Unit 1- POSTPARTUM Flashcards
1
Q
What is uterine involution?
A
The return of the uterus to its pre-pregnant size
2
Q
What is uterine atony?
A
Failure of uterus to contract even after fundal rub
2
Q
What is uterine inversion
A
Uterus turn partially or enterily inside out
2
Q
When does the postpartum period begin?
A
With the delivery of the placenta which is the 4th stage of labor: 2-3 hours following. Ends approximately 6 weeks after delivery
2
Q
What is uterine subinvolution?
A
Uterus isn’t decreasing in size
3
Q
Whats happening to our reproductive organs during the post-partum period?
A
Reporductive organs return to non-pregnant state
4
Q
Our goals during the postpartum period includes?
A
- Decrease maternal mortality
- prevent postpartum hemorrhage & maternal complications
- Facilitate bonding
- Increase breastfeeding rate
- Restore physiological function and provide comfort
- Educate about newborn and self care
- decrease # of unplanned pregnancies
5
Q
Usuing the acronym bubble heb what is our postpartum focused assessment?
A
B: breast- engorgement, nipples, milk production
U: Uterus- fundal height, consistency & location
B: Bladder function- voiding vs. catheter
B: Bowel function- anesthesia can cause delayed bowels
L: Lochia- bleeding/discharge- Color, odor, consistancey and amount
E: Episiotomy/laceration- edema, ecchymosis & approximation
H: Hemmorhoids
E: Emotional/educational needs
B: Bonding
6
Q
PP focused assessments should be done how often?
A
Every 15 mins 1st hour
Every 30 mins 2nd hour
Every 4 hours 24 hours
Every 8-12 hours thereafter
7
Q
What our postpartum nursing interventions?
A
- Educate pt to maintain bedrest to prevent orthostatic hypotension
- Post op vital signs
- report temp greater than 100.4
- Fundal rub
- Assess firmness, height, bladdler, lochia and perineum
- Report abnormal findings to physican
- Infuse pitocin per providers order- helps w/ induction and prevent pp hemorrhage
- Assist with discomfort or after pains- cramping r/t uterus returning to regular size. usually OTC esp. if they are breastfeeding.
- Provide peri care- keep clean prevent infection
8
Q
What abnormal PP findings would we report to physican?
A
- Abnormal VS- increase in pulse, decrease in BP
- Fundus remains boggy after massage (assessing firmness,height)
- 2nd perineal pad soaked w/in 15 mins
- Signs of hypovolemic shick
- pale, clammy, tachycardia, lightheaded or hypotensive
9
Q
if fundus is not midline it could indicate…
A
possible distended bladder— urinating should help
10
Q
If you have been rubbing the fundus and its still not firming up what should we do?
A
Call MD
11
Q
What should we know about PP blood pressure?
A
- Orthostatic hypotension is common
- Increased if mom is in pain, preeclampsia
- Decreased if mom is dehydrated or hypovolemic
12
Q
What should we know about PP pulse?
A
- Bradycardia- 50 normal- due to blood loss
- Tachycardia- pain, anxiety, hypovolemia, or infection
- > 100bpm may indicate excessive blood loss/infection
13
Q
What should we know about PP respirations?
A
- Rarely change 12-20
- Increase could indicate suspected pulmonary embolism, uterine atony, hemorrhage
14
Q
What should we know about PP temperature?
A
- Up to 100.4-1st 24 hours is okay r/t the stress of labor, dehydration
- > 100.4 over 24 hours consider infection
Report if it increases over 100.4 twice in a 24 hour period
15
Q
Csection nursing care in the first 24 hours consists of what?
A
- immediate post op care is same as PACU/Surgical pt
- Respiration and oxygen saturation hourly
- Assess incision site, IV, dressing
- May need a sandbag for pressure on the site
- Staples vs. Dermabond
- Assess for uterine involution
- Anesthesia management- mobility after 8 hours
- Headaches, LOC, Itching
- TCDB & monitor I&O
- Pain relief and comfort measures
- Patient controlled analgesia (PCA)
- 18 to 24 hours of post cesarean analgesia
16
Q
What is are care for a cesection after 24 hours consist of?
A
- Resuming normal activites
- Preventing abdominal distention
- Bowel sounds q4 hours
- Assess incision site, iv site and dressings
- TCDB & Montior I&O
- Teaching for discharge- staples removed if needed
- DC catheter
- DEnsure comfort and emotional support
- Guilt, question why c/s- women feel failed
- Assess newborn care & bonding
17
Q
How do we perform a fundus assessment?
