Post-Partum Changes in the Mother
True or False: A full bladder interferes with uterine contraction because it pushes the fundus up and causes it to deviate to one side, usually the right side.
True
R- Redness
True or False: Redness with tenderness is more likely to indicate infection.
True.
Redness without excessive tenderness is probably the normal inflammation associated with healing.
Definition: The woman may feel let down, but overall, she finds pleasure in life.
When providing discharge teaching, the nurse should prepare the woman for these feelings and reassure her that they are normal and temporary.
Postpartum Blues or 'baby blues'
What is considered normal temperature for a term newborn?
96.8-97.7 (Skin)
97.7-98.6 (Axillary)
What is considered a normal blood glucose level 1-2 hours after birth?
40 mg/dL
True or False: Narcotics, sedatives, anticonvulsants, antihistamines, decongestants, antihypertensives, antimicrobials, and coffee intake are all considered generally safe during lactation.
True.
True or False: Breast milk should be used or stored within 2 hours of pumping to avoid the potential for bacterial contamination.
False. Breast milk should be used or stored within 1 hour of pumping to avoid the potential for bacterial contamination.
**Milk may be safely stored in glass or hard plastic.
After 24 hours, the fundus begins to descend by ___ cm per day.
After 10 days postpartum, it should no longer be palpable.
1.
E- Edema
True or False: Severe edema interferes with healing.
True. Mild edema is common.
Definition: A persistent mood of unhappiness.
The nurse should explain that persistent depression is not expected and should be reported to her healthcare provider.
Postpartum depression.
What other problems can hypothermia cause (2)?
1. Hypoglycemia because the newborn uses glucose to generate heat.
2. Respiratory distress because the higher metabolic rate consumes more oxygen, sometimes beyond teh newborn's ability to supply it.
What blood glucose level 2 hours after birth is considered to be hypoglycemia?
45 mg/dL
Name 2 advantages to breastfeeding.
Easily digested, contains full range of nutrients, doesn't cause newborn allergies, provides natural immunity, convenient and economical, enhances a close mother/child relationship, may play a role in improving brain development of a newborn.
When are couples told they may resume intercourse after having a baby?
6 weeks. Or, when the bleeding has stopped (and use lube!)
Is a soft, boggy uterus good or bad?
Bad. The uterus should be firm and contracted.
A boggy (soft) uterus = uterine atony- the most common cause of postpartum hemorrhage.
E- Ecchymosis (bruising)
True or False: A few smaller superficial bruises are common.
True. Larger bruises interfere with normal healing.
This medical condition puts a woman at increased risk for postpartum depression and should be followed up with.
Hypothyroidism.
What are the 4 ways that heat is lost?
1. Evaporation of liquids from the skin
2. Conduction caused by direct skin contact with a cold surface
3. Convection of heat away from the body by drafts
4. Radiation caused by being near a cold surface, although not in direct contact with it.
What is a normal blood glucose level by 3 hours of age?
50-80 mg/dL
Name 2 infections that are contraindicated to breastfeeding.
HIV and the human T-cell lymphotropic viruses (HTLV-1 and HTLV-2).
Also, herpes simplex virus or varicella zoster virus when lesions on the breast are present.
Mothers who have TB must be isolated but their newborns may still receive their breastmilk.
Name 3 signs of hunger in newborns.
Hand-to-mouth movements, mouth and tongue movements, sucking motions, rooting movements, clenched fists, kicking of legs, crying (a late sign)
1. Massage the fundus until firm
2. Assess bladder and have client empty bladder.
3. Notify provider if massage doesn't help.
4. Prepare to administer uterotonic medication (Oxytocin)
D- Discharge
True or False: Discharge from the perineal suture line is common.
False. No discharge from the perineal suture line should be present.
Postpartum psychosis
Name 4 interventions to prevent heat loss in a newborn.
Evaporation (Dry newborn quickly, dry and cover head of newborn).
Conduction (Prewarm radiant warmer and stethoscope before use, place scale paper on scale, and place warm blanket on other surfaces).
Convection (Place crib away from windows and vents)
Radiation (Place crib away from cold walls. Wrap newborn warmly).
Name 3 risk factors that put newborns at a higher risk for low blood glucose after birth.
Preterm and post-term newborns, small and large for gestational age newborns, newborns of diabetic mothers, and any newborn who is stressed because of hypoxia.
Cyclosporine and Methotrexate, drugs of abuse, and radioactive compounds.
Some psychotropic drugs and antianxiety drugs may cause adverse effects in the infant.
Bromocriptine and Ergotamine (often used to treat migraine headaches) are contraindicated.
Name 4 signs that breastfeeding is successful.
Breast feels firm before feeding and softer after, let-down reflex occurs- a tingling sensation, with milk dripping from the breasts- when a feeding is due, newborn nurses at the breast for 10-15 minutes per breast 8-10 times a day, an audible swallow is heard as the newborn sucks, newborn demands feeding and appears relaxed after feeding, newborn has 6-8 wet diapers per day, newborn passes stool several times a day.
Name the 3 different types of lochia and the duration of each.
Lochia rubra- red- lasts for 3 days after birth.
Lochia serosa- pink- lasts for 3-10 days.
Lochia alba- mucus and clear. 10-21 days.
A- Approximation
True or False: Sometimes the suture line gets separated and that is ok.
False. The suture line should not be separated.
A nurse assesses a 4-week postpartum client who reports feeling sad and overwhelmed. Which statement by the client is the highest priority for the nurse to report to the healthcare provider?
A. “I’m exhausted and sometimes I cry for no reason.”
B. “I don’t feel like eating, and I’ve lost weight since the birth.”
C. “I feel disconnected from my baby and I’m afraid I might hurt her.”
D. “I don’t feel like myself, but I know these feelings will pass.”
C. “I feel disconnected from my baby and I’m afraid I might hurt her.”
This statement indicates risk of harm to the infant, which makes it the top priority. Any thoughts of harming self or baby require immediate intervention for the safety of both the mother and the child.
A nurse is caring for a newborn immediately after birth. Which action is most effective in preventing heat loss due to evaporation?
A. Place the newborn on a warm radiant heat table
B. Dry the newborn thoroughly, especially the head
C. Place a hat on the newborn’s head after assessment
D. Wrap the newborn in prewarmed blankets after bathing
B. Dry the newborn thoroughly, especially the head
Evaporation is the loss of heat when moisture on the skin turns to vapor. Drying the infant right after birth removes amniotic fluid and is the first priority intervention.
Name 4 signs of hypoglycemia in a newborn.
Jitteriness, poor muscle tone, sweating, respiratory difficulty, low temperature, poor suck, high-pitched cry, lethargy, seizures.
A postpartum nurse is assessing a breastfeeding client who delivered 12 hours ago. The client reports nipple soreness and the nurse observes the newborn latching only on the nipple tip. Which action should the nurse take first?
A. Apply warm compresses to the breasts before breastfeeding
B. Encourage the client to express milk manually to soften the breast
C. Assist the client to reposition the newborn with a deeper latch
D. Provide the client with lanolin cream for the nipples
C. Assist the client to reposition the newborn with a deeper latch
Name 4 essential techniques in breastfeeding
Proper body alignment of newborn, newborn's mouth is wide open for areola grasp, proper hand position of mother on breast, newborn's mouth moves in rhythmic motion to compress areola, audible swallow is heard, mother is in relaxed, supported position, room is warm and private, newborn ends feeding relaxed and appears satisfied, mother has soft, non-engorged breasts at end of feeding.