1. Explain puerium
    • Postpartum
    • 6 weeks post-delivery
    • 4th stage of labor
    • 4th Trimester
  2. 3 periods of postpartum and their time periods
    • 1. Immediate: 1st 24hrs
    • 2. Early: 1st week
    • 3. Late: 2nd - 6th week
  3. Define Postpartum
    • Body Recovers
    • Goes back to prepregnancy state
  4. Shrinking or returning to normal size of uterus, cervix and vagina
  5. While giving a uterine massage what should you support?
    Lower uterine segment
  6. While giving a uterine fundus massage what position should the bed be in
  7. When you are massaging the fundus what could be a possible complication if you don't have the pt .....
    Empty Bladder
  8. What things will delay uterine involution?
    • Full Bladder
    • Any condition that over distends the uterus(multifetal pregnancies, hydramnios)
    • Epidural
    • Maternal Exhaustion
  9. How are you VS going to differ from the normal person, immediately postpartum?
    • Temp slightly elevated within the first 24hrs
    • Slow pulse, 50 bpm, for the first week
    • BP should be normal
  10. Most rapid changes pp occurs in what time frame?
    1st 3-4 days
  11. When dorsiflexing the foot the woman experiences pain
    Positive Homan's Sign
  12. Fundal Height Times
    Immediately After Delivery:
