Finals 2nd semester

Unit 1

• 1.1 Concept: Self Management ⭐⭐⭐
• Normal Antepartum (before delivery care)
  • Nurse collects OB & Health History.
• Case Study: patient takes sertraline daily, acetaminophen and naproxen sodium PRN for headaches
  • Pregnant patients cannot take NSAIDS due to pregnant women having extra blood volume, it makes pregnant women bleed easily.
• Weeks of Gestation = Weeks the mother carried the baby
• Early term: anything before 37 weeks
• Preterm: 21-37 weeks
• Twin Pregnancy counts as 1 pregnancy
• Naegele's Rule: Figures out EDD = Last Period - 3MO + 7days
• Spontaneous Abortion: Miscarriage
• Elective Abortion: Medically where you have remainings in body or pt choosing the discontinue pregnancy
• Primipara: 1st pregnancy
• Prenatal Care/Education that you would provide @ 9 weeks
  • 1. Nutrition Education, Prenatal Vitamins
  • 2. Urinalysis to check for glucose, STD’S, ketones, proteins
  • Protein in urine can indicate preeclampsia
  • Glucose can indicate gestational Diabetes
  • 3. Blood sample, for complete blood count to r/o anemia
  • 4. Assist the PCP with collecting specimens for vag culture
  • STD’S, Pap Smear to make sure cervix is healthy, pap smears Shows HBV
  • 5. Order Blood Type, to see if pt needs RH
  • Rhogam if mother has a blood type of B- and has a partner is + and so is baby blood +
  • The fetal cells circulating in the mother, if the baby has a + blood. Mom's cells fight with each other and can create risk that can hurt the baby or the baby in the next pregnancy.
  • Rh is run after delivery
  • Mom receive Rhogam shot during pregnancy and after if needed
  • RECES Factor
  • 6. Collect moms emotions of pregnancy & or symptoms of abuse ( pop eye blood vessels, bruising.)
  • 7. Is she with the same partner
  • 8. Allergies (EX. Avocados are Latex.)
• Fill In the Blank.
  • Routine prenatal visits are scheduled every 4 weeks during the 1st trimester
  • The health Care provider will order an ultrasound to check for fetal anatomy & heart rate & growth & respirations & circumference (head & long bone indicate gestational age ) that could indicate fetal anomalies
  • The nurse informs the pt that she can hear the heartbeat during the second trimester and feel fetal movements after 16 weeks
  • Using Fundal Height is a noninvasive way to monitor the growth of the fetus and is usually done at every visit after 20 weeks gestational but may have 2 weeks margin of error
• Match The expected psychological responses to pregnancy to the correct trimester
  • 1. Mother begins reading about fetal development and asks the nurse about Prenatal classes.
  • First Trimester
  • 2. Reports feeling unsure about the pregnancy to her PCP.
  • First Trimester
  • 3. Expresses concern regarding partner who travels frequently
  • Third Trimester
  • 4. Packs hospital bags.
  • Third Trimester
  • 5. Ask the provider if she’s normal to feel sad one minute and happy the next.
  • Second trimester ( hormones take off )
  • 6. Discusses herself as a baby with parents and looks at albums of herself and her partner
  • First Trimester
• Normal Postpartum ( After Birth )
  • Postpartum Adaptations After Delivery AKA 4th Stage of Labor
  • Location & firmness of Fundus: The fundus lowers, to find the top of the fundus, go below the belly button, support the bottom of the tummy and with dominant hand below belly button and feel. ( if you find it above the belly button and to the side is BAD>)
    • The fundus should get smaller every day. It takes 6wks to go back to normal size.
  • Vital Signs:
    • Heart rate Increase, If infection present bp, temp, hr increase
  • Amount & Color Of Lochia: Lochia is the discharge after delivery, starts off dark and gets lighter and lighter. Too much is 1 pad an hour or less fully saturated.
    • Weight the product: use dry - amount with products with blood on it. Ex: if bed pad weighs 2 pounds after delivery it weighs 10 pounds subtract.
  • Breast Size & Symmetry: Are they the same size, milk production increases after @ 3 day mark
    • Find out if she is breastfeeding
    • Milk produces @ 20 wks of pregnancy
    • Wear ice packs, good bra Signs of nipple trauma
    • Asses the pumping pieces to fit the correct size of nipples
    • Pumping technique and size
    • Mother breast feed not nipple feed. Babies suck by reflux, the top platelet causes a reflux for the baby to suck.
  • Urinary Output:
    • To make sure the uterus is placed and distended, Check for infection, Make sure the kidneys are working properly
  • IV infusion:
    • We have a 18 gauge in case we have to administer blood or large volumes
  • Bonding between mother & Infant:
    • To help mother not get PP depression, help with any questions or concerns the mother may have
  • Involution Of the Uterus & Lochia

