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50 Cards in this Set
- Front
- Back
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Position of Fundus
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Day 1 Postpartum: Just below umbilicus
Day 5 Postpartum: Midway between umbilicus and pubis Day 10 Postpartum: @ Pubis |
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Adverse Factors Affecting Breastfeeding
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Environmental- lack of support, stressful environment, lack of privacy, lack of proper storage for pumped milk, limited access to good nutrition/ clean drinking water
Biological- Infant latch problems, tongue/lip tie, cleft lip/palate, prematurity, metabolic disorders Occupational- Poor hygiene, limited access to baby, decreased skin to skin time, limited access to pump, vegan diets or weight loss dieting Pharmacological- Drug use, contraceptive use, weigh benefits vs. risks when mom is medicated, acute infectious disease (maternal) |
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Sore Nipples
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Expose to air
Alternate nursing positions Evaluate latch/ sucking Apply ointments Apply expressed milk |
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Thrush on Nipples
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S/S: Extremely sore, painful, red, stinging nipples
Management: Use good hand hygiene Acidophilus solution on site Gentian violet on site Acidophilus PO Avoid sugary food/ drink Avoid synthetic skin cleansers Apple cider vinegar wash on nipples/ bras Change breast pads frequently/ do not reuse Refer for antifungal treatment |
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Mastitis
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S/S: red, lumpy or streaky, hot to touch breasts. High fever (refer for antibiotics), malaise.
Management: Belladonna 30C, Phytolacca 30C Frequent nursing, massage Warm compresses/ soaks Empty breast fully at each feeding Increase hydration Evaluate nutrition Increase rest |
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Birth Certificate
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Ensure accurate information and statistics given.
Recognize the BC is a legal record. |
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Facilitate Psycho-social Adjustment
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Encourage open communication between client and partner/family about expected roles
Talk about birth/emotional challenges Encourage early attachment/ bonding Healthy integration of baby into family Explore confidence as a mother |
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Postpartum Depression
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S/S:
Onset- any time in first year Fatigue/ malaise Persistent sadness Increased temper/ anger Difficulty sleeping (mental stress at night) Difficulty completing tasks/ self care/ baby care Low self esteem Increased emotional stress Management: Encourage open communication with partner/ family Recommend counseling Increase nutrition and rest Recommend frequent outings/ sunshine/ fresh air Recommend keeping curtains open during the day to get plenty of natural light Supplements Differential: Baby blues (transient s/s), postpartum thyroiditis |
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Postpartum Psychosis
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In addition to many PPD S/S:
Delusional thinking Suicidal ideation/ behavior Infanticidal ideation/ behavior Management: Immediate professional help (psychiatrist) |
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Late Postpartum Hemorrhage
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S/S:
Obvious external bleeding s/s shock anemia/ fatigue Management: Shepherd's purse treat for shock if applicable refer for methergine/ ergotrate therapy Differential: return of menses |
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Thrombophlebitis
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Increased risk when varicosities present
S/S: Superficial: leg pain, localized heat, tenderness, inflammation, palpation of knot or cord Deep: superficial symptoms plus slight fever, mild tachycardia, generalized edema @ leg, abrupt onset worsens with motion, positive Homan's sign Management: Bed rest, elevation of leg, compression stocking, analgesia, DO NOT MASSAGE, refer for antibiotic, anticoagulant tx Differential: pulled muscle/ charley horse |
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Separation of Abdominal Muscles
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S/S: palpable gap at abdominal midline when woman is engaging ab muscles
Management: 3-6 weeks postpartum, begin abdominal exercises. Start with leg raises, progress to crunches Yoga, exercise Refer to physical therapist |
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Separation of symphysis pubis
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S/S:
Extreme pain @ SP joint Trouble walking, standing Management: Avoid wide lateral stance Knee press exercise Refer for chiro care, physical therapy |
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Urinary Tract Infection
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Increased risk with catheterization @ birth
S/S: Urinary frequency, urgency Dysuria Lower abdominal pain Positive urine culture Worsening to pyelonephritis if: Low grade fever Flank pain CVAT Management: Increase hydration, better nutrition cranberry supplement Uva Ursi supplement Refer for antibiotic therapy Differential: uterine infection |
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Counseling/ Education:
Condition of Vulva, Vagina, Perineum, Anus |
Vulva- may be swollen, sore after birth. Sharp or constant pain is abnormal. Abrasions may sting during urination- use peri-bottle to dilute when urinating. Use ice pack, good hygiene.
