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Maternity > Chapter 15 and 16: Postpartum > Flashcards

Chapter 15 and 16: Postpartum Flashcards

1
Q

Duration of puerperium

A

~6 weeks (some claim it lasts into the first year)

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2
Q

Involution

A

return of uterus to a non-pregnant state after birth

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3
Q

Subinvolution

A

failure of uterus to return to non-pregnant state

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4
Q

Afterpains treatment

A

mild analgesics

-pains are usually worse during breast-feeding - oxytocin strengthens contractions

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5
Q

Lochia categories (3)

A

rubra
serosa
alba

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6
Q

Rubra

A

deep-red mixture of mucus, debris, and blood that occurs first 3-4 days after birth

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7
Q

Serosa

A

pinkish brown expelled 3-10 days postpartum, contains leukocytes, decidual tissue, RBCs, and serous fluid

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8
Q

Alba

A

Creamy white or light brown consists of leukocytes, decidual tissue, reduced fluid content, 10-14 days but can last up to 6 weeks

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9
Q

how long for cervix to return to pre-pregnant status

Education during this time

A

6 weeks

Abstain from using tampon/having sex

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10
Q

Pelvic muscle edu (3)

A

may require up to 6 months to regain tone
kegels
failure to restore leads to urinary incontinence

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11
Q

How long for cardiac output to return to normal

A

Remains high for 3 days after birth, takes 3 months to reach normal

for first 2 weeks: decrease –> bradycardia (40 to 60bpm)

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12
Q

How long for blood volume to return to normal

A

Drops rapidly after birth, returns to normal within 1 month

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13
Q

post partum increased BP means…

A

possibly preeclampsia

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14
Q

postpartum decreased BP means…

A

infection or uterine hemorrhage

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15
Q

Postpartum tachycardia (>100) means…

A

hypovolemia, dehydration, or hemorrhage

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16
Q

How long for GFR and renal plasma flow to return to normal

A

6 weeks

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17
Q

4 main causes of incomplete emptying, bladder distention, difficulty voiding, and urinary retention

A
  1. anesthetic block during labor
  2. perineal lacerations
  3. generalized swelling and bruising of perineum
  4. hematomas
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18
Q

How can urinary retention affect uterus

A

diplacement of uterus from midline to right
inhibit proper contractions –> postpartum hemorrhage
Major cause of uterine atony

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19
Q

What do frequent small voids (less than 150) suggest

A

Urinary retention with overflow

may need cath

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20
Q

Mechanisms of postpartum diuresis (3)

A
  1. large amounts of IV fluid given during labor
  2. decreasing ANTIdiuretic effect of oxytocin as its level declines
  3. buildup and retention of extra fluids during pregnancy and decreasing production of aldosterone
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21
Q

When does diuresis typically begin after birth? How long does it last? when does normal function return?

A

12 hours
1 week
1 month

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22
Q

What causes postpartum skin changes

A

Drop in estrogen and progesterone

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23
Q

What does breast feeding does to estrogen?

A

Keeps it low

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24
Q

First menses after birth for nonlactating women

A

7-9 weeks, majority take up to 3 months

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25
Q

First menses lactating women

A

3-18 months

26
Q

Is breastfeeding a reliable form of contraception

A

No, ovulation may occur before menstruation. Unless mother exclusively breastfeed and infant is younger than 6 months

27
Q

Affect on GI system

A

decreased peristalsis due to analgesics, sx, diminished intrabdominal pressure, low-fiber diet, insufficient fluids, diminished muscle tone

28
Q

How long can you be on colase post-partum?

A

6 weeks

29
Q

How long before first BM typically?

A

3-4 days after birth

30
Q

How long before breast milk is produced

A

4-5 days (colostrum immediately)

31
Q

Hormones involved in breast milk

A

progesterone, estrogen, prolactin, and oxytocin

32
Q

Prolactin “behavior”

A

Increase with the decrease in estrogen and progesterone

Released from anterior pitutiary

Initiates milk production

33
Q

Oxytocin

A

released from posterior pituitary

Promotes milk let-down

34
Q

What causes engorgement

A

increase in blood and lymph supply as precursor to lactation

35
Q

When does engorgement peak

A

3-5 days postpartum

subsides within following 24-36 hours

36
Q

Edu for engorgement

A

Frequent emptying

Standing in warm shower or applying warm compress immediately before feedings

37
Q

Who should not breast feed

A

Drugs

  • antithyroid
  • antineoplastic
  • alcohol
  • street drugs

HIV

newborn with galactosemia or PKU

Mother with serious mental health disorder

38
Q

How long to breast feed?

