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Maternal Newborn > Postpartum > Flashcards

Postpartum Flashcards

1
Q

What are the 4 most complications of early PP?

A

Hemorrhage (bleeding)
Infection
DVT
Pain

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2
Q

What is the postpartum assessment mimic?

A

B breast
U uterus
B bowel
B bladder
L lochia
E edema

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3
Q

Breast assessment
a) What are normal sings?

b) What are abnormal sings?

A

a) Feel tight
tender
warm
full

b) redness
cracked nipples
Mastitis (Unilaterally)

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4
Q

What is mastitis?

A

Breast infection
-warmth
-fever
-pain
-redness

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5
Q

a) What is engorgement?

b) intervention

A

the fullness of breast tissue d/t lymphatic circulation
-tight
-tender
-pain

b) breastfeed frequently
hand pump empty out
warm pad before feeding

Those who not breastfeeding, do not touch even it pain

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6
Q

Education
Mom who planning to give formula

A

Wear tight bra
use cold cabbage leaves
avoid heat(shower)
do not touch and stimuli

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7
Q

Education
Mom who discomforts of breastfeeding

A

Assess baby’s latch
Change NB’s position
a poor latch can lead to nipple soreness
Apply breastmilk on the nipple and air dry after feeding

then
pain medication

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8
Q

Stage of human milk
Colostrum

A

The initial milk
Full of antibodies, white blood cells, and other immune properties

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9
Q

Stage of human milk
Transitions

A

Referred to as the milk coming in
Mature milk day 3-5

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10
Q

Education
Mom who breastfeed

A

Promote early breastfeeding within the first 1 after birth
have them try various positions
Explain how varying positions can prevent nipple soreness
Proper latch techniques

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11
Q

What are the benefits of breastfeeding?

A

Dec uterine hemorrhage by helping the fundus stay firm
Enhanced maternal attachment
Decrease in Type 2 diabetes later in life

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12
Q

Normal Lab values during the early postpartum
WBCs

A

first 4 to 7 days WBC values between 20,000 and 25,000mm are common
“postpartum leukocytosis”
-the body prevents infection and
aids in healing

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13
Q

Normal Lab values during the early postpartum
HGB/HCT

A

HGB/HCT will increase due to a decrease in plasma volume

HGB Normal range
HCT Normal range 36 to 48 percent

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14
Q

Normal Lab values during the early postpartum

Coagulation factors

A

Remain inc elevated
Risk of thrombus formation and thromboembolism. 150k-400k

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15
Q

Normal assessment findings

Colostrum

A

transitions to mature milk by about 72 to 96 hr after birth(3-5 days)
this transition is referred to as the milk coming in

It’s OK the color is yellow

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16
Q

Normal assessment findings

Engorgement

A

The fullness of the breast tissue is a result of lymphatic circulation
The breast will appear tight, tender,
warm, and full

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17
Q

How much blood client cannot lose?

a) vaginal birth
b) cesarean birth

A

a) not more than 500 mL
b) not more than 1,000 mL

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18
Q

Fundus is boggy at U+2
Positioned slightly off to the right

a) What does this indicate?
b) What can this lead to?
c) What is the appropriate intervention?

A

a) Full bladder
b) Increased bleeding
c) Empty bladder

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19
Q

About five hours later the delivery, mom still hasn’t void.

a) What needs to happen now?
b) What safety precautions should you take?

A

a) needs to attempt to empty her bladder
b) Assist her in standing and walking to the bathroom

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20
Q

When we get up the mom for the first time after deliver, what is the most concern?

A

Orthostatic hypotension
in the first 48 hours after birth

Assist patient to sit up and stand slowly

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21
Q

Fundal heights
a) Immediately after birth
b) 12 hr pp
c) 24 hrs pp

A

a) 2cm below the umbilicus
b) 1cm above the umbilicus
c) slightly below the umbilicus

every 24 hr, the fundus should descend 1-2 cm

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22
Q

The mom’s peripad is saturated. What should you ask?

A

When did you change the pad?

