Postpartum Flashcards
Vaginal birth hospital stay
24-48 hrs
C-Section hospital stay
96 hrs (4 days)- longer if complications
Involution Process
Return of uterus to nonpregnant state
When will Uterus reach nonpregnant size?
5-6 weeks but we can only feel the uterus up to 2 weeks postpartum.
When checking fundal height moms uterus, how should she be positioned?
Mom should be no more than 30 degrees when checking fundal height
Postpartum
4th stage of labor
What does the placental site start to do at delivery and why?
At delivery, placental site starts constricting so it doesn’t bleed and cause hemorrhage.
What does the uterus feel like after delivery?
Irregular, modular, and it is raised.
Lochia
Uterine discharge
Rubra
Blood and debris (red) about 1-4 days
Serosa
Old blood and debris (pink or brown) about 4-10 days after delivery
Alba
Debris, serum, and bacteria (yellow or white) about 10 days to 6 weeks
When does regeneration happen?
By 30 weeks postpartum there is a regeneration of the endometrium except at the placental site-that takes 6 weeks
What should you do first if uterus is boggy and shifted to the side?
Empty the bladder. A full bladder can cause a boggy uterus and can make it shift to the side. UO should be 30-60 mLs/hour
What is considered a hemorrhage?
> 500 mL of blood loss for a vaginal birth is considered a postpartum hemorrhagic mother
1000 mL of blood loss for a C-Section is considered a postpartum hemorrhagic mother
Soaks 1 pad in 15 minutes or 2 pads in 30 minutes is also considered a postpartum hemorrhagic mother
10% or more drop in hematocrit is also considered a postpartum hemorrhagic mother
Subinvolution of Uterus: Define, causes, S/S
Slower than expected return
Causes: hemorrhage, retained placental fragments, pelvic infection
S/S: prolonged lochial discharge, irregular or excessive bleeding
Causes of sub volition/hemorrhage
If they had an overextended uterus (big baby, lots of fluid, twins, triplets, etc.), >5 pregnancies, previous C-Section and now a Vback, baby came to fast, previous postpartum hemorrhage, placenta précis, infection, any clotting disorders
S/ of postpartum hemorrhage
Hard to find uterus, soft and boggy uterus, firms up with massage but the min. You stop massaging it it goes back to soft and boggy, the funds is at an unexpected level, excessive lochia
Things to do for a postpartum hemorrhage.
Massage uterus to try and firm it up, replace fluids (LR), may give whole blood or PRBCs, may be given plasma extenders, pack the uterus, can add up to 40 units of oxytocin, last course of action is a historectomy
Oxytocin
As soon as the placenta releases they put 10-20 units IV of oxytocin to help the uterus get its tone.
Methergen
If mom is breast feeding only give in emergency otherwise should not be given if breast feeding.
200-400 much q6-12 he. Up to 7 doses. IM or IV 200 mcg q5hrs. Up to 5 doses.
This is given if mom was induced and the uterus isn’t responding to oxytocin anymore.
Hemabait
250 mcg IM repeat 15-90 min. W/ max of 2 mg
CAN ONLY BE GIVEN IN THE HOSPITAL
only given if merger hen and oxytocin don’t work. If this doesn’t work then mom will go to surgery.
Cytotec
200 mcg suppository
Trauma
Increased HR, decreased BP
Trauma to birth canal 2nd most common cause of early postpartum hemorrhage (Lacerations, Hematomas)
Uterus is nice and firm
SEVERE PAIN UNRELIEVED BY PAIN MEDICATION
Says she has a lot of pressure and she feels anxious
With a hematoma they may do an US to see where it is located. Then they will go into surgery and do an I&D (incision and drainage of hematoma)
Pain postpartum
Pain scale 0-10 (5th VS)
Pain control: change positions every 1-2 hours, position for comfort, distraction, WALK in room or hall, GET MOM UP AND MOVING
After pains
Contractions or after pains:compression of intramyometial vessels
Oxytocin: released by pituitary strengthens and coordinates contractions
Pitocin (oxytocin) is administered IM or IV
Breastfeeding and Pitocin stimulate uterine contractions
After 48 hours they have decreased a LOT and they are usually gone after 3-4 days
For nursing mom Medicate 30 minutes prior to feeding baby
Cervix postpartum
Soft immediately following birth
Ectocervix cervix (portion in vagina): bruised with small lacerations (optimal condition for development of infection)
OS gradually closes over 2 weeks- never regains pre pregnancy appearance
Vagina postpartum
Regarding absent, may be permanently flattened
Initially bruised and edema toys
Localized dryness until ovarian function returns (estrogen)
If breastfeeding estrogen is decreased which causes the vagina to dry up, delayed ovarian function
Abdominal wall postpartum
0-6 weeks it is relaxed
6 weeks it returns to prep regnant state
Diastasis recti abdominis
Abdominal separation due to a large fetus or multifetal gestation
Urinary system postpartum
Postpartum diuretics: within 12 hrs of delivery, excess tissue fluid
BUN level increases as uterus involuted
+1 proteinuria for a couple days
Kidney function: 1 month
GI system postpartum
Appetite: usually very thirsty and hungry following birth
BM: usually delayed 2-3 days (decreased muscle tone of intestines) but usually 8-14 days for bowel pattern to be back to normal
Always listen to bowel sounds and note if they are passing gas
Nipples and Breasts
Help relieves breast feeding pain: cocoanut oil, he’ll pass, let breast milk air dry on nipple
Always look at breasts: are they engorged, red, filling, warm
Colostrum
Starts to produce @ 7 months gestation
Do not throw away, really healthy for baby, protects baby
Gives premature babies some immunity
High in immunoglobulins, protein, and exactly what baby needs
2-3 days
Breast Abcess
Plugged milk duct
KEEP NURSING OR PUMPING THAT SIDE TO UNPLUG IT
Warm painful lump, may itch, red, change in nipple
Postpartum Physical Assessment
Need to monitor how mom is bonding with baby and her emotional status. Skin to skin for mom and baby FIRST HR postpartum check VS q15min, EVERY 30 MIN for the next hour, then check VS q HR for TWO hours. After 4 HRS its checking VS every shift unless it's a C-section then it's q4hrs for 48 hrs. Breast (nipples) Uterus Bladder Bowels Lochia Extra Homan's Emotional
Postpartum Testing
H&H drawn AM after delivery
Drop in hgb is expected- >4 point drop is considered postpartum hemorrhage
Rubella immunization if not immune
Rhogam
If drop in hct or breastfeeding keep taking prenatal vitamins
Postpartum mood disorders
Baby blues
Postpartum depression
Postpartum psychosis
Postpartum depression can happen up to a year after delivery but usually happens around 3 months
May need antidepressants: Paxil, Zoloft, Primalar, Abentyl
Whose at risk for PP depression:
How can we tell if mom has the emotional attachment to baby?
Leaving baby in crib
Letting everyone else take care of baby
Calling baby it
Nurses can facilitate bonding and that is our role, to help the family work as a unit
How can we tell if baby is bonding to parent?
Baby looking at them
Move toward the sound of their voice
They track the parent
When does placental scab pass?
10-14 days post delivery
