maternity nursing overview 2 of 2

8/16/2019 Maternity Nursing Overview 2 of 2

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How To Use A Bulb Syringe

Clear the Mouth first, then the Nose

(M before N)

! Compress the bulb prior to suctioning

! Gently insert the tip of the syringe into the dependent side of the

newborn’s mouth to collect drainage

! Release the compression of the bulb to allow for re-expansion andcollection of the secretions

! Remove the blub syringe from the mouth and squeeze the bulb torelease the collected drainage into the appropriate receptacle ortissue

THE HEALTHY NEWBORN (cont.)


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THE NEWBORN BATH

" Wash the head first (keep the infant wrapped to prevent heat loss)

" Wash the body in 1-2 minutes and dry completely. Remove wetlinen

IMPORTANT TO WORK EFFICENTLY TO PREVENTHEAT LOSS!!



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MEDICATIONS YOU WILL BE ADMINISTERINGVITAMIN K – Administer within 1 hour of birth. Vitamin K is not

required to make clotting factor but is required to convert precursor

proteins made in the liver into activated proteins with coagulantproperties.

Without Vitamin K at birth, bleeding can occur from the GI tract,

umbilicus, circumcision site, and any other puncture site.

Vitamin K is given intramuscularlyinto the thigh.



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MEDICATIONS YOU WILL BE ADMINISTERING (cont.)

EYE PROPHYLAXIS – To prevent from unknown Gonorrhea orChlamydia infection in the mother which can cause blindness in the

infant

Can use: Tetracycline Ointment 1%

Erythromycin Ointment 0.5%

Ophthalmic sol. of Povidine-Iodine 2.5%

# Needs to be given within 1 hour of birth

# Deposit a 1-2 cm ribbon of sterile ointment into the conjuctival sac



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MEDICATIONS YOU WILL BE ADMINISTERING (cont.)

ENGERIX, Hepatitis B vaccine

Mother must sign consent before

this can be given

Given intramuscularly in opposite

thigh of the Vitamin K injection



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6 ‘Rights’ of Medication Administration

!Right Person!Right Drug

!Right Dose

!Right Time!Right Route

!Right documentation


YOU MUSTALWAYS CHECKTHE DRUG WITHTHE PHYSICIAN’SORDER….


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REFLEXES

MORO (Startle) – Hold infant in semi-sitting position, allow head and

trunk to fall backward with support, or place the infant on a flatsurface, make a loud abrupt noise.

The infant will have symmetric abduction and extensionof arms, and legs will follow in a similar pattern; slight shaking ortremor may be included, infant may cry.



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REFLEXES (Cont.)

STEPPING or WALKING – Hold infant vertically under arms or on trunk,

allowing one foot to touch table surface. The infant will simulatewalking alternating flexion and extension of feet.

Term infants will walk on the soles of their feet while

preterm will walk on their toes. This reflex willdisappear at 3-4 months.

PALMAR GRASP – Press the palmar surface of the infant's hand with afinger. The infant will grasp the finger and hold tight when youattempt to withdraw. This reflex will disappear at 2 months



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REFLEXES (Cont.)

BABINSKI (Plantar) – On the sole of the foot, beginning at the heel,

stroke upward along lateral aspect of sole, then move finger across

ball of foot. All toes hyperextend, with dorsiflexion of big toe –recorded as ‘Positive’ sign. Absence of the Babinski requiresneurologic evaluation. This reflex will disappear after 1 year of age.



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REFLEXES (Cont.)

ROOTING – Stroke the infant’s cheek and corner of the mouth and theinfant’s head turns toward the stimulus and the mouth opens. This

will disappear at 3-4 months.

SUCKING – Touch or stroke the baby’s lips – the mouth opens and

sucking movement begin. This reflex will disappear at 12 months.



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REFLEXES (Cont.)

TONIC NECK – Place the infant supine and turn his or her head to

one side – the infant extends the arm on the side in which thehead is turned and flexes the upper extremity on the opposite

side (fencing position)



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REFLEXES



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GENERAL APPEARANCE

COLOR – Consistent with genetic background; pink ucous membranes;

mottled with cooling, bruises over presenting part.

Acrocyanosis – blue palms and soles

Circumoral cyanosis – blue around mouth – requires IMMEDIATEattention

Jaundice – yellow skin color; mild jaundice normal after day 1 of life



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GENERAL APPEARANCE (Cont.)

HARLEQUIN COLOR CHANGE – In side-lying position, red colordemarcated on dependent side, pale color on upper half; persists

1-13 minutes; color reverses if infant is rotated to other side.



