Postpartum Nursing Flashcards
True or False
A woman should be afebrile.
True
Temperature may be ____ for 24 hours after the breast milk comes in.
increased
You will see a transient rise in ____ ___ but it will return to pre-pregnancy baseline in a few days following delivery.
Blood pressure
Low BP can be a sign of:
decreased _____ pressure
OR
_____ _____ r/t hypovolemia
intrapelvic
postpartum hemorrhage
High BP can be due to:
excessive use of ____
________
postpartum _____ ______
oxytocin
vasopressors
pre-eclampsia
Postpartum women will be slightly ____ for the first 6-10 days secondary to decreased cardiac effort, decreased blood volume, and increased stroke volume
bradycardic
What is tachycardia a sign of in a postpartum woman?
hypovolemia
infection
anxiety
pain
***requires further nursing assessment
The uterus rapidly decreases in size to pre-pregnancy size in a process called ____.
involution
Placental site heals by _____.
exfoliation
The fundus will be at the level of the umbilicus ___ hours postpartum.
12
The fundus will be 1 cm below the umbilicus on the ___ postpartum day.
first
The fundus will descend 1 cm per day until it is in the pelvis on the ___ day.
*NO longer palpable
10th
The uterus will will reach its pre-pregnant size by __ - __ weeks postpartum.
5-6
When documenting a fundal check, the nurse should include?
- Consistency
- Location
- Height
When completing fundal palpation, the nurse should have 1 hand above the ___ ___ & 1 hand at the level of ____. Press inward and downward.
symphysis pubis
umbilicus
If you do not support the lower uterine segment when doing fundal palpation, it could result in?
uterine inversion & hemorrhage
What potential risk is greatest if the fundus is boggy?
Increased bleeding
How does a well-contracted fundus feel?
firm, round, and midline
How would you document the amount of lochia present?
scant, small, moderate, or heavy
True or False
Lochia should have a foul odor.
FALSE, it should never have a foul odor because this indicates infection
Lochia rubra is ___ ___
It is seen for the first __-__ days
It has a fleshy odor and small clots are common
bright red
2-3
Lochia serosa is ___
It is seen for days __-__
pink
3-10
Lochia alba is ___
This will continue until the ___ is ___
white
cervix is closed
Normal vaginal blood loss is between ___ - ____ mL
200-500
Normal cesarean blood loss is between ___ - ____ mL
700-1000
For every ___ mL of blood loss, hemoglobin drops 1-1.5 and hematocrit drops __-__%
500
3-4%
1 gram = how many mL of blood?
1 mL
A postpartum hemorrhage is defined as blood loss > ___ mL after childbirth OR clinically drop of hematocrit ___ or more from pre-delivery value
500
10%
___ (primary) postpartum hemorrhage is within the first ___ hours after delivery
*this is MORE common
Early
24
___ (secondary) postpartum hemorrhage is from ___ hours to ___ ___ after delivery.
This is due to _____ (failure to return to normal uterine size)
Late
24 hours - 6 weeks
sub involution
____ is the most important in management, identify risk factors
Prevention
What is the goal of postpartum hemorrhage treatment?
Maintain Hgb >8 g/dl
Plt count > 75,000
Some treatment options for a postpartum hemorrhage are:
Correct ____
manual ____
Oxytocin, __, Hemabate, __
Administer ___ products
balloon ____
B-lynch suture
________
**hypovolemia
compression
methergine, cytotec
blood
tamponade
hysterectomy
What are the 4 T’s?
Tone, Trauma, Tissue, Thrombin
Nursing care for a woman with a postpartum hemorrhage:
1. uterine ____ if a soft, boggy uterus is detected
2. frequent ___ ___
3. assess fundus and ___ often
4. encourage frequent ____ or ____ the woman
5. ____ access
6. assess abnormalities in ____ levels
7. Assess ____ output
8. encourage rest and take ____ precautions
massage
vital signs
bleeding
voiding or catheterize
vascular
hematocrit
urinary
safety
Nursing care for a patient that had an episiotomy or laceration:
- offer ___ ___ (pain/swelling)
- keep area ___ & dry (infection)
- frequent ___ ____
- clean after ___ & ____ (perineal bottle with warm water)
ice packs
clean
sitz baths
voiding & stooling
What education should be given to a mother with an episiotomy/laceration?
- avoid: tampons and douches
- pelvic rest for 6 weeks
- complete healing = 4-6 months
Recommended treatment for perineal discomfort:
___ packs (first 12-24 hours)
___ baths 3-4 times daily
____ ___, don’t wipe, use warm water to clean area
encourage patient to ___ ___ before sitting
____ regimen
monitor ____
ice
sitz
peri-bottle
tighten buttocks
bowel
perineum
A perineal hematoma can occur after spontaneous or operative ____ ____
vaginal delivery
Patient usually complains of pain or an inability to void depending on the ___ and ___ of the hematoma
size and location
What is surgical treatment for a perineal hematoma?
incision and drainage
What are some conservative treatment options for a perineal hematoma?
ice packs, observation, pain management, bladder drainage
Nursing interventions for a patient with a with hemorrhoids:
1. encourage __-__ glasses of water
2. high ___ diet
3. avoid urge to ____
4. avoid ____
5. offer ___ ____
6. early ____
6-8
fiber
defecate
straining
stool softeners
ambulation
Does a patient have to have a bowel movement prior to d/c?
No
When does mensuration return in the non-breastfeeding woman?
7-12 weeks
When does ovulation occur in the non-breastfeeding woman?
70-75 days
The abdominal wall appears loose/flabby and will respond to exercise in __-__ months
2-3
Striae will take on different colors based on the mothers skin color and will ___ ___ but remain visible
gradually fade
What is diastasic recti abdominis?
separation of abdominal muscle (esp women with poor abdominal tone)
Is diastasis recti more common in mothers that had a c-section or vaginal birth?
c-section
Does diastasis recti ever fully heal?
No but it does respond to exercise
Diastasis recti can cause?
-low back pain
-constipation
-urine leakage
-hernia
What does recovery look like for the first hour following a c-section?
VS monitored closely, high risk of bleeding, epidural effect, can hold baby
What does recovery look like for the 1st day following a c-section?
foley first 6-8 hours, advance diet as tolerated, pain management
What does recovery look like for the 2nd day following a c-section?
walking encouraged, passing gas, IV transitioned to saline locked, shower, normal diet
What does recovery look like for the 3rd and 4th day following a c-section?
bandage removed from incision, wound care teaching, staples out if used
Following a c-section, the nurse should check the status of the ____ and report any significant ___ or ____ to the provider
dressings
drainage or discharge
What is the most common organisms associated with perineal cellulitis and episiotomy?
Staphylococcus or Streptococcus
Vaginal secretions contain as many as 10 billion organisms per gram of fluid. Yet, infections develop in only ___% of patients who had vaginal tears or who underwent episiotomies.
1
Postpartum endometritis is defined as an infection the _____.
decidua
What are the most common pathogens causing postpartum endometritis?
normal vaginal flora or gram negative organisms
What are s/s of postpartum endometritis?
fever (first 24-72 h)
pain/tenderness in pelvis
tachycardia
purulent vaginal discharge
What are risk factors for postpartum endometritis?
c-section delivery, prolonged rupture of membranes, prolonged use of internal fetal monitoring, GBS+
What is the treatment for postpartum endometritis?
broad-spectrum antibiotics given IV until women are afebrile for 48 hours
____ ____ is elimination of fluid/waste products through increased perspirations
-feels like menopausal hot flashes
-frequently occur at night
-no clinical significance
postpartum diaphoresis
___ ___ are uterine contractions (shrinking the uterus back to normal size)
after pains
After pains are more common in the____ patient or during ____
multiparous
nursing
After pains usually last __-__ days.
2-3
What are some treatment options for after pains?
lying on abd, ambulation, heat, mild analgesia
Breastfeeding mothers increase intake by ___ kcal in addition to the 300 kcal from pregnancy.
200
total 500 kcal additional per day
Non-breastfeeding mothers decrease intake by ___ kcal
300
return to pre-pregnancy caloric intake
What are some abnormalities the nurse may find when assessing the breasts?
reddened areas or engorgement
What should the nipples look like during an assessment?
soft, pliable, everted
What are some options for nipple cracking/irritation?
- clean warm water, no soap
-use absorbent breast pads
-apply breast milk to nipples and areola after each feeding
-apply warm compress after each feeding
During breastfeeding, the mother should position the nipple so that the infants mouth covers a ___ portion of the areola
large
To release suction, insert a ___ into the infants cheek
finger
Ways to help with engorgement:
1. nurse frequently __-__ hours
2. empty each breast completely (listen for sucking without ___)
3. warm shower/compress to stimulate ____
4. alternate ____ breast with each feeding
5. ___ ____ b/w feedings for pronounced discomfort
1/2-3
swallowing
letdown
starting
cool compress
What are some S/S of plugged milk ducts?
tenderness, lump in area of plugged milk duct
What is the treatment for a plugged milk duct?
warm compress, massage prior to breastfeeding
**IF unrelieved it can lead to mastitis
What is the most common causing organism of mastitis?
