Week 1 (Postpartum) Flashcards
Gravida
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Total number of confirmed pregnancies
- regardless of whether these pregnancies have resulted in birth, miscarraige, abortion, or ectopic pregnancy
Para
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Number of pregnancies in which the fetus or fetuses have reached 20 weeks gestation
- Para is divided into 4 categories: term (T), preterm (P), abortion (A), living (L)
- not the number of individual fetuses
- twins are counted as 1 pregnancy
Term (T or F)
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Number of pregnancies that resulted in full term birth
- 37 + weeks gestation
Preterm Births (P)
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Number of pregnancies that resulted in preterm birth
- 20 - 36 weeks gestation
Abortion (A)
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Number of pregnancies that ended BEFORE 20 weeks gestation
- either due tomiscarraige or elective abortion
Living (L)
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Number of currently living children the woman has
EDC
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Estimated Date of Confinement
- DUE DATE
Naegele’s Rule
Subtracts 3 months from last menstration & add 7 days to calculate the estimated due date (EDD)
Primigravida
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First pregnancy
Multigravida
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2 or more pregnancies
Precipitous
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Quick birth
- Onset to birth is LESS THAN 3 HOURS (from time water breaks to birth of baby)
SVD
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Spontaneous vaginal delivery
LDPR
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Labor, delivery, postpartum, recovery
C/S
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cesarean section
What is the postpartum period?
From delivery to the placenta to the return of the reproductive system to the non-pregnant state
- usually 6-8 weeks
Involution
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When the uterus returns to pre-birth state
- within 12 hours palpate the fundus 1 cm above the umbilicus; make sure the bladder is empty
- by 2 weeks, the fundus should not be palpable
Subinvolution
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Uterus fails to return to normal size
- caused by retained placenta fragments & infection
Afterpains
Painful, intermittent contractions of the uterus after delivery
- most often occur in multiparas from loss of uterine tone & large babies, and are more painful during breastfeeding because it stimulates oxytocin; will relieve in 5-7 days
Placental Site
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Separates from the uterus within 15-30 minutes
* or manual removal (painful)
What can leaving the placenta is left inside & not removing it lead to?
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Risk of Hemorrhage
Lochia
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Combination of blood, mucus, & tissue discharged from the uterine lining
- types: rubra, serosa, alba
- evaluate for clots for possible piece of placenta!
Lochia rubra
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Reddish or red-brown vaginal discharge that occurs IMMEDIATELY after childbirth
- mostly composed of blood with clots (grape size clots)
- Rubra = Ruby Red
- 1 - 3 days
- May have small clots
Lochia serosa
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Pink, serous, & blood-tinged vaginal discharge that lasts 3-4 days after delivery
- Pinkish / brown
- little to no clotting
Lochia alba
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White, cream-colored, or yellow vaginal discharge that occurs 10 days to 6+ weeks after delivery; contains WBCs
Excessive blood loss
Saturation of pad in 15 minutes
QBL
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Quantitative Blood Loss
- 1 g = 1 mL
NORMAL:
* vaginal < 500 mL
* C-section = 1,000 mL
What might presence of free-flowing bright red blood indicate?
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cervical laceration
A vagina should return to normal size within how many weeks of delivery?
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6 - 8 weeks
A nurse is assessing the lochia discharge on a 1 day postpartum woman. THe nurse notes that the lochia is red & has a fleshy odor. The nurse determines that this assessment finding indicates what?
a.) A normal finding
b.) The presenc eof infection
c.) The need for increasing oral fluids
d.) The need for increasing ambulation
a.) A normal finding
Hematoma
Accumulation of blood in the pelvic tissue
S/S:
* unrelenting pain
* pressure in rectum
* ↑ HR
* ↑ RR
* ↓ BP
Episiotomy
Incision into the body of the perineum during 2nd stage of labor (incision made into the vulva)
- Have to assess while woman is lying on her side
- heals in 2-3 weeks after delivvery
- kegels
1st Degree Laceration
Laceration through the skin to the superficial muscles
2nd Degree Laceration
Laceration extends through muscles of the perineal body
3rd Degree Laceration
Laceration through the anal sphincter
4th Degree Laceration
Laceration involves the anterior rectal wall
Urethral laceration
laceration upward from the vagina towards the urethra
Postpartum voiding
Normal = 3,000 mL/day
- Q2 from aldosterone diuresis
- painful
- delayed BM from low intake
- decreased muscle tone, pain, analgesia
- UTIs are comon
Colostrum
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Milk that delivers essential nutrients & antibodies; produced in the first 2-3 days PP
Lactogenesis
Production of milk
Postpartum Complications
- anemia
- gestational diabetes
- clotting
- orthostatic hypotension
- hypertension
- swelling / edema
What type of state is pregnancy?
