Week 5 Postpartum Flashcards
(163 cards)
1
Q
6-8 weeks period after delivery
Begins with delivery of the placenta and ends with ovulation
A
Puerperium
2
Q
Immediate puerperium is first
A
24 hours
3
Q
2nd day to 6th week is
A
Late puerperium
4
Q
Puerperium is also referred as
A
Postpartum
5
Q
CV loss is almost how many cc
A
300-400cc
6
Q
Fluid enters system due to
A
Placental Loss
7
Q
HCT increases why?
A
From dehydration and plasma loss exceeding RBC loss
Leucocytes elevated - 25000 WBC normal
8
Q
What is not uncommon for the first few days?
A
Bradycardia and tachycardia
9
Q
RR should remain
A
Unchanged
10
Q
BP returns to what trimester level?
A
1st Trimester level
11
Q
Temperature elevated up to 100.4 in what?
A
Not uncommon due to dehydration
Temperature above 100.4 should be monitored and/or treated
12
Q
_____________ _______________ usually at night due to decrease in steroidal hormones and loss of accumulated tissue fluid
A
Marked Diuresis
13
Q
Bladder atony and urinary retention is present.
A
True
14
Q
Urethra and bladder trauma from labor and delivery results in what
A
Decreased sensation and urinary retention, increased discomfort and hematuria
Proteinuria may result from tissue damage
15
Q
What hormones drop?
A
Estrogen and progesterone
Estrogen levels rise to follicular levels day 19-21
16
Q
Hormone secreted by anterior pituitary, need for initials production of breast milk; levels continue to rise in breastfeeding moms
A
Prolactin
17
Q
Hypothalamic hormones happen with loss of
A
Placenta
18
Q
What hormones drop?
A
Estrogen and progesterone
19
Q
GnRH rises and may be affected by?
A
Breastfeeding
20
Q
What can be based on variable and may be delayed by breastfeeding?
A
Menses
usually anovulatory but not always
21
Q
GI system has decreased what?
A
Peristalsis especially with c section
22
Q
Hunger returns quickly and may have what?
A
Nausea and vomiting
Hemorrhoids may be a problem from pushing
23
Q
Symptoms of carpal tunnel resolve ?
A
Quickly
24
Q
Numbness of extremities after epidural or spinal should be followed up by
A
Anesthesiologist
25
What may cause postpartum headache?
Spinal or form of dehydration
26
Integumentary system what happens in postpartum
Pigmentation lightens but may not disappear
Varicosities and nevi generally remain but may decrease in severity over time
27
This is affected by hormones, reflexes and learned behaviors
Lactation
28
What is the first substance produced, contains proteins, immune properties, glucose and fluid (may be considered dirty or old in different cultures
Colostrum
29
Loss of estrogen, increased prolactin, suckling help to produce breast milk in 2-4 days
Breast Milk
30
What reflex takes time to develop?
Let down reflex
31
What are facilitating factors for breastfeeding?
Early, frequent feedings
Relaxed mother and baby
Newborn who actively sucks
Nutritional status of mom
Uncomplicated delivery
Everted nipples
32
Name the types of nipple
Normal
Flat
Inverted
33
What are inhibiting factors for breastfeeding?
Separation from newborn
Tense mother
Sleepy newborn
Excessive blood loss
Poor nutritional status of mom
Complicated delivery, infection
Flat or inverted nipples
34
Name problems of breastfeeding
Engorgement
Mastitis
Delayed feeding
Poor latch, position
35
Uterine change used to describe reduction in size of uterus and return to prepregnant state- occurs in 9 days.
Involution
36
What allows for healing of placenta site and is important part of involution ( takes 6 weeks to heal)
Exfoliation
Uterine change
37
Complete expulsion of placenta or membranes, breastfeeding, and early ambulation
Enhanced by uncomplicated labor and birth
38
__________ is at level of umbilicus with 6 to 12 hours after childbirth
Uterus
Decreases by one finger breadth per day
39
Immediately after expulsion of the placenta the top of the fundus is in the
Midline and approximately halfway between the symphysis pubis and the umbilicus.
