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
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
3
Q
what is lochia
A
postbirth uterin discharge
4
Q
is lochia more or less after a c-section?
A
much less
5
Q
what are the 3 stages (in chronological order) of lochia?
A
o Lochia rubra
o Lochia serosa (serosanguinous, whitish)
o Lochia alba
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
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
8
Q
when do we expect to see lochia alba?
A
• Continues 2 to 6 weeks after birth
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
10
Q
when do we expect to see lochia rubra?
A
• Duration of appx 3 to 4 days
11
Q
Terms used to describe amt of lochia on pad
A
scant, moderate, heavy
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
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
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
15
Q
What 2 hormones are most important for lactation?
A
oxytocin and prolactin
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.
17
Q
how can we tell if breast feeding is going well?
A
-by how many poopy diapers the baby is producing
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!)
19
Q
How much milk should a mother be producing, on average, by day 1?
A
30ml (1oz)
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
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
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
23
Q
how long is the postpartum period?
A
traditionally lasts 6 weeks (can vary a lot and last much longer)
24
Q
What is a parous cervix?
A
a cervix that has changed bc it’s been stretched out from past births
25
what is "involution"?
the return of the uterus to nonpregnant state following birth
26
Where should the fundus line be at the end of 3rd stage of labor?
approx 2 cm below umbilicus (within appx 12 hrs returns to appx umbilicus (+/- 1 cm) (temporary)
27
Avg pace of descent of the fundus postpartum?
– Fundus descends 1 to 2 cm every 24 hours
| – 2 weeks after childbirth uterus lies in true pelvis (below iliac crest)
28
What is sub-involution?
failure of uterus to return to non-pregnant state
29
What are some common causes of sub-involution of the uterus?
- retained placental fragments
| - infection
30
How long does it take for the vagina to return to pre-pregnancy size after childbirth?
approx 6-10 weeks
31
what is the "introitus"?
opening that leads to vaginal canal
32
how does the introitus appear in the postpartum period?
erythematous and edematous
33
How long does it take for most episiotomies to heal?
2-3 weeks
34
How long does it take a woman's pelvic floor muscles to regain their tone?
up to 6 months (the muscles are torn and stretched during childbirth)
35
Nursing care for the perineum in postpartum period?
- 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
36
What is diastasis recti
-Separation of the rectus abdominis muscles)
| • More common in women who had poor ab tone before pregnancy
37
When do non-lactating women typically begin ovulation and menstruation after childbirth?
o 70% of non-breastfeeding mothers menstruate within first 12 weeks
38
Which 2 pregnancy hormones drop dramatically in postpartum period?
estrogen and progesterone (begins with the expulsion of the placenta)
39
Why can continuous breastfeeding delay menstruation and ovulation?
Breastfeeding stimulates PROLACTIN (necessary for milk production, and also inhibits release of GONADOTROPIN (necessary for ovulation)
40
• Breast-feeding as a contraceptive method can be effective for 6 months after delivery only IF a woman:
* 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
What changes are expected in the postpartum period with the urinary system?
• 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
When do we typically expect to see spontaneous bowel movements occur postpartum?
-2-3 days after childbirth (may need to give stool softeners, milk of magnesia, encourage fiber, etc)
43
What changes in vital signs do we see in a woman postpartum?
* 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
Why are we concerned if we see hypotension in the postpartum period?
-there could be a “hidden” hematoma somewhere where she is pooling blood. Possible that only manifestation (or the 1st) is hypotension
45
What are potential manifestations of a "hidden" hematoma postpartum?
- hypotension
| - acute bottom pain
46
What are the expected changes in the respiratory system postpartum?
* No significant change in rate
* Ease of “stuffy nose”
* Return to normal tidal volume
47
What is the #1 cause of postpartum bleeding?
boggy uterus
48
What is the potential association btwn the bladder and postpartum bleeding?
-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
What changes occur in blood volume during the postpartum period?
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
Why do we worry if a woman has a headache in the postpartum period?
- 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
What expected changes occur in the musculoskeletal system postpartum?
• Reversal of pregnancy adaptations (i.e. reversal of lordosis)
o Joints are completely stabilized by 6 to 8 weeks after birth
52
What expected changes occur in the integumentary system postpartum?
• 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
What do we auscultate in the "mini" head to toe postpartum assessment?
