week 5 COPY Flashcards by Garrett Anderson

Q

Postpartum physiological changes: Vitals

Expected findings
- Temp elevated up to 100.4 F for_____ hours after birth
- Afebrile after _____ hours
- Temp may continue to be increased for 24 hours after ______ comes in (low grade fever 99 F)
- BP slightly elevated or decreased?
- Bradycardia or tachycardia for 6-10 days?

A

Vitals
Expected findings
- Temp elevated up to 100.4 F for 24 hours after birth
- Afebrile after 24 hours
- Temp may continue to be increased for 24 hours after milk comes in (low grade fever 99 F)
- BP slightly elevated
- Bradycardia for 6-10 days

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Q

Postpartum physiological changes: Vitals

Unexpected/abnormal findings
- Temp > 100.4 F – we suspect ________
- low/high BP? - we suspect r/t preeclampsia, essential HTN, renal disease, anxiety
- low/high BP? - we suspect r/t uterine hemorrhage, hematoma
- tachycardia/bradycardia? – we suspect r/t difficult labor and birth, hemorrhage, r/o fever (infection)
- marked tachypnea/bradypnea? – r/o respiratory disease and pulmonary edema

A

Unexpected/abnormal findings
- Temp > 100.4 F – we suspect infection
- High BP - we suspect r/t preeclampsia, essential HTN, renal disease, anxiety)
- low BP - we suspect r/t uterine hemorrhage, hematoma)
- tachycardia – we suspect r/t difficult labor and birth, hemorrhage, r/o fever (infection)
- marked tachypnea – r/o respiratory disease and pulmonary edema

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Q

Postpartum physiological changes: Vitals

expected vs unexpected finding
- temp 100.1 F 12 hours after birth
- temp 100.1 F 36 hours after birth
- temp 99.1 F 24 hours after birth
- BP slightly elevated
- bradycardia 2 weeks after birth
- high BP
- temp 100.8 F 24 hours after birth
- low BP
- tachycardia
- tachypnea

A

E - temp 100.1 F 12 hours after birth
U - temp 100.1 F 36 hours after birth = should be afebrile within 24 hours
E - temp 99.1 F 24 hours after birth = low fever r/t milk coming in
E - BP slightly elevated
U - bradycardia 2 weeks after birth = should only be for 6-10 days
U - high BP
U - temp 100.8 F 20 hours after birth = too high to be considered expected
U - low BP
U - tachycardia
U - tachypnea

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Q

Postpartum physiological changes: Vitals

Unexpected/abnormal findings
- Temp > 100.4 F – we suspect ___________
- High BP - we suspect r/t ________, _________, ________, _________
- low BP - we suspect r/t ______, __________
- tachycardia – we suspect r/t ___________, _______________, r/o fever (infection)
- marked tachypnea – r/o ___________ and ____________

respiratory disease
pulmonary edema
infection
preeclampsia
HTN
difficult birth and labor
hemorrhage
renal disease
anxiety
uterine hemorrhage
hematoma

A

Unexpected/abnormal findings
- Temp > 100.4 F – we suspect infection
- High BP - we suspect r/t preeclampsia, essential HTN, renal disease, anxiety)
- low BP - we suspect r/t uterine hemorrhage, hematoma)
- tachycardia – we suspect r/t difficult labor and birth, hemorrhage, r/o fever (infection)
- marked tachypnea – r/o respiratory disease and pulmonary edema

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Q

Postpartum physiological changes: Vitals

Unexpected/abnormal findings

High BP - we suspect r/t preeclampsia, essential HTN, renal disease, anxiety)

Treatment T/F
- tocolytic: Procardia
- oxytocin
- Labetalol
- aldomet
- magnesium sulfate
- prostaglandin
- aspirin

A

Treatment
- tocolytic: Procardia - relaxes muscles
- Labetalol - HTN med
- aldomet - HTN med
- magnesium sulfate - relaxes muscles, prevents seizures

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Q

Postpartum physiological changes: Cardiovascular

Expected findings
- cardiac output decrease/increase? – up to 30% for 2 weeks, back to normal levels by 6-12 weeks post birth
- increased/decreased urination?
- weight loss/gain?

Unexpected/abnormal findings
- pulmonary edema, cardiac problems, adventitious lung sounds (crackles) – body is failing to ___________

A

Cardiovascular

Expected findings
- cardiac output decline – up to 30% decline for 2 weeks, back to normal levels by 6-12 weeks post birth
- diuresis, increased urination, weight loss – body is decreasing extracellular fluid

Unexpected/abnormal findings
- pulmonary edema, cardiac problems, adventitious lung sounds (crackles) – body is failing to eliminate extra fluid

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Q

Postpartum physiological changes: Respiratory

Expected findings
- clear lungs
- non-labored breathing
- eupnea = normal breathing

Unexpected/abnormal findings
- tachypnea/bradypnea? – we suspect r/t fever or pain
- tachypnea/bradypnea? – we suspect r/t respiratory compromise, meds, anesthesia
- ______________ – we suspect r/t fluid bolus, Pitocin (anti-diuretic), magnesium sulfate

A

Unexpected/abnormal findings
- tachypnea – we suspect r/t fever or pain
- bradypnea – we suspect r/t respiratory compromise, meds, anesthesia
- fluid overload – we suspect r/t fluid bolus, Pitocin (anti-diuretic), magnesium sulfate

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Q

Postpartum physiological changes: Neurological

Expected or unexpected findings:
- Headaches – may be r/t fluid shifts in first week after birth, stress and fatigue?
- Headaches – may be r/t leakage of CSF from epidural (spinal headache, gets worse when you sit up)?
- Headaches – may be r/t chronic or gestational HTN?
- Headaches – may be r/t preeclampsia – can continue up to 6 weeks PP?
- Headaches with vision changes – spots, blurry, bright lights?

