Postpartum Flashcards
1
Q
Uterine involution-
A
the return of the uterus to its pre-pregnant size
2
Q
Uterine atony-
A
failure of uterus to contract even after fundal rub
3
Q
Uterine inversion-
A
uterus turns partially or entirely inside out
4
Q
Uterine subinvolution-
A
uterus isn’t decreasing in size and fails to descend
5
Q
Postpartum begins with
A
delivery of the placenta
- 4th stage = 2-3 hours after
6
Q
Postpartum ends with
A
~ 6 weeks after delivery
7
Q
Postpartum is what type of adjustment
A
physiological and psychological
- reproductive organs go back to non-pregnant stage
8
Q
Postpartum goals
A
prevent postpartum hemorrhage and maternal complications
Bonding = breastfeeding
Prepregnant state and comfort
Educate on newborns and self-care
Educate contraceptives and lower unplanned pregnancies
9
Q
Postpartum Focused Assessment
A
Breast (engorge, nipples, and milk production)
Uterus (fundus, consistency, and location)
Bladder function (void or cath)
Bowels (gas and go home)
Lochia (color, odor, amount) (# of pad changes)
Epiostomy/Laceration (edema, red, and length)
Hemorrhoids
Emotion/education
Bonding
10
Q
PP focused assessment every
A
Every 15 min. 1st hour
Every 30 min. 2nd hour
Every 4 hours 24 hours
Every 8 to 12 hours thereafter
11
Q
Postpartum nursing interventions
A
edu for bedrest (prevent orthostatic hypotension)
Temp and VS
Fundal Rub (firm, ht, bladder, lochia, and perineum)
Infuse Pitocin/Oxytocin
Assist with discomfort
Pericare
12
Q
Report PP if temp is greater than
A
100.4
13
Q
Report what about the abnormal fundus
A
boggy after massage
- distended if not midline
14
Q
Report after how many pads are soaked
A
2nd within 15 minutes
15
Q
Signs of hypovolemic shock
A
Pale, clammy, tachycardia, lightheaded or hypotensive
16
Q
Signs of hemorrhage
A
increase pulse
low BP
17
Q
Blood pressure of PP woman if high can be
A
pain, anxiety, preeclampsia
18
Q
Blood pressure of PP woman if low can be
A
dehydration, hypovolemia
19
Q
PP woman if Bradycardia could be
A
50 nomral
- due to blood vol loss
20
Q
PP woman if Tachycardia could be
A
pain
anxiety
hypovolemia
infection
21
Q
If >100 bpm PP, what could this indicate?
A
excessive blood loss/infection
22
Q
If RR in PP is higher than 20 suspect
A
pulmonary embolism
uterine atrophy
hemorrhage
23
Q
If the temperature of PP in the 1st 24 hours after birth, this indicates
A
stress of labor
dehydration
24
Q
If the temperature is greater than 100.4 over 24 hours it is considered
A
infection (Chorioamnioitis)
- if 2 high temps report
25
Within the 1st 24 hours of a C-section, what nursing care is needed
**Respirations and oxygen saturation hourly**
Assess Incision site , IV site & dressings
- May need a sandbag for pressure on the site
- Staples vs Dermabond
**Mobility after 8 hours**
- HA, LOC, itching normal
**TCDB, I&Os**
Pain relief and education about maintaining and not catching up on the pain
**18-24 hours post Csection analgesics** = PCA
26
After 24 hours of a C-section, what nursing care is needed
normal
prevent abd distention (BS 4 quads)
Incision, IV, and dressings
TCDB and I&Os
Discharge teachings
D/C cath and IV
**Comfort and emotional support
- guilt, question, feel failed**
Newborn bonding
27
If any discharge is leaking out of the incision,
mark and see if it expands
28
Fundal Assessment
support uterus at syphysis
palpate fundus and assess for
- consistency
- ht to umbilicus
- location
29
1/u
– above umbilicus
30
u/u
– at umbilicus
31
u/1
– below umbilicus
32
Consistency types of fundus
firm = good (pickleball)
boggy = bad (stress ball) - atony = MASSAGE
33
If displaced laterally fundus, what do you do?
