LPN (pre-req) 2040 - Maternity Health

Clock Hours: 60

Delivery Mode
on-ground

Course Description:
The core material presented in this course is basically in chronological order, allowing the student to develop a strong understanding of the interrelationships involved in the family unit from time of conception through prenatal, antepartal and postpartal care. Emphasis is placed upon normal nutrition and the importance of adequate nutrition during pregnancy, lactation and different periods of growth and development in the infant. Diet therapy relative to the complications of pregnancy will be presented. Considerations will be given to the socioeconomic, cultural, and developmental factors influencing dietary patterns. Emphasis will be upon the therapeutic uses and effects of commonly used drugs during the course of pregnancy.

Student Learning Outcomes:
Upon completion of this course, the student will be able to:

Discuss the history, trends, and government influences in obstetrical nursing care.
Discuss the ethical, social, cultural, and legal issues in obstetrical nursing care.
Describe fetal development.
1. Fertilization and Cellular Division
2. Stages of Fetal Development
3. Development of Supportive Structures
4. Fetal and Placental Circulation
5. Special Considerations of Fetal Development
  1. Teratogens and the Fetus
  2. Ectopic Pregnancy
  3. Multifetal Pregnancy (multiple gestation)
Discuss the impact pregnancy has on the family unit.
Discuss the physiological changes related to pregnancy.
1. Maternal adaptation to pregnancy
  1. Signs of pregnancy
    1. Presumptive signs
    2. Probable signs
    3. Positive signs
2. Physiological changes
  1. Reproductive system
  2. Cardiovascular system
  3. Respiratory system
  4. GI system
  5. Urinary system
  6. Integumentary system
  7. Musculoskeletal system
  8. Sensory System
3. Changing nutritional requirements of pregnancy
  1. Weight gain and energy requirements
  2. Protein requirements
  3. Mineral requirements
  4. Vitamin requirements
  5. Dietary supplementation
  6. Dietary restrictions during pregnancy
  7. Special nutritional considerations
4. Common discomforts of pregnancy
Discuss the psychosocial changes related to pregnancy.
1. Maternal psychological response
2. Factors influencing psychosocial adaptation
3. Barriers to prenatal care
4. Abuse and Violence (Partner Abuse)
Discuss prenatal care.
1. Preconception visit
2. Maternal assessment during first prenatal visit
3. Subsequent prenatal visits
4. Assessment of fetal wellbeing
  1. Kick Counts
  2. Ultrasonography
  3. Doppler ultrasound blood flow Assessment
  4. Alpha- Fetoprotein Screening
  5. Multiple Marker Screening
  6. Chorionic Villus Sampling
  7. Amniocentesis
  8. Percutaneous Umbilical Blood Sampling
5. Pharmacological agents
6. Complementary and alternative medicine (CAM) therapies
7. Perinatal Education
  1. Goal of perinatal education
  2. Types of classes
8. The Nurses’ role in prenatal care
  1. Nursing Process for Prenatal Care
  2. Cultural considerations
Describe the nursing care of women with complications during pregnancy, such as but not limited to the following:
1. Diabetes Mellitus (DM)
2. Gestational Diabetes
3. Cardiovascular Disease
4. Hypertensive Disorders
