OB Ch. 28 Study Guide
What is circumcision and when is it done on a newborn?
Removal of the foreskin from the penis; Typically performed in the first two to three weeks after the baby is born.
Which finding should the nurse suspect as abnormal in the newborn during the initial assessment?
Persistent high-pitched cry
Which statement would be a correct description of colostrum?
Slightly yellow & provides antibodies
Involution:
Within 6 to 8 weeks, the uterus again is a pelvic organ, approx the nonpregnant size of 2 oz and no longer palpable.
After delivery of a 9-lb baby, the nurse assesses a perineal laceration extending through the muscles of the perineum. The nurse records this as a ______-degree laceration.
second
Explain the 4 degrees of perineal lacerations:
•First-degree: Extends through the skin and structures superficial to muscles.•Second-degree: Extends through muscles of perineal body•Third-degree: Continues through the sphincter muscle•Fourth-degree: Also involves the the anterior rectal wall
Before initially feeding an infant, what reflex should the nurse assess?
Swallow reflex
Why is vitamin K given to a newborn?
To prevent hemorrhagic disorders.
Large for gestational age:
Weight is greater than the 90th percentile.
The new mother tells the home health nurse that she is concerned about her 5-day-old infant's hard, dried umbilical stump. What time frame should the nurse give the mother for the umbilical stump to fall off?
10-14 days
What is a mongolian spot?
A type of birthmark caused by the pigment in the skin the medical term is congential dermal melanocytosis.
Anterior fontanelle:
Also called the soft spot; Remains soft until it closes at about 12-18 months.
The new mother has decided not to breastfeed the baby. How should the nurse correctly instruct the mother to suppress her milk supply?
Apply a firm bra & ice packs
When assessing mother 12 hours following the delivery of a baby, where should the nurse expect to palpate the fundus?
At the umbilicus
Why is vitamin K given by injection to the newborn?
Bacteria that synthesize vitamin K are not present in newborns.
How should the nurse provide care for the umbilical cord?
Check the cord for bleeding or oozing during the early hours after birth. The cord clamp must be fastened securely with no skin caught in it. Purulent drainage or redness or edema at the base indicates infection. The cord becomes brownish black within 2 or 3 days and falls off in about 10 to 14 days. Care of the cord is varies in different agencies. It may be treated with a bactericidal substance, such as triple-dye solution, antibiotic ointment, or alcohol, three times a day or allowed to dry naturally. None of the treatments commonly used is better at keeping the cord clean and dry than the others. When soiled, the cord should be cleaned with water. This natural treatment of cords may shorten the time to cord separation and does not lead to increased infections. The diaper is folded below the cord to keep the cord dry and free from contamination with urine. Remove the cord clamp about 24 hours after birth if the end of the cord is dry. Although the base of the cord is still moist, it does not bleed if the end is dry and crisp.
The nurse is giving a bath demonstration for a group of new mothers. What should be included in the demonstration?
Cleanse perineum from front to back.
What is the first secretion produced by the breast?
Colostrum
Which of the following would be considered a normal assessment finding in a 1-day postpartum patient?
Complaining of "after pains"
What are normal vital signs after delivery?
During the first 24 hr after giving birth, the womans temp may be elevated slightly if she is dehydrated; Slight bradycardia, 50 to 70 beats/min, sometimes is observed and is not considered abnormal if the other VS are WNL- Tachycardia may occur in response to increased blood loss or physical exertion; BP may be slightly elevated from exertion, excitement, & possibly from the oxytoic meds- A decrease in BP could be caused by altered intrabdominal pressure or hemorrhage; VS normally stabilize within the first 2 hr after.
Moro (Startle) reflex:
Elicited by allowing the head & trunk of the newborn in a semisitting position to fall backward to an angle of at least 30 degrees. The newborn will symmetrically extend and then abduct the arms at the elbows & fingers spread to form a "C". Expected from birth to 4 months.
A new Native American mother tells the nurse that when she goes home, her mother-in-law will be caring for the baby while she rests. The nurse has concerns. What should the nurse do?
