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puerperium
6 week period of time from delivery of the placenta to the time moms body is back to prepregnancy stage
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Early Maternal Assessment
-Vitals
- vaginal birth
- take vitals q15minx4 q30x2 q1h q4-8
- c-section
- take vitals q30minx4h q1hx3 q4-8h
- temperature
- can be up tp 100.4 for 24h if over 100.4 infection has occured
- d/t exertion and dehydration.
- Pulse50-70 bpm commonly occur
- d/t elevated stroke volume
- postpartal tachycardia may result from complication, prolonged labor, blood loss, infection.
- Blood pressurecompare BP to BP of first trimester.
- may have some hypotn but should be back to normal
- Resps should remain normal
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Maternal Assessment
Fundus
- Fundus should be halfway between umbilicus and symphysis pubis within a few minutes of pacental birth.
- within one hour fundus should be at level of umbilicus where it remains for one day. there after the undus will descend one fingerbreadth per day in size
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Maternal Assessment
REEDA
- Redness, Edema, Ecchymosis, Drainage and Approximation
- 0-3 points given for each area
- 0=none
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BUBBLE-HE
Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy(tissue trauma), Homans sign(Legs), Emotions(infant bonding)
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Hormones for Changes in Postpartum Mother
-estrogen
- Estrogen:stimulates the formation of additional ducts in breasts and elongation of existing ducts.
- Progesterone:stimulates the formation of lobules the glands that produce milk
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Medications used for comfort care
- Stool softeners(Colace, Dulcolax)
- Topicals(Lidocaine)Hemorrhoids(witch hazel Tucks) NSAIDs Ibuprofen, Opiods (darvocet, percocet, tylenol)
- sitz baths, encourage ambulation and administraion of tylenol/motrin etc..should be taken 30 mintues prior to breastfeeding to help with pain relief before uterine contractions
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Maternal Assessment
Uterus
- Involution-the process by which the uterus returns to prepregnancy state.
- - the uterus rapidly contracts to prevent hemorrhage. complete healing takes appox. 6-7 weeks.
- the myometrial cells decrease in size not in number.
- subinvolution=failure of the uterus to return to the nonprgnant state.
- d/t multiple births, infection, hydramnios, prolnged labor or difficult birth, grand multiparity or excessive maternal analgesia.
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The uterine fundus is palpated by placing one hand immediately above the symphysis pubis to stablize the uterus and the other hand at the level of the umbilicus
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Maternal assessment
-after pains- are intermittent uterine contractions that occur during the process of involution
primiparous women typically have less pain d/t the uterus' ability to stay contracted
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Lochia blood flow from uterus during puerperium.from palcental delivery up to 6-7weeks.
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Lochia rubra bright red color lasts for up to 3 days postpartum fleshy odor small clots.
- Lochia serosa pinkish brown color, serosanguous consistency and lasts from day 4-10
- Lochia alba yellowish white creamy texture, fleshy odor.
- scant<25cm light<40 moderate>10 heavy one pad saturated within 2 hours.
- excessive pad saturated in 15min or pooling blood under buttocks.
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Interventions for excessive bleeding
first determine cause and tx as prescribed
- excessive bleeding d/t
- cervical/vaginal tear(excessive spurts)
- numerous clots, blood loss(hemorrhage)
- foul odor(infection)
- Lochia rubra>3 days Placental fragments
- Lochia alba and serosa>normal length=endometritis if accompanied with fever pain and abd, tenderness
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Episiotomy:surgical incision made by PCP between vaginal opening and the anus
Use REEDA
sitz bath, ice pack meds to tx after episiotomy
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Homans sign assess for DVT
patients legs should be extended and relaxed with the knees flexed . the examiner dorsiflexs the foot. no pain or discomfort should be present.
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