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wvc ob postpartum

wvc ob postpartum winter 2011

Postpartum Period (when, AKA) When: First 6 weeks after the birth of an infant. AKA: Puerperium
A progressive change of the Postpartum Period Initiation of Lactation
Involution Changes that the reproductive organs (particularly the uterus) undergo after childbirth to return to their nonpregnant size and condition.
3 Processes of Involution 1. Contraction of muscle fibers 2. Catabolism 3. Regeneration of uterine epithelium.
Contraction during involution occurs when and what When: immediately after delivery of the placenta What: uterine muscle fibers contract firmly around maternal blood vessels at area where placenta was attached to control bleeding, uterus becomes smaller after being stretched for many months.
Catabolism during involution occurs how? Enlarged uterine muscle cells are reduced in size by catabolic changes in protein cytoplasm.
Regeneration of uterine epithelial lining begins when and how? When: soon after childbirth. How: the decidua seperates into two layers within 2-3 days, the first/superficial layer is shed in lochia and the second basal layer remains to provide the source of the new endometrium.
Regeneration of the endometrium except at the site of the placental attachement occurs how long after birth? Placental Attachment? 16 days after birth. Approx 6 weeks.
Location of uterine fundus helps determine…? Location just after childbirth? 12 hours after? 2nd day? ...whether involution is progressing normally. Midway between the symphysis pubis and the umbilicus. Ascends to the umbilicus. Begins descending 1 cm a day.
Weight of uterus: at birth, within 1 week of birth, at 6 weeks? 2.2 lb, 1 lb, 2 oz.
Afterpains: what, who affected the most and why? How long do they last? Intermittent contractions after giving birth that cause pain. Multipara women affected most because repeated stretching of muscle fibers leads to a loss of muscle tone. Up to 48 hours.
Nursing Intervention for afterpains(2)? Special Consideration? 1. Analgesics 2. Prone position with small pillow under abdomen. Medication should be taken just before breast feeding: will take 30 minutes to reach the breast milk.
Lochia rubra: what, when? Bloody vaginal discharge that occurs for the first 3 days after childbirth.
Lochia serosa: what, when, other componenets (4)? Pink/pinkish brown vaginal discharge that begins around 4 days after childbirth. 1. Serous exudate 2. Erythrocytes 3. Leukocytes 4. Cervical mucus
Lochia alba: what, when? White, cream-colored, or light yellow vaginal discharge that begins around the 11th day and is present usually until the 3rd week but may persist until the 6th week.
Measuring the amount of lochia Stain on the perineal pad in one hours. Scant: less than a 2.5cm stain. Light: 2.5 – 10 cm stain. Moderate 10 – 15cm stain. Heavy: saturated perineal pad in 1 hour. Excessive: saturated peripad in 15 minutes.
The postpartum cervix Formless, flabby, and open wide immediately after birth. Healing occurs rapidly. The internal opening closes to original shape but the external opening remains more open.
Postpartum vagina regains close to original shape in…? 6 – 10 weeks.
Episiotomy Surgical incision of the perineum to enlarge the vaginal opening, can be very painful.
Postpartum cardiac output? Increases due to addition of uteroplacental blood into central circulation, decreased pressure from the pregnant uterus onto the vessels, and excess extracellular fluid being added to the vascular compartment.
Timeline for postpartum cardiac output? Rise in output peaks 10 -15 mins after birth. Falls to pre-labor levels within an hour but remains elevated for 48 hours after birth. Bradycardia (50-50 bpm) present during early post partum period. Returns to normal level in 6 – 12 weeks.
Postparutm excretion of excess plasma via (2)? Diuresis and diaphoreses.
Postpartum blood values (2)? 1. Leukocytosis due to eleveated WBC count during labor and immediate postpartum period, falls to normal within 6 days. 2. Hematocrit levels drop following remobiliazation and rapid excretion of excess body fluid.
