Childbearing Family Nursing

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alta_refugee
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64086
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Childbearing Family Nursing
Updated:
2011-02-04 14:05:28
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nursing childbearing
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nsg 314 childbearing clinical resource guide test 1
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  1. Stages of labor
    • First
    • period of 8 to 12 hours marked by the onset of regular contractions of the uterus with full dilation of the cervix and the appearance of a small amount of blood-tinged mucus.
    • *Latent
    • *Active
    • *Transition
    • Second
    • full dilation of the cervix to delivery of the fetus.cervical opening is 10 cm.
  2. Latent Phase
  3. Active Phase
  4. Transition Phase
  5. Second Stage
  6. COMFORT
    MEASURES FOR LABOR & BIRTH
    Breathing Patterns

    RELIEVE BACKACHE

    OTHER EFFECTIVE COMFORT MEASURES

    • BEARING
    • DOWN TECHNIQUES



    POSITIONS
  7. BEARING DOWN TECHNIQUES
    • “laboring down” or push only with the urge

    • directed pushing or valsalva pushing

    • open-glottis pushing
  8. MATERNAL
    POSTPARTUM ASSESSMENT
    • OXYGEN: Lungs sounds and respiratory rate for mother
    • every 4 hours. More frequently per protocol if she had intrathecal narcotics.



    • CARDIAC: Rate and rhythm for mother every 4
    • hours. Presence or absence of murmurs.



    • NEUROMUSCULAR: Temperature for mother every 4 hours. Assess
    • anesthesia regression. Dermatomes. Examine epidural/spinal site for fluid loss.
    • Check dressing.
  9. ASSESS
    TWICE A SHIFT:


    ASSESS
    ONCE A SHIFT:



    • ASSESSMENTS
    • WILL BE DONE AND CHARTED EVERY 4
    • HOURS ON BOTH MOTHER AND BABY. FOR A
    • MOTHER WHO IS A NEW ADMISSION
    • ASSESSMENTS ARE DONE EVERY 2 HOURS. THE FIRST
    • THREE TIMES A NEW POSTPARTUM PATIENT VOIDS IT MUST BE MEASURED AND
    • RECORDED.
  10. BREASTS
    • 1. In addition to a visual and detailed physical
    • assessment of the breast, if the mother has chosen to breastfeed, be sure to evaluate
    • position, latch-on and other aspects of breastfeeding in your assessment.

    • • Evaluate for discomfort or
    • tenderness, especially during feedings

    • • Evaluate nipples/breasts
    • for soreness, symmetry, cracks, inverted/everted

    redness, streaking

    • • Degree of softness = soft,
    • filling, or firm

    • • Instruct nursing moms in
    • breast care, positioning and comfort, length of time to breast

    • feed, hygiene (wash breasts with warm water,
    • no soap)

    • 2. Bottle-feeding mothers should be evaluated for
    • breast discomfort and they should be encouraged to wear a supportive bra for
    • comfort. Palpation to assess breast fullness should be light to avoid breast
    • stimulation.
  11. UTERUS
    UTERUS

    1. Client low fowlers

    2. Palpate uterine fundus: put one hand at symphysisto stabilize; while the other

    • hand
    • massages fundus until firm and clots expressed.

    • • Fundus should be midline
    • and firm

    • 1st 24 hrs near umbilicus

    • • recedes 1 cm/day
    • postpartum

    3. Document as

    • U/1 1 cm below umbilicus

    • 1/U 1 cm above umbilicus

    • • Midline or deviation from
    • midline

    • Tone--firm, boggy



    • 4.
    • If administering Pitocin, give at ordered rate
    • and NEVER IV-push

    • Oxytocin
    • High Alert Medication

    • Stimulates uterine smooth muscle, producing uterine contractions similar to
    • those in spontaneous labor

