MATERNAL & CHILD NURSING BULLETS (NLE & NCLEX) NCLEX TIPS DO NOT delegate what you can

n EAT! E - evaluate A - assess T teach When getting to two answers, choose the assessment answer (assess,collect, auscultate, monitor, palpate) over the intervention except in anemergency or distress situation. If one answer has an absolute, discard it. Give priority to answers that deal directly to the pts body, not the machines/equipments. Key words are very important. Avoid answers w/ absolutes for example: always, never, must, etc. Assessment, teaching, meds, evaluation, unstable pt cannot be delegated to an Unlicensed Assistive Personnel. LVN/LPN cannot handle blood. IV push should go over at least 2 minutes. If the pt is not a child an answer w/ family option can be ruled out easily. In an emergency, patients w/ greater chance to live are treated first Use Cold for acute pain (eg. Sprain ankle) & Heat for chronic (rheumatoid arthritis) Guided imagery is great for chronic pain. When pt is in distress, medication administration is rarely a good choice. Always check for allergies before administering antibiotics (especiall PCN). Make sure culture & sensitivity has been done before adm first dose of antibiotic. Do not use why or I understand statement when dealing w/ patients Anytime you see fluid retention. Think heart problemsfirst. An answer that delays care or treatment is ALWAYS wrong When choosing an answer, think in this manner if you can only do ONLY one thing to help this pt what would it be? Pick the most important intervention. Answers are the exact opposite, like bradycardia or tachycardia... one is probably the answer. If two or three answers are similar or are alike, none is correct. When asking patients questions NEVER use why questions. Eliminate all why? answer options. If you have never heard of it please dont pick it! Always deal w/ actual problems or harm before potential problems Always select a pt focused answer. An answer option that states "reassess in 15 minutes" is probably wrong. A guy loses his house in a fire. Priority is using community resources to find shelter, before assisting w/ feelings about the tremendous loss.

Dont fall for reestablishing a normal bowel pattern as a priority w/ small bowel obstruction.
1 t (teaspoon)= 5 ml 1 T(tablespoon)= 3 t = 15 ml 1 oz= 30 ml 1 cup= 8 oz 1 quart= 2 pints 1 pint= 2 cups

1 gr (grain)= 60 mg 1 g (gram)= 1000 mg 1 kg= 2.2 lbs 1 lb= 16 oz Interpersonal model (Sullivan) Behavior motivated by need to avoid anxiety & satisfy needs 1. Infancy 0-18 months others will satisy needs 2. childhood >6yrs learn to delay need gratification 3. juvenile 6-9 years learn to relate to peers 4. preadolescence 9-12 yrs learns to relate to friends of of opposite sex 5. early adolescence12-14yrs:learn independence & how to relate to opposite sex 6. late adolecence 14-21yrs: develop intimate relationship w/ person of opposite sex Developmental 2-3 months: turns head side to side 4-5 months: grasps, switch & roll 6-7 months: sit at 6 & waves bye-bye 8-9 months: stands straight at eight 10-11 months: belly to butt (phrase has 10 letters) 12-13 months: twelve & , drink from a cup

What is an intraosseous infusion? In pediatric life-threatening emergencies, when iv access cannot be obtained, an osseous (bone)

needle is hand-drilled into a bone (usually the tibia), where crystalloids, colloids, blood products & drugs can be administered into the marrow. It is a temporary, life-saving measure, When venous access is achieved it can be d/cd. One medication that cannot be administered by intraosseous infusion is isoproterenol, a beta agonist

Apgar measures HR,RR,Muscle tone, Reflexes,Skin color each 0-2 point. 8-10 OK. 0-3 RESUSCITATE.
A= appearance (color all pink, pink & blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent)

Have trouble remembering fhr patterns in OB? Think VEAL CHOP VC EH AO LP V = variable decels; C = cord compression caused E = early decels; H = head compression caused A = accels; O = okay, not a problem! L = late decels = P=lacental insufficiency, can't fill Which was dangerous when you're pregnant; regular measles (rubeola), or German measles (rubella), so remember: -never get pregnant w/ a German (rubella) If the baby is a posterior presentation, the sounds are heard at the sides. If the baby is anterior, the sounds are heard closer to midline, between the umbilicus & where you would listen to a posterior presentation. If the baby is breech, the sounds are in the fundus near the umbilicus. If the baby is vertex, they are a little bit above the symphysis pubis. School-age kids (5 & ) are old enough, & should have an explanation of what will happen a week before surgery such as tonsillectomy. If you gave a toddler a choice about taking medicine & he says no, you should leave the room & come back in five minutes, b/c to a toddler it is another episode. Next time, dont ask.

The first sign of pyloric stenosis in a baby is mild vomiting that progresses to projectile vomiting. Later you may be able to palpate a mass, the baby will seem hungry often, & may spit after feedings. A child w/ a ventriculoperitoneal shunt will have a small upper-abdominal incision. This is where the shunt is guided into the abdominal cavity, & tunneled under the skin to the ventricles. You should watch for abdominal distention, since fluid from the ventricles will be redirected to the peritoneum. You should also watch for signs of increasing intracranial pressure,s uch as irritability, bulging fontanels, & -pitched cry in an infant. In a toddler watch lack of appetite & headache. Careful on a bed position question! Bed-position after shunt placement is flat, so fluid doesnt reduce too rapidly. If you see s/s of increasing icp, then raise the hob to 15-30 degrees. What could cause bronchopulmonary dysplasia? Dysplasia means abnormality or alteration. Mechanical ventilation can cause it. Premature newborns w/ immature lungs are ventilated & over time it damages the lungs. Other causes could be infection, pneumonia, or other conditions that cause inflammation or scarring It is essential to maintain nasal patency w/ children < 1 yr. b/c they are obligatory nasal breathers. Watch out for questions suggesting a child drinks more than 3-4 cups of milk each day. (Milks good, right?) Too much milk reduces intake of other essential nutrients, especially iron. Watch for anemia w/ milkaholics. & dont let that mother put anything but water in that kids bottle during naps/over-night. Juice or milk will rot that kids teeth right out of his head. What traction is used in a school-age kid w/ a femur or tibial fracture w/ extensive skin damage? A pin is placed in the distal part of the broken bone, & the lower extremity is in a boot cast. The rest is the normal pulleys & ropes youre used to visualizing w/ balanced suspension. While were talking about traction, a kids hinder should clear the bed when in Bryants traction (also used for femurs & congenial hip for young kids). If you can remove the white patches from the mouth of a baby it is just formula. If you cant, its candidiasis. Just know the MMR & Varicella immunizations come later (15 months). Undescended testis or cryptorchidism is a known risk factor for testicular cancer later in life. Start teaching boys testicular self exam around 12, b/c most cases occur during adolescence. No aspirin w/ kids b/c it is associated w/ Reyes Syndrome, & also no nsaids such as ibuprofen. Give Tylenol. It is always the correct answer to report suspected cases of child abuse. Feed upright to avoid otitis media. Position prone w hob elevated w/ gerd. In almost every other case, though, you better lay that kid on his back (Back To Sleep - SIDS). Pull pinna & back for kids < 3 yrs. when instilling eardrops. Kids w/ RSV; no contact lenses or pregnant nurses in rooms where ribavirin is being administered by hoot, tent, etc. Positioning w/ pneumonia lay on the affected side to splint & reduce pain. But if you are trying to reduce congestion the sick lung goes . A positive ppd confirms infection, not just exposure. A sputum test will confirm active disease. Coughing w/o other s/s is suggestive of asthma. Speaking of asthma, watch out if your wheezer stops wheezing. It could mean he is worsening. Before administering that dig. (apical pulse for one full minute). Group-a strep precedes rheumatic fever. Chorea is part of this sickness (grimacing, sudden body movements, etc.) & it embarrasses kids. They have joint pain. Watch for elevated antistreptolysin O to be elevated. Penicillin! Dont pick cough over tachycardia for signs of chf in an infant. Birth weight doubles by 6 month & triple by 1 year of age. If HR is <100 do not give dig to children.

