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Midwifery > Revision for Postnatal Placement > Flashcards

Revision for Postnatal Placement Flashcards

1
Q

What babies on the postnatal ward may need increased care on the PN ward due to increased risk of medical morbidities, feeding difficulties and re-admission?

A
  • Late preterm babies (>36+0/40)
  • Weight 10%
  • hypoglycaemia
  • jaundice
  • congenital abnormalities (e.g. down syndrome, cleft lip/palate)
  • other risk factors related to feeding
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2
Q

What assessments are vital in assessing the wellbeing of babies who require extra care on the PN ward?

A
  • vital signs (temperature, heart rate, respiratory rate)
  • tactile warmth
  • colour
  • output
  • hydration
    hourly for 4 hours then before feeds/ 4 hourly for 24 hours
  • signs of jaundice
  • weight at 24 hours
  • ? blood sugar levels
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3
Q

What is the best way of preventing hypothermia?

A

immediate and uninterrupted skin-to-skin contact

- consider review if 2 hours despite skin-to-skin

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4
Q

What are some signs that supplemental feeds (preferably EBM) may be required for babies requiring extra care? These signs may indicate that discharge should be delayed

A
  • less than 10 minutes effective breastfeeding at most feeds
  • weak, disorganised, immature suck patterns
  • less than 4-5 wet nappies per day after 96 hours
  • > 10% weight loss post birth
  • weight
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5
Q

What midwifery care should be provided prior to discharge from PN ward for babies requiring extra care?

A
  • referral for home visits as required for followup
  • assessed by neonatal doctor
  • written discharge feeding plan
  • assessment of output (wet/dirty nappies), weight loss/gain
  • parent education
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6
Q

In educating parents prior to discharge, what signs should be highlighted as reasons to access further care for their baby?

A
  • lethargy
  • poor feeding
  • vomiting (particularly large after several feeds, or if green)
  • pale
  • excessive crying
  • jaundice
  • less than 5-6 wet nappies in 24 hours
  • fever, rash
  • difficulty breathing
  • turning blue
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7
Q

If parents are concerned about their babies wellbeing what might they do depending on the issue and their level of concern?

A
  • discuss with home visiting midwife
  • visit emergency department
  • see GP
  • call ambulance
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8
Q

What are some other contacts in the community that may be able to help if parents are concerned?

A
  • Australian Breastfeeding Association 24 hour helpline

- MCHN helpline

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9
Q

What assessments should be undertaken by midwives during postnatal home visits for babies requiring extra care?

A
  • routine care
  • assessment of early breastfeeding
  • vital signs
  • signs of jaundice
  • tactile warmth, colour, alertness and frequency of feeds
  • output
  • hydration
  • assessment of behaviour, sleeping and crying
  • weight
  • assessment supplementation
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10
Q

What are some risk factors for adverse outcomes associated with feeding difficulties?

A

Maternal
- history of insufficient milk supply or underweight baby
- lack of previous breastfeeding
- age > 37
- nipple trauma, flat or inverted nipples
- previous breast surgery or breast abnormalities
- excessive, prolonged breast engorgement
- perinatal complications - labour medications, assisted birth, prolonged labour, induction, PPH, hypertension, infection
- preexisting conditions - obesity, diabetes, endocrine disorders
Baby
- preterm
- birth weight 7-10%
- poor output
- multiples

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11
Q

What is expected for babies in terms of weight changes post birth?

A
  • very normal for babies to loose weight in the first few days post birth
  • weight loss>10% requires further assessment
  • about 20-30g weight gain/day (or about 150-200g/week) expected after day 4-5
  • usually regain birth weight by day 10-14
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12
Q

What is expected in terms of babies outputs after birth?

A
  • At least 5 clear wet nappies per day
  • at least 1 soft yellow poo per day
  • no urates after day 3
  • other signs of good hydration
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13
Q

After the first 24 hours, how many times is normal for babies to need to breastfeed?

A

8-12 effective feeds in 24 hours

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14
Q

What is expected in terms of frequency of formula feeds per day?

A

6-8 feeds per day

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15
Q

If If there are concerns about a baby’s weight, feeding or outputs what should be assessed and what care should be provided?

A

if concerns about hydration or milk supply refer to emergency - particularly signs of unwell, poor perfusion or breathing difficulties
otherwise assess breastfeeding positioning, attachment, frequency, supplementation, formula feeding/preparation, follow up visit, consider referral to LC

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16
Q

How can midwives in the birth room support breastfeeding for the well term baby?

A
  • immediate uninterrupted skin-to-skin contact for at least 1 hour or until after first feed
  • assess vital signs, breathing, colour and tone without interrupting skin-to-skin
  • educated about feeding cues
  • help position mother/baby for first feed
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17
Q

What are some early feeding cues?

A
  • crawling movements
  • mouthing
  • vocalising
  • hand-to-mouth
  • searching for the nipple
  • rooting
  • rapid eye movements
  • waking from sleep and becoming restless
  • sucking hands
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18
Q

What are some recommendations you might give a women about breastfeeding?

A
  • should be flexible, unrestricted and on-demand
  • offer both breasts, alternating the starting breast
  • allow baby to finish at first breast before offering second
  • length of feeds is very variable
  • skin-to-skin can facilitate establishment of breastfeeding
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19
Q

When assessing breastfeeding what should you be looking for?

