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SEM 1 > Week 8: PP Care & Newborn Nutrition > Flashcards

Week 8: PP Care & Newborn Nutrition Flashcards

1
Q

Benefits of Breastfeeding: Infant

A

-reduced mortality
-maturation of GI trct and Immune system
-decreased risk of gastroenteritis, celiac disease, crohn’s disease, necrotizing entercolitis (premie), obesity, dental malocclusions
- protects from otitis media, respiratory illness, bacteremia, bacterial meningitis, lymphoma, T1 + T2 DM
lower incidence of allergies
- less likely for SIDS
- enhanced cognitive development
-pain relief during painful procedure

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2
Q

Benefits of Breastfeeding: Mother

A
  • dec. PP bleeding, rapid uterine involution
    -dec. ovarian cancer, beast cancer, rheutamoid arthiritis, HTN, hypercholestermia, cardiovasvular disease, T2 DM
  • rapid PP weightloss
  • delayed return of menses
    -bonding experience
    inc maternal role attainment
    -protection from mood disorders when breastfeeding difficulties are addressed
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3
Q

Describe the Physiology of Lactation

A

1: baby’s hunger triggers hypothalumus, sends signal to posterior pituitary, PP releases oxytocin, muscles contract and squeeze milk
2: suckling stimulates nerves in breast, nerve impulse sent to hypothalamus, PP releases oxytocin, muscles contract and squeeze out milk

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4
Q

The 5 Breastfeeding Positions

A

laidback, football, cross-cradle, cradling, side-lying

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5
Q

Descriptors of a correct latch-on position

A
  • firm tugging but no pinching/pain
  • cheeks are rounded not dimpled
  • jaw glides smoothly w/ sucking
    -swallowing is audible “ca”
  • baby cannot be easily removed from breast
  • nipple is not distorted when baby releases it
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6
Q

How to break suction during breastfeeding

A

insert finger into the side of the baby’s mouth, keep it there until nipple fully released

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7
Q

Baby is fed based on ________

A

demand

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8
Q

Ideal time to begin brestfeeding

A

within the first hour of breastfeeding when newborn is in a quiet and alert state

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9
Q

Cultural considerations for breastfeeding

A

some cultures do not give colostrum and only feed when the milk comes in

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10
Q

What causes sore nipples?

A

poor latch & ineffective suck

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11
Q

What reccomendations can the nurse give for sore nipples?

A

-break suction properly, reposition
- rub breastmilk on nipple after feed
- encourage air drying after a feed
- change nursing bads
- avoud tight bras

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12
Q

What causes engorgement of breasts?

A

occurs 2-6 days PP, when milk production is increased

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13
Q

What does breast engorgement feel/look like?

A

hard breasts, throbbing, flattening of nipples

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14
Q

What can nurses recommend for engorgement?

A

feed frequently
soften breasts with warm compress, shower, hand expression

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15
Q

what causes plugged ducts?

A

engorgement

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16
Q

what do plugged ducts feel like?

A

sore tender lumps

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17
Q

What can nurses recommend for plugged ducts?

A

massage lump before/during feeding
feed on unaffected side first
ensure complete emptying

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18
Q

What are the symptoms of mastitis?

A

fever
tachy
chills
malaise
headache
enlarged axillary nodes

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19
Q

when does mastitis typically occur?

A

2-3 weeks PP

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20
Q

What can help with mastitis?

A

breastfeed 2-3 hours exlcusively
warm compress + massage breasts
antibiotics + antipyuretics

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21
Q

What is parental-infant attachment affectde by?

A

support
parental expectations
newborn behaviours
competing demands
family dynamics
emotional/mental health

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22
Q

How can nurses assess attachment behaviors?

A

-do Ps reach out for baby + call by name
-identification, who it looks like, what makes it special
- change positions w/ ease
- stimulation: do they talk to baby? look at baby?
- comfortability in caring for baby
-concern/disgust changing diapers
- what ways do they show affection?
- comforting techniques used

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23
Q

What factors influence people to bottle feed?

A
  • lack of support for breastfeeding
  • multiple births
  • difficulty establishing brestfeeding (physiological, unadddressed)
  • lack of interest / discomfort
  • maternal medication use / illness
  • myths
  • cultural factors
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24
Q

Effects of overdilution of formula?

A

inadequate nutrients & calories

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25
Q

Effects of under-dilution?

A

hypernatremia- strains kidneys

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26
Q

temperature of bottle-feeds?

A

room-temp, warm

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27
Q

What supplement is not needed for baby’s being bottle-fed for the first 6 mo?

A

Vitamin D

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28
Q

What things should not be given to bottle-fed baby?

A

honey
corn-syrup
alternate milk sources

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29
Q

Can formula be micorwaved?

A

No

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30
Q

can you feed baby with remainder of formula in a bottle at a later time?

