postpartum

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Questions and Answers

What symptom is most indicative of possible postpartum hemorrhage?

  • Slight abdominal tenderness
  • Bright red bleeding after lochia has diminished (correct)
  • Mild breast engorgement
  • Low-grade fever

Which symptom is associated with the need to contact a healthcare provider after discharge?

  • Slight dizziness
  • Mild back pain
  • Occasional headaches
  • Foul-smelling lochia (correct)

What does unilateral breast tenderness and fever commonly indicate postpartum?

  • Cystitis
  • Postpartum depression
  • Mastitis (correct)
  • Preeclampsia

Which of the following is a common expected physical change postpartum?

<p>Uterine involution (B)</p> Signup and view all the answers

What is a potential serious complication indicated by a combination of blurry vision, severe headaches, and fluid retention postpartum?

<p>Preeclampsia (A)</p> Signup and view all the answers

What role does oxytocin play in the management of postpartum hemorrhage?

<p>It stimulates uterine contractions and decreases blood flow. (B)</p> Signup and view all the answers

Which of the following symptoms indicates a potential risk for venous thrombosis postpartum?

<p>Leg pain, swelling, and redness (D)</p> Signup and view all the answers

What symptom paired with difficulty caring for oneself or the infant can suggest postpartum depression?

<p>Persistent feelings of sadness (C)</p> Signup and view all the answers

What is the expected decrease in hemoglobin per 500 mL of blood loss?

<p>1 to 1.5 g/dL (C)</p> Signup and view all the answers

Which symptom is NOT indicative of deep vein thrombosis?

<p>Excessive fatigue (B)</p> Signup and view all the answers

What should be done if the uterus is boggy and displaced to the side?

<p>Instruct the patient to void (C)</p> Signup and view all the answers

Why is quantifying blood loss (QBL) important?

<p>It reduces delay in interventions (A)</p> Signup and view all the answers

What is the relationship between grams and milliliters when measuring blood loss?

<p>1 g equals 1 mL (B)</p> Signup and view all the answers

Which of the following methods can be used when assessing blood in the context of excessive bleeding?

<p>Measuring blood-soaked peripads (C)</p> Signup and view all the answers

What does early assessment of calves and groin areas help identify?

<p>Potential thromboembolism (C)</p> Signup and view all the answers

What is a possible indication that a vessel might be affected by thrombosis?

<p>A hard, cord-like vessel (A)</p> Signup and view all the answers

What is lochia primarily composed of?

<p>Red blood cells, tissue, epithelial cells, and bacteria (C)</p> Signup and view all the answers

Which statement correctly describes colostrum?

<p>It is a yellowish fluid high in protein and contains immunoglobulins. (C)</p> Signup and view all the answers

What is a primary complication associated with breastfeeding?

<p>Mastitis (B)</p> Signup and view all the answers

What should be monitored for during the first postpartum week?

<p>Orthostatic hypotension when standing (A)</p> Signup and view all the answers

When assisting a woman who feels dizzy or faint, what is the first step to take?

<p>Assist her to a sitting or supine position. (C)</p> Signup and view all the answers

What does the hematocrit measure in the context of postpartum care?

<p>Concentration of red blood cells in the blood (D)</p> Signup and view all the answers

How long does colostrum typically continue after delivery?

<p>5 days to 2 weeks (C)</p> Signup and view all the answers

What action should be taken if a woman faints?

<p>Use an ammonia ampule. (D)</p> Signup and view all the answers

Which phase describes a period of dependent behaviors occurring in the first 24 to 48 hours after birth?

<p>Taking In Phase (C)</p> Signup and view all the answers

What is the primary aim of AWHONN's Perinatal Quality Measures?

<p>To ensure safe, equitable, and high-quality care for childbearing families (B)</p> Signup and view all the answers

The 'Taking Hold Phase' is characterized by which of the following?

<p>Increased sensitivity towards the baby’s needs (B)</p> Signup and view all the answers

During which phase do mothers often experience emotional adjustments and role transitions?

<p>Letting Go Phase (C)</p> Signup and view all the answers

What significant hormonal changes occur postpartum?

<p>Rapid decline in progesterone and estrogen levels (C)</p> Signup and view all the answers

What is a characteristic of the 'Baby Blues' emotional state?

<p>Transient feelings of sadness and mood swings (B)</p> Signup and view all the answers

Which statement best describes Lochia discharge?

