RN ATI Capstone Maternal Newborn and Womens Health 2016

RN ATI Capstone Maternal Newborn and Women's Health 2016

Health Promotion and Maintenance - (12) Cancer Disorders: Risk Factors for Ovarian Cancer (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 92) Age greater than 40 years Nulliparity or first pregnancy after 30 years of age Family history of ovarian, breast, or genetic mutation for hereditary nonpolyposis colon cancer

(HNPCC)

BRCA1 or BRCA2 gene mutations Diabetes mellitus Early menarche/late menopause History of dysmenorrhea or heavy bleeding Endometriosis High-fat diet (possible risk) Hormone replacement therapy Use of infertility medications Older adult clients following surgery for cancer

Contraception: Contraindication to Intrauterine Device (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 1)

RISKS/CONTRAINDICATIONS

Best used by women in a monogamous relationship due to the risks of STIs Can cause irregular menstrual bleeding Risk of bacterial vaginosis, uterine perforation, or uterine expulsion Must be removed in the event of pregnancy CONTRA-INDICATIONS: Active pelvic infection, abnormal uterine bleeding, severe uterine distortion; for copper IUD also Wilson’s diseases and copper allergy

Contraception: Evaluating Client Understanding of an Intrauterine Device (Active Learning Template - Medication, RM MN RN 10.0 Chp 1) A chemically active T-shaped device that is inserted through the cervix and placed in the uterus by the provider.Releases a chemical substance that damages sperm in transit to the uterine tubes and prevents fertilization. The most effective contraceptive methods at preventing pregnancy are the long

acting reversible contraceptive (LARC) methods: implant and IUDs.

IUDs can be used by nulliparous and multiparous women.CLIENT EDUCATION: The device must be monitored monthly by clients after menstruation to ensure the presence of the small string that hangs from the device into the upper part of the vagina to rule out migration or expulsion of the device

Expected Physiological Changes During Pregnancy: Identifying a Client's Obstetrical History (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 3) Reproductive Uterus increases in size and changes shape and position.Ovulation and menses cease during pregnancy.Cardiovascular Cardiac output increases (30% to 50%) and blood volume increases (30% to 45% at term) to meet the greater metabolic needs. Heart rate increases during pregnancy beginning around week 5 and reaches a peak (10to15/min above pre-pregnancy rate) around 32weeks of pregnancy.Respiratory Maternal oxygen needs increase. During the last trimester, the size of the chest might enlarge, allowing for lung expansion, as the uterus pushes upward. Respiratory rate increases and total lung capacity decreases.Musculoskeletal Body alterations and weight increase necessitate an adjustment in posture. Pelvic joints relax.Gastrointestinal Nausea and vomiting might occur due to hormonal changes and/or an increase of pressure within the abdominal cavity as the pregnant client’s stomach and intestines are displaced within the abdomen. Constipation might occur due to increased transit time of food through the gastrointestinal tract and, thus, increased water absorption. Renal Filtration rate increases secondary to the influence of pregnancy hormones and an increase in blood volume and metabolic demands. The amount of urine produced remains the same. Urinary frequency is common during pregnancy. Endocrine The placenta becomes an endocrine organ that produces large amounts of hCG, progesterone, estrogen, human placental lactogen, and prostaglandins.Hormones are very active during pregnancy and function to maintain pregnancy and prepare the body for delivery

Infections: Caring for a Client in Labor Who Had a Positive Group B Streptococcus Screen (Active Learning Template - System Disorder, RM MN RN 10.0 Chp 8) Administer intrapartum antibiotic prophylaxis to the following clients.Client who has GBS bacteriuria during current pregnancy Client who has a GBS-positive screening during current pregnancy Client who has unknown GBS status who is delivering at less than 37 weeks of gestation Client who has maternal fever of 38° C (100.4° F) Client who has rupture of membranes for 18 hr or longer

Infertility: Risk Factors Affecting Fertility (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 2) ASSESSMENT Female

AGE: Age greater than 35 years can affect fertility.

DURATION OF INFERTILITY: More than 1 year of coitus without contraceptives. For women over the age 35 or who have a known risk factor, the recommendation is for 6months.

MEDICAL HISTORY: Atypical secondary sexual characteristic, such as abnormal body fat distribution or hair growth, is indicative of an endocrine disorder. Assessment should include hormonal and adrenal gland disorders, as these can contribute to infertility.

