OB: postpartum care

The nurse can help a father in his transition to parenthood with what action? 1.Pointing out that the infant turned to his voice 2.Encouraging him to go home to get some sleep 3.Taping the baby's diaper a different way 4.Suggesting that he let the baby sleep in the bassinet

1

Edema is typically described with a scale of 1+ to 4+ what do this numbers mean?

1+ Minimal edema on pedal and pretibial area 2+ Obvious edema of lower extremities 3+ Edema of face, hands, sacrum, and abdomen 4+ Massive, generalized edema (anasarca)

A primigravida has delivered a baby vaginally after 6 hours of labor. She had an uneventful pregnancy and is in good general health. She is transferred from the recovery room to the postpartum unit. What interventions are included in routine postpartum care? (Select all that apply.) 1.Assessment of intake and output until the patient is voiding in sufficient quantities 2.Insertion of a catheter to assess residual urine after the initial voiding 3.Firm massage of the fundus every 15 minutes 4.Assessment of the emotional status of the new mother 5.Checking of breasts for engorgement and cracking of nipples

1, 4, 5

A baby has a Gomco circumcision. What instruction should the nurse give his parents for care of the circumcised penis? 1.Soak the penis in warm water daily. 2.Cover the glans with a petroleum gauze dressing. 3.Clean the glans with alcohol to promote healing. 4.Remove any yellowish exudate that forms within 24 hours.

2

When performing a postpartum assessment, what should the nurse do? 1.Assist the patient into a lateral position with upper leg flexed forward to facilitate examination of her perineum. 2.Assist the patient into a supine position with her arms above her head and her legs extended for the examination of her abdomen. 3.Instruct the patient to avoid urinating just before the examination because a full bladder facilitates funda position.

2

A neurological assessment of the new born is done at:

24 hours after delivery when the nervous system has had the opportunity to stabilize from the trauma of delivery.

A woman asks the nurse how she will know her baby is getting enough milk. The nurse's response is based on understanding that which is the best determinant? 1.The baby awakens every 4 to 6 hours to eat. 2.The baby stops nursing when full. 3.The baby has 6 to 10 wet diapers per day. 4.The baby cries when hungry.

3

Initial postpartum voiding should occur____________.

4-6 hours after delivery, Urinary retention should be considered if a woman is voiding small amounts (less than 100 mL) frequently.

During the prenatal checkup, the patient tells the nurse, "I've got nausea and vomiting, and haven't been able to eat anything." Which complication does the nurse expect to find if the condition is left untreated? A) Hemorrhage B) Hepatic failure C) Diabetes mellitus D) Cardiac arrhythmias E) Respiratory acidosis

A) Hemorrhage D) Cardiac arrhythmias E) Respiratory acidosis During pregnancy, the patient may have hyperemesis gravidarum, characterized by severe nausea. The patient complains of frequent vomiting throughout the day; due to this, the patient avoids food. Severe vomiting, if left untreated, may cause dehydration and loss of potassium, vitamins and other electrolytes. The fluid and electrolyte imbalance may lead to hemorrhage, cardiac arrhythmias, and respiratory acidosis. Hyperemesis gravidarum does not alter pancreatic and liver functions; therefore, the patient may not have hepatic failure and diabetes mellitus.

A patient in her third trimester of pregnancy reports having pain in the epigastric region along with nausea and vomiting. While collecting data, the nurse learns that the patient has signs of intra-abdominal hemorrhage. What will the nurse expect to find in the patient's laboratory report? Select all that apply. A) Increased liver enzymes B) Increased blood glucose C) Decreased platelet count D) Decreased liver enzymes E) Increased serum creatinine

A) Increased liver enzymes C) Decreased platelet count Pain in the epigastric area, nausea, vomiting and signs of abdominal bleeding are prominent indicators of HELLP (H, hemolysis; EL, elevated liver enzymes; LP, low platelet count) syndrome. In this condition, the patient would have increased liver enzyme levels and a decreased platelet count. The platelet count should be less than 100,000/mm3 in patients suffering from HELLP syndrome and blood glucose levels in these patients are usually decreased. Liver enzymes will be increased in HELLP syndrome. Serum creatinine levels are altered in patients with eclampsia and not in patients with HELLP syndrome.

