4500 Class 7 Postpartum Flashcards
Postpartum assessment and signs of potential complications
(table 22.2)
Intervention for episiotomy
(box 22.2)
Intervention for lacerations
(box 22.2)
Interventions for hemorrhoids
(box 22.2)
Signs of potential psychosocial complications
(box 22.3)
What is BUBBLLEE (post partum assessment)
B — Breasts: firmness and nipples
U — Uterine fundus: location; consistency
B — Bladder function: amount and frequency
B — Bowel function: passing gas or bowel movement, (for vaginal birth)
L — Lochia: amount, colour
L — Legs: perioheral edema (or ‘E’ for extremities)
E — Episiotomy / Laceration or Caesarean borth incision: perineum, discomfort, conditionor repair (if done)
E — Emotionsl Status: mood, fatigue, confidence
Usual duration of postpartum stay in a hospital with vaginal delivery
24-48 hours
Usual duration of postpartum stay in a hospital with caesarian birth
~4 days
When is the 4th stage of labor
1-2 hours postpartum
What are part of our nursing assessments during 4th stage of labor (first 1-2 hours postpartum)
- Physical assessments of birther (VS, targeted assessments)
- Skin-to-skin initiation
- Breast/chest feedingninitiation
- Assisting php with perineal repair - assess perineum
- Assessment of placenta
- Administration of uterotonic medications - meds that promote uterine tone / contraction
- Administration of analgesic meds as needed
- Removal of epidural catheter, post epu assessment, as needed
- Encourage, monitor for void
What do we do when a birther experienced a laceration of they have gone through episiotomy
It will need to be sutured, (perineal repair)
Nurses do with perineal repair
- Assess pain management needs
- Positioning and lightning
- Skin to skin bonding with newborn
- Spinge and needles count
Parameters for BP assessment postpartum
q 15 minutes first hour
q 30 minutes after that for the remainder of 4th stage
Parameters for pulse assessment postpartum
Same as BP
Parameters for measuring temp postpartum
Initially and one more before transfer to podtpartum unit
How often do we assess fundal height and firmness
Same as BP
What donwe assess in perineum PP
Laceration - redness, edema, bruising drainage, approximation
Prescence of hemorrhoids
What are relevant obstetrical history
HTN, diabetes, placenta previa, placental abruption
+ rubella status
+ prescence of infections
+ GBS status and TREATMENT if positive
- RH STATUS
- hepatitis seroslogy
- HIV status
- syphylis
What are LABOUR CONSIDERATIONS
- Length of labour - dystocia
- Induced/augmented
- ROM - time, issues with meconium-stained amniotic fluid
- Any complications (temp/infection, antobiotic administration, blood cultures - FHR concerns, placental abruption)
- IV in situ?
RH protocol
IF MOTHER RH NEG, AND BABY IS RH POS
- treated within 72 hours
What does the uterine (fundal) assessment look like in
A. Normal prgress, days 1-9
B. Size and position of uterus 2 hours after childbirth
C. Two days after childbirth
D. Four days after childbirth
What does the fundus look like at the end of 3rd stage of labour
@u or u/u (fundus at the level of ambilicus)
u/1-2 (fundus 1-2cm below umbilicus)
Fundus 12 hours after birth
May rise to 1 cm above umbilicus
Fundus/uterus 24 hours after birth
Uterus is about the same size that it was at 20 weeks gestation
Uerus after two weeks
No longer abdominally palpable
- ~350 grams
Normal uterine findings
- placement should be midline abdomen. Deflection may indicate a distended bladder
- size and shape should feel round, about the size of a grapefruit, ; larget usually indicates hemorrhage
- the tone should feel firm (again life a grapefruit. If boggy (soft) massage gently, nitofy primary HCP
What are nursing interventions for uterus
- Fundal massage
- Uterotonics as ordered
Information we need to prevent excessive bleeding
U - uterus
