Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 6 > Unit 1- POSTPARTUM > Flashcards

Unit 1- POSTPARTUM Flashcards

1
Q

What is uterine involution?

A

The return of the uterus to its pre-pregnant size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is uterine atony?

A

Failure of uterus to contract even after fundal rub

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is uterine inversion

A

Uterus turn partially or enterily inside out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is uterine subinvolution?

A

Uterus isn’t decreasing in size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Whats happening to our reproductive organs during the post-partum period?

A

Reporductive organs return to non-pregnant state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Our goals during the postpartum period includes?

A
  1. Decrease maternal mortality
    • prevent postpartum hemorrhage & maternal complications
  2. Facilitate bonding
    • Increase breastfeeding rate
  3. Restore physiological function and provide comfort
  4. Educate about newborn and self care
    • decrease # of unplanned pregnancies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What our postpartum nursing interventions?

A
  1. Educate pt to maintain bedrest to prevent orthostatic hypotension
  2. Post op vital signs
    • report temp greater than 100.4
  3. Fundal rub
    • Assess firmness, height, bladdler, lochia and perineum
  4. Report abnormal findings to physican
  5. Infuse pitocin per providers order- helps w/ induction and prevent pp hemorrhage
  6. Assist with discomfort or after pains- cramping r/t uterus returning to regular size. usually OTC esp. if they are breastfeeding.
  7. Provide peri care- keep clean prevent infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What abnormal PP findings would we report to physican?

A
  1. Abnormal VS- increase in pulse, decrease in BP
  2. Fundus remains boggy after massage (assessing firmness,height)
  3. 2nd perineal pad soaked w/in 15 mins
  4. Signs of hypovolemic shick
    • pale, clammy, tachycardia, lightheaded or hypotensive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

if fundus is not midline it could indicate…

A

possible distended bladder— urinating should help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If you have been rubbing the fundus and its still not firming up what should we do?

A

Call MD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should we know about PP blood pressure?

A
  1. Orthostatic hypotension is common
  2. Increased if mom is in pain, preeclampsia
  3. Decreased if mom is dehydrated or hypovolemic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should we know about PP pulse?

A
  1. Bradycardia- 50 normal- due to blood loss
  2. Tachycardia- pain, anxiety, hypovolemia, or infection
  3. > 100bpm may indicate excessive blood loss/infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should we know about PP respirations?

A
  1. Rarely change 12-20
  2. Increase could indicate suspected pulmonary embolism, uterine atony, hemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should we know about PP temperature?

A
  1. Up to 100.4-1st 24 hours is okay r/t the stress of labor, dehydration
  2. > 100.4 over 24 hours consider infection

Report if it increases over 100.4 twice in a 24 hour period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Csection nursing care in the first 24 hours consists of what?

A
  1. immediate post op care is same as PACU/Surgical pt
    • Respiration and oxygen saturation hourly
  2. Assess incision site, IV, dressing
    • May need a sandbag for pressure on the site
    • Staples vs. Dermabond
  3. Assess for uterine involution
  4. Anesthesia management- mobility after 8 hours
    • Headaches, LOC, Itching
  5. TCDB & monitor I&O
  6. Pain relief and comfort measures
  7. Patient controlled analgesia (PCA)
  8. 18 to 24 hours of post cesarean analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is are care for a cesection after 24 hours consist of?

A
  1. Resuming normal activites
  2. Preventing abdominal distention
    • Bowel sounds q4 hours
  3. Assess incision site, iv site and dressings
  4. TCDB & Montior I&O
  5. Teaching for discharge- staples removed if needed
  6. DC catheter
  7. DEnsure comfort and emotional support
    • Guilt, question why c/s- women feel failed
    • Assess newborn care & bonding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do we perform a fundus assessment?

A
  1. Support uterus with one hand at symphysis
  2. 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where should the fundus be located after first day of delivery?

A

fundus at umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

7-10 days after birth where should your fundus be?

A
  1. Fundus below the symphysis pubis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is fundal tone?

A

Is the uterus firm or boggy

Boggy indicates atony which requires massage
Tenderness could indicate infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the purpose of myometrial contractions?

