Maternity: Signs of Pregnancy and Weight Gain

• Quickening is the initial fetal movements felt by the mother.
• Typically occurs around 18-20 weeks of gestation for first-time mothers.
• For mothers who have been pregnant before it is 16-18 weeks.
• The sensation is often described as fluttering or gas-like.
• Presumptive signs of pregnancy are subjective and include amenorrhea, fatigue, nausea/vomiting, breast tenderness, quickening, and urinary frequency.
• Probable signs of pregnancy are objective and include Chadwick's sign, Hegar's sign, Goodell's sign, ballottement, and a positive pregnancy test.
• Positive signs of pregnancy are conclusive and include detection of a fetal heartbeat, ultrasound visualization, and fetal movements felt by an examiner.
• Recommended weight gain during pregnancy is based on pre-pregnancy BMI.

Weight gain recommendations based on BMI

• Underweight (BMI <18.5): 28-40 lbs.
• Normal weight (BMI 18.5-24.9): 25-35 lbs.
• Overweight (BMI 25-29.9): 15-25 lbs.
• Obese (BMI ≥30): 11-20 lbs.
• Weight distribution during pregnancy includes the baby, placenta, amniotic fluid, increased blood volume, breast tissue, and maternal fat stores.

Key Signs in Pregnancy

• Chadwick's sign: Bluish discoloration of the cervix and vaginal mucosa due to increased vascularity, detectable around 6-8 weeks of pregnancy.
• Hegar's sign: Softening of the lower uterine segment (isthmus), palpable around 6 weeks of pregnancy.
• Ballottement: Technique where the examiner feels the fetus rebound after a gentle tap on the cervix, typically noted between 16-18 weeks.
• Goodell's sign: Softening of the cervix, occurring around 4-6 weeks of gestation.

Integumentary Changes

• Hyperpigmentation: Melasma (mask of pregnancy) presents as brownish facial pigmentation.
• Linea nigra: Darkened line down the midline of the abdomen
• Striae Gravidarum are stretch marks on the abdomen, breasts, and thighs.
• Spider Angiomas are small red, spider-like blood vessels on the skin due to increased estrogen.
• Hair and Nails will experience faster hair growth, brittle nails.

Maternal Emotional and Psychological Responses

• First Trimester: Mixed feelings and ambivalence are normal, anxiety about pregnancy outcomes or body changes.
• Second Trimester: Feeling more connected to the fetus, increased sense of well-being and excitement.
• Third Trimester: Anxiety about labor and delivery, impatience as physical discomfort peaks.
• Physiologic anemia: Blood plasma volume increases more than red blood cell mass, leading to a dilutional effect.
• Hemoglobin (Hgb) < 11 g/dL in the first and third trimesters is an indicator of physiologic anemia.
• Hemoglobin (Hgb) <10.5 g/dL in the second trimester is an indicator of physiologic anemia.
• Nursing Management: Educate on iron-rich foods and prenatal vitamins with iron.

Physical Changes During Each Trimester

• First Trimester: Breast tenderness, nausea/vomiting, frequent urination, and fatigue.
• Second Trimester: Physiological anemia, quickening, and visible physical changes (baby bump).
• Third Trimester: Shortness of breath, backaches, edema, and Braxton Hicks contractions.
• McDonald's Rule: Measurement of fundal height (in cm) from the symphysis pubis to the top of the uterus correlates with gestational age in weeks (after 20 weeks), for example, at 28 weeks, fundal height should measure ~28 cm.
• GTPAL is a method to summarize a woman's obstetric history.

GTPAL Components

• Gravida: Total number of pregnancies (including current one).
• Term: Number of pregnancies carried to term (37+ weeks).
• Preterm: Number of pregnancies delivered between 20-36 weeks.
• Abortions: Total losses before 20 weeks (spontaneous or elective).
• Living: Number of currently living children.
• Naegele's Rule is used to calculate the estimated due date (EDD).

