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Maternal Newborn (Mine) > Chapter 17: Postpartum Physiological Adaptations > Flashcards

Chapter 17: Postpartum Physiological Adaptations Flashcards

1
Q

why encourage early breastfeeding for a client who is lactating?

A

will stimulate the production of natural oxytocin and prevent hemorrhage

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2
Q

an elevated temperature of what AFTER first 24 hours could be a sign of infection?

A

38 degrees C

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3
Q

excessive spurting of bright red blood can indicate?

A

cervical or vaginal tear

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4
Q

is postpartum chill normal?

A

yes, unless accompanied by an elevated temp

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5
Q

what is the intervention for a distended bladder?

A

have client empty bladder frequently (every 2-3 hours) or catheterize if necessary

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6
Q

physical changes of the vagina after birth?

A

returns to prepregnancy size with the reappearance of ruggae and thickening of vaginal mucosa

muscle tone is never completely restored

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7
Q

what does postpartum period begin and end with?

A

delivery of placenta and when the body returns to pre-pregnant state

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8
Q

how much is moderate amount of blood?

A

more than 10cm

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9
Q

decreased progesterone levels can cause

A

an increase in muscle tone

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10
Q

temperature should be assessed how often?

A

every 4 hours for the first 8 hours after birth then at least every 8 hours

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11
Q

with diaphoresis & diuresis, excess fluid occurs within how many days

A

the first 2-3 days

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12
Q

what to administer after the placenta is delivered and why?

A

oxytocics IM or IV to promote uterine contractions and prevent hemorrhage

can also give misoprostol, a prostaglandin

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13
Q

what to assess vagina for?

A

episiotomy and lacerations for approximation, drainage, quantity, and quality

bright red trickle of blood from episiotomy site is normal

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14
Q

second stage of lochia

A

lochia serosa

seen approx. 4-10 days after delivery
pinkish brown serosanguineous appearance

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15
Q

varicosities are common where?

A

legs and around anus (hemorrhoids)

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16
Q

how much is scant amount of blood?

A

less than 2.5cm

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17
Q

nursing assessment for uterus after recovery period?

A

assess fundal height, uterine placement and consistency at least every 8 hours

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18
Q

afterpains is more painful in?

A

breast-feeding clients, multiparous clients, and clients who had an “over-distended” uterus

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19
Q

what happens to the endocrine hormones after the delivery of the placenta?

A

estrogen, progesterone, and insulinase levels drop dramatically

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20
Q

milk changes of the breasts

A
  • secretion of colostrum; occurs during pregnancy and 2-3 days after birth
  • milk is produced 3-5 days after birth
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21
Q

physical changes of the breasts

A
  • breasts become heavier and fuller 72-96 hours after birth

- breasts may feel warm, firm, and somewhat tender

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22
Q

what to do if fundus is boggy (not firm)?

A

lightly massage in circular motion

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23
Q

the uterus is palpated at where 12 hours after birth?

