NRS 240 exam 3: postpartum

N/V interventions PP

-essential oils, crackers, soda, cold therapy, fan -zofran, reglan

what causes headahces postpartum

-fluid shifts, leakage of CSF, GHTN, preeclampsia, fluid and electrolyte imbalances, stress

serosa lochia

-pink to brown -3-10 days PP -serosanguineous

lower extermity assessments PP

-redness, tenderness, increased temp -homans sign -edema (unilateral vs bilateral) -circumferences -DTRs

influenza vaccine

administer immediately PP if not immunized and delivered during current flu season.

what substance abuse is contraindicated in breast feeding

amphetamines, alcohol, cocaine, heron and marijuana. methadone is not contraindicated

nursing interventions with energy RT PP women

cluster cares, avoid frequent interruptions, encourage daily rest periods

what is family

family is whatever you consider it. family is a loose term that means alot of different things to different people

respiratory assessment postpartum

observe for shallow breathing, labored breathing, restlessness -diminshed sounds= pumlonary embolism -crackles/rales= fluid overload

define small lochia

small is less than 4 inches in 1 hour about 10-25 ml

postpartum vital signs: RR

-12-24 breaths/min -should return to baseline quickly after birth -should be clear with no rales/crackles/wheezes -bradypnea due to medication or tahcypena due to anxiety, infection

postpartum vital signs: BP

-120/90 -5% increase for first few days, return to pre preganncy levels weeks to months -risk for orthostatic hypotension first 48 hours -if MAP is less than 65 indicate hypovolemia

fluid requirements based on age of infant

-2 days old: 60-80 ml per kg/day -3-7 days old: 100-150 ml/kg/day -8-30 days old: 120-180 ml/kg/day

what are baby blues

-50% of women experience this -normal and will resolve 10-14 days PP -r/t hormone shifts ,fatigue, discomfort, over stimulation, lack of support

what is generalized anxiety disorder

-6-10 % moms experience this -excessive worrying about multiple problems. issues of concerns are realistic but the degree of worry is NOT

why are PP woman at risk for thromboembolism

-Pregnancy - hypercoagulable state -PP have Elevated plasma fibrinogen levels -PP have Deep vein diameter + vessel damage & immobility

MMR vaccine

-administered if rubella non immune -avoid pregnancy for 4 weeks after administration -administering with RhoGAM may interfere with desired immune response -given subq

placental site PP

-after the placenta seperates it leaves a site -site heals by exfoliation over 6 weeks -site after delivery is 8-10 cm and 3-4 by end of third week -increase in bleeding may occur around 7-14 days

what is postpartum depression

-almost 20% of women have depressive episodes during the first 3 months PP -if diagnosed, risk of reoccurence with next child is 30-50% -duration is 6 mo or longer and onset is anytime during the first 12 mo -history of depression, increases risk

nutrition in PP women

-appetite usually good, always remember cultural preferences -if mother is breastfeeding need additional 500 kcal daily and 200-300 mg omega 3 fatty acids -take a multivitamin supplement

substance abuse nursing interventions

-be kind and patient -use pharmacological and non pharmacological measures -promote infant attachment -individualize breastfeeding education -discharge planning; safe home environment, support person, home visits

postpartum vital signs: temperature

-can increase to 100.4 for up to 24 hours, should be afebrile after 24 hours -want to be less than 100.4 and more than 96.8 -less than 96.8 indicates sepsis and 100.4 longer than 2 days is also sepsis

neuraxial morphine (Duramorph)

-common in c-section moms -long acting (unlinke fentayl) -can last up to 24 hours, provides better pain control, results in earlier ambulation, earlier bowel function

rubra lochia

-dark red -1-3 days PP -consists of blood -occasionally small clots (nickel size) -its abnormal to have clots greater than egg size or plum

effects of rapid decrease of estrogen and progestrone postpartum

-decreased estrogen results in diuresis of excess extracellular fluid (like a lot, 3000 ml) -reversed diabetogenic effects, so hypoglycemia, insulin dosage should be decreased

short term increase in temp (not indicating infection) could be caused by what?

