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PNC 102 lecture > chapter 12: postpartum nursing care > Flashcards

chapter 12: postpartum nursing care Flashcards

1
Q

support family dynamic

A
  • include family members in teaching and care
  • provide info about sibling rivalry
  • observe interactions: identify problems, make recommendations and referrals
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2
Q

puerperium

A

period following delivery of placenta until reproductive organs return to a nonpregnant state
- usually about 6 weeks

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3
Q

body begins to change immediately after delivery

A

postpartum shivering: uncontrollable, exact cause unknown, provide w/ a warm blanket, reassure shivering will pass

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4
Q

uterus involution

A

process where oxytocin continues to be released after placenta delivery, causing uterus to contract and shrink
- size and weight decreases
- fundus descents
- afterpains (intermittent uterine contractions)
- exfoliation: sloughing of dead tissue at the placental site

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5
Q

lochia

A

vaginal discharge made up of blood, mucus, and tissue
- may last up to 6 wks
- should get lghter in color and amount over time
- cervical os closes slowly and by day 14 is barely dilated
- vagina: after delivery lacks tone, over 4 wks edema decreases and rugae appear

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6
Q

perineum

A
  • bruised and edematous after delivery
  • muscle tone restored over 4-6 wks
  • kegel exercises promote the return of tone
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7
Q

ovaries and ovulation

A
  • normal function after delivery variable and influenced by breastfeeding
  • menstruation delayed and may not resume for weeks or months if breastfeeding
  • not breastfeeding: may ovulate as early as 27 days after delivery
  • menstruation begins 6-12 wks for bottle feeding women
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8
Q

breasts postpartum

A
  • breasts secrete colostrum before milk is produced
  • nipple stimulation causes prolactin to be released, intiating milk production
  • between second and fourth day breasts engorged with milk
  • breasts may feel warm and tender
  • if not breastfeeding needs interventions to suppress milk production
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9
Q

integumentary system

A
  • abdominal skin resumes its pre pregnancy state except for stretch marks
  • linea nigra fadesbut may never go away
  • melasma fades over days or weeks
  • hair loss resolves
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10
Q

Gi system

A
  • hungry and thirsty after delivery
  • may have sluggish intestinal peristalsis and constipation
  • hemorrhoids can cause pain w/ defecation: stool softener may be prescribed to prevent straining
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11
Q

cardiovascular system

A

60-80% increase in cardiac output after delivery
- loss of plasma volume causes temporary rise in HGB and HCT
fibrinogen levels increase and remain increased for several days after delivery: increases risk for blood clot development

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12
Q

removal of excess fluid stored during pregnancy:

A
  • diuresis: secretion and passage of large amounts of urine

diaphoresis: excessive perspiration

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13
Q

respiratory system

A
  • diaphragm returns to normal position
  • respiratory rate returns to prepregnancy level
  • pregnancy nasal congestion disappears quickly
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14
Q

urinary system

A
  • bladder tone decreases
  • bladder becomes distended and pushes uterus up andto the side
  • displaced uterus can interfere w/ involution and can lead to hemorrhage
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15
Q

musculoskeletal system

A
  • hormone relaxin begins to subside
  • hip pain may continue for a few days
  • diastis recti of abdominal muscles may occur: separation of abd wall muscles, corrected w/ exercises or surgery
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16
Q

uterine assessment

A
  • palpate fundus: note position and location, never palpate without supporting lower segment
  • assess consistency
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17
Q

boggy uterus

A

support lower uterine segment and massage in circular pattern with flattened other hand until uterus becomes firm
- if massage not effective, large blood clot or extreme uterine atony which can lead to postpartum hemorrhage
- full bladder can lead to uterine atony

