Postpartum Flashcards
Engorgement (857)
An uncomfortable fullness of the breasts when that occurs when the milk supply initially comes in. Result of venous and lymphatic stasis. Usually occurs about 3 days postpartum and resolves in 48 hours.
Engrossment (878)
The intense fascination that fathers exhibit for a newborn child.
Treatment for Engorgement (857)
Manual expression of milk. Application of warm moist heat. Compress breasts. Ice packs. Analgesics.
Postpartum Oxytocin (841)
Hormone produced by the posterior pituitary that stimulates uterine contractions and milk release.
Contractions compress blood vessels at the site where the placenta separated from the uterine wall, minimizing venous blood loss.
Priority nursing interventions of a newborn.
Dry thoroughly.
Suction eyes and mouth.
Warm cap.
Fundus 12 hours Postpartum (842)
Immediately after delivery, the uterine fundus is between umbilicus and symphysis pubis.
12 hours after delivery, rises to the umbilicus at midline.
Involution (842)
The gradual decrease in size of the uterus, over about 6 weeks, following child birth.
Types of Lochia (842)
Rubra.
Serosa.
Alba.
Lochia (842)
The fluid waste discharge after delivery.
Consists of blood, tissue, and mucus. Fleshy odor.
Lochia Rubra (842)
0-2 days postpartum.
Bright red drainage, made up of mostly blood.
Lochia Serosa (842)
2-7 days postpartum.
As placental site heals, discharge becomes pink and brown.
Lochia Alba (842)
7-14 days postpartum.
Yellow or white drainage.
Colostrum (874)
The fist stage of breast milk production. Thin, watery, yellow.
Rich in protein, calories, antibodies, and lymphocytes.
Hygiene limitations one day post vaginal delivery.
The cervix is still significantly dilated.
Baths are contraindicated, but showers with good perineum care are OK.
Rationale for stool softeners post vaginal delivery.
Minimize the bearing-down reflex.
Acrocyanosis (867)
Poor peripheral circulation of a newborn results in hands and feet presenting blue.
Can last 7-10 days.
Newborn Jaundice (867)
Icterus neonatorum.
Yellow discoloration caused by deposits of bile pigments. First detected over bony prominences on the face and mucous membranes. Liver not functioning
Abnormal during first 24 hours of life. After 24 hours, maybe normal.
Physiologic Jaundice (867)
Onset 24-48 hours after delivery.
Caused by normal reduction of RBCs, resolves after 7-10 days.
Vernix Caseosa (867)
Yellow white substance covering neonates’ skin.
Protects the skin from amniotic fluid.
Lanugo (867)
Downy fine hair on the forehead, shoulders, and cheeks. From 20 weeks gestation to birth.
Not found on palms, soles, and scalp.
Epstein’s Pearls (867)
Small white nodules found on the hard palate of neonates. Result from epithelial cells and disappear spontaneously within a few weeks.
Meconium (876)
Newborn’s initial stools. Odorless, black-green, and sticky.
Made up of vernix, lanugo, mucus, and amnion.
Phenylketonuria (851)
Condition marked by inability to break down the amino acid phenylalanine to tyrosine. These amino acids build up and are harmful to the central nervous system and can cause brain damage.
Phenylalanine
Plays a role in the body’s production of melanin, the pigment responsible for skin and hair color. Infants with PKU often have lighter skin, hair, and eyes than without the disease.
S/S of Phenylketonuria
Delayed mental and social skills
Jerking movements of the arms or legs
Seizures
Skin rashes
Tremors
Unusual positioning of hand
Galactosemia
Condition where the body is unable to metabolize the sugar galactose, found in milk. Substances made from galactose build up in the infant’s system, causing damage to the liver, brain, kidneys, and eyes.
S/S of Galactosemia
Convulsions
Irritability
Poor feeding (baby refuses to eat formula containing milk)
Poor weight gain
Yellow skin and whites of the eyes (jaundice)
Vomiting
Gomco Clamp circumcision care (850)
Apply petroleum jelly covered gauze to penis after every diaper change.
Keep are clean to prevent infection. Cleans penis carefully with warm water at least every 4 hours.
Newborn Reflexes (870)
Moro.
Tonic Neck.
Crawling.
Dance or Stepping.
Babinski.
Grasp.
Plantar.
Pull to Sit (Traction).
Trunk Incurvation (Galant).
Moro Reflex (870)
Sudden jarring or change in equilibrium causes extension and abduction of extremities and fanning of fingers, with thumb and fore-finger making a C shape, followed by flexion and adduction of extremities.
Tonic Neck Reflex (870)
When infant’s head is quickly turned to one side, arm and leg of that side will extend, the opposite side will flex.
Crawling Reflex (870)
When placed on abdomen, infant will make crawling movements.
Dance or Stepping Reflex (870)
If infant held so that sole of foot touches a hard surface, there will be a reflex simulating walking.
Babinski Reflex (871)
Stroking the sides of the sole of the foot, the big toe will fan out and dorsiflex.
Palmar Grasp Reflex (871)
Place finger in the palm of the hand will elicit grasping by the infant.
Plantar Reflex (871)
Place fingers at the base of the toes, toes curl downwards.
