Post partum prep guide 2018-student PDF

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POSTPARTUM PREP GUIDESome page numbers have been identified throughout the book to help get you started. However, not all page numbers have been identified and students are expected identify page numbers for each answer. Chapters 20, 21 & 33 will help you complete this prep guide. Nita Boxer is a 42 year-old Caucasian female, gravida 3, para 3, who four hours ago delivered twin boys at 38 weeks gestation. Twin A weighed 6 lbs. and Twin B weighed 5 lbs. 6 oz. Nita is being admitted to the postpartum unit following an uneventful fourth stage recovery period. On initial assessment you collect the following data: temperature 99.8F, pulse 86, respiration 22, blood pressure 110/70, fundus boggy and located 1 fingerbreadth above and to the right of the umbilicus, lochia moderate, episiotomy repair intact with perineal edema present. 1. What is a fundus? Part of uterus that is furthest from cervix, measured to determine growth rates during pregnancy 2. What is significant about a boggy fundus (uterine atony)? (pages 486, 803) hypotonia of the uterus, overdistended uterus (due to large fetus, multiple fetuses, hydramnios, distention with clots), history, anesthesia, trauma during labor and birth it is the leading cause of early PPH 3. In order of importance, prioritize 3 nursing interventions for a boggy fundus (uterine atony). (pages 486, 487, 806). Assess (continued) of hemodynamic status, anticipate fluid/blood replacement therapy, anticipate pharmacologic management, anticipate surgical intervention Nita breast fed her twins during the recovery period. She successfully breast fed her other two children. She tells you, “When I breastfeed, I really have a lot of cramping.” 4. What are the physiologic factors associated with the uterine cramping that Nita is experiencing? (page 473). Periodic relaxation and vigorous contractions (more common in subsequent pregnancies), causes afterpains (usually uterus has been overdistended), breastfeeding an dexogenous oxytocic medication usually intensify these afterpains 5. How can the nurse intervene to alleviate discomfort? (please use pharm book or class lecture notes to answer a and b). administer fluids, blood, blood products, or plasma as ordered, apply ice packs a. Can Nita receive Percocet and Ibuprofen at the same time? Why or why not? b. Can she receive Percocet and Acetominophen at the same time? Why or why not?

On the second postpartum day, Nita rates her episiotomy site pain at a 3/10 on the pain scale. You note the area is slightly edematous but not red or ecchymotic. There is no drainage or foul odor. Wound edges are well approximated. 6. Using the REEDA assessment acronym, evaluate the status of Nita’s perineal healing. What is the significance of your findings? (pages 488-489). Redness (erythema): not red Edema: slightly edematous Ecchymosis (bruising): no bruising Drainage: no drainage or odor Approximation: 3/10 pain

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Acute pain related to postpartum physiologic changes 7. State several nursing measures that will be helpful in relieving Nita’s discomfort (pages 484-486). Administer prescribed pain meds and monitor effectiveness, apply ice packs in first 24 hous, use warm water for sitz baths after 24 hours, teach woman to use prescribed perineal creams, sprays, or ointments. Teach woman to tighten buttocks before siting and to sit on flat, hard surfaces. You will be using evidence-based principles and scientific rationales to teach Nita perineal hygiene care. 8. Describe the essential components of perineal care and the rationale for each component Educating woman to wipe from front to back after voiding or defecating, sqqueze bottle filled with warm water or an antiseptic solution is used after voiding to cleanse the area. Change her perineal pad form front to back each time she voids or defecates and wash her hand thoroughly before and after 9. What additional assessments are necessary in the postpartum period when a woman delivers by cesarean birth instead of vaginal birth? Incision status, pain, respirations, lung and bowel sounds, assess using REEDA; assess blood loss during birth, ensure the dressing is clean and dry, suture line intact 10. Some mothers have difficulty voiding following delivery. (page 488) a. What assessment findings would indicate full bladder? Displaced uterus aboce the umbilicus, high intake no output, cramping/discomfort b. What physiologic factors contribute to difficulty voiding during the immediate postpartum period? Ep i d u r a l a n e s t h e s i a , e p i s i o t o my , e x t e n s i c ev a g i n a l o r p e r i n e a l l a c e r a t i o n s , i n s t r u me n t a s s i s t e db i r t h , p r o l o n g e dl a b o r , a f t e r i n d we l l i n gc a t h e t e r i sr e mo v e d , p e l v i cfl o o r mu s c l e sma yb ewe a ka sar e s u l t o f ma n yo f t h e s et h i n g sa n da l s op a i nma yb ed e t e r r i n gt h emo t h e r f r o mv o i d i n g c. What potential complications arise if the mother is unable to empty her bladder? INFECTION, UTI, bladder damage, kidney failure 11. What are the advantages for early ambulation for postpartum women? Reduced incidence of VTE, promotes the return of strength 12. Vickie’s chart indicates that she is rubella non-immune and blood type A negative. Baby Lon is blood type A +. Rubella vaccine and Rh immune globulin (RhoGAM) are ordered in her chart. (pages 493-494) a. Why are these medications given postpartum? To prevent the possibility of contractin these in future pregnancies. They both have potential tetratogenic effects which is why it is not giving during pregnancy and they are advised to not become pregnant within 28 days of receiving the vaccines Rh promotes lysis of fetal Rh-positive blood cells before mother forms her own antibodies against them (prevents maternal sensitization) b. Are there any concerns about drug compatibility if these two medications are administered at the same time? RhoGAM may interfere with immune response to rubella virus vaccine, when live vaccine is given either shortly before or after RhoGAM revaccination may be necessary. (BUT the small postpartum dose may not have any interactions, which is why she must be tested 3 months later) c. What lab work should the nurse review prior to administration of these medications?

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Verify immunity or lack there of to rubella virus, take note of recent history of vaccinations, IgA levels, CBC; verify that woman is Rh negative and has not been sensitized, Coombs’ test negative, baby is Rh positive d. What education should accompany administration of each these drugs? Do not become pregnant within 28 days of receiving the rubella vaccine, notify your health care provider if you do, also notify them of any reactions (potentially life threatening), know the S/S of reactions, do not get live vaccinations within 3 months of receiving RhoGAM e. What route and site will you use to administer each medication? Rubella: SQ, anterior triceps RhoGAM: IM, deltoid 13. What is a mastitis? (page 812) Inflammation (commonly use to refer to infection) of the breast, sudden onet fo flu-like symptoms including fever, chills, body aches, and headache Most commonly in upper outer quadrant of breast and within the first 6 weeks of breastfeeding 14. What are the clinical manifestations of a thrombophlebitis? Why are pregnant and postpartum women at risk? (page 811) CM: pain and tenderness in lower extremity, swelling, (PE: dyspnea, tachypnea, tachycardia, hemoptysis, fever, syncope), warmth, erythema, hardened vein over site More at risk because of lack of movement (venous stasis) and hypercoagulation (C-section even more at risk)operative vaginal birth, VTE history, obesity, maternal >35yo, smoking, multiparity 15. Distinguish between postpartum depression and baby blues ( pages 744-746). Baby blues: go away within a few days or week, sad, anxious, overwhelmed, crying spells, loss of appetite, difficulty sleeping Postpartum depression: can begin any time during the first year, same signs as baby blues but last longer and are more severe, thoughts of harming yourself or your baby, not having any interest in the baby

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