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Maternal Infant > Postpartum Assessment > Flashcards

Postpartum Assessment Flashcards

1
Q

Describe Maternal Physiological Changes

A 
-Postpartum period is 
 interval between birth 
 and return of 
 reproductive organs to 
 their nonpregnant state

-Referred to 4th
trimester of pregnancy

-Traditionally lasts 6
wks, although this
varies among women

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2
Q

List the Goals of Postpartum Care

A 
-Assist and support 
 recovery
-Educate mom about self-
 care
-Educate mom/supports 
 about infant care
-Monitor for signs/risks of --Postpartum Hemorrhage 
 (PPH)
-Monitor for signs/risk of 
 infection
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3
Q

What do I need to know about a postpartum patient?

A

-Infant status and feeding
-GBS (Group B-strep)
status
-Rh status
-Risk for PPH

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4
Q

Assessments: Vital Signs

A
  • Pulse
  • Blood pressure
  • Respirations
  • Temperature
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5
Q

Assessment: PAIN

A

-Subjective pain score
-Resolution of epidural
analgesia

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6
Q

Assessment: BUBBLLEE

A 
Breast
Uterus
Bladder
Bowel
Lochia
Legs
Episiotomy/laceration or C/S birth incision
Emotional
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7
Q

Assessment: BREAST

A 
Soft 
Tenderness
Localized redness
Filling/Full/Engorged 
Is mom pumping?
What type of support does she require?
Nipples
       -status (intact)
       -signs of breakdown (redness,  
        cracking)
       -tenderness, bruising
       -inverted or flat

Colostrum/milk present

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8
Q

Breast Assessment: Day 1 and 2 & 3 and4

A 
Day 1 and 2: 
-Little if any change in -
 breast tissue in first 24 
 hours
-Tingling sensation
-Secrete colostrum
Day 3-4:
-“milk coming in”
-Begin to secrete “true” 
 milk-bluish white in colour
-Breasts may feel warm, 
 firm tender
-Engorgement – due to 
 lymph and venous stasis 
 so breasts feel full, tender 
 and uncomfortable
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9
Q

Breast Assessment - ENGORGEMENT

A 
-breasts become firm, 
 tender, swollen, and hot, 
 and appear shiny and 
 red
-tenderness and swelling 
 may extend into the 
 axilla
-areolae then become 
 firm and the nipples may 
 flatten, making it difficult 
 for the newborn to latch 
 on
-Temporary condition 
 that usually resolves in 
 24 hours
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10
Q

Breast Assessment- HEALTH TEACHING

A

-Frequent feedings
-Ice packs are
recommended in a
rotation of 15 to 20
minutes on, 45 minutes
off between feedings; ice
packs should cover both
breasts. Large bags of
frozen peas or corn make
easy packs and can be
refrozen between uses
-Fresh raw cabbage
leaves placed over the
breasts in between
feedings may help reduce
the swelling and
discomfort
-Anti-inflammatory
medications-Ibuprofen for
pain and swelling
-Stand in warm shower to
start milk flow to manually
express to soften around
areola

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11
Q

Assessment of Uterus (Fundus)

A

***Fundus should always be “firm”

Fundus is measured in relation to the umbilicus

Assessment of the fundus is best in supine position and with an empty bladder

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12
Q

Assessment of Uterus

A

Measured in finger breadths or centimeters

At delivery the fundus is slightly above or at the level of the umbilicus

Involution occurs at ≈ 1 cm per day (1 fingerbreadth)

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13
Q

Assessment of Fundus

A

Degree of firmness:
Support the lower uterine segment with non-dominant hand and palpate the uterine fundus for firmness
Described as:
-firm
-soft
-boggy
***Vigorous massage can potentiate uterine atony

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14
Q

Bladder Assessment includes:

A

Assess urinary output and first void

Assess location of fundus:
Midline or deviated to the right

Full bladder displaces the uterus up and laterally to the right risk that uterus does not contract normallyPPH

Normal pregnancy is associated with increase in extracellular fluid

Bladder has increased capacity and decreased tone

Leads to over-distension of the bladder and increased risk for:
Retention of residual urine
Urinary Tract Infection (UTI)
Postpartum Hemorrhage (PPH)

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15
Q

Signs of a Distended Bladder

A

-Fundus above umbilicus
-Fundus deviated to one
side (usually right)
-Bulge of bladder above
symphysis
-Excessive lochia
-Tenderness over bladder
area
-Frequent voidings (less
than 150 cc)

***When did the patient last void?

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16
Q

Bladder Assessment - Signs of Infection

A

***Signs of infection
-Infrequent/insufficient
voiding
-Discomfort/burning on
urination/foul-smelling urine
-Health Teaching:
-Void frequently; pericare
after each void and BM; ++
drinking.
-Change pads frequently

17
Q

Bowel Assessment includes:

A 
Assess for:
-Passing flatus
-First bowel movement
-Hemorrhoids
-Bowel sounds (all 4 
 quadrants)
18
Q

What is Lochia and what does the Lochia assessment include?

