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Maternal Health > EXAM #3 > Flashcards

EXAM #3 Flashcards

1
Q

What to assess on mother in the first 24 hours after birth

A

-Temp: normal to drop 2 hours after birth. Normal to raise for 24 hours
-Pulse
-Respirations
-BP
-Fundus: Midline, firm at umbilicus
-Lochia
-Episiotomy
-Hemorrhoids
-Bladder
-Homan’s sign neg. DVT
-Mood
-Bonding and attachment

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2
Q

How long is severe pain expected postpartum & what nursing interventions should be implemented?

A

-2-3 days
-Prone position with pillow under the abdomen, sitz bath, ambulation, mild analgesics (Ibuprofen & naproxen) up to 30 mins before breast feeding

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3
Q

BUBBLE HE (B) assessment:

A

Breast
Uterus
Bladder
Bowels
Lochia
Episiotomy (perineum & hemorrhoids)
Homans sign (legs)
Emotions
Bonding

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4
Q

When do the breast begin to fill and what do they fill like?

A

Day 3, full, tight an heavy

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5
Q

When does engorgement occur?

A

Day 4

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6
Q

What prevents milk production?

A

No nipple stimulation, bra and ice packs

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7
Q

What are normal findings on the breast assessment?

A

-Flat, everted, inverted nipples
-Tissue is soft, filling and firm
-Temperature and color

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8
Q

What are normal findings on the uterus assessment?

A

-Involution: Describes the process by which the uterus returns to the nonpregnant state
-Mid-line, not deviated
-Firm
-Afterpains
-Assess in supine position

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9
Q

How to palpate the fundus:

A

-One hand above the pubic sympysis
-the other hand at the umbilicus, press inward and downward

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10
Q

What are normal findings for the bladder assessment?

A

-Spontaneous voiding within 6/8 hours
-Output: 150ml/hr
COLA: Color, odor, last void, amount

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11
Q

What are normal assessment findings for the bowel assessment?

A

-More active after childbirth
-Bowel movement around day 2 or 3
COLA: Color, odor, last void, amount

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12
Q

Nursing interventions to help facilitate normal bowel function:

A

-Drink fluids
-High-fiber
-Avoid ignoring urges & straining
-Early ambulation
-Stool softener and laxatives

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13
Q

What are normal assessment finding for lochia?

A

-Color: Rubra, Serosa, alba
-Amount: Scant, light, moderate, heavy (saturated in 1hr)
-Odor
-Clots v tissue

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14
Q

What are normal assessment finding for Episiotomy incision (perineal assessment)?

A

-No REEDA with incision (redness, edema, ecchymosis, discharge, WITH approximation)
-Assess for hemorrhoids, Tearing, Hematomas

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15
Q

Episiotomy care:

A

-Ice pack for 24/48 hours
-After, Sitz bath for 20 minutes
-Witch hazel pads

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16
Q

What is the first-line medications used to help with discomfort in postpartum?

A

NSAIDs

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17
Q

What position should be avoided for the 1st 3 weeks?

A

-Knee-chest position puts added pressure

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18
Q

+ Homan’s Sign:

A

Indicative of DVT
-Legs are extended and relaxed and kness are flexed
-Sharply dorsiflex the foot and if there’s resistance with discomfort, it is positive

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19
Q

What clinical manifestations are indicative of DVT?

A

Varicose veins, pain, pulselessness, warmth, edema, sensation.

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20
Q

How to prevent DVT:

A

-Early ambulation
-Active/passive ROM
-Avoid prolonged sitting
-Elevate legs
-Drink fluids

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21
Q

What 4 signs are looking for during emotional bonding?

A

-Talking to baby
-Holding the baby
-Gazing at the baby
-Pointing out features

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22
Q

What Hematological and Metabolic changes occur after pregnancy?

A

-Decrease in blood volume (lots of voiding)
-Estrogen Progesterone decrease and Prolactin is produced

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23
Q

What neurological changes occur after pregnancy?

A

Fatigue & discomfort

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24
Q

What changes occur to the renal system, fluids and electrolytes after pregnancy?

