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
OB Exam 2
OB chapter 16
| Question | Answer |
|---|---|
| Key Terms | Attachment Bonding En-Face Peribottle Sitz Bath Postpartum blues |
| attachment | formation of a relationship between a parent and a newborn through a process of physical and emotional interactions |
| bonding | close emotional attraction to a newborn by the parents that develops during the first 30 to 60 minutes after birth |
| en-face | a face-to-face orientation where a newborn or infant gazes directly at a parent's face |
| peribottle | a plastic squeeze bottle filled with warm tap water that is sprayed over the perineal area after each voiding and before applying a new perineal pad |
| sitz bath | room-temperature water to reduce local swelling, promote muscle relaxation, and promote comfort for an episiotomy, perineal trauma and other wounds, inflammation, hemorrhoids, and anorectal infections |
| postpartum blues | a phase of emotional lability characterized by crying episodes, irritability, anxiety, confusion, and sleep disorders |
| postpartum blues vs PPD | mother may laugh and cry but can still continue on caring for baby while PPD cannot |
| Postpartum Nursing Roles | Promote rest & recovery Assess physiologic adaptations Assess psychologic adaptations Prevent complications Educate & support parents with parenthood transition |
| as a mother baby nurse, you have 2 patients so | bundle the activities together |
| planning for discharge/ PP stay | Typical hospital stay is 48 hours May vary depending on facility, mode of delivery, health status / needs of mother and neonate. Postpartum – 4th trimester |
| Postpartum – 4th trimester | 3 months after delivery |
| when does discharge planning start | before arrival since the stays are already so short |
| risk factors for complications | Infection Hemorrhage Thromboembolism |
| infection | RoM increases risk for infection |
| when RoM ask, | when did it happen, if more than 24 hours before active labor then increased risk |
| sign of infection | musty smell/color of lochia |
| when there is infection, there will be | increased WBC GBS positive - if not known, PCP covers this because baby can acquire when delivered which can lead to respiratory infections |
| hemorrhage | uterine atony is associated |
| what amount qualifies as hemorrhage | more than 500cc |
| EBL and QBL | estimated blood loss quantitative blood loss |
| thromboembolism | increased clotting factors = increased risk for TE |
| increased clotting factors compensates for | blood loss |
| most important assessment postpartum | BUBBLEPET |
| nursing assessment timings: hour 1 PP low risk | Q 15 minutes |
| nursing assessment timings: hour 2 PP low risk | Q 30 minutes |
| nursing assessment timings: hour 3-24 PP low risk | Q 4 hours |
| nursing assessment timings: hour 24-72 PP low risk | Q 8 hours (q shift) |
| Nursing Assessments: temp | during the first 24 hours postpartum is within the normal range or a low-grade elevation up to 99°F (37.2°C) |
| why might temperature be slightly elevated | result of dehydration, sweating, or diaphoresis, systemic absorption of metabolites accumulated due to muscle contractions |
| Nursing Assessments: pulse | may be elevated for a few hours after a temperature above 99°F (37.2°C) at any time, or an abnormal temperature after the first 24 hours may indicate infection and must be reported |
| Pulse rates in mothers | 60 to 80 beats/min (bpm) are normal during the first week after birth, yet in the first few days, the pulse may be as low as 40 to 60 bpm (puerperal bradycardia) |
| what might tachycardia mean | anxiety, excitement, fatigue, pain, excessive blood loss or delayed hemorrhage, infection, or underlying cardiac problems |
| Nursing Assessments: respirations | should be within the normal range of 12 to 20 breaths/min at rest |
| Any change in respiratory rate out of the normal range might indicate | pulmonary edema, atelectasis (a side effect of epidural anesthesia), or pulmonary embolism (PE) |
| Nursing Assessments: blood pressure immediately after childbirth | the BP should remain the same as during labor |
| increase in BP could indicate | gestational hypertension, while a decrease could indicate dehydration, shock, orthostatic hypotension, or a side effect of epidural anesthesia |
| Postpartum onset of preeclampsia | may occur from 2 days to 6 weeks following birth, and investigation is necessary if the BP is higher than 140/90 mm Hg |
| what is a common problem regarding BP | orthostatic hypotensions |
