ATI Maternity Nursing Exam 2

what is involution - shrinking of the uterus via contracting starting immediately after birth how long does uterine involution take - uterus returns to normal in 6 weeks what is the first nursing intervention for beginning uterine involution - bolus of pitocin (oxytocin) second step to try to start uterine involution if the bolus of pitocin plus more pitocin did not work - breastfeeding is it okay for the bladder to be full when uterine involution is trying to take place - no- it can prevent contraction and cause uterine atony what position should the uterus be in immediately following birth - 2 fingerbreadths (2cm) below the umbilicus if the uterus is above the umbilicus by 1 cm following birth is that okay? - for a few hours yes- if longer there is suspected blood filling the uterus causing it to expand (hemorrhage) 24 hours post birth where is the uterus in relation to the umbilicus - in line with the umbilicus same as it was at 20 wks gestation how long after birth does it take the uterus to be a pelvic organ again? - 2 weeks how many weeks post birth does it take for the uterus to be normal in size - 6 weeks weight of the uterus immediately after birth - 1000 grams weight of uterus 6 weeks after brith - 70 grams the pain felt when the uterus is contracting after birth is called - after pain med that encourages uterine contraction and prevents Postpartum hemorrhage - oxytocin (Pitocin) What should the uterus feel like? - firm and should be midline what are the 5 hormones that drop quickly after the birth of the placenta - -estrogen -progesterone -beta-human chorionic gonadotropin -HpL -Relaxin if a mom is not breastfeeding when will her estrogen return to normal levels - 2 weeks postpartum HcG is not detectable after how long post birth - 1 month how long does it take for HPL hormone to be absent after birth - 24 hours when is progesterone back to normal levels post birth - after the first menses Prolactin (hormone for breast milk) inhibits what from occurring - menses and ovulation (so moms who are breastfeeding will likely not get pregnant) Prolactin is cued by a drop in ____ which happens immediately after the birth of the placenta - estrogen If maternal Rh is negative and the fetus Rh is positive, the mom needs RhoGam within ____ hours after birth - 72 Lochia ____ is dark red blood and pregnancy debris that lasts 3-4 days - Lochia Rubera fould odor indicates infection, a saturated pad in less than 15 minutes, and clots larger than a plum are abnormal findings for lochia ______ - Rubera lighter red pink or brown in color, debris, WBCs, and serum that lasts about 10-14 days is lochia _____ - serosa once lochia serosa has started, if bright red blood comes out for more than ____ it is abnormal and a problem - 2 hours yellow or white in color, WBCs, serum, mucus, bacteria, and lasts for 2-4 weeks - Lochia Alba lochia that is less than one inch on the pad - documented as Scant lochia that is 4 inches on the pad - light 6 inches of lochia on the pad - moderate pad saturated within an hour - heavy Saturated pad in 15 minutes and pooling under butt - excessive blood loss a uterus that feels soft and spongy, rather than firm and well contracted. - boggy what should the nurse do for a boggy uterus - continuous fundal massage normal blood loss after vaginal delivery - 500ml normal blood loss after c section - 1000 ml 5 postpartum hemorrhage meds - -cytotec (misoprostol a prostaglandin) -Pitocin -TXA Methylergonovine -carbopost (hemabate) Cytotec aka Misoprostol is a ____ - prostaglandin adverse effect of Pitocin - water intoxication Dosage for TXA - 1g IV repeat in 30 minutes dosage for Pitocin - 10-40 U in 500ml when should Methylergonovine not be given - if the patient is hypertensive - don't use more than a week Carbopost (aka Hemabate) should not be given if the patient has - asthma major side effect of Carbopost (Hemabate) - Diarrhea When is colostrum produced? - 2nd trimester to 2-5 days after birth it becomes milk swelling from milk filling ducts with more carbohydrates and less protein and more water than colostrum - primary engorgment maternal temperature going up in the first 24 hours after birth is normal due to ___ - dehydration - after 24 hours a raised temp is a concern while maternal milk develops raised temp is normal t/f? - true caused by a leak of cerebrospinal fluid after a spinal or epidural - spinal headache what can help a patient having a spinal headache - tell them to lay down, it is worse when upright phase where the mother is dependent and passive while recovering - taking in phase phase when the mother is transitioning to independent behavior - taking hold phase when mom accepts new reality and baby is no longer just an idea - letting go phase inflammation of the inner lining of the uterus usually d/t infection after a C-section - endometriosis loss of peristalsis with resulting obstruction of the intestines - ileus - often a complication of a c section after a c section instruct mom not to lift anything heavier than baby for how long - 4-6 weeks (and if taking opioids don't drive) during primary engorgement when volume increases d/t switch from colostrum to milk, if the breast is too full for baby to latch instruct mom to _______ - express milk by hand prior to feeding what should a mom not wanting to breast feed do to slow milk production - wear a supportive bra around the clock for several days