A

Neurological

Expected findings
- *Headaches – may be r/t fluid shifts in first week after birth, stress and fatigue

Unexpected/abnormal findings
- *Headaches – may be r/t
- leakage of CSF from epidural (spinal headache, gets worse when you sit up)
- chronic or gestational HTN
- preeclampsia – can continue up to 6 weeks PP
- Vision changes – spots, blurry, bright lights

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Q

Postpartum physiological changes: Nutrition

Expected findings
- May need to eat foods high in iron/fat? – r/t blood loss during labor
- May need to continue taking prenatal vitamins – especially if breastfeeding/suppressing lactation?
- Breast feeding mothers – increase/decrease calorie intake by 300 cal?
- Non-breastfeeding mothers – increase/decrease calorie intake by 200 cal?

A

Nutrition
Expected findings
- May need to eat foods high in iron – r/t blood loss during labor
- May need to continue taking prenatal vitamins – especially if breastfeeding
- Breast feeding mothers – increase calorie intake by 300 cal
- Non-breastfeeding mothers – decrease calorie intake by 200 cal

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Q

Postpartum physiological changes: Labs

Expected findings

Non-pathologic leukocytosis during first week post birth = WBC 25,000 – 30,000
If its higher than this suspect ________
Blood loss
Vaginal birth _____ mL
c/s birth ______ mL
losing 500 mL of blood = Hematocrit/Hemoglobin decline of 2-3%?
plasma levels go back to normal 4-6 weeks post birth
platelet levels go back to normal by the 6th week post birth
blood values go back to normal by the 6th week post birth

A

Labs
Expected findings
- Non-pathologic leukocytosis during first week post birth = WBC 25,000 – 30,000
- If its higher than this suspect infection

Blood loss
Vaginal birth 200-500 mL
c/s birth 700-1000 mL
losing 500 mL of blood = Hmt decline of 2-3%
plasma levels go back to normal 4-6 weeks post birth
platelet levels go back to normal by the 6th week post birth
blood values go back to normal by the 6th week post birth

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Q

Postpartum physiological changes:
Ovulation/menstruation

Expected findings for non-breastfeeding women or breastfeeding women?
- menstruation occurs in 7-12 weeks
- ovulation occurs by 70-75 days
- menstruation may be delayed by 3 months +

T/F
breastfeeding is not a reliable source of birth control

A

Ovulation/menstruation

Expected findings

non-breastfeeding women
- menstruation occurs in 7-12 weeks
- ovulation occurs by 70-75 days

breastfeeding women
- menstruation may be delayed by 3 months +

T - breastfeeding is not a reliable source of birth control

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Q

Postpartum physiological changes: Weight changes

Expected findings
-initial weight loss of 10-20 lbs – r/t baby/placenta/ amniotic fluid or postpartum diuresis?
-weight loss of 5 lbs – r/t baby/placenta/ amniotic fluid or postpartum diuresis?
-may return to pre-pregnant weight by 6-8 weeks postpartum – depends on person, diet, exercise, etc.

A

initial weight loss of 10-20 lbs – r/t baby, placenta, amniotic fluid
weight loss of 5 lbs – r/t postpartum diuresis
may return to pre-pregnant weight by 6-8 weeks postpartum – depends on person, diet, exercise, etc.

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Q

PP assessment - BUBBLEHE

which one?

breast - size and shape
nipples – cracks, fissures, soreness, inversion
breast fullness – r/t milk presence
abnormalities – reddened areas, engorgement
not breastfeeding = how to prevent engorgement, proper bottle feed info
breastfeed = assess how it is going, observe session, give praise and guidance, talk about prevent/treat engorgement/mastisitis/blocked ducts

A

Postpartum Assessment
B-Breasts

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Q

patients:
- non-lactating women
- breastfeeding mom
- women that doesn’t want to breastfeed
- women asking how to suppress lactation
- women with engorgement that is breastfeeding
- women with engorgement that isn’t breastfeeding

which of the above patients should the nurse advice do the following breast care:
- well-fitting bra or ace wrap binder
- cold compress or cabbage leaves
- anti-inflammatory meds
- avoid stimulating the breasts/nipples
- avoid warm water on breast in shower, shower with back to water
- avoid stimulating the nipple

A

non-lactating women
women that are not breastfeeding
need to suppress lactation
engorgement prevention/treatment for non-breastfeeding moms

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Q

lactation
- feed Q _____ hours (8-12 feedings/24 hours)
- feed _____ mins on 1st breast, offer 2nd breast but infant may not want it or feed as long on it
- expected/unexpected finding - breasts may feel heavy?
- expected/unexpected finding – breasts feel hardened, sore, reddened?
- breastfeeding women should only consume alcohol occasionally?
- don’t consume alcohol at least ___ hours before nursing?

