CVS sampling done between 10-12 weeks of gestation .

it is a GENETIC testing

Absent- 0
Minimal - < 5
Moderate FHR variability 5-25
Maximal variability= greater than 25

Normal Fetal Heart Rate during the MIDDLE of pregnancy= 160-180
Normal Fetal Heart Rate during the END of pregnancy = 120-160

Fetal lung maturation ratio: 2:1
Umbilical cord: 2A(deox) and 1Vein (oxygenated)

1) Bacteria cannot pass through the placenta but drugs, alcohol, nutrients, antibodies can.
2) Passive Immunity (third trimester) passed down from the mother lasts till few months after
birth.
3) Amniotic Fluid is 800-1200 mL at the end of pregnancy


Diet changes during pregnancy:
1) increase calories by 300
2) increase protein
3) increase calcium and phosphorous together
4) increase iodine
5) increase iron

Std and its affects:




Infertility Options:
In Vitro Fertilization (famous)
Surrogate mothers
Embryo Hosts
Adoption

Nigels rule= first day of last menstruation , add seven days and 9 months
Gravida- number of pregnancies
Parita- number of births

Fundal Height in CMs= Gestational Age
Week 16- Fundal height halfway between pubic area and umbilicus
Week 22- Fundal Height at the umbilicus spot
Week 36- Xyphoid Process

Vital signs changes:
BP decreases during 2
nd
semester while HR increase by 10-15.

3 types of Pregnancy Signs
1- Presumptive- early symptoms of pregnancy
Missing period
Breasts enlargement
N/V
Quickening (fetal movement felt by mother. Usually at 16 weeks of
gestation-20
th
week)
2- Probable
Positive pregnancy test
Uterine enlargement
Chadwicks sign= purple discoloration of vagina around (week 4)
Goodells Sign- softening of cervix (week 5)
Hegar sign- softening of lower uterine segment (week 6)
Braxton Hicks contractions
Ballotment rebounding of fetus upon examiners touch on the abdomen

3- Positive (most definite)- diagnostic
Fetal Heart Rate detected by Dropplers Tranducer at weeks 10-12
Fetal palpation felt week 20
Ultra-sound


Adolescent Pregnancy interventions
1) provide extra perinatal care due to lack nutrition, lack of knowledge , lack of development
2) refer adolescent to support groups that can counter the negative socioeconomic environment

Folic acid to prevent neural tube defects such as Left Cleft Lip, Myelengoccal
Alcohol can lead to fetal alcohol syndrome

Usual Antepartum schedule is
Weeks 28-32- ONCE
Weeks 32-36- every two weeks
Weeks 36-40- once every week

1) Sexually transmitted disease Trichomoniasis- Causes pre-mature rupture of membranes
2) If pregnant mother is Rh Negative, must get repeated screenings and receive RHOgam at 28 weeks of
gestation.
3) Rubella vaccine should not be administered at the same time that RHOgam is administered because
the vaccine wont be as effective

