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N113 Postpartum care

N113 - Postpartum Assessment & Care

QuestionAnswer
What is postpartum? From the delivery of the placenta & membranes to the return of a woman's reproductive system to its non-pregnant state - approx 6 weeks.
What is involution? the process by which the uterus returns to its normal size.
What is evidence of satisfactory involution? Firmness of uterus, rate of uterine descent & nature of lochia.
What is the normal rate of descent of the uterus? 1st day postpartum - at or slightly above umbilicus, 2nd day - at or slightly below umbilicus, 3rd day - 1 finger below umbilicus, 4th day - 2 fingers below, by 10th day - behind symphysis - not detectable
What can impede involution? A prolonged labor, general anesthesia, difficult delivery, multiple pregnancies, full bladder, infection, retention of placental fragments.
What is the #1 postpartum concern? Hemorrhage
What are S/S of hemorrhage? Increase pulse rate, decrease in BP, excessive bright red bleeding, boggy uterus that does not respond to massage, unusual pelvic discomfort or back pain, cold, clammy skin
What are the panic levels for H&H? Hb <5.0g/dl & Hct of <20%, hemoglobin will decrease 1 to 1.5 g/dl & hematocrit will decrease 2-4% per 500 ml of blood loss
What are the early or immediate causes of hemorrhage? blood loss greater than 500 ml in first 24 hrs caused by uterine atony, laceration of the genital tract, retained placenta, adherent placenta.
What are later causes of hemorrhage? Retained placenta and infection are the most common causes.
What is lochia? the decidua (lining) which is cast off down to myometrium, a new endometrium is formed
What is lochia rubra and how long does it last? Bright red, tends to clot, serosanguineous, becoming more serous and less bloody - last 1-3 days.
What is lochia serosa and how long does it last? Dark red (or pinkish) to brond, sheds of decidua, looks less like blood - lasts 3-10 days
What is lochi alba and how long does it last? Whitish/yellowish discharge - lasts 10-14 days, may last 3-6 weeks and remain normal.
What is diastasis abdominis? separation of the rectus abdominis muscles may occur leaving part of abdominal wall with no support except skin, subcutaneous fat, fascia & peritoneum.
Why is bathing so important? There is an increased risk for infection during postpartum.
What is an episiotomy? A surgical incision of the perineal body - assess using REEDA - redness, edema, echymosis, discharge, approximation
What is a laceration? A tear in the perineal body which occurs in varying degrees.
1st degree laceration tear through skin & structures that are superficial to muscle
2nd degree laceration extends through perineal muscles - much like an episiotomy
3rd degree laceration continues through anal sphincter muscle
4th degree laceration involves anterior rectal wall
Sulcus tear tear into the tissue of the vagina
What are some concerns involving the bladder? Pt should void within 6-8 hours following delivery, check for bladder distention if less than adequate amount voided - retention with overflow
What can cause bowel dysfunction? Delay in bowel function can be due to loss of abdominal muscle tone, fear of pain, sluggishness due to progesterone effect on smooth muscle function.
Are there any dietary restrictions following delivery? Vaginal deliveries can have normal diet, have increased thirst due to fluid loss & medications. C-sections start on clear liquids until bowel sounds or flatus are present.
How ofter should vitals be checked after delivery? Q15 minutes for 1st hour, q30 minutes for 2nd hour, q4 hours for 24 hours then q8 hours.
What are considered the standard vital signs? Temp, resp, pulse, BP, lochia, fundus & appearance of sutures
What does BUBBLE HE stand for? Breasts, uterus, bladder, bowel function, lochia, episiotomy (or laceration) Homnam's sign, emotional status.
How are the breasts assessed? Are they soft, firm or filling? Any discharge - type & amount, Nipples cracked/lesions? Unusual contour?
How is the uterus assessed? Is it firm? Is it descending? Location & position in abdomen
How is the bladder assessed? Assess for position and size. Teach S/S of infection, teach proper pericare
How is the bowel assessed? Check for flatus/bowel sounds, rectal pressure. Teach need for extra fluids, fiber
How is lochia assessed? Assess for amount: scant, light, moderate, heavy, excessive, assess for odor, clots
How is an episiotomy or laceration assessed? Assess for redness, edema, echymosis, discharge & approximation
What is assessed in regards to emotional status? Is the mother dependent or independent? Is she depressed, is she bonding with the baby, does she understand whats going on?
What does antepartum mean? The time between conception and onset of labor, used interchangeably with prenatal