ask them to void due to baldder distension
reassess
cath if still displaced
34
Fundus involution occurs _____ cm /day
1-2
35
Fundus is on the 1st day PP
at the umbilicus
36
At 7-10 day PP, the fundus is
below the symphisis pulbis
37
If the fundal tone is very tender, this indicates
infection
38
Myometrial (uterus muscle walls) contractions compress placenta
to lower blood loss
- 12-24 hours post-delivery
- High Oxytocin for long time
39
After pains occur more often in what type of births
Multigravidas
Breastfeeding
Overdistended uterus – multiple gestations, polyhydramnios
Rarely felt by Primigravidas
40
Nursing interventions for Uterine involutions
Medicate before breastfeeding (Oxytocin)
Enhance comfort and relaxation to facilitate let down of milk
41
Lochia
vaginal blood from placenta site
42
Normal Lochia
normal menstrual smell (fleshy)
discharge amount lowers daily
- increase with ambulation
- scant-light-moder-heavy-excessive
small clots are normal
43
Excessive Lochia is when a pad is
saturated with in 15 minutes
44
1g weighed by the pad =
1 mL of blood
45
If large clots appear they interfere with
uterine contractions
- obtain wt and report
46
Rubra Stage of Lochia
-time frame
day 1-3
47
Rubra Stage of Lochia
expected findings
Bloody Small Clots- Red
Moderate – Light
Standing/Breastfeeding
Fleshy Odor
48
Rubra Stage of Lochia
- abnormal and report
Large Clots
Heavy (Saturates pad in 15 min)
Foul Odor
Placenta Fragments
49
Serosa Stage of Lochia
-time frame
day 4-10
50
Serosa Stage of Lochia
- expected findings
Pink – Brown Color
Light-Scant
Physical Activity
Fleshy Odor
51
Serosa Stage of Lochia
- abnormal to report
Rubra after 4 days
Heavy (Saturates pad in 15 min)
Foul Odor
52
Alba Stage of Lochi- time frame
day 10
53
Alba Stage of Lochia
- expected findings
Yellow - White Color
Scant - none
Fleshy Odor
54
Alba Stage of Lochia
- abnormal and report
Bright Red (Late PP Hemorrhage)
Foul Odor
55
Vagina changes PP
Greatly **stretched**
Walls appear **edematous**
Multiple small lacerations possible
Vaginal walls are **thin and dry until ovulation** returns (**painful during sex due to breastfeeding due to estrogen in breasts)**
Vaginal wall **regains thickness - estrogen production** reestablished
Vaginal rugae are few and reappear by 3 - 4 weeks
Dyspareunia - breastfeeding moms
56
Changes in Cervix PP
Dilated, edematous, and bruised
Small tears or lacerations may be present
The cervix heals within 6 weeks
- **CERVIX INTERNAL WILL GO BACK
- EXERNAL WILL STAY OPEN**
57
T/F: Vagina muscle tone is never completely restored to its pre-pregnancy state.
True
58
Multipara cervix will look
football shaped
59
Dyspareunia
persistent or recurrent genital pain that occurs just before, during or after sex
60
Perineum changes in PP
edema and bruised
Episiotomy or laceration (degrees)
61
REEDA assess the Perineum
Redness
Edema
Ecchymosis
Discharge
Approx
62
What aggravates the perineum by
sitting
beding
walk
voi
bowel
63
If a PP pt is constipated, do you give them a suppository?
no, healthy eating only
64
Perineal care PP
Ice packs for 24-48 hours
Good hand washing
Peri bottle - cleanse perineum with warm water after each elimination
Apply anesthetic sprays or pads to area - **(not ointments)**
Apply **new peri pad front to back after each elimination
Snug** Peri-pad
65
Sitz bath for 1st 24 hours hour water temp
cold lower edema
66
Sitz bath for after 24 hours hour water temp
warm
67
For perineal comfort, how should the mom sit
pillow btw legs and tighten butt
68
Day of Discharge PP
Maternal and Infant care
Provide **written copies**
Patient & family are on **OVERLOAD**
last VS within an hour
Immunizations and RHOgam for mom
**Car seat**
Birth certificate complete
Follow up and referrals
69
On the day of discharge, let the mother know to see the doctor for
infection
no or painful urination
UTI - urgency
blurry
HA
keg pain
hrting themselves or the baby
70
PP Cardiovascular System
blood loss 300-1000
fluid shifts back to pre-pregnant levels
increase blood back to the heart
- decrease pressure from the uterus to vessels
71
PP chills and shakes 1st 1-2 hours due to
body rids of escess fluid
- work of labor
- nervous system response
**give warm blankets**
72
Vaginal Delivery blood loss
300-500mL
73
Cesarean Birth blood loss
500-1000mL
74
Is a hemorrhage labeled in your hx even if you are losing more blood but not having the symptoms?
