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Module 6 (Labor And Delivery) > Postpartum > Flashcards

Postpartum Flashcards

1
Q

Uterine involution-

A

the return of the uterus to its pre-pregnant size

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2
Q

Uterine atony-

A

failure of uterus to contract even after fundal rub

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3
Q

Uterine inversion-

A

uterus turns partially or entirely inside out

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4
Q

Uterine subinvolution-

A

uterus isn’t decreasing in size and fails to descend

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5
Q

Postpartum begins with

A

delivery of the placenta
- 4th stage = 2-3 hours after

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6
Q

Postpartum ends with

A

~ 6 weeks after delivery

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7
Q

Postpartum is what type of adjustment

A

physiological and psychological
- reproductive organs go back to non-pregnant stage

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8
Q

Postpartum goals

A

prevent postpartum hemorrhage and maternal complications
Bonding = breastfeeding
Prepregnant state and comfort
Educate on newborns and self-care
Educate contraceptives and lower unplanned pregnancies

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9
Q

Postpartum Focused Assessment

A

Breast (engorge, nipples, and milk production)
Uterus (fundus, consistency, and location)
Bladder function (void or cath)
Bowels (gas and go home)
Lochia (color, odor, amount) (# of pad changes)
Epiostomy/Laceration (edema, red, and length)

Hemorrhoids
Emotion/education
Bonding

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10
Q

PP focused assessment every

A

Every 15 min. 1st hour
Every 30 min. 2nd hour
Every 4 hours 24 hours
Every 8 to 12 hours thereafter

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11
Q

Postpartum nursing interventions

A

edu for bedrest (prevent orthostatic hypotension)
Temp and VS
Fundal Rub (firm, ht, bladder, lochia, and perineum)
Infuse Pitocin/Oxytocin
Assist with discomfort
Pericare

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12
Q

Report PP if temp is greater than

A

100.4

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13
Q

Report what about the abnormal fundus

A

boggy after massage
- distended if not midline

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14
Q

Report after how many pads are soaked

A

2nd within 15 minutes

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15
Q

Signs of hypovolemic shock

A

Pale, clammy, tachycardia, lightheaded or hypotensive

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16
Q

Signs of hemorrhage

A

increase pulse
low BP

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17
Q

Blood pressure of PP woman if high can be

A

pain, anxiety, preeclampsia

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18
Q

Blood pressure of PP woman if low can be

A

dehydration, hypovolemia

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19
Q

PP woman if Bradycardia could be

A

50 nomral
- due to blood vol loss

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20
Q

PP woman if Tachycardia could be

A

pain
anxiety
hypovolemia
infection

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21
Q

If >100 bpm PP, what could this indicate?

A

excessive blood loss/infection

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22
Q

If RR in PP is higher than 20 suspect

A

pulmonary embolism
uterine atrophy
hemorrhage

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23
Q

If the temperature of PP in the 1st 24 hours after birth, this indicates

A

stress of labor
dehydration

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24
Q

If the temperature is greater than 100.4 over 24 hours it is considered

A

infection (Chorioamnioitis)
- if 2 high temps report

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25
Q

Within the 1st 24 hours of a C-section, what nursing care is needed

A

Respirations and oxygen saturation hourly
Assess Incision site , IV site & dressings
- May need a sandbag for pressure on the site
- Staples vs Dermabond
Mobility after 8 hours
- HA, LOC, itching normal
TCDB, I&Os
Pain relief and education about maintaining and not catching up on the pain
18-24 hours post Csection analgesics = PCA

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26
Q

After 24 hours of a C-section, what nursing care is needed

A

normal
prevent abd distention (BS 4 quads)
Incision, IV, and dressings
TCDB and I&Os
Discharge teachings
D/C cath and IV
Comfort and emotional support
- guilt, question, feel failed
Newborn bonding

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27
Q

If any discharge is leaking out of the incision,

A

mark and see if it expands

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28
Q

Fundal Assessment

A

support uterus at syphysis
palpate fundus and assess for
- consistency
- ht to umbilicus
- location

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29
Q

1/u

A

– above umbilicus

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30
Q

u/u

A

– at umbilicus

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31
Q

u/1

A

– below umbilicus

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32
Q

Consistency types of fundus

A

firm = good (pickleball)
boggy = bad (stress ball) - atony = MASSAGE

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33
Q

If displaced laterally fundus, what do you do?

