Module 2 Flashcards
What is the postpartum period?
The first 6 weeks after the birth of an infant.
What does involution refer to in the postpartum context?
Changes the reproductive organs, particularly the uterus, undergo after childbirth to return to their nonpregnant state.
What are the three processes involved in uterine involution?
- Contraction of muscle
- Catabolism
- Regeneration of uterine epithelium
At what rate does the fundus descend after birth?
Approximately 1 cm or one fingerbreadth per day.
What is lochia?
Vaginal drainage after childbirth that changes in color and amount.
What are the three types of lochia and their characteristics?
- Lochia rubra: Days 1 to 3, almost entirely blood
- Lochia serosa: Days 3 to 10, pink or brown-tinged
- Lochia alba: After day 10, white or cream
What does subinvolution refer to?
A failure of the uterus to return to its nonpregnant size and shape.
Fill in the blank: Lochia rubra is characterized by _______.
[almost entirely blood with small particles of decidua and mucus]
What are the classifications of perineal lacerations?
- 1st: Superficial vaginal mucosa or perineal skin
- 2nd: Fascia and muscles of the perineum
- 3rd: Extends into or through the external anal sphincter
- 4th: Rectal mucosa
What is the primary hormone responsible for initiating milk production postpartum?
Prolactin.
True or False: Hemoglobin and hematocrit levels are easy to interpret in the first few days postpartum.
False.
What common gastrointestinal issue is experienced postpartum?
Constipation.
What are the signs of potential complications in the postpartum patient?
Increased bleeding, signs of infection, and severe pain.
What factors can increase the risk for postpartum hemorrhage?
- Multiparity
- History of postpartum hemorrhage
- Overdistention of the uterus
- Precipitous or prolonged labor
- Retained placenta
What is the significance of Rho(D) immune globulin?
Indicated for Rh-negative clients with Rh-positive newborns to prevent maternal antibodies affecting subsequent pregnancies.
What changes occur in the cardiovascular system postpartum?
Transient increase in maternal cardiac output, return to pre-pregnancy levels in 6 to 12 weeks.
What is the typical weight loss after childbirth?
Approximately 10 to 13 lb. lost in childbirth.
What are common skin changes during the postpartum period?
- Hair loss
- Melasma
- Linea nigra
- Striae gravidarum
What is the primary cause of urinary retention postpartum?
Diminished sensitivity to fluid pressure and decreased sensation.
What should be assessed during initial postpartum assessments?
- Vital signs
- Skin color
- Fundus location and firmness
- Amount and color of lochia
- Perineum
What are the nursing considerations for afterpains?
- Educate patients that afterpains are self-limiting
- Medicate before breastfeeding
- Use analgesics like Tylenol and Motrin
What is the role of oxytocin postpartum?
Required for milk-ejection or ‘let-down’.
What is the expected return time for the kidneys to normal function postpartum?
Within 4 weeks post birth.
What is diastasis recti?
Separation of the longitudinal muscles of the abdomen.
What is the typical duration for episiotomy healing?
Begins to heal in 2 or 3 weeks, complete healing in 4-6 months.
What are common discomforts experienced postpartum?
- Episiotomy pain
- Hemorrhoids
- Perineal trauma
Fill in the blank: The cervix is _______ postpartum.
[Dilated, edematous, and bruised]
What is the expected time frame for vaginal epithelium restoration postpartum?
6 to 10 weeks.
What is the common practice for assessing lochia flow?
Record the lochia amount per hour.
What are the common nursing interventions for hemorrhoids?
- Applying ice
- Sitz baths
- Perineal care
- Topical anesthetics
What is the effect of breastfeeding on ovarian function postpartum?
Breastfeeding may lead to vaginal dryness and discomfort due to decreased estrogen production.
What is a common neurological change postpartum?
Frontal and bilateral headaches due to changes in fluid and electrolyte balances.
What should be assessed regarding urinary output postpartum?
Time and amount, presence of a catheter, and color and character of urine.
True or False: The risk of thrombus formation decreases postpartum.
False.
What are some risk factors for infection during the postpartum period?
- Operative procedures
- Cesarean section
- Vacuum extraction
- Forceps delivery
- Multiple cervical exams
- Prolonged labor
- Prolonged rupture of membranes
- Manual extraction of placenta or retained fragments
- Diabetes
- Catheterization
- Bacterial colonization of lower genital tract
These factors increase the likelihood of infection in postpartum clients.
When is Rho(D) Immune Globulin indicated?
Indicated for Rh-negative clients with Rh-positive newborns
It should be administered within 72 hours after birth to prevent maternal antibodies from affecting subsequent pregnancies.
What is the purpose of the Rubella Vaccine in postpartum care?
To prevent acquiring rubella during subsequent pregnancies, which can cause serious fetal anomalies
Prenatal antibody screening is performed to determine immunity.
What immunization is recommended for adults to boost protection against Pertussis?
Booster recommended for adults
Typically administered with diphtheria and tetanus.
What is the recommended schedule for postpartum assessments after vaginal birth?
