• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/191

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

191 Cards in this Set

  • Front
  • Back
Puerperium
time of adjustment when reproductive organs return to nearly pre-pregnant state; extends to 6-8 weeks after childbirth, "fourth trimester"
What happens to blood volume, cardiac output, and clotting factors immediately after birth?
Blood Volume: lessened (sweating)
CO: increases
Clotting factors: increase (to protect from postpartum hemorrhage)
How often should you check the mother post partum?
1st hour?
2nd hour?
3-8 hours?
every 8 hours thereafter?
1st: every 15 minutes
2nd: every 30 minutes
3-8: every 1 - 2 hours
Every 8 hours thereafter
True or false: taking a blood pressure can be painful for a woman in the puerperium period.
True
What would you expect for normal vitals for the mom immediately post-partum?
Temp: up to 38C (100.4 F) 1st 24 hours
Tacycardia (early sign of excessive blood loss)
BP: WNL
What could increased BP mean for the postpartum woman?
Pre-eclampsia (if proteinuria + hypertension)
What could decreased BP mean for the postpartum woman?
Can be a late sign of hemorrage
Can cause Orthostatic hypotension
What is the normal EBL for vaginal birth?
Cesarean?
vaginal: 100-500cc
C/S: 700-1000cc
How much does the hemoglobin drop per 500ml blood loss?
2 points drop in hemoglobin
What is considered an abnormal drop in hematocrit?
>10%
What hg/hct level is considered anemia?
Less than or equal to 10/30
What are common values of WBCs for the first 10-12 days postpartum?
Elevated to 20,000-25,000
How long do plasma fibrinogen and clotting factors remain at pregnancy levels?
One week
If someone has pre-eclampsia, they may also be hyper_______.
Reflexive
What could be signs of thrombus formation in the postpartum woman?
Pain, tenderness, redness, warmth, calf size, edema, positive homan's sign
What do varicosities mean postpartum?
Swollen, distended veins, not neessaily a risk for thrombus formation
Can lead to redness, warmth and pain
The process by which the uterus shrinks(returns to non-pregnant state) is called ____.
Involution
How long does it take post partum until the uterus is not palpable?
about 6 weeks
Process of self digestion and reabsorption of the protein which had enlarged the uterine muscle cells.
Autolysis
A large number of cells remain after each pregnancy, resulting in a slight _____ in uterine size
Increase
Two medications that facilitate involution
Methergine (sustained uterine contraction)
Pitocin (rhythmic uterine contractions)
4 things that facilitate involution
Breastfeeding
Fundal massage
Medications
8 factors that could interfere with involution
Full bladder
Overdistended uterus
Prolonged labor
Difficult birth (more vag exams = more bacteria)
Anesthesia
Retained Placenta
Grand Multipara
Infection(uterine muscles don't work as well)
Why might a woman not know her bladder is full postpartum?
Decreased sensitivity
What are two causes of an oversidetended uterus?
Multiple birth
Clots
Fundal height changed:
Immediately
12 hours
Day 1-8
Day 9
5-6 weeks
immediately: 2cm below umbilicus
by 12 hours: 1cm above umbilicus
Day 1-8: decreases 1cm per day
Day 9: not palpable
5-6 weeks: near pre-pregnant size
The bladder fills ______ with postpartum _____
quickly, diuresis
Two medications that facilitate involution
Methergine (sustained uterine contraction)
Pitocin (rhythmic uterine contractions)
4 things that facilitate involution
Breastfeeding
Fundal massage
Medications
8 factors that could interfere with involution
Full bladder
Overdistended uterus
Prolonged labor
Difficult birth (more vag exams = more bacteria)
Anesthesia
Retained Placenta
Grand Multipara
Infection(uterine muscles don't work as well)
Why might a woman not know her bladder is full postpartum?
Decreased sensitivity
What are two causes of an oversidetended uterus?
