OB Test #4

hypoglycemia risks and s/s of the newborn

decreased glucose at risk: preterm, SGA, LGA, diabetic mom, or respiratory distress s/s: jittery, lethargy, poor feeding, abnormal cry, and unstable temp

circumcision benefits

decreased risk of STD's (HIV) decreased risk of penile cancer *decreased risk of UTI's?

maternal concern: activity/exercise

slowly and as tolerated wait 4-6 weeks for abdominal exercise to regain tone joints take 6-8 weeks to stabilize *a sign of too much exercise is increased vaginal bleeding

postpartum phase: letting go

-patient accepts new role and lets go of old role -patient readjust relationships

fluids needs of the newborn

0-2 days: 60-80 mL/kg/day 3-7 days: 100-150 mL/kg/day never give them water it leads to hyponatremia

calories in breastmilk/needs

0-3 months: 110 cals/day breastmilk: 20 cal/oz also contains prebiotics with promote an acidic GI enviornment

postpartum phase: taking in

1-2 days -very passive; no decision making -preoccupied with own needs (moms pain, hunger...) -talk about birth experience a lot

treatment of hypoglycemia in the newborn

1. feed baby 2. oral sucrose gel 3. IV therapy

breastfeeding recommendations

AAP: exclusive for 6 months, then breastfeeding and food introduction for 1 year, and beyond 1 year as desired WHO: exclusive for 6 months, then breastfeeding at food introduction for 2 years, continue as desired

hepatitis B vaccine

consent is required and it protects from hep b

plugged duct treatment

dislodge the plug frequent feedings -being on affected side -position change the newborn -massage area of plugged duct during feeding

REEDA/perineal assessment

don gloves, SIMS position, and lift upper buttock (spread cheeks) redness: infection edema: soft tissue damage ecchymosis: bruising or hematoma drainage: laceration or episiotomy approximation: would edges together *also assess hemorrhoids

newborn procedures: universal newborn screen

done after 24 hours but prior to discharge (state law) checks for genetic and metabolic disorders -phenylketonuria (PKU) -cystic fibrosis -galactosemia

postpartum depression screening and treatment

edinburg postnatal depression screen (score of 12+ required further assessment) psychotherapy -counseling -CBT -support groups antidepressants -SSRI's (zoloft..) alternative tx -electroconvulsive therapy -aromatherapy -massage -acupuncture -light therapy -dietary supplements: flax seed, chia seed, salmon

discharge information for the newborn: diapering

educate on how to change, frequency, and consistency

expected lab findings in the newborn

elevated h&h because of extra RBC's in utero leukocytosis: from physiologic stress of labor

postpartum psychosis signs and symptoms

hallucinations & delusions, disorientation, confusion, extreme judgement deficits, suicidal/homicidal ideation (often related to harm of baby)

polycythemia in the newborn

hct >65% from intrauterine stress, preeclampsia, maternal diabetes, and maternal smoking causes compensated blood flow skin looks red

heat loss: evaporation

heat loss when water is converted to vapor dry baby when bathing and bath blankets?

nursing interventions for afterpains

heating pad, NSAIDs, prone positioning

fundal massage for postpartum hemorrhage

helps with uterine involution by causing contractions and production oxytocin don't stop and keep pressure firm

normal newborn lab values

hemoglobin: 14-24 g/dL hematocrit: 51-56% WBC: 9,000-30,000 glucose: >40-45

newborn reflex: moro (startle)

hold the newborns arms and raise him slightly then let him fall back then with the newborn laying flat clap to elicit a response of arms extending the adducting and fingers will spread then abduct quickly then return to flexion

postpartum depression causes

hormonal changes/drops, psychosocial/situational, and poor nutrition (lack of b12 or folate)

discharge information for the newborn: feedings

how often, hot much, and determine the okay amount

preventing newborn abduction

identification bands: matching with mom staff badges: unique to the unit (pink @st james) staff uniform/scrubs: matching security systems

contraception during breastfeeding

if exclusively breastfeeding lactational amenorrhea methods works as birth control -prolactin inhibits estrogen -suppression of ovulation and return of menses progesterone only contraception is recommended (mini pill, depo..)

postpartum infections: endometriosis

inflammation and infection of endometrium s/s: foul smelling lochia, fever, tachycardia, lower abdominal pain, and chills tx: broad spectrum antibiotics & supportive care (rest, hydration, analgesics..)

