Exam 2 ++ Summary Set - Normal Postpartum Flashcards
(94 cards)
1
Q
the postpartum period is ____
A
the first 6 weeks after the birth of the infant (for this class)
2
Q
name at least 4 challenges of postpartum period
A
(1) sleep deprivation
(2) fatigue
(3) pain
(4) breastfeeding challenges
(5) stress
(6) urinary incontinence
(7) lack of sexual desire
3
Q
rapid reduction in size of uterus and return to pre-pregnant state
A
involution
4
Q
when the process of involution does not happen properly
A
subinvolution
5
Q
_____ increases the risk for postpartum hemorrhage
A
subinvolution
6
Q
allows for healing of placenta site and is important part of involution
A
exfoliation
7
Q
involution / after pains are ___
A
intermittent contractions
8
Q
what states can make involution / after pain more acute?
A
(1) multips
(2) if uterus has been overdistended
(3) breastfeeding
9
Q
why does breastfeeding increase involution / after pain?
A
because of the release of oxytocin
10
Q
to address involution / after pain, nurses should…
A
(1) administer analgesic
(2) help with position changes
(3) apply heat
11
Q
uterus rids itself of debris remaining after birth through discharge
A
lochia
12
Q
at birth, lochia is typically ___
A
bright red
13
Q
the first 3 days after birth, lochia is typically
A
Rubra - dark red
14
Q
days 4-10 after birth, lochia is typically
A
Serosa - pink or brown-tinged
15
Q
days 11-14 after birth, lochia is typically
A
Alba - white, cream or light yellow
16
Q
how will you know if blood is collecting and forming clots within the uterus after birth?
A
the fundus will rise and become boggy
17
Q
a boggy uterus is also called
A
uterine atony
18
Q
we expect the fundus to be ____ after birth
A
firm with some blood
19
Q
expected blood loss after birth is up to ___ before we become concerned
A
500mL
20
Q
1 inch of bleeding is considered
A
light
21
Q
pushing, fetal head descent, and birth trauma can lead to
A
perineal lacerations
22
Q
1st degree perineal laceration is
A
skin only
23
Q
2nd degree perineal laceration is
A
tearing of the perineal muscles
24
Q
3rd degree perineal laceration is
A
anal sphincter tear
25
4th degree perineal laceration is
tears through the rectum
26
when do perineal lacerations require surgery?
4th degree (tears through rectum)
27
name the physiological changes of the cervix after birth
internal os closes and cervix returns to normal; os may remain open for a few days
28
name the physiological changes of the vagina after birth
(1) rugae regained after 3-4 weeks
(2) edema resolves by 6-10 weeks
(3) mucosa becomes atrophic
(4) vaginal walls do not regain thickness until E2 production
29
_____ are likely to experience vaginal dryness and dyspareunia
breastfeeding persons
30
name the physiological changes of the cardiovascular system after birth
(1) hypervolemia
(2) initial increase in CO; then returns to normal within an hour
(3) plasma volume returns to normal
(4) leukocytosis (returns to normal by 6 days)
(5) increase in plasma fibrinogen (risk for clots)
31
immediately after delivery there is a ___ in CO
increase
32
____ returns to pre-labor values within an hour
CO
33
when does CO decrease and return to pre-pregnancy levels?
6-12 weeks after childbirth
34
how does plasma volume return to pre-pregnancy levels?
through diuresis and diaphoresis
35
excreting water through urine
diuresis
36
water loss through sweating
diaphoresis
37
how long is someone at an increased clot risk after pregnancy?
4-6 weeks
38
why do we not give CHCs following birth?
increased risk for clotting
39
name the physiological changes of elimination after birth
(1) hungry and thirsty
(2) temporary constipation
(3) flatulence (more common in C-section)
40
temporary constipation and slow bowels after birth are related to
(1) lingering effects of progesterone
(2) decreased muscle tone
41
normal elimination pattern returns by _____ days after birth
8-14
42
name the physiological changes of the urinary tract after birth
(1) diminished sensitivity to fluid pressure
(2) bladder fills rapidly d/t diuresis
(3) stress incontinence
43
if the fundus is higher than expected on palpation and is not midline, we should suspect
bladder distention
44
if we don't empty the bladder, there is less space for the ____ to ____
uterus to contract effectively
45
why is it important for the uterus to contract effectively after birth?
to avoid excessive bleeding
46
what can you do to help empty the bladder in someone that had an epidural?
straight catheter
47
name the physiologic changes of the MSK system after birth
(1) relaxin decreases and can lead to hip or joint pain
(2) muscle aches and fatigue from effort of labor
48
how do we assess diastasis recti?
