7.1d Discharge/Follow-Up

Question 1

Discharge Planning

Answer 1

• Planning begins as soon as admission

- Education on physical/psychosocial s/s of problems

Question 2

Discharge Basic Information

Answer 2

• Nutrition
• Exercise
• Family planning
• Resumption of sex
• Medications
• Routine baby follow-up care
• Drowsiness medication should not be administered if mother will be the one holding the baby
• Newborn must be secured in car seat for the drive home

Question 3

Sexual Activity and Contraception

Answer 3

• Must be discussed before discharge
• Postpartum perineal pain or lacerations may affect when sex is resumed
• Discomfort may last weeks or months
• Breastfeeding mothers may experience vaginal dryness due to high prolactin and low estrogen
• Change in sleep schedule and family structure may affect sex as well as PPD
• Contraception education
• Breastfeeding is not a reliable form of contraception
• Oral contraceptives can interfere with breast milk production

Question 4

Sexual Activity

Answer 4

• Safe by 2-4 weeks after birth (unless contraindicated)
• Most patients resume by week 5-6
• From 6 weeks to 6 months lubrication may be needed. Strength of orgasms may be decreased for the first 3 months
• Water soluble gel and contraceptive cream/jelly can be used as lubrication
• Breastfeeding can cause mother to feel sexual stimulation
• Kegel exercises to improve feeling of sex as well as bladder/bowel movement

Question 5

Medications

Answer 5

• Prenatal vitamins including breastfeeding mothers
• Supplemental iron for low hemoglobin/hematocrit levels
• Stool softeners for those with episiotomies/lacerations

Question 6

Follow up care

Answer 6

• Within the first 3 weeks there should be follow up with OB
• This is done to address concerns fatigue, pain, breast feeding issues
• Can be done via phone or in the clinic
• Should be done no later than 12 weeks

Question 7

Comprehensive Follow Up Evaluation

Answer 7

• Physical/Social/Psychological well being of patient
• Physical recovery from birth
• Sleep/Fatigue
• Mood/Emotional Well being
• Infant Feeding/Care
• Sexuality
• Birth Spacing (do not get pregnant for at least 18 months after birth)
• Contraception
• Chronic disease management (hypertension/diabetes)
• Review of vaccinations
• Pap Test and Pelvic Examination

Early Follow up Required for patients with
- Hypertension
- Chronic health issues
- High risk for PPD
- Breastfeeding patients with lactation issues
(Routinely seen 3-5 days after birth and again at 2 weeks)

Question 8

Home Visits

Answer 8

• Usually a few days after birth to bridge gap between hospital and patient
• Scheduled 2-4 days after discharge
• Focuses on physiological adjustment, existing complications and emotional adjustment with knowledge and self-care management
  NEWBORN
• Verification that blood sample was drawn

Question 9

Warm Lines

Answer 9

• Help lines for postpartum patients (NOT CRISIS INTERVENTION LINE)

Question 10

Support Groups

Answer 10

• For interactions and conversation with other patients adjusting to motherhood
• Enables patients to share their experiences and concerns and support each other

Question 11

No Family Support and Overwhelmed Mother

Answer 11

• Safety of newborn is key
• Assisting in motherly role and screening for PPD
• Parenting programs and counseling
• 24 hour phonelines should be provided to prevent frustration and anger
• Neglect and abuse could be possible for baby
• Those who were abused as a child are likely to abuse their child

Question 12

Post Partum Fundus Assessment

Answer 12

• Knees should be flexed during assesssment

Question 13

Coombs Test

Answer 13

• During Rhogam therapy Nurse should check Coombs test results are negative, indicating antibodies have not been formed.
• Must be given before 72 hours of birth
• Often given at 3rd trimester and again after birth
• Newborn needs to be rH positive

Question 14

Sitz Bath

Answer 14

• Patients should squeeze their butt together before entering sitz bath to reduce pulling on perineal repairs.
• Water should be warm (38-40 degrees Celsius
• Done twice a day for 20 minutes each

Question 15

Education for At Home Laceration Care

Answer 15

• Use squeeze bottle pointed backwards (not upwards) to remove lochia from vagina
• Topical medications should only be use 3-4 times daily
• Gloves are not needed but patient should wash their hands
• Perineum should be air dried after for 10 minutes once or twice daily to facilitate healing