NUR 340 Exam 2

Newborn murmurs

Transient functional cardiac murmurs may be heard during the neonatal period as a result of the changing dynamics of the cardiovascular system at birth

Vital sign assessment during second, third and fourth stage of labor

*BP, pulse, RR 2nd stage: Q 5-15 min 3rd and 4th: Q 15 min

Ophthalmia neonatorum

-can cause neonatal blindness -hyperacute purulent conjunctivitis occurring during the first 10 days of life. -usually contracted during birth when the baby comes in contact with vaginal discharge of the mother infected with gonorrhea and chlamydia -Most often both eyelids become swollen and red with purulent discharge

Normal lochia after labor

-red -mixed with clots -of moderate flow

Philosophy of labor

-some believe labor needs to be done in hospitals, where others believe it can be done anywhere

Striae gravidarum

-stretch marks; fade to silvery lines -do not disappear -occur on breasts, abdomen, hips

Pharmacologic measures for pain

-systemic analgesia -inhaled analgesia -epidural analgesia

Clubfoot

-turning-inward position -secondary to intrauterine positioning

Maternal changes when lightening occurs

-uterus lowers -abdomen shape changes -breathing becomes easier -decrease in GERD -may have inc in pelvic pressure, leg cramps, dependent edema, low back discomfort -inc in vaginal d/c -more frequent urination

Mother monitoring after labor

-vital signs, amount and consistency of lochia, and uterine fundus monitored every 15 minutes for 1 hour -woman will feel cramp like discomfort

Expected length of a newborn

44-55 cm 17-22 in

Bradycardia in a newborn

<110 often associated with apnea and is often seen with hypoxia.

Assessing amniotic fluid

color, odor, and amount

Cold stress

excessive heat loss that requires a newborn to use compensatory mechanisms (such as nonshivering thermogenesis and tachypnea) to maintain core body temperature

Fetal responses during labor

*If the fetus is healthy, the stress of labor usually has no adverse effects Nurse must be aware for: -Periodic fetal heart rate accelerations and slight decelerations related to fetal movement, fundal pressure, and uterine contractions -Decrease in circulation and perfusion to the fetus secondary to uterine contractions (a healthy fetus is able to compensate for this drop) -Increase in arterial carbon dioxide pressure (PCO2) -Decrease in fetal breathing movements throughout labor -Decrease in fetal oxygen pressure with a decrease in the partial pressure of oxygen (PO2)

Perineal phase

*Phase 2 of stage 2 • period of active pushing • Nullipara, lasts up to 1 h; multipara, lasts up to 30 min • Contraction frequency every 2-3 min or less • Contraction duration 60-90 s • Contraction intensity strong by palpation • Strong urge to push during the later perineal phase • inc in bloody show • fetal head become apparent but disappears between contractions; "crowned"

Placental expulsion

*Phase 2 of stage 3 -coming outside the vaginal opening -placenta expelled within 2-30 min -after expelled, uterus is massaged until firm so blood vesselc constrict

Pelvic phase

*phase 1 of stage 2 -period of fetal descent -the fetal head is negotiating the pelvis, rotating, and advancing in descent

Active phase

*phase 2 of stage 1 • Cervical dilation from 4 to 7 cm; more rapid • Cervical effacement from 40% to 80% • Nullipara, lasts up to 6 h; multipara, lasts up to 4 h • Contraction frequency every 2-5 min • Contraction duration 45-60 s • Contraction intensity moderate to palpation • woman becomes more intense and inwardly focused; interactions in room are limited

RAPP assessment

*respiratory activity, perfusion, and position -method to swiftly evaluate the newborn's condition so that decisions can be made regarding newborn stability

Coagulation postpartum

*risk for blood clots -alterations in hemostasis that favor coagulation, reduced fibrinolysis, and pooling and stasis of blood in the lower limbs; important for minimizing blood loss at childbirth -remain elevated during the early postpartum period -usually return to prepregnant levels after 3 weeks of postpartum

Premonitory signs of labor

- Cervical changes - Lightening - Increased energy level - "Bloody show" - Braxton Hicks contractions - Spontaneous rupture of membranes

Average rate of fetal decent

-1 cm/hr in nulliparous women -2 cm/hr in multiparous women.

Footling or incomplete breech

-10-30% of breeches -one or both legs present -ususally require a c section

Normal newborn weigth

-2,500-4,000 g -5 lb, 8 oz to 8 ilb 14 oz

Normal blood loss from labor

-500 mL for vaginal -1 L for c cestions *blood loss over 1 L is severe

Average amount of voids daily for a newborn

-6-8 -this indicates adequate fluid intake

When can exercise start postpartum

-A healthy woman with an uncomplicated vaginal birth can resume exercise in the immediate postpartum period -walking is fine -do not use jogging stroller until baby can hold their head up; 6-12 m

Maintaining Thermoregulation at birth

-Assess body temperature frequently during the immediate newborn period -baby's temperature should be taken every 30 minutes for the first 2 hours or until the temperature has stabilized, and then every 8 hours until discharge or follow hospital protocols

Afterpains

-Cramping pain after childbirth caused by alternating relaxation and contraction of uterine muscles. -more noticeable in multiparas and those breastfeeding *Primiparous women typically experience mild afterpains because their uterus is able to maintain a contracted state. -usually respond to oral analgesics

Muscle and joint changes postpartum

-Within 6 to 8 weeks after delivery, joints are completely stabilized and return to normal; levels of relaxin, estrogen, progesterone decrease -Parous women will note a permanent increase in their shoe size -Fatigue & discomfort may be experienced d/t dec in relaxin and progesterone; cause hip and joint pain -good body postioning and mechanics are important postpartum

Induction of labor

-amniotomy and augmentation of labor with oxytocin -1 in 4 women are induced or have labor augemented

Spontaneous pushing

-follows mother spontaneous urge -natural way to manage second stage

Nursing intervention to prevent heat loss through convection

-keep the newborn out of direct cool drafts (open doors, windows, fans, air conditioners) in the environment -work inside an isolette as much as possible and minimize opening portholes that allow cold air to flow inside, -warm any oxygen or humidified air that comes in contact with the newborn. -Using clothing and blankets in isolettes is an effective means of reducing the newborn's exposed surface area and providing external insulation. -transporting the newborn to the nursery in a warmed isolette, rather than carrying him or her, helps to maintain warmth and reduce exposure to the cool air.

Most common cause of death from labor

-severe bleeding

Needed calorie intake at birth

108 kcal/kg/day until 6 months old; 650 cal/day -small frequent meals are better -2-4 oz per feeding; 6 feedings a day until 4 m old, then declines

When do infants produce their own antibodies

2-3 months of age

Average amount of lochial discharge

240 to 270 mL (8 to 9 oz)

Normal newborn hematocrit

46-68%

Abnormal stool features

Diarrhea -green and loose -water ring

Which antibodies are in breast milk

IgE IgA IgM IgG

Initial breathing in the newborn

Initiation of respiratory movement Expansion of the lungs Establishment of functional residual capacity (ability to retain some air in the lungs on expiration) Increased pulmonary blood flow Redistribution of cardiac output

Vital signs during first stage of labor

Latent Phase (0-3 cm) - Q 30-60 min Active phase (4-7 cm) -Q 30 min Transition phase (8-10 cm) - Q 15-30 min

Site of gas exchange in the newborn

Lungs

Contractions in True vs False labor

True: Regular, becoming closer together, usually 4-6 min apart, lasting 30-60 s False: irregular, not occurring lose together

Acupuncture

involves stimulating key trigger points with needles

Common causes of head shape variation

molding, caput succedaneum, and cephalhematoma

Signs of bladder infection

nfrequent or insufficient voiding (less than 200 mL), discomfort, burning, urgency, or foul-smelling urine

Involution

Return of the uterus to a nonpregnant state/size after birth

Factors are associated with prolonged deceleration

prolonged cord compression, abruptio placenta, cord prolapse, supine maternal position, vaginal examination, fetal blood sampling, maternal seizures, regional anesthesia, or uterine rupture

Based on the gate control theory of pain

proposes that local physical stimulation can interfere with pain stimuli by closing a hypothetical gate in the spinal cord, thus blocking pain signals from reaching the brain

Pulmonary blood flow and respirations

With the first inspirations, **the pulmonary vascular resistance decreases ***this causes an increase in pulmonary blood flow

Taste at birth

ability to distinguish between sweet and sour by 72 hours old

Oxytocin administration

administered piggybacked into the primary intravenous line with an infusion pump titrated to uterine activity

Ideal maternal position during second stage of labor

one that opens the pelvic outlet as wide as possible, provides a smooth pathway for the fetus to descend through the birth canal, takes advantage of gravity to assist the fetus to descend, and gives the mother a sense of being safe and in control of the labor process

Dyspareunia

painful sexual intercourse

Factors that affect bonding

parent's socioeconomic status, family history, role models, support systems, cultural factors, and birth experiences

Conditions associated with shoulder dystocia

placenta previa -prematurity -high parity -premature rupture of membranes -multiple gestation -fetal anomalies

Chemical Stimulation to stimulate respirations

Cord is cut; end of placental blood flow for the newborn. -This results in Decreased O2 (mild hypoxia), Increased CO2 (decreased pH), Stimulation of respiratory center in the medulla, which stimulates respirations.

Fetal acceleration

-transitory abrupt increases in the FHR above the baseline (> 15 bpm) that last <30 seconds from onset to peak -lasts 15s to 2 min. -associated with sympathetic nervous system stimulation -generally reassuring and require no intervention -denotes fetal movement and well being

Flase (or greater) pelvis

-two iliac bones and the wings of the base of the sacrum -lies above the linea terminalis. -divided from the true pelvis by an imaginary line (linea terminalis) drawn from the sacral prominence at the back to the superior aspect of the symphysis pubis at the front of the pelvis

Systemic analgesics

-typically administered parenterally -risk for respiratory depression; need naloxone -nearly all cross placenta to baby; use least amount of med possible

Sutures

-Sutures: gaps, membranous spaces between the cranial bones, -Sutures are important because they allow the cranial bones to overlap in order for the head to adjust in shape (elongate) when pressure is exerted on it by uterine contractions or the maternal bony pelvis. -help to ID position of fetal head during vaginal exam

Intrauterine pressure catheter

-The catheter is positioned in the uterine cavity through the cervix after the membranes have ruptured. -It reports intensity by measuring the pressure of the amniotic fluid inside the uterus in millimeters of mercury. -It is not recommended for routine use in low-risk laboring women due to the potential risk of infection and injury to the placenta or fetus.

Chest wall of newborn

-The chest wall of the newborn is floppy because of the high cartilage content and poorly developed musculature. -Thus, accessory muscles to help in breathing are ineffective.

Bilirubin

-The liver is also responsible for the conjugation of bilirubin -yellow-to-orange bile pigment produced by the breakdown of red blood cells

BP postpatum

-compare to normal; report deviations -BP immediately after labor should match BP during -increase in BP could indicate gestational hypertension -decrease could indicate shock or orthostatic hypotension or dehydration, a side effect of epidural anesthesia -Should be between 140/90 and 85/60 -assess BP in same position every time

Factors that facilitate uterine involution

-complete expulsion of amniotic membranes and placenta at birth, -a complication-free labor and birth process -breast-feeding -early ambulation

False labor

-condition that occurs in the later weeks of some pregnancies -irregular uterine contractions are felt, but the cervix in not affected

Mechanisms of heat loss

-conduction (3%) -convection (34%) -evaporation (24%) -radiation (39%)

Merconium

-infants first stool -composed of amniotic fluid, shed mucosal cells, intestinal secretions, and blood -greenish black, has a tarry consistency, and is usually passed within 12 to 24 hours of birth -first meconium stool passed is semisterile, but this changes rapidly with ingestion of bacteria through feedings

Late preterm

An infant born between 34 0/7 and 36 6/7 weeks of gestation is identified as "late preterm" and experiences many of the same health issues as other preterm birth infants

Estrogen and progesterone changes with labor

Estrogen rises and progesterone falls

Scarf sign

-How far can the elbows be moved across the newborn's chest? -An elbow that does not reach midline indicates greater maturity. For example, if the elbow reaches or nears the level of the opposite shoulder, this is scored as -1 point; if the elbow does not cross the proximate axillary line, it is scored as 4 points.

Postpartum diuresis causes

-Large amounts of intravenous fluids given during labor -Decreasing antidiuretic effect of oxytocin as its level declines -Buildup and retention of extra fluids during pregnancy -Decreasing production of aldosterone—the hormone that decreases sodium retention and increases urine production *these factors contribute to rapid filling of the bladder within 12 hours of birth

Resumption of menses postpartum

-Nonlactating women: return of menstruation 7 to 9 weeks after birth -Lactating women: return dependent on breast-feeding frequency and duration; anywhere from 2 to 18 months

Placenta inspection

-inspected for its intactness by the health care provider and the nurse to make sure all sections are present -If any piece is still attached to the uterine wall, it places the woman at risk for postpartum hemorrhage because it becomes a space-occupying object that interferes with the ability of the uterus to contract fully and effectively.

Uterine contractions

-involuntary -rhythmic and intermittent; periods of relaxation in between -pauses allow rest, and the return of blood flow to uterus and placenta

Searching nystagmus

-involuntary repetitive eye movement -normal for the first 3 to 6 months of age

First degree perineal laceration

-involves only skin and superficial structures above muscle -Involves the vaginal mucose or perineal skin.

Popliteal angle

How far will the newborn's knees extend? The angle created when the knee is extended is measured. An angle of less than 90 degrees indicates greater maturity. For example, an angle of 180 degrees is scored as -1 point and an angle of less than 90 degrees is scored as 5 points.

Acupressure

-involves the application of a firm finger or massage used in acupuncture to reduce the pain sensation -amount of pressure is important; intensity of the pressure is determined by the needs of the woman -Holding and squeezing the hand of a woman in labor may trigger the point most commonly used for both techniques

Reasons for internal monitoring

-may include multiple gestation, decreased fetal movement, abnormal FHR on auscultation, IUGR, maternal fever, preeclampsia, dysfunctional labor, preterm birth, or medical conditions such as diabetes or hypertension

Normal nose assessment

-small -midline and narrow -able to smell -assess size, symmetry, position, lesions -should be midline and patent, intact septum -slight discharge, no actual drainage should be present common problem: malformation or blockage

Abnormal head size indications

-small head might indicate microcephaly caused by rubella, toxoplasmosis, or SGA status -an enlarged head might indicate hydrocephalus or increased intracranial pressure. *Both need to be documented and reported for further investigation

Small or closed fontanels

-smaller-than-normal anterior and posterior diameters or fontanels that are closed at birth. -Craniosynostosis and abnormal brain development are associated with a small fontanel or early fontanel closure associated with microcephaly

Contraction progression through labor

-start as mild; last 30 sec and occur every 5-7 minutes -as labor progresses contractions last longer (60 sec) and occur more frequently (2-3 minutes); described as mod-high intensity

Bilirubin encephalopathy

-a permanent and devastating form of brain damage -Even in healthy term newborns, extremely elevated blood levels of bilirubin during the first week of life can cause bilirubin encephalopath

Brown fat

-a special kind of highly vascular fat found only in newborns -able to convert chemical energy directly into heat when activated by the sympathetic nervous system -produced during the third trimester; ordinarily disappears by 3 to 5 weeks after birth and is vital for thermogenesis -makes up about 6% of term body weight in the full-term newborn ***there is a finate amount of brown fat

Newborn Blood coagulation

-coagulation factors are synthesized in the liver and Vitamin K is required -Vitamin K is produced in the gut from intestinal flora. -The newborn is not able to produce Vit K until there have been some feedings to promote gut flora. -newborns are given VIT K injections shortly after birth to prevent bleeding. (IM)

Shoulder presentation

- aka shoulder dystocia; shoulders first, head tucked inside -signs appear while woman pushes, neonates head appears over the perineum but then retracts back into the vagina; "turtle sign" -odds are 1 in 300 -usually need a c-section

Nursing phone assessment questions

-Estimated date of birth, to determine if term or preterm -Fetal movement (frequency in the past few days) -Other premonitory signs of labor experienced -Parity, gravida, and previous childbirth experiences -Time from start of labor to birth in previous labors -Characteristics of contractions, including frequency, duration, and intensity -Appearance of any vaginal bloody show -Membrane status (ruptured or intact) -Presence of supportive adult in household or if she is alone

Dilation descriptions

-External cervical os closed: 0 cm dilated -External cervical os half open: 5 cm dilated -External cervical os fully open: 10 cm dilated

Fetal bradycardia

-FHR <110 and lasts 10+ min -can be initial response of healthy fetus to asphyxia -considered an ominous sign when accompanied by a decrease in baseline variability and late decelerations

Partners and the birthing process

-A caring partner can use massage, light touch, acupressure, hand-holding, stroking, and relaxation -can help the woman communicate her wishes to the staff -can provide a continuous, reassuring presence, all of which bring some degree of comfort to the laboring woman *laboring women should always have the option to receive partner support, whether from nurses, doulas, significant others, or family *he or she should provide the mother with continuous presence and hands-on comfort and encouragement

Sleep and Crib Safety teaching

-AVOID SIDS; lay newborn on back in crib; no extra blankets, toys, bumpers AVOID CO-Sleeping; rails up in hospital, do NOT sleep with baby or leave baby in bed; recommended that babies sleep in parents' room for first few months of life

Amniotomy

-Artificial rupture of amniotic membranes -allows the fetal head to have more direct contact with the cervix to dilate it -fetal head must be at -2 station or lower -cervix must be at least 3 cm dilated

3 types of breastmilk

-colostrum: higher in protein, minerals, vitamins; has laxative properties and immunoglobulins (primarily IgA) -transitional milk: mature milk; about 10 days -Mature milk has foremilk and hindmilk 1. foremilk has more water to "slake thirst" 2. hindmilk has more fat - for satiety and growth.

Anthropoid pelvis

-common in men -most common in non-white women; 25 % of all women -oval inlet, long sacrum -deep pelvis; wider front to back than side to side -more favorable compared to android or paltypelloid shapes

Non-pharmacologic pain management methods

-Continuous labor support -Hydrotherapy -Ambulation and position changes -Acupuncture and acupressure -Application of hot and cold -Attention focusing and imagery -Effleurage and massage -Breathing techniques *based on the gate control theory of pain *usually simple, safe, and inexpensive *women can't control contractions, but can control how they respond

Pain management and labor

-Controlling the uterine discomfort without harm to the fetus or labor process is the major focus of pain management during childbirth -Cultural values and learned behaviors influence perception and response to pain, as do anxiety and fear, both of which tend to heighten the sense of pain -care provider needs to find the balance of pain and coping management

Continuous external monitoring

-2 monitors applied to maternal abdomen; between umbilicus and pubis -noninvasive -one detects changes in uterine pressure and converts the pressure registered into an electronic signal that is recorded on graph paper -The other ultrasound transducer records the baseline FHR, long-term variability, accelerations, and decelerations -can be used while the membranes are still intact and the cervix is not yet dilated, and with ruptured membranes and a dilating cervix -measures the approximate duration and frequency of contractions, providing a permanent record of FHR

Social Behaviors

-Cuddling and snuggling into the parent rather than resisting *Cuddliness is very important to parents because they frequently gauge their ability to care for their newborn by the newborn's acceptance or positive response to their actions *Assisting parents to assume comforting behaviors (e.g., by cooing while holding their newborn) and praising them for their efforts can help foster cuddling behaviors.

Motor Maturity

-Depends on gestation and involves evaluation of posture, tone, coordination and movements. -Movements are rhythmic and spontaneous, as babies adapt to their environment, movements should be smoother. -It indicates CNS is processing stimuli appropriately. *Bringing the hand up to the mouth is an example of good motor organization

Pain management used for circumcision

-EMLA® cream -dorsal penile nerve block with buffered lidocaine -acetaminophen -skin-to-skin contact -a sucrose pacifier -swaddling

Pelvic shape

-Each plane of the pelvis has a shape, which is defined by the anterior-posterior and transverse diameters. -The pelvis is divided into four main shapes: 1. gynecoid 2. anthropoid 3. android 4. platypelloid *most pelvises are of mixed type; no two are exactly the same *Regardless of the shape, the newborn can be born vaginally if size and positioning remain compatible

Postpartum nutrition guidlines

-Eat a wide variety of foods with high nutrient density. -Eat meals that require little or no preparation. -Avoid high-fat fast foods. -Drink plenty of fluids daily—at least 2,500 mL (approximately 84 oz). -Avoid fad weight-reduction diets and harmful substances such as alcohol, tobacco, and drugs. -Avoid excessive intake of fat, salt, sugar, and caffeine. -Eat the recommended daily servings from each food group

Palmar grasp

-Elicit the palmar grasp reflex by placing a finger on the newborn's open palm. -The baby's hand will close around the finger. -Attempting to remove the finger causes the grip to tighten. -Newborns have strong grasps and can almost be lifted from a flat surface if both hands are used. -The grasp should be equal bilaterally

Causes of newborn jaunndice

***can be classified into three groups based on the mechanism of accumulation 1. Bilirubin overproduction, such as from blood incompatibility (Rh or ABO), drugs, trauma at birth, polycythemia, delayed cord clamping, and breast milk jaundice 2. Decreased bilirubin conjugation, as seen in physiologic jaundice, hypothyroidism, and breast-feeding 3. Impaired bilirubin excretion, as seen in biliary obstruction (biliary atresia, gallstones, neoplasm), sepsis, hepatitis, chromosomal abnormality (Turner syndrome, trisomies 18 and 21), and drugs (aspirin, acetaminophen, sulfa, alcohol, steroids, antibiotics)

Placental separation

*Phase 1 of stage 3 -detaching from the uterine wall

Dilation and effacement assessment

-Width of cervix determines dilation -Length of cervix determines effacement

Maintaining Airway Patency at BIrth

-immediately after birth, suction to remove fluid/mucous; MOUTH first

Letting go phase

-woman reestablishes relationships with other people -assumes the responsibility and care of the newborn with a bit more confidence -focus is to move forward, assuming the parental role and to separate herself from the symbiotic relationship that she and her newborn had during pregnancy -establishes a lifestyle that includes the infant -relinquishes the fantasy infant and accepts the real one.

Four stages a woman progresses through in establishing a maternal identity in BAM

1. Commitment, attachment to the unborn baby, and preparation for delivery and motherhood during pregnancy 2. Acquaintance/attachment to the infant, learning to care for the infant, and physical restoration during the first 2 to 6 weeks following birth 3. Moving toward a new normal 4. Achievement of a maternal identity through redefining self to incorporate motherhood (around 4 months). The mother feels self-confident and competent in her mothering and expresses love for and pleasure interacting with her infant

Transition to parenthood

1. Commitment, attachment, and preparation for an infant during pregnancy 2. Acquaintance with and increasing attachment to the infant, learning how to care for the infant, and physical restoration during the first weeks after birth 3. Moving toward a new normal routine in the first 4 months after birth 4. Achievement of a parenthood role *may take 4-6 months

3 dimensions of proximity

1. Contact: The sensory experiences of touching, holding, and gazing at the infant 2. Emotional state: emerges from the affective experience of the new parents toward their infant and their parental role. 3. Individualization: Parents are aware of the need to differentiate the infant's needs from themselves and to recognize and respond to them appropriately, making the attachment process also, in some way, one of detachment.

5 additional P's that affect the labor process

1. Philosophy (low tech, high touch) 2. Partners (support caregivers) 3. Patience (natural timing) 4. Patient (client) preparation (childbirth knowledge base) 5. Pain management (comfort measures) *helpful in planning care for the laboring family *These client-focused factors are an attempt to foster labor that can be managed through the use of high touch, patience, support, knowledge, and pain management.

Healthy People 2020 goals related to cesarean births

1. Reduce the rate of cesarean births among low-risk (full-term, singleton, vertex presentation) women having their first child to 23.9% of live births, from a baseline of 26.5%. 2.Reduce the rate of cesarean births among women who have had a prior cesarean birth to 81.7% of live births, from a baseline of 90.8%

Normal newborn platelets

150000-350000 *similar to adults

Normal newborn hemoglobin

16-18 g/dL -initially declines as a result of a decrease in neonatal red cell mass (physiologic anemia of infancy)

Normal newborn RBC

4.5-7.0 Fetus: -has more RBC per cubic mL thean an adult -RBC have a greater affinity for O2 in the fetus -RBC are larger than adults; carry more O2 -at birth, RBC increases as size decreases -newborn RBC lifespan is 80-100 days (adults are 120 days)

Normal number of voids per day for newborn

6-12 wet diapers

Anatomy and physiology of fetal thermoregulation

Body temperature is maintained by maternal body temperature and the warmth of the intrauterine environment

The cardinal movements of labor include which of the following? Select all that apply. a. Extension and rotation b. Descent and engagement c. Presentation and position d. Attitude and lie e. Flexion and expulsion

Answers A, B, and E are correct. The cardinal movements of labor by the fetus include engagement, descent, flexion, international rotation, extension, external rotation, and expulsion only. The other choices describe the various fetal positions.

Benefits of practicing patterned breathing

Breathing: -becomes an automatic response to pain. -increases relaxation and can be used for deal with life's everyday stresses. -is calming during labor. -provides a sense of well-being and a measure of control. -brings purpose to each contraction, making them more productive. -provides more oxygen for the mother and fetus

Early and late cord campling

Early: before 30-40 sec Late: after 3 min -bother change circulatory dynamics during transition

Sensory stimulation to initiate respirations

Newborn is exposed to cold, sound, light, and touch, which also stimulates the respiratory center

Neurobehavioral response

Newborns demonstrate several predictable responses when interacting with their environment. How they react to the world around them is termed a

Site of gas exchange in the fetus

Placenta

Cryptorchidism

Undescended testes

Pseudomenstruation

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

Newborn weight

average: 3,400 g; 7.5 lbs range: 2,500-4,000 g; 5 lb oz-8 lb 13 oz -weight immediately after birth, then daily ***Newborns usually lose up to 6% of their birth weight within the first few days of life, but regain it in approximately 10 days -should be correlated with gestational age -A newborn who weighs more than normal might be LGA or an infant of a diabetic mother -a newborn who weighs less than normal might be SGA, preterm, or have a genetic syndrome -identify the cause for the deviation in size and to monitor the newborn for complications common to that etiology.

Newborn head circumference

average: 32-38 cm; 12.5-15 in -Measure the circumference at the head's widest diameter (the occipitofrontal circumference) ***Head circumference may need to be remeasured at a later time if the shape of the head is altered from birth ***should be approximately one fourth of the newborn's length or about half the infant's body length plus 10 cm

Acquired immunity

two primary processes: (1) the development of circulating antibodies or immunoglobulins capable of targeting specific invading agents (antigens) for destruction and (2) formation of activated lymphocytes designed to destroy foreign invaders. -depends heavily on immunoglobulins such as IgG, IgM, and IgA ***absent until after the first invasion by a foreign organism or toxin -vaccinations; Hep B

Skin texture

typically ranges from sticky and transparent to smooth, with varying degrees of peeling and cracking, to parchment-like or leathery with significant cracking and wrinkling

Hypospadias

urinary meatus is on the ventral surface of the penis *circumcision should be avoided until further evaluation.

Syndactyly

webbed fingers or toes

Hearing at birth

well developed at birth, responds to noise by turning to sound.

Lightening

when the fetal presenting part begins to descend into the true pelvis

Vitamin K administration

• Administer within 1 to 2 hours after birth. • Give as an IM injection at a 90-degree angle into the outer middle third of the vastus lateralis muscle. • Use a 25-gauge, 5/8-in needle for injection. • Hold the leg firmly and inject medication slowly. • Adhere to standard precautions. • Assess for bleeding at injection site after administration.

Signs and symptoms of newborn hypoglycemia

•Jitteriness •Hypotonia •Irritability •Apnea •Lethargy •Temperature instability

Puerperium

six-week period after birth in which the uterus involutes

Kangaroo care

skin to skin contact

Risk factors that contribute to coagulation complications postpartum

-Smoking -obesity -immobility -postpartum factors such as infection, bleeding, and emergency surgery (including emergency cesarean section)

Balance of Hot and cold

*labor is considered a cold state in some cultures (duong) because of the loss of blood -avoid anything cold; from gruits/veggies, to ice packs and sitz baths -the intake of hot food, warm drinks, warm water and staying indoors -Hot-cold beliefs are common among Latin American, African, and Asian people

Erythromycin ophthalmic ointment

***prevent ophthalmia neonatorum; cause neonatal blindness • Be alert for chemical conjunctivitis for 1 to 2 days. • Wear gloves, and open eyes by placing the thumb and finger above and below the eye. • Gently squeeze the tube or ampoule to apply medication into the conjunctival sac from the inner canthus to the outer canthus of each eye. • Do not touch the tip to the eye. • Close the eye to make sure the medication permeates. • Wipe off excess ointment after 1 minute.

