CHAPTER 27 - CARE OF THE MOTHER AND NEWBORN Flashcards


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1

Uterus

Immediately after birth: fundus between symphysis pubis and umbilicus
12 - 48 hrs - fundus rise to umbilicus
1 week: - fundus descent to symphysis pubis
Within 6 weeks - return to pre pregnant position

2

To decrease bleeding + increase tone + involution

Massage fundus over pubic bones

3

Lokia

Ruba (bright red) 1-2 days
Serosa (pink-brown) up to 7 days
Alba (white) 10-14 days

4

Hypovolemic shock

Light headed, funny feeling. Skin cool, clammy, skin ashen/gray, pulse increase, BP decrease

5

Treatment for hypovolemic shock

If uterus atonic - massage
Turn to side, elevate hip & legs 30 degrees
Monitor VS
O2 8-10 mL/min

6

Cervix injuries

Hasty attempt to enlarge fetal head artificially or delivery baby before fully dilated

7

Perineum injury

Hematoma. Vagina is thin,dry.
Perineum - edema, bruising
Episiotomy - free of bruising,erythma. Edges are well approximated

8

Perineum lacerations

First degree- extend skin + superficial structure
Second degree-extend to muscles
Third degree-extend to splincter muscle
Fourth degree-extend to anterior rectal wall

9

Stimulation of nipples (infant sucking)

causes release of oxytocin + contraction of the mamalry ducts = milk ejection
sucking stimuli->hypothalamus->anterior pituitary gland->milk production/let down reflex

10

Cardiovascular changes after birth

Blood volume reduced to normal 2-4 weeks.
Diuresis, diaphoresis, blood loss in delivery.

11

Cardiac output declines rapidly after birth

Risk for thrombus due to high platelets in postpartum period

12

Changes in urinary system

Trauma in delivery with possible edema of bladder, urethra, meatus with decreased urge to void

13

Postpartum headache causes

Hypertention, stress,LEAKAGE OF CSF

14

Gastrointestinal changes

Appetite return to normal. Constipation. Normal bowel elimination return 2-3 days. Decreased abdominal tone + tenderness = reluctant to strain for bowel movement.
NI: Fluid, bulk in diet

15

Endocrine changes

Estrogen + progesterone levels drop after delivery of placenta.
Decreased estrogen = breast engorgement+diuresis of excess fluid
Prolactin is secreted only with nipple stimulation

16

Auto lysis

Occurs as result of withdrawal of estrogen+progesterione

17

Lochia

Rubra: bright red - first 24-48 hrs
Serosa: pink to brown - until 7th day
Alba: yellow to white - continues for 2 wks

18

Musculoskeletal changes

Abominal muscle tone + joint stabililize 6-8 wks
Some pelvic joints may never return to pre-pregnant position
Joints discomfort after delivery = hormone relaxin
Permanent increase in shoe size

19

Integument change

Hyperpigmentation gradually disappear
Hair + nail growth return to normal
Striae may not fade complete -> silver/gray
Diaphrosis at night after first week postpardum

20

Postpartum Maternal Danger

Fever without chills
Malodorous vaginal discharge
Bright red vaginal bleeding after it has turn pink or rust
Edema or painful area on legs
Pain/burning sensation with urination or inability to void
Breast changes (localized pain, heat, edema or malodorous drainage

21

Attachment behaviors 27-4 27-5

...

22

Mother nutritional and metabolic needs

Recovery stage:
Hunger. Fluid replacement. Bowel sounds before solid food given. Oral hygiene. Complete sponge bath.
Later postpardum: Prepregnant weight 6-8 wks ( if did not gain excessive in pregnancy). Well balance diet (non lactating mother). Increase 300-500 cal/day, fluid 2-3 L/day (lactating mother)

23

Hygiene

Excessive perspiration + slight odor discharge is common.
Regular bath encouraged. Sitz bath to reduce discomfort+promote healing of perneum

24

Bladder elimination

Recovery stage: Diuresis + diaphoresis are common. Palpate bladder for fullness = interfere with complete contraction of uterus + hemorrhage. Initial voiding within 4-6 hrs. Encourage voiding Q 2-4 hrs. Monitor for retention (voiding scant amount). Indwelling catheter may be remain for 2 days after cesarean. Review proper cleansing technique.