Multiple birth
Clots
Fundal height changed:
Immediately
12 hours
Day 1-8
Day 9
5-6 weeks
immediately: 2cm below umbilicus
by 12 hours: 1cm above umbilicus
Day 1-8: decreases 1cm per day
Day 9: not palpable
5-6 weeks: near pre-pregnant size
The bladder fills ______ with postpartum _____
quickly, diuresis
5 nursing actions prior to and during feeling for post partum fundal height changes
1 - Have pt. void
2 - lie mother flat
3 - palpate fundal height and location
4 - note any displacement
5 - evaluate consistency
3 interventions for post partum uterine bleeding
1 - uterine massage
2 - breast feeding
3 - Medications
Which med is given to slow uterine bleeding for:
Low BP?
High BP?
Low - Methergine
High - Misoprostol (rectal)
How long do after birth pains last?
2-3 days
What causes after-birth pains?
Hormones (Oxytocin and Prostaglandins)
Other factors (multiparous, over distended uterus, breast feeding, exogenous oxytocin)
What might be indicated if heavier bleeding continues with a firm uterus?
lacerations
5 interventions for after birth pain
1 - warm compress
2 - alternative therapies
3 - Medications
4 - Keep bladder empty
5 - Reassure that it will lessen each day
When does the cervix return to it's original form?
Within a few hours
When is the os of the cervix fingertip sized?
1 week
What happens the the shape of the os after birth?
Shape changes permanently to being more open and oval - "Parous"
Why would you need to refit the diaphragm/cervical cap at 6-week postpartum check-up?
Because the os permanently changes to being parous shape
What is lochia?
Discharge from shedding or soughing of decidua/lining of uterus
How does the color of lochia change:
2-3 days?
3-10 days?
10-21 days?
2-3 days: rubra (red some small clots)
3-10 days? serosa (pink/brown)
10-21 days? alba (yellow/clear)
A ___ amount of oozing with fundal massage may be noticed in the first few days postpartum.
Small
Lochia amounts:
Scant <2.5 cm
Light<10cm
Moderate >10cm
Heavy - 1 pad saturated in less than 2 hours
Episiotomy is equivalent to _____ laceration
2nd degree
Which degree lacerations do not necessarily need repair (if not bleeding)?
1st
Which degree lacerations always need repair?
2nd, 3rd, 4th
First degree lacerations involve
vaginal mucosa, posterior fourchette, perineal skin
Second degree lacerations and episiotomy involve:
Vaginal mucosa, posterior fourchette, perineal skin, and perineal muscles
Third degree laceration
Vaginal mucosa, posterior fourchette, perineal skin, perineal muscles, tear through entire thickness of analsphincter, muscle retracts into the surrounding tissue and can be difficult to see
partial third degree laceration
Sheering of muscle fibers of the sphincter and requires repair
Fourth degree lacerations
Extension of the third degree laceration into the mucosa of the rectum; skin of rectal sphincter is disrupted
Post partum orders for perineal tears
no suppository, no enema, "nothing per rectum"; can get order for stool softener
REEDA Scale
Rates 0-3 for each item: Redness, Edema, Ecchymosis, Discharge, Approximation
What should a nurse also pay attention for when examining the perineum?
Hemorrhoids
Which position is best for visualizing the perineum?
Side-lying
What should you instruct a woman to do when urinating with perineal pain?
Use a squeeze bottle, wipe front to back
How should you instruct a woman to sit to reduce perineal pain?
Tighten buttocks first; sit on firm surface
What are 5 nursing interventions for perineal pain?
Sitz bath after 24 hours, anesthetic spray, meds on regular schedule, ice 12-24 hours, offer stool softener
5 interventions for hemorrhoids
Increase hydration, increase freuits veggies and fiber, witch hazel pads after void, sitz bath for at lease 20 min, anesthetic spray or cream applied sparingly 3-4 times daily
What are two instances in which you would use a sitz bath?
Hemorrhoids, perineal pain
What does a sitz bath do?
improves blood flow to perineum and promotes healing
Can be used at least _____ daily
2 times; up to 5
What kind of response are the chills and shakes?
Neuro
3 nursing interventions for chills/shakes
keep blankets in warmer and have ready to go; reassure the mother that it is common; assure safety of baby
What does diaphoresis do for the post partum woman?
rids of extravascular fluid;
Two nursing interventions for diaphoresis
linen/gown change; protect against chilling
3 things you should teach about 1st time getting out of bed:
Effects of meds, rising slowly, holding baby
Following a c-section, when should a women be getting up out of bed?
