Unit 1- POSTPARTUM

Question 1

What is uterine involution?

Answer 1

The return of the uterus to its pre-pregnant size

Question 2

What is uterine atony?

Answer 2

Failure of uterus to contract even after fundal rub

Question 2

What is uterine inversion

Answer 2

Uterus turn partially or enterily inside out

Question 2

When does the postpartum period begin?

Answer 2

With the delivery of the placenta which is the 4th stage of labor: 2-3 hours following. Ends approximately 6 weeks after delivery

Question 2

What is uterine subinvolution?

Answer 2

Uterus isn’t decreasing in size

Question 3

Whats happening to our reproductive organs during the post-partum period?

Answer 3

Reporductive organs return to non-pregnant state

Question 4

Our goals during the postpartum period includes?

Answer 4

1. Decrease maternal mortality
   
   • prevent postpartum hemorrhage & maternal complications
2. Facilitate bonding
   
   • Increase breastfeeding rate
3. Restore physiological function and provide comfort
4. Educate about newborn and self care
   
   • decrease # of unplanned pregnancies

Question 5

Usuing the acronym bubble heb what is our postpartum focused assessment?

Answer 5

B: breast- engorgement, nipples, milk production
U: Uterus- fundal height, consistency & location
B: Bladder function- voiding vs. catheter
B: Bowel function- anesthesia can cause delayed bowels
L: Lochia- bleeding/discharge- Color, odor, consistancey and amount
E: Episiotomy/laceration- edema, ecchymosis & approximation
H: Hemmorhoids
E: Emotional/educational needs
B: Bonding

Question 6

PP focused assessments should be done how often?

Answer 6

Every 15 mins 1st hour
Every 30 mins 2nd hour
Every 4 hours 24 hours
Every 8-12 hours thereafter

Question 7

What our postpartum nursing interventions?

Answer 7

1. Educate pt to maintain bedrest to prevent orthostatic hypotension
2. Post op vital signs
   
   • report temp greater than 100.4
3. Fundal rub
   
   • Assess firmness, height, bladdler, lochia and perineum
4. Report abnormal findings to physican
5. Infuse pitocin per providers order- helps w/ induction and prevent pp hemorrhage
6. Assist with discomfort or after pains- cramping r/t uterus returning to regular size. usually OTC esp. if they are breastfeeding.
7. Provide peri care- keep clean prevent infection

Question 8

What abnormal PP findings would we report to physican?

Answer 8

1. Abnormal VS- increase in pulse, decrease in BP
2. Fundus remains boggy after massage (assessing firmness,height)
3. 2nd perineal pad soaked w/in 15 mins
4. Signs of hypovolemic shick
   
   • pale, clammy, tachycardia, lightheaded or hypotensive

Question 9

if fundus is not midline it could indicate…

Answer 9

possible distended bladder— urinating should help

Question 10

If you have been rubbing the fundus and its still not firming up what should we do?

Answer 10

Call MD

Question 11

What should we know about PP blood pressure?

Answer 11

1. Orthostatic hypotension is common
2. Increased if mom is in pain, preeclampsia
3. Decreased if mom is dehydrated or hypovolemic

Question 12

What should we know about PP pulse?

Answer 12

1. Bradycardia- 50 normal- due to blood loss
2. Tachycardia- pain, anxiety, hypovolemia, or infection
3. > 100bpm may indicate excessive blood loss/infection

Question 13

What should we know about PP respirations?

Answer 13

1. Rarely change 12-20
2. Increase could indicate suspected pulmonary embolism, uterine atony, hemorrhage

Question 14

What should we know about PP temperature?

Answer 14

1. Up to 100.4-1st 24 hours is okay r/t the stress of labor, dehydration
2. > 100.4 over 24 hours consider infection

Report if it increases over 100.4 twice in a 24 hour period

Question 15

Csection nursing care in the first 24 hours consists of what?

Answer 15

1. immediate post op care is same as PACU/Surgical pt
   
   • Respiration and oxygen saturation hourly
2. Assess incision site, IV, dressing
   
   • May need a sandbag for pressure on the site
   • Staples vs. Dermabond
3. Assess for uterine involution
4. Anesthesia management- mobility after 8 hours
   
   • Headaches, LOC, Itching
5. TCDB & monitor I&O
6. Pain relief and comfort measures
7. Patient controlled analgesia (PCA)
8. 18 to 24 hours of post cesarean analgesia

Question 16

What is are care for a cesection after 24 hours consist of?

