Postpartum Flashcards
Postpartum Period
Puerperium/4th trimester/postpartum period: period after delivery of placenta, lasting for 6 weeks or until reproductive organs return to their normal, nonpregnant state.
Period Definition: changes in all aspects of mother’s life that occur during the first year following birth of child.
Overview of Components of Nursing Management
Mother Physiologic Uterus Cervix Vagina & Perineum Pelvic Muscular Support Hormones Blood Volume and Fluid Loss GI System Breasts Psychologic Transition to Parenting Ability to care for baby & self Newborn Family
Nursing Actions- Immediate PP (First 2 hrs)
Mother & Newborn attachment
Assist with breastfeeding
Spouse involved or other support
Placenta delivery (time, assessed for completeness)
Collection of cord blood
Administration of Pitocin
Assess Q 15 min for ~2 hours following birth
Vitals
Fundal height, firm vs boggy
Perineum , assist with repair, intact? edematous?
Lochia- color, amount (absent, scant, mod, heavy), clots present, free flow
Why do we encourage breastfeeding as soon as possible?
Stimulates oxytocin and this stimulates hemostasis
Placenta Delivery
Considered the 3rd Stage of Labor
Should be <30 mins after baby is delivered
Spontaneous or Assisted
Cord Blood Collection
pitocin
Exogenous oxytocin
Administered after placental delivery; IV or IM
Helps strengthen and coordinate uterine contractions
Breastfeeding is the natural way to increase oxytocin
PostPartum Assessment: Vital Signs
Normal Findings
Temp: up to 38° C (100.4 ° F). > 24 hrs afebrile (mild-r/t dehydration, milk “coming-in”)
Pulse: elevated x 1 hr then begins to decrease.
Resp: should decrease to normal prebirth by 6-8 wks
BP: no-slight alteration. Orthostatic hypotension can develop in 48 hours
Pain: afterpains, musculoskeltal, perineal, nipple pain
Postpartum Care : First 4 hours
Amount of lochia? Fundal height? Uterus firm? VS (include temp) Encourage early void Showered/ sitz bath? Hydration/ eating? Meds prn
Includes care of the baby!
Cardiovascular System
Pregnancy-induced hypervolemia (increase in blood volume by 40-50% above nonpregnancy levels)
blood volume
Diuresis
Post Birth: Cardiac Output & blood components
Cardiac Output
1st Hour: CO= 60-80% > prelabor
2 weeks: CO= 30% > prelabor
6-8weeks: back to normal
Hematocrit: drops x 3-4 days, then returns to normal
*Orthostatic Hypotension
WBC’s: labor can cause rise to 30,000 (may obscure infections)
Clotting Factors and Fibrinogen: Normally increased during pregnancy and remain in puerperium. Combined with vessel damage and immobility… **Risk for DVT’s and PE’s
Reproductive System Adaptations
Uterus
Involution: contraction of muscle fibers; catabolism; regeneration of uterine epithelium
Lochia: rubra, serosa, alba
Afterpains
Cervix:
closure; now appearing as jagged slit-like opening.
Vagina: eventual thickening and return of rugae.
Perineum
BUBBLEEE
B: Breasts (size, contour, engorgement) U: Uterus (height of fundus, firmness) B: Bladder (voiding, bladder emptying) B: Bowels (bowel sounds, distention) L: Lochia (amount, color, odor) E: Episiotomy and perineum (lacerations, hematoma) E: Extremities E: Emotional status
Breast
Normal filling day 2-3 May have engorgement-on day 3-4 Treatment Frequent nursing Cold packs Cabbage leaves Sore Nipples? assess q shift
Uterine Involution
- Height
- Position
- Tone
Where is the fundus?
The bladder can quickly fill and become distended.
This pushes the uterus up and interferes with involution
The uterus can quickly fill with blood (boggy and distended)
What is normal fundus?
Fundus firm, midline, at or near umbilicus
Hemorrhage
greater than 500 cc blood loss
Causes:
Uterine atony - 70 %
Lacerations
retained placental fragments
hematoma
Bladder
Assessment Monitor 2 voids Palpate pubis Straight cath? S/S of UTI?
Reduced kidney function: steroids levels decrease in puerperium
Voiding sensation: affected by:
Perineal lacerations
Generalized swelling and bruising of the perineum and tissues surrounding the urinary meatus
Hematomas
Decreased bladder tone due to regional anesthesia
Diminished sensation of bladder pressure due to swelling, poor bladder tone, and numbing effects of regional anesthesia used during labor
Diuresis
B: Bowels
Relief of pressure on organs Bowel tone and peristalsis Hunger and thirst Bowel remains sluggish constipation Fear of perineal pain/trauma holding back constipation Medications Constipation N & V
L: Lochia
Vaginal discharge in the postpartum (bleeding)
Type:
Rubra
Serosa
Alba
Amount
light, moderate, heavy
Foul odor = infection
Avoid problems
Often problems due to distended bladder
Treatment: empty bladder massage fundus breastfeeding meds - oxytocin 1st line Frequent assessments: Comfort Rounds hourly
E: EpisiotomyPerineal Healing
Lacerations, 1st -4th degree
sutured or not sutured
Episiotomy
sutured
may have 3rd-4th degree extension
Sutures will dissolve
Heals w/in 6 weeks
REEDA Scale for Perineal Evaluation
R = Redness E = Edema E = Ecchymosis D = Discharge A = Approximation
Perineal Care
Treatment
Ice first 24 hours Heat - whirlpool/sitz Clean - rinse after toilet Frequent pad changes Pat dry Topical anesthetics PO analgesia Sit on pillows
Cesarean Birth
Recovery room 2 hours Family bonding/breastfeeding Incision checks/bleeding Pain control Bowel/ bladder function 3 day stay Help at home?
E: Extremities
Promoting Ambulation
Reduces incidence of DVT’s & PE’s
Promotes return of strength
*Monitor w/anesthesia or opioid use
Assess for orthostatic hypotension
Promoting Exercise
Start with simple, non-strenuous exercises
Watch for increased lochia
No abdominal exercise until 4-6 weeks postpartum (8wks for C-Section)
Diastasis Recti – separation of the rectus abdominis muscles
E: Emotional Status
Reva Rubin’s 3 phases
Taking-in phase: the time immediately after birth when the client needs sleep, depends on others to meet her needs, and relives the events of the birth process
Taking-hold phase: the second phase of maternal adaptation, characterized by dependent and independent maternal behavior
Letting-go phase: the third phase of maternal adaptation, occurring later in the postpartum period as the woman reestablishes relationships with other people
Newborn Brings:
Appearance Gender Weight Anomalies Injuries Behavior eye to eye contact crying/quiet hand grasp eating “goodness of fit”
Common Postpartum Medications
Oxytocin (Pitocin) Rhogam Rubella Immunization: live vaccine Pain medication Ibuprofen (best for cramps/breastfeeding) Tylenol Depo Provera
