Postpartum - Unit 3 Flashcards
What is involution?
When the uterus shrinks back up!
What is catabolism (in regards to involution?)
When the cells shrink back after birth.
by the time a woman leaves the hospital, the uterus is 1-2 fingers below the umbilicus. T/F?
True
The uterus should shrink about __ cm per day.
1cm
The weight of the uterus at delivery is about ____ kg
1 week after = ___ g.
4 weeks = ____ g.
1kg (1000g)
500 g
100 g
Less afterpains with each pregnancy. T/F?
FALSE - you’ll have more afterpains.
Lochia - what is it? How do we measure it?
Fancy term for the bleeding you have after pregnancy. You measure it by how much of the pad is saturated.
If the pad is saturated, what do we do?
Ask the mom about it, see how long she’s had it in, etc. Educate educate educate!
If the pad is saturated within an hour, that’s too much or too little?
TOO much.
Saturated pad = whole bad. T/F?
True
15 minutes = excessive bleeding. T/F?
TRUE
Scant bleeding - how much in an hour?
Small/light - how much in an hour?
Moderate - how much in an hour?
HOLY FUCKING SHIT/EXCESSIVE - how much in an hour?
Scant = 2.5 cm in an hour.
Small/light = 10 cm in an hour.
Moderate = 10-15cm in an hour.
HOLY FUCKING SHIT/EXCESSIVE = >15cm.
The cervix will go back to almost closed. T/F?
TRUE
By one week, the mom is dilated to __ cm with edema present for up to ____ to ____ Months.
1cm.
3-4months.
It takes __ to ___ weeks for the epithelial cells of the vagina to be repaired.
It will regain tone but won’t go back to normal. T/F?
6-10 weeks.
True!
You can have a baby immediately after birth - T/F?
FALSE - wait at least 6 weeks!
Cardiac - ___ ml of blood is shifted back into circulation after birth.
500ml
Due to the excess fluid/blood/etc. in the body during pregnancy, how does the body get rid of it?
SWEAT and pottying a ton!
It’s normal to have a slightly elevated WBC after the end of the pregnancy. T/F?
TRUE
Hct takes 4-6 weeks to return to normal, unless there’s excessive blood loss. T/F?
TRUE
Increased coagulation takes about 4-6 months to return to normal. T/F?
FALSE - 4-6 weeks.
Progesterone will make your bowel sludgy for a few days after, so what are women at a risk for?
Normal BM’s return in __ to ___ days.
Constipation - 8-14 `days.
Takes about 4 weeks for the urinary system to return to normal. T/F? Until then, they might lack sensation, etc.
TRUE
Acetone is sometimes normal in the urine. T/F?
TRUE
stress continence disappears at about __ weeks.
8
Sometimes, women can have aches and pains that come out of nowhere a few days after pregnancy, right?
YES
Stretch marks disappear, but skin marks like linea nigra never fade. T/F?
FALSE - linea nigra and such will disappear BUT stretch marks do not disappear (they just get lighter/silvery)
Hair loss - bald spots can happen, but not often. You’ll look normal at about ___ months.
5
Breastfeeding can hold menstruating out, but it’s not contraception. T/F?
TRUE
Quarter sized clots - ok or bad?
Golf ball sized clots - ok or bad?
Grapefruit size - ok or bad?
Quarter sized clots - ok
Golf ball sized clots - ok, as long as they aren’t often.
Grapefruit size - BAD
Prolactin increase milk production __ to ___ days after delivery.
2-3 days
If the mom starts pumping too early, the body will think “okay, great, I’ll make even ____ (more or less?)”
MORE, so don’t encourage a non-breastfeeding mom to pump.
Oxytocin is needed for let-down. T/F?
TRUE
10-13 pounds are lost during birth itself, then 5-8 pounds for diruesis, 2-3 for lochia, and 2-3 for inversion. T/F? She’ll be within 1kg of her pre-pregnancy weight within how long?
TRUE
one year.
Fundal check - push on uterus and then push…do we support the ligaments?
YES
Uterus - shouldn’t be hard. T/F?
FALSE - it should be. If it isn’t, massage that fucker.
If the fundus isn’t midline, then maybe she needs to ___?
PEE
IV - should be left in for how long after birth?
6 hours.
Pneumonia vac - over the age of 19 and you have to have a risk factor, like asthma. T/F?
TRUE
What is BUBBLE-HE?
For focused assessment -
Breasts Uterus Bladder Bowels Lochia Episiotomies Homan's Sign Emotional state
What are some parts of the chart review?
