NUR 3 test 1
Card Set Information
NUR 3 test 1
postpartum mom baby
study this and unit one
What is the Nurse practice act/Standards of care?
“What would any other reasonable prudent nurse do?
-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
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
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
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
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
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
How to promote involution of uterus
-Ambulation ASAP post-delivery
-Breast feeding (releases oxytocin)
Methergine- potent vasoconstrictor, contraindicated if mother has chronic HTN or PIH
Hemobate- cost > oxytocin & Methergine
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.
-Rubra (1-3 days) mod-heavy, red, some clots
-Serosa (4-10 days) mod-scant, pink
-Alba (11-21 days) scant, white-tan,
Gastrointestinal system postpartum
- Delayed bowel evacuation
-Hemorrhoids- tucks pads, epifoam, sitz-bath, dermafoam
-Constipation- increase fiber & fluids, diet, ambulate asap
Rubin’s 3 stages postpartum
- mother focus on self (sleep, her needs, food), content 4 others to make decisions, mom tries to integrate birth experience into reality.
- High-fatigue, mother more independent, verbalize anxiety of competence as mom, “teachable reachable referable”, let mom do as much care as possible.
- relinquish old life, see themselves as a parent, disappointment/grief, fantasize baby’s future, let go of expectations.
-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
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
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
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
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
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- Bowel function
H- Homan’s sign
E- Emotional Status
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