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
what would the nurse assess in pph
- Palpation of Pulses (Rate, Quality, Equality),
BP, pulse oximetry - Skin colour, temperature, turgor
- Level of consciousness
- Heart sounds/murmurs
- Breath sounds
- Anxiety, apprehension, restlessness,
disorientation - Monitor Urinary output
- Monitor hemorrhagic
normal bladder/bowl findings
- voiding within first 6 hrs, usually attempt to empty bladder after 2 hrs
- Potential for bladder distention due to normal
postpartum diuresis - Epidural – potential for urinary retention
- Should have good bowel sounds; be passing gas
How much should post delivery pt be voiding
360cc/12hr or 30cc/hr minimum
what nursing education should you provide to pp pt on bladder and bowels
Encourage voiding – assess ability to void as
full bladder may compromise ability of uterus to
contract post delivery
* Remind to pat dry front to back to avoid infection
* Educate Kegel/pelvic muscles exercises to improve
tone
* Encourage ambulation
* Encourage adequate fluid and food intake
* Stool softener
what is the daily caloric intake rec for normal women
1800-2200
how many added cals should lactating women add to their diet per day
350-400
what vaccination should the mother receive after birth if they havent already
rubella
what is the use of rh immune globulin, who should we give it to, and when
given to rh negative mothers within 72 hrs of giving birth to rh positive baby. The mother may have developed rh antibodies during pregnancy which will attack rh antigens, which will harm the next pregnancy if the fetus is rh positive. The rh immune globulin protects against this immune attack.
post partum blues timeline
1-5 days pp, resolves within 2 weeks
explain the collaborative care of perinatal anxiety disorder
- psychotherapy including cognitive behavioural
therapy (CBT) and exposure response
prevention (ERP)
⮚ Medications
* selective serotonin reuptake inhibitors
(SSRIs) and antianxiety medications
* Benzodiazepines provided for short-
term relief
special considerations to make for SSRIs and antianxiety medications
take up to 2 weeks for these medications to be effective
benzodiazepines special considerations
should be prescribed carefully as they are addictive
explain the collaborative care of perinatal depression
-Psychotherapy-general counselling
(listening visits),
- interpersonal
psychotherapy
- CBT and psychodynamic therapy
in combination with:
- Anti-depressant-selective serotonin
reuptake inhibitors (SSRI) are the first-line
of treatment
* Peer support
* Hospitalization in severe perinatal
depression
examples of antidepressant SSRIs
Sertraline, citalopram, escitalopram
Explain what postpartum psychosis is
- mania
- includes depressions with hallucinations, delusions, thoughts of self or infant harm
- psychiatric emergency, may require psychiatric hospitalization
collaborative care (treatment) of pp psychosis
- first line: antipsychotics, mood stabilizers, and benzodiazepines
- psychotherapy after acute phase has passed
- electroshock therapy
what screening tools are used to screen for depression
-screening edinburgh postnatal depression scale (epds)
- postpartum depression screening scale (pdss)
