Cmca M4-M5

POST PARTUM/ POSTPARTAL PERIOD
 
POSTPARTAL / PUERPERIUM 
▪This refers to the 6 week period after childbirth or

fourth trimester of pregnancy.
▪Retrogressive maternal changes like involution of
the uterus and vagina.
▪Progressive maternal changes like production of milk
for lactation, restoration of normal menstrual cycle
and beginning of a parenting role.
PHYSIOLOGIC CHANGES ON THE
POSPARTAL PERIOD
▪ Retrogressive physiologic
changes that occur during the
postpartal period include those
related specifically to the repro-
ductive system as well as other
systemic changes
PHYSIOLOGIC CHANGES ON THE
POSPARTAL PERIOD
INVOLUTION – is the
process whereby the
reproductive organs return
to their nonpregnant state.
A woman is in danger of
hemorrhage from the
denuded surface of the
uterus until involution is
complete (Poggi, 2007).
PHYSIOLOGIC CHANGES DURING THE
POSTPARTAL PERIOD
REPRODUCTIVE SYSTEM
A.UTERUS
- immediately after birth, weighs about 1000 gms.
- at the end of the first week, it weighs 500 gms.
- by the time involution is complete (6 weeks), it
weighs approximately 50 gms, similar to its
prepregnancy weight.
POSTPARTAL PERIOD
1.Contraction pinch large vessels at the placental site to
prevent hemorrhage. This contraction reduces the size of the
uterus
2.the fundus of the uterus may be palpated through the abdominal wall,
halfway between the umbilicus and the symphysis pubis, within a few
minutes after birth.
3. One hour later, it will have risen to the level of the umbilicus, where it
remains for approximately the next 24 hours.
4.It decreases one fingerbreadth per day—on the first postpartal day, it
will be palpable one fingerbreadth below the umbilicus;
5.On the second day, two fingerbreadths below the umbilicus; and so
on.
POSTPARTAL PERIOD
6. UTERINE DISCHARGE:
LOCHIA - uterine flow,

consisting of blood,
fragments of decidua, white
blood cells, mucus, and
some bacteria.
POSTPARTAL PERIOD
7. ENDOMETRIUM
- by 10th day - regeneration of the epithelium is completed
- by 16th day – the endometrium is restored
- At about 6 weeks – the endometrium of placental site is restored

POSTPARTAL PERIOD
8. CERVIX - a uterine cervix is soft and malleable.
- internal and external os are open.
- by the end of 7 days, the external os has
narrowed to the size of a pencil opening; the cervix feels firm
- The internal os closes as before, but after a

vaginal birth the external os usually remains slightly open and
appears slitlike or stellate (star shaped),
POSTPARTAL PERIOD
10. PUERPERIUM
- develops edema and generalized tenderness
- presence of ecchymosis
* Labia minora and majora remain atrophic and softened and never
returning to prepregnant state.
POSTPARTAL PERIOD
9. VAGINA
- soft, with few rugae .
- returns to prepregnant
stage by 3rd or 4th week.
POSTPARTAL PERIOD
D. BREAST
1. The breasts are usually soft during the first two post-partum
days. On the 3rd to the 5th day they may become engorged
(full and firm). Engorgement is brought about by hormone
Prolactin which is stimulated by the baby's sucking to
promote lactation. And lactation is also stimulated by
decrease level of estrogen and progesterone.
2. Colostrum is secreted continuously during pregnancy.
3. Breast feeding relieves breast engorgement.
PERIODOLOGIC CHANGES
SYSTEMIC CHANGES
- the same body systems that are

involved in pregnancy also involved in
postpartal changes as the body return to its
prepregnant state.
POSTPARTAL PERIOD
1. HORMONAL / ENDOCRINE SYSTEM
ENDOCRINE CHANGES
a. Human chorionic gonadotropin (hCG) and Human
placental lactogen (hPL) is undetectable 1 day after
delivery.
b. Progestin, estrone, and estradiol are at pre pregnancy
state by 1 week.
c. FSH remains low for about 12 days and then begins to
rise as new menstrual cycle is initiated.
POSTPARTAL PERIOD
2. URINARY SYSTEM
- extensive diuresis begins to take place after birth.
- urine output increases from 1500 ml to 3000 ml/day

during first day to fifth day after birth.
- hydronephrosis / increased size of uterus remains

present for 4 weeks.
- Diaphoresis is also present after birth.

