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week 5 Flashcards

1
Q

Postpartum physiological changes: Respiratory

Expected findings
- clear lungs
- non-labored breathing
- eupnea = normal breathing

Unexpected/abnormal findings
- tachypnea/bradypnea? – we suspect r/t fever or pain
- tachypnea/bradypnea? – we suspect r/t respiratory compromise, meds, anesthesia
- ______________ – we suspect r/t fluid bolus, Pitocin (anti-diuretic), magnesium sulfate

A

Unexpected/abnormal findings
- tachypnea – we suspect r/t fever or pain
- bradypnea – we suspect r/t respiratory compromise, meds, anesthesia
- fluid overload – we suspect r/t fluid bolus, Pitocin (anti-diuretic), magnesium sulfate

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2
Q

Postpartum physiological changes: Vitals

Unexpected/abnormal findings
- Temp > 100.4 F – we suspect ________
- low/high BP? - we suspect r/t preeclampsia, essential HTN, renal disease, anxiety
- low/high BP? - we suspect r/t uterine hemorrhage, hematoma
- tachycardia/bradycardia? – we suspect r/t difficult labor and birth, hemorrhage, r/o fever (infection)
- marked tachypnea/bradypnea? – r/o respiratory disease and pulmonary edema

A

Unexpected/abnormal findings
- Temp > 100.4 F – we suspect infection
- High BP - we suspect r/t preeclampsia, essential HTN, renal disease, anxiety)
- low BP - we suspect r/t uterine hemorrhage, hematoma)
- tachycardia – we suspect r/t difficult labor and birth, hemorrhage, r/o fever (infection)
- marked tachypnea – r/o respiratory disease and pulmonary edema

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3
Q

engorgement treatment/prevention appropriate for moms that are breastfeeding or non-breastfeeding?

  • well-fitting bra or ace wrap binder
  • cold compress or cabbage leaves
  • anti-inflammatory meds
  • avoid stimulating the breasts/nipples
  • avoid warm water on breast in shower, shower with back to water
  • avoid stimulating the nipple
A

non-breastfeeding moms with engorgement

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4
Q

postpartum assessment:
E-Emotions/Psychological

PP blues, PP depression, or PP psychosis?

  • 4th week postpartum – greatest occurrence
  • Depression not characterized by mood swings
  • Suicide contemplation
A

PP depression

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5
Q

Postpartum physiological changes: Nutrition

Expected findings
- May need to eat foods high in iron/fat? – r/t blood loss during labor
- May need to continue taking prenatal vitamins – especially if breastfeeding/suppressing lactation?
- Breast feeding mothers – increase/decrease calorie intake by 300 cal?
- Non-breastfeeding mothers – increase/decrease calorie intake by 200 cal?

A

Nutrition
Expected findings
- May need to eat foods high in iron – r/t blood loss during labor
- May need to continue taking prenatal vitamins – especially if breastfeeding
- Breast feeding mothers – increase calorie intake by 300 cal
- Non-breastfeeding mothers – decrease calorie intake by 200 cal

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6
Q

Postpartum physiological changes: Vitals

expected vs unexpected finding
- temp 100.1 F 12 hours after birth
- temp 100.1 F 36 hours after birth
- temp 99.1 F 24 hours after birth
- BP slightly elevated
- bradycardia 2 weeks after birth
- high BP
- temp 100.8 F 24 hours after birth
- low BP
- tachycardia
- tachypnea

A

E - temp 100.1 F 12 hours after birth
U - temp 100.1 F 36 hours after birth = should be afebrile within 24 hours
E - temp 99.1 F 24 hours after birth = low fever r/t milk coming in
E - BP slightly elevated
U - bradycardia 2 weeks after birth = should only be for 6-10 days
U - high BP
U - temp 100.8 F 20 hours after birth = too high to be considered expected
U - low BP
U - tachycardia
U - tachypnea

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7
Q

postpartum assessment: U-Uterus/Abdomen

  • abdomen is loose and flabby?
  • abdomen will not respond to exercise?
  • uterine ligaments will quickly return to normal state?
  • striae (stretch marks) – different colors based on moms skin and time lapsed?
  • for c/s incision use REEDA scale when assessing?
A
  • abdomen is loose and flabby
    X- will respond to exercise
    X- uterine ligaments will slowly return to normal state
  • striae (stretch marks) – different colors based on moms skin and time lapsed
  • for c/s incision use REEDA scale when assessing
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8
Q

which of these would indicate thrombophlebitis during postpartum assessment? SATA

  • temperature changes in extremity
  • pain when the nurse palpates leg
  • one sided itchiness in leg
A
  • temperature changes in extremity
  • pain when the nurse palpates leg
    X- one sided itchiness in leg
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9
Q

Breastfeeding difficulties: Mom not producing enough milk

Mom increase fluid intake = ___ L/day

A
  • Mom increase fluid intake = 2 L/day
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10
Q

s/s of postpartum hemorrhage include: SATA

  • Decreased pulse
  • Decreased BP
  • Decreased LOC
  • Hematoma formation or bulging/shiny skin in the perineal area
A

X- Increased pulse
- Decreased BP
- Decreased LOC
- Hematoma formation or bulging/shiny skin in the perineal area

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11
Q

postpartum uterine infection: Endometritis
infection that involves the lining of the uterus

s/s
- uterine tenderness
- temp spike 104 F
- chills
- foul smelling lochia or vaginal discharge

A
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12
Q

postpartum assessment - BUBBLEHE

which one considers
- depression
- phases and stages post birth
- psychosis
- parent/infant attachment and bonding
- cultural support
- rest and activity
- sex

A

E-Emotions/Psychological

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13
Q

Postpartum physiological changes:
Ovulation/menstruation

Expected findings for non-breastfeeding women or breastfeeding women?
- menstruation occurs in 7-12 weeks
- ovulation occurs by 70-75 days
- menstruation may be delayed by 3 months +

T/F
breastfeeding is not a reliable source of birth control

A

Ovulation/menstruation

Expected findings

non-breastfeeding women
- menstruation occurs in 7-12 weeks
- ovulation occurs by 70-75 days

breastfeeding women
- menstruation may be delayed by 3 months +

T - breastfeeding is not a reliable source of birth control

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14
Q

postpartum assessment:
E-Emotions/Psychological

Risk factors for getting PP blues, PP depression, or PP psychosis?

