Module 3 - Concept - Reproduction- 5 Labor and Delivery PDF

Module 3 - Concept - Reproduction- 5 Labor and Delivery: Module Learning Outcomes 1. Examine the maternal anatomic and physiologic adaptations to labor ○ True vs. false labor True Labor Contractions ○ Can begin irregularly but become regular in frequency ○ Stronger, last longer, and are more frequent ○ Felt in lower back, radiating to abdomen ○ Walking can increase contraction intensity ○ Continue despite comfort measures Cervix (assessed by vaginal exam) ○ Progressive change in dilation and effacement ○ Moves to anterior position ○ Bloody show Fetus - presenting part engages in the pelvis *true labor leads to cervical dilation and effacement* False labor Contractions ○ Painless, irregular frequency, and intermittent ○ Decrease in frequency, duration, and intensity with walking or position changes ○ Felt in lower back or abdomen above umbilicus ○ Often stop with sleep or comfort measures (oral hydration, emptying of bladder) Cervix (assessed by vaginal exam) ○ No significant change in dilation or effacement ○ Often remains in a posterior position ○ No significant bloody show Fetus - presenting part is not engaged in the pelvis 2. Explain the five major factors that affect the labor process and describe the ongoing assessment of maternal progress during the first, second, third and fourth stages of labor. ○ 5 P’s- passage, passenger, powers, position, psyche Passenger Size, presentation (vertex, scapula, buttocks, sinciput, brow) Lie (relation of fetal spine to mom’s spine) - longitudinal, transverse, oblique Attitude (relation of fetal parts to one another) - flexion, extension Position - occiput, sacrum, mentum (chin), sinciput Baby Breach?? *fetus and placenta* Passageway - pelvis and surrounding soft tissues influence labor course Gynecoid: round, strongest association with vaginal delivery *optimal shape* Android: heart-shaped, increases risk of cesarean birth Anthropoid: oval, increased chance of occipital posterior position Platypelloid: rare, strongest association with cesarean birth Powers Primary = involuntary (contractions) ○ Causes cervical change (dilation) ○ Strength affected by if go into labor on own (spontaneous) or induced (iatrogenic exogenous oxytocin) Secondary = voluntary (pushing efforts) ○ No effect on cervical change - causes fetal expulsion *pushing power* frequency and duration. Position Affect an individual's anatomic and physiologic adaption to labor Position changes can relieve fatigue, increase comfort, and improve circulation *asking about mom, not baby* Psyche - Physiological aspect of labor Potential obstacles = stress, past experience, exhaustion, starvation/dehydration ○ Stages/Phases of Labor 1st stage: onset of labor until 10 cm ○ Latent phase = 0-3 cm ○ Active phase = 4-7 cm ○ Transition phase = 8-10 cm 2nd stage: 10 cm until delivery of baby 3rd stage: delivery of baby until delivery of placenta 4th stage: delivery of placenta until about 2 hours postpartum ○ First and Second-nursing Labor interventions ○ SROM assessment First, assess the FHR to ensure no problem from possible umbilical cord prolapse that can occur with the gush of amniotic fluid Verify pthe resence of alkaline amniotic fluid using nitrazine paper (turns blue, pH 6.5-7.5) A sample of fluid can be obtained and viewed on a slide under the microscope - amniotic fluid = ferning pattern, clear, color of water, free of odor 3. Identify signs of developing complications during labor and birth. ○ Identifying, and intervening with Fetal Heart Rate Categories I, II, and III Category 1 Baseline FHR of 110-160/min Baseline FHR variability: moderate Accelerations: present or absent Early deceleration: present or absent Variable or late decelerations: absent Category 2 (all FHR tracings not in category 1 or 3) can contain any of the following Baseline rate ○ Tachycardia ○ Bradycardia not accompanied by absent baseline variability Baseline FHR variability ○ Minimal baseline variability ○ Absent baseline variability not accompanied by recurrent decelerations ○ Marked baseline variability Episodic or periodic decelerations ○ Prolonged FHR