ATI Maternal Newborn Nursing
Contraception
Barrier Methods
- Condoms
- Diaphragms – must be refitted for one every 2 years by a provider or if you have gained more
than 15lbs or have had a full term pregnancy or a 2 nd term abortion, you must also use
spermicide with every act of sex, must remain in place for 6 hours after sex
- Hormone methods, nuva ring, patch, etc. side effects very similar to all they include; chest pain,
SOB, leg pain, HA, vision problems, could mean potential blood clot or stroke, of PE, or HTN.
Smokers are at higher risk and it is recommended they do not take oral BC
Contraindications include: history of blood clots, stroke, cardiac problems, or estrogen related
cancer, or if you are a smoker
Depo Shot – can cause decrease in bone density, loss in calcium mineral, will need adequate calcium
and vitamin D to protect bones.
IUD’s – can increase risk for pelvic inflammatory disease, and uterine perforation, and will increase
risk of ectopic pregnancy, LOOK for change in string length, foul smelling discharge, painful
intercourse, fever, chills, etc
Infertility – inability to conceive after trying for at least 12 months (1yr)
-work up will be done after that, will start with male (usual 40% of time issue is with them)
-test on female, any test that has dye ensure no shellfish allergy or iodine
Pregnancy Signs
3 Signs
1. Presumptive – can be explained by a reason other than pregnancy
2. Probable – abd enlargement, etc
3. Positive – very distinct, fetal heart tones, or fetus on US, feel movement
Negals Rule – tells you when your due date is based on last menstrual cycle (JUST ADD 9 months and 1
week)
GTPAL
Gravidity - # of times woman has been pregnant including current pregnancy
Term births - # of pregnancies that have gone to 38wks or more
Preterm births - # of pregnancies that have gone before 38wks
Abortions or miscarriages - # of
Living children - # of
,Weight Gain and Nutrition during Pregnancy
- Normal weight gain is 25 to 35lbs
- If a patient is already overweight, 15 to 25lbs
- If a patient is underweight recommended 28 to 40lbs
*during first trimester should not gain more than 2-4lbs, after expect weight gain of 1lb per
week
Extra Calories per day – 340/day – 2nd trimester, 450/day – 3rd trimester
*if breast feeding after birth you still need an extra 300-400 a day
Folic Acid – prevents neural tube birth defects, sources are dark leafy veggies, orange juice
You need 2-3 liters of water a day
Limit caffeine to 200-3—mg a day
No ETOH
Diagnostic tests during Pregnancy
US- you want the bladder to be full, sound waves will resonate better
Amniocentesis – you want empty bladder
Nonstress Test – not invasive, measures fetal wellbeing within the last trimester and measures response
of fetal HR to fetal movement (reactive is normal, HR will increase) (nonreactive is not normal, HR will
decrease)
*if nonreactive may have a CST (contraction stress test) done, contractions brought on by
Pitocin/oxytocin/nipple stimulation and during that they will monitor FHR and look for acceleration.
-if no late acceleration you have a negative CST (normal)
*it can send the woman into early labor
Amniocentesis – empty the bladder, test amniotic fluid for genetic abnormalities, usually done around
14 weeks, check for levels of AFP (alpha feta protein), IF AFP levels are high, it is associated with neural
tube defects, if levels are low it is associated with chromosomal disorders such as down syndrome, will
also check the LS ratio which checks for fetal lung maturity
Risks associated – amniotic fluid emboli, hemorrhaging, infection, leaking of amniotic fluid, ruptured
membranes, or even miscarriage.
Bleeding during Pregnancy
Ectopic Pregnancy – ovum is planted outside fallopian tube, symptoms will be unilateral stabbing pain in
lower quadrants
Moller Pregnancy – symptoms of bleeding that resemble prune juice
, Placenta Previa – can be complete, incomplete, or partial
-symptoms are painless, bright red, vaginal bleeding during 2 nd or 3rd trimester, VERY
DANGEROUS
Aburpta Placento – symptoms will be intense localized uterine pain with dark red vaginal bleeding
*Yeast infections are very common during pregnancy
Incompetent Cervix – cervix does not stay closed causing miscarriage *if woman is known to have IC she
will have a cerclage done (closes cervix) usually removed at 37wks.
