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(amniotic fluid, shed mucosal cells, intestinal secretions, blood)
-neonatal hypoglycemia: tachy, tremors, jittery, apnea, seizures, tachypnea-during labor moms BS increase, thus baby’s increases. Baby increases produc of insulin, but when cord cut BS decreases and baby has excess insulin thus leading to hypoglycemia
-do heel stick for hypoglycemic baby and every 30min.
-newborn hypoglycemia value: less than 30mg/dL, less than 20 need IV
Phases of stool
First stool Meconium: black tarry thick with dark
Second stool Transitional: combination of Meconium and milk stool greenish broen and looser
Third stool Milk : breastfeeding seedy with mustard color/formula pale yellow to light brown firmer
outcome but are good indicators of transition
to extrauterine life
-2 points for each one at best, best score is 10
M before N: mouth before nose
- remember they are obligitory nose breathers
Asymmetrical tonic neck
Open mouth and begin a sucking motion when lips touched
Toes should fan out when base of foot stimulated
While being held upright, newborn will make walking or stepping motion
-bradypnea: <30 resp/min
-abnormal breath sounds
-resp distress: nasal flaring, retractions
-seesaw or paradoxical resp
-skin color, cyanosis
-pulse ox <95%
-insertion of prophylactic agent is required in the U.S.
-precautionary measure against ophthalmia neonatrum (inflam of eyes from gonorrheal or chlamydial infection)
-must sign refusal form if dont want infant to get
-can cause chemical conjunctivitis that lasts 24-48 hours, temporary blurred vision
liquid converted to a vapor-cooling amniotic fluid on skin or water after bath- place hat & dry well
– loss of heat that occurs when a liquid is converted to a vapor. (drying infant)
heat lost from cool air flows such as fans, AC units- keep out of doorways and in isolette if temps low, also warm humified air coming to newborn (O2)
- is the flow of heat from the body surface to cooler ambient air (rooms kept at 75°)
– loss of heat from the flow of heat from the body’s surface to cooler ambient air – baby laying in crib not will covered. Airflow around baby causes baby to be cold
1.Keeping the newborn out of drafts.
2.Maintaining warm environmental temperature.
3.Keeping a preterm neonate in an incubator.
placed near a cool object that can steal warm such as large cool window, keep in areas away from cold objects, use warmer if having to remove blankets for a procedure such as lab work
– the loss of heat from the body surface to a cooler solid surface not in direct contact but in close proximity (windows/drafts)
- loss from the body’s surface to a cooler solid that is close to the infant but not touching the infant – closer to a window in winter
lost due to touching cooler objects directly to babies skin-warmed blankets, covering surfaces the infant will lie on with warm towel
– loss of heat from a body surface to cooler surfaces in direct contact (pre-warm Ohio’s, covered scales)
become less active, lethargic, hypotonic & weaker
Can lead to:
Depleted fat stores
Increased oxygen needs
Increased glucose consumption leading to hypoglycemia
Decreased surfactant production
Throw their arms outward and flex knees, arms return to chest and fingers make a C
Curling of toes or grasping of fingers when palms or feet stimulated
With newborns head to one side, the side the baby is facing should have the arm extended straight away from the body with the opposite arm flexed with clenched fist
Can have transient tremors of mouth, chin and extremitites (arms & hands)—normal especially when crying
· Tremors should not be noted at rest or past 1 month of age
Breast- yellow-gold, loose or stringy, sour-smelling
Formula- yellow, yellow-green, or greenish, loose, pasty, or formed, unpleasant odor (differs according to formula)
______________ synthesized in liver by vitamin K which is deficient at birth thus the reason for the injection
is bilirubin-induced neurologic damage that is preventable
A 3 day old term infant who is being breastfed has hyperbilirubinemia (16mg/dl). This is most often treated by:
a. stopping breast feeding
d. blood transfusion
· Bank or banks of lights 45-50 cm above infant
· Other types: bili blanket, bili bed
· Uncovered as much as possible
· Keep eyes and gentials covered
· May need extra fluids to prevent dehydration from insensible losses
· No lotions or oils while under lights
· Monitor temperature and urine output
· O.5-1 mg of vitamin K:
IM in Vastus lateralis—25G, 5/8 in needle, 90°
