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Maternal Nursing > Postapartum Care > Flashcards

Postapartum Care Flashcards

1
Q

The maximum time for placental delivery in the third stage of labor?

A

10-30 minutes (not more than)

Follow “Watchful Waiting Technique”

(But do not hurry placental delivery)

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2
Q

Where will you refer the mother in case >30 minutes placental delivery?

A

Basic Emergency Maternal Obstetrics and Newborn Care (BEMONC)

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3
Q

The signs of placental separation (5)

Part of watchful waiting technique

A
  1. Calkin’s sign (1st sign): uterus becomes firm and globular and rising to the level of the umbilicus
  2. Sudden gush of blood from vagina
  3. Lengthening of the cord (most reliable sign)
  4. Ideally, should be Shultze mechanism (shiny, white-grey)
  5. Firm and contracted fundus
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4
Q

Act to do when lengthening of the cord happens

A

Brandt-Andrews Maneuver with the use of a forceps

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5
Q

Act to do when fundus is boggy

A

Risk: Postpartum Hemorrhage

Fundal massage with the use of the side of the palm

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6
Q

Priority action after delivery of the placenta

A

Check for the completeness of the placental fragements because this can cause the risk for postpartum hemorrhage

[2nd] check for the firmness of the uterus
[3rd] check for the presence of lacerations

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7
Q

What is expectant management of third stage of labor?

A

Watchful Waiting Technique

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8
Q

Active Management of Third Stage of Labor (AMSTL) components (3)

A
  1. injection of uterotonic (oxytocin)
  2. Controlled cord traction (Brandt-Andrews)
  3. Massage uterus
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9
Q

Do not over massage the uterus if firm already

A

This will lead to a rebound effect and make the fundus boggy again

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10
Q

The leading option for decreasing maternal deaths

A

AMTSL

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11
Q

DO NOT PULL the umbilical cord

A

This will break the cord and the uterus will be left inside

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12
Q

Difference between placenta accreta, increta, percreta?

A

Placenta accreta: deeply attached in the endometrium
Placenta increta: myometrium
placenta pecreta: perimetrium

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13
Q

The advised uterotonic medication

A

Oxytocin 10 IU because it is fast acting 2-3 mins with 2-3 hours

Risk: may cause hypotension if bolus
Check BP prior

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14
Q

List of uterotonic

A
  1. Oxytocin
  2. Methylergometrine
  3. Misoprostol
  4. Carbetocin
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15
Q

Oxytocin side effects

A

ADH-like effects, water retention, increase BP

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16
Q

Contraindication for Methylergometrine

A

Patient with cardiac problem may it be peripheral or central (eclapmsia, pre-eclampsia)

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17
Q

Uterine rupture diagnosed via

A

Ultrasound

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18
Q

What will happen to the contractions during a uterine rupture?

A

Contractions will stop

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19
Q

Method of placental delivery that is delivered like a folded umbrella

A

Shultze Mechanism (lesser chance for bleeding)

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20
Q

Refers to the uterus turning inside out with either birth of the fetus or delivery of the placenta

A

Uterine inversion

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21
Q

Placental delivery that increased risk for placental retention

A

Duncan mechanism

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22
Q

Fourth stage of labor (1-2 hrs)

A
  1. Most dangerous stage
  2. Risk for postpartum hemorrhage

Intervention
M - aintain firmness/contracted uterus
A - ssess for a boggy uterus (atony)
M - assage fundus
A - dminister uterotonic drugs

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23
Q

Cause of uterine inversion

A
  1. Traction applied to the umbilical cord to remove the placenta
  2. Pressure is applied to the uterine fundus; when fundus is not contracted
  3. Placenta attached at the fundus; pulling it down
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24
Q

Postpartum Care for the first 6-12 hours:

A

Check for blood loss/bleeding

Normal: not >500cc
CS: not>1000cc

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25
Q

Normal and abnormal temperature of the mother

A

Slight elevation is normal due to exhaustion and dehydration [physiologic]

Watch out for tachycardia, early sign of hypovolemic shock

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26
Q

Protocol for uterine inversion

A
  1. Do not remove the placenta (bleeding)
  2. Administer uterotonic drug
  3. IV fluid line
  4. Oxygen mask
  5. May need antibiotic therpay
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27
Q

