OB/Maternity

involution

the process of the uterus going back to pre-pregnancy stable after childbirth

*uterine muscle contracts

*Blood flow decreases

*Dead Tissue exfoliated

primiparas

first pregnancy

breastfeeding stimulates

oxytocin release from posterior pituitary promoting uterine contractions (cramping)

Urinary system changes in pregnancy

Diuresis (increased/excessive production of urine)

bladder distention

cystitis (bladder infection)

Gastrointestinal systems changes in pregnancy

constipation

hemorrhoids

distention/delayed bowel movements

Endocrine system changes during pregnancy

expulsion of the placenta results in significant hormonal changes

Diabetes

thyroid dysfunction

Cardiovascular system changes in pregnancy

Blood that was part of the fetal circulation shifts back to the mother’s circulation

increased cardiac output → orthostatic hypotension

respiratory system changes in pregnancy

expected findings

respirations 16-24 breaths per minute

respiratory system changes in pregnancy

concern

Post-anesthesia (rate <12 breaths per minute)

Musculoskeletal & Neurologic System Changes in pregnancy

•Diastasis recti abdominis (separation of the abdomen muscles during pregnancy cause distention)

•Effects of epidural

immune system changes in pregnancy

•Temperature should be <100.4 degrees Fahrenheit, 38 celcius

•Rh isoimmunization (RhoGAM within 72 hours postpartum for unsensitized Rh negative women birthing Rh-positive babies)

•Rubella immunization (MMR):  Postpartum for women who are not immune.  Pregnancy should be delayed at least 4 weeks after immunization

live vaccines are not given during

pregnancy because they can harm the baby

what are some vaccinations given

•Tetanus, diphtheria, pertussis (Tdap)

•Varicella

•Influenza

normal temperature

37 - 38C

98.6 – 100.4F

normal pulse

50 – 80  bpm

Normal respirations

12-20 breaths/min

postpartum focused assessment

B breasts

U uterus

B bladder

B bowel

L lochia

E Episiotomy/lacerations

L Lower extremities

E emotional status

Do not palpate a bottle feeding mothers

breast- avoid stimulation

newborns put to breast for breast feeding at least

8 times in 24 hours

what is the first thing the baby will consume

colostrum

when is breast feeding contraindicated

HIV

*Hep C mother CAN

Uterus assessment

Palpate the uterus (fundus) using the two-hand gloved technique (place one hand above the symphysis, supporting the lower uterine segment, while the other gently massages the fundus), noting fundal height, location, and tone.

Height of uterus

At U

umbilicus

Height of uterus

U1

1 fingerbreadth below the umbilicus

Height of the uterus

1U

1 fingerbreadth above the umbilicus

encourage the patient to empty their bladder every

2 hours

Bowel assessment for pregnancy

assess for presence or absence of bowel sounds, abdominal distention or firmness

palpate for distention or firmness

ask the patient if they are passing flatus and last bowel movement

lochia

assess bleeding (lochia) on the under pad

note the color/type, amount, and odor

Lochia rubra

postpartum days 1-3

red

Lochia serosa

postpartum days 4-10

orange

Lochia alba

postpartum day 10

yellow

Episiotomy laceration assessment

•Assess the repaired incision/tear for REEDA

•Slight edema and bruising with an intact perineum is a normal finding with a vaginal delivery.

•Assess for hemorrhoids

•Offer an ice packs to site for first 24 hours, then sitz bath as ordered

first degree episiotomy/laceration

skin only tears

Second degree episiotomy/laceration

Extends through muscles of the perineal body

Third degree episiotomy/laceration

extends through perineal body to anal sphincter

Fourth degree episiotomy/laceration

extends through perineal body and anal sphincter and involves rectal wall

What does the first B in BUBBLE LE stand for

Breast

What does the U in BUBBLE LE stand for

Uterus

What does the second B stand for in BUBBLE LE

Bladder

What does the Third B in BUBBLE LE stand for

Bowel

What does the first L in BUBBLE LE stand for

Lochia

What does the first E in BUBBLE LE stand for

Episiotomy/lacerations

What does the second L in BUBBLE LE stand for

Lower extremities

What does the second E in BUBBLE LE stand for

Emotional status

When assessing the breast assess for

size, softness, tenderness, no engorgement

while also assessing the nipples for things like cracks

what is lochia

mixture of blood, mucus, and uterine tissue

What is episiotomy

an incision made into the perineum to enlarge the vaginal outlet

What are the things to asses on the lower extremities

color, temperature, edema, and circulation

what are some safety concerns with postpartum cesarean delivery care

in recovery area, emergency equipment nearby, side rails up, assessment and interventions along with strategies to promote parenting

