Week 3 info for quiz (chapters 12,13,14 in book and chapter 1, 17,18,19 for ati)

how long is the postpartum period considered to be?

6 weeks long after childbirth

What happens during the postpartum period for the mom?

there is rapid change as the womans body returns to a prepregnant state (if the woman was healthy/ low risk during the pregnancy/labor and at birth there are low postpartum complications)

Why does the postpartum period (4th trimester) present challenges for women?

because of the lack of sleep, fatigue, pain, breastfeeding difficulties, stress, depression and the adaptation to the new role of motherhood

maternal mortality rate

17\.3 deaths out of 100,000 live births in 2017

What are the two biggest risks postpartum in the reproductive system for women?

hemorrhage and infections

What happens to the uterus after birth?

It starts returning back to its pre-pregnancy location/size and healing of the placental wound and takes about 6-8 weeks on average

How do primiparous women experience their uterus moving back to its original location?

usually, no discomfort related to uterine contractions during the postpartum period because their uterus remains contracted.

How do multiparous women/ women who are breastfeeding experience their uterus moving back to its original location?

“afterpains” caused by strong intermittent uterine contractions during the first few postpartum days related to the uterus working to remain contracted, this usually decreases during the 3rd postpartum day

Nursing actions for the uterus postpartum

* inform pt you will be palpating her uterus beforehand to check for involution and bleeding
* have pt void beforehand
* give privacy/lower the head of the bead so the woman is flat and
* assess uterus for location/position/fundus tone
* remove her peri pad to assess lochia the same time the fundus is palpated
* support the bottom of the uterus and in circular motions assess firm or boggy fundus
* measure the distance between the fundus and the umbilicus (1 finger= 1 cm)

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where is the fundus of the uterus immediately postpartum?

\-5 position of the abdomen

Where is the fundus of the uterus located 6-12 hours postpartum?

right at 0 of the abdomen (it aligns with the umbilicus)

nursing action if pt has a boggy fundus?

This is a sign that the uterus is not contracting like it should, there is a risk of excess blood or hemorrhaging for that client

How long does it take for the Ductus venosus umbilical vein to the Inferior Vena Cava (IVC) to close in a newborn?

It should close by day 3 and becomes a ligament

How does the ductus venosus umbilical vein close off?

By clamping and cutting off the umbilical cord

How long after birth does it take the Foramen ovale which is an opening between the R and L atrium to close?

It closes when the L atrial pressure is higher than the R, and should be fully closed by 3 months

What could cause the reopening of the Foramen ovale?

If hypoxia occurs in the newborn

How would increased pressure in the L atrial cause the FO to close?

increase PaCo2 = decreased pulmonary pressure (CO2) = increased pulmonary blood flow =increase pressure in the L atrium = closure of the FO

How long does it usually take the Ductus arteriosus which connects to the descending aorta to close in a newborn?

It should be closed within the first 15 hours after birth

Why would the DA stay open?

If the lungs fail to expand or in the PaO2 levels in the newborn drop (this is more common in preterm babies because their lungs do not have enough surfactants on the surface of their lungs)

Path of DA closure

when the pulmonary vascular resistance became less than the systemic vascular resistance = left to right shunt = closure

what is the normal glucose levels for mom?

70-100

When is a pt considered hypoglycemic?

when glucose levels is

s/s of hypoglycemia in baby

* respiratory distress
* Apnea > 20 seconds
* lethargic (little to no energy)
* tremors
* convulsions
* hypothermia
* bradycardia
* high pitched cry

can hypoglycemia be fatal for a newborn/baby in utero?

Yes if glucose is not regulated in mom/baby

Treatment for hypoglycemia

1st = skin to skin with mom and baby

2nd = breast feed baby

then check blood glucose levels.

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After 30 min of breastfeeding recheck blood glucose levels

Last resort treatment = giving IV dextrose because it is most invasive

How much can baby’s eat at birth?

20-30mL at a feeding

How much can baby’s eat day two after birth?

30-60mL at each feeding

How much can baby eat at day 3 after birth?

90mL per feeding

How soon after birth can you hear bowl sounds in baby?

