CARE OF MOTHER 11-24 Flashcards
1
Q
Postpartum care This period constitutes a physical and psychological
adjustment to the process of childbearing and is
sometimes referred to as the
A
fourth trimester of
pregnancy.
2
Q
medical and nursing care given to a
woman during the puerperium, which is the 6-week
period after delivery, beginning with termination of labor
and ending with the return of the reproductive organs to
the nonpregnant state.
A
Postpartum care
3
Q
Risk factors for postpartum complications, risk factors
may include:
A
may include:
Preeclampsia or eclampsia
Diabetes
Cardiac problems
Uterine overdistention (as a result of multiple
births or hydramnios)
Abruptio placentae or placenta previa
Precipitous or prolonged labor, difficult delivery, or
extended time spent in stirrups
4
Q
Goals of Postpartum Care
A
period following labor during which the maternal
body in general, and the genital organs, in particular
return to the pre-pregnant condition
Duration - 40 days or 6-8 weeks.
Another 4-6 weeks is needed for complete involution
5
Q
The puerperal period is much shorter after abortion.
A
First 10 days - early postpartum
days after - late postpartum
6
Q
B. U. B. B.. L. E. - H. E. Maternal Assessment
A
B - Breast size, shape, and engorgement
U - Uterus: firm or boggy
B - Bladder: tender or distended
B - Bowel movement
L - Lochia: amount, odor, color, clots
E - Episiotomy location, stiches, edema and redness
H - Homan’s sign - positive
E - Emotional status and bonding
7
Q
DVT and Homan’s Sign
A
A positive Homan’s sign is indicative of a DVT
The patient’s leg is positioned at a 90° angle (either
while in supine or sitting)
Dorsiflexion of the foot reveals pain in the calf if
positive|
: redness, sudden sharp pain, and
warmth in the leg
8
Q
Postpartum Biophysical Changes
The uterus contracts firmly after delivery of the
newborn, reducing its size by _____. It
remains this size for about ____days, then decreases in
size (involution) and descends about ____
fingerbreadth per day.
A
more than half
2
one
9
Q
Reproductive System changes
At _____ postpartum days, the uterus cannot be
palpated abdominally.
A
10 to 14
10
Q
Reproductive System changes
It returns to near its
prepregnant size by ______ postpartum weeks.
A
4 to 6
11
Q
Reproductive System changes|
The
site of placental attachment requires ____weeks
to heal;
A
6 to 7
12
Q
Reproductive System changes
endometrial regeneration requires ___
weeks.
A
6
13
Q
- discharge from the uterus lining during
the first 3 weeks after delivery
A
Lochia
14
Q
Lochia - discharge from the uterus lining during
the first 3 weeks after delivery, occurs in three
types.
A
Lochia rubra
Lochia serosa
Lochia alba
15
Q
Lochia:
|
- dark red discharge occurring in
the first 2 to 3 days.
A
Lochia rubra
It contains epithelial cells,
erythrocytes, leukocytes, and decidua, and has
a characteristic human odor.
16
Q
Lochia:
|
- pink to brownish discharge,
occurring from 3 to 10 days after delivery.
A
Lochia serosa
. It is a
serosanguinous discharge containing decidua,
erythrocytes, leukocytes, cervical mucus, and
microorganisms; lochia serosa has a strong
odor.
17
Q
Lochia:
|
- almost colorless to creamy
yellowish discharge occurring from 10 days to 3
weeks after delivery
A
Lochia alba
It contains leukocytes,
decidua, epithelial cells. Fat, cervical mucus,
cholesterol crystals and bacteria. Lochia alba
should have no odor.
18
Q
Complete cervical involution may take
A
3 to 4 months.
19
Q
Rugae reappear by ____postpartum
weeks.
A
3 to 4
20
Q
The estrogen index returns in
A
6 to 10 weeks
21
Q
The abdomen remains _______ for some time
after delivery
A
soft and flabby
22
Q
(separation of abdominal recti
muscles)
A
Diastasis recti
23
Q
Breasts changes include the following:
A
Rapid drop in estrogen and progesterone, increase in secretion of prolactin after delivery
Colostrum is present at the time of delivery; breast
milk is produced by the third or fourth postpartum
day.
Larger and firmer breasts occur with lactation
(primary engorgement). 1-2 congestion subside
In the breast, prolactin stimulates alveolar cells to
produce milk.
24
Q
Sucking of the newborn triggers a
release of _______of the
myoepithelial cells, which stimulate milk flow; this
is known
A
oxytocin and contractility
|
asthe let down-down reflex
25
The average
amount of milk produced in 24 hours increases
with time.