deceleration equal or greater than 2 min but less than 10 min ○ Recurrent late decelerations with moderate baseline variability ○ Recurrent variable decelerations with minimal or moderate baseline variability ○ Variable decelerations with additional characteristics, including “overshoots”, “shoulders” or slow return to baseline FHR Accelerations: absent of induced accelerations after fetal stimulations Category 3 - include either Sinusoidal pattern Absent baseline FHR variability an any of the following ○ Recurrent variable decelerations ○ Recurrent late decelerations ○ bradycardia ○ Labor dystocia nursing interventions (addressed in REP 7) Assist with application of fetal scalp electrode and/or intrauterine pressure catheter Assist with amniotomy (artificial rupture of membranes) Encourage the client to engage in regular voiding to empty the bladder Encourage position changes to aid in fetal descent or open the pelvic outlet. Assist the client to a position on both hands and knees to help the fetus rotate from a posterior to an anterior position Encourage ambulation to enhance the progression of labor Encourage hydrotherapy and other relaxation techniques to aid in the progression of labor Apply counterpressure using the fist or heel of the hand to the sacral area to alleviate discomfort Assist clients in a beneficial position for pushing and coach them about how to bear down with contractions Prepare for a possible operative vaginal birth with forceps or vacuum extractor or for cesarean birth Continue monitoring FHR in response to labor 4. Describe the role and responsibilities of the nurse during labor and childbirth. Assess the client’s labor status before admission to the birthing facility. Conduct admission history, review of antepartum care, and review of the birth plan ○ Option laboratory results, monitor baseline FHR and contractions for 20-30 min, obtain maternal vital signs and check status of amniotic membranes Orient client and partner to unit Perform maternal and fetal assessment continuously through the labor prcess and immediately after birth Avoid vaginal examinations in the presence of vaginal bleeding or until placenta previa or abruptio placentae is ruled out. Vaginal exams should be done by the provider if necessary Cervical dilation is the single most important indicator of the progress of labor Progress of labor is affected by the size of the fetal head, fetal presentation, fetal lie, fetal attitude, and fetal position Frequency, duration, and strength of uterine contractions cause fetal descent and cervical dilation The first stage of labor - Perform Leopold maneuvers and vaginal exam as indicated - Encourage the client to take slow deep breaths before the vaginal exam - Monitor cervical dilation and effacement, station and fetal presentation - Prepare for impending birth as the presenting part moves into positive stations and begins to push against the pelvic floor (crowning) Teach client and partner about what to expect during labor and relaxation measures - breathing, effleurage (gentle circular stroking of the abdomen in rhythm with breathing during contractions), and diversional activities (distraction, concentration on a focal point, or imagery) - Encourage upright positions, application of warm/cold packs, ambulation, or hydrotherapy if not contraindicated. Encourage voiding every 2 hours During active phase - Provide client and fetal monitoring - Encourage frequent position changes, voiding at least every 2 hours, deep cleansing breaths, and relaxation. - Provide non pharm and pharm pain relief as needed and prescribed - Discourage pushing efforts until the cervix is fully dilated - Listen for client statements saying they need to have a BM - sensation is a finding of complete dilation and fetal descent The second stage of labor - Assessment for perineal lacerations - Continue monitoring mom and fetus - Assist in effective pushing position and partner invonvement - Promote rest between contractions - Provide feedback on labor progress to client - Prepare for care of newborn Third stage of labor - Instruct client to push once findings of placental separation is