Ob ch 15, 16, 17 (Stephs)
A nurse is assessing the vital signs of a woman who delivered a healthy newborn vaginally 2 hours ago. Which temperature reading would lead the nurse to notify the health care provider?
100.8°F (38.2°C)
Take Note!
A danger sign is the reappearance of bright-red blood after lochia rubra has stopped. Reevaluation by a health care provider is essential if this occurs.
After the nurse provides instructions to a postpartum woman about postpartum blues, which statement would indicate understanding of it? I will
"Feel like laughing 1 minute and crying the next minute."
A new mother asks the nurse why newborns receive an injection of vitamin K after delivery. What will be the best response from the nurse?
"Newborns lack the intestinal flora needed to produce vitamin K, so it is given to prevent bleeding episodes."
A nurse is teaching a newborn's caregivers how to change a diaper correctly. Which statement, by the caregiver best indicates the nurse's teaching was effective?
"We will fold down the front of her diaper under the umbilical cord until it falls off."
A young mother is concerned for her baby and asks the practical nurse if her baby is okay. What is the best response if the practical nurse notes: RR 66, nostrils flaring, and grunting sounds during respiration?
"Your baby is having a little trouble breathing. I'll let the RN know."
Acquired immunity
(1) the development of circulating antibodies or immunoglobulins capable of targeting specific invading agents (antigens) for destruction and (2) formation of activated lymphocytes designed to destroy foreign invaders. Acquired immunity is absent until after the first invasion by a foreign organism or toxin.
Urinary System Adaptations
. During pregnancy, the glomerular filtration rate and renal plasma flow increase significantly return to normail by 6 wks postpartum
adjusting from a fluid-filled intrauterine environment to a gaseous extrauterine environment
. Passage through the birth canal allows intermittent compression of the thorax, which helps eliminate the fluid in the lungs. Pulmonary capillaries and the lymphatics remove the remaining fluid.
Lochia
. To assess how much a woman is bleeding, ask her how many perineal pads she has used in the past 1 to 2 hours and how much drainage was on each pad lochia pools in the vagina and the uterus while she is lying down . Lochia flow will increase when the woman gets out of bed and when she breast-feeds
The most common mechanism of heat loss in the newborn is ___________________.
. evaporation
The causes of newborn jaundice can be classified into three groups based on the mechanism of accumulation:
1 Bilirubin overproduction, such as from blood incompatibility (Rh or ABO), drugs, trauma at birth, polycythemia, delayed cord clamping, and breast milk jaundice 2Decreased bilirubin conjugation, as seen in physiologic jaundice, hypothyroidism, and breast-feeding 3 Impaired bilirubin excretion, as seen in biliary obstruction (biliary atresia, gallstones, neoplasm), sepsis, hepatitis, chromosomal abnormality (Turner syndrome, trisomies 18 and 21), and drugs (aspirin, acetaminophen, sulfa, alcohol, steroids, antibiotics) (Nagtalon-Ramos, 2014).
Prioritize the postpartum mother's needs 4 hours after giving birth by placing a number 1, 2, 3, or 4 in the blank before each need.
1 Interaction time (first 30 minutes) with the infant to facilitate bonding 2. Sleep and rest without being disturbed for a few hours 3. Learn how to hold and cuddle the infant 4. Watch a baby bath demonstration given by the nurse
Vagina
3 weeks mucosa thickens and rugae return will always remain a bit larger than it had been before pregnancy . Localized dryness and coital discomfort (dyspareunia) usually plague most women until menstruation returns
The nurse has completed assessing the blood glucose levels of several infants who are 24 hours old. Which result should the nurse prioritize for intervention?
30 mg/dL
The newborn's temperature may decrease
3° to 5°F (−16.1° to −15°C) within minutes after leaving the warmth of the mother's uterus
fundus
Approximately 6 to 12 hours after birth, the fundus usually is at the level of the umbilicus. If the fundal height is above the umbilicus, which would be an abnormal finding
Blood Volume
80 to 85 mL/kg of body weight in the term infant the volume may vary by as much as 25% to 40%, depending on when clamping of the umbilical cord occurs. Early (before 30 to 40 seconds) or late (after 3 minutes) clamping of the umbilical cord changes circulatory dynamics during transition. delayed cord clamping offers the newborn many benefits physiologically which include at least a 30% increase in blood volume for term infants and a 50% increase in preterm infants; improvement of systemic blood pressure; increase in the cerebral oxygen index; higher hemoglobin levels at 24 to 48 hours of age; and increased serum iron levels at 4 to 6 months Cord blood has also been described as "nature's first stem cell transplant" because it possesses regenerative properties and can grow into different types of cells in the body
Take Note!
A major source of IgA is human breast milk, so breast-feeding is believed to have significant immunologic advantages over formula feeding
Newborns body mass
A newborn infant's body mass is 75% water, the highest proportion of body water at any stage of a person's life.
Take Note!
A newborn infant's body mass is 75% water, the highest proportion of body water at any stage of a person's life.
The nurse performs a physical examination on a newborn 2 hours after birth. Which of the following findings indicate a need for a pediatric consultation? Select all that apply:
Absent Moro reflex when startled Yellow blanching of the skin when pressure applied to the nose
CULTURAL INFLUENCES DURING THE POSTPARTUM PERIOD
African American Mother may share care of the infant with extended family members. Experiences of older women within the family influence infant care. Mothers may protect their newborns from strangers for several weeks. Mothers may not bathe their newborns for the first week. Oils are applied to skin and hair to prevent dryness and cradle cap. Silver dollars may be taped over the infant's umbilicus in an attempt to flatten the slightly protruding umbilical stump. Sleeping with parents is a common practice.
Take Note!
Afterpains are usually stronger during breast-feeding because oxytocin released by the sucking reflex strengthens the contractions. Mild analgesics can reduce this discomfort.
Postpartum breast engorgement occurs 48 to 72 hours after giving birth. What physiologic change influences breast engorgement?
An increase in blood and lymph supply to the breasts
Take Note!
Apneic periods lasting more than 15 seconds with cyanosis and heart rate changes require further evaluation
A woman in scrubs enters a mother's room, while the nurse is completing an assessment. The woman states the doctor is in the nursery and has requested the infant be brought back for an examination. What will the nurse do?
Ask the woman to see her hospital identification badge.
Lochia
Assess lochia in terms of amount, color, odor, and change with activity and time
episiotomy
Assess the episiotomy and any lacerations at least every 8 hours to detect hematomas or signs of infection. Large areas of swollen, bluish skin with complaints of severe pain in the perineal area indicate pelvic or vulvar hematomas. Redness, swelling, increasing discomfort, or purulent drainage may indicate infection.
Uterus
Assess the fundus (top portion of the uterus) to determine the degree of uterine involution The fundus should be midline and should feel firm.
CRITICAL ATTRIBUTES OF ATTACHMENT
Attachment stages include proximity, reciprocity, and commitment.
Which of the following suggestions would be most appropriate to include in the teaching plan for a postpartum woman who needs to lose weight?
Avoid empty-calorie foods, breast-feed, increase exercise.
Postpartum assessment
BUBBLE-EE - breasts, uterus, bladder, bowels, lochia, episiotomy/perineum/epidural site, extremities, and emotional status - can be used as a guide for this head-to-toe review
Lactation
Breast milk typically appears within 4 to 5 days after childbirth.
interventions to prevent orthostatic hypotension
Check blood pressure first before ambulating the client. Elevate the head of the bed for a few minutes before ambulating the client. Have the client sit on the side of the bed for a few moments before getting up. Help the client to stand up, and stay with her. Ambulate alongside the client and provide support if needed. Frequently ask the client how her head feels. Stay close by to assist if she feels light-headed.