<p>It is the vaginal discharge following childbirth indicative of healing (A)</p> Signup and view all the answers

Under what condition can nurses refuse to assist with a health-care procedure?

<p>Due to personal moral, ethical, or religious beliefs (B)</p> Signup and view all the answers

What occurs during uterine involution postpartum?

<p>The uterus gradually returns to its pre-pregnancy size (A)</p> Signup and view all the answers

Why is skin-to-skin contact significant for mother and baby?

<p>It has been shown to improve bonding and health outcomes (C)</p> Signup and view all the answers

What is typically observed in the cardiovascular adjustments during the postpartum period?

<p>Blood pressure stabilizes almost immediately (A)</p> Signup and view all the answers

In terms of menstrual cycle, what is the expected outcome postpartum?

<p>The return of ovulation varies depending on individual circumstances (D)</p> Signup and view all the answers

Why should a capable pregnant woman's decision to refuse recommended medical interventions be respected?

<p>She may have valid personal beliefs. (C)</p> Signup and view all the answers

What is the significance of evidence-based practice (EBP) in nursing?

<p>EBP improves health care quality and patient outcomes. (A)</p> Signup and view all the answers

How can culture impact the care of a childbearing family?

<p>Cultural beliefs can influence pain management perceptions. (D)</p> Signup and view all the answers

What role does family play in childbirth according to cultural perspectives?

<p>Families can provide emotional and physical support. (C)</p> Signup and view all the answers

In which area might cultural beliefs especially affect a woman's experience during labor?

<p>Pain perception and management. (D)</p> Signup and view all the answers

Which of the following practices is most associated with postpartum care in various cultures?

<p>Community support and involvement. (B)</p> Signup and view all the answers

What might be a consequence of not respecting a capable pregnant woman's autonomy?

<p>Increased likelihood of mental health issues. (D)</p> Signup and view all the answers

What aspect of evidence-based practice can contribute to enhancing patient outcomes?

<p>Incorporating the latest research findings into care. (B)</p> Signup and view all the answers

What is administered to Rh-negative women who give birth to Rh-positive neonates if they are Coombs' negative?

<p>A second injection of Rho immune globulin (D)</p> Signup and view all the answers

Which of the following is NOT part of the postpartum assessment overview?

<p>Nutritional counseling (B)</p> Signup and view all the answers

What is a common reason for pain during the postpartum period?

<p>Uterine contractions or afterpains (D)</p> Signup and view all the answers

Which of the following nonpharmacological interventions can help alleviate postpartum pain?

<p>Using ice packs (B)</p> Signup and view all the answers

What is the maximum daily dose of ibuprofen recommended for postpartum pain relief?

<p>3,200 mg (A)</p> Signup and view all the answers

Which statement regarding NSAIDs for postpartum pain management is true?

<p>They may cause hypersensitivity reactions in certain patients. (C)</p> Signup and view all the answers

Which of these pharmacological interventions is specifically reserved for moderate to severe pain postpartum?

<p>Opioid analgesics (C)</p> Signup and view all the answers

What does the acronym BUBBLELE stand for in the postpartum assessment?

<p>Breast, Uterus, Bladder, Bowel, Lochia, Episiotomy, Lacerations, Emotions (C)</p> Signup and view all the answers

Flashcards

Pregnancy and Childbirth Beliefs

The beliefs and practices surrounding pregnancy, childbirth, and the postpartum period that are specific to a cultural group.

Pain Perception and Management

The way individuals within a culture perceive and cope with pain, including during labor and childbirth. This can vary greatly across cultures.

Postpartum Practices

Postpartum practices are customs and traditions followed after childbirth. Examples include dietary restrictions, bathing practices, and specific care for the mother and newborn. These practices vary significantly across cultures.

Role of Family

The role of the family in supporting the mother and newborn during pregnancy, labor, and postpartum. This can involve providing emotional and practical support, decision-making, and childcare.

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Evidence-Based Practice (EBP)

A healthcare approach that utilizes the best available evidence to guide clinical decision-making.

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Rationale for EBP

Research findings and evidence from clinical practice are used to inform the best approach for providing patient care.

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Impact of EBP

Using EBP improves the quality and effectiveness of care provided to patients. This is a key factor in achieving better patient outcomes.

