post partum

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post partum
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2011-02-01 22:25:32
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postpartum
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  1. refers to the 6week period between delivery or termination of pregnancy and return of reproductive organs to their pre pregnant state
    puerperium
  2. this is the time of emotional, social and physical adjustment
    puerperium
  3. this takes palce the first 30 - 60 minutes after birth
    bonding
  4. what is enhanced for bonding?
    enhanced when the parent and infant touch and interact
  5. When the family finds likeness and differences to other family members
    claiming process
  6. What factors affect family adaptation?
    parental fatigue, previous experience w newborn, parental expectations, knowledge of and confidence in providing for newborn needs, temperament of the newborn
  7. intense interest and preoccupation in the newborn
    engrossment
  8. what are soem engrossment factors?
    fingertipping, mothers voice and high pitched voices
  9. does the father go thru engrossment period?
    yes! he wants to touch, and share an active role in the process
  10. when is it most difficult for a sibling to adaption to a neonate?
    toddler age
  11. what do neonates have the ability to do?
    make eye contact and move eyes to follow the parents, mutual gazing, grasp parents fingers and hold on, move in rhythm to parents voice
  12. return of the uterus to its pre pregnancy size and condition?
    involution
  13. vaginal discharge after childbirth
    lochia
  14. how long does it take for the vagina to regain its pre pregnancy size?
    6 weeks
  15. how does the fundus descend?
    1 cm each day for 10 days
  16. a full bladder will do what?
    push the uterus upward
  17. the lochia is usually what color?
    first red, then pink, yellow and then white
  18. is the odor the same after labor?
    yes
  19. how long is the lochia red?
    1st 3 days
  20. after the red, what color does the lochia turn and when?
    it turns a pink on the 4th day and decreases color changes
  21. the 10th day the color turns what?
    yellowish white
  22. how long after birth is the fundus firm?
    18hrs
  23. when does the cervical os close?
    2 weeks
  24. decreased levels of estrogen=?
    decreased vaginal lubrication
  25. what are the degrees of lacerations?
    • 1st degree= skin and kucous membrane
    • 2nd =skin, mucous and muscle
    • 3rd=skin, mucous, muscle and anal sphinter
    • 4th=skin, mucous, muscle, anal sphinter and rectal muscosa
  26. neuro-hormonal relfec that causes milk to be expressed?
    let down reflex
  27. ovulation takes place as early as what after birth in non breast feeding women?
    27 days
  28. when is milk production initiated after birth?
    2-3 days
  29. non breastfeeind women start their menstrul cycle when?
    3 months
  30. ovulation does take place in breastfeeding women so how long should a woman wait to have sex with out birth control
    190 days
  31. yellowish fluid rich in antibodies and high in protein?
    colostrum
  32. when does engorgement take place?
    day 3 or 4 after birth
  33. when does lactation cease if not used?
    about a week
  34. what do rural indian women believe about their colostrum?
    they believe it harms the baby and discard it
  35. what is the average time a mother breastfeeds?
    2 years
  36. what culture has the lower rate of breastfeeding?
    african american
  37. blood loss average of vaginal birth? cescarean birth?
    500ml, 1000 ml
  38. what does the pregnant mothers temp right after labor?
    100.4
  39. what should remain consistant with baseline?
    BP
  40. pulse should remain where?
    less than 100 and there are times of bradycardia
  41. women have a increased WBC what are they?
    20m-30m X 10-12 days
  42. what levels increase due to loss of plasma?
    H AND H
  43. there are increased clotting factors and fibrogen for a few days postpartume causing what?
    a thrombus formation
  44. what causes bladder distention?
    rapid diuresis
  45. what results in UTI for postpartum?
    urinary stasis or incomplete emptying
  46. what may cause edema on the urinary structures?
    L and D
  47. during L and D cause cause what?
    Dysuria
  48. adequate bladder emptying can help involution in how many days?
    5-7
  49. a distended bladder can displace the uterus and prevent contraction and cause what?
    boggy uterus
  50. what parts of the body return to pre normal state except what?
    the feet
  51. how long will the abd muscles protrude ?
    6 weeks, exercuse will help muscle tone
  52. stiumulating hormone declines?
    melanocyte
  53. True or falso?
    strai may still be visible?
  54. when estrogen levels decrease what else will fade?
    spider angiomas and palmar erythema
  55. what is a huge symptom we can watch for after surgery? and what disease can worsen?
    headache and PIH
  56. weight loss after pregnancy?
    13lb for fetus
  57. what is the weight loss and returning of the uterus in the 6 wks?
    8-9 lbs
  58. how long does it take a woman to return back to normal prepregnant weight?
    6mo - 1year
  59. what helps the mother loose weight?
    breastfeeding
  60. how long does the mothers passive phase last and what phase is this?
