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UTA NURS 4441 Exam 2

UTA NURS 4441 OB Exam 2

Question	Answer
Puerperium	interval between birth of the newborn and the return of the reproductive organs to their normal nonpregnant state; also called the fourth trimester of pregnancy or the postpartum period. Lasting usually about 3 to 6 weeks.
Involution	Return of the uterus to its non-pregnant state after birth after expulsion of the placenta with contraction of the uterine muscle. It begins immediately after the placenta is born and is complete in approximately 6 weeks.
Breast feeding affect in fourth stage of labor	prevents maternal hemorrhage by aiding the contraction of the uterus through oxytocin release.
Location of fundus after third stage of labor	Midline, 2 cm below the umbilicus, the fundus resting on the sacral promontory
Location of fundus 12 hours after birth	At the level of the umbilicus
Amount fundus descends each postpartum day	1-2 cm/ day.
When uterus is unpalpable	10-14 days
Changes to size of uterus with each pregnancy	There is a slight increase in uterine size after each pregnancy.
Subinvolution	Failure of the uterus to return to non-pregnancy state.
Subinvolution causes	Retained placental fragments and infection.
Achievement of postpartum hemostasis	Primarily by compression of intramyometrial blood vessels as the uterus contracts.
Hormone administered to enhance uterine contractility	Pitocin (oxytocin).
Afterpains	Painful uterine cramps that occur intermittently for approximately 2 or 3 days after birth and that result from contractile efforts of the uterus to return to its normal involuted condition. Also called afterbirth pains.
Cause of more noticeable afterpains	births in which the uterus was overdistended (e.g., large baby, multifetal gestation, polyhydramnios)
Afterpain intensifiers	Breastfeeding and exogenous oxytocic medication usually intensify these afterpains, because both stimulate uterine contractions
Lochia	Uterine/vaginal discharge after childbirth (during the puerperium) consisting of blood, tissue, and mucus. Varieties include rubra, serosa, and alba.
Lochia rubra	Red, distinctly blood-tinged vaginal flow that follows birth and lasts 3 to 4 days; consists mainly of blood and decidual and trophoblastic debris.
Lochia serosa	Serous, pinkish brown, watery vaginal discharge that follows lochia rubra until about the tenth day after birth; consists of old blood, serum, leukocytes, and tissue debris.
Lochia alba	Thin, yellowish to white, vaginal discharge that follows lochia serosa on about the tenth day after birth and that may last up to 8 weeks; consists primarily of leukocytes and decidual cells but also contains epithelial cells, mucus, serum, and bacteria.
Lochia changes after C/S	lochia is less
Lochia rubra reoccurrence at 7-14 days postpartum indication	bleeding from the healing placental site.
Postpartum endometritis manifestations	Continued lochia with fever, pain with abdominal tenderness.
Normal lochia odor	Normal menstrual flow odor.
Length of time it takes for episiotomy to heal	2- 3 weeks for initial healing, 4-6 months for complete.
Exercises recommended after childbirth to strengthen perineal muscles	Kegel exercises
Hormone that inhibits ovulation	Prolactin
Ovulation occurrence in non-lactating vs. lactating women	70-75 days (non-breastfeeding) vs. 6 months (breastfeeding). Average times, may range from 2.5 months to 6 months and can occur before or after first menses
First menses postpartum vs. normal	Heavier than normal
Time it takes distended abdominal muscles to return to prepregnancy state	6 weeks
Diastasis recti abdominis	Separation of the two rectus muscles along the median line of the abdominal wall. This is often seen in women with repeated childbirths or with a multiple gestation (e.g., triplets). In the newborn it is usually attributable to incomplete development.
BUN and proteinuria changes postpartum	BUN increases as autolysis of the involuting uterus occurs. The breakdown of excess protein in the uterine muscle cells also contributes to proteinuria, which resolves by 6 weeks postpartum
Method of eliminating accumulated fluids postpartum	Profuse diaphoresis occurs within 12 hours of birth, especially at night, for the first 2-3 days
Postpartal diuresis causes	decreased estrogen levels, removal of increased venous pressure in the lower extremities, and loss of the remaining pregnancy-induced increase in blood volume
Affect of not emptying bladder when full immediately postpartum	Immediately after birth excessive bleeding can occur if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly
Postpartal constipation causes	Decreased tone in intestines during labor, prelabor diarrhea, lack of food during labor and dehydration, perineal tenderness causing mom to resist urge to defecate, and sometimes anal lacerations.