A perinatologist has decided to manage a patient with placenta previa in the home environment. What information should the nurse give the patient about self-care at discharge? Select all that apply. A) Observe for vaginal bleeding B) Count fetal movements daily C) Call immediately if mucus is noted D) limit sexual activity to once a week E) Call when contractions are 10 minutes apart

A) Observe for vaginal bleeding B) Count fetal movements daily C) Call immediately if mucus is noted Patients with stable conditions can often be managed at home. Activity is limited to bed rest with bathroom privileges. The patient should be instructed to report signs and symptoms such as vaginal bleeding, the onset of labor, and rupture of membranes. Also, the patient should be instructed to count the fetal movements daily. Sexual contact is not allowed in the patient with placenta previa.

Which physical signs and symptoms might the postpartum patient experience following delivery? Select all that apply. A) a normal bowel movement within 2 to 3 days B) Increased diaphoresis, most commonly at night C) A low-grade fever the first 48 hours after delivery D) Increased urination beginning 4 to 6 hours after delivery E) Bright red vaginal drainage that will saturate one pad every 15 minutes

A) a normal bowel movement within 2 to 3 days B) Increased diaphoresis, most commonly at night D) Increased urination beginning 4 to 6 hours after delivery A normal bowel movement within 2 to 3 days, increased diaphoresis, and increased urination beginning 4 and 6 hours after delivery are all common physical signs and symptoms that a postpartum patient may experience after delivery. Vaginal bleeding to the extent that one pad is saturated every 15 minutes would be an indication of hemorrhage and would not be normal. Moderate flow is four to eight lightly saturated pads per day. A low-grade fever the first 24 hours (not 48) after delivery is a normal postpartum physical sign.

Afterbirth pains

Afterbirth pains are cramping sensations that result from the contraction of the uterus. They are more common and may be more severe in multiparas and breastfeeding mothers.

If the woman has delivered via cesarean section, she has an abdominal incision with sutures or staples. What needs to be assessed by the nurse?

Assess this incision in the same manner as any other surgical incision. It should remain approximated with no erythema, little exudate, and no malodor (foul odor). Traditionally, the patient has a dressing covering the incision the day of surgery. This is usually removed the next day by the surgeon. The incision likely is left open to the air. Those patients with staples closing their wounds have them removed in approximately 3 days. Adhesive strips may be applied after their removal and remain on for the next 5 to 7 days.

A patient with hyperglycemia had a preterm delivery. What intervention would the nurse most probably plan to prevent complications in the newborn? A) Administer bovine milk to the newborn within two hours of birth. B) Administer glucose solution to the newborn one hour after birth. C) Administer 15 mL of sterile water before breastfeeding the newborn. D) Administer insulin as per primary health care provider's instructions.

B) Administer glucose solution to the newborn one hour after birth. Excess glucose levels during pregnancy (maternal hyperglycemia) causes fetal hyperinsulinism, which causes reduced levels of glucose in the newborn. The hypoglycemia is managed by administering glucose solution to the newborn one hour after the birth. Bovine milk (cow's milk) is fed when there is reduced production of breast milk in the mother. The newborn is fed with water before initiating bottle feeding but not during breastfeeding. The newborn has hyperinsulinemia, and thus should not be administered insulin.

The licensed practical nurse is assessing a postpartum patient 10 weeks after delivery. During palpation, the nurse finds that the patient's uterus is involuted. Which finding enabled the nurse to reach this conclusion? A) The uterine fundus is distended. B) The uterine fundus is no longer palpable C) The uterine fundus is at the level of the umbilicus midline. D) The uterine fundus is between the umbilicus and the symphysis pubis.

B) The uterine fundus is no longer palpable Descent of the uterus to nonpregnant size after delivery is known as involution of the uterus. This can be inferred when the uterus is no longer palpable. When the uterus is palpable, it indicates that the patient's uterus is subinvoluted. The uterine fundus is not palpable so it is firm but not distended. If the uterine fundus is at the level of the umbilicus midline, then it is indicative of subinvolution. Usually, the uterine fundus is located between the umbilicus and the symphysis pubis immediately after the delivery. Therefore, if this observation is persistent even after 10 weeks of delivery, it indicates that the patient has subinvolution.