Pospartum coagulant levels? Remain eleveated for several days, return to normal nonpregnant levels within 4 – 6 weeks.
Postpartum GI conditions (3)? 1. Increased hunger 2. Increased thirst 3. Constipation (first stool usually occurs within 2-3 days, normal patterns resume 8 to 14 days after birth.
Postpartum Urinary Conditions (3)? 1. Risk for overdistention/incomplete emptying of the bladdr, and retention of residual urine. 2. UTI risk 3. Postpartum hemorrhage
Postpartum and the Musculotskeletal system? Muscle aches and fatigue common 1-2 days after birth.
Postpartum Period and the Integumentary System (4)? 1. Hyperpigmentation of skin decrease rapidly after birth. 2. Melasma (mask of pregnancy) and linea nigra fades. 3. Striae garvidarum (stretch marks) fade. 4. Hair loss occurs at 4 to 20 weeks.
Postpartum Period and the Endocrine System? Fairly rapid decline in placental hormone levels (estrogen, progesterone, human placental lactogen). Human chorionic gonadotropin may remain for several weeks.
Resumption of menses/ovulation during postpartum period? 7-9 weeks for non-nursing mother and 8 weeks to 18 months for lactating mothers.
Lactation during the post partum period: timeline, hormones (2)? Milk production begins within 2 -3 days after childbirth. Prolactin initiates milk production, and oxytocin is necessary for milk ejection.
Weight loss during childbirth? 10 – 13 lbs.
Most women gain prepregnancy weight….? About 6 months after childbirth, but retain an average of 2.2 lbs with each pregnancy.
Postpartum assessments begin…? During the fourth stage of child labor, about 1-2 hours after childbirth.
Rho(D) Immune Globulin administered to who, when, wand why? Administered to the mother, if the mother is Rh negative and the newborn is Rh positive, within 72 hours after childbirth, prevents the development of maternal antibodies that would affect subsequent pregnancies.
Rubella Vaccine: what, why, precaution? Administered to the mother after childbirth if she is not immune to rubella, to prevent her from acquiring rubella during subsequent pregnancies which can cause fetal abnormalities, cannot get pregnant within 28 days of immunization.
Focused assessment for vaginal delivery includes these 7 facets. 1.Vital Signs 2.Fundus 3.Lochia 4.Perineum 5.Bladder Elimination 6.Breasts 7.Lower extremities
Postpartum BP? Usually falls 15 – 20 mmHg after birth, mother at Risk for Injury due to orthostatic hypotension.
Postpartun Pulse? 60-90 bpm (though 50-60 may occur) due to increase in central blood supply; tachycardia requires additional assessments to rule out excessive bleeding.
Postpartum Temp? A temp of up to 100.4 deg F is common during the first 24 hours after childbirth.
Normal findings of postpartum fundus assessment? Firmly contracted at or near the level of the umbilicus near the midline (above the expected level or shift from the midline may indicate distended bladder and should be reassessed after bladder has been emptied.
If fundus is difficult to locate or is soft or boggy: what, how? What: fundus should be massaged to stimulate uterine contraction. How: non dominant hand supports/anchors lower uterine segment and dominant hand massages uterus until firm. Once firm, press firmly to expel clots.
Why does the nurse support/anchor the lower uterine segment? To prevent uterine inversion when massage/clot expulsion begins.
3 elements of lochia that are assessed? Amount, color, odor.
Four lochia related scenarios that indicate possible complications and what are they? 1.Constant trickle or dribble of lochia: excessive bleeding. 2.Excessive lochia in the prescence of a contracted uterus: lacerations of the birth canal. 3. Foul Odor: endometrial infection. 4. Absence of lochia: infection.
Acronym listing the five signs to assess following a episiotomy of the perineum and what are they? REEDA: Redness, Edema, Ecchymosis, Discharge, Approximation.