  1. Gestational Hypertension
  2. Pregnancy induced hypertension (PIH)
  3. Preeclampsia
  4. Eclampsia
  5. Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP) Syndrome
  6. Chronic hypertension
5. Hyperemesis Gravidarum
6. Bleeding Disorders
  1. Ectopic pregnancy
  2. Early pregnancy loss
  3. Cervical insufficiency
  4. Gestational trophoblastic disease
  5. Placenta previa
  6. Abruptio placentae
7. Iron Deficiency Anemia
8. Sickle Cell Anemia
9. Blood Incompatibilities
  1. Rh Incompatibility
  2. ABO Incompatibility
10. Asthma
11. Epilepsy
12. Infectious Diseases
13. Sexually Transmitted Infections
14. Trauma
Describe the nursing care of women whose pregnancy is complicated by age-related concerns, such as:
1. Adolescent Pregnancy
2. Pregnancy later in life (advanced maternal age)
Describe the nursing care during antepartum fetal surveillance.
1. Non-stress test (NST)
2. Vibroacoustic stimulation
3. Contraction stress test
4. Biophysical Profile
Describe the components of the birth process.
1. The Four P’s
  1. Power - Contractions
    1. Effects on Cervix
      1. Effacement
      2. Dilatation
    2. Phases
      1. Increment
      2. Peak or acme
      3. Decrement
    3. Terms
      1. Frequency
      2. Duration
      3. Intensity
      4. Interval
  2. Passageway
    1. True versus false pelvis
  3. Passenger
    1. Fetal Head Landmarks
    2. Size of passenger
    3. Number of Passengers
    4. Fetal Station
    5. Fetal Lie
    6. Fetal Attitude
    7. Fetal Presentation
      1. Cephalic
      2. Breech
      3. Shoulder
  4. Position
    1. Maternal Pelvis Side - Left or Right
    2. Fetal Reference Points - Occiput, Mentum, Brow or Sacrum
    3. Maternal Pelvis Quadrant - Anterior, Transverse or Posterior
      1. Placenta
Describe nursing assessment of the birth process.
1. Signs of impending labor
2. Mechanisms of labor
3. True labor versus False labor
Describe the stages and phases of labor.
1. Stage One - Dilatation and Effacement
2. Stage Two - Delivery of Infant
3. Stage Three - Delivery of Placenta
4. Stage Four - Recovery
Discuss the admission process for a patient in labor.
1. Criteria for admission
2. Admission data
  1. Fetal Condition
  2. Maternal Conditions
    1. Medical/Obstetrical History
    2. Drug use: Prescription, over the counter (OTC), Illicit
    3. Plans for Birth and Pain Control
    4. Status of Labor
3. Admission Procedures
  1. Permits and Lab Tests
Describe nursing care of the patient during normal labor and delivery, including but not limited to:
1. Pain management
  1. Relaxation techniques
  2. Modifiers of pain during labor
  3. Nonpharmacological techniques
  4. Pharmacological techniques
    1. Analgesics
    2. Regional analgesics and anesthetics
2. Cultural, spiritual, and ethnic influences
3. Maternal Monitoring
  1. Uterine contractions
  2. Vital signs
  3. Intake and output (I & O)
4. Fetal Monitoring
  1. Fetal heart rate (FHR)
    1. Intermittent auscultation
    2. Continuous Electronic Fetal Monitoring (EFM)
    3. Evaluating FHR Patterns
      1. Baseline FHR
      2. Variability
      3. Accelerations
      4. Early Decelerations
      5. Variable Decelerations
      6. Late Decelerations
      7. Clarifying Nonreassuring FHR Patterns
        
