1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 47 Caring for Mothers and Newborns

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  Mothers and newborns usually have short hospital stays.  Common reasons for home care after discharge include that the mother: Has complications before or after childbirth Has complications before or after childbirth Has health problems Has health problems Needs help with other young children in the home Needs help with other young children in the home Had a multiple birth Had a multiple birth Needs help with meals and housekeeping Needs help with meals and housekeeping

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  INFANT SAFETY AND SECURITY  Babies cannot protect themselves.  Babies cry: To communicate To communicate When wet, hungry, hot or cold, tired, uncomfortable, or in pain When wet, hungry, hot or cold, tired, uncomfortable, or in pain

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  To promote safety and security: Respond to their cries. Respond to their cries. Feed them when hungry. Feed them when hungry. Change diapers as needed. Change diapers as needed. Comfort them. Comfort them. Talk to them. Talk to them.  Nursery equipment must be safe and in good repair.  Babies can become ill quickly. Signs and symptoms may be sudden. Signs and symptoms may be sudden.  Be alert to any change in the baby’s behavior.  Tell the nurse when a sign or symptom began.

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  HELPING MOTHERS BREAST-FEED  Breast-feeding (nursing) is feeding a baby milk from the mother’s breasts. The baby can feed at the mother’s breast. The baby can feed at the mother’s breast. The mother can pump milk from her breasts. The mother can pump milk from her breasts.  Breast-fed babies are fed on demand.  Nurses help new mothers learn to breast-feed.  Tell the nurse if the mother or baby is having problems breast-feeding.

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  BOTTLE-FEEDING BABIES  Formula comes in three forms. Ready-to-feed Ready-to-feed Powdered Powdered Liquid concentrate Liquid concentrate  Bottles are prepared one at a time, or in batches for the whole day. Follow the container directions carefully. Follow the container directions carefully. Use bottles stored in the refrigerator within 24 hours. Use bottles stored in the refrigerator within 24 hours.  Protect the baby from infection. Wash formula containers before opening them. Wash formula containers before opening them. Baby bottles, caps, nipples, and other items must be as clean as possible. Baby bottles, caps, nipples, and other items must be as clean as possible.

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  Feeding the baby Bottle-fed babies are fed on demand. Bottle-fed babies are fed on demand. Most babies do not like cold formula out of the refrigerator. Most babies do not like cold formula out of the refrigerator. To warm a bottle before the feeding, do one of the following: To warm a bottle before the feeding, do one of the following:  Warm it in a pan of water on the stove. Use low heat. Turn the bottle often.  Hold the bottle under warm running tap water. To test the temperature, sprinkle a few drops on the inside of your wrist. To test the temperature, sprinkle a few drops on the inside of your wrist.  The formula should feel warm.

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8  BURPING THE BABY  Babies take in air during feedings. Air in the stomach and intestines causes cramping and discomfort. Air in the stomach and intestines causes cramping and discomfort.  This can lead to vomiting. Burping helps to get rid of the air. Burping helps to get rid of the air.  Most babies burp mid-way and after a feeding. You pat or rub the baby’s back with circular motions. You pat or rub the baby’s back with circular motions.  Do this for 2 or 3 minutes.

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9  Position the baby for burping in one of the following ways: Over your shoulder Over your shoulder  First, place a clean diaper or towel over your shoulder. Support the baby in a sitting position on your lap. Support the baby in a sitting position on your lap.  Hold the towel or diaper in front of the baby.  Remember to support the infant’s head and neck for the first 3 months after birth. Position the baby on your lap with his or her stomach down. Position the baby on your lap with his or her stomach down.  First, place a clean diaper or towel on your lap where the baby’s head will be.