POSTPARTAL PERIOD
-In early puerperium, the bladder is less sensitive to fullness

thereby, overdistention occurs frequently. Urinary tract infection is
common.
- Lactose level in urine is high as the body prepares for

breastfeeding.
POSTPARTAL PERIOD
3. CIRCULATORY SYSTEM
- Continuous increase in fibrinogen level after

delivery.
- Blood volume back to pre-pregnant state on the 3rd
week post-partum.
- Blood loss with vaginal birth – 300 to 500 ml.
- Cesarean birth – 500 to 1000 ml.
- WBC may be as high as 30,000 cells/mm. Part of
the body’s defense system and aid in healing.
POSTPARTAL PERIOD
4. GASTROINTESTINAL SYSTEM
- Woman is hungry and thirsty after delivery.
- Constipation is common due to dehydrating effect

of labor, enema and decrease muscle tone in the intestine.
POSTPARTAL PERIOD
5. INTEGUMENTARY SYSTEM
- the stretch marks on a woman’s abdomen (striae

gravidarum) still appear reddened and may be even more
prominent.
- Excessive pigment on the face and neck
(chloasma) and on the abdomen (linea nigra) will become
barely de- tectable in 6 weeks’ time.
-
POSTPARTAL PERIOD
Effects of Retrogressive Changes
1. EXHAUSTION
2. WEIGHT LOSS
POSTPARTAL PERIOD
VITAL SIGNS CHANGES
- reflect the internal adjustments that occur as a woman’s body

returns to its prepregnant state.
POSTPARTAL PERIOD
VITAL SIGNS CHANGES
1.TEMPERATURE
- always taken orally or tympanically
- first 24 hours temp is slightly elevated/ increased
- an increased of temp of 38C after 24 hours may mean

postpartal infection
* If a woman’s breast is engorged on the 3rd& 4th ppd temp will slightly
increased for a few hours bec of vascularity.
POSTPARTAL PERIOD
VITAL SIGNS CHANGES
2. PULSE
- after birth, to accommodate the increased blood volume returning
to the heart, stroke volume increases thus Pulse rate is slightly lower
than normal (60 – 70 bpm)
* need to evaluate pulse because rapid and thready pulse during

this time could be a sign of hemorrhage.
POSTPARTAL PERIOD
VITAL SIGNS CHANGES
3. BLOOD PRESSURE
- Blood pressure should also be monitored carefully during the

postpartal period, because a decrease in this can indicate bleeding. In
contrast, an elevation above 140 mm Hg systolic or 90mmhg
diastolic – postpartal induced HPN.
POSTPARTAL PERIOD
PROGRESSIVE CHANGES ( Building New Tissues)
1. LACTATION
- Breast milk forms in response to the decrease in estrogen and
progesterone levels that follows delivery of the placenta
- which stimulates prolactin production
- milk production.
- 3RD & 4TH day PPD Engorgement –feeling of tension in the

breasts).
* When the infant begins to suck the nipple its releases Oxytocin to form new milk.
POSTPARTAL PERIOD
PROGRESSIVE CHANGES ( Building New Tissues)
2.RETURN OF MESNTRUAL FLOW

- after placental delivery production of estrogen and progesterone
ends.
- increase production of FSH in Pituitary Gland.
- which result to the start of OVULATION.
*A woman who is not breastfeeding can expect her menstrual flow to

return in 6 to 10 weeks after birth.
- If she is breastfeeding, a menstrual flow may not return for 3 or 4
months (lactational amenorrhe
Psychological Adaptation—Maternal and
Paternal Adjustment
Maternal Adjustment (Reva Rubin, 1961)—know
these characteristics that you will see in the mother.
▪ Taking In Phase—dependent phase

▪ 1st 24 hours range 1-2 days, focus on self and meeting basic needs,
reliance on others to meet needs of comfort, rest, closeness, nourishment,
relives birth, excited and talkative

Paternal Adjustment
▪ Taking Hold Phase—dependent/independent phase

▪ Starts end of 3rd day pp, last for 10 days to several weeks, focuses on care
of baby, desire to take charge, still need nurturing and acceptance by
others, eagerness to learn (period to teach most receptive time to learn),
possible experience pp “blues” .

Paternal Adjustment
▪ Letting Go Phase—interdependent phase

▪ Focuses on forward mov’t of family as unit with interacting members,
reassertion of relationship with partner, resumption of sexual intimacy,
resolution of individual roles.

Paternal Adjustment
▪Postpartum Blues—
▪ Postpartum blues are considered a transient period of depression, occurs 1st
few days of puerperium 
▪What to assess?
▪ Common symptoms
▪ labile, crying, mood swings, anger, depression, let down feelings, fatigue, headaches,
anxiety,
▪ resolves 10-14 days
 
NURSING CARE OF WOMAN AND FAMILY
DURING THE FIRST 24 HOURS AFTER BIRTH
I.ASSESSMENT
1. Health History
- family profile, pregnancy hx, labor and birht hx, infant data,
postpartal course.
2. Laboratory Assessment
- hgb and hct should be measured within 12 – 24 hours after
delivery ( determine blood loss that cause anemic).
I.ASSESSMENT
3. Physical Examination
- this includes: general appearance, hair, skin, breast, abdomen,
puerperium and vaginal discharge
II. NURSING DIAGNOSES and RELATED INTERVENTIONS
1. Nursing Diagnosis: Pain related to uterine cramping (afterpains)

