Newborn and Postpartum
Terms
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- Lochia
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-Rubra: First 3 days after child birth, blood
-Serosa: Fourth day lochia changes to pink or brown-tinged
-Alba: white or cream colored by the 11th day may persist to the 6th week after childbirth - Lochia Amount
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-Scant: les than 1 inch stain on pad
-Light: 1 - 4 inch stain
-Moderate: 4 - 6 inch stain
-Large: Saturated peripad in 1 hour
-Excessive: saturated pad in 15 minutes
-A constant trickle of lochia indicates excessive bleeding and requires immediate attention
-Foul odor can suggest endometrial infection - Perineal Assessment
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-REEDA
-R: redness
-E: edema
-E: ecchymosis (bruising)
-D: discharge
-A: approximation (should be closed as if they were stuck or glued together) - Fundal Height
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-Immediately following delivery the fundus can be found midway between the symphysis pubis and the umbilicus
-Then the fundus rises to the level of the umbilicus and remains at this level for 24 hours
-After 24 hours the fundus begins to desend by approximately 1cm, or 1 fingerbreadth oer day
-By 10th day it is back in the pelvic cavity - Postpartum Vital Signs
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-HR: 50-60 is normal as large amounts of blood return to the maternal circulation after the placenta is born
-B/P: hypotension may indicate a hemorrhage
-Resp: 16-20
-Temp: 100.4 is common during the first 24 hours after birth - Newborn Vital Signs
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-Temp:
*Axillary: 97.7 - 99.5
*Rectal: 97.7 - 99.7
-HR: 120-160
-Resp: 30-60
-BG: 40-45 - Newborn Measurments
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-Weight: 2500-4000g
-Length: 48-53cm
-Head Cir: 33-35.5cm
-Chest Cir: 30.5-33cm - Signs of Delayed Bonding
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-Using negative terms to describe infant
-Discussing infant in impersonal or technical ways
-Failing to give the infant a name or to use name
-Visiting or calling infrequently or not at all
-Decreasing number & length of visits
-Showing interest in other infants
-Refusing offers to hold and learn to care for infant
-Showing decrease in or lack of eye contact - Mastitis
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-A painful infection of the breast usually caused by the entry of germs, often from the baby's mouth, into a milk duct through a crack or fissure in the nipple.
-Symptoms include fever, soreness, and swelling. It occurs in about one in 20 breastfeeding mothers at some time during lactation, most commonly between the tenth and 28th days postnatally. - Breast Feeding
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-Latch within the first 2hrs of birth
-Offer breast every 2-3hrs
-Feed 20min or longer ea side
-Position: football, cross, cradle, side lying
-Stimulate baby's lower lip
-Support baby's head
-Listen for swallows
-Avoid artificial nipples
-Avoid formula or glucose H2O
-Offer encouragement
-Est. care plan if problems
*begin pumping as soon as problem arises
-Not wanting to breast feed:
*do not take hot showers
*No stimulation of breasts
-Tight fitting bras - S/S Mastitis
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-Temp up to 40c
-Hard irregular warm red spot on breasts
-Pain in breasts
-Feel like flu-like symptoms - Avoiding Mastitis
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-Alternating breasts
-Allow breasts to air dry
-Avoid soap or alcohol
-Proper positioning of baby
-Avoid stasis with warm soaks, freq feedings - Rh problems
- -Only an issue for Rh "-" the mom gets RhoGam at 28wks and again at discharge
- Nutritional Needs of Lactating Mother
- -Calories: 2700 (500 more calories than were being consumed before pregnancy)
- Blood Loss
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-Vaginal Birth: 500-700cc
-C-section: 1000cc - Twins
- -Increase risk for post partum hemorrhage
- Subinvolution
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-The failure of the uterus to shrink according to normal progressio
-Caused by retained fragments or infection
-S/S:
*fundus that does not shrink 1cm per day
*Lochia that deviates from rubia-serosa-alba, varies in amount
*Uterine ternderness, heaviness, backache - Involution
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-Retrogressive changes that return the reproductive organs, particularly the uterus to their pre-pregnancy
size and condition - Hematoma
- -Assess for hematoma if pt is complaining of pain in the perineal area
- Baby not breathing
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-Turning blue
-Lower head and stimulate baby to cry - Meconium Aspiration
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-May be caused by:
*hypoxia creating a relaxation of the anal sphincter
*Vagal stimulation possible from cord compression
*GI motility, normal for the term or post term infant
*>38wks, decreased amniotic fluid, increased cord compression
-Can cause pneumonia, asphyxia, pneumothorax, distress - Vernix
- Thick white protectant over skin
- Lanugo
- -Fine hair
- Cephalhematoma
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-Does not cross suture line
-Check for jaundice
