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129 Cards in this Set
- Front
- Back
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The postpartum period is the first ____ weeks after childbirth and is also known as ________.
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6
puerperium |
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______ is the retrogressive changes that return the uterus to the nonpregnant size and condition
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Involution (of the uterus)
(Uterus & cervix are never quite the same size as before pregnancy, but it looks brand new from the inside- no scarring) |
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Involution involves what 3 processes?
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contraction of muscle fibers
catabolism - cell breakdown, components absorbed by blood and excreted in urine regeneration of uterine epithelium |
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When does involution begin?
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immediately after the delivery of the placenta
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Immediately after delivery, the uterus is about the size of a grapefruit. For the first 1-2 hours after delivery, where is the fundus palpable? Within a few hours, the fundus can be palpated at _______ and remains there for 24 hours.
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midway between umbilicus and symphysis pubis
level of umbilicus |
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After 24 hours, the fundus descends about ___ per day and by day ___ is no longer palpable because it is below the pubic symphysis.
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1 cm or one fingerbreadth
Day 10 |
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From the inside, the uterus will slough off cells where the placenta was attached and regenerate epithelial cells so it looks like a fresh new uterus without any scarring. There will be a scar on the uterus however when there is a _______.
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c- section (duh)
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Teaching about fundal massage is important so the woman can do this herself, why is it better for her to do it?
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It hurts less when she does it. (think about pulling off your own band aid)
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If you massage the fundus and make it firm, blood should be coming out the vagina. If there's no blood, what could be the problem?
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A blood clot. Then a lot of blood will suddenly come out once the clot is expelled. Need to check for bleeding when you massage.
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Afterpains are intermittent contractions and are a source of discomfort. It is more acute for multiparas or nulliparas? Why?
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more acute, more pain for multiparas because repeated stretching of muscle fibers and loss of muscle tone.
(In a first pregnancy, afterpains may be very painful because of multifetal or big baby.) |
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What hormones or drugs cause uterine cramping/ after pains?
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Pitocin given postpartum
Natural oxytocin released especially during breastfeeding. |
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Afterpains can interfere with breastfeeding because mom is discouraged from feeding because it makes her cramp. What helps?
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Give her a pain releiver, an NSAID like ibuprofen is best for cramping. (effects prostoglandin)
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For short term pain relief, when should analgesics be given to a breastfeeding mother?
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30 minutes before breastfeeding
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Why don't we want a boggy uterus?
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may be start of hemorrhage, we want uterus to contract (be firm) to prevent excess bleeding and to encourage the process of involution
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Lochia should get lighter and lighter (in color and amount) as days go by. What are the stages of lochia?
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lochia rubra- red color, 1st 3 days
lochia serosa- pink or pinkish brown, about 4th day lochia alba- white, cream or yellow color, continues until 3rd week, may persist for 6 weeks |
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By the 5th or 6th postpartum day, the new mom can start using minipads but should not use _____.
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tampons
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Who has less lochia a c-section or vaginal delivery?
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c- section
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What are the descriptions of each amount when measuring lochia? (i.e. scant, large etc.) What should the odor be like?
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scant- less than 1 inch
light- 1-4 inches moderate 4-6 inches large- saturated in one hour exessive- saturated in 15 min Odor- should be fleshy, earthy musty (a foul odor suggests infection) |
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a surgical incision to the perineal area is a/an ________.
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episiotomy
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1st degree laceration
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superficial vaginal mucosa or perineal skin
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2nd degree laceration
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involves muscles of perineum
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3rd degree laceration
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involves anal sphincter
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4th degree laceration
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extends through anal sphincter into rectal mucosa
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Complaints of excess pain and pressure could be a ______.
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hematoma
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After delivery, how does the new mom's heartrate change?
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Will decrease because of excess blood volume circulating now that the placenta is gone.
HR may go down to 50-60 BPM. Excitement/anxiety/pain could make HR increase. |
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How does her body get rid of excess plasma volume?
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diuresis and diaphoresis
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Urine output after delivery is commonly as much as
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2000- 3000 mL per day
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The new mom will likely be constipated due to the GI tract being put on hold during labor causing less peristalsis. _____ supplements can also cause constipation. When should she expect to have her first BM?
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iron
usually first 2-3 days postpartum |
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Early postpartum, she might not want to try to have a BM because of the pain due to constipation and pain in the perineum, what med can we give her to help?
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colace (docusate sodium)
pericolace (senna & colase) laxative |
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A full bladder can displace the uterus and result in inability of uterus to contract, known as ____ _____.