CONDUCTION
Conduction involves the transfer of heat from one object to another when the two objects are in direct contact with each other.
The nurse is explaining to a postpartum woman 48 hours after her giving childbirth that the afterpains she is experiencing can be the result of which of the following?
Contractions of the uterus after birth
CONVECTION
Convection involves the flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface.
predispose the postpartum constipation
Decreased bowel motility during labor, high iron content in prenatal vitamins, postpartum fluid loss, and the adverse effects of pain medications and/or anesthesia
After teaching a group of nursing students about thermoregulation and appropriate measures to prevent heat loss by evaporation, which of the following student behaviors would indicate successful teaching?
Drying the newborn immediately after birth
Cardiovascular System Adaptations
During pregnancy, the heart is displaced slightly upward and to the left Cardiac output remains high for the first few days postpartum and then gradually declines to nonpregnant values within 3 months of birth. Blood volume, which increases substantially during pregnancy, drops rapidly after birth and returns to normal within 4 weeks postpartum. decrease in both cardiac output and blood volume reflects the birth-related blood loss (an average of 500 mL with a vaginal birth and 1,000 mL with a cesarean birth) cardiac decrease to prelabor values 24 to 72 hours postpartum cardiac dcreases after labor but returns 6-8 weeks postpartum hematocrit level remains relatively stable and may even increase an acute decrease in hematocrit is not an expected finding and may indicate hemorrhage.
Musculoskeletal System Adaptations
During pregnancy, the hormones relaxin, estrogen, and progesterone relax the joints Parous women will note a permanent increase in their shoe size
Oxytocin
During the postpartum period, oxytocin stimulates the uterus to contract during the breast-feeding session and for as long as 20 minutes after each feeding. Oxytocin also acts on the breast by eliciting the milk let-down reflex during breast-feeding
When assessing the episiotomy site of a postpartum client that delivered 3-hours ago, the nurse would document which findings as expected? Select all that apply.
Edema Slight bruising
Immediately after childbirth in the recovery area, the nurse observes the mother's partner's fascination and interest in the new son. This behavior is often termed:
Engrossment
Take Note!
Failure to maintain and restore perineal muscular tone leads to urinary incontinence later in life for many women. practice pelvic floor muscle training exercises (PFMT) to improve pelvic floor tone, strengthen the perineal muscles, and promote healing
POSTPARTUM DANGER SIGNS
Fever more than 100.4°F (38°C) Foul-smelling lochia or an unexpected change in color or amount Large blood clots, or bleeding that saturates a peripad in an hour Severe headaches or blurred vision Visual changes, such as blurred vision or spots, or headaches Calf pain with dorsiflexion of the foot Swelling, redness, or discharge at the episiotomy, epidural, or abdominal sites Dysuria, burning, or incomplete emptying of the bladder Shortness of breath or difficulty breathing without exertion Depression or extreme mood swings
Habituation
Habituation is the newborn's ability to process and respond to visual and auditory stimuli
Emphasize the benefits of a regular exercise program
Helps the woman to lose pregnancy weight Reduces the risk of obesity later in life Increases overall postpartum well-being Increases energy level so the woman can cope with her new responsibilities Speeds the return to prepregnant size and shape Reduces risk of postpartum depression Reduces risk of constipation Reduces mental fatigue Provides an outlet for stress
newborn blood values
Hemoglobin 16-18 g/dL Hematocrit 46-68% Platelets 150,000-350,000/μL Red blood cells 4.5-7.0 (1,000,000/μL) White blood cells 10-30,000/mm3
The nurse is explaining to new parents the various injections their newborn will receive before being discharged home. Which injection should the nurse teach the parents about that will help decrease the incidence of hepatic disease later in life?
Hep B
Which of the following would the nurse assess as indicating positive bonding between the parents and their newborn?
Holding the infant close to the body
neurobehavioral response
How they react to the world around them is termed . Expected newborn behaviors include orientation, habituation, motor maturity, self-quieting ability, and social behaviors. Any deviation in behavioral responses requires further assessment, because it may indicate a complex neurobehavioral problem.
A nursing student questions the nursery nurse why they don't bathe the newborn immediately upon admission to the nursery observation area after birth. The nurse states that this would increase the risk of:
Hypothermia
The major purpose of the first postpartum homecare visit is to
Identify complications that require interventions
Lochia passes through three stages
Lochia rubra is a deep-red mixture of mucus, tissue debris, and blood that occurs for the first 3 to 4 days after birth. As uterine bleeding subsides, it becomes paler and more serous. Lochia serosa is the second stage. It is pinkish brown and is expelled 3 to 10 days postpartum. Lochia serosa primarily contains leukocytes, decidual tissue, red blood cells, and serous fluid. Lochia alba is the final stage. The discharge is creamy white or light brown and consists of leukocytes, decidual tissue, and reduced fluid content. It occurs from days 10 to 14 but can last 3 to 6 weeks postpartum in some women and still be considered normal.
Muslim
Modesty is a primary concern; nurses need to protect the client's modesty. Muslims are not permitted to eat pork; check all food items before serving. Muslims prefer a same-sex health care provider; male-female touching is prohibited except in an emergency situation. A Muslim woman stays in the house for 40 days after birth, being cared for by the female members of her family. Most women will breast-feed, but religious events call for periods of fasting, which may increase the risk of dehydration or malnutrition. Women are exempt from obligatory five-times-daily prayers as long as lochia is present. Extended family is likely to be present throughout much of the woman's hospital stay. They will need an empty room to perform their prayers without having to leave the hospital.
Natural immunity
Natural immunity involves the most basic host defense responses: ingestion and killing of microorganisms by phagocytic cells.
Assess the bladder for distention
Palpation of a rounded mass suggests bladder distention. Also percuss the area: a full bladder is dull to percussion. If the bladder is full, lochia drainage will be more than normal because the uterus cannot contract to suppress the bleeding
AFTERPAINS
Part of the involution process painful uterine contractions more acute in multiparous and breast-feeding stimulation during breast-feeding with oxytocin released from the pituitary gland Primiparous women typically experience mild afterpains because their uterus is able to maintain a contracted state
What is the first action taken by a nurse caring for a newborn with suspected hypoglycemia?
Perform a heel stick to obtain a blood sample for testing for glucose level.
urination may be impeded by:
Perineal lacerations Generalized swelling and bruising of the perineum and tissues surrounding the urinary meatus Hematomas Decreased bladder tone as a result of regional anesthesia Diminished sensation of bladder pressure as a result of swelling, poor bladder tone, and numbing effects of regional anesthesia used during labor
When assessing a postpartum woman, which of the following would lead the nurse to suspect postpartum blues?
Periodic crying and insomnia
A nurse observes a 3-day-old term newborn that is starting to appear mildly jaundiced. What might explain this condition?
Physiologic jaundice secondary to breast-feeding
Which activity would the nurse include in the teaching plan for parents with a newborn and an older child to reduce sibling rivalry when the newborn is brought home?
