300 Nursing Bullets: Maternity & Newborn ~ Professional Group Of Nursess

Maternity & Newborn Nursing

Increase your knowledge and confidence for the Nursing Exam with these easy to digest information regarding the concepts of Maternal and Child Health Nursing. These bullets cover topics about labor, pregnancy, nursing care of the newborn, developmental stages, and many more.

Basic Concepts

The male sperm contributes an X or a Y chromosome; the female ovum contributes an X chromosome.
Fertilization produces a total of 46 chromosomes, including an XY combination (male) or an XX combination (female).
Organogenesis occurs during the first trimester of pregnancy, specifically, days 14 to 56 of gestation.
Implantation in the uterus occurs 6 to 10 days after ovum fertilization.
The chorion is the outermost extraembryonic membrane that gives rise to the placenta.
The corpus luteum secretes large quantities of progesterone.
From the 8th week of gestation through delivery, the developing cells are known as a fetus.
The union of a male and a female gamete produces a zygote, which divides into the fertilized ovum.
Spermatozoa (or their fragments) remain in the vagina for 72 hours after sexual intercourse.
If the ovum is fertilized by a spermatozoon carrying a Y chromosome, a male zygote is formed.
Implantation occurs when the cellular walls of the blastocyte implant itself in the endometrium, usually 7 to 9 days after fertilization.
Implantation occurs when the cellular walls of the blastocyte implant itself in the endometrium, usually 7 to 9 days after fertilization.
Heart development in the embryo begins at 2 to 4 weeks and is complete by the end of the embryonic stage.

Breastfeeding

When both breasts are used for breastfeeding, the infant usually doesn’t empty the second breast. Therefore, the second breast should be used first at the next feeding.
Stress, dehydration, and fatigue may reduce a breastfeeding mother’s milk supply.
To help a mother break the suction of her breastfeeding infant, the nurse should teach her to insert a finger at the corner of the infant’s mouth.
Cow’s milk shouldn’t be given to infants younger than age one (1) because it has a low linoleic acid content and its protein is difficult for infants to digest.
A woman who is breastfeeding should rub a mild emollient cream or a few drops of breast milk (or colostrum) on the nipples after each feeding. She should let the breasts air-dry to prevent them from cracking.
Breastfeeding mothers should increase their fluid intake to 2½ to 3 qt (2,500 to 3,000 ml) daily.
After feeding an infant with a cleft lip or palate, the nurse should rinse the infant’s mouth with sterile water.
Human immunodeficiency virus (HIV) has been cultured in breast milk and can be transmitted by an HIV-positive mother who breast-feeds her infant.
Colostrum, the precursor of milk, is the first secretion from the breasts after delivery.
A mother should allow her infant to breastfeed until the infant is satisfied. The time may vary from 5 to 20 minutes.
Most drugs that a breastfeeding mother takes appear in breast milk.
Prolactin stimulates and sustains milk production.
Breastfeeding of a premature neonate born at 32 weeks gestation can be accomplished if the mother expresses milk and feeds the neonate by gavage.
A mother who has a positive human immunodeficiency virus test result shouldn’t breastfeed her infant.
Hot compresses can help to relieve breast tenderness after breastfeeding.
Unlike formula, breast milk offers the benefit of maternal antibodies.