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uterine atony
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The urinary system changes in the postpartum period in that there is decreased sensitivity to fluid pressure and the bladder fills rapidly due to diuresis. What are some complications this can cause? What nursing implications are indicated?
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UTI (urine stasis)
excessive bleeding (due to displaced uterus- can't contract) Check fundus for firmness and location. Remind her to urinate q 2 h Check for bladder distention |
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She should void at least ___
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300 ml q 4 h
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In the first 2-5 days postpartum she will lose about __ pounds of fluid.
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5
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If the fundus is located above baseline level the bladder may be a distended. What are some other signs of a distended bladder. (5)
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fundus displaced from midline
excessive lochia bladder discomfort bulge of bladder above symphysis frequent voidings of less than 150 ml of urine (bladder may be full and she isn't emptying completely, swollen urethra can cause her to think she's done going, as well as decreased sensitivity) |
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In the first few postpartum days, the hormone Relaxin subsides which causes the ligaments and cartilage of the ____ to return to prepregnancy condition. This can also cause ____ in the hips and joints.
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pelvis
pain |
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Petechiae on the face may be caused by what action during labor?
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clenching of the jaw
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Hip and joint pain can also be caused by prolonged pushing position and ___ ______ of these areas.
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over extension
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True or False: Skin changes including cholasma and the pregnancy rash (purple splotches) during pregnancy usually subside quickly postpartum due to an increase in hormone activity.
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False.
A decrease in hormone activity |
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What hormone gives pregnant women close to term the "waddle?"
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Relaxin
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Do women notice more hair growth or hair loss in the 4-20 weeks following pregnancy?
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Some women exhibit hair loss, however prenatals may continue to cause hair growth.
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Non nursing mothers resume menstration _____ weeks after delivery.
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7-9
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If breastfeeding, menstration may not return for how long?
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12 weeks to 18 months
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Some women may not get a menstrual period until they discontinue breastfeeding or don't breastfeed as often. It is important in patient teaching to inform the patient that she still may be _______ so it's important to use a birth control method if not intending to get pregnant.
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ovulating
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The hormone _______ initiates milk production ____ days after delivery. What is important for initiating this hormone?
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prolactin
2-3 Baby needs to suck. |
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The hormone _______ causes milk to be expressed from alveoli to lactiferous ducts. It does not produce milk but allows milk to be released.
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Oxytocin
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If the woman is not producing milk by the 3rd day, what could be the reason?
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Retained placenta or placental fragments. The placenta has to separate for milk production to occur.
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About how much weight is lost during childbirth?
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5.5 kg (about 12 lbs)
Book says 10-13 lbs |
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How much weight is lost by diuresis and involution?
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2.3 - 3.6 kg (5 - 8 lbs.)
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Adipose tissue gained during pregnancy is slow to lose. About how long after birth can the new mom expect to attain prepregnancy weight?
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6 months
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In assessing vital signs postpartum, it is important to assess for ______ ______ when checking blood pressure.
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orthostatic hypotension
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After a c-section, the focused assessment (BUBBLE- LE) 5 additional assessments to be included are:
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Pain relief / PCA
Respirations due to anesthesia Abdomen- bowel sounds Surgical dressing I & O - IV / Foley |
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To prevent DVT's, we get encourage mom to _____ as soon as possible.
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ambulate / get moving
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Dermaplast is good for .. and tux is good for ....
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numbing episiotomy/ laceration
hemmeroids and perineum pain relief |
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When using ice for pain relief, leave on for about ____ minutes and then remove at least 10 minutes before reapplying.
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20
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What is the most common postpartum complication?
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hemorrhage
(exceeding 500 ml vaginal delivery or 1000ml in c-section) |
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What is the difference between early postpartum hemorrhage and late postpartum hemorrhage?
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Early - 1st 24 h post delivery
Late - after 1st 24 h |
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What are the four causes of hemorrhage?
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4 T's:
Tone- uterine atony Tissue- retained placenta Traua- uterine, cervical, or vaginal lacerations Thrombin- coagulation disorders |
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Wha are the 10 risk factors for postpartum hemorrhage?
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multiparity
overdistention of uterus precipitous labor prologned labor (> 24 h) retained placenta placenta previa abruptio placentae induction/augmentation use of tocolytics operative procedures (vacuum extraction, forceps, c-section) |
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Why is induction or augmentation of labor a risk factor for hemorrhage? How about use of tocolytics?
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Uterus is overstimulated during labor and may not contract after birth.
Tocolytic drugs may still take effect after birth. |
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Uterine atony is more likely to occur with big babies, multifetal pregnancies, and ____.
