ATI Capstone Content Review: Maternal Newborn - Tips of the Week

Look for those key words:

Read the question and all answer options carefully. Make sure you pay attention to words in the question stem such as “most important,” “first,” “initial,” or “last.” Use these cues to help you select your answer, and make sure that the answer you select is answering the question. Is the question asking for an intervention, an assessment, or an evaluation? Choose your answer accordingly.

Having trouble focusing?

If you find it hard to focus while reading all answer options, try reading the options backwards (start with “D” and work up to “A”).

Read rationales for questions carefully as you are studying.

Many students remark that they can get the answer choices narrowed down to 2 and then can’t seem to pick the right one. A good tip for improving your ability to pick the BEST answer is to read rationales for correct answers and begin to understand WHY the correct answer is correct. This will help you gain information that you can carry into future tests.

Helpful mnemonics for Maternal Newborn!!

Cleft lip: nursing care plan (postoperative) — "CLEFT LIP"

Crying, minimize

Logan bow

Elbow restraints

Feed with Brecht feeder

Teach feeding techniques; two months of age (average age at repair)

Liquid (sterile water), rinse after feeding

Impaired feeding (no sucking)

Position—never on abdomen

Complication of severe preeclampsia — "HELLP" syndrome

Hemolysis

Elevated Liver enzymes

Low Platelet count

Dystocia: general aspects (maternal)—"4P's"

Powers

Passageway

Passenger

Psych

Infections during pregnancy — "TORCH"

Toxoplasmosis

Other (hepatitis B, syphilis, group B beta strep)

Rubella

Cytomegalovirus

Herpes simplex virus

IUD: potential problems with use — "PAINS"

Period (menstrual: late, spotting, bleeding)

Abdominal pain, dyspareunia

Infection (abnormal vaginal discharge)

Not feeling well, fever or chills

String missing

Newborn assessment components — "APGAR"

Appearance

Pulse

Grimace

Activity

Respiratory effort

Obstetric (maternity) history — "GTPAL"

Gravida

Term

Preterm

Abortions (SAB, TAB)

Living children

Oral contraceptives: Signs of potential problems — "ACHES"

Abdominal pain (possible liver or gallbladder problem)

Chest pain or shortness of breath (possible pulmonary embolus)

Headache (possible hypertension, brain attack)

Eye problems (possible hypertension or vascular accident)

Severe leg pain (possible thromboembolic process)

Preterm infant: Anticipated problems — "TRIES"

Temperature regulation (poor)

Resistance to infections (poor)

Immature liver

Elimination problems (necrotizing enterocolitis [NEC])

Sensory-perceptual functions (retinopathy of prematurity [ROP])

VEAL CHOP–which relates to fetal heart rate.

Variable decels => Cord compression (usually a change in mother’s position helps)

Early decels => Head compression (decels mirror the contractions; this is not a sign of fetal problems)

Accelerations => O₂ (baby is well oxygenated–this is good)

Late decels => Placental utero insufficiency (this is bad and means there is decreased perfusion of blood/oxygen/nutrients to the baby).

Nine-point Postpartum Assessment...BUBBLEHER

B- Breasts
U- Uterus
B- Bladder
B- Bowel function
L- Lochia
E- Episiotomy
H- Hemorrhoids
E- Emotional Status
R- Respiratory System

Considerations for the pregnant client

Admittance of a pregnant client to a medical-surgical unit:

You may have a pregnant client admitted with a diagnosis unrelated to her pregnancy and, therefore, she may be admitted to a general medical-surgical floor. A mnemonic to assist you in performing important assessment elements for these clients is FETUS.

* F: Document fetal heart tones every shift. To assess fetal heart tones, use a handheld Doppler ultrasound and place it in an area corresponding to uterine height. For example, for a client who's less than 20 weeks pregnant, the most likely area to find fetal heart tones is at the pubic hairline or the symphysis pubis. For a client whose pregnancy is more advanced, such as at 24 weeks, the fetal heart rate can most probably be heard midline between the symphysis pubis and the umbilicus. As the pregnancy advances in weeks, fetal heart tones can be heard closer to and possibly above the umbilicus.

* E: Provide emotional support. Pregnant women who are experiencing unexpected medical conditions are at a high level of anxiety related to how the current medical problem may affect the fetus. You should take extra care to alleviate and reduce your client's anxiety by explaining all medications and treatments. Additionally, be prepared to listen for fetal heart tones anytime the client requests it to further reduce her worry of the fetus' well-being.

