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Exam 1 Knowledge Checks (Postpartum & Breastfeeding)
Terms in this set (67)
Which three processes are involved in involution of the uterus?
The three processes involved in involution are contraction of muscle fibers, catabolism, and regeneration of uterine epithelium.
How is the fundus expected to descend after childbirth?
The fundus is expected to descend 1 cm (approximately 1 fingerbreadth) per day so that by the fourteenth day after birth it cannot be palpated in the abdomen.
Which mothers are most likely to experience afterpains? How are they treated?
A multipara is expected to experience afterpains because repeated stretching of the uterus makes continuous uterine contraction more difficult. Overdistention of the uterus and breastfeeding also cause afterpains. Afterpains are treated with analgesics. Lying in a prone position also provides relief.
What are the differences among lochia rubra, lochia serosa, and lochia alba in appearance and expected duration?
Lochia rubra is red, consists mostly of blood, and lasts for 1 to 3 days. Lochia serosa is pink to brown tinged and usually lasts from the third to tenth days. Lochia alba is white, cream, or yellowish and may last until 3 to 6 weeks after delivery.
When should a woman who is formula feeding her infant expect her menses to resume? When should a woman who is breastfeeding expect her menses to resume?
Menses will resume in about 6 to 8 weeks for 40% to 45% of women who are formula feeding, for 75% by 12 weeks, and for all by 6 months. The breastfeeding woman may begin menses between 12 weeks and 18 months after childbirth.
How does breastfeeding affect the resumption of ovulation and menstruation?
Breastfeeding delays the return of both ovulation and menstruation.
Should the nurse be concerned if a woman who delivered a baby yesterday has a WBC count of 16,000/mm3? Why, or why not?
The white blood cell (WBC) count is normally elevated to an average of 14,000 to 16,000/mm3 after childbirth, although it may rise to 30,000/mm3. If the woman has a fever or is at increased risk for infection, the nurse should be especially alert for a WBC count that increases over 30% in 6 hours and other signs of infection.
Why is the mother at risk for urinary retention? Which two complications may result?
The postpartum woman is at risk for urinary retention because her bladder is less sensitive to fluid pressure, decreasing the urge to void even when the bladder is distended. Trauma of childbirth and lingering effects of regional anesthesia may also make it difficult to void. Urinary tract infection is more likely because stasis of urine allows time for bacteria to multiply. Excessive postpartum bleeding may occur because a full bladder displaces the uterus, causing the uterine muscles to relax.
Why does hyperpigmentation decrease after childbirth?
Hyperpigmentation decreases because estrogen, progesterone, and melanocyte-stimulating hormone decrease rapidly after childbirth.
How much weight will the woman lose during childbirth? How much can she expect to lose by the end of the first week after childbirth?
Women lose approximately 4.5 to 5.8 kg (10 to 13 lb) during childbirth. They often lose another 3.2 to 5 kg (7 to 11 lb) by the end of the first week.
What causes orthostatic hypotension? What are the typical signs and symptoms of orthostatic hypotension?
Orthostatic hypotension results from engorgement of visceral blood vessels from decreased intraabdominal pressure after delivery. Signs and symptoms include a 15 to 20 mmHg drop in systolic blood pressure, dizziness, lightheadedness, or faintness when the woman moves from lying down to sitting or standing.
What additional assessments are necessary when tachycardia is noted? Why?
When tachycardia is noted, assessment of blood pressure (BP), temperature, location and firmness of the fundus, amount of lochia, estimated blood loss at delivery, hemoglobin, hematocrit, and degree of pain are necessary to help identify the cause. Excitement, pain, anxiety, fatigue, dehydration, anemia, infection, or hypovolemia may cause tachycardia.
When is uterine massage necessary? How is the uterus supported during massage?
Uterine massage is necessary when the uterus is not firmly contracted. The nurse places the nondominant hand above the woman's symphysis pubis to anchor and support the uterus during massage.
What does excessive bleeding suggest when the uterus is firmly contracted?
A cervical or vaginal laceration may cause excessive bleeding even when the uterus is firmly contracted.
What additional assessments are necessary for the mother after a cesarean birth?
Assessment of pain, frequent respiratory assessments, auscultation of breath sounds and bowel sounds, inspection of the surgical dressing and wound, and intake and output are necessary for the postcesarean mother.
