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NRSG 344 > NRSG postpartum, newborn, and family > Flashcards

NRSG postpartum, newborn, and family Flashcards

1
Q

Postpartum Period (when, what)

A
  • When: up to 6 wks post birth
  • What: When the reproductive track returns to normal
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2
Q

4th stage of labor

A

first hour after delivery

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3
Q

What happens during the 4th stage of labor

A

*Fundal check begins
*Breastfeeding established
*Client adjusting to situation

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4
Q

Primipara

A

Woman who has had one pregnancy that results in a fetus that attained a wt of 500 g or a gestational age of 20 wks whether or not it was born alive

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5
Q

Multipara

A

A woman who has given birth 2 or more times

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6
Q

Grand multipara

A

A woman who has given birth 5 or more times

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7
Q

Handover report of a postpartum patient

A

*Should be face-to-face to ask questions
*ideally in presence of the pt
*includes accurate and complete prenatal hx
*Risk factors
*Delivery and immediate postpartum recovery summary
*Type of anesthesia, QBL, fluid balance, meds received, pain level
*breastfeeding attempts, and success or need for education

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8
Q

ISBAR

A

Identify yourself
Situation
Background
Assessment
Request or recommendation

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9
Q

Postpartum shivering (what)

A

Seen in 25-50% postpartum women after norm deliveries

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10
Q

PP shivering (when)

A

Usually 1-30 min post delivery, lasts 2-60 min

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11
Q

PP shivering (tx)

A

None needed, warm blanket for reassurance

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12
Q

Fall risk (how to eval)

A

*Evaluate musc control after anesthetic (ask pt to raise her knees, lift her feet one at a time, dorsiflex foot, raise her buttocks off bed
*First ambulation should be w/ assistance
*Sit in shower if needed
*Remain seated when holding the baby
Avoid sudden position changes
Check orthostatic vital signs when appropriate

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13
Q

Who is a fall risk

A

*pts who’ve had anesthetics, narcotics, blood loss, BP

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14
Q

Maternal Phsyiologic changes (first 2-3 days)

A

*Afterbirth pains: contractions during breast feeding
-Positive sign of good sucking by baby, since this stimulates release of oxytocin
-Uterus begins the process of shrinking back to size
-Consider giving Ibuprofen at least 30 min b4 next estimated feeding to reduce afterpains
*Postpartum blues: usually during this stage of PP, subsides in 1-2 wks

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15
Q

A client has just been transferred to the postpartum unit from labor and delivery.
Which of the following nursing care goals is of highest priority?
1. The client will breastfeed her baby every 2 hours.
2. The client will consume a normal diet.
3. The client will have a moderate lochial flow.
4. The client will ambulate to the bathroom every 2 hours.

A
  1. The client will have a moderate lochial flow.
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16
Q

PP interventions (1st hr)

A
  • Assess every 15 min
  • VS
  • Height, consistency (firm or boggy), location of the fundus: umbilicus, 1 finger-breadth, above or below umbilicus
  • Uterus should be at midline. If deviated to the right, likely a full bladder
    -Fundus should be at the midline, if deviated to right, likely a full bladder
    -Amount of lochia (scant, moderate, heavy)
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17
Q

Maternal physiologic changes: Cardio

A

*Increased circulating blood vol. in immediate PP period
* “Auto-transfusion” of blood that circulated in the uterine muscle during preg
* 60-80% rise in cardiac output for 1-2 hr following delivery

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18
Q

Maternal Physiologic Changes: Hematologic

A

Hematocrit may initially drop due to blood loss associated with delivery but stats to rise again as plasma vol decreases due to diuresis and hemoconcentration

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19
Q

A maternity nurse knows that obstetric clients are most at high risk for cardiovascular compromise during the one hour immediately following a delivery because of which of the following?
1. Weight of the uterine body is significantly reduced.
2. Excess blood volume from pregnancy is circulating in the woman’s periphery.
3. Cervix is fully dilated and the lochia flows freely.
4. Maternal blood pressure drops precipitously once the baby’s head emerges.

