PowerPoint 1 Flashcards
Postpartum aka puerperium begins….
Last for….
Immediately after birth
6 weeks
Postpartum aka puerperium begins….
Last for….
Immediately after birth
6 weeks
When does postpartum technically begin?
Delivery of the placenta
Patient is no longer considered pregnant
How long do we closely monitor the patient (Recovery Period) once the Placenta is delivered….
Vag delivery 1 - 2 hrs
Cesaren Section 2 - 3 hrs
Once recovered from delivery the patient is moved to…
Mother/baby Postpartum unit
What is a couplet?
Mother baby pairing.
Nurse has 2 patients
Postpartum Unit length of stay…
Vag delivery 1 - 2 days
C/S 2-3 days
How should baby be in the bassinet?
Tucked in swaddle & No obstruction in crib
C/S born new born infants: Keep this handy to prevent aspirations
Bulb syringe
Safty:
Ensure that Parents don’t walk with baby in Hallways & Everyone wears proper ID & follows safety measures
You will make 70,000$ first year
Teach parents to recognize Beaumont Workers how?
Only give their babies to these workers
Photo name tag with a Pink Strip
Most important teaching
Parents are taught how to prevent kidnapping
Describe profile of a baby stealer
Female
Lives close to facility
Does reconoce
Married
Multiple lost pregnancies
Will take ANY infant available
Should a mom take the new born’s crib into the bathroom when showering?
Yes, to prevent kidnapping.
58% taken from mothers room
Which is best bottle or breast feed?
Both
According to PowerPoint
LATCH Score….
Assesses babies ability to get milk from breast.
0 (Worst) - 2 (Best)
L =latch
A = Audible Swallowing
T = Type of nipple
C = Comfort (of breast)
H = Hold (how baby holds the breast)
What is a good LATCH Score?
> 7
Latching problems on babies end include…
Supply of milk issues on moms end….
Being premature, poor positioning, underdeveloped suck reflex, anatomical difficulty
Diabetes/ thyroid issues
Colostrum is produced when….
Describe composition….
Mid-pregnancy 12 - 18 weeks
Yellow, clear, white: immune factors, protein, sugar and fats
Colostrum has a laxative effect and clears meconium from the infant.
What will happen if meconium isn’t cleared out?
Describe other SE of giving a baby a “laxative “
Jaundice
Weight loss is expected
Colostrum has more or less calories than Formula or Mature milk?
Protein?
Less calories
More protein
Care of mother postpartum (5)
Promote self-care
Peri Care (Use bottle NO WIPING) - Castile soap maybe used
Pain meds
Ambulation
Be her advocate
Measures to suppress lactation if not breast feeding (3)
Tight fitting bra 24hrs a day
Ice for discomfort
No warm water on breast during shower
What is BUBBLE-DEP
- Breasts:
Assess for engorgement, nipple condition (cracks, soreness), and breastfeeding effectiveness.
U - Uterus:
Check the firmness and position of the uterus. It should be firm and descending toward the pelvis. A soft (boggy) uterus can indicate uterine atony and increase the risk of hemorrhage.
B - Bladder:
Assess for urinary function, bladder distention, and any issues with urination (e.g., retention or incontinence).
B - Bowels:
Monitor bowel sounds, bowel movements, and any signs of constipation or discomfort with defecation.
L - Lochia:
Assess the amount, color, and odor of postpartum vaginal discharge (lochia). This helps monitor healing and detect signs of infection.
E - Episiotomy/Perineum:
Check the condition of the episiotomy site, perineum, and any lacerations for healing, signs of infection, or hematoma.
D - Deep Vein Thrombosis (DVT):
Assess the legs for signs of DVT, such as pain, redness, warmth, or swelling in the calves, which can indicate clot formation.
E - Emotional Status:
Evaluate the mother’s emotional and psychological state for signs of postpartum depression, anxiety, or baby blues.
P - Pain:
Assess the type and severity of any pain, such as perineal pain, incisional pain (from cesarean), or breast discomfort, and provide appropriate pain management.
