4.3 Maternal/Newborn & Care of the Older Adult
Key Takeaways
- Normal pregnancy lasts about 40 weeks over three trimesters; recommended folic acid before conception and in early pregnancy reduces neural tube defects, and prenatal visits monitor blood pressure, weight, fundal height, and fetal heart rate.
- Postpartum assessment uses BUBBLE-HE (breasts, uterus, bladder, bowel, lochia, episiotomy/perineum, Homans/legs, emotions); a boggy uterus signals atony and hemorrhage risk, the leading cause of postpartum death.
- Newborn priorities are airway and thermoregulation; APGAR is scored at 1 and 5 minutes, and adequate breastfeeding is confirmed by at least six wet diapers per day after day five plus appropriate weight gain.
- Beers Criteria flag potentially inappropriate medications in older adults; polypharmacy (typically five or more drugs) raises the risk of falls, delirium, and adverse drug events.
- Frailty and normal aging increase fall and dehydration risk; promote independence with mobility aids, toileting schedules, and the least-restrictive safety measures rather than restraints.
Maternal/Newborn Care and Care of the Older Adult
This section brackets the lifespan: supporting a healthy pregnancy and newborn at one end, and safe, dignity-preserving care of the older adult at the other. Practical-nurse questions stay within the PN scope - normal, low-risk situations and health teaching - and expect you to recognize when a finding is a danger sign to escalate.
Normal pregnancy and prenatal care
A term pregnancy is about 40 weeks from the last menstrual period, divided into three trimesters. Nurses summarize obstetric history with GTPAL: Gravida (total pregnancies), Term births, Preterm births, Abortions/miscarriages, and Living children. Preconception and early-pregnancy folic acid (folate) is a cornerstone of prevention because it markedly reduces neural tube defects such as spina bifida - ideally started before conception. Routine prenatal visits monitor blood pressure, weight gain, urine, fundal height, and the fetal heart rate (normal 110-160 beats/min). Teach avoidance of alcohol, tobacco, and unpasteurized foods, and recommended weight gain based on pre-pregnancy BMI.
Danger signs to report immediately include vaginal bleeding, severe or persistent headache, visual changes, epigastric pain, and facial or hand edema (possible pre-eclampsia), plus reduced fetal movement. These exceed PN independent management and require prompt escalation.
Postpartum and newborn basics
After birth, assess the mother systematically with BUBBLE-HE:
| Letter | Assessment |
|---|---|
| B | Breasts (engorgement, latch) |
| U | Uterus (firm and midline vs. boggy) |
| B | Bladder (voiding, distension) |
| B | Bowel (function, flatus) |
| L | Lochia (amount, colour, odour) |
| E | Episiotomy/perineum |
| H | Homans/lower legs (clot signs) |
| E | Emotions (bonding, mood) |
A boggy (soft) uterus indicates uterine atony - the leading cause of postpartum hemorrhage - so the first action is to massage the fundus. Lochia normally progresses from rubra (red) to serosa (pink-brown) to alba (white); saturating a pad in under an hour or foul odour is abnormal. Screen for postpartum depression, distinguishing it from transient "baby blues."
For the newborn, airway and thermoregulation are the priorities; newborns lose heat quickly, so dry them and use skin-to-skin contact. The APGAR score (Appearance, Pulse, Grimace, Activity, Respiration; 0-2 each) is assigned at 1 and 5 minutes; 7-10 is reassuring. Normal newborn vitals: heart rate 110-160, respirations 30-60, and axillary temperature about 36.5-37.5 C. Teach back-to-sleep on a firm, flat surface with no loose bedding to reduce SIDS, and clean, dry cord care.
Breastfeeding
Breast milk is the recommended infant nutrition, ideally exclusive for about the first 6 months. Teach a deep latch with the infant's mouth covering much of the areola, feeding on demand (roughly 8-12 times per day), and alternating breasts. The most reliable sign of adequate intake is output: at least six wet diapers per day after day five, regular stooling, and appropriate weight gain (newborns may lose up to about 7-10% initially, then regain by 2 weeks). Sleeping 8 hours straight, feeding only every 8 hours, or ongoing weight loss are warning signs, not reassurance.
Care of the older adult
Canada's population is aging, so older-adult items are common. Separate expected aging from disease: expected changes include slower reflexes, presbyopia, high-frequency hearing loss, reduced skin elasticity, decreased thirst sensation (dehydration risk), and slower drug clearance. Confusion, delirium, and depression are NOT normal aging and must be investigated.
Frailty - reduced physiological reserve with weakness, slow gait, and weight loss - raises the risk of falls, delirium, and functional decline. Polypharmacy, typically five or more medications, compounds this risk; the Beers Criteria identify medications that are potentially inappropriate in older adults (for example, certain sedatives and anticholinergics). Practical nurses watch for adverse drug events, orthostatic hypotension, and interactions, and reconcile medication lists.
Promoting independence
Health maintenance in later life means promoting function and dignity, not doing everything for the client. Use mobility aids and physiotherapy, scheduled toileting to prevent incontinence and falls, adequate lighting, and the least-restrictive safety measures. Restraints are a last resort, never a first-line fall strategy, because they increase injury and delirium. Encourage self-care within ability, hydration despite reduced thirst, weight-bearing activity, immunization, and social engagement. Support advance-care planning and honour the older adult's autonomy - the same client-centred principle that runs through every health-promotion question on the exam.
Common prenatal discomforts and teaching
Much prenatal PN teaching addresses normal discomforts and their self-care, and the exam asks you to separate these from danger signs. Morning sickness (nausea) in the first trimester is managed with small, frequent, bland meals and dry crackers before rising. Heartburn responds to smaller meals and staying upright after eating. Constipation improves with fibre, fluids, and activity. Back pain and fatigue are expected as pregnancy advances. These are reassured and taught, whereas bleeding, severe headache, visual changes, epigastric pain, and facial edema are reported as possible pre-eclampsia. Teach that a modest, steady weight gain and prenatal vitamins with iron and folate support a healthy pregnancy.
A worked older-adult safety scenario
An 80-year-old on a new antihypertensive reports dizziness when standing. The exam-preferred action is not to restrict activity or apply a restraint, but to check for orthostatic hypotension (compare lying and standing blood pressure), teach the client to rise slowly in stages, ensure adequate hydration despite reduced thirst, review the medication list for contributors, and keep the call bell and a clear, well-lit path available. This preserves mobility and dignity while managing fall risk - the least-restrictive, independence-promoting principle the CPNRE and REx-PN consistently reward over reactive, restrictive answers.
Two hours after a vaginal birth, a practical nurse palpates the mother's fundus and finds it soft and boggy above the umbilicus. What is the nurse's priority action?
A breastfeeding mother asks how she can tell her 10-day-old newborn is getting enough milk. Which finding best indicates adequate intake?
A practical nurse reviews the chart of an 82-year-old client taking eight regular medications, including a sedative-hypnotic and an anticholinergic. Which action best reflects safe care of the older adult?