Disorders of Labor and Delivery

1) Supine Hypotension- If happens, position mother on her side to get the uterus weight off of the vena
cava
2) Premature rupture of membranes- Be aware of infection! Also do plenty of vital signs/ assessment
The symptoms of premature labor are: 1) Back pain that wouldnt go away 2) Contractions/cramps that
are not alleviated by water and laying down 3) watery discharge during lying down.
3) Variable Decelerations- PROLAPSED CORD- when mother can feel the chord coming out. In that
case, position mother on Trendelenberg (or Sims lateral or knee chest) position, then SOHIB. Stop
Pitocin, Oxygen, Assess for Hypoxia, IV fluids, Immediate Birth
4) Early Decelerations- HEAD compression it is okay if Heart beat variability is within normal range
doesnt need interventions
5) Late Decelerations- Placental Insufficiency- Reposition the mother (LEFT SIDE), then S.O.I= Stop
Pitocin, Give Oxygen and IV fluids
6) Hypotension during anesthesia epidural- STOP= Stop Pitocin, Turn Patient to the LEFT, Give Oxygen
and Push IV fluids
7) Placenta previa- is when the placenta detaches itself from the wall of the uterus and drops to the cervix
before term. It is classified as either Partial or Total. SYMPTOMS: Painless Red discharge , SOFT uterus,
HIGHER fundal height than expected. 1) Side lying position 2) monitor for bleeding due to continuous
bleeding 3) if bleeding too much = C section
8) Abruptio Placenta is when the fetus abruptly detaches from the uterine wall and travels somewhere
else around 20
th
week of gestation. This is PAINFUL, uterus is RIGID, with DARK RED Discharge =
symptoms involve pain
Right away, 1) Trendelenberg or lateral position 2) Assess for pain, and hemorrhage 3) Oxygen and IV
fluids 4) prepare for Delivery ! P.P.H.O.I.D
9) risk factors for preterm= multifetus preg, pregnancy younger than 18 and over 40. Preterm is
characterized with changing of colors/consistency of usual discharge, contractions, low back pain and
rupture membranes. 1) stop delivery 2) assess mother and child 3) fluids and medications (tocolytics)
10)percipituous labor= labor that lasts for 3 hours. Have delivery tray available
11)Dystocia- difficult and painful labor . causes: large fetus . Amniotomy and Pitocin are treatments. A lot
of uterine, abdominal pain and lack of progression in labor.
Shoulder dystocia of the infant requires an emergency response by using Mc Roberts maneuver by
flexing thighs of the mother to the abdomen to change the angle of the pelvis.
12) amniotic embolism- amniotic fluid goes into pulmonary circulation= could be fatal . 1) Oxygen 2)turn
patient to the left 3) IV fluids 4) delivery when stable
13) fetal distress (<120 or >160 bpm)= Prepare for C section . 1. Turn patient to the left 2) Oxygen 3)
Stop Oxytocin 4) monitor 5) C section
14) Intrauterine Fetal Demise- absent heart tones, fetal movements= interventions= allow family to
express their feelings . low DIC, low HGB, low platelets, low hct
15) Rupture of the uterus= the fetus had rupture through the uterus. Fetus is palpated outside of uterus
16) Inversion of uterus= monitor for shock, hemorrhage, pain, fix inversion if not surgery
17) fetal bradycardia/tachycardia= Change mothers position, stop Pitocin, give oxygen and notify
physician is a must
18) decreased variability can indicate hypoxemia and acidosis . Temporary decreased variability means
fetal1 sleep state
19) accelerated FHR is a good thing and usually occurs during fetal movements/uterine contractions.
When the accelerations lasts 15 secs with 15 more heart beats. Means that baby is non-acidodic
20) Meconium amniotic fluid= fetal distress
21) Pitocin is discontinued if frequency contraction is less than every 2 minutes and they last longer than
90 seconds. Not prescribed to HYPERtonic uterus. Only hypotonic.
22) Painful red blood discharge with rigid uterus: Abruptio Placenta
23) Painless red blood discharge with soft uterus: Placenta Previa
24) Amniotomy: artificial rupture of membranes
25) Unpleasant odor; infection in amniotic fluid
26) RHOgam is given at 28
th
week of gestation. Kleihauer Betke test is to determine if more RHOgam is
needed.
27) Epiostomy patients: ice packs for the 1
st
24 hours, sitz bath, pain reliever, wipe front to back and hold
the blot area, shower rather than bath , perineal pad and report signs of bleeding
28) Forceps Delivery: using a double crossed spoon like articulated blades to assist in delivery
29) Vaccum extraction: cup suctioning to get fetal head out. Should not be kept in place for more than 25
minutes. Assess every 5 minutes Caput succedaneum is normal and resolves in 24 hours
30) C section 1- informed consent, 2.explanation of procedure, 3. Rh factor testing,4. foley catheter, 5.
prepare abdomen . post op- v/s, pain relieving, coughing/deep breathing, ambulation, signs of infection.
Watch out for INFECTION such as foul smelling lochia which means endometritis . Productive cough
pneumonia. Red redness and edema- thrombophlebitis
31) If during delivery the mother feels that something is coming through the vagina= prolapsed umbilical
cord. Long with slow irregular fetal heart rate= variable fetal heart rate decels and hypoxic . 1) change
position, Oxygen, push IV fluids
32) Bethmethasone is administered to fasten fetal lung maturity
33) If the clients labor progression hasnt changed in 2 hours, call the doctor
34) Shoulder dystocia of the infant requires an emergency response by using Mc Roberts maneuver by
flexing thighs of the mother to the abdomen to change the angle of the pelvis.


Know the different positions of fetal position.

