PostPartum/Home Care

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What are some nursing dx for woman with postpartal complications?: -Risk for altered parenting related to disappointment in the sex of the child
-Fear related to lack of prepartion for child care
-Risk for fluid volume defici related to post-partum hemmorahage
What are some high risk factors for postpartum complications?: PIH
Diabetes
Fast Labor
C-Section
Blood loss from uterus greater than ________ml is considered hemorrhage: 1000
Average blood loss is _____ml w/in 24 hours: 500
What is the reason for early postpartal hemorrhage?: Uterine Atony
Lacerations
Retained Placental fragments
DIC
What is the most frequent reason for hemorrage?: Uterine Atony
Multiple Gestation, hydraminos, large baby, cervical or uterine tears, myoma, anesthesia or pitocin, fetal death or DIC are all causes of _________ ___ ______: Relaxation of the uterus
If the uterus relaxes, there will be a _____ ___ ______: Gush of blood
What is the most high rsk time period after delievery?: 1 hour after delievery
What should the nurse do if PP hemorrhage is suspected?: -Uterine Massage
-Count # of pads
-turn patient on side and look for pooling
-Blood replacement orders
-Pitocin induction if order by physician
Sometimes if the hemmorahage is to bad, a __________ my have to be performed: Hysterectomy
Are small lacerations common after giving birth?: Yes
What are large lacerations caused by?: Difficult labor
Primigravidas
Cervical lacerations are usally on the _____ of the cervix: Sides
The worst perineal laceration is threw entire _______, _____ _______, and also some of the rectal mucous membranes: Perineum and Rectal Scphinter
When a patient has a #4 type perineal laceration you never use or do _________ or _________ ________: Enemas
Rectal Temps
If the patient has a #4 laceration, you always encourage _______ and the use of _____ __________: Fluids
Stool Softeners
An infection of the reproductive tract is called a: Puerperal Infection
If the Puerperal infection progresses it can lead to __________ or __________: Peritonitis
Septicemia
What is the treatment for puerperal infections?: Antibotics
If a person has a vaginal laceration, expect to see ________: Packing
Vaginal lacerations are ______: Rare
Every placenta should be ________ after birth: Inspected
If a large amount is retained _______ bleeding will occur: Immediate
If a small amount of placenta is left in, it may take up to _____ days for hemorrahage to occur: 10 days
Rapid contraction of the uterus after delievery of the placenta: Placenta Sealing
How long does it take for a woman to heal after delievery?: 6-7 weeks
Contractions after birth reduces the bulk of the uterus and the walls of the uterus thicken and contracts causing ________ ________: Uterine Shrinking
Retrogressive changes that return the reproductive organs, particulary the uterus, to their non-pregnanct size and condition: Involution
Some things that may cause uterine involutions to slow down or be delayed is: -Birth of multiples
-Hydraminos
-exhaustion
-Retained placenta
-Full bladder
Part of the uterus that is the farthest from the cervix above the openings of the fallopian tubes: Fundus
The fundus should be located ______ in the abdomen: Midline
Fundal height should be palpated ________: frequently
The uterine consisentency should feel ______: Firm
If the fundus feels boogey that means that the uterus is not ________ as it should be: Contracting
Uterine flow consisiting of blood fragments: Lochia
Three types of Lochia are:: Lochia Rubia
Lochia Serosa
Lochia Alba
Red vaginal discharge that occurs immediately after childbirth composed mostly of blood: Lochia Rubia
Lochia Rubia last for the 1st _____ days: 3
Pinkish or brownish vaginal discharge that follows lochia rubia, composed largely of serous exudate: Lochia Serousa
Lochia serousa starts on the _____ postpartum day: 4
White, cream colored, or light yellow vaginal discharge that follows lochia serosa. Occurs when the amount of blood is decreased and the # of leukocytes is increased: Lochia Alba
Lochia Alba last for approx ____ to ____ weeks: 2-6
If you saturate a pad in less than 1 hour is ____________: Abnormal
If odor is present it is a sign of uterine _________: Infection
These kind of exercises are good for the vagina to get it back in shape: Kegel Exercises
Since the fetal head exerts pressure on the bladder and ureters, it leaves the bladder with loss of _____ and ______: Tone and Edema
After delievery, extensive _________ occurs in the urinary system: Diuresis
The GI system makes this changes after birth to promote healing:: Hungry and Thirsty
Hemorrhoids are common
What is still present in the GI system after labor?: Relaxin
What are some retrogressive changes after childbirth?: Exhaustion
