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Maternal Newborn

Postpartal

QuestionAnswer
____ is the period during which a woman adjusts physicaly and psychologically to the process of childbirth and begins immediately after birth and continues for approx 6 weeks or until the body has returned to near prepregnant state Postpartal period or Puerperium period
____ of the uterus - measurement of descent of fundus for the woman with a vaginal birth, rapidly reduces in size to near pre-pregnant state Involution of uterus
After birth, the fundus will rise to the level of the ____ and then descend ____cm every 24 hours umbilicus then descend 1 cm every 24 hrs
By day ____ should no longer feel the fundus, if it can be flet the uterus has not gone through involution and there is a risk for ____ 10 - hemorrhage
A full bladder can make the uterus deviate to the ____ side, make sure it is empty before doing assessment right
____ is released during breastfeeding which enhanses ____ Oxytocin - involution
Assessing the fundus; empty bladder, ____ position, support lower uterine segment to prevent ____, find fundus around umbilicus by palpating with fingers and make sure it is midline supine position, prevent displacement
Check perineum for lacerations, hemorrhoids, and episiotomy, takes ____ - ____ weeks to heal. 4-6 weeks
Check perineal and incisional areas for REEDA what does REEDA stand for Redness - Echymosis (bruising) - Edema - Drainage - Approximation
____ is the vaginal drainage after delivery - can indicate how well the rupture from the placenta from the uterus is healing Lochia
Lochia starts out bright red after birth then follows a color pattern until clear, what are the colors and about how long for each Rubra (dark red) first 2-3 days, Serosa (pink) 3-10 days, Alba (creamy white or light yellowish), clear
When lochia stops, cervix is considered to be ____ closed
What is the #1 reason for readmission postpartum infection
When is it safe to resume sex episiotomy healed copletely, no lochia and check with physician (about 4-6 weeks)
How much blood loss is normal 200-300cc
Lochia should smell like fresh blood, if smells bad, could be infection
Why do women with CS have less lochia uterus cleaned out when open
___ are outpouching of veins seen around the anus after birth. If large need refrral to proctologist hemorrhoids
Hemorrhoids are very painful, give ____ soak or ___ cream magnesium sulfate soak - cortisone cream
Cervix changes from dimple-like os of a nullipara to a ____ of multipara lateral slit
How long does the vagina take to decrease in size for nonlactating women and why longer in lactating women 3 weeks - lactating women have hypoestrogenic state
Estimated weight loss for the first 6 to 8 weeks after delivery 25-30 lbs
how soon does menstration return for nonlactating women 6-10 weeeks usually
In lactating women, menstration returns at various times because increased levels of prolactin - therefore breastfeeding is not a reliable means of contraception
The abdomen appears loose and flabby because the diastasis recti abdominis ____ seperates (muscle straight down the middle) responds to exercise
Which hormone makes the bowels sluggish after birth progestrone influence
Colace which is a ____ may be given to women who fear the first bowel movement (bearing down) - fear of pain and tearing episiotomy delays elimination stool softener
Puerperal diuresis occures because the ____ system that has been going to baby is going into general circulation cardiovascular system
If the uterus relaxes after birth it can cause hemorrhage
The uterus relaxes when the ____ is full bladder - causes the uterus to hemorrhage
If a woman can not get up to pee after giving birth, palpate the bladder, if full ____ straight cath to prevent relaxation of the uterus = hemorrhage
Dilated uteters increases the risk for ___. UTI. dilated ureters and renal pelvis return to prepregnant state by 6 weeks
If the bladder is empty and the uterus is still boggy then ____ uterus massage
why is WBC count not a good indication of infection in postpartal period WBC normally elevated after delivery so go by temp over 100.4F
The risk for thromboembolism lasts for ____ weeks due to progesterone/estrogen flucations 6 weeks
If a woman has a hx or family hx of DVT then she takes ___ during the postpartal period Lovonox
