Maternal Infant Nursing Study Concepts (Exam 3)
Introduction to Maternal Newborn Nursing
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Providers
o Certified Nurse Midwives (CNM)
 The only advanced practice nurse that can practice in Labor & Delivery
o Unlicensed roles
 CNA-must remain in their scope of care (vital signs and assistive care
only NO assessments)
Social Issues in Maternity
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Social Determinants of Health
o What are they? Poverty is the most severe threat that prevents access to
prenatal care and child care, increases risks.
o Effects on African Americans women and infants? (mortality and complications)
o The US has the most infants that die than any other industrialized nation.
o To save lives more women need access to prenatal care.
Intimate Partner Violence
o Assessment, signs & symptoms
Cultural Considerations
o Touch, communication, social support
o Provide respectful culturally sensitive maternity care
Health Promotion BEFORE pregnancy (PRECONCEPTION)
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Nutrition, Folic Acid (to prevent neural tube defects)
Weight, exercise
Smoking cessation (can reduce fetal growth)
Pregnancy & Fetal Development
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Ovulation- occurs in middle of the month, day 10-14 of the menstrual cycle
Placenta
o What are the functions?
Umbilical cordo 2 Arteries/ 1 Vein
Amniotic fluid
o What are the functions?
Physiological Aspects of Pregnancy
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Signs of pregnancy REVIEW!
o Presumptive (subjective)
o Probable (objective)
o Positive (objective)
Antepartum (prenatal) Care During pregnancy
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Naegel’s Rule (EDD or Due Date)
o LMP (-) 3 months (+) 7 days PRACTICE!!!!!
GTPAL (classification of pregnancies) PRACTICE!!!!!
o Gravida-Number of pregnancies?
o Term-How many weeks?
o Preterm-How many weeks?
o Abortions-How many weeks?
o Living- How many living (count multiples here gestations (twins, triplets, etc.)
Postpartum Adaptations
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Postpartum Hemorrhage
o Signs of hemorrhage- Uterine atony what causes it>
macrosomia>polyhydramnios
o Interventions
o Medications- MUST KNOW ALL 4 generic and brand
 Contraindications (when you can’t give them)
BUBBLE-HE focused assessment. What does the acronym stand for?
Uterine Descent back down in pelvis
o Involution- fundus should go down 1 finger breath from the umbilicus per day
o Subinvolution- the fundus DOES NOT go down as expected, sign of a
Postpartum Hemorrhage
Engorgement
o Prevent by promoting early frequent feeding every 2-3 hours and empty breast
by pumping or expressing the remaining milk
Laceration
o Promote comfort- Ice, sitz bath, topical spray, analgesic
Postpartum blues, depression, psychosis
o When it can occur, what are the signs and symptoms? Hearing things?>report
immediately
Rubin’s phases
o Taking-in tired, taking-hold, letting go
Discharge Education (resumption of sex, infection, bleeding)
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Breastfeeding (techniques, contraindications (HIV), doesn’t prevent pregnancy)
Call provider for signs of infection (FEVER!, odor, discharge)
Sexual intercourse after 6-8 weeks postpartum
Sitz bath
Postpartum Complications
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Deep Vein Thrombosis (DVT) signs of>temp>pain>swelling> warm at site
o Homan’s sign- Dorsi flex foot back to assess for pain
o Prevention- early ambulation and SCD boots for surgical patients
Pulmonary Embolus
Mastitis
o Breast infection
 Promote hand hygiene, frequent feedings and empty breast milk at
every feeding
 Must receive antibiotics
 Should continue to breastfeed
Wound infections> including lacerations
Urinary tract infection
Newborn Nursing Care and Assessment
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Assign Apgar (when done, what are the 5 components, what does the score mean?)
Normal vitals signs of the newborn
o Normal temp
 Normal HR
 Normal respiration
Respiratory complications for cesarean section newborns complications why?
Thermoregulation
o Prevent heat loss
Stool transition from meconium> to yellow (breastfeeding) or brown (bottle feeding)
Newborn Assessment
o Ballard Score (gestational age assessment)
o Caput vs cephalohematoma (which one causes hyperbilirubinemia?)
o Birthmarks, milia, Mongolian spots AFRICAN AMERICAN babies
o Reflexes KNOW THEM ALL!