Answer 16

1. Resuming normal activites
2. Preventing abdominal distention
   
   • Bowel sounds q4 hours
3. Assess incision site, iv site and dressings
4. TCDB & Montior I&O
5. Teaching for discharge- staples removed if needed
6. DC catheter
7. DEnsure comfort and emotional support
   
   • Guilt, question why c/s- women feel failed
   • Assess newborn care & bonding

Question 17

How do we perform a fundus assessment?

Answer 17

1. Support uterus with one hand at symphysis
2. Palpate fundus with other hand and assess uterus for
   
   • Consistency- firm or boggy
   • Height of fundus in relation to the umbilicus
   • 1/U (above umbilicus), U/U (right on umibilicus), U/1 (under umbilicus)
   • Location-midline or displaced laterally
   • Recheck voiding

Question 18

What is uterine invoultion?

Answer 18

The return of the uterus to its pre-pregnancy state

Fundus involution occurs 1-2 cm/day
1. Documented in relation to the umbilicus

Question 19

Where should the fundus be located after first day of delivery?

Answer 19

fundus at umbilicus

Question 20

7-10 days after birth where should your fundus be?

Answer 20

1. Fundus below the symphysis pubis

Question 21

What is fundal tone?

Answer 21

Is the uterus firm or boggy

Boggy indicates atony which requires massage
Tenderness could indicate infection

Question 22

what is the purpose of myometrial contractions?

Answer 22

compress placenta site to decrease blood loss this occurs for 12-24 hours post-delivery High levels of oxytoxcin can cause this

Question 23

After pains occur more often in the...

Answer 23

1. Multigravidas d/t lose of tone 2. Breastfeeding d/t release of oxytocin 3. Overdistended uterus- multi gestations, polyhydraminos 4. Rarely felt by primigravidas

Question 24

What are our nursing interventions for myometrial contractions (after pains)

Answer 24

Medicate before breastfeeding and enhance comfrot and relaxation to facilitate let down of milk

Question 25

What is lochia?

Answer 25

Vaginal discharge- consists of blood from the placenta site 1. Normal menstrual smell 2. Discharge amount ddecreases daily; may increase with ambulation 3. Difficut to quantify - Scant - light - moderate - heavy - excessive- saturated a pad in 15 mins 4. Clots may appear - Small are normal - Large- interfer with uterine contractions-- Obtain weight & report to physican

Question 26

Review: I gram = 1ml of blood 10 grams= 10 ml of blood

Answer 26

calculating lochia make sure to take in consideration pad weight

Question 27

True or false: Anything larger than an egg size clot is concerning esp if it happening beyond the 1st day?

Answer 27

True-- could be placenta fragments

Question 28

What is the first stage of lochia? What is its time frame, expected findings and deviations from normal?

Answer 28

Rubra Timeframe: day 1-3 Expected findings: Bloody small clots- red, moderate-light, increased when standing/breastfeeding, fleshy odor Devations from normal: Large clots, heavy (saturates pad in 15 mins), foul odor, placenta fragments

Question 29

What is stage 2 of lochia and its timeframe, expected findings and deviations from normal?

Answer 29

Serosa Timeframe: day 4-10 Expected findings: Pink-brown color, light scant, increases with physical activity fleshy odor Deviations from normal: Rubra after 4 days, heavy (saturates pads in 15 mins), foul odor

Question 30

What is the 3rd stage of lochia and its timeframe, expected findings and deviations from normal?

Answer 30

Alba Timeframe: Day 10 Expected findings: Yellow-white color, scant-none, fleshy odor deviations from normal: birght red (late PP hemmorrhage) foul odor

Question 31

True or false: A return of bleeding (lochia) should be reported?

Answer 31

True

Question 32

PP changes of the vagina include?

