Metabolism
Test to determine RH+ antibodies in maternal blood
When to treat & with what??
Indirect coombs- RH+ antibodies in MOTHER's blood
Direct coombs- antibody coated RBC's in BABY's blood
If Rh- and NOT sensitized (ie indirect is NEGATIVE), give RhoGam (300 mg IM). If sensitized RG will not treat
s/s Previa, nursing considerations
painless bright red bleeding
rest, possibly bedrest. nothing in vaginal. c/s. NSTs
mastitis s/s & interventions
s/s-unilateral breast/nipple pain, erythema, palpable mass, fever, malaise
interventions- heat, empty affected breast (pump, HE, BF), analgesics, ABX, massage, rest, hydration, comfortable bra
risks for perinatal asphyxia
anything that causes inadequate blood flow placental and/or ultimately to fetus- cord- knot, prolapse, nuchal. Placental abruption (HTN, smoking, SUD), uterine rupture, post-dates, NRFHR, impaired maternal oxygenation or perfusion, hemorrhage, IDM, prolonged labor, anemia
TTN- patho , risks, tx
inability to clear fluids at birth- hi resp rate
risks- c/s, lack of labor, IDM, male, low birth weight, polyhydramnios
usually not seem immediately at birth (may take 1-2 hrs)- support, O2 (less than 40% usually)- clears on own by 72 hours or less as fluids reabsorbed. May not orally feed during time of inc respirations
GDM interventions
check BG (usually 4x daily), diet, exercise, medications (ie SQ insulin, metformin) if diet doesn't control. Increased surveillance, NSTs, maintain fasting less than 92,
s/s GTD (molar pregnancy), nursing teaching
higher than expected fundal height, high HCG levels, N/V/Hyperemesis, prune/chunky bleeding,
don't get pregnant for 1 year
risk factors for puerperal infections
obesity, anemia, DM, malnutrition, smoking, SUD, PROM/PPROM, invasive procedures (internal monitoring, AROM, c/s, foley, instrumental delivery), adolescence, other infections, retained POC
affects of too much O2 on newborn
Retinopathy of prematurity, nuero defects, childhood cancers
BB- normal, expected, mood swings up to 2 weeks, weapiness- usually self resolves
PPD- post partum depression- can develop up to 12 months after delivery, feeling unable to care for self or baby, lack of interest in things normally enjoyed, possibly thoughts of self-harm (or to others)
PP psychosis- changing levels of consciousness, delusions, hallucinations, agitation
this NB complication may begin before 24 hour or peak above 12.5
pathological jaundice/hyperbilirubinemia
s/s abruption & nursing considerations
painful bleeding, may be brown
monitor baby ASAP/place on EFM
what GBS can cause in NB, how to prevent
neonatal sepsis, penicillin during labor
cause of RDS, who's at risk, and tx
lack of surfactant (ground glass appearance)
IDM, preterm
supportive care, mechanical ventilation, O2, O2 sats monitoring, NTE, exogenous surfactant to NB, steroids to mother if suspect PTC,
s/s ectopic pregnancy & medication
sharp one sided abdominal pain, referred shoulder pain, dizziness (internal bleeding, maybe some external)
methotrexate
maternal & infant risks r/t DM
maternal- t2DM, hydramnios, Spon Ab, Shoulder Dys, PPH, infections, PTL, CS/instrumentation, Anemia, Ketoacidos
infant- macrosomia, IUGR, birth injuries (periferal nerves, brachial plexus etc), respiratory, congenital defects, hypoglycemia, polycythemia, hyperbilirubinemia
s/s of worsening cardiac conditions
auscultate rales, cough, SOB, leg swelling, fatigue, chest pain
nursing considerations pt w/HIV & NB care
screen@first visit, test and maintain low viral load (c/s if high), ART medications (including during labor), increased PNC, NSTs, monitor for worsening s/s
NB- bath as soon as stable, thoroughly clean site before meds, ART for 6 weeks. Feeding considerations
MAS- who's at risk?
Expected interventions?
term/post term who experience distress in utero, SGA, IDM. May cause chemical pnuemitis, hear coarse breath sounds
IF NOT VIGOROUS- surfactant (mec inactivates, insulin inhibits production), HIGH levels of O2, hi feq ventilation, inhaled nitric oxide, hydrocortisone, supportive tx
NAS- who's at risk? environment? s/s? meds?
infants of mother's who used opiates, some SSRI's, illicit drugs during pregnancy
quiet, low lights, low stimulus
vomiting, loose stools, poor feeding, inability to sooth or sleep, fever, tachycardia, rigidity, seizures
meds- if neccessary, morphine
Nursing care for infant under phototherapy
cover eyes, assess hydration (I's & O's), rotate q2, frequent feeds, frequent VS, observe jaundice
s/s of mag toxicity, therapeutic level
loss of DTRs, respiratory depression, LOC confusion and lethargy
4-7/8
risks for preterm NB
immature immune system- inadequate surfactant- persistent fetal circulation- hypothermia- intraventricular hemorrhage - weakened reflexes- feeding difficulties- hyperbilirubinemia- altered skin integrity - fluid electrolyte imbalances
NRP
neonatal resuscitation- starts w/PPV usually, if need to give compressions (HR less than 60), 3:1 compressions to breaths- goal is HR > 100
Preeclampsia s/s
elevated BP (140/90, severe 160/110), severe HA, swelling in hands and face, right sided epigastric pain, fluid in lungs auscultated, hyper-reflexivity, clonus