Postpartum Nursing Flashcards
1
Q
puerperium duration
A
begins with delivery of placenta and ends at approximately 6 weeks after delivery
2
Q
postpartum recovery length
A
2-3 hours following delivery of placenta
3
Q
goal of postpartum recovery
A
preventing hemorrhaging and facilitating bonding
4
Q
what is uterus involution
A
the return of the uterus to pre pregnant size
5
Q
what does uterine involution involve
A
the uterus contracts and the endometrum regentrates and the fundus descends
6
Q
how fast does the fundus descend
A
1 cm/day
7
Q
what does a boggy uterus indicate
A
atony - requires massage
8
Q
what does a tender uterus indicate
A
infection
9
Q
primigravidas and afterpains
A
rarely felt
10
Q
multigravidas and after pains
A
more acute
11
Q
what hormone does breast feeding release
A
oxytocin
12
Q
lochia
A
vaginal discharge consisting of blood frm placenta and debris and decidua
13
Q
rubra
A
lochia from day 1-3.
- small clots
- scant to moderate
- increases with standing and breastfeeding
14
Q
serosa
A
lochia from day 4-10
- pink-brown color
- scant
- increases with physical activity
15
Q
alba
A
lochia from day 10
- yellow-white color
- scant
16
Q
what are typical deviations from normal lochia at any stage
A
large clots, heavy flow, foul odor
17
Q
how does the internal os close
A
the same as before pregnancy
18
Q
how does the xternal os close
A
1 cm at the end of first week with the shape permanently changed
19
Q
vagina rugae pospartum
A
few and reappear by 3-4 weeks
20
Q
when is the vaginal epithelim restored by
A
6-10 weeks
21
Q
what happens when the vaginal wall regains thickness
A
estrogen production is reestablished
22
Q
which population is prone to dysparenunia
A
breastfeeding moms
23
Q
normal %age of blood loss in delivery
A
10-30%
24
Q
when does cardiac output return to normal
A
6-12 weeks
25
how does the body remove excess fluid
diuresis and disphoresis
26
when is orthostatic hypotension common
first 48 hours
27
why does orthostatic hypotension happen
decreased vascular resistance
28
which should h/h return to normal
4-6 weeks
29
when does hemostasis occur
4-6 weeks
30
what should be avoided in 3rd to 4th degree lacerations
enemas and suppositories
31
what is uterine atony
failure of the uterus to contract
32
when should diuresis occur
1st 24 hours
33
when should diastasis recti subside
6 weeks
34
what is diastasis recti
separation of the rectus muscles
35
what 2 types of headaches are common post partum
frontal and bilateral headaches
36
explusion of placenta begins d/t rapid decrease of X3
estrogen, progestrone and human placental lactogen
37
what hormone increases to allow for milk production and when does it happen
prolactin 2-3 days after delivery
38
when should menses return in non-lactating women
1-2 months
39
when should menses return in lactating women
3-6 months
40
how much weight is lost during childbirth
10-13 lbs
41
when is the most weight loss in postpartum
first 3 months
42
vaginal birth postpartum focused assessment timings
q 15 minutes for the first hour
every 30 minutes for the second hour
every 4 hours for 24 hours
every 8-12 hours until discharge
43
how do you preform a postpartum focused assessment
BUBBLEHEB
```
breast
uterus
bladder
bowel
lochia
episiotomy/laceration
```
hemorrhoids
emotional/educational needs
bonding
44
what can increased BP indicate X3
pain, anxiety, preeclampsia
45
what can decreased BP indicate X2
dehydration, hypovolemia
46
what does a fever w/n the 1st 24 hours mean
normal
47
what does a fever after the 1st 24 hours mean
infection
48
pain goal for post-partum
under 4
49
if fundal assessment is abnormal:
have mom void and then recheck
50
how do you document perineal tears
REEDA
```
redness
edema
ecchymosis
discharge
approximation
```
51
sitz bath temperatures
cool water for 24 hours
warm water after 24 hours
52
why should you use cool water for sitz baths
decrease edema
53
how should a woman with a perineal tear sit
squeeze glutes and then relax once youre seated
54
when should a woman void post partum
within 6 hours
55
when should you cath a postaprtum patient X3
unable to void
void <150 mL/palpable bladder
elevated/displaced fundus
56
how long are post-c section woman given analgesia
18-24 hours
57
colostrum
liquid gold produced in 1st 1-2 days
contains immunoglobulins and laxatives
58
transitional milk
produced 2-3 days postapartum
59
mature milk contains how many cal/oz
20 kcal/oz
60
foremilk
mature milk stored before feeding that is high in water content
61
hindmilk
mature milk produced during feeding that is high in fat content
62
what temperature encourages milk production
warm
63
how should you schedule breast feeding
on-demand
64
how do you prevent nipple chaffing
alternate feeding positions
65
when should you switch breasts during feeding
switch which breast you start feeding with every time you feed to keep them even
66
what is primary engorgement expected in
breast and bottle feeding moms w/n first 24-48 hours