Day of surgery
What is enough of an exercise for a woman with distasis recti abdominis?
chin to chest
how do you measure the separation of the rectus abdominis?
Fingerbreadths
When are breasts:
Soft?
Filling?
Full?
Soft - 0-48 hours
Filling 48 - 72 hours
Full 72 hours
How long does engorgement discomfort last?
24-36 hours?
Differences in breast feeding and non breast feeding management of engorgement:
Breast uses warm shower, non uses ice and avoids warm water
Breast nurses frequently, non does not express milk intentionally
Non uses pain meds, breast does not
Similarities in management of engorgement for breast feeding and non breast feeding moms
wear supportive bra 24 hrs/day
cabbage leaves
What puts a woman at risk for constipation during pregnancy and labor?
less tone in pregnancy, prelabor diarrhea, dehydration, less intake in labor, analgesia/anesthesia, concern about perineal discomfort
How long can it take for the first post partum BM?
2-3 days
What can a nurse do to encourage a BM in a postpartum woman?
Fiber, fluids, food, activity, stool softeners (c/s and 3rd and 4th tears)
How can you help a post c/s woman avoid flatus pain?
clear liquids then diet as tolerated (usu 2nd day
avoid gas forming foods and carbonated beverages, lie of left side
use rocking chair
Encourage activity
There is decreased ____ and ____ of urinary system post partum
tone and dilation
How long does it take for urinary dilation to return to normal? Tone?
2 weeks to 2 months; 1 week
How much does a woman diurese in the first 24 hours?
2000-3000cc
What are factors that contribute to urinary retention?
dereased sensation, anesthesia, swelling/bruising of perineum, periurethral laceration, overly full bladder
When should a woman first void? and how frequently thereafter?
1-2 hours; every 2-4 hours
What should you monitor regarding urinary elimination in a postpartum c/s woman?
I and O after foley is out, incomplete emptying (retenntion with over flow), measure voids (3 > 250 or 1 > 500), observe for signs of UTI, drink lots and void often
When should a woman void after a normal spontaneous vaginal delivery?
within 8 hours
What are 6 interventions you can use with a NVSD woman post partum to help her void?
Peppermint oil, hand in warm water, running water, assist to bathroom, spray perineum with water, provide perineal pain relief if that is causing retention
Interventions for altered tissue perfusion in post partum woman
Exercises for circulation (q 15 min in recovery, q shift postpartum), support hose, early ambulation
What can contribute to altered family processes?
Separation from neonate pos c/s, pain, IVs, challenges with breastfeeding, disappointment with birth experience
When do you give the rubella vaccine?
If the titer is <1:8
When do you avoid the rubella vaccine?
Immunocompromised persons, allergy to duck eggs
How long should you avoid pregnancy if you receive the rubella vaccine?
1 month
When is RHOgam given?
Within 72 hours of birth
What is the normal length of postpartum hospital stay for vaginal delivery?
C/S?
48 hours; 96 hours
What are the criteria for early discharge?
-healthy mom w/o complications during pregnancy, birth and post partum
-term infant, healthy infant with normal lab and vitals
-social and physical environemtn support continued wellness of mother and infant
-Documentation of mother's ability to care for and feed infant
-Follow up scheduled within 1 week if discharged before 48 hours
How much weight is lost with the birth of the baby? Diuresis?
10-12 pounds; 5 pounds
How long should a woman wait before starting calorie restriction for weight loss?
6 weeks.
When does amenorrhea stop?
Non breast feeding: 6-10 weeks
Breast feeding: 4--7 months (up to a year)
What percent of 1st cycles are anovulatory?
50%
What suppresses ovarian function post partum in breast feeding woman?
prolactin
Can ovulation occur before 1st menstruation?
YES!
The vagina is ______ and _____ post delivery
edematous and congested
When do vaginal rugae return?
3-6 weeks?
Return of pelvic floor muscle tone may take ____
Months
________ cause thin mucosa and vaginal dryness
Low estrogen levels
Thin mucosa and vaginal dryness last longer with which type of feeding?
breast feeding
If perineum is intact, Intercourse is safe when lochia is: rubra, serosa, alba? How long?