Naegele's Rule Formula

• Start with the first day of the Last Menstrual Period (LMP).
• Subtract 3 months.
• Add 7 days and adjust the year if needed.
• Example: If the LMP is July 10, subtract 3 months (April 10), then add 7 days. The EDD is April 17.

Frequency of Prenatal Visits

• 0-28 weeks: Monthly visits (once every 4 weeks).
• 28-36 weeks: Biweekly visits (every 2 weeks).
• 36+ weeks: Weekly visits until delivery.

Discomforts of Pregnancy - First Trimester

• Nausea/Vomiting ("morning sickness"): Encourage small, frequent meals, ginger, or B6 supplementation.
• Fatigue: Adequate rest, naps when needed.
• Breast Tenderness: Wear a supportive bra.

Discomforts of Pregnancy - Second Trimester

• Heartburn: Avoid spicy foods, stay upright after meals, use antacids as needed.
• Back Pain: Encourage proper posture, pelvic tilt exercises.
• Leg Cramps: Increase magnesium/potassium in the diet (bananas).

Discomforts of Pregnancy - Third Trimester

• Edema (swelling): Elevate legs, reduce sodium intake.
• Shortness of Breath: Encourage sleeping propped up with pillows.
• Braxton Hicks Contractions: Distinguish from true labor; encourage hydration.

Tests to Assess Fetal Well-Being

• Biophysical Profile (BPP): Combines ultrasound and NST to assess fetal health.
• BPP measures 5 parameters: fetal breathing movements, fetal movement, fetal tone, amniotic fluid volume, and reactive Non-Stress Test (NST). Measured out of 10 total points.
• Non-Stress Test (NST): Assesses fetal heart rate (FHR) response to movements.
• Reactive NST: 2+ accelerations (at least 15 bpm lasting 15+ seconds) within 20 minutes → normal.
• Non-reactive NST: Absence of accelerations → may indicate further testing is needed.
• Amniocentesis: Performed after 15-20 weeks gestation.
• Amniocentesis extracts amniotic fluid via needle for genetic testing, fetal lung maturity (L/S ratio), or infection.
• Amniocentesis has risks of infection, miscarriage, and preterm labor.
• Chorionic Villi Sampling (CVS): Performed between 10-13 weeks.
• CVS retrieves chorionic tissue via catheter for genetic diagnosis (earlier than amniocentesis).
• CVS has a higher risk of miscarriage compared to amniocentesis.
• Lightening: The descent of the fetus into the pelvis, which often occurs 2 weeks before labor in first pregnancies.
• Braxton Hicks Contractions: Irregular, painless contractions that prepare the uterus for true labor.
• Bloody Show: The passage of a small amount of blood-tinged mucus as the cervix begins to efface and dilate.
• Nesting Instinct: Sudden energy surge to prepare the home.
• Rupture of Membranes (ROM): Could be a premonitory sign if it occurs spontaneously (SROM).

Parameters of Contractions

• Frequency: Time from the start of one contraction to the start of the next.
• Duration: Length of each contraction from start to finish.
• Intensity: Strength of the contraction, assessed by palpation or intrauterine pressure catheter.
• Resting Tone: The relaxation between contractions.

Phases of Contractions

• Increment: Gradual buildup of the contraction.
• Acme: Peak intensity of the contraction.
• Decrement: Gradual relaxation.

Phases of Labor

• First Stage: Cervical dilation (0–10 cm).
• Latent Phase: 0–3 cm dilation; mild contractions.
• Active Phase: 4–7 cm dilation; stronger, more frequent contractions.
• Transition Phase: 8–10 cm dilation; very strong and frequent contractions.
• Second Stage: From full dilation (10 cm) to the delivery of the baby.
• Third Stage: Delivery of the placenta.
• Fourth Stage: Immediate postpartum period (2-4 hours after delivery).