A
- Support uterus with one hand at symphysis
- Palpate fundus with other hand and assess uterus for
- Consistency- firm or boggy
- Height of fundus in relation to the umbilicus
- 1/U (above umbilicus), U/U (right on umibilicus), U/1 (under umbilicus)
- Location-midline or displaced laterally
- Recheck voiding
18
Q
What is uterine invoultion?
A
The return of the uterus to its pre-pregnancy state
Fundus involution occurs 1-2 cm/day
1. Documented in relation to the umbilicus
19
Q
Where should the fundus be located after first day of delivery?
A
fundus at umbilicus
20
Q
7-10 days after birth where should your fundus be?
A
- Fundus below the symphysis pubis
21
Q
What is fundal tone?
A
Is the uterus firm or boggy
Boggy indicates atony which requires massage
Tenderness could indicate infection
22
what is the purpose of myometrial contractions?
compress placenta site to decrease blood loss this occurs for 12-24 hours post-delivery
High levels of oxytoxcin can cause this
23
After pains occur more often in the...
1. Multigravidas d/t lose of tone
2. Breastfeeding d/t release of oxytocin
3. Overdistended uterus- multi gestations, polyhydraminos
4. Rarely felt by primigravidas
24
What are our nursing interventions for myometrial contractions (after pains)
Medicate before breastfeeding and enhance comfrot and relaxation to facilitate let down of milk
25
What is lochia?
Vaginal discharge- consists of blood from the placenta site
1. Normal menstrual smell
2. Discharge amount ddecreases daily; may increase with ambulation
3. Difficut to quantify
- Scant
- light
- moderate
- heavy
- excessive- saturated a pad in 15 mins
4. Clots may appear
- Small are normal
- Large- interfer with uterine contractions-- Obtain weight & report to physican
26
Review: I gram = 1ml of blood
10 grams= 10 ml of blood
calculating lochia make sure to take in consideration pad weight
27
True or false: Anything larger than an egg size clot is concerning esp if it happening beyond the 1st day?
True-- could be placenta fragments
28
What is the first stage of lochia? What is its time frame, expected findings and deviations from normal?
Rubra
Timeframe: day 1-3
Expected findings: Bloody small clots- red, moderate-light, increased when standing/breastfeeding, fleshy odor
Devations from normal: Large clots, heavy (saturates pad in 15 mins), foul odor, placenta fragments
29
What is stage 2 of lochia and its timeframe, expected findings and deviations from normal?
Serosa
Timeframe: day 4-10
Expected findings: Pink-brown color, light scant, increases with physical activity
fleshy odor
Deviations from normal: Rubra after 4 days, heavy (saturates pads in 15 mins), foul odor
30
What is the 3rd stage of lochia and its timeframe, expected findings and deviations from normal?
Alba
Timeframe: Day 10
Expected findings: Yellow-white color, scant-none, fleshy odor
deviations from normal: birght red (late PP hemmorrhage) foul odor
31
True or false: A return of bleeding (lochia) should be reported?
True
32
PP changes of the vagina include?
1. greatly stretched
2. Walls appear edematous
3. Multiple small lacerations possible
4. Vaginal walls are thin and dry until ovulation returns
5. vaginal wall regains thickness- estrogen production reestablished
6. Vaginal rugae are few and reappear by 3-4 weeks
7. Muscle tone is never completely restored to pre pregnancy state
8. Dyspareunia- "pain with sex" more likely in breast feeding
33
What causes the dryness in the vaginal walls pp?
There is a severe drop in estrogen and progesterone once it starts producing again it wont be as dry
34
What happens to the cervix PP?
1. Dilated, edematous, and bruised
2. Small tears or lacerations may be present
3. Cervix heals within 6 weeks but it will never be fully closed again
35
What should we keep in mind with our perineum PP?
1. Perineum may be edematous and brused esp. if patient had to have a episotomy (inscion) or laceration degree is determined by the tissue involved
36
What does REEDA help us assess
Perineum PP
R:redness
E: Edema
E: Ecchymosis- discoloration(bruise_
D: discharge
A: Approximation
37
what are some perineal comfort measures we can provide?
