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Orientation (August 23)

Dr. Booth

205-454-6040Orientation (August 23) Dr. Booth Carruth (Northport) 205-242-9768 First day meeting at 6:20am Park outside Women’s

Carruth (Northport)

205-242-9768(August 23) Dr. Booth 205-454-6040 Carruth (Northport) First day meeting at 6:20am Park outside Women’s pavilion

First day meeting at 6:20am23) Dr. Booth 205-454-6040 Carruth (Northport) 205-242-9768 Park outside Women’s pavilion or ED Do not park

Park outside Women’s pavilion or EDCarruth (Northport) 205-242-9768 First day meeting at 6:20am Do not park outside Fitness One Tuesday and

Do not park outside Fitness Oneday meeting at 6:20am Park outside Women’s pavilion or ED Tuesday and Wednesday Dr. Woods 205-454-6419

Tuesday and WednesdayWomen’s pavilion or ED Do not park outside Fitness One Dr. Woods 205-454-6419 Johnson (St. Vincent’s)

Dr. Woods

205-454-6419not park outside Fitness One Tuesday and Wednesday Dr. Woods Johnson (St. Vincent’s) 817-614-5666 Tuesday 3-11pm

Johnson (St. Vincent’s)

817-614-5666Wednesday Dr. Woods 205-454-6419 Johnson (St. Vincent’s) Tuesday 3-11pm Friday 7-3pm Turner Tuscaloosa DCH, meet at

Tuesday 3-11pmWoods 205-454-6419 Johnson (St. Vincent’s) 817-614-5666 Friday 7-3pm Turner Tuscaloosa DCH, meet at 6:45am, Tuesday

Friday 7-3pmJohnson (St. Vincent’s) 817-614-5666 Tuesday 3-11pm Turner Tuscaloosa DCH, meet at 6:45am, Tuesday and Wednesday

Turner

Tuscaloosa DCH, meet at 6:45am, Tuesday and WednesdayVincent’s) 817-614-5666 Tuesday 3-11pm Friday 7-3pm Turner 205-292-4891 Sherpath Course ID 158049_ltubbs8_1002 Clinical

205-292-4891Turner Tuscaloosa DCH, meet at 6:45am, Tuesday and Wednesday Sherpath Course ID 158049_ltubbs8_1002 Clinical Four

Sherpath Course ID

158049_ltubbs8_1002Tuesday and Wednesday 205-292-4891 Sherpath Course ID Clinical Four hospital days One outside clinical experience

Clinical

Four hospital days205-292-4891 Sherpath Course ID 158049_ltubbs8_1002 Clinical One outside clinical experience Fill out (HIPAA) form for

One outside clinical experienceCourse ID 158049_ltubbs8_1002 Clinical Four hospital days Fill out (HIPAA) form for community site Chapter 17

Fill out (HIPAA) form for community siteClinical Four hospital days One outside clinical experience Chapter 17 and 18: Postpartum Physiologic and Psychosocial

Chapter 17 and 18: Postpartum Physiologic and Psychosocial Adaptations

Postpartum: the first six weeks after childbirth

Postpartum: the first six weeks after childbirth Every body system of the woman goes through changes,

Every body system of the woman goes through changes, not just the reproductive system

Reproductive System

not just the reproductive system Reproductive System Involution of the uterus ( involution: the uterus returning

Involution of the uterus (involution: the uterus returning back to pre-pregnancy size, shape, and location) Three processes Contraction of the muscle fibers Also referred to as “afterbirth pains”

muscle fibers Also referred to as “afterbirth pains” Helps decrease hemorrhaging immediately following childbirth
muscle fibers Also referred to as “afterbirth pains” Helps decrease hemorrhaging immediately following childbirth
muscle fibers Also referred to as “afterbirth pains” Helps decrease hemorrhaging immediately following childbirth

Helps decrease hemorrhaging immediately following childbirth Nurses can help this process with uterine massage Palpating for a hard, firm uterus that is able to clamp down and prevent hemorrhage

uterus that is able to clamp down and prevent hemorrhage Education is important because the massage
Education is important because the massage can also be

Education is important because the massage can also be

Education is important because the massage can also be
Education is important because the massage can also be

painful Breast feeding will also help

Oxytocin or Pitocin IV medication will aid in firming of the uterus, as well

IV medication will aid in firming of the uterus, as well Catabolism: converting cells into simpler,

Catabolism: converting cells into simpler, more basic compounds Regeneration of uterine epitheliumIV medication will aid in firming of the uterus, as well The site of placental attachment

more basic compounds Regeneration of uterine epithelium The site of placental attachment heals by a process

The site of placental attachment heals by a process of exfoliation Leaves the endometrium smooth and without scars

exfoliation Leaves the endometrium smooth and without scars Descent of the Uterine Fundus Fundus: the term

Descent of the Uterine Fundus

Fundus: the term for the top of the uterus

Fundus: the term for the top of the uterus

Involution can be evaluate by measuring the descent of the fundus

Involution can be evaluate by measuring the descent of the fundus

Involution can be evaluate by measuring the descent of the fundus
Involution can be evaluate by measuring the descent of the fundus
Involution can be evaluate by measuring the descent of the fundus
Involution can be evaluate by measuring the descent of the fundus
Involution can be evaluate by measuring the descent of the fundus
Involution can be evaluate by measuring the descent of the fundus
Involution can be evaluate by measuring the descent of the fundus
Involution can be evaluate by measuring the descent of the fundus
Involution can be evaluate by measuring the descent of the fundus

About 1 cm per day

About one finger-breadth down

Note: “U-2” means two finger-breadths below umbilicus

Note: “U+2” means two finger-breadths above umbilicus

It may be above due to a blood clot or a full bladder

14 days after childbirth, the fundus should no longer be palpable

The day of delivery, the uterus will be approximately at the umbilicus and

needs to go back down to sitting in the pelvis During uterine massage, be sure to support lower abdominal muscles to

avoid prolapsing the uterus out of the vagina Afterpains, or intermittent uterine contractions, cause discomfort for many women

A “mushy”, not-firm uterus should be massaged extra until it becomes firm, in
A
“mushy”, not-firm uterus should be massaged extra until it becomes firm, in

order to decrease bleeding

Lochia

Lochia: bleeding after delivery Vaginal discharge Lochia rubra: bright red discharge immediately after delivery
Lochia: bleeding after delivery
Vaginal discharge
Lochia rubra: bright red discharge immediately after delivery
Lochia serosa: serosanguineous pink/brown tinge
Lochia alba: lighter white/yellowish color
Assessment
Color
Amount, type, and odor
Foul odor suggests endometrial infection
Ask about size of any clots being passed, continue to massage uterus, etc.
is normal to bleed on and o ff for several weeks after delivery, but women
should notify physicians if bleeding returns to bright red
It
Bleeding on a peri-pad:
Women should use these external pads, and not tampons, especially if they have stitches on
Women should use these external pads, and not tampons, especially if they have stitches on
Women should use these external pads, and not tampons, especially if they have stitches on

Women should use these external pads, and not tampons, especially if they have stitches on their perineum

Moderate: women may describe this as “having a normal period”

Heavy: saturating a pad in an hour

Vagina and Perineum

VaginaHeavy: saturating a pad in an hour Vagina and Perineum It takes 6-10 weeks for the

It takes 6-10 weeks for the vagina to regain its non pregnant size and contoursaturating a pad in an hour Vagina and Perineum Vagina Perineum After childbirth, it may be

Perineumfor the vagina to regain its non pregnant size and contour After childbirth, it may be

After childbirth, it may be edematous and bruisedvagina to regain its non pregnant size and contour Perineum Episiotomy or trauma Episiotomy is when

Episiotomy or traumaPerineum After childbirth, it may be edematous and bruised Episiotomy is when the physician will cut

Episiotomy is when the physician will cut open the perineum to give the baby more room, and then stitch it up after delivery Any perineal stitches will be dissolvable and disappear on their own in about 6 weeks or soit may be edematous and bruised Episiotomy or trauma Healing takes up to 4-6 months Use

and disappear on their own in about 6 weeks or so Healing takes up to 4-6

Healing takes up to 4-6 monthsand disappear on their own in about 6 weeks or so Use the acronym REEDA Redness,

Use the acronym REEDA Redness, edema, ecchymosis, discharge, approximation of edges (for episiotomy or laceration)own in about 6 weeks or so Healing takes up to 4-6 months Lacerations of the

approximation of edges (for episiotomy or laceration) Lacerations of the Birth Canal Perineum Perineal lacerations

Lacerations of the Birth Canal

Perineumepisiotomy or laceration) Lacerations of the Birth Canal Perineal lacerations are classified in degrees to describe

Perineal lacerations are classified in degrees to describe the amount of tissue involved First-degree: involves superficial vaginal mucosa or perineal skin Second-degree: involves vaginal mucosa, perineal skin, and deeper tissues, which may include fascia and muscles of perineum Third-degree: same as second-degree lacerations but involves the anal sphincter Fourth-degree: extends through the anal sphincter into the rectal mucosaor laceration) Lacerations of the Birth Canal Perineum Episiotomy is physician-made, while a laceration is a

Episiotomy is physician-made, while a laceration is a naturally-occurring tearbut involves the anal sphincter Fourth-degree: extends through the anal sphincter into the rectal mucosa Periurethral

into the rectal mucosa Episiotomy is physician-made, while a laceration is a naturally-occurring tear Periurethral area
into the rectal mucosa Episiotomy is physician-made, while a laceration is a naturally-occurring tear Periurethral area
into the rectal mucosa Episiotomy is physician-made, while a laceration is a naturally-occurring tear Periurethral area
into the rectal mucosa Episiotomy is physician-made, while a laceration is a naturally-occurring tear Periurethral area

Periurethral areathe anal sphincter into the rectal mucosa Episiotomy is physician-made, while a laceration is a naturally-occurring

A laceration in the area of the urethra may cause women di ffi culty urinating

A

laceration in the area of the urethra may cause women di culty urinating after

 

birth

An indwelling catheter may be necessary for a day or two

An indwelling catheter may be necessary for a day or two

Vaginal wallAn indwelling catheter may be necessary for a day or two Cervix A laceration involving the

catheter may be necessary for a day or two Vaginal wall Cervix A laceration involving the

Cervixcatheter may be necessary for a day or two Vaginal wall A laceration involving the mucosa

A laceration involving the mucosa of the vaginal wall

Cervix A laceration involving the mucosa of the vaginal wall Tears in the cervix may be

Tears in the cervix may be a source of significant bleeding after birth

Uterine massage with a firm uterus but still extensive bleeding, may indicate a cervical tearcervix may be a source of significant bleeding after birth Providing Comfort Measures (for swelling, edema,

Providing Comfort Measures (for swelling, edema, and bruising)

Ice packsComfort Measures (for swelling, edema, and bruising) Sitz baths Perineal care Topical medications Sitting

Sitz bathsMeasures (for swelling, edema, and bruising) Ice packs Perineal care Topical medications Sitting measures

Perineal care(for swelling, edema, and bruising) Ice packs Sitz baths Topical medications Sitting measures Analgesics

Topical medicationsedema, and bruising) Ice packs Sitz baths Perineal care Sitting measures Analgesics Cardiovascular System Cardiac

Sitting measuresIce packs Sitz baths Perineal care Topical medications Analgesics Cardiovascular System Cardiac output Transient

Analgesicsbaths Perineal care Topical medications Sitting measures Cardiovascular System Cardiac output Transient increase in

Cardiovascular System

Cardiac output Transient increase in maternal cardiac output after childbirth Excess plasma volume is eliminated by diuresis and diaphoresis Gradually cardiac output decreases and returns to normal in 6-12 weeksSitting measures Analgesics Cardiovascular System Coagulation Increased clotting factors predispose the

Coagulation Increased clotting factors predispose the postpartum woman to clot formation Check clotting factors prior to childbirth to be aware of any conditions H/H following childbirth to make sure they haven’t lost too much blood Average blood loss is 200-500 mL from vaginal delivery and 500-1000 mL from a cesarian deliverycardiac output decreases and returns to normal in 6-12 weeks Replenish with IV fluids and the

vaginal delivery and 500-1000 mL from a cesarian delivery Replenish with IV fluids and the women
vaginal delivery and 500-1000 mL from a cesarian delivery Replenish with IV fluids and the women
vaginal delivery and 500-1000 mL from a cesarian delivery Replenish with IV fluids and the women
vaginal delivery and 500-1000 mL from a cesarian delivery Replenish with IV fluids and the women
vaginal delivery and 500-1000 mL from a cesarian delivery Replenish with IV fluids and the women
vaginal delivery and 500-1000 mL from a cesarian delivery Replenish with IV fluids and the women
vaginal delivery and 500-1000 mL from a cesarian delivery Replenish with IV fluids and the women

Replenish with IV fluids and the women are able to typically quickly replenish themselves, toovaginal delivery and 500-1000 mL from a cesarian delivery Gastrointestinal System Soon after childbirth, the woman

Gastrointestinal System

Soon after childbirth, the woman has increased hunger due to energy expenditurequickly replenish themselves, too Gastrointestinal System Constipation may occur due to Decreased food and fluid

Constipation may occur due to Decreased food and fluid intake during labor Reduced muscle and bowel tone Fear of pain during defecationthe woman has increased hunger due to energy expenditure Patients placed on stool softeners to prevent

Patients placed on stool softeners to prevent pain with first bowel movement, in addition to increasing fluids, fiber, and ambulationReduced muscle and bowel tone Fear of pain during defecation Important to assess bowel sounds and

Important to assess bowel sounds and passing gasbowel movement, in addition to increasing fluids, fiber, and ambulation First stool is typically 2-3 days

First stool is typically 2-3 days post birthbowel movement, in addition to increasing fluids, fiber, and ambulation Important to assess bowel sounds and

fiber, and ambulation Important to assess bowel sounds and passing gas First stool is typically 2-3
fiber, and ambulation Important to assess bowel sounds and passing gas First stool is typically 2-3
fiber, and ambulation Important to assess bowel sounds and passing gas First stool is typically 2-3

Urinary System

Increased bladder capacity and decreased sense of fluid pressure may result in urinary retentionUrinary System Stasis of urine allows time for bacteria to grow and can lead to urinary

Stasis of urine allows time for bacteria to grow and can lead to urinary tract infectionsense of fluid pressure may result in urinary retention Reminded patients (with epidurals) to go to

Reminded patients (with epidurals) to go to the bathroom if they have decreased sensation of full bladderfor bacteria to grow and can lead to urinary tract infection The distended bladder can displace

The distended bladder can displace the uterus and interfere with uterine contraction, causing excessive bleeding as a resultbathroom if they have decreased sensation of full bladder Signs of a distended bladder Location of

Signs of a distended bladder Location of fundus above baseline leveluterine contraction, causing excessive bleeding as a result Fundus displaced from midline Excessive lochia Bladder

a distended bladder Location of fundus above baseline level Fundus displaced from midline Excessive lochia Bladder
Fundus displaced from midline Excessive lochia Bladder discomfort Bulge of bladder above symphysis Frequent voiding
Fundus displaced from midline Excessive lochia Bladder discomfort Bulge of bladder above symphysis Frequent voiding
Fundus displaced from midline Excessive lochia Bladder discomfort Bulge of bladder above symphysis Frequent voiding
Fundus displaced from midline Excessive lochia Bladder discomfort Bulge of bladder above symphysis Frequent voiding
Fundus displaced from midline Excessive lochia Bladder discomfort Bulge of bladder above symphysis Frequent voiding

Fundus displaced from midline Excessive lochia Bladder discomfort Bulge of bladder above symphysis Frequent voiding of less than 150 mL of urine, may indicate urinary retention with overflow

of bladder above symphysis Frequent voiding of less than 150 mL of urine, may indicate urinary
of bladder above symphysis Frequent voiding of less than 150 mL of urine, may indicate urinary
of bladder above symphysis Frequent voiding of less than 150 mL of urine, may indicate urinary
of bladder above symphysis Frequent voiding of less than 150 mL of urine, may indicate urinary

Woman may void 500-1000 mL at a time because the bladder fills rapidly due to diuresis from hormonal changesmL of urine, may indicate urinary retention with overflow Musculoskeletal System Muscles and joints First 1-2

Musculoskeletal System

Muscles and joints First 1-2 days after childbirth, muscle fatigue and aches Especially from stirrup positioning, grasping handrails, contracting body for pushingdue to diuresis from hormonal changes Musculoskeletal System Abdominal wall Diastasis recti Reduction in musculoskeletal

Abdominal wall Diastasis rectigrasping handrails, contracting body for pushing Reduction in musculoskeletal discomfort Exercises to

contracting body for pushing Abdominal wall Diastasis recti Reduction in musculoskeletal discomfort Exercises to
contracting body for pushing Abdominal wall Diastasis recti Reduction in musculoskeletal discomfort Exercises to
contracting body for pushing Abdominal wall Diastasis recti Reduction in musculoskeletal discomfort Exercises to
contracting body for pushing Abdominal wall Diastasis recti Reduction in musculoskeletal discomfort Exercises to

Reduction in musculoskeletal discomfort Exercises to strengthen the abdominal muscles Good posture Body mechanicsstirrup positioning, grasping handrails, contracting body for pushing Abdominal wall Diastasis recti Integumentary System

musculoskeletal discomfort Exercises to strengthen the abdominal muscles Good posture Body mechanics Integumentary System
musculoskeletal discomfort Exercises to strengthen the abdominal muscles Good posture Body mechanics Integumentary System
musculoskeletal discomfort Exercises to strengthen the abdominal muscles Good posture Body mechanics Integumentary System

Integumentary System

Skin gradually returns to non-pregnant state Decrease in hormone levels“Mask” pregnancy with dark marks on face will fade after childbirth Stretch marks (striae gravidarum)

returns to non-pregnant state Decrease in hormone levels “Mask” pregnancy with dark marks on face will

“Mask” pregnancy with dark marks on face will fade after childbirthreturns to non-pregnant state Decrease in hormone levels Stretch marks (striae gravidarum) fade Do not disappear,

Stretch marks (striae gravidarum) fade Do not disappear, thoughpregnancy with dark marks on face will fade after childbirth Loss of hair Normal response to

Loss of hair Normal response to hormone changes Begins 4-20 weeks after delivery Regrown in 6-15 monthsmarks (striae gravidarum) fade Do not disappear, though Neurologic System Discomfort and fatigue Complaints of

Begins 4-20 weeks after delivery Regrown in 6-15 months Neurologic System Discomfort and fatigue Complaints of
Begins 4-20 weeks after delivery Regrown in 6-15 months Neurologic System Discomfort and fatigue Complaints of
Begins 4-20 weeks after delivery Regrown in 6-15 months Neurologic System Discomfort and fatigue Complaints of
Begins 4-20 weeks after delivery Regrown in 6-15 months Neurologic System Discomfort and fatigue Complaints of

