Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nursing - obstetric component > Postpartum Care > Flashcards

Postpartum Care Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Mental Health flashcards Nursing Management of Care flashcards NCLEX-PN® flashcards NCLEX-RN® flashcards Nursing Fundamentals flashcards Nursing Pediatrics flashcards Nursing Safety & Infection flashcards Nursing Pharmacology flashcards Nursing Maternity flashcards Family Nurse Practitioner (FNP) flashcards
1
Q

Postpartum

A

Postpartum: delivery through 6 weeks
“4th trimester”
AKA “puerperium”, from the Greek “puerperos”, meaning “to bear young”
Puerperal = postpartal
Key task: involution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Involution

A

Uterus returns to its normal position, shape, size

Position: pelvic organ

Shape: upside-down pear

Size: fruit-basket pear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Uterus Decreases in Size

A
  1. Uterine contractions
  2. Autolysis
    - Catabolic process
    - Muscle fibers get smaller
    - Protein from myometrial cells reabsorbed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Endometrial Changes

A
  1. Uterine contractions decrease placental site to ½ predelivery size
  2. Blood loss controlled
    - Compression of blood vessels that supply decidual sinuses
    - Compression of sinuses themselves
    - Clot formation in vessels that supply **decidua - endometrium **
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

WBCs

A

Infiltrate placental site, blood vessels, and surrounding tissues
Necrosis begins
3 weeks total for decidual necrosis/regeneration
+
3 weeks for placental site necrosis/regeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lochia (Postdelivery Flow)

A

After delivery, almost entirely blood
As sinuses compressed, clots form, less blood
Forms
1. Rubra (red)
2. Serosa (pink)
3. Alba (yellowish-white)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lochia Rubra: 2-3 Days

A

Blood + mucus + decidual particles + cellular debris from placental site
Endometrial cavity sterile initially, then bacterial growth + WBCs contribute to lochia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Lochia Serosa: At 3-4 Days

A

L_ess oozing blood, more watery (serous)
Pinkish-tan color_
Involution of placental site continues: blood decreases, WBC + cellular debris
predominate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lochia Alba: By Day 10

A

Yellowish-white to white in color
Gone by end of 3rd PP week or brownish mucoid discharge few days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Peripad Assessment (1 Hour)

A

Scant; Light; Moderate; Heavy saturated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PPH (Postpartum Hemorrhage)

A

Early PPH
Within first 24 hours

Uterine atony #1 ( uterus without tone, not contracting) , also genital tract lacerations and retained placenta
Late PPH
After first 24 hours

Retained placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Fundal Height

A

Fundus ( top portion of the uterus ) - at or below the level of umbilicus

Empty bladder - two-handed approach - palpate the abdoemn gently feeling for the top of the uterus while the other hand is placed on the lower segment of the uterus to stabilize it.

* By the 10th day PP, uterus is no longer palpable abdominally

if it is palpable - subinvolution due to retained placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Fundal Characteristics

A

Should be firm, in the midline

Reference position to the umbilicus
FF U/0 (at the level of umbilicus) , FF U/1 (1 cm below) , etc. !!!!!!
FF ( fundus firm) 1/U ( 1 cm above) , FF 2/U ( 2 cm above) , etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Boggy Uterus

A

Uterus not firm? Massage & reassess.
Support base of uterus
 Massage fundus straight down towards patient’s spine
Note passage of clots, retained placenta, pieces of amniotic sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Full Bladder

A

Too high? Over to right side? Probably full bladder. Have patient void & reassess.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medications: Promote Uterine Tone

A
  1. Pitocin (oxytocin)
    10 units (1 ml) IM
    Vastus lateralis or directly into myometrium if C/S patient
    Up to 30 units (3 ml) into 1000 cc bag of an electrolyte solution
    Titrate rate to keep uterus firm, bleeding minimal
    2. Methergine (methylergonovine)
    O.2 mg IM or IV
    Note patient’s BP before administering
    IV carries more risk of complications (HPN, CVA)
17
Q

Bimanual Compression

A

Used for severe cases of uterine atony
Combined with use of oxytocic medications
1 hand in vagina; other on abdomen

18
Q

Bakri Tamponade Balloon

A

Into uterus - fill with saline - leave - direct pressure on wound - stop bleeding

19
Q

Afterpains

A

Primipara: uterus contracts & stays contracted
Multipara: intermittent uterine contractions
Worse with breastfeeding (oxytocin) !!! - lets milk down + uterus contractions

Problems maintaining contraction

  • Uterus overdistended
  • Clots or retained placenta
  • Use of pitocin during labor
20
Q

Cervix

A

Cx & lower uterine segment thin & collapsed; poor tone
Cx soft, edematous, many small lacerations
External os gradually closes & thickens