Answer 32

1. greatly stretched 2. Walls appear edematous 3. Multiple small lacerations possible 4. Vaginal walls are thin and dry until ovulation returns 5. vaginal wall regains thickness- estrogen production reestablished 6. Vaginal rugae are few and reappear by 3-4 weeks 7. Muscle tone is never completely restored to pre pregnancy state 8. Dyspareunia- "pain with sex" more likely in breast feeding

Question 33

What causes the dryness in the vaginal walls pp?

Answer 33

There is a severe drop in estrogen and progesterone once it starts producing again it wont be as dry

Question 34

What happens to the cervix PP?

Answer 34

1. Dilated, edematous, and bruised 2. Small tears or lacerations may be present 3. Cervix heals within 6 weeks but it will never be fully closed again

Question 35

What should we keep in mind with our perineum PP?

Answer 35

1. Perineum may be edematous and brused esp. if patient had to have a episotomy (inscion) or laceration degree is determined by the tissue involved

Question 36

What does REEDA help us assess

Answer 36

Perineum PP R:redness E: Edema E: Ecchymosis- discoloration(bruise_ D: discharge A: Approximation

Question 37

what are some perineal comfort measures we can provide?

Answer 37

1. Ice pack for 24-48 hours 2. Good handwashing 3. Peri bottle- cleanse perineum with warm water after each elimination 4. Apply anesthetic sprays or pads to area (not ointments) 5. Apply new peri pad front to back after each elimination 6. Snug peri pad Sitz bath 1. Cool water for 1st 24 hours to help decrease edema 2. Warm water after 24 hours Analgesics Sitting measures- place pillow inbetween legs tighten glutes prior to sitting then relaxing as you sit

Question 38

What should the nurse be doing the day of discharge of mom and baby?

Answer 38

1. Assessment on both mom and baby 2. Discharge teaching completed - Maternal and infant care - Provide written copies - Patient & family are on OVERLOAD 3. Administer medications if indicated - Immunizations - Rho(D)immune globulin 2nd dose before going home 4. Ensure careseat 5. Birth certificate information complete and follow up appts/referrals made

Question 39

What does blood loss look like PP?

Answer 39

Vaginal: 300-500ml Cesection:500-100ml Anything over would be documented in chart as a hemorroghe due to the amount not necessarily that they did hemorrhage..it would be for obstrical hx

Question 40

What should we know about fluid shifts PP?

Answer 40

1. BP & Pulse should quickly return to pre-pregnant levels 2. Increase of blood flow back to the heart - Decreased pressure from the pregnant uterus on the vessels

Question 41

What should we know about postpartum chills and shakes 1st 1-2 hours?

Answer 41

1. Body is riding excess fluids 2. Related to works of labor 3. Nervous system response Sweating normal at ngith as plasma volume is being restored Warm blankets are ok

Question 42

Our lower body extermity assessment PP should include?

Answer 42

Examine for s/s of thrombophlebitis 1. Palpate pedal pulses 2. Assess for edema 3. Assess DTR

Question 43

What are our nursing interventions for prevention of lower body extermity complications

Answer 43

1. Early ambulation 2. Frequent trips to the bathroom 3. SCD's or compression stocking if indicated

Question 44

What hematologic changes should we be aware of PP?

Answer 44

1. White blood cell count increases (12,000-25,000) d/t stress of labor 2. Hemaglobin & Hematocrit is difficult to interpret for about 4-6 weeks - Plasma is diluted by remobilization of excess body fluid - result in an increase in hematocrit - Return to normal within 4-6 weeks - Plasma volume lose exceeds RBC... oppisite in antepartum 3. coagulation - Elevations in clotting factors increase risk of thrombus formation (hypercoag state)

Question 45

What are some GI changes we might see PP?

Answer 45

Digestion 1. Decrease peristalsis due to analegesia and anesthesia 2. Expect 1st BM 2-3 days postpartum 3. increased appetite 4. Hypoactive bowels Constipation 1. Encourage fiber in diet 2. Stool softners as prescribed

Question 46

What are nursing interventions for our GI changes that happen PP

Answer 46

1. Assess for hemorrhoids- creame as prescribed 2. Encourage early ambulation 3. Avoid enemas & suppositories esp. with 3rd-4th degree lacerations

Question 47

What urinary changes might we see in PP women?

