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exam 3 nur 365 > module 7 > Flashcards

module 7 Flashcards

1
Q

involution

A

shrinking of uterus from pregnant state back down to pre-pregnant state

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2
Q

subinvolution

A
  • uterine atony (no tone of uterus)
  • if involution doesn’t happen
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3
Q

uterine contractions

A
  • continue after delivery of baby and placenta
  • caused by oxytocin
  • uterus shrinks back down to a grapefruit size
  • helps close off blood vessels when placenta separates
  • oxytocin may be given postpartum to promote contraction of uterus
  • breast stimulation promotes oxytocin production
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4
Q

afterpains = painful contractions after birth

A
  • commonly experienced by women who have given birth previously or had a multifetal pregnancy, a large baby, or uterine distention r/t polyhydramnios
  • most pronounced during breastfeeding
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5
Q

fundus immediately after delivery

A

2 cm or finger breadths below the umbilicus

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6
Q

fundus first 4 hours after delivery

A

rises at or above the umbilicus (1cm)

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7
Q

fundus 24 hours PP

A

at umbilicus, steadily shrinks down
- steady descent if 1 cm or finger breadth per day

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8
Q

what is lochia

A
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9
Q

lochia ruba appearance, composition, duration, abnormalities

A

appearance = dark red
composition = blood, decidua, and other pregnancy debris
duration = 3-4 d
abnormalities = foul odor (suggest infection), saturation of pad in 15 min or less, tissue, clots larger than plums, duration more than 4 days

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10
Q

lochia serosa appearance, composition, duration, abnormalities

A

appearance = lighter red, pink, or brown
composition = debris, old blood, white blood cells, serum
duration = 10-14 d
abnormalities = saturation of pad in 15 min or less, foul odor (suggest infection), bright red blood for more than 1-2 h

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11
Q

lochia alba appearance, composition, duration, abnormalities

A

appearance = yellow or white
composition = WBC, serum, mucus, and bacteria
duration = 2-4 wk
abnormalities = foul odor (suggest infection), bright red blood for more than 1-2 h

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12
Q

how to assess the uterus

A
  • nurse should stabilize the lower uterine segment with one hand and palpate the fundus with the other
  • if we just start pressing on fundus without supporting, it can cause prolapse
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13
Q

primary hemorrhage

A
  • postpartum hemorrhage in firsts 24 hrs
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14
Q

secondary hemorrhage

A
  • postpartum hemorrhage 24 hrs-12 wks
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15
Q

REEDA (perineum assessment)

A

r - redness
e- edema
e - ecchymosis
d - discharge
a - approximation

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16
Q

assessing the perineum

A
  • assess for signs of infection, varicosities (hemorrhoids from diminished peristalsis, slowed GI system, wt of belly, pooling of blood that happens with dilated vessels), trauma, and healing
  • have women lay on her side with leg lifted and knees bent
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17
Q

for perineal pain:

A
  • Tylenol and ibuprofen commonly ordered
  • dibucaine ointment to put in pad for numbing
  • ice packs may be applied (especially for the first 24 hours after delivery)
  • after 24 hours, use more moist heat to promote circulation (sitz bath)
  • use peri bottle each time to go to the bathroom
  • colace to ensure stool is soft so less likely to cause pain or require pushing
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18
Q

sitz bath

A
  • basin of warm water that goes under the toilet seat, IV bag filled with warm water is hung, open clamp and water gently comes down into toilet bowl
  • promotes circulation, prevents infection by gently cleaning the area, comforting
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19
Q

colostrum

A
  • produced the first few days after birth and continues until milk comes in
  • thick, yellow, sticky
  • sometimes produced during last trimester
  • usually just several drops (very small in amount)
  • rich in antibodies that the baby needs
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20
Q

interventions to aid with breast discomfort after delivery

A
  • firm supportive bra
  • ice packs can be applied after feeding to minimize swelling/inflammation
  • assess infant’s breastfeeding latch to minimize discomfort and ensure a successful feeding
  • assess for cracks, blisters, bruising, inflammation
  • lanolin soothing ointment, vitamin E, gel packs that can go in bra after feeding
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21
Q

typical blood loss for vaginal delivery

A

200-500 mL

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22
Q

typical blood loss for cesarean delivery

A

up to 1000 mL

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23
Q

do pulses increase or decrease immediately after birth

A

decrease

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24
Q

sign of postpartum hemorrhage (cardiovascular)

A

thready, rapid pulse
decreased BP with increased pulse

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25
Q

hypovolemic shock sign (cardiovascular)

A

weak pulse

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26
Q

increased risk for DVT, PE

A
  • increased clotting factors during pregnancy put mom at risk
  • not mobile if in labor for a long time
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27
Q

monitoring of HCT, HGB

A
  • change in 10 points from pre-delivery indicated PP hemorrhage
  • hemodilution in pregnancy applicable to immediate PP period - expect a little bit lower hematocrit
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28
Q

estrogen levels after delivery

A

return to pre-pregnancy level within 2 weeks in women who are not breastfeeding
- if breastfeeding, it will take longer

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29
Q

prolactin levels after delivery

A

prolactin increases in response to the decrease in estrogen
- helps breastmilk production

