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48 Cards in this Set
- Front
- Back
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4 stages of maternal role attainment
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anticipatory stage
formal stage informal stage personal stage |
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during pregnancy, this is the stage where the woman looks for role models, her mother for example
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anticipatory stage
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when baby is born, stage where mother acts as she believes others expect her to act
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formal stage
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3-10 months after delivery where she develops her own style of mothering
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informal stage
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3-10 months after delivery where she is comfortable with her role as mother
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personal stage
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factors that influence maternal-infant attachment
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personal characteristics
involvement w/own family relationships stability of home environment communication patterns degree of nurturing received as a child age & personality at pregnancy depression baby temperment |
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3 phases of maternal attachment behavior
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acquaintance phase
phase of mutual regulation reciprocity |
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phase of maternal attachment behavior where they explore fingertips, en-face position, respond verbally to sounds of infant
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acquaintance phase
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phase of maternal attachment behavior when adjustment between needs of mother & needs of infant
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phase of mutual regulation
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phase of maternal attachment behavior where mutually gratifying interaction occurs among mother, infant, father
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reciprocity
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NOT ON QUIZ
post-partal risk factors |
preeclampsia
diabetes cardiac disease cesarean birth overdistention of uterus abruptio placentae placenta previa precipitus labor (short) prolonged labor difficult birth extended time in stirrups retained placenta |
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how often are vital signs taken of postpartal woman
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every 4 hours for the 1st 24 hours - preferably at rest
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alterations in VS include
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temperature-slight elevation
BP - should remain stable pulse-slows, then returns to prepregnancy level |
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reason for slight temperature elevation (less that 100.4) up to 24 hrs
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due to dehydration, will drop after pt drinks/eats
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some common postpartal concerns of pt
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gush of blood that sometimes occurs when first arises
night sweats afterpains |
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changes in lochia that cause concern include
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presence of clots
persistent lochia rubra |
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traditional definition of postpartal hemorrhage
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blood loss > 500 ml following childbirth
red heads bleed more normal c-section blood loss 1,000 ml |
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when does early postpartal hemorrhage occur
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in 1st 24 hrs after birth
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when does last postpartal hemorrhage occur
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after 24 hours until 6 weeks after birth - usually caused by incomplete placenta expulsion
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reasons for early postpartum hemorrhage
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overdistension of uterus
rapid or prolonged labor induction w/pitocin use of Mag Sulfate or Brethine prolonged 3rd stage of labor (placenta delivery) preeclampsia retained placental fragments operative birth |
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reasons for early postpartum hemorrhage due to lacerations in reproductive tract
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nulliparity
epidural anesthesia precipitous childbirth forceps or vacuum macrosomia |
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what may be the cause of hemorrhage if there is large amt of bleeding and a firm fundus
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laceration of reproductive tract
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other reasons for early postpartum hemorrhage
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retained placental fragments
vulvar, vagina & pelvic hematomas uterine inversion |
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reason for late postpartum hemorrhage
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most frequently the result of subinvolution of the placental site due to retention of placental fragments
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causes of late postpartum hemorrhage
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endometrium & decidua fail to regenerate to cover the placental site
postpartum fundal height is greater than expected lochia often fails to progress from rubra to serosa to alba normally may have a history of heavy early postpartal bleeding or difficulty in delivery of placenta leukorrhea, backache & foul lochia may occur |
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treatmet for late postpartum hemorrhage
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oral admin of Methergine 0.2 mg q6h for at least 48 hr
antibiotics if infection present D&C may be indicated if retained placenta is suspected |
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signs of postpartum hemorrhage
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excessive or bright red bleeding
boggy fundus that does not respond to massage abnormal clots unusual backache or pelvic discomfort persistent bleeding in the presence of firm uterus rise in level of fundus incr pulse or decr BP hematoma formation or bulging perineal area decr LOC |
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an infection of the reproductive tract associated with childbirth and occurs up to 6 weeks postpartum
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puerperal infection
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most common puerperal infection
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endometritis (infection of uterine lining)
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risk factors for endometritis
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c-section, PPROM, prolonged labor ending in c-section, multiple vaginal exams during labor, diabetes, preexisting infection, vacuum or forceps delivery, manual removal of placenta, lapses in aseptic technique
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what does PPROM stand for
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premature prolonged rupture of membranes
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common causative organisms of puerperal infections
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Staph species
E coli Group B strep |
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s/s of puerperal infections
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bloody, foul smelling discharge that can be profuse or scant
uterine tenderness temp spikes btwn 101 & 104 degrees on 2 or more occasions tachycardia chills |
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treatment for metritis
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antibiotics given until afebrile for 24-48 hrs
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treatment for parametritis & peritonitis
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IV antibiotics usually until afebrile for 48 hrs
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treatment for perineal abcess
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antibiotics, sitz baths, & analgesics
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reasons for incr risk for UTI
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normal postpartal diuresis
incr bladder capacity decr bladder sensitivity from stretching or trauma contamination from catheterization |
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infection of the breast connective tissue that occurs primarily in lactating women
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mastitis
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s/s of mastitis
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warm reddened painful area of the breast, often wedge shaped
fever chills headache flulike muscle aches & malaise usually starts w/bacteria invading breast tissue after trauma common source - infant nose & throat |
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treatment for mastitis
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incr fluids
frequent feedings good supportive bra |
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3 types of thromboembolic disease
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superficial thrombophlebitis
deep vein thrombosis septic pelvic thrombosis |
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clot in saphenous vein
symptoms appear about day 3-4 include tenderness in vein, local heat & redness, may have low grade fever |
superficial thrombophlebitis
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symptoms may include edema of ankle or leg, low grade fever progressing to high fever w/chills, pain, Homan's sign may or may not be positive
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deep vein thrombosis
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thrombophlebitis develops in uterine, ovarian or hypogastric veins
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septic pelvic thrombosis
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tx for thromboembolytic disease
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bed rest
elevate leg moist heat analgesics elastic support hose do not massage leg heparin used for deep vein & septic pelvic thrombosis antibiotics may also be given |
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characteristics of post partum blues
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can occur in 50-80% of moms
typically occurs w/in a few days of birth & is self-limiting mothers report feeling overwhelmed, fatigued, anxious, irritable seems related to rapid alteration of estrogen, progesterone & prolactin levels after birth key feature is episodic tearfulness often w/o an identifiable reason |
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characteristics of postpartum depression
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develops in 7-30% of all PP women in N.America
major mood disorder periods of greatest risk around 4th week PP, just before initiation of menses, and upon weaning risk factors include primiparity, history of PP depression, lack of social support, lack of supporting relationship Edinburgh Postnatal Depression Scale available |
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health education for PP
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physiological changes - involution, diaphoresis, weight loss, breast changes
discomforts - pain from laceration or incision S&S of infection - fever, drainage, odor resumption of intercourse family planning |
