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68C Lpn

Exam 10, Nursing Care During Postpartum Period

Postpartum Hemorrhage Definition: blood loss greater than 500 ml after vaginal birth, or 1000 ml after cesarean birth.
Two Types of Postpartum Hemorrhage Early postpartum hemorrhage.  Late postpartum hemorrhage
A more measurable definition is a decrease in hematocrit of 10 percent or more since admission. Postpartum Hemorrhage
Early Postpartum Hemorrhage Hemorrhage that occurs within 24 hours of delivery.
2 causes of Early Postpartum Hemorrhage The two causes are: Uterine Atony. Trauma.
Uterine Atony; early Postpartum Hemorrhage Refers to the lack of muscle tone that results in failure of the uterine muscle fibers to contract firmly around blood vessels when the placenta separates. Bleeding continues until the fibers contract to stop the flow of blood.
Uterine Atony Pharmacological Measures include what drugs? oxytocin (Pitocin) methylergonovine (Methergine) prostaglandin (Hemabate, Prostin) misoprostol (Cytotec)
postpartum pad saturation after 15 minutes is too much bleeding. Trur or False? True
Late Postpartum Hemorrhage Typically it occurs without warning 6 days to 6 weeks days after delivery.
Common Causes of late Postpartum Hemorrhage: Subinvolution Uterus not going back to normal Most Common Causes: Retained placenta. Pelvic infection.
Late Postpartum Hemorrhage Therapeutic Management Initial treatment - control of excessive bleeding. Oxytocin, Methergine, and prostaglandins are the most commonly used pharmacologic measures/ Dilation and curettage may be necessary to remove fragments if bleeding continues or recurs. /Antibiotics
Subinvolution of the Uterus(uterus not going back to normal) Most Common Causes: Retained placenta. Pelvic infection.
What color is lochia rubra? Dark Red
: What are the signs & symptoms of hemorrhage and what should be taught at discharge? Tachycardia.   Increased respiratory rate/ Decreased blood pressure/ Skin and mucous membranes become pale, cold and clammy/ Anxiety, confusion, restlessness and lethargy/ Urinary output decreased.
Three Major Causes of Thrombosis are: Venous Stasis. Hypercoagulation. Blood Vessel Injury.
Deep Vein Thrombosis (DVT) Clinical Signs and Symptoms WHAT IS A HOMANS SIGN? dorsiflexion (Toes to nose) of the foot causes pain in the calf.
DVT Diagnosis Is made using: Ultrasonography with vein compression. Doppler flow analysis. MRI may be used for pelvic veins.
DVT Therapeutic Management Subsequent Treatment: Heparin During the postpartum period, heparin can be changed to warfarin (Coumadin) therapy and may be continued for 6 weeks to 6 months.
Name two risk factors for thrombosis common in pregnancy? smoking/birthcontrol/ slow recovery/bedrest/
Endometritis: An infection of the uterine lining
Endometritis Therapeutic Management: C/S of the uterine cavity. IV Antibiotics usually clindamycin plus gentamicin until the woman has been afebrile for 48 hours. Analgesics(antipyretics)for fever. Complications:infection may spread to the nearby organs.
Urinary Tract Therapeutic Management Clean-catch or catheterized urine for culture and sensitivity. Broad-spectrum IV antibiotics. Increased fluid intake 3000ml fluid each day.
Mood Disorders: most common Postpartum Depression
BIPOLAR DISORDER a disorder characterized by periods of depression and hypomanic episodes.
Postpartum Psychosis Suicide and infanticide are possible, especially during depressive episodes.
What are the three types of mood disorders related to the postpartum period? Postpartum Psychosis/BIPOLAR DISORDER/Postpartum Depression
what are Puerperal Infections? bacterial infection after childbirth.
Puerperal Sites for Infections; what are they? Endometritis/ Wound Infections (Episiotomy. Lacerations. Surgical incision.) /Mastitis Urinary tract infections/ Septic pelvic thrombophlebitis
Puerperal Infection Signs and Symptoms;what are they? Temperature of 38C (100.4 F) or higher after the first 24 hours.  Localized redness, edema, and pain. Fever, malaise, achiness and loss of appetite.
The postpartum period (or puerperium) when is it? 3 to 6 weeks after delivery Retrogressive and Progressive changes Begins with the delivery of the placenta and ends with resumption of menses.
