OB final - Post Partum Flashcards
PP vitals
-temp below 100.4
-slight elevation in BP
-bardycardia for 6-10 days
causes of the elevated BP postpartum
-PreE
-hypertension
-renal disease
-anxiety
causes of low BP postpartum
-uterine hemorrhage
-hematoma
causes of tachycardia postpartum
-difficult labor & birht
-hemorrhage
causes of marked tachypnae postpartum
respiratory disease
pulmonary edema
how to treat elevated BP postpartum
-procardia 30 XL, labetalol, aldomet
-Mag Sulfate IV
cardiovascular postpartum
-CO declines by 30% in the first 2 weeks & normalizes by 6-12 weeks
-diuresis assists to decrease extracellular fluid and wt loss
-failure to eliminate fluid can lead to pulmonary edema & cardiac problems
what is the most common side postpartum
headache -> may result from fluid shifts in the first week after birth or leakage of CSF d/t epidural, HTN, PreE, stress & fatigue
postpartum nutrition
-high iron foods
-continue prenatal vitamin esp if BF
-BF mother increase 300kcal per day
-non BF mother decrease intake by 200kcal
postpartum changes in labs
-non pathologic leukocytosis during 1st wk (wbc 25000-30000)
-2 to 3 % drop in hct = blood loss of 500ml
-plasma levels reach pre pregnant state by wks 4-6
-platelets return to normal by week 6
ovulation/menstruation for non breastfeeding mothers
-menstruation usually occurs in 7-12 weeks
-ovulation usually occurs within 70 to 75 days
ovulation/menstruation for breastfeeding mothers
-menstruation may be delayed 3 months or longer
Not reliable form of BC
BUBBLE HE
breast
uterus
bowel
bladder
lochia
episiotomy/incision
homan’s/hemorrhoids
emotions
breast assessment
-size & shape
-abnormalities, reddened areas or engorgment
-presence of breast fullness d/t milk
-assess nipples for cracks, fissures, soreness or inversion
suppression of lactation
-well fitting bra or wraps
-cold compression or cabbage leaves
-anti inflammatory medications
-no warm water on breasts
-no stimulation
lactation education
-feed every 1.5-3 hrs
-10 to 20 mins on 1st breast, whatever baby wants on 2nd
-breast may feel heavy but not hard, sore or reddened
-do not consume alcohol 2hr before nursing & limit it
signs of a poor latch
baby making smacking sounds -> unlatch & retry
fluid intake for breast feeding mom
2L/day
mastitis s/s
-sudden onset
-chills & fevers
-reddened, painful swollen areas
-possible discharge
treatment for mastitis
-abx
-supportive bra w/o under wiring
-good hand washing
-warm compress
difference between engorgement & mastitis
gradual, bilateral hardness & not associated with fever
benefits of slow method weaning
-prevents breast engorgement
-allows infants to alter their eating methods at their rates
-provides time of psychological adjustment
diastasis recti abdominis
when the abdominal muscles have separated due to allowing room for the enlarged uterus
after pains
-intermittent uterine contractions associated with uterine involution
-resting prone w/ pillow under abdomen helps keep uterus contracted
-motrin 600 mg po q8 as needed for cramping
motrin contraindications
-do not give if platelets <70,000
-careful using for pt w/ preE
endometritis (PP uterine infection)
involves the lining of the uterus causing tenderness, temp spikes, chills & foul smelling lochia
endometritis treatment
broad spectrum antibiotics like clindamycin & gentamycin until culture & sensitivity results are available, continue until afebrile for 24-48 hrs
when will the fundus be at level with the umbilicus
6-12 hours after delivery
when does the fundus get back into the true pelvis
on the 10th day, descends 1cm per day until then
uterine atony
boggy uterus
increased risk of bleeding caused by high levels of oxytocin, multipara, multiples, LGA and red haired women
if bladder is full, pt needs to void