First sign of cystic fibrosis may be meconium ileus at birth. Baby is inconsolable, do not eat, not passing meconium. Placenta should be in upper part of uterus Eclampsia is seizure. A pt w/ a vertical c-section surgery will more likely have another c-section. Perform amniocentesis before 20 weeks gestation to check for cardiac & pulmonary abnormalities. Rh- mothers receive rhogam to protect next baby. Anterior fontanelle closes by 18 months. Posterior 6 to 8 weeks. Caput succedaneum= diffuse edema of the fetal scalp that crosses the suture lines. Swelling reabsorbs within 1 to 3 days. Pathological jaundice= occurs before 24hrs & last7 days. Physiological jaundice occurs after 24 hours. Placenta previa = there is no pain, there is bleeding. Placenta abruption = pain, but no bleeding. Bethamethasone (celestone)=surfactant. Med for lung expansion. Dystocia= baby cannot make it to canal Pitocin med used for uterine stimulation Magnesium sulfate(used to halt preterm labor) is contraindicated if deep tendon reflexes are ineffective. If pt experiences seizure during magnesium adm. Get the baby out stat (emergency). For cord compression, place the mother in the TRENDELENBERG position b/c this removes pressure of the presenting part off the cord. (If her head is , the baby is no longer being pulled out of hte body by gravity) If the cord is prolapsed, cover it w/ sterile saline gauze to prevent drying of the cord & to minimize infection. For late decels, turn the mother to her left side, to allow more blood flow to the placenta. For any kind of bad fetal heart rate pattern, you give O2, often by mask... When doing an epidural anesthesia hydration before hand is a priority. Hypotension & bradypnea / bradycardia are major risks & emergencies. NEVER check the monitor or a machine as a first action. Always assess the pt first; for example listen to the fetal heart tones w/ a stethoscope in NCLEX land. Sometimes it's hard to tell who to check on first, the mother or the baby; it's usually easy to tell the right answer if the mother or baby involves a machine. If you're not sure who to check first, & one of the choices involves the machine, that's the wrong answer. Best way to warm a newborn: skin to skin contact covered w/ a blanket on mom. When a pt comes in & she is in active labor...RN first action is to listen to fetal heart tone/rate Diaphragm must stay in place 6 hours after intercourse. They are also fitted so must be refitted if you lose or gain a significant amount of weight. Guthrie Test Tests for PKU, baby should have eaten source of protein first Amniotic fluid yellow w/ particles = meconium stained Rhogam : given at 28 weeks, 72 hours post partum, IM. Only given to Rh NEGATIVE mother. Also if indirect Coombs test is positive, dont need to give Rhogam cuz she has antibody only give if negative coombs

4 year old kids cannot interpret TIME. Need to explain time in relationship to a known COMMON EVENT (eg: "Mom will be back after supper"). If kid has cold, can still give immunizations Stranger anxiety is greatest 7 - 9 months, Separation anxiety peaks in toddlerhood Age 4 to 5 yrs child needs DPT/MMR/OPV Placental abruptio: bleeding w/ pain, don't forget to monitor volume status (I&O) An ill child regresses in behaviors Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability, fetal bradycardia, etc) - turn on left side (& give O2, stop Pitocin, IV fluids During Epidural Puncture --> side-lying Prolapsed Cord --> knee-chest position or Trendelenburg Infant w/ Cleft Lip --> position on back or in infant seat to prevent trauma to suture line. While feeding, hold in upright position. Fetal alcohol syndrome -upturned nose, flat nasal bridge,thin upper lip,SGA vastus lateralis is IM administration site for infants, toddlers above 18 months ventrogluteal ,The deltoid & gluteus maximus are for children

A classic difference between abruptio placentae & placenta previav is the degree of pain. Abruptio placentae causes pain, whereas placenta previa causes painless bleeding. A contributing factor in dependent edema in the pregnant pt isv the of femoral venous pressure from 10 mm Hg (normal) to 18 mm Hg (). A multipara is a woman who has had two or more pregnancies thatv progressed to viability, regardless of whether the offspring were alive at birth. A nonstress test is considered nonreactive (positive) if fewer thanv two fetal heart rate accelerations of at least 15 beats/minute occur in 20 minutes. A nonstress test is considered reactive (negative) if two or morev fetal heart rate accelerations of 15 beats/minute above baseline occur in 20 minutes. A nonstress test is usually performed to assess fetal well-being in av pregnant pt w/ a prolonged pregnancy (42 weeks or more), diabetes, a history of poor pregnancy outcomes, or pregnancy-induced hypertension. A pt who has premature rupture of the membranes is atv significant risk for infection if labor doesnt begin within 24 hours. A pt w/ a ruptured ectopic pregnancy commonly has sharp painv in the lower abdomen, w/ spotting & cramping. She may have abdominal rigidity; rapid, shallow respirations; tachycardia; & shock. A pt w/ a ruptured ectopic pregnancy commonly has sharp painv in the lower abdomen, w/ spotting & cramping. She may have abdominal rigidity; rapid, shallow respirations; tachycardia; & shock. A postpartum pt may resume sexual intercourse after the perinealv or uterine wounds heal (usually within 4 weeks after delivery). A pregnant pt normally gains 2 to 5 lb (1 to 2.5 kg) during thev first trimester & slightly less than 1 lb (0.5 kg) per week during the last two trimesters. A pregnant pt who has had rupture of the membranes or who isv experiencing vaginal bleeding shouldnt engage in sexual intercourse.

