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OB > Postpartum > Flashcards

Postpartum Flashcards

1
Q

What is the postpartum goal?

A

assisst women & their partners during initial transition to parenthood.

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2
Q

When does postpartum start?

A

delivery of placenta to about 6wks later

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3
Q

How long is the typical postpartum hospital stay?

A

Up to 48hrs

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4
Q

What is a concern of postpartum care?

A

Shorter stays d/t the need of providing important info on how to care for themselves and the baby in such a short period of time

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5
Q

What is couplet care?

A

-mother/baby care
-a primary nurse for both mom and baby

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6
Q

What does couplet care provide?

A

-an opportunity for bonding/attachment
- more time for the mother to learn how to care for the baby with the help of a nurse

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7
Q

What is rooming in?

A

Mother and nurse share care of the baby

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8
Q

What are benefits of rooming in?

A
  • increases breast feeding success
  • mom can breast feed on demand and learn baby’s early feeding cues
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9
Q

What is a late feeding cue?

A

Crying; harder to latch after this sign

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10
Q

What to do if mother temperature is elevated?

A

Determine if mom is dehydrated or developing an infection

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11
Q

What temperature is common during the first 24hrs after birth?

A

-100.4 F
- usually elevated w/in first hr after birth then decreases

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12
Q

What v/s may fluctuate d/t changes of the cardiovascular system

A

Pulse and blood pressure

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13
Q

What is the normal range of respirations ?

A
  • 16-24
  • need to monitor closely if narcotics are used for pain relief
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14
Q

What may be a reason for elevated blood pressure?

A

Pain; assess

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15
Q

Why might most mom experience Bradycardia after delivery?

A

There is less blood flow to the uterus causing an increase in maternal blood volume

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16
Q

What might tachycardia indicate ?

A

Blood loss or dehydration

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17
Q

What are 3 physiological changes that protect women form excessive blood loss?

A
  1. Elimination of uteroplacental circulation
  2. Loss of placental endocrine function
  3. Fluid shift
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18
Q

By how much is the maternal vascular bed reduced?

A

15%

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19
Q

Without baby and placenta, the uterus doesn’t need much ____

A

Blood

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20
Q

Why does the placenta generate hormones that causes mom to vasodilate (increase size of blood vessel) ?

A

To accommodate for the increase in blood volume

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21
Q

What happens when the placenta is delivered?

A

Stimulus for vasodilation is gone -> blood vessels go back to normal size

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22
Q

Why does blood pressure increase as blood vessel return to normal size?

A

To compensate for loss of volume during initial postpartum period

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23
Q

Why is there an increase in blood volume during fluid shift?

A

During pregnancy fluid is store in tissue and when its over fluid is shoved back into the circulatory system

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24
Q

What keeps women from going into hypovolemic shock?

A

-Sustaining a normal amount of blood loss
- no more than 500 for vaginal deliver
- no more than 1000 for C section

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25
Q

What gets rid of extra fluid?

A
  • excessive peeing
  • sweating
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26
Q

Why does HGB/ HCT increase?

A

D/t the decrease in plasma volume

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27
Q

Why is there fluctuations in HGB and HCT?

A

Fluid shift after pregnancy is over causes fluctuation of concentration on rbc’s

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28
Q

Why are RBC values hard to interpret during the first 2 days Postpartum?

A

Changes in blood volume d/t heavy bleeding

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29
Q

What does rbc’s look like on days 3-4? What should you do?

A

-Rbc’s look like they are decreasing d/t the increase in plasma volume
-monitor bleeding, clots, asses fundus (boggy?), and lab values

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30
Q

WBC will be increased. What is the normal values?

A

-normal value is 12,000
-first 10-12days wbc may be anywhere from 25,000 - 30,000

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31
Q

T/F wbc count of 30,000 means infection

A
  • false
  • look at the whole patient. Fever?
    -Only high wbc? Most likely not an infection
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32
Q

Coagulation factors will be increased which mean uterus clotting easily= good.
Where do we not want to clot?

A

-calves or thighs
- this means DVT

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33
Q

What does BUBBLE-EEE stand for?

A

Breasts, uterus, bladder, bowel, lochia, episiotomy/ laceration, extremities, edema, emotional status

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34
Q

What are the components of breasts?

A

-lactating
-no lactating
-engorgement
-discharge teaching

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35
Q

Should the mom be worried she is not producing milk the first two days?

A

No, a small amount of colostrum will be produced which is beneficial for the baby

36
Q

What is colostrum?

A

Thick and yellow premature milk that is full of antibodies and helps baby pass meconium stool

37
Q

What do you assess the nipple for ?

A

Inversion, flatness, eversion, cracks, blisters and redness of skin

38
Q

What can nipple pain indicate?

A

Baby is latched wrong

39
Q

When does mature milk come?

A

Day 3-5, causes engorgement

40
Q

If a mother chooses not to breastfeed, should they express the milk from their breasts?