Pull to Sit (Traction) Reflex (872)
Pull infant up by the wrist from supine position with head midline. Infant will attempt to hold head upright in sitting position.
Trunk Incurvation (Galant) Reflex (872)
Place infant prone. Running fingers lateral to spine causes trunk flexion in that direction.
Mongolian Spots (866)
Areas of increased pigmentation. Lumbar dorsal area is most common. They may appear bluish black. Most often seen in dark skinned people.
Proper hand position for palpating the uterus after child birth (855)
Placing one hand over the lower segment of the uterus near the pubic bone.
Use the other hand to feel the location and consistency of the uterus.
Types of heat loss in newborns
Evaporation
Conduction
Convection
Radiation
Normal weight loss in newborn infants (873)
Up to 10% in the first week.
Location of Vitamin K shot following delivery (873)
Vastus lateralis, because it is the most developed muscle.
Reason for Vitamin K shot during first 48 hours (873)
Newborns have low prothrombin levels at birth and are at risk for hemorrhage. They can not synthesize Vitamin K until they have adequate intestinal flora.
Normal vitals postpartum (853)
Temperature may rise to 100.4F for 24 hours. Bradycardia for one week. Orthostatic hypotension with vertigo or syncope.
S/S of Hypovolemic Shock (843)
Persistent bleeding.
States malaise feeling.
Anxiety.
Tachycardia.
Hypotension.
Contraindicated care for postpartum patient following vaginal delivery.
Massaging the fundus firmly every 15 minutes.
Routine care of postpartum vaginal delivery.
Maintaining I/O until patient is voiding in sufficient quantities.
Assess emotional status of new mother.
Check breasts for engorgement and cracking of nipples.
Before assessing the fundus, the patient should:
Empty the bladder.
Description for peripad stain, 6 inches long, and bright red.
Lochia rubra, moderate.
Contraindicated breast care teaching for lactating woman.
Washing breasts and nipples with soap and water before each feeding.
Breast care patient teaching during lactation.
Expose nipples to air for 30 minutes daily.
Wearing supportive bra 24hr/day for 4 weeks.
Avoid use of plastic liners in bra.
Indicator that baby is getting enough milk.
6 to 10 wet diapers daily.
Good indicator that mother is still in “taking-in” phase:
Spends majority of her time talking about the delivery experience.
Contraindicated for care of umbilical cord.
Keeping the cord moist.
Indicated for care of umbilical cord.
Clean with alcohol swab.
Keep diaper from touching cord.
Apply triple dye to the cord.
Priority nursing action for postpartum bleeding saturated perineal pad within 15 minutes.
Palpate the uterine fundus.
Best treatment for 48 hours postpartum assessment of breasts reveal swollen, warm, tender on palpation, and bottle feeding.
Apply ice to the breasts for comfort.
Behavior indicating need for further intervention prior to discharge.
Leaves baby on the bed while taking a shower.
Exhibiting behavior considered maladaptive in parent-infant attachment.
Seldom making eye contact with child.
Helping with transition to fatherhood.
Pointing out that the infant turned to his voice.
When performing a postpartum assessment, the nurse should:
Assist the patient into a lateral position with upper leg flexed forward to facilitate examination of her perineum.
Bonding
The process where an infant’s behavior and characteristics call forth a corresponding set of maternal behaviors and characteristics.
Enface
The face-to-face position in which a parent’s and infant’s faces are approximately 20 cm apart and on the same plane or level.
Engrossment
A parent’s absorption, preoccupation, and interest in their infant. Usually describes the father’s intense involvement with his newborn.
Taking-In Phase
Period of maternal postpartum adjustment characterized by a woman’s need to review her labor and birth experiences with the nurse who cared for her while she was in labor.
Other behaviors exhibited include reliance on others to help her meet needs, excitement, and talkativeness.
Nursing intervention to prevent thrombophlebitis post delivery via cesarean.
Promote frequent ambulation.
Client teaching regarding breast feeding postpartum.
Increase calorie intake by 500 per day.
Do not use soap and water on breasts.
Immediate nursing action for postpartum client presenting with thrombophlebitis, chest pain, and dyspnea.
Obtain vital signs.
Immediate nursing action for client suspected of pulmonary embolism.
Administer oxygen by face mask.
Observe cool, clammy skin, restlessness, and excessive thirst in 4hour postpartum client. Immediate nursing action:
Obtain vital signs.
After episiotomy and the delivery of a newborn, the nurse performs a perineal check on the mother.
The nurse notes a trickle of bright red blood coming from the perineum. The nurse checks the fundus and notes that it is firm. The nurse determines that:
The bright red bleeding is abnormal and should be reported.
Involution
The progressive descent of the uterus into the pelvic cavity, which occurs at a rate of ~1cm per day.
Relief practice for breast engorgement while breast feeding.
Massage the breasts before feeding to stimulate let-down.
After delivery, a nurse checks the uterine fundal height. The nurse expects the position to be:
At the level of the umbilicus.
Appropriate nursing intervention for postpartum client 4hours presents with 102F.
Notify the RN.
Notify the physician.
Planning care for postpartum woman with small vulvar hematomas:
Ice pack application to the area.
