Unit 2 - Part 1 - Postpartum Care Flashcards
How long does postpartum period last
6 weeks
Main thing to look for immediately after birth
intense tremors
What causes intense tremors
- reaction to epidural
2. reaction to maternal adrenal production
What to assess during intense tremors
Temp: presence of fever?
Displaced Uterus = full bladder
Definition: the rapid reduction in size of the uterus and the return of the uterus to a non pregnant state
involution
T/F: Afterpains are greater after multiple births
T
A fundus that is above the umbilicus and is boggy (feels soft and spongy rather than firm and well contracted) is associated with excessive _____ _____
uterine bleeding
Definition: relaxation of uterine muscle tone
Uterine Atony
The cause of a distended fundus in a recently delivered woman is likely due to a distended bladder causing a temporary upward displacement of the uterus. What is the first action a nurse should take at this time?
Have the woman empty her bladder and then remeasuring the height of the fundus
If the client is unable to void, an in and out catheterization to empty the bladder is indicated
During involution, bleeding is controlled by what?
compression of muscle fibers
What is one thing someone can do to firm up the uterus
massage it
Definition: represents the healing of the uterus
Lochia
What to assess with lochia
amount. color, odor
Describe Lochia Rubra:
- dark red
- day 2-3
Describe Lochia Serosa:
- pinkish color
- day 3-10
Describe Lochia Alba:
- creamy/yellowish discharge
- day 10 up to 6 weeks
T/F: Lochia with large plum-sized clots are normal the first few days after birth
FALSE!
- only a few SMALL clots (no larger than a nickel) are common
When the lochia flow stops, the cervix is considered to be _____, and chances of infection ascending from the vagina to the uterus _____
- closed
- decrease
T/F: A steady trickle of blood could indicate a laceration in the birth canal and should be reported to the healthcare provider for follow up.
T
Total average volume of lochia is approximately
225 mL
Why is lochia discharge greater in the morning?
because of pooling in the vagina and uterus while the mother lies sleeping
The amount of lochia may also be increased by _____ or _____
exertion or breastfeeding
T/F: Multiparous women usually have more lochia than first-time mothers.
T
Women who undergo a cesarean birth typically have _____ lochia than women who give birth vaginally.
less
Tone and contractility of the vaginal orifice may be improved by
Kegel exercises (perineal tightening exercises)
Describe cervical changes after birth
- flabby, formless
- admits 2 fingertips for few days
- first childbearing permanently changes
Describe vaginal changes after birth
- appears swollen, bruised
- decreased size
How long does it take rugae to return after birth
3-4 weeks
Describe Perineal changes after birth
- soft tissue swollen, bruised
- episiotomy, laceration edges drawn together
How long does it take perineum to heal after birth
2-3 weeks
Nursing care for perineum changes
- ice packs
- sitz baths
- assess urination
- episiotomy care
_____ has been identified as an essential amino acid that decreases the pain of an episiotomy.
Lysine
[can be found in meat, cheese, fish, eggs, and nuts]
The nurse should instruct the client to _____ _____ _____ before sitting to reduce the pain.
tighten the buttocks
To prevent infection, not to reduce pain, the client should…
wash the area daily and the peripad should be changed four times a day
_____ is often prescribed for postpartum pain when a client is experiencing moderately severe pain with inflammation.
ibuprofen (Advil)
_____ is often prescribed on 2nd and subsequent births for after pains.
Percocet
The client needs to be closely monitored for _____ _____ when Percocet is used.
respiratory suppression
When does a women start ovulating/menstruating again after childbirth
6 weeks after if not breastfeeding
- Breastfeeding = at least 3 months after birth
T/F: exclusive breastfeeding reduces the risk of pregnangy
T
Physiologic changes to abdomen
- uterine ligaments stretched
- diastasis recti abdominis (gap of >/= 2.7 cm between the 2 sides of rectus abdominis muscles
- striae/stretch marks
______ stimulate breast duct proliferation, development
progesterone
Once the placenta is expelled, progesterone levels….
fall -> triggers milk production
Best way to get hindmilk rich in fat
When breastfeeding, start off on breast she last left on
Why is colostrum important
It passes immunity to baby
3 stages of human milk
- Colostrum: immediately available at birth
- Transitional milk: Day 2-5
- Mature milk: present by 2 weeks
Are the mother’s bowels sluggish following birth?
