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47 Cards in this Set
- Front
- Back
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Involution
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process by which uterus returns to pre-pregnancy state
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what drug and by what administration is given to aid in post partal involution
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Pitocin IV
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Why is IV pitocin given post partaly?
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To facilitate continuous uterine contraction.
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Uterine involution is usually complete by what time frame?
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three weeks except for placental site which takes six weeks
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describe the after pain of a primapara and a multipara
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primapara does not experience much pain due to strong consistant uterine contractions of the uterus
multipara- can have very strong pain for 24 to 48 hours due to weaker myometrial muscles and intermitent contraction of uterus |
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what may be used for pain in the multipara post partaly
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an OTC or tylenol 3
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Expectation of fundal assessment immediately after dilevery is where?
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between umbilicus and symphysis pubis
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what happens to the uterine fundus 6-12 hours after dilevery
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fundus rises to umbilicus, it is a rebound response
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what is the expected rate of involution each subsequent day after dilevery
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Fundus descends approximately 1 cm/day untill it is again a pelvic organ and cannot be palpated through the abdomen around 10 days to 2 weeks post partum
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Maternal discharge of blood, mucus, and tissue from the uterus
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Lochia
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Red, blood-tinged vaginal discharge that occurs following birth and lasts 2 to 4 days
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Lochia rubra
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Pink, serous, and blood-tinged vaginal discharge that follows lochia rubrua and lasts until the 7th to 10th day after birth
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Lochia serosa
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White vaginal discharge that follows lochia serosa and that lasts from about the 10th day to the 21st day after birth
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Lochia alba
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conidtion of the vagina during post partal period
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vagina has poor tone & lubrication, edema and lacerations, may need vaginal lubrication until hormones return to pre-pregnancy state
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What is appropriate patient teaching for care of vagina after birth
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Estrogen levels will return in 6-10 weeks, women must have pelvic rest (no sex, no tampons) until cleared by physician/CNM, vaginal lacerations will heal on their own.
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Post partaly, return of menses occurs when?
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Non-nursing 6-10 wks/ nursing 24-36 wks
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1st mensturation is usually___.
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anovulatory-no ovulation, but there is mensturation
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post partaly, ovulation occurs when?
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non-nursing 10 wks/ nursing (3 months) 17 weeks
breast feeding mom may not have period for up to 18 months but it is not a form of birth control |
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milk production and maternal breast changes are stimulated/ caused by what part or the brain and what hormone?
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Anterior pituitary, prolactin (pro-duction-of milk)
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the posterior pituitary produces what important maternal hormone (post partal)
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oxytocin/ let down reflex, releases flow of milk
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Nursing interventions for lactation supression
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avoid stimulation and heat(back to shower), wear a tight bra right away like a sports bra not a demi bra, may use 4 inch elastic binder over bra, ice breasts, must be treated mechanially to implement lactation supression, drug therapy no longer used
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Cardiovascular changes of the post partal period
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transient bradycardia(pulse in the 50's)
decreased hemotracrit diuresis estimated blood loss of 500mL |
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Explain the theraputic function of diuresis and the norms for urine output post partaly.
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helps to reduce blood volume and can have 3500 to 4000 mL of urine/dayfor a few days
also sweating may occur and dependent edema will be absorbed and excreted out |
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cabbage leaves
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used for engorgement, used to prevent and restrict lactation, one cold leaf works best, use very cautiously in breast feeding women
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tanic acid
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found in tea, warm tea bags may be placed on nipple to promote healing of nipples
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nipple care during lactation
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tanic acid from tea bags and colostrum on nipple helps lubricate nipple, leave a little milk to rub on nipple after feading to moisturise and protect nipple
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fundal assessment schedule
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q15min for the first hour after childbirth, q30min for the next hour, then hourly for approximately 2 more hours, then q8 hours or more frequently if problems arise
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problems to check for during post partal fundal assessment
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bogginess
positioning out of midline heavy lochia flow presence of clots |
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heavy lochia flow is determined by ___.
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saturation of pad in more than one hour
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Taking In
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women are passive and dependent, often most concerned with her own needs esp food rest/sleep
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transitional state in which mother is passive with baby and uses finger touch to examine/interact with baby, places baby in good en face view to get good eye contact with baby
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Taking In
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Taking Hold
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more independence with regard to management of baby, getting back in control
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post partal phase in which mother directs others as to mom and baby's needs, crageling and enfolding are seen
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Taking Hold
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Letting Go
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mom lets go of baby, must adjust to seperation of baby, must let go of childless roll, adjustment to new role and new life responsibility of being a mother
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Irritable, restless, anxious, lack of sleep can aggrivate, hormonal changes, mood disorder
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Postpartum Blues
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Nursing interventions for maternal postpartum blues
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use emotional adaption education intervention with mom and SO, may need referal to counseling
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signs and symptoms of Postpartum depression
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woman may not see herself as a good mother, hopelesness, dispair, helpless, anxiety/panic, unable to redefine self in positive terms, staying in bed not smiling or happy or excited about baby
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time frame in which postpartum depression takes place
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from 2nd week to 12 months
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nursing interventions for post partum depression
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this is a serious problem and should be refered for counseling and support groups which will help get them through
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Post partum psychosis
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only occurs in mom; paranoid, hallucinations, delusions
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describe the women most at risk for post partum psychosis
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previous pp depression, psychosis, recent stress, lack of support, low self esteem, pre-natal depression, pn anxiety, bi polar (baby may need care by other care giver temporarly)
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onset of post partum psychosis
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3-14 days post partum
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methergine
methergonovine maleate |
stimulates smooth muscle tissue, smooth muscle tissue of uterus is especially sensitive to this drug, used post partaly to stimulate uterine contraction, in order to decrease blood loss by clamping off uterine blood vessles and to promote involution process, has vaso constrictive effect and may result in hypertension esp in women who's bp is already elevated
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pitocin
oxytocin |
exerts a selective stimulatory effect on smooth muscle of uterus and bood vessels, increases strength on myometrial muscle contraction,supporting propagation of contraction (movement of the uterine contraction from one moymetrial cell to the next), cautious use of diluted pitocin administered intravenously at term results in a slow rise of uterine activity, cells are more susceptible to pitocin as pregnancy progresses
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RhoGAM
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given intramuscularly as prophylactic measure at 28 weeks gestation, provides passive antibody protection against Rh antigens, 'tricks' body so body does not produce antibodies of its own (active immunity)
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At what times is RhoGAM administered?
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after any abortion (spontanious or induced), ectopic pregnancy, or amniocentesis, at 28 weeks gestation and within 72 hours of live birth
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Rubella--when does it pose greatest risk to featus and what are the titer values, how long should pregnancy be avoided after immunization?
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1st trimester has geratest teratogenic risks, should avoid pregnancy for 1 month after vaccination (3 months in book, but is out dated), positive titer of 1:16 shows evidence of immunity, negative titer of 1:8 indicates susceptibility to rubella
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