Answer 47

1. Diuresis- begin within the 1st 24 hours - excrete up to 3000ml/day 2. Urinary retention - Diminshed sensitivty to pressure - decreased muscle tone of the bladder - Over distended bladder - Persistent dilation increases risk for UTI - Tramatized meatus

Question 48

what are nursing interventions for the urinary changes we see in PP women?

Answer 48

1. Encourage voiding within 6 hours of delivery - running water, pepperment oil, pour water over vulva - provide hot tea or fluids of choise - Encourage urination in the shower or sitz bath - Tolieting schedule 2. Catheterize - voiding less than 150 ml and the bladder can be palpated - Fundus is elevated or displaced from the midline - Unable to void - >6hours and bladder scan reveals urine Pain medication may help relax encourage kegal exercises to strengthen perineal muscles

Question 49

What musculoskeltal changes might we see in a PP women?

Answer 49

Muscle fatigue 1. Soft and flabby abdomen (mom pooch) 2. Hip or joint pain 3. Feet permently increased in size Pelvic muscle regain tone in 3-6 wks Abdominal wall regain tone in 6weeks 1. Diastasis recti- seperation of the rectus abdominal muscle-- return may take long

Question 50

What are our nursing interventions for musculoskeltal changes seen in PP women?

Answer 50

1. Provide comfrot measures 2. Ice, heat, warm shower or analgesia

Question 51

What are some integumentary changes we might see in a PP women?

Answer 51

1. Hyperpigmentation area gradully disappear - melasma, the "mask of pregnancy" - Palmar erythema - spider nevi fade but some stay in legs 2. Striae gravidrum (stretch marks) - Fade to silvery lines but do not dissappear

Question 52

What are some neuologic changes that occur in PP women?

Answer 52

injury prevention is priority Nursing interventions 1. Assess for headaches - May be related to pre-eclampsia, epidural, spinal - frontal and bilateral headaches are common 2. Severe headaches - Have patient lay down in flat position - Postdural puncture resulting from anesthsia 3. Assess for s/s of preeclampsia- - BP increases and vision changes occur 4. Recommend an epidural blood patch if needed - Small amount of blood is injected over hole that is leaking CSF - Many feel relief right away or may require a second patch.

Question 53

What endocrine changes may occur PP?

Answer 53

1. Hormone changes with expulsion of placenta - Rapid decrease of estrogen and progesterone 2. Prolactin increases- milk production 2-3 days after delivery 3. Oxytocin- milk ejection or "let down" reflex - can be inhibited by stress, anxiety, pain and fatigue

Question 54

what should we know about ovarian function & menstration PP?

Answer 54

Ovulation may occur before postpartum follow up visit 1. Non-lactating women - Prolactin decrease- menses resumes in 1-2 months 2. Lactating women- amenorrhea - Prolactin increases- menses resumes in 3-6 months

Question 55

What is postpartum hemorrhage?

Answer 55

defined as a blood loss of greater than 500ml vaginal birth and 1000ml for csection

Question 56

when does a primary hemorrage normally occur?

Answer 56

within the 1st 24 hours of delivery

Question 57

What are typical causes of a primary hemorrhage?

Answer 57

1. Uterine Atony-r/t retained placneta 2. Lacerations or hematomas

Question 58

When does a secondary PP hemorrage usually occur?

Answer 58

24 hours to 6 weeks

Question 59

What are common causes of a secondary hemorrhage?

Answer 59

1. Subinvolution 2. Retained placenta

Question 60

True or false: PP hemorrhage is a progression?

Answer 60

True-- patient will experience symptoms of hypovolemia (tachycardia, hypotensive, pale, clammy, anxious, confused) and eventally go into hemorragic shock (blue lips/fingernails, decreased urine output, excessive sweating, chest pain, shallow breathing, hypotensive, confused)

Question 61

What are PP heorrhage predisposing risk factors?

Answer 61

1. High parity r/t loss of tone of uterus 2. labor dystocia (difficult labor) 3. Prolonged labor (distended uterus) 4. over-distedned uterus- hydraminos, macrosmia, multiple fetuses 5. operative delivery- vacuum, forcepts, cesection 6. previous postpartum hemorrhage 7. Placenta abruption or previa 8. Infection- retained placenta 9. oxytocin- induction/augmentation 10. Anesthesia or medicaitons- mag sulfate (mag slows down blood clotting), tocolytics

Question 62

What should we know about early postpartum hemorrage: uterine atony?