21
Q

Vagina

A
  1. Damage to soft tissues & support structures
    - Small tears in fascia & musculature
  2. Vagina: smooth, swollen, poor tone
    - Tone restored, but rarely like nullipara’s
    - Rugae reappear after 3 weeks; many not as thick as before
    - Estrogen deficiency by 3-4 weeks = atrophy of epithelial cells (vaginal tissue)
    - Poor lubrication, vasocongestion, sexual response
    - Estrogen normal level 6-10 weeks - no intercoarse until 6 weeks post
22
Q

Introitus ( vaginal opening )

A

Red & swollen, especially if episiotomy or lacerations
Heals by 2 weeks PP if no infections or hematomas
Free of perineal pain
**Extensive lacerations or poor repair = relaxed perineal floor - urine and fecal incontinence **

23
Q

Layers of Tissue in Perineum

A

Degrees

1st: perineal skin + subcutaneous layer
2nd: addition of perineal muscles
3rd: addition of rectal sphincter
4th: addition of rectal mucosa
Episiotomies cut through 2nd degree
Lacerations (tears) usually 1st & 2nd degree
Periurethral lacerations

                              Episiotomies

                    - Midline (median)
                     - Mediolateral

                                   Right or left
24
Q

Pericare (Perineal Care)

A
  1. Ice packs x 24 hours - reduce swelling ( 20 min on ; 20 min off)
  2. Sitz baths ( 2/ day , 10 min ) - warmth brings blood flow to the area - WBC ( healing) + RBC
  3. Peribottle
  4. Topical lidocaine ( allergic to novocaine)
    Sprays
    Foams
    Creams
  5. Tucks (witch hazel) pads
25
Q

Special Considerations: 3rd & 4th Degree Lacerations

A

Nothing per rectum
Edema
Bruising
Emphasize dietary changes
Increase fluids
Increase intake of fruits/vegetables
Encourage ambulation
Stool softeners
Laxatives

* occur with midline episiotomie

26
Q

REEDA Scale

A

Redness
Edema
Eccyhmosis
Discharge
Approximation

* Blue+black dime or smaller - ice for an hour; bigger - call doctor - hematoma - up to 1000 cc blood loss

27
Q

Fallopian Tubes

A

Respond to low estrogen level
Transient, non-bacterial inflammation by PPD #4
Gone once estrogen levels are restored to normal

28
Q

Hormonal Changes

A

Decreased estrogen & progesterone reactivates hypothalamic-pituitary-ovarian feedback
cycle
FSH & LH rise gradually
Lower level than normal menstrual cycle
Breastfeeding governs if normal ovarian function, ovulation, menstruation returns

29
Q

Bottlefeeding or Breastfeeding < 28 Days

A

FSH & estrogen levels rise to follicular phase concentration by 3rd week PP
Menses can occur 6-8 weeks PP
Menses before 6 weeks usually anovulatory
Initial ovulation usually about 10 weeks PP
By 12 weeks PP, 70% have first menses

30
Q

Breastfeeding

A

Associated with delayed ovulation
 Menses return more gradually
12 weeks PP: 45% have menses
36 weeks PP: 55-75% have menses
First 1-2 cycles usually anovulatory
Unclear why delay in menses: possible influence of prolactin

31
Q

Puerperal Morbidity: 1-8%

A

 Morbid temperature:
38 degrees Celsius (100.4 F) or greater, after the first 24 hours PP, on any 2 consecutive
days out of the first 10 PP days
1. Endometritis
2. UTI
3. Thrombophlebitis
4. Mastitis

32
Q

Endometritis

A

 More common in C/S
Lower abdominal pain
Foul-smelling lochia
Treated with oral antibiotics for mild cases; IV for moderate/severe cases
Use of broad-spectrum antibiotics
Rapid response to medications typically

33
Q

UTI

A

Same S/S of any UTI (urgency, frequency, dysuria)
Also flank pain if pyelonephritis (CVA tenderness)
Usually from bowel contaminants
Often were catheterized during labor
Diagnose with urine C/S (straight cath.)
Treat with antibiotics

34
Q

Thrombophlebitis

A

Blood is hypercoagulable due to increased clotting factors
Venous stasis also a factor
Many patients have varicose veins
 May have + Homan’s Sign
Red streaks on leg
Warmth, edema of leg
Treated with heat, elevation, NSAIDs, anticoagulants

35
Q

Mastitis

A

Frequently unilateral
Tender, engorged, erythematous breast
Malaise (feel “flu-like”)
Usually due to S. aureus
Treatment: antibiotics, rest, fluids, Tylenol, empty affected breast q3h, ice, breast support
Can develop into breast abscess (surgical drainage)

Nursing - obstetric component (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions