Chapter 21 & 22 Flashcards
(43 cards)
Describe components of a systematic postpartum assessment.
B - breasts U - uterus B - bladder B - bowel L - lochia E - episiotomy E - emotional state "For first assessment, you will perform a full comprehensive assessment + BUBBLEE, then for each subsequent pp assessment it is just BUBBLEE"
When Does discharge planning begin?
At time of admission
How long can the mother stay in hospital for recovery after delivering vaginally and C-section? (Also, how many hours is considered “early discharge”?
Vaginally - 48 hours / Early = 24 hours
C-Section - 72-96 hours / Early = 48 hours
What are the routine labs that are completed for the pp woman?
Hgb, Hct, Clean catch urinalysis/culture; Immunity and Rh Factor (if unknown)
(T/F) It is okay for an infant to be carried out of the room in a staff members arms
F - They are always wheeled in a bassinet
How do you perform a breast assessment?
Inspect breasts
Palpate for fullness, tenderness, lumps
Assess nipples (intact, inverted, flat, size)
Check for colostrum, milk (Dont Squeeze!)
Find out how well newborn is latching
Breast care teaching – teach correct techniques, manual expression
What is the difference between engorgement and mastitis? (Etiology, When does it usually occur, appearance or breasts/areolae, and how long does it last)
Engorgement – swelling of breast tissue brought about by an increase in blood and lymph supply to the breast as the body produces milk; Blood vessels become congested - fluid leaks into surrounding tissue causing edema
Occurs 3 – 5 days after birth when the milk ‘comes in’
Breasts – firm, tender, hot, shinny
Areolae – firm, nipples flatten
Lasts for about 24 hours
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Mastitis – infection in a breast, usually confined to a milk duct
Presents as influenza-like symptoms (fever, chills, body aches, headache), redness and tenderness in the affected breast
Usually occur in upper outer quadrant of breast
* Untreated engorgement can lead to mastitis
How To Treat Engorgement?
Frequent feeding (q 2-3 hours or on demand)
Manual expression of milk or pumping
Warm compress before feeding (to vasodilate) and ice packs after feeding (to vasoconstrict)
Chilled cabbage leaves
Pain medication (anti-inflammatory, Ibuprofen)
How long should a women be encouraged to exclusively breastfeed?
6 months
What are the causes and treatment of mastitis?
Causes – inadequate emptying of breasts (engorgement), cracked nipples (entry of organisms, staph, strep, E. coli)
Tx – ABX therapy, analgesic, anti-pyretic, fluids, rest
How do you assess the uterus and what is considered normal?
where should it be and what is the consistency
PALPATE: Uterine fundus – firm, midline, first 24 hrs at level of umbilicus; involutes ~1cm/day
Also, determine bladder distention level - if bladder is distended, uterus cannot contract
Tip: Palpate the uterus regardless of c-section
If the bladder is full, what complications may arise in regards to the uterus and how could you tell?
Excessive bleeding
A distended bladder will push uterus to the side.
Two main causes of excessive bleeding?
Uterine atony and bladder distention
Uterine atony often results from retained placental fragments.
What are some support measures to help woman stimulate voiding?
walk her to restroom (or assist on bed pan)
have woman listen to running water
place hands in warm water
pouring water from a bottle over perineum
sitz bath
*sterile catheter if measures were unsuccessful
How do you estimate blood loss?
Hbg,Hct
Weigh the blood (1g = 1ml)
If bleeding occurs in presence of contracted uterus, what could it be?
Could be vaginal or vulvar hematomas or unrepaired lacerations of vagina/cervix, also examine perineum.
What are some reliable indicators of impending hypovolemic shock?
Initially -> pulse (Tachycardia)
Also Assess -> Respiration (Tachypnea), skin condition, urinary output, and LOC
Tip – BP is not a reliable sign b/c it doesn’t drop until woman has lost 40% of blood volume
Steps to be taken when assessing bowel/bladder?
(How often should she void, how many ml should be there,
PALPATE: bladder for distention
Mother should void spontaneously within 6-8 hours pp. with a volume of at least 150ml is expected for each void - Encourage emptying of bladder q 2 to 3 hrs
Full bladder displaces uterus
Find out last bowel movement; request stool softener prn
Renal Suppositories/Enemas contraindicated in which woman?
Renal suppositories/enemas not to be administered in women with 3rd or 4th degree perineal lacerations
Tip: With a 4th degree episiotomy, patient MUST shit at least once before discharge
Name two interventions that can help relieve flatulence
Rocking in a chair and ambulation can help relieve flatulence
Steps to take when assessing lochia and episiotomy
- Assess quantity and type (rubra, serosa, alba)
- Inspect perineum (pain, edema, sutures, whether intact)
What is the ideal time to initiate breastfeeding?
ideal time to initiate is within 1-2 hours after birth
What are the immunizations to be given upon discharge? (if not immune)
- Rubella vaccination: given on discharge as MMR 0.5 ml SQ
- Varicella vaccination: given on discharge, second dose at routine pp visit (4-8wks)
- Tetanus-Diphtheria-Acellular Pertussis (Tdap) vaccine: given upon discharge to protect women against pertussis and to decrease risk of infant’s exposure
- Rh Isoimmunization – Rh immune globin (Rhogam) prevents the Rh negative mother whose had a Rh positive fetus from making antibodies -given within 72 hours after birth
When is PP Depression Screening recommended?
Routine Postpartum Depression screening recommended during infant follow up visits at 1st, 2, and 4th months
