Ch 28 Care of the Mother and Newborn

Postpartum Maternal Danger Signs

- Fever with or without chills - Malodorous vaginal discharge - Excessive amount of vaginal discharge - Bright red vaginal bleeding after it has changed to pink or brown (rust). -Edema; erythmatous or painful area on the legs - Pain or burning sensation with urination or an inability to void - Breast changes, such as localized pain, heat, edema, or malodorous drainage - Pain in the perineal or pelvic area

Atonic uterus

- literally a uterus without tone - Most common reason for post-partum hemorrhage

Which client behavior indicates that a woman needs further teaching regarding breastfeeding her newborn? 1 She leans forward to place her breast in the infant's mouth. 2 She holds the infant level with her breast while in a side-lying position. 3 She touches her nipple to the infant's cheek at the beginning of the feeding. 4 She puts her finger in the infant's mouth to break the suction after the feeding.

1 She leans forward to place her breast in the infant's mouth.

Which drug would be excluded from the prescription of a lactating mother being treated for heart problems? 1 Tenormin 2 Labetalol 3 Metoprolol 4 Propranolol

1 Tenormin

A client with a habit of smoking while on estrogen therapy is at risk for developing which condition? 1 Thrombosis 2 Gastrointestinal upset 3 Endometrial cancer 4 Decreased effectiveness of estrogen

1 Thrombosis

Passages of vesicles (grapelike clusters) may occur around which weeks of gestation?

16 weeks

A client who is scheduled for an amniocentesis tells the nurse, "I'm glad this test will be able to tell me whether or not my baby is well." How would the nurse respond? 1 "Research has shown that this is an excellent test." 2 "A normal amniocentesis result is a reliable indicator of a healthy baby." 3 "This test is useful in detecting potential defects caused by chromosomal errors." 4 "An amniocentesis is a valuable tool for detecting congenital defects in the developing fetus."

3 "This test is useful in detecting potential defects caused by chromosomal errors."

Why would the use of baby powder on an infant be avoided? 1 Skin irritation 2 Skin infection 3 Lung irritation 4 Respiratory infection

3 Lung irritation

Which drug impairs fertility when administered along with fertility drugs? 1 Clomiphene 2 Menotropins 3 Promethazine 4 Choriogonadotropin alfa

3 Promethazine

New Born Respiratory Rate Range?

30 to 60 breaths/min with brief periods of apnea.

A nurse is planning to use a newborn's foot to obtain blood for the required newborn metabolic testing. Which part of the foot is the best site to use for the puncture? 1 Big toe 2 Foot pad 3 Inner sole 4 Outer heel

4 Outer heel

Which dietary information would the nurse emphasize when reinforcing a dietary program for a pregnant client with diabetes? 1 The need to increase high-quality protein and decrease fats 2 The need to increase carbohydrates to meet energy demands and prevent ketosis 3 The need to eat a low-calorie diet that maintains the current insulin coverage and helps prevent hyperglycemia 4 The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary

4 The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary

Baby's Normal body temperature ranges?

97.6° to 99°F (36.4° to 37.2°C)

What pulse rate is considered normal after delivery?

A pulse rate between 50 and 70 beats/min is considered

Harlequin sign

A rare color change that occurs between the longitudinal halves of the newborn's body, such that the dependent half is noticeably pinker than the superior half when the newborn is placed on one side; it is of no pathologic significance.

Vernix caseosa

A white, cheesy substance that covers the body of the fetus.

Fontanelles

Areas where the infant's skull has not fused together; usually disappear at approximately 18 months of age.

Pathologic jaundice

Begins in the first 24 hours and may require treatment with phototherapy

Cephalhematoma

Bleeding between the periosteum and skull from pressure during birth; does not cross suture lines.

How long can breast milk be refrigerated?

Breast milk can be safely stored in a refrigerator for 24 to 48 hours.

Transitional milk

Breastmilk produced between colostrum and mature milk, during the first 4-10 days postpartum.

Lochia rubra

Bright red, clots, 1-2 days after delivery

Nevus flammeus

Capillary angioma below the surface of the skin that is purple or red, caries in size and shape, is commonly seen on the face, and does not blanch or disappear

Strawberry birthmarks

Capillary hemangiomas. May continue to increase in size for several months. Usually disappear early in childhood

Milia

Distended sebaceous glands which appear as tiny white spots on the baby's face.

How long does it take for an episiotomy take to heal?

