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Family Nursing > Postpartum Physiological Assessments and Nursing Care- 12 > Flashcards

Postpartum Physiological Assessments and Nursing Care- 12 Flashcards

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1
Q

postpartum period

A

6-week period after childbirth

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2
Q

Maternal mortality

A

death of a woman from complications of pregnancy and childbirth occurring up to 1 year postpartum

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3
Q

Postpartum Assessment

A

● Vital signs, pain, breath and heart sounds

● Laboratory findings, such as CBC, rubella status, and Rh status

● Breasts

● Uterus

● Bladder

● Bowel

● Lochia

● Episiotomy, lacerations, perineum, hemorrhoids

● Lower extremities

● Emotions, bonding with infant, fatigue, psychosocial factors

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4
Q

Changes of uterus

A

uterus goes back to placement and size prepregnancy takes 6-8 weeks
uterine contractions, atrophy of muscles, decrease in size of uterine cells

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5
Q

Afterpains

A

moderate to severe cramp-like pains related to the uterus working to remain contracted and/or the increase of oxytocin released in response to infant suckling.

occur first few days after birth

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6
Q

Nursing actions- uterus

A

assess for size, location, tone

instruct the woman to void every two hours

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7
Q

Uterine Atony (Boggy Uterus)

A

Uterine atony is the most common cause of postpartum hemorrhage.

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8
Q

Treating atony

A

uterine massage
drugs that promote uterine contraction-oxytocin
notify provider
measure distance between fundus and umbilicus
have patient void if uterus is not in place

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9
Q

oxytocin (pitocin)

A

Oxytocin stimulates the upper segment of the myometrium to contract rhythmically, which constricts spiral arteries and decreases blood flow through the uterus.

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10
Q

Subinvolution

A

failure of the uterus to involute/descend as expected

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11
Q

movement of uterus

A

1cm a day for about 14 days

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12
Q

endometrium, the mucous membrane that lines the uterus

A

undergoes exfoliation and regeneration after birth of placenta- prevents scarring

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13
Q

Lochia

A

bloody discharge from the uterus that contains red blood cells, sloughed off decidual tissue, epithelial cells, and bacteria

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14
Q

nursing actions- lochia

A

assess color amount and odor

assess for clots (egg sized or larger should be weighed)

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15
Q

seeing a clot- why

A

lochia has been pooling in the lower uterine segment.

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16
Q

Retained placental tissue causes what

A

interferes with uterine involution and lead to excessive bleeding

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17
Q

measuring blood conversion

A

1 g equals 1 mL of fluid

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18
Q

good void amount

A

300cc

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19
Q

Vital sign warning signs

A 
BP <90or>160/>100
BPM <50 >120
resp <10 >30
O2 <95
Oliguria <35

agitation, confusion, unresponsiveness

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20
Q

vagina and perineum changes

A

may include edema, mild stretching, minor lacerations, major tears, and/or episiotomies.

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21
Q

midline episiotomy

A

incision that is midline on the perineum. heals quicker

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22
Q

mediolateral episiotomy

A

incision that is made at a 45-degree angle to the perineum.

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23
Q

nursing action peri area

A 
assess
swelling,bruising,mild/mod pain
provide comfort measures
ice first 24-48, then heat
medication as ordered
reduce risk for infection
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24
Q

nonpharmacological interventions

A
  • Ice packs
  • Warm compresses
  • Sitz baths
  • Repositioning
  • Showering
  • Topical treatments
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25
Q

Pharmacological interventions

A
  • NSAIDs- mild to moderate pain

* Opioid analgesics may be used for moderate to severe pain.

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26
Q

changes in breasts

A

decrease in estrogen and progesterone and an increase in prolactin

When the infant suckles, the posterior pituitary releases oxytocin, resulting in the milk ejection reflex, also called the let-down reflex

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27
Q

Colostrum

A

a clear, yellowish fluid, precedes milk production and is secreted after delivery.

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28
Q

Immediately after delivery-breasts

A

fullness tissue may be swollen, it is soft and nontender 24-48 hr

29
Q

around third day- breasts

A

The woman’s breasts become larger, firm, warm, and tender, and the woman may feel a throbbing pain in the breasts.

30
Q

Nursing action-breastfeeding

A

● Inspect and palpate the breasts for signs of engorgement
● Assess the nipples for signs of irritation and nipple tissue breakdown.
● Assess for plugged milk ducts

31
Q

Nursing action-nonbreast feeding

A

● Assess the breasts for primary engorgement.

milk leakage, breast pain, and engorgement may be experienced between 1 and 4 days postdelivery

32
Q

Treatment for breastfeeding women

A

● Frequent feedings to empty the breasts and to prevent milk stasis

● Warm compresses to the breast and breast massage to facilitate the flow of milk prior to feeding sessions

● Express milk by breast pump or manually if the infant is unable to nurse (i.e., preterm infant)

● Ice packs after feedings to reduce inflammation and discomfort

● Analgesics for pain management

● Wear a supportive bra

33
Q

Prevention and treatment for nonbreastfeeding women

A

● Wear a supportive bra

● Avoid stimulating the breast

● Ice packs to breast

● Analgesics for pain management

● Subsides within 48 to 72 hours

34
Q

mastitis

A

infection may be caused by bacterial entry through cracks in the nipples and is associated with milk stasis, engorgement, long intervals between feedings, stress, and fatigue

Symptoms include fever, chills, malaise, flulike symptoms, unilateral breast pain, and redness and tenderness in the infected area.

35
Q

Average blood loss in labor

A

200 to 500 mL through vaginal birth

36
Q

risk for orthostatic hypotension

A

increases during the first postpartum week due to decreased vascular resistance in the pelvis.