Nursing intervention when cold stress is presented

**deterioration could be rapid, this is a critical nursing intervention -when newborns are showing any symptoms, assess temperature, blood glucose, and s/s respiratory distress.

Iron storage of newborns

**generally, there is a 6-month reserve -Newborn iron stores are determined by total body hemoglobin content and length of gestation -If the mother's iron intake was adequate during pregnancy, sufficient iron has been stored in the newborn's liver for use during the first 6 months of age

Neutral thermal environment (NTE)

*An environment in which body temperature is maintained without an increase in metabolic rate or oxygen use Newborns require a NEUTRAL THERMAL ENVIRONMENT (NTE); this keeps the rates of oxygen consumption and metabolism at a minimum; produces growth and stability, and enables the baby to conserve energy for basic body functions. -If the environmental temperature decreases, the newborn responds by consuming more oxygen; metabolic rate increases

Latent phase

*Phase 1 of stage 1 •0-3 cm cervical dilation • Cervical effacement from 0% to 40% • Nullipara, lasts up to 9 h; multipara, lasts up to 5-6 h • Contraction frequency every 5-10 min • Contraction duration 30-45 s • Contraction intensity mild to palpation • most women are talkative; contractions feel like menstrual cramps • may stay home, but notify provider • woman is excited but apprehensive

Consequences of cold stress

*can be severe -As the body temperature decreases, the newborn becomes less active, lethargic, hypotonic, and weaker -high risk for cold stress in the first 12 hours of life -greatest risk is in preterm babies; experience more profound effects -preterm babies have fewer fat stores, poorer vasomotor responses, and less insulation to cope with a hypothermic event

Epstein's pearls

small, white epidermal cysts on the gums and hard palate that disappear in weeks

Alleviating Breast Engorgement in breast feeding woman

*common and temporary -encourage frequent feedings, at least every 2 to 3 hours, using manual expression just before feeding to soften the breast so the newborn can latch on more effectively. -Advise the mother to allow the newborn to feed on the first breast until it softens before switching to the other side.

Ductus arteriosus changes with birth

*connected pulmonary artery to descending aorta -closes and becomes a ligament.

Ductus venosus changes with birth

*connected umbilical vein to inferior vena cava -closes and becomes a ligament

Fetal movements of labor

*deliberate, specific, and very precise movements that allow the smallest diameter of the fetal head to pass through a corresponding diameter of the mother's pelvic structure. -engagement -descent -flexion -internal rotation -extension -external rotation (resititution) -expulsion

The five P's

*factors that affect the process of labor and birth 1. Passageway (birth canal) 2. Passenger (fetus and placenta) 3. Powers (contractions) 4. Position (maternal) 5. Psychological response

Factors associated with increased risk for hearing loss

-Family history of hereditary childhood sensory hearing loss -Congenital infections such as cytomegalovirus, rubella, toxoplasmosis, or herpes -Craniofacial anomalies involving the pinna or ear canal -Low birth weight (less than 1,500 g) -Postnatal infections such as bacterial meningitis -Head trauma -Hyperbilirubinemia requiring an exchange transfusion -Exposure to ototoxic drugs, especially aminoglycosides -Perinatal asphyxia

Foramen ovale

*opening between right and left atrium -closes due to increase in left atrial pressure.

Transition phase

*phase 3 of stage 1 • Cervical dilation from 8 to 10 cm; slows • Cervical effacement from 80% to 100% • Nullipara lasts up to 1 h; multipara, lasts up to 30 min; most difficult and shortest phase • Contraction frequency every 1-2 min • Contraction duration 60-90 s • Contraction intensity strong by palpation; hard, painful

Square window

-How far can the newborn's hands be flexed toward the wrist? -The angle is measured and scored from more than 90 degrees to 0 degrees to determine the maturity rating. -As the angle decreases, the newborn's maturity increases. -For example, an angle of more than 90 degrees is scored as -1 point and an angle of 0 degrees is scored as 4 points.

Full or complete breech

-5-10% of breeches -fetus sits cross legged above cervix -ususally require c section

Frank breech

-50-70 % of breaches -butt first; legs up to face -can result in vaginal birth

GI system development at birth

-A good mucosal barrier is needed in the newborn to prevent harmful bacteria. -Microbes are introduced to the gut through exposure to bacteria during birth and through maternal handling and kissing. -Microbes are also introduced through feeding. -Components of human breastmilk support beneficial microbes. -Stomach capacity grows over the first 4 days, especially the first day, small frequent feeds are needed

Warmed transporter vs radiant warmer

-A warmed transporter is an enclosed isolette on wheels. -A radiant warmer is an open bed with a radiant heat source above.; This type of environment allows health care providers to reach the newborn to carry out procedures and treatments.

Habituation

-Ability to process and respond to auditory and visual stimulation -the ability to block out stimuli that that the newborn is accustomed to. (Example: vacuum cleaners, dog barking, siblings playing). -During the first 24 hours, newborns should increase the ability to habituate to the environmental stimuli.

External rotation (restitution)

-After the head is born and is free of resistance, it untwists, causing the occiput to move about 45 degrees back to its original left or right position (restitution). -the head realigns with the position of the back in the birth canal -External rotation of the fetal head allows the shoulders to rotate internally to fit the maternal pelvis.

Guidelines for recording care (documenting)

-All care rendered, to prove that standards were met -Conversations with all providers, including notification times -Nursing interventions before and after notifying provider -Use of the chain of command and response at each level -All flow sheets and forms, to validate care given -All education given to client and response to it -Facts, not personal opinions detailed descriptions of any adverse outcome -Initial nursing assessment, all encounters, and discharge plan -All telephone conversations

The Safe to Sleep Campaign recommendations to reduce the risk of SIDS

-Always place the baby on his or her back to sleep for all sleep times, including naps. -Room share—keep baby's sleep area in the same room next to where you sleep. -Use a firm sleep surface, free from soft objects, toys, blankets, and crib bumpers.

Risk factors associated with thromboembolic conditions postpartum

-Anemia -Diabetes mellitus -Cigarette smoking -Obesity -Preeclampsia -Hypertension -Severe varicose veins -Pregnancy -Multiple pregnancies -Cardiovascular disease -Sickle cell disease -Postpartum hemorrhage -Oral contraceptive use -Cesarean birth -Severe infection -Previous thromboembolic disease -Multiparity -Bed rest or immobility for 4 days or more -Advanced maternal age > 35 years

3 stage role development process for partners

-Stage 1: Expectations -Stage 2: Reality -Stage 3: Transition to mastery *Similar to mothers, partners also go through a predictable three-stage process during the first 3 weeks as they too "try on" their roles as parents.

Nursing interventions during admission

-Asking about the client's expectations of the birthing process -Providing information about labor, birth, pain management options, and relaxation techniques -Presenting information about fetal monitoring equipment and the procedures needed -Monitoring FHR and identifying patterns that need further intervention -Monitoring the mother's vital signs to obtain a baseline for later comparison -Reassuring the client that her labor progress will be monitored closely and nursing care will focus on ensuring fetal and maternal well-being throughout -As the woman progresses through the first stage of labor, nursing interventions include: -Encouraging the woman's partner to participate -Keeping the woman and her partner up to date on the progress of the labor -Orienting the woman and her partner to the labor and birth unit and explaining all of the birthing procedures -Providing clear fluids (e.g., ice chips) as needed or requested -Maintaining the woman's parenteral fluid intake at the prescribed rate if she has an IV -Initiating or encouraging comfort measures, such as backrubs, cool cloths to the forehead, frequent position changes, ambulation, showers, slow dancing, leaning over a birth ball, side-lying, or counterpressure on lower back -Encouraging the partner's involvement with breathing techniques -Assisting the woman and her partner to focus on breathing techniques Informing the woman that the discomfort will be intermittent and of limited duration; urging her to rest between contractions to preserve her strength; and encouraging her to use distracting activities to lessen the focus on contractions -Changing bed linens and gown as needed -Keeping the perineal area clean and dry -Supporting the woman's decisions about pain management -Monitoring maternal vital signs frequently and reporting any abnormal values -Ensuring that the woman takes deep cleansing breaths before and after each contraction to enhance gas exchange and oxygen to the fetus -Educating the woman and her partner about the need for rest and helping them plan strategies to conserve strength -Monitoring FHR for baseline, accelerations, variability, and decelerations -Checking on bladder status and encouraging voiding at least every 2 hours to make room for birth Repositioning the woman as needed to obtain optimal heart rate pattern -Communicating requests from the woman to appropriate personnel -Respecting the woman's sense of privacy by covering her when appropriate -Offering human presence by being present with the woman, not leaving her alone for long periods -Being patient with the natural labor pattern to allow time for change -Encouraging maternal movement throughout labor to increase the woman's level of comfort -Dimming the lights in the room when pushing and request softened voices be used to maintain a calm and centered ambiance -Reporting any deviations from normal to the health care professional so that interventions can be initiated early to be effective

Continued care of circumcision site

-Assess for bleeding every Q 15 min for first hour, then per protocol; Q 30 minutes for at least 2 hours. -Document the first voiding to evaluate for urinary obstruction or edema. -Squeeze soapy water over the area daily and then rinse with warm water. Pat dry. -Apply a small amount of petroleum jelly with every diaper change if the Plastibell was used; clean with mild soap and water if other techniques were used. -Fasten the diaper loosely over the penis and avoiding placing the newborn on his abdomen to prevent friction. -use pain meds per protocol -watch for voiding -parent education *instruct the parents to check daily for any foul-smelling drainage, bleeding, or unusual swelling.

SIgns of cold stress

-Axillary temp at or below 36.5 C (97.5 F) -Cool skin (may be mottled) -Lethargy -Pallor -Tachypnea -Grunting -Hypoglycemia -Jitteriness -Weak Suck

When to call HCP after discharge

-Axillary temperature greater than 101 F or as directed -Vomiting or diarrhea -Poor feeds or missed feeds -Less than 6 wet diapers a day, sunken fontanels -Jaundice -Lethargy -Inconsolable crying -Breathing difficulty

BUBBLE-EEE acronym for postpartum assessment

-B: Breasts are soft with colostrum leaking; nipples cracked -U: Uterus is one fingerbreadth below the umbilicus; deviated to right -B: Bladder is palpable; client states she hasn't been up to void yet -B: Bowels have not moved; bowel sounds present; passing flatus -L: Lochia is moderate; peripad soaked from night accumulation -E: Episiotomy site intact; swollen, bruised; hemorrhoids present -E: Extremities; no edema over tibia, no warmth or tenderness in calf -E: Emotional status is "distressed" as a result of discomfort and fatigue

BP assessment for newborns

-Blood pressure is not usually assessed as part of a normal newborn examination unless there is a clinical indication or low Apgar scores. -If assessed, an oscillometer (Dinamap) is used. -The typical range is 50 to 75 mm Hg (systolic) and 30 to 45 mm Hg (diastolic). -Crying, moving, and late clamping of the umbilical cord will increase systolic pressure

Anatomy and physiology of newborn thermoregulation

-Body temperature is maintained through a flexed posture and brown fat -elated to the newborn's rate of metabolism and oxygen consumption

Nutrition recommendations for breastfeeding mothers

-Calories: +500 cal/day for the first and second 6 months of lactation -Protein: +20 g/day, adding an extra 2 cups of skim milk -Calcium: +400 mg daily—consumption of four or more servings of milk -Iodine: 290 μg daily—dairy products, seafood and iodized salt -Fluid: +2 to 3 quarts of fluids daily (milk, juice, or water); no sodas

Commination's of FHR patterns

-Category II and III patterns are more significant if they are mixed, persist for long periods, or have frequent prolonged late decelerations, absent or minimal variability, bradycardia or tachycardia, and prolonged variable decelerations lower than 60 bpm -likelihood of fetal compromise is increased if Category II and III patterns are associated with decreased baseline variability or abnormal contraction patterns

Effacement calculations

-Cervical canal 2 cm in length would be described as 0% effaced. -Cervical canal 1 cm in length would be described as 50% effaced. -Cervical canal 0 cm in length would be described as 100% effaced

Summary of fetal to neonatal circulation changes

-Clamping umbilical cord at birth eliminates the placenta as a reservoir for blood. -Onset of respirations causes a rise in PO2 in the lungs and a decrease in pulmonary vascular resistance, which... -Increases pulmonary blood flow and increases pressure in the left atrium, which... *Decreases pressure in the right atrium of the heart, which causes closure of the foramen ovale (closes within minutes after birth secondary to a decreased pulmonary vascular resistance and increased left heart pressure). *With an increase in oxygen levels after the first breath, an increase in systemic vascular resistance occurs, which... *Decreases vena cava return, which reduces blood flow in the umbilical vein (constricts, becomes a ligament with functional closing). *Closure of the ductus venosus (becomes a ligament) causes an increase in pressure in the aorta, which forces closure of the ductus arteriosus within 10 to 15 hours after birth.

Japanese American cultural influence postpartum

-Cleanliness and protection from cold are essential components of newborn care. Nurses should bathe the infant daily. -Newborns routinely are not taken outside the home because it is believed that they should not be exposed to outside or cold air. Infants should be kept in a quiet, clean, warm place for the first month of life. -Breast-feeding is the primary method of feeding. -Many women stay in their parents' home for 1 to 2 months after birth. -Bathing the infant can be the center of family activity at home.

Moro reflex

-aka: the embrace reflex -occurs when the neonate is startled. -The newborn will throw the arms outward and flex the knees; the arms then return to the chest. -The fingers also spread to form a C shape. -The newborn initially appears startled and then relaxes to a normal resting position

Interventions during the third stage of labor

-Describing the process of placental separation to the couple -Instructing the woman to push when signs of separation are apparent -Administering an oxytocic agent if ordered and indicated after placental expulsion -Providing support and information about episiotomy and/or laceration if applicable -Cleaning and assisting client into a comfortable position after birth, making sure to lift both legs out of stirrups (if used) simultaneously to prevent strain -Assess the woman's knowledge of breast-feeding to determine educational needs -Instruct her about latching on, positioning, infant sucking and swallowing -Repositioning the birthing bed to serve as a recovery bed if applicable -Assisting with transfer to the recovery area if applicable -Providing warmth by replacing warmed blankets over the woman -Applying an ice pack to the perineal area to provide comfort to episiotomy if indicated -Explaining what assessments will be carried out over the next hour and offering positive reinforcement for actions -Ascertaining any needs -Monitoring maternal physical status (vaginal bleeding, vital signs, fundus) -Recording all birthing statistics and securing primary caregiver's signature -Documenting birthing event in the birth book (official record of the facility that outlines every birth event), detailing any deviations

Galactosemia

-Description: Absence of the enzyme needed for the conversion of the milk sugar galactose to glucose -Symptoms: Poor weight gain, vomiting, jaundice, mood changes, loss of eyesight, seizures, and intellectual disability; if untreated, galactose buildup causing permanent damage to the brain, eyes, and liver, and eventually death -Treatment: Eliminate milk from diet; substitute soy milk -Timing of testing: First test done on discharge from the hospital with a follow-up test within 1 mo

PKU

-Description: Autosomal recessive inherited deficiency in one of the enzymes necessary for the metabolism of phenylalanine to tyrosine—essential amino acids found in most foods -Symptoms: Irritability, vomiting of protein feedings, and a musty odor to the skin or body secretions of the newborn; if not treated, mental and motor retardation, seizures, microcephaly, and poor growth and development -Treatment: Lifetime diet of foods low in phenylalanine (low protein) and monitoring of blood levels; special newborn formulas available: Phenex and Lofenalac -Timing for screening: Universally screened for in the United States; testing is done 24-48 hours after protein feeding (PKU)

Congenital hypothyroidism

-Description: Deficiency of thyroid hormone necessary for normal brain growth, calorie metabolism, and development; may result from maternal hypothyroidism -Symptoms: Deficiency of thyroid hormone necessary for normal brain growth, calorie metabolism, and development; may result from maternal hypothyroidism -Treatment: Lifelong thyroid replacement therapy -Timing of screening: Testing (measures thyroxin [T4] and TSH) is done between days 4 and 6 of life

Sickle cell anemia

-Description: Recessively inherited abnormality in hemoglobin structure, most commonly found in African American newborns -Symptoms: Anemia developing shortly after birth; increased risk for infection, growth restriction, vaso-occlusive crisis -Treatment: Maintenance of hydration and hemodilution, rest, electrolyte replacement, pain management, blood replacement, and antibiotics -Timing of testing: Bloodspot obtained at same time of other newborn screening tests or prior to 3 months of age

Pelvic measurements to ensure adequacy of the pelvic outlet for vaginal birth

-Diagonal conjugate of the inlet -Transverse or ischial tuberosity diameter of the outlet -True or obstetric conjugate *If the diagonal conjugate measures at least 11.5 cm and the true or obstetric conjugate measures 10 cm or more, then the pelvis is large enough for a vaginal birth of what would be considered a normal-size newborn.

Complications related to difficulty voiding postpartum

-Difficulty voiding can lead to urinary retention, bladder distention, and ultimately urinary tract infection. -Urinary retention and bladder distention can cause displacement of the uterus from the midline to the right and can inhibit the uterus from contracting properly; increases the risk of postpartum hemorrhage. -Urinary retention is a major cause of uterine atony, which allows excessive bleeding. -Frequent voiding of small amounts (less than 150 mL) suggests urinary retention with overflow, and catheterization may be necessary to empty the bladder to restore tone.

Nursing interventions to help maintain body temperature include

-Dry the newborn immediately after birth to prevent heat loss through evaporation. -Wrap the baby in warmed blankets to reduce heat loss via convection. -Skin-to-skin contact with mother as soon as stabilized. -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

Interventions that prevent heat loss through evaporation

-Drying newborns immediately after birth with warmed blankets and placing a cap on their head will help to prevent heat loss through evaporation. -drying the newborn after bathing will help prevent heat loss through evaporation. - Promptly changing wet linens, clothes, or diapers will also reduce heat loss and prevent chilling.

Glomerular filtration rate & Renal plasma flow changes postpartum

-During pregnancy, the glomerular filtration rate and renal plasma flow increase significantly -both Gradually return to normal by 6 weeks *gradual return of bladder tone and normal size and function of the bladder, ureters, and renal pelvis, all of which were dilated during pregnancy

Uterine decent after birth

-During the first few days after birth, the uterus typically descends from the level of the umbilicus at a rate of 1 cm (1 fingerbreadth) per day. -By 3 days, the fundus lies 2 to 3 fingerbreadths below the umbilicus (or slightly higher in multiparous women). -By the end of 10 days, the fundus usually cannot be palpated because it has descended into the true pelvis.

Postpartum assessment timing

-During the first hour: every 15 minutes -During the second hour: every 30 minutes -During the first 24 hours: every 4 hours -After 24 hours: every 8 hours *typically includes vital signs, pain level, epidural site inspection for infection, and a systematic head-to-toe review of body systems **assess woman and the family for psych

Postpartum danger signs during assessment

-Fever more than 100.4° F (38° C) -Foul-smelling lochia or an unexpected change in color or amount -Large blood clots, or bleeding that saturates a peripad in an hour -Severe headaches or blurred vision -Visual changes, such as blurred vision or spots, or headaches -Calf pain with dorsiflexion of the foot -Swelling, redness, or discharge at the episiotomy, epidural, or abdominal sites -Dysuria, burning, or incomplete emptying of the bladder -Shortness of breath or difficulty breathing without exertion -Depression or extreme mood swings

Assessing for any perineal trauma

-Firm fundus with bright-red blood trickling: laceration -Boggy fundus with red blood flowing: uterine atony -Boggy fundus with dark blood and clots: retained placenta

Signs of placental separation

-Firmly contracting uterus -Change in uterine shape from discoid to globular ovoid -Sudden gush of dark blood from vaginal opening -Lengthening of umbilical cord protruding from vagina

Anatomy and physiology of fetal respiratory system

-Fluid-filled, high-pressure system causes blood to be shunted from the lungs through the ductus arteriosus to the rest of the body

Practices to promote self care postpartum

-Frequently change perineal pads, applying and removing them from front to back -Avoid using tampons after giving birth to decrease the risk of infection. -Shower once or twice daily using a mild soap. -Avoid using soap on nipples. -Use a sitz bath after every bowel movement to cleanse the rectal area and relieve enlarged hemorrhoids. -Use the peribottle filled with warm water after urinating and before applying a new perineal pad. -Avoid tub baths for 4 to 6 weeks, until joints and balance are restored, to prevent falls. -Wash your hands before changing perineal pads, after disposing of soiled pads, and after voiding

MyPlate recommendations for lactating women

-Fruits: 4 servings -Vegetables: 4 servings -Milk: 4 to 5 servings -Bread, cereal, pasta: 12 or more servings -Meat, poultry, fish, eggs: 7 servings -Fats, oils, and sweets: 5 servings

General guidelines for Americans from MyPlate (nonlactating women)

-Fruits: Make half of your plate fruits and vegetables. -Vegetables: Eat red, orange, and dark-green vegetables. -Milk: Switch to skim milk or 1%. -Breads, grains, and cereals should be whole grains. -Meat, poultry, fish, eggs: Eat seafood twice a week and beans, which are high in fiber. -Eat the right amount of calories for you; enjoy your food, but eat less. -Be physically active your way in activities that you enjoy. -Fats, oils, and sweets: Cut back on these. -Use food labels to help you make better choices

Hep B vaccine for newborns

-Give VIS sheet -Verify parental consent is signed -Series of 3 IM injections: Ideally given at birth, 1 month, and 6 months; Series should be completed by 18 months of life *If mother is HbsAG positive, HEP B, Vaccine and HBiG is given within 12 hours

Early effects of glucose on the newborn

-Glucose is the main source of energy for the first several hours after birth. -With the newborn's increased energy needs after birth, the liver releases glucose from glycogen stores for the first 24 hours. -Initiating early breast-feeding or bottle feeding helps to stabilize the newborn's blood glucose levels. -No evidence supports universal invasive routine measurement of glucose in healthy term newborns.

Filipino American cultural influence postpartum

-Grandparents often assist in the care of their grandchildren. -Breast-feeding is encouraged, and some mothers breast-feed their children for up to 2 years. -Women have difficulty discussing birth control and sexual matters. -Strong religious beliefs prevail and bedside prayer is common. -Families are very close-knit and numerous visitors can be expected at the hospital after childbirth.

Contraindications to breastfeeding

-HIV disease -galactosemia -radiation or chemotherapy -use of social drugs -active herpes lesions on breast

Fetal tachycardia

-HR >160 and lasts 10 + minutes -can represent an early compensatory response to asphyxia -Fetal tachycardia is considered an ominous sign if it is accompanied by a decrease in variability and late decelerations

Vital sign assessment for newborn: HR

-HR and RR assessed immediately after birth with Apgar scoring. -HR obtained by taking an apical pulse for 1 full minute -should be 110-160

Frequency of HR and RR assessment for a newborn

-Heart and respiratory rates are usually assessed every 30 minutes until stable for 2 hours after birth. -Once stable, the heart rate and respiratory rates are checked every 8 hours. -These assessment time frames may vary per hospital protocols, so nurses should follow the facility's procedures

Maternal physiologic response to labor

-Heart rate increases by 10 to 20 bpm. -Cardiac output increases by 12% to 31% during the first stage of labor and by 50% during the second stage of labor. -Blood pressure increases by up to 35 mm Hg during uterine contractions in all labor stages. -The white blood cell count increases to 25,000 to 30,000 cells/mm3, perhaps as a result of tissue trauma. -Respiratory rate increases and more oxygen is consumed related to the increase in metabolism. -Gastric motility and food absorption decrease, which may increase the risk of nausea and vomiting during the transition stage of labor. -Gastric emptying and gastric pH decrease, increasing the risk of vomiting with aspiration. -Temperature rises slightly, possibly due to an increase in muscle activity. -Muscular aches/cramps occur as a result of the stressed musculoskeletal system. -Basal metabolic rate increases and blood glucose levels decrease because of the stress of labor

Applications of heat and cold

-Heat is typically applied to the woman's back, lower abdomen, groin, and/or perineum -heat is used for pain relief, relieve chills or trembling, decrease joint stiffness, reduce muscle spasm, and increase connective tissue extensibility -Cold/cryotherapy, is usually applied on the woman's back, chest, and/or face during labor

Heel to ear

-How close can the newborn's feet be moved to the ears? -This maneuver assesses hip flexibility: the lesser the flexibility, the greater the newborn's maturity. -The heel-to-ear assessment is scored in the same manner as the scarf sign.

Posture assessment

-How does the newborn hold his or her extremities in relation to the trunk? -The greater the degree of flexion, the greater the maturity. -For example, extension of arms and legs is scored as 0 points and full flexion of arms and legs is scored as 4 points.

Key nursing interventions in the first stage

-Identifying the estimated date of birth from the client and the prenatal chart -Validating the client's prenatal history to determine fetal risk status -Determining fundal height to validate dates and fetal growth -Performing Leopold's maneuvers to determine fetal position, lie, and presentation -Checking FHR -Performing a vaginal examination (as appropriate) to evaluate effacement and dilation progress Instructing the client and her partner about monitoring techniques and equipment -Assessing fetal response and FHR to contractions and recovery time Interpreting fetal monitoring strips -Checking FHR baseline for accelerations, variability, and decelerations -Repositioning the client to obtain an optimal FHR pattern -Recognizing FHR problems and initiating corrective measures -Checking amniotic fluid for meconium staining, odor, and amount -Comforting client throughout testing period and labor -Documenting times of notification for team members if problems arise -Knowing appropriate interventions when abnormal FHR patterns present -Supporting the client's decisions regarding intervention or avoidance of intervention -Assessing the client's support system and coping status frequently

Patience related to labor

-If more time were allowed for women to labor naturally without intervention, the cesarean birth rate would most likely be reduced -using the intervention of patience usually results in less intervention. -Having patience and letting nature take its course will reduce the incidence of physiologic stress in the mother, resulting in less trauma to her perineal tissue.

Cervix changes after birth

-Immediately after childbirth, the cervix is shapeless and edematous and is easily distensible for several days. -gradually closes; typically returns to its prepregnant state by week 6 of the postpartum period; never regains prepregnant appearance -The external cervical os is no longer shaped like a circle, but instead appears as a jagged slit-like opening, often described as a "fish mouth"

Newborn temperature assessment

-In some health care agencies, temperatures are taken immediately after the Apgar score has been taken to allow for identification of hypothermia, which then requires a glucose check -In term newborns, the normal axillary temperature range should be maintained at 97.7° to 99.5° F (36.5° to 37.5° C).

Signs of second stage of labor that need to be assessed

-Increase in apprehension or irritability -Spontaneous rupture of membranes -Sudden appearance of sweat on upper lip -Increase in blood-tinged show -Low grunting sounds from the woman -Complaints of rectal and perineal pressure -Beginning of involuntary bearing-down efforts -contraction frequency, duration, and intensity -maternal vital signs every 5 to 15 minutes -fetal response to labor as indicated by FHR monitor strips -amniotic fluid for color, odor, and amount when membranes are ruptured -the copying status of the woman and her partner

Risks of co-sleeping

-Increases risk for SIDS for infants younger than 4 months -risk of death if parent rolls over the infant -interrupts infant sleeping patterns -risk of asphyxia due to entrapment or airway obstruction -unsafe design of adult beds for infants

Appalachian cultural influence postpartum

-Infant colic is treated by passing the newborn through a leather horse's collar or administering weak catnip tea. -An asafetida bag (a gum resin with a strong odor) is tied around the infant's neck to ward off disease. -Women may avoid eye contact with nurses and health care providers. -Women typically avoid asking questions even though they do not understand directions. -The grandmother may rear the infant for the mother.

Guidlines for assessing FHR

-Initial 10- to 20-minute continuous FHR assessment on entry into labor/birth area -Completion of a prenatal and labor risk assessment on all clients -Intermittent auscultation every 30 minutes during active labor for a low-risk woman and every 15 minutes for a high-risk woman -During the second stage of labor, every 15 minutes for the low-risk woman and every 5 minutes for the high-risk woman and during the pushing stage

Before the newborn's lungs can maintain respiratory function, the following events must occur:

-Initiation of respiratory movement -Expansion of the lungs -Establishment of functional residual capacity (ability to retain some air in the lungs on expiration) -Increased pulmonary blood flow -Redistribution of cardiac output

Breast assessment post partum

-Inspect the breasts for size, contour, asymmetry, engorgement, or erythema. -Check the nipples for cracks, redness, fissures, or bleeding, and note whether they are erect, flat, or inverted -Palpate the breasts for any nodules, masses, or areas of warmth, which may indicate a plugged duct that may progress to mastitis if not treated promptly

Interventions for absent variablity in FHR

-Interventions to improve uteroplacental blood flow and perfusion through the umbilical cord include lateral positioning of the mother, increasing the IV fluid rate to improve maternal circulation, administering oxygen at 8 to 10 L/min by mask, considering internal fetal monitoring, documenting findings, and reporting to the health care provider. -Preparation for a surgical birth may be necessary if no changes occur after attempting the interventions.

