ob exam three
bronchopulmonary dysplasia prognosis
require oxygen support life long abnormalities increased risk for pulmonary decompensation in severe cases
breast physical assessment postpartum
supportive and properly fitted bra if breastfeeding assess warmth, tenderness, firmness, and redness of breast assess nipples monitoring for engorgement, mastitis, and other infection
neonatal abstinence syndrome treatment
swaddling, pacifier, frequent diaper changes, decreased stimulus, skin to skin, small frequent feeding morphine, methadone, buprenorphine
client self teaching nutrition
calorie recommendations, continue taking prenatal vitamin and/or iron supplement
cervical changes postpartum
can be bruised or have lacerations external os of cervix will close slowly; shape altered permanently
immune complication signs and symptoms
can be subtle and nonspecific
parental feeding
can improve neurodevelopment outcomes, growth and mortality in very low birth weight infants
explanation for night sweats
normal physiologic occurrence that results as body attempts to eliminate excess fluids that were present during pregnancy. may be aggravated by plastic mattress pad
physiologic jaundice def
normal process during transition; appears after 24 hours
postpartum blues client self care teaching
normal psychological changes in postpartum period, signs and symptoms, when to call healthcare provider, involving family/support person during education is crucial
postpartum UTI risk factors
nulliparity assisted childbirth prolonged labor
laceration of genital tract risk factors
nulliparity, epidural, precipitous childbirth, macrosomia, instrument-assisted birth, and oxytocin use
education opportunities postpartum
nutritional counseling breastfeeding assistance maternal exercise newborn/infant care newborn/infant development parenting courses
respiratory distress syndrome assessment
observing for signs and symptoms, blood gases
hypothermia assessment
observing for signs and symptoms, temperature monitoring
late/secondary hemorrhage def
occurs 24hr to 12 weeks postpartum
early/primary hemorrhage def
occurs first 24 hours after childbirth; more common
retained placental fragments def
often occurs when partial separation of placenta from uterus, during fundal massage, before spontaneous placental separation wait to fundal massage until after placental separation
relinquishing mother def
one who chooses to place her newborn for adoption or one who has conceived via traditional or gestation means and is acting as a surrogate mother with the intention of placement of the newborn with another family
preterm cardiovascular complications
patient ductus arteriousus
intraventricular hemorrhage causes
maternal preE, fetal asphyxia, chorio
subinvolution treatment
methedrine 0.2mg Q 3-4 hrs for 24-48 hrs antibiotics curettage
onset of mastitis
3-4 weeks postpartum and with any decrease in nursing frequency
persistent pulmonary hypertension risks
34-37 weeks gestation, SGA, LGA, GDM, AMA, PPROM, RDS, diaphragmic hernia, pneumonia, MAS
small for gestational age/fetal growth restrictions def
<10%
leukocytes in mastitis
>100,000
large for gestational age def
>90% or 4000g
puerperal morbidity
A temperature of 38C or higher for any 2 of the first 10 days postpartum, exclusive of the first 24 hours.
persistent pulmonary hypertension assessment
ECHO, preductal-postductal difference is >10% difference
a recently postpartum client who has heavy vaginal bleeding that does not lessen after a fundal massage says, "I am so thirst. May I have some ginger ale?" which is an appropriate reply by the nurse?
I know this is difficult; however, it's best for you to wait until the bleeding has subsided. I can give you a moisturizer for your lips to relieve the dryness
immune complication causes
IgG is transferred to fetus after 32 weeks poor skin integrity invasive procedures and devices maternal infection increases risk
neonatal encephalopathy assessment
MRI
neonatal pain scales
NIPPS, NPASS
DVT or embolism prevention
SCDs until ambulating regularly dangle legs over side of bed within 12 hours postpartum up with assistance
tobacco use during pregnancy
SGA, increased irritability, hypertonic negative impact on breastfeeding long term: ADHD, asthma, neuro disorders, SIDS
retinopathy of prematurity def
abnormal vascular growth of blood vessels in the retina
fundus indicative of full bladder
above umbilicus and deviated to the right
fundus indicative of excessive bleeding
above umbilicus and/or boggy (not firm)
resumption of sexual activity postpartum
abstain until perineum is healed and lochia flow has stopped vaginal dryness common, water-based lubricant milk ejection may occur during intercourse/orgasms
which additional nursing care is needed for the postpartum client after a cesarean birth that may not be necessary following vaginal birth?
