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Maternal Child PP
Maternal/child Postpartum Nursing
| Question | Answer |
|---|---|
| 1. Postpartum nurse provides care that focuses on what? | Transition to parenting |
| 2. Woman’s physiologic recovery | |
| 3. Physiologic wellbeing | |
| 4. Needs of other family members includes: | strategies in plan of care to assist family in adjusting to baby |
| 5. Who should the nurse be concerned with other than the mother | those who will be around the baby i.e. other family members, friends, significant others and their response to the new baby |
| 6. Transfer from recovery, what happens in the traditional setting | woman is moved to PP room after recovery |
| 7. Transfer from recovery, what happens in LDRP setting | woman and infant remain together where both occurred |
| 8. Post anesthesia recovery – when should the woman be discharged from recovery? | regardless of obstetric status NO woman should be discharged from recovery area until completely recovered from anesthesia |
| 9. Transfer from recovery area (table 21-1 – p534) | |
| 10. Who are report given to and what information is given? | |
| 11. Discharge pre-24 // post 48- what are some of the terms used for decreasing length of stay of mothers and newborns after low birth risk? | early postpartum discharge; shortened hospital stay; 1-day maternity stay |
| 12. Laws relating to discharge – what does the newborns’ and mothers’ Health Protection act of 1996 refer to? | vaginal delivery 48 hours and C-section 96 hours stay in the hospital |
| 13. What are the criteria for early discharge- before 24 hours? | the woman as recovered and is able to take care of herself and her newborn |
| 14. Criteria for early discharge – what happens if the mother is discharged before her condition is stable? | the Nurse and provider are still legally responsible |
| 15. couplet or mother – baby care | - |
| 16. infant security | |
| 17. prevention of excessive bleeding | |
| 18. maintenance of uterine tone; | |
| 19. prevention of bladder distention ; | |
| 20. estimate blood loss on pad (21-2 figure) | |
| 21. Prevention of infection | |
| 22. Promotion of comfort | |
| 23. Nonpharmacologic interventions – same as in labor | |
| 24. Pharmacologic interventions | |
| 25. Promotion of rest | fatigue common |
| 26. Promotion of ambulation | early and frequently |
| 27. Promotion of exercises | start with kegel |
| 28. Promotion of nutrition | continue Prenatal vitamins and FE(iron) ~6 weeks post-partum |
| 29. Promotion of normal bladder function | 150 mL per void |
| 30. Promotion of normal bowel function | fiber, fluid, ambulation |
| 31. Promotion of breast feeding | |
| 32. Suppression of lactation | |
| 33. Rubella vaccination | if woman is not immune vaccine is recommended; can give to breast feeding mother; must use contraception for one month |
| 34. Rh isoimmunization | Rh immunoglobulin should be given within 72 hours for Rh negative woman who delivers and Rh + Positive infant |
| 35. Cultural / religious concern with Rh immunoglobulin | some consider this a blood product and will refuse |
| 36. Maternal assessment should include | impact of birth experience; maternal self-image; adaptation to parenthood and parent infant interactions; family y structure and functioning; impact of cultural diversity; |
| 37. Plan of care and implementation | (box 21-5) |
| 38. Discharge teaching- | |
| 39. Sexual activity/ contraception | |
| 40. Prescribed medications | |
| 41. Routine mother and baby checkups | |
| 42. Dealing with activities of daily living at home | |
| 43. Dealing with visitors | |
| 44. Follow-up after discharge | |
| 45. Home visits | should occur shortly after birth to bridge early discharge |
| 46. Telephone follow-up | may use instead of home visits |
| 47. Warm lines- | help line of consultation service |
| 48. Support groups | for sharing and support |
| 49. Referral to community resources | nurse needs to know family needs and availability of community resources |
| 50. Postpartum care is modeled on what | concept of health |
| 51. Cultural beliefs and practices affect | patients response to puerperium |
| 52. Nursing plan of care includes | assessment to detect deviations from normal; comfort measure to relieve discomfort or/and pain; safety measure- prevent injury/infection |
