M/B 3

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  1. Puerperium
    • another name for postpartum period
    • birth to 6 weeks
  2. Involution
    Uterus, and other reproductive organs, returning to prepregnant state
  3. Postpartum assessment of uterus- 
    how often
    what should it feel like, where
    abnormal findings
    • Check q 15 min, should be firm and at umbilicus
    • High and soft fundus suggests bleeding
    • High and deviated to side suggests distended bladder.
  4. postpartum palpation of uterus:
    • If uterus is large, soft or boggy, massage and crede
    • Support uterus with lower hand to prevent prolapsing or inverting the uterus
    • *If uterus is soft, she will hemorrage
  5. RhoGam: Indications
    • If mother if Rh negative and baby is RH positive, AS LONG AS MOM ISN'T SENSITIZED 
    • Give within 72 hrs of birth
  6. Rubella Vaccine: Indications and contraindications
    • Given if not immune AFTER delivery
    • Contra:
    • Don't give while still pregnant because it's a live vaccine. Need to check if allergic to neomycin
    • *Don't give Rhogam as antibodies for Rubella will be suppressed
  7. Hep B for baby: Indications and contraindications
    • 3 shot series, need first at birth
    • prevents liver disease and cancer associated with Hep B
    • Contra: hypersensitivity reaction to first shot, or if birth wt is less than 2500 grams
  8. TDAP: Indications and contraindications
    • babies can't get vaccinated and start building protection against whooping cough until they are two months old.
    • can avoid gap in protection by getting the whooping cough vaccine (called Tdap) during the third trimester
    • Conta: allergic reaction
  9. Early postpartum period: 
    VS- B/P
    • *Hemorrhage is worry
    • B/P should return to pre labor within 6 hrs
    • Report if greater than 140/90 (worried about preeclampsia) or less than 100 mg systolic
    • Falling B/P, check for shock
  10. Early postpartum period: 
    VS - RR
    • Should be within normal range
    • if <16 may be due to analgesic or anesthesia
    • if > 24, may signal infection, pain, excess blood loss or compromise due to pulmonary emboli or edema
  11. Early postpartum period: 
    VS - Temp
    • Initial temp to 38 (100.4) due to exertion or dehydration
    • After 24 hrs temp > 38 (100.4) = infection
  12. Postpartum hemorrhage & causes
    • #1 killer of women worldwide
    • Blood loss >500 for vag birth, >1000 ml for C/S
    • Causes include uterine atony, lacerations, or retained placenta
  13. Uterine atony
    Uterus does not contract
  14. S/S of postpartum hemorrhage
    • Soft boggy uterus
    • Saturation of pad within 30 mins
    • Bleeding is slow & steady or sudden & massive
    • Blood clots may be present
    • Pale color and clammy skin
    • Anxiety and confusion
    • Tachycardia
    • Hypotension
  15. Risks for postpartum hemorrhage
    • History of uterine atony
    • More than 4 children
    • Closely spaced pregnancies
    • Uterine distention
    • Prolonged, difficult, or induced labor
    • Precipitous labor
    • PIH c magnesium
    • General anesthesia
    • Retained placenta fragments
    • Full Bladder
  16. What can cause uterine distention?
    • Macrosomia (large baby)
    • polyhydramnios
    • multiple gestation
    • Uterine myomas (tumors)
  17. What actions are taken to stop hemorrhage
    • #1 priority is massage the uterus!! Bilateral compression of uterus
    • Iv to reduce risk of hypovolemia
    • Blood if needed
    • Platelet and fibrinogen replacement
    • Uterine tamponade
    • Hysterectomy if all else fails. 
    • *If bleeding excessively and uterus firm, look for lacterations
  18. Uterine tamponade
    • done with a balloon inserted into uterus
    • blown up to apply pressure from inside
  19. What medications can be used for hemorrhage
    • Oxytocin
    • Methergine
    • hemabate (can cause explosive diarrhea)
    • Cytotec