A

at or up to 1 cm above umbilicus

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24
Q

education about proper cleansing to prevent infection

A
  • wash hands thoroughly before and after voiding
  • use a squeeze bottle filled with water or antiseptic solution after voiding to cleanse perineal area
  • clean perineal area from front to back
  • blot don’t wipe
  • sparingly use topical application of antiseptic cream or spray
  • perineal pad should be changed from front to back after voiding
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25
what is the normal range for respirations after birth?
16-24 breaths/min
26
when does ovulation and menses return for nonlactating clients?
ovulation happens in 27-75 days menses resume by 4-6 weeks
27
contractions facilitate?
homeostasis at the former placental site
28
true or false: Coagulation factors and fibrinogen levels decrease soon after birth?
False, it stays elevated for 2-3 weeks postpartum
29
what increases the risk of temporary postpartum anal incontinence?
operative vagina birth and anal sphincter lacerations
30
postpartum chill
occurs in the first 2 hours puerperium, an uncontrollable shaking chill immediately after giving birth
31
how often do you do your postpartum assessments?
every 15 mins for first hour every 30 mins for second hour hourly for next 2 hours then 4-8 hours depending on provider's orders
32
decreased progesterone levels can cause
breast engorgement, diaphoresis, diuresis, and diminished vaginal lubrication
33
oxytocin and misoprostol can cause?
hypotension
34
the fourth stage of labor lasts how long?
1-4 hours
35
what is the greatest risks during the postpartum period?
hemorrhage, shock, and infection
36
comfort measures of perineal area
- apply ice packs for first 2-48 hours to reduce edema and provide anesthetic effect - encourage fitz baths at least twice a day - administer analgesia
37
what is contraindicated for client's who have third or fourth degree perineal lacerations?
enemas and suppositories
38
postpartum assessments immediately following delivery include?
monitoring vital signs uterine firmness & its location in relation to umbilicus uterine position in relation to midline of abd. amount of vaginal bleeding
39
what happens to total blood volume after delivery which results in what?
decreases, results in a transient anemia
40
what is the normal range for pulse after birth?
50-90 bpm
41
what happens with cardiac output?
remains elevated for first 48-72 hours then returns to prepregnant state within 6-12 weeks
42
cause of postpartum chills
ossibly related to nervous system response, vasomotor changes, shift in fluids, and/or the work of labor
43
nursing interventions of abnormal lochia
notify provider and perform prescribed interventions based on cause
44
physical changes of the uterus?
decreases in size from 1kg to 60-80g fundal height descends into pelvis 1cm per day accomplished within 6 weeks
45
what can hypercoagulability predispose a postpartum client to have?
thrombus formation and thromboembolism
46
how fast will the cervix regain its form, become firm, with the os gradually closing?
within 2–3 days postpartum
47
when does varicosities begin to regress/empty?
rapidly after childbirth
48
who is Rho(D) immunoglobulin is given to and for what reason?
women who are Rh-negative and gave birth to infants who are Rh-positive within 72 hours to prevent sensitization in future pregnancies
49
what happens to BP after birth?
usually remains unchanged but can be slightly elevated
50
continued flow of lochia series or alba beyond the normal length of time can indicate?
endometritis, esp. if accompanied by fever, pain, or abdominal tenderness
51
Kleihauer-Betke test
determines the amount of fetal blood in maternal circulation if a liar fetomaternal transfusion is suspected
52
the uterus is palpated where just after birth?
at or up to 3 cm below umbilicus
53
how much blood loss during childbirth?
vaginal - 300-500 mL (10% of blood volume) c-section - 500-1,000 mL (15%-30% blood volume)
54
first stage of lochia
lochia rubra lasts approx. 1-3 days after delivery bloody, bright to dark red appearance, fleshy odor, can contain small clots flow increases during breastfeeding and upon rising
55
decreased insulinase can cause
a reversal of diabetogenic effects of pregnancy
56
what is involution of the uterus?
occurs with contractions of the uterine smooth muscle and uterus returns to its pre-pregnant state
57
when does first postpartum ovulation happen in breastfeeding clients?
approx. 6 months after
58
what happens with a client's appetite following delivery?
increased, client should have a good appetite
59
physical changes of the perineum?
edema with bruising can be common, esp with episiotomy or lacerations hematoma or hemorrhoids can be present pelvic floor muscles may be overstretched and weak
60
an elevated temperature of 100.4 during the first 24 hours is due to?
dehydration
61
how much is heavy amount of blood?
one pad saturated in 2 hours
62
what are the comfort measures to soften a client's stools and promote bowel function?
early ambulation, increased fluids, and high-fiber food sources
63
lacerations of the cervix can delay the production of?
estrogen-influenced cervical mucus, a predisposing factor of infection
64
nursing interventions for postpartum chill
pprovide warm blankets and fluids | assure client that chills are a self-limiting common occurrence that will only last a short while
65
persistent lochia rubra in the early postpartum period beyond day 3 can indicate?
retained placental gragnebts
66
does hypovolemic shock happen due to the blood loss? why or why not?
doesn’t usually occur because of the uterus reducing rapidly in size and elimination of placenta putting back 500 mL of blood into maternal systemic circulation
67
a pulse rate greater than what needs to be reported?
100 bpm
68
physical changes of the uterus include
involution of the uterus
69
how much is excessive blood loss?
one pad saturated in 15 mins or less, or pooling of blood under butt
70
oxytocics include?
oxytocin, methylergonovine, and carboprost
71
how long does it usually take for the body to return to the pre-pregnant state?
approx. 6 weeks
72
WBC levels increase or decrease during the first 10-14 days postpartum? what are the common values?
increase 20,000 to 25,000mmm^3
73
what causes the uterus to be displaced to one side, usually the right?
a distended bladder as a result of urinary retention
74
what happens with serum prolactin levels in nonlactating clients?
levels decline within 3 weeks
75
a focused postpartum physical assessment should include assessing the client's?
B: Breasts U: Uterus (fundal heigh, uterine placement, and consistency) B: Bowel and GI function B: Bladder function L: Lochia (color, odor, consistency, and amount [COCA]) E: Episotomy (edema, ecchymosis, approximation) vital signs teaching needs
76
physical changes of the cervix after birth?
soft and can be edamatous, bruised, small lacerations
77
why encourage emptying of the blade every 2-3 hours?
to prevent possible uterine displacement and atony (failure to contact)
78
foul odor can indicate?
infection
79
what to assess perineum for?
erythema, edema, and hematoma
80
numerous clot and excessive blood loss (saturation of one pad in 15 min or less) can indicate?
hemorrhage
81
lochia
post-birth uterine discharge that contains blood, mucus, and uterine tissue
82
how much is light amount of blood?
2.5-10cm
83
what to inspect with lochia?
color, amount, consistency, and odor
84
blood pressure and pulse should be assessed how often?
at least every 15 mins for first 2 hours after birth
85
what happens with serum prolactin levels in breastfeeding clients?
levels remain high
86
third stage of lochia
lochia alba lasts approx. day 11 up to and beyond 6 weeks postpartum yellowish to creamy white, fleshy odor
87
which hormone coordinates and strengthens uterine contractions?
oxytocin
88
bowel elimination may not resume until how many days?
2-3 days
89
methylergonovine, ergonovine, and carbopost can cause?
hypertension
90
afterpains are caused by?
intermittent uterine contractions following delivery
91
what is indicative of frequent voiding of less than 50 mL of uterine?
urinary retention with over flow
92
hematocrit levels increase or decrease during puerperium?
decrease
93
reasons for ineffective newborn feeding patterns
maternal dehydration maternal discomfort newborn positioning difficulty with newborn latching onto breast
94
what are the different positions for breastfeeding?
football hold (under the arm) cradle across the lap (modified cradle) slide-lying
95
what is the importance of proper latch techniques?
to prevent nipple soreness

Maternal Newborn (Mine) (3 decks)

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