Week 1 Post partum Flashcards
1
Q
Storing breast milk
A
- 4 hours room temp, 6-8 in very clean conditions
- back of fridge for 96 hours
- freezer 6-12 months
2
Q
Thawed milk should be refrigerated for no more than ____ and discarded___
A
24 hours
1-2 hrs
3
Q
mothers who don’t eat meat, fish, eggs or milk should have
A
a vit b 12 supplement
4
Q
expected pees
A
start with one per day and increase with each day should stay consistent after day 5 with at least 6 wet diapers/day
5
Q
expected poops
A
day 1-2: at least one or two (meconium, dark green)
Day 3-4: at least 3 (brown, green or yellow)
Day 5+= at least 3 large (soft, seedy, yellow)
6
Q
expected weight loss/ gain in baby
A
5-10% in first 3 days
day 4+ should gain 20-35g/day
7
Q
when does baby regain birth weight
A
by day 10-14
8
Q
early PPH
A
first 24 hours
9
Q
late PPH
A
from 24- 12 weeks
10
Q
contributing factors to uterine atony (8)
A
- bladder distention
- abnormal or prolonged birth
- overdistended uterus
- multiparity (5+)
- oxytocin in labour
- meds that relax the uterus
- operative birth
- low placental implantation
11
Q
contributing factors to lacerations (2)
A
- rapid labour
- instruments (forceps vacuum during birth)
12
Q
laceration signs
A
- continuous trickle of blood brighter than lochia
13
Q
contributing factors to hematoma (3)
A
- prolonged or rapid labor
- large infant
- use of forceps or vacuum.
14
Q
late causes of PPH
A
tone=subinvolution
tissue=retention of placental fragments
15
Q
signs of hypovolemic shock (4)
A
- increase RR and HR
- fall in pulse pressure (fall in systolic, rise in diastolic)
- skin and mucous membranes are cold and clammy
- decrease urine output
16
Q
when can no longer feel fundus
A
by 2 weeks PP
17
Q
how long for placental site to heal
A
6 weeks
18
Q
most common causes of subinvolution (2)
A
- infection
- retained placental fragments
19
Q
signs of subinvolution (3)
A
- fundus height higher than should be
- slow progression of lochia stages
- heaviness, pelvic pain
20
Q
treatment for subinvolution (3)
A
- methylergonovine- maintains firm uterine contractions
- abx for infection
- Dilation and curettage to remove fragments
21
Q
uterine atony is the
A
lack of normal muscle tone
22
Q
causes for tone issues (3)
A
- overdistention (LGA, many fetuses, polyhydramnios)
- prolonged labor
- meds that relax the uterus
23
Q
methylergonovine
- function
- dont give to
A
- maintain firm uterine contractions
- causes increased BP don’t give to those with HTN
24
Q
tranexamic acid
A
helps inhibit the break up of clots so can stop bleeding
25
iv calcium
may be used to counteract the effects of tranexamic acid
26
hematomas
- collection of blood in tissues
- may be easily seen as a bulging bluish or purple mass
27
hematomas signs and symptoms
- severe unrelenting pain not relieved by analgesics
- pressure in the vulva, pelvis or rectum
- maybe cant urinate from pressure
28
treatment of hematoma (4)
- small will resolve
- larger may require incison and drainage of clot
- bleeding vessel ligated
- packed with hemostatic material to stop bleeding
29
what increases chance of placental fragments
- placenta manually removed
- placenta grows more deeply into the uterine muscle
30
treatment for tissue retention (3)
- meds to contract uterus
- curettage
- abx if infection
31
signs of pp hemorrhage
- persistent bright red bleeding
- lochia returning
- soaking pad in one hour or less
32
signs of DVT
- leg edema
- color changes
- pain when walking
- tenderness
- warmth
33
prepregnancy risks for VTE (7)
- BMI > 30 at first antenatal visit
- smoking more than 10 cigarettes/day
- cardiac disease
- lupus
- Sickle cell
- IBD
- varicose veins
34
RF for VTE in current pregnancy (6)
- pre-eclampsia
- preterm birth
- IUGR
- GDM
- placenta previa
- still birth
35
puerperal sepsis
- infection or septicemia after childbirth
36
signs of puerperal sepsis
- fever 38 or more after the first 24 hours and for 2 days after
- other signs of infection (REEDA)
-
37
WBC after birth
- usually rise to about 20-25
- inflammation, pain, stress
- protect from infection
- normal by 12 days PP
38
food to promote healing
protein
vit c
39
mastitis
infection of the breast
organisms from the skin or baby mouth enter through cracks
40
signs of mastitis
- warmth
- redness
- tenderness
- edema
- maybe purulent drainage
- fever/chills
41
if mastitis untreated
abscess
42
treatment for mastitis (4)
- abx
- removal of bm
- analgesics for comfort
- Moist heat
heat enhances blood flow to the area and comfort
43
perinatal psychosis onset
- rapid 48-72 hours PP
44
perinatal psychosis most commonly associated with
bipolar diagnosis
45
46
pt teaching to prevent mastitis (6)
- HH before BF
- wash breasts without sop
- keep nipples dry and exposed to air
- ensure proper latch
