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Post Partum
Stack #126425
| Question | Answer |
|---|---|
| Postpartum | AKA Puerperiuum period or 4th trimester |
| Def postpartum | extends from termination of pregnancy until all systems return to prepregnant state 6 wks or 42 days |
| Involution of Uterus | autolysis of protein, regeneration of endometrium. contraction of uterus |
| autolysis of protein | uterine muscle proteins broken down into simple compounds absorbed and eleminated in urine. Size of endometrial cells decrease, number of cells remains same |
| Endometrium restored to prepregnant state | by end of third week |
| Lochia | superficial layer of granulation tissue cast off from endometrium |
| Inne rlayer of endometrium also granulation tissue | composed of connective tissue and uterine glands regenerates the endometrium. Serves as a barrier against infection |
| Placental site of endometrium | is an exception takes 6 weeks to exfoliate. Forms no scar enables endometrium to resume its cyclic cycle. Permits future implantation |
| Hemmorhage most likely to occur | 1st hr postpartum |
| Cx control bleeding by | compressing and sealing off blood vessels |
| Size and bulk of uterus reduce as uterus contracts because | muscle fibers become shorter |
| Uterine weights | after delivery 2 lbs, one week, 1 lb, 2nd week 12 oz, 6 weeks 2 oz |
| Heighht of fundus after delivery placenta | 2 cm below umbilicus u/2 |
| Fundus 1 hr after delivery | level with umbilicicus or 1 cm above 1/u or U/U |
| Descends how many cm every 24 hrs | 1-2 cm |
| fundus by 9th postpartum day | no longer palpable |
| Predisposing factors | over distended uterus, rapid labor, prolonged labor, nulliparity, prolonged general anesthesia, PIH |
| Lochia | blood from uterine sinuses at the placental site and the necrotic superficial layer of endometrium |
| Lochia Rubra | bright red vaginal bleeding lasts approximately three days |
| Lochia Serosa | pink-brown discharge day 3-14 |
| Lochia Alba | yellowish white thin and creamy 10-21 days |
| Perineal lacerations 1st degree | extends thru skin and structures superficial to muscle |
| perineal lacerations 2nd degree | extends through muscles of perineal body |
| perineal lacerations 3rd degree | continues through anal sphincter |
| perineal lacerations 4th degree | involves anterior rectal wall |
| Factors predisposing to perineal lacerations | heredity, rapid delivery, light skin, red hair |
| Vaginal rugae reappear | 4th week |
| vaginal tone resumed | 6th week |
| no change in breast for ----- days after delivery | 2 |
| milk comes in | day 3 or 4 |
| hormone that stimulates milk production | prolactin |
| other factors that stimulate mild production | mother's diet ( protein, iron, calcium, vitamins), fluid intake, activity level/rest |
| sucking stimulus sends message to hypothalmus stimuates ANTERIOR pituitary | releases PROLACTIN, promotes milk PRODUCTION in alveolar cells |
| sucking stimulus sends message to hypothalmus stimulates POSTERIOR pituitary | releases OXYTOCIN causes LET DOWN reflex and milk ejection |
| Temp 1st 24 hrs | 100.4 |
| Temp 3rd or 4th day | could be milk coming in |
| Bradycardia common | first 6-8 days postpartum 50-70 considered normal up to 3 mos |
| Tachycardia | r/t blood loss |
| Hypotension | uterine bleeding |
| orthostatic hypotension | common 1st 48 hrs |
| cardiac output | elevated 48 hrs |
| Blood volume returns to prepregnant state | 2-3 weeks r/t decrease in progesterone and other placental hormones |
| Leukocytosis | 10-12 days 20-25,000 |
| blood loss | vaginal delivery 200-500 ml. Section 700-1000 |
| Hgb and Hct vary | 1st 72 hrs after delivery there is a greater loss of plasma volume than blood cells which leads to increase in hgb and hct r/t hemoconcentration 3rd - 7th day |
| Renal system | ureters begin to shrink bladder fills quickly Glucosuria is common r/t lactose formation |
| Factors Depressing Urination | trauma to urethra and bladder as infant passes thru pelvis, edema or urethra and meatus, effects of anesthesia, pelvic soreness |
| Weight Loss | @delivery 12 lbs, first 2 weeks 9 lbs, takes six weeks or more to return to prepregnant weight |
