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Family NRSG > Week 5: Monday > Flashcards

Week 5: Monday Flashcards

1
Q

The postpartum period

A
  • Up to six weeks after the birth, when the reproductive tract returns to the normal, prepregnant state
  • The 1st hour after delivery is often referred to as the fourth stage of labor
  • Fundal checks begin
  • Breastfeeding is established
  • Client adjusts to being the mother of 1 or more children
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2
Q

Primipara

A

A woman who has had one pregnancy that resulted in a fetus that attained a weight of 500 g or gestational age of 20 weeks whether or not it was born alive

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3
Q

Multipara

A

A woman who has given birth 2 or more times

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4
Q

Grand multipara

A

A woman who has given birth 5 or more times

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5
Q

Hand off report

A
  1. face to face
  2. ideally in presence of patient
  3. accurate and complete hist
  4. risk facotrs
  5. Delivery and immediate postpartum recovery summary
  6. Anestethia, QBL, fluid balance, meds, pain level
  7. breastfeeding attempts, and sucess or need for edu
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6
Q

SBAR or ISBAR

A
  • Identify yourself
  • Situation
  • Background
  • assessment
  • Recommendation
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7
Q

Postpartum shivering

A
  • Seen in 25 - 50% of postpartum women after normal deliveries
  • Usually begins 1 - 30 minutes after delivery and alsts 2 - 60 min
  • No TX needed other than reassurance and warm blanket
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8
Q

Fall risk

A
  • Pt edu
  • To evaluate muscle control after regional anesthetic ask patient to raise her knees, lift her feet one at a time, dorsiflex her foot, raise her butt off of bed
  • Ambulate with assist first time
  • Assess for anesthetics, narcotics, blood loss, BP
  • sit to shower if necessary, remain seated when holding baby, avoid sudden position changes, check orth. vital signs
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9
Q

first 2 - 3 days, maternal changes

A
  • Afterbirth pains - contractions during breast feeding
  • Pos. sign of good sucking by baby, since this stimulates release of oxytocin
  • Uterus begins the process of shrinking back to size
  • Consider administering Ibuprofen at least 30 min before next est. feeding
  • Blues/fatigue begin around 2 -3 days pp, gradually sibsides in 1 - 2 weeks
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10
Q

Postpartum interventions (textbook p. 463) (1)

A
  • Every 15 min: vital signs, fundal assessment (in relation to umbilicus, firm/boggy, midline)
  • Amount of lochia (scant, moderate, heavy)
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11
Q

Maternal physiologic changes (cardio)

A
  • Cardio: increase in circulating blood volume in the immediate postpartum period
  • auto transfusion of blood that circulated in uterine muscle during pregnancy
  • 60 - 80% rise in cardiac output for 1-2 hours following delivery
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12
Q

Maternal physiologic changes (Hematologic)

A
  • Hematologic: The hematocrit may initially drop due to blood loss associated with delivery but starts to rise again as plasma volume decreases due to diuresis and hemoconcentration
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13
Q

Uterine involution (maternal changes)

A
  • rapid decrease in size of uterus, clients who breast-feed may experience a more rapid involution because of the release of oxytocin
  • Assessment: Findal height decreases about 1 cm/day
  • by 10 days pp the uterus canot be palpated abdominally
  • A flaccid fundus indicates uterine atony, and it should be massaged until firm
  • A tender fundus indicates an infection
  • Afterpains decrease in frequency after the first few days
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14
Q

Assessment of uterus

A
  • Fundus should feel firm like a grapefruit
  • Boggy uterus feels like sponge/difficult to locate
    -Massage if needed
  • Observe bleeding during massage
  • If pad is saturated or clots are larger than nickle, notify provider
  • If you observe a slow steady trickle notify provider
  • If mom concerned about bleeding, apply fresh pad and reassess in one hour
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15
Q

Lochia (maternal changes)

A
  • discharge from the uterus that consists of blood from the vessels of the placental site and debris from the decidua
  • Assessment: Rubra = bright red (birth - day 3)
  • Serosa = brownish pink (days 4 to 10)
  • Alba = white discharge (days 11 - 14)
  • Discharge should not smell foul
  • discharge may increase with ambulation
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16
Q

Amount of lochia

A
  • scant: less than 2.5 cm in one hour on pad
  • Light: less than 10 cm
  • Moderate: less than 15 cm
  • Heavy: saturated menstrual pad
  • Excessive: pad saturated in 15 min
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17
Q

Renal (maternal physiologic changes)

A
  • The client may have urinary retention as a result of loss of elasticity and tone and loss of sensation in the bladder from trauma, meds, anesthesia, and lack of privacy
  • Might not feel the urge to void until she stands up
  • Diuresis usually begins within the first 12 hours after birth
  • A full bladder can displace the uterus and lead to postpartum hemmorrhage
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18
Q

GI (maternal changes)