    Off label: misoprostol, however contraindicated if HTN
  20. Risk factors for UTI postparteum
    • epidural anesthesia
    • urinary stasis
    • multiple catheterizations
    • operative deliveries and frequent SVE
    • neonatal macrosomia (more traumatic delivery)
  21. SVE
    sterile vaginal exam
  22. S/S of UTI postparteum
    • pain 
    • burning on urination
    • frequency 
    • may have gever and superpubic pain
  23. Tx options for UTI postparteum
    • antibiotics
    • cranberry 
    • plum or apricot juice (helps cause it's acidic)
  24. Risk factors for postpartum deep vein thrombosis
    • Due to hypercoagulable state
    • Usually in first 3 days

    *DVT more likely to result in emboli- PE #1 cause of maternal mortality
  25. S/S of postpartum DVT
    • leg pain with walking
    • leg edema
    • calf tenderness
    • Positive homans sign
  26. What prevention measures can nurse take for postpartum DVT
    What implications for future pregnancies?
    • Early ambulation
    • SCD
    • Dorsiflex and extend feet regularly

    • bed rest with elevation of leg, analgesics and possible heat
    • Do not massage legs
    • anticoagulants used (heparin) 

    Past DVT/PE puts you at greater risk for future DVT/PE
  27. Risk factors associated with postpartum infection: antepartum
    • Previous hx of UTI, mastitis or pneumonia
    • Chronic disease such as diabetes
    • Anemia
    • Poor nutrition
    • Low socioeconomic 
    • Obesity 
    • Genital tract infection
  28. Risk factors associated with postpartum infection: Intrapartum
    • C-section
    • Prolonged ROM (>24 hrs)
    • Frequent vaginal exams
    • Internal monitors
    • Chorioamnionitis
    • Prolonged labor
    • Manual removal of placenta
    • Episiotomies or laceration
    • Hematomas or postpartum hemorrhage
    • Poor aseptic technique
    • Poor perineal hygiene
  29. What can you teach mom to help prevent perineal infection following birth
    • Use only water for peri-care
    • Wash front to back
    • pat dry
    • basic good health
  30. 3 phases of maternal transition to parenthood
    • Taking in
    • Taking-hold
    • Letting go
  31. Taking in phase of maternal transition to parenthood
    • Parents review the pregnancy and labor and birth
    • Passive: focus on self/healing, dependant on others, first 24-48 hrs
  32. Taking-hold maternal transition to parenthood
    • Begins to initiate action
    • Focus from self to infant
    • May show signs of baby blues, feelings of inadequacy
    • begin to let outside world in
    • lasts up to a few weeks
  33. Letting go maternal transition to parenthood
    Redefines her new role, requiring some grief work and readjustments of relationships - comes to terms with reality, lets go of what was expected but didn't happen
  34. Factors that may prevent smooth transition through phases of maternal transition to parenthood
    • medications
    • complications
    • C-section
    • Pain
    • preterm infant
    • mood disorders
    • lack of support and financial resources
    • cultural beliefs
    • *teach according to phase
  35. Nursing actions to help fathers adjust to fatherhood
    • Increase contact with infant
    • Increase knowledge of infant and infant care
    • Demonstrate infant care
  36. Review pg 339 in text, on cultural beliefs and postpartum family
    Review tables 15-3, 15-4, 15-5 on pp 383-396
    You Can Do This!!
  37. What nursing actions will promote bonding btwn infant and parents
    • Encourage en face
    • call baby by name
    • cuddle baby close to chest
    • talk/sign to baby
    • breastfeed
    • hold baby close
  38. What are some common practices that tend to interfere with bonding? 
    Why is it important for bonding to occur
    • taking baby away after birth, NICU
    • Important as it fosters development of attachment of parents and infant
    • Provides avenue for parents and infant to learn more about each other
  39. Engorgement
    • Milk comes in, about day 3
    • Breasts are full and need to be emptied
    • Caused by increased venous and lymphatic congestion of breast tissue
    • May be accompanied by temp
    • resolved in 4-16 hrs
  40. peritoneal hematoma:
    cause
    s/s
    tx
    • Due to birth trauma
    • S/S: increasing pain and pressure, subtle changes in VS
    • Will feel firm and painful to touch
    • Small -responds to ice
    • Large - may need to be evacuated
  41. Endometritis:
    cause
    • Infection inside uterus
    • Caused by staph, strep or ecoli; chlamydia or trichamosis
  42. Endometritis: s/s
    • Fever 
    • abd pain and tenderness
    • foul smelling lochia
    • large uterus and chills
  43. Endometritis: tx
    Dx by CBC, blood or other culture, or urinalysis