Postpartal anal incontinence causes	Operative vaginal birth (forceps or vacuum) and anal lacerations.
When real milk comes in (vs. colostrum)	72-96 hours (3-4 days)
When lactation stops	If suckling or expression of milk (pumping) is never begun (or is discontinued), lactation ceases within a few days to a week.
Blood loss during SVD	300 - 500 ml
Blood loss during C/S	500 - 1000 ml
Changes in WBC postpartum	During the first 10 to 12 days after childbirth, Increases to 20,000 to 25,000/mm3.
Clotting factor changes postpartum	Clotting factors and fibrinogen are normally increased during pregnancy and remain elevated in the immediate puerperium
Varicosity changes postpartum	They begin to regress immediately after childbirth
Carpal tunnel syndrome changes postpartum	Postpartum diuresis relieves carpal tunnel syndrome.
Minimal time women can stay in hospital after delivery	48 hours for vaginal births and 96 for C/S.
Charge associated with allowing patient to be discharged before her condition has stabilized	Abandonment
Postpartal infection prevention	wiping front-to-back, applying the peri pad from front-to-back, and changing frequently (each time she uses the bathroom)
Fundal assessment initial nursing action	ask mother to urinate and empty bladder
Most frequent cause of excessive bleeding after birth	Uterine atony—failure of the uterus to contract firmly.
Uterine atony	most frequent cause of excessive bleeding after birth; failure of the uterus to contract firmly
Signs of excessive bleeding	Saturating a pad in 15 minutes
Intervention to assist with good fundal tone and firm contracting uterus	Fundal massage
Primary responsibility when woman is hemorrhaging severely	Remain with the woman and call for help
Non-pharmacological interventions for perineal pain	Use a pillow when sitting, ice packs, topical application, dry heat, cleansing with a squeeze bottle, shower, tub bath or sitz bath
Non-pharmacological interventions for breast pain	Application of ice, heat, cabbage leaves and wearing a well fitted support bra
Opiod affect on intestinal system	Decreased intestinal motility
Thrombophlebitis manifestations	leg redness, tenderness, pain, and positive Homans sign (Pain in the calf of the leg upon dorsiflexion of the foot with the leg extended)
Homans sign	Pain in the calf of the leg upon dorsiflexion of the foot with the leg extended; early sign of phlebothrombosis of the deep veins of the calf (deep vein thrombosis).
Thromboembolism prevention	Early ambulation
Preeclampsia	A pregnancy-specific condition in which HTN and proteinuria develop after 20 weeks of gestation or early in the puerperium in a previously normotensive woman; a vasospastic disease process characterized by increasing HTN, proteinuria, & hemoconcentration.
Expected time to first void postpartum and minimum amount	Within 6-8 hours (usually 6 is the limit) and it must be 150 ml
Engorgement	Swelling of breast tissue caused by increased blood and lymph supply to the breasts as the body produces milk, occurring at about 72 – 96 hours after birth
Timing of rubella vaccination	A SQ injection in the immediate PP period
Rubella vaccination teaching	She should not get pregnant for at least a month
RhoGAM action	Suppression of immune response in nonsensitized women with Rh-negative blood who receive Rh-positive blood cells because of fetomaternal hemorrhage, transfusion, or accident
RhoGAM indications	Routine antepartum prevention at 28 weeks of gestation in women with Rh-negative blood; suppress antibody formation
RhoGAM dosage and route	1 vial (300 mcg) IM in deltoid or gluteal muscle
RhoGAM adverse effects	Myalgia, lethargy, localized tenderness and stiffness at injection site, mild and transient fever, malaise, headache; rarely nausea, vomiting, hypotension, tachycardia, possible allergic response
RhoGAM nursing considerations	Given at 28 weeks of gestation AND within 72 hours after birth if baby is Rh positive
Coombs test	a screening tool for Rh incompatibility.
Timing of first postpartum check-up	6 weeks for vaginal births, 2 weeks for C/S
Attachment	The process by which parents come to love and accept a child and a child comes to love and accept a parent.
Mutuality	Component of parent-infant attachment; the infant's behaviors and characteristics elicit a corresponding set of parental behaviors and characteristics.