· Given within first 1 to 2 hours of birth
· Vitamin K is produced by GI tract when bacteria is introduced after birth
· Injection promotes formation of clotting factors-
· Healthy newborns able to produce own vitamin K by day 8
• Yellow crusting is normal
· Most blood tests performed by heel stick
· Warm the heel for 5-10 min
· Wear gloves
· Use automatic lancet to puncture
· High rate of clotting with this technique
· PKU screened in 24 to 48 hours
Enhance bonding between newborn & parents encouraging interactions
• Soothing calm voice used
• Learn communication from baby
• Least stressful way to provide care
• Comforting newborns with crying relief strategies p 599
• Gentle massage, rocking, mobiles, swaddling, singing, etc
Newborns sleep average ______________/day
• Most complete form of infant nutrition
• Always available at the right temperature and in the right amount
• Easier to digest
• Fewer illnesses and allergies
• Varied taste
• Calorie content adapts to infant’s needs
• Cheaper and more convenient
• Burns about 1000 calories a day for mom
• Decreases chances of obesity and diabetes in child and certain cancers and osteoporosis for mom
• Natural form of birth control
• Time consuming for mom-takes dedication and perseverance
• Anyone can help with feedings
• Flexibility and convenience
• Slower to digest, thus increasing the time between feedings
• Many different types to choose from
• Mom does not need to worry about her diet and medications transferring to the infant
• More expensive
• Formula recalls due to contamination leading to potential harm
• Time consuming (purchasing, storing, mixing, feeding, and cleaning up supplies)
• Decreased PP bleeding & more rapid uterine involution
• Reduced risk of breast, uterine and ovarian cancer
• Quicker weight loss
• Decreased risk of postmenopausal osteoporosis
• Unique bonding
• Decreased incidence & severity of infections
• Decreased rate of SIDS, DM type 1 & 2, lymphoma, leukemia, Hodgkin disease, asthma, allergies, & obesity
• Enhanced IQ & eye development
• Unique bonding
• Breastfeeding is ideally attempted within 1st hour of birth
– Bottle-feeding is started within 4 hours after birth
• 15-30 mL q3-4h for 24 to 48 hours with gradual increase to 90-150 mL per feeding by the second week of life
(T > 38° C or < 36.5 °C; > 100.4°F or <97.7°F)
promotes muscle development in the neck and shoulders
helps prevent tight neck muscles
helps prevent flat areas on back of babies head
helps build muscles baby needs to roll, sit, and crawl
- respiratory rate below 30, above 60
- nasal flaring
- expiratory grunt
- use of intercostal muscles to breathe
- apnea (cessation of breathing for 20 secs)
- nasal breather
- immediately after birth rr = 30-60
- may have peripheral cyanosis for hours
- color should steadily improve
- diaphramatic and shallow
- periodic pauses < 15 seconds
- CBC – platelets, liver functions AST, ALT, creatinine
- Tx – have patient deliver
- Develops more in the 3rd trimester
Base excess -4 to +4
o2 Sat 92 to 94%
Causes of Amenorrhea
Diet to treat Dysmenorrhea
Decrease salt, refined sugar and red meat
Increase natural diuretics(cranberry juice, asparagus,etc. )
Treatment for Primary Dysmenorrhea
Meds(prostaglandin inhibitors, NSAIDS,OCP)
Treatment for secondary Dysmenorrhea
Goal is to remove the cause(may require surgery)
Otherwise, treat using measures for Primary
Horomone Therapy(Oral/IV Estrogen best, but may use estrogen/progesterone combo or Progestin alone)
Therapeutic D&C(Scraping of the Uterine Lining)
Endometrial Ablation (destroying of the endometrial layer of the uterus
Myometectomy(if cause is fibroids)
A harmless condition in which the breasts develop lumps, sometime associated with caffeine consumption. In some, it responds to abstinence from caffeine; in others' it can be treated with vitamin E.
A disease of premature infants who had hyaline membrane disease and required mechanical ventilation for long periods.
There is decreased alveoli, decreased mucous clearance, and a high risk for future lung disease.
monitor temp closely
cover infant's eyes
--> record amt/color, decreased stools = increased bili
Assess: Infection, ileus, shock, hemorrhage, PE, DVT, vaginal discharge, incisionbowel sounds every shift
Turn, cough, deep breath ambulate
Measure I & O, fluids
Restrict activity 4-6 weeks
Provide info: for hormone replacement if indicated
-surgical repair (lithotomy position)
-pre/post op care similar to abdominal surgery
-meticulous perineal care, foley, prevent consitpation
Prevents sperm from entering vagina.