If the mom didn’t change for a long time, change to the new one and asses in an hour

Also, asses the fundus when changing to the new pad

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23
Q

What is lochia? and what are the abnormal sings?

A

Maternal discharge contains blood, mucus, and tissue

odor=infection
excessive clots =bleeding

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24
Q

Lochia rubra is?

A

Dark red
A few small clots are common

NO more than 3days
NO large amount of dark red clots

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25
Q

Lochia serosa is?

A

Pinkish color
3-10 days

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26
Q

Lochia alba is?

A

Yellow whites creamy

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27
Q

Assessment
Bowel

a) how long restart BM?
b) What are some complications?
c) Intervention?

A

a) 2-3 days
b) Constipation
c) Increased fluid, fiber
encourage to ambulation

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28
Q

How do we assess the laceration? What are we looking for?

A

REEDA
Redness
Edema
Ecchymosis
Discharge
Approximation

Infection usually take at least 24-48 hours to show signs

29
Q

What are some comfort measures with perineal pain?

A

Cold then warm
heat can dilate blood vessels inc bleeding

Ice pack (1st 24 hours)
Sitz bath (2nd 24 hours)

Topical spray or Witch Hazel pads

30
Q

Laceration stage
1st
2nd
3rd
4th

A
31
Q

Assessment
Leg

What are you looking for?

A

Tenderness
Warmth
Edema
Change in color
Change in pedal pulses

32
Q

What are the abnormal sings?
Leg

A

Unilateral swellings with redness, warmth, pain
Absent abnormal peripheral pulses

33
Q

intervention if DVT is present

A

Elevate their limb
Confine pt to their bed

34
Q

intervention if not DVT is present

A

Encourage ambulation
Place compression stocking
Elevate legs laying bed or sitting for a long time

35
Q

What is the “Taking in phase”?

How to become mom, process
How to adapt with a baby

A

24-48 he(1-2 days)
Focus on meeting personal needs
Rely on others for assistance
Excited, talkative
Need to review birth experiences with others

36
Q

What is the “Taking hold” phase?

A

day 2-3
Focus on baby care and improving
Want to learn and practice
can experience baby blues

At the same day most moms are discharge

37
Q

What is the “Letting go” phase?

A

Accepting new life as a mom
Focus on family as a unit

38
Q

Is baby blue normal?

A

Yes
due to hormonal changes
Anxiety, mood swings and fatigue are common
Up to 2weeks

39
Q

What signs should you look for that could indicate a problem?
D/T depression

A

Shows little to no interest in the baby
Anger or disappointment directed at the baby
Ignores the baby
Handles the baby roughly
No swing emotion, stay depressed

40
Q

Baby blue
Intervention

A

Talk about the birth experience
Positive self-image
Keep mom+baby together
encourage skin to skin
encourage breastfeeding

41
Q

If the mom is rubella non-immune and has not yet received the rubella vaccine that was ordered.

What do you know about the rubella vaccine?

A

Subcutaneous injection
Live Virus
Avoid pregnancy for 1 month
Should obtain a titer in 3 months

42
Q

Breast-feeding women

a) calories?
b) Which nutrition?
c) How much fluid?

A

a) ad 500 calories to pre-pregnancy requirements
b) Protein, iron
c) 2-3 L

42
Q

Breast-feeding women need to take high Ca food
but if they don’t like milk?

A

Leafy greens
broccoli
yogurt
Cheese

43
Q

When can they start sexual intercourse?

A

laceration has healed, and lochia has stopped
Can take up to 3-4 weeks

44
Q

Which contraception are available to her while she is breastfeeding?

A

Barrier methods
UID
Mini Pill
Depo Provera
Implantable Progesterone

45
Q

PP pain teaching
NSAIDs/Ibuprofen

A

Causes GI upset
take w food
increase the risk of bleeding

DO NOT wait until the pain is 8/10
it won’t work as well

46
Q

Received both the Rubella vaccine
and Rhogam, what teaching is need?