Synchrony	Fit between an infant's cues and the parent's response.
Claiming process	Process by which the parents identify their new baby in terms of likeness to other family members, differences, and uniqueness; the unique newcomer is thus incorporated into the family.
Reciprocity	Type of body movement or behavior that provides the observer with cues, such as the behavioral cues infants provide to parents and parents’ responses to cues.
Parental behaviors that facilitate infant attachment	Looks, gazes; takes in physical characteristics of infant; assumes en face position; eye contact
Percentage of women who experience postpartum blues	50-80%
Postpartum blues peak	5th – 10th day PP
Postpartum blues manifestations	Emotional liability, crying, depression, let-down feeling, restlessness, fatigue, insomnia, headache, anxiety, sadness and anger.
Adolescent trains that may interfere with ability to parent effectively	Egocentricity and concrete thinking.
PPH	Loss of > 500 ml of blood with a SVD and > 1000 ml of blood with a C/S. Also, a 10% change in hematocrit.
Early PPH timing	within 24 hours of birth
Late PPH timing	after 24 and up to 6-12 weeks PP
PPH causes	uterine atony, lacerations of the birth canal, and formation of a hematoma
Iatrogenic	Caused by a health care provider's words, actions, or treatment
Iatrogenic cause of excessive bleeding between separation of the placenta and its expulsion	Undue manipulation of the fundus or excessive traction on the cord.
Signs of placental separation	lengthening of the cord, the separation gush of blood, and the uterus assuming a globular shape
Cause of persistent blood loss once placenta is out	Uterine atony or prolapse
Late PPH cause	Subinvolution, endometritis or retained placental fragments..
Uterine atony	Relaxation of uterus; leads to postpartum hemorrhage. Failure of the uterine muscle to contract firmly.
Leading cause of PPH	Uterine atony.
Uterine atony risk factors	high parity, hydramnios, a macrosomic fetus, multifetal gestation; traumatic birth, use of halogenated anesthesia (e.g., halothane) or magnesium sulfate, rapid or prolonged labor, chorioamnionitis, and use of oxytocin for labor induction or augmentation
Genital tract lacerations risk factors	operative birth, precipitate birth, congenital abnormalities of the maternal soft parts, and contracted pelvis; size, abnormal presentation, & position of fetus; relative size of the presenting part and the birth canal; previous scarring; and varicosities
Genital tract lacerations manifestations	lots of bright red blood on peripad, and it is increasing rapidly, but the uterus is firm and contracted well into a ball, with the fundus exactly where it should be
Max time placenta has to be born after birth of the baby	1 hour
Non-adherent retained placenta management	It is manually removed, i.e., separating the placenta by pulling the edges loose with the fingers and gradually getting the entire placenta out.
Adherent retained placenta management	hysterectomy
Uterine inversion seriousness	It is potentially life-threatening..
Uterine inversion contributing factors	A. fundal implantation B. manual extraction of the placenta. C. short umbilical cord. D. Uterine atony. E. leimyomas. F. abnormally adherent placenta.
Uterine inversion presenting manifestations	Hemorrhage, shock and pain in the absence of a palpable fundus abdominally.
Uterine inversion prevention	The umbilical cord should not be pulled on strongly unless the placenta has definitely separated.
Subinvolution of the uterus manifestations	A larger-than-normal uterus that may be boggy, also prolonged lochial discharge, excessive bleeding.
