ATI MODULE-MATERNAL NEWBORN Christina Graciani

12/13/2021

3rd trimester SOB relief

Maintain: good posture
Use: extra pillows to sleep
Avoid: eating, or drinking too much at once in order to prevent stomach expansion

Abruptio placentae
Premature, partial, or complete separation of: placenta from uterus
s/s : vaginal bleeding, pain in abdomen, uterine contractions

After newborn opens mouth make sure:

cheeks & chin touch the breast, & the mouth covers the nipples.

Antepartum documentation
Health & reproductive hx
Vitals signs
Weiight
Pregnancy confirmation
diagnostic testing results
Calculated/estimated due date,
Current gestational week
Height: fundal
FHR tones
Risk assessment
S/S of : pregnancy, expected physiological changes, complications, any interventions, childbirth

APGAR signs: five signs assessed:v heart rate, respiratory effort, muscle tone, reflex irritability,
& color.
HR, respiratory effort, muscle tone, reflex irritability, color
0-3- severe distress, requires resuscitation-immediately
4-6-moderate difficulty
7-10- minimal or no difficulty
( Lower scores may warrant resuscitative interventions)

Apar HR scoring
0-absent
1-<100bpm
2->100 bpm

APGAR Muscle Tone Scoring

Assess: flexion & movement of extremities
0- flaccid
1- some flexion
2-extremities well flexed

APGAR Respiratory Effort Scoring

0-absent
1-slow weak cry
2-good cry

apgar scoring timing

at 1 minute & again at 5 minutes
score evaluates newborn's ability to adjust to extra-uterine life & ID an resuscitation needs

best practice capillary blood specimen from newborn

heel for blood glucose
-wrap warm moist cloth around heel for 5-10 minutes
-cleanse heel w/ antiseptic
-stabilize foot & puncture outer aspect of heel
-collect blood
-apply pressure w/ dry gauze
-cover w/ adhesive b&age

breastfeeding newborn should have how many diapers per day

6-8 wet 3 stools

circumcision care
-apply petroleum jelly to penis for first 24 hrs to keep diaper from adhering to circ site
-do not use soap or cleansing wipes for at least 5-6 days or until circ has healed
-apply gentle pressure from sterile gauze to control slight bleeding - if continues or if redness,
swelling, pus, odor occurs call provider
-Do not remove yellow exudate from glans after 24 hrs & up to 2-3 days it is part of the healing
process
-apply diaper loosely

color
0-pale or blue
1-pink w/ blue extremities(acrocyanosis)

during assessment of newborn

dry & wrap & place under radiant heat source

During breastfeeding encourages mom to move her newborn..

toward breast to ensure comfortable feeding for both
education preeclampsia
decrease in frequency of urination
report any epigastric or RUQ pain b/c indicate severe pre-eclampsia
call if you do not feel baby at least 4 times per hour
take BP while sitting & support arm at heart level

extrusion
expected newborn response that involves forcing her tongue outward when anything
touches/depresses the tip of her tongue (not useful for breastfeeding but makes ingesting
pureed food difficult until after reflex disappears)

false labor
irregular & subsides or stops w/ walking & comfort measures-cervix does not dilate

FHR can be observed by regular stethoscope/ fetoscope

18-20 weeks

FHR can be observed by ultrasound fetoscope/stethoscope

10th or 11th weeks

For optimal hearing later in pregnancy

use Leopold maneuvers & position ultrasound over fetal back

gestational assessment timeframe

w/in 96 hrs of life if they appear term

gestational diabetes
hyperglycemia, flushed dry skin, fruity breath, rapid breathing, increased thirst/urination

how long should it take adequately nourished newborn to return to birth weight
10-14 days

How much weight gain is expected during pregnancy?

Pre-pregnancy BMI, # of fetus, complicating factors( DM, pre-eclampsia)

Average BMI, single fetus should gain 11.5-16 kg (25-35 lbs)

teen normal weight is same weight gain with special attention on nutritional content >2500
calories/day

Overweight (BMI>25) consume fewer calories & gain 15-25 lbs

how to confirm amniotic membranes have ruptured

nitrazine test for pH- will be alkaline if positive-turn blue/green(6.5), blue-gray (7.0), deep blue
(7.5)

how to prevent mastitis, a breast infection from a fissure or crack in the nipple & progresses to
chills & fever + localized pain, swelling, & redness
position their newborn properly & make sure he grasps areola & not just the nipple. Use your
finger to release suction after feeding to help prevent injury to the nipple. expose nipple to air as
much as possible & wash h&s before touching breasts

