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Post Partum Assessment and Care Flashcards

(101 cards)

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1
Q

5 Main Physiologic Events following stage 4 of labor

A
  1. uterus involutes
  2. lochia is present
  3. breasts begin milk production
  4. intestines are sluggish for a few days as body redistributes fluid and abdomen is more open
  5. Ovarian function and menstruation return
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2
Q

How long does uterus involution take?

A

6 weeks

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3
Q

How long until ovarian function and menstruation return in non-lactating mother?

A

6-12 weeks

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4
Q

What does BUBBLERS stand for?

A

8 point PP assessment
1. breast
2. uterus
3. bladder
4. bowels
5. lochia
6. episiotimy/perineum
7. reaction
8. signs

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5
Q

When is colostrum vs milk produced?

A

colostrum: later stages of pregnancy

milk: 3rd day pp

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6
Q

When should baby be put to breast?

A

First hour

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7
Q

Signs of mastitis

A

red streaks, red spots, sore, warm/tender spot, malaise if systemic

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8
Q

What should a non-breastfeeding mother be taught?

A

Avoid stimulation of the nipples
- tight bra to prevent milk from filling ducts
- cabbage/something cold to constrict blood flow

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9
Q

What is uterus involution?

A

rapid compression of uterus to non pregnancy state

sealing off of placental site

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10
Q

What are patients at risk for if involution does not occur?

A

PP hemorrhage

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11
Q

What impedes uterine involution?

A
  • overextension of uterus (twins, large BW, polyhydraminos, multiparous)
  • long labor/oxytocin induction
  • retained placental fragments
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12
Q

Why would an oxytocin induction impede uterine involution?

A

The uterus is used to having the oxytocin promote contractions; without it, it may not contract

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13
Q

What enhances involution?

A
  • oxytocin with anterior shoulder
  • fundal assessments/massage
  • uncomplicated birth
  • complete placental expulsion
  • breast feeding
  • early ambulation
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14
Q

Boggy uterus

A

a finding upon physical examination where the uterus is more flaccid than would be expected.

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15
Q

What is a boggy uterus associated with?

A

Uterine atony

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16
Q

What is uterine atony

A

occurs when your uterus doesn’t contract (or tighten) properly during or after childbirth. It’s a serious complication that can cause life-threatening blood loss. Uterine atony (or the muscular tone of your uterus) describes a uterus that is soft, or lacking tone.

INVOLUTION NOT OCCURING

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17
Q

During a PP fundal assessment, within 12 hours where should the fundus be and what is not normal?

A

At or below umbilicus; above umbilicus is not normal

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18
Q

What type of palpation must be used for PP fundal assessment?

A

Deep

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19
Q

What three things are you assessing in PP fundal assessment

A
  1. position
  2. firmness
  3. midline
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20
Q

What would cause uterus to not be midline during PP fundal assessment?

A

bladder can displace uterus left or right impeding ability of uterus to go where it wants to go; assure it is empty

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21
Q

What can the massage/stimulation associated with PP fundal assessment cause?

A

Contraction/increased involution

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22
Q

Describe the anticipated progress of fundal involution day to day

A

Height of the fundus about one finger breadth below umbilicus (approx. 1cm) each day

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23
Q

Are you concerned if at at day 4 the fundus is 7 cm below umbilicus?

A

No

Can be involuted more quickly AT OR BELOW; only concern is decrease in rate

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24
Q

What are afterpains?

