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Flashcards in 1229 Exam 4 Postpartum Deck (68):
1

postpartum

(puerperium) begins after the delivery of the placenta and ends when the body returns to the prepregnant state. (aprox. 6 weeks)

2

physiological maternal changes during postpartum:

uterine involution
lochia flow
cervical involution
decrease in vaginal distention
changes in ovarian function and menstration
breast changes
urinary tract changes
GI tract changes
cardiovascular changes

3

Physical Risk during the postpartum period:

hemorrhage
shock
infection
constipation
fatigue
UTI
Thrombophlebitis

4

Hormone released from the pituitary gland, coordinates and strengthens uterine contractions

Oxytocin

5

A firm and contracted uterus prevents what?

bleeding and hemorrhage

6

afterpains

uncomfortable uterine pains during postpartum

7

Decreased estrogen is associated with:

breast engorgement
diaphoresis
diuresis
diminished vaginal lubrication

8

focused physical assessment:

breast
uterus (fundal height, uterine placement and consistency)
bowel and GI function
bladder function
lochia (color, odor, consistency, and amount)
episiotomy (edema, ecchymosis, approximation)
vitals and pain
teaching needs

9

fudus immediately after delivery

firm, midline with the umbilicus, and approximately at the level of the umbilicus

10

fudus 12 hours postpartum

1 cm above umbilicus midline and firm

11

fundus every 24 hours postpartum

should descend approx. 1 to 2 cm (finger breaths)

12

fundus by day six

should be half way between the symphysis pubis and he umbilicus

13

fundus by day ten

should lie within the true pelvis and should not be palpable.

14

uterine involution

uterus returns to its prepregnant state. (aprox 1000g to 60g)

15

locating the fundus

1. explain procedure to pt.
2. wears gloves
3. cup non dominant hand just about the symphysis pubis to support the lower segment of the uterus
4. with dominant hand, palpate the pt's abdoomen to locate.
(usually start a few inches above umbilicus)
*document fundal height, location, and uterine consistency

16

Lochia stages

lochia ruba, lochia serosa, lochia alba

17

bright red color, bloody consistency, fleshy odor, may contain small clots, transient flow increases during breastfeeding and upon rising last 1 to 3 days after deliver

lochia ruba

18

pinkish brown color and serosanguineous consistency. last from approximately day 4 -10 after delivery.

lochia serosa

19

yellowish, white creamy color, fleshy odor. lasts from approximately day 11 up to and beyond 6 weeks postpartum.

lochia alba

20

< 2.5 cm of blood

scant

21

< 10 cm of blood

light

22

> 10 cm of blood

moderate

23

one pad saturated within 2 hours

heavy

24

one pad saturated in fifteen mins or less/ pooling of blood under buttocks

excessive blood loss

25

excessive spurting of bright red blood from the vagina

possibly indicating a cervical or vaginal tear

26

numerous large clots and excessive blood loss

hemorrhage

27

fould odor

infection

28

persistent lochia ruba in the early postpartum period beyond day three:

retained placental fragments

29

continued flow of lochia serosa or alba beyond the normal length of time (esp. if it is accompanied by a fever, pain, or abdominal tenderness)

endometritis

30

Nursing interventions for perineal tenderness, laceration, and episotomy:

promote measures for the client to help to soften her stools
educate the client about proper cleansing to prevent infection
promote comfort measures

31

educate the client about proper cleansing to prevent infection:

wash hands before/after voiding
pt should use a squeeze bottle filled with warm water after each voiding to cleanse the area
pt should clean perineal area from front to back
pt should blot dry, not wipe
pt should sparingly use topical cream or spray
pt perineal pad should be changed from the front to the back.

32

Comfort measures:

apply ice packs to the clients perineum for the first 24-48 hours to reduce swelling
encourage sitz bath twice daily
administer analgesia
opioid analgesia
topical anestehetics

33

Sitz bath (remember everyone is different)

gather materials and apply gloves.
clamp tubing of bag.
add warm water to both bag and bowl of sitz bath.
raise toilet lid, and place bowl
hang bag above toilet (IV pole or hanger)
insert tubing into bowl (make sure tubing is right side up)
slowly unclamp tubing.
**usually takes about 15-20 mins

34

Fundal Massage

massage if fundus is boggy.
can cause a temporary increase in the amount of vaginal bleeding seen as pooled blood leaves the uterus
very uncomfortable procedure

35

Homan's sign and postpartum

(I couldn't find anything in the book, but I learned at clinical)
Homan's sign is important for C-section patients. (just like any other surgery patient)