* T: Measure maternal temperature. Because your client's core body temperature is higher than you can detect through oral or tympanic thermometers, be alert to the presence of a fever. A high maternal temperature can lead to fetal tachycardia and distress. An order for antipyretics on admission to ensure their quick availability will be a prudent request you should make to the admitting physician.

* U: Ask about uterine activity or contractions. Make it a normal part of your routine to ask about any type of uterine pain, tightening, or discomfort throughout your shift. Be aware that early contractions often present as lower back pain. Don't attribute complaints of lower back pain to the hospital bed. If your client reports any unusual activity, take care to softly palpate the lower abdomen for periods of greater than 2 minutes while conversing with her. Watch for subtle changes of facial expression while simultaneously detecting a change in uterine tone. If contractions are suspected, your client will need to be monitored with continuous fetal monitoring in the labor and delivery unit.

* S: Assess for the presence of and changes in sensations of fetal movement. After 20 weeks gestation, all women should be able to report feeling the fetus move. This is an important assessment to perform and document at least every shift, easily accomplished by asking “How often are you feeling the baby move?” By asking this as an open-ended question, you'll receive more information about the quantity of fetal movement such as, “I haven't felt the baby move as much as usual today.” 

Reference: Reeves, S.  (2012).  Woman’s health: Putting your nursing.  Nursing Made Incredibly Easy, 5/6(2012), 20-25.

Admittance of a postpartum client to a medical-surgical unit

There are times when a woman may be hospitalized during the postpartum period for a medical condition. When this occurs, she'll most likely be placed on a general medical-surgical unit. Her admission will cause you to ask: “What's normal during the weeks following the birth of a baby?”

* Breasts. Within the first 24 hours postpartum, colostrum appears and is followed by breast milk within the first 72 hours. Breast engorgement is most likely to occur around day 4 postpartum. The engorged breast will appear full, taut, and even shiny. Although this is normal, it may be very uncomfortable for your client. In contrast, a woman with mastitis will usually run a fever higher than 100° F, report feeling “ill,” and have one breast that's affected (firm, inflamed, swollen, and exquisitely tender to touch). If your client is breastfeeding her newborn, she'll require a breast pump. Depending on the medications ordered, the milk may need to be disposed of and not used for the baby.

* Lochia. Sometimes women will experience lochia (vaginal discharge) until the time of their 6-week postpartum visit. Immediately after delivery, the lochia is red and heavy enough to require a pad change every 1 to 2 hours. By 7 days postpartum, the lochia should be lighter in color (pink to red) and amount, requiring a pad change every 4 hours. Lochia that becomes heavier, has a foul odor, and is accompanied by pelvic pain isn't a normal finding and requires immediate intervention.

* Perineal care. For the first 2 weeks following delivery, clients will need to perform perineal hygiene as taught during the immediate postpartum period. This may include perineal water rinses following elimination using warm water or medicinal rinses, use of sitz baths, and comfort medications to the perineal and anal area.

* Cesarean section. If your client delivered her baby via cesarean section, continued assessment of the surgical incision is warranted for the first 2 to 3 weeks postpartum. Redness and warmth around the incision, excessive bruising around the incision, or incisional drainage requires immediate intervention. If the surgeon used staples to close the incision, they're usually removed approximately 5 days post-delivery.

Remember, the hospitalized postpartum client is likely to be very emotional. Not only will she be experiencing the normal hormonal fluctuations of the postpartum period, she may also be distraught leaving her newborn at home and feeling that she's missing bonding time with her child. Visitation between the mother and her infant may be very limited to minimize the infant's risk of infection, but visits should be arranged if at all possible.

Reference: Reeves, S.  (2012).  Woman’s health: Putting your nursing.  Nursing Made Incredibly Easy, 5/6(2012), 20-25.

Reference: Antipuesto, D. (2011).  Difference between placenta previa and abruption placenta.  Retrieved from http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/difference-between-placenta-previa-and-abruptio-placenta/

More Helpful Pharm Tips!

