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External genitalia R e p r o d u c t i v e S

External genitalia

Reproductive System

Female

MALE

External genitalia

mons pubis

labia majora and minora

Clitoris

Vestibule

perineum

Internal reproductive organs

Vestibule ❖ perineum Internal reproductive organs ❖ Vagina: muscular tube that leads from the vulva to

Vagina: muscular tube that leads from the vulva to the uterus

Cervix: dips into the vagina and forms fornices, which are arch-like structures or pockets.

Ovaries :two sex glands homologous to the male testes,

are located on either side of the uterus. (Hatfield 55) Fallopian tubes: The paired fallopian tubes (also known as oviducts) are tiny, muscular corridors that arise from the superior surface of the uterus near the fundus and extend laterally on either side toward the

ovaries. The fallopian tubes have three sections

Isthmus

Ampulla

infundibulum

Uterus: uterus, or womb, is a hollow, pear-shaped, muscular

structure located within the pelvic cavity between the bladder and the rectum. The uterus is divided into four sections.

cervix

uterine isthmus

corpus fundus (Hatfield 53)

Cellular development

Soma cells:

Makeup organs and bodily tissue of the human body.

Gametes: germ cells/ sex cells found only in the reproductive glands

Nucleus: contains 23 pairs of chromosomes

Each parent donates 1 par of chromosomes ( 46 Chromosomes equals little Mikey)

Each parent donates 22 pairs of autosomes: genetic traits such as eye color, hair color, ear wax consistency.

One pair of sex chromosomes

ear wax consistency. ❖ One pair of sex chromosomes ❖ Penis: reproductive and urinary elimination. ❖
ear wax consistency. ❖ One pair of sex chromosomes ❖ Penis: reproductive and urinary elimination. ❖

Penis: reproductive and urinary elimination.

Scrotum: External sac that houses testes. Protects the testes from trauma & testicular temperature regulation.

Internal reproductive organs

Testes: produce male sex hormone and from spermatozoa

Ductal system: “ vas deferens” the tube in which sperm begin the journey out of the body.

Accessory glands: The seminal vesicles are

paired glands that empty an alkaline, fructose-rich fluid into the ejaculatory ducts during ejaculation. Prostate: muscular gland that surrounds the first part of the urethra as it exits the urinary bladder. The alkaline fluids

secreted by these glands are nutrient plasmas with several key functions, including the following:

Enhancement of sperm motility (i.e., ability to move)

Nourishment of sperm (i.e., provides a ready source of energy with the simple sugar fructose)

Protection of sperm (i.e., sperm are maintained in an alkaline environment to protect them from the acidic environment of the vagina) (Hatfield 51)

Menstrual cycle

Two main components : Ovarian cycle and Uterine cycle Ovarian cycle : Cyclical changes in the ovaries occur in response to two anterior pituitary hormones:

follicle-stimulating hormone (FSH) and luteinizing hormone (LH). There are two phases of the ovarian cycle, each named for the hormone that has the most control over that particular phase. The follicular phase, controlled by FSH, encompasses days 1 to 14 of a 28-day cycle. LH controls the luteal phase, which includes days 15 to 28

Follicular phase

Luteal phase

Fetal development Pre-embryonic stage : 3-4 weeks gestation Embryonic: 5-10 weeks gestation Fetal: 11-40 weeks
Fetal development
Pre-embryonic stage : 3-4 weeks
gestation
Embryonic: 5-10 weeks gestation
Fetal: 11-40 weeks gestation

Uterine cycle: changes that occur in the inner lining of the uterus. These changes happen in response to the ovarian

hormones estrogen and progesterone. There are four phases to this cycle:

and progesterone. There are four phases to this cycle: ❖ Menstrual ❖ Proliferative ❖ Secretory ❖

Menstrual

Proliferative

Secretory

ischemic.

Signs of pregnancy

Presumptive: subjective data the woman reports to the HCP for example, “ My breasts hurt”

Probable : objective data such as cervical changes

Positive : diagnostic confirmation such as, fetal heartbeat & ultrasound

FETAL HEART TONES

CONDITION

CAUSE

GRADE

Fetal Tachycardia

Infection

Mild : > 5 BPM from baseline

Dehydration

Moderate: 6-25 BPM from baseline

 

Fever

Severe: < 25 BPM from baseline

Fetal hypoxemia

Absent : No fluctuation in fetal heart rate

Anemia

Prematurity

Terbutaline

Caffeine

Epinephrine

Theophylline

illicit drugs

Fetal bradycardia

Maternal hypotension

Mild : > 5 BPM from baseline

Supine hypotensive syndrome

Moderate: 6-25 BPM from baseline

Fetal decompression

Severe: < 25 BPM from baseline

Late fetal hypoxia

Absent : No fluctuation in fetal heart rate

Cord compression

Abruptio placenta

Vagal stimulation

Accelerations & Decelerations Accelerations: must be 15 BPM above the FHR baseline for 15 seconds
Accelerations & Decelerations
Accelerations: must be 15 BPM above the FHR baseline for 15
seconds 15x15 window
Decelerations : A decrease in FHR during uterine contraction ”
mirrors contractions usually a U shape
Periodic changes : variations that occur during a contraction.
❖ Reassuring periodic changes : must be 15 BPM
above the FHR baseline for 15 seconds ( 15x15 window)
❖ Benign periodic changes: Early decelerations
Episodic changes: occur in association with medication
administration or analgesia
Decreased or absent variability: medications, narcotics, mag
sulfate ( preeclampsia, preterm), terbutaline, fetal sleep (
normally 20 minute cycles), prematurity, fetal hypoxemia.
Fetal decelerations
Early decelerations : A decrease in FHR during uterine contraction mirrors
uterine contractions . caused by uterine squeeze
❖ FHR slows as the contraction begins
❖ Lowest point coincides with the highest point ACME of the
contraction
❖ Deceleration ends with the contraction
Late deceleration: occurs after the peak of contraction due to uteroplacental
insufficiency, pitocin, HTN, diabetes, placental abruption.
❖ Too many decelerations will indicate a need for C-section
❖ Prepare for fetal resuscitation
Variable decelerations: may indicate cord compression. Occur at different
times during a contraction, resulting in fetal HTN that causes the aortic arch
to slow the FHR. usually abrupt and sudden.
Measures to clarify NONreassuring FHR patterns
❖ Fetal stimulation
❖ Fetal scalp sampling
❖ Fetal scalp oximetry

Variability

FHR drops from baseline then recovers, usually jagged and

erratically shaped. Can happen at anytime during contraction

Nursing interventions : Left Side. IV bolus of fluids, O2 6l mask,

Notify HCP

A great way to remember this is L.I.O.N

Decreased or absent variability: Non reassuring, acute treatment

and monitoring are indicated.

Wandering baselines with no variability could indicate

Wandering baselines with no variability could indicate ❖ Congenital defects ❖ Metabolic acidosis The nurse

Congenital defects

Metabolic acidosis

The nurse should administer 02 and the baby needs to be

delivered as quickly as possible.

Memory trick

C: cord compression H: head compression O: ok Placental insufficiency

V: variable deceleration E:early deceleration A: acceleration Late deceleration

O : ok Placental insufficiency V : variable deceleration E :early deceleration A : acceleration Late
O : ok Placental insufficiency V : variable deceleration E :early deceleration A : acceleration Late

Hematologic Changes

PREGNANCY

Weight gain

 

Blood volume increases by

 

45-50%

A woman should increase her

Red blood cell count increases up to 30%

 

caloric intake by 300 kcal/day during 2nd & 3rd trimesters.

Recommended weight gain depends on pre pregnancy BMI.

FIRST TRIMESTER : 3-4 lb total

 

Signs of pregnancy

Plasma increases up tp 50%

Hemoglobin decreases

Presumptive: subjective data the woman reports to the HCP for example, “ My breasts hurt”

Hematocrit decreases

 

REMAINDER OF PREGNANCY: 1 lb per week.

 

Cardiac changes

Probable : objective data such as cervical changes

Total weight gain: 25-35 lb for a woman with a normal BMI

 

Positive : diagnostic

with a normal BM I   ❖ Positive : diagnostic ❖ Blood pressure slightly decreases ❖

Blood pressure slightly decreases

Heart rate increases by 10-15 BPM

Cardiac output increases

confirmation such as, fetal

heartbeat & ultrasound

confirmation such as, fetal heartbeat & ultrasound Nutrition ❖ When a woman isn't getting the proper

Nutrition

When a woman isn't getting the proper nutrients this can cause Amenorrhea which can inhibit the ability to become pregnant.

Lack of folic acid can cause neural tube defects ( spina bifida) and cause damage to the growing fetus.

Deficits in Vit C have been shown to also cause birth defects and cancer.

Pica:

persistent ingestion of nonfood substances such as clay, laundry starch, freezer frost, or dirt.It results from a craving for these substances that some women develop during pregnancy.

These cravings disappear when the woman is no longer pregnant.

Pica is associated with iron-deficiency anemia, but it is unknown whether iron deficiency is the cause or the result

Nutritional requirements

Proteins: Growth and repair of fetal tissue, placenta, uterus, breasts, and maternal blood volume

Minerals: Prevent deficiencies in the growing fetus and maternal stores

Iron : Formation of hemoglobin; essential to the oxygen-carrying capacity of the blood

Calcium: Nerve cell transmission, muscle contraction, bone building, and blood clotting

Phosphorus: Promotes strong bone growth

Zinc: Fetal growth and maternal milk production

Iodine : Promotes normal thyroid activity, preventing specific birth defects

normal thyroid activity, preventing specific birth defects Vitamin requirements Integumentary changes ❖ Chloasma :

Vitamin requirements

Integumentary changes

Chloasma : “ pregnancy mask” brown blotchy areas on the skin of the face, cheeks, nose and forehead.

