✯ Newborn of the _______ _______ _______ Care
▪︎ Promote PNC (prenatal care)
⇢ Getting her the help she needs during the pregnancy.
▪︎ Newborn drug screen
⇢ Collect urine from a baby in a u-bag. Want to do this as soon as possible after delivery, so if the baby does have the drug in its system it is not cleared prior to use getting the specimen.
⇢ Positive drug screen on the baby is considered child abuse. Otherwise, it is child endangerment. Social services decides if the baby should stay with the mother in these cases.
▪︎ Social service consultation
⇢ See if the mother is going through tx. What are plans for this baby? Is she caring for her other kids appropriately? Can she care for this baby appropriately? Where should the baby go if she can't care for it appropriately?
⇢ Social services can help answer all of these questions. They can help find a safe environment for the child that's best for the mother and baby.
▪︎ Medication administration
⇢ If mother is addicted to morphine, we would get an order for a small amount of morphine and wean the baby off of it.
⇢ Baby is weaned off in a couple of ways.
・The baby gaining weight and growing will help it wean itself. In addition to that we will do abstinence scoring. This will indicate how well the baby doing. We'll adjust the dosing based off of that.
▪︎ Reduce withdrawal symptoms
⇢ Obsessive sucking and then projectile vomititng, diarrhea, skin excoriation, sweating, inability to sleep for a period of time, difficulty calming down, high pitched cry
・Consider all of these things in abstinence scoring
▪︎ Abstinence scoring
⇢ Scoring tool to look at how addicted the baby is
⇢ Used as a decision factor when they're looking at the medication and the decision to wean down or if the baby needs more and is not tolerating a wean.
▪︎ Small, frequent feedings
⇢ Often helpful. If the baby is obsessively sucking and then projectile vomititng this can help alleviate this.
▪︎ Monitor GI status
⇢ Are they having diarrhea or vomititng?
▪︎ Swaddle, pacifier, calm infant
⇢ Provide them with comfort. Can have a difficult time consoling themselves. Gently rock or talk to the baby.
▪︎ Skin protection
⇢ Especially since the baby is at risk for skin excoriation.
⇢ Ex: Desitin to the bottom
▪︎ Decrease stimulation
⇢ Quiet, dark room, etc...
⇢ Helps them sleep and not stay agitated.
▪︎ These babies are in the hospital for a prolonged period of time. It is important that we keep them on task developmentally.
⇢ Talk to them and show them bright colors or use a baby mobile. May also see occupational therapy working with these babies so they can be social and meet all of their developmental milestones.
✯ STIs; __________
▪︎ Signs/ Symptoms:
⇢ Primary symptoms: Fever, weight loss, malaise
・Almost flu-like. Would take place and disappear in about 4 weeks.
⇢ Secondary symptoms: Skin Condylomata lata (plaque like warts), arthritis, inflammation of the liver and spleen, hoarseness in the throat (chronic sore throat)
・Appear in about 6 weeks to 6 months.
・Patients may have a rash on the palms of the hands or the feet that is typical of ______ lesions.
⇢ May cause blindness, psychological implications, death
・If not treated.
▪︎ May be acquired through sexual contact, (less commonly) contact with exudate from the infected person, or transplacentally (if the mother has this and is pregnant)
▪︎ Tx: Benzathine Penicillin G
▪︎ Pregnancy concerns: IUGR, preterm birth, still birth
✯ _________ _________
▪︎ Substances commonly abused during pregnancy:
⇢ Marijuana- no evidence of teratogenic effects (problems, birth defects, learning issues, etc..). However, smoking anything will lead to fetal exposure and should be avoided.
⇢ Cocaine- Fetal risks: Spontaneous abortion (early on in pregnancy), placental abruption (tachycardia, HTN, & vasoconstriction sets this up), IUGR (impaired blood flow through the placenta impairs the fetus from getting nutrients that it needs), preterm birth, still birth
・Leads to vasoconstriction, HTN, tachycardia. Fetal risk here.
・Q: How does cocaine use affect placental blood flow?
⇢ Placental vasoconstriction prevents blood flow through the placenta and prevents the fetus from getting the nutrients and oxygen that it needs.
✯ _________ _________
▪︎ Substances commonly abused during pregnancy:
⇢ PCP- Hallucinogen.
・Overdose leads to HTN, hyperthermia, diuresis, coma- may harm fetus.
⇢ Ecstasy- Derivative of amphetamines.
・May lead to childhood learning and memory impairment
⇢ Heroin- CNS Depressant.
・Fetal risks: preterm birth, IUGR, withdrawal.
・Signs of the baby going through withdrawal may have a high pitched cry that is difficult to console, ability to eat large amounts then vomit that feeding, sweating, skin excoriation, projectile vomititng, loose stool. Would do abstinence scoring on them to see how they are doing with the withdrawal.
・Methadone is often used as treatment to block withdrawal symptoms
✯ ________ _________
▪︎ Definition: Gaining Power and control over an individual in the relationship through manipulative behaviors.
