Skin Trimester Contraction & Lochia Growth
This chapter covers Skin Trimester Contraction & Lochia Growth.
Third trimester
Rapid fetal growth, breathing movements in uterine, oriented to light and refelxes
36 weeks
Return visits are every week after …
140/90
Normal BP for pregnant woman
110-160
Fetal heart rate
Vaginal bleeding
Warning sign in 3rd trimester
Elema in face hands legs and feet
Warning signs in 3rd trimester
Ligthening
Fetal descent , baby dropped down
Braxton hicks contractions
False labour , intermittent tightening
Cervical changes
Cervix becomes softer and spongier
Bloody show
Vaginal discharge, blood tinged mucous plug labour begins 24-48 hours after]
Rupture of membranes
SROM occurs naturally, gush of amniotic fluid out of the vagina, after labour has begun
GI disturbance
Indigestion nausea vomiting and diarrhea
Sudden burst of energy
Encourage mother to eat nutritious meals at this time , unknown reasoning
False labour
Irregular contractions, felt above umbilicus, discomfort in abdomen , no bloody show
True labour
Regular contractions, increase intensity and duration, discomfort in lumbar region, bloody show
Effacement
Shortening and thinning of the cervix
Dilation
Enlargement of cervical opening
Colour odour amount and time
COAT
Dilation of cervix, pressure on pelvis, stretching of vagina, uterine contractions
Causes of pain during labour
Uterine contractions
Smooth muscle of uterus contracts and relaxes
Increment
Contraction phase where strength increases
Acme
Contraction phase that is Period of greatest strength
Decrement
Contraction phase where strength decreases
Frequency
Time from beginning of one contraction to the beginning of the next
Interval
Resting period between contractions (should not be less than 60 seconds)
Duration
Length of one contraction (increment, peak, decrement) 90 seconds max
Uterine agony
Soft boggy uterus , post partum bleeding
1 and 5 minutes
When to apgar score after birth
Fluid and ice chips
Oral comfort measure
Ambulation
How to increase uterine activity
Q2h
When should a pregnant client void
Decrease anxiety
Why use breathing techniques
Slow deep chest breathing
Inhale through nose and exhale through lips 6-9 breaths / minute
Shallow breathing
Inhale and exhale through mouth 2 breaths per second at peak of contraction
Pant-blow breathing
Used when contractions are intense, every three to four breaths is a forceful exhalation through lips
Systemic medication
Opioid analgesics reduce perception of pain
regional block
Epidural , during active labour
Pudenda block
Local analgesic 10-20 minutes before birth
General anesthesia
Given for a c section
Breasts uterus bladder bowel lochia episiotomy
BUBBLE
Firm
Uterus should be …. After birth
1
Uterus should descent immediately after birth and …..cm/day for 10 days
24 hours
How long to check urinary I/O for
Lochia rubra
Heaviest lochia discharge
Lochia serosa
Light blood discharge in lochia
Lochia alba
Yellow/ brown lochia discharge
Redness ecchymosis edema discharge approximation
REEDA
Gestational diabetes
Why monitor blood glucose after birth
Airway
Suctioning of secretions from mouth and nose
Airway breathing and circulation
ABC
Warmth
Infant dried to prevent heat loss by evaporation
6
APGAR score less than ____ is an indication that neonate is in distress
10
Newborn loses ___% of body weight in the first 3-4 days
36.5-37.2
Normal newborn temperature
120-160
Normal heart rate for a newborn
30-60
Normal respirations for a newborn
60-80/40-45
Normal BP for a newborn
Vernix caseosa
White creamy substance covering newborn body
Lanugo
Fine hair on body of newborn
Acrocyanosis
Present for several hours after birth until cardio has stabilized , blue colour of hands and feet
Edema
Present around eyes, face, dorsa of hands and feet, Labia or scrotum
Jaundice
Yellow discolouration of skin, sclera and mucous membranes
Ecchymosis
Large irregular hemorrhagic area of skin (bruise)
Milia
Pearly white cysts of the face
Erythema toxicim neonatorum
Pink rash with yellow papules on newborn
Telagiectasia nevi
Birth marks of dilated capillaries (stork bites)
Nevus flammeus
Large red/purple birthmark on face or neck
Nevus vascularis
Enlarged superficial blood vessel birthmark
Mongolian spots
Large patches of bluish skin on buttocks of dark skinned babies
Epstein’s pealrs
Small epithelial cysts on hard palate
Fontanelle
Soft spot on babies head
Anterior fontanelle
Closes by 18 months
Posterior fontanelle
Closes by 2 months
Caput succedaneum
Edema of newborn scalp at birth
Cephalhematoma
Collection of blood between the periosteum and skull
3 months
Permanent eye colour by how many months
2-3
Chest circumference is how many cm smaller than head
Witch’s milk
Whitish fluid secreted by a newborns nipple
Meconium
Black tarry BM
Rugae
