Chapter 12 Flashcards
what is the postpartum period?
fourth stage 2 hours to discharge
for a first year postpartum woman, the postpartum period can be called
the fourth trimester
maternal mortality associated with pregnancy is
the death of a woman up to 1 year postpartum
BUBBLE HEP stands for
breasts
uterus
bladder
bowel
lochia
episiotomy (aka perineum)
hemorrhoids
emotions
pain
hormonal changes to the breasts
- decrease in estrogen and progesterone
- increase in prolactin
- oxytocin release during breastfeeding
when does true milk come in?
2-4 days after delivery
breast complications
mastitis: redness/itchy/sore/swollen of the breast
- can be result of baby not emptying mom’s breast well
- antibiotics needed
colostrum is
yellow/white discharge from the breasts
- not true milk, but contains a lot of vital nutrients for baby
around the 3rd day postpartum, what breast change can be expected?
engorgement
- swollen lymph tissue surrounding milk ducts, causes lactation
uterine cramping during breastfeeding/latching indicates
- good latch
- oxytocin release
nurse assessment of breasts for a breastfeeding woman includes
- inspect and palpate the breasts
- assess the nipples
- assess for clogged milk ducts
nurse assessment of breasts for a non-breastfeeding woman includes
- inspect and palpate the nipple
- educate woman on ways to avoid milk stimulation
how can a non-breastfeeding woman prevent/avoid stimulating her milk to come in?
- tight, supportive bra
- face away from hot/warm water of shower
how can a breastfeeding woman stimulate her milk to come in?
- warm compress
- warm shower
the involution of the uterus includes
- contractions
- atrophy of the uterine muscles
- decrease in size of the uterus
where is the uterus 6-12 hours postpartum (landmark)?
umbilicus
where is the uterus immediately postpartum (landmark)?
5 finger-breaths below the umbilicus
at what rate does the uterus decrease in size postpartum?
- decreases by 1 finger-breath/day starting at the umbilicus 6-12 hours postpartum.
- ex. day 1 postpartum: uterus is 1 finger- breath below the umbilicus
uterus: afterpains
- occur within the first few days and typically decrease 3 days after delivery
- occurs more commonly with multiparous women; increases with each additional pregnancy
- condition may increase when breastfeeding during the first few postpartum days
why do we frequently assess the uterus?
- identification of uterine atony
nurse assessment of the uterus includes
- location in relationship to umbilicus
- midline or to one side
- firm or boggy
steps to performing a uterine assessment
- inform patient that you will be palpating her uterus and explain the procedure
- medicate for pain if it is not needed emergently
- instruct the woman to void prior to assessment
- provide privacy
- position patient supine (flat position)
- support the lower uterine segment by placing one hand above the symphysis pubis
- locate the fundus with the other hand and gently apply pressure downward
what are the assessment findings of a uterus assessment?
- assess for bladder distention
- fundus:
-tone: firm or boggy
-location: midline, at the umbilicus or 1 cm above
nursing actions: uterus
- massage the fundus
- give oxytocin
- notify MD
common issues of the bladder in the first few days postpartum are
- distention
- cystitis
- rapid filling
- incomplete emptying
- inability to void
incomplete emptying of bladder is usually due to
poor tone or anesthesia
nursing actions of the bladder assessment
- assist woman to bathroom
- encourage voiding within 2-4 hours post-birth
- encourage changing peri pad with each void to assess bleeding
- assess for urinary disturbances
- catheterization per order
- assess for frequency, urgency, and burning
- instruct woman to increase fluid intake to a minimum of 10 glasses per day
- document findings
what is most likely the catheterization order?
straight catheter x1
what happens to muscle tone and motility of the bowel, post-birth?
- decrease post-birth
- returns to normal by 2nd week postpartum
bowel assessment includes
- hemorrhoids
- constipation
- appetite
- weight loss
nurse actions pertaining to the bowel includes
assess for:
- bowel sounds each shift
- constipation
- hemorrhoids
- appetite
- N/V
- increase fluid intake and fiber
- increase caloric intake if breastfeeding
when should a nurse listen to bowel sounds in relation to palpation?
listen before palpation
how much should a breastfeeding mom increase her caloric intake by?
500-1000 calories
what is the lochia?
bloody discharge from the uterus that contains RBCs, sloughed off decidual tissue, epithelial cells, and bacteria
metritis is
infection of the endometrial tissue
*primary complication of the endometrium
lochia: endometrium assessment includes
- exfoliation and regeneration
- healing at the placental site
nurse assessment of lochia includes
- color
- amount: scant, light, moderate, heavy
- odor
- clots
lochia: rubra
- red in color
- days 1-3 postpartum
- small clots
- moderate to scant amount
- fleshy odor
- increased flow standing or breastfeeding
lochia: serosa
- pink or brown in color
- days 4-10
- increased flow during physical activity
- fleshy odor
lochia: alba
- yellow/white in color
- day 10
- scant amount
- fleshy odor
lochia: scant
blood only on tissue when wiped or 1- to 2-inch stain
lochia: light
4-inch or less stain
lochia: moderate
< 6-inch stain
lochia: heavy
saturated pad
changes to the perineum related to the birthing process include
- edema
- stretching
- minor lacerations
- major tears
- periurethral tears
- episiotomy
nursing actions related to the perineum assessment
- assess for REEDA every shift
- explain procedure
- provide privacy
- position woman supine/flat
- remove peri pads, assess anteriorly
- assist woman to her side to assess perineum and rectum
- assess for discomfort and provide comfort measures
- reduce infection
what is REEDA?
redness
edema
ecchymosis
discharge
approximation
(of the perineum)
cardiovascular system assessment includes
- blood loss
- cardiac output
- thromboembolism
- orthostatic hypotension
what is an indication of thromboembolism
no Homan’s sign
interventions for woman with orthostatic hypotension
- instruct woman to change positions slowly
- assist with ambulation for the first few hours
- if woman becomes dizzy- safety first, get to chair or bed (whatever is closer)
- keep ammonia ampule incase someone faints
- assess for blood loss
nurse assessment of cardiovascular system
- assess pulse and BP
- assess for excessive blood loss- active bleeding and saturated peri pads
- assess lower extremities for venous thrombosis
- assess for postpartum chills
how often should the nurse assess pulse and blood pressure?