Lochia

• Scant: <2.5cm
• Light: 2.5cm-10cm ( 1-4 inch
• Moderate: 10-15cm
• Heavy: Pad is saturated in 1 hr or less.

What Factors increase the risk for Hemorrhage

• Baby size
• Multiple Gravida
• Cesareans
• Operatice Vag Deiliervy ( surgical procedure, stitches)
• Anemia
• IN BOOK IS 1000mL ( QBL )
• History of Fibroids

Caring for PP Mom

• Administer : TynNoel, Mortin, Perccait
• Apply ice Pack first 24 hrs
• Apply heat after 24 hrs
• Offer Sitz Bath: 3rd & 4th degree are helpful for moms who have tears
• Offer Peri Bottle: you can use warm water to clean herself
• Administer: Ibuprofen 800 mg Q8 hr Prn

Postpartum Psychosocial Care: ( IMPORTANT FACTOR )

• Becoming acquainted: Bonding & Attachment
• Touch & Verbal Behaviors

Maternal Role Adaptations: ( RUBEN 3 phases of adaptations pg 416 )

• Taking in ( pt talks about her experience, 24 hrs pt takes in what happens )
• Taking Hold ( shift between less about me more about the baby. )
• Letting Go ( reality )
• Becoming a Mother (pg 418)
• Role Attainment, Mercer theorist name 4 Stages: Anticipator , Formal Stage of Birth , Informing Learning , Personal Cultural Influences

Postpartum Depression Screening.

• 10 questions that mother answers to indicate PP depression
• Screening For PP Depression
• Difficulty Bonding
• Severe Fatigue
• Feelings of Doubt
• Sleep Changes
• Hopelessness
• Iriablity
• Trouble Focusing

Family Discharge

• Mother has no complications
• Labs & Rh are resolved. 3 point drop in Hemoglobin mom needs blood.
• Appropriate teaching has occurred
• PP care & F/U Planned ( C/S 2 wks pp , Vag 6wks PP )
• Support TOCO - 24 wks and up to be able to pick up FHR
• Doppler - under 24 wks

1.2 Normal Labor ⭐⭐⭐⭐

• Physiologic Where we want the fetus growing : In uterus to avoid complications
• Fallopian tubes: If pregnancy develops in these can cause Ectopic pregnancy, can be emergent
• Labor
• True Labor
  • A series of continuous & progressive Uterus Contractions
  • Dilation, Cervix Effacement
  • Occurs spontaneously
  • 37-42 wks of pregnancy
• False Labor
  • Braxton hicks
  • Cervix not fully dilated. EX; can send mom back home dilated @ 3
  • Term- 38-42
  • Preterm: 20-37
• Premonitory ( Signs of labors)
  • Means labor is coming but not actually in labor
  • Braxton Hicks contraction
  • Lighting/Dropping : fetus positioned in pelvis
  • Increased clear vaginal secretions
  • Bloody show aka Mucous plus, its snot secretions that fall out, it is kept between the cervix to avoid bacteria entering
  • Energy Spurt aka nesting: all this energy that you start doing shit
  • Small weight loss
  • What do you say to pt that these are false labors?
  • Encourage her and tell her to come back if anything happens

True Labor

• Contractions: Regular intervals; frequency durations & intensity increase over time
• Discomfort: begins in lower back radiates to abdomen
• Comfort Measures: ( Walking, position changes, hydration)
• Contractions increase despite comfort measures
• Cervical Changes: Increased cervical dilation and effacement

False Labor

• Contractions: Irregular intervals; no increase in frequency, duration, or intensity; may dissipate over time
• Discomfort: Located in lower abdomen and groin
• Comfort Measures: ( Walking, position changes, hydration.)
• Contractions may lessen or dissipate with comfort measures
• Cervical Changes: No cervical Changes

