Maternal and Newborn Nursing
Maternal and Newborn Nursing tests prenatal care, labor and birth, postpartum recovery, and newborn adaptation. Questions emphasize normal findings, warning signs, fetal surveillance, and maternal-newborn safety.
Core rules and concepts
- Prenatal. GTPAL records gravida, term, preterm, abortions, living children. Naegele's rule estimates delivery by adding 7 days and subtracting 3 months from the last menstrual period. Preeclampsia is new hypertension after 20 weeks with proteinuria or organ dysfunction; magnesium sulfate prevents seizures. Monitor for magnesium toxicity: loss of deep tendon reflexes, respiratory depression, oliguria.
- Labor. First stage is cervical dilation; second is birth; third is placental delivery; fourth is the first 1–2 hours postpartum. Fetal heart categories guide action. Early decelerations mirror contractions from head compression and are usually benign. Variable decelerations are abrupt from cord compression: reposition, give oxygen if indicated, and stop oxytocin. Late decelerations occur after contractions from placental insufficiency: reposition left lateral, give oxygen, stop oxytocin, and notify the provider.
- Postpartum. The most common cause of early postpartum hemorrhage is uterine atony. A boggy fundus needs massage, bladder emptying, and oxytocin per order. Assess lochia, vital signs, and perfusion.
- Newborn. APGAR is scored at 1 and 5 minutes for heart rate, respiratory effort, muscle tone, reflex irritability, and color. Normal newborn respirations are 30–60/min. Provide warmth, vitamin K, eye prophylaxis, and hepatitis B vaccine per policy.
Worked example
Thirty minutes after birth, a woman has heavy vaginal bleeding and a firm fundus is not felt. The nurse should massage the fundus, empty the bladder, give oxytocin as ordered, and assess vital signs and lochia. If bleeding continues or the fundus remains boggy, escalate immediately because uterine atony can progress to shock.
Traps that cost marks
- Confusing variable and late decelerations, or continuing oxytocin during an abnormal pattern.
- Missing preeclampsia because the patient has only a headache or visual changes.
- Assuming a firm fundus rules out all postpartum bleeding; lacerations can bleed with a firm uterus.
- Applying adult normal ranges to a newborn.