Apgar score

-It can be used as a rapid method for assessing the survival of a neonate. -Assessment of the newborn at 1 minute provides data about the newborn's initial adaptation to extrauterine life. -Assessment at 5 minutes provides a clearer indication of the newborn's overall central nervous system status.

Pelvic floor exercises

-Kegels -strengthen the pelvic floor muscles - do 10 x 5sec contractions whenver changing a diaper, on the phone, or watching TV *avoid the term incontinent. The terms leakage, loss of urine, or bladder control issues are more acceptable to most women

Most common fetal position

-LOA is the most common (and most favorable) fetal position for birthing today, followed by right occiput anterior (ROA). -The positioning of the fetus allows the fetal head to contour to the diameters of the maternal pelvis. -LOA and ROA are optimal positions for a vaginal birth. *occiput posterior position may lead to a long and difficult birth, and other positions may or may not be compatible with vaginal birth.

Psychological response to labor

-Labor influences a woman's self-confidence, self-esteem, and view of life, relationships, and children -strong sense of self and meaningful support from others helps manage labor -safety and security promote sense of control and ability to withstand challanges

Abnormal laceration/episiotomy inspections

-Large areas of swollen, bluish skin with complaints of severe pain in the perineal area indicate pelvic or vulvar hematomas. -Redness, swelling, increasing discomfort, or purulent drainage may indicate infection. **Both findings need to be reported immediately. -A white line running the length of the episiotomy is a sign of infection, as is swelling or discharge. -Severe, intractable pain, perineal discoloration, and ecchymosis indicate a perineal hematoma, a potentially dangerous condition.

Newborns classification by birth weight (regardless of their gestational age as follows)

-Low birth weight: >2,500 g (>5.5 lb) -Very low birth weight: >1,500 g (>3.5 lb) -Extremely low birth weight: >1,000 g (>2.5 lb)

Initial nursing interventions at birth

-Maintain airway -Ensure proper ID -Med Admin: Vit K, erythromycin

Voiding postpartum

-Many women have difficulty feeling the sensation to void after giving birth if they received an anesthetic block during labor (which inhibits neural functioning of the bladder) or if they received oxytocin to induce or augment their labor (antidiuretic effect).

Attachment behaviors

-Maternal attachment begins during pregnancy as the result of fetal movement and maternal fantasies about the infant and continues through the birth and postpartum periods -behaviors include seeking, physical caretaking behaviors, emotional attentiveness to infant's needs, staying close to, touching, kissing, cuddling, choosing the en face (face-to-face) position while holding or feeding the newborn, expressing pride in the newborn and exchanging gratifying experiences with the infant

Benefits of moving around during labor

-Maternal position can influence pelvic size and contours. -Changing position and walking affect the pelvis joints, which may facilitate fetal descent and rotation. -Squatting enlarges the pelvic inlet and outlet diameters, whereas a kneeling position removes pressure on the maternal vena cava and helps to rotate the fetus from a posterior position to an anterior one to facilitate birth

Common Abnormalities in Head or Fontanel Size

-Microcephaly -Macrocephaly -Large fontanels -Small or closed fontanels

Muslim cultural influence postpartum

-Modesty is a primary concern; nurses need to protect the client's modesty. -Muslims are not permitted to eat pork; check all food items before serving. -Muslims prefer a same-sex health care provider; male-female touching is prohibited except in an emergency situation. -A Muslim woman stays in the house for 40 days after birth, being cared for by the female members of her family. -Most women will breast-feed, but religious events call for periods of fasting, which may increase the risk of dehydration or malnutrition. -Women are exempt from obligatory five-times-daily prayers as long as lochia is present. -Extended family is likely to be present throughout much of the woman's hospital stay. They will need an empty room to perform their prayers without having to leave the hospital.

Interventions for promoting tissue integrity

-Monitor episiotomy site for redness, edema, warmth or discharge to identify infection. -Assess vital signs at least every 4 hours to identify changes suggesting infection. -Apply ice pack to episiotomy site to reduce swelling. -Instruct client on use of sitz bath to promote healing, hygiene, and comfort. -Encourage frequent perineal care and peripad changes to prevent infection. -Recommend ambulation to improve circulation and promote healing. -Instruct client on positioning to relieve pressure on perineal area. -Demonstrate use of anesthetic sprays to numb perineal area.

Criteria for discharge postpartum

-Mother is afebrile and vital signs are within normal range. -Lochia is appropriate amount and color for stage of recovery. -Hemoglobin and hematocrit values are within normal range. -Uterine fundus is firm; urinary output is adequate. -ABO blood groups and RhD status are known; rhogam given -Surgical wounds are healing and no signs of infection are present. -Mother is able to ambulate without difficulty. -Food and fluids are taken without difficulty. -Self-care and infant care are understood and demonstrated. -Family or other support system is available to care for both. -Mother is aware of possible complications

African American cultural influence postpartum

-Mother may share care of the infant with extended family members. -Experiences of older women within the family influence infant care. -Mothers may protect their newborns from strangers for several weeks. -Mothers may not bathe their newborns for the first week. Oils are applied to skin and hair to prevent dryness and cradle cap. -Silver dollars may be taped over the infant's umbilicus in an attempt to flatten the slightly protruding umbilical stump. -Sleeping with parents is a common practice.

Signs that may indicate a problem in a newborn's initial assessment

-Nasal flaring -Chest retractions -Grunting on exhalation -Labored breathing -Generalized cyanosis -Abnormal breath sounds: rhonchi, crackles (rales), wheezing, and stridor -Abnormal respiratory rates (tachypnea, more than 60 breaths/minute; bradypnea, less than 25 breaths/minute) -Flaccid body posture -Pallor -Apneic episodes -Abnormal heart rates (tachycardia, more than 160 bpm; bradycardia, less than 100 bpm)

Stage 1: Expectations

-New partners pass through stage 1 with preconceptions about what home life will be like with a newborn. -Many partners may be unaware of the dramatic changes that can occur when this newborn comes home to live with them. -an eye-opening experience.

Renal system development at birth

-Newborn kidneys are immature and unable to concentrate urine well or to excrete drugs well; Risk for dehydration, overhydration, electrolyte imbalances, drug toxicity. -Diuresis in the newborn results in a birthweight loss of 5 - 10% during the first week of life. -The birthweight should be regained by week

Newborns and hypoglycemia

-Newborns Optimal plasma glucose range is 70 - 100 mg/dL -Intervention is needed if Blood glucose level is less than 40 mg/dL. -If a newborn is showing signs of hypoglycemia, nurse performs a heel stick and uses Accucheck to check the level. -During intrauterine life, newborns of diabetic mothers produce higher levels of insulin in response to maternal glucose.; Consequently, at birth, the newborn's insulin level is high, which leads to hypoglycemia.

Vital sign assessment for newborn: Respirations

-Newborns' respirations are assessed when they are quiet or sleeping. -Place a stethoscope on the right side of the chest and count the breaths for 1 full minute to identify any irregularities. -The newborn respiratory rate is 30 to 60 breaths/minute with symmetric chest movement.

Interventions for category 3 patterns

-Notify the health care provider about the pattern and obtain further orders, making sure to document all interventions and their effects on the FHR pattern. -Discontinue oxytocin or other uterotonic agent as dictated by the facility's protocol, if it is being administered. -Turn the client on her left or right lateral, knee-chest, or hands and knees to increase placental perfusion or relieve cord compression. -Administer oxygen via nonrebreather face mask to increase fetal oxygenation. -Increase the intravenous fluid rate to improve intravascular volume and correct maternal hypotension. -Assess the client for any underlying contributing causes. -Provide reassurance that interventions are to effect pattern change. -Modify pushing in the second stage of labor to improve fetal oxygenation. -Document any and all interventions and any changes in FHR patterns. -Prepare for an expeditious surgical birth if the pattern is not corrected in 30 minutes.

Landmark fetal presenting parts

-Occipital bone (O); designates a vertex presentation -Chin/mentum (M); designates a face presentation -Buttocks/sacrum (S); breech position -Scapula/acromion process *A); shoulder presentation

Risk Factors for Postpartum Infection

-Operative procedure (forceps, cesarean birth, vacuum extraction) -History of diabetes, including gestational-onset diabetes -Prolonged labor (more than 24 hours) -Use of indwelling urinary catheter -Anemia (hemoglobin < 10.5 mg/dL) -Multiple vaginal examinations during labor -Prolonged rupture of membranes (>24 hours) -Manual extraction of placenta -Compromised immune system (HIV positive)

Categories for systemic analgesia

-Opioids: butorphanol (Stadol), nalbuphine (Nubain), meperidine (Demerol), morphine, or fentanyl (Sublimaze) -Ataractics: hydroxyzine (Vistaril), promethazine (Phenergan), or prochlorperazine (Compazine) -Benzodiazepines: diazepam (Valium) or midazolam (Versed)

Spontaneous Rupture of Membranes during labor

-PROM; occurs in 8-10% of women with term pregnancy -results in sudden gush or a steady leakage of amniotic fluid -a continuous supply of amniotic fluid is produced to ensure protection of the fetus until birth

Postpartum voiding sensation may be affected by:

-Perineal lacerations -Generalized swelling and bruising of the perineum and tissues surrounding the urinary meatus -Hematomas -Decreased bladder tone as a result of regional anesthesia -Diminished sensation of bladder pressure as a result of swelling, poor bladder tone, and numbing effects of regional anesthesia used during labor

Acrocyanosis

-Persistent cyanosis of fingers, hands, toes, and feet with mottled blue or red discoloration and coldness -It may be seen in newborns during the first few weeks of life in response to exposure to cold. -it is normal and intermittent. -Any change in color of the newborn skin needs further investigation.

Circumcision and penis care

-Petroleum jelly (Coated gauze) should be applied to the circumcised area after the procedure is done with the Gomco or Mogen clamp -with the Hollister Plastibell method, the plastic rim remains in place until healing occurs. The plastic ring typically loosens and falls off in approximately 1 week *If the newborn is uncircumcised, wash the penis with mild soap and water after each diaper change and do not force the foreskin back; it will retract normally over time.

Risk Factors for Postpartum Hemorrhage

-Precipitous labor (less than 3 hours) -Uterine atony -Placenta previa or abruptio placenta -Labor induction or augmentation -Operative procedures (vacuum extraction, forceps, cesarean birth) -Retained placental fragments -Prolonged third stage of labor (more than 30 minutes) -Multiparity, more than three births closely spaced -Uterine over distention (large infant, twins, hydramnios)

Maternal symptoms during transition phase

-Pressure on the rectum is great, and there is a strong desire to contract the abdominal muscles and push. -nausea and vomiting -trembling extremities -backache -increased apprehension and irritability -restless movement -increased bloody show from the vagina -inability to relax -diaphoresis -feelings of loss of control -being overwhelmed; "I can't take it anymore"

Maternal psychological response allowing them to adapt to labor

-Previous birth experiences and their outcomes (complications and previous birth outcomes) -Current pregnancy experience (planned versus unplanned, discomforts experienced, age, risk status of pregnancy, chronic illness, weight gain) -Cultural considerations (values and beliefs about health status) -Support system (presence and support of a valued partner during labor) -Childbirth preparation (attended childbirth classes and has practiced paced breathing techniques) -Exercise during pregnancy (muscles toned; ability to assist with intra-abdominal pushing) -Expectations of the birthing experience (viewed as a meaningful or stressful event) -Anxiety level (excessive anxiety may interfere with labor progress) -Fear of labor and loss of control (fear may enhance pain perception, augmenting fear) -Fatigue and weariness (not up for the challenge/duration of labor)

Vagina changes after birth

-Shortly after birth, the vaginal mucosa is edematous and thin, with few rugae -As ovarian function returns and estrogen production resumes, the mucosa thickens and rugae return in approximately 3 weeks. -The vagina returns to its approximate prepregnant size by 6 to 8 weeks postpartum -will always remain a bit larger than it had been before pregnancy. -Normal mucus production and thickening of the vaginal mucosa usually return with ovulation. -By 3 to 4 weeks, the edema and vascularity have decreased. -Localized dryness and coital discomfort (dyspareunia) usually plague most women until menstruation returns. -Water-soluble lubricants can reduce discomfort during intercourse.

Nursing interventions to limit cold stress and maintain NTE

-Prewarming blankets and hats to reduce heat loss through conduction -Keeping the infant transporter (warmed isolette) fully charged and heated at all times -Drying the newborn completely after birth to prevent heat loss from evaporation -Encouraging skin-to-skin contact with the mother if the newborn is stable -Promoting early breast-feeding to provide fuels for nonshivering thermogenesis -Using heated and humidified oxygen -Always using radiant warmers and double-wall isolettes to prevent heat loss from radiation -Deferring bathing until the newborn is medically stable, and using a radiant heat source while bathing -Avoiding the placement of a skin temperature probe over a bony area or one with brown fat, because it does not give an accurate assessment of the whole body temperature (most temperature probes are placed over the liver when the newborn is supine or side-lying)

Benefits of co-sleeping

-Promotes breast-feeding practices -increases bonding time between the infant and mother -promotes skin-to-skin contact -increases maternal vigilance over infant.

Nursing interventions for promoting effective coping

-Provide a supportive, nurturing environment and encourage the mother to vent her feelings and frustrations to relieve anxiety. -Provide opportunities for the mother to rest and sleep to combat fatigue. -Encourage the mother to eat a well-balanced diet to increase her energy level. -Provide reassurance and explanations that mood alterations are common after birth secondary to waning hormones after pregnancy to increase the mother's knowledge. -Allow the mother relief from newborn care to afford opportunity for self-care. -Discuss with partner expected behavior from mother and how additional support and help are needed during this stressful time to promote partner's participation in care. -Make appropriate community referrals for mother-infant support to ensure continuity of care. -Encourage frequent skin-to-skin contact and closeness between mother and infant to facilitate bonding and attachment behaviors. -Encourage client to participate in infant care and provide instructions as needed to foster a sense of independence and self-esteem. -Offer praise and reinforcement of positive mother-infant interactions to enhance self-confidence in care.

Orientation

-RESPONSE of newborns to auditory and visual stimuli -movement of head and eyes toward the focus of the stimulation. -become more alert when they sense a new stimulus -Prefer human faces and bright, shiny objects and will stare at it. -use this sensory capacity to become familiar with people and objects in their surroundings

Postpartum Diuresis

-Rapid filling of the bladder within 12 hours after birth -Last throughout the first postpartum week -Gradual return to normal emptying time within a month

Breast care postpartum

-Regardless of whether or not the mother is breast-feeding her newborn, urge her to wear a very supportive, snug bra 24 hours a day to support enlarged breasts and promote comfort -use plain water to clean their breasts; avoid soap

Cardiac output changes postpartum

-Remains the same for the first few days -deceases to prelabor values 24 to 72 hours postpartum, rapidly falls over the next two weeks -usually returns to nonpregnant levels within 3 months postpartum. *decrease in cardiac output is reflected in bradycardia first 2 weeks postpartum

Prelabor rupture of membranes (PROM)

-Rupture of membranes with loss of amniotic fluid prior to the onset of labor

Criteria needed for internal monitoring

-Ruptured membranes -Cervical dilation of at least 2 cm -Presenting fetal part low enough to allow placement of the scalp electrode -Skilled practitioner available to insert spiral electrode

Lochia amount descriptions

-Scant: a 1- to 2-in lochia stain on the perineal pad or approximately a 10-mL loss -Light or small: an approximately 4-inch stain or a 10- to 25-mL loss -Moderate: a 4- to 6-in stain with an est -Large or heavy: a pad is saturated within 1 hour after changing it -Women who had a c-section will have less lochia discharge than those who had a vaginal birth, but stages and color changes remain the same

Identification process for the newbord

-Secure two identification bands on the newborn's wrist and ankle that match the band on the mother's wrist to ensure the newborn's identity. -completed in the birthing suite before anyone leaves the room. -Some health care agencies also take an early photo of the newborn for identification in the event of abduction

Guidelines for newborn bathing

-Select a warm room with a flat surface at a comfortable working height. -Before the bath, gather all supplies needed so they will be within reach. -Never leave the newborn alone or unattended at any time during the bath. -Undress the newborn down to shirt and diaper. -Always support the newborn's head and neck when moving or positioning him or her. -Place a blanket or towel underneath the newborn for warmth and comfort. -In this order, progressing from the cleanest to the dirtiest areas: 1. Wipe eyes with plain water, using either cotton balls or a washcloth; Wipe from the inner corner of the eyes to the outer with separate wipes. 2. Wash the rest of the face, including ears, with plain water. 3. Using baby shampoo, gently wash the hair and rinse with water. 4. Pay special attention to body creases, and dry thoroughly. 5. Wash extremities, trunk, and back. Wash, rinse, dry, cover. 6. Wash diaper area last, using soap and water, and dry; observe for rash. -Put on a clean diaper and clean clothes after the bath.

Factors associated with the health care facility or birthing unit that hinder attachment

-Separation of infant and parents immediately after birth and for long periods during the day -Policies that discourage unwrapping and exploring the infant -Intensive care environment, restrictive visiting policies -Staff indifference or lack of support for parent's caretaking attempts and abilities

Diastasis recti

-Separation of the rectus abdominis muscles -more common in women who have poor abdominal muscle tone before pregnancy -responds well to exercise, and abdominal muscle tone can be improved

Using the information about gestational age and then considering birth weight, newborns can also be classified as follows:

-Small for gestational age (SGA)—weight less than the 10th percentile on standard growth charts (usually >5.5 lb) -Appropriate for gestational age (AGA)—weight between 10th and 90th percentiles -Large for gestational age (LGA)—weight more than the 90th percentile on standard growth charts (usually >9 lb)

Focus of nurse during fourth stage of labor

-frequent close observation for hemorrhage -provision of comfort measures -promotion of family attachment.

Suggestions to prevent stress incontinence

-Start a regular program of pelvic floor muscle exercises after childbirth. -Lose weight if necessary; obesity is associated with stress incontinence. -Avoid smoking; limit intake of alcohol and caffeinated beverages, which irritate the bladder. -Adjust fluid intake to produce a 24-hourly urine output of 1,000 to 2,000 mL. -Use either an intravaginal or intra-urethral device that puts pressure onto the urethra so that urine will not leak when bladder pressure rises

Effects of Cold Stress in the Newborn's Brown Fat Metabolism

-The newborn first experiences an increase in norepinephrine in response to a cold environment. -This then influences the triglycerides to stimulate brown fat metabolism. -Cardiac output increases, increasing blood flow through the brown fat tissue. -Subsequently, this blood becomes warmed as a result of the increased metabolic activity of the brown fat

Mexican American cultural influence postpartum

-The newborn's grandmother lives with the mother for several weeks after birth to help with housekeeping and child care. -Most women will breast-feed for more than 1 year. The infant is carried in a rebozo (shawl) that allows easy access for breast-feeding. -Women may avoid eye contact and may not feel comfortable being touched by a stranger. -Nurses need to respect this feeling. -Some women may bring religious icons to the hospital and may want to display them in their room.

Plantar grasp

-The plantar grasp is similar to the palmar grasp. -Place a finger just below the newborn's toes. -The toes typically curl over the finger

The signs of separation that indicate the placenta is ready to delivery

-The uterus rises upward. -The umbilical cord lengthens. -A sudden trickle of blood is released from the vaginal opening. -The uterus changes its shape to globular.

Signs of DVT

-The woman may report lower extremity tightness or aching when ambulating that is relieved with rest and elevation of the leg. -Edema in the affected leg (typically the left), along with warmth and tenderness, and a low-grade fever may also be noted.

Uterine contraction purposes

-Thinning and dilating cervix -thrust the presenting part toward lower segment

Self-Quieting Ability

-This is the newborns' ability to sooth and comfort or console themselves. -Hand to mouth movements, sucking, focusing on stimuli, and motor acticity -This can be helped along by parents (5s's)

Mechanical stimuli to initiate respirations

-Thorax is compressed during birth - BIG SQUEEZE forces amniotic fluid out of lungs. -Next, the chest recoils and negative pressure is created - air enters alveoli in lungs - more fluid is forced out. -The newborn's crying creates intrathoracic positive pressure - the alveoli remain open. -Surfactant (a phospholipid) MUST be present for alveoli to remain open.

Interventions for providing pain relief postpartum

-Thoroughly inspect perineum to rule out hematoma as cause of pain. -Administer analgesic medication as ordered as needed to promote comfort. -Carry out comfort measures to episiotomy as outlined earlier to reduce pain. -Explain discomforts and reassure the client that they are time limited to assist in coping with pain. -Apply Tucks® to swollen hemorrhoids to induce shrinkage and reduce pain. -Suggest frequent use of sitz bath to reduce hemorrhoid pain. -Administer stool softener and laxative to prevent straining with first bowel movement. -Observe positioning and latching-on technique while breast-feeding. Offer suggestions based on observations to correct positioning/latching on to minimize trauma to the breast. -Suggest air-drying of nipples after breast-feeding and use of plain water to prevent nipple cracking. -Teach relaxation techniques when breast-feeding to reduce anxiety and discomfort.

Abdominal muscle changes postpartum

-Tone is diminished -soft and flabby ab muscles ***If rectus muscle tone is not regained through exercise, support may not be adequate during future pregnancies.

Analgesics for postpartum comfort

-Tylenol or NSAIDs -narcotics for severe pain -Common adverse effects of oral analgesics include dizziness, light-headedness, nausea and vomiting, constipation, and sedation *inform woman drugs are excreted in breastmilk (Tylenol and NSAIDs are considered safe -administer meds 1 hour after breastfeeding to control perineal pain

Sex postpartum

-Typically, sexual intercourse can be resumed once bright-red bleeding has stopped and the perineum is healed from an episiotomy or lacerations -typically 3-6 wks

Nursing interventions to limit heat loss through conduction

-Using a warmed cloth diaper or blanket to cover any cold surface touching a newborn directly helps to prevent heat loss through conduction. -Placing the newborn skin-to-skin with the mother also helps prevent heat loss through conduction.

Subinvolution of the uterus

-Uterus remains enlarged with continued lochial discharge which may result in postpartum hemorrhage -result of retained placental fragments or infection

Newborn carbohydrate metabolism

-When the placenta is lost at birth, the maternal glucose supply is cut off; newborns serum glucose declines -term newborn has a blood glucose 70-80 of maternal BG -hypoglycemia is frequently encountered; Blood glucose lower in first 2 days of life -It is essential that regular feeding takes place

Native American cultural influence postpartum

-Women are secretive about pregnancies and do not reveal them early. -Touching is not a typical female behavior and eye contact is brief. -They resent being hurried and need time for sitting and talking. -Most mothers breast-feed and practice birth control.

Amish cultural influence postpartum

-Women consider childbearing their primary role in society. -They generally oppose birth control. -Pregnancy and childbirth are considered a private matter; they may conceal it from public knowledge. -Women typically do not respond favorably when hurried to complete a self-care task. Nurses need to take cues from women indicating their readiness to complete morning self-care activities.

Maternal position and labor

-Women should be encouraged to assume any position of comfort for them -the "peanut shaped" ball has been show to promote vaginal delivery *If the only furniture provided is a bed, this is what the woman will use. -Furnishing rooms with comfortable chairs, beanbags, and other birth props allows a woman to choose from a variety of positions and to be free to move during labor.

Station recordings

-Zero (0): when presenting part is at the level of the maternal ischial spines -when presenting part is above ischial spine, distance is a minus station -when presenting portion is below ischial spine, distance is recorded as a plus *If progressive fetal descent does not occur, a disproportion between the maternal pelvis and the fetus might exist and needs to be investigated

Doula

-a WOMAN who offers emotional and practical support to a mother or couple before, during, and after childbirth -believes in "mothering the mother," but clinical support remains the job of the midwife or medical staff

Partner

-a partner can be anyone who is present to support the woman throughout the experience

Surfactant

-a surface tension-reducing lipoprotein found in the newborn's lungs that prevents alveolar collapse at the end of expiration and loss of lung volume. -It lines the alveoli to enhance aeration of gas-free lungs, thus reducing surface tension and lowering the pressure required to open the alveoli. -Normal lung function depends on surfactant, which permits a decrease in surface tension at end expiration (to prevent atelectasis) and an increase in surface tension during lung expansion (to facilitate elastic recoil on inspiration). -provides the lung stability needed for gas exchange. -The newborn's first breath, in conjunction with surfactant, overcomes the surface forces to permit aeration of the lungs.

Vernix caseosa

-a thick white substance that protects the skin of the fetus. -It is formed by secretions from the fetus's oil glands and is found during the first 2 or 3 days after birth in body creases and the hair. -It does not need to be removed because it will be absorbed into the skin.

Sinusoidal pattern

-a visually apparent smooth, sinewave-like undulating pattern in the FHR baseline with a cycle frequency of 3 to 5 bpm that persists for >20 minutes -attributed to a derangement of CNS control of FHR and occurs when a severe degree of hypoxia secondary to fetal anemia and hypovolemia is present -always considered a Category III pattern, and to correct it a fetal intrauterine transfusion would be needed

Recommended exercises the first weeks postpartum

-abdominal breathing -head lifts -modified sit-ups -double knee roll -pelvic tilt

Prolonged decelerations

-abrupt FHR declines of at least 15 bpm that last longer than 2 minutes, but less than 10 minutes -rate usually drops to less than 90 bpm. -Prolonged decelerations can be remedied by identifying the underlying cause and correcting it.

Nursing care during first stage of labor

-admission history (reviewing the prenatal record) -checking the results of routine laboratory tests and any special tests such -asking the woman about her childbirth preparation (birth plan, classes taken, coping skills) -completing a physical assessment of the woman to establish baseline values for future comparison.

Combined spinal-epidural

-advantageous because of its rapid onset of pain relief; can last up to 3 hours -allows the woman's motor function to remain active -ability to bear down during the second stage of labor is preserved -allows her to ambulate; walking epidural

Newborn's respiratory system transition from fetal to neonatal life

-aeration of the lungs -establishment of pulmonary gas exchange -changing the fetal circulation into the adult type

Internal rotation

-after engagement, head rotates 45 deg. anteriorly to the midline under the symphysis; internal rotation -brings the anteroposterior diameter of the head in line with the anteroposterior diameter of the pelvic outlet -aligns the long axis of the fetal head with the long axis of the maternal pelvis

Factors that influence mothers' perceptions of their competence/confidence in mothering and their expressions of love for their infants

-age -relationship with the father -socioeconomic status -birth experience -experienced stress -available support -personality traits -self-concept -child-rearing attitudes -role strain -health status -preparation during pregnancy -relationships with own mother -depression and anxiety

Braxton Hicks contractions purpose

-aid in moving the cervix from posterior to anterior -help in ripening ther cervix

Nevus flammeus

-aka port-wine stain -commonly appears on the newborn's face or other body areas -It is a capillary angioma located directly below the dermis. -It is flat with sharp demarcations and is purple red. -This skin lesion is made up of mature capillaries that are congested and dilated. -It ranges in size from a few millimeters to large, occasionally involving as much as half the body surface. -Although it does not grow in area or size, it is permanent and will not fade. -Although they may occur anywhere on the body, the majority are located in the head and neck areas. -Port-wine stains may be associated with structural malformations, bony or muscular overgrowth, and certain cancers. -Recent studies have noted an association between port-wine birthmarks and childhood cancer, so newborns with these lesions should be monitored with periodic eye examinations, neurologic imaging, and extremity measurements. -Lasers and intense pulsed light have been used to remove larger lesions with some success. -The optimal timing of treatment is before 1 year of age

Stork bites

-aka salmon patches -superficial vascular areas found on the nape of the neck, on the eyelids, and between the eyes and upper lip ( -name comes from the marks on the back of the neck where, as myth goes, a stork may have picked up the baby. -They are caused by a concentration of immature blood vessels and are most visible when the newborn is crying. -They are considered a normal variant, and most fade and disappear completely within the first year.

Nevus vasculosus

-aka strawberry mark or strawberry hemangioma -a benign capillary hemangioma in the dermal and subdermal layers. -It is raised, rough, dark red, and sharply demarcated ( -It is commonly found in the head region within a few weeks after birth and can increase in size or number. -They are commonly found in about 10% of children. -This type of hemangioma may be very subtle or even absent in the first few weeks of life, but they proliferate in the first few months of life. -Commonly seen in premature infants weighing less than 1,500 g, these hemangiomas tend to resolve by age 3 without any treatment.

