OB WEEK 3 FLASHCARDS (TEST 2)

Who needs Rhogam

mom is Rh neg and baby is Rh positive one dose at 28 weeks' gestation and the second dose within 72 hours after childbirth.

Hair loss post partum

most common 3 months after birth -increased estrogen causes more hairs to go into resting phase and not be shed, so as the estrogen returns to normal, they all start to fall out -regrowth generally returns to normal levels in 4 to 6 months in two thirds of women and by 15 months in the remainder -hair may be less abundant than before pregnancy

Feet size

never returns to normal permanent increase in shoe size

Normal lochia characteristics

Immediately after childbirth, lochia is bright red and consists mainly of blood, fibrinous products, decidual cells, and red and white blood cells. The lochia from the uterus is alkaline but becomes acidic as it passes through the vagina. It is roughly equal to the amount occurring during a heavy menstrual period. The average amount of lochial discharge is 240 to 270 mL. Present for 3 weeks with most women, but may last as long as 6 weeks -at all stages it should smell fleshy, foul indicates infection

1. As a nurse working on a postpartum unit, you enter the room of Ms. Jones, a 22-year-old primipara, and find her chatting on the phone while her newborn is crying loudly in the bassinette, which has been pushed into the bathroom. You pick up and comfort the newborn. While holding the baby, you ask the client if she was aware her newborn was crying. She replies, "That's about all that monkey does since she was born!" You hand the newborn to her and she places the newborn on the bed away from her and continues her phone conversation.

Nursing observations would indicate poor bonding/attachment behaviors between mother and infant based on Disinterest in holding or being close to infant Lack of concern for infant's needs More concerned about phone conversation Negative comment about newborn ("monkey")

Commitment

refers to the enduring nature of the relationship. The components of this are twofold: 1) centrality: parents place the infant at the center of their lives. They acknowledge and accept their responsibility to promote the infant's safety, growth, and development. 2) Parent role exploration: the parents' ability to find their own way and integrate the parental identity into themselves

why stress incontinence after vaginal birth

results in direct pelvic muscle trauma and disruption of fascial supports and also causes damage to the levator ani muscle and pudendal nerve injury

involution

retrogressive changes that return the uterus to its nonpregnant size and condition

diastasis recti

- Separation of the rectus abdominis muscles -is more common in women who have poor abdominal muscle tone before pregnancy. -After birth, muscle tone is diminished and the abdominal muscles are soft and flabby. -Specific exercises are necessary to help the woman regain muscle tone

Blood volume postpartum

-Blood volume, which increases substantially during pregnancy, drops rapidly after birth and returns to normal within 4 weeks postpartum - The decrease in both cardiac output and blood volume reflects the birth-related blood loss (an average of 500 mL with a vaginal birth and 1,000 mL with a cesarean birth). -Blood plasma volume is further reduced through diuresis, which occurs during the early postpartum period - Despite the decrease in blood volume, the hematocrit level remains relatively stable and may even increase, reflecting the predominant loss of plasma. Thus, an acute decrease in hematocrit is not an expected finding and may indicate hemorrhage.

Postpartum diuresis

-Considerable diuresis—as much as 3,000 mL—begins within 12 hours after childbirth and continues for several days - occurs as a result of several mechanisms: the large amounts of intravenous fluids given during labor, a decreasing antidiuretic effect of oxytocin as its level declines, the buildup and retention of extra fluids during pregnancy, and a decreasing production of aldosterone—the hormone that decreases sodium retention and increases urine production (Stables & Rankin, 2010). -Diuresis begins within 12 hours after childbirth and continues throughout the first week postpartum. Normal function returns within a month after birth

Contraindicated for breast feeding

-Drugs such as antithyroid drugs, antineoplastic drugs, alcohol, or street drugs (amphetamines, cocaine, PCP, marijuana) enter the breast milk and would harm the infant -women who are HIV positive should not breast-feed. -newborn with an inborn error of metabolism such as galactosemia or phenylketonuria (PKU), -serious mental health disorder that would prevent her from remembering to feed the infant consistently.

Endocrine changes after birth

-For the woman who is not breast-feeding, estrogen levels begin to increase by 2 weeks after birth. -For the breast-feeding woman, estrogen levels remain low until breast-feeding frequency decreases. -Other placental hormones (human chorionic gonadotropin [hCG], human placental lactogen [hPL], progesterone) decline rapidly after birth. -hCG levels are nonexistent at the end of the first postpartum week, and hPL is undetectable within 1 day after birth -Progesterone levels are undetectable by 3 days after childbirth, and production is reestablished with the first menses. -Prolactin levels decline within 2 weeks for the woman who is not breast-feeding, but remain elevated for the lactating woman

Breast assessment

-Inspect the breasts for size, contour, asymmetry, engorgement, or erythema. -Check the nipples for cracks, redness, fissures, or bleeding, and note whether they are erect, flat, or inverted. -Cracked, blistered, fissured, bruised, or bleeding nipples indicate improper latch -Palpate the breasts lightly to ascertain if they are soft, filling, or engorged, and document your findings. -Use light touch on non-BF to avoid stimulation which would make engorgement worse -As milk is starting to come in, the breasts become firmer; this is charted as "filling." -Engorged breasts are hard, tender, and taut. -Palpate the breasts for any nodules, masses, or areas of warmth, which may indicate a plugged duct that may progress to mastitis if not treated promptly. -Document any discharge that is not colostrum or foremilk