Weight loss
_____ pounds is usually lost upon delievery, and then an additional ____ pounds over 2-5 days: 12
5
If a mothers temp is over _____ is is suggested to be febrile and _______ should be suspected: 100.4
Infection
The pulse should be slightly _____: decreased
BP returns to ______: Normal
Lactation starts to occur and 3 day milk forms in the breast ducts causing primary __________: Engorgement
During the 1st 24hours, you should assess:: Lab Data (H&H and UA)
Family Profile
Pregnancy HX
Labor and Delievery HX
Infant Data
When you do a physical assessment on a mother, you should include: Appearence
Hair
Face for Edema
Eyes
Breasts
Uterus
While doing the uterus assessment the patient should be in the ____ position: Supine
When assessing the uterus you should ____ the contour, palpate the ______, note the ______ and ______ and ______: Observe
Fundus
Consistency
Location
Height
You should palpate the fundus every ___ minutes for the first 4 hours using the 2 hand approach: 15
While doing a lochia assessment you should look for the: Character
Amount
Color
Odor
Prescence of clots
Saturating more than ____ pad an hour is abnormal: 1
While assessing the perineus have the patient turn on their _____: Side
You should lift the butt and exam for: Hematoma
Ecchymosis
Edema
Intactness
Drainage or bleeding
You should assess the rectum for hemmorohods noting the ____, ____ and _____: Number
Size
Location
Epistomies are usually ___-___ inches long: 1-2
The incision should be fused within ____ hours: 24
What are some nursing interventions for a patient with an episotomy?: Pain Relief
Ice Packs
Sitz Baths
Perineal Cleanising and Tucks
Exercise
Cold and Hot therapy
You should always have the patient ______ the bladder before assessment: Empty
B U B B L E H E: Breast
Uterus
Bowel
Bladder
Lochia
Edema

Homan's sign
Everything Else
While doing a breast exam on a mother, it would be a good time to teach self _____ exams: Breast
Note how many ______ _____ the uterus is at: Fingerbreaths
While assessing the bowel, assess for bowel ____ and for _____: Movement
Gas
While assessing the bladder, assess if it is ____, and how often they are ____ to the bathroom and how much: Empty
Going
While assessing the epistomy, assess for any ______: Edema
The Homans sign is a diagnositc tool for identifying ___________: Thromophebilitis
In the everything else category, assess for emotion ____, if pt is calling baby by _____, how the patient ____ the baby, for ______ displayed: Status
Name
holds
behaviors
When assessing someone who had a c-section, always do:: Pain assessment
Abdomin and fundus assessment
I&O's
Anti-Emb stockings
Mouth Care
Back Rub
Perineal Care
Always try to ____ the client in infant positioing and breastfeeding techniques: Assist
When getting ready for discharge always give patient advice on _____ classes that are being offered, _______ instructions and make sure they recieve a ____ copy of instructions, and assess for any ____ needs: Group
Individual
Written
Learning
Always tell the patient how important _________ is either if it is in the facility or with their physician: Follow Up Care
If you are to do a PP home visit, make sure you get this info:: Pregnancy HX
Newborn Hx
Future Plans
Family Assessment
Physical Exam
Follow UP info
Menstration
S&S of infection
If a patient is not nursing menstratuation should start back are ___ to ___ weeks after delievery: 6-10
Nursing Interventions for mother are: Promote Rest
Promote Adequate fluid intake
Promote urinary elimaination
Prevent Constipation and Hemorrohids
A patient after having a baby should drink ____ glasses of water a day: 8
Advise the patient to increase ______ and maintain a high ____ diet and good ____ regimen: Fluids
Fiber
Exercise
Are night sweats normal?: Yes
After pains and a gush of blood when pt initally rises is ______: normal
Family planning includes: Choosing a ____ to have children _______ of pregnancy: Time
Prevention
____% of women will conceive within 1 year of actively having sexual relations where both parties are fertile: 90
____% of unintended pregnancies are by using birth control incorrectly: 50
You need an informed consent for these methods of birth control: Surgical Sterilzation
Oral Contraceptives
Hormonal Injections
IUD's
You always have to remember ____ bias when teaching family planning: Cultural
You always have to _____ circumstnace that lead to choice of contraceptive: Document
Some pre-existing medical conditions that may effect choice of birth control method include: Thrombophlebitis
Stroke
HBP
Smoking
Over the age of 35
Over 198lbs
The only 100% effective method against STD's and pregnancies is ________: Abstinence
Always have the patient ____ to you hat you said to them: Repeat
Personal preferences in birth control methods include: Religious
