Maternal-Newborn Overview
I. Pregnancy
A. Nagele’s Rule: Calculating EDC/EDD:
Take the _________day of the menstrual period (LMP)
Subtract ________________________________________________
Add_____________________________________________
B. Weight Gain During Pregnancy
1. Total weight gain ____________________________________
2. 1st Trimester weight gain ______________________________
3. 2nd/3rd Trimester weight gain ___________________________
4. How do you calculate?
Weeks
12
13
14
15
16
17
18
19
20
30
40
Pounds
C. Fundal Height – Landmarks
1. Fundus is not palpable until week _______________________
2. Fundus typically reaches the umbilical level at week---________
D. Signs of Pregnancy:
1. Positive Signs of pregnancy:
a. Fetal skeleton on _______________________________
b. Fetal presence on _______________________________
c. ______________________________________________
d. Examiner _________________ fetal movement / outline
2. Probable/Presumptive signs of pregnancy:
a. All ___________________ & ______________________
b. Chadwick’s Sign ________________________________
c. Goodell’s Sign __________________________________
d. Hegar’s Sign ___________________________________
E. Pattern of Office Visits
1. Once a month until week _________________
2. Once every two weeks until week __________
3. Once a week until delivery ________________
F. Discomforts of Pregnancy (see Review Question Book)
Discomfort
Morning
Sickness
Urinary
Incontinence
Dyspnea
Back Pain
Trimester(s)
Treatment
II. Labor & Birth
A. Which is the Truest, most valid sign of labor?
a. Bloody show.
c. Mucus plug expulsion.
b. Onset of regular contractions.
D. Rupture of membranes.
B. Terms:
1. Dilation: _______________ of cervix (___________ cm)
2. Effacement: ______________of cervix (____________%)
3. Station: Relationship of fetal ____________________part
to mom’s ________________________________.
4. Engagement: _____________________________________
5. Lie: Relationship between __________________ of baby and
_______________ of mom.
6. Presentation: Part of ___________ that enters birth canal first.
C. Four stages of Labor & Delivery:
1. Stage 1 __________________________________________
(Includes 3 phases of labor--latent, active, transitional)
2. Stage 2 __________________________________________
3. Stage 3 __________________________________________
4. Stage 4 __________________________________________
D. First stage of Labor & Delivery--“Labor Numbers”
LATENT
ACTIVE
TRANSITION
CM
DILATED
CXN FREQ
DURATION
INTENSITY
Note: Contractions should not be longer than ______________
seconds or closer than every ______________ minutes.
E. Assessment of Contractions
1. Frequency: from the_________________ of one contraction to the
_____________________ of the next contraction.
2. Duration: From the beginning to ____________ of one contraction
3. Intensity: ________________ of contraction. Palpate with
________________________________________________.
F. Complications of Labor
1. Prolapsed cord
________________________________________________
________________________________________________
________________________________________________
________________________________________________
2. Interventions for all other complications of labor & birth:
L_________________________________
I _________________________________
O ________________________________
N ________________________________
Pit________________________________
3. Pain medications in labor
Do not administer a SYSTEMIC pain medication to a woman
in labor IF the baby is likely to be ________________ when
the _______________________ is ___________________.
4. Fetal monitor patterns
Low Fetal Heart Rate (Bad)_________________________
FHR Accelerations
_____________________________
Low Baseline Variability (Bad) _______________________
High Baseline Variability ___________________________
Late Decelerations
(Bad)_________________________
Early Decelerations
_____________________________
Variable Decelerations _____________________________
5. Ace of spades: Check ________________________________
G. Second stage of labor & delivery…..
What do you do? In what order?
1. Deliver ___________________________
2. ____________________ mouth and nose
3. Check for _________________________
4. Make sure an ___________
____________ is on the baby
before it ever leaves the _______________ ___________.
H. Third stage of labor & delivery: Delivery of ___________________
1. _________________________________________________
2. _________________________________________________
I. Fourth stage of labor & delivery: Recovery Stage
Recovery Stage = the first two hours after delivery
________ things you do ______ times an hour in _______ stage:
1. ______________ Assess for S&S shock
2. ______________ If boggy, massage. If displaced, void/cath
3. ______________ Excessive Lochia= pad sat in < 15min
4. ______________ Check for bleeding under patient.
