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NRSG 328- Maternity > Week 1 Post partum > Flashcards

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
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2
Q

Thawed milk should be refrigerated for no more than ____ and discarded___

A

24 hours
1-2 hrs

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3
Q

mothers who don’t eat meat, fish, eggs or milk should have

A

a vit b 12 supplement

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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

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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)

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6
Q

expected weight loss/ gain in baby

A

5-10% in first 3 days
day 4+ should gain 20-35g/day

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7
Q

when does baby regain birth weight

A

by day 10-14

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8
Q

early PPH

A

first 24 hours

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9
Q

late PPH

A

from 24- 12 weeks

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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
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11
Q

contributing factors to lacerations (2)

A
  • rapid labour
  • instruments (forceps vacuum during birth)
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12
Q

laceration signs

A
  • continuous trickle of blood brighter than lochia
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13
Q

contributing factors to hematoma (3)

A
  • prolonged or rapid labor
  • large infant
  • use of forceps or vacuum.
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14
Q

late causes of PPH

A

tone=subinvolution
tissue=retention of placental fragments

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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
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16
Q

when can no longer feel fundus

A

by 2 weeks PP

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17
Q

how long for placental site to heal

A

6 weeks

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18
Q

most common causes of subinvolution (2)

A
  • infection
  • retained placental fragments
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19
Q

signs of subinvolution (3)

A
  • fundus height higher than should be
  • slow progression of lochia stages
  • heaviness, pelvic pain
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20
Q

treatment for subinvolution (3)

A
  • methylergonovine- maintains firm uterine contractions
  • abx for infection
  • Dilation and curettage to remove fragments
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21
Q

uterine atony is the

A

lack of normal muscle tone

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22
Q

causes for tone issues (3)

A
  • overdistention (LGA, many fetuses, polyhydramnios)
  • prolonged labor
  • meds that relax the uterus
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23
Q

methylergonovine
- function
- dont give to

A
  • maintain firm uterine contractions
  • causes increased BP don’t give to those with HTN
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24
Q

tranexamic acid

A

helps inhibit the break up of clots so can stop bleeding

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25
Q

iv calcium

A

may be used to counteract the effects of tranexamic acid

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26
Q

hematomas

A
  • collection of blood in tissues
  • may be easily seen as a bulging bluish or purple mass
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27
Q

hematomas signs and symptoms

A
  • severe unrelenting pain not relieved by analgesics
  • pressure in the vulva, pelvis or rectum
  • maybe cant urinate from pressure
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28
Q

treatment of hematoma (4)

A
  • small will resolve
  • larger may require incison and drainage of clot
  • bleeding vessel ligated
  • packed with hemostatic material to stop bleeding
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29
Q

what increases chance of placental fragments

A
  • placenta manually removed
  • placenta grows more deeply into the uterine muscle
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30
Q

treatment for tissue retention (3)

A
  • meds to contract uterus
  • curettage
  • abx if infection
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31
Q

signs of pp hemorrhage

A
  • persistent bright red bleeding
  • lochia returning
  • soaking pad in one hour or less
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32
Q

signs of DVT

A
  • leg edema
  • color changes
  • pain when walking
  • tenderness
  • warmth
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33
Q

prepregnancy risks for VTE (7)

A
  • BMI > 30 at first antenatal visit
  • smoking more than 10 cigarettes/day
  • cardiac disease
  • lupus
  • Sickle cell
  • IBD
  • varicose veins
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34
Q

RF for VTE in current pregnancy (6)

A
  • pre-eclampsia
  • preterm birth
  • IUGR
  • GDM
  • placenta previa
  • still birth
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35
Q

puerperal sepsis

A
  • infection or septicemia after childbirth
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36
Q

signs of puerperal sepsis

A
  • fever 38 or more after the first 24 hours and for 2 days after
  • ## other signs of infection (REEDA)
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37
Q

WBC after birth

A
  • usually rise to about 20-25
  • inflammation, pain, stress
  • protect from infection
  • normal by 12 days PP
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38
Q

food to promote healing

A

protein
vit c

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39
Q

mastitis

A

infection of the breast
organisms from the skin or baby mouth enter through cracks

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40
Q

signs of mastitis

A
  • warmth
  • redness
  • tenderness
  • edema
  • maybe purulent drainage
  • fever/chills
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41
Q

if mastitis untreated

A

abscess

42
Q

treatment for mastitis (4)

A
  • abx
  • removal of bm
  • analgesics for comfort
  • Moist heat
    heat enhances blood flow to the area and comfort
43
Q

perinatal psychosis onset

A
  • rapid 48-72 hours PP
44
Q

perinatal psychosis most commonly associated with

A

bipolar diagnosis

45
Q
A
46
Q

pt teaching to prevent mastitis (6)

A
  • 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
Q

reproductive system changes pp

A

fall in hormones
- HCG
- HPL
- estrogen
- progesterone
most dramatic changes in this system

46
Q

infant death rate is highest in

A

first month of life

46
Q

what is engorgement why it happens

A

uncomfortable fullness in breast
increase in blood and lymph as milk is produced
usually lasts 24-48 hours

