postpartum Flashcards
involution
contraction of muscle fibers; catabolism; regeneration of uterine epithelium
degree of involution
- Descents from level of fundus at rate of 1 fingerbreadth per day
By 10 days cannot be palpated - Fundus is at umbilicus at 24 hrs, then 1 FB below per day until 10 days
lochia
drainage
rubra
dark red blood
- 3 days after birht
serosa
pink drainage
another couple of days or weeks
alba
white discharge
abnormal lochia
infection
after pains
helps uterus clamp down
- can take tylneal and ibeprofin
when are afterpains usually the strongest
- Afterpains are usually stronger during breast-feeding because oxytocin released by the sucking reflex strengthens the contractions. Mild analgesics can reduce this discomfort.
- released oxytocin and clamps uterus down
how the uterus should be
- pressure on vessles
- uterus needs to be tight
- midline and firm after 24 hr at umbillicus
danger sign
the reappearance of bright-red blood after lochia rubra has stopped. Reevaluation by a health care provider is essential if this occurs
cervixnow appearing as jagged slit-like opening
perineum
- almost always tears
- looks for infection
- kagels to tighten everything up
causes of postpartum diuresis
Large amounts of intravenous fluids given during labor
Decreasing antidiuretic effect of oxytocin as its level declines
Buildup and retention of extra fluids during pregnancy
Decreasing production of aldosterone—the hormone that decreases sodium retention and increases urine production
Diuresis + Decreased urge to void =
rapid filling of bladder and retention
distention of bladder
- Distention of the bladder displaces the uterus to the right = major cause of uterine atony
- Retention can also lead to UTIs
- Bladder distention displaces uterus to the right, major cause of uterine atony!
engorgement
Process of swelling of the breast tissue due to an increase in blood and lymph supply as a precursor to lactation
- 75% of women have it
what to do for engorgement
- warm pack before feeding
- empty breast appropriate
lacth
- Assist with LATCH / educate re: breastfeeding
- Proper latch key intervention for preventing complications such as mastitis
teaching points for breast feeding mothers
- Completely empty breasts at each feeding
- Wear a well-fitting, supportive bra
- Apply cool compresses after feedings and warm compresses/showers prior
- Keep taking prenatal during lactation
- Nipple care
- Monitor nodules
what to do after & before feeding
Apply cool compresses after feedings and warm compresses/showers prior
monitor nodules
persistence may indicate fibrocystic disease or malignant growths unrelated to pregnancy
teaching non nursing mothers
- Do not manually express milk from breast
- Do not stimulate the nipples
- Wear a tight-fitting bra
- Use ice packs & Avoid hot showers where water runs over breasts
U- se analgesics
when does breastmilk come in
3-5 days
-. Colostrum before them. Keep taking prenatal vitamins during breastfeeding.
how to care for painful nipples
- nipples- Express some breastmilk on nipples before feeding, Start on less sore nipple, make sure you have a good latch; may need to change position of infant- Parent should be encouraged to do most of the feeding with support from nursing
how many ml does it take for a baby to eat
5ml
mestisis
infected boob
cabbage
frozen helps after feeding
s/s baby hungry
- fist in mouth
- looking for a breats
- lip smacking
- crying
calm them own first
how to break suction
put finger in mouth to break the suction
cream for niples
landelin
Rubin’s Three Postpartum Phases
taking in phase
taking hold phase
letting go phase
taking in phase
- First 24-36 hours after birth
- Focus on self: rely on others to meet their needs
- Very dependent - may need to be reminded to eat, shower, sleep etc.
