Being a new grad in postpartum and needing assistance

[azzurra29]

Hi there,

Thank goodness for these specialty forums.

I've had almost 3 weeks of orientation for a postpartum floor I am working on. Granted, I've learned a lot but since I'm a new grad I'm still learning how to deal with the fusion of obstetric and pediatric physiology and nursing care given. While I've been digging into my OB/PEDS textbook a lot lately, I still don't feel up to par with things. Part of me thinks that the rest will come with time and experiece but I need to be prepared for anything.

SO, what would you say are the most important things to look out for in newborn care i n a nutshell? (if possible)

To me, I'd say the basics are s/sx of infection, dehydration/feeding/hypgoglycemia, hyperbilirubinemia and of course the ABC's. Would you say that's about right? Oh and safety of course.

I must ask however, what to look out for with newborn dehydration? Lethargy, poor tone, dry mucous membranes, elevated temp? anything else? I'm so scared that I must miss one of those signs because from what I've been learning, the important thing is measuring fluid status with the baby's output. So all the wet diapers etc. But I guess some babies will not be gettig enough despite meeting the minimum number of wet diapers? This part gets me confused.

If you wouldn't mind sharing some helpful tips and expertise about this I'd so greatly appreciate it. Many thanks from a desperate new grad

[purplemania, BSN, RN]

Don't delegate vital signs until you can look at a baby or listen to it's cry and know it is in trouble. That will take time. Vital signs are called that for a reason. Get REALLY good at assessment.

[kelisehunter]

Hello-

sorry I can't answer any of your questions since I'm just about to start in an ADN program this fall, but I wanted to ask you a question. I am very eager to begin nursing in post-partum right after I graduate. Would you say that it is hard to get a job in post partum as a new grad? Are they plentiful or competitive? What part of california do you live in? I'm very curious to see what you say.

[Elvish, BSN, DNP, RN, NP]

Dehydrated babies generally have more jaundice than well-hydrated ones. Some uric acid crystals (brick-red tinged urine) are fairly common in the first 24 hours....after then, it's likely a sign of dehydration. Daily weights are important; loss of 7-10% of birth weight is what most pediatricians will accept as WNL.

One other thing -- remember that babies don't always have a fever when they're ill/septic. Sometimes low temps are the only clue that something is off. So be observant.

Good luck. Babies are awesome!!

[rn/writer, RN]

First and foremost--relax. Desperation doesn't promote learning. When you tighten up, you don't breathe normally, and you're likely to miss things.

Learn what a normal, healthy newborn looks and feels like. Enjoy holding and feeding them. Take pleasure in the interaction between mom and baby. The more you learn about "normal," the more "abnormal" will stand out to you.

To tell you the truth, I haven't seen a lot of dehydrated babies. More common are babies who are cold, have blood sugar problems, have respiratory distress, or have an infection.

What I would recommend to you it to see if you can find a STABLE class in your area

http://www.stableprogram.org/

and take it. This program teaches you about the primary concerns of newborn care:

S = Sugar and Safe care

T = Temperature

A = Airway

B = Blood pressure

L = Labwork

E = Emotional support

Dehydration isn't even listed.

Even so, here are some thoughts:

I must ask however, what to look out for with newborn dehydration? Lethargy, poor tone, dry mucous membranes, elevated temp? anything else? I'm so scared that I must miss one of those signs because from what I've been learning, the important thing is measuring fluid status with the baby's output. So all the wet diapers etc.

The indicators you mentioned are all somewhat late signs of dehydration. It's better to head off a dry baby than to treat one.

To prevent dehydration, look first at input. I have had inexperienced breastfeeding moms who hear that they should feed the baby q 2-3 hours and they consistently go three hours even though baby isn't really latching or nursing. I have had bottle-feeding moms who will go four hours despite the baby taking only 5 cc. Common sense ought to tell you that this isn't adequate intake. One poor feeding doesn't automatically lead to dehydration, but 24 hours of this certainly could. I try to impress upon the moms that the longer intervals apply only to babies who are feeding well. Smaller feeds = shorter intervals.

Take into account the size and overall condition of the baby. A shriveled 5 lb. IUGR kiddo is far more vulnerable than a chubby 9 pounder.

Don't go only by temp. Dehydrated kids can be cold.

A simple, non-invasive measure you can do without needing an order is getting a weight. Look at the amount of weight loss since birth. At 7%, we watch our babies very carefully. At 10%, the docs will sometimes ask even breastfeeding moms to supplement until baby's weight is back up.

But I guess some babies will not be gettig enough despite meeting the minimum number of wet diapers? This part gets me confused.

More likely to be the opposite. Some kids are feeding just fine, but for whatever reason, they may take 12-24 hours to pee.

Three weeks of orientation isn't a lot. You shouldn't be expected to function without assistance. Ask lots of questions and put your co-workers' years of experience to good use. For instance, ask not just what another nurse's opinion is, but how she arrived at it.

Think of this learning time as gathering the pieces of a puzzle. As time passes and you start making connections, you will begin to put those pieces into the "big picture." And someday, you may have the chance to help another newbie find her comfort zone.

You can do this.

P.S. Feel free to post any and all questions that occur to you. This site is a fabulous learning tool.

P.S. Even if you don't have access to s STABLE class, you might want to get the book and study it on your own.

[mer_RN]

Don't focus on the details so much yet. stand back and see the big picture. i have precepted many students and new nurses and they forget to connect the little things such as why are you doing a cbc on a gbs pos. mom. why is it important to know mom's prenatal labs. little things like that help you understand the details.

[NurseNora, BSN, RN]

When teaching new Mom's the S/S of dehydration, I tell them that by the end of the first week the baby should be making 5-7 wet diapers a day (heavy wet, not just a little spot), until then we're OK with the baby peeing as many times as it is days old (once the first day, twice the second and so on, most do more, but that is enough). The soft spot should be flat. The eyes and mouth should be wet. The skin should have good turgor. If not making enough wet diapers, sunken soft spot, dry mouth &/or eyes, or if the skin looks like the back of an old woman's hand when you pinch it (one of the benefits of being an old nurse is that I now have a great teaching aid to demonstrate lack of skin turgor--if you're young, you'll have to explain it rather than demonstrating).

I found it helpful to read all the discharge material that the mom's are sent home with so that I am teaching them (and myself) what the local hospital and doctors consider important.

Just ask questions of the other nurses working with you and be prepared to learn from everyone.