Week 5: Monday Flashcards
1
Q
The postpartum period
A
- Up to six weeks after the birth, when the reproductive tract returns to the normal, prepregnant state
- The 1st hour after delivery is often referred to as the fourth stage of labor
- Fundal checks begin
- Breastfeeding is established
- Client adjusts to being the mother of 1 or more children
2
Q
Primipara
A
A woman who has had one pregnancy that resulted in a fetus that attained a weight of 500 g or gestational age of 20 weeks whether or not it was born alive
3
Q
Multipara
A
A woman who has given birth 2 or more times
4
Q
Grand multipara
A
A woman who has given birth 5 or more times
5
Q
Hand off report
A
- face to face
- ideally in presence of patient
- accurate and complete hist
- risk facotrs
- Delivery and immediate postpartum recovery summary
- Anestethia, QBL, fluid balance, meds, pain level
- breastfeeding attempts, and sucess or need for edu
6
Q
SBAR or ISBAR
A
- Identify yourself
- Situation
- Background
- assessment
- Recommendation
7
Q
Postpartum shivering
A
- Seen in 25 - 50% of postpartum women after normal deliveries
- Usually begins 1 - 30 minutes after delivery and alsts 2 - 60 min
- No TX needed other than reassurance and warm blanket
8
Q
Fall risk
A
- Pt edu
- To evaluate muscle control after regional anesthetic ask patient to raise her knees, lift her feet one at a time, dorsiflex her foot, raise her butt off of bed
- Ambulate with assist first time
- Assess for anesthetics, narcotics, blood loss, BP
- sit to shower if necessary, remain seated when holding baby, avoid sudden position changes, check orth. vital signs
9
Q
first 2 - 3 days, maternal changes
A
- Afterbirth pains - contractions during breast feeding
- Pos. sign of good sucking by baby, since this stimulates release of oxytocin
- Uterus begins the process of shrinking back to size
- Consider administering Ibuprofen at least 30 min before next est. feeding
- Blues/fatigue begin around 2 -3 days pp, gradually sibsides in 1 - 2 weeks
10
Q
Postpartum interventions (textbook p. 463) (1)
A
- Every 15 min: vital signs, fundal assessment (in relation to umbilicus, firm/boggy, midline)
- Amount of lochia (scant, moderate, heavy)
11
Q
Maternal physiologic changes (cardio)
A
- Cardio: increase in circulating blood volume in the immediate postpartum period
- auto transfusion of blood that circulated in uterine muscle during pregnancy
- 60 - 80% rise in cardiac output for 1-2 hours following delivery
12
Q
Maternal physiologic changes (Hematologic)
A
- Hematologic: The hematocrit may initially drop due to blood loss associated with delivery but starts to rise again as plasma volume decreases due to diuresis and hemoconcentration
13
Q
Uterine involution (maternal changes)
A
- rapid decrease in size of uterus, clients who breast-feed may experience a more rapid involution because of the release of oxytocin
- Assessment: Findal height decreases about 1 cm/day
- by 10 days pp the uterus canot be palpated abdominally
- A flaccid fundus indicates uterine atony, and it should be massaged until firm
- A tender fundus indicates an infection
- Afterpains decrease in frequency after the first few days
14
Q
Assessment of uterus
A
- Fundus should feel firm like a grapefruit
- Boggy uterus feels like sponge/difficult to locate
-Massage if needed - Observe bleeding during massage
- If pad is saturated or clots are larger than nickle, notify provider
- If you observe a slow steady trickle notify provider
- If mom concerned about bleeding, apply fresh pad and reassess in one hour
15
Q
Lochia (maternal changes)
A
- discharge from the uterus that consists of blood from the vessels of the placental site and debris from the decidua
- Assessment: Rubra = bright red (birth - day 3)
- Serosa = brownish pink (days 4 to 10)
- Alba = white discharge (days 11 - 14)
- Discharge should not smell foul
- discharge may increase with ambulation
16
Q
Amount of lochia
A
- scant: less than 2.5 cm in one hour on pad
- Light: less than 10 cm
- Moderate: less than 15 cm
- Heavy: saturated menstrual pad
- Excessive: pad saturated in 15 min
17
Q
Renal (maternal physiologic changes)
A
- The client may have urinary retention as a result of loss of elasticity and tone and loss of sensation in the bladder from trauma, meds, anesthesia, and lack of privacy
- Might not feel the urge to void until she stands up
- Diuresis usually begins within the first 12 hours after birth
- A full bladder can displace the uterus and lead to postpartum hemmorrhage
18
Q
GI (maternal changes)
A
- Clients are usually hungry after birth
- Constipation can occur, with bowel movement by the second or third postpartum day
- Hemmorrhoids are common
19
Q
Fluid balance and electrolytes
A
- Diuresis begins within 12 hours of birth and continues for up to 5 days
- Urine output may be 3000 ml or more per day
