Maternal and Newborn Nursing Lecture Review

Fundal Status and Lochia: At $1\,hour$ postpartum, finding lochia rubia with small clots and a firm, midline fundus at the umbilicus is an expected finding; the nurse should document and monitor. A fundus deviated from the midline may indicate a distended bladder.
Prolapsed Umbilical Cord: The priority action for a protruding umbilical cord is to insert a gloved hand into the vagina to relieve pressure on the cord to maintain fetal oxygenation.
Labor Complications: Late decelerations indicate uteroplacental deficiency; the priority action is to change the client's position to the side to increase perfusion. Persistent posterior fetal position is a common cause of severe backache during labor. Hyperventilation (tingling fingers, lightheadedness) should be treated by having the client breathe into a paper bag.
Magnesium Sulfate (IV): The priority nursing assessment for a client receiving Magnesium Sulfate for preterm labor is monitoring the respiratory rate.

Pregnancy Signs and Symptoms: Urinary frequency typically occurs during the first trimester and near the end of pregnancy. Movement felt by the mother is a presumptive sign of pregnancy.
Rubella Immunity: A negative rubella titer indicate the client is susceptible and requires immunization following delivery. Pregnancy should be avoided for $1\,month$ after receiving the vaccine.
hydroform mole: Signs of this condition include excessive uterine enlargement and elevated levels of $\text{hCG}$ .
Nutritional Needs: To reduce the risk of neural tube defects, clients should be instructed to take folic acid.
Onset of Labor: A surge of energy is a sign that often precedes the onset of labor.

Reflexes:
- Moro Reflex: Elicited by a sharp hand clap; results in symmetric abduction, extension of arms, and fanning of fingers to form a "C."
- Tonic Neck: Elicited by turning the head quickly to one side (fencing position).
- Plantar Grasp: Involves the newborn's toes.
Physical Findings: A post-term newborn ( $42.5\,weeks$ ) often exhibits dry, cracked skin. Cephalohematoma (swelling that does not cross suture lines) or caput succedanium can occur following vacuum-assisted delivery.
Thermoregulation: Preterm newborns lack adequate temperature control mechanisms. Cold stress can lead to increased oxygen consumption and metabolic acidosis. Newborns utilize brown fat for heat production as the shivering mechanism is rarely operable.

Safety and Hygiene: Crib safety includes removing extra blankets and avoiding heaters or bumpers. Umbilical cord care involves giving sponge baths until the cord stump falls off.
Jaundice: Maternal-newborn blood group incompatibility usually causes jaundice within the first $24\,hours$ of life. Early and frequent feeding helps prevent jaundice by promoting excretion. For phototherapy, newborns must have their eyes covered and must not have lotion applied to the skin (risk of burns).
Glucose and Suctioning: Signs of hypoglycemia include jitteriness and sweating; the nurse should obtain blood glucose via a heel stick. In cases of secretions in the nose and mouth, the priority is to suction the mouth first with a bulb syringe to prevent aspiration.
Phenylketonuria (PKU): Management requires a controlled low-protein diet. Clients should eliminate protein-rich foods such as meat, eggs, milk, and peanut butter.

Question: What is the significance of a distended bladder postpartum?
Response: A distended bladder can cause the fundus to be deviated from the midline, whereas a firm, midline fundus is a normal finding.
Question: Should a nurse perform a fundal massage if the fundus is already firm?
Response: No, fundal massage is not indicated if the fundus is already firm, as the purpose of massage is to firm a boggy fundus.
Question: Why is a rubella vaccination delayed until after delivery?
Response: Immunization during pregnancy is contraindicated because it could cause injury to the fetus.
Question: What is the priority for suctioning a newborn with secretions in the nose and mouth?
Response: The mouth must be suctioned first to ensure the airway is clear and to prevent the infant from gasping and inhaling secretions when the nose is suctioned.
Question: Why is a mother with PKU told to avoid peanut butter?
Response: Peanut butter is a high-protein food, and PKU management requires a low-protein diet to prevent complications.
Question: How do newborns produce heat if they cannot shiver?
Response: Newborns utilize stores of brown fat to generate heat through metabolic activity.