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NURS ADN004 Maternity > Week 5 Postpartum > Flashcards

Week 5 Postpartum Flashcards

1
Q

6-8 weeks period after delivery
Begins with delivery of the placenta and ends with ovulation

A

Puerperium

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2
Q

Immediate puerperium is first

A

24 hours

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3
Q

2nd day to 6th week is

A

Late puerperium

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4
Q

Puerperium is also referred as

A

Postpartum

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5
Q

CV loss is almost how many cc

A

300-400cc

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6
Q

Fluid enters system due to

A

Placental Loss

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7
Q

HCT increases why?

A

From dehydration and plasma loss exceeding RBC loss

Leucocytes elevated - 25000 WBC normal

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8
Q

What is not uncommon for the first few days?

A

Bradycardia and tachycardia

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9
Q

RR should remain

A

Unchanged

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10
Q

BP returns to what trimester level?

A

1st Trimester level

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11
Q

Temperature elevated up to 100.4 in what?

A

Not uncommon due to dehydration

Temperature above 100.4 should be monitored and/or treated

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12
Q

_____________ _______________ usually at night due to decrease in steroidal hormones and loss of accumulated tissue fluid

A

Marked Diuresis

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13
Q

Bladder atony and urinary retention is present.

A

True

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14
Q

Urethra and bladder trauma from labor and delivery results in what

A

Decreased sensation and urinary retention, increased discomfort and hematuria

Proteinuria may result from tissue damage

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15
Q

What hormones drop?

A

Estrogen and progesterone

Estrogen levels rise to follicular levels day 19-21

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16
Q

Hormone secreted by anterior pituitary, need for initials production of breast milk; levels continue to rise in breastfeeding moms

A

Prolactin

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17
Q

Hypothalamic hormones happen with loss of

A

Placenta

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18
Q

What hormones drop?

A

Estrogen and progesterone

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19
Q

GnRH rises and may be affected by?

A

Breastfeeding

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20
Q

What can be based on variable and may be delayed by breastfeeding?

A

Menses

usually anovulatory but not always

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21
Q

GI system has decreased what?

A

Peristalsis especially with c section

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22
Q

Hunger returns quickly and may have what?

A

Nausea and vomiting

Hemorrhoids may be a problem from pushing

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23
Q

Symptoms of carpal tunnel resolve ?

A

Quickly

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24
Q

Numbness of extremities after epidural or spinal should be followed up by

A

Anesthesiologist

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25
Q

What may cause postpartum headache?

A

Spinal or form of dehydration

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26
Q

Integumentary system what happens in postpartum

A

Pigmentation lightens but may not disappear

Varicosities and nevi generally remain but may decrease in severity over time

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27
Q

This is affected by hormones, reflexes and learned behaviors

A

Lactation

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28
Q

What is the first substance produced, contains proteins, immune properties, glucose and fluid (may be considered dirty or old in different cultures

A

Colostrum

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29
Q

Loss of estrogen, increased prolactin, suckling help to produce breast milk in 2-4 days

A

Breast Milk

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30
Q

What reflex takes time to develop?

A

Let down reflex

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31
Q

What are facilitating factors for breastfeeding?

A

Early, frequent feedings
Relaxed mother and baby
Newborn who actively sucks
Nutritional status of mom
Uncomplicated delivery
Everted nipples

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32
Q

Name the types of nipple

A

Normal
Flat
Inverted

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33
Q

What are inhibiting factors for breastfeeding?

A

Separation from newborn
Tense mother
Sleepy newborn
Excessive blood loss
Poor nutritional status of mom
Complicated delivery, infection
Flat or inverted nipples

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34
Q

Name problems of breastfeeding

A

Engorgement
Mastitis
Delayed feeding
Poor latch, position

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35
Q

Uterine change used to describe reduction in size of uterus and return to prepregnant state- occurs in 9 days.

A

Involution

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36
Q

What allows for healing of placenta site and is important part of involution ( takes 6 weeks to heal)

A

Exfoliation

Uterine change

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37
Q

Complete expulsion of placenta or membranes, breastfeeding, and early ambulation

A

Enhanced by uncomplicated labor and birth

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38
Q

__________ is at level of umbilicus with 6 to 12 hours after childbirth

A

Uterus

Decreases by one finger breadth per day

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39
Q

Immediately after expulsion of the placenta the top of the fundus is in the

A

Midline and approximately halfway between the symphysis pubis and the umbilicus.

