PPT Care Flashcards
What does bubblers stand for?
- Breasts
• Uterus
• Bladder
• Bowels
• Lochia
• Episiotomy/Laceration/Perineum
• Reaction (emotions)
• Signs (Vital signs, Pain, Homan’s?)
PPT ongoing care?
Be alert to S+S of complications, monitor pain/manage it, promote sleep, assess learning needs, promote self care/confidence, and assess client/infant interactions
B-breasts?
Want to know if they’re BF or bottle feeding.
For BF- assess nipples for soreness/comfort/bruising/inverted, assess breasts for soft/filling/engorged, look for signs of mastitis
Not BF- asses softness/feeling/comfort/snug fitting bra, avoid nipple stimulation, put ice packs under arms to decreased local pain/swelling/suppress lactation
S+S of mastitis?
Inflammation in the breast. Results initially from blocked milk ducts. S+S: redness, warmth, pain, firmness, fever (if prolonged)
U- uterus?
Want to make sure there’s uterus INVOLUTION (decrease in uterus size to non pregnant state). In the PPT period the uterus should be around the size of an orange
What is involution impeded or enhanced by?
Impeded- full bladder (competes with uterus for space), clots, exhaustion (long duration of labor), membranes still present in uterus, over distended uterus (large baby, polyhydraminos, multiple babies)
Enhanced- expulsion of placenta/membranes, uncomplicated birth/labour, early BF (produces oxytocin=contraction of uterus), early ambulation, oxytocin
What is a boggy uterus?
Feels squishy, soft, and enlarged. It’s not nice/firm like its supposed to be
How should the fundus shrink each day?
Height of fundus will decrease about 1 finger breadth (1 cm) each day
How to perform PPT fundal assessment?
Have pt lay flat/supine, place one hands above symphis pubis to support and the other hand around the umbilicus. Massage fundus deeply using pressure. Should feel a large/round/firm mass. If you can’t find the fundus or if its boggy, massage to make it firm/stimulate it to find it
What are afterpains?
Involution contractions that happen after birth. Usually don’t happen with 1st delivery but with the babies afterwards. It happens during BF. Can use pain medication before BF/empty bladder to help with the discomfort.
What is diastasis recto abdominus and how do you assess this?
Stretching and separation of the rectum muscles. Assess this by asking the pt to lift their head off the bed, and feel for separation of muscles
What can the uterus not involuting lead to?
Increased risk for PPT hemorrhage
How to assess involution for pt with C section?
You can still palpate but be gentle around the incision site to not separate the sutures, and be wary of pain
What to document for uterus and abdomen?
Height, firmness of uterus/position, incision site, musculature (abdominal muscles), and any interventions you did
B- bladder?
PPT pt have decreased sensation, swelling/bruising to their perineum, PPT diuretics (fluid coming into bladder), and increased bladder capacity which =increased risk of retention and UTIs
B- bowels?
Usually don’t have BM for 2-3 days after delivery and elimination returns to normal within 1 week. Need to listen to BS for those with C sections. May experiences constipation, hemorrhoids (from pushing or first BM), or gas (means things are working).
Normal vs abnormal lochia?
Normal- heavy flow expected after delivery, then heavy (1 pad/hr), moderate (<6 inch stain on pad), light (<4 inch), scant (<1 inch). Lochia increases with ambulation/BF
Abnormal- foul smell, large clots, heavy flow, reappearance of red lochia, lasts>4 weeks
Rubra, serosa, and alba lochia?
Rubra is PPT days 1-3: causes dark red/bloody discharge, clots present <loonie in size, freshly/musty/stale odor (not foul)
Serosa is PP days 3-10: pink brownish colour
Alba is PP days 10-24: yellow to white colour, can last up to 6 weeks
What does a fundal massage promote?
Uterine contractions and the goal is to expel clots
What to document for lochia?
Type, quantity, odour, clots, hygiene, and interventions
E- episiotomy?