Affective against pregnancy and STD.
Advantages: Small, disposable and inexpensive
Disadvantages: May be broken, displaced, cause irritation or give dulled sensation
Who uses this: Men
How often used: Every time.
*KY Jelly used to prevent breakage or irritation
placement of small microcoils into fallopian tubes which expand to shape of tubes. Promote growth of scar tissue
In office; no anesthesia
Risks: perforation, pain, infection
the relationship of the presenting part to the four quadrants of the mother’s pelvis
-identified with abbreviation: (1 letter, 2 letter, 3 letter)
relationship of presenting part of fetus to an imaginary line drawn between the maternal ischial spines and is the measure of the degree of descent of the presenting part of fetus through birth canal
- should be determined as soon as labor begins so the rate of descent can be measured
term used to indicate that the largest transverse diameter of the presenting part has passed through the maternal pelvic brim and into the true pelvis (corresponds to station 0 )
- occurs the weeks right before labor or during labor for multigravidas
Reverse CNS depression effects of opioids
If given to mother must make her aware that pain with return
Neonatal narcosis: state of CNS depression in newborn. Alterations may be present for up to 72 hours. (usually given to the baby)
If delivery occurs sooner than anticipated may need to be given IM to neonate
useful for second stage of labor, episiotomies and birth. Relieves pain in lower vagina, vulva and perineum by numbing the pudendal nerve
Commonly used for impending episiotomy when time or the fetal head position makes a pudendal block contraindicated (usually just done for repair)
Local anesthetic injected through the third, fourth or fifth lumbar space into the subarachnoid space, at which point the medication mixes with the CSF.
Mostly used for C-sections.
Effects are within 1-2 minutes and lasts 1-3 hours.
Risks: marked hypotension, decreased cardiac output and placental perfusion and respiratory inadequacy
-Begins with regular uterine contractions
-Ends with full cervical effacement and dilation
ladies are home and start to feel pain not real regular (very slow can be 12 hours) (little cervical pain) (can be uncomfortable) (prolong stage can be detrimental – because they get so tense and un-rested, can admit for therapeutic rest (give sedative and analgesic))
-assess FHR every 45 -60 minutes
typically when you admit people, contractions are around 5 min apart lasting 60 seconds, pri – dilatation of about 1 cm per hour, multi – 11/2cm per hour
Transition: when things really get intense, can start to get the urge to push
assess fetal heart rate every 15-30 min
-Then q hour
•Observe for signs of placental separation and assist
-Until peeing then transfer – can not move until mom is able to do this on her own
the discharge that flows from the vagina after childbirth. During the first 2 to 4 days after delivery, the lochia is red or brownish red (called lochia rubra) and is made up of blood, endometrial decidua, fetal lanugo, vernix, and sometimes meconium, and it has a fleshy odor. About the third day the amount of blood diminishes. The placental site exudes serous material, erythrocytes, lymph, cervical mucus, and microorganisms from the superficial layer called lochia serosa. During the next 10 to 14 days bacteria appear in large numbers along with mucinous decidual material and epithelial cells, causing the lochia to appear whitish yellow (lochia alba).
Baseline FHR less than 110 beats per min (NICHD)
Fetal bradycardia is commonly associated with fetal hypoxemia. However, a number of causes must be considered
Baseline FHR greater than 160 beats per min (NICHD)
- An abrupt (onset to nadir less than 30 sec), visually apparent decrease in the FHR below the baseline
- The decrease in FHR is 15 beats per min or more, with a duration of 15 sec or more but less than 2 min (NICHD)
Cord that is against babies head as the baby descends
If baby cant recover or deal with them mom goes to C-cection
-In association with a uterine contraction, a visually apparent, gradual (onset to nadir 30 sec or more) decrease in FHR with return to baseline
Onset, nadir, and recovery of the deceleration occur after the beginning, peak, and end of the contraction, respectively (NICHD)
Allows the head to accommodate the birth cannel
Will return back to normal within 24 hours
- does not cross the suture line
Complete heart block (Maternal SLE, CMV infection)
Congential heart block
Umbilical cord compression
Amniotic fluid embolism
As with fetal tachycardia, the bradycardic FHR must be analyzed for the presence of periodic changes and decreased variability. These findings are more consistent with hypoxemia. Some fetuses may display a bradycardic FHR but be completely normal. It should be remembered that the range of 110-160 does not represent all normal fetuses. The likelihood of a FHR in the range of 100-110 representing a normal variant increases as the fetus, and its nervous system, matures.
