Maternity Lab Exam

NURS 2502

Postpartum period

The interval between the birth of the newborn and the return of reproductive organs to the normal nonpregnant state.

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Lasts approx. 6 weeks

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Also called puerperium

Involution

the return of the uterus to a nonpregnant state following birth

Subinvolution

failure of the uterus to return to a nonpregnant state

Most common cause is retained placental fragments and infections

What strengthens contractions

oxyctocin

Lochia

Uterine discharge after birth

Pad 1

Lochia rubra

* Dark red
* Small clots
* Cramps

Pad 2

Lochia serosa

* Lasts 4-12 days
* pink/ brown

Pad 3

Lochia alba

* Yellow/ white
* Light flow/ spotting
* Lasts from 12 days- 6 weeks
* No clots

Sara is 20 days postapartum she says she is having period flow style lochia… is this normal?

No period flow lochia lasts about 3-4 days. She should be having light spotting of a white/ yellow discharge (Lochia alba)

This may mean their are retained placenta fragments!!

Melissa experinces a gush of fluid when she stands up, what is this??

Lochia tends to pool in the vagina when lying in bed. This is normal

cervix after birth

soft

Dilation of cervix after birth

10 cm during birth

2nd-3rd postpartum day 2-3 cm dilated

by 1 week postpartum 1cm dilated

External cervical os

Never regains pre-pregnancy apparence

No longer circle, now a jagged slit (fish mouth)

Rugae of vagina

Reapear after 3 weeks

Not as prominent

Excerises to help pelvic floor regain tone

kegal exercises

Abdominal wall postpartum

Takes 6 weeks to return

What characteristics are we assessing with lochia?

Smell

Amount

Colour

Clots

Prolactin

Increases in Breastfeeding woman

Responsible for suppressing ovulation

What should you teach the new mom about their first menstural period after childbirth

* Heavier than normal
* within 3 or 4 cycles should retrun to normal

Profuse diaphoresis

Loss of fluid

at night (usually)

2-3 days after birth

Simmone is afraid she is not having a bowel movement, what should you tell her?

A bowel movemnet may not occur for 2-3 days postpartum

You may feel discomfort

Drink lots of fluid

Stepahnie is concerneed about her stretch marks, what can you tell her?

They may fade

When assessing mom’s breasts what are we looking for?

Firmness

Soreness

Cracks

When assessing the fundus what are we checking for

That it is firm, midline (first 24 hrs at umbilicus) involutes 1-2 cm/ day

What are we assessing for bladder and bowel function

Is she ale to void (within 8 hours of birth)

Bowel movement (by day 3)

Active bowel sounds

What are we assessing for the moms legs

Any swelling

Edema

What are we assessing for the perineum or incision

Edema

Episitomy edeges approximated

C/ section dressing clean and dry

Suture line intact

What should we assess in rectal area

Any hemorrhoids

What is the acronym for the mom assessment

BUBBLLEE

Peri Bottle

Use 3 times a day

Clean perineum area

Warm water

Don’t use every time you go to washroom

Sitz bath

Water runs in

Helps with epistomtomy

What is the ideal time to initate breastfeeding?

1-2 hrs after childbirth

How many calories should a nonlactating woman take in

1800-2200 kcal/day

Benefits of early ambulation

* Decrease chance of blood clotting

When can you bathe the newborn baby

24 hrs after birth

What do you have to check before bathing newborn

Temperature (has to be greater than 36.5)

Axillary (armpit)

What supplies will you get to prepare for newborn bath?

Comb

Face cloth

Shampoo

Outfit

Diaper

Warm blanket

Towel

Basin

Cotton tip applicator

How should we check the temperature of the water (for newborn bath)

wrist

Wash ______ first

face (no soap)

Don’t put soap on babies ________

hands

Blood in babies diaper?

Normal

Pseudomenstruation

Caused by high levels of maternal hormones

Resolves on its own

Meconium

1st bowel movement of baby

Dark, tarry stool

Normal first few days after birth

How to wash babies cord

Use wet cotton tip applicator, touch around cord area throw out. Use a dry one and go around cord area.

Safe sleeping position of baby

on back (supine) alone in crib

Thermogensis

* The newborn attempts to generate heat by increasing muscle activity
* Nonshivering
* accomplished primarily by metabolism of brown fat, which is unique to the newborn, and secondarily by increased metabolic activity in the brain, heart, and liver.