1. Ice pack for 24-48 hours
2. Good handwashing
3. Peri bottle- cleanse perineum with warm water after each elimination
4. Apply anesthetic sprays or pads to area (not ointments)
5. Apply new peri pad front to back after each elimination
6. Snug peri pad
Sitz bath
1. Cool water for 1st 24 hours to help decrease edema
2. Warm water after 24 hours
Analgesics
Sitting measures- place pillow inbetween legs tighten glutes prior to sitting then relaxing as you sit
38
What should the nurse be doing the day of discharge of mom and baby?
1. Assessment on both mom and baby
2. Discharge teaching completed
- Maternal and infant care
- Provide written copies
- Patient & family are on OVERLOAD
3. Administer medications if indicated
- Immunizations
- Rho(D)immune globulin 2nd dose before going home
4. Ensure careseat
5. Birth certificate information complete and follow up appts/referrals made
39
What does blood loss look like PP?
Vaginal: 300-500ml
Cesection:500-100ml
Anything over would be documented in chart as a hemorroghe due to the amount not necessarily that they did hemorrhage..it would be for obstrical hx
40
What should we know about fluid shifts PP?
1. BP & Pulse should quickly return to pre-pregnant levels
2. Increase of blood flow back to the heart
- Decreased pressure from the pregnant uterus on the vessels
41
What should we know about postpartum chills and shakes 1st 1-2 hours?
1. Body is riding excess fluids
2. Related to works of labor
3. Nervous system response
Sweating normal at ngith as plasma volume is being restored
Warm blankets are ok
42
Our lower body extermity assessment PP should include?
Examine for s/s of thrombophlebitis
1. Palpate pedal pulses
2. Assess for edema
3. Assess DTR
43
What are our nursing interventions for prevention of lower body extermity complications
1. Early ambulation
2. Frequent trips to the bathroom
3. SCD's or compression stocking if indicated
44
What hematologic changes should we be aware of PP?
1. White blood cell count increases (12,000-25,000) d/t stress of labor
2. Hemaglobin & Hematocrit is difficult to interpret for about 4-6 weeks
- Plasma is diluted by remobilization of excess body fluid
- result in an increase in hematocrit
- Return to normal within 4-6 weeks
- Plasma volume lose exceeds RBC... oppisite in antepartum
3. coagulation
- Elevations in clotting factors increase risk of thrombus formation (hypercoag state)
45
What are some GI changes we might see PP?
Digestion
1. Decrease peristalsis due to analegesia and anesthesia
2. Expect 1st BM 2-3 days postpartum
3. increased appetite
4. Hypoactive bowels
Constipation
1. Encourage fiber in diet
2. Stool softners as prescribed
46
What are nursing interventions for our GI changes that happen PP
1. Assess for hemorrhoids- creame as prescribed
2. Encourage early ambulation
3. Avoid enemas & suppositories esp. with 3rd-4th degree lacerations
47
What urinary changes might we see in PP women?
1. Diuresis- begin within the 1st 24 hours
- excrete up to 3000ml/day
2. Urinary retention
- Diminshed sensitivty to pressure
- decreased muscle tone of the bladder
- Over distended bladder
- Persistent dilation increases risk for UTI
- Tramatized meatus
48
what are nursing interventions for the urinary changes we see in PP women?
1. Encourage voiding within 6 hours of delivery
- running water, pepperment oil, pour water over vulva
- provide hot tea or fluids of choise
- Encourage urination in the shower or sitz bath
- Tolieting schedule
2. Catheterize
- voiding less than 150 ml and the bladder can be palpated
- Fundus is elevated or displaced from the midline
- Unable to void
- >6hours and bladder scan reveals urine
Pain medication may help relax
encourage kegal exercises to strengthen perineal muscles
49
What musculoskeltal changes might we see in a PP women?
Muscle fatigue
1. Soft and flabby abdomen (mom pooch)
2. Hip or joint pain
3. Feet permently increased in size
Pelvic muscle regain tone in 3-6 wks
Abdominal wall regain tone in 6weeks
1. Diastasis recti- seperation of the rectus abdominal muscle-- return may take long
50
What are our nursing interventions for musculoskeltal changes seen in PP women?
1. Provide comfrot measures
2. Ice, heat, warm shower or analgesia
51
What are some integumentary changes we might see in a PP women?
