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Lap 4

Care of Mother and Newborn- W. Calley

after birth of the baby and placenta the uterus contracts in response to? Oxytocin.
Oxytocin a hormone produced by the posterior piuitary gland that stimulates uterine contractions and release of milk in the mammary glands.
if the uterus does not contract adequatly what is the outcome? blood loss can be excessive.
The placental site will heal by process of which necrotic tissue will slough off from the uterine lining. exfoliation
How long does it take for the uterus to become a plevic organ again? 6 weeks
Involution change in the size of the uterus
Lochia the fluid waste discharged after delivery. Contains blood, tissue and mucous.
blood loss continues for how long after birth? 10 days to 2 weeks.`
Lochia Rubra a bright red drainage.
Lochia Alba slightly yellow to white color drainage.
Lochia Serosa pink to brown color drainage.
When will vaginal mucous production return? with the return of Estrogen production
What is the apperance of the cervix after delivery edematous, strike like, and burising will be present.
First degree Laceration extends only through the vagina and perineal skin
Second degree Laceration extends through muscles of perineal body
Third degree Laceration continues throught the sphincter muscle.
Fourth degree Laceration involves the anterionr rectal wall.
Pelvic Hematoma Collection of blood in connective tissues of the pelvis.
Vulvar Hematoma bleeding into the vulva. Most common type.
Retroperitoneal hematoma caused by laceration of one of the vessels attached to the hypogastric artery. (rupture of cesarean scar)
Perineal Laceration occur when the fetal head is being born
vaginal vault laceration may be circular and may result from forceps baing used.
Cervical Injuries occur when teh cervix retracts over the fetal head.
Colostrum the first secreation produced by breasts, is thin, watery and yellow, rich in proteins, calories, antibioties and lymphocytes.
Hormonal, neurological, and psycholocic responses are responsible for? lactation
Prolactin is the hormone responsible for stimulation milk production
Blood volume is reduced due to diuresis and diaphoresis.
blood loss during vaginal delivery? 300-500 mL
blood loss druing C/S 600-800 mL
Elevation of platelets in the early postpartum period can result in what? thrombus formation
bladder distnesion immediately agter birth can cause? excessive bleeding.
How long does it take for bladder tone to be restored? 5-7 days
Pregnancy Induced Neurological problems... Occur after birth
S/S of Neuro problems carpel tunnel, tingling and numbness in fingers, and headaches.
Childbirth causes what GI disruptions? decreases gastric motility, decreased abdominal tone, and tenderness from episiotomy and hemroids.
Expulsion of the placenta causes what hormone levels to decreas? Estrogen and Progesterone.
What releases Prolactin? nipple stimulation
Engorgement expansion of the breasts caused by expanding veins and production of milk.
Engorgement patient teaching for breastfeeding mothers. application of warm moist heat and manual expression of milk, help releive pain.
Engorgement patinet teaching for non-breastfeeding mothers compression of breasts with a firm bra, wrapped in icepacks and analegesics will help releive pain.
Nutrition for later postpartum stage Diets are not reccomended, continue a well balanced diet, good calorie intake, daily fluid intake of 2-3 L/day.
Metabolic issues for later postpartum stage lactating mother need to consume extra calories, vitamins and minerals and 2-3 L/day of fluids.
Breastfeeding moters need to know what? proper nipple care, air dry nipples, can get pregnant when breastfeeding, feeding techniques.
What is the proper way to store breast milk? frozen in plastic bottles or bags up to two weeks.
How long after breastfeeding is stopped does lactation stop? 5 days.
Activity and excercise during the recovery stage includes? vital signs every 15 min for 2 hours, bedrest, can ambulate when nurse feels it is time, chilling is a normal reaction to labor.
Orthostatic Hypotension occurs commonly when women ambulate after delivery due to rapid decreas in intraabdominal pressure.
A temperature higher than 100.4 after birte is considered what? Significant and should be reported.
What does BUBBLE HE cover in the postpartum assessment? Brests, Uterus, Bladder, Bowel, Lochia, Episiotomy, Homans sign, and Emotional Status.
Breast assessment should be inspected with pt lying down, palpate fo rengorgement, inspect nipples
Uterus assessment fondus should be very firm, gently massage the uterus to help muscle contract.
Bladder assessment watch for symptoms of infection, note any dysuria or urinary retention.
Bowel assessment bowel sounds, encourage activity with rest periods, encourage fluide intake.