| Nursing Assessment: Postpartum Lab work | Hemoglobin & Hematocrit Urinalysis (potentially) - frequency of voiding Rubella status Rh status (if unknown) Newborn cord blood (if mother Rh-) |
| Rubella status - if not immune | give vaccine to mother unless allergic to eggs |
| Rh status (if unknown) Newborn cord blood (if mother Rh-) | Coombs test if mom is negative and baby is positive |
| BUBBLEPET: B | breasts |
| BUBBLEPET: U | uterus |
| BUBBLEPET: B | bowel |
| BUBBLEPET: B | bladder |
| BUBBLEPET: L | lochia |
| BUBBLEPET: E | extremities |
| BUBBLEPET: P | perineum |
| BUBBLEPET: E | emotional needs |
| BUBBLEPET: T | teaching |
| Nursing Assessment: danger signs | Fever Foul-smelling lochia or discharge Severe headaches / blurred vision Calf pain Sudden weight gain Feeling faint, dizzy, or weak Rapid heart rate Dysuria, burning, incomplete emptying Depression, extreme mood swings |
| fever | first 24hrs may be > 100.4°F (38°C) but then should go down and if not tell PCP |
| Foul-smelling lochia or discharge indicates | infection of endometrial lining |
| Severe headaches / blurred vision | observe for preeclampsia |
| Calf pain | TE! observe for different calf sizes |
| Dysuria, burning, incomplete emptying | aka about burning or inability to pee any blood in urine? |
| if mom doesn't void within | 6 hours then there is a problem |
| Depression, extreme mood swings | CVA gently, not diagnostic but may suggest kidney |
| breasts | Size, shape - snt, not red, ask before touching Nipples - cracks, redness, fissures, or bleeding, and note whether they are erect, flat, or inverted Complications |
| Engorged breasts are | hard, tender, and taut |
| uterus | Fundal assessment -- for location and softness Normal findings: fundus should be midline and should feel firm Abnormal / Variations: boggy or relaxed uterus is a sign of uterine atony |
| uterine atony can be the result of | bladder distention, which displaces the uterus upward and to the right, or retained placental fragments |
| uterus is not palpable by | day 10-14 |
| if uterus is tilted to the right, | means the bladder is full so ask them to void |
| uterus should descend | 1 cm/fingerbreadth a day |
| lochia | definite musky scent |
| Foul-smelling lochia and large clots suggests | Foul-smelling lochia suggest an infection, and large clots suggest poor uterine involution, necessitating additional intervention |
| Lochia flow will increase when | the patient gets out of bed (lochia pools in the vagina and the uterus while the patient is lying down) and when they breastfeed (oxytocin release causes uterine contractions) |
| Urge the patient to notify their health care provider if lochia rubra returns because this could indicate | subinvolution or that the patient is too active and needs to rest more |
| bowl/bladder | muted bowel sounds initially voiding |
| About 2 to 3 days following childbirth, | usual bowel elimination returns |
| Considerable diuresis | begins within 12 hours after childbirth and continues for several days, up to 2 weeks |
| Postpartum urinary retention | inability to empty the bladder within 6 hours after a vaginal birth |
| Patients who received regional anesthesia during labor are at risk for | urinary tract infections due to continuous urinary catheterization to prevent urinary retention during labor |
| patients and voiding | they often don't have bowel movements before discharge because they haven't eaten, hormones and spinal/epidural |
| Extremities | bilateral comparison for edema, pain, redness |
| During pregnancy, the state of hypercoagulability protects | the birthing parent against excessive blood loss during childbirth and placental separation |
| hypercoagulable state can increase the risk of | thromboembolic disorders during pregnancy and postpartum |
| emotional status | mood / adjustment bonding / attachment |
| Urinary retention as a result of | decreased bladder tone and emptying can lead to urinary tract infections and postpartum hemorrhage |
| lochia assessment | Amount - QBL Composition Odor |
| interventions of lochia | QBL monitor VS & I/Os massage fundus empty bladder prepare for uterotonics r/o lacerations |
| call PCP if patient soaks | more than 1 pad per hour |
| perineum findings | WNL – edematous & slightly bruised Lacerations – check repair Abnormal: |
| The normal episiotomy site should not have | redness, discharge, or edema |
| First-degree laceration | involves only skin and superficial structures above muscle |
| Second-degree laceration | extends through perineal muscles |
| Third-degree laceration | extends through the anal sphincter muscle |
| Fourth-degree laceration | continues through anterior rectal wall |