Perineal/episiotomy assessment

-Large areas of swollen, bluish skin with complaints of severe pain in the perineal area indicate pelvic or vulvar hematomas. -Redness, swelling, increasing discomfort, or purulent drainage may indicate infection. Both findings need to be reported immediately. -A white line the length of the episiotomy is a sign of infection, as is swelling or discharge. -Severe, intractable pain, perineal discoloration, and ecchymosis indicate a perineal hematoma, a potentially dangerous condition. Report any unusual findings. -Ice can be applied to relieve discomfort and reduce edema; sitz baths also can promote comfort and perineal healing

Stages of lochia

-Lochia rubra is a deep-red mixture of mucus, tissue debris, and blood that occurs for the first 3 to 4 days after birth. As uterine bleeding subsides, it becomes paler and more serous. -Lochia serosa is the second stage. It is pinkish brown and is expelled 3 to 10 days postpartum. Lochia serosa primarily contains leukocytes, decidual tissue, red blood cells, and serous fluid. -Lochia alba is the final stage. The discharge is creamy white or light brown and consists of leukocytes, decidual tissue, and reduced fluid content. It occurs from days 10 to 14 but can last 3 to 6 weeks postpartum in some women and still be considered normal.

Respirations post partum

-Should be within normal range of 16-20 bpm -Tidal volume, minute volume, vital capacity, and functional residual capacity return to prepregnant values, typically within 1 to 3 weeks of birth -Any change in respiratory rate out of the normal range might indicate pulmonary edema, atelectasis, a side effect of epidural anesthesia, or pulmonary embolism and must be reported. -Lungs should be clear on auscultation

Why bradycardia postpartum?

-This decrease in cardiac output is reflected in bradycardia (40 to 60 bpm) for up to the first 2 weeks postpartum. -This slowing of the heart rate is related to the increased blood that flows back to the heart and to the central circulation after it is no longer perfusing the placenta. -This increase in central circulation brings about an increased stroke volume and allows a slower heart rate to provide ample maternal circulation. -Gradually, cardiac output returns to prepregnant levels by 3 months after childbirth

Urinary retention can cause what complications?

-UTI -Urinary retention and bladder distention can cause displacement of the uterus from the midline to the right and can inhibit the uterus from contracting properly, which increases the risk of postpartum hemorrhage. -Urinary retention is a major cause of uterine atony, which allows excessive bleeding. -Frequent voiding of small amounts (less than 150 mL) suggests urinary retention with overflow, and catheterization may be necessary to empty the bladder to restore tone.

Lactation

-interaction of progesterone, estrogen, prolactin, and oxytocin. -Breast milk typically appears within 4 to 5 days after childbirth.

Fundus assessment

-may want to pain med up before the assessment -Using a two-handed approach with the woman in the supine position with her knees flexed slightly and the bed in a flat position or as low as possible, palpate the abdomen gently, feeling for the top of the uterus while the other hand is placed on the lower segment of the uterus to stabilize it -The fundus should be midline and should feel firm. A boggy or relaxed uterus is a sign of uterine atony. This can be the result of bladder distention, which displaces the uterus upward and to the right, or retained placental fragments. Either situation predisposes the woman to hemorrhage.

GI postpartum

-most women experience decreased bowel tone and sluggish bowels for several days or up to a week after birth (this is because of progesterone) -Decreased peristalsis occurs in response to analgesics, surgery, diminished intra-abdominal pressure, low-fiber diet, insufficient fluid intake, and diminished muscle tone. -In addition, women with an episiotomy, perineal laceration, or hemorrhoids may fear pain or damage to the perineum with their first bowel movement and may attempt to delay it. Subsequently, constipation is a common problem during the postpartum period. -A stool softener can be prescribed for this reason.

taking hold phase

-second phase of maternal adaptation, is characterized by dependent and independent maternal behavior. -This phase typically starts on the second to third day postpartum and may last several weeks. -client regains control over her bodily functions during the next few days, she will be taking hold and becoming preoccupied with the present. -She will be particularly concerned about her health, the infant's condition, and her ability to care for her or him. - increased autonomy and mastery of her own body's functioning, and a desire to take charge with support and help from others. Strong desire to care for infant herself -She will show independence by caring for herself and learning to care for her newborn, but she still requires assurance that she is doing well as a mother.

letting go phase

-the third phase of maternal adaptation, the woman reestablishes relationships with other people. -She adapts to parenthood through her new role as a mother. -She assumes the responsibility and care of the newborn with a bit more confidence now -The focus of this phase is to move forward by assuming the parental role and to separate herself from the symbiotic relationship that she and her newborn had during pregnancy. -She establishes a lifestyle that includes the infant. The mother relinquishes the fantasy infant and accepts the real one.

