Induction of labor is associated with some risks and disadvantages, such as overactivity of the uterus. With a perinatal mortality rate of 50%, it is one of the most catastrophic events in the intrapartum period (Beall & Ross, 2012).
WOMEN REQUIRING
It is used to alter the relationship of the uterus, placenta, cord and fetus to improve placental and fetal oxygenation. Overdistension of the uterus is a risk, so the amount of fluid administered must be carefully monitored.
BIRTH-RELATED PROCEDURES
A caesarean section is the birth of the fetus through an incision in the abdomen and uterus. Fetal injury and transient tachypnea of the newborn may also occur (Hyde, Mostyn, Modi, & Kemp, 2012).
Examine the major conditions that place the postpartum woman at risk
Differentiate the causes of postpartum hemorrhage based on the underlying pathophysiologic mechanisms
POSTPARTUM HEMORRHAGE
Classic signs of placental abruption include a small effusion of blood with lengthening of the umbilical cord and slight elevation of the uterus in the pelvis. Prolapse of the uterine fundus onto or through the cervix, so that the uterus is turned outward after delivery, is called uterine inversion.
Massaging the Fundus
Offer explanation to the client and family about what is happening and the purpose of the medication. If a full bladder is present, help the woman empty her bladder to reduce displacement of the uterus.
THROMBOEMBOLIC CONDITIONS
Finally, it is important to be aware of the mother's beliefs about blood transfusion (World Health Organization, 2010). For a woman with deep vein thrombosis, perform bed rest and elevation of the affected limb.
POSTPARTUM INFECTION
Metritis is an infectious condition involving the endometrium, decidua, and adjacent myometrium of the uterus. In addition, the woman may have specific signs and symptoms depending on the type and location of the infection.
Overview of the Woman with a Postpartum Complication
Check all visitors for any signs of active infections to reduce the risk of client exposure. The client will experience resolution of the wound infection as evidenced by a reduction in redness, swelling, and drainage from the wound; lack of purulent drainage; and initial signs and symptoms of wound healing.
POSTPARTUM AFFECTIVE DISORDERS
Unlike the postpartum blues, women with postpartum depression get worse over time, and changes in mood and behavior do not go away on their own. However, the risk of developing postpartum depression for either group was not significantly different.
Edinburgh Postnatal Depression Scale
When interacting with the female, observe for verbal and nonverbal indicators of anxiety as well as her ability to concentrate during the interaction. Help the woman structure her day to regain a sense of control over the situation.
Consider This
Retrieved from CI-NAHL Plus with full text, Ipswich, MA; and Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/reproductivehealth/Depression/index. 2012), Measuring and communicating blood loss during obstetric hemorrhage.
- Evaluate factors that assist in identifying a newborn at risk due to variations in birthweight and gestational age
- Select contributing factors and common complications associated with dysmature infants and their management
- Analyze nursing assessment and management of newborn conditions associated with variations in birthweight and gestational ages
- Integrate knowledge of the risks associated with late preterm births into nursing interventions, discharge planning, and parent education
Evaluate factors that help identify a newborn at risk due to variations in birth weight and gestational age. This chapter discusses the nursing management of newborns with special needs related to variations in birth weight and gestational age.
BIRTHWEIGHT VARIATIONS
Because of the newborn's large size, vaginal birth can be difficult and sometimes lead to birth injury. Chapter 2 3 Nursing Care of the Newborn with Special Needs 809 suspected to be compromised, leading to perinatal mortality and morbidity.
GESTATIONAL AGE VARIATIONS
Close monitoring of the preterm neonate's acid-base and electrolyte balance is essential to identify metabolic discrepancies. A thorough assessment of the premature newborn on admission to the nursery provides a baseline from which changes in clinical status can be identified.
Overview of the Care of a Preterm Newborn
- Characterize the nursing management of a newborn experiencing respiratory distress syndrome
- Research four gastrointestinal system congenital anomalies that can occur in a newborn
- Formulate a plan of care for a newborn with an acquired or congenital condition
- Relate the importance of parental participation in care of the newborn with a congenital or acquired condition, including the nurse’s role in facilitating parental
Explain all events and procedures to the parents to reduce anxiety and promote understanding of the newborn's condition. Chapter 2 3 Nursing care of the newborn with special needs 825 phenomenon, although great progress has been made in perinatal health care. For information related to teaching at the discharge of the family of a late preterm infant, see Teaching Instructions 23.1.