Involution: (Postpartum) 3 Processes what is it? Contraction Catabolism(increasing amout of cells or enlarging them) Regeneration
Regarding to Postpartum Assessment for a Normal, Spontaneous, Vaginal Delivery (NSVD) what would you be assessing? VS Breasts. Uterus. Bladder. Lochia. Perineum. Lower extremities. Other systems/i.e. CV (Cesarean Delivery (CS): same as NSVD and assessments common to post operative patients.)
what hormone does Oxytocin realease? Prolaction (for Breast milk)
Postpartum Assessment for THE UTERUS include what? The top of the uterus is called the fundus./Assess for consistency and location./ the placenta, should contracts firmly./ The fundus is usually +/- 1 to 2 cm above or below the umbilicus for the first 12 hours;It should be midline.
Uterus Assessment postpartum The fundus should remain firm after delivery. 2nd day descends 1 cm daily 
Postpartum Assessment THE BLADDER Palpate and percuss for distention./May urinate frequently in small amounts. Should void 300 to 400 ml./ Urinary retention and overdistention of the bladder/ Nonpregnant state regained in 6 to 8 weeks Know s/s of urinary tract infection.
Postpartum Assessment THE BOWEL Assess for active bowel sounds, abdominal distention, signs of constipation. Usually first bowel movement is in the 2nd-3rd day. Encourage adequate fluid intake, progressive exercise and dietary fiber to facilitate soft stools.
Postpartum Assessment LOCHIA post delivery uterine discharge. Characterized by its appearance and contents. Assessed in conjunction with fundal check, noting: Color. Amount. Odor. Presence of clots.
Lochia Characteristics {Lochia rubra:} Blood content; bright red colored for the for 1-3 days. {Lochia serosa:} Pink to brown discharge day 4 – 10 days. {Lochia alba:} Slightly yellow to white discharge which lasts from 11days to 21 days (may last 6 weeks).
Lochia Volume Heavy is saturating a pad every 1 hours./ Moderate is less than a 4 - 6 inch stain on the pad. / Light is less than a 1 - 4 inch stain. / Scant is less than a 1 inch stain. / Excessive is saturation of a peripad pad within 15 minutes.
Lochia Assessment; report if these sign/symptom occure. Foul smelling, bright red discharge. Clots are passed. Pad is saturated in less than one hour.
What is REEDA: In regards to the Episiotomy checking incision for the following: Redness. Edema. Ecchymosis. Discharge. Approximation.
when assessing the Episiotomy, how would you position the patient? Assess the perineum by having the mother lay on her side in Sims position and flex her upper leg. ALSO note the number and size of hemorrhoids.
Episiotomy Comfort Measures: Ice pack. Topical medications: Dermoplast. Epifoam. Tucks pads. Sitz bath.  Dry heat, heat lamp. Oral analgesics.
Cardiovascular System Assessment for the postpartum assessment include? Blood volume./ Cardiac Output./ Blood clotting factors are higher the postpartum patient is at increased risk for clot formation./ Leukocytosis/ Chills thought to be related to the sudden release of pressure on the pelvic nerve can develop.
Topical medications for Episiotomy include: Dermoplast. Epifoam. Tucks pads.
Neurological System Changes in Postpartum patients. Reversal of maternal adaptations to pregnancy and those from anesthesia and analgesia./Pregnancy-induced neurological discomforts/Postpartum headaches/ Watch for severe headache accompanied by blurred vision, proteinuria
Endocrine Changes in postpartum patient include: Placental hormones decrease./ Ovulation resumes: Breastfeeding delays ovulation./ Nonnursing: menses resume 6 to 8 weeks/ Endocrine glands return to normal.
Musculoskeletal System Changes in postpartum patient include: Abdominal muscle tone returns to normal./ 6 weeks/ May have hip and joint pain Reassurance and told temorary/ Exercise per provider’s guidance
Integumentary System Changes in postpartum patient include: Chloasma (mask of pregnancy) disappears. Striae fade./ Hyperpigmentation of the skin fade after delivery but fade./ Hair loss/ Begins 4 – 20weeks/ Regrown 4 -6 months
Immune System Changes in postpartum patient include: Rho(D) Immune Globulin (Rho Gam):Rh-negative mother/Rh-positive infant.72 hours postpartum. Rubella Immunization:not immune in the immediate postpartum period. Prevent infection; Must consent/counseled/avoid pregnancy/minum: 28 days.
C-Section- Normal postpartum assessment along with postoperative assessment. assess pain/Abd/and resp.
C-section post assessment: post op days 1-3 Intake and Output: IV fluids. Monitor foley drainage. Dietary changes according to protocol. Simethecone for decreasing flatulence.