Hyperemesis – excessive N/V well past 12 weeks, interventions include B6 admin, and antiemetic meds
IF iron deficiency anemia – provider will order iron supplements (take with food rich in vitamin C)
Gestational Diabetes
If woman has this she is at high risk for developing diabetes after pregnancy, oral meds usually
contraindicated, woman will likely have to use insulin to control sugar levels * test occurs 24-28wks of
gestation with a 1hr glucose tolerance test, NO fasting required for initial test, woman is given 50 grams
of oral glucose and then 1hr later test BS level, IF over 130 or 140 they will proceed with next test, OGTT
(oral glucose tolerance test) this DOES require fasting will take fasting glucose level then give 100 grams
of glucose and then test BS levels at 1hr, 2hr, and 3hr
Gestational Hypertension – caused by vasospasm which is caused by poor tissue perfusion, there is NO
proteinuria
Mild Preeclampsia – GH with addition of proteinuria
Severe Preeclampsia – BP that is 160/110 or greater, proteinuria, elevated serum creatinine, visual
disturbances, hyperreflexia, etc.
Eclampsia – severe preeclampsia with onset of seizures
HELP syndrome – is a variant of GH in which hepatic dysfunction comes in
H: hemolysis – resulting in anemia and jaundice
EL: elevated liver enzymes, resulting in high ALT or AST
LP: low platelets – less than 100,000/mm3 resulting in thrombocytopenia
Hypertension Meds: methyldopa, nifidepine, labetalol, and magnesium for eclampsia *helps prevent
seizures but monitor patient for mag toxicity: no reflexes, low urine output, low respirations and LOC
and dysrhythmias (calcium gluconate is antidote)
Pre-term Labor – cervical changes from 20-37wks, vag swab to see if it has fetal fibronectin, meds
include nifidipine, indomethacin
Premature rupture of membranes – major causes of infection
Physiological changes with impending labor
Contraception
Barrier Methods
- Condoms
- Diaphragms – must be refitted for one every 2 years by a provider or if you have gained more
than 15lbs or have had a full term pregnancy or a 2 nd term abortion, you must also use
spermicide with every act of sex, must remain in place for 6 hours after sex
- Hormone methods, nuva ring, patch, etc. side effects very similar to all they include; chest pain,
SOB, leg pain, HA, vision problems, could mean potential blood clot or stroke, of PE, or HTN.
Smokers are at higher risk and it is recommended they do not take oral BC
Contraindications include: history of blood clots, stroke, cardiac problems, or estrogen related
cancer, or if you are a smoker
Depo Shot – can cause decrease in bone density, loss in calcium mineral, will need adequate calcium
and vitamin D to protect bones.
IUD’s – can increase risk for pelvic inflammatory disease, and uterine perforation, and will increase
risk of ectopic pregnancy, LOOK for change in string length, foul smelling discharge, painful
intercourse, fever, chills, etc
Infertility – inability to conceive after trying for at least 12 months (1yr)
-work up will be done after that, will start with male (usual 40% of time issue is with them)
-test on female, any test that has dye ensure no shellfish allergy or iodine
Pregnancy Signs
3 Signs
1. Presumptive – can be explained by a reason other than pregnancy
2. Probable – abd enlargement, etc
3. Positive – very distinct, fetal heart tones, or fetus on US, feel movement
Negals Rule – tells you when your due date is based on last menstrual cycle (JUST ADD 9 months and 1
week)
GTPAL
Gravidity - # of times woman has been pregnant including current pregnancy
Term births - # of pregnancies that have gone to 38wks or more
Preterm births - # of pregnancies that have gone before 38wks
Abortions or miscarriages - # of
Living children - # of
,Weight Gain and Nutrition during Pregnancy
- Normal weight gain is 25 to 35lbs
- If a patient is already overweight, 15 to 25lbs
- If a patient is underweight recommended 28 to 40lbs
*during first trimester should not gain more than 2-4lbs, after expect weight gain of 1lb per
week
Extra Calories per day – 340/day – 2nd trimester, 450/day – 3rd trimester
*if breast feeding after birth you still need an extra 300-400 a day
Folic Acid – prevents neural tube birth defects, sources are dark leafy veggies, orange juice
You need 2-3 liters of water a day
Limit caffeine to 200-3—mg a day
No ETOH
Diagnostic tests during Pregnancy
US- you want the bladder to be full, sound waves will resonate better
Amniocentesis – you want empty bladder
Nonstress Test – not invasive, measures fetal wellbeing within the last trimester and measures response
of fetal HR to fetal movement (reactive is normal, HR will increase) (nonreactive is not normal, HR will
decrease)
*if nonreactive may have a CST (contraction stress test) done, contractions brought on by
Pitocin/oxytocin/nipple stimulation and during that they will monitor FHR and look for acceleration.
