Exam 2 Flashcards
Postpartum HR
> 100 is a red flag after 48hrs - possible hemorrhage
Postpartum Temp
Slight fever okay within 24 hours due to dehydration- increase fluids
AFTER 24hrs if over 100.4, possible infection
Postpartum BP
Low BP sign of hemorrhage
What to do if a lot of lochia
Check fundus FIRST- could be boggy
If boggy- massage it
If still boggy- empty bladder
If STILL boggy- could be neurogenic bladder (REPORT)
Bladder r/t uterus
Full bladder will displace uterus and make uterus feel boggy
Lochia findings
If clot bigger than a dime (1cm)- maybe hemorrhage
Many clots smaller than a dime are okay
Electrolytes to check after giving birth
Chloride and Na
Most frequent cause of postpartum bleeding
Uterine atony- failure of uterine muscle to contract firmly
Nursing interventions for uterine atony
Massage fundus if boggy
Full bladder displacing uterus can prevent normal contractions
Meds- oxytocin, misoprostol, methergine, meth prostaglandin (ASSESS BP W/ ALL)
Possible causes of postpartum bleeding
Overdistended uterus
General anesthesia
Prolonged labor
Hx of uterine atony
Retained placental fragments
Trauma during labor/ birth
Unrepaired lacerations
Ruptured uterus
Placenta accreta -previa- abruption
Coag disorders
HTN
S/S of hemorrhagic shock
Rapid/shallow respirations
Rapid weak pulse
Low BP (late sign)
Cool, pale, clammy skin
Decreased UO
Lethargy
Light headedness
Anxiety
Dyspnea
Interventions with hemorrhagic shock
Call for help
Start IV
Ensure airway
Involution
Uterus returns to pre-pregnancy state
Should not feel fundus after 2 weeks
Fundal height decreases 1-2cm q24hrs
Uterus at umbilicus by 24hrs
Subinvolution
Uterus is not shrinking
Rubra
Deep red/brown
1st: 3-4 days
Serosa
Lighter brown/ pink
2nd: up to 4-10 days
Alba
Lighter white/ creamy
3rd: 10 and more days
Lochia pads
Pad that’s soaked in 15 min or less or pooling of blood under butt means EXCESSIVE BLOOD LOSS
Avg 6 peripads/day is NORMAL
NO bright red blood (lochia) means
Active and continuous bleeding
Endometritis
Infection of lining of uterus
S/S of Endometritis
Fever, chills
Tachycardia
Anorexia
Pelvic pain/back ache
Prolonged after pains
Uterine tenderness
Foul smelling lochia
Increased RBC sedimentation rate
High WBC
Interventions for Endometritis
Broad spectrum Abts (Cephs, PCN, -mycins)
Hydration
Abts d/c’d 24hrs after asymptomatic
Follow up for placenta accreta
Possible hysterectomy depending on how deep placenta is adhered
Perineal care for episiotomy
Topical lidocaine cream
Ice packs 1st 24hrs
Witch hazel
Peri bottle (cold water)
Sits bath connected to cath and basin
Hematomas r/t episiotomy
Painful
Monitor H/H and replace fluids
No sex until stitches heal
Nurse baby on side
Risk factors for Hematomas r/t episiotomy
Use of epidural
Prolonged 2nd stage of labor
Forceps delivery
Uterine inversion
Fundus collapses into uterine cavity (turns inside out)
S/s: hemorrhage, shock and pain
Mastitis S/S
Flu like symptoms
Localized breast pain and tenderness- localized reddened area
Tender axillary lymph nodes
Risk factors of mastitis
Inadequate breast emptying
Sore cracked bleeding nipples
Not washing hands
Tx for mastitis
Bed rest
Abts
Continue lactation - empty breasts every 3-4hrs
Apply heat
Analgesics
Engorgement
Breasts are too full
Firm, tender and hot - appear shiny or taut
If milk isn’t removed, milk production is reduced
Usually occurs within 72-96 hrs after birth and resolves within 24-36hrs
Engorgement IF breastfeeding
Feed/pump regularly and apply warm water before feedings
Engorgement IF NOT breastfeeding
1st: pump milk OUT and do not touch breasts
2nd: apply cold water and cabbage leaves
Wear tight form-fitting bra
Keep husband off breast for 3-4 days
Postpartum blues
Considered normal due to hormones
Tx not necessary
Symptoms should subside <2 wks
Postpartum depression
Occurs first few months after giving birth
Lasts more than 2 weeks
Tx is similar to regular depression
Postpartum psychosis
Can be related to previous depression and bipolar diagnoses
2-4 wks after birth
Can lead to suicide of infanticide
NEEDS TO BE TREATED AND RECOGNIZED
Delusions, hallucinations, panic, delirium
Fundal height after pregnancy
1st hours after birth: 1cm above umbilicus
By day 10, fundus not palpable
Prepregnancy uterine state by 2 weeks after birth
Fundal assessment
Have mom void first
Massage fundus
Mom lies flat with knees flexed
If uterus boggy after 24hrs
Possible Placenta fragments
COLA assessment for Mom
Color, odor, last void/BM, and Amount
BM not necessary before discharge
Must hear flatulence before advancing diet
Neurogenic bladder
Loose ability to feel when they have to go to the bathroom
Scant/light lochia
1-4 in
Moderate lochia
6 in
Severe lochia
Bigger than dime clots - Bad hemorrhage
Episiotomy assessment
REEDA
redness, edema, ecchymosis, discharge and approximation
Hemorrhoids
Prevent constipation
SIMS position best view
Signs of infection: painful, bleeding, itchy and can’t sit
H/H postpartum
Decreases slightly during 1st 48hrs
Returns to normal after 4-8wks
WBC postpartum
Increases (12-25k)
Returns to normal after 1-2wks
CBC postpartum
Clotting factors and fibrinogen increases
Plts: 150-450k
Hct 37-47
Skin to skin contact
ASAP for at least an hour
Cultural considerations after birth
Jewish newborn- circumcision
Asian- doesn’t emphasize touch, delayed breastfeeding
Latching on for breastfeeding
Mouth over nipple, areola and breast
If not latched on correctly- dry cracked nipples can occur
Postpartum DM
Lower glucose lvls
Needs much less insulin after birth- especially if breastfeeding
Benefits of breastfeeding
Aids in contracting uterus and prevents hemorrhage
Baby sick less
Less expensive
Breastfeeding teaching
Additional 500 calories
Breastfeed within 1-2hrs after birth
How to know breast feeding is successful
Mom reports firm tugging, no pinching or pain
Baby sucks with rounded cheeks, NO dimpling
Baby’s jaw glides smoothly
Swallowing is usually audible
Colostrum
First milk 1-3 days
MMR vaccine postpartum
If received, don’t get pregnant for at least 1 month after due to risks of teratogenic effects
Birth control for at least 3 months