Postpartum Flashcards
Postpartum Period
• Period of time during which the body adjusts, both physically and psychologically
• Begins immediately after birth and lasts approximately 6 weeks
• Medical follow-up in 6 weeks unless complications
• Usually discharged on 2nd postpartum day
o C/S delivery client usually goes home on 3rd day
• Need follow-up care
o Phone call, home visit, or postpartal class
General Principles for postpartum Assessment
o Before beginning the physical assessment, ask the woman to void
o Ask if the woman needs pain medication before assessment
• Ensuring that the woman is relaxed before starting
• Body fluid precautions
• Start with Heart, Lung and Bowel Sounds!
Vital Signs first 24 hr after delivery
should be obtained when the mother is at rest
1) Blood pressure: Should remain consistent with baseline during pregnancy
2) Pulse: 60-100 bpm
3) Respirations: 12-20 bpm
4) Temperature: 98o -100.4oF
- AFTER the first 24 hours, temp 100.4oF or above indicates infection
BUBBLE-EE” Assessment
Focused postpartum assessment
- ‘B’reasts
- ‘U’terus
- ‘B’owel
- ‘B’ladder
- ‘L’ochia
- ‘E’pisiotomy/Lacerations/Incision/Epidural Site
- ‘E’xtremities (Homan’s/Clonus/Sensation)
- ‘E’motions
‘Breast’
To Assess:
- Palpate the breasts.
- Ask her if they feel firmer than yesterday. If there is a change, then her milk is starting to come in.
- Ask her if there is any pain or tenderness.
- Inspect the breasts observing for any nipple soreness, cracks, or redness.
Findings for Breast
• 1-2 days after delivery:
primary colostrum present, possible tingling sensation, then filling to full, tender; snug bra needed
• 2-4 days average:
breast milk appears, need to be stimulated by nursing, pumping, or manual expression to maintain milk supply
Abdominal Changes
Skin? Muscles ?
Pains? What can help pains?
- loose & flabby but will respond to exercise
- Uterine ligaments will gradually return to their prepregnant state
• Afterpains: result of intermittent uterine contractions
- Mostly felt by multiparous, multiple-gestation, or hydramnios
- Breastfeeding can cause due to release of oxytocin
- Prone positioning with a pillow beneath the abdomen can help
- May at first intensify the discomfort for about 5 minutes, but discomfort then diminishes greatly if not completely
- Positioning, Ambulation, Analgesics assist with pain control
- Striae will take on different colors based on the mother’s skin color
- Diastasis Recti- separation of the rectus abdominus
Uterus
- Uterus decreases in size in a process called involution
* Rapid reduction in size of uterus & return to condition similar to non-pregnant state
Uterus assessment
• Have client void prior to checking fundus
• Remember to hold bottom of uterus with non-dominant hand for support, but do not push it!
• Starting at the umbilicus, use your dominate hand for palpation
• Should descend one centimeter or fingerbreadth per day
1 fingerbreadth above the umbilicus = U+1 (1/U)
At the level of the umbilicus = U
1 fingerbreadth below the umbilicus = U-1 (U/1)
• Check for FIRMNESS of fundus
• Approximately the size of a grapefruit after delivery and just has hard!
Uterus abnormal findings
- If uterus seems larger than normal, attempt to express clots
- If uterus feels soft (“boggy”) at any time, the uterus is not contracting properly leaving the woman at risk for hemorrhage. The nurse should massage the fundus until firm again. Woman may need Oxytocin/Pitocin or Methergine to stimulate uterine contractions for involution. If the bladder is not midline (most often to the right) the woman may have a full bladder
Uterus normal findings
- 1st 6-12 hours after delivery: firm, midline, and possibly above the umbilicus (U+1) (firm is grapefruit)
- 12-24 hours after delivery: firm, midline, and at or near level of umbilicus
- No longer palpable by 10-14 days; back to pre-pregnant size by 6 weeks
Factors that Enhance Involution
- Uncomplicated labor and birth
- Complete expulsion of the placenta or membranes
- Breastfeeding
- Manual removal of the placenta during c/s
- Early ambulation
Factors that SLOW Involution
- Prolonged labor
- Anesthesia
- Difficult birth
- Grand multiparity
- Full bladder
- Incomplete expulsion of placenta or membranes
- Infection
- Overdistention of uterus
Bowel after labor
Eating ?
What can delay bowel movements ?
• Eating & Drinking
- Vaginal deliveries can eat immediately as tolerated
- C/S delivered client
- NPO until bowel sounds heard
- Start with clear liquid diet
- Flatulence relieved by early ambulation/meds - Bowel tends to be sluggish after birth due to lingering effects of progesterone and decreased abdominal muscle tone
- Episiotomy, lacerations, or hemorrhoids may delay elimination
Bowel assessment
How to avoid constipation ?
• Assess bowel sounds
• May not have a bowel movement for 2-3 days after delivery, potentially longer if c/s
• Avoid constipation
o Stool softeners (docusate sodium)
o Ambulation
o Increase fluid intake (2000 mL/day or more)
o Fresh fruits, roughage
Bladder
• ⬆️ bladder capacity
• Swelling and bruising of tissues around the urethra
• ⬇️ in sensitivity to fluid pressure
• ⬇️ in sensation of bladder filling from anesthesia
• Urinary output is greater due to postpartum diuresis
- must eliminate excess fluid
• ⬆️ chance of infection if stasis occurs
• Full bladder increases the risk of uterine atony