- Desire to review birth experience
- very excited
taking hold phase
- Starts 2nd day and lasts approximately 10 days
- Alternates between need for extensive nurturing and a desire to take charge
- Responds enthusiastically to opportunities to learn and practice baby care
- Emotional change – possible experiences with the “blues”
- more into learning
- labile moods, crying for no reason
- 1-2w after delivery
- still bond and take care of body
letting go phase
- Focus: forward movement of family as unit with interacting members
- Reassertion of relationship with partner
- Resolution of individual roles
- after couple of weeks
danger signs
- Fever more than 100.4°F (38°C)
- Foul-smelling lochia or an unexpected change in color or amount
- Large blood clots, or bleeding that saturates a peripad in an hour: bigger than gold ball size, saturate pad within an hour, 1000ml
- Severe headaches or blurred vision
- Visual changes, such as blurred vision or spots, or headaches
- Calf with localized pain, tenderness, redness, and swelling
- Swelling, redness, or discharge at the episiotomy, epidural, or abdominal sites
- Dysuria, burning, or incomplete emptying of the bladder
- Shortness of breath or difficulty breathing without exertion
- Depression or extreme mood swings
c/s danager signs
100.4
assessment findings for pre-e
hyper reflextive
BUBBLEEE
breast uterus bladder bowls lochia episiotomy extremities emotional status
breast
inspect & Palpate for size, contour, engorgement, nipple condition, milk production
- only touch if they ask
- soft tender right after delivery
uterus
assess fundus consistency, location, r/o tenderness
- firm at midline, and umbilicus
bladder
Assess for distention, tenderness, adequate emptying
- Note the location and condition of the fundus; a full bladder tends to displace the uterus up and to the right.
bowls
Has mother moves bowels, listen X4 for BS, assess for abdominal distention
- flatus, bowl sounds x4, no n/v, stool softener
lochiA
Assess type, amount, color, odor, does change of activity change amount of lochial flow?
- Typically, the amount of lochia is described as follows:
- Scant:a 1- to 2-in lochia stain on the perineal pad or approximately a 10-mL loss
- Light or small:an approximately 4-in stain or a 10- to 25-mL loss
- Moderate:a 4- to 6-in stain with an estimated loss of 25 to 50 mL
= Large or heavy:a pad is saturated within 1 hour after changing it
episiotomy & perineum
asess episiotomy &/or lacerations q. 8 hrs.; assess for approximation, swelling, ecchymosis, D/C, pain
extremities
assess for maternal risk, edema, varicosities,
- calf pain, swelling, redness
emotional staus
assess for maternal mood, bonding with infant, energy/exhaustion levels, desire for independence or lack thereof, touch
- if separated, asking about baby
- The length of time necessary for bonding depends on the health of the infant and mother, as well as the circumstances surrounding the labor and birth
homans and extremities
\: Pulmonary emboli typically result from dislodged deep vein thrombi in the lower extremities. Risk factors associated with thromboembolic conditions include: Anemia Diabetes mellitus Cigarette smoking Obesity Preeclampsia Hypertension Severe varicose veins Pregnancy Multiple pregnancies Cardiovascular disease Sickle cell disease Postpartum hemorrhage Oral contraceptive use Cesarean birth Severe infection Previous thromboembolic disease Multiparity Bed rest or immobility for 4 days or more Advanced maternal age > 35 years (Kline & Kabrhel, 2015).
promoting comfort
Cold and heat applications
Ice pack (1st 24 hours), peribottle, Sitz bath (after 24 hours)
Topical preparations
Analgesics: dermaplastt
assisting with elimination
Promoting voiding Promoting bowel elimination - patting dry, babywash and warm water in a bottle - front to back - fresh pad everytime - clean hands - tucks pads: with hazel
postpartum complications
Coagulation Issues
Postpartum Hemorrhage
Postpartum Infections
Postpartum Emotional Disorders
DVT
Deep Venous Thrombus (DVT)
Lower extremities, various veins from foot to iliofemoral region
s/s of dvt
- most common during pregnancy)
- Unilateral leg pain, calf tenderness, swelling
- Tenderness, warmth, or asymptomatic, Homan’s sign +/-
PE
Pulmonary Embolus (PE) - Complication DVT, clot travels to pulmonary artery, occludes blood flow to lungs
s/s of pe
Dyspnea, tachypnea, tachycardia, apprehension, pleuritic chest pain, cough, hemoptysis (coughing up blood), elevated temperature, syncope, cardiac arrest
superficial interventions for dvt
Analgesics (NSAIDs)
Rest, elevation, compression stockings, heat locally
dvt medical mgmt
Anticoagulant
Initially IV heparin, bed rest, elevate affected leg, analgesia
later oral anticoagulant warfarin (coumadin), compression stockings, ambulation
acute pt (usually dislodged dvt) medical mgmt
Emergent treatment IV: Anticoagulant
IV heparin, later SQ or oral anticoagulants
- prevention: compression stockings, moving around
aspirin alert
Medications containing aspirin are not given to women on anticoagulant therapy because aspirin inhibits synthesis of clotting factors and
can lead to prolonged clotting time and increased risk for bleeding
post partum hemorrhage
Postpartum hemorrhage is a potentially life-threatening complication of both vaginal and cesarean births. It is the leading cause of maternal mortality in the United States.