What tool is used to assess and evaluate wound healing, particularly postpartum perineal trauma

REEDA

What does the R in REEDA stand for

redness

What does the first E in REEDA stand for

Edema

What does the second E stand for in REEDA

Ecchymosis

What does the D stand for in REEDA

discharge

What does the A stand for in REEDA

Approximation

Multiparas

women who have given birth two or more times

Nulliparas

women who have never given birth

attachment

long term emotional connection

bonding

early feelings of affection

acquaintance

learning the baby (cues, behaviors)

claiming process

“she looks like me,” “he acts like his dad”

early parent-infant contact

skin to skin → improves attachment

extended parent - infant contact

couplet care → keeps family together

infants communication to the parents

entrainment

moves in rhythm with parent’s voice

infants communication to the parents

biorhythmicity

infant matches parent’s rhythms

infants communication to the parents

reciprocity

responding to each other

infants communication to the parents

synchrony

smooth, coordinated interaction

mothers dependent phase after childbirth

needs help, focused on self

mothers dependent - independent phase after childbirth

learning infant care

mothers interdependent phase after childbirth

family functioning

mothers postpartum blues phase after childbirth

tearful, emotional, resolves in 2 weeks

fathers engrossment phase after childbirth

intense interest in newborn, adjusting to new role, resuming intimacy, learning infant cues

adolescent parents need

more teaching and support

older parents (>35) are

more stable but may have increased anxiety

same sex couples may have

similar attachment patterns; may face external bias

what are some of the main components of postpartum care

help the mother rest and recover, assess physical and psychological adaptation, prevent complications, teach self care + infant care, and support transition to parenthood

the mother must be fully recovered from

anesthesia before she can be discharged

LDRP model keeps

mother and infant together

Newborns’ & Mothers’ Health Protection Act (1996)

for vaginal birth

must stay in the hospital for a minimum of 24 hours max of 48 hours

Newborns’ & Mothers’ Health Protection Act (1996)

for cesarean

must stay in the hospital for a minimum of 72 hours to 96 hours

nursing interventions for preventing excessive bleeding

maintain uterine tone by massaging the fundus

prevent bladder distension by frequently allowing them to go to the bathroom

nursing interventions for promoting comfort after birth

ice packs, sitz baths, pain meds

monitor respiratory status when patient is on

morphine

check the perineal pad every

4 hours, unless contraindicated

planning for discharge

hygiene and cleaning

making sure patient is able to clean on their own

sexual activity after birth can resume around

6-8 weeks after

babies recognize their mothers by

smell, heart rate, voice

the main difference between postpartum depression and blues

postpartum blues go away after 10 days, but depression last longer and patient doesn’t want to care for the baby

postpartum psychosis

hearing voices and hearing things

GTPAL

G

gravidity

number of pregnancies (twins and triplets are counted as one)

GTPAL

T

Term Births

the number born at term (longer than 37 weeks of gestation)

GTPAL

P

Preterm births

20 -37 weeks of gestation (count twins and triplets as one)

GTPAL

A

Abortions

less than 20 weeks of gestation

GTPAL

L

Living children

current living children, count children individually

definition and incidence of postpartum hemorrhage

leading cause of maternal death worldwide

1000mL or more cumulative blood loss

bleeding with hypovolemia within 24 hours of birth

risks factors of uterine atony

Macrosomia (enlarged baby head)

multiple gestation

prolonged labor

polyhydramnios (extra fluid)

high parity (more pregnancies and deliveries)

chorioamnionitis (infection of the uterus)

labor induction or augmentation with synthetic oxytocin

After a vaginal delivery, an estimated blood loss (EBL) of greater than _______mL is considered a PPH??

500

After a cesarean delivery, an estimated blood loss (EBL) of greater than _______mL is considered a PPH??

1000

retained placenta

placenta not delivered within 30 minutes

Placenta fragments

placenta deteriorates and parts fall off and remain in the uterus