    • Has vasopressor and antidiuretic effects

    • 5. Pitocin
    • can cause increase in BP

    • 6. Teach
    • patient to assess and massage her own fundus

    • 7. Administer
    • pain meds for uterine contraction or “afterbirth pains”
  12. BLADDER
    BLADDER

    (May void copiously the first few days after delivery)

    1. Palpate bladder

    • • Empty, shouldn’t be able
    • to feel above symphysis

    • • If full, prevents uterine
    • contractions

    • • When distended will rise
    • up to right

    • Increases vaginal bleeding

    2. Observe for infection

    • • Infrequent or insufficient
    • urination

    • Discomfort or burning

    • Foul smelling

    • • Note frequency, dysuria,
    • retention

    Causes: perineal edema

    • Lacerations

    • • Long labor without voiding
    • regularly
  13. BOWELS
    BOWELS

    1. Abdomen should be soft and not distended

    • 2. Auscultate bowel sounds, passing gas, and passing
    • of stool.

    3. Document - 1st BM usually 2 days postpartum

    • 4. NO enema or digital exam if pt. has 3rd or 4th
    • degree lacerations!
  14. LOCHIA
    LOCHIA

    • Assess to prevent hemorrhage and shock. Report saturation of OB-Pad in 2 hours or
    • less.

    1. Inspect for color, amount, odor, presence of clots

    • Color

    • • Days 1-4: rubra: red or
    • brownish red

    • • Days 4-10: serosa (in some
    • women my last through 27 days); thin and red; composed of serum and blood.

    • • Days 10-3rd to 6th
    • week: alba: whitish yellow

    • • Color shouldn’t revert to
    • earlier stage.

    • Amount

    • • slight or scant - 4
    • pads/day

    • moderate - 4 to 8 pads/day

    • • heavy - 8 pads (woman’s
    • changing habits influences)

    • 1cc = 1 gm

    • • Odor - earthy, faintly
    • musky; foul may indicate infection

    • • Clots - few small in 1st
    • few days. Document any clots present
  15. EPISIOTOMY/PERINEUM
    EPISIOTOMY/PERINEUM

    • 1. Position
    • on affected side, instruct to flex upper leg; gently lift upper buttock;
    • episiotomy will be midline, right or left.

    • 2. Inspect
    • for:

    • Irritation, approximation of
    • sutures, white line length of episiotomy, ecchymosis,

    • s/s of infection, s/s
    • perineal hematoma, tenderness, swelling, severe, intractable pain, edema,
    • discharge, perineal discoloration, hemorrhoids



    • 3. Employ
    • comfort measures

    • Moist heat - Sitz bath

    • • if shared tub: clean, rinse,
    • dry tub and pad with towel before filling

    • • disposable - place under
    • toilet seat with overflow valve to back

    • • fill 1/3 to ½ full with
    • warm water after connecting bag to groove at front

    • • teach to tighten gluteal
    • muscles until seated, then relax

    • • check q 15 min. - assess
    • pulse as needed, make sure call bell is in reach

    • Ice pack

    • • apply covered pack to
    • perineum (apply immediately after birth and continuously over 24-36 hrs to
    • prevent edema and for comfort

    • • Administer analgesics,
    • Tucks (witch hazel swipes) topical sprays and ointments
  16. Assess
    for thrombophlebitis:
    • Assess
    • for thrombophlebitis:

    1.Assess for:

    • Legs symmetrical? Equally
    • warm? Ask pt about let pain at rest or with ambulation. Ask

    • pt to Flex feet to assess
    • for pain.