Yes
- may provide a stool softener
What can a mother have to eat/drink after a C-section
clear liquids until bowel sounds are present
what is puerperal diuresis
difficult urinating first day, but by day 2 woman will urinate 2-4 L
Describe the temperature of mother after childbirth
- afebrile (normal temperature) except first 24 hours after birth
Describe the BP of mother after childbirth
- immediately: increased BP
Describe the pulse of mother after childbirth
puerperal bradycardia (50-70 bpm) (6-10 days)
When is a seizure most likely to occur in mother
during labor, first 24 hours
- pre-eclamptic = up to 48 hours
Describe WBC/leukocytes after childbirth
increase
Describe hgb & hct after childbirth
normal
Describe platelet levels after childbirth
initially high (so you want to prevent blood clots by ambulating), then they fall
Describe the weight of mother after childbirth
- initial weight loss of 10-12 lbs
Describe labs after childbirth
normal 2-6 weeks after birth
T/F: there is a risk for obesity during the childbearing years
T
mid-stature woman will gain about how much weight during pregnancy
~28 lbs
Describe clinical assessment after childbrith
assess for hypovolemia
T/F: inadequate intake of nutrition can reduce milk volume
T
How much protein should a mother intake when breastfeeding
65 g/day
How much liquid should a mother intake while breastfeeding
A LOT!
Blood pressure elevations may result from excessive use of _____ _____ _____ _____.
oxytocin or vasopressor medications.
Risk for Deficient Fluid Volume secondary to _____ _____ _____ _____
boggy fundus and nausea
Mothers should usually be focused on the infant. Assess for detachment. Mother not wanting to look at baby or take care of baby. Encourage her to care for the baby by…
Demonstrating and getting them involved.
Reddened breasts may indicate _____
mastitis
Pulse range
50-90 bpm
RR range
16-24 breaths per minute
Temperature range
- 6-38 C (98-100.4)
- > 100.4 = infection
Can you breastfeed with mastitis
Yes, it is the best thing to do!
Is it normal to have separation of musculature in abdomen?
Yes, soft/doughy texture is expected
T/F: many women get hemorrhoids during pregnancy, but is not a problem as long as they are not very large
T
How often should mother void
every 4-6 hours
When should mother have bowel
- normal BM by 2nd/3rd day
When is the mother expected to start assuming more responsibility/eagerness to learn
after 12 hours
*explain postpartum blues/depression (should not progress longer than a couple of weeks)
Nursing cares to implement if mother does not want to breastfeed
- provide supportive, well-fitting bra within 6 hours of birth
- ice packs over axiliary area of each breast
- dry out period = 4-5 days
When can a mother resume intercourse after childbirth
- episiotomy healed
- lochia flow stopped
T/F: you should ambulate mother the day after surgery
yes, as soon as you can, but make sure she is steady
Definition: VBAC
vaginal birth after cesarian birth: very high risk!
treat like surgical pt
Definition: REEDA
- Redness
- Oedema: excess watery fluid collecting in cavities of body tissues
- Ecchymosis: discoloration of skin from bleeding underneath, typically caused by bruising
- Discharge
- Approximation: bringing tissue edges into desired apposition for suturing
What is the Newborns’ and Mothers’ Health Protection Act of 1996
guarantees a minimum stay of up to 48 hours following a vaginal birth and 72 hours for a C-section
protein in the urine leads to
preeclampsia
HTN + protein in urine + seizures =
eclampsia
Define: HELLP
LIFE THREATENING TO MOTHER/FETUS
hemolysis
elevated liver ezymes
low platelet count
- Occurs between 28-36 weeks gestation BUT my occur postpartum in up to 30% of cases.
- Reported S/Sx’s
- Headache
- Nausea/vomiting/indigestion with pain after eating/Abdominal or chest tenderness and upper right upper side pain (from liver distention)
- Shoulder pain or pain when breathing deeply
- Bleeding/ Changes in vision/ Swelling
- Platelet infusion should only be given in patients with severely low platelet counts, those with significant bleeding or with very extremely low platelet counts and may require caesarean delivery.
- Right upper quadrant ultrasound my show hepatic infarction or subcapsular hematoma but has no role in acute management of the patient.
- Most infant death occurs do to abruption of the placenta / placental failure
