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Nursing 2300 (VIcky Hansen) > Unit 2 - Part 1 - Postpartum Care > Flashcards

Unit 2 - Part 1 - Postpartum Care Flashcards

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1
Q

How long does postpartum period last

A

6 weeks

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2
Q

Main thing to look for immediately after birth

A

intense tremors

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3
Q

What causes intense tremors

A
  1. reaction to epidural

2. reaction to maternal adrenal production

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4
Q

What to assess during intense tremors

A

Temp: presence of fever?

Displaced Uterus = full bladder

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5
Q

Definition: the rapid reduction in size of the uterus and the return of the uterus to a non pregnant state

A

involution

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6
Q

T/F: Afterpains are greater after multiple births

A

T

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7
Q

A fundus that is above the umbilicus and is boggy (feels soft and spongy rather than firm and well contracted) is associated with excessive _____ _____

A

uterine bleeding

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8
Q

Definition: relaxation of uterine muscle tone

A

Uterine Atony

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9
Q

The cause of a distended fundus in a recently delivered woman is likely due to a distended bladder causing a temporary upward displacement of the uterus. What is the first action a nurse should take at this time?

A

Have the woman empty her bladder and then remeasuring the height of the fundus

If the client is unable to void, an in and out catheterization to empty the bladder is indicated

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10
Q

During involution, bleeding is controlled by what?

A

compression of muscle fibers

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11
Q

What is one thing someone can do to firm up the uterus

A

massage it

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12
Q

Definition: represents the healing of the uterus

A

Lochia

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13
Q

What to assess with lochia

A

amount. color, odor

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14
Q

Describe Lochia Rubra:

A
  • dark red

- day 2-3

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15
Q

Describe Lochia Serosa:

A
  • pinkish color

- day 3-10

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16
Q

Describe Lochia Alba:

A
  • creamy/yellowish discharge

- day 10 up to 6 weeks

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17
Q

T/F: Lochia with large plum-sized clots are normal the first few days after birth

A

FALSE!

- only a few SMALL clots (no larger than a nickel) are common

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18
Q

When the lochia flow stops, the cervix is considered to be _____, and chances of infection ascending from the vagina to the uterus _____

A
  • closed

- decrease

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19
Q

T/F: A steady trickle of blood could indicate a laceration in the birth canal and should be reported to the healthcare provider for follow up.

A

T

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20
Q

Total average volume of lochia is approximately

A

225 mL

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21
Q

Why is lochia discharge greater in the morning?

A

because of pooling in the vagina and uterus while the mother lies sleeping

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22
Q

The amount of lochia may also be increased by _____ or _____

A

exertion or breastfeeding

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23
Q

T/F: Mul­tiparous women usually have more lochia than first-time moth­ers.

A

T

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24
Q

Women who undergo a cesarean birth typically have _____ lochia than women who give birth vaginally.

A

less

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25
Q

Tone and contractility of the vaginal orifice may be improved by

A

Kegel exercises (perineal tightening exercises)

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26
Q

Describe cervical changes after birth

A
  • flabby, formless
  • admits 2 fingertips for few days
  • first childbearing permanently changes
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27
Q

Describe vaginal changes after birth

A
  • appears swollen, bruised

- decreased size

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28
Q

How long does it take rugae to return after birth

A

3-4 weeks

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29
Q

Describe Perineal changes after birth

A
  • soft tissue swollen, bruised

- episiotomy, laceration edges drawn together

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30
Q

How long does it take perineum to heal after birth

A

2-3 weeks

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31
Q

Nursing care for perineum changes

A
  1. ice packs
  2. sitz baths
  3. assess urination
  4. episiotomy care
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32
Q

_____ has been identified as an essential amino acid that decreases the pain of an episiotomy.

A

Lysine

[can be found in meat, cheese, fish, eggs, and nuts]

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33
Q

The nurse should instruct the client to _____ _____ _____ before sitting to reduce the pain.

A

tighten the buttocks

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34
Q

To prevent infection, not to reduce pain, the client should…

A

wash the area daily and the peripad should be changed four times a day

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35
Q

_____ is often prescribed for postpartum pain when a client is experiencing moderately severe pain with inflammation.

A

ibuprofen (Advil)

36
Q

_____ is often prescribed on 2nd and subsequent births for after pains.

A

Percocet

37
Q

The client needs to be closely monitored for _____ _____ when Percocet is used.

A

respiratory suppression

38
Q

When does a women start ovulating/menstruating again after childbirth

A

6 weeks after if not breastfeeding

- Breastfeeding = at least 3 months after birth

39
Q

T/F: exclusive breastfeeding reduces the risk of pregnangy

A

T

40
Q

Physiologic changes to abdomen

A
  • uterine ligaments stretched
  • diastasis recti abdominis (gap of >/= 2.7 cm between the 2 sides of rectus abdominis muscles
  • striae/stretch marks
41
Q

______ stimulate breast duct proliferation, development

A

progesterone

42
Q

Once the placenta is expelled, progesterone levels….

A

fall -> triggers milk production

43
Q

Best way to get hindmilk rich in fat

A

When breastfeeding, start off on breast she last left on

44
Q

Why is colostrum important

A

It passes immunity to baby

45
Q

3 stages of human milk

A
  1. Colostrum: immediately available at birth
  2. Transitional milk: Day 2-5
  3. Mature milk: present by 2 weeks
46
Q

Are the mother’s bowels sluggish following birth?