    2. Assess for:

    • Tenderness, nodules, warm
    • areas, discoloration or varicosities

    • 1. Help
    • prevent thrombophlebitis:

    • • early ambulation - teach
    • to request assistance at first; may become light-headed or faint

    • ·
    • If on bedrest, teach patient stretches and
    • range of motion exercises

    • • avoid constricting
    • clothing and crossed legs
  17. EMOTIONAL
    STATUS
    1. Assess phase

    • • Taking in - immediately
    • after birth

    • sleeps

    • depends on others

    • • relives events surrounding
    • birth

    • • Taking hold - few days
    • postpartum

    • • begins to gain control of
    • body functions

    • • becomes preoccupied with
    • present

    • • is concerned about her
    • health, baby’s health, her ability to care for baby

    • • show independence in
    • self-care and newborn care

    • Letting go

    • • re-establishes
    • relationships with others

    • 2. May feel vulnerable, have mood swings, insomnia,
    • irritability (baby blues)

    • 3. Causes: hormonal changes, role definition,
    • discomfort, fatigue
  18. ABDOMEN
    • Assess C-section incision; reinforce dressing as
    • needed; remove sutures or clips as ordered. Degree of muscle stretching or
    • presence of diastasis recti and linea negra.

    Assess and Document following:

    R - redness

    E - edema

    E - ecchymosis

    D - discharge

    A - approximated edges
  19. VITAL
    SIGNS
    – Be sure to follow individual hospital procedure.

    • 1. Check BP, P q 15 min. Immediately x 4 or more until
    • stable

    2. Then q 30 min, x 2

    3. When stable check VS q shift and PRN
  20. NUTRITION
    • 1. Assess
    • fluid intake. Encourage frequent intake
    • to quench thirst.

    • 2. Assess
    • frequency, consistency, and amount of nutrient intake.

    • 3. Determine
    • if patient is taking prenatal vitamins and iron daily.
  21. CALL
    YOUR INSTRUCTOR & NOTIFY NURSE IF:
    Newborn

    • Baby Temperature: below 97.7 F (36.5C) OR above 98.9 F (37.2 C)

    • Respirations: below 30 OR above 60

    • Pulse: below 100 OR above 160

    • Glucose: below 45mg/dl OR above 150 mg/dl

    • • Has not voided or stooled on your
    • shift

    • Bilirubin above 10 mg/dl

    • orange-yellow
    • pigment of bile, formed principally by the breakdown of hemoglobin in red blood
    • cells after termination of their normal lifespan. Normal
    • levels of total bilirubin are 0.1 to 1 mg/dl

    • Bleeding at circumcision

    Mother

    • • Mom’s fundus above the umbilicus or
    • deviated from the midline

    • Palpable bladder

    • No void in past 4 hours

    • • Saturating a peripad in 2 hours or less
    • (faster than 2 hours)
  22. Newborn
    Assessment
    Neurological


    ENT


    Pulmonary


    Cardiovascular


    GI/GU

    Integumentary/Skeletal


    Reflexes
  23. Differences between caput succedaneum and cephalhematoma.
  24. Newborn Neurological
    • Anterior fontanel – flat, soft, full, tense,
    • sunken, bulging

    Sutures – approximated, separate, overlapping

    • Motor behavior –
    • coordinated, symmetrical. asymmetrical, well-flexed, some flexion,

    lethargic

    • Tone – normal, hypertonic,
    • hypotonic

    • Activity – Alert, crying,
    • active, jittery, lethargic, quiet, sleeping, easily soothed

    • Cry – Normal, high
    • pitched, weak, hoarse

    • Head – symmetrical, round,
    • molded

    • Caput – left, right,
    • parietal, occipital

    • Cephalohematoma – left,
    • right, parietal, occipital
  25. Newborn ENT
    Aricular – pit

    • Eyes – clear, discharge, right, left hemorrhages,
    • periobital edema

    Ears – symmetrical, absent, tag

    Nares – patent

    Palate – complete, incomplete

    • Suck/Swallow – normal, coordinated, weak, absent,
    • inefficient
  26. newborn Pulmonary
    • Chest wall expansion – bilateral and equal,
    • asymmetrical

    • Respiratory effort –
    • unlabored, nasal flaring, grunting, shallow, apnea, tachypnea, no spontaneous
    • respirations