Vagina- Soreness for several days, especially with abrasions/ lacerations. Nothing inside vagina until bleeding stops. Perineum- Will be swollen/ tender. May be some pain when repaired. Ice packs. Peri-bottle to wash, pat dry. Anus- Hemorrhoids may have gotten worse during birth- should diminish soon. Use remedies to reduce. High fiber diet, avoid constipation, increase hydration. |
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Infection of Vaginal Tear/ Incision
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S/S:
Localized pain Dysuria Low-grade temp (sledom above 101°F) Edema- localized Red/ inflamed repair edges Oozing gray-green pus Odor Wound separation/ bleeding Management: Better hygiene Immune support supplements Increased rest, nutrition, hydration Refer for antibiotic treatment/ evaluation of wound |
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Uterine Infection
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S/S:
Persistent fever up to 104°F (depending on severity) Tachycardia Chills (with severe infection) Uterine tenderness Pelvic pain with bimanual exam Subinvolution (delay or cessation of uterine ctx to reduce size of uterus) Lochia- scanty and odorless -or- prurulent and malodorous Onset- variable Refer for antibiotic treatment Differential: UTI |
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Counseling/ Education:
Family Planning/ Contraception |
Communicate about FP before resuming sex
Lactation Amenorrhea- effective with frequent, exclusive nursing around the clock Natural family planning- various methods involving daily monitoring of cycle, basal temp, cervical mucus and cervical placement. Barrier- condom, diaphragm, cervical cap Hormonal- pill (estrogen/progestin, progestin only) may decrease milk supply, cervical ring, injection, implant IUD- hormonal and non-hormonal Abstinence- refraining from sex all the time Sterilization- tubal ligation or vasectomy Abstinence and sterilization are the most effective- All other methods similarly reliable if done perfectly |
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Counseling/ Education:
Consition of the Uterus/ Cervix/ Ovaries |
Uterus- May feel crampy, especially when nursing. Frequent nursing will help the uterus heal properly.
Should feel firm. Mom can massage fundus herself if she notices increased bleeding. Keep bladder empty to reduce cramping. Rest and good nutrition helps with involution/ bleeding. Cervix- Open and friable for the first 3-4 weeks (risk of infection if something enters the vagina). If prolapsed- stay off feet, do kegels/ elevator exercises Ovaries- will be examined at final PP visit. Should not be tender to the touch. |
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Counseling/ Education:
Cystocele/ Rectocele/ Strength of Pelvic Floor |
Cystocele feels like a bulge in the vaginal wall near the urethra. Differing degrees- may protrude from opening. A 1st degree is not a problem if not accompanied by incontinence. Do kegels/ elevators
Rectocele feels like a bulge in the vaginal wall at the perineum. If BM are normal, it should resolve on its own with kegel/elevator exercises of the pelvic floor Pelvic floor may be weak for several days. Should regain tone by 3-6 weeks. Do kegels/ elevators |
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Counseling/ Education:
Breastfeeding, Condition of Breasts, Nipples |
BF q2-3h or on demand. Can go up to 4h at night. Establish a good latch, empty breast at each feeding. May feel emotional/weepy day milk comes in. Watch for s/s of engorgement. Relieve with breast massage/ warm compresses, express a small amount of milk just before nursing.