Infant scrotum is covered in
Pseudomenstruation
Blood tinged mucous discharge from a newborn caused by withdrawal of maternal hormones
Hypospadias
Placement of urinary meatus on underside of penis
Phimosis
Condition where opening of foreskin is so small it can’t be pulled back
Cryptorchidism
Failure of one or both testes to descend
Hydrocele
Fluid around tested in the scrotum
Epispadas
Placement of urinary meatus on top of penis
Rooting
Stroking skin at one corner of mouth and eliciting infant to turn head toward that side
Sucking
Touching newborns lips eliciting what reflez
Extrusion
Tip of tongue is touched of depressed, infant forces tongue outward
Palmar grasp
Finger is placed across Palm, infants finger holds
Plantar grasp
Foot is touched below toes , when touched infant toes curl downward
Tonic neck
Placing infant supine and rotating head to one side, arm and leg will extend on that side
Startle reflex
Moro reflex, holding newborn in semi sitting and allowing head to fall
Gallant
Elicited when infant lying prone with hands under abdomen, infants skin is stroked on one side of spine, infants pelvis and shoulders turn toward that side
Stepping
Holding a baby over a flat surface infant will put feet on surface as if their walking
Babinski
Plantar surface is stroked from heel to under toes, great toe should dorsiflex and other toes fan out
20-30 minutes after birth
Breastfeeding when to start
Suckling
____causes posterior pituitary to secrete oxytocin
Cradle hold footba hold lying down and across lap
Types of positions to hold baby
Foremilk
Watery high in lactose and quenches thirst
Hindmilk
High in fat leads to weight gain and more satisfying
30 minutes
Average breastfeeding session
2-3 hours
Breastfeeding frequency is every ___
4-5
How many diapers in 24 hours is necessary
Half way through feeding
When to burp baby
4-6
How many weeks should you wait before using a pacifier or bottle feeding
Oxygen in air
21%
Oxygen therapy
Used for clients with impaired has exchange and or surgery
Nasal cannula
Most common , inexpensive low-flow device
6L/min
DO NOT administer over
Simple face mask
Masks over clients nose and mouth
5L/min required to
Avoid rebreathing
Partial rebreather mask
Client rebreathes first third of exhaled air, do not allow deflation of bag
Non-rebreather mask
Highest oxygen concentration, client breathes only source of oxygen in the bag
Venturi mask
Precise oxygen concentration delivery
Face tent
When client can’t tolerate masks
Oxygen tent
Enclosed set up , tent with O2 at 15L/min for 15 minutes
Chemical restraint
Psychoactive medication, sedation ex: Ativan , Xanax, Thorazine
Physical restraint
A device that limits voluntary movement ie. Bed rail , table
Environmental restraint
Modulation of clients surroundings , to limit movement ie. Locks on a door, barriers, dead ends
Preventing fall
Cardiac status, lifestyle factors, mobility, emotional state, communication
Hypotension, medications, low vision, unsafe footwear
Older adults at risk for falls why ?
Bed or chair safety monitor
Position switch triggers an audio alarm
Magnetic box monitor
Mounted on a bed or chair , connects to clothing with a clip
Dual sensor
Pressure sensitive combined with beam detector
Restraint use reasons
Avoid harm to client or others around them , to do what is required to provide treatment
Causes of restraints
Increased agitation, increased behavioural problems, loss of dignity, social withdrawl
Least restraint approach
Preserves client dignity, enhances quality of life, CNO endorses this
Least restraint
All possible alternative interventions are exhausted before deciding to use a restraint
Confusion
A mental state characterized by disorientation regarding time, place or person
Delirium idiopathic and dementia
3 major forms of confusion
Delirium
Acute confusion, impaired cognitive functioning, symptoms are reversible
Delirium
Severe symptoms throughout day, worse at night
Idiopathic confusion
No identifiable physiological basis, stressful disturbance in lifestyle, may or may not reverse
Dementia
Chronic confusion, damage to cerebral cortex, irreversible
Non-violent
1. Cognitive impairment behaviour
Anxious
2. Cognitive impairment behaviour
Aggressive
3. Cognitive impairment behaviour
Protective strike technique
Protecting from strikes, duck, move and shield yourself
Release technique
Protecting from grabs
Redirection technique
How to redirect someone
Stabilize ask and repete
step 1 to respond to a physical altercation
Call for help release technique
Step 2 to respond to a physical altercation
Back away open posture
Step 3 to respond to a physical altercation
First trimester
Major organs of the fetus form, uterus raises out of pelvis
Second trimester
Fetus grows size and complexity, uterus at level of umbilicus, fetal movement