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NSG 432 - OB > T5: Postpartum Family > Flashcards

T5: Postpartum Family Flashcards

1
Q

involution

A

the rapid decrease in the size of the uterus as it returns to its non-pregnant state; begins with the placenta is expelled

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2
Q

when feeling for the fundus what is your landmark

A

the umbilicus

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3
Q

right after delivery where is the fundus

A

two fingers below the umbilicus

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4
Q

12 hours after delivery where is the fundus

A

one finger above the umbilicus

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5
Q

24 hours after delivery where is the fundus

A

at the level of the umbilicus

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6
Q

after 25 hours the fundal height…

A

decreases approximately 1cm/day

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7
Q

Subinvolution

A

failure of the uterus to return to non-pregnant state

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8
Q

what are the two most common caused of subinvolution

A

-retained placental fragments
-infection

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9
Q

what group has more pain after birth and why

A

Multigravidas have MORE PAIN after birth because their uterus has lost its elasticity, so it needs to work harder to stay contracted.

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10
Q

placental site

A

where the placenta detaches; leaves a wound in the uterus and it heals by the uterus contacting on itself to control the bleeding

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11
Q

what is the drainage from the placental site called

A

lochia (looks like blood but doesnt clot)

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12
Q

lochia

A

discharge from the uterus that consists of blood from the vessels of the placental site

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13
Q

Lochia rubra

A

red in color, seen from day 1-3

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14
Q

lochia serosa

A

pinkish in color, seen in day 3-14

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15
Q

lochia alba

A

yellow to white in color, seen in day 14 up to 6 weeks

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16
Q

amount of lochia: scant

A

less than 1 inch (2.5cm) on menstrual pad in an hour

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17
Q

amount of lochia: light

A

less than 4 inches (10cm) on menstrual pad in an hour

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18
Q

amount of lochia: moderate

A

less than 6 inches (15 cm) on menstrual pad in an hour

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19
Q

amount of lochia: heavy

A

saturated pad in an hour

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20
Q

amount of lochia: excessive

A

menstrual pad saturated in 15 minutes

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21
Q

how to do a fundal check

A

Place hand over symphysis pubis because you can prolapse the uterus (push it out)

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22
Q

what can a distended bladder do to the uterus

A

can shift the uterus to the side and prevent uterus from staying contracted

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23
Q

A flaccid fundus indicates

A

uterine atony

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24
Q

what should be done for a flaccid fundus (uterine atony)

A

should be massaged until firm; a tender fundus indicates infection

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25
Q

cervix remains open until

A

day 6

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26
Q

what hormones decrease and which ones increase after delivery

A

estrogen and progesterone decrease

prolactin and oxytocin increase

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27
Q

Initially the opening of the vagina (introitus) is…

A

edematous and erythematous

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28
Q

episiotomies and laceration should be healed by

A

week 6

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29
Q

teaching for episiotomies and lacerations

A

o Teach mom to make sure the area is kept clean and dry to prevent infection
o Icepacks to help with swelling

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30
Q

first degree laceration

A

laceration that extend through skin and structures superficial to muscles

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31
Q

second degree laceration

A

laceration that extend through muscles to the perineal body

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32
Q

third degree laceration

A

laceration that extend through the anal sphincter muscle

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33
Q

fourth degree laceration

A

laceration that also involves the anterior rectal wall

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34
Q

pelvic muscular support

A
  • Since the pelvic floor is weak, the patient may have incontinence of urine
  • Encourage Kegal exercises to strengthen pelvic floor
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35
Q

estrogen and progesterone levels are lowest when

A

1 week post partum

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36
Q

oxytocin is for…

A

“let down” reflex of milk or ejection

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37
Q

prolactin is for

A

production of milk

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38
Q

ovulation takes longer in women who

A

breast feed

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39
Q

what does elevated serum prolactin levels in breast feeding women do

A

supressed ovulation

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40
Q

mature milk production begins

A

3 days after delivery

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41
Q

When is colostrum present?

