Chapter 1

Foundations in Maternal-Newborn and Women’s Health Nursing

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Summary

Recent changes in women’s health are focused on promoting health, decreasing mortality, decreasing stigma, and supporting persons AFAB in advocating for themselves to receive quality health care. Organizations such as the CDC and WHO have published recommendations and practice suggestions to guide health-care policy and address social determinants of health . Nurses play an important role in decreasing the stigma of taboo topics by providing education and support. Nurses also encourage self-advocacy in health care by practicing shared decision making and informed consent.

Key terms

maternal-fetal conflict

when maternal interests and fetal interests are incompatible

error of omission

treatment or an assessment by a nurse that is not performed

family-centered care

set of principles that guide health-care delivery according to the strengths and needs of the person, family, and community, promoting involvement of the family in informed…

risk management

identifying risk factors by analyzing processes and procedures and implementing programs to address risk and prevent patient harm

maternal mortality

death of a person while pregnant or within 42 days of birth or termination of pregnancy that was not accidental

community health nurse

provide education and health promotion outside the hospital setting, directly to the public

stem cells

undifferentiated cells that can renew themselves and develop into different types of cells

Chapter 2

Culturally Competent Nursing Care

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Summary

A family consists of people who share a kinship and is defined by the people who make up that kinship. The nurse cares for the family by using inclusive language and respecting all cultures and disabilities. Knowing how people would like to be addressed, knowing when to ask questions at a time family is present, using a professional interpreter, and ordering special equipment for people with disabilities allow patients to… Family, religion, and culture make up a person’s belief system.

Key terms

culture

set of beliefs, attitudes, and practices shared by a group of people or community that is accepted, followed, and passed down to other members of the group

time family

present, using a professional interpreter, and ordering special equipment for people with disabilities allow patients to…

kinship and

defined by the people who make up that kinship

blended family

parents and children who are not biologically related to the other parent, usually created after a death or divorce but also include those who have never married; also called a…

culturally responsive care

occurs when a person’s cultural beliefs are integrated into their health care; culturally responsive care is required for a trusting, effective relationship with the patient and…

Four Cs of Culture model

example of a quick cultural assessment tool that asks questions about what the patient C onsiders to be a problem, the C ause of the problem, how they are C oping with the…

social determinants of health

nonmedical factors that influence health outcomes, including conditions in which people are born, grow, work, live, and age, and the wider sets of forces and systems shaping the…

cultural competence

lifelong process of applying evidence-based nursing in agreement with the cultural values, beliefs, worldview, and practices of patients to produce improved patient outcomes

Chapter 3

Health Promotion, Disease and Injury Prevention, and Well-Person Care

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Summary

Understanding the leading causes of morbidity and mortality among persons AFAB is paramount for public health efforts. The health of a person AFAB is influenced by a great number of factors. Access to health care plays a large part in the health of the individual, family, and community. Health-care education regarding STIs, contraception, mental health, and general overall health influence choices regarding health and safety

Key terms

health of a person AFAB

influenced by a great number of factors

morbidity

being ill from a particular condition

mortality

death from a particular condition

carrier screening

testing offered prior to pregnancy to determine if a couple is at risk for having a child with a particular genetic disorder

disordered eating

maladaptive nutritional practices that are not severe enough to meet the diagnostic criteria for a specific eating disorder but still involve problematic attitudes and behaviors…

resolution phase

return to baseline where muscles are relaxed and pulse, blood pressure, and respirations return to normal

eating disorder

serious mental health condition characterized by abnormal eating patterns, attitudes, and behaviors toward food and weight; often involves a preoccupation with food, weight, body…

excitement phase

phase of the sexual response in which sexual desire and arousal begin in reaction to sexual stimuli, such as physical touch, erotic thoughts, or visual cues

Chapter 4

Influences on Fertility

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Summary

Assessing a couple who presents with infertility involves looking at both partners and the three main factors that are essential for conception: the release of an egg, the presence of sperm, and a healthy environment… Couples with infertility may seek care from a reproductive endocrinologist who specializes in the treatment of infertility. Infertility can be caused by factors in either or both partners, though in many cases, a specific cause cannot be identified. Though conception and pregnancy are largely physiologic events, the nurse must not neglect the important psychosocial factors that are associated with fertility and conception, including stress and societal pressures.