A

no, saliva is mixed in now

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31
Q

How are bottles cleaned?

A

hoat + soapy water

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32
Q

Bottle Feeding Considerations

A
  • Cost (is formula diluted d/t costs)
  • sterilization (clean water, time, storage?)
  • comprehension of formula prep (following instructions)
  • comprehension of feeding techniques (holding bottle, minimal air in nipple)
  • misconceptions (cannot work + breastfeed)
  • cultural (modern practice, partner has no input if baby is breastfed)
  • Nurse: support, nonjudgmental care, respect their decision
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33
Q

What is the BUBBLLEE acoronym for ongoing PP physical assessment?

A

B: breasts firmness + nipple
U: uterine fundus (location, consistency)
B: bladder function (amt, frequency)
B: bowel function (gas, bowel movements)
L: lochia (amt and colour)
L: legs (peripheral edema)
E; Epistomy/Laceration/C-section (discomfort, condition)
E: emotional status (mood, fatigue)

34
Q

PA: Expected Findings of Uterus

A

loose floppy skin - abdomen
uterus firm, contracting (not boggy) [AE: retained placental fragments]
midline of abdomen [AE: full bladder-can’t contract]
afterpains resolve in 3-7 days

35
Q

PA: Abnormal Findings of Uterus

A

uterine atony–> PP hemorrhage
distended abdomen
hypoactive bowel sounds
red, tender, dehiscing incision

36
Q

When does involution begin?

A

immediately after delivery

37
Q

How long does it take for uterus to return to normal position?

A

6 weeks

38
Q

How long does it take for palcental site to heal?

A

6 weeks

39
Q

When does cervix close?

A

4 weeks

40
Q

When does abdomina tone return to pre-pregnant state?

A

6 weeks

41
Q

Abdomen Inspection:

A

distention
incision line infection
dehiscing

42
Q

Abdomen Auscultation:

A

all 4 bowels checked for sounds

43
Q

Abdomen Palpation:

A

uterine descent in relation to umbicillis
firmness
midline position

44
Q

Abdomen Percussion:

A

drum like, suggests gas

45
Q

PA: Vagina Expected Findings

A
  • return to normal 6-8 weeks
    -changes in rugae
    -dryness until ovulation
  • edema
  • clean incision/tear
    -hemmoroids
46
Q

PA: Vagina Abnormal Findings

A

redness
drainage
skin not approximated
hematoma
tenderness
echymosis (bruises)

47
Q

Health Education for Vagina Care

A
  • ice pack for first 24 hrs (20 mins on, 2o mins off), warm bath
  • witch hazel pads
    -hydration
    -stool softners
  • assess pain, discomfort
48
Q

PA: Bleeding Expeceted Findings

A
  • should not smell foul
    1: Lochia Rubra (3-4 days)
    bright red / rust, some decidual debris
    2: lochia serosa (2-4 w)
    pink/brown, old blood/serum/leukocytes/debris
    3: Lochia Alba (4-6w)
    whitish/yellow, mucus/serum/leukocytes, epthelial cells , bacteria
49
Q

PA: Signs of PPH

A

soaking pads 1-2 hrs
clots> golf ball
SOB
lightheadedness
chest pain, palpitation

50
Q

What amount of blood loss indicated PPH?

A
  • 500mL < (vaginal birth)
  • 1000 mL < (c-section)
51
Q

Causes/Risk Factor of PPH

A

Uterine Atony
Tissue
Trauma
Thrombin

52
Q

What causes uterine atony?

A
  • overdistended uterien (large fetus, multiple fetus, hydramnios, clots)
    -anesthesia, analgesia
  • hx
  • high parity
  • prolonged labor, oxytocin induced
  • magnesium sulphate
  • chorioamnionitis
    -uterine subinvolution
    obesity
53
Q

How can tissue cause PPH?

A

retained placental fragments
placenta accreta, increta, percata
placental abruption
placenta previa

54
Q

How can trauma cause PPH?

A

lacerations of birth canal
forcep/vaccum assited birth
c-section
ruptured uterus
inversion of uterus
manuak removal of retained placenta

55
Q

How can thrombin cause PPH?

A

coagulation disorder

56
Q

How is Primary PPH classifed?

A

within 24 hours of birth
- uterine atony
- gental laceration
- retained products of conception
- placenta accreta/incerta
-uterune rupture
- uterine inversion
- DIC

57
Q

How is Secondary PPH classifed?