- Additional fluid lost through increased perspiration
- Fluid loss greater in patients with preeclampsia or eclampsia
- Risk of pulmonary edema and/or unmasking of cardiac disease
20
Q
Postpartum maternal immunizations
A
- Rubella (if lower than 1 to 8)
- Rhogam
- Flu
- T-Dap
- Indicated in each pregnancy, even if the woman has a previous hist of pertusis or vaccination
- If T-dap has not administerd during pregnancy, it should be administered asap postpartum to provide protection to infant indirectly or, if breastfeeding, thorugh transfer of maternal antibodies in breast milk
- The maternal immune response may not be sufficiently rapid to protect the infant until two weeks post-immunization
- Breastfeeding is not a contraindication to recieving any of these vaccines
- Client has the right to decline
21
Q
Rubella
A
- For women who have not had rubella
- For women who are serologically not immune (titer less than 1:8)
- Live attenuated virus vaccine
- Must not be given to pregnant women, so postartum is a gaurunteed, non pregnant time
- Breastfeeding mothers can be vaccinated
22
Q
Rhogam
A
- Given to an Rh- mother prenatally around 26-28 weeks gestation, even though fetal blood type is unknown
- Next dose is given within 72 hours after delivery of an Rh+ infant or if the Rh is unknown
- Must be repeated after each subsequent delivery if baby is Rh+
- Rhogam 300 mcg is the standard dose
23
Q
Postpartum teaching
A
- Assess needs and confidence
- Use interactions with mother to teach
- Incorporate “teach back” method
- Barriers to learning: fatigue, overstimulation
24
Q
Postpartum pain management
A
- pain: caused by episiotomy, lacerations, perineal trauma, incisions, contractions, hemorrhoids, breast engorgement, and nipple tenderness
- Pain causes stress and interferes with ability to interact with infant
- Use pain scale, ask for description of pain, observe patient
25
Q
After birth pains
A
- Occur as a result of contractions of the uterus
- Are more common in multiparas, breast-feeding parents, clients treated with oxytocin, and clients who had an over-distended uterus during pregnancy, such as carrying twins
26
Q
Perineal discomfort
A
- Apply ice packs to the perineum during the first 24 hours to reduce swelling
- After the first 24 hours, apply warmth by sitz baths or warm tub at home
27
Q
Episiotomy
A
- If done, instruct the client to administer perineal care after each voiding
- Encourage the use of an analgesic spray as prescribed
- Administer analgesics as prescribed if comfort measures are successful
28
Q
Perineal lacerations
A
- Care as for an episiotomy; administer perineal care and use analgesic spray and analgesics for comforts
- Rectal suppositories and enemas may be contraindicated (to avoid injury to sutures)
29
Q
Breast discomfort from engorgement
A
- Encourage client to wear a support bra at all times, even while sleeping
- Encourage the use of ice packs between findings if the client is not breastfeeding
- Use of ice packs could diminish milk supply in the breastfeeding client
- Encourage the use of warm soaks or a warm shower before feeding for the breast-feeding client
- Administer analgesics as prescribed if comfort measures are unsuccessful
30
Q
Constipation
A
- Encourage adequate intake of fluids (2000 mL/day)
- Encourage diet high in fiber
- Encourage ambulation
- Administer stool softener, laxative, enema, or suppository if needed and prescribed
31
Q
Postpartum emotional changes
A
- Acknowledge the clients feelings and demonstrate a caring attitude
- Determine availability of family support systems and resources as needed
- Encourage and assist the client to verbalize feelings
- Monitor the newborn for appropriate growth and development expectations
- Assist the significant other and other appropriate family members to discuss feelings and identify ways to assist the client
- All clients should be assessed for depression during pregnancy and PP
32
Q
Patients with chemical dependency
A
- No evidence that withholding analgesics will increase chances of recovery from drug addiction
- No evidence that providing analgesics will worsen addiction
- Patients with chemical dependency often require higher loading doses and maintenance doses
- Consider consulting pain or addiction specialist to help order appropriate doses
33
Q
Breasts (maternal changes)
A
- Breasts continue to secrete colostrum for the first 48 - 72 hours after birth
- A decrease in estrogen and progesterone levels after birth stimulates increased prolactin levels which promotes milk production
- For primiparas, breasts become distended with milk about the third dayl earlier for multiparas
34
Q
Engorgement occurs on…
A
- Approx. day 4 in both breast-feeding and non-breastfeeding clients
- Breast-feeding relieves engorgement
35
Q
Breastfeeding and nursing care
