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OB/Community Health > Postpartum Care > Flashcards

Postpartum Care Flashcards

1
Q

What is postpartum ?

A

interval between birth and the return of the reproductive organs to their normal nonpregnant state
- aka the 4th trimester

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2
Q

What marks the beginning of the postpartum period ?

A

delivery of the placenta
- postpartum period takes about 6-8 weeks

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3
Q

In the immediate postpartum period, what is the nurse doing ?

A
  • assessing mother and providing comfort measures
  • assessing newborn
  • promoting family-infant bonding
  • providing education
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4
Q

What does BUBBLE HEN stand for ?

A
  • breasts
  • uterus
  • bowel
  • bladder
  • lochia
  • episiotomy (lacerations or incision)
  • Homans’s sign (DVT)
  • emotions
  • nutrition
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5
Q

What types of hormonal changes happen after delivery ?

A
  • Prolactin in increased and this stimulates milk production
  • estrogen and progesterone is decreased
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6
Q

What is colostrum ?

A

first milk produced
- packed with IgA (passive immunity)
- high in protein, calories, and vitamins
- aka “liquid gold”

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7
Q

How do we ensure the mother keeps producing breastmilk ?

A
  • put baby to breast q2-3hrs because large gap of time without stimulation causes body to stop producing milk
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8
Q

How can be stop milk production in the mother ?

A
  • wear a tight-fitting bra
  • when showering turn back to warm water to not stimulate production
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9
Q

When do the breasts obtain mature milk ?

A

72-96 hrs (3-4 days)

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10
Q

What assessments do we do for the breasts ?

A
  • palpate tissue for fullness and tenderness
  • ask if they feel breast being full
  • inspect for signs of red, cracked, or blistered nipples
  • if baby has poor latch it can hurt the nipple
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11
Q

What are some breast care we can implement ?

A
  • clean with warm water and dry thoroughly (no soap because it can stay on nipple and baby can consume it)
  • if leaking, use absorbent breast pads
  • apply breast milk to nipple and areola after feeding and let air dry (will prevent blistering/cracks)
  • lanolin or gel pads (can prevent blisters/cracks)
  • cabbage leaves inside bra to help decrease pain & engorgement
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12
Q

What is engorgement ?

A

vascular congestions related to increased blood and lymph supply
- occurs day 3-5 postpartum
- breasts are swollen, hard and painful
- difficult for infant to latch and feed

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13
Q

What is primary engorgement ?

A

happens the first few days because of an increased blood supply to prepare for breastfeeding
- mom only really makes colostrum those first few days

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14
Q

What is secondary engorgement ?

A

caused by an increase of milk supply and baby isn’t drinking enough to empty them

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15
Q

What are some interventions for engorgement ?

A
  • frequent breastfeeding (every 1-2 hrs or long enough to empty breasts)
  • warm shower or compress to stimulate letdown
  • alternate breasts with each feeding
  • milk analgesic before feeding (ibuprofen)
  • ice packs between feeding
  • lactation specialist
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16
Q

What is mastitis ?

A

breast infection that occurs after milk is established
- S&S: red spot or hard lump, warm to touch and tender, may have discharge, fever from mild to severe, itchiness, enlarged/changed nipple sensation
- Tx with antibiotics and mild pain relievers
- continue to breastfeed (milk isn’t infected so its ok for baby to breastfeed)

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17
Q

What is involution ?

A

return of the uterus to a nonpregnancy state following birth
- processes rapidly
- Fundus (top) descends 1 to 2 cm every 24 hrs
- no longer palpable 2 weeks postpartum
- returns to a non-pregnant state by 6 weeks postpartum

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18
Q

What are some assessments we do on the uterus ?

A
  • bimanual palpation of the fundus
  • assess fundal height, firmness, and position
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19
Q

What are contractions and afterpains ?

A

cramping due to uterine contractions
- lasts 2-3 days
- breastfeeding can intensify afterpains and slow uterine bleeding

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20
Q

What are some interventions for contractions and afterpains ?

A
  • heat
  • ambulation
  • mild analgesic (Naproxen, Ibuprofen)
  • the more babies mom has delivered the more intense the afterpains are
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21
Q

Why is Oxytocin given after the delivery of the placenta ?