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30
Q

BUBBLE - EE (B - first)

A

Breast
- should be symmetrically soft and non-tender for the first 24 h postpartum, becoming slowly and progressively more full until milk comes in sometime between postpartum days 2-5

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31
Q

BUBBLE - EE (U)

A

uterus
- should be firm and midline, descending from the umbilicus toward the pelvis at a predictable rate

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32
Q

BUBBLE - EE (B - second)

A

bladder
- encourage frequent emptying of the bladder, because a full bladder can displace the uterus and cause atony
- infrequent emptying of the bladder may also predispose a woman to cystitis

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33
Q

BUBBLE - EE (B - third)

A

bowel
- bowel motility may be slow to recover from the birth and the hormones of pregnancy
- women who delivered by cesarean section are more likely to experience an ileus (lack of movement of intestines)
- women may not have a bowel movement before discharge
- passing flatus and positive bowel sounds are sufficient proof of bowel function
- first bowel movement should be within 24-48 hours after delivery

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34
Q

BUBBLE - EE (L)

A

lochia
- assess and record the amount of lochia per protocols of the institution

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35
Q

BUBBLE - EE (E - first)

A

episiotomy/perineum
- assess any episiotomy wound or other laceration, as well as the general condition of the perineum
- assess for hemorrhoids

36
Q

BUBBLE - EE (E - second)

A

extremities
- assess the patient’s legs for unilateral edema, warmth, induration, or tenderness, any of which may suggest a thromboembolism

37
Q

BUBBLE - EE (E- third)

A

emotional status
- extreme mood swings, anxiety, and depression are cause for concern

38
Q

taking-in phase

A
  • occurs immediately after delivery
  • the mother is focused on her own recovery and takes a passive, dependent role
  • not a great time to do teaching with mom because she is self-focused
39
Q

taking hold phase

A
  • the mother processes the birth experience and transitions to independent behavior
  • start to take on mother role
  • teaching and reassurance
40
Q

letting go phase

A
  • the mother acknowledges her new normal and sees the baby as a person instead of an idea
  • nurses promote bonding
  • confidence
  • new normal
41
Q

C-section considerations

A
  • recovery can take up to 6 weeks
  • remain hospitalized for 3-5 days
  • foley left in until they can ambulate
  • assess for flatus
  • dressing over c-section incision generally removed after 24 hrs
  • staples removed before discharge
  • do not lift anything heavier than the infant for 4-6 wks
  • should not drive if taking opioid
42
Q

c-section complications

A
  • ileus (caused by diminished peristalsis)
  • endometritis (inflammation of the lining of the uterus)
  • blood clots
  • wound complications (dehiscence, infection, or hematoma)
  • surgical injury
  • hemorrhage
43
Q

discharge teaching after birth: nutritional needs

A
  • if mom is breastfeeding, should increase calories 500 calories a day above what they were consuming in pregnancy
  • increasing hydration with a caffeinated beverage
  • increased protein for wound healing
44
Q

discharge teaching after birth: contraception

A
  • if not breastfeeding can get pregnant within 6 weeks or sooner
  • discuss goals
  • if breastfeeding = progesterone only pill
45
Q

discharge teaching after birth: sexual activity

A
  • abstain from sex for at least 6 weeks after delivery
  • if have stitches, wait for the okay from provider
  • when lochia is completely gone, the cervix is closed and they can have sex
46
Q

discharge teaching after birth: smoking

A

go outside to smoke and put alternate covering on so that the baby is not exposed to secondhand smoke

47
Q

patients should be taught to immediately report the following

A
  • new onset leg pain and warmth (DVT)
  • chest pain, SOB, feelings of impending doom (PE)
  • return of heavy, bright red lochia lasting more than a few hours (possible secondary PP hemorrhage)
  • sustained depressed mood or sadness (possible PP depression)
  • thoughts of hurting oneself or infant (possible PP psychosis)
48
Q

signs of infection

A
  • elevated temp and foul smelling lochia
49
Q

uti signs

A

burning, pain, or frequency of urination

50
Q

uterine infection signs

A

pelvic pain, abdominal tenderness

51
Q

mastitis sign

A

localized firm areas of redness on breast, especially with flu-like symptoms

52
Q

hemostatsis after delivery affected by

A
  • increased circulating blood volume
  • uterine contractions
  • hyper-coagulability
53
Q

primary causes of hemorrhage

A
  • uterine atony
  • retained placental fragments
  • genital lacerations/trauma
54
Q

typical blood loss after vaginal birth and c-section

A

vaginal = 500 mL
c-section = 1000 mL

55
Q

PP hemorrhage is bleeding more than….

