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169 Cards in this Set
- Front
- Back
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Reproductive System Changes
This begins when muscle fibers contract around the maternal blood vessels at the site left denuded by placental separation? (body returns to normal state) |
Involution
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Reproductive System Changes
Is palpable in the midline of the abdomen and at about the level of the umbilicus shortly after childbirth? |
The fundus
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Reproductive System Changes
Becomes smaller and the fundus descends about 1cm or one finger breadth a day? |
The uterus
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Reproductive System Changes
Approximately when is the uterus in the pelvic cavity and no longer palpable above the symphysis pubis? |
Ten days after birth.
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Reproductive System Changes
These have more severe after pains because of intermittent contractions of uterine muscles that have been stretched repeatedly? |
Multi paras
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Reproductive System Changes
This may also be strong during breast feeding when oxytocin, which causes the mild ejection reflex, brings about strong contractions of uterine muscles? |
After pains
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Decreases in amount and changes color over time. Starts as Rubra then Serosa, then is brown, then Alba, which is white or cream?
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Lochia
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Is dark red and lasts for three days after childbirth?
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Lochia Rubra
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A serosanguineous discharge that is pink or brown lasting from days 4 to 10?
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Lochia Serosa
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The final discharge is white, cream or light yellow, lasting until the third week after childbirth, may persist until week 6 for some women?
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Lochia Alba
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Normal fragrance is musty, earthy or fleshy?
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Lochia
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Foul smelling Lochia would suggest what?
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Complications or infection.
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Bright red Lochia, in the presence of a firm fundus, suggests what?
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A laceration
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Closes to fingertips by the end of the first week?
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Cervix
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Returns in 3 to 4 weeks?
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Vagina Rugae
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Women who are lactating are hypoestrogenic. What does this cause?
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Lack of lubrication.
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Perineal edema, bruising, episiotomy, hemmorhoids, result from what?
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Pushing
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Menses return in a non-lactating woman by?
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6 to 12 weeks
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This is delayed in fully breast feeding moms?
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Menses and ovulation
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On average, how much blood is lost during a vaginal birth?
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500ml
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On average, how much blood is lost during a C-section?
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1000ml
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Increases in this occur during pregnancy?
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Vascular volume
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Blood from this returns to the central circulation after the birth of the placenta?
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Utero-placental unit.
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The increase in clotting factors puts the new mom at risk for what?
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Thrombus formation
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White blood cell counts increase to as high as?
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30,000
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The average increase in neutrophils, which rise in response to inflammation, pain and stress, and account for most of the increase in WBC's is?
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14000 to 16000
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This count returns to normal values by days 4 to 7?
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Leukocyte
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These are difficult to interpret because of remobilization and excretion of excess body fluid?
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Hemoglobin and Hematocrit
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A womans bowels will be what after delivery?
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Sluggish
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After delivery, the womans abdomen will have?
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Loose tone.
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Muscles separate and abdominal organs can be seen through the skin. Will improve over time?
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Diastasis Recti
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This should remain near pregnancy levels, should be measured with the mother in the same position using the same arm each time?
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Blood Pressure
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This is caused due to a rapid reduction in intra-abdominal pressure, after childbirth, that results in dilation of visceral blood vessels?
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Orthostatic Hypotension specific to Postpartum.
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This causes a blood pressure fall of 15 to 20 mm/Hg when the woman moves from a recumbant to an upright position?
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Engorgement of abdominal blood vessels.
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Also may indicate excessive blood loss?
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Hypotension
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After childbirth mom may void greater than 3 liters per day. This is called what?
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Diuresis
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After childbirth, bladder sensation may?
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decrease
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After childbirth, mom's bladder may increase in what?
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Capacity, swelling and stasis.
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Mom may have bradycardia of 40 to 70 beats for how many days?
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6 to 10 days
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Blood pressure should be baseline or?
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Slightly decreased
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500cc blood loss is what percentage of HCT?
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2%
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Hgb and Hct levels will return to normal after what period of time?
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2 to 6 weeks
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Coagulation factors increase but return within?