Lightning- the dropping of fetus 2 weeks before delivery. Signs= Braxton hicks increase, blood tinged
discharge, sudden energy of nesting 24 hours before. Also known as dropping and engagement
Internal rotation of fetus- when fetus turns from transverse line to occipital position
Crowning- the head appears first
Extension- the rest of the head descends after crowning


True labor- increasing painful contractions like menstrual cramps
False labor- no increase in intensity. More annoying than painful

4 stages of Labor
1
st
stage- Early phase, active phase, latent phase
Early phase- 1-3 cms dilated. Contractions every 15- 30 mins for about 30 -45 seconds
Active Phase- 4-7 cms dilated. Contractions every 3-5 minutes for about 40 seconds
Latent Phase- 8-10 dilated. Contractions every 2-3 minutes for about 60-90 seconds
Interventions- monitor fetal and maternal heart rate. Teach mom breathing exercises. Offer fluids/ice
chips for dehydration. Use droppler transducer

2
nd
stage- Expulsion of the fetus contractions every 2-3 minutes= more bloody show. The head of the
fetus shows. Assess the mother/fetal every 5 minutes

3
rd
stage- expulsion of Placenta after this event, fundus is 2-3 finger breaths below the umbilicus
4
th
stage- 1-4 hours after delivery BP returns to prelabor measurement, pulse is slightly lower than
during labor. Bright red lochia.
First hour- assessment every 15 minutes
2
nd
hour- assessment every half an hour
3
rd
and 4
th
hour- once every hour
Put ice packs on perineum
Give blankets

ANESTHESIA is given right before the delivery (for episiotomy) of the fetus to reduce comfort.
Pudendal block- give through vagina that lasts for 30 minutes
Lumbar Epidural block- Given at L3-L4 and usually is before C section or establishment of delivery . Risk
of HYPOTENSION.
Inthratecal Opiod- Given at Subarachnoid area
Spinal block- given at the spine area is given before birth. L3 and L5. Must lay down supine 8-12 hours
after the injection
General Anesthesia- S/E: respiratory depression

Bishops score: readiness to give birth. 6 is ready.

Station of presenting part
-3= 0 cms dilated
-2= 1-2 cm dilated
-1= 3-4 cms dilated
+1, +2= more than 5 cms dilated



Postpartum
Recovery
1) weight of uterus goes from 2 lbs to 2 ounces in six weeks
2)fundus decreases by 1 finger breath per day (1 cm) . by 10 days, uterus cannot be palpated
3) flaccid fundus= nurse should massage. Rigid fundus= nurse should know its an infection
4)
Rubera color of discharge 1-3 days after delivery
Serosa (brown) discharge 4-10 days after delivery
White clear discharge- 11 days on

Nurse can determine lochia flow by weighing perineal pads before and after use
5) vagina muscle tone is never restored completely
6) Menstruation comes back 1-2 months in non breast feed, and 3-6 months in breast feeding mothers
7) 48-72 hours after delivery- columstrum is secreted , increased prolactin promotes breast milk. By
third day, the breasts are distended with milk.
8) urination should occur within 12 hours after delivery
9) hunger and hemmorhoids commonly occur after delivery
10) after delivery: ASSESS for v/s, PAIN, FUNDUS (must void), Thrombophletits, hemorrhage, administer
Rhogam, assess bonding with new born and provide support.

Common problems after delivery: Uterus pain (afterpain), Perineal Pain, Breast pain, Constipation and
depression

11) no heavy lifting for at least 3 weeks
12) Pitocin side effects post-partum- afterbirth pains also in clients who are multifarous

13)perineal pain -
-pain reliever for after delivery: ice packs and sitz bath! Ice pack on boobs and perineum
-Analgesic spray for perineal care after episiotomy
15) breast pain care-
wear sports bra even when sleeping , ice packs on boobs , warm soaks/shower before breast feeding.
Breasts must be washed once daily for breast-feeding mothers since infants will be exposed to them-
reduce risk of infection
16) constipation
Drink at least 2000 mLs of water daily , fiber, laxative
17) depression must assess before and after delivery
18) breast feeding women must increase caloric intake

Breast feeding for mothers procedures
1) put the infant on babys breast as soon as both are stable
2) assess LATCH
L- LATCH from the infant
a- audible swallowing of the infant
t- type of nipple
c- comfort of mother
h- help given to mother by nurse
3) give ice packs between breast feedings on breasts and warm pack before feeding for blood flow.
4) Contraceptives should not be used within 1
st
6 weeks, but if used afterwards should be PROGESTIN
contraceptives, nOT estrogen based
5) calorie intake must increase
6) cracked nipples should be exposed to air for 10-20 minutes
7) do not use soap to wash breasts because they would remove natural oil and increase crackedness
8) infants stool should be yellow
9) bra should fit well
10) gas producing food should be avoided
PROCEDURES of breast feeding:
Wash hands first
Brush nipple on the lower lip of infant, and guide the nipple in
Make sure the aerola is also in the infants mouth
Nurse for 15-20 minutes
Stop the sucking by putting a clean finger in
Burp the infant (must)

100 . 4 F the first 24 hours after postpartum is NORMAL. Its not normal after 24 hours.

