Maternal and Newborn Nursing
Core concepts
Maternal-newborn nursing spans antepartum, intrapartum, postpartum, and newborn care. Know the stages of labor, fetal monitoring (baseline rate, variability, accelerations, decelerations), and the difference between early (head compression, benign), variable (cord compression, reposition), and late (placental insufficiency, ominous) decelerations. Understand postpartum hemorrhage causes (the "4 Ts": tone, trauma, tissue, thrombin) and interventions (fundal massage, oxytocin, uterotonics). Newborn assessment includes Apgar scoring (appearance, pulse, grimace, activity, respiration at 1 and 5 minutes), thermoregulation, feeding, and jaundice monitoring. Know pregnancy danger signs: hypertension, headache/visual changes (preeclampsia), decreased fetal movement, and bleeding.
Traps in questions
Distinguish late decelerations (intervene: reposition left lateral, oxygen, stop oxytocin, notify provider) from variable decelerations (reposition, check for cord prolapse). A common trap is ordering interventions for a non-reassuring strip without first repositioning the mother and stopping oxytocin. Another trap: confusing postpartum hemorrhage from uterine atony (most common, boggy fundus) with retained placenta. For newborn jaundice, know that pathologic jaundice appears within 24 hours and requires prompt evaluation. Also remember magnesium sulfate for preeclampsia requires monitoring for toxicity (loss of deep tendon reflexes, respiratory depression; antidote calcium gluconate).
Rule of thumb
For any non-reassuring fetal heart tracing, first reposition the mother (left lateral), give oxygen, and stop oxytocin-then notify the provider.
Worked example
A laboring patient on oxytocin shows repetitive late decelerations. Correct action: turn to left lateral, apply oxygen, stop the oxytocin infusion, and notify the provider-do not increase the oxytocin rate.