ATI Maternal Newborn Flashcards

Spermicide must be applied with each act of sexual intercourse and should remain in place 6 hrs after. Empty bladder prior to coitus

Patch applied to dry skin overlying subQ tissue, excluding breast

IM injection given every 11-13 weeks (start should be during first 5 days of clients menstrual cycle)

Insertion of agent resulting in development of scar tissue in Fallopian tubes. Not reversible

Burning or blocking the Fallopian tubes. Not reversible

Ligation and severance of vas deferens. Need alternate form of birth control for 20 ejaculations

Administered at 28 weeks gestation to a mother who is Rh-negative and gives birth to an Rh-positive infant. Recommended following an amniocentesis

Monitor for water intoxication (lightheaded, n/v, headache, malaise) which can lead to cerebral edema, seizures, coma, and death. Contraindicated based on late decelerations

Screens for gestational diabetes and is done at 28 weeks of gestation

Obtained at initial prenatal visit (about 6 weeks gestation)

Glucocorticoid administered IM in 2 injections 24 hr apart, given to stimulate fetal lung maturity if early delivery is anticipated and to prevent respiratory distress. Can cause pulmonary edema (crackles, chest pain, SOB)

Abdominal palpation of fetus, lie, attitude, helps nurse assess the position of the fetus to determine the optimal placement of the fetal monitoring transducer. Empty bladder beforehand, supine positioning

Palpate client's fundus, determine location of fetal back, palpate fetal part presenting at the inlet, and palpate the cephalic prominence to identify the attitude of the head

If positive, indicates rupture of membranes

36.5-37.2

120-160

30-60

60-80 S, 40-50 D

45-55 cm

2,500-4,000 g

Client strokes abdomen using circular motion during contractions

Screening tool for neural tube defects that is effective between 15 and 22 weeks. levels above indicate the need for an ultrasound

Lithotomy position

Fetal HR, breathing, body movements, fetal tone, and qualitative amniotic fluid volume

The risk of asphyxia

Client presses a button whenever they feel fetal movement which allows nurse to assess FHR in relationship to the fetal movement

FHR has moderate variability, accelerated to 15 beats/min for at least 15 seconds and occurs two or more times during a 20 minute period

FHR does not accelerate adequately with fetal movement. Does not meet criteria after 40 minutes. Contraction stress test or biophysical profile is indicated

FHR in response to contractions which decreases placental blood flow

Performed after 14 weeks gestation, empty bladder beforehand, client in supine position

Alpha-Fetoprotein is measured between 16 and 18 weeks and is used to detect neural tube defects (anencephaly), spina bifida, and omphalocele

Chromosomal disorders (Down syndrome)

Lecithin/sphingomyelin ratio- 2:1 indicating lung maturity or 3:1 for diabetes mellitus

Obtains fetal blood from umbilical cord which evaluates isoimmune fetal hemolytic anemia and assesses need for fetal blood transfusion

Alternative to amniocentesis (10-12 weeks gestation)

Blood test that ascertains info about likelihood of fetal birth defects. Includes AFP, hCG, Estriol, Inhibin-A

Placenta abnormally implants in the lower segment of the uterus near or over the cervix. Results in abnormal bleeding during the 3rd trimester as cervix begins to dilate

Placenta is attached to lower uterine segment but does not reach cervix

Painless vaginal bleeding

Premature separation of placenta from uterus. Can occur after 20 weeks gestation

Sudden onset of dark red vaginal bleeding, sharp abdominal pain, and tender rigid uterus (board like)

Pregnancy is terminated before 20 weeks or fetal weight is less than 500 g. Vaginal bleeding, uterine cramping, and partial or complete expulsion of products of conception

Abnormal implantation of a fertilized ovum outside the uterine cavity usually in fallopian tubes. Abrupt unilateral lower-quadrant abdominal pain with or without vaginal bleeding, scant dark red vaginal spotting occurring 6-8 weeks after last normal menses

Swollen, fluid-filled grape like clusters in the placenta. Associated with choriocarcinoma which is a rapidly metastasizing malignancy

Uterine size increasing abnormally fast, abnormally high levels of hCG, nausea and increased emesis, no fetus present on ultrasound, and scant or profuse dark brown or red vaginal bleeding

Avoid amniocentesis and episiotomy because of the risk of blood exposure

Antiviral given at 14 weeks gestation throughout pregnancy for HIV/AIDs. Given to infant for 6 weeks following birth

Toxoplasmosis, Rubella, Cytomegalovirus, and Herpes Simplex Virus

Consumption of raw or undercooked meat or handling cat feces, fever and tender lymph nodes

