Chapter 17:After Delivery Flashcards
Exam 2
1
Q
Postpartum Physiological Changes and Care #1:
How long after birth does pregnancy changes reverse?
A
Most pregnancy changes reverse within 6 weeks after the birth.
2
Q
Postpartum Physiological Changes and Care #1:
Involution
A
Involution is the shrinking of the uterus,
3
Q
Postpartum Physiological Changes and Care #1:
Involution: When does it begin?
A
Involution is the shrinking of the uterus, which begins immediately after the birth.
4
Q
Postpartum Physiological Changes and Care #1:
Involution: By what time should uterus return to prepregnancy size?
A
By 6 weeks, the uterus should be returned to prepregnant size.
5
Q
Postpartum Physiological Changes and Care #1:
What is a defense against postpartum hemorrhage?
A
Uterine contraction after birth is a defense against postpartum hemorrhage.
6
Q
Postpartum Physiological Changes and Care #1:
What is administered after birth?
A
Oxytocin (Pitocin) may be administered after birth to promote uterine contraction and prevent hemorrhage.
7
Q
Postpartum Physiological Changes and Care #1:
Why is oxytocin administered after birth?
A
Oxytocin (Pitocin) may be administered after birth to promote uterine contraction and prevent hemorrhage.
8
Q
Postpartum Physiological Changes and Care #1:
What may contribute to the uterus not contracted as expected?
A
Bladder distention may contribute to the uterus not contracting as expected.
9
Q
Postpartum Physiological Changes and Care #1:
How does placenta site heal? What does this allow for?
A
Placenta site heals by sloughing of the decidua and not by forming scar tissue. This allows for future pregnancies.
10
Q
Postpartum Physiological Changes and Care #1:
What is lochia?
A
Lochia is the vaginal discharge after birth.
11
Q
Postpartum Physiological Changes and Care #2:
What are the three types of Lochia?
A
Lochia rubia
Lochia serosa
Lochia alba
12
Q
Postpartum Physiological Changes and Care #2:
Lochia rubra: What is the appearance?
A
Dark red
13
Q
Postpartum Physiological Changes and Care #2:
Lochia serosa: What is the appearance?
A
Lighter red, pink or brown
14
Q
Postpartum Physiological Changes and Care #2:
Lochia alba: What is the appearance?
A
Yellow or white
15
Q
Postpartum Physiological Changes and Care #2:
Lochia rubra: What is the composition?
A
Blood
Decidua
Other pregnancy debris
16
Q
Postpartum Physiological Changes and Care #2:
Lochia rubra: What is the duration?
A
3-4 days
17
Q
Postpartum Physiological Changes and Care #2:
Lochia serosa: What is the appearance?
A
Lighter red, pink or brown
17
Q
Postpartum Physiological Changes and Care #2:
Lochia rubra: What are abnormalities that can be present?
A
Foul odor (suggests infection)
Saturation of pad in 15 min or less
Tissue
Clots larger than plums
Duration more than 4 days
18
Q
Postpartum Physiological Changes and Care #2:
Lochia serosa: What is the composition?
A
Debris,
old blood
White blood cells
serum
19
Q
Postpartum Physiological Changes and Care #2:
Lochia serosa: What is the duration?
A
10-14 days
20
Q
Postpartum Physiological Changes and Care #2:
Lochia serosa: What are abrnomalities?
A
Saturation of pad in 15 minutes or less
Foul odor (suggests infection)
Bright red blood for more than 1-2 hours
21
Q
Postpartum Physiological Changes and Care #2:
Lochia alba: What is the appearance?
A
Yellow or white
22
Q
Postpartum Physiological Changes and Care #2:
Lochia alba: What is the composition?
A
White blood cells
serum
mucus
bacteria
23
Q
Postpartum Physiological Changes and Care #2:
Lochia alba: What is the duration?
A
2-4 weeks
24
Postpartum Physiological Changes and Care #2:
Lochia alba: What are abnormalities?
Foul odor (suggests infection)
Bright red blood for more than 1-2 hours
25
Postpartum Physiological Changes and Care #3:
What is the typical blood loss during a vaginal birth?
Blood loss during a vaginal birth is typically between 200 to 500 mL
26
Postpartum Physiological Changes and Care #3:
What is the typical blood loss during a cesarean birth?
500 to 1,000 mL during a cesarean birth.
