week 6

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Author:
sambos
ID:
67752
Filename:
week 6
Updated:
2011-02-21 09:52:45
Tags:
post partum care
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Description:
ward chapter 15 and 16
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  1. puerperium
    6 week period of time from delivery of the placenta to the time moms body is back to prepregnancy stage
  2. Early Maternal Assessment
    -Vitals
    • vaginal birth
    • take vitals q15minx4 q30x2 q1h q4-8
    • c-section
    • take vitals q30minx4h q1hx3 q4-8h
    • temperature
    • can be up tp 100.4 for 24h if over 100.4 infection has occured
    • d/t exertion and dehydration.
    • Pulse
    • 50-70 bpm commonly occur
    • d/t elevated stroke volume
    • postpartal tachycardia may result from complication, prolonged labor, blood loss, infection.
    • Blood pressure
    • compare BP to BP of first trimester.
    • may have some hypotn but should be back to normal
    • Resps
    • should remain normal
  3. Maternal Assessment
    Fundus
    • Fundus should be halfway between umbilicus and symphysis pubis within a few minutes of pacental birth.
    • within one hour fundus should be at level of umbilicus where it remains for one day. there after the undus will descend one fingerbreadth per day in size
  4. Maternal Assessment
    REEDA
    • Redness, Edema, Ecchymosis, Drainage and Approximation
    • 0-3 points given for each area
    • 0=none
  5. BUBBLE-HE
    Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy(tissue trauma), Homans sign(Legs), Emotions(infant bonding)
  6. Hormones for Changes in Postpartum Mother
    -estrogen
    • Estrogen:stimulates the formation of additional ducts in breasts and elongation of existing ducts.
    • Progesterone:stimulates the formation of lobules the glands that produce milk
  7. Medications used for comfort care
    • Stool softeners(Colace, Dulcolax)
    • Topicals(Lidocaine)Hemorrhoids(witch hazel Tucks) NSAIDs Ibuprofen, Opiods (darvocet, percocet, tylenol)
    • sitz baths, encourage ambulation and administraion of tylenol/motrin etc..should be taken 30 mintues prior to breastfeeding to help with pain relief before uterine contractions
  8. Maternal Assessment
    Uterus
    • Involution-the process by which the uterus returns to prepregnancy state.
    • - the uterus rapidly contracts to prevent hemorrhage. complete healing takes appox. 6-7 weeks.
    • the myometrial cells decrease in size not in number.
    • subinvolution=failure of the uterus to return to the nonprgnant state.
    • d/t multiple births, infection, hydramnios, prolnged labor or difficult birth, grand multiparity or excessive maternal analgesia.
  9. The uterine fundus is palpated by placing one hand immediately above the symphysis pubis to stablize the uterus and the other hand at the level of the umbilicus
  10. Maternal assessment
    -after pains- are intermittent uterine contractions that occur during the process of involution
    primiparous women typically have less pain d/t the uterus' ability to stay contracted
  11. Lochia blood flow from uterus during puerperium.from palcental delivery up to 6-7weeks.
  12. Lochia rubra bright red color lasts for up to 3 days postpartum fleshy odor small clots.
    • Lochia serosa pinkish brown color, serosanguous consistency and lasts from day 4-10
    • Lochia alba yellowish white creamy texture, fleshy odor.
    • scant<25cm light<40 moderate>10 heavy one pad saturated within 2 hours.
    • excessive pad saturated in 15min or pooling blood under buttocks.
  13. Interventions for excessive bleeding
    first determine cause and tx as prescribed
    • excessive bleeding d/t
    • cervical/vaginal tear(excessive spurts)
    • numerous clots, blood loss(hemorrhage)
    • foul odor(infection)
    • Lochia rubra>3 days Placental fragments
    • Lochia alba and serosa>normal length=endometritis if accompanied with fever pain and abd, tenderness
  14. Episiotomy:surgical incision made by PCP between vaginal opening and the anus
    Use REEDA
    sitz bath, ice pack meds to tx after episiotomy
  15. Homans sign assess for DVT
    patients legs should be extended and relaxed with the knees flexed . the examiner dorsiflexs the foot. no pain or discomfort should be present.

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