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OB > 12 - Postpartum Assessments and Nursing Care > Flashcards

12 - Postpartum Assessments and Nursing Care Flashcards

1
Q

Involution

A

the uterus returns to its pre-pregnant size, shape, + location

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2
Q

Involution occurs thru

A
  • contractions
  • atrophy of uterine muscle
  • decr in size of uterine cells
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3
Q

complete involution takes ____ post-delivery

A

6-8 wks

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4
Q

afterpains

A

mod-severe cramp-like pains r/t uterus working to stay contract and/or incr of oxytocin released in response to infant suckling

-common in multiparous or women who breastfeed
during first few postpartum days
-decr 3 days after delivery

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5
Q

Postpartum Assessment

A
  • VS, pain
  • breath + heart sound
  • lab findings (CBC, rubella, Rh)
  • BUBBLELE
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6
Q

BUBBLELE

A 
breast
uterus
bladder
bowel
lochia
episiotomy (laceratn, perineum, hemorrhoids)
lower extremities
emotions
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7
Q

frequency of fundal assessment post partum

A

1st hr: Q15min
2nd hr: Q30min
next 22 hr: Q4hr
after 24hr: Qshift

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8
Q

Encourage voiding before palpating uterus

A

over distended bladder can lead to uterine displacement + atony

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9
Q

Support the lower uterine segment by

A

placing one hand above the symphysis pubis

-prevents uterine inversion

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10
Q

If uterus is boggy…

A
  • give oxytocin

- massage fundus w palm of hand

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11
Q

Immediately after birth, the uterus fundus is located _____, and is ____.
12 hrs after brith of placenta, it is located _____, and is ___.
24 hrs after brith of placenta, it is located _____, and is ___.

A

midway bw umbilicus + symphysis pubis
+firm + midline

at or 1cm above umbilicus
+firm + midline

1cm below the umbilicus
+firm + midline

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12
Q

The uterus descends __ per day,

by day 14, the fundus has descended into ____

A

1cm

pelvis> not palpable

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13
Q

Subinvolution

A

failure of uterus to descend

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14
Q

Subinvolution may be caused by

A
  • retained placental fragments
  • infection
  • over-distended uterus
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15
Q

most common form of PPH

A

uterine atony aka “boggy”

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16
Q

Uterine Atony aka boggy + nursing action

A

uterus is not contracted

  • immediate action is to massage fundus w palm of hand in circular motion until firm
  • reevaluate in 5-10min
  • if unresponsive to massage, admin oxytocin
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17
Q

Afterpains nursing care

A
  • empty bladder
  • warm blanket to abdomen
  • analgesic (ibuprofen)
  • relaxatn technq
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18
Q

How to assess endometrium

A

check lochia

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19
Q

Lochia

A

bloody discharge

-contains RBC, sloughed decidual tissue, epithelial cells, bacteria

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20
Q

primary complication of endometrium

A

metritis

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21
Q

Assess lochia for…

A

color, amount, odor, + clotting

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22
Q

Scant, Light, Moderate, Heavy, Excessively Heavy

A 
Scant: <1in
Light: <4in
Mod: <6in
Heavy: pad is saturated w/in 1 hr
EH: soaked w/in 15 min
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23
Q

how to assess for clots

A
  • small is normal but should be documented
  • egg or bigger should be weighed + report to HCP
  • 1g = 1 mL
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24
Q

stages of lochia

A

RUBRA (1-3 dy)
SEROSA (4-10 dr)
ALBA (day 10)

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25
Q

Lochia Rubra

expected findings

A

days 1-3

  • red bloody w sml clots
  • scant - mod
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26
Q

Lochia Rubra

abnormal findings

A
  • lrg clots
  • heavy amount
  • foul odor
  • placental fragments
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27
Q

Causes of increased in flow based onstages

A

RUBRA (1-3 dy)- stand + breastfeed
SEROSA (4-10 dr)- phys activity
ALBA (day 10)- no incr flow

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28
Q

Lochia Serosa

expected findings

A

days 4-10

  • pink/brown
  • scant
  • fleshy odor
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29
Q