Episiotomy heals in approximately 3 weeks (when the lochia has stopped).

Which hormone stimulates the growth of the milk ducts to prepare for lactation?

Estrogen

How long should mother breast feed in each breast?

Feed for 10 to 15 minutes from each breast.

Where does milk accumulation begin?

Filling of the breast with milk usually begins in the axillary region, so palpate the body and the tail of the breast.

Syndactyly

Fusion of digits

Want occurs in an ectopic pregnancy when the fallopian tube ruptures?

If the fallopian tube has ruptured, she may have vaginal bleeding, referred shoulder pain, and abdominal rigidity. The risk for hypovolemic shock is present.

When does colostrum start producing?

In the second trimester.

Which hormone changes breast size?

Increased amounts of estrogen

Aquamephyton (Vitamin K)

Indication: prevention of hemorrhagic disease in neonate. Required for hepatic synthesis of blood coagulation factors. Administered IM - 0.5 mg within the first hour of life.

Moro reflex

Infant reflex where a baby will startle in response to a loud sound or sudden movement.

Parent-child attachment (bonding)

Initial phase in a relationship characterized by strong attraction and a desire to interact.

When does the colostrum become milk?

Its production continues for about 2 days after delivery, when true milk production begins.

When can mother take pain medications when breast feeding?

May take a mild analgesic 1 hour before nursing.

A women who have experienced a molar pregnancy must avoid becoming pregnant for how long?

One year.

Lochia serosa

Pinkish/brownish discharge lasting 7 days postpartum

How to clean breasts and nipples?

Plain water and air drying may prevent problems. Some physicians recommend allowing the nipples to dry after feeding without removing the milk residue. If additional moisturizer is needed, small amounts of unscented lanolin or a nipple cream may be used to soften and soothe dry, tender nipples.

let-down reflex.

Prolactin, a hormone secreted by the anterior pituitary gland, is responsible for stimulating milk production in the mammary alveolar cells. Stimulation of the nipples, particularly by the infant's sucking, causes the release of oxytocin from the posterior pituitary gland. Oxytocin stimulates contraction of the mammary ducts, and milk is ejected from the breast.

Involution

Return of the uterus to a nonpregnant state after birth

Administration of Rho(D) immune globulin (RhoGAM) is indicated for those women who are?

Rh negative.

Epstein's pearls

Small, white blebs found along the gum margins and at the junction of the hard and soft palates; commonly seen in the newborn as a normal manifestation.

Engorgement

Swelling of the breasts resulting from increased blood flow, edema, and the presence of milk.

How many sitz should the mother take after vaginal delivery?

Take sitz baths two or three times daily with vaginal delivery.

Acrocyanosis

Temporary cyanotic condition, usually in newborns resulting in a bluish color around the lips, hands and fingernails, feet and toenails. May last for a few hours and disappear with warming.

Mature milk

The breastmilk after colostrum and transitional milk, typically beginning 2 weeks postpartum.

The newborn should void within how many hours of delivery?

The newborn should void within 24 hours of delivery.

How long does the puerperium last?

The puerperium lasts about 3 to 6 weeks

How long can breast milk be frozen?

Two weeks

How to clean umbilical cord?

Use alcohol on cord stump daily. (Be careful to prevent alcohol from dripping down to perineal area.) • Keep area dry; fold diaper down with plastic side on outside to prevent moisture retention. • Sponge bathe for 7 to 10 days until umbilical cord comes off. (Do not soak in bath water.)

Pseudomenstruation

Vaginal bleeding in the newborn, resulting from withdrawal of placental hormones.

When a cesarean delivery has been performed and the use of anesthesia was used, when can the mother start eating solid foods again?

Verify the presence of bowel sounds before giving solid food.

Dry breasts (engorgement, fluid intake)

Wear supportive, well-fitting bra. • Avoid breast stimulation (warm showers). • Apply ice bags for 20 minutes four times a day. • Suppression of lactation takes about 5 days. • Do not drink excessive amounts of fluids (normal: six to eight 8-ounce glasses).

Mottling

a lacy pattern with dilated vessels on pale skin

Colostrum

a specialized form of milk that delivers essential nutrients and antibodies in a form that the newborn can digest

Mongolian spots

areas of deep bluish-gray pigmentation most commonly on the sacral aspect of a newborn

witch hazel (Tucks pads)

astringent for hemorrhoids (reduces itching)

Three interrelated factors of engorgement

congestion, increased vascularity, and the accumulation of breast milk

Ophthalmia Neonatorum

conjunctivitis of the newborn

Caput succedaneum

diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days

Polydactyly

extra fingers or toes

Lanugo

fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.

