NUR 3 test 1

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NUR 3 test 1
2011-09-04 20:21:56
postpartum mom baby

study this and unit one
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  1. What is the Nurse practice act/Standards of care?
    “What would any other reasonable prudent nurse do?
  2. Puerperium
    • -Postpartum, may be referred to as 4th trimester
    • -6 week period following childbirth and expulsion of placenta
    • -All organs go back to where they normally are- Period comes back, breast feeding begins
  3. Regeneration of uterine epithelium
    • -Involution begins directly after delivery of the placenta
    • -Contraction controls bleeding from area where placenta separates from uterus
    • -Uterus becomes smaller as muscles contract & gradually return to original size
  4. Episiotomy (types, vs tear)
    • -Midline or Medial lateral
    • - Reduces pressure on fetal head and shortens second stage of labor
    • - Tear may heal more quickly and may have less scarring
  5. Midline Episiotomy (pro/con)
    • -Minimal blood loss, neat, little scaring, less post-partum pain, shortens 2nd stage of labor
    • -Higher risk to extend into rectal sphincter & urethra
  6. Medial-lateral Episiotomy (pro/con)
    • -More opening, if tearing occurs it’s away from rectum
    • -More blood loss, increased post-partum pain, goes through muscle, have to sit on one side, longer healing, prolonged painful intercourse
  7. 3 stages of labor
    • 1) Begins from the onset of true labor and lasts until the cervix is completely dilated to 10 cm.
    • 2) After the cervix is dilated to 10 cm until the delivery of the baby.
    • 3) Delivery of placenta
  8. How to promote involution of uterus
    • -Ambulation ASAP post-delivery
    • -Massage fundus
    • -Breast feeding (releases oxytocin)
    • -3 drugs,
    • Oxytocin,
    • Methergine- potent vasoconstrictor, contraindicated if mother has chronic HTN or PIH
    • Hemobate- cost > oxytocin & Methergine
  9. Changes in vascular system postpartum
    • -Bradycardin d/t large amounts of blood returning to central circulation. Increases stroke volume decreasing HR.
    • -Tachycardina- excitement, fear, fatigue, pain, dehydration, hypovolemia, anemia, infection. Rule out excessive bleeding/intervene STAT if hemorrhage is suspected.
  10. Lochia
    • -Rubra (1-3 days) mod-heavy, red, some clots
    • -Serosa (4-10 days) mod-scant, pink
    • -Alba (11-21 days) scant, white-tan,
  11. Gastrointestinal system postpartum
    • - Delayed bowel evacuation
    • -Hemorrhoids- tucks pads, epifoam, sitz-bath, dermafoam
    • -Constipation- increase fiber & fluids, diet, ambulate asap
  12. Rubin’s 3 stages postpartum
    • -Taking in- mother focus on self (sleep, her needs, food), content 4 others to make decisions, mom tries to integrate birth experience into reality.
    • -Taking hold- High-fatigue, mother more independent, verbalize anxiety of competence as mom, “teachable reachable referable”, let mom do as much care as possible.
    • -Letting go- relinquish old life, see themselves as a parent, disappointment/grief, fantasize baby’s future, let go of expectations.
  13. Postpartal blues
    • -insomnia, irritability, fatigue, tearful, mood instability
    • -Symptoms usually unrelated to events -begins first week and no longer then 2 weeks
    • -Common and effects 70% of women
    • -Do not confuse with postpartum depression/psychosis
  14. Maternal behaviors indicating positive attachment to infant
    • -Holds baby close. “en face” position, kiss/touch cheek to hers
    • -Speaks to baby in soft voice
    • -Notes desirable traits
    • -Attentive to baby’s reflex actions
  15. Reciprocal infant behaviors to mom’s positive attachment behavior
    • - Eye contact with mom
    • - Roots, sucks, licks
    • - Vocalizes/stretches to mom’s voice
    • - Mimics mom’s facial expressions
  16. Best time to encourage bonding between mom and baby
    • -Early, prolonged contact during the 1st few hours
    • - Rooming in allows for better contact, helps mom feel more confident in her role and ability to care for baby
  17. Negative mothering behavior
    • - Holds baby at far distance
    • - calls baby “it”
    • - Quickly hands baby off
    • - Doesn’t talk to baby, ignores baby’s communication
    • - May express demand for attention in competition w/ infant
    • - These behaviors more common in drug addicts, rape victims
  18. Baby bonding behaviors by fathers
    • -Engrossment- intense fascination & close face-to-face observation
    • - En Face position
    • - Desires to hold, touch, & chuck in the air
    • Post partum assessment
    • B- breast
    • U- Uterus
    • B- Bladder
    • B- Bowel function
    • L- Lochia
    • E- Episiotomy
    • H- Homan’s sign
    • E- Emotional Status
    • R- Relationship
  20. ACS guidelines for first pap smear and how often thereafter?
    - First pap should be within 3 years of beginning sexual activity and yearly after that