-Does not appear until 24 - 48 hours after birth
-Gone within a few weeks - Caput Succedaneum
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-Edema that does cross the suture line
-Swelling due to labor process - Mongolian Spots
- -On butt, looks like bruises
- Thermoregulation
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-If baby's temp goes below 97F put under warmer
-Top priority for cold stress - Bilirubin
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-With the breakdown of RBCs, bilirubin is an usuable byproduct that needs to be excreted
-It can be toxic at high levels
-It is fat soluble so it can be absorbed by the subcut fat
-Causing yellowish discoloration - Physiologic Jaundice
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-Occurs when bilirubin reaches 5-7
-Never present during the first 24 hours of life
-Appears on the second or third day
-Nomral in newborns
-Levels begin to fall about a week after birth
-Photo therapy may be used - Pathologic Jaundice
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-Occurs during the first 24 hours of life
-a bilirubin level above 1 or a total bilirubin concentration that increases by more than 5 per day or is higher than 12 or persists after the second week
-Due to abnormalities causing excessive destruction of RBCs
-Can be due to incompatible blood (mother's/infant's), infection, metabolic disorders - Downs Syndrome
- Trisomial 21
- Addicted Newborn
- -Will have trouble feeding
- Stool
- -The breast fed infant usually has more frequent stools than the formula feed baby
- Tetralogy of Fallot
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-Large ventricular septal defect (VSD - hole in the wall separating the right and left ventricles)
-Pulmonary stenosis (obstructed blood flow to the lungs). - Postpartum Assessment
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-BUBBLE HE
-B: breasts
-U: uterus
-B: bladder
-B: bowel
-L: lochia
-E: episiotomy
-H: homan's Sign
-E: emotional support - Reflexes
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-Moro: allow the head and trunk of newborn to fall backward (arms and legs should extend and abduct
-Palmer grasp: when infant's hand is touched at the base of the fingers the hand should close into a tight fist
-Plantar grasp: same as above except on the feet
-Babinski: stroking the sole of the infant's foot causing the toes to flare
-Rooting: when infant's check is touched near the mouth the head turns toward that side
-Sucking: when the mouth or palate is touched the infant should begin to suck
-Tonic neck: arm and leg should extend on the side of the body in which the head is turned (fencing reflex)
-Stepping: when infant is held upright w/their feet touching a hard surface they should lift one foot then the other as if they were walking - Umbilical Cord Care
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-Cord should be checked for bleeding or oozing
-Cord clamp should be securely fastened
-Parents should clean the cord with alcohol at least 3 times daily
-Fold the diaper below the cord
-Clamp can be removed 24hrs after birth if cord is dry - Umbilical Cord Process
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-It becomes brownish black within 2-3 days
-Falls off within app. 10-14 days after birth - Signs of neonatal hypoglycemia
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-Jitteriness
-Poor muscle tone
-Diaphoresis
-Poor suck
-Tachypnea
-Dyspnea
-Cyanosis
-Apnea
-Low temp
-High-pitched cry
-Irritability
-Lethargy
-Seizures, coma
-Some infants may be asymptomatic - Respiratory Distress Syndrome
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-Increases w/decreased gestational age, multiple gestation and uncontrolled DM
-A deficiency of surfactant production
-Surfactant keeps the aveoli surface tension down to prevent aveoli from collapsing at the end of expiration - -Signs of Respiratory Distress
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-Tachypnea > 60
-Retractions:
*sternal
*substernal
*suprasternal
*intercostal
-Flaring of the nares
-Cyanosis: generalized
-Grunting: end expiratory pressure against a closed glottis
-Seesaw respiration
-Decreased breath sounds
-Crackles - Acrocyanosis
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-Bluish discoloration of the hands and feet due to reduced peripheral circulation
-Normal in the newly born infant
-Should go away after the first couple of hours of life to 1-2 days after birth - Erythromycin Eye Ointment
- -Prophylaxis against gonorrhoeae and chlamydia
- Teratogenic
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-Any substance or agent that is capable of interfering with normal embryonic development and can produce non-heritable birth defects. Tetragenic substances are most often radiation or chemicals
-drugs given to the mother that can cross the placental barrier to the unborn child. They are caplable of interfering with the development of the fetus, causing birth defects. - Newborn Test
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-Heel stick for:
*B/G
*PKU (phenal ketone uria)
*bilirubin test
*Coomb's test
-Auditory test - Breast Fed Infant's Stool
- -Yellow, gold, soft and mushy
- Formula Fed Infant's Stool
- -Pale yellow, formed, pasty
- Alveolar Development
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-Occurs 24-28wks
-Betamethasone can help to mature lungs prior to delivery