What is the postpartum period
Immediate = first 24 h
Early = first week
Late= 2-6 week
Involution
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What is the postpartum period
Immediate = first 24 h
Early = first week
Late= 2-6 week
Involution
What factors SLOW involution
What can INCREASE involution
What method is used to asses uterine involution
Fundal height measurement
Before preforming fundal massage, what do you instruct the women to do?
Empty her bladder
How to preform fundal massage
cup one hand above the symphisis pubis to support the lower uterine segment
With the other hand palpate the top of fundus, if not firm, lightly massage
indicated if the uterus is boggy, causing increased bleeding
Sub-involution
Afterpains
Lochia
Different types of lochia
Lochia rubia = bright red (1-3 days postpartum)
Lochia serosa= pink to brown (4-10 days)
Lochia Alba = yellowish (10 days to 6 weeks)
Assessment of lochia/bleeding
REEDA scale
Assessment of episiotomy site
Nursing care for pain of perineum
During the first few days what hormone regarding muscles decreases?
Relaxin
What should the nurse do to asses for a beginning DVT?
How much blood loss is normal during birth?
Vaginal = 200-500 mL
C-section 1,000 mL
How is fluid built up during pregnancy eliminated?
Labs that change after birth
Changes to VS after birth
Factors that cause urinary retention post partum
tissue around the bladder is traumatized
anesthetic drugs
Bladder had reduced ability to contract
Decreased sensation of needing to void
WATCH FOR URINARY RETENTION
Complications of urinary retention postpartum
Hormone changes post birth
How is weight lost after pregnancy
What are some major causes of hemorrhage postpartum
Early Postpartum Hemorrhage:
Late Postpartum Hemorrhage:
Methods to relive discomfort from breast engorgement
Engorgement usually occurs 3-5 days postpartum
phases of postpartum adaption
Phase 1: Taking in: mother is willing to let others do things for her, hold the baby, ect. Focus is on recovery
Phase 2: Taking hold: Mother becomes interested in caring for infants, increased concern. BEST TIME FOR TEACHING
Phase 3: Letting go: giving up previous lifestyle, accepting the real child (not the ideal)
Postpartum check acronym
B: breasts and nipples (engorgement, lactation, redness)
U: Uterus (fundal height, location, firmness)
B: Bladder (intake/output frequency, pain)
B: Bowel (BM?)
L: Lochia (amount, color, odor, clots?)
E: Episiotomy (REEDA scale)
-
H: Homans Sign (passive dorsiflextion of foot causing pain)
E: Emotional status
Is postpartum chill (shaking) normal/common after birth
Cold vs heat on perinium
Cold: for first 24 hours
Heat: after 24h
Nursing management for application of pain creams to perinial area
Sexual intercourse after birth
Identifying amount of fluid on perineal pad
Scant= 2 inch stain (10 mL)
Small = 4 inch stain (10-25 mL)
Moderate = 6 inch stain (25-50 mL)
Large = >6 inch stain (50-80 mL)
Postpartum hemorrhage
Blood loss more than 500 mL for a vaginal birth and 1000 mL for c section
When is peri pad changed
Physical s/s of hemmorage
Uterine atony
inability of the myometrium to contract
Hematoma
Normal height of fundus post birth
Anahpylactic syndrome of pregnancy (amniotic fluid embolism)
Mastitis
Infection of the breasts
Treated by antibiotics, ice, warm packs, supportive bra
Diastasis Recti
Separated abdominal muscles
Colostrum
Are bowels sluggish after birth?
Yes! Constipation common
Risk factors for postpartum hemorrhage
Thrombocytopenia S/S
Postpartum (puerperal) infection
Endometritis most common
higher risk for:
Normal vital signs for the newborn
RR: 30-60/min
HR: 110-160
B/P: 60-80/40-50
Weight: 5.5-8.8
Length: 18-22 inches
Newborn temperature
Only take auxiliary temp
HIGH RISK for hyPOthermia
Non-shivering thermogenesis
Because newborns cannot shiver to increase body heat, they use non-shivering themogenisis
If Infant is exposed to lots of cold stress, brown fat stores are depleted causing impaired thermoregulation
Where is brown fat found and when does it go away?
found on
Dissapears after three months
Cold stress potential consequences
Skin asessment of the infant
Acrocyanosis (bluish hands and feet) normal for first 6-12 hrs post birth
Pallor/dusky, cyanosis
Harlequin sign
Jaundice
Physiologic Jaundice
Pathological Jaundice
Hydrocephalus
Fontanel abnormabolities
Phenalkeytoneuria (PKU)
Newborn cannot metabolize phenylalanine which is in protein, including breast milk
Ear/eye height
Top of ear should be level with other canthus of eye
Newborn tremors
What indicates hip dysplasia
Asymmetric creases on thighs + limited hip abduction
Newborn reflexes
Newborn car safety
How should newborns be placed after feeding
Should you wait to bathe an infant after feeding?
Yes, risk of regurgitation due to increased handling
Preventing SIDS
Nutrition during breastfeeding
Stages of milk production
Colostrum = first 3-4 days postpartum
Transitional Milk
Mature milk
How long on each breast for feeding
15-20 min
what position should the newborn be in during feeding
chest to chest (babies chest facing mothers chest)
Hand position during breastfeeding
Hand in a C position
Storing breast milk
Preterm/premature infant
Born before 38 weeks, regardless of weight
Term infant
Born between 38-42 weeks, regardless of weight
Low birth weight
Newborn who weighs less than 5.5 lbs or 2500g
Small for gestational age
Below the 10th percentile for weight
Large for gestational age
Above the 90th percentile for weight
Postterm
Born after 42 weeks
What can cause fetal growth restriction (leading to SGA)
Size of newborn if mother has DM
In women with DM who do not have vascular changes
Complication of post-term newborns
When is the newborns resp system fully developed?
After 35 weeks
Nutrition intake is considered sufficient when the preterm newborn gains ___ per day
20-30 grams per day
kangaroo care
Skin to skin contact
Retinopothy of prematurity is caused by
Oxygen toxicity
Most premature infants catch up by__
24 months (2 years) of age
Physical characteristics of preterm newborn
Physical characteristics of post-term newborn
Blanch test for jaundice
Apply pressure on skin over a bony area (nose, forehead, sternum)
S/S of hypoglycemia in newborn
Spina Bifida
Imperfect closure of spinal vertibre
Infants of DM mothers have
High glucose in the fetus during pregnancy
Respiratory distress syndrome
Caused by surfactent (keeps alveoli from collapsing and helps gas exchange) deficiency leading to poor gas exchange
S/S of dehydration in the infant
Nursing care for the infant receiving photo-therapy
is bronze discoloration and maculopapular skin rash during photo-therapy normal?
Yes, this is normal