Nursing Management During the Postpartum Period

This set of flashcards covers key vocabulary and concepts related to nursing management during the postpartum period, including bonding, attachment, assessments, risks, emotional status, and nursing interventions.

Bonding

Close emotional attraction to a newborn by the parents that develops in the first 30 to 60 minutes after birth.

Attachment

Development of a strong affection between an infant and significant others such as parents, siblings, or caregivers.

Postpartum Period Assessment Timings

Assessments in the postpartum period are every 15 minutes during the first hour, every 30 minutes during the second hour, every 4 hours during the first 24 hours, and hourly after 24 hours.

Risk Factors for Postpartum Complications

Infection, exhaustion, excessive fatigue, and potential infection due to leaving fragments are risks that can lead to postpartum hemorrhage.

Preeclampsia Risk Signs

Signs include edema, blood clot, possible UTI, or sudden decrease in oxygen carrying capacity.

Normal Vital Signs in Postpartum Period

Temperature: slight elevation, Pulse: 40-80 bpm (puerperal bradycardia), Respirations: 16-20 breaths per minute, Blood pressure: within usual range, Pain: goal between 0 and 2 on the pain scale.

BUBBLEEE Assessment

Assessment acronym for postpartum physical assessment: Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy/perineum, Extremities, Emotional status.

Emotional Status Assessment

Includes interactions with family, independence, energy levels, eye contact with the infant, posture and comfort with the infant, sleep and rest patterns, and mood swings.

Stages in the Transition to Parenthood

Commitment, acquaintance with the infant, moving towards a new routine, and achievement of the parenthood role.

Teaching Topics for Postpartum Period

Include pain management, immunizations, nutrition, activity and exercise, lactation, discharge teaching, sexuality and contraception, and follow-up care.

Postpartum Blues

Transient emotional disturbances post childbirth characterized by anxiety, irritability, and sorrow, usually resolving within a week.

Ensuring Safety During Ambulation

Check blood pressure, elevate the head of the bed, sit on the side of the bed, assist when standing, and stay close to help if needed.

Importance of Family Adjustment

The birth of a baby changes family dynamics, necessitating the clarification and implementation of new parental and sibling roles.

Nursing Interventions in Postpartum Period

Include optimal cultural care, promoting comfort, assisting with elimination, promoting activity, and ensuring safety.

Critical Attributes of Attachment

Proximity, reciprocity, and commitment are key factors in the development of attachment between parents and infants.

Bonding

Close emotional attraction to a newborn by the parents that develops in the first 30 to 60 minutes after birth.

Attachment

Development of a strong affection between an infant and significant others such as parents, siblings, or caregivers.

Postpartum Period Assessment Timings

Assessments in the postpartum period are every 15 minutes during the first hour, every 30 minutes during the second hour, every 4 hours during the first 24 hours, and hourly after 24 hours.

Risk Factors for Postpartum Complications

Infection, exhaustion, excessive fatigue, and potential infection due to leaving fragments are risks that can lead to postpartum hemorrhage.

Preeclampsia Risk Signs

Signs include edema, blood clot, possible UTI, or sudden decrease in oxygen carrying capacity.

Normal Vital Signs in Postpartum Period

Temperature: slight elevation, Pulse: 40-80 bpm (puerperal bradycardia), Respirations: 16-20 breaths per minute, Blood pressure: within usual range, Pain: goal between 0 and 2 on the pain scale.

BUBBLEEE Assessment

Assessment acronym for postpartum physical assessment: Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy/perineum, Extremities, Emotional status.

BUBBLEEE: Breasts assessment

Assess for consistency (soft, filling, firm, engorged), tenderness, nipple integrity (cracked, bleeding, inverted), and presence of colostrum or milk.

BUBBLEEE: Uterus assessment

Palpate fundus for height (fingerbreadths from umbilicus), location (midline), and tone (firm or boggy). Expect fundus to descend about 1 fingerbreadth per day postpartum.

BUBBLEEE: Bladder assessment

Assess for bladder distention, frequency and amount of voiding, signs of urinary retention, and symptoms of UTI (dysuria, urgency).

BUBBLEEE: Bowels assessment

Auscultate bowel sounds, inquire about last bowel movement, and assess for constipation or hemorrhoids. Encourage fluids, fiber, and ambulation.

BUBBLEEE: Lochia assessment

Assess for color (rubra, serosa, alba), amount (scant, light, moderate, heavy), odor (foul odor suggests infection), and presence/size of clots.