The BUBBLE-DEP assessment is a critical component of postpartum care, ensuring the health and recovery of the mother while also identifying any potential complications early.
Discharge teaching for new mothers (6)
BUBBLE-DEP
Birth control plans?
Ovulation is usually before menses - Ovulation can occur 3 - 6 weeks postpartum. Before the first period
Breast Self Awareness
Importance of 6 week check-up
Can breast feeding stop ovulation?
Yes (lactational amenorrhea)
But it is not a sure method of birthcontrol
Swelling: One leg, usually the calf or thigh, may become noticeably swollen compared to the other.
Pain or Tenderness: The patient may experience pain, cramping, or tenderness in the leg, especially in the calf area. This pain often worsens when walking or standing.
Redness or Discoloration: The skin over the affected area may appear red or bluish in color.
Warmth: The affected leg may feel warmer than the other leg due to increased blood flow and inflammation in the area of the clot.
Leg Heaviness or Fatigue: The affected leg might feel heavy, tired, or uncomfortable.
Visible Veins: Sometimes veins on the surface of the leg may become more prominent or noticeable.
Symptoms of…
DVT
Symptoms of DVT (6)
Swelling: One leg, usually the calf or thigh, may become noticeably swollen compared to the other.
Pain or Tenderness: The patient may experience pain, cramping, or tenderness in the leg, especially in the calf area. This pain often worsens when walking or standing.
Redness or Discoloration: The skin over the affected area may appear red or bluish in color.
Warmth: The affected leg may feel warmer than the other leg due to increased blood flow and inflammation in the area of the clot.
Leg Heaviness or Fatigue: The affected leg might feel heavy, tired, or uncomfortable.
Visible Veins: Sometimes veins on the surface of the leg may become more prominent or noticeable.
Since postpartum patients are at a higher risk of DVT due to pregnancy-related changes in the body (such as increased clotting factors and reduced mobility), any suspicion of DVT should be taken seriously. Immediate medical attention and diagnostic tests, such as an ultrasound, are necessary to confirm the diagnosis and begin appropriate treatment.
Important discharge teachings (4)
DVT Awareness
Excessive Bleeding
S/S Infection
Thoughts of harming self or baby
Maternal self-care
Importance of…
Rest & Sleep
CRYING BABE Assessment
Consist of…
Colic: Evaluate if the baby’s crying is due to colic, which is characterized by prolonged, unexplained crying episodes, often in the late afternoon or evening.
R - Reflux: Consider gastroesophageal reflux, which can cause discomfort after feeding, leading to crying, arching the back, or spitting up.
Y - Yellow (Jaundice): Assess for jaundice (yellowing of the skin or eyes), which can cause lethargy or irritability.
I - Infection: Check for signs of infection such as fever, irritability, or changes in feeding and behavior that could indicate illness.
N - Nappy (Diaper) Change: Determine if the baby is uncomfortable due to a soiled or wet diaper.
G - Gas: Evaluate whether the baby is experiencing gas, which can lead to bloating, discomfort, and crying.
B - Breastfeeding/Bottle Issues: Check for feeding problems, including poor latch, overfeeding, underfeeding, or nipple confusion.
A - Attachment/Comfort: Assess if the baby is crying due to the need for comfort, closeness, or physical contact with the caregiver.
B - Burp: Ensure the baby has been properly burped after feeding to avoid gas buildup, which can cause discomfort.
E - Environment: Check if the baby’s environment is too hot, too cold, too noisy, or otherwise uncomfortable.
The _____ assessment helps identify common reasons why an infant might be crying and guides caregivers in taking appropriate action to alleviate the baby’s discomfort or address underlying issues.
CRYING BABE
Colic (C):
Symptoms: Prolonged, intense crying, often in the evening.
Treatment:
Soothing techniques, such as swaddling, rocking, or using white noise.
Try changing feeding positions or using anti-colic bottles.
