Week 3 Flashcards
postpartum care
What are parent to infant bonding and attachment behaviors?
Calls the baby by name
Cuddles close to chest
En Face
Holds closely while feeding
Kisses baby
Sings/ talks to the baby
What are some bidirectional attachment behaviors?
Becoming “cue sensitive” to the entrance behavior
infants respond to comforting measures
parents respond to the infants cry
parents stimulate and entertain the infant while awake
what are some factors that can affect bonding and attachment?
Timing/time
Proximity of the parent and infant
Weather the pregnancy is wanted or planned
Ability of their parents to process
knowledge base of the couple
Past experience with children
Maturity and educational levels of the couple
Cultural expectations
Extended support system
Maternal and paternal expectations
which one is bidirectional, bonding or attachment?
Attachment
what is defined as the emotional feelings that begin during pregnancy or shortly after birth between the parent and the newborn?
Bonding
what is the emotional connection that forms between the infant and his or her parents?
Attachment
what are the three stages of maternal touch?
Initial: fingertips
2nd: hand to stroke newborn’s head or body
final: holding the newborn close to body
How long how long do postpartum blues last?
First few weeks lasting for a few days and affects the majority of women
what are some signs and symptoms of postpartum Blues?
Difficulty sleeping
Anger
Mood swings
Sadness
Weeping
Anxiety
Difficulty eating
. What is the difference between postpartum Blues and postpartum depression?
In postpartum blues many women are affected, but they are still able to take care of their infant
What are some possible causes of postpartum Blues?
Changes in hormone levels
Fatigue
Stress from new role
at what time of postpartum should the mother contact her health care provider after feeling postpartum Blues and why?
If symptoms persist beyond four weeks, because it might be postpartum depression
what are some factors that can affect transitioning through maternal phases?
Medications such as depressants
Pregnancy, labor, and birth complications
cesarean births
pain
Preterm infants
infants with complications
Mood disorders
Lack of support from partner or support system
Adolescent mothers
Lack of financial resources
Cultural beliefs
what are the three maternal phases?
Taking in (mother and her experience)
taking hold (mother to baby and independence)
letting go
What are the major differences between postpartum blues and depression 14-2
Blues: symptoms disappear without medical intervention, occurs within the first 2 wks postpartum, able to safely care for self and baby
Depression: requires psychiatric intervention, occurs within first 12 months postpartum
Unable to safely care for self and/or baby
What increases the risk of someone having postpartum psychosis or depression?
schizophrenia
What is the process that occurs during the first few weeks of the postpartum period regarding the psychological transition to become a mother?
Maternal phases
Which maternal phase might the woman have a decreased ability to make decisions?
Taking-in phase
Which maternal phase might a woman concentrate on personal physical healing?
Taking-in phase
what might be an indication that a woman is having trouble in becoming a mother?
Delay in transitioning through maternal phases
In which phase does the woman give up the pregnancy role and initiate taking on the maternal role of the mother?
Taking-hold phase
Which maternal phase might the woman relive and speak of the birth experience?
Taking-in phase
In which phase might a woman be dependent on others for her and her infants immediate needs?
Taking-in phase
In which phase might the mother have feelings of inadequacy and being overwhelmed?
Taking-hold phase
In which phase might the women begin to let more of the outside world in?
Taking-hold phase
In which phase might the woman be interested in the newborns cues and needs?
Taking-hold phase
In which phase will the women begin to be independent?
Taking-hold phase
In which maternal phase might it be the easiest to initiate postpartum teaching?
Taking-hold phase
In which phase might the woman show signs and symptoms of baby blue and fatigue?
Taking-hold phase
In which phase might the woman the eager to learn?
Taking-hold phase
In which phase might the woman need verbal reassurance that she is meeting her newborn needs?
Taking-hold phase
In which phase does the movement from independence to the new role of mother fluid and interchangeable with the taking-hold phase?
Letting-go phase
In which maternal phase might the mother have feelings of grief, guilt, or anxiety?
Letting-go phase
In which Maternal phase does grieving and letting go of old relationships behaviors in favor of new ones?
Letting-go phase
When is the best phase for patient teaching?
Taking-hold phase
In which maternal phase is reconnection or growth in relationship with a partner possible?
Letting-go phase
what are breastfeeding contraindications?
Elicit drug use radiation, or chemotherapy agents
Active and untreated TB
HIV positive
Herpes simplex lesions on a breast
Galactosemia
PKU
what is the composition of human milk?
Proteins, carbohydrates such as lactose, and cholesterol, vitamins and minerals, antibodies
what are the 3 stages of human milk as the body establishes the lactation process?
