Post-Partum Hormonal Changes

Iron Deficiency Anemia

• Iron fortified cereal recommended when appropriate
• Daily iron requirement: 11-15mg
• Limit milk intake to <32 ounces per day to prevent fatigue
• Iron supplements: ferrous sulfate, given PO, IV, IM
  • Dosage: 3mg/kg/day (mild), 4-6mg/kg/day (severe)
  • Adverse effects: GI upset, anorexia, N/V, constipation, dark stools, stained teeth
  • Absorbed best on empty stomach with water; avoid giving with milk or tea
  • Give with vitamin C (ascorbic acid) to improve absorption

Croup (Laryngotracheobronchitis)

• Inflammation of larynx, trachea, and major bronchi
• Primarily affects children ages 6 months – 3 years old
• Caused by viral infections (e.g., parainfluenza virus)
• Incidence: fall/winter seasons
• Reoccurrences common
• Symptoms:
  • Seal-like barking cough
  • Inspiratory stridor
  • Marked retractions
  • Cyanosis rare, glottal obstruction possible
• Interventions:
  • Vital signs every 15 minutes
  • Assess breath sounds and oxygen deprivation
  • Humidified oxygen therapy
  • Semi-Fowler's to high Fowler's position
  • Corticosteroid via nebulizer
  • IV therapy for hydration
  • Reduce anxiety for child and family

RSV (Respiratory Syncytial Virus)

• Common infection in infants and children
• Causes infections of the lungs and respiratory tract
• Severe infections in premature babies, infants, and children with heart and lung disease
• Diagnosis: nasal swab, chest x-ray
• Symptoms:
  • Mild cases: congestion, runny nose, dry cough, low-grade fever, sore throat, wheezing, sneezing
  • Severe cases: hospitalization, fever, severe cough, wheezing, nasal flaring, short, shallow, rapid breathing or difficulty breathing, cyanosis, retractions, poor feeding, lethargy, irritability, apnea
• Interventions:
  • Supportive care
  • Assess respiratory system and signs of distress
  • Monitor vitals and pulse ox
  • Upright positioning
  • Administer humidified oxygen
  • Nasal saline drops and suction
  • Keep child hydrated
  • Monitor for signs of dehydration
  • Administer intravenous fluids
  • Collaborate with respiratory therapy
  • Isolation precautions
  • Educate parents and reduce anxiety

Pediatric Dehydration

• Fluid and electrolyte balance
• GI system main route for substance absorption
• Dehydration occurs when fluid loss exceeds intake
• Symptoms:
  • Thirst (mild to extreme)
  • Skin turgor changes
  • Skin temperature changes
  • Sunken fontanelle
  • Sunken eyes
  • Dry mucus membranes
  • Rapid pulse
  • Decreased or dark urine output
  • Low activity level
  • Weight loss
• Treatment:
  • Withhold food
  • Offer ice chips and water in small amounts
  • Increase fluids and diet as tolerated
  • Oral electrolyte replacement
  • IV fluids and electrolyte replacement may be necessary

Newborn Care

• Health promotion and wellness
• Disease prevention and immune system
• Focus on transition from intrauterine to extrauterine life
• Promote bonding and health of baby through parental education

Postpartum Care

• Physiological changes:
  • Thermoregulation
  • Cardiovascular system
  • GI system
  • Urinary system
  • Skin changes
  • Mood changes
• Potential complications:
  • Hemorrhage leading to hypovolemic shock and cardiac arrest
  • Infection
  • Thromboembolic disorders
  • Depression
• Assessment:
  • Vitals and fundus every 15 minutes for 1 hour, then every 30 minutes for 2 hours
  • Arm band/allergy band
  • Delivery information
  • Gravida/para
  • Last pain medication administered
  • Overall appearance
  • IV site
  • Respiratory, cardiac, and extremity assessments
  • Incision (if c-section)
  • Post-operative complications (pneumonia, DVT)

Hormonal Changes

• Relaxin:
  • Loosens and relaxes joints and ligaments in the pelvis for delivery
  • Affects other parts of the body (back, wrists, intestinal tract)
• Human chorionic gonadotropin (hCG):
  • Supports embryonic development
  • Stimulates the corpus luteum to continue producing progesterone
  • High levels in early pregnancy, decrease after the first trimester
  • Disappears around 3 weeks postpartum
• Estrogen:
  • Decreases after delivery, associated with breast engorgement
  • Helps uterine growth, blood circulation to uterus and placenta, and breast development
  • Stimulates milk production, uterine contraction postpartum, and vaginal dryness
• Progesterone:
  • Maintains endometrium
  • Decreases uterine contractility
  • Essential for implantation of embryo
  • Drops after delivery, returns to normal at ovulation
• Oxytocin:
  • Stimulates uterine contraction during labor
  • Causes milk ducts to contract, propelling breast milk to nipples (letdown reflex)
• Prolactin:
  • Stimulates milk production
  • Responsible for lactation, breast development, and other homeostatic functions