Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Postpartum
Module 4
| Question | Answer |
|---|---|
| If the maternal mom has an infection, at what temperature would indicate an infection? | ABOVE 100.4 |
| For the first 24 hours, there will be a little elevated temperature (normal), what cardiovascular system adaptations are present in the postpartum phase? | - Decreased blood pressure - Elevated pulse rate (Watch closely because it is RED FLAGS for Postpartum Hemorrhage!!) |
| Blood volume and cardiac output for postpartum? | - Blood volume would be LOWER - Cardiac output will also be LOWER! - WBC will be elevated |
| What do we give in the postpartum phase to increase hemoglobin? | ALOT of IRON |
| Lochia is what? | The shedding of the uterus |
| 1st menstrual cycle for non-lactating mothers? | 7 - 9 weeks!! |
| 1st menstrual cycle for Lactating mothers? | 2- 18 Months! |
| What are the postpartum adaptations with abdomen with bowel and bladder changes? | - Bowel : Constipation & delayed peristalsis - Bladder: a FULL bladder can displace the uterus and it can become LAZY. (We want to make sure they void) |
| What are some interventions for Labor Afterpains? Is this normal? | - We can administer Motrin to help with the oxytocin contractions. - NORMAL! |
| Weight loss education for postpartum adaptation? | - It took 9 months to gain the weight, it will take that time for it to go away. |
| Psychological postpartum adaptation | - Is the mom bonding with the baby? (Always keep in mind that the first 24 hours can be extreme exhaustion) |
| What can make a bladder Lazy? | - Epidural and foley catheters can inhibit their capability to urinating. - SWELLING puts pressure on the urethra making it difficult to void --> Hematoma |
| Causes of Postpartum Diuresis (excessive urine) | - Large amounts of fluids given during labor - Decreasing ANTIDIURETIC effects of Oxytocin as its level decreases - Buildup and retention of extra fluids during pregnancy (most people have edema in 3rd trimester) - Decreasing production of Aldosterone |
| What do we care about monitoring Diuresis? | - Urine OUTPUT! |
| Maternal Transitions (VS after labor) | ~ Q15 x 4 (first hour) ~ Q30 x 2 (Second hour) ~ Every 4 hrs -- first 24 hrs ~ Every 8hrs -- After 24hrs |
| What would you assess with breasts? | - Engorgement - Blisters - Cracks - Bleeding - Bruising |
| What is the Golden hour? | - Neonate needs skin to skin with mom and help bring/produce the colostrum. |
| What 4 hormones make milk? | - Progesterone - Prolactin -- main one makes the milk - Estrogen - Oxytocin -- stimulates the milk to let it out |
| What is Colostrum? | - LIQUID GOLD (1 -5 days) - Baby gets passive immunity with this in breastfeeding (We highly encourage colostrum even if they do not want to breastfeed) |
| Breastfeeding transition milk | - Colostrum 1 -5 days - Transitional milk 2 - 4 days - Mature milk AFTER 4 - 5th day (Full milk doesn't kick in until 5 days) |
| Engorgement interventions | - Frequent emptying - Warm showers - Compresses before feeding - Cold compresses between feedings, if breastfeeding - Supportive bra - Avoid breast stimulation if not breast feeding (VERY PAINFUL usually until day 4 or 5) |
| When do you check the uterus? | Every initial assessments and vital signs! |
| If the uterus is above the umbilicus, first intervention for uterus displacement is? | - Voiding/urinating - EMPTY Bladder |
| At day 10, where should the uterus be located? | Under the pubic bone |
| By when does the urinary tract return to pre-pregnant size? | By 6 weeks!! |
| How many mL suggests bladder retention? | < 150mL |
| Interventions for bowel for post op C-section? | - Promote fluid intake - AMBULATION - Passing flatus (CANT eat until they pass gas) - Stool softeners as ordered -- ALL C-sections & lacerations |
| If patient does not pass gas, the gas can cause what? | - Shoulder gas pain |
| Lochia Assessment | - Amount - Color - Odor |
| Three types of Lochia | - Rubra (2 - 3 days) - Serosa (3 - 10 days) - Alba (2 - 3 week, up to 4 weeks) |
