Newborn and Postpartum

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Lochia: -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: -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: -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: -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: -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: -Temp:
*Axillary: 97.7 - 99.5
*Rectal: 97.7 - 99.7
-HR: 120-160
-Resp: 30-60
-BG: 40-45
Newborn Measurments: -Weight: 2500-4000g
-Length: 48-53cm
-Head Cir: 33-35.5cm
-Chest Cir: 30.5-33cm
Signs of Delayed Bonding: -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: -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: -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: -Temp up to 40c
-Hard irregular warm red spot on breasts
-Pain in breasts
-Feel like flu-like symptoms
Avoiding Mastitis: -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: -Vaginal Birth: 500-700cc
-C-section: 1000cc
Twins: -Increase risk for post partum hemorrhage
Subinvolution: -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: -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: -Turning blue
-Lower head and stimulate baby to cry
Meconium Aspiration: -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: -Does not cross suture line
-Check for jaundice
-Does not appear until 24 - 48 hours after birth
-Gone within a few weeks
Caput Succedaneum: -Edema that does cross the suture line
-Swelling due to labor process
Mongolian Spots: -On butt, looks like bruises
Thermoregulation: -If baby's temp goes below 97F put under warmer
-Top priority for cold stress
Bilirubin: -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: -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: -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: -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: -BUBBLE HE
-B: breasts
-U: uterus
-B: bladder
-B: bowel
-L: lochia
-E: episiotomy

-H: homan's Sign
-E: emotional support
Reflexes: -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: -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: -It becomes brownish black within 2-3 days
-Falls off within app. 10-14 days after birth
Signs of neonatal hypoglycemia: -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: -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: -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: -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: -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: -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: -Occurs 24-28wks
-Betamethasone can help to mature lungs prior to delivery

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