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Hypercoaguable state
Pregnancy is a —— state.
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hypercoaguable
—– is a common complaint in postpartum because of hormonal shifts. Can also be from pathological etiology like spinal or PP onset of preeclampsia (have they delivered in the past year?
- Increased risk of stroke / seizures
- TX: magnesium sulfate
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headache
Preeclampsia
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A complication of pregnancy characterized by hypertension, edema, & proteinuria
Uterine atony
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Lack of normal muscle tone in the uterus
- tx: hemabate, methergine
- most frequent cause of excessive bleeding PP (from placental fragments
What is the most frequent cause of excessive postpartum bleeding?
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Uterine Atony (lack of normal muscle tone in the uterus)
Edinburgh Postnatal Depression Screening
- Screening tool
- Self-report assessment
- 10 statements
BUBBLE-HE
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- Breasts
- Uterus
- Bowels
- Bladder
- Lochia
- Episiotomy
- Hemorrhoids
- Emotional status
Breast (in BUBBLE-HE)
- condition
- color
- pain
- redness
- nipple condition (normal, inverted, intact, bruised, cracked)
- soft, firm, full, engorged
- observe latch if breast feeding
Uterus (in BUBBLE-HE)
KNOW THE BOLD
- 2 handed fundal check
- Normal: firm fundus, midline, should be at or below the umbilicus
- Interventions: teach to monitor uterus for firmness; advise frequent urinating; ibuprofen for afterbirth pains
- boggy = bad
- void Q2H
Bowel (in BUBBLE-HE)
Normal: soft & non-distended, normal bowel sounds in all quadrants, passing flatus, bowel movmeents with no difficulties
- check for hemorrhoids, episiotomies, lacerations, lochia
Emotions (in BUBBLE-HE)
Assess emotions, mood, attachment to infant; cultural aspects
- cambodian women = no showers after birth
- japanese = avoid washing hair
- chinese = use ginger
REEDA
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- Redness
- Edema
- Ecchymosis
- Drainage
- Approximation
* wound evaluations
Peri Care
- peri bottles
- ice packs / frozen pads
- analgesics
Maternal adaptation
1.) Taking in or dependent phase
2.) Taking hold
3.) Letting go or independent phase
Maternal Adaptation: Dependent Phase
- first 24 hours
- vulnerable & needy
- divert energy to the infant to extent that her basic needs are met
- reliving birth details
- may need assistance with self-care
- inwardly focused/concerned about physical needs
Taking Hold Phase (maternal adaptation)
- Day 2/3 to several weeks
- independent & dependent
- preoccupied with care of the baby
Independent Phase (maternal adaptation)
- Letting go phase
- focus on family as a unit
- resumption of role (intimate partner, individual, etc.)
Postpartum Blues
- Right after delivery - labile & cry for no reason; mild depression
- resolve in 2 weeks (day 10)
- 40-80% prevalence
Teaching:
* rest
* relaxation
* self-care / time
* plan a day out of the house
* talk to partner
* community resources
Postpartum discharge
begins on admission
- look for complications - infection
- no sexual activity for 6 weeks
- medications
- follow-up in 2/3 days for infant & 2 weeks for mom
POST BIRTH warning signs
POST
* Pain in chest
* Obstructed breathing or SOB
* Seizures
* Thoughts of hurting yourself or the baby
BIRTH
* Bleeding: soaking through a pad in an hour or > golf ball clots
* Red or swollen leg that is painful or warm to touch
* Temperature of 100.4 or greater
* Headache that does not get better