25

Bowel elimination

Ideally before discharge. Bowel peristalsis may be slow. MD order for bulk enhancers/stool softener. Suppository to promote bowel evacuation. Bulk, fiber + fluid intake in diet

26

Activity + exercise (1-4 hrs after delivery of placenta)

VS Q 15 min for 2 hrs during recovery stage (or Q15X1, Q30X1, Q hourX4)
Immediately after birth - bed rest to allow body to adjust to fluid volume changes
Nurse will decide when to ambulate (dangle/help to sit up for the first time)

27

Anesthesia patient

Bed rest until she can move legs fully + BP/pulse are within normal limits

28

Cardiovascular postpardum

VS stable within 2 hrs. Temperature >104 2 successive days during the first 10 days=infection.
Bradycardia may persist up to 10 days after delivery. Elevated/decreased BP should be reported

29

Lochia flow suddenly when patient gets out of bed

due to secretions that pool in the vagina drain out of the body when the woman stands

30

Rest & Sleep

Not to be disturbed unless necessary. Take naps during the day to compensate for lost sleep ( if breast feeding)

31

Sex + Reproductive

Fundus + lochia check Q 15 first 2 hrs
Fundus should be contracted + firm, at midline to prevent bleeding
Full bladder can displace fundus+prevent contraction of uterus.

32

On palpation of uterus, observe lochia

Uterus contracted: small - moderate
Tone is poor : increase amount

33

Engorgement

Discomfort when milk supple initally comes in
Result of venous + lymphatic stasis during lactation
Filling of the breast with milk at axillary regions
Seen on third day postpardum and resolves in 48 hrs

34

Breast pospartum

Nipples inspected for inflammation,fissures, or tenderness
Nipples should be solf/supple ( if breast feeding)
Modifications in positioning of baby if tender/cracked nipples a problem
Assist breast feeding mother in establishing lactation

35

Benefits of breast feeding 27-10

Protection against infection
Nutrition, growth, development - reduce incidence of allergy
Maternal benefits: quicker involution, economical

36

Perineum status

If an episiotomy was performed, tissue may appear edematous
MD order Tucks or Nupercainal ointment

37

Hemorroids

disappear after delivery
Topical anesthetics or sitz bath provide reliefs

38

Homan's sign

Early ambulation to prevent inflammation of blood vessles of the leg = thrombophlebitis

39

Coping + stress tolerance

Overwhelmed by responsibility of motherhood.
Intimidated by nurse capability + skill
Felt inept + not wish to ask questions
Establish rapport is essential, listen for fear + anxiety
Monitor for postpardum blues

40

Taking in stage

New mother may be passive first day or two, needs supportive care

41

NDx for postpardum mother

Risk for deficient fluid volume
Risk for infection
Impaired urinary elimination
Constipation
Nutrition: less than body requirements
Acute pain
Impaired tissue integrity
Disturbed sleep pattern
Deficient knowledge
Anxiety
Interrupted family process
Impaired parenting
Situation low self esteem

42

Physiology of normal newborn

Airway is first priority. Suction immediately at birth

43

Vital sign of normal newborn

Respiration: 30-60
Pulse: 120-160
BP: 60-80/40-50
Axillary: 97.6 - 98.6
O2 Sat: 90%

44

Newborn body size + shape

Head is disproportionately to body. Abdomen is prominent with smaller chest, narrow hips.
Weight: 3400 g(7 lbs 8 oz)
Length: 20 inches (50cm)
Head circumference: 13-14 inches (33-35.5 cm)

45

Jaundice: bile pigments (icterus neonatorum)

After 24 hrs: physiologic peaks day 3 due to destruction of RBC
Within first 24 hrs: pathological due to RH incompatabilities

46

Newborn skin

Acrocyanosis - hands+feets for 7-10 days or when infant is cold
Petechia: pressure at birth

