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OB > Exam 1: Postpartum lecture 3 > Flashcards

Exam 1: Postpartum lecture 3 Flashcards

Care/coping of the postpartum patient Assessment- BUBBLEHE Postpartum depression/blues Postpartum medications Postpartum Hemorrhage

1
Q

Postpartum: what is it?

A

critical transitional time
-last about 6 weeks

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2
Q

Postpartum: Materanal physiologic Adaptations - Involution

A

NORMAL
the return of the uterus to a non-pregnant state after birth
- begins immediately after the placenta is delivered (decrease of estrogen+ progesterone) with contractions of the uterine muscle

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3
Q

Postpartum: Materanal physiologic Adaptations - SUBinvolution

A

ABNORMAL
The failure of the uterus to return to the non-pregnant state
-common causes are retained placental parts + infx

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4
Q

Postpartum: Materanal physiologic Adaptations - Lochia

A

NORMAL
right after delivery
-vaginal discharge lasting 4-8 weeks
-color changes result from the changing composition of the tissue expelled

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5
Q

Postpartum: Materanal physiologic Adaptations - Lochia Types

A

-Lochia rubra
-Lochia serosa
- lochia alba

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6
Q

Lochia: what patient should know

A

-color
-smell
-amount to expect

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7
Q

Lochia normal findings

A

-lochia at any stage SHOULD have a fleshy smell

-amounts that are normal: scant, light, + moderate

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8
Q

Lochia abnormal findings

A

-Offensive oder usually indicates an infx

-amount that is abnormal: Heavy amount (saturated in 1 hr)

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9
Q

Lochia rubra: color + lasts for how long?

A

NORMAL
-bright red
-lasting 1-4 days
-within hospital setting

(remember R comes before S)

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10
Q

Lochia serosa: color +lasts for how long?

A

NORMAL
-pinkish brown color
-containing old blood + serum tissue debris
-occurring AFTER rubra lasting 3-10 days

(remember R comes before S)

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11
Q

Lochia alba: color + lasts for how long?

A

NORMAL
-creamy white/light brown
-containing leukocytes + decidual tissue
-lasting 10-14 days + can last 3-6 weeks

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12
Q

Postpartum Maternal physiologic adaptations: Afterpains

A

breastfeeding + IV or IM oxytocin stimulate contractions

-for 1st time pregnancies: mom’s uterine tone is good w/mild contractions

-subsequent pregnancies (more than 1 pregnancies): more acute + uncomfortable cramping.
-more cramping when uterus has been over distended.

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13
Q

Postpartum Maternal physiologic adaptations: Cervix expected findings

A

-internal cervical os gradually closes + returns to normal BY 2 WEEKS

-external os widens + NEVER regains it pre-pregnancy appearance (it appears as a jagged slit-like opening)

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14
Q

Postpartum Maternal physiologic adaptations: Vagina + Perineum

A

-estrogen deprivation that occurs after birth is responsible for causing the thinness of the vaginal mucosa + absence rugae

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15
Q

Postpartum Maternal physiologic adaptations: Vagina normal findings

A

-vagina gradually decreases in size + regains tone over serval weeks (4-6w)

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16
Q

Postpartum Maternal physiologic adaptations: Vagina + Perineum -
teaching

A

water-soluble lubricate during intercourse is recommended for estrogen deficiency

-estrogen deficiency is responsible for decreased lubrication

-Pelvic floor muscle training exercises
-pelvic floor tone + promote healing

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17
Q

Postpartum Maternal physiologic adaptations: Perineum normal findings

A

-Perineum stretches + most women will have some degree of perineal trauma during childbirth
-edema + busing first few days
-Episiotomy or laceration may take as long as 4-6 weeks to heal
-Hemorrhoids d/t pushing

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18
Q

Postpartum Maternal physiologic adaptations: Cardiovascular normal findings

A

-CV system undergoes dramatic changes after birth
-blood volume increases during pregnancy + drops after birth + returns to normal within 4 weeks pp

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19
Q

Postpartum Maternal physiologic adaptations: Cardiovascular - Average blood loss for vaginal delivery + c/s

