Post Partum Test 3 Mother baby

This is by the time the baby is born and time the reproductive organs return to their original state. Takes about 6 weeks worth of time.

Postpartum

What is the nurses goal for Postpartum patients?

Prevent excessive bleeding, Prevent infection, Promote Comfort and rest, Promote bonding

How often are assessment going to be during the 4th stage of labor?

Assessments are going to be every 15 minutes time 8 (2 hours). After the 2 hours, can go to every 8 hours.

What can occur if the fundus is not in the correct place?

It can cause excessive bleeding

What type of lochia is this?

Bright red may contain some small clots, do not want big clots, first 2 hours following birth is like a heavy menstrual period. Can continue for 3 days

Lochia Rubia

What type of lochia is this?

Pink to brown discharge occurs through day 4-10

Lochia Serosa

What type of lochia is this?

White yellow discharge usually day 10-14

Lochia alba

What is a scant amount of lochia?

2.5 cm

What is a light amount of lochia?

Less than 10cm

What is a moderate amount of lochia?

More than 10cm

What is a heavy amount of lochia?

Pad saturated within an hour

What is an excessive amount of lochia?

Pad that is saturated in 15 min or less (EMERGENCY)

What should you do when there is lochia bleeding from the placental site?

Massage the fundus if bleeding is present

How do we determine if the patient is bleeding elsewhere (Non-lochia bleeding)?

The fundus will be firm so it cannot be the placental site. Massaging the fundus will also not help.

What is the biggest priority when dealing with C-Sections?

Prevent infection, after that is bleeding, incision site, lochia, and uterine pain

What sign are we looking for in a postpartum patient for DVT?

Hogans sign

When should the mothers vitals return to normal?

72 hours after delivery

Is it common to have a WBC of 20-25k and elevated coagulation after pregnancy?

YES

What should we check the mother for after birth relating to the immune system?

Rubella status and instruct not to get pregnant for at least 1 month

What should happen if the baby is positive with Hepatitis B?

They will receive the vaccine and immunoglobulin WITHIN 12 hours

What are the teachings and considerations for an Episiotomy?

Help prevent infection for the mother; wash hands before and after voiding, pat dry with toilet paper and change pads wth each void.

It will heal in about 2-3 weeks

When does breast feeding start?

At pregnancy

What happens when the placenta drop/delivers?

Prolactin decreases

How long should infants be given breast milk according to america?

Only need breast milk for the first 6 months; after that introduce supplemental foods but still breast feed until month 12

When do we want to get the baby on the breast after delivery?

within 30 minutes

When should prolactin levels go back to normal after delivery?

between 7-10 days

What helps protect the baby from diseases?

Oligosaccharides

What are the benefits for the mother when breastfeeding?

The longer mom breast feed will decrease risk for cancer, decrease risk for ovarian cancer, will help prevent osteoporosis, will delay the return for period and ovulation

What position for breast feeding is this?

Baby does not have to turn head to swallow, but there is poor head control; may not be best for mom with sore nipples.

Baby rest in crook of elbow; tummy to tummy

Cradle position

What position for breast feeding is this?

Better support for baby’s head, good position for infant with poor latch-on or small infants.

Cross-Handle

What position for breast feeding is this?

Good position for feeding twins, infant needing help

Football or clutch hold

What position for breast feeding is this?

Good for mom with stitches, or very tired. Good for infant who resists breast feeding; support needed

Side lying

What should the diaper count be for the first full 24 hours after birth?

1 diaper

What should the diaper count be after the 2nd 24 hours?

2 diapers

What should the diaper count be after the 3rd 24 hours?

3 diapers

What should the diaper count be after 24 hours when the milk comes in?

6-8 wet diapers

How many stool diapers should the baby have after 24 hours when the milk comes in?

1-2 stools a day

When should infants return to their brith weight?

in 14 days

How long is breast milk good in room temperature?

Good for 4 hours

How long is breast milk good for in the refrigerator?

Good up to 4 days

How long is breast milk good for in the freezer?

Good for 6 months

How long is breast milk good for in the deep freezer?

good for 12 months

If you are HIV positive, on chemotherapy, Active herpes lesions or baby has galactosemia can they breast feed?