Colostrum
Transitional milk consisting of colostrum and milk
Mature milk consisting of foremilk and hind milk
What is the yellowish breast fluid that is present for two to three days after birth?
Colostrum
What are interventions to promote and support breastfeeding?
Formal breastfeeding education
Direct support of mothers during session
Training of primary care staff and breastfeeding techniques for support
Peer support
what is the difference between foremilk and hind milk?
Foremilk is produced and stored between feedings end hind milk is produced towards the end of a session and has higher fat content.
What type of milk is composed of 20% solids and 80% water?
Mature milk
which hormone is responsible for lactation?
Prolactin
______ _____ can lower the fatty acid content of breast milk
extreme malnutrition
in which maternal phase does incorporating the newborn into the mother’s life whereby the baby becomes a separate entity from her?
Letting-go phase
which type of breast milk has higher levels of protein and lower levels of fat, carbohydrates, and calories then other types of milk?
Colostrum
In which phase does the mother accept the newborn as he or she really is?
Letting-go phase
what stage human milk last from day 3 to 10?
Transitional milk
which has a higher water content foremilk or hind milk?
foremilk
to hydrate the baby
In which part of the breast is milk produced?
The areolar glands
high levels of ____ and ______ suppress lactation, so these levels ____ after childbirth
Estrogen, progesterone, decrease
In which phase does the mother give up the fantasy of what it would or could have been?
Letting-go phase
What can decrease milk volume?
Decreased caloric intake and fluids
what type of milk consists of colostrum and milk?
Transitional milk
what is the milk ejection reflex called?
Let down reflex
success in breastfeeding depends on what five factors?
Women’s desire to breastfeed
Proper positioning
Latching on
Supply
Transferring of milk
what are signs of successful breastfeeding?
When the woman a tugging sensation when the newborn suckles
latch on pain is no longer than 10 seconds otherwise pain is a sign of poor latch
newborn’s tongue is between the lower gum and breast
swallowing can be heard
how many feedings should a nurse or lactation consultant observed before being discharged?
Three complete feedings
______activity from the infant increases____ levels and ____ of milk production
Suckling, prolactin, volume
at how many weeks should a newborn recover his birth age?
Two weeks
crying is a ____ sign of hunger
Late
how does an infant crying affect breastfeeding?
May have difficulty latching
need to be calmed down
what are some ways to position the breasts to assist with latching on?
Mother placing one hand around the breast several inches behind areola
the newborn is brought to the breast
what are signs that a newborn’s hunger has been satisfied?
Spontaneously releases suction
does not respond with a rooting reflex when stimulated
Is relaxed and calm
what stimulates the let-down reflex?
Suckling/feeding
Crying babies
Sexual arousal
what is the position called when the newborn is held off to the side?
football or clutch
what is the newborns ability to grasp the breast and to effectively suckle called?
Latching-on
is limiting feeding time necessary? Why or why not?
No it’s not necessary and can be harmful in the establishment of milk supply
what breastfeeding possition facilitates good head control?
Cross cradle position when the baby’s and woman’s abdomen are touching and the newborns back is against the woman’s forearm
Why would you assess lochia?
Frequent assessment in the early postpartum period allows how much blood is being lost
newborns and infants usually nurse from how many breasts at each feeding
One
what are the steps to get a baby to latch?
Align nipple with baby’s nose
place the baby’s mouth one to two inches beyond the base of the nipple
to remove the baby insert a finger into the corner of the baby’s mouth to break the seal
what are some ways to decrease the risk of nipple tissue breakdown?
teach proper technique
Apply warm compresses to the breasts and nipple before feeding
express colostrum or milk and rub it on the areola and nipple at the end of the feeding session
Inspect for signs of irritation
Change holding positions
Wash with water only
What is the bloody discharge from the uterus containing sloughed off necrotic tissue
lochia
how many wet diapers should you expect per day once breastfeeding is established?
At least eight wet diapers and several stools per day
Nipple irritation can lead to tissue breakdown and what infection?
Mastitis
What might you recommend to the mother who has irritation of the nipples?
Apply warm compresses before feedings to enhance the let down reflex
What is a complication of infected endometrial tissue?
Metritis
What are some reasons why some women stop breastfeeding by or before the 8th week?
Decrease milk supply and irritation and pain of the nipples
after how much time is the amount of lochia determined
One hour
Lochia is assessed as what 4 amounts?
Scant, light, moderate, heavy,
What is it called when the perineal pad is saturated within one hour?
Heavy lochia
1 inch on the pad is called
Scant
less than 4 inches on the pad is called
Light
How big are large clots?
10g or 10 milliliters of glucose
why are large clots undesirable postpartum?
