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408 Maternity Final Exam > Postpartum Assessment > Flashcards

Postpartum Assessment Flashcards

1
Q

Describe normal postpartum temperature.

A
  • May be mildly elevated for first 24 hrs (dehydration)
  • PP Chill (fluid shifts, nervous system response to work of labor)
  • PP Diaphoresis (elimination of excess fluid)
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2
Q

Describe abnormal postpartum temperature.

A
  • > 101
  • Assess for potential causes: puerperal sepsis, mastitis, endometritis, UTI
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3
Q

Describe normal postpartum HR.

A
  • Normal: 50-90
  • Remains elevated 1st hour after birth
  • Gradually decreases over 1st 48 hours
  • May be bradycardic (40-50)
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4
Q

Describe abnormal postpartum HR.

A
  • Tachycardia (>100bpm)
  • Causes: hypovolemia, infection, fear, pain
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5
Q

Describe normal postpartum respirations.

A

Normal: 16-24

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6
Q

Describe abnormal postpartum respirations.

A
  • Depressed respirations
  • Causes: spinal anesthesia or an epidural opioid medication
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7
Q

Describe normal postpartum BP.

A
  • Slight increase from baseline (5% increase over 1st few days, return to baseline in a few weeks)
  • Orthostatic hypotension (typically 1st 48 hours)
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8
Q

Describe abnormal postpartum BP.

A
  • Severe hypotension
  • Causes: hypovolemia due to hemorrhage
  • Hypertension (>140/90 x 2 )
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9
Q

What are the normal lab value ranges of WBC pre-pregnancy, during pregnancy, and postpartum?

A
  • Pre-Pregnancy: 5,000-10,000/mm3
  • Pregnancy: ~ 12,000
  • Postpartum: 20-25,000 (normal)
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10
Q

What are the normal lab value ranges of Hgb pre-pregnancy, during pregnancy, and postpartum?

A
  • Pre-Pregnancy: 12-16 g/dl
  • Pregnancy: ~ 12
  • Postpartum: May see initial drop of 1 g
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11
Q

What are the normal lab value ranges of Hct pre-pregnancy, during pregnancy, and postpartum?

A
  • Pre-Pregnancy: 37-47%
  • Pregnancy: ~ 33-39
  • Postpartum: Initial drop of 2-3%
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12
Q

Describe Clotting Factors & Fibrinogen during pre-pregnancy, pregnancy, and postpartum.

A
  • Pre-Pregnancy: normal
  • Pregnancy: increased
  • Postpartum: stay elevated in immediate PP
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13
Q

What does BUBBLE-LP stand for?

A
  • Breast
  • Uterus
  • Bowel/Abdomen
  • Bladder/Urinary Tract
  • Lochia
  • Emotions

Plus

  • Legs
  • Perineum
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14
Q

Expand on Breasts in BUBBLE-LP.

A

Engorgement:

  • Typically starts day 1.5-2 in multiparous person
  • Starts day 3-4 primiparous person
  • Lasts 24-48 hours
  • Breastfeeding to reduce swelling and discomfort, set up supply/demand

Nipples:

  • Assess for soreness, skin breakdown, eversion
  • Breastfeeding: how frequently, assess latch/suck/swallow
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15
Q

Expand on Uterus in BUBBLE-LP.

A
  • After birth, the uterus should be:
    • Firm
    • Midline
    • At or below the umbilicus
  • Within 12 hours after birth, the fundus typically one cm above the umbilicus
  • After postpartum day one: Descends 1-2 cm/24 hours
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16
Q

What is uterine involution?

A
  • Process by which the uterus returns to the non-pregnant state
  • Begins after expulsion of the placenta
  • Returns to non-pregnant location by 6 week postpartum
17
Q

What is sub-involution of the uterus?

A
  • Uterus does not contract and decrease in size
  • In the first few days postpartum, sub-involution often presents as uterine atony (boggy uterus)
  • Increases risk of postpartum hemorrhage
18
Q

Expand on Bowel/Abdomen in BUBBLE-LP.