67
subsequent engorgement is expectedin
women who breast feed
68
breast changes 24 hours PP
breasts are soft
69
breast changes PP day 2
slightly firm and non-tender
70
breast changes 3rd PP day
firm/tender/warm - milk production begins
71
what can help with pain during breast engorgement
cool compresses/frozen cabbage leaves
72
which vitamin helps with nipple trauma
vitamin E
73
newborn caloric intake
85-100 cal/kg/day
74
stages of transition in maternal role attinment X4
anticipator - pregnancy preparation for infant
acquaintance - delivery-6 weeks
new normal - 1st 4 months - learns and respond to infants cues
maternal ID - feels comfortable in her role
75
what is the taking in phae
focused on own needs, allows others to make decisions
the mom begins integrating her birth experience into reality
76
taking hold phase
assumes responsibility for her self and infant
anxious about her competence as mom and welcomes care education
77
letting go phase
accepts and incorporates the infant into her lifestyle, resolves the idealized expectations of the birth experience
relinquishes infant of their fantasy, accepts real infants
78
the 4 T's for postpartum hemorrhage
Tone (uterine)
Trauma
Tissue
Thrombin (coag factors)
79
primary/early PPH predisposing factors X10
```
over distended uterhs
multiparity
oxytocin
precipitous l/d
prolonged labor
placenta abroption
retained placenta
operative delivery
anesthesia
hx of PPH
```
80
what is the #1 cause of PPH
uterine atony
81
what is the 2nd most common cause of PPH
lacerations of any kind
82
3rd most common cause of PPH
hematoma
83
what is a PPH hematoma
250-500 mL blood collection in vaginal or perineal tissue
84
defining symptoms of early PPH's X5
```
boggy fundus
steady trickle of bright red blood
severe pain *****
visible hematoma
discolored bulging mass
```
85
first intervention when PPH is suspected
fundal massage
86
other PPH nursing interventions X4
elevate legs
admin O2
comfort measures - ice/pain meds
notify MD
87
medical management of atony X3
oxytocin
bimanual compression
uterine packing/tamponade
88
medical management of lacerations/hematomas
suture laceration
89
dosage of oxytocin during PPH
10-40 U titrated ti IVF based on uterine tone
10 U IM if no IV access
90
AE of oxytocin X4
dysrhythmias
BP changes
water intoxication
uterine rupture
91
interventions with oxytocin X3
VS
I/O
lung sounds
92
methylergonovine maleate dose
01.-0.2 IM q 2-4 hrs with a max of 5 doses
93
AE of methylergonovine maleate X5
```
N/V
cramping
HA/sever HTN
bradycardia/dysrhytmias
MI
```
94
CI of methylergonovine maleate X2
HTN or cardiac dz
95
interventions of methylergonovine maleate X3
monitor for HA, chest pain/SOB, uterine contractions and vaginal bleeding
96
dose of Carboprost tromethamine
0.24 mcg IM repeated q 15-90 mins with 2 mg max
97
AE of Carboprost tromethamine X6
HA, N/V/D, fever, tachycardia, HTN, pulmonary edema
98
CI o Carboprost tromethamine X4
asthma, cardiac, renal, hepatic dz
99
Misoprostol dosage
800-1000 mcg rectally
100
ae of Misoprostol X6
HA, N/V/D, fever, tachycardia, HTN, pulmonary edema
101
primary cause of late/secondary PPH
retained placental fragments and infection
102
surgical PPH management
dilation and curettage (D&C)
103
uterine inversion
partial or complete turning inside out of uterus
OB EMERGENCY
104
nursing interventions of uterine inversion X3
STOP OXYTOCIN
admin terbutaline/antibiotics
monitor/manage hypovolemic shock
105
medical management of uterine inversions
immediate manual replacement/surgery
106
puerperal infection definition
temp of 100.4+ on 2 occasions *after* the first 24 hours of birth
107
endometritis therapeutic management
IV antibitoics, antipyretics, oxytocin or methylergonovine
108
when is cystitis likely to occur
1st or 2nd postpartum day
109
when is pyelonephritis likely to occur
3rd or 4th PP day
110
what drinks should be avoided with UTi's
carbonated drinks
111
mastitis
a breast infections that occurs most often 2-3 weeks postpartum
112
breastfeeding with mastitis
encourage breastfeeding from affected side first every 2-3 hours
113
superficial thrombophlebitis
palpable thrombus
warm tender swollen area to the affected extremity
114
femoral thrombophlebitis
malaise, chills and fever
diminished peripheral pulses
pain and swelling to affected extremitiy
115
pelvis thrombophlebitis
severe chillds with dramatic body temperature changes
pulmonary embolism may be the first sign
116
pulmonary embolism s/s
feeling of impending doom, sudden chest pain, hemoptysis
117
PE nursing inteentions
semi fowlers
O2 at 8-10 L/min
IVF
118
baby blues
transient depression common 1st few weeks post partum and peak around day 5
119
postpartum depression
depression afterchildbirth persisting past 2 weeks
120
risks for postpartum depression
hx of sexual abuse, unwanted pregnancy, smoking, formula feeding
121
postpartum psychosis
intense depression or relapse of psychotic disorder