A

Involution contractions in multiparous women associated with breastfeeding due to oxytocin increases contractions

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25
What does pain during PP palpation of fundus indicate?
Not contractions, may indicate infection
26
When should you administer pain medication to a breast feeding women to decrease afterpains?
1/2 hour before or PRN
27
What is diastasis recti abdominis?
occurs when the rectus abdominis muscles (six-pack ab muscles) separate during pregnancy from being stretched
28
What is the tupler technique?
The purpose of the program is to heal the weakened connective tissue between the separated abdominal muscles. Consists of elevator exercise, contraction exercise, and head lift exercise
29
What is the webster techniques?
a chiropractic method used during pregnancy to address issues related to pelvic alignment. It involves specific adjustments and manipulations aimed at reducing pelvic misalignments and tension in the ligaments and muscles. By promoting optimal pelvic balance, the Webster Technique may help alleviate discomfort and potentially contribute to a smoother and safer childbirth.
30
Do you need to perform fundal palpation for a c-section/tubal ligation mom?
May or may not assess fundus post-op; belief was increased risk and pain
31
If not palpating fundus, how can we assess bleeding risk in c-section moms?
1. vitals 2. lochia 3. pain 4. risk factors
32
True or false: the risk of PP hemorrhage is increased in C section moms
false: Risk of hemorrhage is less because uterus is completely emptied in surgery
33
Pain not associated with incision in c-section mom is associated with
infection or bleeding
34
Capacity of bladder PP
Increased
35
Sensation of bladder PP
decreased
36
What are PP moms at risk for related to their bladder?
Urinary retention related to swelling/bruising, leading to UTI and deterring involution
37
When is spontaneous bowel movement anticipated PP?
2-3 days
38
When does elimination return to normal PP?
Within 1 week
39
When is lochia rubra expected
days 1-3
40
Describe colour, odour, consistency of lochia rubra
dark red venous blood, stale odour, clots < loonie
41
If lochia rubra persists following day 3 or returns, what may it indicate?
Sub-involution; blood still being transmitted through placental system
42
Describe lochia serosa
Days 3-10 - pinkish brownish
43
Describe lochia alba
Days 10-24 - yellow to white, lasting 6 weeks
44
1st degree perineal laceration
superficial perineal tissue torn
45
2nd degree perineal laceration
perineal muscle torn
46
3rd degree perineal laceration
perineal muscles and anal sphincter torn
47
4th degree perineal laceration
perineal muscles, anal sphincter and rectum torn
48
Describe abnormal lochia
- foul odour - clots larger than placenta - heavy flow - reappearance of rubra - lasts longer than 4 weeks
49
Describe the progression of normal lochia/vaginal flow
stage 4: heavy flow expected progression from 1 pad/hr, moderate <6', light <4', scant <1'
50
What increases vaginal flow
ambulation and breastfeeding
51
Why do hemorrhoids occur
presentin pregnant or develop with pushing
52
What are interventions for hemorrhoids?
ice, frozen pad, tucks (OTC pads of cotton with witchhazel), analgesic
53
Why do hematomas occur?
soft tissue of perineum offers little resistance and can readily accumulate 250-500mls of blood
54
What can prevent hematomas?
Early application of ice
55
What is a cardinal sign of hematoma
relentless pain
56
Normal pad saturation on first day post partum:
1 pad/hr
57
Besides assessment, what other nursing interventions regarding the perineum can occur?
perineal care and education on perineal tone
58
First phase of reactions post partum
taking in - day 1-2 - preoccupied with own needs and recovery tell story - touches and explores infant
59
Second phase of reactions post partum
taking hold - day 2-3 - ready to resume control - eager to learn - rapid mood swings - mothering functioning established
60
Third phase of reactions post partum
letting go sees infant as unique person, allows others to care
61
Describe the initial attachment behaviour post partum
holds infant in en face position: (non-birthing parent/dad), face-to-face position about 20cm, same plane; mother uses soft, high-pitched voice
62
what is the en face position
direct face-to-face and eye-to-eye contact between the mother and newborn. When the newborn's eyes are open, the mother instinctively greets the newborn and talks in high pitched tones to him or her.
63
When do baby blues typically occur and resolve
first 3-5 days PP and resolves spontaneously within weeks
64
What contributes to baby blues?