Neurologic System

Discomfort and fatigueafter delivery Regrown in 6-15 months Neurologic System Complaints of headache need careful assessment (where, pain

Complaints of headache need careful assessment (where, pain scale, etc.) Bilateral and frontal headache are common due to change in fluid and electrolyte balance Spinal headaches due to spinal anesthesia If they are laying completely flat, they do not have a headachein 6-15 months Neurologic System Discomfort and fatigue When they sit up, the pain becomes excruciating

are laying completely flat, they do not have a headache When they sit up, the pain
are laying completely flat, they do not have a headache When they sit up, the pain
are laying completely flat, they do not have a headache When they sit up, the pain

When they sit up, the pain becomes excruciating (“worst headache ever”) Treatment with caeine can sometimes help Blood patch treatment by anesthesia The hole in epidural space before labor has caused spinal fluid to continue to leak and cause the spinal headache

fluid to continue to leak and cause the spinal headache The physician will put another epidural
fluid to continue to leak and cause the spinal headache The physician will put another epidural

The physician will put another epidural in as you pull out 10 mL of blood from antecubital space He injects the blood into the epidural needle to clot and “patch” the hole initially created Headache should immediately subside with this treatment Blurred vision, dizziness, photophobia, and abdominal pain may indicate preeclampsia

photophobia, and abdominal pain may indicate preeclampsia Endocrine System Hormones Human chorionic gonadotropin is
photophobia, and abdominal pain may indicate preeclampsia Endocrine System Hormones Human chorionic gonadotropin is
photophobia, and abdominal pain may indicate preeclampsia Endocrine System Hormones Human chorionic gonadotropin is

Endocrine System

Hormones Human chorionic gonadotropin is present for 3-4 weeksabdominal pain may indicate preeclampsia Endocrine System Resumption of ovulation and menstruation Breastfeeding may

Resumption of ovulation and menstruation Breastfeeding may delay the return of ovulation and menses Ovulation may occur before the first mensesHuman chorionic gonadotropin is present for 3-4 weeks Lactation Prolactin initiates milk production within 2-3

Lactation Prolactin initiates milk production within 2-3 days of the birth Breastfeeding moms can not depend on lactation as birth control, because they may ovulate during that time (even if they do not menstruate)Breastfeeding may delay the return of ovulation and menses Ovulation may occur before the first menses

on lactation as birth control, because they may ovulate during that time (even if they do
on lactation as birth control, because they may ovulate during that time (even if they do
on lactation as birth control, because they may ovulate during that time (even if they do
on lactation as birth control, because they may ovulate during that time (even if they do
on lactation as birth control, because they may ovulate during that time (even if they do

Weight loss

Approximately 5.5 kg (12 pounds) is lost during childbirth From the fetus, placenta, and amniotic fluidAnother 4 kg (9 pounds) is lost over the next 2 weeks Another 2.5 kg

Another 4 kg (9 pounds) is lost over the next 2 weekschildbirth From the fetus, placenta, and amniotic fluid Another 2.5 kg (5 pounds) is lost by

Another 2.5 kg (5 pounds) is lost by six months post deliveryfluid Another 4 kg (9 pounds) is lost over the next 2 weeks Adipose tissue is

Adipose tissue is used for energy expenditure during labor and breastfeeding2.5 kg (5 pounds) is lost by six months post delivery Breastfeeding moms may lose weight

used for energy expenditure during labor and breastfeeding Breastfeeding moms may lose weight quicker Immune System

Breastfeeding moms may lose weight quickerused for energy expenditure during labor and breastfeeding Immune System Temperature Not uncommon to have low

Immune System

Temperature Not uncommon to have low grade temperature (less than 100) within the first 24 hours due to muscular exertion and exhaustion Any fever of 100.4 or higher on several occasions is important for the physician to know and evaluate for infectionBreastfeeding moms may lose weight quicker Immune System Rho(D) immune globulin Rh negative mother (i.e. A-,

Rho(D) immune globulin Rh negative mother (i.e. A-, B-, O-) and develops antibodies to her Rh positive baby (A+, B+, O+) Any Rh negative woman will receive Rhogam injection around 28 weeks IM injection in doctor’s o ffi ce ce

This prevents the mother from becoming iso-immunized in case her baby is Rh positive If baby is Rh negative, everything is good If baby is positive, the mother needs another Rhogam shot to prevent her from developing antibodies for a future pregnancy (antibodies would cause her body to attack the baby)around 28 weeks IM injection in doctor’s o ffi ce Immunizations Will test for rubella and

Immunizations Will test for rubella and other disease immunity at prenatal appointments If the mother is non-immune, they will vaccinate after childbirth before sending the mom and baby home (while they are a postpartum patient) Follow hospital policy for vaccine consent and educate woman on how long to avoid additional pregnancy(antibodies would cause her body to attack the baby) Risk factors for Postpartum Hemorrhage Grand multiparity

and educate woman on how long to avoid additional pregnancy Risk factors for Postpartum Hemorrhage Grand
and educate woman on how long to avoid additional pregnancy Risk factors for Postpartum Hemorrhage Grand
and educate woman on how long to avoid additional pregnancy Risk factors for Postpartum Hemorrhage Grand
and educate woman on how long to avoid additional pregnancy Risk factors for Postpartum Hemorrhage Grand
and educate woman on how long to avoid additional pregnancy Risk factors for Postpartum Hemorrhage Grand
and educate woman on how long to avoid additional pregnancy Risk factors for Postpartum Hemorrhage Grand
and educate woman on how long to avoid additional pregnancy Risk factors for Postpartum Hemorrhage Grand
and educate woman on how long to avoid additional pregnancy Risk factors for Postpartum Hemorrhage Grand
and educate woman on how long to avoid additional pregnancy Risk factors for Postpartum Hemorrhage Grand
and educate woman on how long to avoid additional pregnancy Risk factors for Postpartum Hemorrhage Grand

Risk factors for Postpartum Hemorrhage

Grand multiparity Pregnant many, many times (i.e. 19 kids and counting)additional pregnancy Risk factors for Postpartum Hemorrhage Overdistension of uterus (twins) Rapid or prolonged labor

Overdistension of uterus (twins)Pregnant many, many times (i.e. 19 kids and counting) Rapid or prolonged labor Retained placenta, placenta

Rapid or prolonged labor(i.e. 19 kids and counting) Overdistension of uterus (twins) Retained placenta, placenta previa, or abruptio placentae

Retained placenta, placenta previa, or abruptio placentaeOverdistension of uterus (twins) Rapid or prolonged labor Medications (tocolytics or oxytocin) Tocolytics slow down

Medications (tocolytics or oxytocin) Tocolytics slow down laborRetained placenta, placenta previa, or abruptio placentae Operative procedures (cesarean birth, vacuum extraction)

Operative procedures (cesarean birth, vacuum extraction)(tocolytics or oxytocin) Tocolytics slow down labor Preclampsia or coagulation defects Risk Factors for

Preclampsia or coagulation defectsTocolytics slow down labor Operative procedures (cesarean birth, vacuum extraction) Risk Factors for Postpartum Infection

procedures (cesarean birth, vacuum extraction) Preclampsia or coagulation defects Risk Factors for Postpartum Infection
procedures (cesarean birth, vacuum extraction) Preclampsia or coagulation defects Risk Factors for Postpartum Infection

Risk Factors for Postpartum Infection

Operative procedures (c-section, vacuum extraction, forceps)Multiple cervical examinations Once the water breaks, you want to do as few vaginal examinations

Multiple cervical examinations Once the water breaks, you want to do as few vaginal examinations as possibleOperative procedures (c-section, vacuum extraction, forceps) Prolonged labor Prolonged rupture of membranes (water

Prolonged laboryou want to do as few vaginal examinations as possible Prolonged rupture of membranes (water breaking)

Prolonged rupture of membranes (water breaking)do as few vaginal examinations as possible Prolonged labor Manual extraction of placenta Diabetes Catheterization

Manual extraction of placentalabor Prolonged rupture of membranes (water breaking) Diabetes Catheterization Focused Assessment Following

Diabetesof membranes (water breaking) Manual extraction of placenta Catheterization Focused Assessment Following Vaginal Birth

Catheterization(water breaking) Manual extraction of placenta Diabetes Focused Assessment Following Vaginal Birth Vital signs Blood

Manual extraction of placenta Diabetes Catheterization Focused Assessment Following Vaginal Birth Vital signs Blood

Focused Assessment Following Vaginal Birth

Vital signsCatheterization Focused Assessment Following Vaginal Birth Blood pressure Orthostatic hypotension Pulse

Blood pressure

Blood pressure

Orthostatic hypotension

Orthostatic hypotension

Pulse

Pulse

Respirations

Respirations

Temperature

Temperature

Pain

Pain

Fundus and lochiaPulse Respirations Temperature Pain Perineum Bladder elimination Breasts Lower extremities

PerineumRespirations Temperature Pain Fundus and lochia Bladder elimination Breasts Lower extremities Homan’s sign

Bladder eliminationTemperature Pain Fundus and lochia Perineum Breasts Lower extremities Homan’s sign Edema and deep

BreastsPain Fundus and lochia Perineum Bladder elimination Lower extremities Homan’s sign Edema and deep tendon

Lower extremitiesPain Fundus and lochia Perineum Bladder elimination Breasts Homan’s sign Edema and deep tendon reflexes BUBBLE

Homan’s signPerineum Bladder elimination Breasts Lower extremities Edema and deep tendon reflexes BUBBLE HE Breasts, uterus,

Edema and deep tendon reflexesBladder elimination Breasts Lower extremities Homan’s sign BUBBLE HE Breasts, uterus, bladder, bowels, lochia,

BUBBLE HE Breasts, uterus, bladder, bowels, lochia, episiotomy, Homans’ sign, emotional statusextremities Homan’s sign Edema and deep tendon reflexes Nursing Care After Cesarean Section (1/3 of pregnancies

bowels, lochia, episiotomy, Homans’ sign, emotional status Nursing Care After Cesarean Section (1/3 of pregnancies end

Nursing Care After Cesarean Section (1/3 of pregnancies end up with c-section)

Number of deliveries by cesarean sectionCesarean Section (1/3 of pregnancies end up with c-section) Pain relief Abdomen/incision Low transverse incision is

Pain reliefup with c-section) Number of deliveries by cesarean section Abdomen/incision Low transverse incision is most common

Abdomen/incision Low transverse incision is most common Vertical incision usually indicates emergency surgery Dressing only stays on for the first 24 hours Staples usually on the incision, some only have steri-stripsNumber of deliveries by cesarean section Pain relief Intake and output Caring for self and infant

Intake and outputStaples usually on the incision, some only have steri-strips Caring for self and infant Discharge Teaching

Caring for self and infantthe incision, some only have steri-strips Intake and output Discharge Teaching Signs and symptoms of possible

steri-strips Intake and output Caring for self and infant Discharge Teaching Signs and symptoms of possible
steri-strips Intake and output Caring for self and infant Discharge Teaching Signs and symptoms of possible
steri-strips Intake and output Caring for self and infant Discharge Teaching Signs and symptoms of possible
steri-strips Intake and output Caring for self and infant Discharge Teaching Signs and symptoms of possible

Discharge Teaching

and output Caring for self and infant Discharge Teaching Signs and symptoms of possible complications Breast

Signs and symptoms of possible complications Breast pain, persistent abdominal pain, burning with urination, leg pain or clot

and symptoms of possible complications Breast pain, persistent abdominal pain, burning with urination, leg pain or

indications, foul-smelling drainage, etc.

indications, foul-smelling drainage, etc. Health promotion Nutrition and fluids Activity and exercise Rest and comfort

Health promotion Nutrition and fluids

drainage, etc. Health promotion Nutrition and fluids Activity and exercise Rest and comfort Contraception Sexual

Activity and exercisedrainage, etc. Health promotion Nutrition and fluids Rest and comfort Contraception Sexual activity Prescribed

Rest and comfortHealth promotion Nutrition and fluids Activity and exercise Contraception Sexual activity Prescribed medications

ContraceptionNutrition and fluids Activity and exercise Rest and comfort Sexual activity Prescribed medications Signs/symptoms to

Sexual activityfluids Activity and exercise Rest and comfort Contraception Prescribed medications Signs/symptoms to report Becoming

Prescribed medicationsand exercise Rest and comfort Contraception Sexual activity Signs/symptoms to report Becoming Acquainted Bonding

Signs/symptoms to reportcomfort Contraception Sexual activity Prescribed medications Becoming Acquainted Bonding Describes the initial attraction

Becoming Acquainted

Bondingmedications Signs/symptoms to report Becoming Acquainted Describes the initial attraction felt by parents for their

Describes the initial attraction felt by parents for their infantsSigns/symptoms to report Becoming Acquainted Bonding Enhanced when parents and infants are not separated in the

Enhanced when parents and infants are not separated in the first hour of the birththe initial attraction felt by parents for their infants Unidirectional: parent to the baby (i.e. when

Unidirectional: parent to the baby (i.e. when baby is placed skin to skin with mother)infants are not separated in the first hour of the birth Attachment The process by which

Attachmentthe baby (i.e. when baby is placed skin to skin with mother) The process by which

The process by which an enduring bond between a parent and child is developedwhen baby is placed skin to skin with mother) Attachment Bidirectional: when baby cries and parent

Bidirectional: when baby cries and parent comforts heran enduring bond between a parent and child is developed Begins in pregnancy and extends for

Begins in pregnancy and extends for many months after birthBidirectional: when baby cries and parent comforts her Reciprocal Attachment Behavior Newborn infants have the

Reciprocal Attachment Behavior

Newborn infants have the ability tofor many months after birth Reciprocal Attachment Behavior Make eye contact and engage in prolonged, intense,

Make eye contact and engage in prolonged, intense, mutual gazingAttachment Behavior Newborn infants have the ability to Move eye to attempt to “track” parent’s face

Move eye to attempt to “track” parent’s faceeye contact and engage in prolonged, intense, mutual gazing Grasp and hold parent’s finger Move synchronously

Grasp and hold parent’s fingergazing Move eye to attempt to “track” parent’s face Move synchronously in response to rhythms and

Move synchronously in response to rhythms and patterns in voice (called entrainment)parent’s face Grasp and hold parent’s finger Root: latch on to the breast and suckle Be

Root: latch on to the breast and suckleto rhythms and patterns in voice (called entrainment) Be comforted by parent’s voice or touch Maternal

Be comforted by parent’s voice or touch(called entrainment) Root: latch on to the breast and suckle Maternal touch En face Fingertipping Enfolding:

Maternal touchthe breast and suckle Be comforted by parent’s voice or touch En face Fingertipping Enfolding: holding

En face Fingertipping Enfolding: holding baby with hand
En face
Fingertipping
Enfolding: holding baby with hand
Claiming or “binding in” “The baby has my nose” or “she has your eyes" Verbal
Claiming or “binding in” “The baby has my nose” or “she has your eyes" Verbal

Claiming or “binding in”

“The baby has my nose” or “she has your eyes"Claiming or “binding in” Verbal behaviors Mothers speak in high-pitched voice Calls infant by name Maternal

Verbal behaviors“The baby has my nose” or “she has your eyes" Mothers speak in high-pitched voice Calls

Mothers speak in high-pitched voice Calls infant by name
Mothers speak in high-pitched voice Calls infant by name

Mothers speak in high-pitched voice Calls infant by name

Mothers speak in high-pitched voice Calls infant by name

Maternal (Puerperal) Phrases (KNOW)

Taking-in phase Mother is focused on her own need for food and sleep Passive dependent behavior for 1-2 daysCalls infant by name Maternal (Puerperal) Phrases (KNOW) Taking-hold phase Becomes more independent and concerned for

Taking-hold phase Becomes more independent and concerned for her self-care Not fully independent Shifts attention to the newbornfor food and sleep Passive dependent behavior for 1-2 days Letting-go phase Relinquishes her previous roles

Letting-go phase Relinquishes her previous roles and refocuses on relationship with partner May give her care to a caretaker Adjusting to disappointments May go back to work in this phaseNot fully independent Shifts attention to the newborn Family Adaptations Fathers Relationship, marriage, age, his

to disappointments May go back to work in this phase Family Adaptations Fathers Relationship, marriage, age,
to disappointments May go back to work in this phase Family Adaptations Fathers Relationship, marriage, age,
to disappointments May go back to work in this phase Family Adaptations Fathers Relationship, marriage, age,
to disappointments May go back to work in this phase Family Adaptations Fathers Relationship, marriage, age,
to disappointments May go back to work in this phase Family Adaptations Fathers Relationship, marriage, age,
to disappointments May go back to work in this phase Family Adaptations Fathers Relationship, marriage, age,
to disappointments May go back to work in this phase Family Adaptations Fathers Relationship, marriage, age,
to disappointments May go back to work in this phase Family Adaptations Fathers Relationship, marriage, age,
to disappointments May go back to work in this phase Family Adaptations Fathers Relationship, marriage, age,

Family Adaptations

Fathers Relationship, marriage, age, his own father experience, emotional age, financial situation Engrossment or intense fascination with baby Demonstrate infant care and praise father for performing well Involve him in teaching Encourage parents to negotiate division of child care and household choresMay go back to work in this phase Family Adaptations Siblings “Big brother” or “big sister”

Siblings “Big brother” or “big sister” stickers Educate on potential sibling rivalryfor performing well Involve him in teaching Encourage parents to negotiate division of child care and

care and household chores Siblings “Big brother” or “big sister” stickers Educate on potential sibling rivalry
care and household chores Siblings “Big brother” or “big sister” stickers Educate on potential sibling rivalry
care and household chores Siblings “Big brother” or “big sister” stickers Educate on potential sibling rivalry
care and household chores Siblings “Big brother” or “big sister” stickers Educate on potential sibling rivalry
care and household chores Siblings “Big brother” or “big sister” stickers Educate on potential sibling rivalry
care and household chores Siblings “Big brother” or “big sister” stickers Educate on potential sibling rivalry
care and household chores Siblings “Big brother” or “big sister” stickers Educate on potential sibling rivalry
Educate on expecting jealousy Encourage quality time with older sibling Grandparents May be an asset

Educate on expecting jealousy Encourage quality time with older sibling

expecting jealousy Encourage quality time with older sibling Grandparents May be an asset by helping with

Grandparentsexpecting jealousy Encourage quality time with older sibling May be an asset by helping with other

May be an asset by helping with other children or household choresEncourage quality time with older sibling Grandparents Factors that A ff ect Adaptation Lingering discomfort or

Factors that A ect Adaptation

Lingering discomfort or painor household chores Factors that A ff ect Adaptation Chronic fatigue Knowledge of infant needs Available

Chronic fatiguethat A ff ect Adaptation Lingering discomfort or pain Knowledge of infant needs Available support system

