Exam 2 Newborn/Postpartum info.
Dry, peeling skin is seen in...
postmature newborns
When do newborns have their first bowel movement?
up to 24 hrs for first meconium stool
A diabetic postpartum client plans to breastfeed. The nurse determines that the client's understanding of breastfeeding instructions is sufficient when she states:
"Breastfeeding will assist in lowering maternal blood glucose."
When is APGAR assessed?
1 min, 5 min of birth *If below 8 @ 5 min, they require a 10 min score
Formula feed every...
3-4 hrs
Which action would be most appropriate after assessing a neonate's cry as infrequent, weak, and very high pitched?
Notify the primary care provider because this may indicate a neurologic problem.
Postpartum depression
S/Sx: restless, worthless, guilty, hopeless, moody, sad, overwhelmed
Stomach capacity of newborn:
about 50-60 mLs
How long is cord clamped?
at least first 24 hrs. *can be removed when the cord is dried & occluded & is no longer bleeding
Lochia rubra
deep-red mixture of mucus, tissue debris, & blood. first 3-4 days
Transitional stool is..
greenish brown & of looser consistency than meconium
A client who used heroin during her pregnancy gives birth to a neonate. When assessing the neonate, the nurse expects to find:
irritability and poor sucking.
Stage 3: Transition to Mastery (father)
makes conscious decision to take control & be at the center of newborns life regardless of preparedness *similar to mother's letting-go phase
Lochia serosa
pinkish brown 3-10 days Contains leukocytes, decidual tissue, red blood cells, & serous fluid
Why aren't rectal temp.'s done anymore?
risk of traumatizing the rectal lining
What are Epstein's Pearls?
small,white cysts on hard palate
Prolactin
triggers the synthesis & secretion of milk
What does thrush look like?
white patchy areas on tongue or gums that cannot be removed w/ washcloth; may be painful
Production of vitamin K occurs when?
within 24 hrs. of age from bacterial colonization of the gut (after oral intake)
When does breast milk typically appear?
within 4-5 days after childbirth
Letting-go phase
women reestablishes relationships w/ others, adapts to parenthood, assumes responsibility & care of the newborn with more confidence
The nurse has provided health teaching about physiologic changes that can be expected during the postpartum period to a postpartum client who is bottle-feeding her neonate. Which client statement indicates that this teaching has been effective?
"My menstrual flow should resume in approximately 6 to 10 weeks."
After the birth of her first neonate, a mother asks the nurse about the reddened areas at the nape of the neonate's neck. How should the nurse respond?
"They're normal and will disappear as the baby's skin thickens."
How do you care circumcision?
*Apply petroleum jelly gauze to penis, except if plastibell is used * clean after each void with warm water * milky covering is normal, don't disrupt
Postpartum/puerperium period
*begins after delivery of placenta until about 6 wks (varies) *womens body begin to return to prepregnant state
Lochia
*vaginal discharge that occurs after birth *decidua (spongy layer) of uterus is shed to give the lochia
Engrossment(father or significant other's development of a bond w/ newborn)
1. visual awareness of newborn-attractive, pretty, beautiful 2. tactile awareness- touch or hold newborn 3. Newborn is perfect- doesn't see imperfections 4. Strong attraction to newborn-focuses all attention on newborn 5. awareness of distinct features- distinguish newborn from others 6. extreme elation- "high" 7. Increased sense of self-esteem--feels proud, more mature, and older
HR for newborn:
120-160 * up to 180 if crying
How does the uterus change after birth?
1st week- shrinks by 50%, wt 1 lb. 6 wks- 2 oz. approx. wt prior to pregnancy 1st few day it descends from level of umbilicus at a rate of 1cm(1 fingerbreadth) per day. 3 days, lays 2-3 cm below umbilicus. End of 10 days, fundus can't be palpated
Breastfeed every...
2-3 hrs
Newborns first void:
24-48 hrs post delivery *usually doc is notified if babe hasn't voided after 24 hrs.
How many bowel movement do newborns have in one day?
3-5 daily on average up to 10 May have 1 every 5-7 days after a couple of weeks
Resp. for newborn
30-60 breaths/min
When are bowel sounds present in newborn?
30-60 min after birth
When are kidney's developed in newborn?
34-36 wks gestation
A nurse assigns to a neonate an Apgar score of 8 at 5 minutes. The nurse understands that this score indicates:
A neonate who is in good condition.
A male neonate underwent circumcision. What nursing intervention is part of the initial care of a circumcised neonate?
Apply petroleum gauze to the site for 24 hours.
The liver is responsible for conjugation of what?
Bilirubin (yellow to orange bile pigment produced by the breakdown of red blood cells)
On examination of an African newborn, the nurse notes a macular, blue-black area of pigmentation near the buttocks. Which of the following actions of the nurse is appropriate?
Consider the finding as normal in Africans.
How often should the newborn's body temp. be assessed?
Every 30 min. for the first 2 hrs. or until the temp. has stabilized. THEN every 8 hrs. until discharge
In the newborn, the liver stores what?
Iron
4 mechanisms stimulating respiration:
Mechanical- vaginal squeeze, first gasp initiates the removal of fluid to clear little sacs (doesn't occur in c-sections) Chemical- stimulation; clamp cord, no oxygen from mother, systems kick into gear Sensory- "shock" they go from comfortable to not. It's now noisy, bright, big change. Mom's chest is most zen place, skin to skin calms babe. Mom's temp. adjusts to warm babe Thermal- it's a temp. change, cold stress or hypothermia could result if active measures aren't taken. If preterm bump up the heat
What is milia on a neonate?