Nurses role in assisting with attachment

-promote early parent interactions -facilitate skin-to-skin contact -Encouraging breast-feeding -encourage nurturing activities and contact such as touching, talking, singing, comforting, changing diapers, feeding

Blinking, sneezing, gagging, and coughing (reflex)

-all protective reflexes and are elicited when an object or light is brought close to the eye (blinking); something irritating is swallowed or a bulb syringe is used for suctioning (gagging and coughing); or an irritant is brought close to the nose (sneezing)

Pelvic inlet

-allows entrance to the true pelvis -wider left to right then front to back -sacral prominence in the back, ilium on each side, and the superior aspect of symphasis pubis in the front

Benefit of delaying maternal "bearing down"

-allows for optimal use of maternal energy, has no detrimental maternal effects, and results in improved fetal oxygenation -try to delay "bearing down" until woman feels the urge -delaying pushing for up to 90 minutes after complete cervical dilation resulted in a significant decrease in the time mothers spend pushing without a significant increase in total time in second stage of labor

Lochia assessment postpartum

-amount, color, odor, and change with activity and time -how many perineal pads she has used in the past 1 to 2 hours and how much drainage was on each pad -Lochia flow will increase when the woman gets out of bed and when she breast-feeds -If excessive bleeding occurs, the first step would be to massage the boggy fundus until it is firm to reduce the flow of blood

Symptoms of partner postpartum depression

-appear 1 to 3 weeks after birth Can include: feelings of being very stressed and anxious, being discouraged, fatigued, resentment toward the infant and the attention he or she is getting, and headaches. -Partners experiencing these symptoms should understand that it is not a sign of weakness and professional help can be helpful for them.

Milk stool

-around day 4 -the stools of the breast-fed newborn are yellow-gold, loose/soft, and stringy to pasty in consistency, and typically sour-smelling; watery and seedy. -The stools of the formula-fed newborn vary depending on the type of formula ingested; They may be yellow, yellow-green, brownish-yellow, or greenish and loose, pasty, or more formed in consistency, drier, and they have an unpleasant odor.

Teaching breast self assessment

-assess daily -assessment includes milk assessment, nipple condition, breast feeding success -palpate for soft or firmness

What interval to assess FHR

-assess every 15-30 minutes in active labor; 5-15 when pushing -assess before and after digital exams membrane rupture, medication administered, and ambulation to the restroom

Extremity assessment post partum

-assess for VTEs -determine the degree of sensory and motor function return (recovery from anesthesia) by asking the woman if she feels sensation at various areas the nurse touches and also by observing her ambulation stability. -use compression boots or stocks; encourage ambulation postpartum to reduce risk of DVT

Purpose of vaginal exam during labor

-assess the cervical dilation, percent effacement, and fetal membrane status -gather information on presentation, position, station, degree of fetal head flexion, presence of fetal skull swelling or molding

Frequency of vital sign assessment

-assessed at birth, within 1 to 4 hours after birth according to hospitl policy. -Vital signs are used for identifying a variety of complications and for ensuring well-being of the newborn.

Stepping reflex

-assessed by holding the newborn upright and inclined forward with the soles of the feet touching a flat surface. -The baby should make a stepping motion or walking, alternating flexion and extension with the soles of the feet

Priority after fetal membrane ruptures

-assessing fetal heart rate (FHR) first to identify a deceleration, which might indicate cord compression secondary to cord prolapse

Nursing interventions to promote voiding

-assume a natural voiding position -pour warm water over perineal area -run tap water -blow bubbles through a straw -warm shower -fluid intake -provide privacy -place hand in water *use a cath if patient does not void in 4-6 hrs

Period of decreased responsiveness

-at 30-120 min of age -sleep period or a decrease in activity -Movements are less jerky and less frequent -Heart and respiratory rates decline -muscles become relaxed, and responsiveness to outside stimuli diminishes. -difficult to arouse or interact with the newborn. -No interest in sucking is shown. -This quiet time can be used for both mother and newborn to remain close and rest together after labor and the birthing experience.

Intermittent FHR monitoring

-auscultation via a fetoscope or a handheld Doppler device -assess a full minute after a contraction; then 30 s thereafter -allows woman to be mobile -does not document how the fetus responds to the stress of labor -used to detect FHR baseline and rhythm and changes from baseline -cannot detect variability and types of decelerations -should be done frequently whenever woman feels changes in condition (membrane rupture, bleeding) -more frequent assessments occur after periods of ambulation, a vaginal examination, administration of pain medications, or other clinically important events

Newborn Length

-average is 20 in; 50 cm -range: 44-55 cm; 17-22 in -measure unclothed on a warm blanket -knees held extended

FHR patterns

-baseline FHR and variability -presence of acceleration -periodic or episodic decelerations -changes or trends of FHR patterns over time -nurse must be able to interpret the various parameters to determine if the FHR pattern is a category 1, 2 or 3

Topical treatments for nipple pain

-beeswax, glycerin-based products, petrolatum, lanolin, and hydrogel products -need to remove before breast feeding -Applying expressed breast milk to nipples and allowing it to dry has been suggested to reduce nipple pain -usually pain is r/t incorrect latch/removal

Second period of reactivity

-begins as the newborn awakens and shows an interest in environmental stimuli -lasts 2 to 8 hours in the normal newborn -HR, and RR inc -Peristalsis inc.; not uncommon to pass meconium or void -motor activity and muscle tone increase in conjunction with an increase in muscular coordination -interaction with mother is encouraged -opportunity for parents to examine newborn and ask questions *Teaching about feeding, positioning for feeding, and diaper-changing techniques can be reinforced during this time

First period of reactivity

-begins at birth and lasts 30 min to 2 hrs -newborn is alert, moving, and may appear hungry -Muscle tone and motor activity are increased -Respiration and heart rate are elevated but gradually begin to slow as the next period begins -period of alertness allows parents to interact with their newborn and to enjoy close contact with their new baby -good opportunity for initiating breast-feeding

Attachment process

-begins before birth, during the prenatal period where acceptance and nurturing of the growing fetus takes place. -It continues after giving birth as parents learn to recognize their newborn's cues, adapt to the newborn's behaviors and responses, and meet their newborn's needs.

Stage 2 (expulsive stage)

-begins when the cervix is completely dilated (10cm) and effaced -ends with birth -this stage involves moving the fetus through the birth canal and out of the body -can last minutes to hours -contractions usually 2-3 minutes apart, 60-90 seconds long; strong by palpation -in nullipara, lasts 1 hr; under half that time in multipara -woman usually feels more in control, less irritated, and focused on pushing -urge to push occurs when fetus contacts pelvis -lasts 3 hours in first labor, and 1 hr in each labor after

Mongolian spots

-benign blue or purple splotches that appear solitary on the lower back and buttocks of newborns, but may occur as multiple over the legs and shoulders -They tend to occur in African American, Asian, Hispanic, and Indian newborns but can occur in dark-skinned newborns of all races. -The spots are caused by a concentration of pigmented cells and usually disappear spontaneously within the first 4 years of life. -They should not be confused with bruises caused by trauma

Heartrate changes at birth

-between 110-160 is normal -averages 120-130 -highly dependent on Hr to to maintain CO and BP

Maternal health history and cultural assessment

-biographical info -delivering provider -reason for admission (labor, c-section, complication...) -prenatal record data; tests -health history, family hx -prenatal education -med list -risk factors; DMII, CHF, illicit drugs etc -pain mgt -hx of domestic violence -hx of previous births -allergies -time of last meal -method of infant feeding -name of birth attendant (MD,CNMW)

Abnormal cord findings

-bleeding; may occur if cord clamp is loosened -drainage; generally caused by infection; need immediate treatment

Lab tests needed during delivery

-blood typing (Rh) -syphilis screening -hepatitis B (HbsAg) screening -group B streptococcus -human immune deficiency virus (HIV) testing (if woman gives consent) -drug screening if the history is positive

Blood volume of the newborn

-blood volume of the newborn depends on the amount of blood transferred from the placenta at birth -usually estimated to be 80 to 85 mL/kg of body weight in the term infant -volume may vary by as much as 25% to 40%, depending on when clamping of the umbilical cord occurs

Pelvic outlet

-bound by the ischial tuberosities, the lower rim of the symphysis pubis, and the tip of the coccyx -wider front to back compared to the inlet *for the fetus to get through the pelvis, the outlet must be large enough

Postpartum bowel assessment

-bowel movements may take 1-3 days d/t decrease in muscle tone in the intestines as a result of elevated progesterone levels -woman often hesitant to have bowel movement postpartum -abdomen should not be distended

Vaginal signs associated with progress of the second stage of labor

-bulging of the perineum -labial separation -advancing and retreating of the newborn's head during and between bearing-down efforts -crowning

Support persons role during labor

-can assist the woman to ambulate, reposition herself, and use breathing techniques. -can aid with the use of acupressure, massage, music therapy, or therapeutic touch. -During the natural course of childbirth, a laboring woman's functional ability is limited secondary to pain, and she often has trouble making decisions.; support person can help make decisions based on his or her knowledge of the woman's birth plan and personal wishes.

Fetal scalp electrode

-can be used to monitor the fetal heartbeat without monitoring the maternal intrauterine pressure

Failure of the liver cells to break down and excrete bilirubin

-can cause an increased amount of bilirubin in the bloodstream, leading to jaundice **Bilirubin is toxic to the body and must be excreted

Risks of induced labor

-can lead to birth of an infant too early -a long labor -exposure to a high-alert medication with its potential side effects -unnecessary cesarean birth -maternal and neonatal morbidity -induction of labor may increase the risk of cesarean birth

Lightening in primiparas and multiparas

-can occur 2 or more weeks prior to labor in primiparas -may not occur until labor starts in multipara

Umbilical infections

-can occur because of an embryologic remnant or poor hygiene. -cord infection (omphalitis) can spread to adjacent tissue, causing peritonitis, hepatic vein thrombosis and hepatic abscess. Immediate evaluation and referral is needed

Ambulation and position change during labor as a comfort measure

-can reduce length of labor; speed the process; add gravity -most beneficial in first stage -Uterine contractions have been shown to be better spaced, stronger and more efficient in dilating the cervix when the mother is in an upright position -Changing position frequently (every 30 minutes or so)—sitting, walking, kneeling, standing, lying down, getting on hands and knees, and using a birthing ball—helps relieve pain -Swaying from side to side, rocking, or other rhythmic movements may also be comforting

Newborn Physical Examination

-carried out within the first 24 hours after birth -comprehensive examination should be delayed until after the newborn has completed the transition to extrauterine life -should not be initiated if the newborn is crying or appears to be upset -begin the examination with the least invasive and noxious elements of the examination (auscultation of heart and lungs). -Then examine the areas most likely to irritate the newborn (e.g., examining the hips and eliciting the Moro reflex). -initial observation is key; gives info about the well being of a newborn -typical physical examination of a newborn includes a general survey of skin color, posture, state of alertness, head size, overall behavioral state, respiratory status, gender, and any obvious congenital anomalies

facial nerve paralysis

-caused by trauma from the use of forceps -usually apparent on the first or second day of life. -Typically, the newborn will demonstrate asymmetry of the face with an inability to close the eye and move the lips on the affected side. -may have difficulty making a seal around the nipple, and consequently milk or formula drools from the paralyzed side of the mouth. -Most facial nerve palsies resolve spontaneously within days

Neurologic development pattern

-cephalocaudal and proximal-distal (center-to-outside)

Soft tissues of the passageway

-cerix, pelvic floor muscles, vagina -effacement -The pelvic floor muscles help the fetus to rotate anteriorly as it passes through the birth canal. -The soft tissues of the vagina expand to accommodate the fetus during birth.

Cervical changes before labor

-cervical softening and dilation with descent of the presenting part into the pelvis occur; may occur 1 month or 1 hour prior to labor -cervix changes from an elongated structure to a shortened, thinned segment -collagen fibers undergo enzymatic rearrangement into smaller, more flexible fibers that facilitate water absorption, leading to a softer, more stretchable cervix *changes occur secondary to prostaglandins and pressure from Braxton Hick's contractions *The ripening and softening of the cervix are essential for effacement and dilation, which reflect the enhanced collagen breakdown that was previously inhibited by progesterone

Physical causes of pain during labor

-cervical stretching -hypoxia of the uterine muscle due to a decrease in perfusion during contractions -pressure on the urethra, bladder, and rectum -distention of the muscles of the pelvic floor

Endocrine changes postpartum

-circulating estrogen and progesterone drop quickly with delivery of the placenta -dec estrogen levels are associated with breast engorgement and with the diuresis of excess extracellular fluid accumulated during pregnancy -Estrogen is at its lowest level a week after birth -For the woman who is not breast-feeding, estrogen levels begin to increase by 2 weeks after birth. -For the breast-feeding woman, estrogen levels remain low until breast-feeding frequency decreases. -other placental hormones (hCG, hPL, progeterone) decline rapidly after birth; undetectable levels -Prolactin levels decline within 2 weeks for the woman who is not breast-feeding, but remain elevated for the lactating woman

Factors promoting a positive birth experience

-clear information about procedures -support; not being alone -sense of mastery, self-confidence -trust in staff caring for her -positive reaction to the pregnancy -personal control over breathing -preparation for the childbirth experience

Bladder assessment postpartum

-considerable diuresis occurs within 12 hours; usually complete by day 21 -may not sense need to void, leading to bladder distention and UTI -monitor for signs of urinary tract infections, including fever, urinary frequency and/or urgency, difficult or painful urination, and tenderness over the costovertebral angle ***Full bladder tends to displace the uterus up and to the right. -document all output

Android pelvis

-considered the male shaped pelvis; funneled shape -seen in 20% of women -inlet is heart shaped, posterior segment is reduced in all planes -decent of fetal head is slow -failure of the fetus to rotate is common -poor prognosis of labor; leads to C-sections

Fetal spiral electrode

-considered the most accurate method of detecting fetal heart characteristics and patterns because it involves receiving a signal directly from the fetus -Specially trained labor and birth nurses are permitted to place the spiral electrode on the fetal head when the membranes rupture to assess the FHR in some health care facilities, but they do not place the intrauterine pressure catheter in the uterus

True labor

-contractions occurring at regular intervals that increase in frequency, duration, and intensity -contractions bring about progressive cervical dilation and effacement

Signs of effective breastfeeding

-correct latch -cheeks puff when sucking -audible swallows after first 34 hours "ka sound" -6 wets and 3 stools daily by day 4. -Once mature milk is in, mother feels softening after feeds. -Newborn is satiated after a feed.

Posterior fontanelle

-corresponds with anterior but is at the back of the head -triangular -closes within 8-12 weeks -0.5-1 cm at its widest diameter

Lochia alba

-creamy white or light brown -consists of leukocytes, decidual tissue, and reduced fluid content. -occurs from days 10 to 14 but can last 3 to 6 weeks postpartum in some women and still be considered normal.

Signs of respiratory distress

-cyanosis -tachypnea -expiratory grunting -sternal retractions -nasal flaring

Assessing the Woman Upon Admission

-decide if she is in true labor or not; stay or go home ***highest priorities include assessing FHR, assessing cervical dilation/effacement, and determining whether membranes have ruptured or are intact

Anxiety and fear in labor

-decrease a woman's ability to cope with the discomfort of labor. -Maternal catecholamines secreted in response to anxiety and fear can inhibit uterine blood flow and placental perfusion. -In contrast, relaxation can augment the natural process of labor

Antiemetics fo labor

-decrease nausea and vomiting and lessen anxiety -potentiate the effectiveness of the opioid so that a lesser dose can be given -may inc. sedation -doesn't affect progress of labor -may cause a decrease in FHR variability and possible newborn depression

Lochia rubra

-deep-red mixture of mucus, tissue debris, and blood -occurs for the first 3 to 4 days after birth -As uterine bleeding subsides, it becomes paler and more serous.

Immune system response purposes

-defense (protection from invading organisms), -homeostasis (elimination of worn-out host cells) -surveillance (recognition and removal of enemy cells)

Fetal attitude

-degree of body flexion/extension; -posturing of joints and relationship of fetal parts to each other -flexed attitude is ideal -attitude of extension tends to present larger fetal skull diameters, makes birth difficult

Dilation

-dependent on the pressure of the presenting part as well as contraction and retraction of the uterus -cervical os increases from <1 cm to 10 cm for birth -when fully dilated, cervix is not palpable -Uterine contractions of an intensity of 30 mm Hg or greater promote cervical dilation

Problems that can occur d/t cold stress

-depleted brown fat stores -increased oxygen needs -respiratory distress -increased glucose consumption leading to hypoglycemia -metabolic acidosis -jaundice -hypoxia, -decreased surfactant production -grunting, nasal flaring, and retractions

Caput succedaneum

-describes localized edema on the scalp that occurs from the pressure of the birth process. -It is commonly observed after prolonged labor. -Clinically, it appears as a poorly demarcated soft tissue swelling that crosses suture lines. -Pitting edema and overlying petechiae and ecchymosis are noted -The swelling will gradually dissipate in about 3 days without any treatment. -Newborns who were delivered via vacuum extraction usually have a caput in the area where the cup was used. -fluid collects in the scalp -crosses suture lines -describes as edema of the scalp at the presenting part; disappears in 3-4 days

Continuous Electronic Fetal Monitoring

-detects the fetal pulse by sensing and analyzing tissue movements via Doppler ultrasound -recommended method of intrapartum fetal surveillance for high-risk pregnancies -sound and graph are produced -can be performed externally (indirectly), with the equipment attached to the maternal abdominal wall, or internally (directly), with the equipment attached to the fetus.

Fetal engagement

-determined by pelvic exam -the entrance of the largest diameter of the fetal presenting part (usually the fetal head) into the smallest diameter of the maternal pelvis -The fetus is said to be engaged in the pelvis when the presenting part reaches 0 station -typically occurs in primigravidas 2 weeks before term -multiparas may experience engagement several weeks before the onset of labor or not until labor begins

Interventions for marked variability in FHR

-determining the cause if possible, lateral positioning, increasing intravenous fluid rate, administering oxygen at 8 to 10 L/min by mask, discontinuing oxytocin infusion, observing for changes in tracing, considering internal fetal monitoring, communicating an abnormal pattern to the health care provider, and preparing for a surgical birth if no change in pattern is noted

Transient strabismus

-deviation or wandering of eyes independently -normal for the first 3 to 6 months of age

Vaginal examination

-digital vaginal examinations at intervals of 4 hours for routine assessment and identification of a delay in active labor -check cervix for dilation, effacement and position -if cervix is open, the presenting fetal part, fetal position, station, and presence of molding can be assessed -evaluate membrane and describe as intact, bulging, ruptured -discuss findings with woman and he partner

Function of uterine contractions

-dilate the cervix -to push the fetus through the birth canal

Transverse or ischial tuberosity diameter of the outlet

-distance at the medial and lowest aspect of the ischial tuberosities, at the level of the anus -a known hand span or clenched-fist measurement is generally used to obtain this measurement

Diagonal conjugate of the inlet

-distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis

True or obstetric conjugate

-distance estimated from the measurement of the diagonal conjugate -1.5 cm is subtracted from the diagonal conjugate measurement

Auscultating bowel sounds

-do all 4 quads -then palpate for consistency, masses, and tenderness. -perform systematically in a clockwise fashion -Absent or hyperactive bowel sounds might indicate an intestinal obstruction

Epidural analgesia and labor

-does increase the duration of the second stage of labor -may increase the rate of instrument-assisted vaginal deliveries as well as that of oxytocin administration

Infant abductions teaching

-educate parents about never leaving newborn unattended, keeping crib on far side of room; door closed; staff has special ID; security device -usually occurs during the day

Breathing Techniques

-effective in producing relaxation and pain relief through the use of distraction

Sucking reflex

-elicited by gently stimulating the newborn's lips by touching them. -Placing a gloved finger in the newborn's mouth will also elicit a sucking motion

Cord clamping

-eliminates the placenta as a reservoir for blood -increases systemic vascular resistance *leads to circulation changes

Uterus assessment postpartum

-empty bladder first if possible -auscultate bowel sound before palpating fundus -palpate with two hands -boggy uterus predisposes woman to hemorrhage -6-12 hrs after birth, fundus should be at umbilicus; above is abnormal -nonpalpable by day 10-14

Nursing interventions to support the newborn immune system

-encouraging breastfeeding -infection prevention -administering a Hepatitis B vaccine.

Skink development

-epidermal barrier begins to develop during midgestation and is fully formed by about 32 weeks' gestation. -epidermis is similar to the adult epidermis in thickness and lipid composition; skin development is not complete at birth -less mature the newborn, the less mature the skin functions -Fewer fibrils connect the dermis and epidermis -risk of injury producing a break in the skin from the use of tapes and monitors and from handling is greater than for an adult -At birth, the newborn's skin is dark red to purple. As the newborn begins to breathe air his or her skin color changes to red

Routes for regional pain relief

-epidural block -combined spinal-epidural -local infiltration; for episiotomies -pudendal block; for episiotomies -intrathecal (spinal) analgesia/anesthesia

Lung aeration of the newborn

-establishment of functional residual capacity, allowing pulmonary gas exchange to start. -The first breath of life is a gasp that generates an increase in transpulmonary pressure and results in diaphragmatic descent; Thorax squeeze and chest recoils

Why are reflexes assessed

-evaluate neurologic function and development -Absent or abnormal reflexes in a newborn, persistence of a reflex past the age when it is normally lost, or redevelopment of an infantile reflex in an older child or adult may indicate neurologic pathology

Alleviating Breast Engorgement and suppressing lactation in bottle feeding woman

-explain that breast engorgement is a self-limiting phenomenon that disappears as increasing estrogen levels suppress milk formation (i.e., lactation suppression). -Encourage the woman to use ice packs, to wear a snug, supportive bra 24 hours a day, and to take mild analgesics such as acetaminophen. -Encourage her to avoid any stimulation to the breasts that might foster milk production (warm showers or pumping or massaging the breasts); allow shower to run on back to avoid breasts -Medication is no longer given to hasten lactation suppression because these agents had limited effectiveness and adverse side effects. -Suppression may take 5 to 7 days to accomplish -Reduce your salt intake to decrease fluid retention. -icepacks inside bra

Second degree perineal laceration

-extends through perineal muscles

BP changes postpartum

-falls mostly in the first 2 days and then increases 3 to 7 days after childbirth; and returns to prepregnancy levels by 6 weeks ***significant increase accompanied by headache might indicate preeclampsia and requires further investigation. ***Decreased blood pressure may suggest an infection or a uterine hemorrhage.

Certified nursing midwives

-family centered birthing -associated with fewer unnecessary interventions when compared with obstetricians -CNMs subscribe to a normal birth process where the woman uses her own instincts and bodily signs during labor. -In short, midwives empower women within the birthing environment

Braxton Hicks contractions

-felt as a tightening or pulling sensation of the top of the uterus -They occur primarily in the abdomen and groin and gradually spread downward before relaxing; true labor is felt in the lower back -may experience throughout pregnancy; become more frequent and stronger around labor -irregular -can last 30 sec to 2 min *if the contractions last longer than 30 seconds and occur more often than four to six times an hour, advise the woman to contact her health care provider so that she can be evaluated for possible preterm labor, especially if she is less than 38 weeks pregnant

Breech presentation

-fetal buttock or feet enter the maternal pelvis first and the fetal skull enters last -head may get "hung up"/stuck in pelvis -umbilical cord can become compressed between the fetal skull and the maternal pelvis -buttocks are soft and are not as effective as a cervical dilator during labor compared with a cephalic presentation -risk for trauma of the head; lack oppurtunity for molding -Types of breech presentation (determined by fetal legs): frank, complete, single footling, double footling *associated with prematurity, placenta previa, multiparity, uterine abnormalities (fibroids), and some congenital anomalies such as hydrocephaly

Causes of fetal tachycardia

-fetal hypoxia -maternal fever -maternal dehydration -amnionitis -drugs (e.g., cocaine, amphetamines, nicotine) -maternal hyperthyroidism -maternal anxiety -fetal anemia -prematurity -fetal infection -chronic hypoxemia -congenital anomalies -fetal heart failure -fetal arrhythmias.

Cause of fetal bradycardia

-fetal hypoxia -prolonged maternal hypoglycemia -fetal acidosis -administration of analgesic drugs to the mother -hypothermia -anesthetic agents (epidural) -maternal hypotension -fetal hypothermia -prolonged umbilical cord compression -fetal congenital heart block

Oblique lie

-fetal long axis is at an angle to the bony inlet, and no palpable fetal part is presenting. -This lie is usually transitory and occurs during fetal conversion between other lies. -cannot be delivered vaginally

Risk factors for the development of jaundice

-fetal-maternal blood group incompatibility -prematurity -asphyxia at birth -an insufficient intake of milk during breast-feeding -drugs (such as diazepam [Valium], oxytocin [Pitocin], sulfisoxazole/erythromycin [Pediazole], and chloramphenicol [Chloromycetin]) -maternal gestational diabetes -infrequent feedings -male gender -trauma during birth -resulting in cephalhematoma -cutaneous bruising from birth trauma -polycythemia, previous sibling with hyperbilirubinemia -intrauterine infections such as TORCH (toxoplasmosis, other viruses, rubella, cytomegalovirus, herpes simplex viruses), -ethnicity such as Asian or Native American

Passenger

-fetus and the placenta -fetal: head, attitude, lie, presentation, position, station, and engagement are important factors in the outcome of birth

Fetal presentation

-first body part in pelvic inlet -3 main presentations: cephalic (95% of births), breech (3%), shoulder (2%)

Predictable manner the Apgar score disappears under distress

-first the pink coloration is lost -next the respiratory effort -then the tone -followed by the reflex irritability -finally heart rate

Platypelloid pelvis

-flat pelvis; least common in men and women (3% of women) -shallow cavity, widens at the outlet -difficult for fetus to descend through mid pelvis -poor labor prognosis; arrest at inlet is common -women with this pelvis require cesarean birth

Four categories used to describe FHR variability

-fluctuation range undetectable -fluctuation range observed at <5 bpm -fluctuation range from 6 to 25 bpm -fluctuation range >25 bpm

Nursing Management During the Second Stage of Labor

-focuses on supporting the woman and her partner in making active decisions about her care and labor management, implementing strategies to prolong the early passive phase of fetal descent, supporting involuntary bearing-down efforts, providing instruction and assistance, and using maternal positions that can enhance descent and reduce pain ***empower, don't control

IgM

-found in blood and lymph fluid and is the first immunoglobulin to respond to infection -does not cross the placenta -levels are generally low at birth unless a congenital intrauterine infection is present -offers a major source of protection from blood-borne infections -predominant antibodies formed during neonatal or intrauterine infection are of this class

3 parameters to monitor contractions

-frequency -duration -intensity

L&D physical assessment

-generalized assessment of the body -hydration status, vital signs, auscultation of heart and lung sounds, and measurement of height and weight -Pain level and coping behaviors demonstrated -Uterine activity, including contraction frequency, duration, and intensity -Fetal status, including heart rate, position, and station -Cervical dilation and degree of effacement -Status of membranes (intact or ruptured) -Assess vital signs: temperature, pulse, respirations & blood pressure -Perform Leopold's maneuvers to determine fetal lie -Fundal height measurement -Ability to ambulate safely *provides a baseline

Rh status postpartum

-given to Rh (-) mothers if baby is Rh(+) within 72 hrs of birth -usually receive 2 doses; at 28 weeks and 72 hrs postpartum -technically a blood product; be careful when giving to Jehovah's Witnesses

Zidovudine

-given to the mother to reduces perinatal transmission of HIV from women who are positive to the baby -given to the baby at labor and continued for 6 weeks

Engorged breasts

-hard, tender, and taut

Microcephaly

-head circumference more than 2 standard deviations below average or less than 10% of normal parameters for gestational age, caused by failure of brain development. -There is a reduced production of neurons leading to a reduction of brain volume and as a consequence of that a reduced skull size. -severe microcephaly, defined as more than 3SD, are more likely to have imaging abnormalities and more severe developmental impairments than those with milder microcephaly. About 40% have epilepsy, 20% have cerebral palsy, 50% have intellectual disability, and 20% to 50% have ophthalmologic and hearing disorders -It can be familial, with autosomal dominant or recessive inheritance, and it may be associated with infections (cytomegalovirus), rubella, toxoplasmosis, and syndromes such as trisomy 13, 18, or 21 and fetal alcohol syndrome. -Genetic counseling and clinical management through carrier detection/prenatal diagnosis in families can help reduce the incidence of these disorders

Macrocephaly

-head circumference more than 90% of normal, typically related to hydrocephalus -It is often familial (with autosomal dominant inheritance) and can be either an isolated anomaly or a manifestation of other anomalies, including hydrocephalus and skeletal disorders (achondroplasia).

Patient education and labor

-helps to manage labor and feel in control during labor -if woman in prepared, labor is more likly to be normal/natural; less need to analgesia/anesthesia and less likly to require c section -may effect psychosocial outcomes -helps to promote healthy families during the transition to parenthood and beyond -Learning about labor and birth allows women and couples to express their needs and preferences, enhance their confidence, and improve communication between themselves and the staff.