L - Lochia
E - Lacerations / episiotomies
What does a distended bladder look like
THE UTERUS DISPLAV}CEF ABOVE UMBILICUS AND WELL TO ONE SIDE OF THE MIDLINE
- bladder appears and round, supraoubic bulge
- may be able to palpate bladder
- uterus is usually boggy, above umbilicus and off to the right
- LOCHIA IS HEAVIER
Normal bladder
- Should be able to void spontaneously within 8 hours of birth
- No distension
- Able to empty bladder completely
- No dysuria
When does diuresis start PP
Approx how much
12 hours after birth,
May void up to 3000 ml/day
Intrapartum RIC}SK factors that may cause bladder distension
- Epidural
- Trauma due to extensive vaginal or perinel lacerations / episiotomy or Instrument assissmted birth
- Prolonged labour
- In-dwellling catheter during labour
Minimum amount per void
150 mL
When is bowel movement expected
After 3 days
What are meds that contribute to constipation
Opiod analgesics, iron supplements, Magnesium sulphateq
Interventions for constipation
- Adequate roughage
- Increase fluids
- Ambulation
- Risk of opiod analgesics
- Stoll softeners / laxatives
What is the normal vaginal discharge after delivery callede
Lochia
What is a lochia composed of
Leukocytes, epithelial cells, decidua, suto-lysed protein and bacteria
**NORMAL AMOUNT SHOULD BE SCANT TO MODERATE WITH FEW CLOTS
How does a normal lochia look like Day 1-3, Day 3-10, Day 10-Week8
Dark red (rubra)
Pink / brownish red (serosa)
Yellowish-white (alba)
What do we worry for when
Redness, tenderness, pain, warmth, unilateral swelling?
VTE
How domwe avoid VTE
Ambulation, TEC stockings,
Those at risk LOW MOLECULAR-WEIGHT HE{ARIN during postpartum period
What is the inital nursing intervention with swollen perineum
Offer an ice pack - FOR 15 MINS, NOT MORE THAN 1 TIME IN AN HOUR
How should a normal hemorroid look like in the rectal area postpartum
Soft and pink
How do we assess for episiotomy or laceration
- Intactness — edges should be well approximated
- Edema, bruising, hematoma SHOULD NOT BE PRESENT and should be documented. Inform pcp.
- Infection? Redness, warmth, drainage, nitofy pcp
Classify/differentiate 1st to 4th degree lacerations
1st — skin and strictures superficial to the muscles
2nd — extends through the muscle
3rd — extends through anal sphincter
4th — involves the anterior rectal wall
When should temp be a concern
When 38 degrees or higher lasting more than 4 hours
What is uterine atony, what can cause it
It is the faiture of the uterus to contract firmly
It is the most frequent cause of excessive bleeding
It can be cause by retained placental fragments / membrane
How does excessive bleed happen with uterine atony
The relaxed uterus will fill with blood and clots and blood vessels at the placental site are not clamped off
What to assess w uterine atony
- Significant drop in BP
- check resps, pulse, skin conditiom, urinary output, conciousness (SIGNS OF HYPOVOLEMIC SHOCK)
Top 2 nursing interventions for uterine atony, how?
- Maintain uterine tone
- Prevent bladder distension
BY uterine/fundal massage, uterotonics(prevent PPH)
How and when do we administer Oxytocin?
What does it do
5-10 unites IM or IV after delivery of the anterior shoulder — 3rd stage of labour
Encourage uterine to ‘clamp down” on the open blood vessels at the open placental site, prevent PPH
Name 2 other possible source of excessive bleeding postpartum
- Vaginal / vulval hematomas
- Unrepaired lacerations of the vagina or cervix
- can be common and can be r/t to both ohysical and psychologicl
- may be inpacted by pain
- can be ralated to anemia or infection
FATIGUE
Analgesics recommended/preferred for breat feeding persons
Non-opiods (NSAIDS)
Priorities of Helath Promotion Planning for Future Pregnancies
- Rubella vaccine
- Rh immune globulin; if RH NEG
Hpw much rh immune globulin is given
Usually 300 mcg
