Postpartum Adaptations and nursing care

The first _____ after birth are known as the postpartum period

6 weeks

Many physiologic changes are ______,which is

Retrogressive

• The changes that occurred in body systems during pregnancy are

  reversed as the body returns to the non-pregnant state

When does involution begin

After delivery of the placenta, when the uterine fibers contract 

How big is the uterus after delivery

Large grapefruit or softball

When involution does NOT occur properly, it is known as ______, which leads to?

Sub involution

• Postpartum hemorrhage

Descent of the fundus is documented in relation to the umbilicus. For example, what does U / 1 indicate?

The fundus is one fingerbreadth below the umbilicus

What are afterpains

Intermittent uterine contractions

Afterpains are more uncomfortable for

Multiparas

What leads to loss of muscle tone that causes retracted contraction and relaxtion of the uterus

Fibers

What feeding method causes afterpains to worsen due to the release of oxytocin

Breastfeeding

What is lochia

Vaginal drainage after birth

Lochia Rubra

Dark red or red-brown

• 1-3 days after birth

Lochia Serosa

Pink or brown-tinged

• Day 3 to 10 after birth

Lochia Alba

White, cream, light yellow

• May end on the 14th day or last up to 6 weeks postpartum

Lochia amount is documented

Scant, light, moderate, heavy, and excessive

Scant

<2.5cm (1 inch) stain

Light

2.5cm - 10cm (1-4inch) stain

Moderate

10cm - 15cm (4-6 inch) stain

Heavy

Saturated pad in 1 hour

Excessive

Saturated pad in 15 min

Why is it important to ask the patient how long her pad has been in place

To assess the bleeding and amount

T/F": The lochia of a woman who had a c/section will go through the same phases as that of the woman who had a vaginal birth, but the amount will be reduced.

True

Immediately after birth the cervix is

dilated, edematous, and bruised

___to___ weeks are needed for vaginal epithelium to be restored

6 to 10

The muscles of the perineum are involved in many activities (walking, sitting, urinating, defecating). What interventions can help with discomfort?

• Ice packs

• Teach proper prenatal care

• Give meds

• Topical products

1st degree tear

Involves the superficial vaginal mucosa or perineal skin

Second degree tear

Involves the vaginal mucosa, perineal skin, fascia, and mucles of the perineum

Third degree tear

Same as 2nd degree but extends into or through the external anal sphincter

Fourth degree tear

Extends through the anal sphincter and into the rectal mucosa

The first few menstrual cycles are often

Anovulatory

If a mother is breatfeeding, when does the mentrual cycle normally resume

Between 10 weeks and 6 months

If a mother is NOT breastfeeding, when does her menstrual cycle normally resume

6 to 10 weeks postpartum

Once milk production is established, it continues because of frequent suckling by the infant and removal of milk from the breast. This is known as what?

Supply and demand process

When the baby sucks at the breast, nerves are stimulated. This causes two hormones

Prolactin and oxytocin

Prolactin

Helps make the milk

Oxytocin

Causes the breast to push out the milk

What is the average amount of blood lost in a vaginal delivery

500mL

What is the average amount of blood lost in a c/section delivery

1000mL

 

The body rids itself of excess plasma volume needed during pregnancy by diuresis and diaphoresis.What is diuresis and diaphoresis?

• Excessive urine

• Excessive sweating

Cogulation factors increase during pregnancy which means mother has a greater chance of

Clots and hemorrhage

What can cause discomfort and interfere with bowel elimination in the PP period?

Constipation, episiotomy, and laceration 

Where is the fundus located when the mother has a full bladder?

Displaced upwards and laterally (side)

The greatest loss occurs during the first ___ months postpartum

3

 

If the mothers weight gain during pregnancy was not excessive, she will probably lose all but about 1 kg (2.2 pounds) within a  _____if she follows a well balanced diet.

