Exam 2 maternal notes

Postpartum baby blues

S/S: low self esteem from exhastion, physical discomfort, new role, burst into tears easily, feeling inadequate, mood liability, anorexia, sleep disturbance

Tx:usually rsolves within 10 days

Postpartum depression & Baby blues

Def: inability for mother to function; last past 2 wks, onset within 4 wks after delivery

S/S: Anxiety (can be severe if HX), panic peristant sadness,& mood swings

Intervention: longer maternity leave/ more frequent follow ups, depression therapy, medications

Postpartum Psychosis

def: mother loses touch with reality, occurs within 2-3 wks of delivery

RF:Hx of bipolar disorder

S/S: Confusion, hallucinations, paranoia

Intervention: inpatient hosptilization, meds: antidepressents, antipsyotics, mood stabilizers

Procedure: electroconvulsive therapy

TONE (4 ts)

-boggy uterine atony

cause: long labor, induce/aug or oxytocin

Trauma (4 t’s)

laceration

cause:macrosomia, multi gestation, polyhydramios, >40 wks

Tissue (4 t’s)

products of clot

Thrombin (4 t’s)

bleeding

Attachment (when parent successfully linked with newborn)

Intervention: skin to skin contact within the first hour of birth/c-section

Engrossment

how much attention parent gives to newborn

comp: post traumatic stress disorder&interference w/ normal bonding process

interventions: guided supported interactions such as pointing pout positive parental behaviors

Sibiling visitation precautions

assess for contagious diseases (upper resp. tract illness, fever, etc), wash hands, wear a mask, touch newborn w/ parental assistance

if the mother has a c-section cover it with a protective padding so sibling doesn’t panic

Involution of uterus

after 10 days the uterus recedes under the pubic bone & is no longer palpable

Uterine Atony

The first hour of birth occurs, the uterus becomes relaxed, blood is lost rapidly due to no permanent thrombi at placental site

After pains:

uterus contractions are more forceful to regain pregnancy size, causes, cramping, more common in multipara clients

Reason to not use tampons

toxic shock syndrome

Lochia

separation of the placenta & membranes in the uterus causing bleeding

last up to 6 wks

THERE SHOULDNT BE ANY HUGE CLOTS

Abnormal Lochia that needs to be reported to the HCP

• 1 saturated pad within 1 hour

• Large blood clots

• Pooled lochia (could indicate hemorrhaging)

• Malodorous (possible infection)

• Absent Lochia even after c-section (possible infection)

Lochia peri-care= cleaning

1. squeeze bottle w/ warm water

2. wipe from front to back

3. Blot dry (using absorbment material) w/clean gauze or washcloth

Lochia peri-care= pain

• sitz bath

• ice packs

• opiods

• nsaids/pyretics

• topical witch hazel for hemmorhoids

• stool softener such as docusate sodium

Lochia red

1st-3rd day

Lochia serosa

7th-14th day

Lochia alba

3rd (4th week)

Involution of cervix

right after birth, cervix is soft/out of shape—>contractions begins—>is firm and feels nongravid by a week—>still slightly opened

Vaginal blood loss

300-500 is normal

C-section blood loss

500-1000 is normal

Strae gravidum

stretch marks on abdomen stay postpartum & may be red

Relaxin

hormone during pregnancy that soften & lengthens the cervix & pubis—>relaxes smooth muscle in gut—>constipation, bloating&dyspepsia

Choasoma

excessive pigmentation on face& neck that isnt detectable within 6 weeks

Linea Nigra

dork vertical line on abdomen isn’t detechable within 6 wks

Diaststis recti

overstreching & seperation of abdomen

intervention:sit ups or surgey

Lactation hormones

Prolaction: prodcues milk

Oxytocin opens milk with a “let down” reflex

Fundal height after birth

immediately after birth fundus is halfway between the umbilicus & symphysis pubis

Fundus is misplaced

Intervention: client uses the bathroom

Boggy fundus

• indicates risk for uterine atony&postpartum hemorrhage

Intervention: oxytocin, fundal massage, call HCP if uterus doesn’t respond to massage or bleeding increases

Cause postpartum hemorrhoids

pressure from the fetal head on rectal veins tends to aggravate & produce hemorrhoids (swollen rectal veins)

Preventing postpartum hemorrhoids

• sims position several times a day aids in good venous return to rectal area & reduces discomfort

Homans sign

extending knee straight & dorsiflexing the ankle (pulled upward) to assess for thrombophelbitis. ASK IF THEY FEEL ANY PAIN

Postpartum Discharge teaching

it is advised for women not to return to jobs for atleast 3 to 6 weeks

•When fundal massage isnt effective

1. use oxytocin

2. Carboprost Tromethamin

3. Methylergonivine

4. Misoprostal

Uterine atony interventions

• Elevate lower extremitis

• Offer bedpan or assist in bathroom

• Oxygen 10-12 L/min→Lay supine (no more pregnacy)