Knowledge of infant needsect Adaptation Lingering discomfort or pain Chronic fatigue Available support system Financial aid and community

Available support system Financial aid and community resourcesdiscomfort or pain Chronic fatigue Knowledge of infant needs Expectations of the newborn Previous experience with

Expectations of the newbornsupport system Financial aid and community resources Previous experience with infants Maternal temperament, age

Previous experience with infantsaid and community resources Expectations of the newborn Maternal temperament, age Mom could be 13 or

Maternal temperament, age Mom could be 13 or 45 with first childExpectations of the newborn Previous experience with infants Infant characteristics Baby was product of rape and

Infant characteristics Baby was product of rape and the child looks like that mantemperament, age Mom could be 13 or 45 with first child Other factors: cesarean birth, preterm

Other factors: cesarean birth, preterm or ill infant, birth of multiplesBaby was product of rape and the child looks like that man Cultural Awareness Food preferences

cesarean birth, preterm or ill infant, birth of multiples Cultural Awareness Food preferences Hot vs. cold
cesarean birth, preterm or ill infant, birth of multiples Cultural Awareness Food preferences Hot vs. cold
cesarean birth, preterm or ill infant, birth of multiples Cultural Awareness Food preferences Hot vs. cold

Cultural Awareness

Food preferencespreterm or ill infant, birth of multiples Cultural Awareness Hot vs. cold water at bedside (for

Hot vs. cold water at bedside (for Asian population?)birth of multiples Cultural Awareness Food preferences Family may bring food from home Communication Religious

Family may bring food from homeHot vs. cold water at bedside (for Asian population?) Communication Religious rituals Postpartum Blues Mild

Communication(for Asian population?) Family may bring food from home Religious rituals Postpartum Blues Mild depression: “baby

Religious ritualspopulation?) Family may bring food from home Communication Postpartum Blues Mild depression: “baby blues” A

Postpartum Blues

Mild depression: “baby blues”

Mild depression: “baby blues”

A ff ects 70-80% of new mothers

A

ects 70-80% of new mothers

Begins first week postpartum

Begins first week postpartum

Should not last longer than 2 weeks

Should not last longer than 2 weeks

Must be distinguished from postpartum depression or postpartum psychosis

Must be distinguished from postpartum depression or postpartum psychosis

Must be distinguished from postpartum depression or postpartum psychosis
Must be distinguished from postpartum depression or postpartum psychosis

May be visible in the first few days postpartum while she is still in the hospital

May be crying and hysterical and nurse may need to educate the husband on patience and hormone flooding

August 28

The Labor Experience

Labor “experience"

Begins at the onset of labor through the delivery and lasts until the expulsion of the placentaAugust 28 The Labor Experience Labor “experience" Factors that may trigger labor Maternal factors Stretching of

Factors that may trigger labor Maternal factors Stretching of uterine musclesthe delivery and lasts until the expulsion of the placenta Estrogen/progesterone changes Oxytocin release Starts to

trigger labor Maternal factors Stretching of uterine muscles Estrogen/progesterone changes Oxytocin release Starts to
trigger labor Maternal factors Stretching of uterine muscles Estrogen/progesterone changes Oxytocin release Starts to

Estrogen/progesterone changes Oxytocin release Starts to stimulate contractions in the body Release of prostaglandins

stimulate contractions in the body Release of prostaglandins Fetal factors Fetal cortisol changes If the baby
stimulate contractions in the body Release of prostaglandins Fetal factors Fetal cortisol changes If the baby

Fetal factors Fetal cortisol changes

of prostaglandins Fetal factors Fetal cortisol changes If the baby is stressed, it releases cortisol, which
of prostaglandins Fetal factors Fetal cortisol changes If the baby is stressed, it releases cortisol, which

If the baby is stressed, it releases cortisol, which could stimulate labor Placenta aging Prostaglandins increase causing contractionsof prostaglandins Fetal factors Fetal cortisol changes Symptoms that may precede labor Lightening Time of

Symptoms that may precede labor Lightening Time of engagement “Fetus has engaged into the pelvis” Mom may describe as the “baby has dropped” and can breathe easier, but may void more frequently Vaginal mucus increases “Bloody show” As baby pushes on the cervix more and it dilates, some of the tissue sloughs away like a menstrual cycle Braxton Hicks contractions Like “practice” contractions Can happen a lot during dehydration Burst of energy/nesting Women start get everything ready for the baby to come GI changes Constipation or diarrhea Cervical changes Beginning to dilate Backache Contractions can be in the back “Back labor”which could stimulate labor Placenta aging Prostaglandins increase causing contractions Factors A ff ecting Labor (4

changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff
changes Beginning to dilate Backache Contractions can be in the back “Back labor” Factors A ff

Factors A ecting Labor (4 Ps)

Powers Uterine contractionsPrimary force that moves the fetus through the maternal pelvis Maternal pushing e ff orts

Powers Uterine contractions Primary force that moves the fetus through the maternal pelvis Maternal pushing e

Primary force that moves the fetus through the maternal pelvisPowers Uterine contractions Maternal pushing e ff orts Woman feels an urge to push and bear

Maternal pushing eff orts orts

Woman feels an urge to push and bear down as the fetus distends her vagina and puts pressure on her rectumthrough the maternal pelvis Maternal pushing e ff orts “Push through your bottom” Passage Bony pelvis

“Push through your bottom”fetus distends her vagina and puts pressure on her rectum Passage Bony pelvis Usually more important

Passage Bony pelvisputs pressure on her rectum “Push through your bottom” Usually more important to the outcome of

rectum “Push through your bottom” Passage Bony pelvis Usually more important to the outcome of labor

Usually more important to the outcome of labor than the soft tissuerectum “Push through your bottom” Passage Bony pelvis Bones and joints do not readily yield to

Bones and joints do not readily yield to the forces of labormore important to the outcome of labor than the soft tissue Passenger The passenger is the

Passenger The passenger is the fetus, membranes, and placenta Several fetal anatomic and positional variables influence the course of labor Fetal headBones and joints do not readily yield to the forces of labor Cephalic presentation (head first,

variables influence the course of labor Fetal head Cephalic presentation (head first, optimal position)
variables influence the course of labor Fetal head Cephalic presentation (head first, optimal position)
variables influence the course of labor Fetal head Cephalic presentation (head first, optimal position)
Cephalic presentation (head first, optimal position) Sutures the two frontal bones on the forehead Fontanels
Cephalic presentation (head first, optimal position)
Sutures the two frontal bones on the forehead
Fontanels
Sutures the two frontal bones on the forehead Fontanels Fetal variations Fetal lie Orientation of the

Fetal variations

Fetal lie Orientation of the long axis of the fetus to the long axis of the womanfrontal bones on the forehead Fontanels Fetal variations In more than 99% of pregnancies, the lie

of the long axis of the fetus to the long axis of the woman In more

In more than 99% of pregnancies, the lie is longitudinal and parallel to the long axis of the womanof the long axis of the fetus to the long axis of the woman Transverse lie

Transverse lie
Transverse lie

Attitude Relationship of fetal body parts to one anotherwoman In more than 99% of pregnancies, the lie is longitudinal and parallel to the long

and parallel to the long axis of the woman Transverse lie Attitude Relationship of fetal body
Flexion or extension
Flexion or extension

PresentationFlexion or extension Fetal part that enters the pelvis first Cephalic Vertex, military, brow, face Breech

Fetal part that enters the pelvis firstFlexion or extension Presentation Cephalic Vertex, military, brow, face Breech Frank, full, footling Shoulder Desired

CephalicPresentation Fetal part that enters the pelvis first Vertex, military, brow, face Breech Frank, full, footling

Vertex, military, brow, face
Vertex, military, brow, face

Breechthe pelvis first Cephalic Vertex, military, brow, face Frank, full, footling Shoulder Desired position is ROA

Frank, full, footling
Frank, full, footling

ShoulderVertex, military, brow, face Breech Frank, full, footling Desired position is ROA The fetal part (O-

Desired position is ROAmilitary, brow, face Breech Frank, full, footling Shoulder The fetal part (O- occiput) is to the

The fetal part (O- occiput) is to the right (R) side of the mother’s anterior pelvis (A)Frank, full, footling Shoulder Desired position is ROA It is the most advantageous position that most

It is the most advantageous position that most nearly aligns the fetal to the maternal pelvisto the right (R) side of the mother’s anterior pelvis (A) Variations LOA, occiput to left

Variationsthat most nearly aligns the fetal to the maternal pelvis LOA, occiput to left anterior ROP/LOP,

LOA, occiput to left anteriornearly aligns the fetal to the maternal pelvis Variations ROP/LOP, occiput to right/left posterior RSA/LSA/RSP/LSP,

ROP/LOP, occiput to right/left posteriorthe maternal pelvis Variations LOA, occiput to left anterior RSA/LSA/RSP/LSP, sacal to right/left anterior/posterior

RSA/LSA/RSP/LSP, sacal to right/left anterior/posteriorto left anterior ROP/LOP, occiput to right/left posterior Psyche Anxiety Culture and expectations Scientology has

RSA/LSA/RSP/LSP, sacal to right/left anterior/posterior Psyche Anxiety Culture and expectations Scientology has

Psyche Anxiety

sacal to right/left anterior/posterior Psyche Anxiety Culture and expectations Scientology has to have a

Culture and expectations

Culture and expectations Scientology has to have a silent birth experience with no noise from the
Culture and expectations Scientology has to have a silent birth experience with no noise from the

Scientology has to have a silent birth experience with no noise from the woman Birth as an experienceCulture and expectations

SupportImpact of technology Maternal Adaptations (during labor) Cardiovascular Increased blood volume Blood pressure very

Impact of technologySupport Maternal Adaptations (during labor) Cardiovascular Increased blood volume Blood pressure very slightly increases

Maternal Adaptations (during labor)

CardiovascularImpact of technology Maternal Adaptations (during labor) Increased blood volume Blood pressure very slightly

Increased blood volumeMaternal Adaptations (during labor) Cardiovascular Blood pressure very slightly increases to compensate More

Blood pressure very slightly increases to compensate More than “slightly” is a sign of a bigger issue(during labor) Cardiovascular Increased blood volume Lower pulse Can cause some orthostatic hypotension

Lower pulseMore than “slightly” is a sign of a bigger issue Can cause some orthostatic hypotension Respiratory

than “slightly” is a sign of a bigger issue Lower pulse Can cause some orthostatic hypotension

Can cause some orthostatic hypotensionthan “slightly” is a sign of a bigger issue Lower pulse Respiratory Hyperventilation Due to contractions

Respiratoryissue Lower pulse Can cause some orthostatic hypotension Hyperventilation Due to contractions or pain Help the

pulse Can cause some orthostatic hypotension Respiratory Hyperventilation Due to contractions or pain Help the woman

Hyperventilation Due to contractions or pain Help the woman control her breathing

to contractions or pain Help the woman control her breathing Gastrointestinal NPO causes decreased motility Urinary
to contractions or pain Help the woman control her breathing Gastrointestinal NPO causes decreased motility Urinary

Gastrointestinalto contractions or pain Help the woman control her breathing NPO causes decreased motility Urinary Decreased

NPO causes decreased motilitypain Help the woman control her breathing Gastrointestinal Urinary Decreased sensation and decreased frequency

Urinaryher breathing Gastrointestinal NPO causes decreased motility Decreased sensation and decreased frequency Hematopoietic

Decreased sensation and decreased frequencyGastrointestinal NPO causes decreased motility Urinary Hematopoietic Lose some blood Vaginal- average of 500 mL

Hematopoieticmotility Urinary Decreased sensation and decreased frequency Lose some blood Vaginal- average of 500 mL Cesarean-

Lose some bloodDecreased sensation and decreased frequency Hematopoietic Vaginal- average of 500 mL Cesarean- average of 1000mL After

Vaginal- average of 500 mLand decreased frequency Hematopoietic Lose some blood Cesarean- average of 1000mL After delivery, surge of

Cesarean- average of 1000mLHematopoietic Lose some blood Vaginal- average of 500 mL After delivery, surge of clotting factors to

After delivery, surge of clotting factors to prevent hemorrhageblood Vaginal- average of 500 mL Cesarean- average of 1000mL Fetal Adaptations Placental circulation Exchange of

Fetal Adaptations

Placental circulationof clotting factors to prevent hemorrhage Fetal Adaptations Exchange of oxygen, nutrients, and waste products Most

Exchange of oxygen, nutrients, and waste productsprevent hemorrhage Fetal Adaptations Placental circulation Most placental exchange occurs during the interval between

Most placental exchange occurs during the interval between contractionsExchange of oxygen, nutrients, and waste products Cardiovascular system responds to stress Heart ranges from

Cardiovascular system responds to stressexchange occurs during the interval between contractions Heart ranges from 110 to 160 beats per minute

Heart ranges from 110 to 160 beats per minutecontractions Cardiovascular system responds to stress Pulmonary system Lungs produce fluid to allow normal

Pulmonary systemto stress Heart ranges from 110 to 160 beats per minute Lungs produce fluid to allow

Lungs produce fluid to allow normal development of the airwaysranges from 110 to 160 beats per minute Pulmonary system C-section babies don’t get to expel

C-section babies don’t get to expel fluid from lungs during the delivery the way that a vaginal birth doesproduce fluid to allow normal development of the airways Normal Labor: Theories of Onset Factors with

Normal Labor: Theories of Onset

Factors with a role in starting laborthat a vaginal birth does Normal Labor: Theories of Onset Progesterone withdrawal Increased prostaglandins Increased

Progesterone withdrawalTheories of Onset Factors with a role in starting labor Increased prostaglandins Increased oxytocin More oxytocin

Increased prostaglandinswith a role in starting labor Progesterone withdrawal Increased oxytocin More oxytocin receptors in uterus

Increased oxytocinlabor Progesterone withdrawal Increased prostaglandins More oxytocin receptors in uterus Increased stretching and

More oxytocin receptors in uterusProgesterone withdrawal Increased prostaglandins Increased oxytocin Increased stretching and pressure of uterus and cervix

Increased stretching and pressure of uterus and cervixin starting labor Progesterone withdrawal Increased prostaglandins Increased oxytocin More oxytocin receptors in uterus

True vs. false laborFalse Contractions but no change in cervix Activity doesn’t change pattern Drink a glass of

FalseTrue vs. false labor Contractions but no change in cervix Activity doesn’t change pattern Drink a

Contractions but no change in cervixTrue vs. false labor False Activity doesn’t change pattern Drink a glass of water and rest

Activity doesn’t change pattern Drink a glass of water and rest for a few minutesvs. false labor False Contractions but no change in cervix Hydration or sedation slows/stops contractions True

Hydration or sedation slows/stops contractionspattern Drink a glass of water and rest for a few minutes True Regular contractions increase

a few minutes Hydration or sedation slows/stops contractions True Regular contractions increase in frequency and

Truea few minutes Hydration or sedation slows/stops contractions Regular contractions increase in frequency and intensity

Regular contractions increase in frequency and intensityminutes Hydration or sedation slows/stops contractions True Change in cervix Greater dilation Causing e ff acement

Change in cervixRegular contractions increase in frequency and intensity Greater dilation Causing e ff acement and dilation Time

Greater dilationincrease in frequency and intensity Change in cervix Causing e ff acement and dilation Time to

Causing eff acement and dilation acement and dilation

Time to go to the Hospital

Contractionse ff acement and dilation Time to go to the Hospital Ruptured membranes Water broke Bleeding

Ruptured membranesacement and dilation Time to go to the Hospital Contractions Water broke Bleeding Decreased fetal movement

Water brokeTime to go to the Hospital Contractions Ruptured membranes Bleeding Decreased fetal movement Other Vomiting, fever,

Bleedingto the Hospital Contractions Ruptured membranes Water broke Decreased fetal movement Other Vomiting, fever, etc.

Decreased fetal movementContractions Ruptured membranes Water broke Bleeding Other Vomiting, fever, etc. Mechanism of Labor Engagement,

Othermembranes Water broke Bleeding Decreased fetal movement Vomiting, fever, etc. Mechanism of Labor Engagement,

Vomiting, fever, etc.Water broke Bleeding Decreased fetal movement Other Mechanism of Labor Engagement, descent, flexion, internal

Mechanism of Labor

Engagement, descent, flexion, internal rotation, extension, external rotation, and expulsionmovement Other Vomiting, fever, etc. Mechanism of Labor Terms you hear as the baby is born

Terms you hear as the baby is bornrotation, extension, external rotation, and expulsion Will not be tested over these Rupture of Membranes (ROM)

Will not be tested over theserotation, and expulsion Terms you hear as the baby is born Rupture of Membranes (ROM) Spontaneous

Rupture of Membranes (ROM)

SpontaneousWill not be tested over these Rupture of Membranes (ROM) Water broke on its own; it

Water broke on its own; it just happenedbe tested over these Rupture of Membranes (ROM) Spontaneous “SROM” Artificial Amniotomy Indications Induce labor

“SROM”(ROM) Spontaneous Water broke on its own; it just happened Artificial Amniotomy Indications Induce labor Not

ArtificialWater broke on its own; it just happened “SROM” Amniotomy Indications Induce labor Not prepared for

Amniotomy Indications Induce labor Not prepared for labor and have not started labor Add oxytocin
Amniotomy
Indications
Induce labor
Not prepared for labor and have not started labor
Add oxytocin
Augment labor
“To add to”
They are contracting, but not enough to dilate their cervix
Add oxytocin
Allow internal fetal monitoring

“AROM”Interventions FHR Don’t want to do this if we don’t have to because of infection

Interventions“AROM” FHR Don’t want to do this if we don’t have to because of infection possibility

FHR“AROM” Interventions Don’t want to do this if we don’t have to because of infection possibility

“AROM” Interventions FHR Don’t want to do this if we don’t have to because of infection

Don’t want to do this if we don’t have to because of infection possibility

Fetal heart ratethis if we don’t have to because of infection possibility Keep it monitored because the water

Keep it monitored because the water breaking can a ff ect the baby’s safety ect the baby’s safety

This the first and foremost prioritythe water breaking can a ff ect the baby’s safety TACO Timing Amount Polyhydraminos Color Odor

TACOthe baby’s safety This the first and foremost priority Timing Amount Polyhydraminos Color Odor Hygiene Once

Timingbaby’s safety This the first and foremost priority TACO Amount Polyhydraminos Color Odor Hygiene Once the

Amountsafety This the first and foremost priority TACO Timing Polyhydraminos Color Odor Hygiene Once the fluid

PolyhydraminosThis the first and foremost priority TACO Timing Amount Color Odor Hygiene Once the fluid is

Colorand foremost priority TACO Timing Amount Polyhydraminos Odor Hygiene Once the fluid is out, it is

