Mcn Lec Finals PDF

BANDOQUILLO, H.G. 2-C FINALS TOPIC - POSTPARTUM STAGE - THE NEWBORN - GROWTH AND DEVELOPMENT THROUGHOUT THE LIFESPAN OBSTETRICAL PROCEDURE: EPISIOTOMY = NORMAL SPONTANEOUS VAGINAL DELIVERY FORCEP DELIVERY = CAUSED BY FAILURE TO DESCENT. CAESAREAN SECTION = DUE TO COMPLICATIONS OF...

BANDOQUILLO, H.G. 2-C FINALS TOPIC - POSTPARTUM STAGE - THE NEWBORN - GROWTH AND DEVELOPMENT THROUGHOUT THE LIFESPAN OBSTETRICAL PROCEDURE: EPISIOTOMY = NORMAL SPONTANEOUS VAGINAL DELIVERY FORCEP DELIVERY = CAUSED BY FAILURE TO DESCENT. CAESAREAN SECTION = DUE TO COMPLICATIONS OF PREGNANCY, ISSUES ON THE 5 Ps OF LABOR AND DELIVERY. - DYSTOCIA- PUT HER AT RISK OF BLEEDING. (Labor exceeding 12 to 24 hours or whenever there are signs of difficulty.) ESSENTIAL CONCEPTS: POSTPARTUM CARE REFERS TO THE MEDICAL AND NURSING CARE GIVEN TO A WOMAN DURING THE PUERPERIUM WHICH IS THE 6 WEEK PERIOD AFTER DELIVERY. BEGINNING WITH TERMINATION OF LABOR AND ENDING WITH THE RETURN OF THE REPRODUCTIVE ORGANS TO THE NONPREGNANT STATE.. THIS PERIOD CONSTITUTES A PHYSICAL AND PSYCHOLOGICAL ADJUSTMENT TO THE PROCESS OF CHILDBEARING AND IS SOMETIMES REFERRED TO AS THE FOURTH TRIMESTER OF PREGNANCY.. DURING THIS PERIOD THE UTERUS UNDERGOES INVOLUTION - THE PROGRESSIVE CHANGES IN THE UTERUS AFTER DELIVERY, LEADING ITS RETURN TO NEAR-PREPREGNANT SIZE AND CONDITION. "INVOLUTION OF THE UTERUS" GOALS OF POSTPARTUM CARE PROMOTE NORMAL UTERINE INVOLUTION AND RETURN TO THE NONPREGNANT STATE. PREVENT OR MINIMIZE POSTPARTUM COMPLICATIONS. PROMOTE COMFORT AND HEALING OF PELVIC, PERIANAL AND PERINEAL TISSUES. ASSIST IN RESTORATION OF NORMAL BODY FUNCTIONS.. INCREASE UNDERSTANDING OF PHYSIOLOGIC AND PSYCHOLOGICAL CHANGES.. FACILITATE NEWBORN CARE AND SELF CARE BY THE NEW MOTHER. PROMOTE THE NEWBORN'S SUCCESSFUL INTEGRATION INTO THE FAMILY UNIT.. SUPPORT PARENTING SKILLS AND PARENT NEWBORN ATTACHMENT. FACTORS AFFECTING THE POSTPARTUM EXPERIENCE: THE NATURE OF LABOR AND DELIVERY AND THE BIRTH OUTCOME. PREPARATION FOR LABOR, DELIVERY AND PARENTING. BANDOQUILLO, H.G. 2-C ABRUPTNESS OF THE TRANSITION TO PARENTHOOD. THE FAMILY'S INDIVIDUAL AND COLLECTIVE EXPERIENCES WITH CHILDBEARING AND CHILDREARING THE FAMILY MEMBERS' ROLE EXPECTATIONS. SENSITIVITY AND EFFECTIVENESS OF NURSING AND OTHER PROFESSIONAL CARE.. RISK FACTORS FOR POSTPARTUM COMPLICATION SUCH AS: - PREECLAMPSIA OR ECLAMPSIA - DIABETES - CARDIAC PROBLEMS - UTERINE OVERDISTENTION =ABRUPTIO PLACENTA AND PLACENTA PREVIA = PRECIPITOUS OR PROLONGED LABOR, DIFFICULT DELIVERY. POSTPARTUM / POSTNATAL - PUERPERIUM = PUER -CHILD, PARERE - TO BRING FORTH. WOMAN GOES 2 PHASES: 1. RETROGRESSIVE - INVOLUTION: UTERUS, VAGINA, CERVIX 2. PROGRESSIVE - BREASTS, OVARIES -MENSTRUATION, NEW PARENTING ROLE. NURSING INDEPENDENT RESPONSIBILITIES: BUBBLESHE: MONITOR/ BE AT CLOSE WATCH AND ADVISE MOTHER TO: B- BREASTS - ASSESS FOR ENGORGEMENT/MASTITIS WILL LEAD TO FEVER. CHECK FOR First milk - COLOSTRUM. ENCOURAGE BREASTFEEDING- ENHANCES RELEASE OF OXYTOCIN AND PROSTAGLANDIN-INITIATES UTERINE CONTRACTION FOR SUCCESSFUL INVOLUTION OF THE UTERUS. U - UTERUS - MASSAGE GENTLY AND ENCOURAGE URINATION. To prevent "UTERINE ATONY" FAILURE OF THE UTERUS TO CONTRACT- LOSING BLOOD -LEAD TO HEMORRHAGE - MORTALITY DEATH OF THE MOTHER. B - BOWELS -MUST PASS OUT STOOL WITHIN 24 HOURS - ACTIVITY PERISTALTIC MOVEMENT IS BACK TO NORMAL PARTICULARLY CS MOTHERS. - MUST PASS FLATUS SEVERAL TIMES. B - BLADDER - MUST PASS URINE WITHIN 24 HOURS. EMPTY HER BLADDER- A FULL BLADDER - PREVENTS THE UTERUS TO CONTRACT. WHAT WE CALL "BOGGY UTERUS". L - LOCHIAL MONITORING - SHEDDING OF THE ENDOMETRIAL LINING. E - EPISIOTOMY/LACERATION/INCISION CS - MONITOR SIGNS OF INFECTION. PERFORM DRESSING DAILY OR