SURGICAL HISTORY: Particularly pelvic and abdominal procedures.

OBSTETRIC HISTORY: Past episodes of spontaneous abortions. Other obstetric assessments should include an evaluation of hormone levels throughout the client’s cycle. This can provide information about anovulation, amenorrhea, and premature ovarian failure.GYNECOLOGIC HISTORY: Abnormal uterine contours or any history of disorders that can contribute to the formation of scar tissue that can cause blockage of ovum or sperm.SEXUAL HISTORY: Intercourse frequency, number of partners across the lifespan, and any history of STIs

Labor and Delivery Processes: Behaviors During Latent Stage of Labor (Active Learning Template

• Basic Concept, RM MN RN 10.0 Chp 11)

Contractions

Irregular, mild to moderate

Frequency: 5 to 30 min

Duration: 30 to 45 seconds

Newborn Nutrition: Storage of Breast Milk (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 25) Breast milk can be stored at room temperature under very clean conditions for up to 8 hr. It can be refrigerated in sterile bottles for use within 8 days, or can be frozen in sterile containers in the freezer compartment of a refrigerator for up to 6months. Breast milk can be stored in a deep freezer for 12 months.Thawing the milk in the refrigerator for 24 hr is the best way to preserve the immunoglobulins present in it. It also can be thawed by holding the container under running lukewarm water or placing it in a container of lukewarm water. The bottle should be rotated often, but not shaken when thawing in this manner.Thawing by microwave is contraindicated because it destroys some of the immune factors and lysozymes contained in the milk. Microwave thawing also leads to the development of hot spots in the milk because of uneven heating, which can burn the newborn.Do not refreeze thawed milk.Used portions of breast milk must be discarded

Nursing Care and Discharge Teaching: Care of a Newborn Who Is Uncircumcised (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 26) Remove the newborn from the restraining board, and swaddle to provide comfort.Monitor for bleeding and voiding per facility protocol. Apply gauze lightly to penis if bleeding or oozing is observed.Fan-fold diapers to prevent pressure on the circumcised area.

Liquid acetaminophen 10 to 15 mg/kg can be administered orally after the procedure and repeated every 4 to 6 hr as prescribed for a maximum of 30 to 45mg/kg/day

Nursing Care During Stages of Labor: Interventions During the Third Stage of Labor (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 14) Lasts from the birth of the fetus until the placenta is delivered

Nursing Care During Stages of Labor: Transition Stage of Labor (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 14)

DURING THE TRANSITION PHASE

Continue to encourage voiding every 2 hr.Continue to monitor and support the client and fetus.Encourage a rapid pant-pant-blow breathing pattern if the client has not learned a particular breathing pattern.Discourage pushing efforts until the cervix is fully dilated.Listen for client statements expressing the need to have a bowel movement. This sensation is a finding of complete dilation and fetal descent.Prepare the client for the birth.Observe for perineal bulging or crowning (appearance of the fetal head at the perineum).Encourage the client to begin bearing down with contractions once the cervix is fully dilated

Nutrition During Pregnancy: Client Teaching About Dietary Intake (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 5) Increase calories: An increase of 340 calories/day is recommended during the second trimester.An increase of 462calories/day is recommended during the third trimester. If the client is breastfeeding during the postpartum period, additional caloric intake is advised. The American Academy of Pediatrics (AAP) recommends that breastfeeding women who are well nourished should add 450 to 500 calories/day to a balanced diet.Increasing protein intake is essential to basic growth. Also, the intake of foods high in folic acid is crucial for neurological development and the prevention of fetal neural tube defects. Foods high in folic acid include leafy vegetables, dried peas and beans, seeds, and orange juice. Breads, cereals, and other grains are fortified with folic acid. The March of Dimes recommends that clients who wish to become pregnant and clients of childbearing age take 400 mcg of folic acid .and clients who become pregnant take 600 mcg of folic acid.Iron supplements are often added to the prenatal plan to facilitate an increase of the maternal RBC mass. Iron is best absorbed between meals and when given with a source of vitamin C. Milk and caffeine interfere with the absorption of iron supplements. Food sources of iron include beef liver, red meats, fish, poultry, dried peas and beans, and fortified cereals and breads. A stool softener might need to be added to decrease constipation experienced with iron supplements.Calcium, which is important to a developing fetus, is involved in bone and teeth formation.Sources of calcium include milk, calcium-fortified soy milk, fortified orange juice, nuts, legumes,