A

feed Q 1.5-3 hours (8-12 feedings/24 hours)
feed 10-20 mins on 1st breast, offer 2nd breast but infant may not want it or feed as long on it
expected finding - breasts may feel heavy
unexpected finding – breasts feel hardened, sore, reddened
breastfeeding women should only consume alcohol occasionally
don’t consume alcohol at least 2 hours before nursing

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Q

breastfeeding positions
- _______ – both hands are around baby’s body
- ______________ – allows mom to have a free hand to manipulate breast
- _____________ – allows mom to have a free hand to manipulate breast and takes pressure off abdomen
- ___________ - allows mom to have a free hand to manipulate breast, risk of mom falling asleep and smothering baby

side-lying, cradle, football hold, modified cradle

A

breastfeeding positions
- cradle – both hands are around baby’s body
- modified cradle – allows mom to have a free hand to manipulate breast
- football hold – allows mom to have a free hand to manipulate breast and takes pressure off abdomen
- side-lying - allows mom to have a free hand to manipulate breast, risk of mom falling asleep and smothering baby

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Q

breastfeeding concerns and solutions

__________ – r/t poor latch, allow nipples to dry to prevent breakdown
____________ – teach privacy tactics
____________ – mom can pump milk, others can feed the baby, mom doesn’t have to be there
____________ - mom can pump milk and fathers can bottle feed, fathers can take responsibility for other tasks
______________ -
good signs to look for:
milk at edges of mouth
6-8 wet diapers/day
See Infant swallowing
Breasts softer after feeding

worried infant isn’t getting enough milk,
unequal responsibility or fathers feeling left out, embarrassment in public,
mom feeling tied down to demands of breastfeeding, nipple tenderness/pain

A

breastfeeding concerns
-nipple tenderness/pain – r/t poor latch, allow nipples to dry to prevent breakdown
-embarrassment in public – teach privacy tactics
-mom feeling tied down to demands of breastfeeding – mom can pump milk, others can feed the baby, mom doesn’t have to be there
-unequal responsibility or fathers feeling left out - mom can pump milk and fathers can bottle feed, fathers can take responsibility for other tasks
-worried infant isn’t getting enough milk
- good signs to look for:
- milk at edges of mouth
- 6-8 wet diapers/day
- See Infant swallowing
- Breasts softer after feeding

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Q

how does the nurse know the baby is getting enough milk? SATA
- milk at edges of mouth
- 3-4 wet diapers/day
- See Infant swallowing
- Breasts softer after feeding

A

milk at edges of mouth
X 6-8 wet diapers/day
See Infant swallowing
Breasts softer after feeding

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Q

Breastfeeding difficulties: Mom not producing enough milk

Mom increase fluid intake = ___ L/day

A

Mom increase fluid intake = 2 L/day

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Q

Breastfeeding difficulties: Sore nipples

Must have good latch = ______ shape mouth
Lanolin cream?
Express some breast milk and let dry on nipples?
Allow nipples to air dry?
Begin nursing on breast that is less/more sore?

A

Must have good latch = fish shape mouth
Lanolin cream
Express some breast milk and let dry on nipples
Allow nipples to air dry
Begin nursing on breast that is less sore – b/c baby will have stronger suck at the beginning of feed vs end of feed

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Q

Breastfeeding difficulties: Plugged ducts

Frequent nursing, changing feeding positions, manual massage, warm compress?
Start feeding on breast with plugged duct?
Breast pump may help dislodge plug?
Assess women for pressure from purse strap, infant sling, car seat belt, etc. that may cause _____________
Plugged ducts can lead to ______!!

A

Frequent nursing, changing feeding positions, manual massage, warm compress
Start feeding on breast with plugged duct – vigorous suck may help dislodge plug
Breast pump may help dislodge plug
Assess women for pressure from purse strap, infant sling, car seat belt, etc. that may cause recurring plugged ducts in the compressed area
Plugged ducts can lead to mastitis!!

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Q

Breastfeeding difficulties: Flat/inverted nipples

Rolling, stimulating?
Pump a little before breast feeding?
Use a nipple shield?

A

Rolling, stimulating
Pump a little before breast feeding
Use a nipple shield

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Q

Is this education for a weaning breastfeeding mom or a non-breastfeeding mom that is suppressing lactation?

