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And Clinical Revelations

What is maternal-child health?
6 interconnected aspects

What is maternal-child health?
6 interconnected aspects
Maternal physiology
Fetal/newborn physiology
Medical
Care
Patient experience
Family experience
Nursing
Care

Maternal physiology
• Nutrition
• Hemoglobin
• Weight gain
• Blood pressure
• Kidney and liver function
• Uterus
• Contractions
• Placenta & cord
• Tubes & ovaries

Fetal/newborn physiology
• Fetal heart tones
• Pulse, temp, respiratory rate
• Weight
• Amniotic fluid volume
• Anomalies
• Placental blood flow

Family experience
• Knowledge
• Previous experiences
• Cultural roles and expectations
• Significant other, older siblings, grandparents, extended family
• Facility
• Inclusion/exclusion
• Staff attitudes

Patient experience
• Knowledge
• Previous experiences
• Fear
• Cultural roles and expectations
• Presence/absence of support person
• Facility
• Staff attitudes

Medical care
• What physician orders and does
• Based primarily on physiology
• Patient or family experience is much lower priority
• Physicians receive less training in patient education and support

Nursing Care
• Physiology top priority, but patient and family experience is dealt with simultaneously
• Education high priority
• Culture more important
• Independent nursing interventions
• Medically delegated tasks

Cardinal Movements of Childbirth

Which Are….
• Flexion
• Descent
• Internal rotation
• Extension
• External rotation

Positions for birthing-kneeling

Side lying

Birthing stool

Hands and Knees

Water birth

Hospital birthing room

Typical hospital birth

Crowning

NCLEX-style question
The highest priority in nursing care of the laboring client is:
1. Pain relief
2. Partner involvement
3. Fluid intake
4. Fetal heart rate

Maternal-Child Medications
• Pain Medications
• Tylenol & NSAIDs
• Stronger NSAIDs:
– Keterolac (Toradol)
• Narcotics po:
• codeine po
• Hydrocodone
• Oxycodone
– Injectables:
• Nubain
• Stadol

What question should the nurse ask before administering 10 mg of Nubain IV to a laboring client?
1.“Have you ever had surgery?”
2. “Do you use narcotics regularly?”
3. “What vitamins do you take daily?”
4. “Is your baby a boy or a girl?”

NCLEX –Style Question
A Client who is Latino is in labor and the father is refusing to come into the labor and delivery room. The nursing student assisting in the care believes he should participate in the birth and repeatedly urges the father to come into the labor and delivery room even though he keeps refusing. This nursing student is exhibiting:
A. Cultural sensitivity
B. Ethnocentrism
C. Encouragement
D. Discouragement

NCLEX Style ?
Which of the following methods places emphasis on natural childbirth?
A. Leboyer
B. Lamaze
C. Dick-Read
D. Bradley

NCLEX Style ?
The nurse auscultates the fetal heart rate and determines a rate of 150 to 155 beats/minute. Which of the following nursing interventions is most appropriate?
A. Inform the client that the FHr is normal and document the findings.
B. Document and reassess the FHE in 5 minutes because the rate is too high.
C. Report the FHR to the primary provider immediately and then document.
D. Document and tell the mother she is having a boy because the heart rate is fast.

NCLEX-style question
The laboring primiparous client is in early labor. She asks the nurse how her labor will progress? What is the nurse’s best response?
1.The contractions will gradually get stronger and closer together.”
2. “If you don’t progress fast enough, we’ll start
Pitocin to hurry things along.”
3. “Don’t worry. We’ll take good care of you and make sure everything is fine.”
4. “When your water breaks we will check your cervix to see how far along you are.”