-
Explain puerium
- Postpartum
- 6 weeks post-delivery
- 4th stage of labor
- 4th Trimester
-
3 periods of postpartum and their time periods
- 1. Immediate: 1st 24hrs
- 2. Early: 1st week
- 3. Late: 2nd - 6th week
-
Define Postpartum
- Body Recovers
- Goes back to prepregnancy state
-
Shrinking or returning to normal size of uterus, cervix and vagina
Involution
-
While giving a uterine massage what should you support?
Lower uterine segment
-
While giving a uterine fundus massage what position should the bed be in
Flat
-
When you are massaging the fundus what could be a possible complication if you don't have the pt .....
Empty Bladder
-
What things will delay uterine involution?
- Full Bladder
- Any condition that over distends the uterus(multifetal pregnancies, hydramnios)
- Epidural
- Maternal Exhaustion
-
How are you VS going to differ from the normal person, immediately postpartum?
- Temp slightly elevated within the first 24hrs
- Slow pulse, 50 bpm, for the first week
- BP should be normal
-
Most rapid changes pp occurs in what time frame?
1st 3-4 days
-
When dorsiflexing the foot the woman experiences pain
Positive Homan's Sign
-
Fundal Height Times
Immediately After Delivery:
1. Firm in the midline and 1/2 way between the umbilicus and symphysis pubis
-
Fundal Height
One hour PP
uterus should be contracted firmly with the fundus at the level of the umbilicus
-
Fundal Height
1 day after PP
1 fingerbreath (1 cm) below umbilicus
-
Fundal Height
Anything after the first day
1 fingerbreath per day untill no longer papable
-
When should the fundus be no longer palpable
By the 10th day
-
What promotes involution
- Breastfeeding
- Early ambulation
- Proper Nourishment
-
What factors inhibit involution
- over distention of uterus
- retainted placental fragments
- infection
- grand multiparity
-
When the uterus doens't contract effectivly what could this lead to
-
5 or more pregnancies
Grand Multiparity
-
How is involution assessed?
Measuring fundal height
-
3 phases that occur in maternal adaptation
- Takin IN
- Takin Hold
- Letting Go
-
3 ways bleeding is controlled phsiologically immediately after delivery
- 1.Involution and contraction causes to open blood vessels and seal them off
- 2. Clotting cascade is initiated
- 3. Fibrinogen levels are raised
-
What are signs that the mother is not bonding with baby
- Turning away
- Negative statements about baby
- Refusing to name baby
- Not caring for baby
- Not wanting baby in room
- Gradual withdrawls
-
Group of related symptoms
Syndrome
-
Spongy soft uterus not well contracted
Boggy Uterus
-
When the uterus is not contracting effectively; blood and clots collect in uterus which could lead to what
-
Afterpains are most severe in ? because ?
Multipara because the uterus goes through periods of contraction and relaxation
-
When massaging the fudus what are we assesing?
-
If you over massage the fundus what could happen
Uterus becomes flaccid rather than helping it to contract
-
The blood, mucus, tissue and WBC's make up this
Lochia
-
Describe Lochia Rubra
- 1st 3-4 days
- Red in color
- Fleshy smell
- Small to Moderate Amount
-
Decribe Lochia Serosa
- Days 4-10
- Small Amount
- Brownish-Pinkish Color
-
Decribe Lochia alba
- After day 10
- White, or Pale Yellow in Color
-
How long does lochia last?
2-3 weeks but could last up to 6 weeks
-
3 abnormal findings to watch for in lochia
- 1. Reverse in Pattern
- 2. Fall to decrease or Increases
- 3. Foul odor
-
Ovulation can occur as early as
3 weeks PP
-
Ovulation can occur in the absence of
Menstrual Period
-
A menstrual period can occur in the absence of
Ovulation
-
This suppresses ovulation but is NOT an effective form of birth control
Breastfeeing
-
A PP cervix may appear
Bruised and Torn
-
What appearance does a nulliparous cervix have
Dimpled
-
What appearance does a PP cervix have?
Slit-like doesn't ever go back to original shape
-
When does Rugae return to vaginal walls?