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40
Q

After 6 to 12 hours after birth the fundus is at the level of the

A

Umbilicus

Height of the fundus then decreases about one finger- breadth approximately 1cm each day

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41
Q

Uterus rids itself of debris remaining after birth through discharge called

A

Lochia

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42
Q

Lochia changes

A

Bright red at birth
Rubra- Dark red
Serosa- Pink
Alba- White
Clear

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43
Q

If blood collects and forms clots within the uterus, fundus arises, and becomes boggy then we have ?

A

Uterine Atony

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44
Q

What becomes displaced and deviated to the right when the bladder is full

A

Uterus

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45
Q

Scant lochia is less than

A

2.5 cm on pad

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46
Q

Light lochia is less than

A

10 cm on pad

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47
Q

Moderate is less than

A

15 cm on pad

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48
Q

Heavy saturate pad in 1 hour or less

A

True

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49
Q

Musky menstrual like odor

Odor should be reported to practitioner for possible antibiotics

A

Odor

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50
Q

High fibrinolysin level should prevent clot formation; may have clotting with retained placental fragments, full bladder or atony

A

Clots

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51
Q

Less than 1 inch stain on pad is

A

Scant

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52
Q

Less than 4 inch stain on pad

A

Light amount

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53
Q

Less than 6 inch stain on pad is

A

Moderate amount

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54
Q

Saturated pad is

A

Heavy amount

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55
Q

This remains open for about 2 weeks post delivery

A

Cervix

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56
Q

Bruised, edematous, may have lacerations

When healed has fish mouth appearance

Spurting vaginal bleed from cervical laceration

A

Cervix

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57
Q

Rugae is absent for about how many weeks post delivery

A

6- 8 weeks Vagina

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58
Q

Why is the vaginal mucosa drier?

A

Due to decrease in estrogen

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59
Q

pooling or dark red vaginal bleeding may indicate what?

A

Vaginal Laceration

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60
Q

Introitus swollen, edematous, erythematous

Labia swollen and discolored

A

Perineum/ Vulva

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61
Q

Perineal Alterations

A

Perineum may be swollen and may require application of ice pack

Trauma- Lacerations, bruising, hematomas

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62
Q
A
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63
Q
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64
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65
Q
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66
Q
A
67
Q
A
68
Q
A
69
Q
A
69
Q
A
70
Q

Epistomy is either what two ?

A

Midline
Mediolateral

70
Q

2nd degree is

A

Skin and perineal

70
Q

How many types of lacerations are there?

A

1st degree
2nd degree
3rd degree
4th degree

70
Q

1st degree is

A

Skin tear

70
Q

3rd degree is

A

Perineal skin
Perineal muscles
and some anal sphincter

70
Q

What are steps of care for postpartum bleeding?

A

Massage the fundus
Increase IV and administer uterotonics
- Oxytocin/ Pitocin 20 - 40 units in LR, infuse IV rapidly
- Methergine/ Methylergonovine Maleate
— 0.2 mg IMx 1, hold for B/P >140/90
- Hemabate/Carboprost 250 mcg IM may repeat every 15- 30 minutes up to 8 doses
- Cytotec/ Misoprostyl- 800-1200 mcg PR
- Empty the bladder
- Monitor VS
Notify provider

70
Q

4th degree is

A

Through all layers into rectum wall

71
Q

Edges of episiotomy or laceration should be

A

Approximated

Perineum/ Vulva

72
Q

Pericare should include ice for

A

24 hours and heat

after 24 hours sits bath

Laxative therapy

Monitor for s/s of infection

73
Q

Measurement of descent of fundus for the woman with vaginal birth. Fundus is located two breadths below umbilicus

Always support the bottom of the uterus during any assessment of the fundus

A

Uterine care and support

74
Q

Name the 4 Ts of PP Hemorrhage

A

Tone - uterine atony
Trauma - laceration, hematoma, inversion rupture
Tissue- retained tissue or invasive placenta
Thrombin - coagulopathy

75
Q

What are preconditions that influence attachment?

A

Trust
Support
Communication and caregiving skills
Proximity
Parent- infant fit

76
Q

What is positive feedback for bonding?

A

Enhances bonding
- Eye contact with parent
- Grasp
- Cuddles and calms
- Successful feeding

Assessment
- Appropriate vs inappropriate
- Cultural influences

77
Q

Phase of adjustment that is 1-2 days after delivery, “ all about me”, mom needs nuturing

A

Dependent Phase

78
Q

Taking hold happens 3-7 days and is all about baby and me

A

Dependent and independent

79
Q

Interdependent is

A

Letting go

Day 10 to 6 weeks

Begins to adjust roles and incorporate family

80
Q

What are some parental tasks?

