Maternal and Newborn Nursing – LPN Flashcards

Rapid-review flashcards at NCLEX-PN depth, focused on routine data collection, safe basic care, reinforcing teaching, and knowing what to report to the registered nurse. Scope of practice for the LPN and LVN varies by state, so follow the state nurse practice act and facility policy. Core content is at Maternal and Newborn Nursing.

Pregnancy Basics

Gravida and para

Gravida is the number of pregnancies, no matter how they ended. Para is the number of pregnancies carried to 20 weeks or beyond. Twins delivered at 36 weeks count as para 1, because para counts pregnancies, not babies.

Common discomforts of pregnancy and simple comfort measures

Nausea: dry crackers before rising, small frequent meals. Heartburn: small meals, stay upright after eating. Constipation: fluids, fiber, walking. Leg swelling and varicosities: elevate the legs, avoid crossing them. Back pain: pelvic tilt, low-heeled shoes, good body mechanics.

Warning signs a pregnant client must report right away

Vaginal bleeding, leaking fluid, severe or persistent headache, blurred vision or spots, right upper abdominal pain, sudden swelling of the face or hands, persistent vomiting, fever, painful urination, decreased fetal movement, and regular contractions before 37 weeks.

Why a pregnant client is never left lying flat on her back after about 20 weeks

The uterus presses on the large vein returning blood to the heart, causing dizziness, pallor, nausea, low blood pressure, and a drop in the baby's heart rate. Turn her onto her side, classically the left side, and report the episode.

Normal fetal heart rate

110 to 160 beats per minute. A rate outside this range is reported to the registered nurse.

Foods and substances to avoid in pregnancy

Alcohol (no safe amount), tobacco, unpasteurized dairy and juice, deli meats unless heated until steaming, raw or undercooked meat, fish, and eggs, and high-mercury fish such as shark, swordfish, king mackerel, and tilefish. Avoid changing cat litter because of toxoplasmosis.

Labor and Birth Basics

True labor versus false labor

True: regular contractions that get closer, longer, and stronger, usually felt in the back moving to the front, not relieved by walking or rest, and the cervix changes. False: irregular, felt mostly in the abdomen, and eased by walking, position change, or fluids.

Rupture of membranes

what to observe and report

Note the time, amount, color, and odor of the fluid. Normal fluid is clear with small white flecks. Report green or brown (meconium), a foul odor, cloudiness, or bleeding, and report any change in the fetal heart rate right after the water breaks.

The four stages of labor

First: onset of labor until the cervix is fully dilated at 10 cm. Second: full dilation until the baby is born. Third: birth of the baby until the placenta is delivered, usually within 5 to 30 minutes. Fourth: the first 1 to 4 hours after the placenta, the highest-risk period for heavy bleeding.

Nursing care during an epidural

Check blood pressure frequently as directed, because low blood pressure is the most common problem. Keep the client off her back, help her void or monitor the catheter because she cannot feel a full bladder, and use fall precautions because her legs are weak. Report dizziness, nausea, or a drop in blood pressure immediately.

Postpartum Care

BUBBLE-HE

Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy or perineum, Homan sign or leg check, Emotional status. This is the routine head-to-toe framework for every postpartum check.

Where the fundus should be and how it changes

Firm, midline, and at or near the level of the umbilicus within a few hours after birth, then dropping about one fingerbreadth per day. It is usually no longer felt by about 10 to 14 days. Clients who had a cesarean birth still get fundal checks.

What a boggy fundus means and the first action

The uterus is soft and not contracting, which allows bleeding. Massage the fundus first, support the lower uterus with the other hand, then reassess and report to the registered nurse if it does not firm up or bleeding continues.

What a fundus that is high and pushed to the right means

A full bladder. Help the client empty her bladder, then recheck the fundus. A full bladder keeps the uterus from contracting and causes extra bleeding.

The three stages of lochia

Rubra: dark red, days 1 to 3. Serosa: pinkish-brown, days 4 to 10. Alba: creamy white or yellow, day 11 through about 4 to 6 weeks. The flow should get lighter over time, never heavier.

Lochia findings that must be reported

Soaking a perineal pad in 1 hour or less, a foul odor, large clots, or bright red bleeding that returns after the flow had already lightened. Always look underneath the client, because blood collects under the buttocks.

Why postpartum bradycardia is normal but tachycardia is not

A pulse of 50 to 70 beats per minute is expected in the first days as the extra blood volume of pregnancy is handled by the heart. A fast pulse is the warning sign for bleeding, infection, pain, or anxiety, and it is reported.

The postpartum fever rule

A temperature up to 100.4 degrees F (38 degrees C) in the first 24 hours can come from dehydration and hard work. 100.4 degrees F or higher after the first 24 hours is reported, because it suggests infection.

Normal postpartum changes that do not need reporting

Heavy sweating and large urine output in the first days, chills and shaking right after birth in a client with no fever, afterpains that are stronger during breastfeeding and in clients who have had more than one baby, and fatigue.

Perineal care after a vaginal birth

Ice packs for the first 24 hours to reduce swelling, then sitz baths and warmth afterward. Use a peri-bottle with warm water, pat rather than rub, and always cleanse and wipe front to back. Change the pad at each voiding and wash hands before and after.

REEDA

Redness, Edema, Ecchymosis (bruising), Discharge, Approximation of the wound edges. Used to check an episiotomy or laceration repair.

A postpartum client with severe, unrelieved perineal or rectal pain

Suspect a hematoma, which is a collection of blood in the tissue that can hide a large blood loss. Report it to the registered nurse right away; do not simply give more pain medication and move on.

Signs of mastitis and what happens to feeding

Usually one breast with a red, warm, tender, wedge-shaped area, plus fever and flu-like aching. It is treated with antibiotics, rest, and fluids, and the mother keeps breastfeeding or pumping on that side, because emptying the breast is part of the treatment.

