pp care + complications Flashcards
VS changes
Temp elevated (100.4) up to 24 hr then afebrile, can also be elevated 24 hr after milk production
BP elevated then normal
Bradycardia 6-10 days
VS changes - abn
High BP: preE, essential htn or chronic, renal issues, anx
Treat with procardia, labetolol, aldomet; MgSO4 IV (2g/hr for 24-48 hr, at least 24)
Tachy: hard labor and birth, hemorrhage; rule out infection
Marked tachypnea: resp disease, pulmonary edema
Temp > 100.4: infection
CV changes
CO decrease 30% in 2 wk -> normal by 6-12wk
D/t diuresis (first few days): decrease ECF and weight loss
Failure to do this = pulmonary edema and heart problems (crackles in lungs)
Respiratory changes
Lungs clear, non labored
Eupnea: tachypnea = fever, pain; bradypnea = resp compromise, med, anesthesia
Watch for fluid overload: bolus, pitocin, MgSO4
Neuro changes
HA: most common complaint, fluid shifts 1st week after, leakage of CSF d/t epidural or spinal (blood patch), chronic or gestational htn, preE, stress and fatigue (rest)
Visual: spots, blurring, bright lights
Treat = caffeine, acetaminophen
Nutrition changes
Increase Fe (supplement depending on EBL), may need to continue prenatal vit
Breast feed: increase 300kcal
Non breast feed: decrease 200kcal
Lab value changes
Non patho leukocytosis in 1st week (wbc = 25000 - 30000)
EBL: 2-3% hct = 500mL
Plasma = prepreg state in 4-6 wk PP
Plt normal by 6 wk
Blood values = prepreg state by week 6
Ovulation/menstruation
Non breast feed: o = 70-75 days; m = 7-12wk
Breast feed: m = delayed 3+ mo (exclusive or not), not birth control (can ovulate without bleed)
Weight change
Decrease 10-12 lb (baby, placenta, amniotic fluid
PP diuresis = 5lb
May return to prepreg by 6-8 wk depending on diet and exercise
PP assessment
Breasts
Uterus/abdomen
Bowel
Bladder
Lochia
Episiotomy, lacerations, abd incision
Homan’s sign
Emotions
PP assessment - breasts
Size and shape, abn, red areas, enlarge, fullness d/t milk
Nipples: cracks, fissures, soreness, inversion
how is feeding going? observe, praise and guidance, prevent issues (+ non breastfeeding)
blocked duct = hard in one area -> massage while feeding, heat before, empty with each feed
Non lactating - suppress
Well fitting bra or ace wrap binder, cold compress or cabbage leaves, anti inflam meds, no warm water on breasts, no stim
Lactation
Feed q1.5 - 3hr (8-12x/day)
10-20 min each breast (not as long on 2nd)
Heavy ok; not read, hard, sore
No OH 2hr before nursing, only occasional use (pump and dump)
Cradle position, modified cradle, football hold (c/s), side lying (c/s, dont fall asleep), stomachs flush, feed horizontally not from angle above
Good latch = fish shape mouth (shouldn’t head smacking -> break latch, stroke chin to open mouth more, upper lip flared up lower flared out)
Nipple shield = flavor non aggressive feeder
Allow nipples to dry to prevent breakdown
Concerns about breast feeding
Pain (nipple tenderness -> poor latch), embarrassment, feel tied down, unequal responsibilities (dads left out)
Getting enough milk: edges of mouth, 6-8 wet diapers/day, swallow, softer breasts; s/s = soft breast, audible swallowing
7 days = 1BM with each feed
Breast feed difficulties - insufficient milk
6-8 diapers, increase fluid intake to 2L/day
Breast feed difficulties - sore nipples
Good latch, lanolin cream, express breast milk and let dry (open to air), begin nursing on less sore side
Breast feed difficulties - flat nipples
Roll with fingers, use shield
Breast feed difficulties - plugged ducts
Freq nursing, change positions, manual massage, warm compress, pump, start on affected side (aggressive baby), prevent!, mastitis
Pressure from purse strap, infant sling, car seat belt can cause recurring
Mastitis
Sudden onset, chills, fever, malaise, red, painful, swollen areas, possible drainage, unilateral
Warm compress and analgesics, 7-10 days abx (pcn), take all!, supportive bra all the time to avoid milk stasis (no underwire), HH, prompt attention to blocked ducts, good positioning and latch, supply and demand, report flu like S, regular complete emptying
continue to breastfeed!!
Mastitis - milk stasis
Failure to change infant position to allo emptying of all lobes
Failure to alternate breasts at feedings
Poor suck
Poor let down
Mastitis - bacteria
Poor HH
Improper breast hygiene
Failure to air dry breasts after breastfeed
Use of plastic lined breast pads that trap moisture against nipple
Mastitis - breast/nipple trauma
Incorrect positioning for breastfeeding, poor latch, failure to rotate position on nipple, incorrect or aggressive pumping technique, cracked nipples
Mastitis - obstruction of ducts
Restrictive clothing, constricting bra, underwire bra
Mastitis - feeding changes
Attempted weaning, missed feed, prolonged sleep (through the night), favorite side of nipple soreness
Mastitis - lowered defenses
Stress and fatigue
Engorgement
Venous stasis
Hard and painful d/t soreness
Gradual onset, entire breast affected (bilateral)
No high fever
Dont miss feeding, hand express or pump to soften before feed, nurse 8-12x/day 10-15min/breast (feel soft and empty - switch side), warm compress before feed for let down, cold applications btw feedings to slow milk production (ice), well fitted nursing bra 24hr/day, cabbage leaves (decrease edema), feed more frequently (q1-1.5hr)