Linea nigra: a dark line down the middle of the skin on the abdomen

Striae: develop in response to increased glucocorticoid levels. Also known as stretch marks

increased glucocorticoid levels. Also known as stretch marks Musculoskeletal changes ❖ Lordosis: Excessive inward

Musculoskeletal changes

Lordosis: Excessive inward curvature of the spine

Diastasis rectus abdominis:

tearing of the rectus abdominis muscles

Respiratory changes

Folic acid (Vitamin B9) ❖ Necessary for formation of the nervous system ❖ Prevents up
Folic acid (Vitamin B9)
❖ Necessary for formation of the nervous system
❖ Prevents up to 70% neural tube defects
❖ Diet should include at least 400 mcg of folic acid per day
Vitamin A
Recommended intake via beta-carotene
Too much can be toxic to the fetus

Nasal mucosa edematous due to vasocongestion

Nasal congestion and voice changes possible

Accommodations to maintain lung capacity

May feel short of breath when eupneic

Third trimester diaphragm pressure

Too little can stunt fetal growth and cause impaired dark adaptation and night blindness

Vitamin C

GI changes

Intestines are displaced upwards & to the side.

Pressure changes in the esophagus & stomach which leads to heartburn.

constipation

& stomach which leads to heartburn. ❖ constipation ❖ Essential in the formation of collagen, a

Essential in the formation of collagen, a necessary ingredient to wound healing

Vitamin B6

Necessary for the healthy development of the fetus’s nervous system

for the healthy development of the fetus’s nervous system Vitamin B12 ❖ Needed to maintain healthy

Vitamin B12

Needed to maintain healthy nerve cells, RBCs, form DNA

healthy development of the fetus’s nervous system Vitamin B12 ❖ Needed to maintain healthy nerve cells,
Assessment Admission Components of assessment ❖ Birth imminence ❖ Fetal status Obstetric History ❖ Maternal
Assessment
Admission
Components of assessment
❖ Birth imminence
❖ Fetal status
Obstetric History
❖ Maternal status
❖ Risk assessment
❖ Number and outcomes of previous pregnancies in
GTPAL (gravida, term, preterm, abortions, living)
format (see Chapter 7 for a detailed explanation of
these terms)
❖ Estimated delivery date
❖ History of prenatal care for current pregnancy
❖ Complications during pregnancy
Assessment of reproductive history
❖ Dates and results of fetal surveillance studies, such
as ultrasound or nonstress test (NST)
Gravida: Number of pregnancies the woman has had regardless
of outcome
Nulligravida: never been pregnant
Multigravida: more than one pregnancy
❖ Childbirth preparation classes
❖ Previous labor and birth experiences
Current Labor Status
❖ Time of contraction onset
Parity: the client communicates outcome of previous pregnancies
GTPAL :
❖ Contraction pattern including frequency, duration,
and intensity
G: Gravida – the total number of pregnancies regardless of
outcome
❖ Status of membranes
❖ Description of bloody show or bleeding
T:
Term – the number of pregnancies that ended at term (at or
❖ Fetal movements during the past 24 hours
beyond 38 weeks’ gestation)
Medical–Surgical History
P: Preterm – the number of pregnancies that ended after 20
weeks and before the end of 37 weeks’ gestation either
❖ Chronic illnesses
❖ Current medications
A
: Abortions – the number of pregnancies that ended before 20
❖ Prescribed
weeks’ gestation either spontaneous or induced
❖ Over-the-counter
L:
Living – the number of children delivered who are alive when
❖ Herbal remedies
the history is taken
Social History
❖ Marital status
❖ Support system
❖ Domestic violence screen
❖ Cultural/religious considerations that affect care
❖ Amount of smoking during pregnancy
Prenatal visits
❖ Drug and alcohol use during pregnancy
Desires/Plans for Labor and Birth
Ist visit :
❖ Family History, Medical Surgical History,
Social History, Teaching, Avoiding
teratogenic, substance ingestion, Alcohol,
tobacco, illegal drugs, etc., Diet, nutrition, and
exercise, Infection control
❖ Presence of a partner, coach, and/or doula (see
Chapter 7 for discussion of doulas)
❖ Pain management preferences
❖ Other personal preferences affecting intrapartum
nursing care
❖ Presence of a birth plan
❖ Medication use
❖ Desires/Plans for Newborn
❖ Determining due dates
❖ Plans for feeding—breast or formula
❖ Naegele's rule
❖ Choice of pediatrician
❖ Add seven days to the date of the first day of
the LMP, then subtract three months (and
add a year)
❖ Circumcision preference, if the infant is male
❖ Rooming-in preference (Hatfield 208)
❖ Pelvic examination
❖ Practitioner sizes the uterus to estimate term
❖ Obstetric sonogram: High frequency sound
waves reflect off fetal and maternal pelvic
Tips
structures, allowing structure measurement
If a woman presents with ℅
bleeding ask her how man
sanitary napkins she has
saturated in an hour.
measurement If a woman presents with ℅ bleeding ask her how man sanitary napkins she has
Labor positions Anticipatory signs of labor The Four P’s of Labor ❖ Passageway: Pelvic shape

Labor positions

Anticipatory signs of labor

The Four P’s of Labor

Passageway: Pelvic shape

Passenger: fetus

Powers: contractions

Psyche

The Four P’s of Labor ❖ Passageway: Pelvic shape ❖ Passenger: fetus ❖ Powers: contractions ❖

Fetal lie

Longitudinal lie: Long axis of the fetus is parallel to maternal long axis

Oblique lie: Between longitudinal and transverse lie

Transverse lie: Long axis of fetus is perpendicular to

maternal long axis

Fetal presentation

Foremost part of the fetus that enters the pelvic inlet Three main presentations

Head: Cephalic presentation

for

Feet or buttocks: Breech presentation

Shoulder: Shoulder presentation

Fetal attitude

Relationship of fetal parts to one another

Flexion (ovoid shape):Most favorable vaginal delivery

Military (no flexion or extension)

Brow or frontum (partial extension)

Face (full extension)

or frontum (partial extension) ❖ Face (full extension) ❖ Lightening or sense that the baby has

Lightening or sense that the baby has

“dropped”

Increased frequency, intensity of Braxton Hicks contractions

Gastrointestinal disturbances

Expelling the mucus plug

Feeling a burst of energy

❖ Expelling the mucus plug ❖ Feeling a burst of energy Clinical signs ❖ Ripening (softening)

Clinical signs

Ripening (softening) effacement (thinning) of the cervix

❖ Ripening (softening) effacement (thinning) of the cervix Maternal adaptation to labor ❖ Maternal physiologic

Maternal adaptation to labor

Maternal physiologic adaptation

Increased demand for oxygen during the first stage of labor

Increased heart rate

Increased cardiac output

Increased respiratory rate

Gastrointestinal and urinary systems are affected

Laboratory values impact

Fetal adaptation to labor

Increase in intracranial pressure

Placental blood flow temporarily interrupted at peak of uterine contractions

Stresses cardiovascular system; results in slowly decreasing pH throughout labor

Passing through the birth canal is beneficial in two ways

Stimulates surfactant production; helps clear respiratory passageways

Ecchymosis :a discoloration of the skin resulting from bleeding underneath, typically caused by bruising. (GOOGLE)

Edema: swelling

Caput succedaneum:serosanguinous, subcutaneous, extraperiosteal fluid collection with poorly defined margins caused by the pressure of the presenting part of the scalp against the dilating cervix (tourniquet effect of the cervix) during delivery. (GOOGLE)

Cephalohematoma: is a traumatic subperiosteal haematoma that occurs underneath the skin, in the periosteum of the infant's skull bone. Cephalohematoma does not pose any risk to the brain cells, but it causes unnecessary pooling of the blood from damaged blood vessels between the skull and inner layers of the skin.

but it causes unnecessary pooling of the blood from damaged blood vessels between the skull and
but it causes unnecessary pooling of the blood from damaged blood vessels between the skull and

Stages of labor

First stage: Begins with the onset of true labor and ends with full dilation of the cervix at 10 cm.

1. Early labor

2. Active labor

3. Transition

Latent Phase (Early Labor): Contractions during

early labor are typically five to 10 minutes apart, last 30 to 45 seconds, and are of mild intensity. The cervix is dilated from 1 to 3 cm, and effacement has begun. Possible spontaneous rupture of membranes Assessment

Assess FHR and contractions at least once every hour

Assess maternal status

Assess status of fetal membranes

Assess the woman’s psychosocial state

Goals, expected outcomes

Goal: The woman and fetus remain free from injury

Goal: The woman’s anxiety is reduced

Goal: The woman’s pain is manageable

Goal: The woman and partner have

adequate knowledge of labor process Active Labor: contractions occur every two to five minutes, last 45 to 60 seconds, and are of moderate to strong intensity. The cervix should dilate progressively from 4 to 8 cm.contractions are regular moderate and strong. Rapid effacement. Fetal descent begins. Assessment

Assess woman’s psychosocial state

Assess labor progress

Assess fetal status

Assess maternal status

Transition Phase of Labor: contractions should occur every two to three minutes, last 60 to 90 seconds, and be of strong intensity. The uterus should relax completely between uterine

contractions. Cervical examination during transition reveals dilation between 8 and 10 cm. The client may be nauseous, vomiting or reporting the need to have a bowel movement. Urge to push and bloody show. Assessment

Assess for signs that woman has reached transition phase

Assess woman’s ability to cope

Assess maternal status

Assess fetal status

She will often express irritability, restlessness, and will feel out of control. She may tremble, vomit, or cry. It is important to assess for hyperventilation during this phase.

important to assess for hyperventilation during this phase. Second Stage of Labor: Expulsion of the Fetus

