MATERNAL-CHILD REVIEW
Michelle M. RupardRNC-OB, MSN, FNP, CLNC
ObjectivesFollowing this presentation, the participant will be able to:
1. Calculate estimated date of confinement (EDC)2. Identify common fetal heart rate patterns and associated interventions3. Recognize abnormal findings of pregnancy4. State appropriate client positioning during cesarean section5. Appropriately assess maternal fundus in the postpartum period6. Promote maternal psychosocial adaptation during the Taking-In Phase
GESTATIONAL AGE
Based on first day of LMP~ 280 days (from
first day of LMP)9 calendar months10 lunar months40 weeks
NAEGELE’S RULE
Add 7 days
Subtract 3 months
FETAL HEART RATE ACCELERATIONS
NONREACTIVE NST
WHAT PATTERN IS THIS?
EARLY DECELERATIONS
Lowdermilk and Perry, 2007
VARIABLE DECELERATIONS
Lowdermilk and Perry, 2007
TACHYCARDIABL greater than 160 for
10 minutes or longerIncreased Risk:
Asphyxia Respiratory distress Chorioamnionitis,
sepsis Neonatal pneumonia
Possible Causes: Drugs Anxiety Hyperthyroidism Fever Fetal hypoxia, anemia, acidosis
Assess: Fetal well-being Drug use Fever WBC Abd tenderness Hyperthyroidism
Intervene: O2 at 8-10 l/min via face mask Assist with scalp pH testing Prepare for possible cesarean section
ACOG, 1995, Baxi, et al, 1985, Murray, 2007, Rosevear & Hope, 1989, and Tournaire, et al, 1980
BRADYCARDIABaseline less than 110
Causes: Vagal response Cord prolapse Arrhythmia Possible maternal HR Drug use
Interventions: Assess maternal HR, BP
Increase fetal oxygenation
Limit maternal bearing down
Prepare for delivery and neonatal resusitation
Murray, 2007
ABSENT VARIABILITY
MINIMAL TO MODERATE VARIABILITY
MODERATE VARIABILITY
REASSURING FHR IN THE TERM FETUS
Baseline 110-160
Moderate variability
No periodic decelerations
Accelerations with fetal movement
NONREASSURING FHR IN THE TERM FETUS
Progressive change in baseline (up or down)
Tachycardia
Bradycardia
Decrease or absence of variability
Decelerations Late
Prolonged
Severe variables
Lowdermilk & Perry, 2007, Mattson & Smith, 2004 and Murray, 2007
SPINAL/EPIDURAL NURSING CARE
“Time Out”/Consent Notify anesthesia if platelet count is low Support during placement Assess VS, FHR frequently per P&P Position with wedge under hip afterward Assess adequacy of contractions Foley as ordered Be prepared for interventions related to
maternal hypotension, high block, fetal distress Assess level of block
CESAREAN BIRTH NURSING INTERVENTIONS
Start/maintain IV with #18 gauge cathlon
Shave abdomen Insert foley Check chart for
consent, labwork (CBC, blood-type and cross-match x 2 units PRBC).
Advocate for informed consent
Support mom and her coach
Involve couple as much as possible in decision making
Obtain OR attire for coach and orient to expectations
Continually assess maternal/fetal status
Gilbert & Harmon, 2003
DANGER SIGNS
Vaginal bleeding Sudden gush of fluid
from vagina Edema of hands,
face Severe headache Dizziness, visual
disturbances
Abdominal pain Chills, fever (101ºF) Painful urination Oliguria Persistent vomiting Decrease or absence of fetal movement
THIRD STAGE OF LABOR Begins with birth
Ends with delivery of placenta
NURSING INTERVENTIONS DURING THIRD STAGE Promote skin to skin contact with infant
(if newborn is stable) Assessment, possible resuscitation of
newborn Assess maternal VS, lochia frequently Assist with fundal massage prn Have Pitocin readily available
FOLLOWING DELIVERY… Administer oxytocic medication as ordered
Pitocin 20 units in 1000 ml IV fluid or Pitocin 10 units IM Methergine 0.2 mg IM (contraindicated with HTN)
Assist provider prn in repair of lacerations, episiotomy
Clean perineum with warm water, apply ice pack prn
Replace foot of bed Massage fundus and assess lochia per protocol Complete newborn assessment and care Promote breastfeeding (prn) and family bonding
MASSAGE THE FUNDUS...
Hands on practice!!
TRANSITION TO PARENTHOOD - CHAPTER 24
Period of change and instability for those with new infants; occurs over time
Influences include: meanings, expectations, level of knowledge, environment, level of planning, emotional and physical well-being
Depends on the new parent’s experiences with their parents (infant’s grandparents)
PSYCHOSOCIAL NEEDS Birth Experience Maternal Self-image Maternal Adaptation Parent-Infant
Interaction Family Structure Cultural Diversity
ATTACHMENT AND BONDING INFLUENCES
Parent’s emotional state Support system Level of communication Care-giving skills Proximity of infant Parent-infant fit Positive feedback
NURSING DIAGNOSES AND EXPECTED OUTCOMES Risk for infection Risk for constipation Disturbed sleep pattern Acute pain Risk for injury Ineffective Breastfeeding