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Postpartum:
Normal changes and complications
| Question | Answer |
|---|---|
| What is the 4th stage of labor? | 1-4 hr after delivery, maternal recovery period |
| How long does it take for woman's body to return to prepregnant state? | approximately 6 wk |
| What are initial dangers of the postpartum period? | hemorrhage, shock, and infection |
| What is oxytocin? | a hormone that causes contractions |
| A firm fundus prevents what complication? | hemorrhage |
| Decreased in estrogen after placenta delivery is associated with what? | breast engorgement, diaphoresis, diuresis, vaginal dryness |
| Increase levels of prolactin in lactating women suppresses what? | suppresses ovulation |
| What does indirect Coombs' test of mother's blood indicate? | indicates Rh- mother has not been sensitized by Rh+ fetus |
| What are VS orders for post delivery? | - 15 min X4 in first hr - 30 min X2 in second hr - hourly X2 for two hr - q 4 hr after |
| In assessment of postpartum mother, what does BUBBLE stand for? | Breast, Uterus, Bowel, Bladder, Lochia and Laceration, Edema and episiotomy |
| What is postpartum chill? | chills occurring in first 2 hr postpartum, normal if not accompanied by increase temp. |
| What is involution? | Return of uterus to prepregnant state; one 1 cm per day |
| What is lochia? | blood flow from uterus postpartum (from placental attachment and decidua). |
| What are three stages of lochia? | - rubra: bright red, 1-3 days postpartum - serosa: pinkish brown, 4-10 days postpartum - alba: yellowish white, 11 days - 6 wk postpartum |
| What is true? | bright red blood trickle from episiotomy site in early postpartum is normal. |
| What is the best way to prevent sore nipples in breastfeeding mother? | ensure proper latching techniques |
| What is average blood loss in childbirth? | vaginal delivery: 500 ml c-section delivery: 1000 ml |
| What are WBC postpartum? | elevated up to 20,000-25,000 for first 10-14 days w/o presence of infection and returns to normal |
| How should RN monitor for venous thrombosis? | Homan's test; inspect for redness, swelling, and warmth on legs |
| How to assess for signs of distended bladder? | - fundal height above umbilicus or baseline - fundal displaced midline over to right side - bladder bulges above symphysis pubis |
| What is true? | Feet changes during pregnancy may never return to prepregnant size |
| When should mother pt get a rubella vaccine during postpartum period to protect subsequent fetus from malformations? | when titer of 1:8, obtain consent form, tell pt to not get pregnant for following 3 mo of vaccine |
| Rh- mother with Rh+ infant must be give RhoGAM IM within how many hr? | within 72 hour of infant being born |
| What are readjustments to maternal CV system and vasculature that prevents hypovolemic shock from occuring? | - a 50% increase in circulating blood volume during pregnancy - blood diversion into systemic circulation after placenta delivery - rapid reduction in uterus size |
| What are nursing interventions for pt with hematoma of perineal area? | - ice pack first 24-48 hr - encourage sitz bath 2x/day - Dermaplast spray or witch's hazel pads |
| Maternal psychosocial adaptations during postpartum consist of? | - taking-in phase: relive experience - taking-hold phase: independence in caring - letting-go phase: assume position at home |
| What are kinds of postpartum mood disorders? | - postpartum blues - postpartum depression - postpartum psychosis - postpartum traumatic disorder |
| What is the leading cause of maternal morbidity and mortality in U.S.? | postpartum hemorrahge |
| How is postpartum hemorrhage defined? | - >500 ml blood loss after vaginal birth - >1000 ml blood loss after c-section birth - 10% change in Hct from labor admission to postpartum values |
| What are signs of hypovolemic shock? | hypotension, tachycardia, weak and thready pulse, rapid shallow RR, oliguria |
| What are some risk factors contributing to postpartum hemorrhage? | Uterine atony, lacerations and hematomas, retained placenta fragments, coagulopathies, precipitous labor, mag.sulfate during labor, uterus inversion |
| What are nursing interventions for postpartum hemorrhage? | stop blood loss, IV fluids, O2, urinary catheter, elevating legs, avoid trendelenburg position unless Rx |
| What is bimanual compression? | one hand is inserted in the vagina and the other compresses the uterus through abd wall |
| Wnat are signs of adverse reactions of water intoxication from oxytocin administration? | lightheadedness, N/V, HA, malasie; more serious symptoms can progress to cerebral edema with seizures |
| What is subinvolution? | failure of uterus to resume prepregnant state |
| What oxytocic medication is most commonly used to treat subinvolution? | ergonovine IM |
| What in uterus inversion? | turning inside out of uterus, and may be partial or complete |
| What are risk factors for uterine inversion? | retained placenta, excessive traction applied to umbilical cord, uterine atony |
| What is hematoma? | collection of 250-500 ml clotted blood within tissues, typically appear as bulging bluish mass |
| What is the distinguishable symptom of hematomas? | pain rather than noticeable bleeding |
| What is idiopathic thrombocytopenic purpura (ITP)? | autoimmune coagulopathy disorder in which lifespan of platelets is decreases by antiplatelet antibodies. |
| What is disseminated intravascular coagulation (DIC)? | coagulopathy in which clotting and anticlotting mechanism occur at the same time? |
| What is thrombosis? | blood clot on interior of blood vessel, usually caused by inflammation |
| What is thrombophlebitis? | inflammation of vessel wall caused by clot attachment --> partial occlusion of vessel |
| What is definitive method of diagnosing DVT? | Venography --> invasive and associated with serious consequences |
| What are noninvasive methods commonly used to show presence of thrombus? | - doppler ultrasound scanning - CT - MRI |
| What is pulmonary embolism? | complication of DVT that occurs if embolus is carried to pulmonary artery or one of its branches |
| What is the most common peurperal infection? | Endometritis, if untreated can spread to parametritis and peritonitis |
| What is true | unilateral inflammation of the breast is usually mastitis |
| What is true? | the immediate postpartum period is a time of increased risk for all women for micro-organisms entering repro tract --> infection and septicemia |
| What is postpartum psychosis? | unresolved postpartum depression characterized by delusional thinking and hallucinations |
| How common is postpartum blues? | occurs in 50-80% of women during first few days after birth (and up to 10 days). |
| What are interventions to breast engorgement? | - completely empty breast - cool compress b/2 feeding - warm compress/shower prior to breastfeeding |
| What are breast care for nonlactating women? | avoid breast stimulation and running water over breast for prolonged periods |
| How much weight can postpartum pt lift? | do not lift anything heavier than the infant |
| How long should pt avoid sex? | until episiotomy, laceration is healed and vaginal discharge has turned white |
Created by:
odbal24
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