A

Yes

- may provide a stool softener

47
Q

What can a mother have to eat/drink after a C-section

A

clear liquids until bowel sounds are present

48
Q

what is puerperal diuresis

A

difficult urinating first day, but by day 2 woman will urinate 2-4 L

49
Q

Describe the temperature of mother after childbirth

A
  • afebrile (normal temperature) except first 24 hours after birth
50
Q

Describe the BP of mother after childbirth

A
  • immediately: increased BP
51
Q

Describe the pulse of mother after childbirth

A

puerperal bradycardia (50-70 bpm) (6-10 days)

52
Q

When is a seizure most likely to occur in mother

A

during labor, first 24 hours

- pre-eclamptic = up to 48 hours

53
Q

Describe WBC/leukocytes after childbirth

A

increase

54
Q

Describe hgb & hct after childbirth

A

normal

55
Q

Describe platelet levels after childbirth

A

initially high (so you want to prevent blood clots by ambulating), then they fall

56
Q

Describe the weight of mother after childbirth

A
  • initial weight loss of 10-12 lbs
57
Q

Describe labs after childbirth

A

normal 2-6 weeks after birth

58
Q

T/F: there is a risk for obesity during the childbearing years

A

T

59
Q

mid-stature woman will gain about how much weight during pregnancy

A

~28 lbs

60
Q

Describe clinical assessment after childbrith

A

assess for hypovolemia

61
Q

T/F: inadequate intake of nutrition can reduce milk volume

A

T

62
Q

How much protein should a mother intake when breastfeeding

A

65 g/day

63
Q

How much liquid should a mother intake while breastfeeding

A

A LOT!

64
Q

Blood pressure elevations may result from excessive use of _____ _____ _____ _____.

A

oxytocin or vasopressor medications.

65
Q

Risk for Deficient Fluid Volume secondary to _____ _____ _____ _____

A

boggy fundus and nausea

66
Q

Mothers should usually be focused on the infant. Assess for detachment. Mother not wanting to look at baby or take care of baby. Encourage her to care for the baby by…

A

Demonstrating and getting them involved.

67
Q

Reddened breasts may indicate _____

A

mastitis

68
Q

Pulse range

A

50-90 bpm

69
Q

RR range

A

16-24 breaths per minute

70
Q

Temperature range

A
  1. 6-38 C (98-100.4)

- > 100.4 = infection

71
Q

Can you breastfeed with mastitis

A

Yes, it is the best thing to do!

72
Q

Is it normal to have separation of musculature in abdomen?

A

Yes, soft/doughy texture is expected

73
Q

T/F: many women get hemorrhoids during pregnancy, but is not a problem as long as they are not very large

A

T

74
Q

How often should mother void

A

every 4-6 hours

75
Q

When should mother have bowel

A
  • normal BM by 2nd/3rd day
76
Q

When is the mother expected to start assuming more responsibility/eagerness to learn

A

after 12 hours

*explain postpartum blues/depression (should not progress longer than a couple of weeks)

77
Q

Nursing cares to implement if mother does not want to breastfeed

A
  • provide supportive, well-fitting bra within 6 hours of birth
  • ice packs over axiliary area of each breast
  • dry out period = 4-5 days
78
Q

When can a mother resume intercourse after childbirth

A
  • episiotomy healed

- lochia flow stopped

79
Q

T/F: you should ambulate mother the day after surgery

A

yes, as soon as you can, but make sure she is steady

80
Q

Definition: VBAC

A

vaginal birth after cesarian birth: very high risk!

treat like surgical pt

81
Q

Definition: REEDA

A
  • Redness
  • Oedema: excess watery fluid collecting in cavities of body tissues
  • Ecchymosis: discoloration of skin from bleeding underneath, typically caused by bruising
  • Discharge
  • Approximation: bringing tissue edges into desired apposition for suturing
82
Q

What is the Newborns’ and Mothers’ Health Protection Act of 1996

A

guarantees a minimum stay of up to 48 hours following a vaginal birth and 72 hours for a C-section

83
Q

protein in the urine leads to

A

preeclampsia

84
Q

HTN + protein in urine + seizures =

A

eclampsia

85
Q

Define: HELLP

A

LIFE THREATENING TO MOTHER/FETUS

hemolysis
elevated liver ezymes
low platelet count

  • Occurs between 28-36 weeks gestation BUT my occur postpartum in up to 30% of cases.
  • Reported S/Sx’s
  • Headache
  • Nausea/vomiting/indigestion with pain after eating/Abdominal or chest tenderness and upper right upper side pain (from liver distention)
  • Shoulder pain or pain when breathing deeply
  • Bleeding/ Changes in vision/ Swelling
  • Platelet infusion should only be given in patients with severely low platelet counts, those with significant bleeding or with very extremely low platelet counts and may require caesarean delivery.
  • Right upper quadrant ultrasound my show hepatic infarction or subcapsular hematoma but has no role in acute management of the patient.
  • Most infant death occurs do to abruption of the placenta / placental failure

Nursing 2300 (VIcky Hansen) (64 decks)

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