Postpartum Psychosocial Adaptations Important to assess the woman’s ability to meet her own needs and those of her infant. Parent-newborn relationship assessments are vital.
Mothers Psychosocial Adaptations;Rubin’s Psychological Changes of the Puerperium: Phase 1: Taking In. Phase 2: Taking Hold. Phase 3: Letting Go.
Postpartum Danger Signs Passive reactions, either verbal or nonverbal. Hostile reactions./ Disappointment over the sex of the baby./ Lack of eye contact./ Non-supportive interaction between parents.
What are the Postpartum Blues? Mild depression. Affects 60 – 80% of mothers in U.S. Self-limiting. May benefit for empathy and support Does not affect the mothers ability to care for the infant.
What is Rubin’s Psychological Change? Changes of the Puerperium: Phase 1: Taking In. Mom being more concerned for self Phase 2: Taking Hold. Mother being more intrested in baby Phase 3: Letting Go. Mother allowing others to help care for baby
Common Postpartum Medications During the Postpartum Period if the fundus is not firm, and massaging and breast feeding does not increase the muscle tone prepare to give an oxytocic medication. Most common: Pitocin. Methergine. Usually administered IV.
When should discharge teaching start? When pregnancy is first confirmed
Normal new born temp for a new born 36.5-37.5c AX (97.7-99.5F AX)
Normal new born apical pulse 120-160 bpm (100 sleeping-180 crying)
Normal new born respirations 30-60 breaths/min
what is molding in a new born? refers to change in the shape of the head that allows it to pass though the birth canal.
what are fontanels? are areas of the head where the sutures between the bones meet.
Caput Succedaneum often appears over the vertex of the newborns head as a result of pressure against the mothers cervix during labor. May also occure when the vacuum extractor is used.
Cephalhematoma bleeding between the periosteum and the skull, result of pressure during birth. can occure on one side or both side of the heads over parietal bones.
what are Epsteins pearls? Palatal cysts of the newborn are small white or yellow cystic vesicles.
what is Vernix? is the waxy or cheese-like white substance found coating the skin of newborn human babies
what is Lanugo? is very fine, soft, and usually unpigmented, downy hair as can be found on the body of a fetus or newborn baby.
Normal skin color for a new born: pink or tan
what does redness in a full term baby possibly indicate? polycythemia (is an abnormally high concentration of red blood cells.)
what is Milia? are pearly white bumps on a baby's nose, chin or cheeks.
what is PSEUDOMENSTRUATION in a female newborn? a small amount of vaginal bleeding that may occure from the suddent withdrawal of the mothers hormones at birth.
what is Erythema Toxicum? red blotchy areas that may have white or yellow papules or vesicals in the center? commonly called fleabite rash or newborn rash
what are Mongolian spots? bluish-black marks that resemble bruises.
Infants are nose breathers for the first _____ weeks of life. 3 weeks
what is the Nevus Simplex salmon patch, storks bite or telangiectatic nevus, flank pink or reddish discoloration from dialted capillaries that occure over they eyelids just above the bridge of the nose or at the nape of the neck.
newborns void within ____ hours. 12 hours
when in doubt about a mark, a description is sufficient. True or False? True for ex. a flat reddened area 1x2 cm size over right eyelid that blanches with pressure.
a new mom askes if it is ok to retract her newborns sons foreskin to clean it after a voin; who should the nurse respond? no, this could be harmful to the newborm and is not nessessary.
what is the Moro reflex? the most dramatic reflex, it occures when the head and trunk are allowed to drop back 30 degrees when the infant is in a slightly raised position.
Palmar reflex when the infants palm is touched the hand closes.
Rooting reflex when the infants cheek is touched near the mouth the heads turns towards the side where stroked.
Sucking reflex when the mouth or palate is touched by the nipple or finger, the infant begins to suck.
Plantar grasp reflex is similar to plantar grasp reflex, toes will curl over the finger placed.
Babinski reflex elicited by stroking the latertal sole of the infants foot from heel across the ball of the foot. this causes toes to Flare out.
Tonic neck reflex refers to the posture assumed by newborns when in a supine position. infant extended the arm and leg on the size in whitch the head is turned.
