Post Partum & Complications, Newborn & Complications

post partum

return of reproductive organs to pre-pregnant state, lasting 6 weeks. includes development of attachment relationship

subinvolution

uterus doesn't go down as it should

fundus 12 hours after delivery

midline, firm, @/1cm above umbilicus

BUBBLE PEN assessment

breasts, uterus, bladder, bowel, lochia, episiotomy/incision, pain, emotional status, nutrition

lochia

contains blood, mucus, tissue; smells musty/stale

hemorrhage definition

pad saturated in <30 mins

lochia rubra

bright to darker red, days 1-3; clots smaller than a quarter, heavy flow that increases with movement/breastfeeding

lochia serosa

pink/brownish, days 4-12; moderate flow that increases with activity, watery consistency

lochia alba

yellow/white, day 12-6 weeks, longer with breastfeeding; light flow/spotting, little to no blood.

mastitis risks

improper latch, infrequent/inconsistent feedings, breast distention, nipple trauma, staph infection from baby mouth

mastitis s/s & tx

s/s = flu s/s, tender red breast, inflam; tx = abx, apply breastmilk to nipples & let dry, ice/heat, KEEP BREASTFEEDING

causes of Impaired bonding

PP depression

impaired bonding s/s

disgust with diapers/spitup, expressing dissapointment, apathy with crying, etc.

baby blues

from hormones, lasts 1-2 weeks, will go away

PP depression (PPD)

requires intervention; s/s panic attacks, rejecting infant, flat affect, etc.

PP psychosis

ensure infant safety; s/s paranoia, delusions, thoughts of harming self/infant

normal physiological changes

orthostatic hypotension, thick blood from rapid decrease in volume, blood loss of 500/1000ml for vaginal/c-section

DVT risks

thick blood, increased coag factors for 3 weeks

primary PP hemorrhage

within 24 hours

delayed PP hemorrhage

24 hours - 2 weeks

4 Ts of PP hemorrhage

tone, tissue, trauma, thrombin

Tone (PP hemorrhage)

boggy uterus from overdistention, atony, placental fragments causes hypovolemic shock

Tissue (PP hemorrhage)

prevents uterine constriction causing bleeding; includes placental accreta & uterine fibroids

placental accreta

doesn't adhere normally, delivers spontaneously

uterine fibroids

noncancerous tumors

Trauma (PP hemorrhage)

from hematomas, lacerations, uterine inversion

Thrombin (PP hemorrhage)

disorders: ITP, DIC, von willebrands disease (autosomal dominant)

1st degree tearing

vaginal epithelium & vulva skin

2nd degree tearing

includes the perineal muscles, but not anal sphincter

3rd degree tearing

involves the anal sphincter complex

4th degree tearing

involves the anal spnihcter complex and rectal mucosa

APGAR

appearence, pulse, grimace, activity, respiratory

APGAR scoring

7-10 is good, 4-6 moderate difficulty adapting, 0-3 severe distress

newborn temperature range

97.4-99.6 or 36.5-37.5

newborn respiratory rate range

30-60 bpm

newborn heartrate range

110-160 bpm

conduction

touching cold things

convection

cold air

radiation

cold things nearby

acrocyanosis

blue extremities

telangiectatic nevi

stork bites; flat reddish marks that blanche easily

milia

small raised white spots on face

congenital dermal melanocytosis

mongolian spots; blue/purple skin on the posterior

nevus flammeus

port wine stain; permenant purple/red coloration from capillary malformation

erythema toxicum

newborn rash; pink & goes away within a week

caput succedaneum

swelling that crosses suture lines, lasts few days

cephalohematoma

hematoma that doesn't cross suture lines, lasts weeks, can cause jaundice

moro reflex

startle; loud noise or dropping sensation causes extension of all extremities

neuro assessment reflexes

moro, stepping, rooting, palmar grasp, tonic neck, plantar grasp, babinsky

rooting reflex

sucking; infant will turn and open mouth in response to a stroke on the cheek, and will suck on a finger in the mouth

tonic neck reflex

fencing; turn infants head to the side, hand and foot extend on same side, flexing on the other side

plantar grasp reflex

toes curl in when sole is touched

babinsky

toes fan out when outer sole is stroked

postterm risks

meconium, little/no vernix caseosa, hypoglycemia

preterm risks

hypoglycemia, respiratory distress, hyperbilirubinemia, intraventricular hemorrhage

meds given at birth

erythromycin, vit k, hep b, metabolic screening

erythromycin use

abx; prevents blindness in eyes, can delay for 1 hour

vit k use

prevents hemorrhaging, helps the gut; IM in leg within 1hr

hep b use

vaccination given at birth, 1mo, 6mo; informed consent, immunoglobulin for infants with positive mom, IM in other leg

metabolic screening

heel stick at birth/2 weeks, must recieve feeding for at least 24 hours prior

breastfeeding infants

need vit d supplement; have yellow loose seedy stools

how many diapers daily indicates a well fed infant?

6-8

circumcision NI

no bathing until fully healed, clean with water during diaper changes, don't remove yellow crust

umbilical cord care

keep clean/dry until it falls off around 2 weeks; may clean with water

SIDS NI

baby must sleep on back without blankets, pillows, etc.

infant nutrition

don't give infants water, all babies need iron supplements after 6mo

meconium NI

NICU team ready, only suction if obstructed, admin o2, surfactant, nitric oxide (pulmonary dilator)

infant hypoglycemia background

maternal diabetes, perinatal stress

infant hypoglycemia progression/tx

untreated can cause seizures, brain damage, death; tx feed them, glucose gel, IV dextrose

infant hyperbilirubinemia background

from immature liver & short lifespan of RBCs, blood incompatability (coombs test)

infant hyperbilirubinemia tx

phototherapy, increase feed frequency

unconjugated bilirubin

not yet able to be excreted by the body; toxic, crosses BBB

effects of neonatal substance withdrawal

poor bonding, ADD, delayed growth/development, neurobehavioral changes

NAS s/s

shrill cry, nonstop crying, tremors, increased moro reflex, mottling, retractions, sweating, regurgitation, projectile vomiting, poor feeding, excessive sucking, etc.

NAS tx

morphine to help withdrawal, phenobarbital to prevent seizures

NAS NI

NAS score every 3 hours for morphone dosing, provide low stimulating environment, call CPS to ensure home safety