Ch 17 & 25 Lecture

Question 1

Placental site heals by __.

Answer 1

exfoliation.

Question 2

involution

Answer 2

The process whereby the uterus decreases in size.

The uterus will reach its pre pregnant size by 5−6 weeks postpartum.

Question 3

Uterine debris in the uterus is discharged through __,

which consists of blood, fragments of decidua, white blood cells, mucus and some bacteria.

Answer 3

lochia

Lochia rubra is red (first 2–3 days, or longer)
Lochia serosa is pink (day 3 to day 10)
Lochia alba is white (continues until the cervix is closed)

Question 4

Ovulation usually occurs within ___.

Answer 4

70 to 75 days (non-breastfeeding women) or

6 months in lactating women.

Question 5

The uterus becomes displaced and deviated to the right when __.

Answer 5

the bladder is full

Question 6

Blood loss averages __.

Answer 6

200 to 500 mL (vaginal), 700 to 1000 mL (cesarean)

Question 7

The most common neurologic symptom is ___.

Answer 7

headache

Many women experience headaches due to estrogen drops.
Headaches may be increased with spinal or epidural anesthesia.

Question 8

A common discomfort for postpartum women is intense tremors that resemble shivering. There is no medical reason for this and the nursing intervention is to __.

Answer 8

cover with warm blankets.

Question 9

Postpartum blues

Answer 9

NOT postpartum depression

Transient period of depression; sometimes occurs during the first few days postpartum

Mood swings, Anger, Weepiness, Anorexia, Difficulty sleeping, Feeling of being let down

Lasts 2 weeks or less and goes away

Question 10

Principles of conducting a postpartum assessment:

Answer 10

i. Select the time that will provide the most accurate data
ii. Consider client’s need for premedication
iii. Provide an explanation of the purpose of the assessment
iv. Ensure that the woman is relaxed before starting; be gentle
v. Document and report the results clearly
vi. Take appropriate body fluid precautions
vii. Teach the client as you perform assessment

Question 11

Obtaining maternal vital signs postpartum:

Answer 11

i. Vital signs should be obtained when the mother is at rest
ii. Elevated temperature should last only 24 hours
iii. Increase in BP should be transient
iv. Pulse rate may be slow
v. Breath sounds should be clear

Question 12

BUBBLEHE

Answer 12

Breast
Uterus
Bladder
Bowel
Lochia
Episitomy, lacerations, edema
Homans/Hemorrhoids
Emotional

Question 13

Suppression of lactation in the non-breastfeeding mother:

Answer 13

1. Suggest a tight fitting sports bra
2. Apply ice
3. Avoid breast stimulation; avoid heat
4. Engorgement
5. Lactation usually suppressed in 5-7 days
6. cabbage leaves on breasts

Question 14

assessment of loch

Answer 14

for character, amount, color, odor,
Presence of any clots

Teach the patient:
Normal changes of lochia
Effect of position on lochia
Hygienic measures: Wash hands, Peri-bottle for cleaning, Watch for bleeding

Question 15

episiotomy/laceration wound assessment (REEDA)

Answer 15

1. Redness
2. Edema
3. Ecchymosis
4. Discharge
5. Approximation

Question 16

nursing notes for perineum care:

Answer 16

1. ice pack for pain
2. Pad count for correct assessment of bleeding amount
3. Assess Efficacy of any comfort measures

Question 17

nursing assessment of lower extremities

Answer 17

Assess for signs of thrombophlebitis. Some facilities have discontinued performing a Homans sign; supporters use it as a screening tool (it could dislodge a clot if present)

Assess legs for edema, redness, tenderness, and warmth.

Assess for return of sensation following anesthesia BEFORE ambulation. Ambulate to prevent thrombophlebitis and teach signs.

Question 18

Breastfeeding mothers increase calorie intake by __.

Answer 18

200 kcal (500 kcal over prepregnant requirement)

Nonbreastfeeding mothers decrease intake by 300 kcal.

Question 19

Because new mothers are tired, perform psychological assessment __.

Answer 19

on more than one occasion

Teach about impact sleep/rest can have on woman’s emotions and sense of control.

Question 20

Clues indicating adjustment difficulties:

Answer 20

1. Excessive continued fatigue
2. Marked depression
3. Excessive preoccupation with physical status or discomfort
4. Evidence of low self-esteem
5. Lack of support systems
6. Marital problems/current family crises
7. Inability to care for or nurture newborn
8. These indicate potential for maladaptive parenting, which can lead to child abuse or neglect
9. Refer to public health nurse or other community resources

Question 21

To reduce afterpains, the mother should be placed in __.

