N113 - Postpartum Assessment & Care
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| show | From the delivery of the placenta & membranes to the return of a woman's reproductive system to its non-pregnant state - approx 6 weeks.
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| What is involution? | show 🗑
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| What is evidence of satisfactory involution? | show 🗑
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| What is the normal rate of descent of the uterus? | show 🗑
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| What can impede involution? | show 🗑
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| show | Hemorrhage
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| What are S/S of hemorrhage? | show 🗑
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| show | 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
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| show | blood loss greater than 500 ml in first 24 hrs caused by uterine atony, laceration of the genital tract, retained placenta, adherent placenta.
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| show | Retained placenta and infection are the most common causes.
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| What is lochia? | show 🗑
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| show | Bright red, tends to clot, serosanguineous, becoming more serous and less bloody - last 1-3 days.
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| What is lochia serosa and how long does it last? | show 🗑
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| show | Whitish/yellowish discharge - lasts 10-14 days, may last 3-6 weeks and remain normal.
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| show | separation of the rectus abdominis muscles may occur leaving part of abdominal wall with no support except skin, subcutaneous fat, fascia & peritoneum.
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| show | There is an increased risk for infection during postpartum.
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| What is an episiotomy? | show 🗑
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| show | A tear in the perineal body which occurs in varying degrees.
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| 1st degree laceration | show 🗑
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| show | extends through perineal muscles - much like an episiotomy
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| show | continues through anal sphincter muscle
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| show | involves anterior rectal wall
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| Sulcus tear | show 🗑
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| show | Pt should void within 6-8 hours following delivery, check for bladder distention if less than adequate amount voided - retention with overflow
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| show | 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.
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| show | 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.
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| show | Q15 minutes for 1st hour, q30 minutes for 2nd hour, q4 hours for 24 hours then q8 hours.
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| show | Temp, resp, pulse, BP, lochia, fundus & appearance of sutures
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| What does BUBBLE HE stand for? | show 🗑
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| How are the breasts assessed? | show 🗑
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| How is the uterus assessed? | show 🗑
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| How is the bladder assessed? | show 🗑
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| show | Check for flatus/bowel sounds, rectal pressure. Teach need for extra fluids, fiber
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| How is lochia assessed? | show 🗑
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| How is an episiotomy or laceration assessed? | show 🗑
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| show | Is the mother dependent or independent? Is she depressed, is she bonding with the baby, does she understand whats going on?
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| What does antepartum mean? | show 🗑
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| What does intrapartum mean? | show 🗑
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| show | Time from birth of infant until woman's body returns to essentially prepregnant state.
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| What does para mean? | show 🗑
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| show | Birth that occurs prior to the 20 weeks, either selective or spontaneous. Therapeutic - done to save mother or non-viable fetus.
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| show | Labor that occurs after 20 weeks but before completion of 37 weeks.
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| What is considered a term pregnancy? | show 🗑
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| show | TPAL replaces para & gives more information. T = term infants, P = preterm infants, A = abortions (spontaneous or selective), L = currently living children
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| show | A baby born dead at 20 or more weeks gestation.
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| What is a neonate? | show 🗑
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| What is viability? | show 🗑
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| What is placenta accreta? | show 🗑
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| show | Deep penetration of the placenta into the myometrium
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| show | Perforation of the uterus by the placenta.
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| What is hydroamios & macrosomia and how does it affect the uterus? | show 🗑
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| How are hematomas related to delivery? | show 🗑
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| show | 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.
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| show | Presence of a fever of 100.4
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| What can happen to the infant if infection is present? | show 🗑
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| show | Infection of the muscle of the uterus
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| What is endometritis? | show 🗑
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| show | Infection of the pelvic connective tissue.
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| What is salpingitis & ooporitis? | show 🗑
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| show | An infection of the lining of a vessel in which a clot attaches to the vessel wall.
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| What are the classic signs of a polmonary emboli? | show 🗑
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| show | A small tear in the amnion or chorion high in the uterus allows fluid to enter maternal circulation.
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| What is disseminated intravascular coagulation? | show 🗑
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| show | Taking in, taking hold and letting go.
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| What are the characteristics of the taking in phase? | show 🗑
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| What are the characteristics of the taking hold phase? | show 🗑
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| show | 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.
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| show | 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.
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| How does postpartum depression differ from baby blues? | show 🗑
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| What can cause an elevated temp? | show 🗑
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| What is mastitis? | show 🗑
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