Postpartum Assessment and Recovery: 11 Flashcards
Hemoglobin in pregnancy?
May see initial drop of?
Hematocrit in pregnancy?
May see initial drop of
~ 12 in pregnancy
May see initial drop of 1 g
~ 33-39 in pregnancy
Initial drop of 2-3%
Cardiovascular
What happens to Blood volume?
When does Diuresis begin?
Cardiac output increases by?
Returns to pre-labor values within
Varicose veins?
Shivering?
Blood volume decreases
Diuresis begins within 12hrs PP
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
Varicose veins: 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)
Endocrine changes
Triggered by?
What 2 levels drop ?
What supports production of milk?
Oxytocin produced in response to
When is return of ovulation for non-lactating mothers?
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
-6-9 weeks postpartum, for non-lactating
Postpartum temperature?
Should be less than 101 in the first 24 hours
Postpartum Normal Heart Rate?
Remains?
Gradually decreases over?
May be?
Tachycardia is?
50-90
Remains elevated 1st hour after birth
Gradually decreases over 1st 48 hours
May be bradycardic (40-50)
Tachycardia (>100 bpm)
Causes: hypovolemia, infection, fear, pain.
Postpartum Respirations?
Postpartum BP for hypertension?
16-24
Hypertension >140/90 x 2
BUBBLE LP acronym?
Breast
Uterus
Bowel / abdomen
Bladder/ uterus
Lochia
Emotions
Legs
Perineum
WBC values
During pregnancy?
Postpartum?
~ 12,000
20 - 25,000 is normal
Uterus: Involution
What is it?
Begins after?
Returns to normal by?
After birth, the uterus should be? 3
Within 12 hours after birth?
After postpartum day one?
Process by which the uterus returns to the non-pregnant state
Begins after placenta is out of the body
Returns to normal by 6 weeks postpartum
Firm
Midline
At or below the umbilicus
Within 12 hours after birth, the fundus typically one cm above the umbilicus
Descends 1-2 cm/24 hours
Breast
Assess engorgement and nipples, plus breastfeeding process
Bowels/Abdomen
When is client NPO in post op?
Abdominal exam
Eat when hungry
Prevent constipation
Post-op: NPO if nauseated, vomiting, no bowel sounds
Uterine Atony: Nursing Treatment
soft or lacking tone
Frequent uterine assessment
Fundal massage
Assess bladder
Administer uterotonics
Start or open IV fluids
Quantification of blood loss (QBL)
Subinvolution of the uterus
What is it?
Often presents as?
Increases risk for?
Uterus does not return to its normal size after childbirth
In the first few days postpartum, often presents as uterine atony (AKA ‘boggy uterus’)
Increases risk for postpartum hemorrhage
Diastasis Recti
Postpartum support underwear
provide cross- body support to pull together separated abdominal muscles
Bladder
First 24 hours postpartum, bladder is?
Day 2-4?
Distended bladder does what?
What to do if patient hasnt voided in 6 hours?
what if they havent voided in 24 hours?
First 24 hours postpartum, bladder is edematous, congested, hypotonic
Day 2-4: Diuresis– large volume of urine
Distended bladder: full bladder will push fundus up and right.
Straight cath if pt hasn’t void in 6 hours
Insert foley cath if pt hasn’t void in 24 hours
Lochia Rubra
Color?
how many days PP?
Flow is?
Bright Red
1-3 days postpartum
Flow is like a heavy menstrual period
Blood from placenta site,
trophoblastic tissue debris,
vernix, lanugo, meconium
Lochia Serosa
Color?
How many days postpartum?
flow is?
Pinkish- brown
4-10 days
Flow is moderate to small amount
Blood wound exudate, RBC’s
WBC’s trophoblastic tissue debris,
cervical mucus, microorganisms
Lochia Alba
Color?
How many days PP?
Flow is?
Whitish- yellow
10-14 days, up to 3-6 weeks
Flow is scant (barely)
WBC’s trophoblastic tissue debris
Perineum
REEDA?
How to assess Hemorrhoid?
symptom of Hematoma?
- Redness
- Edema
- Ecchymosis = bruising
- Drainage
- Approximation
Hemorrhoid
* Size and color
* Pressure/itch vs. pain
* soft is normal, hard is bad
Hematoma
Bleeding under skin from leaking vessel-may be black or blue
Symptom: if labia is bigger
Emotions
Postpartum Blues?
Postpartum Depression lasts beyond?
Psychosis?
Blues: Occurs in 80% of birthing people
Depression: Lasts beyond the first 2 weeks and/or interferes with functioning
Psychosis: psychiatric emergency!!!!
Legs (Lower Extremities)
What’s normal?
Assessment?
Abnormal Signs? 2
Abnormalities require?
Normal: increased edema the first few days, and soreness from labor.
Assessment: edema, tenderness, varicosities, pain in calf
Abnormal Signs:
* Unilateral leg pain/edema
* Warmth/tenderness
Abnormalities require immediate followup for VTE!!!!!!!!
