Postpartum Flashcards
When is the Post-partal Period ( puerperium)?
6 weeks period after childbirth
Describe the Taking In Phase?
-First 24-48 hr
-Passive attitude
-Experiencing afterpains or hemorrhage
-Let mom talk about her experience. It helps w/ applying the experience to total life experience.
-Focus on meeting personal needs
-Rely on others for assistance
-Excited, Talkative
-Sleep deprived
NO PATIENT TEACHING
Describe the Taking- hold Phase?
- Begins on day 2 or 3
- Last 10 days to several weeks
- She cares for baby needs more
- Focus on baby care and improving caregiving competency
- Want to take charge but need acceptance from others
- Vaginal birth moms enter the phase FASTER than c sections
- She is learning to make decisions about infants care
Describe the Letting Go Phase?
- Woman defines her new role
- Lets go of made up fantasy of child; accept real image
- Let’s go old role (childless or mother of __ Kids) to new role
- There is grief in this stage and readjustment to relationships
A nurse concludes that the parent of newborn is not showing positive indications of parent-infant bonding. The parent appears very anxious and nervous when asked to bring the newborn to the other parent. Which of the following actions should the nurse use the promote parent-infant bonding?
a )Hand the parent the newborn and suggest that they change the diaper
b) Ask the parent why they are so anxious and nervous
c) Tell the parent that they will grow accustomed to the newborn
d) Provide education about infant care when the parentis present.
D. Nursing interventions to promote paternal bonding include providing education about newborn care and encouraging the parent to take a hands-on approach
A client in the early postpartum period is very excited and talkative. They repeatedly tell the nurse every detail of the labor and birth. Because the client will not stop talking, the nurse is having difficulty completing the postpartum assessments. Which of the following action should the nurse take?
a) Come back later when the client is more cooperative
b) Give the client time to express feelings
c) Tell the client they need to be quiet to the assessment can be completed
d) Redirect the client’s focus so that they will become quiet
B. Recognize that the client is the taking-in phase, which begins immediately following birth and lasts a few hours to a couple of days
A nurse is caring for client who is 1 day postpartum. The nurse is assessing for material adaptation and parent-infant bonding. Which of the following behaviors by the client indicated a need for the nurse to intervene? (select all that apply)
a) Demonstrates apathy when the newborn cries
b) Touches the newborn and maintains close physical proximity
c) Views the newborn’s behavior as uncooperative during diaper changing
d) Identifies and related newborn’s characteristics to those of family members
e) Interprets the newborn’s behavior as meaningful and a way of expressing needs
A. and C
This behavior demonstrates a lack of interest in the newborn ad impaired parent-infant boding
A client’s view of their newborn as uncooperative during diaper changing is a sign of impaired parent–infant bonding.
A nurse is caring for a client who is 2 days postpartum. The client states, “ My 4 years old son was toilet trained and now he frequently wetting himself.” Which of the following statements should the nurse provide to the client?
A) “Your son was probably not ready for toilet training and should wear training pants”
b) Your son is showing an adverse sibling response
c) Your son may need counseling
d) You should try sending your son to preschool to resolve the behavior.
B.
Adverse response by sibling to a new infant can include regression in toileting habits.
What temperature is considered a fever postpartum?
100.4 after 24 hours
If a woman is 10 hours postpartum with a temp of 100 F, What is the cause of the temperature?
The cause is dehydration within 24 hours of birth.
What are the risk factors for Thrombophlebitis ?
Pregnancy C-Section (doubles risk) Operative vaginal birth Pulmonary Embolism or varicosities Immobility Obesity Smoking Multiparity Age greater than 35 years History of Thromboembolism
What are the physical assessment Thrombophlebitis?
Unilateral area of swelling, warmth, and redness
Hardened Vein over the thrombosis
Calf tenderness
What is femoral thrombophlebitis?
is clots involving femoral; saphenous or popliteal veins “milk leg” - white appearance
How to prevent femoral thrombophlebitis?
- Ambulation
- Don’t leave women in the lithotomy position long
- If varicose veins wear support stockings first 2 wk after birth
- remove 2x day to check for mottling or inflammation
- maintain fluid intake of 2 to 3L each day from food and beverage sources to prevent dehydration, which causes sluggish
- discontinue smoking
What is femoral thrombophlebitis signs and symptoms?
