RNC-MNN cheat sheet

Estimated date of delivery (EDD) by Naegele's rule: first day of last menstrual period + 7 days − 3 months + 1 year (280 days from LMP).

Gravida = number of pregnancies including current; Para = number of births after 20 weeks (or ≥ 20 weeks) regardless of outcome; TPAL: Term, Preterm, Abortions (<20 wk), Living children.

Normal fetal heart rate baseline: 110–160 bpm; variability 6–25 bpm is moderate and reassuring.

Gestational diabetes screening: 1-hour 50-g glucose challenge at 24–28 weeks; abnormal ≥140 mg/dL (or ≥130/135 per protocol) followed by 3-hour 100-g OGTT.

Preeclampsia diagnosis: BP ≥140/90 on two occasions ≥4 h apart after 20 weeks plus proteinuria ≥300 mg/24 h or signs of organ dysfunction (thrombocytopenia <100,000, renal insufficiency, liver involvement, pulmonary edema, visual/cerebral symptoms).

Rho(D) immune globulin given at 28 weeks to Rh-negative unsensitized women and within 72 hours postpartum if newborn is Rh-positive.

Fundal height in cm approximates gestational age in weeks between 20 and 36 weeks (±2 cm); discrepancy >3 cm suggests further evaluation.

Quickening (first fetal movement) typically perceived at 18–20 weeks in nulliparas, 16–18 weeks in multiparas.

Group B Streptococcus rectovaginal culture obtained at 36 0/7–37 6/7 weeks; positive results guide intrapartum antibiotic prophylaxis.

First stage of labor: latent phase (0–6 cm) and active phase (6–10 cm); second stage = full dilation to birth; third stage = birth to placental delivery.

Normal labor progress: cervical dilation of at least 1 cm/h in active phase; arrest defined as no cervical change ≥6 cm with ruptured membranes and adequate contractions for ≥4 hours (or ≥6 hours with inadequate contractions).

Fetal heart rate categories: Category I = baseline 110–160, moderate variability, no late/variable decelerations; Category III = absent variability with recurrent late/variable decelerations, bradycardia, or sinusoidal pattern - requires immediate intervention.

Late decelerations = uteroplacental insufficiency; interventions: reposition left lateral, IV fluid bolus, stop oxytocin, administer oxygen, notify provider.

Variable decelerations = umbilical cord compression; interventions: change position, amnioinfusion if recurrent, assess for cord prolapse.

Prolonged deceleration = decrease ≥15 bpm lasting ≥2 minutes but <10 minutes; ≥10 minutes = baseline change.

Uterine tachysystole: >5 contractions in 10 minutes averaged over 30 minutes; reduce or stop oxytocin and consider tocolysis.

Epidural analgesia: monitor maternal blood pressure every 5–15 minutes for 15–30 minutes after bolus; hypotension treated with IV fluids and ephedrine or phenylephrine per protocol.

Shoulder dystocia maneuvers in sequence: McRoberts position, suprapubic pressure, then internal rotational maneuvers (Rubin II, Woods screw) and delivery of posterior arm.

Postpartum hemorrhage definition: cumulative blood loss ≥1,000 mL or bleeding with signs/symptoms of hypovolemia within 24 hours of birth; most common cause is uterine atony.

Uterine atony management: fundal massage, empty bladder, oxytocin (first-line uterotonic), then methylergonovine, carboprost, misoprostol as indicated; avoid methylergonovine in hypertension.

Normal postpartum lochia: rubra (days 1–3, red), serosa (days 4–10, pink/brown), alba (after day 10, white/yellow).

Postpartum endometritis: fever ≥38°C on two of the first 10 days postpartum, uterine tenderness, foul lochia; treat with IV broad-spectrum antibiotics (e.g., clindamycin plus gentamicin).

Deep vein thrombosis risk peaks in the first 6 weeks postpartum; unilateral leg pain, swelling, and warmth warrant Doppler ultrasound.

Postpartum depression screening with Edinburgh Postnatal Depression Scale; score ≥10 suggests possible depression and requires further assessment.

Breast engorgement management: frequent feeding, cold compresses between feeds, gentle expression; avoid excessive pumping which stimulates supply.

Mastitis: unilateral breast pain, redness, fever ≥38.4°C; continue breastfeeding and treat with antibiotics (e.g., dicloxacillin) and analgesics.

APGAR scored at 1 and 5 minutes: Appearance (color), Pulse (heart rate), Grimace (reflex), Activity (muscle tone), Respiration; each 0–2, total 0–10.

Normal newborn vital signs: heart rate 110–160 bpm, respiratory rate 30–60/min, axillary temperature 36.5–37.5°C.

Newborn weight loss up to 7–10% of birth weight in first week is normal; regain birth weight by 2 weeks.

Physiologic jaundice appears after 24 hours, peaks at 3–5 days (term) and resolves by 1–2 weeks; jaundice within 24 hours is pathologic.

Vitamin K 0.5–1 mg IM given to all newborns within 1 hour of birth to prevent hemorrhagic disease of the newborn.

Erythromycin ophthalmic ointment 0.5% applied to both eyes within 1 hour of birth to prevent gonococcal ophthalmia neonatorum.

Newborn screening: heel stick blood spot after 24 hours of age and before discharge; hearing screen before discharge.

Hypoglycemia definition in newborn: blood glucose <40 mg/dL in first 4 hours or <45 mg/dL thereafter; treat with feeding or IV dextrose if symptomatic.

Umbilical cord care: keep clean and dry; monitor for redness, swelling, or discharge indicating omphalitis.

Chain of command: when a concern is not addressed, escalate to charge nurse, supervisor, and physician leadership per institutional policy.

SBAR communication: Situation, Background, Assessment, Recommendation - standardized handoff format.

Time-out before procedures: verify patient identity, procedure, site, and consent with the entire team.

Two-patient identifier: use at least two identifiers (name and date of birth or medical record number) before any intervention.

Medication safety: high-alert medications (oxytocin, insulin, heparin, opioids) require independent double-check and standardized concentrations.

Mandatory reporting: suspected child abuse, intimate partner violence (per state law), and communicable diseases to public health authorities.

Informed consent elements: diagnosis, nature of procedure, risks, benefits, alternatives, and right to refuse; nurse witnesses consent, provider obtains it.

Standard precautions apply to all patients; hand hygiene is the single most effective infection prevention measure.

Sentinel event: an unexpected occurrence involving death or serious physical/psychological injury; requires root cause analysis and reporting per policy.