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grcc OB postpartum

GRCC PN 135 postpartum

QuestionAnswer
What term is used in reference to the 6 week period following childbirth? Postpartum
What is a goal and the number one nursing diagnosis for postpartum care? Prevent Hemorrhage (For whatever reason uterus isn't attaching)
Report hemorrhage or hematomas from lacerations to physician Goal for post partum care
Increase bladder capacity, but decrease ability to hold it Common renal issue postpartum
List other goals for postpartum care -To meet fluid/nutritional needs-Prevent bladder distention-Help mother integrate experience-Report any abnormalities (i.e. bleeding, convulsions)-Facilitate both parent/child interaction-provide mother comfort
List postpartum care related to renal -want to keep bladder empty-May not have sensation due to swelling and bruises.-Void at least 200 ml within first six hours.
When checking fundus, and you can't feel it then what can you ask the mom do? Ask mom if she feels like she can empty her bladder, and then recheck it again.
It is not unusual to have brady cardia for the first 24-48 hrs post partum? T or F? True.
Mom has tachycardia 24 to 48 hours postpartum. What may this mean? The mother may have blood loss or could be anxiety.
When a mother has high BP could mean pre-clampsia
What happens to gastric system postpartum? All ovarian hormones slow down gas system. ---Constipation is still prevelant-Mama may experience increase thirst, increase hunger- eventhough gas stops working.
What is the average wt loss for mom postpartum? 20 pounds
Why would a mother feel like they got hit after labor? This is due to how hard they worked during labor due to position changes and bearing down, etc.
What happens to the skin It may change color during pregnancy, but will return to pre-pg state postpartum
When does breatmilk come in? Usually on the 3 or 4th day post partum.
What steps does a mother take who chose not to breastfeed? Pharmological intervention, don't expel milk, ice breasts, wear support bras, tylenol. Pain should subside after about 48 hours.
Is it normal to have a temp? If so when, how much and for how long? Yes, it is normal to have a temp 24 hours after delivery. Typically, it's about 100.4 f.
What is not normal temp, for how long and how much post partum? There is likely an infection if temp is increased over 100.4 over 48 hours.
Anticipatory phase Who is goin to to what- this is the practice parenting phase.
Postpartum psychological after birth adaption phase This phase referred as the honeymoon phase. It is a very sensitive, nurturing time for both mother and father.
T or F. Dad's hold baby's twice as much as moms? True. Dad's carry baby into church, etc.
What activity increases dad's attachment to baby? Participating in the delivery room.
Which medication does mom have to pump and dump breast milk. Antibiotics go through the milk. Mom has to get rid of milk. Vicodin is okay...if any goes to milk...it is insignificant amounts.
List after birth pain Severe cramp pains, muscle stops bleeding, distanded bladder, multiple gestations, if given pitocin to increase uterine contractions.
Why would moms need lubrication? Because estrogen is decreased causing decrease in secretions.
What do you want to give mom postpartum who has a laceration or episiotomy? You'll want them to put on ice in that area, heat or sitz batch are good, as well as a topical analgesic spray.
This intervention helps to strenghen perinium floor. Kegel excercises
REEDA Acronym for assessing redness, edema, ecamosis, drainage, aproximation of wound.
What do you assess after the first hour after delivery You watch for hemorrhage
Mom is shivering post deliver, how do you treat and is this common. Yes, this is common. Cover with blankets to comfort mother.
When do you take vs after first of postdelivery Take BP every 15 minutes for the first hour.
Signs and symptoms of hemorrhage dizzy, pale, faint, decreased BP. Hemorrhage is the greatest threat to the mom post delivery.
Name three major hemorrhage causes Uterine atony, lacerations and mechanical delivery (i.e. forcep delivery) and retained placenta fragments also cause bleeding.
Pain interventions ID problem and help them overcome it..i.e.:give pain meds, ice sore bottom and engorgement.
Discharge teaching Don't lift anything heavy for at least 2 weeks, bathing is okay, sex is okay after approx 6 wks, normal to be sexually aroused from breast feeding.
Involution (pg 233) The uterus returns to pre-prego size shape and location and the placenta site heals.
Is involution painful? It is usually not painful for pimiparous women, but is painful for multiparous women who are breasfeeding.
After pains Moderate to severe cramping related to uterus working hard to remain contracted as well as the increase of oxytocin in response to infant suckling.
What decreases postpartum hemorrhage? When the uterus contract, it decreases the amount of blood loss. It is important that it is firm
Boggy uterus Uterus is soft and suggests that the uterus has increase blood, leading to excessive blood loss....need to massage it or give oxytocin (as ordered by doc) to stimulate contractions.
Assessment for uterus location, pulse, blood pressure, respiratory rate, temperature q 15 minutes for the 1st hour; q 30 min for the 2nd hour; q 4 hours for the next 22 hours; q shift for the first 24 hours.
Palpate uterus Lay bed flat and make sure mama is in supine position; place hand just above the symphysis pubis and locate fundus with other hand (below or around the belly button)
Measure distance of fundus Each finger breadth equals 1 cm.
