postpartum (ch 20, 21, 22) Flashcards
another term for post-partum period
puerpural/perperium
interval between birth and return of the reproductive
organs to their nonpregnant state
postpartum period
reverting of uterus back to nonpregnant state
-contractions
-afterpains
-placental site (healing w/o scar)
involution
when is uterine involution complete
5-6 weeks
immediately after birth where should uterus be?
after 24 hours?
immediately after: +1 cm above umbilicus
24 hours: at umbilicus
for each day after that: -1 cm below umbilicus
what increases risks of afterpains in uterus (3)
-multiparas
-mothers of large infants
-multiple gestation
when are uterine afterpains usually experienced
2-3 days after birth
what causes increased afterpains
breastfeeding
-oxytocin released from posterior pituitary (causing more uterine contractions)
what makes up the lochia
-sloughed off innermost lining of decidua
-RBCs
-WBCs
-cervical mucous
-bacterial cells
what could cause decreased lochia
c section
what could cause increased lochia (2)
-ambulation
-breastfeeding
3 different types of lochia
-lochia lubra
-lochia serosa
-lochia alba
characteristics of lochia rubra
-days 1-3 PP
-dark/bright red
-small clots
-possible musty odor
-variable flow (heavy to light)
characteristics of lochia serosa
-days 4-10
-pink/ pinkish brown
-no clots
-less odor
-moderate to scant flow
characteristics of lochia alba
-days 10-14 (can last 3-6 weeks)
-light yellow to creamy color
-no clots
-no odor
-scant flow
characteristics of perineum immediately after birth
-tender
-swollen
-bruising
-maybe sutures
-maybe laceration repair
pain control measures for perineum
-ice reduces swelling
-anti-inflammatory creams
-local pain control (epi-foam)
what hormones suppress milk production during prenatal period
estrogen
progesterone
changes in breast within 24 hours after birth
colostrum:
-yellowish fluid high in proteins and minerals
-provides initial infant immunities
changes in breast 3-5 days after birth
-breast milk production begins
-engorgement (painful over-filling, firm, warm to touch, tender)
cardiovascular and hematologic changes after birth
-blood loss (200-1000 mL)
-increased circulating blood volume 15-30%
-loss of vasodilating effects of pregnancy hormones
-shift of ECF into systemic circulation
-increased circulating volume leads to sweat and urination (fluctuating Hgb and Hct for 3-4 days)
-increased WBC during labor and immediately after birth (up to 30,000; back to normal by 4-7 days)
-thromboplastin released at placental site (fibrinogen and clotting factors remain high)
when is blood volume back to pre-pregnancy state
4th week PP
normal blood loss vaginal birth
200-500 mL
normal blood loss C/S
700-1000 mL
changes in endocrine system PP
-estrogen and progesterone decrease (baby blues)
-prolactin elevated
-oxytocin triggers milk let down reflex
-ovulation returns
-menstrual cycle return
when does ovulation return for non-breastfeeding women
7-9 weeks
when does ovulation return for breastfeeding women
average 6 months (highly variable)
when does menstrual cycle return for non-breastfeeding women
about 3 months
when does menstrual cycle return for breastfeeding women
about 6 months
*ovulation frequently returns before menses
changes in urinary system after birth
-aids in removal excess fluids PP
-may void as much as 3 L/day
-may experience bladder distention
-usually will void within 4-6 hrs after birth
when does bladder tone return after birth
5-7 days
characteristics of abdomen after birth
-soft, flabby, protuberant
-exercise to strengthen as per provider instructions
-striae gravidarum fade
-possible diastasis recti
changes in GI system after birth
-very hungry following birth
-decreased muscle tone and mobility
-gaseous distention
-sluggish bowels, fear of BM
-constipation
-BM should occur 2-3 days after birth
musculoskeletal changes after birth
-muscle soreness
-PP chills, trembling, feeling cold
integumentary changes after birth
-pigmentation changes of pregnancy fade
-periods of profuse sweating (normal)
neurologic changes after birth
-headaches common in first PP week
-reversal of maternal adaptations to pregnancy and pregnancy-induced neurologic discomforts
immune system changes after birth
-gradually returns to prepregnant state after mild suppression during pregnancy
-women with autoimmune disease may have “flare up”
