Postpartum Flashcards
What are the 4 most complications of early PP?
Hemorrhage (bleeding)
Infection
DVT
Pain
What is the postpartum assessment mimic?
B breast
U uterus
B bowel
B bladder
L lochia
E edema
Breast assessment
a) What are normal sings?
b) What are abnormal sings?
a) Feel tight
tender
warm
full
b) redness
cracked nipples
Mastitis (Unilaterally)
What is mastitis?
Breast infection
-warmth
-fever
-pain
-redness
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
Education
Mom who planning to give formula
Wear tight bra
use cold cabbage leaves
avoid heat(shower)
do not touch and stimuli
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
Stage of human milk
Colostrum
The initial milk
Full of antibodies, white blood cells, and other immune properties
Stage of human milk
Transitions
Referred to as the milk coming in
Mature milk day 3-5
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
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
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
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
Normal Lab values during the early postpartum
Coagulation factors
Remain inc elevated
Risk of thrombus formation and thromboembolism. 150k-400k
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
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
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
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
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
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
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
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
What is lochia? and what are the abnormal sings?
Maternal discharge contains blood, mucus, and tissue
odor=infection
excessive clots =bleeding
Lochia rubra is?
Dark red
A few small clots are common
NO more than 3days
NO large amount of dark red clots
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
a
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
a
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