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2 weeks to a month
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Estrogen and Progesterone levels drop because the placental hormones are gone. This triggers what?
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Lactation
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Suckling causes a pituitary release of?
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Prolactin (milk production)
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What causes the ejection of breast milk?
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Oxytocin
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These will be soft, filling, firm or engorged?
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Breasts
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After childbirth, mom will lose?
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10 to 12 pounds right away of birth product and 5 pounds in diuresis and diaphoresis early on.
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After childbirth, pulse and respiration should?
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Remain within normal limits.
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This may occur as a result of increased vascular volume, from an increase in cardiac return and a conequant rise in stroke volume?
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Bradycardia
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This may be the first indication of hypovolemia, it may also indicate excitement, pain, fatigue, infection, dehydration, or anemia?
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Tachycardia
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Is common in the first 24 hours after childbirth and may be caused by dehydration or the normal stress response?
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Temperature of 104F.
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How quickly is milk generally produced after childbirth?
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2 to 3 days.
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Oxytocin stimulates this?
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Milk ejection reflex or letdown.
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This will have a decreased sensitivity to fluid pressure due to loss of muscle tone?
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Bladder
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Trauma to the urethra, bladder and urinary nuates often occur during childbirth and interfere with?
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Emptying the bladder.
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The bladder fills more quickly due to what after childbirth?
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Diuresis
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After childbirth, a woman may be completely unaware that her bladder is?
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Distended
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This lifts and displaces the uterus and is often one of the major causes of excessive bleeding after childbirth?
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A distended bladder
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Fundus displaced from midline, excessive Lochia, bladder discomfort, bulge above the symphysis pubis, frequent voiding less than 150ml indicating urinary retention or overflow?
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Signs of a distended bladder
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If in the urine, in the early postpartum period, this suggest dehydration that may have occured during labor?
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Acetone
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Usually the result of catabolic processes of involution?
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Mild proteinuria
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This remains sluggish for several days as the result of progesterone?
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The bowel
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Pain from perineal trauma, episiotomy and hemorhoids interfere with effective?
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bowel elimination
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Occurs during the first hours after childbirth and is passive dependent behavior, the mother is often focused on her own care rather than the infant, she takes in attention and physical care, her primary needs are for food, fluid and sleep. She integrates the childbirthing experience into reality by talking to others?
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Taking in
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Occurs as the mother becomes more independent and assumes care for herself. She gradually shifts her attention from her needs to her infant. She is concerned about her mother skills and is interested in teachings about care for herself and the infant?
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Taking hold
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This is a time of relinquishment as the mother gives up her idealized expectations of the birth and the infant. She is then able to accept the infant who may be very differnt from the infant she dreamed of, she must also give up her lifestyle of a childless woman?
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Letting go
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Mutual gazing of parents and infant, the ability to console the infant, the infants response to parental touch and voice, close and prolonged contact between parent and infant?
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Bonding and Attachment
Positive feedback |
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Making eye contact, prolonged mutual gazing, attempting to track the parents face, grasping and holding the parents fingers, moving in rhythm to the parents pattern of speech, rooting, latching on, suckling, being comforted by the parents voice or touch?
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Reciprocal attachment behaviors from the infant. Infant participation in communication.
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Maternal touch progresses from?
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Fingertipping to infolding to face-to-face engrossment.
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Weepy and moody for the first 1 to 2 weeks?
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Baby blues
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Irritability
Tearfulness Loneliness Mood swings Low self-esteem? |
Baby blues
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Frequent crying
High anxiety Feelings of hopelessness Feeling inadequate Strange feelings about baby Panic attacks Inability to cope Obsessive thoughts? |
Postpartum Depression
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The first voiding should be more than, what amount?
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150ml
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BP baseline?
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Normal
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Pulse 50-90bpm?
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Normal
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Respirations 16-24?
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Normal
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Temperature equal to or less than 38C or 100.4F?
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Normal
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Smooth, even colored, soft filling, firm breasts with intact, erect nipples?