taking in phase

-time immediately after birth when the client needs sleep, depends on others to meet her needs, and relives the events surrounding the birth process. -This phase is characterized by dependent behavior. -During the first 24 to 48 hours after giving birth, mothers often assume a very passive role in meeting their own basic needs for food, fluids, and rest, allowing the nurse to make decisions for them concerning activities and care. -They spend time recounting their labor experience to anyone who will listen in order to integrate the birth experience into reality—that is, the pregnancy is over and the newborn is now a unique individual -When interacting with the newborn, new mothers spend time claiming the newborn and touching him or her, commonly identifying specific features in the newborn

Relief for non-breast feeding women

-wearing a tight, supportive bra 24 hours daily, -applying ice to her breasts for approximately 15 to 20 minutes every other hour -avoiding sexual stimulation -not stimulating the breasts by squeezing or manually expressing milk from the nipples -avoiding exposing the breasts to warmth (e.g., a hot shower) will help relieve breast engorgement. -In women who are not breast-feeding, engorgement typically subsides within 2 to 3 days with application of these measures.

Risk factors for post partum infection

Operative procedure (forceps, cesarean birth, vacuum extraction) History of diabetes, including gestational-onset diabetes Prolonged labor (more than 24 hours) Use of indwelling urinary catheter Anemia (hemoglobin < 10.5 mg/dL) Multiple vaginal examinations during labor Prolonged rupture of membranes (>24 hours) Manual extraction of placenta Compromised immune system (HIV positive)

Why does breast feeding cause after pains?

Oxytocin released during breast feeding causes uterine contractions

Urination can be impeded by...

Perineal lacerations Generalized swelling and bruising of the perineum and tissues surrounding the urinary meatus Hematomas Decreased bladder tone as a result of regional anesthesia Diminished sensation of bladder pressure as a result of swelling, poor bladder tone, and numbing effects of regional anesthesia used during labor (Bope & Kellerman, 2012)

the four stages a woman progresses through in establishing a maternal identity in BAM: (according to Mercer)

1. Commitment, attachment to the unborn baby, and preparation for delivery and motherhood during pregnancy 2. Acquaintance/attachment to the infant, learning to care for the infant, and physical restoration during the first 2 to 6 weeks following birth 3. Moving toward a new normal 4. Achievement of a maternal identity through redefining self to incorporate motherhood (around 4 months). The mother feels self-confident and competent in her mothering and expresses love for and pleasure interacting with her infant

processes of involution

1. Contraction of muscle fibers to reduce those previously stretched during pregnancy 2. Catabolism, which reduces enlarged, individual myometrial cells 3. Regeneration of uterine epithelium from the lower layer of the decidua after the upper layers have been sloughed off and shed during lochial discharge

Characteristics of engrossment for dads

1. Visual awareness of the newborn—the father or partner perceives the newborn as attractive, pretty, or beautiful. 2. Tactile awareness of the newborn—the father or partner has a desire to touch or hold the newborn and considers this activity to be pleasurable. 3. Perception of the newborn as perfect—the father or partner does not "see" any imperfections. 4. Strong attraction to the newborn—the father or partner focuses all attention on the newborn when he is in the room. 5. Awareness of distinct features of the newborn—the father or partner can distinguish his newborn from others in the nursery. 6. Extreme elation—the father or partner feels a "high" after the birth of his child. 7. Increased sense of self-esteem—the father or partner feels proud, "bigger," more mature, and older after the birth of his child

Normal hospital stay

Vaginal: up to 48 hours Cesarean: up to 96 hours

When can sex be resumed

After bright red bleeding has stopped Dryness is common especially when breast feeding so use KY jelly

Risk factors of thromboembolism

Anemia Diabetes mellitus Cigarette smoking Obesity Preeclampsia secondary to exaggeration of hypercoagulable state Hypertension Severe varicose veins Pregnancy Oral contraceptive use Cesarean birth Severe infection Previous thromboembolic disease Multiparity Bed rest or immobility for 4 days or more Advanced maternal age

What nursing interventions are appropriate for poor bonding?

Assess for risk factors in the client—age, outside family support, multiple life stressors, unrealistic expectations of newborn behaviors, level of education, family support system—and determine the client's perception of newborn behaviors and educate her about normal newborn behaviors and mothering activities needed. In addition, model parent care behaviors in caring for a newborn and ascertain the availability of any family support—extended family, neighbors, and community resources.

What specific discharge instructions might be needed?

Based on observations and assessment data, this client would need a referral to the discharge planner, social services department, or local health department for home visit follow-up care. Bonding/attachment behaviors are lacking, possibly placing the newborn at risk for neglect or abuse.