47

Newborn rash

erythema toxicum - disappear without treatment

48

Telangietatic nevi

stork bites (back of neck) due to dilated capillaries. Disappear in 1-2 yrs

49

Mongolian spots

Increased pigmentation (buttocks) seen more in darker skinned people

50

Nevus flammeous

port wine stain due to capillary angioma below the epidermis - may require surgery

51

Capillary hemangiomas

strawberry birth mark. Increase in size for several months then shrink + disappeared early childhood

52

Newborn skin assessment

Vernix caseosa: yellowish/white cream cheese like covering skin at birth
Lanugo: downy, fine hair
Good turgor + tissue elasticity

53

Newborn head

Fontanels papatable. May have molding.

54

Caput succedaneum

Edema in soft tissue of scalp. CROSS SUTURE LINES. Disappear without treatment

55

Cephalhematoma

bleeding within the periosteum. DOES NOT CROSS SUTURE LINES, result of difficult labor. Large hematomas may lead to anemia + jaundice

56

New born face

Chin receding. Cheeks are full, round. Oral cavity intact, closed palate.

57

Epstein pearl

small white nodules on newborn lips - epithelial cells. Disappear within few weeks

58

New born eyes + ears

Eyelids edematous. Strabismus + nystagmus. Nearsighted ( 8-10 inches)
Ears: upper insertion of penna should be even with outer canthus of eye

59

Newborn umbilical cord

Whitish blue-gray with 3 vessles. May contain gelatinous tissue (Wharton jelly)

60

Reflexes 25-7

...

61

Newborn genitals

Female: edematous, may have discharge or blood tinged mucus
Preterm female: labia majora does not cover labia minora and clitoris
Scrotum may be enlarged, edematous (hydrocele)
Penis should be inspected for urethral meatus
Preterm male: cryptorchidism

62

Newborn spine

Straight without curves

63

Newborn extremities

Arms + hands are flexed against the body. Both arms move evenly
Legs should have same length, move freely
Hands + feet should be assessed for syndactyly or polydactyly

64

State law required tests

phynylketonuria (PKU), maple sugar urine disease, glactosemia, hypothyroidism

65

Newborn nutrition + metabolic needs

120 cal/kg/day
Breast milk + formulas balance to meet the needs
Fluid: 140-160 mL/kg/day
Frequency of feeding depend on type of feeding
Adequate intake: 6-8 wet diapers a day

66

Hypothermia

Normal axillary (97.6-98.6). Limited adipose tissue
Radiation: body to cooler surface (not in contact)
Evaporation: water convert to vapor
Conduction: body to cooler surface ( direct contact)
Convection: cooler air currents

67

Newborn hygiene

Body temperature must be stabilized before bathing, then check after.
Bathing: cleansing, observation of infant's condition, comfort, family socializtion
Gather supplies first. Water at 100 degrees. Do not remove Vernix(stay on for 48 hrs).Delay tub bath until cord falls off

68

Hygiene of umbilical and circumcision

Avoid getting cord wet. Use alcohol to promote drying + inhibit bacteria growth
Keep circumcision clean + assess for bleeding. Sterile petroleum gauze applied

69

Newborn elimination

Void within first 24 hrs. Void small amount of poorly concentrated urine.
Bowel elimination first 24 hrs. Meconium: odorless, black-green color, sticky.Stool changes to loose+greenish after taking in nourishment.
Breast fed babies has more frequent stool (pale yellow + sweet smelling)
Skin on perineum + buttocks need to be cleanse from waste, wiping from front to back

70

Newborn rest + sleep

Sleep: 16-20 hrs/day
Most infants do not exceed 5 continuous hours of sleep = disruptive to mother's sleep

71

Newborn Respiratory

Maintain airway is critical. Suctioning is required to remove mucus from nose + mouth. INFANTS ARE OBLIGATED NOSE BREATHERS. Crying is newborn's mean of communication (hunger, pain or attention)

72

Parent-child attachment

Initial phase: strong attraction / desire to interact
Early contact with infant is important to establish bonding.
Encourage early+frequent interaction between newborn and parents