OB Module 1: Part 1 - Postpartum Flashcards
When do all babies get full assessments (at the very least)?
Immediate assessment by nurse and doc at birth, and then again by doc before discharge
What are the 4 areas of the OB Unit?
Labor and Delivery
Postpartum
The Nursery
Neonatal Intensive Care Unit (NICU)
Birth is a life event for a woman where she is …
in a very vulnerable point in her life
It is important that the OB nurse be ____ of how different women cope with extreme pain
non-judgmental
Post partum women need to ___ their birth experiences ____ so that they can do what?
Post partum women need to recount their birth experiences verbally so that they can start to put these experiences into perspective and get on with the work of taking in their infant and mothering
The more ___ the birth, the more they need to recover from
traumatic
Everytime an infant is taken to a mother what must be done?
Sequential numbered ID bracelets are checked
The infant has 2 on and the mother has one while she designates another person to have the fourth bracelet
What assessments are included in postpartum care?
Physical assessments
Interactions w/ and care of infant
Support systems available
Pain Level and coping strategies
Educational needs
VS and BP
BUBBLE Assessment
BUBBLE Assessment
B - Breasts U - Uterus/Fundus B - Belly B- Bottom L - Lochia E - Edema/Homans
What are we looking at in the first B of BUBBLE
Breasts for filling, nipple status and engorgement (rare)
What are we looking at in the U of BUBBLE
Uterus/Fundus in relation to the umbilicus
What are we looking at in the second B of BUBBLE
Belly - Abdominal incisions, bowel sounds, distention, elimination, voiding, and bowels in general
What are we looking at in the third B of BUBBLE
Bottom - check perineum for aswelling, ecchymosis, hematomas, lacerations, episiotomies and the status of repairs, hemorrhoids
What are we looking at in the L of BUBBLE
Lochia vaginal flow
What are we looking at in the E of BUBBLE
Edema - Edema and Homans sign
if the policy is to check Homans, some places do not like at Lourdes Hospital
What are two important considerations regarding VS and BP in reference to a pregnant woman’s post partum circulating blood?
- VS and BP reflect hemodynamic status, but unlike a nonpregnant person, the pregnant woman can lose 30% OF CIRCULATING BLOOD before there are perceivable changes in VS
- A woman can lose 50% before there are significant changes. Women who are anemic prior to labor will be affected with smaller loses!
* Anemia*
Preeclampsia
A potentially life threatening complication of pregnancy
Blood pressure elevations related to this that START in the post partum period
High blood pressure, proteinuria
*Elevations in BP are unusual
What BP and higher is significant in the mother and should trigger initiation of additional and ongoing assessments?
140/90 and greater
*Elevations in BP in this group are unusual
What sort of temperature changes are concerning in the post partum period and what are not?
Elevations could be infection, but LOW GRADE FEVER changes are common when milk “comes in” or is secondary to dehydration in the immediate post partum period
Temperatures above 100.4 are indicative of infection
Endometritis
infection of the uterus often secondary to an infection that develops in the uterus during labor (chorioamnionitis).
If a womans water was broken for >24 hours the risk of developing this infection increases
What infection is Endometritis often secondary to?
Chorioamnionitis
In the post partum period, elevations in pulse and temperature rates could be related to ___ ___ or ___-
blood loss or infection
Shortness of Breath and Syncope are indicators of what in the post partum period?
Significant blood loss
What is included in the group of post partum lab work?
H&H
Review of Rubella Status and administering the vaccine if negative or equivocal
Review of Rh status and administration of Rhogam if the mother is Rh negative and infant is rh positive
Review of hepatitis status and immunization of the infant if HepB positive
Some lab values differ in pregnancy!
What is done if a Rubella status comes back as negative or equivocal for a post partum woman?
She is given the vaccine, but because it is a live vaccine it is important that she NOT GET PREGNANT FOR THE NEXT 3 MONTHS
What is done if the post partum woman comes back as Hep B positive?
The infant must be immunized immediately
The post partum period starts at what time and continues for how long?
Starts at the delivery of the placenta and continues for approximately 6 weeks as the reproductive organs return to their normal non pregnant state
In addition to undergoing significant physical recovery what else must the new mother do?
Put her birth experience into perspective and transition into the role of caregiver for her new infant
___ relating to self care and infant care are important components of the post partum care plan!
Education
What are the immediate post partum changes that occur in the woman?