This occurs when amniotic fluid is forced into an open maternal uterine blood sinus through some defect in the membranes; entering of amniotic fluid in the blood

A

Amniotic fluid embolism

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28
Q

Advise for slightly elevated temperature

A

Increase OFI

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29
Q

The return of the uterus and other reproductive organ to non-pregnant state

A

Involution

Happens 3-4 weeks after delivery; until 6 weeks

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30
Q

When does sex resume

A
  1. After complete healing of perineum, episiotomy, and lochial flow

(usually 2-4 weeks)

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31
Q

Loop of the umbilical cord slips down in front of the presenting fetal part

A

Umbilical cord prolapse

32
Q

Return of menses

A
  1. Lactating: approx 6 months (d/t prolactin)
  2. Non-lactating: 4-6 weeks
33
Q

Position for cord prolapse/cord compression

A

Knee-chest or trendelenburg position

34
Q

Management of cord prolapse/compression

A
  1. Proper position
35
Q

Management of cord prolapse/compression

A
  1. Proper position
  2. Administer tocolotytic medication (MagSu, NSAIDs, Beta-2 Agonist, CCB)
  3. Amnioinfusion (infusion of fluid)
36
Q

Two process of involution:

A
  1. Retrogressive changes: involution of uterus and lochial discharge
  2. Progressive: production of milk, and restoration of normal menstrual cycle
37
Q

The non-returning of uterus to normal state; non-shrinking uterus; bright red lochia at 6 days postpartum

A

Subinvolution

Cause: retained fragments of tissues

38
Q

How long will it take for the uterus to return to its pre-pregnant stage?

A

At 6 weeks

39
Q

How long will it take for the uterus to return to its pre-pregnant stage?

A

At 6 weeks

40
Q

Afterpains

A
  1. Normal
  2. This is due to oxytocin
  3. Breastfeeding releases oxytocin
  4. Promote uterine involution

Priority Action: Give analgesic or pain reliever

41
Q

Breast Postpartum Care

A
  1. Breastfeed immediately after delivery within first 1 hr (30 mins)
  2. Rooming in up to 24 hours
  3. Proper latching and positioning
  4. Wash hands before handling breast
42
Q

Rooming in protocol breastfeeding

A

Day 2-3 hours
Evening 4-6 hours

43
Q

Treatment for everted, flat, inverted nipples

A

Hoffman’s maneuver

44
Q

Sore and cracked nipples

A

Interventions
C - orrect latching on and positioning
R - ecommend to continue breastfeeding
A - dvise to use the least sore breast first
C - ream; lanolin ointmnent
K - eep the breast air dried after feeding
E - xpress milk or colostrum
D - o not use soap, silk bra, and bra with plastic straps

45
Q

The signs of breast engorgement (full breast)

A

H - eavy and tight
E - rythema
A - warm breast to touch
V - ery firm or hard, tender
S - hiny and swollen

ONSET: first 3-5 days postpartum

46
Q

The cause of breast engorgement

A
  1. Improper breast emptying regularly
  2. Delayed breastfeeding
47
Q

The cause of breast engorgement

A
  1. Improper breast emptying regularly
  2. Delayed breastfeeding
48
Q

Management of breast engorgement

A

F - requent breastfeeding
U - se engorged breast first
L - atch the baby properly
L -et mother massage, express milk and air dry the breast

49
Q

Additional management for breast engorgement

A
  1. Apply warm packs 15-20 mins BEFORE feeding
  2. Alternate warm and cold compress
  3. Use cabbage leaves
  4. Try warm shower before breastfeeding
  5. Use last use breast first in your next feeding
  6. Massage and manually express milk in a cup
50
Q

The inflammation of the breast, can be infective or non-infective

A

Mastitis
1. Non-infectious: milk stasis
2. Infectious type: S. aureus bacteria

51
Q

Signs and symptoms of mastitis

A

I - nflammation
N - ursing discomforts
F - lu like chills
E - levated temperature
C - ontinuous burning sensation
T - ender and swollen (lumps)
E - rythema or redness
D - ischarge

52
Q

Management of mastitis

A

A - lternating warm and cold compress
B - reastfeed on demand
C - orrect position and latching on
D - o not use soap in breast
E - xpress milk and massage
F - ree the breast (air and no towel)