Neonatal Care

The initial weight loss for a healthy neonate is 5% to 10% of birth weight.
The circumference of a neonate’s head is normally 2 to 3 cm greater than the circumference of the chest.
After delivery, the first nursing action is to establish the neonate’s airway.
The specific gravity of a neonate’s urine is 1.003 to 1.030. A lower specific gravity suggests overhydration; a higher one suggests dehydration.
During the first hour after birth (the period of reactivity), the neonate is alert and awake.
The neonatal period extends from birth to day 28. It’s also called the first four (4) weeks or first month of life.
A low-birth-weight neonate weighs 2,500 g (5 lb 8 oz) or less at birth.
A very-low-birth-weight neonate weighs 1,500 g (3 lb 5 oz) or less at birth.
Administering high levels of oxygen to a premature neonate can cause blindness as a result of retrolental fibroplasia.
An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate distress, and 0 to 3 indicates severe distress.
To elicit Moro’s reflex, the nurse holds the neonate in both hands and suddenly, but gently, drops the neonate’s head backward. Normally, the neonate abducts and extends all extremities bilaterally and symmetrically, forms a C shape with the thumb and forefinger, and first adducts and then flexes the extremities.
An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate distress, and 0 to 3 indicates severe distress.
If jaundice is suspected in a neonate, the nurse should examine the infant under natural window light. If natural light is unavailable, the nurse should examine the infant under white light.
Vitamin K is administered to neonates to prevent hemorrhagic disorders because a neonate’s intestine can’t synthesize vitamin K.
Variability is any change in the fetal heart rate (FHR) from its normal rate of 120 to 160 beats/minute. Acceleration is increased FHR; deceleration is decreased FHR.
In a neonate, the symptoms of heroin withdrawal may begin several hours to 4 days after birth.
In a neonate, the symptoms of methadone withdrawal may begin 7 days to several weeks after birth.
In a neonate, the cardinal signs of narcotic withdrawal include coarse, flapping tremors; sleepiness; restlessness; prolonged, persistent, high-pitched cry; and irritability.
The nurse should count a neonate’s respirations for one (1) full minute.
Chlorpromazine (Thorazine) is used to treat neonates who are addicted to narcotics.
The nurse should provide a dark, quiet environment for a neonate who is experiencing narcotic withdrawal.
Drugs used to treat withdrawal symptoms in neonates include phenobarbital (Luminal), camphorated opium tincture (paregoric), and diazepam (Valium).
In a premature neonate, signs of respiratory distress include nostril-flaring, substernal retractions, and inspiratory grunting.
Respiratory distress syndrome (hyaline membrane disease) develops in premature infants because their pulmonary alveoli lack surfactant.
Whenever an infant is being put down to sleep, the parent or caregiver should position the infant on the back. Remember the mnemonic “back to sleep.”
The percentage of water in a neonate’s body is about 78% to 80%.
To perform nasotracheal suctioning in an infant, the nurse positions the infant with his neck slightly hyperextended in a “sniffing” position, with his chin up and his head tilted back slightly.
After birth, the neonate’s umbilical cord is tied 1″ (2.5 cm) from the abdominal wall with a cotton cord, plastic clamp, or rubber band.
When teaching parents to provide umbilical cord care, the nurse should teach them to clean the umbilical area with a cotton ball saturated with alcohol after every diaper change to prevent infection and promote drying.
Ortolani’s sign (an audible click or palpable jerk that occurs with thigh abduction) confirms congenital hip dislocation in a neonate.
Cutis marmorata is mottling or purple discoloration of the skin. It’s a transient vasomotor response that occurs primarily in the arms and legs of infants who are exposed to cold.
The first immunization for a neonate is the hepatitis B vaccine, which is administered in the nursery shortly after birth.
Infants with Down syndrome typically have marked hypotonia, floppiness, slanted eyes, excess skin on the back of the neck, flattened bridge of the nose, flat facial features, spade-like hands, short and broad feet, small male genitalia, absence of Moro’s reflex, and a simian crease on the hands.
The nurse instills erythromycin in a neonate’s eyes primarily to prevent blindness caused by gonorrhea or chlamydia.
Fever in the first 24 hours postpartum is most likely caused by dehydration rather than infection.
Preterm neonates or neonates who can’t maintain a skin temperature of at least 97.6° F (36.4° C) should receive care in an incubator (Isolette) or a radiant warmer. In a radiant warmer, a heat-sensitive probe taped to the neonate’s skin activates the heater unit automatically to maintain the desired temperature.