When to go to the hospital

• Contractions
• A pattern of increasing regularity, frequency, duration and intensity
• Nullipara( first pregnancy ): regular contractions, 5 to mins apart for 1 hr
• Multipara ( more than 1 pregnancy ) : regular contractions, 10 min apart for 1 hr
• Ruptured Membranes: water broken
• Bleeding , red bleeding
• DFM
• Other concerns
• How to check if Pt is SROM: PH test, amino acid test

Leopold's Maneuvers:

• Determine the presentation and position of the fetus and to aid in locating fetal sound. To see its breached, this is a manual way of doing it. But now you can do Ultrasound

4 Stages of labor:

• First: Cervical dilations from 0 - 10
• The Progression of labor: Latent, Active, Transition, Push
  • Latent: 0-3 cm
  • Active: 3-7cm
  • Transitions: 7-10cm, Women vomits, Can say abrupt things
• Second: Expulsion 10cm to Baby delivered
• Pushing: 10cm-Birth
• Third: Placenta Delivery from the baby to delivery of placenta
• Fourth Stage: Maternal hemostatic Stabilization
• Recovery phase to make sure she is not hemorrhaging typically 1 - 4 hrs if is stable

Epidural Recommendation

• 3-7cm phase.

Mechanism Of Labor: Movements fetus makes before delivering EDFIEEE ( EVERY, Dumbass FUCKING, IGNORED EEE )

• Engagement: Baby head falls down into cervix ( lighting )
• Descent: starts to come down in cervix
• Flexion: shifts into a ball
• Internal rotation: makes it easier for the baby
• Extension: head comes out, but pops back in like a turtle head
• External Rotation: makes a twist when it comes out
• Expulsion: delivery of the baby

Main Components of the Birth Process ( The 4 P’S) ( Power,Passage,Passenger,Psych)

• Power: Contractions of the uterus that has no control over and maternal pushing
• Contractions is what helps push the baby out
• How to tell if uterus contraction: Toco, Internal Manometry ( can be on the placenta or uterus)
• Passage: Cervix Effacement
• Cervix is not effaced or dilated
• Cervix is 50% effaced and not dilated
• Cervix is 100% effaced and dilated to 3cm
• Cervix is fully dilated to 10cm
• Medication that helps with thinning of cervix : Oxytocin ( PIT )
• Cervix not thinned and fully dilated can cause tearing
• Multigravida labors faster than primigravida
• Passenger: the Baby
• Head Size: Molding
• Presentation: Cephalic, breech, shoulder
• Lie: Longitudinal, oblique, transverse
• Attitude: Flexion
• Position
• Psyche: Moms conditions/state of mind

Membrane Rupture ( in absence of uterine contractions, amniotic sac ruptures)

• After 37 wks

Premature Rupture of Membranes ( PROM ) Your water broke before labor started

• Doesn't have anything to do w. Premature delivery
• Prelabor rupture of membranes Before 37wks

Preterm premature rupture of membranes ( pPROM)