Tret of Fallot- VHOP RIGHT TO LEFT SHUNT = DEFICIENT OXYGEN= ACIDOSIS
Ventricular septal defect (LEFT TO RIGHT SHUNT)
Hypertrophy on the right DUE TO LEFT TO RIGHT SHUNT
Overriding Aorta
Pulmonary Stenosis

Interventions: knee chest position, morphine/propanolol and oxygen

Postpartum conditions
1) forceps cause HEMATOMAS due to damage to the blood vessels . vulvar is the most common one .
life threatening . signs of shock= decreased bp, decreased rr, increased HR, pallor + BROWN
SENSITIVE mass protruding of vagina.
Immediately put ice there and pain relieve. Monitor I/O for hemorrhage. Prepare for immediate
evacuation of the hematoma! P.P= pain relief then prepare for evacuation. Monitor for infection .
2) cystitis can be caused from delivery. Must get urine specimen before getting started on antibiotics.
Burning pain / costalvertebrae angle tenderness are signs
3) any bleeding of more than 500 mL is considered hemorrhage. Massage, assess frequently (5-15
minutes) notify physician, note blood loss by pad count, Pitocin, assess for infection. Prepare for blood
transfusion . risk factors include: multiparity. Causes include: uterine atony, hematoma and lacerations in
the vagina
4) infection- noted by malodurous discharge (smelly) and elevated WBC and elevated temperature .
high calorie, high protein diet, LOTS of fluids, (3k) =I/O, obtain cultures, and administer antibiotics
5) mastitis
6) pulmonary embolism tachycardia, lung crackles, hemoptysis, impending doom. Interventions:
oxygen, elevate head of bed, assess respiratory, give fluids, give anticoagulants
7) subinvolution uterus: larger than usual uterus, a uterus that doesnt go back in size, give Methergine
(to increase contraction)
8) thrombophlebitis a clot in the blood vessel that caused an infection. Usually pelvic thrombophlebitis
after delivery. Pulmonary embolism is the first sign, with chills. Assess for Edema in the legs (first thing)-
part of Circulation of ABCs. Then elevate affected leg, and use a bed cradle to keep the leg off of
bedclothes. Assess for signs of pulmonary embolism. Provide pain relief by putting heat on the affected
leg and elastic stockings. To combat the infection, use antibiotics.

-Use heparin to prevent future clots.
9) perinatal loss- stillbirth etc. consider religious cultures and beliefs. give mother a box with infants
memories.


Care of the newborn!
1) assist with the start of RESPIRATIONS
- look at the cry, if there is seesaw breathing, cyanosis
-look for any gross anomalies

APGAR score immediately after birth- 1 minute and 5 minutes after birth. Scores between 8-10 is okay/no
interventions needed. Scores 4-7= interventions by stimulating infant. Lower than 4= infant resuscitation

Respiratory: vigorous cry or not?
Heart Rate: more than 100/minute?
Muscle Tone- active motion or no?
Reflex Irritability- responding with a cry or no?
Skin Color- cyanosis or no/

2) Vital Signs and see if babys is hypothermia or hyperthermia (96-99 with axillary temperature)
Normal vital signs for newborn
BP-73/55
HR- 110-170
RR- 30-50/minute

3) interventions for new born: airway focus first. Use a bulb syringe and suction out secretions in the
mouth. Then breathing is the 2
nd
focus= crying. Stimulate crying by rubbing the infant. Circulation= make
sure that the babys temperature is stable and keep the baby warm with BLANKETS
- immediately place infant on mother after birth before putting it in the warmer.
- put the baby in the warmer right after to keep the temperature stable
Get footprints and finger prints
Give mother and child same ID bands

4) VITAL SIGNS
a) Auscultate at 4
th
intercoastal space and listen to heart sounds for 1 full minute. Normal Is more than
110 beats per minute
b) keep baby warm throughout the whole examination
c) axillary temperature (96.6-99)
d) respirations : 30-60 per minute