A

-vaginal delivery 300-500 ml
-c/s 500-1000 ml

*if loss more than those than it is considered hemorrhage + can become anemia (tx:iron &/or blood transfusion)

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20
Q

Postpartum Maternal physiologic adaptations: Urinary system normal findings

A

-gradual return of bladder tone + normal size + function of bladder, utters + renal pelvis
-difficulty voiding after delivery can lead to urinary retention, bladder distension, + UTI
-pp diuresis begins within 12 hrs AFTER childbirth + continues throughout the 1st week pp (such as alot of peeing + sweating)

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21
Q

Postpartum Maternal physiologic adaptations: vital signs normal findings

A

-cardiac output returns to prepregant levels by 3 months pp

-a decrease in BP is an expected change in early pp (may suggest hemorrhage or infx)

-temp of 100.4 F in 1st 24 hrs may be d/t dehydration (SHOULD be normal AFTER 24 hrs)

-RR 12-20 bpm @ rest

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22
Q

Postpartum Maternal physiologic adaptations: vital signs abnormal findings

A

-tachycardia/pulse (above 100 bpm) warrants investigation suggest hypovolemia, dehydrations, or hemorrhage

-increase BP (higher than 140/90) may indicate preEclampsia

-BP lower than 85/60 may indicate hemorrhage

-

23
Q

Postpartum Maternal physiologic adaptations: coagulation normal findings

A

-clotting factors increase in pregnancy + remain elevated early pp
-the hyper-coagulable state combined with vessel damage during birth + immobility places women at risk for blood clots

24
Q

Postpartum Maternal physiologic adaptations: musculoskeletal system normal findings

A

-joints stabilized within 6-8 weeks pp
- may notice permanent increase in shoe size

25
Q

Postpartum Maternal physiologic adaptations: Integumentary normal findings

A

-straie gravidarum (stretch marks)
-profuse diaphoresis
-linea nigra (pregnancy line)
-melasma (freckles/dark spots on the face)
-hair loss is temporary

26
Q

Postpartum Maternal physiologic adaptations: endocrine normal findings

A
  • With delivery of placenta there is a rapid clearance of placenta hormones.
    -Estrogen & progesterone drop quickly
    -Prolactin levels increase and remain increased with lactating women.
    -Estrogen levels remain low until breastfeeding frequence decreases.
    -Lactating and non-lactating women differ for first ovulation and establishment of menstruation.
    -Persistence of elevated serum prolactin levels in breast feeding women; suppress ovulation.
    -Ovulation can occur before menstruation.
27
Q

Postpartum Maternal physiologic adaptations: sexual health

A

-birth control
-resuming sexual activity (4-6 weeks)
-discussing sexual activity with patient + partner before discharge is important bc they may resume sexual activity before the 1st pp visit

28
Q

Lactation

A

-After birth: fall in estrogen and progesterone triggers release of prolactin from anterior pituitary gland
-Prolactin levels are highest during the first 10 days PP/remain above baseline for duration of lactation
-Prolactin produced in response in infant suckling and emptying of breasts
-Oxytocin is essential to lactation
-Nipple is stimulated and the posterior pituitary is prompted by hypothalamus to produce oxytocin.
-Oxytocin responsible for the milk ejection reflex or let-down reflex.

29
Q

Postpartum psychological adaptations: normal findings

A

-time of vulnerability to psychiatric disorders
-disrupts family life
-mood/anxiety disorders likely to recur at this time during pp (these meds are not safe for baby intrpartum)
-failure to address may result in tragic consequences

30
Q

Postpartum coping

A

-Assess level of anxiety
-Assess sources of concern
-Identify unmet needs and expectations
-Assess support system of family
-Assess past coping mechanism
-Assess emotional reactions of birth

31
Q

Postpartum emotional reactions: normal findings

A

baby blues

32
Q

Postpartum emotional reactions: abnormal findings

A

-Postpartum depression
-Postpartum anxiety/Panic disorder
-PPD with OCD
-Postpartum Psychosis

33
Q

Baby blues: common signs seen in pp moms

A

due to hormone changes should go away within 2 weeks*

-seen in 85% of new mothers
-sadness
-tear-fullness
-crying spells
-irritability, anxious
-mood swings
-fatigue/sleep caused by sleep deprivation
-appetite disturbance