Explore ways to blend with this safe health teaching
What is gestational age?
How far along a pregnancy is measured in weeks from the first day of the woman's last menstrual cycle to the current date.
What should be included in a teaching plan regarding breast engorgement?
It is usually first observed in the axillary region
What is the name of the vaginal discharge that occurs immediately following delivery?
Lochia rubra
A mother delivered her baby at midnight and it is now 9 a.m. She wants to sleep and asks the nurse to take care of the baby. What is this considered?
Normal "taking in" response
The nurse identifies that the newborn is jaundiced within the first 24 hours of birth, with jaundice occurring over bony prominences of the face and the mucous membrane. What type of jaundice does this represent?
Pathologic
Which tests are performed to detect inborn errors of metabolism in the newborn?
Phenylketonuria (PKU)
A new mother had spinal anesthesia during a cesarean delivery. She now has a desire to void and can wiggle her toes. What should be the nurses response when the mother asks to go the bathroom?
Put slippers on her feet
What is normal heart rate for a newborn?
Ranges from 110 to 160 beats per minute with brief fluctuations above and below this range depending on activity level.
Why do we not want the bladder of woman who just delivered to be distended?
Significant bladder overdistention can lead to denervation and detrusor atrophy; This may result in long-standing voiding dysfunction with persistent urinary retention and overflow incontinence.
Which newborn assessment finding can suggest a chromosomal disorder?
Simian crease
What are epsteins pearls?
Small cysts that can appear in a baby's mouth that look like tiny white bumps; They generally appear along a baby's gums or along the top of the roof of the mouth.
What can happen to a newborns temperature after birth and why do we need to keep them warm?
The babies temperature will drop and hypothermia may occur.
What is colostrum and why it is good for the newborn?
The first substance produced of breast-milk. It is thin, watery, and slightly yellow. It is rich in protein & calories in addition to antibodies and lymphocytes. It also contains high levels of immunoglobulins, which transfer some immunity to the newborn.
Let-down reflex:
The mother may feel a tingling or prickling sensation, when feeding time approaches.
Within the first hour following a vaginal delivery, the nurse assess the mother and finds the fundus is firm and there is a trickle of bright red blood. What should be the nurse's reaction to the assessment?
This is a normal occurrence
The nurse describes the return of the postpartum pt's uterus to a pregravid state as ______.
involution
Why is erythromycin used for the newborn?
Prophylactic Eye Care involves mandatory installation of antibiotic ointment into the eyes to prevent ophthalmic neonatorum. Infections can be transmitted during descent through the birth canal; Ophthalmic neonatorum is caused by gonorrhea or chlamydia and can cause blindness.
How many additional calories does a breastfeeding mother need?
300 to 500 kcal per day.
What is a normal blood glucose for a newborn?
40 to 60 mg/dL
Cephalhematoma:
A collection of blood between the baby's scalp in the skull; Damaged blood vessels release the blood and the blood pools into a mass under the skin of the scalp; The blood vessels are often damaged during labor and delivery.
What is cryptorchidism?
A condition in which one or both of the testes fail to descend from the abdomen into the scrotum.
What is harlequin sign?
A cutaneous condition seen in newborn babies; Characterized by momentary red color changes of half the child sharply demarcated at the body's midline. This transient change occurs in approximately 10% of healthy newborns; It is usually seen between 2 and 5 days of birth.
What is vernix caseosa?
A greasy deposit covering the skin of a baby at birth, made up of shed skin cells and sebaceous secretions.
What is habitation?
A protective mechanism whereby the newborn becomes accustomed to environmental stimuli. Response to a constant or repetitive stimulus is decreased. This allows the newborn to select stimuli that promotes continued learning, avoiding overload.
What is a strawberry birthmark?
A red birthmark named for its color the red tinge of skin comes from a collection of blood vessels close to the skin surface these birthmarks are commonly occur in young children and infants though it's called a birthmark it doesn't always appear at Birth.
Caput succedaneum:
A type of swelling around the skull which can give an infant a conehead appearance; It usually forms after a difficult delivery and will typically disappear within a few days. But if bruising is involved the infant may develop jaundice.