Immature nervous system reflexes

Babinski, Moro, tonic neck, stepping reflex

A pregnant woman with B positive blood takes an indirect Coomb's test during the 20th week of gestation. The nurse finds the test result to be negative. What should the nurse inform the patient? A) "You have to visit the clinic at least 72 hrs before delivery to receive Rhogam." B) "You received a negative result for the test; you don't have to receive Rhogam." C) "You have to visit the clinic after 28 weeks of gestation to take the first dose of Rhogam." D) " You have to visit the clinic after 12 weeks of gestation to take the first dose of Rhogam."

C) "You have to visit the clinic after 28 weeks of gestation to take the first dose of Rhogam." RhoGAM is an immunoglobulin that prevents the antigen-antibody reaction between the Rh-negative mother and the Rh-positive fetus. The need for Rhogam is determined by an indirect Coomb's test. It is recommended to administer Rhogam in the 28th week of pregnancy and 72 hrs before delivery. Because the patient is currently in the 20th week of gestation, the nurse should inform the patient to visit the clinic after 8 weeks to receive the first dose of Rhogam. It should be administered 72 hrs before delivery; however, the nurse should first inform the patient to receive Rhogam at the 28th week of gestation and can then inform the patient about the second dose before delivery. A negative result in the indirect Coomb's test indicates that the patient needs Rhogam. If Rhogam is administered after 12 weeks, by the time the antigen-antibody reaction takes place, the fetus will die.

The nurse is caring for a patient who had an abortion due to a molar pregnancy. The nurse learns that the patient is depressed and likes to be alone. What information should the nurse provide while counseling the couple? A) "Your wife needs space; let her spend time alone." B) "You must adopt a child because your wife cannot conceive." C) "You should not plan for another child for at least one year." D) "Your wife needs to be tested for sexually transmitted disease."

C) "You should not plan for another child for at least one year." The patient who had an abortion due to a molar pregnancy may have anemia and psychological disturbance. To prevent further complications, the nurse should advise the couple to avoid planning for another child for at least one year. Because the patient is depressed, the nurse should suggest that the patient's spouse engage her in daily actives. Leaving the patient alone may cause social withdrawal in the patient. The patient with a molar pregnancy does not become infertile; the nurse should not suggest the couple adopt a child. Molar pregnancy is not associated with sexually transmitted disease (STD); the nurse should not suggest that the patient requires an STD test.

A patient has been admitted with preeclampsia. After an assessment, the nurse notes the patient has edema of the face, hands, and abdomen. How would the nurse document this finding? A) 1+ B) 2+ C) 3+ D) 4+

C) 3+ Edema of the face, hands, sacrum, and abdomen is documented as 3+. Minimal edema on pedal and pretibial areas is documented as 1+. Obvious edema of the lower extremities is documented as 2+. Massive, generalized edema is documented as 4+.

A patient who is 9 weeks pregnant comes to the hospital complaining of vaginal bleeding. An ultrasound reveals no heartbeat or uterine growth. The patient is to be scheduled for dilatation and curettage (D&C). What type of abortion is this? A) Complete spontaneous abortion B) Inevitable spontaneous abortion C) Incomplete spontaneous abortion D) Threatened spontaneous abortion

C) Incomplete spontaneous abortion Incomplete spontaneous abortion is the termination of pregnancy before 20 weeks in which some but not all of the products of conception are expelled. Threatened spontaneous abortion is unexplained bleeding and cramping. The fetus may or may not be alive. Membranes remain intact and the cervical os remains closed. Inevitable spontaneous abortion occurs when bleeding increases and the cervical os begins to dilate. Membranes may rupture. Complete spontaneous abortion occurs when all the products of conception are expelled from the uterus.

The nurse questions a student nurse regarding the effects of cigarette smoking on a fetus and neonates. Which would be the relevant statement made by the nurse? A) Smoking delays the lung maturity of the fetus. B) Smoking ceases mental growth in the neonate. C) Smoking increases the risk of pneumonia in neonates. D) Smoking causes an increase in the heart rate of the fetus.

C) Smoking increases the risk of pneumonia in neonates. Smoking during pregnancy may cause pneumonia in neonates; cigarettes contain tobacco, which impairs pulmonary functions. Lung maturity is delayed in neonates when the patient is administered sedatives like barbiturates. Mental retardation is observed in neonates due to the consumption of alcohol during pregnancy. An increase in heart rate (tachycardia) is observed in the fetus when a pregnant woman takes cocaine.