A

the client should return to have a titer
(after 3 months)
determine whether immunity to rubella has been developed b/c sometimes Rhogam can suppress the immune response

47
Q

All of the following are findings for pp hemorrhage EXPECT?
a) Boggy fundus
b) Bradycardia
c) hypotension
e) Oliguria

A

b Should be tachycardia

Oliguria= no pee

48
Q

PP hemorrhage
a) Complications

b)Intervention

A

a) Hypovolemic shock
Anemia

b) Assess fundus for firmness
Massage the fundus
Assess lochia
Maintain or initiate IV fluids
Provide oxygen
Elevate the client’s legs to a 20° to
30° angle

49
Q

PP hemorrhage
medication

A

Oxytocin - Uterine stimulant
Methylergonovine - Uterine Stimulant

50
Q

DVT
a) Complications

b) Interventions

A

a) Pulmonary Embolus
Stroke
MI

b) early and frequent ambulation
postpartum
Bed rest longer than 8 hr, use
active and passive ROM

51
Q

DVT
prevention teaching

A

Avoid prolonged periods of standing, sitting, or immobility
Avoid crossing the legs,
Maintain fluid intake of 2 to 3 L each day

Discontinue smoking

52
Q

DVT
Medication

A

Heparin - Anticoagulant (IV)
Warfarin - Anticoagulant (PO)

53
Q

Infection
a) Complications
b) Intervention

A

a)
Sepsis
Death

b)
Lab work
Obtain frequent vital signs
Assess pain

54
Q

Pain
Intervention

A

OPQRST

assess pains related to episiotomy, lacerations, incisions, afterpains, and sore nipples.

Teach non-pharm methods (distractions, imagery, heat pads, position changes, cold packs)

55
Q

During ambulation to the bathroom, PP pt experiences a gash of dark red blood that soon stops.
What is this?

a) Evidence of possible vaginal hematoma
b) An indication of a cervical laceration
c) A normal postural discharge of lochia
d) Abnormally excessive lochia Rubra flow

A

c
Massage or ambulation can result in a gash of lochia

56
Q

PP vital sing
Temp

A

Every 4 hr for 8hr then every 8hr
100.4 (38c) is acceptable in the first 24 hr
More than 100.4 could be a sing infection and dehydration

57
Q

PP vital sing
Pulse

A

Every 15 min for the first 2 hr

Bradycardia— normal
Tachycardia—- abnormal

58
Q

PP vital sing
BP

A

Every 15 min for the first 2 hr
If dec significant—bleeding
if inc—- PP HTN

59
Q

Vaginal bleeding
pad being
a) less than 2.5cm
b) 2.5 to 10 cm
c) 10-15cm
d) A lot

A

a) scant
b) light
c) moderate
d) saturated

60
Q

A nurse teaching nonlactating pt.
Which one is the best teaching?

a) wear a supportive bra continuously for the first 72hrs
b) Pump breast every 4hr
c) Use breast shells throughout the day
d) Apply a warm compress

A

a

61
Q

Which sing is an indicator PP hypovolemia caused by hemorrhage?

a) Inc pulse and dec BP
b) Dizziness and inc respiratory rate
c) Cool, clammy skin, and pale mucous membrane

A

a

62
Q

What is mottling skin?

A

blotchy, red-purplish marbling of the skin.

63
Q

Breast engorgement
a) Apply cold or warm before or after
breastfeeding?
b) Apply cold or warm before or after breastfeeding?

A

a) Warm compresses BEFORE
b) Cool compresses AFTER

Caused by dec estrogen

64
Q

PP hemorrhage
risk factor

A

Uterine atony(=boggy)
Birth canal trauma
Precipitous deliver
Placenta fragment

65
Q

What to do if the uterus is still boggy after a massage?

A

Call the provider and stay with pt

Medical emergency!!!

66
Q

What are we looking for when check the Lochia?

A

Color
Oder
Consistency 濃度
Amount

COCA!!

67
Q

PP check-up
a) vaginal birth
b) C section

A

a) 6 weeks
b) 2weeks then 6weeks

68
Q

Mother holding her baby with silence, is this good bounding or bad bonding?

A

Good

Maternal Newborn (20 decks)

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