Ch 28 Care of the Mother and Newborn

A new mother asks the nurse whether she may wash her baby in a tub after they go home. What is the nurse's best response?

"Babies can be bathed in a tub after the cord has fallen off."

While inspecting her newborn a mother asks the nurse whether her baby has flat feet. How should the nurse respond?

"Infants' feet appear flat because the arch is covered with a fat pad."

After the birth of a neonate, a parent asks, "What is that white substance over the baby's body?" The nurse initially responds:

"It's expected, and it's called vernix caseosa."

During labor a client states that she does not want eyedrops or ointment placed in her baby's eyes immediately after birth. How should the nurse respond?

"Let's talk about why you don't want the medicine to be put into your baby's eyes."

After the birth of her daughter, a mother tells the nurse, "I was told that my baby has to have an injection of vitamin K. She's so small to be getting a shot. Why does she have to have it?" How should the nurse respond?

"Newborns are deficient in vitamin K. This treatment will protect your baby from bleeding."

A mother is inspecting her newborn girl for the first time. The infant's breasts are edematous, and she has a pink vaginal discharge. How should the nurse respond when the mother asks what is wrong?

"The swelling and discharge are expected. They're a response to your hormones."

A new mother asks the nurse administering erythromycin ophthalmic ointment to her newborn why her baby must be subjected to this procedure. What is the best response by the nurse?

"This antibiotic helps keep babies from contracting eye infections."

While a mother is inspecting her newborn she expresses concern that her baby's eyes are crossed. How should the nurse respond?

"This is expected. Your baby is trying to focus."

A newborn with a severe bilateral cleft lip and palate is shown to the father first. The father says, "How could this happen to us? What's my wife going to do? It would've been better if she'd never gotten pregnant." How should the nurse respond?

"This must be very hard on you. I can go with you when your wife sees the baby."

A new mother exclaims to the nurse, "My baby looks like a Conehead!" How should the nurse respond?

"This often happens as the baby's head moves down the birth canal—the bones move for easier passage."

a mother delivered at midnight, its now 9am. she wants to sleep and asks the nurse to take care of the baby. what is this considered?

"taking in" stage is a normal response of new mothers. she may be passive for a couple days and needs supportive care

newborn assessment finding for the newborn hygiene

(body temp must be stabilized) bathing; provides complete cleansing, observation of infant's condition

Postpartum Maternal Danger Signs

- Fever with or without chills - Malodorous vaginal discharge - Excessive amount of vaginal discharge - Bright red vaginal bleeding after it has changed to pink or brown (rust). -Edema; erythmatous or painful area on the legs - Pain or burning sensation with urination or an inability to void - Breast changes, such as localized pain, heat, edema, or malodorous drainage - Pain in the perineal or pelvic area

Atonic uterus

- literally a uterus without tone - Most common reason for post-partum hemorrhage

Vitamin K 0.5 mg is prescribed for a newborn. The vial on hand is labeled "1 mL = 2 mg." How many milliliters should the nurse administer? Include a leading zero if applicable. Record your answer using two decimal places.

0.25

Which client behavior indicates that a woman needs further teaching regarding breastfeeding her newborn? 1 She leans forward to place her breast in the infant's mouth. 2 She holds the infant level with her breast while in a side-lying position. 3 She touches her nipple to the infant's cheek at the beginning of the feeding. 4 She puts her finger in the infant's mouth to break the suction after the feeding.

1 She leans forward to place her breast in the infant's mouth.

Which drug would be excluded from the prescription of a lactating mother being treated for heart problems? 1 Tenormin 2 Labetalol 3 Metoprolol 4 Propranolol

1 Tenormin

A client with a habit of smoking while on estrogen therapy is at risk for developing which condition? 1 Thrombosis 2 Gastrointestinal upset 3 Endometrial cancer 4 Decreased effectiveness of estrogen

1 Thrombosis

the umbilical cord will generally fall of when?

10-14 days after birth

normal newborn HR?

120-160

Passages of vesicles (grapelike clusters) may occur around which weeks of gestation?

16 weeks

How much sleep does a newborn need?

16-20 hours a day

Estrogen levels in nonlactating women begin to rise when after birth?

2 weeks after birth & the levels are higher by postpartum day 17 than in women who breast-feed

What kind of milk do you give a baby after 2 years old?

2% milk

Normal bowel elimination should resume within ____ to ____ days after delivery.

2-3 days

Episiotomy takes how long to heal?

2-3 weeks. Sutures are absorbed by the body

Blood volume is reduced to nonpregnant levels by _________ weeks after delivery.

2-4 weeks

Neurological assessment is done when on newborn?

24 hours after birth

a perineal laceration extending through the muscle of the perineum is called what

2nd degree laceration

Colostrum production begins when?

2nd trimester. Continues for about 2 days after delivery, when true milk production begins

Why would the use of baby powder on an infant be avoided? 1 Skin irritation 2 Skin infection 3 Lung irritation 4 Respiratory infection

3 Lung irritation

Which drug impairs fertility when administered along with fertility drugs? 1 Clomiphene 2 Menotropins 3 Promethazine 4 Choriogonadotropin alfa

3 Promethazine

A client who is scheduled for an amniocentesis tells the nurse, "I'm glad this test will be able to tell me whether or not my baby is well." How would the nurse respond? 1 "Research has shown that this is an excellent test." 2 "A normal amniocentesis result is a reliable indicator of a healthy baby." 3 "This test is useful in detecting potential defects caused by chromosomal errors." 4 "An amniocentesis is a valuable tool for detecting congenital defects in the developing fetus."

3 "This test is useful in detecting potential defects caused by chromosomal errors."

May need to assess for PIH up to

3 days

Lochia serosa is?

