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Questions and Answers
What is the function of surfactant in the lungs of newborns?
What is the normal pulse rate range for a newborn?
What is the purpose of early, regular, and frequent nursing?
What is a recommended method for a mother to alleviate breast engorgement?
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What should be monitored after the expulsion of the placenta?
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Which newborn reflex typically does not appear until 8 to 12 months of age?
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What is the shape and location of the anterior fontanelle in an infant?
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What is a significant sign that could indicate uterine atony?
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What is a sign of respiratory distress in preterm infants?
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What does a positive Homans' sign suggest?
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How is surfactant administered to preterm newborns?
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What is the typical time frame for menstrual periods to resume in a woman who is not breastfeeding?
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How can bladder distention affect uterine tone?
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What dietary components are conducive to healing postpartum?
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What is the first initial vaginal discharge called after delivery?
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When should RhoGAM be administered to an Rh-negative mother?
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What medical treatment may be performed for subinvolution?
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What does atony refer to in the context of postpartum care?
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What is an early sign of infection in a postpartum woman?
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Why is alternating breasts for feeding beneficial?
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What is the first sign of inadequate blood volume typically observed in patients?
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Which of the following is not a recommended approach when using an interpreter for patient communication?
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What color and consistency should the stool of a breastfed infant typically be?
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What is the correct response when a mother reports her newborn is sleeping excessively?
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In the context of breast care for nursing mothers, what is a true statement regarding afterpains?
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What is the purpose of using a pulse oximeter in the neonatal intensive care unit?
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Which of the following indicates a possible cervical laceration postpartum?
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Which symptom is typically associated with endometritis after delivery?
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What should be the immediate action if a newborn presents with sternal retractions?
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What is the optimal method for weaning a newborn from breastfeeding?
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Match the following terms related to breastfeeding with their correct descriptions:
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Match the following interventions to their effects for postpartum care:
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Match the characteristics to the relevant infant conditions:
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Match the following nutrients or food types to their postpartum benefits:
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Match the breastfeeding practices with their benefits:
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What techniques can a mother use to alleviate breast engorgement before feeding?
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What is the significance of the anterior fontanelle's shape and closure age in infants?
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How does early ambulation benefit postpartum women?
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What are the characteristics of a preterm infant's skin?
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What dietary items are recommended for postpartum healing?
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What condition is indicated by a high-pitched cry and bulging fontanelles in a newborn?
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What is the relevant nursing intervention when a postpartum woman experiences red bleeding after it has previously changed to pink or white?
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What is the effect of alternating breasts during feeding on milk production?
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Which of the following accurately describes the effects of maternal antibodies on an Rh-negative woman with an Rh-positive infant?
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What complications can arise due to atony of the uterus postpartum?
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What characteristic of a preterm infant's integumentary system is typically observed?
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What intervention should be taken if a newly casted child's leg is to be monitored for complications?
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Which treatment is specifically selected to address subinvolution in postpartum care?
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What are the characteristics of the anterior fontanelle in an infant?
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Which statement best describes the change in skin appearance in preterm infants?
