Week 07 Flashcards
Postpartum Care and Feeding
when and how long is the postpartum period
6 weeks following delivery
how long is the hospital stay for a vaginal birth
24-48 hours
how long is the hospital stay for a c-section birth
48-72 hours
physiological changes for urinary/renal system
diuresis up to 3000 mL a day on 2nd-5th days
physiological changes for the integumentary system
- striae gravidarum (stretch marks) remain
- everything else goes
physiological changes for the cardiovascular system
- cardiac output increases in the first 4 hours
- the heart returns to normal position
physiological changes for the gastrointestinal system
- motility increases
- constipation
- medications
- abdominal muscles
physiological changes for the hematological system
- blood volume (500 mL vaginal/ 1000 mL c-section)
- plasma fibrinogen remains elevated, increasing risk of blood clots
- estrogen and progesterone levels decrease
- prolactin increases
physiological changes for the immune system
- WBC increases due to labor
- rubella vaccine is non-immune globulin 2nd dose if the infant is Rh+
physiological changes for the neurological system
- numbness/dizziness anesthesia
- fatigue
- headaches, investigate if spinal or pre-eclampsia
physiological changes for the musculoskeletal system
- fatigue/ aches
- diastase recti abdominis
physiological changes for ovulation
- can return before period
- can return while breast feeding
physiological changes for lactation
- skin to skin
- allow infant to latch
what is striae gravidarum
stretch marks
what is pre-eclampsia
a potentially dangerous pregnancy complication that involves hypertension, swelling in hands and feet, and protein in urine
what is recti abdominis
the top layer of your abdominal muscles, commonly referred to as a “six pack”
assessment frequency for vaginal birth
every 15 minutes for the first two hours, than every 4 hours for the next 8 hours, then every 8 hours
assessment frequency for cesarian birth
every 30 minutes for 4 hours, then every hour for 3 hours, then every 4-8 hours
what to assess during postpartum assessments
- vital signs
- pain
- pallor
- BUBBLE-HE
what does BUBBLE-HE stand for
- B: breast
- U: uterus
- B: bladder
- B: bowels
- L: lochia
- E: episiotomy (perineum)
- H: homan sign
- E: emotion
what are the risk postpartum
- hemorrhage
- blood clots
- infection
- pneumonia
- pre-eclampsia for 10 days
what to help breastfeeding
- nipple shield
- assessing latch
- how mother is removing infant from the breast
interventions for non-breast feeding mothers
- tight bra
- avoid stimulation
- face away from the shower
what is engorgement
breast tissue swelling
engorgement interventions for lactating mothers
- frequent emptying
- warm showers
- warm compresses
- cold compresses
- cold cabbage
engorgement interventions for non-latching mothers
- tight supportive bras
- ice/cold compresses
- avoid breast and nipple stimulation
- avoid milk expression and pumping
what is mastitis
infection of the breast
signs and symptoms of mastitis
- flu like symptoms
- almost always unilateral
- milk flow has been established
- localized tenderness
mastitis treatment
- feed frequently
- warm compress prior to feeding
- antibiotics
the nursing role for breastfeeding
- administer medications
- supportive bras
- warm/moist compresses
- rest
- fluids
- continue feeding
- pump and dump
- pain management
what is uterine involution
return of the uterus to pre-pregnant state
interventions for slow bowel function
- walking
- encourage fluid intake
- abdominal binder
- fiber
what is the composition of lochia
- erythrocytes
- epithelial cells
- blood
- mucus
- bacteria
what doe lochia rubra look like
- bright red
- like a period
- small clots
what does lochia serous look like
- brownish pink discharge
- more stringy clumps
- more like the end of a period
what does lochia alba look like
- white yellow discharge
- no blood or clots
- spotty
what is the assessment after a perineum episiotomy, think “REEDA”
- R: redness
- E: edema
- E: ecchymosis
- D: discharge
- A: approximation
what is ecchymosis
the medical term for a bruise, which is a discoloration of the skin caused by broken blood vessels
what is hematomas
collection of blood under the skin following injury
risk factors for hematomas
- lacerations
- episiotomies
- forceps
- vacuum
- difficult or prolonged 2nd stage of labor
- nulliparity
signs and symptoms of a hematomas
- pain