• obtain vitals

If fundal massage & medication isnt effective

• Bimanuel compression=HCP inserts one hand vaginally while pushing the fundus through the abdominal wall the other hand

• Blood transfusion

• Hysterectomy or suturing

Subinvolation

at 4-6wks postpartum, the uterus still hasn’t returned & is SOFT & LARGE, lochia, discharge is usually still present

causes: retained placental fragment, mild endometritis, uterine myoma

Med Tx: Methlergonovine→0.2 4x daily→improves uterine tone & complete dilation

Peritonitis

cause: endometritis→lympatic system or uterine oval to peritonala cavity

tx: ng tube, iv fluid, total parentaeral nutrition

Preventing Thrombophelbitis

side-laying or supine recumbent position, NO lithotomy, 6-8 glasses postpartum, ambulate right after birth, NO smoking, NEVER MASSAGE SKIN→pulmonary or cerebral embolism

Urinary retention diagnoiss

catherizing a patien immediabtley after voiding→if amount of urine retained in the bladder is =100m=patient has urinary retention

Tx:

Urinary retention Tx

24 hr indwelling catheter→encourgae patient to void afterward by the end of 6 hours, offer fluid, & analgesic

UTI

s/s: lower abdominal pain

Tx: Sulfur drugs→nitrofurgantoin, amoxicillin, or ampicillin (DO NOT USE SULF DRUGS WHILE BREASTFEEDING)

Newborn head circumference

34-35 cm

Newborn temp.

97.6-98.6 axillary

Newborn Chest circumference

32cm-33cm

Newborn Blood Pressure

80/46

Newborn heart rate

120-140 bpm/sleeping:90-110

Newborn Respirations

30-60 breaths/min

Newborn weight

2500-3400 grams

5.5lbs-7.5lbs

Length

46-54cm

Newborn Blood volume

80-110mL

Newborn RBC

6 million

Epsiten pears

NORMAL small, harmless cysts that commonly appear on the roof of a newborn's mouth or along the gums.

Ankyoglossia (tunge tie: short or tight frenulum)

Tx: None unless trouble sucking or latching mucus in mouth

Intervention: position in side laying

Convection

Tx:eliminating draft

Radiation

Tx:move newborn away from client

Conduction

Tx:cover surface w/ warm blanket

Evaporation

Tx: lay baby on parents abdomen & cover w/ warm blanket

Vitamin K & Hepatitis B

Administers in different vastus lateralis muscle

Spit ups

normal in newborns and infants and usually improve by 12 to 18 months of age

• If newborns begin projectile vomiting or have larger with food refusal, they should be seen by their primary care provider for further evaluation.

First newborn void

pink or dusky (uric acid that is normal)

Small amounts of protein is normal for first few days of life

Why is hepitis B administered in the first 24 of life?

the newborns immune system begins to produce antiodies at 2 mths of age

Blink Reflex

sudden strong light to eye causes movement

*Rooting reflex

0-4 mths

brush or stroke cheek near corner of mouth for head turn for breastfeeding

Sucking relfex

0-6 mths

lips are touched→baby begins sucking motion

Swallowing reflex

food in posterior of tounge causes swallowing reflex

Palmar grasp reflex

6wks-3mths

Grappping object placed on palm

*Planter grasp

8-9mths

object placed on sole of food causes toe curling

Tonic neck reflex

turning the newborns head causes one arm & leg to extend toward the direction of the head & the other arm & leg on the opposite side to contract

Moro reflex

4-5mths

can be done by loud noise

hold baby supine and allow head to drop 1 in→newborn extends extremities, swings arms to embrace position, pulls legs against abdomen

*Babinski reflex

3 mths

sole of foot is stroked in j shape causing toes to fant out

Magnet relfex

push down soles when supine so newborn can push back against pressure

Blue/pale (Apperance)

0

Acrocyanosis (Apperance)

1

Completely pink (Apperance)

2

Absent (Pulse)

0

<100 (Pulse)

1

>100 bpm (Pulse)

2

No crying when stimulated (Grimace)

0

Only cries when stimulated (Grimance)

1

Cries & pulls away naturally & sneezes (Grimance)

2

Limp & Flaccid (Activity)

0

Minimal flexion of extremites (Activity)

1

Maintains position of flexion with brisk movement (Activity)

2

No resp. effort (Resp. effort)

0

Weak cry or slow/diffucult resp. (Resp. effort)

1

Strong vigorous cry (Resp. effort)

2

APGAR interventions

0-3=resuscitate fully

0-6=some resuscitation

Mature skin

Lethery, cracked, wrinkeld skin

Premature skin

sticky, friable, transparent

Mature lanugo

little/bald

Premature lanugo

<40 or 40-50mm=smooth

Mature plantar surface

wrinkles or creases across sole

Premature female genital

prominent clitoris

Port wine stains

Tx: spontaneoulsy fade, if not then cosmetics and laser tx later in life

Stork bites

little pink patches that dont fade→NO Tx