A
  1. Excess blood volume from pregnancy is circulating in the woman’s periphery
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20
Q

On admission to the labor and delivery unit, a client’s hemoglobin (Hgb) was assessed at 11 g/dL and her hematocrit (Hct) at 33%. Which of the following values would the nurse expect to see 2 days after a normal
spontaneous vaginal delivery?
1. Hgb 12.5 g/dL; Hct 37%.
2. Hgb 11 g/dL; Hct 33%.
3. Hgb 10.5 g/dL; Hct 31%.
4. Hgb 9 g/dL; Hct 27%

A
  1. Hgb 10.5 g/dL; Hct 31%.
    ▪The nurse would expect these values – a slight decrease in Hgb and Hct
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21
Q

Maternal Physiologic Changes: Uterine description

A
  • Rapid decrease in the size of uterus
  • Moms who breastfeed may experience a more rapid involution bc of the release of oxytocin
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22
Q

Maternal Physiologic Changes: Uterine Involution (assessment)

A

*Fundal ht decreases about 1 cm/day
*by 10 days PP, uterine cannot be palpated abdominally
*A flaccid fundus indicates uterine atony, and should be massaged until firm
*A tender fundus indicates an infection
*Afterpains decrease in frequency after the first few days

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23
Q

Assessment of uterus

A

*Fundus should feel firm, like grapefruit
*Boggy uterus feels like sponge, difficult to locate
*Observe bleeding during massage
*If pad is saturated or clots are larger than a nickle, or slow steady trickly notify Dr
*Apply fresh pad and reassess hourly

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24
Q

A client has just been transferred to the postpartum unit from labor and delivery. Which of the following tasks should the registered nurse delegate to the nursing care assistant?
1. Assess client’s fundal height.
2. Teach client how to massage her fundus.
3. Take the client’s vital signs.
4. Document quantity of lochia in the chart

A
  1. Take the client’s vital signs.
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25
Q

Lochia changes and names

A

Rubra: bright red discharge that occurs from day of birth to day 3 -> Serosa: brownish pink discharge that occurs from days 4 to 10 ->
Alba: white discharge that occurs from days 11 to 14
*Should not smell foul
*May change w/ ambulation

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26
Q

Amount of Lochia

A

*Scant: Less than 2.5 cm (<1 inch) on a menstrual pad in 1 hour
*Light: Less than 10 cm (<4 inches) on menstrual pad in 1 hour
*Moderate: Less than 15 cm (<6 inches) on menstrual pad in 1 hour
*Heavy: Saturated menstrual pad in 1 hour
*Excessive: Menstrual pad saturated in 15 minutes

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27
Q

Maternal Physiologic Changes: Renal

A

*Common to have urinary retention as result of elasticity/tone
*Might not feel urge to void until she stands up
*Diuresis usually begins in fist 12 hrs post birth
*Full bladder can displace the uterus and lead to postpartum hemorrhage

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28
Q

Maternal Physiologic Changes: Gastro

A

*Moms feel hungry after birth
*Constipation is common with second to third day PP
*Hemorrhoids are common

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29
Q

Fluid Balance and Electrolytes

A

▪ Diuresis begins within 12 hours of birth and continues for up to 5 days
▪ Urine output may be 3000ml or more per day!
▪ Additional fluid lost through increased perspiration
▪ Fluid loss greater in patients with preeclampsia or eclampsia
▪ Risk of pulmonary edema and/or unmasking of cardiac disease

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30
Q

PP maternal immunizations types

A
  1. Rubella
  2. Rhogam
  3. Flu
  4. T-Dap
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31
Q

PP Maternal immunization info

A

*Indicated in each pregnancy
*If T dap is not given during preg, should be given asap
*Breastfeeding is not a contraindication to receiving these vaccines

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32
Q

Rubella Vacc

A

*For moms who have not had rubella, or moms who are serologically not immune (titer of less than 1-8)
*Live attenuated virus in vacc
*Must not be given to preg woman, so PP is a guaranteed, non-preg time
*Breastfeeding moms can get vacc

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33
Q

RhoGAM

A

*Given to an Rh- mother prenatally – around 26-28 weeks gestation, even though fetal blood type is unknown
*Next does is given within 72 hours after delivery of an Rh+ infant or if the Rh is unknown.
*Must be repeated after each subsequent delivery if the baby is Rh+
*RhoGAM 300 mcg is the standard dose

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34
Q

PP teaching

A

*Assess needs and confidence level
*Use interactions w/ mom to teach
*incorporate “teach back” method
*Barriers to learning: fatigue, overstim

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35
Q

PP pain management

A

Use pain scale, ask for description of pain, observe pt

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36
Q

After birth pains

A

*Occurs as a result of contractions of the uterus
*More common in multiparas, breast feeding moms, clients w/ oxytocin, clients w/ over-distended uterus during pregnancy

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37
Q

Perineal discomfort

A

*Apply ice packs to perineum during first 24 hrs to reduce swelling
*After first 24 hrs, apply warmth by sitz bath or warm tub bath at home