A

Reconcile actual child with fantasy child
Establish newborn as separate individual
Develop skills in caring infant
Incorporate infant in family group and establish caregiver roles

81
Q

Report from L &D ( EBL, problems, anesthesia, medications, etc)

Review prenatal and intrapartal records

Review lab work
Physical Assessment
- 8 point check or BUBBLE
- Additional checks for C section

A

Assessment

82
Q

Implementation for nutrition and elimination includes

A

Assess IV Site, solution, rate

Provide diet as ordered - If stable, check BS if C/S

Assist to BR to void ( should void within 6 hours of delivery)
- Encourage increased fluid intake

83
Q

Adaptation includes

A

Reassess any abnormal findings and report
Assess fundal height and consistency
Administer uterotonics for boggy uterus
- Massage fundus
- Administer uterotonics
Empty bladder

Ambulate ad lib when stable assist prn
Vital signs q4hx 24 if no complications

84
Q

Protection includes

A

5 rights for medication administration
Check ID when returning infant to mom
Pain meds as needed
Oxytocic as needed

Teaching: Handwashing, pad changes, Pericare, hygiene

85
Q

Monitor lochia
VS every 4 hours for 24 hours ten at least every shift

Monitor lab work for abnormal values that may affect maternal oxygenation status

A

Oxygenation

86
Q

Infant to mother as soon as possible why?

A

Skin to skin

87
Q

Interactions include ?

A

Facilitate breast feeding
Assess bonding behavior
Encourage golden hour with private time for new patients

88
Q

Assist with infant feeding

A

Role

89
Q

Pitocin is in how many units?

A

10 -20 units Iv or IM

( 30 units in 500 ml LR or 20 units in 1000ml LR)

Action to increase contractility of uterine muscle

Side effects include : HTN, water intoxication, increased uterine cramping

90
Q

This is given when uterus remains boggy with Pitocin

Systematic vasoconstrictor

A

Methergine

Dose 0.2 mg IM

May be given 0.2-0.4 MG PO x 3 days only

Should not be given to hypertensive patients

91
Q

Potent uterine constricting agent
May be given 250 mcg IM Hemabate
Available in suppository
May use cytotec ( Misoprostril 400-800 mcg rectally for PP hemorrhage)

A

Prostaglandins

Side effects: Elevated B/P, nausea, diarrhea, increased temperature

92
Q

Synthetic amino acid (lysine) that plasminogen from being converted to Plasmin, which functions as a clot buster in the body

A

TXA

93
Q

Mix 1 gram in 50 ml of NS and infuse via pump over 10 min

For maintenance, mix 1 gram in 100 ml NS and infuse over 8 hours.

A

TXA

94
Q

This drug side effects include nausea, vomiting, diarrhea, allergy, or excessive blood clotting/ DVT

A

TXA

95
Q

Colace and Surfak are

A

Stool softeners

96
Q

MOM and Senekot are

A

Laxatives

Should be used as directed, generally given 1 time/ day, but may be given more often if 3rd or 4th degree laceration

97
Q

With elimination agents, encourage patient to do what?

A

Plenty of water, increase fiber, and ambulate

Side effects include diarrhea

98
Q

What is not recommended due to high respiratory effects on newborns

A

Percodan

99
Q

What are discouraged in PP moms?

A

Narcotics

NSAIDs best choice

100
Q

Ibuprofen is given every 6h at how much is?

A

600mg-800mg

Toredol IV every 6h- should not be given concurrently

101
Q

Po narcotics include

A

Tylenol with codeine 30 mg 1-2 tabs every 4-6h

Norco 5-10 mg 1-2 tabs every 4-6h
Vicodin 5-10 mg

Percocet 2.5 mg every 4-5 h

Percodan 4.8 mg every 4-6h

IM/IV narcotics - Morphine 2-6 mg IV/ IM
Demerol 2-100 mg IV/IM
Dilaudid 0.2-0.4 mg IV/ IM

102
Q

Analgesics check for

A

Allergies

Monitor for effects and medicate as needed
Monitor acetaminophen intake 4 g max/ day

103
Q

Given to RH negative mom who delivers RH positive infant

A

Rhogam

Must recheck lab values

104
Q

What is a blood product and may require consent?