Cultural
Peer Group
What is Plan B prevention?: Morning after pill
The only 2 methods that help prevent STD's are: Male and female condoms
These are warning signs of Oral Contraceptive Complications: A C H E S: Abdominal Pain
Chest Pain
Severe Headaches, weakness of extremeties
Eye Problems
Severe leg pain or swelling
Abdominal pain when using oral contra. can be a sign of: Benign liver tumor or gallbladder disease
Chest pain, dyspnea or hemoptysis can be a sign of: Pulmonary Embolismn or MI
Severe headaches, weakness or numbness of extremeties can be a sign of: Stroke
Eye problems such as visual changes, blurred vision, double vision or visual loss and speech disturbances can be a sign of: Stroke
Severe leg pain or swelling in the calf or thigh can be a sign of: DVT
Anyone with a hx of the below should not use _____ ______: Thromophelbeits Cerebrovascular or cardiovascular diseases Estrogen dependent cancer or breast cancer Benign or malignant liver tumors Hypertension: Oral Contraceptives
You can use oral contraceptives if hypertension is well controlled by _________: Medication
______ contraceptives should not be used by women who currently hae any of the following: Impaired liver functions Suspected pregnancy Undiagnosised vaginal bleeding Heavy cigarette smoking Any women older than 35 who smokes: Oral
If a women smokes it is ____ and should be evaulated individually: Discouraged
_______ advantages are increased popularity amoung adolscents and there is no risk for pregnacy or STD: Abstinence
A disadvantage of abstinece is ________ of perr sexual activty may stigmatic: Perceptions
the ____ method advantages aew: No monterary cost no devices or chemicals avaliable in any situation No medical side effects: Withdrawal
(coitus interruptis)
Some disadvantages of the withdrawal method include: No protection from stds
unforgiving with incorrect use
Requires self-control and self-awareness on the part of the male
______ _______ is when you abstain from intercourse or use barrier method during times of cycle: Fertitily Awareness
________ awareness advantges are: Increases user knowledge of reproductive potential Minimial Cost: Fertility
Some disadvantages with fertility awareness are:: No protection from STD
Adolscent females often have irregular cycels
Complicated and limits spontaneity
the ______ condom is a thin sheath over penis to act as barrier to semen: Condom
The ______ condom is a polyurethane sheath that lines the vagina to block passage of semen: Female
Some advatages to condoms are:: Inexpensive
STD protection
No hormonal influence
Rare side effects
Easily avaliable OTC
________ are a chemical barrier inserted into the vagina before sexual intercourse: Spermicides
Spermicides include ______, _____, _____, and ____: Foam
Jelly
Cram
Suppository
Some advantages of _______ are: Readily avaliable Some STD protection Rare side effects Provides lubrication during sex: Spermicides
Some disadvantages to spermicides are:: Limits spontaneity
Skin irritation may occur
Too messy
A _______ is a dome shaped rubber cap with a flexible rim, coated with spermicide and inserted into the vagina to provide a protective barrier over the cervix: Diaphram
Some advantages to a diaphram are:: No systemic side effects
Decreased rates of cervical cancer
Some disadvantages to ______ include: Increased rates of UTI Requires health visit for fitting Female must be comfortable touching herself Limits spontaneity: Diaphrahm
________ contraceptive is to prevent pregnancy by suppresing ovulation, thickening cervical mucus, and thining the endometrial lining: Birth Control Pills
A destructive process that converts living cells into simipler compounds. Involved in involution of the uterus after childbirth: Catabolism
Position that allows eye-to-eye contact between the newborn and a parent.: En Face
Optimal distance for en face is ____ to _____cm: 20-22
Intense fascination and close face to face observation between father and newborn: engrossment
First tactile experience between mother and newborn. The mother explores the infants body with her fingertips only: Fingertipping
First 12 weeks after birth, a time for transtition for parents and siblings: 4th trimester
A phase of maternal adaptation that involves relinquishing previous roles and assuming a new role as parent: Letting go
Posterior pituitary horomone that stimulates uterine contractions and the milk-ejection reflex: Oxytocin
Anterior pituitary hormone that promotes growth of breast tissue and stimulates production of milk: Prolactin
Acronym useful for assessing wound healing or prescence of imflammation or infection R E E D A: Redness
Ecchymosis
Edema
Discharge
Approximation
First phase of maternal adaption during which the mother passively accepts care and comfort and details about the newborn: Taking In