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Uterine Atony

A condition in which the uterus does not contract effectively after childbirth, leading to excessive bleeding.

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Uterine Involution

The process by which the uterus returns to its normal size and shape after childbirth.

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Lochia

The normal discharge from the vagina after childbirth, typically bright red initially, then transitioning to brown and finally yellowish-white.

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Afterpains

A common postpartum discomfort characterized by cramping pain in the lower abdomen, caused by uterine contractions.

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Breast Engorgement

Painful swelling of the breasts due to an increase in blood flow and milk production.

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Oxytocin

The hormone released by the pituitary gland that stimulates uterine contractions and milk ejection.

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Oxytocin (Pitocin)

A high-alert medication used to control postpartum hemorrhage by stimulating uterine contractions.

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Postpartum Hemorrhage

A severe complication of childbirth characterized by excessive bleeding.

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What is lochia?

A bloody discharge from the uterus that contains red blood cells (RBCs), sloughed-off decidual tissue, epithelial cells, and bacteria.

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How does the placental site heal?

The process of the placental site healing by shedding necrotic endometrial tissue and regenerating the endometrium.

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What is colostrum?

A yellowish fluid secreted after delivery, higher in protein and lower in carbohydrates than breast milk, containing immunoglobulins G and A.

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What is mastitis?

An infection of the breast, a primary complication associated with breastfeeding.

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What is orthostatic hypotension?

A condition where blood pressure drops significantly when standing up from a lying or seated position.

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Why should women rise slowly after childbirth?

It is important to rise slowly to a standing position after childbirth, as it helps prevent a sudden drop in blood pressure.

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Why is a CBC done postpartum?

A complete blood count (CBC) can help identify and evaluate blood loss and other potential issues after childbirth.

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What is hematocrit?

The hematocrit is a measurement of the concentration of red blood cells in the blood.

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Coombs' Test

This postpartum screening is conducted to check if a woman carrying Rh-negative blood has developed antibodies against Rh-positive blood, which can occur after delivering an Rh-positive baby.

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Rh(D) Immune Globulin

A medication that helps prevent Rh-negative mothers from developing antibodies against their Rh-positive babies. This is used after delivery or during pregnancy if the baby is Rh-positive.

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BUBBLELE

Postpartum assessment acronym encompassing vital signs, labs (CBC, rubella, Rh), vaccinations (Tdap, flu, pneumococcal, COVID-19), breasts, uterus, bladder, bowel, lochia, episiotomy/lacerations, lower extremities, and emotional state/bonding.

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Postpartum Pain

Pain following childbirth, caused by uterine contractions, perineal trauma, lacerations, episiotomy, cesarean incision, nipple pain, breast engorgement, hemorrhoids, or soreness from labor.

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Nonpharmacological Interventions

Non-medication methods to manage postpartum pain, including cold and warm compresses, aromatherapy, sitz baths, repositioning, walking, showering, and topical treatments.

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NSAIDs

Over-the-counter pain relief medications typically used for mild to moderate postpartum pain.

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Opioid Analgesics

Stronger pain relief medications used when other measures haven't worked and postpartum pain is severe.

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Acetaminophen

This medication (acetaminophen) can be used to relieve mild to moderate pain. It is often combined with other pain relievers to enhance its effectiveness.

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Blood Loss and Hemoglobin/Hematocrit

A decrease in hemoglobin levels by 1 to 1.5 g/dL and hematocrit by 3% to 4% for every 500 mL of blood loss.

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Deep Vein Thrombosis (DVT) Symptoms

Deep vein thrombosis (DVT) is a serious condition where a blood clot forms in a deep vein, usually in the legs. It can cause pain, swelling, and redness.

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Assessing for DVT

Assessing the calves and groin area for tenderness, edema, and warmth can help identify potential DVT.

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Boggy Uterus

A boggy uterus indicates that it is not contracting properly, which can lead to excessive bleeding.

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Massaging a Boggy Uterus

Massaging a boggy uterus helps stimulate contractions and reduce postpartum bleeding.

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Displaced Uterus

A displaced uterus to the side suggests a full bladder, which can prevent the uterus from contracting properly.

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Quantifying Blood Loss (QBL)

Quantifying blood loss (QBL) involves accurately measuring the amount of blood lost through pads, linens, and other materials.

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Importance of QBL

QBL helps healthcare providers monitor postpartum bleeding and intervene promptly if necessary.