-Rapid hormonal changes
-Fatigue
-Discomfort
-Overstimulation
-Insecurity
-Anxiety
-Emotional let-down after birth
-Grief response to fantasized birth experience different than actual birth (c/s, vaginal birth , etc.)
-Seen more severe in first time moms

A

PP blues

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15
Q

Breastfeeding difficulties: Plugged ducts

  • Frequent nursing, changing feeding positions, manual massage, warm compress?
  • Start feeding on breast with plugged duct?
  • Breast pump may help dislodge plug?
  • Assess women for pressure from purse strap, infant sling, car seat belt, etc. that may cause _____________
  • Plugged ducts can lead to ______!!
A
  • Frequent nursing, changing feeding positions, manual massage, warm compress
  • Start feeding on breast with plugged duct – vigorous suck may help dislodge plug
  • Breast pump may help dislodge plug
  • Assess women for pressure from purse strap, infant sling, car seat belt, etc. that may cause recurring plugged ducts in the compressed area
  • Plugged ducts can lead to mastitis!!
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16
Q

postpartum assessment: Lochia

_______ days = lochia rubra (red)
______ days = lochia serosa (pink)
_______ days (until cervix is closed) = lochia alba (white)

A
  • 2-4 days = lochia rubra (red)
  • 4-10 days = lochia serosa (pink)
  • 10-20 days (until cervix is closed) = lochia alba (white)
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17
Q

breastfeeding concerns and solutions

  • __________ – r/t poor latch, allow nipples to dry to prevent breakdown
  • ____________ – teach privacy tactics
  • ____________ – mom can pump milk, others can feed the baby, mom doesn’t have to be there
  • ____________ - mom can pump milk and fathers can bottle feed, fathers can take responsibility for other tasks
  • ______________ -
  • good signs to look for:
  • milk at edges of mouth
  • 6-8 wet diapers/day
  • See Infant swallowing
  • Breasts softer after feeding

worried infant isn’t getting enough milk,
unequal responsibility or fathers feeling left out, embarrassment in public,
mom feeling tied down to demands of breastfeeding, nipple tenderness/pain

A

breastfeeding concerns
-nipple tenderness/pain – r/t poor latch, allow nipples to dry to prevent breakdown
-embarrassment in public – teach privacy tactics
-mom feeling tied down to demands of breastfeeding – mom can pump milk, others can feed the baby, mom doesn’t have to be there
-unequal responsibility or fathers feeling left out - mom can pump milk and fathers can bottle feed, fathers can take responsibility for other tasks
-worried infant isn’t getting enough milk
- good signs to look for:
- milk at edges of mouth
- 6-8 wet diapers/day
- See Infant swallowing
- Breasts softer after feeding

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18
Q

causes of boggy uterus/fundus? SATA
- high levels of oxytocin
- multipara
- small for gestational age
- multiples
- LGA - Large for Gestational Age
- Red haired women
- trapped gas

A
  • high levels of oxytocin = uterus no longer responding to meds that promote contraction of uterus
  • multipara
    X- small for gestational age
  • multiples
  • LGA - Large for Gestational Age
  • Red haired women
    X- trapped gas
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19
Q

postpartum assessment: Lochia

-2-4 days = lochia rubra= color ________
-4-10 days = lochia serosa = color _______
-10-20 days (until cervix is closed) = lochia alba = color __________

A
  • 2-4 days = lochia rubra (red)
  • 4-10 days = lochia serosa (pink)
  • 10-20 days (until cervix is closed) = lochia alba (white)
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20
Q

postpartum assessment: U-Uterus/Abdomen

diastasis recti abdominis – separation of the ________ muscles

  • common in multiples or G1?
  • abdomen over distended?
A
  • diastasis recti abdominis – separation of the rectus (abdominal) muscles
  • common in multiples
  • abdomen over distended
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21
Q

T/F - Breastfeeding regularly lowers risk of postpartum hemorrhage r/t oxytocin production

A

T

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22
Q

postpartum assessment:
E-Emotions/Psychological

PP blues, PP depression, or PP psychosis?

s/s
- Mood swings
- Self-limiting
- Irritable or overly sensitive
- Tearfulness without cause
- Difficulty sleeping
- Feeling of being let down
- Anxiety

A

PP blues

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23
Q

postpartum assessment:
E-Emotions/Psychological

PP blues, PP depression, or PP psychosis?