Over a few days to a week - Substitute one cup of formula for one breastfeeding session (so breasts gradually produce less milk)
Over a period of several weeks – substitute more formula feedings for breastfeeding

A

weaning

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Q

Slow weaning is good b/c: SATA
- Prevents engorgement
- Allows infant to alter their own eating methods at their own rates
- Provides time for psychological adjustment
- mom can drink alcohol regularly

A

Prevents engorgement
Allows infant to alter their own eating methods at their own rates
Provides time for psychological adjustment

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mastitis vs engorgement?

mastitis vs engorgement? s/s - sudden onset - chills - fever 101 F + - malaise - red, painful, swollen AREA on breast - usually one breast affected - discharge

mastitis

mastitis vs engorgement? treatment - antibiotics (penicillin) - warm compress - analgesics

mastitis

mastitis vs engorgement? prevention - wear supportive bra at all times (not constricting bra, underwire bra, restrictive clothing) = prevents milk stasis where bacteria can grow - good handwashing, hygiene, air dry breasts - prompt attention to blocked milk ducts - regular complete emptying of the breasts - good infant positioning - good latch - supply and demand – if baby feeds more/mom pumps more = body will cue to make more milk - report flulike symptoms - alternate breasts at feeding - treat cracked nipples

mastitis

mastitis vs engorgement? s/s - hard, painful breasts - entire breast (not an area), or both breasts - gradual onset - NO fever

mastitis vs engorgement? Treatment/prevention (for moms that are breastfeeding) - Don’t miss a feeding - Hand express or pump to soften breasts/nipples before feeding - nurse 8-12x/24 hours and for 10-20 mins/breast each feeding - warm compress before feedings – helps with let down before feeding - cold compress between feedings – slows milk production - well-fitted nursing bra 24/7 - cabbage leaves – help with edema - breast feed more frequently – Q 1-1.5 hours

engorgement

engorgement treatment/prevention appropriate for moms that are breastfeeding or non-breastfeeding? - Don’t miss a feeding - Hand express or pump to soften breasts/nipples before feeding - nurse 8-12x/24 hours and for 10-20 mins/breast each feeding - warm compress before feedings – helps with let down before feeding - cold compress between feedings – slows milk production - well-fitted nursing bra 24/7 - cabbage leaves – help with edema - breast feed more frequently – Q 1-1.5 hours

breastfeeding moms with engorgement

mastitis vs engorgement? treatment/prevention (for non-breastfeeding moms) - well-fitting bra or ace wrap binder - cold compress or cabbage leaves - anti-inflammatory meds - avoid stimulating the breasts/nipples - avoid warm water on breast in shower, shower with back to water - avoid stimulating the nipple

engorgement

engorgement treatment/prevention appropriate for moms that are breastfeeding or non-breastfeeding? - well-fitting bra or ace wrap binder - cold compress or cabbage leaves - anti-inflammatory meds - avoid stimulating the breasts/nipples - avoid warm water on breast in shower, shower with back to water - avoid stimulating the nipple

non-breastfeeding moms with engorgement

postpartum assessment - BUBBLEHE which one? - abdomen - uterine ligaments - striae (stretch marks) - after pains - diastasis recti abdominis

U-Uterus/Abdomen

postpartum assessment: U-Uterus/Abdomen - abdomen is loose and flabby? - abdomen will not respond to exercise? - uterine ligaments will quickly return to normal state? - striae (stretch marks) – different colors based on moms skin and time lapsed? - for c/s incision use REEDA scale when assessing?

- abdomen is loose and flabby X- will respond to exercise X- uterine ligaments will slowly return to normal state - striae (stretch marks) – different colors based on moms skin and time lapsed - for c/s incision use REEDA scale when assessing

postpartum assessment: U-Uterus/Abdomen after pains – intermittent uterine contractions r/t uterine involution/subinvolution? the nurse should advice: - rest prone/supine with pillow under abdomen? - motrin for pain if platelets are less than 70,000? - motrin for pain if has preeclampsia? - motrin for pain if patient had multiples?

- after pains – intermittent uterine contractions r/t uterine involution - rest prone with pillow under abdomen – helps keep uterus contracted - motrin – for cramping - contraindication – if platelets are less than 70,000, or pt has preeclampsia

postpartum assessment: U-Uterus/Abdomen diastasis recti abdominis – separation of the ________ muscles - common in multiples or G1? - abdomen over distended?

- diastasis recti abdominis – separation of the rectus (abdominal) muscles - common in multiples - abdomen over distended

postpartum assessment: U-Uterus/Abdomen uterus - should be undergoing involution or subinvolution? - decrease/increase in weight 100 g? - spongy layer – sloughed off? - basal layer – splits into 2? outer layer - sloughed off? inner layer – foundation for new endometrium? - placenta site heals by exfoliation?

uterus - involution - decrease in weight 100 g - spongy layer – sloughed off - basal layer – splits into 2 - outer layer - sloughed off - inner layer – foundation for new endometrium - placenta site heals by exfoliation

postpartum uterine infection: Endometritis infection that involves the lining of the uterus s/s - uterine tenderness - temp spike 104 F - chills - foul smelling lochia or vaginal discharge

infection that involves the lining of the uterus

Endometritis

mastitis or endometritis? s/s - uterine tenderness - temp spike 104 F - chills - foul smelling lochia or vaginal discharge

