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Gender And Reproductive Health Finals > 4500 Class 7 Postpartum > Flashcards

4500 Class 7 Postpartum Flashcards

1
Q

Postpartum assessment and signs of potential complications

A

(table 22.2)

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2
Q

Intervention for episiotomy

A

(box 22.2)

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3
Q

Intervention for lacerations

A

(box 22.2)

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4
Q

Interventions for hemorrhoids

A

(box 22.2)

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5
Q

Signs of potential psychosocial complications

A

(box 22.3)

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6
Q

What is BUBBLLEE (post partum assessment)

A

B — Breasts: firmness and nipples
U — Uterine fundus: location; consistency
B — Bladder function: amount and frequency
B — Bowel function: passing gas or bowel movement, (for vaginal birth)
L — Lochia: amount, colour
L — Legs: perioheral edema (or ‘E’ for extremities)
E — Episiotomy / Laceration or Caesarean borth incision: perineum, discomfort, conditionor repair (if done)
E — Emotionsl Status: mood, fatigue, confidence

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7
Q

Usual duration of postpartum stay in a hospital with vaginal delivery

A

24-48 hours

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8
Q

Usual duration of postpartum stay in a hospital with caesarian birth

A

~4 days

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9
Q

When is the 4th stage of labor

A

1-2 hours postpartum

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10
Q

What are part of our nursing assessments during 4th stage of labor (first 1-2 hours postpartum)

A
  1. Physical assessments of birther (VS, targeted assessments)
  2. Skin-to-skin initiation
  3. Breast/chest feedingninitiation
  4. Assisting php with perineal repair - assess perineum
  5. Assessment of placenta
  6. Administration of uterotonic medications - meds that promote uterine tone / contraction
  7. Administration of analgesic meds as needed
  8. Removal of epidural catheter, post epu assessment, as needed
  9. Encourage, monitor for void
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11
Q

What do we do when a birther experienced a laceration of they have gone through episiotomy

A

It will need to be sutured, (perineal repair)

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12
Q

Nurses do with perineal repair

A
  1. Assess pain management needs
  2. Positioning and lightning
  3. Skin to skin bonding with newborn
  4. Spinge and needles count
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13
Q

Parameters for BP assessment postpartum

A

q 15 minutes first hour
q 30 minutes after that for the remainder of 4th stage

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14
Q

Parameters for pulse assessment postpartum

A

Same as BP

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15
Q

Parameters for measuring temp postpartum

A

Initially and one more before transfer to podtpartum unit

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16
Q

How often do we assess fundal height and firmness

A

Same as BP

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17
Q

What donwe assess in perineum PP

A

Laceration - redness, edema, bruising drainage, approximation
Prescence of hemorrhoids

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18
Q

What are relevant obstetrical history

A

HTN, diabetes, placenta previa, placental abruption

+ rubella status
+ prescence of infections
+ GBS status and TREATMENT if positive
- RH STATUS
- hepatitis seroslogy
- HIV status
- syphylis

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19
Q

What are LABOUR CONSIDERATIONS

A
  1. Length of labour - dystocia
  2. Induced/augmented
  3. ROM - time, issues with meconium-stained amniotic fluid
  4. Any complications (temp/infection, antobiotic administration, blood cultures - FHR concerns, placental abruption)
  5. IV in situ?
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20
Q

RH protocol

A

IF MOTHER RH NEG, AND BABY IS RH POS
- treated within 72 hours

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21
Q

What does the uterine (fundal) assessment look like in
A. Normal prgress, days 1-9
B. Size and position of uterus 2 hours after childbirth
C. Two days after childbirth
D. Four days after childbirth

A
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22
Q

What does the fundus look like at the end of 3rd stage of labour

A

@u or u/u (fundus at the level of ambilicus)
u/1-2 (fundus 1-2cm below umbilicus)