1. Hyperpigmentation area gradully disappear
- melasma, the "mask of pregnancy"
- Palmar erythema
- spider nevi fade but some stay in legs
2. Striae gravidrum (stretch marks)
- Fade to silvery lines but do not dissappear
52
What are some neuologic changes that occur in PP women?
injury prevention is priority
Nursing interventions
1. Assess for headaches
- May be related to pre-eclampsia, epidural, spinal
- frontal and bilateral headaches are common
2. Severe headaches
- Have patient lay down in flat position
- Postdural puncture resulting from anesthsia
3. Assess for s/s of preeclampsia-
- BP increases and vision changes occur
4. Recommend an epidural blood patch if needed
- Small amount of blood is injected over hole that is leaking CSF
- Many feel relief right away or may require a second patch.
53
What endocrine changes may occur PP?
1. Hormone changes with expulsion of placenta
- Rapid decrease of estrogen and progesterone
2. Prolactin increases- milk production 2-3 days after delivery
3. Oxytocin- milk ejection or "let down" reflex
- can be inhibited by stress, anxiety, pain and fatigue
54
what should we know about ovarian function & menstration PP?
Ovulation may occur before postpartum follow up visit
1. Non-lactating women
- Prolactin decrease- menses resumes in 1-2 months
2. Lactating women- amenorrhea
- Prolactin increases- menses resumes in 3-6 months
55
What is postpartum hemorrhage?
defined as a blood loss of greater than 500ml vaginal birth and 1000ml for csection
56
when does a primary hemorrage normally occur?
within the 1st 24 hours of delivery
57
What are typical causes of a primary hemorrhage?
1. Uterine Atony-r/t retained placneta
2. Lacerations or hematomas
58
When does a secondary PP hemorrage usually occur?
24 hours to 6 weeks
59
What are common causes of a secondary hemorrhage?
1. Subinvolution
2. Retained placenta
60
True or false: PP hemorrhage is a progression?
True-- patient will experience symptoms of hypovolemia (tachycardia, hypotensive, pale, clammy, anxious, confused) and eventally go into hemorragic shock (blue lips/fingernails, decreased urine output, excessive sweating, chest pain, shallow breathing, hypotensive, confused)
61
What are PP heorrhage predisposing risk factors?
1. High parity r/t loss of tone of uterus
2. labor dystocia (difficult labor)
3. Prolonged labor (distended uterus)
4. over-distedned uterus- hydraminos, macrosmia, multiple fetuses
5. operative delivery- vacuum, forcepts, cesection
6. previous postpartum hemorrhage
7. Placenta abruption or previa
8. Infection- retained placenta
9. oxytocin- induction/augmentation
10. Anesthesia or medicaitons- mag sulfate (mag slows down blood clotting), tocolytics
62
What should we know about early postpartum hemorrage: uterine atony?
Uterine atony- poorly contracted uterus, lack of tone major cause of primary PPH
63
What are the signs of uterine atony:
1. Fundus does not firm with massage still feels boggy above umbilicus
2. Steady or sudden saturated pad - 15mins
64
What should we know about early PPH : lacerations?
Lacerations-2nd most common cause of PPH
1. Peri urethral
2. Labia
3. Vagina
4. Cervix
5. Perineum
65
What are signs of an unrepaired laceration?
1. Contionus trickledown vagina
2. Bleeding in spurts
3. Bleeding in presence of contracted fundus
66
What should we know about early PPH: Hematoma?
Hematoma-250-500ml blood collection in the vaginal or perineal tissue
1. Difficult to determine amount of loss
2. blood retained in tissue
67
What are signs of hematoma
1. Intense perineal pain
2. Swelling, blue-black discorlation of perineum
3. Pallor, tachycardia & hypotension
4. Pressure on vagina, urethra or bladder
5. Possible urinary retention or displacement
68
With Early PPH: Atony what does the fundus, lochia, vital signs, pain and key defing assessment show?
Fundus: Boggy, difficult to locate, above expected level, tone lost after massge
Lochia: Excessive, Excessive with clots
Vital signs: Hypotension, tachy
Pain: Normal
Key defining assessment: "boggy fundus"
69
With Early PPH: Lacerations what does the fundus, lochia, vital signs, pain, and key defining assessment show?
Fundus: Firm
Lochia: Bright red vs dark red, steady trickle of blood
Vital signs: hyptension, tachy
Pain: Normal
Key defining assessment: steady trickle of bright red blood
70
With early PPH: hematoma what does the fundus, lochia, vital signs, pain and key defining assessment show?
