typical: week 3 Flashcards
(43 cards)
1
Q
routine newborn care
A
daily assessment
- vital signs
- weight
- diaper care (voiding/stooling. females: no stool towards urethra)
- feeding pattern
- family attachment
- weight and v/s daily: temp stabilization, skin & color assessment, may lose 5-10% birth weight
2
Q
umbilical cord care
A
per hospital protocol
- natural healing, soap and water, alcohol, povidone-iodine
- clamp removed once stump is dry
- falls off approx 10 days
3
Q
newborns: procedures & lab testing
A
- eye prophylaxis (erythromycin w/i 1-2 hours)
- vitamin K (0.5-1mg IM vastus lateralis)
- hep B vaccine prior to discharge or at 1 month old
- hep B immune globulin: w/i 12 hours if mom positive. wash injection site. wash baby right after birth
- glucose
- blood type
- bilirubin
- metabolic screening: PKU (metabolic disorders, thyroid disorders, blood disorders)
4
Q
phototherapy
A
- treatment for hyperbilirubinemia
- special lights to breakdown bilirubin in skin
- cover eyes and genitalia
- promote feeding
- monitor for fluid losses and potential dehydration
- assess stool frequency
- frequent diaper change: billirubin in stool can be irritating
5
Q
discharge planning education
A
- starts when patient is admitted to the hospital
- wrap-unwrap
- bathing: sponge bath until cord falls off
- sleep: back to sleep
- carseat safety
- infant follow-up
- immunizations
6
Q
post circ care
A
- observe for first void
- observe for bleeding
- careful diaper change
- application of vaseline/neosporin
- heals w/i 10 days
7
Q
newborn feeding: formula
A
- gradual introduction of formula
- feed q3-4 hours
- initial feed should be no more than .5oz
- same type of formula consistently
- do not cut nipple
- do not add cereal to formula
- no cereal before approx 3 months
8
Q
contraindications of breastfeeding
A
- maternal cancer therapy or diagnostic/therapeutic radioactive isotopes
- active TB not under treatment (have mother pump)
- HIV
- herpes lesion on breast (pump)
- galactosemia in infant (not tolerating proteins in mother’s milk)
- cytomegalovirus
- maternal substance abuse
- maternal human t-call leukemia
- some medications
9
Q
lactation: milk production & prolactin
A
- after birth, precipitate decrease in estrogen and progesterone levels triggers release of prolactin from anterior pituitary gland
- prolactin levels highest during the first 10 days after birth (gradually decline but remain above baseline levels for duration of lactation)
- prolactin produced in response to infant suckling and emptying of breasts. lactating breasts never completely empty- milk constantly produced as infant feeds.
10
Q
lactation: milk production & oxytocin
A
- the other hormone essential to lactation
- as nipple is stimulated b suckling infant, post. pituitary prompted by hypothalamus produces oxytocin: responsible for milk-ejection reflex or let-down reflex
- nipple-erection reflex is integral to lactation
11
Q
colostrum
A
- a clear, yellowish fluid
- may be present in breast as early as 28 weeks
- present for first 3 days
- more concentrated than mature milk
- extremely rich in immune globulins
- higher concentration of protein and minerals
- less fat than mature milk
12
Q
human milk composition
A
- days 3-5 after delivery mature milk comes in (increase in quantity of milk production)
- day 10 “final” stage of mature milk
- composition changes during each feeding: fat content increase
- foremilk: 60% skim, 35% whole, provides lactose, protein, water-soluble vitamins
- hindmilk (cream)- 5% usually let down 10-20 min into feeding. denser calories.
- changing composition of human milk during each feeding requires breastfeeding long enough to supply balanced feeding
13
Q
postpartum: maternal physiologic changes
A
- postpartum period is interval between birth and return of reproductive organs to their nonpregnant state
- puerperium, 4th stage of pregnancy
- traditionally lasts 6 weeks
14
Q
postpartum: uterus
A
- involution: return to non-pregnant state
- 2cm below umbilicus at end of 3rd stage of labor
- 12hrs: at umbilicus (+/- 1 cm)
- progresses rapidly: fundus descends 1-2cm q24h. 2 weeks: back in pelvis.
