13 Maternal and Child.pdf

FETAL HEART MONITORING ALWAYS check FETAL heart rate!! LOW fetal heart rate (under 110) → BAD ☹ Treatment: LION ( LEFT side, IV, O2, notify!) If Pitocin was running, stop it! HIGH fetal heart rate (over 160) → OKAY 🙂 NO big deal/docum...

FETAL HEART MONITORING ALWAYS check FETAL heart rate!! LOW fetal heart rate (under 110) → BAD ☹ Treatment: LION ( LEFT side, IV, O2, notify!) If Pitocin was running, stop it! HIGH fetal heart rate (over 160) → OKAY 🙂 NO big deal/document Take Mom’s temp (may have fever); nothing wrong with baby LOW baseline variability → BAD ☹ When fetal heart rate stays the same & does not change Treatment: LION ( LEFT side, IV, O2, notify!) HIGH baseline variability → OKAY 🙂 When fetal heart rate is always changing → Good/document! LATE decelerations → BAD ☹ Heart rate slows down near the end or after a contraction Treatment: LION ( LEFT side, IV, O2, notify!) EARLY decelerations → OKAY 🙂 Baby’s heart SLOWS before or at the beginning of a contraction → Fine/document! VARIABLE decelerations → VERY BAD ☹ Prolapsed cord Treatment: ○ Push head back up off the cord Keep your hand there until the baby is delivered ○ Position her in knee chest ***Any position that starts with L, do LION, except variable (push position)*** L’s and V’s = VERY BAD *ALWAYS Check fetal heart rate*** always a good choice on test Stage #2 Delivery of the BABY!!! The purpose of uterine contractions is to push the baby out Order: a. Deliver the head b. Suction the mouth than the nose c. Check for nuchal cord (around the neck) d. Deliver the shoulders than the body e. Baby must have ID band on before it leaves the delivery area Stage #3 Delivery of the PLACENTA The purpose of uterine contractions is to push the placenta out ○ Make sure it is INTACT Make sure the cord has 3 vessels (AVA → 2 arteries & 1 vein) Stage #4 Recovery The purpose of uterine contractions is to contract the uterus to stop bleeding Postpartum technically begins 2 hours after the placenta comes out *4 things you do, 4 times per hour in the 4th stage!* a. VITAL signs: Looking for signs and symptoms of SHOCK Pressures go DOWN, rates go UP, pale, cold & clammy b. Check the FUNDUS If it’s boggy → massage it If it’s displaced → you void or catheterize! c. Check the PADS 100% saturated in 15 minutes or less, she is bleeding excessively If 98% saturated it’s okay She should not soak a pad in one hour or less due to risk of hemorrhage. d. ROLL her over ( check for bleeding underneath her) Postpartum ASSESSMENT: Done every 4-8 hours  ○ B: Breasts ○ U: Uterine fundus** Needs to be FIRM; If boggy, massage! needs to be midline If not, void/cath them Height to fundus related to the belly button: ○ Fundal height = days postpartum 4th postpartum day → 4 below on the 4th day ○ B: Bladder ○ B: Bowel ○ L: Lochia** ( vaginal discharge) Rubra: 1st; red Serosa: 2nd; pink Alba : 3rd; whit e Amo unt: 4”-6” on a pad/hours = okay... SATURATE a pad 15 mins or less = bad. ○ E: Episiotomy ○ H: Hemoglobin & Hematocrit ○ E: Extremity check** Pulses Edema Looking for thrombophlebitis Bilateral calf circumference measurements ○ A: Affect (emotions) ○ D: Discomfort Normal Variations in the NEWBORN Caput succedaneum: ○ Crosses sutures (symmetrical) Refers to the swelling, or edema, of a newborn's scalp soon after delivery. ○ It appears as a lump or a bump on their head. This condition is caused by prolonged pressure from the dilated cervix or vaginal walls during delivery. Cephalohematoma: ○ Does not cross sutures (not symmetrical) ○ Is a traumatic subperiosteal hematoma that occurs underneath the skin, in the periosteum of the infant's skull bone. Physiological vs Pathological Jaundice Milia: Distended sebaceous glands which appear as tiny white spots on baby’s face Epstein’s pearls: Small, white epithelial cysts on baby’s gums Mongolian spots: Bluish-black macules appearing over the buttox and/or thighs of darker-skinned neonates Erythema Toxicum Neonatorum: Red papular rash on baby’s torso which is benign and disappears after a few days Hemangiomas: Benign tumor of capillaries  Vernix caseosa: Whitish, cheese-like substance which appears intermittently over the first 7-10 days Acrocyanosis: Normal cyanosis of baby’s hands and feet which appears intermittently over the first 7-10 days Nevus/Nevi: Generic term for birthmarks Nevus flammeus: nonblanchable port wine stain Telangiectatic nevi: blanchable pink “stork bites” OB Medications Tocolytics: stops labor ○ Terbutaline: causes maternal tachycardia ○ Magnesium Sulfate: HYPERmagnesemia ↓ HR and BP ↓ Reflex es ↓ Respir atory Rate ↓ LOC! Parameters for titrating mag sulfate: Respirations ABOVE 12; it’s okay... Respirations BELOW 12; slow the mag down! Reflexes: we WANT +2.. if it’s +1; slow it down.. +3; speed it up.  Oxytocics: stimulate & strengthen labor! ○ Oxytocin *Pitocin* BIG thing to remember → it can cause uterine hyperstimulation Contractions lasting longer than 90 seconds & closer than every 2 minutes If you see this, back off your PICC! ○ Methergine: causes HIGH BP ○ Hemabate should not be given to a mother with asthma FETAL LUNG MATURING Medications: Given to the baby to help their lungs mature faster Betamethasone (*steroid*) ○ It is given to the mother by IM before the baby is born ○ Can be repeated as long as the baby is in utero Survanta *Surfactant* ○ It is given to the baby after it is born ○ It is given transtracheal (blown in through the trachea; nebulizer) **The only antipsychotic pregnant women can get is Haldol **