With the knee bent, doriflex the foot, if severe pain it is a positive ____ sign Hogman's sign - notify physician
____ is a nervous response to vasomotor change postartal chill - tx warm blanket
What kind of pain is more common in multiparas afterpains - lasts 2-3 days
Afterpains are more severe and frequent in lactating women due to what hormone oxytocin
Taking in stage lasts ___ days which includes sorting reality from fantasy in birth experience, passive focused on her own needs, and relieving experience, taking hold stage lasts ____ days and includes readiness to resume control over her life taking in 1-2 days, taking hold 2-3 days
What are the four stages of maternal role attainment (Mercer's research) Anticipatory stage, Formal stage, Informal stage, and Personal stage
Which of Mercer's stage looks to role models for mothering Anticipatory - during pregnancy
Which of Mercer's stages does the woman act as she believes others expect her to act Formal state - when baby is born
Which of Mercer's stages does the mother develop her own style of mothering Informal stage up to 3 months after delivery
Which of Mercer's stages is the mother comfortable with the role of mother Personal stage - 3-10 months after delivery
____ is a transient period of depression occuring during the first few days after delivery until 10-14 days Postpartum blues
tearfulness, anorexia, difficulty sleeping, and feeling of letdown are all clinical manifestations of Postpartum blues
changing hormone levels, psycholigic adjustments, unsupportive environment, insecurity, fatigue, discomfort, overstimulation and lack of sleep are all causes of Postpartum blues
Acquaintance phase, phase of mutual regulation and reciprocity are the three phases of ____ Maternal attachment behavior
unwraping the babies, fingertip exploration and enface position (direct gazing) are all which phase of maternal attachment behavior acquaintance phase
Which phase of maternal attachment behavior includes the mom adjusting her needs to the infant (any negative feelings may come out here) Phase of mutual regulation - mom adjusts her needs to the infant
Which phase of maternal attachment behavior is mutually gratifying interaction amount mother infant and father reciprocity
What may be given 30 minutes before doing assessment pain medication - perform procedure as gently as possible to avoid unnecessary discomfort
Before performing a physical assessment, be sure to ____ before entering, record findings as clearly as possible,explain purpose of regular assessments and teach client ____ while performing assessment be sure to knock first. Teach client self-care
How high does the temperature elevate due to normal process of birth and how long does it last no more than 38C (100.4F) for 24 hours - due to dehydration, if still high after hydrated may be an infection
Which vital sign should remain stable right after birth blood pressure - if not stable may be due to pregnancy induced HTN
Which vital sign slows then retgurns to pre-pregnancy level after birth Pulse
Any deviations of VS needs to be recorded b/c can be sign of ____ or ____ hemorrhaging or shock
BUBBLEHE stand for what Beast, Uterus, Bladder, Bowel, Lochia, Episiotomy, Hemorrhoid or Homan's, Emotional
Tx for positive Homan's sign Heparin
Urine elimination - Catherize if not voided within ____ hours after delivery or after urinary catherter removal 8
stool softners, ambulation increase fluid intake (200ml/day or more) add fruits and roughage to prevent ___- constipation
Nursing mothers should increase kcal to what over pregnancy requirments 200kcal (in addition to the pregnancy 300 kcal increase)
Iron supplements, if prescribed must be taken for ____ - ____ weeks after delivery to prevent anemia 4-6 weeks
4 physical and developmental tasks to accomplish in the postpartal period restoring physical condition, develope competence in caring for and meeting needs of infant, establish relationship with infant, adapt to altered lifestyle and family structure
mother's general attitude, feelings of competence, available support systems, caregiving skills, fatigue level, sence of satisfaction, and ability to accomplish developmental tasks are what type of adjustment assessment psychologic
