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Maternity/OB Nursing > Postpartum > Flashcards

Postpartum Flashcards

Review postpartum complications, fundal and lochia changes, breastfeeding, and physical changes.

You may prefer our related Brainscape-certified flashcards:
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1
Q

Immediate complication

What are 2 life-threatening postpartum complications of cesarean section?

A

Bleeding and Infection

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2
Q

Immediate complication

How many saturated pads per hour is considered hemorrhage?

A
  • > than 1 pad per hour or
  • one pad that gets saturated within 15 minutes
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3
Q

Immediate complication

How much blood loss is considered hemorrhage for a vaginal delivery and a cesarean delivery?

A
  • Vaginal delivery: > 500 mL after delivery
  • Cesarean delivery: > 1000 mL after delivery
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4
Q

How should pads be measured for postpartum hemorrhage?

A
  • weigh pad before and after use
  • note time in between pad changes
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5
Q

Interventions:

Postpartum hemorrhage

A

Interventions for postpartum hemorrhage:

  • uterine massage
  • empty pt bladder
  • measure pads
  • give oxytocin as ordered
  • monitor VS, I&O, O2 sat, LOC
  • contact provider if it doesn’t resolve
  • pad count (weigh/keep)
  • Keep IV patent, give IV bolus as ordered
  • anticipate possible transfusion
  • draw labs as ordered (CBC, type and crossmatch, coagulation studies)
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6
Q

What maternal temperature is considered normal during the first 24 hours after birth?

A

98.6o - 100.4o F (36o - 38o C)

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7
Q

Interventions:

Postpartum infection

A
  • assess vital signs
  • get cultures of blood, sputum, or lochia
  • antibiotics
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8
Q

What are the normal assessment findings for the fundus on day one after delivery?

A

The fundus should be firm, midline, and at the umbilicus.

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9
Q

How far down should the fundus decrease per day?

A

The fundus should decrease 1 cm downward per day.

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10
Q

What are the interventions if the fundus is boggy or NOT midline?

A
  • have the client urinate
  • gently massage the fundus until firm
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11
Q

What is lochia?

A

Lochia is vaginal discharge after pregnancy.

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12
Q

Describe:

Lochia rubra

A

The first vaginal discharge that is red that occurs from birth of baby to about 2-3 days postpartum.

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13
Q

Describe:

Lochia serosa

A

The second vaginal discharge that is brownish-pink or brown that occurs from 3 - 10 days postpartum.

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14
Q

Describe:

Lochia alba

A

The third vaginal discharge that is yellow to white in color that occurs from about 1-2 weeks postpartum.

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15
Q

Describe abnormal postpartum lochia that indicates infection.

A
  • a very bad odor
  • yellow/green/gray in color
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16
Q

When do postpartum clients start ovulating again?

A

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.

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17
Q

What is colostrum?

A

Colostrum is the first milk that comes in for breastfeeding:

  • birth to about 3 days
  • thick, early creamy milk
  • full of vitamins, minerals and proteins
  • contains immunoglobulins and antioxidants
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18
Q

What is engorgement?

A

Engorgement is when the breasts are very full of milk

It can be painful and uncomfortable for the mother.

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19
Q

What are the interventions for engorgement if the client will not be breastfeeding?

A
  • cabbage
  • wear a snug bra (binder no longer recommended)
  • apply ice packs
  • analgesics
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20
Q

When will engorgement resolve?

A

About 36 hours after it started.

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21
Q

What is the correct way a newborn should latch onto a breast?

A

Newborn mouth should be over entire areola

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22
Q

How long should a breastfeeding baby feed for each breast?

A

Baby feeds on each breast for 15 - 20 minutes.

A breastfeeding session would last between 30 and 40 minutes.

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23
Q

How often should moms breastfeed a newborn?

A

Breastfeed newborns every 2 - 3 hours.

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24
Q

How often should caretakers bottle feed a newborn?

A

Bottle feed a newborn every 3 - 4 hours.

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25
Q

If a newborn has to breastfeed every 2 hours and the client started breastfeeding at 1 PM. When would the next breastfeeding session start?

A

The next breastfeeding session would start at 3 PM

Start at the time of when the client started breastfeeding, not when it ended

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26
Q

How does the mom break the suction from a breastfeeding baby?

A

Break the breastfeeding suction by inserting a finger between the mouth and the breast.

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27
Q

How long is breastmilk or formula the only food given to the baby?

A

Breastmilk or formula is the only food for 4 - 6 months.