| 53. Teaching/counseling | to promote woman’s own feeling of competence in self and baby care |
| 54. Common nursing interventions include | eval/treat boggy uterus & full bladder; pharmacy & non-pharmacy relief of pain/discomfort associated w/episiotomy/lacerations ; measures to promote/suppress lactation |
| 55. Meeting psychosocial needs of new mothers involves : | planning care that considers composition and function of entire family |
| 56. Early postpartum discharge will continue to be trend as a result of | consumer demand; medical necessity ; discharge criteria for low risk childbirth; cost-containment measures |
| 57. Effective means to prevent crisis and facilitate physiologic and Psychologic adjustments in combination include: | early discharge classes; telephone follow-up; home visits; warm lines; support groups |
| 58. Post-partum physiologic adaptations | |
| 59. Involution of uterus | return of the uterus to a non-pregnant state following birth |
| 60. Atrophy of uterine cells | |
| 61. Decidua- shed? What is it called? | Lochia |
| 62. What is the basal layer | |
| 63. 1st layer shed | |
| 64. 2nd layer – new endometrium | |
| 65. Time process | three weeks |
| 66. Factors to enhance uterine involution | uncomplicated L & D ; complete expulsion of products of conception; breast feeding ; early ambulation |
| 67. Uncomplicated L&D | |
| 68. Complete expulsion of products of conception include what | |
| 69. Early ambulation | prevents stasis and blood clotting |
| 70. Involution of placental site | |
| 71. Placental site | |
| 72. Large blood vessels | clotted blood, absorbed |
| 73. Some vessels obliterated | |
| 74. New smaller vessels form | |
| 75. Time of process | 6-8 weeks |
| 76. Site heals by exfoliation | |
| 77. Changes in fundal position | |
| 78. Placenta expelled- between umbilicus & symphysis pubis | |
| 79. The fundal rises to the umbilicus- midline approximately when | within 6-12 hours after birth |
| 80. What should the fundus feel like | **contracted (firm-large grapefruit ) **relaxed (boggy) |
| 81. What is the concern with a boggy fundus, and what should be done | Hemorrhage- massage to promote contractions which will help the fundus firm up |
| 82. What is the approximate daily descent of the fundus | 1 cm./day |
| 83. Lochia is classified by what | appearance and contents |
| 84. What is rubra and how long does it last | Dark red discharge and lasts approximately 2-3 days (it may have some cellular tissues) |
| 85. What is Serosa and how long does it lasts- | pinkish – brown discharge lasting 3-10 days (placental site wound healing) |
| 86. What is Alba and how long does it last | yellowish discharge lasting 1-2 weeks if Not breastfeeding, can last up to 6 weeks when breast feeding (contractions caused by breastfeeding disrupt the wound site ) |
| 87. What type of odor should be associated with a normal discharge | stale, musty , not offensive |
| 88. When do cervical changes occur | immediately after birth it should feel spongy and formless |
| 89. What natural process reduces the risk for infection of the cervix, what other things can be done to reduce the risk of infection | outflow of excess product reduces the risk of infection, client should also be taught to wipe front to back; proper perineal care and regular changing of the pad |
| 90. How long does it generally take the cervix to return to original form | a few hours |
| 91. When is the shape of the external os changed? Is the change permanent? Describe the pre and post shape | the shape of the os is changes after the first birth- It is a permanent change and it goes from being ___________________ to being _____________________ |
| 92. When does the cervix close? | when the Lochia ceases, (the placental wound site has healed) the cervix will then close |
| 93. When can a patient begin using tampons after birth? | ONLY AFTER the cervix is closed, it is recommended that nothing be placed inside the vagina/cervix until it has completely closed |
| 94. Vaginal changes –what does the vaginal area look like after child birth | bruised, edematous and no rugae (folds) |
| 95. Does the rugae (folds) return and if no when, if not why? | returns generally about 3 weeks in non-lactating women Lactating women may have pale or no rugae |