A

-Naturesis
-Diuresis (500 to 1000ml in one go)

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25
What changes occur to the respiratory system after pregnancy?
Decrease in intra-abdominal pressure
26
What changes occur to the integumentary system after pregnancy?
Stretch marks
27
What changes occur to the Cardiovascular system after pregnancy?
-cardiac output returns to normal
28
What changes occur to the Immune system after pregnancy?
-WBCs are elevated -RhD neg mothers who had a baby that is RhD pos, should recieve RhoGAM within 72 hours -If non rubella immune, give MMR after birth -Give Tdap after birth
29
What changes occur to the Reproductive system after pregnancy?
Menstrual occurs 6 to 8 weeks after -Breast feeding mothers will return in 3 months -Ovulation will follow
30
What changes occur to the GI system after pregnancy?
-Muscle fatigue -Diastasis Rect-abdominis (modified sit ups and posture)
31
Postpartum nursing care for tubal ligation:
Air may enter the abdominal cavity which can cause should pain, encourage walking
32
Postpartum nursing care for C-section:
-BUBBLEHE -Prevent DVT -Promote bonding -Foley discontinued after 12hrs -Diet as tolerated -Try NSAIDs over opiates
33
Education/intervention teaching for tubal ligation:
-Medicaid, need signed paper 30 days before prodecure -NOT reversible -Tubes are not tied but are removed -Get consent
34
Nursing education for formula feedings:
-Handwashing -Prepare as instructed -Fomula should constituted with tested source of water -Boiling will not get rid of harmful things -Wash in hot, soapy water & air dry or dishwasher -Do NOT microwave or prop bottle -Burp frequently -Can be fed cold, warmed or room-temp. Heat with pan or electric device
35
When should you throw out formula that was prepared?
24 hours
36
Benefits of breastfeeding for mother:
-Decreased risk of cancers, osteoporosis, & type 2 diabetes -Uterine contractions occur due to the release of oxytocin (involution) -Weight loss -Budget-friendly -infant bonding
37
Benefits of breastfeeding for baby:
-Enhanced immunity & maturity of the GI tract -Decreased risk of SIDS, obesity, asthma, & type 1 diabetes -Decreased pain -Jaw development -Protection againt childhood cancers
38
What conditions/procedures in risk of infection with c-section?
Prolonged procedures, choreo, DM, obese pt, poor diet. Clean with chlorahexidine wipes
39
What hormone makes the alveoli in the breast secrete milk?
Prolactin
40
When and what kind of milk is produced during stage 2 of milk production?
Occurs after delivery The breat produce colostrum (sticky yellow milk)
41
What important things does colostrum contain?
Fats and immunoglobulin
42
When and what is occuring during stage 3 of milk production?
Occurs about 4 days after giving birth Establishment and maintainance of milk supply Milk appears thin and watery
43
What types of milk are produced what is their purpose for the baby?
-Foremilk: quinches thirst -Hindmilk: satiety
44
What is the let down reflex?
Movement of milk into the large lactiferous ducts -tingling in breasts
45
What can be done for women who do not experience the let-down reflex?
-Frequent stimulation of the breast -Increased frequency of feedings -Applying warmth to the breast -Relaxing music
46
Should breast feeding ever be painful?
NO, should feel strong tugging sensation with occasional mild discomfort
47
What should be avoided regaruding nipple care?
Soap, breast creams, oils that contain Vitamin E ONLY WATER or breast milk rubbed into the nipple
48
When is the optimal time to start breast feeding?
ASAP and/or within 1 hour after birth
49
Nursing education for breast feeding:
-Observe for hunger cues and act on it -Show different positions -Show correct latch -Look to see if the bottom lip is "flanged", and the cheek, nose and chin all touch the breast -Never force the baby's head, wait for infant to open their mouth -1st week after birth, may feel after pains (multipara)
50