6 signs of a distended bladder? 1. Location of fundus above baseline level when bladder is empty. 2. Fundus displaced from midline. 3. Excessive lochia. 4. Bladder discomfort. 5. Bulge from bladder above symphysis. 6. Frequent voiding of less than 150 mL of urine.
4 facets of postpartum breast assessment? 1. Size, symmetry, shape, skin condition.
Lower extremity postpartum assessment: looking for signs of, signs/symtoms are, how assessed? Looking for signs of thrombophlebitis: redness, heat, edema, tenderness, examination and palpation of pedal pulses.
Positive Homans Sign? Negative Homans sign? Discomfort in the calf with sharp dorsiflexion of the foot. No discomfort.
Immediate postpartum period? First 24 hours.
Early postpartum period? 1st week.
Late postpartum period? 2nd to 6th week.
3 indications for postpartum catheterization? 1.Unable to void. 2.Amount voided is less than 150 mL. 3.Fundus is elevated and displaced from the midline.
Amount of water a postpartum mother should be encouraged to drink per day? 2500mL
Measure to prevent thrombophlebitis? Encourage ambulation shortly after childbirth.
Usual length of stay following a caesarean birth? 3-4 days.
Important assessment facet of the pain-releived post caeseran mother? Respiration rate, depth, and sounds.
5 ways to prevent abdominal distention in the post caeseran mother? 1.Avoid carbonated beverages 2.Tightening and relieving the abs 3. Simethicone 4. Rectal suppositories 5. Pelvic lifts
Common postpartum nurse-client teaching topics? The process of involution, self-care, how to promote rest and sleep, nutrition, regular bowel elimination, good body mechanics, sexual activity, instructions on follow-up appointments, signs/sym that should be reported,
Postpartum self care education topics? Handwashing, breast care for lactating moms, lactation suppression, care of caeseran incision, perineal care, Kegel exercises.
Kegel exercises? Exercises that strengthen the muscles that surround the urinary meatus and vagina to prevent loss of muscle tone and decrease the risk of urinary incontinence.
Definiton of bonding? Development of a strong emotional tie of a parent to a newborn.
What is the postpartum “sensitive period”? The first 30-60 minutes following birth.
Definition of attachment and timeframe? Development of a strong affectional ties as a result of interaction between an infant and a significant other. Begins in pregnancy and extends for many months after birth.
Fingertipping? First tactile(touch) experience between mother and newborn. The mother explores the infants body with her fingertips only.
The 3 postpartum puerperal phases and what occurs in each? 1.Taking-in: mother passively accepts care/comfort/details about the newborn. 2. Taking-hold: mother assumes control of her own care & initiates care of the infant. 3. Letting-go: involves relinquishing previous roles & assuming a new parent role.
5 criteria for discharge of a new mother? 1.No complications, assessments are normal. 2.Pertinent lab data reviewed, Rho(D) administerd. 3.Mother educated and instructed in postpartum care. 4.Mother exhibits readiness to care for infant. 5. Support available for mom.
Caloric needs of the full term newborn? 45-50 kcal/lb of body weight per day.
Calories in 1 oz of breastmilk/formula? 20kcal/oz.
Newborns and birth weight? Will lose 10% of birth weight during first few days of birth, will regain lost weight by 2 weeks of age.
Fluid needs of the newborn: first 2 days, end of 1st week? 18-27 mL/lb, 45-68 mL/lb.
Colosturm: what, when, composition, benefits? What: thick yellow substance that is the major excretion of the brest during pregnancy and the first 7-10 days after birth. High in protein, fat soluble vitamins/minerals and immunoglobulins. Helps establish normal flora and is a laxative.
Transitional Milk: when, difference compared to colostrums? Appears as milk changes from colostrum to mature milk. Decreased content of immunoglobulins and protein than colostrums. Increased content of lactose, fat, and calories.
Mature Milk: when, color, caloric composition? Appears approximately 2 weeks after birth, bluish, 20kcal/oz.