    2-3 days, and Takin in phase where the mother must replenish her sleep, fluid and food
  61. what is the taking hold phase?
    last appx 10 days and where the mother wants to learn
  62. letting go phase?
    may be disappointed with gender, size or formaties and they must let go of pexpectations and take the role of parent
  63. "Baby blues"
    postpartum blues the are mild and may consist of crying for no reason, fatigue, anxiety, restlessness, let down feeling
  64. how long do the "baby blues" last? and what percent of women?
    2 weeks and 80 %
  65. for the cescarean birth what phase last longer?
    taking in phase
  66. postpartum depression? what percent does it affect? and how many phases?
    more severe than the blues, 12%, mild, mdoerate and severe
  67. level 1 of postpartum depression?
    mild- able to care but not feel love, irritable, sense of loss of self, last first few weeks?
  68. level 2 of postpartum depression?
    moderate- sleep disturbances, fatigue, decreased concentration
  69. 3 stage of postpartum depression?
    severe- violent outbursts, neg feeling toward infant or other family members, wont discuss symptoms, and have harming thoughts
  70. postpartum psychosis?
    most dangerous with thoughts of harming self and infant and may be comes irrational, obbsesive
  71. what is the percentage of births that cause psotpartum psychosis?
    0.1-0.2 %
  72. what percent commit suicide from postpartum psychosis?
    5%
  73. what percent of postpartum psychosis cause infanticide?
    4%
  74. when postpartum psyhchosis happens abotu how long after birth?
    after 24 hrs
  75. how long do women stay in the hospital ?
    48 hrs vaginal, and 96 c-section
  76. are home visits an option now?
    YES! to see how mother are acting and their bonding techniques
  77. what is BUBBLE?
    Breast, Uterus, Bladder, Bowel, Lochia, Episiotomy
  78. what are standard precautions in post partum care?
    wearing gloves when touching anything that is the mothers fluid
  79. when should we assess bubble?
    every shift
  80. what should we note in breast postpartum?
    note size, shape, abnormalities, mastitis, check nipples for cracks, fissures, warmth and tenderness
  81. waht shouldw e note of the uterus postpartum?
    palpate to note consistancy, size, placement, firm, midline
  82. how should the uterus feel?
    firm, grapefruit size
  83. how does the uterus move?
    it rises to the umbillicus and then descends 1 finger breadth daily for 10 days
  84. assess for signs of what on the uterus?
    metritis
  85. when movement occurs postpartum what is normal??
    fever, chills, tenderness
  86. a full bladder can displace the fundus where?
    to the side
  87. how long are I and O kept?
    first 24 hours
  88. when checking the episiostomy, check what?
    the anus and for constipation
  89. rubra
    red
  90. serosa
    pink
  91. alba
    yellowish white
  92. are clots normal after birth
    yes a few
  93. for an episiotomy what position should the mother be in?
    sims
  94. what can be done to decrease discomfort levels after episiotomy?
    tighten but before sitting, and release when sat down, rest daily with feet elevated, kegal exercise, use peri bottle to ease pain and cleaning
  95. the Rh immune globulin given when to prevent what?
    72 hrs to prevetn sensitization of rh negitive mothers who gave birth to rh pos infants
  96. when is the rubella vaccine given?
    postpartum if innsufficient titer to prevent fetal anomolies in future pregnancies
  97. what can cause early hemorrhage?
    uterine atony, retained placental fragments, laceration, hematomas
  98. late hemorrhage?
    subinvolution, retained palcental fragments
  99. what meds cause contraction or uterine smooth muscle?
    pitocin, methergine, prostaglandins
  100. what to do for hematomas?
    apply ice, assess pain, size assessment
  101. infectino occuring between birth and 6 wks postpartum?
    peurperal infection
  102. peurperal include what?
    wound infection, metritis, mastitis and UTI
  103. inflammation of the uterus?
    metritis
  104. 'inflammation of inside the uterus?
    endometriosis
  105. inflammation of the outside of the uterus?
    parametritis
  106. metritis spead through fallopian tubes
    slapingitis
  107. metritis spread through out the ovaries?
    oophoritis
  108. the only symptom may be fever spikes?
    metritis
  109. inflammed breast
    mastitis
  110. when does masttits occur? and what does it cause? symptoms?
    generally during breastfeeding, staph aureus or cadnida albicans and symptoms are 2-4 weeks of cracks, fissures in the nopple for port of entry
  111. whats the odds of a pregnant woman having UTI?
    2-4%
  112. how are UTI caused
    by tauma to bladder and urethra or urinary stasis
  113. risk factors for thromboembolic ?
    venous stasis, hypercoagulation, older than 35, csection, obese, smoking, long time in stirrups, variscosities, history of
  114. treatments of thromboembolic
    analgesia, rest, evlevation of affected leg, local heat application, elastic stockings, coumadin
  115. DIC?
    disseminated intravascular coagulation, abnormal stimulation of clotting mechanism, preexsisting problem, urine of 30ml/hr, blood and products can be given
  116. how is DIC caused?
    when the morther starts to hemmorhage

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