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
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)
26
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
27
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
28
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
29
postpartum assessment - BUBBLEHE which one? - abdomen - uterine ligaments - striae (stretch marks) - after pains - diastasis recti abdominis
U-Uterus/Abdomen
30
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
31
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
32
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
33
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
34
what type of infection should the nurse suspect with these s/s - Frequency and urgency - Dysuria - Nocturia - Hematuria - Suprapubic pain - Slightly elevated temp
UTI
35
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
36
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
37
postpartum assessment - BUBBLEHE which one considers bowel movements?
B - bowels
38
mastitis vs engorgement? treatment - antibiotics (penicillin) - warm compress - analgesics
mastitis
39
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
40
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
41
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
42
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
43
postpartum assessment - BUBBLEHE which one are we considering -thrombophlebitis -hemroids
H-Homan’s/Hemorrhoids
44
postpartum assessment - BUBBLEHE which one considers - bladder capacity - urethra - urinary output - sensation and sensitivity - infection
B - bladder
45
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
46
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.
47
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
48
mastitis vs engorgement? s/s - sudden onset - chills - fever 101 F + - malaise - red, painful, swollen AREA on breast - usually one breast affected - discharge
mastitis
49
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?
50
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
51
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
52
mastitis vs engorgement? s/s - hard, painful breasts - entire breast (not an area), or both breasts - gradual onset - NO fever
53
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
54
postpartum assessment - BUBBLEHE After delivery, vaginal discharge of blood, mucus, atrophied uterine cells/debris
L - Lochia
55
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
56
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
57
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
58
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
59
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
60
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
61
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
62
T/F - Weeks 5-6 uterus will return to normal size
True
63
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
64
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
65
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.
66
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
67
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
68
mastitis or endometritis? s/s - uterine tenderness - temp spike 104 F - chills - foul smelling lochia or vaginal discharge
Endometritis
69
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
70
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
71
mastitis vs engorgement?
72
infection that involves the lining of the uterus
Endometritis
73
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
74
Interventions are appropriate for what? - Ice packs - Topical anesthestics - Waffle cushion - Surgigator - Sitz bath
Interventions for Episiotomy/Lacerations/Incision
75
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
76
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
77
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
78
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
79
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
80
postpartum assessment - BUBBLEHE which one considers -the cervix -external os -vagina changes -lacerations -c/s incision
E-Episiotomy/Lacerations/Incision
81
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
82
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
83
Medical management for PP blues, PP depression, or PP psychosis? - Lithium - Antipsychotics - Electroconvulsive therapy with psychotherapy - Removal of infant - Assess Social support
PP psychosis
84
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
85
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
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
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
87
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)
88
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
89
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
90
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
91
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
92
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
93
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
94
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
95
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)
96
-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
97
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
98
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
99
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
100
Best position to assess perineal area -side lying with superior leg elevated -frog leg -stirups
-side lying with superior leg elevated
101
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
102
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
103
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