40
After 6 to 12 hours after birth the fundus is at the level of the
Umbilicus
Height of the fundus then decreases about one finger- breadth approximately 1cm each day
41
Uterus rids itself of debris remaining after birth through discharge called
Lochia
42
Lochia changes
Bright red at birth
Rubra- Dark red
Serosa- Pink
Alba- White
Clear
43
If blood collects and forms clots within the uterus, fundus arises, and becomes boggy then we have ?
Uterine Atony
44
What becomes displaced and deviated to the right when the bladder is full
Uterus
45
Scant lochia is less than
2.5 cm on pad
46
Light lochia is less than
10 cm on pad
47
Moderate is less than
15 cm on pad
48
Heavy saturate pad in 1 hour or less
True
49
Musky menstrual like odor
Odor should be reported to practitioner for possible antibiotics
Odor
50
High fibrinolysin level should prevent clot formation; may have clotting with retained placental fragments, full bladder or atony
Clots
51
Less than 1 inch stain on pad is
Scant
52
Less than 4 inch stain on pad
Light amount
53
Less than 6 inch stain on pad is
Moderate amount
54
Saturated pad is
Heavy amount
55
This remains open for about 2 weeks post delivery
Cervix
56
Bruised, edematous, may have lacerations
When healed has fish mouth appearance
Spurting vaginal bleed from cervical laceration
Cervix
57
Rugae is absent for about how many weeks post delivery
6- 8 weeks Vagina
58
Why is the vaginal mucosa drier?
Due to decrease in estrogen
59
pooling or dark red vaginal bleeding may indicate what?
Vaginal Laceration
60
Introitus swollen, edematous, erythematous
Labia swollen and discolored
Perineum/ Vulva
61
Perineal Alterations
Perineum may be swollen and may require application of ice pack
Trauma- Lacerations, bruising, hematomas
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63
64
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66
67
68
69
69
70
Epistomy is either what two ?
Midline
Mediolateral
70
2nd degree is
Skin and perineal
70
How many types of lacerations are there?
1st degree
2nd degree
3rd degree
4th degree
70
1st degree is
Skin tear
70
3rd degree is
Perineal skin
Perineal muscles
and some anal sphincter
70
What are steps of care for postpartum bleeding?
Massage the fundus
Increase IV and administer uterotonics
- Oxytocin/ Pitocin 20 - 40 units in LR, infuse IV rapidly
- Methergine/ Methylergonovine Maleate
--- 0.2 mg IMx 1, hold for B/P >140/90
- Hemabate/Carboprost 250 mcg IM may repeat every 15- 30 minutes up to 8 doses
- Cytotec/ Misoprostyl- 800-1200 mcg PR
- Empty the bladder
- Monitor VS
Notify provider
70
4th degree is
Through all layers into rectum wall
71
Edges of episiotomy or laceration should be
Approximated
Perineum/ Vulva
72
Pericare should include ice for
24 hours and heat
after 24 hours sits bath
Laxative therapy
Monitor for s/s of infection
73
Measurement of descent of fundus for the woman with vaginal birth. Fundus is located two breadths below umbilicus
Always support the bottom of the uterus during any assessment of the fundus
Uterine care and support
74
Name the 4 Ts of PP Hemorrhage
Tone - uterine atony
Trauma - laceration, hematoma, inversion rupture
Tissue- retained tissue or invasive placenta
Thrombin - coagulopathy
75
What are preconditions that influence attachment?
Trust
Support
Communication and caregiving skills
Proximity
Parent- infant fit
76
What is positive feedback for bonding?
Enhances bonding
- Eye contact with parent
- Grasp
- Cuddles and calms
- Successful feeding
Assessment
- Appropriate vs inappropriate
- Cultural influences
77
Phase of adjustment that is 1-2 days after delivery, " all about me", mom needs nuturing
Dependent Phase
78
Taking hold happens 3-7 days and is all about baby and me
Dependent and independent
79
Interdependent is
Letting go
Day 10 to 6 weeks
Begins to adjust roles and incorporate family
80
What are some parental tasks?
