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NUR360 > Postpartum Care Fundamentals 2 > Flashcards

Postpartum Care Fundamentals 2 Flashcards

1
Q

Postpartum Assessment includes..

Hint: BUBBLLEE..V!

A 
Breast
Uterine fundus
Bladder
Bowel
Lochia
Legs
Episiotomy/laceration/incision
Emotion status
..Vital signs!
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2
Q

Normal range for heart rate in pregnant persons

A

10-15 bpm above normal is normal

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3
Q

Normal range for respiratory rate in pregnant persons

A

Slight increase from 16-24 breaths/min is normal

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4
Q

Normal range for temperature in pregnant persons

A

36.2 - 38 C

Increase to 38 (due to dehydration)

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5
Q

When is temperature expected to come back down to normal?

A

After 24 hours

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6
Q

How does epidural affect respiration? Or blood pressure?

A

May cause hypoventilation or hypotension

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7
Q

Orthostatic hypotension

A

Feelings of faintness or dizziness immediately after standing up

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8
Q

How do contractions help restore hemostasis postpartum?

A

Compression of intramyometrial blood vessels

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9
Q

What hormone is responsible for uterine contractions

A

Oxytocin

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10
Q

Where is oxytocin produced?

A

posterior pituitary gland

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11
Q

Why is oxytocin administered after expulsion of the placenta?

A

Decrease risk of postpartum hemorrhage

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12
Q

What are afterpains?

A

Afterbirth pains caused by vigorous uterine contractions, more common in subsequent pregnancies

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13
Q

Why is the role of oxytocin in breastfeeding?

A

Oxytocin stimulates let down of milk

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14
Q

Pre-eclampsia is marked by..

A

Hypertension

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15
Q

How does pregnancy affect pulse rate, stroke volume and cardiac output?

A

They increase throughout pregnancy and could remain elevated over nonpregnant values for 12 weeks after birth

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16
Q

Define involution

A

The return of the uterus to a nonpregnant state following birth.

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17
Q

What is the normal rate of uterine involution?

A

1-2 cms q24h

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18
Q

The uterus should not be palpable abdominally after how many weeks?

A

2 weeks

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19
Q

Subinvolution

What causes it?

A

Failure of the uterus to return to a nonpregnant state.

Usually caused by infection or retained placental fragments

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20
Q

Where can you find the fundus within the first 12 hours post delivery?

A

1 cm above umbilicus

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21
Q

What is the two hand technique?

A

Massaging of the uterine fundus with two hands to stimulate contraction. Lower hand supports the uterus to avoid prolapse and inversion of uterus.

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22
Q

What does @u, 1/u or u/2 stand for?

A 
@u = at umbilicus
1/u = 1 cm above umbilicus
u/2 = 2 cm below umbilicus
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23
Q

Why might a fundus be deviated/

A

Obstructed and/or displaced by distended bladder

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24
Q

Lochia rubra

A
  • bright red
  • blood
  • small clots
  • tissue debris
  • 3-4 days postpartum
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25
Q

Lochia serosa

A
  • pink-brown
  • old blood
  • serum
  • leukocytes
  • tissue debris
  • 22-27 days postpartum
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26
Q

Lochia alba

A
  • yellow-white
  • serum
  • leukocytes
  • mucus
  • epithelial cells
  • 2-6 weeks postpartum
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27
Q

How is lochia amount documented?

A

Scant (5 cm)
Light (10 cm)
Moderate (15 cm)
Larger (> 15 cm, full pad!)

28
Q

How are placenta clots identified?

A
  • typically larger than a small plum

- placenta clots CANNOT be pulled apart by hand

29
Q

How to tell when bleeding is “non-lochial”?

A

Firm uterine fundus but bloody discharge spurts or gushes - may indicate cervical or vaginal tear

30
Q

How dilated is the cervix to be expected 2-3 days postpartum?

A

2-3 cm

31
Q

First Degree Perineal Tear

A

Tear in vaginal opening

32
Q

Second Degree Perineal Tear

A

Torn perineal muscles

33
Q

Third Degree Perineal Tear

A

Torn perineal muscles and anal sphincter

34
Q

Fourth Degree Perineal Tear

A

Full tear through to anus, fistula

35
Q

What appropriate nursing interventions are provided in case of 3rd or 4th degree tear?

A
  • Laxatives
  • Liquid diet only
  • no suppositories until tissues are healed
36
Q

When might episiotomy be indicated?

A

Multiple lacerations

37
Q

What is medio-lateral and midline episiotomy?

A

Medio-lateral is to the right while midline is towards anus

38
Q

On average, how long does it take for episiotomy to heal?

A

2 to 3 weeks but 4-6 months can be required for complete healing

39
Q

What nursing interventions are appropriate for perineum care?

A
  • Assess REEDA
  • Assess presence of hemorrhoids
  • Ice therapy to reduce swelling (20 mins on, 20 mins off for first 24 hours)
  • Peri bottle
  • Sitz bath (warm, moist, heat therapy after 24 hours)
40
Q

What does REEDA stand for?

