Book Chapter 16 Flashcards
(121 cards)
1
Q
How often is a postpartum assessment typically performed?
A
During the first hour: q15min
2nd hr: q30min
first 24 hours: q4h
after 24 hours: q8h
2
Q
How often is a postpartum assessment typically performed?
A
During the first hour: q15min
2nd hr: q30min
first 24 hours: q4h
after 24 hours: q8h
3
Q
What hemoglobin level indicates anemia in a postpartum patient?
A
less than 10.5 mg/dL
4
Q
What are the major risk factors for a postpartum hemorrhage?
A
1) precipitous labor (less than 3 hours)
2) uterine atony
3) labor induction or augmentation
4) operative procedures used in aiding birthing process
5) retaining parts of placenta
6) prolonged 3rd stage of labor (>30min)`
7) multiparity
8) uterine overdistention (think SGA infant, twins, hydramnios)
5
Q
What are the major risk factors for a postpartum hemorrhage?
A
1) precipitous labor (less than 3 hours)
2) uterine atony
3) labor induction or augmentation
4) operative procedures used in aiding birthing process
5) retaining parts of placenta
6) prolonged 3rd stage of labor (>30min)
7) multiparity
8) uterine overdistention (think SGA infant, twins, hydramnios)
6
Q
What are the major postpartum risk factors for infection?
A
1) operative procedure to aid in birth (forceps, kiwi extraction, c-section)
2) hx of diabetes/gestational diabetes
3) prolonged labor (more than 24 hours)
4) use of indwelling urinary catheter
5) anemia
6) multiple vag exams during labor
7) prolonged rupture of membranes (>24 hours)
8) manual extraction of placenta
9) compromised immune system (HIV +)
7
Q
What hemoglobin level indicates anemia in a postpartum patient?
A
8
Q
What are the major risk factors for a postpartum hemorrhage?
A
1) precipitous labor (less than 3 hours)
2) uterine atony
3) labor induction or augmentation
4) operative procedures used in aiding birthing process
5) retaining parts of placenta
6) prolonged 3rd stage of labor (>30min)
7) multiparity
8) uterine overdistention (think SGA infant, twins, hydramnios)
9
Q
What acronym do we use to guide the process of the postpartum assessment?
A
BUBBLE-EEE Breasts Uterus Bladder Bowels Lochia Episiotomy Epidural site Extremities Emotional Status
10
Q
What are signs that your postpartum patient is not doing well…the “danger signs” (as listed in book)
A
- temp of more than 38C (100.4F)
- foul-smelling lochia or unexpected change in color/amount
- large blood clots
- bleeding that saturates a peripad in an hour
- severe headaches or blurred vision
- visual changes such as blurred vision or spots
- headaches
- calf pain with dorsiflexion of foot
- swelling, redness, or discharge at an incision site of any kind
- problems with urinary incontinence
- SoB
- depression/mood swings
11
Q
what causes BP changes to vary most often in postpartum patients?
A
position changes, so assess in same position every time
12
Q
What’s the normal postpartum pulse rate during the first week after birth? what is the term for this pulse rate?
A
40-80 bpm; puerperal bradycardia (just remember the gravid uterus is lightened causing a huge rush of blood flow to heart, up SV, down pulse)
13
Q
What could severe pain in the perineal region be in a postpartum pt?
A
a hematoma, check by inspecting palpating the area and if found notify provider
14
Q
T or F, BP postpartum = BP during labor
A
True!
15
Q
what causes
A
a
16
Q
What’s the goal of pain management for postpartum patients?
A
between 0 and 2 at all times, ESPECIALLY after breast-feeding; often accomplished by pre-medicating (biggie with pain: think afterpains due to involution)
17
Q
What could severe pain in the perineal region be in a postpartum pt?
A
a hematoma, check by inspecting palpating the area and if found notify provider
18
Q
just fyi
A
there’s something called foremilk and it’s bluish white
19
Q
What is important to know when assessing a woman’s breasts who is not breast-feeding?
A
use gentle, light touch to avoid breast stimulation which would make any engorgement worse
20
Q
What is the two-handed approach when assessing the fundus?
A
feeling top of uterus with one hand and other hand placed on lower segment of uterus to stabilize it
21
Q
What might nodules, masses, or areas of warmth indicate?
