Nursing Management Postpartum Flashcards
Bonding
Close emotional attraction to a newborn by the parents that develops the first 30-60 minutes
Attachment
development of strong affection between an infant and a significant other
Typical Assessments in Postpartum Period
First Hour-q 15 mins
Second Hour-q 30 mins
First 24 hours-q 4 hours
After 24 hours-q 8 hours
First Hour
q 15 mins
Second Hour
q 30 mins
First 24 hours
q 4 hours
After 24 hours
q 8 hours
Who would you possibly see a slight temperature elevation in the first 24 hours postpartum?
Possible dehydration due to fluid/blood loss during delivery
What would a temperature of 100.4 or greater indicate after delivery?
May indicate infection and needs to be reported
What else may be indicated by an increased temperature that often results in maternal morbidity/mortality?
Maternal Sepsis
Temperature
- use consistent way of measuring (oral)
- stays within normal range or low grade elevation
- slight fever possible (100.4) during first 24 hours
Heart Rate for first week
60-80 bpm are normal during first week after birth
What is a pulse rate of 60-80 bpm called?
puerperal bradycardia
What leads to a decreased HR during postpartum period?
Elevated stroke volume
What may tachycardia in postpartum women represent?
anxiety excitement fatigue pain excessive blood loss/delayed hemorrhage infection underlying cardiac problem
Respirations
12-20 breath per minute
What may a change in respiratory rate that out of normal limits indicate?
pulmonary edema
atelectasis
side effect of epidural
pulmonary embolism
Blood Pressure
Should remain the same as during labor
What could an increase in BP indicate?
gestational hypertension
What could a decrease in BP indicate?
Shock Orthostatic hypertension Dehydration Side effect of epidural Increased blood loss
What is the 5th vital sign?
Pain
Pain Assessment
Type, location, severity
Rate with numeric scale 1-10
Focus on comfort measures
What is our pain level goal?
0-2
What will the physician often order the nurse to do for patient before birth?
Pre-medicate for “after-birth” pains
What comfort measures could the nurse provide to reduce pain?
Perineal care Clean gown Mouth care Warm blankets Adequate fluid intake Reposition frequently Encourage rest
If the woman has severe pain in her perineal region despite use of comfort measures what should the nurse check for?
Hematoma
Danger Signs Postpartum
Fever > 100.4, foul smelling lochia or unexpected change in color/amount, blood clots/bleeding that saturates peripad in 1 hour, severe headaches/blurred vision, visual changes, calf pain w/ dorsiflexion, swelling/redness/discharge at incision lines, problems w/ urination, shortness of breath, depression/extreme mood swings
What does the acronym BUBBLEEE stand for?
B-breast U-uterus B-bladder B-bowels L-lochia E-episiotomy/perineum E-extremities E-emotional status
Breasts
Assess size, contour, engorgement
Assess nipples for cracks, redness, fissures, or bleeding and not whether the are erect, flat, or inverted
Lactogenesis
onset of milk secretion
What will initially trigger lactogenesis?
delivery of the placenta which results in falling levels of estrogen and progesterone
Uterus
asses height of the fundus and firmness
Bladder
assess voiding, bladder emptying
Bowels
bowel sounds and distention
Lochia
assess amount, color, odor, and change with activity and time
Foul smelling lochia suggests?
infection
Large clots in lochia suggest?
poor uterine involution
Pregnancy is associated with an increased risk of what?
thromboembolism which includes pulmonary embolism and DVT
Emotional Status Assessment
Interaction w/ family Level of independence Energy levels Eye contact w/ infant Posture and comfort level w/ infant Sleep and rest patterns Be alert for mood swings, irritability, or crying episodes
Four Stages of Parenthood
- Commitment/attachment, preparation for infant
- Acquaintance/attachment w/ infant; learning how to care for infant; physical restoration
- Moving toward new normal
- Achievement of parenthood role
What factors may affect attachment?
Parent's background Infant temperament and health Care practices Separation immediately after birth Policies discouraging exploring infant Intensive care environment Staff indifference/lack of support
Teaching Topics for Postpartum
Pain/discomfort Immunizations Nutrition Activity/exercise Lactation Discharge teaching Sexuality/contraception Follow ups
Nursing Management in Postpartum
- Providing optimal cultural care
- Promoting comfort
- Assisting w/ elimination
- Promoting activity, rest, and exercise
- Assist w/ self care
- Ensure safety
- Counsel about sexuality and contraception
- Promote Nutrition
- Support choice for newborn feeding
What can be done to promote comfort?
