Postpartum Physiological Assessments and Nursing Care- 12 Flashcards
postpartum period
6-week period after childbirth
Maternal mortality
death of a woman from complications of pregnancy and childbirth occurring up to 1 year postpartum
Postpartum Assessment
● Vital signs, pain, breath and heart sounds
● Laboratory findings, such as CBC, rubella status, and Rh status
● Breasts
● Uterus
● Bladder
● Bowel
● Lochia
● Episiotomy, lacerations, perineum, hemorrhoids
● Lower extremities
● Emotions, bonding with infant, fatigue, psychosocial factors
Changes of uterus
uterus goes back to placement and size prepregnancy takes 6-8 weeks
uterine contractions, atrophy of muscles, decrease in size of uterine cells
Afterpains
moderate to severe cramp-like pains related to the uterus working to remain contracted and/or the increase of oxytocin released in response to infant suckling.
occur first few days after birth
Nursing actions- uterus
assess for size, location, tone
instruct the woman to void every two hours
Uterine Atony (Boggy Uterus)
Uterine atony is the most common cause of postpartum hemorrhage.
Treating atony
uterine massage
drugs that promote uterine contraction-oxytocin
notify provider
measure distance between fundus and umbilicus
have patient void if uterus is not in place
oxytocin (pitocin)
Oxytocin stimulates the upper segment of the myometrium to contract rhythmically, which constricts spiral arteries and decreases blood flow through the uterus.
Subinvolution
failure of the uterus to involute/descend as expected
movement of uterus
1cm a day for about 14 days
endometrium, the mucous membrane that lines the uterus
undergoes exfoliation and regeneration after birth of placenta- prevents scarring
Lochia
bloody discharge from the uterus that contains red blood cells, sloughed off decidual tissue, epithelial cells, and bacteria
nursing actions- lochia
assess color amount and odor
assess for clots (egg sized or larger should be weighed)
seeing a clot- why
lochia has been pooling in the lower uterine segment.
Retained placental tissue causes what
interferes with uterine involution and lead to excessive bleeding
measuring blood conversion
1 g equals 1 mL of fluid
good void amount
300cc
Vital sign warning signs
BP <90or>160/>100 BPM <50 >120 resp <10 >30 O2 <95 Oliguria <35
agitation, confusion, unresponsiveness
vagina and perineum changes
may include edema, mild stretching, minor lacerations, major tears, and/or episiotomies.
midline episiotomy
incision that is midline on the perineum. heals quicker
mediolateral episiotomy
incision that is made at a 45-degree angle to the perineum.
nursing action peri area
assess swelling,bruising,mild/mod pain provide comfort measures ice first 24-48, then heat medication as ordered reduce risk for infection
nonpharmacological interventions
- Ice packs
- Warm compresses
- Sitz baths
- Repositioning
- Showering
- Topical treatments
Pharmacological interventions
- NSAIDs- mild to moderate pain
* Opioid analgesics may be used for moderate to severe pain.
changes in breasts
decrease in estrogen and progesterone and an increase in prolactin
When the infant suckles, the posterior pituitary releases oxytocin, resulting in the milk ejection reflex, also called the let-down reflex
Colostrum
a clear, yellowish fluid, precedes milk production and is secreted after delivery.
Immediately after delivery-breasts
fullness tissue may be swollen, it is soft and nontender 24-48 hr
around third day- breasts
The woman’s breasts become larger, firm, warm, and tender, and the woman may feel a throbbing pain in the breasts.
Nursing action-breastfeeding
● Inspect and palpate the breasts for signs of engorgement
● Assess the nipples for signs of irritation and nipple tissue breakdown.
● Assess for plugged milk ducts
Nursing action-nonbreast feeding
● Assess the breasts for primary engorgement.
milk leakage, breast pain, and engorgement may be experienced between 1 and 4 days postdelivery
Treatment for breastfeeding women
● Frequent feedings to empty the breasts and to prevent milk stasis
● Warm compresses to the breast and breast massage to facilitate the flow of milk prior to feeding sessions
● Express milk by breast pump or manually if the infant is unable to nurse (i.e., preterm infant)
● Ice packs after feedings to reduce inflammation and discomfort
● Analgesics for pain management
● Wear a supportive bra
Prevention and treatment for nonbreastfeeding women
● Wear a supportive bra
● Avoid stimulating the breast
● Ice packs to breast
● Analgesics for pain management
● Subsides within 48 to 72 hours
mastitis
infection may be caused by bacterial entry through cracks in the nipples and is associated with milk stasis, engorgement, long intervals between feedings, stress, and fatigue
Symptoms include fever, chills, malaise, flulike symptoms, unilateral breast pain, and redness and tenderness in the infected area.
