WH Postpartum Flashcards
Recovery stage: the first 2 hours of postpartum
Fourth stage of labor
The first 6-8 weeks following a birth
Postpartum (puerperium)
Bonding, adjusting to parenthood, learning infant care
Psychological processes of postpartum
Uterine involution, lochia flow, breastmilk formation, diaphoresis, diuresis
Physiological processes of postpartum
Assess for complications: PPH, shock, infection
Q15m assess BP, pulse, uterine tone and position, lochia flow (bleeding)
Admin Pitocin or alternate oxytocic med
Provide comfort and support pt with first ambulation and void (watch for orthostatis hypotension). Education. Promote bonding. promote breastfeeding if desired by family, otherwise support formula feeds
Postpartum Nursing Interventions
stimulated by oxytocin. The release of this is stimulated by breastfeeding
Uterine involution
at umbilicus right after delivery, decreases one fingerbreadth per day. Documentation of 1 finder below umbilicus looks like U/1. Documentation of 2 fingers above is recorded as 2/U
Fundal height
After 10 days-2 weeks, the uterus is not palpable abdominally. A “boggy” or relaxed uterus will usually respond to abdominal massage and quickly become firm
Postpartum uterus
EBL (estimated blood loss) and QBL (quatitative blood loss) are measured at birth and in recovery, ongoing significant bleeding is weighed and added into the cumulative blood loss for delivery.
Assess for quantity, color, odor (if any) and consistency.
Quantity: scnat, light, moderate, heavy, saturated pad or excessive (soaking a pad in 15 min, pooling on bedding or linens). If heavy or excessive , weigh on a scale (subtract weight of pad or linens ) for QBL
Color: Rubra, serosa, alba
Consistency: assess for clots
Lochia and blood loss
Red discharge, day 1-3
Rubra
pink, brown, day 4-10
Serosa
pink-yellow-white, day 10-8 weeks
Alba
Interventions: Notify provider.
Monitor VS
Start IV if no current access
Administer meds as ordered
Interventions with Excessive bleeding
Often with some edema or bruising.
Assess approximation and note any drainage (light bleeding cann be normal)
Heals quickly 3-4 weeks dependingn on depth, however full depth healing and sensation can take months.
Ice for first 24 hours, stool softener
Taching: pt to use peri bottle to rinse area adn then pat drym topical anesthetic spray prn, clean front to back
Postpartum perineum
Common in pregnancy and following pushing efforts, treat with medications, ice, witch hazel as needed for pain, may contribute to consipation issues as women may avoid BMs.
Hemorrhoids
Folowing labor there is often a delay in resumption of bowel movements for 1-2 days. If normal peristalsis does not resume, this can happen signficantly and ileus formation can occur. Often laxative or stool softeners are given each day postpartum to avoid these complicatons. Enemas and rectal med prepa re contriandicated in pts who have had a third or fourth degree repair (dont disrupt sutures). Encourage fluids, ambulation, and high fiber foods.
Postpartum constipation
Assess for distention. Sensation may be decreased and a woman may not recognize need to void. Increased diuresis should be notable within 12h of delivery. Up to 3L/day can be eliminated in first few days postpartum. Pain with urination (dysuria) due to a laceration can be improved with pain meds, urinating in warm water (bath or shower), use of peribottle or anesthetic spray
Postpartum Bladder
Colostrum is present and may be leaking prior to labor and birth. Transitions to mature milk on day 3-4, turns white, “comes in” with breast filling and engorgement, may be uncomfortable and dramatic with erythema and breast firmness. No meds given to inhibit milk production. “use it or lose it”. If milk supply is not breastfed or pumped, the body will stop production over the course of many days. If a woman is choosing not to breastfeed, she can aply cabbage leaves inside of bra to breast to inhibit breastmilk. For comfort, supportive bra, cold packs, avoid nipple stimulation.
To encourage milk production, feed frequently, eat and hydrate well, get rest, decrease pain and stress
Breastfeeding is feed on demand but at least every 3 to 4 hours in the first week
Assess ofr unilateral erythema (mastitis), cracked or bleeding nipples (from a poor latch), tenderness or masses (plugged milk duct)
Postpartum Breasts
The way that the baby attaches to the breast. If inadequate, can damage the nipple and feedings are painful. The infant needs a wide open mouth before latching in order to get the entire nipple and aerola into its mouth, just suckling on the tip of the nipple will not supply milk and will harm the mother
Breastfeeding Latch
The baby must do the work, timing is everything. Mother need encouragement to repeatedly offer feedings before an infant is too tired or upset to feed well. Babies who do not feed early may become sverely hypoglycemic, breastfeeding can go well one feeding then be impossible two hours later. Lactation consultatns are available to help with frurations.
Poor feeding effort
An infection within the milk duct, symptoms are unliateral pain, erythema, warmth, fever, and general malaise (flu-like symptoms)/ Continue breastfeeding to prevent milk stasis. The infection will NOT hurt the baby
Mastitis
A blockage of flow of the milk in the duct. A firm mass with discomfort and pressure. The mother can apply heat to try to massage toward the nipple to free the blockage
Plugged milk duct