Outcome Evaluation: Client states degree of pain is tolerable;
demonstrates knowledge of measures for adequate pain relief.
2. Nursing Diagnosis: Risk for infection (uterine) related to lochia and

denuded uterine surface
Outcome Evaluation: Client’s temperature remains below 100.4° F;
lochia is present and without foul odor.
3. Nursing Diagnosis: Disturbed sleep pattern related to exhaustion

from and excitement of childbirth
Outcome Evaluation: Client states she is able to sleep and feels
rested during postpartal period.
4. Nursing Diagnosis: Risk for bathing/hygiene self-care deficit

related to exhaustion from childbirth
Outcome Evaluation: Client takes daily responsibility for own
hygiene. Client appears clean, dressed, and well groomed.
5. Nursing Diagnosis: Imbalanced nutrition, less than body

requirements, related to lack of knowledge about postpartal needs
Outcome Evaluation: Client ingests a 2200- to 2700- kcal diet and
drinks 6 to 8 glasses of fluid daily.
6. Nursing Diagnosis: Risk for impaired urinary elimina- tion or
constipation related to loss of bladder and bowel sensation after
childbirth
Outcome Evaluation: Client voids more than 30 mL/hr without
urinary retention, beginning 1 hour after birth, and has a bowel
movement by postpartum day 4. No urinary incontinence is noted.
6. Nursing Diagnosis: Risk for ineffective peripheral tis- sue perfusion

related to immobility and increased estrogen level
Outcome Evaluation: Client demonstrates negative Homans’ sign
and absence of erythema or pain in calves of legs.
7. Nursing Diagnosis: Pain related to primary breast engorgement

Outcome Evaluation: Client states pain from breast engorgement
is at a tolerable level.
8. Nursing Diagnosis: Health-seeking behaviors related to future

breast health
Outcome Evaluation: Client states the importance of once-yearly
breast examination by a health care provider (or a yearly
mammogram, if appropriate for her age) and her intention to schedule
this examination yearly.
MANAGEMENT OF PUERPERIUM
1. Assessment for evaluation
a. Check height, consistency of the fundus every four
hours.
On delivery day and less frequent thereafter.
b. Check vital signs every four hours.
c. Check amount, color and odor of lochia every four
hours.
d. Check perineum for swelling and bleeding.
e. Assess bonding.
f. Assess emotional status.
g. Assess for pain.
2. Provide comfort measures.

A. After pains is more common in multi areas
due to poor muscle tone.
▪Early ambulation
▪Frequent voiding
▪Present during breastfeeding, analgesic is
given 1/2 hour before breastfeeding
▪ B. Perineal Discomfort.
1.Ice to reduce swelling
(first 24 hours).
2.Sitz bath and perineal
light (after 24 hours).
3. Perineal care after each
voiding.
4. Analgesics if measures
failed.
5. Perineal exercises –
Kegel exercise.
6. Provide perineal care
C. Breast engorgement
1. Well fitting brassiere at all times.
2. Ice pack for non-breast feeders.
3. Warm soaks breast feeders.
4. Analgesics, last resort.
3. Provision of rest.
A. planned nursing care.
B. regulated visiting hours.
4. Discuss Sexual Relations
A. can resume if episiotomy heals and bleeding stops, usually
3-4 weeks.
B. use method of contraception except pills if breast-feeding.
C. discontinue if bleeding occurs.
5. Discuss Nutrition.
▪* requires 3000 calories if breastfeeding and 2300 or
2400 if not breastfeeding.
6. Breastfeeding
LACTATION AND
BREASTFEEDING
Aubreyrose Jimenez Casilang, MAN,RN

OBJECTIVES:
1. To understand the structures of the breast

2. Describe the stages of Lactation
3. Management of common problems in breastfeeding
4. To know the correct positioning in breastfeeding
5. To know the health benefits of breastfeeding
CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 AUBREYROSE CASILANG MAN, RN 9-Jul-19
LACTATION AND BREASTFEEDING
LACTATION
- describes as the production of breast milk and secretion of
mammary gland after delivery.
LACTATION AND BREASTFEEDING
▪ Hormones during breastfeeding
▪ Prolactin levels rise with nipple stimulation

▪ Alveolar cells make milk in response to prolactin when the baby sucks
▪ Oxytocin causes the alveoli to squeeze the newly produced milk into the
duct system
Lactation and Breastfeeding 
Physiology
Latch On and sucking
Oxytocin Release
Releases Milk
Infant Empties Breast
Production Increases
Milk Production Occurs
Interference with this cycle decreases the milk supply.
 
