Clinical Orientation St. Johns

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Clinical Orientation St. Johns
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Security Issues

• Wear identification tag at all times, always
  introduce self
  
• Check moms arm band to babys everytime bring
  baby to room (baby has two bands)
  
• Always push babies in bassinets, never carry in
  hallways
  
• Never leave baby unattended
• WASH HANDS before and after touching baby
• Practice universal precautions use gloves when
  changing diapers and peri-pads
  
• Keep baby wrapped in blanket
• Do not lie babies on abdomens
• CONFIDENTIALITY!!!!!!

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Terminology

• Gravida
• Parity
• Multigravida
• Multipara
• Primigravida
• Primipara
• Term pregnancy
• Postterm
• Preterm
• Abortion (AB)
• meconium

• Stillborn
• Antepartum
• Intrapartum
• Postpartum
• Gestation
• Fundus
• Lochia
• Episiotomy
• Involution
• Afterpains
• colostrum

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Abbreviations

• EDD (EDC0
• SGA
• AGA
• LGA
• NSVD
• VBAC
• LEA

• C/B
• TPAL
• ROM, PROM, PPROM, SROM, AROM
• LDRP

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NIC related to childbearing

• Attachment
• Bleeding reduction postpartum
• Bottle-feeding
• Breast-feeding assistance
• Family integrity promotion (childbearing)
• Infant care
• Lactation counseling

• Lactation suppression
• Newborn care
• Newborn monitoring
• Non-nutritive sucking
• Parent education (childbearing)
• Postpartal care
• Teaching infant care

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Newborn Assessment Care

• Vital signs
• Temp Axillary, normal 36.5-37.0 (97.7-98.6)
• Apical HR 120-160
• Respirations 30-60, count 1 full minute
• Assessment flow sheet

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Nursing care

• High risk for infection
• High risk for hypo/hyperthermia
• High risk for alteration in nutrition
• Risk for altered attachment

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Risk for infection

• Handwashing
• Keep eyes clean
• Circ site clean
• Umbilical site
• Eye prophylaxis
• Avoid exposure
• Hepatitis B

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Temperature regulation

• Methods of heat loss
• Convection
• Radiation
• Evaporation
• conduction

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Interventions avoid heat loss

• Dry infant after birth
• Radiant warmers (31-33.8)
• Check temperature
• Hat on head first 12 hrs
• Wrap and/or double wrap
• Avoid drafts
• Minimize time unwrapped
• Skin to skin contact, mothers arms

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Infant nutrition

• Breast
• -to the breast as soon as possible after birth
• -nurse every 2-3hrs on demand, wake up!
• -document correct alignment, correct areolar
  grasp compression, swallowing
  
• -discourage pacifiers

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Infant nutrition cont.

• Bottle
• -initially 1-3hrs after birth
• -assess ability to suck swallow
• -feed every 3-4hrs, burp ½ - 1 oz
• -initially will take 1-2oz
• -document- time of feeding, amount of feeding

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Attachment Process

• Attachment behaviors
• touching, fondling
• holding
• gazing
• kissing
• cuddling
• talking to infant

• Hi-risk behaviors
• negative comments
• failure to look at infant
• failure to touch infant
• failure to name
• limited handling
• failure to meet physical needs

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Attachment Things to consider

• Maternal exhaustion
• Wanted vs. unwanted pregnancy
• Degree of support
• Sex, appearance, anomalies
• Past experiences
• Culture
• Recipricol relationship
• Early separation

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Postpartum Assessment

• Breasts
• Uterus
• Bowels
• Bladder
• Lochia rubra, serosa, alba
• Episiotomy, incisions (REEDA)

• Clots DVT (Homans)
• Epidural site
• Cesarean Section

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Psychosocial Adjustment

• Factors that influence
• -condition of the mother
• -condition of the infant
• -socioeconomic factors
• -familial factors
• -maternal age, parity
• -role conflict

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Maternal Role Attainment

• Taking in
• Taking hold
• Letting go
• Baby blues
• PP depression
• PP psychosis