Stepping reflex occures when infant is held upright with their feet touching a soild surface.
newborns normal weight 5lb,8oz-8lb,13oz
newborns normal length (33-35.5cm)/13-14inches
Newborns chest circumference 30.5-33cm(12-13in) 2/3 less then head circumference
evidence based practice shows there is none of the treatments commonly used is superior to keeping the cord clean and dry and cleaning with water if soiled. True or False True
when can you start giving infants cows milk? 12 months and above
: Name the three stages of breast milk production. Colostrum Transitional Milk Mature Milk
Name four methods of heat loss. evaporation/conduction/convection/radionation
How is bonding facilitated? Bonding Attachment Maternal touch Verbal behaviors Nursing interventions
Hyperbilirubinemia; There are two types of jaundice: 1: Physiologic Jaundice (also called nonpathological or developmental jaundice). 2:Pathologic Jaundice.
what is Physiologic Jaundice and when does it peak? Appears on the second or third day after birth./ bilirubin levels rise from birth/ Jaundice becomes visible when it reaches 5 to 7 mg/dl. peaks between 2nd – 4th days after birth at 5-6 mg/dl fall to normal levels (1.0 mg/dl) by 5-7 days
Pathologic Jaundice Pathologic Jaundice/Clinical jaundice that lasts more than 2 weeks in a full term infant. Total Serum Bilirubin (TSB) rises and falls by age of infant indicating degree of risk High risk if TSB greater than 8 mg/dL at 24 hours old
most common causes of Pathologic Jaundice Abnormalities causing excessive destruction of erythrocytes. Mother’s and infant’s blood types. Infection. Metabolic disorders.
Breastfeeding Associated Jaundice; Most common cause of jaundice inadequate intake. Levels usually peak at 5-10 mg/dl and fall gradually over several months.
Normal Bilirubin 0.2-1.4
Kernicterus Kernicterus is a type of brain damage that can result from high levels of bilirubin in a baby's blood
Those who survive Kernicterus may suffer from: Cerebral palsy Cognitive impairment Hearing loss and/or More subtle neurologic and developmental problems.
What are Factors that Increase Hyperbilirubinemia Hemolysis of excessive erythrocytes. Short red blood cell life. Liver immaturity. Lack of intestinal flora. Delayed feeding. Trauma resulting in bruising or cephalohematoma. Cold stress or asphyxia
What are Common Risk Factors for Hyperbilirubinemia? Prematurity. Cephalo-hematoma. Bruising. Delayed or poor intake. Cold Stress. Rh or ABO incompatibility. Polycythemia. Sepsis/infection. Sibling with jaundice. Asphyxia. Male gender Maternal diabetes or pre-eclampsia. Breastfeeding
Assessment for jaundice include: Blanch the infant’s skin on the nose or sternum/Determine how far down the body the jaundice extends.
Therapeutic Management for jaundice include: Phototherapy Exchange Transfusion
: Name three nursing interventions for infants undergoing treatment for physiologic jaundice. Maintain a neutral thermal environment, administer phototherapy, provide optimal nutrition, detect complications and teach parents.
what is Acrocyanosis Hands and feet may appear slightly blue. common during the first day
what is a Harlequin Color Change? Deep red color over half of body with pallor on the other half of the body. Cause is vasomotor instability. Usually transient and benign.
What is Cutis Marmorata Mottling Lacelike red or blue pattern. May occur when infant is cold. If persistent it may indicate a chromosomal abnormality
Describe Erythema Toxicum Benign rash of unknown cause in newborns, blotchy red areas that may have white or yellow papules or vesicles in the center. Harmless condition commonly called newborn rash or fleabite rash and resembles small bites or acne
Nevus Flammeus in newborns Known as port wine stain. Permanent, flat, dark, reddish-purple mark. Varies in size and location. Can be removed by laser surgery. Lesions on forehead and upper eye may be associated with Sturge-Weber syndrome.
Nevus Vasculosus in newborns Known as strawberry hemangioma. Enlarged capillaries in the outer layer of skin. Dark red and raised with a rough surface. May grow quickly for 5-6 months. Will disappear without treatment by school age.
Café-au-lait in newborns Permanent light brown spots Usually benign Six or more spots or spots larger than 0.5 cm are associated with neurofibromatosis, a genetic condition of neural tissue.
What is Petechiae in a new born? Pinpoint bruises that resemble a rash. Increased intravascular pressure. May indicate infection or a low platelet count.
Mongolian spots can be mistaken for what condition? Child abuse
Bruises in a new born may occure why? May occur on any part of the body. Bruising on the face or head may be from forceps or vacuum assisted delivery or if there was a tight nuchal cord. Document size, color, and location.
: How long does erythema toxicum last? Hours to 10 days
Methods of circumcisions : foreskin is first separated from the glans with a probe and incised to expose the glans./ Gomco clamp./ Plastibell.