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multipara
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Early signs of postpartum hemorrhage include uterine ______, severe unrelieved ____ or rectal pain, large gush or slow _____ of blood from the vagina, the saturation of more than one peripad per _____, and one early change in vital signs: ______.
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Early signs of postpartum hemorrhage include uterine ATONY, severe unrelieved PERINEAL or rectal pain, large gush or slow TRICKLE of blood from the vagina, the saturation of more than one peripad per HOUR, and one early change in vital signs: TACHYCARDIA
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How much pitocin at what route is usually given in labor and delivery and postpartum?
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IV 10 units in 1 L infused at 20-40 milliunits/min (mU/min) during labor
IM 10 units after delivery of placenta |
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Hemabate/carboprast is an oxytocic given in what route? What is the quantity and frequency.
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IM or into uterine muscle
150 mcg may repeat 15-90 minute intervals. |
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What is a contraindication to giving Hemabate?
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history of asthma
(may cause bronchospasm) |
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Oxytocic medications include: ______, ________, _______, and __________.
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Pitocin
Hemabate Methergine Cytotec |
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Blood pressure needs to be checked before administering _____.
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Methergine (methylergonovine)
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Methergine is given IM ___ mcg every 2-4 h up to ___ doses.
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200 mcg
5 doses |
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Cytotec or _______ is given in what route? How much?
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Misoprostol
PR (per rectum) 1000 mcg |
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What are the 3 most common thromboembolic disorders during pregnancy and postpartum?
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superficial venous thrombosis
DVTs PE |
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DVTs can lead to ____ if interventions are not done early.
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PE
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If any thrombembolic disorders occur, initiate interventions and be sure to ....
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notify MD
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What is the treatment for superficial venous thrombosis?
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analgesics, rest, SCDs
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What is the prevention and treatment for DVTs?
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Prevention: Early ambulation, ROM and gentle leg exercises within 1st 8 hours after childbirth.
Anti embolism stockings & SCDs Use padded stirrups during labor Avoid using pillows under knees or knee gatch after childbirth(sharp flexion at knees and pressure on popliteal space cause pooling in lower extremities). Treatment: Anticoagulant therapy for at least 20 weeks UH --- Standard (unfractionated) Heparin LMWH- Low Molecular Weight Heparin (enoxaparin/Lovenox) Bedrest with affected leg elevated ambulate once symptoms have disappeared analgesics to control pain antibiotic therapy when necessary moist heat provides pain relief and increases circulation Warfarin/Coumadin is contraindicated during pregnancy (teratogenic effects) but is safe to use during lactation and is usually used in addition to heparin and then continued up to 6 months after discontinuing heparin. Monitor PTT, INR, and aPTT throughout anticoagulant therapy. |
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What is the treatment for PE?
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Treatment is aimed at dissolving the clot and maintaining pulmonary circulation.
Oxygen to decrease hypoxia Analgesics to reduce pain & apprehension Bedrest with HOB elevated Monitor Pulse Ox & ABGs Heparin therapy during pregnancy then warfarin after delivery |
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Factors that increase the risk of thrombosis include which of the following: Select all that apply!
early ambulation inactivity vaginal birth cesarean birth smoking administration of pitocin hx of previous thrombosis fluid overload varicose veins renal disorders Diabetes Incipidus Diabetes Mellitus prolonged time in stirrups maternal age < 18 maternal age >35 primigravida multiparity over 3 |
inactivity
cesarean birth smokin hx of previous thrombosis varicose veins Diabetes Mellitus prolonged time in stirrups maternal age >35 multiparity over 3 |
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A postpartum infection is defined as a fever of ___ C or ____ F or higher occuring on at least ___ of the first ____ days after the first ____ hours after birth.
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A postpartum infection is defined as a fever of 38 C or 100.4 F or higher occuring on at least 2 of the first 10 days after the first 24 hours after birth.
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Risk factors for postpartum infection include prolonged ____ and prolonged _____.
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labor (> 24 h)
ROM |
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Risk factors for postpartum infection include multiple _____ examinations and operative procedures such as ______, _____, and _____.
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cervical
c-section, forceps, vacuum extraction |
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The risk of postpartum infection is also more likely when the patient is a ______. Also increased risk with manual _____ of the placenta, the use of _____ catheters, and with the presence of anemia- hemoglobin less than _____ mg/ dl
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diabetic
extraction indwelling/ foley 10 |
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Why is anemia a risk factor for postpartum infection?
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When the woman is anemic, there is a likelihood that she is also deficient in other counts such as WBC.