Uterine and Cervical Involution
Lochia Flow
decrease in Vaginal distention
Breast changes
urinary changes
GI changes
Cardiovascular changes
Endocrine changes
Uterine Involution
Process by which the uterus is transformed from pregnant back/collapses back to the non pregnant state
Period is characterized by restoration of ovarian function in order to prepare for any new pregnancies
Cervical Involution
shrinkage of the cervix back to a pre pregnancy state
Lochia
Vaginal discharge after giving birth, containing blood mucus and uterine tissue
Continues about 4-6 weeks post partum
Every day in 2017, about 810 women died from, ____ causes related to pregnancy and childbirth
preventable
Between 2000 and 2017, the maternal mortality ratio (MMR) dropped by about 38% ___, but the MMR rates are increasing in ___
worldwide; the U.S.
94% of all maternal deaths occur in what countries?
Low and lower middle income countries
MMR
Maternal Mortality Ratio
Number of maternal deaths per 100,000 live births
What group faces a higher risk of complications and death as a result of pregnancy when compared to other women?
Young Adolescents (ages 10-14)
Skilled care ___, ___, and ___ childbirth can save the lives of women and newborns
before, during, AND after
What are some common reasons for pregnancy related deaths in the US (2011-2016)?
Hemorrhage, 11.0%.
Infection or sepsis, 12.5%.
Amniotic fluid embolism, 5.6%.
Thrombotic pulmonary or other embolism, 9.0%.
Hypertensive disorders of pregnancy, 6.9%
Anesthesia complications, 0.3%.
Cerebrovascular accidents, 7.7%.
Cardiomyopathy, 11.0%.
Other cardiovascular conditions, 15.7%.
Other noncardiovascular medical conditions, 13.9%.
Any pregnant woman is in a ___ state, leading to high clot risk
hypercoagulable
Why is cardiomyopathy related pregnancy deaths on the rise?
Because of many women in the US being heavy set during pregnancy
Amniotic Fluid Embolism
Clot that forms after amniotic fluid is swept up into maternal circulation
Uterine Involution starts when and continues through when?
starts in delivery but continues through the post partum period
After Cramps
The uterus continues to contract after delivery. There are dilated blood vessels flow through the muscle fibers of the uterus, so the uterus will contract in a “tourniquet like effect”. These contractions are the after cramps
More noticeable the more pregnancies a woman has
The more contractions = more after cramps felt too
What is the number 1 cause of maternal death in the world and accounts for 27% of all maternal deaths worldwide?
Postpartum hemorrhage
Immediately after expulsion of the placenta, the top of the fundus is …
in the midline and approximately halfway between the symphysis pubic and the umbilicus
After 6-12 hours post partum, where is the fundus?
the highest point of the uterus, the fundus, is usually located at the umbilicus
Feels like a grapefruit in the abdomen
The height of the fundus after 6-12 hours post partum decreases…
about one finger breadth (about 1 cm) each day back to its normal position
It will feel hard like a baseball
If the uterus is above the umbilicus after 6-12 hours, be concerned that it is not what?
well contracts and blood flow may increase
The more distended the uterus has been during pregnancy, the more…
difficult it is for it to contract effectively after delivery
Because of this women who have multiple infants and those that have large infants ARE AT INCREASED RISK FOR HEMORRHAGE
A ___ ___ can interfere with effective post partum uterus contraction
distended bladder
What does it mean if the fundus is pushed to the right and is above the umbilicus?
The bladder is full (and making it compete for space)
Like the uterus, the ___ and ___ involute after delivery
the cervix and vagina
Why do the cervix and vagina have to involute after birth?
they dilated to allow passage of the infant and need to return to pre pregnancy state
Why is it so important the cervix close?
to prevent infection having access to the uterine cavity
How long does cervical and uterine involution take?
process takes up to several weeks to comp[lete
Kegal Exercises
exercises to assist with restoring vaginal tone
Vaginal flow after delivery is usually representative of what?
the shedding of the uterine lining and the oozing from the site of placental implantation
Atony
lack of tone
Excessive post partum bleeding can come from…
Uterine atony
Unrepaired cervical, vaginal or perineal lacerations
Retained placental fragments (lead to bad uterine contraction/involution)
Vaginal or Vulvular Hematomas
Coagulopathies
types of Lochia
Lochia Rubra
Lochia Serousa
Lochia Alba
Lochia Rubra
Initial lochia that is red in color
Occurs 1-3 days post pregnancy
What does brighter red or darker mahogany colored Lochia Rubra Mean?
The brighter red the flow, the fresher the bleeding
Darker more mahogany colored bleeding means older bleeding that collected in the vagina and uterus and was expressed now (not necessarily bad)