Drugs (Atropine, Vistaril, Phenothiazines, Beta-sympathomimetics)
Fetal heart failure
Severe fetal anemia, fetal hydrops
Fetal tachycardia is occasionally seen after a deceleration of the FHR, and in this instance is likely indicative of hypoxemia. This may be due to an attempt by the fetus to increase perfusion by increasing cardiac output or it may be due to increased catecholamine activity from the adrenal medulla in response to the stress of hypoxemia, when associated with a deceleration, and the loss of vagal tone.
FHR accelerations and good (moderate) variability are closely associated and sometimes may be visually indistinguishable, though both are reflective of a well-oxygenated fetus.
Causes by head compression – see as baby is decending into the vaginal canal – mirrors contractions of mom (can be deep or suddel) these are normal and okay to have – baby must recover by end of contraction
The presence of accelerations forms the basis of the nonstress test (NST). An NST is said to be reactive when there are at least two accelerations in a 20 minute period, along with moderate variability and no decelerations.
-not thought to represent hypoxia, but repetitive severe variable decelerations with diminished or absent FHR variability may indicate hypoxia.
-Related to cord compression – can be suddle or deep, not happening ontop of contraction look like a “V”
Start at end of the contraction
Associated with uterine placental consistency
Often have a lose of variability
Baby will eventally crash
Uterine hyperactivity Maternal hypotension
Maternal hypertensive disorders
Placental abruption Placenta previa
IUGR Maternal DM
Chorioamnionitis Postterm gestation
Maternal anemia, SS anemia, etc.
Rh isoimmunization Maternal cardiac disease
Measured in finger breaths
Takes about a week before it becomes a pelvic organ again
6 wks. About the pre pregnant size – never return to pre preg size
- is the first discharge, red in color because of the large amount of blood it contains. It typically lasts no longer than 3 to 5 days after birth.
up to 6 weeks
- Clear or very light pink but mostly white
- ) is the name for lochia once it has turned whitish or yellowish-white. It typically lasts from the second through the third to sixth weeks after delivery. It contains fewer red blood cells and is mainly made up of leukocytes, epithelial cells, cholesterol, fat, and mucus
-Don’t exercise for 6 weeks after childbirth, don’t left anything heaver than the weight of the baby until the lochia alba
of uterus to contract
-Temp above 100.4 then start patient on something
-Displaced to the left and above the umbilicus – can be a reason for uterine distension – have patient use restroom and reassess
clues to look for
Pink Period is first day or two after delivery – char. By heightened joys and feelings of well-being.
Blue Period peaks around day 5 and subside by day 10.
- Oxygenation of the fetus occurs through transplacental gas exchange → at birth the lungs must be established as the site of gas exchange.
- In utero, fetal blood was shunted away from the lungs but with birth the pulmonary vasculature must be fully perfused for this purpose. Clamping the cord causes a rise in blood pressure which increases circulation and lung perfusion.
- All these things must happen within the first minute of life
1.The neonate’s skin is thin.
2.The newborn’s blood vessels are close to the surface.
3.Little subcutaneous or white fat is present to serve as a barrier for heat loss. (the percentage of subcutaneous fat in newborns is only half in adults)
4.Newborns have three times more surface area to body mass than adults.
EvaporationWhen wet surfaces are exposed to the air evaporation occurs. Heat is lost when the surface dries. At birth the neonate is bathed with amniotic fluid. As the amniotic fluid dries up on the infant’s skin (evaporation), the infant loses heat. The same occurs in bathing an infant
When a neonate comes in direct contact with an object cooler than their skin heat loss by conduction occurs. Heat loss by conduction occurs when an infant is placed on a cooler surface or touching them with a cool object or hands.
The transfer of heat to cooler objects that are not in direct contact with the neonate is called the heat loss by radiation. When infants are placed near cold windows or walls heat is lost by radiation. Even neonates placed in incubators losses heat to the walls of the incubator if it is cold even if the surrounding air temperature is warm.
1.Incubators must have double walls.
2.Cribs and incubators should be placed away from the walls and windows