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OB FINAL > Post-partum > Flashcards

Post-partum Flashcards

1
Q

Fourth Stage = Puerperium

A 
Close observation -> 1st hr 
Vital signs for 15 minutes for first hour and 30 minutes 2-4 hours after 
Identify hemorrhage
Identify complications
Ongoing education
Ongoing support
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2
Q

Early Maternal Assessment
Vital signs

Psychosocial

A

Vital signs
Temperature—below 100.4oF – mom dehydrated
Pulse—bradycardia – shift in fluid volume
NO change in BP or RR

Psychosocial
Bonding = bonds to baby
Lack of Attachment – two way street both mom and baby

Adolescents
Poor coping skills
Mental health disorders

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3
Q

Attachment Process

A

Taking-in period – dependent
Mom wants care for herself
Bodily concerns – food/sleep/comfort
Talk about labor; lasting up to a day

Taking-hold period – dependent/interdependent
Strives to master infant-care skills
Assume responsibility

Letting-go - interdependent/independent
Postpartum depression may occur
Might return to work or relinquish a portion of child’s care to other caregivers
5-6 weeks out

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4
Q

Maternal Assessment
Breasts
Breastfeeding vs. non-breastfeeding

A

Breastfeeding moms
Colostrum – yellowish color
Tenderness or engorgement – warm showers help milk come in; prolactin is responsible; 2-4 days to come in

Non-breastfeeding moms
Engorgement – tight bra and ice packs

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5
Q

MASTITIS “Breastmilk Stasis”

Precipitating factors:

A

Inadequate breast drainage
Plugged duct
Poor let-down
Not rotating infant positions

Cracked nipple, fissures

Sometimes: infection
Staph Aureus, E. coli

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6
Q

Mastitis — History and Physical Exam

HCP?

A

Diffuse myalgias, “flu-like” symptoms, breast pain
Wedge-shaped, erythematous, tender, flaking skin
Usually unilateral -> Upper, outer quadrant most common
Fever – low grade temperature does not indicate systemic infection, do not stop breastfeeding

Observe carefully for signs of abscess formation

HCP = abscess, eruption and skin breakdown, temperature above 102

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7
Q

Mastitis Treatment

A

DO NOT stop breastfeeding on the affected side, empty the breast
If mild, symptoms occur for less than 24º and may resolve with frequent nursing or pumping and supportive measures: bed rest, fluids, analgesics
Fever of 102˚ -> may be tx with antibiotics. Antibiotic options include dicloxicillin or cephalexin or clindamycin up to 14 days

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8
Q

Uterus

Immediate post partum vs. 2-4 hours

A

Fundus
Immediate postpartum:
halfway between the symphysis pubis and the umbilicus
2-4 hours postpartum:
level of the umbilicus or one fingerbreadth above

Uterus Involution – back to pre-pregnancy size

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9
Q

Postpartum Hemorrhage

A 
Defined as:
Blood loss >500 ml for vaginal delivery
Blood loss > 1000 ml for C/S
Classified as:
Early, acute or primary 
Within 24 hrs
Late or secondary
 24 hrs to 6 wks after delivery
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10
Q

4 T’s

A

TONE: uterine atony
TISSUE: retained placenta
TRAUMA: lacerations/uterine rupture
CLOTTING: coagulation

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11
Q

Uterine Atony = relaxed uterus

A

Marked hypotonia of uterus - leading cause (70-90%) of PPH complicating 1/20 births (5% of all births)

Overdistention
full-term multiples
macrosomia
Prolonged labor (having troubles contracting during labor will carry over after)
Induction and augmentation with pitocin
Anesthesia
Prolonged third stage (more than 30 mins)
Preeclampsia (magnesium sulfate)
Vacuum/forceps delivery (manipulation of uterus)

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12
Q

Hemhorrage

Less Frequent

A 
Retained placenta
   Nondherent retained placenta
   Adherent retained placenta
   Inversion of uterus
   Subinvolution of uterus

Traumatic injury
Lacerations of genital tract
Uterine rupture (hemorrhage)
Excessive force on umbilical cord - delivery of placenta

Coagulation Disorder
Prolonged clotting - rare

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13
Q

Bladder

A

Void = 4-6 hours postpartum

Anticipate maternal diuresis – Urine volume and flow returns to pre-pregnant by 2-3 days

Retention – frequent voids of less than 150mL; contributes to boggy fundus (high and displaced to the right = full bladder)

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14
Q

Bowel

Strategies to prevent constipation

A

Relaxin—depresses bowel motility; no food in 24 hours
Perineum = sore, hemorrhoids, she might not want to use the bathroom

Early ambulation
Abundant fluids
High-fiber diet

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15
Q

Lochia

A

Composition
Endometrial tissue, blood, lymph

Stages
Rubra (red): 1 to 3 days
Serosa (pink, brown-tinged): 3 to 10 days
Alba (yellowish-white): 10 to 14 days, but can last 3 to 6 weeks and remain normal

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16
Q

Episiotomy

REEDA

A

Or Laceration
REEDA – redness, edema, ecchymosis, discharge, approximation
Vagina: NO SEX for the first 6 weeks
Hematoma (obstructing urethra, larger than a fist=HCP)