| Persistent lochia Rubra or return to Rubra after 3 - 4 days indicates what? | - An URGENT provider notification by the nurse and thorough nursing assessment and evaluation. (When was the last time they changed the pad?) |
| Assess the AMOUNT of Lochia | - Scant: 1 - 2 inch stain (10mL) - Light/Small: 4 inch stain (10 - 25mL) - Moderate: 4 - 6 inch stain (25 - 50mL) - Large/Heavy: Saturated pad within 1 hr. |
| The amount of lochia changes with? | Activity (1mL = 1g) |
| What position do you put the patient to assess episiotomy/laceration with first degree? | - Position on BACK to assess (Supine position) |
| What position do you put the patient to assess episiotomy/laceration with 2 - 4 degree? | - Position on SIDE to assess. (Check for hemorrhoids as well in this position) |
| What does REEDA assess for? | Episiotomy/Lacerations - Redness - Edema - Ecchymosis or hematoma - Discharge - Approximation |
| At what degree of lacerations MUST get stool softeners? | - 3rd & 4th degrees |
| Comfort measures for episiotomy/lacerations ? | - Apply ice packs - Sitz bath - Peri care - Topicals - Analgesics |
| What should the nurse educate on emotional state of exhaustion? | Sleep when the baby sleeps |
| Breastfeeding mothers must increase intake of how many kcal? | 500 kcal |
| Non-breastfeeding mothers must decrease intake of how many kcal? | < 200 kcal |
| What are factors that impact bonding? | - Lack of sleep - Baby in NICU - Pain - C/sections |
| If we see a bonding or attachment issue, what further intervention would we do? | - Get a social service consult (They'll help what resources are available before they go home) |
| What is close emotional attraction to a newborn by the parents that develops the first 30 to 60 minutes after birth? | Bonding |
| What is the development of a strong affection between an infant and a significant other (mother, father, sibling, caregiver)? | Attachment (Longer time) |
| Reva Rubin's Three Phases | - Taking-in phase: Relives the birth process - Taking-hold phase: Dependent & independent maternal behavior (Ex: They do their own peri care) - Letting-go phase: Reestablishes relationships (ex: she got her routine living life with baby) |
| Three-stage role development process for father? | - Expectations (Planning it before baby is born) - Reality (baby cries all night, expectations are shattered) - Transition to mastery (They can make it work with the baby) |
| Nursing interventions for promoting comfort in post partum period? | - Promoting comfort - Topical preparations - Analgesics (NSAIDS, Dermoplast, Tucks) |
| Nursing interventions for assisting in post partum period? | - Assisting with elimination (every 2hrs) - Promoting voiding (every 2hrs) - Promoting bowel elimination |
| Ensuring Safety During Ambulation | - Check BP first - Elevate head of bed for a few minutes - Have client sit on side of bed - Help client stand up - Ambulate alongside client and provide support - Ask how her head feels - Stay close by to assist |
| What is postpartum blues? | Self limiting (goes away on its own) - Up to 2 weeks after birth usually resolve by day 8! - Rule Out Postpartum Depression if this last longer than 2 weeks. |
| What are the symptoms of Baby Blues? | - Anxiety - Fatigue - Tears Etiology: Hormonal changes - Normal (Only emotional, resolves on its own) |
| Postpartum depression usually develops when? | - 1 - 3 months - Up to 1 year |
| Risks for Post partum Depression? | Hx of PPD or depression, mental illness - Preexisting medical conditions - Depressed mood |
| Symptoms of Severe Postpartum Depression | Hopelessness & worthlessness (Needs medications, psychotherapy, social support) |
| If postpartum depression is not treated, this can lead to...? | - Postpartum Psychosis |
| What is known for Psychiatric emergency? When can this happen? | - Postpartum Psychosis - Onset as early as 2 days - Postpartum depression not treated can lead to this. |
| Symptoms of Postpartum Psychosis? | - Delirium - Hallucinations - Anger - Manifestations of mania - Thoughts of hurting self or infant. |