A

compress placenta site to decrease blood loss this occurs for 12-24 hours post-delivery
High levels of oxytoxcin can cause this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

After pains occur more often in the…

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are our nursing interventions for myometrial contractions (after pains)

A

Medicate before breastfeeding and enhance comfrot and relaxation to facilitate let down of milk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is lochia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Review: I gram = 1ml of blood
10 grams= 10 ml of blood

A

calculating lochia make sure to take in consideration pad weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

True or false: Anything larger than an egg size clot is concerning esp if it happening beyond the 1st day?

A

True– could be placenta fragments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the first stage of lochia? What is its time frame, expected findings and deviations from normal?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is stage 2 of lochia and its timeframe, expected findings and deviations from normal?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the 3rd stage of lochia and its timeframe, expected findings and deviations from normal?

A

Alba
Timeframe: Day 10
Expected findings: Yellow-white color, scant-none, fleshy odor
deviations from normal: birght red (late PP hemmorrhage) foul odor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

True or false: A return of bleeding (lochia) should be reported?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

PP changes of the vagina include?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What causes the dryness in the vaginal walls pp?

A

There is a severe drop in estrogen and progesterone once it starts producing again it wont be as dry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What happens to the cervix PP?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What should we keep in mind with our perineum PP?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What does REEDA help us assess

A

Perineum PP
R:redness
E: Edema
E: Ecchymosis- discoloration(bruise_
D: discharge
A: Approximation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are some perineal comfort measures we can provide?

A
  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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What should the nurse be doing the day of discharge of mom and baby?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What does blood loss look like PP?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What should we know about fluid shifts PP?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What should we know about postpartum chills and shakes 1st 1-2 hours?

A
  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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Our lower body extermity assessment PP should include?

A

Examine for s/s of thrombophlebitis
1. Palpate pedal pulses
2. Assess for edema
3. Assess DTR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are our nursing interventions for prevention of lower body extermity complications

A
  1. Early ambulation
  2. Frequent trips to the bathroom
  3. SCD’s or compression stocking if indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What hematologic changes should we be aware of PP?

A
  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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are some GI changes we might see PP?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are nursing interventions for our GI changes that happen PP

A
  1. Assess for hemorrhoids- creame as prescribed
  2. Encourage early ambulation
  3. Avoid enemas & suppositories esp. with 3rd-4th degree lacerations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What urinary changes might we see in PP women?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what are nursing interventions for the urinary changes we see in PP women?

A
  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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What musculoskeltal changes might we see in a PP women?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are our nursing interventions for musculoskeltal changes seen in PP women?

A
  1. Provide comfrot measures
  2. Ice, heat, warm shower or analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are some integumentary changes we might see in a PP women?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are some neuologic changes that occur in PP women?

A

injury prevention is priority
Nursing interventions
1. Assess for headaches
- May be related to pre-eclampsia, epidural, spinal
- frontal and bilateral headaches are common

  1. Severe headaches
    • Have patient lay down in flat position
    • Postdural puncture resulting from anesthsia
  2. Assess for s/s of preeclampsia-
    • BP increases and vision changes occur
  3. 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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What endocrine changes may occur PP?

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what should we know about ovarian function & menstration PP?

A

Ovulation may occur before postpartum follow up visit
1. Non-lactating women
- Prolactin decrease- menses resumes in 1-2 months

  1. Lactating women- amenorrhea
    • Prolactin increases- menses resumes in 3-6 months
55
Q

What is postpartum hemorrhage?

A

defined as a blood loss of greater than 500ml vaginal birth and 1000ml for csection

56
Q

when does a primary hemorrage normally occur?

A

within the 1st 24 hours of delivery

57
Q

What are typical causes of a primary hemorrhage?

A
  1. Uterine Atony-r/t retained placneta
  2. Lacerations or hematomas
58
Q

When does a secondary PP hemorrage usually occur?

A

24 hours to 6 weeks

59
Q

What are common causes of a secondary hemorrhage?

A
  1. Subinvolution
  2. Retained placenta
60
Q

True or false: PP hemorrhage is a progression?

A

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
Q

What are PP heorrhage predisposing risk factors?

A
  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
Q

What should we know about early postpartum hemorrage: uterine atony?

A

Uterine atony- poorly contracted uterus, lack of tone major cause of primary PPH

63
Q

What are the signs of uterine atony:

A
  1. Fundus does not firm with massage still feels boggy above umbilicus
  2. Steady or sudden saturated pad - 15mins
64
Q

What should we know about early PPH : lacerations?

A

Lacerations-2nd most common cause of PPH
1. Peri urethral
2. Labia
3. Vagina
4. Cervix
5. Perineum

65
Q

What are signs of an unrepaired laceration?

