IS INTACT). Complete complete and zero means 10cm dilated, 100% effaced and at ischial spines, fetal monitor shows early decelerations b/c head compression BABY’S coming! 24. 2 huge reasons for bleeding in the third trimester – previa and abruption. Previa is not painful, abruption is. Previa dark red blood, abruption bright red blood. 25. Know the Stages and phases of labor – recognize some of the characteristics and what we would know with a vaginal exam. What nursing interventions should occur? 26. When labor is not progressing what are some of the non – pharmacological and pharmacological means to make a difference. – fluids, walking, rupturing membranes (recommend), bath, Pitocin (titrate very carefully 2 milliunits per minute, progress 2 milliunits every 30 minutes based on fetal coping and contractions), prostins, cervadil, cytotec. 27. Delivery of the baby and delivery of the placenta – what are the risks? – Hemorrhage 28. IUGR, causes, risks, how do you recognize this in the antepartum period? 29. What are the signs of placental separation - risks and nursing interventions? 30. Postpartum risks – how do we intervene if a patient has a postpartum hemorrhage – the initial response? – hemorrhage begin with fundal massage, breast feeding, nipple stimulation. Boggy can be caused by distended bladder (empty it), rapid or prolonged delivery, infection, mom on Mag Sulfate. Give Pitocin, methergine, cytotec and hemabate. 31. Newborn assessment – what is the first assessment? Then? Know APGAR…. And thermoregulation and the prevention of cold stress – 110-160 HR, RR 30-60, Temp 36.5- 37.2, babies can not temp regulate, so use a warmer, wrap them in warm blankets, completely dry them, cover their head, brown fat assists with temp regulation, pre term and IUGR babies do not have brown fat. APGAR at 1 and five minutes. Respiratory distress = nasal flaring, sternal retractions and grunting 32. How do we keep babies safe in the hospital setting? Employees with ID badges, do not carry baby in hallway, wrist bands, HUGS bands, alarms on doors, doors with locks and keypads to unit 33. Physiological jaundice is common – how do you recognize this, the most common cause, and how do we handle Hyperbilirubinemia? What are the treatment modalities and risks of the treatment? – common in breastfed babies, babies with immature liver (IUGR/Pre term), phototherapy (cover eyes, keep diaper on, no oils or lotions, turn frequently, supplements, increase baby’s intake. 34. NAS – neonatal abstinence syndrome – that which a baby endures during withdrawal – what are the signs of NAS? What is the management of the NAS? – S/S: inconsolable, crying, irritable, tremors, skin breakdown, poor weight gain, diarrhea, exaggerated rooting, use scale certain number start meds (methadone, morphine) 35. Milestones of infancy – 6 mos. Roll from tummy to back, hands in mouth, grasp, babbling, weight should be doubled. Posterior fontanel 6-8 weeks, anterior 12-18 mos. 1 year, walking, sit up, triple birth weight, standing, words (no, mama, dada), solid foods, possibly whole milk, preferably formula if not breast feeding. 36. ICP in children – specifically infants. Know possible causes, nursing interventions, priority care – hydrocephalus, trauma, infections. Interventions: keep head elevated, monitor vitals, LOC, posturing. 37. Know informed consents – parents or legal guardians, have to be greater than 18 years or age, must understand and acknowledge risk and benefits (emancipated = prego woman, someone who is married, court ordered emancipated)