1
Q
what is the postpartum period?
A
fourth stage 2 hours to discharge
2
Q
for a first year postpartum woman, the postpartum period can be called
A
the fourth trimester
3
Q
maternal mortality associated with pregnancy is
A
the death of a woman up to 1 year postpartum
4
Q
BUBBLE HEP stands for
A
breasts
uterus
bladder
bowel
lochia
episiotomy (aka perineum)
hemorrhoids
emotions
pain
5
Q
hormonal changes to the breasts
A
- decrease in estrogen and progesterone
- increase in prolactin
- oxytocin release during breastfeeding
6
Q
when does true milk come in?
A
2-4 days after delivery
7
Q
breast complications
A
mastitis: redness/itchy/sore/swollen of the breast
- can be result of baby not emptying mom’s breast well
- antibiotics needed
8
Q
colostrum is
A
yellow/white discharge from the breasts
- not true milk, but contains a lot of vital nutrients for baby
9
Q
around the 3rd day postpartum, what breast change can be expected?
A
engorgement
- swollen lymph tissue surrounding milk ducts, causes lactation
10
Q
uterine cramping during breastfeeding/latching indicates
A
- good latch
- oxytocin release
11
Q
nurse assessment of breasts for a breastfeeding woman includes
A
- inspect and palpate the breasts
- assess the nipples
- assess for clogged milk ducts
12
Q
nurse assessment of breasts for a non-breastfeeding woman includes
A
- inspect and palpate the nipple
- educate woman on ways to avoid milk stimulation
13
Q
how can a non-breastfeeding woman prevent/avoid stimulating her milk to come in?
A
- tight, supportive bra
- face away from hot/warm water of shower
14
Q
how can a breastfeeding woman stimulate her milk to come in?
A
- warm compress
- warm shower
15
Q
the involution of the uterus includes
A
- contractions
- atrophy of the uterine muscles
- decrease in size of the uterus
16
Q
where is the uterus 6-12 hours postpartum (landmark)?
A
umbilicus
17
Q
where is the uterus immediately postpartum (landmark)?
A
5 finger-breaths below the umbilicus
18
Q
at what rate does the uterus decrease in size postpartum?
A
- decreases by 1 finger-breath/day starting at the umbilicus 6-12 hours postpartum.
- ex. day 1 postpartum: uterus is 1 finger- breath below the umbilicus
19
Q
uterus: afterpains
A
- occur within the first few days and typically decrease 3 days after delivery
- occurs more commonly with multiparous women; increases with each additional pregnancy
- condition may increase when breastfeeding during the first few postpartum days
20
Q
why do we frequently assess the uterus?
A
- identification of uterine atony
21
Q
nurse assessment of the uterus includes
A
- location in relationship to umbilicus
- midline or to one side
- firm or boggy
22
Q
steps to performing a uterine assessment
A
- inform patient that you will be palpating her uterus and explain the procedure
- medicate for pain if it is not needed emergently
- instruct the woman to void prior to assessment
- provide privacy
- position patient supine (flat position)
- support the lower uterine segment by placing one hand above the symphysis pubis
- locate the fundus with the other hand and gently apply pressure downward
23
Q
what are the assessment findings of a uterus assessment?
A
- assess for bladder distention
- fundus:
-tone: firm or boggy
-location: midline, at the umbilicus or 1 cm above
24
Q
nursing actions: uterus
A
- massage the fundus
- give oxytocin
- notify MD
25
common issues of the bladder in the first few days postpartum are
- distention
- cystitis
- rapid filling
- incomplete emptying
- inability to void
26
incomplete emptying of bladder is usually due to
poor tone or anesthesia
27
nursing actions of the bladder assessment
- assist woman to bathroom
- encourage voiding within 2-4 hours post-birth
- encourage changing peri pad with each void to assess bleeding
- assess for urinary disturbances
- catheterization per order
- assess for frequency, urgency, and burning
- instruct woman to increase fluid intake to a minimum of 10 glasses per day
- document findings
28
what is most likely the catheterization order?
straight catheter x1
29
what happens to muscle tone and motility of the bowel, post-birth?