In some cases, consider a dietary change for breastfeeding mothers (e.g., reducing dairy).
Consult a pediatrician if symptoms are severe.
Reflux (R):
Symptoms: Frequent spitting up, arching of the back, irritability after feeding.
Treatment:
Treatment:
Keep the baby upright for 20-30 minutes after feeding.
Feed smaller, more frequent meals.
Consider thickened formula or prescribed medications (e.g., antacids) for severe cases.
Consult a pediatrician if symptoms persist or worsen.
Yellow (Jaundice) (Y):
Symptoms: Yellowing of the skin or eyes.
Treatment:
Treatment:
Mild jaundice may be treated by increasing breastfeeding or formula to help eliminate bilirubin.
More severe cases may require phototherapy (light treatment).
Regular monitoring by healthcare providers is necessary to ensure jaundice is improving.
Infection (I):
Symptoms: Fever, lethargy, poor feeding, or unusual irritability.
Treatment:
Treatment:
Immediate medical evaluation is necessary for suspected infections.
Treatment may include antibiotics or antivirals, depending on the type of infection.
Hospitalization may be required for serious infections in newborns.
Nappy (Diaper) Change (N):
Symptoms: Crying related to discomfort from a wet or soiled diaper.
Treatment:
Treatment:
Change the diaper frequently to prevent diaper rash.
Use barrier creams to protect the baby’s skin.
Ensure proper diaper fit and hygiene.
Gas (G):
Symptoms: Bloating, excessive flatulence, or discomfort after feeding.
Treatment:
Treatment:
Gentle tummy massages and bicycle leg exercises.
Burp the baby regularly during and after feedings.
Consider using gas drops (simethicone) if recommended by a pediatrician.
Breastfeeding/Bottle Issues (B):
Symptoms: Difficulty latching, fussiness during feeding, insufficient milk intake.
Treatment:
Treatment:
Ensure proper latch and breastfeeding positions.
Work with a lactation consultant if necessary.
For bottle-fed babies, try different bottle nipples or flow rates.
Ensure the baby is feeding adequately and gaining weight appropriately.
Attachment/Comfort (A):
Symptoms: Crying when left alone, calms down when held or soothed.
Treatment:
Treatment:
Provide skin-to-skin contact and hold the baby to promote bonding.
Use soothing techniques like rocking, swaddling, or soft music.
Create a calming, predictable environment for the baby.
Burp (B):
Symptoms: Irritability or fussiness due to trapped air after feeding.
Treatment:
Treatment:
Burp the baby during and after feedings by gently patting their back.
Try different burping positions (over the shoulder, sitting upright, or lying across the lap).
Environment (E):
Symptoms: Crying related to the baby being too hot, cold, or overstimulated
Treatment:
Treatment:
Adjust the room temperature (ideal temperature is around 68–72°F or 20–22°C).
Reduce noise, bright lights, or overwhelming stimuli.
Ensure the baby is dressed comfortably, neither too many nor too few layers.
The _____ score is a quick assessment performed on newborns shortly after birth to evaluate their overall health and determine if they need immediate medical care. It is usually conducted at 1 minute and 5 minutes after birth and, if necessary, at 10 minutes. The score assesses five key areas and assigns a score of 0, 1, or 2 to each, with a maximum possible score of 10.
A - Appearance (Skin Color)
P - Pulse (Heart Rate)
G - Grimace (Reflex Irritability)
A - Activity (Muscle Tone)
R - Respiration (Breathing Effort)
Total APGAR Scores
____: Generally normal; baby is in good condition and may need only routine post-delivery care.
____: Fairly low; the baby may require some assistance with breathing or other medical care.
____ : Critically low; immediate resuscitation and urgent medical care are needed.
7-10: Generally normal; baby is in good condition and may need only routine post-delivery care.
4-6: Fairly low; the baby may require some assistance with breathing or other medical care.
0-3: Critically low; immediate resuscitation and urgent medical care are needed.
