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Maternal-Child Review

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Presentation on theme: "Maternal-Child Review"— Presentation transcript:

1 Maternal-Child Review
Michelle M. Rupard RNC-OB, MSN, FNP, CLNC

2 Objectives Following this presentation, the participant
will be able to: Calculate estimated date of confinement (EDC) Identify common fetal heart rate patterns and associated interventions Recognize abnormal findings of pregnancy State appropriate client positioning during cesarean section 5. Appropriately assess maternal fundus in the postpartum period 6. Promote maternal psychosocial adaptation during the Taking-In Phase

3 Gestational Age Based on first day of LMP
~ 280 days (from first day of LMP) 9 calendar months 10 lunar months 40 weeks

4 Naegele’s Rule Add 7 days Subtract 3 months

5 Fetal Heart Rate Accelerations

6 Nonreactive NST

7 What pattern is this?

8 Early Decelerations Gradual decrease in FHR.
Onset to nadir is at least 30 seconds. Nadir occurs at peak of ctx. Lowdermilk and Perry, 2007

9 Variable Decelerations
Variable decel characteristics: Abrupt decrease in FHR with onset to nadir LESS than 30 seconds. The decrease in FHR is at least 15 bpm, lasts at least 15 seconds, but less than 2 minutes. Variables VARY in timing, shape and duration. Lowdermilk and Perry, 2007

10 Tachycardia Assess: BL greater than 160 for 10 minutes or longer
Fetal well-being Drug use Fever WBC Abd tenderness Hyperthyroidism Intervene: O2 at 8-10 l/min via face mask Assist with scalp pH testing Prepare for possible cesarean section BL greater than 160 for 10 minutes or longer Increased Risk: Asphyxia Respiratory distress Chorioamnionitis, sepsis Neonatal pneumonia Possible Causes: Drugs Anxiety Hyperthyroidism Fever Fetal hypoxia, anemia, acidosis ACOG, 1995, Baxi, et al, 1985, Murray, 2007, Rosevear & Hope, 1989, and Tournaire, et al, 1980

11 Bradycardia Baseline less than 110 Causes: Interventions:
Vagal response Cord prolapse Arrhythmia Possible maternal HR Drug use Interventions: Assess maternal HR, BP Increase fetal oxygenation Limit maternal bearing down Prepare for delivery and neonatal resusitation Murray, 2007 Nubain, beta blockers can cause Cocaine, cigarettes can cause abruption or fetal compromise Vagal response can be due to head compression, cord compression, forceps application

12 Absent Variability

13 Minimal to Moderate variability

14 Moderate Variability

15 Reassuring FHR in the Term Fetus
Baseline Moderate variability No periodic decelerations Accelerations with fetal movement

16 Nonreassuring FHR in the Term Fetus
Decelerations Late Prolonged Severe variables Progressive change in baseline (up or down) Tachycardia Bradycardia Decrease or absence of variability Lowdermilk and Perry, pg 498 Murray, 2007, pg 59-71 Mattson and Smith pg 309 Lowdermilk & Perry, 2007, Mattson & Smith, 2004 and Murray, 2007

17 Spinal/Epidural Nursing Care
“Time Out”/Consent Notify anesthesia if platelet count is low Support during placement Assess VS, FHR frequently per P&P Position with wedge under hip afterward Assess adequacy of contractions Foley as ordered Be prepared for interventions related to maternal hypotension, high block, fetal distress Assess level of block Discuss controversy regarding IV bolus-

18 Cesarean Birth Nursing Interventions
Start/maintain IV with #18 gauge cathlon Shave abdomen Insert foley Check chart for consent, labwork (CBC, blood-type and cross- match x 2 units PRBC). Advocate for informed consent Support mom and her coach Involve couple as much as possible in decision making Obtain OR attire for coach and orient to expectations Continually assess maternal/fetal status Gilbert & Harmon, 2003 Shave at least 2 inches below pubic hair line Discourage thoughts of C/S as a failed delivery. It is an alternative delivery route

19 Danger Signs Vaginal bleeding Abdominal pain
Sudden gush of fluid from vagina Edema of hands, face Severe headache Dizziness, visual disturbances Abdominal pain Chills, fever (101ºF) Painful urination Oliguria Persistent vomiting Decrease or absence of fetal movement

20 Third Stage of Labor Begins with birth Ends with delivery of placenta

21 Nursing Interventions During Third Stage
Promote skin to skin contact with infant (if newborn is stable) Assessment, possible resuscitation of newborn Assess maternal VS, lochia frequently Assist with fundal massage prn Have Pitocin readily available

22 Following Delivery… Administer oxytocic medication as ordered
Pitocin 20 units in 1000 ml IV fluid or Pitocin 10 units IM Methergine 0.2 mg IM (contraindicated with HTN) Assist provider prn in repair of lacerations, episiotomy Clean perineum with warm water, apply ice pack prn Replace foot of bed Massage fundus and assess lochia per protocol Complete newborn assessment and care Promote breastfeeding (prn) and family bonding Discuss Pitocin after placenta vs after baby

23 Massage the fundus... Hands on practice!!

24 Transition to Parenthood - Chapter 24
Period of change and instability for those with new infants; occurs over time Influences include: meanings, expectations, level of knowledge, environment, level of planning, emotional and physical well-being Depends on the new parent’s experiences with their parents (infant’s grandparents)

25 Psychosocial Needs Birth Experience Maternal Self-image
Maternal Adaptation Parent-Infant Interaction Family Structure Cultural Diversity

26 Attachment and Bonding Influences
Parent’s emotional state Support system Level of communication Care-giving skills Proximity of infant Parent-infant fit Positive feedback

27 Nursing Diagnoses and Expected Outcomes
Risk for infection Risk for constipation Disturbed sleep pattern Acute pain Risk for injury Ineffective Breastfeeding

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