Chapter 17 Postpartum Adaptations and Nursing Care
Cardiac output _______ after birth when blood from the uterus and placenta returns to the central circulation, uterine pressure on the vessels _______, and extracellular fluid moves into the _____ _____. Excess fluid is excreted by _______ and _______.
increases
decreases
vascular compartment
diuresis and diaphoresis
Nurses should provide information about the importance of completely emptying the breasts at each feeding and about measures to avoid nipple trauma to prevent ________.
mastitis
The two most common intrapartum cardiac complications are ______ _____ and _________.
Pulmonary Edema
Arrythmias
Higher rates of ____ _____ ____ and mortality occur in clients who are non-Hispanic Black, American Indian, and Alaska Native race; who are of Hispanic ethnicity; who lack private insurance; and who have lower education levels.
Severe Maternal Morbidity (SMM)
Chemical, mechanical, thermal, and sensory factors combine to stimulate the _______ _____ in the brain and initiate ________ at birth.
respiratory center
respirations
Breastfeeding may delay the return of _______ and ________, but _________ may occur before the first menses. All postpartum clients need information about family planning.
ovulation and menstruation
ovulation
_____________ can sometimes be prevented by careful examination of factors that predispose to excessive bleeding.
Postpartum Hemorrhage (PPH)
These nursing interventions are for what client problem:
supplemental oxygen therapy as needed, client positioning in an upright position with uterine displacement to help optimize cardiac output, and conserving oxygen consumption by limiting client activity and controlling pain and anxiety.
Client with pulmonary edema.
Preexisting conditions, such as obesity, CVD, thrombophilia, diabetes, and chronic hypertension, place the pregnant client at increased risk for ________ and ________.
Morbidity and Mortality
Laboratory values for erythrocytes, hemoglobin, and hematocrit are higher for newborns than for adults because.
less oxygen is available in fetal life than after birth.
Nurses foster ______ and ______ by providing early, unlimited contact between the parents and infant and modeling attachment behaviors.
Bonding and Attachment
Venous stasis that occurs during pregnancy, _______ levels of coagulation factors, and ________ levels of thrombolytic factors that persist into the postpartum period increase the risk for _______ formation during the puerperium.
increased
decreased
thrombus
___________ _________ _____ results from increased hydrostatic pressure in the pulmonary capillaries (hypervolemia). _________ ___________ _____ results when there is increased permeability within the capillary system creating an environment where fluid is able to move in and out of the vessel leading to low intravascular pressure.
Cardiogenic pulmonary edema
Noncardiogenic pulmonary edema
Two main goals for managing hypovolemic shock include.
promoting tissue oxygenation
replacement of adequate fluid/volume.
Increases in blood oxygen levels, shifts in pressure in the heart and lungs, and clamping of the umbilical vessels cause closure of the _____ _______, _____ _____, and _____ ______ at birth.
ductus arteriosus,
foramen ovale,
and ductus venosus.
Maternal adjustment to parenthood is a gradual process involving restorative phases of taking-in, taking-hold, and letting-go. Nurses play a valuable role in the process by first supporting and then fostering independence as the client becomes ready. Explain each phase.
1.Taking-in phase- Mothers focus primarily on their own need for fluid, food, and sleep. During this time the mother must integrate the birth experience into reality. Lasts around 1 day or less.
2. Taking-hold phase- mother exhibits concern about managing their own body functions and assume responsibility for their own care. Mother's may voice concerns of anxiety related to their competence as a parent. Nurse should encourage mother to do as much caretaking as possible. Lasts several days.
3. Letting-go phase- is a time of relinquishment for the parents. during this phase, clients refocus on the relationship with their partner. Identify grief due to different outcome than planned or vision of fantasy baby.
Treatment for deep venous thrombosis includes
anticoagulants, analgesics, and bed rest with the affected leg elevated.