A 
Redness
Ecchymosis (bruising)
Edema
Discharge/discomfort
Approximation
41
Q 
How is the assessment for C/S patients the same or different?
Breast
Uterine fundus
Bladder
Bowel
Lochia
Legs
Emotional status
Incision
Pain
Vitals
A

Breast - same
Uterine fundus - involution is important, capitalize on epidural
Bladder - foley catheter usually in place for 12 hrs
Bowel - gas pains from decreased movement
Lochia - slightly less
Legs - increased risk for venous clot
Emotional status - unplanned c/s
Incision - dressing but also perineum assessment
Pain
Vitals - increased frequency (c/s is a surgery!)

42
Q

What are some things that are important for c/s patient postpartum?

A
  • pass gas
  • ambulate after catheter removed (dangling first!)
  • don’t lift heavier than baby
43
Q

What are 3 postpartum complications?

A
  1. Infection
  2. Postpartum Hemorrhage (PPH)
  3. Perinatal Mood Disorder (PMD)
44
Q

What are the common causes of PPH?

A
  1. Uterine atony (first 24 hours)
  2. Genital tract lacerations
  3. Retained placenta (or infection; 24 hours to 2 weeks postpartum)
45
Q

What are the signs of hypovolemic shock?

A
  • perineal pad soaked within 15 minutes
  • client feels weak, light-headed, nauseated, sees stars
  • client appears anxious
  • skin colour turns ashen or greyish, cool and clammy
  • increased pulse rate
46
Q

What are some nursing implications to prevent PPH?

A
  • assess & monitor RISKS
  • s&s of PPH
  • care coordination
  • health promotion
  • illness prevention
47
Q

The 4 T’s (Risk factors for PPH)

A

Tone
Tissue
Trauma
cloTting

48
Q

What are some risks that could reduce uterine tone?

A
  • multip
  • multifetal pregnancy (overdistended uterus)
  • certain medications
  • faster-than-normal labour
49
Q

What are the nursing interventions for PPH?

A
  1. fundal massage
  2. monitor vital signs
  3. urinary bladder status
  4. circulatory support: IV fluids, oxygen, utertonics (oxytocin)
  5. call for help, stay with cient
50
Q

What medical interventions are used to treat PPH?

A
  • utertonic escalation
  • blood transfusion
  • bimanual uterine compression
  • surgical interventions: intrauterine balloon tamponade, uterine artery embolization, hysterectomy
51
Q

What are the 3 types of Perinatal Mood Disorders (PMD)?

A
  1. postpartum “blues”
  2. postpartum depression (no psychosis)
  3. postpartum depression (psychosis)
52
Q

Postpartum blues

A
  • 50-80%
  • peaks by day 5, subsides by day 10
  • fatigue, sadness, anger, no functional impairment
53
Q

What interventions are appropriate for postpartum blues?

A
  • reassurance
  • health teaching
  • connection with supports and community resources
54
Q

Postpartum depression (no psychosis)

A
  • 10-15%
  • may last week to 1 year
  • appetite change, guilt, worthlessness, inability to cope, intense irrational fears, decreased concentration
55
Q

What interventions are used to treat postpartum depression (no psychosis)?

A
  • non-directive counselling
  • interpersonal psychotherapy
  • CBT
  • peer support
  • medication
56
Q

Postpartum Depression (psychosis)

A
  • 1-2 per 1000 births
  • 2-8 weeks
  • depression, delusions, thoughts of harm to self or infant, agitated, disorganized behaviour, inability to care for infant
57
Q

What interventions are appropriate for postpartum depression (psychosis)?

A
  • prompt assessment and hospitalization
  • medication
  • psychotherapy
58
Q

Name 2 STRONG risk for PP Depression?

A
  1. prenatal depression and/or anxiety

2. personal/family history of depression

59
Q

Name 3 MODERATE risk for PPD?

A
  1. Stressful life event
  2. Lack of social support
  3. Intimate partner violence
60
Q

Name 4 WEAK risk for PPD?

A
  1. single parent
  2. stress of child care
  3. low SES
  4. unwanted/unplanned pregnancy
61
Q

What is the nurse’s role in preventing PMD?

A
  1. screening (listen, care and get to know the client)
  2. health promotion/education/prevention
  3. anticipatory guidance
  4. safety assessment
  5. support, reassurance (referrals)
62
Q

Symptoms of PPD in partner?

A
  • may be different from birth parent
  • anger, irritability
  • increase in violent behaviour
  • increase in substance use
63
Q

Postpartum infection

A

presence of a fever of 38C or higher on 2 successive days of the first 10 postpartum days (not counting first 24 hours)

64
Q

What are some common postpartum infections?

A
  • endometritis
  • wound infections
  • mastitis
  • UTIs
  • respiratory tract infections
65
Q

Endometritis

A

Infection of the lining of uterus

66
Q

Mastitis

A

Breast infection

  • almost always unilateral
  • commonly caused by hemolytic s. aureus

NUR360 (13 decks)

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