A

given as a bolus because we want the uterus to contract firmly so the blood vessels that were connected to the placenta will constrict to prevent hemorrhage

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22
Q

What is uterine subinvolution ?

A

failure of uterus to return to non-pregnant state

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23
Q

What are common causes of uterine subinvolution ?

A
  • retained placental fragments
  • pelvic infections
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24
Q

What are some assessment findings of uterine subinvolution ?

A
  • may be febrile
  • tender uterus
  • boggy uterus (soft/spongy)
  • prolonged or late postpartum bleeding
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25
Q

What is the tx for uterine subinvolution ?

A
  • antibiotics
  • uterine curettage (Dilation &Curettage which is where the cervix is dilated and we scrap uterine tissue)
  • uterotonic medications to induce contractions
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26
Q

What is a adherent retained placenta ?

A

the placenta is still attached
- more common in premature births because the placenta is not ready to detach on its own

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27
Q

How do you detect placental fragments ?

A

with ultrasound

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28
Q

What is uterine atony ?

A

failure of the uterus to contract after delivery
- happens because the uterus gets tired or it gets distended

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29
Q

What are the causes of uterine atony ?

A
  • polyhydramnios (too much amniotic fluid)
  • macrosomia (big baby)
  • multiple gestation or high parity (triplets/quadruplets)
  • birth trauma
  • magnesium sulfate
  • rapid or prolonged labor
  • chorioamnionitis (infection)
  • use of Pitocin for induction or augmentation
  • full bladder
  • retained placenta
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30
Q

What is the priority nursing intervention for uterine atony ?

A

fundal massage

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31
Q

What is the leading cause of postpartum hemorrhage in the 1st hour ?

A

uterine atony

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32
Q

How do you perform a fundal massage ?

A

non-dominant hand is above the symphysis pubis to prevent any downward displacement, uterine prolapse or inversion
- the other hand is cupped to massage and gently compress the fundus toward the lower uterine segment

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33
Q

What are some medications we may use for postpartum hemorrhage ?

A
  • Oxytocin (Pitocin) rapid IV infusion
  • Methergine (methylergometrine) IM (want to avoid in pt’s with high BP
  • Hemabate (carboprost tromethamine) IM (want to avoid in pt’s with asthma because it constricts the bronchioles)
  • Cytotec (misoprostol) rectally
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34
Q

What are some devices we may used for postpartum hemorrhage ?

A
  • Ballon Device (Bakri): goes inside the uterus and fills up the balloon to put pressure on the site where the placenta was to stop the bleeding
  • Vacuum-induced (Jada): goes into uterus and instead of pressure it acts as a vacuum that stops the bleeding (is connected to suctioning)
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35
Q

What is hemorrhagic shock ?

A

hypovolemic shock secondary to hemorrhage
- OB emergency

36
Q

What should you do if your pt goes into hemorrhagic shock ?

A
  • stay calm
  • continue fundal massage to keep uterus firm
  • administer uterotonic medications as ordered by MD
  • monitor VS, determine underlying cause, restore volume with IVF (LR, NS) and blood products
  • protect and maintain airway
  • inform family with simple explanations
37
Q

What is postpartum infection ?

A

puerperal infection: any infection of genital tract within 28 days of delivery
- causes: streptococcal, staph aureus, E. Coli

38
Q

What are some risks of postpartum infection ?

A
  • immunosuppression
  • anemia
  • hemorrhage
  • diabetes
  • prolonged rupture of membranes (ROM)
  • long labor
  • intrauterine monitoring
  • operative birth
  • retained placenta
39
Q

What are some prevention measures for postpartum infection ?

A
  • handwashing
  • nutrition
  • perineal hygiene
  • aseptic technique with childbirth
  • antibiotics
40
Q

What is endometritis ?

A

infection where the placenta was attached
- most common postpartum infection seen with C-sections, prolonged labor, or prolonged ROM

41
Q

What are some S&S of endometritis ?

A
  • chills
  • fever
  • tachycardia
  • nausea
  • fatigue
  • anorexia
  • tender uterus (may have guarding)
  • foul smelling lochia (discharge)
  • increased bleeding
  • increased sed rate & anemia
  • increased WBC
42
Q

What is the tx for endometritis ?

A
  • broad spectrum IV antibiotics
  • hydration
  • rest
  • pain management
43
Q

What happens to the bowels of someone in postpartum ?

A
  • can take 2-3 days for a BM after delivery
  • constipation is normal (encourage early ambulation, fiber intake, hydration, stool softeners)
  • pain anticipated by pt if they had a repair
44
Q

What are some assessments that can be done related to the bowels ?

A
  • auscultate bowel sounds
  • ask pt about last BM and flatus
  • hemorrhoids are common during pregnancy, can be worse after delivery
45
Q

What are some interventions for the bowels ?

A
  • stool softeners
  • TUCKS pads (witch-hazel round pads that can help with hemorrhoid pain)
46
Q

What happens to the bladder postpartum ?

A
  • birth induced trauma can occur to bladder (can be painful to void post repair)
  • postpartum diuresis (losing excess fluid)
  • excessive bleeding can occur because of displacement of the uterus if bladder is full (inability to void post anesthesia and increased risk of UTI)
47
Q

What do you assess about the bladder ?

A

assess ability to void
- amount, color, and odor

48
Q

What is lochia ?

A

uterine blood or discharge after delivery

49
Q

What do you assess about the lochia ?

A

assess color, amount, and consistency
- may contain clots initially
- resembles heavy period first 2 hrs postpartum

50
Q

What is rubra lochia?

A

consists of blood and trophoblastic debris
- bright red, fleshy odor, lasts 3-4 days postpartum

51
Q

What is serosa lochia ?

A

old blood, serum, leukocytes and tissue debris
- pinkish brown color, starts at 3-4 days and lasts 22-27 days after delivery (can go away at 10 days)

52
Q

What is alba lochia ?

A

consists of WBCs, decidua, epithelial cells, mucus, serum and bacteria
- yellowish white color, lasts from 4-8 weeks postpartum

53
Q

What is an episiotomy/lacerations/incision ?

A

surgical incision made into perineum during delivery
- heals within 2-3 weeks

54
Q

What kinds of lacerations are there ?

A

traumatic or spontaneous
- 1st to 4th degree
- locations: labia, perineal, vaginal, cervical, periurethral
- repaired vs. heal naturally

55
Q

What do you assess for in episiotomy/lacerations/incisions ?

A
  • visually inspect perineum for intact sutures (if repaired), swelling and redness
  • side-lying position
  • excessive postpartum bleeding may be due to unrepaired lacerations(s) or hematoma
56
Q

What do you assess if your pt delivered via C-section ?

A

inspect incision for:
- intactness
- redness
- bleeding
- tenderness

57
Q

What is a 1st degree perineal tear ?

A

skin is torn

58
Q

What is a 2nd degree perineal tear ?

A

perineal muscles are torn all the way to the anal sphincter

59
Q

What is a 3rd degree perineal tear ?

A

the tear includes the anal sphincter

60
Q

What is a 4th degree perineal tear ?

A

the tear includes the rectum

61
Q

What are some perineal tear interventions ?

A
  • pt should lie on side as much as possible
  • analgesics and/or topical anesthetics (dermaplast or epifoam)
  • ice packs for first 12-24 hrs to decrease swelling
  • sitz baths 3-4 times/day
  • change pads regularly & with each stool/void
  • teach perineal cleaning: hand hygiene, mild soap & warm water, clean front to back, use squeeze bottle, avoid wiping
62
Q

What are some postpartum C-section care ?

A
  • frequent assessments during recovery- VS, fundal checks, incision
  • safety considerations/risk for falls due to anesthesia/analgesics
  • incisional care and assessment
  • fundal height and massage more of a challenge
  • foley catheter/bladder
  • pain management
  • promote bonding
63
Q

What is Homan’s sign ?

A

dorsiflexion of the pt’s foot
- if pain is felt behind the knee, then it’s considered a (+) Homan’s sign
- to detect DVT
- no longer routine
- inspect calf for edema, inflammation, heat, redness and tenderness

64
Q

What is venous thromboembolism (VTE) ?

A

formation of blood clot inside blood vessel due to inflammation (thrombophlebitis)
- body wants to naturally form clots of prevent hemorrhage but that’s a problem postpartum
- superficial
- deep venous thrombosis
- pulmonary embolism

65
Q

How do we prevent venous thromboembolism (VTE) ?

