Maternal and Newborn Nursing
What this domain tests
Maternal and Newborn Nursing tests labor and birth, fetal surveillance, postpartum complications, and newborn transition and feeding.
Core rules
- First stage: latent to about 6 cm, then active to full dilation. Second stage: full dilation to birth. Third: birth to placental delivery. Fourth: first 1-2 hours postpartum, when hemorrhage risk peaks.
- Fetal heart rate categories: baseline 110-160; accelerations are reassuring; variables suggest cord compression; late decelerations suggest uteroplacental insufficiency and require repositioning, oxygen, IV fluid, and stopping oxytocin.
- Postpartum hemorrhage is most often uterine atony. Assess the fundus, massage, empty the bladder, give uterotonics, and escalate.
- Preeclampsia with severe features: magnesium sulfate for seizure prophylaxis; monitor respirations, deep tendon reflexes, and urine output. Calcium gluconate is the antidote.
- Newborn: dry, warm, stimulate, position the airway; APGAR at 1 and 5 minutes scores heart rate, respiratory effort, tone, reflex irritability, and color.
Worked example
Thirty minutes after a vaginal birth, the fundus is boggy and above the umbilicus, lochia is heavy, and pulse is 118. What first? Reasoning: boggy fundus plus tachycardia means uterine atony with ongoing blood loss. Massage the fundus, empty the bladder, start or increase oxytocin per order, and reassess. Notify the provider and prepare additional uterotonics if massage fails. Documentation follows stabilization.
Traps
- Assuming all bright red lochia is normal; saturating a pad in an hour is not.
- Missing magnesium toxicity: loss of deep tendon reflexes, respiratory depression, oliguria.
- Forgetting that a full bladder displaces the uterus and causes atony.
- Treating newborn cyanosis with oxygen alone while ignoring ventilation.