They can interfere with uterine contractions
when should you expect lochia serosa?
Day 4 to 10
How long will after pains last after childbirth?
First few days to about 36 hours
what stage of lochia is yellow to white in color, scant amount, fleshy odor?
Lochia alba
When does primary hemorrhage happen?
Within the first 24 hrs after birth
less than 6 inches on the pad
moderate
what are some comfort measures 6 postpartum pain management?
Analgesics
relaxation technique
Empty bladder
warm blanket
ice
baths
How many weeks after birth is the postpartum period?
Six weeks
when should you expect lochia alba?
Day 10
What are some signs of postpartum hemorrhage?
Boggy uterus,
Heavy lochia
clots
Decrease in hematocrit and hemoglobin
When should you expect lochia rubra?
Day one to three
what does it mean if there is continued heavy bleeding with firm fundal tone?
It might indicate GI tract laceration or hematoma of the vulva or vagina
Excessive lochia
bright red bleeding
lochia rubra
what stage of lochia is bloody with small clots, moderate to scant amount, increased flow on standing or breastfeeding, fleshy odor?
Lochia rubra
What stage of lochia is pink or brown in color, scant amount, increased flow during physical activity, fleshy odor?
Lochia serosa
When does secondary hemorrhage occur?
From 24 hrs to 12 weeks after birth, but mor prevalent the first 7-14 days after birth
what are some signs of infection that the patient should report after discharge?
foul smelling lochia
Increased temperature
Pelvic or dominical tenderness and pain
Frequency, urgency or burning
during discharge teaching, the nurse should explain that the patient should report signs of what, which are associated with postpartum depression?
thoughts of harming self or infant, and persistent feelings of depression and sadness
What should you doas the nurse if there is heavy bleeding?
Assess uterine tone
massage the uterus if boggy
if foggy and displaced to the side instruct the patient to void and reevaluate
if firm changed the pad and we evaluate in 15 minutes
notify the provider or make life bleeding continues
what are some self-care discharge teachings?
Hygiene
Perineal care
Breast care for lactating and non lactating
pharmacologic and non pharmacologic pain control measures
The mother may be at risk for what nine postpartum knowledge deficits?
Disturbed sleep
Constipation
Pain and impaired comfort
Bleeding
Impaired urinary elimination
Fall injury
Breastfeeding (ineffective)
Infection
Altered skin integrity
After how long after childbirth can a mother resume sexual intercourse?
When the lochia has stopped
perineum has healed
Woman is physically and emotionally ready.
What is the max you should lose during a vaginal delivery?
500 mL
What is the max you should lose during a CS delivery?
1000 mL
what are some reportable signs and symptoms of embolisms and thrombosis?
leg pain
warmth
swelling
Chest pain and shortness of breath
For what symptoms would you call the provider?
Bleeding soaking through one pad/hour or passing a clot the size of an egg
Incision that is not healing
Red or swollen leg that is warm or painful
Temperature of 100.4 or higher
Headache that does not get better even with medicine.
Blurry vision
severe headaches indicate what condition?
preeclampsia
The meaning of “father” to a man varies based on expectations and responsibilities such as?
How he was fathered
How his culture defines the role
By friends and family, and by his partner
women can expect to lose approximately ____ pounds after delivery and an additional____ pounds due to fluid losses.
12, 5-8 pounds
lactating women should increase their calorie intake by ____ calories per day and have a fluid intake of approximately __ liters per day
500, 2
when would you notify the doctor of postpartum chills?
If the woman is cold but has a fever, because it indicates infection
what are 4 signs of DVT?
Calf tenderness, edema, sensation of warmth, pain
aslo darkening skin and SOB
what are some expected physical changes after childbirth?
Uterine involution, after pains, progression of lokia
Breast changes and engorgement
Diaphoresis and diuresis
Weight loss
For what symptoms would you call 911?
Pain in the chest
Obstructed breathing
Seizures
Thoughts of harming yourself or baby
What is the normal hematocrit level of a nonpregnant person?
37-47%
When should a provider be contacted in regards to bleeding?
Heavy lokia saturating in less than one hour
Bright red heavy bleeding after lochia has decreased
factors that influence the man’s transition to fatherhood are:
developmental and emotional age
Cultural expectations
Relationship with his partner or wife
Knowledge and understanding of fatherhood
Previous experiences as father
The manner in which he was fathered
Financial concerns
Support from partner, wife, friend, and family
What is the normal hemoglobin level of a pregnant person?
11-13 g/dL
What are some areas to assess after childbirth?