administering the prescribed pain medication in scheduled intervals
general principles of postpartum assessment
ask woman to void before assessment always do vital signs before assessment pre-medicate if applicable incorporate teaching breasts, uterus, bladder, bowel, lochia, episiotomy, homans, emotional
hypoglycemia treatment
assess at risk groups 30-60 min after birth carefully monitor feeding check blood glucose levels maintain a warm environment monitoring blood glucose Dgel, D10
persistent lochia rubra nursing action
assess location and firmness of fundus assess activity pattern assess for signs of infection record and report findings
presence of clots nursing action
assess location and firmness of fundus, assess voiding pattern, record and report findings
prevention with early ambulation
assist with postpartum ambulation first few times dizziness not uncommon should ensure client is steady, without dizziness, and able to sit without assistance before first shower signs/symptoms of DVT
therapeutic hypothermia
at least 36 wk start with 6 hours lasting 72 keep infant core temp 33-35 degrees C gradual rewarming
urinary tract postpartum
at risk of distention and difficulty voiding- anesthesia even higher risk puerperal diuresis causes rapid filling of bladder urinary stasis increases risk of infection and hemorrhage
where should fundal position be 6-12 hours postpartum?
at umbillicus
sga/fgr signs and symptoms
average sized head with long skinny body, thin umbilical cord, separated sutures
mutual regulation phase
balance is sought between needs of mother and baby
preE postpartum implications
blood pressure increased CNS irritability= increased risk for seizure increased need for bedrest= increased risk for thrombophlebitis
non pharmacological pain management
breastfeeding, nonnutritive sucking, swallowing, skin to skin, oral sucrose
necrotizing entercolitis treatment
broad spectrum antibiotics, surgery, bowel rest
perineal changes postpartum
bruising, swelling, check approximation for any lacerations or episiotomies completely healed by 4-6 months
integumentary birth injuries
brusing lacerations
postpartum thromboembolic risk factors
c/s, prolonged immobility, obesity, smoker, trauma to extremity, diabetes, anemia
postpartum endometritis risk factors
c/s, prom, prolonged labor preceding cesarean birth, multiple vaginal examinations during labor, compromised health status, use of fetal scalp electrode or intrauterine pressure catheter for internal monitoring during labor
pph nursing care management
call for help, initiate rapid response team massage to firm fundus and remove clots initiate or verify IV access weigh pads to accurately monitor blood loss vital signs Q15 oxygen if client desat void or catheterize to eliminate overdistention replace volume with saline or LR elevate legs 30 degrees to promote circulation and venous return
nonnutritive sucking
calming effect, may improve digestion
apnea assessment
continuous monitoring
pulmonary infection prevention
cough/deep breathe and incentive spirometer
postpartum hemorrhage defined
cumulative blood loss greater than or equal to 1000 ml or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process regardless of route of delivery
anemia causes
decrease in erythropoiesis increase need for blood testing short abc life span
thromboembolic disease assessment
edema of leg or ankle, low-grade fever with subsequent chills and high grade fever, tenderness or pain in leg, inguinal area, or abdomen, palpable cord, color changes to affected limb, humans sign, limb pale/cool to touch
full bladder fundal intervention
empty bladder and reassess fundus
ptsd symptoms
feeling numb seeming dazed and unaware of environment irritable intrusive thoughts and flashbacks difficulty thinking and sleeping avoidance of anything remind her of event
taking in period
first several days passive, somewhat dependent, follows suggestions, hesitates with decisions, preoccupied with own needs, food and sleep major
fourth stage of labor
first two hours after birth immediate recovery maternal organs undergo initial change frequent assessments required
venous thrombosis def
formation of blood clot at an area of impeded blood flow in a superficial or deep vein
postpartum endometritis assessment
foul-smelling lochia, fever, uterine tenderness on palpation, lower abdominal pain
sub involution symptoms
fundal height greater than anticipated lochia not progressing normally package, leukorrhea, and foul smelling lochia
acquaintance phase
getting to know baby first day or two
HIV
goal is to reduce transmission
intraventricular hemorrhage assessment
head circumferences, ultrasounds
patient ductus arteriosus treatment
ibuprofen and indomethacin
persistent lochia rubra possible problem
inadequate uterine contractions, retained placental fragments, infection, undetected cervical laceration
hypothermia prognosis
increase risk for hypoglycemia, IHV, acidosis
neonatal abstinence syndrome prognosis
increased risk for mental and behavioral issues decreased IQ
retained placenta postpartum implications
increased risk of hemorrhage increased risk of infection
precipitous labor postpartum implications
increased risk of laceraction to birth canal= hemorrhage
extended period of time in stirrups at birth postpartum implications
increased risk of thrombophlebitis
overdistention of uterus postpartum implications
increased risk of thrombophlebitis increased risk of problems breastfeeding increased risk of hemorrhage increased risk of anemia increased stretching of abdominal muscles increased incidence and severity of afterpains
necrotizing enterocolitis signs and symptoms
increased stomach girth, bowel loops, feeding intolerance, hypotension, temperature instability, respiratory distress
diuresis postpartum
increases postpartum failure to diurese increases risk for pulmonary edema and cardiac issues
temperature postpartum
increases up to 38 C first 24 hours related to exertion, dehydration, and mother's milk coming in
neonatal encephalopathy def
infants >35 weeks who demonstrate neurological dysfunction
peritonitis
infection involving the peritoneal cavity
perperal infection
infection of the reproductive tract associated with childbirth that occurs up to 6 weeks postpartum
which component of nursing care is most important for a newborn with respiratory distress syndrome?
