Exam 5 Flashcards
What occurs to the body during lactation?
increase temperature up to 100.4
may cause diaphoresis
prolactin levels remain elevated
ovulation suppressed
What are the types of milk produced?
colostrum: begins in later parts of pregnancy, as early as 32wks, considered drops of gold, dense in nutrition and immunoglobulins, a lot of cluster feeding will occur with this, table to teaspoon amounts
transition: produced 3 to 4 days after birth, by 2wks there is a substantial amount
mature milk: substantial amount
What are the types of lochia?
rubra: day 1-3, bright red, bloody with fleshy odor, may contain small clots (size of pencil erasers)
serosa: day 4-10, older blood look, pinkish-brown, serosanguineous
alba: day 11 to 4-8wks, yellowish-white with fleshy odor, can be seen even until time of ovulation
How does breastfeeding effect lochia?
breastfeeding releases oxytocin to increase uterine ctx and promote faster slough, can
How much locia is released normally? in excess?
first 24hrs can be moderate to heavy and by 48 it will be light
one maxipad saturated w/in 15min or less, clots bigger than an egg
What types of vaccines are given PP if not immune? What are the risks with the vaccines?
rubella, varicalla, T dap
teratogenic, do not get pregnant for 1 month
What are some perineum cares?
ice for first 24 hrs
heat: whirlpool/sitz
clean: rinse after toileting
frequent pad changes
pat dry
topical/PO anesthetics
sit on pillows or side saddle (avoid direct sitting)
How often is PP assessment done?
Q15min for about 2 hours following birth
What are the normal vitals seen PP?
temp of up to 100.4 for 24 hrs d/t dehydration, lactation, and metabolism changes
pulse is elevated for 1 hr and then begins to decrease, by 8 to 10 wks will return to prebirth values
resp: decreased d/t shift of organs and return to prebirth rates by 8 to 10 wks
bp: no slight alteration, may have orthostatic BP for 48 hrs
pain: present
What could abnormal vitals pp indicate?
temp: greater than 100.4 for more than 24 hours could indicate puerperal sepsis
pulse: rapid could indicate hypovolemia d/t hemorrhage
resp: hypoventilation could occur after epidural or narcotic usage
bp: hypovolemia d/t hemorrhage (late sign)
How is the fundus and uterus assessed pp?
fundus: tone (size of fist or grapefruit, firm) and height (measured by cm above or below umbilicus and is midline or displaced)
uterus involution: descent of uterus, measured at the time of birth and after placental expulsion (should no longer be palpable by day 10), determine if firm or boggy
as the uterus descends the height of the fundus should always be below the uterus, ensure the frequent bladder emptying
What is the onset of pp depression?
within 6 months pp
What are risk factors for pp infections?
C-section
PROM
anemia
hematoma
catheterization
multiple vaginal exams
invasive procedures
DM
obesity
What are the types of pp infections? S/S?
endometritis: can be seen 2-5days pppelvic pain, uterine tenderness and subinvolution, scant to profuse lochia (malodorous or purulent), fever
mastitis (unilateral breast connective tissue infection): milk stasis, nipple trauma, poor hand hygiene; fatigue/chills, pain/tenderness, erythema, odor, malaise, inflammation, purulent drainage, enlarged tender lymph node
UTI: bladder trauma during birthing or poor technique of catheter insertion
any type of surgical or trauma wound: poor hand hygiene, cross contaminatin of lochia into wounds; can begin 24 to 48hrspp, warmth, swelling, tenderness, pain, edema, seropurulent drainage, wound dehisence, evisceration, fever
What causes hemorrhage? What is the priority treatment?
tone: uterine atony, subinvolution of uterus
tissues: retained placenta, placenta accreta
trauma: lacerations, hematoma
thrombin: DIC, ITP, Von Willebrand
fundal massage
What is uterine atony? S/S? Treatment? Nursing interventions? Risk factors?
lack of uterine muscle tone causing absence of ctx
cramping, nausea, restless
provider will perform bi-manual compression
frequent fundal height and uterus assessment
overdistended uterus, prolonged/short/induced labor, use of many uterine ctx agents, low platelets secondary to pregnancy induced HTN
What is subinvolution of uterus? S/S?
failure to uterus to return to normal size after pregnancy
lochia ruba>2wks
What are risk factors of retained placenta? S/S? Nursing interventions?
excessive traction trying to hurry placental expulsion causing premature or partial separation
entrapemtn: certix clamped down around placenta interfering with placental expulsion
placenta accreta
preterm birth
uterine atony, subinvolution, inversion
monitor FH, VS, return of lochia rubra, inspect placenta when expelled
What is a hematoma seen in pp? Treatment?
collection of blood, often in vulvar or vaginal, occurs from injury to blood vessel during normal spontaneous vaginal delivery, in an assisted birth commonly seen in retroperitoneal area by ischial spine
ice to help shrink tissue
What other perinatal complications can lead to DIC?
preeclampsia
amnitoic fluid embolism
sepsis
prolonged fetal death
uterine atony
placental abruption
excessive blood loss
What is ITP? Who is it common in? Treatment?
destruction of platelets by autoantibodies causing low platelets
young women
glucocorticoids and immunoglobulins
What is von willebrand disease?
autosomal dominant bleeding disorder d/t impaired platelet adhesion
What are nursing interventions for hemorrhage? What drugs can be administered?
check uterine tone, massage uterus, administer uterine ctx, assist voiding, replace fluids and administer blood as ordered
pitocin, cytotec, hemabate
What are the three most common venous thromboembolic conditions?
superficial venous thrombosis, DVT, PE
What are early signs of hemorrhage? Late signs?
excessive bleeding, light-headedness, nausea, visual disturbances, anxiety, pale/ashen color, clammy skin
increasing pulse, respirations, and steady or decreasing BP
What is the bacteria causing mastitis?
staph. aureus