A

ask them to void due to baldder distension
reassess
cath if still displaced

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34
Q

Fundus involution occurs _____ cm /day

A

1-2

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35
Q

Fundus is on the 1st day PP

A

at the umbilicus

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36
Q

At 7-10 day PP, the fundus is

A

below the symphisis pulbis

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37
Q

If the fundal tone is very tender, this indicates

A

infection

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38
Q

Myometrial (uterus muscle walls) contractions compress placenta

A

to lower blood loss
- 12-24 hours post-delivery
- High Oxytocin for long time

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39
Q

After pains occur more often in what type of births

A

Multigravidas
Breastfeeding
Overdistended uterus – multiple gestations, polyhydramnios
Rarely felt by Primigravidas

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40
Q

Nursing interventions for Uterine involutions

A

Medicate before breastfeeding (Oxytocin)
Enhance comfort and relaxation to facilitate let down of milk

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41
Q

Lochia

A

vaginal blood from placenta site

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42
Q

Normal Lochia

A

normal menstrual smell (fleshy)
discharge amount lowers daily
- increase with ambulation
- scant-light-moder-heavy-excessive
small clots are normal

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43
Q

Excessive Lochia is when a pad is

A

saturated with in 15 minutes

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44
Q

1g weighed by the pad =

A

1 mL of blood

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45
Q

If large clots appear they interfere with

A

uterine contractions
- obtain wt and report

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46
Q

Rubra Stage of Lochia
-time frame

A

day 1-3

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47
Q

Rubra Stage of Lochia
expected findings

A

Bloody Small Clots- Red
Moderate – Light
Standing/Breastfeeding
Fleshy Odor

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48
Q

Rubra Stage of Lochia
- abnormal and report

A

Large Clots
Heavy (Saturates pad in 15 min)
Foul Odor
Placenta Fragments

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49
Q

Serosa Stage of Lochia
-time frame

A

day 4-10

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50
Q

Serosa Stage of Lochia
- expected findings

A

Pink – Brown Color
Light-Scant
Physical Activity
Fleshy Odor

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51
Q

Serosa Stage of Lochia
- abnormal to report

A

Rubra after 4 days
Heavy (Saturates pad in 15 min)
Foul Odor

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52
Q

Alba Stage of Lochi- time frame

A

day 10

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53
Q

Alba Stage of Lochia
- expected findings

A

Yellow - White Color
Scant - none
Fleshy Odor

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54
Q

Alba Stage of Lochia
- abnormal and report

A

Bright Red (Late PP Hemorrhage)
Foul Odor

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55
Q

Vagina changes PP

A

Greatly stretched
Walls appear edematous
Multiple small lacerations possible
Vaginal walls are thin and dry until ovulation returns (painful during sex due to breastfeeding due to estrogen in breasts)
Vaginal wall regains thickness - estrogen production reestablished
Vaginal rugae are few and reappear by 3 - 4 weeks
Dyspareunia - breastfeeding moms

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56
Q

Changes in Cervix PP

A

Dilated, edematous, and bruised
Small tears or lacerations may be present
The cervix heals within 6 weeks
- CERVIX INTERNAL WILL GO BACK
- EXERNAL WILL STAY OPEN

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57
Q

T/F: Vagina muscle tone is never completely restored to its pre-pregnancy state.

A

True

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58
Q

Multipara cervix will look

A

football shaped

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59
Q

Dyspareunia

A

persistent or recurrent genital pain that occurs just before, during or after sex

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60
Q

Perineum changes in PP

A

edema and bruised
Episiotomy or laceration (degrees)

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61
Q

REEDA assess the Perineum

A

Redness
Edema
Ecchymosis
Discharge
Approx

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62
Q

What aggravates the perineum by

A

sitting
beding
walk
voi
bowel

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63
Q

If a PP pt is constipated, do you give them a suppository?

A

no, healthy eating only

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64
Q

Perineal care PP

A

Ice packs for 24-48 hours
Good hand washing
Peri bottle - cleanse perineum with warm water after each elimination
Apply anesthetic sprays or pads to area - (not ointments)
Apply new peri pad front to back after each elimination
Snug Peri-pad

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65
Q

Sitz bath for 1st 24 hours hour water temp

A

cold lower edema

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66
Q

Sitz bath for after 24 hours hour water temp

A

warm

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67
Q

For perineal comfort, how should the mom sit

A

pillow btw legs and tighten butt

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68
Q

Day of Discharge PP

A

Maternal and Infant care
Provide written copies
Patient & family are on OVERLOAD
last VS within an hour
Immunizations and RHOgam for mom
Car seat
Birth certificate complete
Follow up and referrals

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69
Q

On the day of discharge, let the mother know to see the doctor for

A

infection
no or painful urination
UTI - urgency
blurry
HA
keg pain
hrting themselves or the baby

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70
Q

PP Cardiovascular System

A

blood loss 300-1000
fluid shifts back to pre-pregnant levels
increase blood back to the heart
- decrease pressure from the uterus to vessels

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71
Q

PP chills and shakes 1st 1-2 hours due to

A

body rids of escess fluid
- work of labor
- nervous system response
give warm blankets

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72
Q

Vaginal Delivery blood loss

A

300-500mL

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73
Q

Cesarean Birth blood loss

A

500-1000mL

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74
Q

Is a hemorrhage labeled in your hx even if you are losing more blood but not having the symptoms?