Contracted through children who have rashes or neonates who are born to mothers who had rubella during pregnancy, rash, mild lymphedema, fever, and fetal consequences

Member of the herpes family, transmitted by droplet infection, found in semen, cervical or vaginal secretions, breast milk, placental tissue, urine, feces, or blood

Oral or genital lesions, transmission to the fetus is greatest during vaginal birth if the woman has active lesions. Fetal consequences include miscarriage, preterm labor, and intrauterine growth restriction

Positive GBS may have effects including premature rupture of membranes, preterm labor, chorioamnionitis, infections of urinary tract, and maternal sepsis. Vaginal and rectal cultures are performed at 36-37 weeks of gestation

Penicillin G or Ampicillin (Principen)

Vaginal spotting, vulvar intching, postcoital bleeding and dysuria, white watery discharge

Azithromycin (Zithromax), amoxicillin (Amoxil), erythromycin (Ery-Tab)

Painful urination, frequency, lower abdominal pain (female), dysmenorrhea, yellow-green vaginal discharge, reddened vulva and vaginal walls, if left untreated it can cause PID, heart disease and arthritis

Ceftriaxone (Rocephin)

Thick, creamy, white vaginal discharge, vulvar redness, white patches on vaginal walls, grey-white patches on tongue and gums (neonate)

Fluconazole (Diflucan) and clotrimazole (Monistat)

Expulsion of the products of conception occurs

Prophylactic cervical cerclage is the surgical reinforcement of the cervix with a heavy ligature that is placed submucosally around the cervix to strengthen it and prevent premature cervix dilation (best done 23-24 weeks of gestation)

Stimulates uterine contractions

Excessive n/v possibly related to elevated hCG levels prolonged past 12 weeks of gestation

Elevated because inability to retain fluid results in hemoconcentration

Iron-deficiency occurs during pregnancy due to inadequacy in maternal iron stores and consuming insufficient amounts of dietary iron

Hgb less than 11 in 1st and 3rd trimester and 10.5 in 2nd trimester, and Hct less than 33%

Ferrous sulfate, take on empty stomach, encourage diet rich in vitamin C to increase absorption. Iron dextran when oral supplements cannot be tolerated

Can result in spontaneous abortion, infections (r/t increased glucose in urine), hydraminos, ketoacidosis, hypoglycemia, and hyperglycemia

Jittery, nervousness, weak shrill cry, hypothermia, flaccid muscle tone, headache, weakness, irritability, hunger, blurred vision, tingling of mouth and extremities

Thirst, nausea, abdominal pain, frequent urination, flushed dry skin, and fruity breath

24-28 weeks gestation, a glucola screening test/1-hr glucose tolerance test (50 g oral glucose load followed by plasma glucose analysis 1 hr later, fasting not necessary (positive reading is 130-140 mg/dL or above

Overnight fasting, avoid caffeine, no smoking for 12 hours prior to test, fasting glucose is obtained, 100 g glucose load is given, and serum glucose levels are determined at 1, 2, and 3 hours following ingestion

Begins after 20th week of pregnancy, elevated BP of 140/90 or greater recorded at least twice, 4-6 hours apart, within 1 week period. NO proteinuria

Gestational hypertension along with proteinuria of greater than 1+

BP 160/100 or greater, proteinuria greater than 3+, oliguria, elevated serum creatinine- 1.2+, cerebral or visual disturbances (headache or blurred vision), hyperreflexia with ankle clonus, peripheral edema, hepatic dysfunction, RUQ pain, and thrombocytopenia

Severe preeclampsia symptoms along with seizure activity or coma. Preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentrations

Hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction

Hemolysis resulting in anemia and jaundice

Elevated liver enzymes (ALT and ASP), epigastric pain, and n/v

Low platelets (less than 100,000) resulting in thrombocytopenia, abnormal bleeding and clotting, bleeding gums, petechiae, and possible DIC

Methyldopa, Nifedepine, Hydralazine, Labetalol hydrochloride, avoid ACE inhibitors and angiotensin 2 receptor blockers

Anticonvulsant, monitor BP, pulse, RR, deep tendon reflexes, LOC, urinary output, presence of headache, visual disturbances, epigastric pain, uterine contractions, and FHR, maintain fluid restriction of 100-150 mL/hr

Absence of patellar deep tendon reflexes, urine output less than 30 mL/hr, respirations less than 12/min, decreased LOC, and cardiac dysthythmias

Discontinue, administer calcium fluconate, prepare for actions to prevent respiratory and cardiac arrest