First week –
1 to 4 weeks –
After 4 week –
6 to 10 oz
|
20 oz
30 oz
26
Estrogen and progesterone levels ______ rapidly
after delivery
decrease
27
45% of lactating women resume menstruation by
12
week
28
The cervix becomes thicker and firmer; by the end of
the first postpartum week, it is still dilated about 1 cm,
Complete cervical involution may take
3 to 4 months
29
Complete cervical involution may take 3 to 4 months.
Childbirth results in a permanent change in the
cervical os from round to
elongated.
30
The vagina is ____
after delivery.
smooth and swollen, with poor tone
31
Rugae reappear by ____ postpartum
weeks.
3 to 4
32
The estrogen index returns in ____ weeks
6 to 10
33
Ovulation and resumption of menstruation are
influenced by whether or not the client breast feeds
45% of lactating women resume menstruation by ___
weeks; 80% have one or more anovulatory cycles
before the first ovulation
12
34
Ovulation and resumption of menstruation are
influenced by whether or not the client breast feeds
40% of nonlactating women resume menstruation
by ___ after delivery; 65% by ___; and 90%
by ___ s. Fifty percent ovulate during the first
cycle.
6 weeks
12 weeks
24 week
35
Transient bradycardia (_____beats per minute)
occurs for ____hours after delivery and may
persist for_____days.
50 to 70
24 to 48
6 to 8
36
Blood volume decreases to nonpregnant levels by ____
weeks after delivery.
4
37
Hematocrit rises by the ______ postpartum
day
third to seventh
38
Leukocytosis (______) continues for several days after delivery
20,000 to 30,000 white blood cells per
mm*
39
Blood pressure remains stable and the pulse returns
to nonpregnant rate by ____ months postpartum.
3
40
Any mother whose temperature reaches ______
in any_____, during the
first ___ postpartum days, excluding the first 24
postpartum hours, is considered to be febrile.
38*C (100.4*F)
two consecutive 24-hour periods
10
41
Pulmonary functions return to nonpregnant status by
___ months after delivery.
6
42
A full bladder displaces the uterus and can cause
postpartum hemorrhage;
43
bladder distention can
lead to
urinary retention.
44
Adequate bladder emptying generally resumes in
______ days after tissue swelling and bruising
resolve.
5 to 7
45
the glomerular filtration rate remains elevated for
about _____ days after delivery
7
46
Dilated ureters and renal pelvis return to their
nonpregnant states within _____ weeks after delivery
6 to 10
47
Puerperal diaphoresis and diuresis occur within the
first ____ hours after delivery.
24
48
Gastrointestinal motility and tone return to the
nonpregnant state within ___ weeks after delivery.
2
49
Constipation commonly occurs during the _______ period due to decreased intestinal muscle
tone, perineal discomfort, and anxiety.
early
prepartum
50
he client may return to her prepregnant weight in_____ weeks, if weight gain during pregnancy was
within the normal range.
6
to 8
51
are a common problem in the early
postpartum period, due to pressure on the pelvic floor
and straining during labor.
Hemorrhoids
52
Most women ambulate _____ hours after delivery;
4 to 8
53
early ambulation is encouraged to avoid
complications, promote involution, and improve
emotional outlook.
54
Relaxation and increased mobility of pelvic
articulations occur ____ weeks after delivery.
6 to 8
55
Visible vascular changes of pregnancy disappear as
estrogen levels decreases.
56
decreases gradually after delivery, causing a
decrease in hyperpigmentation
Melanin
57
Taking-in period
occurring 1 to 2 days after delivery
58
Taking-hold period
extending from 2 to 4 days after
delivery
59
Letting-go period
This period generally occurs after the new mother
returns home; it involves a time of family
reorganization.
60
Factors Influencing Successful Transition to
Parenthood During the Postpartum Period:
Response and support of family and friends
Relationship of the birthing experience to
expectations and aspirations
Previous childbearing and childrearing experiences
Cultural influences
61
Within 24 hours after birth, the newborn’s _____ must function sufficiently for
progression to, and maintenance to extrauterine life.
renal,
gastrointestinal (GI), hematologic, metabolic, and
neurologic systems
62
This is a phase of instability during the first 6 to 8
hours of life through which all the newborns pass,
regardless of gestational age or nature of labor and
delivery.
Transition Period
63
Transition Period
In the first period of reactivity, (immediately after
birth),
respiration is rapid, (may reach 80 breaths per
minute), and transient nostril flaring, retractions and
grunting may occur. The heart rate may reach 180
beats per minute during the first few minutes of life
64
this first sleep (known
as ____) occurs within ____hours of birth and
lasts from a few minutes to several hours’
sleep phase. 2
65
Transition Period
The second period of reactivity, starting when the
newborn awakes, is marked by
hyperresponsiveness
to stimuli, skin color changes from pink to slightly
cyanotic, and a rapid heart rate
66
Respiratory Adaptation
Initial respirations are triggered by physical -
sensory-
and
chemical factors-
Physical factors include the effort required to expand
the lungs and fill the collapsed alveoli (e.g. change in
pressure gradients)
Sensory factors include temperature, noise, light,
sound, and a drop in temperature.|
Chemical factors include changes in the blood (e.g.
decreased O2 level, increased CO2 level, and
decreased pH) as a result of the transitory asphyxia
during delivery.
