This document provides information on various topics related to maternal and newborn care including third trimester symptoms, placental abruption signs, newborn feeding positioning, APGAR scoring, circumcision care, gestational age assessment, breastfeeding, and more. Key details covered include timing of APGAR scores, scoring criteria for each component, and using the New Ballard Score to determine gestational age by assessing neuromuscular and physical characteristics.
This document provides information on various topics related to maternal and newborn care including third trimester symptoms, placental abruption signs, newborn feeding positioning, APGAR scoring, circumcision care, gestational age assessment, breastfeeding, and more. Key details covered include timing of APGAR scores, scoring criteria for each component, and using the New Ballard Score to determine gestational age by assessing neuromuscular and physical characteristics.
This document provides information on various topics related to maternal and newborn care including third trimester symptoms, placental abruption signs, newborn feeding positioning, APGAR scoring, circumcision care, gestational age assessment, breastfeeding, and more. Key details covered include timing of APGAR scores, scoring criteria for each component, and using the New Ballard Score to determine gestational age by assessing neuromuscular and physical characteristics.
This document provides information on various topics related to maternal and newborn care including third trimester symptoms, placental abruption signs, newborn feeding positioning, APGAR scoring, circumcision care, gestational age assessment, breastfeeding, and more. Key details covered include timing of APGAR scores, scoring criteria for each component, and using the New Ballard Score to determine gestational age by assessing neuromuscular and physical characteristics.
Maintain: good posture Use: extra pillows to sleep Avoid: eating, or drinking too much at once in order to prevent stomach expansion
Abruptio placentae Premature, partial, or complete separation of: placenta from uterus s/s : vaginal bleeding, pain in abdomen, uterine contractions
After newborn opens mouth make sure:
cheeks & chin touch the breast, & the mouth covers the nipples.
Antepartum documentation Health & reproductive hx Vitals signs Weiight Pregnancy confirmation diagnostic testing results Calculated/estimated due date, Current gestational week Height: fundal FHR tones Risk assessment S/S of : pregnancy, expected physiological changes, complications, any interventions, childbirth
APGAR signs: five signs assessed:v heart rate, respiratory effort, muscle tone, reflex irritability, & color. HR, respiratory effort, muscle tone, reflex irritability, color 0-3- severe distress, requires resuscitation-immediately 4-6-moderate difficulty 7-10- minimal or no difficulty ( Lower scores may warrant resuscitative interventions)
Apar HR scoring 0-absent 1-<100bpm 2->100 bpm
APGAR Muscle Tone Scoring
Assess: flexion & movement of extremities 0- flaccid 1- some flexion 2-extremities well flexed
APGAR Respiratory Effort Scoring
0-absent 1-slow weak cry 2-good cry
apgar scoring timing
at 1 minute & again at 5 minutes score evaluates newborn's ability to adjust to extra-uterine life & ID an resuscitation needs
best practice capillary blood specimen from newborn
heel for blood glucose -wrap warm moist cloth around heel for 5-10 minutes -cleanse heel w/ antiseptic -stabilize foot & puncture outer aspect of heel -collect blood -apply pressure w/ dry gauze -cover w/ adhesive b&age
breastfeeding newborn should have how many diapers per day
6-8 wet 3 stools
circumcision care -apply petroleum jelly to penis for first 24 hrs to keep diaper from adhering to circ site -do not use soap or cleansing wipes for at least 5-6 days or until circ has healed -apply gentle pressure from sterile gauze to control slight bleeding - if continues or if redness, swelling, pus, odor occurs call provider -Do not remove yellow exudate from glans after 24 hrs & up to 2-3 days it is part of the healing process -apply diaper loosely
color 0-pale or blue 1-pink w/ blue extremities(acrocyanosis)
during assessment of newborn
dry & wrap & place under radiant heat source
During breastfeeding encourages mom to move her newborn..
toward breast to ensure comfortable feeding for both education preeclampsia decrease in frequency of urination report any epigastric or RUQ pain b/c indicate severe pre-eclampsia call if you do not feel baby at least 4 times per hour take BP while sitting & support arm at heart level
extrusion expected newborn response that involves forcing her tongue outward when anything touches/depresses the tip of her tongue (not useful for breastfeeding but makes ingesting pureed food difficult until after reflex disappears)
false labor irregular & subsides or stops w/ walking & comfort measures-cervix does not dilate
FHR can be observed by regular stethoscope/ fetoscope
18-20 weeks
FHR can be observed by ultrasound fetoscope/stethoscope
10th or 11th weeks
For optimal hearing later in pregnancy
use Leopold maneuvers & position ultrasound over fetal back
how long should it take adequately nourished newborn to return to birth weight 10-14 days
How much weight gain is expected during pregnancy?