Second Stage of Labor: Expulsion of the Fetus Assessment

Monitor the blood pressure, pulse, and respirations every 15 to 30 minutes

Assess the contraction pattern every 15 minutes

Assess fetal status

Assess the woman’s report of an uncontrollable urge to push

Check the FHR every 15 minutes for the low-risk woman, every five minutes for woman at risk for labor complications

every five minutes for woman at risk for labor complications Third Stage of Labor: Delivery of

Third Stage of Labor: Delivery of Placenta Assessment

Assess the woman’s psychosocial state after she gives birth

Monitor for signs of placental separation

Selected nursing diagnoses

Risk for deficient fluid volume related to blood loss in the intrapartum period

Risk for trauma: Hemorrhage, amniotic fluid embolism, retained placenta, or uterine inversion related to delivery of the placenta

Fourth Stage of Labor: Recovery Assessment

Continue to assess for hemorrhage

Assess the lochia: Color, quantity

Monitor for signs of infection

Monitor for suprapubic distention

Assess comfort level

Assess mother’s psychosocial state during the fourth stage

Assess initial bonding behaviors of the new

stage ❖ Assess initial bonding behaviors of the new family Pushing ❖ Vigorous pushing: take a
stage ❖ Assess initial bonding behaviors of the new family Pushing ❖ Vigorous pushing: take a
stage ❖ Assess initial bonding behaviors of the new family Pushing ❖ Vigorous pushing: take a
family Pushing ❖ Vigorous pushing: take a deep breath, hold the breath, and push while
family
Pushing
❖ Vigorous pushing: take a deep breath, hold the breath, and push while
counting to 10. She is encouraged to complete three “good” pushes in
this manner with each contraction.
❖ open-glottis pushing: method of expelling the fetus that is
characterized by pushing with contractions using an open glottis so that
air is released during the pushing effort.
❖ urge-to-push method, in which the woman bearsdown only when she
feels the urge to do so using any technique that feels right for her

Pain management during labor

Pain

General concepts of pain

Individual &

subjective

 

Pain threshold: Level of pain necessary for an individual to perceive pain

Pain tolerance: Ability of an individual to withstand pain, once recognized

Sensory experience

 

Factors influencing pain

❖ Physiologic

Physiologic

Psychological

Emotional

 

Environmental

Sociocultural

Non Pharmacological pain interventions

Continuous labor support

Principles of pain relief during labor

Women are more satisfied when they have control over the pain experience

   

Comfort measures

Relaxation techniques

Patterned breathing

Attention focusing/concentration

Caregivers commonly underrate the severity of pain

Movement and positioning

Touch and massage

Women who are prepared for labor usually report a more satisfying experience than do women who are not prepared

satisfying experience than do women who are not prepared ❖ Water therapy; hypnosis,Intradermal water injections

Water therapy; hypnosis,Intradermal water injections

Acupressure and acupuncture

Opioids

Medications with opium-like properties (also

known as narcotic analgesics); the most

frequently administered medications to provide analgesia during labor. (ex.:Demerol IV, IM) Advantages

Increased ability for a woman to cope with labor

Medications may be

nurse-administered

Disadvantages

Frequent occurrence of uncomfortable side effects

Nausea and vomiting; pruritus; drowsiness; neonatal depression

Pain not completely eliminated

Possible overdose

❖ Pain not completely eliminated ❖ Possible overdose Anesthesia ❖ Local: Used to numb the perineum

Anesthesia

Local: Used to numb the perineum just before birth, allowing for episiotomy and repair

Regional: Blocks a group of sensory nerves, supplying a particular organ or body area

General :Not frequently used in OB due to risks involved

Complications of anesthesia

Hypotension

Total spinal blockade (rare)

Inadvertent injection into the bloodstream

Spinal headache

Pruritus

Respiratory distress

Fatal complications of anesthesia

Failed intubation

Aspiration

Malignant hyperthermia: is a disease that causes a fast rise in body temperature and severe muscle contractions when someone with the disease gets general anesthesia. It is passed down through families (

google)

muscle contractions when someone with the disease gets general anesthesia. It is passed down through families
muscle contractions when someone with the disease gets general anesthesia. It is passed down through families

DELIVERY

Getting ready for the newborn

If the urinary bladder is full, the birth attendant may request that you perform a straight cath

bed is “broken”—the lower part of the bed is removed to allow room for the birth attendant to control the delivery.

place the woman’s feet on foot pedals or stirrups

clean the woman’s perineum with an antiseptic solution

Position the instrument table close to the birthing bed and uncover it.

Eye shields, gowns, and gloves may be necessary for protection from contact with bodily fluids.

be necessary for protection from contact with bodily fluids. Birthing the placenta ❖ nursing care focuses

Birthing the placenta

nursing care focuses on monitoring for placental separation and providing physical and psychological care to the woman.

the fundus rises in the abdomen, the uterus takes on a globular shape, blood begins to trickle steadily from the vagina, and the umbilical cord lengthens as the placenta separates from the uterine wall.

lengthens as the placenta separates from the uterine wall. Recovery ❖ The new mother is at

Recovery

The new mother is at highest risk for hemorrhage during the first two to four hours of the postpartum period.

Monitor the woman’s vital signs, and palpate the fundus for position and firmness.

The fundus should be well contracted, at the midline, and approximately one fingerbreadth below the umbilicus immediately after delivery.

Assess the lochia (vaginal discharge after birth) for color and quantity. The lochia should be dark red and of a small to moderate amount. If she saturates more than one perineal pad in an hour, palpate and massage the fundus,

Monitor for signs of infection. The temperature may be elevated slightly, as high as 100.4°F, because of mild dehydration and the stress of delivery.

The woman should void within six hours after delivery.

Assess cramping from uterine contractions (referred to as “afterbirth pains”) and perineal pain from edema or episiotomy repair

ibuprofen to be given every six to eight hours

ice pack to the perineum.

pain from edema or episiotomy repair ❖ ibuprofen to be given every six to eight hours
pain from edema or episiotomy repair ❖ ibuprofen to be given every six to eight hours
pain from edema or episiotomy repair ❖ ibuprofen to be given every six to eight hours
The newborn Complications Neonatal resuscitation ❖ Neonatal Resuscitation Program (NRP) ❖ If the newborn
The newborn
Complications
Neonatal resuscitation
❖ Neonatal Resuscitation Program (NRP)
❖ If the newborn doesn't cry immediately: Transport him or
her to a preheated radiant warmer for prompt resuscitation
❖ Must be able to initiate resuscitation and
assist throughout process
❖ Dry him or her quickly to prevent heat loss
❖ First 6 to 12 hours after birth are a critical
transition period for the newborn
❖ Bag and mask connected to 100% oxygen are used to
provide respiratory support
❖ Must be alert to early signs of distress:
❖ Most newborns do not require resuscitation, and the ones
who do generally respond well to a short period of positive
pressure ventilation with a bag and mask.
❖ However, a very small number of infants require chest
compressions, intubation, and medications

Bluish color of the skin and mucous membranes (cyanosis),Brief stop in breathing (apnea), Decreased urine output. Nasal flaring. Rapid breathing.,Shallow breathing.Shortness of breath and grunting sounds while breathing.

of breath and grunting sounds while breathing. ❖ Give constant attention to the airway ❖ Position

Give constant attention to the airway

Position newborn on side; bulb syringe is used to suction mouth first, then nose

Thermoregulation ❖ Critical to protecting the newborn from chilling ❖ Cold stress increases amount of
Thermoregulation
❖ Critical to protecting the newborn from chilling
❖ Cold stress increases amount of oxygen and glucose
needed
❖ Can quickly deplete body’s glucose and develop
hypoglycemia( < 40 mg/ dl )
❖ Easily develop respiratory distress and metabolic
acidosis if exposed to prolonged chilling ( PH < 7.20 )
❖ Dry the newborn while on the mother’s abdomen
❖ Swaddle him snugly, and apply a cap to prevent heat
loss
❖ Kangaroo care
Hypoglycemia
❖ Ideal glucose range 40-60 mg/dL
❖ Perform a heel stick Glucose level of less than 50 mg/dL
requires confirmation (see hospital protocol)Immediately initiate
treatment ( 20-30 mg/dl start a line, 30-40 mg/dl give sugar
bottle)
❖ If the mother is breast-feeding, encourage early and frequent
feedings.
❖ If the newborn is to be bottle-fed, initiate early feedings.

Must be ready to intervene quickly to

prevent complications and poor outcomes

Assessment

Heart and respiratory rates at least every 30 minutes during the first two hours of transition.

Monitor the axillary temperature every 30 minutes until it stabilizes in the expected range between 97.7°F and 99.5°F

Be alert for signs of hypoglycemia.

A full physical assessment including gestational age assessment is completed within the first few hours of life.

assessment is completed within the first few hours of life. Birth ❖ If the newborn cries

Birth

If the newborn cries vigorously: Palpate the base of the umbilical cord and count the pulse for six seconds and multiply x 10

Pulse above 100 bpm and a vigorous cry are reassuring signs

Give constant attention to the airway.

Newborns often have abundant secretions.

A bulb syringe is used to suction the mouth first and then the nose.

Keep the bulb syringe with the newborn, and teach the parents how and when to suction the baby.

INFECTION CONTROL OF THE NEONATE ❖ UMBILICAL CORD STUMP: Use strict aseptic technique when caring
INFECTION CONTROL OF THE NEONATE
❖ UMBILICAL CORD STUMP: Use strict aseptic technique
when caring for the cord
❖ Triple dye, bacitracin ointment, or povidone-iodine used
initially to paint the cord to help prevent the development
of infection.
❖ PREVENT OPHTHALMIA NEONATORUM: a severe eye
infection contracted in the birth canal of a woman with
gonorrhea or chlamydia.
❖ 0.5% erythromycin
a severe eye infection contracted in the birth canal of a woman with gonorrhea or chlamydia.