- decrease post-birth
- returns to normal by 2nd week postpartum
30
bowel assessment includes
- hemorrhoids
- constipation
- appetite
- weight loss
31
nurse actions pertaining to the bowel includes
assess for:
- bowel sounds each shift
- constipation
- hemorrhoids
- appetite
- N/V
- increase fluid intake and fiber
- increase caloric intake if breastfeeding
32
when should a nurse listen to bowel sounds in relation to palpation?
listen before palpation
33
how much should a breastfeeding mom increase her caloric intake by?
500-1000 calories
34
what is the lochia?
bloody discharge from the uterus that contains RBCs, sloughed off decidual tissue, epithelial cells, and bacteria
35
metritis is
infection of the endometrial tissue
*primary complication of the endometrium
36
lochia: endometrium assessment includes
- exfoliation and regeneration
- healing at the placental site
37
nurse assessment of lochia includes
- color
- amount: scant, light, moderate, heavy
- odor
- clots
38
lochia: rubra
- red in color
- days 1-3 postpartum
- small clots
- moderate to scant amount
- fleshy odor
- increased flow standing or breastfeeding
39
lochia: serosa
- pink or brown in color
- days 4-10
- increased flow during physical activity
- fleshy odor
40
lochia: alba
- yellow/white in color
- day 10
- scant amount
- fleshy odor
41
lochia: scant
blood only on tissue when wiped or 1- to 2-inch stain
42
lochia: light
4-inch or less stain
43
lochia: moderate
< 6-inch stain
44
lochia: heavy
saturated pad
45
changes to the perineum related to the birthing process include
- edema
- stretching
- minor lacerations
- major tears
- periurethral tears
- episiotomy
46
nursing actions related to the perineum assessment
- assess for REEDA every shift
- explain procedure
- provide privacy
- position woman supine/flat
- remove peri pads, assess anteriorly
- assist woman to her side to assess perineum and rectum
- assess for discomfort and provide comfort measures
- reduce infection
47
what is REEDA?
redness
edema
ecchymosis
discharge
approximation
(of the perineum)
48
cardiovascular system assessment includes
- blood loss
- cardiac output
- thromboembolism
- orthostatic hypotension
49
what is an indication of thromboembolism
no Homan's sign
50
interventions for woman with orthostatic hypotension
- instruct woman to change positions slowly
- assist with ambulation for the first few hours
- if woman becomes dizzy- safety first, get to chair or bed (whatever is closer)
- keep ammonia ampule incase someone faints
- assess for blood loss
51
nurse assessment of cardiovascular system
- assess pulse and BP
- assess for excessive blood loss- active bleeding and saturated peri pads
- assess lower extremities for venous thrombosis
- assess for postpartum chills
52
how often should the nurse assess pulse and blood pressure?
1st hour: every 15 minutes
2nd hour: every 30 minutes
next 22 hours: every 4 hours
after 24 hours: every shift
53
chest wall compliance returns after the birth of the infant because
the diaphragm pressure is reduced
54
nurse assessment of respiratory system
- assess respiratory rate
- assess breath sounds
- document findings
- incentive spirometer
55
how often should a nurse assess respiratory rate?
1st hour: every 15 minutes
2nd hour: every 30 minutes
next 22 hours: every 4 hours
after 24 hours: every shift
56
nurse assessment/actions of the immune system
- assess temperature
- administer vaccines as indicated
- administer Rho (D) immune globulins as indicated
- document findings
57
how often should a nurse assess temperature
1st hour: every 15 minutes
2nd hour: every 30 minutes
next 22 hours: every 4 hours
after 24 hours: every shift
58
under what conditions would a nurse administer Rho (D) immune globulins?
if mother is Rh - and gave birth to a Rh + fetus
- give to mom
59
is it common for temperature to be elevated after delivery?
yes, for the first 24 hours
60
why may temperature be elevated after delivery?
