Review and Refresh Packet, Class & Readings And Clinical Revelations

What is maternal-child health? 6 interconnected aspects

What is maternal-child health? 6 interconnected aspects Patient experience Fetal/newborn physiology Family experience Maternal physiology Medical Care Nursing Care

Nutrition Hemoglobin Weight gain Blood pressure Kidney and liver function Uterus Contractions Placenta & cord Tubes & ovaries Maternal physiology

Fetal heart tones Pulse, temp, respiratory rate Weight Amniotic fluid volume Anomalies Placental blood flow Fetal/newborn physiology

Knowledge Previous experiences Cultural roles and expectations Significant other, older siblings, grandparents, extended family Facility Inclusion/exclusion Staff attitudes Family experience

Knowledge Previous experiences Fear Cultural roles and expectations Presence/absence of support person Facility Staff attitudes Patient experience

What physician orders and does Based primarily on physiology Patient or family experience is much lower priority Physicians receive less training in patient education and support Medical care

Nursing Care Physiology top priority, but patient and family experience is dealt with simultaneously Education high priority Culture more important Independent nursing interventions Medically delegated tasks

Cardinal Movements of Childbirth

Which Are…. Flexion Descent Internal rotation Extension External rotation

Positions for birthing-kneeling

Side lying

Birthing stool

Hands and Knees

Water birth

Hospital birthing room

Typical hospital birth

Crowning

NCLEX-style question The highest priority in nursing care of the laboring client is: 1.Pain relief 2.Partner involvement 3.Fluid intake 4.Fetal heart rate

Maternal-Child Medications Pain Medications Tylenol & NSAIDs Stronger NSAIDs: –Keterolac (Toradol) Narcotics po: codeine po Hydrocodone Oxycodone –Injectables: Nubain Stadol

What question should the nurse ask before administering 10 mg of Nubain IV to a laboring client? 1.“Have you ever had surgery?” 2. “Do you use narcotics regularly?” 3. “What vitamins do you take daily?” 4. “Is your baby a boy or a girl?”

NCLEX –Style Question A Client who is Latino is in labor and the father is refusing to come into the labor and delivery room. The nursing student assisting in the care believes he should participate in the birth and repeatedly urges the father to come into the labor and delivery room even though he keeps refusing. This nursing student is exhibiting: A.Cultural sensitivity B.Ethnocentrism C.Encouragement D.Discouragement

NCLEX Style ? Which of the following methods places emphasis on natural childbirth? A.Leboyer B.Lamaze C.Dick-Read D.Bradley

NCLEX Style ? The nurse auscultates the fetal heart rate and determines a rate of 150 to 155 beats/minute. Which of the following nursing interventions is most appropriate? A. Inform the client that the FHr is normal and document the findings. B. Document and reassess the FHE in 5 minutes because the rate is too high. C. Report the FHR to the primary provider immediately and then document. D. Document and tell the mother she is having a boy because the heart rate is fast.

NCLEX-style question The laboring primiparous client is in early labor. She asks the nurse how her labor will progress? What is the nurse’s best response? 1.The contractions will gradually get stronger and closer together.” 2. “If you don’t progress fast enough, we’ll start Pitocin to hurry things along.” 3. “Don’t worry. We’ll take good care of you and make sure everything is fine.” 4. “When your water breaks we will check your cervix to see how far along you are.”