A
  • Clients are usually hungry after birth
  • Constipation can occur, with bowel movement by the second or third postpartum day
  • Hemmorrhoids are common
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19
Q

Fluid balance and electrolytes

A
  • Diuresis begins within 12 hours of birth and continues for up to 5 days
  • Urine output may be 3000 ml or more per day
  • Additional fluid lost through increased perspiration
  • Fluid loss greater in patients with preeclampsia or eclampsia
  • Risk of pulmonary edema and/or unmasking of cardiac disease
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20
Q

Postpartum maternal immunizations

A
  • Rubella (if lower than 1 to 8)
  • Rhogam
  • Flu
  • T-Dap
  • Indicated in each pregnancy, even if the woman has a previous hist of pertusis or vaccination
  • If T-dap has not administerd during pregnancy, it should be administered asap postpartum to provide protection to infant indirectly or, if breastfeeding, thorugh transfer of maternal antibodies in breast milk
  • The maternal immune response may not be sufficiently rapid to protect the infant until two weeks post-immunization
  • Breastfeeding is not a contraindication to recieving any of these vaccines
  • Client has the right to decline
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21
Q

Rubella

A
  • For women who have not had rubella
  • For women who are serologically not immune (titer less than 1:8)
  • Live attenuated virus vaccine
  • Must not be given to pregnant women, so postartum is a gaurunteed, non pregnant time
  • Breastfeeding mothers can be vaccinated
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22
Q

Rhogam

A
  • Given to an Rh- mother prenatally around 26-28 weeks gestation, even though fetal blood type is unknown
  • Next dose is given within 72 hours after delivery of an Rh+ infant or if the Rh is unknown
  • Must be repeated after each subsequent delivery if baby is Rh+
  • Rhogam 300 mcg is the standard dose
23
Q

Postpartum teaching

A
  1. Assess needs and confidence
  2. Use interactions with mother to teach
  3. Incorporate “teach back” method
  4. Barriers to learning: fatigue, overstimulation
24
Q

Postpartum pain management

A
  • pain: caused by episiotomy, lacerations, perineal trauma, incisions, contractions, hemorrhoids, breast engorgement, and nipple tenderness
  • Pain causes stress and interferes with ability to interact with infant
  • Use pain scale, ask for description of pain, observe patient
25
Q

After birth pains

A
  • Occur as a result of contractions of the uterus
  • Are more common in multiparas, breast-feeding parents, clients treated with oxytocin, and clients who had an over-distended uterus during pregnancy, such as carrying twins
26
Q

Perineal discomfort

A
  • Apply ice packs to the perineum during the first 24 hours to reduce swelling
  • After the first 24 hours, apply warmth by sitz baths or warm tub at home
27
Q

Episiotomy

A
  • If done, instruct the client to administer perineal care after each voiding
  • Encourage the use of an analgesic spray as prescribed
  • Administer analgesics as prescribed if comfort measures are successful
28
Q

Perineal lacerations

A
  • Care as for an episiotomy; administer perineal care and use analgesic spray and analgesics for comforts
  • Rectal suppositories and enemas may be contraindicated (to avoid injury to sutures)
29
Q

Breast discomfort from engorgement

A
  • Encourage client to wear a support bra at all times, even while sleeping
  • Encourage the use of ice packs between findings if the client is not breastfeeding
  • Use of ice packs could diminish milk supply in the breastfeeding client
  • Encourage the use of warm soaks or a warm shower before feeding for the breast-feeding client
  • Administer analgesics as prescribed if comfort measures are unsuccessful
30
Q

Constipation

A
  • Encourage adequate intake of fluids (2000 mL/day)
  • Encourage diet high in fiber
  • Encourage ambulation
  • Administer stool softener, laxative, enema, or suppository if needed and prescribed
31
Q

Postpartum emotional changes

A
  • Acknowledge the clients feelings and demonstrate a caring attitude
  • Determine availability of family support systems and resources as needed
  • Encourage and assist the client to verbalize feelings
  • Monitor the newborn for appropriate growth and development expectations
  • Assist the significant other and other appropriate family members to discuss feelings and identify ways to assist the client
  • All clients should be assessed for depression during pregnancy and PP
32
Q

Patients with chemical dependency

A
  • No evidence that withholding analgesics will increase chances of recovery from drug addiction
  • No evidence that providing analgesics will worsen addiction
  • Patients with chemical dependency often require higher loading doses and maintenance doses
  • Consider consulting pain or addiction specialist to help order appropriate doses
33
Q

Breasts (maternal changes)

A
  • Breasts continue to secrete colostrum for the first 48 - 72 hours after birth
  • A decrease in estrogen and progesterone levels after birth stimulates increased prolactin levels which promotes milk production
  • For primiparas, breasts become distended with milk about the third dayl earlier for multiparas
34
Q

Engorgement occurs on…

A
  • Approx. day 4 in both breast-feeding and non-breastfeeding clients
  • Breast-feeding relieves engorgement
35
Q

