RN Maternal Newborn 2019 Proctored Focused Review

RN Maternal Newborn 2019 Proctored Focused Review Management of Care Establishing Priorities Medical Conditions: Prioritizing Client Assessment 1. Hyperemesis gravidrum: excessive nausea and vomiting (possible related to elevated hcG levels. Can cause weight loss 2. Iron deficiency anemia: due to inadequacy in maternal iron stores and consuming insufficient amounts of dietary iron. 3. Gestational diabetes mellitus GDM, impaired tolerance to glucose. 4. Gestational hypertension: vasospasm contributing to poor tissue perfusion. . Safety and Infection Control Accident/Error/Injury Prevention Caring for a client who has eclampsia 1. Monitor vital signs with careful attention to blood pressures measurement. 2. Daily dose of aspirin therapy can be initiated late in the first trimester for clients who have a history of early onset preeclapsia. 3. Monitor for manifestations of magnesium sulfate toxicity. 4. Report transient headaches along with episodes of irritability and edema. 5. Magnesium sulfate is medication of choice for prophylaxis/treatment to depress the CNS and prevent seizures 6. Maintain patent airway in even of seizure 7. Remain in bed rest and side lying position Health Promotion and Maintenance Ante/Intra/Postpartum and Newborn Care Fetal Assessment During Labor: Monitoring fetal heartrate 1. Fetal bradycardia: 110/min for 10 min or more a. Uteroplacental insufficiency b. Anesthetic medication c. Umbilical cord prolapse 2. Fetal tachycardia: Greater than 160/min for 10 min or more a. Infection, choriamnionitis b. Fetal anemia c. Dehydration d. Maternal hyperthyroidism 3. Decreased/loss FHR variability a. Congenital abnormalities b. Meds that depress the CNS c. Fetal hypoxemia and metabolic acidemia 4. Early deceleration: slowing of FHR at start of contractions and returning to baseline at end of contraction a. Uterine contraction b. Fundal pressure c. Vaginal exam 5. Late deceleration: slowing FHR after contraction started and returning to baseline after contraction ended. a. Placenta insufficiency b. Preeclampsia c. Maternal diabetes mellitus d. Late or post term pregnancy Postpartum Disorders: identifying risk factors for postpartum hemorrhage 1. Losing more than 500ml for vaginal birth or 100mL for c-section 2. Uterine atony or history of uterine atony 3. Overdistended uterus 4. Prolonger labor, oxytocin-induced labor 5. High parity 6. Ruptured uterus 7. Inversion of uterus 8. Coagulopathies (DIC) 9. Retained placental fragments 10. Administration of magnesium sulfate therapy during labor. Health Screening Newborn Assessment: Eliciting Newborn Reflexes 1. Extensive physical exam performed within 24 hours of birth 2. Posture: resistant to extension of extremities 3. Skin: quick turgor, vernix caseosa present, acrocyanosis 4. Head : 2-3 cm larger than chest circumference. Hydrocephalus, microcephaly 5. Eyes: blue/gray following birth, jerky movements, minimal or no tears 6. Ears: imaginary line through the inner to the outer canthus, should be even with the top of the newborn’s ears. If low, can indicate down syndrome or kidney disorder 7. Sucking and rooting reflex: stroking cheek or edge of mouth 8. Palmar grasp: placing finger in baby’s hand to curl around finger 9. Plantar grasp: toes curling downward 10. Moro reflex: allowing the head and trunk of the newborn in a semisitting position to fall backwards. Baby should abduct the arms at the elbows and fingers to spread to form a “C”