▪︎ Partners may be dating, living together, married, or divorced
▪︎ Q: What percent of perpetrators are men?
⇢ 95% of perpetrators are men.
⇢ There are different perpetrator circumstances.
▪︎ Types of abuse:
⇢ Psychological abuse;
・He is emotionally abusing her, putting her down, making her feel bad about herself, calling her names, belittling her.
・May isolate her from others like her friends and family (Isolation). He can restrict her actions. Forbid her from seeing other people.
・Economic abuse can occur. He can prevent her from getting a job. Asserting his dominance over her in this way. Keeping her finically dependent on him.
・Can make threats or coerce her. Might use intimidation to make her feel afraid. May smash things, harm pets, displaying weapons, yelling, stalking, etc...
⇢ Physical abuse;
・Can include battery.
⇢ Sexual abuse;
・Can include a myriad of activities. Including, but not limited to, Rape.
✯ _______ __________: Nursing Assessment
▪︎ Respect, trust, and advocacy
⇢ Build a relationship with the patient. Going to respect her as a human being, ask her questions, and take her word for it. Don't want to push her too hard on this.
⇢ Build a relationship that has trust at the base of it, so that she feels that she can tell you the truth.
⇢ Going to advocate for her, her desires, and rights.
▪︎ Listen to her
⇢ Maker her feel heard and we'll believe what she says.
▪︎ Stress myths
⇢ Stress that she didn't do anything to make this happen. It is unacceptable behavior.
▪︎ Let her talk at her own speed
⇢ Not going to push her. Ask open ended questions. Be concerned and document things in her own words.
▪︎ May have conflicting feelings toward abuser
⇢ May be in the honeymoon period.
▪︎ Should she leave?
⇢ Want to make sure that she can leave safely and has a plan together.
▪︎ Signs of abuse:
⇢ Neuro signs
・Headaches, tension headaches, migraines, hearing loss, detached retinas
⇢ Gyn signs
・Reports of painful intercourses, frequent STIs, pelvic pain
⇢ OB signs
・Late prenatal care, recurrent therapeutic abortions, recurrent spontaneous abortions
⇢ GI signs
・IBS, feeling of a lump in the throat
⇢ Musculoskeletal signs
・Fibromyalgia, painful joints
⇢ Psychiatric Signs
・Panic, anxiety, mood disorders, substance abuse, eating disorders
⇢ Constitutional Signs
・Abrasions, sleep disturbances, appetite problems, decreased concentration, frequent use of tranquilizers
・Injury to her female organs, accident histories (more than usual), having sexual trauma, history of frequent old fractures
⇢ Other Signs
・History of frequently missed appointments, neglected appearance, and the way she relates to HCP like lack of eye contact. See if she is not acting appropriately given the situation. Defensive injuries. Delayed reports of symptoms or seeking care for injuries way after the incident occurred.
✯ ________: Nursing Assessment
▪︎ Questions to ask...
⇢ Upon admission we ask all patients the following questions. Knowing that statistics are about 1/3 women are abused and pregnancy is often a threat to abusers. OB at time of admission is a great time to intervene for these women.
▪︎ Within the last year, have you been kicked, slapped, pushed or threatened?
▪︎ Since you have been pregnant, have you been kicked, slapped, pushed, or threatened?
▪︎ Within the last year, has anyone forced you to engage in sexual activities?
▪︎ Are you afraid of anyone at home or an ex?
▪︎ If YES..., by who? Total number of times? Was this reported?
⇢ If she has her significant other with her, often times these men will not leave their side. They will answer questions for her and she will defer to them to answer questions.
⇢ Want to ask these when we are alone with the patient.
✯ _______ _______ in Maternal/Child Health Examples;
▪︎ Islamic faith women- modesty, no male alone with patient
⇢ Women prefer modesty, keeping everything but hands and feet exposed. Also, no male is to be alone with these women and this usually means no male caregivers.
⇢ As patient advocates, it would be our job to plan for appropriate care for these patients.
▪︎ Hispanic, African, Asian women- avoid cold postpartum
⇢ These patients may request hot tea or refuse cold water, even to take a medication.
▪︎ Asian women- avoid confrontation, may avoid eye contact, touching is impolite
⇢ Answering "no" to a questions could be considered rude so open-ended questions are better.
▪︎ Jewish women- kosher diet, no physical contact by husband during vaginal bleeding or having discharge.
⇢ One can see how this could be misinterpreted as unsupportive.
▪︎ Amish women- medical decisions made by community, do not believe in baptism
⇢ Amish patients pay out of pocket for medical expenses and adherence to medical advice may be based on this or religious or community input.
⇢ Amish families do not believe in baptism. This may be relevant for the patient experiencing a loss.
▪︎ Many cultures- grandmother is primary helper
⇢ The primary support person during delivery and postpartum is the grandmother, rather than the father of the baby.
⇢ They are seen as having great wisdom.