Breastfeeding and nursing care

A
  • Put the newborn to the mother’s breast as soon as they’re stable (immediately after delivery, if possible)
  • Stay with the client each time the client nurses until the client feels secure and confident with the newborn
36
Q

Assess LATCH score

A
  • Latch achieved by newborn, audible swallowing, type of nipple, comfort of parent, hold or position of baby
37
Q

Best start in L&D

A
  • Skin to skin for 1 -2 hours
  • Routine care on mom’s chest
  • Minimize separation
  • Decrease need for warming, less hypoglycemia
  • Uterine contractions allow less blood loss
  • Immunological components of colostrum protect the infant from bacteria/viruses
  • Increase in the infants digestive peristalsis
  • Promotes attachment and bonding
38
Q

Infant state organization

A
  • Sleep states: deep sleep, light sleep
  • Transitional: drowsy
  • Awake state: quiet alert, active alert, crying
39
Q

Breast feeding benefits

A
  • Passive immunity: Human milk provides passive immunity through colostrum
  • Breast-fed babies also experience fewer allergies/intolerances throughout their lives
40
Q

Breast feeding benefits - Easily digestible

A
  • Provides essential nutrients in an easily digestible form
  • Contains lipase which breaks down dietary fat, making it easily available to baby’s system
41
Q

Breast feeding benefits - brain booster

A

The fats in breast milk are high in linoleic acid and cholesterol which are needed for brain development

42
Q

Breast feeding benefits - Low protein content

A
  • Cow’s milk (not formula) contains proportionally higher concentrations of protein
  • Cow’s milk can be a strain on newborn kidneys - best delayed till at least 3 months of age
43
Q

Breast feeding benefits - Convenient and inexpensive

A
  • Saves time and money in buying and preparing formula
44
Q

Nutrient needs during lactation

A
  • similar to those during pregnancy
  • Needs for energy remain greater than non-pregnant needs
  • Increase of 330 Kcal more than woman’s nonpregnant intake recc.
  • Some women have increased weight loss during lactation which could be seen as another plus for breast feeding
45
Q

Contraindications for lactation

A
  • Smoking, alcohol intake, and excessive caffeien intake should be avoided
  • Some pediatricians feel that smoking during lactation can prevent nicotine withdrawal in newborns
  • If cannot quit, smoke outside after breastfeeding
  • If planning on drinking alcohol at party, breastfeed first
46
Q

Breast-feeding

A
  • During first 24 hours after birth there is little change in breast tissue
  • Colostrum or early milk, a clear yellow fluid, can be expressed from the breasts. Often it leaks toward the end of the pregnancy
  • the breasts gradually become fuller and heavier as the colostrum transitions to mature milk by about 72-96 hours after birth (milk coming in)
47
Q

Breast feeding contraindications

A
  • Herpes lesions on the breasts
  • Regular intake of certain meds that pass into the breast milk and may harm the neonate
  • Restricted diet that interferes with adequate nutrition intake and affects quality of milk produced
  • HIV positive
48
Q

Breast-feeding and nursing care

A
  • Breasts may leak between feedings or during coitus; place breast pad in bra
  • Increase calories by 200-500 per day
  • Avoid OTC meds unless approved by provider
  • Progestin-only birth control pills recommended, not estrogen (can interfere with milk supply)
  • Newborn’s stool: Light yellow, seedy, watery, and frequent
49
Q

Breast-feeding challenges

A
  • Sore nipples: confirm correct latch, not nipple chewing
  • Low milk supply: nursing more often or pumping after breastfeeding will help increase milk supply
  • Engorgement: Hand express or pump a little milk to soften breast before breastfeeding
50
Q

Metabolic changes - diabetes

A
  • Breastfeeding may temporarily precipitate hypoglycemia in women with dependent diabetes
  • Women with gestational diabetes often have normal glucose levels postpatrum
51
Q

Breast care for non breast feeding clients

A
  • Avoid nipple stimulation
  • apply a breast binder, wear a snug fitting bra, apply ice packs, or take a mild analgesic for engorgement
  • Engorgement usually resolves within 24-26 hours after it begins
52
Q

Bottle feeding

A
  • Bottle feeding with formula
  • Reliable and nutritionally adequate
  • Commercial formulas are designed to mimic human milk:
  • Milk based formulas are usually prescribed. Some of these are lactose-free, so they can be used for neonates with galactosemia or lactose intolerance
  • Soy based: are used for babies who could be allergic to cow’s milk protein
53
Q

Formula feeding - amounts (see textbook pp. 604-607)

A
  • In first 24-48 hrs of life a newborn typically consumes 15-30 mL (1/2 to 1 oz) of formula/feeding Q 2-3 hrs
  • Most newborns drink ____
  • Slide 57
54
Q

Notes about quiz

A

We’ll work on care plan
or study guide
and also quiz has 15-20 questions

Family NRSG (8 decks)

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