- if one affected feed on the opposite first
- ice packs or moist heat
46
reproductive system changes pp
fall in hormones
- HCG
- HPL
- estrogen
- progesterone
most dramatic changes in this system
46
infant death rate is highest in
first month of life
46
what is engorgement why it happens
uncomfortable fullness in breast
increase in blood and lymph as milk is produced
usually lasts 24-48 hours
46
how to manage engorgement
expressing enough milk
hand expression
46
when does placental site fully heal
6-7 weeks
46
fullness in breasts happens
day 3
47
uterus should return to normal size by
5-6 weeks if not by 6 then called subinvolution
47
at 12 hours uterus may
rise slightly above umbilicus but will go down
47
when to afterpains decrease
within 48 hours PP
47
what are after pains and when do they occur
menstrual-like cramps that happen after birth
occur during BF with oxytocin release
47
absence of discharge
not normal
could mean retained blood clots- infection
47
if rubra persists could mean
retained placenta
47
after paisn occur more commonly in
overdistention of uterus
48
meds to stimulate uterus
- oxytocin (IM or IV)
- methylergonovine (IM for PPH)
49
vaginal folds
reappear 3 weeks PP
50
perineum care 1st 24 hours
cold packs
reduce edema and bruising and numb area
51
perineum care after 24 hours
heat in a warm pack of sitz bath
- increases circulation and promotes healing
care after void and stool
52
return of mensuration BF or not
BF: 6-12 months
not BF: 7-9 weeks
53
best time between pregnancy and why (3)
2 years
- decrease preterm birth and low birth weight uterine rupture in VBAC
54
oral transdermal BC while BF
- type
-when
low dose progestin-only
4 weeks PP
55
oral, transdermal BC not BF
- 2-3 weeks
estrogen and progesterone
56
engorgement best treatment (2)
ice packs, frequent feeding or hand expression
57
despite blood loss in birth
- there is an increase in BV, CO, and SV from blood returning to the main circulation
- fluids moved from tissues
58
how to reestablish normal fluid balance (2)
diuresis (may reach 3000ml/day)
diaphoresis
59
orthostatic hypotension from
resistance to blood flow in pelvic vessels drop
BP may fall when sits or stands
60
hallmarks of PE (2)
dyspnea and tachypnea
61
hematocrit pp
lowers from fluid shifting into Blood stream
62
hyperpigmentation PP
fade as hormone levels decrease
63
when to resume exercise
as soon as 1st day
64
when get Rh immunoglobin
28 weeks
72 hours PP to Rh + baby
65
stage 1 lactation
secretory differentiation
- colostrum rich in antibodies
66
colostrum provides
protein
vit A E
essential minerals
lower in calories than milk
laxative effect
67
stage 2 of lactation
secretory activation
- removal of placental inhibitory hormones and release of prolactin
68
stage 3 of lactation
galactopoesis
9 days after birth milk production becomes activated by an autocrine method which is driven by milk removal
69
stage 4 lactation
(Involution)
average 40 days after last breastfeed milk secretion stops
70
milk production/expulsion hormones
prolactin
oxytocin
71
prolactin
- role
- released
- hightest concentration
- secretion
- released in response to suckling
- highest concentration at night
72
nighttime BF can help
establish adequate milk supply
73
amount of prolactin does not correlate with
amount of breast milk
74
oxytocin (3)
causes milk to be delivered
contracts muscles around the alveoli which sends signals to nipple
tingling in breast, cramping in uterus
75
protein found in BM
whey
76
fat changes in breastmilk
beginning: lower in fat (foremilk)- quenches thirst
During: increases the fat content
end: (hindmilk), highest in fat, satisfy newborn
77
when to stop prenatals
at least 6 weeks check-up
78
when cath removed after c/s
8-12 hours
79
when to ambulate post c section
no more than 8 hours
80
hourly resps done
24 hours after c/s
resp depression from epidural or spinal narcotics
81
bring newborn to breast or breast to newborn
newborn to breast
82
what may increase interest in feeding
expressing a few drops of colostrum
83
benefits of these BF holds
- cross cradle
- football
- side lying
- classic
- good head control and easy to bring nb to breast
- smaller babies, c/s,
- help mothers rest
- seem familiar hold.
84
improper mouth position signs
noisy sucking, smacking sounds, dimpling of cheeks
85
let down reflex
tingling and release of milk drops when other breast stimulated
86
usually cue to feed times
every 1.5-3 hours during early weeks
87
2 most common challenges with Breast feeding
- perception of inadequate milk
- nipple pain
88
baby should sleep no more than
4 hours at a time
89
pressure in breast can cause (3)
mastitis
blocked ducts
abscess
90
premature birth and breastfeeding implications (3)
- immunological components
- can pump and save later
- cross-cradle or football hold
