The first ______ weeks after the birth of an infant is known as the postpartum period.
6 weeks
What does the word involution refer to?
the changes that the reproductive organs , particularly the uterus, undergo after childbirth as they return to their nonpregnant size and condition
When does uterine involution begin? and how does it begin?
immediatly after delivery of the placenta, when uterine muscle fibers contract around blood maternal blood vessels which helps control bleeding
IMMEDIATLY after delivery, the fundus can be palpated __________________
midway between the symphysis pubis and umbilicus (within a few hours, the fundus rises to the level of the umbilicus and remains at this level for about 24 hours)
After 24 hours, the fundus begins to descend by approx ______ per day, so that by the _____ to _____ day it is in the pelvic cavity and cannot be palpated abdominally
1 cm or 1 fingerbreath per day
10th to 14th day
What does U-3 indicate?
fundus descent is documented in relation to the umbilicus. therefore, U-3 indicates that the fundus is palpable three fingerbreadths below the umbilicus
Afterpains may occur as oxytocin is released from the posterior pituitary during breastfeeding. __________ are frequently used to lessen the discomfort of afterpains.
analgesics
*should be administered at least 30 minutes prior to feeding.
some mothers ALSO find that lying in a side position w/a pillow or blanket under the abdomen helps keep the uterus contracted
Name some benefits of administering analgesics prior to breastfeeding for a women experiencing afterpains.
pain relief, such as comfort and relaxation facilitate teh milk-ejection reflex
For the first ___ days after childbirth, the locia consists almost entirely of blood. Because of it's red color, it is termed _______ _______
3 days
lochia rubra
By about day 4 after childbirth, the amount of blood decreases and the color changes from red to pink or pinkish brown. this lochia is termed ______ ____
lochia serosa
Lochia serosa continues until about the 11th day at which time the discharge becomes white, cream-colored, or light-yellow (lochia ____) and could persist for _____weeks
alba
6 weeks
Because estrogen production is not well established during lactation, breastfeeding mothers are likely to experience ________ _______ and may experience dyspareunia, or discomfort during intercourse
vaginal dryness
This is a surgical incision of the perineal area
episiotomy
On average, _____mL of blood is lost in vaginal deliveries and ______mL is lost in cesarean births
500mL vaginal & 1000mL C-section
*hypervolemia, which produces 50% increase in blood volume at term, allows the woman to tolerate a substantial blood loss during childbirth w/out ill effect.
Concerning cardiac output, a nurse should expect the postpartum mother to experience bradycardia OR tachycardia?
bradycardia = <50-60 beats /minute
Your patient is experiencing an urinary output of 3000mL/day postpartum. This is caused by?
decline in aldosterone and oxytocin
Aldosterone is increased in pregnancy to counteract the salt-wasting effects of progesterone. After birth, EXPECT DIURESIS and DIAPHOSESIS
Your patient is experiencing profuse prespiration day 4 after birth. What is your action?
Explain to the patient the cause and provision of comfort measures
normal WBC is 14,000 to 16,000. 2 days postpartum, Your pt's lab results return and the WBC is 30,000. What more than likely is the cause of this increase?
Leukocytosis is a normal expectation for a new mother. Neutrophils increase in response to inflammation, pain and stress. WBC falls to normal values by 4 to 7 days
These women are HUNGRY!!! nurses anticipate the mother's needs and provide food and fluids soon after childbirth!!
:)
OK...so...bc of the pregnancy, the bladder has increased capacity and lost some muscle tone along with maybe tramatized by the head of the fetus during birth. These things can lead to diminished sensitivity to pressure and new mothers may not have a sensation to void Even when bladder is distended. Name some potential complications related to this:
___________
Risk for overdistention of bladder
incomplete emptying of bladder w/retention & residual urine
urinary tract infection due to above two
postpartum hemorrhage d/t overdistended bladder displacing the uterus resulting in inability for uterus muscles to contract & cause excessive bleeding
Fibrinolytic activity (to break down clots) is decreased or increased during pregnancy?
the abiltiy to break down clots is decreased during pregnancy to prevent excessive bleeding. this causes an increased risk for thrombosis formation. it takes 3-4 weeks before hemostasis returns to normal
True or False:
A women can not get pregnant while she is breast feeding?
