1. Puerperium
    First six weeks after birth of infant
  2. What’s the fourth trimester of pregnancy
  3. Neonate?
    Newborn up till 28 day
  4. Bonding?
    • Rapid process of attachment for the parent and child.
    • Takes place during the first 30-60 minutes after birth.
  5. Attachment
    Long term process that establishes enduring bond between parent and child.
  6. Claiming process
    Parents identified likenesses and differences
  7. Engrossment
    Parents interest and preoccupation in the new born
  8. Factors affecting adaptation of the parents
    • Fatigue
    • Previous experience with newborn
    • Expectations of newborn
    • Knowledge of and confidence in providing care
    • Temperament of newborn *
    • Temperament of parents
    • Age of parents
    • Support systems
  9. Involution
    Return of uterus to prepregnancy size and condition
  10. Lochia
    Vaginal discharge after child birth
  11. It takes _____ for the vagina to regain pre-pregnancy contour
    6 weeks
  12. Let down reflex
    Neurohormonal reflex that causes milk to be expressed
  13. Prolactin
    Responsible for milk production.
  14. Oxytocin
    Responsible for milk “let down” or ejection from breast.
  15. ____ is not a reliable method of birth control
  16. Most non breast feeding mothers will resume me striating within _____
    3 months
  17. Colostrum
    Yellowish fluid rich in antibodies and high in protein first two or three days after birth.
  18. Engorgement occurs by day _____
    Three or four
  19. Vasocongestion of breast tissue during milk production causes
    Distention, swelling, and tenderness
  20. Lactation ceases within ______ if breast feeding stopped or never begun
    One week
  21. To suppress lactation and promote comfort, mothers should
    Wear a well fitting bra continuously for several days.
  22. Mothers can ____ following recovery from analgesia
    Eat and drink
  23. Breast feeding mothers should consume _____ than usual pre preg diet
    500 more calories
  24. Causes difficulty with BM
    • Decreased peristalsis
    • Diarrhea
    • Lack of food during labor
    • Dehydration
    • Perineal trauma
    • Hemorrhoids
    • Anticipation of discomfort
    • Pain medications
  25. Blood loss for vagina birth is ___
    500 ml
  26. Blood loss for c section is ____
  27. Increased levels of clotting factors and fibers protect against ______ but can lead to ____
    Postpartum hemorrhage

    Thrombus formation.
  28. Moms with varicose veins, c sections, or Hx of thrombophlebitis are at increased risk for
    Thrombus formation
  29. Mothers may have problems with _____ and ______ of bladder
    • Over distention
    • Emptying
  30. Full bladder displaces the uterus
    Up and to the side
  31. Uterine atony
    When uterus remains flaccid and the client passed large clots although the fundus has been massaged every 15 minutes
  32. How often should the nurse massage the fundus after birth ?
    Every 15 minutes.

    Helps keep it tight and slows bleeding.
  33. What to do with uterine atony
    Massage the fundus and have someone call the MD
  34. May have permanent ____ in shoe size
  35. Takes ___ for abdominal muscles to return to pre-pregnant state
    6 weeks
  36. In relation to the skin, changes that occur after pregnancy
    • Melanocyte- stimulating hormone declines
    • Hyperpigmentation lightens*
    • Most of the skins elasticity returns
    • Striae (stretch marks) May still be visible
    • Fine hair usually disappears
  37. Maternal discomfort can be caused from
    • Fatigue
    • After pains
    • Muscles ache
    • Episiotomy
    • Abd incision pain
    • Breast enforcement
  38. Mothers with headaches should be assessed for
    Pregnancy- induced hypertension
  39. Immediately after giving birth mothers will lose ____lbs
    • 13
    • Infant, placenta, amniotic fluids, and blood loss.
  40. Within six weeks of giving birth mothers will lose ____lbs

    Resulting from dieresis, diaphoresis, and involution.
  41. It takes _____ for moms to return to prepregnancy weight
  42. Taking in phase
    • Occurs within the first 24 hrs after birth.
    • Mom needs food, drink, and sleep.
  43. Taking hold phase
    • Mother becomes more independent and takes an interest and responsibility for her own care.
    • Focus shifts to the care of the infant
  44. Letting go phase
    Move past the role of expecting and moves forward as a family unit.
  45. Postpartum blues
    Emotional lability and crying for no apparent reason

    Can last 2 weeks
  46. Unplanned C section
    Taking in phase may last longer

    Help mom understand the birth and incorporate the experience into her reality
  47. Postpartum depression
    • Mild, moderate, or severe
    • Cares for infant but Is unable to feel the love
    • Irritability, guilt, shame, unworthiness, sense of self loss.

    Symptoms persists beyond first few weeks after birth.
  48. Postpartum psychosis
    Paranoid, grandiose or bizarre delusion, mood swings, confused thinking, grossly disorganized behavior that represent dramatic change from previous functioning.

    Obsessive concerns about the infant health
  49. Infants with problems
    May be harder to bond with
  50. Newborns and mothers health protection act of 1996
    • Requires health plans to allow 48-hour stay after vaginal birth and 96 hour stay after c-section birth.
    • May offer home care follow up
    • Teach pt to report any fever or bright red discharge
  51. Nursing process for a postpartum pt
    • BUBBLE
    • Breast
    • Uterus
    • Bladder
    • Bowels
    • Lochia
    • Episiotomy, lacerations, and c section
  52. When examining the breast note
    Size, shape, abnormalities and reddened areas

    Palpate for softness, firmness, engorgement, warmth, tenderness

    Check nipples for cracks, fissures, soreness, and inversion.