Uterine contractions and cervical changes occurring between 20 and 37 weeks gestation, persistent low back ache

Vaginal swab for fetal fibronectin which appears between 24-34 weeks. Found when fetal membrane integrity is lost

Nifedipine (inhibits calcium which suppresses contractions) and Magnesium sulfate

Spontaneous rupture of amniotic membranes 2 hour or more prior to the onset of true labor

After 20 weeks of gestation and prior to 37 weeks

Positive test (blue, pH 6.5-7.5) verifies rupture of membranes

Passenger, passageway, powers, position, and psychological response

Fetus and palcenta, presentation, lie, attitude, and fetopelvic or fetal position

The size and shape of the bony pelvis must be adequate to allow fetus to pass through

Uterine contractions cause effacement and dilation of the cervix

Of the woman who is in labor, should engage in frequent position changes during labor to increase comfort, relieve fatigue, and promote circulation

Maternal stress, tension, and anxiety

Greater than 90 seconds or more than five in a 10-min period

Stronger, last longer, more frequent, felt in lower back radiating to abdomen,doesn't decrease with comfort measures, walking can increase intensity, cervix shows progressive change

Decrease in frequency, duration, and intensity, painless, irregular frequency, felt in lower back or abdomen above umbilicus, often stop with sleep or comfort measures, no change with dilation

Cervix 0-3 cm (non pharmacological pain management)

Cervix 3-7 cm (opioids and epidural)

Cervix 8-10 cm

Full dilation and ends with birth (intense contractions every 1-2 minutes) (spinal block, pudendal, and local infiltration)

Delivery of neonate and ends with delivery of placenta

Delivery of placenta and ends with maternal stabilization of vital signs

Decrease with hydration and walking

Light, gentle, circular stroking of client's abdomen

Consistent pressure against sacral area to counteract pain of lower back

Can be used during early or latent phase of labor to relieve anxiety and induce sleep

Meperidine, fentanyl, butorphanol, and nalbuphine (have nalozone ready as the antidote)

Ondansetron and metoclopramide

Bupivacaine, along with morphine or fentanyl (given when client is dilated at least 4 cm). Administer bolus of fluids to offset hypotension, place client in side-lying, sitting, or modified Sims' position

Local anesthetic such as lidocaine or bupivacaine administered transvaginally

110-160

Flat line

<5/min

6-25/min

Greater than 25/min

Baseline 110-160, variability is moderate, accelerates present or absent, early decelerations present or absent, and variable or late decelerations absent

Could be tachycardic or bradycardic

Sinusoidal pattern, absent baseline fetal HR variability, nervous system of neonate not intact

Discontinue pitocin, assist client to side-lying position, administer 02, insert IV, administer tocolytic, notify provider

Administer antipyretic if maternal fever is present, administer 02, administer IV bolus

Reposition client from side to side or into knee-chest

Place client in side-lying position, insert IV catheter and increase fluids, discontinue pitocin, administer 02

Stimulate fetal scalp, assist provider with application of scalp electrode, and place client in left lateral position

50-85 mm Hg

Extends through skin of perineum

Extends through skin and muscle

Extends through skin, muscle, perineum, and anal sphincter muscle

Extends through skin, muscle, anal sphincter, and anterior rectal wall

Determines maternal readiness for labor by evaluating whether the cervix is favorable by rating cervical dilation, effacement, consistency, position, and station

Misoprostol and dinoprostone are agents to ripen servix

Artificial rupture of amniotic membranes

0.9% sodium chloride or lactated ringer's solution is instilled into amniotic cavity to supplement the amount of amniotic fluid. Reduces severity of variable decelerations caused by cord compression

HR below 110 or above 160, shows decreased or no variability, and is hyperactive or no activity

Position client in left side lying reclining position with legs elevated, 8-10 liters of 02

Abnormal labor related to the 5 P's. Hypotonic or hypertonic contractions, with failure to efface and dilate the cervix

Maintain hydration, promote rest and relaxation, and place client in lateral position and provide 02 by mask

Labor that lasts 3 hours or less from onset of contractions to time of delivery

Amniotic fluid embolism. Rupture of amniotic sac causing infiltration of amniotic fluid into the maternal circulation. Amniotic fluid travels to and obstructs pulmonary vessels

Sudden chest pain, cyanosis, dyspnea, pulmonary edema, respiratory arrest

Administer 02, intubate, cardiopulmonary resuscitation as necessary, administer fluids, position client on side with pelvis tilted 30 degrees to displace uterus, administer blood products