| 96. When does the vaginal area begin to decrease in size? Normal – nonlactating women in about 6 weeks | |
| 97. What is Kegal’s | and exercise for tone and contractibility – done by cutting the flow of urine mid-stream (or curling toes around a pencil) |
| 98. Perineal changes - | is expected to have some bruising and be edematous – the labia can also be bruised |
| 99. What is the episiotomy | approximated? |
| 100. Lacerations 1st degree | |
| 101. Lacerations 2 degree | |
| 102. Lacerations 3rd degree | |
| 103. Lacerations 4th degree | |
| 104. What should the abdomen look like | stretched , loose, flabby |
| 105. When should a new mother regain her shape | 2-3 months- exercise can help |
| 106. What is striae – what is the difference between a light vs. dark skinned person | stretch marks – light skin fades to silver or white color, darker skin – darker than surrounding skin |
| 107. Gastrointestinal system – | |
| 108. Hunger and thirst | |
| 109. Decreased peristalsis-is influenced by | hormones |
| 110. What fears may be related to incisional pain and what nursing intervention could be used | clients can become constipated by fear of hurting at the incisional site, stool softeners as prescribed, push fluids and juices with high fiber intake |
| 111. C-section delivery - | clients will have more flatulence- encourage early ambulation, stool softer increase fiber /fluids enema may be necessary |
| 112. Significant change in the Urinary tract after birth - | bladder capacity becomes increased, bruising and edema around the urethra may cause painful urination |
| 113. Why would you encourage the client to void after birth (and post removal of catheters) | the client has a decreased sensitivity to bladder filling |
| 114. What is the average postpartal diuresis amount in 12-24 hours | 2000-3000 mL |
| 115. Why would you stop at 100 mL on a direct catheter? | to prevent bladder spasms |
| 116. Hematuria can be masked by what | lochia |
| 117. Urine specimens can often be contaminated by | lochia Discharge |
| 118. Why do we not want to cath a client? | because we are introducing organisms from the outside of the body to a sterile inside |
| 119. What is the most common cause of low grade fever (<100.4) in a postpartum woman) | slight temp elevations are common due to exertion during labor and dehydration – this is treated by replenishing fluids |
| 120. Blood pressure of a postpartum female | would be stable or slightly decreased |
| 121. Pulse of a postpartum female | Bradycardia is common as the pulse slows down to get rid of volume |
| 122. If the postpartum woman is tachycardia | this is a sign of hemorrhage and the source must be identified |
| 123. Postpartum chill | happens immediately after delivery and is Neurologic, and vasomotor changes |
| 124. Blood values- is it normal to have increased leukocytes | yes- the body is fighting infection and microorganisms |
| 125. What is normal vaginal delivery blood loss | 250-500 mL |
| 126. What is normal C-section delivery blood loss | 7009100 mL |
| 127. Who determines the estimated blood loss during delivery? | this is estimated by the primary health care provider |
| 128. What is normal by the end of the post-partum period | |
| 129. Weight loss initially is what and why | 10-12 lbs. Initially (fetus /placenta) and 5 lbs. diuresis (water) normal weight returns when |
| 130. Maternal comfort and well-being | |
| 131. Monitor the uterine status | |
| 132. Fundus | |
| 133. Umbilical -0 | 1 cm down per postpartum day |
| 134. Status firm /boggy | firm – proper contraction Boggy- Hemorrhage |
| 135. Perineal discomfort | |
| 136. Use of ice pack | to reduce swelling and provide comfort from edema |
| 137. Proper cleansing procedure | clean from front to back to decrease transmission of microorganisms |
| 138. Sitz bath | |
| 139. Topical anesthetics | epi foam – witch hazel pads |
| 140. Self-care | promoting self-care is essential for the mothers wellbeing after discharge , hand hygiene |
| 141. Hemorrhoids | |
| 142. After pains – | |
| 143. Primipara | not felt as strong- Breast feeding may feel a little stronger |
| 144. Multipara | 2nd (+) child- pains are stronger due to weakened muscles – more relaxation and stronger contractions |