Staph aureaus
What are some risk factors for mastitis?
sore nipples, cracked nipples, blocked milk ducts, yeast of breast or mouth
What is the treatment plan for mastitis?
improve breastfeeding technique, antibiotics, anti-fungal if candida present
What are some preventative measures for mastitis?
optimize breastfeeding, appropriate latch, hand washing, supportive bra, prompt attention to blocked milk ducts
What are some complications of mastitis?
breast access, septicemia
Can a breastfeeding mother continue to breastfeed while bring treated for mastitis?
YES, the breast milk is not contaminated
How should a non-breastfeeding mother dry up her milk supply?
-tight-fitting supportive sports bra
-apply cold compresses or cabbage leaves
-avoid breast stimulation or heat to breast
Breastfeeding mothers should NOT consume alcohol for at least __ hours before nursing and alcohol consumption should be ___ to occasional use
2
limited
The muslim culture places a strong emphasis on the legal ____ of a woman and man for raising children.
marriage
Physical pain a mother endures during pregnancy/childbirth = _____ ___ in muslim culture
elevated status
Cultural norms in muslim culture:
Avoid ___ contact: sign of respect
Avoid ____ of opposite sex or strangers
___ hand is unclean, use ___ hand for feeding/meds
____ covers arms/legs/chest/head
Prefer ____ birth attendant
Avoid ___, ___, gelatin due to fasting rules in Ramadan
Prefers ____ the first 2 years
eye
touch
left, right
Hijab
female
pork, lard
breastfeeding
Traditional asian men frequently ___ ___ attend the delivery
DO NOT
____ is the perfect labor position in asian culture
Squatting
Maternal confinement after childbirth for ___ weeks is common in asian culture
3
Asians may request warm water/tea and refuse __ ___
ice packs
In hispanic culture, to protect herself a woman should carry a __ __ or wear a __ ___ around their waist
safety pin
red string
___ food are preferred during postpartum among hispanic women
Hot
In hindu culture, childbirth is a ____ activity
religious
In hindu culture the baby is bathed then dressed in all new attire and the red dot is put on. Some people also name the child on the ___ day.
sixth
In hindu culture, names are chose according to _____
astrology
Haitian mothers are placed on strict ____ for 3 days after delivery
bedrest
In Haitian culture, “White and cold” foods are believed to increase vaginal discharge/risk of ____
hemorrhage
Haitian women __ ___ encourage circumcision
do not
Haitian women are encourage to ___ the baby’s ____ to narrow the ____
pinch
nose
nostrils
Nursing care for the mother who relinquishes her infant:
active listening
provide non-judgmental support
show concern and compassion
personalize care for the mother
Nursing care for the adolescent mother post-discharge:
childcare
transportation
financial support
education
____ ___ is a transient period of depression; occurs during three to seven days postpartum
Postpartum blues
Postpartum blues occurs in ___ of new mothers
85%
S/S of postpartum blues?
Roller coaster of emotions
mood swings
anger
weepiness
anorexia
difficulty sleeping
feeling of being let down
What causes postpartum blues?
hormones, lack of sleep, adjusting to newborn, anxiety
What is the treatment of postpartum blues?
sleep, support, time
Postpartum depression starts within __-__ weeks of having a baby
1-3
Postpartum depression occurs in __ out of ___ new mothers
1, 7
S/S of postpartum depression?
crying for no reason, hopeless, overwhelmed, moody, irritable, panic or excessive worry, thoughts of self harm, ***risk of suicide
What are risk factors for postpartum depression?
hx of depression or bipolar disorder, stressful life event, ambivalence, lack of support, age <20
What is treatment for postpartum depression?
counseling, support group, medication
What is the most effective treatment of PPD?
combination of psychotherapy and antidepressants
Most woman show signs of improvement in __-___ weeks using SSRI medication
2-6
PPD mothers should continue medical therapy for ___ after symptoms resolve
1 year
___ ___ is an acute mental disorder or psychotic reaction following childbirth
postpartum psychosis
Onset of postpartum psychosis is __- __ months after delivery, usually in the first ___ days
1-3
10
S/S of postpartum psychosis?
insomnia, agitated or paranoid, delusions or hallucinations, impulsive, depersonalization, risk of suicide or infanticide
risks for postpartum psychosis?
Hx of postpartum psychosis or hx of bipolar disorder
___ ___ is considered a psychotic emergency that requires ____
Postpartum psychosis
hospitalization
Treatment for postpartum psychosis?
immediate hospitalization, psychological counseling, family support/education, ECT, medications
The greatest barrier to treatment for PPD in women is?
fear of stigma and lack of knowledge