Newborn nutrition

Principles

At birth, the passive intake of nutrition ends and the newborn must actively consume and digest food

Newborn has unique nutritional needs

Healthy term newborn requires

80 to 100 mL/kg/day of water to maintain fluid balance and growth

100 to 115 kcal/kg/day to meet energy needs for growth and development

kcal/kg/day to meet energy needs for growth and development Feeding types Two main types of nourishment

Feeding types

meet energy needs for growth and development Feeding types Two main types of nourishment suitable for

Two main types of nourishment suitable for the healthy term newborn:

Breast milk

Commercial formula

Two delivery methods:

Breast

Bottle

Breastfeeding

Feeding method choices:

Breastfeed exclusively

Breastfeed and supplement with expressed breast milk in a bottle

Breastfeed and supplement with formula

Formula-feed exclusively

Recommended method for feeding newborns

Breast milk is nutritionally superior to commercial formulas

The American Academy of Pediatrics (AAP) recommends

Exclusive breast-feeding until 6 months of age

Continuation of breast-feeding until at least 12 months of age

Healthy People 2020 goals

Increase proportion of women who breastfeed their babies

Increase proportion of women who breastfeed their babies Factors that affect feeding Culture ❖ Acceptability

Factors that affect feeding

Culture

Acceptability of breast-feeding in public

Amount and quality of family and community support for breast-feeding

When a woman initiates breast-feeding

How many times per day a woman breast-feeds

Whether or not a woman supplements

When a woman stops breast-feeding

–In the United States

–83% (highest): Asian or Pacific Islander descent

–59% (lowest): Non-Hispanic African American women

–Hispanic or Latino: Higher initiation rates (81%) than white women at 77%

–Hispanic women are more likely to breastfeed if they are of Mexican descent and have not completely acculturated

Sociodemographic

Breast-feeding rates differ by age, amount of education, and socioeconomic status

Past experiences of a woman and her support system

The feeding experiences and attitudes of the individuals who compose a woman’s support system strongly influence a woman’s choice of feeding method

Intent to return to work or school

Plays an important role in a woman’s feeding choice

Nursing considerations

Provide education

Support the woman

considerations ❖ Provide education ❖ Support the woman Maternal advantages ❖ More rapid uterine involution, less

Maternal advantages

More rapid uterine involution, less bleeding in the postpartum period

Stress levels decrease; may enhance immune function

More sleep at night; weight loss is faster on average

Long-term advantages

Decreased incidence of ovarian and premenopausal breast cancers

Potential osteoporosis protection

Additional research needed

Newborn advantages

Breast milk contains substances that facilitate critical periods of growth and development, particularly in the brain, immune system, and gastrointestinal tract

Breast milk provides immunologic properties

Lower incidences of otitis media, diarrhea, and lower respiratory tract infections

No physiologic disadvantages to either the woman or the newborn

Disadvantages

Maternal conditions or situations in which breast-feeding is contraindicated

Illegal drug use

Active untreated tuberculosis

Human immunodeficiency virus (HIV) infection

Chemotherapy treatment

Herpetic lesions on the breast

Newborn contraindications

Galactosemia

Phenylketonuria

Other medical conditions

Mother producing insufficient breast milk

❖ Galactosemia ❖ Phenylketonuria ❖ Other medical conditions ❖ Mother producing insufficient breast milk

Breastfeeding

Physical control of breastfeeding

When the breast is emptied, it responds by replenishing the milk supply

If emptied incompletely, it will decrease milk supply

Hormonal control of lactation

Pituitary gland releases prolactin and oxytocin

Lactogen

gland releases prolactin and oxytocin ❖ Lactogen What is breast Milk ❖ Unique substance that commercial

What is breast Milk

Unique substance that commercial formulas cannot duplicate, especially immunologic factors

Colostrum

Higher in antibodies; lower in fat; higher in protein

Milk appears approximately three to five days after birth

Breast milk supplies 20 calories per ounce

Newborn features that facilitate

breast-feeding

per ounce Newborn features that facilitate breast-feeding ❖ Newborn facial anatomy ❖ Designed uniquely for

Newborn facial anatomy

Designed uniquely for breast-feeding

Nose breathers

Rooting and sucking reflex

Present at birth

The breast and lactation

Unique organ designed to provide newborn nourishment via lactation

Consists of 15 to 20 lobes containing milk-producing alveoli

Makes milk in response to several different stimuli

Physical emptying of breast

Hormonal stimulation

❖ Sensory stimulation Nutrition requirements for breastfeeding ❖ Foremilk: the breast milk your baby gets
❖ Sensory stimulation
Nutrition requirements for
breastfeeding
❖ Foremilk: the breast milk your baby gets at the
beginning of each feeding when your breasts are full.
Foremilk is high in lactose (milk sugar) and low in fat and
calories. It's thin, watery, and it looks white or bluish.
❖ Approximately 500 kcal/day above her prepregnant
needs
❖ Plenty of fluids
❖ Rest
❖ Eat a balanced diet
❖ Hindmilk: the high-fat, high-calorie breast milk that your
baby gets toward the end of a feeding. It's richer,
thicker, and creamier than foremilk, the breast milk that
your baby gets when he first starts to breastfeed. The
color of hindmilk is creamy white.
❖ Multivitamin each day
❖ Assessing breast-feeding readiness
Positioning for breastfeeding
❖ Flat or inverted nipples
❖ History of breast surgery
❖ Cradle hold
❖ Attitudes toward breast-feeding
❖ football hold
❖ Quality of support for breast-feeding
❖ side-lying position
❖ Refer to lactation consultant if special needs exist
Education
Relieving common maternal breast-feeding problems
WHEN THE BABY ISN'T FEEDING WELL
❖ Sore nipples
❖ Engorgement
❖ Dry mouth
❖ Plugged milk ducts
❖ Not enough wet diapers per day
❖ Mastitis
❖ Breastfeeding amenorrhea
❖ Difficulty rousing the newborn for feeding
❖ Return of woman’s menstrual cycle occurs between
six and 10 weeks post delivery
❖ Not enough feedings per day
❖ Difficulty with latching on or sucking
❖ Ovulation can occur in absence of a menstrual
period, and she can become pregnant
❖ By end of third day of life at least six wet diapers and
about three bowel movements per day

Monitor the newborn’s weight daily during the

hospital stay

wet diapers and about three bowel movements per day ❖ Monitor the newborn’s weight daily during

Cesarean section delivery

Indication

Cesarean section delivery Indication Cesarean Birth Maternal risks ❖ Major surgery risks and risks of birth

Cesarean Birth

Maternal risks

Major surgery risks and risks of birth itself

Increases maternal risk of death

Thrombophlebitis, laceration of uterine artery, bladder, ureter, bowel

Hemorrhage, infection, pneumonia, etc.

Fetal risks

Inadvertent delivery of premature fetus (miscalculation of dates)

Increases incidence of neonatal respiratory distress

Scalpel cutting through the uterine wall can nick the baby.

The fetus can become wedged in

the pelvis after a prolonged second stage with the woman pushing, which can make for a difficult extraction leading to bruising and possibly other injuries.

Cesarean delivery procedures

perioperative period

Preoperative phase: Team approach, 2 MD or 1 MD and 1 first assist R.N and one pediatrician.

LVN cannot care for this client until they have fully recovered from Anesthesia.

informed consent must be obtained by the MD and the anesthesiologist prior to the procedure.

History of previous cesarean birth or other uterine incision

Labor dystocia (failure to progress in labor)

Nonreassuring fetal status

Fetal malpresentation

Active herpes, prolapsed cord (

emergency)

ruptured uterus (emergency)

placenta previa

abruptio placenta.

the rise of C-sections

Change in perception of risk by physicians and patients

Increase in the percentage of pregnant women who are carrying their first child

Rise in the number of older pregnant women

More labor inductions for nonmedical reasons

Almost universal use of continuous electronic fetal monitoring, which carries with it high false-positive indications of fetal compromise

Return to the adage “once a cesarean, always a cesarean”

A decrease in VBAC attempts

Increasing concerns regarding malpractice litigation

Increased prevalence of multiple gestations

Increased prevalence of maternal obesity

New phenomenon of cesarean by demand (women asking for planned cesarean without medical indications)

asking for planned cesarean without medical indications) Contraindications for induced labor Maternal

Contraindications for induced labor

Maternal contraindications for induced labor

Complete placenta previa: placenta covers the cervix

History of vertical uterine incision: This mom will never have a vaginal birth due to risks of uterine rupture and risk of hernia. this incision carries an increased risk of dehiscence

Structural abnormalities of the pelvis

Medical conditions (e.g., active genital herpes): A herpes outbreak can cause the baby to go blind and/ or cause sores of the mouth

Invasive cervical cancer

Fetal contraindications for induced labor

Certain anomalies, such as hydrocephalus

Certain fetal malpresentations

Fetal compromise

indications for induced labor

Postdate pregnancy: pregnancy that has gone past the due date

Premature rupture of membranes (PROM)

Chorioamnionitis: infection of the fetal membranes

Gestational hypertension

Preeclampsia

Severe intrauterine fetal growth restriction

Maternal medical conditions

hypertension ❖ Preeclampsia ❖ Severe intrauterine fetal growth restriction ❖ Maternal medical conditions
hypertension ❖ Preeclampsia ❖ Severe intrauterine fetal growth restriction ❖ Maternal medical conditions
Labor Readiness RIPENING OF THE CERVIX Fetal readiness labor indicators A “Ripe” cervix: Prerequisite for
Labor Readiness
RIPENING OF THE CERVIX
Fetal readiness labor indicators
A “Ripe” cervix: Prerequisite for successful
induced labor. Bishop score is most often
used to determine readiness for labor
The Fetus should be mature. There are several ways to assess
maturity:
❖ ≥38 weeks’ gestation
❖ Five factors evaluated, each factor
scored 0 to 3
❖ Fetal lung maturity is major point of consideration
❖ Score ≥8: Associated with
successful oxytocin-induced labor
❖ Measuring the lecithin/sphingomyelin (L/S) ratio via
amniocentesis assesses lung maturity. An L/S ratio greater
than 2 indicates fetal lung maturity.
❖ Score ≤5: “Unripe” cervix or
Induction of Labor

unfavorable Never schedule an induction without asking the bishop score.