frequency of VS for postpartum care
q4h for 24 hrs
q8-12hr until discharge
BP concern during postpartum
orthostatic hypotension common for 48 hrs
fall risk
can you use homans sign on postpartum women
no! contraindicated
can you use homans sign on postpartum women
no! contraindicated
abnormal findings of nipples
blisters
cracks
fissures
*means baby is not latching on correctly
nursing considerations for palpating fundus
-mom’s bladder empty
-laying supine, hob empty
peripad blood stain = <2 in (<10 mL) within 1 hr
scant
peripad blood stain = 2-4 in (10-25 mL) within 1 hr
light/small
peripad blood stain = 4-6 in (25-50 mL) within 1 hr
moderate
when can you stop measuring voids
3 consistent voids of atleast 150 mL urine
peripad blood stain = >6 in to saturated (50-80 mL) within 1 hr
heavy
pt education for bladder health PP (signs of UTI)
-pain
-frequency
-burning
how often to assess perineum and anus PP
q4h for 24 h
q8-12h until discharge
what do you assess for in perineum and anus PP
-REEDA if episiotomy
-bruising and edema if no episiotomy
-hemorrhoids
REEDA
redness
echimosis
edema
discharge
approximation
risk factors poor nutrition postpartum (need dietary consult) (4)
-underweight prepregnancy
-inadequate weight gain during pregnancy
-low iron stores (Hct)
-excessive intrapartum blood loss
targeted postpartum assessment (BUBBLE-LE)
Breast
Uterus
Bladder
Bowels
Lochia
Episiotomy
Lower extremities
Emotional status
targeted postpartum assessment (BUBBLE-LE)
Breast
Uterus
Bladder
Bowels
Lochia
Episiotomy
Lower extremities
Emotional status
measures to suppress lactation for formula feeding mother (5)
-wear tight bra/breast binder continuously for 72+ hrs
-avoid stimulation (running warm water on breasts in shower, newborn suckling, pumping)
-ice packs (15 mins on, 45 mins off)
-fresh cabbage leaves
-analgesic if needed
interventions for breasts for breastfeeding mother (5)
-nipple care (don’t use soap on them in shower)
-prevention of engorgement
-Tx of engorgement
-support bra (no underwire)
-managing leaking
how to prevent engorgement for breastfeeding moms
frequently nursing baby (q2h)
Tx engorgement for breastfeeding moms
-frequently nursing baby
-completely empty breast with baby/pump
how to manage leaking for breastfeeding moms
-wear t-shirts with print on them
-put pressure on nipples and push them back
-nursing pads (no plastic)
interventions for bowel elimination
-stool softeners (laxative)
-avoid opioids
-OTC Tx for hemorrhoids
-adequate fluid intake
-gas pain (walking, antiflatulence med - simethicone)
interventions for bladder elimination
-assist pt to bathroom or onto bedpan
IF CAN’T PEE (hasn’t 4-6 hrs after birth):
-listen to running water
-put pt hands in warm water
-pour warm water over perineum
-assist into shower/sitz bath
-monitor output
-voiding q2h
-peri care
-assess for S+S UTI
interventions for perineum
-ice for first 24 hrs, can use heat after that
-peri care after each void and bm
-sitz baths
-side lying positions
-kegels
-NO “donuts” rubber rings for sitting
pt teaching for care of perineum
-peri bottle
-sitting (squeeze, sit, relax)
-NO “donuts” rubber rings for sitting
-kegels (do it at all the red lights)
-how to handle maternity pads (change every time she goes to bathroom)
-topical meds
nonpharmacologic interventions for afterbirth pains
-warmth
-distraction
-deep breathing
-imagery
-therapeutic touch
-relaxation
-interaction with infant
nonpharmacologic interventions for episiotomy/perineal laceration
-positioning (side lying)
-ice pack
-topical application
-dry heat
-cleansing with squeeze bottle
-cleansing shower/tub bath
-sitz bath
nonpharmacologic interventions for engorgement
-ice
-well fitting bra
-if breastfeeding: nurse baby/pump
pharmacologic interventions for PP
-analgesics, NSAIDs
-topical antiseptic/anesthetic ointments
-PCA pumps
-continuous epidural analgesia
interventions for rest, fatigue, and exercise PP
-relaxation techniques: back rubs, imagery, music
-limiting visitors prn
-adjust routines as necessary
-comfort of partner
-explain physiologic and emotional components of fatigue and need for rest
interventions for immunity PP, what vaccines can be given
(all ok if breastfeeding)
-rubella (MMR) - given at hospital
-varicella
-Tdap (anyone who will be around baby, if mom didn’t get during prenatal care)
-Rhogam
can live vaccines be given during pregnancy? which vaccines are live?