Neonates who are delivered by cesarean birth have a higher incidence of respiratory distress syndrome.
When providing phototherapy to a neonate, the nurse should cover the neonate’s eyes and genital area.
The narcotic antagonist naloxone (Narcan) may be given to a neonate to correct respiratory depression caused by narcotic administration to the mother during labor.
In a neonate, symptoms of respiratory distress syndrome include expiratory grunting or whining, sandpaper breath sounds, and seesaw retractions.
Cerebral palsy presents as asymmetrical movement, irritability, and excessive, feeble crying in a long, thin infant.
The nurse should assess a breech-birth neonate for hydrocephalus, hematomas, fractures, and other anomalies caused by birth trauma.
In a neonate, long, brittle fingernails are a sign of postmaturity.
Desquamation (skin peeling) is common in postmature neonates.
The average birth weight of neonates born to mothers who smoke is 6 oz (170 g) less than that of neonates born to nonsmoking mothers.
Neonatal jaundice in the first 24 hours after birth is known as pathological jaundice and is a sign of erythroblastosis fetalis.
Lanugo covers the fetus’s body until about 20 weeks gestation. Then it begins to disappear from the face, trunk, arms, and legs, in that order.
In a neonate, hypoglycemia causes temperature instability, hypotonia, jitteriness, and seizures. Premature, postmature, small-for-gestational-age, and large-for-gestational-age neonates are susceptible to this disorder.
Neonates typically need to consume 50 to 55 cal per pound of body weight daily.
During fetal heart rate monitoring, variable decelerations indicate compression or prolapse of the umbilical cord.
A neonate whose mother has diabetes should be assessed for hyperinsulinism.
The best technique for assessing jaundice in a neonate is to blanch the tip of the nose or the area just above the umbilicus.
Milia may occur as pinpoint spots over a neonate’s nose.
Strabismus is a normal finding in a neonate.
Respiratory distress syndrome develops in premature neonates because their alveoli lack surfactant.
Rubella infection in a pregnant patient, especially during the first trimester, can lead to spontaneous abortion or stillbirth as well as fetal cardiac and other birth defects.
In the neonate, the normal blood glucose level is 45 to 90 mg/dl.
Hepatitis B vaccine is usually given within 48 hours of birth.
Hepatitis B immune globulin is usually given within 12 hours of birth.
Boys who are born with hypospadias shouldn’t be circumcised at birth because the foreskin may be needed for constructive surgery.
In neonates, cold stress affects the circulatory, regulatory, and respiratory systems.
Fetal embodiment is a maternal developmental task that occurs in the second trimester. During this stage, the mother may complain that she never gets to sleep because the fetus always gives her a thump when she tries.
Mongolian spots can range from brown to blue. Their color depends on how close melanocytes are to the surface of the skin. They most commonly appear as patches across the sacrum, buttocks, and legs.
Mongolian spots are common in non-white infants and usually disappear by age 2 to 3 years.
Vernix caseosa is a cheeselike substance that covers and protects the fetus’s skin in utero. It may be rubbed into the neonate’s skin or washed away in one or two baths.
Caput succedaneum is edema that develops in and under the fetal scalp during labor and delivery. It resolves spontaneously and presents no danger to the neonate. The edema doesn’t cross the suture line.
Nevus flammeus, or port-wine stain, is a diffuse pink to dark bluish-red lesion on a neonate’s face or neck.
Meconium is a material that collects in the fetus’s intestines and forms the neonate’s first feces, which are black and tarry.
In the neonate, the temperature normally ranges from 98° to 99° F (36.7° to 37.2° C), apical pulse rate averages 120 to 160 beats/minute, and respirations are 40 to 60 breaths/minute.
Tocolytic agents used to treat preterm labor include terbutaline (Brethine), ritodrine (Yutopar), and magnesium sulfate.
The Guthrie test (a screening test for phenylketonuria) is most reliable if it’s done between the second and sixth days after birth and is performed after the neonate has ingested protein.
Caput succedaneum is edema that develops in and under the fetal scalp during labor and delivery. It resolves spontaneously and presents no danger to the neonate. The edema doesn’t cross the suture line.
Mongolian spots can range from brown to blue. Their color depends on how close melanocytes are to the surface of the skin. They most commonly appear as patches across the sacrum, buttocks, and legs.
Mongolian spots are common in non-white infants and usually disappear by age 2 to 3 years.