Odorforemost priority TACO Timing Amount Polyhydraminos Color Hygiene Once the fluid is out, it is time

Hygienepriority TACO Timing Amount Polyhydraminos Color Odor Once the fluid is out, it is time to

TACO Timing Amount Polyhydraminos Color Odor Hygiene Once the fluid is out, it is time to

Once the fluid is out, it is time to change the woman’s pad frequently, because fluid will continue to drain Amniotic fluid is mostly urine from the fetus, which will continue throughout the labor process

the fetus, which will continue throughout the labor process Risks Prolapse cord The cord could float

Risksthe fetus, which will continue throughout the labor process Prolapse cord The cord could float down

Prolapse cordwhich will continue throughout the labor process Risks The cord could float down when the membrane

The cord could float down when the membrane ruptures and gets under the baby’s head before the head is fully engaged in the pelviscontinue throughout the labor process Risks Prolapse cord The cord is the baby’s lifeline and circulation

The cord is the baby’s lifeline and circulation source, so this is an emergency for the babybaby’s head before the head is fully engaged in the pelvis Infection We don’t want the

Infectionand circulation source, so this is an emergency for the baby We don’t want the water

We don’t want the water to be broke for longer than 12 hours because of chance for infectionsource, so this is an emergency for the baby Infection Abruption of placenta Placenta can break

Abruption of placentafor longer than 12 hours because of chance for infection Placenta can break away Contraindications Placenta

Placenta can break awayhours because of chance for infection Abruption of placenta Contraindications Placenta previa Placenta can fall from

Contraindicationsfor infection Abruption of placenta Placenta can break away Placenta previa Placenta can fall from its

Placenta previaof placenta Placenta can break away Contraindications Placenta can fall from its high position at top

Placenta can fall from its high position at top of uterusPlacenta can break away Contraindications Placenta previa Could potentially sit over cervix opening, which would

Could potentially sit over cervix opening, which would prevent a vaginal delivery C-section would be requiredPlacenta can fall from its high position at top of uterus Can not rupture membranes if

Can not rupture membranes if placenta is in the way It would poke the placenta and not the membraneswould prevent a vaginal delivery C-section would be required Fetal position Could not rupture membranes if

in the way It would poke the placenta and not the membranes Fetal position Could not
in the way It would poke the placenta and not the membranes Fetal position Could not

Fetal positionin the way It would poke the placenta and not the membranes Could not rupture membranes

would poke the placenta and not the membranes Fetal position Could not rupture membranes if the

Could not rupture membranes if the baby is breech Could damage baby’s rectum by accident

the baby is breech Could damage baby’s rectum by accident Cord prolapse You wouldn’t want to

Cord prolapsethe baby is breech Could damage baby’s rectum by accident You wouldn’t want to poke the

You wouldn’t want to poke the cord or cause further fetal distressCould not rupture membranes if the baby is breech Could damage baby’s rectum by accident Cord

Sterile proceduredamage baby’s rectum by accident Cord prolapse You wouldn’t want to poke the cord or cause

Amniotomy: Artificial ROM Nursing considerations Obtain baseline information FHR 20 to 20 minutes before procedure

Amniotomy: Artificial ROM

Amniotomy: Artificial ROM Nursing considerations Obtain baseline information FHR 20 to 20 minutes before procedure Assist

Nursing considerations Obtain baseline information

ROM Nursing considerations Obtain baseline information FHR 20 to 20 minutes before procedure Assist with procedure

FHR 20 to 20 minutes before procedureROM Nursing considerations Obtain baseline information Assist with procedure Place absorbent pads Open

Assist with procedure

Assist with procedure

Assist with procedure
Assist with procedure
Assist with procedure
Assist with procedure

Place absorbent pads

Open equipment packet

Provide care after procedure

Provide care after procedure

Identify complications

Notice color

Yellowish/pinkishafter procedure Identify complications Notice color Shouldn’t be bright red Promote comfort Induction of Labor

Identify complications Notice color Yellowish/pinkish Shouldn’t be bright red Promote comfort Induction of Labor

Shouldn’t be bright red Promote comfortIdentify complications Notice color Yellowish/pinkish Induction of Labor Chemical (oxytocin) or mechanical (AROM)

Induction of Labor

Chemical (oxytocin) or mechanical (AROM) initiation of uterine contractionsShouldn’t be bright red Promote comfort Induction of Labor Indications If mom or baby is in

Indications If mom or baby is in distress If mom is past her due dateor mechanical (AROM) initiation of uterine contractions Contraindications Breech position Gastresis or

Contraindications Breech position Gastresis or encephalopathy in fetusIf mom or baby is in distress If mom is past her due date Pitocin (or

Pitocin (or oxytocin) may augment laborBreech position Gastresis or encephalopathy in fetus Amniotomy Prostaglandin E Cervideel (?) Inserted like a

Amniotomyin fetus Pitocin (or oxytocin) may augment labor Prostaglandin E Cervideel (?) Inserted like a tampon

Prostaglandin E Cervideel (?) Inserted like a tampon right next to cervix Releases prostaglandins to help soften and condition cervix for it to be ready for labor Prostaglandins are also in semen, hence the old wives’ tale that sex will “induce"Contraindications Breech position Gastresis or encephalopathy in fetus Pitocin (or oxytocin) may augment labor Amniotomy

for it to be ready for labor Prostaglandins are also in semen, hence the old wives’
for it to be ready for labor Prostaglandins are also in semen, hence the old wives’
for it to be ready for labor Prostaglandins are also in semen, hence the old wives’
for it to be ready for labor Prostaglandins are also in semen, hence the old wives’
for it to be ready for labor Prostaglandins are also in semen, hence the old wives’
for it to be ready for labor Prostaglandins are also in semen, hence the old wives’
for it to be ready for labor Prostaglandins are also in semen, hence the old wives’
for it to be ready for labor Prostaglandins are also in semen, hence the old wives’

labor

Misoprostol (Cytotec) Only used in stillborn cases (no heartbeat at all)labor Causes extremely strong contractions to get the baby out quickly Not compatible with fetal life

(Cytotec) Only used in stillborn cases (no heartbeat at all) Causes extremely strong contractions to get
Causes extremely strong contractions to get the baby out quickly Not compatible with fetal life
Causes extremely strong contractions to get the baby out quickly Not compatible with fetal life

Causes extremely strong contractions to get the baby out quickly Not compatible with fetal life

Causes extremely strong contractions to get the baby out quickly Not compatible with fetal life

Risksto get the baby out quickly Not compatible with fetal life Oxytocin is a strong drug,

the baby out quickly Not compatible with fetal life Risks Oxytocin is a strong drug, so

Oxytocin is a strong drug, so the baby could have decels and not handle labor very well

Induction or Augmentation

Oxytocin (Pitocin) Causes contractions to begin or become regular to cause dilation of cervix Mixed with IV fluids, usually 10 units per 1000 mLand not handle labor very well Induction or Augmentation Always give via infusion Piggyback to site/port

Always give via infusion Piggyback to site/port closest to patient on IV Use pump to control the exact amountcervix Mixed with IV fluids, usually 10 units per 1000 mL Usually ordered by protocol Only

Usually ordered by protocol Only give a su ffi cient amount to cause an e ff ective labor pattern Stepping up pattern with cient amount to cause an e ective labor pattern Stepping up pattern with increasing dose Follow doctor’s orders/typical hospital protocol

Discontinue if FHR is non-reassuring Notify the MD, give oxygen, turn to side, and give medications Don’t slow it down, just cut it o ff completely completely

Don’t slow it down, just cut it o ff completely Contractions are like a bear hug
Don’t slow it down, just cut it o ff completely Contractions are like a bear hug
Don’t slow it down, just cut it o ff completely Contractions are like a bear hug
Don’t slow it down, just cut it o ff completely Contractions are like a bear hug
Don’t slow it down, just cut it o ff completely Contractions are like a bear hug
Don’t slow it down, just cut it o ff completely Contractions are like a bear hug
Don’t slow it down, just cut it o ff completely Contractions are like a bear hug
Don’t slow it down, just cut it o ff completely Contractions are like a bear hug
Don’t slow it down, just cut it o ff completely Contractions are like a bear hug

Contractions are like a bear hug for the baby, which squeezes out its oxygen during that time When the baby is in utero, we want to be specific about “squeezing time” During just placenta delivery, oxytocin can be turned all the way upDon’t slow it down, just cut it o ff completely External Version Attempts to turn fetus

placenta delivery, oxytocin can be turned all the way up External Version Attempts to turn fetus
placenta delivery, oxytocin can be turned all the way up External Version Attempts to turn fetus

External Version

Attempts to turn fetus from a breech or shoulder presentation to a vertex presentationoxytocin can be turned all the way up External Version Attempted after 37 weeks gestation Tocolytic

Attempted after 37 weeks gestationa breech or shoulder presentation to a vertex presentation Tocolytic is given to relax uterus Ultrasound

Tocolytic is given to relax uterusto a vertex presentation Attempted after 37 weeks gestation Ultrasound evaluates fetus and uterus Contraindications

Ultrasound evaluates fetus and uterusafter 37 weeks gestation Tocolytic is given to relax uterus Contraindications Risks Labor Stage 1 Begins

Contraindicationsgiven to relax uterus Ultrasound evaluates fetus and uterus Risks Labor Stage 1 Begins with onset

RisksUltrasound evaluates fetus and uterus Contraindications Labor Stage 1 Begins with onset of labor and ends

Labor

evaluates fetus and uterus Contraindications Risks Labor Stage 1 Begins with onset of labor and ends

Stage 1 Begins with onset of labor and ends with complete cervical dilation (1-10cm) Latent phase Cervix 0-3 cm dilation and 0-40% e acement

cervical dilation (1-10cm) Latent phase Cervix 0-3 cm dilation and 0-40% e ff acement E ff
cervical dilation (1-10cm) Latent phase Cervix 0-3 cm dilation and 0-40% e ff acement E ff
cervical dilation (1-10cm) Latent phase Cervix 0-3 cm dilation and 0-40% e ff acement E ff
cervical dilation (1-10cm) Latent phase Cervix 0-3 cm dilation and 0-40% e ff acement E ff

E acement is thickness

Contraction every 5-10 minutes, mild intensity, lasting 30-45 secondsDiscomfort described as feelings of strong menstrual cramps Medical interventions Nursing actions Great opportunity for

Discomfort described as feelings of strong menstrual crampsevery 5-10 minutes, mild intensity, lasting 30-45 seconds Medical interventions Nursing actions Great opportunity for

Medical interventionsDiscomfort described as feelings of strong menstrual cramps Nursing actions Great opportunity for teaching Especially

Nursing actions Great opportunity for teaching Especially breathing techniquesas feelings of strong menstrual cramps Medical interventions Pain plan NPO (ice chips, maybe popsicles) Hygiene

opportunity for teaching Especially breathing techniques Pain plan NPO (ice chips, maybe popsicles) Hygiene
opportunity for teaching Especially breathing techniques Pain plan NPO (ice chips, maybe popsicles) Hygiene
Pain plan

Pain plan

Pain plan
Pain plan

NPO (ice chips, maybe popsicles)

Hygiene for ruptured membranes

Active phasechips, maybe popsicles) Hygiene for ruptured membranes Average dilation is 1.2 cm per hour depending on

Average dilation is 1.2 cm per hour depending on gravies (which number pregnancy)popsicles) Hygiene for ruptured membranes Active phase Dilation progress is 4-7 cm and 40-80% e ff

Dilation progress is 4-7 cm and 40-80% e ff aced aced

Fetal descentDilation progress is 4-7 cm and 40-80% e ff aced Increased contractions; every two to five

Increased contractions; every two to five minutes for 40 to 60 secondsprogress is 4-7 cm and 40-80% e ff aced Fetal descent Increase in pain May want

Increase in pain May want an epidural at this timeevery two to five minutes for 40 to 60 seconds Medical interventions Nursing actions Transition phase

Medical interventionsseconds Increase in pain May want an epidural at this time Nursing actions Transition phase Stage

Nursing actionspain May want an epidural at this time Medical interventions Transition phase Stage 2 Dilation from

epidural at this time Medical interventions Nursing actions Transition phase Stage 2 Dilation from 8 to

Transition phaseepidural at this time Medical interventions Nursing actions Stage 2 Dilation from 8 to 10 cm

Stage 2time Medical interventions Nursing actions Transition phase Dilation from 8 to 10 cm with 100% e

Dilation from 8 to 10 cm with 100% e ff aced aced

Contractions are intense; every 1-2 minutes and last 60 to 90 secondsStage 2 Dilation from 8 to 10 cm with 100% e ff aced Exhaustion and di

Exhaustion and di ffi culty concentrating culty concentrating

Bloody show60 to 90 seconds Exhaustion and di ffi culty concentrating N/V, backache, diaphoresis, and trembling Strong

N/V, backache, diaphoresis, and tremblingExhaustion and di ffi culty concentrating Bloody show Strong urge to bear down Medical interventions Possible

Strong urge to bear downBloody show N/V, backache, diaphoresis, and trembling Medical interventions Possible for a woman to get an

Medical interventions Possible for a woman to get an epidural at any time, but they have to be able to sit totally still for the anesthesiologist to place the epiduraldiaphoresis, and trembling Strong urge to bear down Nursing actions Begins with complete cervical dilation and

Nursing actionstotally still for the anesthesiologist to place the epidural Begins with complete cervical dilation and ends

the anesthesiologist to place the epidural Nursing actions Begins with complete cervical dilation and ends with

Begins with complete cervical dilation and ends with deliverythe anesthesiologist to place the epidural Nursing actions Stage 3 Starts with pushing E ff ective

Stage 3with complete cervical dilation and ends with delivery Starts with pushing E ff ective pushing using

Starts with pushingcomplete cervical dilation and ends with delivery Stage 3 E ff ective pushing using abdomen and

dilation and ends with delivery Stage 3 Starts with pushing E ff ective pushing using abdomen

E ective pushing using abdomen and bearing down, rather than face pushing

Complete dilationusing abdomen and bearing down, rather than face pushing Sudden burst of energy, improved focus Shorter

Sudden burst of energy, improved focusand bearing down, rather than face pushing Complete dilation Shorter duration with multips than primips Meaning

Shorter duration with multips than primips Meaning it is not their first babyComplete dilation Sudden burst of energy, improved focus Intense contraction every 2 minutes for 60-90 seconds

Intense contraction every 2 minutes for 60-90 secondsmultips than primips Meaning it is not their first baby Increase in bloody show Perineum flattens,

Increase in bloody showbaby Intense contraction every 2 minutes for 60-90 seconds Perineum flattens, with bulging rectum and vagina

Perineum flattens, with bulging rectum and vaginaevery 2 minutes for 60-90 seconds Increase in bloody show Medical interventions Nursing actions Begins after

Medical interventionsshow Perineum flattens, with bulging rectum and vagina Nursing actions Begins after delivery of baby and

Nursing actionswith bulging rectum and vagina Medical interventions Begins after delivery of baby and ends with delivery

rectum and vagina Medical interventions Nursing actions Begins after delivery of baby and ends with delivery

Begins after delivery of baby and ends with delivery of placentaseconds Increase in bloody show Perineum flattens, with bulging rectum and vagina Medical interventions Nursing actions

Shortest stage Lasts 5-20 minutes

Shortest stage Lasts 5-20 minutes

Shortest stage Lasts 5-20 minutes
Shortest stage Lasts 5-20 minutes Mom might have to bear down a little to get the
Shortest stage Lasts 5-20 minutes Mom might have to bear down a little to get the
Mom might have to bear down a little to get the placenta out and have

Mom might have to bear down a little to get the placenta out and have it break away

The area where the placenta tears away is an open wound site, and we will

The area where the placenta tears away is an open wound site, and we will apply pressure at the uterine fundus to discourage bleeding and hemorrhage

Can give pain medicine during this time

Can give pain medicine during this time

Stage 4and hemorrhage Can give pain medicine during this time Begins after delivery of placenta and is

Begins after delivery of placenta and is completed up to 4 hours laterCan give pain medicine during this time Stage 4 Recovery time is typically 1 hour Mechanism

Recovery time is typically 1 hourdelivery of placenta and is completed up to 4 hours later Mechanism of homeostasis occurs Ideal

Mechanism of homeostasis occursup to 4 hours later Recovery time is typically 1 hour Ideal time for breastfeeding and

Ideal time for breastfeeding and bondingtime is typically 1 hour Mechanism of homeostasis occurs Greatest risk is from hemorrhage secondary to

Greatest risk is from hemorrhage secondary to uterine atonyhomeostasis occurs Ideal time for breastfeeding and bonding Continue to monitor fundus and make sure it

Continue to monitor fundus and make sure it says firmGreatest risk is from hemorrhage secondary to uterine atony Cervical Exam Findings Cervical e ff acement

Cervical Exam Findings

Cervical e ff acement acement

Thinning of cervix as it is ‘taken up’ into lower part of uterine segment Expressed
Thinning of cervix as it is ‘taken up’ into lower part of uterine segment
Expressed in percents
100% is completely eff aced

Dilationsegment Expressed in percents 100% is completely eff aced Opening of cervix 0-10 cm Ten centimeters

Opening of cervixExpressed in percents 100% is completely eff aced Dilation 0-10 cm Ten centimeters is "complete" Station

0-10 cm100% is completely eff aced Dilation Opening of cervix Ten centimeters is "complete" Station Relationship

Ten centimeters is "complete"is completely eff aced Dilation Opening of cervix 0-10 cm Station Relationship of presenting part (PP)

Stationof cervix 0-10 cm Ten centimeters is "complete" Relationship of presenting part (PP) to spines (ischial

Relationship of presenting part (PP) to spines (ischial spines in pelvis)Opening of cervix 0-10 cm Ten centimeters is "complete" Station Progresses from negative to positive numbers

Progresses from negative to positive numberscm Ten centimeters is "complete" Station Relationship of presenting part (PP) to spines (ischial spines in

Negative not to see your baby, so if the baby is higher up than the

Negative not to see your baby, so if the baby is higher up than the ischial spines then the numbers are negativeNumbers going down and out the birth canal are positive Pain and the Laboring Woman

Numbers going down and out the birth canal are positiveup than the ischial spines then the numbers are negative Pain and the Laboring Woman Realize

Pain and the Laboring Woman

Realize that pain is highly individualizedout the birth canal are positive Pain and the Laboring Woman Varies with cultures Even request

Varies with cultures

Varies with cultures

Even request no medication as a result of their culture

Even request no medication as a result of their culture

May have fear of epidural

May have fear of epidural

May vary with cultureas a result of their culture May have fear of epidural Individual perception Fear and anxiety

Individual perceptionculture May have fear of epidural May vary with culture Fear and anxiety association RN should

Fear and anxiety associationfear of epidural May vary with culture Individual perception RN should assess needs, o ff er

RN should assess needs, o ff er teaching, and o ff er non-pharmacological relief (CAM) Guided imagery, using a Doula er teaching, and o er non-pharmacological relief (CAM) Guided imagery, using a Doula (birthing coach), lighting, music, aromatherapy, etc.