27
Postpartum Physiological Changes and Care #3:
When does excess blood volume resolve after birth? How?
Excess blood volume resolves over the first few days after birth through blood loss, diuresis, and diaphoresis.
28
Postpartum Physiological Changes and Care #3:
What happens to wbc count during and after labor?
White blood cells elevate during labor and immediate postpartum even without infection.
29
Postpartum Physiological Changes and Care #3:
What should the nurse ensure? What should the nurse monitor and assess signs for?
Nurses should ensure patients are hydrated, monitor for temperature greater than 38˚C (100.4˚F), and assess for signs of infection.
30
Postpartum Physiological Changes and Care #3:
What is there an increased risk for during the postpartum period? Why?
There is an increased risk of DVT or PE during the postpartum period due to increased clotting ability and immobility.
31
Postpartum Physiological Changes and Care #3:
What should the nurse do to decrease risk of PE?
Nurses should encourage early and frequent ambulation to decrease risk of PE.
32
Postpartum Physiological Changes and Care #3:
What circumstances is Rho (D) Immune globulin administered? When?
If a patient is Rh negative and the infant is Rh positive, Rho(D) immune globulin should be administered within 72 hours.
33
Postpartum Physiological Changes and Care #4:
What happens to hormones after detachment of placenta?
Hormones of pregnancy drop quickly after the detachment of the placenta.
34
Postpartum Physiological Changes and Care #4
When do estrogen levels return to prepregnancy levels?
Estrogen levels return to prepregnancy level within 2 weeks in patients who are not breastfeeding.
35
Postpartum Physiological Changes and Care #4:
Maternal adaptation phases after childbirth include:
1. The taking-in phase
2. The taking-hold phase
3. The letting-go phase
36
Postpartum Physiological Changes and Care #4:
Maternal adaptation phases after childbirth include: 1. The taking-in phase
The taking-in phase, where the patient recovers and takes a passive, dependent role.
37
Postpartum Physiological Changes and Care #4:
Maternal adaptation phases after childbirth include: 2. The taking-hold phase
The taking-hold phase, where the patient processes the birth experience and transitions to independent behavior.
38
Postpartum Physiological Changes and Care #4:
Maternal adaptation phases after childbirth include: 3. The letting-go phase
The letting-go phase, where the patient acknowledges the new normal and sees the baby as a person instead of an idea.
39
Physiologic changes of the Cervix, Vagina, and Pelvic Muscles:
What happens by 2-3 days postpartum?
By 2-3 days postpartum, the opening of the cervix (os) has contracted from 10cm to 2-3cm and within a week, to 1 cm.
40
Physiologic changes of the Cervix, Vagina, and Pelvic Muscles:
What happens within 1 week of postpartum?
By 2-3 days postpartum, the opening of the cervix (os) has contracted from 10cm to 2-3cm and within a week, to 1 cm.
41
Physiologic changes of the Cervix, Vagina, and Pelvic Muscles:
How does the cervix (os) appear immediately postpartum?
The os appears bruised immediately postpartum and may be lacerated.
42
Physiologic changes of the Cervix, Vagina, and Pelvic Muscles:
How are small lacerations dealt with immediately after postpartum?
Small lacerations can heal without intervention, but large ones require attention.
43
Physiologic changes of the Cervix, Vagina, and Pelvic Muscles:
How are large lacerations dealt with immediately after postpartum?
Small lacerations can heal without intervention, but large ones require attention.
44
Physiologic changes of the Cervix, Vagina, and Pelvic Muscles:
When does the pelvic floor muscles regain tone?
The pelvic floor muscles regain tone after 6 months.
45
Physiologic changes of the Cervix, Vagina, and Pelvic Muscles:
What can progress the pelvic floor muscle tone?
This progression and the degree of tone regained may be aided by Kegel exercises.
46
Postpartum Nursing Care:
BUBBLEEE
Breasts
Uterus
Bladder
Bowels
Lochia
Episiotomy/perineum
Extremities
Emotional status
47
Breast exam for BUBBLEEE
-Breasts should be symmetrical and soft
-nontender for the first 24 hours, slowly and progressively more until full milk in 2-5 days.