Endometritis

risks for developing mastitis or endometritis? - c/s delivery - PPROM - Prolonged labor - Multiple vaginal exams during labor, especially after ROM - Use of FSE or IUPC - Instrument assisted deliveries – vacuum or forceps - Manual removal of placenta - Chorioamnionitis – infection of chorion and amnion

postpartum uterine infection: Endometritis

Treatment for mastitis or endometritis? - Antibiotics – clindamycin, gentamycin - Culture and sensitivity (will show specific antibiotic that works on this infection) - Continue treatment until afebrile for 24-48 hours

postpartum uterine infection: Endometritis

postpartum assessment: U-Uterus/Abdomen Fundal assessment determines: - position of fundus r/t __________ - above or below - position of fundus r/t __________ - left, right, centered - uterus tone - _______ or ________

Fundal assessment Determines: - position of fundus r/t umbilicus - above or below? - position of fundus r/t midline - midline or offcentered? - uterus tone - firm or boggy?

postpartum assessment: U-Uterus/Abdomen Fundal assessment - uterus should be at level of umbilicus for 6-12 or 12-24 hours post birth? - uterus contracts 1 or 2 fingerbreadth per day (involution)? - uterus descends 1 or 2 cm/day towards pelvis, until it is in the pelvis on the 10th day?

- uterus should be at level of umbilicus for 6-12 hours post birth - uterus contracts 1 fingerbreadth per day (involution) - uterus descends 1 cm/day towards pelvis, until it is in the pelvis on the 10th day

postpartum assessment: U-Uterus/Abdomen Fundal assessment place one hand below umbilicus and other hand on symphysis, apply downward pressure toward vagina = determines if _______ is firm and assists client in expelling ________

- place one hand below umbilicus and other hand on symphysis, apply downward pressure toward vagina = determines if fundus is firm and assists client in expelling clots

postpartum assessment: U-Uterus/Abdomen expected or unexpected findings in fundal assessment? If unexpected, what do we suspect? - uterus should be at level of umbilicus for 6-12 hours post birth - uterus contracts 1 fingerbreadth per day (involution) - uterus descends 1 cm/day towards pelvis, until it is in the pelvis on the 10th day - uterus is off to one side (or is high in the abdomen) - uterus did not change in size from yesterday to today - uterus did not make descending progress towards pelvis - uterus is firm - uterus is soft - uterus is midline

E - uterus should be at level of umbilicus for 6-12 hours post birth E - uterus contracts 1 fingerbreadth per day (involution) E - uterus descends 1 cm/day towards pelvis, until it is in the pelvis on the 10th day U - uterus is off to one side (or is high in the abdomen) = pt needs to void (empty bladder) U - uterus did not change in size from yesterday to today = subinvolution, suspect retained placenta fragments and infection U - uterus did not make descending progress towards pelvis = subinvolution, suspect retained placenta fragments and infection E - uterus is firm U - uterus is soft = indicates uterine atony and increased bleeding, nurse should perform fundal massage E - uterus is midline

causes of boggy uterus/fundus? SATA - high levels of oxytocin - multipara - small for gestational age - multiples - LGA - Large for Gestational Age - Red haired women - trapped gas

- high levels of oxytocin = uterus no longer responding to meds that promote contraction of uterus - multipara X- small for gestational age - multiples - LGA - Large for Gestational Age - Red haired women X- trapped gas

Documenting the fundal assessment FF u/-2 = UU =

FF u/-2 - Firm Fundus = FF - 2 fingerbreadths below umbilicus u/-2 UU - At level of the umbilicus

postpartum assessment - BUBBLEHE which one considers bowel movements?

B - bowels

postpartum assessment: Bowels Bowels will be sluggish r/t: SATA - Progesterone - increased muscle tone - Birth process - Anesthesia T/F - Women should expect to have her first BM up to 3 days after delivery

Bowels will be sluggish r/t - Progesterone X - Decreased muscle tone - Birth process - Anesthesia T - Women should expect to have her first BM up to 3 days after delivery

postpartum assessment: bowels T/F Episiotomy, lacerations, or hemorrhoids may speed up elimination/BM after birth? Might moms have a fear tearing with BM? would appropriate treatment include stool softeners for moms with Episiotomy, lacerations, or hemorrhoids ? Are tucks pads appropriate to use for hemorrhoid itching and coolness? does knee pain often indicate trapped gas?

F - Episiotomy, lacerations, or hemorrhoids may delay elimination T - Mom may fear tearing T - Treatment – stool softeners T - Tucks pads for hemorrhoid itching and coolness F - Shoulder pain = trapped gas (often right shoulder pain)

postpartum assessment - BUBBLEHE which one considers - bladder capacity - urethra - urinary output - sensation and sensitivity - infection

B - bladder

postpartum assessment: B-Bladder - Increased/decreased bladder capacity during pregnancy? - Swelling and bruising of tissues around urethra? - Increase/decrease in sensitivity to fluid pressure? - Increase/decrease in sensation of bladder filling (esp. w/ epidurals)? - Urinary output is higher/lower due to diuresis? - Increased/decreased chance of infection due to dilated ureters and renal pelvis? - Monitor adequacy of urinary elimination and distention?