53
Q

Proper Breastfeeding Attachment

A

C - hin of baby touching mothers breast
A - reola more visible above
L - ower lip is turned outward
M - outh wideley open
S - ucking is slow, deep with some pauses

54
Q

Regulatory Laws Related to Breastfeeding

A

EO 51 - Milk Code
RA 7600 - Rooming In and Breastfeeding Act of 1992
RA 10028 - Expanded Breastfeeding Promotion Act of 2009

55
Q

EO 51 Protocol

A
  1. No plastic bottles
  2. No milk formula/substitutes
  3. No pacifiers
56
Q

The addition of sterile liquid into the uterus to supplement the amniotic fluid

A

Amnioinfusion
-Does not delay the labor but prevents additional cord compression (500 mL)

57
Q

Location of the uterus after birth

A

Immediately after birth: midline between the pubis and umbilicus

One hour after the delivery: level of the umbilicus

58
Q

EARLY DETECTION OF POSTPARTUM HEMORRHAGE

A

M assage uterus
O xytocic drug
T ranexamic acid
I V fluid
E xamination of the genital tract + escalation

59
Q

Bladder Care

A

P alpate for distention above the pubis
E ncourage the patient to pass urine
E nsure passage of urine 6-8 hours after delivery

Encourage urination every 2 hours

60
Q

Bowel Care

A

B owel sound every shift
O bserve fecalith passing in vagina (refer); sign of rectovaginal fistula
W ipe front to back
E ncourage patient to eat digestible foods
L eafy green vegetables and fruits in diet

First bowel after 2nd postpartum day (2-3 days)

61
Q

Lochia serosa

A

Odorless and mixed with WBC and bacteria 4-10 days

62
Q

Lochia

A

Slightly stale odor 11-6 weeks; creamy white with WBC, bacteria, and cholesterol

63
Q

Lochial amount

A

Scant: 1 inch pads
Light: 4 inch pads
Moderate: 6 inch pads
Heavy: saturate in one hour
Excessive: saturate in 15 min

64
Q

Episiotomy

A

W idens the birthcanal
I t is common done at second stage of labor
D octors practice only
E pisiotomy shortens second stage of labor
N ote and assess for REEDA

65
Q

REEDA for episiotomy

A

Redness
Edema
Ecchymosis
Discharge
Approximation of suture

Midline: less bleeding, fast healing
R or L mediolateral: more bleeding, longer healing

66
Q

Surgical needle used for the closure of skin wounds

A

Straight needle

67
Q

Perineal hematoma

A

INITIAL ACTION: cold packs 15-20 mins q4h
For vaginal hematoma

Cold sitz bath 20-30 mins

68
Q

Degree of Perineal Laceration (nurses can repair 1-2)

A

First Degree: vaginal mucus membrane, perineal skin
Second Degree: 1st + perineal muscles
Third Degree: 2nd + sphincter
Fourth Degree: 3rd + rectum

69
Q

Cause of rectovaginal fistula

A
  1. Obstetrical trauma
  2. Crohn’s disease
70
Q

Cause of rectovaginal fistula

A
  1. Obstetrical trauma
  2. Crohn’s disease
  3. Unsutured 3rd and 4th degree laceration
71
Q

Abnormal connection between vagina and urinary bladder

A

Vesicovaginal fistula

72
Q

Homan’s sign

A

WOF: phlegmasia alba dolens or milkyleg (DVT)

passive dorsiflexion of the foot at the ankle with the knees extended

VIRCHOW’S TRIAD

73
Q

Prevention of DVT

A
  1. Early ambulation 6 hrs after delivery
  2. Use support stocking to promote circulation and prevent stasis
  3. Never massage
74
Q

EINC

A

AO 2009-0025

75
Q

When should embolic stocking be worn?

A

Worn q2h, before rising from bed

76
Q

Initial action for embolism

A

Durant maneuver (position left side lying, trendelenburg)

77
Q

Anticoagulant medication for DVT

A
  1. Heparin (does not pass breastmilk)

Antidote: PS
Monitor aPTT
WOF: hematuria, ecchymosis, epistaxis

Maternal Nursing (1 decks)

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