-heart, lungs, and bowel
54
If infant is Rh Positive, and mother is Rh neg, mother must receive RhoGAM in what time frame?
within 72 hours of delivery to prevent Rh Isoimmunization
55
What do we typically see in infants w/ Blood Type A or B born to Type O mothers? And why?
They are more likely to have jaundice d/t maternal antibodies to type A and B blood (ABO Incompatibility)
56
what is bilirubin
breakdown of RBCs
57
Nursing education for a breastfeeding mother postpartum?
* Supportive bra
* Warm compress/Massage (Prior to feeding)
* Nipple Care: Exposure to air after feeding; Express milk; Adequate latch
58
Nursing education for a NON-breastfeeding mother postpartum?
* 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
When should a woman ideally pass her first urine after childbirth?
within 6 hours of delivery or after foley is discontinued
60
what is REEDA?
redness, edema, ecchymosis, drainage, approximation
61
Patient education about lochia and vagina care in postpartum period?
* 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
Warning signs in regards to lochia?
o increase in bleeding once discharged from hospital
| o Increase in amount and return to Red color
63
Patient education about perineal care?
* 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
What is a hemorrhoid?
• 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
Nursing education for presence or absence of hemorrhoids
o Sitz bath (reduces pain)
o Tucks pads (to induce shrinkage and reduce pain)/witch hazel pads
o Stool softeners (reduces strain)
66
What does the homan's sign assess for?
DVT
67
How do we assess the homan's sign?
o Pain w/ dorsiflexion of foot
o Assess calf for red/tender/warm/swelling
o Notify CNM/MD asap!
68
what is endometritis
inflammation of endometrium, infection of uterine lining
69
what is puerperal sepsis:
-any infection of genital canal within 28 days after abortion or birth
o Most occur within first 48 hours
70
Potential postpartum infections
* Puerperal sepsis
* Endometritis
* Wound infections
* Urinary tract infections
* Mastitis
71
3 risk factors for developing endometritis?
o C-section
o Ruptured Membranes in labor for > 24 hours
o Pre-existing vaginal infection (ie group B strep)
72
what is mastitis?
-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
nursing education about mastitis?
- can continue to breast feed!
| - take antibiotic therapy
74
What are the "postpartum blues"?
* 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
what is postpartum depression?
* 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
What are the risks associated with postpartum depression?
o ***personal history of depression (Major Risk Factor!!!)
o Lack of social support
o Family psych history
o Genetic susceptibility
77
What do we recommend about Rubella vaccination during postpartum?
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
What 5 things do we include in the daily/routine assessment of a newborn?
```
o Vital signs
o Weight
o Diaper care: Voiding / stooling
o Feeding pattern
o Family attachment
```
79
what is KERNICTERUS
condition in which unconjugated bilirubin enters the bain and leads to encephalopathy, brain damage, and death
80
When can we remove the cord clamp on the umbilical cord?
once the stump is dry
81
When does the umbilical cord stump usu fall off?
after 10 days
82
What do we teach parents about cord care after discharge?
no immersion baths until cord is fully detachted!
83
What 2 procedures are performed on the newborn immediately after delivery?
-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
why do we give vitamin K to newborns?
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
When do we give Hep B vaccine? What about hep B immunoglobulin?
-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
Common lab tests performed on newborns?
- 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
What is the Tx for hyperbilirubinemia?
phototherapy
88
Nursing care for a newborn undergoing phototherapy? (4 things)
* Cover eyes & genitalia to protect from light
* Promote feeding
* Monitor for fluid losses and potential dehydration
* Assess stool frequency
89
Post-circumcision care?
* Observe for first void
* Observe for bleeding
* Careful diaper change
* Application of vaseline/neosporin
* Heals within 10 days
90
How big is a newborn's stomach on day 1?
cherry
91
How big is a newborn's stomach on day 3?
walnut
92
How big is a newborn's stomach at 1 week?
apricot
93
How big is a newborn's stomach at 1 month?
large egg
94
Why is breast milk considered living tissue?
bc it contains almost as many live cells as blood
95
What is the avg feeding amt on day 1?
5-7ml per feeding (~30ml/day)
96
What is colostrum?
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
when do we expect mature milk to come in?
3-5 days after delivery
98
what day postpartum do we expect to be the "final" stage of reaching mature milk?
day 10