Vital signs, pain, breath sounds
Laboratory findings such as CBC, rubella, hematocrit
Breasts
uterus
Bladder
Bowel
Lochia
And physiognomy, lacerations, perineum, hemorrhoids
Lower extremities
Emotions, bonding with infant, fatigue
how will you know when normal GI function has come back?
Assess bowel sounds
assess for constipation
why might women be at risk for constipation?
Decrease GI motility due to progesterone effects
Decrease physical activity
Dehydration and fluid loss from labor
Effects of epidural
Fear of having a bowel movement after perineal laceration or episiotomy
Perineal pain and trauma
What is the normal hematocrit level of a pregnant person?
33-39%
What is the normal hemoglobin level of a nonpregnant person?
12-16 g/dL
what are some nutritional teachings to give to a patient after childbirth?
Increase fluid intake with fiber and roughage
Encourage women to ambulate to increase GI motility and decrease risk of gas pain
Instruct fluid intake increase of at least 8 to 10 glasses a day
what would you do if a fundus is not midline when doing a fundal exam?
Ask the patient if they have voided and if they have recently, do a bladder scan.
How much should a woman void two to four hours after delivery?
At least 300 milliliters
What is the RBC count of a nonpregnant person?
4.5-5.4 10,000cells/cubic mm
What would you do first if someone is complaining of dysuria?
Check vitals first
What is the RBC count of a pregnant person?
3.8-4.4 10,000cells/cubic mm
why might a woman be asked to stay in bed after childbirth?
Lower body nerve sensation may be diminished for those who have received an epidural during labor
What might the doctor prescribe if a woman is having Constipation after childbirth?
Docusate
what are some teachings or advice you would give a woman with hemorrhoids?
Encourage avoiding sitting for long periods of time by lying on her side
instruct the woman to take sitz baths
how would you assess for diastasis recti abdominis?
When there is separation upon palpating the fundus
RhoGam would be administered during pregnancy at 28 weeks gestation two women with what type of blood?
Anything with a - sign
what is it called when there is separation of the rectus abdominal muscles after birth?
Diastasis recti abdominis
what are some signs of preeclampsia?
Headache but can be due to post epidural or spinal headache
what is an adverse reaction to RhoGam?
Pain at IM site, anemia and fever
how long after birth should postpartum follow up care after the a vaginal delivery be given?
Six weeks after
how long would you expect the effects of an epidural or spinal anesthesia to last for?
At least several hours into early postpartum period
why might some women have headaches after an epidural or spinal?
There is a leakage of cerebrospinal fluid leading to decreased levels of CSF and might be worse when they are upright
what is the action of RhoGam
prevents production of anti-Rh (D) antibodies
Would you give an MMR vaccine for an equivocal level of rubella?
Yes, because they might be less than borderline immune
why might people think that breastfeeding can be used as a contraceptive?
Lactation suppresses menses likely due to hormonal changes including elevated prolactin levels but it is not effective
what do prolactin levels do in non- lactating versus lactating women
they decrease in non lactating and increase in lactating
What is the indication of oxytocin?
Postpartum control of bleeding
Why can’t you give an MMR vaccine during birth?
It’s a live attenuated vaccine
Can you get pregnant right after getting the vaccine?
No, because it will affect the fetus about a month or so after
how long after a C-section should postpartum follow-up care be done?
One to two weeks after delivery
When you you administer an MMR vaccine if a woman’s titer is negative?
After birth
how long after birth should a newborn have follow-up care?
One to two weeks after delivery
what are adverse reactions with IV Oxytocin use?
coma, seizures, hypertension, water intoxication
what is the action of oxytocin?
Stimulates uterine smooth muscle to produce uterine contraction
how long does a intrauterine contraceptive or copper IUD last?
About 1-10 years And can be used with lactation
what are some nursing implications for oxytocin administration?
Monitor vital signs frequently
assess for water intoxication(drowsiness, headache, anuria)
administer with infusion pump
Each patient’s medications will cause uterine cramping
How does a copper IUC work as a contraceptive?
It releases hormones
How does the endocrine system cause amenorrhea?
There is decreased FSH causing no ovulation
What ways besides drugs causes the uterus to retract?
breastfeeding
what are examples of contraceptives that can be used during lactation?
Progestin, depo-provera, and copper IUD, lactational amenorrhea
how often should you assess the uterus after the third stage of Labor?
Every 15 minutes for the first hour
Every 30 minutes for the second hour
Every four hours for the next 22 hours every shift after the 1st 24 hours
how should your hands be when palpating or doing a fundal massage?
One hand just above the symphysis pubis to support the lower uterine segment and the other hand at the top pushing downward
what is a sign that the uterus is not contracted?
