Postpartum Flashcards
What is the postpartum goal?
assisst women & their partners during initial transition to parenthood.
When does postpartum start?
delivery of placenta to about 6wks later
How long is the typical postpartum hospital stay?
Up to 48hrs
What is a concern of postpartum care?
Shorter stays d/t the need of providing important info on how to care for themselves and the baby in such a short period of time
What is couplet care?
-mother/baby care
-a primary nurse for both mom and baby
What does couplet care provide?
-an opportunity for bonding/attachment
- more time for the mother to learn how to care for the baby with the help of a nurse
What is rooming in?
Mother and nurse share care of the baby
What are benefits of rooming in?
- increases breast feeding success
- mom can breast feed on demand and learn baby’s early feeding cues
What is a late feeding cue?
Crying; harder to latch after this sign
What to do if mother temperature is elevated?
Determine if mom is dehydrated or developing an infection
What temperature is common during the first 24hrs after birth?
-100.4 F
- usually elevated w/in first hr after birth then decreases
What v/s may fluctuate d/t changes of the cardiovascular system
Pulse and blood pressure
What is the normal range of respirations ?
- 16-24
- need to monitor closely if narcotics are used for pain relief
What may be a reason for elevated blood pressure?
Pain; assess
Why might most mom experience Bradycardia after delivery?
There is less blood flow to the uterus causing an increase in maternal blood volume
What might tachycardia indicate ?
Blood loss or dehydration
What are 3 physiological changes that protect women form excessive blood loss?
- Elimination of uteroplacental circulation
- Loss of placental endocrine function
- Fluid shift
By how much is the maternal vascular bed reduced?
15%
Without baby and placenta, the uterus doesn’t need much ____
Blood
Why does the placenta generate hormones that causes mom to vasodilate (increase size of blood vessel) ?
To accommodate for the increase in blood volume
What happens when the placenta is delivered?
Stimulus for vasodilation is gone -> blood vessels go back to normal size
Why does blood pressure increase as blood vessel return to normal size?
To compensate for loss of volume during initial postpartum period
Why is there an increase in blood volume during fluid shift?
During pregnancy fluid is store in tissue and when its over fluid is shoved back into the circulatory system
What keeps women from going into hypovolemic shock?
-Sustaining a normal amount of blood loss
- no more than 500 for vaginal deliver
- no more than 1000 for C section
What gets rid of extra fluid?
- excessive peeing
- sweating
Why does HGB/ HCT increase?
D/t the decrease in plasma volume
Why is there fluctuations in HGB and HCT?
Fluid shift after pregnancy is over causes fluctuation of concentration on rbc’s
Why are RBC values hard to interpret during the first 2 days Postpartum?
Changes in blood volume d/t heavy bleeding
What does rbc’s look like on days 3-4? What should you do?
-Rbc’s look like they are decreasing d/t the increase in plasma volume
-monitor bleeding, clots, asses fundus (boggy?), and lab values
WBC will be increased. What is the normal values?
-normal value is 12,000
-first 10-12days wbc may be anywhere from 25,000 - 30,000
T/F wbc count of 30,000 means infection
- false
- look at the whole patient. Fever?
-Only high wbc? Most likely not an infection
Coagulation factors will be increased which mean uterus clotting easily= good.
Where do we not want to clot?
-calves or thighs
- this means DVT
What does BUBBLE-EEE stand for?
Breasts, uterus, bladder, bowel, lochia, episiotomy/ laceration, extremities, edema, emotional status
What are the components of breasts?
-lactating
-no lactating
-engorgement
-discharge teaching
Should the mom be worried she is not producing milk the first two days?
No, a small amount of colostrum will be produced which is beneficial for the baby
What is colostrum?
Thick and yellow premature milk that is full of antibodies and helps baby pass meconium stool
What do you assess the nipple for ?
Inversion, flatness, eversion, cracks, blisters and redness of skin
What can nipple pain indicate?
Baby is latched wrong
When does mature milk come?
Day 3-5, causes engorgement
If a mother chooses not to breastfeed, should they express the milk from their breasts?
