Healthy Postpartum Period (1) Flashcards
how long does it take for the uterus and placenta to return to the pre-pregnancy state?
6 weeks
when is the return of menstruation after birth?
variable 6-10 weeks (if not breastfeeding, usually longer)
can the patient get pregnant again before her period returns?
yes!! can still ovulate
what is the initial milk produced during pregnancy?
colostrum
milk may come in __-__ days postpartum
3-5
what to look out for abdomen/GI postpartum
- dec. bowel sounds
- distention
- decreased peristalsis (progesterone)
- may have anxiety about BM (stool softener)
how urinary output is there usually postpartum
increases (2000-3000ml)
-had fluids running during labor
why can it be difficult to void after birth
edema in the perineal area
how long does it take for cardiac output to stabilize after birth
about an hour
why is there hypervolemia after birth?
- excess bloodflow no longer going to placenta
- protective mechanism
- corrects diuresis (no more extra volume)
how are H&H, WBCs, and platelets looking after pregnancy?
- H&H difficult to interpret at first
- WBC elevated
- platelets decreased (placenta given away)
what is the estimated blood loss for vag and c/s delivery
200-500ml vag
1000 ml c/s
what is temp like postpartum?
can get up to 38 (from exertion/dehydration)
afebrile after 24h
what can a postpartum fever indicate?
infection
what does a postpartum BP normally look like?
slightly elevated
what can a low postpartum BP mean?
hypovolemia/hemorrhage
what does a postpartum pulse look like
slightly decreased
what neuro change happens postpartum and what causes it?
Headache
-fluid shifts
-HTN
-spinal HA (epidural)
what is the initial weight loss PP?
10-12 lbs (infant, placenta, fluid)
how much weight is lost from PP diuresis?
5 lbs
how much weight is lost 8-8 weeks PP?
the rest of the gained weight
when can an exercise regimen be resumed PP?
after follow-up PP visit (4-8 weeks)
what is exacerbating PP contractions/cramping?
pitocin, breastfeeding (oxytocin)
what are the 2 Rubin stages of psychological adjustment to parenthood
taking in and taking hold
what is the Rubin phase of “taking in”
passive
allows others to make decisions for her
(can end 2 days PP)
what is the Rubin phase of “taking hold”
assumes active role
provide mother with reassurance
what is the acronym for PP assessment and what does it stand for?
BUBBLE HE
* B= breasts (latching, scabbing)
* U= uterus (fundus, texture)
* B= bowel
* B= bladder
* L= lochia (vag drainage)
* E= episiotomy
* H= Homan’s (DVT!!!!)
* E= emotional status
what 2 things are looked for in breast assessment?
- consistency
- intactness of nipple (if breastfeeding)
what does it mean if the nipple is not intact?
the baby is not latching properly
what are tips for breast care?
- supportive bra
- nurse on demand
- use lanolin/hydrogel dressings
- if not breastfeeding, avoid nipple stim. and use ice packs!
what to look for in a uterine assessment?
location (fundus)
consistency (firm/boggy (bad))
how is fundus location measures?
finger lengths, above umbilical = +, under = -
how to assess bowels PP?
-ask last BM
-passing gas?
-assess BS/distention
-fear of BM = stool softener
how to assess bladder PP?
-PP diuresis
-difficult urinate (Edema)
-frequency, urgency, burning?
-why are they at risk for UTI? (straight cath/epidural)
where does lochia come from?
placental site / uterine debris
what is lochia composed of, and do c/s deliveries have it too?
- epithelial cells, erythrocytes, bacteria, fetal meconium, lanugo
- yes!
what color is the lochia throughout the days PP?
- rubra (red)= 2-3 days
- serosa (pink)= 3-10 days
- alba (clear/white)= 1-2 weeks
describe scant lochia pad saturation
blood only when wiped or less than 1 inch stain within an hour
describe light lochia pad saturation
less than 4 inch stain within an hour
describe moderate lochia pad saturation
less than 6 inch stain within an hour
describe heavy lochia pad saturation
completely saturated within an hour
what position should a patient be in for parineal assessment?
side-lying
what is the acronym and meaning for perineal assessment?
REEDA
* redness
* edema
* ecchymosis
* drainage
* approximation
when else should REEDA assesment be done besides a peri exam?
c/s incision
what can happen emotionally PP?
- postpartum blues/depression
- mood swings/weepy
- hormones
why is pitocin ordered PP? how is it given diff. in c/s and vag deliveries
to firm the uterus
c/s= until next morning
vag= 1 bag only
what pain meds are given PP?
- IBU
- tylenol (watch liver)
- percocet (watch liver)
- vicodin
what 2 meds (not pitocin/pain) are given PP?
-rubella vaccine
rhogam
when should a pt contact the provider PP?
- sore/red breasts
- saturating pads more than 1/hr
- purulent drainage
- urgency, dysuria, hematuria, difficulty
- HA, CP, SOB, vision
- incision probs
- fever
- depression
