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Mental Health (Josh) > T3 - Nursing Care during PP (Josh) > Flashcards

T3 - Nursing Care during PP (Josh) Flashcards

1
Q

What are we assessing during the 4th stage?

A

VS

Fundus

Lochia

Perineum (REEDA)

Bladder

PAR (post-anesthesia record)

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2
Q

How often do we access VS, etc.?

A

First hour…q15 minutes

Second hour…q30 minutes if stable

Then every hour for 4 hours

Then every 8 hours until discharge

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3
Q

How to remember when to access?

A

q15 x 4 (first hr)
q30 x 2 (second hr)
q1hr x 4 (next four hrs)
q8hr until discharge

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4
Q

Risk factors for excessive bleeding postpartum?

A

Macrosomic (4000g) baby or multiple birth

Long/Difficult labor

Multipara

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5
Q

When would a baby be large for gestational age?

When would a baby be small for gestational age?

A

above 90th percentile

below 10th percintile

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6
Q

Large baby is –

Small baby is —

A

4000 g

2500 g

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7
Q

Fundus should drop — every day

A

1 cm

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8
Q

What is the most common cause of postpartum hemorrhage?

A

uterine atony

***assess for boggy uterus

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9
Q

What is left on the endometrial wall after placenta is expelled?

A

denuded area of exposed blood vessels about the size of a fist

***why there is still some bleeding

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10
Q

Interventions for boggy uterus.

A

Immediate response may be to massage the fundus until firm

Express any clots that may be present …

Check bladder for distention…

Assist patient to empty bladder

Change pad…note quantity of lochia (pad soaked in

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11
Q

Meds used to stimulate contractions postpartum.

A

Pitocin

Methergine (hold if BP 140/90 or greater)

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12
Q

If temp is up during first 24 hours postpartum, what is likely cause?

A

dehydration

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13
Q

Call provider if HR —

A

> 100

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14
Q

What temp indicates infection in postpartum client?

A

Temperature greater than 100.4 that persists X2 days (exclusive of first 24 hours)

***after 24 hrs, think infection

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15
Q

Nursing actions to prevent infection during postpartum stage?

A

Change perineal pad with each voiding or defecation

Peri care

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16
Q

How do we assess the perineum?

A

REEDA

Lochia for color, quantity, and odor

***C-section have less bleeding

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17
Q

Nursing interventions to promote healing of perineum

A

Ice pack (cold) X 1st 24 hours to decrease edema

Sitz bath (warm) after 24 hours – tid X 20 minutes

Peri care with warm water with each urination

Blot dry, wipe from front to back

Apply new pad after each voiding

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18
Q

Scant Lochia is —

Small Lochia is –

Moderate Lochia is —

Heavy Lochia is —

A

Scant = 10 cm (25-50 mL or 25-50grams)

Heavy = 1 pad saturated within 2 hours

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19
Q

Why does bladder fill so quickly postpartum?

A

fluid shift

remember carrying 50% more volume during preg

20
Q

How much fluids should we encourage to prevent UTI?

A

3000 mL/day

21
Q

When do we cath a postpartum client?

A

bladder distended

uterus displaced

6hrs elapsed since last void

voiding less than 150 mL

22
Q

Breast care for lactating client

A

Wash nipples and areola with water (NO SOAP)

Airdry X 20 minutes

Apply expressed breast milk or nonalcohol cream to prevent drying and cracking (Cracks in skin = pathogens mastitis)

Empty engorged breasts manually or with breast pump

Support bra

23
Q

Nonlactating mom needs — calories.

Lactating mom needs – calories

A

1800-2200

additional 450-500/day

24
Q

Nutrition for lactating client

A

Increase fluids

Increase caloric intake to 2700 kcal/day

No meds without consulting physician

Avoid foods gastric irritation, gas or diarrhea

25
Q

When they have mastitis, do they need to stop breastfeeding?

A

yes, b/c they are likely on antibiotics

***pump and dump

26
Q

How to suppress lactation

A

Support bra

Avoid stimulation to breast

Ice packs …15 minutes q hour

Comfort measures for breast engorgement

Analgesic or anti-inflammatory medication

Cool clean cabbage leaves

27
Q

— during pregnancy can continue into postpartum period.

A

PIH

***lasts up to 6 wks after delivery

***investigate pitting edema

28
Q

What is a safe anticoagulant for breastfeeding clients?

A

Heparin

29
Q

What is Homan’s Sign?

A

calf tenderness upon dorsiflexion of foot

***sign of DVT

30
Q

What is best prevention for DVT postpartum?

A

early ambulation

31
Q

What is the purpose of the Indirect Coombs test?

A

detect anti Rh antibodies in mother’s blood

***administer 300 mcg of Rhogam within 72 hrs

32
Q

Prevention of Iso-immunization

A

Indirect Coombs test negative = no anti Rh antibodies in mother’s blood.

Administer RhoGAM 300 mcg IM within 72 hours of delivery

Administer as for blood product

Test immunity in 3 months

33
Q

When would Rubella vaccine be administered postpartum?

A

after birth and again at 1 mth

34
Q

Nursing education regarding Rubella Immnization

A

Teach client to avoid pregnancy X 1 month after each dose

Safe for breast feeding patients

May develop rash…

***can’t take if allergic to eggs

35
Q

What is Hot-Cold Asian Culture?

A

Pregnancy is considered hot condition, heat is depleted during birth, now she is in a cold state for 40 days. She consumes only hot food, & beverages. She may be discourage from showering or bathing because this could cause heat loss

36
Q

What is the ‘Taking In’ Phase?

A

First 1-2 days postpartum

Introspective and preoccupied with own needs rather than new baby

Passive/dependent behavior

Excited & talkative

Touches and explores infant

Needs to verbalize L&D experience

37
Q

What is the ‘Taking Hold’ Phase?

A

Begins by 2nd to 3rd postpartum day, lasts 10 days up to several weeks

Moves toward more independent behavior

Desires to take charge

More receptive to teaching

38
Q

What is the ‘Letting Go’ Phase?

A

Achieves realistic independent role

Establishes norms for self and family

Mothering functions established

Resumption of relationship with partner

Resumption of sexual activity

Family system enters new phase of development

39
Q

Transient depression usually b/t 2nd and 3rd PP day or within 2 wks?

A

Postpartum Blues

40
Q

Characteristics of PP Blues

A

Usually between 2nd and 3rd postpartum day or within two weeks

Characterized by mood swings, anger, tearfulness, feeling let down, anorexia and insomnia

Emotionally labile, cries for no reason

41
Q

What happens if Postpartum Blues persist and don’t resolve spontaneously?

A

evaluate for PP depression

42
Q

Temperature may be elevated after delivery r/t —.

A

dehydration

43
Q

After 24h a temp elevation of — correlates to postpartum infection.

A

100.4F

***This is lower temp than usually considered an infection.

44
Q

— can occur postpartum.

A

Preeclampsia

45
Q

What does BUBBLE-HE stand for?

A 
Breasts
Uterus
Bladder
Bowels
Lochia
Episiotomy/Laceration
Hemorrhoids/Homan's
Emotion

Mental Health (Josh) (26 decks)

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