| 145. Medication | is given to suppress pains (generally same as used in labor) |
| 146. Breastfeeding | the release of oxytocin stimulates uterus contraction – stronger pains are felt during and shortly after breast feeding |
| 147. Suppression of lactations | non breast feeding mothers – no stimulation of breast, binding of breast, use of ice packs for edema , Cabbage leaf for engorgement |
| 148. Rest and activity - | promote bed rest based on pts., needs |
| 149. Resumption of activity | |
| 150. Postpartum exercises | |
| 151. Resumption of sexual activity | |
| 152. Contraception | |
| 153. Foley - | client needs to void within 4 hours of removal; if not client may need to be straight cathed |
| 154. PCA pump | |
| 155. Epidural PCA | |
| 156. Early ambulation | |
| 157. Wound care | only the health care provide removes the dressing, the nurse is responsible for marking and measuring any drainage by circle date and time on the bandage , always assess vital signs |
| 158. Assistance with infant | |
| 159. Nutrition | diet as tolerated- monitors clients bowels – anesthesia, analgesics, NSAIDs, or other meds- stool softeners may be necessary (only given with doctors’ orders) |
| 160. Nursing care for the adolescent patient | assist with new born bonding – the younger the mother is – an older adult female member generally takes over care- you must promote bonding between the mother and the new born |
| 161. Treatment of young mothers | they must be treated as adults , self-care , and child care teaching is essential |
| 162. Postpartum psychological changes postpartum blues- | normal occurrence – pain , disturbed sleep; emotional imbalance; insecurity |
| 163. Postpartum psychological changes infant bonding | |
| 164. ATI BONDING CHAPTER | |
| 165. Family and infant bonding | |
| 166. Maternal newborn bonding | assess pos(+) behaviors—considers infant family member; hold infant face-to-face(en-face);view infant behavior positive; identifie unique characteristics; maintain close contact; provide physical care; respond to infant cries; smile,talk,sing to infant |
| 167. Assess negative behaviors | apathy when infant cries; disgust at infants body excretions; expresses disappointments; turns away from infant; does not seek close contact; handles infant roughly; ignores infant entirely |
| 168. Assess mother for indications of depression | feeling of being down; feeling of inadequacy; anxiety related to breastfeeding; emotional labiality with frequent crying; flat affect, withdrawn; feeling unable to care for infant |
| 169. Interventions to assist bonding: | provide quiet, private environment ; facilitate bonding process-place infant skin to skin, en face; give freq praise, support, reassurance; encourage to express fears, anxiety, feelings |
| 170. Assess Paternal adaptation | does father hold, touch, maintain eye contact; look for physical similarities; talk, sing to infant |
| 171. How long should transition to fatherhood take | process takes several weeks- * expectations- preconceived ideas; * reality- feel sad, frustrated, jealous or embraces need to be actively involved; * Mastery – actively involved in care |
| 172. Development of father – infant bond involves what | * commitment- takes responsibility of parenting; * connected- feelings of attachment ; * room for infant- modifies life to include care of infant |
| 173. Paternal adaptation nursing interventions | *assess for bonding * provide edu when father present * provide guidance, involve as full partner * encourage verbalization of concerns, expectations |
| 174. Sibling adaptation – assess for | positive responses; interest, concern, increased self-independence |
| 175. Assess for adverse responses | signs of rivalry , jealousy ; regression in toileting, sleeping habits; aggression towards infant; attention seeking behaviors , whining |
| 176. Sibling adaptation nursing interventions - | provide tour of maternity unit; |
| 177. encourage parental behavior/sibling adaptation | sibling one of first to see infant; gift from infant; one parent care for infant, other parent with sibling; allow siblings to help with care; preschooler doll to care for |
| 178. impaired parenting | detachment, |