Skin to skin Contact

* Helps control heat loss
* Place the naked healthy baby next to the mother’s skin and cover with a blanket

Cold Stress

* Respiratory rate increases
* Basal metabolic rate increases
* Metabolic acidosis
* Respiratory acidosis
* Hypoglycemia (can be asymptomatic in the newborn)

Hyperthermia

* Occurs less frequently than hypothermia
* Must be corrected
* Body temp greater than 37.5
* skin vessels dilate, skin appears flushed, hands and feet are warm to touch, and the infant assumes a posture of extension
* The newborn who is hyper­thermic because of sepsis appears stressed: vessels in the skin are constricted, colour is pale, and hands and feet are cool
* Serious overheating of the newborn can cause cerebral damage from dehydration or even heat stroke and death

Babies HR is 90 beats / min has a good cry is well flexed slight grimacing and has blue extremities. What APGAR scoring would this be?

7

Babies HR is 120 beats/ min and has a weak cry, flaccid muscle tone with slight grimacing and is a pale blue in colour. What APGAR scoring is the baby?

4

Intrauterine growth restriction

when a baby in the womb (a fetus) does not grow as expected

Rooting reflex

Gently stroke corner of babies mouth they should turn their head toward your stroke

Caput succedaneum

Swelling of scalp of newborn

Cephalohematoma

minor condition

pressure on fetal head ruptures small blood vessels when head is compressed against pelvis during labour

Telangiectatic nevi

Flat, pink spots on skin

Stork bites

Acrocycnosis

Blue extremities

Vernix caseosa

White creamy texture covering skin of fetus

Lanugo

Fine soft hair covering newborn fetus

Milia

Bengin cysts

white bumps

New Ballard Score

Determines gestational age

When determining a newborn’s gestional age using the ballard score, what would indicate low neuromusclar maturity?

Arm pulled across midline of chest

What are the 6 physical characteristics assessed to dtermine newborn gestaional age according to the new ballard scale

* Skin
* Lanugo
* Plantar surfaces
* Breast
* Eye/ Ear
* Genitals

Cradle cap

Patchy scaling or thick crusts on scalp

SIDS

Sudden Infant Death Syndrome

Erythema toxicum

rash seen in full term newborns

fades within a week

Ophthalmia neonatorum

Bacterial eye infection (from gonorrhea)

How can you prevent opthalmia neonatorum?

Erthroymycin

Moro startle reflex

Startled when they feel like they are falling

Arms go out

Tonic neck reflex

Fencing posture

Turn their head to one side

Palmar grasp reflex

Clench object when pressure and touch is applied to palm

Plantar grasp reflex

Flexion of toes

Babinski sign

Sole of foot firmly stroked

Big toe upward

Other toes fan out

Sucking reflex

Place finger in mouth, baby sucks on it

How long after birth does cord become detached from body?

1-3 weeks

Becomes dry and naturally falls off

Vitamin K

IM Injcetion uusally given within 6 hrs of birth

Prevent hemorrhagic disease of newborn

Normal temperature of newborn

Axillary

36\.5-37.5

Respiratory rate of newborn

Count for full minute

30-60 breaths/ min

Normal BP of newborn

60-80/ 40-50

Normal weight of newborn

female 3400 g

male 3500 g

Normal length of baby (top of head to heel)

45-55 cm

Normal head circumference of baby

33-35 cm

What is this condition?

Caput succedaneum

What is this conidtion?

Cephalhematoma

Name 4 benefits of breastfeeding

* Enhances immunity
* Less likely to die from SIDS
* Bonding experince between mom and babe
* Decrease infections

List 4 contraindications of breastfeeding

* HIV
* Breast surgery
* Has drugs in system
* Infectious

Prolactin

Produces milk

Oxytocin

Resposinble for milk ejection reflex (MER)

How do we know the baby is hungry?

* Hand to mouth motions
* Sucking motions
* Rooting reflex
* Clenched fists

Late hunger cue

Crying

What postion for breastfeeding is this?

Laid back breastfeeding

What breastfeeding postion is this?

Cross cradle

What postion of breastfeeding is this?

Football hold

What breastfeeding postion is this?

Cradling

What breastfeeding postion is this?

Side-lying postion

How do we know the feeding is going well?

* Mother feels firm tugging, no pain
* Baby sucks with cheeks rounded
* Audible swallowing

How often should mom breastfeed?

at least 8-12 times per 24 hrs

Kate states “my baby has been asleep for the past 2 hours I really don’t want to wake her to feed” what do you tell her?

Make sure to awake the baby every 3 hours to feed (DAY)

wake baby every 4 hours to feed (NIGHT)

“How long intervals should I breastfeed for?”

30-40 minutes per breast

Karen says “ I always have coffee in the mornings and I didn’t have any all pregnancy, can I have some now?”

Moderate intake of caffeine by breastfeeding mothers appears to pose no risk to normal full-term infants.

“My breasts feel tender and swollen, is that okay?”

Yes this is common, it lasts about 24 hours