Maternity Exam 3

Positive parent attachment behaviors

Eye contact, singing to the baby, maintain lose physical contact

Positive infant attachment behaviors

Smiles, alert, demonstrates strong grasp, follow’s parents face

Negative parent attachment behaviors

Removing baby from room, not interacting, expressing disappointment, negative self-contact

Negative infant attachment behaviors

Poor feeding, long periods of crying, flat affect, unresponsive to parents

Proximity

Physical/psychological experience of parents being close to the infant

Reciprocity

The process by which the infants abilities and behaviors elicit parental response

Reciprocity example

Complimenting baby causing parent to respond thank you

Commitment

Parent places infant at the center of their lives and finds own way to parent their child

What affects bonding

Parents socioeconomic status, family hx, role models, support systems, cultural factors, and birth experience

What results in optimal bonding

Requires a period of close contact within the first few minutes to a few hours after birth

What is bonding

The close emotional attraction to a newborn by the parents that develop during the first 30-60 mins after birth

What is attachment

The development of strong affection between an infant and a significant other

How does attachment differ

Individualized and multifactorial process that differs based on the health of infant/mother, environmental circumstances, and quality of care

Characteristics of attachment

Reciprocated between infant and SO, doesn’t occur instantly, influences child’s view of the world and future relationships, chances and develops over time

Baby blues s/s

Mild depressive symptoms, anxiety, irritability, mood swings, fearfulness, increased sensitivity, fatigue, loss of appetite, insomnia, tearfulness

Factors affecting attachment

Parent’s background, infant temperament and health at birth, care practices, separation immediately after birth, policies discouraging exploring infant, ICU, staff indifference or lack of support for parents

When do baby blue symptoms start

2-4 days after childbirth

When does baby blue resolve

Resolve by day 8 and resolve with restorative sleep

Postpartum depression s/s

Last longer and are more severe and require treatment

What can postpartum depression lead to

Poor bonding, alienation from loved ones, daily dysfunction, and violent thoughts/actions

Return of menstruation for non lactating women

7-9 weeks after birth

Return of menstruation for lactating women

Return dependent on breast feeding frequency and duration- 2-18 months

Progesterone and estrogen postpartum

Levels drop quickly due to removal of placenta

What does hormone drops after pregnancy do

Contribute to mood changes and postpartum or baby blues

Prolactin postpartum

Decline within 2 weeks if not breastfeeding

Respiratory system postpartum women

Tidal and minute volume, vital capacity, and functions; residual capacity return to pre-pregnant values within 1-3 weeks after birth

What causes postpartum diuresis

large amounts of IV fluids, decreased antidiuretic effect of oxytocin, retention of fluids during pregnancy, and decreased production of aldosterone w

When does postpartum diuresis end

Return to normal functioning after a month

Integumentary system postpartum women

Pigmentation faces and stretch marks fade to silvery lines

Musculoskeletal system changes

Joints return to prepregnant state except feet, experience fatigue and activity intolerance for weeks, diminished abdominal muscle tone

Bowel sounds postpartum women

Decreased bowel tones and peristalsis for days

Interventions for bowel sounds

Check before eating after NPO status and start w/ fluids before solids

Constipation postpartum women

Common due to straining effect on perineum

Intervention for constipation

Give stool softeners or Gas-X

Voiding sensation affected by

Perineal laceration, general swelling and edema of the perineum, hematoma, decreased bladder tone due to regional anesthesia, decreased sensation of bladder pressure, bladder distention

What does bladder distention cause

Bladder distention leads to UTI or urinary distention and uterus deviates to the right which will increase risks for postpartum hemorrhage

Cardiac volume postpartum women

Remains high for first few days postpartum and gradually declines within 3 months of birth b

Blood volume postpartum women

Drops rapidly after birth and returns normally within 4 weeks postpartum

What does tachycardia in postpartum women indicate

Hypovolemia, dehydration, or hemorrhage

HR for postpartum women

Bradycardia first 2 weeks (40-60) bpm

Postpartum maternal assessment

Vital signs, pain level, epidural site inspection, systemic head to to toe

What are normal postpartum maternal vital signs: temperature

Up to 100.4 F or 38C

What are normal postpartum maternal vital signs: HR

60-80 bpm

What are normal postpartum maternal vital signs: BP

No higher than 140/90 and no lower than 85/60

How often to check vital signs

1st hour: q15mins
2nd hour: q30mins
First 24hrs: q4hrs
After 24hrs: q8hrs

Head to toe: BUBBLE-EE

Breasts, uterus, bladder, bowels, lochia, episiotomy/perineum/epidural site, extremities, and emotional status wha

