Maternal Newborn Key Concepts PDF

# Maternal Newborn Key Concepts ## Chapter 6: Reproductive Life Planning ### Diaphragm: - Dome shaped cup with a flexible rim that fits snugly over the cervix. Barrier to the passage of sperm. - Should remain in place for 6 hours after coitus. If left in for 24 hours, may cause toxic shock syndro...

# Maternal Newborn Key Concepts ## Chapter 6: Reproductive Life Planning ### Diaphragm: - Dome shaped cup with a flexible rim that fits snugly over the cervix. Barrier to the passage of sperm. - Should remain in place for 6 hours after coitus. If left in for 24 hours, may cause toxic shock syndrome. Using a spermicide will increase effectiveness. Replace every 2 years. - Refit for 15-20 lb. weight fluctuation, after having a baby or abdominal surgery - __Not recommended__ for clients who have a history of toxic shock, Cystocele, UTI's, or uterine prolapse. ### Combined Oral Contraceptives: - Hormonal contraception containing estrogen and progestin, which suppress ovulation, and thicken the cervical mucus to block semen. Prevents implantation. - Observe for and report manifestations of complications (chest pain, SOB, leg pain, headache, vision changes, hypertension) - __Not recommended__ for clients with any thromboembolic disorders, smoking, hypertension. ## Ovulation: - Involves determining fertile days by tracking the menstrual cycle to estimate the time of ovulation, which occurs about 14 days before the onset of the next menstrual cycle. - The fertile period begins when the cervical mucus is thin, slippery, and stretchable between the fingers. ## Chapter 9: Normal Pregnancy and Care of the Developing Fetus ### Functions of the Placenta: - Facilitates transport of nutrients and oxygen to the fetus. - Filters waste and acts as a barrier to certain toxins and substances such as insulin. - Connected to the baby by umbilical cord comprised of 2 arteries and 1 vein. - Hormones secreted include: - __Human chorionic gonadotropin (hCG):__ Found in maternal blood and urine as early as the first missed menstrual period, shortly after implantation has occurred. - __Progesterone:__ Necessary to maintain endometrial lining of uterus during pregnancy. - __Estrogen:__ Contributes to mammary gland development in preparation for lactation - __Human placental lactogen:__ Regulates maternal glucose, protein, and fat levels so adequate amounts are available to the fetus - __Oxytocin & prostaglandin:__ Secreted later in pregnancy to facilitate labor. ### Nagele's Rule: - Method used to determine the estimated delivery date. - Using first day of the last menstrual cycle; subtract 3 months, and add 7 days (and if necessary, add a year) ### Amniocentesis: - Aspiration of amniotic fluid from the pregnant uterus for examination. - Empty bladder before procedure. - If mother is RH negative blood type, administer Rhogam. - Lecithin/sphingomyelin (L/S) ration: in surfactant, primary test of fetal lung maturity. L/S rations is 2:1. ## Nonstress Test: - A noninvasive tool. Measures fetal heart rate response to fetal movement (fetal wellbeing) - The NST is interpreted as reactive if the FHR accelerates at least 15 beats above baseline, for at least 15 seconds and occurs two or more times during a 20- minute period. - If baby hasn't moved, offer mom a drink or snack and have her move around for a few minutes. ## Chapter 10: Psychological and Physiological Changes of Pregnancy ### Reproductive System Changes: - Reproductive changes are those involving the uterus, ovaries, vagina, and breasts. - Amenorrhea, breast tenderness are initial presumptive signs. - Probable signs include cervical changes: - __Hegar's sign__ -softening and compressibility of lower uterus - __Chadwick's sign__ - deepened violet-bluish color of cervix and vaginal ## Chapter 11: Assessment of a Pregnant Family ### Prenatal care: - Involves nursing assessments and client education about pregnancy and birth - Establish baseline of present health, determine gestational age of fetus, monitor fetal development and maternal well-being - Identify women at risk for complications, anticipate and prevent problems before they occur - Provide education about pregnancy, lactation, and newborn care. ### GTPAL: - A more comprehensive system for classifying pregnancy status and provides greater detail on a woman's pregnancy history - __G (Gravida)__ = number of pregnancies, including current pregnancy - __T (Term)__ = 37 + weeks gestation - __P (Preterm)__ = 20 weeks gestation to 36 weeks and 6 days gestation - __A (Abortions)__ = less than 20 weeks gestation - __L (Living)__ = Living children ## Chapter 12: Care to Promote Fetal and Maternal Health ### Exercise: - As a rule, average, well-nourished people should exercise during pregnancy about three times weekly for 30 consecutive minutes. - 5 minutes warm-up exercises, an active phase of 20 minutes, and 5 minutes cool-down exercises. - Advise patients to eat protein and complex carbohydrates at least 15 minutes before exercise to keep blood sugar from falling during exercise and to drink water before and after to prevent dehydration. ### Teratogenic Drugs: - Although not all drugs cross the placenta, most do. - Any drug or herbal supplement could be detrimental to fetal welfare. Therefore, during pregnancy, patients should not take any drug or supplement not specifically prescribed or approved by their obstetric provider. - Risk versus benefit of any drug must be determined before use during pregnancy. ## Chapter 13: Promoting Nutritional Health During Pregnancy - Adequate nutritional intake during pregnancy is essential to promoting fetal and maternal health. - Calories - the average recommended daily allowance of calories for women of childbearing age is 2,200. An additional 300 calories per day is recommended to meet the increased needs of pregnancy. - Should gain 25-35 pounds throughout the pregnancy. - A client with a BMI of 25 to 29.5 should be advised to only gain 15 to 25 pounds during the pregnancy. - Foods to avoid during pregnancy: - Raw fish/Predatory fish/ undercooked meats - Lunch meats/hot dogs - Soft cheeses - Caffeine/alcoholic beverages ## Chapter 15: Care of a Family During Labor and Birth - Engagement occurs when the presenting part passes the pelvic inlet at the level of the ischial spines, referred to as station 0 - Station is the relationship of the presenting part of the fetus to the level of the ischial spines. Crowning occurs around +4 station. - Fetal presentation: The part of the fetus that is entering the pelvic inlet first; (occiput), (mentum),(scapula), (sacrum or feet). - Fetal position: indicated by three letters (i.e. ROA) - First letter indicates: - R = right plane - L = left plane - Second letter indicates the presenting part of the fetus. - O = occiput (head) - S = sacrum (breech) - SC = Scapula (shoulder) - Third letter indicates the position of the fetal backbone in relation to the maternal pelvis. - A = Anterior- towards the maternal abdomen - P = Posterior- towards the maternal backbone - T = Transverse- turned at a 90-degree angle to maternal backbone - Occiput posterior position has greater risk of prolonged labor and delivery, increased back pain. ## Stages of Labor: ### True vs False Labor: - See textbook- Table 15.3 “Differentiating Between True and False Labor Contractions”. - Labor is divided into four stages - __Stage 1__-is cervical dilation from 0 to 10 cms. Separated into three phases. - __Early or Latent phase.__ Usually the longest phase, especially for primipara clients. - __Active phase__ - considered to begin once the cervix reaches 6 cm dilation - __Transition phase__ - 8 to 10 cm dilation. Contractions more intense and more frequent. - monitor contraction time, change positions, support, and encourage client, pain management - __Stage 2__-time span from full dilatation and cervical effacement to crowning of the head and birth of the baby. - Preparing for birth, positioning for birth, pushing, perineal cleaning, episiotomy, birth, cutting and clamping cord. - __Stage 3__-begins immediately after delivery of the baby through delivery of placenta. Oxytocin is often given after delivery of the placenta to facilitate uterine contractions and prevent hemorrhage. - __Stage 4__ - recovery (first few hours after delivery) - Close monitoring of mom and baby - Maternal risks for hemorrhage and infection - Neonatal risks for cold stress, hypoglycemia, and respiratory distress ## Types of Fetal Heart Rate (FHR) Periodic Changes: - Assessing and interpreting FHR patterns involves evaluating the baseline, rate, and periodic changes. - Decelerations can indicate fetal distress and need to be investigated ### Type of decel/accel Variables: | Type of decel/accel | Variables | Cause | Intervention | |---|---|---|---| | Amnioinfusion | | Cord compression | Move mom / | | | Early | Head compression | Identify progress of labor | | Accelerations | | OK | None | | | Late | Placental insufficiency | Emergency/Execute: | | | | | Turn mom to left | | | | | Oxygen | | | | | Turn off oxytocin | | | | | Vital