67
The newborn respiratory rate ranges between _____ breaths per minute.
30 and
60
68
Oral mucous secretions may cause the newborn to
_____, especially during the first 12 to 18
hours.
cough and gag
69
Newborns are obligatory nose breathers. The reflex
response to nasal obstruction, opening of the mouth
to maintain an airway, is not present in most
newborns until ____ weeks after birth.
3
70
(cyanosis of the hands and feet and
around the mouth).
acrocyanosis (
71
Cardiovascular Adaptation
acrocyanosis
PR IS 120-160
100(SLEEP)
BP - 80/46
72
Respiratory Adaptation
physical, sensory,
and chemical factors
rr 30-60 breath/pm\
ORAL MUCOS 12-18 HRS OF BIRTH
obligatory nose bleeders
73
Cardiovascular Adaptation
limited supply of subcutaneous fat
Rapid heat loss in a cool environment occurs by
conduction, convection, radiation, and evaporation.
74
Neurologic adaptation
neurologic system is not fully
developed
uncoordinated movements
labile temperature regulation
Newborn reflexes- for development
75
Gastrointestinal adaptation
Digestive enzymes are active at birth can supp 36 to 38 weeks’ gestation
muscular and reflex for transporting food are present at birth.
Digestion of protein and carbohydrates is readily
accomplished
Salivary glands are immature at birth, little saliva until the newborn is 3 months old
meconium bowel movement contains occult blood is excreted
within 24 hours in 90% of normal newborns.
Some newborns nurse immediately when put to the
breast, others take up to 48 hours for effective
feeding
Random hand-to-mouth movement and finger
sucking have been observed in utero
76
fat digestion and absorption are poor
due to the inadequacy of
pancreatic enzymes and
lipase.
77
Immune system adaptation
cannot limit an invading organism at
the portal of entry.
The immaturity of a number of protective systems increases the risk of infection
inflammatory response is reduced qualitatively
and quantitatively
Phagocytosis is sluggish.
The acidity of the stomach and the production of
pepsin and trypsin are not fully developed until 3 to 4
weeks of age
Immunoglobulin A (IgA) is missing from the respiratory
and urinary tracts, unless the newborn is breast fed.
Infection represents a leading cause of morbidity and
mortality during the neonatal period.
3 immunoglobins:
IgA
IgG
IgM
78
Immune system adaptation
IgA
IgG
IgM
IgG crosses the placenta and is found in the fetus by
the 3rd trimester. It [protects the newborn against
bacterial and viral infections the mother has
developed antibodies for (tetanus, measles, mumps)
IgM is found in the blood and lymph nodes and is the
first immunoglobin to respond to infection. Production
starts at birth. If elevated at birth may indicate
exposure to intrauterine infection
IgA is found in colostrum and can contribute to
passive immunity. It limits bacterial growth in the GI
trac and is produced gradually.
79
Skin Appearance of Newborn
Pale and cyanotic
- poor central nervous system
control
80
Gray color
- indicates infection
81
Cyanosis
– newborn’s lips, hands and feet are likely to
appear cyanotic from immature peripheral circulation
82
Acrocyanosis
– a line seems to be drawn across the wrist
or ankle with pink skin on one side and blue on the othernormal 24 to 48 hours after birth.
83
Jaundice
e - the skin and the eyes appear to be yellow
immature liver function-
84
Physiologic jaundice occurs ___ day of life in
about 50% of all newborn as a result of
2nd or 3rd
breakdown of
fetal RBC.
85
in terms of jaundice
More than 7 mg/100ml -
More than 10 to 12 mg/100ml
Above 20mg/100ml -
can cause jaundice
treatment is considered.
Phototherapy is a common therapy.
damage to the brain( kernicterus)
86
Cephalhematoma -
a collection of blood under the
periosteum of the skull bone
87
Intestinal obstruction
stool cannot be evacuated,
intestinal flora may break down bile leading to the
release of indirect bilirubin into the bloodstream again.
88
Kernicterus
form of brain damage caused by excessive
jaundice
89
Phototherapy -
exposure of the infant to light to initiate
maturation of liver enzymes
90
Pallor
– a result of anemia caused by excessive blood
loss during the cutting of the cord
90
Harlequin sign
reddish appearance on the dependent
side of the body and pale on the upper side because of
immature circulatio
91
Hemangiomas
vascular tumors of the skin
92
Hemangiomas
Nevus flammeus
called portwine stain
macular purple or dark-red lesion that is
present at birth
stork’s beak marks or telangiectasia
(occur as
lighter, pink patches at the nape of the neck.)
