Unit 4 FA2014 - Audio for Students

8/10/2019 Unit 4 FA2014 - Audio for Students

1/18


2/18

Rh Isoimmunization

Mom is Rh-negative

Baby is Rh-positive (antigens are foreign

to moms immune system)

Development of maternal antibodies inresponse to Rh-antigens

Mom is not affected

If sensitization occurscrosses theplacentamay affect the baby (and

subsequent pregnancies)


3/18

Rh Immune Globulin:

Rh Immune globulin (RhIG or Rhogam) is aconcentrated solution of IgG and anti-D derived fromhuman plasma.

Indications

Dosage


4/18

RhoGam Workup

Alternate Name Rh (D) Immune Globulin HumanTest includes:

Mother

Baby

ABO and Rh

Indirect Coombs

ABO and Rh

Direct Coombs

Timing: Specimen collected AFTER delivery.

Testing and administration of RhoGam

should be within 72 hours of delivery

Expected Results: Coombs Negative (< 15 ml fetal RBCs)

Then 300 mcg IM given

What if results are positive:

(> 15 ml fetal RBCs)

Kleihauer-Betke test will be done to

determine the dose of RhoGam to be

administered


5/18

Rhogam Nursing

Interventions Patient teaching

Consent form (if required by agency)

Confirm dose and lot number (bloodproduct)

Observe 20 minutesallergic

response


6/18

Rubella vaccine Rubella non-immune (10-20%)

Titer of 1:8

Enzyme immunoassay level (EIA) less than 0.8

Rubella recommended during PP period

Given SQ O.K. with breastfeeding

Live virus

Caution with members of household who are

immunocompromised

Viral shedding in urine and body fluids

Contraception for 1 month after vaccine (birth

defects)


7/18

PostpartumDiscomfort


8/18

Postpartum Discomfort

#1 Priorityidentify and treat the cause

Afterbirth pains

Episiotomy or lacerations

Hemorrhoids


9/18

Postpartum Discomfort

Nonpharmacologic Interventions

Side lying

Pillow with sitting

Application of ice

Topical (as ordered)

Dry heat

Cleansing with squeeze

bottle, cleansing showeror sitz baths

Witch hazel pads(hemorrhoids)

Pharmacologic Interventions

Opioids Morphine

Percocet

Percodan Nonopioid

Tylenol, Ibuprofen

NSAIDS Naproxen, Anaprox

Topical antiseptic oranesthetic ointmentsand/or sprays

PCA (C-section)


10/18

Psychological assessment

Taking in

Taking hold

Letting go Table 20-4, page 516

Postpartum blues

Postpartum depression Box 21-4, page 547


11/18

Breastfeeding

Commitment

Positioning and latching

Early hunger cues

Late hunger cues

Frequency

Early and often

Increase # of receptor sites

Aids to BF

Pillows, nipple shields, breast cream

Breast pumps

Bras and clothing


12/18

Breast milk Storage

Containers

Temperature

Refrigerator vs. Freezer Patient Teaching, page 650


13/18

Breastfeeding

Contraindications Infants with galactosemia

Active, untreated TB in mother

Maternal HIV

Maternal human T-cell lymphotropic virus type I or IIpositive

Moms who are receiving diagnostic or therapeutic

radioactive isotopes pump and dump (for as long as

there is radioactivity in the milk) Moms with herpes lesions on the breast

Moms receiving chemotherapy

Moms who are abusing street drugs


14/18

Medications & Breastfeeding

Lactation Risk Categories

L1safest

L2safer

L3moderately safe

L4potentially hazardous

L5 - contraindicated

FDA Categories

A

B

C

D

X

Table 21-1, page 547Antidepressant Medications


15/18

Bottlefeeding

Equipment

Bottles, nipples, sterilizing equipment

Type of formula

Regular, soy, special-needs

Heating sources

Suppression of lactation

Ace wrap/tight fitting bra

Cold packs

NSAIDS


16/18

Postpartum Discharge

Before 24 hours

Shortens hospital stay for low risk births

Reduces health care costs

Less medical intervention and more family-focusedexperience

Newborns and Mothers Health Protection Act of 1996

48 hours 96 hours


17/18

Patient Teaching

Signs/Symptomscall MD/CNM

Fever

Breasts

Bleeding

Pain

Edema

Neurologic

Emotional

Elimination


18/18

End of Content for Exam II

Documents

Unit 4 FA2014 - Audio for Students