AS ORDERED BY THE PHYSICIAN. KEEP THE WOUND DRY AT ALL TIMES. - REEDA: THE NURSE MUST INSPECT: REDNESS, ECCHYMOSIS or EDEMA, DISCHARGES-FOUL SMELLY, PUS WHICH IS GREENISH IN COLOR, ASSESSMENT OF THE SKIN WARM TO TOUCH. BANDOQUILLO, H.G. 2-C S - SKIN - EVALUATE FOR THE SKIN TURGOR OF THE MOTHER IF INDICATES DEHYDRATION. H - HOMAN'S SIGN - POSITIVE RESULT, THE MOTHER WILL COMPLAINT OF PAIN. THIS WOULD INDICATE THROMBOPHLEBITIS OR BLOOD CLOTS AT THE LOWER EXTREMITIES WHEN THE FOOT ARE DORSIFLEXED. E - EMOTION - TASK TO ACCOMPLISH ACCORDING TO REVA RUBIN. REVA RUBIN TASKS: PSYCHOLOGICAL TASKS I. TAKING IN - OCCURS 2-3 DAYS POST PARTUM. MOTHER IS PASSIVE. DEPENDENT. Basic and primary needs of mothers are their own food, water, clothing and sleep. - Attention seeker. Always talks about her experiences during labor and delivery. - Not a good time for health teachings from the nurse. - DEPENDENT, PASSIVE, ENERGIES ARE FOCUSED ON BODILY CONCERNS. - UNINTERRUPTED SLEEP. FATIGUE AND IRRITABLE. II. TAKING HOLD - OCCURS 3 - 7 DAYS MAY EXTEND UNTIL 2 WEEKS. SEEKS INDEPENDENCE/ AUTONOMY/ SEEKS PARTICIPATION ON HER NEW ROLE AS A MOTHER. SENSITIVE IN DOING MOTHERING ROLE RIGHT. MORE IN CONTROL OF HER EMOTIONS. BEST TIME FOR HEALTH TEACHING. CONCERNS WITH HER ABILITY TO PARENT SUCCESSFULLY AND ACCEPTS INCREASING RESPONSIBILITY FOR HER NEWBORN. REGAINING CONTROL OVER HER BODILY FUNCTIONS. STRIVES TO MASTER NEWBORN CARE SKILLS. III. LETTING GO -10 DAYS AND BEYOND. DEFINES HER NEW ROLE AS MOTHER... TO TAKE CARE OF HERSELF/OTHER CHILDREN/HUSBAND/ GOES BACK TO WORK. INCORPORATES NEW CHANGES IN HER LIFE. MAY GRIEVE OVER SEPARATION FROM HER NEWBORN. DISPLAYS DEPENDENT-INDEPENDENT BEHAVIORS WHERE SHE WANTED TO FEEL SECURE WHILE MAKING DECISIONS. POSTPARTUM BLUES MAY DEVELOP. BONDING PROCESS AND PARENTING SKILLS ARE ENHANCED. POSTPARTUM DEPRESSION MANY MOTHERS EXPERIENCE A LET-DOWN FEELING AFTER GIVING BIRTH RELATED TO THE MAGNITUDE OF THE BIRTH EXPERIENCE AND DOUBTS ABOUT THE ABILITY TO COPE EFFECTIVELY WITH THE DEMANDS OF CHILDBEARING. TYPICALLY, THIS DEPRESSION IS MILD AND TRANSIENT, BEGINNING 2 TO 3 DAYS AFTER DELIVERY AND RESOLVING WITHIN 1 TO 2 WEEKS. RARELY, RELATIVELY MILD DEPRESSION LEADS TO POSTPARTUM PSYCHOSIS, A PATHOLOGIC CONDITION. BANDOQUILLO, H.G. 2-C NONPREGNANT CONFLICTS: POSTPARTUM BLUES - TRANSIENT FEELING. 1- 2 WEEKS. MOTHER IS DEPRESSED - BUT NOT CLINICALLY DEPRESSED. POSTPARTUM DEPRESSION - MEDICATIONS NEEDED/ SEEK PROFESSIONAL HELP. ANXIETY LEVEL INCREASES. SLEEPLESS NIGHTS. SENSE OF LOSS OF SELF WORTH. POSTPARTUM PSYCHOSIS - LOSES HER SENSE OF WORTH AND SENSE OF REALITY. THINKING SUICIDE AND EVENTUALLY HURTING OR KILLING HER CHILDREN AND HERSELF. ROOMING IN: PARENT - INFANT BONDING CLAIMING OF THE MOTHER TOWARDS HER NEWBORN. IDENTIFY- MY NEWBORN! ATTACHMENT TOWARDS MY NEWBORN. DEVELOPS CONFIDENCE IN MATERNAL ROLE/ SUPPORT SYSTEM LATCH/LATCHING ON - THE FIRST SKIN TO SKIN CONTACT BETWEEN THE MOTHER AND HER NEWBORN DONE RIGHT AFTER DELIVERY. INITIATE BREASTFEEDING. PHYSIOLOGICAL CHANGES POSTPARTUM: INVOLUTION: IS THE PROCESS WHEREBY THE REPRODUCTIVE ORGANS RETURN TO THEIR NONPREGNANT STATE. A MOTHER IS IN DANGER OF HEMORRHAGE FROM THE DENUDED SURFACE OF THE UTERUS UNTIL INVOLUTION IS COMPLETE. INVOLUTION OF THE UTERUS - Uterus involution refers to the process where your pregnant uterus (womb) returns to the way it was before pregnancy. MEASURES TO PROMOTE UTERINE INVOLUTION: 1. MASSAGE UTERUS TO EXPRESS BLOOD CLOTS, EXPEL POOLED BLOOD AND IMPROVE UTERINE FIRMNESS. 2. ASSESS UTERINE FUNDUS. POSTPARTUM, THE FUNDUS GOES DOWN BY 1 FINGERBREADTH ( 1 CM) PER DAY UNTIL THE DAY 10TH THE FUNDUS IS NO LONGER PALPABLE AS IT IS ALREADY BEHIND THE SYMPHYSIS PUBIS. 