| Treatment for PP Psychosis? | - Hospitalization - Psychiatric care - Medication |
| What assessment scale is used to assess postpartum depression? | Edinburgh Postnatal Depression Scale (10 - question Scale) |
| Postpartum Hemorrhage vaginal delivery blood loss? | > 500mL |
| Postpartum Hemorrhage Cesarean Delivery blood loss? | > 1,000mL |
| Severe symptoms of PPH? | - Drop in SBP or DBP of 30mmHg - Drop in hemoglobin of 3g - Estimated blood loss > 1,000mL |
| Early PPH happens when? | - Immediate or primary - Occurs first 24 hrs after birth (***Tachycardia is the EARLY sign of PPH***) |
| Late PPH happens when? | - Secondary or delayed - After 24hrs - 6 weeks |
| Potential causes of PPH? | - Laceration - Hematomas - Uterine Atony - Trauma |
| Risk factors of PPH? | - Grand multiparty - Overdistension of uterus (Polyhydramnios) - Rapid, Precipitous or prolonged labor (Fast labor) - Retained placenta - Medications (Tocolytics, oxytocin) - C/section and vacuum extraction - Placenta previa or abruptio placenta |
| Nursing assessment of Trickle of bright red blood loss means? | Trauma/Laceration |
| Steady stream of blood, darker red with gushing during fundal massage. What would this indicate? | Retained placenta or uterine atony |
| Causes of PPH | Tone (70%) Atonic uterus - boggy fundus Trauma (20%) Lacerations, Hematomas, inversion, rupture Tissue (10%) Retained tissue Thrombosis |
| Trauma fundus will be firm or soft? | FIRM because blood is going into Hematoma |
| Separation of placenta is about 10 mins post delivery but if greater than 10 mins their risk increases for what? | Postpartum Hemorrhage |
| Trauma - Hematoma may require what? | Incision & Drainage - cut hematoma open to release pressure to release the blood. |
| If retained placenta, manual removal with what? | Analgesia |
| Thrombosis abnormal result that is concerning? | LOW PLATELETS = CONCERNING |
| Interventions for PPH | 1. Fundal Massage 2. Weigh Pads 3. Bladder, straight catheter 4. Uterotonic Drugs as ordered (Oxytocin, Methergine, Prostaglandins) 5. IV fluids (Assess for overload) on the 2nd IV 6. Prepare for dilation & curettage 7. Communicate with provider |
| 5 Medications for PPH | 1. Oxytocin 2. Hemabate - runny diarrhea (give with Lomotil) Contraindicated: asthmatics 3. Cytotec (given rectally) 4. Methergine (contraindicated in Hypertension Hx) 5. TXA Lysteda - 10mL (1mL per minute) |
| You are assessing a clients fundus and find it firm, 2cm above the umbilicus, and displaced to the right. What is the most appropriate intervention? (4) | 1. Massage the fundus 2. Have the client void and reassess the fundus 3. Notify the physician 4. Start a pad count |
| What is the biggest priority for Pulmonary Embolism? | 1. ABC's!!!! 2. Oxygen 3. IV heparin 4. Bedrest and analgesia |
| Management of Pulmonary Embolism? | 1. Oxygen 2. Narcotics 3. Bedrest, HOB elevated 4. Pulse Oximetry, arterial blood gases 5. Heparin (Antepartum), Warfarin (Postpartum) 6. Embolectomy - urgent intervention |
| If temperature > 38C (100.4 F) after PP, we suspect what? | - Intra abdominal infection (Chorio) - Duration of AT LEAST 48hrs within 10 days AFTER delivery (100.4 F > after 24hr PP) |
| Risks for PP infections? | - C/sections - Urinary catheter - Retained placenta - Prolonged ROM - Medical conditions ODOR STENCH symptom |
| Postpartum infection symptoms? | 1. Fever > 38 C, chills 2. Headache 3. Malaise 4. Restlessness 5. Anxiety 6. Tachycardia 7. Pain at site of infection 8. Drainage from site of infection |
| Breast-mastitis what will you see? | Red Streaks |
| Nursing management for PP infections? | - IV/oral antibiotics (Ancef) - Anticoagulants for thrombophlebitis - Pain assessment and medication - Vital Signs - Diet & fluids - Comfort measures - Breast pump as indicated - Educate (Handwashing, pericare, meds, and breastfeeding) |
| Within 72 hrs after birth, Rh immune globulin (RhoGAM) is administered to all Rh-negative women who give birth to positive or negative Rh infants ? | Only Rh-Positive infants |
Created by:
MaryL78
Popular Nursing sets