Appearance (Skin Color):
__: Blue or pale all over.
__: Body pink, but extremities are blue.
__: Completely pink.
Pulse (Heart Rate):
__: No heartbeat.
__: Fewer than 100 beats per minute.
__: At least 100 beats per minute.
Grimace (Reflex Irritability):
__: No response to stimulation.
__: Grimace or feeble cry when stimulated.
__: Pulls away, sneezes, coughs, or cries vigorously when stimulated.
Activity (Muscle Tone):
__: Limp, no movement.
__: Some flexion of arms and legs.
__: Active movement.
Respiration (Breathing Effort):
__: Not breathing.
__: Weak or irregular breathing, slow.
__: Strong, regular crying and breathing.
Appearance (Skin Color):
0: Blue or pale all over.
1: Body pink, but extremities are blue.
2: Completely pink.
Pulse (Heart Rate):
0: No heartbeat.
1: Fewer than 100 beats per minute.
2: At least 100 beats per minute.
Grimace (Reflex Irritability):
0: No response to stimulation.
1: Grimace or feeble cry when stimulated.
2: Pulls away, sneezes, coughs, or cries vigorously when stimulated.
Activity (Muscle Tone):
0: Limp, no movement.
1: Some flexion of arms and legs.
2: Active movement.
Respiration (Breathing Effort):
0: Not breathing.
1: Weak or irregular breathing, slow.
2: Strong, regular crying and breathing.
Newborn Screen
Blood test done ____ and managed by Mi Dept of Health
Test for >50 genetic, hormonal, metabolic disorders
Disease tested for at birth (3)
When will parents get information about these test?
24hrs
Cystic fibrosis
Hyperparathyroidism
Phenylketonuria
Parents only get information if ABNORMAL results
A genetic disorder causing thick mucus buildup in the lungs and digestive system, leading to respiratory issues and poor nutrient absorption.
A condition where too much parathyroid hormone raises blood calcium levels, causing weak bones, kidney stones, and fatigue.
A genetic disorder where the body can’t break down phenylalanine, leading to brain damage if untreated. A strict low-phenylalanine diet is required.
Phenylketonuria (PKU), Cystic Fibrosis (CF), Hyperparathyroidism:
Cystic Fibrosis (CF): A genetic disorder causing thick mucus buildup in the lungs and digestive system, leading to respiratory issues and poor nutrient absorption.
Hyperparathyroidism: A condition where too much parathyroid hormone raises blood calcium levels, causing weak bones, kidney stones, and fatigue.
Phenylketonuria (PKU): A genetic disorder where the body can’t break down phenylalanine, leading to brain damage if untreated. A strict low-phenylalanine diet is required
CCHD
Critical Congenital Heart Defects Screening
Completed when?
How is Pulse Ox checked?
Completed at or after 24 hrs of age
Pulse ox checked: Right Hand (pre ductal) & either foot (Post Ductal)
Values should be equal or close (<3% difference)
Failure rate <1%
Very Accurate
Why is CCHD screening done 24 hrs or later after birth?
Newborns need time for their circulation to stabilize and transition from fetal to normal circulation after birth.
Critical Congenital Heart Defect Screen FAILS if…(3)
Any oxygen sat is <90%
Oxygen Sat is <95 in right hand and foot on 3 measures, each measure separated by 1 hr.
> 3% difference exists in oxygen sat between right hand and foot on 3 seperate measures, seperated by 1 hr
New borns are weighed when?
What happens with a new borns weight?
When do we become concerned about a babies weight?
At birth & every 24 hrs inpatient
Weight will initially go Down.
8% loss in birth weight is a concern
The SAME scale is used for new borns weight.
Describe…
Small for gestational age (SGA): Below the 10th percentile for their gestational age.
Appropriate for gestational age (AGA): Between the 10th and 90th percentile for their gestational age.
Medium/Moderate: Often used synonymously with AGA.
Excessive/Large for gestational age (LGA): Above the 90th percentile for their gestational age.