Pre-pregnancy BMI, # of fetus, complicating factors( DM, pre-eclampsia)
Average BMI, single fetus should gain 11.5-16 kg (25-35 lbs)
teen normal weight is same weight gain with special attention on nutritional content >2500 calories/day
Overweight (BMI>25) consume fewer calories & gain 15-25 lbs
how to confirm amniotic membranes have ruptured
nitrazine test for pH- will be alkaline if positive-turn blue/green(6.5), blue-gray (7.0), deep blue (7.5)
how to prevent mastitis, a breast infection from a fissure or crack in the nipple & progresses to chills & fever + localized pain, swelling, & redness position their newborn properly & make sure he grasps areola & not just the nipple. Use your finger to release suction after feeding to help prevent injury to the nipple. expose nipple to air as much as possible & wash h&s before touching breasts
hydramnios excess amount of amniotic fluid- can be difficult to detect FHR
intrapartum care VS, weight, allergies, childbirth preferences & support person, time & nature of last meal/fluid intake & output, character & status of labor(stage , phase), ambulation/activity, fetal status/monitoring/results, amniotic membrane/status/amniotomy, amniotic fluid/bloody show parameters, uterine activity/contractions, Leopold maneuvers/results, IV catheter insertion, infusion details, pail level & interventions for pain management, medications/anesthesia, dilation/ effacement, catheterization, concurrent medical problems, complications, positioning, urge to push/bearing down efforts, outcome of delivery, time of delivery, clamping /cutting of cord, placenta delivery
moro reflex loud/unexpected noise or stimulus demonstrated as an arm flexion & an embracing posture
newborn documentation date & time of delivery, apgar 1 & 5 min, respiratory status, resuscitation interventions/ suctioning, stimulation, thermal interventions, eye prophylaxis, vitamin K administration, VS, weight, length, head circumference, gestational assessment, blood glucose, other diagnostic results, complete physical/body system assessment, feeding, passage of meconium/urine, jaundice, umbilical cord care, circumcision assessment/care, hearing screening, PKU testing
newborn physical assessment timeframe
w/in 12-18 hrs of life
newborns cheeks & jaw should be what when feeding
rounded & glide smoothly while sucking
A newborn should feed how many times in 24 hrs
8-12 w/in 24 hr
nonstress test screen evaluating heart rate patterns in response to fetal movement. Position pt in reclining chair or in semi-fowler's to prevent hypotension have her tilt slightly to one side while doppler transducer records FHR & tocodynamometer IDs uterine contractions & /or fetal movement reactive test is expected-2 FHR accelerations in 20 min lasting for 15 seconds & showing an increase of 15 bmp above baseline nonreactive test-fail
● suppress lactation ● wear -supportive bra first 3 days post delivery.
Engorgement apply: ice packs 15 on 45 off
avoid stimulating breasts, pumping for mils, & decrease warm water: d/t increase milk production
True labor contractions occur regularly & get progressively stronger, more frequent, & last longer, intensify with walking, do not respond to comfort measures, begin in the lower back w. radiation to front, cervix dilates
When suctioning a newborn's secretions
First suction mouth then nose- to reduce risk of aspiration
insert suction in newborn mouth:
compress bulb insert tip into side of the mouth
Gestational Age Determine approximate gestational age of a newborn: assess six neuromuscular, & six physical characteristics.
The four Leopold maneuvers are:
Identifying fetal part > uterine fundus to determine fetal lie & the presenting part Palpating the fetal back to: identify fetal presentation Determining which fetal part lies over pelvic inlet to identify fetal attitude Locating the fetal cephalic prominence to identify the attitude of the head
Apgar scoring A rapid assessment. Performed at 1 minute & again at 5 minutes following newborn’s delivery. The five signs to assess are heart rate, respiratory effort, muscle tone, reflex irritability, & color.
For each assign a score of 0, 1, or 2. A score of 7 to 10 is within the expected reference range & indicates that the newborn is adjusting to extrauterine life adequately. Lower scores may warrant resuscitative interventions.. If a newborn needs resuscitation immediately at delivery, initiate it before 1-minute Apgar scoring
Gestational Age Assessment
To determine the approximate gestational age of a newborn, assess six neuromuscular & six physical characteristics. Assessment is called: the New Ballard Score. It’s appropriate for newborns from 20 to 44 weeks of gestation, with the characteristics to assess varying with the stage of maturity. Each parameter scores from -1 to 5, with the cumulative score correlating with a gestational age between 20 & 44 weeks.
How To Have an Easy and Safe Pregnancy and Bring Forth a Healthy Baby: A Pregnancy Book for First Time Moms for a Successful and Healthy Journey through Pregnancy, Childbirth and Newborn
How To Have an Easy and Safe Pregnancy and Bring Forth a Healthy Baby: A Pregnancy Book for First Time Moms for a Successful and Healthy Journey through Pregnancy, Childbirth and Newborn
