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Maternal Newborn Nursing: Postpartum Care and Complications, Quizzes of Nursing

Pharmacology, Maternity, Pediatrics, L+D

Typology: Quizzes

2021/2022

Uploaded on 02/27/2023

mbelfor
mbelfor 🇺🇸

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Amniotic Fluid Embolism
Amniotic Fluid Embolism: Infiltration
of
amniotic fluid
into maternal circulation, which travels to and obstructs
pulmonary vessels. Leads to respiratory distress and
circulatory collapse.
S&S: Sudden chest pain, dyspnea, cyanosis,
tachycardia, hypotension, bleeding.
Nursing care: Administer
02,
IV fluids, blood products
as prescribed. Assist with intubation and mechanical
ventilation as indicated.
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MATERNAL NEWBORN NURSING
Postpartum Fundal Height
After birth, fundus should
be
firm , midline, and at
the level
of
the umbilicus.
At
12 hours, fundus is 1 cm above the umbilicus.
Fundus descends 1-2cm every 24 hours.
At
day 6, fundus is 1 /2 way between umblicus and
symphysis pubis.
At
2 weeks, uterus should not be palpable.
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MATERNAL NEWBORN NURSING
Fundus
Assessment: Assess fundal height, uterine placement,
and uterine consistency (firm/boggy) every 8 hours.
Nursing care:
If fundus is displaced laterally, have patient empty
bladder! Encourage voiding every 2-3 hours.
If fundus is boggy, massage fundus in circular
motion.
Administer oxytocin as prescribed to increase uterine
contractions and prevent hemorrhage.
Encourage breastfeeding to stimulate release
of
oxytocin.
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Amniotic Fluid Embolism

Amniotic Fluid Embolism: Infiltration of amniotic fluid

into maternal circulation, which travels to and obstructs

pulmonary vessels. Leads to respiratory distress and

circulatory collapse.

S&S: Sudden chest pain, dyspnea, cyanosis,

tachycardia, hypotension, bleeding.

Nursing care: Administer 02, IV fluids, blood products

as prescribed. Assist with intubation and mechanical

ventilation as indicated.

r..

c ;o z

"^03

@ N co

MATERNAL NEWBORN NURSING

Postpartum Fundal Height

  • After birth, fundus should be firm , midline, and at

the level of the umbilicus.

  • At 12 hours, fundus is 1 cm above the umbilicus.
    • Fundus descends 1 - 2cm every 24 hours.
    • At day 6 , fundus is 1 /2 way between umblicus and

symphysis pubis.

  • At 2 weeks, uterus should not be palpable.

..^ r

c ;o z

"^0 3

@ N

MATERNAL NEWBORN NURSING

Fundus

Assessment: Assess fundal height, uterine placement, and uterine consistency (firm/boggy) every 8 hours. Nursing care:

  • If fundus is displaced laterally, have patient empty bladder! Encourage voiding every 2-3 hours.
  • If fundus is boggy, massage fundus in circular motion.
  • Administer oxytocin as prescribed to increase uterine contractions and prevent hemorrhage.
  • Encourage breastfeeding to stimulate release of oxytocin. i; <
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Lochia

Three stages·

  • Lochia rubra : bright red color. Lasts for up to 3 days after delivery.
  • Lochia serosa: pink/brown color. Lasts from day 4 to day 10 after delivery.
  • Lochia alba: yellow/white color. Lasts from day 11 to 8 weeks after delivery. Abnormal lochia: Excess spurting of blood, saturation of r; ..^ < c a pad in <= 1 Sminutes (indicative of hemorrhage), malodorous lochia (indicative of infection), lochia rubra past day 3. Be sure to check for pooled lochia under patient! ; ..________________________, MATERNAL NEWBORN NURSING

Postpartum care for perineum

  • Provide stool softeners to prevent constipation.
  • Educate patient about perinea! cleansing: use

squeeze bottle of water and antiseptic solution after

voiding, wipe front to back, blot dry (don't wipe).

  • Apply ice packs to perienum to reduce pain and CIO edema. r ..
  • Provide sitz baths twice a day (or more).
  • Provide pain medication as ordered (NSAIDs, opioid analgesics after C-section, topical anesthetics, witch " @)

hazel wipes for hemorrhoids. 0 ... N

L_______________________J CIO MATERNAL NEWBORN NURSING

Breasts and Breastfeeding

Colostrum and milk: Colostrum is secreted during

pregnancy and for 2-3 days immediately after delivery.

Rich in antibodies, protein, and fat-soluble vitamins.

Milk produced 3-5 days after delivery.

Patient teaching:

  • Make sure baby is latched on correctly (takes in part of i; the areola, not just the tip of the nipple).!
  • Breastfeeding produces oxytocin, which helps to contract } the uterus and prevents hemorrhaging.
  • Watch for S&S of mastitis: cracked nipples, flu symptoms. ..______________________j "'

f~?ternai-infant bonding

1-------- Signs of ii!]oaired _aonding Ignores infant, disgust with diapers or spit-up, expression of disappointment in infant, apathy when infant cries, does not talk about infant. Nursing interventions:

  • Promote skin-to-skin contact.
  • Encourage early breastfeeding (and educate mom on infant hunger cues)
  • Provide support and praise to mom
  • Encourage cuddling, diapering, feeding , bathing.
    • Provide information about community resources, and support organizations. r., < ., "O^ c ::0 z ;, 0 3 @ ., .._________________________J °' MATERNAL NEWBORN NURSING

Paternal and sibling adaptation

Signs of paternal-infant bonding: Dad holds infant and maintains eye contact. Dad recognizes infant features that are similar to his own. Dad talks, sings, reads to infant.