If these are ineff ective, other methods may be requested Pharmacologic methods ective, other methods may be requested Pharmacologic methods

ective, other methods may be requested Pharmacologic methods IV sedation Sedatives Narcotics The baby may need
ective, other methods may be requested Pharmacologic methods IV sedation Sedatives Narcotics The baby may need

IV sedation Sedativesective, other methods may be requested Pharmacologic methods Narcotics The baby may need Narcan after birth

may be requested Pharmacologic methods IV sedation Sedatives Narcotics The baby may need Narcan after birth

Narcotics The baby may need Narcan after birth if narcotics are used as a pain medicine Must have Narcan available

are used as a pain medicine Must have Narcan available Nerve blocks Pudendals Just nerve blocking

Nerve blocks Pudendalsare used as a pain medicine Must have Narcan available Just nerve blocking saddle area Not

medicine Must have Narcan available Nerve blocks Pudendals Just nerve blocking saddle area Not very common
medicine Must have Narcan available Nerve blocks Pudendals Just nerve blocking saddle area Not very common

Just nerve blocking saddle area Not very common Spinals Done with a C-section If the woman already has an epidural, they will change the

saddle area Not very common Spinals Done with a C-section If the woman already has an
saddle area Not very common Spinals Done with a C-section If the woman already has an
saddle area Not very common Spinals Done with a C-section If the woman already has an
saddle area Not very common Spinals Done with a C-section If the woman already has an
medication in the epidural to convert the anesthesia Epidurals Before Asess, educate, and document Epidurals

medication in the epidural to convert the anesthesia Epidurals

Before Asess, educate, and documentin the epidural to convert the anesthesia Epidurals Epidurals can cause hypotension, so try to give

the anesthesia Epidurals Before Asess, educate, and document Epidurals can cause hypotension, so try to give

Epidurals can cause hypotension, so try to give her lots of fluidsthe anesthesia Epidurals Before Asess, educate, and document Mom is lifeline to baby, and if she

Mom is lifeline to baby, and if she loses blood pressure, the baby will lose circulationcan cause hypotension, so try to give her lots of fluids During Assist healthcare provider After

if she loses blood pressure, the baby will lose circulation During Assist healthcare provider After Assess

During Assist healthcare providerif she loses blood pressure, the baby will lose circulation After Assess and monitor General anesthesia

Afterbaby will lose circulation During Assist healthcare provider Assess and monitor General anesthesia Reserved for emergency

Assess and monitorlose circulation During Assist healthcare provider After General anesthesia Reserved for emergency deliveries

During Assist healthcare provider After Assess and monitor General anesthesia Reserved for emergency deliveries

General anesthesia

Reserved for emergency deliveriesprovider After Assess and monitor General anesthesia Operative Vaginal Birth What is it? Using tools to

Operative Vaginal Birth

What is it?Reserved for emergency deliveries Operative Vaginal Birth Using tools to get the baby out vaginally Episiotomy

Using tools to get the baby out vaginallyfor emergency deliveries Operative Vaginal Birth What is it? Episiotomy Forceps Vacuum Indications Pushing too long

Episiotomy Forceps Vacuum
Episiotomy
Forceps
Vacuum

Indicationstools to get the baby out vaginally Episiotomy Forceps Vacuum Pushing too long and the baby’s

Pushing too long and the baby’s heart rate goes downOperative Vaginal Birth What is it? Using tools to get the baby out vaginally Episiotomy Forceps

Needing to shorten the pushing stageContraindications If it will compromise the baby’s health, do a c-section instead Cephalopelvic disproportion (baby’s

ContraindicationsNeeding to shorten the pushing stage If it will compromise the baby’s health, do a c-section

If it will compromise the baby’s health, do a c-section insteadNeeding to shorten the pushing stage Contraindications Cephalopelvic disproportion (baby’s head too big for the pelvis)

Cephalopelvic disproportion (baby’s head too big for the pelvis)will compromise the baby’s health, do a c-section instead Risks Forceps can cause nerve damage to

Risksdisproportion (baby’s head too big for the pelvis) Forceps can cause nerve damage to face or

Forceps can cause nerve damage to face or neck The physician cannot do this unless it at least +2 stationdisproportion (baby’s head too big for the pelvis) Risks Can cause bruising or soft tissue damage

Can cause bruising or soft tissue damage on baby’s headThe physician cannot do this unless it at least +2 station Technique The physician only pulls

Can cause bruising or soft tissue damage on baby’s head Technique The physician only pulls when

TechniqueCan cause bruising or soft tissue damage on baby’s head The physician only pulls when the

The physician only pulls when the mom is pushingbruising or soft tissue damage on baby’s head Technique Episiotomy Types Midline or medio-lateral Extend First

Episiotomy

TypesThe physician only pulls when the mom is pushing Episiotomy Midline or medio-lateral Extend First through

Midline or medio-lateral
Midline or medio-lateral

Extendthe mom is pushing Episiotomy Types Midline or medio-lateral First through fourth degree Usually only cut

First through fourth degreeis pushing Episiotomy Types Midline or medio-lateral Extend Usually only cut to the second degree, and

Usually only cut to the second degree, and may tear beyond that to fourth degree Often more likely to continue tearing once you’ve been cutMidline or medio-lateral Extend First through fourth degree Purpose To enlarge vaginal opening Possible alternatives

Often more likely to continue tearing once you’ve been cut Purpose To enlarge vaginal opening Possible

PurposeOften more likely to continue tearing once you’ve been cut To enlarge vaginal opening Possible alternatives

To enlarge vaginal openinglikely to continue tearing once you’ve been cut Purpose Possible alternatives Warm compresses Ice packs for

Possible alternativesonce you’ve been cut Purpose To enlarge vaginal opening Warm compresses Ice packs for afterwards to

Warm compressescut Purpose To enlarge vaginal opening Possible alternatives Ice packs for afterwards to control swelling Manual

Ice packs for afterwards to control swellingvaginal opening Possible alternatives Warm compresses Manual support Massage Perineal massage during pushing to

Manual supportWarm compresses Ice packs for afterwards to control swelling Massage Perineal massage during pushing to help

Massage Perineal massage during pushing to help stretchIce packs for afterwards to control swelling Manual support Nursing considerations Colace, sitz baths, etc. Cesarean

Massage Perineal massage during pushing to help stretch Nursing considerations Colace, sitz baths, etc. Cesarean

Nursing considerationsMassage Perineal massage during pushing to help stretch Colace, sitz baths, etc. Cesarean Birth Birth of

Colace, sitz baths, etc.during pushing to help stretch Nursing considerations Cesarean Birth Birth of fetus through incision in abdomen

Cesarean Birth

Birth of fetus through incision in abdomen and uteruspushing to help stretch Nursing considerations Colace, sitz baths, etc. Cesarean Birth Planned or emergency Indications

Planned or emergencyconsiderations Colace, sitz baths, etc. Cesarean Birth Birth of fetus through incision in abdomen and uterus

IndicationsColace, sitz baths, etc. Cesarean Birth Birth of fetus through incision in abdomen and uterus Planned

Baby didn’t tolerate laborBaby is breech Mom or baby could be in distress Contraindications Maternal and fetal risks

Baby is breechBaby didn’t tolerate labor Mom or baby could be in distress Contraindications Maternal and fetal risks

Mom or baby could be in distressBaby didn’t tolerate labor Baby is breech Contraindications Maternal and fetal risks Excess fluid in lungs

Contraindicationslabor Baby is breech Mom or baby could be in distress Maternal and fetal risks Excess

Maternal and fetal risksis breech Mom or baby could be in distress Contraindications Excess fluid in lungs for baby

Excess fluid in lungs for baby since it is not squeezed through birth canalbe in distress Contraindications Maternal and fetal risks Nursing considerations It is major surgery and treated

Nursing considerationslungs for baby since it is not squeezed through birth canal It is major surgery and

It is major surgery and treated as suchis not squeezed through birth canal Nursing considerations Still have to massage fundus Could be incredibly

Still have to massage fundus Could be incredibly painful with surgical incisionconsiderations It is major surgery and treated as such Fetal and Maternal Monitoring Assessment of uterine

fundus Could be incredibly painful with surgical incision Fetal and Maternal Monitoring Assessment of uterine

Fetal and Maternal Monitoring

Assessment of uterine contractionspainful with surgical incision Fetal and Maternal Monitoring External vs. internal Internal (AKA tugboat) Duration,

External vs. internaland Maternal Monitoring Assessment of uterine contractions Internal (AKA tugboat) Duration, frequency, and intensity

Internal (AKA tugboat)
Internal (AKA tugboat)

Duration, frequency, and intensitycontractions External vs. internal Internal (AKA tugboat) Assessment of FHR Internal Intradermal needle in baby’s

Assessment of FHRInternal (AKA tugboat) Duration, frequency, and intensity Internal Intradermal needle in baby’s fontanel Baseline

InternalDuration, frequency, and intensity Assessment of FHR Intradermal needle in baby’s fontanel Baseline rate

Intradermal needle in baby’s fontanel
Intradermal needle in baby’s fontanel

Baseline rateof FHR Internal Intradermal needle in baby’s fontanel Periodic vs. non-periodic changes i.e. changes that occur

Periodic vs. non-periodic changes i.e. changes that occur when there is a contractionIntradermal needle in baby’s fontanel Baseline rate Presence of reassuring signs Presence of non-reassuring

Presence of reassuring signschanges i.e. changes that occur when there is a contraction Presence of non-reassuring signs Is the

Presence of non-reassuring signs Is the baby in distress?rate Periodic vs. non-periodic changes i.e. changes that occur when there is a contraction Presence of

occur when there is a contraction Presence of reassuring signs Presence of non-reassuring signs Is the
occur when there is a contraction Presence of reassuring signs Presence of non-reassuring signs Is the

Assessing Uterine Activity

Assessing Uterine Activity For FHR Time going on x axis BPM going up and down Contractions

For FHR Time going on x axisAssessing Uterine Activity BPM going up and down Contractions How high up it is shows its

Assessing Uterine Activity For FHR Time going on x axis BPM going up and down Contractions

BPM going up and downAssessing Uterine Activity For FHR Time going on x axis Contractions How high up it is

ContractionsActivity For FHR Time going on x axis BPM going up and down How high up

How high up it is shows its intensity But mainly only with intrauterine monitoring How
How high up it is shows its intensity
But mainly only with intrauterine monitoring
How wide it is shows its duration
You can also see frequency (beginning to beginning)

Assessment of FHR

Baseline rate is 110 to 160, determined between contractionsduration You can also see frequency (beginning to beginning) Assessment of FHR Periodic changes vs. non-periodic

Periodic changes vs. non-periodic changesalso see frequency (beginning to beginning) Assessment of FHR Baseline rate is 110 to 160, determined

Consider heart rate relationship to contractions Reassuring signs (baby is doing well) Accelerations, variability in

Consider heart rate relationship to contractions

Reassuring signs (baby is doing well)Consider heart rate relationship to contractions Accelerations, variability in heart rate An increase in fetal heart

to contractions Reassuring signs (baby is doing well) Accelerations, variability in heart rate An increase in

Accelerations, variability in heart rate An increase in fetal heart rate above baseline

in heart rate An increase in fetal heart rate above baseline Must be at least 15

Must be at least 15 beats above baseline and last for at least 15 seconds Causesin heart rate An increase in fetal heart rate above baseline Fetal movement, contractions, sounds or

beats above baseline and last for at least 15 seconds Causes Fetal movement, contractions, sounds or
beats above baseline and last for at least 15 seconds Causes Fetal movement, contractions, sounds or

Fetal movement, contractions, sounds or scalp stimulation Presence of accelerations indicates positive fetal well beingbeats above baseline and last for at least 15 seconds Causes Decelerations Early deceleration Head compression

of accelerations indicates positive fetal well being Decelerations Early deceleration Head compression Vagal

Decelerations

indicates positive fetal well being Decelerations Early deceleration Head compression Vagal response as it is

Early deceleration Head compression Vagal response as it is in the birth canal Mirrors contractions (goes down as a contraction happens)

Head compression Vagal response as it is in the birth canal Mirrors contractions (goes down as
Head compression Vagal response as it is in the birth canal Mirrors contractions (goes down as
Head compression Vagal response as it is in the birth canal Mirrors contractions (goes down as
By the time the contraction is over, the heart rate is back to normal Baby
By the time the contraction is over, the heart rate is back to normal
Baby is adjusting to new and di ff erent environment in birth canal
Treatment
None is needed; it is common to see this type of a decel in this stage of
labor
If cervix has not been checked, assess
If these decels are happening at only 4 cm, it may indicate CPD
these decels are happening at only 4 cm, it may indicate CPD May indicate cephalopelvic disproportion

May indicate cephalopelvic disproportion (CPD) Fetal head larger than maternal pelvis Treatment for CPD is a cesarean section Late deceleration

Treatment for CPD is a cesarean section Late deceleration Impaired uteroplacental function Delay in beginning and
Treatment for CPD is a cesarean section Late deceleration Impaired uteroplacental function Delay in beginning and
Treatment for CPD is a cesarean section Late deceleration Impaired uteroplacental function Delay in beginning and
Impaired uteroplacental function Delay in beginning and end of deceleration in relation to contractions The
Impaired uteroplacental function
Delay in beginning and end of deceleration in relation to contractions
The decel happens after the contraction starts, and the recovery is taking
longer
The baby will not be able to recover between stress of contractions
Caused by utero-placental insu fficiency
Placenta not delivering adequate blood supply to fetus

Placenta not delivering adequate blood supply to fetus

Post due-date, the placenta is “old”

Post due-date, the placenta is “old”

supply to fetus Post due-date, the placenta is “old” Hypertonic contractions (too strong) causes hyper

Hypertonic contractions (too strong) causes hyper stimulation to the baby Treatmentsupply to fetus Post due-date, the placenta is “old” Reposition patient onto side Increases blood flow

Reposition patient onto side Increases blood flow through mom’s vena cava(too strong) causes hyper stimulation to the baby Treatment This is the priority if the patient

onto side Increases blood flow through mom’s vena cava This is the priority if the patient

This is the priority if the patient is not on oxytocinonto side Increases blood flow through mom’s vena cava Discontinue pitocin (which could be amplifying contractions)

Discontinue pitocin (which could be amplifying contractions) This is the first priority in a patient on oxytocin It is the least invasivecava This is the priority if the patient is not on oxytocin Hydration and oxygen C-section

Hydration and oxygenpriority in a patient on oxytocin It is the least invasive C-section if the heart rate

C-section if the heart rate pattern persistson oxytocin It is the least invasive Hydration and oxygen Variable deceleration Cord compression Vary in

and oxygen C-section if the heart rate pattern persists Variable deceleration Cord compression Vary in timing,
and oxygen C-section if the heart rate pattern persists Variable deceleration Cord compression Vary in timing,

Variable decelerationand oxygen C-section if the heart rate pattern persists Cord compression Vary in timing, shape, depth

Cord compression Vary in timing, shape, depth with relation to contractions Not related at all
Cord compression
Vary in timing, shape, depth with relation to contractions
Not related at all to the contraction pattern
If it is a sudden drop with rapid return (v-shape), it is a variable decel
Causes Cord compression

Causes Cord compression

Causes Cord compression
Causes Cord compression

Cord may be wrapped around neck or elsewhere and cause decelerations during a contraction

Severity is measured by the depth and duration of deceleration

Severity is measured by the depth and duration of deceleration

Treatment

Treatment

Treatment
Treatment
Treatment
Treatment

Reposition

Replace fluid with amnioinfusion

C-section may be indicated if decelerations become too severe

If the decels are becoming too deep and/or too wide

FHR

If the decels are becoming too deep and/or too wide FHR VEAL CHOP MINE Variable -

VEAL CHOP MINE Variable - Cord compression - Move patient Early - Head compression - Identify labor progress Accel - Okay! - No action needed Late - Placental insuciency - Execute action immediately

- Identify labor progress Accel - Okay! - No action needed Late - Placental insu ffi
- Identify labor progress Accel - Okay! - No action needed Late - Placental insu ffi
- Identify labor progress Accel - Okay! - No action needed Late - Placental insu ffi
- Identify labor progress Accel - Okay! - No action needed Late - Placental insu ffi

Evaluation of Fetal Monitoring

Review strips Moderate variability (the amount the FHR fluctuates on a strip)Evaluation of Fetal Monitoring Marked variability (the amount the FHR fluctuates on a strip) Calm variability

variability (the amount the FHR fluctuates on a strip) Marked variability (the amount the FHR fluctuates
Marked variability (the amount the FHR fluctuates on a strip) Calm variability
Marked variability (the amount the FHR fluctuates on a strip) Calm variability

Marked variability (the amount the FHR fluctuates on a strip) Calm variability

Marked variability (the amount the FHR fluctuates on a strip) Calm variability

Could be sleeping, but after about 20-30 minutes, the baby should wake up(the amount the FHR fluctuates on a strip) Calm variability Or could be a baby whose

Or could be a baby whose mom just got narcoticsbut after about 20-30 minutes, the baby should wake up Baseline FHR Periodic and episodic changes

Baseline FHRwake up Or could be a baby whose mom just got narcotics Periodic and episodic changes

Periodic and episodic changesOr could be a baby whose mom just got narcotics Baseline FHR Need for nursing care

Need for nursing care Position change Stop oxytocin Oxygen Notify healthcare providergot narcotics Baseline FHR Periodic and episodic changes Questions Interpretation of variability for this strip would

change Stop oxytocin Oxygen Notify healthcare provider Questions Interpretation of variability for this strip would
change Stop oxytocin Oxygen Notify healthcare provider Questions Interpretation of variability for this strip would
change Stop oxytocin Oxygen Notify healthcare provider Questions Interpretation of variability for this strip would
change Stop oxytocin Oxygen Notify healthcare provider Questions Interpretation of variability for this strip would

Questions

Interpretation of variability for this strip would be Absent variability Minimal variability Moderate variability
Interpretation of variability for this strip would be
Absent variability
Minimal variability
Moderate variability
Marked variability
Interpretation of deceleration for this strip would be
Early decel Variable decel Late decel Acceleration Interpretation of the baseline for this strip would
Early decel
Variable decel
Late decel
Acceleration
Interpretation of the baseline for this strip would be

Normaldecel Late decel Acceleration Interpretation of the baseline for this strip would be Bradycardia Tachycardia Combined

Bradycardiadecel Late decel Acceleration Interpretation of the baseline for this strip would be Normal Tachycardia Combined

