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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
First menses lactating women
3-18 months
26
Is breastfeeding a reliable form of contraception
No, ovulation may occur before menstruation. Unless mother exclusively breastfeed and infant is younger than 6 months
27
Affect on GI system
decreased peristalsis due to analgesics, sx, diminished intrabdominal pressure, low-fiber diet, insufficient fluids, diminished muscle tone
28
How long can you be on colase post-partum?
6 weeks
29
How long before first BM typically?
3-4 days after birth
30
How long before breast milk is produced
4-5 days (colostrum immediately)
31
Hormones involved in breast milk
progesterone, estrogen, prolactin, and oxytocin
32
Prolactin "behavior"
Increase with the decrease in estrogen and progesterone Released from anterior pitutiary Initiates milk production
33
Oxytocin
released from posterior pituitary Promotes milk let-down
34
What causes engorgement
increase in blood and lymph supply as precursor to lactation
35
When does engorgement peak
3-5 days postpartum | subsides within following 24-36 hours
36
Edu for engorgement
Frequent emptying | Standing in warm shower or applying warm compress immediately before feedings
37
Who should not breast feed
Drugs - antithyroid - antineoplastic - alcohol - street drugs HIV newborn with galactosemia or PKU Mother with serious mental health disorder
38
How long to breast feed?
At least first year of life
39
Priority with newborn when delivered!
Dry! Then assessed Then kangaroo
40
Relief measures for woman not breastfeeding
supportive bra 24 hours daily Apply ice to breasts 15-20 minutes every other hour No sex No warmth (hot shower)
41
Vital Signs for vaginal birth vs C/S
``` 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
Risk factors of postpartum infection (9)
``` 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
Risk factors for hemorrhage
``` 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
Postpartum assessment
``` B - breasts U - uterus B - bladder B - bowels L - lochia E - epsiootyomy/laceratio/ perineum/ epidural site E - extremities, DVT E - emotions ```
45
When should spontaneous voiding occur post partum?
by hours 8
46
what to assess for lochia
amount, odor, consistency
47
Lochia amounts
scant: 1-2" on pad - 10 mL light: 4", 10-25 mL moderate: 4-6", 25-50 mL Heavy: saturated in 1 hr
48
How to position for episiotomy/perineum assessment
On side with top leg flexted upward at knee and drawn up toward waist
49
Episotomy healing time
majority in first 2 weeks | may take up to 6 months
50
Laceration degrees
1st: involves only skin and superficial structures 2nd: extend through perineal muscles 3rd: extends through anal sphincter 4th: through anterior rectal wall
51
Side effects of epidural med
itching, n/v, urinary retention (doc I and Os)
52
Why are postpartum at risk for DVTs? (4)
- Hypercoaguability protects mother against excessive blood loss (altered coagualiton) - stasis - compression of large veins because of gravid uterus - Localized vascular damage
53
Risk factors for thromboembolism
``` 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
Discharge times
v: 48 hrs | C/s: 96 hrs
55
Cutlural - muslim
``` 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
Postpartum warning signs
``` fever > 100.4 UTI symptoms increased bleeding with foul smell blurred vision and persistent headach overwhelming sadness ```
57
How do nurses assist in attachment
promote kangaroo care encourage breast feeding encourage talking, changing diapers etc.
58
Vaccinations
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
Rh negative mothers What to do if baby is Rh +
check newborn status (Rh+??) verfify that mom's indirect Coomb's is negative give Rh immunoglobulin within 72 hours of birth (Rhogam)
60
Rubin phases
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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