Fundus: firm
Lochia: normal
Vital signs: hypotensive, tachy
Pain: Feeling of pressure, severe, unrelieved pain
Key defining assessment: Severe pain, visible hematoma, discolored bulging moss
71
Early PPH hemorrhage medical management with atony?
1. medications
2. Bimanual compression
3. Uterine packing or tamponade
72
Early PPH laceration/hematoma medical management includes?
1. Pelvic exam- perineum, labia, vagina, cervix, suture laceration
73
Surgical managemet in early PPH includes?
1. Surgical repair-incision and evacuation of hematoma
2. Surgical- d&C, hysterectomy
74
What are our nursing interventions for postpartum hemorrhage
1. perform fundal massage- 1st nursing intervention
2. Review h&h labs & vital signs
3. Maintain or establish large-bore IV
4. o2 8-10 L/MIN
5. Comfort measures- ice, pain, meds
6. education and emotional support
- Bladder training
- Report s/s PPH
7. administer medications- oxytocin
8. Notify physican
9. Assist w. medical management
75
What is a our goal with PPH?
Goal- is to control bleeding & prevent hypovolemic shock
76
What is the action of oxytocin?
Action-stimulates uterine muscle to increase force, frequency and duration of contractions
Can be used with induction and PPH
77
What are adverse reactions of oxytocin?
1. Dysrthythmias, b/p changes, water intoxication, & uterine rupture
78
What are our interventions when patient is on oxytocin?
Monitor v/s, i&o, lung sounds
79
What is action methylegonovine maleate...
Action- stimulates uterine muscle to increase force & frequency of contraction, producing a tetanic contraction of the uterus
Uses- PPH
IM
80
What are adverse effects of methylergonovine maleate?
1. N/V
2. Cramping
3. Headache
4. severe hypertension
5. Bradycardia
6. Dysrhythmias
7. mycardial infarcition
81
What are contraindications of methylegonovine maleate?
1. Cardiac disease
2. Hypertension
82
What are interventions for patients on methylergonovine maleate?
1. Monitor v/s
2. pain
3. headache
4. chest pain,
5. sob
6. uterine contractions
7. vaginal bleeding
83
What is the adverse effects of carboprost tromethamine?
1. Headache
2. n/v/d
3. fever
4. tachycardia
5. hypertension
6. pulm edema
84
What route is carboprost tromethamine given?
IM
85
Carboprost tromethamine is contraindicated for...
1. Asthma,
2. cardiac
3. renal
4. hepatic disease
86
Carboprost tramethamine interventions include?
1. Monitor v/s
2. vaginal bleeding
3. uterine tone
87
What is the route of misoprostol?
Rectally or orally
88
What are adverse effects of misoprostol?
1. Headache,
2. N/V/D
3. Fever
4. tachy
5. HTN
6. Pulm edema
89
Misoprostol interventions include?
1. Monitor v/s
2. vaginal bleeding and uterine tone
90
What should we know about late PPH: subinvolution?
Subinvolution- uterus remains large and fails to descent
- Retained placental fragments & infections
91
What is our assessment and interventions for late PPH subinvolutions?
1. enlarged or boggy "uterus"
2. S/s of bleeding or infection
3. Initate postpartum hemorrhage nursing interventions
Medical management
1. Medications- antibiotics, oxytocin, and or analgesia
2. Ultrasound confirm retained placenta
3. Sugircal management- dilation & curettage (D&C), hysterectomy
92
What is uterine inversion?
OB emergency: partial or complete turning inside out of the uterus
93
What is our nursing assessment show with a uterine inversion?
1. Lower abdominal pain
2. Uterus protruding from vagina
3. Vaginal bleeding & hypovolemia
94
What are our nursing intervetnions and medical management of uterine inversion?
1. Stop oxytocin immediately
2. Administer medciation- terbutaline, antibitoics
3. Monitor for and manage hypovolemic shock
Medical management
1. Immediate manual replacement
2. Surgery
95
Bacterial infection after childbirth will present with
temperature of 100.4 or higher after the first 24 hours and occurs on at least 2 occasions can invade blood/lumphatic system & be life threatenting
96
Risk factors for PP infection includes?
1. Prolonged labor
2. Multiple vaginal exams
3. Tissue trauma
4. Poor hygine
97
How can we reduce the risk of PP infection
1. Handwashing-staff, physcians, and families
2. Early ambulation-promotes drainiage, ciruclation
3. Proper site care
98
What is our nursing assesment and interventions for PP infection?