Engorgement manifests as breast fullness and tenderness
48
Uterus exam for BUBBLEEE
Uterus should be firm and midline, descending from the umbilicus toward the pelvis at a predictable rate
49
Bladder exam for BUBBLEEE
Encourage frequent emptying of the bladder because a full bladder can displace the uterus and cause atony
50
Infrequent emptying of the bladder can lead to what?
Infrequent emptying of the bladder may also predispose a patient to cystitis
51
Slide 7 BOWELS, LOCHIA, EPISTOMY, EXTREMITIES, EMotional
52
Postpartum Nursing Assessments #3:
What does postpartum care include assessment of?
Postpartum nursing care includes assessment of involution, uterine tone and position, and lochia.
53
Postpartum Nursing Assessments #3:
When are post partum nursing assessments done?
Postpartum nursing assessments are done frequently for the first few hours after birth and decrease to once per shift after 24 hours.
54
Postpartum Nursing Assessments #3:
What should the nurse ask the patient about?
The last void of urine and if the perineal pad was changed.
The last time the patient breastfed the infant.
If the patient has been experiencing afterpains.
When the patient last ambulated.
55
Postpartum Nursing Assessments: Uterus #1:
How does the nurse assess the uterus?
To assess the uterus, the nurse should stabilize the lower uterine segment with one hand and palpate the fundus with the other.
56
Postpartum Nursing Assessments: Uterus #1:
What are expected uterine findings?
Expected uterine findings are that the uterus is firm, midline, and near the level of the umbilicus.
57
Postpartum Nursing Assessments: Uterus #1:
What does a boggy uterus indicate?
A boggy uterus indicates uterine atony and a risk for hemorrhage.
58
Postpartum Nursing Assessments: Uterus #1:
When palpating the fundus, what should the nurse assess?
The nurse should assess lochia with palpation of the uterine fundus.
59
Postpartum Nursing Assessments: Lochia
How is lochia documented as?
Lochia is documented as scant, light, moderate, or heavy.
60
Postpartum Nursing Assessments: Perineum:
What should the perineum be assessed for?
The perineum should be assessed for signs of infection, varicosities (hemorrhoids), trauma, and healing.
61
Postpartum Nursing Assessments: Perineum:
How should the perineum be assessed?
To assess a patient's perineum, have the patient lay on the side with the knees bent
62
Postpartum Nursing Assessments: Perineum:
What should you assess the wounds for in the perineum area?
Assess wounds for redness, edema, ecchymosis, discharge, and approximation.
63
Postpartum Nursing Care #1:
What medication should be given for perineum pain?
Acetaminophen and ibuprofen are commonly ordered for childbirth pain.
64
Postpartum Nursing Care #1:
What can be applied for perineum pain?
Ice packs may be applied for perineal pain.
65
Postpartum Nursing Care #1:
What should be done to decrease discomfort and maintain hygiene in the perineum area?
To decrease discomfort and maintain hygiene after urination or defecation, a warm water peri bottle is used over the perineum.
66
Postpartum Nursing Care #1:
What is given to ensure stool is soft? Why is this necessary?
Docusate sodium is often given to ensure stool is soft so that it is less likely to cause pain or require pushing.
67
Postpartum Nursing Care #1:
What could be used for comfort and healing?
A sitz bath may be used for comfort and healing.
68
Postpartum Nursing Care #2:
For breast care:
What should nurses teach patients is first produced for the first few days?
Nurses should teach patients that colostrum is produced for the first few days after the birth and continues until milk comes in.
69
Postpartum Nursing Care #2:
For breast care: How do breasts become?
Breasts can become engorged (i.e., firm, warm, and tender).
70
Postpartum Nursing Care #2:
For breast care:
What should the nurses encourage the patient to do?
The nurse can encourage the patient to pump or hand express engorged breasts to provide relief and soften the breasts for the infant to feed.
71
Postpartum Nursing Care #2
For breast care:
What can be applied after feeding? Why?
Ice packs can be applied after feeding to minimize swelling.
72
Postpartum Nursing Care #2:
For breast care:
Having to do the the infant, what should nurses assess for?
Assess the infants breastfeeding latch to minimize discomfort and ensure a successful feeding.
73
Cesarean Birth Considerations #1:
How long does recovery of a c-section birth take?
Recovery from cesarean birth can take up to 6 weeks.
74
Cesarean Birth Considerations #1:
How long are patients hospitals after a c-section?
Patients generally remain hospitalized for 2 to 5 days after a cesarean birth.
