This Bundle consists of 4 (four) sets of Exam Blueprint | Exam 1, 2 & 3 | NUR 2513 / NUR2513 Maternal Child Nursing / MCN – Rasmussen University
NUR 2513 Maternal-Child Nursing
Exam 1 Blueprint
Module 1:
Nursing roles in the maternal-child healthcare environment
o Scope of practice include:
Preconception health care
Care of women during three trimesters of pregnancy and the
puerperium (6 weeks after childbirth, sometimes termed the fourth
trimester of pregnancy)
Care of infant during the perinatal period (time span beginning at
20 weeks of pregnancy to 4 weeks after birth)
Care of children from birth through late adolescent
Care in a variety of hospital and home care settings
o Maternal and child health nursing is:
Family centered – assessment should always include family as well
as an individual
Community centered – the health of families is both affected by and
influences the health of community
Evidence based
o Phases of health care
Health promotion – educating parents and children to follow sound
health practices through teaching and role modeling
Health maintenance – intervening to maintain health when risk of
illness is present
Health restoration – using conscientious assessment to be certain
that symptoms of illness are identified and interventions are begun
to return patient to wellness most rapidly
Health rehabilitation – helping prevent complications from illness;
helping a patient with residual effects achieve an optimal state of
wellness and independence; helping a patient to accept inevitable
death
Current trend in maternal-child healthcare
o Families are not as extended as in previous generations, so contain fever
members – fewer family members are available as support people in time
of crisis
o The number of single-parent families is increasing so rapidly it now equals
the number of nuclear families in the United States – fever financial
resources than dual-employed parents
o 90% of women in the US work outside their home at least part time; many
women are the main wage earner for their family – health care must be
scheduled at times a working parent can come for care for herself of child
o Families are more mobile than previously; increase in homeless women
and children
o Both child and intimate partner violence is increasing in incidence
o Families are more health conscious than ever before
o Health care must respect cost containment by creating “healthcare homes”
or “medical homes”
o Patient advocacy is necessary as it is easy for families to feel lost in the
healthcare system
o Expansion of community based services
o Accidents are a leading cause of injury/mortality in the school aged
population and therefore education focused on this topic would be
considered high priority
o Mobile, single, employed mom
Recent changes and evolution of maternal-child healthcare
o Immunization has eradicated childhood diseases such as measles and
poliomyelitis
o New fertility drugs and fertility techniques allow more couples to conceive
o The ability to prevent preterm birth and improve the quality of life for both
preterm and late preterm infants has increased dramatically
o Stem cell therapy to replace diseased cells
o Self-care has made childbearing and childrearing families’ active
participants in their own health monitoring
o Measuring maternal and child health
Birth rate in US continue to gradually decrease to 13.4 per 1000
population in 2014 compared to 30.2 per 1000 population in 1909
Increased availability of contraception
Birth rate for women 20-24 years of age is gradually
declining
Fertility rate 62.9% in US – typical of a healthy, high-resource
country
Fetal death rate 5.96% in 2013 for US
Due to increased quality of maternal health and prenatal
care
Neonatal death rate 582.1 in 100,000 live births
Leading cause of death due to prematurity with associated
low birth weight, congenital malformations, maternal
complications of pregnancy, SIDS, and injuries
Infant mortality rate 5.96 per 1000 live births in US 2013
Higher in native Alaskan, native American, and black infants
than it is for white, Asian or pacific islander, or non-Hispanic
newborns
Maternal mortality rate 15.9 per 100000 live births
Child mortality rate 25.5 per 100000
High incidence of homicide and suicide in the 10- to 19-
year-old age group
Cultural and social diversity considerations in maternal-child healthcare