- Every 15 minutes for the first hour
- Every 30 minutes for the second hour
- Every 4 hours for the first 24 hours
- Every 8 to 12 hours thereafter
Assessments are made more frequently if findings are abnormal or if the client has risk factors.
What does an increase in blood pressure postpartum indicate?
Pain or preeclampsia
A decrease may indicate dehydration or hypovolemia from excessive bleeding.
What is the normal respiratory rate during postpartum assessments?
A normal respiratory rate is noted
Assessment is especially important in postpartum cesarean sections, smokers, asthma patients, and those receiving magnesium sulfate.
What does a boggy uterus indicate during a postpartum assessment?
A need for fundal massage to stimulate uterine contraction
Clots can interfere with uterine contraction.
What does the acronym REEDA stand for in assessing perineal lacerations?
- (R) Redness
- (E) Edema
- (E) Ecchymosis
- (D) Discharge
- (A) Approximation
This assessment helps identify signs of infection or healing issues.
What are the primary comfort measures for immediate postpartum care?
- Ice packs
- Sitz baths
- Analgesics
- Perineal care
- Topical medications
- Sitting measures
Ice causes vasoconstriction and prevents edema.
What should be done if a patient is unable to void postpartum?
Catheterize the patient
This is necessary if the amount voided is less than 150 mL and the bladder can be palpated.
What are the criteria for postpartum discharge?
- No abnormal assessments
- Able to ambulate and eat/drink
- Labs reviewed and vaccines given as needed
- Can perform self-care
- Knowledge on how to care for infant
- Arrangements for follow-up care made
These ensure the safety and readiness of the client for discharge.
What are the three puerperal phases in maternal adaptation?
- Taking-in phase
- Taking-hold phase
- Letting-go phase
These phases represent the emotional and physical adjustments mothers make postpartum.
What is a common concern for mothers during the postpartum period related to body image?
Gradual weight loss
Nurses should emphasize that weight loss is gradual and educate on safe activities.
What percentage of clients experience postpartum blues?
50-80%
This condition typically begins in the first week, peaks around day 5, and often resolves within 2 weeks.
What is engrossment in the context of family adaptation after childbirth?
Intense interest in the infant
This includes a desire to touch and hold the baby and a strong attraction to the infant.
What factors can hinder family adaptation after the birth of a newborn?
- Discomfort and fatigue
- Knowledge of infant needs
- Previous experience with newborns
- Unrealistic expectations of the newborn
These factors can create challenges in adjusting to the new family dynamic.
What may unrealistic expectations influence?
Adjustment
Unrealistic expectations may lead to difficulties in adapting to the realities of parenthood.
What characteristics of a newborn may parents be unprepared for?
Molding, blotchy skin, and newborn rash
These characteristics are normal but may surprise new parents.
What do nurses need to teach regarding newborns?
Normal growth and development
Educating parents about what to expect can help ease their transition.
What parental disappointment might occur related to childbirth?
Sex of the child
Parents may have preferences that lead to feelings of disappointment.
What maternal factor can affect family adaptation?
Maternal age
Teenagers may face unique challenges when becoming parents.
How might an adolescent parent typically behave?
Talk less, respond less, appear more passive or less affectionate
These behaviors may indicate challenges in bonding with the infant.
What do teenagers need to develop necessary parenting skills?
Special assistance
Support and guidance are crucial for adolescent parents.
How do personality traits influence attachment?
Calm and secure vs. anxiety and insecurity
Maternal temperament can significantly affect bonding with the infant.
What infant temperament increases parental confidence?
Calm and easily consoled
Infants who are easy to soothe can foster a positive parenting experience.
What can irritability in infants lead to for parents?
Parental frustration
Difficult infants may challenge parents’ coping abilities.
What is a major factor in maternal adjustment?
Availability of a strong support system
Friends, family, and support groups can significantly aid maternal adaptation.
What effect does cesarean birth have on recovery?
Longer recovery time and additional discomfort and stress
Surgical births can complicate the adjustment period for mothers.
What challenges do preterm or ill infants present for parents?
Prolonged separation and stress
This can hinder the bonding process between parents and their infants.
What complexity does the birth of multiple infants add?
Limited activity and preterm complications
Families with multiples may face unique adaptation challenges.
What should care be like for families during adaptation?
Culture specific
Providing culturally sensitive care is vital during this vulnerable time.
What barrier can language create in healthcare?
Communication issues
Language differences can hinder effective patient-provider interactions.
What should be respected in cultural care practices?
Privacy and modesty
It is essential to honor cultural beliefs regarding privacy.
What should dietary practices encourage?
Intake that supports their diet and restrictions
Dietary preferences should be taken into account for better health outcomes.
What is the most appropriate nursing action for a boggy uterus?
Assist the client in emptying her bladder
This action can help correct uterine atony.
What is the best way for nurses to support maternal-infant bonding?
Help the mother identify her positive feelings toward the newborn
Encouraging emotional connection is crucial for bonding.
Fill in the blank: The presence of a strong _______ is a major factor in maternal adjustment.
Support system
A robust support network can significantly aid in the transition to parenthood.
