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Nursing 3 > Postpartum > Flashcards

Postpartum Flashcards

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1
Q

Involution

A

The reduction in the size of the uterus after delivery to the prepregnant size caused by uterine contractions that constrict and occlude underlying blood vessels at the placental site

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2
Q

Factors that Enchance involution

A

Uncomplicated labor and delivery
Breastfeeding
Early ambulation
Complete expulsion of placenta and membranes

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3
Q

Factors that slow involution

A 
Prolonged labor and difficult delivery
Anesthesia
Grand multiparity
Retained placental fragments or membranes
Full urinary bladder
Infection
Overdistention of the uterus
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4
Q

Fundus

A

The top portion of the uterus
A palpable indicator of involution
Could see what is known as a boggy uterus…one that is soft, relaxed and likely to cause hemorrhage
If the bladder is full [retention with overflow] or [foley not draining post C section], the chance of a boggy uterus increases which increases risk for hemorrhage.

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5
Q

Terbutaline or Mag Sulfate

A

Medications used in cases of pregnancy induced hypertension [Mag Sulfate]
Medications used in treatment of premature labor [ Terbutaline, Magnesium sulfate]
These medications create a relaxed environment internally resulting in relaxed uterus that is lazy to contract post birth
Resolution: See an IV bag of Ringers lactate with mag sulfate and second one with Pitocin

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6
Q

Lochia

A

Is the discharge of blood and debris following delivery, musty fleshy odor…types include rubra, serosa, alba
Rubra: 1-3 days, dark red, may have clots smaller than a nickel
Serosa: 4-10 days pink or brownish, watery, odorless
Alba: 11-21 days yellow to white, slight stale odor
Should not contain large clots
Increased by exertion or breastfeeding
Pooling occurs in uterus or vagina if in bed with increased bleeding upon arising

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7
Q

DOcumentation of Lochia flow

A

Scant: blood only on tissue when wiped or 1-2 inch stain [< than 10ml in one hour]
Light: 4 inch or less stain [10-25ml in one hour]
Moderate: less than 6 inch stain [25-50 ml in one hour]
Heavy: saturated pad [50-80 ml in one hour]

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8
Q

Afterpains

A

Caused by intermittent uterine contractions
More painful in multiparous and breastfeeding women
Purpose is to speed involution requiring 10 days and prevent excessive bleeding
Counteracted with 600 mg Ibuprofen and Percocet tabs one or two.

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9
Q

Cervix

A

May appear bruised and edematous with multiple small lacerations
Closes to 2-3 cm after several days admits a fingertip after 1 week
Shape permanently changes after the first delivery from round dimple like os to lateral slit like os

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10
Q

Vagina

A

Edematous with small lacerations
Should be free from perineal pain within 2 weeks
Low estrogen levels lead to decreased vaginal lubrication and vasocongestion for 6-10 weeks leading to painful intercourse

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11
Q

Abdominal wall

A

Soft and flabby with decreased muscle tone
Striae or stretch marks that were red fade to silver
Diastisis recti separation of the rectus muscles of the abdomen may improve

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12
Q

Fundus should be

A

at the umbilicus

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13
Q

Lochia should have a

A

fleshy odor with blood and a small amount of mucus mixed in

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14
Q

Perineum should be

A

Edematous, painful to pressure, and perhaps with hemmorhoids

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15
Q

Breasts should be

A

Soft and secreting colostrum

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16
Q

Uterine involution occurs as a result of

A

Autolysis of protein material within the uterine wall

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17
Q

Cardiovascular

A

Returns to prepregnant state within 2 weeks
Increase in blood volume eliminated by diuresis
First 48 hours are greatest risk especially with clients with heart disease
Blood pressure should remain consistent with pregnancy baseline
Bradycardia of 50 to 70 beats per minute common during the first 6 to 10 days
Tachycardia related to increased blood loss, temperature elevation or difficult labor and birth
Increased fibrinogen continues for 1 week with increased chance for thrombophlebitis

