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How many calories does a newborn need daily?
Breastfed: 85-100kcal/kg Formula fed: 100-110kcal/kg
What % of birth weight are babies expected to lose?
Less than 10%
What is lactogenesis i
During pregnancy a few days are delivery Liquid gold- very rich in immunoglobulins
What is lactogenesis ii?
2-3 days after birth transitional milk gradually changes from colostrum to mature milk (more calories and fat)
What is lactogenesis iii?
Mature bilk that is bluish and not as thick as colostrum
Breast milk is high in taurine, what is that important for?
Brain development and conjugation of bile
What is lactulose important for?
Improved absorption of calcium and provides energy for brain growth
What mineral is lower in breastmilk than formula but is absorbed 5x better?
Iron
Why are enzymes from milk important?
Has infection preventing components
What do igA immunoglobulins do?
Helps protect infants GI tract from infection
Positive effects of breastfeeding are...
Decrease chance of diabetes, asthma, obesity UTI's, ear infections, respiratory diseases, SIDS, etc.
What milk is NOT recommended for infants under 12m?
Unmodified cow's milk (too much protein and sodium)
What source of milk is the source of most commercial formulas?
Modified cow's milk (remove saturated fat, reduce protein and add vitamins and nutrients)
What formula is better tolerated for infants with allergies?
Protein hydrolysate
What would be a few examples of "baby-friendly" breastfeeding?
Feeding 1hr after birth On demand feeding Avoiding formula unless medically indicated
What two hormones prepare the breast for lactation?
Estrogen and progesterone
Increased levels of what initiate milk production?
Prolactin Baby suckling and removing milk increases those levels even more
What hormone increases with nipple stimulation?
Oxytocin "let down" effects ejection reflex
Can you put soap on your nipples?
No! It strips away healthy protective oils
What are some infant hunger cues?
Licking or sucking movements Lip smacking Rooting Hand to mouth movements Sucking on hands Increased activity Crying (a late sign) Try to calm before feeding
What is a nutritive vs a non-nutritive suckling pattern?
Nutritive: Smooth, continuous movements and occasional pauses to rest Non-nutritive: Flutter or choppy motion of the jaw not accompanied by the sounds of swallowing
How many times a day should a baby feed?
8-12 times
LATCH score
Latch, Audible swallowing, type of nipple, Comfort, Hold The higher the score the better
What might indicate a suckling problem?
Dimpling of the cheeks and smacking or clicking sounds
Why is frequent breastfeeding and frequent stools important for infants with jaundice?
Will aid in the excretion of bilirubin!
What is engorgement and what can it lead to?
Edema, hard, tender breasts Mastitis
What can cause a clogged duct?
Missed feedings or engorgement Encourage mom to massage breasts, use heat and frequent feedings
S/S of mastitis?
Flu like symptoms 102.2 or > fever, muscles aches, fatigues lump on breast
Treatment for mastitis?
Antibiotics or go to ER to get breasts drained Encourage mom to still breastfeed!!
Can a chemotherapy mom breastfeed?
NO
How long can you use fresh milk and how long can it stay refrigerated and frozen for?
3-4hrs 72hrs 6 months
How can you wean a baby from breastfeeding?
Omit 1 breastfeeding session per day then wait 3-4 days before omitting another day
What are the 3 involution stages of the uterus?
Muscle contracting back down Cells shrinking (catabolism) Epithelium is regenerating
What are the 3 types of lochia (or vaginal discharge) that you can get after birth?
Rubra (1-3days) Serosa (3-10 days..pink) Alba (up to 6 weeks...white)
When looking at a mother's pad, when would it look like she was hemorrhaging?
Pad is heavily saturated in 15minutes-1 hour
Why do you not want to take a bath right away after childbirth?
Cervix takes a week to go back to 1cm
How long does it take an episiotomy to heal completely?
4-6 months
What is a benefit of nursing your baby after labor?
Helps mom labor down more and prevent postpartum hemorrhage
Is it normal for WBC to increase after birth? When does it return back to normal?
