list some problems with bladder in the postpartum woman
1. urinary distention
2. incomplete emptying
3. retention with overflow
Describe the normal bowel assessment
+ bowel sounds
check for hemorrhoids
check date of last BM
decreased bowel sounds could indicate what?
how can we decrease inflammation on the postpartum woman's bowel area?
How does the nurse assess the perineum?
Have mother lay on her side
lift up her upper buttock/leg
check episiotomy, laceration or for hemorrhoids
use a penlight - a continuous trickle of blood could indicate a tear
evaluate for redness, edema, ecchymosis, discharge, approximation (REEDA)
keep mother comfortable, pain free. use ice packs for 20 minutes at a time, pain meds
Approximation (bringing together especially the cut edges of tissue)
an episiotomy incision can be ______, ______, or ______
RML - right mediolateral
LML - left mediolateral
What do we assess the extremities for in the postpartum woman?
assess lower legs for redness, swelling or warmth
bilateral pedal edema
1+ to 2+ deep tendon reflexes
why do we assess for deep tendon reflexes in the postpartum woman?
because it could be s/s of pregnancy induced hypertension
what is hyperreflexia?
overactive or overresponsive reflexes. Examples of this can include twitching or spastic tendencies. could indicate the cerebral area has some irritability or interupted pathways as related to a seizure.
Match the following:
A. 1st degree laceration 1. to the anal sphincter
B. 2nd degree 2. skin almost to muscle, ice packs for 20 mins
C. 3rd degree 3. to the rectal mucosa
D. 4th degree 4. through the anal sphincter
Assessing the mother education and emotional status
assess her emotional status
get her comfy and pain free
assess fatigue/sleep patterns
assess pain leel
assess mother/infant attachment behaviors
assess teaching needs
what is "taking in" vs. "taking hold"?
taking in is when the mother lets everyone around her do their stuff, she is a bystander
taking hold is when the mother begins doing things on her own, she is active participant
during immediate postpartum, vital signs should be taken
D. q15 minutes for the first hour
true or false... you will see a generalized shaking and chattering of the teeth immediate postpartum?
how often should you check the fundus and lochia immediately postpartum?
q 15 minutes for the first hour after delivery
q 30 minutes for the next 2 to 3 hours
q hour for the next 4 hours
q 4 hours for the rest of the first postpartum day
and then q 8 hours until the patient is discharged
true or false... Every 24 hours the fundus should be 1 cm (or 1 finger breadth) below the umbilicus
don't forget patient history as part of the postpartum assessment!
ask the mother about it, don't just rely on medical records. this is a good way to find out her emotional state about pregnancy and childbirth
this vaginal discharge is similar to menstrual flow and consists of blood, fragments of the decidua, white blood cells, mucus and some bacteria
When assessing lochia, what do we look for?
amount - increases with activity - such as getting oob, lifting heavy objects, walking upstairs, should be present for at least 3 weeks postpartum)
color - rubra, serosa or alba
odor - similar to menstrual flow, should not be foul
true or false... it is normal for the patient to saturate a peri pad in less than an hour