3. ENCOURAGE EARLY AMBULATION. FOR EFFECTIVE WAY TO PROMOTE INVOLUTION OF THE UTERUS. 4. ENCOURAGE BREASTFEEDING. TO RELEASE HORMONE OXYTOCIN THAT INITIATES UTERINE CONTRACTION TO PREVENT UTERINE ATONY. 5. ENCOURAGE REGULAR EMPTYING OF THE BLADDER TO PREVENT BOGGY UTERUS. A DISTENDED BLADDER DOES NOT ONLY PREDISPOSE THE MOTHER BANDOQUILLO, H.G. 2-C TO URINARY TRACT INFECTION, BUT ALSO INTERFERES WITH THE NORMAL CONTRACTION OF THE UTERUS RESULTING TO HEMORRHAGE. 6. EVALUATE INVOLUTION OF UTERUS WITH MONITORING OF AMOUNT AND CHARACTER OF LOCHIAL DISCHARGES. 7. PROMOTE REST AND SLEEP. 8. PROMOTE CORRECT DIET. REPRODUCTIVE CHANGES I. UTERUS: INVOLUTION OF THE UTERUS. UTERINE CONTRACTION IS IMPORTANT TO PREVENT UTERINE ATONY. - AFTERPAINS IN THE ABDOMEN FELT BY THE MOTHER IS NORMAL - DUE TO UTERINE CONTRACTIONS. - MUST CONTRACT FIRMLY AFTER DELIVERY REDUCING HALF OF ITS SIZE. - AT 10TH TO 14TH POSTPARTUM DAY, THE UTERUS CANNOT BE PALPATED ABDOMINALLY. IT RETURNS TO ITS NONPREGNANT SIZE. LOCHIAL DISCHARGES- SHEDDING OF THE ENDOMETRIAL LINING. "DECIDUA; FALLING OFF" 1. LOCHIA RUBRA - PRESENT ON 1 - 3 DAYS POST PARTUM - BLOOD IS DARK RED OR RED IN COLOR 2. LOCHIA SEROSA - PRESENT ON 3 TO 10 DAYS POSTPARTUM - BLOOD IS PINKISH IN COLOR 3. LOCHIA ALBA - PRESENT AT 10 TO 14 DAYS ONWARD POST PARTUM - BLOOD IS WHITISH IN COLOR - NOTE: THE NURSE MUST MONITOR LOCHIAL DISCHARGES DAILY. IF DISCHARGES DOES NOT MANIFEST ANY OF THESE, IT INDICATES FAILURE OF UTERUS TO CONTRACT THAT WILL LEAD TO BLOOD LOSS AND EVEN DEATH. EVALUATING LOCHIAL DISCHARGE: - LOCHIA IS THE TERM GIVEN TO THE VAGINAL DISCHARGE OF A POSTPARTUM MOTHER. MICROSCOPICALLY THE LOCHIA CONSISTS OF: 1. SHREDS OF DECIDUA - LINING OF THE ENDOMETRIUM. 2. EPITHELIAL CELLS 3. RED BLOOD CELLS AND BACTERIA. REASONS FOR LOCHIAL EVALUATION: 1. DETECTION TO NORMALITY VAGINAL DISCHARGE AND RULE OUT POSTPARTAL HEMORRHAGE. 2. EVALUATION OF THE STATE OF UTERINE INVOLUTION. 3. DETECTING THE PRESENCE OF PUERPERAL SEPSIS WITH FOUL AND ABNORMAL LOCHIA. BANDOQUILLO, H.G. 2-C CHARACTERISTICS: 1. ODOR: - NORMAL: FLESHY AND NON OFFENSIVE - ABNORMAL: MALODOROUS OR FOUL. 2. SHOULD NOT EXCEED 4 TO 8 PADS A DAY WITH AN AVERAGE OF SIX.G 3. CERVIX - NONPREGNANT STATE. BECOMES THICKER AND FIRMER. BY THE END OF THE FIRST POSTPARTUM WEEK, IT IS STILL DILATED ABOUT 1CM. COMPLETE CERVICAL INVOLUTION MAY TAKE 3 TO 4 MONTHS. 4. VAGINA - EDEMATOUS. SMOOTH AND SWOLLEN. POOR SKIN TURGOR AFTER DELIVERY. RUGAE REAPPEAR BY 3 TO 4 POSTPARTUM WEEKS. THE ESTROGEN INDEX RETURNS IN 6 TO 10 WEEKS. 5. PERINEUM - EPISIOTOMY MUST HEAL. APPEARS EDEMATOUS AND BRUISED AFTER DELIVERY. EPISIOTOMY AND LACERATIONS MAY BE PRESENT. 6. BREASTS - RAPID DROP IN ESTROGEN AND PROGESTERONE LEVEL OCCURS WITH AN INCREASED IN SECRETIONS OF PROLACTIN AFTER DELIVERY. - COLOSTRUM IS PRESENT AT THE TIME OF DELIVERY. - ENGORGEMENT MAY OCCUR. 7. ABDOMEN - REMAINS SOFT AND FLABBY FOR SOME TIME. STRIAE REMAINS BUT ARE SILVERY WHITE. DIASTASIS RECTI (SEPARATION OF ABDOMINAL RECTI MUSCLES MAY OCCUR IN WOMEN WITH POOR MUSCLE TONE. SYSTEMIC CHANGES: 1. HORMONAL CHANGES - HCG MAY RAPIDLY DECREASE. ESTROGEN AND PROGESTERONE PREPARE FOR MENSTRUATION AND OVULATION. 2. URINARY SYSTEM - MUST VOID WITHIN 24 HOURS. 3. GASTROINTESTINAL SYSTEM - MUST PASS OUT STOOL WITHIN 24 HOURS. CONSTIPATION IS A MAJOR PROBLEM. 4. CIRCULATORY SYSTEM - Hypervolemia, which produces a 30% to 50 % increase in blood volume at term, allows the woman to tolerate a substantial blood loss during BANDOQUILLO, H.G. 2-C childbirth without ill effect. Up to 500 mL of blood is lost in vaginal deliveries and up to 1000 mL is lost in cesarean births. 5. INTEGUMENTARY SYSTEM - MASK OF PREGNANCY DECREASES IN THE NEXT WEEKS AND MONTHS. OTHERS: - WEIGHT LOSS - EXHAUSTION - TIRED OF LABOR AND DELIVERY PROCESS. 