Skin Trimester Contraction & Lochia Growth

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


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