MPN 2040 - Maternity Health for CMA

Clock Hours: 60

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.

Fertilization and Cellular Division
Stages of Fetal Development
Development of Supportive Structures
Fetal and Placental Circulation
Special Considerations of Fetal Development

Teratogens and the Fetus
Ectopic Pregnancy
Multifetal Pregnancy (multiple gestation)

Discuss the impact pregnancy has on the family unit.

Discuss the physiological changes related to pregnancy.

Maternal adaptation to pregnancy
- Signs of pregnancy
  - Presumptive signs
  - Probable signs
  - Positive signs
- Physiological changes
  - Reproductive system
  - Cardiovascular system
  - Respiratory system
  - GI system
  - Urinary system
  - Integumentary system
  - Musculoskeletal system
  - Sensory System
- Changing nutritional requirements of pregnancy
  - Weight gain and energy requirements
  - Protein requirements
  - Mineral requirements
  - Vitamin requirements
  - Dietary supplementation
  - Dietary restrictions during pregnancy
  - Special nutritional considerations
- Common discomforts of pregnancy

Discuss the psychosocial changes related to pregnancy.

Maternal psychological response
Factors influencing psychosocial adaptation
Barriers to prenatal care
Abuse and Violence (Partner Abuse)

Discuss prenatal care.

Preconception visit
Maternal assessment during first prenatal visit
Subsequent prenatal visits

Assessment of fetal wellbeing
- Kick Counts
- Ultrasonography
- Doppler ultrasound blood flow Assessment
- Alpha- Fetoprotein Screening
- Multiple Marker Screening
- Chorionic Villus Sampling
- Amniocentesis
- Percutaneous Umbilical Blood Samplies
Pharmacological agents
Complementary and alternative medicine (CAM) therapies
Perinatal Education
- Goal of perinatal education
- Types of classes
The Nurses’ role in prenatal care
- Nursing Process for Prenatal Care
- Cultural considerations

Describe the nursing care of women with complications during pregnancy, such as but not limited to the following:

Diabetes Mellitus (DM)
Gestational Diabetes
Cardiovascular Disease
Hypertensive Disorders
- Gestational Hypertension
- Pregnancy induced hypertension (PIH)
- Preeclampsia
- Eclampsia
- Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP) Syndrome
- Chronic hypertension
Hyperemesis Gravidarum
Bleeding Disorders
- Ectopic pregnancy
- Early pregnancy loss
- Cervical insufficiency
- Gestational trophoblastic disease
- Placenta previa
- Abruptio placentae
Iron Deficiency Anemia
Sickle Cell Anemia
Blood Incompatibilities
- Rh Incompatibility
- ABO Incompatibility
Asthma
Epilepsy
Infectious Diseases
Sexually Transmitted Infections
Trauma

Describe the nursing care of women whose pregnancy is complicated by age-related concerns, such as:

Adolescent Pregnancy
Pregnancy later in life (advanced maternal age)

Describe the nursing care during antepartum fetal surveillance.
Non-stress test (NST)

Vibroacoustic stimulation
Contraction stress test
Biophysical Profile

Describe the components of the birth process.

The Four P’s
- Power - Contractions
  - Effects on Cervix
    - Effacement
    - Dilatation
  - Phases
    - Increment
    - Peak or acme
    - Decrement
  - Terms
    - Frequency
    - Duration
    - Intensity
    - Interval
- Passageway
  - True versus false pelvis
- Passenger
  - Fetal Head Landmarks
  - Size of passenger
  - Number of Passengers
  - Fetal Station
  - Fetal Lie
  - Fetal Attitude
  - Fetal Presentation
  - Cephalic
  - Breech
  - Shoulder
- Position
  - Maternal Pelvis Side - Left or Right
  - Fetal Reference Points - Occiput, Mentum, Brow or Sacrum
  - Maternal Pelvis Quadrant - Anterior, Transverse or Posterior
Placenta

Describe nursing assessment of the birth process.

Signs of impending labor
Mechanisms of labor
True labor versus False labor

Describe the stages and phases of labor.

Stage One - Dilatation and Effacement
Stage Two - Delivery of Infant
Stage Three - Delivery of Placenta
Stage Four - Recovery

Discuss the admission process for a patient in labor.

