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Maternal Child PP

Maternal/child Postpartum Nursing

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
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***
Created by: Kyn269