1229 Exam 4: Postpartum Flashcards
postpartum
(puerperium) begins after the delivery of the placenta and ends when the body returns to the prepregnant state. (aprox. 6 weeks)
physiological maternal changes during postpartum:
uterine involution lochia flow cervical involution decrease in vaginal distention changes in ovarian function and menstration breast changes urinary tract changes GI tract changes cardiovascular changes
Physical Risk during the postpartum period:
hemorrhage shock infection constipation fatigue UTI Thrombophlebitis
Hormone released from the pituitary gland, coordinates and strengthens uterine contractions
Oxytocin
A firm and contracted uterus prevents what?
bleeding and hemorrhage
afterpains
uncomfortable uterine pains during postpartum
Decreased estrogen is associated with:
breast engorgement
diaphoresis
diuresis
diminished vaginal lubrication
focused physical assessment:
breast
uterus (fundal height, uterine placement and consistency)
bowel and GI function
bladder function
lochia (color, odor, consistency, and amount)
episiotomy (edema, ecchymosis, approximation)
vitals and pain
teaching needs
fudus immediately after delivery
firm, midline with the umbilicus, and approximately at the level of the umbilicus
fudus 12 hours postpartum
1 cm above umbilicus midline and firm
fundus every 24 hours postpartum
should descend approx. 1 to 2 cm (finger breaths)
fundus by day six
should be half way between the symphysis pubis and he umbilicus
fundus by day ten
should lie within the true pelvis and should not be palpable.
uterine involution
uterus returns to its prepregnant state. (aprox 1000g to 60g)
locating the fundus
- explain procedure to pt.
- wears gloves
- cup non dominant hand just about the symphysis pubis to support the lower segment of the uterus
- with dominant hand, palpate the pt’s abdoomen to locate.
(usually start a few inches above umbilicus)
*document fundal height, location, and uterine consistency
Lochia stages
lochia ruba, lochia serosa, lochia alba
bright red color, bloody consistency, fleshy odor, may contain small clots, transient flow increases during breastfeeding and upon rising last 1 to 3 days after deliver
lochia ruba
pinkish brown color and serosanguineous consistency. last from approximately day 4 -10 after delivery.
lochia serosa
yellowish, white creamy color, fleshy odor. lasts from approximately day 11 up to and beyond 6 weeks postpartum.
lochia alba
< 2.5 cm of blood
scant
< 10 cm of blood
light
> 10 cm of blood
moderate
one pad saturated within 2 hours
heavy
one pad saturated in fifteen mins or less/ pooling of blood under buttocks
excessive blood loss
excessive spurting of bright red blood from the vagina
possibly indicating a cervical or vaginal tear
numerous large clots and excessive blood loss
hemorrhage
fould odor
infection
persistent lochia ruba in the early postpartum period beyond day three:
retained placental fragments
continued flow of lochia serosa or alba beyond the normal length of time (esp. if it is accompanied by a fever, pain, or abdominal tenderness)
endometritis
Nursing interventions for perineal tenderness, laceration, and episotomy:
promote measures for the client to help to soften her stools
educate the client about proper cleansing to prevent infection
promote comfort measures
educate the client about proper cleansing to prevent infection:
wash hands before/after voiding
pt should use a squeeze bottle filled with warm water after each voiding to cleanse the area
pt should clean perineal area from front to back
pt should blot dry, not wipe
pt should sparingly use topical cream or spray
pt perineal pad should be changed from the front to the back.
Comfort measures:
apply ice packs to the clients perineum for the first 24-48 hours to reduce swelling encourage sitz bath twice daily administer analgesia opioid analgesia topical anestehetics
Sitz bath (remember everyone is different)
gather materials and apply gloves.
clamp tubing of bag.
add warm water to both bag and bowl of sitz bath.
raise toilet lid, and place bowl
hang bag above toilet (IV pole or hanger)
insert tubing into bowl (make sure tubing is right side up)
slowly unclamp tubing.
