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risks of a c-section
- •Urinary/ uterine infections
- •Breast feeding complications
- •Incision infections/ delayed healing process
how do you assess a c-section incision
- •NO bleeding, discharge
- •NO infection-heat, pain, edema, assess the approximation of the incision line!!!!
- •Keep covered- prevents from infection
what do you monitor a c-section mother for
- Change in position
- deep breaths
- !AUSCULTATE LUNGS!
what do you ask c-section mother about abdomen/bowels
Softness/distention (ask mother about passing gas)
how to monitor c-section mom's I & O
- •monitor IV fluids and output in foley catheter
- •If output is less than 30mL/hr CONTACT PHYS.
Surgical incision in the perineum to facilitate the passage of the baby!
what are the 2 types of episiotomy
what and how to assess moms in the sims position
1.Lift buttock to fully expose perineum area..
- 2.Assess from labia to anus
- •Ecchymosis, edema, hemorrhoids, etc..
client teaching for moving around
- 1.Tighten buttocks when standing and release when seated.
- 2.Elevate legs with (2) pillows
- 3.Kegel exercises
- 4.Peri bottle for restroom
Inflammation of the breast, generally during breastfeeding
mastitis is caused by
Bacteria (Staphylococcus aureus but also Candida albicans
how does bacteria enter the breast
Enters through a crack or fissure in the skin, usually on the nipple *portal of entry
Infections not related to breastfeeding might be a rare form of
s/s of mastitis
- •Swelling, tenderness, redness, and warmth in breast tissue
- •Fever and flu-like symptoms including vomiting and nausea
- •Tenderness or enlarged lymph nodes in the armpit of the same side
- •Breast enlargement on one side only
- •Breast lump and pain
- •Nipple discharge (may contain pus)
- •Nipple sensation changes
when does mastitis appear
between 2-4 weeks after birth
how is mastitis cultured
If infections keep returning, milk from the nipple will be cultured
types of tests to be performed if mastitis is suspected
how to treat mastitis
Applying moist heat to the infected tissue for 15-20 minutes QID
- Antibiotic medications
- Very effective
- Clears quickly
- Prevents abscess formation (early treatment)
- Encouraged to continue breastfeeding or pumping because it is beneficial
what complications could arise from mastitis
what do you do with abscess complication
- drained in an office/surgery
- Temporarily stop breastfeeding
- Milk should be pumped and discarded
when to call health care provider to prevent mastitis and complications
Any portion of the breast tissue becomes reddened, tender, swollen, or hot
You are breastfeeding and develop a high fever
The lymph nodes in the armpit become tender or swollen
how to prevent mastitis
Careful nipple care to prevent irritation and cracking
Feeding often and pumping milk to prevent engorgement of the breast
Proper breastfeeding technique with good latching by the baby
Weaning slowly, over several weeks, rather than abruptly stopping breastfeeding
A mild, transient condition of emotional liability and crying for no apparent reason that effects women who have just given birth and lasts about 2 weeks
symptoms of postpartum blues
Fatigue, anxiety, restlessness, let-down feeling, headache and sadness.
postpartum blues usually disapper in how long
Feeling sad or miserable within 3 days of delivery (common after delivery); peaks about 5 days and disappears approximately 10 days is an example of __________
Is a feeling of extreme sadness and related psychologic disturbances during the first few weeks or months after delivery.
-Abbreviation is PPD
--Is similar to postpartum blues, but more serious, intense, and persistent.
--Mild, Moderate, Severe
cares lovingly for her infant, but is unable to feel love
sx: Irritability, guilt, shame, unworthiness, and a sense of loss of self.
characterized by spontaneous crying, insomnia or hypersomnia, fatigue, decreased concentration, and sometimes food cravings
the irritability of a mother may explode into violent outbursts or uncontollable crying often directed toward significant others.
sx: She will discuss her sx or negative feelings toward the infant, which includes disinterest, annoyance w/ care demands, or harming the infant.
antianxiety, antidepressant or antipsychotic drugs require a doctor’s supervision.
what to ask during postpartum interview
have you been depressed during this pregnancy? Before your pregnancy were you depressed? Are you experiencing stressful events?
