Post partum nursing care

Question 1

period immediately after birth & extending for 6 - 8 wks after delivery
mother’s body returns to its pre-pregnant state
Nursing care should focus on
helping mother & her family adjust to changes
easing transition to the parenting role

Answer 1

postpartum period/puerperium

Question 2

phases of puerperium

Answer 2

1. Taking in
2. Taking hold
3. Letting go

Question 3

First 3 days post partum
Focus on self, not infant, on her own needs for sleep and rest
Passive, dependent and can’t make decisions
Need to discuss labor experiences
Sense of wonderment when looking at the neonate

Answer 3

taking in phase (dependent phase)

Question 4

Dependent - Independent Phase
from 3rd to 10th day postpartum
focus on infant
active, independent and can make decisions
initiates self care activities, focus on bowels, bladder and breastfeeding
responds to instruction about infant care and self care
may express lack of confidence in caring for the neonate

Answer 4

taking hold (dependent-independent phase)

Question 5

10 days to 6 weeks postpartum
readjustment
mother may feel deep loss over separation of baby from her body
wanting to feel safe and secure yet wanting to make decisions
finally redefines her new role
see self as separate from infant
gives up fantasized image of her child and accepts real one

Answer 5

letting go phase (interdependent)

Question 6

Postpartum Maternal concerns and feelings

Answer 6

1. abandonmemnt
2. disappointment
3. postpartal blues

Question 7

mother may feel confused by a sensation very close to jealousy
shared responsibility for infant care can help alleviate these feelings

Answer 7

abandonment

Question 8

difficult for mother to feel positive immediately about a child who does not meet their expectations

Answer 8

disappointment

Question 9

show up 3 to 4 days after birth and may last few weeks after delivery
50% of women experience some feelings of overwhelming sadness
mood swings, sudden crying episodes, irritability, anxiety, loneliness
feeling of happiness and love for newborn may be accompanied by feelings of helplessness, sadness and anxiety sudden and quick change in hormones
emotional and physical stress of giving birth

Answer 9

postpartal blues

Question 10

moderate to severe depression in a woman after she has given birth
may occur soon after delivery or up to a year later caused by changes in hormone levels

Answer 10

postpartum depression

Question 11

rare compared to postpartum anxiety or depression
requires immediate attention, especially if with suicide thoughts or harms herself or baby

Answer 11

postpartum psychosis

Question 12

rapid decrease in uterine size as it returns to the nonpregnant state
weight decreases
fundic height decreases about 1cm per day
endometrium regenerates
by 10 days postpartum, uterus cannot be palpated abdominally
flaccid fundus indicates uterine atony and should be massaged until firm
tender fundus indicates infection

Answer 12

uterine involution

Question 13

uterine discharge consists of blood from placental site and debris from decidua
fleshy in odor, smells like normal menstruation
discharge decreases daily in amount but may increase with ambulation

Answer 13

lochia

Question 14

complete involution may take 3 – 4months
after 1 week the muscle begins to regenerate but is still about 1 cm dilated
permanent change cause by childbirth – the os becomes slit-like or elongated

Answer 14

cervix

Question 15

distention decreases
smooth and swollen
rugae reappear by 3 – 4 weeks
muscle tone is never restored to pregravid state

Answer 15

vagina

Question 16

rapid decrease in Estrogen & Progesterone and increase in prolactin
colostrum is present at time of delivery
breast milk is produced by 3rd or 4th day
sucking of newborn triggers release of OXYTOCIN – milk letdown and contraction of the uterus
average amount of milk produce in 24 hours increases with time

Answer 16

breast

Question 17

when does menses resume in non-breastfeeding mothers and breastfeeding mothers

Answer 17

Menses resume:
Within 8 weeks in non-breastfeeding mothers
Within 3 – 4 months in breastfeeding mothers
Women may ovulate without menstruating, so breastfeeding is not a reliable method of birth control

Question 18

skin changes during pregnancy gradually disappear during postpartum
striae gravidarum do not disappear and assumes a silvery white appearance
hyperpigmentation of areola may not disappear completely
some women are left with a wider and darker areola after pregnancy.
Linea nigra will be barely detectable in 6 weeks time

Answer 18

integumentary system

Question 19

Depends on the rapidity with which pituitary function is restored

Answer 19

ovarian function and menstruation

Question 20

may have urinary retention as a result of loss of elasticity and tone
loss of sensation in the bladder from trauma, medications, anesthesia and lack of privacy
diuresis begins within the first 12 hours of delivery

Answer 20

urinary system

Question 21

women are usually very hungry after delivery due lo lack of food during labor
constipation occurs due to decreased intestinal muscle tone, perineal discomfort and pain from episiotomy, hemorrhage and laceration
bowel sounds are active, but passage of stool through bowel may be slow
hemorrhoids are common

Answer 21

gastrointestinal system

Question 22

may have urinary retention as a result of loss of elasticity and tone
loss of sensation in the bladder from trauma, medications, anesthesia and lack of privacy
diuresis begins within the first 12 hours of delivery

