NCLEX-RN Flashcards: Maternal-Newborn Nursing, Labor and Delivery, Postpartum

Preeclampsia is a hypertensive disorder of pregnancy occurring after 20 weeks gestation, characterized by blood pressure of 140 over 90 or higher on two occasions and proteinuria or end-organ dysfunction. Warning signs include sudden weight gain, facial and hand edema, headache that does not respond to treatment, visual disturbances like seeing spots, and right upper quadrant or epigastric pain indicating liver involvement.

Magnesium sulfate is used in obstetrics to prevent and treat seizures in preeclampsia and eclampsia, and as a tocolytic to delay preterm labor for up to 48 hours to allow administration of corticosteroids for fetal lung maturity. It works by decreasing neuromuscular excitability. Side effects include flushing, sweating, hypotension, decreased deep tendon reflexes, and respiratory depression. The therapeutic serum level is 4 to 7 milliequivalents per liter. Toxicity signs progress from loss of deep tendon reflexes to respiratory depression to cardiac arrest.

Labor has four stages. Stage one begins with regular contractions and cervical dilation and ends at complete dilation of 10 centimeters. It has three phases: latent with slow dilation to 6 centimeters, active with faster dilation from 6 to 10 centimeters, and transition from 8 to 10 centimeters with the most intense contractions. Stage two begins at complete dilation and ends with delivery of the infant, with active pushing. Stage three begins after delivery and ends with delivery of the placenta, usually within 30 minutes.

Postpartum hemorrhage is defined as blood loss exceeding 1,000 milliliters or blood loss accompanied by signs of hypovolemia. The most common cause is uterine atony, where the uterus fails to contract firmly after delivery. Risk factors include overdistended uterus from multiple gestation, polyhydramnios, or macrosomia; prolonged labor; rapid labor; multiple previous pregnancies; magnesium sulfate use; and chorioamnionitis. The nurse assesses fundal firmness every 15 minutes in the first hour. A boggy uterus requires immediate fundal massage.

The Apgar score is assessed at one and five minutes after birth, evaluating five criteria each scored 0, 1, or 2: appearance or skin color, pulse or heart rate, grimace or reflex irritability, activity or muscle tone, and respiration. A total score of 7 to 10 is normal and reassuring, 4 to 6 indicates moderate distress requiring intervention, and 0 to 3 indicates severe distress requiring aggressive resuscitation. Heart rate is the most important indicator of neonatal well-being. A rate below 100 requires positive pressure ventilation.

The normal fetal heart rate baseline is 110 to 160 beats per minute. Reassuring patterns include moderate variability with fluctuations of 6 to 25 beats per minute and accelerations, which are temporary increases of 15 beats above baseline lasting at least 15 seconds. Concerning patterns include late decelerations that begin after the contraction peak and indicate uteroplacental insufficiency, variable decelerations that are abrupt drops indicating cord compression, minimal or absent variability suggesting fetal hypoxia or sedation, and prolonged decelerations lasting more than two minute ---