  • Occurs 1-3 months postpartum

s/s
- Agitation
- Hyperactivity
- Insomnia
- Confusion
- Difficulty remembering or concentrating
- Delusions and hallucinations/illogical thinking
- Suicide risk/infanticide risk

A

PP psychosis

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24
Q

Treatment for mastitis or endometritis?
- Antibiotics – clindamycin, gentamycin
- Culture and sensitivity (will show specific antibiotic that works on this infection)
- Continue treatment until afebrile for 24-48 hours

A

postpartum uterine infection: Endometritis

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25
Q

medications to prevent postpartum hemorrhage:

  • give Oxytocin before/after delivery of placenta and early postpartum period?
  • dont give Methylergonovine maleate (methergine) to woman with _________
  • common side effect of Carboprost
  • route of Misoprostol (Cytotec) is rectal, vaginal, or oral SATA
A

-Oxytocin – after delivery of placenta and early postpartum period
-Methylergonovine maleate (methergine) – don’t give to woman with HTN b/c of rebound HTN risk
-Carboprost – s/e diarrhea
-Misoprostol (Cytotec) – route: rectal, followed by oral (may be given vaginally before birth)

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26
Q

postpartum assessment:
E-Emotions/Psychological

Risk factors for getting PP blues, PP depression, or PP psychosis?

  • Primigravida
  • Ambivalence toward pregnancy
  • History of previous PP depression
  • Higher with history of depression
  • Lack of social support
  • Dissatisfaction with self or body image
  • Adolescent
A

PP depression

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27
Q

postpartum assessment: Bowels

Bowels will be sluggish r/t: SATA
- Progesterone
- increased muscle tone
- Birth process
- Anesthesia

T/F - Women should expect to have her first BM up to 3 days after delivery

A

Bowels will be sluggish r/t
- Progesterone
X - Decreased muscle tone
- Birth process
- Anesthesia

T - Women should expect to have her first BM up to 3 days after delivery

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28
Q

The nurse is doing a fundal assessment on a postpartum patient. The nurse notes bleeding that saturates the peripad in 1 hour and a firm fundus.

What does the nurse suspect?

Should the nurse do a fundal massage?

A

saturated bleeding + firm fundus = Lacerations

fundal massage is not helpful, nurse should assess the perineum, REEDA

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29
Q

postpartum assessment - BUBBLEHE

which one?

  • abdomen
  • uterine ligaments
  • striae (stretch marks)
  • after pains
  • diastasis recti abdominis
A

U-Uterus/Abdomen

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30
Q

postpartum assessment:
E-Emotions/Psychological

Becoming a mother (BAM)

  • ___________ – during pregnancy - role play, expectations
  • __________ – birth – role guided by expectations of others in her social system
  • _____________ – develops role individually
  • ______________ – self, confidence, and competence as mother role

Formal stage, Personal stage, Anticipatory stage, Informal stage

A

Becoming a mother (BAM)
- Anticipatory stage – during pregnancy - role play, expectations
- Formal stage – birth – role guided by expectations of others in her social system
- Informal stage – develops role individually
- Personal stage – self, confidence, and competence as mother role

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31
Q

Postpartum physiological changes: Vitals

Expected findings
- Temp elevated up to 100.4 F for_____ hours after birth
- Afebrile after _____ hours
- Temp may continue to be increased for 24 hours after ______ comes in (low grade fever 99 F)
- BP slightly elevated or decreased?
- Bradycardia or tachycardia for 6-10 days?

A

Vitals
Expected findings
- Temp elevated up to 100.4 F for 24 hours after birth
- Afebrile after 24 hours
- Temp may continue to be increased for 24 hours after milk comes in (low grade fever 99 F)
- BP slightly elevated
- Bradycardia for 6-10 days

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32
Q

The nurse is doing a fundal assessment on a postpartum patient. The nurse notes bleeding that saturates the peripad in 1 hour and a soft fundus.

What does the nurse suspect?

What should the nurse do?

A

saturated bleeding + boggy fundus = Uterine atony

perform fundal massage

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33
Q

patients:
- non-lactating women
- breastfeeding mom
- women that doesn’t want to breastfeed
- women asking how to suppress lactation
- women with engorgement that is breastfeeding
- women with engorgement that isn’t breastfeeding

which of the above patients should the nurse advice do the following breast care:
- well-fitting bra or ace wrap binder
- cold compress or cabbage leaves
- anti-inflammatory meds
- avoid stimulating the breasts/nipples
- avoid warm water on breast in shower, shower with back to water
- avoid stimulating the nipple

A
  • non-lactating women
  • women that are not breastfeeding
  • need to suppress lactation
  • engorgement prevention/treatment for non-breastfeeding moms
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34
Q

what type of infection should the nurse suspect with these s/s
- Frequency and urgency
- Dysuria
- Nocturia
- Hematuria
- Suprapubic pain
- Slightly elevated temp

A

UTI

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35
Q

Breastfeeding difficulties: Flat/inverted nipples

  • Rolling, stimulating?
  • Pump a little before breast feeding?
  • Use a nipple shield?
A
  • Rolling, stimulating
  • Pump a little before breast feeding
  • Use a nipple shield
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36
Q

postpartum assessment: E-Episiotomy/Lacerations/Incision

T/F - Cervical changes

  • Cervix is spongy, flabby, maybe bruised
  • External os may have lacerations, irregular, closes slowly
  • Shape of external os changes to lateral slit
A

all true

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37
Q

postpartum assessment - BUBBLEHE

which one considers bowel movements?

A

B - bowels

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38
Q

mastitis vs engorgement?

treatment
- antibiotics (penicillin)
- warm compress
- analgesics

A

mastitis

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39
Q

postpartum assessment: U-Uterus/Abdomen

after pains – intermittent uterine contractions r/t uterine involution/subinvolution?

the nurse should advice:
- rest prone/supine with pillow under abdomen?
- motrin for pain if platelets are less than 70,000?
- motrin for pain if has preeclampsia?
- motrin for pain if patient had multiples?