A

16 weeks (baby feeds on this for the first 3 days after delivery)

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42
Q

If mother chose not to breast fees, ovulation can occur in

A

27 days

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43
Q

if a mother choses not to breast feed what should be done

A

no stimulation of the breast
o Encourages to wear a tight bra and put cabbage in the bra to reduce pain

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44
Q

WOMEN MAY OVULATE WITH OUT MENSTRUATING, SO…

A

BREAST FEEDING SHOULD NOT BE CONSIDERED A FORM OF BIRTH CONTROL

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45
Q

Diuresis usually begins within

A

first 12 hours after birth

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46
Q

GI system interventions after delivery

A

Clients are usually hungry after birth
-Constipation can occur so stool softener (like Colase) is prescribed
o We want to avoid constipation because it can cause a suture to open
o Hemorrhoids are common

47
Q

Breasts continue to secrete colostrum for

A

the first 48-72 hours after birth

48
Q

Decrease in estrogen and progesterone after birth stimulates

A

increased prolactin levels which promotes breast milk production

49
Q

Breasts become distended with milk on the third day so…

A

o Breast feeding relieves engorgement

50
Q

Breast care for NON-breast-feeding mothers

A

o Avoid stimulation
o Apply breast binder, snug fitting bra, apply ice, and mild analgesic for engorgement

51
Q

CV system post partum

A

Blood volume loss after delivery, however everything goes back to normal at the end of 6 weeks
o Check CBC after delivery to see hoe the patient compensated the loss (hematocrit, WBC, coagulation factors)

52
Q

respiratory system post partum

A

-Decrease in intra-abdominal pressure, mom can breathe easier now
-Decline in progesterone causes the PaCO2 to rise

53
Q

immune system post partum

A

Mild suppression during pregnancy resolves gradually

54
Q

BUBBLE HE assessment

A

Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy, Homan’s Sign, Emotional Status

55
Q

Couplet Care

A

model of caring that emphasizes mother and baby being cared for together, as a pair or “couplet,” during their entire hospital stay by the same nurse

56
Q

nutrition for breast feeding

A

o FLUIDS!
o Calories increase by 200-500 calories/day and continuance of prenatals during breast feeding

57
Q

vaccinations post partum

A
  • Rubella vaccination can be given after delivery, before she goes home
  • Varicella vaccination
  • Tetanus-diphtheria-acellular pertussis (Tdap)
58
Q

Rh iso-immunization

A

Rh immune globulin should be given within 72 hours for R-negative women who deliver an Rh-positive infant

59
Q

a minimum of how many hours after vaginal birth

A

48 hours

60
Q

a minimum of how many hours after cesarean birth

A

96 hours

61
Q

Criteria for discharge

A

o Plan for discharge as soon as the baby is born
o Mom and baby need to be healthy for discharge and need to have education
o Teach nothing in vagina for 6 weeks

62
Q

Baby needs to see pediatrician…

A

1-2 days after discharge for jaundice check and weight

63
Q

Attachment/Bonding

A

the process by which a parent comes to love and accept a child and a child comes to love and accept the parent

64
Q

Proximity

A

proximity and interaction with the infant through which the parent becomes acquainted with the infant and identifies the infant as a member of the family

65
Q

Mutuality

A

the infants’ behaviors and characteristics elicit a corresponding set of parental behaviors and characteristics
o Ex: crying, cooing, smiling

66
Q

Acquaintance

A

Parents use eye contact, touching, talking and exploring to become acquainted with their infant

67
Q

Claiming process

A

identification of the new baby

68
Q

Assessment of Attachment

A

-Eye contact
-Appropriate behavior
o Early skin to skin stimulates maternal affection and can help with thermoregulation
-past history of parents

69
Q

Transition to parenthood is a

A

DEVELOPMENTAL TRANSITION, not a LIFE CRISIS

70
Q

post partum blues time period

A

peak around 5 days and subsides around day 10

71
Q

post partum depression time period

A

depression lasts more than 10 days

72
Q

post partum psychosis time period

A

goes beyond 10 days, hallucinations about things happening, medical intervention is needed

73
Q

what leads to post partum blues

A

Hormone shifts (decrease in estrogen and progesterone and increase in oxytocin and prolactin)

74
Q

treatment for post partum blues

A

no medication required

75
Q

treatment for post partum depression

A

depression medication
- St. John’s Wort is discouraged because it is not known if it can be harmful to the baby through breastmilk

76
Q

what screening instrument most commonly used to identify women with postpartum mood disorders

A

The Edinburgh Postnatal Depression Scale (EPDS)

77
Q

primary hemorrhage

A

occurs within 24 hours of giving birth

78
Q

secondary hemorrhage

A

occurs after the first 24 hours but within the 6 weeks after delivery

79
Q

blood amount for vaginal birth is considered hemorrhage

A

> 500mL

80
Q

blood amount for cesarean birth is considered hemorrhage

A

> 1000mL

81
Q

risk for postpartum hemorrhage

A

-uterine atony
-lacerations of genital tract
-anemia
-hematoma
-retained placenta
-inversion of uterus
-subinvolution