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23
Q

Fundus 12 hours after birth

A

May rise to 1 cm above umbilicus

24
Q

Fundus/uterus 24 hours after birth

A

Uterus is about the same size that it was at 20 weeks gestation

25
Uerus after two weeks
No longer abdominally palpable - ~350 grams
26
Normal uterine findings
- placement should be midline abdomen. Deflection may indicate a distended bladder - size and shape should feel round, about the size of a grapefruit, ; larget usually indicates hemorrhage - the tone should feel firm (again life a grapefruit. If boggy (soft) massage gently, nitofy primary HCP
27
What are nursing interventions for uterus
1. Fundal massage 2. Uterotonics as ordered
28
Information we need to prevent excessive bleeding
U - uterus L - Lochia E - Lacerations / episiotomies
29
What does a distended bladder look like
THE UTERUS DISPLAV}CEF ABOVE UMBILICUS AND WELL TO ONE SIDE OF THE MIDLINE - bladder appears and round, supraoubic bulge - may be able to palpate bladder - uterus is usually boggy, above umbilicus and off to the right - LOCHIA IS HEAVIER
30
Normal bladder
1. Should be able to void spontaneously within 8 hours of birth 2. No distension 3. Able to empty bladder completely 4. No dysuria
31
When does diuresis start PP Approx how much
12 hours after birth, May void up to 3000 ml/day
32
Intrapartum RIC}SK factors that may cause bladder distension
1. Epidural 2. Trauma due to extensive vaginal or perinel lacerations / episiotomy or Instrument assissmted birth 3. Prolonged labour 4. In-dwellling catheter during labour
33
Minimum amount per void
150 mL
34
When is bowel movement expected
After 3 days
35
What are meds that contribute to constipation
Opiod analgesics, iron supplements, Magnesium sulphateq
36
Interventions for constipation
1. Adequate roughage 2. Increase fluids 3. Ambulation 4. Risk of opiod analgesics 4. Stoll softeners / laxatives
37
What is the normal vaginal discharge after delivery callede
Lochia
38
What is a lochia composed of
Leukocytes, epithelial cells, decidua, suto-lysed protein and bacteria **NORMAL AMOUNT SHOULD BE SCANT TO MODERATE WITH FEW CLOTS
39
How does a normal lochia look like Day 1-3, Day 3-10, Day 10-Week8
Dark red (rubra) Pink / brownish red (serosa) Yellowish-white (alba)
40
What do we worry for when Redness, tenderness, pain, warmth, unilateral swelling?
VTE
41
How domwe avoid VTE
Ambulation, TEC stockings, Those at risk LOW MOLECULAR-WEIGHT HE{ARIN during postpartum period
42
What is the inital nursing intervention with swollen perineum
Offer an ice pack - FOR 15 MINS, NOT MORE THAN 1 TIME IN AN HOUR
43
How should a normal hemorroid look like in the rectal area postpartum
Soft and pink
44
How do we assess for episiotomy or laceration
1. Intactness — edges should be well approximated 2. Edema, bruising, hematoma SHOULD NOT BE PRESENT and should be documented. Inform pcp. 3. Infection? Redness, warmth, drainage, nitofy pcp
45
Classify/differentiate 1st to 4th degree lacerations
1st — skin and strictures superficial to the muscles 2nd — extends through the muscle 3rd — extends through anal sphincter 4th — involves the anterior rectal wall
46
When should temp be a concern
When 38 degrees or higher lasting more than 4 hours
47
What is uterine atony, what can cause it
It is the faiture of the uterus to contract firmly It is the most frequent cause of excessive bleeding It can be cause by retained placental fragments / membrane
48
How does excessive bleed happen with uterine atony
The relaxed uterus will fill with blood and clots and blood vessels at the placental site are not clamped off
49
What to assess w uterine atony
- Significant drop in BP - check resps, pulse, skin conditiom, urinary output, conciousness (SIGNS OF HYPOVOLEMIC SHOCK)
50
Top 2 nursing interventions for uterine atony, how?
1. Maintain uterine tone 2. Prevent bladder distension BY uterine/fundal massage, uterotonics(prevent PPH)
51
How and when do we administer Oxytocin? What does it do
5-10 unites IM or IV after delivery of the anterior shoulder — 3rd stage of labour Encourage uterine to ‘clamp down” on the open blood vessels at the open placental site, prevent PPH
52
Name 2 other possible source of excessive bleeding postpartum
1. Vaginal / vulval hematomas 2. Unrepaired lacerations of the vagina or cervix
53
- can be common and can be r/t to both ohysical and psychologicl - may be inpacted by pain - can be ralated to anemia or infection
FATIGUE
54
Analgesics recommended/preferred for breat feeding persons
Non-opiods (NSAIDS)
55
Priorities of Helath Promotion Planning for Future Pregnancies
1. Rubella vaccine 2. Rh immune globulin; if RH NEG
56
Hpw much rh immune globulin is given
Usually 300 mcg

Gender And Reproductive Health Finals (6 decks)

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