Postnatal Care Flashcards
Perineal Care
Maternal Care
- Observations
- Pain relief
- Showering
- Food and fluids
- Perineal care
- Bladder care - voiding to reduce risk of PPH.
- Documentation of labour/birth
Bladder Care
Fundul Assessment
Should be firm/central immediately post-birth.
Moves 1cm downward per day.
No longer palpable by 10d.
Post-Natal Depression Screening
Breast-Feeding Education
- Timing - first hours post-delivery, notice feeding signals (e.g. moving lips, hand to mouth, head side-to-side, breast crawl), ave. 2-3hr.
- Preparation - comfortable position, recently voided, fluids on-hand, assistance from partner, un-swaddle infant.
- Positioning - cradle or football hold
A. chest to chest
B. chin on breast
C. nipple to nose
D. wait for the gape - Monitor signs of good attachment
- Insert clean finger in corner of mouth to break suction
- Reassurance - it gets easier and more comfortable!!
Maternal Observations (8)
- Vital signs
- Vaginal losses
- Signs of PPH
- Signs of DVT
- Fundal height - firm/central, 1cm downward per day.
- Perineal wound
- Voiding bladder and bowels
- Emotional/psychological state - post-baby blues (72hr)
Lochia
Definition
Stages
Post-birth vaginal discharge of blood, mucous, uterine tissue and other material arising from area of placental detachment from uterine wall and shedding of endometrial lining.
1. Rubra (3-4d) - bright/dark red, heavy +/- small blood clots, cramping.
2. Serosa (4-10d) - pink/brown, moderate-light.
3. Alba (10-28) - white/yellow, spotting.
Postpartum Haemorrhage
Definition
Signs/Symptoms
Heavy bleeding post-delivery occurring within 24hrs to 12w.
Persistent excessive bleeding post 3d.
Large blood clots
Bleeding >1pad/hr.
Symptomatic - dizziness, blurred vision, tachycardia, weakness.
Maternal Physiological Changes (5)
- CVS - high-risk DVT for 2w, baseline CO, blood volume and clotting factors by 6w.
- Renal - oliguria 1d, micturition returns 2-5d, bladder/urethral oedema, baseline GFR by 6w.
- Respiratory - diaphragm returns to normal position.
- GIT - decr. motility and risk of constipation.
- Reproductive - uterine shrinkage, fundus not palpable by 10d, cervical closing in 48hr, vaginal tone returns 6, perineal healing 3w-3m, menstruation returns 6w-6/18m (non/lactating).
Neonatal Jaundice
Definition
Cause
Treatment
Yellowish appearance of skin due to accumulation of bilirubin in dermal/subcutaneous tissues and sclera.
Excess RB production + immature liver function = high bilirubin production (x2) and impaired excretion in urine/faeces
Decreases once PU/BO
Phototherapy - blue-green light exposure converts to water soluble isomers.
Bilirubin Encephalopathy
Definition
Signs/Symptoms
Acute bilirubin toxicity and associated brain damage.
- Lethargy
- Hypotonia
- High-pitched cry
- Spasms/arching
- Seizures/coma
Maternal Advice & Education
- Encourage rooming-in
- Breast or bottle feeding
- Perineal and bladder care
- Holding and swaddling
- Settling and safe sleeping
- Bathing and changing nappies
- Adjustment at-home, community resource/services and contact numbers
- Mental health
Neonatal Observations (10)
- ID check
- Vital signs
- BGL - incr. risk of hypo
- Skin - jaundice
- Weight - 10% loss by 5d
- Reflexes
- Cord - drops off by 7d
- Signs of fever/infection or dehydration
- Feeding
- Sleep-wake cycle
Artificial Feeding
Doses
Healthy full-term infant:
5d-3m - 150ml/kg/day
3-6m - 120ml/kg/day
6-12m - 90-120ml/kg/day
Premature infant - 160-180ml/kg/day