1LINCOLN MEMORIAL UNIVERSITY CAYLOR SCHOOL OF NURSING NURS 246 LESSON PLAN: CARE OF THE NEONATE AND POSTPARTAL FAMILY DATES & TIMES: SEE SYLLABUS OBJECTIVES: Upon completion of this unit, the student will demonstrate in the clinical/community setting, in individual and group conferences, and on written material an understanding of the following: 1. Define the key terms found in each assigned chapter. 2. Describe the normal anatomical and physical changes occurring in the postpartal period. 3. Compare normal and abnormal signs of mother-child adaptation or bonding 4. Explain the nurse’s role during the taking-in and taking-hold phases of the postpartal period. 5. Differentiate postpartum blues, depression, and postpartum psychosis and the etiology of each 6. Prepare teaching plans for self-care for the postpartum patient. 7. Explain the etiology, signs, and symptoms, medical management, and nursing responsibilities when caring for a patient with potential or actual problems during the postpartum period, including the various bleeding disorders and puerperal infections. 8. Discuss pharmacologic agents used during the postpartum period, including action, use, usual dosage, route of administration, side effects, and dosage calculation 9. Distinguish the physiologic and anatomic changes occurring in the major body systems of the newborn at birth. 10. Identify nursing responsibilities immediately after birth and during the transitional period. 11. Recognize normal physical and behavioral assessment findings in the newborn. 12. Identify nursing responsibilities during the first 24 hours of the newborn’s life. 13. Distinguish factors of anatomical maturity, which may be utilized as indicators of gestational age. 14. Describe newborn reflexes and their significance. 15. Describe the daily care of the newborn 16. Identify the nutritional requirements of the newborn. 17. Outline Hepatitis B immunization requirements, contraindications, precautions, and administration for the newborn. 18. Identify uses, side effects, action and nursing implications of drugs used for the newborn following birth. 19. Identify alterations in the newborn related to birth trauma. 20. Identify prepregnant, prenatal, and intrapartal factors that lead to early identification of high-risk fetuses/neonates.221. Identify high-risk newborns with commonly occurring health problems and the physiologic process of each. 22. Identify commonly occurring problems and the nursing care for the preterm and post term infant 23. Identify the clinical assessment and basic nursing care associated with respiratory distress in newborns. 24. Describe the cause, diagnosis, and treatment of hyperbilirubinemia. 25. Discuss signs, symptoms, prevention, and management of commonly occurring metabolic alterations in newborns. 26. Describe common congenital abnormalities of the newborn, including etiology, clinical manifestations, and medical, surgical, and nursing management. 27. List signs and symptoms of congenital heart defects and neural tube defects. 28. Differentiate hypospadias, ambiguous genitalia, epispadias, extrophy of the bladder, and imperforate anus and describe the surgical correction for each. 29. Develop a nursing care plan with the etiology, mode of transmission, signs, symptoms, and treatment of the infant with (1) thrush, (2) opthalmia neonatorum, (3) necrotizing enterocolitis, and (4) sepsis. 30. Analyze the clinical manifestations and explain the management of: drug addiction in the newborn, fetal alcohol syndrome, sexually transmitted diseases, hypoglycemia, and AIDS. REQUIRED READINGS: Orshan, S. A. (2008). Maternity, newborn, & women’s health nursing: Comprehensive health care across the life span. Philadelphia: Lippincott, Williams & Willkins. Chapters 18, 19, 20, 21, 22. Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2009). Pharmacology: A nursing process approach (6th ed). St Louis: Elsevier Chapter 54 TOPICAL OUTLINE: I. Nursing Assessment of Women Experiencing Postpartal Adaptation A. Maternal Postpartal Physiologic Adaptation B. Postpartal Psychological Adaptation 1. Development of maternal role 2. Postpartum blues 3. Postpartum depression 4. Postpartum Panic/Postpartum Psychosis C. Postpartal Nursing Management of the New Mother 1. Vital signs 2. BUBBLES 3. Follow-up Assessments to complete Recovery3 D. Promotion of Maternal Comfort and Well-being 1. Comfort 2. Elimination 3. Activity/Rest 4. Self Care 5. Safety 6. Sexuality/Contraception 7. Nutrition 8. Discharge Home E. Nursing Care of Postpartal Women Experiencing Complications 1. Bleeding disorders a. postpartum hemorrhage (early & late) b. lacerations c. hematomas 2. Puerperal infections a. uterine b. genital tract c. wound/incisional d. UTI e. mastitis 3. Thromboembolic complications II. Newborn: Transition to Extrauterine Life A. Physiologic/Anatomic Changes at Birth 1. Resolving fetal circulation 2. Respiratory/Circulatory Adaptation B. Nursing Assessment of the Neonate 1. Immediate Assessment a. Vaginal birth versus Cesarean birth b. APGAR scoring c. Identification d. Weight & Measurements e. Medications 1. Aqua Mephyton (Vitamin K) 2. Ilotycin (Eye Prophylaxis) 3. Hepatitis B Vaccine C. Major Newborn Assessments 1. Gestational age 2. Full physical assessment 3. Neurological/Reflex assessment4 D. Physiologic Adaptation of the Newborn 1. Thermoregulation 2. Glucose metabolism 3. Hematopoietic system 4. Hepatic system 5. Gastrointestinal system 6. Immunologic system 7. Integumentary system 8. Renal system E. Strategies for Gentle Transitioning 1. Gentle handling 2. Use of containment 3. Avoidance of gastric suctioning 4. Use of low lighting 5. Use of axillary temperature assessment F. Basic Care of the Healthy Newborn G. Newborn Nutrition III. Nursing Care of the High-Risk Newborn A. Problems of Size/Age 1. SGA/IUGR 2. LGA/macrosomia 3. Preterm newborn 4. Postterm newborn B. Nursing Care of the Newborn with Acquired/Congenital Conditions 1. Hyperbililrubinemia 2. FAS/drug-addicted newborn 3. Congenital anomalies a. congenital heart disease b. diaphragmatic hernia c. neural tube defects d. gastroschisis e. cleft lip and palate f. esophageal atresia/TE fistula