5) body measurement normal:
18-22 inches in length
5-9 lbs in weight
13-14 inches in head circumference

6) fontanels:
Anterior fontanel: diamond shape= closes at 12 months
Posterior: triangular shape = at 2-3 years old

Asymmetry of molding initially due to birth , and disappears in 72 hours
Caput succedaneum is normal. It is a soft mass on the head and subsides
within a few days
Cephalhematoma- hematoma in the head. Subsides/absorbed within 6 weeks of
birth

7) head lag
8) eyes- presence of red reflex and edematous
9) low set ears= downsyndrome
10)nose should not be flared up
11)tongue: Epstein pearls may be present they are small white cysts in the mouth/tongue . they
are normal
12) when assessing an infants tongue, look for signs of candida- white thrush- which cannot be
removed by wash cloth and can be painful and bleed happens 1-2 days after birth
13) neck inclined to the side. torticollis
14) chest should be circular appearance= anteroposterior = lateral diameter. Should rise and fall in
synchrony. Bronchial sounds heard on auscultation. Milky secretion is common.
15) skin should be pink-red/pink-yellow, cheesy white substance can be found on entire body but more
prominent between folds, milia (small white sebaceous glands) may appear on forehead/nose/chin, dry
peeling skin
16) Kopliks spots- white patchy spots that happen 2 days before measles rash.

Cyanosis- hypothermia, infection, hypoglycemia, cardiac respiratory, neurological abnormalities

Acrocyanosis (normal) peripheral cyanosis is normal in the first few hours and may be notd for the
next 7-10 day
Assess hydration status of the infant by checking skin turgor over the abdomen
Assess for Harlequin Sign (one side being pink/red and other side being pale)
abnormal- means that there is problem with blood shunt cardiac problem
Birth marks:
1) Telangiectatic Nevi (Stork bites) normal, will disappear by age 2- red, flat dilated capillaries on
nape of neck, nose, eyelids
2) Nevus Flammeus- require surgery- no fading- red to purple dense areas of capillaries /capillary
angioma directly below epidermis usually on face
3) Nevus Vasculosus- (strawberry mark)- normal- disappears by age 7-9- raised, dark red rough surface
hemangioma. Usually on head.
4) Mongolian spots- disappears by years 1-2 usually on lumbar dorsal area/buttocks common in
Asians

16) anus- ensure that opening is patent and first stool meconium should pass within 1
st
24 hours
17) Genitals:
Female:
-Smegma (thick white discharge) near clitoris normal
- Pseudonmenstruation- blood tinged mucus
- first voiding within 24 hours

Male:
-prepuce covers glans penis
-verify meatus
-testes can retract with cold
- hernia
-voiding should occur 24 hours

18) Spine: Assess spine, arms, legs, well-coordinated, sporadic movements assess for
hypertonicity/hypotonicity and indentation CNS damage

19) Extremities: common ones, legs should have a distinct space, creases on soles of feet, assessment
for fractures (especially clavicle)
- assess for Ortolanis sign and Barlows sign= two assessment tools for developmental dysplasia of the
hip . No clicks should be heard . positive ortolani maneuver= dysplasia of hips
- pulses are palpated

Tremors: may indicate hypoglycemia

Full body Care on newborns:
1) Cardiovascular System Keep the infant warm, apical heart rate for 1 minute, listen for murmurs,
assess oxygen saturation, palpate pulses, blanch the skin on the trunk and extremities, observe for
cardiac distress
2) Respiratory System-
-Suction the airway as necessary: use a bulb syringe/French catheter for deeper suctioning
- respiratory distress and hypoxemia
- nasal flaring, severe retractions, grunting, cyanosis, bradycardia of apnea lasting longer than 15
seconds
-administer oxygen is a priority
3) Hepatic System: - Jaundice is normal after 24 hours of birth and up to 5
th
day of birth bilirubin also
increases- 6-7 mg/dL
- feed early to keep the bilirubin low
- Liver stores iron from the mother for 5-6 months
- glycogen storage occurs in the liver
- infant is at risk for hemorrhagic disorders because of the lack of Vitamin K. Therefore handle
newborn carefully. Must administer vitamin K in lateral aspect of the middle third of the castus
lateralis muscle
-liver stores iron for 5-6 months
- assess for hemoglobin and blood glucose levels