A

NO! The more pumped out the more the body will make

41
Q

What should a non-lactating mother avoid?

A

-Avoid stimulating the breasts
-do not touch and avoid heat

42
Q

What should you teach the mother regarding her breast at the time of discharge?

A

-S/S of mastitis
- warmth, fever, pain and redness

43
Q

What can a mom do to ease the pain with engorgement?

A

-wear a well fitting bra
-take Motrin

44
Q

What is uterine involution?

A

The return of the uterus to its non-pregnant state

45
Q

Where is the uterus palpable right after birth?

A

Midline; 2cm below belly button

46
Q

How much should the fundus shrink everyday?

A

1cm

47
Q

When is there no longer a risk for postpartum bleeding?

A

When the endometrial lining is back in place

48
Q

What does a fundal massage help?

A

A boggy uterus

49
Q

how do you perform a fundal massage?

A

Put hand on pubis, right above pubic bone, massaging uterine fundus right on top

50
Q

Why is it important for the uterus to be firm?

A

To prevent excess bleeding

51
Q

Why does the uterus contract after birth?

A

Contracts in response to endogenous and exogenous oxytocin

52
Q

Where does endogenous oxytocin come from?

A

Postpartum and breastfeeding

53
Q

What increases pain intensity?

A

Parity, large baby, multi fetal gestation, and breastfeeding

54
Q

How long should a mother refrain from inserting anything in the vagina?

A

6wks or until it returns to its normal consistency

55
Q

After birth how does the cervix appear?

A

No longer a circular shape, now its slit like

56
Q

How does the body excrete excess fluid

A

Diuresis and diaphoresis

57
Q

When should the mom void by? How much?

A

-6-8hrs after birth or removal of catheter
- 150cc each time

58
Q

Why should you be concerned about bladder distention?

A

-can cause a boggy uterus which leads to increase bleeding
-can develop uti

59
Q

Nursing interventions to promote voiding

A

-poor warm water while mom voids to minimize burning
-insert a catheter if mom is still unable to void

60
Q

When will a bowel movement occur ?

A

May take 2-3days

61
Q

Non-pharmacological interventions for Bowels

A

Ambulate, increase fluids and fiber

62
Q

Pharmacological interventions for bowels

A

Stool softener for the first few days

63
Q

What color is lochia ruba? How long does it last?

A

-bright red, reddish brown
-lasts 2-3 days

64
Q

What color is lochia serousa? How long does it last?

A

-pink or brown
-lasts 3-10days

65
Q

What color is lochia alba? How long does it last?

A

-yellow or white
-lasts 10days to 6wks

66
Q

What factors can influence lochial flow?

A

-c section
-ambulation

67
Q

Why do you notify doctor if fundus is firm but mom is still bleeding?

A

May indicate laceration of cervix/vagina that needs to be sutured

68
Q

What is uterine Atony ?

A

Boggy uterus due to failure of uterine to fully contract

69
Q

What does REEDA stand for ?

A

Redness, edema, ecchymosis, discharge and approximation of laceration edges

70
Q

How long does it take for a episiotomy to heal?

A

2-3wks

71
Q

What should you check for during perineal care?

A

-signs of hematoma, discoloration or swelling

72
Q

What shoud you include in teaching about good hygiene?

A

-sitz baths, chuck pad w/ witch hazel, fluids, fiber, stool softner, kegels

73
Q

What should you assess for in the extremities

A

Redness, warmth, pain, differences in size between extremities and diminished peripheral pulses

74
Q

Why dont we massage?

A

Can cause pulmonary embolus

75
Q

Why is ambulation beneficial?

A

Decreases risk of thromboembolism
Increases strength
Helps with constipation

76
Q

What should you assess for if edema is facial or sacral?

A

Preeclampsia

77
Q

How often does baby blues occur?

A

In 85% postpartum women

78
Q

What do you ask regarding moms emotional status?

A

Birth experience, self image, sleep, attachment

79
Q

What are maternal behaviors that demonstrate successful attachment ?

A

Holding, touching, talking, responding to baby’s cries

80
Q

What are nursing interventions to facilitate attachment ?

A

Rooming in, skin to skin

81
Q

What are the phases of reva rubins stage of maternal adjustment

A

Taking in (first 48hrs)
Taking hold (2-4days)
Letting go

82
Q

Physical changes

A

Sciatica relives
Joint pain relief
Stretch marks
Hair loss

83
Q

What helps protect baby from infection?

A

Breastfeeding and good hand washing

84
Q

Non-pharmacological ways to comfort mom

A

Warm pack, deep breathing, relaxation

85
Q

Pharmacological ways to comfort mom

A

Oral pain meds, IM, IV, narcotics
Reassess after pain med is given

86
Q

Pharmacological interventions

A

Rubella (immunity status)
Rh isoimmunization prevention
Rhogam with in 72hrs of birth

OB (4 decks)

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