Unit 4 Bubble-he focus points Flashcards
B- Breasts
•Obvious changes related to milk production
•Must remove bra to examine breasts
•Engorgement usually occurs about 3rd day
•Small amount milk may be produced for up to one month
•Avoid stimulation of breasts until sensation of fullness passes if NOT breastfeeding
-Mechanical suppression used for non-nursing mothers
—–hormones that suppress lactation asso. with thromboembolic disease
—–other drugs unsuccessful & also have serious side effects
(Refer to textbook for nursing measures to alleviate soreness, engorgement, etc)
Bubble-He Acronym
- Breast
- Uterus
- Bladder
- Bowels
- Lochia
- Episiotomy
- Homans Sign
- Emotional status
B- Breasts cont
- To Assess: Ask mom to palpate her breasts. Ask her if they feel soft or firmer than yesterday. If there is a change, then her milk is starting to come in. Ask her if there is any pain or tenderness. Ask her if she has noticed any nipple soreness, cracks, or redness.
- Findings:
- —-1-2 days after delivery: primary colostrum present, possible tingling sensation, then filling to full, tender; snug bra needed (nursing or not).
- —-2-4 days average: breast milk appears, need to be stimulated by nursing, pumping, or manual expression to maintain milk supply
- Abnormal findings include
- —-crackles can mean possible fluid overload
- —-Firmness, heat, and pain indicate engorgement
- —-Redness of breast tissue, heat, pain, fever, and body aches can indicate mastitis
- —-Redness, bruising, cracks, fissures, abrasions, and or blisters on the nipples are usually associated with latching problems
B- Breast
- for breast feeding mothers teach
- —-Do not wait to feed until the baby is crying or distraught
- —-Begin to feed when the baby exhibits some of the following cues, even during light sleep
- ——–hand to mouth or hand to hand movements
- ——–sucking motions
- ——–rooting reflexes
- ——–mouthing
- —-babies consume small amounts in the first 3 days of life then their intake increases 15-30ml in the firs 24 hours to 60-90ml by the end of the first week because the meconium is clearing from the digestive tract.
- —-should feel tugging not pinching or pain
- —-baby sucks with rounded cheeks not dimpled cheeks
- —-th baby’s jaw glides smoothly with sucking
- —-swallowing is usually audible
- —-feed every 2-3 hours throughout a 24 hour period or every hour or so for 3 to 5 feelings and then sleep 3-4 hours between clusters
- —-wake the child even in the night to feed
- —-the average time for early feelings is 30 to 40 minutes or apex 15-20 minutes on each breasts
- —-stools change over time when feeding is adequate. it will be meconium the first 1-2 days the green and thinner days 2-3 and then green yellow by days 3-4.
- —-there will be 5-10 bm a day
Breast
breast feeding moms should Increase their caloric intake 300-500 a day.
- Drink to relieve thirst drinking to much water can dilute the breast milk
- breast feeding can help the mother to loose her baby weight
- rest as much as possible
- Avoid washing nipples with soap because it can dry the nipples
- Modified lanolin can be used to relieve soreness
- Can wear breast pads for leakage
- Can experience rhythmic uterine contractions durin breast feeding and is normal
- breast feeding is not a form of contraception, diaphragm/cap, spermicides, codons are best during the first 4 weeks.
- pill, patch, and rings are not recommended the first 4 weeks of nursing.
- use caution with medications only take what is absolutely essential.
- amid around, chloramphenicol, doxepin, lithium, and radio pharmaceuticals are contraindicated during breast feeding.
Breasts
- avoid alcohol when breast feeding
- smoaking can impair milk production so do not smoke within 2 hours of feeding
- With engorgement feed at least every 2 hours woth one an pump the other
- can use ice, gel packs, and cold compress when encouraged. after breast feeding try cabbage leaves, warmth. before breast feeding use anti inflammatorys, breast massage, and pumping. to much usage of cabbage leaves can reduce supply.
- for sore nipples use correct breast feeding techniques, feed on least sore nipple, wipe and remove saliva, keep open to air as much as possible, breast shells allow air flow.
bottle feeding
- If the infant is taken off the breast befor a year old iron fortified formula should be given.
- The first feeding is ideally given after the baby’s initial transition to extra uterine life.
- feeding readiness cues include stability of vital signs, effective breathing patterns, presence of bowel sounds, and active sucking reflex.
- The newborn should eat every 3-4 hours even if waking the newborn is required. Rigid feeding schedules are not recommended.
- Increases in appitite can be noticed at 10 days, 3 weeks, 6 weeks, 3 months and 6 months and correspond to growth spurts..
- Hold for feedings
- sit comfortably and hold in a semi upright position.
- Feedings are bonding time
- Hold bottle so fluid fills nipple
- If spitting up may need to decrease amount, or feed smaller amounts more frequently.