3-7 days, discharge thins & becomes pink to brown.

New Born Respiratory Rate Range?

30 to 60 breaths/min with brief periods of apnea.

New Born Respiratory Rate Range

30-60 min

Normal respiratory rate for newborn?

30-60 min with brief periods of apnea.

Blood loss during delivery/C-Section?

300-500mL if delivery 600-800ml if C section

Which dietary information would the nurse emphasize when reinforcing a dietary program for a pregnant client with diabetes? 1 The need to increase high-quality protein and decrease fats 2 The need to increase carbohydrates to meet energy demands and prevent ketosis 3 The need to eat a low-calorie diet that maintains the current insulin coverage and helps prevent hyperglycemia 4 The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary

4 The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary

A nurse is planning to use a newborn's foot to obtain blood for the required newborn metabolic testing. Which part of the foot is the best site to use for the puncture? 1 Big toe 2 Foot pad 3 Inner sole 4 Outer heel

4 Outer heel

Resumption of sexual intercourse may begin when?

6 weeks after delivery

Abdominal muscle tone returns & joint stabilization occurs over a ______week period after delivery.

6-8 weeks

Return of the cervix, vagina, & perineum takes how long?

6-8 weeks

in a pregnancy that an excessive amount of weight is not gained how long will it take the mother to reach pre-pregnancy weight after birth

6-8 weeks

Average BP for a newborn?

60-80/40-50

Jaundice disappears when?

7-10 days

Average newborn size?

7lbs 8oz 20 inches long head circumference 13-14 inches Chest circumference 12-13 inches

axillary temperature for newborn?

97.6-98.6 (36.4-37)

Baby's Normal body temperature ranges?

97.6° to 99°F (36.4° to 37.2°C)

What happens to cardiac output pp?

= increases slightly for about 1 hour pp and then will decline

Lochia alba is?

A

A nurse decides on a teaching plan for a new mother and her infant. What should the plan include?

A demonstration and explanation of infant care

What pulse rate is considered normal after delivery?

A pulse rate between 50 and 70 beats/min is considered

A newborn's total body response to noise or movement is often distressing to the parents. What should the nurse tell the parents this response represents?

A reflex that is expected in the healthy newborn

Jaundice - physiologic

Appears between 72-96 hrs PP, starts on face/eyes, can extend down trunk. Refer for bili-check if extends to limbs or past umbilicus with very yellow/orange/squash look or prior with other s/sx (lethargy, difficulty nsg, not passing stool, dark urine, light/chalky stool)

Fontanelles

Areas where the infant's skull has not fused together; usually disappear at approximately 18 months of age.

Episiotomy

Asses patient and look for hemorrhoids.

PT care of umbilical area

Avoid getting cord wet, use alcohol or other substances to promote drying and inhibit microbial growth

BUBBLE-HE

BREAST, UTERUS, BLADDLER, BOWEL,LOCHIA,EPISIOTOMY, HORMAN'S SIGN, EMOTIOANL STATUS,

Pathologic jaundice

Begins in the first 24 hours and may require treatment with phototherapy

A nurse is reviewing the laboratory report of a newborn whose hematocrit level is 45%. What value denotes a healthy infant?

Between 45% and 65%

On the third postpartum day a mother visits the clinic and asks why her newborn's skin has begun to appear yellow. The nurse explains that the change in her infant's skin tone is the result of:

Breakdown of fetal red blood cells

Decreased estrogen levels are associated with?

Breast engorgement & with the diuresis of excess extracellular fluid

How long can breast milk be refrigerated?

Breast milk can be safely stored in a refrigerator for 24 to 48 hours.

Transitional milk

Breastmilk produced between colostrum and mature milk, during the first 4-10 days postpartum.

Lochia rubra

Bright red, clots, 1-2 days after delivery

An infant has surgery for repair of a myelomeningocele. For which early sign of impending hydrocephalus should the nurse monitor the infant?

Bulging fontanels

A new mother with class II heart disease tells a nurse that she is afraid that her heart condition will prevent her from caring for her baby and her home when she is discharged. How should the nurse respond?

By asking her to describe her concerns more fully

How should the nurse assess a newborn's grasp reflex?

By pressing the examining fingers against the palms of the newborn's hands

A 7-lb, 4-oz (3290-g) boy is admitted to the nursery and placed in a warm crib. The neonate begins to choke on mucus. How should the nurse suction him with a bulb syringe?

By suctioning the mouth before the nostrils

Strawberry birthmarks

Capillary hemangiomas. May continue to increase in size for several months. Usually disappear early in childhood

newborn assessment finding for the newborn skin color

Caucasian-pink to slightly reddish African-American; pink or yellowish brown Spanish- olive tint or a slight yellow Asian- rosy or yellowish tan American indian- light pink to dark, reddish brown

How should the cord be cared for?

Check for bleeding or oozing during early hours after birth Cord must be clamped securely with no skin caught in it Purulent drainage, edema, or redness indicates infection Maybe treated with triple-dye solution, antibiotic ointment, or alcohol 3 times a day or allowed to dry naturally. When soiled, it should be cleaned with water

A new mother asks a nurse why medicine is being put in her baby's eyes. What infection should the nurse tell the mother it is given to prevent?

Chlamydia

Shortly after birth the nurse instills erythromycin ophthalmic ointment in the newborn's eyes. The father asks why an antibiotic is needed because the mother does not have an infection. The nurse explains that it protects the newborn from:

Chlamydia and gonorrhea

Women who are not breastfeeding should do what to help with engorgement?

Cold compresses & analgesics

The first secretion of the breasts is called ?