Prenatal Care

At 20 weeks gestation, the fundus is at the level of the umbilicus.
At 36 weeks gestation, the fundus is at the lower border of the rib cage.
A premature neonate is one born before the end of the 37th week of gestation.
Gravida is the number of pregnancies a woman has had, regardless of the outcome.
Para is the number of pregnancies that reached viability, regardless of whether the fetus was delivered alive or stillborn. A fetus is considered viable at 20 weeks gestation.
A multipara is a woman who has had two or more pregnancies that progressed to viability, regardless of whether the offspring were alive at birth.
Positive signs of pregnancy include ultrasound evidence, fetal heart tones, and fetal movement felt by the examiner (not usually present until 4 months gestation
Quickening, a presumptive sign of pregnancy, occurs between 16 and 19 weeks gestation.
Goodell’s sign is the softening of the cervix.
Quickening, a presumptive sign of pregnancy, occurs between 16 and 19 weeks gestation.
Ovulation ceases during pregnancy.
Immunity to rubella can be measured by a hemagglutination inhibition test (rubella titer). This test identifies exposure to rubella infection and determines susceptibility in pregnant women. In a woman, a titer greater than 1:8 indicates immunity.
To estimate the date of delivery using Naegele’s rule, the nurse counts backward three (3) months from the first day of the last menstrual period and then adds seven (7) days to this date.
During pregnancy, weight gain averages 25 to 30 lb (11 to 13.5 kg).
Rubella has a teratogenic effect on the fetus during the first trimester. It produces abnormalities in up to 40% of cases without interrupting the pregnancy.
At 12 weeks gestation, the fundus should be at the top of the symphysis pubis.
Chloasma, the mask of pregnancy, is the pigmentation of a circumscribed area of skin (usually over the bridge of the nose and cheeks) that occurs in some pregnant women.
The gynaecoid pelvis is most ideal for delivery. Other types include platypelloid (flat), anthropoid (ape-like), and android (male-like).
Pregnant women should be advised that there is no safe level of alcohol intake.
Linea nigra, a dark line that extends from the umbilicus to the mons pubis, commonly appears during pregnancy and disappears after pregnancy.
Culdoscopy is a visualization of the pelvic organs through the posterior vaginal fornix.
The nurse should teach a pregnant vegetarian to obtain protein from alternative sources, such as nuts, soybeans, and legumes.
The nurse should instruct a pregnant patient to take only prescribed prenatal vitamins because over-the-counter high-potency vitamins may harm the fetus.
High-sodium foods can cause fluid retention, especially in pregnant patients.
A pregnant patient can avoid constipation and hemorrhoids by adding fiber to her diet.
A pregnant woman should drink at least eight 8-oz glasses (about 2,000 ml) of water daily.
Cytomegalovirus is the leading cause of congenital viral infection.
Tocolytic therapy is indicated in premature labor but contraindicated in fetal death, fetal distress, or severe hemorrhage.
Through ultrasonography, the biophysical profile assesses fetal well-being by measuring fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate (nonstress test), and qualitative amniotic fluid volume.
Pica is a craving to eat non-food items, such as dirt, crayons, chalk, glue, starch, or hair. It may occur during pregnancy and can endanger the fetus.
A pregnant patient should take folic acid because this nutrient is required for rapid cell division.
A woman who is taking clomiphene (Clomid) to induce ovulation should be informed of the possibility of multiple births with this drug.
During the first trimester, a pregnant woman should avoid all drugs unless doing so would adversely affect her health.
A probable sign of pregnancy, McDonald’s sign is characterized by an ease in flexing the body of the uterus against the cervix.
Amenorrhea is a probable sign of pregnancy.
A pregnant woman’s partner should avoid introducing air into the vagina during oral sex because of the possibility of air embolism.
The presence of human chorionic gonadotropin in the blood or urine is a probable sign of pregnancy.
Radiography isn’t usually used in a pregnant women because it may harm the developing fetus. If radiography is essential, it should be performed only after 36 weeks of gestation.
A pregnant patient who has had rupture of the membranes or who is experiencing vaginal bleeding shouldn’t engage in sexual intercourse.
A pregnant patient should take an iron supplement to help prevent anemia.
The duration of pregnancy averages 280 days, 40 weeks, 9 calendar months, or 10 lunar months.
Dinoprostone (Cervidil) is used to ripen the cervix.
Painless vaginal bleeding during the last trimester of pregnancy may indicate placenta previa.
The hormone human chorionic gonadotropin is a marker for pregnancy.
Methergine stimulates uterine contractions.
The administration of folic acid during the early stages of gestation may prevent neural tube defects.
If fundal height is at least 2 cm less than expected, the cause may be growth retardation, missed abortion, transverse lie, or false pregnancy.
The fundal height that exceeds expectations by more than 2 cm may be caused by multiple gestations, polyhydramnios, uterine myomata, or a large baby.
Infants of diabetic mothers are susceptible to macrosomia as a result of increased insulin production in the fetus.
Maternal serum alpha-fetoprotein is detectable at 7 weeks of gestation and peaks in the third trimester. High levels detected between the 16th and 18th weeks are associated with neural tube defects. Low levels are associated with Down syndrome.
A late sign of preeclampsia is epigastric pain as a result of severe liver edema.
Uterine atony is a failure of the uterus to remain firmly contracted.
Women who are carrying more than one fetus should be encouraged to gain 35 to 45 lb (15.5 to 20.5 kg) during pregnancy.
The recommended amount of iron supplement for the pregnant patient is 30 to 60 mg daily.
Mean arterial pressure of greater than 100 mm Hg after 20 weeks of pregnancy is considered hypertension.
Laden’s sign, an early indication of pregnancy, causes softening of a spot on the anterior portion of the uterus, just above the uterocervical juncture.
The treatment for supine hypotension syndrome (a condition that sometimes occurs in pregnancy) is to have the patient lie on her left side.
The hormone relaxin, which is secreted first by the corpus luteum and later by the placenta, relaxes the connective tissue and cartilage of the symphysis pubis and the sacroiliac joint to facilitate passage of the fetus during delivery.