Second phase of maternal adaptation during which the mother assumes control of her own care and initiates care of the infant: Taking Hold
1st 6 weeks after birth: Postpartum Period
3 processes of _____: Contraction of muscle fibers Catabolism Regeneration of uterine epithelium: Involution
The lochia is shed during regeneration, but the ______ layer remains to provide the source of new endometrium: Basal
Exfoliation: scaling off of dead tissue
Since a new endometrium is generated at the site from glands and tissue, this process leaves the uterine lining free of ______ tissue to allow normal pregnancies again.: Scar
Within a few hours after delievery, the fundus should be located at the level of the ___________ and should remain there for 24 hours: Umbilicus
After 24 hours, the fundus begins to ______ by appx 1 cm a dayso that by the 10th to 14th day it is in the pelvic cavity and cannot be palpated: Descend
Intermittent contractions are: Afterpains
Oxytocin during breastfeeding may also cause strong _______ of the uterine muscles: Contractions
_________ are used to lessen the discomforts of afterpains: Analgesics
If mother is breastfeeding she achieves the maximum relief bt taking analgesics ____ minutes prior to breastfeeding: 30 minutes
Lying in the ____ position with a small pillow or folded blanket under the abdomen helps keep the uterus contracted and provides relief for afterpains: Prone
_____ and _______ facilitate the milk-ejection reflex: Comfort and Relaxation
Afterpains decrease repadily after ____ hours: 48
Less than 2.5cm stain on peripad is considered?: Scant
Light is considered _____ to ____cm stain: 2.5-10cm
Moderate is considered ____ to ____ cm stain: 10-15
Lare is saturated peri pad in _____ hour: 1
Excessive is saturated peri-pad in ____ minutes: 15
The vagina _______ entirely regain the nulliparous size: doesn't
Breast feeding mothers are likely to experience vaginal ________ and experience discomfort during intercourse: Dryness
Epistomony site may take ____ to ___ months to heal completely: 4-6
Muscels of the ________ are involved in: walking, sitting, stooping, squatting, bending, defecating,and urinating: Perineum
Relief of ________ discomfort is a nursing priority!: Perineal
_______ml of blood is lost during a delievery, and ______ml in c-section: 500
1000
An _________ in maternal cardiac ouptut occurs after childbirth: Increase
_________ is often noted during the postpartum period: Bradycardia
The rise in cardiac output persists for about ____ hours after childbirth due to an increase in stroke volume: 48
Bradycardia is defined as a pulse rate of ____ to ____ bpm: 50-60
The body rids itself of excess plasma volume by _____ and ________: Diuresis and Diaphoresis
Increased excretion of urine: Diuresis
A urinary output of ________ml a day is not uncommon: 3000
Profuse perspiration: Diaphoresis
Comfort measures for a mom who is experiencing Diaphoresis is ___________ and dry _________: Showers and Dry clothing
An __________ in WBC is normal during postpartum period: increase
Average range of WBC is __________ to ____________: 14000 to 16000
WBC falls to ______ values by 4-7 days after birth: normal
Hemocrit returns to normal valuves within ____ to ____ weeks: 4-6
Elevations is clotting factors continue for several days or longer after delievery causing a continued risk for ___________ formation: Thromobus
Fibrinolytic activty is _____ during pregnancy, but returns shortley after delievery: Decreased
To reduce the risk of thrombophlebitis, early ___________ is required: Ambulation
Nurses should anticiate the mothers need for early _____ and _____ after childbirth: Food and Fluids
The first stool for the mothers occurs ___ to ___ days after childbirth: 2-3
If a patient is complaining of a headache, a careful _______ assessment needs to be done: Neurlogical
Headaches that are most severe when woman is in _____ position and are relieved by the _______ position are bad signs and need to be report to anesthesiologist: Upright
Supine
Menses while lactating may resume as early as _____ weeks or as late as _____ months: 12 weeks to 18 months
Uncomplicated normal births a woman stays in the hospital for _____ hours: 48
If c-section is done, mother stays in _____ hours: 96
Vitals Skin Color Location and firmness of the fundus Amount and color of lochia Perineum Presence and location of pain IV infusions I&O Abdominal incision level of feeling and ability to move: Fourth Stage of labor!!! 1-2 hours after childbirth
H&H, blood type and RH factor, hepatitis B surface antigen, rubella immune status, syphilis screening, and group B strep ststus: Should all be examined when reviewing lab data
The RH immune globin should be adminstered within _____ hours after childbirth: 72