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RESPIRATORY• Diaphragmatic and abdominal breathing

• Rate – 40-60 breaths/minute (may decrease in sleep and

increase after crying)

• Periodic Breathing – pauses in breathing up to 20 seconds

without bradycardia or color change (this is normal)

•

Respiratory Distress - expiratory grunting, nasal flaring,cyanosis

• Allow the newborn to cry – helps to clear retained fetal lung fluid



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TONE/NEUROMUSCULAR

• Term infant is flexed, fists clenched

•

Term infant with healthy tone can be pulled up to sitting positionusing the palmar grasp reflex

• Head moves side to side, moves all extremities, moves smoothly

between behavioral states

• Frank breech presentation mayhave extended legs for a brief time



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Skin

• Vernix caseosa – greasy yellow-white substance covering infant

• Lanugo – fine hair on cheeks, shoulders, forehead, pinna ofears

• Milia – tiny white papules on brow, cheek, and nose

• Erythema toxicum (newborn rash) – small white or yellowpapules on a red base which can last several hours to severaldays

•

Sucking blisters – vesicles on lips, hands from in utero

• Stork bite (nevus simplex) – pink macule on nape of neck, uppereyelids, bridge of nose or upper lip that usually fades

• Mongolian spots – bluish or gray-blue areas of pigmentation on

dorsum and buttocks, commonly found on dark skinned races


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HEADFontanels

# Anterior – palpated as 5cm diamond

# Posterior – palpated as smaller triangle

# Palpate sutures – should be enjoined (sutures aremembranous attachments that make the bones join insuch a way that the head can squeeze through the birthcanal)



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GI/GUABDOMEN

• Soft and rounded – not distended

• Bowel sounds present 1-2 hours after birth

•Abdominal distention caused by mucus, blood and amniotic fluidswallowed during birth

• Infant should void by 24 hours of age

• Meconium stools

(black tarry sticky substance)

may last for 3 days then becomethe seedy yellowish transitional stool

• Failure to pass meconium stool is sign of intestinal obstruction

and places the newborn at high risk for hyperbilirubinemia



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Glucose Monitoring

Normal Blood Glucose for the term infant during the first day of life:

40 – 60 mg/dL

And after the first day of life will range between 50 – 90 mg/dL

Heel puncture for blood glucose testingmust be done on the lateral aspect of the

foot to avoid damage to the nerves and

calcaneus bone


Murray & McKinney 2010


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Conjugation of Bilirubin

Contributing factors in increased bilirubin

# Excess production# Red blood cells break down more quickly

# Decreased albumin

# Immature liver

# Preterm and late term infants

# Lack of intestinal flora# Decreased intestinal motility

# Trauma such as bruising

# Fatty acid release

# Family background



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HYPERBIRUBINEMIA

Physiologic Jaundice – also called nonpathologic ordevelopmental jaundice. Jaundice is visible whenthe bilirubin level reaches 5-7 mg/dL

Bilirubinometer – non invasive devise to measure bilirubinlevel in the infant’s skin

Transcutaneous bilirubinometer(TcB)



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NEWBORN ASSESSMENT



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To Beautiful Mom

MEDICATIONS


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Prenatal vitamins

Iron

Folic acid

Rhogam

Procardia

MEDICATIONS TO KNOW

ANTEPARTUM

Terbutalin

Indocin

Magnesium Sulfate

Colace


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MEDICATIONS TO KNOW (cont.)

Pitocin

Terbutaline

Magnesium sulfate

Fentanyl

Marcaine

Nubain

Stadol

Numorphan

Misprostil

Phenergan

Ampicillin

Gentamycin

Clindamycin

Cefotan

Prostin F2 alpha (hemabate

Methergine

Penicillin-G

Narcan

Barbituates (Seconal)

Benzodiazepines (Valium,Versed)

INTRPARTUM


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Mylicon/Mylanta

Colace

Motrin

Tylenol

Tylenol #3

Percocet/Percodan

Charcoal


POSTPARTUM

Rubella Vaccination

Vicodin

Duramorph

Benadryl

Nubain

Gentamycin

Clindamycin

Methergine, Hemabate


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Erythromycin Ophthalmic

Vitamin K

Hepatitis vaccination

Narcan


NURSERY


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Murray, S. S., & McKinney, E. S. (2010). Foundations ofmaternal-newborn and women’s health nursing (5th ed.).Maryland Heights, MN: Saunders Elsevier.

Harnikka (October 4, 2007). Fundus. Retrieved May 1, 2011,from !""#$%%&&&'()*"*+,'-).%&/"-!01234+567589:;

Wibenson888 (March 14, 2007). Primitive Reflexes. RetrievedMay 1, 2011, from !""#$%%&&&'()*"*+,'-).%&/"-!0126?@A?BB

CypressCC (June 3, 2010). Newborn Assessment. RetrievedMay 1, 2011, from !""#$%%&&&'()*"*+,'-).%&/"-!0121"(#>;3C@#&

REFERENCES

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