1 hours after birth

What is the gastric capacity of baby on day 1,2 and 3 of birth?

20-30mL

30-60mL

and then 90mL per feeding

(same as how much their stomach can hold)

What is meconium?

It is babys first stool, and it is passes between 24-48 hours after birth

What does meconium look like?

It is thick, black and odorless

When does transitional poop start happening in baby?

starts on day 3 after birth and lasts 3-4 days

What does transitional poop look like?

It is black to greenish brown/yellow

What does stool look like for a breastfed baby?

yellow in color and semi-formed, but later becomes golden yellow with a pasty consistency and has a sour odor

What does stool look like in a baby who is formula fed?

it is drier/ more formed than a baby who is breastfed

it is paler yellow/ brownish yellow with a unpleasant odor

Does moms IgG cross the placenta to give immunity to baby?

Yes

active natural immunity

this is from being exposed and forming antibodies

What is acquired immunity?

when you get a vaccine and form antibodies through that

Does passive immunity last?

no it is not permanent

Natural passive immunity comes from where?

it comes form antibodies from the placenta and gives baby protection for the first few months of life (around 8-9months old is when baby’s immune system starts standing/working on its own)

What is artificial passive immunity?

It is through baby having gamma globulin which gives protection for a short time

Known immunoglobulins IgM

found in blood

produced FIRST during an infection then IgG follows to help/support

Known immunoglobulins IgG

Found in blood/ extracellular fluid

it also crosses the placenta and gives baby passive immunity, but long term immunity after vaccine is given

Known immunoglobulins IgA

This is found in external excretions such as tears, saliva and breastmilk

this give baby passive immunity (IT IS MOSTLY FOUND IN BREASTMILK)

What is the post partum assessment of mom?

BUBBLE HL/E

What is BUBBLE HL/E?

Breast = look at contour, size/fullness, any pain, temperature, symmetry and nipple type

Uterus = look at fundal height/firmness (normal is firm and midline)

Bowels = Must have BM before discharge (bowman said it doesn’t matter), assess for hemorrhoids

Bladder = ‘Bladder distention, first void post partum should be > 150mL (she might be voiding more but have smaller amounts when voiding)

Lochia = Look at amount, odor, color and any clots (AOCC) (coca)

Episiotomy = proper wound healing - edema/redness/pain

DVT in legs = Redness, swelling, warmth, pain

emotions = depression/ baby blues

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Lochia 1-3days postpartum

4-10 days postpartum

10 days - 8 weeks postpartum

1. lochia Rubra = dark red
2. Lochia Serosa = Pinkish / brown color
3. Lochia Alba =Yellow to white color

Expected findings with Lochia Rubra for days 1-3 postpartum

Dark red

Bloody with small clots

moderate to scant amount

increased flow in standing or breastfeeding

with fleshy odor

unexpected findings from Lochia Rubra in days 1-3 postpartum

large clots

heavy bleeding (saturates a pad within 1 hour - could be a sign of hemorrhage), excessive bleeding, saturates a pad in 15 minutes

foul odor (indicating infection)

placental fragments

Expected findings with Lochia Serosa from days 4-10 postpartum

Pink or brown color in bleeding

scant amount

increased flow during any physical activity

fleshy odor

unexpected findings from Lochia Serosa from days 4-10 postpartum

continuation of Rubra stage after 4 days

heavy amount of bleeding (saturation of pad after 1 hours - could be a sign of hemorrhage), excessive bleeding, saturates a pad in 15 minutes

foul odor (indicating infection)

Expected findings with Lochia Alba from day 10- 8 weeks postpartum

yellow to white in color discharge

scant amount

fleshy odor

unexpected findings from Lochia Alba from day 10- 8 weeks postpartum

Bright red bleeding, saturates pad in 1 hour (sign of possible late postpartum hemorrhage)

foul odor (sign of infection)

Causes of breast engorgement

delayed / infrequent breastfeeding

incorrect latching of baby to breast

Treatment for breast engorgement

* give analgesics for pain (tylenol/motrin/vicodin)
* apply warm packs on the area - heat will soothe and relax to being down milk (since heat vasodilates and increases circulation = milk flow better)
* gently express milk prior to feeding / pumping
* put baby frequently to breast

How often should a breast-fed baby be feeding?

