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maternal newborn notes
Maternal/Child Nursing (NURS - 114)
American Career College
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Part 1 OB- Prenatal, Natal, Postnatal and Neonatus Birth Control Estrogen/ progestron- it confused the estrogen and progesteron so there will be sloughing of the endometrium and there is no place for implantation Diaphragm- put in 6 hrs before and 6 hrs after sex - Use spermicide to kill sperm - Contraindicate to multiple sex partners - This come with different size so if they gain/ loss weight they will need to get another fitting Basal Temperature- they check their temperature every morning to know if they ovulate the higher temperature mean they are ovulating. No sex during ovulation usually use for calendar method If become pregnant- they need to go to prenatal visit to check if there is problem so they can work any possible problem during pregnancy and on delivery. Diet for pregnant women- vegetable and fruit VITAMINS FOLIC ACID/ B9 to prevent spinal bifida/ neural tube defect Emancipated Minor- minor pregnant/std/hiv can have own choice about their health consider as adult under California law Exercise- moderately exercise no weight lifting, no heel shoes Quickening- movement of the baby - Primigravida- can feel 16-20 wks - Multigravida- can feel bet 14- 16 wks Teach Danger Signs: Epigastric Pain Diplopia Fever Bleeding Blurry Vision Edema in the face/hand Don’t feel fetus Pregnant is overweight/ too big Placenta Previa- means placenta imbeded not in the fundus it imbeded too low that it close cervix so need c- section S/S Non painful bleeding Soft when to touch stomach Abruptio Placenta S/S - Very painful - Hardboard like abdomen Intervention - Check fetal HR 110-160bpm is normal - The RN cannot do cervix exam it has to be the HCP - It has to be done in surgery room
Pregnancy Induce Hypertension - bp high - I will check if there edema in face and hands - Proteinuria - PREECLAMPSIA they will be seizure - Magnesium Sulfate is medication for preeclampsia to prevent eclampsia Adverse Effect: Respiratory depression, deep tendon reflex normal is +2 if its lower than that or absent then its abnormal. CheckI&O normal is 30ml/hr Antidote: IV Calcium Gluconate Side effect: lethargic put siderails up so they wont fall Eclampsia / Seizure: put padded pad on side rails to prevent injuries lower bed and provide 10L via nonrebreather mask GDM- Gestational Diabetes Mellitus - Pregnant do 3 hr Glucose tolerance test - Npo after midnight - Check blood sugar 1st - Give 50 gram carbohydrate sweet solution - 30 min later check blood again every 30 min till 3 hr reach total of 6x - >140 blood sugar result pregnant pt is high risk for GDM - Make sure to maintain normal sugar to prevent complications Complications: o Weigh too big macrosomia o Large for gestational age LGA o Preterm o Surfactant wont develop respiratory distress plarineras intercostal muscles retraction o Tachypnea, granting wheezing stridor cyanosis/latesign o Baby born lethargy hypocalcemia jaundice 1st day /pathological jaundice o Apgar score is low and baby is hypoglycemic o Mother is hyperglycemic so it wont reach placenta Jaundice Reasons: - GDM - Erythroblastosis fetalis- incompatible RH factor of mom is negative and baby is positive Urinary Frequency - During early pregnancy like one month the mother will have urinary frequency due to increase of circulation - At the end of pregnancy it's pressing the true pelvis the mother will have urinary frequency because the fetus is pressing the bladder Edema: - ankle edema normal just rest feet elevated / ambulate/ walk AFP- Alpha-fetoprotein - 16 wks pregnancy - Write label of how many week pregnancy - High when spinal bifida - Low down syndrome Rhogam
- So when you come back after 1 year HCG should be low if its high need treatment with the use of chemotherapy agent such as methotrexate and chemo/ radiation IRON
- Iron- feces will be dark color
- Take it without food but if it will irritate stomach take it with orange juice and food
- Iron make RBC
- When deliver baby blood loss
- Iron deficiency anemia- give extra iron
- Teach them to talk to doctor before taking certain medication to make sure it safe to baby
- If neeed urgent give via IM and use Ztrack technique give it to gluteus maximus/ minimus shoud be 90degress Aspirate it give erloc 0 pull skin tightly laterally wait 10 sec before you release. Press gently with ice. No massage
- Spinach have a lot of iron Vitamin:
- Folic Acid/ B9- give 800mcg per day It will avoid neural tube deffect
- Prenatal visit 1mo-7month 1x 7-8 mon every two wks and 8-9 month everywk till baby born
- Send them to classes how to breath, learn about breast feeding
