Postpartum care of the mother

Nurse is teaching breast care for lactating woman. What information should be included? Select all that apply

- Expose the nipples to air for 20 to 30 minutes daily - Wear a supportive bra 24 hours a day for the first few weeks

Which classification of perineal laceration will the nurse document when noting that extends through this sphincter muscle?

3rd degree

What are warnings signs for postpartum period

Abdomen pain, baby blues, constipation, hemorrhoids, hormonal shift, perineum soreness, and sore breast

Normal vs. Abnormal PP findings

Abnormal-passive reaction, verbal or nonverbal. Hostile reaction, disappointment about gender, lack of eye contact, non supportive interaction between parents Normal-making eye contact, asking questions, smiling at nurses, making comments about baby appearance, parents excited

What signs/symptoms/restrictions would be included in discharge teach of the PP pt

After delivery, the woman is instructed to make a follow up appointment with her PCP in 6 weeks. Infants are seen by the PCP at 2 weeks of age.

Knowledge deficient

Anxiety Parenting Family processes Parenting, impaired Self esteem Nutrition, less than body requirements Nutrition, more than body requirements Pain, acute Tissue integrity, impaired Sleep patterns, disturbances

A woman gave birth 48 hours ago to a healthy baby girl. She has decided to bottle feed during the assessment. The nurse notices that both breast or swollen, warm and tender on palpitation. The patient should be advised that this is best treated with what action.

Apply ice to the breast for comfort

Nurse is performing a routine PP assessment. Which action is indicated before the fundal height is measured?

Ask the patient to empty her bladder

A primigravida has delivered a baby vaginally after 6 hours of labor. She had an uneventful pregnancy and is in good health. She is transferred from recovery to postpartum unit. What interventions are included in routine postpartum care? Select all that apply

Assessment of intake and output until the patient is voiding in sufficient quantities Assessment of emotional status of new mother Checking of breast for engorgement and cracking of nipples

When performing a post partum assessment, what should the nurse do?

Assist a patient into a supine position, with her arms above her head, and her legs extended for the examination of her abdomen

Which process is necessary for the uterus to decrease in size after delivery

Autolysis

When teaching parents had to be there, baby which points of the nurse stress?

Avoid immersing the baby in water, until after the umbilical cord has fallen off

Which period of time following delivery will the nurse expect gradual descension of uterine fundus

Between 36 and 60 hours

What are signs of thrombophlebitis? What nurse to do to assess it?

Calf pain Tenderness or swelling

How do you properly assess the fundus in the postpartum period

Check fundus and lochia every 15 minutes for 1-2 hours after delivery. Fundus should remain contracted, firm, and midline.

When providing education to parents about care of the umbilical cord, what information should be included? Select all that apply.

Cleaning the cord with an alcohol Keep in the diaper folded below the cord

What assessment is required in 4th stage of labor

Close observation and assessment, needs emotional support

What med would be appropriate in the PP period for mild to moderate pain

Codeine (with acetaminophen oxycodone terephthalate)

A baby has a Gomco circumcision. What instruction should the nurse give his parents for care of the circumcised penis?

Cover the glans with a petroleum gauze dressing

Correctly order the events that occur after childbirth

Delivery occurs first Uterine lining shed Followed by bright red drainage, called lochia rubra As a percent aside, heals the discharge things and becomes pink to brown called lochia serosa After the seventh day, the drainage is slightly yellow to white and is called lochia alba. This drainage continues for another 10 days to 2 weeks.

signs and symptoms might a PP experience

Depression, excessive crying, difficulty crying

What discharge teaching can the nurse give new mom who is experiencing urinary incontinence when sneezing or coughing

Do kegals and wear a pad or liner

How can the nurse facilitate of PP blues and PP psychosis

Doesn't discuss labor and birth experience Refusal to interact with baby Refusal to attend infant care Refuse to discuss contraception Reference self as ugly and useless Excessive preoccupation with body image Hormonal factors and fatigue are often responsible

Which action by the nurse in mother will support milk production and promote infant. Comfort select all that apply.

