Chapter 19: Nursing Care of the Family During the Postpartum Period - Test #4

NUR 390: Maternal, Newborn, and Women's Health; Mississippi College - Mrs. McLendon

nursing care of the mother after birth: components of nursing care: assist mother with _____ and _____ after birth

rest and recovery

nursing care of the mother after birth: components of nursing care: assessment of _____ and _____ adaptation

physiologic and psychologic

nursing care of the mother after birth: components of nursing care: prevention of _____

complications

nursing care of the mother after birth: components of nursing care: education regarding _____-_____ and _____ care 

self-management and infant 

nursing care of the mother after birth: components of nursing care: support of _____ and her _____ during transition to parenthood

mother and her partner

in traditional setting, woman is moved to _____ _____ room after recovery

after birth

in labor, delivery, recovery, and postpartum (LDRP) setting, woman and infant remain _____ in room where birth occurred 

together 

in post-anesthesia recovery, regardless of obstetric status, no woman should be discharged from recovery area until _____ recovered from anesthesia

completely

transfer from recovery area: _____ or mother/baby model of care

couplet

planning for discharge: length of stay is dependent upon what 5 factors?

• physical condition of the mother and newborn 

• mental and emotional status of the mother

• social support at home

• educational needs for self-management 

• financial constraints

newborns’ and mothers’ health protection act of 1996 allows for a minimum of ___ hours stay after a vaginal birth and ___ hours after cesarean birth

48; 96

newborns’ and mothers’ health protection act of 1996, low-risk mothers and newborns d/c within ___-___ hours after vaginal delivery (average is 48 hours)

24-36

criteria for discharge: American Academy of Pediatrics recommendations 

planning for discharge: ongoing physical assessment focuses on the evaluation of what 7 factors?

• breasts

• uterine fundus

• lochia

• perineum

• bladder function

• bowel function

• lower extremities

what are the 3 routine laboratory tests when planning for discharge

• H&H

• U/A

• others as indicated

what are some nursing interventions to prevent excessive bleeding?

• maintaining uterine tone

• preventing bladder distension 

• retained placental fragments is a serious concern 

• vaginal or vulvar hematomas 

• nurses should determine saturation volume and soaking appearance for the brands used in their institution so that they can improve the accuracy of blood loss estimation 

*a major intervention to alleviate uterine atony and restore uterine muscle tone is stimulation by gently massaging the fundus until firm

*fundal massage can cause a temporary increase in the amounts of vaginal bleeding seen as pooled blood leaves the uterus

*clots can be expelled 

*the uterus can remain boggy even after massage and clot expulsion

_____ meds used to contract uterus

oxytocic

how do we prevent infection when planning for discharge? (3 factors)

• maintain clean environment 

• avoid exposure to sick individuals

• perineal laceration and episiotomy sites need to be clean 

what are some nonpharmacologic interventions to promote comfort with uterine contractions? (2 factors)

• heating pad

• lying prone

what are some nonpharmacologic interventions to promote comfort with perineal lacerations/episiotomy? (6 factors)

• side lying

• topical application (if ordered) of anesthetic spray or cream

• cleansing with water from a squeeze bottle

• cleansing shower

• tub bath

• sitz bath

what are some nonpharmacologic interventions to promote comfort with hemorrhoids? (3 factors)

• ice packs

• sitz baths 

• topical applications (such as witch hazel pads)

what are some other nonpharmacologic interventions to promote comfort?

• distraction

• imagery 

• touch 

• relaxation

• acupressure 

• aromatherapy 

• hydrotherapy 

• massage therapy 

• music therapy 

• transcutaneous nerve stimulation (TENS)

what are some nonpharmacologic interventions to promote comfort with sore nipples?

adjust newborn latch

what are some nonpharmacologic interventions to promote comfort with breast engorgement? (3 factors)

• cold compresses

• cabbage leaves

• supportive bra

what are some pharmacologic interventions to promote comfort?

• multimodal approach (non-opioid analgesics- acetaminophen/NSAIDS and opioid analgesics) - Tylenol, Ibuprofen, Naproxen, and Percocet 

*monitor mother and baby for opioid CNS depression 

what are some nursing interventions when planning for discharge?

• promoting rest

• promoting ambulation

• promoting exercise

• promoting nutrition

• promoting normal bowel and bladder patterns

why would we promote ambulation when planning for discharge?

reduce risk of venous thromboembolism events

postpone abdominal exercises for ___-___ weeks with cesarean section patients 

4-6

lactating women need an additional ___ to ___ kcal/day over their pre-pregnancy diet for a total of 2300 to 2500 kcal/day

450 to 500

bladder function - void within ___-___ hours of delivery (150 mL)

6-8

bowel function - encourage _____ and a _____ _____ diet 

ambulation and a high fiber 

_____ exercises are a must!!!

Kegel

ideal time for breastfeeding is ___-___ hours after birth while infant is alert and ready

1-2

breastfeeding aids in contracting of the uterus and preventing _____

hemorrhage

provide education and assistance and use the help of _____ _____ if needed

lactation consultants

how do we suppress lactation? (3 factors)

• wear well-fitting supportive bras for the first 72 hours 

• apply ice packs for engorgement 

• may need analgesics/NSAIDS

what are the vaccinations used for the health promotion for future pregnancies?

• rubella vaccination

• varicella vaccination

*avoid becoming pregnant the first month after administration

• tetanus-diphtheria-acellular pertussis vaccine

• preventing Rh isoimmunization

• Rhogam given to mother within 72 hours after delivery if Rh positive baby (when mother is Rh negative)

what are some psychosocial needs of the mother that need to be managed and cared for?

• effect of birth experience (was it different from birth plan?)

• maternal self-image

• adaptation to parenthood and parent-infant interactions

• family structure and functioning

• effect of cultural beliefs and practices (be culturally aware: many cultures consider the woman “impure” or “unclean” while she has lochia

what is some discharge teaching for the mother when planning for discharge?

• self-care and signs of complications

• sexual activity and contraception 

• medications 

intercourse may be resumed ___-___ weeks depending on vaginal delivery, lacerations, or cesarean section

2-6

nonhormonal methods of birth control are best because oral contraceptives can interfere with _____ production

milk

what are some medications that need to be taken after discharge?

• prenatal vitamins for the first 6 weeks 

• stool softeners 

what factors should be followed-up after discharge?

• routine schedule of care 

• home visits 

• telephone follow-up 

• warm lines

• support groups 

• referral to community resources 

routine schedule of care - mother: ___-week PP visit (breast, pap, and pelvic exam)

6

routine schedule of care - newborn: ___ to ___ days after birth or ___ to ___ hours after hospital discharge and again at approximately ___ weeks of age

3 to 5; 48 to 72; 2

• calls to warm lines commonly relate to infant feeding, prolonged crying, or sibling rivalry. families are encouraged to call when concerns arise. telephone numbers for warm lines should be given to parents before hospital discharge.

which of the following responses by an after birth woman indicates she understands teaching regarding the correct process of pelvic floor exercises?

a. “I contract my thighs, buttocks, and abdomen.”

b. “I do 10 of these exercises every day.”

c. “I stand while practicing this new exercise routine.”

d. “I pretend that I am trying to stop the flow of urine midstream.”

d. “I pretend that I am trying to stop the flow of urine midstream.”