A

yes

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75
Q

PP Lower Extremity Assessment

A

s/s of thrombophlebitis
- palpate pedal pulses
- assess edema
- assess deep tendon reflexes

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76
Q

thrombophlebitis nursing interventions

A

Early ambulation
Frequent trips to the bathroom
SCD’s or compression stocking if indicated

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77
Q

Edema 1+

A

< 2 mm
disappears immediately

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78
Q

Edema 2+

A

2-4 mm
few second rebound
common in PP

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79
Q

Edema 3+

A

4-6mm
10-12 sec rebound

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80
Q

Edema 4+

A

6-8 mm
>20 sec rebound

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81
Q

PP Hematologic Changes

A

WBC increase 12-25,000
Hgb and Hct difficult
Coagulation elevated

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82
Q

Why is Hgb and Hct difficult to interpret?

A

Plasma is diluted by the remobilization of excess body fluid
Increase hematocrit
Return to normal within 4 to 6 weeks

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83
Q

Plasma vol loss exceeds what

A

hematocrit loss

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84
Q

Coagulation increase causes what PP

A

HEMORRHOIDS AND VARICOSITY

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85
Q

PP GI changes - Digestion

A

low peristalsis
increase appetite
Hypoactive bowels

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86
Q

PP GI changes - Constipation

A

encourage fiber in the diet
stool softeners

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87
Q

PP GI changes nursing interventions

A

Assess for hemorrhoids
- Hemorrhoid creams as prescribed
Encourage early ambulation
Avoid enemas & suppositories (3rd or 4th degree lacerations)

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88
Q

Expect your 1st BM PP when

A

2-3 days later

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89
Q

Decrease peristalsis due to

A

analgesia and anesthesia

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90
Q

PP Urinary Changes

A

Diuresis = 3000+ mL /day (1st 24 hours starts)
Urinary retention

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91
Q

Urinary Retention in PP

A

low sensitivity to pressure
low muscle tone of the bladder
over distended bladder - push fundus over
persistent dilation increase risk of UTI
Tramatized meatus

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92
Q

PP Urinary Changes Nursing interventions

A

Voiding within 6 hours of delivery
Cathe if less than 150 mL and bladder is palpated
Pain meds to relax
Kegal exercises to strengthen perineal muscles

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93
Q

What are some ways to Encourage voiding within 6 hours of delivery?

A

Running water, peppermint oil, pour water over vulva
Provide hot tea or fluids of choice
Encourage urination in the shower or sitz bath
Toileting schedule

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94
Q

What are the indications for catheterizing the PP mother

A

Voiding less than 150 mL, and the bladder can be palpated
Fundus is elevated or displaced from the midline
Unable to void
> 6hrs and bladder scan reveals urine

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95
Q

PP Musculoskeletal Changes

A

Muscle fatigue
Pelvic muscle tone back at 3-6 weeks
- abd regain 6 weeks

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96
Q

Muscle fatigue

A

soft and flabby abdomen (Mom Pooch) – contractions of the wall
Hip or joint pain analgesic)
Feet permanently increased in size

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97
Q

Pelvic muscle regain tone in

A

3-6 weeks

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98
Q

Abdominal wall regain tone at

A

6 weeks

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99
Q

Diastasis recti

A

separatio of the restus abdominal wall
return to normal may take longer

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100
Q

Nursing Interventions for muscle changes

A

Provide comfort measures
Ice, Heat, warm shower or Analgesia

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101
Q

PP Skin changes

A

Hyperpigmentation area gradually disappear
Striae gravidarum (stretch marks)

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102
Q

Striae gravidarum (stretch marks)

A

Fade to silvery lines but do not disappear
- presumptive sign

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103
Q

Hyperpigmentation area gradually disappear

A

Melasma, the “mask of pregnancy”
Linea nigra
Palmar erythema
Spider nevi fade, some in the legs may remain