What can make the psychologic adjustment difficult fatigue, depression, preoccupation with physical status or discomfort, low self-esteem, lack of support, material probs, inablity to care for newborn, current family crisis (illness or unemployment)
If there is an problem with early attachment, the nurse should find out what the problem is and the ____ of the problem source - devise an approac for development of mother-infant relationship
When giving RhoGAM during the discharge assessment, must get into the muscle not sub Q b/c if in subQ could cause iso-immunization of mom which is a major prob for future babies
Rubella for non-immunized women are given during the discharge assessment where SubQ - tell them not to get pregnant for at least 3 months
Best time to give pt referrlas, follow-up info and Rx Discharge assessment
handouts and discharge instuctional manuals, formal classes, videotapes, individual intraction and demonstrations and closed circuit educational TV shows for new mothers are all examples of ____ methods instructional methods - nurses provide
return demonstration, question and answer session, formal eveluation tool and follow-up call or homehealth visit are all examples of ____ methods evaluation methods - done with nurse
maternal and infant care, role changes, psychological adjustment, special education needs (CS, Multiple, congenital anomaly) and anticipatory guidance are all apart of ____ content teaching content - nurses provide
How often are uterine status and vital signs taken after delivery every 15 min for first hour, then every 30 minutes for second hour, then hourly for 2 more hours, then every 4 hours for first 24 hours (follow institution protocols or physician orders)
What is used to cleanse perineal area peribottle, moist antiseptic towelettes, clean hands
What is used to relieve perineal and hemorrhoidal discomfort icepack on 20 off 10 for 24 hrs, warm sitz bath 102-105 F for 20 min PRN, cool sitz bath, and anesthetic spray, which hazel compresses and ointment
What is done to relieve after pains prone with small pillow uner lower abdomen, warm sitz bath, warm K-Pad, ambulation, analgesic like Ibuprofen or Naproxen Sodium
What can help supress lactation in non-breastfeeding mother suportive bra, ice pack to axillary 20 min 4X/day, avoid stimulation and heat (shower on breast), analgesic (Tylenol or Ibuprofen)
What are the risk factors for suboptimal breastfeeding maternal obesity, primiparity, formula supplementation, pacifiers, CS, 2nd stage more than 1 hr, LBW, flat or inverted nipples
What are breastfeeding concerns Nipple soreness(peak 3-6 day), cracked niples, breast engorgement, plugged ducts, alcohol and medications, return to work, weaning
Ways to promote maternal rest organize nursing care to avoid frequent interruptions, encourage naps (helps decrease probs of establishing breastfeeding pattern) and put sign on mothers door for visitors to check in at nurses station
Teach client to increase ambulation over 6 weeks, avoid ____, ____, ____ activity, and return to work after final postpartal examination heavy lifting (more than baby), excessive stair climbing, and strenuous activity
signs of too strenous activity increased locia and pain
what are the health benefits of postpartial exercises maintain insulin and high-density cholesterol levels, positive self-estem, less fatigue, improves fitness, decreases urinary leakage (kegel exercises)
advantage of mother-baby or couplet care allows time to bond with baby and learn to practise care of infant
Advantages of sibiling visitation reassure mother's love and well-being, opportunity to become familiar with infant
When resuming sex, use only ____ lubercant with female superior or side lying position water-soluble
Why should a mother breastfeed prior to sex to reduce milk flow with orgasm
factors that inhibit sexual experience crying baby, unattractive to mother body, sleep deprivation, hormonal changes, decreased libido
Ways to prevent respiratory infection cough and deep breath every 2-4 hours and CS moms use incentive spirometer
ways to increase circulation after birth leg exercises Q2H until ambulating, tighten abdominal muscles (CS moms have AV boots or stockings to promote circulation)
CS moms must have ____ B4 liquids may be given bowel sounds. Should be passing flatus B4 solid foods given.