Planning a daily "special time" for the older sibling
Risk Factors for Postpartum Hemorrhage
Precipitous labor (less than 3 hours) Uterine atony Placenta previa or abruptio placenta Labor induction or augmentation Operative procedures (vacuum extraction, forceps, cesarean birth) Retained placental fragments Prolonged third stage of labor (more than 30 minutes) Multiparity, more than three births closely spaced Uterine overdistention (large infant, twins, hydramnios)
Concept Mastery Alert
Prioritizing Postpartum Vital Signs It is not uncommon for women to have a temperature elevation up to 100.4°F in the first 24 hours postpartum. There may also be a slight decrease in blood pressure. The nurse should be most concerned about a blood pressure elevation because preeclampsia may occur during the early postpartum period.
Prolactin
Prolactin is also associated with the breast-feeding process by stimulating milk production. High levels of prolactin have been found to delay ovulation by inhibiting ovarian response to follicle-stimulating hormone
Breast milk production can be summarized as follows:
Prolactin levels increase at term with a decrease in estrogen and progesterone levels. Estrogen and progesterone levels decrease after the placenta is delivered. Prolactin is released from the anterior pituitary gland and initiates milk production. Oxytocin is released from the posterior pituitary gland to promote milk let-down. Infant sucking at each feeding provides continuous stimulus for prolactin and oxytocin release
Psychosocial Assessment
Psychosocial assessment of the postpartum woman focuses on emotional status and bonding and attachment.
Blood Cellular Components
Red blood cell production ceases early in the puerperium, causing mean hemoglobin and hematocrit levels to decrease slightly in the first 24 hours. 2 wks begin to rise WBC remains elevated fro 1st 4-6 days after birth then falls to 6,000-10,000/mm3
The nursery nurse notes that one of the newborn infants has white patches on his tongue that look like milk curds. What action would be appropriate for the nurse to take?
Report the finding to the pediatrician.
FACTORS INCREASING A WOMAN'S RISK FOR POSTPARTUM COMPLICATIONS
Risk Factors for Postpartum Infection Operative procedure (forceps, cesarean birth, vacuum extraction) History of diabetes, including gestational-onset diabetes Prolonged labor (more than 24 hours) Use of indwelling urinary catheter Anemia (hemoglobin < 10.5 mg/dL) Multiple vaginal examinations during labor Prolonged rupture of membranes (>24 hours) Manual extraction of placenta Compromised immune system (HIV positive)
Reva Rubin
Rubin's framework is timeless for assessing and monitoring expected role behaviors when planning care and appropriate interventions.
The nurse would expect a postpartum woman to demonstrate lochia in which sequence?
Rubra, serosa, alba
Typically, the amount of lochia is described as follows
Scant: a 1- to 2-in lochia stain on the perineal pad or approximately a 10-mL loss Light or small: an approximately 4-in stain or a 10- to 25-mL loss Moderate: a 4- to 6-in stain with an estimated loss of 25 to 50 mL Large or heavy: a pad is saturated within 1 hour after changing it
ANATOMIC AND PHYSIOLOGIC COMPARISON OF THE FETUS AND NEWBORN
Site of gas exchange Fetus Placenta Newborn Lungs Fetus Circulation through the heart Pressures in the right atrium are greater than in the left, encouraging blood flow through the foramen ovale. Newborn Pressures in the left atrium are greater than in the right, causing the foramen ovale to close. Hepatic portal circulation Fetus Ductus venosus bypasses; maternal liver performs filtering functions Newborn Ductus venosus closes (becomes a ligament); hepatic portal circulation begins .Thermoregulation Fetus Body temperature is maintained by maternal body temperature and the warmth of the intrauterine environment. Newborn Body temperature is maintained through a flexed posture and brown fat.
A nurse helps a postpartum woman out of bed for the first time postpartum and notices that she has a very heavy lochia flow. Which assessment finding would best help the nurse decide that the flow is within normal limits?
The color of the flow is red.
A client gives birth to a baby at a local health care facility. The nurse observes that the infant is fussy and begins to move her hands to her mouth and suck on her hand and fingers. How should the nurse interpret these findings?
The infant is attempting self-consoling maneuvers.
Mexican American
The newborn's grandmother lives with the mother for several weeks after birth to help with housekeeping and child care. Most women will breast-feed for more than 1 year. The infant is carried in a rebozo (shawl) that allows easy access for breast-feeding. Women may avoid eye contact and may not feel comfortable being touched by a stranger. Nurses need to respect this feeling. Some women may bring religious icons to the hospital and may want to display them in their room.
sitz bath
The plastic sitz bath consists of a basin that fits on the commode; a bag filled with warm water is hung on a hook and connected via a tube onto the front of the basin After the first 24 hours, a sitz bath with room temperature water may be prescribed and substituted for the ice pack to reduce local swelling and promote comfort for an episiotomy, perineal trauma, or inflamed hemorrhoids
Overheating
The primary heat regulator is located in the hypothalamus and the central nervous system The immaturity of the newborn's central nervous system makes it difficult to create and maintain this balance. Therefore, the newborn can become overheated easily. For example, an isolette that is too warm or one that is left too close to a sunny window may lead to hyperthermia.
BAM
The process of becoming a mothe
orientation
The response of newborns to stimuli Orientation reflects newborns' response to auditory and visual stimuli, demonstrated by their movement of head and eyes to focus on that stimulus. Newborns prefer the human face and bright shiny objects
key Concepts
The transition to fatherhood is influenced by many factors, including participation in childbirth, relationships with significant others, competence in child care, the family role organization, the father's cultural background, and the method of infant feeding.
Cardiovascular System Adaptations
The umbilical vein carries oxygenated blood from the placenta to the fetus
What should the nurse expect for a full-term newborn's weight during the first few days of life?
There is a loss of 5% to 10% of birth weight in formula-fed and breastfed newborns.
The newborn creates heat in three ways—shivering, muscle activity and through thermogenesis by the metabolism of brown adipose tissue. Which is the most effective?
Thermogenesis is the most effective way to produce warmth for the newborn by increasing cellular metabolic rate in skeletal muscle and brown fat, thereby increasing heat production.
Newborns have several characteristics that predispose them to heat loss:
Thin skin with blood vessels close to the surface Lack of shivering ability to produce heat until 3 months old Limited stores of metabolic substrates (glucose, glycogen, fat) Limited use of voluntary muscle activity or movement to produce heat Large body surface area relative to body weight Lack of subcutaneous fat, which provides insulation Little ability to conserve heat by changing posture (fetal position) No ability to adjust their own clothing or blankets to achieve warmth Inability to communicate that they are too cold or too warm
attachment
This attachment is reciprocal; both the significant other and the newborn exhibit attachment behaviors.
nurse assessment of attachment
This attachment is reciprocal; both the significant other and the newborn exhibit attachment behaviors.
Women Who Should Not Breast-Feed
To prevent HIV transmission to the newborn, women who are HIV positive should not breast-feed.
RADIATION
To reduce heat loss by radiation, keep cribs and isolettes away from outside walls, cold windows, and air conditioners.
Take Note!