A

early ambulation
- due to venous statis & hypercoagulability

66
Q

What are some risk factors for venous thromboembolism ?

A
  • C section pt’s
  • varicose veins
  • age
  • obesity
  • smokers
  • genetics
  • immobility
67
Q

What are some risk factors for DVT ?

A
  • preeclampsia
  • hypertensive disorders
  • C-section
  • any condition that causes pt to be on bedrest/decreased mobility
68
Q

How is DVT diagnosed ?

A

ultrasound or venous study
- doppler flow studies

69
Q

What are some interventions for DVT ?

A
  • heparin or lovenox
  • bed rest, elevate leg
  • analgesics
  • watch for PE
  • SCDs and/or compression stockings
  • avoid prolonged standing
70
Q

How do we assess the pt’s emotional state ?

A
  • edinburg postnatal depression scale (EPDS)
  • assess bonding/engagement in care of newborn
71
Q

What are the baby blue’s ?

A

is normal in the first 2 weeks postpartum
- emotional
- crying for no reason
- may also experience fatigue
- insomnia
- anxiety
- irritability
- fluctuating mood
- increased emotional reactivity

72
Q

What is postpartum blues ?

A

50-85% mother in first 2 weeks postpartum

73
Q

What is the postpartum depression ?

A

10-20% mothers in first year postpartum
- moderate to severe symptoms, prolonged course

74
Q

What are some S&S of postpartum depression ?

A
  • excessive guilt
  • anxiety
  • anhedonia (inability to experience joy)
  • depressed mood
  • insomnia/hypersomnia
  • suicidal ideation
  • fatigue
75
Q

What is postpartum psychosis ?

A

0.01% mothers in first 3 months postpartum
- severe, considered psychiatric emergency
- often necessitates hospitalization
- pt can be a danger to themselves and their children

76
Q

What are some S&S of postpartum psychosis ?

A
  • mixed or rapid cycling
  • agitation
  • delusions
  • hallucinations
  • disorganized behavior
  • cognitive impairment
  • low insight
77
Q

What are some nutrition considerations ?

A
  • iron and iron-rich food is needed for blood loss
  • protein for healing
  • 300 to 500 extra calories if breastfeeding
  • 1800 to 2000 calories per day for non-breastfeeding mothers
  • 300 extra calories a day when pregnant
78
Q

How is the cardiovascular system during pregnancy ?

A
  • blood volume increase 40-45% during pregnancy
  • blood loss during delivery and hormones affect CV system
  • increased HR and decreased BP when hemorrhaging
79
Q

What is usually the first sign of hemorrhaging ?

A

increased HR

80
Q

What happens to the cervix during postpartum ?

A
  • soft immediately after birth
  • during the next 12-18 hrs the cervix shortens, becomes firm, and regains pre-pregnant form
  • external os does not regain its pre-pregnancy appearance
  • cervical os dilated to 10 cm during labor
81
Q

What happens to ovulation and menstruation postpartum ?

A
  • ovulation occurs as early as 27 days
  • menstruation within 3 months after birth for non-breastfeeding moms
  • breastfeeding mom have elevated serum prolactin levels which suppress ovulation
  • can still ovulate and menstruate but this does not prevent pregnancy
82
Q

For the musculoskeletal what is pelvic muscular support ?

A

supportive tissues of pelvic floor torn or stretched during childbirth

83
Q

What happens to the abdomen post-partum ?

A

during first 2 weeks abdominal wall remains relaxed
- woman has a still-pregnant appearance
- return to prepregnancy state takes 6 weeks

84
Q

What is diastasis recti abdominis ?

A

abdominal wall separates

85
Q

What special consideration is there about the Rubella (MMR) vaccine ?

A

do not get pregnant 1 month after getting this vaccine
- can cause congenital birth defects

86
Q

What special considerations are there about the RhoGAM vaccine ?

A

give again within 72 hours after birth to prevent Rh isoimmunization
- Rh sensitization due to mixture of fetal and maternal blood
- RhoGAM kills fetal RH positive blood cells before mom develops antibodies

87
Q

What are the 4 T’s of postpartum hemorrhage ?

A
  • tone (uterine atony)
  • trauma (laceration, uterine inversion)
  • tissue (retained placenta)
  • thrombin (DVT)

OB/Community Health (11 decks)

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