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MCN lecture > Care of mother and fetus during the perinatal period (postpartum) endterm > Flashcards

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

1
Q

postpartal period / puerperium

A
  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
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2
Q

phases of the puerperium (according to reva rubin)

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

What is in the taking in phase

A
  1. first 2 or 3 days
  2. a time of reflection for women and passive dependence
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4
Q

What is in taking hold phase

A

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

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5
Q

What is in letting go phase

A
  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.
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6
Q

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

A

post partal blues/ baby blues

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7
Q

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

A

Postpartal blues
Disappointment
Abandonment

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8
Q

Physiologic Changes of the postpartal period/postpartum care

Reproductive system changes

A
  1. Uterus
  2. Cervix
  3. Vagina
  4. Perineum
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9
Q

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

A

Involution

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10
Q

Measure to promote Involution of the uterus:

A

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

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11
Q

Measures assessing uterine involution:

A
  1. Fundic height evaluation
  2. lochia evaluation :
    - vaginal discharges following delivery
    - heavy odor but not offensive
    Patterns: Rubra, Serosa, Alba
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12
Q

for the cervix what happens?

A
  1. Immediately following birth the cervix is soft and malleable
  2. both external and internal OS are well open
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13
Q

What happens to the vagina?

A
  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
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14
Q

What happens to the perineum

A
  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
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15
Q

What are the systemic changes

A
  1. The hormonal system
  2. The urinary system
  3. The circulatory system
  4. The gastrointestinal system
  5. Integumentary system
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16
Q

what happens in the hormonal system?

A
  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
17
Q

what happens in the urinary system

A
  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
18
Q

what happens in the circulatory system

A
  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
19
Q

what happens in the gastrointestinal system

A
  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
20
Q

what happens in the integumentary system

A
  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
21
Q

What are effects of retrogressive changes

A
  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
22
Q

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

A

Lactation

23
Q

Physiology of breastmilk production:

A

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

24
Q

Measures to promote breast comfort and hygiene:

A
  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
25
Q

return of menstrual flow

A
  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
26
Q

common discomforts of puerperium

A
  1. breast engorgement
  2. after pains
  3. urinary retention
  4. hemorrhoids
  5. constipation
  6. painful episiotomy wound
27
Q

nursing diagnosis

A
  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
28
Q

Outcome Identification /Planning

A
  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
29
Q

Implementation

A
  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.
30
Q

Outcome evaluation

A
  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
31
Q

Postpartal Discharge Instruction:

A

Work
Rest
Exercise
Hygiene
Sexual Activity
Contraception
Follow-Up

32
Q

Muscle strengthening exercise:

A

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

MCN lecture (3 decks)

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