A
  • after pains – intermittent uterine contractions r/t uterine involution
  • rest prone with pillow under abdomen – helps keep uterus contracted
  • motrin – for cramping
  • contraindication – if platelets are less than 70,000, or pt has preeclampsia
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40
Q

Postpartum physiological changes: Vitals

Unexpected/abnormal findings

High BP - we suspect r/t preeclampsia, essential HTN, renal disease, anxiety)

Treatment T/F
- tocolytic: Procardia
- oxytocin
- Labetalol
- aldomet
- magnesium sulfate
- prostaglandin
- aspirin

A

Treatment
- tocolytic: Procardia - relaxes muscles
- Labetalol - HTN med
- aldomet - HTN med
- magnesium sulfate - relaxes muscles, prevents seizures

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41
Q

Postpartum physiological changes: Labs

Expected findings

  • Non-pathologic leukocytosis during first week post birth = WBC 25,000 – 30,000
  • If its higher than this suspect ________
  • Blood loss
  • Vaginal birth _____ mL
  • c/s birth ______ mL
  • losing 500 mL of blood = Hematocrit/Hemoglobin decline of 2-3%?
  • plasma levels go back to normal 4-6 weeks post birth
  • platelet levels go back to normal by the 6th week post birth
  • blood values go back to normal by the 6th week post birth
A

Labs
Expected findings
- Non-pathologic leukocytosis during first week post birth = WBC 25,000 – 30,000
- If its higher than this suspect infection

  • Blood loss
  • Vaginal birth 200-500 mL
  • c/s birth 700-1000 mL
  • losing 500 mL of blood = Hmt decline of 2-3%
  • plasma levels go back to normal 4-6 weeks post birth
  • platelet levels go back to normal by the 6th week post birth
  • blood values go back to normal by the 6th week post birth
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42
Q

postpartum assessment: U-Uterus/Abdomen

expected or unexpected findings in fundal assessment? If unexpected, what do we suspect?

  • uterus should be at level of umbilicus for 6-12 hours post birth
  • uterus contracts 1 fingerbreadth per day (involution)
  • uterus descends 1 cm/day towards pelvis, until it is in the pelvis on the 10th day
  • uterus is off to one side (or is high in the abdomen)
  • uterus did not change in size from yesterday to today
  • uterus did not make descending progress towards pelvis
  • uterus is firm
  • uterus is soft
  • uterus is midline
A

E - uterus should be at level of umbilicus for 6-12 hours post birth
E - uterus contracts 1 fingerbreadth per day (involution)
E - uterus descends 1 cm/day towards pelvis, until it is in the pelvis on the 10th day
U - uterus is off to one side (or is high in the abdomen) = pt needs to void (empty bladder)
U - uterus did not change in size from yesterday to today = subinvolution, suspect retained placenta fragments and infection
U - uterus did not make descending progress towards pelvis = subinvolution, suspect retained placenta fragments and infection
E - uterus is firm
U - uterus is soft = indicates uterine atony and increased bleeding, nurse should perform fundal massage
E - uterus is midline

43
Q

postpartum assessment - BUBBLEHE

which one are we considering
-thrombophlebitis
-hemroids

A

H-Homan’s/Hemorrhoids

44
Q

postpartum assessment - BUBBLEHE

which one considers
- bladder capacity
- urethra
- urinary output
- sensation and sensitivity
- infection

A

B - bladder

45
Q

which of these is required for postpartum discharge? SATA

  • Ability to perform pericare and take meds as ordered
  • Ability to void and pass gas
  • Ability to take fluids and foods with slight difficulty
  • Ability to identify s/s PP depression and resources
  • Reviews teaching material and shows how to care for self and baby
A
  • Ability to perform pericare and meds as ordered
  • Ability to void and pass gas
    X - must have ability to take fluids and foods without difficulty
  • Ability to identify s/s PP depression and resources
  • Reviews teaching material and shows how to care for self and baby
46
Q

postpartum assessment: E-Episiotomy/Lacerations/Incision

Lacerations degree determined by provider

______ - Involves only the skin around the vaginal opening
________- Involves the skin and underlying muscles, requires stitching, most common
_________- Involves the skin, muscles, and anal sphincter
________ - Involves the skin, muscles, anal sphincter, and rectal lining.

A
  • 1st - Involves only the skin around the vaginal opening
  • 2nd - Involves the skin and underlying muscles, requires stitching, most common
  • 3rd - Involves the skin, muscles, and anal sphincter
  • 4th - Involves the skin, muscles, anal sphincter, and rectal lining.
47
Q

Documenting the fundal assessment

FF u/-2 =

UU =

A

FF u/-2
- Firm Fundus = FF
- 2 fingerbreadths below umbilicus u/-2

UU
- At level of the umbilicus

48
Q

mastitis vs engorgement?

s/s
- sudden onset
- chills
- fever 101 F +
- malaise
- red, painful, swollen AREA on breast
- usually one breast affected
- discharge

A

mastitis

49
Q

postpartum assessment: U-Uterus/Abdomen

Fundal assessment determines:
- position of fundus r/t __________ - above or below
- position of fundus r/t __________ - left, right, centered
- uterus tone - _______ or ________

A

Fundal assessment
Determines:
- position of fundus r/t umbilicus - above or below?
- position of fundus r/t midline - midline or offcentered?
- uterus tone - firm or boggy?