Lochia assessment if fetid odor is present may indicate infection, assess carefully
Episiotomy Assessment note size, color, discharge, any sutures, and inflammation.
Position for assessment of an Episiotomy position pt on affected side, flex top leg at knee and draw tward waist. use flashlight to inspect.
Homans' Sign assessment report any positive findings to Primary care provider.
Emotional Status Assessment 3 phases the new mother goes through: "taking in", "taking hold", "letting go"
"Taking in" the time immediately following birth. mother will sleep and depend on others for nurturing and food.
"Taking Hold" this happens over the next few days. will be concernd with her health and babys condition, cares for self and want to learn to care for the newborn.
"Letting go" comes later in postpartum period. reestablis relationships with other people.
Postpartum hygene includes no tub baths until after postpartum exam at 6 weeks to promote tissue repair. use sitz bath for cleansing and comfort. no toilet paper should be used if tear or laceration occured.
Urinary elimination is encouraged beacuse a full bladder can cause what problems? hemorrhage, the full bladder may interfere with contraction of the uterus.
To promote comfort, the nurse should encourage the patient to void how often? at intervals of every 2-4 hours.
Low income mothers contend with stressors that distract them from developing a relationship with their babies.
Chinese, Mexican, Korean, adn Southeast Asian women may eat and drink fluids to replace blood loss, avoid bathing and washing hair, care by family is done for 30-40 day periods while mother rests,
Arabic women eat special meals designed for energy, are expected to stay at home for 40 days after delivery to avoid illness.
Haitian women may request to take the placenta home to bury or burn
Muslim women musk keep her hair, body, arms to the wrists and legs to the ankles covered at all times.cannot be alone with a man other than huband or relative, do not eat pork or other meats that are slaughtered.
What is the ideal diet fo rmuslim women in the hospital? halal meat, kosher meat, seafood or vegetarian.
Algerian mothers may not unwrap baby to explore body, in algeria babys are wrapped tightly to protect them physically and psychologically.
Asian women may not voice pain or complain of pain. they are very obedient. they do not use iced sitz baths because of traditional avoidance of bathing and cold in the puerperium.
Japanese mothers mix breastfeeding and bottle feeding.
Protective Newborn reflexes rooting, sucking, gag, swallow, blink, burp, hiccup, and sneeze.
Why are newborns at risk for hemmorhage? because of low prothrombin levels at birth.
Vitamin K is routinely given to newborns to help build vit k in blood for clotting factor.
What is the daily nutritional requirement for a newborn? 120 calories per kg each day, including proteins, carbohydrates, fats, vitamins and minerals. fluid intake needs are high; 140-160mL/kg/day. breast milk is always perfered.
breast milk is produced in 3 stages. What are these stages? colostrum, transitional milk and mature milk.
Transitional Milk is produced for 1 week. its thinner, and more watery. it is also high in fats, lactose and water-soluble vitamins and contains more calories than colostrum.
Mature Milk is established 2 weeks after delivery. thin adn watery, provides 20 kcal per ounce and contains lactose, proteins, minerals and vitamins.
What is considered a normal weight loos for a newborn? 10% of the body wt. at birth. daily wt. is required. most regain birthweight during the 2nd week.
Standary lab values for an infant Hematocrit (14-24), Glucose (40-60), Bilirubin, direct (0-1), Hemoglobin (14-24)
Diagnostic test required by the state for newborns include phenylketonuria (PKU), maple sugar urine disease (MSUD), galactosemia, and hypothyrodism.
Phenylketonuria (PKU) is done to check whether a newborn baby has the enzyme needed to use phenylalanine in their body. it is an amino acid needed for normal growth and developement.
What disorders can result because the body does not have phenylalanine? brain damage, seizures and mental retardation.
Maple Sugar Urine Disease (MSUD) ia a metabolism disorder passed down through famlies caused by a gene defect in which the body cannot break down certain parts of proteins. the urine will smell like maple syrup.
Galactosemia is a condition in which the body is unable to metabolize the simple sugar galactose (to turn milk into glucose) it is genetic and rare.
when Galactose builds up in the body, what problems may occur? brain damage, seizures and mental retardation, liver problems, infectiona dn chataracts.
Hypothyroidism in infants is very rare but poses threat to a childs physical and mental developement if left untreated.
Respirations 30-60/min for newborn
Blood pressure 60-80/40-50 mm Hg
Axillary temperature 97.6-98.6
Pulse 120-160/min
Acrocyanosis it the slightly blue color on the newborns hands and feet caused by poor peripheral circulation. can last 7-10 days.