-dehydration -breast engorment -post op

what can indicate cardiomypathy/be a red flag related to respiratory system postpartum

-difficulty breathing or SOB (dyspnea) -difficulty breathing when laying down (orthopnea) -cough especially if it is new

PMADs and substance abuse

-dual diagnosis is common. many people with psychiatric disorder will also have substance abuse -opioid abuse is associated with a increased risk of maternal death during hospitalization

nursing interventions with PMADS

-edu women about depression and plan of care including medications -discuss alternative treatments -recognize s/s of PPD as early as possible -cannot depend on women to openly tell us these things so we must ask and recognize s/s -facilitate maternal newborn attachment -provide support -therapeutic communication

comfort measures for non breast feeding mothers

-educate to avoid stimulation to breasts/nipples so avoid the shower head or touch -wear a supportive bra -provide relief with NSAIDS

breasts in non breast feeding mothers

-engorgement occurs 3-4 days pp -resolves within 24-36 hours pp -lactation will cease a few days to weeks

interventions to facilitate return of normal bowel function

-fluids -eat a high fiber diet -don't ignore the urge to go -avoid straning -ambulate -stool softeners -treat hemorrhoids (witch hazel, baths, gels) -avoid narcotics

neurologic postpartum symptoms

-headaches most common -decreased attention/concnetration -decreased memory -tired, so education needs to be reinforced and have support person present

educate patients when to call HCP related to cardiac issues

-heart plapations or racing heart -increased chest pressure or pain -increased difficulty breathing or SOB

Mother is at increased risk of thrombophlebitis, thrombosis, vein inflammation PP. what are some risk factors?

-hypercoagulability (factor V, DVT, PE) -severe anemia -obesity -traumatic delivery -c section -mag recovery

vital signs during PP hemorrhage

-hypotension, tachycardia (weak and thready), and increased RR -vital signs are a late sign, already too late, so much use lochia assessments before this point

immunity in postpartum

-immune suppression from pregnancy will resolve, but it places these women at risk for infection in the mean time -postpartum rebound may trigger flare ups of autoimmune disorders

RhoGAM

-indication is for Rh- mother, with Rh + baby -administer within 72 hours PP -workup needed to determine dose, usually 300 mcg -IV push or IM -protects against erythroblastosis fetalis

weight changes postpartum

-initial weight loss of 10-12 lbs -postpartum diuresis results in additional 5 lb loss (note if gained, or same bc fluid retention) -total weight loss occurs 6-8 weeks or longer

attachment interventions a nurse can perform

-involve parents in care, allow them to take baby temp, change diaper, bath, etc -promote educational opportunities -encourage skin to skin and holding baby -call baby by name and compliment

prolactin during postpartum

-levels increase -levels in non breast feeding women return in 3 weeks -in breast feeding women, levels stay increased and prevent ovulation and menstruation

s/s of substance abuse

-low threshold for pain, so rating pain constantly at a 10 or asking for more medication -lack of involvement with infant care -abusers can be difficult to care for during pregnancy

PP hemorrhage s/s

-may initially present with subtle signs or none at all -obvious sign: excessive free flow and or expression of clots during uterus massage -subtle sign: slow constant trickle over extended period -Hgb and Hct are not accurate indications, early findings may include dizziness, pallor, clammy/cool skin

PPD diagnosis

-must have the presence of 5 or more symptoms during the same 2 week time period. -at least one symptom must be either depressed mood or loss of interest or pleasure -other s/s include weight loss, insomnia, fatigue, feelings of guilt, agitation, decreased concentration

barriers with PMADs and substance abuse

-no discrepancy among women of different ages, races and social status, it can affect anyone -barriers include social stigma, labeling, guilt and lack of resources -women often fear losing custody of child or criminal prosecution

episiotomy

-not very common, research is not promising -associated with increased risk of 3rd and 4th degree lacerations, anal sphincter injuries, severe lacerations/injury, increased infection, delayed healing breakdown in repair, increased blood loss, scarring, increased pain and sexual dysfunction

cultural beliefs and practices: nurses role

-people from specific cultures don't always practice or adhere to "traditional ways" -nurse should never assume, always ask the client what they practice, avoid stereotypical assumptions rather use as guideline

