Postpartum Care and Complications

Flashcards covering physiological changes, nursing assessments (BUBBLE-HE), breastfeeding, complications like hemorrhage and mastitis, and psychological stages of the postpartum period.

Postpartum Temperature Elevation

Temperature may be elevated to $38^{\circ}C$ ($100.4^{\circ}F$) for up to $24$ hours after birth due to exertion/dehydration; may also increase for $24$ hours when milk comes in.

Postpartum Bradycardia

A physiological change where the heart rate slows down, typically occurring during the first $6$ to $10$ days postpartum.

Preeclampsia Medications

Treatments include Procardia $30\,XL$, Labetalol, Aldomet, and Magnesium Sulfate IV ($2\,g/hr$ for $24-48$ hours).

Cardiac Output Decline

Declines by $30\%$ in the first $2$ weeks and reaches normal levels by $6-12$ weeks postpartum.

Eupnea

Normal, good, unlabored breathing; the expected respiratory state in a healthy postpartum woman.

Non-pathologic leukocytosis

An increase in white blood cell count ($WBC$) to $25,000-30,000\,mm^3$ occurring in the early postpartum period (1st week).

Postpartum Blood Loss Averages

Average blood loss is $200$ to $500\,mL$ for a vaginal delivery and $700$ to $1000\,mL$ for a cesarean delivery.

Hematocrit to Blood Loss Correlation

A $2-3\%$ percentage point drop in hematocrit is roughly equal to a blood loss of $500\,mL$.

Menstruation - Non-breastfeeding

Usually occurs within $7-12$ weeks after delivery.

Ovulation - Non-breastfeeding

Usually occurs within $70$ to $75$ days after delivery.

Postpartum Weight Loss (Initial)

An initial loss of $10$ to $12\,lb$ resulting from the birth of the baby, placenta, and amniotic fluid.

BUBBLE-HE

An assessment acronym: Breasts, Uterus/Abdomen, Bowel, Bladder, Lochia, Episiotomy/Lacerations, Homan's/Hemorrhoids, Emotions.

Suppression of Lactation

Methods include a well-fitting bra/binder, cold compresses, cabbage leaves, avoiding warm water or stimulation, and anti-inflammatory medication.

Mastitis

Infection of breast tissue (often Staph. aureus) characterized by sudden onset, chills, fever $\ge 101.0^{\circ}F$, and reddened, painful, swollen areas.

Breast Engorgement

Hard, painful breasts due to venous stasis; treated with frequent nursing, cold applications between feeds, and cabbage leaves for edema.

Slow Method of Weaning

Substituting one cup or bottle feeding for one breastfeeding session over a few days to a week to prevent engorgement.

Diastasis Recti Abdominis

A separation of the rectus muscles of the abdomen.

After pains

Intermittent uterine contractions associated with uterine involution; often treated with Motrin $600\,mg$ PO every $8$ hours.

Uterine Involution

The process by which the uterus returns to a prepregnant state, descending $1\,cm$ (one fingerbreadth) per day until it is in the pelvis on the 10th day.

Endometritis

Infection of the uterine lining characterized by uterine tenderness, temperature spikes ($104^{\circ}F$), chills, and foul-smelling lochia.

Uterine Atony

A 'boggy' or soft uterus that is not well-contracted, leading to increased bleeding; a common cause of postpartum hemorrhage.

Puerperal Diuresis

The excretion of $2000-3000\,mL$ of extracellular fluid by the kidneys postpartum.

Lochia Rubra

Red vaginal discharge consisting of blood, mucus, and debris, occurring for the first $2-4$ days after birth.

Lochia Serosa

Pinkish vaginal discharge occurring from day $4$ to $10$ postpartum.

Lochia Alba

White vaginal discharge occurring from the $10th$ to $20th$ day until the cervix is closed.

Heavy Lochia (Saturation)

A saturated peripad within $1$ hour.

Postpartum Hemorrhage Medications

Oxytocin (Pitocin), Methylergonovine Maleate (Methergine), Carboprost (Hemabate), and Misoprostol (Cytotec).

REEDA Scale

Tool used to assess the perineum or incisions: Redness, Edema, Ecchymosis, Discharge, Approximation.

Homan’s Sign

Assessment for thrombophlebitis by dorsiflexing the foot to check for pain in the calf.

Taking-In Phase

First $1-2$ days after birth; mother is passive, dependent, and focuses on her own needs (food, rest) and birth reality.

Taking-Hold Phase

Starts on day $2-3$; mother is ready to resume control, learn skills, and needs assurance as she takes on maternal roles.

Becoming a Mother (BAM) Stages

Anticipatory (pregnancy), Formal (birth/expectations), Informal (fitting role to lifestyle), and Personal (internalization/harmony).

Postpartum Blues

Transient depression (50-80% of mothers) occurring during first $3-5$ days up to $6$ weeks; usually resolves in $10-14$ days.

Postpartum Depression (PPD)

Major mood disorder occurring usually around the $4th$ week; symptoms include contemplation of suicide and lack of mood swings (persistent low).

Postpartum Psychosis

A psychological emergency (1-2 per 1000) with agitation, delusions, hallucinations, and suicide/infanticide risk; treated with Lithium or antipsychotics.

En face

Direct eye-to-eye contact between mother and newborn.

Engrossment

The father's absorption, interest, and preoccupation with the newborn.

RhoGAM

Injection given to mothers who are Rh negative with an Rh positive baby and a negative Direct Coombs test.

HANDS Program

Health Access Nurturing Development Services; a voluntary home visitation program for new and expectant parents.

Postpartum Sexual Activity Factors

Resume after episiotomy heals and lochia stops (usually $4-6$ weeks); lubrication may be required due to hormonal changes.