Mod 5 Flashcards
After the first hour delivery how often are vitals performed?
Q15 min
Defined the postpartum period.
The critical transition period for women, newborn, and family both physiologically and psychologically
Define puerperium.
A.k.a. postpartum, the period after delivery of the placenta, lasting for six weeks
What is the pain go for a woman in the postpartum period?
0-2
Is a blood pressure change in the postpartum period?
Falls in the first 2 days
Do respirations change in the postpartum period?
No
Does the pulse change in the postpartum period?
Yes 40-80 bpm, puerperal bradycardia
Does the mothers temperature change in the postpartum period?
Slight elevation in the first 24 hr, normal afterwards
What happens to the cervix in the postpartum period?
It begins to close, and now appears as a jagged slit like opening that is not the same as it was before delivery
What happens to the vagina in the postpartum period?
Eventual thickening and return of rugae
Define a boggy uterus.
Not firm, soft
Define involution.
Contraction of muscle fibers, the contraction of the uterus to stop bleeding after birth. Regeneration of the uterine epithelium
Define lochia.
Vaginal discharge after delivery consisting of a superficial layers of the uterus is sloughed off. Consists of lochia rubra, serosa, alba
Define afterpains during the postpartum period.
Painful uterine contractions after delivery that help in involution of the uterus, more painful with multiparas. (Uterus is bigger and more stretched each time = has to contract more so more pain.)
How does fundal height decrease in the postpartum period?
It should decrease one finger birth per postpartum day.
What initiates milk production in the mother during the postpartum period?
Prolactin released from the anterior pituitary
What initiates milk let down in the postpartum mother?
Oxytocin released from posterior pituitary
What provides continue stimulation for prolactin and oxytocin release in the postpartum mother?
The infant sucking
If a mother states that she is not producing milk, what should you do?
Encourage her to nurse and latch the baby, sucking will stimulate milk production and let down.
Two or false afterbirth the cervix returns to its pre-pregnancy state?
False
What happened to the mothers white blood cell count in the postpartum period?
Wbc increases during labor and remains elevated 4 to 6 days after birth
What is the average blood loss with a vaginal birth?
500mL
What is the average blood loss with a cesarean birth?
1000 mL
What happens to glomerular filtration rate and renal flow in the postpartum period?
Increases
When must a woman urinate by after delivery?
Within 6 hrs
What urinary system problem is common with epidurals?
Decrease bladder tone and sensation due to regional Anastasia, leads to diminish sensation of the bladder and pressure due to swelling
What are four causes of postpartum diuresis?
- Large amounts of intravenous fluid given during labor
- Decreasing anti-diuretic effect of oxytocin as its level declines
- Build up and retention of extra fluids during pregnancy
- Decrease in production of aldosterone, a hormone that decreases sodium retention and increases urine production
What is a common G.I. system problem in the postpartum mother?
Constipation due to fear of straining affecting the perineum, administer stool softeners
How long is diaphoresis common for in the postpartum mother?
Approximately one week postpartum
In the postpartum assessment the breasts are at assessed for what?
Size, contour, and engorgement, if they’re soft or hard, tender or nontender. If the mother is secreting clostridium. Also how the baby breast-feeds
In the postpartum assessment the uterus is assessed for what?
Height of fundus, one fingerbirth below umbilicus or deviated to right, firmness
In the postpartum assessment the bladder is assessed for what?
Time of last Voiding, and complete bladder emptying, was there a foley before or after surgery (void after Cathy removal?)
In the postpartum assessment the bowels are assessed for what?
Assess of the mother has had a bowel movement, has bowel sounds, is passing gas, and that there is no distention
In the postpartum assessment the lochia is assessed for what?
Amount, color, odor
In the postpartum assessment the Episiotomy and perineum are assessed for what?
That the perineum is intact, if there is any bruising, lacerations, or a hematoma
In the postpartum assessment the extremities are assessed for what?
there is no edema, no warmth or tenderness to the calf
True or false in the postpartum assessment emotional status should also be assessed
True
what time is typical for the establishment of lactation?
4 to 5 days after childbirth
Define breast engorgement
Process of swelling of the breast tissue due to an increase in blood and lymph supply as a precursor to lactation
Is the mother has chosen to breast-feed how do you help her with Breast engorgement.
Help relieve by frequent emptying, warm showers and compresses before feeding, cold compresses after feeding
If the mother has chosen not to breast-feed how do you help with breast engorgement.
Tight supportive bra, ice, avoid breast stimulation
True or false during the first 24 hours postpartum, a slight elevation in temperature is considered normal?
True
After the birth of the baby where is the uterus located?
It should be approximately two fingerbirths below the umbilicus.
True or false any type of nipple stimulation will cause the uterus to contract?
True
In charting The assessment of the fundus what does U/U mean?
The uterus is over or above the umbilicus
When chart in the assessment of the fundus what does +1/U stand for
The uterus is one fingerbirth above the umbilicus, this is an unusual finding.
When charting the assessment of the fundus what does -1/U mean?
Uterus is below the umbilicus, this is normal for the first day postpartum
Define decidua basalis
The lining of the uterus that is present during pregnancy, it must be shed to form a new endometrial lining, this happens for 4-8 weeks post delivery.
What color is lochia initially?
Bright red and consists of blood and fibrinous products, decidual cells, and red and white blood cells
At any stage lochia should have what smell?
Fleshy/earthy
An offensive odor of lochia usually indicates what?
An infection such as endometriosis
What are the three stages of lochia flow in order?
Lochia rubra, lochia serosa, lochia alba
Define lochia rubra
Deep red mixture of mucous, tissue, debris and blood. Occurs for the first 3-4 days after birth
Define lochia serosa
Pinkish brown discharge and is expelled 3-10 days after birth
Define Lochia alba
Creamy white or light brown discharge, occurs from day 10-14 and can last 3-6 weeks postpartum
What are the parameters for light bleeding
Less than 4 in
What are the parameters for moderate bleeding
Less than 6 in
What is the acronym for the assessment of an episiotomy/laceration/ perineum?
R E E D A
What does the R stand for in REEDA?
R- redness
What does the first E stand for in REEDA?
E- edema
What does the second E stand for in REEDA?
Ecchymosis
What does the D stand for in REEDA?
Discharge, drainage
What does A stand for in REEDA?
Approximation
When a client ambulated for the first time after birth what should you inform them to do?
To call you before they get up so you can help them, because they may faint.
Peri self care after birth involves what?
A squirt bottle with warm water.
How long is ice given for the perineum after vag births?
6-8 but ideally 24hrs followed by heat
True or false checking for homans Sign is controversial because you can dislodge a DVT in the process?
True
What are 4 of the 7 assessment areas for the emotional assessment of the postpartum patient?
- interactions with family
- level of independence
- energy levels
- eye contact with infant
- posture and comfort level with infant
- sleep and rest patterns
- be alert for mood swings, irritability, or crying episodes
Define postpartum blues.
Transient emotional disturbances
What are postpartum blues characterized by?
Anxiety, irritability, insomnia, crying, loss of appetite, sadness
When do the symptoms of postpartum blues usually begin?
2 -4 days after child birth
When do symptoms of postpartum blues usually resolve?
By day 8
Postpartum blues typically resolve with…?
Restorative sleep
Define engrocement
Strong feelings of attachment by a parent towards the newborn