- Burping several times can decrease spitting up.
- Report vomiting one third or more of the feeding at most feedings ire projectile vomiting.
- boil bottles and nipples for 5 minutes.
breast care when bottle feeding
- On third day palpating may reveal tissue tenderness
- Third to fourth day encouragement may occur
- Milk present but do not express
- Discomfort usually decreases 24-36 hours after encouragement
- a breast binde or well-fitted, supportive bra, ice packs, fresh cabbage leaves and mild analgesics may be used to relieve discomfort
- lactation should cease within a few days to a week.
The postpartum uterus
To Assess:
–Have client void prior to checking fundus for accurate assessment
–Remember to hold bottom of uterus with non-dominant hand for support, but do not push it! You will alter your results if you do.
–Starting at the umbilicus, use your dominate hand for palpation
-Should descend one fingerbreadth per day
——1 fingerbreadth above the umbilicus = U+1
At the level of the umbilicus = U
——1 fingerbreadth below the umbilicus = U-1
Check for FIRMNESS of fundus
-Approximately the size of a grapefruit after delivery and just has hard!
If uterus seems larger than normal, attempt to express clots
If uterus feels soft (“boggy”) at any time, the uterus is not contracting properly leaving the woman at risk for hemorrhage. The nurse should massage the fundus until firm again. Woman may need Oxytocin/Pitocin or Methergine to stimulate uterine contractions for involution. If the bladder is not midline (most often to the right) the woman may have a full bladder.
-Findings:
—–1st 6-12 hours after delivery: firm, midline, and possibly above the umbilicus (U+1) (firm is grapefruit)
—–12-24 hours after delivery: firm, midline, and at or near level of umbilicus
—–No longer palpable by 10-14 days; back to pre-pregnant size by 6 weeks
The postpartum uterus
•Involution
—Rapid reduction in size of uterus & return to condition similar to non- state
•“Exfoliation”
—–healing of placenta site
—–prevents development of fibrous scar
•Uterus descends into pelvis 10-14 days after delivery
—-evaluate level of “fundus” each day
•Approaches non-pregnant size by 4-6 weeks
•Entire process of involution takes approximately 6 weeks
The postpartum uterus
-Assessment of Fundus
—–Measure in relationship to umbilicus
—–1 fingerbreadth above the umbilicus = U+1
•1 fingerbreadth below the umbilicus = U-1
•Have client void prior to checking fundus
•Remember to hold bottom of uterus with non-dominant hand
•Should descend one fingerbreadth per day
•Check for FIRMNESS of fundus
—–Approximately the size of a grapefruit after delivery
•If larger than normal attempt to express clots
•MASSAGE fundus until firm
•Subinvolution
—–When uterus DOES NOT involute as expected
the postpartum uterus
- Afterpains
—–Release of OXYTOCIN from posterior pituitary cause uterus to contract more rapidly
———increased amounts released with breastfeeding
———may cause “afterpains”
•Result of intermittent contractions
•Occur more frequently in multiparas, when uterus over distended, or if clots or placental fragments present
•Relief with:
—–lying on abdomen with pillow under “tummy”
—–analgesia
The postpartum uterus
- Oxytocic Agents
- —-Given to maintain uterine firmness and prevent hemorrhage
- —-Oxytocin (pitocin, syntocinon)
- ——–Preferred route – IV or oral
- ——–NEVER give undiluted bolus of oxytocin – causes hypotension
- —-Methylergonovine maleate (methergine)
- ——–Should NOT be given with hypertension
- ——–Preferred route – IM or oral
- —-Prostaglandin (prostin, hemabate)
- ——-Given IM
- ——-Side effects - N&V, diarrhea, fever, flushing, increase diastolic BP
- —-Misoprostal (cytotec)
- ——–Given orally or rectally
The postpartum uterus
-Potential Problems with Contraction of Uterus
—–Boggy” uterus (uterine atony)
———feels soft & spongy rather than firm and contracted
———associated with excessive uterine bleeding
———massage fundus and attempt to express clots
———encourage breastfeeding
•Fundus above the umbilicus
———suspect bladder distention
———may also be deviated to right
—–Excessive tenderness with fundal massage
——Also teach expected changes with Lochia
——Help client determine if bleeding is excessive.
———possible uterine infection
—–Important to teach self fundal massage
Bubble-he uterus
- INVOLUTION
- —Rapid reduction in size of uterus & return to condition similar to nonpregnant state
- —“Exfoliation”
- —Healing of placenta site
- —Prevents development of fibrous scar
- Uterus descends into pelvis 10 - 14 days after delivery
- —Evaluate level of “fundus” each day
- Approaches nonpregnant size by 4-6 weeks
- Entire process of involution takes approx. 6 weeks