o Whites and Asians are more likely to have a two-parent household with
both parents in their first marriage
o Black and Hispanic families are more likely to be single parents, mostly
mothers only
o Foster family – 800,000 American children in foster care due to unsafe
environments created by their parents
o Increasing awareness of individuality and diversity of patients
Legal considerations in maternal-child healthcare
o Nurses are legally responsible for protecting the rights of their patients,
including confidentiality, and are accountable for the quality of their
individual nursing care and that of other healthcare team members
o Documentation for justifying actions
o Informed consent for invasive procedures in children and determining if
pregnant women are aware of any risk to the fetus associated with a
procedure or test
o Emancipated minors have the right to sign for their own health care
o “Wrongful birth” is the birth of a disabled child whose pregnancy the
parents would have chosen to end if they had been informed about the
disability during pregnancy
o “Wrongful life” is the claim that negligent prenatal testing on the part of a
healthcare provider resulted in the birth of a disabled child
o “Wrongful conception” contraceptive measure failed
Ethical considerations in maternal-child healthcare
NUR 2513 Maternal-Child Nursing
NUR2513 MCN Exam 3 Blueprint
Pediatric Respiratory Disorders
BRONCHOSCOPY
o Procedure that lets the doctor look at your lungs and air passages
o Used to diagnose lung issues, tumors, infections and bleeding
o Nursing interventions
Secure informed consent
Check NPO status
Assess s/sx of bleeding, monitor vitals, maintaining patent airway
Position the client, reinforce diet (NPO), prevent aspiration
Do not do in patients with recent head trauma or ICP
Monitor for s/sx of pneumothorax- SOB, tachycardia, chest pain, coughing
BACTERIAL PNEUMONIA
o Nursing assessment
Children may appear acutely ill, high fever, tachycardia, chest/abdominal pain,
signs of respiratory distress
Breath sounds are diminished, crackles in lungs (rales
o Interventions
IV fluids, antibiotics, antipyretics, humidified air, reposition client
Assess O2 sats- administer oxygen as prescribed
Possible CT to check secretion and prevent obstruction
Maintain airway (sometimes tracheostomy)
CYSTIC FIBROSIS
o Assessment
Autosomal recessive disorder of secretory glands leading to poor nutrition and
infections
Thick mucus secretions particularly in pancreas and lungs
Electrolyte balances
Salty tasting sweat/tears, steatorrhea (greasy) stools
Diagnostic test- sweat chloride test
Pulmonary function tests
o Pharmacological management
Pancrelipase- enzyme replacement; aids in digestion
Adverse effects- nausea, diarrhea, abdominal cramps
Nursing Care
o Administer with meals, avoid inhaling powder or spitting into hands,
do not crush tablet
ASTHMA
o Client education
Instruct patient/ parent on s/sx to help monitor effectiveness or treatment and
exacerbation
Identify and avoid personal triggering agents
Provide family with asthma action plan
Use peak flow meter at same time each day
Promote good nutrition, hand hygiene, and reduce allergens in the home
Perform regular exercise as part of asthma therapy (promotes ventilation and
perfusion, maintains cardiac health, and enhances skeletal muscle strength)
o Assessment
Dyspnea, cough, audible wheezing, course lung sounds, wheezing throughout
possible crackles, mucus production, restlessness, irritability, anxiety, sweating, use
of accessory muscles, decreased oxygen saturation, tripod positioning, sitting
retractions, inaudible breath sounds or crackles (severe obstruction)
Exercise intolerance
o Pharmacological management
Quick relief (rescue drugs)
Short-acting bronchodilators- albuterol, levalbuterol
Systemic corticosteroids- dexamethasone, prednisone
Long term (preventer drugs)
Corticosteroids, antiallergy agents (antihistamines), NSAIDs, long-acting
bronchodilators, leukotriene modifiers, nebulizers
CROUP
o Age range= 3months – 5 years, most common at age 2
o Usually only have minimal signs at bedtime
o Affects trachea, larynx, bronchi
o URI symptoms (cough, nasal congestion, fever)
Barky cough, dyspnea, stridor, retractions
o Treatment
Diagnosis- soft tissue imaging of the neck shows steeple sign
Maintain airway, monitor O2 sats
