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lochia is
endometrial sloughing
- day 1-3 rubra (bloody, fleshy odor,
clots)
- day 4-9 = serosa (pink/brown, fleshy
odor)
- day 10 = alba (yellow-white)
- if foul odor = infection
perineum
large flow
accurate measurement of
blood loss
weigh peri-pad
monitor episiotomy/laceration
analgesics;
topical anesthetics,
ice packs for first 12-24 h ;
then 20 min sitz baths 3-4 times/day
- tightening buttocks before sitting
breasts
engorgement
nursing woman
nipple care
= clean with warm water, no soap, dry
thoroughly
- use absorbent breast pads if leaking
- ice before breastfeeding
- apply breast milk to nipples and areola
after each feeding and air dry;
- warm compress after each feeding and
air dry
position nipple so infants mouth covers
large portion of areola and
- release infants mouth from nipple by
inserting finger to break suction
rotate breastfeeding positions
engorgement
device
refridgerated for no more than 48h
frozen in plastic bottles
in fridge or freezer for 2 wk and
deep freezer for 2 mo
dont thaw in microwave or on stove
afterpains
urinary
GI
last 2-3 d
bowel sluggishness
decreased abdominal muscle tone
perineal discomfort lead to constipation
early ambulation
increase dietary fiber and hydration
stool softeners
rubella vaccine
psychosocial adjustment
relieved by
attachment/bonding
attachment/bonding evidence
by first
taking in/dependency
taking hold/dependencyindependency
day 3
- performing self care
- express concern for baby and self
- open to instructions
letting go/independnce
by wk 5-6
- taking on new role responsibilities
- may be grief for relinquished roles
- adjustment to accommodate for infant
in family
POSTPARTUM blues
day 3-7
sexual activities
phases of psychosocial
adjustment
NEONATE UNIT 5
assessment - physical
exam
VS of neonate
wt
length
head circumference
13-14 in = 33-35 cm
- 1/4 body length
chest
temperature
posture of neonate
apical rate
100BPM (sleep)
- 120-140BPM (awake)
- up to 180 = crying
- auscultate for 1 min when not crying
respirations
30-60/min
- mostly diaphragmatic and abdominal
synchronous with chest movements
- get periods of apnea = less than 15s
- neonate is obligatory not breather,
important to keep nose and mouth clear
BP
several days
resistance to extension of
extremities
skin of neonate
sensitive to drying
erythematous (beefy red)
color for few hours after birth
acrocyanosis
vernix caseosa
head of neonatal
lanugo
milia
pigmentation
birthmarks
nevus vasculosus
strawberry mark
- raised, demarcated
- dark red
- rough-surfaced capillary hemangioma
in dermal and subdural layers
- grows rapidly for several mouths then
begins to fade
- disappears by 7yo
nevus flammeus
appear asymmetrical bc of
overriding of cranial bones
during labor and delivery =
molding
fontanelles
anterior fontanelle
diamond shaped
- easily felt
- usu. open and flat (may be moderate
bulging with crying/stooling)
- sustained bulging occur with increased
intracranial pressure
- depression with dehydration
- slight pulsation
- closes by 18mo of age
posterior fontanelles
- triangular
- not easily palpated
- closes bt 8-12 wk of life
head of neonatalcephalhematoma
appear 1-2 d
- does not cross suture line
- disappears in wks to months
caput succedaneum
- present at birth
- overrides suture line
- fluid reabsorbed within hours to days
after delivery
face
symmetrical distribution of
movement of all features
eyes
-edematous
- yellow-white drainage ass.
with silver nitrate drops
(chemical conjunctivitis)
- should disappear 1-2 d
without treatment
- see subconjunctival
hemorrhage
mouth
sucks well
- hard and soft palate intact
ears
hearing eval by
chest
abdomen
first stool
yellow stools/day
genitourinary
female
pseudomenstruation
blood tinge
male
pupillary
palmar grasp
plantar grasp
tonic neck
fencing position
- lying on back with head turned on one
side, arm and leg on that side of body
will be in extension
- while extremities on other side flexed
- disappear by 3-4 mo
moro reflex
stepping reflex
babinski sign
care of penis
uncircumcised
circumcised
eye prophylaxis
IM aquamephyton
maternal hx
- smoking, alcoholism
- infection
- psychosocial problems
birth asphyxia
HIGH RISK
CHILDBEARING TO
NEONATAL
characteristics of preterm
births
SGA characteristics
growth)
chronic intrauterine hypoxia
LGA birth wt 4000g or more
congenital anomalies
apgar score less than 7
early or severe jaundice; get in first 24 h
bilirubin above 15mg/100ml in full
term newborn
deficiency of surfactant in
immature lung
assessment