Reconcile actual child with fantasy child
Establish newborn as separate individual
Develop skills in caring infant
Incorporate infant in family group and establish caregiver roles
81
Report from L &D ( EBL, problems, anesthesia, medications, etc)
Review prenatal and intrapartal records
Review lab work
Physical Assessment
- 8 point check or BUBBLE
- Additional checks for C section
Assessment
82
Implementation for nutrition and elimination includes
Assess IV Site, solution, rate
Provide diet as ordered - If stable, check BS if C/S
Assist to BR to void ( should void within 6 hours of delivery)
- Encourage increased fluid intake
83
Adaptation includes
Reassess any abnormal findings and report
Assess fundal height and consistency
Administer uterotonics for boggy uterus
- Massage fundus
- Administer uterotonics
Empty bladder
Ambulate ad lib when stable assist prn
Vital signs q4hx 24 if no complications
84
Protection includes
5 rights for medication administration
Check ID when returning infant to mom
Pain meds as needed
Oxytocic as needed
Teaching: Handwashing, pad changes, Pericare, hygiene
85
Monitor lochia
VS every 4 hours for 24 hours ten at least every shift
Monitor lab work for abnormal values that may affect maternal oxygenation status
Oxygenation
86
Infant to mother as soon as possible why?
Skin to skin
87
Interactions include ?
Facilitate breast feeding
Assess bonding behavior
Encourage golden hour with private time for new patients
88
Assist with infant feeding
Role
89
Pitocin is in how many units?
10 -20 units Iv or IM
( 30 units in 500 ml LR or 20 units in 1000ml LR)
Action to increase contractility of uterine muscle
Side effects include : HTN, water intoxication, increased uterine cramping
90
This is given when uterus remains boggy with Pitocin
Systematic vasoconstrictor
Methergine
Dose 0.2 mg IM
May be given 0.2-0.4 MG PO x 3 days only
Should not be given to hypertensive patients
91
Potent uterine constricting agent
May be given 250 mcg IM Hemabate
Available in suppository
May use cytotec ( Misoprostril 400-800 mcg rectally for PP hemorrhage)
Prostaglandins
Side effects: Elevated B/P, nausea, diarrhea, increased temperature
92
Synthetic amino acid (lysine) that plasminogen from being converted to Plasmin, which functions as a clot buster in the body
TXA
93
Mix 1 gram in 50 ml of NS and infuse via pump over 10 min
For maintenance, mix 1 gram in 100 ml NS and infuse over 8 hours.
TXA
94
This drug side effects include nausea, vomiting, diarrhea, allergy, or excessive blood clotting/ DVT
TXA
95
Colace and Surfak are
Stool softeners
96
MOM and Senekot are
Laxatives
Should be used as directed, generally given 1 time/ day, but may be given more often if 3rd or 4th degree laceration
97
With elimination agents, encourage patient to do what?
Plenty of water, increase fiber, and ambulate
Side effects include diarrhea
98
What is not recommended due to high respiratory effects on newborns
Percodan
99
What are discouraged in PP moms?
Narcotics
NSAIDs best choice
100
Ibuprofen is given every 6h at how much is?
600mg-800mg
Toredol IV every 6h- should not be given concurrently
101
Po narcotics include
Tylenol with codeine 30 mg 1-2 tabs every 4-6h
Norco 5-10 mg 1-2 tabs every 4-6h
Vicodin 5-10 mg
Percocet 2.5 mg every 4-5 h
Percodan 4.8 mg every 4-6h
IM/IV narcotics - Morphine 2-6 mg IV/ IM
Demerol 2-100 mg IV/IM
Dilaudid 0.2-0.4 mg IV/ IM
102
Analgesics check for
Allergies
Monitor for effects and medicate as needed
Monitor acetaminophen intake 4 g max/ day
103
Given to RH negative mom who delivers RH positive infant
Rhogam
Must recheck lab values
104
What is a blood product and may require consent?
