Review of Maternal-Infant Nursing

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Review of Maternal-Infant Nursing

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• 2006-4-27

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Trends in Maternal-Infant Nursing Care

• Development standard of care, certification,
  advanced practice nurses
• Home Health care for postpartum women, discharge
  from Hops. 12-24 hours after delivery, high risk
  infants discharge home earlier than before
• Consumer involved in the childbearing care Child
  birth class, sibling present, breast-feeding,
  birthing environment (LDR, LDRP), fathers
  involvement, parents leave option for family with
  newborn

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Maternal Nursing concerns areas

• Prenatal care
• Low birth weight
• Mother and infant with HIV infection
• Adolescent pregnancy
• Drug and substance abuse during pregnancy
• Social/family stress and impacts to pregnant
  women and family
• Use and care for pregnant women

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Special Issues in Womens Health

• Violence
• Sexual Transmitted Diseases HIV/AIDS
• 86 of pediatric AIDS cases are transmitted
  through vertical transmission of HIV
• Substance abuse
• Other diseases Heart diseases, cancer,
  osteoporosis, eating disorders

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The Menstrual Cycle

• Ovarian Cycle
• 1. Follicular phase stimulated with FSH to
  promote the development of follicles
• Estrogen-follicle mature-negative feedback
  to hypothalamus and anterior pituitary gland
  inhibiting FSH secretion
• 2. Ovulation increase in body temperature
  (progesterone secretion), fern pattern of the
  cervical mucus, spinnbarkeit elasticity of the
  ovulatorydue to secretion of the estrogen

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The Menstrual Cycle

• 3.Luteal Phase Corpus luteum and anterior
  pituitary gland will secret luteinizing hormones
  (the decrease in Estrogen and progesterone
  positive feedback to Hypothalamus and anterior
  pituitary- stimulating the secretion of FSH
• 4. Premenstrual phase Decline in estrogen and
  progesterone

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The Menstrual Cycle

• Endometrial Cycle
• Proliferative phase
• Secretary phase
• Menstrual phase

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Question

• FSH stimulates which processes in the menstrual
  Cycle?
• Thinking of endometrium
• Maturation of follicle
• Decrease in basal body temperature
• Increase in progesterone production

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Infertility Care

• Infertility affects 15-20 of the populations in
  the reproductive yearsTerms to be understood
• Artificial insemination
• Endometriosis
• Laparoscopy
• Primary Infertility
• Secondary Infertility
• Varicocele
• Endometriosis

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Terms related to Infertility Treatment

• In vitro Fertilization/embryo Transfer
• Gamete intrafallopian tube transfer (GIFT)
• Zygote Intrafallopian Transfer (ZIFT)
• Testing of infertility
• Ovulatory Analysis
• Sperm Analysis
• Testing of STDS
• Tubal Patency test

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Question

• In which phase of the menstrual cycle is thick,
  scant cervical mucus and an elevated BBT seen?
• Estrogenic phase
• Menstrual Phase
• Ovulatory phase
• Luteal Phase

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Names of the infertility drugs

• Clomiphene Clomid-risk of multiple ovulation
• hCG to facilitate the ovulation , side effect
  ovarian over-stimulation
• hMG Menotropin Human Menopausal gonadotropin
• Danazol suppresses ovulation and secretion of
  FSH and Luteinizing hormone to inactive ectopic
  endometrial tissue. Side effect-Wt gain, hot
  flashes, decreased breast size, vaginitis

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Nursing care for infertile couple

• Identify problems and strengths
• Self-esteem disturbance related to diagnosis
• Personal Identity disturbance, related to
  unsuccessful infertility treatment
• Ineffective family coping, compromised live and
  decision making
• Nurse supporter, advocate, counseling,

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Pregnancy Termination

• Legal/ethical Decision making dilemmas
• Counseling regarding pregnancy termination
• Psychological impact of pregnancy termination
• Risk and complication associated
• Grief/guilt/ambivalence/uncertainty feeling after
  terminating of pregnancy

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Sexually Transmitted Diseases

• Chamydia trachmatis infection
• Gonorrhea
• Human Papillomavirus
• Herpes Simplex Virus type 2 infection
• Cytomegalovirus infection
• Syphilis
• Vaginitis
• Human Immunodeficiency Virus Infection

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Quesiton

• Women should be taught to be aware of early
  warning signs of HIV infection which are
• Dyspareunia
• Severe dysmenorrhea
• Occasional Candida infection
• Recurrent episodes of genital warts

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Question

• The purpose of taking Tamoxifen after a
  mastectomy is to
• Alleviate cancer pain
• Act as hormonal replacement therapy
• Block tissue uptake and utilization of estrogen
• Destroy any stray cancer cells in remaining
  breast tissue

