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Nursing 401 > Postpartum Care > Flashcards

Postpartum Care Flashcards

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1
Q

How early can a mother and baby be discharged after a vaginal delivery?

A

24 hours (or earlier) to 48 hours

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2
Q

What is the focus of nursing care in the postpartum period?

A

Strong patient education focus - assessing learning needs of new patient and providing information on self and infant care

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3
Q

What are the three parts of the first stage of labour?

A

Latent phase
Active phase
Transition phase

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4
Q

What occurs during the latent phase, and how many centimetres dilated?

A

Starts when contractions become regular and painful and cervical effacement and dilation commence - to 3 cm

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5
Q

What occurs during the active phase of labour, and how many centres dilated?

A

Labour is well established with contractions becoming more painful and more frequent and longer - 4 to 8 cm

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6
Q

What occurs during the transition phase of labour, and how many centimetres dilated?

A

From 8 to 10 cm, the contractions may take on a more expulsive nature, bearing down feeling.

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7
Q

What occurs during the second stage of labour? (what characterizes this stage)

A

Commences with full dilation of the cervix and ends with the birth of the baby.

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8
Q

What happens physically during the second stage of labour?

A

During this stage the fetal head descends under the pubic arch and gradually thins and stretches the vaginal opening.

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9
Q

How frequent are contractions during the second stage of labour?

A

every 2-3 minutes (usually)

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10
Q

How long does the second stage of labour typically last? (for multips? primips?)

A

Primips - can last up to 3 hours (usually 60 min)

Multip - can be less than 20 mins

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11
Q

What occurs during the third stage of labour? (what characterizes this stage)

A

Commences with the birth of the baby and lasts until the placenta and membranes are delivered.

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12
Q

What facilitates the separation of the placenta from the uterus?

A

The separation of the placenta is facilitated by uterine contractions.
Once the infant is born, the uterus contracts and retracts which causes the placenta to pull away from the wall of the uterus.

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13
Q

How long does the third stage of labour last?

A

Usually occurs within 20-30 minutes

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14
Q

What is the fourth stage of labour? What characterizes it?

A

It is defined as one to four hours after birth, although two hours is the commonly accepted time.

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15
Q

What occurs during the fourth stage of labour?

A

It is the time for physiologic adjustment and stabilization for the mother… it also includes the newborn’s adjustment to extrauterine life.

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16
Q

What are the characteristics of postpartum?

A

Lasts up to 6 weeks after birth.

Physical and psychological adjustments to a pre-pregnant state.

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17
Q

What occurs physiologically to the uterus immediately postpartum?

A

Uterus the size of a grapefruit, 5 cm below the umbilicus.

The walls clamp and the vessels compress.

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18
Q

What occurs physiologically to the uterus 6 to 12 hours postpartum?

A

The uterus is at the umbilicus

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19
Q

How fast is the usual descent of the uterus after birth?

A

The usual descent of the uterus is 1 cm/day

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20
Q

What are some variations/problems that can occur in the uterus after birth? (I.e. ways the uterus might feel “wrong”)

A

If the uterus is boggy and high

If the uterus is firm and deviated to the side

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21
Q

What does a boggy and high uterus cause?

A

Causes increased bleeding and clot formation.

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22
Q

What does it mean if the uterus is firm and deviated tot the side?

A

May be a full bladder

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23
Q

What is the weight decrease in the uterus?

A

The uterus decreases in weight from 1000gms to 50gms

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24
Q

What causes the size of the uterus to decrease?

A

The size decreases due to the decrease in cell size.

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25
Q

How long does the myometrium take to heal?

A

The myometrium takes about 3 weeks to heal

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26
Q

How long does the placenta site take to heal?

A

6-7 weeks

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27
Q

What are some factors affecting involution?

A 
Prolong labour
GA
Excessive analgesia
Difficult birth
Grand multip
Over distention of the uterus
Full bladder
Retention of products of conception
Infection
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28
Q

What action should be taken by the postpartum nurse if the patient experiences a gush of blood?

A

Assess fundus and flow/pad
Vital signs
Episiotomy/tear (rule out source of blood)
More frequent assessments

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29
Q

What teaching should you give the postpartum mother regarding postpartum bleeding?

A

Massage of uterus
Empty bladder q2h
Benefits of breast feeding

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30
Q

What are the three types of lochia?

A

Rubra
Serosa
Alba

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31
Q

What is rubra? When does it occur?

A

Bright red lochia - 2-3 days postpartum

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32
Q

What is serosa? When does it occur?

A

Pinkish lochia - 3-10 days postpartum

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33
Q

What is alba? When does it occur?

A

Creamy/yellowish lochia - 10-24 days postpartum

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34
Q

What are abnormal findings related to lochia?