___ pathophysiologic processes lead to excessive bleeding and tissue ischemia resulting in catastrophic hemorrhage, profound hypovolemic shock, and multisystem organ failure. During ___, anticipate aggressive volume resuscitation with IV fluids and blood products to replace decreased circulating blood volume and maintain perfusion to organs and tissues.
DIC
DIC
_________ _______ requires immediate recognition and management to minimize insufficient oxygen delivery and tissue perfusion resulting from decreased intravascular volume. Circulating blood volume redistributes with preferential shunting of blood to the heart, brain, liver, and lungs, and away from nonessential organ systems, including the kidneys and uterus.
Hypovolemic shock
_____ _____ occurs in newborns after the first 24 hours of life as a result of hemolysis of red blood cells and immaturity of the liver. _____ _____ begins within the first 24 hours and often requires treatment with phototherapy. _____ _____ is often caused by insufficient intake. True breast milk jaundice begins later than physiologic jaundice and may be caused by substances in the milk.
Physiologic jaundice
Nonphysiologic (pathologic) jaundice
Breastfeeding jaundice
Mothers usually progress through four stages of role attainment—anticipatory, formal, informal, and personal—before they attain a sense of comfort and can structure their parenting behaviors to mesh with the infant’s unique needs. Give an explanation of each.
1.Anticipatory- starts during pregnancy with choosing a provider and location for birth, attending child birthing classes, seek out role models to help learn new role.
2. Formal- begins at birth up to 4-6 weeks, where parents' behaviors are guided by health professionals, close friends, and parents as they become acquainted with their infant and learn caregiving through infant cues.
3. Informal- begins when mother's have learned appropriate cues and signals and how to respond to them. Mother gains own version of maternal role.
4. Personal- mother feels a sense pf harmony in the role, enjoys the infant, sees the infant as central person in their life, and has internalized the parental role.
_______ _______ occurs when a clot is dislodged from the vein, or ______ ______ debris is carried by the blood to a pulmonary vessel, which may be completely or partially occluded.
Pulmonary embolism
amniotic fluid
____ is thought to occur when amniotic fluid contents such as fetal cells, tissue, and other debris enter the client’s circulation signaling a sequence of life-threatening reactions at or close to the time of birth.
• Abrupt respiratory distress, depressed cardiac function with circulatory collapse, and massive hemorrhage occur with rapid onset in _____ clients.
• Many clients have a preceding aura, progressive change in mental status, or sense of impending doom prior to an ______ event.
• Initial interventions during an _____ involve calling for the rapid response team and getting help to the bedside; administering cardiopulmonary support if needed; and placing the client in a left lateral uterine displacement position.
Amniotic Fluid Embolus (AFE)
The DKA OB client may present with hallmark signs and symptoms such as elevated glucose levels, polyuria, polydipsia, nausea/vomiting, fruity ketonic breath, tachycardia, hypotension, dehydration/dry mucous membranes, weakness, altered mental status, and coma. Initial treatment utilizing a DKA protocol includes: Hint: there are 4.
(1) restore circulating volume,
(2) correct hyperglycemia,
(3) restore electrolyte imbalance,
(4) identify and treat underlying cause.
Newborns progress through six behavioral states: quiet sleep, active sleep, drowsy, quiet alert, active alert, and crying. Explain each.
During the quiet sleep state, the infant is in a deep sleep with closed eyes and no eye movements.
The active sleep state is a lighter sleep in which the infant’s eyes are closed. The infant moves its extremities, stretches, changes facial expressions, makes sucking movements, and may fuss briefly.
The drowsy state is a transitional period between sleep and waking similar to that experienced by adults as they awaken.
The quiet alert state (also called alert inactivity) should be pointed out to parents because it is an excellent time to increase bonding. The infant focuses on objects or people, responds to the parents with intense gazing, and seems bright and interested in its surroundings.
In the active alert state, the infant seems restless, has increased motor movements, and may be fussy.
The crying state may quickly follow the active alert state if no intervention occurs to comfort the infant.