Tachycardiadecel Late decel Acceleration Interpretation of the baseline for this strip would be Normal Bradycardia Combined

Combineddecel Late decel Acceleration Interpretation of the baseline for this strip would be Normal Bradycardia Tachycardia

September 18

***Pay attention to the IHI Map on Well Newborn Care***

Under “Additional Resources” on the learning module page with the powerpoint18 ***Pay attention to the IHI Map on Well Newborn Care*** This also helps with other

This also helps with other material outside of OB (ICU, peds, community, etc.)Resources” on the learning module page with the powerpoint "Well Newborn Care" is all the way

"Well Newborn Care" is all the way at the bottom Click on it, and there are some important newborn overviews, outcomes, and other information (and things that the academy of pediatrics looks at)other material outside of OB (ICU, peds, community, etc.) “Key Measures” are currently being looked at

(and things that the academy of pediatrics looks at) “Key Measures” are currently being looked at
(and things that the academy of pediatrics looks at) “Key Measures” are currently being looked at

“Key Measures” are currently being looked at by JC (Joint Commission) and IHI THESE MIGHT SHOW UP ON AN EXAM

JC (Joint Commission) and IHI THESE MIGHT SHOW UP ON AN EXAM Chapters 19-23: Normal Newborn

Chapters 19-23: Normal Newborn

Neonatal Period

Definition From birth to first 28 days of lifeUP ON AN EXAM Chapters 19-23: Normal Newborn Neonatal Period Focus of nursing care (even though

Focus of nursing care (even though the nurses will not be around for all of those days) Maintain body heat Maintain respiratory function Decrease risk of infection Assist parents in providing appropriate nutrition and hydration Assist parents in learning to care for their newbornPeriod Definition From birth to first 28 days of life Initiation of Respirations Physiological changes Mechanical,

Assist parents in learning to care for their newborn Initiation of Respirations Physiological changes Mechanical,
Assist parents in learning to care for their newborn Initiation of Respirations Physiological changes Mechanical,
Assist parents in learning to care for their newborn Initiation of Respirations Physiological changes Mechanical,
Assist parents in learning to care for their newborn Initiation of Respirations Physiological changes Mechanical,
Assist parents in learning to care for their newborn Initiation of Respirations Physiological changes Mechanical,
Assist parents in learning to care for their newborn Initiation of Respirations Physiological changes Mechanical,

Initiation of Respirations

Physiological changes Mechanical, chemical, and sensory stimulito care for their newborn Initiation of Respirations   Exposure to temperature changes, baby hears

changes Mechanical, chemical, and sensory stimuli   Exposure to temperature changes, baby hears
 
Exposure to temperature changes, baby hears sound/sees light
Exposure to temperature changes, baby hears sound/sees light
Exposure to temperature changes, baby hears sound/sees light

Exposure to temperature changes, baby hears sound/sees light

Lungs are filled with amniotic fluid and 30mL is forced out during the

birthing process as it is being squeezed through the birth canal Surfactant

birthing process as it is being squeezed through the birth canal Surfactant

Slippery, detergent-like protein within alveoli that assists in helping the lungs to mature

Helps the alveolar sacs remain partially open at the end of exhalation (so they don’t

Helps the alveolar sacs remain partially open at the end of exhalation (so they don’t collapse)

So, the first breath the baby takes is the hardest one because it has to

So, the first breath the baby takes is the hardest one because it has to open the alveolar sacs for the first time Important in helping the baby breathe

is the hardest one because it has to open the alveolar sacs for the first time
Initiation of first breath

Initiation of first breath

Signs of respiratory distress Cyanosis, apnea, tachycardia, retractions (the muscles retract towards the back bone as they try to breathe), grunting, nasal flaringit has to open the alveolar sacs for the first time Important in helping the baby

tachycardia, retractions (the muscles retract towards the back bone as they try to breathe), grunting, nasal

Cardiovascular Adaptation: From Fetal to Neonatal Circulation

Cardiovascular Adaptation: From Fetal to Neonatal Circulation Physiological changes Initiation of changes Ductus venosus

Physiological changes Initiation of changes Ductus venosus In the umbilical cord, there are two arteries and one vein

In the umbilical cord, there are two arteries and one vein The ductus venosus connects the
In the umbilical cord, there are two arteries and one vein The ductus venosus connects the
In the umbilical cord, there are two arteries and one vein The ductus venosus connects the

The ductus venosus connects the umbilical vein to the vena cava This closes by day three of life and becomes a ligamentIn the umbilical cord, there are two arteries and one vein Foramen ovale Opening between the

cava This closes by day three of life and becomes a ligament Foramen ovale Opening between

Foramen ovale Opening between the right and left atrium Closes when the left atrial pressure is higher than the right atrial pressure Ductus arteriosus Connects the pulmonary artery with the descending aorta Usually closes within 15 hours after birth

descending aorta Usually closes within 15 hours after birth Thermoregulation (very important for a neonate) A
descending aorta Usually closes within 15 hours after birth Thermoregulation (very important for a neonate) A
descending aorta Usually closes within 15 hours after birth Thermoregulation (very important for a neonate) A
descending aorta Usually closes within 15 hours after birth Thermoregulation (very important for a neonate) A

Thermoregulation (very important for a neonate)

A fetus is used to its temperature being regulated in-utero by mom and amniotic fluid, etc.after birth Thermoregulation (very important for a neonate) Now it has to regulate its own temperature

being regulated in-utero by mom and amniotic fluid, etc. Now it has to regulate its own

Now it has to regulate its own temperature When it’s first warm, we warm it o , and wrap it in warm blankets to start the process

o ff , and wrap it in warm blankets to start the process Physiological changes Neutral

Physiological changeso ff , and wrap it in warm blankets to start the process Neutral thermal environment

Neutral thermal environment (NTE) Where a baby has to constantly change its O2 consumption depending on what is going on Sometimes it requires minimal oxygen changes and no body temperature changesin warm blankets to start the process Physiological changes Brown fat Adipose tissue that babies have

Brown fat Adipose tissue that babies have (BAT: brown adipose tissue) Dense and highly vascular tissue Neonates have a lot in their neck, thorax around adrenal glands and kidneys, under arms, etc. Helps them stay warmminimal oxygen changes and no body temperature changes Factors that negatively a ff ect thermoregulation

Factors that negatively aff ect thermoregulation Decreased subcutaneous fat Decreased brown fat in pre-term infants Early babies look ect thermoregulation Decreased subcutaneous fat Decreased brown fat in pre-term infants Early babies look scrawny and thin because they don’t have as much Large body surface Loss of heat from convection, radiation, conduction, and/or evaporation Convection: loss of heat from cooler air currents blowing across them (i.e. oxygen mask or air conditioning vent) Radiation: transfer of heat from neonates to cooler objects that are not in direct contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler substances through

contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
contact with them (i.e. cold walls or isolette) Conduction: transfer of heat from neonates to cooler
direct contact of skin (i.e. cold caregivers’ hands or cold, metal scale) Evaporation: loss of

direct contact of skin (i.e. cold caregivers’ hands or cold, metal scale) Evaporation: loss of heat through water vapors (i.e. when babies get a bath or get wet)

Should get a bath quickly or under a radiant warmerwater vapors (i.e. when babies get a bath or get wet) Cold Stress (excessive heat loss

Cold Stress (excessive heat loss that leads to hypothermia and results in a major decrease in baby’s body temperature… causes them to go to respiratory distress)

Cold stress occurs:temperature… causes them to go to respiratory distress) Decreased environmental temperature causes decreased body

Decreased environmental temperature causes decreased body temperature

Decreased environmental temperature causes decreased body temperature

Decreased body temperature causes increased heart and respiratory rates,

Decreased body temperature causes increased heart and respiratory rates,

increased oxygen consumption, An increased depletion of glucose will cause a decreased amount of surfactant

increased oxygen consumption, An increased depletion of glucose will cause a decreased amount of surfactant

Decreased surfactant leads to respiratory distress

Decreased surfactant leads to respiratory distress

Risk factors Premature neonates SGA: babies that are small for gestational age Babies that are already hypoglycemic and having low blood sugars Babies that had cardiorespiratory issues at birthDecreased surfactant leads to respiratory distress Signs and symptoms Watch and assess for cool skin If

Signs and symptoms Watch and assess for cool skin If you get an axillary temperature of 97 or less, take a rectal temperature Assess for pallor and paleness Are they grunting? Do they have a weak suck? Are they lethargic?sugars Babies that had cardiorespiratory issues at birth Nursing actions Actions to decrease risk At birth,

Nursing actions Actions to decrease riskthey grunting? Do they have a weak suck? Are they lethargic? At birth, dry them o

Are they lethargic? Nursing actions Actions to decrease risk At birth, dry them o ff quickly
Are they lethargic? Nursing actions Actions to decrease risk At birth, dry them o ff quickly
Are they lethargic? Nursing actions Actions to decrease risk At birth, dry them o ff quickly
Are they lethargic? Nursing actions Actions to decrease risk At birth, dry them o ff quickly
Are they lethargic? Nursing actions Actions to decrease risk At birth, dry them o ff quickly
Are they lethargic? Nursing actions Actions to decrease risk At birth, dry them o ff quickly
Are they lethargic? Nursing actions Actions to decrease risk At birth, dry them o ff quickly
Are they lethargic? Nursing actions Actions to decrease risk At birth, dry them o ff quickly
Are they lethargic? Nursing actions Actions to decrease risk At birth, dry them o ff quickly
Are they lethargic? Nursing actions Actions to decrease risk At birth, dry them o ff quickly
Are they lethargic? Nursing actions Actions to decrease risk At birth, dry them o ff quickly
At birth, dry them o ff quickly and move wet blankets away

At birth, dry them o quickly and move wet blankets away

At birth, dry them o ff quickly and move wet blankets away
At birth, dry them o ff quickly and move wet blankets away
At birth, dry them o ff quickly and move wet blankets away
At birth, dry them o ff quickly and move wet blankets away

Wrap them in warm blankets

Put them skin to skin with mom

Put them under radiant warmers

Put a stocking cap on them

them under radiant warmers Put a stocking cap on them Babies lose a lot of heat

Babies lose a lot of heat through their head Swaddle them well with a blanket Actions when neonate displays signs of cold stress

a blanket Actions when neonate displays signs of cold stress Metabolic System Babies become metabolically independent
a blanket Actions when neonate displays signs of cold stress Metabolic System Babies become metabolically independent

Metabolic System

Babies become metabolically independent once they are born and separated from momwhen neonate displays signs of cold stress Metabolic System Regulating their own blood sugars and producing

independent once they are born and separated from mom Regulating their own blood sugars and producing

Regulating their own blood sugars and producing their own insulin

Hypoglycemia (a blood sugar less than 40 for a neonate) Optimal range is 70-100 Risk factors Infants of diabetic momsindependent once they are born and separated from mom Regulating their own blood sugars and producing

Hypoglycemia (a blood sugar less than 40 for a neonate) Optimal range is 70-100 Risk factors
Hypoglycemia (a blood sugar less than 40 for a neonate) Optimal range is 70-100 Risk factors
Hypoglycemia (a blood sugar less than 40 for a neonate) Optimal range is 70-100 Risk factors
LGA: large for gestational age

LGA: large for gestational age

Hypothermia

Hypothermia

Hypothermia
Hypothermia

Respiratory distress

Birth trauma

Signs and symptoms Similar to adults Jittery, irritable, lethargic Spell of apnea Temperature instabilityHypothermia Respiratory distress Birth trauma Nursing actions Assess vital signs Assess glucose Most

Nursing actions Assess vital signs Assess glucose Most hospitals have specific protocols for when to run glucose testsirritable, lethargic Spell of apnea Temperature instability Heel stick for blood sugar based on assessment, too

have specific protocols for when to run glucose tests Heel stick for blood sugar based on
have specific protocols for when to run glucose tests Heel stick for blood sugar based on
have specific protocols for when to run glucose tests Heel stick for blood sugar based on
have specific protocols for when to run glucose tests Heel stick for blood sugar based on
have specific protocols for when to run glucose tests Heel stick for blood sugar based on
have specific protocols for when to run glucose tests Heel stick for blood sugar based on
have specific protocols for when to run glucose tests Heel stick for blood sugar based on
have specific protocols for when to run glucose tests Heel stick for blood sugar based on

Heel stick for blood sugar based on assessment, too Decrease cold stress and keep them warmhave specific protocols for when to run glucose tests Hepatic System Physiological changes Immature at time

Hepatic System

Physiological changestoo Decrease cold stress and keep them warm Hepatic System Immature at time of birth Increase

Immature at time of birthand keep them warm Hepatic System Physiological changes Increase in red blood cell turnover in neonates

Increase in red blood cell turnover in neonatesSystem Physiological changes Immature at time of birth They look yellow, or jaundiced, because bilirubin is

They look yellow, or jaundiced, because bilirubin is trying to leave the body, but the immature liver can’t filter it out fast enoughof birth Increase in red blood cell turnover in neonates Bilirubin conjugation Indirect bilirubin AKA unconjugated

Bilirubin conjugationbut the immature liver can’t filter it out fast enough Indirect bilirubin AKA unconjugated bilirubin Fat-soluble

Indirect bilirubin AKA unconjugated bilirubin Fat-soluble substance produced from the breakdown of RBCs Converted to direct bilirubin This is the kind that causes the yellowish skin colorcan’t filter it out fast enough Bilirubin conjugation Direct bilirubin Comes from indirect bilirubin AKA

Direct bilirubin Comes from indirect bilirubin AKA conjugated bilirubin Water-soluble substance In a form that can be excreted through urine and stool This kind is desirable because we want it to be excreted this wayThis is the kind that causes the yellowish skin color Hyperbilirubinemia Put babies under the “bili-lights”

Hyperbilirubinemia Put babies under the “bili-lights” Must keep their eyes covered because the light can damage their vision Eye covering can only come o ff if they are not under the lights They draw bilirubin levels to make sure if they are not under the lights They draw bilirubin levels to make sure it doesn’t get too high Kernicterus (disease of too high bilirubin) causes brain damage

(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an
(disease of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an

Blood coagulation(disease of too high bilirubin) causes brain damage Vitamin K Should get within an hour of

of too high bilirubin) causes brain damage Blood coagulation Vitamin K Should get within an hour

Vitamin K Should get within an hour of birth IM injection given to prevent hemorrhagic disease

damage Blood coagulation Vitamin K Should get within an hour of birth IM injection given to
damage Blood coagulation Vitamin K Should get within an hour of birth IM injection given to
GI System Stomach In thigh (vasterus lateralis) Vitamin K helps with blood clotting Does not

GI System

StomachGI System In thigh (vasterus lateralis) Vitamin K helps with blood clotting Does not hold much

In thigh (vasterus lateralis) Vitamin K helps with blood clotting

(vasterus lateralis) Vitamin K helps with blood clotting Does not hold much when they are born,

Does not hold much when they are born, but eat more and more as time passes(vasterus lateralis) Vitamin K helps with blood clotting Within 7 days, it can hold about 60

Within 7 days, it can hold about 60 mL every three to four hourswhen they are born, but eat more and more as time passes Gastric emptying is initially

Gastric emptying is initially delayed, but speeds up after the first stool7 days, it can hold about 60 mL every three to four hours Characteristics of stools

Characteristics of stoolsis initially delayed, but speeds up after the first stool Meconium Amniotic fluid can be meconium

Meconiumspeeds up after the first stool Characteristics of stools Amniotic fluid can be meconium stained It

Amniotic fluid can be meconium stained It forms during the fourth gestational month

Amniotic fluid can be meconium stained

Amniotic fluid can be meconium stained It forms during the fourth gestational month
Amniotic fluid can be meconium stained It forms during the fourth gestational month
Amniotic fluid can be meconium stained It forms during the fourth gestational month
Amniotic fluid can be meconium stained It forms during the fourth gestational month
Amniotic fluid can be meconium stained It forms during the fourth gestational month

It forms during the fourth gestational month

This is the first stool (if it was not passed in-utero)

Thick, sticky, black, tarry stool that is passed within 24-48 hours (not

smelly) Sticks to baby’s bottom like glue

Mom and dad may need help changing the diaper

Transitional Begin around the third day and continue for three to four days Black to greenish-brown or greenish-yellow These occur in breast-fed and formula-fed babieslike glue Mom and dad may need help changing the diaper Breast-fed Golden yellow/honey mustard, semi-formed

Breast-fed Golden yellow/honey mustard, semi-formed stool Pasty consistency Smell kind of sourThese occur in breast-fed and formula-fed babies Formula-fed Drier consistency, not quite as yellow More

Formula-fed Drier consistency, not quite as yellow More brownish-yellow Unpleasant odor… really smell badsemi-formed stool Pasty consistency Smell kind of sour Diarrhea Not normal in neonates or infants Loose,

Diarrhea Not normal in neonates or infants Loose, watery, green If they have a watery stool, Not normal in neonates or infants Loose, watery, green If they have a watery stool, the parents need to call a pediatrician

have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature
have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature
have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature
have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature
have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature
have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature
have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature
have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature
have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature
have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature
have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature
have a watery stool, the parents need to call a pediatrician Urinary System Kidney function Immature

Urinary System

Kidney functionthe parents need to call a pediatrician Urinary System Immature at birth This can place them

Immature at birthneed to call a pediatrician Urinary System Kidney function This can place them at risk for

This can place them at risk for over-hydration or dehydrationUrinary System Kidney function Immature at birth Watch for quantity of wet diapers Output How many

Watch for quantity of wet diaperscan place them at risk for over-hydration or dehydration Output How many wet diapers they have

Outputor dehydration Watch for quantity of wet diapers How many wet diapers they have Void about

or dehydration Watch for quantity of wet diapers Output How many wet diapers they have Void

How many wet diapers they have Void about 6 times in a 24 hour period (six wet diapers a day)

about 6 times in a 24 hour period (six wet diapers a day) Use of water

Use of waterabout 6 times in a 24 hour period (six wet diapers a day) Most pediatricians don’t

Most pediatricians don’t recommend giving an extra bottle of water because it isdiapers Output How many wet diapers they have Void about 6 times in a 24 hour

empty calories

**hiccups will go awayempty calories The babies get plenty of fluids from formula or breastmilk, so if they need

The babies get plenty of fluids from formula or breastmilk, so if they need a drink, choose the food that has calories (not water)empty calories **hiccups will go away Immune System Immature at birth Physiological changes Active humoral immunity

Immune System

Immature at birthchoose the food that has calories (not water) Immune System Physiological changes Active humoral immunity When

Physiological changeshas calories (not water) Immune System Immature at birth Active humoral immunity When antibodies are produced

Active humoral immunity When antibodies are produced to help them fight thingswater) Immune System Immature at birth Physiological changes Acquired immunity happens with immunizations Passive