Endocrine Agents

Thyroid Hormones (hypothyroidism)

Thyroid Hormones are a synthetic form of thyro xine (T4) (see the form of thyroid in this hormone). These hormones increase metabolic rate, body temperature, oxygen use, renal perfusion, blood volume, and growth processes. These medications are prescribed for clients who have low thyroid hormone production (hypothyroidism).

In hypothyroidism…everything is LOOOOOWWWWWW(HYPOOOOOOOOO)

Common Thyroid Medications:

Levo thyro xine (Syn thro id,Levo thro id)

Lio thyro nien (Cytomel)

Liotrix ( Thyro lar)

Thyroid ( Thryoid USP)

Antithyroid Medications (hyperthyroidism)

Antithyroid medications are used to block (anti) the thyroid hormones. Antithyroid medications block (anti) the conversion of T4 into T3. Used to treat clients with Graves Disease, thyro toxicosis. Antithryoid medications are prescribed for clients who have an overactive thyroid or hyperthyroidism.

In hyperthyroidism….everything is HIGHHHHHHH(HYPERRRRRRRRR)

Clients that are prescribed this medication need to take radioactivity precautions.

Common Antithyroid Medications:

Propylthiouracil (PTU)

Thyroid-Radioactive Iodine (hyperthyroidism)

At high doses, thyroid radioactive iodine destroys thyroid cells. This drug is used for clients who have thyroid cancer and an over active thyroid (hyperthyroidism).

Thyroid-NonRadioactive Iodine (hyperthyroidism)

This medication creates a high level of iodine that will reduce iodine uptake by the thyroid gland. It inhibits the thyroid hormone production and blocks the release of thyroid hormones into the bloodstream.

This medication tastes nasty; has a metallic taste! Clients are to drink this medication through a straw to prevent tooth discoloration. Radioactivity precautions are not necessary due to this drug is nonradioactive.

Oral Hypoglycemic Agents

These medications promote insulin release from the pancreas. Clients who are prescribed oral hypoglycemic agents do not produce enough insulin to lower their blood glucose (blood sugar) levels. Prescribed for clients with type 2 Diabetes Mellitus.

Common Oral Hypoglycemic Agents:

glipizide ( Gluco trol, Gluco trol XL). See the form of glucose in the drug name?

chlorpropamide ( Diab ines). See the form of Diabetes in the drug name?

glyburide ( Diab inese, Micronase). See the form of Diabetes in the drug name?

metformin HCl ( Gluco phage). See the form of glucose in the drug name?

For Insulin Overdose

Common medication for insulin overdose: Gluc agon (see the form of glucose in the drug name?) Glucagon (or glucose) is needed to increase blood glucose or blood sugar.

Anterior Pituitary Hormones/Growth Hormones

These medications stimulate growth. Are used to treat growth hormone deficiencies.

Use cautiously in clients who have Diabetes Mellitus since these medications cause hyperglycemia because of the decreased use of glucose.

Common Anterior Pituitary Hormones/Growth Hormone Agents:

somatropin

somatrem (Protropin)

Posterior Pituitary Hormones/Antidiuretic Hormone

This medication promotes the reabsorption of water within the kidneys; causes vaso constriction due to the contraction of vascular smooth muscle.

Common Posterior Pituitary Hormones/Antidiuretic Hormones:

desmopressin (DDAVP, stimate)

vaso pressin (Pitressin synthetic) (See the form of vaso in the drug name, for vaso constriction)

Anticonvulsants

The anticonvulsants are medications used for the treatment of epileptic seizures.  These meds suppress the rapid and firing of neurons in the brain that start a seizure.

Drugs for all types of seizures, except petit mal:

CaPhe like cafe in French

CA rbamazepine

PHE nytoin/Phenobarbital

Drugs for petit mal seizures:

ValEt

Val proic Acid

Et hosuximide

Phenytoin: adverse effects

P - interactions

H irsutism

E nlarged gums

N ystagmus

Y ellow-browning of skin

T eratogenicity

O steomalacia

I nterference with B metabolism (hence anemia)

N europathies: vertigo, ataxia, headache

All antiepileptic drugs can be remembered by this mnemonic:

Dr.BHAISAB's New PC.

D ...Deoxy barbiturates

B ...Barbiturates

H ....Hydantoin

A ….Aliphatic carbon acids

I ....Iminostilbenes

S ....Succinimides

B ....Benzodiazepines (BZDs)

N ....Newer drugs

P ....Phenyltriazines

C ...Cyclic gaba analogues

 Antiparkinsonian

An antiparkinson, or antiparkinsonian medications are used for clients diagnosed with Parkinson’s Disease.