Answer 62

Uterine atony- poorly contracted uterus, lack of tone major cause of primary PPH

Question 63

What are the signs of uterine atony:

Answer 63

1. Fundus does not firm with massage still feels boggy above umbilicus 2. Steady or sudden saturated pad - 15mins

Question 64

What should we know about early PPH : lacerations?

Answer 64

Lacerations-2nd most common cause of PPH 1. Peri urethral 2. Labia 3. Vagina 4. Cervix 5. Perineum

Question 65

What are signs of an unrepaired laceration?

Answer 65

1. Contionus trickledown vagina 2. Bleeding in spurts 3. Bleeding in presence of contracted fundus

Question 66

What should we know about early PPH: Hematoma?

Answer 66

Hematoma-250-500ml blood collection in the vaginal or perineal tissue 1. Difficult to determine amount of loss 2. blood retained in tissue

Question 67

What are signs of hematoma

Answer 67

1. Intense perineal pain 2. Swelling, blue-black discorlation of perineum 3. Pallor, tachycardia & hypotension 4. Pressure on vagina, urethra or bladder 5. Possible urinary retention or displacement

Question 68

With Early PPH: Atony what does the fundus, lochia, vital signs, pain and key defing assessment show?

Answer 68

Fundus: Boggy, difficult to locate, above expected level, tone lost after massge Lochia: Excessive, Excessive with clots Vital signs: Hypotension, tachy Pain: Normal Key defining assessment: "boggy fundus"

Question 69

With Early PPH: Lacerations what does the fundus, lochia, vital signs, pain, and key defining assessment show?

Answer 69

Fundus: Firm Lochia: Bright red vs dark red, steady trickle of blood Vital signs: hyptension, tachy Pain: Normal Key defining assessment: steady trickle of bright red blood

Question 70

With early PPH: hematoma what does the fundus, lochia, vital signs, pain and key defining assessment show?

Answer 70

Fundus: firm Lochia: normal Vital signs: hypotensive, tachy Pain: Feeling of pressure, severe, unrelieved pain Key defining assessment: Severe pain, visible hematoma, discolored bulging moss

Question 71

Early PPH hemorrhage medical management with atony?

Answer 71

1. medications 2. Bimanual compression 3. Uterine packing or tamponade

Question 72

Early PPH laceration/hematoma medical management includes?

Answer 72

1. Pelvic exam- perineum, labia, vagina, cervix, suture laceration

Question 73

Surgical managemet in early PPH includes?

Answer 73

1. Surgical repair-incision and evacuation of hematoma 2. Surgical- d&C, hysterectomy

Question 74

What are our nursing interventions for postpartum hemorrhage

Answer 74

1. perform fundal massage- 1st nursing intervention 2. Review h&h labs & vital signs 3. Maintain or establish large-bore IV 4. o2 8-10 L/MIN 5. Comfort measures- ice, pain, meds 6. education and emotional support - Bladder training - Report s/s PPH 7. administer medications- oxytocin 8. Notify physican 9. Assist w. medical management

Question 75

What is a our goal with PPH?

Answer 75

Goal- is to control bleeding & prevent hypovolemic shock

Question 76

What is the action of oxytocin?

Answer 76

Action-stimulates uterine muscle to increase force, frequency and duration of contractions Can be used with induction and PPH

Question 77

What are adverse reactions of oxytocin?

Answer 77

1. Dysrthythmias, b/p changes, water intoxication, & uterine rupture

Question 78

What are our interventions when patient is on oxytocin?

Answer 78

Monitor v/s, i&o, lung sounds

Question 79

What is action methylegonovine maleate...

Answer 79

Action- stimulates uterine muscle to increase force & frequency of contraction, producing a tetanic contraction of the uterus Uses- PPH IM

Question 80

What are adverse effects of methylergonovine maleate?

Answer 80

1. N/V 2. Cramping 3. Headache 4. severe hypertension 5. Bradycardia 6. Dysrhythmias 7. mycardial infarcition

Question 81

What are contraindications of methylegonovine maleate?