37
Q

thromboembolism

A

women at risk for two weeks postpartum due to clotting factors

38
Q

postpartum chills

A

vascular instability leads to chills

39
Q

venous thrombosis

A

thrombosis in a vein, caused by a thrombus (blood clot)

40
Q

increase of coagulability

A

puts mom at risk for blood clots

41
Q

Respiratory system changes

A

Chest wall compliance returns after the birth of the infant

42
Q

Rubella Immunization

A

● Postpartum women who are rubella-nonimmune should be immunized for rubella before discharge.
● Women who contract rubella during the first trimester have a 90% chance of transmitting the virus to their fetuses.
● Fetuses exposed to rubella during the first trimester are at risk for birth defects
● Women who are immunized should avoid pregnancy for 4 weeks

43
Q

immune system changes

A

suppressed during pregnancy, returns to normal in postpartum period
mild temp elevations first 24hr

44
Q

Rh isoimmunization

A

Rh-negative woman develops antibodies to Rh-positive blood related to exposure to Rh-positive blood either by blood transfusion or during pregnancy with a Rh-positive fetus.

45
Q

Rho immune globulin

A

● Indication: Administered to Rh-negative women who have given birth to an Rh-positive neonate

● Action: Prevents production of anti-Rh (D) antibodies

46
Q

Transient stress incontinence

A

associated with impaired pelvic muscle function involving the urethra may occur in the first 6 weeks postpartum

47
Q

Common bladder problems first few days post birth

A

Bladder distention, rapid bladder filling, incomplete emptying, and inability to void

48
Q

bladder problems-why

A

administration of intravenous fluids in the postdelivery period, decreased sensation of the urge to void due to anesthesia or analgesia, edema around the urethra, perineal lacerations or episiotomy, operative vaginal delivery, or bladder trauma

49
Q

nursing actions- bladder

A

assist to bathroom
assess for disturbances
measure voids- at least 300cc within 2-4hr post birth
use bladder scan if voids are less than 150ml
assess for UTI signs
instruct 10 glasses water a day
edema should decrease in 24 hr

50
Q

Cystitis-bladder inflammation/infection

s/s and treatment

A

● Symptoms: Frequency, urgency, pain/burning on urination, suprapubic tenderness, hematuria, and malaise

● Treatment: Antibiotic therapy, increased hydration, rest

51
Q

Diaphoresis

A

This profuse sweating, which often occurs at night, assists the body in excreting the increased fluid accumulated during pregnancy

52
Q

endocrine changes

A

Estrogen, progesterone, and prolactin levels decrease. Estrogen levels begin to rise after the first week post-partum.

53
Q

diastasis recti abdominis

A

separation of the rectus muscle

54
Q

muscular/nervous system changes

A

abdominal muscles experience reduced tone and the abdomen appears soft and flabby.
soreness
loss of nerve sensation temporarily from epidural

55
Q

expected findings muscle

A 
some soreness
full sensation for moms without epidural
diminished sensation for moms with epidural
fatigue
no headache
56
Q

GI changes/risks

A

mobility returns to normal by end of week 2

constipation
hemorrhoids
appetite may vary
weight- most experience significant loss during 2-3 weeks post

57
Q

constipation nursing actions

A 
ask about bowel movements
increase fluids
increase fiber
look at past treatment
encourage ambulation
medication as ordered
58
Q

hemorrhoids nursing action

A

avoid sitting for long periods
lay on side
witch hazel
sitz baths

59
Q

fourth trimester

A

lack of sleep, fatigue, pain, breastfeeding difficulties, stress, depression, lack of sexual desire, and urinary incontinence.

60
Q

postpartum visit

A

full assessment of physical, social, and psychological well-being, with screening for postpartum depression

61
Q

Postpartum Discharge Teaching Project: Warning Signs

Call 911

A

Pain in the chest

Obstructed breathing or shortness of breath

Seizures

Thoughts of hurting yourself or baby Call your provider for:

Bleeding soaking though one pad/hour or passing a clot the size of an egg.

Incision that is not healing

Red or swollen leg that is warm or painful to touch

Temperature of 100.4 or higher

Headache that does not get better even after taking medicine, or bad headache with changes in vision

62
Q

Expected physical changes

A

● Uterine involution, afterpains, progression of lochia

● Breast changes, engorgement

● Diaphoresis and diuresis

● Weight loss

● Women can expect to lose approximately 12 pounds immediately after delivery, and an additional 5 to 8 pounds due to fluid losses associated with uterine involution and diuresis

63
Q

Self care for mom

A

● Hygiene

● Perineal care, continue to change pad frequently and use peri-bottle until lochia has stopped

● Breast care for lactating and nonlactating women

● Pharmacological and nonpharmacological pain control measures

64
Q

Lactating women nutrition

A

increase their caloric intake by 500 to 1,000 calories per day and have a fluid intake of approximately 2 to 3 liters per day.

65
Q

Exercise

A

activity decreases constipation
appropriate post part exercises- walking
kegel exercises- strengthen pelvic floor

66
Q

Tobacco use

A

teach about dangers
never allow smoking around baby
encourage women to stay abstinent from smoking or stop

67
Q

weight loss after childbirth- how

A

exercise in combination with diet

diet alone

68
Q

sexual activity- talk with physician

A

● General guidelines are to resume sexual intercourse when the lochia has stopped, perineum has healed, and the woman is physically and emotionally ready.

69
Q

Contraception

A

● Assess the couple’s desire for future pregnancies.

● Assess satisfaction with previous method of contraception.

●encourage talking with doctor

●provide info on different types

Family Nursing (16 decks)

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