Mother Baby Final Exam Review…………….

Contraceptives-
 Implant & IUD (most effective) Both ok for breast feeding.
 Combination oral contraceptives, Nuvaring, and dermal patch- all contain Estradiol &
progestin NOT ok for breast feeding
 Depo Provera- given IM q3 months also ok for breastfeeding
Dysmenorrhea- Very heavy & painful periods caused by the release of excess prostaglandins
 1st line management oral NSAIDS (block prostaglandin) Ibuprophen & Naproxen
 Oral contraceptives & Nuvaring (not 1st line) can be used to suppress menstruation (ok if
we are the ones doing it)
 Depo provera & Mirena IUD (not 1st line) can cause amenorrhea thus eliminating
dysmenorrhea
Breast Health
 Self-exams should be performed 7-10 days after period each month.
 Any changes in breast should be evaluated by provider
 There should NEVER be discharge from breasts unless pregnant or lactating.
Cervical Cancer
 Majority of cases (70%) are caused by HPV.
 Gardisil Vaccine (HPV9)- can protect from 9 different strains of HPV in females age 9
and up.
 Education should include importance of adhering to recommended screening’s, follow up
w/ abnormal screening’s, recommend vaccine, safe sex & regular screening’s.
Labs in pregnancy
1st Trimester-
 Blood Type and Rh
 Antibody screen
 CBC
 RPR
 Hep B and C
 HIV
 GC/CT
 Urine drug screen
2nd Trimester- Labs typically drawn (together) between 24 and 28 weeks
 Repeat CBC
  Repeat HIV
 1 hour Glucose Tolerance Test-
 Repeat antibody screen in Rh negative
3rd Trimester
 Group Beta Strep (GBS)- rectovaginal culture at 36 weeks
GTPAL-
 Gravida- Total number of times pregnant
 Term- pregnancies carried to term
 Preterm- deliveries prior to 38 weeks
 Abortions- any pregnancy ended prior to 20 weeks
 Living- number of living children
Oxytoxics- Think contracting
 Methergine- Given for abnormal bleeding or hemorrhage post-partum NOT TO BE
GIVEN IN PATIENT’S W/ HTN OR HIGH BP. 2nd line for port-partum hemorrhage
 Hemabate- Given in uterine atony and post-partum bleeding SAFER CHOICE THAN
Methergen in hypertensive pt’s 3rd line if pt has HTN & cannot use Methergen.
 Pitocin- synthetic form of oxytocin, used in pre & post delivery to stimulate contractions.
1st line for post-partum hemorrhage.
 Cytotec (Misoprostol)- used both pre & post-delivery, used as cervical ripener to induce
labor, or contractility for post-partum hemorrhage.
Tocolytic’s – think relaxing
 Magnesium Sulfate- used for preterm labor and preeclampsia; always have calcium
gluconate on hand to reverse toxicity; constantly monitor DTR’s, I&O’s, respirations
 Terbutaline- given in preterm labor, may cause tachycardia; do not give if patient has
vaginal bleeding that has not been evaluated.
Betamthosone- promotes fetal lung maturity- 2 doses given IM 24 hrs apart
Vitamin K- given to babies withing the 1st 24 hrs of life to help with blood clotting ability.
Folic Acid- Vital in preventing NTD’s; women planning to become pregnant should begin
taking 3 months prior to conception
Rhogam- Given to RH neg mothers who are carrying or have previously carried RH positive
babies; subsequent pregnancies are at greater risk than the first pregnancy.
Normal physiological changes in pregnancy-
 Stuffy nose
 Leaky breast
  N/V
 Constipation
 Thick white vaginal discharge
 Dependent edema which typically resolves when off of feet.
Abnormal changes red flags!!
 Headaches not relieved by Tylenol
 Vaginal bleeding
 Fluid leaking from vagina
 Edema of hands feet and face
Vital sign changes to know-
 Mother’s HR increases by 10-20 beats above baseline
 Increase in circulating blood volume by 30-50%
 By second trimester BP will decrease; gradually returns to baseline after 6 weeks post-
partum
Amniotic Sac-
 Includes amniotic fluid, fetus & umbilical cord
 Protects baby from infections while intact; once ruptured infection pathway is open.
Amniotic fluid functions-
 Cushions and protects fetus from injury
 Thermoregulation
 Prevents adherence of amnion to fetus
 Allows symmetrical fetal growth
 Provides free movement & aids in musculoskeletal development
 Essential for fetal lung development
Umbilical cord-
 2 arteries, 1 vein
 Wharton’s Jelly protects cord from compression
Fundal height-