104
Q

PP Neuro Changes

A

PRIORITY = INJURY PREVENTION

105
Q

PP Neuro Changes NURSING INTERVENTIONS

A

Assess HA (PRE-ECLAMPSIA, EPIDURAL, OR SPINAL)
- frontal and bilateral common
Severe HA = flat position from Postdural puncture
Epidural blood patch
Caffeine

106
Q

S/S of pre-eclampsia

A

BP increase and vsion chnage

107
Q

Epidural blood patch

A

Small amount of blood is injected over hole that is leaking CSF
Many feel relief right away or may require a second patch

108
Q

PP Endocrine Changes

A

Rapid ↓ of Estrogen & Progesterone
Prolactin ↑ - milk production 2-3 day after delivery
Oxytocin - milk-ejection or “Let-down” reflex

109
Q

Oxytocin - milk-ejection or “Let-down” reflex
can be inhibited by

A

inhibited by stress, anxiety, pain and fatigue

110
Q

If let down reflex happens then

A

stress-free environment
- encouragement and reassurance during breastfeeding

111
Q

Ovulation may occur when

A

before postpartum follow up visit (6 weeks)

112
Q

Non-lactating women MENSES

A

Prolactin ↓ - Menses resumes in 1-2months

113
Q

lactating women MENSES

A

Prolactin↑ - Menses resumes in 3-6 months

114
Q

PP Hemorrhage

A

blood loss greater than 500(vaginal delivery) or 1000(c-section)

115
Q

Primary PP Hemorrhage

A

1st 24 hrs. of delivery
-Uterine Atony
- Lacerations or Hematomas

116
Q

Secondary (late) PP Hemorrhage

A

24 hrs. to 6 wks
- Subinvolution (uterus is still large eventhough it is slowly going down)
- Retained Placenta

117
Q

PP Hemorrhage hypovolemia s/s

A

early catch systematic
- Tachycardia, Hypotensive, Pale, Clammy, Anxious, Confused

118
Q

PP Hemorrhage hemorrhagic shock s/s

A

late catch - at cellular level
- Blue lips/fingernails, ↓urine output, excessive sweating, Chest pain, Shallow breathing Hypotensive, Confusion

119
Q

PP HEMORRHAGE PREDISPOSING RISK FACTORS

A

High parity
Labor dystocia
Prolonged labor
Over - distended uterus - hydramnios, macrosomia, multiple fetuses
Operative delivery - vacuum, forceps, C-section
Previous postpartum hemorrhage
Placenta abruption or previa
Infection - retained placenta
Oxytocin - Induction/Augmentation
Anesthesia or medications - Magnesium sulfate, tocolytics
Anything over distending the uterus or causing relaxation to no contractions

120
Q

EARLY POSTPARTUM HEMORRHAGE: UTERINE ATONY

A

Uterine atony - poorly contracted uterus, lack of tone

121
Q

S/S of uterine atony

A

Fundus does not firm with massage
Soft, boggy uterus above umbilicus
Steady or Sudden saturated pad – 15 min

122
Q

EARLY POSTPARTUM HEMORRHAGE: LACERATION

A

2nd most common
- Peri urethral, Labia, Vagina, Cervix, Perineum

123
Q

Signs of unrepaired laceration

A

Continuous trickledown vagina
Bleeding in spurts
Bleeding in presence of contracted fundus

124
Q

EARLY POSTPARTUM HEMORRHAGE: HEMATOMA

A

250-500ml blood collection in the vaginal or perineal tissue
- difficult to determine amount loss
blood is inside the tissue (bruising welp)

125
Q

Signs of Hematoma

A

Intense perineal pain
Swelling, blue-black discoloration of perineum
Pallor, tachycardia & hypotension
Pressure on vagina, urethra or bladder
Possible urinary retention or displacement

