Symptoms: Itching, Discomfort Bright Red Bleeding Interventions: Stool softeners, witch hazel pads (Tucks), topical ointment, increased fiber in diet

Maternity 5-1 Flashcards by Amanda S.

Postpartum - how many weeks?

the period between the birth of the newborn and the return of the
reproductive organs to their normal non- pregnant state. Usually complete by 6-8 weeks post-birth

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Involution

Return of the uterus to
a non-pregnant state after birth.a non-pregnant state after birth.
Begins with the expulsion of the
placenta and contraction of the
smooth muscle.

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Subinvolution

failure of the
uterus to return to nonpregnantuterus to return to nonpregnant

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Uterine Assessment:

Consistency,
location relative to umbilicus,
midline/right/left
7
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postpartum VS - how often?

Head-to-toe assessment: Q shift and PRN

VS & OB assessment (includes pain!) up to 2 hours PP:
q 15 x 1 hour
q 30 x 1 hour

VS & OB assessment: twice shift/1st 24 hours, once shift/> 24 hours PP

Additional post c/s assessments PRN

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PROCESS OF INVOLUTION (contract the hemo cat)

Contraction of uterine muscle fibers

Hemostasis is achieved primarily by compression of the intra-myometrial blood vessels as the uterine contracts

Catabolism: shrinking of enlarged myometrial cells

After lochia sheds, uterine lining regenerates

Fundus not palpable by 10 days post birth

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FACTORS PROMOTING INVOLUTION

Oxytocin (Pitocin)
Breastfeeding
Urine output
Fundal Massage
Ambulation

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bladder too full

uterus will go to right

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Lochia Rubra (red for 3 days)

~2-3 days
* Blood, decidual
tissue/debris, mucus
* Color: bright red

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Lochia Serosa - what days? (seriously pink and brown)

~3-10 days
* Blood, serum, leukocytes
and tissue debris
* Color: pinkish brown

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Lochia Assessment- how many pad changes a day?

Amount: Initially, expect 6-8 pad changes per day
Odor
Clots

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Lochia - scant (scantly one, do the conversion)

Lochia Assessment
* Scant < 2.5cm (1 inch)

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Vagina and Perineum

Bruising and edema of the perineum
* Lacerations/Episiotomy
* Hemorrhoids

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Hemorrhoids

Symptoms: Itching, Discomfort Bright
Red Bleeding
Interventions: Stool softeners, witch
hazel pads (Tucks), topical ointment,
increased fiber in diet

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Nursing Care: Perineal Trauma

Ice packs: 1st 24 hours
* Peri-bottle with every voiding
* Sitz Bath (after 24 hours)
* Pain Control
25

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Urinary Tract: Postpartum Changes - what about gfr?

Urinary Tract: Postpartum Changes
* Decreased GFR & Renal plasma flow
* Tone/size of structures returns to pre-
pregnancy state (6-8 weeks)

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maximum time to allow a pt to go without peeing?

6 hours

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Nursing Care:
Urinary Tract
Postpartum - how often to void?

Assist patient to void following delivery
* Assess for fundal displacement
* Encourage to void q2 hours
* Pain relief & Edema/trauma: ice, analgesia, sitz bath,
topical spray
* Difficulty voiding:
* Decreased sensation of full bladder
* Pain
* Edema/trauma
* Peppermint essential oil in toilet water
* Document urine output per provider order
* Bladder scanner/straight cath PRN

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GI Tract - constipation for how long?

Bowel tone will improve as
progesterone levels decline.
 Delayed spontaneous bowel
movement, up to 5 days PP.
 Labor/birth effects: pre-labor diarrhea,
lack of food, dehydration, anticipatory
pain due to lacerations/tissue trauma
 C/S: Intra-op narcotics, disruption of
intestines during surgery, delayed
ambulation, NPO

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GI Changes/Nutrition - how many extra calories if breastfeeding?

Breast-feeding vs. bottle-
feeding
* If breast-feeding:
* Encourage prenatal
vitamins
* Increase calories if breast-
feeding (450-500 kcal)
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Nursing Care: GI Changes

Encourage hydration and ambulation
* Diet high in fiber
* Stool softeners/laxatives/anti-gas meds PRN
* Encourage normal food intake
* Adhere to ATC non-narcotic pain regimen post C/S
* Comfort measures
31

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Nursing Care: GI
Changes/Nutrition - foods high in what?

Iron PRN
* Foods high in iron
* Iron supplement/infusion
* Education: constipating
effect of p.o. iron
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Cardiovascular System: Postpartum
Changes - cardiac output

Study These Flashcards

Heart: returns to pre-pregnant position
* Cardiac output: gradually declines/3 months, HR
slows/increased stroke volume

Cardiovascular System: Postpartum
Changes - when does coagulation return to normal? (coag is the number of the beast)

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Increased coagulability of pregnancy: Returns to pre-pregnancy state
by 6 weeks

Respiratory System: Postpartum Changes - RRs?

RR: 16-24  Diaphragm returns to normal position SOB relief

Integumentary System: Postpartum Changes - when does hair loss occur?