Artificial rupture of membranes (AROM) – amniotomy

Causes release of prostaglandins, which enhance labor

Nursing interventions

Observing, documenting amniotic fluid color

Monitoring fetal heart rate

Oxytocin induction of labor

IV oxytocin (Pitocin) is the most common agent used

IV line initiated: Infusion pump required

Baseline fetal heart assessment before induction . The RN can titrate the PIT until fetal distress occurs, however they must call the HCP to obtain an order to decrease the PIT

Potential complications of oxytocin induction IV Pitocin

Potential risk for C-section doubles

Primigravidas versus multi gravidas

Hyperstimulation of uterus leading to one contraction after another without substantial rest periods in between : can blow the uterus. Give 02 10-12L via mask. IV bolus

Water retention may cause

Hyponatremia

Confusion; convulsions

Coma

Congestive heart failure; death

Nursing actions

monitoring mother and baby during pharmacologic induction interventions

Assist with pelvic examination in mechanical ripening of cervix or ROM

Communicate changes as needed

Document fetal heart rate before and after ROM

as needed Document fetal heart rate before and after ROM Methods of Cervical Ripening Mechanical methods

Methods of Cervical Ripening

Mechanical methods

Membrane stripping

Inserting a catheter into the cervix and inflating the balloon holds 30-80cc of fluid

Laminaria: Cervical dilators “seaweed”

Pharmacologic methods

Prostaglandin E 2 (dinoprostone)

Cervidil (string)( tampon like)

Prepidil (gel)

Prostaglandin E 1 (misoprostol) ( can cause rough labor)

Cytotec

Assisted Delivery

Episiotomy: Perineal surgical incision to enlarge the vaginal opening immediately pre birth Forceps: Instruments with curved, blunted blades are placed around the head of fetus to facilitate rapid delivery

Low, outlet forceps are more common than mid forceps

Maternal indications: Fatigue; certain chronic conditions; prolonged second stage of labor

Nonreassuring fetal strip

monitor for skull fracture, bruising, and hypoxia

Vacuum-assisted delivery: RN assisted: Suction cup connected to fetal head; suction is applied, used to guide delivery

Can be hazardous to infant, causing

Scalp trauma, stop vacuum after 3 pop offs

Subgaleal and intracranial hemorrhage

Death

3 pop offs Subgaleal and intracranial hemorrhage Death Potential complications of operative vaginal delivery ❖
3 pop offs Subgaleal and intracranial hemorrhage Death Potential complications of operative vaginal delivery ❖

Potential complications of operative vaginal delivery

Neonatal cephalohematoma; retinal, subdural, and subgaleal hemorrhage occur more frequently with vacuum extraction than with forceps

Facial bruising, facial nerve injury, skull fractures, and seizures: More common with forceps

Potential maternal complications

Extension of episiotomy into anal sphincter

Uterine rupture, perineal pain, lacerations, hematomas, urinary retention, anemia, and

rehospitalization

sphincter ❖ Uterine rupture, perineal pain, lacerations, hematomas, urinary retention, anemia, and rehospitalization
sphincter ❖ Uterine rupture, perineal pain, lacerations, hematomas, urinary retention, anemia, and rehospitalization

Uterine rupture

Assessment

Dramatic onset of fetal bradycardia or deep variable decelerations

Reports by the woman of a “popping” sensation in her abdomen

Excessive maternal (possibly referred) pain

Unrelenting uterine contraction followed by a disorganized uterine pattern

Increased fetal station felt upon vaginal examination

Vaginal bleeding or increased bloody show

Easily palpable fetal parts through the abdominal wall

Signs of maternal shock

What is it?

A serious but rare complication of childbirth. Characterized by tearing of a previous uterine scar from cesarean section. The myometrial wall becomes breached causing hemorrhage into the peritoneum.

becomes breached causing hemorrhage into the peritoneum. Types ❖ Incomplete: rupture only goes through the

Types

Incomplete: rupture only goes through the endometrium and the myometrium only, with the peritoneum still intact.

Complete: rupture goes through the endometrium, myometrium, and peritoneum, and then the contractions would immediately stop.

and then the contractions would immediately stop. Causes ❖ Pressure of baby moving through the birth
Causes ❖ Pressure of baby moving through the birth canal against a previous uterine scar.
Causes
❖ Pressure of baby moving
through the birth canal against
a previous uterine scar.
❖ abnormal presentation
Nursing interventions
❖ prolonged labor
❖ multiple gestation
❖ improper use of oxytocin
❖ traumatic effects of forceps use
or traction.
❖ The nurse should prepare IV fluid
replacement.
❖ IV oxytocin administration .
❖ Laparotomy to control the
bleeding and repair the rupture.
❖ Cesarean hysterectomy or tubal
ligation
Postpartum care Maternal Adaptation During Postpartum Period Weight loss Physiologic adaptation Reproductive system
Postpartum care
Maternal Adaptation During
Postpartum Period
Weight loss
Physiologic adaptation
Reproductive system
Immediate 12 to 14 lb = baby, placenta, and
amniotic fluid
❖ Uterine contraction leads to
involution(shrinking of the uterus
5 to 15 lb (early postpartum) = fluid loss from
diaphoresis, urinary excretion
❖ Measured by assessing fundal height
❖ Factors promote, inhibit involution
❖ Afterpains
Return to prepregnancy weight six months after
childbirth (if within recommended weight gain
range)
assessment/ education
Assess fundal height: Assess the location,
In general, the breastfeeding woman tends to
lose weight faster than the woman who does not
breastfeed because of increased caloric

consistency, and height of the fundus through palpation.

demands.

If the uterus is not firm upon palpation, massage it gently. Placing the infant on the mother’s breast also aids in stimulating contractions.

Nursing interventions for postpartum care after cesarean birth

Assessment

Primary causes of maternal mortality post cesarean

Primary causes of maternal mortality post cesarean ❖ Anesthesia complications ❖ Postpartum infection ❖

Anesthesia complications

Postpartum infection

Hemorrhage

Thromboembolism

Monitor

Lungs; signs of respiratory depression

PCA

discomfort

Incision; bowel sounds; urinary output

Signs of thrombus formation

IV for Sources of pain

Nursing management & Discharge planning

Preventing injury from Rh-negative blood type or non immunity to rubella

Is the woman a candidate for Rho(D) immune globulin (RhoGAM) I'M within 24 hours of delivery. Given and checked as if you were administering a blood product.

Providing patient teaching

Breast care; fundal massage

Perineum and vaginal care

Pain management

Nutrition; constipation

Proper rest

Stress importance of prioritizing self-care

MMR (subq) right before DC if needed

constipation ❖ Proper rest ❖ Stress importance of prioritizing self-care ❖ MMR (subq) right before DC

Evaluation: Goals and expected outcomes

Lochia: blood, mucus, tissue, WBC compose uterine discharge

Rubra: first 3-4 days, small-mod amount, mostly blood and dark red with fleshy odor

Serosa: days 4-10, decreases to small amount, brownish/pink color

Alba: after day 10, white-pale yellow, mostly WBCs

Ovaries

Ovulation can occur as soon as three weeks post-delivery

Cervix

Vagina, perineum

Never fully return to pregravid state; Kegel exercises

Lactation can lead to vaginal dryness, dyspareunia (painful intercourse)

Breasts

Colostrum; prolactin

Cardiovascular system

High plasma fibrinogen levels and other

coagulation factors mark postpartum period Vital signs

Temperature may be slightly elevated first 24 hours

Slow pulse a first, then WNL first week post

delivery

Blood pressure should not be elevated

post delivery ❖ Blood pressure should not be elevated For every 250 mL of blood loss,

For every 250 mL of blood loss, the hemoglobin and hematocrit (H&H) fall by one and two points, respectively. So, if the woman’s H&H were 12 and 34,

then fall to 10 and 30, the approximate blood loss is 500 mL.

fall to 10 and 30, the approximate blood loss is 500 mL. ❖ Musculoskeletal system: Abdomen

Musculoskeletal system: Abdomen is soft, sagging immediately postpartum

Gastrointestinal system: Very hungry; constipation

Urinary system: Transient glycosuria, proteinuria, and ketonuria are normal immediately postpartum

Voiding issues

Integumentary system: Copious diaphoresis

common

Striae (stretch marks) on abdomen and

breasts
breasts

Newborn adaptation

Respiratory system

The Birth process:

Newborn adaptation Respiratory system The Birth process: ❖ Helps expel fetal lung fluid ❖ Stimulates lung
Newborn adaptation Respiratory system The Birth process: ❖ Helps expel fetal lung fluid ❖ Stimulates lung

Helps expel fetal lung fluid

Stimulates lung inflation

Stimulates surfactant production

Surfactant keeps alveoli from collapsing after expansion

Thermoregulatory adaptation

Thermoregulation is the physiologic process of balancing heat production with heat loss to maintain adequate body temperature

Newborn thermoregulation difficulties

Prone to heat loss due to lower proportion of heat-producing tissue

Not readily able to produce heat

Vulnerable to cold stress

Circulation through the heart

Fetal circulation

High pressure in the lungs

causes pressure in right atrium > left atrium Pressure differences help route blood:

Through the foramen ovale, ductus arteriosus

Away from non functioning lungs

Back into general circulation

Ductus venosus shunts fetal blood away from the liver

Newborn loses heat in four ways:

