201_Newborn_first 24 hours and adaptations and discomfort of pp_safe sleep

Question 1

What are you checking in prenatal visits (normal ranges)? (5)

Answer 1

1. Blood pressure (systolic 100-140 / diastolic 60-90)
2. Symphysis fundal height (+/ 2-3 cm of GA, routinely gaining about 1 cm per week; use top of pubic bone as anchor and measure to the top of the fundus) {variation – in care provider, baby may have dropped, long/short waisted people may measure differently)
3. Position (start with the fundus, lateral, pawlick’s, pelvic) – looking for fetal pole (cephalic with homebirth; checking for position)
4. Fetal movement – observe; ask parent have you been feeling regular movement following babes regular patterns? Where are you feeling the kicks? (6 movements in 2 hours)
5. FHR – intermittent auscultation (doppler; pinard; fetoscope)110-160, acels are good, regular rhythm, decels 15 of 15 beats below baseline; listen for minute; listen over the fetal back

Question 2

How often check vital signs of adult immediate pp?

Answer 2

HR, RR, BP, Bleeding, Uterus: q 15 mins for first hour
Temp – once in first hour
All signs at 2 hours.

Question 3

What are you observing in adult in immediate pp? (9)

Answer 3

Vital signs
uterus (at umbilicus +/- 1)
Bleeding
Perineum
Bladder/Bowels (has voided)
Breast/Nipples
Ambulation
Pain/Comfort, Emotions
Dyad (first feed within 1-2 hours)

Question 4

What is being looked at in APGAR score (5)

Answer 4

HR (>100 bpm)
RR (good, crying)
Reflex response (cough, sneeze, cry)
Muscle tone (active/flexed)
Colour (completely pink)

Question 5

Normal APGAR?

Answer 5

7-10

Question 6

Normal newborn measurements?

Answer 6

Weight: for term infants is 2500 – 4500 g
Height: 46 to 54 cm
Head Circumference: 31-38cm

Question 7

How often nb vital assessments?

Answer 7

RR, HR, Temp initially, then every 15-30 mins in first hour
30-60 mins second hour
(RR- full min; HR – full min initially, then 30 seconds if normal)

Question 8

Normal nb findings?

Answer 8

RR: 40-60 breaths/minute (may be 30-60 in first 12 hours)
HR:100 -160 bpm
Temp: (axillary) 36.5-37.5 C

Question 9

Normal newborn breathing?

Answer 9

May be irregular/breathing in clusters/grunting

40-60 bpm

Question 10

Not normal nb breathing?

Answer 10

High pitched sound while breathing
flaring nostils
grunting
retractions
tachy

Question 11

10 Bs of postpartum care?

Answer 11

Baby
Breasts
Bladder
Belly
Bottom
Bowels
Bleeding
Baby blues/BRAIN
Birth control
Blood work

Question 12

What bleeding ISN’T normal pp?

Answer 12

Clot bigger than a plum. Bleeding that fills 2 pads in an hour.

Question 13

Normal physiological changes: pp vital signs?

Answer 13

Within normal limits. Milk temp increase on day 2-3

Question 14

Normal physiological changes: Uterus

Answer 14

Immediate: central, firm, at umbilicus
First week: after pains 72 hours, decrease by 1-3 cm below umbilicus;
1-6 weeks 1-3 cm below umbilicus per day, below pubic bone after day 14

Question 15

Normal physiological changes: Bleeding?

Answer 15

Immediate: moderate, dark red, clots
First week: decreasing colour/amount, red-pink, clots
2-6 weeks: pink, mucosy discharge then brown spotting

Question 16

Normal physiological changes: Perinium?

Answer 16

Immediate: swollen, bruised, tender
First week: decrease tenderness and bruising each day
Week 1-6: Minimal discomfort, well approximated, no bruising

Question 17

Normal physiological changes: Bladder/Bowels?

Answer 17

Immediate: No bowel activity, some difficulty voiding
First week: Increased urine output, mild urinary incontinence, bowel function returns, constipation common
1-6 weeks: Normal function

Question 18

Normal physiological changes: Breast/nipples?

Answer 18

Immediate: Soft breasts, nipples intact, small drops of col
First week: milk production day 2-4, mild engorgement, tender, sore nipples
1-6 weeks: Breasts full before feeding and soft after; nipples intact non tender