A
  1. Contionus trickledown vagina
  2. Bleeding in spurts
  3. Bleeding in presence of contracted fundus
66
Q

What should we know about early PPH: Hematoma?

A

Hematoma-250-500ml blood collection in the vaginal or perineal tissue
1. Difficult to determine amount of loss
2. blood retained in tissue

67
Q

What are signs of hematoma

A
  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
Q

With Early PPH: Atony what does the fundus, lochia, vital signs, pain and key defing assessment show?

A

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
Q

With Early PPH: Lacerations what does the fundus, lochia, vital signs, pain, and key defining assessment show?

A

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
Q

With early PPH: hematoma what does the fundus, lochia, vital signs, pain and key defining assessment show?

A

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
Q

Early PPH hemorrhage medical management with atony?

A
  1. medications
  2. Bimanual compression
  3. Uterine packing or tamponade
72
Q

Early PPH laceration/hematoma medical management includes?

A
  1. Pelvic exam- perineum, labia, vagina, cervix, suture laceration
73
Q

Surgical managemet in early PPH includes?

A
  1. Surgical repair-incision and evacuation of hematoma
  2. Surgical- d&C, hysterectomy
74
Q

What are our nursing interventions for postpartum hemorrhage

A
  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
Q

What is a our goal with PPH?

A

Goal- is to control bleeding & prevent hypovolemic shock

76
Q

What is the action of oxytocin?

A

Action-stimulates uterine muscle to increase force, frequency and duration of contractions

Can be used with induction and PPH

77
Q

What are adverse reactions of oxytocin?

A
  1. Dysrthythmias, b/p changes, water intoxication, & uterine rupture
78
Q

What are our interventions when patient is on oxytocin?

A

Monitor v/s, i&o, lung sounds

79
Q

What is action methylegonovine maleate…

A

Action- stimulates uterine muscle to increase force & frequency of contraction, producing a tetanic contraction of the uterus

Uses- PPH
IM

80
Q

What are adverse effects of methylergonovine maleate?

A
  1. N/V
  2. Cramping
  3. Headache
  4. severe hypertension
  5. Bradycardia
  6. Dysrhythmias
  7. mycardial infarcition
81
Q

What are contraindications of methylegonovine maleate?

A
  1. Cardiac disease
  2. Hypertension
82
Q

What are interventions for patients on methylergonovine maleate?

A
  1. Monitor v/s
  2. pain
  3. headache
  4. chest pain,
  5. sob
  6. uterine contractions
  7. vaginal bleeding
83
Q

What is the adverse effects of carboprost tromethamine?

A
  1. Headache
  2. n/v/d
  3. fever
  4. tachycardia
  5. hypertension
  6. pulm edema
84
Q

What route is carboprost tromethamine given?

A

IM

85
Q

Carboprost tromethamine is contraindicated for…

A
  1. Asthma,
  2. cardiac
  3. renal
  4. hepatic disease
86
Q

Carboprost tramethamine interventions include?

A
  1. Monitor v/s
  2. vaginal bleeding
  3. uterine tone
87
Q

What is the route of misoprostol?

A

Rectally or orally

88
Q

What are adverse effects of misoprostol?

A
  1. Headache,
  2. N/V/D
  3. Fever
  4. tachy
  5. HTN
  6. Pulm edema
89
Q

Misoprostol interventions include?

A
  1. Monitor v/s
  2. vaginal bleeding and uterine tone
90
Q

What should we know about late PPH: subinvolution?

A

Subinvolution- uterus remains large and fails to descent
- Retained placental fragments & infections

91
Q

What is our assessment and interventions for late PPH subinvolutions?

A
  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
Q

What is uterine inversion?

A

OB emergency: partial or complete turning inside out of the uterus

93
Q

What is our nursing assessment show with a uterine inversion?

A
  1. Lower abdominal pain
  2. Uterus protruding from vagina
  3. Vaginal bleeding & hypovolemia
94
Q

What are our nursing intervetnions and medical management of uterine inversion?

A
  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
Q

Bacterial infection after childbirth will present with

A

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
Q

Risk factors for PP infection includes?

A
  1. Prolonged labor
  2. Multiple vaginal exams
  3. Tissue trauma
  4. Poor hygine
97
Q

How can we reduce the risk of PP infection

A
  1. Handwashing-staff, physcians, and families
  2. Early ambulation-promotes drainiage, ciruclation
  3. Proper site care
98
Q

What is our nursing assesment and interventions for PP infection?

