Postpartum adaptations and nursing mgmt

Question 1

Puerperium period

Answer 1

-Begins after delivery of placenta and lasts 6 weeks
-Called 4th trimester
-True postpartum period lasts 9-12 months after birth

Question 2

Maternal physiologic adaptations: reproductive system

Answer 2

-Menstrual cycles returns
-Breastfeeding is not a safe contraceptive
-Uterus returns to prepregnancy size via involution
-Breasts don’t return to prepregnant size

Question 3

Maternal physiologic adaptations: uterine involution

Answer 3

-Uterus returns to normal size via involution
-By 3 days, fundus lies btwn 2-3 fingerbreadths below umbilicus
-By end of 10 days, fundus can’t be palpated
-If these changes don’t occur, subinvolution occurs (delayed or absent involution)
-Uterine involution occurs d/t complete expulsion of amniotic membranes and placenta at birth, complication-free labor, breast-feeding, early ambulation
-Subinvolution occurs d/t full bladder, anesthesia, overdistention of uterine muscles, close childbirth spacing

Question 4

Maternal physiologic adaptations: lochia

Answer 4

-Lochia is vaginal discharge that occurs after birth and lasts for 4-8 weeks
-Results from involution
-Lochia rubra: deep-red mixture of mucus, tissue-debris, and blood that occurs 3-4 days after birth
-Lochia serosa: pinkish brown, expelled 3-10 days after, mostly leukocytes, RBCs, and serous fluid
-Lochia alba: creamy white or light brown, 10-14 days after, consists of leukocytes, tissue, fluid content
-At any stage should have a fleshy smell, an offensive odor usually indicates infection such as endometritis
-A danger sign is reappearance of bright-red blood after lochia rubra has stopped

Question 5

Maternal physiologic adaptations: afterpains

Answer 5

-Uterus contractions prevents hemorrhage from placental site
-Called afterpains
-More common in multiparous and breastfeeding women
-Usually respond to oral analgesics
-Stronger during breastfeeding bc oxytocin released by sucking reflex strengthen contractions

Question 6

Maternal physiologic adaptations: cervix

Answer 6

-Cervix is partly dilated, bruised, and edematous
-Never regains prepregnant state
-External cervical os is no longer shaped like a cervical but as a jagged slit-like opening (similar to a fish mouth)

Question 7

Maternal physiologic adaptations: vagina

Answer 7

-Mucosa thickens and rugae returns after hormone production resumes
-Will always remain a bit larger than it had before
-Dryness and coital discomfort (dyspareunia) plague women until menstruation returns

Question 8

Maternal physiologic adaptations: perineum

Answer 8

-Edematous and bruised
-Muscle tone may not return
-Swollen hemorrhoids
-Encourage women to practice pelvic floor muscle training exercises
-Failure to maintain perineal muscle tone can lead to urinary incontinence later in life

Question 9

Maternal physiologic adaptations: CV system

Answer 9

-Heart is displaced up and to left during pregnancy
-Output remains high then declines
-Blood volume drops
-Acute decrease in Hct indicates hemorrhage
-Common for temp to be 100.4+ in 24 hrs d/t mild dehydration, slight decrease in BP can occur
-Preeclampsia may occur

Question 10

Maternal physiologic adaptations: pulse and bp

Answer 10

-Bradycardia, low BP
-Investigate tachycardia and prolonged HTN
-Prolonged decreased BP can suggest infection or hemorrhage

Question 11

Maternal physiologic adaptations: coagulation

Answer 11

-Cells favor coagulation to reduce blood loss
-Clotting factors increased
-RIsk for thromboembolism

Question 12

Maternal physiologic adaptations: blood cellular components

Answer 12

-Hgb and Hct slightly decrease
-WBC is elevated

Question 13

Maternal physiologic adaptations: urinary system

Answer 13

-Bladder tone and size returns
-Anesthesia can make it difficult to feel sensation to void
-Bladder distention can cause uterus to displace from midline to the right –> risk of hemorrhage
-Urinary retention is major cause of uterine atony (allows excessive bleeding)
-Diuresis

Question 14

Maternal physiologic adaptations: GI system

Answer 14

-Decreased bowel tone and peristalsis
-Stool softener needed
-Most women hungry and thirsty d/t NPO restrictions and energy expended uring labor