A pregnant staff member shouldnt be assigned to work w/ a patientv who has cytomegalovirus infection b/c the virus can be transmitted to the fetus. A pregnant womans partner should avoid introducing air into thev vagina during oral sex b/c of the possibility of air embolism. A probable sign of pregnancy, McDonalds sign is characterized by anv ease in flexing the body of the uterus against the cervix. A rubella vaccine shouldnt be given to a pregnant woman. The vaccinev can be administered after delivery, but the pt should be instructed to avoid becoming pregnant for 3 months. A smacking sound, milk dripping from the side of the mouth, andv sucking noises all indicate improper placement of the infants mouth over the nipple. A woman who is breast-feeding should rub a mild emollient cream or av few drops of breast milk (or colostrum) on the nipples after each feeding. She should let the breasts air-dry to prevent them from cracking. A woman who is taking clomiphene (Clomid) to induce ovulation shouldv be informed of the possibility of multiple births w/ this drug. Abruptio placentae is premature separation of a normally implantedv placenta. It may be partial or complete, & usually causes abdominal pain, vaginal bleeding, & a boardlike abdomen. Acrocyanosis (blueness & coolness of the arms & legs) is normalv in neonates b/c of their immature peripheral circulatory system. After administering magnesium sulfate to a pregnant pt forv hypertension or preterm labor, the RN should monitor the respiratory rate & deep tendon reflexes. After birth, the neonates umbilical cord is tied 1" (2.5 cm) fromv the abdominal wall w/ a cotton cord, plastic clamp, or rubber band. After delivery, a multiparous woman is more susceptible to bleedingv than a primiparous woman b/c her uterine muscles may be overstretched & may not contract efficiently. After the placenta is delivered, the RN may add oxytocin (Pitocin)v to the pts I.V. solution, as prescribed, to promote postpartum involution of the uterus & stimulate lactation. Amniocentesis increases the risk of spontaneous abortion, trauma tov the fetus or placenta, premature labor, infection, & Rh sensitization of the fetus. An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6v indicates moderate distress, & 0 to 3 indicates severe distress. An arrest of descent occurs when the fetus doesnt descend throughv the pelvic cavity during labor. Its commonly associated w/ cephalopelvic disproportion, & cesarean delivery may be required. An estriol level is used to assess fetal well-being & maternalv renal functioning as well as to monitor a pregnancy thats complicated by diabetes. As emergency treatment for excessive uterine bleeding, 0.2 mg ofv methylergonovine (Methergine) is injected I.V. over 1 minute while the pts blood pressure & uterine contractions are monitored. At birth, a neonate normally weighs 5 to 9 lb (2 to 4 kg), measuresv 18" to 22" (45.5 to 56 cm) in length, has a head circumference of 13" to 14" (34 to 35.5 cm), & has a chest circumference thats 1" (2.5 cm) less than the head circumference. B/c a major role of the placenta is to function as a fetal lung,v any condition that interrupts normal blood flow to or from the placenta increases fetal partial pressure of arterial carbon dioxide & decreases fetal pH. B/c oxytocin (Pitocin) stimulates powerful uterine contractionsv during labor, it must be administered under close observation to help prevent maternal & fetal distress. B/c women w/ diabetes have a higher incidence of birthv anomalies than women without diabetes, an alpha-fetoprotein level may be ordered at 15 to 17 weeks gestation.

Before discharging a pt who has had an abortion, the nursev should instruct her to report bright red clots, bleeding that lasts longer than 7 days, or signs of infection, such as a temperature of greater than 100 F (37.8 C), foul-smelling vaginal discharge, severe uterine cramping, nausea, or vomiting. Before internal fetal monitoring can be performed, a pregnantv pts cervix must be dilated at least 2 cm, the amniotic membranes must be ruptured, & the fetuss presenting part (scalp or buttocks) must be at station 1 or lower, so that a small electrode can be attached. Boys who are born w/ hypospadias shouldnt be circumcised at birthv b/c the foreskin may be needed for constructive surgery. Braxton Hicks contractions are usually felt in the abdomen & dontv cause cervical change. True labor contractions are felt in the front of the abdomen & back & lead to progressive cervical dilation & effacement. Breast-feeding of a premature neonate born at 32 weeks gestation canv be accomplished if the mother expresses milk & feeds the neonate by gavage. Caput succedaneum is edema that develops in & under the fetal scalpv during labor & delivery. It resolves spontaneously & presents no danger to the neonate. The edema doesnt cross the suture line. Chloasma, the mask of pregnancy, is pigmentation of a circumscribedv area of skin (usually over the bridge of the nose & cheeks) that occurs in some pregnant women. Cows milk shouldnt be given to infants younger than age 1 becausev it has a linoleic acid content & its protein is difficult for infants to digest. Cutis marmorata is mottling or purple discoloration of the skin. Itsv a transient vasomotor response that occurs primarily in the arms & legs of infants who are exposed to cold. Diaphragmatic hernia is one of the most urgent neonatal surgicalv emergencies. By compressing & displacing the lungs & heart, this disorder can cause respiratory distress shortly after birth. Drinking six alcoholic beverages a day or a single episode of bingev drinking in the first trimester can cause fetal alcohol syndrome. Drugs used to treat withdrawal symptoms in neonates includev phenobarbital (Luminal), camphorated opium tincture (paregoric), & diazepam (Valium). During delivery, if the umbilical cord cant be loosened & slippedv from around the neonates neck, it should be clamped w/ two clamps & cut between the clamps. During the first stage of labor, the side-lying position usuallyv provides the greatest degree of comfort, although the pt may assume any comfortable position. During the transition phase of the first stage of labor, the cervixv is dilated 8 to 10 cm & contractions usually occur 2 to 3 minutes apart & last for 60 seconds. Eclampsia is the occurrence of seizures that arent caused by av cerebral disorder in a pt who has pregnancy-induced hypertension. Electronic fetal monitoring is used to assess fetal well-being duringv labor. If compromised fetal status is suspected, fetal blood pH may be evaluated by obtaining a scalp sample. Fetal alcohol syndrome presents in the first 24 hours after birth andv produces lethargy, seizures, poor sucking reflex, abdominal distention, & respiratory difficulty. Fetal embodiment is a maternal developmental task that occurs in thev second trimester. During this stage, the mother may complain that she never gets to sleep b/c the fetus always gives her a thump when she tries. Fetal station also is described as +1, +2, +3, +4, or +5 to indicatev the number of centimeters it is below the level of the ischial spine; station 0 is at the level of the ischial spine. Fetal station indicates the location of the presenting part inv relation to the ischial spine. Its described as 1, 2, 3, 4, or 5 to indicate the number of centimeters above the level of the ischial spine; station 5 is at the pelvic inlet.