6. ENDOCRINE SYSTEM: ESTROGEN AND PROGESTERONE LEVELS DECREASE RAPIDLY AFTER DELIVERY. OVULATION AND RESUMPTION OF MENSTRUATION. 7. IMMUNE SYSTEM: SLIGHT INCREASE IN MATERNAL BODY TEMPERATURE 8. RESPIRATORY SYSTEM: PULMONARY FUNCTION RETURNS TO NONPREGNANT STATUS, 9. RENAL AND URINARY SYSTEM: RESUME WITHIN 24 HOURS POST PARTUM. A FULL BLADDER DISPLACES THE UTERUS AND CAN CAUSE POSTPARTUM HEMORRHAGE. 10. GI SYSTEM: HUNGER AND THIRST ARE COMMON. 11. MUSCULOSKELETAL SYSTEM: EARLY AMBULATION IS ENCOURAGED. - PARALYTIC ILEUS - MEDICAL ISSUE WHEREIN THE INTESTINES MAY NOT BE ABLE TO RETURN TO NORMAL FUNCTION. VITAL SIGNS CHANGES: 1. TEMPERATURE OF THE MOTHER: - TEMP RISES SLIGHTLY WITHIN 24 HOURS POSTPARTUM - is a SIGN OF DEHYDRATION - TEMP CONTINOUS AFTER 24 HOURS --- INDICATES INFECTION - EPISIOTOMY/INCISION SITE CS/MASTITIS - SIGNS OF REEDA. - VITAL SIGNS MUST BE STRICTLY MONITORED. 2. PULSE RATE 3. BLOOD PRESSURE THE NEWBORN - Neonate/ Newborn: a newborn in a neonatal period. - Neonatal Period: from birth through 28 days of life. ESSENTIAL CONCEPTS: IN THE POSTPARTUM PERIOD, THE NEWBORN EXPERIENCES COMPLEX BIOPHYSICAL AND BEHAVIORAL CHANGES RESULTING FROM THE TRANSITION TO EXTRAUTERINE LIFE. NURSING CARE OF THE NEWBORN IS BASED ON KNOWLEDGE OF THESE CHANGES AND OF THE NEWBORN'S IMPACT ON THE FAMILY UNIT. THE FIRST FEW HOURS AFTER BIRTH REPRESENT ADJUSTMENT PERIOD FOR THE NEWBORN. BANDOQUILLO, H.G. 2-C AFTER THE TRANSITION PERIOD, THE NURSE CONTINUES TO EVALUATE THE NEWBORN AT PERIODIC INTERVALS AND TO ADJUST NURSING CARE PLANS ACCORDING TO ONGOING FINDINGS. THE NURSE MUST SKILLFULLY BALANCE THE FAMILY'S NEED FOR PRIVACY WITH THE NEED TO MONITOR THE NEWBORN'S TRANSITION TO EXTRAUTERINE LIFE. GOALS OF NEWBORN CARE: I. INITIAL POSTPARTUM PERIOD ESTABLISH AND MAINTAIN AIRWAY, BREATHING AND CIRCULATION. MAINTAIN WARMTH AND PREVENT HYPOTHERMIA. ENSURE SAFETY AND PREVENT INJURY AND INFECTION. IDENTIFY ACTUAL AND POTENTIAL PROBLEMS THAT MAY REQUIRE IMMEDIATE ATTENTION. VITAL SIGNS FOR ANY SIGNS OF RESPIRATORY DISTRESS SYNDROME, HYPOTHERMIA, HYPOGLYCEMIA, POOR SUCKING, LETHARGIC, APNEIC EPISODES, EPISODES OF CYANOSIS II. CONTINUING CARE. CONTINUE PROTECTING FROM INJURY OR INFECTION. FACILITATE DEVELOPMENT OF A CLOSE PARENT-NEWBORN RELATIONSHIP. PROVIDE PARENTS WITH INFORMATION ABOUT NEWBORN ASSIST PARENTS IN DEVELOPING HEALTHY ATTITUDES ABOUT CHILDREARING PRACTICES. INTRODUCTION AT BIRTH, THE NEWBORN ADAPTS LIFE OUTSIDE THE UTERUS (extrauterine). PHYSIOLOGIC CHANGES OCCUR IN THE MAJOR ORGAN SYSTEMS WITHIN 24 HOURS AFTER BIRTH. HOW THE NEWBORN ADAPTS TO THESE NEW PHYSICAL CONDITIONS DEPENDS ON SEVERAL FACTORS: 1. MATERNAL AND NEWBORN ANTEPARTAL STATUS: CONDITIONS AND EXPERIENCES (EXPOSURE, ILLNESS DURING PREGNANCY, MATERNAL AND PARTNER ATTITUDES TOWARDS THE PREGNANCY. 2. INTRAPARTUM MATERNAL AND FETAL CONDITIONS. EVENTS (PROGRESSION OF LABOR - LENGTH, COMPLICATIONS. Transition Period: crucial for the NB. Within 48 TO 72 hours ,the NB adapts to extrauterine life. 3. PHYSIOLOGICAL CAPACITY OF THE NEWBORN TO ADAPT TO LIFE OUTSIDE THE UTERUS. 4. IMMEDIATE APPROPRIATE AND ADEQUATE RESPONSES OF PHYSICIANS, NURSES, MIDWIVES TO EMERGING PROBLEMS DURING PREGNANCY, LABOR AND DELIVERY AFTER BIRTH AND THE NEONATAL PERIOD. BANDOQUILLO, H.G. 2-C PHYSIOLOGIC ADJUSTMENT TO EXTRAUTERINE LIFE: DURING THE FIRST 48 TO 72 HOURS OF EXTRAUTERINE LIFE, THE NEWBORN IS IN A PERIOD OF TRANSITION CHARACTERIZED BY INSTABILITY AS THE NEWBORN ADJUSTS. THE FIRST 6 HOURS OF LIFE IS THE PERIOD OF IRREGULAR ADJUSTMENT. PHASES: TRANSITION PERIOD 1. FIRST PERIOD OF REACTIVITY: IMMEDIATELY AFTER BIRTH, THE NEWBORN BREATHES RAPIDLY (UP TO 80 BREATHS PER MINUTE) EXHIBITING BRIEF PERIODS OF GRUNTING, sternal RETRACTIONS AND NASAL FLARING. ( NOSE OBLIGATES) A HEART RATE OF UP TO 180 BEATS PER MINUTE MAY BE SEEN DURING THE FIRST FEW MINUTES AFTER BIRTH. SLEEP PERIOD OCCURS 2. SECOND PERIOD OF REACTIVITY - NEWBORN IS AWAKE AND ALERT. 