Assessment
1. obtain vs and labs
2. pain, tenderness, and warmth at site
3. Purulent drainage
4. wound dehisscense or evisecertion
Interventions
1. Obtain lab and cultures
2. comfort measures- analgesics, sitz bath , warm compress
3. Admin antibiotics
4. assest with i&C
99
What is endometritis?
Infection of the uterine tissure lining the uterus
100
Our nursing assessment of endometritis should include?
1. Pulse over 100
2. fever, chills, malaise, anorexia
3. excessive uterine tenderness
4. lochia returning to rubra from serosa
5. foul smelling or purulent lochia
6. urinary frequency
7. sore cracked & bleeding nipples****
101
What are our interventions for endometritis?
1. bedrest-semi fowler position
2. Admin iv antibiotics, antipyretics, oxytocin or methylergonovine
102
Complications of endometritis include?
1. Salpingitis, peritonitis, septicemia
103
Why are UTI more common in pregnancy?
Urinary stasis due to hypotonic bladder, catheter insertions, delivery can be tramatizing to the bladder and urethra
104
Cystitis is common and what days PP? and how might it present?
1st or 2nd day post partum-- presenting with dysuria, frequency, urgency and **suprapubic tenderness**
cloudy urine,hematuria, and bacteruria
105
When is pylenophritis most common PP and how does it present?
Presents on day 3 or 4 PP
1. fever chills, **costovertebral or flank pain**, n/v, dysuria, urgency, cloudy urine, hematuria, and bacteruria
106
What should we know about thrombophlebitis in PP
1. Increase factors & fibrinogen
- clot forms in vessel wall resulting in inflammation of vessels
- superficial/femoral/pelvic
2. Blood vessel injury- increased risk during pregnancy and birth
3. Hypercoagulation- to prevent postpartum maternal hemorrhage
107
What are s/s of a PP thrombophletbitis?
1. Minimal fever
2. Postie homan sign if assess (tenderness in calf)
3. Pain or dull ache in calf or leg
4. Swelling in extremity below pain
108
What are our nursing interventions for throbophlebitis?
Depends on location
1. Assess the extremities for warm, red, tender, swollen area
2. Bedrest and elevate affected extremitiy
3. Moist warm packs to the area
4. Elastic support stocking or SCD
5. Analegics and or antibotics as ordered
6. IV heparin-may be ordered for femoral or pevlic pain to prevent PE
109
What is our medical management of thrombophlebitis?
1. Diagnosis- doppler or MRI
2. Therapeutic management- early ambulation
3. Anticoagulation treatment- warfarin, monitor PPT & INR, birth control, teratogenic effects.
110
What is a amniotic fluid embolism?
1. Amniotic fluid and debris enter circulation
111
what are s/s of a pulmonary embolism or amniotic fluid embolism?
1. Apprehension-feeling on impending doom
2. sudden dyspnea and chest pain
3. tachy cardia, and tachypenea
4. hempotysis
5. Pulm. crackles and cough
112
What are our nursing interventions for a pulmonary embolism?
1. semi-fowlers to facilitate breathing
2. oxygen 8-10 l/m
3. mointor vital signs and monitor for signs of respiratory distress and hypoxemia
4. Iv fluids, medications-analgesics, anticoag, thrombolyic
113
Maternal needs when breastfeeding increases how?
add 500calories to pre-pregnancy intake
drink 8 glasses of water per day
114
What are condtraindications of breastfeeding?
medications, hiv, chemo, infant conditions
115
what are signs of effective breast feeding?
1. let down reflex
2. latch pain subsides
3. audible swallowing
4. adequate output
5. weight gain
116
True or false: We should alternate 1st breast every 10 min., then 2nd until satisfied; burp between breast .
true-- to prevent nipple trauma
117
The 1st 1-2 days what kind of breast milk is expelled?
Colostrum- Liquid gold full of immunglobulin/laxitves
118
Transitional milk appears at what days
2-3 days
119
What is foremilk?
Stored before feeding high in water content
120
What is hindmilk?
produced during feeding- high in fat content
121
What are signs of engorgement
Primary engorgement occurs in breast or bottle fed mom
1. Increased blood flow returns to body as breasts prepare;happens before milk is produced
2. Breasts- larger, firm, warm, tender with a throbbing pain
- 24 hours breast are soft
- 48 hours slight firm, non tender
- greater than 48 hours firm, tender, warm as milk production begins
3. subsides in 24-48 hours
122
What is subsequent engorgment?