| 179. Nursing interventions for impaired parenting | continued assessment; encourage support of grandparents; family members; home visits and group discussions; info on support groups |
| 180. Recognize postpartum physical adaptations | |
| 181. Describe nursing assessment during the postpartum period | |
| 182. Develop a plan of care for the postpartum client | |
| 183. Describe psychosocial and maternal adjustment during postpartum period | |
| 184. Recognize postpartum disorders | |
| 185. Describe nursing assessment for postpartum disorders | |
| 186. Develop a plan of care for a client with postpartum disorder | |
| 187. Recognize postpartum infections | |
| 188. Describe nursing assessment for postpartum infections | |
| 189. Develop a plan of care for the client with a postpartum infection | |
| 190. Describe nursing assessment for postpartum depression | |
| 191. Recognize postpartum depression | |
| 192. Develop a plan of care for the client with postpartum depression | |
| 193. Post-partum complications | |
| 194. Deep vein thrombosis risk factors | pregnancy; immobility; obesity; smoking ; C-section; multiparty; age 35+ ; DM |
| 195. DVT Assessment | Pt. – leg pain; swelling, warmth, redness; warm extremity; calf tenderness; cough, tachycardia; |
| 196. DVT- cough/tachycardia is most significant why? | both are indicators of pulmonary embolism |
| 197. DVT Dx Procedures | Doppler ultrasound scanning; CAT. MRI |
| 198. DVT Prevention/ Pt. education | early/ freq ambulation; avoid prolonged standing, sitting, immobility; elevate legs when sitting; do not cross legs; fluid intake 2-3 L /day; No smoking; anti-embolic hose (SCDs) |
| 199. DVT_ Nursing interventions | encourage client to rest; elevate extremity/ No pillow under knees ; warm compress-intermittent , continuous; Do Not massage affected extremity ; this high antiembolism stocking; analgesics- NSAIDs; anticoagulants |
| 200. DVT Medications_ | |
| 201. Heparin | * IV 5-7 days/ adjust based on PTT – antidote is Protamine sulfate |
| 202. Warfarin | Oral 3 months; Monitor PT and PTT; Phytonadione available for prolonged clotting times ; antidote Vitamin K (green leafy veg’s) |
| 203. DVT client education | avoid ASA, ibuprophen; electric shavers; avoid ETOH; brush teeth gently; avoid rubbing, massaging legs; avoid prolonged sitting/crossing legs |
| 204. Postpartum hemorrhage risk factors | uterine atony; admin of mag sulfate; lacerations/hematoma ; inversion of uterus; sub involution of uterus; retained placental fragments; coagulopathies (DIC) |
| 205. Postpartum hemorrhage nursing interventions | monitor VS; assess for source of bleeding; fundus; lochia; signs from lacerations, episiotomies, hematomas |
| 206. Assess for bladder distention | |
| 207. Maintain IV fluids | |
| 208. Provide oxygen | |
| 209. Elevate legs to increase venous return | |
| 210. Postpartum medications * | |
| 211. Oxytocin | |
| 212. Methylergonovine (methergine) Not for hypertension | |
| 213. Misoprostol (cytotec) | |
| 214. Carboprost tromethamine (Hemabate) | |
| 215. Monitor and assess for | monitor for adverse reactions; assess uterine tone, vaginal bleeding |
| 216. Uterine atony – what can cause this | Retained placental fragments ; Over distention of uterine muscle ; Prolonged labor ; Oxytocin augmentation , induction ;Precipitate labor ;Mag sulfate administration ;Anesthesia, analgesia administration ;Trauma during labor, birth |
| 217. Uterine atony interventions: | ensure bladder is empty; monitor; express clots; monitor VS; Maintain IV fluids; Provide Oxygen; Administer medications |
| 218. Sub involution of the uterus risk factors | Endometrioses (MOST COMMON) ; pelvic inflammation |
| 219. Nursing interventions; | monitor fundus, lochia; encourage breast-feeding, ambulation, voiding |
| 220. Administer medications | Pitocin, antibiotics |
| 221. Inversion of uterus risk factors | retained placenta; uterine atony; excessive fundal pressure; extreme traction to umbilical cord (pulled placenta – pulled uterine out) ; adherent placental tissue ; multiparty ( overstressed) fibroid tumors |
| 222. Inversion of uterus | |
| 223. Complete | |
| 224. Partial | |
| 225. Replace uterus | |
| 226. Nursing interventions | assess for inverted uterus, maintain IV fluids; admin Oxygen ; D?C Pitocin, admin terbutaline (Pitocin must be stopped before administering terbutaline) |
