Ch 21 Nursing Care of the Family During the Postpartum Period Flashcards
The placenta should be delivered within…
30 minutes of the newborn
How long does the postpartum period last?
Approximately 2 hrs
Delayed delivery of the placenta puts the mother at risk for…
Postpartum hemorrhage
Puerperium
6 weeks after childbirth where mother’s organs return to non pregnant state
Postpartum vital signs: Normal BP
Slightly increased first few days OR can have orthostatic hypotension first 48 hrs
Postpartum vital signs: Hypertension indication
Anxiety, pre eclampsia, essential hypertension (undiagnosed)
Postpartum vital signs: Hypotension indication
Hemorrhage
Postpartum vital signs: normal temp
97.2-100.4
Postpartum vital signs: febrile indication
Infection
Postpartum vital signs: HR
50-90
Postpartum vital signs: Tachycardia
Pain, fever, dehydration, hemorrhage
Postpartum vital signs: RR
16-20
Postpartum vital signs: Bradypnea
effects of opioid medications
Postpartum vital signs: Tachypnea
Anxiety, respiratory disease
Postpartum assessment frequency: Vaginal
8 hrs
Postpartum assessment frequency: c section
4-8 hrs
Assessment: BUBBLE HERP stands for
B - breasts U - uterus B - bladder B - bowel L - loch/legs E - Episiotomy H - hemorrhoids E - emotion R - rubella P - pain
What is included in the postpartum assessment
BUBBLE HERP
Vitals
Assess incision, breath sounds, bowel sounds
Postpartum assessment: Breasts day 1-2
Soft (colostrum)
Postpartum assessment: Breasts day 2-3
Filling
Postpartum assessment: Breasts day 3-5
Full, soften with breast feeding
Postpartum assessment: Breasts abnormal
Engorgement: firmness, heat, pain
Postpartum assessment: Nipples abnormal
Latching problems: Redness, bruises, soreness, pain, blisters
Postpartum assessment: Uterus normal
Firm, midline
First 24 hrs at level of umbilicus
Involutes 1 cm a day
Postpartum assessment: Uterus abnormal
Uterine atony: Soft, boggy, higher level than expected
Lateral deviation: distended bladder
Uterine atony means..
Without tone, failure of uterus to contract
How can we maintain uterine tone?
Fundal massage
Inflammatory infection of the breast almost always caused by infection
Mastitis
Symptoms of mastitis
Breast: Tender, hot, localized redness, pain
swollen axillary lymph nodes on affected side
Pain with breast feeding or expressing
Patients with mastitis milk can be
Clumpy or gelatinous, or have pus or blood in it
Possible systemic symptoms of mastitis
Fever of 101 or higher Chills Headache Malaise Nausea Myalgia Lethargy Fatigue
How is mastitis treated?
Rest, increased fluids, increased feedings, abx
Risk factors for mastitis
Infrequent or insufficient milk removal Being less than 6 weeks postpartum Feeding a baby colonized with staph aureus Nipple damage or trauma Plugged ducts Delayed initiation of breast feeding Stress/Fatigue Nipple shield use Extended pressure on the breast, bra or stomach sleeping
Engorgement
Hard, firm, excessive milk in breasts, tender. Common finding
Mastitis can lead to…
Septicemia