 Sucking, rooting, palmar grasp, plantar grasp, Moro, Babinski, stepping
Medications given to newborn
o Vitamin K IM
 Given Lateral thigh, vast lateralis
 Increases clotting factors
o Erythromycin film in eyes
 Prevent infection in the eyes, STI’s
Newborn screenings (hearing, congenita heart disease, PKU
Safety (ID BANDS 2 immediately on baby wrist and ankle, SIDS, car seat safety, crib
safety)
o Back to sleep
o Approved care seat
 In back rear facing
 Pediatrician selected and appointment scheduled
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Circumcision (type, care, signs and symptoms to report)
o Mogan
 Notify provider for signs of infection, bleeding
 Apply petroleum gel only for Mogan/Gamco
o Plastibell
 Notify provider for signs of infection, bleeding
 NO petroleum gel
Umbilical Cord (care, signs to report)
o No full bath until healed
o Clean with water only
Newborn Feedings (bottle feeding safety, breast feeding how often, how many wets per day?)
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Breastfeeding
o Advantage- antibodies to provide some immunity for the newborn decrease
illnesses, cost, easier
o Disadvantage- engorgement, mastitis, time consuming
o Newborn getting enough milk if 6-8 wet diapers pre day
Bottle feeding
o Do not reuse formula discard after feeding
Newborn Complications
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Respiratory complications
o TTN (signs/symptoms, cause, treatment)
o GBS (signs/symptoms, cause, treatment)
o RDS (signs/symptoms, cause, treatment)
o Meconium Aspiration (signs/symptoms, cause, treatment)
Preterm newborn risks
Thermoregulation
 Types of heat loss- conduction, radiation, convection, evaporation
 Interventions
Shoulder dystocia (clavicle and should assessment-crepitus)
Hypoglycemia (signs of, immediate care priority for macrosomia, risks mother with
diabetes, treatment)
Hyperbilirubinemia (Jaundice) (causes, prevention feed 2-3 hours, treatment, safety)
Promoting bonding in the NICU
o Kangaroo care (skin to skin), Rooming -in
o NICU newborns
 Encourage touch (gown and hand hygiene) as soon as possible
Newborn substance abuse assessments
o Neonatal Abstinence Syndrome (NAS)
 Poor feeder, hypertonic reflexes, difficult bonding, shrill high-pitched
cry, tremors, increased Moro reflex, delayed growth and development
o Fetal Alcohol Syndrome (FAS)
 Congenital defects, delayed growth and development, poor feeders
Contraceptives (Review in ATI!)
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Partner MUST also wear Condom to Prevent STI’s
Most effective
o IUD copper vs Hormonal
o Proper use and replacement
Medroxyprogesterone-(Depo-Provera) (side effects, use, weight gain, bone density)
Combination estrogen and Progestin (birth control pills, risks)
o Thickens cervical mucous
o Prevents ovulation
o Contraindications- hypertension, DVT, smokers, obesity, over 35 etc.
o Miss 1 dose take 2 and get back on track
Progesterone only (mini pill)
o Safer for high patient risk factors and breastfeeding
Decreased effectiveness
o St. john’s wort
o Infection
o Antibiotics
o Not taken as prescribed
Diaphragm
o Must be properly fitted (when to replace)
o Leave in for 6 hours
o Use spermicide
Natural family planning methods
o Cervical mucous (description during ovulation vs not ovulating)
o Basal body temperature (increase temp=ovulation)
Tubal ligation (permanent surgical sterilization for woman)
Vasectomy (safe, has no impact on intercourse or erection)
Breastfeeding is not a contraceptive method
Teen recommended methods (IUD, implant (Nexplanon)WITH CONDOMS!)
Always use condom to prevent STI
Infertility
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Diagnosis
o 12 months no conception when actively trying
Show Compassion
Male and female assessment and testing
o Easiest to analyze is male semen first
Medication
o Clomiphene citrate- Clomid
Intrauterine insemination (IUI) vs Invitro-fertilization (IVF)
Sexually Transmitted Infections (STIs) – Place the pregnant mother and baby in danger of
preterm labor, PROM, chorioamnionitis, IUGR, abortion. Prevention, assessment of TORCH
during pregnancy, and teaching.
Risk Factors- Multiple partners, unprotected sex, IV drug use
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Chlamydia
o Usually asymptomatic, vulvar itching, white-grey discharge
 Treatment-Azithromycin or Amoxicillin
Gonorrhea
o Yellow-greenish foul discharge
 Treatment- Ceftriaxone or Amoxicillin
Syphilis
o Skin rashes reddish- brown, non-painful lesions
 Penicillin G IM 1 dose
HPV
o Vaginal warts
 Trichloroacetic acid (TCA) or cryotherapy freezing
HIV
o Fatigue, diarrhea, weight loss
 Zidovudine IV
HSV
o Pimple-like painful blisters
 Antiviral medication-Acyclovir
Trichomoniasis
o Yellow-green itchy foul discharge
 Metronidazole po
BV
o Foul fishy odor with milky discharge
 Metronidazole po