Labor and Delivery

During labor, to relieve supine hypotension manifested by nausea and vomiting and paleness, turn the patient on her left side.
During the transition phase of the first stage of labor, the cervix is dilated 8 to 10 cm and contractions usually occur 2 to 3 minutes apart and last for 60 seconds.
The first stage of labor begins with the onset of labor and ends with full cervical dilation at 10 cm.
The second stage of labor begins with full cervical dilation and ends with the neonate’s birth.
The third stage of labor begins after the neonate’s birth and ends with the expulsion of the placenta.
The fourth stage of labor (postpartum stabilization) lasts up to 4 hours after the placenta is delivered. This time is needed to stabilize the mother’s physical and emotional state after the stress of childbirth.
Unlike false labor, true labor produces regular rhythmic contractions, abdominal discomfort, progressive descent of the fetus, bloody show, and progressive effacement and dilation of the cervix.
When used to describe the degree of fetal descent during labor, floating means the presenting part is not engaged in the pelvic inlet but is freely movable (ballotable) above the pelvic inlet.
Fetal stations indicate the location of the presenting part in relation to the ischial spine. It’s described as –1, –2, –3, –4, or –5 to indicate the number of centimeters above the level of the ischial spine; station –5 is at the pelvic inlet.
Fetal stations are also described as +1, +2, +3, +4, or +5 to indicate the number of centimeters it is below the level of the ischial spine; station 0 is at the level of the ischial spine.
Fetal stations are also described as +1, +2, +3, +4, or +5 to indicate the number of centimeters it is below the level of the ischial spine; station 0 is at the level of the ischial spine.
Fetal stations indicate the location of the presenting part in relation to the ischial spine. It’s described as –1, –2, –3, –4, or –5 to indicate the number of centimeters above the level of the ischial spine; station –5 is at the pelvic inlet.
Amniotomy is an artificial rupture of the amniotic membranes.
The narrowest diameter of the pelvic inlet is the anteroposterior (diagonal conjugate).
During labor, the resting phase between contractions is at least 30 seconds.
A pregnant patient normally gains 2 to 5 lb (1 to 2.5 kg) during the first trimester and slightly less than 1 lb (0.5 kg) per week during the last two trimesters.
Oxytocin (Pitocin) promotes lactation and uterine contractions.