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Normal
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Clots greater in size than a half dollar?
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Danger sign
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High BP or sharp drop in BP?
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Danger sign
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Tachycardia, tachypenia?
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Danger sign
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Temperatures greather than 38C (100.4F) after the first 24 hours?
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Danger sign
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Breasts are red, tender, hot and swollen. Hard mass palpable, having fissures, sore and non erect.
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Danger sign
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Abdomen soft, rectus muscle intact?
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Normal
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Fundus firm, midline, decreased tenderness to palpation?
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Normal
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Lochia is earthy odor, no clots, less than 6inch per hour of Rubra on the pad, more serosa?
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Normal
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No CVA tenderness or pain over the kidneys from the back?
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Normal
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Diastasis recti-abdominal? (organs showing through the muscle of the abdomen)
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Danger sign
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Fundus is boggy, displaced, high and stays tender?
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Danger sign
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Lochia smells foul with large clots, pads are saturated in one hour, colors are turning to deep reds rather than progressively lighter?
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Danger sign
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CVA tenderness?
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Danger sign
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Perineum is intact, slight edema, bruising, episiotomy is approximate, has small hemroids?
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Normal
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Negative Homans sign?
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Normal
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Voiding 250ml every 4 to 6 hours, bowel movement in 2 to 3 days?
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Normal
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Perineum feels full, painful. Epesiotomy is gaping, tender and inflamed?
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Danger sign
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Pain in the lower extremities, positive Homons sign?
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Danger sign
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Urinary retention, urgency, frequency, disuria and constipation?
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Danger sign
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Developing rest patterns?
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Normal
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Nutrition plus 500 calories?
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Normal
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Passive, reflects, begins responsiblity?
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Normal
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Attatchment, cuddles, day one may be disappointed, next relates plus features?
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Normal
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Offers her breasts readily?
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Normal
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Excess fatigue?
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Danger sign
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Non-lactating minus 300 calories?
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Danger sign
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Blue and depressed, feeling inadequate?
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Danger sign
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Avoids infant care, continues to be disappointed, makes degrading comments?
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Danger sign
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Frustrated with breastfeeding, lack of support?
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Danger sign
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Risk for injury?
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NANDA
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Risk for infection?
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NANDA
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Risk for pain?
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NANDA
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Risk for sexuality problems?
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NANDA
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Risk for impaired parenting?
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NANDA
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Effective breastfeeding, health seeking behaviors?
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NANDA
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Given IM to prevent antibody development in Rh women with Rh+ babies?
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Rh imuneglobin or Rogan
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Given subQ to produce antibodies, woman must avoid pregnancy for three months?
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Live rubella vaccine
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Ambulate early, plenty of fluids, leg compressions?
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Avoid DVT, prevent injury and infection.
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When patient is up for the first time or showering for the first time, encourage her to what and the nurse should do what?
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She should move slowly and the nurse should stay nearby.
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Monitor the uterus for what?
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Fundus height.
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Monitor Lochia for what?
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Color, amount and odor.
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If fundus is boggy?
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Massage or give IV fluids and oxytocin. May give ergotmethylergonovine.
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This should be done by the nurse and the new mother when touching breasts, baby's bottom, or going to the bathroom?
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Hand washing.
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Front to back, irrigate and pat, change pad every four hours, no tampons?
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Perineal care
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Catheterization for urinary retention should remain?
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Asceptic
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No soap, use plain water, expressed milk, air dry, check latch, vary the positions and feed often?
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How to prevent nipple trauma.
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Don't sit or use cushion ring or pillow, ice first, then warm, cool sitz, witch hazel, cane sprays and analgesics?
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Promoting perineal comfort. Hemorhoids
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Lie prone with warm pad under tummy. Use nsaids and decrease feeding?
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To promote comfort in after pain.
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Keep a firm bra on, use ice and avoid stimulation or heat?
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Non-lactating breast care.
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Warmth, support, feed and express?
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Lactating breast care.
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Less than 2kg per month?
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Setting realistic weightloss goals.
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Iron times three months, possibly multivitamin?