Milia are white papules from plugged sebaceous ducts that disappear by age 2 to 4 weeks.
Erythromycin
administered within 1 hr after birth to prevent ophthalmia neonatorum
Jaundice
aka icterus. yellowing of the skin, sclera, & mucous membranes
Immediately after birth what does lochia look like?
bright red & consists mainly of blood, fibrinous products, decidual cells, & red and white blood cells
"maternal blues" aka "baby blues"
characterized by mild depressive symptoms, anxiety, irritability, mood swings, tearfulness, increased sensitivity, & fatigue *peak on postpartum days 4 & 5, may last hours to days, resolve by day 10
Lochia alba
final stage. creamy white or light brown Consists of leukocytes, decidual tissue, & reduced fluid content Occurs from days 10-14, can last 3-6 wks
An increased left atrial pressure causes what to close?
foramen ovale, thus allowing the output from the R. ventricle to flow entirely to the lungs.
Clavicles should be palpated to assess for...
fractures
Torticollis
head inclined to one side as a result of contraction of muscles on that side of the neck
When obtaining a blood sample to screen a neonate for phenylketonuria (PKU), the nurse should obtain the sample from the:
heel
A multigravida client has given birth to a large-for-gestational age infant with Apgar scores of 8 and 9. The priority nursing assessment for this infant is for:
hypoglycemia
After teaching the mother about the neonate's positive Babinski's reflex, the nurse determines that the mother understands the instructions when she says that a positive Babinski's reflex indicates which condition?
immaturity of the central nervous system
One hour after receiving nalbuphine for pain during labor, a primigravida gives birth to a full-term neonate with symptoms of respiratory depression. The nurse anticipates that the neonate will require the administration of which drug?
naloxone
Formula-fed newborns stools become...
pale yellow to light brown
Stage 1: Expectations (father)
preconceptions about home life & what it will be like with a newborn *eye opening experience
Parents who bring a 3-week-old neonate to the hospital report that he's been "throwing up after every feeding." A nurse notes projectile vomiting while assessing the neonate. X-rays confirm:
pyloric stenosis.
Stage 2: Reality (father)
realize expectations aren't realistic, become sad, ambivalent, jealous, & frustrated, they want to be more involved
The newborn has increased energy needs after birth, so the liver does what?
releases glucose from glycogen stores for the 1st 24 hrs.
If nasal flaring occurs, what can this indicate?
respiratory distress
Breast-fed newborns stools become...
seedy, yellow
Cephalhematoma
swelling due to bleeding into an area between bone & periosteum (doesn't cross over suture line) *absorbed w/ in 6 wks no treatment
Engorgement
swelling of breast tissue as a result of an increase in blood & lymph supply as a precursor to lactation *peaks in 3-5 days postpartum, subsides within 24-36 hrs. * occurs from infrequent feeding or ineffective emptying of the breasts * hard and tender to touch * offer frequent feedings, applying warm compress, cabbage leaf compresses *cold compresses reduce swelling * If not breastfeeding, subsides within 2-3 days
Mucosal barrier protects from what?
the penetration of harmful substances (bacteria, toxins, and antigens) present within the intestinal lumen
Newborn receives passive immunity via...
the placenta (immunoglobulin G) & from colostrum (immunoglobulin A)
Where would you touch to elicit plantar reflex on a neonate?
the sole of the foot near the base of the digits, causing flexion or grasping. This reflex disappears around age 9 months.
Taking-in Phase
time immediately after birth, pt needs sleep, depends on others to meet her needs, & relives events of birthing process *24-48 hrs
Umbilical cord should have three vessels...
two arteries & one vein *small,thin cord may be associated w/ poor fetal growth
A client has admitted use of cocaine prior to beginning labor. After the infant is born, the nurse should anticipate the need to include which action in the infant's plan of care?
urine toxicology screening
The nurse determines the client has breast engorgement and should instruct the client to:
use her hand or a pump to express a small amount of breast milk before breastfeeding.
Effective breastfeeding release oxytocin, which causes what?
uterine cramping
Involution
uterus returns to its normal size
Physiologic jaundice
very common. Occurs within the 1st 3 days of life
Nursing interventions to help maintain newborn body temp.
•Dry the newborn immediately after birth to prevent heat loss through evaporation.•Wrap the baby in warmed blankets to reduce heat loss via convection.•Use a warmed cover on the scale to weigh the unclothed newborn.•Warm stethoscopes and hands before examining the baby or providing care.•Avoid placing newborns in drafts or near air vents to prevent heat loss through convection.•Delay the initial bath until the baby's temperature has stabilized to prevent heat loss through evaporation.•Avoid placing cribs near cold outer walls to prevent heat loss through radiation.•Put a cap on the newborn's head after it is thoroughly dried after birth.•Place the newborn under a temperature-controlled radiant warmer
Harlequin sign
Deep pink or red color develops over one side of newborns body while the other side remains pale or normal color * may indicate shunting of blood that occurs w/ cardiac problem or may indicate sepsis
Capet Succedaneum
edema of head (from birth) (crosses over suture line) *normal finding, subsides w/ in few days
What does lochia smell like?
fleshy. If its an offensive odor it usually indicates infection
Vitamin K is administered IM to newborn to prevent what?
hemorrhagic disorders
Taking-hold Phase
maternal adaptation, dependent & independent maternal behavior. Starts 2nd to 3rd day postpartum & may last several weeks
Oxytocin acts so that...
milk can be ejected from alveoli to the nipple
In the newborn, what is suctioned first?
mouth & then nares with a bulb syringe
Newborn has a sponge bath for how long?
until the cord falls off (2 wks)