A

Foul smelling, excessive, return to rubra from serosa/alba

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35
Q

What are some normal deviations that can occur in lochia?

A

Increase flow with breasteeding, multiparity, exertion, and in AM

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36
Q

What are some nursing interventions if concerned about excessive lochia?

A 
Determine source
Assess fundus, flow, episiotomy/tear site, bladder, output, BP & P
Place a new pad on and observe in 1 hour
Continue to assess VS
Weigh pads if necessary
Give oxytocin IM/IV if boggy uterus (as ordered)
Start IV, call Dr.
Catheterize PRN
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37
Q

What changes occur to the cervix and vagina that require postpartum teaching?

A

Bruised and edematous, possible lacerations

38
Q

What should be taught to the patient regarding decreased vaginal tone?

A

Teach Kegal exercises

39
Q

What teaching should be done about dysparunia (painful intercourse)?

A

Teach the use of H2O soluble gel

40
Q

What should be assessed in the perineum?

A

Intact, tear, or episiotomy?
Assess for REEDA (redness, edema, ecchymosis, discharge and approximation)
pain
Assess knowledge of how to care for site

41
Q

What does REEDA stand for? (Perineal assessment)

A 
Redness
Edema
Ecchymosis
Discharge
Approximation (of suture lines)
42
Q

What teaching should be done post-partum on how to care for the perineum?

A 
Application of ice pad and/or tea bag pads
Peri bottle usage
Inspection and wiping clean to dirty
Kegal exercises
Sitz bath
43
Q

When does a non-breastfeeding mother return to menstruation?

A

7-12 weeks

44
Q

When does a breastfeeding mother return to menstruation?

A

Can be as early as 12 weeks and as delayed as 3 years (or as long as she breast feeds for)

45
Q

When does a non-breasfeeding mother return to ovulation?

A

70-75 days

46
Q

When does a breastfeeding mother return to ovulation?

A

6 months

47
Q

What teaching should be done regarding sexual activity post-partum?

A 
After lochia serosa
Decreased pain
Alternative positions
Use of lubricant
Contraception
48
Q

What are some reasons for a delay in bowel movements after labour?

A 
Decreased food in labour
BM in labour and delivery
Fear related to tear/episiotomy
Progesterone
Presence of hemorrhoids
49
Q

What are some nursing interventions for delayed BM after labour?

A

Stool softener
Diet high in roughage and fluids
Hemorrhoid care

50
Q

What causes changes in the urinary system after birth?

A

Increased bladder capacity
Swelling
Bruising and pain
Decreased sensation

51
Q

What are some nursing interventions for changes in the urinary system postpartum?

A

Assess amount, frequency, and characteristics

Teaching

52
Q

What teaching should be done regarding genitourinary changes postpartum?

A

Need to empty bladder Q2h

Signs and symptoms of bladder infection

53
Q

What are the common changes in temperature for the mother during the postpartum period, and why?

A

First 24 hours - up to 38 degrees Celsius because of overexertion and dehydration.
Elevated temp day 3-4 due to lactogenesis

54
Q

What could cause the mother to have an elevated temp more than 24 hours postpartum (besides lactogenesis)?

A

Infection

55
Q

What changes in blood pressure typically occur in the mother during the postpartum period?

A

Transient increase in BP - normal in a few days.

56
Q

In what cases would a woman not experience a transient increase in BP during the postpartum period?

A

Pregnancy Induced Hypertension

Postpartum Hemorrhage

57
Q

What changes in pulse does the mother typically experience postpartum, and when?

A

Bradycardia for 6 to 10 days is normal

58
Q

What circumstances could possibly cause tachycardia in the mother during the postpartum period?

A

Blood loss
Infection
Fear
Pain

59
Q

What changes can occur to the mother’s blood in the postpartum period?

A

Leukocytosis
Hemoglobin and Hematocrit decrease
Platelets decrease
Fibrinolytic levels (risk for thromboembolism)

60
Q

What is the benefit of leukocytosis in the mother during the postpartum period?

A

Increased defense against infection

Increased healing process

61
Q

When do leukocyte levels return to normal after delivery?

A

return to normal by end of first week

62
Q

At what Hgb level is the mother considered anemic?

A

Hgb below 120 considered anemic

63
Q

Why is it best to assess the hemoglobin level after day 2?

A

Due to hemodilution

64
Q

Why does the level of platelets decrease in the mother during the postpartum period?

A

Falls due to placenta separation

65
Q

When does the platelet level return to normal in the mother during the postpartum period?

A

Increases by 3rd to 4th day

66
Q

Why is there an increased risk for thromboembolism in the first 6 weeks after birth?

A

Increased diameter of deep veins

67
Q

What factors are associated with risk of thromboembolic disease during the postpartum period?