Alba, 2-4 weeks
How long should you wait to have sex following extensive perineal repair?
6 weeks
Sexual responses may take a few months to return and may be ____ and ____ ______
slower and less intense.
how long does it take for abdominal tone to return with exercise?
2-3 months
Suggested abdominal exercises
pelvic tilt
partial sit ups
walking
prone position
How much weight can c/s mom lift for first 6 weeks?
Only weight of baby
4 major post partum complications
hemorrhage, infections, embolic phenomena, mental health
What is the leading cause of maternal death and morbidity?
Postpartum hemorrhage
Define postpartum hemorrhage:
blood loss of > 500 ml after birth
How are women able to compensate for fluid loss post partum?
They have a good fluid reserve - overload in pregnancy that is protective.
What is Early and Late Postpartum hemorrhage?
Early: 1st 24 hours
Late: 2nd day up to 4 weeks
Four causes of postpartum hemorrhage
Uterine atony
Lacerations
Retained placental fragments
Clotting problems
8 factors associated with atony
1 - overdistended uterus
2 - Gradmultiparity
3 - Anesthesia
4 - Rapid labor
5 - long labor
6 - Pitocin use in labor
7 - MgSO4 use in labor
8 - Ruptured uterus
7 signs of hypovolemic shock
1 - BP decreases
2 - Pulse increases
3 - Cool and clammy skin
4 - Grayish or ashen skin
5 - Anxiety/Air-hunger
6 - Complaints of weakness, light headedness or nausea
7 - Persistent significant bleeding
5 medications for atony
Pitocin
Methergine
Ergotrate
Prostin
Cytotec
5 Nursing interventions for hemorrhage prevention/cessation
IV for high risk women
Assess for lacerations
External manual compression
Oxygen
Fundus, lochia, and bladder assessment
What causes a postpartum hematoma?
Hidden laceration
What is a postpartum hematoma?
collection of blood from an injured blood vessel in soft, connective tissue
4 factors that contribute to postpartum hematoma
Pelvic congestion of pregnancy
anesthesia
Large infant
Difficult delivery (forceps, position)
How can you tell the difference between edema and a hematoma?
Use a flashlight: edema is translucent
6 symptoms of a postpartum hematoma
Excessive pain at wound site
Feeling of vaginal pressure
Firm, painful to touch
Pain out of proportion to what one would expect
Bluish or redding discoloration
Change in vital signs
6 interventions for post-hemorrhage care
Assistance with self-care
Safety for mom and baby
Rest
Fluids
Nutrition
Vitamin and mineral supplements
Post-hemorrhagem would you encourage or discourage oral fluids?
Encourage
4 things to monitor in post-hemorrhage care
BP
Pulse
Fundal height and firmness
Temperature
Why would surgery be required post-hemorrhage?
To clean out the uterus
2 Serious complications of hemorrhage
Hypovolemic shock
DIC
When would you order antibiotics post-hemorrhage?
If the woman had a fever
How can DIC be treated?
Correct underlying cause
Use anticoagulants
Replace blood components
Oxygen
Fluids
What factors contribute to DIC?
Hemorrhage
Sepsis
Severe preeclampsia
Abruption
Dead fetus syndrome
Amniotic fluid embolsim
Factors that put a woman at risk for post partum infection:
Traumatic birth
Multiple vaginal exams
Underlying disease (Diabetes)
Stasis
Vaginal flora altered
Prolonged ROM
4 signs/symptoms of uterine infection
foul odor
bleeding
tenderness
subinvolution
Preventative measures: respiratory infection
check lungs every 4-8 hours
Cough and deep breath
Ambulate
Incentive spirometer
Preventing postpartum infections:
Hand washing
Sterile technique when necessary
perineal care
Limit vaginal exams
Timely delivery
Prophylactic antibiotics for C/S
Major sign of endometritis
subinvolution
2 causes of endometritis
Retained placental fragments
Infection
4 symptoms of endometritis
Lochia rubra for more than 2 weeks
Fundal height higher than expected
Tender, boggy uterus
S/S infection
Should a nurse use a regular urine specimen to test for proteinuria or hematuria?
No - May need to cath for a specimen, because of lochia in GU tract
When is the surgical dressing removed from the c/s site? When can a woman shower?
