T3 - Nursing Care During Postpartum (Josh) Flashcards Preview

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Flashcards in T3 - Nursing Care During Postpartum (Josh) Deck (46):
1

What are we assessing during the 4th stage?

VS

Fundus

Lochia

Perineum (REEDA)

Bladder

PAR (post-anesthesia record)

2

How often do we access VS, etc.?

First hour…q15 minutes

Second hour…q30 minutes if stable

Then every hour for 4 hours

Then every 8 hours until discharge

3

How to remember when to access?

q15 x 4 (first hr)

q30 x 2 (second hr)

q1hr x 4 (next four hrs)

q8hr until discharge

4

Risk factors for excessive bleeding postpartum?

Macrosomic (4000g) baby or multiple birth

Long/Difficult laborMultipara

5

When would a baby be large for gestational age?

When would a baby be small for gestational age?

above 90th percentile

below 10th percintile

6

Large baby is --

Small baby is ---

4000 g

2500 g

7

Fundus should drop --- every day

1 cm

8

What is the most common cause of postpartum hemorrhage?

uterine atony

***assess for boggy uterus

9

What is left on the endometrial wall after placenta is expelled?

denuded area of exposed blood vessels about the size of a fist

***why there is still some bleeding

10

Interventions for boggy uterus.

Immediate response may be to massage the fundus until firm...Express any clots that may be present

Check bladder for distention…Assist patient to empty bladder

Change pad…note quantity of lochia (pad soaked in

11

Meds used to stimulate contractions postpartum.

Pitocin

Methergine (hold if BP 140/90 or greater)

12

If temp is up during first 24 hours postpartum, what is likely cause?

dehydration

13

Call provider if HR ---

> 100

14

What temp indicates infection in postpartum client?

Temperature greater than 100.4 that persists X2 days (exclusive of first 24 hours)

***after 24 hrs, think infection

15

Nursing actions to prevent infection during postpartum stage?

Change perineal pad with each voiding or defecation

Peri care

16

How do we assess the perineum?

REEDA

Lochia for color, quantity, and odor

***C-section have less bleeding

17

Nursing interventions to promote healing of perineum

Ice pack (cold) X 1st 24 hours to decrease edema

Sitz bath (warm) after 24 hours – tid X 20 minutes

Peri care with warm water with each urination

Blot dry, wipe from front to back

Apply new pad after each voiding

18

Why does bladder fill so quickly postpartum?

fluid shift

(remember carrying 50% more volume during preg)

19

How much fluids should we encourage to prevent UTI?

3000 mL/day

20

When do we cath a postpartum client?

bladder distended

uterus displaced

6hrs elapsed since last void

voiding less than 150 mL

21

Breast care for lactating client

Wash nipples and areola with water (NO SOAP)

Airdry X 20 minutes

Apply expressed breast milk or nonalcohol cream to prevent drying and cracking (Cracks in skin = pathogens mastitis)

Empty engorged breasts manually or with breast pumpSupport bra

22

Nonlactating mom needs --- calories.

Lactating mom needs -- calories

1800-2200

additional 450-500/day

23

Nutrition for lactating client

Increase fluids

Increase caloric intake to 2700 kcal/day

No meds without consulting physician

Avoid foods gastric irritation, gas or diarrhea

24

When they have mastitis, do they need to stop breastfeeding?

yes, b/c they are likely on antibiotics

***pump and dump

25

How to suppress lactation

Support bra

Avoid stimulation to breastIce packs …15 minutes q hour

Comfort measures for breast engorgement

Analgesic or anti-inflammatory medication

Cool clean cabbage leaves

26

--- during pregnancy can continue into postpartum period.

PIH

***lasts up to 6 wks after delivery

***investigate pitting edema

27

What is a safe anticoagulant for breastfeeding clients?

Heparin

28

What is Homan's Sign?

calf tenderness upon dorsiflexion of foot

***sign of DVT

29

What is best prevention for DVT postpartum?

early ambulation

30

What is the purpose of the Indirect Coombs test?

detect anti Rh antibodies in mother's blood

***administer 300 mcg of Rhogam within 72 hrs

31

Prevention of Iso-immunization

Indirect Coombs test negative = no anti Rh antibodies in mother’s blood.

Administer RhoGAM 300 mcg IM within 72 hours of delivery

Administer as for blood productTest immunity in 3 months

32

When would Rubella vaccine be administered postpartum?

after birth and again at 1 mth

33

Nursing education regarding Rubella Immnization

Teach client to avoid pregnancy X 1 month after each dose

Safe for breast feeding patients

May develop rash…

***can't take if allergic to eggs

34

What is Hot-Cold Asian Culture?

Pregnancy is considered hot condition, heat is depleted during birth, now she is in a cold state for 40 days. She consumes only hot food, & beverages. She may be discourage from showering or bathing because this could cause heat loss

35

What is the 'Taking In' Phase?

First 1-2 days postpartum

Introspective and preoccupied with own needs rather than new baby

Passive/dependent behavior

Excited & talkative

Touches and explores infant

Needs to verbalize L&D experience

36

What is the 'Taking Hold' Phase?

Begins by 2nd to 3rd postpartum day, lasts 10 days up to several weeks

Moves toward more independent behavior

Desires to take charge

More receptive to teaching

37

What is the 'Letting Go' Phase?

Achieves realistic independent role

Establishes norms for self and family

Mothering functions established

Resumption of relationship with partner

Resumption of sexual activity

Family system enters new phase of development

38

Transient depression usually b/t 2nd and 3rd PP day or within 2 wks?

Postpartum Blues

39

Characteristics of PP Blues

Usually between 2nd and 3rd postpartum day or within two weeks

Characterized by mood swings, anger, tearfulness, feeling let down, anorexia and insomnia

Emotionally labile, cries for no reason

40

What happens if Postpartum Blues persist and don't resolve spontaneously?

evaluate for PP depression

41

Temperature may be elevated after delivery r/t ---.

dehydration

42

After 24h a temp elevation of --- correlates to postpartum infection.

100.4F

***This is lower temp than usually considered an infection.

43

--- can occur postpartum.

Preeclampsia

44

What does BUBBLE-HE stand for?

Breasts

Uterus

Bladder

Bowels

Lochia

Episiotomy/Laceration

Hemorrhoids/Homan's

Emotion

45

Scant Lochia =

Small Lochia =

Moderate Lochia =

Heavy Lochia =

Scant Lochia = 10 cm (25-50 mL or 25-50 g)

Heavy Lochia = 1 pad saturated within 2 hrs

46

What type of lochia constitutes an immediate assessment?

pad saturated in 15 mins or less

***Notify MD