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triggers synthesis and secretion of milk (made in anterior pituitary
Responsible for let-down reflex; triggered by neonatal suckling at breast or stimulation from breast pump/manual stimulation
swelling of breasts due to stasis of milk. C/O painful, tender, full breasts. Use ice packs to alleviate Sx. Prevention—regular nursing schedule. If not BF, then no nipple stimulation best.
For a first time mother how long does it take for breastmilk to come in?
Name Breastfeeding Teaching points
- 1.Increased cramping during feeds due to Oxytocin release
- 2. Wear supportive bra
- 3. Ice packs to reduce discomfort
- 4. Allow nipples to air dry before putting on bra
- 5. Shower daily but do not ‘scrub’ breasts/nipples
- 6. Teach signs of good latch
Why should patient breast feed regularly?
¢Establish good milk supply
- ¢ keep baby hydrated and nourished
- ¢Prevent engorgement
- ¢ lower risk of mastitis
What is BUBBLE HEP?
- Postpartum Assessment
- Homan's Sign
What is Involution?
Return of uterus to non-pregnant state following birth
What is Subinvolution?
Failure to return to non-pregnant state, common cause= retained placental fragments or infection
Where should the Uterus be located after the 6th postpartum day?
halfway between the symphysis pubis and umbillicus
When should the uterus be returned to true pelvis or prepregnancy state?
When should the uterus no longer be palpable?
9 days postpartum
Ways to Enhance involution
- Breast feeding
- Early Ambulation
What decreases involution process/speed?
- prolonged labor
- difficult delivery
- overdistended uterus
- full bladder
- RETAINED PRODUCTS OF CONCEPTION (RPOC)- SEVERE
-more common in subsequent pregnancies due to decreased muscle tone of uterus (it has to work harder to get back to original size). After pains also increase during breastfeeding.
What to Assess
When to contact Physician
Lochia is discharge of blood and debris following delivery. Heaviest in morning and during/after breastfeeding. May pool in vaginal vault as pt. rests and then may gush (increase) when standing (Gravity!) Do NOT confuse with hemorrhage.
Assess pad saturation in terms of how much blood in one hour. Saturating more than one full pad in 1 hour is excessive. Documentation of lochia is by color and amount. For example: moderate, rubra.
Lochia decreases every few days (see above). Starts off rubra (bright red) then goes to serosa (reddish-brown) and then to alba (whitish). After bleeding decreases there should NOT be any increase in bleeding. Increase in bleeding or recurrence of rubra after lochia already serosa is abnormal.
If there is a foul odor, clots present (larger than a 50 cent piece) or rubra persists past 3 days—notify practitioner.
Continued lochia serosa or alba with presence of fever, pain, or abdominal tenderness. Need to treat with antibiotics.
- Bright Red bloody
- may have small cloths
- fleshy like odor
- 1-3 days post partum
- heavy to moderate throw
- pink to pink brown,
- no clots
- 5-7 days post partum
- decrease in flow
- Cream to yellowish, may be brown
- usually no odor (unless poor hygiene)
- 1-3 weeks post partum
- Scant flow
Normal Newborn Temperature Range?
List Heat Loss Methods
heat loss by touching a cooler surface
loss of heat from air currents
loss of heat to cooler environment
heat loss when water converted to vapor
Why do babies have poor temperature regulation?
- prone to cold stress
- thin skin
- limited fat stores
- limited glucose stores
- large body surface area (can lose heat easily)
- limited ability to shiver
Newborne VS Respiratory Rate, HR, and Temp
- Resp 30-60/min
- HR 110-160/min
- Temp 97.9-99.7
What should you do if HR is 100-110 baby sleeping, has good color and Resps are good?
let baby sleep and recheck when awake
At what Temp should newborne be placed under a warmer?
Cord Care Teaching Tips
- Observe for signs of infection
- allow to fall off naturally
- Expose to air
- No tub baths until healed
What indicates healthy newborne I&Os?
6-12 wet diapers
Why do babies vomit frequently?
How can this be prevented?
- 1. immature GI sphincter and decreased stomach motility
- 2. Burp frequently, don't overfeed, elevate HOB
At what age do babies lose their Iron stores?
6 months- start on fortified cereals progressing to solid foods
When should meconium/urine be passed?
within 24 hours of delivery
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