50
Q

s/s of postpartum hemorrhage include: SATA

  • high temp
  • Pelvis discomfort or backache
  • Persistent bleed + firm uterus
  • Fundus descends in abdomen
A
  • High temp
  • Pelvis discomfort or backache
  • Persistent bleed + firm uterus
    X - Fundus rises in abdomen
51
Q

postpartum assessment:
E-Emotions/Psychological

Is this nursing care for attachment/bonding or PP blues/depression/psychosis?

  • Refer to mental health professional (psychosis should seek immediate care from ER)
  • Educate and give expectations for changes and demands
  • Anticipatory guidance
  • Dispel myths about perfect mother and baby
  • Educate s/s, and teach family members what to look for
  • Help foster positive adjustment in the new family
  • Look for mom depression s/s
  • Screening tools
  • Give resources
  • Home health
  • Telephone
  • Classes
  • Support groups
A

Nursing care: PP blues, PP depression, PP psychosis

52
Q

mastitis vs engorgement?

s/s
- hard, painful breasts
- entire breast (not an area), or both breasts
- gradual onset
- NO fever

A
53
Q

which of these is required for postpartum discharge? SATA

-Appropriate interaction with baby such as leaving the baby unattended or incorrect feeding practices
-Practices principles of infant safety
-Rubella (MMR injection) – if non immune
-RhoGAM injection – if neg mom, pos baby, or direct combs neg

A

X- must show Appropriate interaction with baby such as not leaving the baby unattended and correct feeding practices
- Practices principles of infant safety
- Rubella (MMR injection) – if non immune
- RhoGAM injection – if neg mom, pos baby, or direct combs neg

54
Q

postpartum assessment - BUBBLEHE

After delivery, vaginal discharge of blood, mucus, atrophied uterine cells/debris

A

L - Lochia

55
Q

which of these would indicate thrombophlebitis during postpartum assessment? SATA

  • pain in leg
  • pain in inguinal area
  • pain in lower abdomen
  • one sided edema in leg
A
  • pain in leg
  • pain in inguinal area
  • pain in lower abdomen
  • one sided edema in leg
56
Q

how does the nurse know the baby is getting enough milk? SATA
- milk at edges of mouth
- 3-4 wet diapers/day
- See Infant swallowing
- Breasts softer after feeding

A
  • milk at edges of mouth
    X 6-8 wet diapers/day
  • See Infant swallowing
  • Breasts softer after feeding
57
Q

postpartum Rest and activity

T/F

-Rest
-Resume normal activities
-Avoid heavy lifting
-Avoid climbing stairs multiple times a day
-Resume strenuous activity

A

-Rest
-Resume normal activities
-Avoid heavy lifting
-Avoid climbing stairs multiple times a day
X-Avoid strenuous activity

58
Q

postpartum assessment: E-Episiotomy/Lacerations/Incision

REEDA scale

R =__________
E = __________
E = ___________
D = __________
A = __________

A

R = redness
E = edema of swelling
E = ecchymosis or bruising
D = discharge
A = approximation – how well the edges of the laceration seem to be holding together

59
Q

mastitis vs engorgement?

prevention
- wear supportive bra at all times (not constricting bra, underwire bra, restrictive clothing) = prevents milk stasis where bacteria can grow
- good handwashing, hygiene, air dry breasts
- prompt attention to blocked milk ducts
- regular complete emptying of the breasts
- good infant positioning
- good latch
- supply and demand – if baby feeds more/mom pumps more = body will cue to make more milk
- report flulike symptoms
- alternate breasts at feeding
- treat cracked nipples

A

mastitis

60
Q

postpartum assessment: U-Uterus/Abdomen

Fundal assessment

place one hand below umbilicus and other hand on symphysis, apply downward pressure toward vagina = determines if _______ is firm and assists client in expelling ________

A
  • place one hand below umbilicus and other hand on symphysis, apply downward pressure toward vagina = determines if fundus is firm and assists client in expelling clots
61
Q

postpartum assessment: U-Uterus/Abdomen

uterus
- should be undergoing involution or subinvolution?
- decrease/increase in weight 100 g?
- spongy layer – sloughed off?
- basal layer – splits into 2?
outer layer - sloughed off?
inner layer – foundation for new endometrium?
- placenta site heals by exfoliation?

A

uterus
- involution
- decrease in weight 100 g
- spongy layer – sloughed off
- basal layer – splits into 2
- outer layer - sloughed off
- inner layer – foundation for new endometrium
- placenta site heals by exfoliation

62
Q

T/F - Weeks 5-6 uterus will return to normal size

A

True

63
Q

Postpartum physiological changes: Cardiovascular

Expected findings
- cardiac output decrease/increase? – up to 30% for 2 weeks, back to normal levels by 6-12 weeks post birth
- increased/decreased urination?
- weight loss/gain?

Unexpected/abnormal findings
- pulmonary edema, cardiac problems, adventitious lung sounds (crackles) – body is failing to ___________

A

Cardiovascular

Expected findings
- cardiac output decline – up to 30% decline for 2 weeks, back to normal levels by 6-12 weeks post birth
- diuresis, increased urination, weight loss – body is decreasing extracellular fluid

Unexpected/abnormal findings
- pulmonary edema, cardiac problems, adventitious lung sounds (crackles) – body is failing to eliminate extra fluid

64
Q

breastfeeding positions
- _______ – both hands are around baby’s body
- ______________ – allows mom to have a free hand to manipulate breast
- _____________ – allows mom to have a free hand to manipulate breast and takes pressure off abdomen
- ___________ - allows mom to have a free hand to manipulate breast, risk of mom falling asleep and smothering baby

side-lying, cradle, football hold, modified cradle

A

breastfeeding positions
- cradle – both hands are around baby’s body
- modified cradle – allows mom to have a free hand to manipulate breast
- football hold – allows mom to have a free hand to manipulate breast and takes pressure off abdomen
- side-lying - allows mom to have a free hand to manipulate breast, risk of mom falling asleep and smothering baby

65
Q

Postpartum physiological changes: Weight changes

Expected findings
-initial weight loss of 10-20 lbs – r/t baby/placenta/ amniotic fluid or postpartum diuresis?
-weight loss of 5 lbs – r/t baby/placenta/ amniotic fluid or postpartum diuresis?
-may return to pre-pregnant weight by 6-8 weeks postpartum – depends on person, diet, exercise, etc.