Answer 81

1. Cardiac disease 2. Hypertension

Question 82

What are interventions for patients on methylergonovine maleate?

Answer 82

1. Monitor v/s 2. pain 3. headache 4. chest pain, 5. sob 6. uterine contractions 7. vaginal bleeding

Question 83

What is the adverse effects of carboprost tromethamine?

Answer 83

1. Headache 2. n/v/d 3. fever 4. tachycardia 5. hypertension 6. pulm edema

Question 84

What route is carboprost tromethamine given?

Answer 84

IM

Question 85

Carboprost tromethamine is contraindicated for...

Answer 85

1. Asthma, 2. cardiac 3. renal 4. hepatic disease

Question 86

Carboprost tramethamine interventions include?

Answer 86

1. Monitor v/s 2. vaginal bleeding 3. uterine tone

Question 87

What is the route of misoprostol?

Answer 87

Rectally or orally

Question 88

What are adverse effects of misoprostol?

Answer 88

1. Headache, 2. N/V/D 3. Fever 4. tachy 5. HTN 6. Pulm edema

Question 89

Misoprostol interventions include?

Answer 89

1. Monitor v/s 2. vaginal bleeding and uterine tone

Question 90

What should we know about late PPH: subinvolution?

Answer 90

Subinvolution- uterus remains large and fails to descent - Retained placental fragments & infections

Question 91

What is our assessment and interventions for late PPH subinvolutions?

Answer 91

1. enlarged or boggy "uterus" 2. S/s of bleeding or infection 3. Initate postpartum hemorrhage nursing interventions Medical management 1. Medications- antibiotics, oxytocin, and or analgesia 2. Ultrasound confirm retained placenta 3. Sugircal management- dilation & curettage (D&C), hysterectomy

Question 92

What is uterine inversion?

Answer 92

OB emergency: partial or complete turning inside out of the uterus

Question 93

What is our nursing assessment show with a uterine inversion?

Answer 93

1. Lower abdominal pain 2. Uterus protruding from vagina 3. Vaginal bleeding & hypovolemia

Question 94

What are our nursing intervetnions and medical management of uterine inversion?

Answer 94

1. Stop oxytocin immediately 2. Administer medciation- terbutaline, antibitoics 3. Monitor for and manage hypovolemic shock Medical management 1. Immediate manual replacement 2. Surgery

Question 95

Bacterial infection after childbirth will present with

Answer 95

temperature of 100.4 or higher after the first 24 hours and occurs on at least 2 occasions can invade blood/lumphatic system & be life threatenting

Question 96

Risk factors for PP infection includes?

Answer 96

1. Prolonged labor 2. Multiple vaginal exams 3. Tissue trauma 4. Poor hygine

Question 97

How can we reduce the risk of PP infection

Answer 97

1. Handwashing-staff, physcians, and families 2. Early ambulation-promotes drainiage, ciruclation 3. Proper site care

Question 98

What is our nursing assesment and interventions for PP infection?

Answer 98

Assessment 1. obtain vs and labs 2. pain, tenderness, and warmth at site 3. Purulent drainage 4. wound dehisscense or evisecertion Interventions 1. Obtain lab and cultures 2. comfort measures- analgesics, sitz bath , warm compress 3. Admin antibiotics 4. assest with i&C

Question 99

What is endometritis?

Answer 99

Infection of the uterine tissure lining the uterus

Question 100

Our nursing assessment of endometritis should include?

Answer 100

1. Pulse over 100 2. fever, chills, malaise, anorexia 3. excessive uterine tenderness 4. lochia returning to rubra from serosa 5. foul smelling or purulent lochia 6. urinary frequency 7. sore cracked & bleeding nipples****

Question 101

What are our interventions for endometritis?

Answer 101

1. bedrest-semi fowler position 2. Admin iv antibiotics, antipyretics, oxytocin or methylergonovine

Question 102

Complications of endometritis include?

Answer 102

1. Salpingitis, peritonitis, septicemia

Question 103

Why are UTI more common in pregnancy?