For an extramural delivery (one that takes place outside of a normalv delivery center), the priorities for care of the neonate include maintaining a patent airway, supporting efforts to breathe, monitoring vital signs, & maintaining adequate body temperature. Fundal height that exceeds expectations by more than 2 cm may bev caused by multiple gestation, polyhydramnios, uterine myomata, or a large baby. Gestational age can be estimated by ultrasound measurement ofv maternal abdominal circumference, fetal femur length, & fetal head size. These measurements are most accurate between 12 & 18 weeks gestation. Harlequin sign is present when a neonate who is lying on his sidev appears red on the dependent side & pale on the upper side. HELLP (hemolysis, elevated liver enzymes, & platelets) syndromev is an unusual variation of pregnancy-induced hypertension. Hemodilution of pregnancy is the in blood volume that occursv during pregnancy. The increased volume consists of plasma & causes an imbalance between the ratio of red blood cells to plasma & a resultant in hematocrit. Human immunodeficiency virus (HIV) has been cultured in breast milkv & can be transmitted by an HIV-positive mother who breastfeeds her infant. Hyperpigmentation of the pregnant pts face, formerly calledv chloasma & now referred to as melasma, fades after delivery. If a breast-fed infant is content, has good skin turgor, an adequatev number of wet diapers, & normal weight gain, the mothers milk supply is assumed to be adequate. If a fetus has late decelerations (a sign of fetal hypoxia), thev RN should instruct the mother to lie on her left side & then administer 8 to 10 L of oxygen per minute by mask or cannula. The RN should notify the physician. The side-lying position removes pressure on the inferior vena cava. If a pt misses a menstrual period while taking an oralv contraceptive exactly as prescribed, she should continue taking the contraceptive. If a pt misses two consecutive menstrual periods while taking anv oral contraceptive, she should discontinue the contraceptive & take a pregnancy test. If a pt who is taking an oral contraceptive misses a dose, shev should take the pill as soon as she remembers or take two at the next scheduled interval & continue w/ the normal schedule. If a pt who is taking an oral contraceptive misses twov consecutive doses, she should double the dose for 2 days & then resume her normal schedule. She also should use an additional birth control method for 1 week. If a pregnant pts test results are negative for glucose butv positive for acetone, the RN should assess the pts diet for inadequate caloric intake. If a pregnant pts test results are negative for glucose butv positive for acetone, the RN should assess the pts diet for inadequate caloric intake. If a woman suddenly becomes hypotensive during labor, the nursev should the infusion rate of I.V. fluids as prescribed. If fundal height is at least 2 cm less than expected, the cause mayv be growth retardation, missed abortion, transverse lie, or false pregnancy. If jaundice is suspected in a neonate, the RN should examine thev infant under natural window light. If natural light is unavailable, the RN should examine the infant under a white light. If needed, cervical suturing is usually done between 14 & 18 weeksv gestation to reinforce an incompetent cervix & maintain pregnancy. The suturing is typically removed by 35 weeks gestation. Immunity to rubella can be measured by a hemagglutination inhibitionv test (rubella titer). This test identifies exposure to rubella infection & determines susceptibility in pregnant women. In a woman, a titer greater than 1:8 indicates immunity. Implantation occurs when the cellular walls of the blastocytev implants itself in the endometrium, usually 7 to 9 days after fertilization.

Implantation occurs when the cellular walls of the blastocytev implants itself in the endometrium, usually 7 to 9 days after fertilization. In a full-term neonate, skin creases appear over two-thirds of thev neonates feet. Preterm neonates have heel creases that cover less than two-thirds of the feet. In a neonate, hypoglycemia causes temperature instability, hypotonia,v jitteriness, & seizures. Premature, postmature, small-forgestational-age, & large-for-gestational-age neonates are susceptible to this disorder. In a neonate, symptoms of respiratory distress syndrome includev expiratory grunting or whining, sandpaper breath sounds, & seesaw retractions. In a neonate, the cardinal signs of narcotic withdrawal includev coarse, flapping tremors; sleepiness; restlessness; prolonged, persistent, -pitched cry; & irritability. In a pt who has hypertonic contractions, the uterus doesnt havev an opportunity to relax & there is no interval between contractions. As a result, the fetus may experience hypoxia or rapid delivery may occur. In a premature neonate, signs of respiratory distress include nostrilv flaring, substernal retractions, & inspiratory grunting. In an emergency delivery, enough pressure should be applied to thev emerging fetuss head to guide the descent & prevent a rapid change in pressure within the molded fetal skull. In percutaneous umbilical blood sampling, a blood sample is obtainedv from the umbilical cord to detect anemia, genetic defects, & blood incompatibility as well as to assess the need for blood transfusions. In placenta previa, bleeding is painless & seldom fatal on thev first occasion, but it becomes heavier w/ each subsequent episode. In the early stages of pregnancy, the finding of glucose in the urinev may be related to the increased shunting of glucose to the developing placenta, without a corresponding in the reabsorption capability of the kidneys. In the neonate, temperature normally ranges from 98 to 99 F (36.7v to 37.2 C), apical pulse rate averages 120 to 160 beats/minute, & respirations are 40 to 60 breaths/minute. In the supine position, a pregnant pts enlarged uterus impairsv venous return from the lower half of the body to the heart, resulting in supine hypotensive syndrome, or inferior vena cava syndrome. Infants w/ syndrome typically have marked hypotonia,v floppiness, slanted eyes, excess skin on the back of the neck, flattened bridge of the nose, flat facial features, spadelike hands, short & broad feet, small male genitalia, absence of Moros reflex, & a simian crease on the hands. Kegel exercises require contraction & relaxation of the perinealv muscles. These exercises help strengthen pelvic muscles & improve urine control in postpartum patients. Laceration of the vagina, cervix, or perineum produces bright redv bleeding that often comes in spurts. The bleeding is continuous, even when the fundus is firm. Ladins sign, an early indication of pregnancy, causes softening of av spot on the anterior portion of the uterus, just above the uterocervical juncture. Lanugo covers the fetuss body until about 20 weeks gestation. Thenv it begins to disappear from the face, trunk, arms, & legs, in that order. Linea nigra, a dark line that extends from the umbilicus to the monsv pubis, commonly appears during pregnancy & disappears after pregnancy. Lochia alba is the vaginal discharge of decreased blood & increasedv leukocytes thats the final stage of lochia. It occurs 7 to 10 days after childbirth. Maternal serum alpha-fetoprotein is detectable at 7 weeks ofv gestation & peaks in the third trimester. levels detected between the 16th & 18th weeks are associated w/ neural tube defects. levels are associated w/ syndrome.

