postpartum Flashcards
1
Q
involution
A
contraction of muscle fibers; catabolism; regeneration of uterine epithelium
2
Q
degree of involution
A
- Descents from level of fundus at rate of 1 fingerbreadth per day
By 10 days cannot be palpated - Fundus is at umbilicus at 24 hrs, then 1 FB below per day until 10 days
3
Q
lochia
A
drainage
4
Q
rubra
A
dark red blood
- 3 days after birht
5
Q
serosa
A
pink drainage
another couple of days or weeks
6
Q
alba
A
white discharge
7
Q
abnormal lochia
A
infection
8
Q
after pains
A
helps uterus clamp down
- can take tylneal and ibeprofin
9
Q
when are afterpains usually the strongest
A
- Afterpains are usually stronger during breast-feeding because oxytocin released by the sucking reflex strengthens the contractions. Mild analgesics can reduce this discomfort.
- released oxytocin and clamps uterus down
10
Q
how the uterus should be
A
- pressure on vessles
- uterus needs to be tight
- midline and firm after 24 hr at umbillicus
11
Q
danger sign
A
the reappearance of bright-red blood after lochia rubra has stopped. Reevaluation by a health care provider is essential if this occurs
12
Q
cervixnow appearing as jagged slit-like opening
A
13
Q
perineum
A
- almost always tears
- looks for infection
- kagels to tighten everything up
14
Q
causes of postpartum diuresis
A
Large amounts of intravenous fluids given during labor
Decreasing antidiuretic effect of oxytocin as its level declines
Buildup and retention of extra fluids during pregnancy
Decreasing production of aldosterone—the hormone that decreases sodium retention and increases urine production
15
Q
Diuresis + Decreased urge to void =
A
rapid filling of bladder and retention
16
Q
distention of bladder
A
- Distention of the bladder displaces the uterus to the right = major cause of uterine atony
- Retention can also lead to UTIs
- Bladder distention displaces uterus to the right, major cause of uterine atony!
17
Q
engorgement
A
Process of swelling of the breast tissue due to an increase in blood and lymph supply as a precursor to lactation
- 75% of women have it
18
Q
what to do for engorgement
A
- warm pack before feeding
- empty breast appropriate
19
Q
lacth
A
- Assist with LATCH / educate re: breastfeeding
- Proper latch key intervention for preventing complications such as mastitis
20
Q
teaching points for breast feeding mothers
A
- Completely empty breasts at each feeding
- Wear a well-fitting, supportive bra
- Apply cool compresses after feedings and warm compresses/showers prior
- Keep taking prenatal during lactation
- Nipple care
- Monitor nodules
21
Q
what to do after & before feeding
A
Apply cool compresses after feedings and warm compresses/showers prior
22
Q
monitor nodules
A
persistence may indicate fibrocystic disease or malignant growths unrelated to pregnancy
23
Q
teaching non nursing mothers
A
- Do not manually express milk from breast
- Do not stimulate the nipples
- Wear a tight-fitting bra
- Use ice packs & Avoid hot showers where water runs over breasts
U- se analgesics
24
Q
when does breastmilk come in
A
3-5 days
-. Colostrum before them. Keep taking prenatal vitamins during breastfeeding.
25
how to care for painful nipples
- nipples- Express some breastmilk on nipples before feeding, Start on less sore nipple, make sure you have a good latch; may need to change position of infant- Parent should be encouraged to do most of the feeding with support from nursing
26
how many ml does it take for a baby to eat
5ml
27
mestisis
infected boob
28
cabbage
frozen helps after feeding
29
s/s baby hungry
- fist in mouth
- looking for a breats
- lip smacking
- crying
calm them own first
30
how to break suction
put finger in mouth to break the suction
31
cream for niples
landelin
32
Rubin’s Three Postpartum Phases
taking in phase
taking hold phase
letting go phase
33
taking in phase
- First 24-36 hours after birth
- Focus on self: rely on others to meet their needs
- Very dependent - may need to be reminded to eat, shower, sleep etc.