Oxytocin (Pitocin) action	Contraction of uterus; decreases bleeding
Oxytocin (Pitocin) side effects	Oxytocin (Pitocin)
Oxytocin (Pitocin) dosage and route	10 to 40 units/L diluted in lactated Ringer's solution or normal saline at 125 to 200 milliunits/min IV; or 10 to 20 units IM
Oxytocin (Pitocin) nursing considerations	Continue to monitor vaginal bleeding and uterine tone
Methylergonovine (Methergine) action	Contraction of uterus
Methylergonovine (Methergine) side effects	Hypertension, nausea, vomiting, headache
Methylergonovine (Methergine) contraindications	Hypertension, cardiac disease
Methylergonovine (Methergine) dosage and route	0.2 mg IM every 2 to 4 hr up to five doses; may also be given intrauterine or orally
Methylergonovine (Methergine) nursing considerations	Check blood pressure before giving, and do not give if >140/90 mm Hg; continue monitoring vaginal bleeding and uterine tone
15-Methylprostaglandin F2α (Prostin/15 m; Carboprost, Hemabate) action	Contraction of uterus
15-Methylprostaglandin F2α (Prostin/15 m; Carboprost, Hemabate) side effects	Headache, nausea and vomiting, fever, tachycardia, hypertension, diarrhea
15-Methylprostaglandin F2α (Prostin/15 m; Carboprost, Hemabate) contraindications	asthma or hypertension
15-Methylprostaglandin F2α (Prostin/15 m; Carboprost, Hemabate) dosage and route	0.25 mg IM or intrauterine every 15 to 90 min up to eight doses
15-Methylprostaglandin F2α (Prostin/15 m; Carboprost, Hemabate) nursing considerations	Continue to monitor vaginal bleeding and uterine tone
Dinoprostone (Prostin E2) action	Contraction of uterus
Dinoprostone (Prostin E2) side effects	Headache, nausea and vomiting, fever, chills, diarrhea
Dinoprostone (Prostin E2) contraindications	Avoid with asthma or hypotension
Dinoprostone (Prostin E2) dosage and route	20 mg vaginal or rectal suppository every 2 hr
Dinoprostone (Prostin E2) nursing considerations	Continue to monitor vaginal bleeding and uterine tone
Misoprostol (Cytotec) action	Contraction of uterus
Misoprostol (Cytotec) side effects	Headache, nausea and vomiting, diarrhea
Misoprostol (Cytotec) contraindications	History of allergy to prostaglandins
Misoprostol (Cytotec) dosage and route	800 to 1000 mcg rectally once
Misoprostol (Cytotec) nursing considerations	Continue to monitor vaginal bleeding and uterine tone
Bimanual compression	inserting a fist into the vagina and pressing the knuckles against the anterior side of the uterus, and then placing the other hand on the abdomen and massaging the posterior uterus with it.
Type of shock most likely to be seen postpartum	Hemorrhagic (hypovolemic) shock
The most objective and least invasive assessment of adequate organ perfusion and oxygenation	urinary output of at least 30 ml/hr
disseminated intravascular coagulation (DIC)	Clotting that consumes large amounts of clotting factors, causing widespread bleeding and clotting; associated with abruptio placentae, eclampsia, intrauterine fetal demise, amniotic fluid embolism, and hemorrhage.
DIC manifestations	oozing at the sites of incisions or injections and the presence of petechiae or ecchymosis in areas not associated with surgery or trauma
Percentage of blood loss before postpartum woman demonstrates classic signs of shock	30-40%.
Thromboembolic disease causes	Venous stasis, and hypercoagulation
Cause of decreased incidence of thromboembolic disease	early ambulation
Non-invasive diagnostic method used to identify a thromboembolus	Real-time and color doppler
superficial venous thrombosis management	analgesia (NSAID, not Aspirin); rest with elevation of the affected leg, and elastic stockings; local application of moist heat.
idiopathic thrombocytopenic purpura (ITP)	An autoimmune disorder in which antiplatelet antibodies decrease the life span of the platelets. Thrombocytopenia, capillary fragility, and increased bleeding time are diagnostic findings. Also called immune thrombocytopenic purpura (ITP).
ITP management	corticosteroids or IV immunoglobulin, platelet transfusions, and possibly splenectomy
von Willebrand disease (vWD)	A type of hemophilia; probably the most common of all hereditary bleeding disorders.
vWD management	administration of desmopressin, which promotes the release of vWF and factor VIII or Transfusion therapy with plasma products that have been treated for viruses and contain factor VIII and vWF (e.g., Humate-P, Alphanate)
puerperal infection	infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth; presence of a fever of 38° C or more on 2 successive days of the first 10 postpartum days (not counting the first 24 hours).
Most common postpartum infection	endometritis
Endometritis manifestations	Fever, increased pulse, chills, anorexia, nausea, fatigue, lethargy, pelvic pain, uterine tenderness, foul smelling profuse lochia, increased RBC sed. Rate, leukocytosis, anemia. Pg 834.
Incidence of UTIs in postpartum women	2-4 %
Mastitis manifestations	Chills, fever, malaise local tenderness, pain swelling redness, swelling of lymph nodes in the axilla
Mastitis management	Heat or cold, adequate support, hydration analgesics and antibiotics.