hematologic changes postpartum

-plasma fibrinogen levels remain elevated 3-4 weeks, helps protect against hemorrhage but increases risk of thrombus formation -platelet levels decrease RT placental separation -WBC are elevated for 4-7 days

post partum infection prevention

-proper hand hygiene, perineal hygiene, breast hygiene -facilitate complete bladder emptying -assess nipple trauma and proper latch -provide edu on s/s to watch for

postpartum psychosis

-psychiatric emergency -presence of one or more episodes of elevated energy levels, cognition and mood and one depressive episode -sudden onset -risk factors include bipolar disorder, family history of PPP or depression

uterus involution

-rapid reduction in size and return to non pregnant state -U/2 below umbilicus after delivery and rises to U/1 above postpartum -descend 1 cm every 24 hours -prepregnant state by 6 weeks

spinal headache

-red flag is if lay down fine and sit up with sudden headahce -caused by leakage of CSF -use oral analgesics, hydration, cafeeine, bed rest, blood patch

physiologic processes that effect mood in PP women

-reduced blood flow and abnormal phosphorus metabolism in brain -disturbed activity in neurotransmitters (dopamine, norepinephrine and serotonin) -hormonal changes

postpartum vital signs: pulse

-remains elevated for an hour, decrease over 48 hours -peurperal bradycarida (40-50) is common. -normal range is 60-100 -tachycardia due to pain, fever, dehydration, hemorrhage -bradycardia due to anesthesia/drugs

nursing care for urination

-remove indwelling catheter -measure several first voids -listen to running water, peri bottle, warm shower, relaxation techniques to void -straight Catheter if needed

cardiovascular system postpartum

-returns to prepregnancy 6-12 weeks -auto transfusion immediately after birth 500-750 ml blood per min diverted from placenta to mom (increase stroke volume) -CO peaks 10 min after birth up to 80% and then pre pregnancy by 2-3 weeks -worry about our cardiovascular patients

when can sexual activity resume in PP women

-sexual activity can resume when perineum is healed and lochia stopped. risk of hemorrhage and infection minimal after 2 weeks, before that not as safe

when should bowel patterns resume in PP

-should resume around 2-3 days if no BM by day 5, call HCP -pre pregnancy elimination patterns resume around 2 weeks -3rd or 4th degree lacerations are risk factors for anal incontinence

urinary system PP

-spontaneous voiding should return 6-8 hours -increased risk of infection RT catheter, trauma, urinary retention, poor hygiene -renal function returns to normal 1 mo -transient proteinuria, glycosuria and ketonuria (all normal)

what to educate patients in terms of lochia

-tell them the normal lochia progression, sloughing of placental site is normal -educate them to call HCP if saturating pad in 1 hour of less, passing clots eggs size or larger, return of bright red lochia after previously stopped, persistent bright red lochia occurs, or foul smelling odor

transition into maternal role: maternal role attainment or becoming a mother

-the process by which a woman learns mothering behaviors and becomes comfortable and confident with her identity as a mother

homans sign

-to perform, flex knees slightly and provide support with one hand, dorsiflex foot -positive sign is if there is pain or discomfort in the calf -positive sign may indicate the presence of a thrombus

comfort measures for breasts

-warm compress or shower BEFORE feeding -cold compress to breast AFTER feeding -breast massage -NSAIDS -lonolin and glycerin gel pads

alba lochia

-white or yellow -10-14 days PP -can last 4-8 weeks PP -consists mainly of mucous

conversions

1 lb= 2.2 kg so divide lbs by kg to convert (lbs always bigger number) 30 ml= 1 oz 1 lb= 16 oz, so half a pound is 8 oz i.e 7.8, doing math change to 7.5 because half

treatment for GAD

1. SSRIs: sertraline (Zoloft), citalopram 2. Benzos: lorazepam, alprazolam, clonazepam 3. cognitive beahvioral therapy (especially used with OCD and panic disorder) 4. interpersonal therapy 5. peer support and non directive counseling

treatment for PPD

1. antidepressants (SSRIs) take at least 2 weeks to have an effect and 4-6 weeks for full effect 2. psychoterhapy 3. complimentary and alternative medicine like bright light therapy, exercise, massage and acupuncture

