1. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Chapter 15 Caring for the Postpartal Woman and Her Family

2. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Fourth Trimester  Begins immediately after childbirth  Puerperium—first 6 weeks after birth  Close observation—identify hemorrhage and complications during first critical hour  Ongoing education and support

3. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Safety for Mother and Infant  Prevent infant abductions  Check ID bands  Educate mother about safety measures

4. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Early Maternal Assessment  Vital signs  Temperature—below 100.4 o F (38 o C)  Pulse—bradycardia  Blood pressure  Respirations

5. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Fundus  Immediate postpartum—halfway between the symphysis pubis and the umbilicus  1 hour postpartum—level of the umbilicus or one fingerbreadth above  Then, descends one fingerbreadth each day  Assess lochia

6. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Perineal Assessment  Sim’s position  REEDA  Hemorrhoids  Teach regarding comfort measures  If severe, teach how to manually reposition

7. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Assessment Guide

8. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley BUBBLE-HE  Breasts  Uterus  Bladder  Bowel  Lochia  Episiotomy

9. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Other Important Components  Maternal pain  Homans’ sign  Mother’s emotional status  Infant bonding

10. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Breast Assessment  Firmness, filling  Nodules  Fissures, cracks  Blood  Dried milk  Erect or inverted nipples

11. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Assessment of Uterus  Placental expulsion usually occurs within 15 minutes after birth  Uterine contractions control bleeding  Technique for uterine palpation  Involution  Subinvolution

12. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Fundal Assessment  Location immediately after birth  Descends 1 cm/day  Consistency  Location  Height  Measured in fingerbreadths

13. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Afterpains  Occur during process of involution  More pronounced in multipara  Nursing care  Explain cause  Prone position with abdominal pillow  Sitz baths  Encourage ambulation  Administer mild analgesics

14. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Bladder  Spontaneous void within 6 to 8 hours pp  Monitor first voiding  Anticipate maternal diuresis  Urinary output may reach 3000 mL/day  Urine volume, flow returns to pre-pregnant levels within 2 to 3 days pp

15. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Assessment Findings: Bladder  Incomplete emptying  Overdistention  Urinary retention  Nursing interventions  Support and enhance attempts to void

16. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Bowel  Hunger and thirst after childbirth  Relaxin—depresses bowel motility  Strategies to prevent constipation  Early ambulation  Abundant fluids  High-fiber diet

17. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Lochia  Characteristic indicative of status in process of involution  Lochia rubra  Lochia serosa  Lochia alba  Document amount

18. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Episiotomy  1 to 2 inch surgical incision  Assess REEDA  Ice for first 24 hours  Moist heat—Sitz bath  Dry heat—hot packs

19. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pain Assessment  Determine source  Document location, type, and duration  Administer Tylenol or Ibuprofen  Sitz bath  Educate regarding nonpharmacological measures

20. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Assess for DVT  Homans’ sign  Dorsiflex foot and ask about pain  Clinical assessment  Erythema, unequal calf circumference, heat  Clinical signs are NOT reliable

21. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Emotional Status  Wide range of emotions  May be sad during first 1 to 2 weeks pp  Ongoing assessment and education  Educate regarding “baby blues”

22. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal Physiological Adaptations  Continued Assessment of the Patient

23. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hematological System  Decrease in blood volume  Blood loss  Diuresis  White blood count increased x 5 to 6 days  Fibrinogen increased  Returns to normal by third to fourth week

24. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hormonal Levels  Estrogen and progesterone decrease  Anterior pituitary—prolactin  Placental lactogen, cortisol, growth hormone, and insulinase levels decrease  Insulin needs decrease—“Honeymoon phase”

25. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Neurological System  Altered sleep patterns—maternal fatigue  Numbness in legs, dizziness  Safety for infant and mother  Headaches  Assess quality and location, and carefully monitor vital signs  Implement environmental interventions

26. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Renal System, Fluid and Electrolytes  GFR, Creatinine, and BUN return to pre- pregnant levels within 2 to 3 months  Urinary glucose  Proteinuria  Rapid, sustained natriuresis and diuresis  Output may reach 3000 mL/day

27. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Respiratory System  Respiratory alkalosis and compensated metabolic acidosis may persist  Decrease in intra-abdominal pressure  Relief from dyspnea

28. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Integumentary System  Hormonal changes cause skin alterations  Most disappear  Striae gravidarum

29. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Cardiovascular System  Delivery of the baby, expulsion of the placenta, and loss of amniotic fluid can create cardiovascular instability  Cardiac output remains elevated  Physiological diuresis

30. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Immune System  Rh o (D) immune globulin (RhoGAM)  Rubella vaccination  Nonimmune status  Signed consent form  Avoid pregnancy for 1 month  Flu-type symptoms may occur

31. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Reproductive System  Involution of uterus  Healing of placental site  Vaginal changes  Labia majora and labia minora flaccid

32. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Menstruation and Ovulation  Nonlactating women  Menstruation returns in 6 to 8 weeks  First cycle may be anovulatory  Lactating women  Delayed ovulation and menstruation  Educate—ovulation can precede menstruation, need contraception

33. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Gastrointestinal System  Decreased gastric motility  Decreased muscle tone in abdominal wall  Constipation  Stool softeners

34. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Musculoskeletal System  Laxity of pelvic joints and ligaments  Relaxation of soft tissues  Muscle fatigue  Body aches  Rectus abdominis diastasis  Correct posture  Modified sit-ups

35. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Enhancing Cultural Sensitivity  Conduct cultural assessments  Expand knowledge and understanding  Culturally influenced beliefs  Common health care practices  Customs and rituals

36. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Promoting Recovery and Self-Care

37. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Activity and Rest  Early postpartum ambulation  Mild exercises  Kegel  Increase gradually  Encourage frequent rest periods  Obtain adequate sleep

38. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Nourishment  Weight loss  Appetite  Balanced diet  Multivitamin supplement  Iron if hemoglobin low

39. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Elimination  Void every 4 to 6 hours  Monitor intake and output x 24 hours  Increased risk of infection  Urinary retention  Constipation

40. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Perineal Care  Risk of infection  Teach perineal hygiene  Hand washing  Tampons contraindicated  Cesarean births  Nurse provides perineal care until ambulatory

41. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Ice Packs  Reduce edema and pain  Vasoconstriction and numbing  Apply for 20 minutes every 2 to 4 hours  First 24 hours

42. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Afterbirth Pain  Intermittent uterine contractions during involution  Breastfeeding (release of oxytocin)  Duration: 2 to 3 days  Mild analgesics

43. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Special Considerations  Women with HIV/AIDS  Gloves, safety glasses  Discourage breastfeeding  Patient teaching for infant safety

44. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartal Surgical Patient  Tubal ligation  Cesarean birth  Incisional wound  Recovery from anesthesia  Respiratory care

45. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Infant Feeding Choices  Breastfeeding  Bottle feeding  Educate  Support

46. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Physiology of Lactation  Breast structure  Lactogenesis  Milk ejection reflex—“let down” reflex

47. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Assisting the Breastfeeding Mother  Strategies for Success

48. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Breastfeeding  Initiating the feeding  Achieving proper latch-on  Assessing for milk let-down  Assuming a position of comfort  Assessing for infant weight gain

49. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Ineffective Breastfeeding  Incorrect latch-on (nipple trauma)  Breast engorgement  Complementary care  Ethnocultural considerations  Collecting and storing breast milk

50. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Expressing Breast Milk  Manual—hand  Electric pump  Types of breast pumps  Storage of breast milk  Weaning

51. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Formula Feeding  Safe Practices

52. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Family and Infant Bonding  Transition to parenthood  Assuming the mothering role  Rubin’s phases  Paternal bonding  Factors that interrupt bonding

53. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Adjustment of Other Family Members  Siblings  Tips for parents  Grandparents

54. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Emotional Events During the Puerperium  First 3 months most vulnerable period  Baby blues  Postpartum depression  Postpartum psychosis  Physiological response—tiredness, fatigue

55. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Discharge Planning and Teaching  Maternal Self-Care

56. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal Self-Assessment  Fundus and lochia  Hygiene  Abdominal incision  Body temperature  Elimination  Nutrition

57. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal Self-Assessment  Fatigue  Weight loss  Exercise  Pain management  Mood  Sexual activity and contraception

58. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Special Needs Populations  Adolescent mothers  Woman placing infant for adoption  Older mothers

59. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Community Resources  Support groups  Home visits  Telephone follow-up  Outpatient clinics

60. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Chapter 16 Caring for the Woman Experiencing Complications During the Postpartal Period

61. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Hemorrhage  Definition  Accurately estimating blood loss  Early vs. late  LARRY  4 “T’s”

62. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Hemorrhage  Uterine atony  Hallmark—soft uterus filled with clots and blood  Genital tract trauma  Uterus firm  Tissue  Thrombin

63. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Hemorrhage  Late postpartum hemorrhage  Retained placental fragments  Ergonovine medication, antibiotics, and possible D&C  Hypovolemic shock

64. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Collaborative Management  Frequent vital signs and fundal massage  Note patient’s behavior  Medical management depends on cause  Administer oxygen  Obtain laboratory tests  Accurate I/O

65. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hematoma  Definition  Signs and symptoms  Unremitting pain and pressure  Collaborative management  Careful assessment  Implement pain relief measures

66. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Puerperal Infections  Definition  Types of puerperal infections  Endometritis  Mastitis  Operative wound  Urinary tract  Careful assessment

67. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Collaborative Management  Antibiotics  Encourage rest, increased fluids, proper nutrition  Comfort measures  NSAIDs  Educate patient and family

68. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Thrombophlebitis and Thrombosis  Definition  Pathophysiology—hypercoagulable state, venous stasis and vein injury  Signs/symptoms—pain, tenderness; may be asymptomatic  Diagnostic tests

69. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Collaborative Management  Analgesics; elevate extremity; TED hose; increase fluids; apply moist, warm packs  Complete bedrest with bathroom privileges  Anticoagulation therapy  Measure leg circumference

70. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Complication: Pulmonary Embolism  Abrupt onset: chest pain, dyspnea, diaphoresis, syncope, anxiety  ABC response  Limit visitors  Educate woman and family regarding prevention of thrombus reoccurrence

71. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Psychosocial Complications  Postpartum blues  Self-limiting  Postpartum depression  One of two symptoms exist most/all day  Identify risk factors  Screen at postpartum visits

72. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Psychosis  Onset within first 8 weeks after childbirth  Distinguishing signs: hallucinations, agitation, confusion, suicidal/homicidal thoughts, delusions, sleep disturbances, loss of touch with reality  Requires hospitalization

73. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Psychosocial Postpartal Nursing Care  Teach to seek help if feeling overwhelmed  Encourage rest  Support bonding  Perform holistic assessment  Advocate for home follow-up

74. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postpartum Nursing for Vulnerable Populations  Victims of abuse  Undocumented immigrants  Limited Access to care/homelessness

75. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Chapter 17 Physiological Transition of the Newborn

76. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Adaptations of the Respiratory System  Intrapulmonary fluid  Reduces pulmonary resistance to blood flow  Facilitates initiation of air breathing  Surfactant  Decreases surface tension within alveoli

77. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley The First Breath  Internal stimuli  Chemical factors  External stimuli  Sensory factors  Thermal factors  Mechanical factors

78. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Cardiopulmonary Transitions  Increased pulmonary blood volume  Conversion from fetal to neonatal circulation  Immediate assessment necessary  Skin color  Respiratory rate; breathing pattern

79. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Cardiopulmonary Adaptation  Increased aortic pressure and decreased venous pressure  Increased systemic pressure and decreased pulmonary pressure  Closure of foramen ovale, ductus arteriosus, and ductus venosus

80. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Assessing the Cardiovascular Transition  Pulse  Within 30 minutes—120 to 160 bpm  Capillary refill  <3 seconds adequate  >4 seconds possible underlying problem

81. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Thermogenic Adaptation  Newborns are homeothermic  Neutral thermal environment  Cold stress  Large body area  Limited subcutaneous fat  Limited ability to shiver  Thin skin and blood vessels close to surface

82. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Adaptations to Increase Heat Production  Increased BMR and muscle activity  Peripheral vasoconstriction  Nonshivering thermogenesis  Brown adipose tissue

83. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Mechanisms for Neonatal Heat Loss  Evaporation  Insensible water loss  Conduction  Convection  Radiation

84. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hematopoietic Adaptation  Blood volume  Blood components  Erythrocytes and hemoglobin  Hematocrit  Leukocytes  Platelets

85. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hepatic adaptation  Glycogen and blood glucose maintenance  Iron storage  Conjugation of bilirubin  Coagulation of blood

86. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hyperbilirubinemia  Physiologic jaundice—appears 24 to 48 hours after birth; transient  Pathologic jaundice—present at birth or within 24 hours  Breastfeeding jaundice—2 to 4 days  Breast milk jaundice—7 days; peaks at 10 days

87. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Gastrointestinal Adaptation  Stomach and digestive enzymes  Intestinal peristalsis  Meconium

88. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Genitourinary Adaptation  Kidney function  Bladder capacity 6 to 44 mL  Fluid requirements—60 to 80 mL/kg  Urine output 1 to 3 mL/kg/hour  Nursing assessments  Careful monitoring of I/O  Assess appearance of urine

89. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Immunological Adaptation  Active acquired immunity  Passive acquired immunity  Immunoglobulins

90. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Psychosocial Adaptation  Early stages of activity  First period of reactivity  Period of inactivity and sleep  Second period of reactivity

91. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Behavioral States  Sleep  Deep, quiet; REM  Alert  Drowsy/semidozing  Wide awake  Active awake  Crying

92. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Chapter 18 Caring for the Normal Newborn

93. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley The Immediate Neonatal Assessment  Establish airway  Suction  Provide warmth  Dry the infant  Place on mother’s abdomen; heated blankets  Place beneath radiant heater  Cap

94. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley The Immediate Neonatal Assessment  Observe respiratory effort, color, muscle tone  Stimulate neonate to breathe deeply and cry  Assess heart rate, temperature  Note obvious abnormalities  Check and record number of umbilical cord vessels

95. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Apgar Score—1, 5 minutes  Assesses immediate adaptation  Five categories—each scored 0 to 2  Respiratory effort  Heart rate  Muscle tone  Reflex irritability  Skin color

96. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Immediate Nursing Care  Mother–infant identification  Infection/injury prevention  Eye prophylaxis  Vitamin K injection  Hepatitis B vaccine (parental consent required)  Assess blood glucose  Hematocrit and hemoglobin

97. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley The Later Neonatal Assessment  Body positioning  Skin color  Body size  Level of reactivity  Measurements and determination of gestational age  Ballard Gestational Age by Maturity Rating Tool

98. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Assessment of the Neonate: A Systems Approach

99. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Integumentary System  Inspect skin, scalp, nails, body hair  Color, texture, distribution, disruptions, eruptions, birthmarks  Well-lit room  Birth injuries

100. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Skin Assessment  Smooth and soft  Postterm infants—tough, leathery skin  Pustular melanosis  Milia  Erythema toxicum  Pigmentation—Mongolian spots, café-au-lait marks

101. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Birthmarks  Brown nevi—brown skin marks  Nevus flammeus—“port wine stain”  Telangiectatic nevus—“stork bite”  Nevus vasculosus—“strawberry mark”

102. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Assessment of the Infant’s Head  Symmetry  Eye shape, size, placement, and coordinated lid movement, red reflex, gross vision  Ears: shape, size, placement, hearing  Movement, color of the lips  Chin—appropriate size

103. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Head—Fontanels  Estimate size  Fullness without bulging—normal  Bulging and tense with large head circumference—increased intracranial pressure  Sunken—dehydration

104. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Head  Caput Succedaneum  Diffuse edema, crosses suture lines, disappears in few days  Cephalhematoma  Subperiosteal hemorrhage  Does not cross suture lines  Persists for weeks

105. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Assessment  Mouth  Epstein’s pearls  Teeth  Ability to suck  Hard and soft palate  Neck  Torticollis  Facial features

106. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Respiratory System Assessment  Symmetry in chest movement  Breast tissue  Nasal patency  Respiration rate, pattern, and use of accessory muscles  Auscultate lungs anterior and posterior

107. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Respiratory Assessment  Skin color  Capillary refill  Signs of distress  Retractions  Nasal flaring  Expiratory grunting

108. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Cardiovascular System Assessment  Inspection and auscultation  Point of maximum impulse  Heart rate  Capillary refill  Peripheral pulses  Auscultate all areas—murmurs

109. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Gastrointestinal System Assessment  Abdominal inspection, including umbilical cord  Auscultate bowel sounds, upper abdomen for gastric bubble, and heart sounds of the abdominal aorta  Palpation

110. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Conditions That Warrant Further Assessment  Abdominal distention  Absence of bowel sounds  Discharge from umbilical cord/site  Abdominal mass

111. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Genitourinary System Assessment  Hips abducted  Palpate and inspect scrotum, testes, and penis  Male—retract foreskin  Palpate and inspect female genitalia  Anus and anal wink reflex

112. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Common Findings—Male Infants  Scrotal swelling  Smegma  Hypospadius  Epispadius

113. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Common Findings— Female Infants  Hymenal tags  Vernix caseosa on labia  Pseudomenstruation

114. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Conditions That Warrant Further Assessment  Undescended testicles  Micropenis  Ambiguous genitalia  Imperforate hymen  Imperforate anus

115. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Musculoskeletal System Assessment  Observe infant’s movements in crib  Inspect for differences in extremity length and size  Assess muscle tone and symmetry  Gentle passive ROM to assess joint rotation  Assess head lag  Skin folds on thighs

116. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Common Findings  Torticollis  Developmental dysplasia of the hip  Asymmetry of hip folds  Barlow maneuver  Ortolani maneuver  Crepitus  Unusual positions of foot

117. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Conditions That May Warrant Further Assessment  Fractured clavicle  Polydactyly  Syndactyly  Simian crease

118. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Neurological System Assessment  Reflexes  Major—gag, Babinski, Moro, Galant  Minor—palmar grasp, plantar grasp, rooting and sucking, head righting, stepping, tonic neck

119. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Conditions That Warrant Further Assessment  Shoulder dystocia  Erb’s palsy  Cerebral palsy  Spina bifida

120. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Teaching About Newborn Care  Temperature assessment  Bathing  Nail Care and umbilical cord care  Clothing  Diapering  Attachment

121. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Newborn Care  Circumcision  Ensuring optimal nutrition  Discharge planning for the infant and family  Child care  Newborn metabolic screening tests