mastitis

inflammation of the breast from inadequate emptying of the breast and cracked nipples s/s: fever, chills, malaise, headache, body aches, nausea, localized breast pain, red, hot, tender

pre-operative c-section nursing considerations

informed consent (ensure this is obtained), NPO diet (ideally for 8 hours), get labs (CBC & type/screen), foley catheter, aspiration pneumonia precautions (pepcid and reglan), IV antibiotics (within 30 min-1 hour of cut time), and SCD's

maternal concern: weight loss

initial 10-12 lbs over next days 5 lbs after that period the recommendation is 1-2 lbs/week -with a normal BMI and wt gain of 20-25 lbs they can expect pre-pregnancy weight by 6-8 weeks

postpartum psychosis treatment

inpatient psychiatric care & psychotropic medications (brexanolone-IV & in patient)

postpartum depression signs and symptoms

intense sadness, dear, guilt, inadequacy, irritability, detachment, and obsessive thoughts *family/support people will notice this first can also occur in men

bonding and attachment assessment

is mother attracted to the newborn? -skin-to-skin, eye contact is the mother inclined to nurture baby? -talks to, holds, stays in room does the mother act consistently? -stable emotions or not is the mother sensitive to the newborn's needs as they arise? -picks up when baby cries, changes diapers, feeds is the mother pleased with the baby's appearance and gender? -makes comments like "oh how cute" are there any cultural considerations? -some cultures are less "loving" than others

postpartum hemorrhage cause: trauma

laceration hematoma: bleeding wont be seen but pain will be reported uterine inversion: uterus falls out, rarely occurs but push it back in

normal skin variation: mottling

lacey pattern on skin that comes and goes in first few days from circulation fluctuations can be seen in a cold baby so check temp

maternal alcohol use during breastfeeding

limit to 2 drinks avoid breastfeeding for 2 hours after "pumping & dumping" is not needed

reason for infection risk in the newborn

limited inflammatory response limited ability to recognize and destroy bacteria also newborns don't always get a fever they can be hypo or hyperthermia

newborn skin variation: milia

little white bumps from exposed sebaceous glands

newborn birthmarks: mongolian spots

looks like an ecchymosis most commonly found on african american and other darker skinned populations document this: can look like abuse

newborn respiratory efforts: prior to birth

these must happen for baby to breath -appearance of alveolar ducts -differentiation of alveolar epithelial cells --type I: gas exchange --type II: produce and store surfactant -fetal breathing movements (practice) -decreased production of fetal lung fluid -release of catecholamines -thoracic squeezing (from contractions)

newborn reflex: sucking

nurse should place finger in mouth and baby will suck vigorously and rhythmically

newborn reflex: rooting

nurse should stroke cheek and baby will turn, open mouth, and seek nipple

lactogenesis: stage II

occurs after the placenta is delivered from decreased progesterone the drop in hormone triggers prolactin which makes milk

lactogenesis: stage I

occurs during pregnancy (16-18 weeks by placenta) -development of breast ducts -development of lobules and alveoli lactation is suppressed due to elevated progesterone but colostrum still forms

maternal concern: sex & contraception

on pelvic rest for 2-6 weeks (no sex or tampons or anything up the lady) vaginal dryness is common ovulation by 1 month is common sexual dysfunction is common

normal skin variation: ruddy

tomato red from increased RBC and limited subq fat

causes of postpartum hemorrhage 4T's

tone, tissue, trauma, and thrombin

normal skin variation: harlequin sign

one side of baby is red and one is blue from opposite sides dilating and constricting

nutritional needs from breastmilk

only food/fluid an infant needs for first 6 months of life has fluids, calories, protein, fats, and vitamins

brown fat

only newborns have this adipose tissue stored in axilla, upper back, chest, and over kidneys metabolization and production of heat

pharmacological management of postpartum hemorrhage

oxytocin: treatment and prevention methergonovine, carboprost, or misoprostal only for atony tranexamic acid any type of pph

nursing care of circumcision

pain control: dorsal penile nerve block, ring block, or topical anesthetic assess for bleeding 15-30 minutes for an hour then every 4-6 hours assess voiding following procedure

circumcision risks

pain, bleeding, and infection

newborn birthmarks: stork bite (nevus simplex)