presnt - Administer oxytocicis and analgesics as prescribed - Gently cleanse the perineal area with warm water and apply a perineal pad or ice pack - Promote baby friendly activiites between baby and family to facilitate release of endogenous maternal oxytocin Fourth stage of labor - Assess mom BP and pulse every 15 min for first 2 hours - Assess fundus and lochia every 15 min for first hour - Massage uterine fundus and/or administer oxytocics to maintain uterine tone and prevent hemorrhage - Encourage voiding to prevent bladder distention - Assess episiotomy or laceration repair 5. Compare nonpharmacologic and pharmacologic methods used to enhance relaxation and relieve pain in different stages of labor and for vaginal and cesarean birth. ○ Epidural nursing interventions; preparing a client, during and after Using analgesics such as fentanyl and sufentanil that produce regional analgesia, provides rapid pain relief while still allowing the client to sense contractions and maintain the ability to bear down Nursing action ○ Institute safety precautions like putting up side rails on bed as it can cause dizziness and sedation ○ Assess for nausea and vomiting, and administer antiemetics as prescribed ○ Monitor mom vital signs and for allergic reaction ○ Continue FHR pattern monitoring ○ Non-pharmacological interventions Gate-control theory of pain Cognitive strategies like education and preparation methods Sensory stimulation strategies - aromatherapy, imagery, music… Cutanoeus stimulation strageties Back rubs, massage, walking, rocking, hydrotherapy, acupressure, position changes…. ○ IV pain medication administration Butoprhanol and nalbuphine - pain relief without causing significant respiratory depression to mom or baby Module 4 - Concept - Reproduction- 6 Complications in Pregnancy: Module Learning Outcomes 1. Provide education about screening and diagnostic testing in pregnancy to women with perinatal risk factors. ○ GDM screening Glucose screening test/1 hour glucose tolerance test ○ 50 g oral glucose load followed by plasma glucose analysis 1 hour later performed at 24-28 weeks gestation. Fasting not necessary ○ Positive is 130-140 or greater, additional 3 hour OGTT is indicated Oral glucose tolerance test ○ Following overnight fasting, avoidance of caffeine, and abstinence from smoking for 12 hours before testing - fasting glucose is obtained. A 100 g glucose load is given and serum glucose levels are determined at 1, 2, 3, hour following glucose ingestion Presence of ketones in urine BPP, amniocentesis, nonstress test ○ High-risk pregnancy risk factors Maternal age under 19 and over 40 First pregnancy Extreme obesity Multifetal gestation Chronic renal disease, chronic hypertension Familiar history of preeclampsia DM, rheumatoid arthritis, systemic lupus erythematosus ○ Hyperemesis gravidarum Excessive nausea and vomiting throughout pregnancy Urinalysis, chemistry profile, thyroid test, and CBC completed 2. Develop a plan of care for the woman with pre-gestational diabetes or gestational diabetes. ○ Diabetes mellitus in pregnancy (Pre-existing/Gestational) ○ Monitor client's blood glucose and fetus ○ In contrast to type 1 DM, clients with GDM are managed initially with diet and exercise - if glucose is persistently high, insulin is begun ○ Perform daily kick counts, adhere to appropriate diet, exercise, perform self-administration of insulin and understand the need for postpartum laboratory testing to include OGTT and blood glucose levels 3. Describe the etiologic theories and pathophysiology of preeclampsia. ○ Covered in flip recordings, organs affected which result in outwards s/sx ○ Traditionally diagnosed when proteinuria occurs with GH - but can happen without proteinuria ○ Development of abnormal placenta - uteroplacental arteries becoming fibrous and narrow Pro-inflammatory proteins then go into mothers circulation. Cause endothelial cells to become disfunctional which causes vasocontriction and make kidneys retain more salt…. Leading to hypertension ○ Organ manifestations Cortical brain spasm - HA, hyperreflexia, seizure activity Retinal anterior spasm - visal disturbances, blurry