yes
75
PP Lower Extremity Assessment
s/s of thrombophlebitis
- palpate pedal pulses
- assess edema
- assess deep tendon reflexes
76
thrombophlebitis nursing interventions
Early ambulation
Frequent trips to the bathroom
SCD’s or compression stocking if indicated
77
Edema 1+
< 2 mm
disappears immediately
78
Edema 2+
2-4 mm
few second rebound
common in PP
79
Edema 3+
4-6mm
10-12 sec rebound
80
Edema 4+
6-8 mm
>20 sec rebound
81
PP Hematologic Changes
WBC increase 12-25,000
Hgb and Hct difficult
Coagulation elevated
82
Why is Hgb and Hct difficult to interpret?
Plasma is diluted by the remobilization of excess body fluid
Increase hematocrit
Return to normal within 4 to 6 weeks
83
Plasma vol loss exceeds what
hematocrit loss
84
Coagulation increase causes what PP
HEMORRHOIDS AND VARICOSITY
85
PP GI changes - Digestion
low peristalsis
increase appetite
Hypoactive bowels
86
PP GI changes - Constipation
encourage fiber in the diet
stool softeners
87
PP GI changes nursing interventions
Assess for hemorrhoids
- Hemorrhoid creams as prescribed
Encourage early ambulation
**Avoid enemas & suppositories (3rd or 4th degree lacerations)**
88
Expect your 1st BM PP when
2-3 days later
89
Decrease peristalsis due to
analgesia and anesthesia
90
PP Urinary Changes
Diuresis = 3000+ mL /day (1st 24 hours starts)
Urinary retention
91
Urinary Retention in PP
low sensitivity to pressure
low muscle tone of the bladder
**over distended bladder - push fundus over**
persistent dilation increase risk of UTI
Tramatized meatus
92
PP Urinary Changes Nursing interventions
Voiding within 6 hours of delivery
Cathe if less than 150 mL and bladder is palpated
Pain meds to relax
Kegal exercises to strengthen perineal muscles
93
What are some ways to Encourage voiding within 6 hours of delivery?
Running water, peppermint oil, pour water over vulva
Provide hot tea or fluids of choice
Encourage urination in the shower or sitz bath
Toileting schedule
94
What are the indications for catheterizing the PP mother
Voiding less than 150 mL, and the bladder can be palpated
Fundus is elevated or displaced from the midline
Unable to void
> 6hrs and bladder scan reveals urine
95
PP Musculoskeletal Changes
Muscle fatigue
Pelvic muscle tone back at 3-6 weeks
- abd regain 6 weeks
96
Muscle fatigue
soft and flabby abdomen (Mom Pooch) – contractions of the wall
Hip or joint pain analgesic)
**Feet permanently increased in size**
97
Pelvic muscle regain tone in
3-6 weeks
98
Abdominal wall regain tone at
6 weeks
99
Diastasis recti
separatio of the restus abdominal wall
return to normal may take longer
100
Nursing Interventions for muscle changes
Provide comfort measures
Ice, Heat, warm shower or Analgesia
101
PP Skin changes
Hyperpigmentation area gradually disappear
Striae gravidarum (stretch marks)
102
Striae gravidarum (stretch marks)
Fade to silvery lines but do not disappear
- presumptive sign
103
Hyperpigmentation area gradually disappear
Melasma, the “mask of pregnancy”
Linea nigra
Palmar erythema
Spider nevi fade, some in the legs may remain
104
PP Neuro Changes
PRIORITY = INJURY PREVENTION
105
PP Neuro Changes NURSING INTERVENTIONS
Assess HA (PRE-ECLAMPSIA, EPIDURAL, OR SPINAL)
- **frontal and bilateral common**
Severe HA = flat position from Postdural puncture
Epidural blood patch
**Caffeine**
106
S/S of pre-eclampsia
BP increase and vsion chnage
107
Epidural blood patch
Small amount of blood is injected over hole that is leaking CSF
Many feel relief right away or may require a second patch
108
PP Endocrine Changes
Rapid ↓ of Estrogen & Progesterone
Prolactin ↑ - milk production 2-3 day after delivery
Oxytocin - milk-ejection or “Let-down” reflex
109