3 weeks PP
-
Breastfeeding can lead to dryness of the vaginal walls which leads to
Dyspareunia: painful intercourse
-
What 2 things can cause prolactin levels to rise
- 1. Delivery of placenta (estrogen and progesteron levels fall causing prolactin to rise)
- 2. Suckling
-
When does milk usually come in?
3rd Day
-
What is the average amount of blood loss in a vag delivery
300-500mL
-
What is the average amount of blood loss in a c-section?
500-1000mL
-
As PP blood volume returns to normal you can expect an increase in what?
Hct
-
High plasma fibrinogen levels at PP help bleeding stop but can cause what to occur?
DVT
-
PP Blood Loss
For every 250mL of blood loss the Hct & hgb do what
- Hct: Fall 2 points
- Hgb: Fall 1 point
-
WBC's do what in PP
Raise
-
Immediate PP mom begins to shiver what do you do?
- Assess for temp, if over 100.4 this means infection
- If less than 100.4, give her a warm blanket or two
-
Abdominal wall seperates during pregnancy leaving part of abd wall without muscular support
Diastasis recti abdominis
-
4 risk factors for Diastasis recti abdominis
- Obese
- Over distended abdomen
- Poor Muscle Tone
- Grand Multipara
-
Diminished peristalsis, hemrrhoidal pain, perineal discomfort, and iron supplements can lead to what
Constipation
-
PP bowel function should return to normal when?
End of the 1st week
-
When palpating the fundus if it deviates to the right it is because
Urinary Retention
-
Approximately how many pounds are lost with the expulsion of the fetus, placenta, and amniotic fluid
10-12
-
How many pounds is lost from fluid loss in early PP
5
-
The average woman returns to her prepregnancy wt when?
6 mths PP
-
What does breastfeeding do to your body
Helps you loose wt faster
-
Reva Rubin identified 3 phases the PP woman goes through
- Taking In
- Taking Hold
- Letting Go
-
Explain Taking In
When the woman is mostly concerned with her self
-
Explain Taking Hold
When the woman begins to focus her care on the newborn
-
Explain Letting Go
Woman begins to degine her role as a new parent
-
The enduring emotional bond that develops between a mother and her infant
Attachment
-
Initial component of healthy attachment is the the process of
Bonding
-
Face to Face Bonding
En Face
-
Approx 50-70% of all PP women experience a mild depression that lasts 2-3 days generally called
Postpertum Blues
-
If a woman is goin to hemorrhage she is most likely to do so when
1st hour postpartum
-
What 13 do you assess in a PP assessment
- VS
- Position and Firmness of Fundus
- Amount and character of Lochia
- Status of Perineum
- Bladder distention
- Incision if C-sect
- Breasts
- Homan's Sign
- Pain
- Bonding
- Emotional Status
- Any Labs
- Bowel
-
How ofter do you assess VS
- 1st hr q 15min
- 2nd q 30min
- q 4hrs until 24hr mark
- Add a head to toe assessment each shift
-
Check for what on Breasts
- Crackling
- Redness
- Engorgement
-
Who has more lochia?
Vag Delivery
-
Woman should be voiding what amout PP on a regular basis
100mL
-
What position do you check the perineum in?
Sims
-
We palpate the perineum with a gloved hand when checking for?
Hematoma's
-
When you assess the calves what is the Norm?
- Equal in size bilaterally
- No red or painful areas when feet are dorsiflexed
-
What labs do you need to order?
-
When standing up lochia can alarm the woman because
- Lochia can pool up while sitting down
- Then once erect it may gush out and run down her legs
-
What nursing interventions should you take for a boggy uterus?
-
Bright Red Bleeding that occurs in a steady stream in the presence of a firm fundus is most likely to be caused by what?
Cervical Laceration that was not repaird
-
Unilateral pain and swelling sometimes with hard mass in the breast could indicate
Mastitis
-
What engorgement intervention should you provide for the breastfeeding mom
Warmth
-
What nursing invention should you take for the mom who is feeding the infant formula
-
Why should we give analgesics 30-45 mins before mom breastfeeds?
Reduce feeling of afterpains from uterine contraction due to oxytocin release from suckling
-
What other nonpharm help with afterpains
Warmth
-
Your pt complains of perineal pain...what is your next step?
