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Maternity > Exam 3- week 11 > Flashcards

Exam 3- week 11 Flashcards

1
Q

Name 2 potential sources of oxytocin

what stimulates natural oxytocin release?

A
  • released from posterior pituitary gland
  • can also be given IV or IM
  • breastfeeding stimulates release of oxytocin
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2
Q

compression of intra-myometrial blood vessels as uterine muscle contracts (aka afterbirth pains or postpartum contractions) seeks to achieve what purpose?

A

hemostasis

-• Contractions immediately after birth “seal off” the vessels at the placental implantation site

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3
Q

what is lochia

A

postbirth uterin discharge

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4
Q

is lochia more or less after a c-section?

A

much less

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5
Q

what are the 3 stages (in chronological order) of lochia?

A

o Lochia rubra
o Lochia serosa (serosanguinous, whitish)
o Lochia alba

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6
Q

describe lochia serosa

A

(serosanguinous, white-ish)
• 2nd stage of lochia
• Old blood, serum, leukocytes, and debris
• Begins on appx day 3 or 4 lasts up to 2 weeks after birth

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7
Q

describe lochia alba

A
  • 3rd stage of lochia
  • Leukocytes, decidua, epithelial cells, mucus, serum, and bacteria
  • Continues 2 to 6 weeks after birth
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8
Q

when do we expect to see lochia alba?

A

• Continues 2 to 6 weeks after birth

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9
Q

when do we expect to see lochia serosa?

A

• Begins on appx day 3 or 4 lasts up to 2 weeks after birth

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10
Q

when do we expect to see lochia rubra?

A

• Duration of appx 3 to 4 days

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11
Q

Terms used to describe amt of lochia on pad

A

scant, moderate, heavy

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12
Q

Characteristics of “excessive bleeding”

A

o Saturation of a perineal / sanitary pad within 15 min or less
o Pooling of blood under the buttocks
o **Requires immediate assessment and intervention

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13
Q

What does the acronym BUBBLEHE stand for in postpartum care?

A 
B:  breasts
U: uterus (uterine atony is a big red flag)
B: bladder
B: bowel  (look for tears—the tiny ones are called skin marks and don’t need to be sutured)
L: lochia
E: episiotomy / incision
H: hemorrhoids / homans sign
E: emotional status
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14
Q

What does the acronym BUBBLEHE stand for in postpartum care?

A 
B:  breasts
U: uterus (uterine atony is a big red flag)
B: bladder
B: bowel  (look for tears— tiny ones are "skin marks" and don’t need to be sutured)
L: lochia
E: episiotomy / incision
H: hemorrhoids / homans sign
E: emotional status
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15
Q

What 2 hormones are most important for lactation?

A

oxytocin and prolactin

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16
Q

What 2 hormones are most important for lactation?

A

oxytocin and prolactin

  • Oxytocin elicits the milk let-down reflex during breast-feeding.
  • Prolactin stimulates milk production.
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17
Q

how can we tell if breast feeding is going well?

A

-by how many poopy diapers the baby is producing

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18
Q

How much milk should a mother be producing, on average, by day 10 if she is breastfeeding?

A

750ml (a bottle of wine!)

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19
Q

How much milk should a mother be producing, on average, by day 1?

A

30ml (1oz)

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20
Q

What’s the average # of wet and poopy diapers on days 1-7?

A 
day 1: 1 poop, 1 wet
day 2: 2 poop, 2 wet
day 3: 3 poop, 3 wet
day 4: 4 poop, 4 wet
day 4 and onward: at least 4 poopy diapers every day and the # of wet diapers can/will increase
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21
Q

2 roles of oxytocin in postpartum period?

A

1) stimulates uterus to contract during breast-feeding session and for up to 20 min after each feeding
2) acts on breast by eliciting the milk let-down reflex during breast-feeding

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22
Q

what is the “postpartum period”?

A
  • interval btwn birth & return of reproductive organs to their non-pregnant state
  • Known as 4th stage of pregnancy -start of the postpartum period, the return to nonpregnant state
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23
Q

how long is the postpartum period?

A

traditionally lasts 6 weeks (can vary a lot and last much longer)

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24
Q

What is a parous cervix?

A

a cervix that has changed bc it’s been stretched out from past births

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25
Q

what is “involution”?

A

the return of the uterus to nonpregnant state following birth

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26
Q

Where should the fundus line be at the end of 3rd stage of labor?