- pressure or fullness
- tenderness when touched
- absence of lochia
- unable to void
location of a hematomas
vulva or inside vaginal opening on the vaginal wall
treatment of a hematomas 3-5 cm in diameter
- palliative treatment
- ice for 12 hours
- pain management
- observation
treatment of a hematoma greater than 5 cm
may require incision and drainage l&D
what is nulliparity
a female that has never given birth
what is the taking in phase and when does it start
- dependent, focused on rest and physical recovery
- day 1-2
what is the taking a how phase and when does it start
- dependent to independent, focused on caregiving
- begins on day 2-3
what is the letting go phase and when does it start
- interdependent, focuses on family and role
- begins day 7
when and how long does postpartum blues start and last
first few days after delivery, laast for 10 days
signs and symptoms of postpartum blues
- tearful
- crying easily
- lack of appetite
- sleep pattern disturbance
feelings associated with postpartum blues
- feeling of inadequacies
- fear
- anxiety
- anger
- inability to cope
time frame for postpartum depression to being
two weeks after delivery up to 6 months postpartum
feelings associated with postpartum depression
- persistant sadness
- intense mood swings
- irritability
- anxiety
- fatigue
- feelings of loss
- decreased appetite
- sleep pattern disturbances
- SI
providers may note what associated with postpartum depression
- weight loss
- flat affect
- crying
- irritability
- rejection of infant
- severe anxiety
true or false: postpartum depression does not resolve without intervention
true
does postpartum psychosis need intervention
yes, it is a medical emergency
when does postpartum psychosis usually develop
within 2-3 weeks after delivery
what do patients at risk for postpartum psychosis need
referrals to mental hospital before discharge
what are patients with postpartum psychosis most at risk for
self harm or infant harm
severe symptoms of postpartum psychosis
- confusion
- disorientation
- hallucinations
- delusions
- obsessive behaviors
- paranoia
postpartum psychosis treatments
- hospitalization
- psychotherapy
- appropriate medications
nursing managements for postpartum psychosis
- assessments: observe interactions, assess for SI or delusional thoughts, monitor baby
- interventions: encourage bonding and communication, promote maternal self care, provide resources
medications for postpartum pain management
- Tylenol 1000 mg
- Motrin 800 mg
interventions for postpartum pain management
- cold for 1st 24 hours
- heat
- topical anesthetic creams and sprays
- sitz baths
- non pharmacological
physiology of lactation
- the breast is made of lobules that contain alveoli and acini
- lined with epithelial cells
- ducts form from each alveoli and form the lactiferous duct that opens from the nipple
interventions for promoting brestfeeding
- positioning
- proper latching
- exclusively breastfeed for 6 weeks
- support system
- encourage, so not force
- pain and cramping
breastfeeding benefits for the mother
- decreased risk for breast, ovarian, and uterine cancer
- decreased risk of type 2 diabetes
- decreased risk of postpartum hemorrhage
- enhanced involution
- enhanced postpartum weight loss
- enhanced bonding
- less expensive
breastfeeding benefits for the infant
- enhanced immunity
- enhanced maturation of GI tract
- decreased risk of type 1 and 2 diabetes
- decreased risk of asthma
- decreased risk of childhood obesity
breastfeeding contraindications
- HIV
- chemo (methotrexate)
- lithium
- TB
- herpes on the breast
- varicella
- hep B and C
- drug abuse
- exposure (isotopes)
- infants with galactosemia
after how many ounces should you burp infant
1/2-1 ounces
considerations for prepping formula
- FDA approved non expired formula
- hand hygiene
- follow manufacture directions
- use scoop provided
- wash the top of the formula can before opening
considerations for storing prepared formula
- good for 1 hours after the infant drinks for it
- store prepared formula in the fridge for 24 hours
- you can store ready made or mixed concentrated formulas covered in the fridge for 48 hours
sibiling adaptation
- computation/ sibiling rivalry
- jealousy
- resentment
- regression
- attention seeking behaviors
considerations for infant safe sleep
- back sleeping
- firm sleep surface
- room share with out bed sharing
how long should you avoid drinking postpartum
2 weeks
