Lecture 1 - Introduction Flashcards
What is the antepartum period?
From conception to the onset of labour
What is the intrapartum period?
From onset of labour to delivery of placenta
How long does the postpartum period last?
Usually defined as up to 6 weeks following delivery
–> Up until uterus has returned to pre-pregnancy state
How long does pregnancy typically last?
~280 days (40 weeks)
How many weeks is considered term pregnancy?
37 weeks
–> A term baby is born after 37 weeks
What is normal maternal temperature in the first 24 hours postpartum?
Up to 38°C can be normal d/t dehydration and stress. Should normalize after.
What pulse changes are expected immediately postpartum?
Elevated for first hour can be normal, but should begin to normalize to between 60-100.
What BP changes are normal immediately postpartum?
Should be normal (baseline). Transience of 5% during first few postpartum days can be normal.
–> Elevation d/t fluids or pain might be seen
What resp rate is normal immediately postpartum?
Should be between usual postpartum range (12-24)
What BP changes should be monitored for immediately postpartum?
Orthostatic hypotension
What does BUBBLEE stand for?
B - Breasts
U - Uterus
B - Bladder
B - Bowel
L - Lochia
L - Legs
E - Episiotomy/laceration or caesarean incision
E - Emotional status
What findings are normal in a breast assessment postpartum through the first 5 days?
Days 1-2: Soft
Days 2-3: Full
Days 3-5: Soften with breastfeeding
Colostrum can be expressed
What is colostrum?
First breastmilk that is high in antibodies and nutrients that occurs in small quantities.
How can lactation be suppressed in first 72 hours?
Goal is to reduce discomfort
–> Well fitted-sports bra, ice packs, cabbage leaves, or mild analgesia
Do not stimulate lactation if goal is to suppress lactation
What is involution? When does it occur completely? What enhances it?
The process of the uterus returning to non-pregnant state (6-7 weeks)
–> Enhanced by effective uterine contractions that compress blood vessels (can cause afterpain)
–> Decreased estrogen + progesterone, increased oxytocin
What are postpartum afterpains? In what population are they more common?
Strong and vigorous contractions that can last a week postpartum during involution. Occurs during breastfeeding as oxytocin is released.
–> More common with multiparity and with larger NB
When does endometrial regeneration occur during involution of the uterus?
Almost complete after 3 weeks, except at placental site which takes 6-7 weeks.
What is a major concern if a uterus is not contracting postpartum?
postpartum hemorrhage
Where should the uterus be palpated in the first 24 hours postpartum?
What about 6 days?
When should it no longer be palpable?
Following delivery of placenta - 2cm below umbilicus
12 hours - level of umbilicus
24 hours - 1 cm below umbilicus
Should continue to descend 1-2 cm daily.
Should be halfway between umbilicus and symphysis pubis by day 6.
Not palpable by 2 weeks.
What is subinvolution?
Failure of the uterus to return to a non-pregnant state.
What are some factors that slow involution of the uterus?
Full bladder, prolonged or difficult labour, overdistention, incomplete expulsion of placenta, anesthesia
What is a “boggy” fundus?
fundus is soft and spongy, not firm.
What postpartum uterus assessment findings require intervention?
Fundus deviated from midline
Fundus higher than expected
Boggy fundus
What interventions can be used to encourage involution?
Assist pt to empty bladder
Assess lochia
Gentle fundal massage
If no improvement, report to RM/MD
What is considered an early postpartum hemorrhage? What causes it?
First 24 hours
–> Caused by uterine atony (relaxation)
–> May also be caused by lacerations or retained placental tissue
How common are early PPHs?
Occur in ~5% of births
What is considered a late postpartum hemorrhage? What causes it?
24 hours - 6 weeks PP
–> Due to subinvolution
–> May also be retained placental tissue, infection
A spontaneous void should occur how soon PP?
Within 8 hours
Diuresis occurs when during PP and lasts for how long?
Begins in first 12 hours PP and can be profuse for 3 days.
How should patients be taught to prevent urinary incontinence PP?
Use of Kegel exercises to strengthen pelvic floor muscles.
Bowel sounds should be present immediately following labour. How soon should a bowel movement occur PP?
2-3 days
What are some factors that can contribute to decreased bowel activity PP?