A
  • initial weight loss of 10-20 lbs – r/t baby, placenta, amniotic fluid
  • weight loss of 5 lbs – r/t postpartum diuresis
  • may return to pre-pregnant weight by 6-8 weeks postpartum – depends on person, diet, exercise, etc.
66
Q

which of these would indicate thrombophlebitis during postpartum assessment? SATA

  • pt c/o pain when walking
  • redness in calf
  • warmth in calf
  • homan’s negative sign
A
  • pt c/o pain when walking
  • redness in calf
  • warmth in calf
    X - homan’s positive sign
67
Q

Medical management: PP depression

1st line = sertraline or paroxetine?
2nd line = sertraline or paroxetine?

Is prozac safe for mothers?

A

1st line = sertraline
2nd line = parozetine

-Prozac not recommended with breastfeeding moms

68
Q

mastitis or endometritis?

s/s
- uterine tenderness
- temp spike 104 F
- chills
- foul smelling lochia or vaginal discharge

A

Endometritis

69
Q

postpartum assessment: Lochia

Amount
- Scant
- Light
- Moderate
- Heavy = saturated peripad within __ hour(s). This is too much bleeding = _________________

A
  • Heavy = saturated peripad within 1 hour. This is too much bleeding = postpartum hemorrhage
70
Q

Is this education for a weaning breastfeeding mom or a non-breastfeeding mom that is suppressing lactation?

  • Over a few days to a week - Substitute one cup of formula for one breastfeeding session (so breasts gradually produce less milk)
  • Over a period of several weeks – substitute more formula feedings for breastfeeding
A

weaning

71
Q

mastitis vs engorgement?

A
72
Q

infection that involves the lining of the uterus

A

Endometritis

73
Q

risks for developing mastitis or endometritis?
- c/s delivery
- PPROM
- Prolonged labor
- Multiple vaginal exams during labor, especially after ROM
- Use of FSE or IUPC
- Instrument assisted deliveries – vacuum or forceps
- Manual removal of placenta
- Chorioamnionitis – infection of chorion and amnion

A

postpartum uterine infection: Endometritis

74
Q

Interventions are appropriate for what?

  • Ice packs
  • Topical anesthestics
  • Waffle cushion
  • Surgigator
  • Sitz bath
A

Interventions for Episiotomy/Lacerations/Incision

75
Q

lactation
- feed Q _____ hours (8-12 feedings/24 hours)
- feed _____ mins on 1st breast, offer 2nd breast but infant may not want it or feed as long on it
- expected/unexpected finding - breasts may feel heavy?
- expected/unexpected finding – breasts feel hardened, sore, reddened?
- breastfeeding women should only consume alcohol occasionally?
- don’t consume alcohol at least ___ hours before nursing?

A
  • feed Q 1.5-3 hours (8-12 feedings/24 hours)
  • feed 10-20 mins on 1st breast, offer 2nd breast but infant may not want it or feed as long on it
  • expected finding - breasts may feel heavy
  • unexpected finding – breasts feel hardened, sore, reddened
  • breastfeeding women should only consume alcohol occasionally
  • don’t consume alcohol at least 2 hours before nursing
76
Q

mastitis vs engorgement?

Treatment/prevention (for moms that are breastfeeding)
- Don’t miss a feeding
- Hand express or pump to soften breasts/nipples before feeding
- nurse 8-12x/24 hours and for 10-20 mins/breast each feeding
- warm compress before feedings – helps with let down before feeding
- cold compress between feedings – slows milk production
- well-fitted nursing bra 24/7
- cabbage leaves – help with edema
- breast feed more frequently – Q 1-1.5 hours

A

engorgement

77
Q

postpartum assessment: B-Bladder

  • Increased/decreased bladder capacity during pregnancy?
  • Swelling and bruising of tissues around urethra?
  • Increase/decrease in sensitivity to fluid pressure?
  • Increase/decrease in sensation of bladder filling (esp. w/ epidurals)?
  • Urinary output is higher/lower due to diuresis?
  • Increased/decreased chance of infection due to dilated ureters and renal pelvis?
  • Monitor adequacy of urinary elimination and distention?
A

B-Bladder
- Increased bladder capacity during pregnancy
- Swelling and bruising of tissues around urethra
- Decrease in sensitivity to fluid pressure
- Decrease in sensation of bladder filling (esp. w/ epidurals)
- Urinary output is greater due to diuresis – kidneys rid 2000-3000 mL of extracellular fluid
- Increased chance of infection due to dilated ureters and renal pelvis
- Monitor adequacy of urinary elimination/distention

78
Q

Breastfeeding difficulties: Sore nipples

  • Must have good latch = ______ shape mouth
  • Lanolin cream?
  • Express some breast milk and let dry on nipples?
  • Allow nipples to air dry?
  • Begin nursing on breast that is less/more sore?
A
  • Must have good latch = fish shape mouth
  • Lanolin cream
  • Express some breast milk and let dry on nipples
  • Allow nipples to air dry
  • Begin nursing on breast that is less sore – b/c baby will have stronger suck at the beginning of feed vs end of feed
79
Q

postpartum assessment:
E-Emotions/Psychological

PP blues, PP depression, or PP psychosis?