Infant variables that influence the Maternal Role Attainment (MRA)

appearance, responsiveness, temperament, and health status

BUBBLEEEE to help you remember head to toe assessment

breasts, uterus, bladder, bowels, lochia, episiotomy/perineum/epidural site, extremities, and emotional status

Higher risk of blood clots and coagulation probs postpartum

Normal physiologic changes of pregnancy, including alterations in hemostasis that favor coagulation, reduced fibrinolysis, and pooling and stasis of blood in the lower limbs, place women at risk for blood clots. Smoking, obesity, immobility, and postpartum factors such as infection, bleeding, and emergency surgery (including emergency cesarean section) also increase the risk of coagulation disorders -coagulation factors remain elevated for 2 to 3 weeks postpartum

Cardiovascular changes post partum

During pregnancy, the heart is displaced slightly upward and to the left. This reverses as the uterus undergoes involution. Cardiac output remains high for the first few days postpartum and then gradually declines to nonpregnant values within 3 months of birth.

decent of the uterus post partum

During the first few days after birth, the uterus typically descends from the level of the umbilicus at a rate of 1 cm (1 fingerbreadth) per day. By 3 days, the fundus lays 2 to 3 fingerbreadths below the umbilicus (or slightly higher in multiparous women). By the end of 10 days, the fundus usually cannot be palpated because it has descended into the true pelvis.

postpartum assessment intervals

During the first hour: every 15 minutes During the second hour: every 30 minutes During the first 24 hours: every 4 hours After 24 hours: every 8 hours

Blood pressure post partum

Blood pressure values should be similar to those obtained during the labor process. - In some women there may be a slight transient increase lasting for about a week after childbirth - Decreased blood pressure may suggest an infection or a uterine hemorrhage, dehydration (side effect of epidural), shock, or orthostatic hypotension -An increase in blood pressure could indicate gestational hypertension, or preeclampsia

Increased nutrition requirements for lactating women

Calories: + 500 cal/day for the first and second 6 months of lactation Protein: +20 g/day, adding an extra 2 cups of skim milk Calcium: +400 mg daily—consumption of four or more servings of milk Fluid: +2 to 3 quarts of fluids daily (milk, juice or water); no sodas

local anesthetic sprays commonly used

Dermoplast or Americaine

Urinary changes post partum

During pregnancy, the glomerular filtration rate and renal plasma flow increase significantly. Both usually return to normal by 6 weeks after birth. -Many women have difficulty feeling the sensation to void after giving birth if they received an anesthetic block during labor (which inhibits neural functioning of the bladder) or if they received oxytocin to induce or augment their labor (antidiuretic effect). -These women will be at risk for incomplete emptying, bladder distention, difficulty voiding, and urinary retention. -Assess the bladder for distention and adequate emptying after efforts to void. Palpate the area over the symphysis pubis. If empty, the bladder is not palpable. Palpation of a rounded mass suggests bladder distention. -Also percuss the area: a full bladder is dull to percussion. -If the bladder is full, lochia drainage will be more than normal because the uterus cannot contract to suppress the bleeding.

1. Postpartum breast engorgement occurs 48 to 72 hours after giving birth. What physiologic change influences breast engorgement?

Engorgement refers to the swelling of the breast tissue as a result of an increase in blood and lymph supply to produce milk for the newborn. Estrogen and progesterone levels decrease considerably and are not restored until the first menses returns several weeks or months later, depending on the lactation status of the mother. Colostrum can be secreted as early as 16 weeks' gestation. The mother's body is going through profuse diuresis to restore prepregnant fluid levels to her body and therefore would not be retaining fluid in the breasts. Estrogen and progesterone levels decrease, which allows prolactin to stimulate the glands to secrete milk. Their levels are restored when the first menses returns several weeks or months later, depending on the lactation status of the mother. Delete the "colostrum" rationale there and replace with this one instead: Colostrum is a lemon-colored fluid secreted by both breasts immediately at birth and within 4 to 5 days postpartum it gradually changes to transitional milk and finally mature milk by two weeks. Colostrum production reduces within days after childbirth as transitional and mature milk, thereby not contributing to breast engorgement.

Post partum danger signs

Fever more than 100.4° F (38° C) Foul-smelling lochia or an unexpected change in color or amount Large blood clots, or bleeding that saturates a peripad in an hour Severe headaches or blurred vision Visual changes, such as blurred vision or spots, or headaches Calf pain with dorsiflexion of the foot Swelling, redness, or discharge at the episiotomy, epidural, or abdominal sites Dysuria, burning, or incomplete emptying of the bladder Shortness of breath or difficulty breathing without exertion Depression or extreme mood swings

Laceration classifications

First-degree laceration: involves only skin and superficial structures above muscle Second-degree laceration: extends through perineal muscles Third-degree laceration: extends through the anal sphincter muscle Fourth-degree laceration: continues through anterior rectal wall

Tips for preventing infection

Frequently change perineal pads, applying and removing them from front to back to prevent spreading contamination from the rectal area to the genital area. Avoid using tampons after giving birth to decrease the risk of infection. Shower once or twice daily using a mild soap. Avoid using soap on nipples. Use a sitz bath after every bowel movement to cleanse the rectal area and relieve enlarged hemorrhoids. Use the peribottle filled with warm water after urinating and before applying a new perineal pad. Avoid tub baths for 4 to 6 weeks, until joints and balance are restored, to prevent falls. Wash your hands before changing perineal pads, after disposing of soiled pads, and after voiding

Why slight fever and when can it be expected?