patches of capillaries found on eyelids, nose, neck, and back fade 18 months-2 years small, flat, pink, and blanchable

prevention of postpartum hemorrhage

fundal massage: muscle control and release of oxytocin oxytocin IV infusion: 30 units in 500 mL LR

c-section risks: fetal

respiratory complications (decreased removal of fluid from contraction squeezing) and lacerations

postpartum hemorrhage cause: tissue

retained placenta (failure to expel within 30 min) retained placental fragments (usually causes late PPH) placenta accrete syndrome -placenta accrete: slightly in myometrium -placenta increta: deeply in the myometrium -placenta precreta: penetrates myometrium, uterus, abdomen, attaches everywhere basically --these babies are often delivered at 34 weeks

pumping breastmilk

use double electric pump when breastfeeding is delayed after milk supply is well established

delayed cord clamping

usually 1-5 minutes to increase placental perfusion to newborn hold baby lower than level of placenta they receive around 100 mL extra

plugged ducts

usually due to inadequate emptying of the breast -infrequent feedings -breast compression (wire bra, purse, or diaper bag pressing)

insufficient milk supply

usually from incomplete or infrequent emptying of the breasts frequent breastfeeding or emptying helps herbs: fenugreek, blessed thistle, goat's rue, and shatvari medications: metoclopramide

discharge information for the newborn: bathing

3 time a week heat loss prevention (warm water, bath blanket?..) drowning prevention (do not leave baby alone)

effectiveness signs for breastfeeding

8-12 feedings in a 24 hour period audible swallowing uterine contractions when breastfeeding baby content after feedings (milk drunk) assessment of voiding stool assessment (stool transitions on day 3 then yellow seedy) softening of the breast after feeding weight gain (in baby?)

unplanned c-section indications

arrest of labor (no progression), some cat II or all cat III tracings/fetal intolerance, uterine rupture, cephalopelvic disproportion, infection, and prolapsed cord

surgical technique of c-section

abdominal incision: transverse uterine incision: low transverse/Kerr incision (most common called bikini) or vertical (not ideal, higher incidence of uterine rupture, repeat c-section necessary)

intraoperative & postoperative c-section nursing considerations

allow patient support (support person can be in with the patient), surgical draping (clear option so mom can see her baby), positioning (hip wedge), and skin-to-skin contact after delivery

discharge information for the newborn: crying

amount varies from baby to baby 2 week-3/4 months is the peak then a decrease it is okay to set baby down when crying and walk away when at limit

mastitis treatment

antibiotics, analgesics, antipyretics, and continuation of breastfeeding infection does not pass to infant

tranexamic acid (TXA) for postpartum hemorrhage

antifibrinolytic: blocks the breakdown for fibrin blood clots 1 g IV infusion can cause: headache, n/v, and fever only administered within 3 hours of birth contraindicated with thromboembolism in pregnancy

discharge information for the newborn: clothing

as much as parent needs plus a layer

c-section risks: maternal

infection, hemorrhage, bowel-bladder injury, amniotic fluid embolism, anesthesia complications, and thromboembolism

steps to latching

nose even with nipple engage rooting reflex quickly draw baby into breast

newborn reflex: stepping

hold the newborn upright on flat surface and they should simulate walking pattern

caput succedaneum

"cone head" collection of fluid and edematous swelling of the scalp crosses the suture lines reabsorbed within 12 hours to a few days after birth

cephalohematoma

"goose egg" can be caused from vacuum extraction or head pressing on cervix does not cross suture lines disappears after 2-3 weeks or may take months

postpartum blues

"with milks comes tears" affects 50-80% of women begins at day 3, peaks at day 5, and subsides by day 10 emotional lability: sad, angry, let down, depressed, mood swings, anxiety, and insomnia causes: hormonal changes, fatigue, discomfort/pain, insecurity, and lack of support

postpartum phase: talking hold

2-4 days -ready to take control (decision making, mothering..) -insecure (needs reassurance in decisions)

pain and comfort newborn assessment

FLACC NIPS NPASS CRIES

assessment of latch

L: latch A: audible swallowing T: type of nipple C: comfort H: hold (positioning) scored 0-2

