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XIO > Maternity 5-1 > Flashcards

Maternity 5-1 Flashcards

1
Q

Postpartum - how many weeks?

A

the period between the birth of the newborn and the return of the
reproductive organs to their normal non- pregnant state. Usually complete by 6-8 weeks post-birth

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2
Q

Involution

A

Return of the uterus to
a non-pregnant state after birth.a non-pregnant state after birth.
Begins with the expulsion of the
placenta and contraction of the
smooth muscle.

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3
Q

Subinvolution

A

failure of the
uterus to return to nonpregnantuterus to return to nonpregnant

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4
Q

Uterine Assessment:

A

Consistency,
location relative to umbilicus,
midline/right/left
7
This Photo by Unknown Author is licensed under CC BY

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5
Q

postpartum VS - how often?

A

Head-to-toe assessment: Q shift and PRN

VS & OB assessment (includes pain!) up to 2 hours PP:
q 15 x 1 hour
q 30 x 1 hour

VS & OB assessment: twice shift/1st 24 hours, once shift/> 24 hours PP

Additional post c/s assessments PRN

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6
Q

PROCESS OF INVOLUTION (contract the hemo cat)

A

Contraction of uterine muscle fibers

Hemostasis is achieved primarily by compression of the intra-myometrial blood vessels as the uterine contracts

Catabolism: shrinking of enlarged myometrial cells

After lochia sheds, uterine lining regenerates

Fundus not palpable by 10 days post birth

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7
Q

FACTORS PROMOTING
INVOLUTION

A

Oxytocin (Pitocin)
Breastfeeding
Urine output
Fundal Massage
Ambulation

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8
Q

bladder too full

A

uterus will go to right

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9
Q

Lochia Rubra (red for 3 days)

A

~2-3 days
* Blood, decidual
tissue/debris, mucus
* Color: bright red

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10
Q

Lochia Serosa - what days? (seriously pink and brown)

A

~3-10 days
* Blood, serum, leukocytes
and tissue debris
* Color: pinkish brown

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11
Q

Lochia Assessment- how many pad changes a day?

A
  • Amount: Initially, expect 6-8 pad changes per day
  • Odor
  • Clots
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12
Q

Lochia - scant (scantly one, do the conversion)

A

Lochia Assessment
* Scant < 2.5cm (1 inch)

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13
Q

Vagina and Perineum

A

Bruising and edema of the perineum
* Lacerations/Episiotomy
* Hemorrhoids

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14
Q

Hemorrhoids

A
  • Symptoms: Itching, Discomfort Bright
    Red Bleeding
  • Interventions: Stool softeners, witch
    hazel pads (Tucks), topical ointment,
    increased fiber in diet
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15
Q

Nursing Care: Perineal Trauma

A

Ice packs: 1st 24 hours
* Peri-bottle with every voiding
* Sitz Bath (after 24 hours)
* Pain Control
25

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16
Q

Urinary Tract: Postpartum Changes - what about gfr?

A

Urinary Tract: Postpartum Changes
* Decreased GFR & Renal plasma flow
* Tone/size of structures returns to pre-
pregnancy state (6-8 weeks)

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17
Q

maximum time to allow a pt to go without peeing?

A

6 hours

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18
Q

Nursing Care:
Urinary Tract
Postpartum - how often to void?

A

Assist patient to void following delivery
* Assess for fundal displacement
* Encourage to void q2 hours
* Pain relief & Edema/trauma: ice, analgesia, sitz bath,
topical spray
* Difficulty voiding:
* Decreased sensation of full bladder
* Pain
* Edema/trauma
* Peppermint essential oil in toilet water
* Document urine output per provider order
* Bladder scanner/straight cath PRN

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19
Q

GI Tract - constipation for how long?