how many fingerbreadths apart the muscle separation is
49
typical diastasis recti is ____ fingerbreadths
2
50
diastasis recti usually resolves in ____
6 weeks
51
name the neurologic physiologic changes after birth
(1) bilateral and frontal headaches
(2) spinal headache
(3) preeclampsia
52
if headache is not getting better with rest, hydration, and tylenol, what should we be aware of?
postpartum preeclampsia
53
which type of headache is uncommon?
spinal
54
Name the mental health changes that occur after birth
(1) baby blues
(2) postpartum major mood disorders
(3) postpartum psychosis
55
immediate weight loss of postpartum is ____ due to ____
10-12 lbs; fetus, amniotic fluid, blood loss, and placenta
56
within 2 weeks of birth, the birthing person loses ___ lbs of fluid
~9
57
adipose tissue that was gained during pregnancy can take ____ to lose
6-12 months
58
usual length of stay for a vaginal delivery is
1-2 days
59
usual length of stay for c-section delivery is
2-4 days
60
explain the postpartum assessment schedule immediately following birth
(1) every 15 minutes for 1 hr
(2) every 30 minutes for 1 hr
(3) every hour for 2 hrs
(4) q4h for 24 hrs - c-section
(5) q8h until discharge - vaginal delivery and c/s after 24 hrs
61
the key components of postpartum assessment are
Brain
Breasts
Belly
Bladder
Bottom
Blood
Bowels
Extremities
62
what do you assess with Brain?
emotional status, feelings towards experience
63
what do you assess with Breasts?
(1) BF or formula
(2) tenderness
(3) soft vs firm
(4) color
(5) nipples - everted, flat, or inverted
(6) nipple trauma
(7) lumps
64
firm breasts may indicate
engorgement
65
what do you assess with Belly?
(1) incision and dressing (c/s)
(2) fundus consistency and location
66
we expect the fundus to be ______ after birth
firm and at the belly button
67
what do we assess for Bladder?
(1) monitor 2-3 voids post birth / catheter
(2) 300-400 mL indicates empty bladder
(3) signs of distended bladder
68
name 4 signs of a distended bladder
(1) fundus displaced from midline
(2) excessive lochia
(3) bladder discomfort
(4) bulge of bladder above symphysis
69
what do we assess for Bottom?
(1) perineum healing
(2) perineum comforts
70
REEDA stands for
R = redness
E = edema
E = ecchymosis (bruising)
D = discharge (not lochia)
A = approximation
71
REEDA is used to assess the ___
bottom
72
name 3 interventions for perineum healing
(1) provide fresh pads
(2) ice packs
(3) topical agents
73
what do we assess for Blood?
amount
type
odor
74
foul odor blood suggests ___
endometrial infection
75
what do you assess for Bowels?
(1) gas, esp with c/s
(2) bowel movements
(3) constipation (may lead to hemorrhoids or bleeding)
76
a BM should occur ___ following birth
2-3 days
77
what do you assess for Extremities?
(1) legs for varicosities and signs of thrombophlebitis
(2) edema and DTR
(3) ambulation
78
Deep tendon reflexes should be ___ after birth
1+ or 2+
79
Name at least 4 pieces of education to provide to postpartum patient
(1) ice packs
(2) sitz baths
(3) pericare
(4) aromatherapy
(5) acetaminophen
(6) ibuprofen
(7) topicals
80
ice packs are helpful because they ____
cause vasoconstriction and prevent edema
81
ice packs are best used ____ after birth
12-24 hours
82
in the first 12 hours, the sitz bath should have ___ water
cool
83
after 24 hours, the sitz bath can have ____ water
warm
84
name at least 4 topics of teaching for a PP patient
(1) perinatal mood disorders
(2) breast care
(3) follow-up care
(4) birth control
(5) IDA
(6) body changes
(7) bleeding
(8) peri care
(9) extremities
(10) warning signs
85
what teaching should you do for breast care?
(1) s/s of mastitis
(2) proper latch
(3) moistening nipples
86
s/s of IDA include
(1) weakness
(2) fatigue
(3) lightheadedness
(4) pale skin
87
____ is the main side effect of ferrous sulfate
constipation
88
take ferrous sulfate with ____ to improve absorption
vitamin C
89
what are the warning signs to call a provider?
(1) severe mood changes and self-harm thoughts
(2) concerns for infection
(3) heavy bleeding
(4) high BP
(5) increase in swelling
(6) shortness of breath
90
name at least 3 referral resources
(1) lactation consultant
(2) homecare visits by RN
(3) Doula
(4) public health nurses
(5) PT
(6) early parenting classes
(7) community support groups
91
nothing is recommended in the vagina for ____ after birth
6 weeks
92
how do you manage vaginal dryness?
lubricants and moisturizers
93
what may happen during orgasm?
milk letdown
94
what contraceptives are safe following pregnancy?
non-hormonal, progesterone-only, but NOT CHCs!
