Maternal Newborn 2 Flashcards
Crib slats should be no more than how far apart to prevent entrapment/fractures/suffocation?
2.25 inches
Space between mattress and the sides of the crib?
Less than two finger widths (.8 inches)
How often to check smoke detectors to ensure proper functioning?
How often to replace batteries?
Once a month
Twice per year
Set water heater to what degree?
Set bath water to?
120.2 F or less
100 F
16 weeks pregnant with diabetes and BMI of 31 (overweight) what to include in teaching about diet ??
If BMI greater than 30- limit total caloric intake to 25 kcal/day or less
Do not skip a meal (eat on a schedule) to prevent hypoglycemia and ketoacidosis
Carbs 55% , Protein 20%, Fat 25%
Eat large bedtime snack with at least 25g of complex carbs
How often one should formula feed newborn?
3-4 hours
How much will new born drink of formula during first 24-48 hrs?
15-30mL
Why not to feed newborn water between feedings
Formula Contains enough water to meet newborns fluid needs
Feeding water between feedings can lead to improper calorie intake
How often to burp newborn during feeding ?
A few times during the feeding
to reduce spitting up after feeding
How to listen to fetal heart tones at 12 weeks (3 months)
Ultrasound stethoscope
When should the nurse obtain a blood sample for the MSAFP (maternal serum alpha - fetoprotein) screen?
Between 15 and 20 weeks of gestation
The AFP blood test determines how much AFP is in the mother’s blood.
High levels of AFP may suggest the developing baby has a neural tube defect such as spina bifida or anencephaly
When should the nurse collect a vaginal and anal specimen for GBS? Guillain-Barré syndrome (Streptococcus group B) (rare disorder in which a person’s own immune system damages their nerve cells, causing muscle weakness and sometimes paralysis)
35 -37 weeks
When to measure Fundal height for gestational age?
Between 18 and 30 weeks
What actions should the nurse take for a client who is 18 hours postpartum and his 4th° perineal laceration? Client says the pain is a 4
Witch hazel pads
(cleanse and condition your skin gently and thoroughly. helps tighten pores and tone skin without drying, leaving skin feeling clean, soft and refreshed)
Give ice packs
Cool water sitz bath
Practice relaxation techniques
Client teaching before taking medroxyprogesterone acetate injection for contraception ?
Client may gain weight on this med
Client may also have decrease in bone density (take calcium supplement)
This medication is safe with lactation, however client should wait six weeks after delivery to start medication if breast-feeding
Client will receive injection every 11 to 13 weeks (3 months) as a form of contraception
What finding to report to dr at 38 weeks ?
Glycosuria - (excess sugar in urine - complication of gestational diabetes)
Expected finding of pregnancy?
Leg cramps- poor circulation
Insomnia- physical discomforts
Leukorrhea - Due to an increased amount of cervical mucus from hormonal changes
Best source of folate ? How much a day?
1 cup cooked spinach
600 mcg
What to do for a client receiving betamethasone for preterm labor)
Inject IM in vastus lateralis
Side effect of terbutaline? (treatment of asthma)
Dizziness
Which electrolyte level to monitor for when giving magnesium sulfate?
Magnesium
What is a contraindication (when not to use) for the use of oral contraceptives?
Frequent headaches with visual changes
(It can indicate a cardiovascular conditions such as hypertension) It can lead to increase risk of stroke, heart attack, thromboembolism
Some Antibiotics and antiviral meds (for oral contraceptives- reduce effectiveness)
Serious disorders such as gallbladder disease and liver cirrhosis
UTI prevention teaching for 25 week gestation ?
Empty bladder before going to bed at night
(a full bladder Provides environment that can grow bacteria)
Wipe from front to back
Where all cotton undergarments to avoid trapping heat and moisture
Education about prevention of newborn abduction?
An alarm will sound of someone removes the newborn safety device
The client should only transport newborn between the nursery and room in a bassinet
Never leave a newborn unattended even while showering
Only facility personnel with badges indicating that the individual work specifically in the maternal newborn unit should transport newborns
What is a non-stress test?
Used to determine FHR, baby’s movement, contractions (changes of heart rhythm when moving and contractions )
Client teaching about non-stress test at 33 weeks?