lochia assessment

assess color: rubra, serosa, and alba -rubra for more than 3 days indicates retained placenta -serosa or alba for too long indicates infection assess amount: scant <2.5 cm, light <10 cm, moderate >10 cm, and heavy saturated pad in 2 hours -moderate is normal thru first postpartum day -heavy is never normal flow is increased during breastfeeding and ambulation, pools in vagina when resting, should never be foul smelling, and large clots will pass

barlow-ortolani maneuver

assess hip dislocation in the newborn 1. adduct thigs and exert gentle pressure 2. abduct hips will hearing popping sound if positive test

uterine/fundal assessment

assessing position: should be 2 finger breaths down every day postpartum (involution) -any increase suggests subinvolution assessing tone: should be firm -boggy/soft is a bad finding this stage can also produce afterpains

homan's signs

assessment for DVT -place one hand under need to flex 5 degrees and dorsiflex foot positive test is there is deep calf pain and tenderness

breast surgery and breastfeeding

augmentation or reduction can affect the ability to produce and transfer milk

breast care during breastfeeding

avoid soap on nipples (causes drying and cracking) wear a properly fitting bra (too loose=no support and too tight=clogged ducts) breast pads for leakage

vitamin K

babies have immature clotting factors until they develop a sterile gut given IM 25 g 5/8 inch in vastus lateralis within 1 hour of birth

breastmilk types: transitional milk

begins about 3 day postpartum higher levels of fat

postpartum hemorrhage risk factors

birth, overdistended uterus (polyhydramnios, macrosomia, multipara), grand multipara, obesity, personal characteristics (red hair & fair skin), pitocin induction/augmentation, chorioamnionitis, operative vaginal delivery, preeclampsia, placenta previa, placental abruption, and hx of PPH

normal skin variation: acrocyanosis

blue hands and feet normal for 24 hours and comes and goes for 7 days

lactogenesis: stage III

breast and nipple stimulation from baby sucking -release of prolactin and oxytocin oxytocin moved the milk -let down/milk ejection reflex foremilk -watery, high protein, low fat -over the first few minutes hindmilk -high in fat and calories -comes second

discharge information for the newborn: follow up/reason to contact

breastfeed: 2-3 days then 2 weeks bottle fed: by 2 weeks fever of 100.4 (emergency) temp less than 97.7 jaundice poor feeding less than 6-8 wet diapers a day (after first few days) inconsolability breathing difficulties umbilical cord infection

vitamins in the breastmilk/needs

breastmilk has plenty but lacks vitamin d so supplementation may be needed also commonly low in iron

protein in the breastmilk

breastmilk is high in this so it is easily digested

BUBBLE-HE assessment

breasts, uterus, bladder, bowels, lochia, episiotomy/perineum, homan's sign, and emotional state

other interventions for postpartum hemorrhage

call for help: nurses and provider obtain additional IV site oxygen administration: 10 L via facemask (goal is >95%) foley catheter: decreased fluid in blood frequent vitals assessments: BP! quantitate assessment of blood loss (1g=1mL) lab work: CBC & type/screen blood administration prepare operating room -provider procedures: uterine tamponade, JADA system, uterine suturing, and hysterectomy

other postpartum reproductive changes

cervix: very soft & spongy after birth, can be bruised or lacerated. by day 3 goes to 3 cm dilation and by week 1 should be 1 cm dilated vagina: edematous, rugae reform in 3 weeks, tone in 6 weeks, but will never go back to pre-birth tone, and vaginal dryness is common (6 wk-6 mo)

maternal concern: integumentary changes

changes like melasma fade but do not disappear hair loss is common diaphoresis is also common

types of formulas: powdered

cheapest not sterile well or spring water should be boiled before adding

postpartum perineal care

cleans the perineum: change pad after every restroom use (max 6-8 hours), mild soap and water, use peri bottle after voiding, don't dry cold compress: wear for first 24 hours to provide comfort and decrease edema sitz bath: after 24 hours to promote circulation (promote healing) 2x a day for 20 min topical sprays: helps with stinging and burning hemorrhoid treatments: tucks pads for cooling, comfort, and relief and hydrocortisone cream to shrink oral analgesics: helps with cramping, perineal pain, and use scheduled NSAID

postpartum hemorrhage cause: thrombin

coagulation dysfunction: clotting issue von Willebrand disease idiopathic or immune thrombocytopenia purpura

discharge information for the newborn: temperature

cold stress prevention taking temp (axilla)