signs/IV bolus | | | | | Notify Provider | | | | | Prepare for delivery | ## Leopold Maneuvers: - A systemic method of observation and palpation to determine fetal lie, presentation and position, engagement, and identify best location to place fetal heart rate monitor transducer. - Have client empty bladder. - Place a rolled towel or small pillow under one hip ## Chapter 16: Providing Comfort During Labor and Birth ### Pain Relief: - Pain is a subjective and individual experience, and each client's response to the pain of labor is unique. - __Nonpharmacological methods__ - __Reflexology__ is the practice of stimulating nerve endings on the hand, feet, and ears. - __Effleurage:__ Light, gentle circular stroking of abdomen in rhythm with breathing during contractions. - __Sacral counterpressure:__ Consistent pressure is applied by the support person using the heel of the hand or first against the client's sacral area to counteract pain in the lower back. - __Pharmacological pain management__ - Intravenous narcotics- beneficial in latent phase of labor. - Epidural anesthesia: Beneficial in active phase. Contains an anesthetic injected into the epidural space. NOTE: Epidurals are advantageous for women with heart disease, pulmonary disease, diabetes, and sometimes severe gestational hypertension. Preserves her physical energy. - Priority is to give bolus fluids to prevent hypotension - Local anesthesia to the perineum is beneficial in third stage labor if a laceration is present. ## Chapter 17: Nursing Care of a Postpartal Family ### Psychological Adaptation: - Maternal adjustment begin during pregnancy as the client goes through commitment, attachment, and preparation for the birth of the newborn. ### Lochia: - Post-birth uterine discharge that contains blood, mucus, and uterine tissue. - Three stages of lochia: - __Lochia rubra__ – dark red color, bloody consistency, fleshy odor, can contain small clots, transient flow increases during breastfeeding and upon rising. Lasts 1 to 3 days after delivery - __Lochia serosa__ – Pinkish brown color and serosanguineous consistency. Can contain small clots and leukocytes. Lasts day 4 to day 10 after delivery. - __Lochia alba__ - Yellowish white creamy color, fleshy odor. Can consist of mucus and leukocytes. Lasts from day 10 up to 8 weeks postpartum. - If the patient has a firm uterus with a steady trickle of bright red bleeding, assess for laceration. - Postpartum perineal care: - Instruct client to use peri-bottle with every void and change perineal pads. - Apply ice to perineum for 24hrs to reduce swelling, numb lacerations/episiotomy/hemorrhoids. Sitz baths should be used after 24hrs. - Perform REDDA assessment on dissolvable sutures. - Encourage high fiber diet, fluids, tucks pads and stool softeners. ### Fundal Height: - Fundus should be midline, at the level of the umbilicus on day 1 of delivery. - The fundus should decrease in height 1 cm per day postpartum. - If client fundus is boggy (mushy and soft), and displaced to the side away from midline, this could indicate a full bladder. ## Chapter 18: Nursing Care of a Family With a Newborn ### Heat Loss: - Newborns are prone to heat loss from conduction, convection, radiation and evaporation. - Babies that are premature, small for gestational age or low birth weight are especially prone due to little or no fat for insulation. - Also, newborns cannot shiver to generate heat. ### Infant Cardiac and Respiratory: - The cardiac and respiratory systems undergo the most dramatic changes from intrauterine to extrauterine function. - Normal heart rate is 100 to 160 and normal respiratory rate is 30 to 60. - Functional heart murmurs are normal and reflect the Foramen Ovale and/or Ductus Arteriosis which are in the process of closing during the first hours/days after birth. ### Infant Reflexes: - Newborn reflexes can be tested with consistency by using several simple maneuvers. - __Moro__ - Elicit by allowing the head and trunk of the newborn in a semi-sitting position to fall backward to an angle of at least 30 degrees. The newborn will symmetrically extend and then abduct the arms at the elbows and fingers spread to form a "C". - __Babinski__ - Elicit by stroking outer edge of sole of the foot, moving up toward toes. Toes will fan upward and out - __Rooting__- Elicit response by brushing the infant's cheek. ### Fontanels and Head Assessment: - A newborn's head usually appears disproportionately large. - The head may also appear asymmetric because of the infant's intrauterine position or molding