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Maternal-Newborn (Josh) > T3 - Nursing Care During Postpartum (Josh) > Flashcards

T3 - Nursing Care During Postpartum (Josh) Flashcards

1
Q

What are we assessing during the 4th stage?

A

VS

Fundus

Lochia

Perineum (REEDA)

Bladder

PAR (post-anesthesia record)

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2
Q

How often do we access VS, etc.?

A

First hour…q15 minutes

Second hour…q30 minutes if stable

Then every hour for 4 hours

Then every 8 hours until discharge

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3
Q

How to remember when to access?

A

q15 x 4 (first hr)

q30 x 2 (second hr)

q1hr x 4 (next four hrs)

q8hr until discharge

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4
Q

Risk factors for excessive bleeding postpartum?

A

Macrosomic (4000g) baby or multiple birth

Long/Difficult laborMultipara

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5
Q

When would a baby be large for gestational age?

When would a baby be small for gestational age?

A

above 90th percentile

below 10th percintile

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6
Q

Large baby is –

Small baby is —

A

4000 g

2500 g

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7
Q

Fundus should drop — every day

A

1 cm

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8
Q

What is the most common cause of postpartum hemorrhage?

A

uterine atony

***assess for boggy uterus

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9
Q

What is left on the endometrial wall after placenta is expelled?

A

denuded area of exposed blood vessels about the size of a fist

***why there is still some bleeding

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10
Q

Interventions for boggy uterus.

A

Immediate response may be to massage the fundus until firm…Express any clots that may be present

Check bladder for distention…Assist patient to empty bladder

Change pad…note quantity of lochia (pad soaked in

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11
Q

Meds used to stimulate contractions postpartum.

A

Pitocin

Methergine (hold if BP 140/90 or greater)

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12
Q

If temp is up during first 24 hours postpartum, what is likely cause?

A

dehydration

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13
Q

Call provider if HR —

A

> 100

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14
Q

What temp indicates infection in postpartum client?

A

Temperature greater than 100.4 that persists X2 days (exclusive of first 24 hours)

***after 24 hrs, think infection

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15
Q

Nursing actions to prevent infection during postpartum stage?

A

Change perineal pad with each voiding or defecation

Peri care

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16
Q

How do we assess the perineum?

A

REEDA

Lochia for color, quantity, and odor

***C-section have less bleeding

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17
Q

Nursing interventions to promote healing of perineum

A

Ice pack (cold) X 1st 24 hours to decrease edema

Sitz bath (warm) after 24 hours – tid X 20 minutes

Peri care with warm water with each urination

Blot dry, wipe from front to back

Apply new pad after each voiding

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18
Q

Why does bladder fill so quickly postpartum?

A

fluid shift

remember carrying 50% more volume during preg

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19
Q

How much fluids should we encourage to prevent UTI?

A

3000 mL/day

20
Q

When do we cath a postpartum client?

A

bladder distended

uterus displaced

6hrs elapsed since last void

voiding less than 150 mL

21
Q

Breast care for lactating client

A

Wash nipples and areola with water (NO SOAP)

Airdry X 20 minutes

Apply expressed breast milk or nonalcohol cream to prevent drying and cracking (Cracks in skin = pathogens mastitis)

Empty engorged breasts manually or with breast pumpSupport bra

22
Q

Nonlactating mom needs — calories.

Lactating mom needs – calories

A

1800-2200

additional 450-500/day

23
Q

Nutrition for lactating client

A

Increase fluids

Increase caloric intake to 2700 kcal/day

No meds without consulting physician

Avoid foods gastric irritation, gas or diarrhea

24
Q

When they have mastitis, do they need to stop breastfeeding?

A

yes, b/c they are likely on antibiotics

***pump and dump

25
Q

How to suppress lactation

A

Support bra

Avoid stimulation to breastIce packs …15 minutes q hour

Comfort measures for breast engorgement

Analgesic or anti-inflammatory medication

Cool clean cabbage leaves

26
Q

— during pregnancy can continue into postpartum period.

A

PIH

***lasts up to 6 wks after delivery

***investigate pitting edema

27
Q

What is a safe anticoagulant for breastfeeding clients?

A

Heparin

28
Q

What is Homan’s Sign?

A

calf tenderness upon dorsiflexion of foot

***sign of DVT

29
Q

What is best prevention for DVT postpartum?

A

early ambulation

30
Q

What is the purpose of the Indirect Coombs test?

A

detect anti Rh antibodies in mother’s blood

***administer 300 mcg of Rhogam within 72 hrs

31
Q

Prevention of Iso-immunization

A

Indirect Coombs test negative = no anti Rh antibodies in mother’s blood.

Administer RhoGAM 300 mcg IM within 72 hours of delivery

Administer as for blood productTest immunity in 3 months

32
Q

When would Rubella vaccine be administered postpartum?

A

after birth and again at 1 mth

33
Q

Nursing education regarding Rubella Immnization

A

Teach client to avoid pregnancy X 1 month after each dose

Safe for breast feeding patients

May develop rash…

***can’t take if allergic to eggs

34
Q

What is Hot-Cold Asian Culture?

A

Pregnancy is considered hot condition, heat is depleted during birth, now she is in a cold state for 40 days. She consumes only hot food, & beverages. She may be discourage from showering or bathing because this could cause heat loss

35
Q

What is the ‘Taking In’ Phase?

A

First 1-2 days postpartum

Introspective and preoccupied with own needs rather than new baby

Passive/dependent behavior

Excited & talkative

Touches and explores infant

Needs to verbalize L&D experience

36
Q

What is the ‘Taking Hold’ Phase?

A

Begins by 2nd to 3rd postpartum day, lasts 10 days up to several weeks

Moves toward more independent behavior

Desires to take charge

More receptive to teaching

37
Q

What is the ‘Letting Go’ Phase?

A

Achieves realistic independent role

Establishes norms for self and family

Mothering functions established

Resumption of relationship with partner

Resumption of sexual activity

Family system enters new phase of development

38
Q

Transient depression usually b/t 2nd and 3rd PP day or within 2 wks?

A

Postpartum Blues

39
Q

Characteristics of PP Blues

A

Usually between 2nd and 3rd postpartum day or within two weeks

Characterized by mood swings, anger, tearfulness, feeling let down, anorexia and insomnia

Emotionally labile, cries for no reason

40
Q

What happens if Postpartum Blues persist and don’t resolve spontaneously?

A

evaluate for PP depression

41
Q

Temperature may be elevated after delivery r/t —.

A

dehydration

42
Q

After 24h a temp elevation of — correlates to postpartum infection.

A

100.4F

***This is lower temp than usually considered an infection.

43
Q

— can occur postpartum.

A

Preeclampsia

44
Q

What does BUBBLE-HE stand for?

A

Breasts

Uterus

Bladder

Bowels

Lochia

Episiotomy/Laceration

Hemorrhoids/Homan’s

Emotion

45
Q

Scant Lochia =

Small Lochia =

Moderate Lochia =

Heavy Lochia =

A

Scant Lochia = 10 cm (25-50 mL or 25-50 g)

Heavy Lochia = 1 pad saturated within 2 hrs

46
Q

What type of lochia constitutes an immediate assessment?

A

pad saturated in 15 mins or less

***Notify MD

Maternal-Newborn (Josh) (29 decks)

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