BUBBLEEE: Episiotomy/Perineum assessment

Inspect perineum for lacerations, episiotomy site, hematomas, and edema (using REEDA assessment). Teach perineal hygiene and comfort measures.

BUBBLEEE: Extremities assessment

Assess lower extremities for signs of deep vein thrombosis (DVT) such as redness, warmth, pain, swelling, and tenderness, especially in calves. Check for pedal pulses and edema.

Emotional Status Assessment

Includes interactions with family, independence, energy levels, eye contact with the infant, posture and comfort with the infant, sleep and rest patterns, and mood swings.

REEDA Assessment for Perineum

Acronym used to assess healing of an episiotomy or perineal laceration: Redness, Edema, Ecchymosis (bruising), Discharge (drainage), Approximation of wound edges.

Stages in the Transition to Parenthood

Commitment, acquaintance with the infant, moving towards a new routine, and achievement of the parenthood role.

Teaching Topics for Postpartum Period

Include pain management, immunizations, nutrition, activity and exercise, lactation, discharge teaching, sexuality and contraception, and follow-up care.

Postpartum Teaching: Pain Management

Educate on sitz baths for perineal discomfort, ice packs 20 minutes on/off for 24 hours, topical anesthetics, oral analgesics, and perineal hygiene (e.g., peri-bottle use) to prevent infection.

Postpartum Teaching: Immunizations

Discuss the importance of Rubella vaccine (if non-immune), Tdap (to protect infant from pertussis), and RhoGAM (if Rh-negative mother and Rh-positive baby) before discharge.

Postpartum Teaching: Nutrition

Advise on a balanced diet rich in protein, iron, and fiber. Emphasize increased fluid intake, especially for breastfeeding mothers, and continuation of prenatal vitamins.

Postpartum Teaching: Activity and Exercise

Instruct on gradual increase in activity, avoiding heavy lifting for at least 6 weeks (or as guided by provider), importance of rest, and gentle exercises like walking and kegel exercises.

Postpartum Teaching: Lactation

Provide education on proper latch, feeding cues, positioning techniques, frequency of feedings (8-12 times in 24 hours), and signs of adequate infant intake (wet diapers, stools).

Postpartum Teaching: Sexuality & Contraception

Discuss resumption of sexual activity typically after 6 weeks or provider clearance, importance of contraception (as ovulation can occur before first menses), and options for family planning.

Postpartum Blues

Transient emotional disturbances post childbirth characterized by anxiety, irritability, and sorrow, usually resolving within a week.

Ensuring Safety During Ambulation

Check blood pressure, elevate the head of the bed, sit on the side of the bed, assist when standing, and stay close to help if needed.

Importance of Family Adjustment

The birth of a baby changes family dynamics, necessitating the clarification and implementation of new parental and sibling roles.

Nursing Interventions in Postpartum Period

Include optimal cultural care, promoting comfort, assisting with elimination, promoting activity, and ensuring safety.

Interventions: Promoting Postpartum Comfort

Administer pain medication as ordered, teach non-pharmacological methods (ice packs, sitz baths), provide warm blankets, and ensure adequate rest periods.

Interventions: Assisting Postpartum Elimination

Encourage frequent voiding to prevent bladder distention, provide stool softeners, offer peri-bottle for perineal hygiene, and monitor bowel movements.

Interventions: Promoting Postpartum Activity

Encourage early ambulation after assessing stability, assist with ambulation, and educate on gradual return to light exercises.

Interventions: Preventing Postpartum Hemorrhage

Fundal massage for a boggy uterus, administer oxytocic medications as ordered, monitor vital signs and lochia closely, ensure bladder is empty, and assess for uterine atony.

Critical Attributes of Attachment

Proximity, reciprocity, and commitment are key factors in the development of attachment between parents and infants.

Factors Influencing Parent-Infant Attachment

Positive factors: early skin-to-skin contact, positive birth experience, supportive environment, effective communication. Negative factors: maternal/infant illness, prematurity, difficult labor, postpartum depression, lack of social support, and financial stress.

Postpartum Danger Signs

Fever >100.4^{\circ}\text{F} (>38^{\circ}\text{C}), foul-smelling lochia or sudden increase in amount, sudden or severe abdominal pain, chest pain, calf pain with redness/swelling, severe/persistent headache, vision changes, burning on urination, inability to void, and thoughts of harming self or baby.

Abnormal Postpartum Vital Signs

Report sustained Maternal tachycardia (>100 bpm), significantly elevated blood pressure (>140/90 mmHg) or hypotension, tachypnea (>20 breaths/min