- Encourage to stop smoking to avoid LBW- low birth weight
- NO STD
- No Alchohol- fetal alcohol syndrome
- No drugs- can be addicted and jittery NAGELS RULES: +7 days minus 3 months BPP- Biophysical Profile
- To know if baby is normal inside wound like APGAR SCORE
- 10 is the highest so if you have 10 SCORE ASSURE MOM THAT BABY IS WITHIN EXPECTED RANGE
- They will check baby movement, check pocket of amniotic fluid, muscle tone Cardiac Disease
- Cardiac function is challenged by pregnancy
- Usually mother die when giving birth
- Peripartum cardiomyopathy- they have cardiac problem just when you got pregnant
- Monitor edema, weight gain- for rhf
- Monitor cough, crackles respiratory- lhf
- Iron intake should be enough to avoid anemia
- Limit / restrict sodium
- Stool softeners may be given Adolescents/ Teen-ager pregnancy
- Cephalopelvic disproportion is usual issue in teen age pregnancy
- Risk for PIH, low birth weight, IUGR, anemia, infection, preterm, and perinatal death DIAGNOSTIC TESTS: Ultrasound- is the safest way to check fetus
Nonstress test - they will put monitor in tocotransducer fundus to check for contraction and another monitor in USG + gel to check FHR
- Give clicker to mother and ask to click when baby move
- If baby not moving give orange juice or do vibroacoustic and massage /palpate
- Before giving juice its 120 then after giving juice HR 140 changes in >15 sec then it’s a good baby POSITIVE REACTIVE NST if its less than <15 sec the changes in the HR then its bad so do it again if its still not good do Stress Test Stress Test
- Sign consent
- mother will be given pitocin there should be 3-4 contraction and stimulate the nipple
- Early Deceleration- If baby HR go down every contraction normal result
- If baby HR doesn’t go down every contraction or late reaction then its bad its LATE DECELERATION LATE DECELERATION- If baby HR doesn’t go down every contraction or late reaction then its bad it. fetus can have hypoxia/ UPI- Utera Placenta Insufficiency Intervention
- Position turn left to avoid vena cava syndrome
- O
- Stop pitocin
- Increase fluid
- If not relieve and hr still not normal call HCP Do C/s if nothing resolve PHOTO THERAPY
- Convert indirect bilirubin which insoluble to become direct bilirubin which is soluble
- Green dark stool and green urine is a good sign
- If not treat it will damage the baby brain become impaired Epidural
- Should be given during active Phase
- DON’T GIVE IT EARLY BECAUSE IT WILL PROLONG LABOR
- Don’t give it late because it will make mom and baby very lethargic Labor and Delivery Stage I Mucus Plug and bloody show means its ready Latent Phase Every 8-30min 40 sec contraction still talkative Active Phase Contraction every 5-8min 4-7cm lasting 50-60 sec very painful Give: epidural, stadol, nubain Transition Contraction 2-3min , 80sec 8-10cm touch fierce urge to defecate bulging perineal crowning Effacement 100% 10cm push then welcome to stage 2!!! Episiotomy- medial lateral and do it few second before baby come out to prevent bleeding Dystocia- if force to push at 8cm due to some problem Stage II When baby born ABC- suction Mouth and Nose
Precipitus Delivery - Finish in 3 hrs - It bad because its not yet ready - This is rough delivery - It can cause postpartum delivery - Baby can have injury because its too fast C-Section - Vertical- because baby too big or maybe multiple baby, guarantee next preganancy is c section again up to 3 pregnancy - Horizontal/ bikini- possible next pregnancy is via vagina Preterm Baby - Surfactant factor is that baby lung is not yet ready - Baby is prone to hypothermia very cold - Put baby in incubator/ warmer so they wont loose their heat Magnesium Sulfate - Preeclampsia med magnesium sulfate so check respiration, deep tendon reflex less than +2 ,and I&O<30ml/hr this is toxic so give calcium gluconate magnesium sulfate will decrease bp too so monitor bp too - Thyroidectomy- check for chostek: cheek jerks, trosseau when bp check hand shrink and tetany body is jerking- you can give calcium glocunate too - Tocolytic- decrease contraction ex is magnesium sulfate LATE DECELERATION- If baby HR doesn’t go down every contraction or late reaction then its bad it. fetus can have hypoxia/ UPI- Utera Placenta Insufficiency Intervention - Position turn left to avoid vena cava syndrome - O - Stop pitocin - Increase fluid - If not relieve and hr still not normal call HCP Do C/s if nothing resolve VARIABLE DECELERATION- baby is still inside they press /compression the umbilical cord / prolapse cord/ compression cord so wharton jelly cant protect umbilical cord anymore - Umbilical Cord- 2 arteries and 1 vein. Vein have clean blood Intervention - Knee chest position/trendelenburg to relieve pressure - RN will put 2 finger inside to relieve pressure of prolapse cord - Then C section needed Adverse effect: abortion VITALS of Newborn Newborn respiratory- check abdomen Average weight 3400g 7-8lb tripple in 1yr old Average length 19 - 20 inc 50 cm height will be 50% increase from the NB height Head circumference 13 - 14 inc 33-35 cm No smoking to have normal weight
