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55 Cards in this Set

  • Front
  • Back
6 week period after childbirth
postpartum
________ occurs when there is normal uterine contractions and atrophy of the uterine muscle
involution (occurs after the birth of the placenta)
moderate to severe cramp like pains that occur more in lactating women and women of multiparous women, it is from the release of oxytocin
afterpains (tell the pt that they last around 36 hours)
assess the uterus for location, postition and tone of fundus:
every _____ min for the first hour
every _____ min for the 2 hours
every _____ hours for the next 22 hours
and _______ a shift after 24 hours
every 15 min
every 30 min
every 4 hours
once a shift
where should the uterine fundus be located immediately after birth of the placenta?
at the umbillicus; firm and midline
where should the uterine fundus be 1-2 hours after the birth of the placenta?
midway between the umbilicus and symphysis pubis; firm and midline
where should the uterine fundus be 12 hours after the birth of the placenta?
1 cm above the umbilicus; firm and midline
where should the uterine fundus be 24 hours after the birth of the placenta?
1 cm below the umbilicus; firm and midline
what is the normal rate of involution after 24 hours?
1 cm a day ( 1 cm= 1 finger breadth)
when should the uterine fundus no longer be felt if involution is met?
10 days, the fudus should be non palpable in the pelvis
the mucus membrane that lines the uterus
endometrium
a bloody discharge from the uterus that contains sloughed off necrotic tissue, shows changes that reflect the normal healing process of the placental site
lochia
how often should you inspect the lochia?
everytime you inspect the uterus
describe the stage and characteristic of lochia rubra
last 1-3 days PP, should be bloody with small clots in moderate to scant amounts, increased flow on standing (pooling in uterus) or breastfeeding and should have a fleshy odor
describe the stage and characteristics of lochia serosa
last from day 4-10 PP, can be pink or brown in color in scant amounts, can see an increased flow with activity with a fleshy odor
describe the stage and characteristics of lochia alba
day 10 PP, should be yellow to white in color in scant amount with a fleshy odor
if the lochia has been in the serosa stage then goes back to the rubra stage what should you suspect?
subinvolution
what can large clots interfere with?
uterine contractions
should you teach your patient about how to massage the fundus?
yes- she should understand the importance and risks of a boggy fundus and when to call the dr.
what are the nursing actions when assessing the perineum and vagina? (done every shift)
explain the procedure
provide privacy
assist women to her side
seperate the buttocks to expose and assess
what are the expected finding of a NORMAL vaginal and perineum assessment?
mild edema
minor ecchymosis
aproximation of the episiotomy or laceration
mild to moderate pain
what are some comfort measures that you can do for the patient when there is pain in the vaginal/perineum area?
apply ice for the first 24 hours (decreases edema)
lie her on her side to decrease pressure on perineum
have her tighen gluteal muscle when sitting down (cushions the perineum)
wear peripads snug to avoid rubbing
stiz bath after 24 hours PP
administer pain med
use topical anesthetic
how can you teach your patient to reduce risk for infection
use peribottle after elimination
change peripad frequently ( everytime there is elimination)
WASH HANDS
when does primary engorgement happen and when should it subside?
day 3 PP (when milk is in) and should subside in 24-48 hours unless breastfeeding and then you can have subsequent breast engorgement
this is the fluid that has immunoglobulin G and A , high in protien and low in carbs.
clolstrum; precedes milk production
what is the expected nurse findings in the first 24 hours of the breast
soft and non tender
what is the expected nurse findings PP day 2 of the breast
slightly firm and nontender
what is the expected nurse findings PP day 3 of the breast
firm tender and warm to the touch
what can you educate the patient who is not breast feeding to do to relieve breast engorgement?
apply ice
dont express milk (will encourge milk production)
avoid heat and stimulation
take analgesic for pain
what is the expected amount of blood loss in the average vaginal birthing experience?
400-500 mL: has minimal effect because the women is in a state of pregnancy induced hypervolemia
t/f there is an increase in cardiac output the first few hours postpartum
true- related to the blood that was shunted through the uteroplacental unit returning to the maternal system
when does cardiac output return to normal pre-pregnant levels?
within 48 hours
why is the patient at risk for orthostactic hypotension?
decreased vascular resistance in the pelvis
when should you check vitals in PP period?
same as the fundus check and lochia check
why is it normal for the women to have an elevation in temp during the first 24 hours post birth?
muscular exertion, exhaustion, dehydration, or hormonal changes
when should you further evaluate a temp?
greater than 100.4 after the first 24 hours PP, on two different occasions
if the temp is less than 100.4 in the first 24 hours what should be the nursing interventions?
hydrate the women
promote rest and relaxation
reassess 1 hours after intervention
is bladder distention, imcomplete emptying of the bladder and inability to void normal during the first few days PP?
yes- related to decreased sensation to void and edema around the urethra
why is diureses common the first 12 hours PP?
caused by decreased estrogen and oxytocin levels and it aids in the elimination of excess tissue fluids. (can become problematic if unable to void)
how ofter should you be measuring the amounts being voided?
everytime for at least the first 24 hours
how much should the voids amount to each time?
150 mL each void (if less palpate for distention)
when should the pt be cathed if unable to void?
12 hours
why would you use peppermint oil?
the vapors of the peppermint oil has a relaxing effect on the urinary spincter
what does early voiding reduce the risk of?
cystitis and PPH
T/F estrogen, progesterone, and prolactin levels increase PP?
F- they decrease and then ESTROGEN begins to increase after the first week PP and PROLACTIN increases with breastfeeding
in non lactating women, when does menses usually start?
6-10 wks PP; ovulation can occur by the 4 menses cycle
in lactating women, whens does menses usually start?
lactation supresses menses, it depends on the length and amount of breastfeeding; ovulation is supressesed longer than non lactating women
why is diaphoresis common the first weeks PP?
because of the decreased estrogen levels, usually occurs at night and the body is trying to rid itself of fluid that accumulated during pregnancy
what should you teach the pt about diaphoresis?
its normal
assess for temp with diaphoresis
wear cotton nightwear
is mild to moderate soreness in abd normal in PP?
yes- always assess for diastasis recti (can be felt)
what are some nursing interventions that can provide comfort to the pt?
ice for 20 min to area
heat
warm showers
analegsia
why are postpartum women at an increased risk for GI complications?
decreased GI mobility
decreased physcial activity
dehydration and fluid loss
perineal pain and trauma
is there an increase or decrease in appetite after birth
increase
when should a women be close to her pre-pregnancy weight?
6 months PP, should be about 4 lbs over previous weight
what are the topics that should be discussed during discharge?
signs of complications (deviations from normal)
(smell, increase in blood loss, UTI, Mastitis)
nurtitional needs (500 cals increase for lactation & 2 L of fluid a day)
activity and exercise
rest and comfort (rest when the baby rest)
routine check ups
contraception
sexual activity (6 wks or fully healed-perineum/lochia)
explain all meds that are given!