Hemorrhage, shock, and infection

Breast engorgement, diaphoresis, diuresis, diminished vaginal lubrication

Increase in muscle tone

Blood sugar lowers immediately after birth

Determined amount of fetal blood in maternal circulation if large fetomaternal transfusion is suspected

Within 72 hrs to women who are Rh-negative and gave birth to an infant who is Rh-positive

Breasts, uterus, bowel, bladder, lochia, episiotomy

Decreased in size from 1,000 g to 60 g in two weeks

1 cm above umbilicus 12 hours postpartum

Oxytocin, methylergonovine maleate, and carboprost

140/90 and above BP- don't give. Also assess for n/v and headache

Bright red, clots, 1-3 days after delivery

Pinkish/brown, serosanguineous. Lasts day 4-10 postpartum

Yellowish, white cream color. Lasts approx 11 days-6 weeks postpartum

Less than 2.5 cm

Less than 10 cm

More than 10 cm

One pad saturated within 2 hr

One pad saturated in 15 min or less or pooling of blood under buttocks

Endometritis

Apply ice packs for first 24-48 hours, encourage sitz baths at temp of 38-40 degrees Celsius, administer analgesia

Milk is produced 2-3 days after delivery of newborn

Increased Hct and Hgb (up to 72 hr) leukocytosis of up to 20,000-25,000 (10-14 days)

Elevated pulse, temp (100 degrees F), cardiac output, orthostatic hypotension

Constipation, hemorrhoids

Urinary retention (resulting in distended bladder) assess client's ability to void every 2-3 hours. Excessive diuresis (1500-3000 mL/day) is normal within the first 2-3 days

Client should not get pregnant for 1 month following the immunization

Newborns born to infected mothers should receive the hep B vaccine and hep B immune globulin within 12 hours of birth

Assess after 3 months to determine whether immunity to rubella has been developed

Client should not get pregnant for 1 month following immunization. A second dose is given at 4-8 weeks

Administered prior to discharge

First 24-48 hours, meeting personal needs, needs others for assistance, excited, talkative, need to review birth experience with others

Begins on day 2 or 3, up to 10 days to several weeks. Focus on baby care, wanting to take charge but needs acceptance from others, wants to learn and practice

Focuses on family as a unit, resumption of role (partner, family member)

4-10 weeks

3 months or until cessation of breast feeding

Monitor aPTT (should be 1.5-2 times 30-40 seconds), have protamine sulfate ready

Monitor PT (should be 1.5-2.5 times 11-12.5 seconds) and INR of 2 or 3

Semi-fowler's position, administer 02, administer alteplase or streptokinase

Administer fluid volume replacement (blood products), administer antibiotics, vasoactive drugs, and uterotonics, administer 02, and provide protection from injury

Oxytocin, methylergonovine (Methergine), misoprostol (Cytotec), and Carboprost tromethamine (Hemabate)

Monitor for adverse effects such as fever, chills, diarrhea, headache, and n/v

Boggy uterus, tachycardia, hypotension, skin is pale, cool, clammy, loss of turgor, may result in hysterectomy

Ensure bladder is empty, assess uterus, monitor vitals, IV fluids, 02 2-3 liters via NC, medications for postpartum hemorrhage

Uterus remains enlarged with continued lochial discharge which may result in postpartum hemorrhage

Turning inside out of the uterus (emergency situation)

Pain in the lower abdomen, large, red mass protruding 20-30 cm outside the vaginal opening , dizziness, hypotension, pallor

Terbutaline (Brethine) which relaxes the uterus in order to place it back into the uterine cavity

Uterine atony, subinvolution, inverstion, clots larger than a quarter, the return of lochia rubra, malodorous discharge, elevated temp

Oxytocin. If it doesn't work then move to Terbutaline (Brethine)

Clindamycin (Cleocin)

Tearfulness, insomnia, lack of appetite, sleep pattern disturbances, crying, and feeling letdown. Typically resolve in 10 days without intervention

Occurs within 6 months of delivery and is characterized by persistent feeling of sadness, guilt, weight loss, flat affect, rejection of infant, anxiety, irritability, intense mood swings

Develops within the first 2-3 weeks. Confusion, disorientation, paranoia, pronounced sadness, and obsessive behaviors

0- absent, 1- less than 100, 2- greater than 100

0- absent, 1- slow, weak cry, 2- good cry

0- flaccid, 1- some flexion, 2- well flexed

0- none, 1- grimace, 2- cry

0- blue, pale, 1- pink body, cyanotic hands and feet (acrocyanosis, 2- completely pink

