GRCC PN 135 postpartum
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| What term is used in reference to the 6 week period following childbirth? | Postpartum
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| What is a goal and the number one nursing diagnosis for postpartum care? | Prevent Hemorrhage (For whatever reason uterus isn't attaching)
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| Report hemorrhage or hematomas from lacerations to physician | Goal for post partum care
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| Increase bladder capacity, but decrease ability to hold it | Common renal issue postpartum
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| List other goals for postpartum care | -To meet fluid/nutritional needs-Prevent bladder distention-Help mother integrate experience-Report any abnormalities (i.e. bleeding, convulsions)-Facilitate both parent/child interaction-provide mother comfort
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| List postpartum care related to renal | -want to keep bladder empty-May not have sensation due to swelling and bruises.-Void at least 200 ml within first six hours.
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| When checking fundus, and you can't feel it then what can you ask the mom do? | Ask mom if she feels like she can empty her bladder, and then recheck it again.
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| It is not unusual to have brady cardia for the first 24-48 hrs post partum? T or F? | True.
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| Mom has tachycardia 24 to 48 hours postpartum. What may this mean? | The mother may have blood loss or could be anxiety.
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| When a mother has high BP | could mean pre-clampsia
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| What happens to gastric system postpartum? | All ovarian hormones slow down gas system. ---Constipation is still prevelant-Mama may experience increase thirst, increase hunger- eventhough gas stops working.
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| What is the average wt loss for mom postpartum? | 20 pounds
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| Why would a mother feel like they got hit after labor? | This is due to how hard they worked during labor due to position changes and bearing down, etc.
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| What happens to the skin | It may change color during pregnancy, but will return to pre-pg state postpartum
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| When does breatmilk come in? | Usually on the 3 or 4th day post partum.
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| What steps does a mother take who chose not to breastfeed? | Pharmological intervention, don't expel milk, ice breasts, wear support bras, tylenol. Pain should subside after about 48 hours.
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| Is it normal to have a temp? If so when, how much and for how long? | Yes, it is normal to have a temp 24 hours after delivery. Typically, it's about 100.4 f.
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| What is not normal temp, for how long and how much post partum? | There is likely an infection if temp is increased over 100.4 over 48 hours.
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| Anticipatory phase | Who is goin to to what- this is the practice parenting phase.
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| Postpartum psychological after birth adaption phase | This phase referred as the honeymoon phase. It is a very sensitive, nurturing time for both mother and father.
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| T or F. Dad's hold baby's twice as much as moms? | True. Dad's carry baby into church, etc.
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| What activity increases dad's attachment to baby? | Participating in the delivery room.
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| Which medication does mom have to pump and dump breast milk. | Antibiotics go through the milk. Mom has to get rid of milk. Vicodin is okay...if any goes to milk...it is insignificant amounts.
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| List after birth pain | Severe cramp pains, muscle stops bleeding, distanded bladder, multiple gestations, if given pitocin to increase uterine contractions.
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| Why would moms need lubrication? | Because estrogen is decreased causing decrease in secretions.
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| What do you want to give mom postpartum who has a laceration or episiotomy? | You'll want them to put on ice in that area, heat or sitz batch are good, as well as a topical analgesic spray.
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| This intervention helps to strenghen perinium floor. | Kegel excercises
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| REEDA | Acronym for assessing redness, edema, ecamosis, drainage, aproximation of wound.
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| What do you assess after the first hour after delivery | You watch for hemorrhage
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| Mom is shivering post deliver, how do you treat and is this common. | Yes, this is common. Cover with blankets to comfort mother.
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| When do you take vs after first of postdelivery | Take BP every 15 minutes for the first hour.
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| Signs and symptoms of hemorrhage | dizzy, pale, faint, decreased BP. Hemorrhage is the greatest threat to the mom post delivery.
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| Name three major hemorrhage causes | Uterine atony, lacerations and mechanical delivery (i.e. forcep delivery) and retained placenta fragments also cause bleeding.
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| Pain interventions | ID problem and help them overcome it..i.e.:give pain meds, ice sore bottom and engorgement.
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| Discharge teaching | Don't lift anything heavy for at least 2 weeks, bathing is okay, sex is okay after approx 6 wks, normal to be sexually aroused from breast feeding.
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| Involution (pg 233) | The uterus returns to pre-prego size shape and location and the placenta site heals.
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| Is involution painful? | It is usually not painful for pimiparous women, but is painful for multiparous women who are breasfeeding.
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| After pains | Moderate to severe cramping related to uterus working hard to remain contracted as well as the increase of oxytocin in response to infant suckling.
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| What decreases postpartum hemorrhage? | When the uterus contract, it decreases the amount of blood loss. It is important that it is firm
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| Boggy uterus | Uterus is soft and suggests that the uterus has increase blood, leading to excessive blood loss....need to massage it or give oxytocin (as ordered by doc) to stimulate contractions.
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| Assessment for uterus location, pulse, blood pressure, respiratory rate, temperature | q 15 minutes for the 1st hour; q 30 min for the 2nd hour; q 4 hours for the next 22 hours; q shift for the first 24 hours.
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| Palpate uterus | Lay bed flat and make sure mama is in supine position; place hand just above the symphysis pubis and locate fundus with other hand (below or around the belly button)
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| Measure distance of fundus | Each finger breadth equals 1 cm.