Answer 21

Prone positioning with a pillow beneath the abdomen.
May at first intensify the discomfort for about 5 minutes, but discomfort then diminishes greatly if not completely

Sitz bath, positioning, ambulation, and analgesic are other methods.

Question 22

Nursing care of the adolescent mother:

Answer 22

i. Postpartum hygiene
ii. Contraceptive counseling
iii. Newborn care
iv. Include family in teaching
v. Positive feedback
vi. Child care
vii. Transportation
viii. Financial support
ix. Nonjudgmental emotional support
x. Education regarding newborn care and illness
xi. Education regarding self-care

Question 23

nipple soreness

Answer 23

1. Usually caused by Mother’s own milk
2. treatment: Hypoallergenic medical-grade anhydrous lanolin cream, Peppermint gel, Protective bra shells
3. Consult certified lactation consultant if nipple soreness persists

Question 24

engorged breast

Answer 24

Infant should suckle for an average of 15 minutes per feeding and should feed at least 8 to 12 times in 24 hours

Warm compresses before nursing; Cool compresses after nursing

Mother may express milk manually or with a pump

Well-fitted nursing bra 24 hours a day

Question 25

plugged ducts in the breast

Answer 25

Heat and massage Warm compresses Nurse infant starting on the unaffected breast if plugged breast is tender (Some lactation consultants advocate starting on the affected side because the more vigorous sucking may help dislodge the plug) Breast pump may be effective in unplugging the duct.

Question 26

breastfeeding education:

Answer 26

Breastfeeding mothers should not consume alcohol for at least 2 hours before nursing, and alcohol consumption should be limited to occasional use - Consume alcohol after breastfeeding rather than before a feeding - Mothers with alcoholism who consume large quantities of alcohol daily may be advised not to breastfeed Consult primary healthcare provider before taking over-the-counter medications, prescription medications, or herbal supplements.

Question 27

postpartum hemorrhage (PPH)

Answer 27

Blood loss of 500 ml or more following a vaginal birth Blood loss of 1,000 ml or more or 10% decrease in hematocrit level after cesarean birth Can be Early or Late - “Early” hemorrhage defined as occurring within the first 24 hours after delivery - “Late” hemorrhage defined as occurring between 24 hours and 6 weeks after delivery Occurs in 5% to 8% of postpartal women

Question 28

Interventions of PPH (postpartum hemorrhage)

Answer 28

Stop the hemorrhage Correct the hypovolemia (SHOCK) S/S: Tachcardia, Decrease BP, Pallor Give IV Fluids (a) Large bore IV (16-18 gauge) (b) sometimes 2 IV’s (c) NS or RL Treat the underlying cause

Question 29

Absence of prompt or sustained uterine contraction can result in __.

Answer 29

significant blood loss: Postpartum hemorrhage.

Question 30

What is the leading cause of postpartum hemorrhage?

Answer 30

uterine atony other causes include: lacerations, retained placental fragments, disseminated intravascular coagulation, uterine inversion, uterine rupture, sub involution, and problems of placental implantation.

Question 31

What are nursing interventions for uterine atony?

Answer 31

Uterine massage if a soft, boggy uterus is detected Vascular access (IV-may need large bore): Fluid replacement and transfusion Assess abnormalities in hematocrit levels Assess urinary output: Encourage frequent voiding or catheterize the woman Encourage rest and take safety precautions Assess for shock, anemia -What are signs of shock? Tachycardia, increase BP, pallor

Question 32

Medications used to treat uterine atony

Answer 32

Oxytocin (IV)-Mix with crystalloid fluid Methergine (IM) Hemabate (IM) Cytotec (Rectally) All cause uterine contractions.

