Exam 3 MOM BABY Flashcards
What is included in the BUBBLELE assessment and what are you looking for in each area?
Breast-cracks, e/inverted, tenderness
Uterus-firm, boggy, measure
Bowel-movements
Bladder-
Lochia- bleeding
Episiotomy/laceration- 3rd/4th cannot receive rectal meds (cytotec)
Legs for DVT- swelling, temp, pain?
Emotions
What is normal involution of the fundus, right after birth, at 12 hours after birth
and each day PP till discharge?
-palpable at midline & 2cm below umbilicus
-12 hr after, rise to level of umbilicus
-every 24 hrs, should descend 1-2 cm
What are normal stages of lochia
Lochia Rubra 1-3 days (Dark/Bright Red)
Lochia Serosa 4-10 days (Pinkish Brown)
Lochia Alba 11 days - 6 wks (yellowish white)
When it is abnormal and what patient
education would you give regrading lochia assessment
Clots Larger than a golf ball or egg, or heavy flow
What are the assessments for an episiotomy or laceration? Use REEDA
Redness
Edema
Ecchymosis (bruising)
Discharge
Approximation
What is taking in stage of motherhood
Occurs first 3 days postpartum
Dependent on others for her and her infant’s needs
Speaks about birthing experience
Focus on personal comfort and physical changes and healing
Nurse/Lactation consultant helps with breast feeding
Not a good phase to teach…It’s all about her!
Taking hold stage of motherhood
3-10 days postpartum
Moving between dependent and independent behaviors
Begins to initiate action and make decisions
Assumes care of the infant and shows more interest
Offer reassurance and praise
Give guidance or instruction as needed
Taking hold of her life again… great time to teach!
Letting go stage of motherhood
Occurs 10 days to 6 weeks Postpartum
Movement from independent to role of mother is easy-interdependent
Mother adjusts to her new role.
Establishes and accepts the new image of her baby, family and role.
Focus on family unit
Resumes role of individual
At home you won’t see it in the hospital
What is in colostrum?
High in protein.
Antibodies leukocytes, IgA, IgG, IgM
What is Engrossment?
fathers gazing at heir newborn for prolonged periods of time
What is En face?
Position that allows eye-to-eye contact between the newborn and a parent.
What are afterpains? Who are more likely to get them?
Uncomfortable uterine cramping;
LGA/marcosomnia mothers
Postpartum diuresis
What causes it?
excess fluid accumulated during pregnancy
What causes postpartum chills?
fluid loss
heat loss
hormonal changes
What discharge information is important to discuss and what signs and symptoms
should be reported the physician?
Signs and symptoms of possible complications
Excessive lochia or return of bright red bleeding
Foul-smelling lochia
Increased temperature
Pelvic/abdominal tenderness
Signs of UTI
Breast tenderness
Blurry vision
Leg pain
Thoughts of self harm
Explain postpartum blues, what are the causes and symptoms
a transient, self-limiting mood disorder that starts within 2 or 3 days after delivery and resolves within 2 weeks.
Hormone changes, normal
sadness, crying, lack of appetite, insomnia, fatigue, dysphoria, and impaired concentration
Explain postpartum depression, what are the symptoms
major depression with an onset during pregnancy or in the first 4 weeks after the birth up to 12 months
feeling of guilt, flat affect, rejection of infant, insomnia, fatigue, dysphoria, and impaired concentration.(same as blues)
What medications might we need to give during the postpartum period and why
Hemorrhage Management
oxytocin - top of uterus
Methergine- both segments of uterus
hemabate (causes bronchospasm)
Misoprostol (diarrhea, abdominal pain)
antibiotics for Metritis (most common pp infection)
Contraception: IUD
vaginal insertion
Contraception: diaphragm
Barrier method; Diaphragm must stay in for 6hrs after intercourse
Contraception: Depo-Provera
IM or SQ
suppresses ovulation
safe w/breast feeding
good for 3 months
-can cause osteoporosis-
What are the risk factors of subinvolution (Late PPH)
-full bladder
-prolonged labor
-overdistention
-retained placenta
-uterine atony
-fibroids
-metritis
PPH What are the sign and symptoms? How can we educate our patients?
Prolonged or excessive lochia flow saturating > than 1 pad per hour; foul smelling lochia
Fundus higher level than normal for postpartum time and palpable beyond 7-10 postpartum
Tenderness of the fundus
Lochia fails to change color from serosa to alba within a few weeks
Increased bleeding after increasing activity at home
Fever, pelvic pain
teach women how to assess for themselves
Metritis- What are the risk factors
Occurs more commonly after cesarean birth
Prolonged rupture of membranes
Prolonged labor
Internal fetal and uterine monitoring
Multiple cervical examinations
Obesity
Meconium-stained fluid
Metritis- What are the Signs/symptoms?
