Maternity/Pediatrics Study Guide Chapters 8-10, 12-14

• Nursing Care for Lacerations/Episiotomy (timing is important): begins during

4th stage of labor. Cold packs should be applied for the first 12 hrs to reduce
pain, bruising and edema. After 12-24 hrs of ice, heat in the form of heat
packs or sitz baths may be used to increase blood circulation, enhance
comfort & healing. Mild oral analgesics are usually sufficient for pain.
• Neonatal Complications Related to Vacuum/Forceps Use: Forceps cause
bruising, facial or scalp lacerations, cephalhematoma, or intracranial
hemorrhage. Vacuum can cause harmless area of circular edema.
• Differences Between Caput vs Cephalohematoma in a Newborn: Caput
succedaneum is swelling of the soft tissue of the scalp. Cephalhematoma is a
head blood tumor caused by a collection of blood beneath the periosteum of
the cranial bone.
• Risks of PROM: include weight due to early delivery, infection of the mother,
umbilical cord compression, fetal tachycardia and tenderness over uterine
site
• Side Effects of terbutaline (Brethine): include increased pulse rate and blood
pressure. pg193
• How to Assess Fundus for a Woman who has a Cesarean Birth: To assess the
fundus after C-section, the woman flexes her knees slightly and takes slow,
deep breaths to minimize discomfort. While supporting the lower uterus with
one hand, the fingers of the other hand gently “walked” from the side of the
uterus toward the midline. Massage is not needed is fundus is already firm.
• Symptoms of Hypoglycemia in Newborns: include jitteriness, poor muscle
tone, sweating, respiratory difficulty, low temp, poor sucking, high-pitched
cry, lethargy, seizures
• Expected Findings for Uterus Immediately After Delivery: The uterus
undergoes after birth to return it back to pre-pregnancy size. Rapid reduction
in weight & size- return to pre-pregnancy size in 5-6 wks. Uterine lining shed
when placenta detaches, the fundus descends at a predictable rate as muscle
cells contract to control bleeding; by 10 days post partum fundus should no
longer be palpable. After birth pains are similar to menstrual cramps &
decrease w/in 48 hrs. Vaginal discharge after birth (lochia) is composed of
endometrial tissue, blood, and lymp, and can last up to 10 days after birth. Pg
200-202
• Physiology of Breastfeeding, How to Correctly Teach a Parent About
Breastfeeding (How long, how often, correct latch, preventing problems)
Newborn should be breastfed w/in a few hrs after delivery. Infants nurse 10-
15 mins on each breast 8-10 times daily. They should be fed every 2-3 hrs
daily during the first few weeks.
• Priority When Pt has Soft, Boggy Uterus: gently massage until firm. Have pt or
place a straight catheter. Oxytocin may be given to stimulate uterine
contractions
 Maternity/Pediatrics Study Guide Chapters 8-10, 12-14

• Rubra: know the difference between rubra, serosa, alba, and when they are
expected
o Lochia- vaginal discharge after birth.
o Lochia Rubra- red, mostly blood, lasts about 3 days after birth
o Lochia Senosa- pinkish, blood and mucous content, lasts 3-10 days after
birth
o Lochia Alba- mostly mucous, clear and colorless or white, lasts 10-21 days
after birth
• Correct Teaching for Peri Care: includes using ice packs for the first 12-24
hrs. Then heat to aid healing. Sitz bath increases circulation & promotes
healing. Cleanse area with peribottle filled with warm water to squirt over
area after bowel movement/voiding. Place & remove peri pads from front to
back. Topical meds can be used
• What is done if a postpartum woman is not immune to Rubella (when is
vaccine given?): The Rh negative woman is given a dose of RhoGAM within
72 hrs after giving birth to a Rh positive infant. Only mother is given the
shot. Also given is any type of abortion to Rh positive infant.
• Dietary Changes/Recommendations for a Breastfeeding Mother: Mother
needs 500 addt’l cal/day while breastfeeding, 8-10 glasses of water of fluids
to decrease thirst
• When does menstruation return following birth: Menstrual cycles resume
in 6-8 wks if the woman is not breastfeeding—more delayed if she is.
Ovulation can occur at any time.
• When to give RhoGAM, and to whom: RhoGAM is given IM to mother only
when mother is Rh negative and baby is positive
• Correct care of umbilical cord, signs of problems with umbilical cord: Once
the cord is cut, assess artery-vein-artery (AVA) is present & it is clamped off.
Antibiotic ointment given and possible alcohol application at diaper changes
to promote drying of the cord. Cord should become dry & brownish/black.
Clamp is removed in 24 hrs. Cord should fall off in 10-14 days
• Comfort measures/teaching for breasts when woman is not breastfeeding:
Mother should wear a supportive bra. She should avoid stimulating her
nipples, avoid clothing from brushing, & should stay away from sprayer in
shower
• Why after pains worsen with breastfeeding: After pains with breastfeeding
occur because the sucking causes the posterior pituitary gland to release
oxytocin, which contracts the uterus.
• Correct information about bottle-feeding (how much, how often, how to
position bottle, how to warm, when to burp): Formula is digested slower than
breast milk so feeding should be about every 3-4 hrs. Warming is not
 Maternity/Pediatrics Study Guide Chapters 8-10, 12-14

