Ch 17 & 25 Lecture Flashcards
Placental site heals by __.
exfoliation.
involution
The process whereby the uterus decreases in size.
The uterus will reach its pre pregnant size by 5−6 weeks postpartum.
Uterine debris in the uterus is discharged through __,
which consists of blood, fragments of decidua, white blood cells, mucus and some bacteria.
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)
Ovulation usually occurs within ___.
70 to 75 days (non-breastfeeding women) or
6 months in lactating women.
The uterus becomes displaced and deviated to the right when __.
the bladder is full
Blood loss averages __.
200 to 500 mL (vaginal), 700 to 1000 mL (cesarean)
The most common neurologic symptom is ___.
headache
Many women experience headaches due to estrogen drops.
Headaches may be increased with spinal or epidural anesthesia.
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 __.
cover with warm blankets.
Postpartum blues
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
Principles of conducting a postpartum assessment:
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
Obtaining maternal vital signs postpartum:
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
BUBBLEHE
Breast Uterus Bladder Bowel Lochia Episitomy, lacerations, edema Homans/Hemorrhoids Emotional
Suppression of lactation in the non-breastfeeding mother:
- Suggest a tight fitting sports bra
- Apply ice
- Avoid breast stimulation; avoid heat
- Engorgement
- Lactation usually suppressed in 5-7 days
- cabbage leaves on breasts
assessment of loch
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
episiotomy/laceration wound assessment (REEDA)
- Redness
- Edema
- Ecchymosis
- Discharge
- Approximation
nursing notes for perineum care:
- ice pack for pain
- Pad count for correct assessment of bleeding amount
- Assess Efficacy of any comfort measures
nursing assessment of lower extremities
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.
Breastfeeding mothers increase calorie intake by __.
200 kcal (500 kcal over prepregnant requirement)
Nonbreastfeeding mothers decrease intake by 300 kcal.
Because new mothers are tired, perform psychological assessment __.
on more than one occasion
Teach about impact sleep/rest can have on woman’s emotions and sense of control.
Clues indicating adjustment difficulties:
- Excessive continued fatigue
- Marked depression
- Excessive preoccupation with physical status or discomfort
- Evidence of low self-esteem
- Lack of support systems
- Marital problems/current family crises
- Inability to care for or nurture newborn
- These indicate potential for maladaptive parenting, which can lead to child abuse or neglect
- Refer to public health nurse or other community resources
To reduce afterpains, the mother should be placed in __.
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.
Nursing care of the adolescent mother:
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
nipple soreness
- Usually caused by Mother’s own milk
- treatment: Hypoallergenic medical-grade anhydrous lanolin cream, Peppermint gel, Protective bra shells
- Consult certified lactation consultant if nipple soreness persists
engorged breast
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
plugged ducts in the breast
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.
breastfeeding education:
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.
postpartum hemorrhage (PPH)
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
Interventions of PPH (postpartum hemorrhage)
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
Absence of prompt or sustained uterine contraction can result in __.
significant blood loss: Postpartum hemorrhage.
What is the leading cause of postpartum hemorrhage?
uterine atony
other causes include: lacerations, retained placental fragments, disseminated intravascular coagulation, uterine inversion, uterine rupture, sub involution, and problems of placental implantation.
What are nursing interventions for uterine atony?
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
Medications used to treat uterine atony
Oxytocin (IV)-Mix with crystalloid fluid
Methergine (IM)
Hemabate (IM)
Cytotec (Rectally)
All cause uterine contractions.
Postpartum hemorrhage assessment: The “4 T’s”
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
Nursing action during PPH (postpartum hemorrhage)
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”
Postpartum endometritis
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
Pelvic cellulitis (parametritis)
i) is an infection involving the connective tissue of the broad ligaments
ii) Perineal wound infections
iii) Cesarean wound infections
Respiratory infection
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
Signs of a UTI
i) Frequency and urgency
ii) Dysuria
iii) Nocturia
iv) Hematuria
v) Suprapubic pain
vi) Slightly elevated temperature
UTI nursing interventions and self care measures for the patient:
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
What are nursing interventions for mastitis (infection of the breast)?
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
What are self care measures for mastitis (infection of the breast)?
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
Be alert for signs of intent to self-harm (SAL). Ask:
(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?
postpartum psychosis
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
fundus
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