Newborn compensation

Conduction—body heat transfers to cold object, infant placed in cold scale

Convection—air currents blow over infant’s body, infant susceptible to draft

Evaporation—wet skin dries and evaporates

Radiation—cold object close but not touching, infant close to cold windowpane causing body heat to radiate to window

Newborn Metabolic adaptation

Neonatal hypoglycemia: Blood glucose falls to ≤50 mg/dL (Differs at facilities)

Early signs of hypoglycemia

jitteriness

poor feeding

listlessness

irritability

low temperature

weak or high-pitched cry

hypotonia

Five parameters

Apgar score

Heart rate

Respiratory effort

Muscle tone

Reflex irritability

Color

Scored 0 to 2 points each

well

Flexed posture conserves heat

Burning brown fat produces heat

Late signs of hypoglycemia

Respiratory distress

Apnea

Seizures

Coma

distress ❖ Apnea ❖ Seizures ❖ Coma Newborn Hepatic adaptation Liver immature at birth

Newborn Hepatic adaptation

Liver immature at birth Bilirubin Conjugated

Water-soluble

Excreted in feces

Unconjugated

❖ Water-soluble ❖ Excreted in feces Unconjugated ❖ Fat-soluble ❖ Enters cells causing jaundice

Fat-soluble

Enters cells causing jaundice

Hyperbilirubinemia

High levels of unconjugated

bilirubin in the bloodstream

serum levels ≥4 to 6 mg/dL

Physiologic jaundice

Jaundice that occurs after first 24 hours of life (usually on days 2 or 3 after birth)

Bilirubin levels that peak between days 3 and 5

Bilirubin levels that do not rise rapidly (no greater than 5 mg/dL per day)

First appears on head

The liver manufactures clotting factors necessary for

normal blood coagulation. Several of the factors require vitamin K in their production.

Bacteria that produce vitamin K are normally present in the gastrointestinal tract. However, the newborn’s gut is sterile because normal

flora have not yet been introduced and colonized in the infant’s gastrointestinal tract.

Newborns receive vitamin K (AquaMEPHYTON) intramuscularly shortly after birth

******Prevent hemorrhage ******* If parents refuse, additional paperwork must be signed by parents.

Assessed @ 1 & 5 min of life

Scores 7 to 10 at five minutes: Doing

Scores 4 to 6 at five minutes: Needs close observation

Score 0 to 3 at five minutes: In severe distress

❖ Scores 4 to 6 at five minutes: Needs close observation ❖ Score 0 to 3
❖ Scores 4 to 6 at five minutes: Needs close observation ❖ Score 0 to 3
Complications:Miscarriage Assessment What is it? ❖ Cardinal signs are Can be elective or spontaneous ❖
Complications:Miscarriage
Assessment
What is it?
❖ Cardinal signs are
Can be elective or spontaneous
❖ Spotting and cramping together
❖ Tissue expulsion from the vagina
❖ Elective: The choice to terminate the
pregnancy.
❖ Spontaneous: spontaneous abortion
and pregnancy loss, is the natural death
of an embryo or fetus before it is able to
survive independently. Some use the
cutoff of 20 weeks of gestation, after
which fetal death is known as a stillbirth.
Risks
Age. Women older than age 35 have a higher risk of
miscarriage than do younger women. At age 35, you
have about a 20 percent risk. At age 40, the risk is
about 40 percent. And at age 45, it's about 80
percent.
Previous miscarriages. Women who have had two
or more consecutive miscarriages are at higher risk of
miscarriage.
Causes
Chromosomal abnormalities might lead to:
Chronic conditions. Women who have a chronic
condition, such as uncontrolled diabetes, have a
higher risk of miscarriage.

Blighted ovum. Blighted ovum occurs when no embryo forms.

Intrauterine fetal demise. In this situation, an embryo forms but stops developing and dies before any symptoms of pregnancy loss occur.

Molar pregnancy and partial molar pregnancy. With a molar pregnancy, both sets of chromosomes come from the father. A molar pregnancy is associated with abnormal growth of the placenta; there is usually no fetal development.

❖ Uncontrolled diabetes ❖ Infections ❖ Hormonal problems ❖ ❖ Uterus or cervix problems ❖
❖ Uncontrolled diabetes
❖ Infections
❖ Hormonal problems
❖ Uterus or cervix problems
❖ Thyroid disease
Prevention
❖ Seek regular prenatal care.
❖ Avoid known miscarriage risk factors
— such as smoking, drinking alcohol
and illicit drug use.
❖ Take a daily multivitamin.
❖ Limit your caffeine intake. A recent
study found that drinking more than
two caffeinated beverages a day
appeared to be associated with a
higher risk of miscarriage.

Uterine or cervical problems. Certain uterine abnormalities or weak cervical tissues (incompetent cervix) might increase the risk of miscarriage.

Smoking, alcohol and illicit drugs. Women who smoke during pregnancy have a greater risk of miscarriage than do nonsmokers. Heavy alcohol use and illicit drug use also increase the risk of miscarriage.

Weight. Being underweight or being overweight has been linked with an increased risk of miscarriage.

Invasive prenatal tests. Some invasive prenatal genetic tests, such as chorionic villus sampling and amniocentesis, carry a slight risk of miscarriage.

Treatment ❖ Monitor HcG Levels, a decrease is indicative of miscarriage. ❖ Pelvic rest ❖
Treatment
❖ Monitor HcG Levels, a decrease is
indicative of miscarriage.
❖ Pelvic rest
❖ Bed rest
❖ If it is sure that a miscarriage is
happening : prepare to start an IV,
administer blood & D&C
❖ Bed rest ❖ If it is sure that a miscarriage is happening : prepare to

Complications: Ectopic pregnancy

Complications: Ectopic pregnancy ASSESSMENT   Diagnostics ❖ Pain ❖ H&H: Low if rupture occurs.

ASSESSMENT

 

Diagnostics

Pain

H&H: Low if rupture occurs.

Referred shoulder pain

Diagnosable with ultrasound.

Spotting

Human chorionic gonadotropin level (serum) (hCG) is abnormally

Bleeding into the peritoneum

Bleeding from vagina if rupture

 

occurs

 

Normal signs/ symptoms of pregnancy

 

low; when the test is repeated in 48 hours, the level remains lower

than usual for a normal (intrauterine) pregnancy.

  ❖ Progesterone level (plasma) is
 

Progesterone level (plasma) is

   

lower than expected for an intrauterine pregnancy.

 

Risk Factors

History of tubal surgery

 

Previous ectopic pregnancy

History of pelvic inflammatory disease

Pelvic adhesions

Use of intrauterine device

History of endometritis

Progesterone-only contraceptive use

Use of assisted reproductive technologies

Diethylstilbestrol exposure in utero

Cigarette smoking

Age between 35 and 44

Multiple sexual partners

Vaginal douching

❖ Multiple sexual partners ❖ Vaginal douching ❖ Young age at first sexual intercourse What Am

Young age at first sexual intercourse

What Am I ?

Fetal growth somewhere outside of the uterus, usually within the fallopian tubes.

Causes

Diverticula

Ectopic endometrial implants in the tubal mucosa

Endosalpingitis

History of multiple elective abortions

Intrauterine device

Previous surgery, such as tubal ligation or resection

Sexually transmitted tubal infection

Transmigration of the ovum

Tumor pressing against the tube

Hormonal imbalance

Congenital defects in reproductive tract

Complications

Rupture of fallopian tube

Hemorrhage

Shock

Peritonitis

❖ Infertility ❖ Disseminated intravascular coagulation ❖ Death Treatments ❖ Transfusion with whole blood or
❖ Infertility
❖ Disseminated intravascular
coagulation
❖ Death
Treatments
Transfusion with whole blood or packed red blood
cells to treat hypovolemic shock if the tube has
ruptured.
IV fluid replacement
Supplemental iron if anemia occurs from blood loss
Methotrexate sodium (Trexall) as primary treatment
for unruptured ectopic pregnancy (single I.M. dose
or multidose treatment via I.M. or IV route)
Leucovorin I.N. between doses of multi dose
methotrexate therapy
Rh o (D) immune globulin, human, if the patient is
Rh-negative
Interventions ❖ Vital signs ❖ Vaginal bleeding ❖ Pain level and effectiveness of interventions ❖
Interventions
❖ Vital signs
❖ Vaginal bleeding
❖ Pain level and effectiveness of
interventions
❖ Fluid balance status
❖ Intake and output
❖ Signs and symptoms of hypovolemia and
impending shock
❖ Surgical site (postoperatively)
❖ Intake and output ❖ Signs and symptoms of hypovolemia and impending shock ❖ Surgical site

Complications : Placenta Previa

Assessment

Painless bleeding

Soft, nontender uterus

Fetal malpresentation

Minimal descent of fetal presenting part

Good fetal heart tones

Possible contractions

❖ Good fetal heart tones ❖ Possible contractions What am i? ❖ Three types: Marginal, partial,

What am i?

Three types: Marginal, partial, and total

Common cause of bleeding during the second half of pregnancy

Good maternal prognosis if hemorrhage can be controlled

Usually necessitates pregnancy termination if bleeding is heavy

Fetal prognosis dependent on gestational age and amount of blood lost; risk of death greatly reduced by frequent monitoring and prompt management

complications

Cord being the presenting part, possible cord prolapse

Fetal hypoxia or blood loss

Preterm delivery

Dystocia

Anemia

Hemorrhage

Abruptio placentae

Disseminated intravascular coagulation

Shock

Placenta accreta, increta, percreta

Intrauterine growth restriction

Abnormal fetal presentation

Kidney damage

Cerebral ischemia

Maternal or fetal death

❖ Cerebral ischemia ❖ Maternal or fetal death Patho Improper implantation of the placenta in the

Patho

Improper implantation of the placenta in the lower uterine segment has caused partial or total coverage of the cervical os.With development of the lower uterine segment and gradual changes in the cervix during the third trimester, shearing forces at the attachment site lead to partial detachment and bleeding.

