Toni - Week 4 - Exam 2 Flashcards
what does BUBBLE-EEE stand for?
Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy, Extremities, Epidural site, and Emotional Status; tells what is different in postpartum assessment than M-S assessment
Breasts: what are we assessing?
looking for cuts, cracks, fissures; trauma, tenderness, baby on breast with in minutes; engorgement, even in women that are bottlefeeding, as time goes on → can get engorged.
Uterus: what are we assessing?
Fundus and Incison (Absence of REEDA)
how can we best assess the fundus?
laying bed/patient flat for accuracy; knees up helps
what specifically are we assessing the fundus for?
firmness and location (in relation to umbilicus and midline)
what are we looking for with REEDA?
absence of redness, edema, ecchymosis (bruising), discharge, and approximation on incision sites
Bladder: what are we assessing?
making sure she’s voiding; void within 6 hrs of delivery; get her upright and to the BR before it’s an issue; standing orders for urinary catheters
Bowel: what are we assessing?
If post op, auscultate bowel sounds before fundal assessment; assess for flatus
Bowel: what foods should you avoid if mother is distended d/t gas?
avoid ice, carbonated drinks, apple juice until passing flatus
Bowel: what can stimulate flatus and BM?
Hot black tea and walking
Lochia: what are we assessing for?
how much she is bleeding, looking for clots, odor
Lochia: what is considered heaving bleeding?
1 pad per hr - 100mL (BEWARE: new pads can hold 500mL)
Lochia: what is the acceptable size of a clot?
the size of a walnut
Episiotomy: what are we assessing?
the perineum and any hemorrhoids
Episiotomy: what is the easiest way to assess the perineum?
have patient turn away from you and put one leg up; maybe have her face the door + shut curtain for privacy
Episiotomy: what do we do about hemorrhoids?
educate the woman on how to digitally reinsert them
What are two types of hemorrhoids?
external - hard, itchy, likely to bleed easily, can reinsert
internal - more than likely; prolapsing of vein
Treatment for hemorrhoids?
tucks, spray, reduced before replacing back inside, shower → reinsert → kegals
Extremities: what are we assessing?
Homan’s sign, edema, and DTRs
T/F: Homan’s sign is a good indication of a clot
FALSE; there is not evidence that supports Homan’s sign; more of something we’ve been doing so long, it makes us feel better
Why do we assess DTRs?
the reason we evaluate DTRs on all postpartum women is because 30% of the women WHO DEVELOP preeclampsia, have postpartum onset.
Epidural site: what are we assessing?
that the site is within normal limits - no discharge, inflammation, or redness
Emotional status: what are we assessing?
the bonding of the mother and baby; father and baby
what are the 7 postpartum cardiovascular changes?
- cardiac output is ↑ for first 48 hours (women will notice heavy sweating and urination to get rid of fluid)
- ↓ HR common the first week (40 - 60 bpm)
- BP stable
- Hgb + Hct reflects estimated blood loss (EBL)’
- WBCS ↑ up to 25,000/mm3 = NORMAL
- Hypercoagulable - risk of thromboembolism
- Temp up to 38C (100.4F) normal first 24 hrs (if above 100.4 → call MD)
what is the maximum loss of blood loss for a vaginal delivery?
500mL; estimated
what is the maximum loss of blood for a C Section?
1000 mL; measured
what are all the risk factors that put a postpartum woman at risk for a clot?
hypercoagulable blood (↑ fibrin), ↑ cardiac output, immobility, obesity, surgery
what are the 2 breast changes postpartum?
colostrum first few days and engorgement
T/F even if a baby is not breast-feeding, we keep colostrum as first thing baby eats.
TRUE; it lines the baby’s gut and helps intestinal movement.
define engorgement.
breasts that are sore, swollen, full of milk, hot, red; difficult for baby to latch
What 5 interventions can help a lactating woman with engorgement?
- breast feed, 1.5 - 2hrs
- express breast milk (pump)
- warm compresses (soften tissue easier to express milk)
- ice packs
- green cabbage leaf (green only, freeze + cut hole for nipple)
what 2 interventions can help a NON-lactating woman with engorgement? why?
• ice packs
• firm bra
- dries up within a week; can’t do anything that will express milk → will keep making more
vagina: what 2 changes happen postpartum?
- thin, smooth walls
- dryness (dyspareunia)
perineum: what 4 changes happen postpartum?
- edema
- erythema
- pain all common
- episiotomy/laceration
pelvic floor muscles: what change occurs postpartum?
stretched, atonic (temporary)
what 4 teachings can be done for postpartum vagina and perineum changes?
- kegels (count to the count of 10 x 10 tid)
- delay intercourse for 6 weeks or until complete absence of lochia (cervix is closed; we dont want anything in the open space → infection)
- water soluble lubricant
- contract butt (gluts) before sitting (↑ comfort)
what are the 6 uterine changes postpartum?
- involation (getting smaller)
- contractions (1st time mother my not feel contraction )
- after pains
- placental attachment site heals
- lochia occurs
- cervix firm by the end of first week (umbilicus right after delivery, 1 cm less q day postpartum)
what are the 3 stages of lochia?
rubra, serosa, and alba
when does rubra occur and what does it look like?
day 1 - 3; dark red/brownish
when does serosa occur and what does it look like?
day 3 - 10; pink
when does alba occur and what does it look like
from day 10 up to 6 weeks; yellowish white + creamy
what are the 3 urinary changes postpartum?
