test 3 - PP Flashcards
(147 cards)
1
Q
what is the taking in role? how is mom acting
A
first 1-2 days after birth
mom wants to talk about birth experience/reflect/clarify
2
Q
what behavior is most characteristic of “taking in” phase?
A
relying on others for help/focus on self
3
Q
how does mom act during taking hold phase?
A
wants info about infant care
bonds with infant
important to encourage skin to skin & promote bonding
4
Q
in the “taking hold” phase, mom is doing what actions?
A
Actively seeking help with infant care tasks
—–
Worrying about bodily function/health of baby
5
Q
how does mom act during the letting go phase?
A
Redefines her maternal role - sees infant as own individual
can focus on other rather than just herself/infant
6
Q
how can we encourage paternal involvement?
A
early contact with infant
participation in caregiver activity - change diapers/skin to skin
7
Q
how to clean bottle for bottle feeding?
A
boil for 5-10min
8
Q
how do you warm up bottles?
A
Warmed by placing in bowl of hot water for a few minutes
9
Q
important positioning for bottle feeding?
A
keep baby head higher than rest of body
10
Q
how would baby be positioned in a proper latch?
A
mouth 1-2 inches below nip so areola visible from top lip but not bottom
-
nose, cheek & chin all touching breast
11
Q
how would mom recognize that baby has a good latch?
A
hear no sucking sounds
12
Q
how would baby demonstrate good latch?
A
no clicking/slurping sounds
no dimpling of cheeks
2:1 ratio of suck/swallow
13
Q
how to break latch of baby?
A
insert finger into corner of baby’s mouth to break seal
or
gently lift up at push on baby upper lip
14
Q
5 hunger cues?
A
begin to stir
bob head against mattress/mom
make hand to mouth or hand to hand movement
sucking/licking/smacking lips
15
Q
what hormone is responsible for stimulating milk production?
A
prolactin
16
Q
what hormone is responsible for prompting contractions to eject milk?
A
oxytocin
17
Q
what is the let down reflex/what hormone triggers it?
A
milk released into ducts by infant suckling
release oxytocin
18
Q
what might indicate let down is present?
A
tingling sensation in nipples
infants sucking pattern changes from quick/shallow to slower draws
-
possible increased lochia
19
Q
proper nipple care includes?
A
washing with warm water & AVOIDING soap
AVOIDING breast creams
AVOIDING oils/creams with vitamin E
20
Q
what position is the pt in for peri care assessment?
A
side lying sims
21
Q
what intervention is used for peri care
A
peri bottle (NOT sitz bath)
22
Q
ice/warm frequency & timing for pericare?
A
Ice for first 24 hr then warm compress
Warm for 20 min/day & 3-4x daily
23
Q
how often should you change peripad?
A
with every void
or Q4hr
24
Q
s/sx of endometritis?
A
fever over 101 w/in first 24-48hr of childbirth
tachycardia
uterine tenderness during massage
foul smelling lochia
suprapubic pain
25
pain during fundal massage could be indicative of what infection?
Endometritis
26
what is a late s/sx of Endometritis?
foul smelling lochia
27
Mastitis s/sx?
Unilateral redness/swelling/pain
fever/chills
enlarged axillary lymph nodes
obstruction of milk
28
abx treatment for mastitis?
cephalosporin or/& vanco
need to fully complete course
29
non pharmacological treatment/intervention for mastitis?
Keep pumping
empty Q2-4hr
warm compress
30
infant edu w/ breastfeeding & mastitis?
have infant start feeding with affected breast
31
s/sx of DVT?
unilateral pain/tenderness in LE
decreased peripheral pulse
elevated temperature
32
prevention of DVT?
Resting w/ elevated affected limb
compression stocking/moist or warm packs
warfarin
33
what is the ACHES acronym for oral contraceptives in PP period?
A: Abdominal pain
C: Chest pain
H: Headache, fainting
E: Eye problems
S: Sudden leg pain in calf
34
where would concerning abdominal pain present & might indicate what?
RUQ
liver problem
35
a dull thudding sound over the bladder would indicate what?
an empty bladder
36
what would a full bladder sound like?
resonant sound
37
supporting the lower uterine section during palpation ?
prevents uterine inversion
38
what are normal findings with hemoglobin & hematocrit after uncomplicated vaginal birth?
For them to be "low"
Hemo: 12.1-15.1
hema: 36.1-44.3
39
what finding from a pt on methergine would be immediately reported?
palpations = cardiac rhythm disturbances
40
normal findings of a methergine pt?