fat in the breastmilk

comes from breastmilk specifically hindmilk important for brain development and vision has DHA

anemia of the newborn

common abnormal finding they lose their hgF but cannot produce hgA because they lack iron intake

bowel assessment

common for no bowel movement for 2-3 days (sluggish) -slowed peristalsis, BM during delivery, diarrhea pre-labor, lingering progesterone, and fear ambulation, fluids, and fiber to prevent constipation

bladder assessment

encourage voiding 6-8 hours after birth then every 1-2 hours -decreased urge to void without added pressure from fetus -increased diuresis (2000-3000 mL leave the kidneys) worried about bladder distention, stress incontinence, and UTI's

postpartum hormonal changes

estrogen and progesterone decrease significantly increase prolactin from progesterone decrease decrease in human chorionic gonadotropin (complete after 3-4 weeks) oxytocin: little surges with breastfeeding, fundal massage, and skin to skin contact human placental lactogen

maternal medications during breastfeeding

few contraindications: radioactive agents (nuclear scans) consult a provider prior to use (they pass through breastmilk)

breastmilk types: colostrum

first 3 days of milk production that begins mid-pregnancy concentrated: high level protein & minerals and low levels of fat contains igA (immunity from mom)

guidelines for storage and use of breastmilk

first hand hygiene and proper cleaning of equipment room temp: lasts 4 hours refrigerated: 4 days freezer: 6-12 months never microwave to warm

neurologic assessment: periods of reactivity

first period: awake, alert, increased HR begins at birth-30 min of life inactivity: sleep begins at 30 min and lasts at 60-100 minutes second period: wake again, pass meconium, increase mucous production occurs 2-8 hours after birth and lasts 10 minutes to several hours

discharge information for the newborn: sleep

flat on back no cosleeping avoid soft bedding crib slates >2 1/4' apart mattress should be firm and tight within crib

newborn birthmarks: port wine stain (nevus flammeus)

flat, non-blanchable, dilated capillaries does not disappear but rather gets bigger and darker

circumcision procedures: mogen clamp

foreskin is pulled through the hinge of the clamp

breast engorgement treatment

frequent feedings cold compress between feedings warm compress/warm shower prior to feedings cabbage leaves (15-20 minutes 2-3 times a day) analgesia (nsaids)

cold stress

from an increase basal metabolic rate decreased wt gain, depletion of glycogen, respiratory distress, acidosis, and hyperbilirubemia

heat loss: conduction

from direct contact with cold surface (weighing baby and stethoscope) skin-to-skin/warm mom helps

heat loss: convection

from warm body to cool air swaddle baby, hat on baby, decrease fans, and increase heat

heat loss: radiation

from warm body to cooler surfaces and objects not in contact with body (crib by window)

weaning from breastmilk

gradual is recommended abrupt leads to breast engorgement and mastitis

newborn immunoglobulins

igG: passive protection from mother during pregnancy and where most of their limited immunity comes from igA: colostrum is high in igA but none is present at birth igM: low levels in utero that are immature and low affinity for toxins

positioning for breastfeeding

important factors: maternal comfort & latch cross-cradle clutch/football cradle side-lying

skin-to-skin contact benefits/reasoning

improved bonding, improved breastfeeding success, stabilization of temperature, heart rate, and respirations, and stabilization of blood glucose levels

postpartum infections: wound

incision, laceration, or episiotomy s/s: erythema, edema, warmth, drainage, and fever tx: would culture and antibiotics

thermogenesis

increase basal metabolic rate: leads to cold stress non-shivering thermogenesis: stimulation of sympathetic nervous system and brown fat

delayed cord clamping benefits

increase hemoglobin levels at birth additional preterm infant benefits

maternal nutrition during breastfeeding

increase of 400-500 cal/day from pre-pregnancy no food restrictions is and increased sensitivity (onion, broccoli, beans, and cow milk) fluids to thirst (no need for excess) continue prenatal vitamins vitamin D supplementation

delayed cord clamping disadvantages

increased incidence of jaundice because of the extra hemoglobin to breakdown

pain and comfort effects on newborn

increased metabolism increased demands on the cardiovascular system neuroendocrine imbalances (wt loss, lethargy..)