What is a nevus flammeus?
Also known as port wine stain is a congenital capillary malformation; Usually presents at birth as a flat painless blanchable pink to red lesion that occurs anywhere on the body with unilateral or segmental distribution. The legions do not regress; It may increase in size as the child grows &additionally they may become thicker darker and nodular overtime.
Molding:
An abnormal head shape that results from pressure on the baby's head during childbirth.
Engorgement:
An uncomfortable fullness of the breast that occurs when the milk supply initially comes in.
What should be included when discussing the care of a circumcised infant after discharge from the hospital?
Apply sterile petroleum gauze after each diaper change.
Acrocynaosis:
Bluish or purple coloring of the hands and feet caused by slow circulation often seen in newborns. It is caused by benign vasomotor changes that results in peripheral vasoconstriction and increases tissue oxygen extraction and is a benign condition.
Postmature:
Born after the completion of 42 weeks of gestation with evidence of placental insufficiency.
Preterm/Premature:
Born prior to the completion of 37 weeks of gestation.
What are the nursing interventions for an episiotomy, a laceration, and hemorrhoids?
Cleansing: •Wash hands before and after cleaning perineum and changing pads •Explain procedure•Wash perineum with mild soap and warm water at least once daily •Cleanse from symphysis pubis to anal area •Apply peripad from front to back, protecting inner surface of pad from contamination •Wrap soiled pad and place in covered waste container •Change pad with each void or defecation or at least four times per day •Assess amount and character of lochia with each pad change; Ice Pack: •Apply a covered ice pack to perineum from front to back- during first 2 hr after the birth, to decrease edema and increase comfort and to provide anesthetic effect. Squeeze bottle: •Demonstrate for and assist woman; explain rationale. •Fill bottle with tap water, warmed to approximately 100.4F (38C; comfortably warm on the wrist) •Instruct woman to position nozzle between her legs so that squirts of water reach perineum as she sits on the toilet. •Explain that it takes a whole bottle of water to cleanse perineum •Remind her to blot dry with toilet paper or clean wipes •Remind her to avoid contamination from anal area. •Apply clean pad ; Sitz bath- built in type: •Prepare bath by thoroughly scrubbing with cleaning agent and rinsing. Pad with towel before filling. •Explain procedure •Fill one-half to one-third with water of correct temperature (100.4 to 100,5F [38 to 40.6C]). Some women prefer cool sitz baths; add ice to lower the temperature to a comfortable level •Encourage woman to use at least twice a day for 20 minutes. •Place call bell within easy reach •Teach woman to enter bath by tightening gluteal muscles and keeping them tightened and then relaxing them after she is in the bath. •Place dry towels within reach. •Ensure privacy. •Check on woman in 15 minutes; assess pulse as needed ; Disposable type: •Clamp tubing and fill bag with warm water. •Raise toilet seat, place bath in bowl with overflow opening directed toward back of the toilet. •Place container above toilet bowl •Attach tube into groove at front of bath •Loosen tube clamp to regulate rate of flow; fill bath to half full; continue as previously described for built-in sitz bath. ; Dry heat: •Inspect lamp for defects •Cover lamp with towels •Position lamp 50 cm from perineum; use three times a day for 20-minute periods •Provide draping over woman •If same lamp is used by several women, clean it carefully between uses •Teach woman regarding use of 40-watt bulb at home; Topical applications: •Apply anesthetic cream or spray; use sparingly three or four times a day •Offer witch hazel pads (Tucks) after voiding or defecating; woman pats perineum dry from front to back, then applies witch hazel pads. Explain rationale.
What are the nutritional and metabolic issues of a woman during the later postpartum stage?