The nurse is caring for a new mother and a newborn after 24 hours of delivery. Which findings would suggest that the mother and the newborn are at higher risk of developing complications? Select all that apply. A) The newborn's weight is 2300 g. B) The mother has lost 500 mL of blood. C) The mother has urinary tract infection. D) The newborn's skin appears blue in color. E) The mother has been prescribed magnesium sulphate.

C) The mother has urinary tract infection. D) The newborn's skin appears blue in color. The presence of a urinary tract infection (UTI ) indicates that the patient is at a high risk of developing complications, because UTIs cause electrolyte imbalances, reduced uterine tone, and altered body functions. Bluish skin color indicates that the newborn has respiratory distress and has a risk of cyanosis. A birth weight of 2300 g indicates that the newborn has low birth weight; the complications associated with it can be prevented by providing good nutrition. It should be considered to be a moderate risk rather than a high risk complication. Loss of 500 mL of blood after delivery is an average blood loss for a single birth and does not suggest that the patient is at a high risk of developing complications. Magnesium sulphate is prescribed to patients with hypomagnesemia, but it does not indicate that the patient is at higher risk of developing complications.

The nurse is caring for a pregnant woman with hyperemesis gravidarum. The primary health care provider prescribes saline solution to the patient. Which nutrients should be added to the fluids administered to the patient to prevent fetal complications? Select all that apply. A) Iron B) Calcium C) Thiamine D) Pyridoxine E) Magnesium

C) Thiamine D) Pyridoxine E) Magnesium A patient with hyperemisis gravidarum has frequent vomiting; because of this, the patient experiences fluid loss and electrolyte imbalance. To maintain the fluid and electrolyte balance and the acid-based balance, thiamine, pyridoxine, and magnesium should be added to the fluids administered to the patient. Hyperemesis gravidarum is not associated with anemia and osteoporosis, and therefore, iron and calcium are not added to the fluids administered to the patient.

Cardiovascular system in the postpartum mother

Cardiac output also declines rapidly. The patient is at risk for thrombus formation as a result of elevation of platelets in the early postpartum period.

Low-set ears may indicate what in a newborn?

Chromosomal disorders

caput succedaneum

Commonly seen with molding. It is the result of edema in the soft tissue of the scalp. The tissue feels spongy and may be felt over suture lines. This also disappears without treatment.

Postpartum maternal teaching: nutrition (nursing, dieting)

Continue prenatal vitamins until gone; avoid onions, cabbage, chocolate, spices, and foods that may distress infant; no dieting during breastfeeding.

A patient in the 33rd week of gestation has placenta previa. The primary health care provider (PHP) has referred the patient for a cesarean delivery. Which medications does the nurse expect to be prescribed for the patient? A) Methotrexate (MTX) B) Clomiphene (Clomid) C) Ampicillin (Totacillin) D) Betamethasone (Celestone)

D) Betamethasone (Celestone) Usually, cesarean delivery is recommended for the patient with severe bleeding due to placenta previa. In preterm delivery, fetal lung maturity will be compromised; for the promotion of the fetal lung maturity and to prevent infections, betamethasone (Celestone) should be administered to the patient. Methotrexate (MTX) is a folic acid antagonist and is used for the treatment of proliferating trophoblastic disease in patients experiencing an ectopic pregnancy. Clomiphene (Clomid) causes ovulation stimulation and increases the risk of molar pregnancy. Ampicillin (Totacillin) is an antibiotic used to prevent infection in the patient with septic spontaneous abortion. Therefore, methotrexate (MTX), clomiphene (Clomid) and ampicillin (Totacillin) should not be prescribed to the patient.

A 15-year-old pregnant patient at the 16th week of gestation has profuse, dark brown vaginal discharge. The patient also has symptoms of gestational hypertension. After reviewing the patient's medical history, the nurse informs the primary health care provider that the patient took clomiphene (Clomid). What instruction does the nurse expect to receive from the primary health care provider? A) To assess the blood glucose levels B) To assess the thyroid hormone levels C) To administer Rho (d) immune globulin D) To prepare for suction curettage abortion

D) To prepare for suction curettage abortion The patient who takes clomiphene (Clomid) may have a hydatidiform mole, which is associated with dark brown vaginal discharge during the 16th week of pregnancy. Symptoms of gestational hypertension before 20 weeks of gestation indicate a hydatidiform mole. To prevent further complications, a suction curettage abortion should be recommended for the patient. Clomiphene (Clomid) does not cause hypo- or hyperglycemia; blood glucose levels need not be assessed in the patient. Clomiphene (Clomid) does not impair thyroid functioning and does not alter thyroid hormone levels. Rho (d) immune globulins helps prevent isoimmunization, and can be administered to the patient who is Rh negative. It is not associated with a hydatidiform mole or a molar pregnancy.