Measures to reduce perineum pain postpartum

-ice packs -pouring warm water over the area via a peribottle -witch hazel pads -anesthetic sprays -sitz baths

Fetal assessment during labor and birth

-identifies well-being or sign that indicate compromise -assess amniotic fluid -primary assessment is on FHR patterns -Umbilical cord blood analysis and fetal scalp stimulation are additional assessments performed as necessary in the case of questionable FHR patterns

Benefit of a cephalic presentation

-if head is flexed with chin on chest, the optimal/smallest fetal skull dimension for vaginal birth is presented

Fetal membrane assessment

-if intact, it is a soft bulge that is more prominent during contractions -if ruptured woman may have reported sudden rush of fluid; may be slow trickle -if ruptured prior to admission, HCP should ascertain when rupture occurred; prolonged ruptures inc risk for infection

Stage 4 (restorative stage)

-immediate postpartum; expulsion of placenta and membranes -ends with initial physiological adjustment and stabilization of the mother **initiates postpartum period -focus is on mother; prevent hemorrhage, bladder distention, venous thrombus -lasts 1-4 hrs after birth -mother begins to stabilize -critical period for physiologic transition as well as new family attachment -mother feels peace and excitement, wide awake, very talkative -fundus should be firm and contracted; located between umbilicus and symphysis; slowly rises to umbilicus -massage uterus if bogy -mother may be thirsty/hungry by this point -has hypotonic bladder; limited sensation to acknowledge a full bladder

Benefits of delayed cord clamping

-improving the newborn's cardiopulmonary adaptation -preventing iron-deficient anemia in full-term newborns without increasing hypervolemia-related risks and increased iron stores -increasing blood pressure -improving oxygen transport -increasing red blood cell flow Offers the newborn many benefits physiologically, which include: -at least a 30% increase in blood volume for term infants and a 50% increase in preterm infants -improvement of systemic blood pressure -increase in the cerebral oxygen index -higher hemoglobin levels at 24 to 48 hours of age -increased serum iron levels at 4 to 6 months

Genitals assessment

-in males, evidence of testicular descent and appearance of scrotum (which can range from smooth to covered with rugae) determine maturity -in females, appearance and size of clitoris and labia determine maturity (a prominent clitoris with flat labia suggests prematurity, whereas a clitoris covered by labia suggests greater maturity)

How do newborns respond to cold

-inc activity; resltessness, crying -this increases O2 consumption which inc. RR. -inc crying and activity also results in more energy being expended -This results in an increased metabolic rate, and, to generate heat, the metabolism of brown fat begins

Vision at birth

-incomplete at birth. -Maturation is dependent on nutrition and visual stimulation. -Newborns have ability to focus only on close objects (8 to 10 inches away) with a visual acuity of 20/140 -they can track objects in midline or beyond (90 inches). -This is the least mature sense at birth. -The ability to fix, follow, and be alert is indicative of an intact CNS

Difficulty voiding post partum can cause

-incomplete emptying/urinary retention -bladder distention -UTI

Newborn heartrate and behvior changes

-increase in activity, such as wakefulness, movement, or crying, corresponds to an increase in heart rate and blood pressure. -the compromised newborn demonstrates markedly less physiologic variability overall

Requirements for successful transition from fetal to postnatal circulation

-increased pulmonary blood flow -removal of the placenta -closure of the intracardiac (foramen ovale) and extracardiac shunts (ductus venosus and ductus arteriosus) -changes equalize the right ventricular output with the left

Risk factors associated with overheating

-increases fluid loss, the respiratory rate, and the metabolic rate considerably.

WBC changes postpartum

-increases in labor -remains elevated for first 4 to 6 days after birth -falls to 6,000 to 10,000/mm3 ***white blood cell elevation can complicate a diagnosis of infection in the immediate postpartum period

Blood volume changes postpartum

-increases substantially during pregnancy -drops rapidly after birth -returns to normal within 4 weeks postpartum.

How does a newborn attempt to conserve heat and increase heat production

-increasing the metabolic rate -increasing muscular activity through movement -increasing peripheral vasoconstriction -assuming a fetal position to hold in heat and minimize exposed body surface area

3 phases of contractions

-increment: buildup of the contraction -acme: peak or highest intensity -decrement: descent or relaxation of the uterine muscle fibers

Continuous internal monitoring

-indicated for women or fetuses considered to be at high risk -involves the placement of a spiral electrode into the fetal presenting part, usually the head, to assess FHR, and a pressure transducer placed internally within the uterus to record uterine contractions -does NOThave to include both an intrauterine pressure catheter and a scalp electrode -FHR and the duration and interval of uterine contractions are recorded on the graph paper

Moderate variability in FHR

-indicates that the autonomic and central nervous systems (CNSs) of the fetus are well developed and well oxygenated. -It is considered a good sign of fetal well-being and correlates with the absence of significant metabolic acidosis

Preparing woman for vaginal exam

-inform her of procedure -inform her of what info will be obtained -instruct her on how to assist -tell her how it will be performed and who will be doing it

Internal monitoring compared to external

-internal monitoring can accurately detect both short-term (moment-to-moment) changes and variability (fluctuations within the baseline) and FHR dysrhythmias. -maternal position changes and movement do not interfere with the quality of the tracing with internal monitoring

Complementary behavior

-involves taking turns and stopping when the other is not interested or becomes tired -coo and stare at the parent to elicit a similar parental response to complement his or her behavior. -Parents who are sensitive and responsive to their infant's cues will promote their development and growth. -Parents who become skilled at recognizing the ways their infant communicates will respond appropriately by smiling, vocalizing, touching, and kissing.

Baseline variability of FHR

-irregular fluctuations in the baseline fetal heart rate, which is measured as the amplitude of the peak to trough in bpm -represents the interplay between the parasympathetic and sympathetic nervous systems -FHR variability is an important clinical indicator that is predictive of fetal acid-base balance and cerebral tissue perfusion -FHR is influenced by fetal oxygenation status, cardiac output, and drug effects

Nursing interventions to reduce heat loss through radiation

-keep cribs and isolettes away from outside walls, cold windows, and air conditioners. -using radiant warmers for transporting newborns and when performing procedures that may expose the newborn to the cooler environment will help reduce heat loss.

Pain postpartum

-keep pain between 0-2

Fourth degree perineal laceration

-laceration that extends completely through the rectal mucosa, disrupting both the external and internal anal sphincters -continues through anterior rectal wall

Third degree perineal laceration

-laceration that involves the external anal sphincter -extends through the anal sphincter muscle

Integumentary changes postpartum

-last effects postpartum -darkened pigmentation on the abdomen (linea nigra), face (melasma), and nipples gradually fades with dec in hormones -may experience hair loss; temporary

Anthropometric measurements

-length weight -head circumference -chest circumference

True pelvis

-lies below the linea terminalis. -the bony passageway through which the fetus must travel -made up of three planes: the inlet, the mid-pelvis (cavity), and the outlet.

Effleurage

-light, stroking, superficial touch of the abdomen, in rhythm with breathing during contractions -a relaxation and distraction technique from discomfort -ound to release endorphins and induce a relaxed state

Factors leading to newborn overheating

-limited sweating ability -limited insulation -Although heat production can substantially increase in response to a cool environment, basal metabolic rate and the resultant heat produced cannot be reduced *primary heat regulator in the hypothalamus

Negative effects of Valsalva maneuver

-linked to hemodynamic changes in the mother and interferes with oxygen exchange between the mother and the fetus. -it is associated with pelvic floor damage: the longer the push, the more damage to the pelvic floor.

Large fontanels

-more than 6 cm in the anterior diameter bone to bone or more than a 1-cm diameter in the posterior fontanel -possibly associated with malnutrition, hydrocephaly, congenital hypothyroidism, trisomies 13, 18, and 21, and various bone disorders such as osteogenesis imperfecta.

Assessing FHR: location

-most clearly heard at fetal back -cephalic presentation: the FHR is best heard in the lower quadrant of the maternal abdomen. -In a breech presentation, it is heard at or above the level of the maternal umbilicus -location will change through labor -palpate maternal radial pulse to not confuse with fetal HR

Cephalohematoma

-localized subperiosteal collection of blood of the skull which is always confined by one cranial bone. -This condition is due to pressure on the head and disruption of the vessels during birth. -It occurs after prolonged labor and use of obstetric interventions such as low forceps or vacuum extraction. -The clinical features include a well-demarcated, often fluctuant swelling with no overlying skin discoloration. -The swelling does not cross suture lines and is firmer to the touch than an edematous area -Aspiration is not required for resolution and is likely to increase the risk of infection. -Hyperbilirubinemia occurs following the breakdown of the red blood cells within the hematoma. -This type of hyperbilirubinemia occurs later than classic physiologic hyperbilirubinemia. -usually appears on the second or third day after birth and disappears within weeks or months. -can lead to increased bilirubin levels and subsequent jaundice -Blood collects beneath the scalp; between the periosteum and the bone -occurs several hours after birth -does not cross suture lines -generally reabsorbed within 6-8 weeks

Stage 1

-longest -starts with first true contraction -ends with 10 cm dilation -membranes usually rupture in this stage; may have been earlier or not at all -Primigravida: lasts ~12 hrs; half as long for multiparous -pain is usually the result of dilation in this stage Divided into 3 phases: -latent/early phase -active phase -transition phase

Family centered birthing

-low-tech, high-touch approach requested by many childbearing women, who view childbirth as a normal process -typically done by Midwives (CNM)

Red Reflex

-luminous red appearance seen on the retina -should be seen bilaterally on retinoscopy. -The red reflex normally shows no dullness or irregularities.

Nursing interventions for helping the newborn to make the transition to extrauterine life

-maintaining airway patency -ensuring proper identification -administering prescribed medications -maintaining thermoregulation.

Characteristics of newborn skin

-make up 13% of body weight -sensitive, fragile, with a neutral pH on the surface, lower lipid content, and higher water content when compared with adults *vulnerable to injury and infections

3 levels of postpartum mood disorders

-maternal (baby) blues -postpartum depression -psychosis

Signs of intrauterine infection

-maternal fever -fetal and maternal tachycardia -foul odor of vaginal discharge -an increase in white blood cell count.

Conditions that may decrease uteroplacental perfusion with resultant decelerations

-maternal hypotension, gestational hypertension, placental aging secondary to diabetes and postmaturity, hyperstimulation via oxytocin infusion, maternal smoking, anemia, and cardiac disease.

Complications of CSEs

-maternal hypotension, intravascular injection, accidental intrathecal blockade, postdural puncture headache, pruitis, inadequate or failed block, maternal fever, and pruritus. -Hypotension and associated FHR changes are managed with maternal positioning (semi-Fowler's position), intravenous hydration, and supplemental oxygen

Maternal assessment during labor

-maternal vital signs, including temperature, blood pressure, pulse, respiration, and pain, -review the prenatal record to identify risk factors that may contribute to a decrease in uteroplacental circulation during labor. -If there is no vaginal bleeding on admission, a vaginal examination is performed to assess cervical dilation, after which it is monitored periodically as necessary to identify progress. -Evaluate maternal pain and the effectiveness of pain management strategies at regular intervals during labor and birth.

Green amniotic fluid

-may indicate that the fetus has passed meconium secondary to transient hypoxia, prolonged pregnancy, cord compression, intrauterine growth restriction (IUGR), maternal hypertension, diabetes, or chorioamnionitis -it is considered a normal occurrence if the fetus is in a breech presentation. -If it is determined that meconium-stained amniotic fluid is due to fetal hypoxia, the maternity and pediatric teams work together to prevent meconium aspiration syndrome. -This would necessitate suctioning after the head is born before the infant takes a breath and perhaps direct tracheal suctioning after birth if the Apgar score is low. -In some cases an amnioinfusion (introduction of warmed, sterile normal saline or Ringer's lactate solution into the uterus) is used to dilute moderate to heavy meconium released in utero to assist in preventing meconium aspiration syndrome.

Temperature postpartum

-may run a low grade fever up to 100.4 -give fluid for dehydration -temperature should normalize within 24 hours

Tachycardia postpartum

-may suggest anxiety, excitement, fatigue, pain, excessive blood loss or delayed hemorrhage, infection, or underlying cardiac problems, hypovolemia, dehydration -In most instances of postpartum hemorrhage, blood pressure and cardiac output remain increased because of the compensatory increase in heart rate -Any pulse rate higher than 100 bpm warrants further investigation to rule out complications.

Stool progression

-meconium -transitional stool -milk stool *Early feeds promote early stooling, which helps to prevent bilirubin buildup. *stool formation does not progress backwards, for example, a newborn does not return to meconium after the stool has changed to transitional or a milk stool

Leopold's maneuvers

-method for deterring the presentation, position, and lie of the fetus through 4 specific steps -involves inspection and palpation of the maternal abdomen as a screening assessment for malpresentation -longitudinal lie is expected -presentation should be cephalic, breech, or shoulder

Abdominal distention

-might indicate ascites, obstruction, infection, masses, or an enlarged abdominal organ

Fetoscope

-modified stethoscope attached to a headpiece -used to assess fetal HR

Uterine contraction assessment

-monitor by palpation and/or electronic monitoring -assess frequency, duration, intensity, resting tone

Assessment during the 3rd stage

-monitor placental separation -examining placenta and fetal membranes for intactness the second time (the health care provider assesses the placenta for intactness the first time) -assess for perineal trauma before birth attendant leaves -inspect episiotomy if performed -assess laceration and ensure repair

Skin function (infants)

-most important function of the skin is to provide a protective barrier between the body and the environment. -It limits the loss of water, prevents absorption of harmful agents, protects thermoregulation and fat storage, and protects against physical trauma.

Causes for delay in attachment

-mother's physical and emotional states are adversely affected by exhaustion, pain, and the absence of a support system -if she has an infant in NICU and is separated from it -had a traumatic birth experience, anesthesia, or an unwanted outcome, such as an ill infant

Ensuring Proper Identification at birth

-mother, baby and significant other all get matching ID bands prior to leaving LDR

Proper identification intervention of newborn at birth

-mother, newborn and father or significant other receive bands -baby has 2 bands and bands are used to identify mother and baby. -Check when beginning care and anytime mother and baby are separated. -Also check before any procedures. -Footprint sheets may be completed; security devices are attached.

Nursing interventions during 2nd stage of labor

-motivating -assist with positioning -encourage her to push -give feedback to the mother -suggest her to keep eyes open if she is pushing without progress -use a mirror so she can visualize the process

Bloody show

-mucous plug is expelled d/t cervical softening and inc pressure -ruptured cervical capillaries release a small amount of blood that mixes with mucus, resulting in the pink-tinged secretions known as "bloody show"

Milia

-multiple pearly-white or pale yellow unopened sebaceous glands frequently found on a newborn's nose. -They may also appear on the chin and forehead -They form from oil glands and disappear on their own within 2 to 4 weeks. -When they occur in a newborn's mouth and gums, they are termed Epstein's pearls. -As most lesions break spontaneously within the first few weeks of life, no therapy is indicated

Characteristic activities of the first period of reactivity

-myoclonic movements of the eyes -spontaneous Moro reflexes -sucking motions -chewing -rooting -fine tremors of the extremities

Epidural complications

-nausea and vomiting, hypotension, fever, pruritus, intravascular injection, maternal fever, allergic reaction, and respiratory depression. -Effects on the fetus during labor include fetal distress secondary to maternal hypotension -Ensuring that the woman avoids a supine position after an epidural catheter has been placed will help to minimize hypotension.

Uterine contractions that initiate cervix dilation

-need intensity of 30 mmHg or greater -reaches 50-80 mmHg in labor -resting tone is usually 5-10 mmHg in early labor, and 12-18 in active labor

Erythema toxicum

-newborn rash -a benign, idiopathic, generalized, transient rash that occurs in up to 70% of all newborns during the first week of life. -It consists of small papules or pustules on the skin resembling flea bites. -often mistaken for staphylococcal pustules. -The rash is common on the face, chest, and back -One of the chief characteristics of this rash is its lack of pattern. -It is caused by the newborn's eosinophils reacting to the environment as the immune system matures. -It does not require any treatment and disappears in a few days.

Normal chest assessment

-newborn's chest should be round, symmetric, and 2 to 3 cm smaller than the head circumference Normal: round, symmetric, smaller than head Normal variations: Nipple engorgement, whitish discharge

Nonshivering thermogenesis

-newborn's primary method of heat production -process in which brown fat (adipose tissue) is oxidized in response to cold exposure

Risks for fetus after PROM

-no longer protected from infection -risk for cord prolapse if engagement has not occurred with the sudden release of fluid and pressure with rupture *patient must notify provider once PROM occurs

BP in a newborn

-not routinely take in healthy term newborn -usually highest after birth -reaches a plateau within a week after birth

Risks for third- or fourth-degree lacerations

-nulliparity -being Asian or Pacific Islander -increased birth weight of newborn -operative vaginal birth -episiotomy -longer second stage of labor ***increasing body mass index was associated with fewer lacerations

Typical dilation rates

-nulliparous woman is 1.2 cm/hr -multiparous woman, it is 1.5 cm/hr

Oxytocin changes during labor

-number of receptors for oxytocin in the uterus increases at the end of pregnancy -inc in estrogen increases myometrial sensitivity to oxytocin -oxytocin aids in stimulating prostaglandin synthesis; leads to additional contractions, cervical softening, gap junction induction, myometrial sensitization, thereby leading to progressive dilation

Obesity and breastfeeding

-obese (BMI > 30) are less likely to initiate lactation -have difficulties with latching on -have delayed lactogenesis -experience mechanical challenges -are prone to early cessation of breast-feeding

Emotional status assessment postpartum

-observe how she interacts with her family, her level of independence, energy levels, eye contact with her infant (within a cultural context), posture and comfort level while holding the newborn, and sleep and rest patterns. -Be alert for mood swings, irritability, or crying episodes.

Extension

-occurs after internal rotation is complete -head emerges through extension under the symphysis pubis along with the shoulders -The anterior fontanel, brow, nose, mouth, and chin are born successively.

Flexion

-occurs as the vertex meets resistance from the cervix, the walls of the pelvis, or the pelvic floor -results in the chin contacting the thorax and presenting diameter is changed from occipitofrontal to suboccipitobregmatic (smallest skull diameter)

Marked variability in FHR

-occurs when there are more than 25 beats of fluctuation in the FHR baseline. -Causes of this include cord prolapse or compression, maternal hypotension, uterine hyperstimulation, and abruptio placenta.

Continuous Labor Support

-offering a sustained presence to the laboring woman by providing emotional support, comfort measures, advocacy, information and advice, and support for the partner -associated with reduced cesarean rates -may be A woman's family, a midwife, a nurse, a doula, or anyone else close to the woman

Perineum changes after labor

-often edematous and bruised for the first day or two after birth. -If the birth involved an episiotomy or laceration, complete healing may take as long as 4 to 6 months in the absence of complications -The muscle tone may or may not return to normal -Perineal lacerations may extend into the anus and cause considerable discomfort when attempting to defecate or ambulate. -The presence of swollen hemorrhoids may heighten discomfort. -restoring tone may take up to 6 months. -Pelvic relaxation can occur in any woman experiencing a vaginal birth.

Cold application for postpartum pain

-often the first measure used for vaginal birth pain relief -minimize edema, reduce inflammation, dec capillary permeability, reduce nerve conduction to the site -applied in 4th stage of labor, used for 24 hrs; on for 20 min, removed for 10

Newest protocol for "pushing"

-open-glottis method in which air is released during pushing to prevent the buildup of intrathoracic pressure. -Doing so also supports mother's involuntary bearing-down efforts

Expected newborn behaviors

-orientation -habituation -motor maturity -self-quieting ability -social behaviors *Any deviation in behavioral responses requires further assessment, because it may indicate a complex neurobehavioral problem.

Hydrotherapy

-pain management that involves showering or soaking in a regular tub or whirlpool bath -Warm water provides soothing stimulation of nerves in the skin, promoting vasodilation, reversal of sympathetic nervous response, and a reduction in catecholamines -Contractions are usually less painful in warm water -recommendation for initiating hydrotherapy is that the woman be in active labor; > 5 cm to prevent slowing of labor contractions

Hormone changes during the 3rd stage of labor

-peak levels of oxytocin and endorphins -adrenaline begins to fall -oxytocin causes uterine contractions and helps the woman to enact instinctive mothering behaviors (holding the newborn close to her body and cuddling the baby) -skin-to-skin contact immediately after birth and the newborn's first attempt at breast-feeding further augment maternal oxytocin levels, strengthening the uterine contractions that will help the placenta to separate and the uterus to contract to prevent hemorrhage -Endorphins help block pain -drop in adrenaline level from the second stage, which had kept the mother and baby alert at first contact, causes most women to shiver and feel cold shortly after giving birth

Heat application for pain comfort management postpartum

-peri-bottle; used after each voiding and when applying new peripad -sitz bath after 24 hrs postpartum; room temp water; promoter healing; clean area with peri-bottle prior to use

Gestational ages assessment

-physical signs and neurologic characteristics are assessed -use Ballard gestational age assessment or scale -determines gestational age between 20-44 weeks -scores range from -2 to 5 -physical maturity section of the examination is done during the first 2 hours -neuromuscular maturity section typically is completed within 24 hours after birth

Benefits of kangaroo care/skin to skin

-physiological: thermoregulation, cardiorespiratory stability -behavioral: sleep, breast-feeding duration, and degree of exclusivity -domains, as an effective therapy to relieve procedural pain, and improve neurodevelopment -provides the newborn with optimal physiologic stability, warmth, and opportunities for the first feed

Assessment of uterine contractions by palpation

-place pads of fingers on fundus Described as: -like the tip of the nose: ; mild -like the chin; moderate -like the forehead; strong *document as mild, mod. strong

Postpartum weight loss

-possibly determined by existing weight/body mass index (BMI), diet, age, and activity level -usually 10-13 pounds post delivery

Areas assess on the neuromuscular maturity section

-posture -square window -arm recoil -popliteal angle -scarf sign -heel ear

Category 3 FHR pattern

-predictive of abnormal fetal acid-base status -requires prompt evaluation and interventions; giving maternal oxygen, changing maternal position, discontinuing labor augmentation medication, and/or treating maternal hypotension • Fetal bradycardia (<110 bpm) • Recurrent late decelerations • Recurrent variable decelerations—declining or absent • Sinusoidal pattern (smooth, undulating baseline)

Forces that bring about descent

-pressure of the amniotic fluid -Direct pressure of the fundus on the fetus's buttocks or head (depending on which part is located in the top of the uterus) -Contractions of the abdominal muscles (second stage) -Extension and straightening of the fetal body

Risk factors for partner postpartum depression

-previous history of depression -financial problems -a poor relationship with his/her partner -an unplanned pregnancy

RBC changes postpartum

-production ceases early in the puerperium, causing mean hemoglobin and hematocrit levels to decrease slightly in the first 24 hours; both levels rise slowly the next two weeks

Post partum diaphoresis

-profuse diaphoresis is common during the early postpartum period -Many women will wake up drenched with perspiration during the puerperium; especially first week postpartum. -mechanism is to reduce the amount of fluids retained during pregnancy and restore prepregnant body fluid levels; reduce plasma vol. -Reassure the client that this is normal and encourage her to change her gown to prevent chilling.

Factors that inhibit involution

-prolonged labor and difficult birth -incomplete expulsion of amniotic membranes and placenta -uterine infection -overdistention of uterine muscles (such as by multiple gestation, hydramnios, or a large singleton fetus) -a full bladder (which displaces the uterus and interferes with contractions) -anesthesia (which relaxes uterine muscles) -close childbirth spacing (frequent and repeated distention decreases tone and causes muscular relaxation)

Benefits of a neutral thermal environment

-promotes growth and stability -conserves energy for basic bodily functions -minimizes heat (energy) and water loss

Laboring down

-promotion of passive decent -alternative strategy for second stage management in women with epidurals -fetus will descend and is born without coached maternal pushing

Stages of attachment

-proximity -reciprocity -commitment

Directed pushing

-pushing directed by the caregiver -avoid this

GI changes postpartum

-quickly returns to normal after birth -dec peristalsis in response to analgesics, surgery, diminished intra-abdominal pressure, low-fiber diet, insufficient fluid intake, and diminished muscle tone -constipation d/t fear of perineum pain -most women experience decreased bowel tone and sluggish bowels for several days after birth -hunger and thirst return immediately after labor ***Anticipate the woman's need to replenish her body with food and fluids, and provide both soon after she gives birth.

Factors that affect newborn weight

-racial origin, genetics, maternal age, size of the parents, maternal nutrition, maternal weight prenatally, and placental perfusion

Episiotomy inspection

-receive episiotomy during second stage -should now be intact, edges approximated and clean -no redness -no edema

Any upright or lateral position, compared with supine or lithotomy positions, may:

-reduce the length of the first stage of labor reduce the duration of the second stage of labor -reduce the number of assisted deliveries (vacuum and forceps) -reduce episiotomies and perineal tears -contribute to fewer abnormal fetal heart rate patterns -increase comfort/reduce requests for pain medication -enhance a sense of control by the mother -alter the shape and size of the pelvis, which -assists in descent assist gravity to move the fetus downward

Benefits of a doula

-reduces the need for medications for pain -reduces the need for vacuum or forcep delivery -reduces the need for c sections -associated with slight reduction in length of labor

Benefits of hydrotherapy

-reducing pain, relieving anxiety, and promoting a sense of control during labor -significantly reduced surgical birth rates -shorter second stage of labor -reduced analgesic requirements -a lower incidence of perineal trauma -The research concluded that hydrotherapy during labor significantly aids the labor process, minimizes the use of analgesic medications, offers fast- and short-acting pain and anxiety relief, and should he considered as a safe and effective birthing aid

Harlequin sign

-refers to the dilation of blood vessels on only one side of the body, giving the newborn the appearance of wearing a clown suit. -It gives a distinct midline demarcation, which is described as pale on the nondependent side and red on the opposite, dependent side. -It results from immature autoregulation of blood flow and is commonly seen in low-birth-weight newborns when there is a positional change -It is transient, lasting as long as 20 minutes, and no intervention is needed.

Intensity of contractions

-refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine pressure catheter.

Fetal lie

-relationship of body parts -relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother -3 possible lies: longitudinal, transverse, oblique

Fetal position

-relationship to maternal pelvis -relationship of a given point on the presenting part of the fetus to a designated point of the maternal pelvis -Fetal position is determined first by identifying the presenting part and then the maternal quadrant the presenting part is facing *** position is indicated by 3 letter abbreviation

Tonic neck reflex

-resembles the stance of a fencer and is often called the fencing reflex. -Test this reflex by having the newborn lie on the back. -Turn the baby's head to one side; the arm toward which the baby is facing should extend straight away from the body with the hand partially open, whereas the arm on the side away from the face is flexed and the fist is clenched tightly. -Reversing the direction to which the face is turned reverses the position

Natural immunity

-responses or mechanisms that do not require previous exposure to the microorganism or antigen to operate efficiently -Physical barriers (such as intact skin and mucous membranes), chemical barriers (such as gastric acids and digestive enzymes), and resident nonpathologic organisms make up the newborn's natural immune system -involves the most basic host defense responses: ingestion and killing of microorganisms by phagocytic cells.

Downside to external monitoring

-restricts mothers movement -cannot detect short-term variability -signal disruptions can occur due to maternal obesity, fetal malpresentation, and fetal movement as well as by artifact

Preparation for newborn physical assessment

-review prenatal history -maintain a calm, quiet, warm environment -General survey -Review prenatal and labor record for risk factors Assess: • respirations • skin color •Posture and tone •level of alertness •Behavioral state •Gender •Obvious anomalies

Maternal pelvis divisions

-right anterior, left anterior, right posterior, and left posterior. designates direction of presenting part toward the: front, back, left, right side

Passageway

-route through which the fetus must travel to be born -consist of the pelvis and soft tissue of the mother -relaxin and estrogen allow connective tissue to relax and be more elastic close to labor

Vaccinations postpartum

-rubella if not immune; avoid if her or close family are immunocompromised -TDAP -Flu -Hep B

How to confirm fetal membrane rupture

-sample of fluid is taken from the vagina via a nitrazine yellow dye swab to determine the fluid's pH

IgA

-second most abundant immunoglobulin in the serum -does NOT cross the placenta, and maximum levels are reached during childhood -believed to protect mucous membranes from viruses and bacteria -predominantly found in the gastrointestinal and respiratory tracts, tears, saliva, colostrum, and BREAST MILK

Lochia serosa

-second stage -pinkish brown and is expelled 3 to 10 days postpartum. -primarily contains leukocytes, decidual tissue, red blood cells, and serous fluid.