Methylergonovine (Methergine) is an oxytocic agent used to preventv & treat postpartum hemorrhage caused by uterine atony or subinvolution. Mongolian spots can range from brown to blue. Their color depends onv how close melanocytes are to the surface of the skin. They most commonly appear as patches across the sacrum, buttocks, & legs. Most authorities strongly encourage the continuation ofv breast-feeding on both the affected & the unaffected breast of patients w/ mastitis. Nausea & vomiting during the first trimester of pregnancy arev caused by rising levels of the hormone human chorionic gonadotropin. Neonatal jaundice in the first 24 hours after birth is known asv pathological jaundice & is a sign of erythroblastosis fetalis. Nursing interventions for a pt w/ placenta previa includev positioning the pt on her left side for maximum fetal perfusion, monitoring fetal heart tones, & administering I.V. fluids & oxygen, as ordered. Ortolanis sign (an audible click or palpable jerk that occurs withv thigh abduction) confirms congenital hip dislocation in a neonate. Para is the number of pregnancies that reached viability, regardlessv of whether the fetus was delivered alive or stillborn. A fetus is considered viable at 20 weeks gestation. Pica is a craving to eat nonfood items, such as dirt, crayons, chalk,v glue, starch, or hair. It may occur during pregnancy & can endanger the fetus. Positive signs of pregnancy include ultrasound evidence, fetal heartv tones, & fetal movement felt by the examiner (not usually present until 4 months gestation Pregnancy-induced hypertension (preeclampsia) is an in bloodv pressure of 30/15 mm Hg over baseline or blood pressure of 140/95 mm Hg on two occasions at least 6 hours apart accompanied by edema & albuminuria after 20 weeks gestation. Preterm neonates or neonates who cant maintain a skin temperature ofv at least 97.6 F (36.4 C) should receive care in an incubator (Isolette) or a radiant warmer. In a radiant warmer, a heat-sensitive probe taped to the neonates skin activates the heater unit automatically to maintain the desired temperature. Prostaglandin gel may be applied to the vagina or cervix to ripen anv unfavorable cervix before labor induction w/ oxytocin (Pitocin). Radiography isnt usually used in a pregnant woman b/c it mayv harm the developing fetus. If radiography is essential, it should be performed only after 36 weeks gestation. Respiratory distress syndrome (hyaline membrane disease) develops inv premature infants b/c their pulmonary alveoli lack surfactant. Rubella has a teratogenic effect on the fetus during the firstv trimester. It produces abnormalities in to 40% of cases without interrupting the pregnancy. Rubella infection in a pregnant pt, especially during the firstv trimester, can lead to spontaneous abortion or stillbirth as well as fetal cardiac & other birth defects. Skeletal system abnormalities & ventricular septal defects are thev most common disorders of infants who are born to diabetic women. The incidence of congenital malformation is three times higher in these infants than in those born to nondiabetic women. Skeletal system abnormalities & ventricular septal defects are thev most common disorders of infants who are born to diabetic women. The incidence of congenital malformation is three times higher in these infants than in those born to nondiabetic women. Supernumerary nipples are occasionally seen on neonates. They usuallyv appear along a line that runs from each axilla, through the normal nipple area, & to the groin. Teenage mothers are more likely to have -birth-weight neonatesv b/c they seek prenatal care late in pregnancy (as a result of denial) & are more likely than older mothers to have nutritional deficiencies.

The Apgar score is used to assess the neonates vital functions. Itsv obtained at 1 minute & 5 minutes after delivery. The score is based on respiratory effort, heart rate, muscle tone, reflex irritability, & color. The average birth weight of neonates born to mothers who smoke is 6v oz (170 g) less than that of neonates born to nonsmoking mothers. The classic triad of symptoms of preeclampsia are hypertension,v edema, & proteinuria. Additional symptoms of severe preeclampsia include hyperreflexia, cerebral & vision disturbances, & epigastric pain. The diamond-shaped anterior fontanel usually closes between ages 12v & 18 months. The triangular posterior fontanel usually closes by age 2 months. The duration of a contraction is timed from the moment that thev uterine muscle begins to tense to the moment that it reaches full relaxation. Its measured in seconds. The failure rate of a contraceptive is determined by the experiencev of 100 women for 1 year. Its expressed as pregnancies per 100 woman-years. The Food & Drug Administration has established the following fivev categories of drugs based on their potential for causing birth defects: A, no evidence of risk; B, no risk found in animals, but no studies have been done in women; C, animal studies have shown an adverse effect, but the drug may be beneficial to women despite the potential risk; D, evidence of risk, but its benefits may outweigh its risks; & X, fetal anomalies noted, & the risks clearly outweigh the potential benefits. The fourth stage of labor (postpartum stabilization) lasts to 4v hours after the placenta is delivered. This time is needed to stabilize the mothers physical & emotional state after the stress of childbirth. The frequency of uterine contractions, which is measured in minutes,v is the time from the beginning of one contraction to the beginning of the next. The Guthrie test (a screening test for phenylketonuria) is mostv reliable if its done between the second & sixth days after birth & is performed after the neonate has ingested protein. The gynecoid pelvis is most ideal for delivery. Other types includev platypelloid (flat), anthropoid (apelike), & android (malelike). The hormone relaxin, which is secreted first by the corpus luteum andv later by the placenta, relaxes the connective tissue & cartilage of the symphysis pubis & the sacroiliac joint to facilitate passage of the fetus during delivery. The intensity of a labor contraction can be assessed by thev indentability of the uterine wall at the contractions peak. Intensity is graded as mild (uterine muscle is somewhat tense), moderate (uterine muscle is moderately tense), or strong (uterine muscle is boardlike). The mechanics of delivery are engagement, descent & flexion,v internal rotation, extension, external rotation, restitution, & expulsion. The most common reasons for cesarean birth are malpresentation, fetalv distress, cephalopelvic disproportion, pregnancy-induced hypertension, previous cesarean birth, & inadequate progress in labor. The narcotic antagonist naloxone (Narcan) may be given to a neonatev to correct respiratory depression caused by narcotic administration to the mother during labor. The RN should assess a breech-birth neonate for hydrocephalus,v hematomas, fractures, & other anomalies caused by birth trauma. The RN should instruct a pregnant pt to take only prescribedv prenatal vitamins b/c over-the-counter -potency vitamins may harm the fetus. The occurrence of thrush in the neonate is probably caused by contactv w/ the organism during delivery through the birth canal. The pt w/ preeclampsia usually has puffiness around the eyesv or edema in the hands (for example, I cant put my wedding ring on.). The period between contractions is referred to as the interval, orv resting phase. During this phase, the uterus & placenta fill w/ blood & allow for the exchange of oxygen, carbon dioxide, & nutrients.

