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Obstetrics > Post Partum Assessment and Care > Flashcards

Post Partum Assessment and Care Flashcards

1
Q

5 Main Physiologic Events following stage 4 of labor

A
  1. uterus involutes
  2. lochia is present
  3. breasts begin milk production
  4. intestines are sluggish for a few days as body redistributes fluid and abdomen is more open
  5. Ovarian function and menstruation return
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2
Q

How long does uterus involution take?

A

6 weeks

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3
Q

How long until ovarian function and menstruation return in non-lactating mother?

A

6-12 weeks

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4
Q

What does BUBBLERS stand for?

A

8 point PP assessment
1. breast
2. uterus
3. bladder
4. bowels
5. lochia
6. episiotimy/perineum
7. reaction
8. signs

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5
Q

When is colostrum vs milk produced?

A

colostrum: later stages of pregnancy

milk: 3rd day pp

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6
Q

When should baby be put to breast?

A

First hour

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7
Q

Signs of mastitis

A

red streaks, red spots, sore, warm/tender spot, malaise if systemic

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8
Q

What should a non-breastfeeding mother be taught?

A

Avoid stimulation of the nipples
- tight bra to prevent milk from filling ducts
- cabbage/something cold to constrict blood flow

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9
Q

What is uterus involution?

A

rapid compression of uterus to non pregnancy state

sealing off of placental site

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10
Q

What are patients at risk for if involution does not occur?

A

PP hemorrhage

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11
Q

What impedes uterine involution?

A
  • overextension of uterus (twins, large BW, polyhydraminos, multiparous)
  • long labor/oxytocin induction
  • retained placental fragments
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12
Q

Why would an oxytocin induction impede uterine involution?

A

The uterus is used to having the oxytocin promote contractions; without it, it may not contract

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13
Q

What enhances involution?

A
  • oxytocin with anterior shoulder
  • fundal assessments/massage
  • uncomplicated birth
  • complete placental expulsion
  • breast feeding
  • early ambulation
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14
Q

Boggy uterus

A

a finding upon physical examination where the uterus is more flaccid than would be expected.

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15
Q

What is a boggy uterus associated with?

A

Uterine atony

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16
Q

What is uterine atony

A

occurs when your uterus doesn’t contract (or tighten) properly during or after childbirth. It’s a serious complication that can cause life-threatening blood loss. Uterine atony (or the muscular tone of your uterus) describes a uterus that is soft, or lacking tone.

INVOLUTION NOT OCCURING

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17
Q

During a PP fundal assessment, within 12 hours where should the fundus be and what is not normal?

A

At or below umbilicus; above umbilicus is not normal

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18
Q

What type of palpation must be used for PP fundal assessment?

A

Deep

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19
Q

What three things are you assessing in PP fundal assessment

A
  1. position
  2. firmness
  3. midline
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20
Q

What would cause uterus to not be midline during PP fundal assessment?

A

bladder can displace uterus left or right impeding ability of uterus to go where it wants to go; assure it is empty

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21
Q

What can the massage/stimulation associated with PP fundal assessment cause?

A

Contraction/increased involution

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22
Q

Describe the anticipated progress of fundal involution day to day

A

Height of the fundus about one finger breadth below umbilicus (approx. 1cm) each day

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23
Q

Are you concerned if at at day 4 the fundus is 7 cm below umbilicus?

A

No

Can be involuted more quickly AT OR BELOW; only concern is decrease in rate

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24
Q

What are afterpains?

A

Involution contractions in multiparous women associated with breastfeeding due to oxytocin increases contractions

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25
Q

What does pain during PP palpation of fundus indicate?

A

Not contractions, may indicate infection

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26
Q

When should you administer pain medication to a breast feeding women to decrease afterpains?

A

1/2 hour before or PRN

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27
Q

What is diastasis recti abdominis?

A

occurs when the rectus abdominis muscles (six-pack ab muscles) separate during pregnancy from being stretched

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28
Q

What is the tupler technique?

A

The purpose of the program is to heal the weakened connective tissue between the separated abdominal muscles.

Consists of elevator exercise, contraction exercise, and head lift exercise

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29
Q

What is the webster techniques?

A

a chiropractic method used during pregnancy to address issues related to pelvic alignment. It involves specific adjustments and manipulations aimed at reducing pelvic misalignments and tension in the ligaments and muscles. By promoting optimal pelvic balance, the Webster Technique may help alleviate discomfort and potentially contribute to a smoother and safer childbirth.