A

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
Q

What is endometritis?

A

Infection of the uterine tissure lining the uterus

100
Q

Our nursing assessment of endometritis should include?

A
  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
Q

What are our interventions for endometritis?

A
  1. bedrest-semi fowler position
  2. Admin iv antibiotics, antipyretics, oxytocin or methylergonovine
102
Q

Complications of endometritis include?

A
  1. Salpingitis, peritonitis, septicemia
103
Q

Why are UTI more common in pregnancy?

A

Urinary stasis due to hypotonic bladder, catheter insertions, delivery can be tramatizing to the bladder and urethra

104
Q

Cystitis is common and what days PP? and how might it present?

A

1st or 2nd day post partum– presenting with dysuria, frequency, urgency and suprapubic tenderness
cloudy urine,hematuria, and bacteruria

105
Q

When is pylenophritis most common PP and how does it present?

A

Presents on day 3 or 4 PP
1. fever chills, costovertebral or flank pain, n/v, dysuria, urgency, cloudy urine, hematuria, and bacteruria

106
Q

What should we know about thrombophlebitis in PP

A
  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
Q

What are s/s of a PP thrombophletbitis?

A
  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
Q

What are our nursing interventions for throbophlebitis?

A

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
Q

What is our medical management of thrombophlebitis?

A
  1. Diagnosis- doppler or MRI
  2. Therapeutic management- early ambulation
  3. Anticoagulation treatment- warfarin, monitor PPT & INR, birth control, teratogenic effects.
110
Q

What is a amniotic fluid embolism?

A
  1. Amniotic fluid and debris enter circulation
111
Q

what are s/s of a pulmonary embolism or amniotic fluid embolism?

A
  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
Q

What are our nursing interventions for a pulmonary embolism?

A
  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
Q

Maternal needs when breastfeeding increases how?

A

add 500calories to pre-pregnancy intake
drink 8 glasses of water per day

114
Q

What are condtraindications of breastfeeding?

A

medications, hiv, chemo, infant conditions

115
Q

what are signs of effective breast feeding?

A
  1. let down reflex
  2. latch pain subsides
  3. audible swallowing
  4. adequate output
  5. weight gain
116
Q

True or false: We should alternate 1st breast every 10 min., then 2nd until satisfied; burp between breast .

A

true– to prevent nipple trauma

117
Q

The 1st 1-2 days what kind of breast milk is expelled?

A

Colostrum- Liquid gold full of immunglobulin/laxitves

118
Q

Transitional milk appears at what days

A

2-3 days

119
Q

What is foremilk?

A

Stored before feeding high in water content

120
Q

What is hindmilk?

A

produced during feeding- high in fat content

121
Q

What are signs of engorgement

A

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

  1. subsides in 24-48 hours
122
Q

What is subsequent engorgment?

A

Occurs in breastfeeding moms
1. Distention of milk glands
2. missed a feeding delayed pumping
3. relieve by infant sucking or expressing milk

123
Q

What are our interventions for breast engrogment?

A
  1. frequent feeding or pumping
  2. cool compresses
  3. chilled cabbage leaves to breast 20mins BETWEEN feedings 3x a day
124
Q

What are our nursing interventions for nipple trauma?

A

1.Proper infant removal from breast
2.Allow nipples to air dry 15 mins 2-3 x per day
3.Colostrum to nipples

125
Q

What nursing education can we provide for engorgement in a breast feeding mom

A
  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
Q

What nursing education can we provide for engorgement in non-breast feeding mom?

A
  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
Q

What is mastitis?

A
  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
Q

What are s/s of mastatits?

A
  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
Q

What are our nrusing interventions for mastitis?

A
  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
Q

What should we know about the taking-in-phase of maternal adaptation?

A

Dependent (24-48hours)
1. focused on own needs, unable to make decisions
2. relives birth experiences, adjust to psychosocial changes

131
Q

What should we know about the taking-hold phase in maternal adaptation PP

A

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
Q

What should we know about the letting-go phase in maternal adaptation PP

A

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
Q

What are the risk factors of postpartum blues, depression and psychosis?

A
  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
Q

What should we know about PP blues?

A
  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
Q

What should we know about PPD?

A
  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
Q

What is PP psychosis?

A
  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
Q
A

Module 6 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions