Rnur138 Postpartal Period

Front 1

6 week period after childbirth

Back 1

postpartum,

Front 2

________ occurs when there is normal uterine contractions and atrophy of the uterine muscle

Back 2

involution (occurs after the birth of the placenta)

Front 3

moderate to severe cramp like pains that occur more in lactating women and women of multiparous women, it is from the release of oxytocin

Back 3

afterpains (tell the pt that they last around 36 hours)

Front 4

assess the uterus for location, postition and tone of fundus:
every _____ min for the first hour
every _____ min for the 2nd hour
every _____ hours for the next 22 hours
and _______ a shift after 24 hours

Back 4

every 15 min
every 30 min
every 4 hours
once a shift

Front 5

where should the uterine fundus be located immediately after birth of the placenta?

Back 5

at the umbillicus; firm and midline

Front 6

where should the uterine fundus be 1-2 hours after the birth of the placenta?

Back 6

midway between the umbilicus and symphysis pubis; firm and midline

Front 7

where should the uterine fundus be 12 hours after the birth of the placenta?

Back 7

1 cm above the umbilicus; firm and midline

Front 8

where should the uterine fundus be 24 hours after the birth of the placenta?

Back 8

1 cm below the umbilicus; firm and midline

Front 9

what is the normal rate of involution after 24 hours?

Back 9

1 cm a day ( 1 cm= 1 finger breadth)

Front 10

when should the uterine fundus no longer be felt if involution is met?

Back 10

10 days, the fudus should be non palpable in the pelvis

Front 11

the mucus membrane that lines the uterus

Back 11

endometrium

Front 12

a bloody discharge from the uterus that contains sloughed off necrotic tissue, shows changes that reflect the normal healing process of the placental site

Back 12

lochia

Front 13

how often should you inspect the lochia?

Back 13

everytime you inspect the uterus

Front 14

describe the stage and characteristic of lochia rubra

Back 14

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

Front 15

describe the stage and characteristics of lochia serosa

Back 15

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

Front 16

describe the stage and characteristics of lochia alba

Back 16

day 10 PP, should be yellow to white in color in scant amount with a fleshy odor

Front 17

if the lochia has been in the serosa stage then goes back to the rubra stage what should you suspect?

Back 17

subinvolution

Front 18

what can large clots interfere with?

Back 18

uterine contractions

Front 19

should you teach your patient about how to massage the fundus?

Back 19

yes- she should understand the importance and risks of a boggy fundus and when to call the dr.

Front 20

what are the nursing actions when assessing the perineum and vagina? (done every shift)

Back 20

explain the procedure
provide privacy
assist women to her side
seperate the buttocks to expose and assess

Front 21

what are the expected finding of a NORMAL vaginal and perineum assessment?

Back 21

mild edema
minor ecchymosis
aproximation of the episiotomy or laceration
mild to moderate pain

Front 22

what are some comfort measures that you can do for the patient when there is pain in the vaginal/perineum area?

Back 22

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

Front 23

how can you teach your patient to reduce risk for infection

Back 23

use peribottle after elimination
change peripad frequently ( everytime there is elimination)
WASH HANDS

Front 24

when does primary engorgement happen and when should it subside?

Back 24

day 3 PP (when milk is in) and should subside in 24-48 hours unless breastfeeding and then you can have subsequent breast engorgement

Front 25

this is the fluid that has immunoglobulin G and A , high in protien and low in carbs.

Back 25

Colostrum; precedes milk production

Front 26

what is the expected nurse findings in the first 24 hours of the breast

Back 26

soft and nontender

Front 27

what is the expected nurse findings PP day 2 of the breast

Back 27

slightly firm and nontender

Front 28

what is the expected nurse findings PP day 3 of the breast

Back 28

firm, tender and warm to the touch

Front 29

what can you educate the patient who is not breast feeding to do to relieve breast engorgement?

Back 29

apply ice
dont express milk (will encourge milk production)
avoid heat and stimulation
take analgesic for pain

Front 30

what is the expected amount of blood loss in the average vaginal birthing experience?

Back 30

400-500 mL: has minimal effect because the women is in a state of pregnancy induced hypervolemia

Front 31

t/f there is an increase in cardiac output the first few hours postpartum

Back 31

true- related to the blood that was shunted through the uteroplacental unit returning to the maternal system.

Front 32

when does cardiac output return to normal pre-pregnant levels?

Back 32

within 48 hours

Front 33

why is the patient at risk for orthostactic hypotension?

Back 33

decreased vascular resistance in the pelvis

Front 34

when should you check vitals in PP period?

Back 34

same as the fundus check and lochia check

Front 35

why is it normal for the women to have an elevation in temp during the first 24 hours post birth?

Back 35

muscular exertion, exhaustion, dehydration, or hormonal changes

Front 36

when should you further evaluate a temp?

Back 36

greater than 100.4 after the first 24 hours PP, on two different occasions may be indicative of a pp infection

Front 37

if the temp is less than 100.4 in the first 24 hours what should be the nursing interventions?

Back 37

hydrate the women
promote rest and relaxation
reassess 1 hours after intervention

Front 38

is bladder distention, imcomplete emptying of the bladder and inability to void normal during the first few days PP?

Back 38

yes- related to decreased sensation to void and edema around the urethra

Front 39

why is diureses common the first 12 hours PP?

Back 39

caused by decreased estrogen and oxytocin levels and it aids in the elimination of excess tissue fluids. (can become problematic if unable to void)

Front 40

how ofter should you be measuring the amounts being voided?

Back 40

everytime during the first 24 hours

Front 41

how much should the voids amount to each time?

Back 41

150 mL each void (if less palpate for distention)

Front 42

when should the pt be cathed if unable to void?

Back 42

12 hours

Front 43

why would you use peppermint oil?

Back 43

the vapors of the peppermint oil has a relaxing effect on the urinary spincter

Front 44

what does early voiding reduce the risk of?

Back 44

cystitis

Front 45

T/F estrogen, progesterone, and prolactin levels increase PP?

Back 45

F- they all decrease then...
ESTROGEN begins to increase after the first week PP.
PROLACTIN increases with breastfeeding

Front 46

in non lactating women, when does menses usually start?

Back 46

6-10 wks PP; first menses is usually anovulatory but ovulation should occur by the 4 menses cycle

Front 47

in lactating women, whens does menses usually start?

Back 47

lactation supresses menses, it depends on the length and amount of breastfeeding; ovulation is supressesed longer than non lactating women

Front 48

why is diaphoresis common the first weeks PP?

Back 48

because of the decreased estrogen levels, usually occurs at night and the body is trying to rid itself of fluid that accumulated during pregnancy

Front 49

what should you teach the pt about diaphoresis?

Back 49

its normal
assess for temp with diaphoresis
wear cotton nightwear

Front 50

is mild to moderate soreness in abd normal in PP?

Back 50

yes- always assess for diastasis recti (can be felt)

Front 51

what are some nursing interventions that can provide comfort to the pt experiencing mild to moderate abdominal pain?

Back 51

ice for 20 min to area
heat
warm showers
analegsia

Front 52

why are postpartum women at an increased risk for Constipation?

Back 52

decreased GI mobility
decreased physcial activity
dehydration and fluid loss
perineal pain and trauma

Front 53

is there an increase or decrease in appetite after birth

Back 53

increase

Front 54

when should a women be close to her pre-pregnancy weight?

Back 54

6 months PP, should be about 4 lbs over previous weight

Front 55

what are the topics that should be discussed during discharge?

Back 55

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!

Front 56

What is the purpose of the decidua? Where does the Decidua lie?

Back 56

The decidua prevents scarring after the release of the placenta. It lies between the uterus and the fertilized ovum.

Front 57

How long does it take for the uterus to involute to its near pre-pregnant state?

Back 57

5 to 6 weeks postpartum the uterus should have involuted too it's near pre-pregnant state.

Front 58

What four things can help involution?

Back 58

An uncomplicated labor and birth
Complete expulsion of the placenta or membranes
Breast-feeding
Early ambulation

Front 59

What drug would you give to your postpartum patient who is complaining of menstrual like cramps?

Back 59

NSAIDs or ibuprofen

Front 60

What effect do NSAIDs have on the lining of uterus?

Back 60

They inhibit prostaglandin production which is what causes the cramping pain

Front 61

What secretes prolactin and what is prolactin responsible for?

Back 61

Prolactin is secreted by the anterior pituitary gland. It is responsible for the maturation of the human breast, proliferation of the duct system, and the actual secretory units of the milk secreting units of the breasts

Front 62

Where is oxytocin secreted from and what is it responsible for?

Back 62

Oxytocin is secreted by the posterior pituitary. It is responsible for the letdown reflex.