  • Transient period of depression
  • Occurs 3-5 days postpartum to 6 weeks
  • Usually resolves itself in 10-14 days
A

PP blues

80
Q

postpartum assessment - BUBBLEHE

which one considers
-the cervix
-external os
-vagina changes
-lacerations
-c/s incision

A

E-Episiotomy/Lacerations/Incision

81
Q

engorgement treatment/prevention appropriate for moms that are breastfeeding or non-breastfeeding?

  • Don’t miss a feeding
  • Hand express or pump to soften breasts/nipples before feeding
  • nurse 8-12x/24 hours and for 10-20 mins/breast each feeding
  • warm compress before feedings – helps with let down before feeding
  • cold compress between feedings – slows milk production
  • well-fitted nursing bra 24/7
  • cabbage leaves – help with edema
  • breast feed more frequently – Q 1-1.5 hours
A

breastfeeding moms with engorgement

82
Q

Care after cesarean birth includes SATA:
-Minimize respiratory complications
-resume any activity level
-Deep breathing
-Incentive spirometry
-Ambulation
-Rest between infant care and self care
-Pain management - OTC med
-Minimize gas pains
-Mylicon - OTC gas med
- bedrest

A

-Minimize respiratory complications
X-resume any activity level
-Deep breathing
-Incentive spirometry
-Ambulation
-Rest between infant care and self care
-Pain management - OTC med
-Minimize gas pains
-Mylicon - OTC gas med
X- bedrest

83
Q

Medical management for PP blues, PP depression, or PP psychosis?

  • Lithium
  • Antipsychotics
  • Electroconvulsive therapy with psychotherapy
  • Removal of infant
  • Assess Social support
A

PP psychosis

84
Q

Slow weaning is good b/c: SATA
- Prevents engorgement
- Allows infant to alter their own eating methods at their own rates
- Provides time for psychological adjustment
- mom can drink alcohol regularly

A
  • Prevents engorgement
  • Allows infant to alter their own eating methods at their own rates
  • Provides time for psychological adjustment
85
Q

Postpartum physiological changes: Vitals

Unexpected/abnormal findings
- Temp > 100.4 F – we suspect ___________
- High BP - we suspect r/t ________, _________, ________, _________
- low BP - we suspect r/t ______, __________
- tachycardia – we suspect r/t ___________, _______________, r/o fever (infection)
- marked tachypnea – r/o ___________ and ____________

respiratory disease
pulmonary edema
infection
preeclampsia
HTN
difficult birth and labor
hemorrhage
renal disease
anxiety
uterine hemorrhage
hematoma

A

Unexpected/abnormal findings
- Temp > 100.4 F – we suspect infection
- High BP - we suspect r/t preeclampsia, essential HTN, renal disease, anxiety)
- low BP - we suspect r/t uterine hemorrhage, hematoma)
- tachycardia – we suspect r/t difficult labor and birth, hemorrhage, r/o fever (infection)
- marked tachypnea – r/o respiratory disease and pulmonary edema

86
Q

which of these is required for postpartum discharge? SATA

-Stable vitals
-Involution of uterus
-Lochia amount heavy but no sign of infection
- Education s/s of infection
- Lacerations well approximated

A
  • Stable vitals
  • Involution of uterus
    X - Lochia amount must be ok (scant, light, moderate) + no sign of infection
  • Education s/s of infection
  • Lacerations well approximated
87
Q

medications to prevent postpartum hemorrhage: SATA

  • Magnesium Sulfate
  • oxytocin
  • Methylergonovine maleate (methergine)
  • Carboprost
    -Misoprostol (Cytotec)
A

X- Magnesium Sulfate
- oxytocin
- Methylergonovine maleate (methergine)
- Carboprost
-Misoprostol (Cytotec)

88
Q

postpartum assessment: H-Homan’s/Hemorrhoids

is this thrombophlebitis or hemorrhoids care?

  • Sitz bath
  • Topical anesthetic ointments
  • Rectal suppositories
  • Witch hazel pads
  • Side lying position
  • Avoid prolonged sitting
  • Adequate fluid intake
  • Stool softeners
  • Increase fiber and fluids
  • No enemas or suppositories for 3rd and 4th degree lacerations
A

hemorrhoid care

89
Q

Parent/infant attachment/bonding

  • Enface (___________ response) – direct eye contact, face to face
  • Engrossment (____________ response) – absorption, interest, preoccupation

maternal or paternal

A
  • Enface (maternal response) – direct eye contact, face to face
  • Engrossment (paternal response) – absorption, interest, preoccupation
90
Q

The postpartum patient asks the nurse when she can have Sex again. The nurse should teach? SATA

  • Resume after lacerations healed and lochia stopped – about 4-6 months
  • may need Lubrication
  • need to decide on Contraception
A

X - Resume after lacerations healed and lochia stopped – about 4-6 weeks
- Lubrication
- Contraception

91
Q

postpartum assessment: E-Episiotomy/Lacerations/Incision

T/F - Vagina changes

-Edema, bruised, small superficial lacerations
-3-4 weeks size decreases and rugae reappear
-6 weeks vagina is back to normal size
-2-3 weeks initial healing of lacerations occur, completely healed in 6 months