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18
Q

lochia assessment

A
  • inspect amount and character during uterine massage
  • should be getting better not worse
  • no big clots
19
Q

lochia lasts…

A

3-6 wks, occurs in three stages:
lochia rubra
lochia serosa
lochia alba

20
Q

lochia rubra

A

first discharge, dark red blood

21
Q

lochia serosa

A

3-4th day, brownish red, lighter color

22
Q

lochia alba

A

over 1-2 wks, lighter and yellowish color

23
Q

amount of lochia

A
  • scant: less than 1 in of lochia on pad
  • light: less than 4 in of lochia on the pad
  • moderate: less than 6 in of lochia on pad
  • moderate: less than 6 in of lochia on the pad
  • heavy: pad is saturated within an hr (should not happen)
24
Q

nursing care during first hour after delivery

A
  • most dangerous hour: due to risk of hemorrhage
  • check vital signs every 15 min
  • palpate fundus
  • assess uterine tone and amount of vaginal bleeding
  • when stable, transfer to postpartum or mother baby unit
25
Q

Bubble

A

breasts, uterus, bladder, bowels, lochia, episiotomy/laceration, legs, and emotions

26
Q

breasts

A
  • assess for breast and nipple pain
  • pt teaching guidelines: managing engorgement for the non breastfeeding pt
27
Q

uterus

A

palpate for location and consistency: firm and in the midline

document location of fundus in relationship to umbilicus

28
Q

bladder

A

palpate when assessing the fundus

distention should not be present

29
Q

bowels

A
  • auscultate bowel sounds
30
Q

lochia

A

assess and document amount and type

31
Q

episiotomy/laceration

A

inspect perineum for bruising, erythema, edema, hematoma (collection of blood in subcutaneous space), intactness of repair

32
Q

legs

A

assess for leg pain, adequate circulation, edema, temp

33
Q

emotions

A
  • when placenta is expelled, sudden drop in progesterone
  • notice emotions and postpartum blues
34
Q

nursing care following cesarean birth

A
  • monitor uterine involution and lochia
  • postop care to prevent complications
  • assess pain and cesarean incision
35
Q

nursing care of the adolescent postpartum

A
  • same assessment and physical care
  • more structured teaching: care of the newborn and herself
  • treat as an adult
  • encourage questions
  • direct teaching to teenager, not parents, and include father in teaching if present
  • role model infant care
  • encourage bonding during the taking in phase
  • at higher risk for postpartum depression
36
Q

nursing care for the woman who relinquishes her infant for adoption

A
  • find out the pts birth plan: may want the adoptive parents present at the birth or called after the birth
  • may want to hold the infant then ask infant be kept in nursery
  • may not want to see or hold infant at all
  • provide empathetic care
  • requires same physical care and teaching as any postpartum pt
  • higher than average risk of postpartum depression
37
Q

three phases of postpartum adjustment

A
  1. taking in phase
  2. taking hold phase
  3. letting go phase
38
Q

taking in phase

A
  • mother centered on own needs
  • feels dependent and needs mothering
  • may not initiate interaction w/ the newborn
  • use the en face position
  • identify the infant
  • begin the bonding process: start of lifelong relationship
  • taking in phase may last a day or two
39
Q

taking hold phase

A
  • mother initiates care of the baby
  • wants to be more independent
  • concerned and anxious about own physical care, breastfeeding, and abby care
  • requires praise and positive reinforcement
  • open to learning
  • may last up to 10 or more days
  • may experience postpartum blues
40
Q

letting go phase

A
  • letting go of being childless and more independent
  • attachment w/ newborn occurs
  • learnsto understand her infant’s cries and body language
  • receives positive feedback from the infant when needs are met
  • learns to trust herself and instincts
41
Q

development of family attachment

A
  • family attachment may take more time
42
Q

prep for discharge

A
  • administer MMR to woman found suscpetible to rubella during pregnancy
  • those in contact w/ newborn should have up to date Tdap
  • teaching should occur in small segments throughout hospital stay
  • self care instructions should be written and verbal
43
Q

self care instructions

A
  • sutures for lacerations and the episiotomy repair will dissolve
  • perineal care: ibuprofen/acetaminohen for pain, sitz baths
  • menstrual pad changes, no tampons or douche until follow up
  • breast care: supportive bra
  • hand hygiene before breastfeeding and every diaper change
44
Q
A

PNC 102 lecture (42 decks)

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