Colostrum; milk is watery, thin, slightly yellow. Rich in protein, calories, antibodies, lymphocytes

Ophthalmia Neonatorum

Conjunctivitis of a newborn; caused by presence of Neisseria gonorrhoeae, or Chlamydia trachomatis in the birth canal, which can infect the baby during birth Treated using silver nitrate drops, or tetracycline

When does the cord fall off?

Cord becomes brownish black within 2-3 days & falls off in about 10-14 days

Sequence of events in hypovolemic shoc,

Decreased B/V Decreased Venous return Decreased stroke volume Decreased cardiac output Decrased tissue perfusion

An infant is born with a bilateral cleft palate. Plans are made to begin reconstruction immediately. What nursing intervention should be included to promote parent-infant attachment?

Demonstrating positive acceptance of the infant

Milia

Distended sebaceous glands which appear as tiny white spots on the baby's face. occluded sebaceous gland -> disappears on own

How is blood volume reduced to nonpregnant levels?

Diuresis Diaphoresis

A 1-day-old newborn has just expelled a thick, greenish-black stool. The nurse determines that this is the first stool. What should the nurse do next?

Document the stool in the infant's record

In a noisy room a sleeping newborn initially startles and exhibits rapid movements but soon goes back to sleep. What is the most appropriate nursing action in response to this behavior?

Documenting an intact reflex

A nurse determines that a 1-day-old newborn has a heart rate of 138 beats/min. What is the best nursing action at this time?

Documenting the heart rate

Stepping (walking)

Elicit by holding the newborn upright with feet touching a flat surface. the newborn responds with stepping movement. Disappears 3-4 weeks and replaced with deliberate movement

Palmar grasp

Elicit by placing examiner's finger in palm of newborn's hand. The newborn's fingers curl around examiner's fingers. Expected age: Lessen's between 3 and 4 mths.

Plantar grasp

Elicit by placing examiners's finger at base of newborn toes. the newborn responds by curling toes downward. Expected age: birth to 8 mths.

Babinski reflex (plantar)

Elicit by stroking outer edge of sole of the foot, moving up toward toes. toes will fan upward and out. Expected age: Birth to 1 year!...

How long does it take for an episiotomy take to heal?

Episiotomy heals in approximately 3 weeks (when the lochia has stopped).

Which hormone stimulates the growth of the milk ducts to prepare for lactation?

Estrogen

A nurse teaches a new mother about neonatal weight loss in the first 3 days of life. What does the nurse explain is the cause of this weight loss?

Excretion of accumulated excess fluids

How long should mother breast feed in each breast?

Feed for 10 to 15 minutes from each breast.

Where does milk accumulation begin?

Filling of the breast with milk usually begins in the axillary region, so palpate the body and the tail of the breast.

What should the nurse do to enhance a neonate's behavioral development?

Help the parents stimulate their awake baby through touch, sound, and sight

Want occurs in an ectopic pregnancy when the fallopian tube ruptures?

If the fallopian tube has ruptured, she may have vaginal bleeding, referred shoulder pain, and abdominal rigidity. The risk for hypovolemic shock is present.

A woman who had a home birth brings the infant to the well-baby clinic on the third day after the birth, and the infant weighs 5% less than at birth. What does the nurse suspect as the cause of this weight loss?

Imbalance between nutrient intake and fluid loss

A woman who gave birth to an unwanted baby may have?

Impaired bonding

Signs of psychosocial problems?

Inability or refusal to discuss labor/birth experience Refusal to interact/care for baby Refusal to attend infant care classes Refusal to discuss contraception Calls self ugly/useless Excessive preoccupation with self Marked depression Lack of support system Partner/Family reacts negatively to baby Expression of disappointment over baby gender View of baby as messy or unattractive Baby reminds mom of person she does not like

Which hormone changes breast size?

Increased amounts of estrogen

Coagulation pp

Increased levels clotting factors/fibrinogen during pregnancy remain elevated a few days after delivery to protect against hemorrhage

Aquamephyton (Vitamin K)

Indication: prevention of hemorrhagic disease in neonate. Required for hepatic synthesis of blood coagulation factors. Administered IM - 0.5 mg within the first hour of life.

You should inspect the nipples for?

Inflammation, fissures, & tenderness. Nipples should be kept soft & supple

Parent-child attachment (bonding)

Initial phase in a relationship characterized by strong attraction and a desire to interact.

A nurse in the newborn nursery receives a call from the emergency department saying that a woman with active herpes virus lesions gave birth in a taxicab while coming to the hospital. What does the nurse consider about the transmission of the herpes virus?

It can be acquired during a vaginal birth.

When does the colostrum become milk?

Its production continues for about 2 days after delivery, when true milk production begins.

A nurse is assessing a newborn for signs of hyperbilirubinemia (pathological jaundice). What clinical finding confirms this complication?

Jaundice that develops in the first 12 to 24 hours

How does the nurse provide kangaroo care to a preterm infant?

Keep the newborn in skin-to-skin contact with the parent.

A parent of a preterm infant in the neonatal intensive care unit, asks a nurse why the baby is in a bed with a radiant warmer. The nurse explains that preterm infants are at increased risk for hypothermia because they:

Lack the subcutaneous fat that usually provides insulation

Stage 2 postpartum period

Last about 6 weeks most changes are reverse.

What should the nurse recommend to a new mother when teaching her about the care of the umbilical cord area?

Leave the area untouched or clean with soap and water, then pat it dry.

When can mother take pain medications when breast feeding?

May take a mild analgesic 1 hour before nursing.

A newborn has small, whitish, pinpoint spots over the nose that are caused by retained sebaceous secretions. When documenting this observation, a nurse identifies them as:

Milia

The nurse observes several dark round areas on a newborn's buttocks on a dark-skinned neonate. How should this observation be documented?

Mongolian spots

A women who have experienced a molar pregnancy must avoid becoming pregnant for how long?