keeping the infant in a warm environment
neonatal encephalopathy causes
largely unknown but linked to perinatal asphyxia
acute bilirubin encephalopathy clinical presentation
lethargy fever irritability jitteriness hypotonia apnea poor feeding seizures high-pitched cry
musculoskeletal birth injuries
nasal septal dislocation fractions, CLAVICLE most common
preterm nutrition complications
necrotizing enterocolitis
diabetes postpartum implications
need for insulin regulation episodes of hypoglycemia or hyperglycemia decreased healing
jaundice/hyperbilirubinemia prognosis
neurotoxin= can cause death levels >25mg/dL= risk for bilirubin0induced neurologic disfunction
lochia odor
non offensive and never foul
respiratory distress syndrome prognosis
o2 levels outside 90-95% are associated with worse outcomes risk for pneumothorax
intraventricular hemorrhage prevalence
occurs in 45% of extreme low birthweight infants
neurological birth injuries
ocular, intracranial hemorrhage (increased risk with assistive deliveries), brachial plexus injuries (usually unilateral paralysis of arm), facial nerve trauma (forceps)
meconium aspiration syndrome def
passage of meconium in utero typically due to intrauterine stress. leads to physical obstructions, chemical irritation, infections, and decreased surfactant production
factors that slow involution
prolonged labor, anesthesia, full bladder, retained placaenta
bronchopulmonary dysplasia signs and symptoms
pulmonary edema, narrowing of the airway, airway scarring, wheezing, decreased lung compliance, severe retractions
risks with c/s immobility
pulmonary infection abdominal distention DVT or embolism
persistent pulmonary hypertension etiology
pulmonary resistance remains high right to left shunting in heart -> blood bypasses lungs and fails to get oxygenated self perpetuating and difficult to interrupt
involution of uterus def
rapid reduction in size of the uterus and its return to the pre-pregnant state excess tissue that involved placenta and no longer needed sloughs off
syphilis
rash on posterior and soles of feet fetal hydros, meningitis
cytotec route postpartum
rectal
reeda scale
redness, edema, ecchymosis/brusing, discharge, drainage, and approximation
prevention of mastitis
regular drainage of both breasts
uterine atony definition
relaxation of the uterus; accounts for 80% of PPH
respiratory distress syndrome treatment
respiratory support, surfactant, temperature control, intake and output
necrotizing enterocolitis prognosis
sepsis, DIC, hypoglycemia, metabolic acidosis
intraventricular hemorrhage treatment
supportive care avoid triggers
chlamydia
swelling and discharge vision problems pneumonia
apnea treatment
tactile stimulation CPAP caffeine
a woman who gave birth to a second child 3 weeks ago is depressed, crying, and having extreme difficulty caring for her children. which approach would the nurse take when the husband calls the women's health clinical and asks what he should do?