example postpartum diagnosis
Hopelessness, Powerless, Disturbed Self-esteem, Social isolation, Self-care deficit, Disturbed sleep pattern
postpartum evaluation goals
- Client’s outlook changes
- Improved sleep patterns, appetite, self-control/self esteem/self-worth
the name given to postpartum bleeding. Every woman who delivers a child, either vaginally or through cesarian section, will experience this type of bleeding. It is the way in which body expels excess mucus, placental tissue, and blood after giving birth.
lochia can continue up to _____- weeks and last ____ weeks
After ____ days, your lochia will become a pink color, eventually changing to a yellowish-white color
usually begins as a bright red discharge from the vagina and typically continues between _____ days
what can lochia usually be accompanied by?
numerous small blood clots, about the size of a grape
HOW TO ASSESS FOR LOCHIA
color, odor, amount, consistency
how to deal with lochia
•Rest as much as you can, and avoid excess standing and walking (this will exacerbate the blood flow).
•Use heavy duty maxi pads to soak up the blood.
•Do not use tampons for at least six weeks after pregnancy.
•Tampons can introdubacteria in to the vagina and uterus, causing infection.
bright red discharge for more than seven days after birth
discharge that smells bad
fever and chills
abnormally heavy bleeding (in which a maxi pad is soaked in less than one hour)
are all _____ signs of lochia
client teaching for first bowel movement
Encourage the new mother to drink plenty of fluids
To ambulate frequently and use the bathroom, not a bedpan
Eat a well-balanced diet with increased fiber and fluids
Promptly answer nature’s call to urinate or defecate
what to look for when assessign bowel movement
- Inspect the abdomen for distention
- and auscultate for the present of bowel sounds.
The client’s lab record should be reviewed to check whether she received and enema.
The anus can be inspected when the episiotomy is checked. Make sure to check for hemorrhoids at this point
reasons bowel movement may be delayed
Peristalsis has been decreased by the effects of the increased progesterone level during pregnancy; this may take several days to become normal again
Lack of food during labor
Perineal trauma, episiotomy repair, or hemorrhoids
Mother’s anticipation of discomfort
Certain pain medication can cause constipation
A score that is given for each sign at 1 minute and 5 minutes after the birth. If there are problems with the baby an additional score is given in 10 minutes. A score of 7-10 is considered normal. While 4-7 might require resuscitative measures and a baby with an apgar score of 3 and below requires immediate resuscitation.
purpose of apgar
quickly evaluate newborns physical condition after delivery and to determine any immediate needs for extra medical or emergency care.
- A – Activity (muscle tone)
- P – Pulse
- G – Grimace (reflex irritability)
- A – Appearance (skin color)
- R – Respiration
Quickly determines the need for extra medical or emergency care.
Fat soluble vitamin that can be easily be found in dark green leafy vegetables.
what is vitamin k used for
blood clotting and to prevent vitamin k deficiency
why are vitamin k injections given
because the baby has very low vitamin K due to the reason of it not crossing the placental barrier which leaves the baby deficient of vitamin K and there is very low vitamin K in breast milk.
precursor of prothrombin
benefits of vitamin k
prevent a serious disease called hemorrhagic disease of the newborn. Vitamin K also plays an important role in bone health.
Hepatitis B vaccine is a vaccine developed for the prevention of hepatitis B virus given within the first 12 hours of birth.
hep B vaccine
purpose of hep B
prevent complications due to infection of the hepatitis B virus. Such complications include: liver damage, cancer, and even death.
action of hep B vaccine
Provides passive immunity to the newborn until the baby is able to develop antibodies
hep B vaccine benefits
Protects your child against the hepatitis B virus, which can lead to liver damage, cancer, and even death.
known as neonatal conjunctivitis (baby pink eye) is an inflammation of the surface or covering of the eye because of infections or non-infectious causes such as a bacteria called staphylococcus aureus, genital herpes, gonorrhea, and Chlamydia which can be passed from the mother to the child during birth.
purpose of opthalmia medications
prevent damage to the delicate eye of the infant.
Treatment of ophthalmia neonatorum would be __________ and ________ and they are used to treat complications due to exposure of the disease.
benefits of opthalmia meds and treatment
The benefits of treating the infected mother are to prevent exposure of the infection to the unborn infant.