The presence of meconium in the amniotic fluid during labor indicatesv possible fetal distress & the need to evaluate the neonate for meconium aspiration. The preterm neonate may require gavage feedings b/c of a weakv sucking reflex, uncoordinated sucking, or respiratory distress. The smallest outlet measurement of the pelvis is the intertuberousv diameter, which is the transverse diameter between the ischial tuberosities. The specific gravity of a neonates urine is 1.003 to 1.030. A lowerv specific gravity suggests overhydration; a higher one suggests dehydration. The treatment for supine hypotension syndrome (a condition thatv sometimes occurs in pregnancy) is to have the pt lie on her left side. Through ultrasonography, the biophysical profile assesses fetalv well-being by measuring fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate (nonstress test), & qualitative amniotic fluid volume. To assess a neonates rooting reflex, the RN touches a finger tov the cheek or the corner of the mouth. Normally, the neonate turns his head toward the stimulus, opens his mouth, & searches for the stimulus. To assess coordination of sucking & swallowing, the RN shouldv observe the neonates first breast-feeding or sterile water bottlefeeding. To avoid contact w/ blood & other body fluids, the RN shouldv wear gloves when handling the neonate until after the first bath is given. To elicit Moros reflex, the RN holds the neonate in both handsv & suddenly, but gently, drops the neonates head backward. Normally, the neonate abducts & extends all extremities bilaterally & symmetrically, forms a C shape w/ the thumb & forefinger, & first adducts & then flexes the extremities. To establish a milk supply pattern, the mother should breast-feed herv infant at least every 4 hours. During the first month, she should breast-feed 8 to 12 times daily (demand feeding). To estimate the date of delivery using Ngeles rule, the nursev counts backward 3 months from the first day of the last menstrual period & then adds 7 days to this date. To estimate the true conjugate (the smallest inlet measurement of thev pelvis), deduct 1.5 cm from the diagonal conjugate (usually 12 cm). A true conjugate of 10.5 cm enables the fetal head (usually 10 cm) to pass. To help a mother break the suction of her breast-feeding infant, the RN should teach her to insert a finger at the corner of the infants mouth. To perform nasotracheal suctioning in an infant, the RN positionsv the infant w/ his neck slightly hyperextended in a sniffing position, w/ his chin & his head tilted back slightly. To prevent heat loss in the neonate, the RN should bathe one partv of his body at a time & keep the rest of the body covered. To prevent heat loss, the RN should place the neonate under av radiant warmer during suctioning & initial delivery-room care, & then wrap the neonate in a warmed blanket for transport to the nursery. To prevent her from developing Rh antibodies, an Rh-negativev primigravida should receive Rho(D) immune globulin (RhoGAM) after delivering an Rh-positive neonate. To prevent ophthalmia neonatorum (a severe eye infection caused byv maternal gonorrhea), the RN may administer one of three drugs, as prescribed, in the neonates eyes: tetracycline, silver nitrate, or erythromycin. Two qualities of the myometrium are elasticity, which allows it tov stretch yet maintain its tone, & contractility, which allows it to shorten & lengthen in a synchronized pattern. Variability is any change in the fetal heart rate (FHR) from itsv normal rate of 120 to 160 beats/minute. Acceleration is increased FHR; deceleration is decreased FHR.

Vernix caseosa is a cheeselike substance that covers & protects thev fetuss skin in utero. It may be rubbed into the neonates skin or washed away in one or two baths. Visualization in pregnancy is a process in which the mother imaginesv what the child shes carrying is like & becomes acquainted w/ it. Vitamin K is administered to neonates to prevent hemorrhagicv disorders b/c a neonates intestine cant synthesize vitamin K. When a pregnant pt has undiagnosed vaginal bleeding, vaginalv examination should be avoided until ultrasonography rules out placenta previa. When both breasts are used for breast-feeding, the infant usuallyv doesnt empty the second breast. Therefore, the second breast should be used first at the next feeding. When informed that a pts amniotic membrane has broken, thev RN should check fetal heart tones & then maternal vital signs. When teaching parents to provide umbilical cord care, the nursev should teach them to clean the umbilical area w/ a cotton ball saturated w/ alcohol after every diaper change to prevent infection & promote drying. When used to describe the degree of fetal descent during labor,v floating means the presenting part isnt engaged in the pelvic inlet, but is freely movable (ballotable) above the pelvic inlet. When used to describe the degree of fetal descent, engagement meansv when the largest diameter of the presenting part has passed through the pelvic inlet. Whenever an infant is being put to sleep, the parent orv caregiver should position the infant on the back. (Remember back to sleep.) A: Abortion or loss of fetus before 20 weeks F/T: Full-term delivery at 38 weeks or longer L: Number of children living (if a child has died, further explanation is needed to clarify the discrepancy in numbers). P: Preterm delivery between 20 & 37 weeks A 16-year-old girl who is pregnant is at risk for having a -birth-weight neonate. A clinical manifestation of a prolapsed umbilical cord is variable decelerations. A complete abortion occurs when all products of conception are expelled. A fever in the first 24 hours postpartum is most likely caused by dehydration rather than infection. A habitual aborter is a woman who has had three or more consecutive spontaneous abortions. A late sign of preeclampsia is epigastric pain as a result of severe liver edema. A -birth-weight neonate weighs 2,500 g (5 lb 8 oz) or less at birth. A major developmental task for a woman during the first trimester of pregnancy is accepting the pregnancy. A mother should allow her infant to breast-feed until the infant is satisfied. The time may vary from 5 to 20 minutes. A mother who has a positive human immunodeficiency virus test result shouldnt breast-feed her infant. A neonate whose mother has diabetes should be assessed for hyperinsulinism. A pt who has a cesarean delivery is at greater risk for infection than the pt who gives birth vaginally. A pt who has postpartum hemorrhage caused by uterine atony should be given oxytocin as prescribed. A pregnant pt can avoid constipation & hemorrhoids by adding fiber to her diet.

