Postpartum Nursing Care Flashcards
What stage of labor is the postpartum period?
4th stage
How long does the postpartum period last?
6 weeks
What are our nursing goals during the post partum period? (6)
- Prevent hemorrhage –> promote perfusion and oxygenation
- Assist in recovery
- Identify deviations from normal
- Provide comfort
- Promote bonding
- Education
Describe the let down reflex
(1) Stimulation of the nipples sends a signal to the brain –> (2) The brain releases oxytocin causing the milk ducts to expand and contract –> (3) The expansion and contraction moves milk from dripping to actively flowing
Colostrum secretion time frame?
First 48-72 hours
Mature milk should arrive in the breasts about when?
Around day 3 (however can be between 3-5 days)
A decrease in what two (2) hormone levels allow for the increase of prolactin levels, which promote breast milk production?
Estrogen and progesterone
Puerperal Infection
Any infection within 28 days of miscarriage, abortion, or birth
Name some common puerperal infections
- Endometritis
- Mastitis
- UTI
- Wound infection
Risks for puerperal infection
- cracks in nipples
- surgical incision
- tissue trauma during labor
- open wound
- retained placenta or clots
- increased pH of vagina after birth
Blood draw before or after antibiotics are given to treat an infection?
Blood draw before
Mastitis
Inflammation of the breast tissue
Causes/risks for mastitis
- poor breastfeeding technique
- inadequate milk duct drainage
- blocked milk duct
- poor hygiene
s/s of mastitis
- flu-like symptoms (fever & chills)
- redness and warmth of the breast
- tenderness
- edema and heaviness of affected breast
- possible purulent drainage
Mastitis treatment
- breastfeeding
- moist heat
- massage the area to improve flow and reduce stasis
- increase fluid intake
- supportive bra
- emotional support
Placenta accreta
Abnormal adherence of placenta to uterine wall
- hole in the uterus when the placenta detaches and/or retained placenta
- hole often ends in emergency hysterectomy
Definition of postpartum hemorrhage?
Loss or > 500 mL of blood for a vaginal birth OR loss of > 1000 mL of blood for a c/s
- can be primary/early (within 24 hrs) OR secondary/late (after 24 hours)
- change in hematocrit by 10%
T T T T mnemonic for PPH causes?
Tone, trauma, tissue, thrombin
PPH causes related to tone
Lack of uterine tone (uterine atony) — soft, spongy, boggy uterus — slow and steady loss of blood
Causes
- repeated uterine distention (multiple gestations/multifetal gestations)
- muscle fatigue from delivery
- unable to empty bladder (pushes on uterus)
- obstetric medications (anesthetics, magnesium sulfate, nifedipine, terbutaline)
PPH causes related to trauma
Damage to genital structures — uterus, vagina, perineum
- incision from c/s
- from baby passing through vaginal canal
- from medical instruments (forceps, vacuum extraction, episiotomy)
Hematoma — mass or collection of blood
- severe pain
- persistent bleeding
PPH causes related to tissue
Placental fragments retained in uterine cavity
Prevention
- make sure placenta comes out intact
- remove retained tissue ASAP
PPH risk factors
- uterine atony
- magnesium administration
- lacerations of the cervix/vagina
- hematoma development
- retained placental fragments
- obesity