Oxytocin - milk-ejection or “Let-down” reflex
can be inhibited by
inhibited by stress, anxiety, pain and fatigue
110
If let down reflex happens then
stress-free environment
- encouragement and reassurance during breastfeeding
111
Ovulation may occur when
before postpartum follow up visit (6 weeks)
112
Non-lactating women MENSES
Prolactin ↓ - Menses resumes in 1-2months
113
lactating women MENSES
Prolactin↑ - Menses resumes in 3-6 months
114
PP Hemorrhage
blood loss greater than 500(vaginal delivery) or 1000(c-section)
115
Primary PP Hemorrhage
1st 24 hrs. of delivery
-Uterine Atony
- Lacerations or Hematomas
116
Secondary (late) PP Hemorrhage
24 hrs. to 6 wks
- Subinvolution (uterus is still large eventhough it is slowly going down)
- Retained Placenta
117
PP Hemorrhage hypovolemia s/s
early catch systematic
- Tachycardia, Hypotensive, Pale, Clammy, Anxious, Confused
118
PP Hemorrhage hemorrhagic shock s/s
late catch - at cellular level
- Blue lips/fingernails, ↓urine output, excessive sweating, Chest pain, Shallow breathing Hypotensive, Confusion
119
PP HEMORRHAGE PREDISPOSING RISK FACTORS
High parity
Labor dystocia
Prolonged labor
Over - distended uterus - hydramnios, macrosomia, multiple fetuses
Operative delivery - vacuum, forceps, C-section
Previous postpartum hemorrhage
Placenta abruption or previa
Infection - retained placenta
Oxytocin - Induction/Augmentation
Anesthesia or medications - Magnesium sulfate, tocolytics
**Anything over distending the uterus or causing relaxation to no contractions**
120
EARLY POSTPARTUM HEMORRHAGE: UTERINE ATONY
Uterine atony - poorly contracted uterus, lack of tone
121
S/S of uterine atony
Fundus does not firm with massage
Soft, boggy uterus above umbilicus
Steady or Sudden saturated pad – 15 min
122
EARLY POSTPARTUM HEMORRHAGE: LACERATION
2nd most common
- Peri urethral, Labia, Vagina, Cervix, Perineum
123
Signs of unrepaired laceration
Continuous trickledown vagina
Bleeding in spurts
Bleeding in presence of contracted fundus
124
EARLY POSTPARTUM HEMORRHAGE: HEMATOMA
250-500ml blood collection in the vaginal or perineal tissue
- difficult to determine amount loss
blood is inside the tissue (bruising welp)
125
Signs of Hematoma
Intense perineal pain
Swelling, blue-black discoloration of perineum
Pallor, tachycardia & hypotension
Pressure on vagina, urethra or bladder
Possible urinary retention or displacement
126
Atony - fundus
"Boggy”
Difficult to locate
Above expected level
Tone lost after massage
127
Atony - lochia
Excessive
Excessive with clots
128
Atony - vs
Hypotension
Tachycardia
129
Atony - pain
normal
130
Atony - key defining assessment
Boggy” Fundus
131
Laceration - fundus
firm
132
Laceration - lochia
Bright red vs dark red Steady trickle of blood
133
Laceration - vs
Hypotension
Tachycardia
134
Laceration - pain
Normal
135
Laceration - key defining assessment
Steady trickle of bright red blood
136
Hematoma - fundus
firm
137
Hematoma - lochia
normal
138
Hematoma - vs
Hypotension
Tachycardia
139
Hematoma - pain
Feeling of pressure,
Severe, unrelieved pain
140
Hematoma - key defining assessment
Severe Pain
Visible hematoma
Discolored bulging mass
141
Early Postpartum Hemorrhage: Atony
Nursing Assessment
Medications
Bimanual compression (fisting)
Uterine packing or Tamponade
142
Early Postpartum Hemorrhage: Laceration/Hematoma
Nursing Assessment
Pelvic exam - perineum, labia, vagina, cervix
Suture laceration
143
Early Postpartum Hemorrhage
Surgical Mgmt
Surgical repair - incision and evacuation of hematoma
Surgical - D&C, Hysterectomy
144
Nursing Interventions PP Hemorrhage
Perform fundal message - 1st nursing intervention
Review H&H labs & Vital Signs
Maintain or establish large-bore IV
