Post Partum w/ Assessment Flashcards
Postpartum (PP) period
- Approximately 6 weeks In duration (longer if c/s)
- Normal reproductive cycle will start again
- Body preparing for lactation
Psychological Changes
taking-in
1-3 days, will be talking about delivery (bad or good experience)
- talk to mother, ask her about labor! - review pregnancy - dependant in baby care (interested but hungry, cold) - all about mother
Psychological Changes
taking-hold
Initiating own actions
- mother wants to take on more responsibility - teach but let mother do!! - mother may question ability - give mother support!!
Psychological Changes
letting-go
(wont usually see)
- ways to help homless - reorganize thought and family
Maternal concerns and feelings
- Abandonment
- Disappointment
- Postpartum blues
- Postpartum Depression
Abandonment
Everyone paying attention to baby now instead of mother
Disappointment
Baby doesn’t live up to fantasy baby
Postpartum Blues
- 80% of woman.
- hormones are gone
- mother crying and doesn’t know why
- can last up 2 weeks
Postpartum Depression
- blues lasting longer than 2 weeks
- lasts weeks up to months
- needs meds, therapy
Respiratory changes
- Hormonal changes relieve stuffiness
- Relief from dyspnea due to the birth the lungs can expand easier and the diaphragm is more useable
Hormonal changes
- Due to decrease in Placental lactogen, insulin need down
- increased prolactin
Urinary changes
- urinate and sweat a lot - trying to get rid of fluid
- urine may contain protein
- ureters decrease in size to normal
- will be putting out 3x more urine
- reassure pt this goes away in 24-48 hr
- bladder should return to normal within 6 wk
Circulatory changes
- If anemic prenatally will be more so postpartum
- elevated WBCs x 5-6 days
- hemoglobin of 9 do not send home
- coagulation will still be high
- varicosities/hemorrhoids recede
GI changes
- will have BM by second day
- may be afraid to poop because afraid it might hurt
- bowel sound active
Integumentary changes
- Stretch marks still red, will start to change to silvery (cauc) , darker (Blacks) at 3-6 months
- Hair may still fall out
MS changes
- Diastasis recti will indent at first & may appear bluish
- Everything back to normal by 6 wk
PUPPs
-Pruritic Uticarial Papules & Plaques of pregnancy
Neuro changes
- Altered Sleep Patterns
- Numbness in legs, dizziness
- Safety when getting up
- Headaches
- Need to be evaluated
Immune system changes
-If Rh neg, needs RhoGam within 72 hours
-Rubella vaccination
(Avoid pregnancy for 1 month, Flu-like SS may occur)
Vital Signs
Temp: Can be high (dehydrated?). Normal to have temp, give fluids. will be elevated for 24 hr. 100.4 = international fever. Fever can come when milk comes (engorgement).
Pulse: if rapid look under blanket (infection)
b/p: depends on medicine. if still contracting will be elevated. 140/90 report!! orthostatic htn
Reasons for C/S
emergency, maternal (herpes, hiv/aids, cpd) tumor, pih, placenta problems, prolapsed cord, breech, transverse lie, big baby, big head, conjoined twins
Lochia rubria
- red
- 1-3 days pp
Lochia serosa
- pink
- 3-10 days pp
lochia alba
- white
- 10-14 days pp
- may last 6 wk
methergine
do not give if BP high!
Subinvolution
- not progressing the way it should
- increase risk of hemorrhage
Bladder
- Assess for fullness, due to void – 6 hours
- Subjective s/s during and after void
- Monitor first few voids
- Returns to normal in 2-3 days
Constant trickle of blood caused by?
- laceration of cervix or vagina
- call Dr!! (nothing nurse can do)