Pregnancy Complications

An ectopic pregnancy is one that implants abnormally, outside the uterus.

A habitual aborter is a woman who has had three or more consecutive spontaneous abortions.

Threatened abortion occurs when bleeding is present without cervical dilation.

A complete abortion occurs when all products of conception are expelled.

Hydramnios (polyhydramnios) is excessive amniotic fluid of more than 2,000 ml in the third trimester.

In an incomplete abortion, the fetus is expelled, but parts of the placenta and membrane remain in the uterus.

When a pregnant patient has undiagnosed vaginal bleeding, a vaginal examination should be avoided until ultrasonography rules out placenta previa.

Nonstress Test

A nonstress test is considered nonreactive (positive) if fewer than two fetal heart rate accelerations of at least 15 beats/minute occur in 20 minutes.

A nonstress test is considered reactive (negative) if two or more fetal heart rate accelerations of 15 beats/minute above baseline occur in 20 minutes.

A nonstress test is usually performed to assess fetal well-being in a pregnant patient with a prolonged pregnancy (42 weeks or more), diabetes, a history of poor pregnancy outcomes, or pregnancy-induced hypertension.

Placental Abnormalities

Placenta previa is abnormally low implantation of the placenta so that it encroaches on or covers the cervical os.

In complete (total) placenta previa, the placenta completely covers the cervical os.

In partial (incomplete or marginal) placenta previa, the placenta covers only a portion of the cervical os.

Abruptio placentae is a premature separation of a normally implanted placenta. It may be partial or complete, and usually causes abdominal pain, vaginal bleeding, and a boardlike abdomen.

In placenta previa, bleeding is painless and seldom fatal on the first occasion, but it becomes heavier with each subsequent episode.

Nursing interventions for a patient with placenta previa include positioning the patient on her left side for maximum fetal perfusion, monitoring fetal heart tones, and administering I.V. fluids and oxygen, as ordered.

Treatment for abruptio placentae is usually immediate cesarean delivery.

A classic difference between abruptio placentae and placenta previa is the degree of pain. Abruptio placentae cause pain, whereas placenta previa causes painless bleeding.

Because a major role of the placenta is to function as a fetal lung, any condition that interrupts normal blood flow to or from the placenta increases the fetal partial pressure of arterial carbon dioxide and decreases fetal pH.

Preeclampsia

Pregnancy-induced hypertension is a leading cause of maternal death in the United States.

Pregnancy-induced hypertension (preeclampsia) is an increase in blood pressure of 30/15 mm Hg over baseline or blood pressure of 140/95 mmHg on two occasions at least 6 hours apart accompanied by edema and albuminuria after 20 weeks gestation.

The classic triad of symptoms of preeclampsia is hypertension, edema, and proteinuria. Additional symptoms of severe preeclampsia include hyperreflexia, cerebral and vision disturbances, and epigastric pain.

After administering magnesium sulfate to a pregnant patient for hypertension or preterm labor, the nurse should monitor the respiratory rate and deep tendon reflexes.

Eclampsia is the occurrence of seizures that aren’t caused by a cerebral disorder in a patient who has pregnancy-induced hypertension.

In a patient with preeclampsia, epigastric pain is a late symptom and requires immediate medical intervention.

In a pregnant patient, preeclampsia may progress to eclampsia, which is characterized by seizures and may lead to a coma.

HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is an unusual variation of pregnancy-induced hypertension.

Contraceptives

The failure rate of a contraceptive is determined by the experience of 100 women for 1 year. It’s expressed as pregnancies per 100 woman-years.

Before providing a specimen for a sperm count, the patient should avoid ejaculation for 48 to 72 hours.

If a patient misses two consecutive menstrual periods while taking an oral contraceptive, she should discontinue the contraceptive and take a pregnancy test.

If a patient who is taking an oral contraceptive misses a dose, she should take the pill as soon as she remembers or takes two at the next scheduled interval and continue with the normal schedule.

If a patient who is taking an oral contraceptive misses two consecutive doses, she should double the dose for 2 days and then resume her normal schedule. She also should use an additional birth control method for 1 week.

300 Nursing Bullets: Maternity & Newborn