week 5 Flashcards by Garrett Anderson

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

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

non-breastfeeding moms with engorgement

How well did you know this?

Not at all

Perfectly

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

PP depression

How well did you know this?

Not at all

Perfectly

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?

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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?

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

How well did you know this?

Not at all

Perfectly

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

temperature changes in extremity
pain when the nurse palpates leg
X- one sided itchiness in leg

How well did you know this?

Not at all

Perfectly

Breastfeeding difficulties: Mom not producing enough milk

Mom increase fluid intake = ___ L/day

Mom increase fluid intake = 2 L/day

How well did you know this?

Not at all

Perfectly

s/s of postpartum hemorrhage include: SATA

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

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

postpartum assessment - BUBBLEHE

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

E-Emotions/Psychological

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

PP blues

How well did you know this?

Not at all

Perfectly

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 ______!!

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!!

How well did you know this?

Not at all

Perfectly

postpartum assessment: Lochia

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

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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 __________

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

How well did you know this?

Not at all

Perfectly

postpartum assessment: U-Uterus/Abdomen

diastasis recti abdominis – separation of the ________ muscles

common in multiples or G1?
abdomen over distended?

diastasis recti abdominis – separation of the rectus (abdominal) muscles
common in multiples
abdomen over distended

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

PP blues

How well did you know this?

Not at all

Perfectly

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

PP psychosis

How well did you know this?

Not at all

Perfectly

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

postpartum uterine infection: Endometritis

How well did you know this?

Not at all

Perfectly

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

-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)

How well did you know this?

Not at all

Perfectly

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

PP depression

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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?

saturated bleeding + firm fundus = Lacerations

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

How well did you know this?

Not at all

Perfectly

postpartum assessment - BUBBLEHE

which one?

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

U-Uterus/Abdomen

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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?

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

How well did you know this?

Not at all

Perfectly

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?

saturated bleeding + boggy fundus = Uterine atony

perform fundal massage

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

UTI

How well did you know this?

Not at all

Perfectly

Breastfeeding difficulties: Flat/inverted nipples

Rolling, stimulating?
Pump a little before breast feeding?
Use a nipple shield?

Rolling, stimulating
Pump a little before breast feeding
Use a nipple shield

How well did you know this?

Not at all

Perfectly

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

all true

How well did you know this?

Not at all

Perfectly

postpartum assessment - BUBBLEHE

which one considers bowel movements?

B - bowels

How well did you know this?

Not at all

Perfectly

mastitis vs engorgement?

treatment
- antibiotics (penicillin)
- warm compress
- analgesics

mastitis

How well did you know this?

Not at all

Perfectly

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?

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

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

postpartum assessment - BUBBLEHE

which one are we considering
-thrombophlebitis
-hemroids

H-Homan’s/Hemorrhoids

postpartum assessment - BUBBLEHE

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

B - bladder

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

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

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.

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.

Documenting the fundal assessment

FF u/-2 =

UU =

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

UU
- At level of the umbilicus

mastitis vs engorgement?

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

mastitis

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 ________

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?

s/s of postpartum hemorrhage include: SATA

high temp
Pelvis discomfort or backache
Persistent bleed + firm uterus
Fundus descends in abdomen

High temp
Pelvis discomfort or backache
Persistent bleed + firm uterus
X - Fundus rises in abdomen

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

Nursing care: PP blues, PP depression, PP psychosis

mastitis vs engorgement?

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

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

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

postpartum assessment - BUBBLEHE

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

L - Lochia

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

pain in leg
pain in inguinal area
pain in lower abdomen
one sided edema in leg

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

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

postpartum Rest and activity

T/F

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

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

postpartum assessment: E-Episiotomy/Lacerations/Incision

REEDA scale

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

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

mastitis

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 ________

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

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?

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

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

True

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 ___________

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

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

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

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.

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.

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

pt c/o pain when walking
redness in calf
warmth in calf
X - homan’s positive sign

Medical management: PP depression

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

Is prozac safe for mothers?

1st line = sertraline
2nd line = parozetine

-Prozac not recommended with breastfeeding moms

mastitis or endometritis?

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

Endometritis

postpartum assessment: Lochia

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

Heavy = saturated peripad within 1 hour. This is too much bleeding = postpartum hemorrhage

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

weaning

mastitis vs engorgement?

infection that involves the lining of the uterus

Endometritis

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

postpartum uterine infection: Endometritis

Interventions are appropriate for what?

Ice packs
Topical anesthestics
Waffle cushion
Surgigator
Sitz bath

Interventions for Episiotomy/Lacerations/Incision

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?

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

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

engorgement

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?

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

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?

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

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

PP blues

postpartum assessment - BUBBLEHE

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

E-Episiotomy/Lacerations/Incision

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

breastfeeding moms with engorgement

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

-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

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

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

PP psychosis

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

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

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

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

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

medications to prevent postpartum hemorrhage: SATA

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

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

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

hemorrhoid care

Parent/infant attachment/bonding

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

maternal or paternal

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

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

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

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

all true

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

engorgement

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

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

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

“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

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?

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)

-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

Postpartum hemorrhage

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?

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

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

Postpartum Assessment
B-Breasts

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?

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

Best position to assess perineal area

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

-side lying with superior leg elevated

scale used in assessing perineum

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

s/s of postpartum hemorrhage include: SATA

Excessive bleed, heavy bleed
dark red bleed
Boggy fundus that doesn’t respond to massage
Abnormal clots

Excessive bleed, heavy
X- Bright red bleed
Boggy fundus that doesn’t respond to massage
Abnormal clots

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

-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

Brainscape's Knowledge GenomeTM

week 5 Flashcards

Brainscape's Knowledge Genome^TM