82
Q

uterine atony

A

poorly contracted uterus that does not adequately compress large open vessels at the placental site which can result in hemorrhage

83
Q

s/s uterine atony

A

a soft (boggy) uterus is palpated

84
Q

causes of uterine atony

A

multiple pregnancies, if they have rapid or prolonged labor, and prolonged use of oxytocin, obesity (large baby), polyhydramnios (large amount of amniotic fluid >1500mL)

85
Q

Placenta accrete

A

when placenta is slightly penetrating lining of the uterus (myometrium)

86
Q

Placenta increate

A

deeper penetration into the uterus

87
Q

Placenta percreta

A

completely into the uterus and can go into other organs too

88
Q

intervention for placenta increate and percreta

A

hysterectomy

89
Q

Anemia must be..

A

o fixed during pregnancy because it can lead to post-partum hemorrhage.

90
Q

Hematoma

A

localized collection of blood in the tissues and can occur internally

91
Q

retained placenta

A

Placenta or fragments of the placenta remain in the uterus preventing the uterus from contracting which leads to uterine atony or subinvolution

92
Q

Inversion of the uterus

A

turning inside out of uterus

93
Q

first step for post partum hemorrhage

A

evaluation of contractility of uterus: DO A FIRM FUNDAL MASSAGE!

94
Q

second step for post partum hemorrhage

A

active the protocol (click emergency light, activate medication, call doc, gets nurse help), V/S, IV Fluids (LR), give PITOCIN FIRST AS BOLUS, need to get another IV catheter access because you may need a blood transfusion and it NEEDS ITS OWN LINE!

95
Q

medication fro second step of post partum hemorrhage

A

IV Fluids (LR), give PITOCIN FIRST AS BOLUS

96
Q

third step for post partum hemorrhage

A

PLACE FOLEY because distended bladder can cause uterus not to contract

97
Q

fourth step for post partum hemorrhage

A

give CYTOTEC (Misoprostol) (1000mg given per rectum)

98
Q

Cytotec (Misoprostol) Administration

A

rectal (1000mg)

99
Q

fifth step for post partum hemorrhage

A

Methergine given IM or PO (never IVPush)

100
Q

Methergine administration

A

given IM or PO (never IVPush)

101
Q

what needs to be checked before methergine is given

A

§ MUST CHECK BP BEFORE GIVING if BP is elevated cannot give because it causes vasoconstriction and can cause patient to stroke

102
Q

sixth step for post partum hemorrhage

A

give Hemabate (Carboprost) given IM (never IVPush)

103
Q

Hemabate (Carboprost) administration

A

given IM (never IVPush)

104
Q

what needs to be checked before Hemabate (Carboprost) is given

A

MUST MAKE SURE PATIENT IS NOT ASTHMATIC

105
Q

Two of the most common SE of Hemabate (Carboprost)

A

N/V/D, so make sure Lomotil or Imodium is ordered to help with diarrhea

106
Q

seventh step for post partum hemorrhage

A

BAKRI BALLOON

107
Q

Bakri Balloon

A

BAKRI BALLOON which stays in uterus for 24 hours filled with 500 mL of NS, must be removed OVER TIME because you want to observe the bleeding
-Puts pressure on the uterus

108
Q

Idiopathic thrombocytopenic purpura (ITP)

A

disorder in which a deficiency of platelets results in abnormal blood clotting, marked by tiny purple bruises (purpura) that form under the skin

109
Q

Von Willebrand Disease

A

bleeding disorder caused by a deficiency of von Willebrand factor, a “sticky” protein that lines blood vessels and reacts with platelets to form a plug that leads to clot formation

110
Q

Disseminated intravascular coagulation

A

abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues

111
Q

Puerperal sepsis

A

any infection of genital tract within 28 days after miscarriage, induced abortion, or birth
o Most common infecting agents are numerous streptococcal and anaerobic organisms

112
Q

Endometritis

A

inflammation/infection of the inner lining of the uterus

113
Q

Mastitis

A

inflammation of the breast as a result of a blocked duct and infection

114
Q

s/s Mastitis

A

o localized heat and swelling, pain, elevated temperature
o Intervention: apply heat to site, maintain lactation in breastfeeding mothers, encourage manual expression of breast milk, supportive bra without an underwire

NSG 432 - OB (14 decks)

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