Well Postpartum Flashcards
*BUBBLE HE
Breast Uterus Bladder Bowel Lochia Episiotomy
Homan’s sign
Emotional
*What is being asses breast wise?
Size, symmetry, trauma/bruising, aerolar, nipple, dimpling
*What do dimpling and/or thickening of the breast indicate?
Tumor
*Trauma of the breast may look like and indicate what?
look: blisters, redness, bruising
indicate: the baby is not positioned correctly while being fed
*What is abnormal for breast tenderness and what ma it indicate?
Tenderness—
Lumpy– milk ma not be evenly distributed
*Potential issue for a flat or inverted nipple?
Issues with attachment and breast feeding.
*What may be caused by oxytocin release other than milk production?
Stimulation of the uterus to contract
- helps return it to normal size
- may cause the mother discomfort
*What are we assessing regarding the uterus?
Is it shrinking back to normal
*What three things help/lead to the uterus shrinking?
- Contraction of the muscle fibers
- Converting of cells into simple compounds
- Epithelial regeneration
*By what day at the latest should the uterus no longer be palpable?
14
*What is the size/weight of the uterus right after birth?
large grapefruit
about 2.2lbs
*What is a soft (boggy) uterus at an increased risk for?
Bleeding
*What can be done to firm up a boggy uterus
- Massage until it firms up
- Take oxytocin
- DNC (not first option)
*What are we concerned about regarding the bowels postpardum?
Constipation
*Why may constipation occur postpartum
- epidural
- reduced muscle and bowel tone from pregnancy
- decreased fluid and food intake during labor
*When should mom have her first stool after giving birth/
2-3 days post birth
*What leads to increased potential for urinary retention post birth?
- increased bladder capacity due to no more pressure from baby
- decrease in the sensitivity to fluid pressure
*What can be caused by a distended bladder?
- Displacement of the uterus. Which can cause an increase in bleeding.
- infection/UTI
*Signs of a distended bladder
-Fundus is displaces off mid-line and baseline
-Excessive lochia
-Bladder discomfort
Void <150ml
*What is asses in regards to lochia (3)?
Amount
Type
Odor
*What does a foul odor of the lochia indicate?
Suggest an endometrial infection
- Lochia rubra
- appearance
- when is it seen
Red/Brown color
1-3 days post birth
- Lochia serosa
- appearance
- when is it seen
Pink, possibly with a brown tinge
4-10 days post birth
- Lochia alba
- appearance
- when is it seen
Light cream/yellow color
day 11
*What makes us worried about the amount of lochia/
When the pad is heavily saturated in 15min
or, according to simulation, the mom is changing her pad every hour
Risk factors for postpardum hemorrage
- grand multiparity (uterus is like a baloon)
- Big baby/overdistention of uterus
- Retained placenta
- Too fat or too slow of labor
- Placenta previa
- Placenta abrupto
- Medications (tocolytics, oxytocin)
- C-section
- Coagulation defects
Placenta previa
Part of the placenta is over the cervix
Placenta abrupto
Placenta breaks from the uterine wall before the baby is born
*What is an episiotomy?
When a cut is made to increase the vaginal opening.
*Why is an episiotomy done?
Baby is coming too fast and before the mom has been completely dilated
*Is a medio-lateral or mid-line episiotomy preferred? Why?
Medio-lateral
-less risk to cut tearing to the anus, which would increase the risk for infection
How long does it take the vagina to return to its normal size and contour?
6-10 weeks
What does REEDA stand for and what is it assesing
Assessing episiotomy healing Redness Edema Ecchymosis Discharge, drainage Approximation
*What is the purpose of homan’s sign
To asses for DVT
*When should homan’s sign not be done?
When signs of a DVT are present
- redness
- swelling
- warm to touch
*How to preform homan’s sign and what indicates a DVT
supine, leg bent at 90 (like trying to make the side and top of a box), flex the foot
If there is a pain in the back of the leg that indicate a DVT
Risk associated with the separation of the rectus muscles postpardum
- hernia
- Muscle aches
- Muscle fatigue (constipation)
What position should a women maintain postpartum and why?
Semi-fowlers
-to promote lochia drainage
Considerations regarding menstruation/ovulation postpardum
- ovulation may occur before first period postpartum
- breastfeeding may delay ovulation and menstruation
Why may breastfeeding mothers experiance vaginal dryness?
Decreased estrogen
Risk factors for postpartum infection
- Operative birth procedures
- multiple cervical examinations
- prolonged labor
- manual extraction of the placenta
- diabetes
- catheterization
Symptoms of postpartum depression
- change in sleep pattern
- anger/rage
- weeping/sadness
- difficulty concentration
- changes in appetite
- anxiety
What is bonding?
initial attraction felt by parents towards the infants. Unidirectional from parent to child
What is attachment?
Process by which an enduring bond between a parent and child is developed. Starts in pregnancy and extends many months after birth
Name some reciprocal attachment behaviors. (6)
- Eye contact
- Attempts of infant to “track” parents face or voice
- Grasping/holding parents’s finger
- Successful breastfeeding
- Being comforted by parent’s voice
- Movements in response to parents voice
what are the 3 puerperal phases
Taking-in
Taking-hold
Letting-go
What does the taking-in phase entail and when does it occur?
birth-1/1.5 days postpartum
- mom is focused on herself and her needs
- has to process and deal with not being prgnante anymore.~~ seen throug talking about the birth details
- Is happy to let others take care of her child
What does the taking-hold phase entail and when does it occur?
Lasts a few days after the taking-in phase
- shift of focus to baby and its behaviors
- most teachable time
- time of anxiety for new moms
- mom may compare herself and her skill to the nurse
- mom is independent in care
- there is concern about what is happening in her own body
What does the letting-go phase entail and when does it occur?
not told when
- relinquishing life without baby
- can’t do things you used to
- new things you have to do