Lochia Serosa

abnormal findings

A
  • cont of rubra stage after day 4
  • heavy amt
  • foul odor
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30
Q

Lochia Alba

expected findings

A
  • yellow-white color
  • scant
  • fleshy odor
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31
Q

Lochia Alba

abnormal findings

A
  • bright red
  • heavy
  • foul odor
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32
Q

REEDA

A 
assessment for perineum
Redness
Edema
Ecchymosis
Discharge
Approximation of edges
33
Q

expected perineum findings

A
  • mild edema
  • minor ecchymosis
  • visible approximation of edges
  • mild-mod pain
34
Q

Perineum discomfort teaching

A
  • ice or cold therapy for 1st 24 hr
  • heat therapy/sitz bath after 24 hr 2x/day for 20 min
  • lie on side
  • tighten glutes before sitting, relax glutes when sitting
  • peripads to prevent rubbing
  • topica anesthetic + analgesic
35
Q

How to reduce infection w perineum

A
  • peri-bottle w warm water to rinse perineum after poop
  • change peripad frequently
  • hand washing
36
Q

local anesthetics + analgesic for perineum

A
  • witch hazel
  • NSAID like ibuprofen/motrin: 400-800mg Q4-6hr
  • opioids
37
Q

Hormone related breasts

A
  • fall in E + P
  • rise in prolactin
  • infant suckles> release of oxytocin> let down reflex
38
Q

Primary Engorgement

A

incr in vascular + lymphatic system

  • precedes lactogenesis
  • breasts become larger, firm, warm, tender, maybe throbbing
  • subsides w/in 24-48 hr
39
Q

Subsequent Engorgement

A

occurs in women who breastfeed

  • engorgement r/t distention of milk glands
  • relieved by expressing milk
40
Q

primary complication of breastfeeding

A

mastitis

-infection of breast fr stagnant milk

41
Q

Breasts expected findings (24 hr, day 2, day 3)

A

24 hr: soft + nontender
day 2: slightly firm + nontender
day 3: firm, tender, warm to touch

42
Q

Pathological Engorgement

A
  • hard, swollen, red, tender, painful

- elevated temp

43
Q

Plugged milk ducts symptoms + nursing action

A

palpation of pea sized breast lumps

  • freq feedings, changing infant position
  • warm compress or shower before feeding
  • massage breasts before feeding
44
Q

Teaching for NonBreastfeeding women

A
  • milk leakage, pain, + engoregment should subside after 4 days
  • supportive bra
  • avoid stim breasts to lead to atrophy of milk ducts
  • ice packs to breasts
  • analgesic
  • avoid heat
45
Q

avg blood loss fr vaginal birth and c section

A

V: 200-500mL

C: 1000mL
-minimal effects bc of pregnancy-induced hypervolemia

46
Q

Cardiac Output is ___ for ___ and returns to pre-pregnant levels within ____

A

increased for 24-48hr

returns to norm in 10 days

47
Q

WBC rise by ___ within a fe hours of birth, then returns to normal in ___

A

25,000/mm

7days

48
Q

orthostatic hypotensin is r/t

A

decreased vascular resistance in pelvis

49
Q

postpartum chills

A

feeling cold + shaky in first few hours after postpartum

-r/t vascular instability

50
Q

Cardiac expected findings

A
  • 5% incr in BP
  • bradycardia
  • blood loss wnl
  • postpartum chills w norm temp
51
Q

risk for DVT

A
  • dont cross legs
  • frequent ambulation
  • compression stockings
  • check legs for warm, swelling, edema
52
Q

when is checking for breath sounds indicated?

