Week 2 Postpartum Flashcards
What is the most major thing to observe for in a postpartum mom?
Hemorrhage
What 5 assessments are done to detect PPH
- VS
- Fundal location and tone
- Bladder
- Lochia
- Peri and Labial areas
How often are postpartum VS taken?
q15 minutes for the first 4 hours
WHat is the most common reason for excessive PP bleeding?
Uterus doesnt contract and compress open vessels
What aspects are noted during a fundus assessment?
- Firmness
- positioning
- Height
How do you prevent prolapse or inversion when performing a fundal assessment/ uterine massage?
By supporting the lower segment
How often should a fundus assessment be done?
With every vital check
What are normal findings for a fundus assessment?
at U and ML
or Below the ML
(measured in finger breaths)
If the uterus is boggy what do you do?
- Assess for hemorrhage
- Massage uterus
- Increase pitocin
A full postpartum bladder can lead to a PPH. Why?
Because the full bladder will not allow for an appropriate uterine contraction and thus the uterus will not be able to close the exposed vessels
If the fundus is _____ upon assesment, a full bladder should be suspected
- Above the U
- Displaced to one side (usually the right)
How much should the post partum mother void?
250ml or more
What is the guide line for maximum Lochia flow?
One fully saturated pad in an hour
What do you assess for when inspecting the postpartum peri and labial areas?
-Hematoma formation
if rapidly expanding it will enlarge tissues and cause large amounts of pain
What is the guideline for inspecting episiotomy’s or and other incision?
REEDA
What does REEDA stand for?
Redness Edema Ecchymosis Discharge Approximation
What are the three main methoids of promoting postpartum comfort
- Ice
- Analgesics
- Warmth
When/how should ice be applied postpartum?
- Promptly after delivery
- 10-20 min intervals
How is warmth provider postpartum?
Warm blankets
When assessing Abdominal dressings, what should be checked? three things
Clean
Dry
Intact
If there is drainage on the dressings what do you do?
Depending on the amount, you reinforce, or mark the edges and reassess to see if expanding
When providing post-op pain relief, how long do you follow the anesthesia orders before moving over to OB/FP?
24 hours
An APGAR score of 0-3 =
Severely Depressed
An APGAR score of 4-6 +
Moderately depressed
An APGAR score of 7-10 =
Excellent condition
When/How often is APGAR assessed?
at 1 minute and 5 minutes sometimes at 10 minutes as well
Whar does APGAR stand for?
Appearence Pulse Grimace (reflex irritability) Appearance Respirations
What is an APGAR 0 score for activity?
Absent
What is an APGAR 0 score for Pulse
Absent
What is an APGAR 0 score for Grimace
Flaccid
What is an APGAR 0 score for Appearance?
Blue, pale
What is an APGAR 0 score for Respirations?
absent
What is an APGAR 1 score for Activity?
Arms and legs flexed
What is an APGAR 1 score for Pulse
Below 100
What is an APGAR 1 score for Grimace?
Some flexion of extremities
What is an APGAR 1 score for Appearance?
Body pink extremities blue
What is an APGAR 1 score for Respirations
Slow, Irregular
What is an APGAR 2 score for Activity?
Active movement
What is an APGAR 2 score for pulse?
above 100
What is an APGAR 2 score for Grimace?
Active motion (sneeze, cough, pull away)
What is an APGAR 2 score for Appearance?
Completely pink
What is an APGAR 2 score for respirations
Vigorous cry
An APGAR of at least __ is needed before prolonged skin 2 skin is allowed
8
How does hypothermia cause respiratory distress in infants?
The infants metabolic rate is raised and O2 consumption is higher
What are some ways to support the thermoregulation of a neonate?
- Warmer
- Delay bath
- Dry immedatley
- Hat on head
- Skin to skin
- Swaddle
What are the three identifications for the neonate?
- Foot print
- Matching bands (verified at beginning of shift)
- Ankle security band
Discuss the postpartum adaptation of the reproductive system.
