Week 8: PP Care & Newborn Nutrition Flashcards
Benefits of Breastfeeding: Infant
-reduced mortality
-maturation of GI trct and Immune system
-decreased risk of gastroenteritis, celiac disease, crohn’s disease, necrotizing entercolitis (premie), obesity, dental malocclusions
- protects from otitis media, respiratory illness, bacteremia, bacterial meningitis, lymphoma, T1 + T2 DM
lower incidence of allergies
- less likely for SIDS
- enhanced cognitive development
-pain relief during painful procedure
Benefits of Breastfeeding: Mother
- dec. PP bleeding, rapid uterine involution
-dec. ovarian cancer, beast cancer, rheutamoid arthiritis, HTN, hypercholestermia, cardiovasvular disease, T2 DM - rapid PP weightloss
- delayed return of menses
-bonding experience
inc maternal role attainment
-protection from mood disorders when breastfeeding difficulties are addressed
Describe the Physiology of Lactation
1: baby’s hunger triggers hypothalumus, sends signal to posterior pituitary, PP releases oxytocin, muscles contract and squeeze milk
2: suckling stimulates nerves in breast, nerve impulse sent to hypothalamus, PP releases oxytocin, muscles contract and squeeze out milk
The 5 Breastfeeding Positions
laidback, football, cross-cradle, cradling, side-lying
Descriptors of a correct latch-on position
- firm tugging but no pinching/pain
- cheeks are rounded not dimpled
- jaw glides smoothly w/ sucking
-swallowing is audible “ca” - baby cannot be easily removed from breast
- nipple is not distorted when baby releases it
How to break suction during breastfeeding
insert finger into the side of the baby’s mouth, keep it there until nipple fully released
Baby is fed based on ________
demand
Ideal time to begin brestfeeding
within the first hour of breastfeeding when newborn is in a quiet and alert state
Cultural considerations for breastfeeding
some cultures do not give colostrum and only feed when the milk comes in
What causes sore nipples?
poor latch & ineffective suck
What reccomendations can the nurse give for sore nipples?
-break suction properly, reposition
- rub breastmilk on nipple after feed
- encourage air drying after a feed
- change nursing bads
- avoud tight bras
What causes engorgement of breasts?
occurs 2-6 days PP, when milk production is increased
What does breast engorgement feel/look like?
hard breasts, throbbing, flattening of nipples
What can nurses recommend for engorgement?
feed frequently
soften breasts with warm compress, shower, hand expression
what causes plugged ducts?
engorgement
what do plugged ducts feel like?
sore tender lumps
What can nurses recommend for plugged ducts?
massage lump before/during feeding
feed on unaffected side first
ensure complete emptying
What are the symptoms of mastitis?
fever
tachy
chills
malaise
headache
enlarged axillary nodes
when does mastitis typically occur?
2-3 weeks PP
What can help with mastitis?
breastfeed 2-3 hours exlcusively
warm compress + massage breasts
antibiotics + antipyuretics
What is parental-infant attachment affectde by?
support
parental expectations
newborn behaviours
competing demands
family dynamics
emotional/mental health
How can nurses assess attachment behaviors?
-do Ps reach out for baby + call by name
-identification, who it looks like, what makes it special
- change positions w/ ease
- stimulation: do they talk to baby? look at baby?
- comfortability in caring for baby
-concern/disgust changing diapers
- what ways do they show affection?
- comforting techniques used
What factors influence people to bottle feed?
- lack of support for breastfeeding
- multiple births
- difficulty establishing brestfeeding (physiological, unadddressed)
- lack of interest / discomfort
- maternal medication use / illness
- myths
- cultural factors
Effects of overdilution of formula?
inadequate nutrients & calories
Effects of under-dilution?
hypernatremia- strains kidneys
temperature of bottle-feeds?
room-temp, warm
What supplement is not needed for baby’s being bottle-fed for the first 6 mo?
Vitamin D
What things should not be given to bottle-fed baby?
honey
corn-syrup
alternate milk sources
Can formula be micorwaved?
No
can you feed baby with remainder of formula in a bottle at a later time?
no, saliva is mixed in now
How are bottles cleaned?
hoat + soapy water
Bottle Feeding Considerations
- Cost (is formula diluted d/t costs)
- sterilization (clean water, time, storage?)
