Maternal and Child Nursing Flashcards

A 32-year-old primigravida at 36 weeks gestation in a Saudi hospital is diagnosed with HELLP syndrome. Her lab results show: platelets 68,000/μL, LDH 820 U/L, AST 112 U/L, and serum creatinine 1.4 mg/dL. The physician plans delivery. Which nursing intervention takes HIGHEST priority in the immediate predelivery period?

Answer: Administer IV magnesium sulfate 4–6 g loading dose over 15–20 minutes to prevent seizures

In HELLP syndrome, the risk of eclamptic seizures is significant and magnesium sulfate is the first-line prophylactic agent per SCFHS/MOH obstetric protocols. A loading dose of 4–6 g IV over 15–20 minutes followed by a maintenance infusion is administered prior to delivery. While urine output monitoring, blood product preparation, and fetal positioning are all important concurrent measures, seizure prophylaxis with MgSO4 is the highest-priority nursing action because an uncontrolled seizure can precipitate abruption, fetal distress, and maternal hemorrhage.

A neonate born at 34 weeks gestation is admitted to the NICU in a Saudi tertiary hospital. On day 2 of life, the nurse notes abdominal distension, bloody stools, and absent bowel sounds. An abdominal X-ray reveals pneumatosis intestinalis. Which action should the nurse prioritize FIRST?

Answer: Discontinue all enteral feedings immediately and insert an orogastric tube for decompression

The clinical and radiological findings describe necrotizing enterocolitis (NEC), a neonatal emergency. The first nursing priority is to make the infant nil by mouth (NPO) and insert an orogastric tube for gastric decompression to prevent further bowel distension and perforation risk. Continuing feeds would worsen NEC. Enemas are absolutely contraindicated as they can perforate the already-compromised bowel. Antibiotic therapy (typically IV, not oral) is initiated after cultures, but the immediate physical intervention of bowel rest and decompression comes first.

A Saudi woman is in active labor at 39 weeks with an epidural in place. Her nurse notes a sudden drop in fetal heart rate to 90 bpm lasting 3 minutes with no recovery, coinciding with the mother reporting painless but profuse vaginal bleeding (bright red). Uterine tone on palpation is absent between contractions and the uterine contour appears asymmetrical. Which condition does this presentation MOST likely indicate?

Answer: Uterine rupture requiring emergency laparotomy

The constellation of sudden profound fetal bradycardia, painless profuse hemorrhage, absent uterine tone (loss of the uterine contour), and asymmetrical uterine shape strongly suggests uterine rupture. The uterus loses its normal shape as the fetus may partially or fully extrude into the peritoneal cavity. Placenta previa causes hemorrhage but does not cause loss of uterine contour or tone. Placental abruption is typically painful with a board-like uterus. Variable decelerations do not cause vaginal bleeding or uterine shape change. Uterine rupture is a category-I obstetric emergency requiring immediate surgical intervention under MOH/SCFHS emergency obstetric protocols.

A 7-year-old Saudi child is admitted with acute streptococcal pharyngitis. On day 14, the child presents with periorbital edema, tea-colored urine, hypertension (BP 130/88 mmHg), and oliguria. Urinalysis shows 3+ protein, RBC casts, and granular casts. Which nursing intervention is MOST appropriate to include in the immediate management plan?

Answer: Restrict sodium and fluid intake and monitor blood pressure every 2–4 hours

This presentation is classic post-streptococcal glomerulonephritis (PSGN). The primary nursing concerns are hypertension and fluid overload. The immediate management includes sodium restriction (≤2 g/day), fluid restriction based on urine output plus insensible losses, and frequent blood pressure monitoring to guide antihypertensive therapy. Encouraging fluids would worsen hypertension and edema in an oliguric patient. Penicillin treats active infection but PSGN is immune-mediated and the acute phase does not respond to antibiotics (the throat infection is already resolving by this stage). RBC casts indicate glomerular inflammation, not permanent failure — PSGN in children typically resolves spontaneously; dialysis is rarely needed.

A lactating Saudi mother at 6 weeks postpartum presents to the primary health care center with a 3-day history of a painful, erythematous, wedge-shaped area on her right breast, fever of 38.9°C, and flu-like symptoms. She has been exclusively breastfeeding. Which statement about her management reflects current evidence-based practice consistent with Saudi MOH/WHO breastfeeding guidelines?

Answer: Prescribe dicloxacillin 500 mg four times daily and encourage continued breastfeeding from both breasts

This presentation describes mastitis (not yet abscess). Saudi MOH and WHO guidelines both recommend: (1) continuing breastfeeding from both breasts — cessation worsens milk stasis, the primary driver of mastitis progression; (2) antibiotic therapy targeting S. aureus, typically dicloxacillin or flucloxacillin for 10–14 days; (3) supportive measures including analgesia and frequent effective milk removal. Immediate surgical referral is unwarranted — a discrete fluctuant mass and ultrasound confirmation are required to diagnose abscess. Discarding milk is unnecessary; breastfeeding during mastitis is safe for the infant. Weaning the affected side would accelerate abscess formation.

A nurse in a Saudi NICU is caring for a 28-week preterm neonate receiving nasal CPAP at FiO₂ 0.35. Arterial blood gas shows: pH 7.22, PaCO₂ 62 mmHg, PaO₂ 54 mmHg, HCO₃ 24 mEq/L, SaO₂ 86%. The neonatologist suspects surfactant deficiency. Before surfactant administration via the INSURE technique (Intubate–Surfactant–Extubate), which nursing assessment finding would indicate that the neonate is NOT an appropriate INSURE candidate at this moment?

Answer: Blood pressure of 38/20 mmHg (MAP 26 mmHg) requiring ongoing dopamine infusion at 10 mcg/kg/min

The INSURE technique involves brief intubation for surfactant delivery, which requires hemodynamic stability. Hemodynamic instability — specifically cardiovascular compromise requiring vasoactive support (dopamine infusion) with a MAP of 26 mmHg in a 28-weeker (normal MAP ≥ gestational age in weeks, i.e., ≥28 mmHg) — is a contraindication to elective intubation for INSURE, as the procedure carries risk of further cardiovascular deterioration. Grade II IVH is not a contraindication to INSURE. Mild bradycardia during suctioning is common and not disqualifying. A temperature of 36.6°C is within acceptable range. Cardiovascular stabilization must precede elective intubation in the INSURE protocol.