post partum Flashcards
Para
“Para” refers to the number of pregnancies that have reached the stage of viability (20 weeks of gestation or more), regardless of the outcome.
pertains to delivers
Parity is the number of births (hence completed pregnancies) that occurred at 20 weeks gestation or greater.
Gravid:
refers to the total number of times a woman has been pregnant,
regardless of the pregnancy outcome.
primigravida
preggy for the first time
multigravida
preggy more than once
nulligravida ( N)
never been preggy
void
void
nullipara
one who has never borne a viable child (over 20 weeks-para 0)
primpara
a woman who has had one delivery of a viable infant or infant (para 1)
multipara
a woman has had two or more deliveries of viable infant ( para II, III)
multipara
a woman who has had two or more deliveries of viable infants ( para II, III)
puerperium
the six-week post-partial period. It ends when body returns to pre-pregnant state
three phases of puerperium
immediate = first 24 hrs
early = 2nd to the 7th
late = 7th day through 6th week
Involution
healing of the birth canal and the return of the uterus and all systems to the “almost” pre-pregnant state.
rate of involution
faster in primip than multip rt muscle tone.
faster in a breastfeeding mom than nonbreastfeeding rt oxytocin.
gestation
period of fetal development from conception to birth (period of pregnancy)
trimester
refer to a period of three months. pregnancy is divided into first, second third semester
Full term
beginning of 38th week to end of 42nd week
pre term
20th to the 37th week
abortion
cessation of pregnancy before 20 weeks
stillborn
Delivery of an infant of viable age (over 20 weeks) who was not alive when delivered
ectopic pregnancy
development of the embryo outside the uterine cavity. not viable. removal surgically approx 6-8 weeks of pregnancy
Ergotrane for postpartum use-
Therapeutic Effect:
Administration:
Side Effects:
Nursing Interventions:
Therapeutic Effect:
Ergonovine is used to prevent or manage postpartum hemorrhage by promoting uterine contractions.
It acts directly on uterine smooth muscle, causing sustained contractions.
Administration:
Ergonovine is typically administered either orally or intramuscularly after delivery to enhance uterine contraction.
Side Effects:
Common side effects may include nausea, vomiting, headache, and increased blood pressure.
It can cause coronary vasospasm, so caution is needed in patients with cardiovascular disease.
Nursing Interventions:
Monitor blood pressure closely during administration, especially in patients with hypertension.
Assess for adverse reactions such as chest pain, shortness of breath, or signs of coronary vasospasm.
Educate the patient about the purpose of the medication and potential side effects.
Colace for postpartum use-
Therapeutic Effect:
Side Effects:
Nursing Interventions:
Therapeutic Effect:
Colace is used to prevent or treat constipation in the postpartum period. It works by increasing the water content of the stool, making it softer and easier to pass. Docusate (Colace) is a stool softener that acts as a surfactant. It reduces the surface tension of the stool, allowing water to penetrate and soften the stool.
Side Effects:
Common side effects include mild stomach cramps.
Serious side effects are rare, but if allergic reactions (such as rash, itching, swelling, or severe dizziness) occur, medical attention should be sought.
Nursing Interventions:
Encourage Hydration: Advise the patient to maintain adequate hydration by drinking plenty of water throughout the day.
Dietary Fiber: Encourage a diet rich in fiber, including fruits, vegetables, and whole grains, to further support bowel regularity.
Monitor Bowel Movements: Monitor the patient’s bowel movements and assess for improvements in stool consistency.
Educate the Patient: Provide education on the importance of regular bowel movements and the proper use of Colace.
Tucks pads
Tucks pads are commonly used after vaginal deliveries to provide relief from perineal discomfort, including swelling, soreness, and irritation.
Dermoplast
is an over-the-counter topical anesthetic spray commonly used for pain relief and soothing relief from minor skin irritations.
It is often used for postpartum care to alleviate discomfort associated with episiotomies or perineal tears after childbirth.
The rubella vaccine
is generally not administered immediately postpartum. Rubella vaccination is part of the routine childhood immunization schedule. The vaccine is typically given as part of the combination vaccine known as the MMR vaccine, which protects against measles, mumps, and rubella.
Primapara vs Multipara
Primapara (First-time mothers, primipara):
Uterine Tone: The uterine muscles of a primiparous woman are often less toned and less elastic compared to those of a multiparous woman. This may result in a slightly longer involution process.
Stretching: The uterine muscles experience significant stretching during the first pregnancy. The stretching and increased uterine size may impact the rate at which the uterus contracts and returns to its non-pregnant size.
Postpartum Contractions: Primiparous women may experience more pronounced postpartum contractions as the uterus works to involute. These contractions help expel blood and tissue from the uterus.
Involution Duration: The overall duration of involution may be slightly longer in primiparous women due to factors like initial uterine tone and muscle elasticity.
