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TABLE OF CONTENTS-PART II
CONTENT PAGE
I. Overview of Maternity Nursing……………… .................................................................3
II. Normal Pregnancy…………………………. .........................................................................5
III. Fetal Assessment……………………..……………………………………………………………………….…...9
IV. Uncomplicated Labor and Delivery…………………………….………………………….…….….……11
V. Analgesia and Anesthesia ……………………….…………………………………………………………...14
VI. Nursing in the Normal Puerperium………...................................................................16
VII. Nursing Care of the Normal Newborn…………………..………………………………..……….…...20
VIII. High Risk Neonate………………………..…………………………….………………………….……….….…23
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I. OVERVIEW OF MATERNITY NURSING
1. OBJECTIVES:
At the completion of this class the student will be able to:
B. Delineate significant legal and ethical issues that influence the practice of
maternal–child nursing.
D. Define various statistical terms relevant to health care: birth rate, infant mortality
rate, neonatal mortality rate, and maternal mortality rate.
2. LECTURE OUTLINE
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c. CNS-Clinical Nurse Specialist/Nurse Consultant
2. Informed Consent
4. Standards of Care
1. Standardized Procedures
6. Nursing Role
1. Fertilization
2. Cellular multiplication
a. Development
b. Structure
c. Function
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II. NORMAL PREGNANCY
1. OBJECTIVES:
At the end of this class the student will be able to:
A. Describe the anatomical and physiological changes that occur during pregnancy.
F. Explain the process of role transition to motherhood and the maternal tasks of
pregnancy.
K. Identify various nutritional risk factors and explain their effects on a pregnancy.
L. List various education topics, especially safety issues, such as substance abuse, travel,
vaccinations, violence and battering in the family, and warning signs.
2. LECTURE OUTLINE
2. Cardiovascular 7. Neurological
3. Respiratory 8. Gastrointestinal
4. Genitourinary 9. Endocrine
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5. Integumentary
B. Pregnancy Diagnosis
1. Terminology
a. gravida, para
2. Pregnancy test
3. Nagele’s Rule
4. Classic Indicators
C. Prenatal History
1. First Trimester
a. History taking
b. Physical Exam
c. Lab tests
d. Educational topics
2. Second Trimester
b. Lab tests
c. Potential complications
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3. Third Trimester
b. Lab tests
1. Mother
2. Father
3. Siblings
4. Grandparents
D. Safety Issues
2. Medications
3. Immunizations
E. Multifetal pregnancies
1. Maternal concerns
a. physiological
2. Fetal concerns
a. risk of PTL/PROM
b. types
c. delivery complications
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F. Cultural variations
1. Types of variations
2. Nursing care
G. Maternal Nutrition
1. Nutritional requirements
Ms. T. is a 15-year-old patient who visits the clinic for the first time at 24 weeks’ gestation. She tells the
RN that “she doesn’t know why she didn’t get prenatal care sooner.” She works part time at a local fast
food outlet, and eats one meal a day at the restaurant. She now weighs 128 pounds. She tells the RN
that she weighed about 110 pounds before the pregnancy. She lives at home with her parents, and her
mother does most of the cooking. She is from a low-income family.
Develop a nursing care plan that focuses on assisting the patient to improve her nutrition patterns from
now until delivery of the neonate.
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III. FETAL ASSESSMENT
1. OBJECTIVES:
At the end of this class the student will be able to:
B. Discuss the purpose, procedure, advantages, and potential risks for each specific
fetal diagnostic procedure.
C. Discuss the nurse’s role in patient education regarding fetal assessment testing.
F. Identify appropriate nursing interventions and rationales for various fetal heart patterns.
2. LECTURE OUTLINE
A. Fetal Assessment
a. biophysical c. sociodemographic
b. psychosocial d. environmental
2. Nursing interventions
1. Biophysical Assessment
c. MRI
2. Biochemical Assessment
a. amniocentesis
b. PUBS
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c. CVS
3. Nursing role
E. Biophysical Profile
3. Fetal tone
4. Reactive NST
5. AFI/AFV
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IV. UNCOMPLICATED LABOR AND DELIVERY
1. OBJECTIVE:
At the completion of this class, the student will be able to:
H. Apply the nursing process to care for a laboring woman with electronic fetal heart rate
monitoring.
I. Apply the nursing process to the care of the laboring woman from admission to the
postpartum period.
K. Apply the nursing process to the care of a woman experiencing a surgical birth.
2. LECTURE OUTLINE
1. Maternal response
2. Fetal response
1. Passageway
2. Passenger
3. Powers
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4. Placenta
5. Psyche
6. Position (maternal)
C. Labor Physiology
2. Signs of Labor
6. Mechanism of Labor
7. Labor Duration
D. Plan of Care
1. Assessment-Data Collection
2. Nursing Diagnoses
3. Interventions/Priority Setting/Evaluations
1. Amniotomy
2. Induction/Augmentation
3. Version
4. Episiotomy
5. Forceps/Vacuum
6. Surgical Birth
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CRITICAL THINKING EXERCISES FOR LABOR AND DELIVERY
1. Describe the data you would need to collect with a patient who has called in to the unit stating
that her “membranes have ruptured.” List any tests or procedures that you would want to perform.
2. The father of the baby in #1 scenario arrives with the patient who is in early labor. He appears
uncomfortable and in the way. Explain how you can incorporate him into the plan of care.
3. Another patient calls into the LDR unit because she believes that she is in labor. She states, “My
contractions started three hours ago and they are about 10 minutes apart. Should I come to the
hospital?” Her due date is this week. What other information would you need in order to advise the
patient?