Question 15

Maternal physiologic adaptations: musculoskeletal system

Answer 15

-Return of joint states
-Permanent increase in shoe size
-Hip and joint pain
-Loss in muscle tone and separation of longitudinal muscles (rectus abdominis muscles)
-Separation of rectus abdominis muscles (diastasis recti)
-If rectus muscle tone is not regained thru exercise, support may not be adequate for future pregnancies

Question 16

Maternal physiologic adaptations: integumentary system

Answer 16

-Linea nigra and melasma fade
-Hair loss
-Striae gravidarum (stretch marks) fade to silvery lines
-Profuse diaphoresis

Question 17

Maternal physiologic adaptations: respiratory system

Answer 17

-16-24 breaths per min
-SOB and rib aches are resolved
-Resolves within 1-3 weeks

Question 18

Maternal physiologic adaptations: endocrine system

Answer 18

-Rapid clearance of placenta hormones
-Estrogen low until breastfeeding frequency decreases
-hCG, hPL, and progesterone decline
-Prolactin levels depend if breastfeeding or not (present if yes)

Question 19

Maternal physiologic adaptations: weight loss

Answer 19

-Lactation not sufficient enough to lose weight
-Rate of weight loss d/t lifestyle factors

Question 20

Maternal physiologic adaptations: sexual health

Answer 20

-Painful intercourse
-Effects on relationships, mood, and sexual health

Question 21

Maternal physiologic adaptations: lactation

Answer 21

-Appears 4-5 days after birth
-Estrogen stimulates growth of milk collection system while progesterone stimulates growth of milk production system
-Progesterone triggers secretion of milk
-Oxytocin causes ejection of milk
-Milk production will subside if mother is not breastfeeding
-Breast crawl: infant moves up from abdomen to breast
-Let down reflex: tingling sensation in both breasts before or after breastfeeding
-Engorgement: swelling of breast tissues as precursor to lactation, from infrequent feeding, stand in warm shower or apply warm compresses before feeding, cabbage leaf compresses, breast massage, breast pumping

Question 22

Maternal physiologic adaptations: suppressing lactation

Answer 22

-Tight, supportive bra 24 hrs daily
-Ice to breasts
-Avoid sexual stimulation
-Avoid exposing breasts to warmth

Question 23

Maternal physiologic adaptations: ovulation and menstruation

Answer 23

-Estrogen drops significantly at birth
-Progesterone quiets uterus to prevent preterm birth
-Oxytocin stimulates breastfeeding
-Prolactin present in breastfeeding women
-Nonlactating women: menstruation resumes in 7-9 weeks
-Lactating women: menstruation resumes in 3 months
-Ovulation may occur before menstruation, therefor breastfeeding is not contraception unless mother exclusively breastfeeds, has had no period since giving birth, and infant < 6 m

Question 24

Cultural considerations: balance of hot and cold

Answer 24

-Viet women view postpartum period as cold state (duong) and protect themselves from warmth
-Practices: warm water for hygiene and stimulation of lactation, consuming warm foods, staying indoors
-Chinese women view postpartum period as states that disturb yin and yang
-Practices: physical activity, maintenance of body warmth, certain food consumption
-Many cultures believe loss of blood is hot, postpartum period is cold, and mother must balance that w/ intake of hot foods
-Cold foods such as fruits and veggies should be avoided
-Present in Latin American, African, and Asian cultures

Question 25

Physiological adaptations: parental attachment behaviors

Answer 25

-Attachment: formation of relationship btwn parent and newborn
-Maternal attachment affects child development and parenting
-Oxytocin’s effects enhanced by skin-to-skin contact, breastfeeding, eye contact, social vocalizations, maternal and milk odors, newborn massage

Question 26

Physiological adaptations: mood disorders

Answer 26

-Ascending order of severity: maternal baby blues, postpartum depression, psychosis
-Baby blues: mild depressive s/s, anxiety, irritability, mood swings, loss of appetite, trouble sleeping, tearfulness, increased sensitivity, fatigue

