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91 Cards in this Set

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What does involution of the uterus mean?
Returning of uterus to pre-pregnancy size
How does involution happen?
decreased cell size and exfoliation-scaling off of dead tissue and regrowth of endothial tissue w/o scarring at site of attachment
Schedule of Involution
Level of fundus at 24h-umbilicus
Down 1cm/day
What effects the schedule of involution?
-increased breast feeding quickens involution
-full bladder, atony and clots slow down involution
What must you remember if involution is not on "schedule"
to not only look at fundus but with lochia and other risk factors
What are some signs
Fundus above Umbilicus
What are some causes of abnormal involution
Accumulation of clots
What are some risks of abnormal involution?
Prolonged labor
Abnormal involution
Also called sub-involution
What are some signs
Fundus above Umbilicus
Boggy
Deviated to one side
Not on schedule
What are some causes of abnormal involution
Accumulation of clots
Full bladder
What are some risks of abnormal involution?
Prolonged labor
Parity > 5
Over-distention of uterus
Retained products of conception.
If the fundus is deviated to one side what does it normally mean?
Usually means she has a full bladder
What are the three types of Lochia
Lochia rubra-dark red, some clots lasts 2-3 days
Lochia Serosa-Pink, ppd 3- ppd 10(may see earlier with c/s)
Lochia Alba-yellowish 1-2wk more
Normal findings of lochia
Decreases in volume
Odor is musty-not foul
>flow w/ breast feeding/ in the am
Lighter in color each day
Abnormal findings of lochia
increased volume
foul odor
serosa to rubra
What may happen to lochia if mom is tired
increased volume and color-tell mom to slow down
What might you see when looking at lochia if mom has an infection
increased volume, increased color and odor
Cervical changes post partum
flabby, open 2cm, closes in about 2 wk,if cervix is lacerated see firm fundus with > bleeding
Vaginal changes post partum
edematous and bruised. will return to ruggae in few weeks
Perineum changes post partum
edematous from trauma
Phychological changes
Rubin
taking in stage
maternal passivity and dependence. mom preoccupied with own needs. may not be interested in baby for mins to days. NORMAL
Phychological changes
Rubin
Taking hold stage
more focus on self care and baby care. less dependence on others. GOOD TIME FOR TEACHING
What are some factors that contribute to phychological changes?
Post partum period see high levels of hormones suddenly drop causes abrupt change in hormone levels
exhaustion
Nursing assessment-health perception
hx-planned, prenatal visits, education, moms thoughts
RX-esp if breast feeding
Rubella status
Rh status
Nutrition/Metabolic
SKIN
Mom carries excess fluid that needs to be gone: profuse sweating esp at night. diuresis.
linea nigra starts to fade
striae-bright red to silvery
Nutrition/Metabolic
Nutrition
SVD-resume normal diet
c/s- sips and chips to +BS and flatus
continue with PNV for 6wks
if breast feeding drink to thirst
Nutrition/Metabolic
Food restrictions
No restrictions but certain foods may make baby fussy. watch what you eat and how baby reacts. If you eats these foods during preg infant already starts to tolerate
Nutrition/Metabolic
weight
DONT DIET avg loss 25-30# 6wk appt. DO NOT DIET
ELIMINATION
Gastrointestinal
SVD- abd is doughy and no tone, assess for rectis abdominus (may nn PT if severe)
C/S- assess BS, flatus, distention.
Common to see hemorrhoids- note number and size
ELIMINATION
G/U
risk for retention due to trauma of urethral site or swelling. May not feel urge to void. W/I 24h should see diurisis.
ELIMINATION
why is it important to make sure mom is voiding?