Risk Factors

Medications

I.V. fluids, such as lactated Ringer solution or normal saline solution, using a large-bore catheter

Oxygen

Fresh frozen plasma and platelets, as necessary, for coagulation problems

Tocolytics, such as terbutaline sulfate, calcium channel blockers, or magnesium sulfate short-term to halt preterm labor and

to allow time for doses of betamethasone dipropionate (Diprolene)

Betamethasone dipropionate to enhance

(Diprolene) ❖ Betamethasone dipropionate to enhance ❖ Advanced maternal age (over age 35) ❖ Defective

Advanced maternal age (over age 35)

Defective vascularization of the decidua

Endometriosis

Multiparity

Infertility treatments

Multiple pregnancy

Previous uterine surgery or cesarean birth

Smoking

Male fetus

Cocaine use

History of placenta previa

High altitudes

Uterine abnormalities inhibiting normal embryonic implantation (such as prior curettage or the presence of uterine

fetal lung maturity if less than 34 weeks' gestation Interventions ❖ Pad counts, the patient
fetal lung maturity if less than 34 weeks'
gestation
Interventions
❖ Pad counts, the patient should not saturate
more than one pad an hour.
❖ Monitor blood counts
❖ Monitor fetal heart tones
❖ Monitor contractions
❖ Prepare for c-section
❖ Do not perform cervical exams
fibroids)
fibroids)
Complications: Abruptio Placenta
Complications: Abruptio Placenta

What Am I?

Common cause of bleeding during the second half of pregnancy

Assessment

Rigid board-like abdomen

Abdominal pain

Difficulty palpating baby.

Signs of fetal distress: prolonged fetal bradycardia, repetitive late decelerations, and decreased short-term variability; absent fetal

heart tones

Uterine hypertonicity

Abdominal tenderness

❖ Uterine hypertonicity ❖ Abdominal tenderness Priorities ❖ Keep baby safe, continuous monitoring ❖

Priorities

Keep baby safe, continuous monitoring

Manage maternal shock

Complications

Cesarean delivery

Hemorrhage/coagulopathy

Retroperitoneal bleed/bleeding into the abdomen

Shock

Acute kidney injury

Disseminated intravascular coagulation (DIC)

Adult respiratory distress syndrome

Multisystem organ failure

Maternal death

Fetal hypoxia or asphyxia

Precipitous labor and delivery

Prematurity

Fetal death

labor and delivery ❖ Prematurity ❖ Fetal death Causes ❖ Car accidents ❖ Domestic or IPV

Causes

Car accidents

Domestic or IPV

Previous C-section

Rupture of membranes

Cocaine use

Smoking

Pregnancy induced hypertension

use ❖ Smoking ❖ Pregnancy induced hypertension ❖ Sepsis Labs ❖ Serum hemoglobin level test and

Sepsis

Labs

Serum hemoglobin level test and platelet count are decreased.

Fibrin degradation products test shows progression of abruptio placentae and indicates the presence of DIC.

Hypofibrinogenemia suggests severe abruption (fibrinogen levels less than or equal to 200 mg/dL).

Kleihauer-Betke test is positive if fetal-maternal transfusion has occurred.

Rh o (D) antibody screening is positive if isoimmunization has

occurred.

screening is positive if isoimmunization has occurred. ❖ Premature separation of the placenta from the uterine
screening is positive if isoimmunization has occurred. ❖ Premature separation of the placenta from the uterine

Premature separation of the placenta from the uterine wall

Usually occurs after 20 weeks' gestation, most commonly during the third trimester, and peaks at 24 to 26 weeks' gestation

PATHo

Improperly implanted placenta separates before the pregnancy reches term. If the abruption is classified as concealed it is bleeding into the uterus. Can be classified on scale of 0-3, 3 being the worst prognosis.

be classified on scale of 0-3, 3 being the worst prognosis. Interventions ❖ Insert an indwelling

Interventions

Insert an indwelling urinary : monitor urine output.

Obtain blood specimens for Hb level and hematocrit, coagulation studies, and typing and crossmatching.

Evaluate the extent and amount of bleeding; perform a pad count,

Provide continuous external electronic fetal monitoring if the fetus is viable.

Give I.V. fluids and blood products. Maintain one to two large-bore I.V. lines; inspect I.V. insertion sites frequently for signs and symptoms of inflammation or infiltration. Provide I.V. site care according to your facility's policy.

Position the patient on her left side to enhance uteroplacental perfusion.

Administer oxygen, as ordered, on the basis of pulse oximetry levels and respiratory status.

Prepare the patient for emergency delivery, as

appropriate.

Hyperemesis gravidarum

Assessment

Hypotension

Elevated H&H

Decreased urine

output

Hypokalemia

Weight loss

Ketonuria

What is it?

Excessive vomiting that leads to dehydration, starvation, and even death among pregnant populations Related to increased estrogen levels

pregnant populations Related to increased estrogen levels Interventions ❖ 48 hours of NPO status ❖ IV

Interventions

48 hours of NPO status

IV fluids

Antiemetics as ordered

Vitamins

Decrease environmental stimuli

Clear liquids and small dry feedings as tolerated.

Give either cold or hot food, nothing room temp.

❖ Give either cold or hot food, nothing room temp. Complications Critical labs ❖ Potassium ❖

Complications

either cold or hot food, nothing room temp. Complications Critical labs ❖ Potassium ❖ Have the

Critical labs

Potassium

Have the patient on tele

Monitor for symptoms of shock and fluid volume deficit.

❖ Monitor for symptoms of shock and fluid volume deficit. Diagnostic studies ❖ Potassium, sodium, chloride,
Diagnostic studies ❖ Potassium, sodium, chloride, and protein levels are decreased due to losses from
Diagnostic studies
❖ Potassium, sodium, chloride, and protein levels
are decreased due to losses from vomiting.
❖ Blood urea nitrogen, non protein nitrogen, and
uric acid levels are increased due to renal
compromise and hemoconcentration.
Hemoglobin (Hb) level and hematocrit (HCT) are
increased due to hemoconcentration.
❖ Urinalysis reveals ketones and, possibly, protein;
urine specific gravity increases.
❖ Vitamin B1 and B6 levels are decreased due to
impaired intake.
❖ Thyroid-stimulating hormone, thyroxine, and
triiodothyronine levels may be mildly increased.

Dehydration

Wernicke's encephalopathy from vitamin B1 deficiency

Mallory-Weiss tears (esophageal tears and bleeding)

Esophageal bleeding

Pneumothorax

Acute tubular necrosis

Electrolyte and acidbase imbalances

❖ Esophageal bleeding ❖ Pneumothorax ❖ Acute tubular necrosis ❖ Electrolyte and acid ‑ base imbalances
❖ Esophageal bleeding ❖ Pneumothorax ❖ Acute tubular necrosis ❖ Electrolyte and acid ‑ base imbalances
What is it? preeclampsia Extreme elevation in blood pressure during pregnancy with the presence of
What is it?
preeclampsia
Extreme elevation in
blood pressure during
pregnancy with the
presence of protein in the
urine after 20 weeks of
gestation.
Assessment
Types
❖ Sudden weight gain
❖ Swelling of the face and
hands
❖ Headache
❖ Blurry vision
❖ Hyperreflexia
❖ Mild : 30/15 mmhg off of baseline
six hours apart. Increase the
amount of protein in the diet
because they are spilling it into the
urine. Glomerular damage is
present.
❖ Clonus ( seizures)
❖ Severe: 160/110 mmHg 6 hours
apart. May have an episode of
seizure activity. Have mag sulfate
ready.
Interventions
Magnesium sulfate
Vasodilator & sedative
❖ Magnesium sulfate : have
calcium gluconate at
bedside.
Monitor for pulmonary
edema
❖ Monitor for sedation and
hyporeflexia.
❖ Seizure precautions
Monitor for signs of mag
toxicity: decreased
DTRS, BP, respiration,
decreased LOC.
❖ Safety checks
Risk factors
❖ Labor will halt: have
oxytocin ready if
indicated.
❖ History of preeclampsia.
❖ Chronic hypertension.
❖ First pregnancy.
❖ New paternity
❖ Age. The risk of preeclampsia is higher for very
Care
young pregnant women as well as pregnant
❖ Decrease environmental
stimuli. This decreases the
risk of seizures.
women older than 40.
❖ Obesity.
❖ Initiate seizure precautions
❖ Multiple pregnancy. Preeclampsia is more
❖ Monitor mom and baby
common in women who are carrying twins,
triplets or other multiples.
❖ Interval between pregnancies. Having babies
less than two years or more than 10 years apart
leads to a higher risk of preeclampsia.
❖ In vitro fertilization. Your risk of preeclampsia is
increased if your baby was conceived with in
vitro fertilization.
Nclex tip!

Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) or greater,documented on two occasions, at least four hours apart , is abnormal.