what are the 2 most important interventions for prevention of PP hemorrhage

1. massage 2. empty bladder

risk factors for PMADs

1. personal or family history of depression, anxiety, OCD, or other mental illness 2. previous perinatal depression or anxiety

what are the top 10 advantages of skin to skin

1. stabilization of HR/RR/weight 2. daily vaccine against infection. moms who skin to skin with babies produce antibodies that are specific to hospital and home 3. earlier and more successful feeding 4. improved sleep 5.thermal synchrony- mom can warm babe 6. decreased crying 7. shorter hospital stay (ex NICU) 8. increased milk production 9. decreased PP depression 10. improved brain development

breastfeeding considerations with mood disorder drugs

1. use of SSRIs is generally okay 2. lithium should NOT be used while breastfeeding 3. need to weight risk vs benefit to mother and infant

how long can it take for pregancy changes to reverse during postpartum period

6 to 7 weeks, sometimes up to a 12 months to reverse changes from pregnancy. this is a time with decreased estrogen and progesterone results in uterine cell atrophy

during a PP assessment the nurse assesses the calves of a clients legs. the nurse is checking for which of the following s/s (select all) a. pain b. warmth c. discharge d. ecchymosis e. redness

A, B, E

new parents express concern that because the mom under went general for her c-section that they did not have the chance to hold and bond with baby immediately after her birth. the nurses response should convey to the parents that: a. attachment and bonding is a process that occurs over time and does not require early contact b. the time immediately after birth is critical period c. early contact is essential for optimum parent-infant relationship d. they should be happy infant is healthy

A. attachment and bonding is a process and separation is okay. it wont negatively impact babe

nurse informs a PP women that which of the following is the reason we give ibuprofen for after birth pains? a. ibuprofen is take ever 2 hours b. it has an antiinflammatory effect c. it is given via parenteral route d. it can be administered in high doses

B

BUBBLE HER VANE (components of a postpartum assessment)

B-breasts U- uterus B- bladder B- bowel L- lochia E- episotomy/incision H- homan E-emotions R-rest V-vitals A- attachment N- nutiriton E- education

a nurse observes that a 15 year old mother seems to ignore her newborn. a strategy that the nurse can use to facilitate mother-infant bonding is what a. tell mother she must pay attention to infant b. show mother how the infant initiates interaction and pays attention to her c. demonstrate for the mother different positions for holding her infant d. arrange for the mother to watch a video on parental interactions

B. show her that her baby needs her and pays attention to her (infant facilitating)

in regards to parents' early and extended contact with their infant and the relationships built nurses should be aware that a.immediate contact is essential for the parent child relationship b. skin to skin is preferable to contact with the body totally wrapped in a blanket c. extended contact is especially important for adolescents and low income women because they are at risk for parenting inadequacies d. mothers need to take precedence over their partners and other family matters

C

several weeks after a women is discharged you receive a call from her. she is upset, worried and has reoccurring fears about her baby that something bad is going to happen. she cant sleep. the most likely explanation for this behavior is a. postpartum depression b. postpartum psychosis c. postpartum anxiety d. exhaustion

C we would also advise this women that this is temporary but she should seek professional help

the nurse is evaluating the involution of a woman who is 3 days postpartum. which of the following findings would the nurse evaluate as normal? a. fundus 1 cm above the umbilicus b. fundus 2 cm above the umbilicus c. fundus 2 cm below the umbilicus d. fundus 3 cm below the umbilicus

D, starts at umbilicus after birth and moves down 1 cm per a day

a women gave birth to a daughter instead of a son, which she really wanted. now she seems withdrawal and is staying in bed. which is the best nursing action? a. no action, this is natural b. referral for psychiatric consult c. reassure her that the baby is beautiful and healthy d. helping the mother to verbalize her disappointment

D. the mother needs to acknowledge and accept her disappointment. the nurse is the most reliable and confidential person the patient could tell.

which woman at 24 hours following birth is least likely to experience afterpains? a. primpara who is breastfeeding twins b. multipara who is breastfeeding 10 lbs full term baby c. multipara who is bottle feeding her 8 lb baby d. primipara who is bottle feeding her 7 lb baby

