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grcc OB postpartum
GRCC PN 135 postpartum
| Question | Answer |
|---|---|
| What term is used in reference to the 6 week period following childbirth? | Postpartum |
| What is a goal and the number one nursing diagnosis for postpartum care? | Prevent Hemorrhage (For whatever reason uterus isn't attaching) |
| Report hemorrhage or hematomas from lacerations to physician | Goal for post partum care |
| Increase bladder capacity, but decrease ability to hold it | Common renal issue postpartum |
| List other goals for postpartum care | -To meet fluid/nutritional needs-Prevent bladder distention-Help mother integrate experience-Report any abnormalities (i.e. bleeding, convulsions)-Facilitate both parent/child interaction-provide mother comfort |
| List postpartum care related to renal | -want to keep bladder empty-May not have sensation due to swelling and bruises.-Void at least 200 ml within first six hours. |
| When checking fundus, and you can't feel it then what can you ask the mom do? | Ask mom if she feels like she can empty her bladder, and then recheck it again. |
| It is not unusual to have brady cardia for the first 24-48 hrs post partum? T or F? | True. |
| Mom has tachycardia 24 to 48 hours postpartum. What may this mean? | The mother may have blood loss or could be anxiety. |
| When a mother has high BP | could mean pre-clampsia |
| What happens to gastric system postpartum? | All ovarian hormones slow down gas system. ---Constipation is still prevelant-Mama may experience increase thirst, increase hunger- eventhough gas stops working. |
| What is the average wt loss for mom postpartum? | 20 pounds |
| Why would a mother feel like they got hit after labor? | This is due to how hard they worked during labor due to position changes and bearing down, etc. |
| What happens to the skin | It may change color during pregnancy, but will return to pre-pg state postpartum |
| When does breatmilk come in? | Usually on the 3 or 4th day post partum. |
| What steps does a mother take who chose not to breastfeed? | Pharmological intervention, don't expel milk, ice breasts, wear support bras, tylenol. Pain should subside after about 48 hours. |
| Is it normal to have a temp? If so when, how much and for how long? | Yes, it is normal to have a temp 24 hours after delivery. Typically, it's about 100.4 f. |
| What is not normal temp, for how long and how much post partum? | There is likely an infection if temp is increased over 100.4 over 48 hours. |
| Anticipatory phase | Who is goin to to what- this is the practice parenting phase. |
| Postpartum psychological after birth adaption phase | This phase referred as the honeymoon phase. It is a very sensitive, nurturing time for both mother and father. |
| T or F. Dad's hold baby's twice as much as moms? | True. Dad's carry baby into church, etc. |
| What activity increases dad's attachment to baby? | Participating in the delivery room. |
| Which medication does mom have to pump and dump breast milk. | Antibiotics go through the milk. Mom has to get rid of milk. Vicodin is okay...if any goes to milk...it is insignificant amounts. |
| List after birth pain | Severe cramp pains, muscle stops bleeding, distanded bladder, multiple gestations, if given pitocin to increase uterine contractions. |
| Why would moms need lubrication? | Because estrogen is decreased causing decrease in secretions. |
| What do you want to give mom postpartum who has a laceration or episiotomy? | You'll want them to put on ice in that area, heat or sitz batch are good, as well as a topical analgesic spray. |
| This intervention helps to strenghen perinium floor. | Kegel excercises |
| REEDA | Acronym for assessing redness, edema, ecamosis, drainage, aproximation of wound. |
| What do you assess after the first hour after delivery | You watch for hemorrhage |
| Mom is shivering post deliver, how do you treat and is this common. | Yes, this is common. Cover with blankets to comfort mother. |
| When do you take vs after first of postdelivery | Take BP every 15 minutes for the first hour. |
| Signs and symptoms of hemorrhage | dizzy, pale, faint, decreased BP. Hemorrhage is the greatest threat to the mom post delivery. |
| Name three major hemorrhage causes | Uterine atony, lacerations and mechanical delivery (i.e. forcep delivery) and retained placenta fragments also cause bleeding. |
| Pain interventions | ID problem and help them overcome it..i.e.:give pain meds, ice sore bottom and engorgement. |
| Discharge teaching | Don't lift anything heavy for at least 2 weeks, bathing is okay, sex is okay after approx 6 wks, normal to be sexually aroused from breast feeding. |
| Involution (pg 233) | The uterus returns to pre-prego size shape and location and the placenta site heals. |
| Is involution painful? | It is usually not painful for pimiparous women, but is painful for multiparous women who are breasfeeding. |
| After pains | Moderate to severe cramping related to uterus working hard to remain contracted as well as the increase of oxytocin in response to infant suckling. |
| What decreases postpartum hemorrhage? | When the uterus contract, it decreases the amount of blood loss. It is important that it is firm |
| Boggy uterus | Uterus is soft and suggests that the uterus has increase blood, leading to excessive blood loss....need to massage it or give oxytocin (as ordered by doc) to stimulate contractions. |
| Assessment for uterus location, pulse, blood pressure, respiratory rate, temperature | q 15 minutes for the 1st hour; q 30 min for the 2nd hour; q 4 hours for the next 22 hours; q shift for the first 24 hours. |
| Palpate uterus | Lay bed flat and make sure mama is in supine position; place hand just above the symphysis pubis and locate fundus with other hand (below or around the belly button) |
| Measure distance of fundus | Each finger breadth equals 1 cm. |
| What does uterus shifted to one side indicate | A distended bladder |