    Tx with abx and analgesics
  44. Postpartum blues
    • transitory depression due to changing hormone levels and responsibility of enlarging family
    • comes on 3rd to 10th day
    • Shouldn't last longer than a few weeks
  45. Postpartum depression
    • Intense and pervasive sadness, disordered thinking and severe mood swings
    • Gradual onset anytime during 1st year
    • lasts longer than a couple weeks
  46. Postpartum Psychosis
    • Variant of bipolar
    • Abrupt onset usually 3 days to 2 months

    S/S: paranoia, hallucinations, delusions, ext

    • Often have hx of previous or family bipolar
    • Tx: immediate hospitalization and eval
  47. What should nurse teach mom about self-care measures to promote healthy recovery and to prevent infections/complications
    • Good hand hygiene
    • Educate on S/S of infection 
    • Educate on SE of meds
    • Promote good nutrition
    • Careful perineal hygiene
  48. Witches milk in newborn
    • When baby lactates due to mothers hormones still in her
    • No intervention needed, totally normal. Will go away on own
  49. 4 ways infants can experience heat loss
    • Evaporation
    • Convection
    • conduction
    • radiation
  50. Evaporation
    • Loss of heat through conversion of liquid to vapor
    • Ex: bathing or directly after bath
  51. Convection
    • Flow of heat from body to cooler surrounding air
    • Ex: air conditioners or oxygen masks
  52. Conduction
    • transfer of body heat to cooler solid object to contact with body
    • Ex: cold hands, equipment
  53. Radiation
    • transfer of body heat to a cooler solid object not in contact with baby
    • Ex: Cold walls of isolette, cold equipment near neonate
  54. Importance of keeping baby warm
    Cold stress on baby can lead to increased RR and HR, which leads to increase O2 consumption, depletion of glucose, and decrease of surfactant = RESPIRATORY DISTRESS
  55. PKU
    • ideal time for test is 2-4 days of life so they can ingest breast milk or formula
    • 1st in hospital, 2nd 2-4 wks in office
    • *Tests for amino acid deformity
    • Important to prevent brain damage if infant has deformed enzyme and can't break down proteins in milk
  56. Blood glucose testing in newborn
    • Is done if baby is SGA (small gestational age) 
    • Also if baby is LGA (Large gestational age) or GDM (gestational diabetes mother)
    • Normal levels is 50-90 in newborn
    • If <40, feed with formula and keep warm
  57. Bilirubin
    • All infants tested at 24 hrs old and AT NIGHT, follow up as needed
    • Tx: light therapy

    • *recall bilirubin is a yellow substance the body creates when it replaces old red blood cells. Liver helps break down the substance so it can be removed from the body in the stool. If liver is unable to break down, can build up causing jaundice. Toxic accumulation causes kernicterus
    • In infants, increase in RBC turn over immature liver unable to keep up
  58. Kernicterus
    toxic accumulation of bilirubin which causes brain damage
  59. Safety measures to prevent infant abduction
    What is nurses responsibility if Code Pink is called
    • Cord alarm (top/tot guard)
    • Only nurses with pink badges can move babies. Babies must have matching arm band 

    • If code pink is called, go to nearest exit and guard door until code pink is cleared
    • If you see someone suspicious, supposed to follow or distract but do not attemp chase
  60. S/S of infant respiratory distress & interventions to solve
    • Expiratory grunting, nasal flaring
    • RR >60
    • intercostal and substernal retractions
    • cyanosis