Staff perceptions one year after implementation of the Individualized Newborn Developmental Care and Assessment Program (NIDCAP). Necrotizing enterocolitis section of the newborn baby. eds.), Current Diagnosis and Treatment: Pediatrics (20th ed.).
ACQUIRED DISORDERS Perinatal Asphyxia
Chapter 2 4 Nursing the At-Risk Newborn: Acquired and Congenital Conditions of the Newborn 835 make this transition so that by the 1st minute of age. Laboratory or diagnostic tests can be used to identify the etiology of neonatal asphyxia. Chapter 2 4 Nursing Care of the At-Risk Newborn: Acquired and Congenital Conditions in the Newborn 841 decrease in surfactant production.
Minimize handling of the newborn by bundling nursing care and limit stimulation in the newborn's environment to reduce stress. Assess the newborn for signs of birth trauma that include the head (tense, bulging fontanelles, cephalhematoma, skull fractures, and facial nerve palsy), shoulders and limbs (deposition, paralysis), and skin (bruising).
Overview of an Infant of a Diabetic Mother
C h a p t e r 2 4 Nursing management of the newborn at risk: acquired and congenital newborn conditions 859 The manifestations of withdrawal are a function of. Bacterial infections of the newborn affect approximately 2 out of every 1,000 live births (Anderson-Berry, Bellig, & Ohning, 2012). Cuddle, cuddle or hold the newborn to promote bonding when it's out of the lights.
Early symptoms may be vague due to the newborn's inability to mount an inflammatory response. CHAPTER 2 4 Nursing care of the newborn at risk: acquired and congenital conditions of the newborn 871 WITH EVIDENCE OF BASED PRACTICE 24.1.
CONGENITAL CONDITIONS
- Define the key terms used in this chapter
- Identify normal developmental changes occurring in the newborn and infant
- Identify the gross and fine motor milestones of the newborn and infant
- Express an understanding of language development in the first year of life
- Describe nutritional requirements of the newborn and infant
- Develop a nutritional plan for the first year of life
- Identify common issues related to growth and development in infancy
- Demonstrate knowledge of appropriate anticipatory guidance for common developmental issues
Postoperative care includes close observation of all body systems of the newborn to identify any complications. C h a p t e r 2 4 Nursing Management of Newborns at Risk: Acquired and Congenital Conditions in Newborns 875 touch their newborn. After enough of the defect is within the abdominal cavity, a surgical repair is performed (Glasser, 2011).
Transient tachypnea in the newborn occurs when fluid in the lungs is removed slowly or incompletely. C h a p t e r 2 4 Nursing Management of Newborns at Risk: Acquired and Congenital Newborn Conditions 879 Mukherjee, S., & Ozden, N.
GROWTH AND DEVELOPMENT OVERVIEW
The baby experiences extraordinary changes in the neurological system during the first year of life. Amylase (necessary for digesting complex carbohydrates) and lipase (essential for proper fat digestion) are both deficient in infants and do not reach adult levels until about 5 months of age. At birth, the baby may be covered with vernix (early gestational age) or vernix may be found in skin folds, axillae, and groin areas (later gestational age).
The baby stands independently from a hunched position and walks around 12 months of age (plus or minus 3 months). The newborn spends most of the time sleeping, but at 2 months the baby is ready to start socializing.
THE NURSE’S ROLE IN NEWBORN AND INFANT GROWTH AND
C h a p t e r 2 5 Growth and development of the newborn and infant 903 to the cradle or the hospital room. Newborns and their mothers only spend a short time in the hospital after birth, so it is very important that parents can care for their newborns and know when to call the primary care provider with concerns. Periodic screening for adequate growth and development is recommended by the American Academy of Pediatrics (AAP) for all infants and children.