What does intrapartum mean? The time between the beginning of labor and the birth of the infant.
What does puerperium or postpartum mean? Time from birth of infant until woman's body returns to essentially prepregnant state.
What does para mean? The number of pregnancies in which the fetus has reached 20 or more weeks gestation when they are born regardless of live or still born.
What does abortion mean? Birth that occurs prior to the 20 weeks, either selective or spontaneous. Therapeutic - done to save mother or non-viable fetus.
What is preterm or premature labor? Labor that occurs after 20 weeks but before completion of 37 weeks.
What is considered a term pregnancy? A pregnancy from the beginning of 38 weeks of gestation to the end of 42 weeks
What does TPAL stand for? TPAL replaces para & gives more information. T = term infants, P = preterm infants, A = abortions (spontaneous or selective), L = currently living children
What is considered a still birth? A baby born dead at 20 or more weeks gestation.
What is a neonate? First 28 days after birth.
What is viability? Capacity to live outside the uterus - about 22-25 weeks gestation.
What is placenta accreta? Slight penetration of placenta into the myometrium
What is placenta increta? Deep penetration of the placenta into the myometrium
What is placenta percreta? Perforation of the uterus by the placenta.
What is hydroamios & macrosomia and how does it affect the uterus? Hydraminos is too much amnionic fluid, macrosomia is a large baby. Both stretch the uterus more than normal and make it hard for the uterus to contract after birth.
How are hematomas related to delivery? There is an injury to a blood vessel, vulvar, vaginal, subperitoneal causing a collection of blood in the pelvic tissue, can lead to postpartum hemorrhage.
What are S/S of a hematoma? Vulvar - most common & most can be seen, Upper vaginal - difficulty voiding due to pressure on urethra or meatus, Upward - severe lateral uterine pain, flank pain, abdominal distention. May have S/S of shock without blood loss & a well contracted uterus.
What is the first sign of infection? Presence of a fever of 100.4
What can happen to the infant if infection is present? Leading cause of newborn sepsis & meningitis, infant infected through vaginal birth, can lead to death or severe neurological damage. Routine screening done at 32-36 weeks. Ampicillin or gentamycin can be given during labor.
What is metritis? Infection of the muscle of the uterus
What is endometritis? Infection at the placental site
What is parametritis? Infection of the pelvic connective tissue.
What is salpingitis & ooporitis? Infection of the tubes & ovaries.
What is thrombophelpitis? An infection of the lining of a vessel in which a clot attaches to the vessel wall.
What are the classic signs of a polmonary emboli? Sudden onset of SOB, chest pain, tachypnea, dyspnea, apprehension, cough, hempotysis, diaphoresis, fever, circumoral cyanosis.
What causes an amniotic fluid embolism? A small tear in the amnion or chorion high in the uterus allows fluid to enter maternal circulation.
What is disseminated intravascular coagulation? The coagulation sequence is activated by injury to the epithelium, or by bacterial particles or other foreign material. The result is disseminated clotting causing organ damage due to small clot occluding capillaries and consumptions of clotting factors.
What are the psychological adjustment stages? Taking in, taking hold and letting go.
What are the characteristics of the taking in phase? Consists of days 1-3, pts are passive & dependent, preoccupied with own needs, talkative, identifying and interpreting infant, gentle finger touch.
What are the characteristics of the taking hold phase? Consists of days 3 to 2 weeks. Pts resume control of life, concern with control of body functions, worry about quality and quantity of breast milk and ability to feed baby.
What are the characteristics of the letting go phase? Accept and realize the physical separation of infant and relinquish role of childless individual. Challenge - extreme exhaustion of night time care and sleep deprivation, anticipatory guidance needed regarding the realities of motherhood.
What are postpartum or baby blues? Can occur 1-2 weeks after birth, often peaks around 5th day and subsides by 10th day - believed to be related to hormone levels. Exhaustion is rated as one of the top causes.
How does postpartum depression differ from baby blues? Symptoms persist longer than 2 weeks and intensify.
What can cause an elevated temp? A temp elevated to 100.4* in the 1st 24 hours post delivery can be due to exertion & dehydration.
What is mastitis? An infection of the breast tissue. More common in breast feeding mothers.
Created by: jrb265 on 2009-02-07



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