Postpartum

Question 1

Involution

Answer 1

Where the uterus rapidly reduces in size to the non-pregnant state

Question 2

6-12 hours later…

Answer 2

The uterus should remain midline, firm.
- If it rises above the umbilicus and it feels “boggy” suspect the risk of postpartum hemorrhage.

Question 3

Lochia Flow

Answer 3

• Discharge in the uterus rids of debris after birth
• Rubra: First 2 days it is dark red and clotting may be present ( smaller than nickel, plum sized = hemorrhage )
• Serosa: Pinkish, occurs 3-10 days after
• Alba: Whiteish/ yellow
• Pink to red can mean hemorrhage
• Due a pad count

Question 4

Breast Changes

Answer 4

• Decrease in placental hormone = increased prolactin which promotes milk production

Question 5

Colostrum

Answer 5

• Clear/gold fluid, precursor to full milk production.

Question 6

IF NOT breastfeeding

Answer 6

• May become full or “engorged” o 3-5th day

Question 7

Blood Volume

Answer 7

-Common to loose 300-500 ml
- Over 500 ml = Postpartum hemorrhage

Question 8

PP Assessment
7 B’s and E

Answer 8

• Belly
• Bottom
• Bleeding
• Bowel
• Bladder
• Breasts
• Blues
• Extremities

+ lochia, lacerations, vital signs, assess

Question 9

Fundal Assessment

Answer 9

• Decreases by 1-2 cm every 24 hrs

Question 10

Fundal Checks

Answer 10

• Ensure bladder is empty
• Assess for:
• Consistency
• FIRM IS NORMAL
• BOGGY ( HEMM)
• Location:
• At umbilicus below or above
• Midline location of fundus is normal
• Lateral Shift: May mean full bladder
• Lochia: Assess with fundal pressure for gush, trickle

Question 11

PP Pain Intervention

Answer 11

1. NSAIDS
2. Narcotics: Constipation and nausea
3. Ice, heat, rest

Question 12

PP Warning Signs

Answer 12

• Bright red bleeding, increased bleeding, soaking more than 1 pad an hour, large clots
• Temp over 100.4
• Increased pain
• Foul smelling lochia ( Infection )
• Urinary burning, frequency
• Calf pain
• BLOSS LOSS OVER 500 ML

Question 13

PP Education

Answer 13

• 2-3L fluids
• 1800-2200 cals
• If lactating increase calories by 330 a day in first 6 months
• AAP Diet: 450-500 cals

Question 14

Inversion of Uterus

Answer 14

• Stop Oxytocin
• Avoid excess traction of umbilical cord
• Surgery?

Question 15

PP Hemorrhage Risks

Answer 15

• Prolonged labor
• Retained placenta
• Use of oxytocin
• Preeclampsia
• History
• Coagulation disorders
• Placenta abruption

Question 16

PP Hemorrhage Interventions

Answer 16

• Emergency response
• Massage the uterus until firm
• Oxytocin
• O2
• Monitor vitals signs
• Catheter to empty bladder
• ECG

Question 17

Hypovolemic Shock

Answer 17

• Decreased BP is a late sign: Women loose 30-40% of blood volume before BP decreases
• Increased pulse is an early sign
• Rapid/ shallow respirations
• Pale
• Dizzy
  Administer: Oxygen 10-12L/ min, fluids, blood, meds

Question 18

PP Infection

Answer 18

• Endometitis * Most common: Fever, chills, nausea, fatigue, uterine tenderness, FOUL smelling lochia
  -Treatment: Single dose pre op antibiotics to reduce incidence, treat with broad spectrum IV antibiotics
• Wound infection
• UTI: RF- Catherization, C-Section, S/S: Dysuria, frequency, urgency, back pain, Treatment: Urinalysis, treatment of organism
• Breast infection

Question 19

Mastitis

Answer 19

• Blocked milk duct = incomplete emptying of the breast the blockage causes milk to back up, leading to breast infection.
• S/S: Breast tenderness, warmth, swelling, rash, pain, burning, fever
• Treatment: Antibiotics, pain management, breastfeeding

Question 20

Hemorrhoids

Answer 20

• Pain
• Perineal assessment