O2 8-10 L/min
Comfort measures - ice, pain meds
Education and emotional support
Bladder training
Report s/s PPH
Administer medications - Oxytocin
Notify physician
Assist with medical management
145
GOAL for nursing PP hemorrhage
is to control bleeding & prevent hypovolemic shock
146
PPH - Oxytocin
- action
stimulates uterine muscle to ↑ force, frequency & duration of contractions
147
PPH - Oxytocin
- adverse reactions
dysrhythmias, B/P changes, water intoxication, & uterine rupture
Interventions - monitor V/S, I & O, lung sounds
148
PPH - METHYLERGONOVINE MALEATE
- action
**stimulates uterine muscle** to increases force & frequency of contraction, producing a tetanic contraction of the uterus
149
PPH - METHYLERGONOVINE MALEATE
- adverse reactions
nausea, vomiting, cramping, headache, **severe hypertension, bradycardia, dysrhythmias, myocardial infarction**
150
PPH - METHYLERGONOVINE MALEATE
- interventions
monitor V/S, pain, headache, chest pain, shortness of breath, uterine contractions,** vaginal bleeding (working?)**
151
PPH - CARBOPROST TROMETHAMINE
- interventions
monitor V/S, vaginal bleeding and uterine tone
152
PPH - CARBOPROST TROMETHAMINE
- actions
stimulates uterine muscle to contract
153
PPH - CARBOPROST TROMETHAMINE
- adverse effects
headache, nausea, vomiting, diarrhea, fever, tachycardia, hypertension, **pulmonary edema**
154
PPH - CARBOPROST TROMETHAMINE
- contraindicated
**asthma, cardiac**, renal & hepatic disease
155
PPH - misoprostol
- action
stimulates uterine muscle to contract
156
PPH - misoprostol
- adverse effects
headache, nausea, vomiting, diarrhea, fever, tachycardia, hypertension, pulmonary edema
157
PPH - misoprostol
- interventions
monitor V/S, vaginal bleeding and uterine tone
158
PPH - misoprostol
- route
rectally on tissue dmaage sit with prostaglandin
159
LATE POSTPARTUM HEMORRHAGE SUBINVOLUTION
retain placenta fragments and infection
160
Late PPH Subinvolution nursing assess
Enlarged or “boggy” uterus
Signs & symptoms of bleeding or infection
Initiate postpartum hemorrhage nursing interventions
161
Late PPH Subinvolution med mgmt
antibiotics, oxytocin, and/or analgesia
Ultrasound confirm retained placenta
Surgical management- dilation & curettage (D&C), hysterectomy
162
Uterine Inversion
OB emergency
- partial/complete turning inside out of the uterus
163
Uterine Inversion Nursing Assessment
Lower abdominal pain
**Uterus protruding from vagina**
Vaginal bleeding & Hypovolemia
164
Uterine Inversion interventions
**Stop Oxytocin immediately**
Administer medications - Terbutaline, antibiotics
Monitor for and manage hypovolemic shock
165
Uterine Inversion medical mgmt
Immediate manual replacement
Surgery
166
PP Infection
Bacterial infection after childbirth
**temp >100.4 after the 1st 24 hours and at least twice
- can go into lymph and life threatening
167
PP Infection risk factors
Prolonged labor
Multiple vaginal exam
Tissue trauma
Poor hygiene
168
PP Infection risk reduction
Hand washing- staff, physicians & families
Early ambulation- promotes drainage & circulation
Proper site care
169
Site infections
episiotomies, laceration, or Cesarean incision
170
PP Infections nursing assessments
Obtain Vital signs & Labs
Pain, tenderness, and warmth at the site
Purulent drainage
Wound dehiscence or evisceration
171
PP Infections nursing interventions
Obtain lab and cultures as ordered
Comfort measures - analgesics, sitz baths, warm compresses
Administer medications - antibiotics
Assist with incision and drainage
172
Endometritis
infection of the uterine tissue lining the uterus
173
Endometritis assessment
Pulse > 100
Fever, chills, malaise, anorexia
Excessive uterine tenderness