Prolonged rupture of membranes,

• If ruptured more than 18 hrs c/s

AROM: Artificial Rupture of Membranes

• Doc does it
• Complication: can cause prolapse cord, where the cord slips over the baby head and goes out the vagina , which can cause fetal death due to the cord losing circulation/oxygen
• Nurse shoves her hand in the vagina and lifts up the baby head and STAT C/S , mom may be intubated due to the timing.
• Fetal monitor will show the baby HR going down steadily
• If you don't see a cord, we will flip mom first to see if it changes the pt hr
• 18 - 24 HRS IS HOW LONG A PT CAN STAY LABORING BEFORE C.S
• Due to infections
• Can cause mortality
• Bad things happen leaving pts ruptured, will need constant monitoring
• Contractions
• DIF : Duration, Intestinty, Frequency
• Fetal Station Numbers ( Indicated the position of the head near or in pelvis )
• Fetal Station is stated in negative & positive #
• -5 station is a floating baby ( wont be born anytime soon.)
• -3 station is when the head is above the pelvis
• 0 Station is when the head is at the bottom of the pelvis, aka being fully engaged
• +3 station is within the birth canal
• +5 station is crowning
• EX: The nurse receives a report on a laboring client that the fetus is at a -2 station and transverse. The mother asks what this means, what is the best explanation?
  • It means the bay is about 2cm above ur hips bones and lying sideways
• Fetus Head Sutures
• Presentation
• Cephalic: What we want
• Breech: But down head up, Hard to delivery, the cervix can clamp down on the uterus neck, C/S are the way to deliver it
• Transverse Lie: Baby lying sideway, Doc can perform a version, if unsuccessful will need c/s
• Fetal Lie
• Longitudinal: Baby is alignment with moms spine
• Oblique: somewhat head down but twisted
• Transverse: lying side to side
• Fetal Attitude
• Flexion: flexing
• Extension: Stretching itself out
• Vertex position: Head down
• Military: Hands squared up
• Brow forehead
• Face: Baby face is presented
• Fetal Positioned:
• The relationship of the presenting part of the fetus, ( sacrum, mentum or occiput) Preferably the occiput, in reference to its directional position as it relates to one of the 2 maternal pelvic quadrants
• Positioned is labeled with three letters
  • The First Letter Reference either the R or L side of the maternal pelvis
  • The second letter reference the presenting part of the fetus, either occiput ( O ), sacrum ( S ) Mentum ( M ) or scapula ( Sc )
  • The third letter reference either the anterior ( A ), posterior ( P ) or transverse ( T ) part of the maternal pelvis
  • EX: LOA ( left, occiput anterior, which they like because baby does the twist to delivery)
  • Don't really worry about it
• Ways Physicians can Take the baby out
• Vacuum: Suctioning the baby out
• Forceps: Manual strong extenders that stretch mom during labor, clamp over fetus head, pulls fetus & causes tear
• KIWI: A manual pump suction on fetus that helps baby come out ( Can cause edema in baby head )

Fetal monitoring

• External: On moms abdomen
• Internal: In uterus or baby head
• Scalp Pro: screws into baby head, baby begins to crown and doc just cuts it, can fall out on the own, gently untwist off baby head
• Psyche: Moms state of mind and feeling of control is critical
• We want our patients educated, control
• Fear, tension and pain: we don't want that for our patients to have
• Moms state of mind is important
  • The state of the mothers psych is a crucial aspect of childbirth
  • Marked anxiety, fear or fatigue
  • Decreases a woman's ability to cope with labor pain
  • Maternal catecholamines are secreted in response to anxiety or fear, they inhibit uterine contractility and placental blood flow
  • Relaxation augments the natural process of labor
• Bonding:
• Skin to skin ( kangaroo care )
• Family adaptation to baby, visiting with sibling, skin to skin from dad
• Placing baby with mom after c/s someone needs to stay with mom due to not having full strength of arms etc

Natural Labor

• Cannot Medicate mom @ 8cm or epidural can cause fetal respiratory
• Change position, birthing ball can be alternatives of pain

Midwives:

• Professional Trained Support person that helps mother thru delivery or can even delivery mother at home

Individual and Cultural Values

• A woman's culture givers her cues about how she should behave and react to labor and how she should interact with her newborn
• Knowledge of the values and practices of cultural groups that the nurse encounters provides a framework to assess and care for the women and her family
• Birth is an emotional experience
• Always be aware of your feelings

Lethargy positions: most common for pts with epidurals, pit

Medications: Oxytocin (Pitocin)

• Used for dilations
• Pitocin bolus: helps with hemorrhaging
• Side Effects: BP & HR Change, Have to monitor with this medication, due the medication can rupture the membranes and cause fetal morality
• Start dose low, can go up in dose if baby can handle it

1.3 Newborn ⭐⭐⭐⭐

Nutrients and oxygen, blood is provided by umbilical cord This Sack is called Amniotic Sac

• Most Critical and immediate adjustment the newborn makes at birth is to establish Respirations. This begins a dynamic sequence of cardiopulmonary changes.
• If a newborn does not start an effective breathing pattern we must help!!
• Once cord is clamped baby needs to breathe ASAP
• Once baby comes out needs to be stimulated
• What Exactly Makes A Newborn Start Breathing?
• Chemical: Decrease in Po2 & pH, Pco2 during birth stimulate medulla
• Mechanical: Compression of fetal chest to expel lung fluids
• Thermal: Decrease in temp, stimulates skin sensors
• Sensory: Tactile stimuli & light, sound smell and pain ( stimulating )
• Vaginal delivery helps squish the fluid out of baby where a c/s doesn't
• OBJECTIVE Vigorous Cry = 2
• What does this score mean anyway?
  • 0-3 Indicates Severe Distress
  • 4-6 indicates moderate distress
  • 7-10 indicates no distress
• Completed at 1 minute of life, 5 minutes of life and 10 minutes as needed
  • ( Remember, care of the infant is never based solely on the APGAR Score.)

