Module 06: Care of the Mother and Child During Postpartum Period Flashcards
This phase is known as the six (6) weeks after birth. Under this, the body readjusts physically and psychologically from being pregnant to after birth. This occurs immediately after birth up to 6 weeks until woman’s body to near non-pregnant state.
Postpartal Period (Pueperium)
What is the nurse’s role during postpartum care?
(1) Provide physical care to pregnant woman because patient will experience immense pain.
(2) Provide emotional support, influence the future health of the children.
This refers to the changes of reproductive organs which undergo after birth o return to their pre-pregnancy size and condition.
Involution (Usually occurs in 10 days)
This refers to the failure of the uterus to return to pre-pregnant state after 6 weeks.
Sub-involution (Hemorrhage or Postpartum Hemorrhage: The leading cause of mortality)
This pertains to the cramps following childbirth, this is characterized to be caused by uterine contractions.
Afterpains (This is similar to intermittent cramping manifested in menstrual periods).
Afterpains are more prevalent among women who are:
Women who are breastfeeding because of the hormone of oxytocin, which helps in stimulating the uterine contraction.
This is known as the vaginal discharge after delivery.
Lochia
This is defined as the incision to enlarge the vaginal opening. This aids in cervical dilatation to cater the fetal head and prevent lacerations.
Episiotomy (Midline or Mediolateral)
This incision is characterized as the stitching together the margins of a tear in the tissues around the vaginal opening.
Episiorrhaphy
This is known as the conflicting feelings of joy and emotional letdown during the first weeks of birth. This often occurs due to changes in hormones, specifically the decrease of estrogen and progesterone.
Postpartum blues
This is known as the intense interest of fathers to their new child, which promotes early bonding. This may be furthered by skin to skin contact.
Engrossment
This is known as the persistent mood of unhappiness. Moreover, this is a medical condition that many women get after having a baby. It’s strong feelings of sadness, anxiety (worry) and tiredness that last for a long time after giving birth.
Postpartum Depression
This is known as the affectionate tie that occurs over time as infant and caregivers interact.
Attachement
This phenomenon refers to the strong emotional tie that forms soon after birth between parents and the newborn.
Bonding
This is known as a yellow-ish rich in protective antibodies that is secreted by the breast.
Colostrum
This is known as the infant status in the room with the mother. Under this, this initiative the baby remains with the mother’s room for 23 to 24 hrs a day.
Rooming In
These are substances that increase the production or flow of milk, and a common problem with breastfeeding is the perceived insufficiency of milk supply (breastmilk stimulators, like food and supplements).
Galactogogue
Enumerate BUBBLESHE.
(A) Breast
(B) Uterus
(C) Bladder
(D) Bowel
(E) Lochia
(F) Episiotomy
(G) Vital signs
(H) Homan’s signs
(I) Emotional status
This is known as the period after delivery, usually lasting for 6 weeks. It is characterized as the fourth trimester of pregnancy and is also considered as a time for maternal changes in the body.
Postpartum
These are changes wherein the body returns to the pre-pregnancy state.
Retrogressive
These are changes that prepare the body for new changes in relation to postpartum.
Progressive
What are different retrogressive changes?
(A) Shrinking and descent of the uterus
(B) Sloughing of the uterine
(C) Development of the lochia
(D) Contractions
(E) Recovery of vaginal and pelvic floor muscle
What are the different progressive changes?
(A) Production of breastmilk.
(B) Beginning of parenteral role.
This is caused by intermittent uterine contractions. This occurs mostly in multiparas or in women whose uterus was overly distended.
Afterpains (self-limiting discomforts: 48 hours postpartum)
Why does breastfeeding cause more afterpains?
Breastfeeding causes more afterpains because sucking stimulates the posterior pituitary gland to release oxytocin.
This medication is contraindicated for postpartum because it may cause bleeding.
Aspirin
What happens to the breast on the first and second day of the mother’s postpartum period?
The breast tissues should feel soft upon palpation.
What happens to the breast on the third day of the mother’s postpartum period?
The breast should begin to film warm and firm.
What happens to the breast on the third and fourth day of the mother’s postpartum period?
The breast should appear large and reddened with taut and shiny skin. It should feel hard, tensed and painful.
This is known as the feeling of fullness and sometimes tenderness in the breasts due to the oversupply of milk.
Engorgement (3rd or 5th day)
What should be felt by the examiner when the breast is engorged?
(A) Firm nodule is detected on palpation.
(B) Nodularity is bilateral and diffuse.
(C) Breast appears reddened and shiny, feels warm and tender.
This pertains to how your baby attaches to your breast to feed (areola).
Latching
How does the breast feel before lactation?
Soft with a yellowish fluid from the nipples
How does the breast feel after lactation?
Warm to touch and firm
When the mother’s breast is engorged due to an oversupply of milk, the tenderness of the breast is characterized to persist for how long?
48 hours (but may return to normal size after one to two weeks)
When the mother’s breast is engorged due to an oversupply of milk, breast nipples are characterized to be normally:
Normally erect and non inverted (if inverted, utilize nipple suction)
How should the nurse promote breast hygiene?
(A) Wash nipples with plain water (to avoid drying effects which can cause cracking.
(B) Teach a woman to wash her breast daily & clean water and dry them with soft towel.
(C) Insert clean gauze pad if colostrum discharge is heavy
(D) Assess mother’s knowledge of regular breast examination.
Under BREAST, what should the nurse check for every eight (8) hours?
(A) Consistency, size, shape, and symmetry of the breasts.
(B) Beginning of lactation.