DVT management	anticoagulant therapy, bed rest with the affected leg elevated, and analgesia; elastic stockings.
PE management	IV heparin followed by SQ heparin
newborn’s first period of reactivity	lasts up to 30 minutes after birth
respiratory rate of the newborn	breaths are shallow and irregular, ranging from 30 to 60 breaths/min, with periods of breathing that include pauses in respirations lasting less than 20 seconds.
Apneic periods that should be evaluated	lasting longer than 20 seconds
signs of respiratory distress in the immediate newborn period	Nasal flaring; retractions; grunting with exhalation; increased use intercostal muscles, see-saw respiration, rate less than 30 or more than 60.
Apneic episode contributing factors	Rapid increase in body temperature, hypothermia, hypocalcemia or sepsis.
mL of blood in the average newborn	300 ml of blood.
Amount blood can be increased if “placental transfusion” is allowed to occur	100 mL
Placental transfusion	the cord is not cut immediately and the blood in the cord and placenta is allowed to flow into the baby
Persistent tachycardia indicates	anemia, hypovolemia, hyperthermia, or sepsis
Persistent bradycardia indicates	congenital heart block or hypoxemia
Four modes of heat loss	convection, radiation, evaporation, conduction
Convection mode of heat loss	flow of heat from body surface to cooler air,
radiation mode of heat loss	loss of heat from body surface to cooler solid surface in relative proximity (not direct contact)
evaporation mode of heat loss	loss of heat that occurs when liquid is converted to vapor
conduction	loss of heat from body surface to cooler surfaces in direct contact
Expected time infant must void after birth	within 24 hours
source of bilirubin	Breakdown of RBCs and the newborn liver’s inability to process this
intervention that reduces serum bilirubin	Feeding stimulates peristalsis, which then causes less bilirubin to be reabsorbed by the gut
age infants should be able to concentrate their urine	Approximately 3 months
Epstein’s pearls	Small whitish areas found on the gum margins at the juncture of the hard and soft palate
3 vitamins newborns need to synthesize once bacteria is established in the intestine	Vitamin K, folate, and biotin
capacity of the stomach of the newborn	Less than 30 mL on day 1 to more than 90 mL on day 3 (p. 535 )
color of meconium	Greenish black
stools of breast-fed babies	Yellow to golden in color; pasty in consistency, resembles mixture of mustard and cottage cheese and has odor similar to sour milk
stools of bottle-fed babies	Pale yellow to light brown in color, firmer in consistency, with a more offensive odor than breast-fed babies
when normal, term infants pass meconium	within first 12 to 24 hours
length of time iron stores last in a full-term breast-fed infant vs. in a preterm infant	4-6 months vs. 2-3 months
normal blood glucose level for a newborn in the first several hours after birth	50-60
normal blood glucose level by the third day of life	60-70
pathologic jaundice criteria	appears within 24 hours of birth, if total serum bilirubin levels increase by more than 5 mg/dl in 24 hours, and if the serum bilirubin level exceeds 15 mg/dl at any time
worst long-term disorders involving hyperbilirubinemia	Kernicterus
kernicterus	Bilirubin encephalopathy involving the deposit of unconjugated bilirubin in brain cells, resulting in death or impaired intellectual, perceptive, or motor function and adaptive behavior.
Signs of infection in newborns	Do not have fevers; Lethargy, irritability, poor feeding, vomiting or diarrhea, decreased reflexes, and pale or mottled skin color, apnea, tachypnea, grunting or retracting
vernix caseosa	A cheese-like substance that is fused with the epidermis and serves as a protective covering. The amount of vernix decreases with age and is shed into the amniotic fluid.
Acrocyanosis	Peripheral cyanosis; blue color of hands and feet in most infants at birth that may persist for 7 to 10 days.