        Fetal Stimulation
        
        Fetal Scalp Sampling
        
        Fetal Scalp Pulse Oximetry
5. Position Changes
  1. For comfort
  2. For delivery
  3. For complications
6. Coping with Labor
  1. Instructions regarding when to “Push”
  2. Encouragement to Partner
  3. Mood Changes
7. Pharmacological agents
8. Assessment
9. Interventions
10. Alternative methods of delivery
Describe nursing care during obstetrical procedures.
1. Induction or augmentation
  1. Indications
  2. Contraindications
  3. Labor readiness
  4. Cervical ripening
    1. Mechanical methods
    2. Pharmacologic methods
    3. Hygroscopic dilators
  5. Stripping of membranes/amniotomy
  6. Oxytocin induction
2. Amnioinfusion
3. Version
4. Episiotomy
  1. Midline
  2. Mediolateral
Describe nursing care of women with complications during labor and delivery.
1. Lacerations
  1. First Degree
  2. Second Degree
  3. Third Degree
  4. Fourth Degree
2. Assisted delivery
  1. Forceps
  2. Vacuum Extractions
3. Problems with Mother
4. Prolonged Labor
5. Problems with Fetus
6. Dysfunctional Labor (Dystocia)
7. Precipitate Birth
8. Premature Rupture of Membranes (PROM)
9. Preterm Labor
10. Postterm Pregnancy and Labor
11. Intrauterine Fetal Death
12. Amniotic Fluid Embolism
13. Shoulder Dystocia
14. Umbilical Cord Prolapse
15. Uterine Inversion
16. Uterine Rupture
17. Placental Abnormalities
18. Umbilical Cord Abnormalities
Describe nursing care associated with cesarean delivery (c-section).
1. Indications
2. Incidence
3. Risks
4. Maternal Complications
5. Fetal Complications
6. Incision Types
  1. Abdominal
  2. Uterine
7. Steps of a Cesarean Birth
  1. Preoperative Phase
  2. Intraoperative Phase
  3. Postoperative Phase
  4. Emergency of Unplanned Cesarean Birth
8. Nursing Care for the Cesarean Birth
9. Vaginal Birth After Cesarean (VBAC)
  1. Prerequisites
  2. Contraindications
  3. Risks and Benefits
Describe nursing care immediately after delivery.
1. Maternal
  1. Vital Signs
  2. Assessment of Fundus
  3. Medications
  4. Post-Cesarean Birth
  5. Post-Epidural/Post-Spinal
  6. Perineum
2. Infant
  1. Birth to 1 hour
    1. Apgar scoring
    2. Thermal Environment
    3. Cardio-Respiratory Function
    4. Gastrointestinal (GI)- First 24 Hours
    5. Medications - Prophylaxis
      1. Erythromycin
      2. Vitamin K
    6. Identification
      1. Infant’s footprints/Mother’s fingerprint
      2. Identification (ID) Bands
      3. Photograph with ID Card
    7. Weight/Length
Describe changes in maternal anatomy and physiology during the postpartum period.
1. Uterus
2. Lochia
3. Perineum
4. Abdominal Wall
5. Weight Loss
6. Breasts
  1. Breast Feeding
  2. Non-Breastfeeding
7. Bladder
8. Gastrointestinal (GI) System
9. Extremities
  1. Homan’s Sign
Describe nursing care of the patient and family during the postpartum period.
1. Assessment
  1. Vital signs
  2. Labs
  3. Fundus
    1. Involution
    2. Fundal Massage
  4. Afterpains
  5. Perineum
    1. Episiotomy/Lacerations
  6. Lochia
    1. Color
    2. Consistency
  7. Breasts/Nipples
  8. Bowel and Bladder
    1. Voiding
    2. Defecation
  9. Maternal- Newborn Bonding
  10. Pain
2. Interventions
  1. Pharmacological Agents
  2. Perineal Care
    1. Sitz bath/care of hemorrhoids
  3. Bathing
3. Discharge and Discharge Teaching
  1. Ovulation and menstruation
  2. Birth control
  3. Rubella vaccine and RhoGam
  4. Activity, Rest, and Diet
  5. Follow-up appointments
Discuss how nursing care of the patient is altered during the postpartum period following cesarean delivery.
1. Assessment
  1. Uterus
  2. Lochia
  3. Abdominal Dressing
  4. Urinary Catheter
  5. Respiratory Care
