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OB chapter 13

Postpartum assessment and nursing care

Postpartum period (puerperium) is defined as the 6-week interval from childbirth to the return of the uterus and other organs to a prepregnant state.
Involution refers to the changes that the reproductive organs (particularly the uterus) undergo after the birth of the newborn to return to the prepregnant size and condition
Normal fundus descension 1 cm (about one fingerbreadth) a day
postpartum cramping afterpains
Normal lochial discharge and sequence lochia rubia, bright red, lasts 1-3 days and may contain small clots; lochia serosa, pink to brown, should not contain clots, can last up to 27 days; lochia alba, yellow to white, by 10 days and up to sixth week postpartum
Mechanisms to lose excess fluid postpartum diuresis (increased excretion of urine) and diaphoresis (profuse perspiration)
High WBCs postpartum are not normal leukocytosis (an increase in WBC count to 15,000/mm3 or more occurs immediately after birth) returns to normal within 10 days postpartum
Normal vital signs postpartum T:38C/100.4F in first 24 hours but afebrile after; P:50-60 bpm for first 6-8 days postpartum; BP: should remain stable after birth
cause of urinary retention increased capacity of bladder, less muscle tone, anesthetic drugs, edematous and trauma to bladder area, results in diminished awareness of need to urinate leading to decreased sensitivity to fluid pressure-woman does not feel urge to void
what skin change will not disappear? Striae gravidarum
what do you tell a patient that doesn’t plan to breast feed, about engorgement? avoid any breast stimulation, including newborn suckling, pumping the breasts, or allowing warm water to flow on the breasts during showers; can use a snug bra (72 hours), ice packs and mild analgesics to relieve breast discomfort
Can you get pregnant while breastfeeding yes, breastfeeding is not an effective contraception method
describe postpartum blues tearfulness, insomnia, lack of appetite, and a feeling of being disappointed; occurs in about 70% of women during first 10 days after birth and lasts up to 10 days
Rubin’s phases of maternal adaptation taking in; taking hold; and letting go
How often should vital signs be taken in the 1st hour after delivery? every 15 minutes, then every 30 minutes if woman’s status is stable
preparing a woman to take a sitz bath at home encourage the woman to clean a portable basin or the tub before using it, warm temperature should be approximately 38-40.5C/100-105F
rubella vaccine in pregnancy and breastfeeding women who have a rubella titier of less than 1:10 are given the rubella vaccine to protect the next fetus from fetal malformations; the woman must not get pregnant for the next 3 months
what do you do when a fundus is displaced to the right? massage and emptying of the bladder
correct perineal care lie on side; use a pillow when sitting; use ice pack, moist or dery heat or topical applications (if ordered); cleanse the perineum with a squeeze bottle, and take a warm shower or a sitz bath
siblings and new babies early involvement can help reduce the older child’s anxiety, jealousy, and rivalry toward the newborn; regression may also occur; special attention should be given to older siblings
concerning assessment data (DVT signs) dyspnea and tachycardia
what elicits a + Homan’s sign pain on dorsoflexion
shivering after delivery cover with a warm blanket or have a hot drink, chill is a common experience after birth; after 24 hours chill may indicate infection
most serious complication following c-section thromboembolism
weight loss immediately after delivery decreases by approximately 4.5-5.4 kg (10-12 lbs); an additional 2.3 kg (5lbs) is lost during the early postpartum period as a result of diuresis and diaphoresis
REEDA a mnemonic for assessing Redness, Edema, Ecchymosis (bruising), Discharge, and Approximation of the wound from an episiotomy
Created by: laotracuata