vision, scotoma Impaired liver function - kidney glomerular damage - increased plasma level uric acid and creatinine, oliguria Pulmonary edema Liver ischemia - elevated liver enzymes, NV, epigastric pain, RUQ ○ Presence of s/sx Headache (HA) - frontal Epigastric pain, RUQ abdominal pain Visual disturbances - scotoma, phototobia, or double vision 4. Discuss the preconception, antepartum, intrapartum and postpartum management of women with hypertensive disorders in pregnancy. ○ Hypertensive conditions of Pregnancy (Chronic and Gestational) Chronic Hypertensive conditions Elevated blood pressure that predates the pregancy Concerns of progression to superimposed preeclampsia Fetal concerns of poor perfusion and oxygenation HA, visual disturbances, epigastric pain, and new onset proteinuria should be done on patient. Gestational Hypertensive conditions Begins after 20th week of pregnancy No presence of edema, BP returns to baseline by 12 weeks postpartum ○ Preeclampsia assessment signs and symptoms, treatment Report of headaches may occur along with episodes of irritability. Edema may be present. Affects pregnant women after 20 weeks and up to 6 weeks after delivery Assessment of BP, edema, DTR’s, Clonus, proteinuria Manage symptoms after delivery, usually subside on own. Additional measures like O2 and medications. ○ Magnesium sulfate-Adverse Effects/Contraindications/Side Effects/Interactions and Medication administration (prevention of seizures) Toxicity - absence of patellar deep tendon reflexes, urine outmut less than 30 ml/hr, respirations less than 12/min, decreased LOC, cardiac dysrhythmias. ○ If suspected, stop immediately, administer antidote calcium gluconate or calcium chloride, and prepare to prevent respiratory or cardiac arrest Monitor BP, pulse, RR, deep tendon reflexes, LOC, urinary output, presence of headache, visual disturbances, epigastric pain, uterine contractions, and FHR and activity. ○ HELLP syndrome - labs demonstrating progression Hemolysis - resulting in anemia and jaundice Elevated liver enzymes - elevated ALT or AST, epigastric pain, and N/V Low platelets - less than 100,000. Resulting in thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly disseminated intravascular coagulation ○ Eclampsia nursing interventions Seizure precautions Delivery is best way to “treat” Reduce stress - quiet environment with low lighting 5. Differentiate among causes, signs and symptoms, possible complications and management of miscarriage, ectopic pregnancy, cervical insufficiency and hydatidiform mole. ○ Hemorrhagic conditions - bleeding during pregnancy- abortions, molar pregnancies, ectopic ○ Early pregnancy bleeding - misscarriage (spontaneous abortion), ectopic pregnancy, cervical insufficiency, hydatidiform mole ○ Abortions- types threatened, inevitable: complete, incomplete, missed. Threatened = cramping, vaginal bleeding, FHT’s present, and closed cervix Inevitable = cramping, vaginal bleeding, FHT’s present/absent, dilated cervix or membranes ruptured Incomplete: only some of the products (tissue) of conception leave the body Complete: all of the products of conception leave the body Missed: the pregnancy has failed and the products of conception do not leave the body 6. Compare and contrast placenta previa and placental abruption in relation to signs and symptoms, complications, and management. ○ Hemorrhagic conditions - bleeding during pregnancy- Placenta previa: placenta low lined in uterus. Can partially or fully cover cervix creating a problem for how baby can get out Risk factors = previous c section, AMA, multiparity, smoking, high altitudes, race (asian), multiple gestation, male fetus Maternal risks - hemorrhage, abnormal attachment, possible hysterectomy Fetal risks - preterm birth, anomalies, IUGR DX through ultrasound, NO VAGINAL EXAM! Pelvic rest >37 weeks delivery is treatment plan of choice and 30 mm(3cm) in 2nd and 3rd trimester unlikely to give preterm birth. Long cervix Fetal fibronectin (fFN) - “glue” found in plasma and produced during fetal life. Presence during late 2nd and early 3rd trimester may be related to placental inflammation. Women with