One year.

A nurse is planning to use a newborn's foot to obtain blood for the required newborn metabolic testing. What part of the foot is the best site to use for the puncture?

Outer heel

The practice of separating parents from their newborn immediately after birth and limiting their time with the infant during the first few days after delivery contradicts studies of:

Parent-child attachment

a newborn is jaundiced over the bony prominence of the face and mucous membranes within the first 24hrs of birth. this represents what?

Pathologic jaundice; caused by too much bile pigments called icterus neonatorum.

Test perform to newborn

Phenylketonuria (PKU) , biotinidase, thyroid

Black newborn is usually what color?

Pinkish or yellowish brown

White newborn is usually what color?

Pinkish to slightly reddish

How to clean breasts and nipples?

Plain water and air drying may prevent problems. Some physicians recommend allowing the nipples to dry after feeding without removing the milk residue. If additional moisturizer is needed, small amounts of unscented lanolin or a nipple cream may be used to soften and soothe dry, tender nipples.

A nurse weighs a neonate who is born at 29 weeks' gestation. The weight is 1619 g (3 lb 9 oz). In light of this weight and gestational age, how should this infant be classified?

Preterm

let-down reflex.

Prolactin, a hormone secreted by the anterior pituitary gland, is responsible for stimulating milk production in the mammary alveolar cells. Stimulation of the nipples, particularly by the infant's sucking, causes the release of oxytocin from the posterior pituitary gland. Oxytocin stimulates contraction of the mammary ducts, and milk is ejected from the breast.

A 7-lb newborn is admitted to the nursery with a prescription for intramuscular phytonadione (vitamin K, Aquamephyton) 1 mg. The nurse explains to the parents that this vitamin is administered to:

Promote clotting of the blood

The nurse administers the prescribed vitamin K intramuscularly to a newborn immediately after birth to:

Promote the synthesis of prothrombin

A new mother asks a nurse how to care for her baby's umbilical cord stump. What should the nurse teach the mother?

Provide sponge baths until the stump falls off.

A client's membranes rupture during the transition phase of labor, and the amniotic fluid appears pale green. What priority intervention for the infant can the nurse anticipate implementing upon delivery?

Providing for suctioning of the oropharynx as the head emerges

Pull to sit (Traction) Reflex

Pull infant up by the wrist from supine position with head in midline. Head lags until infant is in upright position, then head is held in the same place with chest and shoulder momentarily before falling forward; infant will attempt to right head.

What will help with engorgement of a mom who isnt breast feeding?

Put cold packs in her bra

newborn assessment finding for the newborn VS

RR- 30-60 bpm with brief periods of apnea (if>60 could have fluid in airway) P- 120-160 bpm BP- 60-80/40-50 mm Hg AxTemp- 97.6-98.6F

During the second reactive period a newborn becomes more alert and responsive and there is an increase in mucus production and gagging. What should the nurse do first?

Remove secretions from the pharynx

What is the most important parameter for the nurse to monitor during the first 24 hours after the birth of an infant at 36 weeks' gestation?

Respiratory distress

Administration of Rho(D) immune globulin (RhoGAM) is indicated for those women who are?

Rh negative.

Asian newborns are usually what color?

Rosy or yellowish color

Lochia is?

S

diastasis recti

Separation of the longitudinal muscles of the abdomen (rectus abdominis) during pregnancy.

The most appropriate method for a nurse to evaluate the effects of the maternal blood glucose level in the infant of a diabetic mother (IDM) is by performing a heel stick blood test on the newborn. What does this test determine?

Serum glucose level

Desquamation

Shedding of epithelial elements; chiefly of the skin in scales or sheets

Simean crease

Single palmar crease; seen in Downs syndrome

Epstein's pearls

Small, white blebs found along the gum margins and at the junction of the hard and soft palates; commonly seen in the newborn as a normal manifestation.

S/S of hypovolemic shock

States she feels weak, lightheaded, funny, sick to stomach, or sees stars Becomes anxious or exhibits air hunger Skin turns ashen or grayish Skin feels cool & clammy Pulse rate increases BP declines

A health care provider tells a mother that her newborn has multiple visible birth defects. The mother seems composed and asks to see her baby. What nursing action will be most helpful in easing the mother's stress when she sees her child for the first time?

Staying with her after bringing the infant to help her verbalize her feelings.

During a vertex vaginal birth the nurse notes meconium-stained amniotic fluid. What is the priority nursing intervention for the newborn?

Suctioning the airway

At 10 hours of age a newborn has a large amount of mucus in the nasopharynx and becomes cyanotic. What is the nurse's initial action?

Suctioning the mouth

Moro (startle) reflex

Sudden jarring or change in equilibrium causes extension and abduction of extremities and fanning of fingers, with index finger and thumb forming a C shape, followed by flexion and adduction of extremities; legs may weakly flex; infant may cry.

On the second day of life, minutes after drinking 2½ ounces of formula, a newborn regurgitates about half an ounce. The mother remarks, "My baby spits up after every feeding." What should the nurse do next?

Suggest that she hold her baby upright for 30 minutes after feeding

Engorgement

Swelling of the breasts resulting from increased blood flow, edema, and the presence of milk.

How many sitz should the mother take after vaginal delivery?

Take sitz baths two or three times daily with vaginal delivery.

After being shown to the parents, a preterm male newborn weighing 3 lb 15 oz (1500 g) is moved to the neonatal intensive care unit. What should the nurse's plan for parental visits include?

Taking them to visit their son as soon as possible

Acrocyanosis is?

Temporary cyanotic condition, usually in newborns resulting in a bluish color at the extremities. Lasts 7-10 days

What should the care of a newborn infant whose mother has had untreated syphilis since the second trimester of pregnancy include?