necessary. Do not microwave (may cause hot spots), never prop bottle in
baby’s mouth- may cause aspiration, as is associated with cavaties & ear
infections. Infant should be held in cradle position with head slightly elevated
above body. Hold bottle so nipple is always full. Feed slowly & burp after 1-
1.5 ozs. Burp infant by placing on your lap leaning slightly forward, support
head & gently pat back.
• Correct teaching about storing breast milk (freezing): Breast milk can be
stored at room temperature for 4 hrs, stored in fridge for up to 24 hrs and
frozen for 3 mths. Milk can be thawed in fridge for 24 hrs or by running under
lukewarm water.
• 1st Sign of Hypovolemic Shock: Hypovolemic shock occurs when the
volume of blood is depleted & cannot fill the circulatory system. Body
responds by increased heat and respiratory rate. Tachycardia is usually the
first sign. Blood pressure also falls & skin and mucous membranes become
cold, clammy, & pale.
• Signs of Uterine Atony (what is is, symptoms): Uterine Atony is the lack of
normal muscle tone in the uterus, the muscle does not compress allowing
the blood vessels at the placenta to bleed freely & usually massively
o May be caused by uterine over-distention, retained placental
fragments, prolonged labor/use of drugs during labor to relax uterus
• Nursing Priorities When Uterine Atony (Hemorrhage) Happens: uterus is
difficult to feel & is baggy (soft). Fundal height is high above the
umbilicus. Lochia is increased and may contain large clots. Bleeding may
be dramatic or may be prolonged.
o Uterus should be massaged until firm but not excessively as it will
tire and make atony worse. Mother should void.
• Medications used to treat uterine atony (boggy uterus): A dilute oxytocin
IV infusion is most common drug ordered to control uterine atony. Also
methergine may be given or a prostaglandin as carbopost.
• Correct breast care/teaching re:Breastfeeding for a woman who has
Mastitis: Mastitis is an infection of the breast usually occurring 2-3 wks
after birth. It occurs when organisms from the infant’s mouth enter small
cracks in the nipple/areola. Breast enlargement and inadequate milk
emptying is associated. Signs & Symptoms:
 Redness & heat in breast
 Tenderness
 Edema & heaviness in breast
 Purulent drainage (may or may not be present)
 Fever or chills in woman
o If not treated infected area becomes walled off and an abscess
 Maternity/Pediatrics Study Guide Chapters 8-10, 12-14