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Study Notes
Breastfeeding
- Early, regular, and frequent nursing helps prevent breast engorgement
- Nursing mothers may have more afterpains since infant suckling releases oxytocin, which contracts the uterus
- Relief for engorgement includes pumping, cold compresses, and heat
- Manual massage can soften the breasts and express milk
- Wear a supportive bra 24/7
Preterm Infant Care
- Preterm infants have thin skin and are prone to respiratory distress syndrome (RDS)
- Insufficient surfactant predisposes the preterm infant to RDS
- Surfactant can be administered via ET tube
- The preterm infant requires humidified incubator, prone positioning, and no diapers
- The growth rate of the preterm newborn nears that of the term infant by the second year
- The production of surfactant is deficient in preterm infants
Newborn Care
- The newborn's head may be out of shape due to molding
- The normal newborn's pulse rate is 110 to 160 beats/min
- Newborns have very little subcutaneous fat, making them susceptible to cold
- Loss of vernix caseosa causes dry skin and peeling
- Straining in newborns is due to underdeveloped abdominal musculature
- Blinking, sneezing, gagging, and sucking reflexes are present in a full-term newborn
Postpartum Care
- Post-partum hemorrhage is a risk
- Oxytocin (Pitocin) is the most common drug to control uterine atony
- Atony describes a lack of normal muscle tone
- Lochia rubra is the initial red vaginal discharge lasting up to 3 days
- The fundus is normally firm, about the size of a grapefruit, at the umbilicus level
- Fever after 24 hours may indicate an infection
- The Rh-negative woman should receive RhoGAM within 72 hours after the birth of an Rh-positive infant
- Severe cramping and fever are manifestations of endometritis
- The normal range for a white blood cell count for a postpartum woman is 20,000 to 30,000 cells/dL
- Return to bright red lochia rubra may indicate a late postpartum hemorrhage
Other
- Homans' sign is suggestive of a deep vein thrombosis
- Hydrocephalus is characterized by increased cerebrospinal fluid in the brain ventricles
- Down syndrome children are prone to cardiovascular system deformities
- The woman with mastitis can breastfeed unless an abscess forms
- Diaper placement below the umbilical stump allows for drying by air circulation
- When weaning a newborn from breastfeeding, the mother should eliminate the favorite feeding last
- An affirmative nod does not always mean understanding or agreement
- The best answer for postpartum care after a c-section is to encourage use of the football hold to decrease pressure on the operative site
- Anticoagulant therapy is continued for 6 weeks after birth to minimize the risk of embolism
- Moist heat promotes blood flow, comfort, and complete emptying of the breast
Breast Engorgement
- Early, regular, and frequent nursing prevents breast engorgement.
- If engorgement occurs, the mother can pump her breasts to stimulate milk flow and soften the areola.
- Cold compresses between feedings and heat before feedings reduce discomfort and engorgement.
- Manual breast massage helps soften the breasts and express milk.
- Wearing a supportive bra 24/7 can also help.
Respiratory Distress Syndrome (RDS)
- Preterm infants have insufficient surfactant and are predisposed to RDS.
- Signs of RDS include labored breathing and increased respiratory rate.
- Surfactant can be administered via ET tube at birth or when RDS symptoms occur.
Postpartum Involution
- The uterus returns to its normal size after delivery through a process called involution.
- Early ambulation and range-of-motion exercises prevent blood clots in the postpartum woman.
- Medical treatment for subinvolution focuses on addressing the cause, which might involve removing retained placental fragments.
Newborn Assessments and Care
- The anterior fontanelle is diamond-shaped and closes between 12 and 18 months.
- Normal newborn pulse rate is between 110 and 160 beats per minute.
- The newborn's head may be misshapen due to "molding" during birth.
- Hydrocephalus is characterized by increased cerebrospinal fluid in the brain.
- Newborns have very little subcutaneous fat, making them susceptible to cold.
- The newborn's first stool, called meconium, is black and sticky.
- Newborn's have ineffective sweat glands and cannot cool themselves via evaporation.
Postpartum Hemorrhage
- A boggy uterus requires massage until it becomes firm to prevent hemorrhage.
- Late postpartum hemorrhage can manifest as a return to red bleeding after it has changed to pink or white.
- Oxytocin (Pitocin) is the most common drug used to control uterine atony.
- Overdistended bladder can also cause uterine atony.
Postpartum Care
- Legumes and vitamin C foods support healing.
- Abdominal tighteners, head lifts, pelvic tilts, and Kegel exercises are beneficial for postpartum involution.
- A snug bra worn around the clock can alleviate discomfort from engorgement.
- Menstrual periods resume in about 6 to 8 weeks if the woman is not breastfeeding.
Preterm Infant Care
- The growth rate of a preterm infant nears that of a term infant by the second year.
- Preterm infants have thin, transparent skin and superficial scalp veins.
- Preterm infants have decreased subcutaneous fat and are susceptible to heat loss.
- The gestational age is based on the actual time spent in the uterus.
