Postpartum Care Fundamentals 2 Flashcards
Postpartum Assessment includes..
Hint: BUBBLLEE..V!
Breast Uterine fundus Bladder Bowel Lochia Legs Episiotomy/laceration/incision Emotion status ..Vital signs!
Normal range for heart rate in pregnant persons
10-15 bpm above normal is normal
Normal range for respiratory rate in pregnant persons
Slight increase from 16-24 breaths/min is normal
Normal range for temperature in pregnant persons
36.2 - 38 C
Increase to 38 (due to dehydration)
When is temperature expected to come back down to normal?
After 24 hours
How does epidural affect respiration? Or blood pressure?
May cause hypoventilation or hypotension
Orthostatic hypotension
Feelings of faintness or dizziness immediately after standing up
How do contractions help restore hemostasis postpartum?
Compression of intramyometrial blood vessels
What hormone is responsible for uterine contractions
Oxytocin
Where is oxytocin produced?
posterior pituitary gland
Why is oxytocin administered after expulsion of the placenta?
Decrease risk of postpartum hemorrhage
What are afterpains?
Afterbirth pains caused by vigorous uterine contractions, more common in subsequent pregnancies
Why is the role of oxytocin in breastfeeding?
Oxytocin stimulates let down of milk
Pre-eclampsia is marked by..
Hypertension
How does pregnancy affect pulse rate, stroke volume and cardiac output?
They increase throughout pregnancy and could remain elevated over nonpregnant values for 12 weeks after birth
Define involution
The return of the uterus to a nonpregnant state following birth.
What is the normal rate of uterine involution?
1-2 cms q24h
The uterus should not be palpable abdominally after how many weeks?
2 weeks
Subinvolution
What causes it?
Failure of the uterus to return to a nonpregnant state.
Usually caused by infection or retained placental fragments
Where can you find the fundus within the first 12 hours post delivery?
1 cm above umbilicus
What is the two hand technique?
Massaging of the uterine fundus with two hands to stimulate contraction. Lower hand supports the uterus to avoid prolapse and inversion of uterus.
What does @u, 1/u or u/2 stand for?
@u = at umbilicus 1/u = 1 cm above umbilicus u/2 = 2 cm below umbilicus
Why might a fundus be deviated/
Obstructed and/or displaced by distended bladder
Lochia rubra
- bright red
- blood
- small clots
- tissue debris
- 3-4 days postpartum
Lochia serosa
- pink-brown
- old blood
- serum
- leukocytes
- tissue debris
- 22-27 days postpartum
Lochia alba
- yellow-white
- serum
- leukocytes
- mucus
- epithelial cells
- 2-6 weeks postpartum
How is lochia amount documented?
Scant (5 cm)
Light (10 cm)
Moderate (15 cm)
Larger (> 15 cm, full pad!)
How are placenta clots identified?
- typically larger than a small plum
- placenta clots CANNOT be pulled apart by hand
How to tell when bleeding is “non-lochial”?
Firm uterine fundus but bloody discharge spurts or gushes - may indicate cervical or vaginal tear
How dilated is the cervix to be expected 2-3 days postpartum?
2-3 cm
First Degree Perineal Tear
Tear in vaginal opening
Second Degree Perineal Tear
Torn perineal muscles
Third Degree Perineal Tear
Torn perineal muscles and anal sphincter
Fourth Degree Perineal Tear
Full tear through to anus, fistula
What appropriate nursing interventions are provided in case of 3rd or 4th degree tear?
- Laxatives
- Liquid diet only
- no suppositories until tissues are healed
When might episiotomy be indicated?
Multiple lacerations
What is medio-lateral and midline episiotomy?
Medio-lateral is to the right while midline is towards anus
On average, how long does it take for episiotomy to heal?
2 to 3 weeks but 4-6 months can be required for complete healing
What nursing interventions are appropriate for perineum care?
- Assess REEDA
- Assess presence of hemorrhoids
- Ice therapy to reduce swelling (20 mins on, 20 mins off for first 24 hours)
- Peri bottle
- Sitz bath (warm, moist, heat therapy after 24 hours)
What does REEDA stand for?
