Hi! I’m Joanna Jackson, and we’ll review
postpartum and newborn care. First, let’s
start with the nursing assessment. A really easy
way to remember this is by the word “bubble”,
B for breast, U for uterus, B for bowel, the
next B for bladder, L for lochia, meaning
the color, odor, consistency, and the amount,
and E for episiotomy.
So, let’s review normal findings for the
postpartum period. It’s very perfectly normal
to have postpartum chill, to have a rapid
decrease in the size of the fundus, one to
two centimeters every 24 hours. The fundus
should remain firm. The lochia changes should
occur in three stages; bright red, a bloody
consistency and a fleshy odor one to three
days. Then pinkish brown color for four to ten
days. And finally, a yellowish white creamy
color for up to six weeks. The breast should
also secrete colostrum for two to three days
before the milk begins. It’s also normal to
have an increased appetite
following delivery. Constipation can last
for up to three days following childbirth.
Hemorrhoids, urinary delays, the fundus should
become firm, and psychosocial adaptation to
help develop the bond between the mother and
the baby. Patient education is vitality important
during the postpartum period, especially
for first-time moms. Encourage patients to
eat a well-balanced diet, encourage patients
to ambulate when they’re able, encourage
patients to empty their bladder regularly,
and reinforce the importance of postpartum
strengthening exercises. Remind clients who
receive both the rubella
vaccine and RhoGAM to return to the provider
after three months to determine if immunity
to rubella has been developed. Recommend for
patients to rest when the newborn sleeps.
Encourage the parents to bond with their new baby.
And provide information regarding community
resources for young mothers. Patient education
is vitally important to prevent some of these
common postpartum complications. Some examples
of these include: DVT or deep vein thrombosis,
which can lead to a pulmonary embolism. So
be sure that you’re completing physical
exams regularly. ITP known as idiopathic
DIC known as disseminated intravascular coagulation,
uterine atony is the inability of the uterine
muscles to contract following childbirth,
and then infections of the uterus, breast,
urinary tract, or the C-section scar. Postpartum
depression or psychosis is also common.
So be sure to address those psychosocial needs.
Now we’ll discuss newborn care. The most
common assessment for newborn care is the
Apgar score. This is completed at one minute
and five minutes of life. A score of zero
to three indicates severe distress of the
baby. A score of 4 to 6 indicates moderate distress.
And a score of seven or higher indicates no
distress. This is an example of the Apgar score.
You assess the heart rate, the respiratory
rate, the muscle tone, the reflexes, and the
color of the baby. You mark these scores at
one minute and five minutes in the blank column.
It’s important to know what are normal findings
for a newborn baby. Be sure to review
weight, length, the head circumference, and
the chest circumference before taking
Respirations of 30 to 60 breaths per minute
with normal short periods of apnea are normal.
The pulse of 100 to 160 beats per minute,
remember to check this for a full minute.
Blood pressure of 60 to 80 over 40 to 60 is
perfectly normal in a newborn, and a temperature
of 36.5 to 37.2 Celcius. Additional nursing
assessment findings include, that the newborn’s
head should be two to three centimeters larger
than his chest. The sutures of the newborn should
be palpable, separated, and may be overlapping.
Assess the newborn’s eyes for symmetry in
size and shape. And remember that the eye color
may change within three to twelve months.
Eyeball movements will demonstrate random
jerky movements. And newborns will sneeze
frequently and it’s perfectly normal. Bowel
sounds should be present one to two hours
following birth. It’s common to also
assess a newborn’s
reflexes. The following reflexes are present
from birth to four months of life. The stepping
reflex, which is present birth to four weeks.
This is stimulated by holding the newborn upright
with his feet touching a flat surface. The
newborn will respond with stepping movement.
The startle reflex, also known as the moro
reflex. The newborn’s arms and legs are
symmetrically extended and then abduct, while
his fingers spread to form a C. Sucking and
rooting. This is when a newborn’s cheek or
mouth is touched. She will turn her head
and start to suck. The tonic neck reflex.
Newborns will extend their arm and leg on
the side when their head is turned to that
side with flexion over arm and leg on that
opposite side. The following reflexes are
present from birth
to six to twelve months of life: the palmar
grasp, the planter grasp, and the Babinski’s
reflex. The palmar grasp is when you’re
placing an object in the newborn’s hand.
The newborn will grasp at it. The planter
grasp is stimulated by touching the sole of
the newborn’s foot. The newborn responds
by curling her toes downward. Babinski’s
reflex is stimulated by stroking the outer
edge of the newborn sole of her foot, moving
up toward her toes, her toes will then fan
upward and out.
Tips for success, when in doubt, always assess,
diagnose, plan, and then implement.
Always assess before taking any action. If two answers
feel correct, and they frequently will, do
your best to choose the best answer. And then
remember, opposites attract, if two responses
are very similar or opposites of each other,
the answer is usually in one of those two options.