A

more than 24 hrs after birth BUT less than 12 weeks
- subinvolution of uterus
-retained products of conception
- infection
- DIC

58
Q

NC: PPH, Goal of Care

A

management of hypovolemic shock, restore circulating blood volume, elimnate cause of hemorrhage

59
Q

NC: PPH, interventions

A

2 Venous access w/ catheter
- fluid recuscitation
- adminsiter crystalloids (lactated ringer+ saline)
- colloids (albumin)
- blood + blodo components
packed RBC (if actively bleeding w/ no improvement)
infusion of fresh frozen plasma if clotting factors + plts are below normal

60
Q

NC: PPH, Nursing Assessment

A

Plapate pulses, BP, O2
skin: colour, temp, turgor
LOC
heart sounds/murmurs
breath sounds
anxiety, disorientation, apprehension, restlessness
Urinary output
Bleeding

61
Q

NC: PPH, Nursing Interventions

A

CBC
IV -tocolytics
medications to relax uterus- uterotonics
medications to contract uterus

62
Q

PA: Bladder & Bowels Expected Findings Post Deilvery

A
  • voiding occurs within first 6 hours
  • attempt to empty bladder after 2 hrs
  • potential for bladder distension d/t normal post-partum diuresis
  • epidural: urinary retention potential
  • good bowel sounds, pass gas
63
Q

Nursing Considerations: Bladder & Bowels

A
  • enourage voiding, assess ability to void, regular voiding (360cc/12hrs)
  • encourage pat dry front to back
  • encourage kegel/pelvic muscle exercise
  • encourage ambulation
  • encourage adequate fluid/food intake
  • stool softners may be needed
64
Q

Signs of Poor Maternal Emotional Status

A
  • can’t discuss labour/birth experience
  • feels ugly/useless
  • preoccupied with body image
  • depressed
  • lacks support system
  • partner/family reacts negatively to baby
    -refuses to interact/care for baby
  • disappointment over baby’s sex
  • sees baby as messy/unattractive
  • baby reminds them of people they don’t like
    -difficulty sleeping
  • loss of appetite
65
Q

What are things the nurse should promote as a part of PP care?

A

1:rest (pp fatigue
2:ambulation (orthostatic hypotension, prevent falls, prevent venous thromboembolism)
3:exercise
4:nfection (precuations, perineal care, HH)
5: comfort (non-pharmacolgical + pharmacological interventions)
6: nutrition (1800-2200 calories, 350-400 + for lactating women)
7: normal bladder + bowel function
8: breastfeeding (skin-skin)
9: rubella vaccination (if pt not immune)
10: Rh isoimmunization: within 72hrs after birth

66
Q

How long after delivery should a maternal identity be established?

A

4 months

67
Q

What are S/S of Postpartum Blues

A

mood swings
crying spells
feeling low
fatigue
frustration
anxiety
emotional
confused
muddled thinking

68
Q

When & Why do Pastpartum Blues occur?

A

1-5 days PP, resolves in 2 weeks
Due to hormonal changes, stress, role transition, challenges with breastfeeding

69
Q

How can nurses care for patients with PP Blues?

A

validation
reassurance
education

70
Q

Affects of Perinatal Mood Disorders?

A

stress for pateient
disrupts famiyl life
affects couple relationship
parental infant attachment
quality of parenting
social, mental, behavioural development of kids

71
Q

Who is at higher risk of developing PPD?

A

indigenous
Black
Adolescents

72
Q

What is Perinatal Depression?

A

intense sadness, severe moodswings > 2 weeks
irritability
detachment towards baby
guilt, shame, stigma
reluctant to discuss feelings
obsessive thoughts about harming infant
reluctant to seek help
loneliness, lack of emotional support

73
Q

What SSRIs can be given for Perinatal depression?

A

sertraline
citalopram
escotalopram

74
Q

What is Postpartum Psychosis?

A

rare
elevated energy levels, cognition, mood (mania)
depression (hallucinations, delusions, self harm, infant harm)

75
Q

Patient Teaching: Perinatal Mood Disorders

A

relax for 15 mins a day (meditation, hot bath)
good diet
exercise (30 mins a day)
sleep as much as possible
get out of the house
don’t overcommit
ask for help
support group
talk to people

76
Q

PMD Screening & Score

A

EDPH (edinburg post-natal depression scale)
PDSS (postpartum depression screening scale)

scores higher than 10/30 = possible depression, need assessment

77
Q

What is Perinatal Loss & Grief

A

feelings related to maternal death, neonatal/fetal death, child with complex condition

78
Q

Grief Response: Phase 1

A

Shock and Numbness

  • unreality, loss of innocence, powerless, disbelief, denial
  • devastation, depression, intense outburst, can’t concentrate or make decisions
79
Q

Grief Response: Phase 2

A

searching & yearning

  • lonliness, empty, yearning
    -guilt
  • anger, resentment, bitterness, irritability
80
Q

Grief Response: Phase 3

A

disorientation

  • deep sadness, depression
  • insomnia, social withdrawal, lack of energy
81
Q

Grief Response: Phase 4

A

Re-orginization + Resolution

  • self-esteem + confidence
    -can cope with challenges
  • placed loss in perspective

SEM 1 (11 decks)

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