    *** if mastitis is diagnosed, pt can still breast feed as long as there aren’t abscesses****
  53. When assess uterus
    • Palpate fundus
    • Note size, consistency, and placement.
    • Fundus should be around the umbilicus for the first 12hrs after birth.
    • Should be firm and midline
    • Should decrease one finger breadth per day (1cm) *****
    • After pains
    • Breast feeding stimulated the release of oxytocin which stimulates uterine contractions. = involution 👌🏻
  54. If uterus is boggy, soft, and above umbilicus, nurse should
    • Massage the fundus or encourage breast feeding
    • If those don’t work md may prescribe pitocin
  55. If boggy uterus with fundus above the inimical snd divisors to the side assess
    Fullness of bladder and distention
  56. I and o is kept for ____hr after birth
  57. Inspect anus for ____ when checking episiotomy
  58. Lochia:
    • Vaginal discharge after birth
    • Changes from rubra (red) to serosa (pink) to alba (white)
  59. Assess______ with lochia
    Color, amount, Pedro and presence of clots.
  60. For the first three days lochia is
    Rubra with small pieces of mucus
  61. On 4th day after birth,lochia
    • Decreases
    • Color is pink or brown
  62. After 10 days, Lochia
    Discharge becomes yellowish white (alba)
  63. It is _____ for lochia to increase with animation of increases activity
  64. To assess episiotomy
    • Mom in sims position
    • Redness=inflammation
    • Ecchymosis= bruising
    • Edema= swelling
    • Possible discharge
    • Approximation of suture line
    • Pain of labia
  65. Temp increases to ___ for ____ after birth
    • 100.4
    • 24 hrs
  66. After 24 hrs and elevated temp may indicate ___\ after birth
  67. Pulse may decrease to _____ after ____
    • 50-70
    • First hour

    Elevation may indicate pain, anxiety, or HEMORRHAGE
  68. Increased BP after birth may indicate
  69. Decreased BP after birth may indicate
    Excessive bleeding
  70. S/s of thrombophlebitis
    • Redness, heat, edema, and tenderness
    • Homans signs: pain with dorsal flexion of foot.
  71. Bonding and attachment is
    • The way mothers hold, examine, and speak to infant.
    • Important signs: cradling, gazing at infant, speaking pleasantly
  72. Assess parenting capability by
    Observing feedings, dispersing, bathing and consoling skills
  73. Assess self care by
    • Showering, perineal care, checking the fundus, breast care, and rest.
    • Encourage mom to bathe, toilet, and feed herself independently.

    ***** assist moms with first time getting out of bed after brith******
  74. Rh Immune Globulin
    Given with 72 hrs to prevent sensitization or Rh

    (Neg mom, positive baby)
  75. Rubella immunization
    Recommended for all women who have not had rubella or have 1:8 titer in postpartum period.

    • Should be given before discharge.
    • Breast feeding allowed
    • Shouldn’t get pregnant for three months.
  76. What to assess with c sections
    • Incision:redness, heat, pain, edema, and suture line approximation.
    • *may produce less lochia and clots.
    • Assess RR and breath sounds
    • Assess effort of changing position, cough and deep breathing, incentive spirometer.
    • Assess abd and bs, I AND O, pain.
  77. Uterine atony
    • Hemorrhage is a stead food of blood.
    • Uterus boggy or soft.
  78. Retained placental fragments
    Prevents uterus from contracting effectively and bleeding continues.
  79. Laceration of the birth canal
    May occur in the perineum, vagina, cervix, or around urethral meatus.
  80. Hematoma
    Bleeding into tissue with no external laceration.
  81. Late hemorrhage occurs
    1-2 weeks after birth
  82. First sign of late hemorrhage
    Tachycardia from hypovolemic shock.
  83. Predisposing factors for late hemorrhage
    Low playlets, Hx of bleeding, Hx of alcohol abuse, herbal and homeopathic remedies, ASA or NSAIDS, obesity or poor nutrition.
  84. Medical management of hemorrhage
    • Oxytocin/pitocin
    • Possible D&C or evacuation of hematoma
    • Md palpates uterus to make sure it’s contracting
    • Thorough exam of birth canal for laceration or hematoma
  85. Puerperal infection
    • Occurs between birth and 6 weeks postpartum
    • Fever of 100.4 on two separate occasion within 24hr.
    • Includes wound infection, metritis, mastitis, and UTI
  86. Med/surg management of infection
    • Removal of suture to allow drainage
    • C&S to ID organism.
    • Hot showers for comfort and blood flow for pts with mastitis. Still allows to breast feed until abscess ruptures

    • Metritis=iv antibiotics
    • Mastitis= early antibiotic therapy to prevent abscess
  87. Risk factors for thrombophlebitis
    35+, c section, prolonged time in stirrups, obesity, smoking, Hx of varicosities or venous thromboses.
  88. How to prevent thrombophlebitis
    • Frequent early ambulation to increase venous return
    • Avoid prolonged standing or sitting
    • Do not cross legs
  89. Med surg management of thrombophlebitis
    • Analgesics, antibiotics,
    • iv heparin if DVT is present for 5-7 days followed by anticoagulant for 6 weeks or more.
    • Rest, elevation of affected leg, local application of heat, TED, Doppler for affected extremity.
  90. DIC
    Disseminated intravascular coagulation

    Abnormal stimulation of clotting

    Causes clots then causes bleeding.
  91. DIC may result from
    Missed abortions, abruptio placentae, amniotic fluid embolism, sever preeclampsia, hemorrhage and a dead fetus.
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