Postpartum adaptations and nursing mgmt Flashcards

Question

Physiological adaptations: parental attachment behaviors

Answer 1

-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

Answer 2

-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

Answer 3

-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

Answer 4

-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

Answer 5

-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

Answer 6

-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

Answer 7

-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

Answer 8

-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)

Answer 9

-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

Answer 10

-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

Answer 11

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

Answer 12

-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

Answer 13

-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

Answer 14

-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

Answer 15

-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)

Answer 16

-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

Answer 17

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

Answer 18

-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

Answer 19

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

Answer 20

-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

Answer 21

-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

Answer 22

-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

Answer 23

-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

Answer 24

-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

Answer 25

-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

Answer 26

-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

Answer 27

-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

Answer 28

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

Answer 29

-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

Answer 30

-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

Answer 31

-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)

Answer 32

-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

Answer 33

-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

Answer 34

-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)

Answer 35

-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

Answer 36

-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

Answer 37

-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

Answer 38

-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

Answer 39

-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

Answer 40

-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

Answer 41

-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

Answer 42

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

Answer 43

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 8. Encourage mom to the let-down reflex 9. Guide mom's hand to form "C" on breast (sandwich technique) 10. Have mom tickle baby's upper lip w/ nipple 11. Bring infant rapidly to breast w/ wide-open mouth 12. Tell mom to listen for sucking sounds 13. Have mom use finger to break suction 14. Instruct mom to burp baby before changing breasts

Answer 44

-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

Answer 45

-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

Answer 46

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

Answer 47

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

Answer 48

-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

Answer 49

-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

Answer 50

-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

Answer 51

-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

Answer 52

-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

Answer 53

-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

Answer 54

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

Answer 55

-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