 12 weeks@ symphysis
 20 weeks @ umbilicus
 After 20 weeks, measure from the symphysis to the fundus and the # in CM will
correspond with the # in weeks gestation
 measuring larger?  LGA, polyhydramnios
 Measuring smaller? IUGR, oligohydramnios (or a combination)
Factors contributing to IUGR
 Smoking
 Drug use & alcohol use
 diabetes, chronic hypertension, and morbid obesity
 Genetic factors: trisomy 13 and trisomy 18
 Infection: cytomegalovirus, rubella, and toxoplasmosis
 A 2-vessel umbilical cord
 malnutrition
Hyperemesis Gravidarium Persistent vomiting unrelated to other causes, a measure of
acute starvation (usually large ketonuria), and some discrete weight loss, most often 5% of
the prepregnancy weight.
 Often requires short-term hospitalization
 Differs from the typical nausea and vomiting that affects 70% of pregnant women in the
extent of the physiologic effects
Care of Pt w/ preterm labor
 IV fluids (correct dehydration that could be causing the uterus to contract)
 Bedrest
 Administration of tocolytics (terbutaline, nifedipine, magnesium sulfate)
 Monitor both FHR and uterine activity
Vaginal bleeding should always be reported and evaluated
 Darke red bleeding placental abruption
 Bright red bleeding with pain  Uterine rupture
 Bright red bleeding w/o pain  placenta previa
Preeclampsia
 S/S- headache, epigastric pain, edema of hands, feet and face, visual disturbances
 Assessment- Proteinuria, DTR 3-4+, ankle clonus
Placental Abruption-
 Contractions every minute
 Firm rigid abdomen
 Dark red vaginal bleeding
 Fetal distress Non-reassuring fetal HR
 INTRAUTERINE RESUSCITATION & RAPID DELIVERY VIS C-SECTION
Supine Hypotensive syndrome
Never leave a pregnant woman after 20 weeks flat on her back! Use a hip tilt or wedge
Non- stress test-
 FHR baseline
 Variability
 Presence of accelerations (HR rises 15 beats above
the baseline for a duration of at least 15 seconds)
 Absence of decelerations
components of a biophysical profile
 Fetal movement
 Fetal Tone
 Fetal Breathing
 Amniotic Fluid
 NST
 Each receives a score of 0-2 points for a total of 10.
 The ultrasound total is a max of 8.
MSAFP- Maternal Serum Alpha Feta Protein:
 Screening test to detect increased risk for: Trisomy 21 & Trisomy 18
 Open neural tube defects
 Collected between 14 and 22 weeks
Intrauterine Resuscitation
 Reposition patient- usually lateral position
 Increase rate of IV infusion
 Administer O2 via face mask
 The purpose is to increase oxygentation/perfusion to the patient.
Late decelerations
 Caused by uteroplacental insufficiency
 onset of the deceleration occurs after the beginning of the contraction, and the lowest
point of the deceleration(nadir) occurs after the peak of the contraction
Early decelerations- these are ok and normal as they occur at peak of contraction when baby
has most head compression.
Dilation/effacement/station- The nurse performs a vaginal exam on her patient in labor and
notes that the cervix has dilated 6 centimeters and that it has effaced (or thinned out) 90%; the
presenting part is 1 cm above the ischial spines 6/90/-1.
Stages of labor-
 Patient must be actively contracting
 First stage is from 0-10cm (longest stage)
  Latent phase- 0-3cm- slow cervical changemild contractions, more widely spaced
 Active phase- cervical change of 0.5-1cm/hr, contractions are longer (60 seconds) and
more frequent (q 2-3 min)
 Transition- more rapid cervical change 1-1.5cm/hrcontractions are longer (60-90
seconds), stronger, and more frequent (q2-3min)may start to feel pelvic or rectal
pressure
 Second Stage: fully dilatedpushingdelivery
 Third Stage: after delivery of the fetus through placental delivery
Cord prolapse-
 Lift presenting part off cord
 Place pt in Trendelenburg
 Prepare for c section
OB Emergencies-
 Placental aburuption- dark red blood rigid abdomen
 Placenta previa- painless bright red bleeding
 Cord prolapse- you will see the cord and also likely to see decline in FHR
 Amniotic fluid embolism- typically will see respiratory difficulty or distress…sets off a
cascade of events potentially leading to DIC, massive blood loss and maternal death
 TAKE CARE OF PT FIRST & DOCUMENT LATER
Newborn Vitals-
 Hr- 120-160
 RR- 30-60
 T- 36.5-37.4