Testing for congenital syphilis

How should a nurse screen the newborn of a diabetic mother for hypoglycemia?

Testing heel blood with the use of a glucose-oxidase strip

Mature milk

The breastmilk after colostrum and transitional milk, typically beginning 2 weeks postpartum.

The newborn should void within how many hours of delivery?

The newborn should void within 24 hours of delivery.

How long does the puerperium last?

The puerperium lasts about 3 to 6 weeks

Milk stool

These usually appear by the fourth day. In breastfed infants, stools are yellow to golden, are pasty in consistency. Formula fed smells worse than breastfed

A newborn's total body response to noise or movement is often distressing to the parents. What should the nurse explain about this response?

This reflexive response is an expected part of development.

Murmurs are common in newborns. True or False?

True

How long can breast milk be frozen?

Two weeks

Most common infections in pregnant women ?

UTI Masitis

How to clean umbilical cord?

Use alcohol on cord stump daily. (Be careful to prevent alcohol from dripping down to perineal area.) • Keep area dry; fold diaper down with plastic side on outside to prevent moisture retention. • Sponge bathe for 7 to 10 days until umbilical cord comes off. (Do not soak in bath water.)

Phototherapy is prescribed for a neonate with hyperbilirubinemia. Which nursing intervention is appropriate to reduce the potentially harmful side effect of the phototherapy?

Using shields on the eyes to protect them from the light

Pseudomenstruation

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

A nurse plans to administer vitamin K to a newborn. What site should the nurse use for the injection?

Vastus lateralis

When a cesarean delivery has been performed and the use of anesthesia was used, when can the mother start eating solid foods again?

Verify the presence of bowel sounds before giving solid food.

Women who are breastfeeding should do what to help with engorgement?

Warm shower/warm packs & manual expression

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).

Tonic neck reflex( fencing)

With newborn in supine, neutral position, examiner turns newborn's head quickly to one side.. the newborn's arm and leg on that side extend and opposing arm and leg flex.

spina bifida

a congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the spinal cord to protect it

what may interfere with the complete contraction of the uterus, potentially causing hemorrhage

a full bladder (mother should void within 4-6 hrs after delivery; an indwelling cath may be used 1-2 days after a cesarean birth)

Prolactin is what?

a hormone that stimulates milk production

Mottling

a lacy pattern with dilated vessels on pale skin

when assessing the perineum after an episiotomy is performed would be

a lateral position with the upper leg toward the chest; perineum should be approximated and tissue may appear edematous

when pain in the calf when the ankle is dorsiflexed and the knee bent is know as

a positive homans sign (indicates inflammation of the blood vessels of the leg and could indicate possible thrombophlebitis

what is colostrum

a thin, watery, slightly yellow substance that is first produced in lactating mothers; rich in protein, calories, antibodies, lymphocytes and has high levels of immunoglobins; present for 2-4 days after delivery.

hip dysplasia

abnormal development of the pelvic joint causing the head of the femur and the acetabulum not to be aligned properly

microcephaly

abnormal small head.

2nd degree tear

additionally muscles of the perineum but not the rectal sphincter

what should you do to help a mother who has a 3rd degree laceration and is afraid to have a BM

administer stool softener as prescribed; encourage fluids and bulk in the diet.

when can you give a baby milk?

after 1 years

discharge instructions that should be given concerning circumcision at discharge?

apply sterile petroleum gauze after each diaper change

Mongolian spots

areas of deep bluish-gray pigmentation most commonly on the sacral aspect of a newborn

newborn assessment finding for the newborn extremities

arms and hands generally flexed against body; arms should move evenly; legs should be same length; hips move freely; hands and feet should be assessed for syndactyly/polydactyly (fused/webbed digits, too may digits)

bowel

assess for bowel sounds, encourage activity, and adequate fluid.

if a new mother had spinal anesthesia during a c-section, desires to get up and go to the bathroom to void, and can wiggle her toes, what should the nurses' response be?

assist the pt to ambulate to the bathroom

witch hazel (Tucks pads)

astringent for hemorrhoids (reduces itching)

vernix caseosa

at birth the skin is covered with a yellowish white cream cheese-like substance. It protect the newborn form the amniotic fluid.

a uterus that feels soft/boggy is termed

atonic uterus; should be massaged to increase contractility

the self ingestion that occurs in tissue/cells by enzymes in the cells themselves and contributes to involution is?

autolysis

Lochia rubra is?

b

bladder.

be alert of sigh of infection after urination . Note for dysuria or urinary retention.

stool of baby that is bottle fed

brown more formed

what may put a mother at risk for thrombus

cardiac output declines rapidly; d/t high platelets in early postpartum

newborn assessment finding for the newborn face

chin is receding cheeks full and round oral cavity should be intact with a closed palate Epstein's pearls may be observed (white, epithelial inclusion cysts in the midline of the palate)

what should be included in the demonstration of newborn bathing?

cleanse perineum from front to back, umbilical cord care, bath water temp, safe methods of holding and positioning, do not scrub to vigorously

first secretion produced by the breast

colostrum

Three interrelated factors of engorgement

congestion, increased vascularity, and the accumulation of breast milk

Caput succedaneum

diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days feels spongy crosses suture lines

causes of fluid loss during delivery

diuresis, diaphoresis, and blood loss in delivery

gynecomastia

either sex may have enlarged breast. it is result of maternal hormones.

sucking and rooting

elicit by stroking the cheek or edge of mouth. Newborn turns the head toward the die that is touched and starts to suck. Expected age: Usually disappears after 3 to 4 mths.

a result of venous and lymphatic stasis that happens during lactation is called

engorgement (seen about 3 days after delivery and usually resolves in about 48hrs)

what are some potential evaluations of psychosocial aspects of new parents?

