Postpartum and Newborn Care (Nursing)

00:01 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.

00:28 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.

01:20 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.

02:07 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 thrombocytopenia, 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.

02:56 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 the test.

03:53 Respirations of 30 to 60 breaths per minute with normal short periods of apnea are normal.

04:00 The pulse of 100 to 160 beats per minute, remember to check this for a full minute.

04:07 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.

04:40 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.

05:14 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.

05:58 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.

06:20 Tips for success, when in doubt, always assess, diagnose, plan, and then implement.

06:27 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.