from vaginal birth. - Fontanels should be soft and flat. Depressed fontanels may indicate dehydration. Bulging may indicate intercranial pressure. - Anterior fontanel closes at 12 to 18 months. Posterior fontanel closes at 8 weeks. - Cephalohematoma – collection of blood, between the periosteum and the skull bone that it covers. - Caput succedaneum – localized swelling of the soft tissues of the scalp caused by pressure on the head during labor. Dependent edema which usually resolves within 24 to 48 hours after delivery. - Molding - the part of the infant's head that is engaged with the pelvis and molds to fit the pelvic contours during labor. Often called a “Cone head". Can take several days for the bones to move back into normal alignment. ### Hypoglycemia: - Produces few symptoms in newborns, so glucose is tested with a heel capillary blood sample. - Transitional neonatal hypoglycemia usually resolves within 48 hours of birth. If it persists beyond that period, there may be a pathologic cause. - A serum glucose reading that is less than 40 mg per dL of blood indicates hypoglycemia in symptomatic infants (or asymptomatic infants less than 4 hours of age). A reading less than 45 mg per dL for asymptomatic infants who are 4 to 48 hours of age are classified as hypoglycemia. - Newborn symptoms of hypoglycemia include jitteriness, lethargy, and seizures, and intravenous glucose may be prescribed. ## Chapter 19: Nutritional Needs of a Newborn ### Breastfeeding: - The optimal source of nutrition for newborns and facilitates bonding between mother and newborn. - Breastfeeding is recommended for the first 6 months. - Newborns should be breastfed every 2 to 3 hours. - Adequate weight gain, voiding and resting between feedings indicate good nutrition. - Breastfeeding will provide immunity as well as nutrients for the newborn. - Colostrum: Secreted from the mother's breasts during postpartum days 1 -3. It is a watery, yellow fluid. It contains maternal antibodies/IgA immunoglobulin, providing passive immunity to the newborn. - Breast milk comes in on day 4. Mature breast milk is produced by day 10. - Advantages for the mother: Release of oxytocin aids in uterine involution, may serve a protective function in preventing breast and ovarian cancer. May return to pre-pregnant weight sooner, reduces cost of feeding and preparation time for feeding, excellent opportunity to enhance a true bond between mom and baby, long term effect may include decreased risk of hip fractures and osteoporosis in the post-menopausal period for women. - Advantages for the infant: Lactoferrin is an iron-binding protein that interferes with the growth of pathogenic bacteria, lysozyme actively destroys bacteria by dissolving their cell membranes, possibly increasing the effectiveness of antibodies, interferon helps to interfere with viral growth. Breastfeeding exclusively for 6 months can reduce risk of obesity later in life - Infant should be gaining weight if adequate nutrition is provided. For additional signs of adequate nutrition see Box 19.2 in textbook - To calculate the adequacy of LATCH see Table 19.2 in textbook. ## Chapter 20: Pregnancy Complication from a Preexisting or Newly Acquired Illness ### Diabetes Mellitus in Pregnancy: - Gestational diabetes is an impaired tolerance to glucose with the first onset or recognition during pregnancy. - Management- Diet-controlled, oral glycemic agents (glyburide/metformin). Insulin needs will increase as the pregnancy progresses. Insulin does not cross the placenta to the baby. - An exercise routine should be followed to improve glucose regulation. - Carbohydrate intake needs to be limited to 50% of caloric intake. - Risk to baby - Hypoglycemia (jitteriness, diaphoresis, lethargy when glucose is below 40), macrosomia, electrolyte imbalance, birth trauma, spontaneous abortion, and congenital anomalies. - Risk to mom – Infections, hydramnios, ketoacidosis, hypoglycemia, hyperglycemia (which can cause excessive fetal growth) - Mom has an increased risk of developing type 2 diabetes later in life. ### Heart Disease: - Cardiac disease can affect pregnancy in different ways depending on the cause of the heart condition. - As a rule, those with cardiac disease need two 30-minute rest periods a day sitting with feet elevated, and a full night’s sleep. - Rest should be in the left lateral recumbent position to prevent supine hypotension syndrome and increased heart effort. - Keeping the head of the bed elevated will also help to decrease stress on a compromised