Postpartum Flashcards by Yuko Porter

What are the 4 most complications of early PP?

Hemorrhage (bleeding)
Infection
DVT
Pain

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What is the postpartum assessment mimic?

B breast
U uterus
B bowel
B bladder
L lochia
E edema

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Breast assessment
a) What are normal sings?

b) What are abnormal sings?

a) Feel tight
tender
warm
full

b) redness
cracked nipples
Mastitis (Unilaterally)

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What is mastitis?

Breast infection
-warmth
-fever
-pain
-redness

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a) What is engorgement?

b) intervention

the fullness of breast tissue d/t lymphatic circulation
-tight
-tender
-pain

b) breastfeed frequently
hand pump empty out
warm pad before feeding

Those who not breastfeeding, do not touch even it pain

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Education
Mom who planning to give formula

Wear tight bra
use cold cabbage leaves
avoid heat(shower)
do not touch and stimuli

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Education
Mom who discomforts of breastfeeding

Assess baby’s latch
Change NB’s position
a poor latch can lead to nipple soreness
Apply breastmilk on the nipple and air dry after feeding

then
pain medication

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Stage of human milk
Colostrum

The initial milk
Full of antibodies, white blood cells, and other immune properties

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Stage of human milk
Transitions

Referred to as the milk coming in
Mature milk day 3-5

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Education
Mom who breastfeed

Promote early breastfeeding within the first 1 after birth
have them try various positions
Explain how varying positions can prevent nipple soreness
Proper latch techniques

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What are the benefits of breastfeeding?

Dec uterine hemorrhage by helping the fundus stay firm
Enhanced maternal attachment
Decrease in Type 2 diabetes later in life

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Normal Lab values during the early postpartum
WBCs

first 4 to 7 days WBC values between 20,000 and 25,000mm are common
“postpartum leukocytosis”
-the body prevents infection and
aids in healing

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Normal Lab values during the early postpartum
HGB/HCT

HGB/HCT will increase due to a decrease in plasma volume

HGB Normal range
HCT Normal range 36 to 48 percent

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Normal Lab values during the early postpartum

Coagulation factors

Remain inc elevated
Risk of thrombus formation and thromboembolism. 150k-400k

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Normal assessment findings

Colostrum

transitions to mature milk by about 72 to 96 hr after birth(3-5 days)
this transition is referred to as the milk coming in

It’s OK the color is yellow

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Normal assessment findings

Engorgement

The fullness of the breast tissue is a result of lymphatic circulation
The breast will appear tight, tender,
warm, and full

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How much blood client cannot lose?

a) vaginal birth
b) cesarean birth

a) not more than 500 mL
b) not more than 1,000 mL

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Fundus is boggy at U+2
Positioned slightly off to the right

a) What does this indicate?
b) What can this lead to?
c) What is the appropriate intervention?

a) Full bladder
b) Increased bleeding
c) Empty bladder

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About five hours later the delivery, mom still hasn’t void.

a) What needs to happen now?
b) What safety precautions should you take?

a) needs to attempt to empty her bladder
b) Assist her in standing and walking to the bathroom

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When we get up the mom for the first time after deliver, what is the most concern?

Orthostatic hypotension
in the first 48 hours after birth

Assist patient to sit up and stand slowly

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Fundal heights
a) Immediately after birth
b) 12 hr pp
c) 24 hrs pp

a) 2cm below the umbilicus
b) 1cm above the umbilicus
c) slightly below the umbilicus

every 24 hr, the fundus should descend 1-2 cm

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The mom’s peripad is saturated. What should you ask?

When did you change the pad?

If the mom didn’t change for a long time, change to the new one and asses in an hour

Also, asses the fundus when changing to the new pad

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What is lochia? and what are the abnormal sings?

Maternal discharge contains blood, mucus, and tissue

odor=infection
excessive clots =bleeding

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Lochia rubra is?

Dark red
A few small clots are common

NO more than 3days
NO large amount of dark red clots

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Lochia serosa is?

Pinkish color 3-10 days

Lochia alba is?

Yellow whites creamy

Assessment Bowel a) how long restart BM? b) What are some complications? c) Intervention?

a) 2-3 days b) Constipation c) Increased fluid, fiber encourage to ambulation

How do we assess the laceration? What are we looking for?

REEDA Redness Edema Ecchymosis Discharge Approximation Infection usually take at least 24-48 hours to show signs

What are some comfort measures with perineal pain?

**Cold then warm** **heat can dilate blood vessels inc bleeding** Ice pack (1st 24 hours) Sitz bath (2nd 24 hours) Topical spray or Witch Hazel pads

Laceration stage 1st 2nd 3rd 4th

Assessment Leg What are you looking for?

Tenderness Warmth Edema Change in color Change in pedal pulses

What are the abnormal sings? Leg

Unilateral swellings with redness, warmth, pain Absent abnormal peripheral pulses

intervention if DVT is present

Elevate their limb Confine pt to their bed

intervention if not DVT is present

Encourage ambulation Place compression stocking Elevate legs laying bed or sitting for a long time

What is the "Taking in phase"? How to become mom, process How to adapt with a baby

24-48 he(1-2 days) Focus on meeting personal needs Rely on others for assistance Excited, talkative Need to review birth experiences with others

What is the "Taking hold" phase?

day 2-3 Focus on baby care and improving Want to learn and practice can experience baby blues At the same day most moms are discharge

What is the "Letting go" phase?