BREASTFEEDING
• Breastmilk is the preferred

method of feeding a newborn
because it provides numerous
health benefits to both the
mother and the infant.
• COLOSTRUM a sticky white
or yellow fluid secreted by the
breasts during the second half
of pregnancy and for a few
days after birth, before breast
milk comes in.
The Benefits of Breastfeeding
The 3 E’s in Breastfeeding
▪E arly as possible
▪E xclusive for 4-6mos
▪E xtended up to 2 y.o
√As Early as possible
• Immediately after delivery, suckling the breast may reduce the risk
of postpartum hemorrhage. Suckling stimulates release of
hormones which help milk flow and cause contraction of the
uterus
• Immunoglobulin (IgA) in colostrum provides anti-infective
protection to the baby
Exclusive for 4-6 months
• For the first 6 months of life a well-nourished mother can provide
through breast milk al the nutrients and fluids an infant needs
• Full breastfeeding delays resumption of ovulation and the return
of menstrual cycle, protecting the mother from unplanned
pregnancy through LAM
Extended up to 2 years
• Mothers can continue breastfeeding their baby as long as she
feels comfortable doing it. However, the baby needs other foods
in addition to breastmilk.
• Breastfeeding offers important economic advantage to families. It
costs more to use milk formula than to give food supplements to a
mother.
LATCH Breastfeeding Charting System
0 1 2
L atch Too sleepy or reluctant; no latch Repeated attempts; hold nipple in Grasps breast; tongue down; lips
achieved mouth stimulate to suck flanged; rhythmic sucking
A udible swallowing None A few with stimulation Spontaneous and intermittent
under 24 hour old; spontaneous
and frequent over 24 hour old
T ype of nipple Inverted Flat Everted (after stimulation)
C omfort Engorged; cracked, bleeding, Filling; reddened/small blisters or Soft, nontender

large blisters or bruises; severe bruises; mild/moderate discomfort
discomfort
H old (positioning) Full assist (staff holds infant at Minimal assists (i.e. place pillows No assist from staff; mother able
breast) for support, elevate head of bed); to position/hold baby by self
teach one side; mother does
other; staff holds and then mother
takes over
3 Positions mothers can utilize while nursing
• Transverse/crossover hold
– The proper way to hold the baby
is chest-to-chest, at the level of
the breast. Baby’s head should
be in the crook of your arm and
your hand should hold baby’s
buttocks
• Football hold
– The football hold is a good
position for latch-on problems,
or for premature or Cesarean
birth babies
• Lying down hold
– The lying down position is
especially useful after a
Cesarean birth. Side lying
position allows mother and baby
to rest while breastfeeding
Breastfeeding Barriers
▪ Breast Pathology
▪ Flat/inverted nipples, breast reduction surgery that severed milk ducts, previous
breast abscess, extremely sore nipples (cracked, bleeding, blisters, abrasions)
▪ Hormonal pathology
▪ Failure of lactogenesis, hypothyroidism
▪ Overall health
▪ Smoking, anemia, poor nutrition, depression
▪ Psychosocial
▪ Restrictive feeding schedules, mother without support system, not rooming in with
baby, bottle supplementing when not medically required
▪ Other
▪ Previous breastfed infant who failed to gain weight well, perinatal complication
(hemorrhage, htn, infection
 
BREASTFEEDING TEACHING METHODS
▪ With infant in mother’s arms
▪ Consistent information
▪ Repeat information in a variety of ways
▪ Watch the mother feed the baby and help
▪ Let the mother know she may have difficulties at first
▪ Remind mom that baby is learning with her
▪ Praise the mother’s progress, help build confidence
▪ Provide discharge support
Aubreyrose Jimenez – Casilang, MAN, RN
OBJECTIVES
▪ According to World Health Organization “ the use of range of
methods of fertility regulation to help individuals / couples
attain certain objectives:
▪ Avoid unwanted birth

▪ Bring about wanted birth
▪ Produce a change in the number of children born
▪ Regulate the intervals between pregnancy
▪ Control time at which birth occur.
INTRODUCTION
▪ FAMILY PLANNING
- a term used for pre-pregnancy planning and action to delay,
prevent or actualize a pregnancy
BENEFITS OF FAMILY PLANNING
▪ BENEFITS TO THE MOTHER

1.Reduce health risk
2.Below 20 y.o and above 35 y.o at risk of developing
complications during pregnancy
3.Phsyical strain during child bearing
4.Reduce number of maternal death
5.Reduce the risk of ovarian cyst
▪ BENEFITS TO THE FATHER

1.Allows the father to keep constant balance between their
physical, mental and social well- being.
2.Increase sense of respect because he is able to provide the

type of education and home environment.
▪ BENEFITS TO THE CHILDREN

1.Ensure better chance of survival at birth
2.Promote physical growth and development
3.Prevent birth defects
▪ BENEFITS TO THE WHOLE FAMILY

1.Help family enjoy better life.
TYPES OF FAMILY PLANNING
1.Natural Family Planning
2.Artificial Family Planning

TYPES OF FAMILY PLANNING
1.Natural Family Planning

- no introduction of chemical of foreign material into the
body
- practice may varies from culture, religion and tradition
- effectiveness varies greatly to couples ability to refrain

from intercourse on fertile days.
TYPES OF NATURAL FAMILY PLANNING
1. RHYTHM ( CALENDAR) METHOD