Parent Teaching for circumcisions use warm water to clean. Yellow crust on glans is normal. Apply petroleum jelly. watch for signs of infection,bleeding or swelling, if the plastibell slips onto the shaft or hasn’t come off by 5-8 days or if the baby hasn’t voided within 8 hours.
: For what reason should a parent contact a Nurse or provider following a circumcision? Notify physician of signs of infection, excessive bleeding or swelling, if the plastibell slips onto the shaft or hasn’t come off by 5-8 days or if the baby hasn’t voided within 8 hours
Gestational Age Classifications: Preterm less than 36 (book states) slides state 38 weeks.
Gestational Age Classifications: Term 38-42 weeks.
Gestational Age Classifications:Post Term beyond 42 weeks.
Ballard Scoring System Gives a score to each assessment area with the total score determining the gestational age of the infant.
Handicaps of Preterm Newborn: Inadequate Respiratory Function: Respiratory Distress Syndrome Symptoms of respiratory distress may begin within the first hours after birth. Symptoms include tachypnea, tachycardia, nasal flaring, cyanosis, xiphoid and intercostal retractions and grunting.
Inadequate Respiratory of the newborn causes Inadequate amounts of surfactant. Poorly developed cough reflex and narrow respiratory passages. Apneic spells. Weak chest wall muscles.
Thermoregulation; why does a preterm infant lose heat? Thin skin Lack of brown fat Larger head and greater body surface area Temp control center of the brain is immature Limp, extended body posture Complications of heat loss
Name the signs and symptoms of cold stress in preterm infants. Decreased skin temperature, increased respiratory rate with periods of apnea, bradycardia, mottling of skin and lethargy.
Problems with Fluid and Electrolyte Balance in preterm infants Preterm infants lose fluid very easily.   Skin has little protective subcutaneous white fat and is more permeable than a term infant’s skin. Kidney development incomplete. Electrolyte regulation imbalance.
Name five physiologic handicaps of the preterm newborn Inadequate respiratory function Immature immune system Poor temperature control Immature kidneys Problems with fluid & electrolyte balance Problems with digestion & jaundice
Bronchopulmonary Dysplasia Chronic condition occurring most often in infants weighing less than 1500 g at birth.Infants continue to require oxygen, positive pressure ventilation of continuous positive airway pressure at 36 weeks’ gestation.
Bronchopulmonary Dysplasia Pathophysiology High levels of oxygen, oxygen-free radicals, and high positive-pressure ventilation that damage bronchial epithelium and interfere with alveolar development.
BPD Pathophysiology results in: Inflammation. Atelectasis. Edema. Airway hyperreactivity with loss of cilia, thickening of the walls of the alveoli, and fibrotic changes
Bronchopulmonary Dysplasia Manifestations ventilation needed/weaned off ventilation and oxygen. Other signs include: Tachycardia. Tachypnea. Retractions. Rales. Wheezing. Respiratory acidosis. Increased secretions. Bronchospasm. Characteristic changes in the lungs on chest X-ray.
Periventricular-Intraventricular Hemorrhage Most common in infants <32 weeks or < 1500 grams. Less frequent and severe if mother received steroids. Caused by ruptured blood vessels in the germinal matrix. Graded on 1-4 scale.
Periventricular-Intraventricular Hemorrhage S/S include: Lethargy, poor muscle tone Apnea or cyanosis Full or bulging fontanels A drop in hematocrit Abnormal eye positions or seizures
Nursing Necrotizing Enterocolitis Avoiding situations which increase cerebral blood flow and blood pressure./ Handling is kept to a minimum/ Pain and environmental stressors are reduced./ Daily head circumference and observation for changes in neurological status.
Retinopathy of Prematurity Infants of less than 30 weeks 1500 g or less/ Exact cause unknown but associated with oxygen use/ Check pulse oximetry Treatment: Consult with an ophthalmologist. Possible laser photocoagulation surgery. Cryotherapy. Reattachment of the retina.
Necrotizing Enterocolitis Exact causes unknown. Immaturity of gut may be a factor. Mortality rate is 10-30%.   During asphyxia blood is diverted from the GI tract.
Necrotizing Enterocolitis Incidence much higher after infants have been _____. Less common in infants who receive _____ ____. Fed/ breast milk.
Necrotizing Enterocolitis Signs/Symptoms Abdominal distention. Increased gastric residuals. Decreased or absent bowel sounds. Vomiting. Bile-stained emesis or residuals. Occult blood in stools. Abdominal tenderness. Signs of infection.