Touch is a basic instinctual interaction between a parent and his or her infant and has a vital role in the infant's early development. Parents provide a variety of tactile stimulation while addressing their infant's daily care routines
Prevention of correction of constipation
encouraging the use of the side-lying position, proper toileting habits, assuming positions that minimize putting pressure on the hemorrhoids, and not straining during defecation will be helpful in reducing discomfort
Balance of Hot and Cold
Vietnamese women view the postpartum period as a cold state (duong) and protect themselves through warmth Cultural practices include warm water for hygiene and stimulation of lactation, consuming warm foods, and staying indoors In China, childbearing and postpartum are viewed as states which disturb the normal health balance between yin and yang. In order to restore balance in health, postpartum women engage in practices for a month related to the maternal role, physical activity, maintenance of body warmth, and certain food consumption that will restore their balance. for many cultures Because childbirth involves the loss of blood, which is considered hot, the postpartum period is considered cold, so the mother must balance that with the intake of hot food Foods consumed should be hot in nature, and cold foods, such as fruits and vegetables, avoided Hot-cold beliefs are common among Latin American, African, and Asian people
jaundice
When unconjugated bilirubin pigment is deposited in the skin and mucous membranes as a result of increased bilirubin levels also known as icterus, develops, with a yellowing of the skin, sclera, and mucous membranes. Visible jaundice as a result of increased blood bilirubin levels occurs in more than half of all healthy newborns.
objective:Increase the number of mothers who breast-feed ever from a baseline of 74% to 81.9%.
Will improve maternal health via breast-feeding's beneficial effects
PSYCHOLOGICAL ADAPTATIONS
Within 15 minutes of holding a newborn, men experience raised levels of oxytocin, cortisol, and prolactin
Bilirubin
a yellow to orange bile pigment produced by the breakdown of red blood cells. In utero, elimination of bilirubin in the blood is handled by the placenta and the mother's liver. However, once the cord is cut, the newborn must now assume this function. Newborns produce bilirubin at a rate of approximately 6 to 8 mg/kg/day. This is more than twice the production rate in adults, . Bilirubin production typically declines to the adult level within 10 to 14 days after birth Failure of the liver cells to break down and excrete bilirubin can cause an increased amount of bilirubin in the bloodstream, leading to jaundice
A nurse who has worked in a nursery for 15 years informs the nursing student that feeding an infant early has advantages. The nurse describes which biggest advantage?
allows the baby to pass stools, which helps to reduce bilirubin
Urinary retention and bladder distention
can cause displacement of the uterus from the midline to the right and can inhibit the uterus from contracting properly can be at risk for postpartum hemorrhage Frequent voiding of small amounts (less than 150 mL) suggests urinary retention with overflow, and catheterization may be necessary to empty the bladder to restore tone.
. Signs of respiratory distress to observe for
cyanosis, tachypnea, expiratory grunting, sternal retractions, and nasal flaring. Respirations should not be labored, and the chest movements should be symmetric.
Meconium
composed of amniotic fluid, shed mucosal cells, intestinal secretions, and blood. It is greenish black, has a tarry consistency, and is usually passed within 12 to 24 hours of birth.
Gastrointestinal System Adaptations
constipation is a common problem during the postpartum period
pulse and blood pressure
decrease in cardiac output is reflected in bradycardia (40 to 60 bpm) for up to the first 2 weeks postpartum. Tachycardia (heart rate above 100 bpm) in the postpartum woman warrants further investigation MAY INDICATE hypovolemia, dehydration, or hemorrhage A significant increase accompanied by headache might indicate preeclampsia and requires further investigation. Decreased blood pressure may suggest an infection or a uterine hemorrhage.
Responses of the immune system serve three purposes
defense (protection from invading organisms), homeostasis (elimination of worn-out host cells), and surveillance (recognition and removal of enemy cells).
lactating women menses
depends on breast feeding frequencey and duration
lactation
describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young
Elevation of a client's temperature is a crucial first sign of infection. However, when is elevated temperature not a warning sign of impending infection?
during the first 24 hours after birth owing to dehydration from exertion
Topical Preparations
e ice packs, ice sitz baths, and application of cool witch hazel pads, such as Tucks® hemorrhoid pain include local anesthetics (dibucaine) or steroids (hydrocortisone acetate)
perineum
episiotomy or laceration, complete healing may take as long as 4 to 6 months in the absence of complications at the site, such as hematoma or infection edematous and bruised for the first day or two after birth Local comfort measures such as ice packs, pouring warm water over the area via a peribottle, witch hazel pads, anesthetic sprays, and sitz baths can relieve pain.
Four major hormones are influential during the postpartum period
estrogen, progesterone, prolactin, and oxytocin
Factors that facilitate uterine involution include
expulsion of amniotic membranes and placenta at birth, a complication-free labor and birth process, breast-feeding, and early ambulation.
en face
face-to-face
first period of reactivity
first period of reactivity begins at birth and may last from 30 minutes up to 2 hours.
Newborns who are breast-fed receive antibodies
from the breast milk which includes IgE, IgA, IgM, and IgG Healthy infants begin to produce their own antibodies, starting at 2 to 3 months of age.
Treatments to reduce the pain of breast engorgement
heat or cold applications, cabbage leaf compresses, breast massage and milk expression, ultrasound, breast pumping, and anti-inflammatory agents Between feedings, applying cold compresses to the breasts helps to reduce swelling
episiotomy site
normal episiotomy site should not have redness, discharge, or edema.
A client appears to be resting comfortably 12 hours after giving birth to her first child. In contrast, she labored for more than 24 hours, the primary care provider had to use forceps to deliver the baby, and she had multiple vaginal examinations during labor. Based on this information what postpartum complication is the client at risk for developing?
infection
uterine involution
involve substantial tissue destruction and subsequent repair and remodeling ex. the woman's menstrual cycle, interrupted during pregnancy, will begin to return several weeks after childbirth, if the woman is not breast-feeding. Ovulation can return any time, thus breast-feeding should not be considered as a safe contraceptive and other methods should be used to prevent pregnancy. The uterus, which has undergone tremendous expansion during pregnancy to accommodate progressive fetal growth, will return to its prepregnant size over several weeks
Complementary behavior
involves taking turns and stopping when the other is not interested or becomes tired
uterine atony
is a loss of tone in the uterine musculature
Surfactant
is a surface tension
Bonding
is the close emotional attraction to a newborn by the parents that develops during the first 30 to 60 minutes after birth
Attachment
is the development of strong affection between an infant and a significant other (mother, father, sibling, and caretaker).
In the postpartum period, mood disorders can be divided into three distinct entities in ascending order of severity
maternal (baby) blues, postpartum depression, and psychosis
MRA
maternal role attainment
nonlactating women menses
menstruation may resume as early as 7 to 9 weeks after giving birth
baby blues
mild depressive symptoms, anxiety, irritability, mood swings, loss of appetite, trouble with sleeping, tearfulness (often for no discernible reason), increased sensitivity, and fatigue
A nurse is inspecting the perineal pad of a client who gave birth vaginally to a healthy newborn 6 hours ago. The nurse observes a 5-inch stain of lochia on the pad. The nurse would document this as:
moderate.
nursing implications promoting attachment
nurses can encourage nurturing activities and contact such as touching, talking, singing, comforting, changing diapers, feeding—in short, participating in routine newborn care.
objective:Increase the number of mothers who breast-feed at 6 months from a baseline of 43.5% to 60.6%.
nursing significance : Will increase the rate of breast-feeding, particularly among low-income and certain racial and ethnic populations who are less likely to begin breast-feeding in the hospital or to sustain it through the infant's first year
One of the most important elements in a newborn's survival is
obtaining a stable body temperature to promote an optimal transition to extrauterine life. On average, a newborn's temperature ranges from 97.9° to 99.7°F (36.6° to 37.6°C). Since newborns lose heat easily after birth, having skin-to-skin contact with their mothers is recommended as the initial method for maintaining newborn body temperature.
