Intro to Maternity Nursing and Postpartum Care – Flashcards
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What is an advanced practice midwife that can bill insurance(at hospital, not at home)? They need a referring physician (which can be remote)
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Certified Nurse Midwives (Master's Degree) They are qualified to give complete care during pregnancy, child birth and postpartum
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What type of midwife can be arrested for practicing?
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Lay/traditional midwife
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What is the main factor that decreases the death rate in OB?
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Better and widespread prenatal care!
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Should the uterus feel firm or boggy post delivery?
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Firm, boggy is a bad sign, must give massage to make firm
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What is the issue (for the mother) with prolonged bed rest in traditional hospitals?
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DVT and pneumonia
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Why do facilities stand to benefit from shorter hospital stays?
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DRG's (Diagnosis Related Groups) - insurance pays a set amount related to disease or OB, so hospital wants to get patient out sooner, keep the difference
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Average cost of vaginal delivery vs. c-section?
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3-10,000 vs. 10-40,000
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The postpartum period is often called the ____ trimester and can last up to 6 weeks post delivery
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4th trimester (puperium period) Can get pauperism infection
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When can a new mommy get back to a regular exercise program?
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6 weeks post delivery, but can do kegal exercises and reverse curl immediately.
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What does BUBBLE HE Stand for?
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Breasts, Uterus, Bladder, Bowels, Lochia, Emotional, Homans, Episiotomy
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What does the term Involution mean? How long does it take?
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Referrs to the uterus returning to the Pre-Pregnant size after birth and takes 10-14 days.
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When documenting uterine descent, what does the nurse chart for at the Umbilicus?
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U
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When a uterus is higher than expected or deviated, what does that mean?
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Full bladder
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What chemical in the body causes milk let down and also causes contractions in the uterus to control the bleeding?
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Oxytocin
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How does the mama help to release oxytocin?
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Breast feed
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What can the nurse offer the mama to control inflammation?
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Ice pack, sitz bath, pain meds
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True or false? The more children the women had, the more severe the after pains?
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True
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How many days until the fundal height has shrunk down and is no longer palpable?
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7-10 days
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How does a nurse identify if the mama has an infection?
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Lochia smells bad and lots of vaginal drainage
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How many weeks along is the patient if her fundal height measures 20 cm?
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20 weeks
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What is considered full term?
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37-42 weeks
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True or False: A full bladder doesn't effect child birth process?
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False, a full bladder can inhibit fetal descent, so put in straight catheter if she seems full.
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If you assess the funds and it is U+2 and to the right, what do you do?
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Have the patient void.
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When assessing fundus, what position is the mama in?
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Supine
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What happens if you push wrong on the fundus?
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Uterine inversion
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IF there is excess lochia, what might be the problem?
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Boggy uterus, needs to do a fundal massage. This is dangerous and can lead to PPH
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True or False: Light Lochia covers 4-6 inches on a pad in 2 hours?
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False, Light lochia covers 1-4 inches, Scant is less than 1 inch, moderate is 4-6 inches, and heavy saturates pad in less than 1 hour
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Describe the characteristics/color of Lochia in the first 3 weeks?
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Rubra in the first 3 days, Serosa: days 4-10 which is pink or brown, and Alba: days 11-21, decreased amounts in white cream or light yellow
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How much blood is loss in a C-section? Vaginal delivery?
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1000ml in C-section, Up to 500 ml in a vaginal birth. C-section bleeds less on the pad because its cleaned out after the c-section.
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When a patient has a midline episiotomy, what should the nurse teach?
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Increase fiber in the diet, increase fluid intake, and take a stool softener
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When a patient gets hemorrhoids, what is important nurse teaching?
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Talk to patient about stool softener, sitz bath to relieve pain, keep the area clean, use tuck's pads (soaked in Witch hazel), ice and lidocaine based sprays.
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How much does a woman's blood volume increase during pregnancy?
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50%, 2 Liters more of blood to Oxygenate the placenta
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To treat edema in postpartum, patient should elevate legs, wear compression stalkings, drink fluids, and ____
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ambulate, muscle contractions help to circulate fluid and pee it out.
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If patients hemoglobin is 9, what does this mean, and what do we do?
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It is a low blood count and we find out if she is chronically anemic, is she light headed/dizzy? a fall risk? Does she need iron?
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If a patient is a C-section, and they say they have no pain, why would we want them to cough or roll?
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to assess pain level, because they are going to have to get up and walk, and we want to premeditate to get pain under control, so they are willing to get up.
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What is chloasma
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mask of pregnancy, hyper pigmentation of areola and line negra, usually disappears at end of pregnancy
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True or false: Hair loss, brittle nails, and a rash are common postpartum changes
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True
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Prolactin does what?
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Milk production, if not breast feeding, prolactin will diminish and return to prepregnant levels in 2 weeks
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What is the "let down" hormone?
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Oxytocin
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True or false: Breast feeding is a good form of birth control?
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False, contraception must be used, breast feeding not a guarantee
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Average amount of weight a woman loses post child birth?
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12 lbs, they also lose another 5-8 lobs from involution and diuresis. They usually get back to prepregnant weight about 6-12 months after birth,
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What are the initial signs of hypovolemic shock?
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Tachycardia, pale, initial rise in BP and then fall,
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True or false: Initially a mother's pulse rate might be slightly bradycardic post childbirth?
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True, due to increased blood volume, HR may be slightly low
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A temperature over ____ may indicate an infection?
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100.4
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A postpartum client is lying in a pool of blood and her fundus is boggy, what is the priority action?