Key terms

fertility

person’s ability to become pregnant

chromosome

contains thousands of genes, which make up the basic unit of heredity and are composed of proteins and DNA

infertility

inability to become pregnant after 1 year of regular sexual intercourse without using any form of birth control

intrauterine insemination (IUI)

medical procedure performed by medical providers or specially trained nurses, in which specially washed sperm cells are injected through a catheter into the uterus

karyotype

simple blood test where the sample is treated with a special stain that allows the chromosomes to be visualized, sorted into their 23 matching pairs so that they can be…

Chapter 5

Family Planning

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Summary

Contraindications, side effects, and effectiveness of different methods are discussed, and shared decision making concludes with the person choosing a method they are confident in using The cost of FAM, coitus interruptus, or abstinence is minimal to zero, and there is no need to obtain a prescription. Contraceptive education and access empower persons to plan for education, create a career, become healthy prior to pregnancy, and choose when to start a family. The nurse aids in this process by providing education on different methods of contraception that are individualized, safe, and affordable.

Key terms

coitus interruptus

method of contraception, called withdrawal or pulling out, when the penis is withdrawn from the vagina prior to ejaculation

diaphragm

dome-shaped silicone cup that is inserted into the vagina to cover the cervix, preventing sperm from reaching the uterus

emergency contraception (EC)

form of contraception that is effective in interrupting a pregnancy before it begins if administered within a specific time frame after sexual intercourse

fertility awareness methods (FAM)

methods requiring the person who is menstruating to monitor the menstruation cycle and fertile window and to avoid vaginal coitus intimate contact during the fertile window

quick start method

method in which the patient begins taking COC pills on the day of the appointment because they have been deemed “reasonably certain” of not being pregnant due to history taking…

spinnbarkeit

cervical mucus that is more estrogen dominant, presents as clear, stretchable, and much more amenable to sperm mobility, occurring at ovulation

Sunday start method

in which the patient is educated to begin taking COC pills on the Sunday that follows the first day of the next menstrual cycle

Chapter 6

Structural and Tissue Disorders of the Reproductive System

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Summary

Endometriosis can cause patients to experience debilitating pain and can increase concern for fertility. Perimenopause and menopause can be difficult times for some patients. Menstrual disorders can significantly impact a patient’s physical and emotional well-being. Menstrual disorders that cause pain can decrease the patient’s quality of life and interfere with daily tasks.

Key terms

perimenopause

phase of menstrual irregularities that is attributed to fluctuating hormone levels lasting for months up to several years and that ends when menses has ceased for 12 months

endometriosis

chronic and often painfully debilitating gynecologic disorder characterized by the presence of endometrial-like tissue outside the uterus

fistula

abnormal connection between two surfaces in the body that are not meant to be connected

abnormal uterine bleeding (AUB)

common gynecologic condition characterized by atypical bleeding patterns that deviate from a person’s normal menstrual cycle

premenstrual dysphoric disorder (PMDD)

similar to PMS but has a more extreme presentation, causing extreme depression and anxiety in the luteal phase of the cycle

premenstrual syndrome (PMS)

common and cyclic disorder that occurs during the luteal phase of the menstrual cycle in people who menstruate; characterized by mood swings, irritability, anxiety, fatigue…

congenital malformation

abnormality of a structure that develops during formation of the embryo and presents with a wide variety of symptoms

leiomyoma

(also, fibroid ) benign tumor that develops from the smooth muscle tissue of the uterus

Chapter 7

Commonly Occurring Reproductive and Genitourinary System Infections

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Summary

There is still a stigma surrounding STIs. STIs are a health problem in the United States and the world. Patient education is an important part of prevention. Patients need to be educated about how to prevent STIs as well as how to recognize them and when to report symptoms.

Key terms

stigma

negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against a group of people

whiff test

test on vaginal sample in which a few drops of potassium hydroxide (KOH) are mixed with the sample; the KOH kills bacteria and leaves only yeast behind, revealing if there is a…

human immunodeficiency virus (HIV)

enveloped retrovirus that is encapsulated by two single-stranded RNAs and can be the cause of AIDS

herpes simplex virus (HSV)

virus that causes herpes and is not curable

group B streptococcus

type of bacteria that can live in a person’s gastrointestinal and genital tracts without causing problems but that can invade the body and cause infection

human papillomavirus (HPV)