- elevated temp
- systemic fever
- chills
- pain
- unilateral localized: redness, swelling, warmth hard inflamed swell below lesion
- swelling is white and shiny
What is low-molecular-weight Heparin used for?
anticoagulant
prevent formation of other clots and to prevent enlargement of the existing clot
monitor aPTT 1.5-2/5 times the control level 30 to 40 seconds
Heparin (IV) antidote
protamine sulfate
Heparin client education
-Report bleeding from the gums or nose, increased vaginal bleeding, blood in the urine and frequent bruising
-rotate injection site
-avoid taking aspirin or ibuprofen (increases bleeding tendencies)
-avoid rubbing or massaging legs
use electric razor for shaving.
What is Warfarin used for?
- Anticoagulant
- used as treatment of clots. It administered orally and is continued by the client for approximately 3 months
Warfarin Client education
-Report bleeding from the gums or nose, increased vaginal bleeding, blood in the urine and frequent bruising
Use birth control to avoid pregnancy due to the teratogenic effects to warfarin. Oral contraceptives are contraindication because of the increased risk for thrombosis.
-Avoid alcohol use ( inhibits warfarin)
Normal amount of blood loss in delievery
Vaginal birth- 500ml or less
C-section 1000 ml or less
What are Postpartum hemorrhage risk factor?
- Uterine atony
- Trauma
- Retained placenta fragments
- Development of Disseminate Intravascular Coagulation (DIC)
- Ruptured Uterus
- Prolonged labor, oxytocin-induced labor
What are the 4 T’s that cause hemorrhage?
Tone
Trauma
Tissue
Thrombin
What is Uterine Atony?
- relaxation of uterus ( most frequent cause)
- inability of the uterine muscles to contract adequately after birth
What are the signs and symptoms of Hypovolemic Shock
- decreased blood pressure
- shallow respirations
- pale
- clammy skin
- increased anxiety
When checking perineal pads, what are somethings to look out for?
- if a woman is saturating pads in 15 minutes (hemorrhage)
- Always turn the patient to her side to check for pooling blood underneath her.
What should a nurse do to AVOID Uterine Atony? (safeguards)
Palpate fundus frequently to ensure uterine contractions
check lochia
check vital signs
What to do if PT has Uterine Atony?
Massage Fundus to encourage contractions
if the fundus does not firm, may Rx a bolus/ IV oxytocin
if oxytocin doesnt work: hemabate IM; Methergine IM; Cytotec (rectal)
Oxytocin (uterine stimulate)
induces or augments labor
promotes uterine contractions
controls postpartum bleeding
promotes milk letdown
Nursing actions for Oxytocin?
- Monitor maternal v/s every 15 minutes
- Do NOT leave client unattended while the oxytocin is infusing
- Assess uterine tone and vaginal bleeding
- Monitor for adverse reactions of water toxicity (lightheadedness n/v headache malaise)
- These reactions can progress to cerebral edema with seizures, coma, and death.
Methylergonovine (Methergine)
Uterine stimulant
controls postpartum hemorrhage
Nursing Actions of Methergine?
- Assess uterine tone and vagina bleeding
- Monitor for adverse effects: hypertension, N/V and headache
What patients CANNOT have Methergine?
Pt with hypertension, cardiovascular disease and peripheral vascular disease CANNOT take Methergine
How often is Methergine given to a patient?
every 2-4 hours
Carboprost Tromethamine (Hemabate)
Uterine stimulant
controls postpartum hemorrhage
Nursing Actions for Carboprost (Hemabate)
monitor v/s
monitor vaginal bleeding and uterine tone
monitor for adverse reactions: fever hypertension chills headache n/v and diarrhea
Monitor for anaphylaxis (wheezing, chest tightness, dyspnea, rash, pruritus, swelling of the face lips or throat)
What patients CANNOT have Hemabate?
Asthmatic patients
hepatic, renal and cardiac disease
Acute Pelvic Inflammatory Disease
Misoprostol (Cytotec)
uterine stimulant
controls postpartum hemorrhage
Nursing Actions for Cytotec?
Assess uterine tone and vaginal bleeding
administer rectally
