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exam 3 Flashcards

1
Q

How long does the post partum period last

A

6 weeks or longer

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2
Q

other words for post partum

A

puerperium
4th trimester

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3
Q

what does skin to skin do for baby

A

encourage to breast feed (bc of rooting), maintain there blood sugar, and maintain there temperature

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4
Q

how often does assessment need to occur in post partum moms

A

every 15 mins for first hour
then every 30 mins for a hour
then every hour

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5
Q

why do we want post partum mom to empty bladder often

A

a full bladder misplaces uterus

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6
Q

what vitals may be increased after birth

A

temp- from dehydration
pulse - may be high initially and could increase if hemorrhage (hypovolemia)
BP- if too high monitor for preeclampsia

monitor low RR if on narcotics

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7
Q

labs to monitor postpartum

A

hemoglobin and hematocrit will be decreased

WBC may increase to 25-30k

coagulation factors increased- risk for DVT

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8
Q

possible causes of infection in post partum

A

Uterine infection can occur, UTI, infection at surgical site or laceration, mastitis

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9
Q

avg blood loss from vaginal delivery

A

300-500mL

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10
Q

avg blood loss for C section

A

500-1000 mL

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11
Q

Involution of fundus

A

return to non-pregnant state

fundus descends about 1cm/day
no longer palpable in week 2

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12
Q

uterine atony

A

uterus isn’t contracting

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13
Q

sub-involution

A

failure of fundus to return to pre-pregnant state.

usually due to retained placental fragments or infection

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14
Q

how does bleeding slow after birth

A

contractions compress blood vessels
oxytocin strengthens contractions
breast feeding stimulates contractions
pitocin gaven to further contract uterus

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15
Q

after birth pains and interventions

A

caused by contraction of uterus

apply warmth, analgesics, early ambulation, distraction, education

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16
Q

best non opioid analgesic for post partum

A

ibuprofen advil

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17
Q

post partum lochia

A

lochia rubra- bright/dark red blood 1-3 days after delivery

lochia serosa- pink/brown blood 3-10 days after delivery

lochia alba- white discharge 2-6 weeks after delivery

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18
Q

what else can cause vaginal bleeding besides placenta detachment

A

unrepaired lacerations

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19
Q

nonlochial bleeding

A

More common with instrument births like vacuum assisted

spirts with firm uterus
excessive bleeding continues
bright red
hematoma

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20
Q

REEDA- perineum assessment

A

Redness
Edema
Ecchymosis
Drainage
Approximation

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21
Q

treating post partum hemorrhoids and perineal lacerations

A

ice
sitz bath
analgesics
cleanse the area
OTC ointments or supplements
lie down as much as possible

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22
Q

kegel exercise benefits

A

urinary bowel incontinence
strengthening pelvic floor
easy labor and delivery
healing hemorrhoids