telling him that his wife may be suffering from depression and needs emergency care
explanation for large stomach after birth and failure to lose all weight gained during pregnancy
the baby, amniotic fluids, and placenta account for only a portion of the weight gained during pregnancy. the remainder takes approximately six weeks to lose. abdomen also appears large because of decrease muscle tone. postpartum exercises will help
explanation for gush of blood that sometimes occurs when she first arrises
there is a normal pooling of blood in the vagina when the woman lies down to rest or sleep. gravity causes blood to flow out when she stands
T pneumonic for bleeding
tone, trauma, tissue, and thrombin
respiratory distress syndrome causes
too little surfactant causes alveoli to collapse= decreased lung compliance
pharmacological pain management
topicals, acetaminophen, opioids, nerve block, deep sedation
hematoma risk factors
trauma to area, primiparity, macrosomia, prolonged second stage, preE, clotting disorder, history of vulvar varicosities
discharge assessment and follow up postpartum
up to date on immunization access to and filled prescriptions for analgesics ensure client has access to follow-up care discuss family planning and contraception before discharge home visit or follow-up phone call 3-4 days after discharge
intraventricular hemorrhage signs and symptoms
usually occur in first 5 days, diagnosed with ultrasound
apnea prognosis
usually resolve by 44 weeks for very preterm
retinopathy of prematurity treatment
usually resolves itself more severe cases require intervention
uterine atony risk factors
uterine distention, prolonged labor, oxytocin in labor, grand-multiparty, anesthesia, magnesium sulfate, Procardia, terbutaline, prolonged 3rd stage of labor, pre eclampsia, retained placental fragments
abdomen postpartum
uterine ligaments stretched and takes postpartum period to recover; also responds to exercises diastatic recti abdominis straie/stretch marks generally fade with time
PPH treatments
uterine tamponade uterine artery embolization surgical management
retained placental fragments treatment
uterotonic agents or curettage
fundal massage
utilized if uterus not firm and contracted may expel clotsand correct cause consider pain medication if additional massage/interventions needed
immune complication prevalence
very common- 43%
treatment for afterpains
warm pack to abdomen, analgesics, ambulation, and prone position with pillow
cleft lip and palate special considerations
watch feedings monitor for respiratory issues
uterine inversions causes
weak muscle, relaxed uterus from anesthesia or drugs, abnormal placental adherence to uterus, manual removal of placenta, or cord tugging
thrombophlebitis def
when clot forms as a response to inflammation in the vein wall
pulmonary embolism def
when clot, formed in deep leg veins, is carried to pulmonary artery
how does phototherapy work
when exposed to blue light bilirubin is converted to lumirubin which does not need to be conjugated in the liver
persistent pulmonary hypertension signs and symptoms
within 24 hours cyanosis and respiratory distress split S2 or systolic murmur
the nurse has received the end-of-shift report on the postpartum unit. which client should the nurse see first?
woman day of delivery, fundus firm 2 cm above umbilicus
prostaglandin contraindications
women with cardiovascular, renal, liver disease, or asthma
jaundice/hyperbilirubinemia symptoms
yellowing that starts in face and moves down yellowing of eyes
persistant pulmonary hypertension prognosis
10% mortality rate risk for developmental delay, CP
weight loss postpartum
10-12 lbs after delivery of neonate and placenta 5lbs from puerperal diuresis return to pre pregnancy by 6-8 weeks postpartum
average blood loss cesarean delivery
1000 mL
corrected age used until when
2 years of life
target weight gain
20-30g/kg/day
average blood loss vaginal delivery
200-500 mL
twelve hours after a spontaneous birth a clients temperature is 100.4 F. which condition would the nurse suspect as the cause of this increase temperature?
dehydration
phototherapy monitoring
dehydration, closely monitor intake and output obtain and monitor vital signs weight loss reassess bilirubin level per providers orders (TURN OFF LIGHT WHILE DRAWING BLOOD AND NO TCB)
what is jaundice/hyperbilirubinemia
difficulties conjugating bilirubin and removing it from body
postpartum UTI clinical therapy
straight catheter x1 bladder scanner to evaluate volume of urine in bladder reoccurrence of distention indwelling catheter for 24 hrs often indicated
alcohol use during pregnancy
structural defects, vision and hearing problems 1st cause of preventable birth defects long term: substance abuse, risk taking behaviors, cognitive impairments
sepsis symptoms
subtle temperature instability, irritability, lethargy, respiratory symptoms, poor feeding, tachycardia, poor perfusion, hypotension
bronchopulmonary dysplasia treatment
supportive may need tracheostomy for long term oxygen delivery increased calorie needs and fluid restrictions
persistent pulmonary hypertension treatment
supportive care first ECMO treat underlying cause
cleft lip and palate treatment
surgical repair at 3 months for lip and 6 months for palate
bright red blood with
suspect lacerations
treatment for laceration
suture/repair
immune complication treatment
antibiotics
DVT and PE treatment
anticoags strict bedrest elevation of affected limn compression stockings analgescs closely monitor for bleeding
preterm respiratory complications
apnea of prematurity respiratory distress syndrome bronchopulmonary dysplasia
postterm
birth at 42wk gestation or later
cleft lip and palate causes
due to genetic syndromes or exposure to teratogens
methergine contraindications
hypertension preE
anemia signs and symptoms
poor weight gain, increased oxygen needs, braydcardia, and apnea
enteral tube feeds
for infants who can't suck, swallow, or breath often started small and gradually increased
cardiac disease postpartum implications
increased maternal exhaustion
clinical therapy for postpartum psychosis and ptsd
psychiatric meds (lithium for psychosis), support groups, electroconvulsive therapy, removal of baby (for psychosis)
hypothermia causes
decrease in subq and brown fat lack of muscle tone immature brain
postpartum/puerperium period
after competition of the third stage of labor; period during which the woman readjusts, physically and psychologically, from pregnancy and birth. it begins immediately after birth and continues for approximately six weeks or until the body has returned to a near non pregnant state
third stage of labor
after delivery of fetus and until delivery of placenta shortest stage of labor placenta and amniotic membranes examined for intactness cord blood obtained
which clinical manifestation would the nurse assess for in a client a few hours into alcohol withdrawal?
