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Maternal and newborn nursing encompasses one of the most critical and rewarding areas of healthcare. Understanding the physiological changes, potential complications, and essential nursing interventions throughout pregnancy, labor, delivery, and the postpartum period is crucial for NCLEX success. This comprehensive guide covers high-yield topics to help you feel confident on exam day.
Antepartum Care (Before Birth)
Normal Physiological Changes in Pregnancy
Pregnancy triggers profound adaptations throughout the maternal body systems to support fetal growth and development.
Cardiovascular System Changes
Blood volume increases by 30-50% to meet increased demands
Heart rate increases by 10-15 beats per minute
Blood pressure typically decreases in second trimester due to vasodilation
Cardiac output increases by 30-50%
Supine hypotension may occur due to vena cava compression
Respiratory System Changes
Tidal volume increases leading to deeper breathing
Respiratory rate remains relatively unchanged
Oxygen consumption increases by 15-20%
Shortness of breath common due to diaphragm elevation
Renal System Changes
Glomerular filtration rate increases by 40-50%
Kidneys filter more blood, leading to increased urination
Glucose may appear in urine due to decreased renal threshold Risk of urinary tract infections increases
Gastrointestinal System Changes
Digestion slows due to progesterone effects
Gastric emptying delayed, contributing to nausea Constipation common due to decreased motility Heartburn frequent from gastric acid reflux
Musculoskeletal System Changes
Joints loosen due to relaxin hormone
Posture shifts as center of gravity changes
Lower back strain increases with fetal growth
Separation of abdominal muscles (diastasis recti) may occur
Common Pregnancy Discomforts and Management
First Trimester
Morning sickness: Small, frequent meals; avoid triggers; ginger may help
Fatigue: Adequate rest; balanced nutrition; light exercise
Breast tenderness: Supportive, well-fitting bra
Urinary frequency: Normal finding; report burning or pain
Second Trimester
Heartburn: Small meals; avoid spicy foods; remain upright after eating
Constipation: Increase fiber intake; adequate fluids; regular exercise Leg cramps: Stretch calf muscles; adequate calcium and magnesium Varicose veins: Elevate legs; avoid prolonged standing
Third Trimester
Back pain: Proper posture; supportive shoes; prenatal massage
Shortness of breath: Sleep with head elevated; avoid supine position
Swelling (edema): Elevate legs; side-lying position; report sudden onset
Braxton Hicks contractions: Change position; hydration; differentiate from true labor
Essential Prenatal Nutrition
Key Nutritional Requirements
Folic acid (400-800 mcg daily): Prevents neural tube defects
Iron (27 mg daily): Prevents maternal anemia; supports increased blood volume Calcium (1,000 mg daily): Fetal bone development; prevents maternal bone loss Protein (70-100 g daily): Fetal growth and development
Additional calories: 300-500 extra calories daily in second and third trimesters
Foods to Avoid
Raw or undercooked meats, eggs, and seafood
High-mercury fish (shark, swordfish, king mackerel) Unpasteurized dairy products and juices
Alcohol and recreational drugs
Excessive caffeine (limit to 200 mg daily)
Intrapartum Care (Labor and Delivery)
The Four Stages of Labor
Stage 1: Cervical Dilation
Early labor: Cervix dilates 0-3 cm; contractions every 5-30 minutes Active labor: Cervix dilates 4-7 cm; contractions every 2-5 minutes Transition: Cervix dilates 8-10 cm; contractions every 1-3 minutes
Stage 2: Birth of the Baby
From complete cervical dilation to birth of infant Maternal urge to push begins
Duration varies: first baby 30 minutes to 3 hours; subsequent babies typically shorter
Stage 3: Delivery of Placenta
From birth of baby to delivery of placenta Usually lasts 5-30 minutes
Signs of placental separation: uterine shape change, cord lengthening, gush of blood
Stage 4: Recovery and Stabilization
First 1-4 hours after placental delivery
Critical monitoring period for hemorrhage
Vital signs monitored every 15 minutes initially
True vs. False Labor
|
True Labor |
False Labor (Braxton Hicks) |
|
Regular, progressive contractions |
Irregular contractions |
|
|
|
|
True Labor |
False Labor (Braxton Hicks) |
|
Cervical changes occur |
No cervical changes |
|
Pain in back radiating to abdomen |
Pain mainly in abdomen |
|
Contractions increase with activity |
May decrease with activity |
|
Not relieved by position change |
Often relieved by position change |
|
C C |
|
Fetal Heart Rate Monitoring
|
Normal Fetal Heart Rate |
|
C |
|
C |
Baseline: 110-160 beats per minute
Moderate variability: 6-25 bpm fluctuations (reassuring)
