Exam 10: Postpartum Care
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| Puerperium (postpartum) | a variable period of time, usually 6-8 weeks after delivery, during which the mother's body begins to adapt both physically & psychologically
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| Involution | process that refers to the changes the reproductive organs, particularly the uterus, undergo after childbirth to return to their nonpregnant size and condition
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| 3 Processes of Involution | Contraction.
Catabolism.
Regeneration
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| Contraction | immediately after delivery of placenta, uterine muscle fibers contract firmly around maternal blood vessels at the area where the placenta was attached.
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| Catabolism | total number of cells remains unchanged; the enlarged muscle cells undergo catabolic changes in protein cytoplasm (self-dissolution of tissues or cells by enzymes in the cells themselves) that causes a reduction in individual cell size
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| Regeneration | The uterine epithelium begins with the outer portion of the endometrial layer being expelled with the placenta. Decidua separates into 2 layers. Layer 1 sheds. Layer 2 builds new endometrim. (16 day process.)
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| Postpartum Assessment | focused postpartum assessment is necessary in order for the nurse to be aware of deviations from normal and prevention of major postpartum complications.
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| Normal, Spontaneous, vaginal Delivery (NSVD): assessment | VS-Breasts-Uterus-Bladder-Lochia-Perineum-Lower Extremities-Other Systems
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| Cesarean Delivery (CS): Assessment | same as NSVD and assessments common to post operative patients.
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| Normal Vaginal Spontaneous Delivery: Assess Vital Signs | Temperature may be elevated for up to 24 hours with no other symptoms.
Blood Pressure should remain stable.
Pulse: bradycardia is common.
Respirations: normal respiratory rate is common.
Pain
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| Normal Vaginal Spontaneous Delivery: Assess Breasts | Breasts should be examined for engorgement (firm and tender).
If mother is not breastfeeding, wear supportive or sports bra.
If mother is breastfeeding, reassurance may be needed. Nurse baby, apply heat
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| Normal Vaginal Spontaneous Delivery: Assess Uterus | Assess for consistency and location.
Involution occurs immediately following the expulsion of the placenta, contracts firmly.
Birth- Midway
The fundus is usually +/- 1 to 2 cm above or below the umbilicus for the first 12 hours; It should be midl
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| Normal Vaginal Spontaneous Delivery: Assess Bladder | Palpate and percuss for distention.
Uterus is displaced upward and laterally.
Increased lochia.
Should void 300 to 400 ml.
Urinary retention and overdistention of the bladder
UTI and Hemorrhage
Nonpregnant state regained in 6 to 8 weeks
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| Normal Vaginal Spontaneous Delivery: Assess Bowels | Assess for active bowel sounds, abdominal distention, signs of constipation.
Usually first bowel movement is in the 2nd-3rd day.
Encourage adequate fluid intake, progressive exercise and dietary fiber to facilitate soft stools.
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| Normal Vaginal Spontaneous Delivery: Assess Locia (Post Delivery Uterine Discharge | Characterized by its appearance and contents.
Assessed in conjunction with fundal check, noting:
-Color.
-Amount.
-Odor.
-Presence of clots.
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| Locia Rubra: | Blood Content; bright red colored for the 1-3 days.
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| Lochia Serosa | Pink to brown discharge day 4-10 days
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| Lochia Alba | Slightly yellow to white discharge which lasts from 11 days to 21 days (may last 6 weeks)
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| Lochia Volume | Heavy is saturating a pad every 1 hours.
Moderate is less than a 4 - 6 inch stain on the pad.
Light is less than a 1 - 4 inch stain.
Scant is less than a 1 inch stain.
Excessive is saturation of a peripad pad within 15 minutes.
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| Report to provider if... | Foul smelling, bright red discharge.
Clots are passed.
Pad is saturated in less than 1 hour.
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| Check Episiostomy for REEDA | Redness.
Edema.
Ecchymosis.
Discharge.
