Post Partum

Question 1

Post Partum Period

Answer 1

6-12 weeks after delivery

Question 2

Bubble hee

Answer 2

Breast
Uterus
Bladder
Bowels
Lochia
Episiotomy/Perineum
Hemorrhoids
Emotions

Question 3

Breasts

Answer 3

Ask for subjective input
What is moms feeding plans
Then ask permission to assess
Engorgement and Mastitis

Question 4

Breast engorgement

Answer 4

Congested fluid and blood in the breasts
Swollen, firm, and painful
Massage breasts and use cold pads

Question 5

Mastitis

Answer 5

S/S: inflammation, infection, redness, pain/tenderness, localized heat and swelling, fever, malaise
Cure: antibiotics and continuing lactation

Question 6

Bladder

Answer 6

Last void/catheterization
Normal:
- bladder should not be palpable
- decreased urge to void
- retention from dec elasticity
Abnormal:
- urge, but inability, to void

Question 7

Bowels

Answer 7

Constipation
Hemorrhoids
Fear of first BM after delivery

Question 8

Episiotomy

Answer 8

Assess for REEDA:
R-redness
E-edema
E-ecchymosis
D-discharge
A-approximation of repair

Question 9

Perineal Care

Answer 9

Cleanse perineum after each elimination
Wash hands before and after
Use peri bottle and provide steady stream of warm water over perineum
Sermon-blast spray
Witch hazel tuck pads
Ice pack for comfort and edema
Peri-pad

Question 10

Hemorrhoids

Answer 10

Veins in the blood vessels in and around your anus and lower rectum become swollen and irritated
Pain or discomfort
Swelling around anus
Bleeding

Question 11

Emotions after pregnancy

Answer 11

Postpartum depression
The baby blues
Psychosis

Question 12

Postpartum depression

Answer 12

PPD is a mood is a mood disorder that affects some women after childbirth. Mothers with PPD can experience extreme sadness and anxiety. Makes it hard to complete activities of a mother.
S/S:
Severe mood swings
Intense irritability and anger
Feelings of shame, guilt and inadequacy
Withdrawal from family and friends

Question 13

The baby blues

Answer 13

A lot more common than PPD
happen the first few days after childbirth and and are a lot less serious than PPD
normally dont need treatment
S/S:
Sadness, changes in sleeping and eating patterns, reduced libido

Question 14

Postpartum Psychosis

Answer 14

Hx of pre-existing mental health disorders increase patients risk (50%)
PP depression with psychotic features
S/S:
- most often in 2 to 4 weeks
- abnormally elevated energy levels/cognition/mood along with one or more depressive episodes
- strange behavior, hallucinations, paranoia
-inc risk for suicide and infanticide

Question 15

Epidural Site

Answer 15

Assess for:
- edema
- erythema
- ecchymosis
- drainage

Question 16

Pharmacological interventions prior to D/C

Answer 16

Rh immune globulin (Rhogam)
Influenza
MMR (Rubella non-immune or equivocal)
Stool softeners
Analgesics
Tdap (pertussis)

Question 17

Rh Incompatibility considerations

Answer 17

Rh positive father
Rh negative mother
—->
Rh neg mom will have Rh neg
Rh positive cells from baby enter mom
Causes production of Rh antibodies
Rh antibody attack the Rh positive baby causing Rh disease

Question 18

When to call provider postpartum

Answer 18

Sudden, persistent, spiking fever
Change in lochia
Pain at laceration
Infection
Mastitis - breast tenderness
Thrombophlebitis - calf pain
UTI
Depression

Question 19

Uterus

Answer 19

Fundal height
Fundal location
Uterine tone

Question 20

Lochia

Answer 20

Assess for:
Amount
Color
Clots
Odor
When was peri-care last done?

Question 21

Uterine Atony

Answer 21

Soft and weak uterus after childbirth
Uterine muscles dont contract enough to clamp placental blood vessels shut after childbirth
Can lead to life threatening blood loss
Major risk factor for PP hemorrhage

Question 22

Postpartum hemorrhage

Answer 22

Severe loss of blood after childbirth
- Early: first 24 hrs
- Late: 24hr-12weeks
Risk:
- uterine atony
- Genital tract lacerations
- retained placenta
- unsterile inversion
- abnormal placentation
- coagulation disorders

Question 23

Signs of PP hemorrhage

Answer 23

Excessive bright red trickling
Constant trickle or gushing
Boggy fundus -no response to massage
Abnormal clots
Unusual pelvic discomfort or backache
Persistent bleeding in presence of firmly contracted uterus
Rise in level of fundus
Hematoma formation

Question 24

PP hemorrhage treatment

Answer 24

1. Oxytocin admin
2. Uterine massage
3. Umbilical cord traction

Team:
- standing orders
- uterine massage (DONT STOP)
- assess bladder
- notify HCP
- vascular access inc/start pitocin
- consider other uterotonic meds
- vital signs

If still continues:
- manual extraction
- uterine tamponade devices, BT cath balloons
- hysterectomy
- fluid replacement (NS, LR, or blood transfusion)
- O2 nonrebreather face mask 10-12L