double-stranded DNA virus that replicates in the basal cell layer of stratified squamous epithelial cells, which then replicate and cause hyperplasia and possible cancer

pyelonephritis

bacterial infection of the upper urinary tract that causes inflammation of the kidneys

hepatitis

viral infection with three main types, hepatitis A, hepatitis B, and hepatitis C

Chapter 8

Disorders of the Breast

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Summary

A common fear of people experiencing a change in their breasts is that they have cancer, especially because many benign changes mimic symptoms of breast cancer. However, benign breast changes encompass several different conditions, including trauma, breast pain, infection, skin changes, nipple discharge, and tumors. These changes are often associated with fluctuations in estrogen, which may explain why they are more common in persons of childbearing age. Nurses play a role in educating the person on the difference between their diagnosis and breast cancer.

Key terms

benign breast changes

umbrella term that encompasses several different noncancerous conditions that occur in the breast tissue, including trauma, breast pain, infection, skin changes, nipple…

change in their breasts

that they have cancer, especially because many benign changes mimic symptoms of breast cancer

lumpectomy

surgical procedure that removes the tumor, a small ring of healthy tissue around the tumor (to ensure that all cancer cells are removed) and, possibly, some axillary lymph nodes

calcification

calcium deposit found in the breast tissue that is usually benign but can sometimes indicate an early breast cancer

triple negative cancer

cancer that is negative for HER2 protein and estrogen/progesterone receptors

triple positive cancer

cancer that is positive for HER2 protein and estrogen/progesterone receptors

mammary ductal ectasia

(also: periductal mastitis ) chronic inflammation of the breast tissue that also causes dilated mammary ducts with thickened walls; plasma cell infiltration; leakage of fluid…

Chapter 9

Violence Against Women

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Summary

Violence against women is a worldwide problem, and some populations are at a higher risk. To understand and prevent violence against women, theories have been developed and integrated into the health-care and legal systems. Intimate partner violence can include physical, financial, and sexual violence. The perpetrator’s aim is to control the partner by any means possible.

Key terms

violence against women

any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion, or…

sexual violence

continuum of sexual activity that covers unwanted kissing, touching, or fondling; sexual coercion; rape; and control of the outcome of a pregnancy and the forbidding of…

age-related rape

also known as statutory rape; occurs when one sexual partner is below the age of consent, determined by each state

acid attack

premeditated attack in which acid is thrown on someone to torment, hurt, burn, and disfigure them

domestic violence

form of abuse that occurs within a family or household; can take many forms, including physical, emotional, sexual, and financial abuse

financial abuse

exploitation or misuse of a person’s financial resources, often by a trusted person, such as a family member or caregiver

hate crime

criminal offense motivated by prejudice or bias against an individual or group based on their race, ethnicity, religion, sexual orientation, gender identity, or other…

Chapter 10

Pregnancy

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Summary

It is important for the nurse to understand how hormone production during pregnancy and the growth of the fetus are responsible for the physiologic and anatomic changes that occur throughout the pregnancy, affecting… The nurse also needs to differentiate between the presumptive, probable, and positive signs of pregnancy. The major hormones establishing, supporting, and maintaining the pregnancy are produced by the placenta The patient education provided by the nurse to the pregnant person includes the functions of the hormones of pregnancy, the systemic physiologic changes during pregnancy, and the signs of pregnancy

Key terms

pregnancy

produced by the placenta

positive signs of pregnancy

signs that directly confirm a person is pregnant

growth of the fetus

responsible for the physiologic and anatomic changes that occur throughout the pregnancy, affecting…

free-standing birthing center

provides intrapartum, postpartum, and normal newborn care to low-risk persons whose pregnancy is uncomplicated and there is only one fetus in a vertex presentation

presumptive signs of pregnancy

symptoms noticed by the patient and are the least reliable symptoms of confirming a pregnancy because the signs can also occur with other medical conditions

probable signs of pregnancy

objective cues occurring during pregnancy and noticed by the provider and are also associated with gynecologic conditions, not just pregnancy

TORCH

group of infectious diseases that can be passed from the pregnant person to the fetus and is a known teratogen; diseases included are toxoplasmosis, other (originally only…

Chapter 11

Prenatal Care

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Summary

Prenatal care in the first trimester of pregnancy often involves reassuring the pregnant person. The physical examination is a modified head-to-toe examination and a focused reproductive examination of the patient. The initial prenatal visit includes a comprehensive history and physical of the person who is pregnant. The history focuses on the pregnant person, the biological father (or sperm donor) of the baby, family, and lifestyle practices.