The benefits of the medication are to prevent complications once infected.
A process that is done to promote healing, avoid infection, and irritation of the umbilical cord.
umbilical cord care
purpose of umbilical cord care
The purpose is to promote healing and prevent infection.
actions of umbilical cord care
Keeping the cord dry and clean is the best way to promote healing and it prevents infection of the umbilical cord.
benefits of umbilical cord care
The benefit of umbilical cord care is that it will dry within 10 to 21 days leading the stump to drop off leaving a small wound that would take only a few days to heal.
how long does umbilical cord take to dry
what are signs of placental seperation
- globular shape of the uterus
- gush of blood from the vagina
- protruding umbilical cord
what stage can an episiotomy be performed
characteristics of what stage
- Mother may be irritable during a contraction and alternate between wanting to be touched and talked to, and wanting to be left alone.
- It isn't unusual for a woman to grunt or moan when the
contractions reach their peak.
when does crowning occur
when the head can be seen between contractions
how does mom actively participate in birth
by bearing down and contracting abdominal muscles
- Contractions continue strong and occur every 1-2 mins
- Contraction duration is 60 – 90 sec.
-Phase begins when cervical dilation is complete (10cm)
and ends with the birth of the baby
- Phase begins when cervix is dilated 8 cm and ends at 10 cm
- Contractions are intense every 2-3 mins.
- Contraction duration is 60-90 sec.
- Client may appear restless during this time
- Characteristics of transition phase may include irritability,statements like “don’t touch me”, difficulty following direction, anger, increased rectal temperature, perspiration on upper lip etc.
- Phase begins when cervix is dilated 4 cm and ends at 8 cm
- Contractions are moderate – intense and occur every 3-5 mins
- Contraction duration is every 30-60 seconds
- Discomfort Varies
- Deep breathing is more focused during this stage
- Longest phase that ends when the cervix is dilated 3 cm
- Contractions are mild and occur every 10-20 mins.
- Contraction duration lasts 15-30 sec.
- Client is often alert, talkative or anxious
- Best time for client teaching is in this phase
- Walking is encouraged if membranes have not ruptured
prenatal testing which a small amount of amniotic fluid (about 30 ml) is withdrawn with a fine needle from the uterus; this is done under ultrasound guidance. Fluid is then sent to the lab for analysis.
why is amniocentesis performed
to look for certain types of birth defects such as: down syndrome, sickle cell disease, cystic fibrosis, muscular dystrophy, tay-sachs and similar diseases. May also detect certain neural tube defects.
when is amniocentesis performed
offered to women who have significant risk for genetic diseases including abnormal ultrasound, family history of certain birth defects, previously had a child or pregnancy with a birth defect, or will be 35 or older at the time of delivery. May also detect the sex of the baby.
risks of amniocentesis
May cause miscarriage, injury to the mother and the baby, infection, and preterm labor. Complications are extremely rare.
when is amniocentesis usually scheduled
15th and 18th week of pregnancy.
accuracy of amniocentesis
what does semen contain
millions of tiny sperm cells
where does semen swim to
- fallopian tubes
when does a woman become pregnant
When a sperm enters, the egg becomes fertilized
what are factors that block pregnancy
poor egg or sperm quality or damage to reproductive systems
a process that manually combines an egg and sperm in a laboratory. This is a complex procedure which involves several steps
steps of invitro
monitoring & stimulating the development of healthy eggs in the ovaries
*Collecting the eggs
*Securing the sperm
*Combining the eggs and sperm while providing an appropriate environment for fertilization and early embryo growth
*And lastly, transferring the embryos into the uterus
success rate for invitro
women under 35 years old is 30 to 35%.
when the sperm is directly inserted into the cervix and makes its way into the uterus and fallopian tubes and then fertilizes the eggs
when the sperm is inserted into the fallopian tubes to produce high fertility rates
artificial insemination is good when
good for couples with an un-identical source of infertility, the man has some sperm deficiencies or the woman has cervical mucus problems.
benefits of AI
sperm can be tested for genetic disorders
disadvantages of AI
several attempts are needed before a woman becomes pregnant.
