Maternal-Newborn Nursing: Labor, Birth, Postpartum, and Newborn Care

Comprehensive practice flashcards covering labor and birth processes, intrapartum emergencies, postpartum assessments, complications, and newborn nursing care.

What are the five essential components ("5 Ps") that define the labor and birth process?

Passenger (fetus and placenta), Passageway (bony pelvis and soft tissues), Powers (involuntary contractions and voluntary pushing), Position (maternal positions), and Psychologic response.

How does fetal lie describe the relationship between the fetus and the mother, and which lie is normal?

Fetal lie describes the relationship of the fetal long axis (spine) to the mother's spine: longitudinal (normal), transverse, or oblique.

What are the shapes and typical closure timeframes for the anterior and posterior fontanelles?

The anterior fontanelle is diamond-shaped and closes at $12\text{--}18\text{ months}$; the posterior fontanelle is triangular and closes by $2\text{--}3\text{ months}$.

How is fetal station defined and measured in relation to maternal anatomy?

Station measures the descent of the presenting part relative to the ischial spines in centimeters, ranging from $-5$ (floating/above) to $0$ (engaged at the spines) to $+5$ (crowning/below).

What Bishop score threshold indicates that the cervix is favorable for induction of labor?

A Bishop score of $\ge 8$ indicates a favorable cervix ready for induction.

What is the chronological sequence of the cardinal movements of labor?

Engagement, Descent, Flexion, Internal rotation, Extension, External rotation (restitution), and Expulsion ("Every Darn Fool In Evanston Eats Eclairs").

What definitive clinical finding differentiates true labor from false labor?

True labor produces progressive cervical dilation and effacement, whereas false labor causes no cervical change.

What maternal behaviors and physiological symptoms typically signal the transition phase ($8\text{--}10\text{ cm}$) of the first stage of labor?

Severe irritability, nausea, trembling or shaking, intense rectal pressure, and statements such as "I can't do this."

What are the classic clinical signs that indicate placental separation during the third stage of labor?

A sudden gush of dark blood, lengthening of the umbilical cord, and the uterus rising up and becoming globular in shape.

What is the normal baseline range for fetal heart rate (FHR) and what is the single most reliable indicator of fetal oxygenation?

Normal baseline FHR is $110\text{--}160\text{ bpm}$; moderate variability ($6\text{--}25\text{ bpm}$) is the most reliable indicator of intact oxygenation.

According to the VEAL CHOP mnemonic, what physiological mechanism underlies each FHR decelerative pattern?

Variable decelerations = Cord compression; Early decelerations = Head compression; Accelerations = OK (oxygenated/reassuring); Late decelerations = Placental insufficiency.

What emergency nursing actions constitute intrauterine resuscitation (LION) for nonreassuring FHR patterns?

Reposition client to Left side (or lateral), give an IV fluid bolus, administer $\text{O}_2$ at $10\,\text{L/min}$ via nonrebreather mask, Notify the provider, and stop oxytocin immediately.

What is the primary maternal adverse effect of epidural block anesthesia, and how is it prevented?

Hypotension; it is prevented by preloading with an IV fluid bolus of $500\text{--}1,000\,\text{mL}$ of lactated Ringer's solution.

Why should systemic opioid analgesics be avoided when delivery is expected within $1\text{--}4\text{ hours}$?

Opioids cross the placenta and can cause neonatal respiratory depression; naloxone should be kept readily available for the newborn.

What is the prerequisite for an amniotomy (AROM), and what must the nurse assess immediately before and after the procedure?

The fetal presenting part must be engaged ($0$ station) to prevent cord prolapse; the nurse must check the FHR immediately before and after.

How is uterine tachysystole defined, and what is the nurse's first intervention if the client is receiving oxytocin?

Defined as more than $5$ contractions in $10\text{ minutes}$ averaged over a $30\text{-minute}$ window; the nurse's first action is to stop the oxytocin infusion immediately.

Which previous uterine surgery strictly contraindicates a trial of labor after cesarean (TOLAC) or VBAC?

A prior classical (vertical) uterine incision, due to the high risk of catastrophic uterine rupture.

What hallmark sign indicates shoulder dystocia, and what primary nursing interventions should be executed?

The "turtle sign" (head retracts against perineum); execute McRoberts maneuver (hyperflexing legs to abdomen) combined with suprapubic pressure, never applying fundal pressure.

What immediate physical action must the nurse take upon recognizing an umbilical cord prolapse?

Insert a sterile gloved hand into the vagina to manually push the fetal presenting part upward off the cord, place client in knee-chest or Trendelenburg position, and prepare for emergency cesarean without pushing the cord back.

How does the clinical management of hypotonic labor dystocia differ from hypertonic labor dystocia?

Hypotonic dystocia (weak/infrequent contractions in active labor) is treated with amniotomy and oxytocin; hypertonic dystocia (frequent, painful, uncoordinated contractions with high resting tone in latent labor) is managed with rest, sedation, and hydration (no oxytocin).

What is the expected descent rate and location of the uterine fundus during the normal postpartum period?