Key terms

trimester

14 weeks of pregnancy; the 280 days of gestation during pregnancy are divided into three periods, called trimesters

physical examination

a modified head-to-toe examination and a focused reproductive examination of the patient

first trimester

0 to 13 weeks and 6 days of gestation

fundal height

measurement from the symphysis pubis to where the fundus (or top) of the uterus is palpated in a patient who is pregnant

integrated or sequential screenings

tests performed in the first and second trimesters of pregnancy to determine if there is an increased risk for abnormal chromosome and neural tube defects in the fetus

quad marker screen

measures the maternal serum levels of four pregnancy markers, alpha fetoprotein, hCG, unconjugated estriol, and inhibin-A, to determine if there is an increased risk for abnormal…

shoulder presentation

when the fetus is in a transverse lie and the shoulder is presenting into the pelvis first

estimated date of delivery (EDD)

date the pregnant patient is expected to give birth, plus or minus 2 weeks

Chapter 12

Pregnancy at Risk

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Summary

Nutritional imbalances from overnutrition or undernutrition require specific nutritional interventions and monitoring during preconception and pregnancy to prevent anemia and other complications. A high-risk pregnancy is one in which the pregnant person and fetus are at increased risk for adverse health outcomes during pregnancy. Preexisting medical conditions, such as hypertension, diabetes, and thyroid disorders, should be managed closely prior to and after conception with an interdisciplinary care team. The first trimester is a critical time for fetal development, so conditions that develop during this period can significantly compromise fetal health.

Key terms

anemia

level of red blood cells or hemoglobin that is too low to supply enough oxygen to the tissues of the body

preexisting medical condition

medical condition that is present prior to conception

first trimester

a critical time for fetal development, so conditions that develop during this period can significantly compromise fetal health

undernutrition

imbalance of nutrition related to inadequate intake of food and necessary nutrients

high-risk pregnancy

pregnancy that has an increased likelihood of maternal and fetal complications

overnutrition

imbalance of nutrition that results from excessive food intake

complete abortion

occurs when there is a termination of pregnancy that results in all the products of conception being expelled from the uterus, such as the fetus, placenta, and other tissue

dilation and curettage (D&C)

surgical procedure in which the contents of the uterus are removed by dilating the cervix and using a surgical instrument (curette) to evacuate the uterine tissue and lining

Chapter 13

Prenatal Testing

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Summary

Nurses are responsible for obtaining a comprehensive obstetric and menstrual history and educating pregnant persons on the routine, screening, and diagnostic tests available and the reasons they are performed and… It is important for nurses to educate the pregnant person on the screenings recommended and inform them that the screenings predict the risk of the fetus having a genetic, structural, or neural tube defect. Additional diagnostic testing is needed if the screenings come back abnormal Many prenatal tests are recommended during the first trimester of pregnancy.

Key terms

screening

test used to identify whether a fetus is more or less likely to have certain birth defects, many which are genetic disorders

biophysical profile (BPP)

scoring system to evaluate fetal well-being in the following areas: fetal heart rate, fetal breathing movements, fetal body movements, fetal muscle tone, and amount of amniotic…

cell-free DNA (cfDNA) screening

blood test that can be done as early as 10 weeks’ gestation and up until delivery that screens for certain conditions caused by an abnormal number of chromosomes

chorionic villus sampling (CVS)

prenatal diagnostic test conducted between the 10th and 13th week of pregnancy to diagnose fetal chromosomal, metabolic, or DNA abnormalities

fetal movement count

(also called “kick count”) test that keeps track of the fetus’s movements and that can be performed at home by the pregnant person

fetoscopy

procedure that involves inserting a thin fiber-optic tube, or fetoscope, into the uterus through a small incision made in the abdomen of the pregnant person

integrated screen part 2

(also called quad screen) blood test taken between 15 and 20 weeks’ gestation to screen for neural tube defects such as spina bifida and chromosomal disorders such as Down…

Chapter 14

Childbirth Education Options

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Summary

The organization provides childbirth education to families, provides recommendations for health-care providers and practices, advocates for birthing rights, and proposes ways to protect physiologic birth. The Bradley Method is childbirth education that includes nutrition, exercise, knowledge of medical interventions, and continuous labor support. Essential to the Bradley Method is the support person for the laboring person The philosophy is grounded in the fear-tension-pain cycle, the idea that fear causes tension, which then causes pain; therefore, if a person can reduce fear, they can reduce pain.