4. Based upon the information you obtained, you ask the patient in #3 to come to the hospital.
What other information can you now obtain to further confirm that she is in labor?
5. Your patient was admitted with a birth plan and is experiencing complications necessitating a
surgical birth. Identify pertinent nursing diagnoses and interventions which may facilitate an acceptable
outcome at this time.
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V. ANALGESIA AND ANESTHESIA
1. OBJECTIVES
At the end of this lecture, the student will be able to:
A. Describe the origin of discomfort during the various phases and stages of labor.
B. Explain how excessive pain can affect the laboring and the fetus.
C. Describe how various physiological and psychosocial factors can affect the pain
experience.
E. Describe how medication can affect a pregnant woman and the fetus or neonate.
2. LECTURE OUTLINE
A. Labor Pain
2. First Stage
3. Second Stage
4. Third Stage
1. Physiological effects
2. Psychological effects
1. Your assigned patient has received an opioid spinal medication for her cesarean birth.
Describe the nursing responsibilities in the first 24 hours post-delivery.
2. The patient in LDRP room #2 is in the transition phase of stage I of labor. She is
requesting some pain medication. How would you proceed in this situation?
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VI. NURSING IN THE NORMAL PUERPERIUM (POST PARTUM PERIOD)
1. OBJECTIVES:
At the completion of this class, the student will be able to:
A. Explain the physiological changes that occur during the postpartum period.
C. Describe the nursing responsibilities regarding teaching the patient and family during
the postpartum period.
D. Apply the nursing process to the care of the postpartum woman and family.
F. Compare the nursing assessment, interventions, and diagnosis for a woman who
delivers vaginally with those experiencing surgical births.
I. Identify nursing assessments, diagnoses and interventions for women and neonates
receiving formula feeding.
K. Develop strategies for promoting family learning during the early postpartum period.
2. LECTURE OUTLINE
a. Reproductive system
b. Cardiovascular
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c. Gastrointestinal
d. Renal
e. Muscular-skeletal
f. Integumentary
g. Endocrine
h. Psychosocial
B. Nursing Process
2. Nursing Diagnoses
3. Interventions/Rationales
C. Early Discharge
2. Nursing diagnoses
1. Physiology of lactation
3. Supply/Demand
1. Formula types
2. Common problems
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3. Neonatal nutritional requirements
G. Contraception Education
2. Methods
a. Coitus interruptus
c. Barrier methods
d. Hormones
e. Intrauterine devices
f. Sterilization
1. As you assess your patient and inquire about the breastfeeding, she tells you that she is
considering discontinuing breastfeeding because she “doesn’t have enough milk.” Indicate what other
information you need in order to intervene in this situation. How would you respond to this statement?
2. Your patient, a newly delivered primipara 22 year old, is crying in her room. Her midwife has just
informed her that she meets the criteria for early discharge and will be discharged later in the day. How
would you intervene in this situation?
3. Your assigned patient is a recent immigrant from Mexico. She does not speak any English. Her
baby is in the Level II nursery with jaundice and under phototherapy. Your patient has no immediate
family in the country and no other support systems. Describe how you would proceed to provide
optimal care for this patient?
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LATCH Scoring to assess Breastfeeding
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VII. NURSING CARE OF THE NORMAL NEWBORN
1. OBJECTIVES:
At the end of this class, the student will be able to:
A. Describe the respiratory and cardiovascular changes that occur in the transition from
fetal to extrauterine life.
D. Describe the role that bilirubin plays in the development of physiological, pathological,
and breast milk jaundice.
F. Describe the periods of reactivity and the six behavior states of the newborn.
2. LECTURE OUTLINE
2. Cardiovascular transition
B. Neurological adaptation
1. Thermoregulation
2. Reflexes
3. Sensory adaptation
C. Hematological adaptation
1. Neonatal differences
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D. Musculoskeletal system
2. Extremities
E. Gastrointestinal system
1. Mouth/throat
2. Stomach
3. Intestines
4. Digestive enzymes
5. Stool patterns
F. Hepatic system
2. Hyperbilirubinemia/physiological jaundice
G. Genitourinary system
1. Anatomy
2. Voiding
4. Genitals
H. Integumentary system
2. Desquamation
3. Birthmarks
I. Immune system
1. Neonatal considerations
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J. Psychosocial adaptation
1. Behavioral states
1. Assessment
2. Nutrition
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VIII. THE HIGH RISK NEONATE
1. OBJECTIVES:
At the end of this class the student will be able to:
A. List risk factors that may place the neonate in jeopardy at birth.
D. Compare and contrast physiological problems of preterm, post term, small for
gestational age and large for gestational age neonates.
F. Describe the techniques, equipment and medications used for neonatal resuscitation.
G. Apply the nursing process to the care of a neonate with a respiratory diagnosis.
J. Summarize the nursing assessments and initial interventions for a newborn with
selected congenital abnormalities.
K. Develop a plan of care for a neonate born to a mother with substance abuse problems.
M. Identify priority nursing interventions utilized in the level II (SCN) and III nursery settings.
N. Compare and contrast levels of care for the high risk newborn.
2. LECTURE OUTLINE
2. Transport
3. Multidisciplinary approach
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B. The Preterm Neonate
1. Risk factors
4. Nursing Care
C. Dysmature Neonates
1. Risk factors
2. Mode of transmission
3. Causes of susceptibility
4. Causes of infection
5. Location of infection
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F. Neonate with hyperbilirubinemia
1. Types
2. Causes
a. Maternal factors
1. ABO/Rh incompatibility
b. Fetal/Neonatal factors
3. Nursing care
1. Problems
2. Pathophysiology
3. Nursing care
1. Common characteristics
2. Nursing care
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