From dehydration because of fluid lost during labor First 24 hrs post partum

Food requirements for lactating women

Fruits: 4 servings Vegetables: 4 servings Milk: 4 to 5 servings Bread, cereal, pasta: 12 or more servings Meat, poultry, fish, eggs: 7 servings Fats, oils, and sweets: 5 servings

Food requirements for non lactating women

Fruits: Make half of your plate fruits and vegetables. Vegetables: Eat red, orange, and dark-green vegetables. Milk: Switch to skim milk or 1%. Breads, grains, and cereals should be whole grains. Meat, poultry, fish, eggs: Eat seafood twice a week and beans, which are high in fiber. Eat the right amount of calories for you; enjoy your food, but eat less. Be physically active your way in activities that you enjoy. Fats, oils, and sweets: Cut back on these. Use food labels to help you make better choices

Why no ovulation while breast feeding?

High levels of prolactin have been found to delay ovulation by inhibiting ovarian response to follicle-stimulating hormone

1. A new nurse assigned to the postpartum mother-baby unit makes a comment to the oncoming shift that Ms. Griffin, a 25-year-old primipara, seems lazy and shows no initiative in taking care of herself or her baby. The nurse reported that Ms. Griffin talks excessively about her labor and birth experience and seems preoccupied with herself and her needs, not her newborn's care. She wonders if something is wrong with this mother because she seems so self-centered and has to be directed to do everything.

Is there something "wrong" with Ms. Griffin's behavior? Why or why not? No this is normal behavior for a mother in the first 2 days post birth What maternal role phase is being described by the new nurse? Taking in What role can the nurse play to support the mother through this phase? The nurse can be supportive through this early phase by providing a restful, quiet environment to facilitate her recovery from childbirth. Providing her with simple guidance and suggestions of how she can care for herself and her newborn will assist the new mother in expanding her focus. Praising her for her accomplishments in care will reinforce it.

2. Mrs. Lenhart, a primipara, gave birth to a healthy baby boy yesterday. Her husband John seemed elated at the birth, calling his friends and family on his cell phone minutes after the birth. He passed out cigars and praised his wife for her efforts. Today, when the nurse walked into their room, Mr. Lenhart seemed very anxious around his new son and called for the nurse whenever the baby cried or needed a diaper change. He seemed standoffish when asked to hold his son, and he spent time talking to other fathers in the waiting room, leaving his wife alone in the room.

Is this normal behavior? Yes, inexperienced first-time fathers are anxious around their newborns because this is a new experience for them and many do not know how to handle or care for their newborns yet. Paternal attachment is a gradual process that occurs over weeks and months. He is probably feeling overwhelmed with this tiny baby and, although he probably wants to help, he is anxious about how or what to do without appearing awkward. The nurse can help new fathers adjust to their role by taking time to listen to their concerns and demonstrating how they can become involved in the care of their newborn. Staying in the room and physically supporting the father as he tries out his new role will provide encouragement for him to become involved. The nurse can slowly introduce fathers to the care needs of their newborn and encourage their participation. This supportive role by the nurse can help reduce role strain and enhance family adjustment.

Comfort measures for perineal area

Local comfort measures such as ice packs, pouring warm water over the area via a peribottle, witch hazel pads, anesthetic sprays, and sitz baths can relieve pain

cultures in which men don't get involved in birth process

Mexican Americans, Arab Americans, Asian Americans, and Orthodox Jewish Americans

Promote tissue integrity

Monitor episiotomy site for redness, edema, warmth or discharge to identify infection. Assess vital signs at least every 4 hours to identify changes suggesting infection. Apply ice pack to episiotomy site to reduce swelling. Instruct client on use of sitz bath to promote healing, hygiene, and comfort. Encourage frequent perineal care and peripad changes to prevent infection. Recommend ambulation to improve circulation and promote healing. Instruct client on positioning to relieve pressure on perineal area. Demonstrate use of anesthetic sprays to numb perineal area.

Risk factors of postpartum hemorrhage

Precipitous labor (less than 3 hours) Uterine atony Placenta previa or abruptio placenta Labor induction or augmentation Operative procedures (vacuum extraction, forceps, cesarean birth) Retained placental fragments Prolonged third stage of labor (more than 30 minutes) Multiparity, more than three births closely spaced Uterine overdistention (large infant, twins, hydramnios)

Summary of breast milk production

Prolactin levels increase at term with a decrease in estrogen and progesterone levels. Estrogen and progesterone levels decrease after the placenta is delivered. Prolactin is released from the anterior pituitary gland and initiates milk production. Oxytocin is released from the posterior pituitary gland to promote milk let-down. Infant sucking at each feeding provides continuous stimulus for prolactin and oxytocin release

RBC's post partum

Red blood cell production ceases early in the puerperium, causing mean hemoglobin and hematocrit levels to decrease slightly in the first 24 hours. During the next 2 weeks, both levels rise slowly.