-Uterine involution
–Muscles contract, Catabolism occurs, Epithelium regenerates
(process begins immediately after placenta delivery)
-Fundus Decends
-Afterpains occur
-Lochia is present
-Cerivx heals
-vagina regenerates
-Perineum heals depending on extent of injury
-
Describe the postpartum regeneration of the epithelial lining of the uterus
- Begins within 2-3 days
- All but attachment site regenerates after 3 weeks
- Placental site heals after 6 weeks
- Regeneration occurs at the lower layer of the decidua
Describe postpartum descent of the fundus
- 1 cm a day
- 14th day should be in pelvic cavity and not palpable
- Documented in relation to the Umbilicus
Decribe postpartum afterpains
- Intermittent contractions (caused by Oxytocin from milk production)
- More acute for Multip d/t loss of tone from overstretching causing extra contractions
Describe postpartum Lochia
-1-3 days rubia
-3-10 days serosa
-10+ alba
Should end by 14 days but may persist for 6 weeks
What is the cause of the common short bleeding episode 7-14 days after birth?
-Eschar sloughing from placental healing site
When should a mother be evaluated r/t increased bleeding after birth
If it is extreme or just persists at a increased rate for 1-2+ hours
describe the postpartum cervix
- Heals rapidly
- Should be no more than 1cm after the first week
describe the postpartum Vagina
- Rugae reappear at 3-4 weeks
- 6-10 weeks for full epitheial restoration
- Regeneration is dependent on the production of estrogen
What is Dyspareunia
painful sexual intercourse due to medical or psychological causes
What are the four common postpartum laceration locations?
- Perineum
- Periurethral
- Vaginal Wall
- Cervix
Describe nursing care for lacerations/hemorrhoids
- Sitz bath after 24 hours
- Perineal bottle (peri bottle)
- Benzocaine spray/tucks
- Analgesics
Describe postpartum ovulation
- returns by 6 weeks
- if lactating, menses usually resume between 10weeks to 6months
When should contraception be used after birth?
- Non-BF = 6months or earlier
- Exclusive BF = asap if active
When does lactation begin?
-After expulsion of placenta
Describe the physiology of lactation
- Estrogen and progestrone decline
- Prolactin initiates milk production 2-3 days
- Supply and demand. More feedings=more milk
What hormone is responsible for milk ejection? “let-down”
Oxytocin
Where is milk ejected from?
Lactferous ducts
At term, the mothers blood volume has increased by____
30-45%
Describe the postpartum CV system
- CO increases as blood flow returns to mom
- -return flow also from decreased pressure from uterus
- Normal CO returns to prelabor within an hour
- CO returns to prepregnant within 6-12 weeks
How is excess plasma volume eliminated postpartum?
- Diuresis r/t decline in adrenal hormones and oxytocin
- Urinary output increases up to 3L/day
- Diaphoresis is very common too
Describe the Hematologic system postpartum
- Marked Leukocytes: WBC as high as 30k after labor
- WBC’s normalize within 6 days
- HgB and HCT normalize within 4-6 weeks
Describe the postpartum Coagulation
-Clotting Factors increased for the first 4-6 weeks
Describe the post partum GI system
- Constipation Common
- First stool in 2-3 days with a normal pattern by 8-14 days
An increase in WBCs of ___% in 6hrs after birth is an indication of ___
30
infection
Describe the UI function postpartum
- Normal Kidney function in 4 weeks
- Protein and acetone may be present due to uterine involution (catabolism)
Why are post partem moms at risk for UTI’s?
Urinary stasis
What type of incontinence is common for up to 8weeks PP
Stress
Describe the post partem M/S system
-Relaxin subsides and Hip/joint pain will subside
Describe the postpartum Abdominal wall
Possible Diastasis Recti
Describe the postpartum integ. system
- Hormonal skin changes will begin to subside
- Striae lighten
- Loss of hair at 4-20 weeks is normal Secondary to hormonal changes regrows in 4-6 months
What is the most important thing to review in the PP chart
Risk factors for PPH
What are some common risk factors fror PPH
- Grand multiparity (five or more)
- Overdistention of the uterus
- Precipitous labor (< 3 hours)
- Drugs (Pitocin, mag sulfate, general anesthesia)
- Hx of C section
- PROM, PPROM
What are six major risk factors for PP infection?
- Operative procedures
- Multiple cervical exams
- Prolonged labor
- Prolonged ROM
- Manual extraction of placenta
- DM
If a mother is given a Rubella/Varicella vaccine PP, what teaching is done specific to pregnancy
-Do not get pregnant for 28days after
Describe PP BP
- Abnormal if above 140-90
- Ortho. Hypo is common
- MAP 70-100 normal
How do you calculate MAP?
double the diastolic blood pressure and add the sum to the systolic blood pressure. Then divide by 3.