Answer 103

Urinary stasis due to hypotonic bladder, catheter insertions, delivery can be tramatizing to the bladder and urethra

Question 104

Cystitis is common and what days PP? and how might it present?

Answer 104

1st or 2nd day post partum-- presenting with dysuria, frequency, urgency and **suprapubic tenderness** cloudy urine,hematuria, and bacteruria

Question 105

When is pylenophritis most common PP and how does it present?

Answer 105

Presents on day 3 or 4 PP 1. fever chills, **costovertebral or flank pain**, n/v, dysuria, urgency, cloudy urine, hematuria, and bacteruria

Question 106

What should we know about thrombophlebitis in PP

Answer 106

1. Increase factors & fibrinogen - clot forms in vessel wall resulting in inflammation of vessels - superficial/femoral/pelvic 2. Blood vessel injury- increased risk during pregnancy and birth 3. Hypercoagulation- to prevent postpartum maternal hemorrhage

Question 107

What are s/s of a PP thrombophletbitis?

Answer 107

1. Minimal fever 2. Postie homan sign if assess (tenderness in calf) 3. Pain or dull ache in calf or leg 4. Swelling in extremity below pain

Question 108

What are our nursing interventions for throbophlebitis?

Answer 108

Depends on location 1. Assess the extremities for warm, red, tender, swollen area 2. Bedrest and elevate affected extremitiy 3. Moist warm packs to the area 4. Elastic support stocking or SCD 5. Analegics and or antibotics as ordered 6. IV heparin-may be ordered for femoral or pevlic pain to prevent PE

Question 109

What is our medical management of thrombophlebitis?

Answer 109

1. Diagnosis- doppler or MRI 2. Therapeutic management- early ambulation 3. Anticoagulation treatment- warfarin, monitor PPT & INR, birth control, teratogenic effects.

Question 110

What is a amniotic fluid embolism?

Answer 110

1. Amniotic fluid and debris enter circulation

Question 111

what are s/s of a pulmonary embolism or amniotic fluid embolism?

Answer 111

1. Apprehension-feeling on impending doom 2. sudden dyspnea and chest pain 3. tachy cardia, and tachypenea 4. hempotysis 5. Pulm. crackles and cough

Question 112

What are our nursing interventions for a pulmonary embolism?

Answer 112

1. semi-fowlers to facilitate breathing 2. oxygen 8-10 l/m 3. mointor vital signs and monitor for signs of respiratory distress and hypoxemia 4. Iv fluids, medications-analgesics, anticoag, thrombolyic

Question 113

Maternal needs when breastfeeding increases how?

Answer 113

add 500calories to pre-pregnancy intake drink 8 glasses of water per day

Question 114

What are condtraindications of breastfeeding?

Answer 114

medications, hiv, chemo, infant conditions

Question 115

what are signs of effective breast feeding?

Answer 115

1. let down reflex 2. latch pain subsides 3. audible swallowing 4. adequate output 5. weight gain

Question 116

True or false: We should alternate 1st breast every 10 min., then 2nd until satisfied; burp between breast .

Answer 116

true-- to prevent nipple trauma

Question 117

The 1st 1-2 days what kind of breast milk is expelled?

Answer 117

Colostrum- Liquid gold full of immunglobulin/laxitves

Question 118

Transitional milk appears at what days

Answer 118

2-3 days

Question 119

What is foremilk?

Answer 119

Stored before feeding high in water content

Question 120

What is hindmilk?

Answer 120

produced during feeding- high in fat content

Question 121

What are signs of engorgement

Answer 121

Primary engorgement occurs in breast or bottle fed mom 1. Increased blood flow returns to body as breasts prepare;happens before milk is produced 2. Breasts- larger, firm, warm, tender with a throbbing pain - 24 hours breast are soft - 48 hours slight firm, non tender - greater than 48 hours firm, tender, warm as milk production begins 3. subsides in 24-48 hours

Question 122

What is subsequent engorgment?

Answer 122

Occurs in breastfeeding moms 1. Distention of milk glands 2. missed a feeding delayed pumping 3. relieve by infant sucking or expressing milk

Question 123

What are our interventions for breast engrogment?

