Postpartum
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| How long is the postpartum period? | Six weeks
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| What does the acronym BUBBLE stand for when doing an assessment? | Breast, Uterus (fundus & flow), Bowel & GI function, Bladder function, Lochia (color, odor, consistency, and amount), Episiotomy (edema, ecchymosis, approximation)
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| What hormones fall in the blood levels following delivery? | Estrogen, progesterone, hCG, and hPL
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| When is it recommended for a postpartum patient to resume sexual activity? | Avoided until episiotomy is fully healed and lochia flow has stopped
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| What is involution? | Changes in the reproductive organs after birth to return them to pre-pregnancy size and condition
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| How long does it take for the uterus to return to the pre-pregnancy size? | 5-6 weeks
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| How long does it take for the placental site to fully heal? | 6-7 weeks
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| Where is the fundus felt immediately after delivery? | Midline, at or below umbilicus
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| What should the fundus feel like after delivery? | Firm, about the size of a grapefruit
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| After 24 hours, how does the fundus descend each day? | 1 cm (one fingers width)
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| How long after delivery should it take for the uterus to no longer be palpable? | 10 days
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| What interferes with uterine contraction because it pushes the fundus up and causes it to deviate to one side, usually to the right? | Bladder
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| What feels like intermittent contractions similar to menstrual cramps? | After pains
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| What is the cause of after pains during nursing? | Infant suckling causes the posterior pituitary to release oxytocin, a hormone that contracts the uterus
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| How often and what is assessed in the fundus after delivery? | Routine intervals for firmness, location, and position in relation to midline
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| What is red because it is composed mostly of blood and last approximately 3 days after birth? | Lochia rubra
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| What is pinkish because it is blood and mucus and last from about the third through tenth day after birth? | Lochia serosa
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| What is mostly mucus and is colorless or white, and last from the tenth to twenty-first day after birth? | Lochia alba
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| What has a fleshy or menstrual odor and should never have a foul odor? | Lochia
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| How is vaginal discharge determined after birth? | Peripads are counted or weighed
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| What is the weight configuration of a peripad? | 1 gram of weight = 1 mL volume of blood
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| How much is scant? | 2 inch stain (10 mL)
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| How much is light? | 4 inch stain (10-25 mL)
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| How much is moderate? | 6 inch stain (25-50 mL)
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| How much is large or heavy? | > 6 inch stain (50-80 mL) one pad saturated within 2 hours
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| What is considered excessive blood loss? | One pad saturated in 15 minutes or less or pooling of blood under buttocks
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| What do you report when assessing bleeding? | Excessive spurting or bright red blood from vagina, numerous large clots, foul smelling lochia with or without fever, lochia rubra that persist beyond third day, unusually heavy lochia flow, and lochia that returns to bright red after being serosa or alba
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| What can contribute to a constant trickle of bright red lochia? | Bleeding from lacerations of cervix or vagina
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| When do you apply cold packs to perineum? | Within the first 24 hours
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| When do you use sitz bath? | After the first 24 hours
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| What topical medications can be used on the perineum to reduce inflammation and numb? | Hydrocortisone, pramoxine (Epifoam), Americaine and Dermoplast
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| When does the menstrual cycle typically resume if the mother is not breastfeeding? | 6-8 weeks
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| What is delayed if breastfeeding; however, it can occur at anytime after birth making pregnancy possible? | Ovulation
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| When assessing episiotomy or any laceration, what does the acronym REEDA stand for? | Redness, edema, ecchymosis, discharge, approximation
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| When do the breast become firm and lumpy as blood flow increases and milk production begins? | By the third day
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| What can be a port of entry for microorganisms? | Cracks in nipples
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| What type of bra should a nursing or non nursing mother wear? | Firm supporting
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| How does a non nursing mother care for her breast? | Don't stimulate nipples, apply cold compresses (cold cabbage leaves)
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| What additional assessment is made with a mother who had a cesarean? | Abdominal dressing; assess for REEDA, temperature, increased pulse rate
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| What is the % of increase in blood volume in a pregnant woman? | 50%
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| How does the woman's body rid itself of the excess fluid volume after birth? | Diuresis (excess urine) 3000 mL/day and diaphoresis (profuse perspiration)
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| What are the hallmark signs of pulmonary embolism? | Dyspnea and tachypnea
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| What values may a woman's WBC raise to after delivery in response to inflammation, pain, and stress? | 12,000-20,000
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| When do WBC count return to normal? | 12 days postpartum
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| What is the treatment for tremors that resemble shivering or chills immediately after birth? | Cover with warm blankets
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| When are vitals taken after recovery period? | Every 4 hours x 24 hours.