- using calendar method.
- abstaining from coitus on the days of menstrual cycle

when a woman is most likely to conceive ( 3 or 4 days
before or until 3 or 4 days after ovulation).
- Woman keeps a diary of 6 menstrual cycle

2. BASAL BODY TEMPERATURE (BBT)

- Identifying fertile and infertile period of woman’s cycle by
daily taking and recording of the rise in body temperature
during and after ovulation.
- just before the ovulation, a woman’s BBT falls about 0.5°F

- at time of ovulation, her BBT rises a full degree ( influence
of progesterone). And it is maintained on the rest of menstrual
cycle.
3. CERVICAL MUCUS / OVULATION
- It is a fluid produced by small glands near the cervix.
- this fluid changes throughout the cycle, from scant and

sticky, to cloudy and thick, to slick and stringy
4. COITUS INTERRUPTUS
- one of the oldest known method of contraception

- couple proceeds with coitus until moment of ejaculation
which offers little protection.
5. LACTATION AMENORRHEA
- natural birth control technique based on the lactation

(breast milk production) causes amenorrhea (lack of
menstruation).
TYPES OF ARTIFICIAL / BARRIER FAMILY
PLANNING
1. CONDOM
- Easily available, safe and inexpensive

- Protects against STD’s
PLANNING
2. DIAPHRAGM
- most common and easiest to fit and use.

- the device is introduced 3 hrs before intercourse and be
kept at least 6 hours after intercourse.
PLANNING
3. SPERMICIDES
- available as vaginal foam, gel, tablets, creams and

suppositories
- alter sperm cell membrane permeability resulting to killing
of sperm.
PLANNING
3. ORAL PILL
- convenient to use, protects from unwanted pregnancy

PLANNING
4. INTRAUTERINE DEVICE (IUD)
- a small, often T-shaped birth control device that is inserted

into a woman's uterus to prevent pregnancy.
PLANNING
5. BILATERAL TUBAL LIGATION
- a surgical procedure that involves blocking the fallopian tubes

to prevent the ovum (egg) from being fertilized. It can be done by
cutting, burning or removing sections of the fallopian tubes or by
placing clips on each tube.
PLANNING
6. VASECTOMY
- a surgical procedure for male sterilization or

permanent contraception. During the procedure, the male vas
deferens are cut and tied or sealed so as to prevent sperm from
entering into the urethra and thereby prevent fertilization of a
female through sexual intercourse.
Immediate Care of the Newborn
including Assessment
NCM 107: Module 6

Essential Intrapartum Newborn Care
4 Core Steps
Immediate and thorough drying Properly timed cord clamping
Early skin-to-skin contact Non-separation of the newborn and

Icon Icon
mother for early initiation of
breastfeeding.
Immediate Care:
1. Establish and maintain a
patent airway
Image
Maintain appropriate body temperature
333. Immediate Assessment

APGAR
APGAR
All infants appear cyanotic at the
moment of birth. They grow pink Muscle Tone
shortly after the first breath.
Acrocyanosis (cyanosis of the hands & Mature newborns hold their
Image or icon Image or icon
feet) is so common in newborns that a extremities tightly flexed,
score of one in this category is simulating their intrauterine
normal.
Color position. It is tested by observing
their resistance to any effort to
extend their extremities
Heart Rate Reflex Irritability

Auscultating a newborn heart with a
stethoscope is the best way to Newborn’s response to a suction
determine the heart rate; however, catheter in the nostrils or the
heart rate also may be obtained by response to having the sole of
observing & counting the pulsations
of the cord at the abdomen if the the feet slapped.
cord is still uncut.
APGAR
Respiratory Effort
Respirations are
counted by watching
Image or icon
respiratory
Image or icon
movements. A mature
newborn usually cries
and aerates the lungs
spontaneously at about
30 secs. after birth.
Heart Rate
• Auscultating a newborn
heart with a stethoscope is
the best way to determine
the heart rate; however,
heart rate also may be
obtained by observing &
counting the pulsations of
the cord at the abdomen if
the cord is still uncut.
Muscle Tone
• Mature newborns hold
their extremities tightly
flexed, simulating their
intrauterine position. It
is tested by observing
their resistance to any
effort to extend their
extremities
Reflex Irritability
• Newborn’s response
to a suction catheter
in the nostrils or the
response to having
the sole of the feet
slapped.
Color
• All infants appear
cyanotic at the moment
of birth. They grow pink
shortly after the first
breath. Acrocyanosis
(cyanosis of the hands &
feet) is so common in
newborns that a score
of one in this category is
normal.
NEWBORN
Criteria 0 1 2
A - ppearance Blue Acrocyanosis Pink

(Color)
P- ulse 0 <100 100 and above

(Heart Rate)
G - rimace No response Grimace; weak cry Good, strong cry;

(Reflex Irritability) sneeze
A - ctivity. Limp, flaccid Some flexion of Well-flexed

(Muscle Tone) extremities extremities
R- esp. Effort Absent Weak cry Good, strong cry!
NURSING CARE MANAGEMENT 101-MATERNAL AND CHILD NURSING