    Tx: Blow by O2, CPAP, ET tube
  61. Cephalhematoma
    • Collection of bloody fluid btwn the bone and periosteal membrane
    • does NOT cross suture lines
    • disappears in 3 weeks to a few months
    • Sometimes may have to be drained with needle
    • Otherwise, hematoma will resolve on own
  62. Caput succedaneum
    • Swelling under the scalp
    • Will cross suture lines
    • Happens with normal delivery from being pushed out
    • Will go away on own, no tx needed
  63. Risk factors for Downs
    • Triple (or Quad) marker screening at 15 to 20 weeks with hCG and inhibin A 
    • Levels twice the normal rate indicate Trisomy 21
    • Risks involve maternal age over 35 and paternal age over 40
  64. S/S of Downs
    • Flat facial features, with small nose
    • Upward slant to eyes
    • Flat facial features
    • Low set ears
    • Low muscle tone (babies appear floppy)
  65. Advantages of breastfeeding
    • Enhances involution of uterus
    • Promotes closeness and attachment
    • Decreases risk for osteoporosis and breast cancer
    • Ovulation MAY be delayed
    • Easier to digest with fewer allergies
  66. Promotion of breastfeeding
    • Encourage feeding when baby is awake and quiet
    • Have lactation come consult
    • Validate fears and concerns
    • Positive encouragement especially for first time moms
  67. Techniques to teach for breast feeding
    • Teach what a good latch should look and feel like
    • options for how to hold baby
    • listen for sucking and swallowing
  68. Best time to breastfeed
    • On demand at first till milk comes in
    • during alert quiet cycle
    • Best to get an early feeding before baby has long sleep after birth
  69. What are the contraindications to breastfeeding
    • If mom has HIV or active herpes lesions on breast
    • Newly dx active TB
    • Chemotherapy, radioactive isotopes, or illicit drugs
    • Infants with PKU
    • Meds which pass through breast milk...
    • Teach pt to make sure HCP knows if breastfeeding
  70. Hormone involved in let down reflex, and what things are stimulated by it's release
    • Oxytocin
    • Nipple stimulation/sucking
    • Orgasm
    • Baby cry
    • Skin to skin
  71. Advantages & teaching to formula feeding
    • Both parents are able to feed
    • Infant doesn't eat as much as formula takes longer to digest
    • *Teach baby can eat every 3-4 hrs. Prepared formula only good for 4 hrs, then toss. Make sure to burp
  72. Strategies to decrease risk of SIDS
    • Place infant on back to sleep
    • Use firm mattress
    • No pillow/stuffed animals
    • Breastfeeding
    • Smoke free environment
    • Prevent overheating of baby, use light weight clothing
  73. Teaching about bathing
    • Don't need to bath daily, causes skin irritation
    • Cleaning genital, rectal area with plain water 
    • Clean neck and face with water after each feeding
    • Until cord falls off, sponge bath only
  74. Normal parameters for newborn vital signs
    • Temp: 97.7 - 98.6 (36.5 - 37)
    • HR: 110 - 160
    • RR: 30-60
    • BP: 80-60/45-40
  75. Teaching of circumcision: 2 types of procedures
    Gomco of Magen clamp: lubricate circ site after every diaper change for first week

    Plastibell: No lub, causes increased risk for displacement of plastic ring. Ring falls off within 7-10 days. Do not remove yourself
  76. Teaching of care for circumcised infant
    • Do not wash yellow crusted areas as glans penis heals
    • Call provider if no voiding for 24 hrs
    • Check for bleeding every 4 hrs for first 24 hr, call provider if bleeding
    • Also call if entire penis is red, warm and swollen or if there is damage
  77. S/S of shaken baby syndrome
    • Abusive head trauma..
    • Extreme irritability,
    • poor feeding,
    • breathing probs
    • convulsions
    • vomiting,
    • pale or bluish skin
  78. Prevention of shaken baby
    • PREVENTION aimed at educating patents
    • Inform it's normal for baby to cry for 30 mins
    • Ok to feel frustrated
    • Ok to place baby in crib and leave room
    • Call family, friends, or parental stress line when feeling overwhelmed
  79. Lochia
    • blood, mucus and tissue
    • Report change to earlier color of lochia, foul smell