Sometimes this creates conflict in the health care system when the health care providers have a different value system than the infant's family. The nurse should not make assumptions about a family's cultural practices based on their skin color, accent, or name; rather, the nurse should perform an appropriate assessment (Leininger & MacFarland, 2006).
NURSING PROCESS OVERVIEW
The AAP and the Advisory Committee on Immunization Practices (ACIP) have made recommendations for immunization schedules. Nurses caring for newborns and infants should be familiar with the recommended infant/child periodic screenings (examinations) as well as the current immunization schedule (see Chapter 31 for further information on immunizations). Usually these practices are not harmful and can be supported by the health care team, but safety must always be considered.
Many communities now include people from different cultures, so it is important that nurses practice transcultural nursing (nursing care that is culturally guided and that respects the differences between the individual). Many nurse researchers are investigating the cultural aspects of healthcare and the impact that cultural diversity has on health.
Growth and Development Issues in the Newborn and Infant
- Explain normal physiologic, psychosocial, and cognitive changes occurring in the toddler
- Identify the gross and fine motor milestones of the toddler
- Demonstrate an understanding of language development in the toddler years
- Discuss sensory development of the toddler
- Demonstrate an understanding of emotional/social development and moral/spiritual development during toddlerhood
- Implement a nursing care plan to address common issues related to growth and development in toddlerhood
- Encourage growth and learning through play
- Develop a teaching plan for safety promotion in the toddler period
- Demonstrate an understanding of toddler needs related to sleep and rest, as well as dental health
- Develop a nutritional plan for the toddler based on average nutritional requirements
- Provide appropriate anticipatory guidance for common developmental issues that arise in the toddler period
- Demonstrate an understanding of appropriate methods of discipline for use during the toddler years
- Identify the role of the parent in the toddler’s life and determine ways to support, encourage, and educate the parents about toddler growth, development, and concerns during this period
Parents should keep an eye on the child at all times (no child protection can replace the watchful eye of a caring parent). Watching and listening to the baby feed can assess the adequacy of the baby's latching technique. While the baby is learning, put one ounce of breast milk or formula into the cup.
Persistent problems with waking during the night should be discussed with the child's primary care provider. What is the nurse's best instruction regarding the child's oral health?
GROWTH AND
The toddler period comprises the second 2 years of life, from age 1 to age 3. Having learned that parents are predictable and reliable, the toddler now learns that his or her behavior has a predictable, reliable effect on others. As more grandparents assume the primary caregiver role for their grandchildren, nurses must be aware of the possibility of increased stress placed on the older caregiver, especially during the active and sometimes difficult years of toddlerhood (Bigbee et al., 2011).
DEVELOPMENT OVERVIEW
The color of the stool can change (yellow, orange, brown or green) depending on the baby's diet. Thus, mastering the development of motor skills contributes to the toddler's growing sense of self-esteem. Language is a very important part of a toddler's ability to organize his world and actually make sense of it.
Emotional development in the early years focuses on separation and individuation (Papalia & Feldman, 2011). Faeces can be seen as part of the child and the toddler may be upset to see it disappear into the toilet.
THE NURSE’S ROLE IN TODDLER GROWTH AND DEVELOPMENT
C h a p t e r 2 6 Growth and development of the young child 929 When the young child is hospitalized, growth and development can be changed. The toddler's primary task is to establish autonomy, and the toddler's focus is mobility and language development. Isolation for infectious disease further limits the young child's ability to find some control over the environment.
Growth and Development Issues in the Toddler
- Identify normal physiologic, cognitive, and psychosocial changes occurring in the preschool-age child
- Express an understanding of language development in the preschool years
- Implement a nursing care plan that addresses common concerns or delays in the preschooler’s development
- Integrate knowledge of preschool growth and development with nursing care and health promotion of the preschool-age child
- Develop a nutrition plan for the preschool-age child
- Identify common issues related to growth and development during the preschool years
- Demonstrate knowledge of appropriate anticipatory guidance for common developmental issues that arise in the preschool period
The safest place for the little one to ride is in the back seat of the car. Remove firearms from the home or keep them in a locked cabinet out of the child's reach. A significant stressor in the baby's life can also disrupt the toilet training process (toilet training may not be achieved until around the time a sibling is born).