Respiratory 30- 60 with apnea of less than 10 sec is normal Pulse- 120 160 BP 60 - 8 - 0/40-50 MMHG Axillary temp- 97 to 98. Blood Sugar- 40/60 usually if baby is hypoglycemic mom is hyperglycemic Skin Color Caucusian: Pink to slightly reddish African American- pink or yellowish brown Spanish- olive tint or a slight yellow Asian- rosy or yellowish tan American Indian Light pink to dark AFTER FEEDING THE BABY- turn baby to right so the food will go to duodenum Encourage to do breast feeding Colostrum- yellow color with antibody 1st milk is good for the baby Bleeding - Never normal - Come to doctor - How to know if bleeding if continue more than 350ml bleeding - Post blood normal 30ml/hr - Check postpartum bleeding PART 2 PANOPTO OB FINALS POSTPARTUM Bubble He B-breast- - Engorgement day 2-3 started axilla area - Need to drain breast 10 min each left and right - If baby pretrem and cant suck so pump the milk from breast - Mastitis wash hand, infection happen doctor give antibiotic - Before taking antibiotic feed the baby first after 4 hrs you can give breast milk again - If bottle feeding use tight bra, use cabbage leave and cold compress - Don’t put breast in warm water while showering if you want to bottle feed no suction to stop stimulating milk - Nipple sore baby need still to latch sucking half of areola and nipples when you wanna end feeding use two fingers to detach the baby from latching - Lanolin cream - No hard soap - Room air the breast U-uterus- - Need to be firm and midline - Boggy/soft- eflurrage or massage - If after massage still boggy- the pt vasodilation then its risk for postpartum bleeding - Doctor will prescribed ergonovine/ pitocin - Deviate left or right need to go empty bladder check the analgesia is no longer effective by wiggling toe then help pt to toilet if cant give bed pan and if still cant the catheter needed - Bladder should be empty every 2 hrs csection leave folley catheter for 2 days - Teach them how to use spray to clean the area
- Atonia- boggy soft uterus
- Retention placenta
- Bleeding from episiotomy Note: tachycardia is first s/s of shock or hemorrhage and bleeding Pitocin/Ergonovine/Methylergonovine
- Are medication for bleeding
- Ergonovine/methylergonovine- should be given when placenta out
- Pitocin- safe to give during deliver but need to monitor vitals bec of vasoconstrict can that can make BP high and make the uterus ruptured Immunizations
- Rubella Titer- if not immune under 1:8 give MMR shot before discharge after delivery
- Cant be pregnant for 3 mos because it can cause birth defect
- need to use birth control for
- VBAC- is vaginal birth after c section only can happen if bikini c section horizontal need c section again of up to 3 conception Endometritis
- It is in the endometrium
- Abdominal pain
- Unusual bleeding NEONATUS VITALS of Newborn Newborn respiratory- check abdomen Average weight 3400g 7-8lb tripple in 1yr old Average length 19 - 20 inc 50 cm height will be double in 1 yr old Head circumference 13 - 14 inc 33-35 cm No smoking to have normal weight Respiratory 30 - 60/40-60 with apnea of less than 10 sec is normal Pulse- 120 160 BP 60 - 8 - 0/40-50 MMHG Axillary temp- 97 to 98. Blood Sugar- 40/60 usually if baby is hypoglycemic mom is hyperglycemic Calcium is 7 to 10 mg/dL Platelet 50,000 to 300,000/mm 3 HGB- 14 to 24 g/dL for a newborn. WBC- 9,000 to 30,000/mm 3 for a newborn. Skin Color Caucusian: Pink to slightly reddish African American- pink or yellowish brown Spanish- olive tint or a slight yellow Asian- rosy or yellowish tan American Indian Light pink to dark
- LGA Large gestation Age- above 90 percentile
- AGA Appropriate gestational Age- 10 - 90 percentile
- SGA Small gestational Age- under 10 percentile