A
plugged duct that could progress to mastitis if not treated
22
Q
just fyi
A
there’s something called foremilk and it’s bluish white
23
Q
In what position should the woman be when assessing the fundus?
A
supine position with knees flexed slightly and bed in flat position as low as possible
24
Q
What is the two-handed approach when assessing the fundus?
A
feeling top of uterus with one hand and other hand placed on lower segment of uterus to stabilize it
25
What's a sign of uterine atony?
a boggy or relaxed uterus
26
If a fundus is not firm, what intervention can the nurse do to firm it up?
massage it
27
Is it a normal or abnormal finding if fundal height is above the umbilicus?
abnormal, usually do to bladder being full
28
The fundus progresses downward at a rate of ______ after childbirth
one fingerbreadth or 1cm/day
29
what does u/1 mean?
top of fundus located 1cm below the umbilicus (u/1 is normal for first postpartum day)
30
If a fundus is not firm, what intervention can the nurse do to firm it up?
massage it
31
What are signs of a UTI in postpartum pt.s?
fever, urinary frequency and/or urgency,foul-smelling odor difficult or painful urination, and tenderness over the costovertebral angle
32
insufficient voiding in postp pt. is determined by how many mL?
less than 200
33
How can the nurse check if the bladder is empty?
palpate the area over the symphysis pubic; if empty, the bladder is not palpable AND percuss area, if full bladder then dull to percussion
34
will a full bladder decrease or increase lochia drainage?
increase b/c uterus cannot contract to suppress bleeding
35
Is constipation a common problem for postpartum pts?
yes
36
insufficient voiding in postp pt. is determined by how many mL?
less than 200
37
How do we measure the amount of lochia? What are the 4 different levels? Describe
by how much a pad is saturated over a certain amount of time
1) Scant: a 1-2 inch lochia strain on the perineal pad or approximately a 10-mL loss
2) light or small: 4-inch stain, 10-25mL loss
3) moderate: 4-6 in stain, 25-50mL loss
4) large or heavy: pad saturated within 1 hr after changing
38
Many women are afraid of having a BM b/c they think they'll rip stitches from their episiotomy or exacerbate hemorrhoids. What prevents this?
stool softenere and laxatives
39
Is constipation a common problem for postpartum pts?
yes
40
What two actions will cause lochia flow to increase and it is not an abnormal finding? aka an increase in lochia flow is expected when the woman does these two things
1) lochia flow ill increase when woman gets out of bed b/c lochia pools while she's lying
2) will increase when breast-feeds b/c oxytocin release causes uterine contraction
41
How do we measure the amount of lochia? What are the 4 different levels? Describe
by how much a pad is saturated over a certain amount of time
1) Scant: a 1-2 inch lochia strain on the perineal pad or approximately a 10-mL loss
2) light or small: 4-inch stain, 10-25mL loss
3) moderate: 4-6 in stain, 25-50mL loss
4) large or heavy: pad saturated within 1 hr after changing
42
What is the range for total volume of lochial discharge?
150-400 mL
43
just fyi
this is nitpicky, but check under the woman to make sure additional blood is not hidden or absorbed on her perineal pad, also good time to assess for hemorrhoids
44
according to the book, what's the first step if excessive bleeding occurs?
massage the boggy fundus until it is firm to reduce the flow of blood
45
will a woman with cesarean birth or vag birth have less lochia discharge?
the woman who had a cesarean birth will have less lochia discharge
46
Which type of lochia discharge reappearing is a bad sign?
if lochia rubra reappears after serosa and alba
47
To assess an episiotomy/perineal area, what position should the patient be put in?
on her side with top leg flexed upwards at the knee and drawn towards waist AKA sim's (doesn't say specific side), stand with her back facing you
48
T or F, a postpartum patient arrives on the unit and you notice bruising and slight edema of the perineal area, you should report this finding to a provider
False, this is a normal finding
49
What are the classifications for lacerations?