False: a women CAN get while breastfeeding. ovulation may occur before the first menses. Therefore contraceptive measures are important considerations when sexual relations are resumed for both lactating and nonlactating women.
_________is necessary for milk ejection, or "let down". This hormone is produced by the posterior pituitary gland and causes milk to be expressed from the alveoli into the lactiferous ducts during suckling
oxytocin
Why would Rh (D) immune globulin be administered if the mother is Rh-negative and the newborn is Rh-positive?
To prevent the development of maternal antibodies that would affect subsequent pregnancies.
When would the Rh (D) immune globulin be administered if the mother was Rh-negative and the newborn Rh-positive?
72 hours after childbirth
Why would the rubella vaccine be offered to the mother who is not immune to rubella AFTER she has the child?
Rubella vaccine is offered to the mother after childbirth (if she is not immune to rubella) to prevent her from acquiring rubella during subsequent pregnancies (whould could produce serious fetal abnormalties)
Assessments:
q_____ for the first hour
______ for the next hour
______ for the first 24 hours
______ thereafter
q15 minutes 1st hour
q30 minutes for the next hour
q4hrs for the 1st 24 hours
q8hrs thereafter
If the fundus is difficult to locate or is soft or "boggy", the nurse should:
stimulate the uterine muscle to contract by gently massaging the uterus
To expel clots, the nurse must support the lower uterine segment. This support prevents what?
inversion of the uterus (turning inside out) when the nurse applies firm pressure downward toward the vagina
The most commonly used drug used to maintain contraction of the uterus & thus prevent postpartum hemorrhage is ____
oxytocin (pitocin)
Excessive lochia in the presence of a contracted uterus suggests:
lacerations of the birth canal and the health care provider must be notified so the lacerations can be located and repaired
A foul odor of lochia suggests _______
A normal description of the odor of lochia is ___________
endometrial infection
"fleshy" "earthy"
The acronym REEDA stands for what?
R - redness
E - edema
E - ecchymosis (bruising)
D - discharge
A - approximation (the edges of the wound should be close, as though stuck or glued together)
Diuresis is highest between the ____ & ____ days after birth
2nd - 5th
When mothers receive epidural narcotics for postoperative pain relief, __________ must be assessed frequently because narcotics ______________
respirations
depress the respiratory center
Name some things the nurse should do IF the respiratory rate for a pt on narcotics after birth should do?
notify the anesthesioloigist immediately
elevate the hob to facilitate lung expansion
admin oxygen
follow protocol to admin antagonists (NARCAN)
The new mother recovering from a c-section is on bed rest for ___ to ____ hours
8 - 12 hours immediatly after delivery
You should teach new mothers and ______which physical signs and symptoms should be reported to the health care provider immediately.
at least one other family member
________ describes the initial attraction felt by parents and is unidirectional
bonding - during this time the infant is in a quite alert stage and seems to gaze directly at the parent
_______ is the process by which an enduring bond to a child is developed through plesurable, satisfying parent child interaction
attachment
Initially, when the infant is placed in the mother's arms, she holds is in this position ______________
en face - with the infant's face in the same vertical plane as her own.
What is fingertipping? And when is it most common?
fingertipping is common during the early minutes as the mother gets aquainted with the tiny stranger. she may gently explore the infant's face, fingers and toes with her fingertips only
During the ________, the mother is focused primarily on her own need for fluid, food, and sleep
taking-in phase
A major task during this time is to integrate her birth experience into reality. She discusses her labor and delivery in detail w/visitors or by telephone
taking-in phase
During the _______phase, the mother exhibits concern about managing her own body and assums responsibiltiy for her own self-care. This phase is also called the "teachable, reachable, referable moment" it is an ideal time to review previously taught material & provide additional instructions
taking-hold phase
This phase is a time of letting go of expectations of the baby/birth and a carefree lifestyle
Letting-go phase
The nurse understands that ________has been reached when the mother achieves confidence in her ability to care for her infant and becomes comfortable with her identitiy as a mother
role attainment
The father's developing bond to his newborn is called _______
engrossment
When hemorrhage occurs in the first 24 hours after childbirth, it is termed _____________. When it occurs after 24 hours, it is called ___________
early postpartum hemorrhage
late postpartum hemorrhage
The two major causes of early postpartum hemorrhage are: _______ and _______
uterine atony
trauma to the birth canal during labor & delivery
_______refers to lack of muscle tone that results in failure of the uterine musle fibers to contract firmly around blood vessels wht the placenta separates
atony
How many predisposing factors for postpartum hemorrhage can you list?