Lanugo	Downy, fine hair on fetus between 20 weeks of gestation and birth that is most noticeable over the shoulder, forehead, and cheeks but is found on nearly all parts of the body except the palms of the hands, soles of the feet, and the scalp.
telangiectatic nevi (stork bites)	Clusters of small, red, localized areas of capillary dilation frequently seen in neonates at the nape of the neck or lower occiput, upper eyelids, and nasal bridge that can be blanched with pressure of a finger and usually fades by second year of life.
erythema toxicum	Innocuous pink papular neonatal rash of unknown cause, with superimposed vesicles appearing within 24 to 48 hours after birth and resolving spontaneously within a few days. Also called erythema neonatorum, newborn rash, or flea bite dermatitis.
hormone responsible for mucoid vaginal discharge and pseudo menstruation in neonatal girls and breast swelling and “witches milk” in either gender	Estrogen, from the mother’s blood
scrotum of a term male vs. preterm male	By 28 to 36 weeks of gestation, the testes can be palpated in the inguinal canal, and a few rugae appear on the scrotum. At 36 to 40 weeks of gestation, the testes are palpable in the upper scrotum, and rugae appear on the anterior portion.
caput succaneum vs. cephal hematoma	Caput succedaneum: edema of the scalp noted at birth; crosses suture lines. Cephalhematoma: bleeding between periosteum and skull bone appearing within first 2 days- does not cross suture lines
tests for hip dysplasia	Barlow test and Ortolani’s maneuver
age crying peaks	Crying peaks in the second month and then decreases
Source of contamination on newborn	blood and amniotic fluid, vernix and vaginal bacteria on the skin until bathed
Apgar score	Numeric expression of the condition of a newborn obtained by rapid assessment at 1 and 5 minutes of age; developed by Dr. Virginia Apgar
5 areas assessed in generating an Apgar Score	Heart rate, respiratory effort, muscle tone, reflex irritability and color
Alarming ID bracelet placement	Before mom and baby are separated after birth
assessment done to determine gestational age	New Ballard Score
New Ballard Score	assessment done to determine gestation age that can be used with newborns as young as 20 weeks of gestation. The tool has the same physical and neuromuscular sections but includes −1 to −2 scores that reflect signs of extremely premature infants
signs of extremely premature infants	fused eyelids; imperceptible breast tissue; sticky, friable, transparent skin; no lanugo; and square-window (flexion of wrist) angle greater than 90 degrees
medications used to prevent ophthalmia neonatorum	Erythromycin Ophthalmic Ointment, 0.5% and Tetracycline Ophthalmic Ointment 1%
ophthalmia neonatorum	Infection in the neonate's eyes usually resulting from gonorrheal or other infection contracted when the fetus passes through the birth canal (vagina).
delivery techniques that can cause injury to the baby	Forceps-assisted births, vacuum extractors, version and extraction, cesarean sections
TcB monitor correlation with the serum bilirubin levels	The new monitors provide accurate measurements within 2-3 mg/dl in most neonatal populations at serum levels below 15 mg/dl.
total serum bilirubin normal	1 – 12 mg/dl
glucose measurements in a neonate that indicate hypoglycemia	less than 40-50 mg/dl
hypoglycemia manifestations	Jitteriness, lethargy, poor feeding, hypotonia, temperature instability (hypothermia), respiratory distress, apnea, and seizures
hypocalcemia manifestations	Jitteriness, high-pitched cry, irritability, apnea, intermittent cyanosis, abdominal distention, and laryngospasm
best treatment for both hypoglycemia and hypocalcemia	feeding, as early as possible
heel stick location	Outer aspect of the heel
2 injections all infants in the NN receive	Hep B vaccine and vitamin K
size needle used for IM injections in newborns	25 gauge, 5/8 inch
muscle used for injections in newborns	Vastus lateralis
Hyperbilirubinemia treatment	early feeding and, if that doesn’t work, phototherapy or exchange blood transfusion – rare
methods of circumcision that requires use of Vaseline for post care	Gomco or Yellen
when plastic ring falls off when the plastibell method of circumcision has been used	5-7 days
length of time yellow exudate on the glans after circumcision last	2-3 days
bathing before cord has fallen off	Sponge baths are usually used until the infant's umbilical cord falls off and the umbilicus is healed.