1st degree: involves skin only and superficial structure above muscle
2nd: extends thorugh perineal muscles
3rd: extends through anal sphincter muscle
4th: continues through anterior rectal wall
50
How often do you assess an episiotomy or any lacerations?
at least q8h
51
in terms of inspecting a laceration/episiotomy, what sould indicate a pelvic or vulcar hematoma? an infection? a perineal hematoma?
pelvic/vulvar hematoma - bluish skin with complaints of severe pain in the perineal area
infection - redness, swelling, a white line the length of the episiotomy, purulent drainage
perineal hematoma - severe, intractable pain, perineal discoloration, and ecchymosis (very dangerous condition)
52
A postpartum patient who had a cesearean birth is experiencing itching, N/V, urinary retention, and leg weakness, what is this most likely the result of?
side effects of the epidural
53
What 3 factors predispose women to clotting disorders during pregnancy?
1) stasis - due to gravid uterus compression on large veins
2) altered coagulation
3) localized vascular damage - occurs during birthing process
54
in how many pregnancies does a pulmonary embolism occur in?
1 in 2000 (on p 491 there's all the risk factors for pulm embo, if you're feeling craycray)
55
Let's say a diagnosis of pulmonary embolism is made in a woman who's pregnant what three things is going to be required of that patient treatment-wise?
1) prolonged therpay with heparin (up to about 9 months)
2) prophylaxis during future pregnancies (or a good reason to not have more kids)
3) avoidance of oral contraceptive pills (ok that explains the more kids)
56
What are the signs/symptoms of a pulmonary embolism in a pregnant woman?
- lower extremity tightness
- aching when walking
- relieved by elevating leg
- edema in affected leg (usually left) w/ warmth/tenderness
- low-grade fever
57
What diagnostic tool is needed to make a definitive diagnosis of pulmonar emolism?
a duplex ultrasound w/ physical findings
58
so remember, women at increased risk for emboli....
make sure they have compression stocking/boots/devices and that they ambulate to reduce thrombophlebitis
59
When does bonding first develop?
the first 30 to 60 minutes after birth
60
T or F, bonding is unidirectional
true, it is from parent to infant
61
What is attachment?
the development of strong affection between an infant and significant other; unlike bonding it is reciprocal!
62
When a mother holds her baby in such a way that they can make eye contact with each other, what position is this?
en face position and it is a sign of attachment
63
what is one of the most basic instinctual interaction between parent and infant that plays a role in attachment/bonding?
touch
64
according to the book, how long can it take to "become" a parent
4-6 months
65
According to Mercer, what are the 4 stages of the transition into parenthood?
1) commitment, attachment, and preparation for an infant during pregnancy
2) acquaintance with and increasing attchment to the infant, learning how to care for infant, physical restoration of mom after birth
3) moving toward a new normal in first 4 months
4) achievement of parenthood role aorund 4-6 months
66
What are the three major factors that influence attachment?
1) parents' background
2) infant (temperament and health)
3) care practices (includes that of hospital personnel)
67
What are some factors at the hospital that can discourage parent/infant attachment
- separation immediately after birth and for long period
- policies discouraging unwrapping/exploring infant
- ICU environment, restrictive visiting
- staff indifference
68
What are the three attachment stages (and of course fucking substages)? Explain them
1) Proximity: parent/infant being close
---substageI: Contact - sensory experiences
substageII: Emotional state - new emotions about being parents
substageIII: Individualization - parents can differentiate between infant's needs and themselves, can respond to infant needs, something about creating attachment by detaching
2) Reciprocity: infant's actions elicitting response in parents
----dimensionI: complementary behavior: taking turns and stopping when other isn't interested, being complementary to one another
dimensionII: sensitivity - parents who are sensitive will respond best to infants actions
3) commitment: enduring nature of relationship
----componentI: centrality - infant placed at center of lives
componentII - parent's find own way and integrate parental identity
69
too lazy to write it out but look up negative and positive attachment behaviors on 494, pretty self-explanatory
kkkk
70
What's expected hospital stay of vag delivery pt? of c-section pt?
vag - discharged within 48 hours
| c-section - up to 96 hours
71
What topics does the nurse need to discuss before discharge?
a. pain
b. immunizations
c. nutrition
d. activity
e. lactation
f. discharge teaching
g. sexuality and contraception
h. follow-up
72
According to the book, what are the cultural consideration for the postpartum period for African-Americans?
- mother shares care with extended family
- older women influence care
- mothers protect newborn from strangers for several weeks
- don't bathe newborn first week, instead oils applied to skin and hair
- silver dollars taped over infant's umbilicus to attempt to flatten
- sleeping with parents common
73
According to the book, what are the cultural consideration for the postpartum period for the Amish?
