Module 5 - Postpartum Care Flashcards
Puerperium
- known as the postpartum period
- six weeks after childbirth
- sometimes referred to as the fourth trimester of pregnancy
Puerperal Bradycardia
- bradycardia in the first 48h after a baby is born, all the blood going to the placenta and fetus has nowhere to go so there is an increase in maternal circulation
- normal for first 48h, concerning when pt heart rate is 80-100 because of possible hemorrhaging, assess lochia flow is like
Identify the components of a postpartum assessment and distinguish between typical and abnormal findings for both vaginal and caesarean births:
Vital signs
Pulse: narrow pulse pressure, bp is decreased
BP: would tell us if there is blood loss occurring, shouldn’t change drastically from baseline, if low then septic
Respiratory Rate: depending on medications given during delivery, may be lower during initial post partum period, but not deviate much from baseline
Identify the components of a postpartum assessment and distinguish between typical and abnormal findings for both vaginal and caesarean births:
Fundus
> Involution
- return of the uterus to pre pregnancy size and condition
- takes approximately 5-6 weeks after delivery
Firmness
Height
- the fundus should descend at the predictable rate
- after placenta is delivered the fundus is palpated at or below the umbilicus (1cm)
- after 24 hours the fundus descends 1 cm per day
- no longer palpable after 10 days
Location
- midline
- a full bladder can displace the fundus
Lochia
> vaginal discharge after delivery composed of endometrial tissue, blood and lymph
- rubra; red mostly of blood, lasts for 3 days
- serosa; pinkish, mix of blood and mucus lasts 3-10 days
- alba; mostly mucus, clear and colourless or white and lasts 10-21 days
character - rubra, serosa, alba
colour: bright red, pink, clear, white, green and brown
odour: similar to menstrual odor
Consistency: thick
clots: number and size of clots
amount:
- scant: less than 5cm stain
- light: less than a 10cm stain
- Moderate: less than a 15 cm stain
- Large: larger than a 15 cm stain or one pad saturated within 2 hours
- Excessive: saturation of a pad within 15 mins
Provide teaching on normal lochia sequencing and what to report
- foul smelling lochia
- lochia rubra that persists longer than 3 days
- unusually heavy flow
- lochia that returns to bright red after it has progress to serosa or alba
- presence of large clots, especially if followed by lochia rubra
Perineum
> episiotomy or perineal laceration
- heal within 2-3 weeks
- assess for REEDA
- vulvar hematoma, perineal bruising
hemorrhoids
- temporarily worsen from pressure on perineum
nursing considerations
- cool compress: ice packs or cold pads for the first 24 hrs
- heat application after 24 hours- sits bath, warm pack
- hygienic measures- peri bottle used after each void and bm
- topical medications - witch hazel, benzocaine, hydrocortisone with pramoxine
- donut or ring pillows for sitting
Bladder
> kegel exercises
full bladder impedes on uterine contractions
Postpartum diuresis
- within 12 hrs, women begin to diurese
- up to 4L
distention
- decreased muscle tone of the bladder and ureters
- bladder fills quickly but is not completely empty
- the women may not feel the urge to void or feel that her bladder is full
urination
- frequency, amount, colour and odor
- full bladder displaces the uterus, and puts them at risk for postpartum hemorrhage
Breasts
> breastfeeding mothers
- before lactation, a yellowish fluid, colostrum can be expressed from nipples
- tenderness may persist from 48 hrs after start of lactation
non-breastfeeding mothers
- engorgement resolves spontaneously, discomfort decreases within 24-36 hours
- breast binder or tight bra, ice packs, fresh cabbage leaves, or milk analgesics may be used to relieve discomfort
assessment
- check breast for size, shape and symmetry
- engorement
- breast is hard, erect and very uncomfortable
- nipple may be too hard and erect for the newborn to grasp
- check for cracks, redness, blisters, size and shape of the nipple
patient teaching
- wear a comfortable bra to support the breasts
- if not breastfeeding, avoid nipple stimulation
- wash with water to avoid drying effects of soap
Bowels
> spontaneous bowel evacuation may not occur for 2-3 days after childbirth
can be painful
resumes normal activity shortly after birth as progesterone levels decrease
constipation may occur due to:
- medications, stretched abdominal muscles, hemorrhoids, perineal swelling and pain, slight dehydration and little food intake during labor makes the faces harder
assess for:
- flatus
- bowel sounds
- defecation
nursing care
- encourage fluids; add fire to the diet, ambulate
- administer stool softeners (lax-a-day)
Extremities
> prescene of edema to the feet and hands and face
legs for presence of thrombosis
- redness, warmth, tenderness to tough, positive homans signs
hypermobility of the joints stabilizes within 6 weeks, except for the feet
- an increase in shoe size may be noticed
patient teaching
- begin light exercise first day after vaginal delivery
- abdominal lightening, head lift, pelvis tilt, kegel exercises
assessments
- homan’s signs: calf pain experience upon dorsiflexion of the foot, indication of thrombophlebitis
Emotions
> the birth of an infant brings about physical changes in the mother but also causes many emotional and relationship changes in all family members
> assessment
- bonding
- family interaction
- support
- physical contact with newbornDescribe the psychological changes a mother makes in the postpartum period
- phase 1
- mothers birth experience,- phase 2
- mother initiates action and begins to care for new born
- phase 3
- letting go of their old life, fantasy child for reality
- phase 2
Postpartum blues
- temporary feeling a low mood, conflicting feelings after the birth
1-2 wees
Postpartum depression
- time doesnt help
- feeling low, anxiety, paranoia, insecurity, negativity
- lasting long
- consistent
- is the mom thinking of hurting herself or the child
discharge teaching
- self management and signs of complications
- sexual activity/contraception
- prescribed medications
- routine mother and baby checkups
- dealing with victors