No! teratogenic
-varicella
-MMR
-flu nasal spray
what vaccines can be given during pregnancy
-hep B
-flu shot
-COVID shot
-Tdap
instructions after MMR vaccine postpartum
-do not get pregnant for 1-3 months (teratogenic)
-if receiving Rhogam with MMR, check titer
when should people who will be around newborn baby get Tdap shot
2+ weeks before baby is there
who gets Rhogam
Rh- moms who have Rh+ baby
what does Rhogam do
prevents mom’s body from making antibodies
S+S of complications to call hcp for
-lochia: heavy, clots, odor
-fever
-red, warm lump in breast
-painful urination
-tenderness in calf
-change in eating pattern
-inability to sleep despite exhaustion
-isolating from others
approximate weight loss right after delivery
10-14 lbs
when is follow up visit with hcp for mom? for baby?
-C/S: 2 weeks
-vaginal: 6 weeks (unless discharged early)
-baby: 2 weeks
assessment of attachment behaviors from parent to baby
-touch
-call baby by name
-claiming behaviors
-displaying affection
-responsiveness
-comforting techniques
parent process of ‘claiming’ the baby
-“like” other family members
-“different” from other family members
-“unique” individual
assessment of abnormal attachment behaviors from parent to baby (deviation from normal)
-inability/refusal to discuss labor experience
-refusal to care for/interact with infant
-excessive preoccupation with self
-signs of marked depression
-lack of support system
3 phases of maternal postpartum adjustment
- dependent: taking in phase
- dependent-independent: taking hold phase
- interdependent: letting go phase
phase of maternal postpartum adjustment:
-1-2 days
-focus on self
-verbalizes need for food and sleep
-talkative, reliving of birth experience
-passive and dependent behavior (relies on others, defers decision making)
dependent: taking in phase
“princess phase”
*take care of her needs
phase of maternal postpartum adjustment:
-day 2/3/4 to 10-14 days
-focus: care of newborn, competent mothering
-independent in self care activities
-verbalizes concern about body functions of self and baby
-desire to take charge
-still needs nurturing and acceptance by others
-open to teaching on care of self and baby
-lack of confidence in self as mother, needs nurturing
dependent-independent: taking hold phase
*lots of praise, encouraging mom to do tasks
*don’t totally take over
*teaching
phase of maternal postpartum adjustment:
-focus: family unit, interacting members
-reassertion of relationship with partner
-resumption of sexual intimacy
-resolution of individual roles
interdependent: letting go phase
S+S baby blues
(peaks around days 5-10, then decreases)
-mood swings, cries easily for no reason
-depressed mood, let down feeling
-restlessness, fatigue, insomnia
-headache, anxiety, sadness, anger, feeling overwhelmed
-loss of appetite
contributing factors to baby blues
-hormonal fluctuations
-major psychological adjustments
-perineal and breast discomforts
-exhaustion
-mother’s poor self concept about her body
S+S postpartum depression
-worsening of sleep disturbances
-appetite change, eating problems
-increased intensity and duration depressed feelings
-no compensatory measures to deal with fatigue and exhaustion
-withdrawal and social isolation
-thoughts of harming baby
-lack of interest in caring for baby
nursing interventions postpartum depression
-identify women at high risk
-listen actively
-compassionate care
-teach symptoms and to call for help
interventions for baby blues
-teach about it
-teach coping strategies
-folllow up phone calls
4 stages paternal adjustment
- expectations
- reality
- transition to mastery
- reward
S+S stage 2 paternal adjustment (reality)
-sadness
-ambivalence
-jealousy
-frustration
-overwhelming desire to be more involved
-may feel alone
S+S stage 3 paternal adjustment (transition to mastery)
-working to create role of involved father
-increasing confidence with child care
-talk to other fathers
-struggle for positive feedback from partner and infant
positive behaviors in sibling adaptation
-increase in and concern for infant
-increased independence
negative behaviors in sibling adaptation
-regression in toileting and sleep habits
-aggression towards baby
-attention seeking behaviors
1 predictor of how sibling will adapt to baby
age and developmental level
strategies for sibling adaptation
-make comparisons to his/her birth
-small gift from baby
-someone else holding baby when sibling comes in (mom embraces sibling)
-have sibling be among first to meet the baby
-“big brother”/”big sister” t shirt
-plan individual time alone for each child with each parent