Best measure for knowing breastfeeding is successful
Weight
Moro / Startle Reflex
Arms out, arching their back, and then bringing their arms back in toward their body. Present from birth and usually fades by 4 to 6 months of age
Describe how saddling affects this reflex?
Prevents it and promotes longer/ deeper sleep
Is traditional swaddling still practiced?
It’s becoming abandoned
Studies show its better for babies to have access to their hands for Dev & Safety reasons
When do you bathe a baby?
Why?
Wait 12 hrs after birth.
A bath after birth will affect THERMOREGULATION
Why do babies on sugar protocols need several normal blood glucose checks before a bath?
Stress from the bath temp can Drop Blood Glucose
Post new born bath procedure…
Place skin-to-skin with mother & check temperature within 1hr. (Ensures thermoregulation)
Babies are screened for hearing 24 hrs after birth.
Why is it common to “refer” in 1 ear if baby was a C/S?
Why are new borns screened for hearing loss?
Refer = Didn’t pass hearing test
A C/S a baby may have fluid trapped in middle ear due to lack of Pressure from Natural Birth
New borns are screened because early treatment will improve results
Describe how to test a babies hearing..
Test when Sleeping
3 sensors placed in Forehead, Nape of neck, back of shoulders
Earphones are placed and emit clicking sound.
If infants moves at appropriate time they Pass if not Refer
CORD CARE
Clamp?
How the cord should appear…
Diaper….
Time to fall off..
Alcohol
Stays clamped
Stump dry, no S/S of infection (edema, Purulent drainage, odor)
Diaper under the stump
Cord fall off in 10 days
No Alcohol
Record all I & O’s
T or F
What does blue line on diaper mean…
T
Urine present
Protocol for HbsAg (Heptitis B Surface Antigen) Negative & Positive mom.
Neg. Hepatitis B vaccine within first 2 months
Pos. Hepatitis B vaccine in 12 hours & HBIG (Hepatitis B Immunoglobulin) - Different areas for injection
Status unknown: Hepatitis B <12 hrs of birth & Test Mother. If mother is positive infant receives HBIG ASAP
Circumcision is offered when…
It is usually completed when…
Completed by Obstetrician
Offer first 1 - 3 days
Atleast 12 hrs old and in good health
Phimosis…
When the foreskin cannot be fully retracted over the glans penis
Decreased
UTI / STI
Penis cancer
Phimosis
Risk of giving partner cervical cancer (HPV)
Describes which elective procedure
Circumcision
Circumcision & Vitamin K (Explain)
When does the new born begin to produce vitamin K
Parents must agree to their son to receive vitamin K (K = Klotting) before a circumcision.
They may otherwise refuse Vitamin K
Instantly after birth but Takes Weeks - Months to produce sufficient vitamin K
Circumcision Care
Who performs the initial post procedure check?
(Caution parents not to change diaper until first post procedure check is done)
If bleeding apply new gauze with petroleum jelly (wicks moisture & keeps penis clean) Apply pressure.
If bleeding is excessive or doesn’t stop in 5 minutes….
When should infant urinate after circumcision
Nurse
Contact HCP
6 - 8 hrs
Discharge Teachings Circumcision
Apply….
If yellow crust appears….
Avoid immersion baths T or F
Can infant formula tylenol be given?
Petroleum jelly
Leave yellow crust alone, it is healing
T avoid immersion baths
Yes, infant tylenol is a thing.
To reduce risk of SIDS
Sleep posistion
Breastfeeding?
Pacifier?
Swaddle?
Back to bed, No reclined sleeping, No CoSleeping
Breastfeeding if able
Pacifier use after 2 weeks
Tummy Time…
Supervised placement of infant on stomach to allow them to strengthen muscles.
&
Avoid (plagiocephaly) flat spots on head
Condition in which an otherwise healthy baby cries excessively and is difficult to soothe, typically for more than 3 hours a day, at least 3 days a week, for 3 weeks or longer. It usually begins in the first few weeks of life and peaks around 6 weeks, often resolving by 3 to 4 months of age.
Colic