Postoperative Care
- The casted leg should be kept elevated.
- Elbow restraints are used postoperatively to prevent infants from damaging operative areas.
Newborn Reflexes
- Blinking, sneezing, gagging, and sucking reflexes are present in full-term newborns.
- The rooting reflex causes the infant's head to turn in the direction of anything that touches the cheek.
- The Moro reflex is elicited by jarring the infant's crib and is characterized by the infant drawing up the legs, fanning the arms, and then bringing the arms to the midline.
Newborn Complications
- Hypoglycemia in newborns can manifest as a high-pitched cry.
- Severe jaundice can lead to kernicterus, a buildup of bilirubin in the brain tissue, which can cause serious brain damage.
Postpartum Assessments
- Fever after 24 hours post-delivery suggests an infection.
- Sever cramping and fever are signs of endometritis.
- When checking the fundus, the nurse gently walks the fingers from the side of the uterus to the midline.
Maternal Care
- It is important to explore a postpartum woman’s feelings to determine if she is experiencing persistent depression.
- Encouraging the use of the football hold after surgery helps decrease pressure on the operative site.
- If a mother does not wish to breastfeed, a snug bra worn around the clock can help alleviate discomfort.
- Breastfeeding mothers may have more afterpains due to the release of oxytocin during breastfeeding.
- Some pain medications should not be taken while breastfeeding.
- If a new mother seems depressed, it is important to explore her feelings.
Infant Care
- The shampoo is done last to minimize heat loss.
- When weaning from breastfeeding, eliminate the favorite feeding last.
- Gently rubbing the infant's back, ankles, or feet can stimulate the infant to breathe.
- Diaper placement below the umbilical stump promotes air circulation and drying.
- The infant’s hips are kept lower than the lesion.
- The infant is usually not in diapers.
- The nurse should check the infant's identification band with the mother.
Nursing Considerations
- Specific nursing responsibilities for necrotizing enterocolitis include measuring the abdomen and listening to bowel sounds.
- A pain in the calf when flexed and the foot is dorsiflexed is a positive Homans' sign, suggestive of a deep vein thrombosis.
- Use of a pulse oximeter to monitor arterial blood gases in high-risk infants is a priority in the NICU.
- The nurse may need an interpreter to communicate with patients who speak other languages.
- Hand washing is the most important precaution to prevent infection.
- Straining in the newborn period is normal and results from underdeveloped abdominal musculature.
- It is normal for newborn to lose 5-10% of their birth weight in the first 3-4 days.
- A return to bright red lochia rubra may indicate a late postpartum hemorrhage.
- A child with Down syndrome has generalized hypotonicity, which can cause mucus accumulation and respiratory problems.
- The child with hydrocephalus has a heavy head and poor muscle tone.
Other Topics
- A late preterm infant is between 34 and 36 weeks gestation.
- The ability to discriminate between a mother's voice and other voices can occur within three days of life.
- The infant's stool should be bright yellow, soft, and pasty.
- The infant is placed prone in a humidified incubator.
- Atony describes a lack of normal muscle tone.
- Medical management for hypovolemic shock includes: stopping blood loss, IV fluids, blood transfusions, and oxygen saturation assessment.
- Moist heat helps with breast engorgement.
Breast Engorgement
- Early, regular, and frequent nursing helps to prevent breast engorgement.
- If engorgement occurs, the mother can pump her breasts to get the milk flow started and soften the areola.
- Cold applications between feedings and heat just before feedings may help to reduce discomfort and engorgement.
- Manual massage of all segments of the breasts helps to soften them and express milk downward in the duct system.
- The mother should wear a supportive but not excessively tight bra 24 hours a day.
Respiratory Distress Syndrome
- Insufficient amounts of surfactant predispose the preterm infant to respiratory distress.
- Alternating breasts for feeding increases milk production, particularly hindmilk, which has a higher protein and fat content.
- In preterm newborns, surfactant can be administered via ET tube at birth or when symptoms of RDS occur, with improvement of lung function seen within 72 hours.
