1. Ways for baby and mom to bond
    • Rooting, sucking, comforting
    • gazing eye contact, grasping parent fingers
    • tracking parents face and movement with parent's voice
  2. Which phase is this:
    - more focused on self/own needs for sleep/food
    - talking about the birth experience 1-2 days

  3. Which phase is this:
    - more independent
    - teachable moments over day

  4. Which phase is this: 
    - Accepts realities 
    - May lead to postpartum blues

  5. What is this term: Behaviors exhibited by fathers experiencing an intense preoccupation and interest in their newborn children
  6. List how these physiologic adaptations will effect the body during postpartum: (increase or decrease)

    a. Cardiac output
    b. Plasma volume
    c. WBC
    d. HCT
    e. Clotting factors
    f. Fibrinolytic
    • a. increase (bradycardia common)
    • b. decreased (diuresis / diaphoresis)
    • c. increase in 4-7 days
    • d. decreased
    • e. increase
    • f. decreased risk for clots
  7. What are urinary changes in postpartum?
    Bladder has increased capacity, decreased tone and sensitivity
  8. Match purpose of each med:

    1. Colace 
    2. Senekot
    3. Mylicon

    a. anti-gas, relieves abdominal pain
    b. stool softner safe during pregnancy.
    c. stool softner for women who have recently given birth
    • 1. b
    • 2. c
    • 3. a
  9. Name uses for Pitocin during labor and after labor
    • During: causes uterus to contract and induce labor
    • After: control bleeding after childbirth
  10. Match drug with use:

    1. Methergine
    2. FeSO4 / FeGluconate
    3. Lanisol Cream

    a. Used to help control bleeding and to improve muscle tone in uterus
    b. Helps reduce pain during breastfeeding
    c. Iron supplement to prevent anemima
    • 1. a
    • 2. c
    • 3. b
  11. Match drug with use:

    1. Dermaplast spray
    2. Anusol suppositories
    3. Tucks

    a. Hemorrhoids relief wipes
    b. Tx of hemmorhoids
    c. Pain relief for perineal care
    • 1. c
    • 2. b
    • 3. a
  12. Fill in:

    After pregnancy, healing at the placental site takes approximately ___ weeks.
    6 weeks by a process of exfoliation (scaling off of dead tissue)
  13. This term refers to the changes of the reproductive organs, particularly the uterus, that undergo after childbirth.
    What are its three processes?
    • Involution
    • 1. contraction of muscle fibers
    • 2. Catabolism (process of breaking ddown cells into simpler compounds)
    • 3. Regeneration of uterine epithelium
  14. What are some etiologies of afterpains of a primipara?
    • If her uterus has been overdistended by multifetal pregnancies
    • a large infant
    • polyhydramnios
    • retained blood clots are present
    • Oxytocin from breastfeeding that causes contractions
  15. Fill in: Some mothers find that lying in the ____ position witha  small pillow under the abdomen helps keep the uterus contracted and provides relief
    prone position
  16. Put the descriptions of lochia colors in order:

    Lochia Serosa
    Lochia Rubra
    Lochia Alba
    • 1. Lochia Rubra - for the first 3 days after childbirth, lochia consists almost entirely of blood, giving it a reddish / brown color
    • 2. Lochia Serosa - amount of blood decreases, changing it from red to pink / brown-tinged
    • 3. Lochia Alba - the discharge becomes white, cream, or light yellow
  17. Fill in: Lochia is present for most women until the __a__ week after child birth but may be present until the __b__ week..
    • a. 3rd week
    • b. 6th week
  18. After childbirth, the vaginal rugae (folds) take __a__ weeks to be regained, but may take __b__ weeks for the vagina to complete involution and gain the same size and contour.
    • a. 3-4 weeks
    • b. 6-10 weeks
  19. How does breastfeeding and lactation affect estrogen levels?
    Because ovarian function, and thus, estrogen production, is not well established during lactation, breastfeeding mothers are likely to experience vaginal ddryness and experience dyspareunia (discomfort during sex).

