Nursing Management Postpartum Flashcards
1
Q
Bonding
A
Close emotional attraction to a newborn by the parents that develops the first 30-60 minutes
2
Q
Attachment
A
development of strong affection between an infant and a significant other
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
4
Q
First Hour
A
q 15 mins
5
Q
Second Hour
A
q 30 mins
6
Q
First 24 hours
A
q 4 hours
7
Q
After 24 hours
A
q 8 hours
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
9
Q
What would a temperature of 100.4 or greater indicate after delivery?
A
May indicate infection and needs to be reported
10
Q
What else may be indicated by an increased temperature that often results in maternal morbidity/mortality?
A
Maternal Sepsis
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
12
Q
Heart Rate for first week
A
60-80 bpm are normal during first week after birth
13
Q
What is a pulse rate of 60-80 bpm called?
A
puerperal bradycardia
14
Q
What leads to a decreased HR during postpartum period?
A
Elevated stroke volume
15
Q
What may tachycardia in postpartum women represent?
A
anxiety excitement fatigue pain excessive blood loss/delayed hemorrhage infection underlying cardiac problem
16
Q
Respirations
A
12-20 breath per minute
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
18
Q
Blood Pressure
A
Should remain the same as during labor
19
Q
What could an increase in BP indicate?
A
gestational hypertension
20
Q
What could a decrease in BP indicate?
A
Shock Orthostatic hypertension Dehydration Side effect of epidural Increased blood loss
21
Q
What is the 5th vital sign?
A
Pain
22
Q
Pain Assessment
A
Type, location, severity
Rate with numeric scale 1-10
Focus on comfort measures
23
Q
What is our pain level goal?
A
0-2
24
Q
What will the physician often order the nurse to do for patient before birth?
A
Pre-medicate for “after-birth” pains
25
What comfort measures could the nurse provide to reduce pain?
```
Perineal care
Clean gown
Mouth care
Warm blankets
Adequate fluid intake
Reposition frequently
Encourage rest
```
26
If the woman has severe pain in her perineal region despite use of comfort measures what should the nurse check for?
Hematoma
27
Danger Signs Postpartum
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
28
What does the acronym BUBBLEEE stand for?
```
B-breast
U-uterus
B-bladder
B-bowels
L-lochia
E-episiotomy/perineum
E-extremities
E-emotional status
```
29
Breasts
Assess size, contour, engorgement
| Assess nipples for cracks, redness, fissures, or bleeding and not whether the are erect, flat, or inverted
30
Lactogenesis
onset of milk secretion
31
What will initially trigger lactogenesis?
delivery of the placenta which results in falling levels of estrogen and progesterone
32
Uterus
asses height of the fundus and firmness
33
Bladder
assess voiding, bladder emptying
34
Bowels
bowel sounds and distention
35
Lochia
assess amount, color, odor, and change with activity and time
36
Foul smelling lochia suggests?
infection
37
Large clots in lochia suggest?
poor uterine involution
38
Pregnancy is associated with an increased risk of what?
thromboembolism which includes pulmonary embolism and DVT
39
Emotional Status Assessment
```
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
Four Stages of Parenthood
- 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
What factors may affect attachment?
```
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
Teaching Topics for Postpartum
```
Pain/discomfort
Immunizations
Nutrition
Activity/exercise
Lactation
Discharge teaching
Sexuality/contraception
Follow ups
```
43
Nursing Management in Postpartum
- 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
What can be done to promote comfort?
Cold and heat applications
Topical preparations
Analgesics
45
What is commonly the first measure used after a vaginal birth to relieve perineal discomfort and edema from an episiotomy?
Ice pack
46
What heat comfort measure is often used to cleanse the perineal area after voiding?
peribottle
47
Peribottle
plastic squeeze bottle filled with warm tap water
48
After the first 24 hours what may be prescribed and substituted for the ice pack to reduce local swelling and promote comfort?
Sitz bath with room temperature water
49
What type of treatment is used as a topical preparation?
Local anesthetic spray such as benzocaine used to numb the perineal area after cleansing
50
What analgesics are prescribed to relieve mild postpartum discomfort?
Acetaminophen and NSAID's such as ibuprofen or naproxen
51
What analgesic may be prescribed for moderate to severe pain?
Codeine or oxycodone in conjunction with aspirin or acetaminophen
52
Common adverse effects of oral analgesics are?
```
dizziness
lightheadedness
nausea
vomiting
constipation
sedation
```
53
A full bladder will interfere with uterine contraction and may lead to what?
hemorrhage
54
How long does the woman have to void after birth before she will receive a catheter?
4-6 hours
55
What may help the patient have a bowel movement?
```
Stool softener/laxative
Ambulating
Increase fluids
Increasing fruits and vegetables
Small amounts of prune juice or hot liquids
High fiber foods
Walking daily
```
56
What foods are high in fiber?
```
Bran cereals
Whole grains
Dried fruits
Fresh fruits
Raw vegetables
```
57
Ensuring Safety during Ambulation
```
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
How many additional calories per day should a mother consume while lactating?
500
59
How much extra protein should a mother consume a day?
20 g or more; adding an extra 2 cups of skim milk
60
How much extra calcium will the mother need a day?
400 mg or more; consumption of four or more servings of milk/day
61
How much extra iodine will the mother need a day?
290 mcg/daily; dairy products, seafood, and iodized salt
62
Why is iodine necessary for the baby?
So they can produce thyroid stimulating hormone which helps brain development
63
When does breast engorgement typically occur?
first week postpartum
64
Alleviating Breast Engorgement in Breastfeeding Women
- 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
Alleviating Breast Engorgement in Bottle-feeding Women
- Encourage to use ice packs, wear a snug/supportive bra 24 hours a day, take mild analgesics
- Avoid any breast stimulation
66
Characteristics of Postpartum Blues
anxiety, irritability, insomnia, crying, loss of appetite, and sadness
67
When do symptoms of Postpartum Blues begin and typically end?
Begin 2-4 days after childbirth and resolve by day 10
| -typically resolve w/ restorative sleep
68
Why is early ambulation encouraged?
Encouraged to reduce the risk of DVT/PE and to improve strengthening
69
When should the woman nap?
When baby naps
70
Importance of PP Exercise
```
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
How to prevent stress incontinence:
- Start regular program of pelvic floor muscle exercises
- Lose weight
- Avoid smoking
- Limit caffeine and alcohol
72
Self-Care Measures
- 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
How long should mom avoid tub baths?
4-6 weeks
74
What factors contribute to a decreased sex drive after birth?
- 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
When can the couple resume sexual activity?
Once bright-red bleeding has stopped and the perineum is healed from any trauma
-third to sixth week postpartum