Postpartum diuresis
occurs as a result of several mechanisms: the large amounts of intravenous fluids given during labor, a decreasing antidiuretic effect of oxytocin as its level declines, the buildup and retention of extra fluids during pregnancy, and a decreasing production of aldosterone—the hormone that decreases sodium retention and increases urine production
baby blues
peak at days 4 and 5 may last hours or days and usually resolve by day 10
puerperium
period begins after the delivery of the placenta and lasts approximately 6 weeks.
Estrogen
plays a major role during pregnancy, but levels drop profoundly at birth and reach their lowest level a week into the postpartum period
Cervix
prepregnant state by week 6 of the postpartum period. never regains its prepregnant appearance . The internal cervical os gradually closes and returns to normal by 2 weeks, whereas the external os widens and never appears the same after childbirth The external cervical os is no longer shaped like a circle, but instead appears as a jagged slit-like opening, often described as a "fish mouth"
Proximity
refers to the physical and psychological experience of the parents being close to their infant. This attribute has three dimensions: Contact: The sensory experiences of touching, holding, and gazing at the infant are part of proximity-seeking behavior. Emotional state: The emotional state emerges from the affective experience of the new parents toward their infant and their parental role. Individualization: Parents are aware of the need to differentiate the infant's needs from themselves and to recognize and respond to them appropriately, making the attachment process also, in some way, one of detachment.
newborn's most dramatic and most rapid extrauterine transitions occur in four interdependent areas
respiratory, circulatory, thermoregulation, and their ability to stabilize their blood glucose levels All four areas must all make successful transitions for the newborn to adapt to extrauterine life. Although the transition usually takes place within the first 6 to 10 hours of life, many adaptations take weeks to attain full maturity.
Cold stress
s excessive heat loss that requires a newborn to use compensatory mechanisms (such as nonshivering thermogenesis and tachypnea) to maintain core body temperature The consequences of cold stress can be quite severe. As the body temperature decreases, the newborn becomes less active, lethargic, hypotonic, and weaker. All newborns are at risk for cold stress, particularly within the first 12 hours of life.
If excessive bleeding occurs
the first step would be to massage the boggy fundus until it is firm to reduce the flow of blood
brown fat
the newborn's primary method of heat production is through nonshivering thermogenesis. This is a process in which brown fat (adipose tissue) is oxidized in response to cold exposure. Brown fat is a special kind of highly vascular fat found only in newborns. . The brown coloring is derived from the fat's rich supply of blood vessels and nerve endings Brown fat makes up about 6% of term body weight in the full-term newborn
Lactogenesis
the onset of milk secretion, initially triggered by the delivery of the placenta, which results in falling levels of estrogen and progesterone, with the continued presence of prolactin
taking-hold phase
the second phase of maternal adaptation, is characterized by dependent and independent maternal behavior. This phase typically starts on the second to third day postpartum. during phase mom is concerned about health and babies health.
Umbilican
two umbilical arteries and one umbilical vein begin to constrict at birth, because with placental expulsion, blood flow ceases.
A boggy or relaxed uterus is a sign of
uterine atony (loss of muscle tone in the uterus). This can be the result of bladder distention, which displaces the uterus upward and to the right, or retained placental fragments.
infants younger than 3 months of age, the CDC
vaccination with (Tdap) (combination of diphtheria, pertussis, and tetanus vaccines
postpartum assessment
vital signs and physical and psychosocial assessments. It also includes assessing the parents and other family members, such as siblings and grandparents, for attachment and bonding with the newborn. During the first hour: every 15 minutes During the second hour: every 30 minutes During the first 24 hours: every 4 hours After 24 hours: every 8 hours
If a woman does not desire to breast-feed
wearing a tight, supportive bra 24 hours daily, applying ice to her breasts for approximately 15 to 20 minutes every other hour, avoiding sexual stimulation, and not stimulating the breasts by squeezing or manually expressing milk from the nipples. In addition, avoiding exposing the breasts to warmth (e.g., a hot shower) will help relieve breast engorgement. In women who are not breast-feeding, engorgement typically subsides within 2 to 3 days with application of these measures.
To reduce infant and mother vulnerability and potential illness
Women are kept warm, stay inside to prevent becoming chilled, bathe infrequently, and avoid exercise new mothers rest and recuperate.
Striae gravidarum
(stretch marks) that developed during pregnancy on the breasts, abdomen, and hips gradually fade to silvery lines
When assessing a term newborn (6 hours old), the nurse auscultates bowel sounds and documents recent passing of meconium. These findings would indicate:
A patent anus with no bowel obstruction and normal peristalsis
After birth, the nurse would expect which fetal structure to close as a result of increases in the pressure gradients on the left side of the heart?
Foramen ovale
Pelvic floor exercises
Kegels
lochia infection
Lochia at any stage should have a fleshy smell; an offensive odor usually indicates an infection, such as endometritis.
Self-Quieting Ability
Swaddling tightly; Side/stomach position on the lap of the caretaker; Shushing loudly or continuous white noise; Swinging using any rhythmic movement; and Sucking
kangaroo care
skin-to-skin contact by placing the infant onto the bare chests of mothers and fathers to enhance parent-newborn attachment
uterus
weighs 2.2 lbs after birth by 1 week uterus shrinks 50% by 6 weeks it weighs 2 oz after birth uterus decends from belly buttin at a rate inf 1 cm a day. byt day 3 the fundus lies 2-3 fingerbreadths below umbilicus by day 10 cannot be palpated bc it descended into the true pelvis
periodic breathing
which is the cessation of breathing that lasts 5 to 10 seconds without changes in color or heart rate . Periodic breathing may be observed in newborns within the first few days of life and requires close monitoring.
If fluid is removed too slowly or incompletely
with decreased thoracic squeezing during birth or diminished respiratory effort), transient tachypnea (respiratory rate above 60 breaths per minute) of the newborn occurs. Examples of situations involving decreased thoracic compression and diminished respiratory effort include cesarean birth and sedation in newborns.
Breasts
Inspect the breasts for size, contour, asymmetry, engorgement, or erythema
Which of the following newborns could be described as breathing normally?
Newborn D is breathing shallowly, at a rate of 36 bpm, with short periods of apnea.
neonatal period
is defined as the first 28 days of life
Reciprocity
is the process by which the infant's abilities and behaviors elicit parental response. Reciprocity is described by two dimensions: complementary behavior and sensitivity.
A woman who is about to be discharged after a vaginal birth notices a flea-like rash on her newborn's chest that consists of tiny red lesions all across the nipple line. What is the best response from the nurse when explaining this to the woman?
"It is a normal skin finding in a newborn."
the four stages a woman progresses through in establishing a maternal identity in BAM:
1 Commitment, attachment to the unborn baby, and preparation for delivery and motherhood during pregnancy 2 Acquaintance/attachment to the infant, learning to care for the infant, and physical restoration during the first 2 to 6 weeks following birth 3 Moving toward a new normal 4 Achievement of a maternal identity through redefining self to incorporate motherhood (around 4 months). The mother feels self-confident and competent in her mothering and expresses love for and pleasure interacting with her infant (Mercer & Walker, 2006)
The transition to parenthood, according to Mercer (2006), involves four stages:
1 Commitment, attachment, and preparation for an infant during pregnancy 2 Acquaintance with and increasing attachment to the infant, learning how to care for the infant, and physical restoration during the first weeks after birth 3 Moving toward a new normal routine in the first 4 months after birth 4.Achievement of a parenthood role around 4 months
Uterine Involution : Involution involves three retrogressive processes:
1.Contraction of muscle fibers to reduce those previously stretched during pregnancy 2.Catabolism, which shrinks enlarged, individual myometrial cells 3. Regeneration of uterine epithelium from the lower layer of the decidua after the upper layers have been sloughed off and shed during lochial discharge
Find two web sites about the transition to extrauterine life that can be shared with other nursing students as well as nursery nurses. Critique the information presented in terms of how accurate and current it is.
