Postpartum Care Flashcards
Postpartum Period
Birth to about 6 weeks after
Return of reproductive organs to pre-pregnancy state
4th Trimester
Puerperium
Uterus Weight Full Term
11x bigger than per-pregnacny!!
6weeks - 80 grams
Subinvolution
Failure of uterus to return to original state
Hemorrhage is a BIG Problem
Most common cause: Retained placental fragments and infection
Oxytocin
Released by posterior pituitary
Promotes homeostasis
Prevents hemorrhage
Causes contractions- compresses blood vessels
Helps uterus get smaller
Breastfeeding within 1-2 hours also helps!
Afterpains
Contractions after birth
More common with 2+ child
Lochia Rubra
Red discharge
Birth to about 4 days
Lochia Serosa
Pink discharge
Day 3/4 until about 10 days
Lochia Alba
White/ Yellow discharge
Can continue up to 4-8 weeks after delivery
Flow is normally until 6 weeks
Menstrual Cycle
Not breastfeeding will return around 4-10 weeks
Breastfeeding will return around 3 months or cessation of breastfeeding
Fundus Movement
Decreases 1cm a day
Hemorrhage
1 pad per hour
>500 ml vaginal deliver
> 1,000 ml c-section
Fluid Change
Diuresis 12 hours after birth
Decreased bladder sensitivity- may cause over distention of the bladder
Diaphoresis is very common- especially at night
May lose up to 5lbs in first few days
1st Degree Laceration
Only the skin of the perineal area
2nd Degree Laceration
Skin and the perineal muscle
3rd Degree Laceration
Skin, perineal muscle, and part of the anal sphincter
4th Degree Laceration
Skin, perineal muscle, complete tear of anal sphincter and involves tissue lining the rectum
Extensive repair
Bowel Function
May take up to 3-4 days From lack of food during labor, fear r/t lacerations STOOL SOFTENERS! Should be passing gas NO SEX 6 WEEKS
Breast Changes
Little change in 1st 24 hours 72-96 hours breast milk comes in (3-4 days) Become fuller and heavier Warm, full and tender Cant pump away inflammation Progesterone DROPS
Not Breastfeeding Measures
Tight, supportive bra
Avoid stimulation- hot shower
Breast Binder
Ice packs
Ovulation
Not breastfeeding- 7-9 weeks
Breastfeeding- 2-18months depending on exclusivity
Blood Changes
Increased clotting factors and fibrinogen
Hypercoaguable state
High risk for thromboembolism, especially after c/s
150,000 platelet count= LOW < = Pre-eclampsia
Skin Changes
Face, nipples and line down center of stomach get darker from increased estrogen
Striae Gravidarum
Stretch marks
darker pink/ red/ purple in white women
2/3 get them
10% of black women get them- appear lighter
BUBBLE HE
Breasts Uterus Bladder Bowel Lochia Episipotmy Homans sign Emotional status
Breast Assessment
Assess for engorgement, sore or cracked nips
Uterus Assessment
Fundus should be level of belly button shortly after birth
Moves 1 cm a day
To the right- possible full bladder or uterine atony!!
Fundal massage if uterine atony is expected
Bladder Assessment
Assess for complete emptying, burning and ability to void
Epidural- may need straight cath
C- seciton- indwelling cath
Bowel Assessment
No bowel movement 2-4 days
Passing gas is a positive sign
For a c/s assess bowel sounds
Lochia Assessment
Rubra- while in hospital Assess amount, color, any odor More than a pad an hour- EXCESSIVE Clots are normal with fundal massage 1st few times ambulating- use a blue pad, blood can pool in vagina then rush out when standing
Episiotomy Assessment
Assess approximation, swelling, bruising
Ice packs are recommended
Topical meds can help - epifoam, benzocaine
3rd and 4th degree- sitz baths!
Homans Sign
Quickly dorsiflexing the foot upward
Looking for calf pain- can indicate thromboembolism
Assess for leg soreness, warmth or redness
Ambulating PP
After meds wear off and are stable
4x a day
Sequential Compression Devices
For c-section patients
On until ambulating
Decreases chances of blood clots
Emotional Status Assessment
Note affect, support system
Assess for hx or anxiety, depression, panic disorders
Reaction to labor and birth
Interactions with the baby and partner/family members
DTAP Immunization
PERTUSSIS
In late 2nd or 3rd trimester
Recommended for those interacting most with baby
Not immunized during pregnancy- do in PP
Rubella Immunization
Vaccination during PP if not immune
Informed consent is important!
Cannot get pregnant for 1month after vaccination
Side effect: muscle pain
RHOgam
Given to RH- moms at 28 weeks
Prevents sensitization
Sensitization can occur during miscarriage, trauma, birth
Jehovah witness denies - made from human plasma
RH -/+ Problems
If not given RHOgam, RH- blood will attack RBC of baby
Causes anemia, jaundice, and more
Discharge Lengths
Vaginal delivery - 48hour
C-section - 96hours, stay a tleast for 48 hours, most go home around day 3
Prenatal Vitamins
Continue for up to 6 weeks after birth
Supporting Mom & Baby Bonding
Early skin to skin
Rooming in
Touching behaviors
Eye contact, odor, voice recognition
Discharge Teaching
Bathing/dressing, diapers, hearing and newborn screening, circumcision care, breastfeeding, formula feedings, contraception, care after discharge, are seat, back to sleep, self care.
6-8week for 1st checkup
SMILE!
YOURE GOING TO DO GREAT!