What needs to be assessed in an adolescent mother maternal-infant interaction, roles of support people, plans for discharge, knowledge of childrearing, plans for foll-up care
Teaching needs for adolescent mothers self-care, infant care and behaviors, contraception, responsibilities of motherhood, goal setting, peer relationships, and resources
nursing interventions for the woman who relinquishes her newborn emotional support, explain grief process, respect special requests regarding care of infant (whether to see and hold infant, early discharge, transfer to medical unit)
When to call primary care provider for temperature sudden, persistent or spiking fever over 100.4F or 38C
When to contact primary care provider with change in lochia foul smelling, return to bright red bleeding, excessive amount, or passage of large clot
When to contact primary care provider with changes in breasts evidence of mastitis, such as breast tenderness, reddened areas and malaise
When to contact primary care provider with thrombophlebitis calf pain, tenderness and redness
When to contact the primary care provider with UTI urgency, frequency and burning on urination
call primary care provider if experiencing ____ postpartal depression incapacitating
When is birth certificate information, info on support groups, follow-up care and plan for follow-up visit done discharge
What is assessed for preparation of discharge mother's physical and psychologic condition, newborn adjustment, family adjustment, need for outside resources
A nurse is assessing the lochia of a 24-hour postpartum client and notes the presence of blood clots. What would be the appropriate nursing action? Assess voiding pattern.
A nurse is teaching a postpartum client about the medication methylergonovine maleate (Methergine) that is ordered for postpartum bleeding. What must the nurse caution the client to avoid? asprin
____ may cause an overdistended uterus, contributing to afterpains. Hydramnios may cause an overdistended uterus, contributing to afterpains.
A nurse is assessing a 12-hour postpartum client. Where should the nurse expect to palpate the fundus? midway and at the level of the umbilicus
T/F Pt is allergic to aspirin; therefore, she cannot have the Empirin #3. true
While the nurse is palpating the fundus of a 12-hour postpartum client, she complains of severe pain. What diagnosis should the nurse suspect? uterine infection
The nurse is caring for four postpartum clients. Which client is at greatest risk for bladder atony? 39-week-gestation client with a 36-hour labor
The nurse is teaching nutrition requirements to a breastfeeding postpartum client. What is the correct amount of caloric intake by the client required for successful breastfeeding? 500 more than prepregnancy
The nurse is caring for four high-risk postpartum clients. Which predisposing condition places a client at risk for developing pulmonary edema? pregnancy-induced hypertension
The nurse is researching the relationship between estrogen and lactation. What condition is the lactating client more susceptible to? dyspareunia
The nurse is caring for a postpartum client 10 hours after a normal vaginal birth. Where should the nurse expect to palpate the fundus? level with the umbilicus
The nurse assesses an 8-hour-postpartum client. Findings include a constant trickle of lochia rubra, with a firm fundus at the level of the umbilicus. What might the nurse suspect? a cervical laceration
A new non-breastfeeding mother asks the nurse, "When should I expect my next period?" The most correct statement by the nurse would be\: "6-9 weeks."
Assessment of the postpartal woman includes an evaluation of the lochia. Evaluation of the lochia includes character, amount, odor, and the presence of clots. What nursing action is indicated if the client says she has heavy vaginal bleeding? Assess the perineum and lochia. If heavy bleeding is not seen, ask the client to put on a clean perineal pad and then reassess the client's pad in 1 hour.
Assessment of the postpartal woman includes an evaluation of the lochia. Evaluation of the lochia includes character, amount, odor, and the presence of clots. Describe the normal progression of lochia after birth. First 1-3 days\: rubra; following rubra, days 3-10\: serosa
Normal Vaginal Birth.Ms. Jenkins is concerned because she experiences a rush of blood when she first gets out of bed to walk to the bathroom. Is this a serious problem? How would you explain it to the client? The gush of blood is normal and occurs because blood pools in the vagina when the client is lying down. When she stands, gravity causes the blood to flow.
what is engrossment? The characteristic sense of absorption, preoccupation, and interest in the newborn demonstrated by fathers during early contact is termed engrossment.
Ms. Jenkins tells you, "I don't feel as excited about the baby as I expected. Mostly, I'm just tired. Is there something wrong with me?" How would you best respond to her concerns? Assure Ms. Jenkins that a "let down" feeling after childbirth is common. Allow her to express her negative feelings & provide emotional support.
Created by: cgwayland on 2008-06-17



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