heart. ## Chapter 21: Sudden Pregnancy Complications ### Rhogam: - Rh incompatibility occurs when an Rh-negative mother carries a fetus with an Rh-positive blood type. Rhogam is a commercial preparation of passive Rh antibodies against the maternal Rh factor. - Mom gets Rhogam at 28 weeks and if her baby is Rh-positive, she gets another Rhogam within 72 hours of delivery. - Give Rhogam anytime fetal and maternal blood could mix. - Amniocentesis, miscarriage, delivery, ectopic pregnancy, etc. ### Ectopic Pregnancy: - An abnormal implantation of a fertilized ovum outside of the uterine cavity usually in the fallopian tube. - Expected findings: - Unilateral stabbing pain and tenderness in a lower abdominal quadrant. (On the same side as the ectopic pregnancy) - Ruptured tubal pregnancy = Referred shoulder pain due to blood in the peritoneal cavity deep lower quadrant pain, ecchymosis (bluish discoloration or bruising) around the umbilicus. - Therapeutic procedures: - If unruptured: Give Methotrexate to dissolve the pregnancy. - If ruptured will require emergency surgery (usually a laparoscopy) to repair the damaged fallopian tube and stop the internal bleeding. ### Hydatidiform Mole (Gestational Trophoblastic Disease): - Proliferation and degeneration of trophoblastic villi in the placenta. - Tissue grows rapidly but the embryo fails to develop beyond a primitive state. - Assessment: - Excessive vomiting - Weight loss - Larger than expected uterine growth - Vaginal bleeding (risk for anemia) - Symptoms of hypertension - Risk for choriocarcinoma - Diagnosed by ultrasound – has a “snowstorm” appearance - Suction curettage is done to aspirate and evacuate the mole - May need treatment with methotrexate to inhibit tissue growth ### Placenta Previa: - Occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus. - The abnormal implantation results in bleeding during the third trimester of pregnancy as the cervix begins to dilate and efface. - Risks - previous placenta previa, uterine scarring, maternal age greater than 35, multifetal gestation, smoking, closely spaced pregnancies. - Assessment – Painless red bleeding, uterus soft, reassuring FHR. - Nursing care – no vaginal exam, IV fluids, assess fundal height, assess for bleeding and contractions. - Mom will need to be delivered by C/S. ### Abruptio Placentae: - The premature separation of the placenta from the uterus. - The separation occurs after 20 weeks of gestation, usually in the third trimester. - It has significant maternal and fetal morbidity. - Risks - maternal hypertension, cocaine use, smoking, premature rupture of membranes, blunt trauma, and multifetal pregnancy. - Assessment – sudden onset of intense localized uterine pain with dark red vaginal bleeding, contractions with hypertonicity, fetal distress, signs of hypovolemic shock. - Nursing actions – palpate the uterus for tenderness and tone, fetal distress -perform C/S, IV fluids, blood products, oxygen. ### Preterm Labor: - Labor that occurs before the end of week 37 of gestation. - It occurs in approximately 9% to 11% of all pregnancies. - It is always potentially serious because if it results in the infant’s birth, the infant will be immature. - Meds to know: - **Terbutaline** – A beta-adrenergic agonist that is used as a tocolytic that relaxes smooth muscles and inhibits uterine activity. - Drug of choice when patient first comes in showing signs of preterm labor. - Side effects include: tachycardia (hold dose for HR 120<), nervousness, pulmonary edema, hypotension. - **Betamethasone** – A glucocorticoid that is administered to stimulates surfactant production in the fetal alveoli. - Monitor for maternal hyperglycemia. This medication will affect her blood sugar. - Report findings of pulmonary edema. ### Preeclampsia: - A condition categorized by hypertension, proteinuria, and edema. - The condition can progress in severity based on additional assessment/lab findings. - Assessment findings when the condition is worsening: - Severe continuous headache (possible maternal hemorrhage) - Nausea - Blurring of vision (due to cerebral edema) - Epigastric pain (liver) - Hyperactive DTRS - HELLP Monitor labs= RBC/HCT/HGB, Liver Enzymes, Platelets - Medication - Anticonvulsant -usually treated with Magnesium Sulfate. - Watch for signs of Mag toxicity; decreased DTR’s, respirations less than 12/min, decreased urine output, decreased level of consciousness. - Mag toxicity antidote is calcium gluconate and should be at the bedside while the client is being treated with Magnesium