postpartum c-section nursing considerations

major abdominal surgery -pulmonary infection, DVT, incisional infection -deep breath and cough, early ambulation, and SCD's incisional pain -long acting opioids, oral pain medication, acetaminophen, NSAIDS, opioids, cold compress, splint pillow intenstinal gas -manipulation of bowel leads to decrease GI motility and increased gas -right should referred pain -ambulation, rocking chairs, decrease gas forming foods, and anti-flatulence medications removal of foley catheter -4 to 8 hours post partum diet -regular unless under general

erythromycin ophthalmic ointment 0.5%

maternal gonorrhea is the reasoning but all babies get this within 1 hour of life do not touch tube to eye administer from inner to outer canthus after 1 minute wipe away excess ointment

contraindications for breastfeeding

maternal infections -HIV/AIDS (in USA) -active TB -varicella -active herpes zoster -brucellosis newborn -galactosemia

postpartum nursing considerations diabetes mellitus

maternal tissues are sensitive to insulin supplemental insulin requirements decrease (risk for hypoglycemia) assess glucose levels (check for hypoglycemia frequently)

APGAR score

measured at 1 min and 5 min if the score is <7 continue to monitor every 5 min for 20 minutes a score of 0-3 is severe distress 4-6 moderate 7-10 okay

voiding/elimination of the newborn

meconium: passes in 12-24 hours of birth is amniotic fluids, mucosal cells, and bilirubin transitional stools: thin brown/green part meconium and part fecal matter fecal stools: by day 4 -breastfeeding: yellow seedy -bottle feedings: peanut butter looking?

types of formulas: concentrate

mid-range cost commercially sterile diluted with equal parts water

maternal caffeine use during breastfeeding

moderate intake is deemed safe

risk factors for DVT

most at risk for 3 weeks postpartum obesity, advanced maternal age, hx of smoking, previous thrombus, preeclampsia, hemorrhage, postpartum infection, immobility, and c-section is at 2x risk

circumcision procedures: gomco clamp (yellen)

most common metal bell placed under the forskin/over the glans to protect the penis

types of formulas: ready-to-feed

most expensive sterile

maternal stress and fatigue during breastfeeding

negatively impacts milk production sleep when baby sleeps stress prevention

gestational age assessment

new ballard score neuromuscular maturity -posture: increase flexion = increased age -square window: more bendy from relaxant -arm recoil: greater recoil=greater age -popliteal angle -scarf sign: full term elbow won't go passed midline -heel to ear: less close to ear at full term physical maturity -skin: -lanugo: begins to decrease after 32 wks -plantar surface: creases -breast: buds no buds -ear/eye: only assessed in VERY preterm -genitals

maternal smoking during breastfeeding

nicotine is transferred to breastmilk so avoid for 2 hours prior to breastfeeding decreases prolactin levels

breast assessment

nipples (redness, cracking, trauma..) most changes won't be seen until day 3 postpartum at day 3 or 4 colostrum changes into transitioning breastmilk education that will make breasts heavy, full, and tender when palpated breasts no longer feel soft

formula feeding disadvantages

no anti-infective properties linked to increased incidence of GI and respiratory infections potential for bacterial contamination cows milk protein allergy is common caregivers determine the volume consumed (over or underfeeding) expensive preparation is time consuming lower bioavailability of nutrients missing numerous nutritional ingredients

postpartum lab values

non-pathologic leukocytosis: WBC stay increased decreased hematocrit: 2-3% decrease in HCT and 500 mL blood loss (MAX) increased clotting factors and fibrinogen takes 3-4 weeks for labs to return to normal

home care after circumcision

petroleum jelly for 7-10 days (not with plasti bell) bleeding assessment at every diaper change cleanse with water only for first 3-4 days sponge bath until healed appearance will be red with yellow crust (DO NOT PICK OFF) assess for infection (increased redness, edema, odor, and discharge)

newborn reflex: palmar grasp

place fingers in palms of newborn and fingers should close over the finger

circumcision procedures: plasti bell

placed over the glans then suture tied around the foreskin and rim of the bell which remains for about a week

planned c-section indications

placenta previa, malpresentation, active genital herpes, a repeat (c-section with first baby might need one with second baby), elective (trauma reasons..), and certain maternal cardiac diseases

supporting newborn respiratory effort

positioning: head back for patency of airway drying leads to stimulation PRN bulb syringe -suction mouth prior to nose -place in the side of mouth -rinse with water water