agitation, tremulousness
lochia day 10-21
alba
postpartum endomedtritis
an inflammation of endometrium portion of the uterine lining
preterm hematologic complications
anemia
postpartum endometritis treatment
antibiotics (IV for metritis) wound with pus/drainage or infected stitch will have be opened and drained
treatment for mastitis
antibiotics, frequent and complete emptying of breast, rest and increased fluids, supportive bra, heat/ice, nsaids, monitor for access formation, probiotics to promote health flora and decrease risk for candida albicans
A neonate born at 35 weeks' gestation has Apgar scores of 8 and 9. At 4 hours of age the newborn begins to experience respiratory distress, has a below-normal temperature in a warm environment, and has a low blood glucose level. What problem does the nurse suspect?
bacterial sepsis
mastitis diagnosis
based on presenting signs and symptoms culture and sensitivity of breast milk if client does not respond to antibiotics or has reoccurring mastitis
postpartum exercises
begin keels right after birth to help with vaginal tone and prevent urinary leakage short walks abdominal exercises retone muscles reassess exercises if increased lochia or pain vigorous exercise only after cleared at 6 wk postpartum visit
very preterm
birth from 28 to 31 6/7 wk gestation
moderate-to-late preterm
birth from 32 to 36 6/7 wk gestation
late preterm
birth from 34 to 36 6/7 wk gestation
early term
birth from 37 to 38 6/7 wk gestation
full term
birth from 39 to 40 6/7 wk gestation
late term
birth from 41 to 41 6/7wk gestation
extremely preterm
birth prior to 28wk gestation
preterm
birth prior to 37wk gestation
intraventricular hemorrhage def
bleeding into the later ventricle of the brain
immune complications assessment
blood cultures, lumbar puncture, C-reactive protein
sepsis assessment
blood cultures, lumbar puncture, CPC, CRP, chest xray
hypoglycemia def
blood glucose <45 mg/dL (<40 in first four hours)
explanation for passing clots
blood pools at the top of then vagina and forms clots that are passed upon rising or sitting on the toilet
afterpains postpartum
caused by intermittent uterine contractions more common in multiparas oxytocic agents and breastfeeding makes afterpains worse
headache postpartum
causes include cerebrospinal fluid leakage or stress
apnea causes
central, obstructive, or mixed
at 20 hours of age, a newborn is found to have a bilirubin concentration of 13mg/dL. which finding most likely contributed to this bilirubin level?
cephalhematoma
kernicterus clinical presentation
cerebral palsy sensorineural hearing loss gaze abnormalities dental enamel dysplasia (permanent irreversible effects)
meconium aspiration syndrome assessment
chest x-ray, arterial blood gasses
sepsis risk factors
chorioamnioitis, maternal intrapartum temperature of 100.4 F or greater, delivery prior to 37 wk gestation, maternal GBS colonization, prolonged rupture of membranes of 18 hrs or more, fetal tachycardia, meconium-stained fluid, use of a fetal scalp electrode, use of forceps, apgar score of 6 or less
superficial vein disease def
clot involves saphenous vein; more common in women with pre-existing varicose veins and seen 3-4 days postpartum
phototherapy parent education
cluster care and feed newborn at least every 2-3 hours avoid lotions or ointment; can cause skin burns AQUAPHOR ONLY adverse effects are few
preterm temperature instability complications
cold stress
the nurse plans to delegate some of the tasks for the discharge of a postpartum client to an unlicensed health care worked. which activity must be performed by the nurse?
comparing identification bands of the mother and infant
fundus still boggy after massage
concern for postpartum hemorrhage
common complications of infant of diabetic mother
congenital abnormalities stillbirth hypoglycemia hyperbilirubinemia polycythemia delayed lung maturity
meconium aspiration syndrome treatment
deep suctioning is no longer supported focus on maintenance of ventilation and perfusion surfactant therapy ECMO
nursing assessment for mastitis
daily assessment of breast including skin color, surface temperature, nipple condition, and presence of pain if infection present, assess for cracked nipples, poor hygiene, engorgement, supplemental feedings, change in routine or feeding pattern, abrupt weaning, or lack of breast support
necrotizing enterocolitis causes
delayed transit time, increased permeability of GI tract, failure of colonization of good bacteria, breast milk has decreased risk
neonatal encephalopathy prognosis
depends on severity
posttraumatic stress disorder def
development of characteristic symptoms following exposure to one or more traumatic events... examples labor and delivery, loss of baby
hemoglobin and hematocrit postpartum
difficult to interpret because of changing blood volume postpartum 2-3 point drop hematocrit for every 500mL blood loss
which education would the nurse provide to a mother of a newborn regarding the safe use of breast milk?