Assessing newborns state of alertness, posture, muscle tone

-should be alert and not persistently lethargic. -normal posture is hips abducted and partially flexed, with knees flexed. -Arms are adducted and flexed at the elbow. -Fists are often clenched, with fingers covering the thumb. -To assess for muscle tone, support the newborn with one hand under the chest. -Observe how the neck muscles hold the head. -The neck extensors should be able to hold the head in line briefly. -There should be only slight head lag when pulling the newborn from a supine position to a sitting one

Analysis of amniotic fluid

-should be clear when membrane ruptures; either spontaneous or with amnihook -cloudy'foul-smelling indicated infection -green may indicate fetus passed merconium secondary to transient hypoxia, prolonged pregnancy, cord compression, intrauterine growth restriction (IUGR), maternal hypertension, diabetes, or chorioamnionitis; this is normal if fetus is in breech position

Babinski reflex

-should be present at birth and disappears at approximately 1 year of age. -It is elicited by stroking the lateral sole of the newborn's foot from the heel toward and across the ball of the foot. -The toes should fan out. -A diminished response indicates a neurologic problem and needs follow-up

Inspection of normal episiotomy site

-should not have redness, discharge, or edema. -assess for hemorrhoids at this time -may take 4 to 6 months for the episiotomy to heal completely -assess at least Q8H -Ice can be applied to relieve discomfort and reduce edema; sitz baths also can promote comfort and perineal healing

Respiratory rate postpartum

-should return to normal; 12-20 -diaphragm lowers -lung sounds should be clear -Any respiratory rate out of normal range may indicate pulmonary edema, atelectasis, a side effect of epidural anesthesia, or pulmonary embolism; must be reported

Fetal head

-size and presence of molding -largest fetal structure; 1/4 of total surface area -face and cranial base are fused/fixed -5 cranial bones are not fused; soft and pliable with gaps (Sutures and fontanelles) -molding occurs during labor and fluid collects in the scalp or blood collects beneath the scalp further distorting shape -after birth, structures close

The areas assessed on the physical maturity examination include

-skin texture -lanugo -plantar creases -breast tissue -eyes and ears -genitals

First line treatment with hypothermia

-skin to skin with mom; reduces discomfort from painful procedures

Medical indications for inducing labor

-spontaneous rupture of membranes and when labor does not start -large size fetus not expected to navigate the maternal pelvis -fetal growth restriction (FGR) where external intervention is needed -a pregnancy of more than 42 weeks' gestation -maternal hypertension, diabetes, or lung disease -a uterine infection

Topical preparations for perineal pain

-spray (benzocaine) ; use after peri-bottle -ice packs, ice sitz -cool witch hazel (Tucks); hemmorrhoids -pharm measures for hemmorrhoids: dibucaine and steroids

Exercise progression postpartum

-start gradual -begin with pelvic floor exercises on day 1 postpartum -progress to abdomen, butt, and thigh exercises by week 2 -avoid jaring/bouncing movements for 6-8 wks -too much too soon can increase bleeding; return of lochia rubra; inc bleeding is a warning the woman is "over doing it"

Stage 3 (placental expulsion)

-starts after birth -ends with separation and birth of placenta -uterine contractions usually expel placenta within 5-30 minutes -skin to skin during this period -blood loss is approx. 500 mL

The two most important diameters that can affect the birth process

-suboccipitobregmatic: approximately 9.5 cm at term -biparietal: approximately 9.25 cm at term

Maintaining airway at birth

-suction MOUTH then NOSE with bulb syringe (mouth first to avoid gasp) -Keep bulb syringe in crib near baby's head.

Energy level changes with labor

-sudden increase in labor; referred to as "nesting" -usually occurs 24-48 hours prior to onset of labor -Epinephrine increases, progesterone decreases

Maternal self care of breastfeeding

-supportive bras -no soap or lotions on nipples -colostrum on nipples and allow to air-dry -notify HCP or LC if nipples are reddened or cracked -engorgement occurs around day 3 and is temporary; continue to nurse -take warm showers to stimulate let down -warm soaks -express to softness if it is difficult for baby to latch -Can take NSAID for discomfort. Diet -need more calories -drink to thirst -make sure HCP and pediatrician know of any meds or new prescriptions

Liver function

-synthesis, degradation, and regulation of pathways involved in the metabolism of carbohydrates, proteins, lipids, trace elements, and vitamins -blood coagulation, and also iron storage, carbohydrate metabolism, and conjugation of bilirubin become fully active by 3 months of age

Parts to a uterine contraction

-systolic and diastolic phases -waves tha tmove down to the cervix and up to the fundus -Build up phase: increment -gradually reaches the acme: peak intensity; entire uterus contracted -then letting down: decrement -each contraction followed by rest

Attention Focusing and Imagery

-tactile stimuli such as touch, massage, or stroking -auditory stimuli such as music, humming, or verbal encouragement -Visual stimuli might be any object in the room, or imagine the beach, a mountaintop, a happy memory, or even the contractions of the uterine muscle pulling the cervix open and the fetus pressing downward to open the cervix -Breathing, relaxation, positive thinking, and positive visualization work well for mothers in labor

Phases of Maternal Adaptation to Parenthood

-taking in -taking hold -letting go

Nursing interventions to instruct the mother on to promote breastfeeding

-tell mothers that they need to believe in themselves and their ability to accomplish this task -Select a quiet corner or room where you won't be disturbed. -Use a rocking chair to soothe both you and your infant. -Take long, slow deep breaths to relax before nursing. -Drink while breast-feeding to replenish body fluids. -Listen to soothing music while breast-feeding. -Cuddle and caress the infant while feeding. -Set out extra cloth diapers within reach to use as burping cloths. -Allow sufficient time to enjoy each other in an unhurried atmosphere. -Involve other family members in all aspects of the infant's care from the start. -Contact a local La Leche or Nursing Mother's group for continued guidance/support.

Newborn vital signs

-temperature, pulse, and respirations are monitored frequently and compared with baseline -only assess BP if condition warrants it Taken: -On admission to the nursery or in the labor and birth room after the woman/parents are allowed to hold and bond with the newborn -Once every 30 minutes until the newborn has been stable for 2 hours -Then once every 4 to 8 hours until discharge

Periodic baseline changes in FHR

-temporary, recurrent changes made in response to a stimulus such as a contraction. -acceleration or deceleration

Floating

-term used when engagement has not occurred, because the presenting part is freely movable above the pelvic inlet.

Neuraxial analgesia/anesthesia

-the administration of analgesic (opioids) or anesthetic (capable of producing a loss of sensation in an area of the body) agents, either continuously or intermittently, into the epidural or intrathecal space to relieve pain ***does not interfere with the progress or outcome of labor -no need to withhold neuraxial analgesia until the active stage of labor

Baseline fetal heart rate

-the average FHR that occurs during a 10-minute segment that excludes periodic or episodic rate changes, such as tachycardia or bradycardia. -assessed when woman does not have contractions and the fetus is not experiencing episodic changes -normal: 110-160

Periodic breathing

-the cessation of breathing that lasts 5 to 10 seconds without changes in color or heart rate -may be observed in newborns within the first few days of life and requires close monitoring **Apneic periods lasting more than 15 seconds with cyanosis and heart rate changes require further evaluation

Bonding

-the close emotional attraction to a newborn by the parents that develops during the first 30 to 60 minutes after birth *unidirectional, from parent to infant

Descent

-the downward movement of the fetal head until it is within the pelvic inlet -occurs intermittently with contractions and is brought about by different forces -occurs throughout labor; ends with birth -mother will feel discomfort

Molding

-the elongated shaping of the fetal head to accommodate passage through the birth canal -It occurs with a vaginal birth from a vertex position in which elongation of the fetal head occurs with prominence of the occiput and overriding sagittal suture line. -It typically resolves within a week after birth without intervention -elongate shape of the fetal skull at birth as a result of overlapping of cranial bones

COmmitment

-the enduring nature of the relationship. -centrality and parent role exploration. -In centrality, parents place the infant at the center of their lives; promote the infant's safety, growth, and development. -Parent role exploration is the parents' ability to find their own way and integrate the parental identity into themselves

Cardiovascular adaptations at birth

-the first step in cardiovascular adaptation occurs when the cord is clamped, which increases systemic vascular resistance. -Concurrently, as the newborn is breathing, lung fluid is being replaced with oxygen, the pulmonary vessels are dilating, there is decreased pulmonary resistance and increased pulmonary blood flow. -All of this creates pressure changes in the heart. -These pressure changes close the fetal circulatory structures. *Significant hypoxia can cause fetal circulatory structures to reopen - this results in persistent fetal circulation, which means the newborn would be circulating unoxygenated blood.

Convection

-the flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface. -example of convection-related heat loss would be a cool breeze that flows over the newborn.

Attachment

-the formation of a relationship between a parent and his or her newborn through a process of physical and emotional interactions -Early and sustained contact between newborns and their parents is vital for initiating their relationship. -reciprocal between infant and caregiver -bonding is an essential component

Fontanelles

-the intersections of sutures -anterior and posterior fontanelles are also useful in helping to identify the position of the fetal head -these allow for molding -forms the soft spot

Biparietal diameter

-the largest transverse diameter of the fetal skull -distance between the two parietal bones -approx. 9.25 cm at term

Longitudinal lie

-the long axis of the fetus is parallel to that of the mother -fetal spine to maternal spine side-by-side

Transverse lie

-the long axis of the fetus is perpendicular to the long axis of the mother -fetal spine lies across the maternal abdomen and crosses her spine -cannot be delivered vaginally

Radiation

-the loss of body heat to cooler, solid surfaces that are in proximity but not in direct contact with the newborn -amount of heat loss depends on the size of the cold surface area, the surface temperature of the newborn's body, and the temperature of the receiving surface area -For example, when a newborn is placed in a single-wall isolette next to a cold window, heat loss from radiation occurs. -Newborns will become cold even though they are in a heated isolette

Evaporation

-the loss of heat when a liquid is converted to vapor -may be insensible (such as from skin and respiration; individual is not aware of its occurance) or sensible (such as from sweating; objective and can be noticed) -depends on air speed and the absolute humidity of the air -heat is lost at delivery as amniotic fluid evaporates -bathing causes heat loss

IgG

-the major immunoglobulin and the most abundant, making up about 80% of all circulating antibodies -found in serum and interstitial fluid -the only class able to cross the placenta (starting at 20-22 weeks gestation) -produces antibodies against bacteria, bacterial toxins, and viral agents

Lactogenesis

-the onset of milk secretion -initially triggered by the delivery of the placenta, which results in falling levels of estrogen and progesterone, with the continued presence of prolactin

Stage 3: Transition to mastery

-the partner makes a conscious decision to take control and be at the center of his/her newborn's life regardless of his/her preparedness. -This adjustment period is similar to that of the mother's letting-go phase, when she incorporates the newest member into the family.

Catecholamine release at birth

-the physical forces of the contractions of labor and birth, mild asphyxia, increased intracranial pressure as a result of cord compression and uterine contractions, and the cold stress experienced immediately after birth lead to an increased release of catecholamines that is critical for the changes involved in the transition to extrauterine life.

Reciprocity

-the process by which the infant's abilities and behaviors elicit parental response -2 dimensions: complementary behavior and sensitivity

Fetal station

-the relationship of the presenting part to the level of the maternal pelvic ischial spines -measured in centimeters; refered as a +/- depending on its location above/below the ischial spines (narrowest part of the pelvis)

Expulsion

-the rest of the body is expelled more smooth after the head and shoulders

Taking hold phase

-the second phase of maternal adaptation -characterized by dependent and independent maternal behavior. -typically starts on the second to third day postpartum and may last several weeks. -become preoccupied with the present. -She will be particularly concerned about her health, the infant's condition, and her ability to care for her or him. -She demonstrates increased autonomy and mastery of her own body's functioning, and a desire to take charge with support and help from others. -She will show independence by caring for herself and learning to care for her newborn, but she still requires assurance that she is doing well as a mother. -She expresses a strong interest in caring for the infant by herself.

What affects newborns hematologic values

-the site of the blood sample (capillary blood has higher levels of hemoglobin and hematocrit compared with venous blood) -placental transfusion (delayed cord clamping and normal shift of plasma to extravascular spaces, which causes higher levels of hemoglobin and hematocrit) -gestational age (increased age is associated with increased numbers of red cells and hemoglobin)

Anterior fontanelle

-the soft spot -diamond-shaped space that measures from 4-6 cm -It remains open for 12 to 18 months after birth to allow for growth of the brain

Mid pelvis (cavity)

-the space between the inlet and the outlet -snug and curved, fetus must travel through to reach the outside -as fetus travels through this, chest is compressed, causing fluid and mucous to be expelled and allows air to fill lungs

Nesting

-the sudden increase in energy -many women will focus their energy toward childbirth preparation by cleaning, cooking, preparing the nursery, spending extra time with children in the household

Conduction

-the transfer of heat from one object to another when the two objects are in direct contact with each other -refers to heat fluctuation between the newborn's body surface when in contact with other solid surfaces, such as a cold mattress, scale, or circumcision restraining board -Heat loss by conduction can also occur when touching a newborn with cold hands or when the newborn has direct contact with a colder object such as a metal scale

Gynecoid pelvis

-the typical female pelvis; 40% of women -most favorable for vaginal birth; inlet is round, outlet is roomy -allows early and complete fetal internal rotation during labor

Respirations of a newborn

-they are shallow and irregular, ranging from 30 to 60 breaths per minute, with short periods of apnea (less than 15 seconds). -varies according to activity -should not be labored -the chest movements should be symmetric

Transitional stool

-thin, brown to green, less sticky than meconium -typically appear 3 days after initiation of feeding -If breast-fed, the stools will resemble light mustard with seed-like particles -f formula-fed, the stools will be tan or yellow in color and firmer. *The frequency of bowel movements varies widely from one infant to another. ***Newborns that are fed early pass stools sooner, which helps to reduce bilirubin buildup

Effacement

-thinning of the cervix -allows the presenting fetal part to descend into the vagina -The process of cervical effacement and dilation is similar to that of pulling a turtleneck sweater over your head. -in primigravidas, this typically starts before labor and dilation -in multiparas, this may not start until after dilation and labor have begun

Deceleration

-transient fall in FHR caused by stimulation of the parasympathetic nervous system -classified as early late and variable

If fluid is removed too slowly or incompletely from the lungs...

-transient tachypnea (respiratory rate above 60 bpm) of the newborn occurs -Examples of situations involving decreased thoracic compression and diminished respiratory effort include cesarean birth and sedation in newborns

Opioids for labor

-typically are administered intravenously -lipophilic; cross the placental barrier -do not affect labor progress in the active phase -associated with newborn respiratory depression, decreased alertness, inhibited sucking, and a delay in effective feeding -may cause a decrease in FHR; usually transient -To reduce the incidence of newborn depression, birth should occur within 1 hour or after 4 hours of administration to prevent the fetus from receiving the peak concentration

Causes for absent or minimal variability in FHR

-typically is caused by fetal acidemia secondary to uteroplacental insufficiency, cord compression, a preterm fetus, maternal hypotension, uterine hyperstimulation, abruptio placenta, or a fetal dysrhythmia.

Taking in phase

-typically lasts 1 to 2 days and may be the only phase observed by nurses in the hospital setting -the time immediately after birth when the client needs sleep, depends on others to meet her needs, and relives the events surrounding the birth process. -characterized by dependent behavior -first 1-2 days mother takes a passive role in meeting needs; feeding, rest, allow nurse to make decisions -recount labor process to anyone that will listen; helps to integrate process to reality, the infant is not its own person -When interacting with the newborn, new mothers spend time claiming the newborn and touching him or her, commonly identifying specific features in the newborn, i.e. "he has my nose"

Women who should not breastfeed

-use of drugs such as antithyroid drugs, antineoplastic drugs, alcohol, herpes infection on the breasts, or street drugs -HIV+ women -a newborn with an inborn error of metabolism such as galactosemia or phenylketonuria (PKU), active tuberculosis, or a mother with a serious mental health disorder that would prevent her from remembering to feed the infant consistently

Fern test

-used to confirm ruptured membranes -vaginal fluid sample obtained -sample observed under microscope -positive sign would notice "fern" patterns under microscope

Cephalic presentation

-usually present the occipital portion; aka vertex presentation -variations of vertex include military, brow and facial presentation

Respiratory changes postpartum

-usually remain within the normal adult range of 16 to 24 breaths per minute. -diaphragm returns to its usual position. -Anatomic changes in the thoracic cavity and rib cage resolve quickly. -discomforts such as shortness of breath and rib aches are relieved. -Tidal volume, minute volume, vital capacity, and functional residual capacity return to prepregnant values, typically within 1 to 3 weeks of birth

Lochia

-vaginal discharge after childbirth -continues 4-8 weeks after birth -results from onvolution ***at any stage should have a fleshy smell; an offensive odor usually indicates an infection, such as endometritis. ***A danger sign is the reappearance of bright-red blood after lochia rubra has stopped. Reevaluation by a health care provider is essential if this occurs.

Nitrazine test

-vaginal fluid is acidic; amniotic fluid is alkaline -ammonitic fluid turns nitrazine swab blueish green to deep blue; pH is 6.5-7.5 -if acidic nitrazine swab stays yellow or olive green pH 5-6 -False bostive common with a large bloody show -if inconclusive, may need fern test

Apgar score timing

-valuate a newborn's physical condition at 1 minute and 5 minutes after birth -additional assessment is done at 10 minutes if the 5-minute score is less than 7

Common skin variations

-vernix caseosa stork bites or salmon patches -milia -Mongolian spots -erythema toxicum -harlequin sign -nevus flammeus -nevus vasculosus

Variable decelerations

-visually apparent abrupt decreases in FHR below baseline and have an unpredictable shape on the FHR baseline, possibly demonstrating no consistent relationship to uterine contractions -usually occur abruptly with quick deceleration -most common deceleration pattern found in the laboring woman and are usually transient and correctable -associated with cord compression -lassified either as category II or III depending on the accompanying change in baseline variability

Early decelerations

-visually apparent, usually symmetrical, and characterized by a gradual decrease in the FHR in which the nadir (lowest point) occurs at the peak of the contraction. -rarely dec >30-40 bpm below baseline -often seen in active stage of normal labor, during pushing, crowning, and vacuum extraction -possibly a result of fetal head compression -NOT indicative of fetal distress and do not require intervention.

Late decelerations

-visually apparent, usually symmetrical, transitory decreases in FHR that occur after the peak of the contraction. -FHR does not return to baseline levels until well after the contraction has ended. -Delayed timing of the deceleration occurs, with the nadir of the uterine contraction. -associated with uteroplacental insufficiency; when blood flow within the intervillous space is decreased to the extent that fetal hypoxia or myocardial depression exists -imply some degree of fetal hypoxia. -Recurrent or intermittent late decelerations are always category II (indeterminate) or category III (abnormal) -Acute episodes with moderate variability are more likely to be correctable, whereas chronic episodes with loss of variability are less likely to be correctable

Administering Prescribed Medications at Birth

-vitamin K -eye prophylaxis with either erythromycin or tetracycline ophthalmic ointment

Tachycardia in a newborn

-volume depletion -cardiorespiratory disease -drug withdrawal -hyperthyroidism >160

Intra-abdominal pressure

-voluntary muscle contractions -compresses the uterus and adds to the power of the expulsion forces of contractions *Interference with these forces (highly sedated or extremely anxious) can compromise the effectiveness of these powers.

Expression and storage of breastmilk

-wash hands -use clean containers to store milk in either refrigerator or freezer. -Warm milk immunoglobulins in warm pan or bottle warmer -NEVER MICROWAVE -check temperature by putting a few drops on inside of wrist. -follow hospital instructions regarding refrigeration and freezing. -Discard used milk.

Stage 2: Reality

-when partner realizes their expectations are not what they thought -Feelings change from elation to sadness, ambivalence, jealousy, and frustration -May develop partner postpartum depression; strain relationships -some find parenting fun but not prepared

Indications for continuous EFM

-women receiving oxytocin infusing -women having epidural analgesia -a variety of problems related to a compromise in either fetal or maternal health -prolonged rupture of membranes (>24 hours) -moderate hypertension (>150/100) -confirmed delay in the first or second stage of labor -the presence of meconium

Herbal medicine and labor

-women use herbs to induce labor and also during labor for pain relief -use of herbs during labor have been found to benefit some women by easing the labor process without side effects, but clinical trials are lacking to prove the safety and effectiveness of them

Epidural contraindications

-women with a previous history of spinal surgery or spinal abnormalities, coagulation defects cardiac disease, obesity, infections, and hypovolemia. -also is contraindicated for the woman who is receiving anticoagulation therapy.

Massage

-works as a form of pain relief by increasing the production of endorphins in the body

3 Retrogressive Processes of Involution

1. Contraction of muscle fibers to reduce those previously stretched during pregnancy 2. Catabolism, which shrinks enlarged, individual myometrial cells 3 Regeneration of uterine epithelium from the lower layer of the decidua after the upper layers have been sloughed off and shed during lochial discharge

Prioritize the postpartum mother's needs 4 hours after giving birth by placing a number 1, 2, 3, or 4 in the blank before each need. _________ Learn how to hold and cuddle the infant. _________Watch a baby bath demonstration given by the nurse. _________ Sleep and rest without being disturbed for a few hours. _________ Interaction time (first 30 minutes) with the infant to facilitate bonding.

1. Interaction time (first 30 minutes) with the infant to facilitate bonding 2. Sleep and rest without being disturbed for a few hours 3. Learn how to hold and cuddle the infant 4. Watch a baby bath demonstration given by the nurse

The five S's

1. Swaddling tightly 2. Side/stomach position on the lap of the caretaker 3. Shushing loudly or continuous white noise 4. Swinging using any rhythmic movement 5. Sucking

3 letter abbreviation for position

1. The first letter defines whether the presenting part is tilted toward the left (L) or the right (R) side of the maternal pelvis. 2. The second letter represents the particular presenting part of the fetus: -O for occiput, S for sacrum (buttocks), M for mentum (chin), A for acromion process, and D for dorsal (refers to the fetal back) when denoting the fetal position in shoulder presentations 3. The third letter defines the location of the presenting part in relation to the anterior (A) portion of the maternal pelvis or the posterior (P) portion of the maternal pelvis. -If the presenting part is directed to the side of the maternal pelvis, the fetal presentation is designated as transverse (T). *For example, if the occiput is facing the left anterior quadrant of the pelvis, then the position is termed left occiput anterior and is recorded as LOA.

7 behaviors of engrossment

1. Visual awareness of the newborn—the partner perceives the newborn as attractive, pretty, or beautiful. 2. Tactile awareness of the newborn—the partner has a desire to touch or hold the newborn and considers this activity to be pleasurable. 3. Perception of the newborn as perfect—the partner does not "see" any imperfections. 4. Strong attraction to the newborn—the partner focuses all attention on the newborn when they are in the room. 5. Awareness of distinct features of the newborn—the partner can distinguish his/her newborn from others in the nursery. 6. Extreme elation—the partner feels a "high" after the birth of his/her child. 7. Increased sense of self-esteem—the partner feels proud, "bigger," more mature, and older after the birth of his/her child

Stages of labor

1. dilation: 0-10 cm; 3 phases 2. expulsive: dilation (10 cm) to birth; may last 3 hours 3. placental: Separation and delivery of the placenta; usually takes 5-10 min, but may take up to 30 min 4. restorative: 1-4 h after the birth of the newborn; time of maternal physiologic adjustment

Three factors that predispose women to thromboembolic disorders during pregnancy

1. stasis: compression of the large veins because of the gravid uterus 2. altered coagulation: state of pregnancy) 3. localized vascular damage: may occur during the birthing process **All of these factors increase the risk of clot formation and having it travel to the lungs.

Normal newborn WBC

10-30000/mm3 -Leukocytosis is present as a result of birth trauma soon after birth

Bearing down/pushing assessment during second, third and fourth stage of labor

2nd stage: Assist with every effort 3rd and 4th stage: None

Behavior/psychosocial assessment during second, third and fourth stage of labor

2nd stage: Observe every 15 min: cooperative, focus is on work of pushing newborn out 3rd stage: Observe every 15 min: often feelings of relief after hearing newborn crying; calmer 4th stage: Observe every 15 min: usually excited, talkative, awake; needs to hold newborn, be close, and inspect body

Vaginal discharge assessment during second, third and fourth stage of labor

2nd stage: Observe for signs of descent—bulging of perineum, crowning 3rd stage: Assess bleeding after expulsion 4th: Assess every 15 min with fundus firmness

FHR assessment during second, third and fourth stage of labor

2nd stage: Q 5-15 min by doppler or continuously by EFM 3rd: Apgar scoring at 1 and 5 min 4th: Newborn—complete head-to-toe assessment; vital signs every 15 min until stable

Contractions/uterus assessment during second, third and fourth stage of labor

2nd stage: palpate every one 3rd: observe for placental separation 4th: palpating for firmness and position Q 15 min for first hour

Factors affecting attachment

3 major factors: 1. Parents' background (includes the care that the parents received when growing up, cultural practices, relationship within the family, experience with previous pregnancies and planning and course of events during pregnancy, postpartum depression) 2. Infant (includes the infant's temperament and health at birth) 3. Care practices (the behaviors of physicians, midwives, nurses, and hospital personnel, care and support during labor, first day of life in separation of mother and infant, and rules of the hospital or birthing center) **attachment occurs more readily with the infant whose temperament, health, appearance, and gender fit the parent's expectations.

Simian line

A single crease in the palm of the hand that may indicate chromosomal disorders such as Down Syndrome.

On the fetal heart monitor, the nurse notices an elevation of the fetal baseline with the onset of contractions. This elevation would describe _____________.

Acceleration—elevation of FHR above the baseline; a category I pattern, which is normal.

Most important aspects of nursing management related to newborn skin variations include

Adequate recognition of the lesions and knowledge of their natural history so that accurate information can be offered to the parents/significant other or partner. *majority of the skin lesions do not require any therapeutic intervention, but referral is necessary if there is: visual, airway or ear-canal obstruction, extensive growth, severe facial disfigurement, recurrent bleeding, infection, or ulceration, or excessive concern by the parents.

Anatomy and physiology of newborn respiratory system

Air-filled, low-pressure system encourages blood flow through the lungs for gas exchange; increased oxygen content of blood in the lungs contributes to the closing of the ductus arteriosus (becomes a ligament)

Apgar score parameters

Assess 5 parameters that evaluate a newborn's cardiorespiratory adaptation after birth. ***Appearance, Pulse, Grimace, Activity, Respiratory*** 1) heart rate (absent, slow, or fast), 2)respiratory effort (absent, weak cry, or good strong yell) 3) Activity/muscle tone (limp, or lively and active) 4) Grimace/response to irritation stimulus 5) color ***arranged most to least important -scored 0 (absent or poor response), 1 or 2 (normal) **heart rate was found to be the most important diagnostic and prognostic of the five signs

Postpartum blues/baby blues/maternal blues

Characterized by: -mild depressive symptoms -anxiety -irritability -mood swings -lose their appetite -have trouble sleeping -tearfulness (often for no discernible reason) -increased sensitivity -fatigue -Emotional lability is the most prominent symptom of the maternity blues -typically peak on postpartum days 4 and 5, may last hours to days, usually resolve by day 10. -typically do not affect the mother's ability to function and care for her child. -reassurance and validation of the woman's experience, as well as assistance in caring for herself and the newborn are typically warranted -follow up care is important to avoid depression

In the taking-in maternal role phase described by Rubin (1984), the nurse would expect the woman's behavior to be characterized as which of the following? a. Gaining self-confidence b. Adjusting to her new relationships c. Being passive and dependent d. Resuming control over her life

Click To Hide The correct response is C. According to Reva Rubin, the mother is very passive and is dependent on others to care for her for the first 24 to 48 hours after giving birth. Gaining self-confidence would characterize a mother in the taking-hold phase, during which the mother demonstrates mastery over her own body's functioning and feels more confident in caring for her newborn. Adjustment to relationships does not occur until the third phase, letting go, when the mother begins to separate from the symbiotic relationship she and her newborn enjoyed during pregnancy and birth. Resuming control over her life would denote the second phase of taking hold, during which the mother does resume control over her life and gains self-confidence in her newborn care.

Step 3 of Leopold's maneuvers

Complete the second maneuver to determine position. -While still facing the woman, move hands down the lateral sides of the abdomen to palpate on which side the back is located (feels hard and smooth). -Continue to palpate to determine on which side the limbs are located (irregular nodules with kicking and movement).

Preoperative circumcision preparation

Confirm the following: -Infant is at least 12 hours old or older -Infant has received standard vitamin K prophylaxis -Infant has voided normally at least once since birth -Infant has not eaten for at least an hour prior to the procedure -Written parental consent has been obtained -Correct identification of the infant brought to the procedure room -need pain meds/comfort measures

Conjugated vs unconjugated bilirubin

Conjugated (direct): -excreted from liver cells as a constituent of bile -water soluble -in the liver Unconjugated (indirect): -fat soluble -in the blood *liver process the unconjugated bilirubin into conjugated bilirubin

In an effort to decrease complications for the infant right after birth, the nurse would expect to administer which medication for prophylaxis of potential eye conditions? a. Silver nitrate solution b. Vitamin K c. Gentamicin ophthalmic ointment d. Tetracycline ophthalmic ointment

D. Prophylactic agents that are currently recommended (and in most states legally required) include erythromycin 0.5% ophthalmic ointment or tetracycline 1% ophthalmic ointment in a single application.