Lochia documentation terms

Scant: a 1- to 2-inch lochia stain on the perineal pad or approximately a 10-mL loss Light or small: an approximately 4-inch stain or a 10- to 25-mL loss Moderate: a 4- to 6-inch stain with an estimated loss of 25 to 50 mL Large or heavy: a pad is saturated within 1 hour after changing it

To prevent stress incontinence

Start a regular program of Kegel exercises after childbirth. Lose weight if necessary; obesity is associated with stress incontinence. Avoid smoking; limit intake of alcohol and caffeinated beverages, which irritate the bladder. Adjust fluid intake to produce a 24-hourly urine output of 1,000 to 2,000 mL. Use either an intravaginal or intra-urethral device that puts pressure onto the urethra so that urine will not leak when bladder pressure rises

kegel exercises

Supportive tissues of the pelvic floor are stretched during the childbirth process, and restoring their tone may take up to 6 months. Pelvic relaxation can occur in any woman experiencing a vaginal birth. Nurses should encourage all women to practice Kegel exercises to improve pelvic floor tone, strengthen the perineal muscles, and promote healing. -otherwise they could suffer urinary incontinence for the rest of their lives

Why does tachycardia need to be investigated in postpartum period?

Tachycardia (heart rate above 100 bpm) in the postpartum woman warrants further investigation. It may indicate hypovolemia, dehydration, anxiety, excitement, fatigue, pain, excessive blood loss or delayed hemorrhage, infection, or underlying cardiac problems

2. Jennifer Adamson, a 34-year-old single primipara, left the hospital after a 36-hour stay with her newborn son. She lives alone in a one-bedroom walk-up apartment. As the postpartum home health nurse visiting her 2 days later, you find the following: Home cluttered and in disarray Fundus firm and displaced to right of midline Moderate lochia rubra; episiotomy site clean, dry, and intact Vital signs within normal range; pain rating less than 3 points on scale of 1 to 10 Breasts engorged slightly; supportive bra on Newborn assessment within normal limits Distended bladder upon palpation; reporting urinary frequency Which of the assessment findings warrants further investigation?

Tearful client pacing the floor holding her crying son Distended bladder upon palpation; reporting frequency Fundus firm and displaced to right of midline

6. Prioritize the postpartum mother's needs 4 hours after giving birth by placing a number 1, 2, 3, or 4 in the blank before each need.

The correct answer would be: 1. Interaction time with the infant for about 30 minutes to facilitate bonding 2. Sleep and rest without being disturbed for a few hours to restore mother 3. Lessons on holding and cuddling the infant 4. Watching a baby bath demonstration given by the nurse

Postpartum vagina

The vagina returns to its approximate prepregnant size by 6 to 8 weeks postpartum but will always remain a bit larger than it had been before pregnancy. -Normal mucus production and thickening of the vaginal mucosa usually return with ovulation. -By 3 to 4 weeks, the edema and vascularity have decreased. The vaginal epithelium is generally restored by 6 to 8 weeks postpartzum -Localized dryness and coital discomfort (dyspareunia) usually plague most women until menstruation returns. Water-soluble lubricants can reduce discomfort during intercourse.

WBC's post partum

The white blood count, which increases in labor, remains elevated for first 4 to 6 days after birth but then falls to 6,000 to 10,000/mm3. This white blood cell elevation can complicate a diagnosis of infection in the immediate postpartum period.

Combined hormonal contraceptives

They recommend that postpartum women not use combined hormonal contraceptives during the first 21 days after childbirth because of the high risk for venous thromboembolism (VTE) during this period. During days 21 to 42 postpartum, women without risk factors for VTE generally can initiate combined hormonal contraceptives, but women with risk factors for VTE (e.g., previous VTE or recent cesarean delivery) generally should not use these methods. After 42 days postpartum, no restrictions on the use of combined hormonal contraceptives based on postpartum status apply

6. Which of the following would the nurse assess as indicating positive bonding between the parents and their newborn?

a. Desiring to be in close proximity to another human being is all part of the bonding process. Bonding cannot take place with separation of individuals. Closeness is needed by the two people bonding, and not having others hold the infant. Buying or wearing expensive clothes has no emotional effect on a bonding relationship. Requesting that nurses provide care separates the parent from the infant and suggests that the parents lack the desire for closeness with their infant.

8. The major purpose of the first postpartum homecare visit is to:

a. Home visits are usually made within the first week of discharge to assess the mother and newborn. This visit is made primarily to provide the nurse with the opportunity to recognize common biomedical and psychosocial problems or complications. Although not the primary reason, this visit also offers an opportunity to provide support and guidance to the parents in making the adjustment to the change in their lives. The home visit is not the time to complete PKU testing or complete the birth certificate.

normal size of the uterus

approximately 1,000 g (2.2 lb) soon after birth, undergoes physiologic involution as it returns to its nonpregnant state. Approximately 1 week after birth, the uterus shrinks in size by 50% and weighs about 500 g (1 lb); at the end of 6 weeks, it weighs approximately 60 g (2 oz), about the weight before the pregnancy

3. Which of the following suggestions would be most appropriate to include in the teaching plan for a postpartum woman who needs to lose weight?

b. Because weight loss is based on the principle of intake of calories and output of energy, instructing this woman to avoid high-calorie foods that yield no nutritive value and expending more energy through active exercise would result in weight loss for her. Acid-producing foods (plums, cranberries, and prunes) are typically recommended for women to prevent urinary tract infections to acidify the urine, not for weight-loss purposes. Increasing fluid intake (water) would be good for weight loss because it fills the stomach and reduces hunger sensations; however, this option does not identify which fluids should be increased. Increasing high-calorie juice and soda drinks would be counterproductive to weight-loss measures. Fluid restriction combined with a high-protein diet would increase the risk of gout and formation of kidney stones. Carbohydrates are needed by the body to make ATP and convert it to energy for cellular processes. Limiting snacks might be a good suggestion depending on which ones are selected. Raw fruits and vegetables are excellent high-fiber snacks that will help in an overall weight-loss program.