hydramnios
excess amount of amniotic fluid- can be difficult to detect FHR

intrapartum care
VS, weight, allergies, childbirth preferences & support person, time & nature of last meal/fluid
intake & output, character & status of labor(stage , phase), ambulation/activity, fetal
status/monitoring/results, amniotic membrane/status/amniotomy, amniotic fluid/bloody show
parameters, uterine activity/contractions, Leopold maneuvers/results, IV catheter insertion,
infusion details, pail level & interventions for pain management, medications/anesthesia,
dilation/ effacement, catheterization, concurrent medical problems, complications, positioning,
urge to push/bearing down efforts, outcome of delivery, time of delivery, clamping /cutting of
cord, placenta delivery

moro reflex
loud/unexpected noise or stimulus demonstrated as an arm flexion & an embracing posture

newborn documentation
date & time of delivery, apgar 1 & 5 min, respiratory status, resuscitation interventions/
suctioning, stimulation, thermal interventions, eye prophylaxis, vitamin K administration, VS,
weight, length, head circumference, gestational assessment, blood glucose, other diagnostic
results, complete physical/body system assessment, feeding, passage of meconium/urine,
jaundice, umbilical cord care, circumcision assessment/care, hearing screening, PKU testing

newborn physical assessment timeframe

w/in 12-18 hrs of life

newborns cheeks & jaw should be what when feeding

rounded & glide smoothly while sucking

A newborn should feed how many times in 24 hrs

8-12 w/in 24 hr

nonstress test
screen evaluating heart rate patterns in response to fetal movement. Position pt in reclining
chair or in semi-fowler's to prevent hypotension have her tilt slightly to one side while doppler
transducer records FHR & tocodynamometer IDs uterine contractions & /or fetal movement
reactive test is expected-2 FHR accelerations in 20 min lasting for 15 seconds & showing an
increase of 15 bmp above baseline
nonreactive test-fail

nuchal cord
umbilical cord encircles newborn's neck

phototherapy can
increase GI motility & cause loose green stools

postpartum documentation
VS, fundal assessment/massage, fundal height, uterine contractions, lochia/clots,
perineum/episiotomy status & interventions, incision/dressing status, pain assessment &
interventions, medications, urinary output/status/diuresis, diaphoresis, breasts/feeding
efforts/interventions, assessment of lower extremities, maternal-newborn bonding

pre-eclampsia
HA, vision changes, epigastric /abdominal pain, edema in face & h&s especially

pre-eclampsia should eat what type of diet?

balanced diet that includes 60-70 g PRO+ 400 mcg folic acid + 1200mg Na+ 11-12 mg zinc +
1.5 g Na
water 48-64 oz/day
sodium <6 g/day

preterm new ballard score

lesser degree of flexion, creases of plantar surface are faint red markings or absent, flat areola
b/c lack of breast tissue, translucent to friable

Reflex irritability
lightly stroke foot
0- none
1-grimace
2-cry

For the patients not planning to breastfeed:

● suppress lactation
● wear -supportive bra first 3 days post delivery.

Engorgement apply: ice packs 15 on 45 off

avoid stimulating breasts, pumping for mils, & decrease warm water: d/t increase milk
production

True labor
contractions occur regularly & get progressively stronger, more frequent, & last longer, intensify
with walking, do not respond to comfort measures, begin in the lower back w. radiation to front,
cervix dilates

When suctioning a newborn's secretions

First suction mouth then nose- to reduce risk of aspiration

insert suction in newborn mouth:

compress bulb
insert tip into side of the mouth

Gestational Age
Determine approximate gestational age of a newborn​: assess six neuromuscular, &
six physical characteristics.

The four Leopold maneuvers are:

Identifying fetal part > uterine fundus to determine fetal lie & the presenting part
Palpating the fetal back to: identify fetal presentation
Determining which fetal part lies over pelvic inlet to identify fetal attitude
Locating the fetal cephalic prominence to identify the attitude of the head

Apgar scoring
A rapid assessment. Performed at 1 minute & again at 5 minutes following newborn’s delivery.
The five signs to assess are heart rate, respiratory effort, muscle tone, reflex irritability, & color.

For each assign a score of 0, 1, or 2. A score of 7 to 10 is within the expected reference range &
indicates that the newborn is adjusting to extrauterine life adequately. Lower scores may
warrant resuscitative interventions.. If a newborn needs resuscitation immediately at delivery,
initiate it before 1-minute Apgar scoring

Gestational Age Assessment

To determine the approximate gestational age of a newborn, assess six neuromuscular & six
physical characteristics. Assessment is called: the New Ballard Score.
It’s appropriate for newborns from 20 to 44 weeks of gestation, with the characteristics to
assess varying with the stage of maturity. Each parameter scores from -1 to 5, with the
cumulative score correlating with a gestational age between 20 & 44 weeks.