do not thaw the breast milk in the microwave breast milk can be stored for up to 6 months in the freezer
neonatal abstinence syndrome def
drug withdrawal in infants from mothers that use drugs while pregnant usually seen in first 48-72 hours
post term infants assessment
dry, cracked skin no vernix, lanugo meconium staining
retinopathy of prematurity signs and symptoms
edema, hemorrhage, detachment of the retina
vaginal changes postpartum
edematous and bruising evident, rugae no longer present vagina returns to near normal size and regale returns
white blood cells postpartum
elevated postpartum (20-25k) returns to normal by end of 1st week
postpartum diaphoresis
elimination of excess fluid and waste perspiration at night common offer fresh, dry gowns/linens and shower/sponge bath encourage increased fluid intake
lung physical assessment postpartum
encourage cough and deep breathing; incentive spirometer with c/s, monitoring for pulmonary edema (preterm and preE women at higher risk)
nursing interventions to assist mother in process
encourage skin to skin instruct about newborn caregiving building awareness of and responsiveness to infant interactive capabilities promoting maternal newborn attachment preparing the woman for maternal social role
seizures post partum
epileptics at higher risk postpartum ensure they are taking antiepileptics
large hematoma treatment
evacuation via incision and drainage, ligation of blood vessel, sometimes vaginal packing, antibiotics often ordered
prolonged labor postpartum implications
exhaustion increased risk of hemorrhage nutritional and fluid depletion increased bladder atony and/or trauma increased pain and bruising from prolonged time in stirrups
difficult birth postpartum implications
exhaustion increased risk of perineal lacerations increased risk of hemorrhage anemia
nursing considerations for phototherapy
expose as much skin as possible to light position light and/or pad in line with bank of lights; position height appropriately remove all the baby's clothing except diaper apply eye covering
toxoplasmosis
eye and neuro issues
gonorrhea
eye lid swelling and discharge, leads to eye damage
subinvolution def
failure of a part to return to its normal size after functional enlargement, such as failure of uterus to return to normal size after pregnancy
platelets postpartum
falls as a result of placental separation returns to normal by six weeks postpartum
maternal newborn initial attachment behavior
familiarizes self with baby, touching activities, face to face and eye to eye contact, greets newborn and talks in high pitched voice, responds verbally to noises newborn makes
mother/baby (couplet) care def
family-centered approach for maternal-child nursing where both the mother and her baby are cared for by the same nurse, with the baby remaining at the mothers bedside
mastitis signs and symptoms
flu-like symptoms, warm-reddened painful area of breast
critical postpartum teaching concepts
headache, leg pain, abnormal vaginal bleeding, swelling of face or extremities, chest pain or shortness of breath, thoughts of harming self or baby, oral temperature of 100.4 F or higher, excessive incisional pain or discharge
uterine stimulatns
help contract the atonic uterine muscles oxytocin, cytotec, methergine, and hematate/prostaglandin prophylactic IV/IM oxytocin most effective right after cord clamping
pathologic jaundice def
hemolytic diseases causing total bilirubin to be higher; appear first 24 hours ABO/Rh incompatibility increase RBC breakdown
abruptio placentae, placenta previa postpartum implications
hemorrhage anemia decreased uterine contractility after birth= increased risk of infections
postpartum psychosis risk factors
history of bipolar disorder and postpartum psychosis
ptsd risk factors
history of prior trauma and/or psychiatric history and women who undergo emergency c/s
sibling reaction to postpartum
hospital visitation encouraged, opportunity to see mother and meet baby before discharge need reassurance that they are still special to the parents regression of sibling not uncommon
gi system postpartum
hunger and thirst immediate postpartum period common sluggish bowels delayed elimination and constipaition for fear related pain with bearing down increased gas pain
risk factors for postpartum depression
hx of depression, ppd, or bipolar illness stressful life events primiparity ambivalence about maintaining the pregnancy lack of social support dissatisfaction with herself complication of delivery loss of newborn age
causes of postpartum thromboembolic disease
hyper coagulability of blood, increased blood clotting factors, postpartum thrombocytosis, release of thromboplastin substances from decider, placenta, and fetal membranes with delivery, increase in fibrinolysis inhibitors venous status injury to epithelium of vessel
postterm and LGA complications
hypoglycemia meconium aspiration syndrome birth trauma infection cephalopelvic disproportion polycythemia
late preterm infants at risk for
hypothermia, hypoglycemia, respiratory distress, jaundice, feeding difficulties
low or decreasing blood pressure a sign of
hypovolemia and/or hemorrhage
small hematoma treatment
ice first 24 hrs and then heat
postpartum women with psychiatric disorder assessment