Yes, can go up to 30k Takes 6 days to go back to normal
Why would a mother's hct be low postpartum?
Due to fluid shifts into the veins which causes more fluid than hematocrit numbers... gets diluted
How long does it take for hct and coagulation to return to normal?
4-6 weeks
What might be some causes of constipation in mothers postpartum?
Pain meds Decrease in fluid Labor or C-section (slows motility) Fear of having 1st BM after having baby
True or false... Protein in urine is normal post partum, only when they are pregnant does it indicate preeclampsia
True
What is acetone in urine a result of?
Dehydration
What can ovulation recur after labor?
3 weeks...it is possible to get pregnant again without a period
What does REEDA stand for when doing an assessment?
Redness Edema Ecchymosis Drainage Approximated
What does BUBBLE-HE stand for when doing an assessment?
Breasts Uterus Bladder Bowels Lochia Episiotomies Homan's sign Emotional status
What immunizations would you look for in their chart?
Rubella, Pertussis, Varicella, Flu, Pneumonia
What is some post partum nursing care?
Ice Packs Sitz bath Analgesics Perineal care Topical medications Sitting measures Promoting bladder elimination Providing fluids and food
What are some S/S that should be reported post partum?
Fever, localized redness, swelling/pain, persistent abdominal tenderness, feelings of pelvic pressure, persistent perineal pain, frequency, urgency, or burning on urination, abnormal changes in lochia, localized tenderness or warmth in legs, edema or separation of abdominal incision or foul drainage from incision
What is the taking-in phase?
Mom is focused on herself...tired, hungry, thirsty (lasts day or less)
What is the taking-hold phase?
More independent and attention shifts to baby (over several days)
What is the letting-go phase?
Giving up some things, previous role Giving up ideal childbirth that may have not happened
What is a hemorrhage defined as?
>500ml blood loss after vaginal birth >1000ml blood loss after C-section
How does ACOG define a postpartum hemorrhage?
cumulative blood loss of >1000 or blood loss accompanied by S/S of hypovolemia within 24hrs following birth process
What are the 5 T's that cause a hemorrhage and an example of each KNOW THIS!!!
Tone: uterus not contracting Tocolytics: Mag Sulfate Tissue: Retained placenta Trauma: Cervical laceration Thrombin: Pre-existing clot disorder or DIC
When is the patient at greatest risk for getting a post partum hemorrhage?
The first hour
What should you be assessing during fundal checks?
Fundus is firm ball size of grapefruit Level of umbilicus Midline
How can you assess blood loss?
Weight peripad of chucks 1g of weight = 1ml of blood
What is the first intervention for a postpartum hemorrhage?
Fundal massage!
What should you be looking at vital wise when managing a postpartum hemorrhage?
q3-5min MAP tachypnea, tachycardia O2, RR Consider telemetry
What are some other nursing interventions for postpartum hemorrhage?
Bladder management Elevate legs Medications I's and O's IV access (for LR or plasma expanders) Assess for shock Lab work Transfusions
What 4 meds can be given for postpartum hemorrhage?
Oxytocin: Tightens uterus 20-40 units/min Methylergonovine Misoprostol Carboprost Tromethamine
What medication is contraindicated with asthma?
Carboprost Tromethamine
What medications in contraindicated with HTN?
Methylergonovine
What are some thromboembolic disorders?
Superficial Venous Thrombophlebitis DVT PE
What causes thromboembolic disorders?
Venous Stasis Hypercoagulable blood Injury to the endothelial surface of blood vessel
What is a puerperal infection?
A bacterial infection after childbirth 100.4 or higher fever first 24hrs and occurring on at least 2 of the first 10 days postpartum
Different types of bacterial infections
Endometritis Wound infection UTI Mastitis Septic pelvic thrombophlebitis
What are some affective disorders post partum women might experience?
Postpartum... blues, depression, psychosis Bipolar 2 disorder Panic disorders Postpartum OCD PTSD
When are late preterm infants born?
Between 34 and 38 weeks
How often should you monitor the temperature for a late preterm infant?
Every 3-4hrs
What is kangaroo care?