A

Rhogam

Given deep IM within 72 hours of delivery

105
Q

Prevents formation of antibodies

Protects future pregnancies from R isoimmunization

Destroys any cells already in mom’s body

A

Rhogam

106
Q

Indicated for rubella non immune moms
Should provide Rubella fact sheet
Pt should not become pregnant for 3 months to prevent rubella syndrome in new fetus/

A

Rubella Vaccine

Given Im or SQ one time

Mom may not retain immunity

107
Q

This should be given IM prior to discharge if patient has no documentation of current immunization

A

TDAP

108
Q

Potentially fatal communicable disease which has become a public health concern over the past several years

A

Pertussis

Whooping cough

109
Q

Perineal care includes

A

Peri rinse - should use peri bottle each void
Sitz bath, use prn- particularly with generous episiotomy or 3rd and 4th degree laceration or hemorrhoids

Tucks and Dermaplast

Icex 24hr, Heat after 24 hr

110
Q

50%-80% of all pp women experience this

A

PP blues within 1st 2 weeks after childbirth

Blues are usually self limiting
Last several days
Often peak by the end of 1st week

111
Q

Tearfulness
Mood swings
Anxiety
Fatigue
Sadness
Insomnia
Confusion

A

PP Blues s/s

Give extra rest, reassurance, and therapeutic listening help to alleviate many of these symptoms of PP blues

112
Q

How many percent progress from PP blues to depression

A

9%-15%

Need one or two symptoms that exist most or all day

Depressed mood
Decrease interest/ pleasure in previous enjoyable activities

113
Q

Risk factors for PPD include

A

Undesired pregnancy
Hx of depression
Recent changes
Death of family
Financial stress
Low self esteem
Homelessness

114
Q

Form of MDD that develops within 4 weeks of postpartum and the diagnostic criteria are otherwise identical to those applied to major depression

A

Postpartum Depression

115
Q

PPD to be any major depressive disorder occurring within the first 2-6 months postpartum and some authorities extend this to 1 year postpartum

A

True

PPD

116
Q

Symptoms of PPD affect who?

A

Everyone in family and mom

117
Q

Name s/s of PPD

A

Anorexia or weight loss
Insomnia
Fatigue
Withdrawal
Suicidal thoughts
Infant neglect/ abuse

118
Q

Risk factors for PPD include

A

Hx of depression
Family hx of depression
Psychological stress
Chemical alterations

119
Q

What is 1st important step in collaborative management of PPD?

A

Rule out hypothyroidism

Now begin CBT and IPT which are shown to be great at treating perinatal depression

120
Q

Rare but severe form of mental illness that affects not only the new mother but also entire family

A

Postpartum Psychosis

May appear 24- 48 hours after delivery but may not appear until 8 weeks pp

121
Q

What women are at greatest risk for PP psychosis?

A

Women with bipolar disorder

Greater support of genetics in mood disorders

1st time mothers 40-44 years of age are at greatest risk

122
Q

What are the distinguishing signs of PP psychosis?

A

Hallucinations
Delusions
Confusion
Sleep disturbances
Suicidal and homicidal thoughts
Loss of touch of reality

May resemble a sudden manic attack

123
Q

What are some behavioral cues that may signal psychosis?

A

Hyperactivity, agitation, confusion, or suspiciousness

Reports auditory hallucinations to inflict harm to the infant

Voices or delusions that make her believe the infant is dead or defective or birth did not occur

Voices excessive complaints

Exhibits obsessive concerns about the baby’s health and welfare

124
Q

What is the immediate treatment of postpartum psychosis?

A

Mood stabilizer- lithium or valproic acid
Antipsychotic medications- chlorpromazine, thioridazine, and trifluoperazine
Anti anxiety medications- benzos

If required ECT often leads to rapid improvement

Long term psychotherapy and pharmacological treatment follows immediate care

125
Q

Psychological reaction occurring after experiencing a highly stressful event that may be characterized by depression, anxiety, flashbacks, recurrent nightmares, and avoidance of reminders of event

A

PTSD

126
Q

Advise abstinence for 6 weeks PP

Barriers, OCPs, Norplant, Sterilization

Breast feeding should not be considered method of birth control

A

True

True

True

127
Q

Nutrition we look for?

A

Assess diet orders and toleration of diet taken

For C section- Assess bowel sounds and nausea and vomiting before serving diet

C/S > sips, liquids, DAT> may go to regular if tolerating liquids well

128
Q

Dismissal teaching includes what?

A

Assess needs and learning deficits

Teach to the individual’s specific needs
- 1st vs multiple infants at home
Girls vs Boys
More is more

Include self care needs ( rest, eating, exercise, etc)

129
Q

Teaching includes what as well?