- muscular exertion
- exhaustion
- dehydration
- hormonal changes
61
what (negative reasons) could cause temperature to be elevated after delivery
- flu
- rubella (german measles)
- tDAP (pertussis: whooping cough)
- Rh isoimmunization
62
what abrupt changes r/t endocrine happen after the placenta is delivered?
- estrogen and progesterone decrease
- prolactin levels increase
63
how long do prolactin levels increase postpartum?
- up to 6 weeks after delivery
64
when do menses resume postpartum?
non-breastfeeding: 10 weeks postpartum
breastfeeding: 17 weeks postpartum
65
diaphoresis
profuse sweating
- often occurring at night
- assists body in secreting the increased fluid accumulated during pregnancy
66
how is the muscular system affected by labor/delivery?
separation of rectus muscle
67
how is the nervous system affected by labor/delivery?
the lower body nerve sensation diminishes for women who received an epidural
68
nurse assessments/actions of the muscular and nervous systems postpartum
assess:
- diastasis recti abdominitis
- muscle tenderness
- decreased nerve sensation
- headache
- fatigue
-promote rest/sleep: sleep when baby sleeps
69
discharge/follow-up care includes
- education:
-normal physical changes
-self care
-signs of complications
- postpartum visit 4-6 weeks: vaginal; 2 weeks: c/s
70
signs of complications to include in discharge teaching
- heavy lochia
- return of bright red blood
- foul smelling lochia
- temperature
- pain (pelvis or abdominal: if its more than when they left the hospital- warning sign)
- urinary complication
- leg pain, swelling, redness
- thoughts of harming self or baby
71
AWHONN postpartum discharge teaching includes what acronym?
POST BIRTH
72
POST
- pain in chest
- obstructed breathing/shortness of breath
- seizures
- thoughts of hurting yourself or the baby
73
BIRTH
- bleeding through 1 pad in an hour or more, egg sized or bigger clots
- incision that is not healing
- red or swollen leg that is warm and painful to touch
- temperature of 100.4
- headache that does not get better even after taking medication OR headache with visual changes
74
who should you call for POST vs BIRTH?
POST: call 911
BIRTH: call provider
75
health promotion points
- nutrition and fluids
- smoking cessation
- activity and rest
-no heavy lifting for 2 weeks
-up and down the stairs: limit
- contraception
-encourage to wait 1 year before trying to conceive again
- sexual activity
-no sex for 6 weeks
- medications
-keep taking meds that she took in hospital
-narcotics: contraindications, addiction risks
76
comfort measures for uterine afterpains:
- warm blanket/compress on the abdomen
- encourage patient to empty bladder
- relaxation techniques
- analgesics: ibuprofen
77
how often should baby be on breast?
q2-3 hours
78
if the uterus is not midline upon palpation, the nurse should ____
try to get patient to void
79
nursing actions for hemorrhoids
- encourage woman to avoid sitting for long periods of time, lay on side
- stool softener (colace) or laxative
- witch hazel pads or topical anesthetics
- sitz baths
80
clot assessment findings
- small clots noted in patient chart
- egg-size or larger should be weighed and findings report to MD
- should be examined for the presence of tissue
-retained placental tissue (PPH**)
81
clot weight: 1g of blood is equivalent to ___ mL of blood loss?
1 g weight equals 1 mL of blood loss
82
bladder cystitis: definition & s/x
-bladder inflammation or infection
s/x:
- frequency
- urgency
- pain or burning on urination
- suprapubic tenderness, hematuria, malaise
83
bladder cystitis: treatment
- antibiotic therapy
- increased hydration
- rest
84
is PP fever normal? chills?
PP fever is normal, chills is not
85
emotions
- 1/7 women experience PPD (depression)
- 13-21% of women experience perinatal anxiety
- 2/3 young pregnant women report one or more mental health issues
- around 20% of postpartum deaths are from suicide
86
patient teaching for mom r/t ovulation/menstruation after delivery:
- still ovulating, even when menses haven't resumed
- need to talk about birth control
- no tampons
- no intercourse
- no douches
NU 330
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