Lochia returning to rubra form serosa
Foul smelling or purulent lochia
Urinary frequency
**Sore cracked & bleeding nipples**
174
Endometritis interventions
Bedrest - semi-fowlers position
Administer IV antibiotics, Antipyretics, Oxytocin or Methylergonovine
Complications- Salpingitis, Peritonitis, Septicemia
175
UTI and pregnancy
urinary stasis due to a** hypotonic bladder**
Catheter insertion
Delivery can traumatize the bladder and/or urethra
176
Cystitis occurs
1-2 day PP
177
Cystitis assessment
Slight or no fever
Dysuria, frequency, urgency, **suprapubic tenderness**
Cloudy urine, hematuria, and bacteriuria
178
Pyelonephritis occurs
3-4th day PP
179
Pyelonephritis ASSESSMENT
Fever, chills, **costovertebral or flank pain**, nausea and vomiting
Dysuria, urgency, cloudy urine, hematuria, and bacteriuria
180
uti+ interventions
Encourage juices to acidify the urine - cranberry
Increase fluid intake & avoid carbonated drinks
Educate to complete antibiotics
Obtain lab as ordered - CBC, UA, urine culture and sensitivity
181
uti+ mgmt
UTI - PO antibiotics
Pyelonephritis - IV hydration and broad-spectrum antibiotics
182
Thrombophlebitis
increase clotting factors and fibrinogen
- clot in vessel walls = inflammation of the vessel
= superficial, femoral, pelvic
183
Blood vessel injury
increase risk during pregnancy and birth
184
Hypercoagulation
prevent PP maternal Hemorrhage
185
S/S of thrombophlebitis
Minimal fever
Positive Homan sign if assessed
Pain or dull ache in calf or leg
Swelling in extremity below pain
186
thrombophlebitis interventions
depend on location
Assess the extremities for a warm, red, tender, swollen area
Bedrest & Elevate affected extremity
Moist warm packs to the area
Elastic support stockings or SCD’s
Analgesics and or antibiotics as ordered
IV Heparin - may be ordered for femoral or pelvic to prevent PE’s
187
thrombophlebitis mgmt
Diagnosis - Doppler or MRI
Therapeutic management- Early ambulation
Anticoagulation treatment
Warfarin
Monitor PPT & INR
Birth control teratogenic effects
188
Pulmonary embolism
clot enters vascular and occludes blood low to the lungs
- amniotic fluid embolism and debris enters circulation
189
Pulmonary embolism s/s
Apprehension - feeling on impending doom
Sudden dyspnea and chest pain
Tachycardia, and tachypnea
Hemoptysis (expectoration of blood or bloody sputum)
Pulmonary crackles and cough
190
Pulmonary embolism interventions
Semi-fowlers to facilitate breathing
Oxygen 8-10 L/m
Monitor vital signs
Monitor for signs of respiratory distress and hypoxemia
IV fluids, medications - analgesics, anticoagulants, thrombolytic
191
Pulmonary embolism mgmt
Chest X-ray, Lung Scan, Pulmonary Angiogram
Clot management - dissolve or surgery
192
Advantages of Breastfeeding
adequate nutrition for **first 6 months of life**
Easier to digest
Promotes brain growth
Reduces risk of neonatal infections
Promotes bonding
Convenient
Inexpensive
Reduced incidence of SIDS, allergies, childhood obesity
193
Maternal needs for breastfeeding
Add 500 calories to pre-pregnancy intake
Drink 8 glasses of water per day
194
Breastfeeding Success means
depend on mother desire, positioning, and latch
- skin to skin and undressed
tummy to tummy
nipple to baby nose
195
Breastfeeding contraindication
Medications, HIV, Chemo, Infant conditions
- severe cleft palate
196
Breastfeeding positioning
Cross Cradle, Football
197
Breastfeeding time
on demand
- 1st breast 10 min., then 2nd until satisfied; Burp between breast
Alternate positions to prevent nipple trauma
198
Baby diapers per day = good
1 pee and 1 poo for 5 days
199
Infant signs of hunger
Rooting, Sucking, Hands to mouth
200
Effective Feeding
Let down reflex