keys to success for breastfeeding

prenatal education and nipple assessment initiate breastfeeding within 1 hour of birth rooming in (helps baby smell mom) skin-to-skin contact frequent breastfeeding avoid supplementation -medication indications: dehydration, excessive wt loss... -donor breast milk post-discharge support -women, infant, children (WIC) -lactation consultation

postpartum depression risk factors

previous postpartum depression, hx of depression, stressful life event, unmarried or marital discord, lack of support, preterm or ill neonate, adolescent pregnancy, unintentional pregnancy, and substance abuse

postpartum psychosis risk factors

previous psychosis, primipara, and hx of bipolar disorder

breastmilk types: mature milk

production begins between 10-14 days postpartum stage III of lactogenesis increased water content

maternal concern: neuro changes

profound fatigue recommendation: nap when baby naps, rely on support, cluster nursing care around rest headache from fatigue and hormonal changes

misoprostal for postpartum hemorrhage

prostaglandin: stimulated uterine contractions 600 mcg PO can cause: headache, n/v, and fever only given to patient with both HTN and asthma

MMR vaccine

protects against measles, mumps, and rubella would be used if mother was rubella nonimmune can cause fever, rash, lymphadenopathy, and pain at injection site avoid pregnancy for 28 days after dose, does not go through breastmilk, and informed consent is required

TDAP vaccine

protects against tetanus, diphtheria, and pertussis would be used if patient did not receive dose during third trimester can cause pain at injection site, fever, headache, lethargy, and n/v/d should be administered two weeks prior to contact with newborn and is safe with breastfeeding

varicella vaccine

protects against varicella would be used if patient did not have previous dose can cause pain at injection site, fever, mild rash, and temporary pain and stiffness in joints avoid pregnancy for 28 days after dose, safe with breastfeeding, and informed consent is required

formula feeding advantages

provides nutrition when breastmilk is not available both parents can have a role/responsibility in feeding

newborn procedures: critical congenital heart disease screening (CCHD)

pulse oximetry -right hand/wrist: preductal saturation (before aorta) -right foot: postductal saturation (after passage of aorta) sp02 greater than 95% and within 3 points of each other is a pass

newborn skin variation: erythema toxicum

pustules white or yellow with red base the "normal newborn rash" peaks at 24-48 hours and lasts up to 3 weeks theory is that clothing causes this

newborn birthmarks: infantile/strawberry hemangioma

raised closely packed blood vessels, growth from 2 weeks to 6 months of care common of face and scalp

discharge information for the newborn: carseats

rear-facing until 2 years of age backseat middle is the safest 45 degree angle 5 point safety harness clip at armpit level avoid bulky clothing never placed in front of airbag always a new carseat/know the history of the carseat

newborn procedures: hearing screen

recommended prior to discharge but no later than 1 month of age if a newborn fails they get rescreened but if they fail again more assessment is needed

baby benefits of breastfeeding

reduce risk of type I & II diabetes, obesity, asthma, celiac disease, and SIDS, protection from respiratory, GI, urinary, and ear infections, bacterial meningitis, and allergies, they have increase intelligence and enhanced neurodevelopment

maternal benefits of breastfeeding

reduces risk of breast and ovarian cancer, type II diabetes, RA, HTN, PPH, PPD, and MI, enhanced bonding, hormones, cost saving, no preparation, and extra calories burned

postpartum nursing considerations gestational diabetes mellitus

return to normal glucose levels: placenta is problem so it is corrected quickly increased risk of type II (70%)

family centered care during postpartum

rooming in: as much care for baby IN THE ROOM as possible couplet care: same nurse for mom & baby skin-to-skin: with mom AND dad inclusion of partner, siblings, and family in plan of care

sore nipples

severe pain, blisters, cracking, and bleeding most commonly from a poor latch -poor positioning -infection

integumentary assessment

should be warm, dry, and pink can have desquamation (cracked, dry, peeling) can have vernix caseosa (antimicrobial & skin protection)

discharge information for the newborn: pacifiers

significant sids reduction naptime and bedtime do not use until breastfeeding is well established/going well never have it on a carrier around neck

preventions of hypoglycemia in the newborn

skin-to-skin, early frequent breast feeding, and prevent temp instability

discharge information: home visits or telephone follow-up

some states have a law that a nurse must follow up in home -physical & emotional assessment -breastfeeding assessment -newborn assessment -referrals when needed nursing staff can touch base (educate, answer questions...)