A

Diet
Safety needs
Physiologic interventions requiring changes
Immunizations
Follow up appointments
Referrals and resources

130
Q

Ideal method of birth control would be

A

100% :
Safe
effective
available
reliable
free

Instantly reversible, convenient no Rx, no interference with sex

131
Q

Reality is birth control is

A

Many types

Many advantages and disadvantages

No 100% perfect or ideal method and none expected in near future

132
Q

Making a choice includes

A

Effectiveness
Ease of use
Lifestyle fit
Cost
Safety

133
Q

100 % effective, safe, and free

No side effects
Encouraged by some groups

Total abstinence may be difficult or impossible, may forget to protect from STDs and STIs

A

Abstinence

134
Q

Sex play without intercourse
Almost 100% effective
Prevents STDs and STIs if bodily fluids not exchanged

Includes
Masturbation
Erotic massage
Body contact
Erotica
Sex toys

A

Outercourse

135
Q

Advantages include

A

No medical or hormonal side effects
Safe sex if no fluids exchange
May enhance experience
Costs nothing

Disadvantages include

May not protect
Difficult to abstain

136
Q

81-96 effective

No effective against STDs or STIs

Can be used when no other method is available

Pre ejaculate may have sperm
Spillage
Messy

A

Withdrawal

137
Q

80-99% effective low cost

No medical or hormonal side effects
Low cost no Rx required
Accepted by most
Requires cooperation of partners
May be risky
Requires careful record keeping

A

Periodic Abstinence or Fertility Awareness

138
Q

Methods of Periodic Abstinence or Fertility Awareness

A

Ovulation method- ass cervical mucus
symptothermal methods- basal body temp. +mucus
Calendar rhythm method
standard days method Cyclebeads
Creighton Model

139
Q

86-98% effective
Effective against STDs and STIs
Readily available inexpensive no Rx
Readily available
Can be used as pat of sex play
Can cause allergic reaction
Loss of sensation and breakage
Requires interruption to apply

A

Condoms

140
Q

72-97% effective
Some protection form of STIs
Easily available
Usually need to wait short time
Not effective after one hour
May cause allergic reaction
Messy

A

Foams, creams, gels etc

141
Q

79-95% effective

Some protection from STDs and STIs
Readily available
Allows women to be responsible for protection
May be messy and awkward

A

Female Condoms

142
Q

82-94% effective
Not effective against STDs and STIs
No major health problems and can last for several years
Can be messy and may cause allergic reactions
May cause infection and decrease spontaneity
Relatively inexpensive

A

Diaphragms and Cervical Caps

143
Q

Estrogen and progesterone combos prevent release of

A

Ovum 97-99% effective

143
Q

Mini pills contain only

A

Progestin

144
Q

Both types prevent sperm and egg from joining by

A

Thickening mucous

Both types prevent implantation

145
Q

Oral Contraceptives are not effective against

A

STDs and STIs

146
Q

nothing to insert during intercourse
may regulate periods
Helps prevent acne, anemia, PMS
Protects from ovarian CA, PID, non- CA breast tumors, ovarian cysts
Must be taken daily
Should not take if smoker or hx of blood clots

A

Oral Contraceptives

147
Q

Small silicone implants, similar to stents, are inserted into the fallopian tubes, through the vagina and cervix

Office procedure that takes 10 minutes

Requires 3 month use of back up method of birth control, then an Essure confirmation test, where dye is inserted into the tube to confirm placement of the plugs and blockage of the tubes

Should be considered permanent

A

Essure

148
Q

What are some serious side effects of essures?

A

Heavy and irregular menstrual periods
Weight gain and fluctuation
Internal breakage and migration of device
Chronic pelvic pain and back pain
Depression
Extreme fatigue
Allergic reactions to the nickel
Suicidal Thoughts
Systemic tissue inflammation

149
Q

Matchstick sized rod inserted in the arm to prevent pregnancy

Contains Progestin, prevents the eggs from leaving the ovaries and thickens cervical mucus

Require insertion by a healthcare provider

Costs 400-800 lasts 3 years

A

Birth Control Implant

Implanon and Nexplanon

150
Q

IM injection given every 12 weeks

99.7% effective
Nothing to take or insert

A

Depo Provera

151
Q

Side effects include irregular bleeding, HA, weight gain, depression, abd pain

A

Depo Provera

Side effects can’t be reversed and must wear off

152
Q

Small device placed in uterus and may have medication in device

97.4 - 99.2

Last 5-10 years
No effect on hormone levels
Cramping, spotting, bleeding may occur

Rare infection or uterine perforation may occur

A

IUD

153
Q

Surgical dissection of fallopian tubes

A

Tubal ligation

154
Q

Surgical dissection of vas deferens

A

Vasectomy

155
Q

Sterilization should be considered

A

Permanent

Rare failure due to spontaneous resection

NURS ADN004 Maternity (11 decks)

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