Professional Documents
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Direct: resulting from complications during pregnancy, labor/birth, postpartum, and from interventions,
Indirect: due to a preexisting disease or a disease that develops during pregnancy that doesn't have a direct
Late: death occurs more than 42 days after termination of pregnancy from either direct or indirect causes
Pregnancy Related: maternal death during pregnancy or within 42 hours of termination of pregnancy
regardless of COD
circulation
HR: 120-160 Color: pink Cry: lusty RR: 30-60 Muscle Tone: flexion
Breasts
Uterus
Bladder
Bowel
Lochia
Episiotomy
Homan's Sign
Emotional
State
Bonding
Assessment of Respirations
q15 minutes for the first hour postpartum
Vaccinations Rh Isoimmunization
Trap, Hep B, Varicella, Influenza when an Rh negative mother develops antibodies to Rh positive blood
Women who contract Rubella during the 1st trimester have a exposure through blood transfusions or exposure to an Rh positive fetus
90% chance of transmitting the virus to the fetus mother produces IgG anti-D antibodies which crosses the placenta
fetus has birth defects - deaf, blind, cardiac/mental and causes hemolysis in the fetus
retardation Rho immune globulin/RhoGam is given to Rh negative mothers at 28
Nonimmunized mother should be immunized prior to hospital weeks - prevents the production of the anti-Rh antibodies
discharge Coomb's Test: Rh negative mothers who give birth to Rh positive newborns
Women who receive the Rubella immunization should avoid are screened for anti-Rh antibodies
pregnancy for at least 4 weeks if the test is negative, a 2nd dose of RhoGam is given
a 300 mag dose of RhoGam = 1500U Rophylac, which must be
given IM within 72 hours post delivery
Assess bladder for distention - voiding less than 150 mL/occurrence will place the mother at risk for uterine atony & displacement of uterus
to a dextroverted position (shifted to the right)
Encourage frequent voiding and increased fluid intake - insert straight/foley catheter as per MD order
Check temperature q4 hours and signs and symptoms of infection
intake
shift
For an early delivery
administer 12mg
betamethasone to the mother
to help strengthen fetal lungs
All would be C/S. A primigravida breech position is an indication for C/S. A multigravida breech position is also
an indication for C/S unless the mother is rapidly dilating or of the physician thinks the baby is small enough.
Girls can present with an edematous labia. Boys can present with 1 scrotum and a large amount of edema
Middle Phase: 4-7 cm dilation, 40-80% effacement, Transition Phase: 8-10 cm dilation, 80-100%
Latent Phase: 0-3 cm dilation, 0-40% effacement,
more intense UCs q2-5 minutes lasting 45-60 seconds effacement, more intense UCs q1-2 minutes lasting
irregular to q10-15 minutes UC
Ongoing Labor Support: ice chips for dry mouth otherwise 60-90 seconds
Admit to LDR: introduce and establish rapport
NPO Ongoing Labor Support: ice chips for dry mouth
have patient undress, place in semi-fowlers
SVE & ROM if indicated otherwise NPO
position on bed and obtain UA specimen
Pain Management: medication or epidural as indicated patient is often irritable, diaphoretic, and may
obtain history - PMH, PSH, prenatal
Continuous evaluation of labor progress have the urge to bear down
CBC, possible drug screen, rapid ELISA HIV as
Patient/Family/Labor Coach support and education as SVE & ROM as indicated
needed; SVE exam
necessary Epidural Anesthesia: hyperbolus IV fluids as indicated
Maternal Vital Signs
low risk patients: q1 hour maternal vital Signs q1-2 minutes post
Pushing Phase: complete dilation to birth of baby
temperature q4 hours if membranes epidural/foley insertion
Ongoing Labor Support: ice chips for dry mouth
are intact and q2 hours if ROM Continuous evaluation of labor progress
otherwise NPO
high risk patients: q15-30 minutes Patient/Family/Labor Coach support and education
patient if often irritable and diaphoretic
temperature q2-4 hours based on as necessary
usually has the urge to bear down so assist into
membrane status proper pushing position - mother may be Stage 3: Placenta Delivery
ROM, SROM, AROM - also assess fluid amount, color exhausted or have a burst of energy & guttural Usually within 3-5 minutes but may take up to 30
and odor sounds may be exhibited minutes
EFM: Leopold's Maneuver for fetal back location; FVS for SVE as indicated Cord lengthens
baseline FHR, variability, accelerations and decelerations Continuous evaluation of labor progress and support of Trickle of Blood: active, bright red bleeding
Venous Access: start IV or saline lock mother Observe cord blood aspiration for blood sampling
Labor Support Patient/Family/Labor Coach support and education as Examination of placenta for intactness
necessary
Begins after the delivery of the placenta and ends within 4 hours after delivery
NB assessment, NB medications are given, mother may breastfeed for the first time, maternal/infant bonding is encouraged, NB receives a first bath
NB Assessment
NB is dried, stabilized, and placed under a radiant warmer for thermoregulation and APGAR scoring
NB medications: 1mg/0.5kg vitamin K, ophthalmic ointment erythromycin in both eyes, 10mcg/0.5mL Hep B vaccine with maternal consent
NB head to Toe Assessment and Ballard Scale
pediatrician examination
Patient/Family/Labor support and education Evaluate NB upon delivery with primary RN and faculty
Evaluate & Care for mother post delivery with primary RN
and faculty
Baseline FHR of 120-160 bpm with moderate (+2) variability. Acceleration of 15x15.