Answer 123

1. frequent feeding or pumping 2. cool compresses 3. chilled cabbage leaves to breast 20mins BETWEEN feedings 3x a day

Question 124

What are our nursing interventions for nipple trauma?

Answer 124

1.Proper infant removal from breast 2.Allow nipples to air dry 15 mins 2-3 x per day 3.Colostrum to nipples

Question 125

What nursing education can we provide for engorgement in a breast feeding mom

Answer 125

1. Supportive bra 2. Alternate feeding position 3. Warm compresses 4. Breast massage 5. Latch education 6. On-demand feedings 7. Proper removal of infant

Question 126

What nursing education can we provide for engorgement in non-breast feeding mom?

Answer 126

1. Supportive bra 2. Breast binders 3. Ice pack to breast 4. avoid breast stimulation 5. avoid milk expression 6. avoid heat 7. analgesia for pian

Question 127

What is mastitis?

Answer 127

1. Occurs 2-3 weeks postpartum after prolonged engorgment & inadequate emptying of breasts 2. inflammation, bacterial infection of the lacting breast 3. **unilateral**-risk for abscess if untreated

Question 128

What are s/s of mastatits?

Answer 128

1. sore cracked nipples 2. flu-like symptoms- fatigue, malaise, fever, chills 3. Painful, swollen, warm, tender area, or palapble mass 4. purulent drainage

Question 129

What are our nrusing interventions for mastitis?

Answer 129

1. Good handwashing 2. DO NOT stop breast feeding abruptly 3. Apply WARM pack or shower prior to breastfeeding 4. massage affected area before and during feeding to ensure emptying 5. encourage breast feeding from affected side FIRST 2-3 hours 6. manual expression or breast pump Q4 hours 7. Obtain breast milk culture and sensitvity as ordered 8. Administer analgescis, antibiotics as ordterd (oral antix 10-14 days) 9. Monitor for breast abscess & need for I&D 10. Encourage patient to wear supportive bra without underwire

Question 130

What should we know about the taking-in-phase of maternal adaptation?

Answer 130

Dependent (24-48hours) 1. focused on own needs, unable to make decisions 2. relives birth experiences, adjust to psychosocial changes

Question 131

What should we know about the taking-hold phase in maternal adaptation PP

Answer 131

Dependent/independent 1. Focus shifts to infant & maternal role 2. Anxious/bit overwhelmed about competence as a mom & accepts advice 3. may experience baby blues/fatigue

Question 132

What should we know about the letting-go phase in maternal adaptation PP

Answer 132

Letting-go phase- interdependent 1. Resolve their idealized expectation of birth expereience 2. Accepts reality of infant and incorportes into lifestyle 3. Separates newborn and self; confident in caretaking activites 4. Relationship with partner grows with reconnection

Question 133

What are the risk factors of postpartum blues, depression and psychosis?

Answer 133

1. Hormone changes- rapid decrease in estrogen and progestorne 2. hx of depression 3. pregnancy or childbirth complications, pain or discomfort 4. anxiety related to new role as mother 5. unplanned pregnancy 6. low self-esteem 7. lack of socal support 8. life stresses- socioeconomic factors 9. IPV-- poor relationship w/ partner

Question 134

What should we know about PP blues?

Answer 134

1. 1st week PP, peaks around 5th day 2. Irriatbility, fatigue, crying, mood swings & anxiety 3. Cuase unkown: hormone changes, discomfort, sleep deprivation, body image concerns, stress 4. doesnt usually affect ability to care for infant, resolves w/o interventions around 10-14 days

Question 135

What should we know about PPD?

Answer 135

1. Persists past 2 weeks, occurs in 1st 3 months & lasts up to 1 year 2. Persistent low mood 3. Risks include: hx of sexual abuse, unwanted pregnancy, smoking, formula feeding 4. Unable to safely care for infant and self

Question 136

What is PP psychosis?

Answer 136

1. Peaks at 48 hours to 2 weeks 2. intense depression relapse of psychotic d/o, confusion, auditory & visual hallucinations, insomnia 3. Criteria must include a major depressive disorder w/psychosis- bipolor 1, bipolor II, unspecified functional psychois, schizoaffective disorder 4. Therapeutic managment nec. medical emergency, serious mood instabilities, though of suicide, infanticide