    1. Firm in the midline and 1/2 way between the umbilicus and symphysis pubis
  13. Fundal Height
    One hour PP
    uterus should be contracted firmly with the fundus at the level of the umbilicus
  14. Fundal Height
    1 day after PP
    1 fingerbreath (1 cm) below umbilicus
  15. Fundal Height
    Anything after the first day
    1 fingerbreath per day untill no longer papable
  16. When should the fundus be no longer palpable
    By the 10th day
  17. What promotes involution
    • Breastfeeding
    • Early ambulation
    • Proper Nourishment
  18. What factors inhibit involution
    • over distention of uterus
    • retainted placental fragments
    • infection
    • grand multiparity
  19. When the uterus doens't contract effectivly what could this lead to
    • Hemorrhage
    • Boggy Uterus
  20. 5 or more pregnancies
    Grand Multiparity
  21. How is involution assessed?
    Measuring fundal height
  22. 3 phases that occur in maternal adaptation
    • Takin IN
    • Takin Hold
    • Letting Go
  23. 3 ways bleeding is controlled phsiologically immediately after delivery
    • 1.Involution and contraction causes to open blood vessels and seal them off
    • 2. Clotting cascade is initiated
    • 3. Fibrinogen levels are raised
  24. What are signs that the mother is not bonding with baby
    • Turning away
    • Negative statements about baby
    • Refusing to name baby
    • Not caring for baby
    • Not wanting baby in room
    • Gradual withdrawls
  25. Group of related symptoms
  26. Spongy soft uterus not well contracted
    Boggy Uterus
  27. When the uterus is not contracting effectively; blood and clots collect in uterus which could lead to what
    • Boggy Uterus
    • Hemorrhage
  28. Afterpains are most severe in ? because ?
    Multipara because the uterus goes through periods of contraction and relaxation
  29. When massaging the fudus what are we assesing?
    • Location
    • Height
    • Position
  30. If you over massage the fundus what could happen
    Uterus becomes flaccid rather than helping it to contract
  31. The blood, mucus, tissue and WBC's make up this
  32. Describe Lochia Rubra
    • 1st 3-4 days
    • Red in color
    • Fleshy smell
    • Small to Moderate Amount
  33. Decribe Lochia Serosa
    • Days 4-10
    • Small Amount
    • Brownish-Pinkish Color
  34. Decribe Lochia alba
    • After day 10
    • White, or Pale Yellow in Color
  35. How long does lochia last?
    2-3 weeks but could last up to 6 weeks
  36. 3 abnormal findings to watch for in lochia
    • 1. Reverse in Pattern
    • 2. Fall to decrease or Increases
    • 3. Foul odor
  37. Ovulation can occur as early as
    3 weeks PP
  38. Ovulation can occur in the absence of
    Menstrual Period
  39. A menstrual period can occur in the absence of
  40. This suppresses ovulation but is NOT an effective form of birth control
  41. A PP cervix may appear
    Bruised and Torn
  42. What appearance does a nulliparous cervix have
  43. What appearance does a PP cervix have?
    Slit-like doesn't ever go back to original shape
  44. When does Rugae return to vaginal walls?
    3 weeks PP
  45. Breastfeeding can lead to dryness of the vaginal walls which leads to
    Dyspareunia: painful intercourse
  46. What 2 things can cause prolactin levels to rise
    • 1. Delivery of placenta (estrogen and progesteron levels fall causing prolactin to rise)
    • 2. Suckling
  47. When does milk usually come in?
    3rd Day
  48. What is the average amount of blood loss in a vag delivery
  49. What is the average amount of blood loss in a c-section?
  50. As PP blood volume returns to normal you can expect an increase in what?
  51. High plasma fibrinogen levels at PP help bleeding stop but can cause what to occur?
  52. PP Blood Loss
    For every 250mL of blood loss the Hct & hgb do what
    • Hct: Fall 2 points
    • Hgb: Fall 1 point
  53. WBC's do what in PP
  54. Immediate PP mom begins to shiver what do you do?
    • Assess for temp, if over 100.4 this means infection
    • If less than 100.4, give her a warm blanket or two
  55. Abdominal wall seperates during pregnancy leaving part of abd wall without muscular support
    Diastasis recti abdominis
  56. 4 risk factors for Diastasis recti abdominis
    • Obese
    • Over distended abdomen
    • Poor Muscle Tone
    • Grand Multipara
  57. Diminished peristalsis, hemrrhoidal pain, perineal discomfort, and iron supplements can lead to what
  58. PP bowel function should return to normal when?
    End of the 1st week
  59. When palpating the fundus if it deviates to the right it is because
    Urinary Retention
  60. Approximately how many pounds are lost with the expulsion of the fetus, placenta, and amniotic fluid
  61. How many pounds is lost from fluid loss in early PP
  62. The average woman returns to her prepregnancy wt when?
    6 mths PP
  63. What does breastfeeding do to your body
    Helps you loose wt faster
  64. Reva Rubin identified 3 phases the PP woman goes through
    • Taking In
    • Taking Hold
    • Letting Go
  65. Explain Taking In
    When the woman is mostly concerned with her self
  66. Explain Taking Hold
    When the woman begins to focus her care on the newborn
  67. Explain Letting Go
    Woman begins to degine her role as a new parent
  68. The enduring emotional bond that develops between a mother and her infant
  69. Initial component of healthy attachment is the the process of
  70. Face to Face Bonding
    En Face
  71. Approx 50-70% of all PP women experience a mild depression that lasts 2-3 days generally called
    Postpertum Blues
  72. If a woman is goin to hemorrhage she is most likely to do so when
    1st hour postpartum
  73. What 13 do you assess in a PP assessment
    • VS
    • Position and Firmness of Fundus
    • Amount and character of Lochia
    • Status of Perineum
    • Bladder distention
    • Incision if C-sect
    • Breasts
    • Homan's Sign
    • Pain
    • Bonding
    • Emotional Status
    • Any Labs
    • Bowel
  74. How ofter do you assess VS
    • 1st hr q 15min
    • 2nd q 30min
    • q 4hrs until 24hr mark
    • Add a head to toe assessment each shift
  75. Check for what on Breasts
    • Crackling
    • Redness
    • Engorgement
  76. Who has more lochia?
    Vag Delivery
  77. Woman should be voiding what amout PP on a regular basis
  78. What position do you check the perineum in?
  79. We palpate the perineum with a gloved hand when checking for?
  80. When you assess the calves what is the Norm?
    • Equal in size bilaterally
    • No red or painful areas when feet are dorsiflexed
  81. What labs do you need to order?
    • H&H
    • RhoGAM
    • Rubella
  82. When standing up lochia can alarm the woman because
    • Lochia can pool up while sitting down
    • Then once erect it may gush out and run down her legs
  83. What nursing interventions should you take for a boggy uterus?
    • Massage
    • Oxytocin
  84. Bright Red Bleeding that occurs in a steady stream in the presence of a firm fundus is most likely to be caused by what?