Key terms

childbirth education

becoming educated in the process of pregnancy, labor, birth, and postpartum and newborn care

Bradley Method

childbirth education that includes nutrition, exercise, knowledge of medical interventions, and continuous labor support

philosophy

grounded in the fear-tension-pain cycle, the idea that fear causes tension, which then causes pain; therefore, if a person can reduce fear, they can reduce pain

physiologic birth

birth that occurs vaginally and without medical intervention

deepening

relaxation to the point where the birthing person is in a limp, almost anesthetized state

birth plan

form of communication between a birthing person, their support people, and the care team they have chosen for their birth outlining their wishes for the labor and birth

inhibiting

conscious act of preventing oneself from rushing into an action without thoughtful consideration of the body

directing

consciously organizing one’s body prior to and during an action so that the head leads the body’s movement

Chapter 15

Process of Labor and Birth

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Summary

To remember these interactions, think of the 5 P’s: power, passage, passenger, position, and psyche. The nurse’s understanding of the expected progression of the four stages of labor is crucial when providing care during each step, starting at triage through transfer of the patient to the postpartum recovery room. Labor is an intricate process that involves the laboring person, the fetus, and the interactions between them. If any of these components is not functioning as expected, the labor and birth can be impacted.

Key terms

labor

uterine contractions that lead to dilation and effacement of the cervix and move the presenting fetal part through the pelvis

four stages of labor

crucial when providing care during each step, starting at triage through transfer of the patient to the postpartum recovery room

position

position of the laboring and birthing person; impacts much of the birth process and often changes the course of labor

psyche

mind of the laboring and birthing person, which can have a lasting impact on every stage of labor and birth

power

strength of the uterine muscle contractions and the birthing person’s expulsive efforts

passage

pelvic anatomy that the fetus navigates during birth

passenger

fetus and how they proceed through the passage

restitution

external rotation of the fetal head once the head is born, whereby the fetus then turns to the left or right oblique diameter of the pelvis to allow passage of the shoulders…

Chapter 16

Electronic Fetal and Uterine Contraction Monitoring

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Summary

The nurse uses the FHR to determine the well-being of the fetus during the antepartum and intrapartum periods by evaluating for FHR baseline variability, accelerations, and decelerations. Signs of a nonreassuring FHR tracing include minimal or absent variability, late decelerations, marked variability, and prolonged decelerations. Nurses in the perinatal area are trained and can be certified in FHR monitoring. A reassuring FHR tracing demonstrates adequate oxygenation and includes moderate variability, accelerations, and a baseline FHR between 110 and 160 bpm.

Key terms

late decelerations

symmetrical, gradual decreases in FHR after the start of a uterine contraction, with return to baseline after the ending of the contraction

prolonged decelerations

isolated, sporadic decelerations of at least 15 bpm from the FHR baseline that last 2 to 10 minutes from onset to return to baseline

FHR baseline

average beats per minute in a 10-minute segment, excluding periodic changes or marked variability

accelerations

abrupt increases in the FHR above the baseline 15 bpm or more lasting 15 seconds or more

nurse

aware of the advantages and disadvantages of each type of monitoring technique

perinatal area

trained and can be certified in FHR monitoring

contraction frequency

how often the contractions are occurring, determined by measuring from the beginning of one contraction to the beginning of the next contraction

contraction length

how long the contraction lasts, determined by measuring the time between the beginning of the contraction to the end of the contraction

Chapter 17

Pain Management During Labor and Birth

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Summary

The laboring person has many options for nonpharmacologic methods to control pain, fear, and anxiety in labor. When the laboring person is relaxed, fewer stress hormones are released into the body, and the person experiences less pain. Some of these relaxation techniques, such as biofeedback and hypnosis, should be practiced during pregnancy to prepare for labor. Other techniques, such as massage, position changes, and acupressure, can be used for the first time in labor.