NO! The more pumped out the more the body will make
What should a non-lactating mother avoid?
-Avoid stimulating the breasts
-do not touch and avoid heat
What should you teach the mother regarding her breast at the time of discharge?
-S/S of mastitis
- warmth, fever, pain and redness
What can a mom do to ease the pain with engorgement?
-wear a well fitting bra
-take Motrin
What is uterine involution?
The return of the uterus to its non-pregnant state
Where is the uterus palpable right after birth?
Midline; 2cm below belly button
How much should the fundus shrink everyday?
1cm
When is there no longer a risk for postpartum bleeding?
When the endometrial lining is back in place
What does a fundal massage help?
A boggy uterus
how do you perform a fundal massage?
Put hand on pubis, right above pubic bone, massaging uterine fundus right on top
Why is it important for the uterus to be firm?
To prevent excess bleeding
Why does the uterus contract after birth?
Contracts in response to endogenous and exogenous oxytocin
Where does endogenous oxytocin come from?
Postpartum and breastfeeding
What increases pain intensity?
Parity, large baby, multi fetal gestation, and breastfeeding
How long should a mother refrain from inserting anything in the vagina?
6wks or until it returns to its normal consistency
After birth how does the cervix appear?
No longer a circular shape, now its slit like
How does the body excrete excess fluid
Diuresis and diaphoresis
When should the mom void by? How much?
-6-8hrs after birth or removal of catheter
- 150cc each time
Why should you be concerned about bladder distention?
-can cause a boggy uterus which leads to increase bleeding
-can develop uti
Nursing interventions to promote voiding
-poor warm water while mom voids to minimize burning
-insert a catheter if mom is still unable to void
When will a bowel movement occur ?
May take 2-3days
Non-pharmacological interventions for Bowels
Ambulate, increase fluids and fiber
Pharmacological interventions for bowels
Stool softener for the first few days
What color is lochia ruba? How long does it last?
-bright red, reddish brown
-lasts 2-3 days
What color is lochia serousa? How long does it last?
-pink or brown
-lasts 3-10days
What color is lochia alba? How long does it last?
-yellow or white
-lasts 10days to 6wks
What factors can influence lochial flow?
-c section
-ambulation
Why do you notify doctor if fundus is firm but mom is still bleeding?
May indicate laceration of cervix/vagina that needs to be sutured
What is uterine Atony ?
Boggy uterus due to failure of uterine to fully contract
What does REEDA stand for ?
Redness, edema, ecchymosis, discharge and approximation of laceration edges
How long does it take for a episiotomy to heal?
2-3wks
What should you check for during perineal care?
-signs of hematoma, discoloration or swelling
What shoud you include in teaching about good hygiene?
-sitz baths, chuck pad w/ witch hazel, fluids, fiber, stool softner, kegels
What should you assess for in the extremities
Redness, warmth, pain, differences in size between extremities and diminished peripheral pulses
Why dont we massage?
Can cause pulmonary embolus
Why is ambulation beneficial?
Decreases risk of thromboembolism
Increases strength
Helps with constipation
What should you assess for if edema is facial or sacral?
Preeclampsia
How often does baby blues occur?
In 85% postpartum women
What do you ask regarding moms emotional status?
Birth experience, self image, sleep, attachment
What are maternal behaviors that demonstrate successful attachment ?
Holding, touching, talking, responding to baby’s cries
What are nursing interventions to facilitate attachment ?
Rooming in, skin to skin
What are the phases of reva rubins stage of maternal adjustment
Taking in (first 48hrs)
Taking hold (2-4days)
Letting go
Physical changes
Sciatica relives
Joint pain relief
Stretch marks
Hair loss
What helps protect baby from infection?
Breastfeeding and good hand washing
Non-pharmacological ways to comfort mom
Warm pack, deep breathing, relaxation
Pharmacological ways to comfort mom
Oral pain meds, IM, IV, narcotics
Reassess after pain med is given
Pharmacological interventions
Rubella (immunity status)
Rh isoimmunization prevention
Rhogam with in 72hrs of birth