causes of postpartum hemorrhage
Uterine atony
risk factors for pph
Prolonged labor Manual extraction of placenta Pitocin augmentation History of postpartum hemorrhage Large baby Grand multiparity
blood loss for postpartum hemorrhage
> 500 mL following a vaginal birth
1,000 mL following a cesarean birth
Any amount of bleeding that places the mother in
hemodynamic jeopardy
primary ppt
within 24 hours
delayed ppt
24hr to 12 weeks after birth
pph nursing assessment
Risk factors
Uterine tone; vaginal bleeding
therapeutic management pph
Focus on underlying cause Uterine massage Fundal massage Removal of retained placental fragments Antibiotics for infection Repair of lacerations
nursing management for pph
(priority) Fundal massage; QBL Administration of uterotonic Drug Guide 22.1 p. 847 Fluid administration Monitoring for signs and symptoms of shock Emergency measures if DIC occurs
complications from pph
- Complication: Disseminated Intravascular Coagulation (DIC)
- Clotting and anticlotting mechanisms occur at the same time
Not a primary condition; secondary to pregnancy complications (placental abruption, infection, preeclampsia/eclampsia, hemorrhage, etc.) - Manifestations include unusual spontaneous bleeding from gums and nose; oozing , trickling or flow of blood from incision/laceration; petechiae, hematuria
- Institute emergency measures to control bleeding and impending shock; prepare to transfer to ICU
- Identification of underlying condition and elimination of causative factors are essential
labs and nursing care for DIC
Labs: CBC, blood type/cross, clotting factors
Nursing Care
Administration of fluid volume replacement (can include blood/blood products)
Administer pharmacological interventions (antibiotics, vasoactive mediations, uterotonic agents)
Administer supplemental oxygen
Protect from injury
pph medications
- Oxytocin (Pitocin)
- Methylergonovine (Methergine )
- Hemabate (Carboprost, Prostin 15m)
- Misoprostol (Cytotec)
oxytocin
Action: stimulates uterine smooth muscle. Has vasopressor and antidiuretic effects.
Usually given wide open for PPH; however drug resources say for PPH only administer via pump at 10 to 40 milliunits per minute, can go up to 80 milliunits for short period.
Methylergonovine (Methergine ) contraindications
Hypertension, pre-eclampsia,
Cardiac diseas
Methylergonovine (Methergine )
- Ergot alkaloid
- Dose: 0.2 mg IM; most likely will start 0.2 mg PO q 6 hours x 4 after stable
- Action: stimulates uterine and vascular smooth muscle.
- use filter needle, open with gauze, open away
hemabate
contraindication
- Dose: 250 mcg IM q 15 minutes x 3
- Contraindication: Asthma
- Lomotil- anti-diarrheal given to help with the side effect of Hemabate
- causes vomiting, explosive diarrhea take lomotal and zofran with it
misoprostol
800-1000 rectally
pp infection s/s
Increased temp, redness swelling, uterine tenderness, chills, fever, localized pain
pp labs
blood culture, CBC, urine cultures, uterine culture
pp prevention
To include good handwashing, aseptic technique, teaching perineal hygiene, teaching signs and symptoms of an infection
sings of baby blues
go away in a few says or 1 week
•Sad, anxious, or overwhelmed feelings, Crying spells, Loss of appetite,Difficulty sleeping
signs of postpartum depression
(can begin any time in the first year):
•Same signs as baby blues, but they last longer and are more severe, Thoughts of harming yourself or your baby, Not having any interest in the baby
s/s of postpartum phsyosis
Seeing or hearing things that are not there
•Feelings of confusion
•Rapid mood swings
•Trying to hurt yourself or your baby
s/s of postpartum anxiety
Panic attacks
Obsessive thoughts/behaviors
when to call health provider about mood
- The baby blues continue for more than 2 weeks
•Symptoms of depression get worse
•Difficulty performing tasks at home or at work
•Inability to care for yourself or your baby
•Thoughts of harming yourself or your baby