engrossement (preoccupation, absorption, and interest in the infant), how they will provide, will I be a good parent, insufficient knowledge, self-perception is common for new mother. "taking in" stage may happen the first couple days and will need supportive care. Mood swings are common d/t stresses, fatigue and rapid hormonal changes. cognitive and perceptual issues; controlling pain is important i.e. episiotomy pain, cramping or if cesarean birth, the incision site. PT for care of self and newborn is important throughout the stay in the hospital.

hydrocephalus

excessive cerebral fluid within the brain cavity surrounding the brain.

newborn assessment finding for the newborn eyes

eyelids may appear edematous strabismus (cross-eyed) nystagmus (abnormal movement of the eyes) nearsightedness

newborn assessment finding for the newborn genitals

female may be edematous pseudo menstruation (in female infants) scrotum may be enlarged and edematous, indicating a hydrocele penis inspected for position of the urethral meatus

Lanugo?

fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn. from 20 weeks on

newborn assessment finding for the newborn head

fontanels should be palpable may have molding caput succedaneum (localized edema on the newborn scalp) cephalohematoma (localized effusion of blood beneath the periosteum of the skull; does not cross suture line unlike cs; is firmer than edema like a water filled balloon)

lactation

function of secreting milk or period during which milk is secreated.

NI for the fundus for the first 2hrs after delivery

fundus and lochia are checked q15min; fundus should remain contracted, firm and at the midline; if not severe bleeding may occur; encourage mother to empty bladder before fundus palpation d/t bladder displacing fundus and preventing fundus from contracting.

Postpartum headaches may be caused by which various conditions?

gestational hypertension stress leakage of cerebrospinal fluid into the extradural space during placement of the needle for epidural or spinal anesthesia.

newborn assessment finding for the newborn skin appearance

good turgor and tissue elasticity

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.

newborn assessment finding for the newborn characteristics of body size and shape

head disproportionately large for its body the abdomen is prominent, with a smaller chest and narrow hips average weight-3400g (7lbs, 8oz) average length- 20 inches (50cm) head circumference- 13-14 inches (33-35.5cm)

What will help with engorgement of a mom who is breast feeding?

hot shower

teaching regarding breast engorgement

if breastfeeding; manual expression of milk, application of warm, moist heat (like a hot/warm shower), cabbage leaves inside the bra has been known to alleviate symptoms. If non breastfeeding; wear snug/comfortable bra for compression, wrapped ice packs and analgesics prn

How long does the fudus take to return to the pelvis?

in 10 days.

If a native American mother tells the nurse when she goes home, her mother-in-law will be caring for the baby while she rests. would this be concerning? if so, what should the nurse do?

in certain cultures it is acceptable for the mother to completely rest and let family members take care of the baby. it is important for the nurse to initiate and observe mother/baby bond while in the facility to ensure there is as much interaction as possible between mother and baby

telangienctatic nevi

in newborn skin " stork bites" are flat, pink or red marks often seen on the eyelids, nose, or nape of the neck. These are dilated capillaries that becomes more vivid when the infant cries. . they are not significant to the healthy of the infant and disappear at 1 to 2 years of age.

nevus flammeus

in newborn skin- Port wine stain- is a capillary angioma below the surface of the skin that is purple or red, varies in size and shape, is commonly seen on the face, and does not blanch or disappear.

Diuresis

increased formation and secretion of urine/fluid

newborn assessment finding for the newborn rest and sleep

infants sleep 16-20hrs/day usually time awake is spent crying, eating or in quiet alertness most infants do not exceed 5hrs of sleep for some months; can disrupt the mother's need for sleep

mastitis

inflammation of the breast; most commonly occurs in women who are breastfeeding

uterus

inspect top of uterus, the fundus. if not firm, muscle are not contracting and or has placental fragment. predispose for hemorrhage. Gently massage the uterus.

3rd degree tear

into the rectal sphincter

term for a postpartum uterus' return to a pregravid state

involution

Cephalohematoma

is a collection of blood between the peritoneum and the skull bone that it covers. It does not cross the suture line. It results from trauma during birth such as pressure of the fetal head again the maternal pelvis in a prolonged difficult labor or forceps delivery. It appears in the first 1 to 2 days after birth and resolve in 2 to 3 weeks.

What causes autolysis to occur after birth?

is a result of the sudden withdrawal of estrogen and progesterone, which releases proteolytic enzymes into the endometrium.

Tolbutamide

is an oral hypoglycemic agent used in the treatment of type 2 diabetes mellitus. It is known to have teratogenic effects like neonatal hypoglycemia.

What's the color of lochia the first three days after delivery?

is dark red

PT care of the circumcision;

keep clean/assess for bleeding, sterile petroleum gauze may be applied to the penis after diaper change/baths.

vaginal discharge that occurs immediately following delivery

l

Native American newborns are usually what color?