Non-Stress Test (NST) Parameters

• Evaluates fetal well-being by monitoring fetal heart rate (FHR) in response to movements.
• Reactive NST: At least 2 accelerations within a 20-minute period and Increase of ≥15 bpm lasting ≥15 seconds.
• Non-Reactive NST: Absence of accelerations; may require further testing (e.g., BPP).
• 0-28 Weeks: Monthly visits for frequency of prenatal appointments.
• 28-36 Weeks: Biweekly visits for frequency of prenatal appointments.
• 36 Weeks to Delivery: Weekly visits frequency of prenatal appointments.

Stages of Labor

• First Stage: Latent (early) phase is 0–3 cm.
• First Stage: Active phase is 4-7 cm.
• First Stage: Transition phase is 8-10 cm.
• Second Stage: Expulsion of the baby.
• Third Stage: Expulsion of the placenta.
• Fourth Stage: Recovery.

The 5 "P"s of Labor

• Powers: Uterine contractions and maternal pushing efforts.
• Passenger: The fetus (size, position, presentation).
• Passageway: The pelvis and soft tissues.
• Position: Maternal position during labor.
• Psyche: Maternal emotional state and preparation.

Additional 5 "P"s of Labor

• Pain relief: Comfort measures and analgesia.
• Patience: Avoid rushing labor (reduce interventions).
• Preparation: Antenatal education for the mother.
• Professional support: Role of the nurse or midwife.
• Partner participation: Supportive presence.

Determination of Rupture of Membranes (ROM)

• Nitrazine Test: Amniotic fluid turns the paper blue (alkaline).
• Fern Test: Amniotic fluid creates a fern-like pattern under a microscope. Sudden gush or slow leak of fluid is an indicator of Rupture of Membranes (ROM). Assess for color, odor, and time of rupture to monitor infection risk if membranes have ruptured.

Fetal Lie, Presentation, and Position

• Longitudinal is where the fetus aligned with the maternal spine (normal Lie).
• Transverse is where the fetus is perpendicular to the maternal spine. For Presentation, Cephalic the head comes first (vertex is ideal).
• Breech: Buttocks or feet first for Fetal Presentation.
• Shoulder: Shoulder presents first. Occiput Anterior (OA) is the ideal fetal position for delivery. Occiput Posterior (OP) is a fetal position that may cause prolonged labor.

Cardinal Movements of Labor

• Engagement: Fetal head enters the pelvic inlet.
• Descent: Movement downward into the pelvis.
• Flexion: Fetal chin tucks to chest.
• Internal Rotation: Rotation to align with maternal pelvis.
• Extension: Head extends as it passes under the symphysis pubis.
• External Rotation (Restitution): Head realigns with shoulders.
• Expulsion: Baby is delivered.
• Delivery of the Placenta occurs during the third stage of labor.

Signs of Placental Separation

• Lengthening of the umbilical cord.
• Gush of blood.
• Uterus becomes firm and rises.

Interventions for Types of Stages of Labor

• First Stage (Latent, Active, Transition Phases) - Latent Phase (0–3 cm dilation): Encourage ambulation and upright positions and educate on breathing techniques for relaxation.
• Provide emotional support and reassurance in the latent phase of the first stage of labor.
• First Stage (Latent, Active, Transition Phases) - Active Phase (4–7 cm dilation): Monitor contraction patterns and fetal heart rate (FHR).
• Administer pain relief as needed, and assess the cervix regularly for progress during the active phase of the first stage of labor.
• First Stage (Latent, Active, Transition Phases) - Transition Phase (8–10 cm dilation): Offer continuous support and encouragement and assist with breathing techniques in transition phase.
• Manage maternal discomfort during the transition phase of the first stage of labor.
• Second Stage (Delivery of Baby): Encourage maternal pushing efforts; use upright positions to promote descent.
• Provide perineal support and monitor FHR with each contraction.
• Offer clear instructions and emotional encouragement to reduce maternal exhaustion and reduce discomfort.
• Third Stage (Delivery of Placenta): Observe for signs of placental separation (lengthening cord, gush of blood).
• Administer oxytocin as needed to promote uterine contractions.
• Inspect the placenta for completeness to avoid retained fragments.
• Monitor maternal vital signs and uterine tone in the fourth stage (postpartum recovery).
• Assess for signs of hemorrhage (fundal massage if necessary).
• Provide bonding time for mother and baby (skin-to-skin contact).