Year

Women are cleared to go home after a vaginal delivery after

48 hours

Women are cleared to go home after a c/section after

72-96 an hour

Postpartum assesments begin during the

4th stage of labor

List a few risk factors for postpartum hemorrhage

• Grand Multiparty (5 or more)

• overdistention of the uterus

• precipitous labor (<3 hours)

• prolonged labor

• medications (oxytocin, general anesthesia, tocolytic)

List a few risk factors for postpartum infection:

• Operative procedures

• multiple vaginal exams

• prolonged ROM

 

If the Rubella vaccine (or any live vaccine) is administered POSTPARTUM, what important education is needed?

She can’t get pregnant for 28 days after receiving the vaccine

If BP increased from baseline it could indiacte

Pain and anxiety

If BP decreased from baseline it could indiacte

Hypovolemia

What temp needs to be reported

> 100.4

REEDA

• Redness

• Edema

• Echymosis

• Discharge

• Approximation

In order for healing to take place, the edges of the wound should be approximated. What does approximated mean?

The edges of the wound are pulled together

If an output of < 30 mL/hour is concerning, what is the minimum output expected for a 12 hour shift?

360mL

What is the “normal” DTR finding? What is “hyperactive?”

+1 or +2. +3

• +4 for hyperactive

What causes vasoconstriction and is most effective in the first 24          hours after birth to prevent edema and numb the area?

Ice

Pain medications can help with afterpains and perineal discomfort. What medications are typically given

Tylenol and ibuprofen

Teach the mother to

Use a perineal bottle after each void and to pat dry instead of wipe

Topical medications are provided, such as

Numbing spray (Dermoplast) and Hydrocortisone cream.

How should the mother be encouraged to sit if she had a laceration or episiotomy

Sit slightly to the side to prevent full weight from resting on the site

What interventions can help stimulate the sensation of needing to void if the mother is having difficulty

• Run sink water

• Sip on fluids

• Blow bubbles through the straw

Fluids and food

• 2500mL water

• Eat meals and snacks

PCA Pump

• Continuous IV Infusion for a low-concentration narcotic

• Self-administer

• Limits the amount administered to prevent overdose

• Immediate pain relief when needed

What oral analgesic is typically prescribed for women recovering from c/sections

Percocet

When a woman takes narcotics in the postpartum period, what should be assessed frequently!!

Respirations

How long is a pulse oximeter used following surgery to detect decreased oxygen saturation

24hr

What repirations and oxyegn is concerning

12 breaths/min and <95%

What should be auscultated in all four quadrants of the abdomen on a postpartum c/section patient?

Bowel sounds

What additional abdominal assessments are performed on a c/section patient?

Surgical dressing and fundus

Ice chips and clear fluids are allowed after a c/section delivery. When can a patient typically resume a normal diet following a c/section?

Passing gas or bowel sounds have returned

The nurse may need to assist the mother with feeding her infant after delivery. Why?

The pain can interfere with breastfeeding or care for the baby

How long are post c/section mothers normally on bedrest? Since these women are in bed, what should be done to prevent thrombi?

• 12 hours

• SCD on legs, flex and bend knees in bed

What is removed after the 24 hour mark

• IV

• Catheter

• Dressing

Breast cae for lactataing women

• Teach women to avoid soap on nipples because it removes natural lubrication.

• Women should also wear a supportive bra.

Breast care for NON-LACTATING WOMEN

• Ice packs are used to suppress lactation.

• Teach women to wear a firm bra 24 hours/day.

• Chilled cabbage leaves help with discomfort.

When can women do sexual acitivity postpartum

6 weeks postpartum

How does the mother integrate her birth experience into reality?

Discuss their L&D many times

How long does the taking-in phase last

2 days but can go longer in emergent situations

Taking-Hold phase

• Mom becomes more independent.

• Shifts attention to the infant's behaviors.

• May verbize anxiety about her competence as a mother.

• May last for 10 days

Letting-Go Phase

• Giving up the old life to accommodate the new infant

• Coming to terms with the reaility of the birthing experience

• Giving up the fantasy of what their ‘ideal’ child would be

Postpartum blues lasts

Beyond 2 weeks which indiacates Postpartum depression

The postpartum blues (does not/ does) affect the mothers ability to care for the infant

Does not