Postpartum Flashcards
Postpartum
After delivery for 6 wks
Involution
Return of the uterus to pre-pregnant state
Lochia
Shed uterine epithelial cells
vag bleeding
Lochia
Rubra
Dark red and consists mainly of blood and trophoblastic debris; Bloody, dy 1-3
norm
Lochia
Serosa
consists of old blood, serum, leukocytes, and tissue debris; Pinkish/brown, dy 4-10
Lochia
Alba
Lochia alba consists of leukocytes,
decidua, epithelial cells, mucus, serum, and bacteria. White/Cream, dy 11-21
Amount of Lochia
Scant
< 2.5 cm
Amount of Lochia
Light
< 10 cm
Amount of Lochia
Moderate
> 10 cm
Amount of Lochia
Heavy
1 pad w/in 2hrs
Amount of Lochia
Excessive
pad is saturated in 15 mins
What will we assess?
VS
Pain
Breast
Uterus
Bladder
Bowel
Lochia
DVT
Episiotomy
Emo. Attach
Bonding
Feeding
BUBBLEDEP
How often do we assess?
Q15 mins: 1st hour
Q30 mins: 2nd hour
Q4 hrs: first 24 hours
Q8 hrs: after 2 hours
Always on indication !, temp may be elevated ( > 100.4) 1st 24 hrs (dehyration), BP >= 140/90 = danger sign
PP Immunizations
Rho GAM (- mom, + baby)
Tdap ( if not gotten in 2 yrs)
Rubella, Varicella in non-immune
Maternal Adaptation
Taking In: dependent on others ( 24-48hrs, desires sleep, needs nurturing)
Taking Hold: Increasing autonomy ( confidence in infant care, may feel inadequate, don’t take over, praise effort)
Letting Go: adapts to new parenthood (separation of newborn form self, confidence in caretaking)
Promote early skin to skin + rooming in
Newborn Attachment
prolonged eye contact, mutual gazing
tracking parent face
holding fingers
“enterainment” - dancing w/ voice
synchrony - infant cues + parent respone
Family Adaptions: Pospaturm Blues
Normal, occur 1-2 wks pp
unexplained tearfulness, feeling down, decrease appetite
self- limiting
Family Adaption: Postpartum Depression
Irritablity
Extreme sadness
Lack of desire to care for baby
Last longer than ( 6-10 weeks)
Require intervention
* OB visit
* Meds ( SSRI)
Most patient risk factors: H/x of Depression , Single mothers, Multipara moms
PP Psychological changes: Postpartum Psychosis
Medical Emergency
Psych admission for treatment
Self harm/ infant harm risk
Admission to psychiatric unit for treatment
PP Depression
Requires intervention
Therapy, meds, diet, exercise, sleep,
Zulresso: expensive, 60 hrs IV dose
Discharge Education
Increase fluids, fiber, stool softeners
rest periods
no heavy lifting
no tampons, no douching, no tub for 6 wks
no sex 6 wks
flu appt: 6 wks ( 1 wks for c/s)
* newborn visit w/in 1-2 days
S/S DVT
Breasts
Inspect
colostrum: early milk -> mature milk by about 72 - 96 hours after birth
Engorgement/ Mastitis
* relief: tight bra, cool compress, no stim, cabbage
Not Breastfeeding ?
Risk for engorgement
* occurs 3-4 day PP, resolves in 1-2 days AFTER milk comes
Uterus
Funal Height, firm, midline
* @ umbilicus after delivery, 1 FB above the umbilicus, etc
* 1-2 cm/dy
Displaced up + right = void
Boggy = uterine atony = PPH
* life threatening, massage fundus
Myometrium contractions: After pains
* d/t increase oxytocin
Postpartum Hemorrhage
Risk Factors: Grandmulti, overdistention of uterus, precipitous labor, prolonged labor, retained placenta, placenta previa/abruptio, operative procedures
PPH= leading causes of maternal mortality
Causes: ( 4 T’s = Tone, Tissue, Trauma, Thrombus)
Uterine atony, vag. lac, Cervix lac., Hematoma, retained placental fragment, full bladder
90% PPH due to uterine atony
Blood loss greater than
* 500 cc vag birth, or 1000 cc c/s
Early PPH: 1st 24hrs
Late PPH: 24 HRS -> 12 wks
S/S of Postpartum Hemorrhage
boggy uterus, blood gushm > 1 pad/ 15 mins, severe perineal pain, tachycardic
CALL MD IF UTERUS DOES NOT FIRM UP
PPH Meds
- Oxytocin 20 units IM/IV
-
Methylergomovine Maleate 0.2 mg IM, follwed by tablets ever 4-6 hours
( Preeclampsia or BP !!! > 140/90, hold call MD) -
Hembate, prostin 15 M 250 mg IM
( contra: Asthma, keep in fridge)
Side Effect of Meth: stomach upset/ diarrhea/ nausea
Med are given after
Bladder
Diuresis occurs: 3000 cc/dy
Encourage freg emptying + fluids
Assess for lower extremity edema
Diaphoresis common @ night
S/S Bladder Distention
* Fundus above baseline + displaced from midline
* Excessive lochia
* Discomfort , bulging bladder
* Freq voiding < 150 cc
Bowels
May take 3 days, normal pattern in 8-14 dys
ask about passing gas, inspect distention
auscultate x4
Assess hemorrhoids
Stool Softners ! Colace, Ducolax, Senakot
Perineum
Lacerations
* 1st: Superficial
* 2nd: Vag. Muscosa
* 3rd: 2nd + anal sphincter
* 4th: to rectal muscosa
Episiotomy = 2nd degree lac
REEDA
* Redness, Edema, Ecchymosis, Drainage, Analgesia
SKIN TO SKIN
Glycemic control, 1 hr min
