OB NEW MATERIAL

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