Cold and heat applications
Topical preparations
Analgesics
What is commonly the first measure used after a vaginal birth to relieve perineal discomfort and edema from an episiotomy?
Ice pack
What heat comfort measure is often used to cleanse the perineal area after voiding?
peribottle
Peribottle
plastic squeeze bottle filled with warm tap water
After the first 24 hours what may be prescribed and substituted for the ice pack to reduce local swelling and promote comfort?
Sitz bath with room temperature water
What type of treatment is used as a topical preparation?
Local anesthetic spray such as benzocaine used to numb the perineal area after cleansing
What analgesics are prescribed to relieve mild postpartum discomfort?
Acetaminophen and NSAID’s such as ibuprofen or naproxen
What analgesic may be prescribed for moderate to severe pain?
Codeine or oxycodone in conjunction with aspirin or acetaminophen
Common adverse effects of oral analgesics are?
dizziness lightheadedness nausea vomiting constipation sedation
A full bladder will interfere with uterine contraction and may lead to what?
hemorrhage
How long does the woman have to void after birth before she will receive a catheter?
4-6 hours
What may help the patient have a bowel movement?
Stool softener/laxative Ambulating Increase fluids Increasing fruits and vegetables Small amounts of prune juice or hot liquids High fiber foods Walking daily
What foods are high in fiber?
Bran cereals Whole grains Dried fruits Fresh fruits Raw vegetables
Ensuring Safety during Ambulation
Check BP first Elevate head of bed for few mins Sit on side of bed for few mins Help client stand Ambulate alongside client Frequently ask how her head feels Stay close
How many additional calories per day should a mother consume while lactating?
500
How much extra protein should a mother consume a day?
20 g or more; adding an extra 2 cups of skim milk
How much extra calcium will the mother need a day?
400 mg or more; consumption of four or more servings of milk/day
How much extra iodine will the mother need a day?
290 mcg/daily; dairy products, seafood, and iodized salt
Why is iodine necessary for the baby?
So they can produce thyroid stimulating hormone which helps brain development
When does breast engorgement typically occur?
first week postpartum
Alleviating Breast Engorgement in Breastfeeding Women
- Encourage frequent feedings-q 2-3 hours
- Use manual expression just before feeding to soften the breasts for easier attachment
- Advise mom to let infant feed on first breast until it softens before switching
Alleviating Breast Engorgement in Bottle-feeding Women
- Encourage to use ice packs, wear a snug/supportive bra 24 hours a day, take mild analgesics
- Avoid any breast stimulation
Characteristics of Postpartum Blues
anxiety, irritability, insomnia, crying, loss of appetite, and sadness
When do symptoms of Postpartum Blues begin and typically end?
Begin 2-4 days after childbirth and resolve by day 10
-typically resolve w/ restorative sleep
Why is early ambulation encouraged?
Encouraged to reduce the risk of DVT/PE and to improve strengthening
When should the woman nap?
When baby naps
Importance of PP Exercise
Lose pregnancy weight Reduce risk of obesity Increase overall well being Increase energy levels Reduce risk of PP depression Reduce constipation Provide an outlet for stress
How to prevent stress incontinence:
- Start regular program of pelvic floor muscle exercises
- Lose weight
- Avoid smoking
- Limit caffeine and alcohol
Self-Care Measures
- Frequently change perineal pads
- Avoid using tampons
- Shower once per day w/ mild soap and avoid soap on nipples
- Sitz bath after q bowel movement
- Avoid tub baths for 4-6 weeks
- Good hand-washing
How long should mom avoid tub baths?
4-6 weeks
What factors contribute to a decreased sex drive after birth?
- Fatigue/weakness
- Perception of decreased attractiveness
- Change in body appearance
- Vaginal bleeding/perineal discomfort
- Hemorrhoids
- Sore breasts
- Decreased vaginal lube due to increased estrogen
When can the couple resume sexual activity?
Once bright-red bleeding has stopped and the perineum is healed from any trauma
-third to sixth week postpartum