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18
Q

Walking after C section first postop day

A

decreases risk of blood clots

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19
Q

CV - blood

A

Increased white blood cells up to 30,000 does not necessarily mean infection or may mask signs of infection; an > of 30% in 6 hours indicates pathology
Decreased hemoglobin is related to the amount of blood loss during delivery; should return to prelabor value in 2-6 weeks
Hematocrit increases by 3-5 days related to diuresis

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20
Q

Patient safety risks

A

Due to lower Hgb, diuresis, and volume shifting the pt is at risk for syncope and falls

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21
Q

Falls

A

2008 analysis of reported medical errors showed that patient falls were the most frequently reported incident!!!!!!!!!!!
Falls made up 40% of the 533 total events reported by hospitals to the state.
Most of the reported falls, 71%, occurred in the patient’s room, usually when the patient was attempting to use the bathroom.

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22
Q

Urinary

A

Increased risk of urinary retention and UTI
Diuresis of 2000-3000ml increases the output in the first 12 to 24 hours and accounts for about a 5lb weight loss
Increased glomerular filtration rate enhances diuresis
A FULL BLADDER DISPLACES THE UTERUS INCREASING THE RISK OF UTERINE ATONY AND POSTPARTAL HEMORRHAGE
Fluids lost also thru diaphoresis with increased perspiration most commonly at night

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23
Q

Gastrointestinal

A

Hunger and thirst common
Drink Drink Drink water!!!!
Risk for constipation increases because of decreased peristalsis, use of narotic analgesics, dehydration and decreased mobility during labor, fear of pain from having a bowel movement
Risk for hemorrhoids increases because of pressure from pushing

24
Q

Endocrine

A

Estrogen and progesterone drop rapidly after delivery of placenta
 Menstruation usually resumes at 7-9 weeks for non lactating women with 90% experiencing a menstrual period by 12 weeks
Ovulation and menstruation return time is prolonged in lactating women and affected by the length of time women breast feed and whether formula supplements are used

25
Q

Lactation

A

Have let down reflex which is the release of milk by contractions of the alveoli of the breast
Colostrum is firstmilk secreted and rich in protein and immunoglobulins
Primary engorgement occurs in the second or third day as the supply of blood and lymph is increased and traditional milk produced [ use of cabbage leaves]
Mature milk produced after 2 weeks

26
Q

Suppress lactation

A

ice bags, snug bra

27
Q

Boggy displaced fundus intervention

A

gentle massage fundus until firm

28
Q

Afterpains tx

A

analgesic

29
Q

100.2 temp 4 hours after delivery

A

encourage fluids

30
Q

Psychosocial changes

A

Phases of Maternal Adjustment:

  1. Taking-in Phase: 0-3 days; focus to self; passive;dependent, touches and explores newborn
  2. Taking Hold Phase: 3-10 days; obsessed with body functions; rapid mood swings
  3. Letting Go Phase: 10days to 6 weeks; mothering functions established
31
Q

Bonding

A

The process by which the parents form an emotional attachment
Use term known as en face position
Soft low pitched tone of voice
Engrossment is the father’s absorption, preoccupation and interest in infant

32
Q

Postpartum blues

A

Transient depression starting on day 2
Related to hormonal shifts, fatigue and psychological stress
Involves mood swings, anger, tearfulness, feeling let down, anxious, insomnia
Usually resolves spontaneously..if not heading into depression

33
Q

Postpartum assessment

A

Feeding:
Breast or bottle
Engorgement or tenderness in breasts
Nipples: redness, cracking, flat, inverted, nipple shield, everted

Uterus:
Palpate for what feels like a “grapefruit”
Determine firmness, height[@U or @U1]
Inspect any abdominal incisions for REEDA[redness, edema, ecchymosis, discharge, approximation of skin edges] staples or sutures

34
Q

Bladder

A

Should void within 6-8 hours
Assess for frequency, buring, urgency…UTI
Assess for retention with overflow
Palpate for bladder distention