American Academy of Pediatrics, http://www.aap.org; Neonatal Network, http://www.neonatalwork.com
neutral thermal environment
An environment in which body temperature is maintained without an increase in metabolic rate or oxygen use A neutral thermal environment promotes growth and stability, conserves energy for basic bodily functions, and minimizes heat (energy) and water loss If the environmental temperature decreases, the newborn responds by consuming more oxygen. The respiratory rate increases (tachypnea) in response to the increased need for oxygen. As a result, the newborn's metabolic rate increases.
Period of Decreased Responsiveness
At 30 to 120 minutes of age, the newborn enters the second stage of transition—that of the sleep period or a decrease in activity. This phase is referred to as a period of decreased responsiveness. Movements are less jerky and less frequent. Heart and respiratory rates decline as the newborn enters the sleep phase. The muscles become relaxed, and responsiveness to outside stimuli diminishes. During this phase, it is difficult to arouse or interact with the newborn. No interest in sucking is shown. This quiet time
A G1 P1001 mother is just home after giving birth to her first child 5 days ago. Her birth was complicated by an emergency cesarean birth resulting from incomplete cervical dilation (dilatation) and hemorrhage. The nurse determines that the mother has not slept longer than 3 hours at one time. The appropriate nursing diagnosis for this client care issue is:
At risk for postpartum depression due to inadequate rest.
FACTORS AFFECTING ATTACHMENT
Attachment behaviors are influenced by three major factors: Parents' background (includes the care that the parents received when growing up, cultural practices, relationship within the family, experience with previous pregnancies and planning and course of events during pregnancy, postpartum depression) Infant (includes the infant's temperament and health at birth) Care practices (the behaviors of physicians, nurse practitioners, midwives, nurses, and hospital personnel, care and support during labor, first day of life in separation of mother and infant, and rules of the hospital or birthing center) (Lewis & Rudolph Separation of infant and parents immediately after birth and for long periods during the day Policies that discourage unwrapping and exploring the infant Intensive care environment, restrictive visiting policies Staff indifference or lack of support for parent's caretaking attempts and abilities
Fetal to Neonatal Circulation Changes
Before birth, the foramen ovale allowed most of the oxygenated blood entering the right atrium from the inferior vena cava to pass into the left atrium of the heart. The ductus arteriosus becomes functionally closed within the first few hours after birth.Closure depends on the high oxygen content of the aortic blood that results from aeration of the lungs at birth.
In the taking-in maternal role phase described by Rubin (1984), the nurse would expect the woman's behavior to be characterized as which of the following?
Being passive and dependent
Blood pressure
Blood pressure readings should not be higher than 140/90 mm Hg or lower than 85/60 mmHg Be alert for orthostatic hypotension, which can occur when the woman moves rapidly from a lying or sitting position to a standing one. increase in blood pressure could indicate gestational hypertension, whereas a decrease could indicate shock or orthostatic hypotension or dehydration
After teaching a group of breast-feeding women about nutritional needs, the nurse determines that the teaching was successful when the women state that they need to increase their intake of which nutrients?
Calories and protein
Nutrition for the Breast-Feeding Mother
Calories: + 500 cal/day for the first and second 6 months of lactation Protein: + 20 g/day, adding an extra 2 cups of skim milk Calcium: + 400 mg daily—consumption of four or more servings of milk Iodine: 290 mcg daily—dairy products, seafood, and iodized salt Fluid: + 2 to 3 quarts of fluids daily (milk, juice, or water); no sodas BOX 16.4
Japanese American
Cleanliness and protection from cold are essential components of newborn care. Nurses should bathe the infant daily. Newborns routinely are not taken outside the home because it is believed that they should not be exposed to outside or cold air. Infants should be kept in a quiet, clean, warm place for the first month of life. Breast-feeding is the primary method of feeding. Many women stay in their parents' home for 1 to 2 months after birth. Bathing the infant can be the center of family activity at home.
Which of these activities would best help the postpartum nurse to provide culturally sensitive care for the childbearing family?
Educating himself or herself about diverse cultural practices
A new mother was brought to the postpartum unit who gave birth 12 hours ago. Because this is her first child, which of the following goals by the nurse is most appropriate?
Effective education of both parents before discharge
BREAST-FEEDING
Estrogen stimulates growth of the milk collection (ductal) system, whereas progesterone stimulates growth of the milk production system Prolactin and oxytocin result in milk production if stimulated by sucking Skin-to-skin contact during the first hour following birth is the gold standard to initiate breast-feeding
The nurse is caring for a newborn who was delivered via a planned cesarean delivery. The nurse determines the infant requires closer monitoring than a vaginal delivery infant based on which factor?
Excessive fluid in its lungs, making respiratory adaptation more challenging.
While in the nursery clinical setting, identify the period of behavioral reactivity (first, inactivity, or second period) for two newborns born at different times. Share your findings during the post conference for that clinical day.
First period of reactivity behavior: burst of rapid, jerky movements of the extremities; sucking activity; smacking and rooting; and fine tremors of the extremities. Second-period behavior: newborn's alertness gradually declines and he or she sleeps. Third period: newborns awaken and become more interactive with the environment. Movement is smoother compared with the first period of reactivity. Meconium may be passed during this period.
To foster maternal role attainment, three specific interventions for nurses were identified
First, instructions about infant care and the infant's capabilities are more effective if they are specifically focused on that particular mother's infant. Second, mothers prefer live classes rather than videotapes so they can ask questions. In short, interactive nurse-client relationships are associated with positive maternal growth. Third, identifying barriers that reduce skin-to-skin periods of mother-to-infant during the postpartum hospital stay and intervening to reduce them have implications for both maternal role development and breast-feeding success, if she has chosen this method.
normal episiotomy site should not have redness, discharge, or edema.
First-degree laceration: involves only skin and superficial structures above muscle Second-degree laceration: extends through perineal muscles Third-degree laceration: extends through the anal sphincter muscle Fourth-degree laceration: continues through anterior rectal wall
Filipino American
Grandparents often assist in the care of their grandchildren. Breast-feeding is encouraged, and some mothers breast-feed their children for up to 2 years. Women have difficulty discussing birth control and sexual matters. Strong religious beliefs prevail and bedside prayer is common. Families are very close-knit and numerous visitors can be expected at the hospital after childbirth.
Assess for voiding problems
Have you (voided, urinated, gone to the bathroom) yet? Have you noticed any burning or discomfort with urination? Do you have any difficulty passing your urine? Do you feel that your bladder is empty when you finish urinating? Do you have any signs of infection such as urgency, frequency, or pain? Are you able to control the flow of urine by squeezing your muscles? Have you noticed any leakage of urine when you cough, laugh, or sneeze?
EVAPORATION
Heat loss via evaporation also occurs when bathing a newborn. Drying newborns immediately after birth with warmed blankets and placing a cap on their head will help to prevent heat loss through evaporation.
Take Note!
Human breast milk provides a passive mechanism to protect the newborn against the dangers of a deficient intestinal defense system. It contains antibodies, viable leukocytes, and many other substances that can interfere with bacterial colonization and prevent harmful penetration.
