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NU314 OB > Nursing Management Postpartum > Flashcards

Nursing Management Postpartum Flashcards

1
Q

Bonding

A

Close emotional attraction to a newborn by the parents that develops the first 30-60 minutes

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2
Q

Attachment

A

development of strong affection between an infant and a significant other

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3
Q

Typical Assessments in Postpartum Period

A

First Hour-q 15 mins
Second Hour-q 30 mins
First 24 hours-q 4 hours
After 24 hours-q 8 hours

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4
Q

First Hour

A

q 15 mins

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5
Q

Second Hour

A

q 30 mins

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6
Q

First 24 hours

A

q 4 hours

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7
Q

After 24 hours

A

q 8 hours

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8
Q

Who would you possibly see a slight temperature elevation in the first 24 hours postpartum?

A

Possible dehydration due to fluid/blood loss during delivery

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9
Q

What would a temperature of 100.4 or greater indicate after delivery?

A

May indicate infection and needs to be reported

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10
Q

What else may be indicated by an increased temperature that often results in maternal morbidity/mortality?

A

Maternal Sepsis

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11
Q

Temperature

A
  • use consistent way of measuring (oral)
  • stays within normal range or low grade elevation
  • slight fever possible (100.4) during first 24 hours
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12
Q

Heart Rate for first week

A

60-80 bpm are normal during first week after birth

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13
Q

What is a pulse rate of 60-80 bpm called?

A

puerperal bradycardia

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14
Q

What leads to a decreased HR during postpartum period?

A

Elevated stroke volume

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15
Q

What may tachycardia in postpartum women represent?

A 
anxiety
excitement
fatigue
pain
excessive blood loss/delayed hemorrhage 
infection
underlying cardiac problem
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16
Q

Respirations

A

12-20 breath per minute

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17
Q

What may a change in respiratory rate that out of normal limits indicate?

A

pulmonary edema
atelectasis
side effect of epidural
pulmonary embolism

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18
Q

Blood Pressure

A

Should remain the same as during labor

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19
Q

What could an increase in BP indicate?

A

gestational hypertension

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20
Q

What could a decrease in BP indicate?

A 
Shock 
Orthostatic hypertension 
Dehydration
Side effect of epidural 
Increased blood loss
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21
Q

What is the 5th vital sign?

A

Pain

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22
Q

Pain Assessment

A

Type, location, severity
Rate with numeric scale 1-10
Focus on comfort measures

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23
Q

What is our pain level goal?

A

0-2

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24
Q

What will the physician often order the nurse to do for patient before birth?

A

Pre-medicate for “after-birth” pains

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25
Q

What comfort measures could the nurse provide to reduce pain?

A 
Perineal care
Clean gown
Mouth care
Warm blankets
Adequate fluid intake
Reposition frequently 
Encourage rest
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26
Q

If the woman has severe pain in her perineal region despite use of comfort measures what should the nurse check for?

A

Hematoma

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27
Q

Danger Signs Postpartum

A

Fever > 100.4, foul smelling lochia or unexpected change in color/amount, blood clots/bleeding that saturates peripad in 1 hour, severe headaches/blurred vision, visual changes, calf pain w/ dorsiflexion, swelling/redness/discharge at incision lines, problems w/ urination, shortness of breath, depression/extreme mood swings

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28
Q

What does the acronym BUBBLEEE stand for?

A 
B-breast
U-uterus
B-bladder
B-bowels
L-lochia
E-episiotomy/perineum
E-extremities
E-emotional status
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29
Q

Breasts

A

Assess size, contour, engorgement

Assess nipples for cracks, redness, fissures, or bleeding and not whether the are erect, flat, or inverted

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30
Q

Lactogenesis

A

onset of milk secretion

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31
Q

What will initially trigger lactogenesis?

A

delivery of the placenta which results in falling levels of estrogen and progesterone

32
Q

Uterus

A

asses height of the fundus and firmness

33
Q

Bladder

A

assess voiding, bladder emptying

34
Q

Bowels

A

bowel sounds and distention

35
Q

Lochia

A

assess amount, color, odor, and change with activity and time

36
Q

Foul smelling lochia suggests?

A

infection

37
Q

Large clots in lochia suggest?

A

poor uterine involution

38
Q

Pregnancy is associated with an increased risk of what?

A

thromboembolism which includes pulmonary embolism and DVT

39
Q

Emotional Status Assessment

A 
Interaction w/ family 
Level of independence 
Energy levels
Eye contact w/ infant 
Posture and comfort level w/ infant
Sleep and rest patterns
Be alert for mood swings, irritability, or crying episodes
40
Q

Four Stages of Parenthood

A
  • Commitment/attachment, preparation for infant
  • Acquaintance/attachment w/ infant; learning how to care for infant; physical restoration
  • Moving toward new normal
  • Achievement of parenthood role
41
Q

What factors may affect attachment?