Name four common complications of the preterm newborn. Necrotizing Enterocolitis/Bronchopulmonary Dysplasia/Retinopathy of Prematurity /Periventricular-Intraventricular Hemorrhage
: At what gestational age do infants have the ability to suck and swallow? 32-34 weeks
What respiratory rate is the safe upper limit for oral feedings? 60
what are Advantages of Kangaroo care? Improved infant growth Decreased length of hospital stay Less crying Fewer pain responses Fewer infections.Infant must have stable vital signs and will need continued monitoring for response to KC.
The Post-term Newborn Many post dates infants are of normal size. In these cases placental function has decreased as the pregnancy is prolonged.
Post-mature Newborn,Physical Characteristics: Thin with loose skin. Unusually alert and wide-eyed. Little vernix and lanugo. Skin is wrinkled, cracked and peeling. Nails long.
Problems with Post Maturity Asphyxia. Meconium aspiration. Poor nutrition status. Higher perinatal mortality rate. Risk for low temperature. Polycythemia and jaundice.
Post-term Nursing Care Observe infant for: Respiratory distress. Hypoglycemia. Hypothermia. Jaundice.
Describe the physical characteristics of a post-term infant Encourage parents to visit the baby in NICU. Allow the parents to touch the infant as soon as possible, involve them in the infants care if the infant is stable. Initiate Kangaroo care if parents are willing.
Hydrocephalus Caused by imbalance in production and absorption of CSF in ventricles of the brain
Hydrocephalus Pathophysiology Often associated with ____________. myelomeningocele.
Arnold-Chiari Malformation Congenital anomaly in which the cerebellum and medulla oblongata extend down through the foramen magnum
Hydrocephalus Assessment in Infants Head enlargement is predominant sign in infants. Sutures may be widely separated. Setting sun sign. Sclera is visible above the pupils of the eyes.
What are the two classifications for hydrocephalus? Communicating and noncommunicating hydrocephalus
Neural Tube Defects in newborns Abnormalities derived from the embryonic neural tube Failure of neural tube closure produces defects of varying degrees.
Spina Bifida in newborns Midline defect involving failure of the bony spine to close Categorized into two types: Spina Bifida Occulta Spina Bifida Cystica
Spina Bifida Occulta Not externally visible/ Failure of the vertebral arch to close, usually without other anomalies.
Spina Bifida Cystica:(Visible defect with external saclike protrusion.) Two major forms, What are they? Meningocele: encases meninges and spinal fluid. Spinal cord not involved Meningomyelocele: contains meninges, nerve roots, spinal cord, and spinal fluid.
Neural Tube Defects include what factors? drugs, radiation, maternal malnutrition, chemicals and possibly a genetic mutation of folate pathways which may result in abnormal development.
Neural Tube Defects Diagnostic Evaluation MRI Ultrasound CT Myelography Prenatal detection by elevated AFP(= alpha-feto protein (elevated in NTD)),fetal ultrasound & CVS (CVS = chorionic villi sampling.)
Name two types of spina bifida cystica. Meningocele and myelomeningocele
cleft/lip palate Facial malformations that occur during embryonic development
Cleft Lip Minor notching of the lip or complete separation through the lip and into floor of nose Failure of the maxillary and median nasal processes to fuse
Cleft Palate Midline fissure of the palate that result from failure of the two sides to fuse May include hard and soft palate
Feeding Considerations If infant had trouble with nipple feeding, a rubber tipped medicine dropper, an Asepto syringe or Breck feeder are safe efficient options.
Feeding Considerations;Cleft/Lip palate Feed in upright position Feed slowly Wash away milk curds ESSR feeding
What is the difference between cleft lip and cleft palate? Cleft lip includes minor notching in the lip through complete separation through the lip into the floor of the nose. Cleft palate/mid-line fissure in the palate/failure of the two sides to fuse.May be both hard/soft palate/pr only the soft palate.
