Class 3 Study Guide Flashcards
Subinvolution
delayed return of uterus to its non-pregnancy size and consistency
can cause hemorrhage
Lochia:
Scant- Light- Moderate- Heavy- Excessive
scant: less than 1 in L: 1-4 in M: 4-6 in H:1 pad in an hour E: 1 pad in 15 mins
dyspareunia
discomfort during intercourse due to vaginal dryness cause by lack of estrogen production during lactation/breastfeeding
Episiotomy
first degree
second degree
third degree
fourth degree
1st: involved superficial vaginal mucosa or perineal skin
2nd: involves vaginal mucosa, perineal skin and deeper tissues that may be fascia or muscle
3rd: same as second, but involves anal sphincter
4th: extends to anal sphincter and rectal mucosa
Why is protein and acetone found in urine during first few days postpartum?
protein: results from catobolic process of involution
acetone: suggest dehydration
What does diastasis recti usually resolve?
seperation of abdominal rectus muscles that ussualy resolves within 6 weeks postpartum
Hair loss and pospartum
hair loss begins at 4-20 weeks after delivery and is regrwn in about 4-6 months
caused my hormonal changes
What s/s to do you monitor for what may indicate developing or worsening preeclampsia?
headache proteinuria blurred vision photophobia abdominal pain
Describe normal weight loss during postpartum
about 12 lbs lost during child birth which is weight of fetus, placenta, amniotic fluid, and blood loss
additional 9 lb during first 2 weeks and another 5.5 by 6 months
younger and lower prepregnnacy weight loose weight quicker
most women retain about 2.2 lb per pregnancy
List risk factors for hemorrhage
grand multiparity
over distention of uterus (LGA, twins, hydramnios)
rapid/prolong labor
retained placenta
placenta previa/abrupto
drugs (tocolytics, mag sulfate, oxytocin)
operative procedures (vacuum, forceps, c/s)
uterine fibroid
history of hemorrhage
preeclampsia
coagulation defects
List risk factors for infection
operative procedures (vacuum, forceps, c/s) multiple cervical examinations prolonged labor prolonged ROM manual extraction of placenta or retained fragments DM catherization bacterial colonization of genital tract
How much food/fluid is encouraged within first 24 hours post delivery?
food should be readily available at all times
2500 mL of fluids a day
Why is bonding a nursing priority during postpartum and ways a nurse may promote bonding
Bonding is the initial attraction felt by parents for their infants
Bonding is enhances when parent and infant are permitted to touch and interact within first 30-60 mins
Infant may be placed on mothers chest after delivery and nurses may put off procedures to mother and baby can bong
How can you assess maternal adaption?
Progression through puerperal phases:
- taking in (passive, dependent)
- taking hold (autonomous, seeks information)
- letting go (relinquishes fantasy baby)
Maternal Mood:
-mood, energy, eye contact, posture, comfort
Factors that affect mood:
- age of mother (teens may need support)
- previous experiences
- maternal and infant temperaments
- c/s
Interaction with infant:
- maternal touch (progress from fingertip to enfolding)
- verbal interaction (progress from calling infant it to name)
- response to infant cues or signals
Preparation for parenting:
-breastfeeding classes, parenting or infant care
Caloric requirements for full term newborn
85-100 kcal/kg is breastfed
100-110 kcal/kg if formula fed
Fluid requirements for full term newborn
60-100 mL/kg first 3-5 days of life and gradually increase to 150-175 mL/kg
Colostrum
Higher in protein, vitamens and minerals
Rich in IgA
low in carbs, fat, and lactose
Develops during pregnancy and early days following birth
Transitional Milk
milk amount increases dramatically
immuglobulins and protein decrease lactose, fat and calories increase
vitamin content same as mature milk
Begins at day 2-3, and ends around day 10
Mature Milk
Contains about 20kcal/oz
nutrients sufficient to meet infants needs
provides imunoglobulins and other antibacterial components
Comes in around day 10
How often should the infant be breastfed?
every 1.5 to 3 hours with about 8-12 feedings per 24 hours
How can you tell if the baby is getting enough milk
- counting # of wet and soiled diapers, infants should have 3-4 wet diapers and 4 stools daily.
- infant weight gain
Latch Scoring
L: latching onto breasts = 2, repeated attempts=1, no sustained latch=0
A:audible swallowing=2, few swallows=1, no swallowing=0
T: Type of nipple, everted=2,flat=1, inverted=0
C: comfort, soft nontender breast=2, redness or mild-moderate discomfort=1, severe discomfort =0
H: hold/position of the infant. no assistance needed =2, some assistance =1,more requires staff to position=0
Drug transfer and breastfeeding
- most medications pass through breast milk to some degree and are safe for lactation, but always double check with provider.
- if medication passes in large amounts and isn’t safe for infant, pump and dump temporarily until medications are no longer being taken.
Breastfeeding and HIV/Hep B
- Contraindicated with HIV
- Mothers with Heb A, B, C can breast feed, if hep B infant should receive HBIG and HBV vaccine