Key terms

laboring person

relaxed, fewer stress hormones are released into the body, and the person experiences less pain

biofeedback

mind-body practice where a sensor monitors different pain reactions in the body while the person uses techniques to control those reactions

acupressure

practice of stimulating or putting pressure on specific areas of the body

epidural anesthesia

regional anesthesia produced by injection and infusion of a local anesthetic (bupivacaine [Marcaine]) and a narcotic (fentanyl) around the spinal nerves to block pain from T10 to…

focal points

used when the laboring person focuses on a picture or an object during the contraction to direct attention away from the contraction

doulas

trained support laypersons who provide emotional, physical, and social support during pregnancy, labor, and postpartum

pudendal block

local anesthetizing of the pudendal nerve that provides sensation to the perineum, anus, vulva, and clitoris

imagery

uses the mind-body connection to focus the laboring person’s awareness on a positive image

Chapter 18

Nursing Care and Interventions During Labor and Birth

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Summary

Starting at the time the laboring person arrives in the obstetric triage unit, the nurse establishes a relationship with the person during this first stage in the process of becoming a parent. Whether the care is as simple as getting ice chips or as complicated as fetal monitor interpretation, the nurse is the care provider at the bedside. The second stage of labor is an exciting time for families. The birthing person is now fully dilated, and the birth of the newborn is near.

Key terms

care

as simple as getting ice chips or as complicated as fetal monitor interpretation, the nurse is the care provider at the bedside

birthing person

now fully dilated, and the birth of the newborn is near

obstetric triage

rapid assessment and prioritization of care based on the specific obstetric and gynecologic needs

second stage of labor

an exciting time for families

shoulder dystocia

condition presenting during delivery in which the head of the newborn is delivered but a shoulder is trapped behind the birthing person’s pubic bone

amniotomy

procedure performed during labor and delivery in which a health-care provider intentionally breaks the amniotic sac or amniotic membrane; known as the artificial rupture of…

delayed cord clamping

allowing extra time for blood in the cord and placenta to flow to the baby by waiting to clamp the cord, usually for 1 minute after birth

fourth-degree laceration

tear that extends through the skin, subcuticular tissue, muscles of the perineum, and anal sphincter into the rectal mucosa; includes damage to the pelvic floor and surrounding…

Chapter 19

Complications of Labor and Birth

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Summary

The nurse is aware of the causes of labor dystocia and the most common treatments to resolve those causes Labor dystocia can be caused by multiple factors. When one or more of these factors are abnormal, labor dystocia occurs.

Key terms

nurse

aware of the causes of labor dystocia and the most common treatments to resolve those causes

dystocia

lack of progress during labor, which could make it prolonged or difficult

pelvic dystocia

labor complication that occurs when the size of the fetal head is larger than the size of the maternal pelvis due to a small capacity of the pelvic inlet, midpelvis, or pelvic…

precipitous labor

delivery that is extremely rapid and usually less than 3 hours from start of the contractions to birth

fetal dystocia

complication in which the fetal head is unable to navigate through the pelvis

succenturiate lobe

accessory lobe that is separate from the main placenta

Bishop score

tool used to determine if the cervix is favorable

Chapter 20

Postpartum Care

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Summary

The postpartum period is a time of many changes. The nurse assesses for normal and abnormal changes during the postpartum period. During the immediate postpartum period, the nurse performs routine postpartum assessments using the BUBBLEHE acronym. Postpartum healing and transitioning to being the primary caregiver of a newborn are influenced by resolution of physiologic changes, support systems, and culture and traditions.

Key terms

postpartum depression

mood disorder whose symptoms are feelings of extreme stress, detachment from the newborn, anxiety, and feelings of being overwhelmed that last longer than 2 weeks and are more…

primary caregiver of a newborn

influenced by resolution of physiologic changes, support systems, and culture and traditions

lochia alba

final postpartum discharge that is yellow-white and consists of white blood cells, epithelial cells, and mucus; occurs from approximately day 10 to 28

postpartum blues

(also: baby blues ) low moods that are common during the first 2 weeks of the postpartum period that resolve by themselves without treatment or medication

taking-in phase

phase starting 1 or 2 days after birth, in which the postpartum person is concerned with physical recovery, adapting to body changes, and caring for the newborn

engorgement

painful sensation of filling of the breasts, described as a feeling of hard breasts that ache and are hot to the touch

lactogenesis

physiologic process of developing the means to secrete milk

Chapter 21

Postpartum Complications

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Summary

The nurse assesses for signs of infection beginning in recovery directly after birth until discharge home. The nurse is aware that infection can progress quickly and cause morbidity and mortality. Postpartum hemorrhage is an emergency that is treated by a multidisciplinary team. The nurse is the first line in prevention of PPH by recognizing risk factors and close monitoring of uterine consistency and lochia, encouraging frequent voiding, and assessing the incision and perineum.