How can hypostatic pneumonia be prevented?
Hypostatic pneumonia can be prevented by frequent turning, coughing, breathing deeply, and ambulating early and frequently.
Which nursing measures are used to prevent or minimize abdominal distention?
Early ambulation, tightening and relaxing the abdominal muscles, restriction of carbonated beverages and straws for drinking, pelvic lifts, and simethicone or rectal suppositories as ordered prevent or minimize abdominal distention.
How is lactation suppressed when the mother elects not to breastfeed?
Current recommendations include instructing the woman to wear a firm bra 24 hours a day and express only a small amount of milk if absolutely necessary for pain relief. The woman may use cold compresses or gel packs inside the bra for comfort. Cold cabbage leaves also promote comfort. Analgesics may be recommended by the provider.
What is the major challenge nurses have in preparing new mothers for discharge?
Providing adequate information in a short time is a major problem in preparing parents for discharge.
What are the criteria for discharge of the mother?
Before discharge, the nurse should be sure that the mother has no complications and all assessments and laboratory work are normal. Ambulation and ability to eat and drink should be normal. The mother should indicate understanding of self-care instructions, signs of complications and proper responses, and infant care. Postpartum follow-up care should be arranged. She should have adequate support during the early days after discharge.
How do bonding and attachment differ?
Bonding describes the initial attraction felt by the parents for the infant. Attachment is the development of an enduring, loving relationship between parents and child. It is progressive and requires response from the infant.
How does maternal touch change over time?
Maternal touch may progress from fingertipping in the discovery phase to stroking, then enfolding the infant, and then to consoling behaviors.
How does verbal interaction change over time?
Parents progress from referring to the newborn as "it" to "he" or "she" and then to using the given name. Parents who know the sex of the baby before birth may call the infant by name from before birth.
How do maternal behaviors in the taking-in phase differ from those in the taking-hold phase?
The mother is focused primarily on her own needs during the taking-in phase. She often is passive and dependent and repeatedly recounts her birth experience. In the taking-hold phase, she becomes more independent, focuses on the infant, and exhibits a heightened readiness to learn.
What does the mother (and the father) relinquish in the letting-go phase?
In the letting-go phase, parents relinquish previous lifestyle patterns to assume the parenting role.
How do the parents progress through the stages of role attainment?
The anticipatory stage begins during pregnancy as women prepare for the birth. The formal stage begins with birth as they become acquainted with the baby. During the informal stage, parents respond to their infant's unique cues rather than relying on directions from others. The personal stage is attained when the mothers feel comfortable with their roles as parents.
How is postpartum blues different from postpartum depression? How can nurses intervene for this common emotional response?
Postpartum blues may be related to emotional letdown, discomfort, fatigue, and anxiety about parenting and body image. It is characterized by irritability, fatigue, tearfulness, mood swings, and anxiety. The symptoms are usually unrelated to events, and the condition does not seriously affect the mother's ability to care for the infant. With postpartum depression, the depression becomes severe, lasts longer than 2 weeks, or interferes with the mother's ability to cope with daily life. Nurses can provide reassurance to the mother and teach the family about postpartum blues and warning signs of postpartum depression. Many facilities or providers conduct a screening for depression before discharge.
Why does the nurse examine the mother's prenatal record and her labor and delivery record?
The nurse examines a woman's previous records to identify factors that would predispose her to complications such as postpartum hemorrhage.
Why is a mother who has given birth to twins at increased risk for postpartum hemorrhage?
Overdistention of uterine muscles from a twin gestation makes the uterine contraction more difficult and excessive bleeding more likely.
Can the nurse be positive that bleeding is controlled when the fundus is firm and the lochia is moderate? Why or why not?
The nurse cannot be certain that bleeding is controlled because concealed bleeding can occur in soft tissue and produce a hematoma.
How is uterine atony treated?
Initial management of uterine atony focuses on measures to contract the uterus, such as massaging, expressing clots, and emptying the bladder. Pharmacologic measures include fluid replacement and administration of oxytocin, methylergonovine, or other drugs such as carboprost.
How are hematomas treated?
Large hematomas may require incision and evacuation of clots, as well as ligation of the bleeding vessel. Small hematomas do not require treatment.