light pink to a dark, reddish brown. Depends on tribe

yellow/whitish discharge that may continue 7 days to 2 weeks after birth is

lochia alba

bright red discharge during 1-3 days after birth

lochia rubra

pink/brown discharge after birth that lasts up to 7 days is

lochia serosa

Ileus

loss of peristalsis with resulting obstruction of the intestines

metabolic issues of newborn; hypothermia

maint of body temp is critical for newborn care large surface area of newborn and limited amount of adipose tissue can contribute to low body temps. heat is lost through RADIATION; heat loss d/t transfer from body to cooler surfaces/objects not in contact with body (NI; keep infant wrapped; work quickly to avoid exposure; use radiant warmer, locate crib away from outside wall) EVAPORATION: loss when water is converted to vapor (NI; dry infant thoroughly after bath_ CONDUCTION: loss of heat to cooler surface via direct skin contact (NI; pad surfaces under infant, warm other equipment I.e. stethoscope before use) CONVECTION: loss of heat to cooler air currents (NI; reduce drafter from open doors, window, or air conditioner; wrap newborn to protect from cold)

newborn assessment finding for the newborn activity and exercise

maintaining a clear airway is critical to the newborn; may need to suction to remove mucus from nose and mouth infants are obligate nose breathers and the nasal passageway must be kept open and free of mucus (use blue bulb prn) crying is the only means of communication for the infant; indicates hunger, pain or simply the need for attention

observed mom and infant interactions which indicate bonding

makes eye contact and talks with infant; cuddles with infant; says infants name when speaking to or about infant; interactive with the care of the infant

polydactyly

malformation of digits, commonly seen as webbing or fusion of two or more digits to form extra digits

syndactyly

malformation of digits, commonly seen as webbing or fusion of two or more digits to form one structure.

first stool is called

meconium

where should the fundus be located right after birth

midway between the umbilicus and symphysis pubis

plan of acre for a newly circumcised infant would include?

monitor for bleeding during the first 12hrs

the normal reflex that is seen in newborns who jerk around when their position is changed

moro reflex; ext and abduction of extremities and fanning of fingers, with index finger and thumb forming a c shape, followed by flexion and adduction of extremities, legs may weakly flex and infant may cry

test that detects inborn errors of metabolism in newborns

newborn screening test, PKU, phenylketonuria

what is the purpose for the administration of vit k to the newborn?

newborns are not able to synthesize vit k in the colon until they have adequate intestinal flora

what diet should a lactating/nonlactating mother maintain

nonlactating mothers should maintain a pre-pregnancy diet. lactating mothers should increase 300-500 ca;/day and 2-3L of fluids/day is recommended for lactating mother to maintain an adequate diet for breastfeeding

during the immediate postpartum period, mom has a temp of 100.2F, pulse of 52, RR of 18 and BP of 138/84. What should the nurse do? is this normal?

normal but fever should not persist for more than 2 consecutive days

know how to measure lochia discharge

observable on pad: scant is about an 1 inch stain light is 1-4 inch stain moderate is about 4-6 inch stain heavy is saturated in 1 hour

When is jaundice considered pathologic?

occurs sooner than 48 hours after birth

used after delivery of the placenta to contract and compress blood vessels of the uterus where the placenta separated from the wall?

ocytocin

Spanish newborns are usually what color?

olive tint or slight yellow cast

Which hormone causes the uterus to contract?

oxytocin

Homans' sign

pain in the calf which indicates inflammation of the blood vessels of the leg and possible thrombophlebitis.

Telangiectatic nevi (stork bites)

pale pink or red spots; frequently found on the eyelids, nose, or nape of the neck. Usually fade by the second birthday.

normal characteristics of a breastfed infants stools

pale, yellowish and sweet smelling, sometimes with small curds in it

BREAST

palpate for engorgement or nodules. Inspect nipples for pressure, soreness, cracks, or fissures

assessment for parent-child attachment

parent should have a strong attraction; a desire to interact with infant if bonding doesn't occur it would be difficult to maintain energy required to meet newborn's needs early contact is important to establish bonding nurse should encourage early and frequent interaction between baby and parent.

1st degree tear

perineal skin vaginal mucus membrane without muscle involvement

normal findings in the newborn during initial assessment?

persistant high pitched cry

What kind of gauze is used to for circumcision?

petroleum gel gauze

erythema toxicum

pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks. elevated hive-like rash may result white vesicles -> not contagious, no tx, resolves on own

What color is the lochia after 4 or 5 days after delivery?

pinkish brown.

Mummification

producing a dry, hard mass

uterine involution increases

proteinuria

measures to help prevent infant abduction

recognize facility id badges do not give infant to anyone not wearing this badge respond to electronic sensor alarm never leave the infant unattended

the hormone that "relaxes hip and joints to prepare the body for birth

relaxin

Nutritional needs of the newborn

requires approx. 120 cal/kg/day breast milk and formulas are balanced for newborn needs fluid need; 140-160 mL/kg/day frequency of feeding depends on type of feeding: breastfed babies may tend to eat more frequently that formula fed newborns d/t the fluctuation of lactation or factors that may affect breast feeding.

NI for the postpartum mother

risk for deficient fluid volume risk for infection impaired urinary elimination constipation nutrition; less than the body requires nutrition; more than the body requires pain, acute impaired tissue integrity disturbed sleep pattern deficient knowledge anxiety risk for impaired parenting interrupted family processes impaired parenting situation low self esteem

newborn assessment finding for the newborn reflexes

rooting sucking gag swallow blink burp hiccup sneeze moro reflex aka startle reflex

How long does it take for a mother to return to prepregnate weight?

she usually returns to her prepregnant weight in 6 to 8 weeks without significant dietary restrictions.

newborn assessment finding for the newborn elimination:

should void within 24 hrs; usually voids small amounts of poorly concentrated urine (as fluid intake increases, kidney function improves, urination becomes more frequent) bm within 24 hours; odorless, black-green color, sticky (meconium) initially; when infant begins to taking nourishment the stool changes to greenish and loose. or breastfed babies tend to pass stool frequently; pale yellow and sweet-smelling sometimes with curds.

newborn assessment finding that can suggest a chromosomal disorder

simian crease (of hand); (also low set ears can be indicative of chromosomal abnormalities)

can reduce discomfort and promote healing of the perineum

sitz bath

normal findings in a 1-day postpartum pt?

slightly elevated temp up to 100.4F, light to moderate discharge of lochia rubra, perineum tenderness, constipation, tender/sore/engorged breasts, but fever should not persist for more than 2 consecutive days. (indicative of puerperal infection)