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30
Q

Do you need to perform fundal palpation for a c-section/tubal ligation mom?

A

May or may not assess fundus post-op; belief was increased risk and pain

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31
Q

If not palpating fundus, how can we assess bleeding risk in c-section moms?

A
  1. vitals
  2. lochia
  3. pain
  4. risk factors
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32
Q

True or false: the risk of PP hemorrhage is increased in C section moms

A

false: Risk of hemorrhage is less because uterus is completely emptied in surgery

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33
Q

Pain not associated with incision in c-section mom is associated with

A

infection or bleeding

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34
Q

Capacity of bladder PP

A

Increased

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35
Q

Sensation of bladder PP

A

decreased

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36
Q

What are PP moms at risk for related to their bladder?

A

Urinary retention related to swelling/bruising, leading to UTI and deterring involution

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37
Q

When is spontaneous bowel movement anticipated PP?

A

2-3 days

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38
Q

When does elimination return to normal PP?

A

Within 1 week

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39
Q

When is lochia rubra expected

A

days 1-3

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40
Q

Describe colour, odour, consistency of lochia rubra

A

dark red venous blood, stale odour, clots < loonie

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41
Q

If lochia rubra persists following day 3 or returns, what may it indicate?

A

Sub-involution; blood still being transmitted through placental system

42
Q

Describe lochia serosa

A

Days 3-10 - pinkish brownish

43
Q

Describe lochia alba

A

Days 10-24 - yellow to white, lasting 6 weeks

44
Q

1st degree perineal laceration

A

superficial perineal tissue torn

45
Q

2nd degree perineal laceration

A

perineal muscle torn

46
Q

3rd degree perineal laceration

A

perineal muscles and anal sphincter torn

47
Q

4th degree perineal laceration

A

perineal muscles, anal sphincter and rectum torn

48
Q

Describe abnormal lochia

A
  • foul odour
  • clots larger than placenta
  • heavy flow
  • reappearance of rubra
  • lasts longer than 4 weeks
49
Q

Describe the progression of normal lochia/vaginal flow

A

stage 4: heavy flow expected
progression from 1 pad/hr, moderate <6’, light <4’, scant <1’

50
Q

What increases vaginal flow

A

ambulation and breastfeeding

51
Q

Why do hemorrhoids occur

A

presentin pregnant or develop with pushing

52
Q

What are interventions for hemorrhoids?

A

ice, frozen pad, tucks (OTC pads of cotton with witchhazel), analgesic

53
Q

Why do hematomas occur?

A

soft tissue of perineum offers little resistance and can readily accumulate 250-500mls of blood

54
Q

What can prevent hematomas?

A

Early application of ice

55
Q

What is a cardinal sign of hematoma

A

relentless pain

56
Q

Normal pad saturation on first day post partum:

A

1 pad/hr

57
Q

Besides assessment, what other nursing interventions regarding the perineum can occur?

A

perineal care and education on perineal tone

58
Q

First phase of reactions post partum

A

taking in - day 1-2
- preoccupied with own needs and recovery tell story
- touches and explores infant

59
Q

Second phase of reactions post partum

A

taking hold - day 2-3
- ready to resume control
- eager to learn
- rapid mood swings
- mothering functioning established

60
Q

Third phase of reactions post partum

A

letting go
sees infant as unique person, allows others to care

61
Q

Describe the initial attachment behaviour post partum

A

holds infant in en face position: (non-birthing parent/dad), face-to-face position about 20cm, same plane; mother uses soft, high-pitched voice

62
Q

what is the en face position

A

direct face-to-face and eye-to-eye contact between the mother and newborn. When the newborn’s eyes are open, the mother instinctively greets the newborn and talks in high pitched tones to him or her.

63
Q

When do baby blues typically occur and resolve

A

first 3-5 days PP and resolves spontaneously within weeks

64
Q

What contributes to baby blues?

A

Decrease in estrogen and progesterone levels; hormonal change as contribution, as well as time of increased stress

65
Q

Describe the symptoms of baby blues

A

Tearfulness, agitation, mood swings, generalized anxiety, acute disturbances in appetite and sleep, a perception of being overwhelmed and uncertain, and irritability

66
Q

True or false: baby blues are a part of the perinatal mood disorder spectrum

A

False

67
Q

Care for baby blues

A

recognition, reassurance, education, awareness of blues as a risk factor for postpartum depression

68
Q

What are the post partum pinks

A

Mild elation/euphoria hours/days after birth

Normal but may also be a warning for other problems

69
Q

_______ % of those with baby blues will develop post partum depression

A

20

70
Q

What is the edinburgh postnatal depression scale screening tool?