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True or False: You need a doctor's order to do a culture.
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False.
(Dr.'s sometimes don't really like proof that their patient has an infection, but too bad!) |
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S/S of a postpartum infection include fever, chills, and pain or ______ of wounds. Puralent wound ______ or wound edges not _______, and an abnormal _____ or ____ of lochia. The WBC count will be ____, there may be suprapubic ____, body aches, and general ____. Localized area of warmth, redness, or tenderness in the ______ is another sign of infection. Also signs of UTI which include...
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S/S of a postpartum infection include fever, chills, and pain or REDNESS of wounds. Purelent wound DRAINAGE wound edges not APPROXIMATED, and an abnormal DURATION or ODOR of lochia. The WBC count will be HIGH, there may be suprapubic PAIN, body aches, and general MALAISE. Localized area of warmth, redness, or tenderness in the BREASTS is another sign of infection. Also signs of UTI which include frequency, urgency, dysuria, hematuria
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In monitoring WBC count postpartum, the first ___ days the count should be high, but after this an elevated number may indicate infection.
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2
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What are infections of the uterus?
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metritis with pelvic cellulitis
(inflammation of uterine tissue) |
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What is the name of the infection of the lactating breast? Can it be treated at home?
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mastitis
No, this infection needs medical interventions (antibiotics) to keep it from progressing. Don't try to tough it out! |
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What are some s/s of mastitis? How does it occur? How can it be prevented?
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flu like symptoms, breast pain
Usually due to bacteria entering breast through nipple. To prevent mastitis, wash hands prior to every feeding and a daily shower is sufficient for cleaning the breasts. |
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Can a woman with mastitis continue to breastfeed? When can mastitis develop?
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Yes. The infection is in the tissue, not the ducts. It can begin anytime after breastfeeding, between the first 10 days or 2-6 months of breastfeeding...... (yeah that's what she said so basically anytime)
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Septic Pelvic Thrombophlebitis is a severe condition where an infection of the uterus leads to the ____ system. The patient will be very ill and usually ends up in the ICU. What are some s/s?
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venous/circulatory
fever and constant abdominal pain within 1 week of delivery fever often persists without response to antibiotic treatment |
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What are the 2 types of septic pelvic thromboplebitis. What are they? What is the treatment for this condition?
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ovarian vein thrombophlebitis (OVT) and deep septic pelvic thrombophlebitis (DSPT).
anticoagulation therapy and broad spectrum antibiotic therapy |
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Nursing mothers need ____ calories above normal needs and between ___ to ____ eight oz. glasses of fluids each day. A supplement with a daily multivitamin may be needed.
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500
8 to 10 Prenatal vitamins can be continued. |
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If not nursing, the new mom should return to prepregnancy caloric intake but should be sure to include ____ and ____ in her diet to promote healing.
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protein
vitamin C |
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The new teen mom is more likely to have deficiency in _____ and should continue taking prenatals.
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iron
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Postpartum teaching should include components of self care such as
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handwashing
breast care perineal care incision care kegal exercises rest nutrition exercise |
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Postpartum teaching should include information about the s/s of ______ and ______.
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infection & hemorrhage
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Postpartum teaching also should include infant care, sexual activity, contraception, and health promotion. When should she have follow up visits?
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2 and 6 weeks postpartum
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True or False: when addressing the subject of resuming sexual activity and contraception, the nurse should wait until the patient asks about such delicate questions so we don't offend her.
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False. The nurse needs to bring up sensitive topics because many are hesitant to ask.
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The new mom should wait about ___ to ____ weeks before beginning abdominal exercise or until she gets the ok from the doctor.
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4 to 6
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The rubella vaccine is offered after childbirth if not immune. Is it safe for breastfeeding moms? How long must she wait to get pregnant again?
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Yes it's safe to breastfeed but cannot be administered during pregnancy or within one month of getting pregnant.
1 month or 28 days |
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Bonding is unidirectional while attachment is _______.
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bidirectional
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The stages of maternal role attainment include
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Anticipatory Stage- begins in pregnancy: buy books, choose Dr, etc.
Formal Stage- Baby is born somewhat guided by others (Dr, mom, books etc. ) learning about baby cues Informal Stage- comfortable & confident with role Personal Change- baby is part of their life now. "What did we do before we had kids?" |
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What are 9 factors to look for that may negatively affect maternal and family adaptation
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lingering discomfort or pain
chronic fatigue knowledge deficit of infant needs lack of support system expectations of the newborn not reality late knowledge about pregnancy (didn't know about pregnancy, little time to plan) inexperience with infants preterm or ill infant infant characteristics such as a very fussy baby, inability to console |
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True or False: There is no known direct cause for the postpartum blues.