  6. Thrombophlebitis
  7. Pain Management
  8. Vital Signs and Lab Values
2. Interventions
  1. Pharmacological Agents
  2. Incision Care
  3. Bathing
  4. Ambulation
3. Discharge and Discharge Teaching
  1. Activity
  2. Follow-up appointments
Describe psychological adaptation of the postpartum patient.
1. Bonding
2. Development of Positive Family Relationships
3. Postpartum Depression
4. Postpartum Psychosis
5. Malattachment in the Postpartum Period
6. Grieving Parents
Describe nursing care of the patient with complications during the postpartum period.
1. Hemorrhage
  1. Major causes
  2. Nursing Interventions
2. Thromboembolic disorders
  1. Nursing Interventions
3. Postpartum Infections
  1. Nursing Interventions
4. Constipation
  1. Nursing Interventions
Describe nursing care of the normal newborn.
1. Assessment
  1. Vital Signs
  2. Measurements
    1. Weight
    2. Length
    3. Head circumference
    4. Chest circumference
  3. General Appearance
    1. Skin
    2. Head
    3. Face
    4. Eyes
    5. Ears
    6. Nose
    7. Mouth
    8. Neck
    9. Thorax
    10. Abdomen
    11. Umbilical Cord
    12. Female/Male External Genitalia
    13. Anus
    14. Eliminations
    15. Extremities
    16. Back
  4. Neurological Assessment
  5. Gestational Age Assessment
  6. Behavioral Assessment
2. Priorities in Nursing Care
  1. Maintaining Effective Airway
  2. Facilitating Thermoregulation
    1. Mechanisms of Heat Loss
  3. Laboratory Screenings
    1. Hypoglycemia
    2. Polycythemia and Anemia
    3. Disease Screening
  4. Safety
    1. Identification and Security
    2. Positioning
  5. Prevention of Hemorrhage
  6. Prevention of Infection
  7. Nourishment
  8. Parent Education
Describe nursing care of the newborn with complication/anomalies.
1. Newborn with Special Considerations
  1. HIV
  2. Infants Born to Substance-abusing Mothers
    1. Perinatal Substance Abuse
    2. Fetal Alcohol Syndrome
  3. Adoption
  4. Small for Gestational Age
  5. Large for Gestational Age
  6. Infants Born to Diabetic Mothers
2. The Preterm Infant
  1. Appearance and Activity
  2. Special Needs
    1. Nutrition
    2. Thermoregulation
    3. Maintaining oxygenation
    4. Prevention of infection
    5. Infant stimulation
    6. Assessment for neurologic sequelae
    7. Metabolic Complication
      1. Hypoglycemia
    8. Inborn Errors of Metabolism
      1. Congenital Hypothyroidism
      2. Phenylketonuria
      3. Galactosemia
3. Birth Injuries
  1. Intracranial or Intraventricular Hemorrhage
  2. Facial Paralysis
  3. Erb’s Palsy
  4. Fractures
4. Nervous System Abnormalities
  1. Hydrocephalus
    1. Types
    2. Early Recognition and Treatment
      1. Ventriculoperitoneal Shunt
      2. Lumboperitoneal Shunt
      3. Ventriculoatrial Shunt
    3. Nursing Care
    4. Complications and Prognosis
  2. Spina Bifida
    1. Diagnosis
    2. Types
    3. Nursing Considerations
    4. Complications and Long-term Care
5. Developmental Disabilities
  1. Mental Retardation
  2. Down’s Syndrome
6. Craniofacial Abnormalities
  1. Craniosynostosis
  2. Cleft Lip and Cleft Palate
7. Digestive Tract Abnormalities
  1. Esophageal Atresia/Tracheoesophageal Fistula
  2. Imperforate Anus
  3. Abdominal Hernias
    1. Oomphalocele
    2. Gastroschisis
    3. Diaphragmatic Hernia
8. Disorders of the Heart and Circulatory System
  1. Congenital Heart Disease
  2. Hemolytic Disease of the Newbor
    1. Rh Incompatibility
9. Orthopedic Abnormalities
  1. Congenital Dislocation of the Hip
  2. Club Foot
  3. Syndactyly
10. Other Disorders
  1. Hypospadias
Discuss various types of infant feeding.
1. Breastfeeding
2. Formula Feeding