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Chapter 7

NURS 3524 Chapter Notes - Chapter 7: Postpartum Depression, Anaphylaxis, Lactation


Department
Nursing
Course Code
NURS 3524
Professor
Mavoy Bertram
Chapter
7

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- Persistent cyanosis: hypoxia/vasoconstriction
- Short/ no nails = preterm
- Grasp reflex
- Babinski reflex: stroke sole upward from the heel causes big to dorsiflex and other toes to hyperextend
- Muscle tone, determine if they are equal bilaterally: hypotonia suggests some hypoxia, neurologic or muscular
disorder, or down syndrome
Maintain a patient airway
- Avoiding neck flexion or hyperextension is critical to achieve and maintain a patent airway
- Supine position during sleep for all newborns
- Suctioning may be done with a bulb syringe. Gentle suctioning and correct technique to prevent mucosal damage
and edema. If nasal suctioning is necessary it must be done after oral suctioning to minimize the aspiration of
oropharyngeal contents
Maintain a stable body temp
- Rapidly drying the skin and hair with warm towel and placing the infant in skin to skin contact with mother, covered
with blanked minimizes heat loss
- Place cribs far away from windows, cool walls, or ventilating units
- Place infant on padded covered surface rather than directly on a cool hard table
Protect from infection and injury
- Hand washing
- Eye care: prophylactic eye tx against ophthalmia neonatorum – give drug within 1 hour of birth. Prophylactic eye tx:
silver nitrate solution, erythromycin ointment, or tetracycline are all effective vs gonococcal conjunctivitis
- Oral erythromycin in tx of chlamydia trachomatis
- Vit K administration: Vit K is administered to prevent hemorrhagic disease of the newborn
- Hep B vaccine: first of three doses recommended between birth and 2 months of life for all newborns to hep B
surface antigen negative mothers. Injection in the vastus lateralis muscle.
- Newborn screening: PKU screening. Important for nurse to collect specimens at the appropriate time i.e. after 24
hours, or after introduction to feedings, hospitalized infants must be screened before 7 days of age.
- HIV positive mother should not breastfeed and infant should be treated with antiretroviral prophylaxis for 6 weeks.
- Universal newborn hearing screening: delay test by 48 hours in children born by c section due to retained fluid in
middle ear.
- Bathing: wear gloves when bathing child until blood and amniotic fluid are removed by bathing. Bathing within 1st
hour of life not recommended as it interferes with skin to skin holding and breastfeeding. Don’t disrupt skin’s “acid
mantle” which has a pH of about 5 soon after birth and bacteriostatic effects of this pH is significant. Use only plain
warm water. For the first 2-4 weeks, child should be bathed no more than 2-3 times per week with a plain warm
sponge bath. Routine daily bathing for newborns is no longer recommended.
- Care of umbilicus: cleaning the cord initially with sterile water or neutral pH cleanser then cleaning the cord with
water. Some studies found that cord drying and separation time to be enhanced by topical breast milk. Place diaper
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below the cord. Avg. separation time 5-15 days. It takes a few more weeks for the cord base to heal after
separation. Keep the base clean and dry and watch for infections.
- Circumcision: usually done in the hospital. Reduced risk of HPV and HIV trasmission in circumcised males.
Providing optimum nutrition
- Human milk is the best option for the infant’s nutrition up to 1 year of age.
- Breast milk contains immunologic properties
- Some studies suggest that breast feeding has an analgesic effect on newborns
- The fat content of human milk s composed of lipids, triglycerides, and cholesterol. Cholesterol is essential for brain
growth.
- The primary source of carbs in human milk is lactose. Others are glucose, galactose and glucosamine. These carbs
have protection fxns.
Human milk contains proteins whey and casein in a 60:40 ratio. This ratio makes it more digestible and produces
soft stool seen in infants who are breast fed, making constipation uncommon. Whey also believed to play an
important role in preventing allergies.
- Human milk contain other host defenses.
- Colostrum: high levels of igA that prevents viruses and bacteria from invading. The intestinal mucosa; thus
protecting from infection.
- The amounts of nutrients in human milk during the 1st 6 months is sufficient for infant growth, except for Vit D.
which is found in varying amounts depending on the mother’s intake or exposure to UV light. Might need to take
supplements 200 IU daily.
- Studies show that human milk produces higher intelligence
- There are variations in human milk rt the timing of lactation cycle. Also variation varies with gestational age
(preterm human milk defers from mature milk)
- Closeness to the mother while being breast fed gives the infant a sense of peaceful security
- Contraindications to breastfeeding:
oMaternal chemo and certain neoplastic drugs
oActive TB not under tx
oHIV positive mother
oGalactosemia in infant
oMaternal herpes lesion on breast
oMaternal substance abuse
oCmv
oMothers receive diagnostic and radioactive isotopes or who had exposure to radioactive materials.
- A small number of medications are contraindicated for breastfeeding mothers.
- Mastitis is not a contraindication if discomfort is tolerable.
- Galactogogues (herbal products) are reported to increase breast milk production
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