NEWBORN
Score Interpretation:
0-3 Resuscitation ASAP!
4-6 Guarded → Continuous
monitoring & suctioning
7- 10 Best possible condition
NURSING CARE MANAGEMENT 101-MATERNAL AND CHILD NURSING

Immediate Care of the Newborn including Assessment
THANK YOU!
ROUTINE NEWBORN CARE
Sofia Magdalena N. Robles, PhDNEd, RN

Prevention of hypothermia
▪Dry the infant properly so that heat is
not lost from evaporation of moisture
on the baby’s skin.
▪Hypoglycemia may result from

hypothermia
▪Hypothermia causes cold stress.
S. Robles 9/12/21
Promoting safety and preventing injury
S. Robles 9/12/21
Eye care with the administration of erythromycin eye

ointment is done after birth.
S. Robles 9/12/21
Vit K is injected into the vastus lateralis
to assist in blood clotting
S. Robles 9/12/21
Assess the infant for indications of trauma
S. Robles 9/12/21
Physical Examination
S. Robles 9/12/21
Anthropometric measurements
S. Robles 9/12/21
Anthropometric measurements
S. Robles 9/12/21
Common skin marks of the newborn
▪ 1.Desquamation -peeling of skin; indicates

postmaturity
▪ 2. Mongolian spots - bluish-black/slate gray

pigmentation across the sacrum or buttocks;
disappear by SCHOOL AGE
S. Robles 9/12/21
▪ Vernix caseosa -cheese-like material, serves as

.3.
insulator
▪ 4.Lanugo - fine, downy hair at shoulders, back and

upper arms; disappear by 2 weeks.
S. Robles 9/12/21
5. Milia - plugged or unopened sebaceous gland on

the cheek or across the bridge of the nose;
disappear by 2-4 week
▪ 6. Nevi (Stork bites) - pink or red flat areas of capillary dilatation seen on upper lids, nose, upper
lip, nape and neck; disappears at 1st and 2ndyear.
S. Robles 9/12/21
▪ 7. Erythema toxicum -- aka-fleabite rash; pink papules with vesicles
seen at nape, back and buttocks; appears usually 2nd day; no
treatment needed.
▪ 8. Nevus flammeus - aka portwine stain; red to purple in color; do not

blanch on pressure and do not disappear.
S. Robles 9/12/21
▪ 9. Strawberry hemangioma - elevated areas formed by immature
capillaries and endothelial cells; complete disappearance by 10 yrs old.
10. Cavernous hemangiomas -

dilated vascular spaces; do not
disappear with time.
▪ 11. Forceps marks - disappears in 1-2 days.
S. Robles 9/12/21
S. Robles 9/12/21
Abnormal skin Findings:
▪ 1.Pallor -excessive blood loss; inadequate blood flow from cord;
decreased iron stores; blood incompatibility
▪ 2. Gray – infection
▪ 3. Jaundice -the yellowish discoloration primarily of the sclera,

nails, or skin
S. Robles 9/12/21
S. Robles 9/12/21
Newborn & Infant: Common
Health Problems
Neonatal Common Health Problems
Health Problem Definition Intervention

Constipation -more common bottle- -add more fluids or
fed infants, fluid carbohydrates/sugar
deficient -adding foods with bulk,
such as fruits and
vegetables
-if anal sphincter is tight,
dilate 2-3 x daily with
gloved little finger
Loose stools -management depends on
cause
Common Health Problems

Constipation -more common bottle- -add more fluids or
fed infants, fluid carbohydrates/sugar
deficient -adding foods with bulk,
such as fruits and
vegetables
-if anal sphincter is tight,
dilate 2-3 x daily with
gloved little finger
Loose stools -management depends on
cause
Neontal Common Health Problems

Colic -a paroxysmal abdominal pain -feed by self demand
occurring in infants under 3 -burp the baby twice during a
months of age feeding
-face becomes red and flushed, - feed in upright position -
fists clenched, abdomen change milk formula, if needed
becomes tense -reduce sugar content
Causes:
- overfeeding
- gas distention
- too much carbohydrates tense
and unsure mother
Spitting up - due to poorly developed -feed in upright position
sphincter -position on right side after
feeding
- burp more frequently
Neonatal Common Health Problems

Skin irritation -may be due to poor - expose to air
hygiene -irritation from - careful washing and
urine, feces or laundry rinsing of skin
products - starch bath (for
Miliaria or prickly-heat
rash)
Seborrheic dermatitis -involves sebaceous -apply mineral oil or
/cradle cap glands Vaseline on the scalp at
-due to poor hygiene night
- giving shampoo bath
in the morning
Infancy Common Health Problems

Thumb -infant's chief pleasure and may -during infancy and early
not be satisfied by breast- or childhood, no need to restrain
sucking bottle-feeding nonnutritive sucking of the fingers
/Use of Pacifier -reaches its peak at age 18 to 20 unless the habit extends into the
months and is most prevalent late preschool years
when the child is hungry, sick, or -Malocclusion may occur if thumb
tired. sucking persists past 4 to 6 years
or when the permanent teeth erupt
pacifier use in infancy is
associated with a higher incidence
of malocclusion,

Teething -eruption of the deciduous -cold is soothing
(primary) teeth -Giving the child a frozen
-age of tooth eruption shows teething ring or an ice cube
considerable variation among wrapped in a washcloth helps
children relieve the inflammation.
-physiologic process; some nonprescription topical
discomfort is common as the anesthetic ointments are
crown of the tooth breaks available, such as Baby Ora-
through the periodontal Jel
membrane.