Hyperbilirubinemia-
 Appearance: Yellow skin and mucous membranes, scleral icteris (yellow discoloration)
  Testing: indirect and direct bilirubin mainly, possibly CBC if incompatibility exists and
you are looking for associated anemia
 Phototherapy- no lotions or creams, cover eyes and genitals, feedings every 2-3 hours,
monitor I&O’s and temp.
Mastitis
 Unilateral, redness, swelling warm to touch, tender and possible fever.
Managing postpartum bleeding
 Breastfeeding helps as it stimulates contractions this is first line option accompanying
fundal massage

Care of Children………….
Growth-
 By 12 months should be birth weight x3
Milestones-
 Know fine motor skills (uses hands)
 Gross motor (walking rolling sitting up)
 At 9 months should have pincer grasp

Croup-
 Ages 3-5 most common in age 2
 Barky cough, stridor, dyspnea
  position with HOB elevated
 provide humidified air
 corticosteroids to reduce inflammation (dexamethasone at 0.6mg/kg x 1),
 Racemic epinephrine for more severe cases (stridor at rest)
Bronchiolitis-
 Wheezes that are not cured by stridor
 elevate HOB,
 provide humdified air,
 offer clear liquids PO,
 possibly IVF.
 Suggest to parents: expose to steamy shower or put a cool mist humidifier in the
child’s room
Asthma-
 Wheezing, prolonged expiration
 Retractions
 Medications used to manage: SABA, LABA, ICS, systemic corticosteroids
 Know how to administer a nebulizer treatment:
 Hook up the tubing to the air source
 Appropriate delivery system (mask, etc)
 Take vital signs before and after
 Instruct the patient:
 Treatment will last about 10-15 minutes
 Take slow, deep breaths
Asthma
 When using an inhaler or a nebulizer, take slow deep breaths to get the medicine down
into the tissue that we want it to work on.
 Advise them to rinse and expectorate after inhaled corticosteroid (avoid thrush, etc)
 Understand the asthma action plan: (review in the text)
Green Zone- symptoms are well controlled
Yellow Zone- having some symptoms that disrupt activities
Red Zone- symptoms are limiting the individual and NOT getting better
Pyloric stenosis-
 Exam- olive shaped mass palpated from the left side and located above and to the right of
the umbilicus in the mid epigastrum beneath the liver edge(926)
 Symptoms: weight loss, dehydration, constipation, olive shaped mass, vomiting after
feeds (projectile)
Intussuception-
 acute abdominal pain (sometimes mimics colicky pain), legs drawn up, possible
vomiting, dehydration, abdominal distention
 sausage shaped mass in RUQ(usually); imaging via u/s
 radiologic (ultrasound with air enema) or surgical
Immunizations-
 Remember that infants and young children receive a DTaP while adolescents and
adults receive a TDaP
 Know which vaccines cannot be given until after 12 months: ex: MMR, Varicella
 Most viruses that we vaccinate for DO NOT have approved antiviral therapy…so
vaccination is how we protect. If they contract the illness supportive management
Anaphylaxis
 Know what medications to give
Epinephrine
Antihistamines
corticosteroids
 Know what to teach the patient/family
Be aware of triggers
Make all caregivers aware of the allergy
Wear a MedicAlert bracelet
Use of epipen and self injection…if you have to use epipencall EMS!!!

HYPERTHYROID

• Tachycardia with palpitations

• Presence of Goiter
• High blood pressure
• Increased perspiration
• Shakiness and tremor
• Emotional lability
• Hyper-defecation
• Increased appetite accompanied by weight loss
• Difficulty sleeping

HYPOTHYROID
 • Bradycardia
• Fatigue
• Hypothermia
• Hoarse voice
• Drowsiness, even after sleeping through the night
• Delayed or arrested puberty
• Constipation