Nothing else should be given up until that time.

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28
Q

Can breastfeeding mothers take medications?

A

When breastfeeding, all medications and over-the-counter medications need to be approved by the HCP first before taking.

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29
Q

What are the complications of breastfeeding?

A
  • cracked nipples
  • mastitis
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30
Q

What are the interventions for cracked nipples?

A
  • no soap (dries out the skin)
  • expose breasts to air for part of the day
  • use different breastfeeding positions for baby
  • apply lanolin (emollient)
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31
Q

Describe:

Mastitis

A

Mastitis is an infection of the breast with clogged milk ducts.

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32
Q

Interventions:

Mastitis

A
  • heat or cold packs (to decrease inflammation)
  • supportive bra (no wire bras - too much constriction)
  • still breastfeed or pump every 4 hours
  • antibiotics (doxycycline, cephalexin - Keflex)
  • rest
  • increase fluid intake
  • pain meds (ie. ibuprofen)
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33
Q

Medications:

Mastitis

A
  • analgesics
  • antibiotics
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34
Q

What are the general assessments postpartum?

A

Assess for:

  • bleeding
  • infection
  • pain
  • perineal hematoma
  • incision for cesarean delivery
  • depression
  • DVT (thrombophlebitis)
  • fundal height
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35
Q

What are the general interventions postpartum?

A
  • vital signs
  • intake and urinary output
  • encourage fluids/fiber/walking
  • pain relief
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36
Q

What are the specific assessments and interventions for the renal system postpartum?

A
  1. assess urine output
  2. may have retention if anesthesia was used
    • encourage urination or straight cath

Client will have frequent urination to get rid of extra fluids.

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37
Q

What are the specific assessments and interventions for the gastrointestinal system postpartum?

A
  1. assess for constipation
    • ​encourage fluids/fiber/walking
    • stool softeners
  2. give extra 500 calories per day due to breastfeeding
  3. multivitamin for deficiencies
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38
Q

What are the specific assessments and interventions for mental health postpartum?

A
  1. assess for postpartum depression
    • therapeutic communication, possible group therapy, and medications
  2. assess for mom/baby bonding
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39
Q

What are the specific assessments and interventions for the cardiac system postpartum?

A

Assess for DVT (thrombophlebitis) and pulmonary embolism

Provide life-saving interventions and notify HCP

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40
Q

What are the specific assessments and interventions for pain postpartum?

A

Assess for pain

  • ice packs to perineum
  • sitz baths
  • analgesics
  • suppositories if client had episiotomy
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41
Q

BUBBLEHE

A

B- Breasts

U - Uterus

B - Bladder

B - Bowel

L - Lochia

E - Episiotomy/Perineum

H - Hemorrhoids

E - Emotional Status

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42
Q

What are normal assessment findings postpartum?

A
  • Takes time for uterus to go back to normal
  • Abdominal cramps = normal - uterus shrinking back to pre-pregnancy size - esp when baby is breastfeeding
  • Normal to pass large amounts of urine during the first few days because the body is getting rid of extra fluid from pregnancy - blood focused to uterus now has to recalibrate
  • The first BM may not occur for 2-3 days due to hormones, medications, dehydration, fear and decreased physical activity → Norco – causes constipation (education opportunity)
  • Hair loss is not unusual. Normal growth cycle will return but could take 6-15 months
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43
Q

What are some abnormal postpartum assessment findings?

A
  • Soaking more than 1 pad/hour
  • Foul smelling discharge
  • Fever of 100.4 F or higher
  • Severe HA, excessive swelling, visual disturbances
  • Incisional separation or pain that will not go away
  • No BM within 4 days
  • Urination problems (frequency, burning, discomfort, hematuria)
  • Pain, warmth, tenderness in legs (calf area)
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44
Q

What are some high-risk postpartum complications that can occur?

A
  1. hemorrhage
    1. early
    2. late
  2. infection
    1. endometritis (high risk w/C-sections)
    2. UTI
    3. mastitis
  3. thromboembolitic disease
    1. PE
    2. DVT
  4. psychiatric problems
    1. postpartum blues
    2. Postpartum Depression
    3. Postpartum psychosis
45
Q

What are the “4 T’s” of postpartum hemorrhage?

A

The Four T’s mnemonic can be used to identify and address the four most common causes of postpartum hemorrhage:

  1. Tone (uterine atony)
  2. Trauma (laceration, hematoma, inversion, rupture)
  3. Tissue (retained tissue or invasive placenta)
  4. Thrombin (coagulopathy)
46
Q

How is post-partum hemorrhage (PPH) defined?