Electronic Fetal Monitoring (EFM)

• It assesses fetal heart rate (FHR) and uterine contractions during labor to identify potential fetal distress.
• Baseline FHR: Normal is 110–160 bpm.
• Variability: Absent - minimal fluctuations → concerning; may indicate fetal hypoxia and Moderate - normal, reassuring pattern.
• Accelerations: Temporary increases in FHR (>15 bpm for ≥15 seconds) → reassuring.

Types of Decelerations and Nursing Interventions

• Early Decelerations: Cause - head compression during contractions, appearance - gradual decrease mirrors contraction, and intervention - no action needed, normal finding.
• Late Decelerations: Cause - uteroplacental insufficiency (fetal hypoxia), and appearance - gradual decrease beginning after the contraction starts and ends after it ends.
• For late decelerations, reposition the mother (left lateral), administer oxygen, increase IV fluids, and notify provider if persistent.
• Variable Decelerations: Cause - umbilical cord compression, appearance - abrupt decrease in FHR, variable timing with contractions.
• For variable decelerations, reposition the mother (side-to-side or knee-chest), administer oxygen if severe, and amnioinfusion may be ordered.
• The immediate care of the infant is to dry them to prevent heat loss and clear airway with a bulb syringe if necessary.
• After the infant is born, perform APGAR scoring at 1 and 5 minutes to assess appearance, pulse, grimace, activity, and respiration.
• Facilitate skin-to-skin contact to promote warmth and bonding when bonding with the newborn.
• If the mother desires, initiate breastfeeding if mother desires when bonding with the newborn.
• Assess for any signs of distress (grunting, retractions, cyanosis) on the newborn when monitoring.
• Maintain thermoregulation for the newborn by placing them under a radiant warmer if needed when monitoring them.
• The nitrazine test determines pH.
• Amniotic Fluid will be alkaline (blue on test strip).
• Urine will be acidic (yellow on test strip).
• A fern test observes whether amniotic fluid is present creating a fern-like pattern under a microscope.
• Amniotic fluid is clear or slightly tinged and odorless.
• Urine may have a distinct smell and is yellowish.
• Involution: The uterus returns to its pre-pregnancy size and location.
• The involution process begins immediately after birth with contractions to compress blood vessels.
• After delivery, the uterus weighs ~1,000 g.
• One week of postpartum, the uterus weighs ~500 g.
• Six weeks of postpartum, the uterus weighs ~60-80 g.
• Right after delivery, the fundal height of the uterus is at or slightly above the umbilicus.
• Fundal height decreases ~1 cm/day and is not palpable abdominally by day 10-14.
• Interventions for the uterus during postpartum is fundal massage to ensure firmness and prevent hemorrhage.
• Hormonal changes: Prolactin stimulates milk production; levels increase with frequent breastfeeding.
• Hormonal changes: Oxytocin is released during nursing which causes the let-down reflex and uterine contractions (aids involution).
• Colostrum is a thick, yellow fluid rich in antibodies and is produced in the first 1-3 days.
• Mature milk arrives ~72-96 hours postpartum and has a bluish-white and thinner appearance.
• Proper latch technique is important when providing nursing interventions in relation to breastfeeding and lactation.
• Preventing engorgement: Frequent feeding or pumping should be taught to the mother and their family.
• Use of a lanolin cream can help treat sore nipples and a proper latch adjustment technique should be demonstrated to provide relief.
• Hydration and nutrition are important to support milk production.