A 
Pelvic or abdominal surgery
History/family history of this disease
Obesity (BMI>30)
Age > 35
Operative delivery - forceps
Varicose veins
Prolonged immobility
Multiparity
Active infection or inflammation
68
Q

What are some pains a woman can experience in the postpartum period?

A

Perineal pain

Afterpains (in the uterus)

69
Q

What are the causes of perineal pain in the postpartum period?

A

Birth/tear/episiotomy

70
Q

What causes uterine afterpains during the postpartum period? (pains in the uterus)

A

Due to decreased tone of uterus and alternating contractions and relaxing of the uterus.

  • increased in oxytocin administration
  • increased with breast feeding
  • increased in pultips or with distended uterus (large baby, twins, hydraminous)
71
Q

How long do severe afterpains normally last during the postpartum period?

A

Severe up to 2-3 days

72
Q

What kind of analgesia/anesthesia is most commonly used during a caesarean birth? (2 types)

A

Most women will have had either spinal or epidural anesthesia during their C section

73
Q

What are the effects of a spinal or epidural used for C-section (general effects)

A

Restriction on sensation and motor function

74
Q

What are some common feelings experienced by women who have had a C-section?

A

May feel angry, disappointed, or feel that they have failed.

75
Q

How should the nurse interact with a patient who has had a C-section and is experiencing anger, disappointment or feelings of failure?

A

Allow time for the woman to ask questions, express their feelings and seek clarity.
Reinforce that vaginal birth is possible after a C-section

76
Q

What teaching should be done for a woman who has had a C-section?

A

Teach about wound infection - redness, swelling, discharge, increasing pain

77
Q

What are the three phases of Rubin’s 1961 Theory (psychosocial dimension)?

A

Taking in phase
Taking hold phase
Letting go phase

78
Q

What occurs during the Taking in phase according to Rubin’s 1961 theory (psychosocial dimension)? When does this occur after birth?

A

First 1 to 2 days.
Mother is somewhat dependent and preoccupied with her own needs, needs to talk about labour and delivery, food and sleep a major focus.

79
Q

What occurs during the Taking hold phase according to Rubin’s 1961 theory (psychosocial dimension)? When does this occur after birth?

A

Around 2nd or 3rd day, mother becomes concerned with the care of her baby and is ready to learn, becomes more independent.

80
Q

What occurs during the Letting go phase according to Rubin’s 1961 theory (psychosocial dimension)?

A

Mother defines her new role and gives up her old role, requires some grief work and readjustment of relationships.

81
Q

What are postpartum blues, and when do they occur?

A

Transient blues, not problematic

Appears within the first few days postpartum and resolves within 10-14 days

82
Q

How many women experience postpartum blues?

A

Experienced by 50 to 80% of postpartum women

83
Q

What are the signs/symptoms of postpartum blues?

A 
Mood swings
Anger
Teary
Anorexia
Difficulty sleeping
Let-down feeling
84
Q

What are the causes of postpartum blues?

A 
Changing hormonal and psychological adjustment
Insecurity
Unsupportive environment
Fatigue
Discomfort
Overstimulation
85
Q

What are some nursing interventions for postpartum blues?

A

Assess

Teach when to ask for assistance

86
Q

What is postpartum depression? How is it different than postpartum blues?

A

More serious than the blues - with intense and pervasive sadness and severe mood swings.

87
Q

How common is postpartum depression, and when does it occur?

A

10-15% of women experience postpartum depression, during the first year after the birth

88
Q

Why should family be included in teaching about signs and symptoms of postpartum depression?

A

Many women go to great lengths to conceal their postpartum depression from family and friends - if family is included in teaching, they know what signs and symptoms to watch for

89
Q

What is postpartum psychosis, and how common is it?

A

Includes auditory or visual hallucinations, paranoia, delirium, and impulsive thoughts and actions.
It is rare with 0.1-0.2% of women affected.

90
Q

Why is it important to include the father in the birth and postpartum process?

A

While our care is focus on assessing and promoting maternal well-being, the family centered care model also encourages us to focus on the family unit.
Some men feel excluded at times and struggle to find their place.
Compare themselves to a sportsman sitting on the substitute bench.

91
Q

What are some important teaching topics for newborn care?

A

Importance of skin to skin
Newborn feeding - breastfeeding and bottle feeding
Behaviours - sleep wake state
Infant crying - including shaken baby syndrome
Safe sleep environment

92
Q

What are some important teaching topics for maternal care?

A

Normal physiological changes
Newborn feeding - breast, nipple care, engorgement, expression
Rest and activity
Post partum blues and depression
Smoke free environment
Self care
Increased pain, increased bleeding, fever
Aware of public health nurse contact/role

Nursing 401 (21 decks)

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