Preventing PP complications & comfort measures

Question 1

When are PP mothers still a falls risk?

Answer 1

Even when the epidural wears off

Question 2

What is included in post-epidural care to prevent falls? Hint: 5

Answer 2

1) Assess muscle/ motor strength & sensory function of legs
2) Ensure they are safe to ambulate before assisting them
3) Always assist with first ambulation post-epidural
4) Monitor for dizziness & provide support
5) Stay nearby when toileting

Question 3

Why is there a risk of syncopal episodes post-epidural?

Answer 3

Due to hemodynamic changes after delivery

Question 4

List 3 interventions to help avoid syncopal episodes post-epidural

Answer 4

1) “Dangle” at bedside before standing
2) Keep wheelchair nearby
3) Ensure VS & bleeding is stable before ambulation

Question 5

What should be nearby incase the PP mother does faint?

Answer 5

Ammonia inhalant

Question 6

List 3 interventions to prevent DVT in C-section pt

Answer 6

1) Admin Lovenox/ Heparin
2) Use sequential compression devices (SCDs)
3) Encourage ambulation ASAP (usually 8 hrs post surgery)

Question 7

List 3 interventions to prevent respiratory complications in C-section pt

Answer 7

1) Incentive spirometer
2) Encourage deep breathing & coughing exercises
3) Ambulate ASAP

Question 8

How does incentive spirometry help prevent resp. cpmplications?

Answer 8

It improves lung function & encourages movement

Question 9

How does deep breathing & coughing help prevent resp. complications?

Answer 9

Prevents pooling of respiratory secretions in the lungs

Question 10

List 3 ways to prevent wound infections in C-section pt

Answer 10

1) Hand hygiene before touching incision
2) Daily shower; use clean towels
3) Teach wound care; Inspect daily for signs of infection using REEDA

Question 11

List 3 interventions to promote peristalsis in C-section pt

Answer 11

1) Early ambulation
2) Dulcolax
3) Milk of Magnesium

Question 12

List 5 interventions for constipation in C-section pt

Answer 12

1) Offer colace (docusate Na)
2) Ambulation
3) Fluids
4) Fiber
5) Bring it up before they ask (could be embarrassed or fearful)

Question 13

List 2 non-pharmacological pain relief interventions for vaginal delivery

Answer 13

1) Ice packs in underwear for first 24-48 hrs
2) Warmth after 48 hrs → sitz bath; peri-bottle; warm compress/ heating pad to abdomen for cramping

Question 14

What pharmacological pain relief is used for cramping in vaginal deliveries?

Answer 14

Ibuprofen or Acetaminophen

Question 15

When would taking Ibuprofen or Acetaminophen be contraindicated?

Answer 15

In bleeding disorders

Question 16

How should we teach moms to take Ibuprofen / Acetaminophen?

Answer 16

With food to prevent upset stomach

Question 17

What pharmacological pain relief can we use for perineal/nipple discomfort in vaginal deliveries?

Answer 17

Topical agents
1) Dermopalst numbing spray
2) Pads with witch hazel
3) Ointments for hemorrhoids

Question 18

When can opioids be used in mother who had a vaginal delivery?

Answer 18

If she has a 4th degree laceration or medial-lateral episiotomy

Question 19

List 3 non-pharmacological pain relief interventions for C-section

Answer 19

1) Splinting of incision when moving/ coughing
2) Ambulation
3) Buddy pillow or abdominal binders

Question 20

How is incisional splinting effective in mothers who had a C-section?

Answer 20

Helps reduce strain & pain of abdominal muscles

Question 21

How can ambulation be effective pain relief in mother’s who had a C-section?

Answer 21

Promotes interstitial motility, prevents gas, reduces risk of complications (i.e. paralytic ileus & DVT)

Question 22

List 5 pharmacological pain relief methods used for mother’s who had C-section

Answer 22

1) Narcotic analgesia
2) Ketorolac NSAID
3) Ibuprofen NSAID
4) Acetaminophen (PO or IV)
5) Simethicone (Gas-X)

Question 23

What would we give to a PP C-section mother if she received general anesthesia?

Answer 23

Morphine or Dilaudid through PCA pump

Question 24

When should narcotics be given if pt received spinal duramorph for C-section?

Answer 24

May not receive extra narcotic for 24 hrs but after 24 hrs she can get percocet or oxycodone (w/ or w/o tylenol)

Question 25

What is a really important adjunct Tx for pain relief in C-section pts?

Answer 25

Ketorolac NSAID

Question 26

When would Ketorolac NSAID be administered? **Hint: 2**

Answer 26

1) First 24 hrs when mom is not eating a lot & had an empty stomach 2) If she was kept NPO or on clear liquids through labor

Question 27

How can Ketorolac be given & what does it work well with?