Key terms

nurse

aware that infection can progress quickly and cause morbidity and mortality

postpartum psychosis (PPP)

mood disorder that occurs suddenly and can be very dangerous, with symptoms occurring within a few hours to weeks after birth; characterized by delusional thinking…

quantitative blood loss (QBL)

process of weighing and measuring the amount of blood loss during the birth and immediate postpartum period

early PPH

(also: primary PPH ) hemorrhage that occurs after birth of the placenta up to 24 hours postpartum

late PPH

(also: secondary PPH ) hemorrhage that occurs after the first 24 hours up to 12 weeks postpartum

primary PPH

(also: early PPH ) hemorrhage that occurs after birth of the placenta up to 24 hours postpartum

secondary PPH

(also: late PPH ) hemorrhage that occurs after the first 24 hours up to 12 weeks postpartum

Chapter 22

Immediate Care of the Newborn

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Summary

Assessing a newborn as they transition from intrauterine to extrauterine life is a critical job for the nurse. The neonatal transition period is an important time for careful assessment, early recognition of neonatal distress, and initiation of proper management. To do it competently, the nurse must know what normal newborn behavior is in order to recognize what is not normal. The nurse auscultates newborn heart tones quickly and efficiently and recognizes lung sounds that are normal.

Key terms

neonatal transition period

an important time for careful assessment, early recognition of neonatal distress, and initiation of proper management

homeothermic

attempting stabilization internally despite significant temperature variations in the environment the neonate is presently in

second period of reactivity

third and final episode of neonatal behavior lasting about 2 to 8 hours, characterized by increased activity, alertness, oral secretions, and an interest in feeding and…

nonshivering thermogenesis

increase in metabolic heat production above the basal metabolism that is not associated with muscle activity

convection

heat loss occurring when heat is transferred from the body surface to the surrounding air by a current

evaporation

heat loss that occurs when liquid is converted to vapor

Apgar assessment

standardized assessment to evaluate the response of the newborn’s transition to extrauterine life based on heart rate, respiration, reflex irritability, muscle tone, and color at…

Chapter 23

Newborn Assessment

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Summary

Performing the physical assessment with the new parents in the room is a good opportunity for the nurse to educate the parents on safety issues in handling and caring for their newborn. It is important for the nurse to know how to complete a comprehensive and accurate physical assessment on a newborn. New parents and even experienced ones will look to the nurse for guidance before discharge about how to integrate the newborn into their family, how to feed and soothe their newborn, and how to recognize when their… The nurse’s assessment should always work from the least invasive to the more invasive to avoid irritating the newborn and to maintain thermoregulation.

Key terms

new parents in the room

a good opportunity for the nurse to educate the parents on safety issues in handling and caring for their newborn

caput succedaneum

benign condition that crosses the suture lines in which edema is observed on a newborn’s scalp shortly after birth and is related to trauma during the delivery

cephalohematoma

condition in which there is an accumulation of serosanguineous or bloody fluid below the periosteum of the skull that does not cross the suture line, typically from an…

lanugo

fine, soft hair that covers the newborn’s back, shoulders, cheeks, forehead, and scalp; more common in newborns that are born early and often disappears within 4 weeks after birth

tongue-tie

(also: ankyloglossia ) abnormally short frenulum or a frenulum that is attached near the bottom of the tongue

phimosis

condition in which the opening of the foreskin is small and cannot be pulled back over the tip of the penis

Epstein pearls

small, firm, white cysts containing keratin that are sometimes found on the gums of a newborn’s mouth

meconium ileus

condition in which there is no passage of meconium in the first 24 to 48 hours after birth

Chapter 24

Care of the Typical Newborn

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Summary

Basic care of the newborn involves many important topics. Infant safety is essential, both in the hospital and at home, and nurses must reinforce this topic as often as possible. Nurses teach parents to identify hospital staff by their picture ID badges and, if badges are not easily visible, to ask to see them. Nurses should check parents’ and infant’s ID bands to make sure that the numbers match any time the family has been separated.