D. prime moms are less likely to experience cramping and she is bottle feeding so do not have the breast pain

which lab finding would the nurse note as normal for a new mother following birth a. an increase in hematocrit b. drop in white blood cell count c. decrease in coagulation factors d. trace to 1+ proteinuria

D. proteinuria is normal after birth for first day or so

mom is PP 6 hours after vaginal. the nurse notes that the fundus is firm at the umbilicus there is heavy lochia rubra, and perineal sutures are intact. which of the following actions should the nurse take? a. do nothing, this is normal b. massage the fundus c. take a woman to the bathroom d. call provider

D; because the uterine assessments were good, uterus is working, but still bleeding. it could be a cervical laceration.

REEDA

R-redness E-edema E-ecchymosis D-drainage A-approximation

what is attachment

The process by which a parent comes to love and accept a child and a child comes to love and accept a parent, this happens through bonding. The terms attachment and bonding continue to be used interchangeably.

interventions for pain

Vag: ibuprofen 800mg Q8H, acetaminophen 650mg Q4-6H, hydrocodone, Norco, Tramadol C/S: ibuprofen 800mg Q8H, acetaminophen 650mg Q4-6H, oxycodone, Percocet, Tramadol and non pharmocological such as heat/ice/bath

does change in one member affect all family members?

Yes, so if mom gets sick it effects whole family not just nuclear.

Tdap immunization

administered during each pregnancy, recommended timing is 27-36 weeks gestation. -administered immediately PP if never received a prior dose, not administered during pregnancy

gas pain interventions pp

ambulation early and often, chewing gum, rocking in chair, heat therapy, avoid gaseous foods like beans or broccoli, antifltulent meds like simethicone

lower extremities nursing interventions

ambulation, leg exercises, anti-embolism stockings, avoid pressure behind knees, elevate legs while sitting, hydration. need to edu patients that if they experience red or swollen leg, painful leg or warm to the touch to call.

lochia assessment

asses for amount, character, clots, odor. normal is scant to moderate amount, small clots and fleshly odors

how do we check for preeclampsia

assess headaches, LOC, vision, reflexes, clonus, seizures

activity recommendations for PP mom

avoid heavy lifting, excessive stair climbing and strenuous activity. -can resume normal activities by 4-6 weeks PP

infant inhibiting behaviors that affect bonding

baby behavior that inhibits strong attachment. crying for hours, not making eye contact, unpredictable sleep/feed cycle, ignore parents, seeks attention from any adult

why do we assist with ambulation the first time with mom PP?

because increased risk of orthostatic hypotension. teach them to sit on the side of the bed and then slowly move to standing and walking.

when should a women call her HCP related to her breasts

call if breasts are cracked/bleeding nipples, engorgement and or hard lumpy, reddened area on breast, fever or flu like s/s

s/s of GAD

constant worry, feeling that something bad is going to happen, patient may request a lot of extra care, racing thoughts, sleep problems, withdrawal, loss of ability to cope, GI disturbances, dizziness, headaches, tense (this is that video we watched in class of lady walking baby)

neuraxial morphine side effects

decreased RR, hypotension, sedation, urinary retention, constipation, N/V, pruritis

early contact and extended contact for parent-infant

early: skin to skin as soon as possible, promote early breastfeeding. this is important but not going to make or break attachment. extended: couplet care or rooming in, bringing the focus to family centered care.

education related to episiotomy/laceration/incision

educate to call HCP if -temp is greater than 100.4 -foul smelling vaginal or incisional blood or discharge -increased redness or pus -incision is not healing

what is entrainment and biorhythmicicty?