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| What does uterus shifted to one side indicate | A distended bladder
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| What does a distended bladder do? | It interferes with uterine contractibility and places the woman at risk for excessive blood loss.
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| Expected finding of fundus 1 to 2 hours after birth? | It is midway between umbilicus and symphsis pubis and is firm and midline
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| Expected finding of fundus 12 hours after birth? | Fundus is located 1 cm above umbilicus and is firm and midline.
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| Expected finding of fundus 24 hours after birth? | It is located 1 cm below the umbilicus and is firm and midline.
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| Typically, how much does uterus descend each day? | 1 cm per day.
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| By what day should the uterus be back to its pre-prego state? | by day 10 the fundus should be descended into the pelvis and should not be palpable.
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| Endometrium | mucus membrane that lines the uterus- regenerates after birth through the process of necrosis.
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| Lochia | Bloody discharge from the uterus that contains sloughed off necrotic tissue from the endometrium- reflects the healing stage of the uterine placental site.
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| Assessing lochia- Scant | is less than 1 inch of pad
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| Assessing lochia- light | Less than 4 inch of pad
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| Assessing lochia- moderate | less than 6 inches of pad
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| assessing lochia- heavy | Pad is saturated within one hour after changing.
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| Is it normal to have small clots in lochia? | Yes, it's normal to have clots, but should be noted in the patients chart
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| When are clots not normal in lochia? | When they are large. Large clots interfere with uterine contractions. They should be weighed..10 grams = 10ml of blood loss.
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| Lochia Rubra | Expected day 1-3, bloody with small clots, moderate to scant amount, increased flow when standing, fleshy odor (not foul odor)
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| Locia Serosa | Expected from days 4-10. Pink or brown color, scant amount, increased flow during activity, fleshy odor.
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| Lochia Alba | Expected day 10. Yellow to white in color, scant amount, fleshy odor.
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| Normal fundus location after 2 days postpartum | About 2cm or 2 fingers below umbilical.
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| After pain teaching | Last up to 36 hours and is common with multiparous mama's
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| What increases after pains | Distended bladder- recommend mama to empty bladder, place warm blanket on ab, take advil, and follow relax techniques.
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| When should mama notify doctor | When there is a sudden increase of lochia, bright red bleeding after rubra stages and foul odor.
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| What can mama do to reduce the risk of infection? | Change peripad frequently because lochia is a medium for bacterial growth.
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| When assess in the vagina and perineum | Use REEDA: redness, edema, ecchymosis, discharge, approximation of edges of episiotomy or laceration.
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| Provide what type of comfort measures for vagina an perineum | Apply ice, encourage mama to lie on side to decrease pressure of perineum, tighten gluteal muscles as she sits down and relax when she is sitting; siztz baths 2x/day for 20 min; analgesics; use a topical anesthetic.
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| Primary engorgement | Happens 3rd day after birth to both nonfeeding and breastfeeding mama's. Throbbing pain in the breasts and should subside in 24-48 hrs.
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| subseqeunt breast engorgement | Related to distention of milk glands that is relieved by baby suckle or expressing milk.
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| mastitis | infection of the breast
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| colostrum | clear, yellow fluid, preceds milk production. Higher in protein and lower in carbs than breast milk. Contains IgA
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| Iga | found in colostrum/breatmilk and provides protection for newborn during the early weeks of life.
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| Patient education for non breast feeding mama's | Apply ice to breasts, not to express milk, avoid heat to the breasts, take analgesic for pain.
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| What is the average blood loss | 400 to 500 ml related to vaginal birthing experience.
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| When is there an increase cardiac output? | the first few postpartum hours related to blood that was shunted through the uteroplacental unit returning to the maternal system
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| When should cardiac output return to pre-prego levels | Within 48 hours.
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| WBC Levels within a few hours of birth | WBC may increase to 25,000/mm within a few hours and returns to normal within 7 days.
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| Clotting is a risk for how long | during pregnancy and should return to normal after 2 weeks postpartum levels.
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| Increased risk of Orthostatic Hypotension | Occurs hours following birth during the first 24 hours and will need assistance when ambulating.
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| Postpartum chills | cold and shaking following birth and is related to vascular instability. Offer a warm blanket
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| What does increase pulse rate mean? | Excessive blood loss
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| Temps elevated less than 100.4f during first 24 hours of birth | Hydrate the woman, promote relaxation and rest, reassess in hour after interventions.
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| Elevated temp over 100.4 (38c) | Hydrate and contact physcian
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| What is common with renal system | Bladder distention, incomplete emptying of bladder, and inability to void are common during the first few days of post birth.
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| Diuresis | caused by decrease estrogen and oxytocin levels and occurs within 12 hours post birth. It aids in elimination of excess tissue fluids.
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| Primary renal complications | distended bladder and cystitis
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| Nursing interventions for renal problems | If voiding less than 150ml, then palpate distended bladder. If no voiding after 12 hours post birth, then catheterize.
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| Signs of cystitis | Frequency, urgency and or burning on urination.
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| Best to void within how many hours after birth | within 6 hours...early voiding decrease risk of cystitis
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| What happens to the endocrine system? | Estrogen, progesterone, and prolactin levels decrease. However, estrogen levels rise after the first week postpartum.
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| Nnonlactating women | Prolactin level decline 3 postpartum weeks. Menses begin 6 to 10 weeks post birth. Ovulation occurs by the 4th cycle.
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| Lactating women | Prolactin levels increase in response to the infants suckling. Lactation suppresses menses.
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