Drink 8 to 10 glasses of fluids daily, continue her prenatal vitamins and minerals until they are gone, avoid spicy food, chocolate, and onions

What time of day would infant abduction most likely occur

During visiting hours

Refers to the face to face position in which a parent and infant faces are approximately 20 cm apart and on the same plane or level

En face

The nurse observes, a new mother, turning away from her infant Insigne deeply which intervention with must be appropriate for the nurse

Encourage the new mother to discuss her feelings by sitting next to her and stating having a baby can be overwhelming

The fathers behavior when introduced to his new baby, it's typically an intense fascination. What is this behavior considered?

Engrossment

The term applied to a pair of absorption, preoccupation an interest in his or her infant, the term typically is used to describe the fathers intense involvement with his newborn

Engrossment

The nurse helps the breast-feeding woman change her newborn's diaper after the babies first bowel movement. The mother expresses concern because of a large amount of sticky dark green, almost black stool. She asked the nurse if something is wrong. What information should be included in the nurses response

Explain that this type of stool is called meconium and is expected for the first few bowel movements of all newborns

How to explain to use a peri bottle

Fill bottle with warm water, aim to peri area, and squeeze

What is colostrum? And color?

First secretion produced by the breast. It's color is light yellow and thick.

What assessment findings would be normal for the pt who is 1 day postpartum

Fundus may be be one finger breadth above or at the level of the umbilicus

During a postpartum, check, the nurse assesses the new mothers uterus, and notes it being boggy. What is the nurses first intervention

Gently massage the fundus to increase contractility

Action with pt experiencing PP pt suffering from a persistent headache

Gestational HTN, stress, and leakage of CSF into the extradural space during placement of the needle for epidural. Depending on cause, it can last 1-3 days or even weeks.

Which complication will the nurse suspect when the patient perineal pad is soaked, pulse is 110beats/min, bp 80/60 mm Hg, and reports feeling weak, lightheaded, and sick to stomach

Hypovelemic shock

The new mother reports feeling weak lightheaded being sick to her stomach. The LPN also knows that the patient peroneal pad is so since you last checked it 15 minutes ago the patient skin is cool and clammy. The pulse is 110 bpm in the blood pressure is 80/60. What complication do these symptoms indicate

Hypovolemic shock

What to teach the bottle feeding mother about care of her breasts after delivery and engorgement

If not breastfeeding, compress breast with firm bra, wrap ice packs, and analgesics are recommended

What are the most appropriate patient problems for a breast feeding mom? Select all that apply

Imbalanced nutrition: less than body requirements related to the demands during lactation Anxiety related to lactation expectations Potential for infection related to dry, cracked nipples

Which physical signs and symptoms might the postpartum patient experience following delivery. Select all that apply.

Increase urination, beginning 4-6 hours after delivery, increase diaphoresis most commonly at night, and normal bowel movement, within 2 to 3 days.

Which complication will the nurse include when educating a patient about a bladder distention following childbirth select all that apply

Infection Delayed return of normal voiding Excessive bleeding immediately after giving birth

Nurse finds bright red bleeding on pt peripad. The stain is about 6 inches long. What is correct description of the character and amount of lochia?

Lochia rubra, moderate

What to teach a mom about breastfeeding

Manual pumping of breast may help in some cases ( an infant who can't suck) ( mother gone for some time) Benefits of breast feeding- more rapid involution of uterus, mother bonds more with baby, has antibacterial and antiviral properties, immunoglobulins, and anti allergy factors, milk has growth, digestive, and protein factors

What is priority after the nurse assesses a boggy uterus

Massage until firm

What observations indicate infant bonding is occurring

Mother is involved in baby care, mother making eye contact, and asks questions about baby

What assessment is done prior to getting out of bed after a spinal or epidural

Pain, sensation of legs, vital signs

On examining a woman who gave birth five hours previously, the nurse finds out the woman has saturated a peri pad within 15 minutes. What action is a nurses first priority