NO, they cannot breastfeed

What are the 6 conditions that influence the transition to being a parent?

Meaning, Expectations, The level of knowledge on this situation, Environments they are from, Level of planning they are able to do, and Parents emotional and physical well-being

How do we help the transition to parenthood?

Skin to skin contact and positive signs for siblings

What is the good behaviors of parenthood?

The mother is interested in the baby, positive things of the baby, responds to the baby crying, actually wants to touch the baby, the mom wants to care for the baby, she considers the baby a family member, smiling and talking to the baby.

What are the bad behaviors of parenthood?

The mother turns away from the baby, not responding to the crying, baby spits up and mother shows disgust, talking as if the baby is incorporative, does not include the baby in family contest

What phase of after labor is this?

Taking in, the first 24-48 hours after delivery

Mother is excited and talkative

Mother is dependent on the staff to meet basic needs. Talks a lot about her labor and delivery experience

Dependent Phase

What phase of after labor is this?

Starts on day 2-3 and can last to several days to weeks

Mother is taking more charge of things. Getting ready to discharge home. Really trying to take care of themselves but slowly easing back to normal life with some help

wants to learn and practice

Post partum blues takes place in this phase

Taking Hold Phase (Dependent - Independent Phase)

What phase of after labor is this?

Focus is on the family and independent for themselves and the other kids, Mostly getting back to a normal life

Interdependent Phase (Letting go phase)

What is the acceptable amount of blood loss during labor?

500 mL or less

What could the first (early) 24 hours of Post-partum hemorrahge be caused by?

Can be caused by uterine atony, lacerations, or inversion of the uterus

What could late or after 24 hours of post-partum hemorrhage be caused by?

Caused by placental fragments

What are the common findings of Post-partum Hemorrhage?

Boggy uterus, blood clots larger than a quarter, pad saturated in less than 15 minutes, oozing that is bright red, tachycardia, hypotension, pale cool skin, oliguria

What is this complication in post partum?

Turning the uterus inside out. Life threatening.

Huge hemorrhage risk

To get back in you must relax the uterus and stop the oxytocin that is given; Meds like toepylitic and anitbiotics are given

Uterine Inversion

What is this postpartum infection?

Infection of the lining of the uterus; uterine tenderness, foul smelling lochia

Increased incidence in c-section

Needs good handwashing, good pericare, sitz baths, good hygiene

Endometritis

What phase of after labor is this?

Breast infection

Flu like symptoms, fever, chills, malaise, unilateral breast

CAN BREAST FEED; will take antibiotics to fix and will need to empty breast 2-3 hrs

Mastitis

What psychological change is this in post partum?

Can start in the dependent-independent phase. 1-2 weeks

Everything’s is good and then is starts to hit and feels like everything’s falling apart. Let down feeling, insomnia, anxiety but typically goes away on its own

Postpartum Blues

What psychological change is this in post partum?

Onset within 4 weeks of childbirth and way more intense than the blues

Intense sadness, severe mood swings, intense fears and anxiety, anger. Risk is hx of it before pregnancy. CANNOT take care of herself and the baby;

Tx: antidepressant therapy

Depression

What psychological change is this in post partum?

The mother has delusions, they think the baby is possessed and wanting to harm their selves or the baby. Rejection over the bby. Many might know that there is somethings not right. If we suspect it we CANNOT LEAVE THE BABY ALONE WITH THE MOTHER

Hx of abuse, unplanned pregnancy, decrease social support may cause

Psychosis

What is the teaching for discharge for a mother after birth?

No sexual activity for 2-4 weeks, Headache, fever, or chills for 2-4 days need to be reported, Increase bleeding with clots or foul smelling odor needs reporting, Localized breast pain and cracking are reported, post partum depression s/s, and Need to see their doctor in 6 weeks

What are the goals for the newborn?

Support the transition to extrauterine life, support behavioral adaptations, Feedings, Prevent infection, Prevent injury, promote bonding and saftey

What is the client education for contraception during discharge?

If breastfeeding, do not take oral contraceptives until milk production is well established at 6 weeks.

What should we teach for a mother with engorgement?

Apply cold compresses 15 min on and 45 min off. Fresh, cold cabbage leaves can be placed inside the bra. Mild analgesic can be taken for the pain

What is the first medication we give for a Boggy fundus that is causing secondary bleed?

