JACQUELINE ARAH LIM TARIO R.N.

PLACENTAL STAGE

is the period from birth of the baby through delivery

of the placenta

Signs of the placental separation

• Lengthening of the umbilical cord• Sudden gush of vaginal blood• Change in shape of the uterus (globular)

• Firm contraction of the uterus• Appearance of the placenta at vaginal

opening

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PLACENTAL EXPULSIONAfter separation, placenta is delivered either by: -the natural bearing down effort of the mother or -gentle pressure on the contracted uterine fundus by the physician or nurse-midwife (Crede’s maneuver)

MECHANISM

SCHULTZE DUNCAN

INFORMATION TO RECORD

• a. Time the placenta is delivered.• b. How delivered (spontaneously or manually

removed by the physician).• c. Type, amount, time and route of

administration of oxytocin. Oxytocin is never administered prior to delivery of the placenta because the strong uterine contractions could harm the fetus.

• d. If the placenta is delivered complete and intact or in fragments.

Pharmacology

ACTION It stimulates the uterus to contract to control postpartum hemorrhage

DOSAGE -10-40 units to 1L intravenous solution

POSSIBLE ADVERSE EFFECT HypertensionNURSING IMPLICATIONS Monitor blood pressure

OXYTOCIN (PITOCIN)

NURSING CARE OF THE MOTHER

1.Obtain vital signs (q 15 minutes for the first hour)

Temperature

-slightly increase during the first 24 hours because of dehydration during the labor

Pulse -usually slightly slower than normal during the postpartal period

-end of 1 week, pulse rate will return to normal

Respiratory Rate

- maybe fairly rapid immediately after birth

Blood Pressure

- decrease in BP can indicate bleeding

-Elevation above 140 mmHg systolic may indicate the development of postpartal PIH

-Oxytocics may increase BP

2.Palpate the fundus-position

-observe the amount and characteristicsof lochia

3.Ensure uterine contraction

-massage it gently

4. Perform perineal care-apply ice to the perineum to minimize swelling

5. Provide warmth-offer a clean gown or warmed blanket

6. Administer analgesics PRN

7. Provide emotional support

Assess the following:BreastUterusBladderBowelLochiaEpisiotomy

SkinHoman’s SignEmotional Response

CARE OF THE NEWBORN

CARE OF THE NEWBORN

1.AIRWAY• Wipe mouth and nose of secretions after

delivery of the head.• Suction secretions from mouth and nose.

-Compress bulb syringe before inserting-Suction mouth first, then, the nose-Insert bulb syringe in one side of the mouth

•Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant in a position that would promote

drainage of secretions

Trendelenburg position – head lower than the body

Side lying position – If trendelenburg position is contraindicated,place infant in side lying position

to to permit drainage of mucus from the mouth.

Keep the nares patent. Remove mucus and other particles that may be cause obstruction. Newborns are obligatory nose breathers until

they are about 3 weeks old.

2.WARM-rub dry -Take auxillary temperature at the end

of the first hour of life then every 4 hours for the 1st 24 hours of life-If rectal the purpose is to detect bowel

imperporate anus

3.MONITOR CHARACTER OF CRYING

A crying infant is a breathing infant. Stimulate the baby to cry if baby does not cry spontaneously, or if the cry is weak.

Do not slap the buttocks rather rub the soles of the feet.Stimulate to cry after secretions are removed.The normal infant cry is loud and husky.

•High, pitched cry – indicates hypoglycemia, increased intracranial pressure.

•Weak cry – prematurity•Hoarse cry – laryngeal stridor

4.UMBILICAL CORD CARE-clamp is applied ½ to 1 inch from the abdomen

-the cord and the area around it are cleansed with antiseptic solution

The cord stump usually dries and fall within 7 to 10 days leaving a granulating area that heals on the next 7 to 10 days

Instruction to the mother on cord care:• No tub bathing until cord falls off. Do not sponge bath to

clean the baby. See to it that cord does not get wet by water or urine.

• Do not apply anything on the cord such as baby powder or lotion, except the prescribed antiseptic solution which is 70% alcohol.

• Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet when the diaper soaks with urine.

5.EYE CARE

• Crede Treatment- Gonorrheal conjunction prophylaxis

Silver nitrate, erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose.

6.Vitamin K (Aquamephyton) Administration

-0.5 mg (preterm) and 1 mg (full term) Vitamin K or aquamephyton is injected IM in the newborn’s vastus lateralis (lateral anterior thigh)

7. Initial Feeding-may breastfeed immediately after birth(Breastfeeding and Rooming –in Act of 1992 RA 7600 Also promotes breastfeeding and requires immediate rooming in of the newborn)

8.BATHING

• Complete bath within an hour after birth to remove vernix caseosa (current practice in some settings delays bathing after an hour and vernix caseosa is spread throughout the newborn’s body for temperature maintenance)

• Mild soap• Proceed from the cleanest to the dirtiest area

of the body

9.IDENTIFICATION

• Foot stamping• Nametag

APGAR SCORING

• The APGAR Scoring System was developed by Dr. Virginia Apgar as a method of assessing the newborn’s adjustment to extrauterine life.

APGAR SCORING

Score:7 – 10 Good adjustment, vigorous4-6Moderately depressed infant, needs airway clearance0-3Severely depressed infant, in need of resuscitation.

Head Circumference 34 – 35 cm

Temperature 97.6 – 98.6 F axillary

Chest Circumference 32 – 33 cm

Heart Rate 120 – 140 bpm

Respirations 30 – 60 bpm

Weight 2.5 to 3.4 kg

Length 46 to 54 cm

ASSESSING THE AVERAGE NEWBORN

BREASTFEEDING AND ROOMING IN

ROOMING-IN-an arrangement in a hospital whereby a newborn

infant is kept in a crib at a mother’s bedside instead in a nursery

The Rooming-In and Breast-Feeding Act of 1992 Republic Act No. 7600

Benefits from breastfeeding

• Breastfeeding protects babies

The cells and antibodies in breast milk protect babies from illness.

• Breast milk is easier to digest  Breast milk is easier to digest than formula. The proteins in formula are made from cow’s milk and it takes time for babies’ stomachs to adjust to

digesting them.

•Breastfeeding provides maternal bonding

It can help them feel more secure, warm, and comforted

• Breastfeeding is economical– Formula and feeding supplies can cost well