A

approx 2 cm below umbilicus (within appx 12 hrs returns to appx umbilicus (+/- 1 cm) (temporary)

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27
Q

Avg pace of descent of the fundus postpartum?

A

– Fundus descends 1 to 2 cm every 24 hours

– 2 weeks after childbirth uterus lies in true pelvis (below iliac crest)

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28
Q

What is sub-involution?

A

failure of uterus to return to non-pregnant state

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29
Q

What are some common causes of sub-involution of the uterus?

A
  • retained placental fragments

- infection

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30
Q

How long does it take for the vagina to return to pre-pregnancy size after childbirth?

A

approx 6-10 weeks

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31
Q

what is the “introitus”?

A

opening that leads to vaginal canal

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32
Q

how does the introitus appear in the postpartum period?

A

erythematous and edematous

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33
Q

How long does it take for most episiotomies to heal?

A

2-3 weeks

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34
Q

How long does it take a woman’s pelvic floor muscles to regain their tone?

A

up to 6 months (the muscles are torn and stretched during childbirth)

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35
Q

Nursing care for the perineum in postpartum period?

A
  • encourage daily kegel exercises to promote healing
  • try to lay on side (takes pressure off perineum)
  • irrigate and ice for first 24 hours
  • AFTER first 24 hrs, try sitz baths and heat
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36
Q

What is diastasis recti

A

-Separation of the rectus abdominis muscles)

• More common in women who had poor ab tone before pregnancy

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37
Q

When do non-lactating women typically begin ovulation and menstruation after childbirth?

A

o 70% of non-breastfeeding mothers menstruate within first 12 weeks

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38
Q

Which 2 pregnancy hormones drop dramatically in postpartum period?

A

estrogen and progesterone (begins with the expulsion of the placenta)

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39
Q

Why can continuous breastfeeding delay menstruation and ovulation?

A

Breastfeeding stimulates PROLACTIN (necessary for milk production, and also inhibits release of GONADOTROPIN (necessary for ovulation)

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40
Q

• Breast-feeding as a contraceptive method can be effective for 6 months after delivery only IF a woman:

A
  • Has not had a period since she gave birth
  • Breast-feeds her baby at least 6x daily on both breasts
  • Breast-feeds her baby “on demand” at least q4 hrs
  • Doesnt substitute other foods for a breast-milk meal
  • Provides nighttime feedings at least q6 hrs
  • Does not rely on this method after 6 months
41
Q

What changes are expected in the postpartum period with the urinary system?

A

• Urine components (there’s a lot of plasma being diuresed)
• Postpartal diuresis
o Within 12 hours women begin to diurese
o Profuse diaphoresis often occurs at NIGHT for first 2-3 days
• Urethra and bladder (make sure to keep them empty so uterus can properly involute!)

42
Q

When do we typically expect to see spontaneous bowel movements occur postpartum?

A

-2-3 days after childbirth (may need to give stool softeners, milk of magnesia, encourage fiber, etc)

43
Q

What changes in vital signs do we see in a woman postpartum?

A
  • Temp: May increase to 38 C X 24 hrs (worry if we see fever in 1st 2 weeks)
  • Pulse: May be elevated X one hour
  • Respirations: Normal (Diaphoresis occurs)
  • Blood Pressure (normal) (we worry about HYPOTENSION)
44
Q

Why are we concerned if we see hypotension in the postpartum period?

A

-there could be a “hidden” hematoma somewhere where she is pooling blood. Possible that only manifestation (or the 1st) is hypotension

45
Q

What are potential manifestations of a “hidden” hematoma postpartum?

A
  • hypotension

- acute bottom pain

46
Q

What are the expected changes in the respiratory system postpartum?

A
  • No significant change in rate
  • Ease of “stuffy nose”
  • Return to normal tidal volume
47
Q

What is the #1 cause of postpartum bleeding?

A

boggy uterus

48
Q

What is the potential association btwn the bladder and postpartum bleeding?

A

-a full bladder can put pressure on the uterus and make it hard for uterus to fully retract. Can lead to a boggy uterus

49
Q

What changes occur in blood volume during the postpartum period?

A

o Blood volume increase eliminated within first 2 weeks after birth, with return to non-pregnancy values by 6 months after delivery
o Previous excess blood volume of pregnancy protects mothers from post-delivery shock

50
Q

Why do we worry if a woman has a headache in the postpartum period?

A
  • could be postpartum pre-ecclampsia
  • could be caused by gestational HTN, stress, or leakage of CSF into extradural space during placement of needle for epidural or spinal anesthesia (rare but very serious)
51
Q

What expected changes occur in the musculoskeletal system postpartum?