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Family System Changes During The Childbearing
Cycle

• Structure
• Power
• Boundaries
• Affect or feelings
• Intergenerational patterns and roles
• Communication patterns
• Cultural background and riturals

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Bonding and Attachement

• Bonding is affected by Maternal-Sensitive period.
• Attachment is developed through out the first
  year of life.
• Important for nursing practice do not make
  inaccurate judgment, understand that childbearing
  is a major transition I the life of a family

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Nursing intervention for the three Phases of
crisis

• Precrisis Predictable and development events in
  the life cycle
• Discuss change with family structure, adding new
  member
• Assess risk factors, past coping and problem
  solving
• Implement health teaching
• Implement health promotion and maintenance
  strategies

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Nursing intervention for the three Phases of
crisis

• Crisis Coping strategies not sufficient to deal
  with changes in family structure and problem in
  development
• Clarify the problem
• Assist the family in going an understanding of
  the situation
• Acceptance of the family
• Use appropriate interpersonal and institutional
  resources
• Assess family to express feeling ways of
  solving problem

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Nursing intervention for the three Phases of
crisis

• Postcrisis Crisis has been resolved, leading to
  a higher, the same, or lower of family function
• Support the family in its new strategies of
  resolution
• Emphasize growth potential in solutions
• Attempt to reverse or lessen effects of
  maladaptation through appropriate rehabilitative
  effort or therapy

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Psychosocial aspects of childbearing Theories

• 1. Psychosocial Change in the mother Accepting
  the pregnancy
• Symbolic meaning of the pregnancy
• Self-image and body image during pregnancy

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Psychosocial aspects of childbearing Theories

• 2. Role Assumption and maternal Adaptation
• Maternal Identity
• Maternal role attainment Motivation for
  motherhood, preparation for motherhood, conflict
  resolution, maternal attachment behavior,
  relationship with mother
• Role conflict and attainment of the maternal role

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Role conflict and attainment of the maternal role

• Inability to achieve the good Motherrole
• Lack of knowledge and preparation for the
  maternal role
• Establishing a relationship with the fetus

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Maternal Ambivalence in Pregnancy

• No questions asked about pregnancy, labor and
  delivery, infant care
• No interest in fetus
• Past negative experience with pregnancy or labor
  and delivery
• Denial of pregnancy and fetal movement
• Pregnancy and parenthood interfering with life
  style
• Continue activities that may hurt the fetus
  (smoking or drinking)
• Reporting persistent and many physical complains.
  

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Rh Immunization

• Check by Indirect Coombs test to detect
  antibodies in the serum that target red blood
  antigens to cause fetus hemolysis
• Antibody titer gt 116 indicates possibility of
  severe hemolytic diseases
• Mother with Rh-negative should receive Rhogam
  within 72 hours (any invasive procedure that may
  cause the mixing of the maternal blood with fetus)

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Psychosocial aspects of childbearing Theories

• 3. Psychosocial Change in the father
• Development of the father role
• Participation in the childbearing cycle
• Father-infant interactions and the father role
• The Couvade Syndrome-bodily symptoms
  experienced by a father during the course of his
  partners pregnancy.
• 4. Psychosocial Change in Sibling view

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Adaptation to Pregnancy

• Key terms
• Acquaintance
• Ambivalence
• Attachment
• Avoidance
• Bonding

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• Mrs. H. 33 wks shared that her husband was afraid
  of harming the unborn baby during intercourse.
  Which is the best response of the nurse?
• Gentle vaginal intercourse is safe throughout
  pregnancy
• each couple has a unique situation, bring your
  husband in for a talk with the doctor
• The baby is well protected by your tissues, but
  if contractions occur, abstain and notify the
  doctor
• vaginal Penetration is prohibited anyway during
  the last month of pregnancy because of the
  dangers of infection
• 
  3

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• When teaching prospective fathers about pregnancy
  and birth, the nurse should plan to include which
  priority information?
• The possible difficulties in each trimester
• The cost of caring and raising a child
• The normal range of feeling that may experienced
  in different stages of pregnancy
• The importance of his role in the act of
  conception and in the determination of the sex of
  the fetus.
• 3

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Pregnancy and weight gain

• First Trimester 2-4 pounds (0.9-1.8 kg), 1 pound
  per week (0.45 kg) during 1st 2nd trimester
• Total weight gain 13.18 kg or 29 pounds

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Pregnancy and Nutrition

• Obesity recommend to gain wt 7-11.5 kg
• Underweight
• Teenage pregnancy low wt gain during pregnancy,
  associated with LBW infant
• 19 of the baby wt lt 2000 gram
• decrease 7.4 of LWB infant if wt gain
  improve to 11kg (25 lbs).
• Frequent meal skipping and consumption of
  fast food (high salt, sugar, low vit and minerals)