Psychological Adaptations After Birth

• Taking-In Phase (1-3 days postpartum): Focus on self (fatigue, physical recovery).
• Taking-In Phase (1-3 days postpartum): Relies on others for care, reflects on birth experience.
• Taking-In Phase (1-3 days postpartum) Nursing Implementations: Provide rest, support, and actively listen.
• Taking-Hold Phase (Day 3 to 2 weeks): Shift focus to newborn care; actively seeks education (e.g., feeding, diapering).
• Taking-Hold Phase (Day 3 to 2 weeks): Anxiety about new parenting role is common.
• Taking-Hold Phase (Day 3 to 2 weeks) Nursing Implementations: Offer reassurance, provide guidance and skill education.
• Letting-Go Phase (2+ weeks postpartum): Accepts changes in lifestyle and family dynamics.
• Letting-Go Phase (2+ weeks postpartum): Grieves loss of independence or prior self-image.
• Letting-Go Phase (2+ weeks postpartum) Nursing Implementations: Support emotional adjustments and encourage communication.

Postpartum Assessment: Vital Signs & Nursing Interventions

• Temperature: May rise slightly (<100.4°F) in the first 24 hours due to dehydration or lactation.
• Pulse: Bradycardia (50-70 bpm) may occur due to cardiovascular adaptation during postpartum.
• Implementations in the Vital Signs should maintain a stable blood pressure and watch for signs of preeclampsia with elevated BP, headache, and visual changes.
• Respirations should be in the normal range and tachypnea may indicate embolism or hemorrhage.

Postpartum Assessment: Nursing Interventions

• Regular fundal assessments should be done to ensure firmness.
• Monitor lochia for color, amount, and odor.
• Encourage early ambulation to reduce clot formation.
• Support hydration and nutrition (high in iron, protein).

Nursing Concerns When Assessing a Post-C-Section Patient

• Perform key assessments related to pain, monitor incision site for tenderness/redness, use pain scales.
• Perform a respiratory status assessment to encourage deep breathing and use of incentive spirometry to prevent pneumonia.
• Mobility: Assess for risk of deep vein thrombosis (DVT), encourage ambulation
• Incision: Check for signs of infection (redness, warmth, discharge).
• Nursing interventions after a c-section should provide pain relief, IV or PO analgesics.
• Nursing interventions after a c-section should monitor for bowel and bladder function return.
• Teach proper wound care and signs of complications and provide emotional support for recovery and adjustment Urinary System Adaptations have changes such as increased diuresis (up to 3,000 mL/day) within the first 24-48 hours postpartum.
• There is a risk of urinary retention due to swelling or trauma from delivery with urinary system adaptations.
• Bladder distention can interfere with uterine contraction leading to an increased risk of hemorrhage with patients going through urinary system adaptations.
• Encourage frequent voiding (every 2-3 hours) as a nursing intervention for patients going through urinary system adaptations.
• Monitor for urinary retention (palpable bladder, decreased output) as a nursing intervention for patients going through urinary system adaptations.
• Catheterize if necessary and educate on hydration to promote urinary function as nursing interventions for patients going through urinary system adaptations.

Types of Lochia

• Postpartum vaginal discharge that consist of blood, mucus, and uterine tissue.
• Rubra: Bright red, 1-3 days postpartum, moderate flow.
• Serosa: Pinkish-brown, 4-10 days postpartum.
• Alba: Whitish-yellow, up to 6 weeks postpartum.
• Nursing Lochia Implementations include monitoring amount, color, and odor.
• Excessive bleeding: May indicate uterine atony or retained fragments.
• Monitor for foul odor which could indicate infection (endometritis).