A

Worldwide, postpartum hemorrhage is the leading cause of pregnancy related deaths (approximately 140,000 women die each year due to PPH)

It is:

  • >500 mL blood loss following a vaginal delivery
  • > 1000 ml blood loss following a cesarean delivery
  • OR 10% drop in Hematocrit (HCT) from pre-delivery baseline
  • OR PP hemodynamic instability (abnormal/unstable BP, HR, arrhythmia etc. )
  • OR PP blood transfusion needed
47
Q

What are some risk factors for post-partum hemorrhage?

A
  • Uterine atony is a very common cause for Early PPH
  • Over distension of the uterus (macrosomic baby, multiple gestation, polyhydramnios)
  • Exhaustion of uterus muscle (long labors, medicines that cause uterus to relax ie. mag)
  • Use of medications which cause the uterus to relax
  • Placenta problems (placenta acreta, abruptio)
  • Lacerations and hematomas
  • Previous history of PPH doubles or triples the risk of a repeat occurrence
48
Q

What are the clinical signs of post-partum hemorrhage?

A
  • Boggy uterus (hard to find)
  • Saturating a peri pad within one hour
  • multiple clots expressed during fundal massage
  • Decreased Blood pressure
  • Increased heart rate
  • Decreased urinary output/oliguria (shunt from kidneys first –> oligo)
  • Extreme thirst
  • restlessness
  • constant oozing, trickling of bright red blood from vagina
  • skin pale, cool, clammy,
  • dizzy/lightheaded
49
Q

What are the lab tests for PPH?

A
  • Hgb and hct
  • Coagulation profile (PT)
  • Blood type and crossmatch
50
Q

What are the nursing interventions for post-partum hemorrhage? Why?

A
  • VS
  • Assess source of bleeding
    • Fundal height, position, firmness-massage
    • Assess lochia-color quantity and clots (size)
    • Signs of bleeding-lacerations, episiotomy, or hematoma
  • Assess bladder for distension
    • Insert an indwelling catheter
  • Maintain/initiate IV fluids with isotonic solution (LR, NS)
  • Administer o2
  • Elevate Legs
  • Blood transfusion
51
Q

What are the most common risk factors for Early Post-partum hemorrhage?

A

uterine atony, lacerations of perineum

52
Q

What are some first-line treatments for post-partum hemorrhage?

A
  1. Controlled traction on umbilical cord w/prolonged 3rd stage >30 min
  2. uterine massage after birth
  3. administration of Oxytocin after delivery of placenta (IM or IV)

These 3 interventions can prevent 50% of PPH.

53
Q

What are second line meds for PPH?

A
  • Methylergonovine (methergine)
  • Carboprost (hemabate)
  • Misoprostol (cytotec)
54
Q

What are some other treatments for PPH?

A
  • Manual removal of retained placental fragments by Health care provider
    • Uterine Tamponade
    • Bakri Balloon
  • Uterine Artery Embolization
  • Surgical Management - Last resort is a hysterectomy
55
Q

Define early PPH vs. late PPH

A

early: after birth up to 24 hours
late: 24 hours - 6 weeks postpartum

56
Q

What are the main causes for early PPH and late PPH?

A

Early: uterine atony, lacerations

Late: retained placenta

57
Q

What are lacerations a potential cause of and when do you suspect it?

A

Another factor in Early PPH: lacerations of the cervix, vagina or perineum
Suspect lacerations if the uterus is firm and bright red bleeding persists

58
Q

What are hematomas and when would you suspect them?

A
  • Injury to a blood vessel from birth trauma or inadequate hemostasis at the site of repair of an incision or laceration
  • Patients will often have severe pain
59
Q

What is the treatment for a hematoma?

A
  • Ice packs and analgesia
  • Small ones resolve on their own (< 3cm and not expanding)
  • Large ones and ones that are expanding require surgical intervention
60
Q

Describe late PPH.

A
  • Most frequently due to subinvolution or retained placental fragments
  • Lochia fails to progress from rubra to serosa to alba normally
  • Lochia serosa that persists for longer than 2 weeks may be suggestive of subinvolution
  • Placental fragments must be removed!
61
Q

What are the nursing interventions for PPH?