position for sleeping is currently recommended	Supine position
cord care recommendations	cleaning the cord with sterile water initially and subsequently with plain water
occurs before each spurt in development	Immediately before each spurt in development is a predictable short period of disorganization in the baby
suction order	mouth first, then nose
Times/day infant should breastfeed	Latch and feed effectively at least eight times per 24 hr (every 1.5 to 3 hours)
Oz of formula/day	3-4 oz every 3-4 hrs (24 oz day)
Number of diapers/day	two to six wet diapers per 24 hr until the fourth day of life and then six to eight wet diapers and at least three bowel movements every 24 hours (breastfeeding) or one every 48 hours (formula-fed)
Vital sign normals for newborns	HR: 120-160 when awake; RR: 30-55 without retractions, grunting, or nasal flaring; temp: 36.5 to 37.2 axillary
Length of time infants should be breastfed exclusively	6 months
contraindications to breastfeeding	Infants with galactosemia, mothers with HIV or TB or Human T-cell lymphotrophic virus type I or II; mothers receiving radiation or chemotherapy, and mothers using street drugs and certain other meds
galactosemia	Inherited, autosomal recessive disorder of galactose metabolism, characterized by a deficiency of the enzyme galactose-1-phosphate uridyltransferase.
Calories human milk contains	67 kcal/100 ml or 20 kcal/oz
Problem associated with cow’s milk	Although cow’s milk is high in calcium, the calcium/phosophorus ratio is low, resulting in decreased absorption
weeks gestation the breast begin making colostrum	Around week 16 of gestation
How the body “knows” when to make more milk	As more milk is removed from the breast, more is produced
postpartum complications with decreased risk when breastfeeding	Postpartum hemorrhage
breastfeeding affect on afterpains	causes increased afterpains d/t Increased release of oxytocin with breastfeeding causing more uterine contractions
hormones that affect women’s emotions	Prolactin and Oxytocin
When real milk (as opposed to colostrum) “comes in”	Day 3 to 5
Foremilk	initial milk: bluish with milk that is part skim milk (approximately 60% of the volume) and part whole milk (approximately 35% of the volume). It provides primarily lactose, protein, and water-soluble vitamins.
Hindmilk	relased 10-20 minutes into feeding; contains the denser calories from fat necessary for ensuring optimal growth and contentment between feedings.
breastfeeding positions	Football hold, cradle, modified cradle or across lap, and side-lying
amount of areola baby’s mouth should cover if properly “latched on”	the mouth should cover the nipple and an areolar radius of 2-3 cm around the nipple.
demand feeding	The infant determines the frequency of feeding by exhibiting feeding cues.
Length of feedings on each breast once lactation is established	15-20 mins per breast
nipple confusion prevention	Avoid bottle feeding and pacifiers until breastfeeding is well established, after 3-4 weeks.
benefits of breast milk for preterm infants	Higher concentrations of energy, fat, protein, sodium, chloride, potassium, iron, and magnesium. Enhances retinal maturation and improves neurocognitive outcomes; decreases the risk of necrotizing entercolitis.
Length of time breast milk can be stored	Room Temperature: up to 8 hours; Refrigerator: up to 8 days; Frozen up to 6 months; Deep Freeze: up to 12 months
Breast milk thawing	In the refrigerator for gradual thawing, or in warm water for faster thawing.
Breast milk use after thawing	use within 24 hours and it should not be refrozen.
Microwave dangers r/t breast milk	should not be used for thawing since it does not heat evenly and can cause burns to the mouth, throat, and upper GI tract. It also decreases the effectiveness of Vitamin C and antiinfective properties.
additional Kcal needed by breastfeeding woman	300-500 calories per day
product that helps women with flat or inverted nipples	Breast shells
oral contraceptive not likely to interfere with milk supply	POPs (Progesterone-only pills) and other progesterone-based contraceptives.
breast augmentation affect on breast feeding	usually no affect
engorgement manifestations	Painful overfilling of breast; breast are firm, tender, hot, shiny, taut, nipples may flatten
When engorgement is likely to occur	3-5 days after birth when milk has come in
How often mother with engorgement should breastfeed	Frequently, q2 hours
interventions recommended for engorgement	Feed every 2 hours, massage breasts, use breast pump if infant not emptying breast, cold compresses, raw cabbage leaves.
causes of sore nipples	Poor positioning, incorrect latch-on, improper suck, monolial infection.
Mastitis manifestations	Flu-like signs and symptoms like fever, chills aches, headache, along with localized redness and swelling, especially in one quadrant of the breast.
Mastitis management	Antibiotics, analgesics, antireptics, frequent feeding/pumping, warm compresses, rest.
implications/risks of propping a baby bottle	They can choke and it deprives them of parental interaction.

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