46
Q

how to manage engorgement

A

expressing enough milk
hand expression

46
Q

when does placental site fully heal

A

6-7 weeks

46
Q

fullness in breasts happens

A

day 3

47
Q

uterus should return to normal size by

A

5-6 weeks if not by 6 then called subinvolution

47
Q

at 12 hours uterus may

A

rise slightly above umbilicus but will go down

47
Q

when to afterpains decrease

A

within 48 hours PP

47
Q

what are after pains and when do they occur

A

menstrual-like cramps that happen after birth
occur during BF with oxytocin release

47
Q

absence of discharge

A

not normal
could mean retained blood clots- infection

47
Q

if rubra persists could mean

A

retained placenta

47
Q

after paisn occur more commonly in

A

overdistention of uterus

48
Q

meds to stimulate uterus

A
  • oxytocin (IM or IV)
  • methylergonovine (IM for PPH)
49
Q

vaginal folds

A

reappear 3 weeks PP

50
Q

perineum care 1st 24 hours

A

cold packs
reduce edema and bruising and numb area

51
Q

perineum care after 24 hours

A

heat in a warm pack of sitz bath
- increases circulation and promotes healing
care after void and stool

52
Q

return of mensuration BF or not

A

BF: 6-12 months
not BF: 7-9 weeks

53
Q

best time between pregnancy and why (3)

A

2 years
- decrease preterm birth and low birth weight uterine rupture in VBAC

54
Q

oral transdermal BC while BF
- type
-when

A

low dose progestin-only
4 weeks PP

55
Q

oral, transdermal BC not BF

A
  • 2-3 weeks
    estrogen and progesterone
56
Q

engorgement best treatment (2)

A

ice packs, frequent feeding or hand expression

57
Q

despite blood loss in birth

A
  • there is an increase in BV, CO, and SV from blood returning to the main circulation
  • fluids moved from tissues
58
Q

how to reestablish normal fluid balance (2)

A

diuresis (may reach 3000ml/day)
diaphoresis

59
Q

orthostatic hypotension from

A

resistance to blood flow in pelvic vessels drop
BP may fall when sits or stands

60
Q

hallmarks of PE (2)

A

dyspnea and tachypnea

61
Q

hematocrit pp

A

lowers from fluid shifting into Blood stream

62
Q

hyperpigmentation PP

A

fade as hormone levels decrease

63
Q

when to resume exercise

A

as soon as 1st day

64
Q

when get Rh immunoglobin

A

28 weeks
72 hours PP to Rh + baby

65
Q

stage 1 lactation

A

secretory differentiation
- colostrum rich in antibodies

66
Q

colostrum provides

A

protein
vit A E
essential minerals
lower in calories than milk
laxative effect

67
Q

stage 2 of lactation

A

secretory activation
- removal of placental inhibitory hormones and release of prolactin

68
Q

stage 3 of lactation

A

galactopoesis

9 days after birth milk production becomes activated by an autocrine method which is driven by milk removal

69
Q

stage 4 lactation

A

(Involution)
average 40 days after last breastfeed milk secretion stops

70
Q

milk production/expulsion hormones

A

prolactin
oxytocin

71
Q

prolactin
- role
- released
- hightest concentration

A
  • secretion
  • released in response to suckling
  • highest concentration at night
72
Q

nighttime BF can help

A

establish adequate milk supply

73
Q

amount of prolactin does not correlate with

A

amount of breast milk

74
Q

oxytocin (3)

A

causes milk to be delivered
contracts muscles around the alveoli which sends signals to nipple
tingling in breast, cramping in uterus

75
Q

protein found in BM

A

whey

76
Q

fat changes in breastmilk

A

beginning: lower in fat (foremilk)- quenches thirst
During: increases the fat content
end: (hindmilk), highest in fat, satisfy newborn

77
Q

when to stop prenatals

A

at least 6 weeks check-up

78
Q

when cath removed after c/s

A

8-12 hours

79
Q

when to ambulate post c section

A

no more than 8 hours

80
Q

hourly resps done

A

24 hours after c/s
resp depression from epidural or spinal narcotics

81
Q

bring newborn to breast or breast to newborn

A

newborn to breast

82
Q

what may increase interest in feeding

A

expressing a few drops of colostrum

83
Q

benefits of these BF holds
- cross cradle
- football
- side lying
- classic

A
  • good head control and easy to bring nb to breast
  • smaller babies, c/s,
  • help mothers rest
  • seem familiar hold.
84
Q

improper mouth position signs

A

noisy sucking, smacking sounds, dimpling of cheeks

85
Q

let down reflex

A

tingling and release of milk drops when other breast stimulated

86
Q

usually cue to feed times

A

every 1.5-3 hours during early weeks

87
Q

2 most common challenges with Breast feeding

A
  • perception of inadequate milk
  • nipple pain
88
Q

baby should sleep no more than

A

4 hours at a time

89
Q

pressure in breast can cause (3)

A

mastitis
blocked ducts
abscess

90
Q

premature birth and breastfeeding implications (3)

A
  • immunological components
  • can pump and save later
  • cross-cradle or football hold

NRSG 328- Maternity (4 decks)

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