What signs show the baby has a good latch and is getting milk?
-Infant sucks and swallows -2:1 or 1:1 suck/swallow -milk can be seen at the corners of the mouth
51
What ratio is considered nonnutritive sucking?
5:1 suck/swallow
52
Infant-feeding readiness cues:
-Begin to stir -Bob the head -Hand-to-mouth or hand-to-hand movements -Sucking, lip-smacking, licking -Rooting -Increased activity: arms and legs flexed and hands in a fist
53
How many wet diapers should we have a day?
6 to 8
54
How often does a breast-feeding baby need to eat?
2-3 hours, 15 minutes on each breast
55
Positions for breast feeding:
Cradle, cross-cradle, football and side-lying
56
Breast engorgement: definition and when it occurs
Excessive swelling and congestion in the breast 3/4th day
57
What are symptoms of severe engorgment?
Pain, tenderness, hardness, and warmth to the touch
58
How to fix engorgment:
-Express the milk via pump or feeding -Warm soaks and ice after -Massage
59
What meds are used for engorgment?
Ibuprofen before feedings
60
What causes sore nipples?
Poor latch
61
How to help fix sore nipples:
-Alt position -Express milk and rub it in to the nipples -Air dry and some sunlight -Cabbage leaves
62
Fresh breast milk can stay out for how long?
4 hours room temp
63
How long can breast milk be refrigerated?
4 days
64
How long can breast milk be frozen?
6months to 1 year
65
How to thaw milk:
-In a collection container in the fridge -Under warm water or water basin -NEVER in hot water or room temp
66
What time-frame is considered an early PP hemorrhage?
within first 24 hours caused by uterine atony (most common)
66
What are signs of early PPH?
tachycardia, 15% drop in BP, decrease in O2 sats less than 95%
67
What time-frame is considered a late PP hemorrhage?
24 hours to 12 weeks
68
What are the 4 Ts?
-Tone -Trauma -Tissue -Thrombin
69
What does a continuous trickle of bright red blood mean?
Lacteration (uterus will be contracted) or hemorrhage (uterus wiil be boggy)
70
What is a cardinal sign of a hematoma?
Unrelieved pain or pressure
71
What medications are we going to give for PPH?
-Oxytocin (pit): 20 U in 1000ml of LR. Bolus them -Cytotec: rectally -Hemabate: IM up to 8 doses. NO asthma due to bronchospasm & horrible diarrhea (give immodium) -Methergine: IM. Do NOT administer if hypertensive
72
What is a common cause of late PPH?
retained placenta
73
What occurs during the takin-in phase?
The mother is consumed with relieving and reorganizing their birth experiences
74
What occurs during the taking-hold phase?
The mother feels better and is ready to assume the mothering role
75
What occurs during the letting go phase?
The mother starts to see the infant as separate from herself. Starts adapting to parenthood
76
What are the post partum blues?
A normal reaction to the dramatic changes that occur after birth and lasts for 2 weeks. -R/t hormones -Symptoms are mild and do NOT impair the ability to care for herself or the baby
77
What is uterine atony?
Failure of the uterine myometrium to contract and retract following birth
78
What is the hallmark sign of uterine atony?
Boggy uterus filled with clots and blood
79
What are risk factors for PPH?
-Prolonged or precipitous labor -History -Mutiple gestations -large infant -Polyhydramnios -Trauma -Chorio -Retained placenta -Agumentation or induction of labor with oxytocin
80
Nursing interventions for PPH:
-Vs -Fundal massage -Uterine location -Palpate bladder -Weight blood loss -Measure how long it takes to saturate a pad -LOC changes, pain level and behavior -2 large bore IVs -medications Oxygen 30 U -Foley -I & Os -Oxygen 10 to 12L
81
What is it called in late PPH where the uterus cannot contract down due to retained placenta?
Subinvolution
82
What are ss of hypovolemic shock in PPH?
Tachycardia, restlessness, anxiety, pallor, cool clammy skin, hypotension
83
What is a sign of early hypovolemic shock?
tachycardia
84
What is a hematoma?
A localized collection of blood in connective or soft tissue under the skin