Breasts become fuller when milk comes in- let-down reflex. Improper latch can lead to painful nipples. Frequent sucking can lead to soreness, cracking and bleeding. Keep nipples clean (with plain water) and dry (air dry) between feedings. Apply nipple creams, switch nursing positions. |
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Counseling/ Education:
Maternal vitals, digestion, elimination |
Vitals:
Any BP issues should resolve over several days to pre-pregnancy baseline Pulse may be elevated in immediate PP, resolves within several hrs to normal. Pulse >100 is abnormal. R/O infection, late hemorrhage, dehydration Temp up to 101°F may be normal the day milk comes in. Otherwise should be in normal range. Shortness of breath or rapid breathing needs further evaluation R/O fluid overload, embolism Digestion: appetite should increase, heartburn should resolve soon Elimination: Urination should occur within a few hours of birth and then continue as normal. Use peri-bottle to reduce stinging with urination. Keep bladder empty. Should have BM within 1-2 days. Don't fight it- constipation will make it worse. Support perineum with warm compress when attempting BM first time after birth. Treat constipation, hemorrhoids. |
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Counseling/ Education:
Return of Menses |
Non-lactating women: 8-10 weeks PP
Lactating women: variable, but usually 4-6 months Ovulation can happen before menstruation, but most women ovulate by the 3rd cycle |
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Counseling/ Education:
Lochia vs. Abnormal Bleeding |
Lochia Rubra- Red (contains mostly blood)
Duration: Immediate PP to day 2 or 3. Heavy, tapering off Lochia Serosa- Pink (Serous fluid, some blood) Duration: 7-8 days Moderate, tapering off Lochia Alba- Creamy white/ yellowish (contains mostly leukocytes) Duration: 2-4 weeks Scant, may have odor like menstrual flow Abnormal bleeding: bleeding that gets heavier, redder. Foul odor, large clots, soaking a pad in 20 mins. Needs more rest. R/O retained fragments Odor- R/O infection |
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1-2 Day PP Visit
Maternal |
-Assess home environment
Does she have enough help? Is there food in the house? -General health: hygiene, comfort level, dizziness, energy, sleep, emotions -Vitals: BP, Temp, Pulse, Resp -Fundus: just below U, firm -Assess lochia: should be rubra -Breasts/Nipples: Any pain when nursing? Has milk come in (maybe day 2)? Evaluate latch. -Perineum: Follow up any concerns from birth. Inspect repair, assess for cystocele/ rectocele (may be presenting now) -Appetite, diet, hydration -Rh negative: Administer RhoGam |
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1-2 Day PP Visit
NB |
Feeding: Frequency, duration, latch.
Sleep patterns- should be sleeping most of the day Skin- assess for jaundice, dehydration, milia Cord stump- remove clamp if dry, assess for infection Vitals- heart sounds/rate, lung sounds/rate, temp -Elimination pattern Follow up any issues from NB exam NB metabolic screen |
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Day 3 PP Visit
Maternal |
-Breasts: evaluate for engorgement, nipple pain. Has milk come in?
-Uterus: assess lochia, fundus should be firm and 3-4 fb < U -Vitals: BP, R, P, T (temp can be elevated as milk is coming in) -Help at home? -How is she sleeping? -Emotional well-being? -Integration of baby into family- how are siblings doing with new baby? - Discuss birth -Follow up any issue from previous visit |
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Day 3 PP Visit
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-Cord: should be very dry. assess for infection
-Jaundice- recommend sunbathing, frequent nursing -Dehydration- skin should not be dry and wrinkly -Nursing patterns, follow up latch issues -Vitals- P, R, T -Weight -Elimination pattern |
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Day 7 PP Visit
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-Partner going back to work? Other help at home?