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What is AWHONN?

A professional nursing association representing nurses in neonatal nursing.

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What is AWHONN's stance on individual nurses' rights regarding reproductive health care procedures?

AWHONN supports the right of nurses to refuse to participate in health-care procedures that conflict with their personal moral, ethical, or religious beliefs. This right is protected under federal law.

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How does AWHONN aim to improve perinatal care outcomes?

AWHONN promotes collaborative, interdisciplinary approaches to improve perinatal care. This includes measures that focus on key areas like safety, reducing preventable complications, and promoting patient-centered care.

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What is Healthy People 2023?

A nationwide program in the USA aimed at promoting health and preventing diseases.

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What are some of the goals of Healthy People 2023?

Healthy People 2023 goals encompass a broad range of health objectives, including reducing maternal and infant mortality rates, promoting breastfeeding, and improving access to quality healthcare.

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What is Uterine Involution?

The process by which the uterus returns to its normal size after childbirth. It usually takes about 6 weeks.

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What is Lochia Discharge?

The vaginal discharge that occurs after childbirth. It typically changes in color and volume over time, starting with red, then becoming pink, and finally yellow.

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What are some of the Breast Changes that happen postpartum?

The breasts undergo various changes after birth, including enlargement, tenderness, and milk production.

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What are some of the Hormonal Shifts that occur postpartum?

Hormonal levels fluctuate significantly after childbirth, leading to mood swings, fatigue, and other physical and emotional changes.

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What are the Cardiovascular Adjustments that happen postpartum?

The heart rate and blood volume gradually return to their pre-pregnancy levels. Some women may experience temporary low blood pressure.

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What are some of the Perineal and Abdominal Healing aspects of postpartum?

The perineal area (between the vagina and anus) and the abdominal muscles need time to heal. This may involve pain, soreness, and discomfort.

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When do Ovulation and Menstruation return after childbirth?

Ovulation and menstruation usually return within a few weeks or months after birth, but the timing varies depending on breastfeeding status and individual factors.

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What are the Baby Blues?

A common condition that many mothers experience in the first few days to weeks after childbirth. It involves mood swings, tearfulness, anxiety, and fatigue.

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What is Bonding with the Baby?

A process where the mother and baby form an emotional bond through touch, eye contact, and interaction.

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What is the Sense of Role Transition, specifically Rubin's Restorative Phase?

A period of adjustment where the new mother adapts to her new role and responsibilities. This involves learning to care for the baby, navigating family dynamics, and managing physical and emotional changes.

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What is the Taking-In Phase of Rubin's Restorative Phase?

The first phase of Rubin's Restorative Phase is characterized by dependent behavior. New mothers typically focus on their own physical recovery and rely on others for support.

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What is the Taking-Hold Phase of Rubin's Restorative Phase?

The second phase of Rubin's Restorative Phase is characterized by a shift towards independence. New mothers start taking more responsibility for their own care and begin engaging with their baby.

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What is the Letting-Go Phase of Rubin's Restorative Phase?

The final phase of Rubin's Restorative Phase is characterized by a transition from independence to a new identity as a mother. This involves accepting the new role and responsibilities, integrating the baby into the family, and forming a strong bond with the child.

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Study Notes

Vocabulary

  • Birth rate: Number of live births per 1,000 people. U.S. rates have declined since 1960.
  • Very premature: Neonates born before 32 weeks of gestation.
  • Moderately premature: Neonates born between 32 and 33 weeks of gestation.
  • Late premature: Neonates born between 34 and 36 weeks of gestation.
  • Infant mortality: Death before age 1.
  • Binuclear family: Children of divorced parents in separate homes.
  • Nuclear family: 2 parents and a child living together.
  • Extended family: Aunts, uncles, or grandparents living with the family.
  • Blended family: Step-families (2 adults and their children).
  • Puerperium: The first 42 days after childbirth.
  • Standards of Practice: Set of standards to ensure consistent and quality nursing care.
  • Scope of Practice: Defines the range of services provided by nurses, based on state regulations.
  • Evidence-based practice: Nursing care based on research and proven methods.
  • Informed Consent: Agreement to a procedure after a full disclosure of risks, benefits, alternatives and consequences.
  • Ethical principles: Guidelines for social values and norms in patient care.
  • Autonomy: Patient's right to self-determination.
  • Fidelity: Keeping promises and commitments.
  • Justice: Fair and equitable distribution of care.
  • Beneficence: Positive actions to help others.
  • Nonmaleficence: Avoidance of causing harm.
  • Veracity: Honesty and truthfulness in interactions with patients.
  • Paternalism: Healthcare professionals making decisions for/on behalf of patients.
  • Ethical dilemmas in perinatal/neonatal care arise from the well-being of both the mother and her child being considered.