sulfate. ## Chapter 23: Complication of Labor or Birth ### Bishop Score: - Used to determine maternal readiness for labor by evaluating whether the cervix Is favorable by rating the following 5 items; - Cervical dilation, - Cervical effacement, - Cervical consistency (firm, medium, soft etc.), - Cervical position (posterior, mid-position, or anterior), - Station of presenting part. - Cervical ripeness is determined by performing a pelvic exam to identify condition of the cervix. ### Forceps Delivery: - Consists of using an instrument with two curved spoon-like blades to assist in the delivery of the fetal head. - Traction is applied during contractions. - This is considered an operative delivery - Indications – prolonged second stage of labor, fetal distress, abnormal presentation, and arrest of rotation. - Complications – lacerations of the cervix, lacerations of the vagina and perineum, injury to bladder, facial nerve palsy of the neonate, facial bruising on the neonate, and subdural hematoma in the neonate. - Criteria before using forceps – make sure bladder is empty, membranes should be ruptured, and fetal presenting part engaged. ### Oxytocin: - An effective uterine stimulant, but there is a thin line between adequate stimulation and hyperstimulation. - The nurse may need to decrease or turn off the oxytocin infusion if hyperstimulation occurs. - The nurse may need to increase the infusion if there is arrest of labor to augment the labor contractions. ## Chapter 24: Surgical Intervention for Birth ### Cesarean Birth: - Cesarean birth is indicated to alleviate problems such as CPD, breech/transverse position, active STI, multiple fetus births, or failure to progress in labor, emergencies. - C/S should be reserved for clients with indications and should be discouraged as an elective procedure. - Remember both mom and baby are at risk for hypothermia because the operating room is kept much cooler than normal. ### Internal Electronic Monitoring: - Internal electronic monitoring is the most precise method for assessing FHR and uterine contractions. - __Fetal Scalp Electrode__- Provides monitoring for fetal heart rate via electronic scalp device. Can be useful when the fetus is difficult to monitor, or healthcare provider wants more accurate monitoring. - __Intrauterine Pressure Catheter (IUPC)__- Provides continuous contraction monitoring with more accuracy of intensity, duration, and frequency. ## Chapter 25: Postpartum Complication ### Post-Partum Depression: - Occurs within 2 weeks to 6 months of delivery and is characterized by persistent feelings of sadness and intense mood swings, does not resolve without intervention. - Assessment – feelings of guilt and inadequacies, irritability, anxiety, fatigue, feelings of loss, lack of appetite, persistent feelings of sadness, sleep pattern disturbances, and problems bonding/attaching with the baby. - Assess for the safety of mom and baby ### Subinvolution: - When the uterus remains enlarged with continued lochia discharge. - Can result in postpartum hemorrhage. - Risk factors – multipara, macrosomia, pelvic infection, and endometritis, retained placental fragments not completely expelled from the uterus. - Expected findings – Prolonged vaginal bleeding, fundal height greater than expected for the postpartum day. ### Mastitis: - Infection of the breast may occur as early as the seventh post-partal day or until the baby is weeks or months old. - Milk stasis, which can be caused by a blocked duct, engorgement, or a bra with an underwire. - Nipple trauma and cracked or fissured nipples. - Poor breastfeeding technique with improper latching of the infant onto the breast, which can lead to sore and cracked nipples. - Decrease in breastfeeding frequency due to supplementation with bottle feeding. - Contamination of breasts due to poor hygiene. - Expected findings - Painful or tender localized hard mass and reddened area, usually on one breast. - Chills, fever, headache, body ache. - Fatigue ### Postpartum Hemorrhage: - Is considered to occur if the client loses more than 1000 mL during the first 24 hours following a vaginal or cesarean birth. - Contributing factors include: multigravida, macrosomia or large for gestational age baby, multiple gestation (twins, triplets etc.), uterine atony, retained placental tissue. - Complications that can occur following postpartum hemorrhage include hypovolemic shock, anemia, and disseminating intravascular coagulation (DIC). - Hemorrhage may occur either early (within the first 24 hours following