Question 27

Physiological adaptations: phases of maternal adaptation to parenthood

Answer 27

-Reva Rubin phases
-Taking in phase: time immediately after birth when client needs sleep, passive role in meeting basic needs, recount labor experience, find genetic similarities in baby, 1-2 days, only phase observed by nurses d/t shortened postpartum stays
-Taking hold phase: 2nd or 3rd day, lasts several weeks, concerned for own health and baby’s health, increased autonomy of body, requires assurance that she is doing well as mother
-Letting go phase: reestablishes relationship w/ other ppl, adapts to parenthood, process of becoming a mother (BAM)
-BAM: 1) commitment to unborn baby, 2) attachment to infant and learning to care for them, 3) moving toward new normal, 4) achievement of maternal identity

Question 28

Physiological adaptations: partner psychological adaptations

Answer 28

-Stress importance of early contact btwn partner and newborn as well as participation in infant care activities to foster relationship
-Engrossment: partner’s developing bond w/ newborn (time of intense absorption, preoccupation, and interest)
-Engross characteristics: visual awareness of newborn, tactile awareness of newborn, perception of newborn as perfect, strong attraction to newborn, awareness of distinct features of newborn, extreme elation, increased sense of self-esteem

Question 29

Physiological adaptations: 3 stage role developmental process

Answer 29

-Expectations: preconceptions abt what home life will be like, unaware of dramatic changes, eye-opening experience
-Reality: expectations don’t align w/ reality, lack of preparedness, depression in partner
-Transition to mastery: partner makes conscious decision to take control and be at center of newborn’s life regardless of preparedness, similar to mother’s letting go phase

Question 30

Nursing assessment in postpartum period

Answer 30

-Focus on assistance of families to maximize adjustment, surveillance for maladaptation, education, consultation, collaboration
-Begins 1 hr after birth
-Need for firm grasp of normal findings to recognize abnormal findings
-BUBBLE-EE: breasts (soft w/ colostrum), uterus (1 cm below umbilicus, deviated to right), bladder (palpable, no void yet), bowels (passing gas but not BM yet), lochia (moderate), episiotomy (swollen, bruised, hemorrhoids), extremities (no edema), emotional status (distressed)
-VS q15m 1st hour
-VS q30min 2nd hour
-VS q4h 24 hours
-VS q8h after 24 hours

Question 31

Nursing assessment in postpartum period: vital signs assessment

Answer 31

-Temp: slight fever in 1st day d/t dehydration, anything after is sepsis
-Pulse: puerperal bradycardia, tachycardia after suggests mood changes, fatigue, hemorrhage, cardiac problems, infection
-Respirations: diaphragm descends, changes in rate indicate pulmonary edema, atelectasis, or pulmonary embolism
-BP: BP should be same immediately after birth, increase indicates gestational HTN while decrease indicates shocks or orthostatic hypotension or dehydration, shouldn’t be higher than 140/90 or lower than 85/60
-Pain: Goal is pain of 0-2/10 especially after breastfeeding, if severe pain in perineal region despite meds, check for hematoma

Question 32

Nursing assessment in postpartum period: breasts

Answer 32

-Nipples that are cracked, blistered, fissured, bruised, or bleeding indicates baby is improperly positioned during breastfeeding
-For women who are not breastfeeding, use gentle touch to avoid engorgement
-Any discharge from nipple should be described if is it not colostrum (creamy yellow) or foremilk (bluish white)

Question 33

Nursing assessment in postpartum period: uterus

Answer 33

-Empty bladder before assessing fundus and bowel sounds
-Use 2 handed approach w/ woman in supine position and knees flexed slightly
-Fundus should be midline and firm
-Boggy uterus is sign of atony (d/t bladder distention)
-Fundus at level of umbilicus 6-12 hrs after birth
-Fundus progresses down at rate of 1 cm per day, nonpalpable by 10-14 days

Question 34

Nursing assessment in postpartum period: bladder

Answer 34

-Diuresis as much as 3,00 mL/day
-Postpartum retention is inability to empty the bladder within 6 hrs after vaginal birth
-Monitor for UTIs
-Women who received anesthesia and catheter at higher risk for UTI
-Full bladder –> lochia drainage will be more than normal
-Insufficient voiding: < 200 mL