75
Cesarean Birth Considerations #1:
What kind of births have more complications?
More complications arise from cesarean births than vaginal births, particularly if the birth was an emergency.
76
Cesarean Birth Considerations #1:
Common cesarean complications include:
Endometritis (inflammation of the lining of the uterus)
Wound complications (dehiscence, infection, or hematoma)
Hemorrhage
Surgical injury
Blood clots
77
Cesarean Birth Considerations #1:
Common cesarean complications include:
What are wound complications that occur?
(dehiscence, infection, or hematoma)
78
Endometritis:
Endometritis (inflammation of the lining of the uterus)
79
Cesarean Birth Considerations #2:
What is left in place until the patient can ambulate?
A Foley catheter is left in place until the patient can ambulate.
80
Cesarean Birth Considerations #2:
What is the patient assessed for (having to do with bowels)? Why?
Patient is assessed for flatus because it is evidence that the bowels are working.
81
Cesarean Birth Considerations #2:
When is the dressing over the c-section incision removed?
The dressing over a cesarean incision is generally removed after 24 hours.
82
Cesarean Birth Considerations #2:
When are staples or sutures removed?
Staples or sutures are generally removed between 3 and 7 days postpartum.
83
Cesarean Birth Considerations #2:
What kind of feelings may the patient feel about c-section?
The patient may need to express feelings of being letdown, especially if the surgery was not planned.
84
Cesarean Birth Considerations #2:
What kind of weight can the patient lift?
Patients should be taught not to lift anything heavier than the infant for 4 to 6 weeks.
85
Cesarean Birth Considerations #2:
Why should patients not drive?
Patients should not drive as long as they are taking opioid medications.
86
Postpartum Discharge Instructions #1:
When does discharge planning start?
Discharge planning starts when the patient is admitted to the hospital.
87
Postpartum Discharge Instructions #1:
When is a patient discharged after vaginal birth?
The patient will usually be discharged within 48 hours of an uncomplicated vaginal birth
88
Postpartum Discharge Instructions #1:
When is a patient discharged after c-section birth?
The patient will usually be discharged within 48 hours of an uncomplicated vaginal birth and nearly half of patients within 48 hours of a cesarean birth.
89
Postpartum Discharge Instructions #1:
Patients should be taught to report the following:
New onset pain, burning, pain, or frequency of urination
New onset leg pain and warmth (may indicate a DVT).
Chest pain and shortness of breath (signs of a PE).
Localized firm areas of redness on the breast, especially with flu-like symptoms
Pelvic pain
90
Postpartum Discharge Instructions #1:
Patients should be taught to report the following:
What can new onset leg pain and warmth indicate?
(may indicate a DVT).
91
Postpartum Discharge Instructions #1:
Patients should be taught to report the following:
What can chest pain and SOB indicate?
Chest pain and shortness of breath (signs of a PE).
92
Postpartum Discharge Instructions #2:
What are teaching for a patient to return to the hospital?
Elevated temperature
Foul-smelling lochia
Return of heavy, bright red lochia lasting more than a few hours (possible secondary postpartum hemorrhage).
Sustained depressed mood or sadness (possible postpartum depression).
Thoughts of hurting oneself or infant (possible postpartum psychosis).
93
Postpartum Discharge Instructions #2:
What are teaching for a patient to return to the hospital: What can return of heavy, bright red lochia lasting more than few hours indicate?
(possible secondary postpartum hemorrhage).
94
Postpartum Discharge Instructions #2:
What are teaching for a patient to return to the hospital: What can sustained depressed mood or sadness indicate?
Sustained depressed mood or sadness (possible postpartum depression).
95
Postpartum Discharge Instructions #2:
What are teaching for a patient to return to the hospital: What can thoughts of hurting oneself or infant indicate?
Thoughts of hurting oneself or infant (possible postpartum psychosis).
96
Postpartum Discharge Instructions #4:
Patients should be taught the following self-care:
Perineal care
Breast care
Pain control
Discharge medications
Nutritional needs
Activity and exercise
Rest
Contraception
Sexual activity
Smoking
97
Slide 19 if you have time
probs not
98
Slide 21 should be read
Breastfeeding Education Points
99
Postpartum Psychosocial Changes and Care:
What is included?
Bonding
Attachment
Maternal Adaptation
Partner Adaption
Nursing Education
Postpartum Support International (PSI)