birth) or late (24 hours to 6 weeks after giving birth). - Flow (amount): - Scant = less than 2.5 cm on the peri-pad - Light = 2.5 cm to 10 cm on the peri-pad - Moderate = more than 10 cm on the peri-pad - Heavy = one pad saturated within 1-2 hours - Management - Weigh blood saturated items - Always subtract the dry weight of the pad or chux - 1 gram = 1 mL - Perform more frequent fundal checks/VS - Draw labs and administer blood products if indicated - Encourage intake of protein and iron for RBC production/tissue healing ### Uterine Atony: - Results from the inability of the uterine muscle to contract adequately after birth. - This can lead to postpartum hemorrhage. - Urine retention/bladder distention, retained placental fragments, prolonged or precipitous labor, magnesium sulfate, anesthesia and analgesia administration, trauma during labor and birth from an operative delivery are all plausible causes of uterine atony. ## Chapter 26: Nursing Care of a High-Risk Newborn ### Surfactant: - Is a phospholipid that assists in alveoli expansion. - Surfactant keeps alveoli from collapsing and allows gas exchange to occur. - Premature newborns are at a higher risk of Respiratory distress syndrome due to lack of surfactant which can result in hyaline membrane disease, pneumothorax, and pneumonia. - An amniocentesis can be done to determine the LS ratio which can indicate if the fetal lungs are mature enough that Respiratory Distress Syndrome (RDS) is not likely to occur. ### Respiratory Distress Syndrome: - Occurs because of surfactant deficiency in the lungs and is characterized by poor gas exchange and ventilatory failure. - Risk factors – preterm gestation, maternal diabetes mellitus, premature rupture of membranes, hypovolemia, cesarean birth without labor, maternal hypertension, and maternal use of barbiturates or narcotics - Nursing care – maintain thermal environment, maintain adequate oxygenation, and decrease stimuli. - The expected respiratory rate reference range is 30 to 60 - Diagnosis – by chest x-ray - Treatment – administer lung surfactant ### Meconium Aspiration Syndrome: - If hypoxia occurs in utero, a vagal reflex is stimulated which relaxes the rectal sphincter. This releases meconium into the amniotic fluid. An infant can aspirate meconium either in utero or with the first breath at birth. - Assessment: tachypnea, retractions, grunting, and cyanosis ### Hyperbilirubinemia Prevention/Phototherapy Treatment: - A fetus’s liver processes little bilirubin in utero because the mother’s circulation does this for the fetus. - The breakdown of RBCs causes a by-product of bilirubin. - If this is not excreted in stool, it can build up and result in jaundice. - Maintain an eye mask over the newborn's eye’s while under lights - Feed the newborn early and frequently, every 3 to 4 hours. This will promote bilirubin excretion in the stools. - Maintain adequate fluid intake to prevent dehydration. ### Kernicterus (Acute Bilirubin Encephalopathy): - Acute bilirubin encephalopathy is the destruction of brain cells by invasion of bilirubin resulting in permanent cell damage. - High levels of bilirubin can also lead to hearing loss. - This invasion results from the high concentration of bilirubin that forms in the bloodstream from an excessive breakdown of red blood cells at birth. - At the point that bilirubin levels rise, and jaundice occurs, phototherapy or exchange transfusion can be initiated. ### SIDS (Sudden-Infant-Death-Syndrome): - SIDS is a sudden unexplained death in infancy. It tends to occur at a higher than usual rate in: - Infants of adolescent birthing parents - Infants of closely spaced pregnancies - Underweight and preterm infants - Infants with bronchopulmonary dysplasia BPD - Multiple gestations (i.e. twins) - Native American infants, Alaskan Native infants, economically disadvantaged Black infants - Infants of narcotic-dependent birthing parents. - The peak age of incidence is 2 to 4 months of age. - Although the cause of SIDS is unknown, in addition to prolonged but unexplained apnea, other possible contributing factors include: - Sleeping prone rather than supine - Viral respiratory or botulism infection - Exposure to secondary smoke - Pulmonary edema - Brainstem abnormalities - Neurotransmitter deficiencies - Heart rate abnormalities - Distorted familial breathing patterns - Decreased arousal responses - Possible lack of surfactant in alveoli - Sleeping in a room without moving air currents (the infant rebreathes expired carbon dioxide) ==End of OCR for page 14==