Chapter 11 and 12 Flashcards
what is the timeframe for post partum
Immediately after birth of baby and in six weeks after birth
how long does the hospital stay postpartum
mom stays 48 hours for vaginal birth and 72 hours for C-section
what are some common fears postpartum
newborn abduction and newborn switching
what are some interventions you can do for fear of newborn abduction and newborn switching
ID bracelets right when the baby is born, it is checked every time in and out of the room, security system a sensor on the ankle umbilical clamp it locks down the unit if sensor gets too close to the door, the baby could stay in the room, the nurse badge needs to be visible and have identifier that shows that they work on the floor
how often do you assess postpartum
vaginal birth Q 15 minutes X2 hours, then queue 4hours for 8 hours then Q8 to 12 hours for C sections Q 30 minutes for four hours then Q1 hour for three hours then queue 4 to 8 hours
what are the ss of postpartum chills
uncontrollable shaking within two hours postpartum, sometimes not cold it is normal and will go away
what is the treatment for postpartum chills
warm drinks more blankets
what is the blood pressure do postpartum
decrease blood pressure can be normal or mean uterine hemorrhage
what are the signs of a preeclampsia headache
headache, blurred vision, epigastric pain, edema, photophobia, proteinuria
what are the signs of leaking cerebral spinal fluid headache
headache when sitting up and goes away when laying down
what is the temperature do postpartum
increase temp within first 24 hours as normal because exertion from delivery, dehydration from no food or water, after the first 24 hours the patient should be afebrile 100.4 or more could mean infection
what is the heart rate do postpartum
bradycardia normal and 1st 6 to 10 days
how do you diagnose postpartum preeclampsia with blood pressure
increase systolic blood pressure of 30, 15 in diastolic or 140 / 80
what do respirations do postpartum
may have increased because of fear, pain, excitement, exertion, excessive blood loss
what are the signs of pulmonary embolism
sudden tachypnea, abnormal lung sounds, chest pain, anxiety, call rapid and give O2
what in the breasts produce milk
mammary glands
what happens to the areola in breasts during postpartum
darkens and enlarges with pregnancy main ducks coverage and open into the nipple
what does the quantity of milk depend on
how the baby feeds the more nursing the more milk that will be produced
what are the milk production cells
alveoli ducts that collect milk from the alveolus and transport it towards the nips
when does breast firming happen and what does it mean
milk coming in about 3 days postpartum the breast will start to fill can cause increase in temperature four to five days milk will leak
what are Montgomery tubercles
emit waxy substance that lubricates the nips it acts as an anti infective to protect the nips
how should you wash the nips
water only soap will dry them out and cause cracking
what are some uterus complications postpartum
uterine atony meaning lack of muscle tone causes boggy uterus
what is involution
process of uterus returning to pre pregnancy state results from decrease in size of myometrial cells
why are there contractions after delivery
prevent hemorrhage the contraction is sealing off for the placenta was implanted into the uterine lining
when should the mom void postpartum
6 to 8 hours of 150 MLS/hr, to avoid urinary retention or stasis by the 2nd to 5th day should be getting 3000 milliliters per day
what causes decreased bladder tone
edema from pressure of presenting part and labor, effects of progesterone on smooth muscle, mucosa hyperemia from increased blood vessel size
how long does it take placental implantation to heal
six to seven weeks postpartum via exfoliation and results in uterine scarring
what does the relaxin hormone do
slows bowel activity causing Constipation
when should the mom have a bowel movement postpartum
first two to three days postpartum
besides relaxing what are some other causes of Constipation
meds, abdominal muscles have been stretched, hemorrhoids, sore, episiotomy or laceration, dehydration, decreased gastric motility related to hormones
what is lochia comprised of
erythrocytes, epithelial cells, blood, fragments of decidua (uterine tissue), mucus or bacteria
when do the edges of an episiotomy become fused
1st 24 hours
what is the treatment for Constipation
increase fiber, ambulate, drink more water, stool softeners
what color is lochia ruba and when do you see it
one to three days bright red
what color is lochia serosa and when do you see it
4 to 10 days pinkish brownish color
what color is lochia Alba and when do you see it
over 10 days white to yellow color
what is the treatment for hemorrhoids
ice packs, which Hazel, laying on side, topical ointments, sit on firm surface because soft surfaces will decrease blood flow and increase pain
what is after pain postpartum
intermittent uterine contractions it is worse for multi Paris, pain or worse when breastfeeding because of the release of oxytocin
what are some interventions you can do for pain postpartum
sitz bath, cold first 24 hours then heat, topical creams and sprays can also use non pharmacological methods
when should postpartum pain end
5 to 7 days
what medication can you give prior to breastfeeding for pain
Motrin give 30 minutes before
what should you document for postpartum pain
onset, location, type, duration, factors that make it better or worse
what is hemorrhage and when do you see it
first one to two hours observe closely for hemorrhage it is blood loss over 1000 MLS for C-section or 500 MLS for vaginal birth
when is late postpartum hemorrhage
after first 24 hours and up to 12 weeks
what is postpartum hemorrhage caused by
retained placenta fragments, sub involution of uterus
when is early postpartum hemorrhage