Key Postpartum Interventions

• Postpartum care focuses on supporting the mother's physical recovery, emotional adjustment, and transition to motherhood.
• Perform fundal checks to ensure the uterus is firm and midline, and massage if the uterus is boggy to prevent hemorrhage.
• One intervention is to monitor for displacement caused by a full bladder. Assess color, amount, consistency, and odor of lochia in lochia monitoring.
• Abnormalities can arise from the vital signs with excessive bleeding, large clots, or foul-smelling discharge which may indicate infection or hemorrhage.
• Check for elevated pulse (may indicate hemorrhage or pain) when monitoring vital signs.
• Monitor blood pressure for signs of preeclampsia or shock when monitoring vital signs.
• Administer analgesics as needed, especially for perineal or incision pain.
• Educate about non-pharmacological pain relief methods like ice packs, and sitz baths to provide pain management.
• Encourage early ambulation to help reduce the risk of deep vein thrombosis (DVT) and promote bowel and bladder function.
• Encourage voiding every 2-3 hours to prevent bladder distention and urinary retention in bladder care.
• Monitor for urinary output, particularly after catheter removal.
• Educate on proper perineal care (wipe front to back, use warm water rinse) for infection prevention.
• Assess C-section incision or perineal area for redness, warmth, drainage for infection prevention.
• Screen for signs of postpartum blues, depression, or anxiety to provide emotional support
• Encourage communication and offer referrals if needed to provide emotional support.
• Educate new moms on the proper latch techniques for breast care and lactation, and breastfeeding frequency (~8-12 times per day).
• Signs of breastfeeding challenges: engorgement, cracked nipples, and mastitis.
• Prolactin: Promotes milk production; levels increase with frequent feeding.
• Oxytocin: Facilitates milk let-down and uterine contractions.
• Proper hydration and nutrition is important, as well as rest and proper pacing when completing self-care. normalize postpartum emotional changes (baby blues).
• Help new moms recognize signs of postpartum depression that require intervention, and discuss timing of resuming sexual activity (~6 weeks or after clearance).
• Offer information about postpartum contraception options like lactational amenorrhea method and IUD's
• Report any heavy bleeding, severe headaches, visual disturbances, fever, or calf pain/swelling which may indicate DVT.

Role of Hormones

• Estrogen/Progesterone: Levels drop significantly after delivery which contributes to mood swings and postpartum "baby blues."
• Prolactin: Stimulates milk production; highest during breastfeeding.
• Oxytocin: Responsible for let-down reflex and uterine contractions postpartum.
• Human Chorionic Gonadotropin (hCG): Declines rapidly, leading to hormonal readjustments.

Cardiovascular Adaptations Post Delivery

• Excess blood volume decreases through diuresis and diaphoresis (sweating).
• Up to 3,000 mL of urine output per day in the first 48 hours is normal for the body.
• Cardiac Output remains elevated immediately postpartum, then normalizes within 6-12 weeks with an increased stroke volume due to fluid shifts and uterine contraction.
• Clotting factors remain elevated in the immediate postpartum period, increasing the risk for thromboembolism.
• Encourage early ambulation to prevent DVTs and Assess legs for signs of clots is important during a nursing intervention.
• Monitor vital signs for signs of hypovolemia or postpartum hypertension.
• Postpartum Hemorrhage (PPH) is considered to occur when blood loss exceeds 500 mL after vaginal delivery or 1,000 mL after C-section.
• Uterine atony is the most common cause of PPH (Tone)
• Remained placental fragments (Tissue) or Perineal or uterine lacerations (Trauma) can be caused by PPH.
• Thrombin (Coagulopathy) can be caused by PPH.
• Excessive bleeding is a sign of PPH.
• A boggy uterus despite massage, and symptoms of hypovolemic shock: Tachycardia, hypotension, and pallor is a sign of PPH. The immediate actions for treating PPH are to perform fundal massage to stimulate uterine contractions and ensure the bladder is empty.
• Oxytocin stimulates uterine contractions, and Methylergonovine helps contract the uterus in PPH.
• Carboprost Tromethamine helps with uterine atony and Misoprostol is rectally administered to promote uterine tone in PPH.
• One additional intervention for PPH is to insert a large-bore IV for fluid replacement or blood transfusion if needed.
• Prepare for manual removal of retained placenta or surgical intervention if necessary (D&C)

