Maternal newborn mod 4 pt 1

normal pp findings (uterus, fundus, contractions)

uterus will return to non preg state, 2 weeks after birth uterus is non palpable (non preg stste by 6 weeks), fundus descends 1-2 cm every 24 hours, pt will experience pp contrcations

subinvolution

uterus fails to return to non preg state

Lochia

post birth discharge

lochia rubra

blood debrie (reddish color) lasts 3 days

lochia serosa

old blood, secrum, etc (reddish brown color), lasts 22-27 days

lochia alba

leukocytes, bacteria, etc. (clear discharge) 2-6 weeks

cervix after birth

soft immediately after birth 12-18 hours cervix will shorten and become firm

pp assessment- fundus

hard ball in adb

menstural cycle after birth

non lactating- as early as 27 dyas, breastfeeding- up to 6 months for reterun

vaginal rugae

appears within 3 weeks

1st degree laceration

perineal skin, vag mucus membranes

2nd degree laceration

skin, mucous membranes, fascia of perineal body

3rd degree laceration

skin mucous membranes, rectal sohincter (but doesnt go through)

4th degree laceration

goes through rectal sphincter

with lacerations access REEDA what does it stand for

redness, edema, ecomosis, drainage, and approximation

colostrum

liquid gold, yellow fluid (important for baby to have this)

when does milk come in for mom

wihtin 72-96 hours (colostrum comes immediately, then milk)

breastfeeding moms should wear

a supportive bra

non breastfeeding moms should wear

tight compressed bra, cold/ice on breast

non breastfeeding moms should stay away from

heat, release of milk (will lactate)

diuresis

within 12 hpours women will diuresis, large amounts of voids expected, diuresis ofetn occurs at night 2-3 days, excessive bleeding can occur

stay vag birth vs c section

vag- min 48hr stay, c section- min 96 hr stay

discharge POSTBIRTH

P-pain in chest, O-obstructed breathing or SOB, S-seizures, T-thoughts of hurting self or baby, B-bleeding soaking through one pad or passing clot size of egg, I-incision not healing, R-red or swollen leg warm or painful to touch, T- temp 100.4 or higher, H- headache that doesnt go away, bad headache with vision change

pp assessment BUBBLELE

B-breast, U-uterus, B-bowel movement, B-bladder, L-lochia, E- episiotomy/laceration/hemorrhoids, L-lower extremties, E-emotional state (when to notify provider)

postpartum nanagement

prevent excessive bleeding, bladder distention, and infection, promote comfort (tylenol and ibueprofen)

post birth for mom and baby what to do

immediate skin to skin uninterrupted

Postpartum hemorrhage

1000ml or more blood loss or bleeding with hypovolemia within 24hrs of birth, primary source of blood loss= plaental site

PPH management

weigh blood soaked items/quantify blood loss after birth

Early acute primary hemorrhage

within 24 hours after birth, up to 12 weeks pp, from subinvolution of uterus, infection, retain placenta fragements or coagulation

primary causes of hemorrhage (4T’s)

Tone: uterine atony, Tissue: retained placental fragments, Trauma: lacerations or hemtoma, Thrombin disorders: DIC

Tone: uterine atony

leading cause of hemorrhage, failure of myometrium to contract and retract after birth (will prevnt hemostasis from hapoening), soft uterus filled with clots and blood, s/s: decreased tone and uterine muscle, bleeding slow and steady or profuse, large bogy uterus, clots may be presnet

subinvolution of uterus

does not decline in size, later in pp period, uterus is soft and larger =, lochia return to rubra and heavy, back pain

Trauma: Lacerations

ueterus will remain firm and midline, but still bleeding, steady trickling stream of bright red blood, s/s: firm uterus, continued bleeding, steady unclotted bright red blood

Trauma: hematoma

blood retained in tissue, may not be diagnosed until in hypovolemic shock, s/s: firm uterus, sudden onset of perineal pressure or pain, buldging area iunder skin, difficulty viding or sitting bc of pain

Tissue: retained placental tissue

usually after discharge, priority intervention- educate on signs, notify [provider if sudden increase in lochia or retrun of lochia, increased temp, bright red bleeding, uterine tenderness, s/s: profuse bleeding occur after 1st week pp, subinvolution of uterus, increase temp, uterine tenderness, pale skin, tahcycardia, hypertension

Thrombin disorders

s/s: oozing from IV site, nosebleeds, petechiae, bleeding gums, hypotensio, other signs of shcok. early recognition= tranbsfer to ICU

PPH

fundal massage (bladder empty), admin uterotonics (oxytocin), bimanual compression, uterine tamponan, pressure on uterine iste

Hemorrhagic shock

excessive blood and fluid loss,signs may not appear until after 30-40% of blood loss, manage: restore blood volume, eliminating cause, etsablish two large bore IV, fluid resusitation, PRBC

VTE (venous thromboembolic disease)

from blood clot caused by inflammation or partial obstruction of vessel

signs if DVT

dependant edema, abrupt unilateral leg pain, erythema, low grade fever, positive homa sign

signs of PE

SOB, resp. distress, tachycardia, tachypnea, dyspnea, plural chest pain, fever

PP infection

infection of genital tract within 28 days of miscarriage, stillbirth, or birth, signs: fever (100.4), on 2 days out of first 10 days pp

Endometritis

begins at plavental site then to entire endometrium, s/s: fever, lower abd pain, uterine tenderness, tachycardia, subinvolution, malaise, headache, chulls, heavy/foul smelling lochia. manage: IV antibiotics, hydration, rest, pain relief, educate= handwashing, peri care, pads changed every 3-4 hours, encourage ambulation

Mastitis

unilateral, one breast, develops after flow of milk has been established, in later pp, if not treated could kead to breast abcess, occurs in first 3-6 months of breastfeedig, s/s: breast tenderness, engorgemnet, malaise, breast swelling, pain or burning while breastfeeding, ski redness, fever, treatment: acetemenefin, antibiotics, encourage breastfeedingf on affected side to unclog duct