A
  • Uterine massage
  • Empty the patient’s bladder
  • Oxytocin as ordered
  • Monitor VS, I&O, O2 sat, LOC
  • If not resolved quickly, contact Health care provider
  • Pad count (weigh or keep)
  • Keep iv patent, give iv bolus as ordered but anticipate possible transfusion
  • Draw labs as ordered (CBC, type and Crossmatch, coagulation studies…)
62
Q

Define postpartum endometritis.

A
  • Infection of the uterine lining
  • Associated with childbirth
63
Q

What are the risk factors PP endometritis?

A
  • Cesarean birth (had uterus opened up)
  • Chorioamnionitis
  • Pprom
  • Compromised health status (ie. immunosupression, anemia)
  • Manual removal of placenta (doctor can introduce bacteria)
  • Diabetes mellitus
  • Anemia
64
Q

What would you find on assessment for pp endometritis?

A
  • uterine tenderness on palpation
  • foul smelling lochia
  • tachycardia
  • chills
  • fever
65
Q

What is the treatment for pp endometritis?

A
  • IV abx
  • if fever persists after 48 hours, keep testing
66
Q

How is pp cystitis defined and what are the risk factors?

A
  • Lower urinary tract infection, Typically caused by E. coli
  • Trauma to Urinary tract
  • Urinary retention
  • Contamination during catheterization
67
Q

How do we prevent and treat pp cystitis?

A
  • Keep bladder empty during labor and postpartum period - good for them to get up and walk
  • Avoid catheterization if possible but Use careful aseptic technique when you must do it
  • Clean catch specimen for Culture & sensitivity (C&S) if infection suspected
  • Antibiotics to treat
68
Q

Define pp mastitis.

A
  • Infection of the interlobular connective tissue of lactating women
  • Onset typically between 2-8 weeks after delivery
69
Q

What are the s/s of pp mastitis?

A
  • Warm, reddened, painful area on the breast
  • Fever, chills, headache, flu-like aches and malaise (tiredness, discomfort)
  • can have bright yellow milk
  • can lose supply if severe
70
Q

How can you prevent pp mastitis?

A
  • Handwashing before breastfeeding
  • Supportive but non-constricting bra
  • Frequent and complete emptying of breast milk - feed q2hrs
  • Avoid trauma to nipples
    • Learn correct latch technique
    • Keep nipples dry between feedings
71
Q

How do you treat pp mastitis?

A
  • Keep breastfeeding
  • Antibiotics (ie. doxycycline, cephalexin - Keflex)
  • Rest
  • Increased fluid intake
  • Warm or ice packs - open draining wound, probably cold, whatever makes them feel comfortable
  • Pain medications such as ibuprofen (b/c antiinflammatory)
72
Q

Define thromboembolic disease and common types seen pp.

A

Blood clots (often DVT or PE)

73
Q

What are the main causes of thromboembolic disease?

A
  • Venous stasis
  • hypercoagulability
  • injury to epithelium of blood vessel
74
Q

What are the risk factors of thromboembolic disease?

A
  • Cesarean birth (12 hours in bed post c-section)
  • Prolonged immobility
  • Obesity
  • Smoking
  • Varicose veins
  • diabetes
75
Q

What are the s/s of a DVT?

A
  • Leg pain/tenderness (but not always)
  • Unilateral swelling, warmth, redness
  • Calf tenderness
76
Q

What are the s/s of a PE?

A
  • Apprehension/anxiety
  • Pleuritic chest pain (severe, not heart)
  • Dyspnea
  • Tachypnea
  • Hemoptysis
  • Peripheral edema
  • Distended neck veins
  • elevated temp
  • Hypotension
  • Hypoxia
  • Diaphoresis
77
Q

What is the tx of a DVT?

A
  • Immediate administration of anticoagulants
    • Heparin or Low molecular weight heparin
  • Maintenance with warfarin is started at 1-5 days
  • Strict bed rest and elevation of affected limb are required
  • Once symptoms have subsided, ENCOURAGE walking (Have patient wear support Hose but NOT when there are symptoms)
  • Do not massage affected extremity
  • Measure the leg circumferences
  • Administer analgesics (NSAIDs)
78
Q

What is the tx of a PE?

A
  • Bedrest
  • Place client in semi fowler’s position
  • Administer o2 by mask
  • Anticoagulant therapy
  • Other medications that may be used
    • Thrombolytic therapy -Alteplase (activase), steptokinase (Steptase)
79
Q

What meds are used to break up a PE (thrombolytic therapy)?

A
  • Alteplase (activase)
  • steptokinase (Steptase)
80
Q

What are the 3 pp psychiatric disorders and what is their incidence/timeline?