Provide rest, elevate HOB, provide humidified air
Systemic corticosteroids: reduce inflammation, dexamethasone @ 0.6 mg/kg
Nebulized budesonide
Nebulized racemic EPI for more severe cases (stridor at rest)
PERTUSSIS
o Highly contagious- whooping cough-Bordetella for diagnosis
o Assessment
Common cold manifestations: runny nose/congestion, sneezing, mild fever, mild
cough
Severe coughing starts in 1-2 weeks
Coughing fits, violent and rapid coughing, loud “whooping” sound upon
inspiration
Paroxysmal coughing- refers to series of expiratory coughs after a deep inspiration
Apnea in infants may be the only symptom
o Nursing interventions
Educate client to get vaccinated while pregnant
Increase fluids, promote coughing, proper positioning, chest physiotherapy
Isolation precautions
BRONCHIOLITIS
o Inflammation of the bronchioles and small bronchi- usually due to viral illness such as RSV
o Most common in children younger than 2
o Assessment
Initially- rhinorrhea, intermittent fever, pharyngitis, coughing, sneezing, wheezing,
possible ear or eye infection
With illness progression- increased coughing and sneezing, fever, tachypnea and
retractions, refusal to nurse or bottle feed, copious secretions
Severe illness- tachypnea (greater than 70/min), listlessness, apneic spells, poor air
exchange, poor breath sounds, cyanosis
o Nursing Interventions
Supplemental oxygen to maintain oxygen saturation equal to or greater than 90%
Encourage fluid intake- oral fluids first, IV fluids until acute phase has passed
Maintain airway
Bronchodilators NOT recommended
Nasopharyngeal suctioning as needed
Avoid tobacco exposure
Palivizumab- antibody injection that is recommended to prevent RSV
EPIGLOTTITIS
o Inflammation of epiglottis- flap of cartilage that covers the opening to the larynx to keep
out food and fluid during swallowing
o EMERGENCY- does not allow the airway to stay open
o Assessment
Symptoms
Begin as mild URI, after 1-2 days inflammation spreads to epiglottis
Child develops severe stridor, high fever, hoarseness, very sore throat
Difficulty swallowing to the point that they are drooling, tongue may
protrude
o Nursing interventions
Protect airway
Avoid throat culture or using a tongue blade
Prepare for intubation
Provide humidified oxygen
Monitor continuous oximetry
Administer corticosteroids and IV fluids as prescribed
Administer antibiotic therapy starting with an IV, then transition to oral (10-day
course)
Droplet isolation precautions for first 24 hours after IV antibiotics initiated
Pediatric Cardiovascular Disorders
Medications
Chest tube management
o Keep system closed and below chest level
o Ensure suction control chambers are filled/set to ordered amount of suction
o Monitor for bubbles- may indicate leak or air leak from patient’s lungs
o Assess drainage- color/consistency/volume/ bloodiness
o REPORT any drainage that changes
o Do NOT aggressively milk the chest tube- causes negative pressure
o Ensure adequate pain control
PATENT DUCTUS ARTERIOSUS (PDA)
o Occurs when fetal shunt fails to close after several days of life- allows blood to flow from the
aorta through the PDA and into the pain pulmonary artery- Extra blood flow increases
pulmonary circulation
o Common in premature babies
o Assessment
Systolic murmur at second intercostal space
Congestion, increased work of breathing, difficulty feeding, failure to thrive
o Treatment
Furosemide
Increased feedings to help child gain weight
COARCTATION OF THE AORTA
o Narrowing or constriction of the aorta- forces the heart to pump harder to get blood to aorta
NUR 2513 Maternal-Child Nursing
NUR2513 MCN Exam 2 Blueprint
Post-Partum Care- Maternal
Attachment/Bonding
o Nursing assessment
Normal findings
Skin to skin contact after birth improves bonding between mother and baby
Kissing infant
Direct eye contact (en face position)
Abnormal findings
Complications of attachment/bonding will increase with complications of a
pregnancy
o Interventions to facilitate bonding
Guided supportive interactions, such as pointing out positive parental behaviors and
infant responses
Help parents sort out their feelings about being a new parent or about their new
responsibilities
Use anticipatory guidance to strengthen parent-infant bonding
Facilitate skin to skin contact
Lochia
o Assessment
Color (technical terms)- what does each color indicate?