A pregnant pt should take an iron supplement to help prevent anemia. A pregnant pt should take folic acid b/c this nutrient is required for rapid cell division. A pregnant pt w/ vaginal bleeding shouldnt have a pelvic examination. A pregnant woman should drink at least eight 8-oz glasses (about 2,000 ml) of water daily. A pregnant woman who has hyperemesis gravidarum may require hospitalization to treat dehydration & starvation. A premature neonate is one born before the end of the 37th week of gestation. A very--birth-weight neonate weighs 1,500 g (3 lb 5 oz) or less at birth. Administering levels of oxygen to a premature neonate can cause blindness as a result of retrolental fibroplasia. After a stillbirth, the mother should be allowed to hold the neonate to help her come to terms w/ the death. After amniocentesis, abdominal cramping or spontaneous vaginal bleeding may indicate complications. After delivery, if the fundus is boggy & deviated to the right side, the pt should empty her bladder. After delivery, the first nursing action is to establish the neonates airway. After feeding an infant w/ a cleft lip or palate, the RN should rinse the infants mouth w/ sterile water. After the amniotic membranes rupture, the initial nursing action is to assess the fetal heart rate. Amenorrhea is a probable sign of pregnancy. Amniotomy is artificial rupture of the amniotic membranes. An ectopic pregnancy is one that implants abnormally, outside the uterus. Any vaginal bleeding during pregnancy should be considered a complication until proven otherwise. At 12 weeks gestation, the fundus should be at the top of the symphysis pubis. At 20 weeks gestation, the fundus is at the level of the umbilicus. At 36 weeks gestation, the fundus is at the lower border of the rib cage. B/c of the anti-insulin effects of placental hormones, insulin requirements during the third trimester. Before feeding is initiated, an infant should be burped to expel air from the stomach. Before performing a Leopold maneuver, the RN should ask the pt to empty her bladder. Before providing a specimen for a sperm count, the pt should avoid ejaculation for 48 to 72 hours. Breast-feeding mothers should their fluid intake to 2 to 3 qt (2,500 to 3,000 ml) daily. Cerebral palsy presents as asymmetrical movement, irritability, & excessive, feeble crying in a long, thin infant. Chlorpromazine (Thorazine) is used to treat neonates who are addicted to narcotics. Chorionic villus sampling is performed at 8 to 12 weeks of pregnancy for early identification of genetic defects. Colostrum, the precursor of milk, is the first secretion from the breasts after delivery. Common complications of early pregnancy ( to 20 weeks gestation) include fetal loss & serious threats to maternal health.

Crowning is the appearance of the fetuss head when its largest diameter is encircled by the vulvovaginal ring. Culdoscopy is visualization of the pelvic organs through the posterior vaginal fornix. Cytomegalovirus is the leading cause of congenital viral infection. Desquamation (skin peeling) is common in postmature neonates. Dinoprostone (Cervidil) is used to ripen the cervix. Direct antiglobulin (direct Coombs) test is used to detect maternal antibodies attached to red blood cells in the neonate. During crowning, the presenting part of the fetus remains visible during the interval between contractions. During fetal heart monitoring, early deceleration is caused by compression of the head during labor. During fetal heart rate monitoring, variable decelerations indicate compression or prolapse of the umbilical cord. During labor, the resting phase between contractions is at least 30 seconds. During labor, to relieve supine hypotension manifested by nausea & vomiting & paleness, turn the pt on her left side. During pregnancy, the abdominal line from the symphysis pubis to the umbilicus changes from linea alba to linea nigra. During pregnancy, weight gain averages 25 to 30 lb (11 to 13.5 kg). During the first hour after birth (the period of reactivity), the neonate is alert & awake. During the first trimester, a pregnant woman should avoid all drugs unless doing so would adversely affect her health. During the transition phase of labor, the woman usually is irritable & restless. Erythromycin is given at birth to prevent ophthalmia neonatorum. Fertilization produces a total of 46 chromosomes, including an XY combination (male) or an XX combination (female). Fetal demise is death of the fetus after viability. From the 8th week of gestation through delivery, the developing cells are known as a fetus. Goodells sign is softening of the cervix. Gravida is the number of pregnancies a woman has had, regardless of outcome. Heart development in the embryo begins at 2 to 4 weeks & is complete by the end of the embryonic stage. Hepatitis B immune globulin is usually given within 12 hours of birth. Hepatitis B vaccine is usually given within 48 hours of birth. -sodium foods can cause fluid retention, especially in pregnant patients. Hot compresses can help to relieve breast tenderness after breast-feeding. Hydramnios (polyhydramnios) is excessive amniotic fluid (more than 2,000 ml in the third trimester). If a pregnant pts rubella titer is less than 1:8, she should be immunized after delivery. If a woman receives a spinal block before delivery, the RN should monitor the pts blood pressure closely. If the mother wishes to breast-feed, the neonate should be nursed as soon as possible after delivery.

If the neonate is stable, the mother should be allowed to breast-feed within the neonates first hour of life. If the ovum is fertilized by a spermatozoon carrying a Y chromosome, a male zygote is formed. Implantation in the uterus occurs 6 to 10 days after ovum fertilization. In a neonate, long, brittle fingernails are a sign of postmaturity. In a neonate, -set ears are associated w/ chromosomal abnormalities such as syndrome. In a neonate, the symptoms of heroin withdrawal may begin several hours to 4 days after birth. In a neonate, the symptoms of methadone withdrawal may begin 7 days to several weeks after birth. In a pt w/ preeclampsia, epigastric pain is a late symptom & requires immediate medical intervention. In a pregnant pt, preeclampsia may progress to eclampsia, which is characterized by seizures & may lead to coma. In an incomplete abortion, the fetus is expelled, but parts of the placenta & membrane remain in the uterus. In complete (total) placenta previa, the placenta completely covers the cervical os. In neonates, cold stress affects the circulatory, regulatory, & respiratory systems. In partial (incomplete or marginal) placenta previa, the placenta covers only a portion of the cervical os. In the early postpartum period, the fundus should be midline at the umbilicus. In the neonate, a straight spine is normal. A tuft of hair over the spine is an abnormal finding. In the neonate, the normal blood glucose level is 45 to 90 mg/dl. In the pt w/ preeclampsia, blood pressure returns to normal during the puerperal period. Infants of diabetic mothers are susceptible to macrosomia as a result of increased insulin production in the fetus. Lightening is settling of the fetal head into the brim of the pelvis. Lochia rubra is the vaginal discharge of almost pure blood that occurs during the first few days after childbirth. Lochia serosa is the serous vaginal discharge that occurs 4 to 7 days after childbirth. Massaging the uterus helps to stimulate contractions after the placenta is delivered. Maternal hypotension is a complication of spinal block. Mean arterial pressure of greater than 100 mm Hg after 20 weeks of pregnancy is considered hypertension. Meconium is a material that collects in the fetuss intestines & forms the neonates first feces, which are black & tarry. Meconium is usually passed in the first 24 hours; however, passage may take to 72 hours. Methergine stimulates uterine contractions. Milia may occur as pinpoint spots over a neonates nose. Molding is the process by which the fetal head changes shape to facilitate movement through the birth canal. Mongolian spots are common in non-white infants & usually disappear by age 2 to 3 years. Most drugs that a breast-feeding mother takes appear in breast milk.