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Risk of Obesity to pregnancy

• Gestational diabetes
• Urinary tract infections
• Inadequate weight gain
• Wound infection
• Thromboembolism
• PIH
• Fetal monitoring difficulty
• Prolonged labor
• Fetal Macrosomia
• Birth trauma

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Question-Nutrition

• In comparison with a single fetus pregnancy,
  nutrition needs when there are twins much
  include
• Increased calorie intake of 300 per fetus each
  day
• Low-salt foods to prevent edema
• Additional fluid intake of 2-3 glasses per day
• Iron and folic acid needs for 10 more per day

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Warning Signs in Pregnancy

• Headache
• Altered vision blurring, double vision, seeing
  spots
• Nausea/vomiting
• Epigastric pain/abdominal pain
• Muscular irritability/seizures
• Signs of infectionfever, burning in urination,
  flank pain, diarrhea,
• Vaginal bleeding
• Decrease or cessation of fetal movement

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Assessment for Neural Tube Defects

• open neural tube defects leak alpha-fetoprotein
  (AFP)
• Elevate AFP level in maternal serum and amniotic
  fluid may indicate the fetus has neural tube
  defects

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Amniocentesis

• Performed around 15-18 weeks of gestation to
  identify genetic abnormality
• Risk
• Trauma to the fetus, placenta, umbilical cord, or
  maternal structures
• Infection
• Premature labor and spontaneous abortion

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Amniocentesis

• Warning signs after receiving amniocentesis
• Body temperature elevation
• Fluid leaking from the vaginal
• Mild Cramping and abdominal aching
• Decreased fetal movement

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Chorionic Villus Sampling

• To detect genetic or chromosomal defects
• Can be done in early pregnancy 9-10 weeks
  gestation
• Risk miscarriage 3.7-7.7, 1.7 discrepancy of
  result between villus karyotype and fetus,
  rupture amniotic sac, chorioamnionitis,
  oligohydramnios, intrauterine growth retardation

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The Nonstress test

• Check fetus well-being
• Check fetal movement in relation to fetal heart
  rate acceleration
• Reactive HR acceleration with fetus movement
• Non reactive no HR acceleration with fetus
  movement

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Genetic Problem

• Autosomal Recessive Disorders 25 of the
• Risk of passing the disorder to each of their
  offspring. 14 chance of demonstrating the
  disorder, 50 change of being a carrier to the
  recessive trait, each child has 25 chances of
  not having the diseases and not being a carrier
• -Cystic fibrosis, PKU, Sickle cell anemia,
• -X-linked disorders Hemophilia, color blindness,
  G6PD

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Nursing and family with Genetic disorders

• Perform Karyotype examination
• Genetic Counseling-support for decision making
• Genetic screen for potential risk

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Assisting the client to cope with First-Trimester
Discomforts

• Nausea/vomiting-morning sickness
• Ptyalism excess saliva in the mouth
• Altered taste
• Bleeding gums
• Breast tenderness
• Urinary frequency
• Nasal stuffiness and Epistaxis
• Increased vaginal secretion
• Fatigue

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Ensure Safety and removing barriers to care

• Promoting client safety home, work, lifestyle,
  environment, danger/warning signs of pregnancy
• Removing barriers Social Economic factors, lack
  of insurance, inability to pay, lack of free
  prenatal service, limit access to prenatal care
  for economically poor women, limited or
  expensive transportation, small children,
  cultural

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Psychologic changes and concerns of a mother at
2nd Trimester

• Aware of that the pregnancy can be recognized by
  others
• Acceptance of pregnancy
• Maternal role attainment fetus movement fosters
  internalization and fantasy
• Fantasies binding to infants
• Relationship with mother
• Body image begins to view fetus as separate form
  own body, change the perception of body boundary
  as protective barrier to fetus

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Question

• The nurse should assess for which developmental
  task of the pregnant women in her third
  trimester?
• Bonding to the fetus in preparation for birth
• Accepting the fetus as a wanted responsibility
• Understanding the baby is an independent being
• Preparing to separate from the fetus through the
  birth process

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Question-DM mother

• The nurse teaches the newly pregnant diabetic the
  importance of self glucose monitoring in the
  first trimester to prevent
• Hypoxia in the fetus
• The onset of diabetes in fetus
• Unusually large fetal development
• Teratogenic effects of hyperglycemia

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Question- Preterm Labor

• Magnesium Sulfate may be prescribed as a
  tocolytic drug because one of the expected
  actions is
• Promoting diuresis
• Lowering blood pressure
• Inducing sedation and rest
• Promoting smooth muscle relaxation