Elevated temp ↑100.4
Tender enlarged uterus
Prolonged and severe uterine cramping
Foul-smelling lochia
Malaise
Lab test confirm dx.
Elevation of leukocytes
Increased RBC and Sedimentation rate
Metritis- Nursing interventions?
Patient education on decreasing risk
Good handwashing
Change peri pad q 3-4 hours (front to back)
Early ambulation
Increase fluid intake
Monitor for s/s , vital signs
Report assessment data to provider
Provide pain management
Administer antibiotics
Provide emotional support and discharge teaching
Mastitis
What are the Signs/symptoms?
painful or tender localized hard mass and reddened area
flu-like manifestations (chills, fever, h/a, body ache)
fatigue
Hard, tender palpable mass
Warmth
Tachycardia
Malaise
Purulent drainage
Mastitis- Nursing interventions/education
obtain VS
assess pain
inspect breasts
administer antibiotics
wash hands
frequent breast pad changes
air dry
proper positioning
complete emptying (during feeding)
ice/warm packs
continue feeding frequently esp on affected side
wear well fitting bra
rest and maintain at least 3k mL fluid per day
What is the major cause of early PPH
uterine atony
PPH How do you estimate blood loss?
Weigh all bloodied pads and linens for accurate blood loss-1 ml blood =1 gram
What are some of the causes of lacerations and hematomas
Episiotomy is the MAJOR risk factor- forceps, prolonged second stage
precipitous birth
cephalopelvic disproportion
size/abnormal presentation/position
previous scarring
Laceration findings
sensation of oozing/trickling blood
excessive rubra lochia
vaginal bleeding with firm uterus
hematoma findings
pain
pressure sensation in rectum/vagina
difficulty voiding
bulging, bluish mass or area of red purple discoloration on vulva, perineum, or rectum
Nursing care for lacerations/hematoma
assess pain
visually/manually inspect area
evaluate lochia
assess VS & hemodynamic status
ID source of bleeding
ice packs
pain med
sitz bath and freq perineal hygiene
what is QBL
quantitive blood loss
PPH blood loss amounts
500mL for vaginal
1000mL for c-section
How do you prevent uterine inversions
Pelvic exam
Maintain IV fluids
Administer O2
Stop oxytocin
Administer terbutaline
Avoid traction on the umbilical cord
Post-partum psychosis
Signs/symptoms
Hallucinations, delusions thought of self harm or harming infant, agitation, inability to sleep, bizarre or irrational behavior
PPP Nursing interventions /treatment
get plenty of rest
self care
schedule follow up visits
seek counseling
consider community resources
Educate at risk mom’s and their support system of early signs of PPP
Mood swings, strange beliefs, and hallucinations
Ballard Gestational Age
What two characteristics does it measure
Assesses Physical and Neuromuscular maturity
Reflexes: Tonic neck
examiner turns newborn’s head quickly to one side. newborn’s arm and leg on that side extend and opposing arm and leg flex
Reflexes: Rooting and Sucking
elicit by stroking the cheek or edge of mouth. newborn turns the head toward the side that is touched and starts to suck
Reflexes: Moro
elicit by allowing the head and trunk of the newborn in a semi sitting position to fall backward to an angle of at least 30 degrees. the newborn will symmetrically extend and then abduct the arms at the elbows and fingers spread to form a C
what is cold stress
Excessive heat loss that leads to hypothermia
risk factors for cold stress
Prematurity
SGA
Hypoglycemia
Prolonged resuscitation efforts
Sepsis
Neurological, endocrine or cardiopulmonary problems
mechanisms of heat loss
Evaporation-surface liquid–>vapor
convection- flow of heat to cooler air
conduction- loss of heat from contact w/cooler surface
radiation- loss of heat from close to cooler surface
Cold stress nursing interventions
Dry thoroughly and remove wet blankets
Hat
Skin to skin and pre-warmed blankets and clothes
Swaddle
Place under radiant warmer if unable to reach temp of greater than 97.7
stages of human milk
Colostrumm-2-3 days after birth. Also excreted in third trimester
Transitional milk- colostrum and milk..lower levels of protein
Mature milk- 20% solid 80% water
Foremilk- mostly water w/nutrients
Hind milk- high fat content, produced during feeding
3 major immunoglobulins
IgG, IgA, IgM