entrainment: baby moves toward parents voice biorhythmicity: infant being in tune with the mother's natural rhythms. The mother's heartbeat or a recording of a heartbeat can soothe a crying infant

acquaintance

eye contact, touching, talking, and exploring to become acquainted with their infant

how does poor nutrition relate to postpartum depression

folate and vitamin b12 needed for serotonin synthesis. low folate decreases response to antidepressant medications (have serotonin defiency)

postpartum psychosis (PPP) s/s

hallucinations, delusions, agitation, inability to sleep, bizarre irrational behavior, paranoia, suicidal thoughts. these moms will often be very blunt and tell you how exactly they plan to kill themselves or baby, they have no feelings of attachment to delusions

claiming

how you incorporate baby into family. examples are like "he has my eyes" or "he looks just like his older brother"

parental inhibiting behaviors for attachment

ignores baby, rushes feedings, waking up baby, expresses disappointment, makes no effort to interpret infants actions, views infant as ugly

PMADs adverse maternal outcomes

impaired sleep, poor nutrition, inadequate weight gain in pregnancy, increased risk of substance abuse, missed prenatal and PP visits, decreased adherence to healthcare provider advice -impaired attachment biggest

s/s of mood disorder: affective instability

includes behaviors such as agitation, sadness, elation, blunting, speech may be monotone and responses brief

mutuality

infant's behaviors and characteristics elicit a corresponding set of parental behaviors and characteristics like baby cries and mom picks up

what is lochia and what is abnormal?

is the discharge to remove debris remaining after birth. should not be musty, stale, inoffensive odor that can indicate infection. want the trend to go from heavy and dark to light color and lighter flow.

what is cultural relativsim

is the opposite of ethnocentrism. if refers to learning about and applying the standards of another culture to activities within that culture

developing cultural competence

key components include communicating respectfulness for a wide range of differences i.e alternative medicines/traditional healing practices, recognizing culturally different communication style (eye contact, touch, etc), anticipating the need to address language ability and literary

uterine atony

lack of uterine muscle tone (boggy), results in excessive uterine bleeding and filling with blood clots, common cause of bladder distention and leading cause of PP hemorrhage

what position should we place mom in to examine her bottom?

lateral SIMS

define scant lochia

less than 1 inch in 1 hour or only on TP while wiping

moderate lochia

less than 6 inches in 1 hour, about 25-50 ml. this is okay

treatment for postpartum psychosis (PPP)

lithium is first line treatment, inpatient psychiatric care, antipsychotics (antidepressants not recommended), psychotherapy, need constant supervision

baby math

make sure you can calculate 10 percent of something and convert lbs to oz 1 lb= 16 oz 1 oz= 28 grams so convert pounds to ounces by multiplying (lbs x 16) and then multiply by 28 for 10% convert to decimal 0.1 and multiply by original number

when should follow up care be done for PP mother? for infant?

maternal: 2 weeks after c/s or 6 weeks after vaginal. PRN if needed sooner baby: 48-72 hours after discharge and at 2 weeks of age

PP chills

may occur immediately after birth, benign finding if afebrile (no fever), nursing interventions are warm blanket, warm drink reassurances.

baby blues s/s

mood swings, weepiness, stressed, sad, anxious, lonely, tired, difficulty sleeping, feelings of letdown

what patients should be monitored more closely while taking neuraxial morphine and why

morbidly obese, concurrently receiving magnesium sulfate, and diagnosis of obstructive sleep apnea. these patients are at higher risk for respiratory depression that results in irreversible neurologic injury or death

what is most important to assess with an adolescent mom

need to assess support system. young moms can be amazing mothers if they have the right support. need to assess family, job, school all forms of support

maternal age older than 35

need to assess why the baby is coming later in life. was it a mistake, was it because of infertility, was it her career? need to assess social support and support system. this mother is considered "sandwich" taking care of her own baby plus her parents

perinatal substance abuse warning signs

no prenatal care, late prenatal care, missing appointments, poor nutrition, frequent encounters with the law, marital or family disputes. (like the patient that refused to eat because she didnt want baby)

normal energy findings in PP women and signs of potential complications

normal: able to care for self and infant and be able to sleep signs of complications: lethargy, extreme fatigue, difficulty sleeping

normal PP findings for emotions and signs of potential complications

normal: excited, happy, interested and or involved in infant care signs of complications: sad, tearful, excessive weepiness, irritability, disinterested in infant care

lactogenesis

occurs around 72-96 hours PP. transition of colostrum to mature milk, breasts are fuller and heavier. may feel nodular, warm, firm and tender on palpation

heavy lochia

pad saturated in 1 hour, this is not good. we would call provider

excessive lochia

pad saturated in 15 minutes. this is an emergency

what are PMADs and how common are they?