- comprehension of formula prep (following instructions)
- comprehension of feeding techniques (holding bottle, minimal air in nipple)
- misconceptions (cannot work + breastfeed)
- cultural (modern practice, partner has no input if baby is breastfed)
- Nurse: support, nonjudgmental care, respect their decision
What is the BUBBLLEE acoronym for ongoing PP physical assessment?
B: breasts firmness + nipple
U: uterine fundus (location, consistency)
B: bladder function (amt, frequency)
B: bowel function (gas, bowel movements)
L: lochia (amt and colour)
L: legs (peripheral edema)
E; Epistomy/Laceration/C-section (discomfort, condition)
E: emotional status (mood, fatigue)
PA: Expected Findings of Uterus
loose floppy skin - abdomen
uterus firm, contracting (not boggy) [AE: retained placental fragments]
midline of abdomen [AE: full bladder-can’t contract]
afterpains resolve in 3-7 days
PA: Abnormal Findings of Uterus
uterine atony–> PP hemorrhage
distended abdomen
hypoactive bowel sounds
red, tender, dehiscing incision
When does involution begin?
immediately after delivery
How long does it take for uterus to return to normal position?
6 weeks
How long does it take for palcental site to heal?
6 weeks
When does cervix close?
4 weeks
When does abdomina tone return to pre-pregnant state?
6 weeks
Abdomen Inspection:
distention
incision line infection
dehiscing
Abdomen Auscultation:
all 4 bowels checked for sounds
Abdomen Palpation:
uterine descent in relation to umbicillis
firmness
midline position
Abdomen Percussion:
drum like, suggests gas
PA: Vagina Expected Findings
- return to normal 6-8 weeks
-changes in rugae
-dryness until ovulation - edema
- clean incision/tear
-hemmoroids
PA: Vagina Abnormal Findings
redness
drainage
skin not approximated
hematoma
tenderness
echymosis (bruises)
Health Education for Vagina Care
- ice pack for first 24 hrs (20 mins on, 2o mins off), warm bath
- witch hazel pads
-hydration
-stool softners - assess pain, discomfort
PA: Bleeding Expeceted Findings
- should not smell foul
1: Lochia Rubra (3-4 days)
bright red / rust, some decidual debris
2: lochia serosa (2-4 w)
pink/brown, old blood/serum/leukocytes/debris
3: Lochia Alba (4-6w)
whitish/yellow, mucus/serum/leukocytes, epthelial cells , bacteria
PA: Signs of PPH
soaking pads 1-2 hrs
clots> golf ball
SOB
lightheadedness
chest pain, palpitation
What amount of blood loss indicated PPH?
- 500mL < (vaginal birth)
- 1000 mL < (c-section)
Causes/Risk Factor of PPH
Uterine Atony
Tissue
Trauma
Thrombin
What causes uterine atony?
- overdistended uterien (large fetus, multiple fetus, hydramnios, clots)
-anesthesia, analgesia - hx
- high parity
- prolonged labor, oxytocin induced
- magnesium sulphate
- chorioamnionitis
-uterine subinvolution
obesity
How can tissue cause PPH?
retained placental fragments
placenta accreta, increta, percata
placental abruption
placenta previa
How can trauma cause PPH?
lacerations of birth canal
forcep/vaccum assited birth
c-section
ruptured uterus
inversion of uterus
manuak removal of retained placenta
How can thrombin cause PPH?
coagulation disorder
How is Primary PPH classifed?
within 24 hours of birth
- uterine atony
- gental laceration
- retained products of conception
- placenta accreta/incerta
-uterune rupture
- uterine inversion
- DIC
How is Secondary PPH classifed?