Press the button when you feel the baby move
Eat and drink as usual prior to the test
The stress monitors for accelerations in the fetal heart rate with fetal movement
contraction stress test teaching?
measure the baby’s heart rate during uterine contractions During contractions, the flow of blood and oxygen to the placenta temporarily slows down.
measure the baby’s heart rate during uterine contractions
Might require a IV infusion for the administration of Oxytocin
Might require the client to perform nipple stimulation to initiate contractions
Postpartum discharge teaching instructions
Do not use powder on newborn due to aspiration
Use a firm mattress in the newborns crib to reduce SIDs
Do not put pillows or comforters in crib
Place in Supine position
Car seat safety with a newborn
Place in car seat rear facing in the middle of the backseat until two years old or until weight and height restrictions are ok
Position the retainer clip at the level of the babies armpits
Play shoulder harness straps in the slats at or below the level of the newborn shoulders
The guardian should position the newborn in the car seat at 45° angle to prevent the newborns head from falling forward which can lead to airway obstruction
What to do for constipation and pregnancy?
Drink 2L water/ day
Do not take mineral oil - depletes vit A,D, E, K
Avoid enemas because it can trigger labor or cause injury to client or fetus
Do not take docusate sodium because it can cause dependence and electrolyte imbalance
What to report with a pt taking oxytocin
Stimulates uterine contractions
If urine output is less than 120 mL q 4 hours -
can indicate urine retention which can lead to hyponatremia and water intoxication
Nausea, vomiting, headache, hypotension
More than five contractions in 10 minutes or single contractions lasting longer than two minutes
Formula preparation teaching?
Spitting up can indicate over feeding or gastroesophageal reflex
Over diluted formula can result in an adequate growth and too much formula can stress the newborns renal system
Client may use tapwater after running from faucet for two minutes. The client should then boil it for 1 to 2 minutes and cool it for no longer than 30 minutes. Sterile bottled water is also safe
Client should discard any formula that remains in a bottle if you’re feeding
What report in the active phase of the first stage of labor?
Report fetal heart rate below 110 or above 160
Report Uterine contractions lasting shorter than 40 seconds or more than 90 seconds
Report Green fluid from the vagina which indicates that the fetus has passed meconium stool.
Early decelerations are expected in this phase of labor
Postpartum complications after 18 hours of birth?
The funds should be located at the level of the umbilicus for the first 24 hours after birth. After that it should decrease 1 cm each day.
A temperature of 100.4°F is an expected finding in the first 24 hours after birth due to dehydration
Lochia that is bright red or contains large blood clots (may indicate excessive bleeding)
Login with small blood clots is an expected finding in the first 24 hours
How to administer phytonadione? (Vit k)
IM
Until the newborn can produce its own
To report to the provider for a client who is receiving magnesium sulfate?
Absent deep tendon reflexes Which can lead to respiratory or cardiac arrest
Report a urinary output of less than 25 to 30 mL per hour
One hour oral glucose tolerance test client who is pregnant teachings?
Avoid caffeine in the morning because it can increase glucose levels
Three hour glucose tolerance test teachings?
Be sure to ingest A proper amount of carbohydrates for at least three days before the test,
except for the overnight 12 hrs fast immediately before the test
urine sample at the start of the test
What to know about hgb?
During the postpartum. The clients Hgb little can decline moderately for 3 to 4 days
What to know what WBC during postpartum?
During the first 10 to 12 days after birth the clients WBC can increase it to 25,000 and still be in the expected reference range,
anything over can indicate an infection
How long is normal time for newborns First void to occur?
24 hours
How should the newborns umbilical cord look?
Two arteries and one vein
If only 1 Artery nb could have renal anomaly
Time frame to report jandauce
First 24 hours of life
Actions to take to decrease the clients risk of developing thrombophlebitis?
Instructed to ambulate several times a day to increase circulation
Report any pain or tenderness in the legs
Do not give an NSAIDS
Apply warm compresses to the Legs to prevent clot formation
Breastfeeding teaching for 12 hour newborn ?
Awake newborn to feed every 4 hours for first 24-48 hours after birth
Do not remove colostrum from nipples
After 6 months- feed iron rich foods
Use breast pump after feeding only if newborn is not able I feed at the breast.
Intrauterine device teachings?
Report late, abnormal spotting, or bleeding to the provider
Report pain during intercourse
Report to the provider if you can not feel the strings because it can be an indication of dislodgment
Report exposure to infection or unusual vaginal discharge
How often to bathe newborn?
Hair?
Bath water temp?
Q 2-3 days to protect skin
Wash hair 1-2x weekly
Keep water temperature at 100°F
How to take nb blood glucose
Wash hands and put on gloves Warm infants heel Cleanse site with alcohol and dry Apply pressure using gauze Cuddle and comfort infant
Report to provider 48 hours after delivery?