A 
Lochia is uterine blood flow and is normal after birth from the placental site.
Assessment includes:
   -Amount
   -Type
   -Presence and size of 
     clots
   -Odour
19
Q

Describe Rubra, Serosa, and Alba Lochia

A

Rubra: dark red discharge and may contain blood clots (From day 1 to day 3 or 4)

Serosa: lochia is thinner & is pink or brown discharge (from day 3 or 4 to and can last 22 to 27 days, although typically after day 10 turns to alba)

Alba: yellowish white discharge (persist 4 to 8 weeks after delivery).
What is a concern if lochia rubra lasts longer than 3 or 4 days?

20
Q

Describe Lochia Odour and health teaching.

A

Odour: normal- “musky” scent

Abnormal- Foul smelling

Health Teaching:

  • Pericare
  • Frequent pad changes
  • Frequent urination
  • Increased fluid intake
  • Increased activity
21
Q

Leg Assessment includes:

A 
Assessment :
-Over all symmetry
-Presence of pain 
 (especially with 
 ambulation)
-Swelling
-Temperature
-Presence of any raised 
 reddened areas 
 (especially on the  
 posterior calf)
-Presence of varicosities
***Assessing for signs of Deep Vein Thrombosis (DVT)
Health Teaching: 
-Increased activity early 
 post delivery (especially 
 after C/S)
-Analgesia
-Support stockings
-Decrease risk factors (ie. 
 Smoking)
22
Q

Assessment for Episiotomy/Laceration/Perineum includes?

A 
-Assess in side-
 lying position
-Assess pain
-Assess for REEDA
   Redness
   Edema
   Ecchymosis
   Discharge
   Approx. of edges

**Increased pain may indicate infection, hematoma, hemorrhoids

23
Q

PERI CARE includes?

A

-Cleaning
-Wash hands b/f
after cleansing perineum/changing pads.
-Wash perineum with mild
soap and warm water at
least once daily.
-Cleanse from symphysis
pubis to anal area.
-Apply peripad from front
to back, protecting inner
surface of pad from
contamination.
-Wrap soiled pad and place
in covered waste
container.
-Change pad with each
void or defecation
-Assess amount and
character of lochia with
each pad change
-Ice Pack (for First 24
Hours)
-Squeeze Bottle (Peri
Bottle)
-Sitz Bath
-Analgesics for pain and
swelling (ie. ibuprofen)

24
Q

Emotional Status- 3 stages of postpartum include?

A

3 Stages of Postpartum
1. “Taking In Phase” patient is focused on self, the delivery, ingestion of food, and resting more.

  1. “Taking Hold Phase” patient is now focused on her health and her baby. This is the phase where the best health teaching is established.
  2. “Letting Go Phase” patient now is ready to re-engage with her previous relationships. Increased socialization is now occurring.
25
Q

Emotional Assessment Includes:

A 
-Is new mom bonding with 
 her baby?
-Does new mother have 
 support systems?
-Is there evidence of 
 attempt to transition to 
 new role as 
 parent/parents?
-Do you anticipate 
 resources required for 
 discharge?
26
Q

Emotional Assessment: Perinatal Mood Disorders (PMD)

A 
Postpartum Blues
-Up to 80% of women; 
 functioning is NOT 
 impaired
-All ethnic and racial 
 groups experience the 
 postpartum blues.
-Emotionally labile and often cry easily for no apparent reason.
-Symptoms include 
 depression, a let-down 
 feeling, restlessness, 
 fatigue, insomnia, 
 headache, anxiety, 
 sadness, and anger
-Blues are transient, mild, 
 and time limited and do 
 not require treatment 
 other than reassurance 
-Etiology unknown
27
Q

Emotional Assessment - POSTPARTUM DEPRESSION

A 
Postpartum Depression
-An intense and pervasive 
 sadness with severe and 
 labile mood swings
-More serious and 
 persistent than 
 postpartum blues
-Low energy, general lack 
 of enjoyment and labile 
 mood swings; reduced 
 concentration and self 
 esteem and feelings of 
 hopelessness,inadequacy and guilt; alterations in sleep and eating patterns, and in severe cases suicidal ideation
-10 to 15% of new mothers
-Symptoms rarely disappear 
 without outside help
-Box 24-4 and 24-5 for 
 complications and risk factors
28
Q

Emotional Assessment- Postpartum Psychosis

A 
-A syndrome most often 
 characterized by 
 depression, delusions, 
 and thoughts by the 
 mother of harming either 
 the infant or herself 
-Occurs in 0.1 to 0.2% of 
 postpartum women 
-Once a woman has had 
 one postpartum episode 
 with psychotic features, 
 there is a 30 to 50% 
 likelihood of recurrence 
 with each subsequent 
 birth
-Mean time to onset is 
 within first two weeks
-Auditory or visual 
 hallucinations, paranoid 
 or grandiose delusions, 
 extreme deficits in 
 judgment accompanied 
 by high level of 
 impulsivity that can 
 contribute to increase risk 
 of suicide or infanticide.
29
Q

Assessment and Treatment of PMD

A

-RNAO Best practice Guidelines for PPD
-Edinburgh Postnatal Depression Scale (EPDS)
-Inpatient admittance
-Antipsychotic and mood stabilizers
ECT

Maternal Infant (5 decks)

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