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38
Q

Epiostomy

A

*Instruct pt to administer perineal care after each voiding
*Encourage the use of analgesic spray as prescribed

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39
Q

Perineal lacerations

A

*Care like epiostomy
*Rectal suppositories and edemas may be contraindicated (to avoid injury to sutures

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40
Q

Breast discomfort from engorgment

A

*Wear support bra at all times
*use ice packs between feedings (if not breast feeding: could diminish milk)
*Warm soaks or a warm shower
*Analgesics

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41
Q

PP Consipation

A

*encourage fluids (2000 mL/day)
*Encourage diet high in fiber
*Encourage ambulation
*Stool softeners, laxatives, enemas, suppositories

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42
Q

PP emotional changes

A

*Acknowledge feelings
*Determine availability of fam support
*Encourage verbalization of feelings
*Monitor newborn for appropriate growth
*Assist SO and fam members to discuss feelings
*All clients be assessed for depression during preg or PP

43
Q

Pt’s w/ chemical dependencies

A

➢No evidence that withholding analgesics will
increase chances of recovery from drug addiction
➢No evidence that providing analgesics will worsen
addiction
➢Patients with chemical dependency often require
higher loading doses and maintenance doses
➢Consider consulting pain or addiction specialist to
help order appropriate doses

44
Q

Maternal Physiological Changes: Breast

A

*Continues to secrete colostrum for 48-72 hrs post birth
*Decrease in estrogen and progesterone levels after birth stimulates increased prolactin levels which promotes milk production
*For primiparas: breasts becomes distended w/ milk about third day; earlier for multiparas
*Engorgement occurs on approximately 4 days in both breast-feeding and non-breast feeding clients
*Breast feeding relieves engorgement

45
Q

Breast feeding and nursing care

A

*Put bb to mother’s breast as soon as they’re stable
*Stay w/ client each time client curses until client feels secure and confident
*Assess LATCH score (Latch achieved by newborn; audible swallowing; types of nipple; comfort of parent; hold or position of baby)

46
Q

Best starts in L&D

A

*Skin to skin for 1-2 hrs: routine care of mom’s chest, minimize separation
*Decrease needs for warming
*Less hypoglycemia
*Uterine contractions allows less blood loss
*Immunological components of colostrum protect the infant from bacteria/virus
*Increase in the infant’s digestive peristalsis
*Promotes attachment and bonding

47
Q

Infant sleep states

A

Deep and light sleep

48
Q

Infant awake states

A

Quiet, active, crying

49
Q

Best awake state to feed

A

Quiet state

50
Q

Breast feeding benefits

A

*Passive immunity
*Easily digestible
*Brain booster
*Low protein content
*Convenient, inexpensive

51
Q

Nutrient needs during lactation

A

*High cal, protein, calcium, zinc, vit B and C
*Increase of 200-500 cal more than nonpreg intake recommended

52
Q

Contraindications of breast feeding

A

Smoking, alcohol, excessive caffeine intake should be avoided
*Smoking and drinking should be after breast feeding
*Herpes lesions on breasts
*Some meds
*Restricted diet
*HIV positive
*Progestin-only birth control pills (not estrogen)

53
Q

Breast feeding positions

A

*Cradle hold
*Cross cradle hold
*Lying on side
*Football hold
*Laid back

54
Q

Breast feeding changes

A

*During first 24 hrs post birth, little change in breast tissue
*Colostrum or early milk, clear yellow fluid, can be expressed from breast. Often leaks toward end of preg (during coitus) place pads in bra
*Breast become fuller and heavier as colostrum changes to mature milk (72-96 hrs after birth)

55
Q

Breast feeding challenges

A

*Sore nipples: confirm correct latch
*Low milk supply: nursing more often or pumping will help increase supply
*Engorgement: hand express or pump

56
Q

Metabolic changes: Diabetes and breast feeding

A

*BF may temporarily precipitate hypoglycemia in women w/ insulin dependent diabetes
*Mom’s with gestational diabetes often have normal glucose levels postpartum

57
Q

Breast care for non breast feeding moms

A

*Avoid nipple stim
*Apply breast binder, wear snug bra, apply ice packs, mild analgesics
*Engorgement usually resolves in 24-26 hrs post birth

58
Q

Bottle feeding

A

*Reliable and nutritionally adequate
*Commercial formulas are designed to mimic human milk

59
Q

Formula feeding: Amounts

A

*24-48 hrs old: 15-30 mL Q 2-3 hr
* 1-2 wks: 90-150 mL
*Gastro capacity gradually increases
*Newborns should be fed on demand, not going longer than 4 hrs between
*Wt gain should be monitored