Q 1-2 hours

Should you wake baby up to feed?

Yes, you should be feeding breastfed baby’s every 1-2 hours

If mom has mastitis and is on antibiotics can she still breastfeed?

yes

What is mastitis?

An inflammation or infection of the breast

How often should you be feeding a baby that is formula fed?

Q 3-4 hours

If a baby is breastfed what is the longest amount of time they can go without eating?

3-4 hours max

s/s of mastitis?

could be accompanied by and infection

this usually happens after pts go home because they are not having constant education/support form nursing staff on how to and when to breast feed

\* Early detection/ treatment is important to avoid continued infections/side effects

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* tenderness
* warmth
* swelling of breasts
* lump or thickened breast tissue in the area
* pain/burning sensation when breastfeeding/pumping
* redness on the surface of the breast
* low energy
* cold like symptoms - fever over 101F/ increased WBCs

If new mom does not want to breastfeed what nursing interventions should happen?

* have the pt wear a supportive bra - like a sports bra for the first 72 hours
* ice the breasts = vasoconstriction = lower milk production
* DO NOT STIMULATE THE BREASTS (no partner play)

Which hormone is the most important when it comes to milk production?

PROLACTIN

What is the first milk that is produced?

Colostrum = yellow or orange in color “the liquid gold”

lasts about 5 days-2 weeks postpartum = then transitional milk happens = then mature milk starts to be produced

* it has more protein in it and less carbs than breast milk and contains immunoglobulins G and A which gives protection to baby for the first few weeks of life

What does transitional milk look like compared to colostrum?

it goes from yellow to white in color

From colostrum and transitional milk which one has more protein and which one has more carbs?

colostrum = more protein and less carbs

transitional milk has more carbs and less protein

What are the two types of mature milk produced?

Fore milk = clear to blue in colors and has more water in it

* baby has to feed for 15min before the milk switches from foremilk to hindmilk

Hind milk = white or cream colored and this has more of the fat in it

Why is colostrum considered to be “liquid gold”

it contains high levels of immunoglobulins

has high level of protein (specifically IgA 80-90% of what it is made of)

it contains more WBC than mature milk

It gives baby their first immunization from diseases

it contains at least 2 antioxidants that have a protective function and which contributes to the healthy establishment of the bifidus flora int eh baby’s digestive tract

It also has a protective function of sealing the gut lining to prevent adherence of pathogens

What are the factors that influence a woman to breastfeed?

Partner support

social stigma

What are the advantages to breastfeeding?

$ saver

decrease in Otitis Media in baby (OM)

lowers diarrhea, RSV, obesity in baby

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Why should mom not breastfeed?

If she has HIV, Hep B/C, Active TB and has meth or cocaine in her system/ is actively using

Are you able to drink when nursing?

Yes, just pump and dump

What is the composition of human milk?

6% protein

42% carbs = which is going to make it sit in baby stomach longer

52% cholesterol = is needed for baby’s brain development

What happens to baby if they go longer than 4 hours of not feeding?

They can become hypoglycemic and lose their warmth

Which hormone is responsible for the let-down reflex?

PROLACTIN

What are the different feeding positions that baby can be in?

How do you know feeding baby is effective??

BM/Wet diapers

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Weight gain

6-8 wet diapers a day

meconium shows up 24-48 hours after birth - it should be sticky and tarry colored

Bottle feeding advantages

Convenient

and baby can be fed Q 3-4 hours instead Q1-2 hours with breastfeeding

Disadvantages to bottle feeding

the cost of formula

and there is no IgG in the formula as with breastmilk

What is formula composed of?