| What does a distended bladder do? | It interferes with uterine contractibility and places the woman at risk for excessive blood loss. |
| Expected finding of fundus 1 to 2 hours after birth? | It is midway between umbilicus and symphsis pubis and is firm and midline |
| Expected finding of fundus 12 hours after birth? | Fundus is located 1 cm above umbilicus and is firm and midline. |
| Expected finding of fundus 24 hours after birth? | It is located 1 cm below the umbilicus and is firm and midline. |
| Typically, how much does uterus descend each day? | 1 cm per day. |
| By what day should the uterus be back to its pre-prego state? | by day 10 the fundus should be descended into the pelvis and should not be palpable. |
| Endometrium | mucus membrane that lines the uterus- regenerates after birth through the process of necrosis. |
| Lochia | Bloody discharge from the uterus that contains sloughed off necrotic tissue from the endometrium- reflects the healing stage of the uterine placental site. |
| Assessing lochia- Scant | is less than 1 inch of pad |
| Assessing lochia- light | Less than 4 inch of pad |
| Assessing lochia- moderate | less than 6 inches of pad |
| assessing lochia- heavy | Pad is saturated within one hour after changing. |
| Is it normal to have small clots in lochia? | Yes, it's normal to have clots, but should be noted in the patients chart |
| When are clots not normal in lochia? | When they are large. Large clots interfere with uterine contractions. They should be weighed..10 grams = 10ml of blood loss. |
| Lochia Rubra | Expected day 1-3, bloody with small clots, moderate to scant amount, increased flow when standing, fleshy odor (not foul odor) |
| Locia Serosa | Expected from days 4-10. Pink or brown color, scant amount, increased flow during activity, fleshy odor. |
| Lochia Alba | Expected day 10. Yellow to white in color, scant amount, fleshy odor. |
| Normal fundus location after 2 days postpartum | About 2cm or 2 fingers below umbilical. |
| After pain teaching | Last up to 36 hours and is common with multiparous mama's |
| What increases after pains | Distended bladder- recommend mama to empty bladder, place warm blanket on ab, take advil, and follow relax techniques. |
| When should mama notify doctor | When there is a sudden increase of lochia, bright red bleeding after rubra stages and foul odor. |
| What can mama do to reduce the risk of infection? | Change peripad frequently because lochia is a medium for bacterial growth. |
| When assess in the vagina and perineum | Use REEDA: redness, edema, ecchymosis, discharge, approximation of edges of episiotomy or laceration. |
| Provide what type of comfort measures for vagina an perineum | Apply ice, encourage mama to lie on side to decrease pressure of perineum, tighten gluteal muscles as she sits down and relax when she is sitting; siztz baths 2x/day for 20 min; analgesics; use a topical anesthetic. |
| Primary engorgement | Happens 3rd day after birth to both nonfeeding and breastfeeding mama's. Throbbing pain in the breasts and should subside in 24-48 hrs. |
| subseqeunt breast engorgement | Related to distention of milk glands that is relieved by baby suckle or expressing milk. |
| mastitis | infection of the breast |
| colostrum | clear, yellow fluid, preceds milk production. Higher in protein and lower in carbs than breast milk. Contains IgA |
| Iga | found in colostrum/breatmilk and provides protection for newborn during the early weeks of life. |
| Patient education for non breast feeding mama's | Apply ice to breasts, not to express milk, avoid heat to the breasts, take analgesic for pain. |
| What is the average blood loss | 400 to 500 ml related to vaginal birthing experience. |
| When is there an increase cardiac output? | the first few postpartum hours related to blood that was shunted through the uteroplacental unit returning to the maternal system |
| When should cardiac output return to pre-prego levels | Within 48 hours. |
| WBC Levels within a few hours of birth | WBC may increase to 25,000/mm within a few hours and returns to normal within 7 days. |
| Clotting is a risk for how long | during pregnancy and should return to normal after 2 weeks postpartum levels. |
| Increased risk of Orthostatic Hypotension | Occurs hours following birth during the first 24 hours and will need assistance when ambulating. |
| Postpartum chills | cold and shaking following birth and is related to vascular instability. Offer a warm blanket |
| What does increase pulse rate mean? | Excessive blood loss |
| Temps elevated less than 100.4f during first 24 hours of birth | Hydrate the woman, promote relaxation and rest, reassess in hour after interventions. |
| Elevated temp over 100.4 (38c) | Hydrate and contact physcian |
| What is common with renal system | Bladder distention, incomplete emptying of bladder, and inability to void are common during the first few days of post birth. |
| Diuresis | caused by decrease estrogen and oxytocin levels and occurs within 12 hours post birth. It aids in elimination of excess tissue fluids. |
| Primary renal complications | distended bladder and cystitis |
| Nursing interventions for renal problems | If voiding less than 150ml, then palpate distended bladder. If no voiding after 12 hours post birth, then catheterize. |
| Signs of cystitis | Frequency, urgency and or burning on urination. |
| Best to void within how many hours after birth | within 6 hours...early voiding decrease risk of cystitis |
| What happens to the endocrine system? | Estrogen, progesterone, and prolactin levels decrease. However, estrogen levels rise after the first week postpartum. |
| Nnonlactating women | Prolactin level decline 3 postpartum weeks. Menses begin 6 to 10 weeks post birth. Ovulation occurs by the 4th cycle. |
| Lactating women | Prolactin levels increase in response to the infants suckling. Lactation suppresses menses. |
Created by:
Wends1984
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