Postpartum Care and Newborn Nutrition Flashcards
Postpartum Changes and Ongoing Physical Assessment (BUBBLE)
B = Breasts (firmness) and nipples
U = Uterine fundus (location; consistency)
B = Bladder function (amount; frequency)
B = Bowel function (passing gas or bowel movements)
L = Lochia (amount; colour)
L = Legs (peripheral edema)
E = Episiotomy/Laceration or Caesarean birth incision (perineum: discomfort; condition of repair, if done)
E = Emotional status (mood, fatigue)
Uterus - Expected findings
⮚Loose floppy abdominal skin
⮚ Uterus firm and contracting; not boggy** (feels
spongy), midline of abdomen
* Boggy uterus may be due to retained placental
fragments
* Uterus displace to the right may indicate full
bladder
➤ Uterus cannot contract well if bladder full
⮚ Uterus descending 1 fingerbreadth/day
⮚ Afterpains-resolve in 3 to 7 days.
Uterus - abnormal findings
⮚Uterine atony-failure of the uterus to contact-lead to
postpartum hemorrhage
⮚Distended abdomen and hypoactive bowel sounds
⮚ Red, tender, dehiscing incision
when should involution begin
immediately post delivery
how does oxytocin play a role in involution
oxytocin is released from pituitary glands and creates uterine contractions
what causes afterpains
exogenous oxytocin, breastfeeding
when should the uterus return to normal position
by 6 weeks
what are normal findings of the cervix post delivery
shortened and firm 2-3 days post delivery, and closed by about 4 weeks, and no longer round in shape
normal findings in abdomen
- initial poor abdominal muscle tone
- edema
- clean incision or tear (for c-section)
explain the IAPP for uterus (inspect, auscultate, palpate, percuss)
Inspect: distension; incision line post C-
section for infection, dehiscing,
Auscultate: all 4 quadrants for bowel
sounds
Palpate: uterine descent in relation to
umbilicus; firmness and position-abdominal
midline
Percuss: Drum like sound suggests
abdominal gas
when does the vagina and vulva return to normal post delivery
6-8 weeks
what are expected findings in the vagina and vulva pp
changes in vaginal rugae
dryness until ovulation returns
abnormal findings in abdomen pp
redness, ecchymosis (bruising), drainage, skin not approximated, hematoma (pooling blood - looks like bruise), tenderness
what pt education should the nurse provide regarding vagina and vulva care after delivery
Ice packs for first 24 hrs. (rotate 20
minutes on, 20 minutes off); then warm
sitz baths (warm shallow bath to sit in to relieve perineal pain)
Some women find witch hazel pads relieve
pain
importance of Adequate hydration
Potential need for stool softeners
Bleeding (provide the measurement in cm)
Scant:
Light:
Moderate:
Heavy:
5, 10, 15, >15cm
What are the normal findings of bleeding after delivery, give timeline.
- Lochia rubra (3 to 4 days)
➤ Bright red or rust coloured flow
➤ Blood and decidual and trophoblastic debris - Lochia serosa (lasting approximately 2 to 4 weeks)
➤ Pink, brownish coloured
➤ Old blood, serum, leukocytes, and debris - Lochia alba (4-6 weeks)
- Whitish, yellow
➤ Leukocytes, decidua, epithelial cells, mucus,
serum, and bacteria
what are the signs of PPH
Soaking pad 1-2 hrs.; passing clots >golf ball; SOB,
lightheaded, chest pains; palpitations
what should you do if you notice signs of pph
notify hcp
criteria of pph for vaginal and c-section birth
Loss of 500 mL or more of blood after vaginal birth and
1000 mL or more after Caesarean birth
what are the pph causes/risk factors *summarized see ppt for full list
- uterine atony: e.g. overdistended uterus - large fetus, multiple fetus
- placental abnormalities: e.g., retained fragments, previa
-trauma - Coagulopathy (DIC)
primary pph classification w causes/risk factors
Primary PPH occurs within 24 hours of the birth.
uterine atony
genital laceration
retained products of conception
placenta accreta/increta
uterine rupture
uterine inversion
Coagulopathy (DIC)
secondary pph classification w causes/risk factors
Secondary PPH occurs more than 24 hours but
less than 12 weeks after the birth
subinvolution of uterus
retained products of conception
infection
coagulopathy
what is the goal of care in a pt with pph
manage hypovolemic shock - restore circulating blood vol - eliminate the cause of hemorrhage
describe interventions to care for pph
- establish 2 venous sites w/ large bore iv cath (18 gauge or bigger) for fluid resuscitation - using crystalloids like lactated ringers or nacl, also colloids like albumin , or for blood/blood components for severe bld loss
- Packed RBCs are usually infused if the patient is
still actively bleeding and no improvement in
their condition - Infusion of fresh frozen plasma may be needed
if clotting factors and platelet counts are below
normal values