A
- Put the newborn to the mother’s breast as soon as they’re stable (immediately after delivery, if possible)
- Stay with the client each time the client nurses until the client feels secure and confident with the newborn
36
Q
Assess LATCH score
A
- Latch achieved by newborn, audible swallowing, type of nipple, comfort of parent, hold or position of baby
37
Q
Best start in L&D
A
- Skin to skin for 1 -2 hours
- Routine care on mom’s chest
- Minimize separation
- Decrease need for warming, less hypoglycemia
- Uterine contractions allow less blood loss
- Immunological components of colostrum protect the infant from bacteria/viruses
- Increase in the infants digestive peristalsis
- Promotes attachment and bonding
38
Q
Infant state organization
A
- Sleep states: deep sleep, light sleep
- Transitional: drowsy
- Awake state: quiet alert, active alert, crying
39
Q
Breast feeding benefits
A
- Passive immunity: Human milk provides passive immunity through colostrum
- Breast-fed babies also experience fewer allergies/intolerances throughout their lives
40
Q
Breast feeding benefits - Easily digestible
A
- Provides essential nutrients in an easily digestible form
- Contains lipase which breaks down dietary fat, making it easily available to baby’s system
41
Q
Breast feeding benefits - brain booster
A
The fats in breast milk are high in linoleic acid and cholesterol which are needed for brain development
42
Q
Breast feeding benefits - Low protein content
A
- Cow’s milk (not formula) contains proportionally higher concentrations of protein
- Cow’s milk can be a strain on newborn kidneys - best delayed till at least 3 months of age
43
Q
Breast feeding benefits - Convenient and inexpensive
A
- Saves time and money in buying and preparing formula
44
Q
Nutrient needs during lactation
A
- similar to those during pregnancy
- Needs for energy remain greater than non-pregnant needs
- Increase of 330 Kcal more than woman’s nonpregnant intake recc.
- Some women have increased weight loss during lactation which could be seen as another plus for breast feeding
45
Q
Contraindications for lactation
A
- Smoking, alcohol intake, and excessive caffeien intake should be avoided
- Some pediatricians feel that smoking during lactation can prevent nicotine withdrawal in newborns
- If cannot quit, smoke outside after breastfeeding
- If planning on drinking alcohol at party, breastfeed first
46
Q
Breast-feeding
A
- During first 24 hours after birth there is little change in breast tissue
- Colostrum or early milk, a clear yellow fluid, can be expressed from the breasts. Often it leaks toward the end of the pregnancy
- the breasts gradually become fuller and heavier as the colostrum transitions to mature milk by about 72-96 hours after birth (milk coming in)
47
Q
Breast feeding contraindications
A
- Herpes lesions on the breasts
- Regular intake of certain meds that pass into the breast milk and may harm the neonate
- Restricted diet that interferes with adequate nutrition intake and affects quality of milk produced
- HIV positive
48
Q
Breast-feeding and nursing care
A
- Breasts may leak between feedings or during coitus; place breast pad in bra
- Increase calories by 200-500 per day
- Avoid OTC meds unless approved by provider
- Progestin-only birth control pills recommended, not estrogen (can interfere with milk supply)
- Newborn’s stool: Light yellow, seedy, watery, and frequent
49
Q
Breast-feeding challenges
A
- Sore nipples: confirm correct latch, not nipple chewing
- Low milk supply: nursing more often or pumping after breastfeeding will help increase milk supply
- Engorgement: Hand express or pump a little milk to soften breast before breastfeeding
50
Q
Metabolic changes - diabetes
A
- Breastfeeding may temporarily precipitate hypoglycemia in women with dependent diabetes
- Women with gestational diabetes often have normal glucose levels postpatrum
51
Q
Breast care for non breast feeding clients
A
- Avoid nipple stimulation
- apply a breast binder, wear a snug fitting bra, apply ice packs, or take a mild analgesic for engorgement
- Engorgement usually resolves within 24-26 hours after it begins
52
Q
Bottle feeding
A
- Bottle feeding with formula
- Reliable and nutritionally adequate
- Commercial formulas are designed to mimic human milk:
- Milk based formulas are usually prescribed. Some of these are lactose-free, so they can be used for neonates with galactosemia or lactose intolerance
- Soy based: are used for babies who could be allergic to cow’s milk protein
53
Q
Formula feeding - amounts (see textbook pp. 604-607)
A
- In first 24-48 hrs of life a newborn typically consumes 15-30 mL (1/2 to 1 oz) of formula/feeding Q 2-3 hrs
- Most newborns drink ____
- Slide 57
54
Q
Notes about quiz
A
We’ll work on care plan
or study guide
and also quiz has 15-20 questions