Immediately following birth, the fundus is firm and at the level of the umbilicus; it subsequently descends downward by roughly $1\,\text{cm}$ (one fingerbreadth) each day and is no longer palpable abdominally by about $2\text{ weeks}$.

What is the most likely cause of a postpartum fundus that is high, soft, and deviated to the right?

A distended urinary bladder; the immediate intervention is to assist the client to void or catheterize if necessary.

What are the three stages of lochia, including their appearance and typical day ranges?

Lochia rubra (dark red, days $1\text{--}3$), lochia serosa (pink-brown, days $4\text{--}10$), and lochia alba (yellow-white, day $11$ to roughly $6\text{ weeks}$).

During which of Rubin's maternal adaptation phases is a new mother most receptive to discharge teaching and infant care demonstrations?

The taking-hold phase (begins day $2\text{--}3$ and extends several weeks), characterized by independence, taking charge, and eagerness to master infant care tasks.

What is the first and most critical nursing action when assessing a boggy uterus with heavy vaginal bleeding postpartum?

Perform immediate vigorous fundal massage while supporting the lower uterine segment.

What maternal medical condition contraindicates the administration of methylergonovine, and what condition contraindicates carboprost?

Methylergonovine is contraindicated in hypertension/preeclampsia; carboprost is contraindicated in clients with asthma.

How can a nurse clinically distinguish between postpartum bleeding caused by cervical lacerations versus a perineal hematoma?

A laceration presents with continuous bright red trickling or bleeding despite a firm, contracted midline fundus; a hematoma presents with severe perineal/rectal pain and pressure with normal lochial flow and a firm fundus.

What education should be provided to a postpartum client diagnosed with mastitis regarding infant feeding?

Instruct the mother to continue frequent breastfeeding or pumping to empty the affected breast, apply warm compresses, and complete the full prescribed course of antibiotics.

How do postpartum blues, postpartum depression (PPD), and postpartum psychosis differ in duration and clinical severity?

Postpartum blues resolve within $2\text{ weeks}$ and do not impair infant care; PPD persists beyond $2\text{ weeks}$ with severe sadness, insomnia, and detachment; postpartum psychosis is a psychiatric emergency presenting with hallucinations, delusions, and risk of infant harm.

What are the standard acceptable vital sign ranges for a stable term newborn?

Heart rate $110\text{--}160\text{ bpm}$ (apical for one full minute), respiratory rate $30\text{--}60\text{ breaths/min}$, and axillary temperature $97.7\text{--}99.5\,^{\circ}\text{F}$.

What are the four mechanisms of heat loss in a newborn, with an example of each?

Evaporation (wet skin after delivery or bathing), Conduction (direct contact with cold scale or hands), Convection (cool air currents from drafts or air vents), and Radiation (placing crib near cold external walls or windows).

What anatomical distinction separates caput succedaneum from a cephalohematoma?

Caput succedaneum is edema of the scalp that crosses cranial suture lines and resolves in days; cephalohematoma is a subperiosteal collection of blood that does not cross suture lines and increases jaundice risk.

Which three prophylactic medications are routinely administered to a newborn shortly after birth, and why?

Vitamin K (IM in vastus lateralis within $1\text{ hr}$ to prevent hemorrhage), erythromycin ophthalmic ointment (in lower conjunctival sacs to prevent ophthalmia neonatorum), and hepatitis B vaccine (IM before discharge).

How does the onset timing differentiate physiologic jaundice from pathologic jaundice in the neonate?

Physiologic jaundice appears after the first $24\text{ hours}$ of life (typically days $2\text{--}3$); pathologic jaundice appears within the first $24\text{ hours}$ of birth and requires immediate medical notification.

What critical nursing interventions are required while a newborn is undergoing phototherapy?

Apply opaque eye shields over closed eyes, expose all skin except diaper, reposition every $2\text{ hours}$, monitor body temperature, provide frequent feedings to promote bilirubin excretion, and avoid applying lotions or oils.

Why is routine neonatal circumcision contraindicated in an infant born with hypospadias?

The intact prepuce (foreskin) is surgically required for later cosmetic and functional reconstructive repair of the misplaced urethral opening.

What non-pharmacological soothing interventions are prioritized for an infant showing signs of Neonatal Abstinence Syndrome (NAS)?

Swaddling snugly, dimming room lights, minimizing sound and stimulation, cluster nursing care, and offering small, frequent feeds.

What physical presentation characterizes a newborn with Erb-Duchenne palsy (brachial plexus injury) following shoulder dystocia?

The affected arm hangs limp alongside the body, is internally rotated with an extended elbow, and exhibits an absent Moro reflex on the involved side.

What are the safe storage duration guidelines for freshly expressed human breast milk?

Up to $4\text{ hours}$ at room temperature, up to $4\text{ days}$ stored in the refrigerator, and up to $6\text{ months}$ in the freezer.

What key environmental safety instructions should be taught to parents to prevent Sudden Infant Death Syndrome (SIDS)?

Always place the infant on their back to sleep, utilize a firm flat mattress in a crib free of bumper pads, blankets, pillows, or toys, avoid overheating, and room-share without bed-sharing.