- postpartum diuresis and diaphoresis
- bladder (↓ tone, ↑ capacity)
- full bladder displaces uterus
what can the bladder changes (↓ tone/↑ capacity) cause?
urinary retention and infection
when the bladder displaces the uterus, which direction does it go? what can this cause?
to the right; can cause:
- uterine atony (interferes with contraction)
- ↑ lochia
- **make sure to empty bladder
when should we expect a woman to void postpartum/?
expect void within 6 hrs; catherterize only if needed as ordered
***get her up, do peri care; may have to measure first two voidings
how can we encourage urination?
- privacy
- running water
- hand in warm water
- slow exhale/blow through fist or straw
- peppermint oil in specipan (fumes surround meatus = local relaxation)
what 4 changes can we expect with the GI system postpartum?
- significant hunger and thirst common (haven’t eaten in a while)
- may not have BM for 2 - 3 days (natural diarrhea before labor)
- increased risk for constipation and hemorrhoids
- tears involving anal sphincter can occur (3rd or 4th degree tears)
what are the 3 ways that tears can occur?
- midline episiotomy
- assisted delivery (forceps/vacuum)
- large baby
what are the 5 ways we can promote bowel elimination?
- ambulation, fluids and fiber
- stool softeners as ordered (q day if no BM then prn)
- suppositories (NOT if laceration involves rectum)
- encourage to obey BM urge; bear down normally ( you will not tear stitches out)
- teach may gently reinsert small hemorrhoids into anus
what are 3 interventions to promote bowel elimination post surgery (C-S or tubal ligation)
- assess for flatus/distention
- avoid ice, cold/carbonated drinks, and apple juice
- encourage warm/room temperature liquids (black tea, warm blanket, walk q hour)
when will a non-lactating mother’s menstruation return postpartum?
7 - 9 weeks
when with a lactating mother’s menstruation return postpartum?
3 - 18 months
what is menstruation delayed by?
frequent feedings (on demand/8 - 12 feedings q day) no supplementation (with H2O or formula)
what should we teach woman about menstruation return?
ovulation may occur before first period; she could get pregnant
what are 3 ways we can promote comfort to a woman experiencing after pains?
- warm blanket
- relaxation breathing
- analgesics (ibuprofen + norco)
what 4 ways can we promote perineum comfort?
- ice pack
- sitz bath x 20 min tid
- contract butt before sitting
- perineal care
what 3 tools are used in postpartum peri care?
- peri bottle (warm water)
- blot dry (wiping could be painful)
- peri meds (tucks + spray)
what 5 ways can we promote comfort post C/S?
- gentle C/S fundal checks
- teach exhale when turning (relaxes)
- position baby to avoid pressure on abdomen (football hold)
- assist to lift baby from crib (can’t twist well)
- may have had duramorph spinal (or PCA)
what are the 3 steps to providing a gentle C/S fundal check?
- first explain what you are going to do
- have her inhale then press down over the fundus as she exhales with 1/2 fingers
- if placement too high/low, repeat above
what is RhoGAM?
an immunoglobulin given to block immune response and prevent maternal sensitization
when is RhoGAM indicated?
for Rh- mom who has Rh+ baby (mixing of blood)
what do we have to confirm for RhoGAM?
- mom has negative indirect Coombs test (sensitivity test)
- baby has negative direct Coombs test (cord blood)
when do we administer RhoGAM and where?
Administer 300mcg RhoGAM IM within 72 hours of birth
- given in deltoid to ensure deposited in muscle
- if goes into subQ not the same effect
when is Rubella (MMR) indicated?
indicated if mother is non-immune to rubella (maternal title < 1:8)
how much of the MMR vaccine do we give and when?
0.5 mL subQ just prior to discharge to avoid side effects in the hospital
what are the side effects of MMR?
burning @ site and mild rash
what do we want to teach with the MMR?
teach to avoid pregnancy for 4 weeks; can be administered at same time as RhoGAM
what is bonding and when should it occur?
the attraction to newborn felt by parent; reaching out towards newborn; ideally occurs in critical period right after birth; also occurs in times of crisis
what is attachment?
development of affectionate relationship between parent and newborn - “saying looks like dad, cooing”
what are the different phases of maternal adjustment?
taking in, taking hold, and letting go
when does taking in take place and what does it consist of?
1 - 2 days postpartum; mother is preoccupied with herself and baby, wants to talk about birth, explores infant
when does taking hold take place and what does it consist of?
2 - 3 days postpartum; obsessed wit her body functions - mood swings (begin to take responsibility and control of motherhood
when does the letting go take place and what does it consist of?
10 days - 6 weeks; mothering functions established, sees infant as unique person instead of a fantasy
what are the four stages of partner psychological adjustment?
engrossment, expectations, reality, and transition to mastery
define engrossment.
absorbed, preoccupied with baby
define expectations.
not always based on reality
define reality.
partner realizes expectations not realistic
define transition to mastery.
partner makes conscious decision to take control and be more involved
what is our role with the partner?
letting him help with infant care, treat family has triad with education
what are 6 ways to promote adaptation to parenthood?
- newborn with mother ASAP after birth
- delay procedures that can impact bonding (assessment, bath)
- 24 hr rooming in with partner
- adequate pain relief
- teach infant comforting
- support parent and model infant care
what are 4 methods we can teach the parents about infant comforting?
- swaddling
- shushing sound
- rhythmic motion
- holding with tummy pressure
what are positive attachment behaviors from baby?
baby smiles, alert, cuddles, and consolable
what are positive attachment behaviors from mom?
mom assumes en face position, makes direct eye contact, progressive maternal touch, speaks positively about newborn
what are negative attachment behaviors from baby?
baby fussy/cries, stiff when held, inconsolable
- interferes with attachment; mom feels like failure
what are negative attachment behaviors from mom?
mom expresses disappointment, uninterested in infant, does not hold baby close