    Also, vaginal walls do not regain their thickness until estrogen production by the ovaries is reestablished.
  20. How long can it take for the perineum to heal after an episiotomy (surgical incision of the perineal area to enlarge the opening for birth)?
    The incision site heals in 2-3 weeks, but complete healing may take 4-6 months.
  21. What two ways does the mom's body rid itself of excess plasma volume needed during pregnancy?
    • 1. Diuresis (urine): decreases adrenal hormone aldosterone, which reduces sodium retention, and fluid excretion accelerates. Oxytocin is also reduced, which promoted reabsorption of fluid.
    • **3,000ml/day of urine is common***
    • 2. Diaphoresis (perspiration)
  22. What should be applied to all women who are receving a cesarean delivery, especially if they are not already receiving anticoagulants?
    Pneumatic compression devices
  23. Why is constipation a common problem during postpartum?
    • Bowel tone and intestinal motility were diminished as a result of progesterone (remains sluggish for several days)
    • Abdominal musculature is relaxed
    • Decreased food and fluid intake during labor, resulting in small, hard stools
    • Perineal trauma, episiotomy, and hemorrhoids
    • Fear of pain when defecating
  24. What causes the loss or diminished sensation to void even when the bladder is distended for a postpartum mom? What risk can this lead to?
    The urinary meatus may become traumatized and swollen as the fetal head passes beneath the bladder. 

    Urinary retention and overdistention may cause UTIs and increased postpartum bleeding.
  25. What is diastasis recti?
    The longitudinal muscles of the abdomen that separate during pregnancy, which may be minimal or severe.

    It usually resolves within 6 weeks
  26. Although uncommon, spinal headaches after spinal anesthesia may occur. What position can cause it to be severe, and which may relieve it?
    • Upright position (severe)
    • Supine (relief)
  27. How early can the resumption of ovulation and menstraution after the last birth?
    • Some as early as 3 weeks
    • 45% of non-nursing women menstruate at 6-8 weeks
    • 75% by 12 weeks
    • ALL within 6 months.
  28. List all initial assessments of a postpartum mom (9)
    • 1. VS
    • 2. Skin color
    • 3. Location and firmness of fundus
    • 4. Amount and color of lochia
    • 5. Perineum (edema, episiotomy, lacerations, hematoma)
    • 6. IV infusion (site, patency, drug)
    • 7. Urinary output (time and amount of last void)
    • 8. If applicable, status of abdominal incision and dressing
    • 9. Level of feeling and ability to move if regional anesthesia was administered
  29. T or F: Women who are pregnant should get the Rubella vaccine if they are not yet vaccinated
    False: According to the CDC, they should not get vaccinated, but only before or after pregnancy. 

    Women are advised not to become pregnant for at least 28 days after receiving the rubella vaccine.
  30. At what ages should a child get the DTAP vaccine (5 doses for Pertussis)?

    How early should the Tdap (booster) be given?
    How often should adults get the booster?
    • 1. 2 months
    • 2. 4 months
    • 3. 6 months
    • 4. 15-18 months
    • 5. 4-6 years of age

    The Tdap should thenbe given at 11-12 years of age

    Adults should get a booster every 10 years
  31. T or F: when doing postpartum assessments, you should alternate between left and right arms to get the most accurate BP reading
    False: the mother should have it taken in the same arm each time, as well as in the same position each time. 