-if no late acceleration you have a negative CST (normal)
*it can send the woman into early labor
Amniocentesis – empty the bladder, test amniotic fluid for genetic abnormalities, usually done around
14 weeks, check for levels of AFP (alpha feta protein), IF AFP levels are high, it is associated with neural
tube defects, if levels are low it is associated with chromosomal disorders such as down syndrome, will
also check the LS ratio which checks for fetal lung maturity
Risks associated – amniotic fluid emboli, hemorrhaging, infection, leaking of amniotic fluid, ruptured
membranes, or even miscarriage.
Bleeding during Pregnancy
Ectopic Pregnancy – ovum is planted outside fallopian tube, symptoms will be unilateral stabbing pain in
lower quadrants
Moller Pregnancy – symptoms of bleeding that resemble prune juice
, Placenta Previa – can be complete, incomplete, or partial
-symptoms are painless, bright red, vaginal bleeding during 2 nd or 3rd trimester, VERY
DANGEROUS
Aburpta Placento – symptoms will be intense localized uterine pain with dark red vaginal bleeding
*Yeast infections are very common during pregnancy
Incompetent Cervix – cervix does not stay closed causing miscarriage *if woman is known to have IC she
will have a cerclage done (closes cervix) usually removed at 37wks.
Hyperemesis – excessive N/V well past 12 weeks, interventions include B6 admin, and antiemetic meds
IF iron deficiency anemia – provider will order iron supplements (take with food rich in vitamin C)
Gestational Diabetes
If woman has this she is at high risk for developing diabetes after pregnancy, oral meds usually
contraindicated, woman will likely have to use insulin to control sugar levels * test occurs 24-28wks of
gestation with a 1hr glucose tolerance test, NO fasting required for initial test, woman is given 50 grams
of oral glucose and then 1hr later test BS level, IF over 130 or 140 they will proceed with next test, OGTT
(oral glucose tolerance test) this DOES require fasting will take fasting glucose level then give 100 grams
of glucose and then test BS levels at 1hr, 2hr, and 3hr
Gestational Hypertension – caused by vasospasm which is caused by poor tissue perfusion, there is NO
proteinuria
Mild Preeclampsia – GH with addition of proteinuria
Severe Preeclampsia – BP that is 160/110 or greater, proteinuria, elevated serum creatinine, visual
disturbances, hyperreflexia, etc.
Eclampsia – severe preeclampsia with onset of seizures
HELP syndrome – is a variant of GH in which hepatic dysfunction comes in
H: hemolysis – resulting in anemia and jaundice
EL: elevated liver enzymes, resulting in high ALT or AST
LP: low platelets – less than 100,000/mm3 resulting in thrombocytopenia
Hypertension Meds: methyldopa, nifidepine, labetalol, and magnesium for eclampsia *helps prevent
seizures but monitor patient for mag toxicity: no reflexes, low urine output, low respirations and LOC
and dysrhythmias (calcium gluconate is antidote)
Pre-term Labor – cervical changes from 20-37wks, vag swab to see if it has fetal fibronectin, meds
include nifidipine, indomethacin
Premature rupture of membranes – major causes of infection
Physiological changes with impending labor