What are kegel exercises

Pelvic floor exercises that help strengthen the muscles and help control incontinence in women after childbirth

Description of kegel exercise

10 5-second contractions periodically throughout the day

Boddy or relaxed uterus

Signs of uterine atony and can be the result of bladder distention

Fundus location after birth

Typically between umbilicus and symphysis pubis 1-2 hrs after birth

How does fundus progress

Goes downward 1cm/day or 1 fingerbreadth wh

When is fundus nonpalpable

By day 9-14

Treatment for lacerations

Assess q8hrs, RICE method, OTC meds (acetaminophen or NSAIDs)

1st degree perineal laceration

involves only skin and superficial structures above muscle

2nd degree perineal laceration

extends through perineal muscles

3rd degree perineal laceration

Extends through anal sphincter muscle

4th degree perineal laceration

Continues through anterior rectal wall

Perineal Hematoma

Severe intractable pain, perineal discoloration, and eccymosis

Episiotomy

Incision made in the perineum to enlarge the vaginal outlet and theoretically shorten the second stage of labor

Infection with episiotomy

A white line w

What is used to assess a woman’s perineum status

REEDA

What does REEDA stand for

Redness, edema, ecchymosis, discharge, and approximation of skin edge

Perineum Redness

Area may feel warm to touch

Perineum edema and ecchymosis

May indicate vaginal trauma

Perineal discharge

Should follow the expected lochia pattern

Approximation of skin edge

Should be well aligned without gaps

After pains oxytocin

Shrinks the uterus back to pre-pregnancy shape

After pains breastfeeding

Helps shrink the uterus but causes pain

Rubra lochia (1st stage)

First 3-4 days after birth, deep red mucus, tissue, blood(smells like menstrual blood)

Serosa lochia (2nd stage)

Reddish brown discharge, 4-10 days after birth

Alba lochia (3rd stage)

White discharge, 10-28 days days after birth

Involution

Uterus shrinks, contraction of muscle fibers and regeneration of uterine epithelium

Taking in phase (first 3 days)

Time immediately after birth when the client needs others to meet her needs (self, sleep, and food) and relives the birth process

Nursing role for taking in phase

Listen to mom discuss delivery, teach self care, not about baby

Taking hold phase (days 4-10)

2nd phase, mom is more dependent and takes on role of the mother (dependent and independent maternal behavior)

Nursing role for taking hold phase

Best tine to talk about the baby such as plans for breastfeeding or pediatrician

letting go phase

3rd phase, woman reestablishes relationship w/ others and may grieve separation from baby

First period of reactivity

Birth to 30 minutes to 2 hours after birth

What happens during first period of reactivity

Newborn is alert, moving, may appear hungry, best for breastfeeding, spontaneous Moro reflexes, RR and HR increased

Decreased responsiveness period

30 to 120 mins old

What happens during decreased responsiveness

Period of sleep or decreased activity, HR and RR decrease, respond to stimulus decrease, time for baby and mother to rest, not interested in feeding

Second period of reactivity

2-8 hours, newborn awakes and shows interest in stimuli, where baby passes meconium and voids, perfect time for mom to examine baby and ask questions

Hearing

Newborns should turn head to noise

Smell

Newborns should be able to distinguish mothers smell from others

Taste

Grimace to sweet and sour tastes to

Touch

Sensitive to pain and response to tactile stimuli v

Vision

Incomplete at birth but can only focus on close objects

IgM

Found in blood lymph and fluid and is the first to respond to infection

IgA

Found in gastrointestinal and respiratory tracts, tears, saliva, colostrum, and breastmilk

IgG

Found in serum and interstitial fluids

Acquired immunity in newborns

Absent until first invasion by foreign organism or toxin

Natural immunity in newborns

Physical barriers (intact skin and mucous membranes), chemical barriers (gastric acid and digestive enzymes), resident non pathological organisms

Conduction

Transfer of heat from object to object when they are in direct conduct

Conduction example

When a baby’s body surface meets a solid object like a scale or circumcision board

Conduction intervention

Place a warm blanket on surface prior to placing baby on object

Convection

Flow of heat from body surface to cooler surrounding air to air circulating over body surface

Convection example

Cool breeze from the doorway or corridor

Convection intervention

Close open doors, place baby in warmed isolated or dress baby in warm clothes with a hat

Evaporation

Loss of heat when liquid is converted to a vapor

evaporation example

Baby is covered with various fluids and the fluid becomes evaporated into air after delivery