Question 35

Nursing assessment in postpartum period: bowels

Answer 35

-Constipation is common
-Spontaneous movements may not occur for 103 days after giving birth

Question 36

Nursing assessment in postpartum period: lochia

Answer 36

-How many saturated pads in 1-2 hrs
-Woman who saturates pad within 30-60 min is bleeding more than one who saturates a pad in 2 hrs
-Scant: 1-2 in stain or 10 mL loss
-Light or small: 4 in stain or 10-15 mL loss
-Moderate: 4-6 in stain or 25-50 mL los
-Large or heavy: pad saturated within 1 hr after changing it
-Report abnormal findings: heavy, bright red lochia w/ large tissue fragment or foul odor
-Lochia is medium for bacterial growth

Question 37

Nursing assessment in postpartum period: episiotomy/perineum and epidural site

Answer 37

-If episiotomy was done, position woman on her side w/ top leg flexed upward at knee and drawn up toward waist, gently lift upper buttock
-Site is edematous and bruised
-1st degree laceration: only skin and superficial structures
-2nd degree laceration: extends thru perineal muscles
-3rd degree laceration: extrends thru anal sphincter muscle
-4th degree laceration: continues thru anterior rectal wall
-Large areas of swollen, bluish skin w/ complaints of severe pain in perineal area indicates pelvic or vulvar hematomas
-White line running length of episiotomy is infection

Question 38

Nursing assessment in postpartum period: extremities

Answer 38

-VTE is umbrella term for PE and DVT
-State of hypercoagulability
-Factors predisposing women to these conditions: statis (compression of large veins bc of gravid uterus), altered coagulation (state of pregnancy), localized vascular damage (may occur during birthing process)
-Assess degree of sensory and motor fxn return
-Prolonged heparin therapy, prophylaxis during future pregnancies, avoidance of oral contraceptive pills
-Edema in left leg and low-grade fever
-Duplex ultrasound for dx
-DVT progresses to PE

Question 39

Nursing assessment in postpartum period: bonding and attachment

Answer 39

-Native American mothers handle baby less and use cradleboards to carry them
-Native American and Asian American mothers delay breastfeeding until milk comes in d/t belief that colostrum is harmful
-Bonding: close emotional attraction to newborn by parents that develop during 1st 30-60 min after birth; from parent to infant; optimal bonding during 1st few min after birth
-Attachment: development of strong affection btwn infant and caregiver; happens over time
-En face position: face-to-face while holding or feeding newborn
-Touch is basic instinctual interaction btwn parent and infant
-Important for mother to visit child in special care nursery but priority is to assist mother in dealing w/ grief from giving birth to child w/ special needs
-Reciprocity: infant’s abilities elicit parental response (complementary behavior: taking turns and stopping when other is not interested)
-Commitment: enduring nature of relationship (centrality and parent role explanation)

Question 40

Nursing assessment in postpartum period: proximity

Answer 40

-Proximity: physical and psychological experiences of parents being close to infant; in 3 dimensions
-Contact: sensory experiences of touching, holding, gazing at infant
-Emotional state: emerges from affective experience of new parents toward their infant
-Individualization: aware of need to differentiate infant’s needs from themselves, making attachment process detachment

Question 41

Promoting comfort: promoting tissue integrity

Answer 41

-Monitor episiotomy site fore signs of infection
-Ice pack
-Sitz bath
-Frequent perineal care
-Ambulation
-Anesthetic sprays

Question 42

Promoting comfort: providing pain relief

Answer 42

-Inspect perineum to rule out hematoma
-Witch hazel pads to swollen hemorrhoids
-Stool softener and laxative
-Nipples should be air-dried after breastfeeding and use plain water to prevent nipple cracking

Question 43

Promoting comfort: promoting effective coping

Answer 43

-Well-balanced diet
-Reassure that mood alterations are common
-Community referrals
-Skin-to-skin contact

Question 44

Cultural influences: African American

Answer 44

-Shared care of infant w/ extended family
-Experiences of older women influence infant care
-Protection from strangers
-No baths during 1st week
-Oils applied to skin and hair to prevent dryness and cradle cap
-Silver dollars taped over umbilicus in attempt to flatten umbilical stump
-Sleeping w/ parents