34
Q

Postpartum depression: risk factors

A

occurs in about 15% of time goes beyond 2 weeks*

-increase risk of PPD among teenage mothers; 50% higher thank older mothers

increased incidence with:
-hx of personal or family of mood disorder

Negative life event such as:
-loss of loved one
-poor marital support
-divorce
-financial difficulties
-thyroid disorders

35
Q

Postpartum depression: common signs seen in pp moms

A

-Depressed mood
Functional impairment
Lack of affectionate bonding
-Changes of sleep pattern or eating pattern
-Excessive fatigue
-Psychomotor agitation
-Feelings of worthlessness
Suicidal ideation
Loss of interest in pleasurable activities

36
Q

PPD: medical management (nonpharm)

A

-Natural course is one of gradual improvement over the six months after birth

Nonpharmacologic options
-Psychotherapy
-support groups

37
Q

PPD: medical management (pharm)

A

Pharmacologic intervention:
- antidepressants
- anti-anxiety agents
- mood stabilizers
- antipsychotics

(pharm interventions done w/nonpharm interventions)

38
Q

PP psychosis

A

most severe of mood disorders in PP period-psychiatric emergency

screening tools to prevent or detect it early

1-2/1000 births
-occurs 1-4 weeks after birth or up to 90 days after birth

39
Q

PP psychosis: characteristics

A

-severely impaired ability
-agitation
-hallucinations **
-delusions**
-paranoia**
-severe mood depression

to look for: depression-sleep, energy level, + fatigue

40
Q

PP assessments: VS, physical, psychosocial done when ?

A

done in L&D
1st hr: Q15 mins
2nd hr: Q 30 mins

done in PP
1st 24hrs after: Q4 hrs
After 24 hrs: Q8 hrs

41
Q

Pain scale: nursing interventions

A

anything 4 or higher want to give tx

42
Q

What does BUBBLE-EE stand for?

A

B- breasts
U- uterus
B- bladder
B- bowels
L- lochia
E-episiotomy /perineum/ epidural site
—–
E- extremities
E- emotional status

43
Q

What does BUBBLE-EE used for?

A

Focus assessment for pp patient

44
Q

Breast assessment normal findings

A

for breastfeeding moms only

nipple status
-erect nipples for good lactation + easy for baby to attach to

45
Q

Breast assessment abnormal findings

A

abnormal nipple status

-nipples are flat or inverted (call for lactation consult)

-any redness, cracks, soreness (give cream)

46
Q

Uterus assessment normal findings

A

important check for hemorrhage or lacerations

normal
-firm uterus
-1st hr fundus is firm @ the umbilicus
-FF @ U
FF -1
FF-2

47
Q

Uterus assessment abnormal findings

A

abnormal
-not firm uterus is called Boggy or uterine acne (massage fundus to firm it)
-uterus is going up to the right side, high up d/t full bladder (encourage mom to use restroom)
-FF+2
FF+1

48
Q

Episiotomy/Perineum/Epidural Site: assessment + nursing interventions

A

-roll pt on their side and look (lift cheek) to check for infx, hemorrhoids, swelling

-keep ice on 1st 24 hrs + apply cream + witch hazel or numbing spray
-still swelling after 24 hr try steam from under toilet + have them sit on seat

49
Q

extremities assessemnt

A

mainly in calves

-no sign of blood clots d/t increase risk
-any SOB or redness/swelling on calves (call provider ASAP)

50
Q

Emotional status assessment

A

-are they attaching w/ baby?
-screening tools for PPD

51
Q

Maternal nutrition

A

-fluids**
-nutrient dense diet for lactating moms
500 extra calories a day

52
Q

infant nutrition: who should not breastfeed?

A

-HIV
-PKU
-Drug abuse

53
Q

prior to discharge immunizations

A

-rubella
-Tdap
-Influenza
- Rh status Rhogam shot (if the mom is Rh - and the baby is Rh + )

54
Q

causes of PPH

A

-tone:uterine atony**
-trauma: laceration/rupture**
-tissue:retained placenta
-thrombin: coagulopathy (bleeding disorder)

OB (8 decks)

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