J. Postpartum assessment
1. Uterus
Tone:______________________________________
Location: Midline _____________________________
Height:_____________________________________
______________________________________
2. Lochia
Color: Rubra _________________________________
Serosa_________________________________
Alba __________________________________
Amount
Excessive = Saturate pad in ________________
3. Extremities
S&S Thrombophlebitis: the most valid sign is ____________
________________________.
K. Variations in the Newborn
1. Milia -
distended sebaceous glands which appear as tiny
white spots on baby’s face.
2. Epstein’s Pearls – small, white epithelial cysts on baby’s gums
3. Mongolian Spots – bluish-black macules appearing over the
buttocks and/or thighs of darker-skinned neonates.
4. Erythema Toxicum Neonatorum – red popular rash on baby’s
torso which is benign and disappears after a few days.
5. Hemangimas – benign tumor of capillaries
6. Cephalohematoma – swelling caused by bleeding between
the osteum and periosteum of the skull. This swelling
does not cross suture lines.
7. Caput Succedaneum – edematous swelling on scalp caused by
pressure during birth. This swelling may cross suture
lines. It usually disappears in a few days.
8. Hyperbilirubinemia – normal, physiologic jaundice appears after 24
hours of age and disappears at about one week of age.
9. Vermix caseosa (caseus=cheese) – whitish, cheese-like substance
which covers the skin of an unborn baby.
10. Acrocyanosis – normal cyanosis of baby’s hands and feet which
appears intermittently over the first 7-10 days
11. Nevus/Nevi – generic term for birthmark.
Nevus flammeus=nonblanchable port wine stain.
Telangiectatic nevi=blanchable pink “stork bites”
L. OB Medications
Tocolytics-____________________________________labor.
Terbutaline
Nifedipine
Maternal ____________________
Maternal__________________,
_________________________,
_________________________
Oxytocics-____________________________________labor.
Oxytocin
Fetal / Neonatal Lung Meds
Betamethasone
Beractant (Notice the ending
“actant” like in SurfACTANT)
1. Give to
1. Give to
2. Route
2. Route
3. Before
3. After
PSYCHOTROPIC DRUGS
NOTE: All psych drugs cause ___________________________________
A. Phenothiazines
1. All end in ___________________________________
2. Ex: Thorazine, Compazine
3. Actions: (Does not cure disease. Reduces symptoms.)
a. Large doses: __________________________
b. Small doses: __________________________
c. Major ________________________________
4. Side effects:
Remember ABCDEFG…
A= ____________________________________________________
B= ____________________________________________________
C= ____________________________________________________
D= ____________________________________________________
E= ____________________________________________________
F= ____________________________________________________
G= ____________________________________________________
Teach patient to report sore throat & any S/S of infection to doctor.
5. Nursing care: treat side effects. Number one nursing diagnosis
is ____________________________.
6. “Deconate” after name of drug means it is a ___________________
IM form given to ____________________patients.
B. Benzodiazepines
1. Antianxiety meds (considered____________________________)
2. Always end in ___________________________________________.
3. Prototype: Diazepam (Valium)
4. Indications:
a. induction of anesthetic
b. Muscle relaxant
c. Alcohol withdrawal
d. Seizures--especially status epilepticus
e. Facilitates mechanical ventilation
5. Tranquilizers work quickly.
MUST NOT take for more than _________________.
6. Side Effects:
A= ____________________________________________________
B= ____________________________________________________
C= ____________________________________________________
D= ____________________________________________________
7. Number one nursing diagnosis: ___________________________
C. Tricyclic Antidepressants
1. “_____________________” to treat depression.
2. Names all have “-TRIP-“ If TRIP is in the name it is a TRIcyclic
antidepressant.
3. Side effects
A= ____________________________________________________
B= ____________________________________________________
C= ____________________________________________________
D= ____________________________________________________
E= ____________________________________________________
4. Must take med for ____________________before beneficial effects.
D. Momoamine Oxidase (MAO) Inhibitors
1. Antidepressants
2. Depression is thought to be caused by a deficiency of norepinephrine,
dopamine, and serotonin in the brain. Monoamine oxidase is the
enzyme responsible for breaking down norepinephrine, dopamine
and serotonin. MAO inhibitors prevent the breakdown of these
neurotransmitters and thus restore more normal levels and decrease
depression.
3. Drug names:
The generic names of these drugs are almost impossible to
memorize they are so random. So here is how you get the question
correct: IF they give you a patient with depression and ask you what
foods to avoid the drug MUST be a MAOI. They are the only psych
drugs where we worry about diet.
