Postpartum Flashcards
What does BUBBLE stand for?
BUBBLE
• B- breasts
◦ pain, redness, cracking, soreness
• U- uterus
◦ fundal height, placement, consistency
• B- bowel
◦ might be difficult to have first bowel movement, prophylactic stool softener
• B- bladder
◦ 12 hours post birth –> diuresis expected
• L- lochia
◦ vagincal bleeding (color, odor, consistency, amount [COCA])
• E- episiotomy
◦ approximation of edges, edema, ecchymosis
• H- hamens sign,
◦ check for DVT -move toes to nose, if pain in calf check for DVT –> false positives common!
• E- emotional status
Return of uterus to pre-pregnancy state =
involution
3 fundal assessment pieces
consistency (not boggy), location (midline), height
how does height of uterus change after birth?
◦ height drops immediately after birth and then it goes back up, drops one finger down each day
when palpating the uterus always suppport….
lower uterine segment
if you don’t support the uterus when palpating what can happen?
inversion, hemorrhage
scant lochia = < ___ cm
2.5
light lochai = ____ - ____ cm
2.5-10
moderate lochia = > _____ cm
10
heavy lochia =
1 pad saturated in 2 hours
excessive lochia =
pad saturated in <15 min or pooling under buttocks
re: type of lochia:
1-3 days after delivery, dark red color, blood consistency, can contain small lcots
◦ amount similar to heavy period about 2 hour after delivery
rubra
re lochia type:
4-10 days after delivery, can increase with physical acticivty
lochia serosa
re lochia type:
10 days-8 weeks, yellowish white creamy color, fleshy odor, mucus and leukocytes
lochia alba
circling back - 3 types of lochia ?
rubra - 1-3 days
Serosa- 4-10 days
alba- 10 day- 8 weeks
chill or not chill:
if you have lochia serosa and then have lochia rubra
not chill!
**Shouldn’t go back! Always want to be moving forward through stages
Assessment of perineum/ episiotom
- Redness
- Edema
- Ecchymosis
- Discharge
- Approximation of edges of episiotomy or laceration
REEDA
perineal hematoma feels like
acute sharp stabbing pain
when do we see colostrum vs breast milk
- Colostrum = Secretion during pregnancy and 2 to 3 days after birth
- Milk = comes in 3 to 5 days after delivery
to know that bebe is getting enough titty milk what do we assess?
counting the number of wet diapers (6-8 in 24 hours period but not the first few days)
how often to titty feed the bebe?
every 2 to 3 hours and on demand - 15 -20 minutes on each breast
engorgement onset can be as early as. _____
day 2-5
why dem nipz getting cracked?
not latching properly
uh oh- mastitis! what are the s/s?
◦ infection! not just engorged, systemic, fever, reddened area, chills, headache, antibiotic
– pump and dump if abx not safe for baby
general guidelines for positioning baby for breastfeeding?
◦ alignment- hip and shoulders in a line
◦ nipple and part of areola in mouth
◦ C hold above and below breast
◦ chin presses toward breast and nose goes away
◦ no pinching or pain + tugging sensation
- alternate offering different breast first
- no pacifier/bottle during first 3-4 weeks until breast feeding is established
normal or not normal to have uterine contractions with breast feeding? why?
normal-
• breastfeeding releases oxytocin causing uterine contractions to increase uterine tone
how quickly do we want preggo to start breastfeeding after birth?
within 1 hour if no complications
re: maternal role attainment phases::
taking in, taking hold, or letting go:
first 24-48 hours • Focus on personal needs • Rely on others for assistance • Excitement and talkative • Recounts birth experience with others
taking in
re: maternal role attainment phases::
taking in, taking hold, or letting go:
- Starts day 2 or 3 and last 10 days to several weeks
- Focus on baby care and newborn skills and improving competency as caregiver
- Need acceptance
- Want to learn and practice
- Experiencing physical and emotional discomforts
taking hold
re: maternal role attainment phases::
taking in, taking hold, or letting go:
- Focus on the family as a unit
- Resumption of role
letting go
blues, depression of psychosis:
- Tearfulness, insomnia, lack of appetite, feelings of letdown or inadequacies
- Usually resolves in 10 days without intervention
postpartum blues
blues, depression of psychosis:
- Persistent feelings of sadness and intense mood swings
- Occurs within 6 months of delivery
- Interventions usually necessary
post partum depression
blues, depression of psychosis:
- Confusion, disorientation, hallucinations, delusions, obsessive behaviors, paranoia
- Develops within the first 2 to 3 weeks postpartum
- The client may attempt to harm herself or her infant
- Psychiatric care
postpartum psychosis
causes of mastitis?
‣ milk stasis causes by blocked duct, engorgement, underwire bra
‣ cracked/fissured/trauma nipple
‣ poor breastfeeding technique
‣ decrease frequency of lactation
‣ contamination of breast due to poor hygiene
findings for mastitis?
‣ painful, tender, localized hard mass, reddened area
‣ usually on 1 breast
‣ flu like sxs - chills, fever, fatigue
‣ axillary adenopathy on affected side
interventions for mastitis?
‣ abx
‣ hygiene
‣ empty breast completely, air dry nipples, frequency 2-4 hours
‣ proper positioning/latching
this is an infection of uterine lining
• Endometritis
onset of Endometritis
3-5 days postpartum @ site of placental attachment
endometritis findings?
‣ *pelvis pain/tenderness, chills, fatigue, loss of appetite
‣ dark profuse lochia, odorous lochia, tachycardia
Postpartum hemorrhage =
◦ EBL > _____ with vaginal delivery
◦ EBL > _____ with c-section
◦ EBL > 500 with vaginal delivery
◦ EBL > 1000 with c-section
findings for post partum hemorrhage?
cool, pallor, hypotension, tachycardia , bright red blood, uterine atony
what is uterine atony?
• inability of uterus to contract –> fundus massage!
what is placenta accrete?
placenta grows too deeply into the uterine wall
–> hemorrhage
what is placenta increta?
placental villi extend into the myometrium
–> hemorrhage
what is placenta precreta?
placenta attaches itself to myometrium and grows through the uterus and potentially to the nearby organs
–>hemorrhage
what is subinvolution of uterus?
remains enlarged and not going back down
if fundus is firm but there is bright read bleeding our concerns are
laceration or hematoma
meds for postpartum hemorrhage:
Oxytocin – Pitocin Methylergonovine maleate – Methergine Carboprost tromethamine – Hemabate Misoprostol – Cytotec Dinoprostone – Prostin E2
dosing/admin for oxytocin for postpartum hemorrhage?
- Stimulates uterine smooth muscle / Contractions
- 10 units IM
- 10-40 units in 1000 ml crystalloid IV fluid
Methylergonovine maleate – Methergine is contraindicated in….
high blood pressure!
admin of Methylergonovine maleate – Methergine for postpartum hemorrhage
- 0.1 – 0.2 mg IM every 2-4 hours
* Followed by 0.2 mg PO every 4-6 hours X 24 hours (for 6 doses)
Carboprost tromethamine – Hemabate is contraindicated in….
asthma!
admin of Carboprost tromethamine – Hemabate for postpartum hemorrhage?
- Stimulates contractions of the myometrium (prostaglandin analogue)
- 0.25mg (250 mcg) IM
admin of misprostol for postpartum hemorrhage?
- Stimulates powerful contractions of the myometrium (prostaglandin analogue
- 800-1000 mcg rectally