- First visualize the perineum to rule out hematoma and that the episiotomy is well approximated
- Ice packs (20 min on/20 min off) 1st 24hrs
- Sitz Bath After 24hrs
- Mild analgesics with a narcotic
- Benzocaine Sprays
-
Nursing interventions for hemorrhoids
- Sitz Bath
- Witch Hazel Pads
- Hydrocortisones
-
Infection of the uterine lining
Endometritis
-
Instruct the PP to change her pad q
4hrs
-
What is used to clean the perineum
Perri Bottle
-
First time mom is at risk for fainting the first time she showers because
Warm water causes peripheral blood vessels to dilate leading to hypotension resulting in fainting
-
3 reasons to do an In & Out cath
- Distention
- 6 hours without void
- Several voids less than 100mL
-
Anytime a narcotic is administered with a spinal or epidural what is a possible risk?
Respiratory Depression
-
Report low RR when
Below 12 bpm
-
Report a low pulse ox when
Less than 95%
-
Abdominal surgeries such as c-sections cause gas to build up and manifests as pain where?
Shoulder
-
Common side effect of narcotics usually fixed with benadryl
Pruritus
-
How long is a cath left in with a c-sec birth
24hrs
-
What should be available in the cse that hte meds cause RR of 12 or less
Narcan
-
If the fundus is firm and the woman has no vaginal bleeding how often should you massage the fundus
YOU DON'T
-
How often should you asses lung status after a c-sec
q 4 hrs
-
How often should you TCDB
q 2hrs
-
When the basal dose of analgesia doesn't control the pain adequately
Break through pain
-
Research has shown it is easier to control pain when
Before it starts
-
If pruritis becomes unberable what should your intervention be
Narcan
-
Pain from flatus can be an issue after a c-sec so you need to teach your pt to avoid
- Very Hot or very cold drinks
- Soda
- Drinking through a straw
-
Discharge day is focused on
Pt teaching
-
Postpartum Danager Signs (12)
- Fever greater than 100.4
- Shaking Chills
- Localized reddened, painful area on one breast
- Frequency, Urgency, and Painful Urination
- SOB or Chest pains
- Severe unremitting abd or back pain
- Foul Smelling Lochia
- Increased in Heavy lochia or passage of clots
- Lochia pattern reversal
- Severe pain/reddness or swelling at epi site or incision
- Swollen painful reddened area on calf
- Prolonged or severe depression
- Thoughts of harming self or baby
-
How many calories should the breastfeeding mom take in
500 more cal
-
How many calories should a formula feeding mom cut out of her diet
300 cal
-
What does mag sulfate do?
- Taken in toxic prevents seizures
- Sedates the nervous system to control B/P
-
What can be done to help muscle tone
Kegal Exercise
-
A falling in BP particularly in the presence of an increasing Pulse is suggestive of what
Hemorrhaging
-
Is transient glycosuria, proteinura and ketouria normal in the 10th of PP
No just normal after immediate PP
-
Dilation of renal pelvis and uters
Is this common
Due to what
Duration
- Hydronephrosis
- Yes
- Due to hormonal influences
- 4 weeks after delivery
-
What is the nursing intervention for a Rh neg mom
RhoGAM injection withing 72hrs of delivery
-
If mom is not immune to rubella what would you do?
- Administer vaccine
- PT TEACHING No pregnant within 3 months of injection
-
Out put should be at what
30mL per hour
-
Difference between C-Sec and Vag
- IV longer
- Longer to ambulate
- Diet
- No epi
- Abd incision
- Higher risk for gas pains
- Higher risk for infection
- More itching
- Cath longer
- Higher risk for Respiratory Disorders
- More pain
- Longer hospital stay
- higer risk for hemorrhage
- Decreased peristalsis
- Higher risk for thrombus formation
- Ausculatated more often
- Uterus descends faster
- More blood loss
- Less lochia
- Goes from rubra to serosa more quickly
-
BUBBLE
- B: Breasts
- U: Uterus
- B: Bowel
- B: Bladder
- L: Lochia
- E: Epi/incision/ c-sec
-
REEDA
- R: Redness
- E: Edema
- E: Ecchymosis (Brusing)
- D: Discharge
- A: Approximation
|
|