The answer has 15!
1. overdistention of the uterus (multiple babies, large infant, hydramnios)
2. multiparity (>5)
3. use of tocolytic drugs
4. precipitate labor & delivery (contractions that were excessively vigorous)
5. Prolonged labor (contractions that were barely effective)
6. Use of forceps or vacuum extractor
7. c-section or previous uterine surgery
8. MANUAL removal of placenta
9. PREVIOUS postpartum hemorrhage
10. general anesthesia
11. placenta previ, accreta or low implantation (uterus implantation weird)
12. Labor that was induced or augmented w/oxytocin
13. chorioamnionitis (inflammation of amniotic sac)
14. clotting disorders
15. disseminated intravascular clotting
What are the major signs of uterine atony? (5 listed)
uterine fundus is difficult to locate
a soft or "boggy" feeling fundus
uterus becomes firm when massaged but loses its tone when message is stopped
a uterine fundus located above the expected level
excessive lochia
True or False: a constant trickle or dribble of bleeding is just as dangerous as bleeding that is profuse and dramatic?
True
If the uterus is not firmly contracted, the first intervention is to :
massage the fundus until it is firm and to express clots that may have accumulated in the uterus
Massaging the uterus:
One hand is placed just above _______ to support the lower uterine segment while the other hand gently but firmly ______the _______in a circular motion. Clots that may have accumulated in the uterine cavity are expressed by applying _____but_____pressure on the fundus in the direction of _______. It is critical NOT TO attempt to express clots until the uterus is firmly _______. Pushing on an uncontracted uterus could _____the uterus and cause ___________.
symphysis pubis
massages the fundus
gentle but firm
the vagina
contracted
invert
massive hemorrhage
If the uterus does not remain contracted after uterine massage or if the fundus is displaced, the problem may be a _______
distended bladder - a full bladder lifts and displaces the uterus and prevents effective contraction of the uterine muscles
Pharmacologic measures may also be necessary to maintain firm contraction of the uterus. A rapid IV infusion of ________ often increases uterine tone and controls bleeding
oxytocin (pitocin)
Bleeding from lacerations of the genital tract is often _______ in contrast to the ________color of lochia
bright red
darker red
During _________, to control bleeding, one hand is inserted into the vagina and the other compresses the uterus through the abdominal wall
bimanual compression
___________produce deep, severe, unrelieved pain and feeling of pressure. This should be suspected if the mother demonstrates systemic signs of concealed blood loss, such as falling blood pressure or tachycardia, when the fundus is firm and lochia is within normal limits.
hematoma
The most common causes of late postpartum hemorrhage are _________ and ___________
subinvolution (delayed return of the uterus to its nonpregnant size and consistancy) AND fragments of placenta that remain attached to the myometrium when the placenta is delivered
List the early signs of postpartum hemorrhage: (5 listed)
an uncontracted uterus
large gush or slow, steady trickle of blood from the vagina
Saturation of more than one peripad per hour
Severe, unrelieved perineal or rectal pain
Tachycardia
___________is one of the earliest signs of hypovolemic shock
tachycardia
sufficient fluid volume is infused to produce a urinary output of at least ___ml/hr
30 ml/hr
During a hemorrhage situation, the healthcare team makes every effort to locate and stop the bleeding. Interventions may include:
uterine packing
ligation of the uterine, ovarian or hypogastric artery
hysterectomy
__________refers to a slower-than-expected return of the uterus to its nonpregnant size after childbirth
subinvolution
The most common causes of subinvolution are __________ & _____.
retained placental fragments
pelvic infection
signs of subinvolution include:
prolonged discharge of lochia
irregular or excessive uterine bleeding
and sometimes profuse hemorrhage
During pregnancy, the pt may be placed on _____, which does NOT cross the placenta, to prevent thrombus formation
heparin or a low molecular weight heparin such as Lovenox. It is discontinued during labor and resumed 4-12 hours after childbirth
This is a term used to describe bacterial infections after childbirth
puerperal infection
What is the first line of treatment for mastitis?
antibiotic therapy and continued emptying of the breast by breastfeeding or breast pump