Diet remains an important concern postpartum. Many women are concerned about the weight gained during pregnancy and wish to lose the excess as soon as possible. Dieting must not deprive the woman of necessary nutrition. If the woman has not gained excessive weight during pregnancy, she usually returns to her prepregnancy weight in 6 to 8 weeks without significant dietary restrictions. Most physicians do not recommend any weight-loss diets until after this time. Women who are not breast-feeding should continue to eat a well-balanced diet that follows MyPlate suggestions. Women who are breast-feeding generally continue the diet recommended during pregnancy because the body needs extra calories, vitamins, and minerals for lactation. The breast-feeding mother should maintain the increased caloric intake of 300 to 500 kcal/day as part of a well-balanced diet and should maintain a daily fluid intake of 2 to 3 L.
Stepping (walking) reflex:
Elicited by holding the newborn upright with feet touching a flat surface. The newborn responds with stepping movements. Expected from birth to 4 weeks.
Palmar grasp:
Elicited by placing a finger in the palm of a newborn's hand. The newborn's fingers curl around the examiner's finger. Lessens between 3 & 4 months
Plantar grasp:
Elicited by placing examiner's finger at the base of the newborn's toes. The newborn responds by curling their toes downward. Expected from birth to 8 months.
Babinksi reflex (plantar):
Elicited by stroking outer edge of sole of the foot, moving up toward the toes. Toes will fan upward and out. Expect from birth to 1 year.
Tonic neck reflex:
Elicited with newborn's in supine, neutral position, examiner turns newborn's head quickly to one side. The newborn's arm & leg on that side extend & the opposing & leg flex. Expected from birth to 3 to 4 months
Where would acrocyanosis be assessed on a newborn?
Feet
What is lanugo?
Fine, soft hair that covers the body & limbs of a human fetus or newborn.
What is a telangiectatic nevi?
Flat pink spots on their skin that appear on the face and neck, eyelids, upper lip, back of their neck, and forehead.
When is Hepatitis B given to the newborn?
For newborns to healthy clients recommended dosage schedule is at Birth 1 month and 6 months. For clients infected with hepatitis B the vaccine is given within 12 hours a birth and at 1 month 2 months and 12 months.
What is a characteristic of a normal breast-fed infant's stool?
Green & loose
Explain the bowel elimination differences among newborn:
Initial stools are odorless, black-green, & sticky (Meconium). It is made up of vernix, strands of lanugo, mucus, & other substances from amniotic fluid. Occasionally, the first stool is encased in mucus and called a meconium plug; Once the infants begins to take nourishment;, the stool changes. Transitional stools, which occur on about the second day, tend to be greenish and loose. There are seen until about the fourth day, when the milk stool is seen; Breast-fed babies tend to pass stool frequently, sometimes with every feeding. The stool is pale yellow and sweet smelling. Small curds may be observed; Babies who are bottle fed tend to have fewer stools, usually two or three per day after the first 2 weeks. These are bright yellow and pasty in consistency- the odor may be slightly stronger that that of breast-fed babies. This type of stool continues until solid food is introduced
Describe the changes in the uterus after delivery:
It contracts in response to oxytocin. This contraction compresses blood vessels at the site where the placenta is separated from the uterine wall. In the first 12 hr after delivery, the fundus rises to the level of the umbilicus at the midline. In the following 24 to 48 hr, the utereus begins a gradual descent. It moves approx one fingerbreadth per day; within a week, it is barely palpable at the level of the symphysis pubis and weighs 1lb. Uterine lining sheds (lochia).
What does BUBBLE-HE stand for?