Reddened area on the calf
Dysuria (painful and difficult urination)
Cracked nipples – can lead to mastitis (inflammation in breast gland/utter)
What to do FIRST for Client receives Iv fentanyl 10 minutes ago for pain and has slurred speech and altered mental status?
Take O2 saturation
Apply tocotranducer to abdomen (Monitor clients contractions)
Administer naloxone
Ask the patient to rate the pain from a scale of 0 to 10 because of reverse effects of pain medication
Risk factors for developing being pre-eclampsia at 26 weeks of gestation
Rheumatoid arthritis – systemic lupus (Connective tissue diseases increases clients risk)
BMI greater than 30
Multifetal gestation (more than one fetus)
Infection
Chronic hypertension (headache)
Abnormal Uric acid level
What to recommend to someone with hyperemesis gravidarum (severe prolonged vomiting)
Monitor intake and output to determine clients hydration status
Eat foods and drink fluids separately
Eat cold or room temp foods
Low fat and high protein diet
Collect specimens for your analysis, CBC, electrolytes, liver enzymes, Bilirubin levels
If the funders is 2 cm above the umbilicus at two hours postpartum and is boggy what is the likely cause of this?
Bladder distention (pushing on uterus)
This is a slow, oozing trickle of blood, during which the funders can remain firm?
Cervical laceration
Is uterine bleeding and expected findings after delivery?
Yes. It often contains large clots resulted from a relaxed distended
This can lead to uterine atony (loss of muscle tone) and excessive vagina bleeding?
Retention of placental fragments
Interventions for a patient with eclampsia priority following a seizure?
Administer oxygen by facemask at 10 L a minute FIRST
The nurse should use an 18 gauge catheter to administer magnesium sulfate
Insert a indwelling urinary catheter to monitor the clients Output
The nurse should raise the side rails of the bed and pad the rails with blankets or pillows to ensure safety
What is a kosher diet?
Avoid eating meat and dairy together
Understanding the purpose of carboprost (oxytocin properties) after postpartum ?
Reduce bleeding/hemorrhage after birth
When to receive Rh immune globin?
If mother is Rh negative (to treat Rh incompatibility)
What to receive to treat anemia ?
Iron supplements
Finding to expect with a client who is a primigravida (pregnant for the first time) and has hyperthyroidism?
Diaphoresis (sweating)
Expected finding of hypothyroidism?
Cold intolerance
Hoarseness
Hair loss
Report to doctor if happens around 37 weeks as a sign of hypertension or preeclampsia?
Blurred vision
Newborn umbilical cord care teaching?
Report any drainage from babies umbilical cord- could be infection
Only use warm water to wash cord
The cord should fall off within 10 to 14 days
Secure the diaper below the cord to prevent infection and promote drying
Discharge teaching with a client who has mastitis (inflammation of breast gland or nipple) of the left breast?
Pump breast frequently- to prevent growth of bacteria and increase comfort
Continue breast feeding or pump (does not contaminate milk)
How to relieve Engorgement (blocked milk ducts) pain in breasts?
Apply cold cabbage leaves
When might client experience leukorrhea (White or gray vagina discharge from estrogen increase) in pregnancy?
Throughout the entire pregnancy
When should the client expect abdominal enlargement by?
The 14th week of pregnancy
When should the client feel fetal movement in pregnancy also known as quickening?
At 16 to 20 weeks
Potential complication of giving birth to a newborn who is large for gestational age (LGA)
InCrease of the risk of hemorrhage to do uterine atony (stress on muscles)
Expected findings for a client who is postpartum?
Deep tendon reflex is between 1+ and 2+
Leukocytosis for 4-7 days
Elevated temperature during the first 24 hours after birth
Magnesium sulfate IV for preeclampsia- What is indication of magnesium sulfate toxicity that you should report to the provider?
Respiratory depression
Decreased urine output
Proteinuria is an indication of what during pregnancy?
Preeclampsia
What are expected findings for someone who has Endometritis (inflammation of inner pinning of uterus) and is 48 hours post partum following a C-section
*Elevated HR
Elevated respiration’s
Fever
Chills
Nausea
Anorexia
Fatigue
Pelvic pain
Lochia with foul odor
Normal WBC range
Erythrocyte sedimentation rate
12k-25k
rate of 20mm/hr
Common adverse effect of metronidazole? (Do not need to tell dr)
Metallic taste in mouth
What medication can reduce effectiveness of contraceptives?
Penicillins and tetracycline
If breastfeeding and prescribed metronidazole, what to educate patient?
Do not breast feed for 8-10 days
-pump and dump while taking medication and for 24-48 hours after last dose.