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23
Q

what hormones decrease with delivery

A

hCG
estrogen
progesterone
hCS
cortisol
insulinase

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24
Q

what hormones increase in post partum

A

prolactin when breast feeding

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25
when do post partum moms get periods
depends on if breastfeeding not breast feeding- within 12 weeks
26
when does breast milk come in
2-5 days after delivery
27
colostrum
yellow thick fluid that comes from breath prior to milk, nutritious
28
what helps with non-breastfeeding breast
ice (no heat!) wear snug bra avoid stimulation anti-inflam meds cabbage leaves monitor for engorgement
29
when can post partum moms eat
vaginal- as tolerated c section- after return of normal bowel sounds
30
what are some normal findings to mom that may occur after birth
difficulty voiding pelvic soreness headaches fatigue diastasis recti abdominis possible hair loss flare up of autoimmune diseases
31
when does post partum moms cardiac output return to normal
by 6 months, but it will start decreasing 2 weeks post partum
32
C section needs
asses foley assess bowel sounds inspect abdominal incisions for REEDA early ambulation avoid carbonated beverages encourage turn, cough, deep breath every 2 hours perform ROM exercises SCDs
33
meds for hemorrhage treatment or prevention
oxytocin methylergometrine carboprost tromethamine misoprostol
34
antihypertensive meds
nifedipine labetalol hydralazine
35
vaccinations for post partum moms
MMR varicella Tdap Flu rhogam if needed
36
BUBBLE post partum assessment
Breast Uterus Bowels Bladder Lochia Episiostomy/laceration
37
new borns and mother health promotion act of 1996
vaginal delivery hospital stay- at least 48 hours id needed C section- 96 hours as needed
38
Healthy outcomes of mothers transitioning to parenting
subjective well being role mastery well being of interprofessinal relationships
39
acquaintance
mom is touching, exploring, making eye contact with baby starts to bond
40
mutuality
infant behaviors elicits corresponding parent behaviors infant wants response
41
what is claiming identified by
likeness differences uniqueness
42
reciprocity and synchrony
mutually gratifying interaction among mother, infant, father Takes a few weeks to develop. When parents learn baby's needs by baby's signals
43
3 phases of maternal post partum adjustment
taking in- for 1-2 days after delivery. Mom needs food and sleep taking hold - 2nd-3rd day. mom focuses for care of baby and is ready to take charge letting go- focus becomes family
44
post partum blues
Transient period of depression. This occurs first few days after delivery, mom has a little bit of sadness. Only last 3-5 days. If last longer than 2 weeks- screen for PPD
45
sibling adaption to new child
may be come jealous, especially around age 2/3 may see regression
46
concerns of adolescent mother
uses less verbal interaction less responsive interacts less positively assess interaction, support, discharge, knowledge, maturity
47
what makes adolescent pregnancy successful
support system maturity
48
how much blood loss is considered a hemorrhage
more than 500 mL vaginally or more than 1000 mL c section
49
early/primary PPH
within first 24 hours of birth
50
late/secondary PPH
after first 24 hours to up to 12 weeks
51
PPH causes
uterine atony retained placental fragments lacerations of genital tract hematomas sub involution of uterus
52
risk factors of uterine atony
high parity multiple gestation precipitous labor prolonged labor- uterus is tired fetal demise (death) magnesium sulfate- relaxes uterus tocolytic agents augmented labor c section chorioamnionitis Think- what led to uterus being extremely stretched
53
the 4 Ts
what causes PPH tone = main problem. Uterus over stretched tissue= placenta retained trauma = lacerations thrombin = bleeding disorders
54
When should placenta deliver on own after birth
30 mins
55
what needs to be done if placenta doesn't deliver on its own
a manual contraction needs to be done which puts at risk for PPH if there is part of placenta left over. The uterus may also get scraped. The mom is also at risk for infection if its done manual
56
decidua
normal placenta adherenece
57
accreta
placenta attached to myometrium wall the most common abnormal placenta adherence
58
increta
placenta invading into uterine wall abnormal
59
pancreta
placenta protrudes its self out to other organs abnormal
60
what to assess for if there is bleeding but uterus is firm
laceration
61
what to assess for if there is no bleeding but vital sign changes
hematoma
62
what can be done if uterus is boggy
empty bladder give uterotonics then reassess if still boggy: o2 labs IV fluids or blood possible possible surgery is persists
63
signs of PPH
excessive or bright red bleeding boggy fundus abnormal clots high temp unusual pelvic discomfort/backache persistent bleeding rise in level of fundus increased pulse/decreased BP (late sign) hematoma decreased LOC
64
PPH interventions
perform fundal massage and check for clots eliminate bladder distention assess for shock administer fluids, blood administer uterotonic meds o2 labs- CBC, blood type and crossmatch, coagulation studies assess circulatory status
65
what needs to be given with blood in PPH
clotting factors- so mom doesnt bleed everything you have her
66
What is the most objective and least invasive assessment of adequate organ perfusion and oxygenation
urine output
67
meds for PPH
pitocin- helps contract methergine- helps contract hemabate- helps contract misoprostol- helps contract tranexamic acid- helps mom clot
68
what is hemabate contraindicated in
asthma
69
side effect of hemabate (carboprost)
awful diarrhea
70
what is methergine contradicted in
HTN
71
hypovolemic shock s/s
rapid, shallow respirations irregular pulse decreased BP (late sign) cool, clammy, pale skin decreased urinary output lethargy anxiety decreased venous pressure
72
DVT s/s
pain redness warmth enlarged vein possible low grade temp
73
DVT prevention
EARLY AMBULATION
74
Pulm embolusm s/s
Dyspnea, chest pain, tachycardia, nervousness
75
thromboembolic interventions
heat elevation bedrest analgesics- NSAID compression stockings anticoagulant therapy monitor for PE
76
Endometritits
infection in lining of uterus
77
puerperal sepsis
any infection of the genital canal within 28 days after miscarriage, abortion or birth
78
post partum infections
wound infections UTI mastitis- feels like flu puerperal sepsis
79
post partum depression s/s
usually occurs in first 2 weeks and can last up to a year Loss of appetite Insomnia Intense irritability and anger Overwhelming fatigue Loss of interest in sex Lack of joy in life Feelings of shame, guilt or inadequacy Severe mood swings Difficulty bonding with your baby Withdrawal from family and friends Thoughts of harming yourself or your baby
80
risk factors for developing PPD
primigravida, bipolar, family history, complications
81
PPD w psychotic features
confusion/disorientation hallucinations paranoria attempts to harm self or baby
82
POST- when to call 911
pain in chest obstructed breathing seizures thoughts of harming
83
BIRTH- call your healthcare provider
bleeding incision that isnt healing red/swollen leg temp above 100.4 headache

maternity (4 decks)

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