4. Side effects:
A= ____________________________________________________
B= ____________________________________________________
C= ____________________________________________________
D= ____________________________________________________
5. Interactions: (patient teaching)
a. To prevent severe, acute, sometimes fatal __________________
crisis, the patient MUST avoid all foods containing tyramine.
Foods containing tyramine:
1) Fruits and veggies: Remember salad “________________”
Avoid B- Bananas
A- Avocados
R- Raisins (any dried fruits)
2) Grains: all okay.
3) Meats:
No organ meats: liver, kidney, tripe, heart, etc.
No preserved meats: smoked, dried, cured, pickled,
hot dogs.
4) Dairy: no aged cheeses. No yogurt.
5) Other: no alcohol, elixirs, tinctures, caffeine, chocolate,
licorice, soy sauce.
b. Drug interactions: Teach patients not to take over-the-counter
medications unless they are prescribed.
E. Lithium (an electrolyte--notice -ium ending as in potassium, etc.)
1. Used for treating bipolar disorder (manic-depression) --it decreases the ________________________.
2. Side Effects:
The three “P’s”
a. ____________________________
b. ____________________________
c. ____________________________
3. Toxic: tremors, metallic taste, severe diarrhea, and ANY other
neurological sign besides paresthesia.
a. Number one intervention: _________________________
b. If sweating, give ___________________ as well as fluids
4. NOTE: Closely linked to sodium, Monitor sodium levels.
Low Sodium levels prolong lithium’s half-life, causing lithium
toxicity. High sodium levels decrease the effectiveness of lithium.
F. Fluoxetine
Fluoxetine is an SSRI. If you see a drug that has -XET- or -XEP- it is an
SSRI antidepressant.
1. Similar to a tri-cyclic antidepressant---same info
2. Side effects: _____________________________
3. Fluoxetine causes __________________ so give before 12 noon.
If BID, give at 6A and 12N.
4. When changing the dose of Fluoxetine for an adolescent or young adult,
watch for ____________________________________________.
G. Haloperidol Also has a deconate form.
1. Same info as Phenothiazines. Side effects: _______________________
2. Elderly patients may develop NMS from overdose. NMS is Neuroleptic
Malignant Syndrome--a potentially fatal hyperpyrexia with temp of
_________. Dose for elderly patient should be HALF of usual adult dose.
3. Safety concerns R/T __________________________
H. Clozapine
1. Used to treat severe schizophrenia.
2. Advantage: It does NOT have side effects _______________________
Disadvantage: It DOES have side effect: _______________________
3. Do not confuse with Klonopin (Clonazepam)
I. Sertraline
1. Another SSRI like Fluoxetine.
2. Also causes insomnia but CAN be given in evening.
3. Watch for interaction with:
St. John’s Wort - Serotonin syndrome
SADHeadWarfarin (Coumadin) - watch for _____________________________
Prioritization, Delegation & Staff Management
A. Prioritization
1. Decide which patient is _______________ or _______________
Examples:
Answers have four parts: Age, Gender, Diagnosis/Surgery, Modifying
phrase. Ignore _________________________________The
____________________is more important than
the_____________________. In a tie go with the modifying phrase.
2. Two rules of prioritization.
RULE #1: “__________________ beats _____________________
RULE #1: “__________________ beats _____________________
Things that make a patient STABLE
Things that make a patient UNSTABLE
1. Use of the word stable.
1. Use of the word unstable.
2. Chronic illness.
2. Acute illness.
3. Regional or local anesthesia.
3. General anesthesia.
4. Post-op > than 12 hours ago
4. Post-op less than 12 hr.
5. Unchanged assessments.
5. Changed or changing assessments.
6. The phrase “ready to be discharged’ 6. The phrases, “Newly admitted”, or
or “to be discharged.”
“Newly diagnosed”.
7. Lab abnormals of an A or B level.
7. Lab abnormals of a C or D.
8. Stable patients are experiencing the 8. Unstable patients are experiencing
typical ____________ signs and
_____________ signs and symptoms
symptoms of the disease with which
(complications).
they have been diagnosed and for
9. Always unstable: Hemorrhage,
which they are receiving treatment.
hypoglycemia, Hyperpyrexia, pulse or
resp rate of “0”.
RULE #2: (Caution: Use only as a ______________________________)
“The more _______________the______________, the higher the priority.”
