Childbearing Family Nursing

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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
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  3. Active Phase
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  4. Transition Phase
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  5. Second Stage
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  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:
    Image Upload 5


    • 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.
    Image Upload 6
  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.

    Image Upload 7


    • 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
    Image Upload 8
  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)

    Image Upload 9



    • 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.
Author
ID
64086
Card Set
Childbearing Family Nursing
Description
nsg 314 childbearing clinical resource guide test 1
Updated
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