A
  • Abdominal exam
    • soft vs. distended
    • bowel sounds in all 4 quadrants
    • Diastasis Recti
  • Eat when hungry
  • Prevent constipation
  • Post-op: NPO if nauseated, vomiting, no bowel sounds
19
Q

What is Diastasis Recti?

A
  • Condition that occurs when the rectus abdominal muscles in the front of the belly separate
  • Normal in many postpartum people and can be reversed
  • Postpartum support underwear—provide cross-body support to pull together separated abdominal muscles
20
Q

Expand on Bladder/Urinary Tract in BUBBLE-LP.

A
  • First 24 hours postpartum: bladder edematous, congested, hypotonic
  • Day 2-4: Diuresis – large volume of urine
  • Pericare done frequently
  • Distended bladder
  • May displace fundus – usually up and right
21
Q

Expand on Lochia in BUBBLE-LP.

Normal estimated blood loss at delivery?

A

Normal Estimated Blood Loss at delivery: up to 1000ml, regardless of the mode of birth

22
Q

What are the different types of lochia?

A
  • Rubra
  • Serosa
  • Alba
23
Q

Describe Rubra Lochia.

A
  • Bright red
  • 1-3 days postpartum
  • Flow is like a heavy menstrual period
24
Q

Describe Serosa Lochia.

A
  • Pinkish-brown
  • 4-10 days
  • Flow is moderate to small amount
25
Q

Describe Alba Lochia.

A
  • Whitish-yellow
  • 10-14 days, up to 3-6 weeks
  • Flow is scant
26
Q

Expand on Emotions in BUBBLE-LP.

A
  • Postpartum Blues
    • Day 3 – Day 10
    • Occurs in 80% of birthing people
  • Postpartum Depression
    • Lasts beyond the 1st 2 weeks and/or interferes with functioning; 25% of people
  • Psychosis: psychiatric emergency
    • High mood with racing thoughts
    • Severe confusion, paranoia
    • Hallucinations (auditory or visual)
    • Begin suddenly within 2 weeks after childbirth
27
Q

Expand on Legs in BUBBLE-LP.

A
  • Increased edema the first few days
  • Soreness from labor (not pain)
  • Normal reflexes
  • Assessment: edema, tenderness, varicosities, pain in calf
  • Abnormal Signs:
    • Unilateral leg pain/edema
    • Warmth/tenderness
  • Abnormalities require immediate evaluation for signs of venous thromboembolism!
28
Q

Expand on Perineum in BUBBLE-LP.

A
  • REEDA
    • Redness
    • Edema
    • Ecchymosis
    • Drainage
    • Approximation
  • Hemorrhoid
    • Size and color
    • Pressure/itch vs. pain
    • Hard or soft
  • Hematoma
    • Bleeding under skin from leaking vessel- may be black or blue
29
Q

Cardiovascular changes that occur postpartum?

A

Blood volume decreases:

  • Diuresis begins within 12hrs PP
    • Extracellular fluid plus delivery blood loss
  • Cardiac output increases by 60-80% immediately post delivery
    • Returns to pre-labor values within 1 hour of birth
    • Returns to pre-pregnancy levels by 6-8 weeks postpartum
  • Varicosities
    • Most resolve in the postpartum period
  • Shivering – not uncommon in the first few hours following birth, caused by sudden transition in body state (sympathetic nervous system release)
30
Q

Endocrine changes that occur postpartum?

A
  • Triggered by delivery of placenta
    • Estrogen & progesterone drop dramatically
    • Increased prolactin supports production of milk
    • Oxytocin produced in response to nipple stimulation -triggers let-down reflex
  • Return of ovulation
    • Differs between lactating and non-lactating women
      • 6-9 weeks postpartum, non-lactating
      • Breastfeeding average 6 months

408 Maternity Final Exam (6 decks)

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