Neonatal testing for phenylketonuria is mandatory in most states. Neonates are nearsighted & focus on items that are held 10" to 12" (25 to 30.5 cm) away. Neonates typically need to consume 50 to 55 cal per pound of body weight daily. Neonates who are delivered by cesarean birth have a higher incidence of respiratory distress syndrome. Nevus flammeus, or port-wine stain, is a diffuse pink to dark bluish red lesion on a neonates face or neck. Nitrazine paper is used to test the pH of vaginal discharge to determine the presence of amniotic fluid. Obstetric data can be described by using the F/TPAL system: Organogenesis occurs during the first trimester of pregnancy, specifically, days 14 to 56 of gestation. Ovulation ceases during pregnancy. Oxytocin (Pitocin) promotes lactation & uterine contractions. Painless vaginal bleeding during the last trimester of pregnancy may indicate placenta previa. Parity doesnt refer to the number of infants delivered, only the number of deliveries. Pelvic-tilt exercises can help to prevent or relieve backache during pregnancy. Placenta previa is abnormally implantation of the placenta so that it encroaches on or covers the cervical os. Precipitate labor lasts for approximately 3 hours & ends w/ delivery of the neonate. Pregnancy-induced hypertension is a leading cause of maternal death in the United States. Pregnant women should be advised that there is no safe level of alcohol intake. Progesterone maintains the integrity of the pregnancy by inhibiting uterine motility. Prolactin stimulates & sustains milk production. Quickening, a presumptive sign of pregnancy, occurs between 16 & 19 weeks gestation. Respiratory distress syndrome develops in premature neonates b/c their alveoli lack surfactant. Spermatozoa (or their fragments) remain in the vagina for 72 hours after sexual intercourse. Spontaneous rupture of the membranes increases the risk of a prolapsed umbilical cord. Strabismus is a normal finding in a neonate. Stress, dehydration, & fatigue may reduce a breast-feeding mothers milk supply. Subinvolution may occur if the bladder is distended after delivery. Symptoms of postpartum depression range from mild postpartum blues to intense, suicidal, depressive psychosis. The administration of folic acid during the early stages of gestation may prevent neural tube defects. The administration of oxytocin (Pitocin) is stopped if the contractions are 90 seconds or longer. The best technique for assessing jaundice in a neonate is to blanch the tip of the nose or the area just above the umbilicus. The chorion is the outermost extraembryonic membrane that gives rise to the placenta.

The circumference of a neonates head is normally 2 to 3 cm greater than the circumference of the chest. The corpus luteum secretes large quantities of progesterone. The duration of pregnancy averages 280 days, 40 weeks, 9 calendar months, or 10 lunar months. The first immunization for a neonate is the hepatitis B vaccine, which is administered in the nursery shortly after birth. The first menstrual flow is called menarche & may be anovulatory (infertile). The first stage of labor begins w/ the onset of labor & ends w/ full cervical dilation at 10 cm. The fundus of a postpartum pt is massaged to stimulate contraction of the uterus & prevent hemorrhage. The hormone human chorionic gonadotropin is a marker for pregnancy. The initial weight loss for a healthy neonate is 5% to 10% of birth weight. The length of the uterus increases from 2" (6.3 cm) before pregnancy to 12" (32 cm) at term. The major cause of uterine atony is a full bladder. The male sperm contributes an X or a Y chromosome; the female ovum contributes an X chromosome. The most common method of inducing labor after artificial rupture of the membranes is oxytocin (Pitocin) infusion. The mothers Rh factor should be determined before an amniocentesis is performed. The narrowest diameter of the pelvic inlet is the anteroposterior (diagonal conjugate). The neonatal period extends from birth to day 28. Its also called the first 4 weeks or first month of life. The normal hemoglobin value in neonates is 17 to 20 g/dl. The RN instills erythromycin in a neonates eyes primarily to prevent blindness caused by gonorrhea or chlamydia. The RN may suction the neonates nose & mouth as needed w/ a bulb syringe or suction trap. The RN must place identification bands on both the mother & the neonate before they leave the delivery room. The RN should check the neonates temperature every 1 to 2 hours until its maintained within normal limits. The RN should count a neonates respirations for 1 full minute. The RN should keep the sac of meningomyelocele moist w/ normal saline solution. The RN should place the neonate in a 30-degree Trendelenburg position to facilitate mucus drainage. The RN should provide a dark, quiet environment for a neonate who is experiencing narcotic withdrawal. The RN should suggest ambulation to a postpartum pt who has gas pain & flatulence. The RN should teach a pregnant vegetarian to obtain protein from alternative sources, such as nuts, soybeans, & legumes. The percentage of water in a neonates body is about 78% to 80%. The presence of human chorionic gonadotropin in the blood or urine is a probable sign of pregnancy. The recommended amount of iron supplement for the pregnant pt is 30 to 60 mg daily. The second stage of labor begins w/ full cervical dilation & ends w/ the neonates birth.

The third stage of labor begins after the neonates birth & ends w/ expulsion of the placenta. The three phases of a uterine contraction are increment, acme, & decrement. The umbilical cord normally has two arteries & one vein. The union of a male & a female gamete produces a zygote, which divides into the fertilized ovum. Threatened abortion occurs when bleeding is present without cervical dilation. To avoid puncturing the placenta, a vaginal examination shouldnt be performed on a pregnant pt who is bleeding. To obtain an estriol level, urine is collected for 24 hours. Tocolytic agents used to treat preterm labor include terbutaline (Brethine), ritodrine (Yutopar), & magnesium sulfate. Tocolytic therapy is indicated in premature labor, but contraindicated in fetal death, fetal distress, or severe hemorrhage. Treatment for abruptio placentae is usually immediate cesarean delivery. Unlike false labor, true labor produces regular rhythmic contractions, abdominal discomfort, progressive descent of the fetus, bloody show, & progressive effacement & dilation of the cervix. Unlike formula, breast milk offers the benefit of maternal antibodies. Uterine atony is failure of the uterus to remain firmly contracted. When a pt is admitted to the unit in active labor, the RNs first action is to listen for fetal heart tones. When providing care, the RN should expose only one part of an infants body at a time. When providing phototherapy to a neonate, the RN should cover the neonates eyes & genital area. W/ advanced maternal age, a common genetic problem is syndrome. W/ early maternal age, cephalopelvic disproportion commonly occurs. Women who are carrying more than one fetus should be encouraged to gain 35 to 45 lb (15.5 to 20.5 kg) during pregnancy.