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| How high can temperature rise in woman in the first 24 hours following delivery? | 100.4
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| What can lead to postpartum hemorrhage? | Full/distended bladder
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| What are the signs of a distended bladder postpartum? | Fundal height above umbilicus or baseline level, displaced from midline over to side, bladder bulges above symphysis pubis, excessive lochia, tenderness over bladder, frequent voiding <150mL
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| What are ways to help alleviate constipation? | Increase fluid and fiber intake, increase activity such as walking
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| What is the separation of the longitudinal abdominal muscles that extend from chest to symphysis pubis. (Usually resolved within 6 weeks) | Diastasis recti
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| When does hypermobility of the joints stabilize? | Within 6 weeks
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| What exercises can be done to help muscles after birth? | Abdominal tightening, head lift, pelvic tilt, and Kegel
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| When is the Rhogam shot given to the Rh- mother if the baby is Rh+? | Within 72 hours of delivery
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| If the mother does not have immunities to rubella, when is she vaccinated? | After delivery before she leaves the hospital
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| What are the postpartum blues (Baby blues)? | Conflicting feelings of joy and emotional letdown during first few weeks, self limiting, and normal/common feeling
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| What is postpartum depression? | Persistent mood of unhappiness, nonpsychotic depressive illness, occurs within 4 weeks after delivery, and may interfere with maternal-infant bonding
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| What are the signs and symptoms of postpartum depression? | Lack of enjoyment in life, disinterest in others, intense feelings of inadequacy, unworthiness, guilt, inability to cope, loss of mental concentration, disturbed sleep, constant fatigue and feelings of ill health
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| What are the risk factors for postpartum depression? | Inadequate social support, poor relationship with partner, life & childcare stress, low self-esteem, unplanned pregnancy
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| What is the treatment for postpartum depression? | Psychotherapy, increased social support, and possible antidepressant medications
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| What is postpartum psychosis? | Impaired sense of reality; less common than postpartum depression, can be fatal for mother & infant (infanticide & suicide)
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| What is the treatment for postpartum psychosis? | Psychiatric therapy including psychotropic medications
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| Why is taking psychotropic medications contraindicated for breastfeeding? | Pass through breast milk
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| When does early postpartum hemorrhage occur? | Within 24 hours
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| When does late postpartum hemorrhage occur? | Between 24 hours and 6 weeks
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| What is a major risk of postpartum hemorrhage? | Hypovolemic shock
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| How can you tell if a postpartum woman is experiencing hemorrhage? | Slow pulse rate; suspect hypovolemic shock or infection if the pulse rate is >100 beats/min
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| What are the signs and symptoms of postpartum hemorrhage? | Tachycardia, falling systolic BP, pale, cold & clammy skin, mental status changes, and decreased urinary output
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| What are the causes of early hemorrhage? | Uterine atony, lacerations/tears of reproductive tract, hematomas in reproductive tract, precipitous delivery, and magnesium during labor
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| What are the causes of late hemorrhage? | Retention of placental fragments, and subinvolution of uterus
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| What medications are considered uterine stimulants (contract uterus)? | Oxytocin IV, methylergonovine (Methergine) IM, and carboprost (Hemabate) deep IM
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| What medication can cause severe hypertension, stroke, and is contraindicated in patients with hypertension & preeclampsia? | methylergonovine (Methergine)
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| What medication can cause intense (explosive) diarrhea? | carboprost (Hemabate)
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| Why does anemia occur postpartum? | Due to hemorrhage due to loss of erythrocytes
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| What are signs & symptoms of PE? | Dyspnea, coughing, sudden chest pain, decrease LOC, diaphoresis
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| What is the patient teaching to prevent PE? | Don't cross legs, don't massage affected leg, avoid pressure in popliteal space behind knee, early ambulation, and antiembolic stockings
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| What are the danger signs of anticoagulant therapy? | Prolonged bleeding from minor injuries, nosebleeds, unexplained bruising
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| What is the patient teaching for anticoagulant therapy? | Use soft-bristled toothbrush, and stress the importance of completing follow up blood test
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| What is a puerperal infection? | An infection or septicemia after childbirth
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| What causes an increased risk for puerperal infection? | Cracks in nipples, surgical incision, tissue trauma during labor, open wound @ placental insertion site, retained placenta or clots, and increased pH of vagina after birth
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| What is the inflammation of the lining of the uterus and the most common cause of fever? | Endometritis
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| What is the best way to prevent infection from occurring? | Hand hygiene
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| What is an infection of the breast? | Mastitis
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| What are the signs and symptoms of mastitis? | Redness & heat in tissue, tenderness, edema & heaviness, purulent drainage, fever, chills, & other systemic signs of infection
