Postpartum Adaptations and Nursing care

Question 1

Assessment of the Postpartum Client

Answer 1

• Pre-pregnancy the uterus is about the size of a fist
• During pregnancy the uterus stretches to accommodate the size of the baby

Question 2

Involution:

Answer 2

is the rapid reduction of the uterus to the nonpregnant size and condition

Question 3

Routine Physical Assessment:
Skin/ v/s

Answer 3

• Head to Toe
• General response
• Skin (diaphoresis, edema)
• Vital Signs: must be consistent with pregnancy (ex: if pt was hypertensive before birth, the pt should still have increased BP)
• BP-consistent with BP during pregnancy
• Temperature 36.2-38C [98-100.4F]

Question 4

Blood Loss:

Answer 4

• 200-500ml a blood loss is WNL for natural birth
• Up to 1000 mL (1L) is WNL fo C-section

Question 5

Signs of hemorrhage:

Answer 5

• Orthostatic dizziness
• weakness
• fatigue
• SOB
• tachycardia
• hypotension
• pallor
• cold
• moist skin
• saturating a pad in 1 hr

Question 6

Breast

Answer 6

Nipples
- Flat, inverted, cracked, sore; can make it difficult to be BF.
Skin at nipple site
- Condition: intact, Cracked, sore
Breast consistency
- Soft, firm, engorged
Lactation status
- Colostrum: is what comes before milk, it is a thick yellow and contains lots of nutrients and antibodies the baby needs.
— Last 1-3 days
- milk

Question 7

Uterus

Answer 7

Fundus: the top of the uterus.
- Immediately after birth the fundus is halfway between the symphysis pubis & the umbilicus
- 12-24 hours after the delivery the fundus should be at the umbilicus
- The fundus should descend in one finger breath (1 cm) every day postpartum

Question 8

Access Fundus for:

Answer 8

Consistency
- Firm
- Boggy:
— Boggy fundus: is a softer uterus that is not contracting,
we start with a fundal massage for one minute if it is still bogging, this is indicative of a postpartum hemorrhage.
- Stay with patient and call for assistance
- Or call HCP while following protocol
- Likely administer Pitocin to firm the uterus and stimulate contraction
Location
- Height in relationship to Umbilicus
- Midline or deviated

Question 9

Bladder

Answer 9

• Assess for distention: can cause the fundus to shift; ensure patient is voiding
• Assess first few voids need to pee 3 times before DC
  Amount, Color, Character
• Check for catheterization orders

Question 10

Bowel

Answer 10

Assess for
- Bowel sounds
- Flatus; can be painful if they are not passing gas- can lead to referred pain in shoulder
- Bowel movements
— Most women are also constipated after birth because of pain medication
— The extra progesterone slows down, bowel movement
— NPO at the time of admission
- Give stool softeners as necessary
- Encourage diet & fluids
- Teach about prevention of constipation

Question 11

Lochia

Answer 11

discharge after birth

Question 12

Lochia Assess:

Answer 12

Color:
- Rubra (dark red- lasts 1-3 days),
- Serosa (pinkish)- lasts 4-10 days
- Alba (white)- lasts until the placenta heals- (4-6 weeks)
Amount:
- Scant, <2.5 cm (1-inch) stain
- Light, 2.5- 10cm (1-4 inch) stain
- Moderate, 10-15 cm (4-6 inch) stain
- Heavy, saturated in 1 hr
- Lochia amount increases after getting up out of bed for the first time. Make sure mom knows this is normal.
- Extra activity or breast-feeding also increases the amount of lochia due to increased Pitocin
- Lochia should stop within 4-6 weeks (signifying the site of the placenta has healed)
- Foul odor
- Clots

Question 13

Lochia: Scant

Answer 13

<2.5 cm
1 inch stain

Question 14

Lochia: light

Answer 14

2.5 to 10 cm
1 to 4 inch

Question 15

Lochia: moderate

Answer 15

10 to 25 cm
4 to 6 inch

Question 16

Lochia: Heavy

Answer 16

Saturated in 1 hour

Question 17

Lower Extremities

Answer 17

• Assess for Thrombophlebitis: inflammation of the vein related to DVT
• Homen’s Sign: indicates DVT, it is pain when the knee is bent
• if on Magnesium Sulfate (causes muscle weakness)- assess Deep Tendon Reflexes
• Assess for Edema

Question 18

Episiotomy/C-Section Suture Site: Assess

Answer 18

Assess incision site: REEDA
- Redness
- Edema
- Ecchymosis
- Discharge, drainage
- Approximation
Assess perineum-hemorrhoids

Question 19

Emotional Status
- En Face:
- Puerperal Phases:

Answer 19

• *Bonding
• Attachment
• En Face: mom and baby face to face
  Puerperal Phases: postpartum phases-mom recognizing new role as a mom
• Taking In Phase
• Taking Hold Phase
• Letting Go Phase

Question 20

Affective Disorders

Answer 20

Post Partum Blues
Post Partum Depression

Question 21

Post Partum Blues

Answer 21

• Transient- resolve within 2 weeks
• Emotional lability: happy one second & Sad the next
• Signs: Sad, crying, insomnia, poor appetite, anxiety
• Mother still able to care for self and infant
• Affects up to 80% of all mothers

Question 22

Post Partum Depression

Answer 22

• Longer lasting. Onset within 4 weeks of birth and lasts at least 2 weeks.
• Change in appetite & sleep
• Loss of interest in all activities. Unable to care for self or infant
• Difficulty concentrating, thinking
• Thoughts of suicide
• *Unable to care for self or infant
• Affects 10%-15% of all mothers

Question 23

PPD Risk Factors

Answer 23

• Previous PPD
• First pregnancy
• Hormonal fluctuations
• Immaturity or low self esteem
• Dysfunctional relationship
• Single, young maternal age (lack of support)
• Unwanted or unplanned pregnancy

Question 24

PPD Treatment

Answer 24

• Psychotherapy
• Antidepressants (SSRI, Tricyclic)-most considered safe during breastfeeding
• But Takes up to 4 weeks to become effective and must be continued for 12 months after symptoms subside
• Brexanolone infusion (Gaba-A receptor): 60 hour infusion- very expensive

Question 25

Discharge Teaching

Answer 25

• Breast Care
• *Breast Feeding
• Diet
• Lochia
• Postpartum complications
• Comfort measures
• Resumption of sexual activity: (when placental site heals 4-6 weeks)
• Contraception
• Newborn care
• Nutrition
• Exercise
• s/s of PP depression