more than 24 hrs after birth BUT less than 12 weeks
- subinvolution of uterus
-retained products of conception
- infection
- DIC
NC: PPH, Goal of Care
management of hypovolemic shock, restore circulating blood volume, elimnate cause of hemorrhage
NC: PPH, interventions
2 Venous access w/ catheter
- fluid recuscitation
- adminsiter crystalloids (lactated ringer+ saline)
- colloids (albumin)
- blood + blodo components
packed RBC (if actively bleeding w/ no improvement)
infusion of fresh frozen plasma if clotting factors + plts are below normal
NC: PPH, Nursing Assessment
Plapate pulses, BP, O2
skin: colour, temp, turgor
LOC
heart sounds/murmurs
breath sounds
anxiety, disorientation, apprehension, restlessness
Urinary output
Bleeding
NC: PPH, Nursing Interventions
CBC
IV -tocolytics
medications to relax uterus- uterotonics
medications to contract uterus
PA: Bladder & Bowels Expected Findings Post Deilvery
- voiding occurs within first 6 hours
- attempt to empty bladder after 2 hrs
- potential for bladder distension d/t normal post-partum diuresis
- epidural: urinary retention potential
- good bowel sounds, pass gas
Nursing Considerations: Bladder & Bowels
- enourage voiding, assess ability to void, regular voiding (360cc/12hrs)
- encourage pat dry front to back
- encourage kegel/pelvic muscle exercise
- encourage ambulation
- encourage adequate fluid/food intake
- stool softners may be needed
Signs of Poor Maternal Emotional Status
- can’t discuss labour/birth experience
- feels ugly/useless
- preoccupied with body image
- depressed
- lacks support system
- partner/family reacts negatively to baby
-refuses to interact/care for baby - disappointment over baby’s sex
- sees baby as messy/unattractive
- baby reminds them of people they don’t like
-difficulty sleeping - loss of appetite
What are things the nurse should promote as a part of PP care?
1:rest (pp fatigue
2:ambulation (orthostatic hypotension, prevent falls, prevent venous thromboembolism)
3:exercise
4:nfection (precuations, perineal care, HH)
5: comfort (non-pharmacolgical + pharmacological interventions)
6: nutrition (1800-2200 calories, 350-400 + for lactating women)
7: normal bladder + bowel function
8: breastfeeding (skin-skin)
9: rubella vaccination (if pt not immune)
10: Rh isoimmunization: within 72hrs after birth
How long after delivery should a maternal identity be established?
4 months
What are S/S of Postpartum Blues
mood swings
crying spells
feeling low
fatigue
frustration
anxiety
emotional
confused
muddled thinking
When & Why do Pastpartum Blues occur?
1-5 days PP, resolves in 2 weeks
Due to hormonal changes, stress, role transition, challenges with breastfeeding
How can nurses care for patients with PP Blues?
validation
reassurance
education
Affects of Perinatal Mood Disorders?
stress for pateient
disrupts famiyl life
affects couple relationship
parental infant attachment
quality of parenting
social, mental, behavioural development of kids
Who is at higher risk of developing PPD?
indigenous
Black
Adolescents
What is Perinatal Depression?
intense sadness, severe moodswings > 2 weeks
irritability
detachment towards baby
guilt, shame, stigma
reluctant to discuss feelings
obsessive thoughts about harming infant
reluctant to seek help
loneliness, lack of emotional support
What SSRIs can be given for Perinatal depression?
sertraline
citalopram
escotalopram
What is Postpartum Psychosis?
rare
elevated energy levels, cognition, mood (mania)
depression (hallucinations, delusions, self harm, infant harm)
Patient Teaching: Perinatal Mood Disorders
relax for 15 mins a day (meditation, hot bath)
good diet
exercise (30 mins a day)
sleep as much as possible
get out of the house
don’t overcommit
ask for help
support group
talk to people
PMD Screening & Score
EDPH (edinburg post-natal depression scale)
PDSS (postpartum depression screening scale)
scores higher than 10/30 = possible depression, need assessment
What is Perinatal Loss & Grief
feelings related to maternal death, neonatal/fetal death, child with complex condition
Grief Response: Phase 1
Shock and Numbness
- unreality, loss of innocence, powerless, disbelief, denial
- devastation, depression, intense outburst, can’t concentrate or make decisions
Grief Response: Phase 2
searching & yearning
- lonliness, empty, yearning
-guilt - anger, resentment, bitterness, irritability
Grief Response: Phase 3
disorientation
- deep sadness, depression
- insomnia, social withdrawal, lack of energy
Grief Response: Phase 4
Re-orginization + Resolution
- self-esteem + confidence
-can cope with challenges - placed loss in perspective