    The BP should then be compared to that with the predelivery period.
  32. If the fundus remains soft and uncontracted with the initial massage, what are the next steps to make?
    • Continue to support the lower uterine segment
    • Keep massaging fundus until firm, then apply pressure to express any clots that may accumulate in uterus
    • Notify healthcare provider, and begin oxytocin administration as prescribed
  33. When assessing the perineum, what does the acronym REEDA stand for?
    • It is used as a reminder that the site of an episiotomy or perineal laceration should be assessed:
    • R: redness
    • E: edema
    • E: ecchymosis (bruising)
    • D: Discharge
    • A: approximation (edges of the wound should be closed, as though stuck together)
  34. What can a positive Homans sign show and indicate?
    A positive Homan sign shows as discomfort in the calf with passive dorsiflexion of the foot, which may indicate DVT.
  35. Fill in: Women should be encouraged to drink approximately ____ mL of fluids each day.
    2500 mL
  36. How long will a new mom recovering postop of a c-sec usually stay on bed rest
    8-12 hours
  37. How can you help prevent abdominal distention?
    • Early, frequent ambulation
    • Tightening and relaxing the abdominal muscles
    • Pelvic lifts
    • Avoiding carbonated beverages (accumulation of intestinal gas)
    • Simethicone (used to relieve symptoms of extra gas such as belching, bloating)
    • Rectal suppositories
  38. List some breast care teachings for lactating mothers.
    Measures for non-BF mothers
    • Instruct mother to avoid using soap on nipples
    • Keep nipples dry between feelings
    • Wear a good sized bra.
    • Non-BF: initiate measures to suppress lactation: well-fitting bra or sports bra 24 hours a day, until breasts become soft
    •  - manage discomfort by applying ice and analgesics
    •  - refrain from stimulating milk production by pumping or massaging breasts
    •  - don't allow warm water to fall directly on breasts
    • Tenderness and engorgement should return to normal in 48-72 hours
  39. Which phase is this: The mother is focused primarily on her own needs (fluid, sleep, sleep, etc.) She takes in details of her baby, but is content to allow others to make decisions.

    The major task for the mom is to integrate her birth experience into reality. 

  40. Which phase is this: The mother becomes more independent. She exhibits concern about managing her own body functions and assumes responsibility for her own care. 

    When she feels more comfortable, she shifts attention to the infant, and welcomes information about behaviors exhibited by newborns. 

    This is also called the "teachable, reachable, referable moment."

  41. Which phase is this: This is a time of relinquishment for the mother and often for the father. Many mothers must give up idealized expectations of the birth experience, like accepting a c-sec if a natural birth is not possible. 

  42. List these stages of maternal role attainment in order:

    Personal stage
    Informal stage
    Anticipatory stage
    Formal stage
    • 1. Anticipatory stage: begins during pregnancy when the women chooses a physician or midwife, attends childbirth classes, etc.
    • 2. Formal stage: begins with the birth of the infant for 4-6 weeks. behaviors may be guided by others such as health professionals, friends, or parents. Major task is for parents to become acquanted with their infants.
    • 3. Informal stage: Begins when mother has learned appropriate responses to her infant's cues or signals. Then begins to respond accordingly.
    • 4. Personal stage: attained when the mom feels a sense of harmony in her role, sees infant as a central person in her life. Mom feels comfortable with role of parent.
  43. For fathers, bonding is called...
    Engrossment: intense interest in infant appearance
  44. In post partum, state whether these will increase or decrease:

    cardiac output
    plasma volume
    Clotting factors
    • cardiac output increased, and bradycardia common
    • plasma volume decreased
    • wbc's increase in 4-7 days
    • HCT is decreased
    • clotting factors increase: DVT can occur
  45. T or F: 50% of moms will start ovulating 28 days after birth of baby
  46. Which oral contraceptives are good for a mom who had just given birth and is starting ovulation
    Progesterone only
  47. Precipitous labor
    Very fast labor
  48. T or F: a preeclampsia mom will always have an IV
  49. Which part of the foley cath will you assess the urine?
    the color of urine in the tube, not the bag
  50. Witch Hazel
    Witch hazel can be applied topically to reduce inflammation and swelling and is safe to use during pregnancy. If you're treating varicose veins on your vulva, saturate a maxi pad with witch hazel and wear it at night.
  51. How can teas help with postpartum?
    Chamomile consumed to relieve digestive ailments like bloating and flatulence. Pepperment to relieve irritable bowel syndrome, and gas pains
  52. How is methergine used
    It is also used to help control bleeding and to improve muscle tone in the uterus after childbirth. You should not use methylergonovine during your pregnancy. This medication is to be used only after delivery of your baby.
  53. Which medication is safe to give for postpartum depression when breastfeeding?
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