Describe PP pulse
- Bradycardia may occur possibly R/T large volume of return blood D/T increased Stroke volume
- If tachy. Suspect PPH
Describe PP temp.
up to 38 (100.4) common in first 24 D/T dehydration and PP leukocytosis
Describe the focused PP assessment
8 things
- VS
- Pain
- Fundus
- Lochia
- Perineum
- Bladder Elimination
- Breasts
- Lower Extrem
Describe Normal PP bladder elim. Values
- Frequent small voids (under 150) = retention
- Measure first 2-3 voids
- D/C measuring if voiding 300-400ml
Describe PP breast assessment
- Should be soft and non-tender
- Nipples may have redness, blistering, or fissures
- Nipple should be described as Inverted, Flat, or retracted
Describe the PP Lower Extremity assessment
-Look for S/S of thrombophlebitis or DVT
-Measure Calf
-Check for edema (cause by fluid redistribution)
Diuresis highest between 2nd and 5th day
-Check DTR’s
Breast milk changes in ___ different stages
3
What are the three stages of breast milk
Lactogenesis 1, 2, 3
Describe Lactogenesis 1
- Begins during Preg\ and first days after birth
- Colostrum only (higher in protein and some nutrients)
- Rich in Immunoglobulin A (protects infants GI tract)
- Establishes normal intest. Flora
- Laxative
Describe Lactogenesis II
2-3 days after birth
- Transitional between colostrum and mature milk
- Immuno and Protein decrease
- Lactose, calories, and fat increase
Describe Lactogenesis III
- Mature Milk
- Thinner and Blueish (mother may think it is not as rich)
- 20kcal/oz
- Immunos still present
Describe the protein in Breast milk
- High in Taurine (bile conjugation and brain development)
- Casein and Whey
- More whey than casein = easier to digest
Describe the CHO’s in Breast milk
- Lactose is major CHO
- Improves absorption of calcium and provides energy for brain growth
Describe the Fat in Breast Milk
- 50% of calories
- Easy to digest
- Hindmilk has more fat
- Triglycerides are the major fat
Describe the vitamin content of Breast milk
- A,E,C are High
- D is low
What is the Recommended vit D supplimentation within the first few days of life
400iu
Describe the enzymes in breast milk
- Aid in digestion
- Pancreatic amylase present in BM (CHO digestion)
- Lipase in BM (fat digestion)
Describe infection prevention component of Breast milk
- Bifidus Factor promotes growth of Lactobacillus Bifidus
- This produces an acidic environment that retards the growth of pathogens
What are the daily calorie needs of a breast feeding infant?
85-100 Kcl/kg
What are the daily calorie needs of a formula fed infant?
100-110kcl
___% weight loss in an infant in the first 3 days is considered normal
10
PP neonate weight loss should is caused by ___
fluid shifts and excretion of ECF
PP neonate weight should return to BW by ___ days
10
What are the daily fluid needs of an infant for the first 3-5 days
60-100ml/kg
What are the daily fluid needs of an infant after the first 3-5 days
150-175 ml/kg
When is the baby getting enough milk?
- Frequent swallowing
- smooth suck/swallow
- See the milk in their mouth
- feed them 8-12 times a day
- 2 wet by day 2, 3 by 3, 6 by 4
- 3+ bm a day after day 3
- Weight gain
- Maybe seems satisfied
What are the three phases of Maternal adaptation?
- Taking in
- Taking hold
- Letting go
What is the major task of Taking in?
- INtegrate birth into reality
- Discuss her experience with others
Describe a mother in the taking in phase
1-2 days
- Mother is focused on her needs
- She is passive and dependent
- Is very observant but trusts others with the neonates care
Describe a mother in the taking hold phase
3-10 days -Independent -Concerned about managing her own care -Is receptive to info about her baby -Should be encouraged to care for the baby This is prime time for teaching
Describe a mother in the letting-go phase
10days+
- Relinquishing of previous roles
- May be upset about the birth process or the infant
- May feel grief
- She refocuses the relationship with her partner
- Relinquishes the care of the child
