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IM 6 Test 1 > Postpartum Nursing > Flashcards

Postpartum Nursing Flashcards

1
Q

puerperium duration

A

begins with delivery of placenta and ends at approximately 6 weeks after delivery

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2
Q

postpartum recovery length

A

2-3 hours following delivery of placenta

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3
Q

goal of postpartum recovery

A

preventing hemorrhaging and facilitating bonding

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4
Q

what is uterus involution

A

the return of the uterus to pre pregnant size

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5
Q

what does uterine involution involve

A

the uterus contracts and the endometrum regentrates and the fundus descends

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6
Q

how fast does the fundus descend

A

1 cm/day

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7
Q

what does a boggy uterus indicate

A

atony - requires massage

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8
Q

what does a tender uterus indicate

A

infection

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9
Q

primigravidas and afterpains

A

rarely felt

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10
Q

multigravidas and after pains

A

more acute

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11
Q

what hormone does breast feeding release

A

oxytocin

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12
Q

lochia

A

vaginal discharge consisting of blood frm placenta and debris and decidua

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13
Q

rubra

A

lochia from day 1-3.

  • small clots
  • scant to moderate
  • increases with standing and breastfeeding
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14
Q

serosa

A

lochia from day 4-10

  • pink-brown color
  • scant
  • increases with physical activity
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15
Q

alba

A

lochia from day 10

  • yellow-white color
  • scant
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16
Q

what are typical deviations from normal lochia at any stage

A

large clots, heavy flow, foul odor

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17
Q

how does the internal os close

A

the same as before pregnancy

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18
Q

how does the xternal os close

A

1 cm at the end of first week with the shape permanently changed

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19
Q

vagina rugae pospartum

A

few and reappear by 3-4 weeks

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20
Q

when is the vaginal epithelim restored by

A

6-10 weeks

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21
Q

what happens when the vaginal wall regains thickness

A

estrogen production is reestablished

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22
Q

which population is prone to dysparenunia

A

breastfeeding moms

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23
Q

normal %age of blood loss in delivery

A

10-30%

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24
Q

when does cardiac output return to normal

A

6-12 weeks

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25
Q

how does the body remove excess fluid

A

diuresis and disphoresis

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26
Q

when is orthostatic hypotension common

A

first 48 hours

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27
Q

why does orthostatic hypotension happen

A

decreased vascular resistance

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28
Q

which should h/h return to normal

A

4-6 weeks

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29
Q

when does hemostasis occur

A

4-6 weeks

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30
Q

what should be avoided in 3rd to 4th degree lacerations

A

enemas and suppositories

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31
Q

what is uterine atony

A

failure of the uterus to contract

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32
Q

when should diuresis occur

A

1st 24 hours

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33
Q

when should diastasis recti subside

A

6 weeks

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34
Q

what is diastasis recti

A

separation of the rectus muscles

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35
Q

what 2 types of headaches are common post partum

A

frontal and bilateral headaches

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36
Q

explusion of placenta begins d/t rapid decrease of X3

A

estrogen, progestrone and human placental lactogen

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37
Q

what hormone increases to allow for milk production and when does it happen

A

prolactin 2-3 days after delivery

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38
Q

when should menses return in non-lactating women

A

1-2 months

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39
Q

when should menses return in lactating women

A

3-6 months

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40
Q

how much weight is lost during childbirth

A

10-13 lbs

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41
Q

when is the most weight loss in postpartum

A

first 3 months

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42
Q

vaginal birth postpartum focused assessment timings

A

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

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43
Q

how do you preform a postpartum focused assessment

A

BUBBLEHEB

breast
uterus
bladder
bowel
lochia
episiotomy/laceration

hemorrhoids
emotional/educational needs
bonding

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44
Q

what can increased BP indicate X3

A

pain, anxiety, preeclampsia

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45
Q

what can decreased BP indicate X2

A

dehydration, hypovolemia

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46
Q

what does a fever w/n the 1st 24 hours mean

A

normal

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47
Q

what does a fever after the 1st 24 hours mean

A

infection

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48
Q

pain goal for post-partum

A

under 4

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49
Q

if fundal assessment is abnormal:

A

have mom void and then recheck

50
Q

how do you document perineal tears

A

REEDA

redness
edema
ecchymosis
discharge
approximation
51
Q

sitz bath temperatures

A

cool water for 24 hours

warm water after 24 hours

52
Q

why should you use cool water for sitz baths

A

decrease edema

53
Q

how should a woman with a perineal tear sit

A

squeeze glutes and then relax once youre seated

54
Q

when should a woman void post partum

A

within 6 hours

55
Q

when should you cath a postaprtum patient X3

A

unable to void

void <150 mL/palpable bladder

elevated/displaced fundus

56
Q

how long are post-c section woman given analgesia

A

18-24 hours

57
Q

colostrum

A

liquid gold produced in 1st 1-2 days

contains immunoglobulins and laxatives

58
Q

transitional milk

A

produced 2-3 days postapartum

59
Q

mature milk contains how many cal/oz

A

20 kcal/oz

60
Q

foremilk

A

mature milk stored before feeding that is high in water content

61
Q

hindmilk

A

mature milk produced during feeding that is high in fat content

62
Q

what temperature encourages milk production

A

warm

63
Q

how should you schedule breast feeding

A

on-demand

64
Q

how do you prevent nipple chaffing

A

alternate feeding positions

65
Q

when should you switch breasts during feeding

A

switch which breast you start feeding with every time you feed to keep them even

66
Q

what is primary engorgement expected in

A

breast and bottle feeding moms w/n first 24-48 hours

67
Q

subsequent engorgement is expectedin

A

women who breast feed

68
Q

breast changes 24 hours PP

A

breasts are soft

69
Q

breast changes PP day 2

A

slightly firm and non-tender

70
Q

breast changes 3rd PP day

A

firm/tender/warm - milk production begins

71
Q

what can help with pain during breast engorgement

A

cool compresses/frozen cabbage leaves

72
Q

which vitamin helps with nipple trauma

A

vitamin E

73
Q

newborn caloric intake

A

85-100 cal/kg/day

74
Q

stages of transition in maternal role attinment X4

A

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
Q

what is the taking in phae

A

focused on own needs, allows others to make decisions

the mom begins integrating her birth experience into reality

76
Q

taking hold phase

A

assumes responsibility for her self and infant

anxious about her competence as mom and welcomes care education

77
Q

letting go phase

A

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
Q

the 4 T’s for postpartum hemorrhage

A

Tone (uterine)
Trauma
Tissue
Thrombin (coag factors)

79
Q

primary/early PPH predisposing factors X10

A 
over distended uterhs
multiparity
oxytocin
precipitous l/d
prolonged labor
placenta abroption
retained placenta
operative delivery
anesthesia
hx of PPH
80
Q

what is the #1 cause of PPH

A

uterine atony

81
Q

what is the 2nd most common cause of PPH

A

lacerations of any kind

82
Q

3rd most common cause of PPH

A

hematoma

83
Q

what is a PPH hematoma

A

250-500 mL blood collection in vaginal or perineal tissue

84
Q

defining symptoms of early PPH’s X5

A 
boggy fundus
steady trickle of bright red blood
severe pain *****
visible hematoma
discolored bulging mass
85
Q

first intervention when PPH is suspected

A

fundal massage

86
Q

other PPH nursing interventions X4

A

elevate legs
admin O2
comfort measures - ice/pain meds
notify MD

87
Q

medical management of atony X3

A

oxytocin
bimanual compression
uterine packing/tamponade

88
Q

medical management of lacerations/hematomas

A

suture laceration

89
Q

dosage of oxytocin during PPH

A

10-40 U titrated ti IVF based on uterine tone

10 U IM if no IV access

90
Q

AE of oxytocin X4

A

dysrhythmias
BP changes
water intoxication
uterine rupture

91
Q

interventions with oxytocin X3

A

VS
I/O
lung sounds

92
Q

methylergonovine maleate dose

A

01.-0.2 IM q 2-4 hrs with a max of 5 doses

93
Q

AE of methylergonovine maleate X5

A 
N/V
cramping
HA/sever HTN
bradycardia/dysrhytmias
MI
94
Q

CI of methylergonovine maleate X2

A

HTN or cardiac dz

95
Q

interventions of methylergonovine maleate X3

A

monitor for HA, chest pain/SOB, uterine contractions and vaginal bleeding

96
Q

dose of Carboprost tromethamine

A

0.24 mcg IM repeated q 15-90 mins with 2 mg max

97
Q

AE of Carboprost tromethamine X6

A

HA, N/V/D, fever, tachycardia, HTN, pulmonary edema

98
Q

CI o Carboprost tromethamine X4

A

asthma, cardiac, renal, hepatic dz

99
Q

Misoprostol dosage

A

800-1000 mcg rectally

100
Q

ae of Misoprostol X6

A

HA, N/V/D, fever, tachycardia, HTN, pulmonary edema

101
Q

primary cause of late/secondary PPH

A

retained placental fragments and infection

102
Q

surgical PPH management

A

dilation and curettage (D&C)

103
Q

uterine inversion

A

partial or complete turning inside out of uterus

OB EMERGENCY

104
Q

nursing interventions of uterine inversion X3

A

STOP OXYTOCIN

admin terbutaline/antibiotics

monitor/manage hypovolemic shock

105
Q

medical management of uterine inversions

A

immediate manual replacement/surgery

106
Q

puerperal infection definition

A

temp of 100.4+ on 2 occasions after the first 24 hours of birth

107
Q

endometritis therapeutic management

A

IV antibitoics, antipyretics, oxytocin or methylergonovine

108
Q

when is cystitis likely to occur

A

1st or 2nd postpartum day

109
Q

when is pyelonephritis likely to occur

A

3rd or 4th PP day

110
Q

what drinks should be avoided with UTi’s

A

carbonated drinks

111
Q

mastitis

A

a breast infections that occurs most often 2-3 weeks postpartum

112
Q

breastfeeding with mastitis

A

encourage breastfeeding from affected side first every 2-3 hours

113
Q

superficial thrombophlebitis

A

palpable thrombus

warm tender swollen area to the affected extremity

114
Q

femoral thrombophlebitis

A

malaise, chills and fever
diminished peripheral pulses
pain and swelling to affected extremitiy

115
Q

pelvis thrombophlebitis

A

severe chillds with dramatic body temperature changes

pulmonary embolism may be the first sign

116
Q

pulmonary embolism s/s

A

feeling of impending doom, sudden chest pain, hemoptysis

117
Q

PE nursing inteentions

A

semi fowlers
O2 at 8-10 L/min
IVF

118
Q

baby blues

A

transient depression common 1st few weeks post partum and peak around day 5

119
Q

postpartum depression

A

depression afterchildbirth persisting past 2 weeks

120
Q

risks for postpartum depression

A

hx of sexual abuse, unwanted pregnancy, smoking, formula feeding

121
Q

postpartum psychosis

A

intense depression or relapse of psychotic disorder

IM 6 Test 1 (5 decks)

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