A nurse is caring for the client who gave birth a week ago. The client informs the nurse that she experiences painful uterine contractions when breastfeeding the baby. Which should the nurse do next? a. Have the client stop breastfeeding. b. Instruct the client to take a warm shower. c. Ask how often the client is breastfeeding. d. Tell the client to take an NSAID orally.

D. Approximately one-third of students who answered this question in Wolters Kluwer's adaptive learning systems, powered by PrepU, answered "Ask how often the client is breastfeeding." This is a question that should be asked during lactation consultation, but it is not an intervention the nurse should implement upon learning the client is experiencing this pain. The client should be instructed to take a milk analgesic such as an NSAID.

Anatomy and physiology of fetal hepatic portal circulation

Ductus venosus bypasses; maternal liver performs filtering functions

Anatomy and physiology of newborn hepatic portal circulation

Ductus venosus closes (becomes a ligament); hepatic portal circulation begins

Nursing assessment when ambulating with CSE

Evaluate for safety includes: -no postural hypotension -normal leg strength by demonstrating a partial knee bend while standing ***Nurse needs to assist with ambulation at all times *Currently, anesthesiologists are performing walking epidurals using continuous infusion techniques as well as CSE and client-controlled epidural analgesia

Negative parent attachment behaviors

Expresses disappointment or displeasure in infant; fails to "explore" infant visually or physically; fails to claim infant as part of family; avoids caring for infant; finds excuses not to hold infant close; has negative self-concept; appears uninterested in having infant in room; frequently asks to have infant taken back to nursery to be cared for; assigns negative attributes to infant and calls infant inappropriate, negative names (e.g., frog, monkey, tadpole)

Normal newborn temp

F- 97.9-99.7 C-36.6-37.6 ***normal axillary temp is 36.5-36..5 (97.7-99.5)

How does bilirubin cause jaundice

Failure of the liver cells to break down and excrete bilirubin can cause an increased amount of bilirubin in the bloodstream -When unconjugated bilirubin pigment is deposited in the skin and mucous membranes as a result of increased bilirubin levels, jaundice, also known as icterus, develops, with a yellowing of the skin, sclera, and mucous membranes

Negative infant attachment behaviors

Feeds poorly, regurgitates often; cries for long periods, colicky and inconsolable; shows flat affect, rarely smiles even when prompted; resists holding and closeness; sleeps with eyes closed most of time; stiffens body when held; is unresponsive to parents; doesn't pay attention to parents' faces

Patterns of breathing learned for labor

First pattern: -slow-paced breathing -the woman inhales slowly through her nose and exhales through pursed lips. -breathing rate is 6 to 9 bpm. Second pattern: -woman inhales and exhales through her mouth at a rate of four breaths every 5 seconds. -rate can be accelerated to two breaths per second to assist her to relax. Third pattern: -similar to the second pattern except that the breathing is punctuated every few breaths by a forceful exhalation through pursed lips. -All breaths are kept equal and rhythmic and can increase as contractions increase in intensity

Defining extent of lacerations/tears during labor

First-degree laceration: -extends through the skin Second-degree laceration: -extends through the muscles of the perineal body Third-degree laceration: -continues through the anal sphincter muscle Fourth-degree laceration: -also involves the anterior rectal wall *3rd and 4th stage need special attention to fecal incontinence *provider should repair any lacerations during the third stage of labor.

Education and support for breastfeeding

Frequency of feeds: 8 times in a 24-hour period; about every 2-3 hours Duration: -Allow newborn to nurse as long as they want on first side, then change to other side -burp between sides. -not breastfeeding if asleep -teach mother to look for active nursing. -alternate breasts and change positions from feed to feed. Supply and demand: -The more the baby sucks, the more the breasts are stimulated to produce milk. -Sucking stimulates release of oxytocin and prolactin. -Oxytocin causes let-down or milk-ejection reflex. -This can occur even when a mother thinks of her baby or hears another baby cry. -Prolactin stimulates milk-production. -So, the supply of milk is influenced by the demand of nursing. -To establish a good milk supply, it is important that the mother avoid supplements and use of pacifiers during the first few weeks. -Resources: Written instructions and lists of area resources and LCs; Warm-lines to call back to hospital for questions; Lactation Consultants in hospital and in community

Methods of circumcision

Gomco clamp Hollister Plastibell Mogen Clamp

Bladder & renal structure changes post partum

Gradual return within 6 weeks

Posture

How does the newborn hold his or her extremities in relation to the trunk? The greater the degree of flexion, the greater the maturity. For example, extension of arms and legs is scored as 0 points and full flexion of arms and legs is scored as 4 points.

Arm recoil

How far do the newborn's arms "spring back" to a flexed position? This measure evaluates the degree of arm flexion and the strength of recoil. The reaction of the arm is then scored from 0 to 4 points based on the degree of flexion as the arms are returned to their normal flexed position. The higher the points assigned, the greater the neuromuscular maturity (for example, recoil less than a 90-degree angle is scored as 4 points).

Stimuli for initiating respirations

Hypercapnia, hypoxia, and acidosis resulting from normal labor become stimuli for initiating respirations -Separation from placenta causes mild hypoxia & ↓ pH -Sensory changes stimulate respiratory center - breathing continues

Which antibody crosses the placenta while in utero?

IgG

Temperature checks during first stage of labor

In every phase: -Q4H; more frequent if membranes rupture

Normal ear assessment

Inspect the ears for size, shape, skin condition, placement, amount of cartilage, and patency of the auditory canal Normal: soft and pliable with quick recoil when folded and released Common variations: Low-set ears, hearing loss

Maneuver 4

Is the fetal head flexed and engaged in the pelvis?

Iceterus

Jaundice

Most common fetal attitude

Joints flexed -back is rounded -chin on chest -thighs flexed on abdomen -legs flexed at knees *most favorable for vaginal birth *presents the smallest fetal skull diameters to the pelvis

FHR assessment during first stage of labor

Latent Phase (0-3 cm) - Every hour by Doppler or continuously by EFM Active phase (4-7 cm) -Every 30 min by Doppler or continuously by EFM Transition phase (8-10 cm) - Every 15-30 min by Doppler or continuously by EFM

Vaginal exam during first stage of labor

Latent Phase (0-3 cm) - Initially on admission to determine phase and as needed based on maternal cues to document labor progression Active phase (4-7 cm) and Transition phase (8-10 cm) -As needed to monitor labor progression

Contraction assessment during first stage of labor

Latent Phase (0-3 cm) -Every 30-60 min by palpation or continuously if EFM Active phase (4-7 cm) -Every 15-30 min by palpation or continuously if EFM Transition phase (8-10 cm) -Every 15 min by palpation or continuously if EFM

Behavior/psych assessment during first stage of labor

Latent Phase (0-3 cm) -With every client encounter: talkative, excited, anxious Active phase (4-7 cm) -With every client encounter: self-absorbed in labor; intense and quiet now Transition phase (8-10 cm) - With every client encounter: discouraged, irritable, feels out of control, declining coping ability

Positive parent attachment behaviors

Makes direct eye contact; assumes en face position when holding infant; claims infant as family member, pointing out common features; expresses pride in infant; assigns meaning to infant's actions; smiles and gazes at infant; touches infant, progressing from fingertips to holding; names infant; requests to be close to infant as much as allowed; speaks positively about infant

Newborns and hypoglycemia risk factors

Newborns of diabetic mothers LGA or SGA Pre or Postterm Hypothermia Infection Respiratory Distress or Resuscitation

Apgar score ranges

Normal: 8+; no intervention needed other than supporting normal respiratory efforts and maintaining thermoregulation 4-7: moderate difficulty adjusting to extrauterine life 0-3: severe distress in adjusting to extrauterine life

Normal mouth assessment

Normal: aligned in midline, symmetric, intact soft and hard palate Common variations: Epstein's pearls, erupted precocious teeth, thrush, cleft lip/pallet

Normal eye assessment

Normal: clear and symmetrically placed on face; online with ears -may be marked edema of the eyelids and subconjunctival hemorrhages due to pressure during birth -PERRLA -should have blink and pupillary reflex -red reflex should be seen bilaterally on retinoscopy Common variation: Chemical conjunctivitis, subconjunctival hemorrhages, transient strabismus, searching nystagmus

Normal extremities and spinal assessment

Normal: extremities symmetric with free movement -Inspect the hands for shape, number, and position of fingers and presence of palmar creases Common variations: Congenital hip dislocation; tuft or dimple on spine

Normal Face assessment

Normal: full cheeks, facial features symmetric Variations/common problems: Facial nerve paralysis, nevus flammeus, nevus vasculosus

Normal abdomen assessment

Normal: protuberant contour, soft, three vessels in umbilical cord (2A, 1V) -bowel sound assessment in all 4 quads -no masses or tenderness -inspect the umbilical area for signs of bleeding, infection, inflammation, redness, swelling, purulent drainage or bleeding, erythema around the umbilicus, granuloma, or abnormal communication with the intra-abdominal organs Common variations: Distended, only two vessels in umbilical cord

Nursing interventions r/t perineum postpartum

Nurses should encourage all women to practice pelvic floor muscle training exercises (PFMT) to improve pelvic floor tone, strengthen the perineal muscles, and promote healing. ***Failure to maintain and restore perineal muscular tone leads to urinary incontinence later in life for many women.

Spontaneous birth of the placenta

Occurs in one of two ways: -the fetal side (shiny gray side) presenting first (called Schultz's mechanism or more commonly called "shiny Schultz's") -the maternal side (red raw side) presenting first (termed Duncan's mechanism or "dirty Duncan"). *if placenta does not spontaneously deliver, provider assists with manual extraction

Maneuver 2

On which maternal side is the fetal back located? (Fetal heart tones are best auscultated through the back of the fetus.)

Most common screening tests for newborns

PKU hypothyroidism galactosemia sickle cell disease

Normal genitals assessment

Passage of meconium indicates patency *Normal male: smooth glans, meatus centered at tip of penis -scrotum usually appears relatively large with well-formed rugae and that should cover the scrotal sac. There should not be bulging, edema, or discoloration Normal female: swollen female genitals as a result of maternal estrogen Common variations: Edematous scrotum in males, vaginal discharge in females, pseudomenstruation

Step 2 of Leopold's maneuvers

Perform the first maneuver to determine presentation. -Facing the woman's head, place both hands on the abdomen to determine fetal position in the uterine fundus. -Feel for the buttocks, which will feel soft and irregular (indicates vertex presentation); feel for the head, which will feel hard, smooth, and round (indicates a breech presentation).

Step 5 of Leopold's maneuvers

Perform the fourth maneuver to determine attitude. -Turn to face the client's feet and use the tips of the first three fingers of each hand to palpate the abdomen. -Move fingers toward each other while applying downward pressure in the direction of the symphysis pubis. If you palpate a hard area on the side opposite the fetal back, the fetus is in flexion, because you have palpated the chin. If the hard area is on the same side as the back, the fetus is in extension, because the area palpated is the occiput. *Also, note how your hands move. If the hands move together easily, the fetal head is not descended into the woman's pelvic inlet. If the hands do not move together and stop because of resistance, the fetal head is engaged into the woman's pelvic inlet

Step 4 of Leopold's maneuvers

Perform the third maneuver to confirm presentation. -Move hands down the sides of the abdomen to grasp the lower uterine segment and palpate the area just above the symphysis pubis. -Place thumb and fingers of one hand apart and grasp the presenting part by bringing fingers together. -Feel for the presenting part. If the presenting part is the head, it will be round, firm, and ballottable; if it is the buttocks, it will feel soft and irregular.

Step 1 of Leopold's maneuvers

Place the woman in the supine position and stand beside her.

Anatomy and physiology of newborn circulation through the heart

Pressures in the left atrium are greater than in the right, causing the foreman ovale to close

Anatomy and physiology of fetal circulation through the heart

Pressures in the right atrium are greater than in the left, encouraging blood flow through the foreman ovale

Nursing interventions for hemorrhoid discomfort

Prevention or correction of constipation, encouraging the use of the sidelying position, proper toileting habits, assuming positions that minimize putting pressure on the hemorrhoids, and not straining during defecation will be helpful in reducing discomfort

Nursing care in 3rd stage of labor

Primarily focuses on: -immediate newborn care and assessment and observing for signs of placental separation, -being available to assist with the delivery of the placenta, recording the time of expulsion and inspecting it for intactness. -nurse should also be assessing by palpating the uterus before and after placental expulsion.

Powers

Primary: uterine contractions -cause complete dilation and effacement of the cervix Secondary: intra-abdominal pressure -voluntary; pushes and bears down

The National Institute for Health and Care Excellence (NICE) guidelines for laboring positioning

Recommend discouraging women from lying supine or semi-supine during labor and encourage them to adapt to any other position that they find comfortable since lying on their backs is associated with longer labors, increase in surgical births, increased pain, and a higher incidence of FHR abnormalities.

Positive infant attachment behaviors

Smiles; is alert; demonstrates strong grasp reflex to hold parent s finger; sucks well, feeds easily; enjoys being held close; makes eye-to-eye contact; follows parent's face; appears facially appealing; is consolable when crying

When assessing a term newborn (6 hours old), the nurse auscultates bowel sounds and documents recent passing of meconium. These findings would indicate: a. Abnormal gastrointestinal newborn transition and needs to be reported b. An intestinal anomaly that needs immediate surgery c. A patent anus with no bowel obstruction and normal peristalsis d. A malabsorption syndrome, resulting in fatty stools

The correct answer is C. The findings indicate a patent anus with no bowel obstruction and normal peristalsis.

Which of the following newborns could be described as breathing normally? a. Newborn A is breathing deeply, with a regular rhythm, at a rate of 20 bpm. b. Newborn B is breathing diaphragmatically with sternal retractions, at a rate of 70 bpm. c. Newborn C is breathing shallowly, with 40-second periods of apnea and cyanosis. d. Newborn D is breathing shallowly, at a rate of 36 bpm, with short periods of apnea.

The correct answer is newborn D. Normal breathing can be described as shallow, at a rate of 36 bpm, with short periods of apnea.

The nurse administers a single dose of vitamin K intramuscularly to a newborn after birth to promote: a. Conjugation of bilirubin b. Blood clotting c. Foreman ovale closure d. Digestion of complex proteins

The correct response is B. Vitamin K is needed for blood clotting and is a vital component of the blood-clotting cascade. The newborn's gut is sterile at birth and unable to manufacture vitamin K on its own without an outside source initially. Vitamin K has no impact on bilirubin conjugation, transport, or excretion. It is not involved in closing the foramen ovale; cutting the cord and changing gradient vascular pressures are responsible for this closure. Vitamin K has no influence over the digestive process of complex proteins.

The nurse is instructing the postpartum client who plans to bottle-feed her newborn about measures to prevent breast engorgement when she is discharged. Which of the following measures should the nurse include in the teaching plan? a. Decreasing her fluid intake for the first week at home b. Wearing a tight-fitting supportive bra 24 hours daily c. Take a diuretic to release the extra fluid in the breasts d. Manually express the milk that is accumulating

The correct response is "B" since wearing a supportive bra will decrease the discomfort and provide support for the heavy breasts. Engorgement will improve within 24 to 48 hours, although the milk supply may take several weeks to resolve. Responses "A" and "C" are incorrect since this is harmful advice to give a postpartum woman. Extra intake of fluids is recommended, not a reduction of them to keep her hydrated. Response "D" is incorrect since no attempt should be made to express milk from the breasts, as this will simply promote milk let down and further milk production and increase engorgement.

Which of the following would the nurse assess as indicating positive bonding between the parents and their newborn? a. Holding the infant close to the body b. Having visitors hold the infant c. Buying expensive infant clothes d. Requesting that the nurses care for the infant

The correct response is A. Desiring to be in close proximity to another human being is all part of the bonding process. Bonding cannot take place with separation of individuals. Closeness is needed by the two people bonding, and not having others hold the infant. Buying or wearing expensive clothes has no emotional effect on a bonding relationship. Requesting that nurses provide care separates the parent from the infant and suggests that the parents lack the desire for closeness with their infant.

Postpartum breast engorgement occurs 48 to 72 hours after giving birth. What physiologic change influences breast engorgement? a. An increase in blood and lymph supply to the breasts b. An increase in estrogen and progesterone levels c. Colostrum production increases dramatically d. Fluid retention in the breasts due to the intravenous fluids given during labor

The correct response is A. Engorgement refers to the swelling of the breast tissue as a result of an increase in blood and lymph supply to produce milk for the newborn. Estrogen and progesterone levels decrease, which allows prolactin to stimulate the glands to secrete milk. Their levels are restored when the first menses returns several weeks or months later, depending on the lactation status of the mother. Colostrum is a lemon-colored fluid secreted by both breasts immediately at birth, and within 4 to 5 days postpartum it gradually changes to transitional milk and finally mature milk by 2 weeks. Colostrum production reduces within days after childbirth as transitional and mature milk, thereby not contributing to breast engorgement.

When determining the frequency of contractions, the nurse would measure which of the following? a. Start of one contraction to the start of the next contraction b. Beginning of one contraction to the end of the same contraction c. Peak of one contraction to the peak of the next contraction d. End of one contraction to the beginning of the next contraction

The correct response is A. Frequency is measured from the start of one contraction to the start of the next contraction. The duration of a contraction is measured from the beginning of one contraction to the end of that same contraction. The intensity of two contractions is measured by comparing the peak of one contraction with the peak of the next contraction. The resting interval is measured from the end of one contraction to the beginning of the next contraction.

The major purpose of the first postpartum homecare visit is to: a. Identify complications that require interventions b. Obtain a blood specimen for PKU testing c. Complete the official birth certificate d. Support the new parents in their parenting roles

The correct response is A. Home visits are usually made within the first week of discharge to assess the mother and newborn. This visit is made primarily to provide the nurse with the opportunity to recognize common biomedical and psychosocial problems or complications. Although not the primary reason, this visit also offers an opportunity to provide support and guidance to the parents in making the adjustment to the change in their lives. The home visit is not the time to complete PKU testing or complete the birth certificate.

A nurse observes a 3-day-old term newborn that is starting to appear mildly jaundiced. What might explain this condition? a. Physiologic jaundice secondary to breast-feeding b. Hemolytic disease of the newborn due to blood incompatibility c. Exposing the newborn to high levels of oxygen d. Overfeeding the newborn with too much glucose water

The correct response is A. Physiologic jaundice typically starts after 72 hours of breast-feeding. There is an enzyme in breast milk that inhibits the breakdown of bilirubin, and it is reflected on the newborn skin as jaundice. Hemolytic disease of the newborn typically shows within 24 hours after birth due to the different types of blood between mother and newborn. Exposure to oxygen has no link to causing jaundice in the newborn. Glucose water is not a cause of jaundice, but it might promote more frequent bowel movements which assist in eliminating bilirubin.

When caring for a client during the active phase of labor without continuous electronic fetal monitoring, the nurse would intermittently assess FHR every: a. 15 to 30 minutes b. 5 to 10 minutes c. 45 to 60 minutes d. 60 to 75 minutes

The correct response is A. Several professional women's health organizations have published guidelines concerning the timing of intermittent FHR assessments during the active stage of labor. The current recommendation is that intermittent FHR is assessed every 15 minutes during the active phase of labor.

A prophylactic agent is instilled in both eyes of all newborns to prevent which of the following conditions? a. Gonorrhea and chlamydia b. Thrush and enterobacter c. Staphylococcus and syphilis d. Hepatitis B and herpes

The correct response is A. The eyes of newborns can be exposed to gonorrhea and/or chlamydial organisms if they are present in the mother's vagina during the birth process, possibly resulting in a severe infection and blindness. Therefore, eye prophylaxis is administered. Thrush and Enterobacter typically do not affect the eyes. Thrush develops in the newborn's mouth after exposure to maternal vaginal yeast infections during the birth process. Infections with Staphylococcus and syphilis are contracted through bloodstream exposure or via the placenta and not by contact with the maternal vagina during birth. Eye treatment would not impact/treat either infectious process. Hepatitis B and herpes are not treatable with eye ointment.

After birth, the nurse would expect which fetal structure to close as a result of increases in the pressure gradients on the left side of the heart? a. Foramen ovale b. Ductus arteriosus c. Ductus venosus d. Umbilical vein

The correct response is A. The foramen ovale is the fetal structure within the heart that allows blood to cross immediately to the left side and bypass the pulmonary circuit. When left side pressure gradients increase at birth, this opening closes, thereby establishing an extrauterine circulation pattern. The ductus venosus is not located in the heart; it is located between the umbilical vein and the inferior vena cava, and it shunts blood away from the liver during fetal life. The ductus arteriosus connects the pulmonary artery to the aorta to bypass the pulmonary circuit. It begins to constrict as pulmonary circulation and arterial oxygen tension increase. The umbilical vein, along with two umbilical arteries, is part of the umbilical cord that is cut at birth.

During the fourth stage of labor, the nurse assesses the woman at frequent intervals after giving childbirth. What assessment data would cause the nurse the most concern? a. Moderate amount of dark red lochia drainage on peripad b. Uterine fundus palpated to the right of the umbilicus c. An oral temperature reading of 100.6° F d. Perineal area bruised and edematous beneath her ice pack

The correct response is B. A full bladder causes displacement of the uterus above it, and increased bleeding results secondary to the uncontracted status of the uterus. Massaging the uterus will help to make it firm but will not help to bring it back into the midline, since the full bladder is occupying the space the uterus would normally assume. Notifying the primary health care provider is not necessary unless the woman continues to have difficulty voiding and the uterus remains displaced. The normal location of the uterus in the fourth stage of labor is in the midline. Displacement suggests a full bladder, which is not considered a normal finding.

Which fetal lie is most conducive to a spontaneous vaginal birth? a. Transverse b. Longitudinal c. Perpendicular d. Oblique

The correct response is B. A longitudinal lie places the fetus in a vertical position, which would be most conducive for a spontaneous vaginal birth. A transverse lie does not allow for a vaginal birth because the fetus is lying perpendicular to the maternal spine. A perpendicular lie describes the transverse lie, which would not be conducive for a spontaneous birth. An oblique lie would not allow for a spontaneous vaginal birth because the fetus would not fit through the maternal pelvis in this side-lying position.

Which of the following suggestions would be most appropriate to include in the teaching plan for a postpartum woman who needs to lose weight? a. Increase fluid intake and acid-producing foods in her diet. b. Avoid empty-calorie foods, breastfeed, increase exercise. c. Start a high-protein, low carbohydrate diet and restrict fluids. d. Eat no snacks or carbohydrates after dinner.

The correct response is B. Because weight loss is based on the principle of intake of calories and output of energy, instructing this woman to avoid high-calorie foods that yield no nutritive value and expending more energy through active exercise would result in weight loss for her. Acid-producing foods (plums, cranberries, and prunes) are typically recommended for women to prevent urinary tract infections to acidify the urine, not for weight-loss purposes. Increasing fluid intake (water) would be good for weight loss because it fills the stomach and reduces hunger sensations; however, this option does not identify which fluids should be increased. Increasing high-calorie juice and soda drinks would be counterproductive to weight-loss measures. Fluid restriction combined with a high-protein diet would increase the risk of gout and formation of kidney stones. Carbohydrates are needed by the body to make ATP and convert it to energy for cellular processes. Limiting snacks might be a good suggestion depending on which ones are selected. Raw fruits and vegetables are excellent high-fiber snacks that will help in an overall weight-loss program.

A laboring woman is admitted to the labor and birth suite at 6-cm dilation. She would be in which phase of the first stage of labor? a. Latent b. Active c. Transition d. Early

The correct response is B. Cervical dilation of 6 cm indicates that the woman is in the active phase of the first stage of labor. In this phase, the cervix dilates from 3 to 7 cm with 40% to 80% effacement occurring. During the latent phase, the cervix dilates from 0 to 3 cm. During the transition phase, the cervix dilates from 8 to 10 cm. The first stage of labor is divided into three phases: latent, active, and transition. There is no early phase.

The nurse would expect a postpartum woman to demonstrate lochia in which sequence? a. Rubra, alba, serosa b. Rubra, serosa, alba c. Serosa, alba, rubra d. Alba, rubra, serosa

The correct response is B. Lochia discharge from the uterus proceeds in an orderly fashion, regardless of a surgical or vaginal birth. Its color changes from red to pink to whitish cream consistently, unless there is a complication. The correct sequence is rubra (red), then serosa (pink/brownish), and then alba (white, creamy).

As the nurse is explaining the difference between true versus false labor to her childbirth class, she states that the major difference between them is: a. Discomfort level is greater with false labor. b. Progressive cervical changes occur in true labor. c. There is a feeling of nausea with false labor. d. There is more fetal movement with true labor.

The correct response is B. Progressive cervical changes occur in true labor. This is not the case with false labor.

When assessing the term newborn, the following are observed: newborn is alert, heart and respiratory rates have stabilized, and meconium has been passed. The nurse determines that the newborn is exhibiting behaviors indicating: a. Initial period of reactivity b. Second period of reactivity c. Decreased responsiveness period d. Sleep period for newborns

The correct response is B. The behaviors demonstrated by the newborn, such as alertness, stabilized heart and respiratory rates, and passage of meconium are associated with the second period of reactivity. The first period of reactivity starts with a period of quiet alertness followed by an active alertness with frequent bursts of movement and crying. During the decreased responsiveness period, also called the sleep period, the newborn is relatively unresponsive and difficult to waken.

Engrossment

The father's or significant other's developing bond with the newborn—a time of intense absorption, preoccupation, and interest

Which of the following observations would suggest that placental separation is occurring? a. Uterus stops contracting altogether. b. Umbilical cord pulsations stop. c. Uterine shape changes to globular. d. Maternal blood pressure drops.

The correct response is C. After the placenta separates from the uterine wall, the shape of the uterus changes from discoid to globular. The uterus continues to contract throughout the placental separation process and the umbilical cord continues to pulsate for several minutes after placental separation occurs. Maternal blood pressure is not affected by placental separation because the maternal blood volume has increased dramatically during pregnancy to compensate for blood loss during birth.

Which activity would the nurse include in the teaching plan for parents with a newborn and an older child to reduce sibling rivalry when the newborn is brought home? a. Punishing the older child for bedwetting behavior b. Sending the sibling to the grandparents' house c. Planning a daily "special time" for the older sibling d. Allowing the sibling to share a room with the infant

The correct response is C. An older sibling needs to feel he or she is still loved and not upstaged by the newest family member. Allowing special time for that sibling reinforces the parent's love for him or her also. Regression behavior is common when there is stress in that sibling's life, and punishing him brings attention to negative behavior, possibly reinforcing it. The older sibling might feel he or she is being replaced and is not wanted by the parents when he or she is sent away. Including the older sibling in the care of the newborn is a better way to incorporate the newest member into the family unit. Sharing a room with the infant could lead to feelings of displacement in the sibling. In addition, frequent interruptions during the day and night will awaken the sibling and not allow a full night's sleep or undisturbed nap.

The nurse notes the presence of transient fetal accelerations on the fetal monitoring strip. Which intervention would be most appropriate? a. Reposition the client on the left side. b. Begin 100% oxygen via face mask. c. Document this as indicating a normal pattern. d. Call the health care provider immediately.

The correct response is C. Fetal accelerations denote an intact central nervous system and appropriate oxygenation levels demonstrated by an increase in heart rate associated with fetal movement. Accelerations are a reassuring pattern, so no intervention is needed. Turning the woman on her left side would be an appropriate intervention for a late deceleration pattern. Administering 100% oxygen via face mask would be appropriate for a late or variable deceleration pattern. Since fetal accelerations are a reassuring pattern, no orders are needed from the health care provider, nor does the health care provider need to be notified of this reassuring pattern.

Which condition would be missed if a newborn were screened before he had tolerated protein feedings for at least 48 hours? a. Hypothyroidism b. Cystic fibrosis c. Phenylketonuria d. Sickle cell disease

The correct response is C. Ingestion of certain amino acids found in breast milk or formula must be accumulated in the newborn to identify a deficiency in an enzyme that cannot metabolize them. If the PKU test is done prior to 24 to 48 hours after feeding, it must be repeated after the infant has tolerated feedings for at least that length of time. Identifying hypothyroidism is not linked to ingesting protein feedings. Cystic fibrosis is a genetic inherited condition not related to protein intake. Sickle cell disease is a genetically inherited condition unrelated to protein ingestion in the newborn.

After teaching a group of breast-feeding women about nutritional needs, the nurse determines that the teaching was successful when the women state that they need to increase their intake of which nutrients? a. Carbohydrates and fiber b. Fats and vitamins c. Calories and protein d. Iron-rich foods and minerals

The correct response is C. Lactating mothers need an extra 500 calories to sustain breast-feeding. An additional 20 g of protein is also needed to help build and regenerate body cells for the lactating woman. Additional intake of carbohydrates or fiber is not suggested for lactation. An increase in fats is not recommended, nor is it needed for breast-feeding. To obtain adequate amounts of vitamins during lactation, women are encouraged to choose a varied diet that includes enriched and fortified grains and cereals, fresh fruits and vegetables, and lean meats and dairy products. An increase in vitamins via supplements is not recommended. Choosing a variety of foods from the food pyramid will provide the lactating woman with adequate iron and minerals.