Average blood loss in labor
200 to 500 mL through vaginal birth
risk for orthostatic hypotension
increases during the first postpartum week due to decreased vascular resistance in the pelvis.
thromboembolism
women at risk for two weeks postpartum due to clotting factors
postpartum chills
vascular instability leads to chills
venous thrombosis
thrombosis in a vein, caused by a thrombus (blood clot)
increase of coagulability
puts mom at risk for blood clots
Respiratory system changes
Chest wall compliance returns after the birth of the infant
Rubella Immunization
● Postpartum women who are rubella-nonimmune should be immunized for rubella before discharge.
● Women who contract rubella during the first trimester have a 90% chance of transmitting the virus to their fetuses.
● Fetuses exposed to rubella during the first trimester are at risk for birth defects
● Women who are immunized should avoid pregnancy for 4 weeks
immune system changes
suppressed during pregnancy, returns to normal in postpartum period
mild temp elevations first 24hr
Rh isoimmunization
Rh-negative woman develops antibodies to Rh-positive blood related to exposure to Rh-positive blood either by blood transfusion or during pregnancy with a Rh-positive fetus.
Rho immune globulin
● Indication: Administered to Rh-negative women who have given birth to an Rh-positive neonate
● Action: Prevents production of anti-Rh (D) antibodies
Transient stress incontinence
associated with impaired pelvic muscle function involving the urethra may occur in the first 6 weeks postpartum
Common bladder problems first few days post birth
Bladder distention, rapid bladder filling, incomplete emptying, and inability to void
bladder problems-why
administration of intravenous fluids in the postdelivery period, decreased sensation of the urge to void due to anesthesia or analgesia, edema around the urethra, perineal lacerations or episiotomy, operative vaginal delivery, or bladder trauma
nursing actions- bladder
assist to bathroom
assess for disturbances
measure voids- at least 300cc within 2-4hr post birth
use bladder scan if voids are less than 150ml
assess for UTI signs
instruct 10 glasses water a day
edema should decrease in 24 hr
Cystitis-bladder inflammation/infection
s/s and treatment
● Symptoms: Frequency, urgency, pain/burning on urination, suprapubic tenderness, hematuria, and malaise
● Treatment: Antibiotic therapy, increased hydration, rest
Diaphoresis
This profuse sweating, which often occurs at night, assists the body in excreting the increased fluid accumulated during pregnancy
endocrine changes
Estrogen, progesterone, and prolactin levels decrease. Estrogen levels begin to rise after the first week post-partum.
diastasis recti abdominis
separation of the rectus muscle
muscular/nervous system changes
abdominal muscles experience reduced tone and the abdomen appears soft and flabby.
soreness
loss of nerve sensation temporarily from epidural
expected findings muscle
some soreness full sensation for moms without epidural diminished sensation for moms with epidural fatigue no headache
GI changes/risks
mobility returns to normal by end of week 2
constipation
hemorrhoids
appetite may vary
weight- most experience significant loss during 2-3 weeks post
constipation nursing actions
ask about bowel movements increase fluids increase fiber look at past treatment encourage ambulation medication as ordered
hemorrhoids nursing action
avoid sitting for long periods
lay on side
witch hazel
sitz baths
fourth trimester
lack of sleep, fatigue, pain, breastfeeding difficulties, stress, depression, lack of sexual desire, and urinary incontinence.
postpartum visit
full assessment of physical, social, and psychological well-being, with screening for postpartum depression
Postpartum Discharge Teaching Project: Warning Signs
Call 911
Pain in the chest
Obstructed breathing or shortness of breath
Seizures
Thoughts of hurting yourself or baby Call your provider for:
Bleeding soaking though one pad/hour or passing a clot the size of an egg.
Incision that is not healing
Red or swollen leg that is warm or painful to touch
Temperature of 100.4 or higher
Headache that does not get better even after taking medicine, or bad headache with changes in vision
Expected physical changes
● Uterine involution, afterpains, progression of lochia
● Breast changes, engorgement
● Diaphoresis and diuresis
● Weight loss
● Women can expect to lose approximately 12 pounds immediately after delivery, and an additional 5 to 8 pounds due to fluid losses associated with uterine involution and diuresis
Self care for mom
● Hygiene
● Perineal care, continue to change pad frequently and use peri-bottle until lochia has stopped
● Breast care for lactating and nonlactating women
● Pharmacological and nonpharmacological pain control measures
Lactating women nutrition
increase their caloric intake by 500 to 1,000 calories per day and have a fluid intake of approximately 2 to 3 liters per day.
Exercise
activity decreases constipation
appropriate post part exercises- walking
kegel exercises- strengthen pelvic floor
Tobacco use
teach about dangers
never allow smoking around baby
encourage women to stay abstinent from smoking or stop
weight loss after childbirth- how
exercise in combination with diet
diet alone
sexual activity- talk with physician
● General guidelines are to resume sexual intercourse when the lochia has stopped, perineum has healed, and the woman is physically and emotionally ready.
Contraception
● Assess the couple’s desire for future pregnancies.
● Assess satisfaction with previous method of contraception.
●encourage talking with doctor
●provide info on different types