b/c a full bladder causes the uterus to be higher and off to one side causing the uterus to be soft
*a risk for hemorrhage*
ACTIVITY-EXERCISE
activity level
VS
Adlib
VS- BP should return to Prepreg, pulse slower at 50-70bpm, resp the same, temp may raise as high as 100.4 normal (WBC also go up)
ACTIVITY-EXERCISE
Musculoskeletal
Risk for thrombophlebitis due to state of hypercoaguablity
REST
initially wired then crash
encourage to rest when baby sleeps
cluster nursing care
discourage massive visitors causes overstimulation for baby and no sleep for mom
COGNITIVE-PERCEPTUAL
Knowledge
self-care- what is going to happen to fundus, peri care, exercise, sleep, *birth control*
Infant care-feeding, diapers
COGNITIVE-PERCEPTUAL
PAIN
Perineal- ice 12-24h, motrin and peri bottle
Afterbirth- failure of uterus tos tay contracted, increases with every delivery, strongest when breast feeding
cord care, bulb syringe, infant safety
DONT FORGET DAD
important not to discourage father in what he is doing, ler himbe and do it in his own way
ATTACHMENT
Klaus and Kennel- feedback cycle important for baby to give feedback to mom
SEXUALITY-REPRODUCTIVE
Assess-duration of labor, type of delivery, condition of baby, anesthesia/analgesia, EBL, check H&H
BIRTH CONTROL
Resumption of intercourse
POST PARTUM PHYSICAL ASSESSMENT
BUBBLE
breast, uterus, bowels, bladder, lochia, episiotomy or laceration on perinum
POST PARTUM PHYSICAL ASSESSMENT
Breasts
uniformly soft 2-3 days
assess for hardness, redness and cracks *address immediately* Teach-supportive bra, warm h2o stimulates let down, use of cabbage levels helps if you don't want to BF
POST PARTUM PHYSICAL ASSESSMENT
Fundus/Uterus
remember to support cervical neck when palpating fundus
POST PARTUM PHYSICAL ASSESSMENT
Bladder/bowels
Full bladder=atony. Keep empty
Bowel-use of stool softners help overcome fear of first BM
POST PARTUM PHYSICAL ASSESSMENT
lochia
Assess:amount;heavy soaks pad in 1h, moderate 4-5in/hr, light, 2-3in/hr, scant
note size and amount of clots
*anything above moderate NOT NORMAL*
POST PARTUM PHYSICAL ASSESSMENT
PERINEUM
ASSESS: edema, ecchymosis, hemrrhoids. lg area of bruising may mean hematoma
TEACH: use of ice, peri bottle, spray (tucks)
NURSING DIAGNOSIS
ATTACHMENT, risk for impaired
Fluid bolume deficit risk(hemorrhage)
pain, acute
Urinary elimination impaired
sleep pattern disturbed
risk for infection
POSTPARTUM COMPLICATION

HEMORRHAGE
ETIOLOGY;80-90% uterine atony
POSTPARTUM COMPLICATION
Hemorrhage risk factors
overdistention
prolonged/precipitous labor
high parity
interventions(pitocin,tocolytics, general)
POSTPARTUM COMPLICATION
hemorrhage assessments
boggy uterus
dark red bleeding
large clots
POSTPARTUM COMPLICATION
Hemorrhage interventions
fundal massage
IV access-replaces fluid/blood transfusion
Meds
Bimanual uterine massage
surgery-last resort
POSTPARTUM COMPLICATION
Meds for hemorrhage
oxytocin
Oxytocin- dose for pph; iv 10-40units added to 1000cc, IM 10units
S/E; anaphylaxis, HTN, N/V, >cramps
monitor I&O, lochia, fundus
POSTPARTUM COMPLICATION
meds/methergine
dose; IM 0.2 mg q 2-4hrs slow push, PO 0.2mg TID or QID
S/E: >BP, HA, dizziness, palpaitations, >cramps
what do oxytocin and methergine have in common, and what makes them different
both stimulate smooth muscles of uterus so they can contract. Oxy is intermittent and meth is continuous. never use either with PERCADAN
POSTPARTUM COMPLICATION
hemorrhage meds/hemabate
prostaglandin
dose: IM 250ug/ml deep IM q 1 1/2 - 3h(may be injected transabd into uterus by MD)
S/S: n/v, diarrhea, fever, chills
use with caution if hx of bronchospasms
POSTPARTUM COMPLICATION
Lacerations/location
cervix/uterus/vagina
POSTPARTUM COMPLICATION
lacerations/risk factors
forceps, vacuum, prolonged or precipitous delivery, pushing before 10cm, malnutrition(poor turgur)
POSTPARTUM COMPLICATION
lacerations/assessment
firm fundus, bright red bleeding
firm fundus and hvy lochia suspect uterus laceration call md
POSTPARTUM COMPLICATION
lacerations/interventions
visualize and repair
POSTPARTUM COMPLICATION
Retained placenta
occurs if placenta does not seperate after one hour. remove under general can be done with hand. Increased risk of PPH and infection