85
What is a hallmark sign and other signs of a hematoma?
acute unrelenting pain -other: pressure in the rectal and or vaginal area, bluish color, tachycardia, hypotension, fullness.
86
Nursing interventions for hematomas:
-Listen to the patient's complaints -Vs -Examine vaginal area -NOTIFY PCP -Ice for 12 hours -pain meds -after 12 hours sitz bath -Drainage for hematoma over 5cm -IV fluids -Oxygen -I&Os -Foley
87
Superficial thrombosis:
In small veins they may appear like a hard knot
88
Care for superficial thrombosis:
Ted hose, ambulation, and keep the legs elevated while sitting
89
DVT:
Redness, swelling, heat, unilaterally in the calf. Pallor & weak pulses
90
What position should a postpartum patient avoid?
Knee-chest
91
Who is at the greatest risk of thromboembolic disorders?
-Post-op CS -Hx -Smoker -Obesity -older women
92
Nursing interventions for thromboembolic disorders:
-Heparin for 3 mths -NSAIDS -Rest & elevation on the affected leg -Compression socks -Moist, warm packs -leg circumference daily
93
T or F. All post partum women are in a hypercoagulable state
True
94
Sudden sharp, chest pain, SOB, and anxiety suggests...
pulmonary embolus
95
Nursing interventions for PE:
-ABCs -Oxygen -IV -ICU -Morphine -family support
96
What is endometritis?
-Infection of the endometrium
97
Signs and symptoms of endometritis:
-Temp over 100.4 for over two days or a temperature of 101.6 in the first 24 hours -Tachycardia -Uterine tenderness -suprapubic pain -Subinvolution -Malaise -Foul-smelling lochia
98
Temp of ____F + is indicative of sepsis
102.2 F
99
Risk factors for endometritis
-Long labor -ROM greater than 24 hours -C-section -+ GBS -Operative vaginal delivery -Prior STI
100
What is mastitis?
Infection and inflammation of the mammary glands.
101
signs and symptoms of mastitis:
-Fever, chills -Pain and tenderness in one breast -Warmth -Aches -Nipples with cracks, fissues or sores -Flu-like
102
If there is abcess formation (pus) what should the nurse do?
Notify PCP
103
Nursing interventions for mastitis:
-Antibiotics -Heat or cold -Hydration -Pain meds -Proper latch -hand hygiene
104
Education for mastitis
-Continue breast feeding on the affected side first for at least 15 minutes -empty breast every 2-4 hours
105
What is PP depression?
-Major depressive disorder that develops within 4 weeks -Characterized by a depressed mood or decreased interest or pleasure
106
Signs and symptoms of PP depression:
-depression -disinterest -lack of appetite -insomnia -restlessness -anxiety -hopeless -inability to cope -suicidal thoughts
107
Nursing interventions for PP depression:
-CBT & IPT -therapy -resources -asking probing questions -Meds: SSRIs, SNRIs, TCAs, Antidepressants, antipsychotics, mood stabilizer
108
What is PP psychosis?
Dramatic sudden onset within 24 hours of birth Not associated with baby blues or depression
109
Risk factors for PP psychosis:
-First time mothers (who are older) -Hx of bipolar and psychotic disorders
110
Clinical manifestations of PP psychosis:
-Auditory hallucinations -Delusions -Confusion -Sleep disorders -Suicide -Homicide and infanticide
111
Nursing management of PP psychosis:
-Meds -Therapy -Electroconvulsive therapy
112
Discharge teaching for warning signs post partum:
-Temp -Bleeding -Pain: abdominal, breast, Perineal, Headache & epigastric (pre-eclampsia) -Mood -Leg cramps
113
Are after pains normal? Nursing interventions?
Yes. Apply counter pressure with a small pillow under the abdomen laying prone
114
Education/ discharge teaching for self care:
-Pericare -Breast care -Contraception -Work, exercise, sex should only be resumed if they are cleared by the provider
115
Discharge teaching for infant care:
-Bathing -Cord care -Vaccinations -Circumcision care -Pericare
116
What are warning signs in infants?
Fever, refusal to feed, abnormal stooling, lack of urine output, fussy, lethargy

Maternal Health (4 decks)

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