126
Q

Atony - fundus

A

“Boggy”
Difficult to locate
Above expected level
Tone lost after massage

127
Q

Atony - lochia

A

Excessive
Excessive with clots

128
Q

Atony - vs

A

Hypotension
Tachycardia

129
Q

Atony - pain

A

normal

130
Q

Atony - key defining assessment

A

Boggy” Fundus

131
Q

Laceration - fundus

A

firm

132
Q

Laceration - lochia

A

Bright red vs dark red Steady trickle of blood

133
Q

Laceration - vs

A

Hypotension
Tachycardia

134
Q

Laceration - pain

A

Normal

135
Q

Laceration - key defining assessment

A

Steady trickle of bright red blood

136
Q

Hematoma - fundus

A

firm

137
Q

Hematoma - lochia

A

normal

138
Q

Hematoma - vs

A

Hypotension
Tachycardia

139
Q

Hematoma - pain

A

Feeling of pressure,
Severe, unrelieved pain

140
Q

Hematoma - key defining assessment

A

Severe Pain
Visible hematoma
Discolored bulging mass

141
Q

Early Postpartum Hemorrhage: Atony
Nursing Assessment

A

Medications
Bimanual compression (fisting)
Uterine packing or Tamponade

142
Q

Early Postpartum Hemorrhage: Laceration/Hematoma
Nursing Assessment

A

Pelvic exam - perineum, labia, vagina, cervix
Suture laceration

143
Q

Early Postpartum Hemorrhage
Surgical Mgmt

A

Surgical repair - incision and evacuation of hematoma
Surgical - D&C, Hysterectomy

144
Q

Nursing Interventions PP Hemorrhage

A

Perform fundal message - 1st nursing intervention
Review H&H labs & Vital Signs
Maintain or establish large-bore IV
O2 8-10 L/min
Comfort measures - ice, pain meds
Education and emotional support
Bladder training
Report s/s PPH
Administer medications - Oxytocin
Notify physician
Assist with medical management

145
Q

GOAL for nursing PP hemorrhage

A

is to control bleeding & prevent hypovolemic shock

146
Q

PPH - Oxytocin
- action

A

stimulates uterine muscle to ↑ force, frequency & duration of contractions

147
Q

PPH - Oxytocin
- adverse reactions

A

dysrhythmias, B/P changes, water intoxication, & uterine rupture
Interventions - monitor V/S, I & O, lung sounds

148
Q

PPH - METHYLERGONOVINE MALEATE
- action

A

stimulates uterine muscle to increases force & frequency of contraction, producing a tetanic contraction of the uterus

149
Q

PPH - METHYLERGONOVINE MALEATE
- adverse reactions

A

nausea, vomiting, cramping, headache, severe hypertension, bradycardia, dysrhythmias, myocardial infarction

150
Q

PPH - METHYLERGONOVINE MALEATE
- interventions

A

monitor V/S, pain, headache, chest pain, shortness of breath, uterine contractions,** vaginal bleeding (working?)**

151
Q

PPH - CARBOPROST TROMETHAMINE
- interventions

A

monitor V/S, vaginal bleeding and uterine tone

152
Q

PPH - CARBOPROST TROMETHAMINE
- actions

A

stimulates uterine muscle to contract

153
Q

PPH - CARBOPROST TROMETHAMINE
- adverse effects

A

headache, nausea, vomiting, diarrhea, fever, tachycardia, hypertension, pulmonary edema

154
Q

PPH - CARBOPROST TROMETHAMINE
- contraindicated

A

asthma, cardiac, renal & hepatic disease

155
Q

PPH - misoprostol
- action

A

stimulates uterine muscle to contract

156
Q

PPH - misoprostol
- adverse effects

A

headache, nausea, vomiting, diarrhea, fever, tachycardia, hypertension, pulmonary edema

157
Q

PPH - misoprostol
- interventions

A

monitor V/S, vaginal bleeding and uterine tone

158
Q

PPH - misoprostol
- route

A

rectally on tissue dmaage sit with prostaglandin

159
Q

LATE POSTPARTUM HEMORRHAGE SUBINVOLUTION

A

retain placenta fragments and infection

160
Q

Late PPH Subinvolution nursing assess

A

Enlarged or “boggy” uterus
Signs & symptoms of bleeding or infection
Initiate postpartum hemorrhage nursing interventions

161
Q

Late PPH Subinvolution med mgmt

A

antibiotics, oxytocin, and/or analgesia
Ultrasound confirm retained placenta
Surgical management- dilation & curettage (D&C), hysterectomy

162
Q

Uterine Inversion

A

OB emergency
- partial/complete turning inside out of the uterus

163
Q

Uterine Inversion Nursing Assessment

A

Lower abdominal pain
Uterus protruding from vagina
Vaginal bleeding & Hypovolemia

164
Q

Uterine Inversion interventions

A

Stop Oxytocin immediately
Administer medications - Terbutaline, antibiotics
Monitor for and manage hypovolemic shock

165
Q

Uterine Inversion medical mgmt

A

Immediate manual replacement
Surgery

166
Q

PP Infection

A

Bacterial infection after childbirth
**temp >100.4 after the 1st 24 hours and at least twice
- can go into lymph and life threatening

