Week 3 Pre Work.doc - Week 3 Pre WORK 5 Due 2359 on Sunday Week 3 Upload your copy under Journal Week 3 for Week 3 Pre work Complete ATI N306F3 Practice

Week 3 Pre Work.doc - Week 3 Pre WORK 5 Due 2359 on Sunday...

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Unformatted text preview: Week 3 Pre WORK 5 Due @ 2359 on Sunday, Week 3 Upload your copy under Journal Week 3 for Week 3 Pre work Complete ATI N306F3 Practice Assessment and attach the report with a minimum score of 76%, with your prework Chapter 12 DURHAM: Postpartum Physiological Assessments & Nursing Care Define the following: Uterine involution o The process where the uterus returns to a non-pregnant state After pains o After birth pains, caused by the contraction of the uterus as it returns to pregnancy size. Lochia rubra o Day 1-3 postpartum, Bloody with small clots, moderate to scant amount, fleshy odor. Lochia serosa o Day 4-10 postpartum, pink or brown color, scant amount, increased flow with activity fleshy odor Lochia alba o Day 10 postpartum, yellow to white in color, scant amount and fleshy odor Primary engorgement o Increase in the vascular and lymphatic system of the breast, precedes milk production, subsides after 1-2 days if not breastfeeding Subsequent breast engorgement o Women who breast feeds, related to the distention of the milk glands, relieved by expressing the milk manually or the baby drinking it Colostrum o Clear, yelloishj fluid that precedes milk production, higher in protein and lower in carbs than breast milk. Contains immunoglobulins G and A that protect the newborn during the early weeks of life. Diastasis recti abdominis o Separation of the abdominal muscles, makes the flabby appearance, returns to normal with time Maternal fatigue o Occurs with the first 3 months after birth, exhaustion related to caring for the newborn Methods of contraception o Natural Abstinence o Barrier method Condoms o Diaphragms Fits over the cervix, prescription o Orals Combination of estrogen and progesterone oral contaception o Hormone implants IUC, intrauterine contraceptives tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t2y Revision Date: 1-8-16 Page 2 06-06-19 Week 3 Pre WORK o Sterilization Vasectomy and tubal ligation OB panel o RPR Rapid Plasma Reagin, used to test for Syphilis, Chlamydia, 1 st trimester o HepBSag Hep b surface antigen, checks for hep B HBsAg positive women, the neonate is given HBIG and hep B vaccines series o Rubella Given to rubella non-immune mothers, should be given prior to discharge o Blood type and Rh Blood type can be assessed at birth, Rhogam is given to Rh negative mothers who are giving RH positive babies, given within 72 hours o GBS Group B streptococcus, routine screening 35-37 weeks gestation. If positive antibiotics are given to reduce vertical transmission to the fetus Methods of Contraception o Abstinence 100% chance success rate o Spermicidal gels OTC, possible allergic reaction and irritation o Long acting reversible sterilization IUC, copper material, hormone implants o Sterilization Vasectomy Males Tubal Ligation Females Outline format Define and explain nursing action for: Boggy uterus o Uterus is not contracting, nurse is to massage the fundus, give oxytocin o Measure the fundus, determine the position of the uterus. Endometrium/lochia o Postpartum bleeding 3 stages Rubra, serosa and Alba o Inspect the peripad and change frequently Assess for amount and clots, foul odor can indicate possible infection. BubbleHe REEDA o Redness, edema, ecchymosis discharge and approximation Related to an episiotomy Provide comfort measures, ice bath, lie on her side administer pain meds Mastitis o Complication of the breast infection Caused by unresolved plugged milk ducts Typically occurs 3-4 weeks after birth Treatment: ATB tx, hydration tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t2y Revision Date: 1-8-16 Page 2 06-06-19 Week 3 Pre WORK Apply heat before breastfeeding Breast engorgement o Painful complication of the breast Teaching: Apply ice, pain meds DO NOT EXPRESS the milk or apply HEAT, it will cause more milk production Nursing care for the o Breastfeeding woman Provide teaching How to hold the baby How to make the baby latch on Apply heat packs o Non breastfeeding woman Monitor for pain r/t engorgement Monitor for mastitis Apply cold packs Orthostatic hypotension o Increased risk r/t PPH, blood loss o Increased risk for falls o A sudden drop in BP from laying, sitting to standing position Venous thrombosis o Increased risk d/t the hypercoagubility of pregnancy o Clot formation in the venous system that travels and possibly occludes causing ischemia to that affected organ o Pain, commonly seen on the lower extremities o Prevention would be promoting ambulation to prevent venous stasis o Diagnostic test: Venous doppler/ultrasound, chest x ray (PE) Tx: anticoagulation therapy o Manage pain Rubella immunization o Give rubella vaccine to rubella