When assessing a postpartum woman, which of the following would lead the nurse to suspect postpartum blues? a. Panic attacks and suicidal thoughts b. Anger toward self and infant c. Periodic crying and insomnia d. Obsessive thoughts and hallucinations

The correct response is C. Periodic crying and insomnia are characteristics of postpartum blues, in addition to mood changes, irritability, and increased sensitivity. Panic attacks and suicidal thoughts or anger toward self and the infant would be descriptive of postpartum psychosis, when some women turn this anger toward themselves and have committed suicide or infanticide. Women experiencing postpartum blues do not lose touch with reality. Obsessive thoughts and hallucinations would be more descriptive of postpartum psychosis.

The AAP recommends that all newborns be placed on their backs to sleep to reduce the risk of: a. Respiratory distress syndrome b. Bottle mouth syndrome c. Sudden infant death syndrome d. GI regurgitation syndrome

The correct response is C. Research has identified sleeping position and its link to SIDS. Since 1992, the AAP has recommended that all newborns be placed on their backs to sleep. This recommendation has reduced the incidence of SIDS dramatically. Respiratory distress syndrome involves a lack of surfactant in the lungs, not sleeping position. The intake of formula or juice (high lactose exposure) being allowed to sit in the infant's mouth during sleep is the cause of bottle mouth syndrome. Positioning on the back might aggravate the GI regurgitation syndrome rather than help it.

3. When managing a client's pain during labor, nurses should: a. Make sure the agents given do not prolong labor b. Know that all pain relief measures are similar c. Support the client's decisions and requests d. Not recommend nonpharmacologic methods

The correct response is C. The entire focus of the labor and birth experience is for the family to make decisions, not the caretakers. The nurse's role is to respect and support those decisions. Decisions about pain management are not based on length of the various stages of labor, but rather on what provides effective pain relief for the laboring woman. Pain relief measures differ. Each individual responds differently and uniquely to various pain relief measures. Not recommending nonpharmacologic measures demonstrates bias on the nurse's part; it is not the nurse's decision to make, but rather the client's.

The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings by the nurse would be expected? a. Cream-colored lochia; uterus above the umbilicus b. Bright-red lochia with clots; uterus 2 fingerbreadths below umbilicus c. Light pink or brown lochia; uterus 4 to 5 fingerbreadths below umbilicus d. Yellow, mucousy lochia; uterus at the level of the umbilicus

The correct response is C. The nurse would expect light pink or brown lochia, and the uterus should be four to five fingerbreadths below the umbilicus. Cream-colored lochia wouldn't be seen for about 10 to 14 days after childbirth, thus it wouldn't be observed this early in the postpartum period. The uterus would be involuting downward into the pelvis, thus it would not be above the umbilicus by this timeframe. Bright-red lochia would be observed for up to 3 days postbirth, not 5 days later unless there was a problem. The uterus descends into the pelvis at a rate of 1 cm/day, thus the fundus should be 4 to 5 cm (fingerbreadths) below the umbilicus by now.

The shortest but most intense phase of labor is the: a. Latent phase b. Active phase c. Transition phase d. Placental expulsion phase

The correct response is C. The transition phase of the first stage of labor occurs when the contractions are 1 to 2 minutes apart and the final dilation is taking place. The transition phase is the most difficult and, fortunately, the shortest phase for the woman, lasting approximately 1 hour in the first birth and perhaps 15 to 30 minutes in successive births. Many women are not able to cope well with the intensity of this short period, become restless, and request pain medications. During the latent phase, contractions are mild. The woman is in early labor and able to cope with the infrequent contractions. This phase can last hours. The active phase involves moderate contractions that allow for a brief rest period in between, helping the woman to be able to cope with the next contraction. This phase can last hours. The placental expulsion phase occurs during the third stage of labor. After separation of the placenta from the uterine wall, continued uterine contractions cause the placenta to be expelled. Although this phase can last 5 to 30 minutes, the contraction intensity is less than that of the transition phase.

Which assessment would indicate that a woman is in true labor? a. Membranes are ruptured and fluid is clear. b. Presenting part is engaged and not floating. c. Cervix is 4 cm dilated, 90% effaced. d. Contractions last 30 seconds, every 5 to 10 minutes.

The correct response is C. True labor is characterized by contractions occurring at regular intervals that increase in frequency, duration, and intensity. These contractions bring about progressive cervical dilation and effacement. Thus, a cervix dilated to 4 cm and 90% effaced indicates true labor. Rupture of membranes may occur before the onset of labor, at the onset of labor, or at any time during labor and thus is not indicative of true labor. Engagement occurs when the presenting part reaches 0 station; it typically occurs 2 weeks before term in primigravidas and several weeks before the onset of labor or at the beginning of labor for multiparas. Contractions of true labor typically last 30 to 60 seconds and occur approximately every 4 to 6 minutes.

When a client in labor is fully dilated, which instruction would be most effective to assist her in encouraging effective pushing? a. Hold your breath and push through entire contraction. b. Use chest-breathing with the contraction. c. Pant and blow during each contraction. d. Wait until you feel the urge to push.

The correct response is D, since nondirected pushing, based on current research, leads to better outcomes for both mother and infant. Holding breath and pushing throughout the entire contraction reduce blood flow and oxygenation to the fetus. Chest breathing is not effective since it doesn't increase abdominal pressure to assist the uterus to contract. Panting and blowing are used to abstain from pushing, which is not what is needed to expel the fetus.

Which of the following would lead the nurse to suspect that a postpartum woman was developing a complication? a. Fatigue and irritability b. Perineal discomfort and pink discharge c. Pulse rate of 60 bpm d. Swollen, tender, hot area on breast

The correct response is D. A swollen, tender area on the breast would indicate mastitis, which would need medical intervention. Fatigue and irritability are not complications of childbearing, but rather the norm during the early postpartum period secondary to infant care demands and lack of sleep on the caretaker's part. Perineal discomfort and lochia serosa are normal physiologic events after childbirth and indicate normal uterine involution. Bradycardia is a normal vital sign for several days after childbirth because of the dramatic circulatory changes that take place with the loss of the placenta at birth and the return of blood back to the central circulation.

After teaching a group of nursing students about thermoregulation and appropriate measures to prevent heat loss by evaporation, which of the following student behaviors would indicate successful teaching? a. Transporting the newborn in an isolette b. Maintaining a warm room temperature c. Placing the newborn on a warmed surface d. Drying the newborn immediately after birth

The correct response is D. Evaporation is the loss of heat as water is lost from the skin to the environment. Drying the newborn at birth and after bathing, keeping linens dry, and using plastic wrap blankets and heat shields will all prevent heat loss through evaporation. Placing the newborn on a warmed surface will prevent heat loss via conduction. Maintaining a warm room temperature will prevent heat loss via convection. Transporting the newborn in an isolette will prevent heat loss via radiation.

Which one of the following immunizations is most commonly received by newborns before hospital discharge? a. Pneumococcus b. Varicella c. Hepatitis A d. Hepatitis B

The correct response is D. Most newborns are started on the hepatitis B series before discharge from the hospital and receive the remaining two immunizations at 1 month and 4 to 6 months of age. The pneumococcal vaccine is given between 2 and 23 months of age, not at birth. Varicella immunization is not given until 12 to 18 months of age. Hepatitis A immunization is recommended for children and adolescents in selected states and regions and for high-risk groups. It is not a universal vaccine for all children.

Which of these activities would best help the postpartum nurse to provide culturally sensitive care for the childbearing family? a. Taking a transcultural course b. Caring for only families of his or her cultural origin c. Teaching Western beliefs to culturally diverse families d. Educating himself or herself about diverse cultural practices

The correct response is D. Nurses need first to become educated about various cultural practices to incorporate them into their care delivery. By gaining an understanding of diverse cultures different from their own, nurses can become sensitive to these different practices and not violate them. Attending a transcultural course might be beneficial, but this would take several weeks to complete and the information is needed much sooner to provide culturally sensitive care for an admitted client and her family. Caring only for families of the nurse's cultural origin would not be possible or realistic in our global, culturally diverse population within the United States. Nurses need to care for every person regardless of their color, creed, or nationality with respect and competence. Teaching diverse cultural families Western beliefs would demonstrate ethnocentric behavior and would not be professional. Each culture needs to be respected and learned about with tolerance and understanding.

At birth, a newborn's assessment reveals the following: heart rate of 140 bpm, loud crying, some flexion of extremities, crying when bulb syringe is introduced into the nares, and a pink body with blue extremities. The nurse would document the newborn's Apgar score as: a. 5 points b. 6 points c. 7 points d. 8 points

The correct response is D. One point would be subtracted for color (acrocyanosis) and 1 point for fair flexion of extremities. All the assessment parameters should rate 2 points, except for color and flexion. Therefore, any score except 8 points would be incorrect.

The nurse is explaining phototherapy to the parents of a newborn. The nurse would include which of the following as the purpose? a. Increase surfactant levels b. Stabilize the newborn's temperature c. Destroy Rh-negative antibodies d. Oxidize bilirubin on the skin

The correct response is D. Phototherapy reduces the bilirubin on the newborn's skin via oxidation. Phototherapy does not affect surfactant levels in the newborn's lungs, nor does it help to stabilize temperatures in the newborn. In fact, it might cause hyperthermia at times if not monitored closely. Phototherapy cannot destroy Rh antibodies attached to RBCs within the circulation.

The nurse is explaining to a postpartum woman 48 hours after her giving childbirth that the after-pains she is experiencing can be the result of which of the following? a. Abdominal cramping is a sign of endometriosis b. A small infant weighing less than 8 lb c. Pregnancies that were too closely spaced d. Contractions of the uterus after birth

The correct response is D. The direct cause of afterpains is uterine contractions. Mothers experience abdominal pain secondary to contractions, especially when breast-feeding because sucking stimulates the release of oxytocin from the posterior pituitary gland, which causes uterine contractions. There is no association of afterpains with endometriosis. The small size of the newborn wouldn't stretch her uterus, thus would not be a contributing factor to her discomfort now. Pregnancies spaced too close together can contribute to frequent stretching of the uterus, but this is not the cause of afterpains.

Immediately after childbirth in the recovery area, the nurse observes the mother's partner's fascination and interest in the new son. This behavior is often termed: a. Attachment b. Engrossment c. Bonding d. Temperament

The correct response to the question is "B" because partner's or significant others' developing bond with the newborn—a time of intense absorption, preoccupation, and interest—is called engrossment. Responses "A," "C," and "D" are incorrect since they are terms typically describing the close relationship between the mother-infant dyad, not the father.

Which of the following practices would not be included in a physiologic birth? a. Early induction of labor <39 weeks gestation b. Freedom of movement for the laboring woman c. Continuous presence and support throughout labor d. Encouraging spontaneous pushing when urge felt

The correct response to this question is "A" since inducing labor artificially, rather than waiting for spontaneous labor to start doesn't provide for a physiologic birth. Nature should be allowed to take its course without artificial means to initiate labor. Responses "B," "C," and "D" all contribute to physiologic birth practices.

Which of the following findings in a newborn would be considered normal? a. Passage of meconium within the first 24 hours b. Respiratory rate of 80 breaths/minute c. Yellow skin tones at 10 hours after birth d. Bleeding from the umbilicus area

The correct response to this question is "A" since meconium is usually passed during the first 24 hours of life in most newborns. Response "B" is incorrect since the normal range for newborn respirations in newborn is 40 to 60 bpm. Response "C" is incorrect since finding jaundice within the first 24 hours would indicate pathologic jaundice, not physiologic jaundice and medical intervention would be warranted. Response "D" is incorrect since no bleeding from the umbilicus is normal and this finding needs additional evaluation.

Which of the following findings in a newborn would the nurse document as abnormal when assessing the newborn head? a. Two soft spots palpated between the cranial bones b. A spongy area of edema outlined on the head c. Head circumference 32 cm, chest 34 cm d. Asymmetry of the head with overriding bones

The correct response to this question is "C" because the circumference of the newborn's head should be approximately 2 cm greater than the circumference of the chest at birth. Response "A" is incorrect because these two soft spots are fontanels which are normally found on all newborn's heads. The posterior fontanel will close within 6 weeks and the anterior fontanel will close in about 18 months. Response "B" is incorrect because scalp edema (caput succedaneum) is commonly found on newborn's head due to trauma sustained from childbirth. It will dissipate within days. Response "D" is incorrect since overriding of bones (molding) is a common finding on all newborns to accommodate their head through the birth canal during childbirth.

By the end of the second stage of labor, the nurse would expect which of the following events? The a. cervix is fully dilated and effaced b. placenta is detached and expelled c. fetus is born and on mother's chest d. woman to request pain medication

The correct response to this question is "C" because the second stage of labor is defined as beginning with complete dilation of the cervix (10 cm) and ending with the expulsion of the fetus. Response "A" is incorrect because the cervix is fully dilated at the start of stage 2, not at the end of it. Response "B" is incorrect due to the fact that the third stage of labor is defined as the period following the birth of the newborn through the expulsion of the placenta. Response "D" is incorrect since typically most women desiring pain medication would be requesting it in the active phase of labor in stage 1.

A new mother was brought to the postpartum unit who gave birth 12 hours ago. Because this is her first child, which of the following goals by the nurse is most appropriate? a. Early discharge for the mother and newborn b. Rapid transition into her role of being a parent/caretaker c. Minimal need for expression of her feelings now d. Effective education of both parents before discharge

The correct response to this question is "D" because both parents will need education about the newborn, how to care for it, and how to care for themselves. Education is essential to help both parents in their transition and adaptation to parenthood. Response "A" is an incorrect response because that should never be the goal to discharge someone early, but only when they are appropriately prepared and stable. Response "B" is incorrect because the parenthood role happens over time, not immediately after giving birth and during the hospital stay. Response "C" is incorrect due to the fact that most postpartum women do wish to express their feelings and this activity should be encouraged, not stifled.

After the nurse provides instructions to a postpartum woman about postpartum blues, which statement would indicate understanding of it? I will: a. "Need to take medication daily to treat the anxiety and sadness." b. "Call the OB support line only if I start to hear voices." c. "Contact my doctor if I become dizzy and fell nauseated." d. "Feel like laughing one minute and crying the next minute."

The correct response to this question is "D" because emotional lability is typical of postpartum blues which is usually self-limiting. Response "A" is incorrect since postpartum blues don't require any medication to treat. Response "B" is incorrect since this behavior would indicate postpartum psychosis and not merely the "blues." Response "C" would indicate a physical condition, such as infection, not a mental disorder.

Because the newborn's red blood cells breakdown much sooner than those of an adult, what might result? a. Anemia b. Bruising c. Apnea d. Jaundice

The correct response to this question is "D" since newborns produce bilirubin (red blood cell breakdown end product) at twice the rate of adults, their liver is not able to conjugate bilirubin as quickly as needed, this results in jaundice. Response "A" is incorrect since newborns typically have more red blood cells than needed, thus anemia wouldn't result. Responses "B" and "C" are not linked to the red blood cell breakdown and are incorrect responses.

A nursing student questions the nursery nurse why they do not bathe the newborn immediately upon admission to the nursery observation area after birth. The nurse states that this would increase the risk of: a. Jaundice b. Infection c. Hypothermia d. Anemia

The correct response to this question would be "C" since newborns can rapidly become stressed by changes in environmental temperatures that bathing would cause through conduction. Postponing the newborn bath until the temperature has stabilized will help prevent newborn hypothermia. Responses "A," "B," and "D" are incorrect responses since there is no linkage between infection, jaundice, and anemia to infant bathing.

Physiologic preparation for labor would be demonstrated by: a. Decrease in Braxton Hicks contractions felt by mother b. Weight gain and an increase in appetite by mother c. Lightening, whereby the fetus drops into true pelvis d. Fetal heart rate accelerations and increased movements

The correct response would be "C" since as labor nears, the fetus gets into position by descending into the maternal true pelvis in preparation for birth. The woman will experience heaviness in her lower pelvis and urinary frequency when this occurs. Response "A" is incorrect since there is an increase in uterine contractions as the uterus becomes more irritable and readies for true labor. Response "B" is incorrect since most women experience a weight loss and a decrease in appetite close to the start of their labor. Response "D" is incorrect due to the fact that the fetus is in a cramped environment at term and has limited room to move around. The fetal heart rate would remain within the normal range of 110 to 160 bpm unless there is a problem.

The nurse performs a physical examination on a newborn 2 hours after birth. Which of the following findings indicate a need for a pediatric consultation? Select all that apply: a. Respiratory rate of 50 breaths per minute b. Intermittent episodes of apnea, lasting <10 seconds each c. Absent Moro reflex when startled d. Preauricular skin tag noted on left ear e. White raised bumps noted on nose and face f. Yellow blanching of the skin when pressure applied to the nose

The correct responses to this question are "C" and "F" because they are abnormal findings that need further evaluation by the pediatrician. Absence of the Moro reflex might indicate a neurologic problem and yellow blanching of the skin over a bony prominence might indicate pathologic jaundice since it is before 24 hours old. Physiologic jaundice typically occurs after 24 hours old, but a pathologic jaundice occurs before 24 hours old. The remaining choices "A," "B," "D," and "E" are all normal findings in the newborn.

Interventions that are underutilized in promoting a normal birth. Select all that apply. a. Oral nutrition and fluids in labor b. Open glottis pushing in the second stage of labor c. Skin-to-skin contact after birth for infant bonding d. Routine artificial rupture of membranes (amniotomy) e. Labor induction with Pitocin given intravenously f. Routine episiotomy to shorten labor length

The correct responses would include "A," "B,"and "C" since all of these are evidence-based interventions that are physiologically sound without placing the mother or the neonate in any danger. Food and clear fluids provide hydration and nutrition and give comfort to laboring women. Fasting during labor will increase gastric acid production. Open glottis while pushing allows the woman's body to sense the urge to push naturally. Skin-to-skin contact promotes mother-infant bonding and warmth. Incorrect responses would include "D," "E," and "F" since these are artificial means to speed up the labor process which places the mother and newborn in jeopardy. Amniotomy may be associated with umbilical cord prolapse and fetal heart rate decelerations. Episiotomy is associated with an increase in third- and fourth-degree perineal lacerations, discomfort, and healing delays. Induction with Pitocin may cause tetanic contractions causing hypoxia to the fetus.

Contraction strength in true vs false labor

True: Become stronger with time, vaginal pressure is usually felt False: Frequently weak, not getting stronger with time or alternating (a strong one followed by weaker ones)

Any changes in activity in true vs false labor

True: Contractions continue no matter what positional change is made False: Contractions may stop or slow down with walking or making a position change

Contraction discomfort in true vs false labor

True: Starts in the back and radiates around toward the front of the abdomen False: Usually felt in the front of the abdomen

When to stay or go to the hospital: True vs False labor

True: Stay home until contractions are 5 min apart, last 45-60 s, and are strong enough so that a conversation during one is not possible—then go to the hospital or birthing center. False: Drink fluids and walk around to see if there is any change in the intensity of the contractions; if the contractions diminish in intensity after either or both—stay home.

Gestational age scoring

Typically newborns are also classified according to their gestational age as: -Preterm or premature—born prior to 37 completed weeks' gestation, regardless of birth weight -Term—born between 38 and 42 weeks' gestation Post-term or postdates—born after completion of week 42 of gestation -Postmature—born after 42 weeks and demonstrating signs of placental aging

Maneuver 1

What fetal part (head or buttocks) is located in the fundus (top of the uterus)?

Maneuver 3

What is the presenting part?

Antigen

a foreign substance that induces an immune response in the body

Smell at birth

ability to distinguish between mother's breast milk and breast milk from others

Anocutaneous reflex

aka anal wink -elicited by stimulating the perianal skin close to the anus. -The external sphincter will constrict (wink) immediately with stimulation. -This indicates S4-S5 innervations

Galant refelx

aka: truncal incurvation reflex -present at birth and disappears in a few days to 4 weeks -With the newborn in a prone position or held in ventral suspension, apply firm pressure and run a finger down either side of the spine. -This stroking will cause the pelvis to flex toward the stimulated side. -This indicates T2-S1 innervation. -Lack of response indicates a neurologic or spinal cord problem.

Infant variables identified as influencing Maternal role attainment (MAR)/Becoming a mother (BAM)

appearance, responsiveness, temperament, and health status

Elective induction of labor in nulliparas

associated with increased rates of cesarean, postpartum hemorrhage, neonatal resuscitation, and longer hospitalizations without improvement in neonatal outcomes

Pain during the first stage of labor

associated with ischemia of the uterus during contractions

Pain during second stage of labor

aused by the stretching of the vagina and perineum and compression of the pelvic structures

Newborn chest circumference

average: 30-36 cm; 12-14 in -generally equal to or about 2 to 3 cm less than the head circumference -measured on the unclothed newborn's chest just below the nipple line without pulling it taut

Parts to newborn care

bathing and hygiene elimination and diaper area care cord care circumcision care environmental safety measures prevention of infection

Where is brown fat found

between the scapulae, axillae, at the nape of the neck, in the mediastinum, and in areas surrounding the kidneys and adrenal glands

Plantar creases

creases on the soles of the feet, which range from absent to covering the entire foot, depending on maturity (the greater the number of creases, the greater the newborn's maturity)

A nurse is describing the many changes a newborn will go through during his or her first couple of weeks after birth. The nurse explains how the functions of the placenta are taken over by which organ? a. Intestine b. Cardiovascular system c. Kidneys d. Liver

d. Liver

Breast tissue swelling secondary to vascular congestion after childbirth and preceding lactation describes ___________________.

engorgement

Cord blood

described as "nature's first stem cell transplant" because it possesses regenerative properties and can grow into different types of cells in the body

Purpose of EFM

detect FHR changes early before they are prolonged and profound

Infection prevention teaching

educate parents about handwashing, monitor cord and circumcision, avoiding crowds

Psychosocial information observed by nurse

emotions, support system, verbal interaction, cultural background and language spoken, body language and posture, perceptual acuity, and energy level

The most common mechanism of heat loss in the newborn is ___________________.

evaporation

Nursing role to encourage partners to interact with newborn

express their feelings by seeing, touching, and holding their son or daughter and by cuddling, talking to, and feeding him or her will help to cement this new relationship.

Polydactyly

extra fingers or toes

Eyes and ears assessment

eyelids can be fused or open and ear cartilage and stiffness determine the degree of maturity (the greater the amount of ear cartilage with stiffness, the greater the newborn's maturity)

Minor reflexes

finger grasp toe grasp *ROOTING* sucking head righting stepping tonic neck

A deviated fundus to the right side of the abdomen would indicate a _____________.

full bladder

Blood plasma volume changes postpartum

further reduced through diuresis, which occurs during the early postpartum period

Major reflexes

gag Babinski Moro Galant

Hematocrit changes postpartum

hematocrit level remains relatively stable and may even increase, reflecting the predominant loss of plasma ***acute decrease in hematocrit is not an expected finding and may indicate hemorrhage.

Influences on pain perception

her previous experiences with pain, fatigue, pain anticipation, genetics, positive or negative support system, health care provider's presence and encouragement, labor and birth environment, cultural expectations, and level of emotional stress and anxiety

Lanugo assessment

soft downy hair on the newborn's body, which is absent in preterm newborns, appears with maturity, and then disappears again with postmaturity

Hydrotherapy risks

hyperthermia, hypothermia, changes in maternal heart rate, fetal tachycardia, and unplanned underwater birth

Thermoregulation

process of maintaining the balance between heat loss and heat production in order to maintain the body's core internal temperature -newborns are VULNERABLE to underheating and overheating -The more preterm a newborn is, or the less subcutaneous fat a newborn has, the greater the risk or thermoregulatory problems -infant temp drops 3-5 deg as soon as it is born

Epinephrine and norepinephrine changes with birth

increased levels of epinephrine and norepinephrine stimulate increased cardiac output and contractility, surfactant release, and promotion of pulmonary fluid clearance

The term that describes the return of the uterus to its prepregnant state is _____________.

involution

Downside to continuous monitoring of FHR

limit maternal movement and encourages the woman to lie in the supine position, which reduces placental perfusion

L&D admission assessment

maternal health history, physical assessment, fetal assessment, laboratory studies, and assessment of psychological status

Category 2 FHR pattern: indeterminate

not predictive of abnormal fetal acid-base status and but does require evaluation and continued monitoring • Fetal tachycardia (>160 bpm) present • Bradycardia (<110 bpm) not accompanied by absent baseline variability • Absent baseline variability not accompanied by recurrent decelerations • Minimal or marked variability • Recurrent late decelerations with moderate baseline variability • Recurrent variable decelerations accompanied by minimal or moderate baseline variability; overshoots, or shoulders • Prolonged decelerations >2 min but <10 min

Nursing care during the second stage of labor

ocuses on supporting the woman and her partner in making decisions about her care and labor management, implementing strategies to prolong the early passive phase of fetal descent, supporting involuntary bearing-down efforts, providing support and assistance, and encouraging the use of maternal positions that can enhance descent and reduce the pain.

Primary goal EFM

provide information about fetal oxygenation and prevent fetal injury that could result from impaired fetal oxygenation during labor

Puerperal bradycardia

pulse 60 -80 bpm postpartum

Objective of fetal heart rate monitoring

reduce the mortality/morbidity by ensuring that all fetal hypoxic insults are identified in time to allow removal or alteration of the reason for it, or to enable a safe birth of the fetus before irreversible asphyxia damage occurs

Duration of contractions

refers to how long a contraction lasts and is measured from the beginning of one contraction to the end of that same contraction.

Frequency of contractions

refers to how often the contractions occur and is measured from the beginning of one contraction to the beginning of the next contraction.

Touch at birth

sensitivity to pain, responds to tactile stimuli

Best way to assess fetal wellbeing during intermittent FHR monitoring

start listening to the FHR at the end of the contraction (not after one) so that late decelerations could be detected

Category 1 FHR pattern: normal

strongly predictive of normal fetal acid-base status at the time of observation and needs no intervention • Baseline rate (110-160 bpm) • Baseline variability moderate • Present or absent accelerations • Present or absent early decelerations • No late or variable decelerations *Can be monitored with intermittent auscultation during labor

When is newborn PKU screening conducted

the newborn needs to ingest enough breast milk or formula to elevate phenylalanine levels for the screening test to identify PKU accurately, so newborn screening for PKU testing should not be performed before 24 hours of age.

Dilation (r/t labor)

the opening or enlargement of the external cervical os

Proximity

the physical and psychological experience of the parents being close to their infant; has 3 dimmensions

Breast tissue

the thickness and size of breast tissue and areola (the darkened ring around each nipple), which range from being imperceptible to full and budding

Prochlorperazine

typically given intravenously or intramuscularly with morphine sulfate for sleep during a prolonged latent phase. It counteracts the nausea associated with opioids

Epispadias

urinary meatus is on the dorsal surface of the penis *circumcision should be avoided until further evaluation.

How to decrease Braxton Hicks contractions

walking, voiding, eatting, inc fluid intake, changing positions

Nursing assessment during fourth stage of labor

woman's vital signs, status of the uterine fundus and perineal area, comfort level, lochia amount, and bladder status. *The focus of nursing management during the fourth stage of labor involves frequently observing the mother for hemorrhage, providing comfort measures, and promoting family attachment. -HR ususally slower: 60-70bpm -BP is normalized; not a good indicator of shock -fever indicates dehydration or infection -RR usually between 16-24 -Assess fundal height, position, and firmness every 15 minutes during the first hour following birth; should be firm, located in the midline and below the umbilicus -massage fundus if boggy If the fundus is displaced to the right of the midline, suspect a full bladder as the cause. -pain should be at or under 3/10 -Voiding should produce large amounts of urine (diuresis) each time; palpate to ensure emptying

Postpartum head to to assessment timing

•During the first hour: every 15 minutes •During the second hour: every 30 minutes •During the first 24 hours: every 4 hours •After 24 hours: every hour

Key Advantages of Breastfeeding to the newborn

•Immune support •Microbiome in gut •Reduced risk of obesity, diabetes, heart disease •Improved tooth and jaw development •Promotes optimal bonding •Inexpensive •Less illness & healthcare costs

Key Advantages of Breastfeeding to the mother

•Involution support •Associated with postpartum weight loss •Reduced risk of cancers, and type 2 diabetes, osteoporosis •Reduced risk of postpartum depression •Some contraceptive benefits •Cost savings

Newborn characteristics related to newborn heat loss

•Thin skin with blood vessels close to the surface • lack of ability to shiver (until 3 m old) • large surface area to body weight • lack of subcutaneous fat • poor glycogen/glucose storage • Inability to communicate cold or hot • Inability to adjust the environment • Immature ability to sweat • Limited use of voluntary muscle activity or movement to produce heat • Little ability to conserve heat by changing posture (fetal position) • No ability to adjust their own clothing or blankets to achieve warmth