- subinvolution: failure to return to shape. common causes are retained placental fragments and infection
15
Q
postpartum: uterus contractions
A
- hemostasis achieved by compression of intramyometrial blood vessels as uterine muscle contracts
- contractions immediately after birth “seal off” the vessels at the placental implantation site
- oxytocin strengthens and coordinates uterine contractions (released by stimulation of breastfeeding).
16
Q
lochia
A
- rubra: blood and decidual and trophoblastic debris. approx 3-4 days
- serosa: old blood, serum, leukocytes, debris. starts about day 5- lasts 22-27 days
- alba: leukocytes, decidua, epithelial cells, mucus, serum, bacteria. 2-6 weeks after birth.
give Pitocin if low tone or excessive bleeding
17
Q
postpartum: excessive bleeding
A
- saturation of a perineal/sanitary pad within 15 minutes or less
- pooling of blood under butt
- requires immediate assessment and intervention
- most lochia described as scant, light, moderate
18
Q
postpartum: vagina and perineum
A
- vagina returns to size by 6-10 weeks
- introitus erythematous & edematous
- episiotomies heal within 2-3 weeks
- hemorrhoids and anal varicosities common, decrease w/i 6 weeks
- peri-care: ice, cooling agents, stiz bath
- kegel exercises encourage healing
- 6 months to regain pelvic muscular tone
19
Q
postpartum: endocrine
A
estrogen & testosterone drop with expulsion of placenta
pituitary hormones & ovarian function:
- lactating and non-lactating women differ in timing of first ovulation and menstruation
- 70% nonbreastfeeding mothers menstruate w/i 12 weeks
- breast feeding: ovulation depends on patterns of feeding
- may ovulate before first menstrual cycle
20
Q
postpartum: urinary system
A
- diuresis: within 12 hours. profuse often occurs for the first 2-3 days.
urethra and bladder - excessive bleeding can occur because of displacement of the uterus if bladder is full.
21
Q
postpartum: GI
A
appetite:
- most new mothers very hungry after recovery
bowels:
- spontaneous bowel evacuation may not occur for 2-3 days after.
22
Q
postpartum: blood volume
A
- increase eliminated within first 2 weeks, return to normal 6 months after delivery
- previous excess blood volume of pregnancy protects mothers from post-delivery shock
- readjustments in maternal vasculature after childbirth dramatic and rapid
- assess for peripheral edema
23
Q
postpartum: cardiac output
A
- slightly elevated with remaining increased volume
- hgb & hct: loss in plasma volume
- WBC: 12,000. up to 20,000 ok
24
Q
postpartum: neuro
A
- pregnancy-induced neurologic discomforts abate
- headache requires careful assessment: gestational HTN, stress, leakage of CSF during needle placement
25
postpartum: integumentary
- chloasma disappears
- hyperpigmentation of areola and linea nigra may not regress completely. some women may have permanent pigmentation, stretch marks may not disappear.
- vascular abnormalities, epulis regress with rapid decline in estrogen
- coarse or bristly hair usually remains, fine hair usually disappears
26
Focused postpartum assessment
```
B: breasts
U: uterus
B: bladder
B: bowel
L: lochia
E: epis/incision
H: hemorrhoids/homans
E: emotional status
```
27
postpartum blues
"pink": first 1-2 days. joyful.
"blue"
- 50-80% of women experience some form of transient blues
- emotionally labile
- may progress to depression, restlessness, fatigue, insomnia, physical symptoms.