What are the major signs of subinvolution?
The major signs of subinvolution are prolonged lochial discharge, irregular or excessive uterine bleeding, pelvic pain and heaviness, backache, fatigue, and malaise.
What is the nurse's primary responsibility in the management of subinvolution?
Nurses should teach the mother how to palpate the fundus; estimate fundal height; and report abnormalities of lochia, a foul odor, or pelvic pain.
Why is it sometimes difficult to recognize that the woman is becoming hypovolemic?
It may be difficult to recognize hypovolemia because of compensatory mechanisms, such as carotid and aortic baroreceptors, which constrict peripheral blood vessels. This shunts blood to the central circulation, maintains blood pressure, and increases the heart rate.
Why is the risk for thrombus formation increased in pregnancy and in the postpartum period?
Venous stasis increases during pregnancy because of compression of the large vessels by the enlarging uterus. At birth, stasis may occur when the woman is in stirrups. Changes in the coagulation and fibrinolytic systems during pregnancy and the postpartum period elevate the factors that favor coagulation and decrease the factors that favor lysis of clots.
What are the signs and symptoms of SVT?
Signs and symptoms of superficial venous thrombosis include swelling, tenderness, warmth, and redness.
How does the long-term treatment for DVT in the pregnant woman differ from that in the woman who is in the postpartum period?
Heparin remains the long-term treatment of the pregnant woman with deep venous thrombosis because warfarin (Coumadin) may be teratogenic and predisposes the fetus to hemorrhage. Heparin is changed to warfarin in the postpartum period.
Why is bed rest prescribed for the woman with DVT?
Bed rest is prescribed for the woman with deep vein thrombosis to decrease swelling and to promote venous return from the leg.
What additional nursing assessments are necessary when the mother is receiving anticoagulants?
The nurse assesses mothers receiving anticoagulants for unexplained bruising; petechiae; bleeding from the nose, bladder, or gums; or increased vaginal bleeding. Signs of hemorrhage, such as tachycardia, falling blood pressure, or other signs of shock, also should be noted.
In addition to assessment, physical care, and teaching, what should the nurse consider for the mother with a DVT being treated at home?
The nurse should assess family structure and function that will need to change as a result of prolonged treatment for the mother. The nurse should evaluate mother-infant interaction and determine what support system may be available to provide assistance.
Why is the woman who had an assisted birth or cesarean birth at increased risk for postpartum infection?
Cesarean birth or the use of vacuum extraction or forceps may result in trauma that provides a portal of entry for infectious organisms.
Why do the normal physiologic changes of childbearing make a mother especially susceptible to infection of the reproductive system?
All parts of the reproductive tract are connected, and organisms can move from the vagina through the cervix, uterus, and fallopian tubes and into the peritoneal cavity. Alkalinity of the vagina during labor, necrosis of the endometrium, and the presence of lochia encourage bacterial growth.
Why is infection more likely to develop in a mother who had prolonged labor?
When labor is prolonged, organisms have time and opportunity to ascend from the vagina into the uterus, increasing the risk of infection. Also, there may be more vaginal examinations and ruptured membranes for a longer time.
What are the signs and symptoms of endometritis? How is it usually treated?
Fever, chills, lethargy, malaise, anorexia, abdominal pain and cramping, uterine tenderness, purulent foul-smelling lochia, tachycardia, and subinvolution are signs and symptoms of endometritis. It usually is treated by IV administration of antibiotics, antipyretics, and oxytocics to promote involution.
What are the most common sites for wound infections?
Wound infection most often occurs in cesarean incisions, episiotomies, and lacerations.
How does the nurse assess for wound infection?
Incisions and lacerations should be inspected for redness, tenderness, edema, and approximation of the edges of the wound, which may pull apart with infection.
What measures can the woman take to decrease the risk for UTI? How does the treatment for cystitis differ from that for pyelonephritis?
To prevent urinary tract infection, the woman should be advised to drink at least 2500 to 3000 mL of fluid each day, empty her bladder every 2 to 3 hours during the day, and practice meticulous hygiene. Cystitis and pyelonephritis may be treated with oral antibiotics on an outpatient basis. Severe pyelonephritis or infection may require hospitalization and IV antibiotics.
How can mastitis be prevented?