Approximations
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| NSVD Topical Medications for Episiostomy | Dermoplast
Epiform
Tucks Pads
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| NSVD Cardiovascular System Assessment | Blood volume.
Cardiac Output.
Blood clotting factors are higher the postpartum patient is at increased risk for clot formation.
Leukocytosis
Chills thought to be related to the sudden release of pressure on the pelvic nerve can develop.
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| NSVD Neurological System Changes | Reversal of maternal adaptations to pregnancy and those from anesthesia and analgesia.
Watch for severe headache accompanied by blurred vision, proteinuria
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| NSVD Endocrine Changes | Placental hormones decrease.
Ovulation resumes:
-Breastfeeding delays ovulation.
-Nonnursing: menses resume 7 to 9 weeks
Endocrine glands return to normal.
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| NSVD Musculoskeletal System Changes | Abdominal muscle tone returns to normal.
-6 weeks
May have hip and joint pain
-Reassurance and told temorary
Exercise per provider’s guidance.
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| NSVD Integumentary System Changes | Chloasma (mask of pregnancy) disappears.
Striae fade.
Hyperpigmentation of the skin fade after delivery but fade.
Hair loss
-Begins 4 – 20weeks
-Regrown 4 -6 months
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| NSVD Immune System Changes | Rho(D) Immune Globulin (Rho Gam):
-Given to a Rh-negative mother who has a Rh-positive infant.
-Within 72 hours.
Rubella Immunization)given to the mother not immune in immediate postpartum period.
-Prevent infection during subsequent pregnancies.
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| NSVD Cesarean Delivery | Pain Level.
PCA.
Opioids & Other meds
Respiration: IS use.
Ambulate according to protocols.
ABD: Auscultate bowel sounds; Keep NPO until return.
Observe dressing.
Be gentle doing assessment of fundus.
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| NSVD Cesarean Delivery: I&O | IV fluids.
Monitor foley drainage.
Dietary changes according to protocol.
Simethecone for decreasing flatulence
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| Postpartum Psychosocial Adaptations | Important to assess the woman’s ability to meet her own needs and those of her infant.
Parent-newborn relationship assessments are vital.
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| Postpartum Psychosocial Adaptations: Mother | Rubin’s Psychological Changes of the Puerperium:
Phase 1: Taking In.
Phase 2: Taking Hold.
Phase 3: Letting Go.
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| Postpartum Psychosocial Adaptations: Woman's Self | Self-Concept.
Body Image.
Sexuality.
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| Postpartum Psychosocial Adaptations: Woman's Self Nursing Interventions | Kegel Exercise to strengthen pubococcygeal muscles.
Emotional Needs: parenting is a learned role.
Mother must be taught:
-Take care of herself.
-Use good hand washing.
-Breast care.
-Incision/episiotomy care.
-REST.
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| Postpartum Danger Signs | Passive reactions, either verbal or nonverbal.
Hostile reactions.
Disappointment over the sex of the baby.
Lack of eye contact.
Non-supportive interaction between parents.
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| Postpartum Blues | Mild depression.
Affects 70 – 80% of mothers in U.S.
Self-limiting.
May benefit for empathy and support
Does not affect the mothers ability to care for the infant.
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| Family Adaptation (Postpartum): Mother | Primary caregiver to the infant.
Loss of freedom.
Must be sensitive to concerns.
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| Family Adaptation (Postpartum): Father | Must be engrossed in child’s life to develop a bond.
Eager to help, but may lack confidence.
Must be included in teaching.
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| Family Adaptation (Postpartum): Siblings | Depends on developmental level.
Toddler:
-Infant is competition.
-May have sleep problems.
-Regression.
Preschooler: look more than touch.
School age: easily adapts.
All need attention and reassurance.
Sibling classes may help.
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| Common Postpartum Medications: most common | Pitocin.
Methergine.
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| Discharge Teaching | No complications.
Normal assessments.
Immunizations given if needed.
Discharge teaching given.
Demonstration of readiness to take care of self and baby is evident.
Support person is available.
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