Care of mother and fetus during the perinatal period (postpartum) endterm

Question 1

postpartal period / puerperium

Answer 1

1. 6 week period after childbirth
2. termed the fourth trimester of pregnancy
3. maternal changes that are both retrogressive and progressive
4. the optimal period for parent-child bonding

Question 2

phases of the puerperium (according to reva rubin)

Answer 2

1. taking in phase
2. taking hold phase
3. taking go phase

Question 3

What is in the taking in phase

Answer 3

1. first 2 or 3 days
2. a time of reflection for women and passive dependence

Question 4

What is in taking hold phase

Answer 4

begins to initiate action herself and take a strong interest in caring for her baby, however feels insecure about her ability to care

Question 5

What is in letting go phase

Answer 5

1. the woman finally redefines her new role
2. she gives up the fantasized image of her child and her previous role of being childless or a mother of only one or two.

Question 6

what is the term used when the mother feels:
1. Feelings of overwhelming sadness that cannot be accounted for.
2. They burst into tears easily and are irritable
3. Evidenced by tearfulness, feelings of inadequacy, mood lability, anorexia and sleep disturbance.
4. due to decrease in estrogen and progesterone
happens to 50% of postpartial women

Answer 6

post partal blues/ baby blues

Question 7

what are the maternal concerns and feelings in the postpartal period?

Answer 7

Postpartal blues
Disappointment
Abandonment

Question 8

Physiologic Changes of the postpartal period/postpartum care

Reproductive system changes

Answer 8

1. Uterus
2. Cervix
3. Vagina
4. Perineum

Question 9

Is the process whereby the reproductive organs return to their non pregnant state

Answer 9

Involution

Question 10

Measure to promote Involution of the uterus:

Answer 10

proper positioning
oxytocin drugs as ordered
breastfeeding
early ambulation
regular bladder emptying
proper postpartum diet

Question 11

Measures assessing uterine involution:

Answer 11

1. Fundic height evaluation
2. lochia evaluation :
   - vaginal discharges following delivery
   - heavy odor but not offensive
   Patterns: Rubra, Serosa, Alba

Question 12

for the cervix what happens?

Answer 12

1. Immediately following birth the cervix is soft and malleable
2. both external and internal OS are well open

Question 13

What happens to the vagina?

Answer 13

1. following birth, the vagina is soft, and its diameter is greater than normal
2. The hymen is permanently torn and heals with small separate tags of tissue

Question 14

What happens to the perineum

Answer 14

1. development of edema and generalized tenderness
2. a portion may have ecchymosis from rupture of surface capillaries
3. some women may have episiotomy incisions that are extremely painful
4. both labia majora and minora remain atrophic and softened
5. edematious and tender immediately after birth due to pressure during birthing

Question 15

What are the systemic changes

Answer 15

1. The hormonal system
2. The urinary system
3. The circulatory system
4. The gastrointestinal system
5. Integumentary system

Question 16

what happens in the hormonal system?

Answer 16

1. the pregnancy hormones begin to decrease as soon as the placenta is no longer present
2. By the week 1, progesterone and estrogen are at prepregnant levels

Question 17

what happens in the urinary system

Answer 17

1. pressure during birth may leave the bladder with transient loss of tone
2. extensive diuresis begin to take place almost immediately following birth
3. diaphoresis is noticeable soon after birth

Question 18

what happens in the circulatory system

Answer 18

1. diuresis evident between the 2nd and 5th days postpartum and blood loss
2. by the 1st or 2nd week postpartum, the blood volume has returned to its normal prepregnancy level
3. high level of plasma fibrinogen during the first postpartal week
4. increase number of leukocytes in the blood
5. varicosities present may recede

Question 19

what happens in the gastrointestinal system

Answer 19

1. digestion and absorption begin to be active soon after birth
2. hemorrhoids often are present
3. bowel sounds are active
4. bowel evacuation is difficult