Accepting new life as a mom Focus on family as a unit

Is baby blue normal?

Yes due to hormonal changes Anxiety, mood swings and fatigue are common Up to 2weeks

What signs should you look for that could indicate a problem? D/T depression

Shows little to no interest in the baby Anger or disappointment directed at the baby Ignores the baby Handles the baby roughly No swing emotion, stay depressed

Baby blue Intervention

Talk about the birth experience Positive self-image Keep mom+baby together encourage skin to skin encourage breastfeeding

If the mom is rubella non-immune and has not yet received the rubella vaccine that was ordered. What do you know about the rubella vaccine?

Subcutaneous injection Live Virus Avoid pregnancy for 1 month Should obtain a titer in 3 months

Breast-feeding women a) calories? b) Which nutrition? c) How much fluid?

a) ad 500 calories to pre-pregnancy requirements b) Protein, iron c) 2-3 L

Breast-feeding women need to take high Ca food but if they don't like milk?

Leafy greens broccoli yogurt Cheese

When can they start sexual intercourse?

laceration has healed, and lochia has stopped Can take up to 3-4 weeks

Which contraception are available to her while she is breastfeeding?

Barrier methods UID Mini Pill Depo Provera Implantable Progesterone

PP pain teaching NSAIDs/Ibuprofen

Causes GI upset take w food increase the risk of bleeding DO NOT wait until the pain is 8/10 it won't work as well

Received both the Rubella vaccine and Rhogam, what teaching is need?

the client should return to have a titer (after 3 months) determine whether immunity to rubella has been developed b/c sometimes Rhogam can suppress the immune response

All of the following are findings for pp hemorrhage EXPECT? a) Boggy fundus b) Bradycardia c) hypotension e) Oliguria

b Should be tachycardia Oliguria= no pee

PP hemorrhage a) Complications b)Intervention

a) Hypovolemic shock Anemia b) Assess fundus for firmness Massage the fundus Assess lochia Maintain or initiate IV fluids Provide oxygen Elevate the client's legs to a 20° to 30° angle

PP hemorrhage medication

Oxytocin - Uterine stimulant Methylergonovine - Uterine Stimulant

DVT a) Complications b) Interventions

a) Pulmonary Embolus Stroke MI b) early and frequent ambulation postpartum Bed rest longer than 8 hr, use active and passive ROM

DVT prevention teaching

Avoid prolonged periods of standing, sitting, or immobility Avoid crossing the legs, Maintain fluid intake of 2 to 3 L each day Discontinue smoking

DVT Medication

Heparin - Anticoagulant (IV) Warfarin - Anticoagulant (PO)

Infection a) Complications b) Intervention

a) Sepsis Death b) Lab work Obtain frequent vital signs Assess pain

Pain Intervention

OPQRST assess pains related to episiotomy, lacerations, incisions, afterpains, and sore nipples. Teach non-pharm methods (distractions, imagery, heat pads, position changes, cold packs)

During ambulation to the bathroom, PP pt experiences a gash of dark red blood that soon stops. What is this? a) Evidence of possible vaginal hematoma b) An indication of a cervical laceration c) A normal postural discharge of lochia d) Abnormally excessive lochia Rubra flow

c Massage or ambulation can result in a gash of lochia

PP vital sing Temp

Every 4 hr for 8hr then every 8hr 100.4 (38c) is acceptable in the first 24 hr More than 100.4 could be a sing infection and dehydration

PP vital sing Pulse

Every 15 min for the first 2 hr Bradycardia--- normal Tachycardia---- abnormal

PP vital sing BP

Every 15 min for the first 2 hr If dec significant---bleeding if inc---- PP HTN

Vaginal bleeding pad being a) less than 2.5cm b) 2.5 to 10 cm c) 10-15cm d) A lot

a) scant b) light c) moderate d) saturated

A nurse teaching nonlactating pt. Which one is the best teaching? a) wear a supportive bra continuously for the first 72hrs b) Pump breast every 4hr c) Use breast shells throughout the day d) Apply a warm compress

Which sing is an indicator PP hypovolemia caused by hemorrhage? a) Inc pulse and dec BP b) Dizziness and inc respiratory rate c) Cool, clammy skin, and pale mucous membrane

What is mottling skin?

blotchy, red-purplish marbling of the skin.

Breast engorgement a) Apply cold or warm before or after breastfeeding? b) Apply cold or warm before or after breastfeeding?

a) Warm compresses BEFORE b) Cool compresses AFTER Caused by dec estrogen

PP hemorrhage risk factor

Uterine atony(=boggy) Birth canal trauma Precipitous deliver Placenta fragment

What to do if the uterus is still boggy after a massage?

Call the provider and stay with pt Medical emergency!!!

What are we looking for when check the Lochia?

Color Oder Consistency 濃度 Amount COCA!!

PP check-up a) vaginal birth b) C section

a) 6 weeks b) 2weeks then 6weeks

Mother holding her baby with silence, is this good bounding or bad bonding?

Good