167
Q

PP Infection risk factors

A

Prolonged labor
Multiple vaginal exam
Tissue trauma
Poor hygiene

168
Q

PP Infection risk reduction

A

Hand washing- staff, physicians & families
Early ambulation- promotes drainage & circulation
Proper site care

169
Q

Site infections

A

episiotomies, laceration, or Cesarean incision

170
Q

PP Infections nursing assessments

A

Obtain Vital signs & Labs
Pain, tenderness, and warmth at the site
Purulent drainage
Wound dehiscence or evisceration

171
Q

PP Infections nursing interventions

A

Obtain lab and cultures as ordered
Comfort measures - analgesics, sitz baths, warm compresses
Administer medications - antibiotics
Assist with incision and drainage

172
Q

Endometritis

A

infection of the uterine tissue lining the uterus

173
Q

Endometritis assessment

A

Pulse > 100
Fever, chills, malaise, anorexia
Excessive uterine tenderness
Lochia returning to rubra form serosa
Foul smelling or purulent lochia
Urinary frequency
Sore cracked & bleeding nipples

174
Q

Endometritis interventions

A

Bedrest - semi-fowlers position
Administer IV antibiotics, Antipyretics, Oxytocin or Methylergonovine
Complications- Salpingitis, Peritonitis, Septicemia

175
Q

UTI and pregnancy

A

urinary stasis due to a** hypotonic bladder**
Catheter insertion
Delivery can traumatize the bladder and/or urethra

176
Q

Cystitis occurs

A

1-2 day PP

177
Q

Cystitis assessment

A

Slight or no fever
Dysuria, frequency, urgency, suprapubic tenderness
Cloudy urine, hematuria, and bacteriuria

178
Q

Pyelonephritis occurs

A

3-4th day PP

179
Q

Pyelonephritis ASSESSMENT

A

Fever, chills, costovertebral or flank pain, nausea and vomiting
Dysuria, urgency, cloudy urine, hematuria, and bacteriuria

180
Q

uti+ interventions

A

Encourage juices to acidify the urine - cranberry
Increase fluid intake & avoid carbonated drinks
Educate to complete antibiotics
Obtain lab as ordered - CBC, UA, urine culture and sensitivity

181
Q

uti+ mgmt

A

UTI - PO antibiotics
Pyelonephritis - IV hydration and broad-spectrum antibiotics

182
Q

Thrombophlebitis

A

increase clotting factors and fibrinogen
- clot in vessel walls = inflammation of the vessel
= superficial, femoral, pelvic

183
Q

Blood vessel injury

A

increase risk during pregnancy and birth

184
Q

Hypercoagulation

A

prevent PP maternal Hemorrhage

185
Q

S/S of thrombophlebitis

A

Minimal fever
Positive Homan sign if assessed
Pain or dull ache in calf or leg
Swelling in extremity below pain

186
Q

thrombophlebitis interventions

A

depend on location
Assess the extremities for a warm, red, tender, swollen area
Bedrest & Elevate affected extremity
Moist warm packs to the area
Elastic support stockings or SCD’s
Analgesics and or antibiotics as ordered
IV Heparin - may be ordered for femoral or pelvic to prevent PE’s

187
Q

thrombophlebitis mgmt

A

Diagnosis - Doppler or MRI
Therapeutic management- Early ambulation
Anticoagulation treatment
Warfarin
Monitor PPT & INR
Birth control teratogenic effects

188
Q

Pulmonary embolism

A

clot enters vascular and occludes blood low to the lungs
- amniotic fluid embolism and debris enters circulation

189
Q

Pulmonary embolism s/s

A

Apprehension - feeling on impending doom
Sudden dyspnea and chest pain
Tachycardia, and tachypnea
Hemoptysis (expectoration of blood or bloody sputum)
Pulmonary crackles and cough

190
Q

Pulmonary embolism interventions

A

Semi-fowlers to facilitate breathing
Oxygen 8-10 L/m
Monitor vital signs
Monitor for signs of respiratory distress and hypoxemia
IV fluids, medications - analgesics, anticoagulants, thrombolytic

191
Q

Pulmonary embolism mgmt

A

Chest X-ray, Lung Scan, Pulmonary Angiogram
Clot management - dissolve or surgery

192
Q

Advantages of Breastfeeding

A

adequate nutrition for first 6 months of life
Easier to digest
Promotes brain growth
Reduces risk of neonatal infections
Promotes bonding
Convenient
Inexpensive
Reduced incidence of SIDS, allergies, childhood obesity

193
Q

Maternal needs for breastfeeding

A

Add 500 calories to pre-pregnancy intake
Drink 8 glasses of water per day

194
Q

Breastfeeding Success means

A

depend on mother desire, positioning, and latch
- skin to skin and undressed
tummy to tummy
nipple to baby nose