High protein and low cholesterol

Parent teaching when formula feeding baby

burp after every 1 oz that baby eats - by rubbing and tapping baby’s back

What are bonding behaviors? is it unidirectional (only from parent to child) or bidirectional (from parent to child and child to parent)

this is between the parent to infant and begins at birth and serves as the basis for mutual attachment

* the parent faces the infant / looks then in the face
* the parent calls the infant by name
* the parent cuddles the infant close to their chest
* the parent talks/sings to the infant
* the parent kisses the infant
* the parent breastfeeds or holds baby close when bottle feeding

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THIS IS UNIDIRCTIONAL ONLY FROM THE PARENT TO THE INFANT

What is attachment behaviors is it unidirectional (only from parent to child) or bidirectional (from parent to child and child to parent)

it is the enduring emotional tie between the infant and parent where the child will cry/suck/babble to get and maintain proximity to adults who also engage in attachment behaviors such as kissing/touching/embracing the infant to establish attachments

* the parent responds to the infants cry
* the infant responds to the parents comforting measures
* the parents stimulate and entertain the infant while awake
* the parents become cue sensitive to the infants behaviors

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THIS IS BIDIRECTIONAL FROM THE PARENT TO THE CHILD/CHILD TO THE PARENT

What happens during the taking in phase?

It is a dependent phase that lasts for the first 24 hours to 2 days postpartum

the focus is on self and the mom meeting her basic needs

mom has reliance on others to meet her needs of comfort/rest/closeness/nourishment/reliving birth/ the mom is excited and talkative

What happens during the taking hold phase?

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the mom is in the independent/dependent phase

this starts day 3 pp and lasts for 10days-several weeks pp

mom focuses care on baby/ has a desire to take charge

mom still needs nurturing and acceptance by others

mom has an eagerness to learn (this is the period where she is most receptive to learn)

mom could experience pp “blues”

What happens during the letting - go phase?

mom focuses on the forward movement of family as a unit with interacting members

mom could start reassertion of her relationship with partner

mom could also resume sexual intimacy with her partner

and resolution of individual roles starts again

s/s of baby blues for mom during pp period

* mom feels weepy/ crying for no reason
* she “does not feel like herself” or “this isn’t me”
* she could feel impatient/ irritable/ restless/ anxious/ sad/ have mood changes and poor concentration

s/s of post partum depression (PPD)

* mom has difficulty sleeping/ feels exhausted/ has low sex drive/ lacks energy/ has changes in appetite - with weight loss or gain
* feels weepy/ has excessive worry, agitation, anxiety, feelings of inadequacy, hopelessness, despair, guilt, sadness, fear of being alone, irritability, difficulty concentrating, panic, anger
* scary thoughts about baby (health concerns or wanting to hurt baby/self)

What are the physical musculoskeletal system changes during the PP period?

Back pain

rectus abdominis = separation of the rectus abdominus muscle

What is a cardio/nervous system change during the PP period

maternal hypotension

What are the urinary system pp period changes?

* voiding smaller amounts but more frequency
* do not wait 12 hours pp to void that could increase the chance of a UTI

What are the respiratory system pp period changes?

* the diaphragm goes back to normal
* RR goes back to normal
* fluid overload = decreased lung sounds based from mom being in bed for 3 days

What are some types of contraceptives used pp?

Diaphragm, spermicide, birth control pill (combined pills, mini pill), patch for women, Depo-Provera shot, NuvaRing, implant (copper and non copper), vasectomy, tubal ligation

pt education when using the contraceptives in the form of a diaphragm

* must be fitted and refitted if pt loses or gains more than 15 pounds
* needs to be refitted every 2 years
* has to be left in place for 6 hours after sexual intimacy
* pt needs to use spermicide when using this form of contraceptive

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How does the birth control pill work in the body?

It stops ovulation

thins out the uterine lining

thickens cervical mucus

What are some forms of birth control pills, patches, rings and shots?

* combined pills (E+P)
* Mini pill (P only)
* Patch (E+P)
* Depo-Provera shot
* NuvaRing ((E+P)
* Implant (nexplanon) (P only)
* IUD (copper and non copper IUD)

Pt education for combined pills (E+P)

* DO NOT TAKE IF PT IS RECENTLY A PP OR IS BREASFEEDING
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Pt education for minipill contraceptive

* This is progesterone only
* this does not prevent ovulation as effectively
* and is safe to take when breastfeeding