Circumcision sergical removal of the foreskin. yellow exudate is normal
Care after Circumcision areas should be kept clean and dry, wash penis gently during diaper changes, reapply fresh sterile petroleum gause. report immediately any signs of edema or purulent, malodorous discharge, or elevated temperature and delayed healing
What type of cry may signify a Neurological proplem? a high-pitched cry.
Meconium infants first stool, is composed of amniotic fluid and its constituents, intestinal secretions, shed mucosal cells, and possibly blood. (should be passed in 24-48 hours)
Transitional Stools greenish brown to yellowish brown, thin and less sticky than meconium, and may contain some milk curds; usually appear by third day after initaion of feeding
Milk Stool usually appears by foruth day, in breastfed infants stools are yellow to golden, are pasty and have an odor similar to sour milk; formula fed infants stools are pale yellow to light brown, ar firmer and have a more offensive odor.
Moro reflex sudden jarring or change in equilibrium causes extension and abduction of extremities and fanning of fingers with index finger and thumb formin a c shape, followd by flexion and adduction of extremities.
Tonic Neck Reflex when infants head is quickly turned to one side, arm and leg will extend on that side, and opposite arm and leg will flex; posture resemples fencing position.
postpartum danger signs fever, malodorous vaginal discharge, excessive amount of discharge, bright red vaginal bleeding after it has changed to pink or rust, edema or redness to legs, pain or burning upon urination, localized breast pain, heat, edema or malodorous drainage.
Radiation loss that occurs when heat transfers from the body to cooler sufaces and objects no in contact with the body. to prevent heat loss wrap body well, limit time exposed, use warmer.
Evaporation loss when water is converted into a vapor, to prevent kry infan thotoughly after delivery and when bathing
Conduction loss of heat to a cooler surface by direct skin contact, prevent by padding surfaced under infant, warm equiptment.
Convection loss of heat to cooler air currents, to prevent reduce drafts from open doors, windows or air conditioning. wrap newborn.
Umbillical Cord Care watch for indications of infection such as edema, redness and drainage at base, it will fall of in 2-3 days, may be treated with antibiotic ointment or alcohol three times a day or allowed to dry naturally, keep cord dry, when soiled clean with water
Signs of Hypovolemic Shock persistent significant bleeding, weak, sick to stomach, anxiety, skin is ashen or grayish and cool to touch, pulse increases, blood pressure declines
characteristics of a newborn head is large for body, abdomne is prominent, smaller chest and narrow hips.
RH factor mother who are RH+ or RH-, have to have RhoGAM to prevent killing her baby because of RH incompability
Parent child attachment is defined as the initial phase in a relationship characterized by strong attraction and desire to interact.
influences on position of the uterus Involution and Autolysis
promote uterine contractility have pt to fully empty bladder, prevent bladder distension, massage fundus to prevent excessive bleeding.
How do you correctly massage a relaxed uterine fundus? gently but firmly massage the fundus in a circular motion to promote hardning of the uterus. if it feels boggy do not press to hard.
What can the nurse do to provide emotional support for parents? the nurse can provide emotional support by pt teaching and empathetic listening. Also to anser any questions or concerns that the parents may have.
Puerperium the postpartum period
Involution when the uterus decreases to the nonpregnant size and becomes a pelvic organ again
Autolysis self digestion that occurs in tissues or cells by enzymes in the cells themselves
diuresis the increased formation and secretion of urine
diaphoresis the secretion of sweat
Harlequin sign half o fthe newborns body appears deep red and the other side of the body appears pale as a result of vasomotor disturbance, with some contracting while other dilate.
Physiologic Jaundice jaundice occuring 48 hours or later fter birth. caused by the normal reduction in the number of red blood cells
Vernix Caseosa a yellowish white cream cheeselike substance covering the skin at birth.
Lanugo downy, fine hair characteristic of the fetus, between 20 wks of gestation and birth
Fontanelles broad area or soft spot consisting of a strong band of connective tissue contiguous with cranial bones and located at the uunction of the bones
Cryptorchidism the testicles are not decended in preterm infants
Syndactyly malformation of digits
Polydactyly execssive number of digits
Pseudomenstruation discharge of blood dinged mucous from the vagina
Gynecomastia the breasts are be inlarged in either sex as a result of maternal hormones
Mummification mortification, producing a dry, hard mass. as in the umbillicle cord hardning.
Created by: wcalley