195
Q

Breastfeeding contraindication

A

Medications, HIV, Chemo, Infant conditions
- severe cleft palate

196
Q

Breastfeeding positioning

A

Cross Cradle, Football

197
Q

Breastfeeding time

A

on demand
- 1st breast 10 min., then 2nd until satisfied; Burp between breast
Alternate positions to prevent nipple trauma

198
Q

Baby diapers per day = good

A

1 pee and 1 poo for 5 days

199
Q

Infant signs of hunger

A

Rooting, Sucking, Hands to mouth

200
Q

Effective Feeding

A

Let down reflex
Latch pain subsides
Audible swallowing
Adequate output
Weight gain

201
Q

Colostrum - “Liquid Gold”

A

1st 1-2 days
- immunoglobulins and laxatives

202
Q

Transitional milks

A

2-3 days

203
Q

Mature milk

A

22-23 calories /oz

204
Q

Foremilk

A

stored before feeding – high in water content

205
Q

HIndmilk

A

produced during feeding – high in fat content

206
Q

Breast Assessment

A

Engorgement - soft, swollen, firm, or tender
Palpate lumps and nodules

207
Q

Nipple Assessment

A

Flat, retracted or inverted
Red, cracked, blistered, or bleeding

208
Q

Mother-infant couple breastfeeding

A

Comfort of position for mom
Infant’s readiness for feeding (stimulated)
Mother’s desire to breastfeed or bottle feed
- shield and pump before

209
Q

Primary engorgementoccurs in

A

occurs breast & bottle feeding moms

210
Q

Primary engorgement patho

A

increase blood flow returns to body as breasts prepare; happens before milk is produced

211
Q

Primary engorgement s/s

A

larger, firm, warm, tender, with a throbbing pain

212
Q

Primary engorgement 24 hours s/s

A

breasts are soft

213
Q

Primary engorgement 48 hours s/s

A

slightly firm, non tender

214
Q

Primary engorgement > 48 hours s/s

A

firm, tender, warm as milk production begins

215
Q

Primary engorgement subsides in

A

24-48 hours

216
Q

Subsequent engorgement occurs in

A

occurs in breastfeeding mom

217
Q

Subsequent engorgement patho

A

Distention of milk glands

218
Q

Subsequent engorgement reason

A

Missed a feeding, delayed pumping

219
Q

Subsequent engorgement relief by

A

by infant sucking or expressing milk

220
Q

Breast Engorgement interventions

A

Frequent feeding or pumping
Cool compresses briefly
Chilled cabbage leaves to breast
20 min between feeding 3X/day
- still want the milk

221
Q

Nipple Trauma
interventions

A

Proper infant removal from the breast
Allow nipples to air dry 15 minutes - 2-3 times a day - limit visitors
Colostrum to nipples

222
Q

How do you remove the baby from feeding on the breast

A

putting finger in the side of the mouth

223
Q

Breastfeeding engorgement education

A

Supportive bra
Alternate feeding position
Warm compresses
Breast massage
Latch education
On-demand feedings
Proper removal of infant

224
Q

Non-Breastfeeding engorgement education

A

Supportive bra
Breast binders (sport bra too small)
Ice pack to breast
Avoid breast stimulation
Avoid milk expression
Avoid heat
Analgesia for pain
- no hot shower

225
Q

Mastitis occurs

A

2-3 weeks postpartum after Prolonged engorgement & inadequate emptying of breasts

226
Q

Mastitis assess

A

Inflammation, bacterial infection of the lactating breast
Unilateral - risk for abscess if untreated

227
Q

Mastitis s/s

A

Sore cracked nipples
Flu-like symptoms - fatigue, malaise fever, chills
Painful, red, swollen, warm, tender area, or palpable mass
Purulent drainage

228
Q

MASTITIS NURSING INTERVENTIONS

A

Good handwashing
DO NOT stop breastfeeding abruptly
Apply warm pack or shower prior to breastfeeding
Massage affected area before & during feeding to ensure emptying
Encourage breastfeeding from affected side first every 2-3 hours
Manual expression or breast pump Q4 hours
Obtain breast milk culture & sensitivity as ordered
Administer analgesics, antibiotic as ordered (oral antibx 10-14 days)
Monitor breast for abscess & need for incision & drainage
Encourage patient to wear supportive bra without underwire

229
Q

Taking-in phase - Dependent

A

(24-48 hours)
Focused on own needs, unable to make decisions
Relives birth experience, adjust to psychological changes