within the 1st 24 hours postpartum more likely in the first four
What is early postpartum hemorrhage caused by
laceration, uterine atony, hematoma
what are the signs of early shock
restlessness, increased heart rate, pallor, cold clammy hands, decrease UOP
what is the management done for hemorrhage
stop the blood loss, first you want to massage the uterus, IV fluids, blood transfusion, O2, Foley Cath vital signs including fundus and lochia Q 15 minutes till stable, uterine packing, balloon tamponade, ligation of uterine arteries, hysterectomy, give oxytocin/methergine/hemabate
what could bleeding without clots mean
retaining placental fragments
what could bright red bleeding with clots mean
laceration
after the dangers of hemorrhage and shock have passed what are you worried about now
infection especially uterine infection
what are the risks for infection
the uterine cavity because it’s an open wound, placental site because it’s an open wound, surgical incision, cracks in the nips, increased pH in vaginal secretions
how do you prevent infection postpartum
wash hands, keep incisions clean with Perry bottle frequent pad changing after every feed, check incisions, pat after voiding from front to back, sitz bath
what do hemoglobin levels do postpartum
decrease one gram from vaginal, 2 grams for C-section normal is 12 to 16
what does estrogen and progestrogen do postpartum
dramatically decrease after delivery of placenta, also signals pituitary gland to release prolactin which prepares for lactation
what does hematocrit do postpartum
should return to pre pregnancy levels by four to six weeks normal is 36 to 48%
what is a hematoma
localized collection of blood under the skin following injury or laceration of blood vessels without injury to outer tissue, often in vulva but can occur in vaginal wall
what are the risks for hematoma
lacerations, episiotomies, operative vaginal deliveries like forceps, difficult or prolonged second stage of delivery, nulli para
what is the treatment for hematoma
if three to five centimeters palliative care with ice packs for first 24 hours, pain meds and observation if over 5 centimeters then incision and drainage which will increase the risk for infection
what are the signs of the hematoma
swelling, redness, warmth, pelvic pain, increased pulse, decreased BP, decrease HCT, fundal check is normal, moderate to scant lochia which is normal
what happens with ovulation postpartum
menstruation usually resumes 6 to 8 weeks for non breastfeeding if they are exclusively breastfeeding they may not ovulate for three months most men straight by 12th week first cycle is anovulatory but ovulation can proceed menstruation
what is mastitis
usually two to three weeks postpartum, milk stasis or infection entering cracks in the nips
what are the signs of mastitis
redness, heat, tenderness, edema
what is the treatment for mastitis
antibiotics, removing milk from breasts, lots of hydration, applying heat or cold for comfort
What is the appearance postpartum
they still look pregnant because abdominal muscles have been stretched takes 6 to 8 weeks to get back to pre pregnancy
What is diastasis
separation of abdominal muscles
what is the teaching of exercise postpartum
If they exercise before and during they could probably go back to a modified workout they’re starting a new routine that could take 10 to 12 weeks
what is rubella vaccine given postpartum
if not immune then it is given immediately postpartum to prevent complications for future pregnancies teach that you should not get pregnant at least one month after
who gets RhoGAM
given to RH- mom who has Rh+ baby gets 128 weeks and another one 72 hours postpartum
what is the taking in phase
it is early in postpartum the mom is passive with care, reliving birthing experience, focusing on food fluids and restorative sleep
what is the taking hold phase
mom cares for infant, increased concern for body function, cares for herself, interested in learning to care for baby
what is the letting go phase
mom lets go of previous role and sees parenting as primary role, reconciles with how birth went and how she wanted it to go
what are postpartum Blues
normal to feel a little down but overall happy with life related to withdrawal of estrogen and progesterone and cortisol
what is the treatment for postpartum Blues
support and reassurance
what is postpartum depression and when does it happen
two to four weeks postpartum persistent mood of unhappiness, mom can’t care for herself or baby
what are signs of postpartum depression
sleep issues, guilt, fatigue, helplessness, worthlessness feeling
what is the treatment for postpartum depression
referred promptly for eval
what are the signs of postpartum psychosis
delusions, hallucinations, agitation, inability to sleep, irrational behavior
what assessment is done for postpartum psychosis
Edinburg assessment
how often should a mom pee postpartum
Q4 hours need to change Perry pad every time
what are the signs of a UTI
painful urination, foul odor to urine, lower abdominal pain
how often should you use a Peribottle or sitz bath
three times a day should be used until bleeding stopped or perineal discomfort relieved
what should you teach a mom who had a vaginal delivery when to call the doctor
temp 100.4 or more, flu like symptoms, assess for bleeding like soaking a pad in an hour or more bright red bleeding, large clots, foul smelling discharge
what should you teach the mom to avoid postpartum
tampons, douches, sex or anything up the vagina for six weeks
what is the teaching involved for C sections postpartum
pat incision dry, steri strips will eventually fall off, call the doctor of signs of infection including temp, drainage, swelling, watch for dehiscence
what should you encourage postpartum for nutrition
well balanced diet including healthy low fat diet with protein carbs fruit and veggies
when is follow up postpartum
two weeks and six weeks for C-section six weeks for vaginal