Conduction anesthesi

Epidural block

Polydactyly

Extra digits.

Kick counts

Fetal activity of less than three kicks per hour is considered serious and must be reported. Fetal activity decreases in the presence of hypoxia.

Classification of abruptly placenta: grade 1, grade 2, grade 3

Grade I - vaginal bleeding, no distress to mom and baby. Grade II - uterine tenderness and tetany, with or without external evidence of bleeding. The mother is not in shock, but there is fetal distress. Grade III - the woman is in shock (although the bleeding may not be obvious), and the fetus is dead.

Urinary system in the postpartum mother

Immediately after giving birth, the woman may bleed excessively if the bladder becomes distended because it pushes the uterus up and to the side and prevents the uterus from firmly contracting. bladder tone is usually restored 5 to 7 days after childbirth, with daily urinary output of up to 3 L common.

Postpartum maternal teaching: fundus (height, massage)

It is back into the pelvis in 10 days.

Common skin observations in the newborn: milia

Milia are small white spots usually seen on the nose and chin. They are a result of occluded sebaceous glands and disappear spontaneously within a few weeks.

What are some of the side effects of oxytocin (Pitocin) and methylergonovine (methergine)?

Monitor vital signs closely if these medications are given because they may cause elevated blood pressure, bradycardia, nausea, headache, vertigo, and other side effects.

Factors that place the postpartum patient and newborn at risk

Mother: abnormal vital signs Infant (factors for admission to the NICU): signs of respiratory distress syndrome, asphyxiation (apparel score, 6 at 5 minutes), persistent cyanosis, chromosomal anomalies, CNS depression for longer than 24 hrs, hypoglycemia, hypocalcemia, hyperbilirubinemia, hypomagnesemia, hypermagnesemia, anemia

Gastrointestinal system in the postpartum mother

Normal bowel elimination should resume within 2 or 3 days after delivery.

The flow of lochia may increase suddenly when the patient gets out of bed, what must the nurse keep in mind when assessing the patient for this type of changes?

Once the lochia has changed to serosa or alba, excessive exercise or activity may result in the lochia changing back to rubra. This is a sign to slow down and increase activity gradually.

Musculoskeletal system in the postpartum mother

Patients may feel discomfort in the joints immediately after delivery because of secretion of the hormone relaxin. However, even when all other joints return to their normal pregnant state, those of the parous woman's feet do not. The new mother may notice a permanent increase in shoe size.

Immune system in the postpartum mother

Patients who are Rh negative and who give birth to infants who are Rh positive must receive RhoGAM within 72 hours of delivery.

Placenta previa

Placenta previa occurs when the placenta implants in the lower uterine segment. Placenta previa is described by the degree to which the placenta covers the internal cervical os: complete with total coverage; partial with incomplete coverage; and marginal, which indicates that only an edge of the placenta approaches the internal os. The cause is unknown. Risk factors include cesarean birth, possibly related to endometrial scarring; multiple gestation (because of the larger placental area); closely spaced pregnancies; and advanced maternal age (older than 35 years).

Neurological system in the postpartum mother

Postpartum headaches may be caused by various conditions, including gestational hypertension, stress, and leakage of cerebrospinal fluid into the extradural space during placement of the needle for epidural or spinal anesthesia.

What are some predisposing factors for abruptly placenta?

Predisposing factors include trauma, chronic hypertension, and GH. Abruptio placentae is three times more likely to occur in women with gravidity of more than five. Women who use cocaine during pregnancy have a significant incidence of premature separation of the placenta. Blunt external abdominal trauma, usually the result of motor vehicle accidents or maternal battering, is an increasingly significant cause of placental abruption.

Normal new born vital signs

RR: 30-60 breath/min; reaching is diaphragmatic and effortless. HR: 120-160 bpm; apical pulse must be taken (murmurs are common in new born). BP: 60-80/40-50 Temp: 97.6 - 98.6 (36.4-37)

Protective newborn reflexes

Rooting, sucking, gag, swallow, blink, burp, hiccup, and sneeze.