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10  DIAPERING  In breast-fed babies, stools are yellow and seedy-looking. They are soft or runny. They are soft or runny.  In bottle-fed babies, stools are yellow to brown. Their stools are firmer. Their stools are firmer.  Over time, an elimination pattern develops.  Stools are usually soft and unformed. Hard, formed stools signal constipation. Hard, formed stools signal constipation. Watery stools mean diarrhea. Watery stools mean diarrhea.  Diarrhea is very serious in infants. Tell the nurse at once if you suspect constipation or diarrhea. Tell the nurse at once if you suspect constipation or diarrhea.

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  Diapers are changed when wet or when stools are present.  To care for cloth diapers: Rinse a soiled cloth diaper in the toilet. Rinse a soiled cloth diaper in the toilet. Store soiled diapers in a diaper pail. Store soiled diapers in a diaper pail. Wash them daily or every 2 days. Wash them daily or every 2 days. Do not wash them with other laundry items. Do not wash them with other laundry items. Wash them in hot water. Wash them in hot water.  Use a baby laundry detergent. Put them through the wash cycle a second time without detergent. Put them through the wash cycle a second time without detergent. Hang them outside to dry if possible. Hang them outside to dry if possible.  Otherwise, dry them in the dryer.

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  Disposable diapers are secured with Velcro or tape strips. Fold soiled diapers so the soiled area is on the inside. Fold soiled diapers so the soiled area is on the inside. Discard the diaper in the trash container. Discard the diaper in the trash container.  Do not flush it down the toilet.  Changing diapers often helps prevent diaper rash. When changing diapers, make sure the baby is clean and dry before applying a clean diaper. When changing diapers, make sure the baby is clean and dry before applying a clean diaper. If a diaper rash develops, tell the nurse at once. If a diaper rash develops, tell the nurse at once.

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  CARE OF THE UMBILICAL CORD  The umbilical cord connects the mother and the fetus (unborn baby).  Shortly after delivery, the doctor clamps and cuts the cord. A cord stump is left on the baby. A cord stump is left on the baby.  The stump dries up and falls off about 2 weeks after birth.  The cord provides a place for microbes to grow. You need to keep it clean and dry. You need to keep it clean and dry.  Cord care is done at each diaper change.

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  Cord care involves the following: Keep the stump clean and dry. Do not get the stump wet. Keep the stump clean and dry. Do not get the stump wet. Keep the diaper below the cord. Keep the diaper below the cord. Give sponge baths until the cord falls off. Give sponge baths until the cord falls off. Do not pull the cord off. Do not pull the cord off. Report the following to the nurse: Report the following to the nurse:  Swelling, redness, odor, or drainage from the stump  Bleeding from the cord or navel area  Fever

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15  CARE OF THE CIRCUMCISION  The surgical removal of foreskin from the penis is called a circumcision. The procedure is thought to: The procedure is thought to:  Prevent urinary tract infections in infants  Lower the risk of cancer of the penis  Decrease the risk of sexually transmitted diseases  Circumcision is a religious ceremony in the Jewish faith.  Circumcision should not interfere with voiding.

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16  Carefully observe for signs of bleeding and infection.  Check the diaper for bleeding.  Report any concerns to the nurse at once.  The area should heal in 7 to 10 days.  Circumcision care involves the following: Clean the penis at each diaper change. Clean the penis at each diaper change.  Use mild soap and water, plain water, or commercial wipes as the nurse directs. Apply a petrolatum gauze dressing. Apply a petrolatum gauze dressing.  Or use a cotton swab to apply petrolatum jelly to the penis. Apply the diaper loosely. Apply the diaper loosely.

17. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17  BATHING AN INFANT  A bath is important for: Hygiene Hygiene Good skin care Good skin care Comfort and to relax babies Comfort and to relax babies Time to hold, touch, and talk to the baby Time to hold, touch, and talk to the baby Stimulation Stimulation  Being touched and held helps babies learn safety, security, and love and belonging.