A

• Reversal of pregnancy adaptations (i.e. reversal of lordosis)
o Joints are completely stabilized by 6 to 8 weeks after birth

52
Q

What expected changes occur in the integumentary system postpartum?

A

• Chloasma usu disappears at end of pregnancy
• Vascular abnormalities, spider angiomas, palmar erythema, and epulis (swollen gums) regress with rapid decline in estrogens
• Abundance of fine hair usu disappears after birth
• Hyperpigmentation of areolae and linea nigra may NOT regress completely after childbirth
o Stretch marks on breasts, abdomen, and thighs may fade but NOT disappear
• Spider nevi persist indefinitely for some

53
Q

What do we auscultate in the “mini” head to toe postpartum assessment?

A

-heart, lungs, and bowel

54
Q

If infant is Rh Positive, and mother is Rh neg, mother must receive RhoGAM in what time frame?

A

within 72 hours of delivery to prevent Rh Isoimmunization

55
Q

What do we typically see in infants w/ Blood Type A or B born to Type O mothers? And why?

A

They are more likely to have jaundice d/t maternal antibodies to type A and B blood (ABO Incompatibility)

56
Q

what is bilirubin

A

breakdown of RBCs

57
Q

Nursing education for a breastfeeding mother postpartum?

A
  • Supportive bra
  • Warm compress/Massage (Prior to feeding)
  • Nipple Care: Exposure to air after feeding; Express milk; Adequate latch
58
Q

Nursing education for a NON-breastfeeding mother postpartum?

A
  • Supportive bra
  • Ice packs to breast and axilla
  • Avoid hot water in shower
  • Do not express milk (milk will be gradually re-absorbed)
  • Cabbage leaves on nipples can help to slow milk production
59
Q

When should a woman ideally pass her first urine after childbirth?

A

within 6 hours of delivery or after foley is discontinued

60
Q

what is REEDA?

A

redness, edema, ecchymosis, drainage, approximation

61
Q

Patient education about lochia and vagina care in postpartum period?

A
  • Observe bleeding: Should decrease in amt and lighten in color
  • Monitor bleeding in response to activity
  • No tampons (anything put inside the vagina can be a vector for bacteria)
  • No tub bathing
  • No sex for 6 weeks (can depend)
62
Q

Warning signs in regards to lochia?

A

o increase in bleeding once discharged from hospital

o Increase in amount and return to Red color

63
Q

Patient education about perineal care?

A
  • Icepacks for first 24 hours
  • Peribottle
  • Sitz bath:Warm water soak AFTER 24 hours
  • Avoid straining for BM and use sitz bath after BM
64
Q

What is a hemorrhoid?

A

• occur as a result of progesterone-induced vasodilation and from pressure of enlarged uterus on lower intestine and rectum (-aka dilated vein that poking out of anus)
-more common in women w/ constipation, poor fluid intake or poor dietary habits, smokers, or previous Hx of hemorrhoids

65
Q

Nursing education for presence or absence of hemorrhoids

A

o Sitz bath (reduces pain)
o Tucks pads (to induce shrinkage and reduce pain)/witch hazel pads
o Stool softeners (reduces strain)

66
Q

What does the homan’s sign assess for?

A

DVT

67
Q

How do we assess the homan’s sign?

A

o Pain w/ dorsiflexion of foot
o Assess calf for red/tender/warm/swelling
o Notify CNM/MD asap!

68
Q

what is endometritis

A

inflammation of endometrium, infection of uterine lining

69
Q

what is puerperal sepsis:

A

-any infection of genital canal within 28 days after abortion or birth
o Most occur within first 48 hours

70
Q

Potential postpartum infections

A
  • Puerperal sepsis
  • Endometritis
  • Wound infections
  • Urinary tract infections
  • Mastitis
71
Q

3 risk factors for developing endometritis?

A

o C-section
o Ruptured Membranes in labor for > 24 hours
o Pre-existing vaginal infection (ie group B strep)

72
Q

what is mastitis?

A

-introduction of bacteria into breast soft tissue (this is NOT A MILK INFECTION!).
-Happens d/t “bad latch” causing cracks and leaving a port of entry for bacteria
• Unilateral
• Usu occurs after Milk Production (usu 2-4 wks postpartum)
• Inflammatory edema and engorgement of breast
• Red, warm, painful area on one breast

73
Q

nursing education about mastitis?

A
  • can continue to breast feed!

- take antibiotic therapy

74
Q

What are the “postpartum blues”?