Fear or pain or tearing sutures
NPO status/decreased appetite
Constipation d/t analgesia
Hemorrhoids
Dehydration
Immobility
What should lochia be assessed for? What is is a normal lochia volume?
~240-400 ml in total
–> Assess for colour/amount/odour/clots or placental fragments which can prevent involution
What are the three classification of lochia?
Rubra, serosa, alba
What is considered heavy bleeding postpartum
If a pad is saturated in 1-2 hours
What is considered lochial bleeding? What about non-lochial?
Lochial
–> Uterine atony
–> Retained placental fragments
Non-lochial
–> Unrepaired cervical or vaginal tears
What is lochia rubra? How long does it last PP?
Dark/bright red blood containing decidual debris or small clots
–> Lasts 3-4 days
What is lochia serosa? How long does it last?
Pink/brownish red. Contains older blood, serum, leukocytes, and tissue debris
–> Day 4-14 days (up to 4 weeks)
What is lochia alba? How long does it last?
Yellowish white, contains leukocytes and decidual debris.
–> Begins after 10-14 days, and may continue until 4-6 weeks after birth.
What assessments should be done on the legs PP?
Edema: Some ankle edema normal for first few days
Thrombophlebitis: Redness, tenderness, pain
How common is DVT PP?
Occurs in less than 1% of births, more common in c-section
What laceration/episiotomy findings are normal PP?
Edema reaches maximum by 24 hours PP and can cause difficulty urinating at this time.
Edges should be well approximated
What can be done to encourage healing and decrease pain from a laceration/episiotomy?
Ice packs for first 24 hours
Perineal hygiene
Sitz bath
What are normal findings of a c-section incision?
Dressing should be clean and intact, suture line intact.
PP blues appears around day 3, how long does it last typically?
Usually only 2 weeks - if not improving we begin to suspect PPD.
What are some additional considerations for post-op care following a C-section?
Cough & Deep breathing
Gradual ambulation
Pain relief
Rest
Assess for signs of infection
How long does full healing take after a c-section?
4-6 weeks.
When is Anti-D Ig given to Rh- mothers?
Prophylactically at 28 weeks and within 72 hours of delivery (or up to 28 days) if fetus is Rh+.
What is the role of the newborn admission nurse?
Responsible only for the newborn and know antepartum and intrapartum history. Prepared for neonatal resuscitation.
–> Note time of birth, immediate NB assessment & intervention prn, APGAR score, identification.
What questions should we ask during NB assessment?
- Amniotic fluid clear of meconium
- Breathing or crying
- Muscle tone (flexion)
- Is baby full term?
What should be done immediately after a NB is born?
Place infant prone on birthing parent for skin to skin. Dry & stimulate NB.
Assess airway and auscultate HR (>100)
If the answer to any of the main 4 NB assessment questions is no, what should be done?
- Place NB supine on radiant warmer
- Suction using bulb syringe
- Dry
- Assess resp effort, HR, colour.
What things are assessed in APGAR?
HR, resp rate, muscle tone, reflex irritability, colour.
(Activity, pulse, grimace, Appearance, Respirations)
When is an APGAR score performed?
1 minute and 5 minutes of life
What is acrocyanosis?
cyanotic extremities.
What care procedures are performed early in NB’s life?
Identification
Physical - weight, measure, gestational age
Medication - erythromycin ophthalmic ointment (2hrs), Vit K (6hrs)
What are signs of respiratory distress in the newborn?
Nasal Flaring
Intercostal or subcostal retractions
Grunting
Resp rate outside of 30-60 range is concerning
What NB HR is normal?
110-160 with variations
Are murmurs normal in the NB?
Murmurs are common and usually temporary
What is a normal NB temperature?
36.5-37.5°C, axillary
Hypothermia of the NB can result in what complications?
Cold shock:
Resp distress, hypoglycemia, jaundice (hyperbilirubinemia which crosses BBB)
What is physiological jaundice and how common is it in NBs?
Physiological jaundice affects 60% of infants by day 2-5 of life.
Considered pathological if it occurs in first 24 hours or persists beyond 7-14 days.
How many voids are expected in first week of life?
1 void per day of life for first 5 days, then expect 6-7 wet diapers daily.
Meconium should occur by what age? How long does it last?
Expect first stool by 24-28 hours, lasts up to 3 days.