Ratio of proteins in mature milk and why? Higher ratio of whey to casein because the curd of whey is smaller and easier to digest than the curd of casein.
Major carbohydrate of mature milk and what does it do(2)? Lactose. 1. Improves absorption of calcium. 2. Provides energy for brain growth.
% of calories in breast milk provided by fat? Half (50%).
3 vitamins found in high content in breast milk? Vitamin that is not found in high amounts? A, E, and C are found in high amounts. Breast milk is low in Vit D, supplements may be necessary.
Casein in breast milk interferes with? Iron absorption.
2 enzymes found in milk and what do they do? 1.Pancreatic amylase: digests carbs. 2.Lipase: increases fat digestion.
4 substances in breast milk that help prevent infection in the infant? 1.Bifidus factor 2.Lysozymes 3.Lactoferrin 4.Immunoglobulins.
What effects do the maternal diet have on breast milk? The levels of water soluble vitamins.
Special needs formulas (3) and who needs them? 1.Soy: allergies, galactosemia, lactase deficiency. 2.Hydrolyzed: more universally tolerated. 3.Concentrated: pre-term infant.
Timelines for breast milk delivery? Only breast milk for the first 6 months. Breastfeeding should continue for the first 12 months with the addition of solids at 6 months.
How long should a mother wait to introduce a formula combination to infants and why? 3-4 weeks of age. So that lactation can be well established before decrease in feeding frequency thus milk production occurs.
Mothers should avoid what on their nipples and why? The mother should avoid soap on her nipples to prevent removal of the natural protective oils from the Montgomery tubercles of the breasts.
Two types of nipples that may cause breastfeeding difficulties? 1. Inverted 2. Flat
3 types of milk filled breasts and their appearance/qualities? 1. Soft: feel like a cheek. 2. Filling: slightly firmer. 3. Engorged: hard, tender, with taut shiny skin.
Scoring tool for breastfeeding assessment? LATCH scoring tool.
What is at the center of nursing interventions for breastfeeding? Teaching/education.
Two hand positions for breast feeding and the preferred method? C-grip and V-grip. C-grip is preferred.
Frequency of infant breast feedings? Every 2-3 hours.
Length of breast feedings? 10-15 minutes on each side.
Foremilk? The watery first milk that quenches the infant’s thirst.
Hindmilk? The later milk that is richer in fat, more satisfying, and leads to weight gain.
6 common causes of decreased milk supply? 1.Formula use 2.Inadequate rest/diet 3.Use of caffeine 4.Use of alcohol 5.Use of medications 6.Smoking by parents or in the home.
6 Infant problems related to breastfeeding? 1.Nipple confusion 2.Sleepy Infant 3.Suckling Problems 4.Prematurity 5.Illness/Congenital effects 6.Jaundice
4 common maternal breast problems? 1.Engorgement 2.Nipple Trauma 3.Flat/Inverted Nipples 4.Plugged ducts
Do drugs/meds transfer to breast milk? YES
6 conditions in which breastfeeding should be avoided? 1.Active tuberculosis 2.HIV Infection 3.Galactosemia 4.Mother in chemotherapy 5.Maternal drug abuse 6.Unsafe med/drug use by mother.
2 methods of milk expression? 1. Hand Expression. 2. Use of a breast pump.
When should a mother who cannot breast feed begin using a breast pump? within 24 hours after birth.
How long can breast milk be refrigerated? 48 hours.
How should breat milk be stored? In a glass or plastic container with a tight cap, refrigerated or frozen.
When is the right time to wean a child of breast milk/feeding? There is no right time, though is weaned before 12 months of age an iron fortified formula should be used rather than cow’s milk.
3 types of milk formulas? 1.Ready to use 2.Concentrated liquid 3.Powdered
Cautions for formula feeding? Sterile water and aseptic technique should be used in its preparation, formula should never be heated in a microwave, the bottle should not be propped, infants should not be coaxed into finishing all of the formula once disinterest is noted.
Created by: wvc