A
  1. Postpartum Blues
    • The mildest of the three
    • Also known as “Adjustment Reaction with depressed mood”
    • Or “baby blues”
    • Occurs in as many as 85% of mothers
    • Typically begins 2-4 days after delivery and resolves within 10-14 days
  2. Postpartum depression
    • Also known as “Peripartum major mood episodes”
    • Occurs in 10-20% of all PP women
    • Typically begins about 4th week after delivery but can occur anytime in the first year
  3. Postpartum psychosis
  • Most serious of the three
  • Also known as “Postpartum mood episodes with psychotic features”
  • Occurs in 1-2 per 1000 women
  • Symptoms usually show up within a few days of delivery
  • considered an emergency
81
Q

What are the 3 phases of psychologic adjustments for new moms?

A
  1. Taking in (2-3 days)
    • Preoccupied with own needs, passive, dependent
    • Touches and explores infant
    • Needs to discuss her L&D experience
  2. Taking hold (3-10 days)
    • Obsessed with body functions, initiates self care
    • Rapid mood swings
    • Responds to instruction about infant care and self care
  3. letting go (10 days - 6 weeks)
    • Mothering functions have been established
    • Sees infant as a unique person
82
Q

What are the s/s of postpartum blues?

A
  • Mood swings
  • difficulty sleeping
  • anorexia
  • a feeling of letdown
83
Q

What are the risk factors of pp blues?

A
  • changing hormone levels
  • pain
  • fatigue
  • an unsupportive environment or insecurity
84
Q

What should you do to encourage mothers experiencing pp blues?

A

Positive reinforcement of good behaviours

85
Q

What are the s/s of pp depression?

A
  • Similar to symptoms of postpartum blues but PERSISTS
  • Feelings of worthlessness
  • Lack of interest in usual activities
  • Lack of concern over personal appearance
  • Irritability or hostility toward baby
  • Thoughts of suicide
86
Q

What are the risk factors of pp blues?

A
  • History of depression prior to pregnancy
  • History of bipolar disorder
  • Stressful life events
  • Lack of social support or a stable life partner
  • Loss of newborn
  • First pregnancy or young mother
87
Q

What is the tx of pp depression?

A
  1. Individual or group therapy, plus…
  2. Antidepressants (some are bf safe)
    1. Selective serotonin reuptake inhibitors (SSRIs)
    2. Tricyclic antidepressants
88
Q

What are the s/s of postpartum psychosis?

A
  • Sleep disturbances
  • Depersonalization*
  • Confused, irrational
  • Hallucinations, delusions
  • Psychomotor disturbances:
  • Stupor
  • Agitation
  • rapid and incoherent speech
89
Q

What are the risk factors of pp psychosis?

A
  • History of previous postpartum psychosis
  • History of bipolar disorder
  • Family history of either condition above
90
Q

What is the Tx of pp psychosis?

A
  • Keep mom and baby safe!
  • inpatient psychiatric care
  • Antipsychotic medications
  • Psychotherapy
  • Social support
91
Q

What are the nursing interventions for psychological issues?

A
  • Observe patient with the baby, by herself, with her family and friends
  • Review history
  • Note adequacy of coping skills
  • Note degree of self-esteem
  • Recognize early signs of problems
  • Support positive parenting behaviors
  • Discuss patients plans for baby and self
  • Refer to social services if necessary
92
Q

What are the 3 types of lochia and when are they seen?

A
  1. Lochia rubra, <3 day pp and should not recur
  2. Lochia serosa, 3-10 days pp
  3. Lochia alba, 1-2 weeks pp
93
Q

What are abnormal findings pertaining to lochia?

A
  • lochia “going backwards”
  • bright red for a long time after delivery
  • clots bigger than egg/golf ball
  • *note that C-sections will have less bleeding dt uterus being “cleaned”
94
Q

How do you assess the breasts pp?

A
  • Determine if breast or bottle feeding
  • inspect for redness or engorgement
  • inspect for fissures, cracks, inversion
  • Palpate lightly for softness
    • slight firmness dt filling
    • tightness can be engorgement (usually 3-4 days pp)
    • warmth or tenderness?
95
Q

What is pt teaching for breastfeeding moms?

A
  • Use supportive bra
  • Keep nipples dry and watch for fissures or cracks*
  • Watch for reddened or tender spots on breast - mastitis, or plugged duct (has to be massaged and emptied to avoid mastitis)
  • Additional teaching during breastfeeding attempts as needed
96
Q

What is pt teaching for non-breastfeeding moms?