- provide encouragement and support
- differentiate depression
28
postpartum depression
- approx 10% mothers
- intense/pervasive sadness/severe mood swings/difficulty falling asleep/irritability
- feelings of guilt
- disinterest in baby/fears of harming baby
- 6 months/supportive care/medications
29
planning future pregnancies
- rubella vaccine: if not immune. must use contraception for one month. virus shed in urine and stool: good hand hygiene
- Rh: should be given within 72 hours of Rh+ birth. Should have received one dose at 28 weeks
- discuss contraception options
- no intercourse for 6 weeks
- may receive Depo at discharge
- considerations with breastfeeding
30
transition to extrauterine life: first period of reactivity
- lasts up to 30 minutes after birth
- newborn's heart rate increases to 160-180 bpm
- decreases after 30 minutes
- decrease in motor activity after period
- keep skin to skin in birth room
31
transition to extrauterine life: second period of reactivity
- occurs 4-8 hours after birth
- tachycardia, tachypnea occur
- meconium passed
- increased muscle tone, changes in skin color, mucus production (c-section babies might not equilibriate as easily)
32
newborn physiologic adaptations: respiratory
Initiation of breathing
- vaginal birth: fluid in lungs "squeezed out"
- change in pressure and other stimuli causes air to "rush in" to the lungs
- chemoreceptors and carotid bodies stimulate respirations
- normal breathing: irregular, 30-60 per minute
- pauses less than 20 seconds
- signs of respiratory distress: grunting, retracting, cyanosis
- maintaining adequate oxygen supply: combination effect of respirations, oxygen demand, glucose control, temperature.
33
newborn physiologic adaptations: cardiovascular
- change from fetal and "newborn" circulation
- closure of patent ducts due to pressure changes and function of lungs: decreased pulmonary resistance, increased pressure in L ventricle, murmurs may persist
- heart rate and sounds: 120-160, auscultate one full minute
- BP: 60-80/40-50
- blood volume: cord clamping, fetal hgb
34
newborn physiologic adaptations: thermogenic
- maintaining heat is critical
- thermogenesis: no shivering mechanism, maintain heat by metabolism of brown fat, triggered by activity in brain, heart, & liver
- heat loss
- temp regulation: 36.5-37.2 (97.7-99.7)
- axillary temp
35
newborn physiologic adaptations: renal
- inability to concentrate urine (3mos)
- immature ability to regulate bicarb
- f/e: excess amount in extracellular fluid
36
newborn physiologic adaptations: GI
- no bacteria in GI: cannot make vitamin K yet
- stomach capacity 30-90mL
- stool:
- - meconium: amniotic fluid, bilirubin, cells, occult blood
- - pass within 12-24 hours, up to 48hrs
- - transitional stool: day 3: greenish brown- yellowish brown; thin & sticky
- - milk stool: day 4: breastfed: yellow- gold; pasty. formula: yellow to light brown, firmer, smelly
37
newborn physiologic adaptations: hepatic
- iron storage: 4-6 months
- carbohydrate metabolism: own glucose metabolism, make own insulin, depletion of glycogen stores 24 hours
Jaundice:
- bilirubin (breakdown of RBC) in skin
- physiologic phenomenon: after 24 hours of life
- earlier jaundice can be pathologic and require treatment
38
newborn physiologic adaptations: immune, skeletal, neuro
immune: no IgA
skeletal: more cartilage
neuro: reflex development and assessment
39
newborn assessment
- general survey
- vital signs
- weight, length
- head, chest, abdominal circumference
- systems
(observe in quiet alert state. )
40
newborn assessment: head and skin
- fontanelles
- caput succedaneum (generalized edema of scalp- resolves 3-4 days)
- cephalhematoma (collection of blood b/t skull bones and periosteum. does NOT cross suture line)
- desquamation (peeling skin)
- mongolian spots
- lanugo
- milia
- nevi (stork bites- blanch)
- erythema toxicum: rash. looks like bug bites. unknown etiology, goes away on its own.
- creases in hands/feet
- Simian crease: single palmar crease=Downs
- Plantar creases= gestational age
41
newborn assessment: head
- circumference: larger than chest (no more than +/- 2cm)
- shape
- anterior fontanelle (closes at 18mo)
- posterior fontanelle (closes at 8-12wks)
42
newborn assessment: skeletal
At birth more cartilage than ossified bone
- extremities: position, ROM
- assessment of hips & feet
- Ortolani maneuver
- Barlow
- club foot
- polydactyl
43
Reflex assessment
```
rooting
- turns head towards stimulus and opens mouth
sucking & swallowing
grasp
- hands and feet
moro
- "startle": extension of arms and legs w/stimuli
babinski
- hyperextension w/flexion of toe
stepping
tonic neck
```