Murmurs
1. Soft
2. Quiet
3. Moderately loud
4. Loud w/ thrill
5. VERY LOUD heard w/ stethoscope off chest
6. VERY LOUD can be heard across the room
Cardiac Cath Care-
 NPO 4-6 hours
 Assess for allergies prior to surgery (because of use of contrast dyes that may cause a
reaction in individuals with shellfish allergies)
 Lay flat and keep the affected extremity level following the procedure.
Seizures-
 Roll on side & maintain airway
 Note time & onset
Increased ICP- for child has suffered head trauma
 HYPOTHYROID
 Bradycardia
 Fatigue
 Hypothermia
 Hoarse voice
 Drowsiness, even after sleeping through the night
 Delayed or arrested puberty
 Constipation
Fractures-
  Stabilize extremity
 Assess neurovascular status
 DO NOT assess ROM b/c it needs to be stabilized
 Apply ice & elevate
UTI-
Possible symptoms in infants:
irritability
Fever
vomiting
In older children:
Abdominal pain
Malaise
Fever
Enuresis
Burn Injuries
Remember priorities:
 Protect the airway
 Fluid replacement
 Risk for infection
 Pain management
Lily is a 9 year old female with a superficial thickness burn to her right forearm. What
does she need?
Superficial thickness usually heals in 4 days
Pain management would likely be NSAIDS/Tylenol
No fluid replacement is needed
Anemia
 Newborn: 12.7–18.6 g/dL
 2 Months: 9.0–14.0 g/dL
 2 Years: 10.5–12.7 g/dL
 6–12 Years: 11.2–14.8 g/dL
 12–18 Years: 10.7–15.7 g/dL
 FRUIT JUICE ENHANCES IRON ABSORPTION AND MILK BLOCKS
Sickle cell
 Hemoglobin electrophoresis
  IEF
 HPLC
Ideopathic thrombocytopenia purpuria
 History usually includes a recent viral infection or illness
 On exam:
 Petechiae
 Bleeding gums
 Epitaxis
Blood administration
 Must be started withing 30 minutes
 Completed within 4 hours
 Remain w/ patient for first 15 minutes
 Save transfusion bag for at least 1 hour
Leukemia
Fever occurs in approximately 50% of the cases
Fatigue and lethargy
ALL patients have anemia and are therefore pale
Anorexia
Bone or joint pain is present
Osteosarcoma
Symptoms:
 Pain and swelling are the most common presenting symptoms.
 The pain increases with activity and weight bearing and may cause the child
to limp.
 It is common for a child to have a dull, aching pain for several months before
diagnosis.
Diagnostic tests:
Xray, MRI
Serum alkaline phosphatase or lactic acid dehydrogenase; (elevated)
Biopsy

What to include in the plan:

Care of the child with a chronic condition:
Allow the child to make choices and participate in self-care activities to increase
independence and a sense of control.
Educate the child and family about the disease process
Emphasize the child's strengths.
Keep the child involved with peers is important to foster bonds and social interaction.
Kubler Ross Stages of Grief
Denial- feeling of numbness, shock and disbelief- reminds the family to slow down, “take it
easy,” pay attention to safety measures
Anger- the family and child have developed awareness about the reality of the diagnosis;
become angry with God or Higher Power or experience a spiritual crisis encourages the family to
find a positive outlet for the emotions
BARGAINING- the family to try to bargain with either self or with God in hopes that the child's
life will be spared reinforce that the child's illness is not anyone's fault
DEPRESSION- the family and child may begin to feel a profound sadness talk to the hospital
social worker, physician, or a professional counselor to obtain help.
ACCEPTANCE- many family members find strength and joy in everyday living provides
community resources for the family to help them continue in the grieving process.
Munchausen
 Be able to recognize patterns associated with this… know if further
evaluation is needed and what that is.
 Frequent hospital/ER visits with major workups can be a flag- review the
chart… look for chronic conditions that might explain it. If not, consider
munchausen by proxy as a possibility.
PTSD
 Occurs after a traumatic experience or event
Symptoms associated:
Hypervigilance or overprotective behavior
Poor sleep
Withdrawal from family/isolation
Flashbacks
Nightmares
Parenting styles
 AUTHORITARIAN- parents enforce rules and strict expectations of each family
member; children have little say in decision making, and punishment follows any
deviation from the established rules shy, sensitive, conforming, submissive, loyal,
and honest children
 AUTHORITATIVE- parents find a common ground between enforcing rules and
allowing some freedom for their children to participate in decisions; produces
children who are assertive, self-reliant, and highly interactive with high self-
esteem; best meets the needs of the child
 LAISSEZ FAIRE- Allows the children control over their environment and
subsequent behavior with less input from the parents; few rules to follow; children
are able to make their own decisions; punishment is inconsistent when used;
children from this family tend to be disrespectful, aggressive, and disobedient,
possibly growing up to be irresponsible
Altered Family Processes
Apply this to the patient and family.
Identify nursing diagnoses associated within this: Caregiver Role Strain, Compromised family
coping, etc
Identify the disruption: communication, role strain, illness.
Facilitate communication
Coordinate meetings/conference for sharing information about the child’s condition with the
family