Class 3 Study Guide

Question 1

Subinvolution

Answer 1

delayed return of uterus to its non-pregnancy size and consistency

can cause hemorrhage

Question 2

Lochia:

Scant-
Light-
Moderate-
Heavy-
Excessive

Answer 2

scant: less than 1 in
L: 1-4 in
M: 4-6 in
H:1 pad in an hour
E: 1 pad in 15 mins

Question 3

dyspareunia

Answer 3

discomfort during intercourse due to vaginal dryness cause by lack of estrogen production during lactation/breastfeeding

Question 4

Episiotomy

first degree
second degree
third degree
fourth degree

Answer 4

1st: involved superficial vaginal mucosa or perineal skin
2nd: involves vaginal mucosa, perineal skin and deeper tissues that may be fascia or muscle
3rd: same as second, but involves anal sphincter
4th: extends to anal sphincter and rectal mucosa

Question 5

Why is protein and acetone found in urine during first few days postpartum?

Answer 5

protein: results from catobolic process of involution
acetone: suggest dehydration

Question 6

What does diastasis recti usually resolve?

Answer 6

seperation of abdominal rectus muscles that ussualy resolves within 6 weeks postpartum

Question 7

Hair loss and pospartum

Answer 7

hair loss begins at 4-20 weeks after delivery and is regrwn in about 4-6 months

caused my hormonal changes

Question 8

What s/s to do you monitor for what may indicate developing or worsening preeclampsia?

Answer 8

headache
proteinuria
blurred vision
photophobia
abdominal pain

Question 9

Describe normal weight loss during postpartum

Answer 9

about 12 lbs lost during child birth which is weight of fetus, placenta, amniotic fluid, and blood loss

additional 9 lb during first 2 weeks and another 5.5 by 6 months

younger and lower prepregnnacy weight loose weight quicker

most women retain about 2.2 lb per pregnancy

Question 10

List risk factors for hemorrhage

Answer 10

grand multiparity
over distention of uterus (LGA, twins, hydramnios)
rapid/prolong labor
retained placenta
placenta previa/abrupto
drugs (tocolytics, mag sulfate, oxytocin)
operative procedures (vacuum, forceps, c/s)
uterine fibroid
history of hemorrhage
preeclampsia
coagulation defects

Question 11

List risk factors for infection

Answer 11

operative procedures (vacuum, forceps, c/s)
multiple cervical examinations
prolonged labor
prolonged ROM
manual extraction of placenta or retained fragments
DM
catherization
bacterial colonization of genital tract

Question 12

How much food/fluid is encouraged within first 24 hours post delivery?

Answer 12

food should be readily available at all times

2500 mL of fluids a day

Question 13

Why is bonding a nursing priority during postpartum and ways a nurse may promote bonding

Answer 13

Bonding is the initial attraction felt by parents for their infants
Bonding is enhances when parent and infant are permitted to touch and interact within first 30-60 mins
Infant may be placed on mothers chest after delivery and nurses may put off procedures to mother and baby can bong

Question 14

How can you assess maternal adaption?

Answer 14

Progression through puerperal phases:

• taking in (passive, dependent)
• taking hold (autonomous, seeks information)
• letting go (relinquishes fantasy baby)

Maternal Mood:
-mood, energy, eye contact, posture, comfort

Factors that affect mood:

• age of mother (teens may need support)
• previous experiences
• maternal and infant temperaments
• c/s

Interaction with infant:

• maternal touch (progress from fingertip to enfolding)
• verbal interaction (progress from calling infant it to name)
• response to infant cues or signals

Preparation for parenting:
-breastfeeding classes, parenting or infant care

Question 15

Caloric requirements for full term newborn

Answer 15

85-100 kcal/kg is breastfed

100-110 kcal/kg if formula fed

Question 16

Fluid requirements for full term newborn

Answer 16

60-100 mL/kg first 3-5 days of life and gradually increase to 150-175 mL/kg

Question 17

Colostrum

Answer 17

Higher in protein, vitamens and minerals
Rich in IgA
low in carbs, fat, and lactose

Develops during pregnancy and early days following birth

Question 18

Transitional Milk

Answer 18

milk amount increases dramatically
immuglobulins and protein decrease lactose, fat and calories increase
vitamin content same as mature milk

Begins at day 2-3, and ends around day 10

Question 19

Mature Milk

Answer 19

Contains about 20kcal/oz
nutrients sufficient to meet infants needs
provides imunoglobulins and other antibacterial components

Comes in around day 10

Question 20

How often should the infant be breastfed?

Answer 20

every 1.5 to 3 hours with about 8-12 feedings per 24 hours

Question 21

How can you tell if the baby is getting enough milk

Answer 21

• counting # of wet and soiled diapers, infants should have 3-4 wet diapers and 4 stools daily.
• infant weight gain

Question 22

Latch Scoring

Answer 22

L: latching onto breasts = 2, repeated attempts=1, no sustained latch=0

A:audible swallowing=2, few swallows=1, no swallowing=0

T: Type of nipple, everted=2,flat=1, inverted=0

C: comfort, soft nontender breast=2, redness or mild-moderate discomfort=1, severe discomfort =0

H: hold/position of the infant. no assistance needed =2, some assistance =1,more requires staff to position=0

Question 23

Drug transfer and breastfeeding

Answer 23

• most medications pass through breast milk to some degree and are safe for lactation, but always double check with provider.
• if medication passes in large amounts and isn’t safe for infant, pump and dump temporarily until medications are no longer being taken.

Question 24

Breastfeeding and HIV/Hep B

Answer 24

• Contraindicated with HIV

- Mothers with Heb A, B, C can breast feed, if hep B infant should receive HBIG and HBV vaccine

Question 25

breastmilk storage

Answer 25

• fresh unrefrigerated milk should be used within 1 hour
• freezer for 1 month
• deep freezer for 6 months
• refrigerated 48 hours

Question 26

Formula teaching

Answer 26

• ready to use formula shouldn’t be diluted and if opened, use within 48 hours
• concentrated requires dilution and if opened, use within 48 hours
• powdered requires 2 oz of water, is not appropriate for immunocompromised infants due to bacterial growth