Decrease in estrogen and progesterone levels; hormonal change as contribution, as well as time of increased stress
65
Describe the symptoms of baby blues
Tearfulness, agitation, mood swings, generalized anxiety, acute disturbances in appetite and sleep, a perception of being overwhelmed and uncertain, and irritability
66
True or false: baby blues are a part of the perinatal mood disorder spectrum
False
67
Care for baby blues
recognition, reassurance, education, awareness of blues as a risk factor for postpartum depression
68
What are the post partum pinks
Mild elation/euphoria hours/days after birth Normal but may also be a warning for other problems
69
_______ % of those with baby blues will develop post partum depression
20
70
What is the edinburgh postnatal depression scale screening tool?
a simple questionnaire used to screen for signs of postpartum depression in new mothers. It consists of 10 questions that assess a woman's mood, feelings, and emotional well-being during the postpartum period. Higher scores on the scale indicate a greater likelihood of postpartum depression, prompting further evaluation and support for the mother.
71
____% of patients and _____% of partners experience PPD
1/7 moms 1/10 partners
72
What signs are important to consider post partum?
Vital signs Signs of pain Signs of DVT r/t hypercoaguable state and decreases mobility - pain, pulse, pallor, paralysis, paresthesia
73
What additional assessments need to be performed on a c-section postpartum mother?
- foley (ins and outs) - IV - DB and Coughing - Early ambulation - Sedation Score - Analgesia
74
Outside of bubblers, what other assessments are performed for post partum mothers?
1. Rh negative 2. Rubella 3. HgB 4. Nutrition
75
If baby is Rh positive for an Rh negative mom, what occurs?
Mom may get WinRho (RhoGAM) within 72 hours of delivery
76
What vaccine is offered PP and what should you advise patients on?
Rubella; not to get pregnant for 3 months
77
When is HgB tested post partum?
1 day pp r/t anemia due to blood loss
78
What education must you provide a BF mom post partum regarding nutrition?
At least 200 calories more than pregnancy diet
79
Reoccurence of ovulation/menstruation in non-lactating moms
6-8 weeks; delayed but not reliable form of birth control
80
True or false: a BF mom will experience her period and return of menstruation faster than a non BF mom
False Prolactin suppresses ovulation
81
When can PP patients engage in sexual activity?
wait until lochia has stopped and perineum has healed typically 3-6 weeks
82
What contraception is recommended as safe for breast feeding and why?
Progestin only No estrogen related side effects -Contraceptives which contain estrogen have been linked to reduced milk supply and early cessation of breastfeeding even when started after milk supply is well established and baby is older Decreases VTE risk
83
Why is combination estrogen/progestin not recommended until after 6 weeks?
Increased VTE risk
84
What is tubal ligation?
permanent female sterilization done laproscopically as outpatient
85
True or false: you palpate the fundus following a tubal ligation procedure
False; or very gently if needed
86
4 most common PP complications
1. hemorrhage 2. infection 3. depression 4. DVT
87
What symptoms regarding vaginal flow PP would you report?
foul smelling, heavy flow, clots
88
What symptoms regarding temperature PP would you report?
chills/fever T>38
89
What symptoms regarding pain PP would you report?
constant in lower abdomen
90
What symptoms regarding urine PP would you report?
Pain, burning, urgency or difficulty passing
91
What peripheral vascular system symptoms PP would you report?
Redness / swelling / pain in leg DVT
92
What respiratory changes PP would you report?
Unexplained shortness of breath or chest pain
93
What CNS related changes PP would you report?
headache, vision changes, fainting, dizziness
94
Why would you report tender red area in breast with flu-like symptoms?
Signs of mastitis
95
PP Client outcome criteria: ______ Hemoglobin with no _____________
normal, fainting/dizziness
96
PP Client outcome mobility
satisfactory ambulation
97
PP lochia client outcome criteria
decrease colour and amount by day 3-5 no foul odour
98
PP Client outcome uterus
firm, midline, contracted
99
PP Client voiding criteria
at least 1 void prior to discharge without dysruia
100
PP Client breast criteria
soft/supple nipples soft: day 1-2 filling: day 3-4 fullness evident engorgement controlled
101
What is breast engorgement
a condition where a new mother's breasts become overly full, swollen, and painful due to an accumulation of milk

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