Book Chapter 16 Flashcards
How often is a postpartum assessment typically performed?
During the first hour: q15min
2nd hr: q30min
first 24 hours: q4h
after 24 hours: q8h
How often is a postpartum assessment typically performed?
During the first hour: q15min
2nd hr: q30min
first 24 hours: q4h
after 24 hours: q8h
What hemoglobin level indicates anemia in a postpartum patient?
less than 10.5 mg/dL
What are the major risk factors for a postpartum hemorrhage?
1) precipitous labor (less than 3 hours)
2) uterine atony
3) labor induction or augmentation
4) operative procedures used in aiding birthing process
5) retaining parts of placenta
6) prolonged 3rd stage of labor (>30min)`
7) multiparity
8) uterine overdistention (think SGA infant, twins, hydramnios)
What are the major risk factors for a postpartum hemorrhage?
1) precipitous labor (less than 3 hours)
2) uterine atony
3) labor induction or augmentation
4) operative procedures used in aiding birthing process
5) retaining parts of placenta
6) prolonged 3rd stage of labor (>30min)
7) multiparity
8) uterine overdistention (think SGA infant, twins, hydramnios)
What are the major postpartum risk factors for infection?
1) operative procedure to aid in birth (forceps, kiwi extraction, c-section)
2) hx of diabetes/gestational diabetes
3) prolonged labor (more than 24 hours)
4) use of indwelling urinary catheter
5) anemia
6) multiple vag exams during labor
7) prolonged rupture of membranes (>24 hours)
8) manual extraction of placenta
9) compromised immune system (HIV +)
What hemoglobin level indicates anemia in a postpartum patient?
What are the major risk factors for a postpartum hemorrhage?
1) precipitous labor (less than 3 hours)
2) uterine atony
3) labor induction or augmentation
4) operative procedures used in aiding birthing process
5) retaining parts of placenta
6) prolonged 3rd stage of labor (>30min)
7) multiparity
8) uterine overdistention (think SGA infant, twins, hydramnios)
What acronym do we use to guide the process of the postpartum assessment?
BUBBLE-EEE Breasts Uterus Bladder Bowels Lochia Episiotomy Epidural site Extremities Emotional Status
What are signs that your postpartum patient is not doing well…the “danger signs” (as listed in book)
- temp of more than 38C (100.4F)
- foul-smelling lochia or unexpected change in color/amount
- large blood clots
- bleeding that saturates a peripad in an hour
- severe headaches or blurred vision
- visual changes such as blurred vision or spots
- headaches
- calf pain with dorsiflexion of foot
- swelling, redness, or discharge at an incision site of any kind
- problems with urinary incontinence
- SoB
- depression/mood swings
what causes BP changes to vary most often in postpartum patients?
position changes, so assess in same position every time
What’s the normal postpartum pulse rate during the first week after birth? what is the term for this pulse rate?
40-80 bpm; puerperal bradycardia (just remember the gravid uterus is lightened causing a huge rush of blood flow to heart, up SV, down pulse)
What could severe pain in the perineal region be in a postpartum pt?
a hematoma, check by inspecting palpating the area and if found notify provider
T or F, BP postpartum = BP during labor
True!
what causes
a
What’s the goal of pain management for postpartum patients?
between 0 and 2 at all times, ESPECIALLY after breast-feeding; often accomplished by pre-medicating (biggie with pain: think afterpains due to involution)
What could severe pain in the perineal region be in a postpartum pt?
a hematoma, check by inspecting palpating the area and if found notify provider
just fyi
there’s something called foremilk and it’s bluish white
What is important to know when assessing a woman’s breasts who is not breast-feeding?
use gentle, light touch to avoid breast stimulation which would make any engorgement worse
What is the two-handed approach when assessing the fundus?
feeling top of uterus with one hand and other hand placed on lower segment of uterus to stabilize it
What might nodules, masses, or areas of warmth indicate?
plugged duct that could progress to mastitis if not treated
just fyi
there’s something called foremilk and it’s bluish white
In what position should the woman be when assessing the fundus?
supine position with knees flexed slightly and bed in flat position as low as possible
What is the two-handed approach when assessing the fundus?
feeling top of uterus with one hand and other hand placed on lower segment of uterus to stabilize it
What’s a sign of uterine atony?
a boggy or relaxed uterus
If a fundus is not firm, what intervention can the nurse do to firm it up?
massage it
Is it a normal or abnormal finding if fundal height is above the umbilicus?
abnormal, usually do to bladder being full
The fundus progresses downward at a rate of ______ after childbirth
one fingerbreadth or 1cm/day
what does u/1 mean?
top of fundus located 1cm below the umbilicus (u/1 is normal for first postpartum day)
If a fundus is not firm, what intervention can the nurse do to firm it up?
massage it
What are signs of a UTI in postpartum pt.s?
fever, urinary frequency and/or urgency,foul-smelling odor difficult or painful urination, and tenderness over the costovertebral angle
insufficient voiding in postp pt. is determined by how many mL?
less than 200
How can the nurse check if the bladder is empty?
palpate the area over the symphysis pubic; if empty, the bladder is not palpable AND percuss area, if full bladder then dull to percussion
will a full bladder decrease or increase lochia drainage?
increase b/c uterus cannot contract to suppress bleeding
Is constipation a common problem for postpartum pts?
yes
insufficient voiding in postp pt. is determined by how many mL?
less than 200
How do we measure the amount of lochia? What are the 4 different levels? Describe
by how much a pad is saturated over a certain amount of time
1) Scant: a 1-2 inch lochia strain on the perineal pad or approximately a 10-mL loss
2) light or small: 4-inch stain, 10-25mL loss
3) moderate: 4-6 in stain, 25-50mL loss
4) large or heavy: pad saturated within 1 hr after changing
Many women are afraid of having a BM b/c they think they’ll rip stitches from their episiotomy or exacerbate hemorrhoids. What prevents this?
stool softenere and laxatives
Is constipation a common problem for postpartum pts?
yes
What two actions will cause lochia flow to increase and it is not an abnormal finding? aka an increase in lochia flow is expected when the woman does these two things
1) lochia flow ill increase when woman gets out of bed b/c lochia pools while she’s lying
2) will increase when breast-feeds b/c oxytocin release causes uterine contraction
How do we measure the amount of lochia? What are the 4 different levels? Describe
by how much a pad is saturated over a certain amount of time
1) Scant: a 1-2 inch lochia strain on the perineal pad or approximately a 10-mL loss
2) light or small: 4-inch stain, 10-25mL loss
3) moderate: 4-6 in stain, 25-50mL loss
4) large or heavy: pad saturated within 1 hr after changing
What is the range for total volume of lochial discharge?
150-400 mL
just fyi
this is nitpicky, but check under the woman to make sure additional blood is not hidden or absorbed on her perineal pad, also good time to assess for hemorrhoids
according to the book, what’s the first step if excessive bleeding occurs?
massage the boggy fundus until it is firm to reduce the flow of blood
will a woman with cesarean birth or vag birth have less lochia discharge?
the woman who had a cesarean birth will have less lochia discharge
Which type of lochia discharge reappearing is a bad sign?
if lochia rubra reappears after serosa and alba
To assess an episiotomy/perineal area, what position should the patient be put in?
on her side with top leg flexed upwards at the knee and drawn towards waist AKA sim’s (doesn’t say specific side), stand with her back facing you
T or F, a postpartum patient arrives on the unit and you notice bruising and slight edema of the perineal area, you should report this finding to a provider
False, this is a normal finding