What does uterus shifted to one side indicate A distended bladder
What does a distended bladder do? It interferes with uterine contractibility and places the woman at risk for excessive blood loss.
Expected finding of fundus 1 to 2 hours after birth? It is midway between umbilicus and symphsis pubis and is firm and midline
Expected finding of fundus 12 hours after birth? Fundus is located 1 cm above umbilicus and is firm and midline.
Expected finding of fundus 24 hours after birth? It is located 1 cm below the umbilicus and is firm and midline.
Typically, how much does uterus descend each day? 1 cm per day.
By what day should the uterus be back to its pre-prego state? by day 10 the fundus should be descended into the pelvis and should not be palpable.
Endometrium mucus membrane that lines the uterus- regenerates after birth through the process of necrosis.
Lochia Bloody discharge from the uterus that contains sloughed off necrotic tissue from the endometrium- reflects the healing stage of the uterine placental site.
Assessing lochia- Scant is less than 1 inch of pad
Assessing lochia- light Less than 4 inch of pad
Assessing lochia- moderate less than 6 inches of pad
assessing lochia- heavy Pad is saturated within one hour after changing.
Is it normal to have small clots in lochia? Yes, it's normal to have clots, but should be noted in the patients chart
When are clots not normal in lochia? When they are large. Large clots interfere with uterine contractions. They should be weighed..10 grams = 10ml of blood loss.
Lochia Rubra Expected day 1-3, bloody with small clots, moderate to scant amount, increased flow when standing, fleshy odor (not foul odor)
Locia Serosa Expected from days 4-10. Pink or brown color, scant amount, increased flow during activity, fleshy odor.
Lochia Alba Expected day 10. Yellow to white in color, scant amount, fleshy odor.
Normal fundus location after 2 days postpartum About 2cm or 2 fingers below umbilical.
After pain teaching Last up to 36 hours and is common with multiparous mama's
What increases after pains Distended bladder- recommend mama to empty bladder, place warm blanket on ab, take advil, and follow relax techniques.
When should mama notify doctor When there is a sudden increase of lochia, bright red bleeding after rubra stages and foul odor.
What can mama do to reduce the risk of infection? Change peripad frequently because lochia is a medium for bacterial growth.
When assess in the vagina and perineum Use REEDA: redness, edema, ecchymosis, discharge, approximation of edges of episiotomy or laceration.
Provide what type of comfort measures for vagina an perineum Apply ice, encourage mama to lie on side to decrease pressure of perineum, tighten gluteal muscles as she sits down and relax when she is sitting; siztz baths 2x/day for 20 min; analgesics; use a topical anesthetic.
Primary engorgement Happens 3rd day after birth to both nonfeeding and breastfeeding mama's. Throbbing pain in the breasts and should subside in 24-48 hrs.
subseqeunt breast engorgement Related to distention of milk glands that is relieved by baby suckle or expressing milk.
mastitis infection of the breast
colostrum clear, yellow fluid, preceds milk production. Higher in protein and lower in carbs than breast milk. Contains IgA
Iga found in colostrum/breatmilk and provides protection for newborn during the early weeks of life.
Patient education for non breast feeding mama's Apply ice to breasts, not to express milk, avoid heat to the breasts, take analgesic for pain.
What is the average blood loss 400 to 500 ml related to vaginal birthing experience.
When is there an increase cardiac output? the first few postpartum hours related to blood that was shunted through the uteroplacental unit returning to the maternal system
When should cardiac output return to pre-prego levels Within 48 hours.
WBC Levels within a few hours of birth WBC may increase to 25,000/mm within a few hours and returns to normal within 7 days.
Clotting is a risk for how long during pregnancy and should return to normal after 2 weeks postpartum levels.
Increased risk of Orthostatic Hypotension Occurs hours following birth during the first 24 hours and will need assistance when ambulating.
Postpartum chills cold and shaking following birth and is related to vascular instability. Offer a warm blanket
What does increase pulse rate mean? Excessive blood loss
Temps elevated less than 100.4f during first 24 hours of birth Hydrate the woman, promote relaxation and rest, reassess in hour after interventions.
Elevated temp over 100.4 (38c) Hydrate and contact physcian
What is common with renal system Bladder distention, incomplete emptying of bladder, and inability to void are common during the first few days of post birth.
Diuresis caused by decrease estrogen and oxytocin levels and occurs within 12 hours post birth. It aids in elimination of excess tissue fluids.
Primary renal complications distended bladder and cystitis
Nursing interventions for renal problems If voiding less than 150ml, then palpate distended bladder. If no voiding after 12 hours post birth, then catheterize.
Signs of cystitis Frequency, urgency and or burning on urination.
Best to void within how many hours after birth within 6 hours...early voiding decrease risk of cystitis
What happens to the endocrine system? Estrogen, progesterone, and prolactin levels decrease. However, estrogen levels rise after the first week postpartum.
Nnonlactating women Prolactin level decline 3 postpartum weeks. Menses begin 6 to 10 weeks post birth. Ovulation occurs by the 4th cycle.
Lactating women Prolactin levels increase in response to the infants suckling. Lactation suppresses menses.
Created by: Wends1984