Molding

Shaping of the fetal head during movement through the birth canal.

Prolactin

Stimulates milk production.

The nursing assessment in parent newborn relationships must include_______________.

The mother's reaction to the sight of the newborn. Documentation in the nurses notes concerning bonding behaviors noted is needed. Observations should include both verbal and non-verbal behaviors of parents.

The student nurse is assisting a registered nurse (RN) while assessing a pregnant patient. The RN tells the student nurse that the patient has mild preeclampsia. Which findings enabled the RN to reach this conclusion? The patient's blood pressure is 160/110 mmHg. The patient's urinary output is 250 mL/24 hours. The patient's weight increased by 0.5 kg every month. The patient's urine test indicates the presence of albumin.

The patient's urine test indicates the presence of albumin.

What information should be handed off to the postpartum nurse in regards to the mother and baby when transferring from the recovery area?

The postpartum nurse should be advised about the name of the: 1) primary care provider 2) gravidity and parity 3) age 4) anesthetic used 5) medications given 6) duration of labor and time of rupture of membranes 7) oxytocin induction or augmentation 8) type of birth and repair 9) blood type and Rh status 10) rubella immunity status; syphilis and hepatitis serology test results 11) intravenous (IV) infusion of any fluids 12) physiologic status since birth 13) description of fundus, lochia, bladder, and perineum 14) infant's gender and weight; time of birth; pediatrician; chosen method of feeding 15) any abnormalities noted; and assessment of initial parent-infant interaction.

The newborn spine

The spine should be straight without curves. The normal cervical and lumbar curves develop once the infant begins to stand. Also, examine the spine for dimples, tufts of hair, and masses that may indicate abnormalities of spinal column development.

Placenta previa medical management

The woman should be advised to count fetal movements daily. Sexual intercourse is not allowed in the patient diagnosed with placenta previa.

What may be seen with mild preeclampsia?

Urine testing frequently shows 1+ to 2+ albumin readings. The urinary output is at least 500 mL/24 hr.

Perineal Lacerations

When caring for the woman with a third-degree or fourth-degree laceration, the nurse must assess the bowel habits. Rectal treatments such as enemas or suppositories are contraindicated for women who have third-degree or fourth-degree lacerations.

When is a C-section necessary with a patient diagnosed as having placenta previa?

When the placenta is partially or completely covering the cervical os.

rooting reflex

a baby's tendency, when touched on the cheek, to open the mouth and search for the nipple.

The rapid decrease in intraabdominal pressure after birth results in:

a dilation of the blood vessels that supply the intestines (known as splanchnic engorgement), which causes blood to pool in the viscera. This contributes to orthostatic hypotension; when a woman who has recently given birth stands up, she may faint or feel lightheaded. Assess her color, pulse, and level of consciousness (LOC) in response to conversation and then assist her in ambulating to the bathroom.

Common skin observations in the newborn: new born rash or erythema toxicum neonatorum

an elevated, hive-like rash that may result in small white vesicles. It is not contagious and, like milia, disappears without treatment.

Common skin observations in the newborn: strawberry birthmarks

are capillary hemangiomas. These may continue to increase in size for several months. They normally then begin to shrink spontaneously and usually disappear early in childhood.

Common skin observations in the newborn: Mongolian spots

areas of increased pigmentation. The lumbar dorsal area is the most common location. The area may appear bluish black. These are most often seen in darker-skinned people.

acrocyanosis

blueness of the extremities caused by poor peripheral circulation. Most commonly observed when the infant becomes cold.

Cephalohematoma

caused by bleeding within the periosteum of a cranial bone. It is confined to a particular bone and does not cross suture lines. This is usually a result of difficult labor. Cephalhematomas generally appear 1 or 2 days after birth. These normally absorb without treatment. Large hematomas may lead to anemia and jaundice, which necessitate medical intervention.

Common skin observations in the newborn: telangientactic Nevi or "stork bites"

flat pink or red marks often seen on the eyelids, nose, or nape of the neck. These are dilated capillaries that become more vivid when the infant cries. They are not significant to the health of the infant and disappear at 1 to 2 years of age.

Harlequin sign

half of the newborn's body appears deep red and the other half appears pale as a result of vasomotor disturbance, with some vessels constricting while others dilate.