Multipara (Women who have given birth more than once, multipara):
Uterine Tone: Multiparous women often have better uterine tone and more elastic muscles due to the effects of previous pregnancies. This may contribute to a faster and more efficient involution process.
Previous Stretching: The uterus has already undergone stretching and changes in previous pregnancies. This can make the uterine muscles more responsive to contractions and involution in subsequent pregnancies.
Postpartum Contractions: While multiparous women also experience postpartum contractions, these contractions may be less intense compared to those in primiparous women. The uterine muscles may contract more efficiently.
Involution Duration: Multiparous women may experience a relatively quicker involution process compared to primiparous women, but the exact duration can vary among individuals.
Hemabate
medication/
helps with abortion too…..
including the prevention or treatment of postpartum hemorrhage (excessive bleeding after childbirth).
AMENorrhea
the absence of menstruation
*‘L/Live births’
is the number of offspring that are currently living
nulli
primi
multi
none
first
multiple
assessment for postpartum
(state the times) ( first 2 hrs)
every 15 min first 2 hr after birth
temp
4 hr for the first 8hr after birth
BUBBLE
B- BREAST
U- UTERUS ( FUNDAL HEIGHT, UTERINE PLACEMENT/CONSISTENCY)
B- BOWEL N GI
B-BLADDER (FUNCTION)
L- LOCHIA (COLOR, ODOR, CONSISTENCY, AMOUNT)
E- EPISOTOMY (EDEMA/ ECCHOYMOSIS / APPROXIMATION)
The puerperium period refers to
Postpartum
(6 weeks)
fun·dus
/ˈfəndəs/
nounANATOMY
the part of a hollow organ (such as the uterus or the gallbladder) that is farthest from the opening.
stri·a
/ˈstrīə/
nounTECHNICAL
plural noun: striae
a linear mark, slight ridge, or groove on a surface, often one of a number of similar parallel features.
C/S –
Cesarean section.
Chloasma,
more commonly known as melasma, is an acquired pigmentary disorder of the skin, characterized by areas of discoloration known as hyperpigmentation.
Linea nigra
(sometimes called the ‘pregnancy line’) is a dark line of skin down the middle of your abdomen.
Tubal ligation ( think about briana)
the fallopian tubes are cut or blocked to disrupt the path normally taken by eggs from the ovaries. Tubes tied
SBE / SBE
Self breast exam- is an inspection of your breasts to increase your awareness of how they look and feel when you are in good health so that you can report any changes or concerns to your doctor.
subjection birthing experience
Visual estimation of blood loss (EBL)
can result in underestimation of blood loss, causing delay and failure of early interventions for PPH, thus adversely affecting maternal morbidity and mortality.
mediolateral vs midline
mediolateral (45 degree) is more painful than midline
Medications
– Pitocin/Oxytocin
– Methergine (or Ergotrate)
side effects ,when to give
(brand)
immediately after delivery
and in 1000 ml IV after
IM or oral medication to
increase uterine tone
(given if boggy)
* Side effects- Increased
BP, headache, seizure.
* Must monitor.
Lochia-
Lochia flow-
Color progress =
Rubra / serosa / alba (albino) =
the outer layer of the endometrium
healing of the endometrium
from bright red- to
pinkish red to brownish white
- Should go back in color or amount T or F
- Fleshy odor – not foul smelling T or F
False
True
Lochia
Day 1-3
Day 4-10
Day 10
think about my period/ things that exacerbate more flow
Rubra/bloody/fleshy/small clots/scant/increase flow with standing
Serosa/ Sacnt/ Increase Flow with activity/ Fleshy
Alba/Yellow/white/ Fleshy Odor
perineum expected findings after birth
perieneum = the area between the anus and the scrotum or vulva
mild edema
minor ecchyomis
approximation
Lochia increases with (4)
-with breastfeeding
- with massage –dark = pooled. Red=fresh
- when getting OOB and standing up
-with exertion – esp. when goes home
DECREASES CSECTION
Episiotomy Assessment
* what do during the assesment *
roll Mom on side and check with
flashlight for REEDA (lift buttocks)
- Lacerations – will need to call
healthcare provider
T or F= we insert enema?
1st, 2nd, 3rd, or 4th degree
FALSE
- Hematomas –
will need to call
healthcare provider
– d/t pressure during delivery- (No ice)
Nursing comfort measures:
– Ice pack –
– Sitz bath –
– Teach how to sit
– Analgesic –(5)
Nursing comfort measures:
– Ice pack – 1st 24 hrs
– Sitz bath – after 24 hrs
– Analgesic –ibuprofen, acetaminophen,
light opiods – oxycodone,
Americaine spray, cortisone cream
Diastasis Recti
– Can feel below sternum
on abdomen
PULL IN/isometric excerisis = planks
GI interventions
Day 1
Day 2
Day 3
Increase fiber, increase fluids
* Day 1 – Colace, fluids, fiber
* Day 2 – Dulcolox, fluids, fiber
* Day 3 – Fleets prn
Hormones
Diuresis d/t estrogen & vascular
pressure
– to rid body of extra fluids and blood of
pregnancy
– Urine output expected to be excessive –
800 – 1000 ml/ 8 hrs
- Diaphoresis – profuse sweating- especially
at night.