A

a simple questionnaire used to screen for signs of postpartum depression in new mothers. It consists of 10 questions that assess a woman’s mood, feelings, and emotional well-being during the postpartum period. Higher scores on the scale indicate a greater likelihood of postpartum depression, prompting further evaluation and support for the mother.

71
Q

____% of patients and _____% of partners experience PPD

A

1/7 moms 1/10 partners

72
Q

What signs are important to consider post partum?

A

Vital signs
Signs of pain
Signs of DVT r/t hypercoaguable state and decreases mobility
- pain, pulse, pallor, paralysis, paresthesia

73
Q

What additional assessments need to be performed on a c-section postpartum mother?

A
  • foley (ins and outs)
  • IV
  • DB and Coughing
  • Early ambulation
  • Sedation Score
  • Analgesia
74
Q

Outside of bubblers, what other assessments are performed for post partum mothers?

A
  1. Rh negative
  2. Rubella
  3. HgB
  4. Nutrition
75
Q

If baby is Rh positive for an Rh negative mom, what occurs?

A

Mom may get WinRho (RhoGAM) within 72 hours of delivery

76
Q

What vaccine is offered PP and what should you advise patients on?

A

Rubella; not to get pregnant for 3 months

77
Q

When is HgB tested post partum?

A

1 day pp r/t anemia due to blood loss

78
Q

What education must you provide a BF mom post partum regarding nutrition?

A

At least 200 calories more than pregnancy diet

79
Q

Reoccurence of ovulation/menstruation in non-lactating moms

A

6-8 weeks; delayed but not reliable form of birth control

80
Q

True or false: a BF mom will experience her period and return of menstruation faster than a non BF mom

A

False

Prolactin suppresses ovulation

81
Q

When can PP patients engage in sexual activity?

A

wait until lochia has stopped and perineum has healed

typically 3-6 weeks

82
Q

What contraception is recommended as safe for breast feeding and why?

A

Progestin only

No estrogen related side effects
-Contraceptives which contain estrogen have been linked to reduced milk supply and early cessation of breastfeeding even when started after milk supply is well established and baby is older

Decreases VTE risk

83
Q

Why is combination estrogen/progestin not recommended until after 6 weeks?

A

Increased VTE risk

84
Q

What is tubal ligation?

A

permanent female sterilization done laproscopically as outpatient

85
Q

True or false: you palpate the fundus following a tubal ligation procedure

A

False; or very gently if needed

86
Q

4 most common PP complications

A
  1. hemorrhage
  2. infection
  3. depression
  4. DVT
87
Q

What symptoms regarding vaginal flow PP would you report?

A

foul smelling, heavy flow, clots

88
Q

What symptoms regarding temperature PP would you report?

A

chills/fever T>38

89
Q

What symptoms regarding pain PP would you report?

A

constant in lower abdomen

90
Q

What symptoms regarding urine PP would you report?

A

Pain, burning, urgency or difficulty passing

91
Q

What peripheral vascular system symptoms PP would you report?

A

Redness / swelling / pain in leg

DVT

92
Q

What respiratory changes PP would you report?

A

Unexplained shortness of breath or chest pain

93
Q

What CNS related changes PP would you report?

A

headache, vision changes, fainting, dizziness

94
Q

Why would you report tender red area in breast with flu-like symptoms?

A

Signs of mastitis

95
Q

PP Client outcome criteria: ______ Hemoglobin with no _____________

A

normal, fainting/dizziness

96
Q

PP Client outcome mobility

A

satisfactory ambulation

97
Q

PP lochia client outcome criteria

A

decrease colour and amount by day 3-5 no foul odour

98
Q

PP Client outcome uterus

A

firm, midline, contracted

99
Q

PP Client voiding criteria

A

at least 1 void prior to discharge without dysruia

100
Q

PP Client breast criteria

A

soft/supple nipples
soft: day 1-2
filling: day 3-4
fullness evident
engorgement controlled

101
Q

What is breast engorgement

A

a condition where a new mother’s breasts become overly full, swollen, and painful due to an accumulation of milk

Obstetrics (12 decks)

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