LBW- low birth weight - Are mother who's still smoking while smoking - 2500 grams and below Priority after giving birth - ABC suction Mouth and Nose - Thermoregulation quickly dry to avoid evaporation - Conduction/contact- they touch something cold make sure back warm, stetoscope should be warm - Convection/air- away from door no AC - Radiation- put cap in the head Mandatory before going home: - Phytonadione/Vitamin K- Give via Vastus lateralis /mid thigh to prevent bleeding Because the gut of the baby is still sterile they don’t have flora - Priority after giving birth- Vatus lateralis as well - Erythromycin- eye ointment 0% to avoid getting blind if mom is asymptomatic to Gonorrhea/ chlamadia - From inner canthus to outer canthus - PKU- phenylketonuria check of the guthrie test do it day 2/3 so that baby took milk already before discharge to know if baby have some sensitivity like lactose intolerance if its worst they cant handle protein and it can damage brain and have impaired cognitive. - Phenylalanine is too high normal is 2 but PKU positive have 10 - That’s why you will find phenylketone - Cant eat, beans, egg, meat if severe - Hearing Screening- Make sure baby is not deaf before going home Strabismus- is normal in newborn Nystagmus- involuntary movement of the eye is normal as well with NB 1st wk of life- they will loss 10% of their weight 1st wk- wake them up every 2 hr to feed them after 1st wk no need waking them up 1st wk- no tear is normal Umbilical Cord: two artery and 1 vein Wharton jelly- protect umbilical cord Vernix Caecaeosa- protects baby inside the mommy's amniotic fluid which is alkaline it looks like cream cheese Pathological Jaundice: 1st day jaundice possible from GDM or imcompatable RH/ erythroblastosis fetalis RH- Mom Rh+ baby Hypoglycemia baby- high pitch, lethargic and apgar score low, PETICHAE Bulging fontanel- cry vigorously is normal/ if they are quiet is abnormal may IICP Sunken Fontanel- dehydration Mongolian spot, milia, abstein purple in the mouth, stork bite- all normal 6 - 10 wet diaper- enough hydration Subtract dry diaper to wet diaper to know how many ml they pee Iron- when they 4-6 mos is cereal with iron fortified first solid food Spinal Bifida - Lack of folic acid/vit b Different type:
- OCCULTA- nothing inside the pouch
Sistica
- Meningocele- with meningis inside risk for meningitis
Urinary urgency will go away at 12 weeks but will return near the end of pregnancy
Quickening - occurs between the 4th and 5th month of pregnancy
Folic Acid
Diaphragm change after 20 % weight loss
late deceleration - lay Pt on side
15 year old - I need to know more about your sexual activity
Pregnant following nutrition - iron
Not enough amniotic fluid at this time- asking why she cant have amniocentesis fluid at 12 wks
Kegel exercise - will help pelvic muscle stretch
FHR above umbi cord - Frank breech
22 weeks gestation - at the umbilical
Fluttering in the stomach at 18 weeks - quickening (baby movement)
What exercise not to do - I will not participate in rocketball
FHR 100 for 10 min period - report to provider
Round firm movable at the fundal uterus and long smooth surface on the right side - right upper quadrant
Ultrasound FHR - 12 weeks
May 4 - february 11 EXAM 1 PEDS
- Nightlight on if baby hard time sleeping
- Baby who has hospitalize usually regress but will return when the child is feeling better
- You should expect your child to be upset when you leave. Separation anxiety question for 8 mos old child
- MMR 4-5 yrs old
- Blowing cotton balls instead of incentive spirometer
- Potassium 2 is low and most important electrolyte
- Non of the kids at my school like me and I don’t like them too- clique for adolescent
- Notify the charge nurse- adolescent pt is in terminal disease parent want to proceed w/ treatment child doesn’t want
- I really wanna do well in school. 10 year old developmental about accomplishment
- Weight the infant same time everyday- IV therapy how to know therapeutic response
- Temperature 40 the last time pt have dtap cant give vaccine go home next time
- Give a soft stuffed animals Temper tantrum to soothe the child
- Identity- adolescent
- Give squick and squeeze for- 7 mo old bay appropriate toy
- Bubble one syllable sound- for 7 mo old need evaluation
- Modeling clay- appropriate toy
- Push and pull toy appropriate toy for 10 mos
- Mashed potato- for 14 mo old food
- Candidiasis- Baby with AIDS
- Defining sense of self- adolescent
- Gardicil- HPV
- Toddler have a decrease nutritional needs- teaching in nutrition of toddlers
- Positive moro reflex- abnormal for 9 mos
- Ignore- Temper tantrum
- Deliver 4cm/ 1 1/2 inc compression- for cpr
- Have the child sit and head forward put a 10min pressure in the nose- nosebleed/ataxia
- Upright position- when pt cant breath
- Iron deficiency- drink a quart of milk
Give acetiminophen not aspirin for pt who have fever
Wash your hands before breastfeeding
Contact poison control
Offering negative response due to the need of autonomy for 18 mos autonomy vs shame and doubt
The infant is unable raise head when its prone position report to provide for 3mos old
Attempt to gain control of the situation for teaching information about toddler temper tantrums
Rotavirus for 4 mo immunization
maternal newborn notes
Course: Maternal/Child Nursing (NURS - 114)
University: American Career College
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