60
Q

Phases of maternal adjustment: Rubin

A
  1. Dependent (taking in)
  2. Dependent-independent phase (taking hold)
  3. Interdependent (letting go)
61
Q

Dependent phase

A

▪ First 24-48 hours
▪ Focus is on self and own basic needs, not infant
▪ Relies on others
▪ Is excited and wants to talk about birth experience

62
Q

Dependent-independent

A

▪ Second to third day to 10 days
▪ Mother begins taking responsibility of self and newborn

63
Q

Interdependent

A

▪ Focus is on the forward movement of family as a unit with interacting members
▪ Reassertion of relationship with partner—resumption of intimacy and resolution of individual roles

64
Q

Attachment observations in mom: What should we look for

A

*Seeks newborn face-seeks eye contact
*Touch newborn with fingertips first then palms
*Cuddling
*Acts consistently
*Seeks info
*Sensitive to changes in newborn
*Happy with infants responses
*Pleased w/ infant’s appearance

65
Q

The nurse is developing a plan of care for a postpartum client during the “taking in” phase.
Which of the following should the nurse include in the plan?
1. Teach baby-care skills such as diapering.
2. Discuss the labor and birth with the mother.
3. Discuss contraceptive choices with the mother.
4. Teach breastfeeding skills such as pumping.

A
  1. During the taking in phase, clients need to internalize their labor experiences.
    Discussing the labor process is appropriate for this postpartum phase.
66
Q

The nurse is developing a plan of care for the postpartum client during the “taking hold” phase. Which of the
following should the nurse include in the plan?
1. Provide the client with a nutritious meal.
2. Encourage the client to take a nap.
3. Assist the client with activities of daily living.
4. Assure the client that she is an excellent mother

A
  1. Clients in the taking hold phase need assurance that they are learning the skills they will need to care for their new baby.
67
Q

S/S of PP blues

A

◦ Anxiety
◦ Cries easily for no apparent reason
◦ Emotional labile
◦ Expresses a let-down feeling
◦ Sadness

68
Q

S/S of PP depression

A

◦ Anxiety
◦ Appetite changes
◦ Crying, sadness
◦ Difficulty concentrating or making decisions
◦ Irritability and agitation
◦ Lack of energy
◦ Less responsive to the infant
◦ Loss of pleasure I normal activities
◦ Suicidal thoughts

69
Q

S/S of PP psychosis

A
  • Break with reality
  • Confusion
  • Delirium
  • Delusions
  • Hallucinations
  • Panic
  • Try to hurt or kill baby
70
Q

Sudden changes

A
  1. Major circulation changes
  2. Breathing
  3. Maintaining temperature
  4. Eating
  5. Coping with new stressors
71
Q

Duration of transition periods

A

6-8 hrs of age
* Remember to consider prenatal risk factors, labor, and medications when assessing neonate

72
Q

Transition period

A

*The placenta is responsible for gas exchange in utero
*Majority of healthy newborns take their first breaths spontaneously
*Onset of respirations stimulate cardiopulmonary changes that transfer the neonate from fetal to neonatal circulation

73
Q

RN role in transition

A

Reduce stress, observe, assess, communicate concerns to newborn provider

74
Q

Fetal prep in utero

A

*Lung fluid decreases near term
*Catecholamine surge prior to labor
*Catecholamine levels are lower in neonates born via scheduled c-section
*Increased surfactant production occurs in last few weeks of pregnancy – helps keep alveoli open after birth

75
Q

Cardio changes when NB takes 1st breath

A
  1. Pulmonary vascular bed dilates which increases blood flow to lungs
  2. Pressure in right atrium decreases
  3. Pressure in left atrium increases
  4. These changes cause foramen ovale, ductus arteriosus, & ductus venous (fetal bypass to the liver) to close
76
Q

Postnatal circulation

A

Foramen ovale between 2 atria (top heart chambers) closes, normal circ begins
*Ductus atrious closes
*Right side of heart pumps to the lungs. Left side of heart pumps to the body

77
Q

Patent ductus Arteriosus

A
  • More common in premature babies than in fullterm babies
    *Temporary
78
Q

Immediate NB care at birth

A

*Establish respirations
*Prevent heat loss through (Conduction, convection, evaporation, radiation)

79
Q

The nurse assisted with the birth of a newborn. Which nursing action is most effective in preventing heat loss by evaporation?
A. Warming the crib pad
B. Closing the doors to the room
C. Drying the infant with a warm blanket
D. Turning on the overhead radiant warmer