It is a postpartum assessment.B: Breast- For assessment of the breasts; Have the patient lie down and remove her bra. Palpate both breasts for engorgement or nodules, & Inspect nipples for pressure soreness cracks or fissures.U: Uterus- The top of the uterus the fundus should remain very firm, if it becomes soft the uterine muscles are probably not Contracting properly or the uterus has retained placental fragments. Both conditions predispose the patient to Hemorrhage. Gently massage the uterus to help the muscles contract and expel the placental fragments.B: Bladder- The new mother may urinate frequently the first few days after giving birth be alert for signs and symptoms of infection also monitor for any dysuria or urinary retention.B: Bowel- Because of early discharge from the hospital many women leave without having had a bowel movement; Assess for bowel sounds and encourage activity with rest periods & adequate fluid intake.L: Lochia- Has a definite fleshy scent but also has a fetid odor and may indicate infection assess carefully.E: Episiotomy- Most new mothers have an episiotomy and in some cases a laceration. Position the patient on her effected side instruct her to flex her top leg at the knee and bring up toward her waist; Use a flashlight and wear gloves, stand behind the patient, gently lift her top butt off to expose her perineum & assess for hemorrhoids also.H: Homans sign- For patient assessment: Position the legs flat on the bed while she reclines in the Supine position; Dorsiflex her foot toward the ankle; Assess both extremities if she reports calf pain; If homans sign is positive, further assessment is needed because a DVT in the leg is indicated.E: Emotional status- Consider the three phases most new mothers go through; The first is taking in the time immediately after birth; She sleeps, depends on others for nurturing and food, & may have religious events surrounding the birth; To over the next few days she is taking hold, she is preoccupied with the present, concerned about her health and her baby's condition she cares for herself, & wants to learn to care for her newborn; & The next phase Letting Go comes later in postpartum; She re-establishes relationships with other people; Monitor emotional status, noting how she interacts with family, her level of Independence, sleep and rest patterns, mood swings, & irritability or crying.
What is lochia? Describe the differences among lochia rubra, lochia serosa, and lochia alba:
Lochia is bloody discharge after delivery. It consists of blood, tissue, and mucus. As the uterine lining is shed, the necrotic tissue, blood, and mucus leave the body through the vagina. It has a fleshy odor similar to menstrual discharge. For the first day or two, it is made mostly of blood, which results in a bright red drainage called lochia rubra. Some small clots may be passed during this phase. As the placental site heals, the discharge thins and becomes pink to brown; this is called lochia serosa. After the seventh day, the drainage is slightly yellow to white and is called lochia alba. This drainage continues for another 10 days to 2 weeks.
A new mother asks for advice on how to quiet her fussy newborn. Which responses would be appropriate to suggest to the mother? (SePlect all that apply.)
Prewarm the crib sheets with a hot water bottle; Swaffle the newborn tightly in a receiving blanket; Offer a pacifier or allow the infant to suckle at the breast; Take the infant for a ride in the car
The new mother calls the nurse to her room to show how her baby is "jerking around" when she changes his position. The nurse understands that the baby is exhibiting which normal reflex?
Moro reflex
During the immediate postpartum period, the mother has a temperature of 100.2F (37.8C), pulse 52, respirations 18, BP 138/84. What should the nurse do?
Nothing as the vital signs are normal
The nurse is caring for a newborn who was circumcised earlier in the day. What should be included in the plan of care?
Observation for bleeding for the first 12 hours
The postpartum mother with a third degree laceration tells the nurse she is afraid to have a bowel movement because of her painful episiotomy. What should the nurse do?
Offer stool softeners as prescribed
What hormone is released with breastfeeding and what does this hormone do?
Oxytocin; To establish the lactation response, the breast must be stimulated adequately so that prolactin can be released by the anterior pituitary. Once the milk supply is established, prolactin production decreases and oxytocin is released as the baby suckle; It primarily maintains the supply of milk.
Which of the following measures could help prevent infant abduction? (Select all that apply.)
Require staff members to wear appropriate identification badges; Respond immediately when an alarm sounds; Never leave infants unattended at any time.
What are normal vital signs for a newborn?
Respiratory rate: 30 to 60 breaths per minute with brief periods of apnea.Pulse: 120 to 160 beats per minute.Blood pressure: 60 over 40 280 / 50 mm hg. Accelerate temperature: 97.6 degrees Fahrenheit to 98.6 degrees Fahrenheit.
During the later postpartum stage, what are the activity and exercise restrictions?
The physician indicates when postpartum exercises are suitable for the new mother, whether she deliver vaginally or via cesarean. The woman should begin gradually and avoid vigorous exercise until after the examination at 6 weeks, when the physician releases her to do so. Teach her isometric exercises that help toning without causing undue exertion.
The nurse is observing a new mother interact with her infant. Which observation would indicate that bonding is occurring? (Select all that apply.)