4. The nurse would expect a postpartum woman to demonstrate lochia in which sequence?

b. Lochia discharge from the uterus proceeds in an orderly fashion, regardless of a surgical or vaginal birth. Its color changes from red to pink to whitish cream consistently, unless there is a complication. The correct sequence is rubra (red), then serosa (pink/brownish), and then alba (white, creamy).

puerperium

begins after the delivery of the placenta and lasts approximately 6 weeks. During this period the woman's body begins to return to its prepregnant state

2. In the taking-in maternal role phase described by Rubin (1984), the nurse would expect the woman's behavior to be characterized as which of the following?

c. According to Reba Rubin, the mother is very passive and is dependent on others to care for her for the first 24 to 48 hours after giving birth. Gaining self-confidence would characterize a mother in the taking-hold phase, during which the mother demonstrates mastery over her own body's functioning and feels more confident in caring for her newborn. Adjustment to relationships does not occur until the third phase, letting go, when the mother begins to separate from the symbiotic relationship she and her newborn enjoyed during pregnancy and birth. Resuming control over her life would denote the second phase of taking hold, during which the mother does resume control over her life and gains self-confidence in her newborn care.

7. Which activity would the nurse include in the teaching plan for parents with a newborn and an older child to reduce sibling rivalry when the newborn is brought home?

c. An older sibling needs to feel he or she is still loved and not upstaged by the newest family member. Allowing special time for that sibling reinforces the parent's love for him or her also. Regression behavior is common when there is stress in that sibling's life, and punishing him brings attention to negative behavior, possibly reinforcing it. The older sibling might feel he or she is being replaced and is not wanted by the parents when he or she is sent away. Including the older sibling in the care of the newborn is a better way to incorporate the newest member into the family unit. Sharing a room with the infant could lead to feelings of displacement in the sibling. In addition, frequent interruptions during the day and night will awaken the sibling and not allow a full night's sleep or undisturbed nap.

4. After teaching a group of breast-feeding women about nutritional needs, the nurse determines that the teaching was successful when the women state that they need to increase their intake of which nutrients?

c. Lactating mothers need an extra 500 calories to sustain breast-feeding. An additional 20 g of protein is also needed to help build and regenerate body cells for the lactating woman. Additional intake of carbohydrates or fiber is not suggested for lactation. An increase in fats is not recommended, nor is it needed for breast-feeding. To obtain adequate amounts of vitamins during lactation, women are encouraged to choose a varied diet that includes enriched and fortified grains and cereals, fresh fruits and vegetables, and lean meats and dairy products. An increase in vitamins via supplements is not recommended. Choosing a variety of foods from the food pyramid will provide the lactating woman with adequate iron and minerals.

1. When assessing a postpartum woman, which of the following would lead the nurse to suspect postpartum blues?

c. Periodic crying and insomnia are characteristic of postpartum blues, in addition to mood changes, irritability, and increased sensitivity. Panic attacks and suicidal thoughts or anger toward self and the infant would be descriptive of postpartum psychosis, when some women turn this anger toward themselves and have committed suicide or infanticide. Women experiencing postpartum blues do not lose touch with reality. Obsessive thoughts and hallucinations would be more descriptive of postpartum psychosis.

5. The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings by the nurse would be expected?

c. The nurse would expect light pink or brown lochia, and the uterus should be four to five fingerbreadths below the umbilicus. Cream-colored lochia wouldn't be seen for about 10 to 14 days after childbirth, thus it wouldn't be observed this early in the postpartum period. The uterus would be involuting downward into the pelvis, thus it would not be above the umbilicus by this timeframe. Bright-red lochia would be observed for up to three days post birth, not five days later unless there was a problem. The uterus descends into the pelvis at a rate of 1 cm/day, thus the fundus should be 4 to 5 cm (fingerbreadths) below the umbilicus by now.

Leopolds maneuver

check the fundus first next palpate side to side to find back vs. arms and legs third, figure out which fetal part is presenting into the pelvis fourth, change positions to face womans feet, and palpate the fetal head or presenting part to verify position

Postpartum diaphoresis

mechanism to reduce the amount of fluids retained during pregnancy and restore prepregnant body fluid levels. -It can be profuse at times. -It is common, especially at night during the first week after birth. -Reassure the client that this is normal and encourage her to change her gown to prevent chilling.

factors that facilitate uterine involution

complete expulsion of amniotic membranes and placenta at birth, a complication-free labor and birth process, breast-feeding, and early ambulation.