Measures to prevent mastitis include correct positioning of the infant during nursing, frequent emptying of the breasts, and avoiding nipple trauma and supplemental feedings. In addition, the woman should avoid continuous pressure on the breasts caused by tight bras or infant carriers.
Why do most newborns lose weight after birth?
Infants lose weight after birth because of insufficient intake and normal loss of meconium and extracellular fluid.
What are the differences among colostrum, transitional breast milk, and mature breast milk?
Colostrum is rich in protein, vitamins, minerals, and immunoglobulins. Transitional milk has less protein and immunoglobulins but more lactose, fat, and calories than colostrum. Mature milk appears less rich than colostrum and transitional milk, but it supplies all nutrients needed.
How does breast milk compare with commercial formulas?
Breast milk nutrients are in an easily digested form and in proportions required by the newborn. Commercial formulas contain cow's milk adapted to simulate human milk. Infants may develop allergies to modified cow's milk and may need other types of formula, but they are unlikely to be allergic to human milk.
What factors that help prevent infection are present in breast milk?
Breast milk contains bifidus factor to help establish intestinal flora, leukocytes, lysozymes that are bacteriolytic, lactoferrin to bind iron in bacteria, and immunoglobulins.
What types of commercial formulas are available?
Commercial formulas include modified cow's milk formula, soy-based or hydrolyzed formulas, and formulas for preterm infants or those with special needs.
What factors influence a woman's choice of feeding method?
Support from her partner, family and friends, cultural influences, employment demands, knowledge about each method, and education may influence a woman's choice of feeding method.
What is the effect of suckling on the let-down reflex and milk production?
Suckling causes release of oxytocin, which produces the let-down reflex. Suckling and removal of milk cause the release of prolactin to increase milk production. Therefore the more frequently the infant breastfeeds, the more milk is produced. Infrequent feedings decrease prolactin output and milk production.
What preparation of the breasts is needed during pregnancy?
During pregnancy, identification of flat and inverted nipples is important. Soap should not be used on the nipples. No other preparation is necessary.
How can the nurse help the mother establish breastfeeding during the initial feeding sessions?
The nurse can help the mother establish breastfeeding in the beginning by initiating early feeding, helping position the infant at the breast, and showing the mother how to position her hands. The nurse also can help the infant latch on to the breast, assess the position of the mouth on the breast, check for swallowing, and remove the infant from the breast properly.
What should the nurse teach the mother about frequency and quality of feedings?
The mother should feed the infant every 1.5 to 3 hours (8 to 12 times each day) for about 10 to 15 minutes on each side or longer if the infant wishes. Length of feedings may vary but should average at least 20 minutes of effective suckling.
What wake-up techniques should the nurse teach the mother of a sleepy infant?
To wake up a sleepy infant, unwrap the infant's blankets, talk to the infant, change the diaper, rub the infant's back, place the baby skin to skin with you, and express colostrum onto the breast.
How does sucking from a bottle differ from suckling from the breast?
Sucking from a bottle requires pushing the tongue against the nipple to slow the flow of milk. Suckling from the breast requires drawing the nipple far into the mouth so that the gums compress the areola.
What help can the nurse offer the mother with engorged breasts?
To help the mother with engorged breasts, the nurse can encourage nursing frequently, applying heat and cold, massaging, and expressing milk to soften the areola.
How should the nurse advise the mother with sore nipples?
The nurse should advise the mother with sore nipples to ensure proper positioning of the infant at the breast, vary the position of the infant, apply colostrum or compresses to the nipples, and expose the nipples to air.
What teaching should be included for the mother who plans to work and breastfeed?
The mother who plans to work and breastfeed should be taught use of a breast pump, proper storage of milk, and ways to maintain her milk supply.
What should the mother know about weaning?
There is no one right time for weaning. Breastfeeding for at least 1 year is often recommended. Weaning should be done gradually to help the mother avoid engorgement and help the infant adjust.
What questions might a mother have about formula feeding?
A mother might ask about the types of formula available, how to prepare it correctly, frequency and amount of feedings, and feeding techniques.
Why should mothers avoid propping bottles?
Propping bottles risks aspiration of milk. Infants who sleep with a propped bottle have more ear infections and may develop cavities when the teeth come in.
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