Question 45

Cultural influences: Amish

Answer 45

-Childbearing is the women’s primary role in society
-Opposition to birth control
-Pregnancy is a private matter
-Do not respond well when hurried to complete self-care task

Question 46

Cultural influences: Appalachian

Answer 46

-Infant colic is treated by passing newborn thru a leather horse’s collar or giving weak catnip tea
-An asafetida bag (gum resin w/ strong odor) is tied around neck to ward off disease
-Women avoid eye contact w/ staff
-Women avoid asking questions even when they don’t understand directions
-Grandmother may rear infant for the mother

Question 47

Cultural influences: Filipino American

Answer 47

-Grandparents help in care
-Breastfeeding is encouraged, can be up to 2 yrs
-Uncomfortable discussing birth control and sexuality
-Strong religious beliefs, bedside prayer is common
-Close-knit family w/ lots of visitors at hospital

Question 48

Cultural influences: Japanese Americsn

Answer 48

-Protection from cold
-Infant bathes daily
-Not routinely taken outside of home d/t belief of no cold air exposure
-Kept in quiet, clean, warm place for 1st month
-Breastfeeding encouraged
-Women stay in parents’ home 1-2 months after birth
-Bathing can be center of family activity at home

Question 49

Cultural influences: Mexican American

Answer 49

-Grandmother lives w/ mother after birth to help
-Breastfeed for more than 1 year
-Carried in rebozo (shawl) for easy breastfeeding
-Women avoid eye contact and don’t want to be touched by stranger
-Mom may bring religious icons and display them in room

Question 50

Cultural influences: Muslim

Answer 50

-Modesty
-No pork
-Prefer same-sex provider
-Touch by male is prohibited unless in emergency
-Women stay in house for 40 days after birth
-Breastfeed, but some holidays and religious events call for fasting (risk for dehydration or malnutrition)
-Exempt from obligatory 5x/day prayers as long as lochia is present
-Extended family is likely to be present throughout much of hospital stay
-Family may need empty room for prayers w/o having to leave hospital

Question 51

Cultural influences: Native American

Answer 51

-Women are secretive about pregnancies
-Touching is not typical, eye contact is brief
-Resent being hurried, need time for sitting and talking
-Breastfeed, use birth control

Question 52

Promoting comfort: cold

Answer 52

-Ice pack for perineal area during 1st 24 hours following birth
-20 min on 10 min off
-Change frequently for assessments

Question 53

Promoting comfort: heat

Answer 53

-Peribottle is plastic squeeze bottle filled w/ warm tap water that is sprayed over perineal area after each voiding and before applying new pad
-After 1st 24 hours, sitz bath w/ tepid water is used instead of ice pack
-Hydrotherapy

Question 54

Promoting comfort: topical preparations

Answer 54

-Benzocaine topical numb perineal area
-Witch hazel pads placed between hemorrhoids and perineal pad
-Local anesthetic: dibucaine
-Steroid: hydrocortisone acetate
-Nipple pain products: beeswax, glycerin-based products, petrolatum, lanolin, hydrogel products

Question 55

Promoting comfort: analgesics

Answer 55

-Acetaminophen and NSAIDs (ibuprofen, naproxen) for mild pain
-Codeine or oxycodone for severe pain in conjunction w/ aspirin or acetaminophen
-Drugs excreted in breastmilk (mild drugs are safe)

Question 56

Assisting w/ urinating

Answer 56

-Full bladder interferes w/ uterine contraction –> hemorrhage
-Pour warm water over perineal area, sound of running water, blow bubbles thru straw, taking warm shower
-If the above actions don’t stimulate voiding within 4-6 hrs following birth, catheterization may be needed

Question 57

Assisting w/ defecating

Answer 57

-Constipation d/t high Fe in vitamins, fluid loss, decreased bowel motility
-Stool softener (docusate) or laxative used
-Ambulating, increasing fluids and fiber (cereal, whole grains, dried fruits, fresh fruits, raw veggies), small amts of prune juice, hot liquids can help