Congenital Clubfoot A complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus and ankle equinus
Congenital Clubfoot/ Talipes varus inversion or bending inward
Congenital Clubfoot/ Talipes valgus eversion or bending outward
Congenital Clubfoot/ Talipes equines plantar flexion, toes lower than heel
Congenital Clubfoot/ Talipes calcaneus: dorsiflexion, toes higher than heel
what is a Barlow test for? HIP DYSPLASIA
Ortolani is a test to diagnostic evaluation for what? HIP DYSPLASIA
Barlow’s Test & Ortolani’s Sign is proformed by doing what to the newborn? Maneuvers used during the physical examination to assess the hips for dysplasia. (Left) Ortolani maneuver. (Right) Barlow maneuver
what is a Pavlik harness used for? Variety of hip abnormalities/Developmental Hip Dysplasia
True or False: Developmental Hip Dysplasia is often not detected at the initial examination after birth True
Phenylketonuria (PKU) A genetic disorder that causes central nervous system damage from toxic levels of the amino acid phenylalanine in the blood (has poor smelling urine)
Causes of Phenylketonuria (PKU) A deficiency of the liver enzyme phenylalanine hydrolase, which is needed to convert phenylalanine to tyrosine
Phenylketonuria (PKU) S/S Digestive problems, feeding difficulties Failure to thrive (growth failure) Vomiting, and later progress to seizures Musty odor in urine and severe intellectual disability
Diet for PKU (Phenylketonuria) Diet is primarily fruits, vegetables, and starches with a phenylalanine-free protein supplement
Why is early detection of PKU crucial? : Phenylalanine(PKU) accumulates in the blood and causes severe mental retardation if not treated early.
Down Syndrome (Trisomy 21) : MOST COMMON CHROMOSOMAL abnormality of a generalized syndrome.
There are three phenotypes:Down Syndrome (Trisomy 21) Trisomy 21 (nonfamilial trisomy 21) Translocation of chromosomes 15 and 21 or 22 Mosaicism (is a condition in which cells within the same person have a different genetic makeup.)
What is Mosaicism: Refers to cells with both normal and abnormal chromosomes
Diagnostic Evaluation for Down Syndrome (Trisomy 21) Alpha-fetoprotein (AFP) screening   Multiple Marker screening Chorionic villus sampling Amniocentesis( after positive AFP Screening) Nuchal translucency (screening, is an ultrasound test. It screens for Down syndrome.)
What is Trisomy 21? Three number 21 chromosomes instead of the normal two.
in regards to Hemolytic Disease of the Newborn if the Mother and babies blood mixes and it doesnt termintate pregnancy, what is our main focus? Focus is prevention of Kernicterus (is a rare neurological condition that occurs in some newborns with severe jaundice)
What is the primary aim of therapeutic management? : Prevention of isoimmunization, also with the focus on prevention of kernicterus.
Periventricular-Intraventricular Hemorrhage is Defined as: bleeding around and into the ventricles of the brain.
Periventricular-Intraventricular Hemorrhage grade ONE: bleeding occurs just in the germinal matrix.
Periventricular-Intraventricular Hemorrhage grade TWO: bleeding also occurs inside the ventricles.
Periventricular-Intraventricular Hemorrhage grade THREE: ventricles are enlarged by the blood.
Periventricular-Intraventricular Hemorrhage grade FOUR: there is bleeding into the brain tissues around the ventricles
What are the signs of PIVH? Signs include poor muscle tone, lethargy, respiratory distress, cyanosis, apnea, decreased reflexes, full or bulging fontanelles and seizures.
Why is the infant of a diabetic mother often hypoglycemic after delivery? Due to the abrupt loss of maternal glucose and the overproduction of insulin by the infant.
testing and Monitor glucose levels in a in are very important. what is a normal infant glucose? ( 40-45mg/dl)
Postpartum is defined as Six weeks post delivery
Postpartum Commonly Used Vaccines: RHo (D) Immune Globulin: RhoGAM, Rhophylac, BayPho-D
RhoGAM Vaccines Dosage and Route: 300 mcg0 IM (deltoid recommended)At 28 weeks of pregnancy 72 hours of delivery 72 hours after termination pregnancy
How much can you administer IM to a mom or newborn? 5ml for a mom 3ml to a newborn
Rubella vaccine (Meruvax II) Vaccine is administered after childbirth or abortion or at least 4 weeks before pregnancy to women whose antibody screen show they are not immune to rubella.
Contraindication and Precautions Rubella vaccine (Meruvax II): immunosuppressed Pregnant Sensitive to neomycin or eggs Respiratory tract or febrile infection Active untreated tuberculosis conditions of bone marrow or lymphatic system.
Doseage and Nursing implication for Rubella vaccine (Meruvax II): Dosage and Route: 0.5 ml SQ Nursing Implications: Pregnancy not advised until 4 weeks
The LPN can Reconstitute with any .9 diluents to administer Rubella vaccine (Meruvax II): TRUE OR FALSE? FALSE Reconstitute only with diluents supplied with the vial of Rubella vaccine (Meruvax II)
Pain Medications Analgesics for Postpartum: Non Opiod: - Acetaminophen (Tylenol, Panadol). - Ibuprofen (Motrin, Advil).  - Ketorolac (Toradol).