A
  • breasts (soft, firm, colour, pain)
  • nipples (cracks, blisters, trauma, shape, flat/inverted)
  • positioning
  • attachment
  • signs of milk transfer
  • frequency
  • output
  • hydration
  • jaundice
  • weight loss
20
Q

When educating parents, what are signs of adequate milk intake?

A
  • baby mostly settled between feeds, although common to have periods where unsettled and very frequent feeding
  • rhythmic sucking and swallowing may be seen or heard
  • breasts feel fuller at start of feed and softer at end of feed once milk is in
21
Q

What are are the recommendations around giving breastfed babies supplementary feeds in the early postnatal period?

A
  • supplementation with formula not required in first 24 hours in the healthy term newborn
  • supplementation should only be recommended if there is a medical reason
  • EBM is first choice if supplementation required
  • formula should only be given if there is a medical indication and there is insufficient EBM
  • feeds should be given by cup, syringe or spoon
  • bottles, teats and pacifiers should be avoided
22
Q

If a baby has had uninterrupted skin to skin and a first breastfeed, what is normal in terms of when the next feed is likely to be?

A
  • baby should be allowed to sleep for up to 8 hours until it shows readiness to feed
  • ongoing skin to skin contact should be encouraged
23
Q

What are the minimum set of observations for newborns?

A
  • heart rate
  • respiratory rate
  • temperature
  • skin colour
  • oxygen saturation (postductal between 6-24 hours)
  • As appropriate: cord, check ID labels, weigh, assess feeds, stools, urine, hearing screen, length, head circ, transcutaneous billirubin, newborn screening test
24
Q

Why is postductal oxygen saturation measured routinely in newborns?

A

as screening for congenital heart and non-cardiac conditions that may otherwise be missed

25
Q

What are some signs of adequate breastfeeding?

A
  • frequency (6-12 times in first 24, 8-12 times>24)
  • swallowing
  • content after most feeds, looks healthy, good skin tone and bright eyes
  • 1 wet nappy per day of life
  • stools - mec to 48h, trans72)
26
Q

When should baby observations be done on the newborn?

A
  • after birth
  • hourly for first four hours
  • if under neonatal medical care or if there are other indications
27
Q

In the ISBAR mnemonic for handover what does I stand for?

A

Introduction

- identify self, role and location

28
Q

In the ISBAR mnemonic for handover what does S stand for?

A

Situation

- What is happening?

29
Q

In the ISBAR mnemonic for handover what does B stand for?

A

Background

- what is the clinical background?

30
Q

In the ISBAR mnemonic for handover what does A stand for?

A

Assessment

- what are the observations? what do you think the problem is?

31
Q

In the ISBAR mnemonic for handover what does R stand for?

A

Recommend

- what do you recommend? want the person you called to do? be clear and specify timeframe

32
Q

In terms of breastfeeding codes, what does A usually refer to?

A

Mother unassisted

33
Q

In terms of breastfeeding codes, what does B usually refer to?

A

Midwife assistance given

34
Q

In terms of breastfeeding codes and attachment, when is it common to score a 6 and what does it refer to?

A
  • regular suck and swallow >10 minutes

- usually first feed after birth and >72 hours

35
Q

In terms of breastfeeding codes and attachment, when is it common to score a 3 and what does it refer to?

A
  • attached, irregular suck and swallow
  • usually first 48 hours
  • if >48 hours score 4 and suspect poor attachment
36
Q

In terms of breastfeeding codes and attachment, when is it common to score a 5 and what does it refer to?

A
  • attached, regular suck and swallow 10 minutes, generally >72 hours
37
Q

What is the usual indication for administering vitamin K?

A
  • prophylaxis of hemorrhagic disease of the newborn
38
Q

What is hemorrhagic disease of the newborn?

A
  • a newborn bleeding disorder
  • may impact 2-5 babies out of every thousand untreated babies
  • breastfed at greater risk than formula fed
39
Q

What equipment do you need to give a newborn vitamin k injection?

A
  • kidney dish
  • 1ml syringe
  • drawing up needle
  • 23 gauge 25mm needle for term baby OR 25 gauge 16mm needle for small or prem baby
  • 7% alcohol swab
  • cotton wool ball
  • vitamin K ampoule (stock strength usually 2mg in 0.2ml)
40
Q

What is the usual dose of vitamin K?

A

1mg in 0.1ml

- if baby

41
Q

What is the usual procedure for administering vitamin k?

A
  • obtain consent
  • two midwives to check drug order, the vitamin k and the baby labels
  • hand hygiene
  • inject IM (90 degrees, no need to draw back) usually before transfer to PN ward, usually into lateral aspect of babies thigh, into opposite thigh used for injection of hep b or other medications (may also be given orally)
  • apply gentle pressure with cotton ball
  • discard sharps
  • settle baby
  • hand hygiene
  • sign medicine chart and document
42
Q

What is the procedure for giving vitamin k orally?

A
  • 3 doses of 2mg (0.2ml)
  • at birth
  • at 3-5 days (usually with newborn screening)
  • at 4 weeks
43
Q

What are the generic and trade names for vitamin K?

A
  • phytomenadione

- Konakion

44
Q

What is the normal temperature for a newborn baby (per axilla)?

A

36.5-37.1C

45
Q

What is the normal heart rate for a newborn baby?

A
  • 100-160bpm

- healthy term and pink

46
Q

What is the normal respiration rate for a newborn baby?

A

30-60 breaths per min

- no signs of respiratory distress

Midwifery (27 decks)

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