1st hour: every 15 minutes
2nd hour: every 30 minutes
next 22 hours: every 4 hours
after 24 hours: every shift
chest wall compliance returns after the birth of the infant because
the diaphragm pressure is reduced
nurse assessment of respiratory system
- assess respiratory rate
- assess breath sounds
- document findings
- incentive spirometer
how often should a nurse assess respiratory rate?
1st hour: every 15 minutes
2nd hour: every 30 minutes
next 22 hours: every 4 hours
after 24 hours: every shift
nurse assessment/actions of the immune system
- assess temperature
- administer vaccines as indicated
- administer Rho (D) immune globulins as indicated
- document findings
how often should a nurse assess temperature
1st hour: every 15 minutes
2nd hour: every 30 minutes
next 22 hours: every 4 hours
after 24 hours: every shift
under what conditions would a nurse administer Rho (D) immune globulins?
if mother is Rh - and gave birth to a Rh + fetus
- give to mom
is it common for temperature to be elevated after delivery?
yes, for the first 24 hours
why may temperature be elevated after delivery?
- muscular exertion
- exhaustion
- dehydration
- hormonal changes
what (negative reasons) could cause temperature to be elevated after delivery
- flu
- rubella (german measles)
- tDAP (pertussis: whooping cough)
- Rh isoimmunization
what abrupt changes r/t endocrine happen after the placenta is delivered?
- estrogen and progesterone decrease
- prolactin levels increase
how long do prolactin levels increase postpartum?
- up to 6 weeks after delivery
when do menses resume postpartum?
non-breastfeeding: 10 weeks postpartum
breastfeeding: 17 weeks postpartum
diaphoresis
profuse sweating
- often occurring at night
- assists body in secreting the increased fluid accumulated during pregnancy
how is the muscular system affected by labor/delivery?
separation of rectus muscle
how is the nervous system affected by labor/delivery?
the lower body nerve sensation diminishes for women who received an epidural
nurse assessments/actions of the muscular and nervous systems postpartum
assess:
- diastasis recti abdominitis
- muscle tenderness
- decreased nerve sensation
- headache
- fatigue
-promote rest/sleep: sleep when baby sleeps
discharge/follow-up care includes
- education:
-normal physical changes
-self care
-signs of complications - postpartum visit 4-6 weeks: vaginal; 2 weeks: c/s
signs of complications to include in discharge teaching
- heavy lochia
- return of bright red blood
- foul smelling lochia
- temperature
- pain (pelvis or abdominal: if its more than when they left the hospital- warning sign)
- urinary complication
- leg pain, swelling, redness
- thoughts of harming self or baby
AWHONN postpartum discharge teaching includes what acronym?
POST BIRTH
POST
- pain in chest
- obstructed breathing/shortness of breath
- seizures
- thoughts of hurting yourself or the baby
BIRTH
- bleeding through 1 pad in an hour or more, egg sized or bigger clots
- incision that is not healing
- red or swollen leg that is warm and painful to touch
- temperature of 100.4
- headache that does not get better even after taking medication OR headache with visual changes
who should you call for POST vs BIRTH?
POST: call 911
BIRTH: call provider
health promotion points
- nutrition and fluids
- smoking cessation
- activity and rest
-no heavy lifting for 2 weeks
-up and down the stairs: limit - contraception
-encourage to wait 1 year before trying to conceive again - sexual activity
-no sex for 6 weeks - medications
-keep taking meds that she took in hospital
-narcotics: contraindications, addiction risks
comfort measures for uterine afterpains:
- warm blanket/compress on the abdomen
- encourage patient to empty bladder
- relaxation techniques
- analgesics: ibuprofen
how often should baby be on breast?
q2-3 hours
if the uterus is not midline upon palpation, the nurse should ____
try to get patient to void
nursing actions for hemorrhoids
- encourage woman to avoid sitting for long periods of time, lay on side
- stool softener (colace) or laxative
- witch hazel pads or topical anesthetics
- sitz baths
clot assessment findings
- small clots noted in patient chart
- egg-size or larger should be weighed and findings report to MD
- should be examined for the presence of tissue
-retained placental tissue (PPH**)
clot weight: 1g of blood is equivalent to ___ mL of blood loss?
1 g weight equals 1 mL of blood loss
bladder cystitis: definition & s/x
-bladder inflammation or infection
s/x:
- frequency
- urgency
- pain or burning on urination
- suprapubic tenderness, hematuria, malaise
bladder cystitis: treatment
- antibiotic therapy
- increased hydration
- rest
is PP fever normal? chills?
PP fever is normal, chills is not
emotions
- 1/7 women experience PPD (depression)
- 13-21% of women experience perinatal anxiety
- 2/3 young pregnant women report one or more mental health issues
- around 20% of postpartum deaths are from suicide
patient teaching for mom r/t ovulation/menstruation after delivery:
- still ovulating, even when menses haven’t resumed
- need to talk about birth control
- no tampons
- no intercourse
- no douches