Weight is between 10th and 90th percentile

Weight is below 10th percentile

Weight is above 90th percentile

Weight is of 2,500 grams or less at birth

Growth rate does not meet expected norms

Birth between week 38 and 42

Born prior to completion of 37 weeks

Born after completion of 42 weeks gestation

Flat, pink or red marks that easily blanch and are found on the back of the neck, nose, upper eyelids, and middle of forehead

Capillary angioma below the surface of the skin that is purple or red, caries in size and shape, is commonly seen on the face, and does not blanch or disappear

Localized swelling of the soft tissue of the scalp caused by pressure in the bead during labor. Resolved in 3-4 days

Collection of blood between the periosteum and skull bone

Small white cysts found on the gums and at the junction of the soft and hard palates

Low set ears, protruding tongue, absence of head control

Touch sole of foot, toes curl downwards

Startle

0-6 day 1, 8 or less day 2, and 12 or less day 3

15-30 min after birth, HR may be 160-180

30 min- 2 hr after birth, newborn is quiet, HR and RR will decrease

2-8 hours after birth. Often gags or chokes on mucus that has accumulated in his mouth

PKU is a defect in protein metabolism which can result in mental retardation

Less than 25

More than 60

Contact with cooler surface

Flow of heat from body to cooler air

Loss of heat as surface liquid is converted to vapor

Loss of heat from body to cooler surface that is close to but not in direct contact

97.7 or 36.5

To prevent ophthalmia neonatorum. Lower conjunctival sac of each eye starting from inner canthus and moving outwards

To prevent hemorrhagic disorders because this vitamin is not produced in the GI tract until day 8 (once breast milk is introduced into gut)

Birth, 1 month, and 6 months

Blood glucose less than 40, jitteriness, twitching, weak high pitched cry, irregular respiratory effort, cyanosis, seizures, eye rolling, give formula immediately

100-140 mL/kg/24 hr

110 kcal/kg/day then 3-6 months it's 100 kcal/kg/day

20 kcal/oz

Every 3 hours during day, every 4 hours during night (8-12 times within a 24 hr day)

Fenugreek and metoclopramide (Reglan)

Room temp 8 hr, refrigerated 8 days, freezer 6 months, and deep freezer 12 months

Bowel movements are yellow, soft, and formed, stool after every feeding, after couple of weeks movements will decrease to 1-2 times a day, void 6-8 times per day

Do not wash off the yellowish mucus that forms over the glans, avoid wrapping in tight gauze, check for bleeding every 15 min after procedure for the first hour, monitor for the first void

Use rear-facing car seat in back seat, preferably the middle until age 2 or until the child reaches max height and weight

High pitched shrill cry, tremors, increased Moro reflex, increased deep tendon reflexes, increased muscle tone, tachypnea, sweating, temp greater than 99 degrees

Rapid mood changes, hypersensitivity to noise, dehydration, and poor weight gain

Low birth weight, SGA, decreased Moro reflex, hypo or hyperthermia

Increased incidence of seizures, higher birth weight, higher risk of SIDs

Preterm birth and meconium staining

Preterm or SGA, drowsy, jittery, respiratory distress, frequent infections, poor weight gain, emotional disturbances

Facial anomalies, stabismus, ptosis, cleft lip or palate, deafness, abnormal palmar creases, irregular hair, developmental delays, prenatal and postnatal growth retardation

Avoid eye contact, and use vertical rocking and a pacifier

Blood glucose of 40 or less or in a preterm newborn 25 or less

Tachypnea, nasal flaring, expiratory grunting, retractions, fine crackles, cyanosis

Beractant (Survanta)

Below 10th percentile, hair is sparse, dry, loose skin, decreased fat, dry yellow umbilical cord, acrocyanosis, wide-eyed and alert

90th percentile or more than 8 lbs, 12 oz, findings of increased ICP (dilated pupils, vomiting, bulging fontanels), plump face, tachypnea, retractions, cyanosis, hypotonic muscles

Normal newborn physiology, no other manifestations, appears after 24 hours

Result of an underlying disease appearing before 24 hours (or persistent after day 7)

Results from untreated hyperbilirubinemia with levels t or higher than 25 mg/dL

Primary treatment for hyperbilirubinemia, prescribed if the level is greater than 15 mg/dL prior to 48 hr of age, greater than 18 mg/dL prior to 72 hr of age, and greater than 20 mg/dL at any time

Maintain eye mask over neonate's eyes, keep female undressed, avoid lotions or ointments, remove from phototherapy every 4 hours, reposition every 2 hours

Failure of the esophagus to connect to the stomach

Inability to metabolize galactose into glucose, give newborn soy-based formula because galactose is present in milk, breastfeeding is contraindicated