Cold Stress in Newborns

• When a newborn's body temperature drops below the normal range (<36.5°C or 97.7°F), leading to metabolic and respiratory complications.
• Look for increased respiratory effort marked by tachypnea, nasal flaring, and grunting/retractions.
• Additional signs for newborns are Hypoglycemia which causes jitteriness, poor feeding, and lethargy.
• Metabolic Acidosis, Weak cry, decreased tone, and Peripheral Vasoconstriction are also signs.
• Nursing implementions would be immediate drying after birth and maintain a neutral thermal environment (radiant warmer, skin-to-skin contact,)
• Nursing implementions would be to monitor the temperature regularly (axillary thermometry), provide warm blankets, and avoid exposing the baby unnecessarily.
• Newborns are born with developed sensory systems but require stimulation to optimize adaptation.
• The least developed sense they are born with is their vision.
• They can see objects 8-12 inches away (ideal distance for eye contact during feeding) with a preference for high-contrast patterns and human faces.
• Are Fully developed at the time of birth and recognize and respond to the maternal voice related to hearing.
• They have a keen sense of smell and can identify their mother's scent within hours after birth which relates to smell.
• They have a most developed sense that relates to touch and touch.
• New borns will respond positively to skin-to-skin contact and gentle handling Most developed sense they are born with is touch. A normal newborn respiratory rate is 30–60 breaths per minute. Signs of distress. Look for symmetric chest rise and fall, and signs of respiratory effort or distress in the new born.

Signs of Respiratory Issues

• Tachypnea is when the Respiratory rate > 60 breaths/min.
• Nasal Flaring: Indicates airway obstruction or distress.
• Grunting: Reflects increased effort to maintain open alveoli.
• Intercostal or Substernal Retractions: Indicates respiratory distress syndrome or meconium aspiration.
• Central Cyanosis: Bluish discoloration of lips or face; a late sign of hypoxia.
• Transient Tachypnea of the Newborn (TTN) is common in C-section deliveries and typically resolves within 48-72 hours and the treatment is supportive care.
• Respiratory Distress Syndrome (RDS) is commonly seen in preterm infants due to surfactant deficiency.
• The treatment is surfactant therapy, oxygen, or mechanical ventilation.
• Conduction: Heat loss through direct contact with a cooler surface.
• Convection: Heat loss to cooler surrounding air.
• Evaporation: Heat loss as moisture on the skin evaporates.
• Radiation: Heat loss to nearby cooler surfaces without direct contact.
• Newborns cannot shiver, so they rely on metabolizing brown fat for heat production (Non-shivering Thermogenesis).
• Brown fat is located around the neck, scapulae, axillae, and kidneys, when broken down, generates heat to raise body temperature.
• Definition: Excess bilirubin in the blood due to immature liver function or hemolysis.
• Physiologic Jaundice appears after 24 hours of life, peaks at 2-4 days, and resolves by 7 days. The cause is the immature liver which is unable to process bilirubin efficiently.
• Pathologic Jaundice appears within the first 24 hours or persists beyond 7 days. The cause is Hemolytic disease of the newborn.
• Look for Yellow discoloration of the skin and sclera with the sign and symptoms.
• Look for Poor feeding and Lethargy or irritability which are also the sign and symptoms.
• Severe cases are an indicator and are marked by High-pitched cry and seizures.
• Assess for jaundice starting at the face and progressing downward to monitor it.
• Check bilirubin levels using transcutaneous or serum testing to monitor the condition.
• Perform Phototherapy to converts bilirubin into a water-soluble form for excretion.
• Cover the baby's eyes and monitor for dehydration, also start frequent feeding.

