Postpartum Flashcards
Review postpartum complications, fundal and lochia changes, breastfeeding, and physical changes.
Immediate complication
What are 2 life-threatening postpartum complications of cesarean section?
Bleeding and Infection
Immediate complication
How many saturated pads per hour is considered hemorrhage?
- > than 1 pad per hour or
- one pad that gets saturated within 15 minutes
Immediate complication
How much blood loss is considered hemorrhage for a vaginal delivery and a cesarean delivery?
- Vaginal delivery: > 500 mL after delivery
- Cesarean delivery: > 1000 mL after delivery
How should pads be measured for postpartum hemorrhage?
- weigh pad before and after use
- note time in between pad changes
Interventions:
Postpartum hemorrhage
Interventions for postpartum hemorrhage:
- measure pads
- give oxytocin
What maternal temperature is considered normal during the first 24 hours after birth?
98.6o - 100.4o F (36o - 38o C)
Interventions:
Postpartum infection
- assess vital signs
- get cultures of blood, sputum, or lochia
- antibiotics
What are the normal assessment findings for the fundus on day one after delivery?
The fundus should be firm, midline, and at the umbilicus.
How far down should the fundus decrease per day?
The fundus should decrease 1 cm downward per day.
What are the interventions if the fundus is boggy or NOT midline?
- have the client urinate
- gently massage the fundus until firm
What is lochia?
Lochia is vaginal discharge after pregnancy.
Describe:
Lochia rubra
The first vaginal discharge that is red that occurs from birth of baby to about 5 days postpartum.
Describe:
Lochia serosa
The second vaginal discharge that is brownish-pink or brown that occurs from 5 - 10 days postpartum.
Describe:
Lochia alba
The third vaginal discharge that is yellow to white in color that occurs from about 11 - 14 days postpartum.
Describe abnormal postpartum lochia that indicates infection.
- a very bad odor
- yellow/green/gray in color
When do postpartum clients start ovulating again?
Postpartum clients can start ovulating soon after birth even without having their period yet and while breastfeeding.
Teach clients about contraceptives to prevent pregnancy too soon.
What is colostrum?
Colostrum is the first milk that comes in for breastfeeding:
- it starts about 24 - 72 hours after birth
- it is more clear and watery in consistency.
What is engorgement?
Engorgement is when the breasts are very full of milk
It can be painful and uncomfortable for the mother.
What are the interventions for engorgement if the client will not be breastfeeding?
- wear a binder and/or a very snug bra
- apply ice packs
- analgesics
When will engorgement resolve?
About 36 hours after it started.
What is the correct way a newborn should latch onto a breast?
Newborn mouth should be over entire areola
How long should a breastfeeding baby feed for each breast?
Baby feeds on each breast for 15 - 20 minutes.
A breastfeeding session would last between 30 and 40 minutes.
How often should moms breastfeed a newborn?
Breastfeed newborns every 2 - 3 hours.
How often should caretakers bottle feed a newborn?
Bottle feed a newborn every 3 - 4 hours.
If a newborn has to breastfeed every 2 hours and the client started breastfeeding at 1 PM. When would the next breastfeeding session start?
The next breastfeeding session would start at 3 PM
Start at the time of when the client started breastfeeding, not when it ended
How does the mom break the suction from a breastfeeding baby?
Break the breastfeeding suction by inserting a finger between the mouth and the breast.
How long is breastmilk or formula the only food given to the baby?
Breastmilk or formula is the only food for 4 - 6 months.
Nothing else should be given up until that time.
Can breastfeeding mothers take medications?
When breastfeeding, all medications and over-the-counter medications need to be approved by the HCP first before taking.
What are the complications of breastfeeding?
- cracked nipples
- mastitis
What are the interventions for cracked nipples?
- no soap (dries out the skin)
- expose breasts to air for part of the day
- use different breastfeeding positions for baby
- apply lanolin (emollient)
Describe:
Mastitis
Mastitis is an infection of the breast with clogged milk ducts.
Interventions:
Mastitis
- heat or cold packs (to decrease inflammation)
- supportive bra (no wire bras - too much constriction)
- still breastfeed or pump every 4 hours
Medications:
Mastitis
- analgesics
- antibiotics
What are the general assessments postpartum?
Assess for:
- bleeding
- infection
- pain
- perineal hematoma
- incision for cesarean delivery
- depression
- DVT (thrombophlebitis)
- fungal height
What are the general interventions postpartum?
- vital signs
- intake and urinary output
- encourage fluids/fiber/walking
- pain relief
What are the specific assessments and interventions for the renal system postpartum?
- assess urine output
- may have retention if anesthesia was used
- encourage urination or straight cath
Client will have frequent urination to get rid of extra fluids.
What are the specific assessments and interventions for the gastrointestinal system postpartum?
- assess for constipation
- encourage fluids/fiber/walking
- stool softeners
- give extra 500 calories per day due to breastfeeding
- multivitamin for deficiencies
What are the specific assessments and interventions for mental health postpartum?
- assess for postpartum depression
- therapeutic communication, possible group therapy, and medications
- assess for mom/baby bonding
What are the specific assessments and interventions for the cardiac system postpartum?
Assess for DVT (thrombophlebitis) and pulmonary embolism
Provide life-saving interventions and notify HCP
What are the specific assessments and interventions for pain postpartum?
Assess for pain
- ice packs to perineum
- sitz baths
- analgesics
- suppositories if client had episiotomy
What are the specific assessments and interventions for Cesarean delivery?
- assess incision
- encourage walking
- prevent DVT and constipation
- encourage cough and deep breathing
- prevent pneumonia
What is the teaching to a client that needs to get the MMR vaccination postpartum?
Teach client to use contraceptives for 1 - 3 months after vaccination due to risk of harm to fetus.