B. Delegation
1. Do not delegate the following responsibilities to an ___________:
a. Starting an ___________________
b. Hanging or mixing ____________________________
c. Evaluating ____________________________
d. Giving ________________________ meds
e. Giving an ________________________
f. Performing _______________________________________
_____________________________________________
g. ______________________ of care
h. Developing or performing ___________________________
2. Do not delegate the following responsibilities to _______________:
a. ____________________May document what they did.
b. ________________________Except for VS on stable clients.
c. ____________________May apply OTC topical lotions/creams.
d. ____________________Except for _________________
You may delegate: ____________________________________
3. Do not delegate to ____________________________:
________________responsibilities. They can only do what you
________________ them to do.
C. Staff Management
1. How do you ___________________ with ____________________
_______________________ of staff?
2. Four options:
a. _________________________________________________
b. _________________________________________________
c. _________________________________________________
d. _________________________________________________
3. How do you choose between the three options? Ask yourself three
questions:
#1. “Is what they’re doing _____________________?”
If the answer is yes, _______________________________
If the answer is no, go on to question #2:
#2. “Is the patient or staff member in immediate ______________
of physical or psychological _______________?”
If the answer is yes, _______________________________
If the answer is no, go on to #3:
#3. “ Is this behavior ___________________, not _____________,
but simply __________________________?
If the answer is yes, ______________________________
Test-Taking Skills
“ACE OF SPADES” ANSWERS:
A. Psych Questions
1. Best: “Nurse will examine own ______________about…”
2. Next: “Establish a ___________________________________.”
B. Nutrition
1. In a tie, either pick _____________________or ______________.
2. Never pick ____________________________for children.
3. Never mix _________________________in children’s food.
4. Toddlers: __________________________-food
5. Preschoolers:______________________! One meal a day is okay.
C. Pharmacology
1. Most commonly tested area in pharm: ______________________.
2. If you know what a particular drug does, choose a side effect in the
same _____________________where the drug is working.
3. If you have no clue what the drug does, look to see if it’s PO.
If so, pick ________________side effects.
4. Never tell a child that medicine is _____________________.
D. OB
1. Ace of spades answer: “Check__________________”
E. Med-Surg
1. What is the FIRST thing you assess in a med-surg situation?
_______________________________________________
2. What is the FIRST thing you DO in a med-surg situation?
_______________________________________________
F. Pediatrics
Three rules re: Growth & Development Questions. They are all based on
the principle: ___________________________________________.
Rule #1:
When in doubt, call it _________________________________.
Example: “You’re caring for a 6-year-old child who can’t read…”
a. Call the physician
b. Preform a developmental screening test (DDST)
c. Reassure mother that this is normal
Rule #2:
When in doubt, pick the ___________________________age.
Example: “At what age should a child be able to walk?”
a. 3 months
b. 12 months
c. 14 months
d. 3 years
Rule #3:
When in doubt, pick the __________________________task.
Example: “A child is 6 months old. What task would he have most recently
mastered?”
a. Social smile
b. Rolling over
c. Sitting up
d. Five-word vocabulary
General Guessing Skills
1. Rule out_________________________________(“always”, “never”)
2. If two answers say the same thing, _________________________
is right. (tachycardia, racing heart)
3. If two answers are _________________________, one of them is
probably right.
4. ___________________strategy: is one answer more global?
Example:
What is important to do with a suicidal client?
a. Remove sharp objects from client’s possession
b. Institute suicide precautions
c. Remove belt
d. Have an aide present to observe at all times
5. When you’re stuck between two answers, read the
________________ again!
6. Sesame Street Rule: “One of these things is not like the others; one
of these things just doesn’t belong.”
Example:
Cholenutrabencid (fictitious drug) side effect:
a. GI cramping
b. Heartburn
c. Joint pain
d. Peptic ulcer disease
7. Don’t be tempted to answer a question based on your
____________________instead of your knowledge.
Example:
Which of the following is important in the administration of
Amikacin IVPB?
a. Cover the Amikacin bag with foil to protect from
exposure to light
b. Use IV pump
8. If something really seems _____________________, it probably is.
Right answers are different from wrong answers just because
they’re right!
9. If you don’t know the answer, you DO know the answer:
Use your ___________________________________
Three expectations you are not allowed to have:
1. Do not expect _______________________________!
2. Do not expect _______________________________!
3. Do not