B-Bladder - Increased bladder capacity during pregnancy - Swelling and bruising of tissues around urethra - Decrease in sensitivity to fluid pressure - Decrease in sensation of bladder filling (esp. w/ epidurals) - Urinary output is greater due to diuresis – kidneys rid 2000-3000 mL of extracellular fluid - Increased chance of infection due to dilated ureters and renal pelvis - Monitor adequacy of urinary elimination/distention

what type of infection should the nurse suspect with these s/s - Frequency and urgency - Dysuria - Nocturia - Hematuria - Suprapubic pain - Slightly elevated temp

UTI

postpartum assessment - BUBBLEHE After delivery, vaginal discharge of blood, mucus, atrophied uterine cells/debris

L - Lochia

postpartum assessment: Lochia _______ days = lochia rubra (red) ______ days = lochia serosa (pink) _______ days (until cervix is closed) = lochia alba (white)

- 2-4 days = lochia rubra (red) - 4-10 days = lochia serosa (pink) - 10-20 days (until cervix is closed) = lochia alba (white)

postpartum assessment: Lochia -2-4 days = lochia rubra= color ________ -4-10 days = lochia serosa = color _______ -10-20 days (until cervix is closed) = lochia alba = color __________

- 2-4 days = lochia rubra (red) - 4-10 days = lochia serosa (pink) - 10-20 days (until cervix is closed) = lochia alba (white)

The nurse is doing a fundal assessment on a postpartum patient. The nurse notes bleeding that saturates the peripad in 1 hour and a soft fundus. What does the nurse suspect? What should the nurse do?

saturated bleeding + boggy fundus = Uterine atony perform fundal massage

The nurse is doing a fundal assessment on a postpartum patient. The nurse notes bleeding that saturates the peripad in 1 hour and a firm fundus. What does the nurse suspect? Should the nurse do a fundal massage?

saturated bleeding + firm fundus = Lacerations fundal massage is not helpful, nurse should assess the perineum, REEDA

T/F - Weeks 5-6 uterus will return to normal size

True

postpartum assessment: Lochia Amount - Scant - Light - Moderate - Heavy = saturated peripad within __ hour(s). This is too much bleeding = _________________

- Heavy = saturated peripad within 1 hour. This is too much bleeding = postpartum hemorrhage

-Uterine atony -Lacerations -Episiotomy -Retained placenta fragments -Hematomas -Uterine inversion – prolapse of uterus -Uterine rupture -Placenta implantation problems (accrete, increta, percreta) -Coagulation disorders – low platelets, DIC these are all complications that can cause ________________ in a postpartum woman

Postpartum hemorrhage

s/s of postpartum hemorrhage include: SATA - Excessive bleed, heavy bleed - dark red bleed - Boggy fundus that doesn’t respond to massage - Abnormal clots

- Excessive bleed, heavy X- Bright red bleed - Boggy fundus that doesn’t respond to massage - Abnormal clots

s/s of postpartum hemorrhage include: SATA - high temp - Pelvis discomfort or backache - Persistent bleed + firm uterus - Fundus descends in abdomen

- High temp - Pelvis discomfort or backache - Persistent bleed + firm uterus X - Fundus rises in abdomen

s/s of postpartum hemorrhage include: SATA - Decreased pulse - Decreased BP - Decreased LOC - Hematoma formation or bulging/shiny skin in the perineal area

X- Increased pulse - Decreased BP - Decreased LOC - Hematoma formation or bulging/shiny skin in the perineal area

T/F - Breastfeeding regularly lowers risk of postpartum hemorrhage r/t oxytocin production

T

Treatment to prevent postpartum hemorrhage: SATA -Uterine massage (for soft uterus) -Assess perineum for bleeding or clots -Frequent void or cath the woman -Look for abnormal Hct levels – CBC repeated on 1st day postpartum -Diet high in fat

- Uterine massage (for soft uterus) - Assess perineum for bleeding or clots - Frequent void or cath the woman - Look for abnormal Hct levels – CBC repeated on 1st day postpartum X - Diet high in iron

medications to prevent postpartum hemorrhage: SATA - Magnesium Sulfate - oxytocin - Methylergonovine maleate (methergine) - Carboprost -Misoprostol (Cytotec)

X- Magnesium Sulfate - oxytocin - Methylergonovine maleate (methergine) - Carboprost -Misoprostol (Cytotec)

medications to prevent postpartum hemorrhage: - give Oxytocin before/after delivery of placenta and early postpartum period? - dont give Methylergonovine maleate (methergine) to woman with _________ - common side effect of Carboprost - route of Misoprostol (Cytotec) is rectal, vaginal, or oral SATA

-Oxytocin – after delivery of placenta and early postpartum period -Methylergonovine maleate (methergine) – don’t give to woman with HTN b/c of rebound HTN risk -Carboprost – s/e diarrhea -Misoprostol (Cytotec) – route: rectal, followed by oral (may be given vaginally before birth)

postpartum assessment - BUBBLEHE which one considers -the cervix -external os -vagina changes -lacerations -c/s incision