(C) Presence of infection
(D) Presence of breast mass
What should be the nursing care for mothers who are breastfeeding?
(A) Inspect the breast for local tenderness.
(B) Wear a comfortable and good supporting bra to support engorged breast.
(C) Inspect the nipples for redness, cracking, inverted, flat or presence of caked milk.
(D) Assess the mother’s knowledge of regular breastfeeding.
(E) Application of warm compress or standing under a warm shower to relieve discomfort.
A woman who is not breastfeeding may experience more discomfort, how should the nurse promote breast comfort?
(A) Accumulation of milk inhibits further milk formation
(B) Engorgement subsides in about 2 days
(C) Apply cold compresses, 3 to 4 times a day during the period of engorgement
(D) May also take oral analgesic
(E) Wear a snug-fitting bra or commercial breast finder
(F) Avoid nipple stimulation
The most dramatic change for the uterus during the mother’s postpartum period is delineated to be:
Involution
This is defined as the inability of the uterus to return to its pre-pregnant state after six (6) weeks.
Sub-involution (No uterine involution would denoted postpartum hemorrhage).
What are the two processes that transpire during the involution phase of the uterus?
(A) Sealing off placental site to prevent bleeding with the help of uterine contraction (the placenta seals of the implanted site).
(B) Uterus decrease in size.
At what stage does the uterus return to its pregnant state after delivery?
5 to 6 weeks of delivery
What happens to the size and weight of the uterus after birth?
(A) It undergoes reduction in size and weight after birth.
(B) The uterine lining sheds.
(C) The basal layer of the uterus remains for future pregnancies.
How long does it take for the placental site to heal after delivery?
The placental site heals by 6 to 7 weeks postpartum.
How does the uterus descend after birth?
(A) It descends at a predictable rate
(B) Location: Midline or below the level of umbilicus
(C) Shape: Firm Mass
(D) Frequency: Begin to descend about 1 cm (1 finger width) each day
Where can the uterus be palpated one hour after birth, and for how long?
The uterus can be palpated at the level of the umbilicus for the first 24 hours after birth.
What does it indicate if the uterus is not in the midline?
The bladder is distended, and the patient should empty her bladder.
What does it mean if the uterus is soft and baggy?
It is not contracting, which can lead to bleeding.
At what point is the uterus no longer palpable postpartum?
10 days postpartum. (the cervix is soft and malleable)
What is the state of the internal and external os immediately postpartum?
Both the internal and external os are open.
(A) The internal os closes as it was before pregnancy and closes before the external os.
(B) The external os is narrowed in size but remains slightly open.
How does the cervix appear after childbirth?
The cervix appears slit-like or stellate (star-shaped).
What is the condition of the cervix when non-gravid?
The cervix is firm when non-gravid.
: What leads to the closing of the cervix postpartum?
Contraction of the uterus leads to the closing of the cervix by the end of 7 days.
What are the different factors that retard uterine involution?
(A) Prolonged labor
(B) Anesthesia
(C) Difficult birth
(D) Multi-parity (may contribute to more afterpains)
(E) Full bladder
(F) Incomplete expulsion of placenta and placental fragments
(G) Infection
(H) Over distention of uterus
(I) Polyhydramnios (A condition of excessive amniotic fluid.)
How often should uterine assessments be done immediately postpartum?
Every 30 minutes for 4 hours, then every 8 hours for 3 days.
What is the correct position for the mother during a uterine assessment?
The mother should be positioned supine, with the abdomen observed for contour.
What should be palpated during a uterine assessment?
The consistency of the fundus of the uterus (It should be firm, soft or baggy).
Where should the uterus be located during an assessment?
The uterus should be midline.
What is important to remember when palpating the uterus?
Never palpate the uterus without supporting the lower segment.
What should be done if the uterus is soft and boggy (non-contracting)?
(A) Massage with a gentle, rotating motion.
(B) Administer oxytocin as prescribed.
(C) Encourage breastfeeding.
(D) Allow the mother to void or empty her bladder.
(E) Apply a cold compress to the fundus area to stimulate contractions.
This is known as the excessive urine production; the patient is at risk for dehydration as 2 to 3 liters of fluid accumulated during pregnancy are expelled postpartum.
Diuresis
How does daily urine output change from the 2nd to 5th day after birth?
Daily urine output increases from 1500 ml to 3000 ml per day.
What causes a transient loss of bladder tone postpartum?
Decreased ability to sense voiding due to fetal head pressure and epidural anesthesia.
How long does the increased size of the uterus and kidneys (hydronephrosis) last postpartum?
It remains for 4 weeks after birth.
What are the risks associated with the increased size of the uterus and kidneys postpartum?
There is an increased possibility of urinary stasis and urinary tract infections (UTIs).
How can a nurse assess for a full bladder postpartum?
By frequently assessing the abdomen; a full bladder will feel hard or firm just above the symphysis pubis and will be resonant upon assessment.
What else should be assessed during the promotion of urinary elimination?
The height and location of the uterus.
What should be the appropriate nursing care to promote urinary elimination?
(A) Encourage to void at the end of the first hour after birth
(B) Promote privacy, run water at the sink
(C) Encourage fluid intake
(D) Promote kegel exercises
(E) Use warm tap water during perineal care
(F) Urinary catheterization as ordered (straight or foley catheterization)
How is digestion and absorption affected immediately after birth?
Digestion and absorption are active immediately after birth.
What condition related to the rectum might be present postpartum?
Hemorrhoids may be present postpartum.
What should be assessed regarding bowel sounds postpartum?
Active bowel sounds should be present.