IgA
IgA is the second most abundant immunoglobulin in the serum. IgA does not cross the placenta, and maximum levels are reached during childhood. IgA is predominantly found in the gastrointestinal and respiratory tracts, tears, saliva, colostrum, and breast milk.
Appalachian
Infant colic is treated by passing the newborn through a leather horse's collar or administering weak catnip tea. An asafetida bag (a gum resin with a strong odor) is tied around the infant's neck to ward off disease. Women may avoid eye contact with nurses and health care providers. Women typically avoid asking questions even though they do not understand directions. The grandmother may rear the infant for the mother.
Before the newborn's lungs can maintain respiratory function, the following events must occur:
Initiation of respiratory movement Expansion of the lungs Establishment of functional residual capacity (ability to retain some air in the lungs on expiration) Increased pulmonary blood flow Redistribution of cardiac output
Because the newborn's red blood cells break down much sooner than those of an adult, what might result?
Jaundice
The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings by the nurse would be expected?
Light pink or brown lochia; uterus 4 to 5 fingerbreadths below umbilicus
Rh Status
Mothers who are Rh-negative and have given birth to an infant who is Rh-positive should receive an injection of Rh immunoglobulin within 72 hours after birth to prevent a sensitization reaction in the Rh-negative woman who received Rh-positive blood cells during the birthing process.
Need for sleep suggestions from nurse,
Nap when the infant is sleeping, because getting uninterrupted sleep at night is difficult. Reduce participation in outside activities and limit the number of visitors. Determine the infant's sleep-wake cycles and attempt to increase wakeful periods during the day so the baby sleeps for longer periods at night. Eat a balanced diet to promote healing and to increase energy levels. Share household tasks to conserve your energy. Ask the father or other family members to provide infant care during the night periodically so that mothers can get an uninterrupted night of sleep, if they are not breast-feeding. Review your family's daily routine and see if you can "cluster" activities to conserve energy and promote rest.
Three-Stage Role Development Process for partners
New partners pass through stage 1 (expectations) with preconceptions about what home life will be like with a newborn. Stage 2 (reality) occurs when partners realize that their expectations in stage 1 are not realistic. In stage 3 (transition to mastery), the partner makes a conscious decision to take control and be at the center of his/her newborn's life regardless of his/her preparedness. This adjustment period is similar to that of the mother's letting-go phase
Take Note!
Newborns that are fed early pass stools sooner, which helps to reduce bilirubin buildup
Take Note!
Note the location and condition of the fundus; a full bladder tends to displace the uterus up and to the right.
Objective: Increase the proportion of mothers who breast-feed their babies.
Nursing Significance Will provide infants with the most complete form of nutrition, improving their health, growth and development, and immunity
Take Note!
Ovulation may occur before menstruation. Therefore, breast-feeding is not a totally reliable method of contraception unless the mother exclusively breast-feeds, has had no menstrual period since giving birth, and whose infant is younger than 6 months
When assessing the term newborn, the following are observed: newborn is alert, heart and respiratory rates have stabilized, and meconium has been passed. The nurse determines that the newborn is exhibiting behaviors indicating:
Second period of reactivity
Social Behaviors
Social behaviors include cuddling and snuggling into the arms of the parent when the newborn is held. Usually newborns are very sensitive to being touched, cuddled, and held. Cuddliness is very important to parents, because they frequently gauge their ability to care for their newborn by the newborn's acceptance or positive response to their actions.
taking in phase
mother and newborn bonding The taking-in phase typically lasts 1 to 2 days and may be the only phase observed by nurses in the hospital setting because of the shortened postpartum stays that are the norm today.
Which of the following would lead the nurse to suspect that a postpartum woman was developing a complication?
Swollen, tender, hot area on breast
an average of 120 to 130 bpm
Tachycardia may be found with volume depletion, cardiorespiratory disease, drug withdrawal, and hyperthyroidism. Bradycardia is often associated with apnea and is often seen with hypoxia.
Stomach and Digestion
The cardiac sphincter and nervous control of the stomach is immature, which may lead to uncoordinated peristaltic activity and frequent regurgitation. they have limited ability to digest complex carbohydrates and fats, because amylase and lipase levels are low at birth. As a result, newborns excrete a fair amount of lipids, resulting in fatty stools. Normally, term newborns lose 5% to 10% of their birth weight as a result of insufficient caloric intake within the first week after birth, shifting of intracellular water to extracellular space, and insensible water loss. To gain weight, the term newborn requires an intake of 108 kcal/kg/day from birth to 6 months
Second Period of Reactivity
The second period of reactivity begins as the newborn awakens and shows an interest in environmental stimuli. This period lasts 2 to 8 hours in the normal newborn (Davidson, 2014). Heart and respiratory rates increase. Peristalsis also increases. Thus, it is not uncommon for the newborn to pass meconium or void during this period. In addition, motor activity and muscle tone increase in conjunction with an increase in muscular coordination Teaching about feeding, positioning for feeding, and diaper-changing techniques can be reinforced during this time.
Dramatic changes occur in the cardiovascular system at birth. When the umbilical cord is clamped and the placenta is separated, there is a resultant increase in systemic blood pressure and changes to the three major fetal shunts (ductus venosus, foramen ovale, and ductus arteriosus) occur. Outline what happens to cause their functional closures during this period of transition.
Transition from fetal to adult circulation begins with clamping of the umbilical cord and continues through the first few weeks of life. There is an increase in systemic resistance due to the loss of the placental circuit. The increased pressure in the left atrium causes functional closure of the foramen ovale. Initial respiration opens pulmonary vasculature, favoring circulation to the lungs now. Increased oxygenation of circulating blood causes constriction and functional closure of the ductus arteriosus; and the absence of placental circulation closes the ductus venosus.
Engrossment
Visual awareness of the newborn—the partner perceives the newborn as attractive, pretty, or beautiful. Tactile awareness of the newborn—the partner has a desire to touch or hold the newborn and considers this activity to be pleasurable. Perception of the newborn as perfect—the partner does not "see" any imperfections. Strong attraction to the newborn—the partner focuses all attention on the newborn when they are in the room. Awareness of distinct features of the newborn—the partner can distinguish his/her newborn from others in the nursery. Extreme elation—the partner feels a "high" after the birth of his/her child. Increased sense of self-esteem—the partner feels proud, "bigger," more mature, and older after the birth of his/her child
The nurse is instructing the postpartum client who plans to bottle-feed her newborn about measures to prevent breast engorgement when she is discharged. Which of the following measures should the nurse include in the teaching plan?
Wearing a tight-fitting supportive bra 24 hours daily
Native American
Women are secretive about pregnancies and do not reveal them early. Touching is not a typical female behavior and eye contact is brief. They resent being hurried and need time for sitting and talking. Most mothers breast-feed and practice birth control.
Amish
Women consider childbearing their primary role in society. They generally oppose birth control. Pregnancy and childbirth are considered a private matter; they may conceal it from public knowledge. Women typically do not respond favorably when hurried to complete a self-care task. Nurses need to take cues from women indicating their readiness to complete morning self-care activities.
cesarean birth lochia
Women who had a cesarean birth will have less lochia discharge than those who had a vaginal birth, but stages and color changes remain the same.
nursing postpartum intevention
Women with an increased risk for this condition during the postpartum period should wear antiembolism stockings or use sequential compression devices to reduce the risk of venous stasis by preventing blood from pooling in the calves of the legs. Encouraging the client to ambulate after childbirth reduces the incidence of thrombophlebitis.
Physical examination
assessing the breasts, uterus, bladder, bowels, lochia, episiotomy/perineum and epidural site and extremities.