Rhogam
Given deep IM within 72 hours of delivery
105
Prevents formation of antibodies
Protects future pregnancies from R isoimmunization
Destroys any cells already in mom's body
Rhogam
106
Indicated for rubella non immune moms
Should provide Rubella fact sheet
Pt should not become pregnant for 3 months to prevent rubella syndrome in new fetus/
Rubella Vaccine
Given Im or SQ one time
Mom may not retain immunity
107
This should be given IM prior to discharge if patient has no documentation of current immunization
TDAP
108
Potentially fatal communicable disease which has become a public health concern over the past several years
Pertussis
Whooping cough
109
Perineal care includes
Peri rinse - should use peri bottle each void
Sitz bath, use prn- particularly with generous episiotomy or 3rd and 4th degree laceration or hemorrhoids
Tucks and Dermaplast
Icex 24hr, Heat after 24 hr
110
50%-80% of all pp women experience this
PP blues within 1st 2 weeks after childbirth
Blues are usually self limiting
Last several days
Often peak by the end of 1st week
111
Tearfulness
Mood swings
Anxiety
Fatigue
Sadness
Insomnia
Confusion
PP Blues s/s
Give extra rest, reassurance, and therapeutic listening help to alleviate many of these symptoms of PP blues
112
How many percent progress from PP blues to depression
9%-15%
Need one or two symptoms that exist most or all day
Depressed mood
Decrease interest/ pleasure in previous enjoyable activities
113
Risk factors for PPD include
Undesired pregnancy
Hx of depression
Recent changes
Death of family
Financial stress
Low self esteem
Homelessness
114
Form of MDD that develops within 4 weeks of postpartum and the diagnostic criteria are otherwise identical to those applied to major depression
Postpartum Depression
115
PPD to be any major depressive disorder occurring within the first 2-6 months postpartum and some authorities extend this to 1 year postpartum
True
PPD
116
Symptoms of PPD affect who?
Everyone in family and mom
117
Name s/s of PPD
Anorexia or weight loss
Insomnia
Fatigue
Withdrawal
Suicidal thoughts
Infant neglect/ abuse
118
Risk factors for PPD include
Hx of depression
Family hx of depression
Psychological stress
Chemical alterations
119
What is 1st important step in collaborative management of PPD?
Rule out hypothyroidism
Now begin CBT and IPT which are shown to be great at treating perinatal depression
120
Rare but severe form of mental illness that affects not only the new mother but also entire family
Postpartum Psychosis
May appear 24- 48 hours after delivery but may not appear until 8 weeks pp
121
What women are at greatest risk for PP psychosis?
Women with bipolar disorder
Greater support of genetics in mood disorders
1st time mothers 40-44 years of age are at greatest risk
122
What are the distinguishing signs of PP psychosis?
Hallucinations
Delusions
Confusion
Sleep disturbances
Suicidal and homicidal thoughts
Loss of touch of reality
May resemble a sudden manic attack
123
What are some behavioral cues that may signal psychosis?
Hyperactivity, agitation, confusion, or suspiciousness
Reports auditory hallucinations to inflict harm to the infant
Voices or delusions that make her believe the infant is dead or defective or birth did not occur
Voices excessive complaints
Exhibits obsessive concerns about the baby's health and welfare
124
What is the immediate treatment of postpartum psychosis?
Mood stabilizer- lithium or valproic acid
Antipsychotic medications- chlorpromazine, thioridazine, and trifluoperazine
Anti anxiety medications- benzos
If required ECT often leads to rapid improvement
Long term psychotherapy and pharmacological treatment follows immediate care
125
Psychological reaction occurring after experiencing a highly stressful event that may be characterized by depression, anxiety, flashbacks, recurrent nightmares, and avoidance of reminders of event
PTSD
126
Advise abstinence for 6 weeks PP
Barriers, OCPs, Norplant, Sterilization
Breast feeding should not be considered method of birth control
True
True
True
127
Nutrition we look for?
Assess diet orders and toleration of diet taken
For C section- Assess bowel sounds and nausea and vomiting before serving diet
C/S > sips, liquids, DAT> may go to regular if tolerating liquids well
128
Dismissal teaching includes what?
Assess needs and learning deficits
Teach to the individual's specific needs
- 1st vs multiple infants at home
Girls vs Boys
More is more
Include self care needs ( rest, eating, exercise, etc)
129
Teaching includes what as well?