    Retractions – none, mild, moderate, marked

    • Breath sounds – clear,
    • bilateral, equal, right, left, absent, coarse, moist, rales, rhonchi, stridor

    • Secretions suctioned –
    • none, bulb, wall, small amount, moderate amount, large amount, clear, yellow,
    • green, bloody, thick, thin
  27. newborn Cardiovascular
    • Circulation/color – pink,
    • dusky, jaundiced, pale, acrocyanosis, mottled, circumoral cyanosis, mottled,
    • ruddy

    Capillary refill - < 3 seconds, > 3 seconds

    • Heart Sounds – regular, irregular, distant, no
    • audible murmur, soft murmur, loud murmur

    • Pulses – palpable/equal x4, bounding, equal,
    • unequal, absent, weak

    Skin turger – rapid rebound

    • Edema – absent, generalized, moderate, severe,
    • specific area

    • Cord exam –
    • number of vessels (3 expected) meconium stained, no abnormalities
  28. newborn GI/GU
    • Abdomen – soft, distended,
    • firm, flat, rounded, bowel sounds present/absent, hypoactive, hyperactive. Infant
    • feeding – breast, bottle, D10W, D5 W, water, taken well, fair, poorly, nipple, cup, dropper, oral gavage,

    • Anus – patent, visually
    • assessed, meconium passed, unable to assess

    • Genitals – normal for
    • Gestational age, edematous, testes descended R/L, testes not palpable,
    • epispadius, hypospadius, vaginal tag, vaginal discharge, pseudomenses

    • Bagged for Urine specimen
    • – limited prenatal care, history of maternal drug use, positive maternal
    • toxicology screen, maternal temperature
  29. newborn Integumentary/Skeletal
    Extremities – Moves all extremities, full ROM

    • Gluteal folds – symmetrical, asymmetrical, knees
    • even

    • Skin integrity – intact, forceps marks, facial
    • bruising, caput, Cephalohematoma, laceration/puncture

    • Skin appearance – vernix, milia, peeling, meconium
    • staining, rash, petechiae, bruising, lesions

    • Birth marks – Mongolian sports, storks bite, nevi,
    • note noted,

    • Spine – straight and intact, hair tufts, pilonidal
    • dimple

    • Other physical
    • findings – no anomalies noted, skin tags, webbed digits, simian
  30. newborn Reflexes
    Grasp reflex – present/absent

    Moro reflex – present/absent

    • elicited by a sudden
    • loud noise, normal response
    • consists of flexion of the legs, an embracing posture of the arms, and usually
    • a brief cry

    Rooting reflex – present/absent/weak

    Gag reflex – present, hypo or hyperactive

    Blink reflex – present, absent, unable to assess
  31. NEWBORN VITAL SIGNS
    • Pulse
    • 100–160 bpm
    • During sleep as low as 80 bpm; if
    • crying, up to 180 bpm
    • Apical pulse counted for 1 full minute


    • Blood Pressure
    • 80–60/45–40 mm Hg at birth
    • 100/50 mm Hg at day 10




    • Respirations
    • 30–60 respirations/minute
    • Predominantly diaphragmatic but
    • synchronous with abdominal
    • movements
    • Respirations are counted for 1 full minute


    • Temperature
    • Normal range: 36.5C–37.2C
    • (97.7F – 98.9F)
    • Axillary: 36.5C–37.2C (97.7F – 98.9F)
    • Skin: 36C–36.5C (96.8F – 97.7F)
    • Rectal: 36.6C–37.2C (97.8F – 99F)
  32. Neonatal Infant Pain Scale
    • Instruction:
    • Performs NIPS score with VS, immediately before and 30 min after painful
    • procedures.




    • Documents NIPS score in the
    • medical record with vital signs Intervenes for NIPS score of 2
    • or more.