Criteria for admission
- Admission data
  - Fetal Condition
  - Maternal Conditions
    - Medical/Obstetrical History
    - Drug use: Prescription, over the counter (OTC), Illicit
    - Plans for Birth and Pain Control
    - Status of Labor
- Admission Procedures
  - Permits and Lab Tests

Describe nursing care of the patient during normal labor and delivery, including but not limited to:

Pain management
- Relaxation techniques
- Modifiers of pain during labor
- Nonpharmacological techniques
- Pharmacological techniques
  - Analgesics
  - Regional analgesics and anesthetics
Cultural, spiritual, and ethnic influences
Maternal Monitoring
1. Uterine contractions
2. Vital signs
3. Intake and output (I & O)
Fetal Monitoring
- Fetal heart rate (FHR)
  - Intermittent auscultation
  - Continuous Electronic Fetal Monitoring (EFM)
  - Evaluating FHR Patterns
    - Baseline FHR
    - Variability
    - Accelerations
    - Early Decelerations
    - Variable Decelerations
    - Late Decelerations
    - Clarifying Nonreassuring FHR Patterns
      - Fetal Stimulation
      - Fetal Scalp Sampling
      - Fetal Scalp Pulse Oximetry
Position Changes
- For comfort
- For delivery
- For complications
Coping with Labor
- Instructions regarding when to “Push”
- Encouragement to Partner
- Mood Changes
Pharmacological agents
Assessment
Interventions
Alternative methods of delivery

Describe nursing care during obstetrical procedures.

Induction or augmentation
- Indications
- Contraindications
- Labor readiness
- Cervical ripening
  - Mechanical methods
  - Pharmacologic methods
  - Hygroscopic dilators
- Stripping of membranes/amniotomy
- Oxytocin induction
Amnioinfusion
Version
Episiotomy
- Midline
- Mediolateral

Describe nursing care of women with complications during labor and delivery.

Lacerations
- First Degree
- Second Degree
- Third Degree
- Fourth Degree
Assisted delivery
- Forceps
- Vacuum Extractions
Problems with Mother
Prolonged Labor
Problems with Fetus
Dysfunctional Labor (Dystocia)
Precipitate Birth
Premature Rupture of Membranes (PROM)
Preterm Labor
Postterm Pregnancy and Labor
Intrauterine Fetal Death
Amniotic Fluid Embolism
Shoulder Dystocia
Umbilical Cord Prolapse
Uterine Inversion
Uterine Rupture
Placental Abnormalities
Umbilical Cord Abnormalities

Describe nursing care associated with cesarean delivery (c-section).

Indications
Incidence
Risks
Maternal Complications
Fetal Complications
Incision Types
- Abdominal
- Uterine
Steps of a Cesarean Birth
- Preoperative Phase
- Intraoperative Phase
- Postoperative Phase
- Emergency of Unplanned Cesarean Birth
Nursing Care for the Cesarean Birth
Vaginal Birth After Cesarean (VBAC)
- Prerequisites
- Contraindications
- Risks and Benefits

Describe nursing care immediately after delivery.

Maternal
- Vital Signs
- Assessment of Fundus
- Medications
- Post-Cesarean Birth
- Post-Epidural/Post-Spinal
- Perineum
Infant
- Birth to 1 hour
  - Apgar scoring
  - Thermal Environment
  - Cardio-Respiratory Function
  - Gastrointestinal (GI)- First 24 Hours
  - Medications - Prophylaxis
    - Erythromycin
    - Vitamin K
  - Identification
    - Infant’s footprints/Mother’s fingerprint
    - Identification (ID) Bands
    - Photograph with ID Card
  - Weight/Length

Describe changes in maternal anatomy and physiology during the postpartum period.

Uterus
Lochia
Perineum
Abdominal Wall
Weight Loss
Breasts
- Breast FeedingNon-Breastfeeding
- Bladder
Gastrointestinal (GI) System
Extremities
- Homan’s Sign

Describe nursing care of the patient and family during the postpartum period.