forms. Milk is not contaminated as it happens outside of the ducts

but if an abscess forms it may rupture into the ducts.
o Antibiotics and continual removal of breast milk is the treatment.
Woman may need an incision & drainage of infected abscess. She
should not wean baby as it causes engorgement and stasis of the
milk, which makes it worse.
• Correct discharge teaching (warning/danger signs) for postpartum
woman: Postpartum depression is a nonpsychotic depressive illness that
is usually manifested within 4 wks after delivery, (affects 10-20%) nurse
must observe for chronic fatigue & complaints of sleeplessness.
• Signs of Late postpartum hemorrhage- occurs 24 hrs to 6 wks after
childbirth usually results from:
o Retention of placental fragments
o Subinvolution of the uterus
o Women should report persistent bright red bleeding, return of the
red bleeding after it has changed to pinkish or white.
• Signs of DVT/SVT and how it might be prevented and treated:
o Deep Vein Thrombosis (DVT)- can involve vein from the feet to the
femoral area and is characterized by pain, calf tenderness, leg
edema, color changes, pain when walking, and sometimes a
positive Homan’s sign. Treated similarly as SVT with the addition of
subQ/IV anticoagulant therapy drugs such as Heparin. May be
continued for 6 wks after birth
o Superficial Vein Thrombosis (SVT)- involves the saphenous vein of
the lower leg and is characterized by painful, hard, reddened, warm
vein that is seen easily. Treated with administration of analgesics,
local application of heat & elevation of legs to promote venous
drainage.
o Both can be prevented with frequent ambulation, do not cross legs
or impede blood flow. Antiemboli stockings may help.
• Signs of postpartum depression and appropriate nursing response if pt
has them- Nurse should assess mother’s support system, whether one is
getting enough sleep, exercise and proper nutrition to improve overall
health and sense of well-being. Signs of postpartum depression are:
o Lack of enjoyment in life
o Disinterest in other; loss of normal give & take in relationships
o Intense feelings of inadequacy, unworthiness, guilt, inability to cope
o Disturbed sleep
o Constant fatigue & feelings of ill health
 Maternity/Pediatrics Study Guide Chapters 8-10, 12-14

• Risk factors (contributing factors) for Hematoma/Cervical lacerations:

o Cervical lacerations- injury is sutured during delivery; can be caused
from rapid birth, can cause perfuse bleeding since vascular beds are
engorged as well as use of forceps or vacuums during birth.
Characteristics are a continuous trickle of blood that is brighter than
normal lochia, firm fundus and an onset of hypovolemic shock that
may be gradual and overlooked
o Hematoma- is a collection of blood within the tissue, usually caused
by prolonged or rapid labor, large infant, and also use of
forceps/vacuums. Usually on the vulva or inside of the vagina. If
visible, it is a bluish/purplish mass. Severely or poorly relieved pain
or pressure in the vulva, pelvis, or rectum. Large amounts of blood
lost into tissues can cause signs & symptoms of hypovolemic shock.
Lochia is normal in color.
• Symptoms of PE, and appropriate nursing response if your patient had
them: Pulmonary Edema (PE)- occurs when pulmonary artery is
obstructed by a blood clot that breaks off and lodges in the lungs. Signs &
symptoms include sudden chest pain, cough, & dyspnea, decreased level
of consciousness and signs of heart failure. Possible if mother has a DVT.
All symptoms must be reported immediately
• Why molding happens to the infant’s head: Molding may occur in a fetus
head because skull bones are soft and conform to the size and shape of
the birth canal. Fontanels are not fused to aid in the delivery
• Signs of respiratory distress in a newborn: Symptoms of the respiratory
stress include increase in respiration of 60bpmin or more, tachypnea,
grunt sounds like, nasal flaring, cyanosis, & intercostal & sterna
retractions
• What the Moro reflex is, whether it is normal or not: The Moro reflex
occurs when a baby is startled, they draw their legs up and arms fan out
and come to the midline in an embrace position. The absence of this in
the term infant indicates abnormalities of the nervous system
• Normal appearance/assessment of the fontanelles: Fontanelles are
unossified spaced or soft spots on the baby’s head. They protect the head
in the delivery process. The anterior fontanel is diamond shaped usually
closed by 12-18 mths. If bulging, it is an indication of hydrocephalus,
increase pressure on the brain, increase fluid. If sunken in, can indicate
dehydration.
• Normal vital signs for Newborns:
o Respirations: 30-60 breaths/min
o Heart Rate: 110-160 beats/min
o Temperature: 97.8°-98.9° F
 Maternity/Pediatrics Study Guide Chapters 8-10, 12-14