Question 58

Promoting activity, rest, and exercise

Answer 58

-Early ambulation
-Nap when infant is sleeping
-Reduce participation in outside activities, limit visitors
-Increase baby’s wakeful periods during day so it can sleep longer at night
-Share household tasks to conserve energy
-Cluster activities
-Targeted exercise program
-Women who are unable to return to a healthy weight by 6 m postpartum increase their risk for chronic diseases (metabolic syndrome, obesity, CVD)
-Uncomplicated vaginal birth can resume light exercise
-Jogging strollers when infant is 6-12 m
-Exercise progression: pelvis floor –> abdominal, buttock, thigh-toning
-Recommended exercises: abdominal breathing, head lifts, modified sit-ups, double knee roll, pelvic tilt
-Exercising too much too soon can cause bleeding (if this occurs, stop exercising and lie down until bleeding slows)

Question 59

Preventing stress incontinence

Answer 59

-Pelvic floor exercises after vaginal birth
-More vaginal deliveries = more stress incontinence d/t increase in intra-abdominal pressure
-Consider walking, biking, swimming, low-impact aerobics
-Avoid smoking, alc, caffeine
-Adjust fluid intake to produce 24 hr output of 1,000-2,000 mL
-Avoid word incontinent, use leakage, loss of urine, or bladder control issues instead
-Pelvic floor exercises: 10 5 sec contractions when they’re doing activities, trying to start/stop urine when on toilet

Question 60

Assisting w/ self-care measures

Answer 60

-Apply/remove pad from front to back
-Avoid using tampons
-Shower once or twice daily using mild soap, avoid soap on nipples
-Use sitz bath after every BM
-Use peribottle after urinating and before new pad
-Avoid tub baths for 4-6 weeks until joints and balance return to prevent falls
-Wash hands when dealing w/ pads

Question 61

Ensuring safety

Answer 61

-Check BP before ambulating client
-Check for low HnH before ambulating client
-Elevate HOB for few min before ambulating client
-Have client sit on side of bed for a moment before getting up
-Help client to stand up, and stay w/ them
-Ambulate alongside client
-Ask how client’s head feels
-Place newborn on crib if women feels sleepy
-Keep door closed while infant is in room

Question 62

Counseling abt sexuality and contraception

Answer 62

-Sex can be resumed once bright red bleeding stops and perineum is healed
-No scientific backup to wait until 6 weeks postpartum
-Couple starts at own timeframe
-Fluctuations in sexual interest is normal
-Let-down reflex (milk excretion) during orgasm and breasts are sensitive when touched
-Use water-based gel lubricant d/t precoital vaginal lubrication being impaired
-Progestin-only contraceptives are best choice d/t no effect on milk production

Question 63

Promoting maternal nutrition

Answer 63

-Eat wide variety of foods
-Eat meals that require little preparation
-Make sure foods are well-cooked
-Avoid high-fat fast foods
-Drink at least 2,500 mL daily
-Avoid fad weight-reduction diets and alc, tobacco, drugs
-Avoid excessive fat, salt, sugar, caffeine
-Calories: +500/day
-Protein: +20 g/day
-Ca: +400 mg/day
-Iodine: 290 ug/day
-Fluid: +2-3 qt/day (milk, juice, water, no soda)
-Women’s diet is generally good in hospital, but declines once home

Question 64

MyPlate serving recommendations for lactating women

Answer 64

-Fruits: 4
-Veggies: 4
-Milk: 4-5
-Glass of water w/ each breastfeeding session
-Bread, cereal, pasta: 12+
-Meat, poultry, fish, eggs: 7
-Fats, oils, sweets: 5

Question 64

MyPlate recommendations for nonlactating women

Answer 64

-Fruits: half of plate
-Veggies: half of plate; red, orange, dark green veggies
-Milk: skim or 1%
-Whole grains
-Seafood twice a week and beans
-Eat less calories
-Cut back on fats, oils, sweets

Question 65

Women who shouldn’t breastfeed

Answer 65

-Mother who uses antithyroid drugs, antineoplastic drugs, alc, HIV, street drugs, or has severe mental health disorder
-Newborn w/ galactosemia or PKU, untreated TB