230
Q

Taking-hold phase

A

Dependent/Independent
Focus shifts to infant & maternal role
Anxious/ Bit overwhelmed about competence as mom & accepts advice
May experience baby blues/fatigue

231
Q

Letting-go phase

A

Interdependent
Resolve their idealized expectations of birth experience
Accepts reality of infant and incorporates into lifestyle
Separates newborn and self; confident in caretaking activities
Relationship with partner grows with reconnection

232
Q

Paternal Adaptation

A

Engrossment - bonds with newborn
Intense interest in infant
Looks forward to parenting but lacks confidence

233
Q

Sibling Adaptation

A

Can be + or –
Provide Extra attention
provide sibling gift,
allow to see baby 1st
Mom/child quality time alone

234
Q

Bonding Adaptation assessment

A

Eye contact
Smiling, kissing, talking, singing
Naming and claiming infant
Positive comments
Responds to cues
Comfort level of care

235
Q

Bonding Adaptation interventions

A

Comfort level
Facilitate bonding
Rooming in
Cluster care
Education
Infant behaviors & cues
Role model infant care
Provide positive feedback
Culture-sensitive
Professional Interpreter

236
Q

Postpartum blues, depression, and psychosis risk factors

A

Hormone changes - rapid ↓ Estrogen & Progesterone
History of depression
Pregnancy or childbirth complications, pain or discomfort
Anxiety related to new role as mother
Unplanned pregnancy
Low self-esteem
Lack of social support
Life stresses - socioeconomic factors
Intimate partner violence - poor relationship with partner

237
Q

PP Blues “Baby Blues”
time

A

1st wk PP, peaks around 5th day

238
Q

PP Blues “Baby Blues”
s/s

A

Irritability, Fatigue, Crying, Mood swings, & Anxiety

239
Q

PP Blues “Baby Blues”
cause

A

Cause unknown;
Hormone changes, discomforts, sleep deprivation, body image concerns, Stress

240
Q

PP Blues “Baby Blues”
mom’s infant care

A

Doesn’t usually affect ability to care for infant. Resolves without interventions 10-14 days

241
Q

PP Depression
time

A

Persists past 2 weeks.
Occurs in 1st 3 months & last up to 1 yr

242
Q

PP Depression
s/s

A

Persistent low mood

243
Q

PP Depression
risk

A

Risks include:
History of sexual abuse
Unwanted pregnancy
Smoking, Formula feeding

244
Q

PP Depression
maternal to infant

A

Unable to safely care for infant and self

245
Q

PP Psychosis
time

A

peaks 48 hrs. to 2 wks.

246
Q

PP Psychosis
s/s

A

Intense depression
relapse of a psychotic d/o, Confusion, Auditory & visual hallucinations, Insomnia

247
Q

PP Psychosis
criteria include

A

major depressive disorder with psychosis
Bipolar I, Bipolar II, Unspecified functional psychosis, Schizoaffective disorder

248
Q

PP Psychosis
mgmt

A

Medical emergency, Serious mood instabilities, thought of suicide, infanticide

249
Q

Postpartum blues, depression, and psychosis interventions

A

Review history for risk factors
Monitor maternal - infant interaction
Education - patient and family
S & S postpartum blues, depression and psychosis
Importance of rest, ↓ stress, emotional and physical support
Compliance with prescribed medications
Notify PCP if symptoms persist, thought of self or infant harm
Provide information support groups

250
Q

Mild Blues, Depression, and Psychosis

A

psychotherapy

251
Q

Moderate Blues, Depression, and Psychosis

A

psychotherapy & antidepressants

252
Q

Severe Blues, Depression, and Psychosis

A

Psychotherapy, antidepressants, & Intense Psychiatric care, Crisis intervention

253
Q

Assessment of Adolescent Parenting

A

Knowledge level
Prenatal care
Support system
Boyfriend, Grandparents
Expectations of childcare & support
Attitude towards parenting
Economic status
Culture/Spiritual beliefs
IPV
Unsafe Behaviors
Smoking, drugs, peer activities

254
Q

Adoption decision

A

Exciting time - giving child a “better life”
Struggle - intense guilt, depression & regret

255
Q

Adoption factors

A

Single
Adolescent
Economic status
Result of incest or rape
Not emotionally ready for parenthood
Partner disapproval of pregnancy

256
Q

Adoption parents

A

Plans can be Independent, Private or Public agency
Feel anxious and overwhelmed
Teaching on basic infant care

Module 6 (Labor And Delivery) (7 decks)

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