Impact of Culture on Childbearing Families

  • Pregnancy and childbirth beliefs: Vary by culture, with some viewing it as natural and others requiring medical oversight.
  • Pain perception and management: Varies by culture; some cultures prioritize pain tolerance, while others focus on comfort.

Evidence-Based Practice in Nursing

  • EBP: Integration of best current evidence, clinical expertise, and patient/family preferences to provide optimal care.
  • Research: Systematic investigation to generate or test theories or explanations.
  • Family-centered maternity care: Focuses on the physiological and psychosocial needs of the family.
  • Childbirth location trends shifting from hospitals to birthing centers and homes.
  • Patient-centered care during labor, delivery, and post-partum (Involving the patient in decision making).
  • Labor pain interventions: Vary in use and approach based on a patient's comfort preference.
  • Infant mortality rate: Primarily driven by birth defects, prematurity, and low birth weight.
  • Maternal mortality rate: Rate has fluctuated, with birth defects and issues related to pregnancy having a notable effect.
  • Increased survival rates for preterm infants.
  • Postpartum stay time trends.

AWHONN's Perinatal Quality Measures

  • Education: Ongoing training on best practices for nurses.
  • Standardized protocols: Applying evidence-based guidelines throughout the hospital.
  • Data collection and monitoring: Utilizing quality improvement tools to track compliance and outcomes.
  • Reducing rates of maternal and infant mortality.
  • Reducing the rate of preterm births.
  • Increasing the proportion of women who have a healthy weight prior to pregnancy.
  • Increasing postpartum depression screenings.
  • Increasing breastfeeding rates.

Physiologic Changes During the Postpartum Period

  • Uterine involution: Returning the uterus to its pre-pregnancy size (6 weeks).
  • Placental site healing stages (lochia): Red, pinkish to whitish discharge.

Postpartum Period

  • Blood loss after delivery in vaginal and cesarean delivery.
  • Pain management: varies by patient, and includes comfort measures.
  • Hormonal shifts: Changes in estrogen, progesterone, prolactin, and oxytocin levels.
  • Cardiovascular adaptations: Return of blood volume and cardiac output to pre-pregnancy levels.
  • Perineal and abdominal healing: Assessing healing, inflammation and pain.
  • Lochia (Discharge): Normal and excessive bleeding.

Emotional Changes Postpartum

  • Baby blues: Mild mood swings, irritability, and tearfulness (up to 2 weeks).
  • Bonding with infant: Emotional connection facilitated by skin-to-skin contact/breastfeeding.
  • Role transition: Adjusting to responsibilities of motherhood (Varying levels of acceptance, or not accepting the role).

Postpartum Depression

  • Severity and persistence of symptoms, distinguishing from baby blues.
  • Professional support needed.
  • Sleep disturbances and fatigue (due to baby needing care)
  • Relationship dynamics: Changes in spousal/partner and/or social support.

Postpartum Assessment

  • BUBBLE-LE (Vital signs, breasts, uterus, bladder, bowel, lochia, episiotomy/lacerations, perineum/hemorrhoids, lower extremities).

Nursing Actions in Postpartum Care

  • Reviewing maternal and infant conditions.
  • Administering medications/treatments when needed.
  • Monitoring for complications (infection or other issues)

Shorter Gestational Period Risk

  • Increased risk of complications due to undeveloped organs.

Neonatal Birth Weight Rates

  • Defining normal birth weight, low birth weight (LBW), and very low birth weight (VLBW).
  • Recent trends in LBW and VBLW rates.

Maternal Death and Mortality Rates

  • Defining maternal mortality.
  • Causes of maternal death/mortality.
  • Rates of maternal mortality in the U.S.
  • Comparing maternal mortality risk for specific demographic groups.

Implications of Teen Pregnancy

  • Teen pregnancies often present educational, economic, and individual challenges.
  • Health concerns and/or increased mortality rate associated with teen mothers and their children.

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