APGAR Scores

• Purpose: Evaluates newborn's adaptation to extrauterine life at 1 minute and 5 minutes postdelivery. A score may also be assessed at 10 minutes if needed.
• The score range is 0–2; total score out of 10.
• Evaluate Appearance (Skin Color).
• 0: Blue/pale all over.
• 1: Pink body, blue extremities.
• 2: Completely pink.
• Evaluate the Pulse (Heart Rate):
• 0: Absent.
• 1: <100 bpm.
• 2: ≥100 bpm.
• Evaluate the Grimace (Reflex Irritability):
• 0: No response to stimulation.
• 1: Grimaces only.
• 2: Crying or active withdrawal.
• Evaluate Activity (Muscle Tone):
• 0: Flaccid.
• 1: Some flexion of extremities.
• 2: Active movement.
• Evaluate the Respiration:
• 0: Absent.
• 1: Slow, irregular breathing.
• 2: Strong cry.
• Interpretation of Score: - 7-10: Normal.
• 4-6: Moderate distress.
• 0-3: Severe distress; requires resuscitation.
• The ortolani Maneuver helps to confirm hip dysplasia in newborns by relocating the hip.
• The purpose is to identify an unstable hip that can be dislocated. Involves flexing the hips and knees at 90 degrees, then applying gentle downward pressure with abduction.
• Assess the newborn with the Apgar Scale and dry and warm them immediately after their birth.
• Early identification of issues are abnormalities or respiratory distress, and if needed administer medication. Vitamin K injection help prevent bleeding due to immature clotting factors.
• Erythromycin eye ointment helps with the prevention of eye infections.
• Assess or look for Respiratory Distress: Grunting, nasal flaring, retractions, tachypnea (>60 breaths/min), cyanosis
• Assess or look for Hypoglycemia: Lethargy, poor feeding, jitteriness, hypothermia.
• Assess or look for Infection: Fever, poor feeding, irritability.
• Assess or look for Jaundice: Yellow skin/sclera.

Hypoglycemia In Newborns

• Definition: Blood glucose <40 mg/dL.
• At-Risk Newborns of any of these include; Premature or small-for-gestational-age , Infants of diabetic mothers, and Infants with perinatal stress
• Assess for Poor feeding, jitteriness, tremors, Lethargy, hypothermia, and for Seizures.
• The intervemtions are to Perform blood glucose screenings and encourage early and frequent feeding, and Administer oral glucose gel or IV dextrose if needed.
• Care for the stump by keeping the umbilical cord stump clean and dry while avoiding covering the stump with the diaper and Allowing the stump to fall off naturally (~7–10 days). If an infection is recognized, intervene on and treat using antibiotics and wound care.

Ballard Scale

• Used for Gestational Age Assessment to assess the neuromuscular and physical maturity to estimate gestational age.
• Assess the Neuromuscular Maturity to see: Posture (Flexion increases with gestational age) and Square Window (Flexion of the wrist) and the Scarf Sign (Arm crosses the chest less in term infants)
• Assess the Physical Maturity, to assess Skin (Smooth and opaque in term infants; thin and transparent in preterm).and Lanugo ,as well as the Plantar Creases.
• Then Place the newborn into one of the following categories (Preterm: <37 weeks, Term: 37-41 weeks, and Post-Term: >42 weeks.
• Types of Jaundice:
• Physiologic (after 24 hours): Common in 60% of newborns.
• Pathologic (within 24 hours): Due to hemolysis or infection. Look for Yellowish skin/sclera starting at the face and progressing downward, also assess for: Poor feeding and/or lethargy, finally: Severe cases (High-pitched cry, arching, kernicterus).
• Increased metabolic demand when they cannot maintain normal temperature.

Hypothermia indicators in a New Born

• Assess and identify signs of hypothermia (<36.5°C or 97.7°F, look for Jitteriness, poor feeding, and/or Hypoglycemia and respiratory distress, orSkin changes.
• When educating the new parents teach breastfeeding techniques, latch guidance, and feeding frequency (every 2-3 hours) during the Feeding session.
• Ensure that the Newborn is spongebathed with warm water and a gentle soap. Use a firm mattress and avoid loose bedding or stuffed toys in the crib, Also, the newborns should be placed on their back to sleep to prevent SIDS.