Answer 27

**Can be given IV** Works really well in conjuction w/ the spinal or PCA

Question 28

When can Ibuprofen NSAID be given to C-section mother?

Answer 28

After first 24 hrs when mom is eating

Question 29

What is the usual dose given of Ibuprofen in mom who had a C-section?

Answer 29

Larger dose → usually 800 mg

Question 30

Why would we give Acetaminophen post C-section?

Answer 30

Very good adjunct to narcotics & NSAIDS → can get synergistic effect from using all 3 in combo

Question 31

What is the usual dose of Acetaminophen given post C-section?

Answer 31

650-1000 mg → make sure to not exceed max dose of 4000 mg

Question 32

List 2 reasons Simethicone (Gas-X) can be given after C-section

Answer 32

1) Helps alleviate gas pain 2) Helps reduce discomfort caused by intestinal bloating

Question 33

What is safe pharmacological pain relief given for uterine involution?

Answer 33

Ibuprofen 600 mg PO q6h for after pains

Question 34

What is NOT safe to give for uterine involution pain relief? **Hint: 3**

Answer 34

1) Oxycodone 2) Tylenol 3) Docusate sodium

Question 35

List 3 non-pharmacological interventions for BF mothers with sore / cracked nipples

Answer 35

1) Proper positioning & latch 2) Topical lanolin 3) Gel discs

Question 36

Does topical lanolin need to be washed off before BF?

Answer 36

NO

Question 37

How do gel discs help with nipple pain?

Answer 37

Promote moist wound healing; keep in fridge to add extra comfort

Question 38

List 4 non-pharmacological interventions for non-BF mothers w/ engorgement

Answer 38

1) Supportive bra 2) Ice packs 3) Do NOT try to express milk 4) Cabbage leaves in bra

Question 39

Why is supportive bra important for non-BF mom with engorgement?

Answer 39

Helps reduce heaviness & discomfort **Should gently compress breasts**

Question 40

Why are loose fitting bras not recommended for non-BF moms w/ engorgement?

Answer 40

Allow too much movement which can be uncomfortable & exacerbate swelling

Question 41

How can putting cabbage leaves in bra help with engorgement in non-BF moms?

Answer 41

Shown to have anti-inflammatory properties that may help reduce swelling & discomfort **Remove after 20 min to avoid skin irritation**

Question 42

List the 3 phases of psychosocial adaptation to PP

Answer 42

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

Question 43

What is the taking in phase? **Hint: 8**

Answer 43

1) Occurs immediately after birth (lasts 24-48 hrs) 2) Mom is overwhelmed, focused on herself 3) Wants to talk ab birth & replays it to process 4) Not yet receptive to learning 5) Needs support from others 6) Nurse should assist with NB care & self-care for mom 7) Keep teaching short, realistic, & supportive 8) Patience is key!!

Question 44

What is the taking hold phase? **Hint: 5**

Answer 44

1) Occurs around day 2 (may take longer) 2) Begins adjusting to motherhood & accepting new reality 3) Starts focusing on baby & self-care 4) Full of questions & will need guidance 5) Ideal time for teaching

Question 45

What is the letting go phase? **Hint: 3**

Answer 45

1) Occurs after 1st month (often by 6 wk checkup) 2) Gains confidence in identity as mother & begins to feel more at ease 3) Continue to provide support but more in the background

Question 46

List 6 common Sx of baby blues

Answer 46

1) Mood swings 2) Weepiness 3) Frustration 4) Irritability 5) Disappointment 6) Sense of being let down by motherhood

Question 47

What are baby blues often triggered by?

Answer 47

Hormonal shifts → rapid drop in estrogen & progesterone after delivery

Question 48

How should we Tx baby blues?

Answer 48

Usually resolve on their own in 10-14 days **reassure mom that this is normal part of transition to prevent feelings of guilt or inadequacy**

Question 49

Why do women often suffer in silence from PPD? **Hint: 3**

Answer 49

1) Social stigma 2) Fear of judgment 3) Comparison to idealized images

Question 50

List 3 effects of PPD

Answer 50

1) Interferes w/ bonding 2) Affects infant development 3) Can worsen w/o intervention

Question 51

List 2 ways PPD can affect infant development

Answer 51

1) Reduced mother-baby interactions (fewer smiles, cooing, & baby talk) 2) Less stimulation → developmental delays

Question 52

List 6 risk factors for PPD

Answer 52

1) Hx of mood disorder 2) Stressful life events 3) Unplanned pregnancy 4) Lack of social support 5) Complications during pregnancy / delivery 6) Body image issues

Question 53

Postpartum Depression: Hx of mood disorders **Hint: 3**

Answer 53

1) Depression; anxiety; OCD at any point in life 2) mood disorders during pregnancy ↑ risk 3) Hormonal shifts PP can trigger biochemical imbalance