POSTPARTUM COMPLICATION
Hematoma/risk
risk: episotomy, prolonged second stage
POSTPARTUM COMPLICATION
hematoma/assessment
pain more than expected, localized blue or red swelling, vaginal or rectal mass on palpation
POSTPARTUM COMPLICATION
Hematoma/interventions
observe, ice or drain and treat with antibiotics
POSTPARTUM COMPLICATION
Thrombophlebitis/risk
obesity, >age, >parity, hx of thrombosis or anemia
POSTPARTUM COMPLICATION
superfical vs deep vein thrombophlebitis
superficial-redness, pain and heat, +/- fever, +/- homans. tx-elevation, ted, analgesics
Deep vein- leg or pelvic, fever/chills, < pedal pulses, milk leg (cool and pale) tx with heparin, bedrest and analgesic
POSTPARTUM COMPLICATION
infection/risk
freq vaginal exam, anemia, pph, retained placenta, c/s
POSTPARTUM COMPLICATION
infection/types
local, endometritis most common site is wher placenta implants, PID, peritonitis, sepsis
POSTPARTUM COMPLICATION
infection/assess
lochia-will increase and be foul smelling
fever/chills
abd pain
POSTPARTUM COMPLICATION
infection/RX
analgesic, abx, assess for pariliticilleus
Mastitis
Breast infection, usually S. auerus, coming from baby;s resp system when feeding
occurs most freq in primips and usually infects one breast
Mastitis
Assessment
>temp with chills, malaise, tachy, headache, tender breast with reddened area.
SYSTEMIC REACTION
MASTITIS
Treatment
antibiotics frequent nursing(helps keep engorgment to a min) heat and analgesics
PP psychological adjustment
pp blues
transient and normal occurs in 50-80% of woman usually occurs 3-4d PP
PP psychological adjustment
pp blues
S/S and treatment
crying jags, anxiety, labile, fatiques, "muddled thinking"
tx: support, normalize it
PP psychological adjustment
pp depression
Can happen anytime after birth *SERIOUS acute Depression, occurs in 10-15%
lasts up to 6 monthes or longer
woman who have hx of depression or a sick baby are more at risk
PP psychological adjustment
pp depression
S/S
sleep disturbances, less energy, change in appetite, crying and feelings of worthlessness, thoughts of suicide
PP psychological adjustment
pp depression
treatment
therapy-supportive, antidepressents-almost always
may be hospitalized until stable.
PP psychological adjustment
pp depression w/ pychosis
very rare, 0.01%
high rate of reoccurance
PP psychological adjustment
pp depression w/ pychosis
Etiology
chemical, >sensitivity of hypothalmic dopamine D2 recptors(?)
PP psychological adjustment
pp depression w/ pychosis
S/S
delusins, hallucinations, disorganized or catatonic behavior, loosening of associations esp around themes of childbirth
PP psychological adjustment
pp depression w/ pychosis
ONSET
10days -8wks
PP psychological adjustment
pp depression w/ pychosis
Treatment
Seperate mom and baby!! most woman have thoughts of harming baby before do it. be aware. hospitalization, anti-psychotic meds and follow up with future preg
Breastfeeding
American Academy of Pediatrics recommends
exclusive BF to 6mo and the supplement with solids and continue to BF to 1yr
Benefits of breatfeeding
for baby
<diarrhea, uti's, pneumonia, otis media, celiac disease, chron's, meningitis,a sthma, allergies, sids,lymphoma, leukemia, IDDM, childhood obesity
Benefits of BF for Mom
< breast CA, PPH, weight retention, $ spent on formula, conveince may lessen risk for osteoporosis
Breast feeding contraindications
HIV+, serious illness, drug therapy
levels of drug and their risk
L1-safest
L2-safer
L3-mod. safe
L4-hazardous
L5-contraindicated
Milk Production
prolactin- suckling produces for ilk production
Oxytocin-for let down
Componets of milk
colostrum-rich but low volume called liquid gold due to high levels of antibodies
fore milk-tend to have more h2o
hind milk-high in fat and calories
new thought is to nurse on one side until empty so infant gets the hind milk.
Latch ON
Feeding clues:rooting, hands to mouth, sucking
Clues are given before screaming, pay attention!
What is the the most common reason for breasts being sore
the baby is not properly latched on
Systematic assessment of infant at breast or SAIB
correct postion +1
baby latched on +1
baby sucking +1
audible swallowing heard =1
TOTAL SCORE 4