perinatal mood and anxiety disorders. very common, affects more women than preeclampsia, PP hemorrhage and gestational diabetes combined.

parental facilitating behaviors for attachment

positive claiming, touching baby, smiling at baby, consoling baby when cry or hungry, talks or sings to baby, assigns meaning to infants actions

UTI and PP

postpartum bladder is perfect environment for UTI due to bacteria from vaginal exams, catheters, trauma to the area, etc. need to educate our patients on s/s of UTI and to take preventive measures

PMADs adverse infant outcomes

preterm birth, low birth weight, developmental and cognitive delays, increased crying, interfered bonding, prediction of difficult temperament at 4 to 6 months. -impaired attachment biggest

factors that influence transition into maternal role

prolonged labor, type of delivery, analgesia, maternal age, social support, gestational age, admission to NICU, anomalies, role conflicts and socioeconmic concerns

what is reciprocity

reciprocity is type of body movement or behavior that provides the observer with cues. The observer or receiver interprets those cues and responds to them. Reciprocity often takes several weeks to develop with a new baby. so like how mom reacts to baby cry

what is a nuclear family

represented the traditional American family in which husband, wife, and their children (either biologic or adopted) live as an independent unit, sharing roles, responsibilities, and economic resources. nuclear family style is decreasing in the US

neuraxial morhpine nursing care

respiratory assessments (pulse ox, ventilation so RR and depth, and LOC) -monitor every hour for the first 12 hours and every other hour for the second 12 hours -antidote nacrcan

postportum diuresis

results from decreased estrogen, removal of increased venous pressure in extremities and decreased pregnancy blood volume. -occurs within 12 hours and continues for a week PP -more than 3000 ml per day

acculturation vs assimilation

retain some of own culture while adopting cultural practices of dominant society is acculturation. assimilation is no remaining cultural practices or values, completely adapted. "melting pot"

what are some ways to facilitate sibling acceptance of the new baby

sibling classes, involve sibling in care of infant, give sibling their own baby doll to care for, have a picture of the older child in the labor room, don't hold baby when child comes into room instead go up to baby together to meet.

nursing interventions for emotions in PP women

skin to skin, positive reinforcement, supportive environment, non judgmental approach

abnormal uterus findings

soft, boggy, higher than expected, lateral deviation. -use massage as first intervention then empty bladder

risk factors for mood disturbances in PP women

stress, early trauma, neglect, abuse, family history, medical and psychiatric disorders, substance dependence, being in the second or sixth decades of life

fluid requirement example: if infant weights 7 lbs 8 oz and was born 20 hour ago, what would the minimum fluid intake requirement be?

this baby would need 60-80 ml/kg/day so start by converting weight to kg (7.5 divided by 2.2 kg= 3.4) then multiply 3.4 by 60 ml and 3.4 by 80 ml to get your range which is 204-272 ml, to convert back to oz divide by 30ml (1oz)

communication through senses: odor

this is babes strongest sense. mom breast milk has a specific and unique sense. so does baby.

what are some positive attachment behaviors between PP mom and baby that we want to see

touching, holding, gazing, looking at face/into eyes, talking, calling by name, and identifying positive characteristics of baby

how do we screen for PMADs

use the edinburgh postnatal depression scale (EPDS). a positive screening is if score greater than 10 or answer yes to thought of harming self or baby

what is the leading cause of hemorrhage

uterine atony

what values define PP hemorrhage: c-section and vaginal

vaginal: bleeding more than 500 ml is hemorrhage c-section: bleeding more than 1000 ml postpartum hemorrhage is unpredictable and can happen to anyone even without risk factors

behaviors affecting parental attachment: infant- facilitating

when baby facilitates attachment through things like eye contact, grasping, holding fingers, easily consolable, clings to parents, enjoys cuddles

what is synchorny

when mom and babe are in rhythm together and both are reward. for example, baby does a specific cry when hungry vs wet and mom can identify that