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True
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Postpartum Blues is a form of mild depression after childbirth that is self-___, begins in the first week of the postpartum period, and does not last longer than ___ weeks.
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limiting
2 |
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In contrast to the Postpartum Blues, Postpartum Depression can develop anytime during the first ___ months postpartum. The cause is unknown but may be related to hormonal changes. The symptoms are present for at least ___ weeks.
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12
2 |
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True or False: If a woman has postpartum depression with her first pregnancy, she is unlikely to experience it again with a second pregnancy.
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False. She is more likely to experience this type of depression again.
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Is a person with postpartum depression in touch with reality? Is she a threat to the baby?
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Yes she is in touch with reality.
Not usually if the case is mild. The mother can meet the basic needs of the child such as food, cleanliness but fails to meet the social needs of the child (bonding, playing, etc.) |
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What are some s/s of postpartum depression?
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flat affect
lack of joy or motivation unable to feel pleasure or love feelings of unworthiness, guilt, shame little interest in food complaints of ill health difficulty concentrating just "not into it" (parenting) panic attacks may have suicidal thoughts |
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What are some treatment options for women with postpartum depression?
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psychotherapy
social support SSRI (prozac, celexa) TCA (tricyclines) hormones |
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Postpartum psychosis is different than postpartum depression in that the woman is out of touch with _____.
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reality
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Postpartum psychosis is rare and develops within ___ weeks.
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3
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True or False: There is no known direct cause for the postpartum blues.
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True
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Postpartum Blues is a form of mild depression after childbirth that is self-___, begins in the first week of the postpartum period, and does not last longer than ___ weeks.
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limiting
2 |
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In contrast to the Postpartum Blues, Postpartum Depression can develop anytime during the ___ months postpartum. The cause is unknown but may be related to hormonal changes. The symptoms are present for at least ___ weeks.
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12
2 |
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True or False: If a woman has postpartum depression with her first pregnancy, she is unlikely to experience it again with a second pregnancy.
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False. She is more likely to experience this type of depression again.
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Is a person with postpartum depression in touch with reality? Is she a threat to the baby?
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Yes she is in touch with reality.
Not usually if the case is mild or well controlled. The mother can meet the basic needs of the child such as food, cleanliness but fails to meet the social needs of the child (bonding, playing, etc.) |
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True or False: There is no known direct cause for the postpartum blues.
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True
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Postpartum Blues is a form of mild depression after childbirth that is self-___, begins in the first week of the postpartum period, and does not last longer than ___ weeks.
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limiting
2 |
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In contrast to the Postpartum Blues, Postpartum Depression can develop anytime during the ___ months postpartum. The cause is unknown but may be related to hormonal changes. The symptoms are present for at least ___ weeks.
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12
2 |
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True or False: If a woman has postpartum depression with her first pregnancy, she is unlikely to experience it again with a second pregnancy.
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False. She is more likely to experience this type of depression again.
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Is a person with postpartum depression in touch with reality? Is she a threat to the baby?
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Yes she is in touch with reality.
Not usually if the case is mild or well controlled. The mother can meet the basic needs of the child such as food, cleanliness but fails to meet the social needs of the child (bonding, playing, etc.) |
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A person with postpartum ______ may be tearful and have feelings of guilt or worthlessness. She may have sleep and appetite disturbances and may even hear voices. She might hallucinate and have delusions that her infant is ____ or ____.
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psychosis
dead or defective |
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Postpartum psychosis is different than postpartum depression in that the woman is out of touch with _____.
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reality
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A person may develop psychosis within ____ weeks and the condition is rare.
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3
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People with what psychological disorders are more likely to experience postpartum psychosis?
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Bipolar with manic and depressive episodes
Major depression (with or without manic episodes) Schizophrenia |
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There is a risk of suicide or hurting children when a mother has postpartum psychosis and immediate interventions are necessary. What treatments are needed?
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Need medication & referral to a specialist
Must stay on medication in order to be safe from hurting self/others |
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Autolysis of the excess tissue of the uterus is called?
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Involution
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When does involution begin? When is it completed?
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With expulsion of placenta and takes about 6 weeks to complete
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When would you expect to see lochia serosa in the postpartum patient?
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after 4 days
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What are the four causes of hemorrhage?
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4 T's
Tone- uterine atony Tissue- retained placenta Trauma-uterine/cervical/vaginal lacerations Thrombin- coagulation disorders |