| 227. Inversion of uterus following replacement | observe close; assess hemodynamics; avoid aggressive fundal massage; administer oxytocic’s, antibiotics, (prophylactic tx) Client education ( c-birth with subsequent pregnancies) |
| 228. Retained placenta risk factors | partial separation of placenta; entrapment of placenta; excessive traction on cord prior to placental separation (breaking/leaving pieces) adherent placental tissue; COMMON IN PRETERM BIRTHS 20-24 WEEKS) |
| 229. Retained placenta nursing interventions | assess for uterine atony, sub involution, inversion; monitor fundus, lochia , VS; maintain IV fluids; admin oxygen; admin Pitocin(contractions) /terbutaline (relaxation) ; possible surgery- D&C , hysterectomy |
| 230. Lacerations and or hematomas risk factors | operative vaginal birth- forceps, suction, CPD (big Head); macrocosmic infant, abnormal presentation; prolonged pressure on vaginal mucosa, scarring of vagina- infections, injury, surgery, Nullipara, light skinned, reddish hair |
| 231. Lacerations and or hematomas assess | vaginal bleeding, is the uterus firm or contracted; continuous slow bleed- bright red; sever rectal, perineal pain, pressure |
| 232. Nursing interventions | attempt to identify the source, use Ice packs (edema) sitz bath, pain meds (as prescribed) May require surgical intervention |
| 233. Infections- what is the most common and what S/S are present | Endometrtis- most common, uterine tenderness, Lochia-profuse, odor, bloody; fever; tachycardia |
| 234. Wound types, what do we assess? | Lacerations and episiotomies , assess REEDA, fever , pain |
| 235. Cesarean wound Risk and Rx | risk- emergency C-section, assess REEDA; Rx- identify microorganism; antibiotics; wound tx , treat of sx |
| 236. Mastitis risk factors | milk stasis-(blocked ducts) ; cracked nipples; poor breast feeding techniques; decrease in breastfeeding – supplementation; poor hygiene (inadequate hand washing) |
| 237. Nursing interventions for mastitis | assess reddened areas , enlarged nodes; encourage hand hygiene; proper feeding positions; ice pack/warm pack; rest, analgesic, increased fluids; well-fitting bra; admin antibiotics, teach importance of completion of therapy |
| 238. UTI risk factors | hypotonic bladder; epidural anesthesia; Catherization; freq pelvic exam; genital tract injuries; Hx of UTI; C-birth |
| 239. UTI nursing interventions | Assess for UTI; obtain urine sample; admin antibiotics; teach proper perineal hygiene; encourage increased fluid intake ; recommend cranberry juice (increases acid in urine to help flush microorganisms) |
| 240. Postpartum blues/ depression risk factors | hormonal changes; physical discomfort/pain; socioeconomic factors; decreased support system; anxiety new role as mother; unplanned/unwanted pregnancy; Hx prev depressive episodes; low self-esteem; Hx domestic violence |
| 241. Postpartum blues assessment | sadness; lack of appetite; sleep pattern disturbance; feelings of inadequacies; intense mood swings; crying |
| 242. Postpartum depression assessment | feeling of guilt and inadequacy; irritability; anxiety; persistent fatigue; feeling of loss; lack of appetite; sadness, mood swings, sleep disturbance |
| 243. Postpartum depression signs and symptoms | crying; weight loss; flat effect; postpartum psychosis (hallucinations, delusional thoughts of self-harm or harming the infant) |
| 244. Postpartum depression nursing interventions | interactions mother-infant; client’s mood /affect; encourage communication of feelings; compliance w/med therapy; sched f/u visit at home; sleep when infant sleeps; take time out for self |
| 245. Cesarean delivery | nursing care, Foley, PCA pump, epidural PCA , early ambulation, wound care, assistance w/ infant, nutrition |
| 246. Adolescent mother | nursing care – adolescent pt. ; assist w/ pt.- newborn bonding; treat as adult; teach self-care |
| 247. Postpartum complications risk factors | c-delivery; prolonged ROM; Prolonged labor; Bladder cath; hemorrhage; mastitis; URI ; UTI; thrombophlebitis; hematoma, abscess formation, endometritis; perineal cellulitis ***Maintain fowlers position*** |
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Kyn269
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