Lochia Rubra- Red- Day 1-3
o Blood, fragments of decidua, and mucous
Lochia serosa- Pink- Day 3-10
o Blood, mucus, and invading leukocytes
Lochia alba- white- Day 10-14 (may last 6 weeks)
o Largely mucus, leukocyte count high
Abnormal Findings
Odor: suggests that the uterus has become infected. Requires immediate
intervention
Absence of lochia in days 1-3: indicates postpartal infection
Normal Findings
Volume- Normals/Abnormals
Fundal Assessment
o Technique
One hand above belly button and other hand on symphysis pubis
o Location (how does it “move” after delivery)
Moves downward to the pelvis at 1 fingerbreadth per day
o Normal/abnormal
Normal: Firm
Abnormal: Boggy
If fundus is boggy the nurse massage the fundus until it becomes firm
o Potential complications
Nursing assessment
Postpartum Hemorrhage
o Medications
Oxytocin, methergine, hemabate, Cytotec
BUBBLEHE
o Assessment
Breasts- looking for redness, engorgement, and pain
Looking at the nipples for cracking, redness, or bleeding
Uterus (Fundus) – looking for location (noting the midline), or boggy
Bladder- voiding or bladder distention
Bowels- bowel function, auscultate bowel sounds, then palpate abdomen
Lochia (vaginal drainage) – checking for bleeding, character, quantity, clots, or odor
Episiotomy- assessing for approximation, edema, or ecchymosis
Homans- dorsiflexion looking for DVT
Emotional- birthing experience, how well they are bonding with the baby.
Postpartum depression vs Baby blues
o Baby Blues: First Few postpartum days, peaks day 5, subsides over several days
Symptoms: tearfulness, mood swings, insomnia, fatigue, anxiety, difficulty
concentration, irritability, poor appetite
o Assessment
o Postpartum Depression: appears around 2 weeks, must be referred for evaluation and
interventions
o Symptoms: Sleep, guilt, fatigue, feeling hopeless of worthless, suicidal
o Nursing interventions
Edinburgh postnatal depression scale
Discharge teaching
Laceration/Episiotomy
o Assessment- Normal/Abnormal
REEDA
Redness, edema, ecchymosis, discharge, approximation of skin
ALWAYS CHECK: episiotomy, tearing, hematoma formation, hemorrhoids
o Nursing interventions
Clean perineum using warm with every bathroom
Ice to perineum for 1st 24 hours
Sitz bath after first 24 hours
Medications (oxycodone/acetaminophen, ibuprofen, lidocaine spray)
Postpartum infections
o Assessment findings
o Nursing interventions
Postpartum hemorrhage
o Signs/symptoms – blood loss greater than 500cc or 1000cc during c-section, boggy fundus,
tachycardia, hypotension, pale, alterations in mental status
o Nursing interventions – massage fundus, straight cath if needed, fluid bolus to correct
hypotension, Oxtytocin or methergine, hemabate, or Cytotec should be given
Lactation/Breast care
o Assessment findings-Normal/Abnormal
o Common problems-mastitis, plugged milk ducts, etc.
o Nursing interventions
o Breastfeeding
Post-Partum Preeclampsia
o Assessment findings
NUR 2513 Maternal-Child Nursing
NUR2513 MCN Exam 1 Blueprint
Describe the Evolution and Trends of Maternal-Child Healthcare
Current trends influencing maternal-child healthcare
o Families contain fewer members
o The number of single-parent families is increasing
o 90% of women in the US work outside their home
o Increase in # of homeless women & children
o Both child and intimate partner violence is increasing
o Cost of healthcare is increasing
o Health care must respect cost containment by creating “healthcare homes”
o Patient advocacy is necessary as it is easy for families to feel lost in healthcare
o Resources
o Family dynamics
Identify culture – Black & Hispanics are more likely to be single parents
Determine family structure and how family cultivates bonding and communication
Plan of care should address boundaries and coping mechanisms within the family
Compare Methods of Reproductive Planning and Contraception
Assessment for options:
Assess personal values, ability to use method correctly, if method will affect sexual
enjoyment, financial factors, relationship long term vs short term, prior experiences with
contraceptives, future plans
Types
o Natural Family Planning (NFP): method that involves identifying the fertile period
and avoiding intercourse during that time every cycle
AKA as calendar rhythm method
Maintain diary: accurately record # of days in each cycle; count from 1st day
or menses for a period of at least 6 menstrual cycles
Start of fertile period Is figured by subtracting 18 days from the # of days in
the shortest cycle
End of fertile period is calculated by subtracting 11 days from the # of days of
the longest cycle
Most useful when combined with basal body temp method
Disadvantage: requires accurate recording; adherence of abstinence during
fertile periods
o Fertile Awareness-Based method (FAMs): includes identifying the fertile time
during the cycle and use abstinence or other contraceptive methods during fertile
periods. May interfere with sexual spontaneity and require several months of
symptom/cycle charting for they may be used effectively
o Basal Body Temperature: taking a women’s temp each morning and look for a rise
of 0.5-1 degrees – increase in temp is evidence that ovulation has occurred (24-36
hrs prior)
Take temp immediately after waking; if working night, take temp after
awakening from the longest sleep cycle
1st day temp drops or elevates is considered the 1st fertile day – extends for 3
days
o Coitus Interrupts: also known as withdrawal method
Be aware that pre-cum fluid can leak from the penis prior to ejaculation
LEAST effective methods of BC – does not protect against STIs
o Lactation Amenorrhea Method: an infant is under 6 mo; being breastfed every 4
hours during the day and every 6 hrs at night, receives no supplement feeding and
menses has not returned
o Cervical mucus ovulation detection method: AKA Billings method
o Abstinence: no sex – most EFFECTIVE form of BC
Can eliminate risk of STIs
Disadvantages: requires self-control, high failure due to lack of adherence
o Barrier Methods:
Diaphragm: not recommended for pts who have history of TTS, cystole,
uterine prolapse or UTIs
Circular rubber disk placed over cervix before intercourse to halt
passage of sperm
Cervical cap; insert 6 hr before sex and leave for 6hr after; not recommended
for pts who have abnormal pap test results or history of TTS
condoms (male/female), spermicides – insert 12 min before intercourse; only
effective for 1 hour after insertion; should not be removed for 6 hours
o Hormonal methods: transdermal patch, orals, vaginal rings
Routine pap and breast exam might be needed
Observe for ACHES – chest pain, SOB, leg pain (DVT), headache, vision
changes (stroke), HTN
If miss dose; take on as soon as possible
Take at bed if nausea occurs
Use in caution with pts who have history of thrombus disorder, stroke, heart
attack, diabetes, smoking
Decrease when taken with meds that affect liver enzymes (antibiotics,
antifungals, anticonvulsants)
Progestin-only pills: take pill at same time everyday; DO NOT miss pill
o Emergency Contraception: hormone or copper releasing IUD, EC plan B, and
generic forms available OTC
Take pill within 72 hours of unprotected sex
DOES not terminate established pregnancy
Contraindicating in pts with distorted shaped uterus, women with severe
dysmenorrhea or menorrhagia (long painful periods)
o Depo-Provera: injected every 3 months – reversible after 10 months
Causes temporary reduction in bone mineral density
SE: irregular bleeding, weight gain, depression, headache, breast tenderness
SAFE for breast-feeding mothers
Can impair glucose tolerance in pts with diabetes and increase risk for pts
that don’t