Breast
Day-1 to 5
Day 1: soft colostrums
Day 2: soft-filling
Day 3:Filling-firm
Day 4-5: firm/engorged
weight loss
13-15 #( infants, placenta and amniotic fluid). Five LBS in next 5-7 days (total 19-20) d/t diuresis and increase BMR
Breast feeding Women
nutrtion
extra
500 cal/day
Skin care:
– Shower frequently
– Lotion is okay, not on breasts
– Cocoa butter may decrease stretch marks
Neurologic
7
- Headaches – after
spinal/epidural - may be a sign of preeclampsia (Lay flat –worse when sitting up) - Leg cramps
- Back spasms-
- increase fluids (IV or
PO) - Blood patch
- Dorsiflex foot/ bare
foot on the cold floor - Warm shower, rel
Effect on Pulse and BP
BP – NORMALLY
– Below 90/60 + tachycardia =
– Above 130/90 = ( hint not too bad)…
– Above 140/90 = indicates( think about Susan)
- Pulse decrease in postpartum period
- Bradycardia 50 to 70 bpm d/t blood volume
90/60 to 130/90 - BP –
– Below 90/60 + tachycardia = shock
– Above 130/90 – can be use of oxytocins
– Above 140/90 – HTN, pre-eclampsia
Pulse of ______ can mean
hemorrhage in PP woman!
85-90
If Hgb < 10 or Hct < 35% =
ANEMIA
WBC may be elevated (12,000 to 25,000) bc
d/t trauma, stress of labor and delivery,
production to prevent infection
Coagulation Factors
increase or decrease
are increased after delivery causing the pp patient to be very prone to emboli
Prevention of thrombophlebitis
* NURSING:
- Assess calves for redness, swelling, pain, heel
cord stretch
– Compression stockings (Teds)
– Early and frequent ambulation
– No tight knee highs
– No crossing legs or Taylor sitting (Indian Style)
– Health teaching – call if pain. No rubbing leg
Accommodations for
C-Section Moms
Interventions:
VS:
ACTIVITY:
ELIMINATION:
DIET/FLUIDS:
PERSONAL HYGIENE:
REST:
- VS – q4h and Chest assessment
- Activity – OOB with help. Splint incision
- Elimination – Foley. Assist to BR after out
- Diet/Fluids – NPO til Bowel sounds. IV fluids
X 24 hrs usually - Personal hygiene – shower day 2. Incision
OTA/dermabond - REST!!! – Mom needs helpers until healed
* Pain meds – IV pain med po meds asap
* Caring for infant-will need help at home 1st week
Resumption of sexual
intercourse
* HCP advice –
- Healing
– Internal:
– External: - Possibility of pregnancy –
- Health teaching –
- HCP advice – usually 3-6 weeks
- Healing
– Internal: end of lochia (about 3 weeks) =
placental site healed.
– External: episiotomy or lacerations 2-3 weeks - Possibility of pregnancy –
– 2-4 weeks –non-lactating
– Lactating – 4-8 weeks - Health teaching – sensitive to mom’s and
partner’s desires. Pain, infection, tender tissues,
lubrication. Need for FP to prevent pregnancy
Vaccine Administration
* Rubella –
- RhoD Immune Globulin-
If not immune –test done while
pregnant. Given before discharge. Must obtain
signed consent.
– Important– tetragenic. Woman must use form of
birth control for 4 weeks after.
RhoGam used for
Rh- mom with Rh+ baby to prevent development of
antibodies to subsequent
Rh+ baby’s blood
(precautions as if giving bld)
R
If allergic to duck eggs
may need adrenalin. Must practice contraception or 1 month after the vaccination.
oxytocin + misoprostol adverse
hint.. pressure ..
hypotension
scant
light
moderate
heavy
less than 2.5
2.5 cm to 10 cm
more than 10 cm
one pad within 2 hr
stillborn
delivery of an infant of viable age (over 20 weeks)
ectopic preggy
development of an embryo outside uterine NOT VIABLE . REMOVAL OF FETUS 6-8 WEEKS.
term
38th - 42 weeks
preterm -
20- 37 weeks
Tears
1st=
2nd =
3rd =
4th=
vaginal membrane and perineal (SKIN)
plus perineal skin (SKIN + MUSCLES)
skin, muscles and sphincter muscle
plus rectal mucus membrane