A

Bowel tone will improve as
progesterone levels decline.
 Delayed spontaneous bowel
movement, up to 5 days PP.
 Labor/birth effects: pre-labor diarrhea,
lack of food, dehydration, anticipatory
pain due to lacerations/tissue trauma
 C/S: Intra-op narcotics, disruption of
intestines during surgery, delayed
ambulation, NPO

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20
Q

GI Changes/Nutrition - how many extra calories if breastfeeding?

A

Breast-feeding vs. bottle-
feeding
* If breast-feeding:
* Encourage prenatal
vitamins
* Increase calories if breast-
feeding (450-500 kcal)
30This Photo by Unknown Author is licensed under CC BY

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21
Q

Nursing Care: GI Changes

A

Encourage hydration and ambulation
* Diet high in fiber
* Stool softeners/laxatives/anti-gas meds PRN
* Encourage normal food intake
* Adhere to ATC non-narcotic pain regimen post C/S
* Comfort measures
31

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22
Q

Nursing Care: GI
Changes/Nutrition - foods high in what?

A

Iron PRN
* Foods high in iron
* Iron supplement/infusion
* Education: constipating
effect of p.o. iron
32
This Photo by Unknown Author is licensed under CC BY-SA-NC

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23
Q

Cardiovascular System: Postpartum
Changes - cardiac output

A

Heart: returns to pre-pregnant position
* Cardiac output: gradually declines/3 months, HR
slows/increased stroke volume

24
Q

Cardiovascular System: Postpartum
Changes - when does coagulation return to normal? (coag is the number of the beast)

A

Increased coagulability of pregnancy: Returns to pre-pregnancy state
by 6 weeks

25
Q

Respiratory System:
Postpartum Changes - RRs?

A

RR: 16-24
 Diaphragm returns to normal
position
SOB relief

26
Q

Integumentary System:
Postpartum Changes - when does hair loss occur?

A

Pregnancy pigmentation fades: melasma, linea nigra, nipples
* Hair loss: more hairs in resting phase pre-birth, most hair loss by 3
months PP w/ dec in estrogen
* Striae gravidarum: stretch marks start to fade

27
Q

linea nigra - fade or not?

A

usually fades

28
Q

integumentary

A

Pregnancy pigmentation fades: melasma, linea nigra, nipples
* Striae gravidarum: stretch marks start to fade

29
Q

endocrine

A

Delivery of placenta: rapid clearance of placental hormones

30
Q

Endocrine System - when does menses return for breastfeeding and non-breastfeeding?

A

Ovulation may occur before first period.
* Menses: May return at 6-8 weeks if not breastfeeding exclusively or
exclusively
* Breast-feeding: dependent upon frequency of breast-feeding,
average 6 months
39

31
Q

endocrine

A

Delivery of placenta: rapid clearance of
placental hormones
* Adrenal release: patient may experience
shaking in 1st 30 min PP
* Decrease in estrogen: diuresis, remain low if
breastfeeding
* HCG, HPL, progesterone all drop
* Prolactin: inc w/ breastfeeding, released by
anterior pituitary
38

32
Q

Postpartum Pain Management:
Sources of Pain

A

Remember: Assess, Intervene PRN, Re-assess, Document!
* Uterine cramping
* Afterpais
* Stronger w/ multiparity, full bladder, breastfeeding
* Oral analgesia, heat therapy, frequent voiding
* Perineal/labial/rectal
* Oral analgesia, care of lacerations/hemorrhoids
* Breasts:
Nipple tenderness
Assess positioning
Teach nipple care
 Engorgement
Encourage frequent breastfeeding
Cold packs
NSAIDS
Supportive bra
Cold Cabbage leaves
Areola softening
42

33
Q

Sources of Pain - Post C-Section pain

A

Assist w/ mobility PRN
* Promote early ambulation
* Promote return of GI function
* Ensure pain controlled: the more mobile the patient, the less
likely pain is to be severe
* Assess incision for infection
43

34
Q

Postpartum Pain Management:
Analgesia

A

Oral Analgesia: Acetaminophen, Ibuprofen, Oxycodone
* IV, non-narcotic: Acetaminophen, ketoralac
* NSAIDs (ibuprofen/ketorolac)
* Inhibit prostaglandin
* Decrease inflammatory responses
* Effective in peripheral tissues
* Epidural/Spinal: Duramorph
* PCA: dilaudid, morphine
44

35
Q

Lactation: Breast Changes - what stimulates breast tissue?