    Interventions include:

    a. Reposition (place prone or side-lying

    • b. Wrap and swaddle in warm blanket (provide
    • intrauterine-like support)

    c. Support skin-to-skin or kangaroo care

    • d. Reduce stimulation (environment, dim lights,
    • quiet voice)

    e. Hold and rock in vertical position

    f. Light Massage or stroking (avoid area of pain)

    g. Put to breast or feed as appropriate

    • h. Pacifier (if provided by the parent(s) and per
    • their consent)

    i. Oral sucrose as ordered per MD

    3. Limitations:

    • • A falsely low score may be seen in an infant who is too ill to
    • respond or who is receiving a paralyzing

    agent.
  33. Newborn gestational age assessment
  34. DISCHARGE
    TEACHING
    • FEEDING
    • DIAPERING
    • WHEN TO CALL THE BABY’S DOCTOR
    • SAFETY
    • ENVIRONMENTS
    • BREASTS
    • ABDOMEN:
    • NUTRITION:
    • PERINEUM:
    • EPISIOTOMY
    • BOWELS
  35. FEEDING
    • – Do NOT let the
    • baby sleep longer than 4 hours (during the day) between feedings for the first
    • 6 weeks.

    • A. If
    • breastfeeding teach to feed as often as baby desires. Do not go longer than 3
    • hours during day time and or 4 hours at night without attempting to feed.

    • B. Frequency
    • and amount if bottle feeding (Don’t
    • teach to breast feeding Mom)





    • C. Positioning/Burping
    • (Teach to ALL Moms)

    • 1. Position
    • in football, cradle, cross-cradle or side-lying positions for breastfeeding.
    • Maintain proper support for head and neck and straight body alignment. If
    • bottle-feeding, hold baby close and in semi-sitting position for feedings. Never prop a bottle or leave a baby
    • unattended for feedings. Do not bottle
    • feed a baby in an infant seat. Support
    • head well.

    • 2. After
    • a feeding, always place the baby on its back for sleeping.

    3. Burping

    • 4. Breastfed
    • babies do not have to be burped routinely.

    • a. Breastfed
    • babies do not have to be burped routinely.

    • b. Done
    • in 3 positions

    • 1) Over
    • the shoulder

    • 2) Across
    • the lap

    • 3) Sitting
    • with chin supported

    • c. If
    • the baby has been crying it might be necessary to burp the baby before feeding.

    • d. Burp
    • the baby when sucking slows down or stops or after ½ to 1 oz for newborns.



    D. Preparation/Storage

    • 1. Be
    • sure to check the type of formula you have and read the instructions for

    preparation.

    • 2. There
    • are 4 forms of formula

    • a. Concentrated
    • (liquid): Must add water

    b. Powdered: Must add water

    • c. Ready
    • to use: Place required amount in bottle

    • d. Prepackaged
    • Ready to Use; Open and serve

    • 3. Store
    • all prepared formulas in the refrigerator.
    • NEVER save formula left in a bottle.
    • Throw it away. Change liners or wash bottles in warm soapy water after
    • feedings.
  36. DIAPERING
    • A. First
    • five days equals a minimum of 1 wet diaper per day of life. Then, the baby is
    • getting enough to eat if it voids 6 – 8 times/day.

    • B. Check
    • diapers when baby wakes up and before putting baby to bed.

    • C. Clean
    • diaper area with warm water when changing diaper. Use a mild soap and water if stool is
    • present.

    • D. Wipe
    • a female’s perineal area from front to back and be sure to clean in the folds.

    E. Stools

    • 1. First
    • 2 days – Meconium stools – Dark green-black, thick, sticky

    • 2. About
    • day 3; greenish to yellow green

    • 3. End
    • of first week; yellowish

    • a. Breastfed
    • stools – loose, non-smelly

    • b. Bottle
    • fed stools – formed with odor

    • Should have at least one stool per day. Don’t
    • place diaper over u
  37. WHEN TO CALL THE BABY’S DOCTOR
    • A. If
    • you have trouble getting the baby to wake up.