o Blood Pressure: 30/46 mm/Hg

o Abnormalities to be reported:
 Temperature Above 99.88° F or Below 97.1° F
 Respirations Above 60 breaths/min or Below 30 breaths/min
 Noisy respirations
 Nasal flaring or chest retraction
• Correct guidelines for bathing newborn (when to use soap, when to wash
hair, correct direction for bathing, how to clean eyes): Use a mild soap.
Bathe face first then a head to toe directions. Eyes cleaned from inner to
outer using cotton swab for each eye. Genitalia cleaned front to back.
Shampoo hair last due to large heat loss
• Stool color/consistency for breastfed babies versus bottle fed babies, what
meconium looks like and when it is expected: Meconium is the first stool a
baby passed w/in 8-24 hrs, it is a black, thick, and sticky/tarry. This will
gradually change w/in a wk as they turn greenish yellow with mucous as it
is called the transitional stool. Breastfed babies have bright yellow, soft,
pasty stools, passed 3-6 times/day. Bottle fed infants have stools that are
more solid and vary from yellow to brown & are fewer in numbers. Small,
putty like stool or diarrhea is abnormal.
• Straining in a newborn is from an underdeveloped abdominal musculature
and is normal and not an indication of constipation is when there is dry,
hard stool. Infants can go 5-6 days w/o stool & not indication of
constipation.
• In the first 3-4 days infant loses 5-10% of the birth weight. Will normalize
after 3-4 days and by 10 days will regain this weight.
• A female genitalia may have white/blood tinged mucous discharge whitish
is caused by hormonal withdrawal from the mother at birth
• Neonate sleeps 15-10 hrs/day. Phases of sleep/wake:
o First reactive phase- first 30 min of life-most alert, best time to
initiate bonding
o Sleep phase- next few hrs infant becomes drowsy
o Second reactive phase- after deep sleep infant “becomes
responsive or alert”
o Stability phase- after 24 hrs sleep wake pattern becomes more
stabilized
o An infant held upright is more alert than being cradled. Patterns of
reactivity that influence bonding and reaction to stimuli:
o Quiet sleep- infant does not move
 Maternity/Pediatrics Study Guide Chapters 8-10, 12-14

o REM- Respirations are irregular, eye movements are evident and

limb & mouth movements may be seen
o Active alert- displays diffused motor activity
o Crying- infant’s crying is accompanied by vigorous motor activity of
extremities
o Transitional- infant is going between one of the previous states to
another
• Milia- white pinpoint pimples caused by obstruction of the sebaceous
glands, may be seen on nose & chin. Disappear w/in a few weeks
• Bulb Care: compress ball portion of syringe, insert narrow portion of the
bulb into the side of the infant’s mouth to avoid gag reflex. Suction mouth
first, to prevent aspiration of mucous, during a gasp when gag reflex is
triggered when you do the nose. Release pressure and listen for
suctioning. Remove bulb and empty contents into receptacle.
• Use standard precautions, hand washing, cleansing, & replacing of
equipment, proper disposal of diapers & linens
• Jaundice is due to an increase of bilirubin. This puts newborn at risk for
hyperbilirubinemia as well as kernicterus.
• If preterm labor is eminent, mother may be given glucocorticosteroids to
increase lung maturity in fetus ages 24-24 wks. Betamethasone may be
given in 2 IM injections, 24 hrs apart. Thyroid hormones are given in the
form of thyroid releasing hormone in fetuses younger than 28 wks.
• Signs of hypoglycemia in a newborn:
• Prolonged pregnancy is a risk to the fetus because as the placenta ages it
does not deliver oxygen and nutrients efficiently, causing the fetus not to
tolerate labor well. Asphyxia caused by chronic hypoxia while in the
uterus because the deteriorated placenta. Seizures because of hypoxia.
Large size of infant.
• A post term infant fetus may be long, thin and looks as though weight was
lost. Skin is loose, especially around thigh and buttocks. Little lanugo or
vernix, leaving the skin dry—cracks & peels and is almost like parchment
in texture. Nails are long and may be stained with meconium. Infant is
alert & has thick hair.
• Hydrocephalus is a condition characterized by an increase of
cerebrospinal fluid w/in the brain, which causes pressure changes in the
brown & increase in head size. It may be congenital or acquired by an
obstruction such as tumor/infection.
•
• Non-invasive pain relief measures for a newborn: Swaddling with the hand
near the mouth, cuddling, rocking, nonnutritive sucking and quiet
 Maternity/Pediatrics Study Guide Chapters 8-10, 12-14

environment.
• Correct care for circumcised penis:
o Keep area clean, change diaper
o Wash area with warm water, avoid alcohol
o Do not remove yellow crust from penis
o Apply diaper loosely
o Report redness and bleeding
o Observe for at least 6 wet diapers per day
• Symptoms of neonatal abstinence syndrome in newborns: Body tremors
and hyper-irratablity are principle signs of this condition, wakefullness,
diarrhea, poor feeding, sneezing and yawning may also be present
• Symptoms of increasing ICP if infant with hydrocephalus: High pitched
cry, unequal pupil size, or response to light, bulging fontanels, irratability,
or lethargy.