**usually takes about 15-20 mins
Fundal Massage
massage if fundus is boggy.
can cause a temporary increase in the amount of vaginal bleeding seen as pooled blood leaves the uterus
very uncomfortable procedure
Homan’s sign and postpartum
(I couldn’t find anything in the book, but I learned at clinical)
Homan’s sign is important for C-section patients. (just like any other surgery patient)
peri colace
stool softener/ laxitive
stadol
pain medication
rhogam
rh negative mothers with rh positive babies ( given 72 hours after delivery)
mylicon
gas relief
dilaudid
pain
toradol
pain
percocet
pain
Psycholsocial risk:
depression altered family processes disturbance in body image/self-esteem role conflict altered sexuality patterns
Report from L&D nurse will include:
OBGYN (provider) Age gravida, para anesthetic labor induced type of birth and repair Rh status feeding abnormalities bonding group B strep status rubella iv fluids sex/wt of the infant description of the fundus, lochia, bladder, and perineum
Vital signs
check q15 mins first hour, q30 mins second hour
bp up slightly first hour
pulse increased first few hours
temp may go up to 100.4 first 24 hours
respirations remain normal
assessments done twice a day until discharge
uterine involution
take 4-6 weeks
occurs by decrease in size of the muscle cells
should be firm and midline
cervix
soft immediately after birth
within 2 to 3 postpartum days it has shortened, become firm, and regained form
urinary incontinence higher in
women who have given birth
increased parity
increased age
evaluation of episiotomy healing
redness edema ecchymosis discharge, drainage approximation
examining the perineum
ask woman to lie in the Sim’s position
wear nonsterile gloves
make sure there is good lighting
gently lift the buttocks to expose the perineum and anus
breastfeeding
before lactation a yellowish fluid, colostrum, can be expressed from nipples
tenderness may persist for 48 hours after start of lactation
nonbreastfeeding
engorgement resolves spontaneoulsy and discomfort decreases within 24-36 hours
breast binder or tight bra, ice packs, or mild analgesics may be used to relieve discomfort
length of stay
48 hours after uncomplicated vaginal
72-96 hours after uncomplicated c-section
hemorrhage
500mL or greater in vaginal
1000mL or greater in C-section
uterine atony
lack of tone
treatment: massage fundus, increase pitocin, make sure bladder empty
**If uterus fails to respond to oxytocin: ERGOTRATE, METHERGINE, CARBOPROST TROMETHAMINE
Other causes of hemorrhage
retained placental fragments: Tx: D&C cervical or vaginal tear: Tx: surgical repair Inversion of uterus subinvolution of the uterus hemorrhagic shock-- EMERGENCY
orthostatic hypotension
occurs in first 48 hours, due to sudden changes in blood circulation
many faint
*assist first one or two times up out of bed
1st shower must be assisted
SVT (Superficial venous thrombosis)
swelling, redness, tenderness, warmth, pain or asymptomatic
Tx: analgesia, elevation of ext., TEDS
DVT (Deep venous thrombosis)
same as SVT plus, pedal edema, + homans sign, extr cool, pale, decreased pedal pushes
TX; anticoagulant therapy, bedrest, and analgesia
Pulmonary Embolism
S&S: DVT, abdominal pains, chest pain, dyspnea, tachypnea, hypotension
Nursing care: elevate the head of the bed, administer oxygen, apply pulse oxymetry, IV fluids, initiation of heparin, bed rest, frequent VS
Nutritional aspects
usually very thirsty and hungry after delivery
vaginal delivery-regular diet
c-section- asses bowel sounds, clear liquids and progress
Taking In
1 to 2 days after delivery
mother is passive and somewhat dependent as she sorts reality from fantasy in birth experience
food and sleep are major needs
taking hold
2 to 3 days after delivery
mother ready to resume control over her life
she is focused on baby and may need reassurance
postpartum blues and depression S&S
cry easily lose appetite insomnia feel anxious begin 2-3 days after birth and disappear witin a week or two
causes of postpartum blues
hormonal changes
emotional reaction
discomfort
fatigue
postpartum depresion
decrease interest in food, decreased interest in surroundings, unable to feel pleasure, fatigue, sleep disturbance, obsessive thinking, decrease hygiene, decrease ability to concentrate, odd food cravings, irritability, rejection of infant, panic attack
Tx: antidepressants, sedatives, mood stabilizers
Postpartal psychosis
**EMERGENCY
rare
associated w fatigue and not caring for baby
may develop symptoms similar to bipolar disorder or schizophrenic reaction
S&S: depression, reject baby, jealous of husband, refuses to care for baby, agitation, volatile
discharge teaching
rest, hygiene, incision care/sitz baths, avoid heavy lifting, sexual intercourse, use of contraceptive, follow up, exercise