  • Encourage Dad to take hands-on approach! Adverse sibling adaptation: Regression in toileting or sleeping habits, aggression towards infant, behavior issues intended to gain attention. Education for parents on sibling adaptation:
  • Let sibling be one of the first people to see the baby.
  • Provide a gift from the infant to the sibling.
  • Give preschoolers a doll to care for, and/or allow older siblings to help provide care to the baby. r "' < ., "O^ c ::0 z ;, 0 3 @ ., .._________________________J O> MATERNAL NEWBORN NURSING

Breast care

Discharge teaching: Wash hands before breastfeeding, wear supportive bra, drink lots of fluids, apply breastmilk to sore nipples and allow to air dry, report signs of mastitis to provider (cracked/sore nipples, flu-like symptoms). Breast engorgement: Empty breasts with each feeding (until breasts soften), apply cool compresses after feedings, apply warm compresses (or take warm shower) prior to breastfeeding. Apply fresh cold cabbage leaves to breasts. [ 2 Suppression of lact~tion: '!'Jear suppo~ive bra for first 72 hours, avoid breast st1mulat1on, and avoid warm water over breasts. Use mild analgesics as needed. Apply fresh cold cabbage leaves to breasts.

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Postpartum teaching: sexual intercourse

  • Avoid sexual intercourse until vaginal discharge is

white (lochia alba) and episiotomy is healed -

around 2-4 weeks.

  • Physical reaction to sexual stimulation may be

diminished for first three months after delivery.

  • Use of a OTC lubricant may be needed to prevent

discomfort. ,

..

  • Ovulation may occur as early as 1 month after

delivery. Pregnancy can occur while breastfeeding

0

(even if menses has not returned). Discuss use of :

contraception.

MATERNAL NEWBORN NURSING

Deep vein thrombosis

S&S: Unilateral leg pain, swelling, warmth, redness. Prevention: Ambulate early and frequently, avoid prolonged immobility, elevate legs when sitting, a~oid crossing legs, drink 2-3L of fluid per day, no smoking , wear antiembolic stockings. Nursing care of DVT:.

  • Bed rest and elevation of affected extremity above heart.
  • No pillows or knee gatch under knees!
  • Apply warm moist compresses.
  • Do NOT massage legs.
  • Administer analgesics, anticoagulants (heparin, warfarin) as prescribed. Implement bleeding precautions. MATERNAL NEWBORN NURSING

Pulmonary Embolism

PE: Complication of DVT where the embolus moves into the pulmonary vasculature, occluding the vessel and obstructing blood flow to the lungs. S&S: Dyspnea, chest pain, tachypnea , hypotension, hypoxia, peripheral edema, bloody sputum. Treatment of PE:

  • Place patient in semi-Fowler's position.
  • Administer 02
  • Administer thrombolytic meds as prescribed (alteplase, streptokinase ).
  • Implement bleeding precautions. N co r .. < .. 't) c z "^0 3 @ N co ,- '
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'----------------------~°'

      • MATERNAL NEWBORN NURSING

Mastitis

Mastitis: Breast infection, usually involving S. aureus. Risk factors: Blocked duct, nipple trauma from poor breastfeeding technique, inadequate hand hygiene. S&S: Painful, reddened, hard area on one breast, flu-like symptoms (fever, body aches), fatigue, elevated WBCs. Nursing care:

  • Administer antibiotics.
  • Provide education to mom: Wash hands before breastfeeding. Allow nipples to air-dry. Make sure infant takes in nipple AND areola, empty breasts completely with each feeding, breastfeed frequently. Use breast Cl)^ I"" < Cl)

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UTI

Risk factors : Postpartum hypotonic bladder, urinary catheterization, frequent pelvic examinations, c-section. S&S: Urinary urgency, frequency, pain. Fever, chills, malaise, cloudy/malodorous urine, suprapubic pain, urinalysis positive for bacteria, WBCs, and RBCs. Nursing care:

  • Obtain urine sample.
  • Administer antibiotics.
  • Provide education : wipe front to back, increase fluid intake (3Uday), drink cranberry juice. I"" QI < QI

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Postpartum Mental Health

Postpartum blues: Lasts <= 1 O days. Symptoms: crying, insomnia, decreased appetite, feeling of "letdown". Resolves without intervention. Postpartum depression: Occurs within 6 months of delivery. Symptoms: persistent feelings of sadness, intense mood swings, lack of appetite, rejection of infant, flat affect, anxiety/panic attacks. Typically requires intervention. i

Postpartum psychosis: Occurs within 2-3 weeks. History of 2

bipolar disease is key risk factor. Symptoms: confusion, } hallucinations, delusions, paranoia. Patient and/or infant is at risk for harm. (^) 0 ... L----------------------..J co