Postpartum Flashcards
what changes postpartum physical adpatations
- vital signs
- cardiovascular
- reproductive
- urinary
- gastrointestinal
- musculoskeletal
- interhumentary
- neurologic
- immune
VS: postpartum temperature
97-100.4
may be elevated for 24 hr after brith and elevated again after milk comes in
VS: postpartum BP
usually 120/80
- assess for orthostatic hypotension
- assess for hypertension/ reclampsia
VS: postpartum HR
60-100 normal
-slight bradycardia not uncommon (50-90)
Postpartum changes in cardiovascular/ lab values and EBL
- increase blood volume 40-50%
- normal pp blood loss (EBL): 200-500mL vaginal and 700-1000mL cesarean
- cardiac output: preload increased and returns to normal with 1hr
postpartum changes reproductive system
everything: uterus lochia cervix vagina breast
changes in uterus postpartum
- spongy layer of decide is sloughed off
- placental site heals by exfoliation
- uterin cells will atrophy : involution
changes in lochia postparturm
-uterine debris in the uterus is discharged though loch
changes in cervix/ vagina postpartum
- cervix: spongy, flabby, and may appear bruised
- extrnal os may have lacerations is irregular and closes slowly: shape of the external os changes to a lateral slit
- vagina may be edematous , bruises with small superficial lacerations
postpartum changes in breast/lacation
- estrogen/progesterone decrease
- breast are ready for lactation
relationship between postpartum ovulation and menstruation
- nonbreastfeeding: menstruation occurs 7-12 weeks, first ovulation can occur 5 week
- breastfeeding, takes 3 or more months for mensuration/ovulation: exclusive bf reduce risk of pregnancy
postpartum urinary changes
- postpartum diuresis causes loss fo 5 lbs
- increased bladder capacity
- urinary stasis
causes of urinary stasis
- swelling and bruising of tissues around the urethra
- decrease in sensitivity to fluid pressure
- decrease in sensation of bladder filling
postpartum changes in gastrointestinal
- hungry 1-2hr after brith
- bowel patterns slow and risk for constipation
causes of risk of constipation
-episiotomy, lacerations or hemorrhoids may delay elimination
postpartum changes musculoskeletal
- loose and flabby but will respond to exercise
- diastasis recti abdominis
diastasis recti abdonminis
abdominal muscle divides into 2, may cause hernia
postpartum changes integumentary
- perineum may be: edematous, bruised
- lacerations or episiotomy may be present
- striae
postpartum changes neurologic
-headaches and carpal tunnel
postpartum changes immune
- rubella: can cause brith defects
- Rh + results in incompatibility
- HIV
postpartum assessment mnemonic
Breast Uterus Bowel Bladder Lochia Episiotomy/Lacerations H- Hemorrhoids/Homan's Emotions
how to initiate an assessment
- identify yourself
- identify your patient
- ppe
what to look for in breast assessment
- skin integrity: abnormalities, redness, blisters, nipple: cracks, tissues, soreness, inversion
- consistency: presence of breast fullness due to milk presence and engorgement
- lactation status
what to look for in a uterus/abdominal assessment?
- tone
- position of funds to midline
- heigh of fundus related to umbilicus
- assess incision for bleeding, approximation and signs of infections
Fundal message
- bimanual
- to make fundus firm
- may hurt
what to look for in a bowel and bladder assessment
- intestinal elimination: maternal concerns regarding bowel movements
- adequacy of urinary elimination
- bladder distention and pain during urination
Assessment of loch and perineum
- assess loch for: amount, color, order, presence of clots
- wound assessed for REEDA
- presence of hemorrhoids
- level of comfort/discomfort
- efficacy of any comfort measures
What does REEDA stand for and when is it used
- assessing any wound
- Redness
- Edema
- Ecemycin: bruising
- Discharge
- Approximation
Postpartum loch flow
- scant: 1inch stain
- light:1-4inch stain
- moderate 1-6 inch stain
- heavy: saturated within an hour
Episiotomy what is it and what to do for it
incision for in perineum
-sitz bath recommended
Hemorrhoids
distended viens
assessment for extremities
- asses calf for redness and warmth
- varicosities (viens)
- edema
Nursing process
- Assessment
- nursing diagnosis
- planning
- implementation/interventions
- evaluation
nursing diagnoses for postpartum patient
- knowledge deficient
- fluid volume deficient
- urinary retention
- constipation
- infection, risk for..
- pain, acute
- sleep pattern, disturbed/fatigue
interventions: comfort measures: relieve of afterpains
- positioning
- ambulation
- analgesics
interventions: comfort measures: perineal care
- ice packs
- sitz baths
- analgesics
interventions: suppressing lactation
- well bitting bra
- cold compresses or cabbage leaves
- anti- inflammatory meds
care of C-section mother
- minimize complications: deep breathing and incentive spirometry, ambulation, pain management
- rest
- minimize gas pains
- consider grief response
care of postpartum adolescent: discussion
- postpartum hygiene: demonstrate self care
- contraceptive consoling
- newborn care: physical exam at bedside
care of postpartum adolescent: nurse-patient relationship
- positive feedback
- sensitive, nonjudgemental
- still trying to meet educational goals
- relies on others
care of postpartum adolescent: opportunities
- include family
- role model
- ensure knowledge and skills/ teach back
- information about options in community
cultural influence in postum period
- determine customs and practices
- ask about fluids and temperature
- breastfeeding practices: assistance or alone
- role of grandmother
maternal psychological adjustment: taking in period
they need a moment to care for themselves, not ready to learn or assume full care of baby (day 1)
maternal psychological adjustment: taking hold
ready to learn and take care of baby (2-3 days)
attachment
interactive process between the parent and infant which develops their relationship
signs of attachment
- en face position
- fingertip explorations– palmar contact–enfolding
- engrossment: father’s characteristics
postpartum blues
adjustment reaction with depressed mood
-related to rapid changes in estrogen, progesterone, prolactin
how many people experience postpartum blues
85%
how long does postpartum blues last
2-4day to 14 days
Contributing factors to postpartum blues
- anxiety of new moms
- physical discomfort of early postpartum
- difficulty sleeping
- feeling let down