4) Renal System
-weight loss of 5-15% is normal during the first week of life from voiding/limited intake. Birth weight should
be regained 10-14 days after
-weigh the newborn daily
-weigh diapers daily (for input and output)
-measure specific gravity of urine
-assess for dehydration dry mucus membrane, poor skin turgor, sunken fontanels)
Sunken fontanels: is a sign of DEHYDRATION

5) Immune System
- newborn receives passive immunity from immunoglobin G (from PLACENTA) and immunglobin A
(colostrum)
-immunoglobin M= infection in utero
- aseptic technique/standard precautions when handling the newborn- use gloves/wash hands
-must administer eye medication within 1 hour to prevent ophthalmia neonatorum (usually
erythromycin, tetracycline) * Silver nitrate may be prescribed but is use is minimal because it doesnt
protect against chlamydial infection/cause chemical conjunctivitis

6) Chord Care:
Umbilical clamp can be removed after24 hours if not bleeding keep cord keep and dry. Diaper must be
below the cord and not touch it
-assess cord for swelling/discharge
-cord falls off within 2 weeks

7) Circumcision Care:
- apply petroleum jelly gauze to the penis except when a plastibell is used. After first void, remove it- then
observe for infection teach how to care for circumcision by squeezing warm water over the penis after
each void. Milky covering the glans penis is normal and should not be disrupted

8)
Newborns are able to digest carbs, proteins PARTIALLY and NOT fats.
-sterile water/d5W may be given to bottle fed babies before bottle feeding them
Schedule for milk feeding: breast feeding: every 2-3 hours. Bottle-fed: every 3-4 hours. Always burp the
infant every time after feeding . position baby on right side after feeding
However side lying/prone lying is not recommended= leads to death easily

9) normal stool passing
a) first stool is passed within 24 hours- meconium- greenish black/thick/sticky/tar like consistency
b) transitional stool- greenish brown and looser consistency
- seedy yellow stool- more common in breast fed infants
- looser yellow to light brown stools- formula fed newborns

10) must perform phenylketonuria test- tests for neurological deficits
11) head
-size is usually bigger.
-open fontanels to allow for brain growth
-assess for sunken fontanels
- test newborns reflexes

12) prevent cold stress. Keep infant warm and wrapped in blanket.
Cold stress can lead to acidosis
Cold stress-> pulmonary constriction and peripheral constriction-> reduced
uptake of oxygen consumption-> anaerobic glycolysis-> lowered pH and lowered O2->
metabolic acidosis
Take temperature of a newborn every hour for the 1
st
four hours , and every 4 hours for the
remainder of the first 24 hours and then ever shift

13)
Reflexes:
-Rooting reflex diminishes by 3-4 months.
-Swallowing happens after sucking
-Tonic Neck/Flexing: disappear within 3-4 months
-when face is faced to left side, left leg and arm are extended while right arm and leg flex

14) Palmar-plantar grasp-
When you place a finger on the infants palm/feet and infant curls the fingers, and newborns toes curl
downwards
Plantar response diminishes within 8 months
Palmar response diminishes within 3-4 months

15) Moro-reflex
When you make the infant fall backwards to at least a 30 degree angle, the infants arms and legs flex
and assume a C position. (or a body jerk) Should diminish by 6 months of age. But if not,
neurological delay

16) Startle Elicit- best after 24 hours of birth
- arms adduct while elbows flex
-hands are clenched
-should disappear within 4 months

17) pull to sit response
Head lags as pulling infant up from a supine position- then the head is level with the chest/shoulders
momentarily before falling forward. Head lifts for a few minutes .

18) Plantar reflex: disappears after 1 year old
-stroke the heel of the foot and the toes will hyperextend while the big .

19) walking reflex: disappears for 3-4 months
Holding baby up and baby starts walking while being held up.

20) crawling reflex: disappears after 6 week
- place the newborn on the abdomen and he/she starts crawling.

21) Formula Feeding:
- do not heat the bottle of formula in a microwave oven
- inform that the formula is a sufficient diet for the first 4-6 months
- assess the clients ability to burp the newborn

Breast feeding
-assess the newborns ability to suck
Sufficient diet for 4-6 months

___________________________________


PRETERM NEWBORN- infant born before 37 weeks of gestation
Symptoms: IMMATURITY of ALL body systems! Plus lanugo on the skin
Interventions: maintain A, B, C
Reposition baby every 1-2 hours
Vital signs frequently (every 2-4 hours)
Humidification
POST-TERM newborns and Larger gestational newborns
1) assess for HYPOGLYCEMIA