A

1000 mL despite uterine massage and first line uterotonics (oxytocin)

56
Q

first intervention if you walk in a room and see mom has heavy lochia

A

assess/touch fundus

57
Q

next steps to heavy lochia

A

If boggy → atony → massage the fundus to increase tone of uterus
○ If massage does not make uterus firm → oxytocin IM or bolus
○ Methergine, misoprostol
○ If you see hemorrhaging and know that the fundus is firm → know the cause is something
else (coagulation issue, laceration, hematoma that we cant see from outside) → call provider

58
Q

reasons for atony

A
  • retained placental and/or membranes
  • failure to progress in the second stage of labor
  • adherent placenta
  • LGA infant
  • labor induction
  • prolonged first or second stage of labor
  • high parity (5 or more pregnancies with gestation periods greater or equal to 20 wk)
  • uterine overdistension
  • uterine infection
59
Q

treatment for PP hemorrhage

A

Call for help.
○ Fundal massage of a boggy uterus.
○ Assess for lacerations or hematoma if the fundus is firm.
○ Bladder catheterization for inability to void.
○ Establishing intravenous access.
■ Large bore
■ Fluid boluses
○ Oxytocin administered as a first-line uterotonic medication.
○ Misoprostol
○ Methergine
○ Lower HOB and feet raised → trendelenburg position
■ Blood will circulate to major organs ○ O2 supplementation

60
Q

symptoms of PE

A

dyspnea, cough, sweating, and
pleuritic chest pain.
○ Medical emergency
○ Educate new moms on s/s because it often happens after they go home

61
Q

symptoms of DVT

A

swelling, pain, localized redness, warmth, and tenderness.
● DVTs are often diagnosed with ultrasound imaging.

62
Q

superficial vein thrombosis symptoms

A

pain, tenderness, and redness along the length of the vein. The vein may feel cord-like. A superficial vein thrombosis is often self-limiting.

63
Q

care for lacerations

A

Dibucaine ointment
● Ice/sitz bath
● Constipation protocol
○ Ambulation
○ Hydration
○ High fiber diet
○ Stool softners around the clock

64
Q

first degree laceration

A

superficial

65
Q

second degree laceration

A

goes into the perineal muscle and anal sphincter; requires stitching

66
Q

third degree laceration

A

increased tearing of anal sphincter and perineal muscle; requires stitching; painful

67
Q

fourth degree laceration

A

tearing right into rectum, very painful, lots of stitching and healing time, can be repaired in OR under anesthesia

67
Q

fourth degree laceration

A

tearing right into rectum, very painful, lots of stitching and healing time, can be repaired in OR under anesthesia

68
Q

If hematoma less than 3cm

A

comfort care

69
Q

If hematoma greater than 3cm

A

excise, drain, cauterize

70
Q

hematoma nursing care

A

Pain meds
○ Ice
○ Careful assessment
○ Urinary catheter because hematoma can press on urethra

71
Q

General symptoms of a postpartum infection include:

A

A fever that persists beyond the initial 24 hours after birth.
○ A fever that begins 2 to 10 days after birth.
○ Elevated WBC count that continues to rise rather than fall.

72
Q

risk factors for PP infections

A

operative vaginal delivery
○ Prolonged second stage of labor, pushing for a long time
○ Third- or fourth-degree laceration
○ Meconium-stained fluid

73
Q

Endometritis:

A

infection of the lining of the uterus.

74
Q

Endometritis risk factors

A

chorioamnionitis, prolonged labor, and prolonged rupture of membranes.

75
Q

Endometritis s/s

A

Fever
○ Uterine tenderness (tenderness that wasn’t there before, pain felt when mom is hugged)) ○ Flu-like symptoms
○ Tachycardia
○ Foul smelling lochia
- treated w/ IV broad-spectrum antibiotics

76
Q

Lactational Mastitis:

A

inflammation of the breast tissue often associated with infection
- milk stasis

77
Q

Factors contributing to mastitis

A

delayed breast emptying, poor drainage of one or more
ducts, inconsistent pressure on breasts (like poorly fitting bra), oversupply of milk, or nipple trauma.

78
Q

mastitis s/s

A

tender, red area of breast, malaise, or a high fever.
○ Feel very sick

79
Q

mastitis treatment

A

Cold compresses
○ NSAIDs
○ Regular and complete emptying of the breast
■ Mom has to remove the milk
○ Antibiotics: broad spectrum
○ Increase hydration

80
Q

postpartum blues

A

transient, self-limiting mood disorder that starts 2 or 3 days after delivery and resolves within 2 weeks.
○ Rapid shift in mood; up + down: happy then crying

81
Q

Postpartum depression

A

major depression with an onset during pregnancy or in the first 4 weeks
after birth.
○ Goes on longer than 2 weeks postpartum

82
Q

Postpartum psychosis

A

rare disorder that affects a woman’s sense of reality.

83
Q

diagnosed with postpartum depression

A

a woman must meet at least five of the nine diagnostic criteria for major depressive disorder during a 2-week period with at least one of the symptoms being a depressed mood or diminished pleasure in all or most activities.

84
Q

Warning signs for postpartum depression include:

A

Low mood for at least 2 weeks
○ Negative attitude toward the infant
○ Anxiety about the health of the infant
○ Concern about the ability to care for the infant
○ Use of alcohol, street drugs, drugs prescribed to others, or tobacco

85
Q

Disturbance of a woman’s perception of reality as evidenced by:

A

hallucinations
○ thought disorganization
○ disorganized behavior
○ Delusions

exam 3 nur 365 (3 decks)

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