After a cesarean section, women often have restrictions that limit oral intake to__________.

ice or liquids for the first day with a gradual reintroduction to the diet.

Thrombophlebitis

is a potential complication of the postpartum period. Early and frequent ambulation is the key to preventing this problem. Remember that inactivity predisposes patients to development of thrombophlebitis.

Vaginal and urethral lacerations

may result from forceps rotation, especially in cases of cephalopelvic disproportion(baby's head is too big to pass through), rapid fetal descent, and precipitous birth. Lacerations can also occur around the urethra (periurethral) and in the area of the clitoris.

What is an atonic uterus? What must be done to fix it? What should the nurse look for?

one that has lost muscle tone, feels soft or boggy. Gently massage the fundus to increase contractility. Small clots frequently are expressed during this maneuver, and the uterus regains good contracted tone. If this does not result in contraction, the primary care provider should be notified.

Colustrum

produced in the first three days, clear-yellow fluid that contains antibodies.

Common skin observations in the newborn: Nevus flame us or port wine stain

s a reddish purple discoloration often seen on the face. This is a capillary angioma below the epidermis. Unfortunately, these do not disappear spontaneously. Medical techniques have been developed that reduce or remove port-wine birthmarks.

What may be seen with severe preeclampsia?

severe preeclampsia may appear suddenly. Blood pressure readings increase; readings of 160/110 mm Hg or higher on two separate occasions 6 hours apart with the pregnant woman on bed rest are common. Urine testing for albumin shows 3+ to 4+ readings. The urinary output is less than 500 mL/24 hours. Clonus is noted with pending seizure activity.

Epstein pearls

small white cysts found on the midline portion of the hard palate of some newborns.

Salycilates

such as aspirin, are usually avoided because they may interfere with clotting mechanisms.

When a general anesthetic has been used, such as during a cesarean delivery, what must be verified first?

the presence of bowel sounds before giving solid food.

syndactyly

webbed fingers or toes.

Postpartum maternal teaching: sexuality (sexual activity)

•Avoid sexual activity until after first postbirth office visit and approval by primary care practitioner. •If episiotomy is not healed and sexual activity is resumed, there is increased discomfort and chance of infection.

Postpartum maternal teaching: breasts

•Breastfeeding (nipple care, engorgement, feeding techniques, breast pump) Air dry; wear a good supportive bra. For engorgement, apply heat, warm shower; may pump to enable baby to latch on. •Dry breasts (engorgement, fluid intake) •Wear supportive, well-fitting bra. •Avoid breast stimulation (warm showers). •Apply ice bags for 20 minutes four times a day. •Suppression of lactation takes about 5 days. •Do not drink excessive amounts of fluids (normal: six to eight 8-ounce glasses).

Postpartum maternal teaching: perineum (episiotomy care, cleansing, healing, douching, tampons)

•Do not douche or use tampons until after first office visit when primary care practitioner says it is okay. •Continue using witch hazel (Tucks pads) for discomfort and to aid in healing. •Episiotomy heals in approximately 3 weeks (when the lochia has stopped).

Postpartum maternal teaching: Lochia (amount, changes, warning signs)

•For the first 3 days, lochia is dark red, like menstrual flow; 2 or 3 days after this, it is pinkish brown. •Moderate flow consists of four to eight lightly saturated pads a day. •Flow continues for 3 to 4 weeks. •In the last couple of weeks, lochia is a yellowish color with a musty, stale odor. •Report any foul-smelling or bright red discharge or large clots. •Flow may increase with overactivity. Rest; if flow does not subside, notify primary care practitioner.

Postpartum maternal teaching: exercise (when, how much)

•Increased lochia or pain means you need to reevaluate activity. •Do not resume strenuous exercises until primary care practitioner approves. •Gradually increase activity.

Postpartum maternal teaching: cesarean birth (incision, activity)

•Notify primary care practitioner of any redness, drainage, separation of incision, temperature greater than 100.4° F (38° C).

Postpartum maternal teaching: report to primary caregiver

•Temperature greater than 100.4° F (38° C) •Chills •Change in lochia: foul odor, return to bright red, excessive amount •Calf pain, tenderness, or swelling •Evidence of mastitis: breast tenderness, cracking, redness, or a feeling of discomfort or uneasiness •Urinary urgency, burning, or frequency •Severe or incapacitating depression