Post Partum Flashcards
Post Partum Period
6-12 weeks after delivery
Bubble hee
Breast
Uterus
Bladder
Bowels
Lochia
Episiotomy/Perineum
Hemorrhoids
Emotions
Breasts
Ask for subjective input
What is moms feeding plans
Then ask permission to assess
Engorgement and Mastitis
Breast engorgement
Congested fluid and blood in the breasts
Swollen, firm, and painful
Massage breasts and use cold pads
Mastitis
S/S: inflammation, infection, redness, pain/tenderness, localized heat and swelling, fever, malaise
Cure: antibiotics and continuing lactation
Bladder
Last void/catheterization
Normal:
- bladder should not be palpable
- decreased urge to void
- retention from dec elasticity
Abnormal:
- urge, but inability, to void
Bowels
Constipation
Hemorrhoids
Fear of first BM after delivery
Episiotomy
Assess for REEDA:
R-redness
E-edema
E-ecchymosis
D-discharge
A-approximation of repair
Perineal Care
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
Hemorrhoids
Veins in the blood vessels in and around your anus and lower rectum become swollen and irritated
Pain or discomfort
Swelling around anus
Bleeding
Emotions after pregnancy
Postpartum depression
The baby blues
Psychosis
Postpartum depression
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
The baby blues
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
Postpartum Psychosis
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
Epidural Site
Assess for:
- edema
- erythema
- ecchymosis
- drainage
Pharmacological interventions prior to D/C
Rh immune globulin (Rhogam)
Influenza
MMR (Rubella non-immune or equivocal)
Stool softeners
Analgesics
Tdap (pertussis)
Rh Incompatibility considerations
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
When to call provider postpartum
Sudden, persistent, spiking fever
Change in lochia
Pain at laceration
Infection
Mastitis - breast tenderness
Thrombophlebitis - calf pain
UTI
Depression
Uterus
Fundal height
Fundal location
Uterine tone
Lochia
Assess for:
Amount
Color
Clots
Odor
When was peri-care last done?
Uterine Atony
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
Postpartum hemorrhage
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
Signs of PP hemorrhage
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
PP hemorrhage treatment
- Oxytocin admin
- Uterine massage
- 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
