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SEM 1 > Week 8: PP Care & Newborn Nutrition > Flashcards

Week 8: PP Care & Newborn Nutrition Flashcards

1
Q

Benefits of Breastfeeding: Infant

A

-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

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2
Q

Benefits of Breastfeeding: Mother

A
  • 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
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3
Q

Describe the Physiology of Lactation

A

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

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4
Q

The 5 Breastfeeding Positions

A

laidback, football, cross-cradle, cradling, side-lying

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5
Q

Descriptors of a correct latch-on position

A
  • 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
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6
Q

How to break suction during breastfeeding

A

insert finger into the side of the baby’s mouth, keep it there until nipple fully released

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7
Q

Baby is fed based on ________

A

demand

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8
Q

Ideal time to begin brestfeeding

A

within the first hour of breastfeeding when newborn is in a quiet and alert state

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9
Q

Cultural considerations for breastfeeding

A

some cultures do not give colostrum and only feed when the milk comes in

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10
Q

What causes sore nipples?

A

poor latch & ineffective suck

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11
Q

What reccomendations can the nurse give for sore nipples?

A

-break suction properly, reposition
- rub breastmilk on nipple after feed
- encourage air drying after a feed
- change nursing bads
- avoud tight bras

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12
Q

What causes engorgement of breasts?

A

occurs 2-6 days PP, when milk production is increased

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13
Q

What does breast engorgement feel/look like?

A

hard breasts, throbbing, flattening of nipples

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14
Q

What can nurses recommend for engorgement?

A

feed frequently
soften breasts with warm compress, shower, hand expression

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15
Q

what causes plugged ducts?

A

engorgement

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16
Q

what do plugged ducts feel like?

A

sore tender lumps

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17
Q

What can nurses recommend for plugged ducts?

A

massage lump before/during feeding
feed on unaffected side first
ensure complete emptying

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18
Q

What are the symptoms of mastitis?

A

fever
tachy
chills
malaise
headache
enlarged axillary nodes

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19
Q

when does mastitis typically occur?

A

2-3 weeks PP

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20
Q

What can help with mastitis?

A

breastfeed 2-3 hours exlcusively
warm compress + massage breasts
antibiotics + antipyuretics

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21
Q

What is parental-infant attachment affectde by?

A

support
parental expectations
newborn behaviours
competing demands
family dynamics
emotional/mental health

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22
Q

How can nurses assess attachment behaviors?

A

-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

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23
Q

What factors influence people to bottle feed?

A
  • lack of support for breastfeeding
  • multiple births
  • difficulty establishing brestfeeding (physiological, unadddressed)
  • lack of interest / discomfort
  • maternal medication use / illness
  • myths
  • cultural factors
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24
Q

Effects of overdilution of formula?

A

inadequate nutrients & calories

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25
Effects of under-dilution?
hypernatremia- strains kidneys
26
temperature of bottle-feeds?
room-temp, warm
27
What supplement is not needed for baby's being bottle-fed for the first 6 mo?
Vitamin D
28
What things should not be given to bottle-fed baby?
honey corn-syrup alternate milk sources
29
Can formula be micorwaved?
No
30
can you feed baby with remainder of formula in a bottle at a later time?
no, saliva is mixed in now
31
How are bottles cleaned?
hoat + soapy water
32
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
33
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)
34
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
35
PA: Abnormal Findings of Uterus
uterine atony--> PP hemorrhage distended abdomen hypoactive bowel sounds red, tender, dehiscing incision
36
When does involution begin?
immediately after delivery
37
How long does it take for uterus to return to normal position?
6 weeks
38
How long does it take for palcental site to heal?
6 weeks
39
When does cervix close?
4 weeks
40
When does abdomina tone return to pre-pregnant state?
6 weeks
41
Abdomen Inspection:
distention incision line infection dehiscing
42
Abdomen Auscultation:
all 4 bowels checked for sounds
43
Abdomen Palpation:
uterine descent in relation to umbicillis firmness midline position
44
Abdomen Percussion:
drum like, suggests gas
45
PA: Vagina Expected Findings
- return to normal 6-8 weeks -changes in rugae -dryness until ovulation - edema - clean incision/tear -hemmoroids
46
PA: Vagina Abnormal Findings
redness drainage skin not approximated hematoma tenderness echymosis (bruises)
47
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
48
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
49
PA: Signs of PPH
soaking pads 1-2 hrs clots> golf ball SOB lightheadedness chest pain, palpitation
50
What amount of blood loss indicated PPH?
- 500mL < (vaginal birth) - 1000 mL < (c-section)
51
Causes/Risk Factor of PPH
Uterine Atony Tissue Trauma Thrombin
52
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
53
How can tissue cause PPH?
retained placental fragments placenta accreta, increta, percata placental abruption placenta previa
54
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
55
How can thrombin cause PPH?
coagulation disorder
56
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
57
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
58
NC: PPH, Goal of Care
management of hypovolemic shock, restore circulating blood volume, elimnate cause of hemorrhage
59
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
60
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
61
NC: PPH, Nursing Interventions
CBC IV -tocolytics medications to relax uterus- uterotonics medications to contract uterus
62
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
63
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
64
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
65
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
66
How long after delivery should a maternal identity be established?
4 months
67
What are S/S of Postpartum Blues
mood swings crying spells feeling low fatigue frustration anxiety emotional confused muddled thinking
68
When & Why do Pastpartum Blues occur?
1-5 days PP, resolves in 2 weeks Due to hormonal changes, stress, role transition, challenges with breastfeeding
69
How can nurses care for patients with PP Blues?
validation reassurance education
70
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
71
Who is at higher risk of developing PPD?
indigenous Black Adolescents
72
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
73
What SSRIs can be given for Perinatal depression?
sertraline citalopram escotalopram
74
What is Postpartum Psychosis?
rare elevated energy levels, cognition, mood (mania) depression (hallucinations, delusions, self harm, infant harm)
75
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
76
PMD Screening & Score
EDPH (edinburg post-natal depression scale) PDSS (postpartum depression screening scale) scores higher than 10/30 = possible depression, need assessment
77
What is Perinatal Loss & Grief
feelings related to maternal death, neonatal/fetal death, child with complex condition
78
Grief Response: Phase 1
Shock and Numbness - unreality, loss of innocence, powerless, disbelief, denial - devastation, depression, intense outburst, can't concentrate or make decisions
79
Grief Response: Phase 2
searching & yearning - lonliness, empty, yearning -guilt - anger, resentment, bitterness, irritability
80
Grief Response: Phase 3
disorientation - deep sadness, depression - insomnia, social withdrawal, lack of energy
81
Grief Response: Phase 4
Re-orginization + Resolution - self-esteem + confidence -can cope with challenges - placed loss in perspective

SEM 1 (11 decks)

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