identify risk factors obtain personal/prenatal/family health history provide screening tools observe for objective signs of depression recognize risk for suicide
presence of clots possible problem
inadequate uterine contractions that allow bleeding from vessels at the placental site
immune complications prognosis
increase risk of mortality and longer hospital stay
postpartum UTI causes
increased diuresis increased bladder capacity decreased bladder sensitivity from stretching or trauma bacterial shedding with urinary stasis contamination from catheterization inhibited neural control of bladder following anesthesia
cesarean birth postpartum implications
increased healing needs increased pain from incision increased risk of infection increased length of hospitalization exacerbation of carpal tunnel syndrome
mastitis definition
inflammation of the breast with or without bacterial infection, that occurs primarily in lactating women
contraception postpartum
information made available to couple before discharge from hospital stress that pregnancy can occur before first menstrual period returns
vulvar, vaginal, and pelvic hematomas caused by
injury to blood vessel from birth trauma soft tissue opportunistic for large and rapid hematoma development
retained placental fragments diagnosis
inspect delivered placenta for intactness and for any missing fragments uterine exploration sonography
postpartum chills
intense tremors that resemble shivering immediately after birth caused by hormones, anesthesia, and release of pressure on the pelvic nerves
lactation post partum
interplay of hormones lead to established milk production
preterm neurological complications
intraventricular hemorrhage periventricular leukomalacia
anemia treatment
iron supplementation, blood transfusions
neonatal abstinence syndrome signs and symptoms
irritability, high-pitched cry, sleep/wake disturbance, failure to thrive, hypertonia, hyperactive reflexes, tremors, skin excoriation, disorganized feeding, vomiting, frequent loose stool, swelling, sneezing, mottled skin, fever, nasal stuffiness, yawning
which finding would the nurse report to the health care provider after assessing a 12-hour old newborn?
jaundice
apnea prevention
keep at stable temperature airway in neutral position
jaundice exchange transfusions
most effective way, but more risk, more expensive reserved for very high levels or neonate with neurologic symptoms very effective in ABO/Rh incompatibility blood is removed and replaced 10% at a time
postpartum psychosis def
most serious of psychiatric disorders but rare a medical emergency because of suicide and infanticide risk
hypothermia signs and symptoms
mottled, cyanotic, cool to touch
hypoglycemia signs and symptoms
lethargy, sleepiness, limpness, poor feeding, hypothermia, temperature instability, pallor, cyanosis, respiratory distress, hypotonia, tremors, high-pitched cry, exaggerated Moro reflex
maternal newborn attachment factors
level of trust and self esteem, capacity for enjoying herself, adequacy of knowledge about childbearing and childrearing, prevailing mood or usual feeling ton, and reactions to the present pregnancy
oral feeds
limit feeding attempt to 15-20 min limit number of attempts per day stop with signs of distress
retinopathy of prematurity risk factors
low gestational age and weight artificial ventilation surfactant therapy
fetal alcohol syndrome signs and symtpoms
low nasal bridge minor ear abnormalities indistinct philtrum micrognathia epicanthal folds short palpebral fissures flat mid face and short nose thin upper lip
phototherapy goals
lower bilirubin
neonatal encephalopathy treatment
maintain physiologic hemostasis seizure control fluid restriction therapeutic hypothermia
uterine inversions treatment
manual repositioning of uterus in pelvis by doctor
lochia def
maternal discharge of blood, mucus, and tissue from the uterus
patient ductus arteriosus screening
measure spo2 on right hand (pre-ductal) then on other extremity (post-ductal) greater than 3% deviations indicate follow up, repeat results indicate heart defect
anemia assessment
monitor for signs and symptoms, cbc
postpartum blues symptoms
mood swings, anger, weepiness, anorexia, difficulty sleeping, and a feeling of letdown... when asked why she's crying responds IDK
explanation for afterpains
more common in multipara. caused by contraction and relaxation of uterus. increased by oxytocin, breastfeeding. received with mild analgesics and time
intraventricular hemorrhage prognosis
mortality rate is 40% at grade IV bleed cerebral palsy post hemorrhagic hydrocephalus
reciprocity
mutual regulation achieved and mother/baby interaction mutually gratifying
respiratory distress syndrome signs and symptoms
pale, cyanotic, decreased lung sounds/crackles, retractions, nasal flaring, tachypnea, grunting chest x-ray show ground glass appearance
fundus is not firm
perform fundal massage and should firm up with massage
postpartum blues def
period of depression that can occur postpartum
cytomegalovirus
petechiae, jaundice, neuro issues, hearing loss
on the third postpartum day after a cesarean birth a client tells the nurse that her breasts feel warm, firm, and tender. the skin is shiny and taut. which condition would the nurse suspect as the cause of the client's breast discomfort?