Communication
encompasses an understanding of not only a person's language, and loudness of speech, but also the meaning of touch and gestures
REDUCING POSTPARTUM WEIGHT RETENTION AND IMPROVING BREAST-FEEDING OUTCOMES IN OVERWEIGHT WOMEN Nursing implications
encouraged to breast-feed express risk of cardiovascular diseases, diabetes, hypertension, and cancer will be increased as they age
peribottle
is a plastic squeeze bottle filled with warm tap water that is sprayed over the perineal area after each voiding and before applying a new perineal pad.
Glucose
is an essential fuel for brain metabolism. When the placenta is lost at birth, the maternal glucose supply is cut off. Hypoglycemia is one of the most frequent problems encountered, and maintaining glucose homeostasis is one of the important physiologic events during the fetal-to-newborn transition. Glucose is the main source of energy for the first several hours after birth.
nervous system
is immature and continues to develop to achieve a full complement of cortical and brainstem cells by 1 year of age. The brain increases its size threefold during the first year of life. newborn has an acute sense of hearing, smell, and taste. The newborn's sensory capabilities include the following: Hearing—well developed at birth, responds to noise by turning to sound Taste—ability to distinguish between sweet and sour by 72 hours old Smell—ability to distinguish between mother's breast milk and breast milk from others Touch—sensitivity to pain, responds to tactile stimul Vision—is incomplete at birth. Maturation is dependent on nutrition and visual stimulation. Newborns have ability to focus only on close objects (8 to 10 in away) with a visual acuity of 20/140; they can track objects in midline or beyond (90 in). This is the least mature sense at birth. The ability to fix, follow, and be alert is indicative of an intact CNS
Thermoregulation
is the process of maintaining the balance between heat loss and heat production in order to maintain its core internal temperature.
postpartum adjustment period
lasts well into the first year, making the fourth phase of labor the longest can also be defined to include the changes in all aspects of the mother's life that occur during the first year after a child is born
insufficient voiding
less than 200 mL discomfort, burning, urgency, or foul-smelling urine
temperature
mother's temperature during the first 24 hours postpartum is within the normal range or a low-grade elevation. Some women experience a slight fever, up to 100.4°F (38°C), during the first 24 hours. This elevation may be the result of dehydration because of fluid loss during labor. temp should go back to normal by 24 hrs postpartum a temp of 100.4 or higher is abnomral after the first 24 hrs elevated temp can be the reason for maternal sepsis, signficant maternal morbidity and mortality
The immune system's responses can be divided into two categories
natural and acquired immunity.
Heart Rate
newborn's heart rate is approximately 110 to 160 bpm. an average of 120 to 130 bpm
breast crawl
newborn's instinct was to seek nourishment after birth. They move on their mother's abdomen up to her breast instinctively instinct arises when a newborn, left undisturbed and skin-to-skin on the mother's trunk following birth, moves toward her/his mother's breast for the purpose of locating and self-attaching for the first feeding the newborn uses leg and arm movements to propel her/himself toward the breast. Upon reaching the sternum, the newborn will bounce her/his head up and down and side to side. As the newborn approaches the nipple, her/his mouth opens and, after several attempts, latch-on and suckling take place. . Nurses have a responsibility to promote the health of their childbearing families and provide evidence-based care. Encouraging use of the breast crawl can be the first step in health promotion for every newborn
newborn rbc
newborn's red blood cells have a life span of 80 to 100 days, compared with 120 days in adults.
Respirations
out of the normal range might indicate pulmonary edema, atelectasis, a side effect of epidural anesthesia, or pulmonary embolism and must be reported
Cold stress in the newborn can lead to
problems if not reversed: depleted brown fat stores, increased oxygen needs, respiratory distress, increased glucose consumption leading to hypoglycemia, metabolic acidosis, jaundice, hypoxia, and decreased surfactant production
Thermoregulation
producing heat through nonshivering thermogenesis. Newborns have a decreased ability to regulate their body temperature, producing heat through nonshivering
Factors that inhibit involution include
prolonged labor and difficult birth, incomplete expulsion of amniotic membranes and placenta, uterine infection, over-distention of uterine muscles (such as by multiple gestation, hydramnios, or a large singleton fetus), a full bladder (which displaces the uterus and interferes with contractions), anesthesia (which relaxes uterine muscles), and close childbirth spacing (frequent and repeated distention decreases tone and causes muscular relaxation).
Stress incontinence Nursing Implications
provides support for the widespread recommendation that PFMT the promotion of healthy weight can also help prevent or reduce incontinence as a woman ages.
Progesterone
quiets the uterus to prevent a preterm birth during pregnancy, and its increasing levels during pregnancy prevent lactation from starting before birth takes place. Progesterone levels are reestablished with the first menstrual cycle
Coagulation
reduced fibrinolysis, and pooling and stasis of blood in the lower limbs, place women at risk for blood clots 3 weeks return to prepregnant levels Smoking, obesity, immobility, and postpartum factors such as infection, bleeding, and emergency surgery (including emergency cesarean section) also increase the risk of coagulation disorders giving birth stimulates hypercoagulability hypercoagulable state, combined with vessel damage during birth and immobility, places the woman at risk for thromboembolism (blood clots) in the lower extremities and the lungs.
Attachment behaviors include
seeking, physical caretaking behaviors, emotional attentiveness to infant's needs, staying close to, touching, kissing, cuddling, choosing the en face (face-to-face) position while holding or feeding the newborn, expressing pride in the newborn and exchanging gratifying experiences with the infant
Emotional Status
ssess the woman's emotional status by observing how she interacts with her family, her level of independence, energy levels, eye contact with her infant (within a cultural context), posture and comfort level while holding the newborn, and sleep and rest patterns. Be alert for mood swings, irritability, or crying episodes.
Three factors predispose women to thromboembolic disorders during pregnancy:
stasis (compression of the large veins because of the gravid uterus), altered coagulation (state of pregnancy), and localized vascular damage (may occur during the birthing process). All of these factors increase the risk of clot formation and having it travel to the lungs.
letting-go phase
the third phase of maternal adaptation, the woman reestablishes relationships with other people. She adapts to parenthood through her new role as a mother. She assumes the responsibility and care of the newborn with a bit more confidence now. She establishes a lifestyle that includes the infant
taking-in phase
the time immediately after birth when the client needs sleep, depends on others to meet her needs, and relives the events surrounding the birth process. This phase is characterized by dependent behavior. First 24-48 hrs mothers assume a very passive role
Pulmonary emboli
thromboembolic conditions include: Anemia Diabetes mellitus Cigarette smoking Obesity Preeclampsia Hypertension Severe varicose veins Pregnancy Multiple pregnancies Cardiovascular disease Sickle cell disease Postpartum hemorrhage Oral contraceptive use Cesarean birth Severe infection Previous thromboembolic disease Multiparity Bed rest or immobility for 4 days or more Advanced maternal age > 35 years
Lochia
vaginal discharge that occurs after birth and continues for approximately four to eight weeks It results from involution, during which the superficial layer of the decidua basalis becomes necrotic and is sloughed off. Immediately after childbirth, lochia is bright red and consists mainly of blood, fibrinous products, decidual cells, and red and white blood cells. lochia from the uterus is alkaline but becomes acidic as it passes through the vagina The average amount of lochial discharge is 240 to 270 mL (8 to 9 oz) Women who have had cesarean births tend to have less flow because the uterine debris is removed manually along with delivery of the placenta