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18  Planning for the bath is important. You cannot leave the baby alone if you forget something. You cannot leave the baby alone if you forget something.  There are two bath procedures for babies. Sponge baths are given: Sponge baths are given:  Until the cord stump falls off  Until the umbilicus and circumcision heal The tub bath is given after the cord site and circumcision heal. The tub bath is given after the cord site and circumcision heal. A baby both tub is used. A baby both tub is used.

19. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19  NAIL CARE  The baby’s fingernails and toenails are kept short.  Nails are best cut when the baby is sleeping.  Use infant nail clippers and a soft emery board. For fingernails, clip following the natural shape of the nail. For fingernails, clip following the natural shape of the nail. For toenails, clip straight across as for an adult. For toenails, clip straight across as for an adult. Smooth rough or sharp edges with a soft emery board. Smooth rough or sharp edges with a soft emery board.

20. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20  WEIGHING INFANTS  The infant’s birth weight is the baseline for measuring growth.  The nurse uses weight measurements: In the assessment step of the nursing process In the assessment step of the nursing process To measure the amount of breast milk taken during breast-feeding To measure the amount of breast milk taken during breast-feeding  The baby is weighed before and after breast-feeding.

21. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 21  CARE OF THE MOTHER  Postpartum means after childbirth. The postpartum period starts with birth of the baby. It ends 6 weeks later. The postpartum period starts with birth of the baby. It ends 6 weeks later.  The mother adjusts physically and emotionally to childbirth.

22. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 22  A vaginal discharge occurs after childbirth. It is called lochia. It is called lochia.  Lochia consists of blood and other matter left in the uterus from childbirth. Lochia rubra is dark or bright red discharge. Lochia rubra is dark or bright red discharge.  Mainly blood, it is seen during the first 3 to 4 days. Lochia serosa is pinkish brown drainage. Lochia serosa is pinkish brown drainage.  It lasts until about 10 days after birth. Lochia alba is whitish drainage. Lochia alba is whitish drainage.  It continues for 2 to 6 weeks after birth. Normally, lochia smells like menstrual flow. Normally, lochia smells like menstrual flow.  Foul-smelling lochia signals an infection.

23. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 23  Good perineal care is important. Sanitary pads are changed often. Sanitary pads are changed often. When wiping after elimination, the mother wipes from front to back. When wiping after elimination, the mother wipes from front to back. Sanitary napkins are applied and removed from front to back. Sanitary napkins are applied and removed from front to back. Good hand washing is essential: Good hand washing is essential:  After perineal care  After changing sanitary napkins  After elimination Standard Precautions and the Bloodborne Pathogen Standard are followed. Standard Precautions and the Bloodborne Pathogen Standard are followed.

24. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 24  Some mothers have episiotomies. The doctor performs this procedure during childbirth to increase the size of the vaginal opening for the baby. The doctor performs this procedure during childbirth to increase the size of the vaginal opening for the baby. The doctor may order sitz baths for comfort and hygiene. The doctor may order sitz baths for comfort and hygiene. Complications can develop. Complications can develop.  These include infection and wound separation (dehiscence). Tell the nurse at once if the mother complains of: Tell the nurse at once if the mother complains of:  Pain  Discomfort  Discharge

25. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 25  Some mothers deliver by cesarean section (C-section). (C-section). The baby is delivered through an incision in the abdominal wall. The baby is delivered through an incision in the abdominal wall. A C-section is done when: A C-section is done when:  The baby must be delivered to save the baby’s or mother’s life.  The baby is too large to pass through the birth canal.  The mother has a vaginal infection that could be transmitted to the baby.  A normal vaginal delivery will be difficult for the baby or mother.

26. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 26  The mother has emotional reactions after childbirth. Causes include: Causes include:  Hormone changes  Lifestyle changes  Lack of sleep  Frequent visits and telephone calls  Advice and opinions about parenting The mother can help herself by: The mother can help herself by:  Resting when the baby sleeps  Taking time for herself and her partner  Complications can occur: During pregnancy, labor, and delivery During pregnancy, labor, and delivery In the postpartum period In the postpartum period