Fontanelles
- The anterior fontanelle is diamond-shaped and located at the junction of the two parietal and two frontal bones.
- It should not be raised or sunken, and it closes between 12 and 18 months of age.
Postpartum Involution
- Early ambulation and range-of-motion exercises are valuable aids to prevent thrombus formation in the postpartum woman.
- Medical treatment for subinvolution is selected to correct the cause.
- Treatment may include dilation of the cervix and curettage to remove retained placental fragments from the uterine wall.
Postpartum Discharge
- Blood-tinged mucus discharged from the vagina is caused by hormonal withdrawal from the mother at birth.
- Menstrual periods resume in about 6 to 8 weeks if the woman is not breastfeeding.
Preterm Infant
- The growth and development of the fetus are abruptly halted by a preterm birth.
- One of the characteristics of the preterm infant is skin that is loose and transparent.
- The infant is placed prone in a humidified incubator, and the sac is covered with dressings of sterile saline.
- The infant's hips are kept lower than the lesion, and the infant is usually not in diapers.
Uterine Atony
- Atony describes a lack of normal muscle tone.
- If the uterus is atonic, then muscle fibers are flaccid and will not compress bleeding vessels.
- The nurse should immediately massage it until it becomes firm.
- Bladder distention can cause uterine atony.
- Oxytocin (Pitocin) is the most common drug ordered to control uterine atony.
Newborn
- Newborns have very little subcutaneous fat, which offers little insulation against cold.
- Newborns have ineffective sweat glands and cannot cool themselves through evaporation.
- The newborn's head may be out of shape from molding.
- The normal range for a newborn's pulse rate is 110 to 160 beats/minute.
Hydrocephalus
- Hydrocephalus is characterized by an increase in cerebrospinal fluid in the ventricles of the brain.
- The child with hydrocephalus has a heavy head on a small body with poor muscle tone; the head must be supported when feeding and moving the child to prevent injury to the neck.
Surfactant
- Surfactant begins to appear at the age of 24 weeks and is adequate to support life at the age of 34.
- The production of surfactant, necessary for the absorption of oxygen by the lungs, is deficient in the preterm infant.
Postpartum Hemorrhage
- When the nurse teaches the postpartum woman about normal changes in lochia, it is important to explain that a return to red bleeding after it has changed to pink or white may indicate a late postpartum hemorrhage.
Homans' Sign
- A pain in the calf of the leg when the leg is flexed and the foot is dorsiflexed is a positive Homans' sign.
- Homans' sign is suggestive of a deep vein thrombosis.
Gestational Age
- Term infants over 4000 g (8.8 lb) may be classified as large for gestational age (LGA).
- For the preterm infant this is less than 38 weeks, for the term infant it is 38 to 42 weeks, and for the postterm infant it is beyond 42 weeks.
- A late preterm infant, also known as a near-term infant, is born between 34
Newborn Reflexes
- Blinking, sneezing, gagging, and sucking reflexes are present in the full-term newborn.
- Pincer grasp does not occur until between 8 and 12 months.
- The ability to discriminate between a mother's voice and other voices may occur as early as in the first 3 days of life.
Casting
- The casted leg should be kept elevated.
Preterm Newborn Growth
- In the absence of severe birth defects and complications, the growth rate of the preterm newborn nears that of the term infant by about the second year.
Postpartum Period
- Loss of vernix caseosa leaves the skin dry, causing peeling.
- The gestational age is the age based on the actual time in the uterus.
- Increased temperature is a sign of infection.
VP Shunt
- An increasing abdominal girth in a child with a VP shunt may be indicative of malabsorption of the cerebrospinal fluid (CSF) that is being shunted to the peritoneum.
- If the fontanelles are bulging, the child will be positioned in a semi-Fowler's position to promote drainage from the ventricles through the shunt.
Down Syndrome
- Down syndrome children are prone to deformities of the cardiovascular system.
- Congenital heart deformities are also associated with this condition.
- The child with Down syndrome has generalized hypotonicity, which caused mucus accumulation and respiratory problems.