93
Hemangiomas
Strawberry hemangioma
refers to elevated areas formed by immature
capillaries and endothelial cells
high estrogen
levels of pregnancy
, may appear up to 2 weeks
after the first year ,they tend to be absorbed
and shrink in size
hydrocortisone ointment-may speed the
disappearance by interfering with the binding
of estrogen to its receptor sites
surgery rarely recommended
94
Hemangiomas
Cavernous hemangioma
dilated vascular spaces
usually raised and resemble a strawberry
hemangioma in appearance
steriods,interferon-alfa-2a ,or vincristine –used
to reduce size
surgical removal of lesion
Assess hematocrit levels for possible internal
blood loss / bleeding of lesion located maybe
on the internal organs
95
Mongolian spots
gray patches across the sacrum or buttocks and
possibly on the arms and legs
They disappear by school age without treatment
Be sure to inform parents that these are not bruises
96
Vernix caseosa
– a white cream cheese-like substance
that serves as a skin lubricant in utero
document color of vernix, because it takes the color
of the amniotic fluid
yellow from bilirubin, green from meconium
97
Lanugo
fine downy hair that covers a newborn’s
shoulders, back and upper arms
rubbed away by the friction of bedding and clothes
against the newborn’s skin
by 2 weeks of age, it has disappeared
98
Desquamation
within 24 hours the skin of the newborns
becomes extremely dry which may result in peeling
similar to a sunburn
99
Milia
– pinpoint white papule that can be found on the
cheek across the bridge of the nose due to plugged
sebaceous gland
Disappear by 2 to 4 weeks of age
Reminder: avoid scratching or squeezing to prevent
infection
100
Erythema toxicum
a newborn rash , called flea-bite
rash
Begins with a papule, increase in severity to become
erythema on the 2nd day, and then disappears by the
3rd day
caused by a newborn’s eosinophils reacting to the
environment as the immune system matures
it requires no treatment
101
GI tract is usually sterile after birth, bacteria may be
cultured from the intestinal tract in most babies within ____ hours of life.
5
hours to 24
102
Accumulation of bacteria in the GI tract is necessary fo
digestion and for the synthesis of Vitamin K
103
Newborn’s stomach holds about _ ml
60 to 90 ml
104
Newborn regurgitates easily because of an immature _
cardiac sphincter between the stomach and esophagus
105
Immature liver functions may lead to
lowered glucose
and protein serum levels
106
First stool of a newborn is usually passed within 24
hours after birth
(meconium)
107
If a newborn does not pass a meconium stool by 24 to
48 hours after birth, the possibility of some factor such
as
meconium ileus, imperforate anus ,or volvulus
should be suspected
108
Meconium
a sticky tar like, blackish-green, odorless
material
fromm
mucus, vernix, lanugo,
hormones and carbohydrates(intra uetrin life)
109
Meconium
2nd or 3rd day of life is termed
transitional stool
(green and loose resemble diarrhea to the
untrained eye)
110
4th day of life breastfed babies passes what kind of stool
3 or 4 light yellow
stools per day, sweet-smelling
111
Formula fed babies passes what kind of stool
2 or 3 bright yellow stools a
day, slightly more noticeable odor
112
A newborn placed under phototherapy lights as a
treatment for jaundice has what kind of stool
bright green stools because
of increased bilirubin excretion
113
Newborn with bile duct obstruction have what kind of stool
clay-colored
(gray) stools, because pigment are not entering the
intestinal tract
114
Black/Tarry stoo
– after 2 or more days indicates
intestinal bleeding
115
flecked stools usually indicate an anal fissure
indicates what
Blood
116
Mucus is mixed with stool or stool is watery and loose
indicates what
(milk allergy, lactose intolerance )
117
Blink Reflex
this reflex serves a protective
function against hurting the eye
118
Rooting Reflex
Brushing the cheek or stroking near the mouth of the
newborn will cause the head of the newborn to turn to
that direction.
Dissapear kn 6 weeks
119
Sucking Reflex
Touching the newborn’s lips causes the baby to make
sucking motions.
Dissapear 6 months
120
Extrusion Reflex
Until 4 months of age, any food placed on the anterior
portion of the tongue of babies will be expelled by
them
121
Palmar Grasp Reflex
Objects placed on newborns’ palms will be grasped
by newborns.
Dissapear 6 weeks to 3 months
122
Walk-in-Place Reflex
If newborns are held in a vertical position with their
feet touching a hard solid surface, newborns will take
few, alternating steps.
123
