week 6 Flashcards by anya perez

placenta needs to be delivered within

30 minutes

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breast fed babies require what supplementation

vitamin D

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B.U.B.B.L.E — post-partum assessment

B = breasts
U = uterus
B = bowel
B = bladder
L = lochia
E = episiotomy

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how often should the patient be assessed when post-partum

BP & pulse checked every 15 min for the first 2 hours after birth

then every 4 hours for the first 8 hours

then every 8 hours

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oxytocin

strengthens uterine contractions

*stimulated by breastfeeding

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HcG can be detected for how long when in post partum

up to 4 weeks

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result of decreased estrogen

*diminishes vaginal lubricancy = local dryness & intercourse discomfort

breast engorgement

diaphoresis

diuresis of excess extracellular fluid

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when does ovulation occur in lactating moms

lactation delays return of ovulation
approx 6 months
infants suck affects prolactin

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when do non lactating moms ovulate

ovulation occurs 7 to 9 weeks after birth\

menses resume in 12 weeks

prolactin decline reaching pre-pregnant levels by week

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on the 6th post partum day the uterus should be

halfway between the symphysis pubis and umbilicus

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uterus location during third stage of delivery

midline & 2cm below umbilicus

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1 hour after delivery the fundus should be

at the level of umbilicus

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after 2 weeks the uterus should be

within the true pelvis and not palpable

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interventions to assess the uterus

patient supine w knees slightly flexed
palpate fundus & observe lochia flow
document fundal height

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when assessing fundus

never palpate w/o cupping

fingers between fundus & umbilicus

firm or boggy

location

(+) = above umbilicus
(-) = below umbilicus

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oxytocics

*administered after placenta delivery

oxytocin
methylergonovine
carbopost

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prostglandin med

misprostol

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lochia rubra

occurs 1 to 3 days post-partum

dark red, small clots, fleshy odor

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lochia serosa

occurs day 4 to 10 post p

serosanguinous, pinkish-brown

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lochia alba

day 10 to 8 weeks post p

yellowish white, mucus, luekocytes

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3 types of lochia

lochia rubra
lochia serosa
lochia alba

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5 types of lochia amount

scant = less than 2.5cm
light = 2.5 to 10cm
moderate = more than 10 cm
heavy = one saturated pad within 24hrs
excessive = saturated in 15 min or less

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post partum the cervix will appear

edematous & bruised

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post partum the vagina will appear

rugae & increased dryness

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post partum it is normal in the perineum to find

hemorrhoids and hematomas

in a patient w episiotomy

normal to experience a bright red trickle of blood *initial healing in 2 to 3 weeks *complete = 4 to 6 months

colostrum appears

during and up to 2 - 3 days after birth

breast milk appears

3 to 5 days after delivery

4 positions for breast-feeding

1. football hold 2. cradle 3. across the lap 4 side lying

avg blood loss in vaginal delivery

300 to 500 ml

avg blood loss in a c-section

500 to 1000ml

avg weight los during first 5 days after delivery

19 pounds

lab values in post partum

DECREASED HCT increased wbc increased temp

Gi and bowel changes during post partum

constipation hemorrhoids no spontaneous bowel movement for 2-3 days

urinary changes during post partum

increased urine output within 12 hours of delivery urinary retention is normal

Rh vaccine can be administered

within 72 hours of delivery

Rubella & MMR vaccine in pregnancy

NO RUBELLA / MMR no pregnancy for 4 weeks

tetanus / pertusis vaccine while pregnant

any time okay w breast feedding

3 phases of maternal role attachment

1. dependent 2. dependent - independent 3. interdependent

dependent

the "taking in phase" first 23 to 48 hrs

interdependent

"letting - go" family is seen as a unit role resumptiob

dependent - independent

"taking hold" phase begins day 2-3 baby blues caregiving competency acceptance from others

wiping

FRONT TO BACK

In 24 hours, a newborn should be fed

8 to 12 times a day

considerations for breast feeding

breast softens as baby feeds burp in between boobs WARM = RELEASE COLD = PAIN no wire bras

intervention for sore nipples

apply a small amount of breast milk and allow to air dry after breast feeding

considerations for NON-BREAST FEEDING

pump every 4 hours to relieve discomfort NO WARM WATER cabbage leaves inside bra cold compress 15 on, 45 off

after delivery sex can resume

2 to 4 weeks after

episiotomy assessment

R.E.E.D.A. R = redness E = Edema E = echomyosis D = discharge A = approximation

postpartum hemorrhage occurs

blood loss is greater than 500 ml (vaginal) OR 1000ml (c-section) quarter sized clots perineal pads saturated in less than 15 min

meds to control post partum hemorrhage

methylergovine misoprostol carboprost

uterine atony

inability of the uterine muscle to contract adequately after birth

s/s of uterine atony

boggy lateral displacement larger uterus excess bleeding tachycardia hypotension

subinvolution of the uterus

uterus remains enlarged w continual lochial discharge --- can result in post partum hemorrhage

s/s of subinvolution of the uterus

boggy enlarged uterus prolonged lochia

inversion of the uterus

PRESENTS AS A MASS *complete = fundus as a mass in vagina *prolapse = protrudes 20-30cm outside introitus *incomplete = dilated cervix

terbutaline

tocolytic that relaxes uterus stops pre-term labor

4 reasons for post partum hemorrhage (acronym)

T.T.T.T (4 T'S) T1 = tone T2 = tissue T3 = trauma T4 = coagulation

to prevent mastitis

completely empty each breast *breast hygiene

s/s of mastitis

cracked / fissured nipples nipple trauma painful localized hard mass flu like symptoms

s/s endometritis

*inflammation of the uterus dark lochia --purulent/malodorus fever uterine tenderness / enlargement

calories in breast milk / formula

20kcal/oz

an infant is properly breastfeeding when

the breat is touching their nose, cheeks, and mouth

when breastfeeding

15 to 20 minutes each side burp when alternating boobs insert finger into mouth to release suction

how long can formula be refridgerated

48 hours

breast milk in room temperature lasts

up to 8 hours

refridgerated breast milk can last

8 days

breast milk frozen vs deep frozen

frozen 6 mo deep frozen 12 o

considerations for thawing breast milk include

lukewarm water no shaking no re-freezing can defrost in refrigerator for 24hrs