Rh Incompatibility
- The only woman with antibodies against the Rh-positive infant is the Rh-negative woman who has had one Rh-positive child and is now pregnant with another.
Postpartum Immunizations
- The woman who is not immune to rubella is immunized in the immediate postpartum period, because there is no danger of her being pregnant.
Newborn Bathing
- The shampoo is done last, because the large surface area of the head predisposes the infant to heat loss.
Fundus
- Immediately after the placenta is expelled, the uterine fundus can be felt as a firm mass, about the size of a grapefruit, at the level of the umbilicus.
- The fundus is checked gently by walking the fingers from the side of the uterus to the midline.
Hypoglycemia
- There are many signs of hypoglycemia in the newborn. One is a high-pitched cry.
- A blood glucose level of less than 40 mg/dL is considered hypoglycemic.
- If the screening sample is below 40 mg/dL, a venous sample will be drawn.
- After the blood has been drawn, the infant should be fed to prevent a further drop.
Increased ICP
- Increased ICP is manifested by high-pitched cry, inequality of pupils, and bulging fontanelles.
Postpartum Depression
- If a postpartum woman seems depressed, it is important to explore her feelings to determine if they are persistent and pervasive.
Developmental Dysplasia of the Hip (DDH)
- The gluteal folds are asymmetrical because the head of the femur has slipped out of the acetabulum.
- There is also limited abduction of the affected side, and when the legs are flexed the affected leg seems to be shorter.
Mastitis
- The woman with mastitis can continue to breastfeed unless an abscess forms.
Diaper Placement
- Diaper placement below the umbilical stump allows for drying by air circulation.
Lochia
- The initial vaginal discharge after delivery is called lochia rubra. It is red and moderately heavy.
- Lochia rubra lasts for up to 3 days postpartum.
Postoperative Care
- The patient should be evaluated for ambulatory ability, and the abdominal dressing and infusion site should be covered with a waterproof cover.
- The patient should be provided a shower chair and positioned with her back to the water stream.
RhoGAM
- The Rh-negative woman should receive RhoGAM within 72 hours after the birth of an Rh-positive infant.
Apgar Score
- The Apgar score is a standardized method of evaluating the newborn's condition immediately after delivery.
- Five objective signs are measured: heart rate, respiration, muscle tone, reflexes, and color.
- The score is obtained 1 minute after birth and again after 5 minutes.
Preterm Newborn Complications
- Paleness, vomiting, and bulging fontanelles can indicate complications in the preterm newborn.
- Transparent skin and superficial scalp veins are expected findings.
Stimulating Breathing
- Gently rubbing the infant's back, ankles, or feet may stimulate the infant to breathe.
Taking Hold
- In phase 2, taking hold, the mother begins to initiate action and becomes interested in caring for the infant.
- In doing so, she may become critical of her performance.
Hematoma Formation
- Delivering a large infant and a prolonged labor are risk factors for hematoma formation.
Necrotizing Enterocolitis
- Bloody stools, abdominal distention, diarrhea, and bilious vomitus are signs of necrotizing enterocolitis.
- Specific nursing responsibilities include measuring the abdomen and listening to bowel sounds.
Communication with Interpreters
- The nurse may need an interpreter to understand and provide optimal care to the woman and her family.
- If possible, when discussing sensitive information the interpreter should not be a family member, who might interpret selectively.
- The interpreter should not be of a group that is in social or religious conflict with the patient and her family, an issue that might arise in many Middle Eastern cultures.
- It is also important to remember that an affirmative nod from the woman may be a sign of courtesy to the nurse rather than a sign of understanding or agreement.
Postoperative Care for Cesarean Birth
- The best answer is to encourage use of the football hold to decrease pressure on the operative site.
Breastfeeding
- Some pain medications should not be taken when breastfeeding.
- The stool of a breastfed infant is bright yellow, soft, and pasty.
Inadequate Blood Volume
- Tachycardia is usually the first sign of inadequate blood volume.
Infection Prevention
- Hand washing is the most reliable precaution available to prevent infection.