with _____ possibility of multiple births. This is the result of doctors implanting several embryos to increase the chances of pregnancy
what can multiple births lead to
risk of miscarriage, pregnancy complications, premature births and neonatal deaths.
a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy (especially during third trimester of pregnancy).
caused when the body of a pregnant woman does not secrete excess insulin required during pregnancy leading to increased blood sugar levels
s/s of gestatinal DM
Fatigue, excessive thirst and urination, low blood sugar, jaundice.
risk factors for DM
Miscarriage, growth restriction, growth acceleration, fetal obesity, birth defects, developing gestational diabetes.
how to manage DM
Cesarean birth, insulin, appropriate meal planning, increased physical activity and properly-instituted insulin treatment
Meals: cut down sweets, eats three small meals and one to three snacks a day, maintain proper mealtimes, and include balanced fiber intake in the form of fruits, vegetables and whole-grains.
- -Increased physical activity: walking, swimming, etc.
- -Monitor blood sugar level frequently, doctors may asked to check the blood glucose more often than usual.
Is a blood pressure of 140/90 Hg or higher before pregnancy or before the 20th week of gestation that lasts longer than 6 weeks after delivery.
A diastolic pressure of more than __ mm Hg in the ___ trimester, may also indicate ______.
_______ hypertension develops rapidly and moves to a crisis state faster than in woman without _____hypertension
risk factors for chronic hypertension
More still births, abruption placenta, and severe renal failure
s/s of chronic hypertension
Headaches, edema, disturbed sleep, eye problems, diminished urinary output
management of chronic hypertension
During pregnancy monitor blood pressure at the frequency your doctor recommends and be sure to keep all your doctor appointments. Diet and exercise is highly recommended for obese patients.
chronic medical problems during pregnancy
complications during pregnancy
- abruptio placenta
- placenta previa
- hyperemesis gravidarum
complications during L & D
- postpartum hemorrhge
- prolonged labor
- umbilical cord compression
premature separation from the wall of the uterus of a normally implanted placenta.
causes of abruptio placenta
maternal hypertension, smoking, multiple pregnancies, use of alcohol
mgmnt of abruptio placenta
- No special diet or
- restrictions are required, remain on bed rest, analgesics are given
occurs when implantation is in the lower uterine segment with the placenta lying over or very near the internal cervical os, the opening into the uterus.
causes of placenta previa
Uterine scarring from DNC, or cesarean birth, or endometritis, maternal advancing age and smoking.
mgmnt of placenta previa
bed rest, drug to accelerate fetal lung maturity (Celestone
severe form of nausea and vomiting occurring during pregnancy that usually persists beyond the first trimester
causes of hyperemesis gravidarum
Increased estrogen level gonadotropin production, or trophoblastic activity, excessive production of saliva.
mgmnt of hyperemesis gravidarum
Hospitalization and IV therapy may be required for 48 hours accompanied with bed rest. The client is kept NPO until signs and symptoms have stopped.
excessive bleeding from the uterus.
causes of postpartum hemorrhage
impaired contractions of the uterus after deliveyr causing the blood vessels that opened when the placenta detached from the wall of the uterus continue to bleed; small pieces of placenta remain attached, infection, obesity, prolonged labor, use of forceps or vacuum-assisted delivery.
mgmnt of postpartum hemorrhage
manual massage of the uterus, removal of placental pieces that remain in the uterus; packing the uterus with sponges and sterile materials; tying off bleeding blood vessels; replacing lost blood and fluid; oxygen mask for the mother.
causes of prolonged labor
over sedation; malpresentation, macrosomia(newborn with excessive birth weight);cervical dystocia(failure of the cervix to dilate); small or narrow pelvis; inadequate intensity of contractions (weak, irregular, or uncoordinated).
mgmnt of prolonged labor
oxytocin infusion(for dilation); epidosin (for uterine contractions); Cesarean section
occurs if the cord becomes wrapped around the baby's neck or if it is positioned between the baby's head and the mother's pelvic bone.
umbilical cord compression
cause of umbilical cord compression
reduced amniotic fluid
mgmnt of umbilical cord compression
oxygen for the mother; vacuum assisted delivery; emergency Cesarean section.
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