Accelerations: Increase of 15 bpm for 15 seconds (reassuring)
Concerning Patterns
Late decelerations: Gradual decrease after contraction peak (indicates uteroplacental insufficiency)
Variable decelerations: Abrupt decrease (may indicate cord compression)
Prolonged decelerations: Decrease lasting 2-10 minutes
Minimal or absent variability: Less than 6 bpm fluctuation
Nursing Interventions for Non-reassuring Patterns
Change maternal position (left side-lying preferred) Administer oxygen at 8-10 L/min via mask
Increase IV fluid rate (if not contraindicated) Discontinue oxytocin if infusing
Notify healthcare provider immediately Prepare for potential cesarean delivery
Postpartum Care (After Birth) Postpartum Assessment - "BUBBLE HE" B - Breasts
Assess for engorgement, tenderness, nipple condition 
Support breastfeeding or suppression as appropriate Monitor for signs of mastitis (redness, warmth, fever)
U - Uterus
Should be firm, midline, and descend 1 cm daily 
Fundal massage if boggy (soft and enlarged)
Monitor for subinvolution (delayed return to normal size)
B - Bladder
Monitor for distension and adequate emptying Encourage frequent voiding (every 2-3 hours)
Full bladder can displace uterus and increase bleeding risk
B - Bowel
First bowel movement usually within 2-3 days 
Encourage fiber intake, fluids, and mobility
Stool softeners may be needed, especially after cesarean
L - Lochia (Vaginal Discharge)
Lochia rubra: Days 1-3, bright red with small clots
Lochia serosa: Days 4-10, pinkish-brown, serosanguinous
Lochia alba: Days 10-14+, whitish-yellow, decreasing amount
E - Episiotomy/Laceration
Assess for healing, signs of infection
REEDA scale: Redness, Edema, Ecchymosis, Discharge, Approximation Sitz baths, ice packs, topical analgesics for comfort
H - Homan's Sign/Extremities
Assess for deep vein thrombosis (DVT) 
Check for calf pain with dorsiflexion
Encourage early ambulation and leg exercises
E - Emotions/Bonding
Monitor for postpartum depression symptoms Assess maternal-infant bonding
Provide emotional support and resources
Postpartum Complications
Postpartum Hemorrhage
Primary: >500 mL blood loss (vaginal) or >1000 mL (cesarean) within 24 hours
Secondary: Excessive bleeding 24 hours to 12 weeks postpartum
Causes: Uterine atony, retained placental fragments, lacerations, coagulation disorders
Signs and Symptoms
Heavy bleeding, clots larger than golf ball Fundus soft, boggy, or displaced
Tachycardia, hypotension, dizziness
Pallor, weakness, decreased urine output
Nursing Interventions
Massage fundus if boggy Empty bladder
Administer oxytocin as ordered Monitor vital signs closely
Prepare for additional interventions (medications, surgery)
Pregnancy Complications Hypertensive Disorders Gestational Hypertension
Blood pressure ≥140/90 on two occasions, 4+ hours apart Develops after 20 weeks gestation
No proteinuria or other organ involvement
Preeclampsia
Hypertension + proteinuria (≥300 mg/24 hours) or other organ dysfunction May include severe headaches, visual changes, epigastric pain
HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets
Eclampsia
Preeclampsia with generalized seizures
Medical emergency requiring immediate intervention
Magnesium sulfate is drug of choice for seizure prevention/treatment
Nursing Care for Preeclampsia
Monitor blood pressure frequently
Assess for symptoms: headache, visual changes, epigastric pain Daily weights and intake/output monitoring
Protein monitoring (dipstick or 24-hour collection)
Seizure precautions: padded side rails, suction available
Administer magnesium sulfate as ordered (monitor for toxicity)
Bleeding Disorders
Placenta Previa
Placenta implants near or over cervical opening
Painless, bright red bleeding typically in third trimester 
Complete bed rest, no vaginal exams
Cesarean delivery usually required
Placental Abruption (Abruptio Placentae)
Premature separation of normally implanted placenta
Painful bleeding with rigid, tender uterus
May be concealed (no visible bleeding) or revealed 
Emergency delivery often required
Key Differences
|
Condition |
Pain |
Bleeding |
Uterus |
|
Placenta Previa |
Painless |
Bright red, intermittent |
Soft, non-tender |
|
Placental Abruption |
Severe pain |
Dark red, constant |
Rigid, tender |
|
C C |
|||
Newborn Care and Assessment
APGAR Score Assessment
Assessed at 1 and 5 minutes after birth
|
Sign |
0 Points |
1 Point |
2 Points |
|
Appearance (color) |
Blue/pale all over |
Pink body, blue extremities |
Pink all over |
|
Pulse (heart rate) |
Absent |
<100 bpm |
>100 bpm |
|
Grimace (reflex response) |
No response |
Grimace |
Cry/active withdrawal |
|
Activity (muscle tone) |
Limp |
Some flexion |
Active motion |
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