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| What is the treatment for mastitis? | Antibiotics, mild analgesics, continue to breastfeed with unaffected breast, pump & dump milk from affected breast, massage area of inflammation to improve flow and reduces stasis
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| What is a slower than expected or failure of the uterus to return to its normal pre-pregnant condition? | Subinvolution
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| What are the signs and symptoms of subinvolution? | Fundal height greater than expected, persistence of lochia rubra, pelvic pain & heaviness, and fatigue
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| What do you report in subinvolution? | Abnormal pattern, fever, pain, persistent red lochia, and foul smelling vaginal discharge
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| When are postpartum follow ups scheduled? | 2 weeks and 6 weeks
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| What is the patient teaching for a postpartum patient when they go home? | Perineal care continued until lochia flow stops, douches & tampons should not be used until 6 week f/u, coitus should be avoided until the episiotomy is fully healed and lochia has stopped
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| What are the signs that the newborn is hungry? | Hand to mouth movements, mouth & tongue movements, suckling movements, rooting movements, clenched fist, kicking of legs, and crying (late sign)
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| What rises post delivery from the anterior pituitary gland an causes an increase in production of breast milk? | Prolactin
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| What is released from the posterior pituitary gland and causes milk to be delivered from alveoli (milk producing sacs) through the duct system to the nipple (let down reflex) | Oxytocin
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| What is a thin yellowish fluid rich in protective antibodies, secreted late in pregnancy and first few days after birth, provides protein, vitamin A & E; lower in calories than milk? | Colostrum
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| What is secreted 7-10 days after birth, has fewer immunoglobulin's and proteins but increased lactose, fat, and calorie count? | Transition milk
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| What is secreted by 14 days after birth, is bluish in color, and supplies all nutrients an infant needs (20kCal/oz)? | Mature milk
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| What are some advantages of breastfeeding? | Promotes mother-infant bonding, maintains infant temperature, and suckling stimulated oxytocin release to contract mother's uterus
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| What are some contraindications of breastfeeding? | Use of antimetabolites, antineoplastic drugs, or chloramphenicol; true galactosemia, and women with untreated active TB, HIV, active herpes zoster of breast, and drug/alcohol abuse
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| How do you know that an infant is latched on correctly? | As much of the areola is in the infants mouth as possible
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| If a woman starts a feeding on the right side, which side does she start the next feeding on? | Left side
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| How does a mother remove the infant from the breast? | Break the suction my placing finger in corner of infants mouth or indenting breast
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| What is the best way to treat sore nipples? | Apply small amount of breast milk and let air dry after feeding
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| How is the best way to determine intake of infant? | Infant nurses for 10-15 minutes / breast, 8-10 times per day; infant should have 6-8 weights per day and passes several stools per day
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| How often should a infant feed? | Every 2-3 hours
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| What is the best way to help with engorgement? | Encourage breastfeeding, pump to get milk flow started, and apply warm packs to relieve discomfort before feedings (cold packs between feedings)
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| How long can breast milk stay at room temperature before needing to be discarded? | Up to 4 hours
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| Where and how long can breast milk be stored? | Refrigerator - 24 hours, freezer 3 months, deep freezer 6 months
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| What is the best way to thaw breast milk? | Refrigerator, or warm water (do not microwave)
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| How many additional calories does a breastfeeding mother need to consume? | 500
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| How much should a breast feeding mother need to drink? | 2-3 L / day
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| When weaning, which feeding is eliminated first? | Daytime
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| What are the different types of formula? | Ready to feed, concentrated liquid, and powdered
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| What is important to remember when using formulas? | Overdilution or underdilution of concentrated liquid or powder can result in serious illness
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| How often is a formula infant fed? | Every 3-4 hours
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| What are the warning signs to report when taking oral contraceptives? | Severe abdominal pain, chest pain, dyspnea, bloody sputum, severe headache, weakness, numbness of extremities, eye problems (blurring, double vision), severe leg pain or swelling, and speech disturbance
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| When does a diaphragm must be refitted? | After each birth, weight change of 10 lbs. or more, and every 2 years
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| What position is eye to eye contact that helps with the bonding process? | En face
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| What refers to a strong emotional tie that forms soon after birth between parents and newborn? | Bonding
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| What refers to an affectionate tie that occurs over time as infant and caregivers interact? | Attachment
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| What signs require additional intervention from the nurse during maternal infant bonding? | Indifference to infants signal of hunger or discomfort, failure to identify infants communication, avoidance of eye contact with infant, discussing infant in negative terms, and continually finding excuses for not holding or caring for infant
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