You cannot get pregnant _____ months after recieving the Rubella Immunization: 3 months
An increase in BP from baseline suggests: Precclampsia
A decrease in BP from baseline may indicate ________ or __________ resulting from excessive bleeding: Dehydration or Hypovolemia
Hypotension may also indicate _________: Hypovolemia
Risk for injury applies to the woman who has ______ hypotension: orthostatic
__________ may indicate excitement, fatigue, pain, dehydration, hypovolemia, anemia or infection: Tachycardia
Normal pulse should be ____ to ____bpm, but ____ to ____ may be normal: 60-90
50-60
A normal respiration rate of ____ to _____ breaths per minute should be maintained: 12-20
Multiparity, overdistension of the uterus, precipitous labor, prolonged labor, retained placenta, placenta previa induction or augmenation of labor, adminstration of tocolytics, and operative procedures are all signs of what postpartum high risk factor?: Hemmorrahage
Operative procedures, multiple cervical exams, prolonged labor, prolonged rupture of membranes, manual extraction of placenta, diabetes, indwelling catheter, or anemia are all postpartum high risk factors for?: Infection
A constant trickle of lochia indicates excessive ________ and requires immediate attention: Bleeding
Excessive lochia in the prescene of a __________ uterus suggest lacerations of the birth canal and the health care provider must be noified so that the lacerations can be located and repaired: Contracted
You should continue to support lower uterine segment and massage until firm and apply pressure to the fundus to express clots that may be accumulating in uterus. Also, you need to notifiy doctor and begin oxytocin adminstration if the fundus becomes ____: Soft and Uncontracted
Signs of infection include:: Maternal fever
Tachycardia and uterine tenderness and pain
Abscence of lochia may also indicate a ____________: Infection
Frequent voidings of less than ____ml of urine indicates urinary retention with overflow: 150ml
______ or _______ indicates Soft tissue damage that can delay healing of an epistomoy: Ecchymosis or edema
Signs of an empty bladder include a ____ fundus in the midline and a ________ bladder: Midline
Nonpalpable
When the mother can void at least ____ to _____ml, the bladder isusally empty: 300-400ml
Subjective symptoms of urgency, frequency and dysuria suggest a ________ _________ ________: UTI
Dimpling or thickening of breast can be a sign of a breast _______: Tumor
The breast may feel Lumpy as the various lobes begin to produce _____: milk
______ pulses should be assessed with each assessment: Pedal
Deep tendon reflexes should be ____+ to ____+: 1+ to 2+
Brisker than average and hyperactive reflexes (___+ to ____+) suggest precclampsia: 3+ to 4+
!st 24 hours PP is called the ________ postpartum period: Immediate
The 1st week is referred to as the _____ postpartum period: Early
2nd week to 6th week is the _____ postpartum period: Late
The mother should be advised to squeeze her buttocks together before _______ and to lower her weight slowly onto her buttocks: Sitting
Ice Packs, Perineal Care, Topical Meds, Sitting, Sitzs baths and Analgesics are all ______ measures: Comfort measures
Medicating mother for perineal pain, running water placing the mother hands in water and pouring water over the vulva, encouraging urination in shower or sitzs bath, providing hot tea or fluids of choice, and asking the mother to blow bubbles thrugh a st: Relaxation
Urinary _______ is major cause of uterine atony: Retention
If these things happen a mother must be ________-: Unable to void Amount voided is less than 150ml Fundus is elevated or displaced from midline: Catherizied
Women should be encouraged to drink apprx ______ml of fluids each day: 2500ml
If a respiratory rate is below 12 breaths per minutes the nurse should: Notify anesthesologist immediatetlu
Elevate head of the bed
Adminster oxygen and apply pulse oxi
Adminstster nartoic antagonist (narcan)
Observe for reoccurance of resp. depress
These are the signs of ____________ ______ (lack of movement in bowel): Abdominal distension Absent or decreased bowel sounds no pssage of flatus or stool: Paralytic ileus
The mother who delievers baby by c-section is on bed rest for ____ to ____hrs: 8-12
Comfort and refreshining measures for c-section client include:: Oral hygeine
perineal care
sponge bath
cclean linen
Clear liquids are changed to soft or regular diet once _____ sounds are heard: Bowel
Mother usually can shower ____ days after c-section: 2
The best hold for breast feeding on a mother who had a c-section is:: Side-lying or football hold
The best method for preventing abdominal distension is:: Frequent Ambulation

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