Question 54

Postpartum Depression: List 4 stressful life events that can ↑ risk of PPD

Answer 54

1) Loss of loved one 2) Divorce/ major relationship issues 3) Moving, financial stress, or job loss 4) Coping skills become overwhelmed

Question 55

Postpartum Depression: How can unplanned pregnancy ↑ risk of PPD

Answer 55

1) Feelings of doubt/ uncertainty 2) Cognitive distortions (i.e. "I don't love my baby enough") 3) Can lead to guilt & exacerbate depression

Question 56

Postpartum Depression: How can lack of social support lead to PPD **Hint: 3**

Answer 56

1) No help w/ baby, housework, or self-care 2) ↑ fatigue & sleep deprivation 3) No emotional support from partner/ family

Question 57

Postpartum Depression: How can complications during pregnancy/ delivery ↑ risk of PPD

Answer 57

1) Unexpected events ↑ anxiety 2) C-section, traumatic birth, NICU stay 3) Can create negative perception of experience

Question 58

Postpartum Depression: How can body image issues ↑ risk of PPD

Answer 58

1) Stretch marks, sagging skin, engorged breasts 2) Social media does NOT show PP bodies, leading to shame

Question 59

List 6 S/S of PPD

Answer 59

1) Persistent sadness or lack of joy 2) Disturbances in eating or sleeping 3) May have significant anxiety component 4) Feelings of worthlessness, inadequacy as mother 5) Thoughts of hurting self 6) OCD component - unwanted thoughts

Question 60

Postpartum Depression: Persistent sadness or lack of joy

Answer 60

1) NOT just mood swings → sadness is constant 2) Lack of interest in previously enjoyed activities

Question 61

Postpartum Depression: Disturbances in eating/ sleeping

Answer 61

1) Some overeat, others have no appetite 2) Insomnia or excessive sleeping 3) Chronic fatigue despite sleep

Question 62

Postpartum Depression: Anxiety component

Answer 62

1) New onset of panic disorder PP 2) Excessive worry about baby's safety

Question 63

Postpartum Depression: Feeling worthless; Inadequacy as mother

Answer 63

1) Believes she is a bad mother 2) Negative thoughts → "My family would be better off" → "I made a mistake having this baby" → "I should be happy, but i'm not"

Question 64

Postpartum Depression: Thoughts of hurting self

Answer 64

**Usually not 1st Sx but can develop** 1) These thoughts require immediate intervention

Question 65

Postpartum Depression: OCD component - Unwanted thoughts

Answer 65

1) obsessive worry ab baby's well-being 2) Compulsively checking baby (i.e. breathing; feeding) 3) Irrational fears (i.e. baby falling off changing table)

Question 66

Tx for PPD: Therapy

Answer 66

1) Cognitive-behavioral therapy 2) Support groups

Question 67

Tx for PPD: SSRIs (selective serotonin reuptake inhibitors)

Answer 67

**1st line Tx → antidepressants** 1) Zoloft (Sertraline) → preferred 2) Prozac (Fluxoetine) → longer half-life

Question 68

Are SSRIs safe for breastfeeding?

Answer 68

Most are → psychiatrists should NOT discourage BF

Question 69

Tx for PPD: Brexanolone (Zulresso)

Answer 69

1) IV infusion for severe PPD 2) Addresses hormonal causes 3) Expensive but promising Tx

Question 70

Tx for PPD: Electroconvulsive therapy (ECT)

Answer 70

1) reserved for severe, treatment-resistant cases 2) Works faster than SSRIs (1-2 wks) 3) Fewer side effects than long term meds

Question 71

Tx for PPD: Alternative therapy methods for mild PPD

Answer 71

1) Exercise (i.e. walking) 2) Sunlight exposure/ light therapy 3) Avoid herbal supps w/o consulting provider

Question 72

When are PP mothers at highest risk for suicide?

Answer 72

**When Tx begins** → energy returns before mood improves → ↑ energy gives more ability to carry out plan

Question 73

List an example of a PPD screening tool

Answer 73

EPDS self report → couples will fill out together; max score of 30

Question 74

Differentiate between baby blues & PPD

Answer 74

Baby blues → Sx temp & mild PPD → Sx persist & affect daily life

Question 75

What to teach PP patient about hygiene (self-care) **Hint: 10**

Answer 75

1) Hand hygiene 2) Wipe front to back 3) Change pads every 2-3 hrs 4) Peri-bottle for rinsing 5) Get foley out ASAP; Void frequently 6) Shower daily; Use clean towels 7) Nothing in vagina for 6 wks (tampons; sex; douching) 8) Teach incisional care → hand hygiene before touching (REEDA) 9) Address cracked nipples 10) Regular nursing to prevent plugged ducts

Question 76

List 4 Post-birth warning signs that require immediate attention / call to doctor

Answer 76

1) Severe H/A 2) Pain in legs (DVT) 3) Excessive bleeding 4) Trouble breathing