negative result have less than 1% of giving birth within 2 weeks Having multiples - hyperextending uterus ○ Magnesium sulfate-Adverse Effects/Contraindications/Side Effects/Interactions and Medication administration (tocolytic) ○ Betamethasone, Terbutaline (tocolytic) 2. Define and describe indications and medications for cervical ripening and labor induction and augmentation. ○ Bishop scoring (induction vs augmentation) Used to determine maternal readiness for labor evaluated whether the cervix is favorable by rating cervical dilation, effacement, consistency, position, and station of presenting part Less than 8 = not ripe Over or equal to 8 = ripe Induction: initiating labor that has not started yet Augmentation: enhances labor that is already in progress but not progressing adequately ○ Oxytocin administration (augmentation) ○ Cervical ripening (chemical) Cytotec a prostaglandin gels ○ Cervical ripening (mechanical) balloon Balloon catheter inserted into intracervical canal to dilate the cervix 3. Summarize nursing care for a woman experiencing a trial of labor, induction or augmentation of labor, a forceps- or vacuum-assisted birth, a cesarean birth, or a vaginal birth after a cesarean birth (VBAC). ○ PP (REP 8) C-section care 4. Discuss obstetric emergencies and their appropriate management. ○ Labor dystocia nursing interventions A prolonged and difficult labor Assist with application of fetal scalp electrode and/or intrauterine pressure catheter. Assist with amniotomy (artificial rupture of membranes). Encourage client to engage in regular voiding to empty the bladder. Encourage position changes to aid in fetal descent or to open up the pelvic outlet. Assist the client to a position on both hands and knees to help the fetus to rotate from a posterior to anterior position. Encourage ambulation to enhance the progression of labor. Encourage hydrotherapy and other relaxation techniques to aid in the progression of labor. Apply counterpressure using fist or heel of hand to sacral area to alleviate discomfort. Assist the client into a beneficial position for pushing and coach them about how to bear down with contractions. Prepare for a possible operative vaginal birth with forceps or vacuum extractor or for a cesarean birth. Continue monitoring FHR in response to labor. ○ Chorioamnionitis - What is it, manifestations and treatment? Infection of membranes (amnion and chorion) that surrounds fetus during pregnancy Happens more often when amniotic sac has been broken for a while. Main symptom is a fever. Can be fast heart rate, painful uterus, or foul smelling amniotic fluid Antibiotics and expedited delivery for treatment ○ OB emergencies signs and symptoms and nursing interventions Shoulder dystocia, cord prolapse, uterine rupture (OB Emergency case studies) Shoulder dystocia: head is delivered and shoulders get stuck Can cause trauma, bruising, and hyperbilirubinemia to newborn Can cause birth trauma and risk of operative delivery Important maneuvers = suprapubic pressure and McRoberts Umbilical cord prolapse: First clue is you see it on fetal monitoring - variable decelerations Oxygen to increase perfusion to birthing person and therefore fetus SVE that is sustained until delivery - displacement of fetal head to take pressure off cord Hands and knees position to help take pressure off the umbilical cord Fetal monitoring to ensure fetal well being to determine urgency of C section Prepare for an emergency cesarean. Uterine rupture - main risk with TOLAC/VBAC Module 5 - Concept - Reproduction- 8 Normal Postpartum and Postpartum Complications: Module Learning Outcomes 1. Describe the anatomic and physiologic changes that occur during the postpartum period, including lochial flow and uterine involution characteristics. Postpartum assessment -BUBBLE-LE * listing abnormal findings and potential complications next to each one* ○ Breasts - clogged ducts/engorgement - mastitis *stage 2: birth - delivery of placenta causes Prolactin surge and decreased progesterone Milk comes in 2-5 days after birth All about demand. More sucking = more milk production ○ Uterus - displaced or boggy - uterine atony or