36

peri colace

stool softener/ laxitive

37

stadol

pain medication

38

rhogam

rh negative mothers with rh positive babies ( given 72 hours after delivery)

39

mylicon

gas relief

40

dilaudid

pain

41

toradol

pain

42

percocet

pain

43

Psycholsocial risk:

depression
altered family processes
disturbance in body image/self-esteem
role conflict
altered sexuality patterns

44

Report from L&D nurse will include:

OBGYN (provider)
Age
gravida, para
anesthetic
labor induced
type of birth and repair
Rh status
feeding
abnormalities
bonding
group B strep status
rubella
iv fluids
sex/wt of the infant
description of the fundus, lochia, bladder, and perineum

45

Vital signs

check q15 mins first hour, q30 mins second hour
bp up slightly first hour
pulse increased first few hours
temp may go up to 100.4 first 24 hours
respirations remain normal
assessments done twice a day until discharge

46

uterine involution

take 4-6 weeks
occurs by decrease in size of the muscle cells
should be firm and midline

47

cervix

soft immediately after birth
within 2 to 3 postpartum days it has shortened, become firm, and regained form

48

urinary incontinence higher in

women who have given birth
increased parity
increased age

49

evaluation of episiotomy healing

redness
edema
ecchymosis
discharge, drainage
approximation

50

examining the perineum

ask woman to lie in the Sim's position
wear nonsterile gloves
make sure there is good lighting
gently lift the buttocks to expose the perineum and anus

51

breastfeeding

before lactation a yellowish fluid, colostrum, can be expressed from nipples
tenderness may persist for 48 hours after start of lactation

52

nonbreastfeeding

engorgement resolves spontaneoulsy and discomfort decreases within 24-36 hours
breast binder or tight bra, ice packs, or mild analgesics may be used to relieve discomfort

53

length of stay

48 hours after uncomplicated vaginal
72-96 hours after uncomplicated c-section

54

hemorrhage

500mL or greater in vaginal
1000mL or greater in C-section

55

uterine atony

lack of tone
treatment: massage fundus, increase pitocin, make sure bladder empty

**If uterus fails to respond to oxytocin: ERGOTRATE, METHERGINE, CARBOPROST TROMETHAMINE

56

Other causes of hemorrhage

retained placental fragments: Tx: D&C
cervical or vaginal tear: Tx: surgical repair
Inversion of uterus
subinvolution of the uterus
hemorrhagic shock-- EMERGENCY

57

orthostatic hypotension

occurs in first 48 hours, due to sudden changes in blood circulation
many faint
*assist first one or two times up out of bed
1st shower must be assisted

58

SVT (Superficial venous thrombosis)

swelling, redness, tenderness, warmth, pain or asymptomatic

Tx: analgesia, elevation of ext., TEDS

59

DVT (Deep venous thrombosis)

same as SVT plus, pedal edema, + homans sign, extr cool, pale, decreased pedal pushes

TX; anticoagulant therapy, bedrest, and analgesia

60

Pulmonary Embolism

S&S: DVT, abdominal pains, chest pain, dyspnea, tachypnea, hypotension

Nursing care: elevate the head of the bed, administer oxygen, apply pulse oxymetry, IV fluids, initiation of heparin, bed rest, frequent VS

61

Nutritional aspects

usually very thirsty and hungry after delivery

vaginal delivery-regular diet
c-section- asses bowel sounds, clear liquids and progress

62

Taking In

1 to 2 days after delivery
mother is passive and somewhat dependent as she sorts reality from fantasy in birth experience
food and sleep are major needs

63

taking hold

2 to 3 days after delivery
mother ready to resume control over her life
she is focused on baby and may need reassurance

64

postpartum blues and depression S&S

cry easily
lose appetite
insomnia
feel anxious
begin 2-3 days after birth and disappear witin a week or two

65

causes of postpartum blues

hormonal changes
emotional reaction
discomfort
fatigue

66

postpartum depresion

decrease interest in food, decreased interest in surroundings, unable to feel pleasure, fatigue, sleep disturbance, obsessive thinking, decrease hygiene, decrease ability to concentrate, odd food cravings, irritability, rejection of infant, panic attack

Tx: antidepressants, sedatives, mood stabilizers

67

Postpartal psychosis

**EMERGENCY
rare
associated w fatigue and not caring for baby
may develop symptoms similar to bipolar disorder or schizophrenic reaction

S&S: depression, reject baby, jealous of husband, refuses to care for baby, agitation, volatile

68

discharge teaching

rest, hygiene, incision care/sitz baths, avoid heavy lifting, sexual intercourse, use of contraceptive, follow up, exercise