When antibodies are produced to help them fight things Acquired immunity happens with immunizations Passive

Acquired immunity happens with immunizationsWhen antibodies are produced to help them fight things Passive immunity This is not permanent Happens

Passive immunity This is not permanent Happens with antibiotics from the mother to the fetusfight things Acquired immunity happens with immunizations Risk factors for infection Immature defense systems Lack of

Happens with antibiotics from the mother to the fetus Risk factors for infection Immature defense systems
Happens with antibiotics from the mother to the fetus Risk factors for infection Immature defense systems

Risk factors for infectionHappens with antibiotics from the mother to the fetus Immature defense systems Lack of experience with

Immature defense systemsfrom the mother to the fetus Risk factors for infection Lack of experience with di ff

Lack of experience with di ff erent organisms erent organisms

Breakdown of skin (like dry cracks), dry mucous membranessystems Lack of experience with di ff erent organisms To prevent infant infections, good hand washing

To prevent infant infections, good hand washing is key Mom, dad, visitors, caretakers, etc.Breakdown of skin (like dry cracks), dry mucous membranes Periods of Reactivity First period of reactivity

hand washing is key Mom, dad, visitors, caretakers, etc. Periods of Reactivity First period of reactivity

Periods of Reactivity

First period of reactivityMom, dad, visitors, caretakers, etc. Periods of Reactivity Begins at birth and lasts for 30 minutes

etc. Periods of Reactivity First period of reactivity Begins at birth and lasts for 30 minutes

Begins at birth and lasts for 30 minutes Important to be with mom and spend time with her at the beginning They are very active and awake and alert during this time Appear hungry, moving around, respirations and heart rate are up

hungry, moving around, respirations and heart rate are up Good time to try to breast feed
hungry, moving around, respirations and heart rate are up Good time to try to breast feed
hungry, moving around, respirations and heart rate are up Good time to try to breast feed
hungry, moving around, respirations and heart rate are up Good time to try to breast feed

Good time to try to breast feed Don’t be the nurse that does their assessments for thirty minutes Make sure the baby is okay, but let mom be with them at first Finish footprints and long assessments during the period of inactivity

and long assessments during the period of inactivity Period of inactivity Thirty minutes to two hours
and long assessments during the period of inactivity Period of inactivity Thirty minutes to two hours
and long assessments during the period of inactivity Period of inactivity Thirty minutes to two hours

Period of inactivityand long assessments during the period of inactivity Thirty minutes to two hours after birth, they

Thirty minutes to two hours after birth, they fall into a deep sleepduring the period of inactivity Period of inactivity Heart rate and respirations drop Second period of

Heart rate and respirations dropto two hours after birth, they fall into a deep sleep Second period of reactivity Lasts

Second period of reactivitythey fall into a deep sleep Heart rate and respirations drop Lasts 4-6 hours More awake

Lasts 4-6 hoursHeart rate and respirations drop Second period of reactivity More awake and alert Interested in eating,

More awake and alertdrop Second period of reactivity Lasts 4-6 hours Interested in eating, usually pass their meconium stool

Interested in eating, usually pass their meconium stooldrop Second period of reactivity Lasts 4-6 hours More awake and alert Neonatal Assessment Head to

Neonatal Assessment

Head to toe assessmentLasts 4-6 hours More awake and alert Interested in eating, usually pass their meconium stool Neonatal

General survey of the baby when they are bornGeneral survey Review prenatal and labor record for risk factors What has mom’s labor been

General surveyGeneral survey of the baby when they are born Review prenatal and labor record for risk

Review prenatal and labor record for risk factors What has mom’s labor been like?General survey of the baby when they are born General survey Has she had pain meds?

record for risk factors What has mom’s labor been like? Has she had pain meds? Any
Has she had pain meds?

Has she had pain meds?

Has she had pain meds?
Has she had pain meds?

Any drug use?

Etc.

Observe respiratory patternbeen like? Has she had pain meds? Any drug use? Etc. Observe posture Assess skin for

Observe posturemeds? Any drug use? Etc. Observe respiratory pattern Assess skin for color, birthmarks, and birth trauma

Assess skin for color, birthmarks, and birth traumause? Etc. Observe respiratory pattern Observe posture Assess alertness/activity Assess muscle tone Head to toe

Assess alertness/activityposture Assess skin for color, birthmarks, and birth trauma Assess muscle tone Head to toe Posture

Assess muscle tonebirthmarks, and birth trauma Assess alertness/activity Head to toe Posture Head circumference “Cone head” for a

Head to toebirth trauma Assess alertness/activity Assess muscle tone Posture Head circumference “Cone head” for a day or

PostureAssess alertness/activity Assess muscle tone Head to toe Head circumference “Cone head” for a day or

Head circumference “Cone head” for a day or so from coming through the birth canal Usually the head comes first and is the biggest part of the babyalertness/activity Assess muscle tone Head to toe Posture If the head comes through, the rest of

the head comes first and is the biggest part of the baby If the head comes
the head comes first and is the biggest part of the baby If the head comes

If the head comes through, the rest of the baby will, too Microcephalythe head comes first and is the biggest part of the baby Small head Macrocephaly Big

Small head Macrocephaly Big head

baby will, too Microcephaly Small head Macrocephaly Big head Chest circumference Around the nipple line Length
baby will, too Microcephaly Small head Macrocephaly Big head Chest circumference Around the nipple line Length

Chest circumference Around the nipple linebaby will, too Microcephaly Small head Macrocephaly Big head Length Weight Temperature Axillary is taken first

LengthBig head Chest circumference Around the nipple line Weight Temperature Axillary is taken first Rectal is

WeightBig head Chest circumference Around the nipple line Length Temperature Axillary is taken first Rectal is

Temperature Axillary is taken first Rectal is taken, too, to check for patency of the anusChest circumference Around the nipple line Length Weight Respirations Pulse Check all the pulse points throughout

RespirationsRectal is taken, too, to check for patency of the anus Pulse Check all the pulse

Pulseis taken, too, to check for patency of the anus Respirations Check all the pulse points

too, to check for patency of the anus Respirations Pulse Check all the pulse points throughout
too, to check for patency of the anus Respirations Pulse Check all the pulse points throughout
too, to check for patency of the anus Respirations Pulse Check all the pulse points throughout
too, to check for patency of the anus Respirations Pulse Check all the pulse points throughout

Check all the pulse points throughout the assessment

Blood pressure Itty bitty cu ff s with a machine Too tiny to be done manually s with a machine Too tiny to be done manually

Integumentary (important to be pink and pretty and cute) Acrocyanosis Normal (even hours later) The palms of the hands and the soles of the feet stay blue If they are blue around the mouth or the trunk is blue, that is NOT OKAYbitty cu ff s with a machine Too tiny to be done manually Need some oxygen

Need some oxygen Pilonidal dimple At the top of their butt crack Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and its not open to the skin

Headcrack Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and

Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and its
Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and its
Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and its
Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and its
Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and its
Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and its
Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and its
Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and its
Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and its
Pediatricians will sometimes send for an ultrasound to make sure the spine has closed and its

Molding Skull will round up on its ownFontanels Anterior and posterior Caput Swelling of the head that can cross suture lines CAput

FontanelsMolding Skull will round up on its own Anterior and posterior Caput Swelling of the head

Molding Skull will round up on its own Fontanels Anterior and posterior Caput Swelling of the

Anterior and posteriorMolding Skull will round up on its own Fontanels Caput Swelling of the head that can

Caputwill round up on its own Fontanels Anterior and posterior Swelling of the head that can

Swelling of the head that can cross suture lines CAput CAn cross suture lines Like a cap

cross suture lines CAput CAn cross suture lines Like a cap Cephalohematoma Swelling of the head

Cephalohematoma Swelling of the head that does not cross suture linescross suture lines CAput CAn cross suture lines Like a cap Neck/clavicles Eyes Make sure there

Swelling of the head that does not cross suture lines Neck/clavicles Eyes Make sure there are

Neck/claviclesSwelling of the head that does not cross suture lines Eyes Make sure there are no

of the head that does not cross suture lines Neck/clavicles Eyes Make sure there are no

Eyesof the head that does not cross suture lines Neck/clavicles Make sure there are no fractures

Make sure there are no fractures Large babies could fracture a clavicle

are no fractures Large babies could fracture a clavicle In relation to ears Ears Nose Two

In relation to earsare no fractures Large babies could fracture a clavicle Ears Nose Two nares Mouth Feel inside

EarsLarge babies could fracture a clavicle In relation to ears Nose Two nares Mouth Feel inside

Nosebabies could fracture a clavicle In relation to ears Ears Two nares Mouth Feel inside mouth

Two narescould fracture a clavicle In relation to ears Ears Nose Mouth Feel inside mouth Do they

Mouthfracture a clavicle In relation to ears Ears Nose Two nares Feel inside mouth Do they

Feel inside mouth Do they have a suck reflex?a clavicle In relation to ears Ears Nose Two nares Mouth Feel roof of mouth for

Feel roof of mouth for cleft palatenares Mouth Feel inside mouth Do they have a suck reflex? Chest/lungs Cardiac PMI (point of

have a suck reflex? Feel roof of mouth for cleft palate Chest/lungs Cardiac PMI (point of

Chest/lungshave a suck reflex? Feel roof of mouth for cleft palate Cardiac PMI (point of maximum

Cardiacreflex? Feel roof of mouth for cleft palate Chest/lungs PMI (point of maximum impulse) Murmur Abdomen

PMI (point of maximum impulse)Feel roof of mouth for cleft palate Chest/lungs Cardiac Murmur Abdomen Listen for bowel sounds Palpate

Murmurpalate Chest/lungs Cardiac PMI (point of maximum impulse) Abdomen Listen for bowel sounds Palpate abdomen Cord

AbdomenChest/lungs Cardiac PMI (point of maximum impulse) Murmur Listen for bowel sounds Palpate abdomen Cord Two

Listen for bowel soundsCardiac PMI (point of maximum impulse) Murmur Abdomen Palpate abdomen Cord Two arteries and a vein

Palpate abdomenof maximum impulse) Murmur Abdomen Listen for bowel sounds Cord Two arteries and a vein Even

CordMurmur Abdomen Listen for bowel sounds Palpate abdomen Two arteries and a vein Even with the

Two arteries and a veinMurmur Abdomen Listen for bowel sounds Palpate abdomen Cord Even with the cord clamp, you can

Even with the cord clamp, you can see those three vessels at the endbowel sounds Palpate abdomen Cord Two arteries and a vein Extremities Moving all four Vertebral column

Extremitiesthe cord clamp, you can see those three vessels at the end Moving all four Vertebral

Moving all fouryou can see those three vessels at the end Extremities Vertebral column Turn them over and

Vertebral columnthose three vessels at the end Extremities Moving all four Turn them over and run hand

Turn them over and run hand down spineat the end Extremities Moving all four Vertebral column Is it straight? Rectum Rectal temp. for

Is it straight?four Vertebral column Turn them over and run hand down spine Rectum Rectal temp. for patent

RectumTurn them over and run hand down spine Is it straight? Rectal temp. for patent anus

Rectal temp. for patent anusthem over and run hand down spine Is it straight? Rectum Genitourinary Girls Are their labia

Genitourinaryspine Is it straight? Rectum Rectal temp. for patent anus Girls Are their labia minor covered

Girlsstraight? Rectum Rectal temp. for patent anus Genitourinary Are their labia minor covered by the labia

Rectum Rectal temp. for patent anus Genitourinary Girls Are their labia minor covered by the labia

Are their labia minor covered by the labia majora

Pseudomenstruation Little spots of blood in diaper Does not mean they are getting their menses Just a hormonal rush from momRectum Rectal temp. for patent anus Genitourinary Girls Are their labia minor covered by the labia

HypospadiasLittle spots of blood in diaper Does not mean they are getting their menses Just a

Little spots of blood in diaper Does not mean they are getting their menses Just a
Little spots of blood in diaper Does not mean they are getting their menses Just a
Little spots of blood in diaper Does not mean they are getting their menses Just a
Instead of the meatus at the end of the penis, it’s a little bit underneath

Instead of the meatus at the end of the penis, it’s a little bit underneath

Referral to urologist, and instead of circumcising him before discharge, they will use some of
Referral to urologist, and instead of circumcising him before
discharge, they will use some of the foreskin to correct the issue
Epispadias
Instead of the meatus at the end of the penis, it’s more on the top
Hydrocele
Enlarged scrotum due to excess fluid
Sometimes it corrects itself, but usually it doesn’t
May need surgery
Undescended testes
Feel for the testes: has one or both or neither descended

Musculoskeletal Are the baby’s extremities flaccid or toned? Polydactyly Extra digits (too many fingers or toes) Not uncommonFeel for the testes: has one or both or neither descended May have extra on both

Extra digits (too many fingers or toes) Not uncommon May have extra on both or just
Extra digits (too many fingers or toes) Not uncommon May have extra on both or just
Extra digits (too many fingers or toes) Not uncommon May have extra on both or just
Extra digits (too many fingers or toes) Not uncommon May have extra on both or just
Extra digits (too many fingers or toes) Not uncommon May have extra on both or just

May have extra on both or just one hand/foot If it is just skin and there is no bone (skin tags), the pediatrician can tie it o with a suture and it will dry up and fall oIf there is a bone, it will have to be surgically removed Syndactyly Digits are webbed together Usually just a webbing of skin Requires a surgical procedure to split the webbing and separate the fingers or toes

to split the webbing and separate the fingers or toes Neurological Tremors/jitteriness Hypoglycemia Pitch of cry
to split the webbing and separate the fingers or toes Neurological Tremors/jitteriness Hypoglycemia Pitch of cry
to split the webbing and separate the fingers or toes Neurological Tremors/jitteriness Hypoglycemia Pitch of cry
to split the webbing and separate the fingers or toes Neurological Tremors/jitteriness Hypoglycemia Pitch of cry
to split the webbing and separate the fingers or toes Neurological Tremors/jitteriness Hypoglycemia Pitch of cry
to split the webbing and separate the fingers or toes Neurological Tremors/jitteriness Hypoglycemia Pitch of cry

Neurological Tremors/jitteriness Hypoglycemia Pitch of cry High pitches can be due to mom’s drug useto split the webbing and separate the fingers or toes Reflexes Moro/startle Tonic neck On guard

Reflexes Moro/startle Tonic neck On guard in a sword fight Rooting Hungry and looking for nipple Sucking Palmar grasp Stroke palm and they grasp Plantar grasp Stroke bottom of foot and grasp with their toes Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates spinal cord injury Stepping/dancingfingers or toes Neurological Tremors/jitteriness Hypoglycemia Pitch of cry High pitches can be due to mom’s

Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
Babinski Toes fan out Normal reflex up to one year of age Outside of that, indicates
GI/GU Stool Urine Genitalia Skin Breasts Hair and nails Born with hair and nails Gestational

GI/GU

StoolGI/GU Urine Genitalia Skin Breasts Hair and nails Born with hair and nails Gestational Age Assessment

UrineGI/GU Stool Genitalia Skin Breasts Hair and nails Born with hair and nails Gestational Age Assessment

GenitaliaGI/GU Stool Urine Skin Breasts Hair and nails Born with hair and nails Gestational Age Assessment

SkinGI/GU Stool Urine Genitalia Breasts Hair and nails Born with hair and nails Gestational Age Assessment

BreastsGI/GU Stool Urine Genitalia Skin Hair and nails Born with hair and nails Gestational Age Assessment

Hair and nails Born with hair and nailsGI/GU Stool Urine Genitalia Skin Breasts Gestational Age Assessment Ballad Maturational Score Sometimes called Dubowitz

Skin Breasts Hair and nails Born with hair and nails Gestational Age Assessment Ballad Maturational Score

Gestational Age Assessment

Ballad Maturational Scorenails Born with hair and nails Gestational Age Assessment Sometimes called Dubowitz (Dubowitz neurological

Sometimes called Dubowitz (Dubowitz neurological examination)

Sometimes called Dubowitz (Dubowitz neurological examination)

Seen in textbook and in learning modules

Seen in textbook and in learning modules

Determines gestational maturity of infants

Determines gestational maturity of infants

Physical and neuromuscular maturitymodules Determines gestational maturity of infants To see how the baby developed Where does the baby

To see how the baby developed Where does the baby fall in the following categories?maturity of infants Physical and neuromuscular maturity SGA: small for gestational age Below the 10th percentile

Where does the baby fall in the following categories? SGA: small for gestational age Below the

SGA: small for gestational age Below the 10th percentile for gestational ageWhere does the baby fall in the following categories? AGA: appropriate for gestational age LGA: large

AGA: appropriate for gestational ageage Below the 10th percentile for gestational age LGA: large for gestational age Above the 90th

LGA: large for gestational age Above the 90th percentile for gestational agefor gestational age AGA: appropriate for gestational age Pain Assessment Assess baby just like adults, they

age Above the 90th percentile for gestational age Pain Assessment Assess baby just like adults, they
age Above the 90th percentile for gestational age Pain Assessment Assess baby just like adults, they

Pain Assessment

Assess baby just like adults, they just can’t tell us they are hurting Do this if we were doing blood work, injection, heel stick, circumcision, etc.the 90th percentile for gestational age Pain Assessment Gave “sweeties” (sugar water) Reassess pain after event

doing blood work, injection, heel stick, circumcision, etc. Gave “sweeties” (sugar water) Reassess pain after event
doing blood work, injection, heel stick, circumcision, etc. Gave “sweeties” (sugar water) Reassess pain after event

Gave “sweeties” (sugar water) Reassess pain after eventdoing blood work, injection, heel stick, circumcision, etc. Document intervention (i.e. swaddling tight, cuddled,

Document intervention (i.e. swaddling tight, cuddled, comforted, etc.)Gave “sweeties” (sugar water) Reassess pain after event Sources of pain Premature Infant Pain Profile (PIPP)

Sources of pain(i.e. swaddling tight, cuddled, comforted, etc.) Premature Infant Pain Profile (PIPP) Neonatal Infant Pain

Premature Infant Pain Profile (PIPP)swaddling tight, cuddled, comforted, etc.) Sources of pain Neonatal Infant Pain Scale (NIPS) Early Care Administering

Neonatal Infant Pain Scale (NIPS)etc.) Sources of pain Premature Infant Pain Profile (PIPP) Early Care Administering vitamin K (within 1

Early Care

Administering vitamin K (within 1 hour) Infants cannot synthesize vitamin K Prevents bleeding problems IMProfile (PIPP) Neonatal Infant Pain Scale (NIPS) Early Care Providing eye treatment (within 1 hour) Erythromycin

Providing eye treatment (within 1 hour) Erythromycin ophthalmic ointment Prevents ophthalmia neonatorumK (within 1 hour) Infants cannot synthesize vitamin K Prevents bleeding problems IM Injects from syphilis