| 3 pahses of Maternal Adjustment | 1) Dependent phase taking in 2) Dependent-Independant phase taking hold, 3) Interdependant phase Letting Go |
| Dependent Taking In Phase | 1st 24 hrs after delivery. Inward focus. Needs to retell labor delivery story over&over to integrate into life experience.Energy focused on own helath and well being.Verbalizes need for food and sleep.Behavior passive and dependent mother the mother |
| Dependent Independent Phase | 1-3 days energy level increases focuses on self and baby Ideal time for teaching responds enthusiastically. Altering need for nurturing with desire to take charge |
| Interdependant Lettin gGo Phase | Needs to give up roll of childless person Takes on roles and responsibilities of new parent Gives up fantasy of newborn and accepts reality requires grief work, readjustment |
| Nursing Care Delivery Room | supine position 1-2 hrs head elevated 45 degrees No BRP r/t orthostatic hypotension, monitor hemmorhage q 15 min, f1st hr, q 30 2nd |
| Delivery /room cont | palpate fundus for firmness & location, note lochia, assess v/s q 15 and q 30, warm blankets for chills and tremors, clear liquids, small amts ice pack perineum, analgesics |
| Nursing Care PP Unit | assess fundus, lochia, v/s q 15, voiding stay with client 1st visit to BRP, Instruct peri care and episiotomy care, analgesics for pain, assess hemmorhoids with penlight.Instruct change pad each trip |
| episiotomy care | ice packs 1st 12 hrs, sitz baths thereafter, peri bottle, wipe(pat) front to balck, change pad every time to avoid infection, analgesics for pain |
| hemorrhoids | assess with penlight lateral sims, tucks pads, dermoplast, creams/ointments Pepperoni Pizza Pad |
| Breast care Non Lactation | wash breasts dialy, snug bra, do not express milk, moderate fluid intake, ice packs for tenderness, breast binder, analgesics. AVOID hot water on breasts |
| Sore Nipples | Check latch on, full areola, check how infant is removed from breast, do not use breast as pacifier, rotate position on breast, air dry nipples, shorten time on breast but feed more often, ointments/cream last resort |
| Engorged breasts | use warm compresses 15-20 min before feeding, express some milk to enable latch on. Best is prevention feed often every 2 hrs awake, 4 at night |
| Post Partum Medications | stool softners, laxative of choice, analgesics, Rhogam (72hrs), rubella vaccine, discuss birth control |
| S/S bonding deficiency | negative verbalizations, negative identification, unrealistic expectations, intolerant of crying, baby too demanding, diapers yukky, lack of support, sibling rivalry, spousal jealousy |
| 10 B's | Boggy Belly, Bleeding, Bottom, Bladder, Bowels, Breasts, Bonding, Blood Type, Blues, Birth Control |
| Bubble He | Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy/Incision, Hemorrhoids, Emotions |
| Characteristics of Infant Abductor | female (12-50), overweight, immature, impulsive, frequently has lost a baby or is infertile, married or cohabiting SO would like a child, usually lives in community where abduction occurs |
| Characteristics Abductor 2 | often visits nursery and asks detailed questions, about hosp procedures and layout, usually preplans but not the target, frequently impersonates hospital personnel, often aquainted with personnel or parents |
| Nurses Role Preventing Abduction | know characteristics of infant abductors, know whos on unit, be alert for strange behavior, educate parents NEVER leave baby alone and know who they are releasing baby to (ID) |
| methergine | stimulates smooth muscle tissue, smooth muscle tissue of uterus is especially sensitive to this drug, used post partaly to stimulate uterine contraction, in order to decrease blood loss by clamping off uterine blood vessles and to promote involution proce |
| Rh Isoimmunization | hemolytic disease arising from incompatibility of rh factors of maternal and fetal blood |
| RH incompatibility only occurs | with rh - mother, rh + father produce rh+ baby. Mother must be rh- baby must be rh+ for icompatiblity |
| to be rh - must be homozygous for the trait | dd |
| Direct coombs test | done on babies blood positive means maternal antibodies are present in babies blood (cord) |