Lochia alba

slightly yellow to white This drainage continues for another 10 days to 2 weeks.

newborn assessment finding for the newborn spine

straight w/o curves

what NI should be carried out immediately following the delivery of a newborn?

suction the nose and mouth for airway patency

Circumcision

surgical removal of the foreskin

appropriate suggestions for quieting a fussy newborn

swaddle; prewarm crib sheets; suckle breast/pacifier; movement such as a car ride/stroller/carriage/rocking or cradle; skin to skin contact; soothingly talking with infant; or infant may need stimulation like repositioning or bring into the room with the rest of the family

which reflex should be assessed before allowing the initial feeding of an infant?

swallow reflex

Rubin's Restorative Phases

taking in, taking hold, letting go

bonding

the itnitial phase in a relationship characterized by strong attraction and a desire to interact.

meconium

the newborn initial stools are odorless, black-green, and sticky. It is made of vernix, strands of lanugo, mucus, and other substances form the amniotic fluid.

involution

the pelvic decrease size to the non pregnant size of 2 ounces.

Lochia

the postpartum vaginal discharge that typically continues for 4-6 weeks after childbirth

diaphoresis

the secretion of sweat, especially when profuse, cold sweat, circulation has started to decrease

autolysis

the self dissolution or self-digestion that occurs in tissue or cells by enzymes in the cells themselves. is the results of withdrawn of estrogen and progesterone, which release proteolytic enzymes into the endometrium.

puerperium

the stage that lasts from the time of placenta delivery to when reproductive organs return to nonpregnant size and position

cryptorchidism

the testicles are normally descended in term infants. in preterm infants they may not be descended.

Where is the uterine fundus after delivery?

the uterine fundus is about midway between the umbilicus and the symphysis pubis or slightly higher. Should decend 1 cm per day.

When is Rhogam administered?

they must receive RhoGAM within 72 hours of delivery.

transitional stool

thin, brown to green

what should a nurse encourage the mother to do to prevent contamination/infection

thorough handwashing and perineal care with a squirt bottle after voiding and defacating.

4th degree tear

through the sphincter and into rectal mucosa

latch-on

to grip; to fasten onto

12 hours post delivery, where would you expect to palpate the fundus?

umbilicus

newborn assessment finding for the newborn ears

upper insertion of the pinna should be even with theouter canthus of the eye

appropriate way to assess the fundus of the postpartum pt

use one hand on the lower uterine segment and the other hand to palpate the fundus for size and position

NI and assessment for the newborn

verify and identify security bracelets to parent PT handwashing for before infant care PT safety practices to reduce injury to infant state laws require certain diagnostic tests on newborns (PKU) aka newborn screening

what are the NI for a mother during the recovery stage (1-4hrs after placenta delivery)

vs should be monitored q15min for the first 2hours (vs should stabilize during the first 2 hours)

what is vernix caseosa and its purpose?

white cream-like substance that is on the surface of the infant to protect in the environment within the amniotic fluid

newborn assessment finding for the newborn umbilical cord

whitish blue-gray with 3 vessels (two arteries, 1 vein) contain a gelatinous tissue called whartons jelly (gives structure and prevents vessels from injury) if little to no whartons jelly could signal congenital abnormalities

pre-pregnant blood level with return to normal within

within 2-4 weeks

Vital signs normally stabilize within how many hours after delivery?

within the first 2 hours after delivery

color of baby stool when breast fed ?

yellow colored, more often

within the 1st hour following a vag delivery, you find the fundus is firm and there is a trickle of bright red blood. is this normal?

yes, lochia rubra can last 1-2 days postpartum

Nutrition (Nursing, Dieting)

• Continue prenatal vitamins until gone. • Nursing: need 500 kcal more than prepregnant diet; need increased protein, 400 mg calcium each day, 8 to 10 glasses of fluid each day; avoid onions, cabbage, chocolate, spices, and foods that may distress infant; no dieting during breast-feeding.

Emotions (Bonding, "Baby Blues")

• Mother may be tearful or anorexic and have difficulty sleeping. • Hormonal factors and fatigue are often responsible. • Notify primary care practitioner if prolonged, increased, or unmanageable.

Hypovolemic Shock Nursing Intervention

• Notify primary health care provider. • If uterus is atonic, massage gently and expel clots to cause uterus to contract; compress uterus manually, as needed, with two hands. Add oxytocic agent to IV drip, as ordered. • Give oxygen via face mask or nasal prongs at 8 to 10 L/min. • Tilt the woman to her side or elevate the right hip; elevate her legs to at least a 30-degree angle. • Provide additional or maintain existing IV infusion of lactated Ringer's solution or normal saline solution to restore circulatory volume. • Administer blood or blood products, as ordered. • Monitor vital signs. • Insert an indwelling urinary catheter to monitor perfusion of kidneys. • Administer emergency drugs, as ordered. • Prepare for possible surgery or other emergency treatments or procedures. • Chart incident, medical and nursing interventions instituted, and results of treatments.

Hypovolemic Shock symptoms after birth

• Woman has persistent significant bleeding (perineal pad soaked within 15 minutes); this bleeding may not be accompanied by a change in vital signs or maternal color or behavior. • Woman states she feels weak, lightheaded, "funny," or "sick to my stomach" or she "sees stars." • Woman begins to act anxious or exhibits air hunger. • Skin turns ashen or grayish. • Skin feels cool and clammy. • Pulse rate increases. • Blood pressure declines.

Hygiene post partume?

▪Excessive perspiration normal ▪Lochia has musty odor ▪Encourage bathing ▪May have vertigo (due to vascular fluid shift) -> supervise 1st shower ▪No baths x 6 weeks ▪Sitz baths encouraged if available