Latch pain subsides
Audible swallowing
Adequate output
Weight gain
201
Colostrum - “Liquid Gold"
1st 1-2 days
- immunoglobulins and laxatives
202
Transitional milks
2-3 days
203
Mature milk
22-23 calories /oz
204
Foremilk
**stored before** feeding – high in **water** content
205
HIndmilk
**produced during** feeding – high in **fat** content
206
Breast Assessment
Engorgement - soft, swollen, firm, or tender
Palpate lumps and nodules
207
Nipple Assessment
Flat, retracted or inverted
Red, cracked, blistered, or bleeding
208
Mother-infant couple breastfeeding
Comfort of position for mom
Infant’s readiness for feeding (stimulated)
Mother’s desire to breastfeed or bottle feed
- shield and pump before
209
Primary engorgement occurs in
occurs breast & bottle feeding moms
210
Primary engorgement patho
increase blood flow returns to body as breasts prepare; happens before milk is produced
211
Primary engorgement s/s
larger, firm, warm, tender, with a throbbing pain
212
Primary engorgement 24 hours s/s
breasts are soft
213
Primary engorgement 48 hours s/s
slightly firm, non tender
214
Primary engorgement > 48 hours s/s
firm, tender, warm as milk production begins
215
Primary engorgement subsides in
24-48 hours
216
Subsequent engorgement occurs in
occurs in breastfeeding mom
217
Subsequent engorgement patho
Distention of milk glands
218
Subsequent engorgement reason
Missed a feeding, delayed pumping
219
Subsequent engorgement relief by
by infant sucking or expressing milk
220
Breast Engorgement interventions
Frequent feeding or pumping
Cool compresses briefly
**Chilled cabbage leaves to breast
20 min between feeding 3X/day**
- still want the milk
221
Nipple Trauma
interventions
Proper infant removal from the breast
Allow nipples to **air dry 15 minutes - 2-3 times a day** - limit visitors
Colostrum to nipples
222
How do you remove the baby from feeding on the breast
putting finger in the side of the mouth
223
Breastfeeding engorgement education
Supportive bra
Alternate feeding position
**Warm** compresses
Breast massage
Latch education
On-demand feedings
Proper removal of infant
224
Non-Breastfeeding engorgement education
Supportive bra
**Breast binders (sport bra too small)
Ice** pack to breast
Avoid breast stimulation
Avoid milk expression
Avoid heat
Analgesia for pain
- no hot shower
225
Mastitis occurs
2-3 weeks postpartum after Prolonged engorgement & inadequate emptying of breasts
226
Mastitis assess
Inflammation, bacterial infection of the lactating breast
Unilateral - risk for abscess if untreated
227
Mastitis s/s
Sore cracked nipples
Flu-like symptoms - fatigue, malaise fever, chills
Painful, red, swollen, warm, tender area, or palpable mass
Purulent drainage
228
MASTITIS NURSING INTERVENTIONS
Good handwashing
**DO NOT stop breastfeeding abruptly**
Apply warm pack or shower prior to breastfeeding
Massage affected area before & during feeding to ensure emptying
Encourage breastfeeding from **affected side first every 2-3 hours**
Manual expression or breast pump Q4 hours
Obtain breast milk culture & sensitivity as ordered
Administer analgesics, antibiotic as ordered (oral antibx 10-14 days)
Monitor breast for abscess & need for incision & drainage
Encourage patient to wear **supportive bra without underwire**
229
Taking-in phase - Dependent
(24-48 hours)
Focused on own needs, unable to make decisions
Relives birth experience, adjust to psychological changes
230
Taking-hold phase
Dependent/Independent
Focus shifts to infant & maternal role
Anxious/ Bit overwhelmed about competence as mom & accepts advice
May experience baby blues/fatigue
231
Letting-go phase
Interdependent
Resolve their idealized expectations of birth experience
