BC3-nursing, postpartum assessment
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| puerperium | the postpartal pperiod, to last 6 weeks after birth. physical and psychological adjustment of mom. body returns to prepregnant state | ||||
| Uterus involution | return of uterus size and location. back to 30 to 60 grams, fundus is unable to be palpated above symphisis by 10 days | ||||
| subinvolution | failure of uterus to return to normal prepregnat size | ||||
| fundus | top of uterus, size of large grapefruit immediately pp | ||||
| location of fundus | pp located midway between symphisis and umbilicus, birth to 6 hours | ||||
| location of fundus pp | by 6-12 hours, fundus rises to umbilicus and decreases 1 fingerbreadth/day until 10 days | ||||
| boggy fundus | hemorrhage | ||||
| fundus high and deviated | full bladder | ||||
| breastfeeding facilitates | involution ( the return of uterus to preppregnant state) | ||||
| Lochia | menstural like discharge postpartum | ||||
| Rubra | dark red lochia days 1-3, contains epithelial cells, erythrocytes, leukocytes, shreds of deciduas | ||||
| serosa | pinkish lochia days 3-10, more serous | ||||
| alba | creamy colored lochia yellowish, lasts 1-2 weeks | ||||
| character of lochia | never absent, foul smelling, or full of large clots, never reverse itself | ||||
| cervical changes | Os closes by 7 days, only admits a finger. Cervical lacerations usually heal if not too extensive. | ||||
| severly lacerated cervix | pp hemorrhage | ||||
| vagina pp | size decreases and rugae return within 3 weeks | ||||
| kegels | ppp exercises to improve tone and contractility of vagina. can do any time, should do often. | ||||
| return of menses | in non-nursing women by 6=10 weeks | ||||
| breastfeeding return of menses | get periods within 30-36 weeks, ovulate in 17 to 28 weeks not a form of birth control | ||||
| perineum pp | swelling and edema may occur, episiotomy may be present, external hemorrhoids may be present related to L &D, bruising can occur. | ||||
| perineum care pp | ice first 24 hours then heat (sitz bath) | ||||
| prolactin and oxytocin | hormones that cause milk production | ||||
| Colostrum | thick creamy substance, before milk comes in, high iin fat, protein, fat soluable vitamins and high level antibodies and immunoglobulins | ||||
| how long is colostrum available | at delivery and for the first 2-4 days | ||||
| transitional milk | replaces colostrum, in breast first 2 weeks of life. contains lactose, water soluable vitamins, elevated levels of fat, more calories than colostrum | ||||
| mature milk | thin apperance, high % of water, protein is lower in breast milk than formula higher in carbohydrates | ||||
| abdomen pp | tone will return in 2-3 months with exercise, stretch marks fade over time | ||||
| GI system pp | sluggish bowel d/t lingering effects of Relaxin (hormone) of if mom had c section | ||||
| Urinary tract pp | at risk for overdistension r/t increased bladder capacity, swelling around urethra, and dec. sensitivity to pressure (epidural) | ||||
| urination pp | needs to void frequently and shouldnt let go beyond 4-6 hours without voiding. Diuresis occurs, increasing urine output and returning blood volume to normal rapidly | ||||
| vital signs pp | postpartum infection suggested by 38C any 2 episodes after 24 hours(100.4 F) | ||||
| BP pp | should remain stable, elevations may be indicative of PIHand decrease may indicate hemorrhage | ||||
| pulse | normal pulse is 60-90, immediately after delivery there may be an increase in pulse, then days 1-6pp, the pulse is a normal bradycardia | ||||
| pp leukocytosis | 15,000-20,000 normal | ||||
| pp HGB | usually drops 2 pts related to blood loss (normal HGB is 12-15) | ||||
| ppH+H | return to normal with reduction of blood volume | ||||
| weight loss pp | 10-12 lbs at birth, return to normal with reduction of blood volume | ||||
| physiologic pp chill | related to vasomotor changes andnervous response to delivery | ||||
| diaphoresis pp | elimination of excess fluid and waste products via perspiration, night sweats often occur | ||||
| Afterpains pp | intermittent uterine contractions, they are more painful in multips. May occur with breastfeeding or administration of methergine | ||||
| taking -in phase | mom- more passive, dependent, needs care for her needs , still focused inward, starting to move out. may need to talk about L& D experience | ||||
| taking-hold phase | after day 2-3 Mother resumes control of her life and body functions. wants to take care of her newborn, seeks information about baby care. may need reassurance | ||||
| postpartum blues | transient period of depression occuring first week or so ppp. related to shift in horemones, exhaustion, discomfort | ||||
| BUBBLE HE HA | Breasts, Uterus, BOwels, Bladder, Lochia, Episiotomy, Homans sign, edema, hemorrhoids, attachment | ||||
| Postpartum infection | any clinical infection infection of the genital canal which occurs within 28 days after childbirth or abortion | ||||
| sites of pp infection | episiotomy, lacerations of vagina or cervix, placental site, c section incision | ||||
| chorioamnionitis | may be a result of PROM it is inflammatory reaction of fetal membranes in response to bacteria/ viruses in amniotic fluid | ||||
| endometritis | usually at placental site, permits the start of the infection. If not treated, and prevented from spreading, it can travel along genital tract, become more extensive and serious | ||||
| symptoms of pp infection | temp of 100.4 or higher on 2 successive days, not counting first 24 hours of birth, accompanied by fatigue, lethargy, lack of appitite, chills, perineal discomfort, lower abdominal paiin, nausea, foul profuse lochia | ||||
| treatment of pp infection | prevention, most effective and cheapest method. fluids and broad spectrum antibiotics breastfeedig may continue | ||||
| mastitis | infection of breasts | ||||
| mastitis symptoms | painful breasts, high fever, chills, low BP | ||||
| mastitis lab findings | entric gram neg. bacteria, usually staph aureus, from the newborns mouth | ||||
| treatment of mastitis | antibiotics, good bra support of breasts, local heat or cold, and analgesics. Encourage continued breastfeeding or pumping breasts |
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Created by:
goryan
on 2007-11-26