non-immune mother directly after giving birth o Requires consent form to be signed Rh isoimmunization o Given to mother that is RH negative but has a RH positive baby Cystitis o Bladder inflammation/infection o Promote frequent urination to prevent infection o Assess for urinary disturbances o Assess for s/s of UTI’s o Peppermint oil is good to help voiding Postpartum complications o Complications that occur after delivery of the baby o Variety of events can occur UTI’s RH incompatibility Infections Mastitis Breast engorgement Episiotomy site tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t2y Revision Date: 1-8-16 Page 2 06-06-19 Week 3 Pre WORK Chapter 13 DURHAM: Transition to Parenthood Outline format Define and explain nursing action for the following: Transition to parenthood o Factors ■ Previous life experiences: Previous experiences with caring for infants and children can foster a smoother transition to parenthood. ■ Length and strength of the relationship between partners: A strong relationship between the couple can foster a smoother transition to parenthood. ■ Financial considerations: Financial concerns can hamper the transition to parenting. ■ Educational levels: Decreased ability to read and comprehend information regarding child care may hamper the couple’s ability to gain knowledge in the care of the infant. ■ Support systems: A lack of positive support in the care of the woman and infant may hamper the transition to parenting Rubin’s theory o Maternal phases (3) Taking in Taking hold Letting go Mercer’s theory – 4 stages ■ Commitment, attachment, and preparation for an infant during pregnancy ■ Acquaintance with and increasing attachment to the infant, learning how to care for the infant, and physical restoration during the early weeks after birth ■ Moving toward a new normal during the first 4 months ■ Achievement of a maternal identity around 4 months Maternal Phases o Taking In (dependent behaviors) The woman focuses on the personal comfort and physical changes Relives the birthing experience Adjustment to the changes Accepting of dependency of others Concentrates on physical healing o Taking hold (dependent to independent) Focus moves from self to infant Becomes more independent Increase in ability to make decisions Interested in the newborns cues and needs Transitions to maternal role May need verbal reassurance that she is meeting the newborns needs o Letting go (Independence to mother hood role) Incorporating the newborn into her life Accepting the newborn as she is May go back to work or school tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t2y Revision Date: 1-8-16 Page 2 06-06-19 Week 3 Pre WORK Increase anxiety or guilt Reconnection with partner Fatherhood o Transition to fatherhood Men typically do not fantasize about father hood Many factors influence their transition Evolves over time with contact with the infant o Paternal phases Adolescent parents o Adolescent parents are taking on the responsibilities of parenting at the same time they are working through the developmental tasks of being a teen. o Teen mothers o Teen fathers o Nursing actions o Establish trust first o Find ways to make educ fun, easy to understand o Social support varies, higher In some cultures o Bonding o Bonding Unidirectional—parent → baby Bonding behaviors Begins during pregnancy o Attachment Bidirectional—parent ↔ baby Attachment behaviors-emotional connection that forms between infant and parents o Risk factors for delayed bonding and/or attachment NICU Culture Support circle o Nursing actions Identify maladaptive behaviors and intervene Ie: planned or unplanned o Maternal Touch- 3 stages o Three stages Initial: touches tentatively with fingertips Second stage: becomes more comfortable and uses hand to stroke head and/or body Final stage: holds infant in arms and brings close Engrossment o Engrossment-development of intense interest in newborn o Nursing actions Promote bonding Co parenting o Raising together Multiparas o Concerns of multiparas when taking on a new child o Less help w/each child o Love each on the same? Sibling rivalry tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t2y Revision Date: 1-8-16 Page 2 06-06-19 Week 3 Pre WORK o “no longer the baby” Postpartum Blues o Prevalence: 80% o Possible causes: possibly hormonal o Signs and symptoms: common days 3-5 Crying, mood, anger, anxiety, confusion UNABLE TO TAKE CARE OF NB o Nursing actions Ask for help Get rest >4 weeks, seek help for PPD o Postpartum Depression Chapter 16 DURHAM: Discharge Planning & Teaching Outline format Define and list nursing action 5 Rights of teaching Composition of human milk 6% protein, 42% carbs 52% cholesterol-essential for brain development (not in formula) Stages of human milk Stage 1: Colostrum-yellow, high in Protein, IgG Stage 2: Transitional milk Stage 3: Mature milk Foremilk-when starting feed(b4)..high in water Hind milk-during feed, high in cholestrol