3. STABILITY: 6 HOURS TO 24 HOURS. ADJUSTED TO EXTRAUTERINE LIFE. ADAPTATION OF THE NEWBORN'S. I.CARDIOVASCULAR SYSTEM: CHANGES IN THE FETAL CIRCULATORY SYSTEM OCCUR IMMEDIATELY AFTER BIRTH AND DURING THE NEONATAL PERIOD. - DUCTUS VENOSUS: BECOMES OBLITERATED AND BECOMES THE LIGAMENTUM VENOSUM. - DUCTUS ARTERIOSUS: IS OBLITERATED AND BECOMES THE LIGAMENTUM ARTERIOSUM. - FORAMEN OVALE: USUALLY BECOMES OBLITERATED. CHANGES IN THE CARDIOVASCULAR SYSTEM ARE NECESSARY AFTER BANDOQUILLO, H.G. 2-C BIRTH. THE LUNGS NOW MUST OXYGENATE THE BLOOD THAT WAS FORMERLY OXYGENATED BY THE PLACENTA.. WHEN THE CORD IS CLAMPED, THE NEWBORN IS FORCED TO TAKE IN OXYGEN THROUGH THE LUNGS. AS THE LUNGS INFLATE FOR THE FIRST TIME, IT DECREASES PRESSURE IN THE CHEST MOST SPECIALLY IN THE PULMONARY ARTERY THAT IS RESPONSIBLE IN THE CLOSURE OF DUCTUS ARTERIOSUS. AS PRESSURE INCREASES IN THE LEFT SIDE OF THE HEART, THE FORAMEN OVALE CLOSES.. ACROCYANOSIS OR CYANOSIS OF HANDS AND FEET AND PERIORAL AREA RESULT FROM THE SLOW PERIPHERAL CIRCULATION AFTER BIRTH. NORMAL AFTER BIRTH.. AN AVERAGE BLOOD PRESSURE LEVEL OF 80/46mmHg CAN BE OBSERVED AND THIS DEPENDS OF THE NEWBORN SIZE AS WELL AS ITS LEVEL OF ACTIVITY.. THE PULSE RATE VARIES FROM 120 TO 160 BEATS PER MINUTE DURING WAKING PERIODS AND 100 BEATS PER MINUTE WHILE SLEEPING. CRYING OR AFTER CYRING 180 BEATS/ MIN. II. RESPIRATORY SYSTEM. 80 breaths/min for the first few minutes of life, then 30 to 60 breaths/min when respiratory activity is established. A FIRST BREATH IS A MAJOR UNDERTAKING BECAUSE IT REQUIRES A TREMENDOUS AMOUNT OF PRESSURE IN THE LUNGS. FLUID IN THE LUNGS THAT WAS ACCUMULATED INTRAUTERINE LIFE ALLOWS THE LUNGS TO INFLATE MORE. SIGNS OF RDS: (RESPIRATORY DISTRESS SYNDROME) 1. APNEA - BREATHING THAT EASES FOR 10 TO 15 SECONDS 2. GRUNTING 3. STERNAL RETRACTION 4. NASAL FLARING - WHICH IS OBSERVED TO BE FREQUENT/ FAST 5. GENERALIZED CYANOSIS - THE ENTIRE BODY IS BLUE 6. WEAK MUSCLE COORDINATION 7. POOR SUCK - POOR ROOTING, GAG, SWALLOWING = SURVIVAL III. GASTROINTESTINAL SYSTEM: STOMACH HOLDS 60 TO 90ML.. MECONIUM - AFTER BIRTH. SOFT AND YELLOWISH IN COLOR.. TRANSITION STOOL - 2ND TO 3RD DAY OF LIFE. GREENISH IN COLOR.. FORMULA MILK: BRIGHT YELLOW IN COLOR. PRONE TO CONSTIPATION. CASEIN - ENZYME FOUND IN MILK FORMULA.. BREASTFED: LIGHT YELLOW IN COLOR, SWEET SMELL.. JAUNDICE: BRIGHT GREEN STOOL. BILE PROBLEM: CLAY-COLORED STOOL. ANAL FISSURE: BLOOD TINGED STOOL IV. URINARY SYSTEM: PASS OUT URINE WITHIN 24 HOURS AFTER BIRTH. 15ML SINGLE VOIDING OF THE NEWBORN. BANDOQUILLO, H.G. 2-C V. IMMUNE SYSTEM: IMMATURE, PERMITTING THE ENTRY OF NUMEROUS INVADING ORGANISMS AND RESPONDING POORLY TO INFECTION. VI. THERMOREGULATION AND METABOLIC ADAPTATION: THERE IS A SIGNIFICANT DECREASE IN BODY TEMPERATURE AS THE NEWBORN ADAPTS TO COOLER EXTRAUTERINE LIFE.. COLD STRESS CAN BE LETHAL. (HYPOTHERMIA) this could lead to RDS VII. NEUROLOGIC ADAPTATION: NEWBORN REFLEXES ARE IMPORTANT INDICATOR OF NORMAL DEVELOPMENT. EXHIBITS UNCOORDINATED MOVEMENT- NORMAL THAT MAY BE EXHIBIT —-- BALLARD SCORING:. The Ballard score is commonly used to determine gestational age. Here's how it works: Scores are given for 6 physical and 6 nerve and muscle development (neuromuscular) signs of maturity. The scores for each may range from -1 to 5. The scores are added together to determine the baby's gestational age. NEWBORN SENSORY PARAMETERS. HEARING: DETECTION OF SOUNDS IS POSSIBLE ONCE EUSTACHIAN TUBES ARE CLEAR.. VISION: OBJECTS 6 TO 8 INCHES AWAY ARE VISIBLE TO THE INFANT.PREFERENCE FOR BLACK AND WHITE PATTERNS. SENSITIVITY TO LIGHT. ABILITY TO TRACK PARENTS USING THE EYES. EXTRAOCULAR BANDOQUILLO, H.G. 2-C MUSCLE COORDINATION IS IMMATURE AT THIS TIME. TEARLESS DUCTS.