- Desire to review birth experience
- very excited
34
taking hold phase
- Starts 2nd day and lasts approximately 10 days
- Alternates between need for extensive nurturing and a desire to take charge
- Responds enthusiastically to opportunities to learn and practice baby care
- Emotional change – possible experiences with the “blues”
- more into learning
- labile moods, crying for no reason
- 1-2w after delivery
- still bond and take care of body
35
letting go phase
- Focus: forward movement of family as unit with interacting members
- Reassertion of relationship with partner
- Resolution of individual roles
- after couple of weeks
36
danger signs
- Fever more than 100.4°F (38°C)
- Foul-smelling lochia or an unexpected change in color or amount
- Large blood clots, or bleeding that saturates a peripad in an hour: bigger than gold ball size, saturate pad within an hour, 1000ml
- Severe headaches or blurred vision
- Visual changes, such as blurred vision or spots, or headaches
- Calf with localized pain, tenderness, redness, and swelling
- Swelling, redness, or discharge at the episiotomy, epidural, or abdominal sites
- Dysuria, burning, or incomplete emptying of the bladder
- Shortness of breath or difficulty breathing without exertion
- Depression or extreme mood swings
37
c/s danager signs
100.4
38
assessment findings for pre-e
hyper reflextive
39
BUBBLEEE
```
breast
uterus
bladder
bowls
lochia
episiotomy
extremities
emotional status
```
40
breast
inspect & Palpate for size, contour, engorgement, nipple condition, milk production
- only touch if they ask
- soft tender right after delivery
41
uterus
assess fundus consistency, location, r/o tenderness
| - firm at midline, and umbilicus
42
bladder
Assess for distention, tenderness, adequate emptying
| - Note the location and condition of the fundus; a full bladder tends to displace the uterus up and to the right.
43
bowls
Has mother moves bowels, listen X4 for BS, assess for abdominal distention
- flatus, bowl sounds x4, no n/v, stool softener
44
lochiA
Assess type, amount, color, odor, does change of activity change amount of lochial flow?
- Typically, the amount of lochia is described as follows:
- Scant: a 1- to 2-in lochia stain on the perineal pad or approximately a 10-mL loss
- Light or small: an approximately 4-in stain or a 10- to 25-mL loss
- Moderate: a 4- to 6-in stain with an estimated loss of 25 to 50 mL
= Large or heavy: a pad is saturated within 1 hour after changing it
45
episiotomy & perineum
asess episiotomy &/or lacerations q. 8 hrs.; assess for approximation, swelling, ecchymosis, D/C, pain
46
extremities
assess for maternal risk, edema, varicosities,
| - calf pain, swelling, redness
47
emotional staus
assess for maternal mood, bonding with infant, energy/exhaustion levels, desire for independence or lack thereof, touch
- if separated, asking about baby
- The length of time necessary for bonding depends on the health of the infant and mother, as well as the circumstances surrounding the labor and birth
48
homans and extremities
```
: Pulmonary emboli typically result from dislodged deep vein thrombi in the lower extremities. Risk factors associated with thromboembolic conditions include:
Anemia
Diabetes mellitus
Cigarette smoking
Obesity
Preeclampsia
Hypertension
Severe varicose veins
Pregnancy
Multiple pregnancies
Cardiovascular disease
Sickle cell disease
Postpartum hemorrhage
Oral contraceptive use
Cesarean birth
Severe infection
Previous thromboembolic disease
Multiparity
Bed rest or immobility for 4 days or more
Advanced maternal age > 35 years (Kline & Kabrhel, 2015).
```
49
promoting comfort
Cold and heat applications
Ice pack (1st 24 hours), peribottle, Sitz bath (after 24 hours)
Topical preparations
Analgesics: dermaplastt
50
assisting with elimination
```
Promoting voiding
Promoting bowel elimination
- patting dry, babywash and warm water in a bottle
- front to back
- fresh pad everytime
- clean hands
- tucks pads: with hazel
```
51
postpartum complications
Coagulation Issues
Postpartum Hemorrhage
Postpartum Infections
Postpartum Emotional Disorders
52
DVT
Deep Venous Thrombus (DVT)
| Lower extremities, various veins from foot to iliofemoral region
53
s/s of dvt
- most common during pregnancy)
- Unilateral leg pain, calf tenderness, swelling
- Tenderness, warmth, or asymptomatic, Homan’s sign +/-
54
PE
```
Pulmonary Embolus (PE)
- Complication DVT, clot travels to pulmonary artery, occludes blood flow to lungs
```
55
s/s of pe
Dyspnea, tachypnea, tachycardia, apprehension, pleuritic chest pain, cough, hemoptysis (coughing up blood), elevated temperature, syncope, cardiac arrest
56
superficial interventions for dvt
Analgesics (NSAIDs)
| Rest, elevation, compression stockings, heat locally
57
dvt medical mgmt
Anticoagulant
Initially IV heparin, bed rest, elevate affected leg, analgesia
later oral anticoagulant warfarin (coumadin), compression stockings, ambulation
58
acute pt (usually dislodged dvt) medical mgmt
Emergent treatment IV: Anticoagulant
IV heparin, later SQ or oral anticoagulants
- prevention: compression stockings, moving around
59
aspirin alert
Medications containing aspirin are not given to women on anticoagulant therapy because aspirin inhibits synthesis of clotting factors and
can lead to prolonged clotting time and increased risk for bleeding
60
post partum hemorrhage
Postpartum hemorrhage is a potentially life-threatening complication of both vaginal and cesarean births. It is the leading cause of maternal mortality in the United States.