140/90 millimeters of mercury (mm Hg) or greater,documented on two occasions, at least four hours apart
PRETERM LABOR Assessment ❖ Regular or frequent sensations of What is it? abdominal tightening (contractions)
PRETERM LABOR
Assessment
❖ Regular or frequent sensations of
What is it?
abdominal tightening (contractions)
Onset of labor anywhere
between 20-37 weeks
gestation.
❖ Constant low, dull backache
❖ A sensation of pelvic or lower abdominal
pressure
❖ Mild abdominal cramps
❖ Vaginal spotting or light bleeding
❖ Preterm rupture of membranes — in a

Risk factors

Previous preterm labor or premature birth,

particularly in the most recent pregnancy or

in more than one previous pregnancy

Pregnancy with twins, triplets or other

multiples

Problems with the uterus, cervix or placenta

Smoking cigarettes or using illicit drugs

Certain infections, particularly of the

amniotic fluid and lower genital tract

Some chronic conditions, such as high

blood pressure and diabetes

Stressful life events, such as the death of a

loved one

Too much amniotic fluid (polyhydramnios)

Vaginal bleeding during pregnancy

Presence of a fetal birth defect

An interval of less than six months between

pregnancies

Infection of tissues that surround and

pregnancies ❖ Infection of tissues that surround and support your teeth (periodontal disease) gush or a

support your teeth (periodontal disease)

gush or a continuous trickle of fluid after

the membrane around the baby breaks

or tears

❖ A change in type of vaginal discharge — watery, mucus-like or bloody Prevention ❖
A change in type of vaginal discharge —
watery, mucus-like or bloody
Prevention
❖ Seek regular prenatal care.
❖ Eat a healthy diet
❖ Avoid risky substances.
❖ Consider pregnancy spacing.
❖ Be cautious when using assisted reproductive
technology (ART).
cautious when using assisted reproductive technology (ART). Treatment ❖ Terbutaline: Tocolytic ❖ Magnesium sulfate

Treatment

Terbutaline: Tocolytic

Magnesium sulfate

Betamethasone : to stimulate maturation of babies lungs.

Hydration

Treatment of UTI

❖ Magnesium sulfate ❖ Betamethasone : to stimulate maturation of babies lungs. ❖ Hydration ❖ Treatment
Prolapsed cord Diagnosis What is it Umbilical cord prolapse occurs when the umbilical cord comes
Prolapsed cord
Diagnosis
What is it
Umbilical cord prolapse
occurs when the umbilical
cord comes out of the uterus
with or before the presenting
part of the fetus. It is a
relatively rare condition and
occurs in fewer than 1% of
pregnancies. Cord prolapse is
more common in women who
have had rupture of their
amniotic sac
Umbilical cord prolapse should always be
considered a possibility when there is a
sudden decrease in fetal heart rate or
variable decelerations, particularly after the
rupture of membranes. With overt
prolapses, the diagnosis can be confirmed
if the cord can be palpated on vaginal
examination. Without overt prolapse, the
diagnosis can only be confirmed after a
cesarean section, though even then it will
not always be evident at time of procedure
Treatments
❖ Lift the baby's head off the cord.
❖ Trendelenburg or knee chest
position
❖ Hyperoxygenate mom
Causes
❖ Never push the cord back in
Premature delivery of the baby
Delivering more than one baby
per pregnancy (twins, triplets,
etc.)
Excessive amniotic fluid
Breech delivery (the baby comes
through the birth canal feet first)
Management
An umbilical cord that is longer
than usual
❖ Monitor fetal heart tones
NCLEX Tip If the cord stops pulsating fetal death has occured.
NCLEX Tip
If the cord stops pulsating fetal
death has occured.

manual elevation of the presenting fetal part

repositioning of the mother to be head down with feet elevated

filling of the bladder with a foley catheter, or tube through the urethra to elevate the presenting fetal part

use of tocolytics (medications to suppress labor) have been proposed, usually in addition to bladder filling rather than a standalone

intervention

to suppress labor) have been proposed, usually in addition to bladder filling rather than a standalone
to suppress labor) have been proposed, usually in addition to bladder filling rather than a standalone

Assessment of Growth and Development of the Infant

Head Should measure 13.75 cm at birth

-Posterior fontanelle should close by 2nd month -Anterior fontanelle should close in 12-18 months

Height and weight

- In the first 6 months birth weight doubles and baby should grow 6 inches

- By 12 months birth weight should triple and baby should grow 10-12 in.

Skelton

- Is made up of cartilage at 3 month gestation and continues to ossify and grow throughout life.

- Bone age, injury, abuse or nutritional deficits can be determined by X-Ray.

Circulation

- Hemoglobin and RBCs decrease when respiratory system takes over until 3 months of age

Neuro

Well checkup schedule

Second week of life

2, 4, 6, 9 months of age.

Vitals

HR: 70 resting - 180 awake and crying ( accurate HR is taken apically)

RR: 30 but can range from 20-50 with increase or decrease of activity.

BP: 85/60 mmHg

Temp: 98.6

- Nerve cells grow and coordination begins in an orderly pattern.

Physical milestones

Jerky quivering arm movements,

Brings hands to mouth , makes fists

Head flops back if unprepared

Strong reflexes

5-8 feedings per day - 3 meals 2 snacks

Progresses from sleeping 20 hours a day to 10-12 hours at night and two naps by 12 months,place awake child in crib to sleep

Psychological milestones

Focuses 8-12 in away

Eyes wonder and cross

Likes black and white/ high contrast patterns.

Prefers human face to other patterns

Hearing is fully mature, may turn toward sound

Likes sweet smells, dislikes sour

Likes soft sensations

Likes to be handled gently

Social Milestones

0-1 month: extensive sleep, dependent, eye contact

0-3 months: smiles and fixes on faces,solitary play

3-6 mo: enjoys peekaboo, smiles at familiar faces

6-12 mo: knows name, gives and takes objects, understands easy commands.

Emotional growth

0-1 mo: general tension

1 mo: happy and sad emotions

6 mo: separation anxiety

6-12 mo: stranger anxiety, shows curiosity by 12 months .

Language

0-3 mo: Cries, grunts and Coo

0-6 mo: babbling, vowels, half consonants

12 mo: 1-2 words, imitation, responding to simple commands

Nutrition

Rapid growth causes a need for the greatest amount of nutrients

4-6 mo- 12 mo: breast milk or commercial formula, introduction of solid foods. One food at a time starting with veggies.

You may need to supplement Vit C/D iron, fluoride.

6mo: iron rich foods are needed to supplement

7-8 mos: self feeding begins by grasping and bringing food to mouth. Ends with use of utensils

WIC program helps children and women get proper nutrition when they qualify

Age

Theorist

Stage

Description

Nursing care

Birth -18 mo

Sigmund Freud

Oral

Pleasure center in mouth

Encourage self feeding. Avoid putting objects in mouth

1st year

Erik Erikson

Trust vs

Depends on parents to meet needs to create trust

Encourage bonding and family relationships

mistrust

Birth -2 yrs

Jean Piaget

Sensorimotor

Coordinates sensory experiences with physical action

Plan tactile activities with use of colorful materials

stage

Assessment of Growth and Development of the Toddler 1-3

Physical growth

slows

Communication and mobility

Safety

Proper restraint in car seat

Never leave the toddler alone in water even buckets pose a drowning risk

Put away poisons and medications with locks

Burns from hot appliances and water are common

skills increase

Stubbornness , explore,

dependent

Begin to explore Autonomy

“ I DO MYSELF”

Bed rituals are important

Height and weight

- Gain 5 to 10 LBs per year

- Grow 3 inches per year

- Normal to go on food jags

Learns to stand alone and walk,

1

year Need 12-14 hours a day of sleep

3

years need 10-12 hours

Discipline

Training and instructing to produce positive

behavior patterns

Self control is gradual

2yrs: begin accepting responsibility

Consistency and timing are key

Calmly remove the child from the situation

Tell child the behavior is bad, not them

Well visits

15 mo for shots

Annually after that

Assess growth/ development, caregiver skill,and relationship between toddler and parent

Physical milestones

Psychological milestones

Lordosis and pot belly, organs adapt moderately to stress

Well established walking

Hand eye coordination

Well established walking

Progressive development of fine motor skills

Growth is slowed and stable

They begin to draw and write

Bones and muscles still immature requires nutrition and exercise for adequate development

Bladder control is gained , with occasional relapses

Brain is 90% developed by age 5

Social Milestones

Moves to parallel play, mostly imitates role models

Does Not share readily until later toddler years

Separation anxiety is overcome easily

Emotional growth

Many emotions in one day

Increased use of emotion language and understanding of emotion

causes/ consequence understanding

Language

Vocabulary begins to increase names objects, body parts, animals, and familiar locations

Primary method of communication

Continuous questioning “why”

Toys that talk are preferred

Brief sentences

Nutrition

Require about 1000-1400 calories a day

Toddlers should be active 60 min a day

Fruites: 1-1.5 cups

Veggies: 1-1.5 cups

Grains : 3-5 oz

Protein : 2-4 oz

Dairy : 2-2.5 cups

Allow children to eat when hungry instead of forcing

meals.

Age

Theorist

Stage

Description

Nursing care

18 mo- 3 years

Sigmund Freud

Anal

Pleasure center in the anus

Encourage the family to teach good hygiene

1- 3 years

Erik Erikson

Autonomy vs

Mastering environment and building self esteem

Support bonding and family relationships

shame and

doubt

 

2-7

Jean Piaget

Pre operational

Sensory / action coordination, symbolic thinking. Represent world and words together

Plan drawing and writing, tactile experiences. Use colorful materials to stimulate senses.

Assessment of Growth and Development of the preschool child

Growth rate has slowed

-Language and play change remarkable

- soak up info “little sponges, let them choose their own clothes”

- 3yrs still chubby faced

- 5 yrs leaner and taller and better coordinated but can't distinguish fantasy from real life.

Height and weight

Well checkup schedule

Boosters and vaccines

4-6yrs

Annual exams for growth and health

Gains 3-5 lb a year and grows 2.5 in. a year

By 12 months birth weight should triple and baby should grow 10-12 in.

Skelton

Gross motor skills improve by age 5 they can climb, jump, catch and throw

A ball and ride a bicycle.

5 yrs, leaner taller and better coordinated, teach them to wash hands thoroughly

Bathing and brushing teeth still need supervised, can't wash own hair.

Dentition

The skull is 90% of adult size by age 6