-Assess diet/ hydration -Activity level- should still be resting frequently -Bleeding- should be serosa. If rubra returns, she needs to rest more, get help at home -Discuss birth -Evaluate perineum repair: should be closed, obviously healing -BF should be well established -Emotional: evaluate for baby blues/ PPD -Give instructions for next few weeks: rest often, resume sex only if bleeding has stopped completely, call if s/s of infection -NB: weight check, assess jaundice, follow up any previous issues, cord should be gone |
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3-4 Week PP Visit
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Discuss family planning, evaluate readiness for sex
Maternal vitals Uterus should not be palpable Inspect perineum Weight check baby, 2nd metabolic screen |
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6-8 Week PP Visit
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-Follow up any issues with repair
-Well woman- pap, fit for diaphragm (if applicable), assess health of cervix, vagina, vulva, perineum, anus -Uterus should not be palpable from abdomen -Cervix should be firm, closed, situated high in vault -Internal muscle tone should be almost back to normal. Recommend kegels, elevators if weak. -Laceration healing should be complete, tenderness ok Abdominal tone- check for diastasis. If >1 fb, suggest ab exercises Breast: exam, teach self exam Assess diet, breastfeeding Adjustment to parenting Weight, length check baby |
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General Health Assessment of Infant
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Temp: 97.7- 99.6°F
HR: 100-160 bpm, regular rate and rhythm Resp: 30-60/min, clear lung sounds, no flaring, grunting, retractions Weight: Loss of 5-7% normal in first 7-10 days, back to birth weight by 2 weeks, gain 6 oz/ week Length: grow 1"/mo. Head circumference: grow 1/2"/mo. Neuromuscular: good tone, grasp, neck strength improves, reflexes Alertness: sleeping, quiet alert, active alert, fussy, crying Wake/sleep patterns: sleep 15-20/day in first month. Transitions to longer sleeping at night, shorter during day. By 2 weeks, most will sleep 5+ hrs/night. May be interrupted by illness, growth spurts, teething |
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NB Jaundice
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Physiologic: Onset after 24 hrs, affecting eyes, face. Should resolve by day 10.
Pathologic: Onset within 24 hrs, affecting eyes, face, worsening to trunk, extremeties. persists >1 week >13mg/dL total bilirubin Management: Physiologic- sunbathing- undressed to diaper, 30 mins, twice per day. Frequent nursing. Assess for lethargy/ hydration Pathologic: above remedies, plus refer to physician for treatment |
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Care of circumcised penis
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Expect reddened glans and remaining foreskin
May be edema of remaining foreskin, drainage Healing should be apparent by 1-2 days/ complete healing by 1 weeks Expect irritability at diaper changes Wash hands before and after diapering Initial Vaseline dressing should be left on 24 hrs- replace if necessary Initial dressing should be removed after 24 hours, replaced with clean vaseline dressing at every changing Educate s/s infection: failed healing, prolonged redness, heat, pus, foul odor, fever. Refer for treatment Sponge baths 1st 2 weeks, then immersion baths Clean penis with clear warm water only |
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Care of intact penis
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Keep clean and dry- mild soap only
Do not retract foreskin- this will break adhesions and possibly introduce infection Foreskin becomes retractible at age 2 Teach child and assist with retracting foreskin and cleaning penis with soap/water |
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Feeding patterns
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Should be fed q2-3h, lasting 10-20 mins per breast (may nurse longer)
Encourage more night sleeping after BF established No more than 4h breaks between feedings for 1st few weeks Demand increases with: Teething Illness Growth Spurts: -2 to 3 weeks -6 weeks -3 mos -6 mos |
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Urine and Stools- Newborn
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2-6 wet diapers/day for days 1-2
6-8 wet diapers/day for day 3 and beyond Stooling every day 4-6/day Day 1-3: Meconium, dark green-black tarry Day 3-5: transitions to green/yellow, thinner Day 5 and on: yellow, thin, seedy Some babies will go days without stooling (after the first month or so), then have a blow-out. If >5 days with no stool, refer to ped |
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Parental Instructions:
Diaper Rash |
Prevent diaper rash by keeping the area clean and dry. Change diapers soon after wetting or stooling.
When changing, use mild wipes or plain water washcloths to clean area. Treat rash with natural oil (coconut/olive). Aloe vera/ calendula cream for inflammation. Fungal diaper rash can be treated with OTC anti-fungal (miconazole). Make sure cloth diapers are getting clean when laundered. Use very hot water. Periodically remove residue by soaking in a weak bleach/water solution, double-rinse. Dry in the sun or in extra hot dryer. |
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Parental Instructions:
Cradle Cap |
Apply natural oil (coconut/olive) to scalp. Leave on all night. Comb scales away gently with a fine-toothed comb. Use natural shampoo.
Cradle cap might return. Treatment can be repeated. Condition will eventually resolve. |
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Parental Instructions:
Heat Rash |
This happens when baby is overheated, causing sweat to linger in skin creases which irritates the skin.