Improving the APGAR score

• Appearance: Oxygen Pulse: Assisted Ventilation, intubated, cpap ( Secondary Apnea happens to baby and is hard to recover)
• Grimace: Stimulation and ventilation
• Activity: Stimulation and ventilation
• Respiration: That's right, stimulation and ventilation
• Stimulation is: Vigorous repeated drying with warm, dry blanket. Also back rubbing and rubbing soles of feet.
• Too much Oxygen to primies can cause blindness
• A newborn's 5 min APGAR Score is 5, Which of the following interventions will you provide to this newborn ?
• Some resuscitation assistance such as oxygen, and rubbing baby's back and reassess APGAR score.
• Full resuscitation assistance is under 4 APGAR SCORE
• Signs and Symptoms of respiratory distress
• Tachypnea ( greater than 60)
• Nasal flaring
• Expiratory Grunting
• Reactions ( sucking in air, lines underneath the ribs)
• Central Cyanosis
• Apnea Greater than 10-20 secs ( baby are period breathers, respiratory needs to be counted in the full minute )
• Breathing Assistance
• CPAP ( Neopuff )
• Flow By Oxygen
• Suctioning
• Thermoregulation
• Most temp assessments are done axillary
• The normal range is 36.6C to 37.5C ( 97.7 - 99.5F )
• Measured by digital thermometer only
• Mckinney states the warmer can be used to measure temp, not safe as they are not calibrated to be precise. This is the main cause of hyperthermia, which will increase O2 usage. ( NEVER TRUST THE WARMER)
• Cold Babies are sick babies
• All newborn require diligent monitoring of temp
• First temp is taken Rectal ( Due to inverted anus, some babies are born with that. )
• Brown Fat
  • Newborns cannot shiver
  • About 5% of an infant's birth weight is brown fat
  • Activated by cold, lost as infant ages and expends amount at birth
  • Important for non-shivering thermogenesis
  • What happens with the fat brown is gone? its come doesn't come back
• Thermoregulation
• Conduction: Heat loss by direct contact with a cooler surface
  • Putting a baby on a table
• Convection: Flow of heat from body surface to air current of cooler air
  • Can also be warmer, fan
• Evaporation: Loss of heat as surface liquid is converted to vapor
  • Vapor, out of pool and cold
• Radiation: Heat loss from the body surface to a cooler solid surface that is close, but not in direct contact to the infant
  • Feeling cold from the window but not touching
• The baby is delivered, then placed on the mothers abdomen. The use of a pre-warmed abdomen is and example of Conduction.
• As you begin to evaluate the infant, you use several dry blankets to remove the fluid covering the infant. This is an example of preventing heat loss by Evaporation.
• As you are drying the infant, you notice that the air conditioning has been turned up and the vent is flowing directly on the newborn. You politely ask the labor nurse to turn the temperature of the room up to prevent heat loss by Convection.
• After one hour of skin-to-skin and a successful breastfeeding, you are asked to measure the newborn. You place the infant on a pre-warmed infant warmer that works to warm the infant by Radiation.
• The use of a pre-warmed mattress for the infant is another Example of preventing heat loss by conduction.
• Problems from cold stress
  • Increased oxygen need
  • Decreased surfactant production
  • Respiratory Distress
  • Hypoglycemia ( low BS, common in cold baby )
  • Metabolic Acidosis ( can die )
  • Jaundice
  • Grunting
• Preterm
  • Preterm newborn is vulnerable
  • Decrease skin temp
  • Increased R rate with apnea
  • Bradycardia
  • Mottling
  • Lethargy
  • Interventions: Place infant under radiant warmer or in incubator adjusted so infant is kept at 97 to 98 degrees

Prevention of hypothermia.. An ounce of prevention is worth a pound of cure

• Keep hat on infant
• Swaddle infant ( 2 blankets )
• Closely monitor infants temperature, hourly rounding
• Hourly rounding to ensure infant is wrapped snugly in blanket
• Closely monitor for signs of potential heat loss ( convection, conduction , radiation, evaporation.)
• Stabilize temperature prior to bathing
• Can take two hours to warm up baby
• Infants are primarily warmed by two methods
  • Skin to Skin ( mom, dad, keep baby on chest)
  • Overhead Radiant Warmers ( Panda )

A nurse is called to the birthing room to assist in the assessment of a newborn who was birth at 32 weeks gestation. The newborn’s birth weight is 1,100 grams. Which of the following are expected findings of this newborn?