A
  • Use supportive bra
  • Avoid breast stimulation
  • Apply cold packs
  • Apply cold, raw cabbage leaves inside bra
97
Q

What are normal vs. abnormal findings of the uterus pp?

A
  • Palpate the position of the fundus in relation to the umbilicus
  • Is fundus firm or boggy?
  • Is fundus in midline? - ask if they’ve voided. If it’s not midline, may indicate full bladder. Have them void first (documentation ex: U-2)
  • Inspect abdominal incision for patients with a cesarean delivery using REEDA mnemonic
  • Excessive pain may indicate infection
98
Q

What does the REEDA mneomic stand for when assessing an incision/laceration?

A

R-Redness

E-Edema

E-ecchymosis

D - discharge/drainage

A - approximation

99
Q

What is patient teaching for uterus pp?

A
  • fundal position
  • firmness
  • how to massage fundus
  • C-section fundus -sore
100
Q

What are assessment findings/interventions for bladder pp?

A
  • Assess bladder for distension frequently due to postpartum diuresis - 2-3 hours = need to void
  • Assess frequency, burning or urgency
  • A boggy uterus, displaced uterus or palpable bladder is a sign of bladder distension
  • Catheterization may be needed if distension is noted and patient can not void
101
Q

What will you teach the pt about bladder to encourage voiding?

A
  • Out of bed - even if c section
    • Ambulation helps them feel better
    • Helps pass gas
    • helps them heal fast if c-section
  • Pouring warm water on perineum
  • Running water in the sink (to mimic sound of urine flow)
  • Encourage relaxation and breathing
  • Encourage frequent voiding
  • Increase the amount of water she drinks - they forget to drink
102
Q

What would you look for when assessing bowels?

A
  • Bowel movements normally return within 2-3 days after childbirth
  • Constipation can increase pressure on sutures and increase discomfort, but won’t pop out sutures if pt has a laceration
  • bowel sounds - can be hypoactive
  • Is pt passing gas?
  • med - Colace/ docusate sodium
103
Q

What do you need ot teach the pt about bowels/BM?

A
  • Help re-establish normal bowel pattern
    • Encourage ambulation
    • Encourage fluids
    • Encourage fresh fruits/vegetables/fiber in diet
  • Stool Softeners
  • Don’t be afraid!
104
Q

How should you assess lochia?

A
  • Have pt lay on side and bend knee and look from back (hemorrhoids can be checked this way too)
  • Assess for character, amount, odor and clots
    • If it smells, indicative of infection
  • Assess for Rubra, Serosa, and Alba
  • Clots and heavy bleeding may be caused by uterine relaxation, retained placenta fragments or an unknown cervical laceration
  • Sample charting:
    • “Scant lochia rubra on pad, no unusual odor noted, no clots expelled during fundal massage.”
105
Q

What would you teach the pt about lochia?

A
  • Inform patient of the normal changes with color and characteristics
  • Effect of position changes
    • Dizziness, gush of fluid when getting up
  • Hygienic measures
    • Wipe front to back, peri bottle, pat dry
    • Peri bottle should have clean water
  • Patients who have a Cesarean birth may experience less bleeding
106
Q

How do you assess the perineum?

A
  • Inspect Perineum area for REEDA
    • R- Redness
    • E- Edema
    • E- Ecchymosis (Bruising)
    • D- Discharge (Drainage)
    • A- Approximation (of wound edges)
  • Sample charting: “Perineum intact.”
107
Q

What do you teach the pt about the episiotomy/peri area?

A
  • Discuss the type of episiotomy or laceration patient has (4 degrees)
  • Sutures will dissolve on own
  • Ice packs
  • Sitz Baths - seat and can sit perineum in water
  • Peri bottle after voiding and BM
  • Kegel exercises
  • Topical sprays or foam for pain control - numbing foam
108
Q

How do you assess hemorrhoids?

A
  • Patient in sims -same time as lochia/peri
  • Tucks pads, warm water
  • Note the size, number and pain or tenderness
  • Sample charting:
    “One pea-sized hemorrhoid noted, non-tender.”
109
Q

What would you teach the pt about hemorrhoids?

A
  • Care - tucks pads, warm water, witch hazel, preparation H
  • Pain management
  • Discussion regarding what they are and what future implications may be involved
    • Sometimes they come back or don’t go away

Maternity/OB Nursing (6 decks)

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