Gravida/para, time of delivery, type of delivery, episiotomy or lacerations, anesthesia/meds given, surgery?, history, meds in general, food/drug allergies, condition of infant, lab data, need for rhogam, immunizations, risk factors for bleeding
What are some parts of the initial assessment?
Vital signs, skin color, fundus, lochia, perineum, pain, IV, urinary output, level of feeding and ability to stand.
What are some comfort measure we can give?
Ice packs, sitz bath, perineal care, topical medications, pain medications, promoting bladder elimination and providing fluids and food.
Ice pack for the first __ hours, then warm water.
24 hours.
Episiotomy - patients need to pat dry with toilet paper, and they should not WIPE dry. T/F?
TRUE
For episiotomy patients, what are some sprays they should use?
Demaplast (Benzacaine) spray - it’s cold and numbing. Use it every other time they go to the bathroom.
The opposite time is hydrocortizone.
Witch hazel pads every time.
What are some post-partum pain meds?
Ibuprofen and naproxen - but might have norco, tylenol #3 for 3rd or 4th degree episiotomy repair.
C-section - after, they might get what med for pain? (Hint, starts with P!)
Percocet
What are some assessments after a c-section?
Pain relief, respirations, abdomen, I/O
C-Section - I/O until catheter comes out. T/F?
True
24 hours after c-section - resume normal activities. T/F?
True
Encourage use of straws after c-section - T/F?
FALSE - it increases gas pain.
What do we do for the first 24 hours after c section?
24 hours after?
First 24 = providing pain relief, overcoming immobility, providing comfort.
After 24 hours - resuming normal activities, assisting with feeding, preventing abdominal distention, teaching for discharge
Handwashing - is it important?
YES
Are cabbage leaves good for breast engorgement?
YES
Babies can something eat every 30 minutes..or two hours. T/F?
True - so it can disrupt rest for a mom.
How long until women should resume sex?
AT LEAST 6 weeks.
What are some signs and symptoms that should be reported?
Fever, localized area of redness/swelling/or pain in either breast, persistent abdominal tenderness, feelings of pelvic fullness or pressure, persistent perineal pain, frequency/urgency/burning on urination, abnormal changes in lochia, localized tenderness/redness/warmth in the legs, redness/separation/ or edema of abdominal incision or foul drainage from incision
Localized area of redness in breast = what?
Probably mastitis
Pelvic fullness might be a what?
Retained placenta
Persistent perineal pain might be a what?
Hematoma
Lochia normally goes to yellow at the end. What should we do if it turns to red?
Report it!
Bonding - two ways. T/F?
FALSE - it is one way. Parent to child.
Attachment - one way?
FALSE - it is two ways. Parent to child and back.
What are the three puerperal phases?
Taking in, taking hold & letting-go
What is the taking-in phase?
You’re just focused on your own needs as the mother. Usually lasts less than a day.
What is the taking hold phase?
Lasts several days, attention shifts towards baby. They are taking care of the baby but forgetting more about themselves, like “oh, I forgot to wash my hair today!”
What is the letting-go phase?
Letting go of their old life, or maybe the pregnancy didn’t end well? Maybe the kid went to NICU? All that.
What’s engrossment for the fathers?
They realize it’s real and become all excited and involved with the bambino!
Kids - might regress once the baby comes. T/F?
TRUE
What are some factors that affect family adaptation?
Discomfort and fatigue, knowledge of infants needs, previous experience, expectations about the newborn, maternal age, maternal temperament, temperament of the infant, support system, birth experience.
Hispanic, Middle Eastern, and Asian women - hate privacy. T/F?
FALSE - they want more privacy.
Muslims - value modesty. T/F?
TRUE
Hispanic/Native American women - they might have increased direct communication. T/F?
FALSE - they will probably have decreased direct communication.
Asian/Hispanic women - follow traditions. T/F?
True
Indian women - return home for 16 weeks. T/F?
TRUE
Phillipines - mom comes to take care. T/F?
TRUE
Mother in law in Korea - she stays away. T/F?
FALSE - she comes to care for baby and mom.
Restriction - 40 days after for Russian moms. T/F?
True
Laotian women - one month after - near a fire- T/F?
TRUE
Native American women - 20 days of rest or until cord falls off. T/F?
True
Asian/Hispanic women - they have to stay cold after birth. T/F?
FALSE - they stay warm.
Mexican women after birth - they tay warm, eat no spicy foods, and do nothing for 40 days. T/F?
True
