Class 7: Postpartum Assessment - 4th Stage Flashcards
define: postpartum period
- the interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state
what is the postpartum period also referred to as?
- puerperium
what is the approx length of the postpartum period
- approx 6 weeks
what are important aspects of the postpartum period for health care providers to consider? (5)
- assessment of normal physiological and psychological processes and interventions as needed
- awareness of cultural safety, determinants of health, needs of the family in supporting care during the postpartum period & transition to home enviro for both birther & newborn
- education regarding ongoing care of self & newborn care needs –> includes S&S that require further attention
- help mother rest
- address clinical concerns that arise for fetus & mother
what is the goal of education during the postpartum period
- prep parents to safely transitions home with newborns
in the hospital, the usual postpartum stay for a vaginal delivery is approx ____ after birth? what does this depend on?
- approx 24-48 h
- depends on complications involved during pregnancy and/or delivery and/or with the newborn
how long might the postpartum period be for a c-section
- 72 hrs
what is 1 of the main goals of the postpartum stay
- prep for transition to the home enviro and supporting new mothers/parents to confidently care for themselves and their newborn
what is the 4th stage of labor
- first 1-2 hrs postpartum
what assessments are done in 4th stage if labor (5)
- physical assess of birther (VS, targeted assess)
- assist PCP w perineal repair & assess perineum
- assess placenta
- remove epidural cath, post-epidural assess
- encourage & monitor for void
what is initiated in the 4th stage of labor (2)
- skin-to-skin contact
- breast/chest feeding
what meds are admin during 4th stage of labor (2)
- uterotonic meds
- analgesics
what is the important of establishing skin-to-skin contact in the 4th stage of labor (5)
- helps w bonding
- temp stabilization
- helps w transition to extrauterine
- increases oxytocin lvls
- helps w breast feeding
when should chest feeding be initiated in the 4th stage of labor
- first 1-2 hrs
what are uterotonic meds
- meds that promote uterine tone/contractions –> control bleeding
what is included post-epidural assessment
- make sure epidural is intact after removal
if the birther experienced a laceration or required an episiotomy it will need to be…
- sutured
what is the nurses role in assisting w perineal repair (4)
- assist w positionin
- help w lighting
- hand sutures
- assess for pain mngmt needs (ex. lidocaine)
describe pain mngmt for perineal repair for birthers who received an epidural
- may not need additional meds for pain mngmt, but they might
describe skin-to-skin between the birther and newborn during perineal repair
- can be skin-to-skin and bonding w mom as long as pain is controlled
what is especially imp when assisting w perineal repair
- remember sponge & needle counts –> may be placed inside vagina d/t bleeding
what must be included in the assessment of the placenta
- both fetal and maternal sides by both PCP and us
what is to be assessed r/t the fetal side of the placenta (2)
- vessels
- location of umbilical cord on placenta
what is battle door insertion of the umbilical cord of placenta
- inserted on periphery of placenta
what is assessed r/t the maternal side of the placenta (3)
- intactness
- ensure no fragments of placenta are missing
- should be lobular
why is it imp to ensure there are no fragments of the placenta missing and therefore still in uterus
- prevents ligature of vessels for bleeding
what should be assessed r/t membranes of the placenta (3)
- do the membranes appear to be compelte?
- should be a hole
- should not be jagged, indicates pieces left behind
describe the freq of assessment of the BP and P during the 4th stage of labor
- BP: q15 min for first hour, then q30 min for remainder of 4th stage
- P: same as BP
describe freq of assessment of T in 4th stage of labor
- initially and once more before transfer to postpartum unit
what is assessed r/t the fundus in 4th stage of labor? what is this assessed in combo with?
- assessment of fundal height
- firmness
- in combo w assessment of vaginal bleeding
describe freq of assessment of fundus in 4th stage of labor
- q15 min for first hour
- usually q30 for remainder of 4th period
what is assessed r/t lochia in 4th stage of labor (5)
- color
- amt
- size & number of clots
- odour
- observe perineum for other sources of bleeding (laceration? episiotomy?)
what is assessed r/t bladder in 4th stage of labor
- assess for distension
- if bladder apparent, higher fundal height = indication of distension
what is assessed r/t perineum in 4th stage of labor (6)
assess laceration for:
- redness
- edema
- bruising
- drainage
- approximation
- presence of hemorrhoids
mngmt of ____ is one of the most signif concerns of the early postpartum period
- mngmt of postpartum bleeding
see slides for info on report from birthing unit to postpartum unit
- lotssss of stuff, too much info for cards
