Test #4 - Rest & Exercise/Oxygen Need Flashcards
(50 cards)
What are some items that provide relief for hemorrhoids?
- Sltz baths
- Topical anesthetic ointments
- Rectal suppositories
- Witch hazel pads
What are some relief items of afterpains?
Positioning (prone position)
Analgesia administered an hour before breastfeeding
Encourage early ambulation - monitor for dizziness and weakness
What are some items to teach about postpartum medications?
Postpartum patient may need medications to promote comfort, treat anemia, immunize, and prevent development of antigens (in nonsensitized Rh-negative woman)
Postpartum patients should be informed about name of medication, expected action, possible side effects
Nurse must review safety measures with medications
What are some items to remember about rest postpartum?
Organize nursing care to avoid frequent interruptions, educate new mother that fatigue may persist for several weeks
Mother should be encouraged to rest when baby rests
Mother may need to make adjustments at home and work
What do you need to teach about ovulation and menstration for the postpartal woman?
- Menstruation returns between 6 and 10 weeks after birth in nonlactating mother. Lactating mothers may begin ovulation returns 3-6 months
- Return of ovulation and menstruation in breastfeeding mother is prolonged related to length of time breastfeeding continues
What do you need to teach them about sexual activity post partum?
Sleep deprivation, vaginal dryness, and lack of time together may impact resumption of sexual activity
Usually sexual intercourse is resumed once episiotomy has healed and lochia has stopped (about 6 weeks)
Breastfeeding mother may have leakage of milk from nipples with sexual arousal
What are some items to remember about contraception post partum?
Information on contraception should be part of discharge planning
Nursing staff need to identify advantages, disadvantages, risk factors, any contraindications
Breastfeeding mothers concerned that
contraceptive method will interfere with
ability to breastfeed - they should be given
available options
What are some postpartum C-Section assessments?
Breasts must be assessed, assess location and firmness of fundus, lochia, and incision site
Assess Foley catheter in place, color, and amount noted - bowel sounds are checked: present, decreased, or minimal
Abdominal Incision
What are some nursing care items for C-Section?
Cesarean birth is major abdominal surgery - if general anesthesia used, abdominal distension may cause discomfort
Turn every 2 hours, early ambulation, avoid carbonated beverages - may need enemas and stool softeners
Pulmonary infections may occur because of immobility and use of narcotics because of altered immune response
Encourage turn, cough, deep breath every 2 hours while awake until she is ambulating
What are some pain and comfort interventions postpartum?
Administer analgesics within the first 24 to 72 hours - allows woman to become more mobile and active
Encourage visits by family and newborn, which provides distraction from painful stimuli
Encourage non-pharmacologic methods of
pain relief (breathing, relaxation, and
distraction) - encourage rest
What happens for the attachment after a C-Section?
Physical condition of mother/newborn and maternal reactions to stress, anesthesia, and meds may impact mother-infant attachment
By 2nd or 3rd day, cesarean birth mother moves into “taking-hold period”
Emphasize home management and encourage mother to allow others to assume housekeeping responsibilities
-Stress how fatigue prolongs recovery and may
interfere with attachment process
What do you need to do to prepare mom for discharge?
Preparation for discharge should begin when expectant mother enters birthing unit
Mother needs to be aware of signs of postpartum complications and should be aware of her self-care needs
Nurses should begin first by assessing knowledge and expectations of new mother and family
Nurse should be available to answer questions and provide support to parents
Nurse should review with new mother any information she has received regarding postpartum exercises, prevention of fatigue, sitz bath and perineal care, etc. -nurse should spend time with parent to determine if they have any last-minute questions before discharge
What is postpartum hemorrhage defined as?
Blood loss that exceeds 500 ml after vaginal childbirth or 1000 ml after cesarean birth
What are some risk factors for postpartum hemorrhage?
Induction/Augmentation
Uterine infection
Maternal malnutrition
Anemia
Gestational hypertention
History of hemorrhage
History of blood clotting problems
What are some specific items that put a patient at risk for post partum hemorrhage?
Overdistention of uterus - from hydramnios, macrosomia, or multiple gestations
Grand muitip - old uterus with poor muscle tone
Anesthetics that relax uterus
Trauma - from use of mid forceps, intrauterine manipulation, forceps rotation - all could cause lacerations
Prolonged or rapid labor
What are some items to do and remember when dealing with postpartum hemorrhage? (What to monitor/might not see)
You must monitor uterine tone and lochia flow carefully
-Where is fundus? Is it firm? Is there large clots?Bleeding?
Do not rely on VS changes (BP usually remains normal)
Changes in BP or pulse may not be seen until there has been a significant blood loss because woman is starting off with a higher blood volume from pregnancy
What happens during early postpartum hemorrhage?
Occurring in the first 24 hrs after birth
Bleeding may be slow or heavy and massive
Uterine Atony
Trauma to birth canal during L&D
Abnormalities: Placenta accreta, inversion, retained placenta
DIC
What is Uterine Atony?
Relaxation of the uterus
It won’t contract
Lack of muscle tone that results in failure of uterine fibers to contract firmly around blood vessels when the placenta separates
Most common cause of PP hemorrhage
Blood may be flowing out of uterus or pooling inside of uterus
Causes 80% to 90% of early PP hemorrhages
What are some risk factors that can lead to Uterine Atony?
Overdistention
Dysfunctional or prolonged labor
Oxytocin augmentation, Use of anesthesia
Prolonged third stage of labor
Gestational hypertension
HX of hemorrhage, blood clotting problems, anemia
Retained placental fragments
Grandmultiparity
Placenta previa or Accreta
What is retained placenta and what do you need to check for?
Retained Placenta sometimes caused by it being peeled off instead of waiting for it to separate naturally
It’s usually caused by massaging thefundus before separation occurs
Need to check the placenta and make sure it’s intact
Treatment -manual extraction, D&C, or hysterectomy
What are some predisposing factors that lead to lacerations of the birth canal ?
Common cause of Hemorrhage (20%)
Includes: Vaginal, Perineal or Cervical Lacerations
Hematomas
Macrosomia
Rapid labor and delivery
Lacerations of Birth Canal - may be spontaneous or caused by instrument
The primary care provider usually checks for lacerations after a vaginal birth
What is DIC (Disseminated intravascular coagulation)?
Causes blood coagulation problems
Clotting that is diffuse and consumes large amounts of clotting factors, including platelets, fibrinogen, prothrombin, and factors V and VII
Widespread external bleeding, internal bleeding, or both can result
Vascular occlusion of small vessels resulting from small clots forming in the microcirculation can also occur
Unusual bleeding i.e. spontaneous bleeding from the woman’s gums or nose may be noted. Petechiae may appear around a blood pressure cuff placed on the woman’s arm
What can cause DIC?
May result from PIH
amniotic embolism
sepsis
abruptio placentae
prolonged fetal demise
excessive blood loss
What are some assessment findings for DIC?
Excessive bleeding may occur from the site of a slight trauma
Symptoms also may include tachycardia and diaphoresis
(e.g., venipuncture sites, intramuscular or subcutaneous injection sites, nicks from shaving of perineum or abdomen, and injury from insertion of a urinary catheter)
