week 6 Flashcards
placenta needs to be delivered within
30 minutes
breast fed babies require what supplementation
vitamin D
B.U.B.B.L.E — post-partum assessment
B = breasts
U = uterus
B = bowel
B = bladder
L = lochia
E = episiotomy
how often should the patient be assessed when post-partum
BP & pulse checked every 15 min for the first 2 hours after birth
then every 4 hours for the first 8 hours
then every 8 hours
oxytocin
strengthens uterine contractions
*stimulated by breastfeeding
HcG can be detected for how long when in post partum
up to 4 weeks
result of decreased estrogen
*diminishes vaginal lubricancy = local dryness & intercourse discomfort
breast engorgement
diaphoresis
diuresis of excess extracellular fluid
when does ovulation occur in lactating moms
lactation delays return of ovulation
approx 6 months
infants suck affects prolactin
when do non lactating moms ovulate
ovulation occurs 7 to 9 weeks after birth\
menses resume in 12 weeks
prolactin decline reaching pre-pregnant levels by week
on the 6th post partum day the uterus should be
halfway between the symphysis pubis and umbilicus
uterus location during third stage of delivery
midline & 2cm below umbilicus
1 hour after delivery the fundus should be
at the level of umbilicus
after 2 weeks the uterus should be
within the true pelvis and not palpable
interventions to assess the uterus
patient supine w knees slightly flexed
palpate fundus & observe lochia flow
document fundal height
when assessing fundus
never palpate w/o cupping
fingers between fundus & umbilicus
firm or boggy
location
(+) = above umbilicus
(-) = below umbilicus
oxytocics
*administered after placenta delivery
oxytocin
methylergonovine
carbopost
prostglandin med
misprostol
lochia rubra
occurs 1 to 3 days post-partum
dark red, small clots, fleshy odor
lochia serosa
occurs day 4 to 10 post p
serosanguinous, pinkish-brown
lochia alba
day 10 to 8 weeks post p
yellowish white, mucus, luekocytes
3 types of lochia
lochia rubra
lochia serosa
lochia alba
5 types of lochia amount
- scant = less than 2.5cm
- light = 2.5 to 10cm
- moderate = more than 10 cm
- heavy = one saturated pad within 24hrs
- excessive = saturated in 15 min or less
post partum the cervix will appear
edematous & bruised
post partum the vagina will appear
rugae & increased dryness
post partum it is normal in the perineum to find
hemorrhoids and hematomas
in a patient w episiotomy
normal to experience a bright red trickle of blood
*initial healing in 2 to 3 weeks
*complete = 4 to 6 months
colostrum appears
during and up to 2 - 3 days after birth
breast milk appears
3 to 5 days after delivery
4 positions for breast-feeding
- football hold
- cradle
- across the lap
4 side lying
avg blood loss in vaginal delivery
300 to 500 ml
avg blood loss in a c-section
500 to 1000ml
avg weight los during first 5 days after delivery
19 pounds
lab values in post partum
DECREASED HCT
increased wbc
increased temp
Gi and bowel changes during post partum
constipation
hemorrhoids
no spontaneous bowel movement for 2-3 days
urinary changes during post partum
increased urine output within 12 hours of delivery
urinary retention is normal
Rh vaccine can be administered
within 72 hours of delivery
Rubella & MMR vaccine in pregnancy
NO RUBELLA / MMR
no pregnancy for 4 weeks
tetanus / pertusis vaccine while pregnant
any time
okay w breast feedding
3 phases of maternal role attachment
- dependent
- dependent - independent
- interdependent
dependent
the “taking in phase”
first 23 to 48 hrs
interdependent
“letting - go”
family is seen as a unit
role resumptiob
dependent - independent
“taking hold” phase
begins day 2-3
baby blues
caregiving competency
acceptance from others
wiping
FRONT TO BACK
In 24 hours, a newborn should be fed
8 to 12 times a day
considerations for breast feeding
breast softens as baby feeds
burp in between boobs
WARM = RELEASE
COLD = PAIN
no wire bras
intervention for sore nipples
apply a small amount of breast milk and allow to air dry after breast feeding
considerations for NON-BREAST FEEDING
pump every 4 hours to relieve discomfort
NO WARM WATER
cabbage leaves inside bra
cold compress 15 on, 45 off
after delivery sex can resume
2 to 4 weeks after
episiotomy assessment
R.E.E.D.A.
R = redness
E = Edema
E = echomyosis
D = discharge
A = approximation
postpartum hemorrhage occurs
blood loss is greater than
500 ml (vaginal) OR 1000ml (c-section)
quarter sized clots
perineal pads saturated in less than 15 min
meds to control post partum hemorrhage
methylergovine
misoprostol
carboprost
uterine atony
inability of the uterine muscle to contract adequately after birth
s/s of uterine atony
boggy
lateral displacement
larger uterus
excess bleeding
tachycardia
hypotension
subinvolution of the uterus
uterus remains enlarged w continual lochial discharge — can result in post partum hemorrhage
s/s of subinvolution of the uterus
boggy
enlarged uterus
prolonged lochia
inversion of the uterus
PRESENTS AS A MASS
*complete = fundus as a mass in vagina
*prolapse = protrudes 20-30cm outside introitus
*incomplete = dilated cervix
terbutaline
tocolytic that relaxes uterus
stops pre-term labor
4 reasons for post partum hemorrhage (acronym)
T.T.T.T (4 T’S)
T1 = tone
T2 = tissue
T3 = trauma
T4 = coagulation
to prevent mastitis
completely empty each breast
*breast hygiene
s/s of mastitis
cracked / fissured nipples
nipple trauma
painful localized hard mass
flu like symptoms
s/s endometritis
*inflammation of the uterus
dark lochia –purulent/malodorus
fever
uterine tenderness / enlargement
calories in breast milk / formula
20kcal/oz
an infant is properly breastfeeding when
the breat is touching their nose, cheeks, and mouth
when breastfeeding
15 to 20 minutes each side
burp when alternating boobs
insert finger into mouth to release suction
how long can formula be refridgerated
48 hours
breast milk in room temperature lasts
up to 8 hours
refridgerated breast milk can last
8 days
breast milk frozen
vs
deep frozen
frozen 6 mo
deep frozen 12 o
considerations for thawing breast milk include
lukewarm water
no shaking
no re-freezing
can defrost in refrigerator for 24hrs