(IMMATURE LACRIMAL DUCTS). TOUCH: ABILITY TO SENSE PRESSURE, PAIN AND TOUCH. SENSITIVITY TO CUDDLING.. TASTE: TASTE BUDS DEVELOP AFTER BIRTH. PREFERENCE TO SWEET TASTE. EXTRUSION REFLEX- BITTER FOOD. TONGUE PUSH IT OUTWARD.. SMELL: ABILITY TO DIFFERENTIATE PLEASANT FROM UNPLEASANT ODORS. THE IMMEDIATE NEWBORN CARE: I. ESTABLISH AIRWAY: TOP PRIORITY - NEWBORNS ARE NOSE BREATHERS - POSITION NEWBORN IN SLIGHT TRENDELENBURG 15 TO 30 DEGREE. - TO ALLOW SECRETIONS TO DRAIN. - ABC: (AIRWAY, BREATHING, CIRCULATION). SUCTION THE MOUTH AND NOSE - SUCTION SECRETIONS SHALLOWLY AND BRIEFLY WITH THE USE OF THE RUBBER SYGRINGE. PRETERM - LESS THAN 5 SECONDS, FULL TERM - 5 TO 10 SECONDS. - ADMINISTRATION OF OXYGEN: IS NOT A ROUTINE NEWBORN CARE BUT TO ENSURE PATENT AIRWAY AND GOOD SUPPLY OF ATMOSPHERIC AIR. - RETROLENTAL FIBROPLASIA - INJUDICIOUS USE OF OXYGEN CAN DAMAGE THE RETINA CAUSING PERMANENT BLINDNESS. II. KEEP THE NEWBORN WARM. AT BIRTH 37.3, DROPS 35.5 DUE TO MECHANISM OF HEAT LOSS. - EVAPORATION - ALLOWING THE NEWBORN TO DRY WITHOUT COVERING A TOWEL. - CONDUCTION = DIRECT CONTACT WITH COLD EQUIPMENT - CONVECTION = LOSS OF HEAT TO SURROUNDINGS - SUCH AS AIRCON. - RADIATION = NOT IN DIRECT CONTACT. WALLS, FLOOR AND CEILING. NOTE: INITIAL TEMPERATURE TAKING IS DONE PER RECTUM TO DETECT IMPERFORATE ANUS. BANDOQUILLO, H.G. 2-C BANDOQUILLO, H.G. 2-C ANTHROPOMETRIC MEASUREMENTS: VII. ANTHROPOMETRIC MEASUREMENTS: -WEIGHT: WEIGHT LOSS OF 5 TO 10% OF BIRTHWEIGHT DURING THE FIRST WEEK OF LIFE IS CONSIDERED NORMAL. "PHYSIOLOGIC WEIGHT LOSS". 1. URINE AND MECONIUM PASSAGE 2. DROP OF WATER RETAINING MATERNAL HORMONES FROM THE NB BODY. 3. INADEQUATE INTAKE. NB IS ADJUSTING TO FEEDING. BREASTFED OR BOTTLEFED. - HEIGHT: 19 TO 21 INCHES OR 50 CM. ( CROWN TO HEAL). - HEAD CIRCUMFERENCE: 33 TO 35 CM (EYEBROW). - ABDOMINAL GIRTH: 31 TO 33 CM. (UMBILICUS). BANDOQUILLO, H.G. 2-C - CHEST CIRCUMFERENCE: 31-32 CM (2 CM LESS THAN THE HEAD). NIPPLE LINE. COMPREHENSIVE PHYSICAL EXAMINATION - ALERT, ACTIVE AND WITH GOOD CRY 1. HEAD AND FACE: - Head size in relation to the body. - Look for molding - Presence of cephalhematoma - collection of blood in the skull AND Does not cross suture. - caput succedaneum - edema of the scalp AND Crosses sutures. - Feel for fontanels- ANTERIOR AND POSTERIOR FONTANELS - SUNKEN FONTANELS MAY INDICATE DEHYDRATION. - TENSED OR BULGING FONTANELS MAY INDICATE INCREASED INTRACRANIAL PRESSURE. 2. EYES:. Color. Check for any discharge from the eyes - conjunctivitis.. Presence of symmetrical and clear pupils which are equal, round and reactive to light.. Presence of intact blink reflex.. Strabismus and NYSTAGMUS ARE COMMOM FINDINGS.. DOLL'S EYE - MAY BE SEEN WHEN THE HEAD IS TURNED AND EYE MOVEMENT LAG BEHIND.. PRESENCE OF REF REFLEX - REDDISH ORANGE REFLECTION OF LIGHT FROM THE BACK OF THE EYE. 3. NOSE AND MOUTH: - MASAL PATENCY IS DETERMINED. - Presence of sucking and crying movements - Tongue tied (frenulum) - Epstien pearls - WHITISH SECRETIONS ON THE TONGUE - ORAL Thrush -indication OF INFECTION - candida ALBICANS - Cleft lip/palate - Uncoordinated sucking and swallowing - ABNORMAL. - ROOTING/ SUCK/EXTRUSION/SWALLOWING/GAG REFLEXES - SURVIVAL OF THE NEWBORN IN TERMS OF FEEDING.f 4.. EARS AND NECK: - Presence of normal soft, symmetrical firm ears with good recoil. - Position of ears- low set below the level of the canthi of the eyes - points to genetic abnormality.