oxytocin for postpartum hemorrhage

stimulated uterine contractions (prevention and treatment) up to 80 units in 500-1000 mL LR can cause: headache, nausea, and fluid retention high alert medication

newborn respiratory effort: initiation of respirations

stimulation of thermal, auditory, and visual sensory receptors with the first big breath there is generation of high negative pressure in the lungs which forces out remaining fluid

fall prevention of the newborn

strap in car seat.. don't leave unattended high bed rails don't carry down hall (should be in bassinet)

newborn reflex: babinski

stroke the sole of the newborns foot in a inverse j pattern which should cause toes to extend and dorsiflex

newborn feeding cues

sucking motion hand to mouth movement rooting reflex (on demand feeding)

rhogam administration

suppresses rh isoimmunization in the non-sensitized rh negative women with an rh-incompatible pregnancy administered at 28 weeks to an rh negative woman and within 72 hours of delivery to a mother who is rh negative and the newborn is ph positive can cause nausea, dizziness, headache, injection site pain, and malaise give at room temp, contraindicated with previous anaphylactic reaction human globulin products, and is safe with breastfeeding

pain management of the newborn

swaddling (extremities flexed) non-nutritive sucking oral sucrose (2 minutes prior to painful procedure) skin-to-skin breastfeeding holding/rocking/cuddling touch/light massage medication (acetaminophen or nsaids then morphine or fentanyl)

lactation suppression

takes 5-7 days -engorgement and discomfort are common interventions -tight fitting sports bra for at least 72 hours continuously -application of cold compress to breast for 20 minutes 4 times a day -avoid breast and nipple stimulation -mild analgesic/anti-inflammatory medications (tylenol)

newborn procedures: heel stick

takes less than 1 mL warm heel to promote vasodilation use oral sucrose for pain control penetrate the outer aspect of the heel -can cause fibrosis and scarring and necrotizing osteochondritis (if bone is punctured)

postpartum vital signs

temp can be elevated to 100.4 in first 24 hours and as milk transitions -not a fever just elevation from dehydration, stress.. blood pressure can have slight increase in first few days also orthostatic hypotension is common -never greater than 140/90!! pulse elevated in the first hour but decreased in days 6-10 respirations normal

postpartum hemorrhage

traditional definition -vaginal delivery >500 mL -c-section: >1000 mL revised definition ->1000 ml blood loss -vaginal bleeding with signs and symptoms of hypovolemia within 24 hours of birth early/primary: within 24 hours of birth typically first hour late/secondary: occurs 24hr-12 weeks often

discharge information: follow-up care

traditionally 6 weeks ACOG recommends ongoing and individualized care -within 3 weeks followed by NO longer than 12 weeks *schedule follow-up appointment before they leave!

sore nipples treatment

treat cause (usually latch) colostrum massaged into nipples lanolin ointment/cream pumping begin breastfeeding on less traumatized side

breast engorgement

usually when transitional milk comes in increased blood flow to the breasts increased volume of breastmilk -alveoli become distended breast will be firm, tender, hot, shiny, and taut

postpartum hemorrhage cause: tone

uterine atony: boggy open uterus (most common) subinvolution: uterus fails to shrink

carboprost for postpartum hemorrhage

uterotonic: stimulated contractions of the uterus 250 mcg IM every 15 minutes up to 8 doses can cause: diarrhea, headache, n/v, fever, and increased BP contraindicated in HTN and asthma NO with preeclampsia

methergonovine for postpartum hemorrhage

uterotonic: stimulates contractions of the uterus 0.2 mg IM every 2-4 hours up to 5 doses can cause: increased BP, n/v, and headache contraindicated in HTN and cardiac disease NO with preeclampsia

length of stay for birth types

vaginal delivery: 24 hours -depends on birth center or hospital c-section: 2-3 days

head to toe/initial assessment of the newborn

vital signs: respirations first, then the rest with an axillary temp measure: head circumference, chest circumference, length, and weight (SGA, LGA, AGA?)

maternal concern: return of fertility

when EXCLUSIVELY breastfeeding: up to 6 months when bottle feeding: 7-9 weeks

newborn reflex: tonic neck

when newborn is on back turn head to one side, the arm the head is facing should extend