normal postpartum Flashcards
how often should the uterus be assessed postpartum
- 1hr: q15mins
- 2 hrs: q30 mins
- next 22hrs: q4hrs
what should be done before assessing the fundus
instruct the pt to void first
how should the lower uterine segment be supported during fundal assessment
place one hand just above the pubic symphysis to prevent uterine inversion
what is uterine involution
return of the uterus to its nonpregnant state after birth
how long does uterine involution take
around 6-8 wks
what are afterpains, and who experiences it more
- mod to severe cramps caused by UCs
- more common in multiparous women
why do afterpains occur
uterus contracts to remain firm and prevent hemorrhage
what interventions help relieve afterpains
- encourage frequent voiding
- warm compress
- ibuprofen/acetaminophen
where is the uterien fundus immediately after birth
midway between the umbilicus and pubic symphysis
where should the fundus be within 12 hrs postpartum
level of umbilicus or 1cm above
how much does the uterus descend each day postpartum
~ 1cm each day
when is the uterus no longer palpable
by day 14, as it descends into the pelvis
when does the cervix regain its prepregnancy form
after 2-3 days, but doesn’t return to its original shape, appears like a jagged slit “fish mouth”
how does lactation affect the cervix
hormonal changes leads to thinner vaginal mucosa and reduces lubrication
what is the purpose of lochia
- expel remaining tissue, bacteria
- shedding prevents scarring
- indicates stage of healing
what are the 3 types of lochia and their timeframes
- lochia rubra (1-3D): red, small clots
- lochia serosa (4-10D): pink/brown, serosanguineous
- lochia alba (11-21D): creamy yellow
what are abnormal findings with lochia
- foul odor
- heavy bleeding
- large clots
what does REEDA stand for in perineal assessment
R: redness
E: edema
E: ecchymosis
D: discharge
A: approximation of edges
how long do perineal lacerations/episiotomies take to heal
~ 6 wks
interventions for perineal pain & healing
- first 2 days: ice packs, cold sitz baths
- after 1st day: warm sitz baths
- lie on side to reduce pressure
- wear peripads snugly to prevent rubbing
- topical anesthetics
how can postpartum mothers prevent perineal infections
- use peri-bottle with warm water after elimination
- change peripads frequently
- wash hands when doing pericare
when do vaginal folds (rugae) begin to reappear postpartum
~ 3 wks but are less prominent
how does estrogen deprivation effect the vagina postpartum
- thinner vaginal mucosa
- temporary loss of rugae
leading to vaginal dryness and discomfort (dysparenunia)
when does vaginal lubrication improve postpartum
once ovarian function returns (menstruation), the vaginal mucosa will thicken
what hormonal changes occur leading to milk production postpartum
- decreased estrogen & progesterone
- increased prolactin
what hormone is responsible for the milk ejection reflex
oxytocin (posterior pituitary gland) in response to infant suckling
what is colostrum
yellowish fluid that precedes milk production, high in protein and low in carbs, filled with immune stuff
what is primary breast engorgement
temporary swelling, tightness, and discomfort d/t increased vascular and lymphatic flow
what is crucial to assess postpartum when listening to breath sounds
pulmonary edema
what happens to stroke volume and CO postpartum
- increases in the first 24-48hrs as blood returns from the uteroplacental unit
- returns to prepregnancy levels within 10 days
why does the risk for orthostatic hypotension increase postpartum
deceased vascular resistance in the pelvis during the first week, resulting in less blood return to the heart
why might WBCs be elevated postpartum
can rise to 30,000 (normal is 4.5-11) d/t stress and labor and will return to normal within a week
what are the s/s of postpartum cystitis
- increased urinary frequency & urgency
- dysuria: pain or burning
- suprapubic tenderness
- hematuria
- malaise
why does postpartum diaphoresis occur
d/t decreased estrogen, help the body to excrete excess fluid retained during pregnancy
mostly at night
what are Rubin’s 3 stages of maternal behavior
- taking in (24-48hrs)
- taking hold (wks)
- letting go (long-term)
what is the focus of the mother during Rubin’s taking in stage
- focus on own comfort and physical recovery
- relives and talks about birth exp
- depends on others
- decreased ability to make decisions
how does the mother’s behavior change in Rubin’s taking hold stage
- focus starts to shift to infant
- interested in infant cues and needs
- start to leg go of pregnancy role
- more independent
what emotional struggles may occur during Rubin’s taking hold stage
- feelings of inadequacy/overwhelmed
- baby blues: mood swings, sadness, crying, fatigue
when should a mother seek help for postpartum depression
if symptoms of baby blues lasts 4+ wks and interfere with daily function
what happens during Rubin’s letting go stage
- accepts the baby as an individual
- returns to work
- reconnect with partner
- may feel guilt, anxiety, grief about leaving the baby
HR > 100bpm after first 24-48 hours can indicate what
- postpartum hemorrhage
- infection
- dehydration
what are some feeding cues that indicate the baby is hungry
- licking, smacking of lips
- extend tongue
- putting hand in mouth, sucking on fingers
- turning head to mother’s voice
what are the LATCH score categories
L: latch
A: audible swallowing
T: type of nipple
C: comfort of nipple
H: hold/positioning
what does the LATCH score tell you
score of < 2 indicates areas for support
newborns typically feed on one breast for how long
10-15 mins
how often should a newborn feed
feed q1-3 hrs
8 to 12 feeds/day
nurse teaching for latching
bring newborn close to breast with chin touching the lower half of the breast, then bring the newborn up and over the nipple
nurse teaching for removing a newborn from nipple
gently slide a clean finger into the corner of the mouth to break suction
