Review and Refresh

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Review and Refresh

• Packet, Class Readings
• And Clinical Revelations

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What is maternal-child health?

• 6 interconnected aspects

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What is maternal-child health?6 interconnected
aspects
Fetal/newborn physiology
Maternal physiology
Medical Care
Patient experience
Family experience
Nursing Care
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Maternalphysiology

• Nutrition
• Hemoglobin
• Weight gain
• Blood pressure
• Kidney and liver function
• Uterus
• Contractions
• Placenta cord
• Tubes ovaries

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Fetal/newborn physiology

• Fetal heart tones
• Pulse, temp, respiratory rate
• Weight
• Amniotic fluid volume
• Anomalies
• Placental blood flow

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Family experience

• Knowledge
• Previous experiences
• Cultural roles and expectations
• Significant other, older siblings, grandparents,
  extended family
• Facility
• Inclusion/exclusion
• Staff attitudes

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Patient experience

• Knowledge
• Previous experiences
• Fear
• Cultural roles and expectations
• Presence/absence of support person
• Facility
• Staff attitudes

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Medical care

• What physician orders and does
• Based primarily on physiology
• Patient or family experience is much lower
  priority
• Physicians receive less training in patient
  education and support

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Nursing Care

• Physiology top priority, but patient and family
  experience is dealt with simultaneously
• Education high priority
• Culture more important
• Independent nursing interventions
• Medically delegated tasks

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Cardinal Movements of Childbirth
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Which Are.

• Flexion
• Descent
• Internal rotation
• Extension
• External rotation

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Positions for birthing-kneeling
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Side lying
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Birthing stool
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Hands and Knees
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Water birth
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Hospital birthing room
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Typical hospital birth
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Crowning
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NCLEX-style question

• The highest priority in nursing care of the
  laboring client is
• Pain relief
• Partner involvement
• Fluid intake
• Fetal heart rate

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Maternal-Child Medications

• Pain Medications
• Tylenol NSAIDs
• Stronger NSAIDs
• Keterolac (Toradol)
• Narcotics po
• codeine po
• Hydrocodone
• Oxycodone
• Injectables
• Nubain
• Stadol

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What question should the nurse ask before
administering 10 mg of Nubain IV to a laboring
client?

• 1.Have you ever had surgery?
• 2. Do you use narcotics regularly?
• 3. What vitamins do you take daily?
• 4. Is your baby a boy or a girl?

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NCLEX Style Question

• A Client who is Latino is in labor and the
  father is refusing to come into the labor and
  delivery room. The nursing student assisting in
  the care believes he should participate in the
  birth and repeatedly urges the father to come
  into the labor and delivery room even though he
  keeps refusing. This nursing student is
  exhibiting
• Cultural sensitivity
• Ethnocentrism
• Encouragement
• Discouragement

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NCLEX Style ?

• Which of the following methods places emphasis on
  natural childbirth?
• Leboyer
• Lamaze
• Dick-Read
• Bradley

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NCLEX Style ?

• The nurse auscultates the fetal heart rate and
  determines a rate of 150 to 155 beats/minute.
  Which of the following nursing interventions is
  most appropriate?
• A. Inform the client that the FHr is normal and
  document the findings.
• B. Document and reassess the FHE in 5 minutes
  because the rate is too high.
• C. Report the FHR to the primary provider
  immediately and then document.
• D. Document and tell the mother she is having a
  boy because the heart rate is fast.

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NCLEX-style question

• The laboring primiparous client is in early
  labor. She asks the nurse how her labor will
  progress? What is the nurses best response?

1.The contractions will gradually get stronger
and closer together. 2. If you dont progress
fast enough, well start Pitocin to hurry things
along. 3. Dont worry. Well take good care of
you and make sure everything is fine. 4. When
your water breaks we will check your cervix to
see how far along you are.