Sleep Problems 1. Dyssomnias: the child has trouble -careful assessment is essential
either falling or staying asleep at -"Let the child cry until falling asleep," is
night, or has difficulty staying awake
during the day.
difficult to implement and inappropriate for
2. Parasomnias, are characterized as certain conditions
-parental presence at bedtime
confusional arousals, sleepwalking,
sleep terrors, nightmares, and -nurses must discuss infant sleep problems with the
rhythmic movement disorders; these mother (and family) in addition to other
typically occur in children 3 to 8 years developmental aspects of newborn care. encourage
old parents to establish bedtime rituals that do not foster
problematic patterns.
-placing infants awake in their own crib
-the bed should be used for sleeping only, not as a
playpen.
-advisable not to hang playthings over or on the bed;
in this way the child associates the bed with sleep,
not with activity .

Head Banging -Rhythmically banging -pad the rails of crib so
heads against bars of a they cannot hurt
crib for a period of time themselves
before falling sleep -reassure that this is a
-begins during the second normal mechanism for
half of the first year of life relief of tension
up to preschool period
-associated with naptime
or bedtime, lasting for 15
minutes (normal)
-use it to relax or fall sleep

Miliaria or prickly heat -clusters of pinpoint, -Bathe infant twice a day
rash reddened papules with during hot weather
occasional vesicles and -small amount of baking
pustules surrounded by soda to be added to the
erythema usually on the bath water
neck to around the ears -reduce amount of
and unto the face down clothing
onto the trunk -lower room temperature
-occurs most often in
warm weather or when
babies are overdressed or
sleep in overheated rooms

Baby-Bottle Syndrome -putting an infant to bed with a -advise parents never to put
bottle can result in aspiration their baby to bed with a bottle
and decay of all the upper teeth -encourage to fill bottle with
and the lower posterior teeth water and use a nipple with a
-liquid from the propped bottle smaller hole to prevent the
continuously soaks the upper baby from receiving a large
front teeth and lower back teeth amount of fluid.
-most serious when the bottle is -if refuses to drink anything but
filled with sugar water, milk or milk, dilute the milk with water
fruit juice more and more each night until
-carbohydrate ferments to the bottle is down to water only.
organic acids demineralizing
the tooth enamel until it decays.
Neonate & Infant Common Health Problem
THANK YOU!
NEWBORN REFLEXES
Sofia Magdalena N. Robles, PhDNEd, RN

NEWBORN
Rev S. Robles 9/12/21

NEWBORN
Neuromuscular System
NEONATAL REFLEXES
Reflexes Disappearance
Rooting reflex 6 weeks
Sucking Reflex 6 months
Extrusion Reflex 4 months
Palmar grasp 6 weeks-3 months
Stepping (Walk-in-place/Dancing) Reflex 3 months
Placing (**anterior surface of leg) 3 months
Plantar grasp 8-9 months

NEWBORN
Neuromuscular System
Neonatal Reflexes
Reflexes Disappearance
3 months
Magnet Reflex
3 months
Crossed Extension Reflex
2-3 months
Trunk Incurvation Reflex
3 months
Landau Reflex (Parachute Reaction)
6 weeks
Bauer's (Crawling)Reflex
Do not disappear
Blink Reflex (see objects 9-12" at midline)
Do not disappear
Swallowing Reflex
THE REFLEXES
Blinking Reflex

Blinking Reflexes
▪Purpose: to protect the eye from any

object coming near it by rapid eyelid
closure.
▪Can be elicited by shining a strong light
such as penlight or otoscope light on
the eye.
▪A sudden movement toward the eye can
elicit the blink reflex.

Rooting Reflex

Rooting Reflex
▪Purpose: serves to help a newborn find

food.
▪Newborn’s cheek is brushed or stroked

near the corner of the mouth, the child
will turn its head on that direction.
▪Disappears at 6th week of life.

Sucking Reflex

Sucking Reflex
▪Purpose: serves to help a newborn find

food.
▪Newborn’s lips are touched, the baby
makes a sucking motion.
▪Disappears at 6 months.
▪Disappears immediately if it is never
stimulated.