Pregnancy pigmentation fades: melasma, linea nigra, nipples * Hair loss: more hairs in resting phase pre-birth, most hair loss by 3 months PP w/ dec in estrogen * Striae gravidarum: stretch marks start to fade

linea nigra - fade or not?

usually fades

integumentary

Pregnancy pigmentation fades: melasma, linea nigra, nipples * Striae gravidarum: stretch marks start to fade

endocrine

Delivery of placenta: rapid clearance of placental hormones

Endocrine System - when does menses return for breastfeeding and non-breastfeeding?

Ovulation may occur before first period. * Menses: May return at 6-8 weeks if not breastfeeding exclusively or exclusively * Breast-feeding: dependent upon frequency of breast-feeding, average 6 months 39

endocrine

Delivery of placenta: rapid clearance of placental hormones * Adrenal release: patient may experience shaking in 1st 30 min PP * Decrease in estrogen: diuresis, remain low if breastfeeding * HCG, HPL, progesterone all drop * Prolactin: inc w/ breastfeeding, released by anterior pituitary 38

Postpartum Pain Management: Sources of Pain

Remember: Assess, Intervene PRN, Re-assess, Document! * Uterine cramping * Afterpais * Stronger w/ multiparity, full bladder, breastfeeding * Oral analgesia, heat therapy, frequent voiding * Perineal/labial/rectal * Oral analgesia, care of lacerations/hemorrhoids * Breasts: Nipple tenderness Assess positioning Teach nipple care  Engorgement Encourage frequent breastfeeding Cold packs NSAIDS Supportive bra Cold Cabbage leaves Areola softening 42

Sources of Pain - Post C-Section pain

Assist w/ mobility PRN * Promote early ambulation * Promote return of GI function * Ensure pain controlled: the more mobile the patient, the less likely pain is to be severe * Assess incision for infection 43

Postpartum Pain Management: Analgesia

Oral Analgesia: Acetaminophen, Ibuprofen, Oxycodone * IV, non-narcotic: Acetaminophen, ketoralac * NSAIDs (ibuprofen/ketorolac) * Inhibit prostaglandin * Decrease inflammatory responses * Effective in peripheral tissues * Epidural/Spinal: Duramorph * PCA: dilaudid, morphine 44

Lactation: Breast Changes - what stimulates breast tissue?

Prenatally: Mammary glands develop/proliferate * Estrogen stimulates dev’t of breast tissue

Lactation: Hormones - Prolactin -what do high levels do?

 High levels suppress FSH/ovulation  Inc days 4-5 PP w/ drop of estrogen/progesterone  Increase in response to nipple stimulation

Maternal Contraindications to Breastfeeding

Chemotherapy or radioactive isotopes * “illicit” drugs * Active TB * HIV positive (in the U.S.) * Certain Rx drugs * Resources: Lactmed, Hale’s guide

uterine weight

Uterus weighs 2.2 lb (1,000 g) at time of FT birth, 2 oz at 6 wk PP

lochia light - (lights out at 10)

* Light < 10 cm (4 inches)

lochia moderate - (moderate comes after lights out)

* Moderate > 10cm

lochia heavy - pad in how many hours?

* Heavy = one saturate pad within 2 hours

decreased estrogen - mucosa?

thin mucosa, absence of rugae, dryness (3-4 weeks)

urinary - diuresis due to...(what hormones?)

* Increased output: diuresis due to decreased oxytocin/decreased blood volume/decreased aldosterone (12 hours PP-1 week) * Risk for urinary retention: swelling, anesthesia, decreased urge to void, pain * Risk of infection: d/c foley ASAP

what drugs help involution? (hmm, helps involution?)

Hemabate, Misoprostol, Methergine

BP - when does it return to normal? (it's all within the postpartum timeframe)

* BP: decrease/1st 2 days PP, inc to normal by 6 weeks PP

blood volume - when does it return to normal? (jessica's blood is 26)

* Blood volume: drops rapidly PP/returns to pre-pregnant state 2-6 weeks

plasma - how does it decrease?

* Plasma volume: decrease through diuresis/increase H &H

when do wbc return to normal? (think, WBC can't stay high too long)

* WBCs: rise intrapartum, return to normal at 4-6 days PP

clotting factors - how long do they stay elevated? (clots until age 23)

* Clotting factors remain elevated 2-3 weeks PP * Monitor for DVT/thromboembolism

hemaglobin and hematocrit? when is the dip?

* H & H: initial dip (1st 24 hours), then rise

when does tidal volume return to normal? (tidal 13)

Tidal volume/functional residual capacity: pre-pregnant state by 1- 3 weeks PP

diaphoresis - when does it occur? (sweat at first)

* Diaphoresis: mechanism to rid body of excess fluid in first week PP

endocrine - adrenal release when? (think of pt)

* Adrenal release: patient may experience shaking in 1st 30 min PP

Decrease in estrogen - what happens? (estrogen dies)

* Decrease in estrogen: diuresis, remain low if breastfeeding

* HCG, HPL, progesterone drop or increase?

* HCG (Human chorionic gonadotropin), HPL (Human placental lactogen (HPL), progesterone all drop

prolactin - increase or decrease?

* Prolactin: inc w/ breastfeeding, released by anterior pituitary

postpartum breasts - when do they become fuller?

* PostpartumBreasts gradually become fuller and heavier 72-96 hours PP * Transition from colostrum only to full breast milk

Maternity 5-1 Flashcards

(57 cards)