| interventions for perineum | Ice can be applied to relieve discomfort and reduce edema; sitz baths also can promote comfort and perineal healing |
| bonding (first) | Unidirectional Close emotional attraction to baby Develops 30-60 minutes after birth Vital to attachment “getting acquainted” |
| attachment (later on) | Reciprocal or 2 way interaction En Face (face to face) position Development of strong affection between infant and significant other Bonding is vital to attachment process |
| Nursing Management in Postpartum – pt 1 | promote comfort assist with elimination promote activity, rest and exercise prevent stress incontinence assist with self care meaures ensure safety |
| Nursing Management in Postpartum – pt 2 | counsel about sexuality and contraception promote nutrition support feeding method promote family adjustment and wellbeing prepare for discharge |
| promoting comfort - Pharmacologic | Afterpains - Ibuprofen/Naproxen Perineal trauma- antiseptic or anesthetic ointment or spray Opioids – reserved for severe pain not relieved by other means – used sparingly and with education |
| promoting comfort - Nonpharmacologic | Afterpains - heating pad; prone positioning Perineal trauma - ice pack; sitz bath Nipple soreness - correct latch; nipple cream Engorgement - ice; cabbage leaves; hand expression |
| Stress incontinence | Involuntary leakage of urine |
| Pelvic muscle trauma from | vaginal delivery disrupts fascia and damages muscles/nerves |
| risk of Stress incontinence increases with | number of births |
| first line treatment of stress incontinence | pelvic floor muscle exercises (Kegel exercises) |
| Childbirth can lead to changes in | sexual function due to physical, psychological, and contextual factors |
| Sexuality & Contraception | Gradually resume activity, but full recovery may take up to 6 months. No set timeline for resuming sex after childbirth; it depends on individual comfort levels and healing –different than past |
| promote nutrition | lactating vs non lactating |
| Breast-Feeding is recommended by | the American Academy of Pediatrics for the first 6 months of life |
| breast feeding | The Baby-Friendly Hospital Initiative promotes breastfeeding through ten steps immediate skin-to-skin contact, staff education, support for parents |
| Contraindications for breast feeding | infant galactosemia, maternal HIV or HTLV infection, active untreated tuberculosis, and certain illicit drugs or medications, chemo |
| Bottle-Feeding (formula) | Support and respect this decision Type of formula Amount to feed Prep & storage guidelines |
| Breast Care for Breastfeeding & Bottle-Feeding Parents | Wear a supportive bra Watch for & manage engorgement Breastfeeding: frequent feedings, manual expression, and breast massage |
| Bottle-feeding | self-limiting; use ice packs, wear a supportive bra, and avoid breast stimulation |
| Positive signs of parenteral attachment | en face position |
| Select appropriate interventions | early contact (e.g., skin to skin!) extended contact (e.g., rooming in) communication through touch, eye contact, voice, scent) |
| Promote Family Well-Being & Adjustment: Sibling Adaptations | Reactions vary and are influenced by developmental age Parent’s attitude towards the chance sets the stage Sibling rivalry is common Adjustment takes time and requires parenteral interventions |
| Positive behaviors from siblings include | showing an interest in baby or concern for wellbeing |
| Prepare for Discharge: Talk about the postpartum blues | d/t a sharp fall in hormones Period of emotional lability |
| Check discharge criteria | No signs of infection Bleeding controlled Infant is ok’d by pedi Education complete Family/support available |
| Rubella | For non-immune clients (titers < 1:8) Informed consent No pregnancy for at least 28 days after vaccine |
| Rhogam | If infant is Rh+ Give within 72 hours – IM injection Informed Consent Protects fetus of transfer |
| Tdap & Flu | d/t increased pertussis and risk to newborn Informed consent |
| Adolescents | self-image, roles, future Increased risk for PPD, poor partner relations, and child abuse/neglect social support is VITAL but often lacking |
| Midlife Parenting | Well-established in careers and routines = parenthood transition challenging Aging = difficulty parenting Realistic expectations are important |
| Sexual & Gender Minority Couples | Face different challengers than heteronormative couples (lack of social or family support, public ignorance, legal barriers) Misunderstood Complex-decision making involved in reproductive technologies |
Created by:
leh195