Occurs in breastfeeding moms
1. Distention of milk glands
2. missed a feeding delayed pumping
3. relieve by infant sucking or expressing milk
123
What are our interventions for breast engrogment?
1. frequent feeding or pumping
2. cool compresses
3. chilled cabbage leaves to breast 20mins BETWEEN feedings 3x a day
124
What are our nursing interventions for nipple trauma?
1.Proper infant removal from breast
2.Allow nipples to air dry 15 mins 2-3 x per day
3.Colostrum to nipples
125
What nursing education can we provide for engorgement in a breast feeding mom
1. Supportive bra
2. Alternate feeding position
3. Warm compresses
4. Breast massage
5. Latch education
6. On-demand feedings
7. Proper removal of infant
126
What nursing education can we provide for engorgement in non-breast feeding mom?
1. Supportive bra
2. Breast binders
3. Ice pack to breast
4. avoid breast stimulation
5. avoid milk expression
6. avoid heat
7. analgesia for pian
127
What is mastitis?
1. Occurs 2-3 weeks postpartum after prolonged engorgment & inadequate emptying of breasts
2. inflammation, bacterial infection of the lacting breast
3. **unilateral**-risk for abscess if untreated
128
What are s/s of mastatits?
1. sore cracked nipples
2. flu-like symptoms- fatigue, malaise, fever, chills
3. Painful, swollen, warm, tender area, or palapble mass
4. purulent drainage
129
What are our nrusing interventions for mastitis?
1. Good handwashing
2. DO NOT stop breast feeding abruptly
3. Apply WARM pack or shower prior to breastfeeding
4. massage affected area before and during feeding to ensure emptying
5. encourage breast feeding from affected side FIRST 2-3 hours
6. manual expression or breast pump Q4 hours
7. Obtain breast milk culture and sensitvity as ordered
8. Administer analgescis, antibiotics as ordterd (oral antix 10-14 days)
9. Monitor for breast abscess & need for I&D
10. Encourage patient to wear supportive bra without underwire
130
What should we know about the taking-in-phase of maternal adaptation?
Dependent (24-48hours)
1. focused on own needs, unable to make decisions
2. relives birth experiences, adjust to psychosocial changes
131
What should we know about the taking-hold phase in maternal adaptation PP
Dependent/independent
1. Focus shifts to infant & maternal role
2. Anxious/bit overwhelmed about competence as a mom & accepts advice
3. may experience baby blues/fatigue
132
What should we know about the letting-go phase in maternal adaptation PP
Letting-go phase- interdependent
1. Resolve their idealized expectation of birth expereience
2. Accepts reality of infant and incorportes into lifestyle
3. Separates newborn and self; confident in caretaking activites
4. Relationship with partner grows with reconnection
133
What are the risk factors of postpartum blues, depression and psychosis?
1. Hormone changes- rapid decrease in estrogen and progestorne
2. hx of depression
3. pregnancy or childbirth complications, pain or discomfort
4. anxiety related to new role as mother
5. unplanned pregnancy
6. low self-esteem
7. lack of socal support
8. life stresses- socioeconomic factors
9. IPV-- poor relationship w/ partner
134
What should we know about PP blues?
1. 1st week PP, peaks around 5th day
2. Irriatbility, fatigue, crying, mood swings & anxiety
3. Cuase unkown: hormone changes, discomfort, sleep deprivation, body image concerns, stress
4. doesnt usually affect ability to care for infant, resolves w/o interventions around 10-14 days
135
What should we know about PPD?
1. Persists past 2 weeks, occurs in 1st 3 months & lasts up to 1 year
2. Persistent low mood
3. Risks include: hx of sexual abuse, unwanted pregnancy, smoking, formula feeding
4. Unable to safely care for infant and self
136
What is PP psychosis?
1. Peaks at 48 hours to 2 weeks
2. intense depression relapse of psychotic d/o, confusion, auditory & visual hallucinations, insomnia
3. Criteria must include a major depressive disorder w/psychosis- bipolor 1, bipolor II, unspecified functional psychois, schizoaffective disorder
4. Therapeutic managment nec. medical emergency, serious mood instabilities, though of suicide, infanticide
137
