Postpartum Flashcards
What stage is postpartum?
Stage 4
How long is the postpartum period?
6 weeks up to 1 year
which systems go through changes in the mother’s postpartum period?
Every system
Frequency of a postpartum Assessment
Every 15 minutes for first hour, then every 30 minutes for 1 hour, the every hour for two hours
How to do fundal massage
One hand on top of fundus, one above pubic symphysis
What should be assessed in a postpartum assessment?
Vital signs, fundus, bleeding, IV with added pitocin/oxytocin
When can a CBC be done on a postpartum patient?
1st postpartum day
What is a common WBC postpartum?
15,000-25,000/mL
What is the Hgb decrease postpartum?
1.0-1.5 g/dL per 500ml of blood loss
What will happen to fibrinogen, clotting factors, and platelets in a postpartum patient? What needs to be monitored because of this?
They increase. Respiratory function should be monitored to know if there is a pulmonary embolism
How should a patient be positioned for a uterine assessment?
Laying flat
What does bubblehehe stand for?
B- breasts
U- uterus
B- bladder
B- bowels
L- lochia
E- episiotomy/laceration
H- hemorrhoids
E- extremities
H- hemorrhage
E- emotional assessment/education
What should you assess on breasts?
Soft, filling, engorgement, colostrum
What are nipple shells used for? The smaller hole? The larger hole?
Everting the nipples
Sore nipples
Symptoms of mastitis
Fever, malaise, unilateral breast pain, and tenderness in the infected area
Treatment for mastitis
Antibiotic therapy, analgesia, rest and hydration
If a uterus is firm, how much bleeding would be expected?
Scant
What should be done if the uterus is boggy?
Express clots and note bleeding amounts, give pitocin or other uterotonic, empty bladder or insert a foley, do vital signs as needed
How long should a fundus be massaged?
Until firm
What is the first vital sign that changes during a postpartum hemorrhage?
Heart rate becomes tachycardic
How many days after childbirth should the uterus no longer be palpable?
14 days
How much smaller does a uterus become each day following childbirth?
1cm per day
What should be assessed when assessing the bladder?
Assess for pain or difficulty voiding: burning, difficulty starting stream or odor, frequency
Is the bladder palpable?
What is cystitis?
Bladder inflammation/infection
When should bowel sounds be checked?
Before fundal check
When should a woman have a bowel movement after childbirth?
2nd or 3rd day postpartum
What should be assessed with lochia?
Color, odor, amount and presence of clots or tissue
When should lochia be assessed?
With each fundal assessment
What kind of lochia is present on days 1-3? 4-10? 11-21?
Lochia rubra, lochia serosa, lochia alba
How much lochia is seen at scant, light, and moderate levels? What is it called if the pad is completely soaked?
<1 inch, 1-4 inches, 4-6 inches, saturated
What is the most common cause of postpartum hemorrhage?
Uterine atony
What should be done for a postpartum hemorrhage?
Start 2 large bore IVs, anticipate uterotonicmedications, anticipate hangingblood, monitor vital signs and breath sounds, foley to monitor output, prep for surgery if uterine atony is not resolved
What are the 4 Ts of postpartum hemorrhage etiology?
Tone, tissue, trauma, thrombin
What does REEDA stand for?
R=redness, E= edema/swellings, E=ecchymosis or bruising, D=drainage/discharge
A= approximation
When is the REEDA scale used?
To assess episiotomies and lacerations
What should be assessed when assessing extremities?
Edema, pedal pulses, capillary refill, signs and symptoms of DVT
What % of women experience perinatal mood disorders?
20%
What needs to be done if Duramorph is administered?
Respiratory assessment q1 hr