A

Prenatally: Mammary
glands develop/proliferate
* Estrogen stimulates dev’t
of breast tissue

36
Q

Lactation:
Hormones - Prolactin -what do high levels do?

A

 High levels suppress
FSH/ovulation
 Inc days 4-5 PP w/ drop of
estrogen/progesterone
 Increase in response to nipple
stimulation

37
Q

Maternal Contraindications to
Breastfeeding

A

Chemotherapy or radioactive isotopes
* “illicit” drugs
* Active TB
* HIV positive (in the U.S.)
* Certain Rx drugs
* Resources: Lactmed, Hale’s guide

38
Q

uterine weight

A

Uterus weighs 2.2 lb (1,000 g) at time of FT birth, 2 oz at 6 wk PP

39
Q

lochia light - (lights out at 10)

A
  • Light < 10 cm (4 inches)
40
Q

lochia moderate - (moderate comes after lights out)

A
  • Moderate > 10cm
41
Q

lochia heavy - pad in how many hours?

A
  • Heavy = one saturate pad within 2 hours
42
Q

decreased estrogen - mucosa?

A

thin mucosa, absence of rugae, dryness (3-4 weeks)

43
Q

urinary - diuresis due to…(what hormones?)

A
  • Increased output: diuresis due to decreased oxytocin/decreased blood volume/decreased aldosterone (12 hours
    PP-1 week)
  • Risk for urinary retention: swelling,
    anesthesia, decreased urge to void, pain
  • Risk of infection: d/c foley ASAP
44
Q

what drugs help involution? (hmm, helps involution?)

A

Hemabate, Misoprostol, Methergine

45
Q

BP - when does it return to normal? (it’s all within the postpartum timeframe)

A
  • BP: decrease/1st 2 days PP, inc to normal by 6 weeks PP
46
Q

blood volume - when does it return to normal? (jessica’s blood is 26)

A
  • Blood volume: drops rapidly PP/returns to pre-pregnant
    state 2-6 weeks
47
Q

plasma - how does it decrease?

A
  • Plasma volume: decrease through diuresis/increase H &H
48
Q

when do wbc return to normal? (think, WBC can’t stay high too long)

A
  • WBCs: rise intrapartum, return to normal at 4-6 days PP
49
Q

clotting factors - how long do they stay elevated? (clots until age 23)

A
  • Clotting factors remain elevated 2-3 weeks PP
  • Monitor for DVT/thromboembolism
50
Q

hemaglobin and hematocrit? when is the dip?

A
  • H & H: initial dip (1st 24 hours), then rise
51
Q

when does tidal volume return to normal? (tidal 13)

A

Tidal volume/functional residual
capacity: pre-pregnant state by 1-
3 weeks PP

52
Q

diaphoresis - when does it occur? (sweat at first)

A
  • Diaphoresis: mechanism to rid body of excess fluid in first week PP
53
Q

endocrine - adrenal release when? (think of pt)

A
  • Adrenal release: patient may experience shaking in 1st 30 min PP
54
Q

Decrease in estrogen - what happens? (estrogen dies)

A
  • Decrease in estrogen: diuresis, remain low if breastfeeding
55
Q
  • HCG, HPL, progesterone drop or increase?
A
  • HCG (Human chorionic gonadotropin), HPL (Human placental lactogen (HPL), progesterone all drop
56
Q

prolactin - increase or decrease?

A
  • Prolactin: inc w/ breastfeeding, released by anterior pituitary
57
Q

postpartum breasts - when do they become fuller?

A
  • PostpartumBreasts gradually become fuller and heavier 72-96 hours
    PP
  • Transition from colostrum only to full breast milk

XIO (372 decks)

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