maternal newborn

signs of sepsis in the newborn

temp instability, poor feeding, lethargy, respiratory distress (grunting, nasal flaring, tachypnea), hypotonia, sometimes signs of shock (mottled skin, hypotension)

what broad spectrum antibiotics should be prescribed for a neonatal sepsis?

ampicillin and gentamicin

ectopic pregnancy

missed menses, spotting, unilateral abdominal pain, once confirmed administer methotrexate or prepare for surgery, monitor hCG levels for 7 weeks

fallopian tube rupture signs

sudden sharp abdominal pain, referred shoulder pain, cullen sign, signs of shock, avoid administering strong analgesics bc it can mask these rupture symptoms

what supplement interferes with methotrexate?

folic acid

molar pregnancy

dark brown vaginal bleeding, grape like clusters, high fundal height, prepare for vacuum aspiration, after removal monitor hCG levels for a year for cancer, NO IUDs

pathologic jaundice

appears within 24hrs of birth or lasts greater than 2wks, immediately notify HCP to prevent kernicterus

physiologic jaundice

most common, appears AFTER 24hrs of birth, peaks in 2-5 days and resolves spontaneously

umbilical cord prolapse interventions

lift presenting part off cord with sterile gloved hand, position knees to chest or in trendelenburg

shoulder dystocia signs and interventions

“turtle” sign, perform McRoberts (flex maternal thighs against abdomen), apply suprapubic pressure

amniotic fluid embolism findings

sudden maternal respiratory distress and hypotension

amniotic fluid embolism interventions

call RRT, administer 100% O2 and prepare for intubation, IV fluids/vasopressors

meconium aspiration syndrome (MAS) risk factors

post term gestation (more likely to pass meconium in utero), fetal distress during labor (stimulates defecation)

MAS nursing actions

notify HCP of meconium staining, limp or not breathing prepare for tracheal suction via endotracheal tube

respiratory distress syndrome

alveolar collapse from insufficient surfactant production bc of preterm birth (before 34wks)

respiratory distress syndrome nursing actions

administer maternal steroids for preterm labor <34 weeks (prevention), administer inhaled surfactant to newborn via endotracheal tube, CPAP, supplemental O2, gavage feedings, maintain warmth

transient tachypnea of the newborn (TTN)

benign and from retained lung fluid, resolves spontaneously in 1-3 days, administer oxygen PRN

placenta previa

abnormally implanted over the cervix, bright red bleeding, soft abdomen, painless

placenta abruption

prematurely detaches from the uterus, dark red bleeding, firm/rigid abdomen, painful

4 T’s of postpartum hemorrhage

tone, trauma, tissue, thrombin

diagnostic criteria for pre- e

SBP >140 or DBP >90 plus new onset of proteinuria or signs of organ dysfunction

hold mag sulfate if?

toxicity signs (decreased or absent DTRs, decreased LOC, decreased RR, decreased UOP), or respiratory depression

hyperreflexia in pregnancy indicates?

impending seizures and requires seizure precautions

preeclampsia maternal complications

placental abruption or HELLP

meds for pre e

antihypertensives labetalol, hydralazine, nifedipine and MAG SULFATE IV to prevent seizures

pre e signs of HELLP

jaundiced, has RUQ pain, persistent heartburn, or signs of internal bleeding (petechiae, bruising)

preterm labor risk factors

infection, uterine overstretching, or a history of PTL

preterm labor symptoms

contractions or backache occurring <37 completed weeks to stop activity immediately, lie down on their side, hydrate, and notify HCP after 1 hour if there is no improvement

diagnostics for preterms labor

prepare the client for a cervical exam and perform a fetal fibronectin (fFn) test to evaluate the risk for delivery within 7 days

preterm labor interventions

administer steroids (betamethasone) for active PTL, administer tocolytics (terbutaline, magnesium sulfate, nifedipine, indomethacin) to slow or stop uterine contractions

threatened miscarriage

pregnancy still progressing, but symptoms suggest miscarriage is likely, no tissue passage, spotting

missed miscarriage

pregnancy ended, no tissue passed, tissue remains in uterus, no bleeding or spotting

inevitable miscarriage

cervix dilates and tissue remains in uterus the miscarriage is unavoidable, bleeding moderate

incomplete miscarriage

some tissue passed, but some remains in uterus, heavy bleeding

complete miscarriage

all tissue passed from the uterus, transitions from heavy to light bleeding after passing

toxoplasmosis

avoid cat litter and undercooked meat, wash fruits and veggies

TORCH

toxoplasmosis, Other infections (HIV, Hep B, GBS), Rubella, CMV, HSV

HIV in pregnancy

antiviral therapy to mother and newborn if mother is positive, if high viral load must be c section delivery, breastfeeding is a NO

Hep B in pregnancy

administer hep B immune globulin (HBIG) and hepatitis B vaccine to newborns of affected mother within 12hrs of birth

GBS in pregnancy

screen at 35-37wks

CMV in pregnancy

emphasize hand hygiene during pregnancy especially when handling diapers or saliva from young children

HSV in pregnancy

start suppressive therapy during last trimester if client is HSV positive, vaginal lesions present=c-section, avoid breastfeeding if active breast lesions

tocolytics

mag sulfate, terbutaline, nifedipine, indomethacin

terbutaline

use caution in maternal cardiac conditions, discontinue and notify HCP >120-130bpm

nifedipine

teach clients to rise slowly to prevent orthostatic hypotension

indomethacin

can prematurely close fetal ductus arteriosus, DO NOT ADMINISTER TO greater than 32 wks gestation or for longer than 48hrs

uterine stimulants and cervical ripening

oxytocin, methylergonovine (methergine), carboprost (hemabate), misoprostol, dinoprostone (cervidil, prepidil)

oxytocin contraindicated in?

clients with classical incision

methylergonovine (methergine)

caution bc it causes vasoconstriction, contraindicated in HTN

carboprost (hemabate)

caution a prostaglandin that can cause bronchospasm so contraindicated in asthma

misoprostol

can cause uterine tachysystole, contraindicated in clients with uterine surgery

dinoprostone (cervidil, prepidil)

can cause uterine tachysystole