Postpartum headaches may be caused by which various conditions?

gestational hypertension stress leakage of cerebrospinal fluid into the extradural space during placement of the needle for epidural or spinal anesthesia.

How long does the fudus take to return to the pelvis?

in 10 days.

Diuresis

increased formation and secretion of urine

What causes autolysis to occur after birth?

is a result of the sudden withdrawal of estrogen and progesterone, which releases proteolytic enzymes into the endometrium.

Tolbutamide

is an oral hypoglycemic agent used in the treatment of type 2 diabetes mellitus. It is known to have teratogenic effects like neonatal hypoglycemia.

What's the color of lochia the first three days after delivery?

is dark red

Ileus

loss of peristalsis with resulting obstruction of the intestines

When is jaundice considered pathologic?

occurs sooner than 48 hours after birth

Telangiectatic nevi (stork bites)

pale pink or red spots; frequently found on the eyelids, nose, or nape of the neck. Usually fade by the second birthday.

Puerperium

period from delivery until the reproductive organs return to normal

What color is the lochia after 4 or 5 days after delivery?

pinkish brown.

Mummification

producing a dry, hard mass

Diaphoresis

profuse sweating

Newborn rash (erythema toxicum)

red blotchy areas which resolves on its own

Lactation

secretion of milk

Autolysis

self-destruction of cells; decomposition of all tissues by enzymes of their own formation without microbial assistance

How long does it take for a mother to return to prepregnate weight?

she usually returns to her prepregnant weight in 6 to 8 weeks without significant dietary restrictions.

Lochia alba

slightly yellow to white This drainage continues for another 10 days to 2 weeks.

Prolactin

stimulates milk production

Circumcision

surgical removal of the foreskin

Gynecomastia

the condition of excessive mammary development in the male

Meconium

the first bowel movement of the newborn

Lochia

the postpartum vaginal discharge that typically continues for 4-6 weeks after childbirth

let-down reflex

the reflex that forces milk to the front of the breast when the infant begins to nurse

Where is the uterine fundus after delivery?

the uterine fundus is about midway between the umbilicus and the symphysis pubis or slightly higher. I

When is Rhogam administered?

they must receive RhoGAM within 72 hours of delivery.

latch-on

to grip; to fasten onto

Cryptorchidism

undescended testicles

Vital signs normally stabilize within how many hours after delivery?

within the first 2 hours after delivery

Nutrition (Nursing, Dieting)

• Continue prenatal vitamins until gone. • Nursing: need 500 kcal more than prepregnant diet; need increased protein, 400 mg calcium each day, 8 to 10 glasses of fluid each day; avoid onions, cabbage, chocolate, spices, and foods that may distress infant; no dieting during breast-feeding.

Emotions (Bonding, "Baby Blues")

• Mother may be tearful or anorexic and have difficulty sleeping. • Hormonal factors and fatigue are often responsible. • Notify primary care practitioner if prolonged, increased, or unmanageable.

Hypovolemic Shock Nursing Intervention

• Notify primary health care provider. • If uterus is atonic, massage gently and expel clots to cause uterus to contract; compress uterus manually, as needed, with two hands. Add oxytocic agent to IV drip, as ordered. • Give oxygen via face mask or nasal prongs at 8 to 10 L/min. • Tilt the woman to her side or elevate the right hip; elevate her legs to at least a 30-degree angle. • Provide additional or maintain existing IV infusion of lactated Ringer's solution or normal saline solution to restore circulatory volume. • Administer blood or blood products, as ordered. • Monitor vital signs. • Insert an indwelling urinary catheter to monitor perfusion of kidneys. • Administer emergency drugs, as ordered. • Prepare for possible surgery or other emergency treatments or procedures. • Chart incident, medical and nursing interventions instituted, and results of treatments.

Hypovolemic Shock symptoms after birth

• Woman has persistent significant bleeding (perineal pad soaked within 15 minutes); this bleeding may not be accompanied by a change in vital signs or maternal color or behavior. • Woman states she feels weak, lightheaded, "funny," or "sick to my stomach" or she "sees stars." • Woman begins to act anxious or exhibits air hunger. • Skin turns ashen or grayish. • Skin feels cool and clammy. • Pulse rate increases. • Blood pressure declines.