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Nursing 3 Exam 3 > Unit 33 Postpartum > Flashcards

Unit 33 Postpartum Flashcards

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1
Q

What is involution?

A

Reduction in the size of uterus after delivery to pre-pregnant size cause by uterine contractions that constrict and occlude blood vessels at the placental site.

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2
Q

What are factors that enhance involution?

A
  • Uncomplicated labor and delivery
  • Breastfeeding
  • Early ambulation
  • Complete expulsion of placenta and membranes
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3
Q

What factors slow involution?

A
  • Infection
  • Full urinary bladder
  • Anestesia
  • Prolonged labor and delivery
  • Grand mutiparty
  • Retained placental fragments
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4
Q

What is the top part of the uterus called?

A

the fundus (palpable indicator of involution)

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5
Q

What is a boggy uterus and how is it corrected?

A
  • A boggy uterus is one that is soft , relaxed, and likely to cause hemorrhage
  • To correct you would massage the uterus to tighten and expel clots
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6
Q

What will a full bladder do to the uterus?
How could you check for a full bladder?
How long until you should void postpartum?

A

-A full bladder will shift the uterus left or right (displace it) increasing the risk for postpartum hemorrhage

  • With a bladder scanner
  • Palpate for full bladder
  • Should void within 6-8 hours postpartum
  • *Encourage voiding every 2-3 hrs even if no urge
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7
Q

What medication is used in cases of hypertension in pregnancy and to prevent seizures?

A

Magnesium sulfate

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8
Q

What is are medications used in treatment of premature labor?

A

Terbutaline and Magnesium sulfate

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9
Q

Post delivery the normal placement of the fundus should be where? If raised or to either side what could happen?

A

At the umbilicus
(1 finger a day goes down)

Then the uterus could continue to bleed

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10
Q

What is Lochia, the types, and what should it not contain?

A
  • It is the discharge of blood and debris following delivery
  • Musty fleshy odor, small amount of mucus

Rubra: 1-3 days, dark red, may have clots smaller than nickel

Serosa: 4-10 days, pink or brownish, watery, odorless

Alba: 11-21 days yellow to white, slight stale odor

Should NOT contain large clots
C-sections have decreased lochia due to suctioning in surgery

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11
Q

What is a procedure to remove clots?

A

[Dilation and curettage]

-Refers to the dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping

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12
Q

What could be an indication of hemorrhage regarding chuck pads?

A

If you are changing them more than 3 times in an hour = abnormal

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13
Q

What are the terms used to document the amount of Lochia flow?

A

Scant: 1-2 inch stain or only on tissue when wiped [< than 10 ml in one hour]

Light: 4 inches or less stain [10-25 ml in one hour]

Moderate: Less than 6 inch stain [25-50ml in one hour]

Heavy: saturated pad [50-80ml in one hour]

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14
Q

What are afterpains and how are they counteracted?

A
  • Intermittent uterine contractions
  • Stimulated by breastfeed
  • More painful in breastfeeding/multiparous women

Counteracted with 600mg Ibuprofen and one or two Percocet tabs

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15
Q

Briefly describe the cervix, vagina, and abdominal wall postpartum.

A

Cervix:

  • Closes to 2-3 cm after several days/finger after 1 week
  • Shape permanently changes after first delivery from round dimple to lateral slit
  • May appear bruised and edematous with small lacerations

Vagina:

  • Edematous with small lacerations
  • Should be free from pain within 2 weeks
  • Low estrogen levels decreases vaginal lubrication meaning painful sex for 6-10 weeks

Abdominal Wall:

  • Soft and flabby with decreased muscle tone
  • Striae or stretch marks once red fade to silver
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16
Q

How should the perineum be postpartum? What are ways to reduce perineum pain?

A
  • Edematous and painful to pressure, perhaps displaying hemorrhoids
  • Pain relieved though use of Tucks, Nupercainal ointment, ice (20 min on and 10 min off), Sitzs baths
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17
Q

Postpartum how should the breasts be?

A

-Soft and secreting colostrum

18
Q

How does uterine involution occur?

A

Autolysis of protein material within the uterine wall

19
Q

What decreased the risk of slots after Sx such as a C-section?

A

Walking

20
Q

What does a fever of 100.4F or below postpartum indicate?

A

Simply that fluids are needed

21
Q

What is considered a normal WBC lab value postpartum?

A

Could be up to 30,000 because placenta site is healing

22
Q

Describe the cardiovascular system postpartum.