A

all true

92
Q

mastitis vs engorgement?

treatment/prevention (for non-breastfeeding moms)
- well-fitting bra or ace wrap binder
- cold compress or cabbage leaves
- anti-inflammatory meds
- avoid stimulating the breasts/nipples
- avoid warm water on breast in shower, shower with back to water
- avoid stimulating the nipple

A

engorgement

93
Q

Treatment to prevent postpartum hemorrhage: SATA

-Uterine massage (for soft uterus)
-Assess perineum for bleeding or clots
-Frequent void or cath the woman
-Look for abnormal Hct levels – CBC repeated on 1st day postpartum
-Diet high in fat

A
  • Uterine massage (for soft uterus)
  • Assess perineum for bleeding or clots
  • Frequent void or cath the woman
  • Look for abnormal Hct levels – CBC repeated on 1st day postpartum
    X - Diet high in iron
94
Q

postpartum assessment:
E-Emotions/Psychological

taking in phase or taking hold phase?

  • 1-2 days after birth
  • Passive, dependent
  • Processes reality vs imagined birth experience
  • Food and rest are important
  • 2-3 days after birth
  • Control, mothering
  • Continue to provide assurance and support
A

“taking in” phase
- 1-2 days after birth
- Passive, dependent
- Processes reality vs imagined birth experience
- Food and rest are important

“Taking hold” phase
- 2-3 days after birth
- Control, mothering
- Continue to provide assurance and support

95
Q

postpartum assessment: bowels

T/F

Episiotomy, lacerations, or hemorrhoids may speed up elimination/BM after birth?

Might moms have a fear tearing with BM?

would appropriate treatment include stool softeners for moms with Episiotomy, lacerations, or hemorrhoids ?

Are tucks pads appropriate to use for hemorrhoid itching and coolness?

does knee pain often indicate trapped gas?

A

F - Episiotomy, lacerations, or hemorrhoids may delay elimination
T - Mom may fear tearing
T - Treatment – stool softeners
T - Tucks pads for hemorrhoid itching and coolness
F - Shoulder pain = trapped gas (often right shoulder pain)

96
Q

-Uterine atony
-Lacerations
-Episiotomy
-Retained placenta fragments
-Hematomas
-Uterine inversion – prolapse of uterus
-Uterine rupture
-Placenta implantation problems (accrete, increta, percreta)
-Coagulation disorders – low platelets, DIC

these are all complications that can cause ________________ in a postpartum woman

A

Postpartum hemorrhage

97
Q

Postpartum physiological changes: Neurological

Expected or unexpected findings:
- Headaches – may be r/t fluid shifts in first week after birth, stress and fatigue?
- Headaches – may be r/t leakage of CSF from epidural (spinal headache, gets worse when you sit up)?
- Headaches – may be r/t chronic or gestational HTN?
- Headaches – may be r/t preeclampsia – can continue up to 6 weeks PP?
- Headaches with vision changes – spots, blurry, bright lights?

A

Neurological

Expected findings
- *Headaches – may be r/t fluid shifts in first week after birth, stress and fatigue

Unexpected/abnormal findings
- *Headaches – may be r/t
- leakage of CSF from epidural (spinal headache, gets worse when you sit up)
- chronic or gestational HTN
- preeclampsia – can continue up to 6 weeks PP
- Vision changes – spots, blurry, bright lights

98
Q

PP assessment - BUBBLEHE

which one?

  • breast - size and shape
  • nipples – cracks, fissures, soreness, inversion
  • breast fullness – r/t milk presence
  • abnormalities – reddened areas, engorgement
  • not breastfeeding = how to prevent engorgement, proper bottle feed info
  • breastfeed = assess how it is going, observe session, give praise and guidance, talk about prevent/treat engorgement/mastisitis/blocked ducts
A

Postpartum Assessment
B-Breasts

99
Q

postpartum assessment: U-Uterus/Abdomen

Fundal assessment

  • uterus should be at level of umbilicus for 6-12 or 12-24 hours post birth?
  • uterus contracts 1 or 2 fingerbreadth per day (involution)?
  • uterus descends 1 or 2 cm/day towards pelvis, until it is in the pelvis on the 10th day?
A
  • uterus should be at level of umbilicus for 6-12 hours post birth
  • uterus contracts 1 fingerbreadth per day (involution)
  • uterus descends 1 cm/day towards pelvis, until it is in the pelvis on the 10th day
100
Q

Best position to assess perineal area

-side lying with superior leg elevated
-frog leg
-stirups

A

-side lying with superior leg elevated

101
Q

scale used in assessing perineum

A

REEDA scale

R = redness
E = edema of swelling
E = ecchymosis or bruising
D = discharge
A = approximation – how well the edges of the laceration seem to be holding together

102
Q

s/s of postpartum hemorrhage include: SATA

  • Excessive bleed, heavy bleed
  • dark red bleed
  • Boggy fundus that doesn’t respond to massage
  • Abnormal clots
A
  • Excessive bleed, heavy
    X- Bright red bleed
  • Boggy fundus that doesn’t respond to massage
  • Abnormal clots
103
Q

which of these are good ways to prevent thrombophlebitis? SATA

-Avoid prolonged sitting
-Avoid prolonged standing
-Avoid crossing legs
-Take frequent breaks while traveling by car, plane, etc.
-SCDS
-Early ambulation
-Adequate fluid intake

A

-Avoid prolonged sitting
-Avoid prolonged standing
-Avoid crossing legs
-Take frequent breaks while traveling by car, plane, etc.
-SCDS
-Early ambulation
X-Adequate fluid intake

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