- childbearing woman's primary role
- oppose birth control
- preg a private matter, conceal it
- don't like when hurried to complete self-care tasks
74
According to the book, what are the cultural consideration for the postpartum period for the Appalachian?
- infant colic treated by passing newborn through a leather horse's collar or administering weak catnip tea
- asafetida bag (gum resin with strong odor) tied around infant's neck to ward away disease
- women avoid eye contact
- women avoid asking questions
- grandmother may rea infant for mother
75
According to the book, what are the cultural consideration for the postpartum period for Fillipino Americans?
- grandparent involved in care
- breast-feeding encouraged, sometimes up to 2 years old
- BC and sexual matters taboo
- religious beliefs/prayer
- close-nit families, lots of visitors
76
According to the book, what are the cultural consideration for the postpartum period for Japanese Americans?
- cleanliness and protection from cold big
- bathe infant daily
- newborns not taken outside, kept inside 1st month of life with mom
- breast-feed
- bathing infant important activity for fam
77
According to the book, what are the cultural consideration for the postpartum period for Mexican Americans?
- after birth newborn's grandmother lives in house
- breast-feed for more than a year
- infant carried in rebozo (shawl) for easy breast-feeding
- women avoid eye contact and don't like strangers touching them
- religious icons in room
78
According to the book, what are the cultural consideration for the postpartum period for Muslims?
- modesty primary concern
- don't eat pork
- same-sex health care
- mom stays in house for 40 days after birth cared for by female members
- will breast-feed but relgious events call for fasting so dehydration malnutrition risk
- as long as lochia is present, women can skip 5x daily prayers
- extended family likely present, need empty room to perform prayers
79
According to the book, what are the cultural consideration for the postpartum period for Native Americans?
- women secretive about pregnancies
- touching uncommon and eye contact brief
- resent being hurried
- breast-feed
- BC accepted practice
80
What is the most common first measure used after a vag birth to relieve perineal discomfort?
ice pack
81
during what stage of labor is an ice pack applied to perineal area? what does it prevent?
4th stage and used for the first 24 hours to reduce edema, pain, bleeding and prevent hematoma formation
82
How often do we apply an ice pack to the perineum?
applied for 20 and removed for 10
83
If no commercial ice packs are available how can the nurse make one?
fill a surgical glove with crushed ice as long as pt doesn't have a latex allergy
84
when do we use a peribottle?
after each voiding and before applying a new peri pad (remember flow of water from front to back)
85
After the first 24 hours what can the ice pack be substituted with?
a sitz bath with room temp water
86
what are hygenic sitz baths?
also called Suri-Gators
| - sprays an antiseptic, water, or both onto perineum
87
what are two local anesthetic sprays that can provide temporary relief for peri pain? what do you ahve to do before applying them?
- Dermoplast or Americaine
| - rinse peri area with water via peribotth and/or sitz bath
88
What are cool wtich hazel pads used for in treating postpartum patients?
hemorrhoids
89
what type of products are used in treating nipple pain?
- beeswax
- lycerin-based
- petrolatum lanolin
(these three though need to be removed before infant breast-feeds which can cause more nipple irritation)
- hydrogel
- breastmilk
90
What are the main causes of nipple trauma?
- incorrect latch-on and/or removal of infant
91
How much time prior to breastfeeding should you administer a mild analgesic?
an hour
92
how long would you wait before catheterizing a post-partum patient
if patient hasn't voided 4-6 hours after birth
93
do prenatal vitamins cause decreased or increased bowel motility? why?
yes b/c they are high in iron content
94
Why might a nurse have a woman blow bubbles through a straw as a nonpharm intervention?
to help stimulate the woman to urinate
95
Why might a nurse want a postpartum patient to drink a small amount of prune juice?
stimulates bowel motility
96
What can advice can a nurse give a mother to promote rest?
1) nap when infant is sleeping b/c doesn't sleep through night
2) reduce visitors and outside activities
3) assess infant's sleep-wake cycle and try to keep baby awake longer during day
4) eat balanced diet
5) share household tasks if partner present/let others take care during night so mother can sleep
6) cluster activities
97
what's the average gestational weight gain?