Key terms

influenza

viral illness that can cause many of the same symptoms as the common cold but is accompanied by severe body aches and higher fever; commonly referred to as the flu

physiologic regurgitation

(also: reflux ) spitting up of stomach contents in infants, or reflux, that occurs when the lower esophageal sphincter muscle lets the stomach contents back into the esophagus…

umbilical hernia

hernia caused by a small hole in the muscular part of the abdominal wall that allows the tissue to bulge out when there is increased abdominal pressure (e.g., crying)

respiratory syncytial virus (RSV)

contagious virus causing an illness that is more serious than a cold or upper respiratory infection

sudden infant death syndrome (SIDS)

unexplained death, usually during sleep, of a seemingly healthy baby that is less than a year old

transcutaneous bilirubin (TCB) monitor

painless handheld light meter that is routinely used to scan for bilirubin in the skin

transitional stool

stool that follows meconium and is yellowish-green

breast milk jaundice

(also: late-onset breast milk jaundice ) jaundice occurring in the first 3 to 5 days of life and lasting 3 weeks to as long as 3 months for some infants

Chapter 25

Care of the Newborn at Risk

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Summary

Nurses performing initial and ongoing early assessments on newborns need to be aware of and question signs and symptoms of birth trauma. The neonate can have pain, impaired mobility, or respiratory distress because of these injuries. The more serious consequences of birth trauma can lead to seizures and coma. Edema, bruising, immobility, or abnormal movement can be related to both common and life-threatening birth injuries.

Key terms

respiratory distress

a state when the increased efforts of breathing cannot meet ventilation and oxygenation demands

birth trauma

(also, birth injury) any physical injury to a newborn caused by labor and delivery

neonatal abstinence syndrome (NAS)

occurs when the newborn has been exposed to drugs, legal or illegal, that are no longer available, resulting in withdrawal

psychosocial assessment

assessment to determine a family's mental health and social well-being; is performed by a social worker prior to discharge to identify and support any social or financial needs…

Turner syndrome (TS)

monosomy X is a random formation of reproductive cells in the parent giving birth to the person with the syndrome

subarachnoid hemorrhage

bleeding within the subarachnoid space; occurs in full-term infants as a result of trauma and is the most common

omphalocele

common congenital abdominal wall defect where abdominal contents are held within a sac outside the abdomen

Chapter 26

Perinatal Bereavement

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Summary

The cause of early and late pregnancy loss is many times related to chromosomal abnormalities. Pregnancy loss at any stage in the pregnancy is devastating to the parents. They are grieving the loss of their child and the family they had envisioned. During this grief, they must then make decisions about what treatment plan is best.

Key terms

perinatal bereavement

experience of perinatal persons, their partners, support persons, and family members during and after a perinatal loss

late pregnancy loss

occurs after 20 weeks’ gestation and is commonly defined as intrauterine fetal demise

pregnancy

devastating to the parents

early pregnancy loss

occurs before 20 weeks’ gestation and is most often the result of an abortion

perinatal loss

involuntary end of pregnancy after implantation or death of a newborn within 28 days after birth

intrapartum fetal death (IPFD)

death that occurs after 20 weeks of gestation and after the onset of labor but before birth

neonatal death

when a baby dies within the first 28 days of life

antepartum fetal death

death that occurs before the onset of labor

Chapter 27

Unfolding Case Study: Applying Clinical Judgment

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Summary

The measurement of clinical judgment is essential to demonstrate that a new graduate nurse is prepared to provide safe and competent patient care. Clinical judgment is the thinking the nurse performs when carrying out the steps of the nursing process. Clinical judgment is essential for providing safe and effective nursing care that enhances the achievement of patient outcomes Understanding how clinical judgment is measured prepares the new graduate for the Next Generation of NCLEX-RN question formats

Key terms

clinical judgment

cognitive, decision-making process nurses perform while carrying out the nursing process

measurement of clinical judgment

essential to demonstrate that a new graduate nurse is prepared to provide safe and competent patient care

recognize cues

ability to determine what information related to the patient situation is most important

evaluate outcomes

ability to determine if the expected patient outcomes are met

analyze cues

ability to determine what the patient cues mean within the context of the patient situation

take actions

ability to implement what intervention(s) to do first, next, or in order of sequence

prioritize hypotheses

ability to arrange the identified patient problems based on urgency

generate solutions

ability to develop a plan to achieve patient outcomes