The mother is making eye contact with the infant; The mother is cuddling with the infant & napping;
How often do newborns eat if breastfeeding or bottle feeding?
The new mother has her baby nurse at 2 to 3 hour intervals during the night, this may persist for weeks until the infant is capable of sleeping for 5 to 6 hours without a feeding.
Pueriperium:
The postpartum periods; Lasts from the time the woman delivers the placenta until the reproductive organs return to approx the nonpregnant size and position. It lasts about 3 to 6 weeks and consists of two stages.
Why is it critical for the fundus of the uterus to remain firm and midline during the recovery stage? What needs to be done if the uterus is boggy?
This is critical because severe bleeding may result if the uterus does not tightly constrict the placental site; Gently massage the fundus to increase contractility. Small clots are frequently expressed during this maneuver, and the uterus regains good contracted tone. If this does not result in contraction, the primary care provider should be notified.
What is milia?
Tiny white bumps that commonly appear on a baby's face; It develops when tiny skin flakes become trapped in small pockets near the surface of the skin. Although milia can develop at any age, they're most common among newborns the tiny white bumps most commonly appear on a baby's nose chin or cheeks. They usually disappear on their own in a few weeks in newborns.
What is the appropriate way to assess the fundus of the postpartum patient?
Using one hand on the lower uterine segment while the other hand locates the fundus of the uterus
Posterior fontanelle:
Usually closes first before the anterior fontanelle during the first several months of an infant's life (6-8 weeks)
What is pseudomenstruation?
Uterine bleeding or blood-tinged vaginal discharge that resembles menstruation but is not associated with the typical endometrial changes thereof. Also known as a false period.
What is the term for the cream cheese-like substance that protects the infant's skin from amniotic fluid?
Vernix caseosa
Following delivery of the newborn, which nursing intervention should be carried out immediately?
Warm the infant.
Low birth weight:
Weight is 2500 grams or less at Birth (less than about 5.5 lb).
Appropriate for gestational age :
Weight is between the 10th and 90th percentile.
Small for gestational age:
Weight is less than the 10th percentile.
What are the benefits of breastfeeding?
•Anti-infective properties: Immunoglobulins, lymphocytes, and other immune components that are present in breast milk protect the infant against infection. The bifidus factor in breast milk encourages encourages growth of normal bacterial flora in the infant's GI tract. •Nutrition: Breast milk is specifically made for the human infant. Its protein, carbohydrate, and fat ratios are thought to be ideal for growth and development. It is well digested and readily absorbed. •Growth & development: Breast-feeding promotes better tooth and jaw alignment. It may be less likely to produce obesity in the child, and it may favor optimal bonding between mother and infant. •Allergy: Breast-feeding may reduce the incidence of allergies in infants high risk for allergic conditions •Maternal benefits: Hormones produced in breast-feeding help contract and shrink the uterus. Breast-feeding requires no formula preparation or bottle sterilization and is more economical than formula feeding.
Describe the apparent warning signs of possible difficulties in parent-child relationships immediately following delivery:
•When the infant is brought to the parents, do they reach out for the infant and call the infant by name? (Recognize that in some cultures parents may not name the infant in the early newborn period) •Do the parents speak about the infant in terms of identification, such as who the infant looks like, what appears special about their infant compared with other infants? •When parents are holding the infant, what kind of body contact is there? Do parents feel at ease changing the infant's position? Do they use fingertips or whole hands? Are there parts of the body they avoid touching or parts of the body they investigate & scrutinize? •When the infant is awake, what kinds of stimulation do the parent's provide? Do they talk to the infant, to each other, or to no one? How do they look at the infant? With direct visual contact, avoidance of eye contact, or looking at other people or objects? •How comfortable do the parents appear in terms of caring for the infant? Do they express any concern regarding their ability or disgust for certain activities, such as changing diapers? •What type of affection do they demonstrate to the newborn, such as smiling, stroking, kissing, or rocking? •If the infant is fussy, what kinds of comforting techniques do the parents use, such as rocking, swaddling, talking, or stroking?