Dress baby in loose clothing. Remove layers to keep baby comfortable. Cool of rooms with fan. Check baby's temp periodically by feeling hands and feet. They should be slightly cool to the touch. Adjust clothing, A/C and heat as needed. Calendula cream or aloe vera for inflammation. Keep baby's skin dry. |
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Mouth Thrush
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S/S:
White patches on the tongue, gums, hard palate which do not easily wipe off. If the patches do wipe off, it may look red or bleed. Diaper rash- may be red, or red with raised dots. A whitish sheen to the inside of the lips or the saliva. Baby refusing to nurse, pulling off breast. and becoming fussy. Management: Treat mother's nipples concurrently Gentian violet or refer for oral anti-fungal treatment. Disinfect anything that goes in baby's mouth witha vinegar wash and rinse with plain water. Mom should avoid sugary foods, take probiotics. |
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Colic
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Constant fussiness
R/O infection, GI blockage, intolerance to something in mother's diet. Calming techniques: -Take care of baby's basic needs first: feed, diaper -Swaddle -Hold and swing or use rocker or baby swing -Shooshing or white noise -Offer pacifier or other non-nutritive sucking -Go for a car ride Evaluate mother's emotional health |
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Newborn Infections
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S/S:
Fever, fussiness, lethargy, poor color/ jaundice, irritability, dehydration, runny nose/ eyes, tachypnea, poor feeding R/O dehydration/ hypoglycemia: Evaluate breastfeeding, mom's diet and nutrition. Check blood sugar. Refer to pediatrician for infection. Provide follow-up care as needed. Mother can supplement immune support. |
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Cardio-respiratory abnormalities- Newborn
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S/S:
Cyanosis, resp distress, abnormal heart rhythm, persistent bradycardia, tachycardia, hypothermia, poor feeding, tachypnea, apnea Refer to pediatrician. Initiate EMS if necessary. Provide follow-up care as needed. |
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Hypoglycemia- Newborn
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Increased risk with: LGA, SGA, Premature, POstmature, Maternal diabetes.
S/S: <40mg/dL blood glucose lethargy irregular resp hypothermia poor feeding irritability tremors Management: Increase nursing freq and duration Supplement with breastmilk Supplement with molasses water (1tsp: 1cup) Refer/transport for <30mg/dL |
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Failure to Thrive
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S/S:
Lethargy, dehydration, constipation, irritability, excessive crying, little or no weight gain, does not regain birth weight by 2 weeks, initial weight loss >10% birth weight, little or no head/ length growth. Management: R/O metabolic disorder, GERD, cleft lip/ palate, lip/tongue tie Evaluate mom's diet: increase calories, hydration, supplements Evaluate freq/ duration of feedings (increase these) Evaluate elimination patterns Assess weight frequently, refer if weight gain not improving (remedies have failed). |
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Newborn Hemorrhagic Disease
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aka Vitamin K Deficiency Bleeding VKDB
Early Onset: <24hrs. associated with moms taking anti-coagulant or anti-convulsant drugs Classic Onset: >24hrs. Late Onset: 2-12 weeks after birth S/S: Visible bleeding from GI tract, umbilicus, ears, nose, throat, heel prick site, circumcision wound, intracranial) vomiting, convulsions, coma Blood in stool of vomit Unexplained bruising Black tarry stool after mec has cleared Bleeding >6min from a small wound (like heel prick), even when pressure is applied. Neurologic s/s Jaundice with dark urine Failure to thrive Prevention: vitamin K injection at birth Management: Emergency transfer |
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Hemolytic Disease of the NB
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aka erythroblastosis fetalis
Due to blood incompatibility with mother S/S: Jaundice in 1st 24h Elevated bilirubin Enlarged liver Can cause general edema, resp distress, heart failure, pallor, hydrops, stillbirth (prenatally) May result in neonatal death |
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Polycythemia
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aka plethora
Hgb >22/ Hct >65% S/S: Ruddy-red, dark pink color shortly after birth (may have cyanosis of extremeties) Jaundice Resp distress oliguria lethargy jittery swelling sezures persistent erection in boys poor feeding Refer to pediatrician/ transfer care immediately |
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End of Care/ Continuing Care
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Referral to pediatrician/ family practice for continued care
Refer for hearing screen Perform/ refer for metabolic screen |
