ATI: RN Maternal Newborn 2019 Remediation
1. Infections: Treatment for Gonorrhea.
- Maternal infections during pregnancy require prompt identification ... [Show More] and treatment by a provider.
- Lab tests done for Gonorrhea:
● Urethral and vaginal cultures
● Urine culture
- Medications prescribed for Gonorrhea:
● Ceftriaxone (Rocephin) IM
● Azithromycin (Zithromax) PO
- One dose prescription
- Broad-spectrum antibiotic
- Bactericidal action
2. Pain Management: Nursing Actions to Reduce Pain.
- With pain, it is important to attempt nonpharmacological treatments to relieve pain. These treatments could be effleurage, music therapy, hydrotherapy, massage, position changes, hypnosis, biofeedback.
- If these don't work, pharmacological pain management may be used this includes: sedatives, opioid analgesics, epidural and spinal analgesia, regional blocks, or general anesthesia.
3. Sources of Nutrition: Teaching a Client About High-Calcium Food. (see TEMPLATE as well)
- Calcium is important due to its involvement of bone and teeth formation. Sources include milk, fortified soy milk, fortified orange juice, nuts, legumes, dark leafy vegetables. Daily recommendation is 1,000 mg for pregnant and non-pregnant women over the age of 19 and 1,300 mg for those under 19.
4. Early Onset of Labor: Laboratory Values During Tocolytic Therapy.
- Fetal fibronectin (can be related to inflammation of the placenta that can lead to preterm birth), cervical cultures (test for presence of infectious organisms), CBC, and urinalysis are assessed during preterm labor.
● 1. Monitor for magnesium sulfate toxicity- loss of deep tendon reflexes, urinary output less than 30 mL/hour, respiratory depression.
● 2. Positive nitrazine paper test or positive ferning test is conducted on amniotic fluid to verify rupture of membranes.
● 3. After PROM, obtain CBC test.
5. Medical Conditions: Client Teaching About Magnesium Sulfate.
- Magnesium sulfate is an anticonvulsant that would be prescribed for a client who is exhibiting signs and symptoms of severe preeclampsia as evidenced by this client's elevated blood pressure and 3+ proteinuria.
- Signs of magnesium sulfate toxicity include the absence of patellar deep-tendon reflexes, urine output less than 30 mL/hr, respirations less than 12/min, and a decreased level of consciousness.
6. Prenatal Care: Immunizations for a Client Who Is at 30 Weeks of Gestation.
- The adult vaccine is called Tdap for protection from all three: tetanus, diphtheria and whooping cough. All women should get the Tdap shot between 27 and 36 weeks of each pregnancy, preferably in the first few weeks of that window.
7. Early Onset of Labor: Findings to Report to the Provider for a Client Who is Receiving Magnesium Sulfate.
- Monitor the client closely. Discontinue tocolytic therapy immediately if the client exhibits manifestations of pulmonary edema, which includes chest pain, shortness of breath, respiratory distress, audible wheezing and crackles, and a productive cough containing blood-tinged sputum.
- Monitor for adverse effects (hot flashes, diaphoresis, burning at IV site, nausea, vomiting, drowsiness, blurred vision, headache, non-reactive nonstress test, reduced fetal heart rate variability).
- Monitor for magnesium sulfate toxicity and discontinue for any of the following adverse effects: loss of deep tendon reflexes, urinary output less than 30 mL/hr or 100 mL/hr, respirations less than 12/min, pulmonary edema, severe hypotension, or chest pain.
8. Medical Conditions: Adverse Reactions of Magnesium Sulfate
- Signs of magnesium sulfate toxicity include the absence of patellar deep-tendon reflexes, urine output less than 30 mL/hr, respirations less than 12/min, and a decreased level of consciousness.
9. Assessment and Management of Newborn Complications: Caring for a Newborn Whose Mother has Type 2 Diabetes Mellitus.
● Gestational diabetes. In this condition, you don’t have diabetes before pregnancy. You develop it during pregnancy. This type of diabetes goes away after your baby is born.
● Pre-gestational diabetes. In this condition, you have diabetes before getting pregnant. You may have type 1 or type 2 diabetes.
- People with type 1 diabetes don’t make insulin. Your body needs insulin to use blood sugar. You’ll need to take insulin shots.
- People with type 2 diabetes can’t use the insulin they make. Or their bodies don’t make enough insulin. You’ll need blood sugar-lowering medicine and possibly insulin.
● Monitoring: Your baby’s healthcare provider may draw his or her blood. This will check your baby’s blood sugar, blood calcium, and other levels. This may be done through a heel stick, a needle in your baby's arm, or an umbilical catheter (a tube placed in your baby's umbilical cord).
● Glucose: Your baby may need a glucose and water mixture as an early feeding. Or your baby may need glucose given into a vein (intravenously or IV). Your baby’s healthcare provider will closely watch his or her blood sugar levels. This is done in case your baby’s blood sugar levels drop too low.
● Help with breathing: Your baby may need oxygen or a breathing machine to breathe better.
● Your child may need extra care if he or she has birth defects or injuries. Your child may need to see a specialist. This depends on his or her condition.
10. Assessment of Fetal Well-Being: Caring for a Client Following Chorionic Villus Sampling.
- Information to provide to the client: "To help relieve any cramping, you should lie down and rest. You can also take acetaminophen (such as Tylenol). You can take 650 to 1,000 mg every 4 hours as needed. Do not take more than 4,000 mg in 24 hours.”
- Chorionic villus sampling (CVS) is assessment of a portion of the developing placenta (chorionic villi), which is aspirated through a thin sterile catheter or syringe inserted through the abdominal wall or intravaginally through the cervix under ultrasound guidance.
- CVS is a first-trimester alternative to amniocentesis with one of its advantages being an earlier diagnosis of any abnormalities.
- CVS is ideally performed at 10 to 13 weeks of gestation.
- Complications: Spontaneous abortion (higher risk with CVS than with amniocentesis), Risk for fetal limb loss (greatest risk prior to 9 weeks of gestation), Miscarriage, Chorioamnionitis and rupture of membranes.
11. Assessment of Fetal Well-Being: Reviewing Results of Nonstress Test.
- Fetal heart rate reactivity is tested with a non-stress test.
- Non-stress test: Observing for acceleration of fetal heart rate with movement.
Shows intact central and autonomic nervous systems.
- Non-stress test = Reactive: Means at least 2 accelerations of FHR with fetal movement. FHR is normal baseline with moderate variability, accelerations 15/minute at least 15 seconds twice in 20 minutes
- Non-stress test = Non-reactive: Accelerations not seen or accelerations were not wide enough (>15 beats per min). May need further assessment.
12. Complications Related to the Labor Process: Identifying Prolonged Decelerations.
- Prolonged fetal heart rate deceleration >2 min but < 10 min.
- Prolonged decelerations can be caused by any mechanism which normally may lead to periodic or episodic decelerations, but the return to baseline is dela [Show Less]