5. Which of the following would lead the nurse to suspect that a postpartum woman was developing a complication?

d. A swollen, tender area on the breast would indicate mastitis, which would need medical intervention. Fatigue and irritability are not complications of childbearing, but rather the norm during the early postpartum period secondary to infant care demands and lack of sleep on the caretaker's part. Perineal discomfort and lochia serosa are normal physiologic events after childbirth and indicate normal uterine involution. Bradycardia is a normal vital sign for several days after childbirth because of the dramatic circulatory changes that take place with the loss of the placenta at birth and the return of blood back to the central circulation.

2. Which of these activities would best help the postpartum nurse to provide culturally sensitive care for the childbearing family?

d. Nurses need first to become educated about various cultural practices to incorporate them into their care delivery. By gaining an understanding of diverse cultures different from their own, nurses can become sensitive to these different practices and not violate them. Attending a transcultural course might be beneficial, but this would take several weeks to complete and the information is needed much sooner to provide culturally sensitive care for an admitted client and her family. Caring only for families of the nurse's cultural origin would not be possible or realistic in our global, culturally diverse population within the United States. Nurses need to care for every person regardless of their color, creed, or nationality with respect and competence. Teaching diverse cultural families Western beliefs would demonstrate ethnocentric behavior and would not be professional. Each culture needs to be respected and learned about with tolerance and understanding.

3. The nurse is explaining to a postpartum woman 48 hours after her giving childbirth that the afterpains she is experiencing can be the result of which of the following?

d. The direct cause of afterpains is uterine contractions. Mothers experience abdominal pain secondary to contractions, especially when breast-feeding because sucking stimulates the release of oxytocin from the posterior pituitary gland, which causes uterine contractions. There is no association of afterpains with endometriosis. The small size of the newborn wouldn't stretch her uterus, thus would not be a contributing factor to her discomfort now. Pregnancies spaced too close together can contribute to frequent stretching of the uterus, but this is not the cause of afterpains.

effects of relaxin and progesterone postpartum

declining relaxin and progesterone levels, which cause hip and joint pain that interferes with ambulation and exercise. -Good body mechanics and correct positioning are important during this time to prevent low back pain and injury to the joints. -Within 6 to 8 weeks after delivery, joints are completely stabilized and return to normal.

Postpartum cervix

gradually gets back to normal by week 6 -The cervical os gradually closes and returns to normal by 2 weeks, whereas the external os widens and never appears the same after childbirth. The external cervical os is no longer shaped like a circle, but instead appears as a jagged slit-like opening, often described as a "fish mouth

Baby blues

haracterized by mild depressive symptoms, anxiety, irritability, mood swings, tearfulness (often for no discernible reason), increased sensitivity, and fatigue. The "blues" typically peak on postpartum days 4 and 5, may last hours to days, and usually resolve by day 10. Although these symptoms may be distressing, they do not reflect psychopathology, and they typically do not affect the mother's ability to function and care for her child.

Factors that inhibit involution (subinvolution)

include a prolonged labor and difficult birth, incomplete expulsion of amniotic membranes and placenta, uterine infection, overdistention of uterine muscles (such as by multiple gestation, hydramnios, or a large singleton fetus), a full bladder (which displaces the uterus and interferes with contractions), anesthesia (which relaxes uterine muscles), and close childbirth spacing (frequent and repeated distention decreases tone and causes muscular relaxation).

postpartum depression

last longer, are more severe, and require treatment. Some signs and symptoms of depression include feeling: Restless Worthless Guilty Hopeless Moody Sad Overwhelmed

Stage 2 for dads: reality

occurs when fathers or partners realize that their expectations in stage 1 are not realistic. Their feelings change from elation to sadness, ambivalence, jealousy, and frustration. Many wish to be more involved in the newborn's care and yet do not feel prepared to do so. Some find parenting fun but at the same time do not feel fully prepared to take on that role. -Risk factors for male postpartum depression include previous history of depression, financial problems, a poor relationship with his partner, and an unplanned pregnancy. Symptoms of depression appear 1 to 3 weeks after birth and can include feelings of being very stressed and anxious, being discouraged, fatigued, resentment toward the infant and the attention he or she is getting, and headaches

Position for perineal inspection

on side with top leg raised and her back to the nurse raise her upper buttock and inspect the anus for hemorrhoids and the episiotomy for irritation, ecchymosis, tenderness, or hematomas.

Stage 1 for dads: expectations

preconceptions about what home life will be like with a newborn. Many men may be unaware of the dramatic changes that can occur when this newborn comes home to live with them. For some, it is an eye-opening experience.

Stage 3 for dads: transition to mastery

the father or partner makes a conscious decision to take control and be at the center of his newborn's life regardless of his preparedness. This adjustment period is similar to that of the mother's letting-go phase, when she incorporates the newest member into the family.

Reciprocity

the process by which the infant's abilities and behaviors elicit parental response. Reciprocity is described by two dimensions: 1) complementary behavior: Complementary behavior involves taking turns and stopping when the other is not interested or becomes tired. An infant can coo and stare at the parent to elicit a similar parental response to complement his or her behavior. 2) Sensitivity: Parents who are sensitive and responsive to their infant's cues will promote their development and growth. Parents who become skilled at recognizing the ways their infant communicates will respond appropriately by smiling, vocalizing, touching, and kissing.

lochia

vaginal discharge that occurs after birth