(within 1 hour) Erythromycin ophthalmic ointment Prevents ophthalmia neonatorum Injects from syphilis or gonorrhea
(within 1 hour) Erythromycin ophthalmic ointment Prevents ophthalmia neonatorum Injects from syphilis or gonorrhea
(within 1 hour) Erythromycin ophthalmic ointment Prevents ophthalmia neonatorum Injects from syphilis or gonorrhea
(within 1 hour) Erythromycin ophthalmic ointment Prevents ophthalmia neonatorum Injects from syphilis or gonorrhea
(within 1 hour) Erythromycin ophthalmic ointment Prevents ophthalmia neonatorum Injects from syphilis or gonorrhea

Injects from syphilis or gonorrheaproblems IM Providing eye treatment (within 1 hour) Erythromycin ophthalmic ointment Prevents ophthalmia neonatorum

Squeeze in from inner to outer canthus Cardiorespatory status Positioning status Suctioning secretions Mouth and
Squeeze in from inner to outer canthus Cardiorespatory status Positioning status Suctioning secretions Mouth and

Squeeze in from inner to outer canthus

Cardiorespatory status Positioning status

to outer canthus Cardiorespatory status Positioning status Suctioning secretions Mouth and then nose Close

Suctioning secretions

Suctioning secretions Mouth and then nose Close observation
Suctioning secretions Mouth and then nose Close observation

Mouth and then nose Close observationSuctioning secretions

Continuing Care

Thermoregulation Prevent heat loss Perform expanded assessmentsMouth and then nose Close observation Continuing Care Interventions Dry and covered Avoid contact with cold

Interventions Dry and covered Avoid contact with cold surfaces Keep away from drafts Skin to skin with momPrevent heat loss Perform expanded assessments First 4 Hours Universal precautions Maintain body heat Dry

cold surfaces Keep away from drafts Skin to skin with mom First 4 Hours Universal precautions
cold surfaces Keep away from drafts Skin to skin with mom First 4 Hours Universal precautions
cold surfaces Keep away from drafts Skin to skin with mom First 4 Hours Universal precautions
cold surfaces Keep away from drafts Skin to skin with mom First 4 Hours Universal precautions
cold surfaces Keep away from drafts Skin to skin with mom First 4 Hours Universal precautions
cold surfaces Keep away from drafts Skin to skin with mom First 4 Hours Universal precautions

First 4 Hours

Universal precautionsKeep away from drafts Skin to skin with mom First 4 Hours Maintain body heat Dry

Maintain body heat Dry immediatelySkin to skin with mom First 4 Hours Universal precautions Support respirations Apgar score Performed at

Support respirationsUniversal precautions Maintain body heat Dry immediately Apgar score Performed at 1 minute and 5 minutes

Apgar score Performed at 1 minute and 5 minutes Receive 0-2 in 5 categories:Maintain body heat Dry immediately Support respirations Heart rate, color, reflexes, muscle tone, and respirations

at 1 minute and 5 minutes Receive 0-2 in 5 categories: Heart rate, color, reflexes, muscle
at 1 minute and 5 minutes Receive 0-2 in 5 categories: Heart rate, color, reflexes, muscle
at 1 minute and 5 minutes Receive 0-2 in 5 categories: Heart rate, color, reflexes, muscle
at 1 minute and 5 minutes Receive 0-2 in 5 categories: Heart rate, color, reflexes, muscle

Heart rate, color, reflexes, muscle tone, and respirations Total score will be between 0 and 10 Review Clinical Skills (Apgar Score) in Sherpath

0 and 10 Review Clinical Skills (Apgar Score) in Sherpath Vital signs Identifying bands Number on
0 and 10 Review Clinical Skills (Apgar Score) in Sherpath Vital signs Identifying bands Number on

Vital signs0 and 10 Review Clinical Skills (Apgar Score) in Sherpath Identifying bands Number on baby’s band

Identifying bands Number on baby’s band that matches mom and dad’s bracelet BEFORE they ever leave to go to the nursery Most hospitals also have alarm systems Beep if baby is close to an exit Doors lock if baby gets closer to exitReview Clinical Skills (Apgar Score) in Sherpath Vital signs Neonatal assessment Gestational age assessment Administer

Neonatal assessmentis close to an exit Doors lock if baby gets closer to exit Gestational age assessment

Gestational age assessmentDoors lock if baby gets closer to exit Neonatal assessment Administer erythromycin ophthalmic ointment Administer

Administer erythromycin ophthalmic ointmentto exit Neonatal assessment Gestational age assessment Administer vitamin K injection Bath with neutral pH soap

Administer vitamin K injectionage assessment Administer erythromycin ophthalmic ointment Bath with neutral pH soap Get vernix o ff If

Bath with neutral pH soap Get vernix o ff If they maintain their temperature Dress them all up to send back to momma If they maintain their temperature Dress them all up to send back to momma

Promote parent infant attachmentBath with neutral pH soap Get vernix o ff If they maintain their temperature Dress them

vernix o ff If they maintain their temperature Dress them all up to send back to
vernix o ff If they maintain their temperature Dress them all up to send back to
vernix o ff If they maintain their temperature Dress them all up to send back to
vernix o ff If they maintain their temperature Dress them all up to send back to
vernix o ff If they maintain their temperature Dress them all up to send back to
vernix o ff If they maintain their temperature Dress them all up to send back to
vernix o ff If they maintain their temperature Dress them all up to send back to
vernix o ff If they maintain their temperature Dress them all up to send back to

Care 4 Hours to Discharge

Vital signsCare 4 Hours to Discharge Neonatal assessment Promote parent-infant attachment Promote sibling attachment Prevent infant

Neonatal assessmentCare 4 Hours to Discharge Vital signs Promote parent-infant attachment Promote sibling attachment Prevent infant abduction

Promote parent-infant attachmentCare 4 Hours to Discharge Vital signs Neonatal assessment Promote sibling attachment Prevent infant abduction Tell

Promote sibling attachmentsigns Neonatal assessment Promote parent-infant attachment Prevent infant abduction Tell on admission to not let

Prevent infant abduction Tell on admission to not let anybody take their baby without a name tag with a picturePromote parent-infant attachment Promote sibling attachment People may come to their house and pose as a

anybody take their baby without a name tag with a picture People may come to their

People may come to their house and pose as a community health nurse to take their baby Don’t signify outside that you have had a baby “It’s a Girl” signs, stroller/carseat boxes on the curb, etc.

a Girl” signs, stroller/carseat boxes on the curb, etc. Instruct parents to place neonate on back

Instruct parents to place neonate on back to sleepa Girl” signs, stroller/carseat boxes on the curb, etc. Assist with feedings Provide information on newborn

Assist with feedingsetc. Instruct parents to place neonate on back to sleep Provide information on newborn care Provide

Provide information on newborn careto place neonate on back to sleep Assist with feedings Provide information on normal newborn characteristics

Provide information on normal newborn characteristicsAssist with feedings Provide information on newborn care Providing Other Care Blood glucose Assess all infants

Providing Other Care

Blood glucose Assess all infants for risk factors and signs of hypoglycemia Perform screening test for blood glucose Maintain safe levels per policyon normal newborn characteristics Providing Other Care Bilirubin Assess risk for jaundice Ensure infant is feeding

Bilirubin Assess risk for jaundice Ensure infant is feeding well Explain condition to parentstest for blood glucose Maintain safe levels per policy Providing skin care Bathing As long as

Providing skin care BathingEnsure infant is feeding well Explain condition to parents As long as cord is still attached

Explain condition to parents Providing skin care Bathing As long as cord is still attached Clean
Explain condition to parents Providing skin care Bathing As long as cord is still attached Clean
Explain condition to parents Providing skin care Bathing As long as cord is still attached Clean
Explain condition to parents Providing skin care Bathing As long as cord is still attached Clean
Explain condition to parents Providing skin care Bathing As long as cord is still attached Clean
Explain condition to parents Providing skin care Bathing As long as cord is still attached Clean
Explain condition to parents Providing skin care Bathing As long as cord is still attached Clean
As long as cord is still attached Clean several times a day with alcohol (the

As long as cord is still attached Clean several times a day with alcohol (the cord has no nerve endings or feeling

As long as cord is still attached Clean several times a day with alcohol (the cord
The alcohol makes it dry up

The alcohol makes it dry up

Give baby a sponge bath every day Usually with darker complexion babies (Asian or African
Give baby a sponge bath every day Usually with darker complexion babies (Asian or African
Give baby a sponge bath every day Usually with darker complexion babies (Asian or African
Give baby a sponge bath every day Usually with darker complexion babies (Asian or African
Give baby a sponge bath every day Usually with darker complexion babies (Asian or African
Give baby a sponge bath every day Usually with darker complexion babies (Asian or African
Give baby a sponge bath every day Usually with darker complexion babies (Asian or African
Give baby a sponge bath every day Usually with darker complexion babies (Asian or African
Give baby a sponge bath every day Usually with darker complexion babies (Asian or African
Give baby a sponge bath every day Usually with darker complexion babies (Asian or African

Give baby a sponge bath every day

Give baby a sponge bath every day Usually with darker complexion babies (Asian or African

Usually with darker complexion babies (Asian or African

Fold down front of diaper to give cord some room

Once it falls o, they can give baby a full bath

If they see dark spots on baby, they are not bruises or trauma marks

They are Mongolian spots

American) Babies may have a lot of lenugo (on arms, ears or back)

This rubs o

Sometimes born with a tooth

Milia: white pimples on cheeks or nose

Do not pop, they will go away if left alone

Vernix: may be in groin or armpitsNewborn rash: may look like mosquito bites Cleaning the diaper area Assist with feedings Protecting

Vernix: may be in groin or armpits Newborn rash: may look like mosquito bites Cleaning the

Newborn rash: may look like mosquito bites Cleaning the diaper areaVernix: may be in groin or armpits Assist with feedings Protecting Infant Identification bands Preventing infant

Assist with feedingsrash: may look like mosquito bites Cleaning the diaper area Protecting Infant Identification bands Preventing infant

Protecting Infant

Identification bandsthe diaper area Assist with feedings Protecting Infant Preventing infant abduction Nurse’s role includes teaching

Preventing infant abductionAssist with feedings Protecting Infant Identification bands Nurse’s role includes teaching parents how to safeguard

Nurse’s role includes teaching parents how to safeguard their infantsInfant Identification bands Preventing infant abduction Doors have locks and badge swipes, etc. Preventing infection

Doors have locks and badge swipes, etc.includes teaching parents how to safeguard their infants Preventing infection Scrupulous hand washing Mom needs to

Preventing infectiontheir infants Doors have locks and badge swipes, etc. Scrupulous hand washing Mom needs to watch

Scrupulous hand washingDoors have locks and badge swipes, etc. Preventing infection Mom needs to watch for this, because

Mom needs to watch for this, because baby will be back in hospital with a feverswipes, etc. Preventing infection Scrupulous hand washing Circumcision Reasons for choosing circumcision (not

Circumcision

Reasons for choosing circumcision (not mandatory procedure)baby will be back in hospital with a fever Circumcision Religious reasons More circumcisions in the

Religious reasonsReasons for choosing circumcision (not mandatory procedure) More circumcisions in the south than in the north

More circumcisions in the south than in the northcircumcision (not mandatory procedure) Religious reasons To prevent certain conditions Parental preference Lack of

To prevent certain conditionsreasons More circumcisions in the south than in the north Parental preference Lack of knowledge regarding

Parental preferencein the south than in the north To prevent certain conditions Lack of knowledge regarding care

Lack of knowledge regarding care of the foreskinthe north To prevent certain conditions Parental preference Reasons parents reject circumcision Belief that uncommon

Reasons parents reject circumcisionpreference Lack of knowledge regarding care of the foreskin Belief that uncommon conditions do not necessitate

Belief that uncommon conditions do not necessitate surgery and pain in the infantcare of the foreskin Reasons parents reject circumcision Procedure Done by OB doctors (“surgeons”) as opposed

Procedureconditions do not necessitate surgery and pain in the infant Done by OB doctors (“surgeons”) as

Done by OB doctors (“surgeons”) as opposed to pediatricians

Done by OB doctors (“surgeons”) as opposed to pediatricians

Put on Emla cream or lidocaine to numb the nerves on the penis Gomco Clamp
Put on Emla cream or lidocaine to numb the nerves on the penis Gomco Clamp

Put on Emla cream or lidocaine to numb the nerves on the penis Gomco Clamp

PDF File  
PDF File  

PDF File

 
Loosen foreskin around the glans

Loosen foreskin around the glans

Put metal cone in between

Put metal cone in between

Cut the end of the foreskin away

Cut the end of the foreskin away

Needs vaseline each time they change the diaper Clean well with water (NOT ALCOHOL LIKE

Needs vaseline each time they change the diaper Clean well with water (NOT ALCOHOL LIKE THE CORD)

Needs vaseline each time they change the diaper Clean well with water (NOT ALCOHOL LIKE THE
Vaseline keeps diaper from sticking to circumcision Keep away from diaper wipes just in case

Vaseline keeps diaper from sticking to circumcision Keep away from diaper wipes just in case

CORD) Vaseline keeps diaper from sticking to circumcision Keep away from diaper wipes just in case
PlastiBell

PlastiBell

 
PDF File  
PDF File  

PDF File

 
Insert a plastic ring around the glans, tie a string to put plastic ring in

Insert a plastic ring around the glans, tie a string to put plastic ring in place

5-7 days, the plastic ring will loosen and fall o ff in the diaper in the diaper

Does not require vaseline or anythingthe plastic ring will loosen and fall o ff in the diaper Complications of Circumcision Hemorrhage

Complications of Circumcision

Hemorrhagerequire vaseline or anything Complications of Circumcision Infection Unsatisfactory cosmetic e ff ect Urinary

Infectionor anything Complications of Circumcision Hemorrhage Unsatisfactory cosmetic e ff ect Urinary retention We

Unsatisfactory cosmetic e ff ect ect

Urinary retention We like for them to void within 4-6 hours afterwardsHemorrhage Infection Unsatisfactory cosmetic e ff ect Stenosis or fistula of the urethra Adhesions Necrosis

Stenosis or fistula of the urethraWe like for them to void within 4-6 hours afterwards Adhesions Necrosis Injury to the glans

Adhesions4-6 hours afterwards Stenosis or fistula of the urethra Necrosis Injury to the glans Pain during

Necrosisafterwards Stenosis or fistula of the urethra Adhesions Injury to the glans Pain during and after

Injury to the glansStenosis or fistula of the urethra Adhesions Necrosis Pain during and after surgery Use the sweeties

Pain during and after surgeryof the urethra Adhesions Necrosis Injury to the glans Use the sweeties sugar water and the

Necrosis Injury to the glans Pain during and after surgery Use the sweeties sugar water and

Use the sweeties sugar water and the numbing pain medication prior to the surgeryNecrosis Injury to the glans Pain during and after surgery Signs of Complications Bleeding more than

Signs of Complications

Bleeding more than a few drops with first diaper changespain medication prior to the surgery Signs of Complications Failure to urinate Signs of infection: fever

Failure to urinateBleeding more than a few drops with first diaper changes Signs of infection: fever or low

Signs of infection: fever or low temperature, purulent or foul-smelling drainage Dry, crusty drainage may be normal Not normal if it is foul-smellinga few drops with first diaper changes Failure to urinate Displacement of the PlastiBell It should

Displacement of the PlastiBell It should loosen up and fall off Should not loosen and fall down the shaft of the penis Should not loosen and fall down the shaft of the penis

ff Should not loosen and fall down the shaft of the penis If more penis is
ff Should not loosen and fall down the shaft of the penis If more penis is
ff Should not loosen and fall down the shaft of the penis If more penis is
ff Should not loosen and fall down the shaft of the penis If more penis is

If more penis is visible at the end, call the pediatricianff Should not loosen and fall down the shaft of the penis Immunization Hepatitis B Now

Immunization

is visible at the end, call the pediatrician Immunization Hepatitis B Now included with other routine

Hepatitis B Now included with other routine childhood vaccinations

B Now included with other routine childhood vaccinations Although not required Newborns of hepatitis-positive mothers

Although not required Newborns of hepatitis-positive mothers should receive vaccine and hepatitis immune globulin Newborns of uninfected mothers may also receive the vaccine prior to dischargeB Now included with other routine childhood vaccinations Newborn Screening Hearing loss Most common congenital

Newborn Screening

receive the vaccine prior to discharge Newborn Screening Hearing loss Most common congenital abnormality Newborns

Hearing loss Most common congenital abnormality Newborns should be screened by 1 month of age

discharge Newborn Screening Hearing loss Most common congenital abnormality Newborns should be screened by 1 month
discharge Newborn Screening Hearing loss Most common congenital abnormality Newborns should be screened by 1 month
Metabolic screening Phenylketonuria (PKU) Several drops of blood on a paper that is sent to

Metabolic screening Phenylketonuria (PKU) Several drops of blood on a paper that is sent to the state

Several drops of blood on a paper that is sent to the state Serious disease that
Several drops of blood on a paper that is sent to the state Serious disease that
Several drops of blood on a paper that is sent to the state Serious disease that

Serious disease that can cause them to be mentally retarded Easily treated with a supplement in their diet So every baby is tested for it

a supplement in their diet So every baby is tested for it Hypothyroidism Galactosemia Cannot properly
a supplement in their diet So every baby is tested for it Hypothyroidism Galactosemia Cannot properly

Hypothyroidism Galactosemia Cannot properly metabolize galactose (a milk sugar)

Cannot properly metabolize galactose (a milk sugar) Parents Want to Know Positioning/head support Safe sleep

Parents Want to Know

Positioning/head support Safe sleep (SIDS) American Academy of Pediatrics recommends all infants be placed supine to sleepmetabolize galactose (a milk sugar) Parents Want to Know If the baby turns itself over, that’s

Pediatrics recommends all infants be placed supine to sleep If the baby turns itself over, that’s
Pediatrics recommends all infants be placed supine to sleep If the baby turns itself over, that’s
Pediatrics recommends all infants be placed supine to sleep If the baby turns itself over, that’s

If the baby turns itself over, that’s di erent Avoid overheating Baby’s room should be cool Pacifier use in infants over 1 month of age Sucking can prevent SIDS sometimes Should not sleep in a bed or couch with adults Plagiocephaly (flattened back of the head) Supervised periods of lying prone each day “Tummy time” When the baby is awake

lying prone each day “Tummy time” When the baby is awake Wrapping "Burrito" swaddling Babies breath
lying prone each day “Tummy time” When the baby is awake Wrapping "Burrito" swaddling Babies breath
lying prone each day “Tummy time” When the baby is awake Wrapping "Burrito" swaddling Babies breath
lying prone each day “Tummy time” When the baby is awake Wrapping "Burrito" swaddling Babies breath