Maternal, Newborn and Pediatric Nursing
What to master
This domain splits into three logics that you should keep separate.
Antepartum/intrapartum. Gravida/para and GTPAL terminology; estimated date of delivery; signs of pregnancy; danger signs (vaginal bleeding, severe headache, visual changes, decreased fetal movement). Fetal heart monitoring: early decelerations mirror contractions (head compression, benign); variable decelerations are cord compression (reposition, then reassess); late decelerations begin after the contraction peak and signal uteroplacental insufficiency.
Postpartum. The four "B" hazards: bleeding, bladder, bowel, breast. Postpartum haemorrhage means a boggy uterus until proven otherwise - massage the fundus first. Know preeclampsia/eclampsia and magnesium sulfate toxicity (loss of deep tendon reflexes, respiratory depression, oliguria) with calcium gluconate as antidote.
Newborn and child. APGAR at 1 and 5 minutes; thermoregulation and hypoglycaemia risk; jaundice timing; weight-based paediatric dosing; dehydration assessment in infants (fontanelle, tears, mucous membranes, urine output).
Traps in questions
- Confusing early and late decelerations - this is the single most tested distinction.
- "Massage the fundus" versus "call the provider" in a boggy uterus: massage first.
- Assuming all childhood fever requires antipyretics - the priority is often hydration and assessment.
- Forgetting that paediatric doses are per kilogram, and that a safe dose range may make an ordered dose wrong.
Worked example
Late decelerations appear with oxytocin infusing. Options: increase oxytocin, continue monitoring, stop oxytocin and reposition to the left side, document. Choose stop oxytocin and reposition - remove the stressor, improve uterine blood flow, then notify.
Rule of thumb
Late = hypoxic fetus: stop the oxytocin, turn her, give oxygen, notify.