Pain Medications Analgesics for Postpartum: Opiod Darvocet-N/ Lortab/Percocet/Tylenol with codeine # 3/Tylox( acetaminophen and oxycodone)/ Vicodin (hydrocodone and acetaminophen)/ Vicodin ES (hydrocodone and acetaminophen).
LAXATIVES for postpartum:Fecal Wetting Agents: Docusate calcium (Surfak). Docusate sodium (Colace).
LAXATIVES for postpartum:Saline Laxatives: Milk of Magnesium
LAXATIVES for postpartum:Stimulant Laxatives: Bisacodyl (Dulcolax). Casanthranol (Peri-Colace). Senna (Senokot).
LAXATIVES for postpartum:Suppositories: Glycerine. Bisacodyl. Simethicone: (Mylicon)
OXYTOCICS for postpartum Oxytocin: (Pitocin): Action: Stimulates uterine contractions Indications: Control postpartum hemorrhage.
Route/Dosage: IV infusion:For OXYTOCICS for postpartum Route/Dosage: IV infusion: Dilute 10-40 units in 10000ml of IV solution. Begin at rate of 20-40 mu/min IM injection: 10 units after delivery of the placenta
Methylergonovine maleate (Methergine)OXYTOCICS for postpartum Stimulates contraction and causes arterial vasoconstriction Indications: Prevention and treatment of postpartum or post-abortion hemorrhage
Methylergonovine maleate (Methergine)OXYTOCICS for postpartum Dose/Route Route/dosage: 0.2 mg IM every 2 to 4 hours for a max of five doses.
Carboprost tromethamine (Hemabate, Prostin): OXYTOCICS for postpartum Stimulates contraction Indications: Treatment of postpartum hemorrhage and abortion.
Carboprost tromethamine (Hemabate, Prostin): OXYTOCICS for postpartum: Route/Dosage: Route/Dosage: 250 micrograms IM. May repeat at 15-90 min intervals. Max dose 2 mg.
Newborn are treated with the following medications: Vitamin K1 (Phytonadione). Antiinfectives: Erythromycin Ophthalmic Ointment. Tetracycline. Vaccines: Hepatitis B Vaccine. Hepatitis B Immune Globulin (HBIG).
Newborn are treated with the following medications: Vitamin K Required for hepatic synthesis of blood coagulation factors II (prothrombin), VII, IX, and X. Therapeutic Effects: prevention of bleeding due to hypoprothrombinemia
Dosage and Route (cont.): Newborn are treated with the following medications: Vitamin K Prevention of Hemorrhagic Disease of Newborn IM 0.5-1 mg, within 1 hr of birth May be repeated in 2-3 1-5 mg given IM to mother 12-24 hr before delivery Treatment of Hemorrhagic Disease of Newborn IM, SQ (Neonates ): 1-2 mg/day.
Newborn are treated with the following; Hepatitis B Vaccine (Recombivax, Engerix-B): Provides immunization against Hepatitis B infection
Hepatitis B Vaccine (Recombivax, Engerix-B) (cont.): DOSEAGE Recombivax: 5 mcg IM at birth, 2nd dose at 1-4 mo, 3rd dose at 6-18 mo (same dose) Engerix-B: 10 mcg, same follow-up schedule as above
HEPATITIS B IMMUNE GLOBULIN (HBIG) Antibodies and passive immunity Indications: Prophylaxis for infants of hepatitis B surface antigen-positive mothers.
HEPATITIS B IMMUNE GLOBULIN (HBIG) doseage and route Dosage and Route: 0.5ml within 12 hours of birth if possible but no later than 1 week of age. Give IM in the anterolateral thigh; should not be given IV
what does the mnemonic B-U-B-B-L-E HE-HE stand for and what is it used for? Used for postpartum patient assessment. B-breasts U-Uterus B-Blabber B-Bowel L-Lochia E-Episiotomy H-Hemorrhoids E-Edems H-Homans signs E-Emotional Response
What is a nursing consideration for the Hep B vaccine in a newborn? bathe infant before injection to wash off vernix.
what are the 2 antiinfectives we give newborns? Erythromycin Ophthalmic Ointment. Tetracycline.
Nursing implications for Vitamin K Monitor for side effects and adverse reactions. Children may be especially sensitive to the effects of vitamin K, which may increase incidence of side effects. Neonates, especially premature neonates, may be more sensitive than older children.
What is the contraindications/precautions of giving the Rubella Vaccine? immunosuppressed Pregnant Sensitive to neomycin or eggs Respiratory tract or febrile infection Active untreated tuberculosis conditions of bone marrow or lymphatic system.
Created by: charlie1010