35
Q

Lochia

A

Type, quality, amount, odor
Ask to leave a pad in bathroom to see
Correlate with expected characteristics of bleeding
C-sections have decreased lochia due to suctioning in surgery
Know if woman had history of anticoagulant therapy increasing bleeding or clotting abnormalities

36
Q

Bowel

A

Assess for flatus
Inspect for signs of distention
Auscultate bowel sounds
Administer stool softener ordered sometimes you see Colace or Pericolace or Senakot or MOM or Bisacodyl
Typical laxatives for severe constipation include Mag citrate, Lactulose or Miralax.
Does it transfer through breast milk????

37
Q

Episiotomy

A

Inspect perineum..looking for redness, hematoma, any signs of infection
Look for hemorrhoids
Pain reduced through use of Tucks, Nupercainal ointment, ice, Sitz baths

38
Q

Homans sign

A

Pain in calf: ….thrombophlebitis…looking for pedal edema, warmth, redness, pedal pulse request bilateral dopplers
C-sections have flowtrons or sequencial compression boots
Heavy to obese more at risk
Need to ambulate

39
Q

Emotional status

A

Appropriate for situation
Phase of postpartal psychological adjustment
Assess for signs of blues or depression
Assess attachment and bonding

40
Q

Postpartum Implementation, hemmorhage

A

Prevent hemorrhage:
Assess for risk factors..long arduous, delivery, multigravida, use of mag sulfate[ more to come under pre-eclampsia], use of terbutaline[ muscle relaxant], any unusual history with bleeding issues
Usually run 1 or 2 1000cc bags with Pitocin [oxytocin] in it to prevent this
Keep bladder empty..full bladder annoys uterus and causes it to relax and bleed out
Sometimes a large clot in the uterus or sometimes inadvertently a 4x4 is left in and the uterus cannot contract so it bleeds

41
Q

Other things to monitor

A

Assess for bogginess…massage
Another oxytoxic medication is known as Methergine or Ergotrate…more powerful than Pitocin
Monitor for side effects of these drugs…hypertension with Methergine and Ergotrate
Pitocin…BP may initially drop but then increase by 30% above baseline…
Pitocin also has an antidiuretic effect which can cause urinary retention[ more to come under Induction and Hemorrhage]

42
Q

Promote comfort

A

Apply ice to perineum 20 minutes on and 10 off…many units have a “shake” sanitary pad with built in chemical ice
Place these pads in the hospital utilized “panties” which look like the top of panty hose..but white
Utilization of portable plastic Sitz baths..follow package insert directions
Obtain a perineal care package…squirt bottle, Tucks, Nupercainal ointment, Dermoplast with instructions
Teach to blot only from front to back never wipe

43
Q

Pain comfort

A

Check physician orders usually has Ibuprofen 600-800mg along with Percocet to decrease inflammation/edema and pain
Some have Morphine Epidural Infusions for 24 hours…watch for respiratory depression, n/v, itching, urinary retention, sleepiness
Benadryl is given for reaction to spinal and epidural anesthesia

44
Q

Promote bowel elimination

A

Encourage early and frequent ambulation
Encourage increased fluids and fiber
Administer stool softeners as ordered…suppositories are contraindicated if third or fourth degree perineal laceration involving the rectum
No straining at stool…normal pattern return in 2 to 3 weeks

45
Q

Urinary elimination

A

Encourage voiding every 2 to 3 hours even if no urge
Catheterize as ordered for urinary retention…foley catheters for 12 to 24 post c-section
Stout beer: the dark beer, Killians Red, Irish Harp, Becks Stout or Extra Stout…these are diuretics..also high in B vitamins..promote diuresis and increased milk supply

46
Q

You are assisting Lucy to the bathroom for the first time following delivery.
What nursing assessments should you make before Lucy gets up????
What teaching regarding perineal hygiene should you initiate at this time???
Lucy decides to remain in the bathroom and take a shower after she voids. What precautions should you take to ensure her safety????