Swallowing Reflex
▪Same with the adult,

food that reaches
the posterior portion
of the tongue will
automatically
swallowed

Extrusion Reflex
▪A newborn will extrude any substance

that is placed on the anterior portion of
the tongue
▪Disappear at about 4 months of age

Palmar Grasp Reflex

Palmar Grasp Reflex
▪Newborn will grasp an object placed on

their palm by closing their fingers on it.
▪Disappear at about 6 wks - 3 months
▪At 3 months baby begin to grasp

meaningfully

Stepping Reflex

Step(Walk)in Reflex
▪Newborn who is held in vertical position with
their feet touching a hard surface will take a
few quick, alternating steps.
▪Disappear by 3 months of age

Plantar Grasp Reflex

Plantar Grasp Reflex
▪When an object touches the sole of the
newborn’s foot at the base of the toes, the
toes grasp in the same manner as the finger’s
do.
▪Disappears at about 8-9 months of age in
preparation for walking.

Tonic Neck Reflex
▪Fencing reflex, when the newborn lie in
their backs, their head usually turn to one
side or the other, the arm and leg on the
side on which the head turns extend and
the opposite side contract.
▪Disappear at about 3 to 4 months of age.

Babinski Reflex
▪When the side of the sole of the foot is
stroked in an inverted J curve from the heel
upward the newborn fan the toes.
▪Remain positive until at least 3 months of

age.

Moro Reflex

Magnet Reflex
▪If pressure applied to the sole of the foot
of the baby lying in supine position, the
baby pushes back against the pressure.
▪Test the spinal cord integrity.

Trunk Incurvation Reflex

Crossed Extension Reflex
▪One leg of newborn lying in supine is
extended and the sole of the foot is
irritated by being rubbed with sharp
object, such as thumb nail.
▪This cause the newborn to raise the other

leg and extend it as it trying to push away
the hand irritating the first leg

Landau’s Reflex

Landau’s Reflex
▪A newborn who is held in a prone position
with a hand underneath supporting the trunk
should demonstrate some muscle tone.
▪Also called Parachute reflex

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POST PARTUM/ POSTPARTAL PERIOD

▪This refers to the 6 week period after childbirth or

LOCHIA - uterine flow,

- by 16th day – the endometrium is restored

- At about 6 weeks – the endometrium of placental site is restored

- The internal os closes as before, but after a

- develops edema and generalized tenderness

- soft, with few rugae .

- the same body systems that are

- urine output increases from 1500 ml to 3000 ml/day

- hydronephrosis / increased size of uterus remains

- Diaphoresis is also present after birth.

-In early puerperium, the bladder is less sensitive to fullness

- Lactose level in urine is high as the body prepares for

- Continuous increase in fibrinogen level after

- Woman is hungry and thirsty after delivery.

- Constipation is common due to dehydrating effect

- the stretch marks on a woman’s abdomen (striae

VITAL SIGNS CHANGES

- reflect the internal adjustments that occur as a woman’s body

- first 24 hours temp is slightly elevated/ increased

- an increased of temp of 38C after 24 hours may mean

* need to evaluate pulse because rapid and thready pulse during

- Blood pressure should also be monitored carefully during the

- which stimulates prolactin production

- 3RD & 4TH day PPD Engorgement –feeling of tension in the

2.RETURN OF MESNTRUAL FLOW

- which result to the start of OVULATION.

*A woman who is not breastfeeding can expect her menstrual flow to

▪ Taking In Phase—dependent phase

reliance on others to meet needs of comfort, rest, closeness, nourishment,

relives birth, excited and talkative

▪ Taking Hold Phase—dependent/independent phase

of baby, desire to take charge, still need nurturing and acceptance by

others, eagerness to learn (period to teach most receptive time to learn),

possible experience pp “blues” .

▪ Letting Go Phase—interdependent phase

reassertion of relationship with partner, resumption of sexual intimacy,

resolution of individual roles.

1. Nursing Diagnosis: Pain related to uterine cramping (afterpains)

2. Nursing Diagnosis: Risk for infection (uterine) related to lochia and

3. Nursing Diagnosis: Disturbed sleep pattern related to exhaustion

4. Nursing Diagnosis: Risk for bathing/hygiene self-care deficit

5. Nursing Diagnosis: Imbalanced nutrition, less than body

6. Nursing Diagnosis: Risk for ineffective peripheral tis- sue perfusion

7. Nursing Diagnosis: Pain related to primary breast engorgement

8. Nursing Diagnosis: Health-seeking behaviors related to future

2. Provide comfort measures.

Aubreyrose Jimenez Casilang, MAN,RN

1. To understand the structures of the breast

▪ Prolactin levels rise with nipple stimulation

Latch On and sucking

Infant Empties Breast

Milk Production Occurs

Interference with this cycle decreases the milk supply.

• Breastmilk is the preferred

▪E xclusive for 4-6mos

C omfort Engorged; cracked, bleeding, Filling; reddened/small blisters or Soft, nontender

▪ Avoid unwanted birth

▪ BENEFITS TO THE MOTHER

▪ BENEFITS TO THE FATHER

2.Increase sense of respect because he is able to provide the