A
  • Transient condition mild, rapid mood swings
  • Decreased concentration, insomnia, tearfulness, crying
  • Day 2-3 after delivery; peaks day 5, RESOLVES WITHIN 2 WEEKS
  • Resolves on own or w minor support: Occasional use of anti anxiety meds
75
Q

what is postpartum depression?

A
  • Depressed mood interfering w/ interest/pleasure for the majority of day, nearly daily for 2 WEEKS: 5-9%
  • Symptoms: Anxiety, anger, panic, irritability, guilt, overwhelmed
  • Cultural variations may contribute to un-diagnosis or misdiagnosis
76
Q

What are the risks associated with postpartum depression?

A

o ***personal history of depression (Major Risk Factor!!!)
o Lack of social support
o Family psych history
o Genetic susceptibility

77
Q

What do we recommend about Rubella vaccination during postpartum?

A

o **If woman is not immune, vacc is recommended
o Must use contraception for 1 month
o Virus sheds in urine and stool: Good handwashing is key
o Made from eggs: beware for allergies
o No contraindication with breastfeeding

78
Q

What 5 things do we include in the daily/routine assessment of a newborn?

A 
o	Vital signs
o	Weight 
o	Diaper care: Voiding / stooling
o	Feeding pattern
o	Family attachment
79
Q

what is KERNICTERUS

A

condition in which unconjugated bilirubin enters the bain and leads to encephalopathy, brain damage, and death

80
Q

When can we remove the cord clamp on the umbilical cord?

A

once the stump is dry

81
Q

When does the umbilical cord stump usu fall off?

A

after 10 days

82
Q

What do we teach parents about cord care after discharge?

A

no immersion baths until cord is fully detachted!

83
Q

What 2 procedures are performed on the newborn immediately after delivery?

A

-Administration of erythromycin and tetracycline antibiotic ointment for prevention of opthalmia neonatorum (can cause neonatal blindness)
-Vitamin K (mandated in all 50 states)
o 0.5 – 1 mg IM X 1 dose shortly after birth in anterior thigh (vastus lateralis)

84
Q

why do we give vitamin K to newborns?

A

o Usu, bacteria of intestine produce vit K in adequate quantities, but newborn’s bowel is sterile, so vit K is not produced in intestine until after microorganisms are introduced, (e.g. w/ 1st feeding)
-Usu it takes ~1 wk for newborn to produce enough vit K to prevent vit K deficiency bleeding

85
Q

When do we give Hep B vaccine? What about hep B immunoglobulin?

A

-Hepatitis B Vaccine
o Prior to discharge from newborn nursery
o Given at 1 month of age
-Hepatitis B Immune Globulin
o HBIG administered within 12 hours of birth ONLY IF mom is Heb B positive (WASH LEG and body)

86
Q

Common lab tests performed on newborns?

A
  • glucose (esp if mom is diabetic)
  • blood type (esp if mom is Rh neg or type O)
  • bilirubin
  • metabolic screening (PKU, metabolic disorders, thyroid and blood disorders)
87
Q

What is the Tx for hyperbilirubinemia?

A

phototherapy

88
Q

Nursing care for a newborn undergoing phototherapy? (4 things)

A
  • Cover eyes & genitalia to protect from light
  • Promote feeding
  • Monitor for fluid losses and potential dehydration
  • Assess stool frequency
89
Q

Post-circumcision care?

A
  • Observe for first void
  • Observe for bleeding
  • Careful diaper change
  • Application of vaseline/neosporin
  • Heals within 10 days
90
Q

How big is a newborn’s stomach on day 1?

A

cherry

91
Q

How big is a newborn’s stomach on day 3?

A

walnut

92
Q

How big is a newborn’s stomach at 1 week?

A

apricot

93
Q

How big is a newborn’s stomach at 1 month?

A

large egg

94
Q

Why is breast milk considered living tissue?

A

bc it contains almost as many live cells as blood

95
Q

What is the avg feeding amt on day 1?

A

5-7ml per feeding (~30ml/day)

96
Q

What is colostrum?

A

o a clear, yellowish fluid (May be present in breast as early as 28 wks)
o Present for first 3 days
o More concentrated than mature milk (also has less fat)
o Extremely rich in immune globulins
o Higher concentration of protein and minerals

97
Q

when do we expect mature milk to come in?

A

3-5 days after delivery

98
Q

what day postpartum do we expect to be the “final” stage of reaching mature milk?

A

day 10

Maternity (6 decks)

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