Diet
Safety needs
Physiologic interventions requiring changes
Immunizations
Follow up appointments
Referrals and resources
130
Ideal method of birth control would be
100% :
Safe
effective
available
reliable
free
Instantly reversible, convenient no Rx, no interference with sex
131
Reality is birth control is
Many types
Many advantages and disadvantages
No 100% perfect or ideal method and none expected in near future
132
Making a choice includes
Effectiveness
Ease of use
Lifestyle fit
Cost
Safety
133
100 % effective, safe, and free
No side effects
Encouraged by some groups
Total abstinence may be difficult or impossible, may forget to protect from STDs and STIs
Abstinence
134
Sex play without intercourse
Almost 100% effective
Prevents STDs and STIs if bodily fluids not exchanged
Includes
Masturbation
Erotic massage
Body contact
Erotica
Sex toys
Outercourse
135
Advantages include
No medical or hormonal side effects
Safe sex if no fluids exchange
May enhance experience
Costs nothing
Disadvantages include
May not protect
Difficult to abstain
136
81-96 effective
No effective against STDs or STIs
Can be used when no other method is available
Pre ejaculate may have sperm
Spillage
Messy
Withdrawal
137
80-99% effective low cost
No medical or hormonal side effects
Low cost no Rx required
Accepted by most
Requires cooperation of partners
May be risky
Requires careful record keeping
Periodic Abstinence or Fertility Awareness
138
Methods of Periodic Abstinence or Fertility Awareness
Ovulation method- ass cervical mucus
symptothermal methods- basal body temp. +mucus
Calendar rhythm method
standard days method Cyclebeads
Creighton Model
139
86-98% effective
Effective against STDs and STIs
Readily available inexpensive no Rx
Readily available
Can be used as pat of sex play
Can cause allergic reaction
Loss of sensation and breakage
Requires interruption to apply
Condoms
140
72-97% effective
Some protection form of STIs
Easily available
Usually need to wait short time
Not effective after one hour
May cause allergic reaction
Messy
Foams, creams, gels etc
141
79-95% effective
Some protection from STDs and STIs
Readily available
Allows women to be responsible for protection
May be messy and awkward
Female Condoms
142
82-94% effective
Not effective against STDs and STIs
No major health problems and can last for several years
Can be messy and may cause allergic reactions
May cause infection and decrease spontaneity
Relatively inexpensive
Diaphragms and Cervical Caps
143
Estrogen and progesterone combos prevent release of
Ovum 97-99% effective
143
Mini pills contain only
Progestin
144
Both types prevent sperm and egg from joining by
Thickening mucous
Both types prevent implantation
145
Oral Contraceptives are not effective against
STDs and STIs
146
nothing to insert during intercourse
may regulate periods
Helps prevent acne, anemia, PMS
Protects from ovarian CA, PID, non- CA breast tumors, ovarian cysts
Must be taken daily
Should not take if smoker or hx of blood clots
Oral Contraceptives
147
Small silicone implants, similar to stents, are inserted into the fallopian tubes, through the vagina and cervix
Office procedure that takes 10 minutes
Requires 3 month use of back up method of birth control, then an Essure confirmation test, where dye is inserted into the tube to confirm placement of the plugs and blockage of the tubes
Should be considered permanent
Essure
148
What are some serious side effects of essures?
Heavy and irregular menstrual periods
Weight gain and fluctuation
Internal breakage and migration of device
Chronic pelvic pain and back pain
Depression
Extreme fatigue
Allergic reactions to the nickel
Suicidal Thoughts
Systemic tissue inflammation
149
Matchstick sized rod inserted in the arm to prevent pregnancy
Contains Progestin, prevents the eggs from leaving the ovaries and thickens cervical mucus
Require insertion by a healthcare provider
Costs 400-800 lasts 3 years
Birth Control Implant
Implanon and Nexplanon
150
IM injection given every 12 weeks
99.7% effective
Nothing to take or insert
Depo Provera
151
Side effects include irregular bleeding, HA, weight gain, depression, abd pain
Depo Provera
Side effects can't be reversed and must wear off
152
Small device placed in uterus and may have medication in device
97.4 - 99.2
Last 5-10 years
No effect on hormone levels
Cramping, spotting, bleeding may occur
Rare infection or uterine perforation may occur
IUD
153
Surgical dissection of fallopian tubes
Tubal ligation
154
Surgical dissection of vas deferens
Vasectomy
155
Sterilization should be considered
Permanent
Rare failure due to spontaneous resection