Answer 22

urinary system

Question 23

ambulation may be encouraged 4 – 8 hours after delivery
done to avoid complications, promote involution and improve emotional outlook

Answer 23

musculoskeletal system

Question 24

advantages of early ambulation

Answer 24

prevent constipation
prevent thrombophlebitis
prevent urinary problems
promote rapid recovery and return of woman’s strength
hastens drainage of lochia
improves GIT & GUT function
provides a sense of well-being

Question 25

rest & sleep as much as needed during early postpartum period promote healing by reducing BMR and allowing O2 & nutrients to be utilized for tissue growth, healing & regeneration instruct mother to avoid heavy lifting and strenuous activity after discharge woman may resume light housekeeping on second week and can go back to normal activities by 4 to 6 weeks

Answer 25

rest and sleep

Question 26

resumption of sexual activity

Answer 26

can be resumed 3 to 4 weeks after vaginal delivery if : bleeding has stopped perineum is healed it does not cause pain

Question 27

assessment monitor VS assess height, consistency and location of fundus monitor color, odor, & amount of lochia assess for breast engorgement monitor perineum for swelling or discoloration monitor episiotomy for healing assess incisions or dressings of CS birth client monitor bowel status and I&O encourage ambulation and frequent voiding assess bonding with newborn infant assess emotional status

Answer 27

nursing responsibilities

Question 28

Instruct to come back immediately if with: Heavy vaginal bleeding or bright red vaginal discharge Fever Foul smelling lochia Swollen, tender, hot area on her leg Burning sensation on urination Persistent pelvic or perineal pain

Answer 28

client teaching

Question 29

Occurs as a result of contraction of the uterus Are more common in multiparas, those with overdistended uterus, breastfeeding mothers & clients treated with oxytocin

Answer 29

afterbirth pains

Question 30

apply iced napkin to the perineum during first 24 hours to reduce swelling apply iced pack on hypogastrium sitz bath after the first 24 hours administer perineal care after each voiding analgesics as prescribed

Answer 30

perineal discomfort

Question 31

breastfeed frequently apply warm packs before feeding; ice packs between feedings wearing of support bra expose to nipples to air 10 – 20 minutes after feeding rotate the position of the baby for each feeding be sure that the baby is latched on to areola

Answer 31

breast discomfort

Question 32

bleeding 500 ml or more following delivery

Answer 32

post partum hemorrage

Question 33

During the 1st 24 hours after delivery Caused by uterine atony, lacerations or inversion of the uterus

Answer 33

early post partum hemorrhage

Question 34

After the 1st 24 hours after delivery Caused by retained placental fragments

Answer 34

late postpartum hemorrage

Question 35

inability of myometrium to contract and constrict blood vessels, resulting in open sinuses at site of placental separation cause of 80 – 90% of early hemorrhage may be slow & steady or sudden & massive BP and PR may not change until it’s too late

Answer 35

uterine atony

Question 36

medications to stimulate uterine contractions

Answer 36

IM Methergine and IM or IV Oxytocin

Question 37

surgical removal of the uterus

Answer 37

Hysterectomy

Question 38

uterus remains large, and soft at 4 to 6 weeks postpartum incomplete return of uterus to its prepregnant size and shape Lochia is still present

Answer 38

subinvolution

Question 39

infection of the urinary bladder burning pain on urination lower abdominal pain urinary frequency fever forced fluids up to 3L/day institute measures to assist void, encourage frequent and complete emptying of the bladder urinalysis antibiotics as prescribed

Answer 39

cystitis

Question 40

localized collection of blood into tissues of the reproductive sac after delivery severe pain, pressure in perineal area with discolored skin signs of shock (pallor, tachycardia, hypotension) monitor VS, place ice at hematoma site, prepare for incision and evacuation of hematoma, ligation of bleeders administer analgesics, antibiotics or blood products as required

Answer 40

vulvar hematoma

Question 41

inflammation of breast as a result of infection seen in breastfeeding mothers 2-3 weeks after delivery but may occur anytime during lactation localized heat and swelling, pain, elevated temperature, flu-like symptoms advise good handwashing and breast hygiene techniques warm or cold packs encourage breastfeeding use of support bra analgesic and antibiotics as prescribed

Answer 41

mastitis

Question 42

passage of thrombus, often originating in one of the uterine or pelvic veins, into the lungs, where it disrupts circulation of blood Dyspnea, tachypnea, tachycardia, cough, rales, hemoptysis, pleuritic chest pain, feeling of impending doom Give O2, head levated, monitor VS, streptokinase and anticoagulants as prescribed

Answer 42

pulmonary embolism

Question 43

formation of a clot in vessel wall due to inflammation of vessel wall partial obstruction of vessel can occur increased blood-clotting factors superficial, femoral, pelvic elevate legs, never massage, monitor for signs of pulmonary embolism warm packs, analgesics and heparin as prescribed

Answer 43

thrombophlebitis