Question 20

what happens in the integumentary system

Answer 20

1. following birth, striae gravidarum still appear red
2. chloasma and linea nigra will be barely detectable in 6 weeks time
3. diastasis recti will not fade and appears as slightly indented, bluish tinged on the abdomen

Question 21

What are effects of retrogressive changes

Answer 21

1. exhaustion
2. weight loss
3. vital signs
   A. temperature - slight increase the first 24 hrs and will be reduced and become normal
   - occasionally on the 3rd or 4th day postpartum when milk comes in the womens temperature rises for period of hours
   B. pulse - generally slightly slower than normal. by the end of the 1st week PR has returned to normal (rapid and thread pulse can be sign of hemorrhage)
   C. Blood pressure - a reading above 140/90 may indicate the development of post partal PIH
   - if the acute blood loss (orthostatic hypotension or dizziness) can be experienced by the women

Question 22

the formation of breastmilk is initiated whether or not the mother plans to breastfed

Answer 22

Lactation

Question 23

Physiology of breastmilk production:

Answer 23

Lactogenesis I ( milk synthesis
Lactogenesis II engorgement - may occur from birth to 5 - 10 days post partum often term as transitional milk
Lactogenesis III - can occur by day 10 until weaning post partum
lactogenesis IV - occurs after a complete weaning from postpartum

Question 24

Measures to promote breast comfort and hygiene:

Answer 24

1. express a small amount of milk
2. wear a well fitting bra
3. use of compresses
4. breast massage
5. analgesics as ordered
6. breast hygiene

Question 25

return of menstrual flow

Answer 25

1. return of menstrual flow is expected within 6 to 10 weeks if not breasfeeding 2. as a result of decreases hormones will lead to an increase of FSH to stimulate follicular functions and ovulation

Question 26

common discomforts of puerperium

Answer 26

1. breast engorgement 2. after pains 3. urinary retention 4. hemorrhoids 5. constipation 6. painful episiotomy wound

Question 27

nursing diagnosis

Answer 27

1. Pain and discomfort R/T uterine cramping and perineal sutures 2. Risk for infection R/T presence of open episiotomy wound 3. Risk for sleep pattern disturbance R/T exhaustion during pregnancy and childbirth 4. risk for altered nutrition, less than body requirements R/T lack of knowledge 5. risk for altered elimination R/T presence of painful episiotomy wound or partial loss of badder and bowel sensation 6. risk for deficient fluid volume R/T postpartal hemorrhage 7. risk for breast pain and discomfort R/T breast engorgement 8. risk for altered family coping R/T an additional family member 9. risk for complications in human lactation / breastfeeding 10. Health seeking behavior / fears R/T care of newborn 11. Uncertainty regarding the infants wellbeing if there are congenital anomalies

Question 28

Outcome Identification /Planning

Answer 28

1. Allow optimal time for family-infant interaction. 2. Provide adequate time for a woman to rest to prevent exhaustion 3. Promote breastfeeding and infant-maternal bonding 4. Provide instruction to a woman to monitor her health and baby’s health while at home. 5. Refer patient and her partner to helpful websites and healthful resources when appropriate

Question 29

Implementation

Answer 29

1. to enhance family functioning & bonding 2. should geared toward increasing a woman’s self-esteem 3. that allows her to view herself as a new mother 4. that helps a woman view her new infant as part of her family.

Question 30

Outcome evaluation

Answer 30

1. The parents verbalize about one positive comment about their child’s characteristics before discharge 2. The woman states she believes she will be able to manage newborn care with the support of her significant others. 3. The woman’s lochial flow is no more than one saturated perineal pad (50 ml) every 3 hours. 4. The patient states she is tired but feels able to manage her newborn & family care 5. Physical interaction and holding of the infant appears appropriate and responsive to infant’s needs

Question 31

Postpartal Discharge Instruction:

Answer 31

Work Rest Exercise Hygiene Sexual Activity Contraception Follow-Up

Question 32

Muscle strengthening exercise:

Answer 32

Abdominal breathing Chin-to-chest Perineal contraction Arm raising Leg raising Sit-ups