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Maternal-Child Review

Maternal-Child Review. Michelle M. Rupard RNC-OB, MSN, FNP, CLNC. Objectives Following this presentation, the participant will be able to:. Calculate estimated date of confinement (EDC) Identify common fetal heart rate patterns and associated interventions

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Maternal-Child Review

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  1. Maternal-Child Review Michelle M. Rupard RNC-OB, MSN, FNP, CLNC

  2. Objectives Following this presentation, the participant will be able to: • Calculate estimated date of confinement (EDC) • Identify common fetal heart rate patterns and • associated interventions • Recognize abnormal findings of pregnancy • State appropriate client positioning during • cesarean section • 5. Appropriately assess maternal fundus in the • postpartum period • 6. Promote maternal psychosocial adaptation during the • Taking-In Phase

  3. Gestational Age • Based on first day of LMP • ~ 280 days (from first day of LMP) • 9 calendar months • 10 lunar months • 40 weeks

  4. Naegele’s Rule • Add 7 days • Subtract 3 months

  5. Fetal Heart Rate Accelerations

  6. Nonreactive NST

  7. What pattern is this?

  8. Early Decelerations Lowdermilk and Perry, 2007

  9. Variable Decelerations Lowdermilk and Perry, 2007

  10. BL greater than 160 for 10 minutes or longer Increased 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 Tachycardia ACOG, 1995, Baxi, et al, 1985, Murray, 2007, Rosevear & Hope, 1989, and Tournaire, et al, 1980

  11. Baseline 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 Bradycardia

  12. Absent Variability

  13. Minimal to Moderate variability

  14. Moderate Variability

  15. Reassuring FHR in the Term Fetus • Baseline 110-160 • Moderate variability • No periodic decelerations • Accelerations with fetal movement

  16. Progressive change in baseline (up or down) Tachycardia Bradycardia Decrease or absence of variability Decelerations Late Prolonged Severe variables Nonreassuring FHR in the Term Fetus Lowdermilk & Perry, 2007, Mattson & Smith, 2004 and Murray, 2007

  17. 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

  18. 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 Cesarean Birth Nursing Interventions

  19. 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 Danger Signs

  20. Begins with birth Third Stage of Labor • Ends with delivery of placenta

  21. 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

  22. 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

  23. Massage the fundus... Hands on practice!!

  24. 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)

  25. Psychosocial Needs • Birth Experience • Maternal Self-image • Maternal Adaptation • Parent-Infant Interaction • Family Structure • Cultural Diversity

  26. Attachment and Bonding Influences • Parent’s emotional state • Support system • Level of communication • Care-giving skills • Proximity of infant • Parent-infant fit • Positive feedback

  27. Nursing Diagnoses and Expected Outcomes • Risk for infection • Risk for constipation • Disturbed sleep pattern • Acute pain • Risk for injury • Ineffective Breastfeeding

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