- The nurse washes his or her hands between handling different babies.
Newborn Straining
- Straining in the newborn period is normal.
- It results from underdeveloped abdominal musculature.
- No treatment is required.
Anticoagulant Therapy
- Anticoagulant therapy is continued with heparin or warfarin (Coumadin) for 6 weeks after birth to minimize the risk of embolism.
Rooting Reflex
- The rooting reflex causes the infant's head to turn in the direction of anything that touches the cheek in anticipation of food.
Jaundice
- Severe jaundice can cause kernicterus, an accumulation of bilirubin in the brain tissue, which can lead to serious brain damage.
- The light breaks down excess bilirubin so that it can be excreted.
Cervical Laceration
- The bright trickle of blood with a firm uterus suggests a cervical laceration.
Major Depression
- Major depression is a disorder characterized by deep feelings of worthlessness, guilt, serious sleep, and appetite disturbances, and sometimes delusions about the infant being dead.
Neonatal Intensive Care Unit (NICU)
- Use of a pulse oximeter to carefully monitor arterial blood gases in high-risk infants continues to be a priority in the neonatal intensive care unit (NICU).
Late Postpartum Hemorrhage
- A return to bright red lochia rubra may indicate a late postpartum hemorrhage and must be reported.
Postpartum Support
- The nurse may help the woman by being a sympathetic listener.
- The nurse should elicit the new mother's feelings about motherhood and her infant.
Cleft Palate
- Children with cleft palate are at risk of ear infections and dental disorders.
- Parents should be instructed to take the child to the health care provider at the first sign of earache.
Pulmonary Embolism
- Symptoms of early pulmonary embolism may not be dynamic.
- The cough with shortness of breath and temperature elevation is a clue to this possible complication.
Infant Identification
- The nurse should check the band number of the infant with that of the mother by asking the mother to verbally read the number.
Newborn Weight Loss
- It is typical for the newborn to lose 5% to 10% of his or her birth weight in the first 3 to 4 days of life.
- No change in the plan of care is needed.
Postpartum Infection
- Fever after 24 hours following delivery is suggestive of an infection.
- Severe cramping and fever are manifestations of endometritis.
Respiratory Distress
- Sternal retractions are evidence that the newborn is in respiratory distress and should be reported immediately.
White Blood Cell (WBC) Count
- The patient should be assessed further for other signs of infection, because a white blood cell (WBC) count of 20,000 to 30,000 cells/dL is normal in the early postpartum period.
Moro Reflex
- The Moro reflex is a normal neonatal reflex. It is elicited when the infant's crib is jarred. The infant responds by drawing the legs up, fanning the arms, and then bringing the arms to the midline in an embrace position.
Bulb Syringe
- The bulb is depressed, and then the tip is inserted into the mouth and then the nose. The depression is slowly released, creating the suction.
Elbow Restraints
- Elbow restraints are used postoperatively to prevent the infant from damaging the operative area.
Hypovolemic Shock
- Medical management for the patient experiencing hypovolemic shock includes stopping blood loss, giving IV fluids to maintain circulating volume and replace fluids, giving blood transfusions to replenish erythrocytes, and assessment of oxygen saturation. Anticoagulants would not be given.
Breastfeeding Care
- Moist heat promotes blood flow to the area, comfort, and complete emptying of the breast.
Weaning from Breastfeeding
- When weaning a newborn from breastfeeding, the mother should eliminate the favorite feeding last.
- One feeding should be eliminated at a time, and the need for comfort feeding should be expected.
- In younger infants formula will need to be substituted.
- The mother should not be instructed to pump in place of eliminated feeding or the breasts will continue to produce milk.
Afterpains
- Breastfeeding mothers may have more afterpains because infant suckling causes the posterior pituitary to release oxytocin, which is a hormone that contracts the uterus.
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Description
This quiz covers essential topics related to breastfeeding, preterm infant care, and general newborn care. It highlights important practices for nursing mothers and the specific needs of preterm infants. Test your knowledge on how to provide the best care for newborns and understand the physiological aspects involved.