Milk production o Lactation The production of breastmilk o Prolactin Primary hormone responsible for lactation Produced during pregnancy but high levels of estrogens and progesterone suppress location o Let down reflex Milk ejection reflex Caused by a oxytocin, can occur during the reflex of hearing the baby suckle, or sexual arousal Breastfeeding positions o Football hold o Cradle hold Latching on and scoring o The babies ability to latch onto the nipple Scoring: L: Latch A: audible swallowing T: type of nipple C: Comfort H: Hold (positioning) tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t2y Revision Date: 1-8-16 Page 2 06-06-19 Week 3 Pre WORK Signs of successful breastfeeding o The babies hunger is satisfied after feeding o The baby latches on properly Bottle feeding o Advantages Provides a pleasurable experience for both mother and father Allows the mother to leave the infant with other people Decreases the number of feedings o Disadvantages Increased time to prepare the formula Increased cost compare to breastfeeding Abusive head trauma aka shaken baby syndrome o Shaking the baby violently, causes head trauma Circumcision o Gomco or Mogen clamp o Apply a protective lubricant over the circumcision site after each diaper change for the first week. The protective lubricant helps keep the area clean and keeps the wound from adhering to the diaper. The circumcised area heals within 2 weeks. Plastibell Applying lubricants on the penis when a Plastibell has been used is not recommended because lubricants can increase the risk of displacement of the plastic ring The plastic ring falls off in 7–10 days. Parents should not pull it off. Cord care o Cord begins to dry once it is clamped and cut o Falls off on its own after 2 weeks o Inform PCP if foul odor or bleeding is noted Potential signs of illness ■ Rectal temperature >100.4°F (38.0°C) or <96.8°F (36.0°C) ■ Loss of appetite ■ Lethargy (infant is sleepy and not as active as usual) ■ Watery green stools ■ Vomiting ■ Decrease in the number of wet diapers ■ Skin rash ■ Fontanels are sunken or bulging ■ Bleeding from circumcision site and/or cord site ■ Foul odor from the circumcision site and/or cord site Safety o Car seats Backseat Used until they are 1 year old or 20 pounds o Prevention of falls Instruct parents not to leave their newborn/infant on an elevated flat surface without supervision. Instruct parents not to leave their newborn/infant in an infant car seat on an elevated surface unattended. Install gates at stairwells. Select a highchair with a wide base to prevent tipping over. SIDS o Sudden infant death syndrome Reducing the Risk of SIDS To reduce the risk of SIDS, the American Academy of Pediatrics tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t2y Revision Date: 1-8-16 Page 2 06-06-19 Week 3 Pre WORK recommends: ■ Placing newborns and infants on their backs when sleeping (Fig. 16-9) ■ Placing newborns or infants on a firm mattress for sleeping ■ Keeping pillows or stuffed animals out of the sleeping area ■ Breastfeeding ■ Maintaining a smoke-free environment ■ Preventing overheating of the infant by controlling room temperature and using lightweight clothing (AAP, 2005b) Temperature taking o Take the temp before calling the provider o Digital thermometers are safer than mercury ones Rectal temperatures for children 3 years of age and younger ■ Oral temperatures for children 4 years of age and older ■ Axillary temperature (although not as accurate) can also be used for children older than 3 months. Discharge teaching o Key points Teaching parents about infant feeding ■ Teaching about use of any equipment, such as apnea monitors that may be needed to care for their infant at home ■ Teaching parents how to perform treatments such as dressing changes, suctioning, and oxygen administration ■ Teaching parents about medication administration ■ Teaching parents about safety issues such as car seat use, and positioning the infant on his or her back during sleep ■ Encouraging parents to learn infant CPR ■ Teaching parents about basic newborn care ■ Educating parents on what to expect after discharge, such as sleep patterns, feeding, infant behavior, and developmental milestones ■ Discussing follow-up care such as physician’s visits, immunization schedules, and appointments for developmental care Medications Oxytocin Pharmacological method for induction of labor with oxytocin Ibuprofen o NSAID used for mild to moderate pain Depo-Provera o Hormonal contraceptive, given every 3 months, can be used when lactacting Rubella Vaccine o Vaccine for rubella, given after delivery if mother is non-immune Hemabate o PPH med given if mother is not reactive to oxytocin or merthergine theraoy RhoGam o Given to RH negative mothers who are giving birth to RH negative babies tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t2y Revision Date: 1-8-16 Page 2 06-06-19 ...
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