Soft or boggy uterus
how would you assess the position of the fundus?
Measure the distance between the fundus and belly button
By how much does the uterus descend everyday?
1 cm
Why must you put your hand on the symphysis pubis when doing a fundal massage?
Prevent uterine inversion
what are the steps to express milk manually?
- Wash hands
- massage each quadrant
- form the letter C with the thumb at the 12:00 position and forefinger at the 6:00 position
- push the thumb and finger towards the chest wall
- lean over and direct the spray of milk into a clean container
- repeat several times
- occasionally massage distal areas
- reposition fingers at 3:00 and 9:00 and repeat
when is a good time to express milk?
At the end of a feeding session
Is breastfeeding a reliable method of contraception?
no
At day three postpartum, where should the fundus be?
3cm below the belly button
where should the fundus be immediately after postpartum?
Around the belly button or 0
where should the fundus be 6-12 hours after postpartum?
Around the belly button or 0
how long can you store expressed milk in a deep freezer?
6 to 12 months
how should you not thaw breast milk?
In a microwave oven or stove top or in room temp
what does it mean if a uterus has shifted to the side?
Patient might have a full bladder and it needs to be emptied
What does REEDA stand for?
Redness
Edema
Ecchymosis
Discharge
Approximation of edges of episiotomy or laceration
by what day should the uterus be unpalpable?
Day 14
How long can you store breast milk at room temperature?
6 to 8 hours
in which position should the woman be when assessing for lochia and REEDA?
Side-lying
how long can you store expressed milk in a refrigerator?
Up to five days
Where in the refrigerator should breast milk be stored
in the back of the fridge
how long can you store expressed milk in a freezer Attached to a refrigerator?
Three to six months
What is the postpartum BUBBLE LE assessment?
Breasts
Uterus
Bowels
Bladder
Lochia
Episiotomy, laceration, perineum, hemorrhoids
Lower extremities
Emotional status, bonding, fatigue, psychosocial factors
How should you thaw breast milk?
Bottle or bag in the refrigerator overnight
placing it under warm running water or bottle warmer
setting it in a container of warm water
what are some ways to increase sibling attachment?
Spending time during the prenatal period talking about upcoming arrival
Opportunities to feel the baby move and hear the heartbeat
providing opportunities to spend time with the older children alone
Giving siblings a present from their new brother or baby sister
Explaining why babies cry and how they communicate
Taking siblings on a outing while the infant stays home
what are some disadvantages to formula feeding?
Need for increased:
time to prepare formula
cost
risk of infection from lack of antibodies
risk of childhood obesity and insulin dependent diabetes
how do newborns indicate hunger?
By being in an awake/alert state
making mouth and tongue movements
Making hand-to mouth movements
Rooting
What is REEDA used for?
Perineal Assessment of the fundus and lochia and c-section
What are advantages of formula feeding?
Anyone can feed that infant
autonomy for the mother
decreases the frequency of feedings since digestion of formula is slower than that of human milk
What are 7 advantages of breastfeeding?
Decreased risk of infant diarrhea
Respiratory infections
Hospitalization for RSV
Otitis media
Necrotizing enterocolitis
Childhood obesity
Cost
What are some side effects of breastfeeding?
Painful nipples
Mastitis
engorgement
what is a bad latch score?
A low score because it means that more support is needed
What are signs of cystitis?
Frequency, urgency
Pain/burning on urination
Malaise
what are risk factors for mastitis?
History of mastitis with a previous infant
Cracked and or sore nipples
Use of antifungal cream
Key clinical practices of Baby Friend Hospital Initiative for breastfeeding (8)
Discuss importance and management of breastfeeding with women and their families.
Facilitate immediate and uninterrupted skin-to-skin contact and support breastfeeding ASAP after birth.
Support initiating and maintaining breastfeeding and managing difficulties.
Don’t provide breastfed newborns any food or fluids other than breast milk, unless medically indicated.
Enable mothers and their infants to remain together and rooming-in 24 hours a day.
Support mothers to recognize and respond to their infants’ cues for feeding.
Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.
Coordinate discharge so that parents and infants have timely access to ongoing support and care.
Critical management procedures of Baby Friend Hospital Initiative for breastfeeding
1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions.
1b. Have a written infant feeding policy that is routinely communicated to staff and parents.
1c. Establish ongoing monitoring and data-management systems.
- Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding.
What other ways causes the uterus to retract?
Breastfeeding
What are advantages of breastfeeding for the mother?
Decrease in infection and weight, bonding with the infant
What are the five rights of teaching?
Right time
Context
Goal
Content
Method
How would you treat cystitis?
Abx, increased hydration, rest