A 
Parent's background
Infant temperament and health 
Care practices
Separation immediately after birth
Policies discouraging exploring infant
Intensive care environment
Staff indifference/lack of support
42
Q

Teaching Topics for Postpartum

A 
Pain/discomfort
Immunizations
Nutrition
Activity/exercise
Lactation
Discharge teaching
Sexuality/contraception
Follow ups
43
Q

Nursing Management in Postpartum

A
  • Providing optimal cultural care
  • Promoting comfort
  • Assisting w/ elimination
  • Promoting activity, rest, and exercise
  • Assist w/ self care
  • Ensure safety
  • Counsel about sexuality and contraception
  • Promote Nutrition
  • Support choice for newborn feeding
44
Q

What can be done to promote comfort?

A

Cold and heat applications
Topical preparations
Analgesics

45
Q

What is commonly the first measure used after a vaginal birth to relieve perineal discomfort and edema from an episiotomy?

A

Ice pack

46
Q

What heat comfort measure is often used to cleanse the perineal area after voiding?

A

peribottle

47
Q

Peribottle

A

plastic squeeze bottle filled with warm tap water

48
Q

After the first 24 hours what may be prescribed and substituted for the ice pack to reduce local swelling and promote comfort?

A

Sitz bath with room temperature water

49
Q

What type of treatment is used as a topical preparation?

A

Local anesthetic spray such as benzocaine used to numb the perineal area after cleansing

50
Q

What analgesics are prescribed to relieve mild postpartum discomfort?

A

Acetaminophen and NSAID’s such as ibuprofen or naproxen

51
Q

What analgesic may be prescribed for moderate to severe pain?

A

Codeine or oxycodone in conjunction with aspirin or acetaminophen

52
Q

Common adverse effects of oral analgesics are?

A 
dizziness
lightheadedness 
nausea
vomiting
constipation
sedation
53
Q

A full bladder will interfere with uterine contraction and may lead to what?

A

hemorrhage

54
Q

How long does the woman have to void after birth before she will receive a catheter?

A

4-6 hours

55
Q

What may help the patient have a bowel movement?

A 
Stool softener/laxative
Ambulating 
Increase fluids 
Increasing fruits and vegetables
Small amounts of prune juice or hot liquids 
High fiber foods 
Walking daily
56
Q

What foods are high in fiber?

A 
Bran cereals
Whole grains
Dried fruits
Fresh fruits
Raw vegetables
57
Q

Ensuring Safety during Ambulation

A 
Check BP first
Elevate head of bed for few mins
Sit on side of bed for few mins
Help client stand
Ambulate alongside client
Frequently ask how her head feels
Stay close
58
Q

How many additional calories per day should a mother consume while lactating?

A

500

59
Q

How much extra protein should a mother consume a day?

A

20 g or more; adding an extra 2 cups of skim milk

60
Q

How much extra calcium will the mother need a day?

A

400 mg or more; consumption of four or more servings of milk/day

61
Q

How much extra iodine will the mother need a day?

A

290 mcg/daily; dairy products, seafood, and iodized salt

62
Q

Why is iodine necessary for the baby?

A

So they can produce thyroid stimulating hormone which helps brain development

63
Q

When does breast engorgement typically occur?

A

first week postpartum

64
Q

Alleviating Breast Engorgement in Breastfeeding Women

A
  • Encourage frequent feedings-q 2-3 hours
  • Use manual expression just before feeding to soften the breasts for easier attachment
  • Advise mom to let infant feed on first breast until it softens before switching
65
Q

Alleviating Breast Engorgement in Bottle-feeding Women

A
  • Encourage to use ice packs, wear a snug/supportive bra 24 hours a day, take mild analgesics
  • Avoid any breast stimulation
66
Q

Characteristics of Postpartum Blues

A

anxiety, irritability, insomnia, crying, loss of appetite, and sadness

67
Q

When do symptoms of Postpartum Blues begin and typically end?

A

Begin 2-4 days after childbirth and resolve by day 10

-typically resolve w/ restorative sleep

68
Q

Why is early ambulation encouraged?

A

Encouraged to reduce the risk of DVT/PE and to improve strengthening

69
Q

When should the woman nap?

A

When baby naps

70
Q

Importance of PP Exercise

A 
Lose pregnancy weight
Reduce risk of obesity 
Increase overall well being
Increase energy levels
Reduce risk of PP depression
Reduce constipation
Provide an outlet for stress
71
Q

How to prevent stress incontinence:

A
  • Start regular program of pelvic floor muscle exercises
  • Lose weight
  • Avoid smoking
  • Limit caffeine and alcohol
72
Q

Self-Care Measures

A
  • Frequently change perineal pads
  • Avoid using tampons
  • Shower once per day w/ mild soap and avoid soap on nipples
  • Sitz bath after q bowel movement
  • Avoid tub baths for 4-6 weeks
  • Good hand-washing
73
Q

How long should mom avoid tub baths?

A

4-6 weeks

74
Q

What factors contribute to a decreased sex drive after birth?

A
  • Fatigue/weakness
  • Perception of decreased attractiveness
  • Change in body appearance
  • Vaginal bleeding/perineal discomfort
  • Hemorrhoids
  • Sore breasts
  • Decreased vaginal lube due to increased estrogen
75
Q

When can the couple resume sexual activity?

A

Once bright-red bleeding has stopped and the perineum is healed from any trauma
-third to sixth week postpartum

NU314 OB (21 decks)

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