A

1. Assess BP, dizziness, skin color, pulse
2. Need for cleansing after voiding with a peri bottle of warm water, patting from front to back to decrease UTI, comfort measures…Dermoplast
3. Make sure she knows how to use emergency call bell…can experience orthostatic hypotension and faint in shower..have ammonia on you..in med room..do not trust…better to leave door open to hear her…better not to have an incident report and they faint fast

47
Q

Rh issues

A

Rh negative mother:
A woman who is Rh negative with an indirect Coombs test negative and whose infant is Rh positive with a direct Coombs test negative is given Rhogam
Need to administer Rhogam to prevent Rh sensitization and future hemolytic disease of newborn
Comes from blood lab…syringe…must be signed for
Usual dose 300ug IM within 72 hours of delivery
Must chart lot number and date of expiration

48
Q

Vaccines

A

If needs rubella vaccine…to provide immunity to mother and avoid fetal malformations if the disease is contracted in a future pregnancy
Must note batch # and date of expiration on permission slip prior to administration
Avoid a pregnancy for 3months as this is a live attenuated vaccine

49
Q

Postpartum Red Flags

A

Bright red bleeding saturationg more than 1 pad per hour or passing large clots
Temperature > than 100.4F
Chills
Excessive Pain
Reddened or warm areas of breast: mastitis
Reddened or gaping episiotomy; foul smelling lochia
Inability to urinate, burning, frequency
Calf pain, tenderness, swelling

50
Q

Promote successful infant feeding patterns

A

Suppression of lactation and successful bottle feeding:
Utilixe snug bra or breast binder continuously for 5 to 7 days to prevent engorgement
Avoid heat and stimulation of the breasts
Apply ice packs for 20 minutes four times a day if engorgement occurs
Many different types of formulas…Enfamil, Similac, Prosobe, some with iron, different caloric value, look at labels
Go to drug store or grocery store and check out baby formulas

51
Q

Establish lactation

A

Utilize a well fitting nursing bra for support..day as well as night
Teach breast care including no use of soap and air drying nipples after feeding
Encourage nursing on demand…more they feed, more milk supply
Nurse 10 to 15 minutes on first breast and until baby lets go on the second; the next feeding start with second breast first
Locate the lactation consultant on the hospital floor
Know about resources such as the Postpartum Place in Chatham for support
Educate about diet…no caffeine, no chocolate, no gassy foods such as peas, broccoli,cauliflower, watch dairy as well, lot of liquids, no spicy….no soda
If baby has sufficient wet diapers in 24 hours and is gaining weight, milk supply is good
Watch stress level..higher stress, less milk supply, need to pump and store if miss feeding; no pumping, milk supply drops
Teach positions, cradle, football hold, side lying…teach how to break suction from nipple when nursing

52
Q

Culture

A

Many different beliefs:
Some feel they should not even get out of bed
Amount of closeness and degree of contact between mother and newborn is usually cultural
Culture may influence how long breast feeding continues
Feeding practices vary across cultures

53
Q

Security issues in hospital

A

You must at all times identify baby ID to mother ID before giving or leaving baby in room
If you give the wrong baby to the wrong mother and that baby breastfeeds on the incorrect mother, you could have a lawsuit especially if that mother has any diseases
At no time are you to walk around with any of these babies, transport is always by bassinet…if you inadvertently slip or fall, you are looking at a lawsuit….

54
Q

Promote rest and gradual return to activity

A

Organize care to avoid frequent interruptions
Teach the woman to resume activity gradually over 4-5 weeks; avoid lifting, stairclimbing, strenuous activity
Know that on file are discharge instructions for each specific physician

55
Q

Nutritional Intake on Discharge

A

Encourage fluid intake of 2000 ml/day
Encourage use of prenatal vitamins
Encourage good nutritional food…who is cooking..support team….

Nursing 3 (10 decks)

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