E-Episiotomy/Lacerations/Incision

postpartum assessment: E-Episiotomy/Lacerations/Incision T/F - Cervical changes - Cervix is spongy, flabby, maybe bruised - External os may have lacerations, irregular, closes slowly - Shape of external os changes to lateral slit

all true

postpartum assessment: E-Episiotomy/Lacerations/Incision T/F - Vagina changes -Edema, bruised, small superficial lacerations -3-4 weeks size decreases and rugae reappear -6 weeks vagina is back to normal size -2-3 weeks initial healing of lacerations occur, completely healed in 6 months

all true

postpartum assessment: E-Episiotomy/Lacerations/Incision Lacerations degree determined by provider ______ - Involves only the skin around the vaginal opening ________- Involves the skin and underlying muscles, requires stitching, most common _________- Involves the skin, muscles, and anal sphincter ________ - Involves the skin, muscles, anal sphincter, and rectal lining.

- 1st - Involves only the skin around the vaginal opening - 2nd - Involves the skin and underlying muscles, requires stitching, most common - 3rd - Involves the skin, muscles, and anal sphincter - 4th - Involves the skin, muscles, anal sphincter, and rectal lining.

scale used in assessing perineum

REEDA scale R = redness E = edema of swelling E = ecchymosis or bruising D = discharge A = approximation – how well the edges of the laceration seem to be holding together

postpartum assessment: E-Episiotomy/Lacerations/Incision REEDA scale R =__________ E = __________ E = ___________ D = __________ A = __________

R = redness E = edema of swelling E = ecchymosis or bruising D = discharge A = approximation – how well the edges of the laceration seem to be holding together

Interventions are appropriate for what? - Ice packs - Topical anesthestics - Waffle cushion - Surgigator - Sitz bath

Interventions for Episiotomy/Lacerations/Incision

Care after cesarean birth includes SATA: -Minimize respiratory complications -resume any activity level -Deep breathing -Incentive spirometry -Ambulation -Rest between infant care and self care -Pain management - OTC med -Minimize gas pains -Mylicon - OTC gas med - bedrest

-Minimize respiratory complications X-resume any activity level -Deep breathing -Incentive spirometry -Ambulation -Rest between infant care and self care -Pain management - OTC med -Minimize gas pains -Mylicon - OTC gas med X- bedrest

Best position to assess perineal area -side lying with superior leg elevated -frog leg -stirups

-side lying with superior leg elevated

postpartum assessment - BUBBLEHE which one are we considering -thrombophlebitis -hemroids

H-Homan’s/Hemorrhoids

postpartum assessment: H-Homan’s/Hemorrhoids is this thrombophlebitis or hemorrhoids care? - Sitz bath - Topical anesthetic ointments - Rectal suppositories - Witch hazel pads - Side lying position - Avoid prolonged sitting - Adequate fluid intake - Stool softeners - Increase fiber and fluids - No enemas or suppositories for 3rd and 4th degree lacerations

hemorrhoid care

which of these would indicate thrombophlebitis during postpartum assessment? SATA - pt c/o pain when walking - redness in calf - warmth in calf - homan's negative sign

- pt c/o pain when walking - redness in calf - warmth in calf X - homan's positive sign

which of these would indicate thrombophlebitis during postpartum assessment? SATA - pain in leg - pain in inguinal area - pain in lower abdomen - one sided edema in leg

- pain in leg - pain in inguinal area - pain in lower abdomen - one sided edema in leg

which of these would indicate thrombophlebitis during postpartum assessment? SATA - temperature changes in extremity - pain when the nurse palpates leg - one sided itchiness in leg

- temperature changes in extremity - pain when the nurse palpates leg X- one sided itchiness in leg

which of these are good ways to prevent thrombophlebitis? SATA -Avoid prolonged sitting -Avoid prolonged standing -Avoid crossing legs -Take frequent breaks while traveling by car, plane, etc. -SCDS -Early ambulation -Adequate fluid intake

-Avoid prolonged sitting -Avoid prolonged standing -Avoid crossing legs -Take frequent breaks while traveling by car, plane, etc. -SCDS -Early ambulation X-Adequate fluid intake

postpartum assessment - BUBBLEHE which one considers - depression - phases and stages post birth - psychosis - parent/infant attachment and bonding - cultural support - rest and activity - sex

E-Emotions/Psychological

postpartum assessment: E-Emotions/Psychological taking in phase or taking hold phase? - 1-2 days after birth - Passive, dependent - Processes reality vs imagined birth experience - Food and rest are important - 2-3 days after birth - Control, mothering - Continue to provide assurance and support

“taking in” phase - 1-2 days after birth - Passive, dependent - Processes reality vs imagined birth experience - Food and rest are important “Taking hold” phase - 2-3 days after birth - Control, mothering - Continue to provide assurance and support

postpartum assessment: E-Emotions/Psychological Becoming a mother (BAM) - ___________ – during pregnancy - role play, expectations - __________ – birth – role guided by expectations of others in her social system - _____________ – develops role individually - ______________ – self, confidence, and competence as mother role Formal stage, Personal stage, Anticipatory stage, Informal stage

