Postpartum assessment and nursing care
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| 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.
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| 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
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| Normal fundus descension | 1 cm (about one fingerbreadth) a day
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| postpartum cramping | afterpains
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| 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
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| Mechanisms to lose excess fluid postpartum | diuresis (increased excretion of urine) and diaphoresis (profuse perspiration)
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| 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
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| 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
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| 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
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| what skin change will not disappear? | Striae gravidarum
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| 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
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| Can you get pregnant while breastfeeding | yes, breastfeeding is not an effective contraception method
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| 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
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| Rubin’s phases of maternal adaptation | taking in; taking hold; and letting go
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| 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
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| 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
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| 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
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| what do you do when a fundus is displaced to the right? | massage and emptying of the bladder
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| 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
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| 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
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| concerning assessment data (DVT signs) | dyspnea and tachycardia
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| what elicits a + Homan’s sign | pain on dorsoflexion
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| 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
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| most serious complication following c-section | thromboembolism
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| 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
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| REEDA | a mnemonic for assessing Redness, Edema, Ecchymosis (bruising), Discharge, and Approximation of the wound from an episiotomy
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