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Pain during labor

• Analgesia demerol (meperidine)
• Sedative Seconal and Nembutal
• Narcotic analgesics Fentanyl, Stabol
• Anesthesia Marcaine (Bupavacaine) Alfenta
  (Alfentani)

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Epidural Block

• Give to women in 2-4 cm Cx dilation
• Giving anesthesiologist into epidual space at
  L-2, L-3, L-4 or L-5
• Provide pain relief in lower part of body
• Labor stimulation by Oxytocin may need
• Prevent Hypotensive effect (500-1000 ml Lactated
  Ringers)
• Monitoring uterus contraction and fetus condition

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Side Effects of Epidural Analgesia

• Respiratory depression in newborn (Narcan)
• Pruitus (itching)
• Nausea and vomiting
• Urinary retention
• Hypotensive
• Affect labor process, unable to push during
  second stage of labor (assessment important)

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Question

• A Client has received an effective dose of
  epidural anesthesia. The IV rate is 250 ml/hour
  and position is semi-Fowlers. Her blood
  pressure has dropped significantly. The first
  nursing intervention is to
• Slow the rate of IV infusion to avoid overload
• Retake the BP, initial hypotension is expected
• Begin oxygen by face mask, lower head, elevate
  legs.
• Call back anesthesiologist to deal with the
  condition

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Induction or Augmentation of Labor

• Induction starting labor artificially by
  oxytocin
• Augmentation stimulation of labor once it has
  begun naturally.
• Amniotomy color of the amniotic fluid
• Assess risk frequency of contraction, maternal
  tolerance, pain, fetus well-being, discomfort,
  progress of labor, complication

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Lamaze Technique Question

• The nurse teaching the Lamaze technique evaluates
  her success when the couple do the following
• Break the fear/tension/pain cycle
• Bond successfully with the newborn
• Use positive feedback with each other during
  labor
• Maintain control during labor by their techniques
  of breathing and relaxation

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Question (pain and childbirth class)

• In developing childbirth classes the nurse plans
  to include techniques that normally minimize pain
  perception, which of these are inappropriate?
• Using muscle relaxation methods
• Invalidating the perception of pain
• Refocusing attention on another subject
• Implementing anxiety reduction techniques

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• In developing childbirth classes the nurse plans
  t include techniques that normally minimize pain
  perception, which of these are inappropriate?
• Using muscle relaxation methods
• Invalidating the pain perception
• Refocusing attention on another subject
• Implementing anxiety reduction techniques

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Vaginal Birth After Cesarean Section (VBAC)

• Repeat CS in USA 80
• Fear of weakening the uterine scare
• Twice Maternal Risk in C/S than in Vaginal birth
• Qualification primary cesarean not due to pelvic
  factors. Classic uterine incision???
• Support of staff and womens desire to have
  vaginal birth are optimal factor for trying VBAC

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Question

• When membranes rupture spontaneously during
  labor, the nurse at the bedside must immediately
  
• Monitor fetal heart rate
• Change the bed ped and give peri care
• Increase the flow rate of intravenous fluid
• Report the color and consistency of the fluid

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Question

• During labor, while lying supine in bed, Millie
  M. States she feels dizzy and weak, vital signs
  show an elevated pulse and lowered BP, the nurse
  should first
• Notify the physician
• Check for vaginal bleeding
• Apply oxygen by mask at 10 L/min
• Rotate her to the left side-lying position

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Question

• Five hours prior to arriving at the DR, your
  clients amniotic membranes ruptured, which is a
  priority in the nursing planning?
• Monitoring urinary output hourly
• Providing frequent perineal care
• Increasing fluid intake intravenously
• Assessing temperature at least every 2 hours

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Question

• During transitional labor, when the fetal heart
  rate tracing shows a drop of 50 beats for 20
  seconds and the rate returns to baseline, which
  is the first nursing action?
• Call for physician at once
• Turn client toward the left lateral position
• Position client to relieve pressure on the cord
• Do nothing, continue to observe since there is a
  rapid return to baseline

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Postpartum Lactation

• Colostrum contain Immunoglobulins G and A (Ig G,
  Ig A) to protect newborns gastrointestinal
  System
• Secretion stage prolactin hormone
• Let-down reflex Neurohormonal Reflex primary
  responds to infants sucking, posterior pituitary
  gland secretes oxytocin.

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Question hypoglycemia newborn

• Which would indicate to the nurse that the
  newborn may be hypoglycemic?
• Hyperthemia with flushed skin
• Residual tremors after movement
• Vigorous sucking on nipple or on fist
• Frequent loose stools

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Please Keep your good work and study hard,
maternal-infant nursing is an interesting subject
for you to learn!