Assessment
- Vital signs
- Labs
- Fundus
  - Involution
  - Fundal Massage
- Afterpains
- Perineum
  - Episiotomy/Lacerations
- Lochia
  - Color
  - Consistency
- Breasts/Nipples
- Bowel and Bladder
  - Voiding
  - Defecation
- Maternal- Newborn Bonding
- Pain
Interventions
- Pharmacological Agents
- Perineal Care
  - Sitz bath/care of hemorrhoids
- Bathing
Discharge and Discharge Teaching
- Ovulation and menstruation
- Birth control
- Rubella vaccine and RhoGam
- Activity, Rest, and Diet
- Follow-up appointments

Discuss how nursing care of the patient is altered during the postpartum period following cesarean delivery.

Assessment
- Uterus
- Lochia
- Abdominal Dressing
- Urinary Catheter
- Respiratory Care
- Thrombophlebitis
- Pain Management
- Vital Signs and Lab Values
Interventions
- Pharmacological Agents
- Incision Care
- Bathing
- Ambulation
Discharge and Discharge Teaching
- Activity
- Follow-up appointments

Describe psychological adaptation of the postpartum patient.

Bonding
Development of Positive Family Relationships
Postpartum Depression
Postpartum Psychosis
Malattachment in the Postpartum Period
Grieving Parents

Describe nursing care of the patient with complications during the postpartum period.

Hemorrhage
- Major causes
- Nursing Interventions
Thromboembolic disorders
- Nursing Interventions
Postpartum Infections
- Nursing Interventions
Constipation
- Nursing Interventions

Describe nursing care of the normal newborn.

Assessment
- Vital Signs
- Measurements
  - Weight
  - Length
  - Head circumference
  - Chest circumference
- General Appearance
  - Skin
  - Head
  - Face
  - Eyes
  - Ears
  - Nose
  - Mouth
  - Neck
  - Thorax
  - Abdomen
  - Umbilical Cord
  - Female/Male External Genitalia
  - Anus
  - Eliminations
  - Extremities
  - Back
- Neurological Assessment
- Gestational Age Assessment
- Behavioral Assessment
Priorities in Nursing Care
- Maintaining Effective Airway
- Facilitating Thermoregulation
  - Mechanisms of Heat Loss
- Laboratory Screenings
  - Hypoglycemia
  - Polycythemia and Anemia
  - Disease Screening
- Safety
  - Identification and Security
  - Positioning
- Prevention of Hemorrhage
- Prevention of Infection
- Nourishment
- Parent Education

Describe nursing care of the newborn with complication/anomalies.

Newborn with Special Considerations
- HIV
- Infants Born to Substance-abusing Mothers
  - Perinatal Substance Abuse
  - Fetal Alcohol Syndrome
  - Adoption
- Small for Gestational Age
- Large for Gestational Age
- Infants Born to Diabetic Mothers
The Preterm Infant
- Appearance and Activity
- Special Needs
  - Nutrition
  - Thermoregulation
  - Maintaining oxygenation
  - Prevention of infection
  - Infant stimulation
  - Assessment for neurologic sequelae
  - Metabolic Complication
    - Hypoglycemia
  - Inborn Errors of Metabolism
  - Birth Injuries
  - Galactosemia
    - Phenylketonuria
    - Congenital Hypothyroidism
Birth Injuries
- Intracranial or Intraventricular Hemorrhage
- Facial Paralysis
- Erb’s Palsy
- Fractures
Nervous System Abnormalities
- Hydrocephalus
  - Types
  - Early Recognition and Treatment
    - Ventriculoperitoneal Shunt
    - Lumboperitoneal Shunt
    - Ventriculoatrial Shunt
  - Nursing Care
  - Complications and Prognosis
- Spina Bifida
  - Diagnosis
  - Types
  - Nursing Considerations
  - Complications and Long-term Care
Developmental Disabilities
- Mental Retardation
- Down’s Syndrome
Craniofacial Abnormalities
- Craniosynostosis
- Cleft Lip and Cleft Palate
Digestive Tract Abnormalities
- Esophageal Atresia/Tracheoesophageal Fistula
- Imperforate Anus
- Abdominal Hernias
  - Oomphalocele
  - Gastroschisis
  - Diaphragmatic Hernia
Disorders of the Heart and Circulatory System
- Congenital Heart Disease
- Hemolytic Disease of the Newborn
  - Rh Incompatibility
Orthopedic Abnormalities
- Congenital Dislocation of the Hip
- Club Foot
- Syndactyly
Other Disorders
- Hypospadias

Discuss various types of infant feeding.

Breastfeeding
Formula Feeding