It is a surgical incision to prevent soft tissue damage during delivery. It’s not routinely done, but the physician uses scissors to snip tissue blocking fetal expulsion
Different types of perineal lacerations?
These occur naturally during delivery. Can be 1, 2 (goes into perineal muscle), 3 (goes into anal sphincter), and 4 (goes through anal sphincter/tear the rectum) degrees. 2/3/4 always require some repair, and 1st degree can usually heal on its own
What is a hematoma?
Blood vessel inside perineal body rupture, and accumulate lots of blood. Can prevent by application of ice. A sign of hematoma is relentless pain
How to treat hemorrhoids?
Ice, frozen paid, analgesic, and tucks (pad with with hazel on it)
Perineal care PPT?
Wipe front to back, change pads frequently, can use ice pads, soak in tub, peri wash bottle (use every time they go to bathroom and flush from front-back), and pain meds
What are kegel exercises?
Strengthen the pubococcygeus muscles by contracting pelvic floor muscles for 3 sec then relax for 3 sec/repeat 10-15 times several times a day. You can basically do this anywhere/anytime. Kegel exercises improve support to pelvic organs, stops flow of urine.
What to document for perineum?
Intact, episiotomy, laceration, hemorrhoids/hematoma, hygiene, and interventions
Reactions by days?
Take in: 1-2 PPT day, preoccupied with their own needs, tell their story, touches/explores infant
Take hold: 2-3 day, ready to resume control, eager to learn, mood swings, mothering function established
Let Go: see infant as unique person, allow other to care for infant
Psychological reaction PPT (attachment and bonding)?
A- hold infant en face position (face to face) 20 cm away, use high soft pitch voice
B- process by which parents form emotional relationship with infant (support this by keep mom/baby together)
What is PPT blues? S+S and what we can do
Normal response in 75-85% of women. Occurs in 3-5 days PPT and resolves spontaneously within weeks. S+S: tearfulness, mild depression symptoms, mood swings, agitation, anxiety, disturbance in sleep/appetite, being overwhelmed, irritable
Care- recognize, reassure, educate, blues is risk factor for PPT depression
What is PPT pinks?
Mild elevation and euphoria hrs or days after birth. This is normal but may be a warning for other problems.
What is PPT depression?
Up to 20% of PPT blues develop PPT depression. The client (1/7) or partner (1/10) can develop this. The experience depressive symptoms
What is PPT psychosis?
Very rare (1/1000 births) where they experience psychosis after giving birth. This is an emergency psychiatric condition and needs psychiatric care
Some challenges in PPT?
Babe care, fatigue from sleep deprivation, feel incompetent, finding time for self, loss of freedom, integrating baby into family (siblings), and social/cultural influences
S- signs?
Take VS, pain, signs of DVT (pain, redness, cyanosis, increased calf circumference, edema, warmth)
C section monitoring?
Foley (observe output and flow), monitor IV, deep breathe/cough, early ambulation, sedation score (anesthetic effects)
Nutrition for PPT if BF?
Have them eat 200 calories or more if BF
When will PPT client start ovulating again?
Non lactating is 6-8 weeks. Exclusive BF can be longer, but you can get pregnant without having a period b/c contraception period happen 2 weeks before menstruating (so BF not reliable birth control)
Time recommended to continue sexual activity?
3-6 weeks usually. Wait until lochia has stopped and perineum has healed
Different methods of contraception?
Condom, IUD, permanent sterilization, diaphragm/cervical cap, use of estrogen/progestin (or progestin separately)
What is PPTL and a vasectomy?
PPTL- permanent sterilization for women, done outpatient, done laparoscopic, don’t palpate fundus after
Vasectomy- seal/tie/cut the vas deferens, its permanent
Most common PPT complications? 4 of them
Hemorrhage, infection, depression, and thrombophlebitis/DVT (risk has gone down b/c of ambulation 1-2 hrs after birth)