    • B. An
    • axillary (under the arm pit) temperature above 99 degrees (teach how to do).

    • C. Vomiting
    • – spitting up a large part or all of a feeding two or more times.

    • D. Diarrhea
    • – Three or more green, liquid stools (Stools have a water ring around them).

    • E. Refusing
    • to eat two feedings in a row.

    • F. Reddening
    • around the cord area or a bad smell from the cord.
  38. BATHING
    AND CORD CARE
    • A. No
    • tub bath for baby until the cord is dry and falls off – approximately 7 – 10
    • days.

    • B. Baby
    • does not need a complete bath every day – may just wash face and diaper area.

    • C. Be
    • sure to have clean clothes, diapers, towels, soap, and water ready before
    • starting the bath.

    • D. Room
    • and water should be warm.

    • E. Make
    • sure that the diaper is secured underneath the cord until the cord has dried
    • and fallen off. Cleanse with soap and water only if urine or feces get on cord.


    F. Don’t place diaper over umbilical cord
  39. SAFETY
    • A. Do
    • not leave the baby on a bed or couch without adult supervision.

    • B. Babies
    • should be on their back for sleep, but may play supervised while on their
    • tummy.

    • C. Car
    • seats are required by law – those should be secured carefully before starting
    • the car. Practice with the car sear
    • before picking the baby up from the hospital.

    • D. Have
    • Mom and/or Dad demonstrate the use of the bulb syringe and tell you what to do
    • for choking (flip the baby over and give back blows/chest thrusts).
  40. ENVIRONMENTS
    • A.
    • Crying – the baby may cry frequently – they usually have a fussy period of
    • approximately two hours
    • each day. Pick the baby up and comfort
    • it. Be sure the baby is not hungry or
    • wet. The baby may need to suck and a pacifier is good for this
    • after the first 3-4 weeks if breastfeeding,
    • anytime if bottle-feeding.

    • B. Dress
    • the baby like the warmest person in the family dresses. Do not over dress the baby.
    • This can make them too hot.
  41. BREASTS
    • A. Stages
    • of milk production:

    1. Colostrum: first 2 – 3 days

    • 2. Transitional
    • milk begins by approx 3- 5 days after
    • birth

    • a.
    • Continues to change in composition for about 10
    • days

    • 3. Mature
    • milk is established by approx 2 weeks

    • B. The
    • “let down” reflex; what it is and how to facilitate it

    C. Engorgement

    • 1. Fluid
    • build-up usually 2 – 3 days after delivering and 24 hours before milk comes in

    • 2. How
    • and why it occurs

    • 3. How
    • to minimize it





    • D. Importance
    • of wearing bra

    • 1. For
    • comfort

    • 2. To
    • decrease engorgement and tenderness

    • E. Manual
    • expression of milk or colostrum

    • F. Nipple
    • hygiene – Do not wash with soap

    • G. Use
    • of lanolin on breasts/nipples

    • H. Signs
    • of possible breast infection and actions to treat.

    • 1. Pain,
    • warm, hard, redden area

    • 2. Fever,
    • feeling ill

    • 3. Change
    • baby’s nursing position

    • 4. Increase
    • frequency of nursing

    • 5. Call
    • provider
  42. BREASTS
    • A. Stages
    • of milk production:

    1. Colostrum: first 2 – 3 days

    • 2. Transitional
    • milk begins by approx 3- 5 days after
    • birth

    • a.
    • Continues to change in composition for about 10
    • days

    • 3. Mature
    • milk is established by approx 2 weeks

    • B. The
    • “let down” reflex; what it is and how to facilitate it

    C. Engorgement

    • 1. Fluid
    • build-up usually 2 – 3 days after delivering and 24 hours before milk comes in

    • 2. How
    • and why it occurs

    • 3. How
    • to minimize it





    • D. Importance
    • of wearing bra

    • 1. For
    • comfort

    • 2. To
    • decrease engorgement and tenderness

    • E. Manual
    • expression of milk or colostrum

    • F. Nipple
    • hygiene – Do not wash with soap

    • G. Use
    • of lanolin on breasts/nipples

    • H. Signs
    • of possible breast infection and actions to treat.