These medications increase dopamine activity or reduce acetylcholine activity in the brain. They do not halt the progression of the disease. These medications offer symptomatic relief.

Antiparkinsonian Drugs include: A Cat Does Like Milk!

A nticholinergic Agents

C OMT Inhibitors (catechol-O-methyltransferase); An enzyme involved in degrading neurotransmitters.

D opamine Agonists

L evodopa

M AO-B Inhibitors

Ophthalmic

Ophthalmic medications are drugs used for the eye.  These medications are typically prescribed for clients who have Glaucoma, Macular Degeneration. Other ophthalmic medications are used to treat allergic conjunctivitis, inflammatory disorders, dyes to visualize the eye, and to treat infections or viruses.

Beta-Adrenergic Blocking Agents

Prescribed for clients who have open-angle glaucoma. These agents decrease the production of aqueous humor. Block beta1 and beta2 receptors.

Common Beta-Adrenergic Ophthalmic Blocking Agents:

beta xolos ( Bet optic ) (see the form of beta in the drug names?) See optic in Betoptic? Opthalmic medication.

levo beta xolol ( Beta xon) (see the form of beta in the drug names?)

levobunolol ( Beta gan) (see the form of beta in the drug name?)

timolol ( Bet imol) (see the form of beta in the drug name?)

Prostaglandin Analogs

First line treatment for glaucoma. Fewer side effects and just as effective as the beta-adrenergic Ophthalmic blocking agents.

These drugs lower IOP by facilitating aqueous humor outflow by relaxing the ciliary muscle.

Common Prostaglandin Analogs:

latanoprost (Xal atan ) (see the suffix atan in this drug and the drug below, they are the same)

Travoprost (trav atan ) (see the suffix atan in this drug and the drug above; they are the same)

Alpha2-Adrenergic Agonists

These drugs lower IOP by reducing aqueous humor production and by increasing outflow. Also delays optic nerve degeneration and protects retinal neurons from death.

Common Alpha2-Adrenergic Agonists:

Brimon idine (Alphagan) (see the similarities with idine in the name of the drug)

Apraclon idine (Iop idine ) (see the similarities with idine in both of the names of the drug)

Direct Acting Cholinergic Agonist/Muscarinic Agonist (parasympathomimetic agent)

These drugs stimulate the cholinergic receptors in the eye, constricts the pupil (miosis), and contraction of the ciliary muscle. IOP is reduced by the tension generated by contracting the ciliary muscle and promotes widening of the spaces within the trabecular meshwork, thereby facilitating outflow of aqueous humor.

Common Direct Acting Cholinergic Agonist Agents:

Pilocarpine

Key points of ophthalmic medications:

· Cylo plegics are drugs that cause paralysis of the ciliary muscle…plegic-like paraplegic, paralysis

· Mydriatics are drugs that dilate the pupil.

· Drug therapy for glaucoma is directed at reducing elevated IOP, by increasing aqueous humor outflow or decreasing aqueous humor production.

· Oculus Dexter: OD (right eye)

· Oculus Sinister: OS (left eye)

· Oculus Uterque: OU (both eyes)

Remember BAD POCC: Ophthalmic Medication Classes for treatment of Glaucoma

B -beta adrenergic blocking agents

A -Alpha-Adrenergic Agonists

D -Direct Acting Cholinergic Agonists

P -Prostaglandin Analogs

O -Osmotic Agents

C -Carbonic Anhydrase Inhibitors

C -Cholinesterase Inhibitor; An indirect acting Cholinergic Agonist

Remember BAD POCC for key points or side effects of Opthalmic Medications:

B -Blurred vision

A -Angle closure glaucoma (medications are used for this kind of glaucoma)

D -Dry eyes

P -Photophobia

O -Ocular pressure (used to treat OP from glaucoma)

C -Can Cause systemic effects

C -Ciliary muscle constriction

Reference: Lehne, R. A. (2007).Pharmacology for nursing care (6^th ed.). St. Louis: Saunders.

Web Tip of the Week:

A great Immunization case study available on the web – check it out!

http://www.wisc-online.com/objects/viewobject.aspx?id=nur1703