    Postpartum hemorrhage would be saturation of pad in 15 min or less or 2 within 30 min
  80. Lochia - amount
    • scant - less than 1"
    • light - less than 4"
    • moderate - less than 6"
    • Heavy - saturation of 1 pad in 2 hrs
  81. Lochia rubra
    • dark red
    • first 2-3 days
    • some clots normal
  82. Lochia serosa
    • pinkish brown
    • day 3 to day 10
  83. Lochia alba
    • creamy yellow
    • day 10 to 3-4 weeks

    *Menses will return in about 4 weeks to 3 months if not breastfeeding - 6 weeks to 10 months if breastfeeding
  84. Let down reflex
    • Baby sucks, hypothalamus stimulates posterior pituitary to release oxytocin
    • Causes contraction of muscles around milk ducts allowing milk to flow into sinuses or reservoirs
    • Both breasts simultaneously
  85. Duramorph protocol
    • helps prevent itching in newborn
    • Morphine that is injected into mom spinal column before epidural is removed will cause itching in baby
  86. engrossment
    Infant and father contact and affect on each other
  87. Retained placenta
    • placenta that has not undergone placental expulsion within 30 minutes of the baby's birth
    • Impairs ability of uterus to contract
  88. Placenta accreta
    • Can cause retained placenta
    • superficial penetration of the myometrium
    • placenta attaches too deep in the uterine wall but it does not penetrate the uterine muscle.
  89. Placenta increta
    • Can cause retained placenta
    • placenta attaches itself even more deeply into the muscle wall of uterus.
  90. Placenta precreta
    • Can cause retained placenta
    • placenta attaches itself and grows through the uterus, sometimes extending to nearby organs, such as the bladder.
  91. Thrombophlebitis
    • a blood clot in a vein causes inflammation and pain.
    • due to pregnancy induced hypercoagulable state
  92. What is #1 cause of maternal mortality in us
    PE
  93. Ductus venosis
    • connection between umbilical cord to liver
    • closes by day 3, becomes a ligament
  94. Foramen ovale
    • hole in heart
    • closes when left atrial pressure greater than right atrial pressure
  95. Ductus arteriosus
    • artery to aorta
    • closes within 15 hrs
  96. Brown adipose tissue
    • special tissue on infant
    • promotes increased metabolism, heat production and heat transfer to peripheral system
  97. Acrocyanosis
    • pink with blue hands and feet
    • normal for first day
    • should clear up in 12 hrs
    • if it doesn't, will cause cold stress
  98. Vit K injection
    • Neonates have a drop in Vit K
    • Vit K injection decreases risk for bleeding until neonates intestine begin to synthesize
  99. vernix caseosa
    • whitish cheese like substance
    • disappears near term
  100. Lanugo
    soft growth of fine hair
  101. erythema toxicum
    newborn rash
  102. Stork bites
    small reddened areas often on nape of neck
  103. Strawberry mark
    • dark or bright red raised, rough area
    • hemangioma
    • Will eventually go away
  104. epsteins pearl
    • cysts on palate
    • last 1 week
  105. hypospadias
    opening on lower surface of penis
  106. epispadias
    opening on upper surface of penis
  107. polydactyly
    more than normal number of fingers and/or toes
  108. syndactyly
    webbed fingers or toes
  109. Ortolani maneuver
    checks for dislocated hips
  110. Tonic neck reflex
    • when you turn baby's head one way, arms follow (straight arm in direction baby looking, other arm up over head)
    • disappears in 4-6 months
  111. gavage feeding
    a way to provide breastmilk or formula directly to your baby's stomach (via GI tube or NG tube)

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Author:
jskunz
ID:
324565
Filename:
M/B 3
Updated:
2016-10-16 21:04:12
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