A

At least first year of life

39
Q

Priority with newborn when delivered!

A

Dry!
Then assessed
Then kangaroo

40
Q

Relief measures for woman not breastfeeding

A

supportive bra 24 hours daily
Apply ice to breasts 15-20 minutes every other hour
No sex
No warmth (hot shower)

41
Q

Vital Signs for vaginal birth vs C/S

A 
V:
1st hour: Q15 min, temp x1
2nd hour: Q30 min
3rd hour: x1
Then Q8 until discharge

C/S:
Q30 min x 4 hours
Q 1hr x 3 hours
Q 4-8 hrs until discharge

42
Q

Risk factors of postpartum infection (9)

A 
operative procedure
history diabetes
prolonged labor (>24 hrs)
urinary cath
Anemia
many vaginal exams
prolonged ROM (>24 hrs)
Manual extraction of palcenta
Compromised immunity
43
Q

Risk factors for hemorrhage

A 
precipitous labor
uterine atony
placenta previa or abruptio
labor induction or aug.
Operative procedure
retained placental fragments
Prolonged third stage (>30 minutes)
Multiparity
Uterine overdistention (large kid, twins, hydramnios)
44
Q

Postpartum assessment

A 
B - breasts
U - uterus
B - bladder
B - bowels
L - lochia
E - epsiootyomy/laceratio/ perineum/ epidural site
E - extremities, DVT
E - emotions
45
Q

When should spontaneous voiding occur post partum?

A

by hours 8

46
Q

what to assess for lochia

A

amount, odor, consistency

47
Q

Lochia amounts

A

scant: 1-2” on pad - 10 mL
light: 4”, 10-25 mL
moderate: 4-6”, 25-50 mL
Heavy: saturated in 1 hr

48
Q

How to position for episiotomy/perineum assessment

A

On side with top leg flexted upward at knee and drawn up toward waist

49
Q

Episotomy healing time

A

majority in first 2 weeks

may take up to 6 months

50
Q

Laceration degrees

A

1st: involves only skin and superficial structures
2nd: extend through perineal muscles
3rd: extends through anal sphincter
4th: through anterior rectal wall

51
Q

Side effects of epidural med

A

itching, n/v, urinary retention (doc I and Os)

52
Q

Why are postpartum at risk for DVTs? (4)

A
  • Hypercoaguability protects mother against excessive blood loss (altered coagualiton)
  • stasis
  • compression of large veins because of gravid uterus
  • Localized vascular damage
53
Q

Risk factors for thromboembolism

A 
anemia
DM
cigs
obesity
preeclampsia
hypertension
severe varicose
pregnancy
oral contraceptives
C/S
severe infection
PRevious thromboembolic disease
Multiparity
bed rest for >4 days
advanced maternal age
54
Q

Discharge times

A

v: 48 hrs

C/s: 96 hrs

55
Q

Cutlural - muslim

A 
modesty
no pork
same-sex provider
stays in house 40 days after birth
women exempt from obligatory 5-times-daily prayers if they have lochia
extended family present
56
Q

Postpartum warning signs

A 
fever > 100.4
UTI symptoms
increased bleeding with foul smell
blurred vision and persistent headach
overwhelming sadness
57
Q

How do nurses assist in attachment

A

promote kangaroo care
encourage breast feeding
encourage talking, changing diapers etc.

58
Q

Vaccinations

A

Rubella for mothers who are not immune (attenuated virus is not communicable)
Avoid getting pregnant for 28 days

Tdap: tetanus, diphtehria, acellular pertussis - give to mom

Flu - safe in pregnancy and postpartum

59
Q

Rh negative mothers

What to do if baby is Rh +

A

check newborn status (Rh+??)
verfify that mom’s indirect Coomb’s is negative

give Rh immunoglobulin within 72 hours of birth (Rhogam)

60
Q

Rubin phases

A

Taking in phase: the mother is very passive and is dependent on others to care for her for the first 24 to 48 hours after giving birth.

Taking hold phase:
Gaining self-confidence would characterize a mother in the taking-hold phase, during which the mother demonstrates mastery over her own body’s functioning and feels more confident in caring for her newborn.

Letting go phase:
when the mother begins to separate from the symbiotic relationship she and her newborn enjoyed during pregnancy and birth.

Maternity (8 decks)

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