Maternity test 4

• These notes cover newborn care, postpartum issues, and potential complications in newborns.

Newborn Care Teaching for Family

• Educate family, including grandparents, about changes in newborn care practices.
• Offer classes for caregivers and families.
• Clarify the caregiver role versus the parent role.

Transition to Parenthood for Adoptive Parents

• Suggest resource groups for adoptive parents.

Postpartum Depression Risk

• Screen all clients with a validated tool for postpartum depression.
• Educate clients about the manifestations of postpartum depression.
• Outline various treatment options for postpartum depression.

Postpartum Depression Treatment Options

• Psychotherapy, especially cognitive behavioral therapy, is an option.
• Antidepressant medications are an option.

Teach-Back Method for Newborn Care

• Have the client repeat verbal instructions to assess understanding.
• Have the client demonstrate care tasks they will perform at home.

Client Education on Constipation

• Promote rest and healing as general self-care measures.
• Encourage plenty of fluids and a well-balanced diet.

Postpartum Symptoms Requiring Medical Attention

• Extreme swelling in hands or face
• Headache that does not improve
• Dizziness or fainting
• Vision changes, such as blurry vision or seeing spots
• Fever greater than 38°C (100.4°F)
• Chest pain or difficulty breathing
• Severe pain or swelling in the extremities
• Heavy bleeding (soaking a pad in 1 hour or less)
• Foul-smelling bleeding or discharge
• Thoughts of hurting themselves or their baby

Nursing Actions for Chest Pain

• Instruct clients to contact their provider or go to the emergency department.

Resumption of Sexual Activity After Birth

• Sexual activity can typically resume around 6 weeks postpartum.

Car Seat Safety

• Use an appropriate car seat for the infant's age and weight.
• Avoid using car seats with an unknown history.

Heat Loss Prevention in Newborns

• Hypothermia is heat loss.
• Infants lose heat quickly due to limited brown fat.
• Dry infants immediately and place them skin-to-skin.

Concerns Regarding Newborn Vaccination

• Share the recommended vaccine schedule for children.
• Encourage hesitant parents to discuss concerns with a healthcare provider.

When to Call a Newborn's Healthcare Provider

• Rectal temperature greater than 38°C (100.4°F)
• Yellowing of the skin or eyes (jaundice)
• Sleeping more than usual or difficulty waking up
• Lack of movement
• Seizure activity
• Difficulty breathing
• Refusing multiple feedings in a row
• Vomiting or diarrhea, especially with blood
• Signs of dehydration such as decreased wet diapers and sunken fontanelles

Newborn Adaptations - Lanugo

• Lanugo on newborns often disappears within the first few weeks.

Newborn Adaptations - Immune System

• Breast milk provides immune benefits.
• Newborns receive antibodies, immunoglobulins, and white blood cells.
• Newborns form their own antibodies between 12-20 months.
• Breastfeeding lowers the risk of respiratory and GI disorders.

Newborn Adaptations - Hematologic

• HbF (fetal hemoglobin) is gradually replaced after birth.
• HgA (adult hemoglobin) appears around the 3rd to 6th month of life.

Newborn Adaptations - Nocturnal Sleeping

• Changes in sleeping patterns occur around 2-3 months.
• Circadian rhythms begin developing at this time.
• Nocturnal sleeping begins.

Newborn Adaptations - Auditory

• Newborn recognizes the voice of the maternal in utero.

Newborn Assessment - Back Area

• Common finding: sacral dimple (skin over the coccyx).
• If the sacral dimple is deep and large (>0.5cm) above the gluteal cleft, assessment for neural tube defects is necessary.

Newborn Assessment - Lingual Frenulum

• A lingual frenulum attached to the tongue can cause feeding issues.
• Assess the newborn's sucking reflex.

Normal Newborn Findings After Vaginal Birth

• Murmurs are normal on the first day of birth
• Caput succedaneum and cephalohematoma are common findings on the head.
• Fontanels will be patent, soft and flat.
• The head may have molding.
• Subconjunctival hemorrhage is common in the eyes.
• Pupillary response and red reflex should be present.

Newborn Chest Asymmetry

• Asymmetry may be a lack of a pectoralis muscle

Shaken Baby Syndrome (SBS)

• Results in diffuse brain injury, retinal hemorrhages, and rib/long bone fractures.

First Breastfeeding After Birth

• Encourage the first attempt at breastfeeding when the newborn is skin-to-skin with the mother.
• Delay routine newborn care until after the first feeding is completed.

Circumcision Complications

• Findings that indicate complications include:
• Hypoglycemia
• History of hemophilia
• Indication of infection
• Low or no urine output

Critical Congenital Heart Disease (CCHD)

• CCHD screening with pulse oximetry:
• SpO2 less than 90%
• SpO2 less than 95% in both extremities, three times separated by 1 hour
• Greater than 3% absolute difference in SpO2 between the right hand and foot

Nonpharmacological Pain Relief for Newborns

• Place the newborn's arms and legs in flexion, close to the midline of the torso.

Esophageal Atresia/Transesophageal Fistula

• Nursing interventions include:
• Airway maintenance
• NPO status
• Family support and education
• Pre-op care (IV fluids, antibiotics, thermoregulation)
• Positioning
• Oral care after surgery
• Sham-feeding protocol to help newborn learn to feed
• Small feedings via gastrostomy tube, removed by suction

Gastroschisis Management

• Place the lower half of the newborn's body in a clear, sterile bag.
• Prepare for surgical repair.

Epispadias

• In males, the urethra opens on the top or side of the penis

Phenylketonuria (PKU) Screening

• Obtain a blood sample via heel stick 1-3 days after birth.

Meconium Aspiration Syndrome

• Monitor preductal and postductal pulse oximetry.

Effective Phototherapy in Newborns

• Assess transcutaneous bilirubin (TcB) levels.

Nursing Interventions for Phototherapy

• Provide eye protection for the newborn.

Blood Type Incompatibility

• ABO or Rh incompatibility: the mother has type O blood, and the fetus has type A, B, or AB blood.

Newborns with Prenatal Substance Exposure

• Clinical manifestations can include tremors, excessive crying, irritability, hyperactive reflexes, tachypnea, sleep problems, inability to self-regulate, feeding issues, and seizures. Consoling therapies: Swaddling, non-nutritive sucking, family education and support

Hypoxic-Ischemic Encephalopathy (HIE)

• Manifestations include hypotonia, slow bilateral reflexes, and extraocular movements.

Management of Newborns with Mothers Positive for COVID-19

• Implement nursing management for newborns born to mothers with positive COVID-19.
• Use protective equipment to prevent the spread of viral particles.

Duchenne-Erb (Erb's) Palsy

• Manifestations include an absent Moro reflex, arm extended at the elbow, and decreased grasp on the affected side.

Secondary Traumatic Stress

• Characterized by emotional stress from hearing about trauma experiences.
• Smells, sounds, and colors may be triggers.

Nurse Resiliency

• Unit debriefings to process emotions, and support work-life balance and mindfulness

Grieving Parents

• Nursing interventions for a client grieving the loss of their newborn: primary source of support for families

Grief and Loss

• Include personal preferences (hold newborn)

Respiratory Distress Syndrome Complications

• Acute:
• Pneumothorax
• Infection
• Intraventricular hemorrhage
• Patent ductus arteriosus (PDA)
• Long-term:
• Bronchopulmonary dysplasia
• Retinopathy of prematurity

Risk Factors for Pregnancy Complications

• Genetics
• Fetal development
• Teratogen exposure
• Pregnancy complications
• Environmental factors