Front 63

What is the most common cause of early postpartum hemorrhage?

Back 63

Uterine atony

Front 64

What are the drugs used to promote uterine contractions in the postpartum period?

Back 64

1-Oxytocin
2-Methergine
3-Hemabate

Front 65

What is the route and dosage of Methergine?

Back 65

0.2 mg IM

Front 66

In which patient would Methergine be used with caution and why?

Back 66

Any patient with a history of hypertension. Methergine causes significant vasoconstriction which increases blood pressure.

Front 67

What is Hemabate?
What does Hemabate do?
How is it given?

Back 67

It is a prostaglandin.
It contracts smooth muscle such as the uterus.
Suppository.

Front 68

In which patient would you use Hemabate with caution?

Back 68

Because the respiratory system is composed of smooth muscle and Hemabate is a prostaglandin which contracts smooth muscle you would look at the patient's history of reactive airway disease because prostaglandins have the potential of causing status asthmaticus.

Front 69

True or false - if a patient experiences status asthmaticus r/t reactive airway disease you would apply oxygen via nasal cannula

Back 69

False.

Front 70

What effect does the Hypoestrogen State have on the vaginal vault?

Back 70

The vaginal vault loses rugaetion and becomes very smooth. There is decreased vaginal vascularity, vaginal dryness, and decreased sensation.

Front 71

When can a postpartum woman anticipate her first bowel movement? When can she expect normal bowel habits to return?

Back 71

The first bowel movement should occur 2 to 3 days after childbirth. Normal habits should return around two weeks.

Front 72

How can we help healthy bowel habits to return the postpartum period?

Back 72

Stool softeners twice a day. Drinking 6 to 8 glasses of water daily. The patient should be up and moving around. The patient should be eating lettuce and whole-grain breads.

Front 73

What measures can we take to help reduce flatus in postop patients?

Back 73

Have them use cups without straws. Drink water that is at room temperature. Early ambulation.

Front 74

What criteria would you not use to assess for a UTI in a postpartum patient?

Back 74

Urgency and frequency. These patients are naturally diuresing the excess blood volume from pregnancy so urgency and frequency should be expected.

Front 75

What are the hallmarks of a UTI in the postpartum patient?

Back 75

A dribbling stream or pain and burning from within the bladder.

Front 76

What should hemoglobin values be during pregnancy and when should they return to normal values in the postpartum period?

Back 76

> 11 g/dL. It will take eight weeks to normalize.

Front 77

What should hematocrit values be during pregnancy and when should they return to normal values in the postpartum period?

Back 77

> 32%. It will take eight weeks to normalize.

Front 78

What are normal pregnancy values for white blood cell counts? What exception is made to this? When should these values return to normal?

Back 78

5 to 15,000 mm³. Most doctors in the Kansas City area will except 25 to 30,000 mm³ as long as there are no signs of infection. It should take seven days to normalize.

Front 79

What are normal pregnancy values for platelets. When do they decrease or increase? When should the platelets normalize?

Back 79

150 to 350,000 mm³. They decreased afterbirth but then increase by day 2 to 3. Platelets should return to normal at approximately week 2.

Front 80

What would cause blood pressure to decrease or increase in the postpartum period?

Back 80

Blood pressure may decrease related to physiological adjustments for hemorrhage. Blood pressure may increase related to excessive use of medications or the development of preeclampsia.

Front 81

Should you eat or not eat when taking NSAIDs?

Back 81

Eat. NSAIDs cause a high degree of stomach upset.

Front 82

What is the taking in phase?

Back 82

A period of dependent behaviors that occurs during the first 24 to 48 hours after birth. The woman concentrates on healing, personal comfort, physical and psychological changes. She relives and speaks about the birth experience.

Front 83

What is the taking hold phase?

Back 83

This is the move between dependent and independent behaviors. it can last up to weeks. The woman begins the role of mother, she is eager to learn, and she is focused on the newborns cues and needs.

Front 84

In what phase are postpartum women in while in the hospital? Is this a good time for teaching?

Back 84

Women are in the taking in phase. This is not a good time for teaching but it's the only time we have. Therefore repeating information many many times maybe necessary.

Front 85

What changes does the cervix go through during the postpartum period?

Back 85

It is soft immediately after birth. In 2 to 3 days it shortens,becomes firm, and regains its form. Many of these changes are related to edema and bruising and it will take about six weeks to correct itself.