Question 33

Postpartum hemorrhage assessment: The "4 T's"

Answer 33

Tone, Trauma, Tissue, Thrombin Tone (1) Fundal firmness (presence of “boggy” uterus) (2) Fundal height according to time after delivery (3) Fundal position in relationship to midline (4) Amount of lochia (pad saturation) Trauma (lacerations) (1) Cervical/vaginal lacerations: Fundal check (will be firm), Lochia check (will be heavy; possibly bright red and gushing) (2) Perineal lacerations (a) Visual inspection of laceration or sutured repair (3) Perineal hematomas (4) Visual inspection of perineum (5) Check for severe pain or feeling of perineal pressure Tissue (Retained placental fragments) (1) Fundal check for boggy fundus (2) Lochia check: large fragment will cause heavy bleeding; small fragment may cause sudden delayed bleeding Thrombin (1) Disseminated intravascular coagulation

Question 34

Nursing action during PPH (postpartum hemorrhage)

Answer 34

i) Call for help ii) Massage uterus iii) Administer medications iv) Ensure Large Bore IV access (2) v) Replace volume with Normal Saline or Lactated Ringers vi) Apply Pulse Oximeter, blood pressure (1) Can give O2 (2-4 L or depends on pulse ox) vii) Assess blood loss viii) Draw CBC, Type and Crossmatch, Coagulation studies ix) Provide emotional support x) Remain CALM (1) “we are going to take care of you”

Question 35

Postpartum endometritis

Answer 35

an inflammation of the endometrium portion of the uterine lining occurring up to 6 weeks post partum Classic symptom is Foul smelling lochia, fever, uterine tenderness on palpation Treatment-Antibiotics

Question 36

Pelvic cellulitis (parametritis)

Answer 36

i) is an infection involving the connective tissue of the broad ligaments ii) Perineal wound infections iii) Cesarean wound infections

Question 37

Respiratory infection

Answer 37

Assess for: i) Fever ii) Malaise iii) Abdominal pain iv) Foul-smelling lochia (classic symptom of infection) v) Larger-than-expected uterus vi) Tachycardia vii) Can use the REEDA Scale (1) R: redness (2) E: edema (3) E: ecchymosis (4) D: discharge (5) A: approximation Prevention of Infection i) Good perineal care ii) Hygiene practices to prevent contamination of the perineum iii) Thorough hand washing iv) Sitz baths v) Adequate fluid intake vi) Diet high in protein and vitamin C

Question 38

Signs of a UTI

Answer 38

i) Frequency and urgency ii) Dysuria iii) Nocturia iv) Hematuria v) Suprapubic pain vi) Slightly elevated temperature

Question 39

UTI nursing interventions and self care measures for the patient:

Answer 39

Nursing Interventions i) Good perineal hygiene ii) Good fluid intake iii) Frequent emptying of the bladder iv) Teach to Void before and after intercourse v) Wear cotton underwear vi) Increase acidity of the urine Self-Care Measures: UTI i) Good perineal hygiene ii) Maintain adequate fluid intake iii) Empty bladder with the urge to void, or at least every 2 to 4 hours while awake

Question 40

What are nursing interventions for mastitis (infection of the breast)?

Answer 40

Nursing Interventions i) Proper feeding techniques ii) Supportive bra worn at all times to prevent milk stasis iii) Meticulous hand washing iv) Prompt attention to blocked milk ducts v) Mother can rotate baby for nursing, massage the caked area toward the nipple as baby nurses vi) Warm, moist compresses vii) Antibiotics

Question 41

What are self care measures for mastitis (infection of the breast)?

Answer 41

Self-Care Measures: Mastitis i) Breastfeed frequently (1) Mother may want to stop because PAINFUL, but keep nursing through this (2) Importance of regular, complete emptying of the breasts (3) Good infant positioning and latch-on (4) Principles of supply and demand ii) Importance of taking a full course of antibiotics iii) Report flulike symptoms

Question 42

Be alert for signs of intent to self-harm (SAL). Ask:

Answer 42

(a) Is there a Specific plan with a designated time? (b) Is there an Accessible weapon or other means? (c) How Lethal is the method identified in the plan?

Question 43

postpartum psychosis

Answer 43

MOST serious of postpartum psychiatric disorders Although rare, 1 to 2 in 1000 Considered an emergency i) PROVISION for the baby and mother’s SAFETY is KEY ii) The woman needs to have an immediate referral to psychiatric care Signs & Symptoms i) Sleep disturbances-unable to sleep ii) Depersonalization iii) Confusion iv) Hallucinations, Delusions v) Psychomotor disturbances-agitated state, rapid incoherent speech vi) NOT IN TOUCH WITH REALITY

Question 44

fundus

Answer 44

the top portion of the uterus. Fundus will be at the level of the umbilicus 6−12 hours postpartum Fundus will be 1 cm below the umbilicus on the first postpartum day Fundus will descend 1 cm per day until it is in the pelvis on the 10th day