Question 66

Breastfeeding technique

Answer 66

1. Mom washes hands
2. Educate mom that afterpains will increase during process
3. Make sure mom is comfortable and not hungry
4. Tell mom to start feeding when baby is awake and alert
5. Encourage mom to the let-down reflex
6. Guide mom’s hand to form “C” on breast (sandwich technique)
7. Have mom tickle baby’s upper lip w/ nipple
8. Bring infant rapidly to breast w/ wide-open mouth
9. Tell mom to listen for sucking sounds
10. Have mom use finger to break suction
11. Instruct mom to burp baby before changing breasts

Question 67

Ways to help mom feel more comfortable during breastfeeding

Answer 67

-Quiet room
-Rocking chair
-Deep breaths before nursing
-Drink water while breastfeeding
-Soothing music
-Cuddle infant
-Extra cloth diapers to use as burping clothes
-Unhurried process
-Contact La Leche League or nursing mothers’ group

Question 68

Bottlefeeding education

Answer 68

-6 feedings a day until 4 months
-Feeding decline after 4 months for other foods
-Wash hands before starting
-Powdered formula mixes more easily and lumps dissolve faster w/ tepid water
-Store formula in fridge
-Don’t microwave formula
-Never prop bottle
-Tilt bottle so infant doesn’t take air
-Discard excess formula
-Don’t dilute powder w/ formula
-Prepared formula should be discarded within 1 hr after feeding

Question 69

Breast engorgement

Answer 69

-Occurs during 1st week
-Common d/t change in hormones and milk
-Resolves within 72 hrs
-Disappears as estrogen increases d/t lactation suppression

Question 70

Alleviating breast engorgement in breastfeeding woman

Answer 70

-Feedings q2-3h
-Manual expression before feeding starts
-Allow newborn to feed on 1st breast until it soften before switching to other side

Question 71

Alleviating breast engorgement in bottlefeeding woman

Answer 71

-Ice packs
-Wear snug, supportive bra 24 hrs/day
-Tylenol
-Avoid stimulation of breasts such as warm shower or pumping/massaging breasts
-Drink to quench thirst
-Reduce Na intake

Question 72

Discharge education

Answer 72

-Sleep-wake cycle (reversed)
-Variations in newborn appearance and developmental milestones (growth spurts)
-How to interpret crying cues (hunger, wet, discomfort)
-Sensory enrichment (mobile)
-Follow-up care, important phone numbers
-Integrate siblings (rivalry)
-Ways to make time together as a couple

Question 73

Postpartum blues

Answer 73

-Sharp fall in hormones
-Phase of emotional lability characterized by crying, irritability, anxiety, confusion, sleep disorders
-Seek further eval if no resolution within 2 weeks
-Mgmt: encourage her to vent feelings, suggest getting outside help w/ baby and housework, provide phone numbers, make woman aware of disorder
-Risk for postpartum depression and psychosis

Question 73

Sibling rivalry

Answer 73

-Expect regression (bedwetting, thumb sucking)
-Encourage discussion and participation
-Buy T-shirt that says “I’m the big brother/sister”
-Spend special time w/ child
-Purchase gift for child to give to newborn
-Move sibling from crib to youth bed
-Show sibling photos of baby growing

Question 74

Shortened hospital stay if following criteria are met

Answer 74

-Mother is afebrile and VS normal
-Lochia is appropriate
-H&H is normal
-Uterine fundus is firm
-ABO and RhD are known
-Wounds healing, no infection
-Ambulating w/o difficulty
-Eating/swallowing w/o difficulty
-Family support
-Mother is aware of possible complications

Question 75

Preparing for discharge: providing maternal immunizations

Answer 75

-Check rubella immunity status
-Don’t give rubella vax if immunocompromised, and immune status of close contacts needs to be determined 1st
-Tdap for mother during postpartum stay recommended by CDC
-Flu vax can be given
-Adverse effects: rash, joint symptoms, low-grade fever
-Avoid pregnancy for at least 28 days following immunization

Question 76

Preparing for discharge: Rh status

Answer 76

-Mom is Rh neg + baby is Rh pos = RhoGAM at 28 weeks GA and within 72 hrs following birth
-RhoGAM is a blood product

Question 77

Preparing for discharge: providing outpt follow-up

Answer 77

-Uncomplicated vaginal birth –> office visit 4-6 weeks after discharge
-C-section –> 2 weeks after discharge
-Postpartum stay should be long enough to allow identification of early problems and ensure family is able to prepare to care for infant at home