Postpartum blues versus something that needs urgent help

Blues are common tearfulness and mood swings that start within days and go away by about 2 weeks. Report sadness or hopelessness lasting longer than 2 weeks, inability to care for herself or the baby, or any statement about harming herself or the baby. Hallucinations or strange beliefs about the baby are an emergency, and the infant must not be left alone with her.

Postpartum warning signs to teach before discharge

Fever, foul-smelling discharge, soaking a pad in an hour, severe headache or vision changes, chest pain or trouble breathing, pain, swelling, warmth, or redness in one calf, and thoughts of harming self or baby. Remind her that high blood pressure problems can start after going home.

Newborn Care

Normal newborn vital signs

Heart rate 110 to 160 beats per minute while awake, respirations 30 to 60 per minute and irregular, axillary temperature 97.7 to 99.5 degrees F (36.5 to 37.5 degrees C). Always take a newborn temperature under the arm, not rectally, for routine checks.

Newborn breathing findings that must be reported immediately

A rate over 60 that stays up, grunting, nasal flaring, chest retractions, pauses in breathing longer than 20 seconds, and cyanosis around the mouth or of the trunk and lips.

Acrocyanosis versus central cyanosis

Acrocyanosis is blue hands and feet with a pink trunk and face in the first 24 to 48 hours, and it is normal. Central cyanosis, meaning blue lips, tongue, or trunk, is never normal and is reported at once.

The four ways a newborn loses heat and how to prevent each

Evaporation: dry the baby right away and remove wet blankets. Conduction: prewarm the scale, mattress, and your stethoscope and hands. Convection: keep the baby away from drafts, vents, and open doors. Radiation: keep the crib away from cold windows and outside walls.

Why a cold newborn is a serious problem

Newborns cannot shiver. Getting cold makes them burn energy and oxygen fast, which leads to low blood sugar, trouble breathing, and acid buildup in the blood. Skin-to-skin contact with the parent is one of the best warming methods, and the first bath is delayed until the temperature is stable.

Signs of low blood sugar in a newborn and what to do

Jitteriness or tremors, poor feeding, sleepiness or floppiness, a weak or high-pitched cry, temperature instability, and pauses in breathing. Check a blood glucose and report it; do not simply swaddle the baby and wait. Babies at highest risk are large or small for their age, preterm, and infants of diabetic mothers.

Normal newborn skin findings that are not problems

Milia (tiny white bumps on the nose and chin), erythema toxicum (a blotchy newborn rash), vernix caseosa, lanugo, congenital dermal melanocytosis (bluish patches formerly called Mongolian spots), and molding of the head from birth.

Newborn jaundice

the timing rule

Yellow skin or eyes appearing in the first 24 hours must be reported immediately because it suggests a serious cause. Jaundice that starts after 24 hours and peaks around days 3 to 5 is usually normal newborn jaundice. Frequent feeding helps the baby get rid of bilirubin in the stool; plain water does not and is never given.

First void and first stool expectations

First urine within 24 hours and first meconium stool within 24 to 48 hours. Report if either does not happen. Stools go from black tarry meconium, to greenish transitional, to yellow and seedy in breastfed babies or pale yellow to tan and firmer in formula-fed babies.

Newborn cord care

Keep it clean and dry, fold the diaper down below it, and let it fall off on its own in about 7 to 14 days. Do not pull on it and do not routinely use alcohol. Report spreading redness on the belly, pus, foul odor, or fever.

Circumcision care with a Plastibell

Do not remove the ring; it falls off on its own in about 5 to 8 days. A yellowish film on the tip is normal healing and is not wiped off. Clean gently with warm water, never alcohol. Report bleeding more than a few drops, no urination within 6 to 8 hours, foul odor, or swelling with fever.

The heel stick newborn screening

Usually done at 24 to 48 hours of age after the baby has been feeding. Warm the heel first and use the lateral (outer) part of the heel to avoid injuring the heel bone. Comfort measures include swaddling, a pacifier, and skin-to-skin contact.

Safe sleep teaching

Back to sleep every time, on a firm flat surface with a fitted sheet, in the baby's own crib or bassinet in the parents' room. No pillows, blankets, bumper pads, positioners, or stuffed toys. Avoid overheating and any smoke exposure. Supervised tummy time is for awake play only.

Breastfeeding basics to reinforce

Feed 8 to 12 times in 24 hours on demand. Watch for early hunger cues such as rooting, hand to mouth, and lip smacking, because crying is a late cue. A good latch has a wide-open mouth taking in the nipple and much of the areola, with lips flanged out and audible swallowing. Break suction with a clean finger before removing the baby.

How parents can tell the baby is getting enough milk

At least 6 wet diapers a day by about day 4 to 5, three or more stools a day in the early weeks, audible swallowing during feeds, contentment after feeding, and steady weight gain after the normal early weight loss.

Safe formula preparation

Mix exactly as the label directs. Adding extra water can cause dangerous low sodium and seizures, and too little water strains the kidneys. Never microwave a bottle because of hot spots. Hold the baby semi-upright with the nipple full of formula, never prop the bottle, and discard formula left in the bottle after a feeding.

When parents must call the provider about a newborn

An axillary temperature of 100.4 degrees F (38 degrees C) or higher in a baby under about 3 months is an emergency. Also call for poor feeding, unusual sleepiness, fewer wet diapers, repeated vomiting, worsening yellow color, breathing trouble, or a cord or circumcision site that looks infected.

Car seat teaching

Rear-facing in the back seat, properly secured, and never in front of an active airbag. The harness is snug with the chest clip at armpit level, and bulky coats go over the buckled harness, not under it.

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