Astig Nurse - NP2 Cram Sheet

Maternal and Newborn Health

Maternal Death

  • Definition: Death within 42 days after expulsion of product of pregnancy.

Postpartum Hemorrhage (PPH)

  • Definition of Early PPH: Blood loss >500 cc within 24 hours postpartum (Primary cause: uterine atony).

  • Definition of Late PPH: Bleeding after 24 hours due to retained placenta.

  • Normal Blood Loss After Cesarean Section: 1000 cc.

  • Signs of Hypovolemic Shock: Tachycardia and hypotension.

  • Management: Bimanual compression, uterine massage, and administering oxytocin (first line treatment).

Uterine Changes

  • Involution: Return of the uterus to its prepregnant state (takes about 5 weeks).

  • Subinvolution: Non-return to prepregnant state.

  • Weight Loss After Delivery: 11 to 13 lbs.

  • Expected Weight Return: 2 to 3 months postpartum.

Fundus Assessment

  • Post-Delivery Location: Fundus should be assessed midline.

Afterpains

  • Enhanced by breastfeeding; priority is to provide analgesics immediately.

Lochia Colors

  • Rubra: Dark red (1-3 days postpartum).

  • Serosa: Pink (4-10 days).

  • Alba: White (11 days onward).

Labor and Delivery

Stages of Labor

  1. First Stage: Ends with complete/full cervical dilation.

  2. Second Stage: Ends with delivery of the fetus.

  3. Third Stage: Ends with delivery of the placenta.

Maneuvers for Assessment

  • Leopold's Maneuver 1: Fundal grip to determine fetal presentation (breech or cephalic).

  • Leopold's Maneuver 2: Umbilical grip to find fetal back for FHT.

  • Leopold's Maneuver 3: Pawlik's grip to determine fetal engagement.

Complications During Pregnancy

Preeclampsia/Eclampsia

  • Diagnosed after 20 weeks of gestation; triad includes hypertension, proteinuria, and edema.

  • Drug of Choice (DOC): Magnesium Sulfate for anticonvulsant and seizure prevention.

Ectopic Pregnancy

  • Strongest risk factors: Smoking, IUD, past ectopic pregnancies.

  • Most common site: Ampullary.

Endometriosis

  • Presence of endometrial tissue outside the uterus; gold standard for diagnosis: Laparoscopy.

  • Signs: Dark blue/brownish-black implants.

Abruptio Placentae

  • Symptoms: Painful and red vaginal bleeding; complications include trauma, smoking, cocaine, etc.

Neonatal Care

Newborn Assessment

  • Apgar scores taken at 1 and 5 minutes; scores of 7-10 indicate no distress.

  • Jaundice: Appears first in forehead and face, pathologic if within 24 hours of birth.

Common Conditions

  • Respiratory Distress Syndrome: Due to lack of surfactant in premature infants.

  • Meconium Aspiration Syndrome: Note signs including absence of bowel movement and vomiting.

Breastfeeding Management

  • Begins within 30 minutes of birth;

  • Cold compress for mastitis prior to breastfeeding; engorgement treated with warmth.

Infant Development

  • Milestones include walking at 15 months and first tooth eruption at 6 months.

Scoliosis and Cast Management

Scoliosis Treatment

  • Brace Type: Milwaukee brace; to be worn 23 hours a day.

  • Exercises: Heel lifts, sit-ups, swimming.

Cast Care

  • Monitor for complications such as cast syndrome (nausea, vomiting). Assess neurovascular status every 2 hours initially.

Pharmacological Management

Medications in Pregnancy

  • Drugs Contraindicated: Accutane, streptomycin (risk of deafness).

  • Safe Antibiotics: Penicillin and Amoxicillin.

Health Promotion and Education

Education for Mothers

  • Importance of folic acid to prevent neural tube defects.

  • Recommendations for a healthy diet postnatally, including vitamin A and nutrition to prevent complications.

Emotional Support

  • Addressing "baby blues" with emotional support post-delivery.