25-35lbs
98
women should lose their pregnancy weight by how long postpartum
6 months
99
when can jogging strollers be used
when infant is 6-12 months old
100
why should the postpartum patient avoid jarring or bouncing movement at first?
b/c of joint laxity; joints don't staiblize until 6-8 weeks postpartum
101
What are ways to reduce stress incontinence?
1) Kegel exercises
2) lose weight
3) avoid smoking/alcohol/caffeine
4) adjust fluid intake to produce 24hr urine ouput of 1000-2000mL
5) use intravag or intra-urethral device to put pressure on urethra to prevent urine leaking out
102
What are the 5 postpartum exercises?
1) abdominal breathing (lie on floor and take deep breaths, slowly exhale for 3-5 second)
2) head lift: lying with knees flexed and feet flat on surface, lift head to chest hold for 3-5 sec, return to start)
3) modified sit-ups: raise head and shoulder 6-8 inchse, waist on surface, slowly return)
4) double knee roll: lyig with knees ben, roll knees to side and touch ground)
5) pelvic tilt: lying knees bent, arms to side lift pelvis and hold 3-5)
103
How often should you do Kegels and how long do you hold?
10 sets of hold for 10 second, release for 10 seconds and do this 3x/day
104
should you use tampons on a postpartum patient?
no, infection risk
105
should you give a postpartum patient a tub bath?
no avoid for 4-6 weeks until joints are balanced and restored
106
What are 3 big safety concerns for postpartum patients?
1) falls - orthostatic hypotension
2) if sleepy, put baby back in crib on its back
3) abduction - keep doors closed and make sure they check the identification of anyone entering the room
107
When can a couple engage in seuxal intercourse again after birth?
once bright red bleeding has stopped and lacerations/episiotomy is healed...`.usually 4-6 weeks after birth
108
What are some common sexual changes in the postpartum patient?
1) fluctuation in sexual interest
2) let-down reflex during orgams
3) sensitive breasts
4) impaired precoital vag lube (use water-based lube)
109
what's important to know about combined hormonal contraceptive use and postpartum patients?
- combined hormonal contraceptives NOT recommended during the first 21 days after childbirth b/c of high risk for DVT; during 21-42 days after only women without risk factors for DVT should initiate
110
What are the nutrition guidelines for a woman who is breast-feeding?
a) calories: +500 cal/day for first and second 6 months of lactation (so for a year?)
b) protein: +20g/day, adding an extra 2 cups of skim milk
c) calcium: +400 mg daily - consumption of four or more servings of milk
d) fluid: +2 to 3 quarts of fluids daily, no sodas
111
where do nutritional problems usually start?
at home not at a healthcare facility
112
T or F breastfeeding enhance afterpains
T, breastfeeding stimulates oxytocin release which plays a part in contractions that cause afterpains
113
what is the sandwich technique?
a technique used in breastfeeding to help the mom get baby to latch on, mom grasps brest by making a C with hand where thumb stabilizes top of breast and remaining four fingers support breast from below
114
what are the different classifications of bottle formula?
1) cow's milk-based (Enfamil, Similac)
2) soy protein-based (Isomil, Prosobee, Nursoy)
3) specialized therapeutic for infants with protein allergies (Nutranigen, Pregestimil, Alimentum)
---- all come in different forms
a) powders: must be mixed with water
b? condensed liquid: must be diluted with equal amounts of water
c) ready to use
d) prepackaged (ready to use in disposable bottles)
115
how much energy to newborns need to consume a day?
108 cal/kg which is usually 650 cal/day
116
how many ounces are consumed in each feeding by a newborn
2-4 ounces
117
until 4 months, how many feeding a day do bottle-fed infants need?
6 then declines
118
T or F if a patient's baby is suffering from a low temperature, a non-pharm intervention is heating up its milk in the microwave
False, NEVER heat up formula in the microwave - doesn't heat evenly
119
When feeding a newborn what position should it be in when hel?
always hold the bottle yourself and never prop it, hold baby in dominant arm which should be supported by a pillow or have newborn in semiupright supported by te crook of your arm
120
what type of formula should you only use in the first year?
only iron-fortified formula
121
T or F you should only use plain water to clean a mother's breasts
T, soap is drying and should be avoided