A

C. Drying the infant with a warm blanket

80
Q

Thermoregulation

A

Cold stress will interfere with normal transition by increasing oxygen and
glucose consumption
*Lose body heat quickly: surface body mass ration, small amount of fat insulation

81
Q

Responses (Cues) to Cold Stress

A

*Vasoconstriction
*Increased resp rate
*Non-shivering thermogenesis
*s/s of hypoglycemia

82
Q

Common NB probs

A

*Hypothermia
*Hypoglycemia
*Resp difficulties

83
Q

After birth care

A

*NB cared for as recovering pt
*Critical pt
*Observe frequently until stable
*Early recognition of abnormal transition

84
Q

Initial care of NB

A

*Assess
*Interventions
*Medications
*Ensure NB proper ID
*General exams: VS body measurements

85
Q

Assessment of NB

A

*Observe/assist w/ initiation of resps (Do not wait for APGAR)
*Monitor nasal flaring, grunting, retractions, abnormal resps
*VS
*Assist w/ breastfeeding

86
Q

APGAR

A

*Assess appearance, pulse, grimace, activity, respiration
*Assessed at 1 and 5 min
*Score 8-10: No intervention needed
*Score 4-7: Stimulate- rub bb’s back, give o2
*Score 0-3: Full resuscitation

87
Q

Interventions for NB

A

*Wear non-sterile gloves
*Suction mouth first then nose
*Dry to stimulate and rub back for cry
*Maintain temp: Warm hat, blanket
*Keep NB w/mom to facilitate bonding

88
Q

Meds for NB

A

*Vit K injection: in thigh in first 6hr of birth
*Erythromycin eye ointment: Topical antibiotic to prevent eye infection from gonorrhea and chlamydia
*Hep B vacc: Given w/i 24 hr, followed up for completion
(for HBV infection from infected mom: Hep B vacc and hep B globulin w/i 12 hr of birth)

89
Q

Ensure the NB’s proper ID

A

*Matching ID bracelets
*Footprints for NB and finger prints for mom

90
Q

Initial physical

A

*Keep NB warm
*Begin w/ general observations, least disturbing to NB
*Ballard scale
*VS

91
Q

Ballard scale

A

used for gestational age assessment r/t physical and neuro criteria

92
Q

NB VS

A

HR: 110-160 BPM
*90-110 is sleeping
*up to 180 if crying
Resp: 30-60 (assess for full min)
Axillary temp: 97.7-99.5 F
BP: not usually done unless cardiac issues

93
Q

Body measurements: Head

A

*Should be 1/4 body length
*Bones not fused
*Suture: palpable and may overlap
*Size of fontanels can vary due to molding
*Molding is asymmetrical from pressure in birth canal (disappears about 72 hrs)
*Masses from birth trauma

94
Q

Caput succedaneum

A

edema of soft tissue over bone (crosses over suture line; it subsides in few days)
*Common and benign

95
Q

Other body assessment: Penis

A

Circumcision is not required/expected (parents can choose)
*Slight tremors noted in the NB may be a common finding but could also be sign of hypoglycemia, hypocalcemia, or drug with-drawl

96
Q

Infant reflexes

A

*Rooting: Helps baby find latch
*Sucking: Helps baby feed
*Moro: response to sudden loss of support (spreading of arms, pulling arms in, crying)

97
Q

Heel stick test

A

*Screen for Hemoglobinopathies (sickle cell disease), Inborn errors of metabolism, Galatosemia, Severe combined immunodeficiency

98
Q

Other infant tests

A

*Hearing
*Critical Congenital heart disease (CCHD)

99
Q

Hospital length of stay

A

*Vag: 24-48 hrs
*Cesarean: 2-3 days if no complications

100
Q

Follow up care

A

*Uncomplicated vag delivery: 4-6 wks
*Complicated vag or cesarean: 7-14 days
*NB visit w/ breast feeding clinic or LIP: 3 days

101
Q

Elimination: Wets

A

*1 wet on 1st day
*6+ by day 6
(up to day six, should be peeing as many times as days old (5 days = 5 wets))

102
Q

Elimination: Stools

A

*1st 24 hrs: 1-5 mec (dark green and sticky)
*Day 2-4: 1-3 dark green transition to loose yellow
*Day 6 and beyong: 4+ runny yellow, seedy

103
Q

Discharge care:

A

*Self care: s/s of complications like fever, heavy bleeding
*Sexual activity/contraceptions: 6 wks abstinence, can become preg b4 first period following birth
*Prescribed meds
*Routine mother and baby checkups

NRSG 344 (11 decks)

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