Unremitting pain and pressure
Careful assessment
Implement pain relief measures
Hemorrhoids
Need to approximate episiotomies and lacerations
17
Q

Post-Cesarean BUBBLE-HE

A

Increased risk respiratory problems (anesthesia, sedentary)

Pain
incisional, rather than perineum discomfort
may have long-acting morphine from epidural

Positioning for BF
Abdominal distention– may be normal or indicate infection
Harder to assess uterus
Limited lochia

Compression:
SCDs (sequential compression device)
Venodyne boots
TED stockings

Grief response
Mother/Infant interaction

18
Q

Surgical Procedure

Major Risks

A

Major risks
Respiratory Depression
Anesthetic gases or medications (epi/spinal)
Maternal or Newborn respiratory depression

Infection –> Pre-operative prevention
Surgical Care Improvement Project Measure, pt must have antibiotic within 2 hours

19
Q 
Thrombophlebitis - DVT 
Risk of Pulmonary Embolism
Thromboembolism 
Pulmonary Emboli
(4)
A

Increased blood volume
Venous stasis in lower extremities
Hypercoagulation
Compression of inferior vena cava in 3rd trimester

20
Q 
Thromboembolic Disease
Nursing interventions (6)
A

Nursing Interventions:
Complete bedrest with bathroom privileges
Measure leg circumference
Anticoagulation therapy
Analgesics
Increase fluids
Elevate extremity; TED hose; apply moist, warm packs

21
Q

Prioritize Nursing Interventions

Post partum

A
  1. Fundal massage
  2. Administer oxygen
  3. IVF
  4. Medications
    Oxytocin (Pitocin) - common post C-section
    Methylergonovine (Methergine) – C/I with HTN
    Carboprost (Hemabate)
    Misoprostol (Cytotec) – off-label use; rectal, stimulates contractions
  5. Frequent vital signs
  6. Accurate I/O
  7. Insert foley
    Obtain laboratory tests
22
Q

Hemorrhage treatments – 2

A 
Internal Tamponade -- reverse foley
Internal Tamponade (Bimanual) -- provide compression to decrease bleeding; feel around for placenta/tissue if not responding to fundal massage
23
Q

Emotions - Attachment

A 
Maternal touch
First 24 hrs progresses from discovery phase
Touches infant with finger-tips
Enfolding the infant
Consoling behaviors and face to face
Identifies specific features R/T family members
Claiming or binding in
Maternal sensitive period

Verbal expressions
Progresses from referring to infant as “it” to “he” or “she”
Finally calling the infant by name

24
Q

Psychosocial Behavior

A 
First 3 months most vulnerable
Postpartum blues “Baby blues”
Postpartum depression
Postpartum psychosis
Physiological response—tiredness, fatigue

C/S moms: grief response to unanticipated delivery can complicate attachment***

25
Q

Postpartum Depression

A

10 to 15% women
Loss of interest, apathy, lack of emotional response
Feelings unworthiness, shame, guilt
Sleep disturbances, hopelessness, anxiety, insomnia
Panic attacks, suicidal thoughts
May not pick up on infant’s cues or smiles
Negative infant reaction

Symptoms > present at least 2 wks

26
Q

Postpartum Psychosis

A

Onset within first 8 weeks after childbirth
Distinguishing signs: hallucinations, agitation, confusion, suicidal/homicidal thoughts, delusions, sleep disturbances, loss of touch with reality
Requires hospitalization

27
Q

Mental health / Behavioral health (3)

A

Mental health disorders during the postpartum period have implications for mother, newborn, and entire family
Interfere with attachment to newborn and family integration
May threaten safety and well-being of mother, newborn, and other children

28
Q

Anti-depressant Drugs

A

Drugs safe to use while breastfeeding
Sertraline (Zoloft)
Paraxetine (Paxil)
Clomipramine (Anafranil)

Drugs of concern
Fluoxetine (Prozac)
Due to long half-life
Reports of colic, tremors, and insomnia in newborns

29
Q

Self-Care and Discharge Instructions (5)

A 
Maternal Self-Assessment
     Fundus and lochia
     Hygiene
     Abdominal incision
     Pain management
     Temperature

Nutrition, Elimination
Fatigue, Mood
Weight loss, Exercise
Sexual Activity, Contraception

30
Q

Pain Management at home

Pain Assessment

A

Educate regarding nonpharmacological measures
Ice Packs
Sitz bath
Administer Tylenol or Ibuprofen

31
Q

Nursing Assessments for DVT (8)

A 
Erythema
Low grade fever
Swelling and pain in lower extremities 
Asymmetry
Diminished pedal pulses
Homan's sign
Unilateral leg pain
Dependent edema
32
Q

Nursing Assessments for PE

A 
Pleural chest pain
Pink frothy sputum
Tachycardia
Anxiety/apprehension
Dyspnea
Tachypnea
Fever
33
Q

Post-partum blues

A

first 2 weeks postpartum
Irritability, anxiety, fluctuating mood, and increased emotional reactivity due to changing hormones
Mild and spontaneous remits, not considered psyc disorder

OB FINAL (8 decks)

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