Palpate the women's fundus

What are warning signs that a mother isn't bonding with baby

Passive reaction, either verbal or nonverbal Doesn't touch, hold, or talk in affectionate term or tones

Measures could prevent infant abduction

Personnel must wear name badges, no one without proper identification should handle/transport infants, question people walking in halls w/babies, investigate anyone near an exit with baby

The nurse can help a father and his transition to parenthood with what action

Pointing out that the infant turned to his voice

What type of bleeding is abnormal in the postpartum period

Postpartum hemorrhage

Where should the fundus be located 12 hours after delivery

Rised to the umbilicus

What are the 3 types of lochia and how long?

Rubra- bright red drainage, 1-2 days after delivery Serosa- pink to brown drainage, until day 7 Alba- yellow to white drainage, 10-12 days

Which statement accurately describes a let down reflex

Shedding of the uterine lining through a sequence of lochia serosa, lochia alba, and lochia rubra

What interventions are appropriate for the PP pt with a laceration in regards to bowel movement

Stool softeners, hydration, fiber ice packs, sitz bath

What assessments should be performed regarding urination? What limitations will be present?

Support bladder above symphysis pubis and check for fullness Encourage voiding, full bladder could interfere with complete contraction, causing hemorrhage Initial void should occur 4-6 hours after delivery Tissue edema can cause issues Some women experience reduced sensitivity and unaware of full bladder

What phase of maternal postpartum adjustment characterized by a woman's, need to review her labor and birth experience with the nurse who care for her while she was in labor. Other behaviors exhibited include reliance on others to help her meet her needs excitement and talkativeness

Taking in

What is the normal variation in vital signs during PP period

Temp may rise to 100.4 F (38 C) due to dehydration. Heart rate between 50-70 beats/min is considered normal. Respirations should be within normal limits. BP could be slightly elevated due to from exertion, excitement, and possibly from oxytocin medications.

A baby boy is one hour old one admitted to the newborn nursery. He weighs 7 lbs. 3 oz. is 21 inches long has irregular respirations at 42 breaths per minute with adequate chest movement a heart rate of one 45 bpm and a temperature of 35.6°C and is acrocyanotic. What is an appropriate goal for this baby with the next two hours based on these findings

Temperature will stabilize at 36.5° to 37°C.

A woman asked the nurse how she will know her babies get enough milk. The nurse this response is based on understanding that watch is best determined?

The baby has 6 to 10 wet diapers per day

In evaluating maternal adjustment, which behavior leads the nurse to believe that the patient is still in her taking in phase

The majority of the mothers time is spent talking about her delivery experience

The nurse observes several interactions between a post partum woman and her new son. Which behavior if exhibited by this woman does the nurse identify as maladaptive regarding parent infant attachment

The mother barely makes eye contact with her son

A first time mother is to be discharged from the hospital tomorrow with her baby girl, which maternal behavior indicates a need for further intervention by the nurse before she can be discharged

The mother leaves the baby on her bed while she takes a shower.

What would you teach pt about engorgement

The symptoms and methods to obtain relief. If breast feeding, interventions such as manual expression of milk and application of warm, moist heat are most useful

What occurs during the "taking in" response

This time occurs immediately after birth. She sleeps, depend on others for nurturing and food, and relives the event surrounding the birth.

Normal changes in mood might the PP pt experience with perineal discomfort when seated?

Uncomfortable, unrelaxed, burning, irritation, exhaustion

Normal progression of involution

Uterus decrease 1cm per day in size

What is hypovolemic shock? Signs and symptoms

Women has persistent bleeding. This bleeding may not change her in vital signs, color, or behavior. States feeling weak, lightheaded, "funny" or "sick to my stomach" Acts anxious, or exhibits air hunger. Skin turns pale and clammy. HR increase, BP drops.

Refers to the process, whereby an infants, behavior and characteristics call forth a corresponding set of maternal behaviors and characteristics

bonding

What is engrossment?

the characteristic sense of absorption, preoccupation, and interest in the infant demonstrated by fathers during early contact.