retained placenta (PPH) Involution = process of uterus returning to nonpregnant state #1 intervention is to assess fundus and check that uterus is clamped down - good is firm, midline, scant, light lochia, and without clots. ○ Bowel - gas pain or abdominal pain - constipation May take up to 3 days before 1st BM postpartum ○ Bladder - urinary retention or UTI or pylenophrenitis ○ Lochia - extra bleeding - PPH, anemia, blood transfusion, hysterectomy Lochia rubra days 1-3: bright red, small to no clots Lochia serosa days 4-9: pinkish, brown, more discharge Lochia alba day 10+: yellow/white ○ Episiotomy/lacerations - inflammation or pain - infection, incontinence, sepsis ○ Legs (thrombosis) - thrombophlebitis - DVT, PE Want mamas moving around ○ Emotions - baby blues - postpartum mood disorders Stage 1: dependent phase, 1st 24 hours. Moms in hospital, we see them in this phase, tell birht story to family members and visitors Stage 2: dependent/independent phase, 10 days to several weeks Focused on new role, nurses do not see them during this period, optimal time for teaching, give pamphlets and handouts to help, educate on follow ups Stage 3: interdependent phase New parent role is accepted and reestablishing relationship with partner Baby blues happens in 80% of patients. Over 10 days = postpartum depression 2. Recognize signs of potential complications in the postpartum woman. Postpartum complications/assessments Mastitis, URI, UTI, thrombophlebitis, mood disorders, hematoma, absess formation, endometrios, perineal cellulitis… Recognizing Abnormal postpartum assessment ○ BUBBLE-LE assessment 3. Formulate a care plan for a woman in the postpartum period. Postpartum care, including 1st-4th degree lacerations ○ Encourage ambulation, fluids ○ Perineal lacerations Redress, ecchymosis, edema, drainage, and approximation (of edges) for assessment of lacerations First degree and second degree are usually okay - More interventions for 3rd and 4th degree due to involvement of anal sphincter Risks of infection, pain, incontinence, bleeding/trauma Interventions are antibiotic, pain medications, decrease pressure/straining, stool softeners, fluid, fiber, ambulation, and ensure referral to urology/pelvic floor PT Postpartum pharmacological & non-pharmacological comfort measures 4. Describe ways in which nurses can assist with parent-infant attachment and parental postpartum adjustment. 5. Identify causes, signs and symptoms, possible complications, and nursing management of postpartum hemorrhage, postpartum infection, postpartum thromboembolic disorders, and postpartum psychological complications. Nursing interventions based on fundal assessment ○ Fundal massage if boggy or or soft uterus to firm it ○ Monitoring fundal and lochia ○ Encourage breast feeding - oxytocin released PPH- 4T’s recognition and nursing interventions and treatment ○ Tone (70%) caused by uterine atony - uterus is boggy, not contracting. Vigourously massage fundus and utertonic meds (meds to help uterus contract) ○ Trauma (20%) caused by unrepaired lacerations or episiotomy extended or not approximated, bleeding at site, hematomas visible or not seen Identify and contact provider for suture/repair Fundus is usually firm, trickling of blood despite firm uterus ○ Tissue (10%) caused by retained placenta - uterus is boggy, not contracting due to retained tissue sending message to not contract until all products of conception expelled Fundal massage, assist provider with removal of tissue, and meds -utertonic meds that help uterus contract ○ Thrombin (1%) caused by coagulopathy, clotting disorders pre-existing or new onset Call for help and assist with labs and blood transfusions Last and worse case scenario - sick quick and bad, call for help ASAP. Treatment of Postpartum hemorrhage medications -(Oxytocin) Pitocin, Methergine, Cytotec, Hemabate Postpartum infections-Endometritis, Mastitis, UTI’s, wound infections ○ Mastitis - antibiotics. No need to stop breastfeeding - may need a lactation consult ○ Uterus - endometritis, infection of lining of uterus, most common postpartum infection ○ Bladder - UTIs, occur in 2-4% of postpartum patients (especially after a catheter) ○ Lacerations/incision - cesarean incision infection Postpartum mood disorders ○ Can start as soon as 2 weeks postpartum or as late as 1 year postpartum ○ Risk factors : history of mental health disorders, limited support, hisotry of mood disorder are most at risk, traumatic deliveries Deep vein thrombosis (DVT) prevention ○ Thrombophlebitis (inflammation) : elevate, heat, pain meds, and SCDs ○ Thrombosis (DVT) : reduce risk by compression socks, ambulation, SCD boots, and eduction — treatment consists of strict bedrest and anticoagulants Module 5 - Concept - Reproduction- 9 Normal Newborn and Newborn Complications: Module Learning Outcomes 1. Discuss the physiologic and behavioral adaptations that the neonate must make during the period of transition from the intrauterine to the extrauterine environment. ○ Cold stress signs & symptoms, prevention Main symptoms are hypothermia, pale, and mottled cold skin Can lead to exacerbate, hyperbillirubinemia, respiratory distress Avoid by minimizing heat loss and maintaining neutral thermal environment - put a hat on baby, blanket. 2. Explain newborn hyperbilirubinemia and describe related nursing assessments and interventions, including phototherapy. ○ Hyperbilirubinemia/Jaundice Newborn has immature liver, excess of unconjucted bilirubin leads to jaundice. More feeding - more poop - more bilirubin excretion - less risk of jaundice Hyperbilirubinemia = high jaundice Jaundice = total serum bilirubin over 6-7 mg/dL Risk factors: born before 36 weeks, exclusive breastfeeding, prior baby with jaundice, significant bruising during delivery Acute bilirubin encephalopathy = bilirubin toxicity when bilirubin levels are high enough to cross the blood-brain barrier Lethargy, irritability, seizures, coma, death Kericterus = irreverisble long term effects of bilirubin toxicity Hypotonia, hearing loss, delayed motor skills, cerebral palsy Pathologic jaundice: less common, presents WITHIN 24 hours of life, due to medical condition with the common cause being blood type incompatibility Physiologic jaundice: common (60% term, 80% preterm), presents AFTER 24 hours of life, usually self resolves without treatment ○ Phototherapy nursing interventions Light energy used to change shape of bilirubin causing unconjugated - conjugated for easier excretion - reduces circulating bilirubin ○ Baby only in diaper, eye mask on, temperature q4 hours, ensure proper hydration, and avoid lotions 3. Describe how to perform a physical assessment on a newborn, including the APGAR score. ○ Newborn assessment- initial and follow up assessments Quick initial assessment to observe for life threatening abnormalities and respiratory issues External assessment: Skin color, peeling, birthmarks, foot creases, breast tissue, nasal patency, and meconium staining (can indicate fetal hypoxia) Chest: Point of maximal impulse location; ease of breathing; auscultation for heart rate and quality of tones; and respirations for crackles, wheezes, and equality of bilateral breath sounds Abdomen: Rounded abdomen and umbilical cord with one vein and two arteries Neurologic: Muscle tone and reflex reaction (Moro reflex); palpation for the presence and size of fontanels and sutures; assessment of fontanels for fullness or bulge Other observations: Inspection for gross structural malformations ○ Newborn physical assessment -integumentary and skeletal system Skin should be deep red to purple initially with acrocyanosis (bluish tint to feet and hands) Skin turgo should be quick with texture being dry, soft, smooth Vernix caseosa (protective, thick, cheesy covering) vary Lanugo (fine downy hair) varies Normal deviations ○ Milia - small raised pearlyor white spots on nose chin and forehead. Disappear without treatment (parents should not squeeze) ○ Mongolain spots - pigmination that are blue, gray,brown, or black that are commonly on back or buttocks ○ Telangiectatic nevi (stork bites) - flat pink or red marks that usually fade by second year of life ○ Nevus flammeius (port wine stain) - capillary angioma-below the surface of skin that is purple or red ○ Erythema toxicum (erythema