HA
Dysrhythmia
N/V
41
what intervention would best facilitate mother-baby bonding in hospital?
limiting separation to exceptional circumstances only
42
diff btwn baby blues & PP depression
BB: Periods of happy followed by periods of tearfulness
- usually resolves in 10 days
____________
PPD: insomnia/hyper-insomnia
- Anorexia
- Withdrawal from friends/activity
- At least for 2wks, daily
43
what positions should mom avoid post partum?
Knee to chest
44
normal timing for Rubra lochia?
first 1-3 days PP
or day 3/4
45
normal timing for Serosa lochia?
day 4ish - 10
46
@ what days/timing with serosa lochia would you alert your PCP?
beyond 7-10days
47
how long may alba Lochia last?
8wk
Avg presenting 10-14day
48
if lochia has an odor what can it be indicative of?
infection
49
@ what size are clots concerning?
Larger than quarter/egg
50
how to tell difference btwn blood clot & tissue?
Clot: jello-ish
Tissue: Harder
51
what is a clot made of?
Blood components like fibrin & platelets
52
tissue in the lochia can be/indicate what?
retained placenta fragments & can lead to infection
53
shold Lochia increase in amount?
no -- this is sx of hemorrhage
54
priority pt education on lochia
if color changes back to previous stage color this is a sx hemorrhage = get help
55
what can cause a fundus to deivate off midline to the R?
Distended bladder
56
what does a boggy uterus indicate?
atony
uncontracted & increased risk for hemorrhage
57
how should fundus feel upon palpation?
firm globular mass
58
proper technique for fundal massage
one hand above symphysis pubis & one at belly button level
59
where should the fundus be located immediately after delivery?
halfway btwn umbilicus & symphysis pubis
60
where does the fundus move to 1hr - 24 hr after birth?
level of umbilicus
61
what could a high uterus/fundus indicate?
above umbilicus = Uterine atony
62
main s/sx of a hematoma
"unrelenting" Pain & pressure
63
what would we see if examining for a hematoma?
bluish discoloration & bulging tissue
"full" feeling tissue
64
V/S changes if hematoma is large?
hypotension & tachyc
65
comfort care for hematoma?
if less than 3-5cm: ice for first 12 hr then sitz bath after
66
potential complication from hematoma to monitor for?
Shock
67
how often are VS monitored after vaginal birth?
Q15 min for 2 hr
68
how often are VS measured after CS?
Q15min Q4hr
69
how should a nurse reassure a pt exeriencing chills/uncontrollable shaking in PP?
reassure its a normal physiological experience
70
what is the time limit on a 100.4 fever?
24 hr
71
what cardiac pattern is coming in 6-10 days PP?
bradycardia (50-70)
72
what happens to BP in PP?
should compare to the BP in 1st trimester
73
if a PP pt is having pain similar to menstrual cramps, what is she most likely having?
afterpains
74
give what for afterpains?
NSAIDS
75
what is involution in PP?
uterus returns to pre pregnancy size
76
what are the 4 T's in PPH?
Tone
Trauma
Tissue
Thrombin
77
what is the "hallmark" sign of problems with "tone"
boggy uterus
78
what would a boggy uterus indicate?
failure of uterus to contract, increased risk of PPH
79
what are factors that contribute to "trauma" r/t PPH?
Rapid labor
fetal macrosomnia
C/S & operative deliveries
U rupture
80
what color would blood be if it was r/t tone?
dark red w/ clots
81
what color would blood be if it was related to trauma?
bright red
trickle or stream
82
what delivery style is more at risk for hematomas?
operative births (FORCEPS)
83
steps in order of latching baby?
position baby tummy to tummy w mom
align baby nose w/ mom nipple
wait for baby to open mouth wide
bring baby to breast quickly
ensure baby mouth covers most of areola
84
best action to take if baby isnt latching well?
reposition & try again
85
how can mom tell if baby is actively feeding vs self soothing?
hearing rhythmic suck/swallow
86
signs baby is NOT getting enough milk/emptying breast?
fussy after feeding
breasts feel full after feeding
few wet diapers
87
benefits of breast feeding for birthing parent/baby?
optimal nutrition
enhancing bonding
reduce risk of certain infections
88
are large clots normal in the first week?
no
89
what is the preferred procedure for perineal care PP?
peri bottle with warm water & pat dry
90
s/sx of endometritis?
high fever
foul smelling lochia
lower abdominal pain
91
potential complications of oral contraceptives in immediate PP?
abdominal pain
HA, dizzy, fainting
eye problems
sudden calf pain
chest pain
92
clinical difference btwn PPD & baby blues?
symptoms daily & persist longer than 2 weeks + severe mood swings
93
why should PP pt avoid knee to chest position for 3 weeks?
places additional pressure on perineum
94
who is at risk for PPH?