24 hours; after dressing is removed
A foley in for how long puts a woman at risk of UTI?
8-24 hours
Do UTIs tend to manifest early or late?
Late - 2-3 weeks
3 medications for endometritis
methergine
Antibiotics
Iron supplements
3 organisms that cause mastitis
Staph Aureus
E. Coli
Yeast
Is mastitis common?
No. Less than 1% of women
6 contributing factors to mastitis
Damaged nipples
trauma to breastFatigue
Stress
Milk stasis
Poor drainage (blocked duct)
T/F Mastitis usually only happens in the first 5 days of breast feeding
False. Can happen anytime during lactation
Symptoms of mastitis
Fever (over 101)
Reddened,warm, swollen area
Flu-like symptoms
Chills
Headache
Nursing interventions for mastitis
Prevention
Rest
Fluids
Frequent nursing
Local heat
Analgesics
Antibiotics
Supportive bra
4 types of postpartum embolic phenomena
Pulmonary embolus
Amniotic Fluid Embolus
Deep Vein Thrombosis
Superficial vein thrombosis
Why do clotting factors alter during pregnancy?
To prevent hemorrhage
7 factors contributing to thrombophlebitis
Altered clotting factors during pregnancy
Inactivity
C/S
Multipara
Over 35 years old
Obesity
Smoker
Treatment for thrombophlebitis
Rest
Elevation of legs
Analgesia
heat
Support hose
anticoagulants
Pulmonary embolus
dislodged clot that circulates to lung; blocks blood flow of to a portion of lung
Symptoms of pulmonary embolus:
Chest pain
Apprehension
Shortness of breth
Tachycardia
Hypotension
Diaphoresis
Atelectasis
Contributing factors to amniotic fluid embolus:
Tumultuous labor
Oxytocin with hypertonic contractions
AROM
Symptoms of amniotic fluid embolus
Chest pain
Dyspnea
Cyanosis
Frothing at mouth**
Tachycardia
Hypotension
Hemorrhage
What percent of women get the baby blues?
75-80%
When are baby blues usually noted?
2-10 days, peaks at day 5
What percent of women have postpartum depression?
10-15%
What is the recurrence rate of postpartum depression?
70%
What percent of women have postpartum psychosis?
0.1 - 0.4%
What is the recurrence rate of postpartum psychosis?
25%
When do baby blues set in? How do they resolve?
Within 1st few days; resolve without treatment
What are common signs of a woman with baby blues?
Cries easily
Fatigued
Disrupted sleep
To be considered depression, how long does sadness persist?
More than 2 weeks postpartum
Characteristics of postpartum depression
Severe mood swings
Irritability
Intense fears and anxieties
Ruminations of tuilt and inadequace
Anger
Thoughts of harming baby and or slef
May appear healthy
What increases risk of post partum depression?
History of depression
What kind of help does a woman suffering from postpartum depression need?
Professional help/counselling
Maybe meds
What does postpartum psychosis begin with?
Usually begins with severe depression (fatigue, insomnia, restlessness, emotional liability)
Characteristics of postpartum psychosis
Dilusions (break with reality; auditory hallucinations)
Incoherence/Irrational statements
Paranoia/Suspiciousness
Complains of inability to move, stand, work
When is the onset of postpartum psychosis?
Usually 2-3 weeks postpartum; almost always within 8 weeks postpartum
Bonding
Parent to infant
Immediately after birth
Eye contact, body movement
High risk infant or mother influences
Attachment
Infant to parent, and parent to infant
First year of life
quality/ timing of experiences influence
infant: sucking, clinging crying, smiling, etc.
Attachment definition
enduring twoway bond or relationship of affection between persons
Engrossment
father's absorption in infant
3 stages of father-infant attachment
Expectations
Reality
Transition to mastery
Which maternal role development stage is the optimal teaching time?
Taking hold
What are the three maternal role development stages?
Taking in 1-2 days
Taking hold 3 days - weeks
Letting go 7-10 days+
In which maternal role development stage does the mom focus on herself and her own needs?
Taking in
In which maternal role development stage does the woman start to focus more on the whole family?
Letting go
When may a woman feel socially isolated?
Letting go stage