neonatorum)- pink rash that appears suddenly anywhere during first 3 weeks aka newborn rash. No treatment required ○ Apgar-scoring nursing interventions Scores given at 1 and 5 minutes of life Scores out of 10 ○ If 5 minute score is less than 7, will repeat again at 10 minutes of life ○ If 10 minute score is less than 7, will repeat again at 15 and then again at 20 minutes if needed Acrocyanosis - blue or purple color of extremities ○ Normal in 1st 48 hours of life 4. Provide nursing care to assist with the newborn adaptation and to teach caregivers about newborn care. ○ Initial steps neonatal resuscitation Newborn should be able to clear most secretions in airway passages - if not, suctioning of mouth and nasal passages with bulb syringe can be done to remove excess mucus in respiratory tract Newborns delivered by C section are more susceptible to fluid in lungs than newborns who were delivered vaginally If bulb is unsuccessful, use mechanical suction to clear airway and institute emergency procedures if airway does not clear Bulb should be kept with the newborn and instruct family how to use it. ○ Newborn respiratory distress s/sx Mild: nasal flaring, grunting, and retractions (use of intercostal or subcostal muscles “drawing in” of tissue between ribs) Moderate/severe: suprasternal or subclavicular retractions with stridor or gasping, seesaw or paradoxical respirations, circumoral cyanosis (bluish of lips/muscous membranes), central cyanosis -late sign of distress indicating hypoxemia, and apnea > 30 seconds. ○ Newborn assessment recognize changes or abnormalities Cold stress - ineffective thermoregulation can lead to hypoxia, acidosis, and hypoglycemia Hypoglycemia Hemorrage caused by improper cord care or placement of clamp ○ Newborn heat loss (LO 1?) Conduction - flow of heat from body surface to a cooler surface in direct contact Evaporation - moisture vaporization from newborn skin before dried after bath Convection - loss of heat due to ambient air (naked baby in bassinet losing heat to cool air around them rather than being swaddled with a hat) Radiation - flow of heat from body surface to a cooler solid surface nearby (not directly touching) ○ Newborn hypoglycemia risk factors Infants of diabetic mothers Small for gestational age (SGA) and intrauterine growth restriction (IUGR) Large for gestational age (LGA) Premature infants Infants with low Apgar scores Babies born to a birthing person diagnosed with chorioamnionitis Infants with difficulty feeding ○ Newborn discharge teaching: Newborn care- ex: Sudden infant death syndrome (SIDS) group work discussion Crying - cry when hungry, overstimulated, wet, cold, hot, tired, bored, or need to be burped. ○ Swaddling, movement, stimulation…. Sleep-walk cycle: sleep about 16-19 hr/day with periods of wakefulness gradually increasing ○ Place newborn in supine position to greatly decrease risk of sudden unexpected infant death (SUID) Cord care - cord clamp is removed before dischanrge. To prevent infection keep cord dry and keep top of diaper folded underneath it Best ways to hold a newborn ○ Cradle hold - cradle newborns head in the bend of the elbow ○ Upright position - hold newborn upright, face them toward the holder while supporting ○ Football hold - support half of body in holders forearm with newborns head and neck resting in the palm of the hand. Good for breastfeeding and shampooing hair 5. Describe nutritional needs of infants, anatomic and physiologic aspects of breastfeeding, newborn feeding-readiness cues, and maternal & infant indicators of effective breastfeeding. ○ BF basic teaching/care Lactating women need an additional 450-500 kcal/day over their pregnancy diet Breast milk has antibodies and is directly made for the baby Recommendations are: Infants be breastfed exclusively for first 6 months of life Breastfeeding should continue for at least 12 months and therefore as desired Complementary foods can be introduced after 6 months Effective feeding = hungry cues go away, baby is nice and relaxed after eating

Module 3 - Concept - Reproduction- 5 Labor and Delivery PDF

Document Details

Tags

Related

Summary

Full Transcript