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N434 > Postpartum > Flashcards

Postpartum Flashcards

1
Q

Postpartum Period

A

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.

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2
Q

Overview of Components of Nursing Management

A 
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
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3
Q

Nursing Actions- Immediate PP (First 2 hrs)

A

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

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4
Q

Why do we encourage breastfeeding as soon as possible?

A

Stimulates oxytocin and this stimulates hemostasis

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5
Q

Placenta Delivery

A

Considered the 3rd Stage of Labor
Should be <30 mins after baby is delivered
Spontaneous or Assisted
Cord Blood Collection

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6
Q

pitocin

A

Exogenous oxytocin
Administered after placental delivery; IV or IM
Helps strengthen and coordinate uterine contractions
Breastfeeding is the natural way to increase oxytocin

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7
Q

PostPartum Assessment: Vital Signs

A

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

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8
Q

Postpartum Care : First 4 hours

A 
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!

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9
Q

Cardiovascular System

A

Pregnancy-induced hypervolemia (increase in blood volume by 40-50% above nonpregnancy levels)
 blood volume
Diuresis

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10
Q

Post Birth: Cardiac Output & blood components

A

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

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11
Q

Reproductive System Adaptations

A

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

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12
Q

BUBBLEEE

A 
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
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13
Q

Breast

A 
Normal filling day 2-3
May have engorgement-on day 3-4
Treatment
Frequent nursing
Cold packs
Cabbage leaves
Sore Nipples? assess q shift
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14
Q

Uterine Involution

A
  1. Height
  2. Position
  3. Tone
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15
Q

Where is the fundus?

A

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)

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16
Q

What is normal fundus?

A

Fundus firm, midline, at or near umbilicus

17
Q

Hemorrhage

A

greater than 500 cc blood loss

Causes:

Uterine atony - 70 %
Lacerations
retained placental fragments
hematoma

18
Q

Bladder

A 
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

19
Q

B: Bowels

A 
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 &amp; V
20
Q

L: Lochia

A

Vaginal discharge in the postpartum (bleeding)

Type:
Rubra
Serosa
Alba

Amount
light, moderate, heavy

Foul odor = infection

21
Q

Avoid problems

A

Often problems due to distended bladder

Treatment: 
empty bladder
massage fundus
breastfeeding
meds - oxytocin 1st line
Frequent assessments: 
Comfort Rounds hourly
22
Q

E: EpisiotomyPerineal Healing

A

Lacerations, 1st -4th degree
sutured or not sutured

Episiotomy
sutured
may have 3rd-4th degree extension

Sutures will dissolve

Heals w/in 6 weeks

23
Q

REEDA Scale for Perineal Evaluation

A 
R = Redness
E = Edema
E = Ecchymosis
D = Discharge
A = Approximation
24
Q

Perineal Care

A

Treatment

Ice first 24 hours
Heat - whirlpool/sitz
Clean - rinse after toilet
Frequent pad changes
Pat dry
Topical anesthetics
PO analgesia
Sit on pillows
25
Q

Cesarean Birth

A 
Recovery room
2 hours
Family bonding/breastfeeding
Incision checks/bleeding
Pain control
Bowel/ bladder function
3 day stay
Help at home?
26
Q

E: Extremities

A

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

27
Q

E: Emotional Status

A

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

28
Q

Newborn Brings:

A 
Appearance
Gender
Weight
Anomalies
Injuries
Behavior
eye to eye contact
crying/quiet
hand grasp
eating
“goodness of fit”
29
Q

Common Postpartum Medications

A 
Oxytocin (Pitocin)
Rhogam
Rubella Immunization: live vaccine
Pain medication
Ibuprofen (best for cramps/breastfeeding)
Tylenol
Depo Provera

N434 (14 decks)

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