Part I Flashcards
(25 cards)
During the first 12 hours postpartum (PP), the uterine fundus is supposed to be at the level of the ___________.
umbilicus
true or false - IV oxytocin administration might make the fundus lower in the immediate PP period
true
After delivery, how will the fundus position change?
*Every 24 hours - should descend 1-2 cm or 1 fingerbreadth (FB)·
*Day 10-no longer palpable (fundus descended all the way into pelvis)
*If a fundus is lower than expected that is OK! Too high is more concerning.
If a fundus is high (midline or deviated), what should the nurse focus on doing?
*Assist pt in emptying bladder (esp. if fundus is off to side)
*massage fundus
true or false - Cold packs right after delivery and should continue around 24 hours
true! Swelling could keep the mother from peeing
What should the nurse teach regarding any injury to the perineum?
- use cold the first 24 hours
- then after 24 hours, one can use heat to help with vasodilation
What is the average blood loss for a vaginal and cesarean delivery?
- 500 mL for vaginal delivery
- 1000 mL for a cesarean delivery
Is diuresis and diaphoresis normal in postpartum recovery?
yes -
Up to 3000 mL urine output daily is normal
Why are the risks of clots higher during pregnancy and postpartum recovery?
Coagulation factors remain higher for 2-3 weeks to normalize causing higher risk of thromboembolism.
*Risk of clots remains elevated for 12 weeks.
How does BP change after delivery?
*Hypotension normal for about 2 days then BP slowly increases.
*Pre-pregnancy level by 6 weeks PP.
*Low or decreasing BP may indicate infection or hemorrhage!
Hypertension can be postpartum ________________!
preeclampsia
How may a mother’s pulse change after delivery?
*Bradycardia (40-60) normal for up to 2 weeks PP because of ↓ in cardiac output.
*Investigate Tachycardia-may indicate hemorrhage, hypovolemia, or dehydration.
true or false - Temperature up to 100.4 normal for first 24 hours, but only okay for 24 hours!!
*KNOW THIS!!
true!!
Temp up to 100.4 is not concerning in those first 24 hours… unless there are other signs of infection
What are some postpartum urinary system adaptations?
- Often increased sensation (anesthetic)=incomplete emptying & bladder distension
- Can result in hemorrhage and/or UTI
- GFR and renal plasma flow rate return to normal by 6 weeks postpartum
- Diuresis begins about 12 hours PP and lasts about 1 week. Remember, up to 3000 mL daily!! Work on keeping that bladder empty.
What should a nurse know about Bowel function postpartum?
Constipation
* First stool usually within 2-3 days
* Assess for bowel sounds and flatus (especially after cesarean delivery)
* Stool softeners prn, high fiber foods, ambulation
Increase oral fluids to 2000 mL or more
What is her normal pattern?
How does the musculoskeletal system change postpartum?
MUSCULOSKELETAL SYSTEM
- Relaxin, estrogen, and progesterone increase to relax joints in pregnancy
- After birth, all decrease (requires 6-8 weeks)-joints return to prepregnantsize (except feet)
- Possible separation of abdominal muscles from pregnancy (diastasis recti)
- More common with overdistention or poor pre-pregnancy abdominal tone
- Treatment=exercises with great outcome
- General muscular postpartum aches and pains respond well to NSAIDS
What are the “taking in” and “taking hold” processes in Maternal Role Adaptation?
Taking In: Passive, dependent behavior, preoccupied with her own needs-often 24-48hours (nervous with the baby; more comfortable with others caring for the baby)
*Talks about her L&D, follows suggestions, hesitates with decisions
Taking Hold: Happens by the 2nd or 3rd day lasts several weeks
*Ready to resume control of herself and mothering
*Eager to learn, independent behavior, focused on baby
*Often eager for discharge to home.
How much lochia is concerning?
Soaking a pad an hour is concerning
*clots bigger than a nickel are too much
*bleeding should not becoming heavier or darker than previously (should continue to get lighter in volume/color)
What is the specific nursing care after a cesarean section?
- Follow BUBBLE EE assessments plus a special focus on surgical related assessments:
- Assess vitals, fundal height/firmness, abdominal girth, the dressing, lochia, urine output, LOC every 15 minutes for the 1st hour, then every 30 minutes for the next hour, then every 4 hours if stable
The 1st 24 hours:
· Assess pain and implement relief measures
· TCDB as ordered
· Ambulate as soon as possible-see orders
· Basic care and comfort (Clean gown, sheets, pads, ice/water as appropriate, Mouth care, hygiene help, Teach, help BF, answer questions, support family)
What are the most common postpartum complications?
· Hemorrhage
· Infection
· Thromboembolic Disease
· Postpartum Psychiatric Disorders
What are the ABCs with putting a baby to bed?
ABC - baby in crib
Alone. Back. Crib.
Postpartum hemorrhage (PPH) is defined as a cumulative blood loss greater than _________ with signs and symptoms of hypovolemia.
greater than 1,000 mL
What is the difference between Early (primary) and Late (delayed) Postpartum Hemorrhage
· Early (Primary)-First 24 hours *most common
*Uterine atony-80% of cases
· Late (Delayed)-24 hours to 12 weeks after birth
*Subinvolution of the placental site or retained placental fragments most cases.
What are the goals of the medical team with Postpartum Hemorrhage?
o Stop the hemorrhage.
o Correct the hypovolemia. (crank them full of fluids!)
o Treat the underlying cause.