PT w/ uterine overdistention
preeclamptic pt
hx of hemorrhage
prolonged labor
95
in a PT who reports a 6/10 in perineal area, what is the most appropriate initial intervention
apply ice pack to area
96
if a pt reports fever, chills, uterine tenderness 5 days PP, what actions should the nurse take?
assess lochia for color/ordor
check her temp/VS
admin prescibed ABX
97
teaching for PT about safety promoting in partner violence
save utility/rent recepits
--
hide money & extra keys
--
find/store important documents
--
remove weapons from home
98
why might a herparin dose be higher for a pregnant woman than regular?
physiological changes in preg require higher doses
99
after a fast birth & a 2nd degree tear, the PT has a boggy, deviated uterus and increased vaginal bleeding.
What is the priority nursing action?
Massage the uterine fundus with continual lower segment support
100
why do we provide lower segement support/careful of too agressive fundal massage?
can cause uterine prolapse
101
what lab value would be indicative a PT discharge with Warfarin is meeting goals?
INR of 2.5
102
how would you explain what heparin does to a pt?
prevent extension of current clot & prevent new clot formation
103
what can be the normal amount UO for a PP pt in 24hr?
3,000
150cc/hr
104
if a pt was only letting out 25-30cc of urine, what can you do?
cath, increase fluids
or sitz bath
105
measurement of "scant" in lochia assessment?
1in
or blood only on tisse when wiped
106
measurement of "light" when lochia assessment?
less than 4in on peripad
107
how would moderate peripad assessment measure?
less than 6in
108
what would classify as heavy in peripad assessment?
saturated within hour
109
for episitomy care, do you use heat or ice first?
ice for 1st 24hr
110
how should you apply peripad?
front to back
111
when asking parents of different cultures about infant care, what should nurse ask about?
bathing
112
who would be at risk for infection?
C/S
Prolong/rapid labor
multiple vaginal exams
113
what can put a C/S pt at a higher risk for infection at surgical site?
Obesity (BMI 35)
114
if a mom is in a BUFA situation, what should the nurse do?
have her recovery on PP or medsurg floor (pt choice)
talk about baby if the PT does
115
what meds can put a PT at a higher risk of PPH?
Oxytocin
Mg Sulfate!!
116
s/sx of pulm embolism?
sudden sharp chest pain, SOB & anxiety
117
what sound would be heard in a Pulm embolism?
Rales in lungs
118
what temp is indicative of sepsis in first 24 hr?
102.2
119
most common abx for mastitis?
penicillin
120
what antidepressant cant be take for nursing mom?
fluoxetine
121
what medicinal herb should be avoided when breast feeding?
St. Johns Wart
122
s/sx of PP psychosis?
w/in 24 hr of giving birth
---
auditory hallucination
delusions
sleep disorders
suspicion/fear
suicidial/homicidal
123
meds & considerations for PP PSYCHOSIS?
lithium --> NO breast feeding
Valporic acid
124
length of time to avoid tampon, sex or tbh anything in vagina?
6 weeks
125
route for Oxy?
IV (30u/500mL)
126
when should moms not breastfeed?
HIV
127
what should you consider for adolesent PP patients?
they're making 2 transitions
(into adult & into mom)
additional support
128
what is necessary to do before introducing solid feeding after C/S?
checking for present bowel sounds
129
benefits for mom w/ breastfeeding?
decreased risk of T2 diabetes
decreased risk of Breast, ovarian cancer
130
baby benefits of breastfeeding?
Decreased risk of SIDS
Decreased risk of asthma
131
what can help baby naturally start breastfeeding within golden hour?
don't wipe amnio fluid off hands - mom smells like it (helps navigate)
132
what often causes sore nipples & what can we recommend to mom?
poor latch & to watch/reposition baby
use breast milk
133
suggestions for preventing postpartum thrombo events?
early ambulation (assistance 1st time)
active/passive leg exercises
elevate legs
lots of fluids (10-12 8oz glasses)
134
What shouldnt you do for PP thrombo events?
No pillow behind knees
Avoid sitting/standing in one position for prolonged period of time
Don't cross your legs
135
ice & what can help with episotomy pain?
Ice & sitz bath
136
what time frame should mom void within for first time?
4hr
137
how should infant be placed on mom?
nose aligned with nipple
138
how long can store milk at room temp?
4hr
139
store in fridge length?
4 days
140
store in freezer length?
6-12 months
141
normally WBC value?
5-10,000
142
if a patient is having difficulty voiding, what can the nurse recommend to help?
sitz bath
143
if a pulse is 110, what is the next action?
reassess
144
when assessing the fundus, what position is the PT in?
supine
145
what position isnt recommended to feedf/for feeding?
Flexed
146
engorgement interventions?
warm compress
pump
147
necessary for PPH intervention?
18g IV (large bore IV )
want 2 optimally