- - TRISOMY 21 OR DOWN SYNDROME. - Presence of neck webbing - indicates possible chromosomal abnormality. - Crepitus - poor arm movement - Check neck for nodes and masses - FOR EARS - CHECK FOR ANY SKIN TAGS 6. CHEST: - Presence of normal round and symmetrical chest. BANDOQUILLO, H.G. 2-C - Breasts swelling with occasional milky secretions. "witch milk" - after birth due to maternal hormones. - Presence of symmetrical shallow breathing coinciding with movements of the abdomen. - Presence of crackles or rhonchi - ABNORMAL FINDINGS. - Heart sounds and presence of murmurs - INDICATES heart problems. 7. ABDOMEN: - Bowel sounds - present within about 2 hours of life. - KIDNEYS PALPABLE - UMBILICAL CORD - INSPECT FOR - AVA - CHECK FOR ANY MASSES AND NODES 8. ANUS: - Patency - IMPERFORATE ANUS. - First stool within 24 hours of life. GENITALIA: FEMALE. Presence of edematous labia, enlarged clitoris - NORMAL. Presence of smegma (thick, white mucus VAGINAL discharge). Pseudomenstruation or vaginal discharge due to the release of maternal hormone.. First voiding should occur with 24 hrs. after birth.. MALE: - Presence of prepuce or foreskin - CIRCUMCISION - Assess for hernia/hydrocele - First voiding should occur within 24 hours of life..- Cryptorchidism: absences of testes/ undescended testes - Epispadias: opening of urinary meatus is on the dorsal surface - upper - Hypospadias: opening of urinary meatus is on the ventral surface. - LOWER - Micropenis - small penis (metabolic disorders) 10. BACK AND SPINE:. Flexed posture, flexed arms and legs with chin flexed on upper chest. SKIN: Assess for intact skin and absence of lesions. 11. UPPER AND LOWER EXTREMITIES:. Presence of palmar. Plantar grasp reflexes. Assess for symmetry of movement. Check presence, strength and symmetry of pulses. 12. SKIN: BANDOQUILLO, H.G. 2-C - hemagiomas: vascular tumors, flaT or elevated. - Harlequin: lying on his side - upper body turns red. Common in preterm. - Nevus flammeus: purple, dark red lesions " portwine" found on face and thighs. - Storkbeak marks: patches on napes of neck. - Strawberry hemagiomas: elevated - RED IN COLOR. flat bigger patches. Disappears at 4 months. - Caverneous hemagiomas: raised patches but does not disappear. - Mongolian spots: BLUE PIGMENTATION ON THE LOWER BACK, SACRUM AND BUTTOCKS. collection of pigments (melanocytes) - Desquamation- dryness of the skin ( MOST COMMON IN post term) - Erythema toxicum - rashes - Flea bite rash - petechiae - Milia - white small spots on the nose - Lanugo - Vernix caseosa NEWBORN NURSING CARE: PLANNING AND OUTCOME DETERMINATION. DURING THE TRANSITION PERIOD, GOAL SHOULD SET AND ACHIEVED: - Maintenance of a patent airway. - Provision of a conducive thermal environment for the newborn. - Protection of the newborn against infection and injury. - Identification and management of existing and potential Complications THE GOALS FOR CONTINUING CARE INCLUDE:. Adequate newborn nourishment. Urine voiding and bowel movement within 24 hours. Strong parent-infant bond. Family education regarding newborn care SUMMARY PROFILE OF THE NEWBORN:. LENGTH: 46 to 54 cm (measurement from crown to heel). HEAD CIRCUMFERENCE: 34 to 35cm. CHEST CIRCUMFERENCE: 31 to 32cm. HEART RATE: 120 to 160 beats/min. RESPIRATION: 30 to 60 breaths/min. PERIODIC RESPIRATION: common and normal during this time after birth.. COUGHING AND SNEEZING: reflexes are present at birth to clear airway. BANDOQUILLO, H.G. 2-C POINTERS TO REMEMBER!. Newborns are obligate nose breathers. They breathe through their nose FIRST FEW DAYS OF LIFE.. WEIGHT: 2.5 to 3.4 kg.. During the first few days of life, the newborn loses 5 to 10 percent of birth weight. This is called PHYSIOLOGIC WEIGHT LOSS. - Newborn is no longer