physiologic engorgement
the nurse in the postpartum unit is teaching self-care to a group of new mothers. which color would the nurse teach them that the lochial discharge will be on the fourth postpartum day?
pinkish brown
taking hold period
postpartum day 2 or 3 ready to resume control of mothering and life; critical judges own ability to care for abby; nurse should reassure client and encourage
sga/fgr complications
prematurity, FETAL HYPOXIA, mas, hypothermia, hypoglycemia, polycythemia
migraines postpartum
prevalence returns to pre-pregnancy baseline postpartum
exfoliation part of healing process
prevents uterine scarring that can affect future pregnancies and implantation
postpartum blues risks
primipara, hormones, unsupportive environment/insecurity, fatigue, and pain
uterine inversion def
prolapse of the uterine fundus to or through the cervix so that the uterus is in effect, turned inside out after birth
bronchopulmonary dysplasia causes
results from oxygen adminsitration and mechanical ventilation
cardiac output postpartum
return to predelivery levels 1hr post delivery return to prepregancy level 6-12 weeks postpartum
reoccurrence of ovulation and menstruation postpartum
returns 7-12 weeks for non lactating women and 3 months to as late as 3 years for lactating women
hypothermia treatment
rewarming
siblings and others
rooming-in and visiting hours encourages participation of attachment for other family members/siblings
lochia day 2-4
rubra
skin infections
scalded skin syndrome- staph aureus
transient tachypnea of the newborn signs and symptoms
seen within 2 hours of birth, clear breath sounds, typically resolve in 24-48 hours
neonatal encephalopathy signs and symptoms
seizures, poor tone, diminished reflexes, feeding difficulties, weak cry 5 and 10 min APGAR below 5 acidemia
transient tachypnea of newborn treatment
self limiting, monitor closely some may need supplemental oxygen and NG feeds
transient tachypnea of the newborn causes
self-limiting, delayed clearance of alveolar fluid increased risk for c-sections, preterm, diabetic mothers
GBS
sepsis, pneumonia, meningitis
lochia day 7-10
serosa
lochia amount
should never exceed moderate, average 6 partially saturated peri pads/day normal
meconium aspiration syndrome signs and symptoms
signs of respiratory distress within 15 min increased anterior posterior diameter rale and rhonchi
abdominal distention prevention
simethicone ambulate when able general anesthesia client at higher risk lie on left side; promotes gas expulsion
father newborn interactions
similar to mothers attachment engrossment: sense of absorption, preoccupation, and interest in baby
postion to assess perineum
sims postion/buttocks lifted
postpartum psychosis symptoms
sleep disturbances depersonalization confusion hallucinations psychomotor imbalances
client self teaching for sleep
sleep when baby sleeps, utilize family and friends for support/assistance, delegate/postpone unnecessary tasks
lochia presence of clots
small clots not unusual because of pooling blood in vagina; large clots abnormal
which clinical manifestations of withdrawal would the nurse anticipate in a newborn exposed to opioids prenatally?
sneezing, hyperactivity, high-pitched cry, exaggerated Moro reflex
a newborn has an Apgar score of 3 at 1 minute after birth. which is the immediate nursing action response to this Apgar score?
start resuscitation
perineum client teaching
stitches will dissolve in a few weeks cleanse perineum with peribottle after elimination when wiping change peri pads frequently perineal ice packs for first 24hrs sitz bath after 24 hrs witch hazel, benzocaine spray, dibucaine analgesics for pain, stool softeners NO SUBMERGED BATHS
goal for postpartum hemorrhage
stop hemorrhage correct hypovolemia treat the underlying cause
apnea signs and symptoms
stopping breathing for 20 seconds or more or stopping in breathing associated with bradycardia (70-80bpm) or hypoxemia (80-85%)
blood pressure postpartum
transient rise immediate postpartum common then return to pre-pregnancy baseline within couple days orthostatic hypotension
becoming a mother (BAM)
transition process of becoming mother and change in mother-child relationship commitment, attachment, and preparation (pregnancy) acquaintance, learning, and physical restoration (first 2-6 weeks after birth) moving toward a new normal (2 weeks to 4 months) achievement of the maternal identity
which conditions increase the risk for postpartum hemorrhage?
twin birth, over distended bladder, retained placental fragments