Redness Ecchymosis (bruising) Edema Discharge/discomfort Approximation
How is the assessment for C/S patients the same or different? Breast Uterine fundus Bladder Bowel Lochia Legs Emotional status Incision Pain Vitals
Breast - same
Uterine fundus - involution is important, capitalize on epidural
Bladder - foley catheter usually in place for 12 hrs
Bowel - gas pains from decreased movement
Lochia - slightly less
Legs - increased risk for venous clot
Emotional status - unplanned c/s
Incision - dressing but also perineum assessment
Pain
Vitals - increased frequency (c/s is a surgery!)
What are some things that are important for c/s patient postpartum?
- pass gas
- ambulate after catheter removed (dangling first!)
- don’t lift heavier than baby
What are 3 postpartum complications?
- Infection
- Postpartum Hemorrhage (PPH)
- Perinatal Mood Disorder (PMD)
What are the common causes of PPH?
- Uterine atony (first 24 hours)
- Genital tract lacerations
- Retained placenta (or infection; 24 hours to 2 weeks postpartum)
What are the signs of hypovolemic shock?
- perineal pad soaked within 15 minutes
- client feels weak, light-headed, nauseated, sees stars
- client appears anxious
- skin colour turns ashen or greyish, cool and clammy
- increased pulse rate
What are some nursing implications to prevent PPH?
- assess & monitor RISKS
- s&s of PPH
- care coordination
- health promotion
- illness prevention
The 4 T’s (Risk factors for PPH)
Tone
Tissue
Trauma
cloTting
What are some risks that could reduce uterine tone?
- multip
- multifetal pregnancy (overdistended uterus)
- certain medications
- faster-than-normal labour
What are the nursing interventions for PPH?
- fundal massage
- monitor vital signs
- urinary bladder status
- circulatory support: IV fluids, oxygen, utertonics (oxytocin)
- call for help, stay with cient
What medical interventions are used to treat PPH?
- utertonic escalation
- blood transfusion
- bimanual uterine compression
- surgical interventions: intrauterine balloon tamponade, uterine artery embolization, hysterectomy
What are the 3 types of Perinatal Mood Disorders (PMD)?
- postpartum “blues”
- postpartum depression (no psychosis)
- postpartum depression (psychosis)
Postpartum blues
- 50-80%
- peaks by day 5, subsides by day 10
- fatigue, sadness, anger, no functional impairment
What interventions are appropriate for postpartum blues?
- reassurance
- health teaching
- connection with supports and community resources
Postpartum depression (no psychosis)
- 10-15%
- may last week to 1 year
- appetite change, guilt, worthlessness, inability to cope, intense irrational fears, decreased concentration
What interventions are used to treat postpartum depression (no psychosis)?
- non-directive counselling
- interpersonal psychotherapy
- CBT
- peer support
- medication
Postpartum Depression (psychosis)
- 1-2 per 1000 births
- 2-8 weeks
- depression, delusions, thoughts of harm to self or infant, agitated, disorganized behaviour, inability to care for infant
What interventions are appropriate for postpartum depression (psychosis)?
- prompt assessment and hospitalization
- medication
- psychotherapy
Name 2 STRONG risk for PP Depression?
- prenatal depression and/or anxiety
2. personal/family history of depression
Name 3 MODERATE risk for PPD?
- Stressful life event
- Lack of social support
- Intimate partner violence
Name 4 WEAK risk for PPD?
- single parent
- stress of child care
- low SES
- unwanted/unplanned pregnancy
What is the nurse’s role in preventing PMD?
- screening (listen, care and get to know the client)
- health promotion/education/prevention
- anticipatory guidance
- safety assessment
- support, reassurance (referrals)
Symptoms of PPD in partner?
- may be different from birth parent
- anger, irritability
- increase in violent behaviour
- increase in substance use
Postpartum infection
presence of a fever of 38C or higher on 2 successive days of the first 10 postpartum days (not counting first 24 hours)
What are some common postpartum infections?
- endometritis
- wound infections
- mastitis
- UTIs
- respiratory tract infections
Endometritis
Infection of the lining of uterus
Mastitis
Breast infection
- almost always unilateral
- commonly caused by hemolytic s. aureus