    • 1. Pain,
    • warm, hard, redden area

    • 2. Fever,
    • feeling ill

    • 3. Change
    • baby’s nursing position

    • 4. Increase
    • frequency of nursing

    • 5. Call
    • provider
  43. ABDOMEN:
    • A. Fundus
    • is palpated after delivery to check for position change from bleeding or full
    • bladder

    • B. It
    • hurts when palpated (touched) because it is a sore muscle

    • C. Normal
    • progression of uterus from abdominal organ to pelvic organ after delivery

    • D. Cause
    • and duration of “after birth pains”

    • E. Importance
    • of complete bladder emptying

    • F. Measures
    • to facilitate bladder emptying:

    • 1. Squatting
    • or standing to void

    • 2. Sound
    • of water running

    • 3. Voiding
    • in a sitz bath

    • 4. Relaxation
    • techniques

    • 5. Pouring
    • water over perineal area
  44. NUTRITION:
    • A. You
    • may continue to take prenatal vitamins, iron, and folic acid while
    • breastfeeding and during all childbearing years but confirm recommendation with
    • PCP.

    • B. If
    • lactating, increase caloric intake by 200-500 calories per day for a singleton
    • delivery and double this for a twin pregnancy.

    • C. If
    • not lactating can return to pre-pregnant diet and calories per day.

    • D. Continue
    • to drink a minimum of 6-10 eight ounce glasses of water or non-caffeinated and
    • non-carbonated fluids per day to quince thirst. Additional fluid intake does
    • not increase breast milk production.

    • E. Drinking
    • alcohol is not recommended. If lactating, breastfeed or pump, then have
    • alcoholic drink so that the majority can be metabolized by maternal system
    • prior to next feeding time. Adult
    • metabolism of alcohol is approximately 1 ounce in 2 hours. Mothers’ breastfeeding
    • premature or ill infants should avoid alcohol entirely until her infant is
    • healthy. Chronic or heavy consumers of alcohol should not breastfeed.
  45. PERINEUM:
    • A. Hygiene
    • for perineal area

    • 1. Change
    • pads every time you void

    • 2. Use
    • peri-bottle to wash with after each void

    • 3. Cleanse
    • perineum from vulva towards anus

    • 4. Put
    • on peri-pad from front to back and remove it the same way

    • B. Length
    • of time to expect lochia discharge after delivery:

    • 1. 1st
    • – 3rd days – Rubra

    • 3rd – 7th
    • days – Serosa

    • 7th day – 3rd
    • week – Alba


    • A. Need to report to M.D. if lochia has foul odor
    • or if changes from whitish to bright red



    • B. When
    • sexual intercourse can be resumed. Some
    • of the factors influencing this are:

    • 1. Degree
    • of perineal tenderness

    • 2. Length
    • of time of lochia discharge

    • 3. Healing
    • of placental site

    • 4. Preference
    • of couple
  46. EPISIOTOMY
    • A. Kegal’s
    • exercises to promote healing, to decrease swelling and to increase circulation
    • to the area

    • B. Comfort
    • measures: ice packs initially after
    • delivery up to 24 hrs, heat later; sitz bath

    • C. Use
    • of local anesthetic sprays, creams or witch hazel pads (if ordered)
  47. BOWELS
    • A. Reassure
    • that having bowel movement will not cause damage to episiotomy

    • B. Fluid
    • and dietary measures to combat constipation

    • C. Proper
    • position while at toilet (leaning back with feet elevated on a foot stool)
    • helps to relax anal sphincters

    • D. Use
    • of cold compresses or witch hazel if ordered for hemorrhoids

    • E. Use
    • of warm sitz baths if ordered.

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