• Abundant Lanugo, Weak grasp, Translucent skin ( ^ hair )

Neonatal Transition

• First period of reactivity: From birth until they fall asleep. Best time to get in firth breastfeeding
• Period of decreased activity: Fall into deep sleep
• Second period of reactivity: Awake again, ready to feed and bond

Behavioral States

• Quiet Sleep: Deep sleep with no eye movements, little or no response to noise ( hard to breastfeed)
• Active Sleep: has Rem, may move or fuss, more likely to startle, may or may not stay asleep ( hard to breastfeed)
• Drowsy State: Transition from sleep to wake, eyes are glazed and unfocused
• Quiet Alert: Excellent time for bonding, alert and interested in surroundings
• Active Alert: Fussy, restless, aware of feeling hungry or cold
• Crying: Follows active alert if needs, untended, may take time to comfort
• Interventions: Diaper changes, milk on lips, swaddle

Common Assessment Findings

• Caput Succedaneum: Fluid/swelling in head, goes away
• Cephalohematoma: takes several weeks to go away, big bump on head caused by pressure. Blood in the scalp.

Difference between Cephalohematoma and Caput Succedaneum

• Cephalohematoma involves blood pooling in the scalp
• Caput succedaneum involves swelling of the head
• CH is caused by damaged blood vessels inside the head
• CS is caused by physical pressure on the outside of the head

Normal Cranial Findings ( Normal )

• Head molding ( goes away in 6 hrs ) Head shifts to fit birth canal
• Internal fetal Monitoring scalp Probe: heals

Umbilical Cord Normal Expectations

• 2 arteries and 1 Vein ( Smiley face )
• Cord Care: keep it free from the diaper
• Cannot submerge baby in water till cord falls off. Water can cause bleeding to the site. Just let it fall off.

Normal Discolorations In Neonate

• Acrocyanosis Blue Discoloration of foot ( Baby thats not doing well will have it on arms/hands to)
• Facial Bruising ( menta delivery )
• Milia: clogged pores on face or nose
• Erythema Toxicum AKA Newborn Rash: no known cause, on chest & face, come & go
• Vernix: cream cheese on baby
• Lanugo: hair on baby, tends to fall off , can be sign of a preterm baby
• Epstein Pearls : white dot on gum line
• Mongolian Spots: discoloration looks like a bruise, small, dark, massive, chart it, some go or stay
• Natal Teeth: Some baby have teeth, we take them out due to aspiration risk

Newborn Poop

• Meconium: babies first poop , black or green, tar , sticky , sterile has no bacteria
• Urate Crystals: Brick Dust , mostly in breastfed babies, dehydrated baby

Reflexes

• Rooting, looking for breast , after 15 mins of birth , easiest baby to put the baby in the breast
• Morrow AKA Startle Reflex: to see if baby had a shoulder injury
• Sucking: within 10 mins after delivery
• Babinski: running finger down bb foot and refluxes

To Circumcise or Not, That is the questions

• Personal Choice of parents, we neither encourage nor discourage
• If parents choose not to circumcise, make sure the have skills to care for penis, this also involves teaching the CHILD to care for his penis
• Ensure adequate analgesia during the procedure. Injected lidocaine is the best
• Surgical Procedure that involves informed consent and time-out
• Method of surgery decided by MD, most stick to one method they prefer
• Its cultural, religious, something the parents need to choose for their kid, nurse cannot influences
  Pros
  Cons
  Lower incidence of Hiv & STI’s
  Cultural and Regional preferences
  Lower penile cancer rate
  Cost
  Cultural and religious beliefs
  Only healthy infants are circumcised at birth Possibility of phimosis
  Whole lot of men want their foreskin back
  Prefer appearance of circumcised penis

VITAMIN K must be given before a circumcised baby due to risk of hemorrhage.

