3 Nursing Management During The Postpartum Period

Question 1

What we want in report

Answer 1

Time & type of delivery
Gravida, Parity, weeks gestation
APGAR, feeing, meds, voids
Hx
Meds during labor
Lab values
Rhogam and rubella
RISK for hemorrhage, infection, thrombosis

Question 2

Rhogam steps

Answer 2

1:moms blood type (-)
2: fetal blood type (+)
3: drawl antibody screening (indirect coombs)
If (-) then we give rhogam within 72hrs
If (+) then we dont give

Question 3

Rubella if non immune we give

Answer 3

MMR vacine

Question 4

Planning for discharge

Answer 4

Begine on admission to PP unit

Criteria for discharge:
Stable mother and infants
Ability to effectively care for self and baby

Typical dicharhe:
Low risk vag = 48hrs
C/s 72hrs

Baby has to have peed/pooed/feeding well

Question 5

Assessing postpartum;

Know how often
Assessment

Answer 5

Know after delivery it is more then gradually gets less

Assessment:
-Head to toe
Focused: BUBBLE
-Breasts, Uterine fundus, Bladder/Bowel function,Lochia, and Episiotomy/laceration/cs incision
-PAIN

Question 6

Assesment postpartum :
VS
Neuro
Cardiac and respiratory

Answer 6

BP sam or slightly above baeline

2BP >140/90 least 4 hr apart require follow up

HR:May see bradycardia early

RR: WDL, clear

Temp: slight elevated d/t dehydration
(>100.4 after 24hrs suggest infection)

Neuro: HA, visual disturbances, DTR’s

Question 7

Assessment of

Urinary

Answer 7

Urinary: void within 6 hrs:
-foley catheter
-diuresis

Question 8

BREASTS
Type of bra
Feel
Nipple
Teaching(3)

Answer 8

Well-fitting supportive bra
Feel: soft, filling, full, engorged(large, painful)

Nipples: inverted/everted, red, cracks, soreness

Teaching:
-Breastfeeding
-Lactation supression (no, stimulation, no warm, facing away shower)
-possible problems

Question 9

Uterus

Position to check
Tone
Height
Position of uterus

Afterpains
Teachings

Answer 9

Lay flat

Tone: firm, firm with, massage, boggy(need massage)

Height: 1cm per day drop

Position: midline or shifted

Question 10

Lochia

Stages: color
Amount
Measurement
Pooling in vagina
Clots
Foul odor

Answer 10

Rubra, serosa, alba

Heavy=1pad saturated per hour (excessive if done in 15min)

1G=1ml

Pooling in vagina: run down when ambulating

Clots: larger than a golf ball need to notify someone
if gush of blood after then may be hemorraging

Foul oder=infection

Question 11

Lacerations

Ways to describe/types

Answer 11

Perineal: degree 1-4

Periurethral

Vaginal wall

Cervical

Question 12

Perineal care

Answer 12

Hand washing

Peri bottle

Wiping/patting

Icepacks

Sitzbath

Topical meds

Question 13

Bowel assessment and tx

Avoid what

Answer 13

Sounds/movement

Hemorrhoids: size and pain

Tx:
Stool softener
Avoid carbonation and straws (cause gas)

Question 14

Bladder assessment/tx

Void how soon
Full bladder inhibits what
Burning means
Uti prevention

Answer 14

Void 4-6hrs after f/c removed

Full bladder inhibits involution

Burning or pain = periurethral tear

Tx:
UTI prevention (empty bladder, hydrate, hand hygiene)

Question 15

DVT

Signs
How to tx

Answer 15

Homans sign (ankle flex hurts calf)
Unilateral red leg
Warm to touch
Pain (dull)
Swelling

Tx:
Ambulation
Lovenox

Question 16

When can c-section dressing come off and they can shower

Answer 16

24hours

Question 17

Pp RF for infection

Answer 17

Operative procedure
Diabetes
Prolonged labor
F/c
Anemia
Alot of vaginal exams
Prolonged ROM
Manual extraction of placenta
Compromised immune system

Question 18

PP RF for hemorrhage

Answer 18

Precipitous labor
Uterine atony
Placenta previa/abruptio
Labor induction/augmentation
Operation
Reatined placenta fragments
Prolonged 3rd stage
Multiparity
Uterine overdistention

Question 19

How to prevent bleeding
-uterine tone (3)
-bladder distention

Answer 19

Maintain uterine tone:
-assess bleeding
-massage a boggy uterus
-meds: oxytocin, methergine

Prevent bladder distention

Question 20

Promoting comfort and rest
Assess what
After pain tx
Perineum pain tx
Breast

Answer 20

Assess pain

Afterpains:
-warmth, lying prone, pain meds

Perineum:
-icepacks, sitz baths, topical

Breast: engorgement
-other powerpoint on how to tx depending if breastfeeding

Question 21

Promoting breastfeeding

Answer 21

Skin to skin

Infant cues:
-sucking motions
-hand-to-mouth
-rooting reflex
-crying (late sign)

Question 22

Vacinations
-MMR
-Varicella
-Tdap
-Rhogam

Answer 22

MMR:(if not immune)
Avoid pregnancy x 1month

Varicella: (if not immune)
Avoid pregnancy x 1month

Tdap: if not received

Rhogam: within 72 hrs

Question 23

Sexual activity and contraception after birth (3)

Answer 23

Bleeding stopped and perineum healed
-usually 5-6 weeks

Vaginal dryness: water soluble lube

Ovulation occur around 1 month after birth