Becoming a mother (BAM) - Anticipatory stage – during pregnancy - role play, expectations - Formal stage – birth – role guided by expectations of others in her social system - Informal stage – develops role individually - Personal stage – self, confidence, and competence as mother role

postpartum assessment: E-Emotions/Psychological PP blues, PP depression, or PP psychosis? - Transient period of depression - Occurs 3-5 days postpartum to 6 weeks - Usually resolves itself in 10-14 days

PP blues

postpartum assessment: E-Emotions/Psychological PP blues, PP depression, or PP psychosis? s/s - Mood swings - Self-limiting - Irritable or overly sensitive - Tearfulness without cause - Difficulty sleeping - Feeling of being let down - Anxiety

PP blues

postpartum assessment: E-Emotions/Psychological Risk factors for getting PP blues, PP depression, or PP psychosis? -Rapid hormonal changes -Fatigue -Discomfort -Overstimulation -Insecurity -Anxiety -Emotional let-down after birth -Grief response to fantasized birth experience different than actual birth (c/s, vaginal birth , etc.) -Seen more severe in first time moms

PP blues

postpartum assessment: E-Emotions/Psychological PP blues, PP depression, or PP psychosis? - 4th week postpartum – greatest occurrence - Depression not characterized by mood swings - Suicide contemplation

PP depression

postpartum assessment: E-Emotions/Psychological Risk factors for getting PP blues, PP depression, or PP psychosis? - Primigravida - Ambivalence toward pregnancy - History of previous PP depression - Higher with history of depression - Lack of social support - Dissatisfaction with self or body image - Adolescent

PP depression

postpartum assessment: E-Emotions/Psychological PP blues, PP depression, or PP psychosis? - Occurs 1-3 months postpartum s/s - Agitation - Hyperactivity - Insomnia - Confusion - Difficulty remembering or concentrating - Delusions and hallucinations/illogical thinking - Suicide risk/infanticide risk

PP psychosis

postpartum assessment: E-Emotions/Psychological Is this nursing care for attachment/bonding or PP blues/depression/psychosis? - Refer to mental health professional (psychosis should seek immediate care from ER) - Educate and give expectations for changes and demands - Anticipatory guidance - Dispel myths about perfect mother and baby - Educate s/s, and teach family members what to look for - Help foster positive adjustment in the new family - Look for mom depression s/s - Screening tools - Give resources - Home health - Telephone - Classes - Support groups

Nursing care: PP blues, PP depression, PP psychosis

Medical management: PP depression 1st line = sertraline or paroxetine? 2nd line = sertraline or paroxetine? Is prozac safe for mothers?

1st line = sertraline 2nd line = parozetine -Prozac not recommended with breastfeeding moms

Medical management for PP blues, PP depression, or PP psychosis? - Lithium - Antipsychotics - Electroconvulsive therapy with psychotherapy - Removal of infant - Assess Social support

PP psychosis

Parent/infant attachment/bonding - Enface (___________ response) – direct eye contact, face to face - Engrossment (____________ response) – absorption, interest, preoccupation maternal or paternal

- Enface (maternal response) – direct eye contact, face to face - Engrossment (paternal response) – absorption, interest, preoccupation

postpartum Rest and activity T/F -Rest -Resume normal activities -Avoid heavy lifting -Avoid climbing stairs multiple times a day -Resume strenuous activity

-Rest -Resume normal activities -Avoid heavy lifting -Avoid climbing stairs multiple times a day X-Avoid strenuous activity

The postpartum patient asks the nurse when she can have Sex again. The nurse should teach? SATA - Resume after lacerations healed and lochia stopped – about 4-6 months - may need Lubrication - need to decide on Contraception

X - Resume after lacerations healed and lochia stopped – about 4-6 weeks - Lubrication - Contraception

which of these is required for postpartum discharge? SATA -Stable vitals -Involution of uterus -Lochia amount heavy but no sign of infection - Education s/s of infection - Lacerations well approximated

- Stable vitals - Involution of uterus X - Lochia amount must be ok (scant, light, moderate) + no sign of infection - Education s/s of infection - Lacerations well approximated

which of these is required for postpartum discharge? SATA - Ability to perform pericare and take meds as ordered - Ability to void and pass gas - Ability to take fluids and foods with slight difficulty - Ability to identify s/s PP depression and resources - Reviews teaching material and shows how to care for self and baby

- Ability to perform pericare and meds as ordered - Ability to void and pass gas X - must have ability to take fluids and foods without difficulty - Ability to identify s/s PP depression and resources - Reviews teaching material and shows how to care for self and baby

which of these is required for postpartum discharge? SATA -Appropriate interaction with baby such as leaving the baby unattended or incorrect feeding practices -Practices principles of infant safety -Rubella (MMR injection) – if non immune -RhoGAM injection – if neg mom, pos baby, or direct combs neg

X- must show Appropriate interaction with baby such as not leaving the baby unattended and correct feeding practices - Practices principles of infant safety - Rubella (MMR injection) – if non immune - RhoGAM injection – if neg mom, pos baby, or direct combs neg