Circumcision Care

• Plastibell : piece of plastic wrapped around penis: no care, will fall off 10 days after. No Vaseline gauze
• Gomco and Mogan Clamp ( scalpel l used to cut off skin) Vaseline gauze

Medications

• Erythromycin ( EES ) : Prophylactic to prevent opthalmia neonatorum which is blindness caused by STI gonorrhea, chlamydia or trachomatis
• Vitamin K/Phytonadione: Prophylactic for hemorrhagic disease of the newborn. Provides assistance with clotting until the gut is colonized. Given IM, thigh in vastus laterals
• Hepatitis B Vaccination: Given IM in opposite thigh as vitamin K. not the same med as HBIG ● Requires Consent of mother
• All injections are given to infants IM in thigh, Vastus lateralis

Nutritional Requirements

• The full term breastfed newborn needs an average of 85-100 kcal/kg daily
• The full-term formula fed newborn needs 100-110 kcal/kg daily ( fooorrmulaa = moooreeeula )
• Most ‘’ regular ‘’ formulas and breast milk contain 20 kcal/kg daily
• Infants may lose up to 10% of their birth weight, but is should be regained by 2wks of age
• Newborns should not be given supplemental water
• Parents using powdered formula must be instructed on how to correctly mix it.
• NEED TO KNOW THE PERCENTAGE OF HOW MUCH WEIGHT A BABY LOSS

$\frac{Old \ weight - \ new \ weight}{old \ weight} \times 100$

• Example: Birth weight was 3.26 kg
• New weight is 3.172 kg what is the total weight loss %?
• 3.26-3.172= .088/3.26 = 0.02699387 x 100 = 2.699 ( round ) 2.70% loss

Considerations When Choosing

• Does mom have support from family ( Partner ) and friends
• Does mom plan to return to work outside the home and when?
• What culture does the family belong to
• How supportive is the hospital staff? This is critical with a hospital that desires to be designated as ‘’ baby friendly.’’ baby friendly means supportive of breastfeeding
• It is time for a baby who is in a drowsy behavioral state to breastfeed. Which of the following techniques could the mother use to arouse the baby?
• Hand express milk onto the baby's lips
• Talk with the baby while making eye contact
• Remove the baby’s shirt and change the diaper

How do I know the baby is getting enough?

• Do you hear swallowing
• Does the baby seem satisfied
• Does baby have 8-10 wet/dirty diapers a day
• Has newborn lost more than 10% of their birth weight the first week after birth
• Breasts less firm/see milk on baby's mouth

Recommendation of how many mls babies should receive in feedings

• Day 1 5-7 ml
• Day 3 22-27 ml
• 1 wk 45-60ml
• 1 MO 80-150

The nurse is concerned that a bottle fed baby may become obese because of which activity by the mother ?

• She encourages the baby to finish the bottle at each food

How do they compare
Breast Milk
Formula
Less allergy no cows milk
Closely mimics breast milk as much as possible
Has important antibodies
Has added iron
Low in vitamin D/ require supplement Expensive $$
Contains iron that is better absorbed
Has numerous preparations for at-risk infants

Assists Bonding
-Higher Calories ( Prematurity )
Possibly free $
Better for some metabolism disorders

Breastmilk Poop Vs Formula

• BreastMilk: Slimy, looks like diarrhea
• Formula: Thicker, smells

What if mom decides not to breastfeed?

• Support her decision
• Encourage her to wear a tight bra
• Apply Ice Packs

When Performing nursing care for a newborn after birth, which of the following nursing interventions is the highest priority?

• The Greatest risk to the newborn is cold stress, therefore the highest priority intervention is to prevent heat loss. Covering the newborn’s head with a cap prevents cold stress due to excessive evaporative heat loss.
• Risk Factors for low blood glucose ( Hypoglycemia ) OBJECTIVE
• Large Gestational Age ( LGA )
• Small for gestational age ( SGA )
• Infant of diabetic mother
• Poorly Regulated diabetic mother
• Low APGAR score
• Prematurity/Postmaturity
• Growth Restriction
• Cold stress
• Symptoms & Signs of Neonatal Hypoglycemia ( LOW GLUCOSE )
• Abnormal Cry
• Irritability
• Apnea, Cyanosis
• Jitteriness, tremor
• Feeding