Oxytocin

What is the secondary medication after oxytocin do we give for hemorrhage and what are the considerations?

Methylergonovine and cannot give if there is hypertension present so skip and go to third medication

What is the 3rd medication given if we have to skip methylergonovine for hemorrhage?

Carboprost (fever, chlls, n/v, diarrhea SE)

What is the 4th medication give after Carboprost does not work during post partum hemorrhage?

Misoprostol (Given rectally and improves clotting factor)

What is the last medication after do we give if Misoprostol does not work during postpartum hemorrhage?

Tranexamic acid

What do we implement for a postpartum hemorrhage before doing a hysterectomy?

We would try Bimanual uterine or Jada Compression. Do this if medications are also not working

What is the number one thing the newborn has to do during birth?

It has to breath

What are the signs that the newborn is not breathing well?

Cyanosis, chest retractions, nasal flaring, grunting

What is acrocyanosis and is it normal?

It is when the feet and hands turn blue or purple after birth. YES it is normal

How do we determine the difference between acrocyanosis and facial bruising on a newborn?

You would check the inside of the infants mouth; facial bruising will have pink coloration in the mouth

What are the three shunts that close at birth?

Ductus Ateriosus, Foramen Ovale, and Ductus Venosus (High pressure keeps the ducts open)

What are the three things that are going to initiate how the baby takes a breath?

Mechanical factors (Coming through birth canal), Thermal factors (temp change from cooler air), and Chemical factors (Contractions cause temporary hypoxic events)

Do repeat C-Sections get the 3 breathing factors?

NO

What type of heat loss is this?

Flow of the body heat to cooler air (make sure air is warm)

Convection

What type of heat loss is this?

Heat loss to cooler temperatures in close proximity. Ex. Baby crib next to a cold window

Radiation

What type of heat loss is this?

Moisture leaving the skin; leaving the baby wet (Keep baby dry)

Evaporation

What type of heat loss is this?

Body heat lost to a cooler surface in direct contact. Ex. cold wall or weight table

Conduction

When do we give Ophthalmic Erythromycin to prevent chlamydia and Gonorrhea?

1 hour after birth

What vitamin must the baby be given after birth and to get a circumcision if male?

Vitamin K for clotting factors

What should we verify before giving the infant to the designated mother?

Need to check bracelets and make sure the numbers are the same

Can a mother breastfeed if they are HIV positive and what should we do after birth if positive?

NO they cannot breast feed and the baby should be bathed right after birth

When will the baby get the vaccine if the mother is positive for HEP B?

Within 12 hours after birth

How does the APGAR score work in relation to birth?

HR: 100 or over gets 2 points; Less than 100 gets 1 point; Nothing gets 0

Respirations: Over 30 gets 2 points; Less than 30 gets 1 point; Nothing gets 0

Relfexes: Strong gets 2 points; Some reflexes gets 1 point; Flaccid gets 0

Color: Pink color gets 2 points; Some blue extrem gets 1 point; Pallor gets 0

Noises: Good cry gets 2 points; slight cry and grimace gets 1 point; No cry gets 0

How long does apnea need to be for it to be a problem?

Greater than 15 seconds

When should we get a blood pressure on an infant and where do we put it?

Get a BP if suspect something wrong. Goes on infants leg

Where do we check an infants pulses?

On the Femoral Artery

What does a absent pulse indicated on a newborn?

Hip dysplasia

What is the normal Hbg for a newborn?

14-24

What is the normal Hct for a newborn?

44-64

What is the normal RBC for a newborn?

4800-7.1M

What is the normal Glucose for a newborn?

40-60

What should the billirubin be after day 1?

2-6

What should the billirubin be after day 2?

6-7

What should the billirubin be after day 3?

4-6 or less

What type of bruising/laceration is this after birth for a newborn?

When there is swelling on the back of the head due to compression of the vessel with decrease venous return; goes away in 3-4 days

Caput

What type of bruising/laceration is this after birth for a newborn?

Bleeding underneath the skin of the baby’s head; Usually between the suture line of the head

Take 3-6 weeks ti go away and high risk for jaundice due to immature liver

Cephalhematoma