Skin to skin contact
What 3 risks are a part of the baby triad?
Temperature, hypoglycemia, respiratory issues
How would be some characteristics of a 24w baby?
fragile see through skin, not a lot of subq fat
What can stress a baby easily and why should they be avoided?
light and noise Can decrease O2 and cause a bradycardia episode
What would be some common respiratory issues?
Apneic spells (greater than 20seconds), effort of breathing (using accessory muscles, nasal flaring, grunting
What is the Nurse's role in coalition?
When 2 or more groups join to maximize resources, increasing their influence and improving their chances of success in achieving a common goal, they form a coalition
What is the Nurse's role as a change agent?
Nurses communicate with elected officials at the local, state, and federal levels through letters, emails, or personal visits, belonging to a professional organization, speaking publicly, or serving on advisory boards engage the nurse in effecting policy change
What does the Title VIII funding (HRSA) do?
provides the largest source of federal funding for nursing education
What is the Patient Protection and Affordable Care Act of 2010 (Health Care Reform Act)?
All U.S. citizens and legal residents mandated to have qualifying health coverage, Subsidized premiums for lower income families, Required coverage of dependent adult children up to age 26 for those with group policies, Significant insurance changes, funded through new fees and taxes
What is the Welfare Reform Act of 1996?
Restricted eligibility for Aid to Families with Dependent Children (AFDC), Medicaid, and other federally funded welfare programs
What is the Health Insurance Portability and Accountability Act (HIPAA) of 1996?
This law offered protection for patient privacy and confidentiality
What is the Occupational Safety and Health Act of 1970?
Focused on health needs and risks in workplace and environment
What is a public sector?
Influenced by social and political theories, needs are determined by voting shifts, electoral realignment, and term limits
What is a private sector?
Includes employers, professional organizations, nonprofit health care organizations (American Heart Association), and for-profit corporations that deliver, insure, or fund health care services outside government control
What is the public health policy?
Decisions made by legislative, executive, and judicial branches of one of the three levels of government (local, state, or federal), Influence health care through monitoring, production, provision, and financing of health care services
When does a bill become a law?
passed both houses (congress- senate and house of representatives) and signed by the president, Executive branch neither signs nor veto's the bill, Vetoed by the President but is approved by a 2/3 vote in the House of Representatives and Senate
What is Bicameralism?
Power to enact laws is shared by the House of Representatives and the Senate
What are the positions in the judicial branch of government?
federal: U.S. Supreme Court; U.S. Court of Appeals; U.S. Circuit Court, state: State and County Courts, local: Indiana Circuit Courts, Indiana District Courts, Indiana Probate Courts
What are the positions in the legislative branch of government?
federal: U.S. Congress, state: Indiana State Legislature, local:City council County Board of Commissioners Township Board of Supervisors Township Board of Trustees
What are the positions in the executive branch of government?
federal: president and Vice President, state: governor, Local: Mayor County Executive Township Supervisor
What are the three branches of government?
Legislative (makes law), Executive (carries out the law), Judicial (applies the laws to specific court cases, determines whether someone has broken the law, and evaluates laws to make certain that they are legitimate)
What are the three separate levels of the US government?
federal, state, and local governments
What is the purpose of the government?
Regulation of conditions beyond individual control and provision of individual protection through a population-wide focus
What is the importance of nursing in policy and legislation?
Nurses can be the powerful force that brings about change in the delivery and quality of the health care of aggregates
What is the role of the community health nurse in primary care?
First line or point-of-access medical and nursing care controlled by providers and focused on the individual, May not be the norm in developing or less developed countries that have overwhelming needs for basic necessities - safe drinking water, sanitation, hygiene
What is the role of the community health nurse in primary health care?
Essential services that support a healthy life, Involves access, availability, service delivery, community participation, and the citizen's right to health care
What does an effective health care delivery system need to do?
increase access and efficiency, improve health status through health promotion and disease prevention, eliminate health disparities, Protect individuals and families from financial loss due to catastrophic illness
What are the two basic health care systems?
market-based, population based
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