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massage the uterus
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What is the first milk called from mama?
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Colostrum, milk usually comes in 2-4 days. The first days, mama's breasts are soft and filling
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Check nipples for shape (everted, flat, inverted), _____, and ____
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nipple trauma and mastitus (infection)
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Is positive homan's sign a definitive sign of DVT?
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No
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Advantages to PO meds?
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longer pain coverage, and longer 1/2 life than IV
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What is normal bowel sounds for postpartum?
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1 sound in 10 seconds is normal in each quadrant
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Can a postpartum c-section patient have food initially?
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No, bowel was exposed to air, NPO, only sips and chips until pass bass, progress slowly to avoid vomiting. Warm fluids and warm compress
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What does REEDA stand for?
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Surgical wound assessment (C-Section): Redness, Edema, Echymosis, Drainage, Approximated (hissing, coming a part)
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If there is blood on the C-section dressing, what do you do?
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Put a line around it and check it to see if it grows
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What helps to dry up milk if not breastfeeding?
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cold compresses, tight shirts, cold showers, no stimulation, leaf cabbage under bra
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What do you teach a patient about signs of infection?
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Fever, pain/tenderness, foul smelling odor, drainage
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True or False: The taking in phase mom is preoccupied with herself, reviews the reality of giving birth and compares infant to fantasy child. More concerned with rest, food and comfort
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True, The other phases are: Taking Hold Phase: she resumes control of her life, interested in caring for new born; the Letting-Go Phase: may take several weeks, letting go of what she thought it was going to be, to accepting what is
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True or false: Postpartum blues affects 70-80% of mamas and should last 2-4 weeks?
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False, should only last maximum of 2 weeks and starts within the first week, to distinguish between postpartum depression - which is a downward spiral - symptoms more severe and can last up to 1 year.
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Your friend says she is not sure she wants a doctor to deliver her second baby because she believes doctors are too busy to talk with her when she has check ups. The best alternative professional to suggest is:
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Certified Nurse-Midwife
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Difference between social communication and therapeutic conversation is that therapeutic is:
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focused on achieving a relevant goal for the patient
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A nursing diagnosis differs from a collaborative problem primarily in terms of whether the nurse:
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Can prescribe definitive treatment for the problem
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What is the significance of bradycardia during the early postpartum period?
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Blood volume and cardiac output increase as blood from the uteroplacental unit returns to the central circulation and as excess extracellular fluid enters the vascular compartment for excretion. Because stroke volume increases, pulse decreases.
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What makes pregnant and postpartum women at risk for venous thrombosis?
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They have higher fibrinogen levels which increase ability to form clots, also some women have additional risk factors: varicose veins, thrombophlebitis history, or a cesarean birth
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How does full bladder at birth lead to postpartum hemorrhage?
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it interferes with the ability of the uterus to contract firmly and occlude open vessels a the placental site.
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Which mom's would be candidates for Rhogam?
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Rh(-) mom, with a Rh(+) baby
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When checking a woman's funds 24 hours after C-section of her 3rd baby, the nurse finds her fundus at the level of her umbilicus, firm and in the middle, her next action related to this assessment is to:
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Document it as normal
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A woman who is 18 hours postpartum says she is having hot flashes and sweating. The nurses response:
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tell her that her body is getting rid of unneeded fluid
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A woman who is 3 hours postpartum has difficulty urinating and she finally urinates 100 ml, the initial nursing action is:
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Assess the height of the fundus
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A young mother is excited about her first baby, the best teaching to help her obtain adequate rest is to suggest:
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plan to sleep when the baby sleeps
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Choose the best independent nursing action to aide episiotomy healing in a women 24 hours postpartum?
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Warm sitz baths taken 4 times a day
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To prevent breast engorgement, the nurse should teach the non-breastfeeding postpartum women to:
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wear well-fitting bra and breast binder constantly
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A woman who is 4 hours postpartum ambulates to the bathroom and suddenly has a large gush of lochia rubra. The nurses' first action should be to:
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determine whether the bleeding slows to normal or remains large
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Twelve hours after birth, a mother lies in bed resting. Although she will be discharged in another 12 hours, she does not ask about her baby or provide care. What is the probable reason for her behavior?
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She is still in the taking-in phase of maternal adaptation
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A newborn is rooming in with his teenage mother who is watching TV. The nurse notes the baby is awake and quiet. The best nursing action is:
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pick the baby up and point out his alert behaviors to mom.
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Where does hemorrhage usually happen to the mother?
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At the placental insertion site
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How much fluid can uterus hold?
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5 liters, and it sits behind pubic symphonies
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What is the neck of the uterus?
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The cervix
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What is "in the call" mean?
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The baby is born in the sac
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If placenta doesn't come out whole, what does this mean?
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It can lead to hemorrhage and/or sepsis
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Fastest growing group of homeless people is:
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women and children
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Early postpartum period lasts from:
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second day after birth until end of the first week
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Immediate postpartum period is:
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first 24 hours after delivery
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Where is Uterus immediately after delivery?
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low and then within 6-12 hours it springs up to U or U+1
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How long does cardiac output remain elevated after birth?
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up to 2 days after birth
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When should hematocrit levels return to normal?
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4-6 weeks
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True or false: Patient should urinate within 2 hours after delivery?
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False, within 4 hours, or try straight catheter
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What is a side effect of epidermal?
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Spinal Headache
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If you are going to breastfeed and be on "the pill", what kind of birth control?
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Progesterone only
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If patient had duramorph, how often do you check vitals?
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Q1 hour x 24 hours, check respiratory