Generational age is based on maternal history, USS, and NB maturation evaluation (Ballard Scale)
The NB should exhibit flexion of the extremities - lack of flexion is related to prematurity or a depressed NB
Measurements
head circumference: 33-33.5 cm/ 13-14 in.
chest circumference: 30.5-33 cm/ 12-13 in
length: 45-53 cm/ 19-21 in
weight: 2500-4000 g; 5lbs 8oz - 8lbs 13oz
axillary temperature: 36.5-37.2 C/ 97.9-99 F
Vital Signs
RR: 30-60 breaths per minute with diaphragmatic and abdominal breathing (slightly irregular pattern)
apical pulse/HR/pre-clamped umbilical cord rare: 120-160 bpm
BP: 50-75/30-45 mm Hg
Head: note the size and shape of head, palmate fontanels and suture lines
fontanels are open, soft, flat and slightly depressed that may bulge with crying - anterior fontanel is diamond shaped that closes by 18 months, posterior fontanel is triangular
and closes in 2-4 months
suture lines should be approximated - they are sometimes overriding just after delivery and should not be separated
check for capital succedaneum (fluid can cross suture lines) and cephalohematoma (blood doesn't cross suture lines)
Eyes/Ears: note position and discharge
check eyes for sclera, pupil size and blink reflex. Pediatrician will check for + red reflex
check ears for vernix and drainage - a hearing screen is state mandated that NBs can either PASS or DEFER
NB may be referred to an audiologist if fails to pass screen in one or both ears.
Nose: observe shape and check nares for patency
Neck: neck is short with skin folds
Mouth: inspect lips, gums, palate, and tongue - test for rooting, sucking, swallowing, and gag reflexes
Chest/Lungs: barrel shaped and symmetrical, auscultation all lung fields (AF in lungs may cause crackles), RR, observe chest for retractions
Cardiac: listen to all cardiac landmarks, assess S1 and S2, point of maximal impulse at 3rd-4th intercostal space, HR, peripheral pulses
bilaterally
murmurs in 30% of NBs disappear within 2 days
landmarks on the NB chest are much more compact related to the small surface area of the chest
the NB heart is tipped higher in the chest - as a result, the mitral valve is located approximately at the 3rd-4th intercostal space
Inspect anus prior to inserting a rectal thermometer - rectal is usually the mode for assessing the initial temperature in a NB
Observe for meconium - the NB should have the first stool within 24 hours
Females Males
inspect labia majora and minora which may be edematous inspect penis and note the position of the urethral opening, looking
pseudo-menstruation may be present as slight vaginal bleeding for hypospadias or epispadias
directly related to the excretion of maternal hormones and is normal inspect the scrotum for rugae/septum - palmate scrotum for the
inspect perineum for urethra, clitoris and vaginal opening (introitus) presence of testes
inspect tested for hydrocele
NB should urinate within 24 hours
Initial Period of Reactivity: in the first 15-30 minutes after birth, the NB is alert, active and crying or is in a quiet alert state, just looking
around
NB vigorously responds to environmental stimuli - cold, heat, touch, sounds, light
HR may be as high as 180 bpm and RR can be as high as 90 breaths per minute, rapid and irregular with brief periods of cyanosis
Sleep State: begins about 30 minutes after birth where the NB is unresponsive to external stimuli - respirations decrease sometimes below
normal range and HR decreases within normal limits
Second Period of Reactivity: follows the sleep state, varies between alert and quiet alters state and lasts 2-8 hours
increased bowel activity and may have first meconium stool; NB may void
Erythromycin Opthalmic Ointment (0.5%): STATE MANDATED prophylaxis treatment for gonorrheal/chlamydial eye infections
Vitamin K IM Injection (0.5-1mg/0.5mL): into the left vastus lateralis for NB clotting factors
Hepatitis B Vaccine: the 1st of 3 doses is generally given in the hospital after signed consent is obtained into the rig vastus lateralis
1st dose - HBIg (hepatitis immune globulin) is given within 12 hours of birth
2nd dose - given at 1-2 months of age
3rd dose - given at 6-18 months of age
Elective surgery to remove the foreskin of the penis - decision is made by the NBs parents and requires a consent
Contraindications: urogenital defect, preterm status, NBs with bleeding problems, RDS or other unstable conditions of the NB
Risks: hemorrhage, infection, adhesions, pain, too much foreskin removed
Pre-Operative: NB vital Signs and verification that the NB has voided
NPO 2-3 hours prior to the procedure
pain management as per MD order
Emla Cream (lidocaine 2.5% & prilocaine 2.5%) applied to the penis prior procedure
Lidocaine injected into the surgical site by MD
Acetaminophen orally 1 hour prior to the procedure
non-nutritive glucose sucking prior/during the procedure
Procedure: Gomco clamp or Plastibell
Post-Operative: check penis q15 minutes for bleeding, check for any postop pain med orders, usually acetaminophen q4-6 hours; penis will be covered by petroleum gauze
vital signs and postoperative voiding; swaddle infant for comfort and feed prn