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59 Cards in this Set
- Front
- Back
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What is involution?
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Reduction in size of uterus to nonpregnant state (uterine contractions help this)
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What are some factors that enhance involution?
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-breastfeeding
-early ambulation -complete expulsion of placenta & membranes |
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What are some factors that slow involution?
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-prolonged labor & difficult deliveryy
-anesthesia -grand multiparity -retained placental fragments -full bladder -infection -over-distention of the uterus |
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How does involution work?
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Just know that it starts at about the level of the umbilicus and works its way down. You can palpate it to measure.
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What's a "boggy" uterus?
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Soft, relaxed (not easy to palpate)
Likely to cause *hemorrhage |
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What's lochia?
What increases it? |
Debris from delivery & uterine lining.
exertion & breastfeeding |
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What's the normal progression of lochia?
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Bright red --> rubra(dark red) --> serosa(pink) --> alba(white)
Unexplained increase or return to rubra is ABNORMAL |
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If the fundus has gone down, is firm (like its supposed to be) but there is still significant bleeding, what would you suspect?
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Cervical laceration
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What decreased hormone levels lead to painful intercourse due to decreased vaginal lubrication?
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Low estrogen levels
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Is breastfeeding a reliable means of contraception?
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No
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What is the main cause of postpartum hemorrhage?
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Full bladder
A full bladder pushes the uterus up and it cannot contract (uterine relaxation causes hemorrhage) |
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How can you tell if a full bladder is causing hemorrhage?
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The uterus deviates to the side and becomes boggy
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What's the phase in maternal adjustment where you will need to help reorient the pt and possibly explain things you have previously explained to them?
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Taking-in phase
1-2 days after delivery Having trouble sorting reality from fantasy in birth experience |
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If a pt has the "baby blues", what would you need to further evaluate them for?
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postpartum depression
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Who is at an increased risk for PPD?
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1st time mothers & women w/ hx of depression
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With a mom Rh"+" & the baby is Rh"-" who already got Rhogan while pregnant, what needs to happen next?
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They need another dose of Rhogan within 72h of birth or else it could compromise future pregnancies
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If a mother's rubella status is <1:10, what needs to happen?
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Need a rubella shot upon discharge
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When is an ideal time for teaching?
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While performing your assessment
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What's the additional needs of a C/S or BTL pt along with postpatal teaching?
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PostOP
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What do you need to teach when taking the pts et baby's temp?
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How to take temp at home and read thermometer
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What does the nursing assessment for a postpartal pt include?
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B - Breast
U - Uterus B - Bladder B - Bowel L - Lochia E - Episiotomy/Laceration H - Hemorrhoids/Homans E - Emotional B - Bonding |
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Breast assessment:
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assess for encorgement: full/congested breast - tx with warm packs, pump or feed q 3-4h
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Education for mother who does not want to breast feed:
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-tight sports bra
-warm shower water on back only, do not let on breasts -no breast stimulation |
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What do you need to do prior to assessing the uterus?
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Have pt void
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When do we want the pt to void?
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Within 4hrs of delivery or after dc of foley
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What can you provide to help a pt void?
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peppermint oil
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What dietary restrictions are there after a c/s or btl?
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-no carbonated drinks
-avoid lots of sweets -no straws |
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What change in lochia would indicate infection?
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odor
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What would the passage of clots indicate? (clots larger than a nickle)
What would you do about it? |
Inadequate uterine contractions
Assess location & firmness of fundus Assess voiding pattern Record & report findings |
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What would persisten lochia rubra indicate?
What would you do about it? |
Inadequate uterine contractions
Retained placental fragments Undetected cervical laceration Assess location & frimness of fundus Assess activity pattern Assess for signs of infection Record & report findings |
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What's a major complication of an episiotomy that you need to assess for?
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Ecchymosis or bruising
If a pt c/o pain, suspect a hematoma. Use an ice pack and pain meds, if doesn't get better then notify MD (may need I&D or incisional packing) |
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What do we chart on Homan's sign because it is not evidence-based?
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Chart "not assessed"
However, need to assess for redness, tenderness, areas of heat in calves, severe abdominal or flank pain |
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What's a non-narcotic used to help with cramping & abdominal pain?
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Toradol
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What uterine stimulants do we use postpartum?
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Oxytocin....then if this is not working, give:
Methergine |
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Whats the bad side effect of methergine?
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Increases BP
DO NOT give with already high bp |
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Is it okay to give analgesics for cramps before breastfeeding?
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Yes!
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What's the key to increasing circulation?
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Early ambulation (for vaginal & cesarean deliveries)
Caution for orthostatic hypotension due to blood loss |
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What is contraindicated with 3rd-4th degree episiotomy lacerations?
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rectal suppositories & enemas
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Nutrition needs for....
Breastfeeding: Bottle feeding: |
Breast=+500cals/day
Bottle=reg diet |
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What's important teaching for mom et family?
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*Handwashing
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Important teaching for adolescent mother:
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1) *perineal care to prevent infection
2) infant care 3) contraception |
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Education for when they go about about when they would need to contact their physician:
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-sudden, persistent, or spiking fever
-change in lochia (smell, return to bright red, excessive amt, passage of clots) -s/sx DVT -s/sx UTI -s/sx PPD |
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What teaching needs to be done for infant cord care?
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Clean with alcohol with every diaper change
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What do you teach to decrease urinary leakage or urinary incontinence?
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Kegel exercises
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What must a pt have before they can leave the hospital with their baby?
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a car seat
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What is early hemorrhage?
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>500cc in 1st 24hrs after delivery
decrease in HCT of 10pts We want them to regenerate the RBCs themselves, but if symptomatic (fainty, dizzy) will get a tranfusion |
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What can alter clotting factors?
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Anesthesia or MgSO4 (Magnesium Sulfate - used for preeclampsia)
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What during L&D needs to be assessed to prevent hemorrhage?
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Inspect the placenta - make sure there are no fragments left in the uterus
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Tx of hemorrhage:
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Uterine massage
Oxytocin, methergine If placental fragments, remove them (D&E - dilation & evacuation) |
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Postpartum infection:
1) Temp >_____in 1st 24h 2) Temp >_____for 2 days during the next 10 days postpartum |
1) 101
2) 100.4 |
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Intrapartal causes of infection:
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-PROM (premature rupture or membrane)
-Multiple exams after rupture of membrane |
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We have increasing rates of this, and need to monitor for it:
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IV site phlebitis
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What's the most common PP infection?
What causes it? |
Endometritis
Staph or strep |
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What's a safe tx for DVT because it does not cross the placental barrier?
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Heparin
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Nursing interventions for PE:
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-Semi-fowlers
-O2 -Call MD |
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Causes of DIC:
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Disseminated Intravascular Coagulation
-septic shock -retained fetal death -hydatiform mole: started to become pregnant, but body did not form a baby, just a clump of cells |
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s/sx DIC:
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-Increased PT
-Thrombocytopenia -Bleeding - gums, puncture sites -Ecchymosis TX: very complex, PRBC, Plasma, whole blood, fibrinogen |
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Teaching for mastitis:
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-*Do not stop breastfeeding, will get worse
-heat -pump to avoid engorgement |
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s/sx mastitis:
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infection, fever, flu-like symptoms, reddened area of breast
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