Accepts reality of infant and incorporates into lifestyle
Separates newborn and self; confident in caretaking activities
Relationship with partner grows with reconnection
232
Paternal Adaptation
Engrossment - bonds with newborn
Intense interest in infant
Looks forward to parenting but lacks confidence
233
Sibling Adaptation
Can be + or –
Provide Extra attention
provide sibling gift,
allow to see baby 1st
Mom/child quality time alone
234
Bonding Adaptation assessment
Eye contact
Smiling, kissing, talking, singing
Naming and claiming infant
Positive comments
Responds to cues
Comfort level of care
235
Bonding Adaptation interventions
Comfort level
Facilitate bonding
Rooming in
Cluster care
Education
Infant behaviors & cues
Role model infant care
Provide positive feedback
Culture-sensitive
Professional Interpreter
236
Postpartum blues, depression, and psychosis risk factors
Hormone changes - rapid ↓ Estrogen & Progesterone
History of depression
Pregnancy or childbirth complications, pain or discomfort
Anxiety related to new role as mother
Unplanned pregnancy
Low self-esteem
Lack of social support
Life stresses - socioeconomic factors
Intimate partner violence - poor relationship with partner
237
PP Blues “Baby Blues”
time
1st wk PP, peaks around 5th day
238
PP Blues “Baby Blues”
s/s
Irritability, Fatigue, Crying, Mood swings, & Anxiety
239
PP Blues “Baby Blues”
cause
Cause unknown;
Hormone changes, discomforts, sleep deprivation, body image concerns, Stress
240
PP Blues “Baby Blues”
mom's infant care
Doesn’t usually affect ability to care for infant. Resolves without interventions 10-14 days
241
PP Depression
time
Persists past 2 weeks.
Occurs in 1st 3 months & last up to 1 yr
242
PP Depression
s/s
Persistent low mood
243
PP Depression
risk
Risks include:
History of sexual abuse
Unwanted pregnancy
Smoking, Formula feeding
244
PP Depression
maternal to infant
Unable to safely care for infant and self
245
PP Psychosis
time
peaks 48 hrs. to 2 wks.
246
PP Psychosis
s/s
Intense depression
relapse of a psychotic d/o, Confusion, Auditory & visual hallucinations, Insomnia
247
PP Psychosis
criteria include
major depressive disorder with psychosis
Bipolar I, Bipolar II, Unspecified functional psychosis, Schizoaffective disorder
248
PP Psychosis
mgmt
Medical emergency, Serious mood instabilities, thought of suicide, infanticide
249
Postpartum blues, depression, and psychosis interventions
Review history for risk factors
Monitor maternal - infant interaction
Education - patient and family
S & S postpartum blues, depression and psychosis
Importance of rest, ↓ stress, emotional and physical support
Compliance with prescribed medications
Notify PCP if symptoms persist, thought of self or infant harm
Provide information support groups
250
Mild Blues, Depression, and Psychosis
psychotherapy
251
Moderate Blues, Depression, and Psychosis
psychotherapy & antidepressants
252
Severe Blues, Depression, and Psychosis
Psychotherapy, antidepressants, & Intense Psychiatric care, Crisis intervention
253
Assessment of Adolescent Parenting
Knowledge level
Prenatal care
Support system
Boyfriend, Grandparents
Expectations of childcare & support
Attitude towards parenting
Economic status
Culture/Spiritual beliefs
IPV
Unsafe Behaviors
Smoking, drugs, peer activities
254
Adoption decision
Exciting time - giving child a “better life”
Struggle - intense guilt, depression & regret
255
Adoption factors
Single
Adolescent
Economic status
Result of incest or rape
Not emotionally ready for parenthood
Partner disapproval of pregnancy
256
Adoption parents
Plans can be Independent, Private or Public agency
Feel anxious and overwhelmed
Teaching on basic infant care
