Exam 3 pt 2 Flashcards
what is classified as a hemorrhage
> 500 EBL for vag delivery
1000 EBL for Csection
OR peripad saturation in 15 min or less
failure of the uterus to return to a nonpregnant state
sub involution
recognized causes of subinvolution
- retained placental fragments
- pelvic infection
s/s of sub involution
- prolonged lochial discharge
- irregular or excessive bleeding
- sometimes hemorrhage
- boggy uterus or larger than normal
med treatment of sub involution
Ergonovine or methylergonovine
other treatment of sub involution
dilation and curettage may be performed to remove retained placental fragments
antibiotic therapy if cause is infection
if woman’s uterus is not firm…
perform uterine massage and allow her to void
cardiovascular system changes postpartum
blood volume decreases
cardiac output decreases
hematocrit, hemoglobin, and WBC changes
gastrointestinal system changes postpartum
- abdomen returns to post pregnancy 6 wks after birth
- striae may persist
- diastasis recti abdominis
- lukewarm quick shower
- blood goes to abdominal organs not brain*can cause HYPOTENSION
when can pt eat post partum
when you are sure they are not going back to OR
monitor for 1-3 hours, if scant bleeding then can eat
describe bowel evacuation post partum
occurs 2-3 days after childbirth
urinary system changes postpartum
diuresis and diaphoresis
what urine component disappears by 1 wk post partum
renal glycosuria because HPL hormone is gone
why does postpartal diuresis occur
getting rid of the fluid given in labor and the 1000 mL plasma
how often should you monitor pt for bladder distention postpartum
Q1H, catheters if necessary Q4H
musculoskeletal system changes postpartum
pelvis returns to pre pregnancy position(hip pain)
joints are stabilized 6-8 wks after birth due to RELAXIN
endocrine system changes postpartum
- decrease in estrogen and progesterone
- pituitary hormones, ovarian function, and prolactin stay elevated in breastfeeding mother
integumentary system changes postpartum
hair falls out may lose 20% of hair and cholasma disappears
when does ovulation occur if not lactating
27 days after birth
when does ovulation occur if lactating
70-75 days after birth
what birth control pills can be given if breastfeeding
progesterone only* (no estrogen to be able to breast feed so IUD or depo)
immune system changes postpartum
need for rubella vaccine determined
when is mom given RHOGAM postpartum
if mom is Rh negative and the baby is Rh positive RHOGAM is given within 72 hours of delivery
describe milk 24 hours after delivery then 72-96 hours after
24 hrs- milk is thick (colostrum)
72-96 hrs-milk matures based on supply demand
very condensed breast milk
very rich in fats and nutrients because baby’s stomach is very small and can only handle a little bit
colostrum
engorgement support
frequent feedings, moist heat PRN, supportive bra, allow milk to dry on areolas, lanolin
important to remember when breastfeeding
need to alternate breast every feed
when does engorgement of breasts occur
in 24-36 hrs after milk comes in
relief for nonbreastfeeding mothers
ice packs,cold cabbage Q2H, ASA/Motrin, NO heat, NO massage/stimulation/expression of milk
do not let nonbreastfeeding mothers….
pump/feed even once d/t supply demand system
when does the amount of menstrual flow return to prepregnancy volume
within 3-4 cycles (first menstrual cycle is heavier than normal)
red discharge in the hospital that should subside by 5 days
rubra
serous discharge, blood with serum up to 3-4 wks
serosa
white discharge, WBC shedding with mucus
alba
describe the different levels of peripad saturation
scant-less than 1 in light-less than 4 in moderate- >4 in heavy- saturation of peripad in 1 hr *hemorrhage- saturation of peripad in 15 min
Rubin Stages of Development
1) Taking In
2) Taking Hold
3) Letting Go
describe the Taking In stage
day 1 (first 24 hrs for vag and first 48 hrs for csec) focus is self and meeting basic needs
describe the Taking hold stage
begins after day 1 (>25 hrs for vag and >49 hrs for csec)
focus is care of baby and competent mothering
optimal teaching period by nurses
describe the letting go stage
begins after taking hold phase (abt 2 wks)
focus is forward movement of family as a unit with interacting members
what psychological change is common following birth
labile emotions/fluctuate (fatigued and tired d/t loss of placenta and rapid shift of hormones)
what are the postpartum blues
occur 1-10 days after birth
weepy (loss of placenta)
approx. 50-80% of all women
emotional and liable for no reason
symptoms of postpartum blues
depression, a let down feeling, restlessness, fatigue, insomnia, headache, anxiety, sadness, and anger
coping with postpartum blues
rest, relaxation techniques, self care, plan a day out, talk with partner
describe depression potpartum
usually starts at 2 wks and lasts up to one year
grossly underdiagnosed, underassessed
tense, irritable, sleeplessness, feels inept as mother
what do we give mothers for depression
SSRIs and birth control
describe psychosis postpartum
rare
occurs within 3 weeks postpartum
bipolar or major depression precipates it
what elevates risk of psyhological risks postpartum
history of previous psychological history (anxiety/depression)
*the worse the psychiatric illness, the more we worry about them and the greater risk they are
C-section post op assessment
assess uterine firmness/position assess lochia and incision site for bleeding assess abdominal distention ambulate and warm compress assess bowel sounds inspect dressing for infection assess lungs
abdominal distention can have referred pain where
to shoulder
cannot feed pt until…
bowel sounds return