A
  • oxytocin
  • large amt of IV fluid
  • tocolytics (Mg sulfate, pr terbutaline)
  • infection
  • preeclampsia
  • bed rest

bc all are at risk for pulmo edema

53
Q

expected resp findings

A

-clear lung sounds
12-20 bmp
PaO2 95% or more

54
Q

For women w a temp of less than 100.4, ____

For women w a temp greater than 100.4, ____

A

<8-10 glasses of fluids, promote rest + relax, reassess after 1 hr

> drink minimum of 10 glasses of fluids, contact HCP

55
Q

type of incontinence

A

transient stress incontinence

-assoc w pelvic muscle function involving urethra in first 6 wk postpartum

56
Q

primary bladder complications

A

1 bladder distention

2 cystitis

57
Q

bladder nursing actions

A
  • encourage voiding 2-4hr after delivery
  • measure voidings
  • assess for signs of bladder distention
  • use peppermint oil bc relaxing effect on sphincter
58
Q

how much should patient void 2-4 hr after delivery?

A

300 ml w/in 2-4 hrs after delivery

-palpate if void is less than 150mL> sign of urinary retention

59
Q

bladder distention 4 s/s

A
  • uterine atony
  • displacement of uterus above umbilicus to the right
  • incr lochia
  • fullness in suprapubic area
60
Q

Diuresis

A

incr UO of 3,000 mL or more per day

  • caused by DECR in E levels w/in 12 hr after birth
  • aids in elimination of excess fluid
61
Q

if pt is unable to void + has over-distended bladder..

A

indwelling urinary catheter in place for 24 hr

62
Q

cystitis + s/s

A

bladder inflammation/infection

  • freq
  • urge
  • pain/burn
  • suprapubic tenderness
  • malaise
63
Q

cystitis Tx

A
  • abx therapy
  • incr hydratn
  • rest
64
Q

menses begins __ after childbirth

A

7-9 wk

  • avg 10 wk for nonlactating
  • 17 wk for lactating
65
Q

For nonlactating women, prolactin cont to decline for _____. For lactating women, prolactin ___

A

> 3 wks

> incr in response to infant suckling

66
Q

Diaphoresis + Diuresis is caused by

A

decline in estrogen

>aids in excretion of incr fluid accumulation from pregnancy

67
Q

Diaphoresis nursing action + education

A
  • assess for infectn by checking temp
  • –norm if temp is wnl
  • –should be no signs of fever, warmth, + chills
  • wear cotton
68
Q

Normal muscular/nervous system findings

A
  • diastasis recti
  • diminished lower body sensation fr epidural
  • mild to no muscle tenderness
  • assess for headache, notify HCP if it seems like preeclampsia
  • fatigue
69
Q

if diminished lower body fr epidural is present…

A

then delay ambulation

70
Q

GI muscle + motility decr postbirth but return to normal by end of…

A

2nd week

71
Q

constipation

A

decr motility r/t dresidual effects of progesterone, decr phys activity, + dehydratn, fluid loss, anxiety r/t apisiotomy/laceratn
-usually returns to norm in 2-3 days

72
Q

hemorrhouds

A

common due to birthing process

  • sometimes persists but most slowly resolve
  • painful
73
Q

appetite

A

often exceptionally hungry after birth for first few days

74
Q

wt loss

A

significant wt loss in first 2-3 wks

  • immediately after birth lose 11-12 lb
  • diureses causes another 5-8 lb
75
Q

avg woman at the end of 6 mos postpartum is approximately ___ abover her prepartum wt

A

3 lb

76
Q

GI teaching

A
  • incr diber> induce peristalsis
  • incr fluid intake (3,000ml) to soften bowel
  • assess bowel sounds + constipatn
  • encourage ambulatn
  • stool softener
  • assess appetite
  • assess n/v
77
Q

hemorrhoid teaching

A
  • lie on side
  • avoid sitting for long periods
  • witch hazel or topical anesthetics
  • sitz bath aid in circulation + reducing pain
78
Q

docusate colace

A 
stool softener
PO 100 mg daily
-admin w full glass of water
-may take 1-3 days to take effect
-DONT GIVE W/IN 2 HRS OF OTHER LAXATIVES
79
Q

Laceration degrees

A

1st: vag mucosa membrane + perineal skin
2nd: +peri fascia
3rd: + rectal sphincter
4th: + rectal mucosa + lumen

OB (18 decks)

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