    Cervical Laceration that was not repaird
  85. Unilateral pain and swelling sometimes with hard mass in the breast could indicate
  86. What engorgement intervention should you provide for the breastfeeding mom
  87. What nursing invention should you take for the mom who is feeding the infant formula
    • Cold
    • Tight Bra
  88. Why should we give analgesics 30-45 mins before mom breastfeeds?
    Reduce feeling of afterpains from uterine contraction due to oxytocin release from suckling
  89. What other nonpharm help with afterpains
  90. Your pt complains of perineal pain...what is your next step?
    • First visualize the perineum to rule out hematoma and that the episiotomy is well approximated
    • Ice packs (20 min on/20 min off) 1st 24hrs
    • Sitz Bath After 24hrs
    • Mild analgesics with a narcotic
    • Benzocaine Sprays
  91. Nursing interventions for hemorrhoids
    • Sitz Bath
    • Witch Hazel Pads
    • Hydrocortisones
  92. Infection of the uterine lining
  93. Instruct the PP to change her pad q
  94. What is used to clean the perineum
    Perri Bottle
  95. First time mom is at risk for fainting the first time she showers because
    Warm water causes peripheral blood vessels to dilate leading to hypotension resulting in fainting
  96. 3 reasons to do an In & Out cath
    • Distention
    • 6 hours without void
    • Several voids less than 100mL
  97. Anytime a narcotic is administered with a spinal or epidural what is a possible risk?
    Respiratory Depression
  98. Report low RR when
    Below 12 bpm
  99. Report a low pulse ox when
    Less than 95%
  100. Abdominal surgeries such as c-sections cause gas to build up and manifests as pain where?
  101. Common side effect of narcotics usually fixed with benadryl
  102. How long is a cath left in with a c-sec birth
  103. What should be available in the cse that hte meds cause RR of 12 or less
  104. If the fundus is firm and the woman has no vaginal bleeding how often should you massage the fundus
  105. How often should you asses lung status after a c-sec
    q 4 hrs
  106. How often should you TCDB
    q 2hrs
  107. When the basal dose of analgesia doesn't control the pain adequately
    Break through pain
  108. Research has shown it is easier to control pain when
    Before it starts
  109. If pruritis becomes unberable what should your intervention be
  110. Pain from flatus can be an issue after a c-sec so you need to teach your pt to avoid
    • Very Hot or very cold drinks
    • Soda
    • Drinking through a straw
  111. Discharge day is focused on
    Pt teaching
  112. Postpartum Danager Signs (12)
    • Fever greater than 100.4
    • Shaking Chills
    • Localized reddened, painful area on one breast
    • Frequency, Urgency, and Painful Urination
    • SOB or Chest pains
    • Severe unremitting abd or back pain
    • Foul Smelling Lochia
    • Increased in Heavy lochia or passage of clots
    • Lochia pattern reversal
    • Severe pain/reddness or swelling at epi site or incision
    • Swollen painful reddened area on calf
    • Prolonged or severe depression
    • Thoughts of harming self or baby
  113. How many calories should the breastfeeding mom take in
    500 more cal
  114. How many calories should a formula feeding mom cut out of her diet
    300 cal
  115. What does mag sulfate do?
    • Taken in toxic prevents seizures
    • Sedates the nervous system to control B/P
  116. What can be done to help muscle tone
    Kegal Exercise
  117. A falling in BP particularly in the presence of an increasing Pulse is suggestive of what
  118. Is transient glycosuria, proteinura and ketouria normal in the 10th of PP
    No just normal after immediate PP
  119. Dilation of renal pelvis and uters
    Is this common
    Due to what
    • Hydronephrosis
    • Yes
    • Due to hormonal influences
    • 4 weeks after delivery
  120. What is the nursing intervention for a Rh neg mom
    RhoGAM injection withing 72hrs of delivery
  121. If mom is not immune to rubella what would you do?
    • Administer vaccine
    • PT TEACHING No pregnant within 3 months of injection
  122. Out put should be at what
    30mL per hour
  123. Difference between C-Sec and Vag
    • IV longer
    • Longer to ambulate
    • Diet
    • No epi
    • Abd incision
    • Higher risk for gas pains
    • Higher risk for infection
    • More itching
    • Cath longer
    • Higher risk for Respiratory Disorders
    • More pain
    • Longer hospital stay
    • higer risk for hemorrhage
    • Decreased peristalsis
    • Higher risk for thrombus formation
    • Ausculatated more often
    • Uterus descends faster
    • More blood loss
    • Less lochia
    • Goes from rubra to serosa more quickly
  124. BUBBLE
    • B: Breasts
    • U: Uterus
    • B: Bowel
    • B: Bladder
    • L: Lochia
    • E: Epi/incision/ c-sec
  125. REEDA
    • R: Redness
    • E: Edema
    • E: Ecchymosis (Brusing)
    • D: Discharge
    • A: Approximation
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