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Needed supplements
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Plus 500calories?
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Breastfeeding mom.
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Minus 300 calories?
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Non-breastfeeding mom.
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Ensure food sources of?
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Protein and calcium
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No alcohol 2 to 4 hours before what?
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Breastfeeding
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Caffeine should be what?
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Moderate
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Discourage cigarette smoking but mom can still?
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Breastfeed while smoking
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Mom should sleep when?
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Baby is sleeping.
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An exercise you can do for life?
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Kegel
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When new moms exercise should be?
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Simple and gradually increased, no heavy lifting.
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When may sexual activity begin?
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When the Lochia stops and the Perineum healed and she can comfortable fit two fingers in her vagina without pain.
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Before sex, a new mom should what?
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Lubricate and feed the baby. (new mom should be allowed to control position because of pain)
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As mom reflects and integrates?
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Reassure her.
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When mom and dad perform skills for baby?
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Praise a positive effort.
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Frame your suggestions in?
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Positive language.
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Regarding changes, roles, newborn development and sibling reactions?
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Provide anticipatory guidance
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Ensure mom and partner aware of symptoms of depression?
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Report to a provider immediately.
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Fever greater than 100.4, chills, foul smelling Lochia, excessive bright red and large clots?
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Contact provider.
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Mastitis, malaise, breasts red hot and tender?
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Contact provider.
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Thrombophlebitis, calf pain, red swollen?
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Contact provider.
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Urinary urgency, frequency, burning and pain?
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Contact provider.
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Incisions, red with edema, painful, having discharge, separated?
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Contact provider.
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Depression with continous thoughts of harm?
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Contact provider.
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Mom reviews recommended self-care including rest, activity, breast and perineal pain relief, she plans for specific nutritional needs, she gathers contact numbers for the unit, provider and agency support groups such as WIC and PAT. She follows up with her doctor, home visits and regular check-ups, she is attached to her infant and cares for her safety?
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Health seeking behaviors / ready for discharge.
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What are the two main risk factors for postpartum?
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Hemorrhage and infection.
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Grand multiparity (5 or more births)
Overdistention of the uterus Precipitous labor (<3 hours) Prolonged labor Retained placenta Placenta previa or abruptio placentae Induction or augmentation of labor Administration of tocolytics to stop uterine contractions Operative procedures (vacuum extraction, forceps, cesarean birth) |
Risk Factors for Hemorrhage
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Operative procedures
Multiple cervical examinations Prolonged labor (>24 hours) Prolonged rupture of membranes Manual extraction of the placenta Diabetes Catheterization Anemia |
Risk Factors for Infection
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Palpate the fundus for uterine tone and position.
Assess the amount and color of lochia Determine vital signs |
Every 15 minutes for the first hour following childbirth
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Every 15 minutes for the first hour. Repeat assessments every 30 minutes for the next hour (more fequently if condition warrants). Continue assessments every 4 hours for 24 hours (or according to facility protocol). Assess every 8 hours after 24 hours?
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Initial Assessments for preventing hemorrhage
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If the uterine is soft or boggy?
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Massage the uterus to stimulate contraction and restore firm tone.
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Attempt to express clots only?
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When uterus is firm.
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Stop massaging when?
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When uterus becomes firm.
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If massage fails to restore uterine tone, expect to administer which IV med?
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Oxytocin, methylergonovine maleate, or prostaglandin.
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If there are signs of bladder distention and she is unable to void?
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Catheterization
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Use a plastic bag or glove filled with ice or a chemical cold pack for the first 12 hours following childbirth?
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Intervention for hemorrhoids and laceration
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What should the mother do to lessen perineal pain when sitting down?
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Squeeze her buttocks together before sitting and to lower her weight slowly.
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Cool water sitz bath reduces what?
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Pain caused by edema
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Warm water sitz bath increases what?
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Circulation to promote healing
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This constant pressure causes the uterus to remain contracted and relieves pain of intermittent contracttions.
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Lieing in a prone position with a small pillow under the abdomen.
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