Maternal–Newborn Nursing Comprehensive Study Notes
Student Learning Outcomes (mapped to CSLOs)
- Determine safe, patient-centered, evidence-based care for pregnant clients (CSLO 1).
- Identify developmental principles, preventive strategies, and early-detection measures that promote optimal maternal health (CSLO 1, 2, 4).
- Differentiate medications frequently prescribed during pregnancy (CSLO 1, 4).
- Examine caring and professional behaviors when providing antepartum nursing care (CSLO 2).
- Demonstrate effective verbal, non-verbal, and written communication with pregnant clients (CSLO 3).
- Determine collaborative relationships that improve antepartum outcomes (CSLO 5).
- Identify leadership skills required to coordinate antepartum care (CSLO 6).
Core Theory Content
- Maternal physiologic changes
- Cardiovascular: ↑ plasma volume ≈ 30\text{–}50\%, ↓ systemic vascular resistance → physiologic anemia & benign systolic murmurs.
- Respiratory: ↑ tidal volume, mild respiratory alkalosis (facilitates fetal CO₂ removal).
- Renal: ↑ GFR ≈ 50\%; glycosuria common.
- Musculoskeletal: lordosis, relaxation of pelvic ligaments d/t relaxin.
- Integumentary: chloasma, linea nigra, striae gravidarum.
- Endocrine: ↑ insulin resistance (d/t placental lactogen), ↑ thyroid activity.
- Significance: Guides normal/abnormal assessment, medication dosing, and anticipatory teaching.
- Maternal psychological adaptation
- Trimester-specific tasks (e.g., acceptance, body-image changes, preparation for birth).
- Common emotions: ambivalence → introversion → nesting.
- Nursing role: validate feelings, refer for perinatal mood disorders.
- Health-promotion basics
- Nutrition: extra +340 kcal/day (2nd tri), +452 kcal/day (3rd tri). 71 g protein/day. Emphasize folic acid 400\;\mu g pre-conception, 600\;\mu g during pregnancy.
- Sleep/Rest: left-lateral position improves uteroplacental perfusion.
- Activity/Exercise: moderate aerobic & strength training \le 30 min most days; avoid contact sports & supine position after 20 wks.
- Cultural influences
- Food taboos, birth attendants, postpartum rituals. Example: hot–cold theory in many Latino/Asian cultures → prefer “warm” foods postpartum.
- Nursing implication: provide culturally safe care; collaborate with interpreters/spiritual leaders.
- Key antepartum laboratory & diagnostic tests
- Initial panel: blood type & Rh, antibody screen, CBC, VDRL/RPR, HIV, HBsAg, rubella titer, varicella titer.
- Ongoing: urine dip (protein, glucose), GTT @ 24–28 wks, GBS swab @ 35–37 wks.
- Fetal surveillance: ultrasound, non-stress test (NST), biophysical profile (BPP).
- Developmental tasks for the childbearing family
- Reworking relationships, renegotiating roles, integrating infant into family system.
- Rubin’s tasks for the mother: safe passage, acceptance, binding-in, giving of oneself.
- Management & nursing care
- Routine visit schedule: q4w to 28 wks → q2w to 36 wks → weekly.
- Danger signs: vaginal bleeding, leaking fluid, ↓ fetal movement, severe headache, visual changes, persistent abdominal pain.
Family Theory & Dynamics (Clinical Learning Laboratory)
- Definition of family: two or more individuals joined by blood, marriage, adoption, or emotional commitment who share resources & responsibility.
- Family functions
- Affective (emotional support)
- Economic
- Reproductive
- Healthcare
- Socialization
- Educational
- Family structures
- Nuclear
- Single-parent
- Blended/step
- Extended
- Alternative (cohabiting, LGBTQ+, grandparents as parents, foster/adoptive)
- Activities that strengthen families: shared meals/rituals, open communication, conflict-resolution skills, flexible roles, supportive community ties.
- Parenting roles: nurturer, provider, decision-maker, teacher, resource person, disciplinarian.
- Impact of family size & configuration
- Spacing:
- Ordinal position: oldest = ↑ responsibility; middle = negotiator; youngest = risk-taker.
- Sibling interaction: preparatory classes reduce regression/jealousy.
- Multiple births: twin-to-twin transfusion, increased parenting workload, financial strain.
- Functional vs. dysfunctional families
- Functional: adapt to stress, clear boundaries, collaborative problem-