A
  • Returns to pre-pregnant state within 2 weeks
  • First 48 are greatest risk especially with clients with heart disease
  • BP should remain consistent with pregnancy baseline
  • Bradycardia 50-70 bpm common during first 6-10 days
  • Tachycardia related to increased blood loss, temp elevation, of difficult labor and birth
  • Increased fibrinogen continues for 1 week with increased chance for thrombophlebitis
  • Decreased Hgb is related to amount of blood loss during delivery, should return to prelabor value in 2-6 weeks
  • Hct increases by 3-5 days related to diuresis
23
Q

Due to lower Hgb, diuresis, and volume shifting postpartum, what is the patient at risk for?

A

Syncope/fainting

Falls

24
Q

If a patient has voided five times in a morning, what would the nurse initially do?

A
  • Collect the next voiding/measure the amount of urine to assess for retention with overflow
25
Q

What does eating lots of ice do postpartum?

A

Decreases Hgb

26
Q

Why is there a risk of constipation and hemorrhoids postpartum?

A

Risk for constipation related to decreased peristalsis, use of analgesics, dehydration and decreased mobility during labor, and fear of pain from having a bowel movement

Risk for hemorrhoids increases because of pressure from pushing

27
Q

Describe endocrine function and lactation postpartum.

A

Endocrine:

  • Estrogen and progesterone drop rapidly after delivery of placenta
  • Menstruation usually resumes at 7-9 weeks for non lactating women
  • Ovulation and menstruation return time is prolonged in lactating women

Lactation:
-They have let down reflex which is the release of milk by contractions of the alveoli of the breast
-Colostrum is first milk secreted, rich in protein and immunoglobulins
-Mature milk produced after 2 weeks
-Primary engorgement occurs in second or third day as the supply of blood and lymph is increased and traditional milk produced
(use cabbage leaves to help with engorgement)

28
Q

What helps with lactation suppression?

A
  • Applying ice bags for 20 minutes, four times a day if engorgement occurs
  • Use of snug bra or breast binder continuously for 5-7 days to prevent engorgement
  • Avoiding heat and stimulation of breasts
29
Q

What is the normal urinary output per hour?

A

30-50 ml/hr

30
Q

Regarding psychosocial postpartum changes what are the phases of maternal adjustment?

A
  1. Taking in phase: 0-3 days; focus to self, passive and dependent, touches and explores newborn
    (reflecting)
  2. Taking hold phase: 3-10 days, obsessed with body functions, rapid mood swings
  3. Letting go phase: 10 days to 6 weeks: mother functions established
31
Q

What is bonding and what is engrossment?

A

Bonding is the process which the parents form an emotional attachment
-Use en face position, soft low pitched tone of voice

Engrossment is the father’s absorption, preoccupation, and interest in the infant

32
Q

What is true regarding laxatives postpartum?

A

Careful with them as they can transfer to baby via breastmilk

33
Q

How would you provide pain comfort postpartum?

A
  • Ibuprofen 600-800mg along with Precocet to decrease inflammation/edema and pain
  • Benadryl is given for reaction to spinal and epidural anesthesia
34
Q

How to promote bowel elimination postpartum?

A
  • Encourage early and frequent ambulation
  • Encourage increased fluids and fiber
  • Administer stool softeners as ordered (suppositories contraindicated if third or fourth degree perineal laceration involving rectum)
  • No straining at stool, normal patterns returns in 2-3 weeks
35
Q

What are postpartum warning signs?

A

-Bright red bleeding saturation more than 1 pad per hour or passing large clots

  • Temp > 100.4F
  • Chills
  • Excessive pain
  • Reddened or warm areas of breasts: mastitis
  • Foul smelling Lochia
  • Inability to urinate, burning, frequency,
  • Calf pain, tenderness, swelling
36
Q

What is engorgement?

A

Breasts are painfully overfull of milk.

37
Q

Wha are ways to establish lactation and important information regarding breastfeeding?

A
  • Utilize well fitting nursing bra for support day/night
  • Teach breast care including no use of soap and air drying nipples after feeding
  • Encourage nursing on demand, more they feed, more milk supply
  • Nurse 10-15 on first breast and until baby lets go on second, next nursing vice-versa
  • No caffeine, no chocolate, no gassy foods, no spicy, no soda
  • Higher stress leads to less milk supply
38
Q

What is of the most importance before performing any assessment, intervention, etc with the mother and baby?

A

Identify baby ID to mother ID before giving or leaving baby in room

(baby always transported by bassinet)

39
Q

What are a few important rest and gradual return to activity/nutrition information for discharge?

A

-Teach woman to resume activity gradually over 4-5 weeks; avoid lifting, stairclimbing, strenuous activity

  • Encourage 2000ml/day fluid intake
  • Encourage prenatal vitamins
40
Q

what is the biggest complication with cystic fibrosis?

A

pneumothorax

Nursing 3 Exam 3 (8 decks)

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