NUR 2513 Maternal-Child Nursing
Exam 1 Review
GYN/General
■ Current trends influencing maternal childcare
– An expansion of community-based services (i.e. WIC)
– Accidents are a leading cause of injury/mortality in the school aged populatiotherefore education focused on this topic would be considered high priority
■ What influences changes in types of care required to support maternal-child health– Families are smaller, higher number of single parents and working moms
– Considerations must be given to these structural shifts when planning care (djudge people)
■ Phases of menstrual cycle and what happens during each
– Proliferative, secretory/luteal, ischemic, menses
Proliferative – Phase 1 Menstrual Cycle
■ Ovary produces estrogen in follicular fluid, controlled by pituitary FSH (follicle stimulati■ Endometrium thickness increases up to 8x between days 5 and 14 d/t rapid proliferati■ First half of the menstrual cycle
■ AKA proliferative, estrogenic, follicular, postmenstrual phase
Secretory – Phase 2 Menstrual Cycle
■ Progesterone forms in corpus luteum, controlled by luteinizing hormone
■ Endometrium glands gain corkscrew appearance and dilate with glycogen and mucin
– Looks like “a rich, spongy velvet”
■ AKA pregestational, luteal, premenstrual, secretory phase
Ischemic – Phase 3 Menstrual Cycle
■ Corpus luteum regresses after 8-10 days = decreased progesterone = degenerative enaround days 24-25
■ Capillaries rupture = mini hemorrhages
■ Endometrium sloughs off
Menses – Phase 4 Menstrual Cycle
■ Body expels blood from ruptured capillaries, mucin, fragments of endometrial tissue, amicroscopic, atrophied, unfertilized ovum
Conception
■ Cannot happen without ovulation
■ Think about the life expectancy of the sperm along with the period of viability for the ovum
– Can occur 2-3 days before ovulation up to 1 day after
NUR 2513 Maternal-Child NursingExam 2 Review
Postpartum
Topics:
◦ Lochia
◦ Fundal Assessment
◦ Preeclampsia
◦ Postpartum Depression
◦ Activity Modification
◦ Postpartum period is also called
◦ “4th trimester” or
◦ Puerperium
◦ Care begins immediately after childbirth and continuethrough 6 weeks post-delivery
◦ Mom is typically okay to return to work by 6 weeks
◦ Nurse teaches new mother how to care for herself andher baby
◦ Assess for s/s reproductive tract infections (most
common site)
◦ Endometritis
◦ Nursing actions
◦ EDUCATION
◦ Assessment
Lochia
◦ Rubra
◦ “Ruby” red
◦ 1-3 days
◦ Blood, fragments of decidua (the thick layer of modified mucous
membrane which lines the uterus during pregnancy and is shed with the
afterbirth), mucus
◦ Serosa
◦ “Rose” pink
◦ Days 3-10
◦ Blood, mucus, invading leukocytes
◦ Alba
◦ “Albino” white
◦ Days 10-14 (up to 6 weeks)
◦ Largely mucus, high leukocytes
◦ Amounts
◦ Soaking a pad in 15 minutes is too much
Fundal Assessment
◦ Support lower uterine segment w/ one hand and
palpate fundus with fingertips of the other hand
◦ Assess lochia at the same time
◦ Color, amount, any clots?
◦ If boggy?
◦ Massage.
◦ If boggy and displaced
◦ Empty bladder and massage
◦ Pressure of birth causes edema leading to decreased
bladder sensation
◦ Increased risk for urinary retention
◦ May require straight cath to empty bladder
◦ Expected location at delivery
◦ Midline, midway between umbilicus and symphysis◦ 1-2 hours post-delivery
◦ At level of umbilicus
◦ Charted as @U
◦ 12 hours
◦ 1 cm above umbilicus
◦ @U+1
◦ 24 hours
◦ 1 cm below umbilicus
◦ @U-1
◦ 2 days
◦ 2 cm below umbilicus
◦ @U-2
◦ 3 days
◦ 3 cm below umbilicus
◦ @U-3
◦ 7 days
◦ Palpable at symphysis pubis
◦ 10 days
◦ Not palpable
NUR 2513 MATERNAL-CHILD NURSIFinal Exam Review
Painful/Heavy periods
Management
NSAIDS
Ibuprofen is first line treatment
Then naproxen
Begin medication regimen 1-2 days before onset of period, continue throughout duratioof cycle
Block prostaglandins that cause dysmenorrhea
Other option: Contraceptive methods to regulate hormones or block menstruation
Part of every standard gynecological exam, more frequent for high-risk
Recommended yearly for ages 20+
Age 20+ should do self-exams at the same time each month, best done 1 week afthe beginning of period
This allows the woman to know what is normal for her
Changes such as lumps, thickening, skin consistency, or unexpected discharge
from the nipple are considered abnormal
Fetal Heart Rate
Range: 110-160
Location is based on gestation age
Higher in abdomen if breech
Labs:
1
ST TRIMESTER (1-12WKS) 2
ND TRIMESTER (13-27WKS) 3
RD TRIMESTER (28-40W• Blood Type and Rh
- Antibody screen
- CBC
- RPR
- Hep B and C
- HIV
- GC/CT
- Urine drug screen
Labs typically drawn (together)
between 24 and 28 weeks: - Repeat CBC
- Repeat HIV
- 1 hour Glucose Tolerance
Test- - Repeat antibody screen in
Rh negative - Group Beta Strep (GBSrectovaginal culture aweeks