under the influence of salt and fluid retaining maternal hormones. - Passing of feces and urine within 24 hours of life. - KEEPING THE NEWBORN WARM AT ALL TIMES! - CLEARING OF SECRETIONS REMAINS A TOP PRIORITY! GROWTH AND DEVELOPMENT THROUGHOUT THE LIFESPAN TERMS: GROWTH - HEIGHT AND WEIGHT DEVELOPMENT - COGNITIVE, MORAL, MATURITY. NOTE: EXCEPT FOR ISSUES OF HEALTH WHICH MAY BE AFFECTING EACH OF THESE. ISSUES: 1. STRESSORS 2. SAFETY 3. PHYSICAL ACTIVITY/ HEALTH ISSUES 4. INTERPERSONAL RELATIONSHIPS 5. NUTRITION 6. ENVIRONMENTAL SAFETY THEORIES OF GROWTH AND DEVELOPMENT. GROWTH AND DEVELOPMENT ARE CONTINUOUS PROCESS FROM CONCEPTION TO DEATH.. GROWTH AND DEVELOPMENT PROCEED IN AN ORDERLY SEQUENCE (HEAD TO TOE). CHILDREN PASS THROUGH THE PREDICTABLE STAGES AT DIFFERENT RATES. ALL BODY SYSTEMS DO NOT DEVELOP AT THE SAME TIME.. DEVELOPMENT IS CEPHALOCAUDAL.. DEVELOPMENT PROCEEDS FROM PROXIMAL TO DISTAL BODY PARTS.. DEVELOPMENT PROCEEDS FROM GROSS TO REFINED SKILLS.. THERE IS AN OPTIMUM TIME FOR INITIATION OF EXPERIENCES OF LEARNING.. NEONATAL REFLEXES MUST BE LOST BEFORE DEVELOPMENT. A GREAT DEAL OF SKILL AND BEHAVIOR IS LEARNED BY PRACTICE. BANDOQUILLO, H.G. 2-C INFANCY:. ERIKSON: TRUST VS. MISTRUST. FREUD: ORAL STAGE- EXPLORES THE WORLD BY USING MOUTH.. PIAGET: SENSORIMOTOR. RELATES TO THE WORLD USING THEIR SENSES.. 0-3 MONTHS: RECLINER SLEEPS 20 HOURS A DAY.. 3-6 MONTHS: SITTER. STARTS ROLL OVER. BIRTH WEIGHT MAY DOUBLE AT 6 MONTHS.. 6-9 MONTHS: BOUNCER OR CRAWLER. CAN PULL SELF TO A SITTING POSITION. EVERYTHING GOES IN THE MOUTH. SAFETY PRECAUTIONS!. 9-12 MONTHS: CRUISER OR WALKER. WALKS WITH HELP. LOVES TO CRUISE AROUND FURNITURES. BIRTH WEIGHT TRIPLES AND LENGTH DOUBLED.. SOLITARY PLAY AND ENTERTAIN SELF FOR SHORT PERIOD OF TIME.. FIRST SOCIAL SMILE: 6 MONTHS IS DOMINANT. TODDLER (1-3 YEARS). ERIKSON: AUTONOMY VS. SHAME AND DOUBT. FREUD: ANAL STAGE -A STAGE LETTING GO MAJOR MILESTONE: ELIMINATION ( TOILET TRAINING/ POTTY TRAINING.. PIAGET: PREOPERATIVE STAGE. INTO EVERYTHING - EXPLORATIVE. TEMPER TANTRUMS. NEGATIVISTIC. FAVORITE WORD: NO. PUSH AND PULL TOYS BANDOQUILLO, H.G. 2-C. PARALLEL PLAY - TWO TODDLERS ARE SEATED TOGETHER THEY DON'T SHARE THEIR TOYS, JUST PLAY ON THEIR OWN.. RITUALS AND ROUTINES. SEPARATION ANXIETY - IS DOMINANT PRESCHOOLER ( 3 TO 6 YEARS). FEARS MUTILATION OF GENITALIA - MALE: MASTURBATE · ASSOCIATIVE PLAY. FEARS ABANDONEMENT - HATE TO BE ADMITTED IN THE HOSPITAL. ERIKSON: INITIATIVE VS. GUILT. FREUD: PHALLIC STAGE. PIAGET: INTUITIVE THINKING. EGOCENTRISM REACHES IT PEAK.. IMAGINARY FRIENDS ARE COMMON - TALKING TO THEMSELVES. · CURIOUS. PANDORA BOX - KEEP EVERYONE'S SECRET FROM THEM. SECRETS ARE NOT SAFE.. FAVORITE WORD: WHY SCHOOL AGE: ( 6 TO 12 YEARS OLD). FEAR DEATH OF YOUR PARENTS/ANY LOVED ONES.. ERIKSON: INDUSTRY VS. INFERIORITY. FREUD: LATENT STAGE ( NO SEXUAL PROGRESS/ NO SEXUAL MOTIVATION). PIAGET: CONCRETE OPERATIONAL. MODESTY/POLITE PARTICULAR.. FAVOR PEERS - GIRLS WITH GIRLS, BOYS WITH BOYS. CRUSHES STARTS.. LOSS OF CONTROL - BECAUSE THE LOVE COMPETE.. THEY DEMAND EXPLANATION OF PROCEDURES. COMPETITIVE PLAY WITH THE OPPOSITE SEX ADOLESCENT (12 TO 18 YEARS) - PUBERTY STAGE. PEER GROUP IS VERY IMPORTANT. PARENTS ARE - SOURCE OF DAILY CONFLICT. ALTERED BODY IMAGE - SECONDARY SEX CHARACTERISTICS. ERIKSON: IDENTITY VS. ROLE CONFUSION. FREUD: GENITAL STAGE - RELATIONSHIPS FROM THE OPPOSITE SEX.. PIAGET: FORMAL OPERATIONAL THOUGHT. DEPRESSION AND SUICIDE IS MOST COMMON - HARD TO FIND YOURSELF. YOUNG ADULT: INTIMACY VS. ISOLATION. MIDDLE AGED: GENERATIVITY VS. STAGNATION. OLDER ADULT: INTEGRITY VS. DESPAIR BANDOQUILLO, H.G. 2-C BANDOQUILLO, H.G. 2-C BANDOQUILLO, H.G. 2-C BANDOQUILLO, H.G. 2-C BANDOQUILLO, H.G. 2-C BANDOQUILLO, H.G. 2-C