61
causes of postpartum hemorrhage
Uterine atony
62
risk factors for pph
```
Prolonged labor
Manual extraction of placenta
Pitocin augmentation
History of postpartum hemorrhage
Large baby
Grand multiparity
```
63
blood loss for postpartum hemorrhage
>500 mL following a vaginal birth
>1,000 mL following a cesarean birth
Any amount of bleeding that places the mother in
hemodynamic jeopardy
64
primary ppt
within 24 hours
65
delayed ppt
24hr to 12 weeks after birth
66
pph nursing assessment
Risk factors
| Uterine tone; vaginal bleeding
67
therapeutic management pph
```
Focus on underlying cause
Uterine massage Fundal massage
Removal of retained placental fragments
Antibiotics for infection
Repair of lacerations
```
68
nursing management for pph
```
(priority) Fundal massage; QBL
Administration of uterotonic
Drug Guide 22.1 p. 847
Fluid administration
Monitoring for signs and symptoms of shock
Emergency measures if DIC occurs
```
69
complications from pph
- Complication: Disseminated Intravascular Coagulation (DIC)
- Clotting and anticlotting mechanisms occur at the same time
Not a primary condition; secondary to pregnancy complications (placental abruption, infection, preeclampsia/eclampsia, hemorrhage, etc.)
- Manifestations include unusual spontaneous bleeding from gums and nose; oozing , trickling or flow of blood from incision/laceration; petechiae, hematuria
- Institute emergency measures to control bleeding and impending shock; prepare to transfer to ICU
- Identification of underlying condition and elimination of causative factors are essential
70
labs and nursing care for DIC
Labs: CBC, blood type/cross, clotting factors
Nursing Care
Administration of fluid volume replacement (can include blood/blood products)
Administer pharmacological interventions (antibiotics, vasoactive mediations, uterotonic agents)
Administer supplemental oxygen
Protect from injury
71
pph medications
- Oxytocin (Pitocin)
- Methylergonovine (Methergine )
- Hemabate (Carboprost, Prostin 15m)
- Misoprostol (Cytotec)
72
oxytocin
Action: stimulates uterine smooth muscle. Has vasopressor and antidiuretic effects.
Usually given wide open for PPH; however drug resources say for PPH only administer via pump at 10 to 40 milliunits per minute, can go up to 80 milliunits for short period.
73
Methylergonovine (Methergine ) contraindications
Hypertension, pre-eclampsia,
| Cardiac diseas
74
Methylergonovine (Methergine )
- Ergot alkaloid
- Dose: 0.2 mg IM; most likely will start 0.2 mg PO q 6 hours x 4 after stable
- Action: stimulates uterine and vascular smooth muscle.
- use filter needle, open with gauze, open away
75
hemabate
| contraindication
- Dose: 250 mcg IM q 15 minutes x 3
- Contraindication: Asthma
- Lomotil- anti-diarrheal given to help with the side effect of Hemabate
- causes vomiting, explosive diarrhea take lomotal and zofran with it
76
misoprostol
800-1000 rectally
77
pp infection s/s
Increased temp, redness swelling, uterine tenderness, chills, fever, localized pain
78
pp labs
blood culture, CBC, urine cultures, uterine culture
79
pp prevention
To include good handwashing, aseptic technique, teaching perineal hygiene, teaching signs and symptoms of an infection
80
sings of baby blues
go away in a few says or 1 week
| • Sad, anxious, or overwhelmed feelings, Crying spells, Loss of appetite, Difficulty sleeping
81
signs of postpartum depression
(can begin any time in the first year):
• Same signs as baby blues, but they last longer and are more severe, Thoughts of harming yourself or your baby, Not having any interest in the baby
82
s/s of postpartum phsyosis
Seeing or hearing things that are not there
• Feelings of confusion
• Rapid mood swings
• Trying to hurt yourself or your baby
83
s/s of postpartum anxiety
Panic attacks
| Obsessive thoughts/behaviors
84
when to call health provider about mood
- The baby blues continue for more than 2 weeks
• Symptoms of depression get worse
• Difficulty performing tasks at home or at work
• Inability to care for yourself or your baby
• Thoughts of harming yourself or your baby