| Indirect Coombs | done on mother dtects presence of free floating antibodies in mothers blood |
| Rho Gam | immunoglobulin solution containing RH antibodies Destroys fetal cells in maternal circulation befoe sensitization occurs. Blocks maternal antibody production and prevents permanent active immunity. Providestransient passive immunity that lasts 2 wks |
| Criteria for Post Partum RhoGam (to be given with 72 hrs) | Infant must test RH+ via cord blood, Infant must also have negative direct coombs on cord blood Mother must have negative indirect cooms |
| Rho Gam administration | given to all RH- mothers at 28 weeks gestation, also given after abortion, ectopic pregnancy, chorionic villi sampling and amniocentesis |
| Early Post Partum Hemmorrhage | 1st 24 hrs 4 causes: UTERINE ATONY, lacerations of genital tract, retained placental fragments, blood co agulation problems |
| Mgt uterine atony | Hemabate (Prostin 15M) given IM if hemmorhage not responding to fundal massage |
| Retained placenta | hemmorrhage occurs if placenta is only partially separated r/t massage of fundus prior to placental separation. D&C |
| Placenta Accreta | abnormal adherence of placenta to uterine wall D& C or hysterectomy |
| Late Postpartum Hemorrhage | most frequently retained placental fragments develops a day or two after delivery |
| Very Late Postpartum Hemorrhage | Placental polyp r/t fragement being retained for a week or more and becoming necrotic polyp begins to slough and causes sudden bleeding with boggy uterus, inc HCG, and large amount of vaginal bleeding Mgt: IV oxytocin Methergine, antibiotics |
| Nursing care postpartum hemorrhage | periodic assessments fundal height and firmness, Pad count for bleeding. Massage fundus til firm, increase IV rate with pitocin, express clots, monitor for signs of anemia, encourage rest, EDUCATION most important |
| Education | Normal post partum course, signs of abnormal bleeding, fundal massage, assessing fundal height and consistency, inspecting episiotomy and lacerations |
| Call MD | saturation 1 pad an hour, boggy uterus that does not respond to massagem abnormal clots, temp over 100.4, unusual pelvic, rectal discomfort or backache |
| Predisposing Factors PP Infection | prolonged rupture of membranes, retained placental fragments, postpartum hemorrhage, pre existing anemia, prolonged or difficult labor with instrument delivery |
| Types Postpartum Infections | Thrombophlebitis, Perineum, endometritis, mastitis, uti |
| endometritis | infalmmation of enometrium, placental site excellent medium bacterial growth. Fever must be distinguished from milk fever, temp 100.4 and above 2 sucessive days not counting 1st day after delivery, general malaise, anorexia, chills are early signs |
| later S/S endometritis | perineal discomfort, tachycardia, pelvic pain and tenderness |
| Mgt endometritis | antibiotic, iv fluid, analgesics Encourage PO fluids, rest semi fowlers, maintain pericare |
| Prevention endometritis | educate client importance of peri care, diet high in protein and vitamin c to promote healing |
| Mastitis | inflamation of breast tissue, ussually unilateral Staph aureus. Nipple fissure becomes infected, involves duct system, inflammatory edema and engorgement, obstruction of milk lobe regional obstruction breast abscess |
| S/S Mastitis | chills, feverr, malaise, local breast tenderness,in upper outer qudrant, axillary lymph nodes enlarge and are tender, flu like symptoms |
| Mgt Mastits | intensive abx 10 days, breast support, local heat, analgesics, maintain lactation via pump, discard milk, encourage fluid intake, If abscess develops I&D |
| Prevention Mastits | teach proper breast feeding technique to prevent cracked nipples. Avoid milk stasis, proper handwashing, avoid tight clothing, bra at all times, daily breast assessment report s/s |
| UTI | difficulty voiding r/t vulvar edema and loss of bladder tone from pressure of fetal head or increased residual volume ( incomplete emptying) |
| Mgt UTI | broad spectrum abx 10 days analgesics for pain |
| Interventions | encourage 3-4000 mls fluid daily, provide rest, encourage pericare |
| Tetracycline or Sulfonamides | discard milk |
Created by:
margaretptz
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