Postpartum Period

BUBBLE HER

breast, uterus, bladder, bowels, lochia, episiotomy/incision, homan’s sign/DVT, emotional status, rhogam/vaccine

what does nipple breakdown indicate when breastfeeding

there is an issue with latching or positioning

nipple care education

breastfeeding hurts, don’t want friction, use own colostrum or purified lanolin for lubrication, let it air dry

purified lanolin 

oil based product, don’t wipe it off until the next feed

what does warmth do to the breasts

prompts blood circulation and let down

how to stimulate milk production

heat packs

what happens to the body while breastfeeding the baby

oxytocin is released which increases uterine contractions

pain control for breastfeeding

ibuprofen which is the first line NSAID, naproxen sodium, low dose opioids 

what to watch for if opioids are used for breast feeding

respiratory depression and infant sedation

what to do if mom wants to bottle feed baby

decrease nipple stimulation in the first few days, use cold packs to help decrease milk production

how to suppress the breast to prevent milk from coming out

tight fitting bra, no nipple stimulation

bottle feeding education

suppression, comfort, engorgement

engorgement 

happens to both breastfeeding and bottle feeding moms, expressing milk will relieve the pain 

mastitis

infection in the breast tissue

what can cause mastitis

engorgement if left untreated, clogged milk ducts

mastitis s/s

unilateral pain, swelling, redness, sudden onset of flu like symptoms

mastitis treatment

antibiotics, bed rest, breastfeeding

goal of treatment of mastitis

decrease pain adn swelling

mastitis education

change nursing pads regularly, loose clothing, moms can still breastfeed baby 

how to massage the uterus

stabilize and use firm pressure to encorage uterine contractions

desired uterine assessment findings

firm, midline, below the umbilicus

what does a deviated uterus indicate

bladder is full and mom needs to use toilet 

when is it ok for the uterus to be below or above the umbilicus

for the first 12 hours the uterus can be above but after 24 hours it should be below 

how much does blood volume changes during prenancy

40-45%

how does the blood volume changes at delivery

blood volume shifts rapidly to help reduce the fluid load

expected blood loss for vaginal and c section

vaginal 500ml and c section 1000 ml

expected temperature

eelvated up to 100.4 in the first 24 hours

expected pulse

SV + CO increases in the first hour, gradual return to baseline in 48 hours 

expected blood pressure

baseline, orthostatic hypotension

expected h and h

first 24 hours: decreases slightly

day 3-4: plateau 

expected WBC

30000

expected clotting factors and fibrinogen

increase during pp period especially in the first 48 hours, hypercoagulation 

postpartum hemorrhage risk factors

overdistended uterus, oxytocin IOL, high parity, mag infusion, instrumented delivery, c section, placenta abnormalities, IUFD 

how can a uterus be overdistended

macrosomic baby, polyhydramnios, multiple gestations

how is mag infusion and risk factor for postpartum hemorrhage

smooth muscle relaxer

postpartum hemorrhage causes

tone with uterine atony, tissue with retained placenta, trauma with lacerations, thrombin with coagulation 

what to do if blood loss appears excessive for postpartum hemorrhage 

evaluate the uterus by palpating, treat the cause 

number 1 cause of postpartum hemorrhage

uterine atony

postpartum hemorrhage nursing interventions

massage the fundus, bladder elimination, IV oxytocin, O2/fluid bolus, additional meds, bimanual exam, bakri balloon, JADA, surgery 

what medications are used to treat hemorrhage

misoprostol, methylergonovine, carboprost

methylergonovine contraindications

HTN or hypotension

carboprost contraindications and what can it cause

HTN and asthma, can cause explosive diarrhea

bimanual exam

mechanically removing clots and fragments from the vagina using sterile gloves

bakri balloon

balloon to keep firm shape

JADA

vacuum to keep vessels open

bladder assessment

distention or stasis, consider the obstacles, foley

what obstacles can prevent a mom from voiding

inflammation from labor swelling or trauma, fear

what to give new mom if they are fearful to void or have a bowel movement

give peri bottle with warm water and pat dry 

how should the mom void or have a bowel movement to prevent stiches from coming apart 

don’t push, no bearing down, relax 

what are moms at risk for regarding the bladder

UTI

if they have a foley or not when should they void

within 6 hours but if they don’t measure the amount when they do void 

what are new moms at risk for regarding bowels

constipation

bowel interventions

docusate sodum, high fiber diet, mobilizing, hydration

how should new moms have a bowel movement for the first time

feet up, no bearing down, use peri bottle 

s/s of UTI 

urgency, frequency, dysuria, lower abdominal pain 

UTI risk factors

pelvic exams, foley

prevention of UTI

bladder care, hand hygiene, hydration, sterile technique

bladder care to prevent UTI

empty bladder, toileting schedule, change pad everytime, wipe front to back 

UTI nursing interventions

UA, antibiotics, education

what happens if UTI get left untreated

pyelonephritis, risk for permanent kidney damage and failure

lochia assessment

color, odor, amount

lochia colors

rubra, serosa, alba

rubra

bright red blood, day 1-3

serosa

pinkish brown, day 4-10

alba

whitish yellow day 10 to week 6

expected lochia color

consistent change to red to clear

abnormal lochia color

sudden retunr to bright red after turning a lighter color

normal lochia odor

no distinct odor

abnormal lochia odor

prolonged or foul smelling odor can indicate infection

normal lochia amount

gradual decrease

abnormal lochia amount

pad saturated in 15 min

c section/incision care

no heavy lifting of 10 lbs for 4-6 weeks, splint if pressure is applied, shower with back facing the water, hand hygiene, no baths until incision heals 

vagina/pericare

first 24 hours use ice pack and no heat, after 24 hours use sitz baths to increase warmth blood flow and circulation which promotes healing 

when should you call provider for hemorrhoid

excessive bleeding or many clots

medication to treat hemorrhoids

hydrocortisone acetate and pramoxine hydrochloride to decrease irritation and inflammation 

hematoma

hidden hemorrhage, more often in vaginal births, monitor for internal bleeding 

hematoma s/s

difficulty urinating, hesitancy, uncontrolled severe pain 

wound infection assessment

redness, edema, emosis, drainage, approximation, odor

endometritis with stats

most common pp infection in the lining of uterus, 2% vaginal and 10-15% c section

endometritis s/s

fever, increase HR, chills, nausea, pelvic pain, tender uterus, foul lochia, leukocytosis 

endometritis care

IV antibiotics, pain meds, rest, hydration, support bonding and feeding 

when does endometritis usually occus

c section birth after prolonged labor and ruptured membranes

DVT assessment

symmetry, edema, redness, pain

whose at risk for a DVT postpartum and what can it cause

c section moms, leading cause of maternal death

how does a postpartum mom get pulmonary embolism

dislodged DVT

pulmonary embolism s/s

dyspnea, chest pain, tachypnea, tachycardia, decrease SpO2, apprehension, cough, crackles, hemoptysis

pulmonary embolism nursing intervention

seni fowler position, oxygen, IV heparin or warfarin, alteplase

what to assess for regarding emotional status

mood and monitor for changes, coping methods, support systems

emotional support teaching

encourage rest, self care, normalize emotions, communicate needs, when to seek help 

baby blues

mild, transient, short term, normal

postpartum depression

persistent for longer than 10 days, interferes with care

postpartum depression s/s

guilt, irritability, anxiety/panic attacks, flat affect

postpartum depression treatment and nursing interventions

screen for SI/HI, community resources, medication, validate feelings, encourage communication 

when does a mom need rhogam 

mom is rh negative, baby is rh positive, mom is not already sensitized

rubella and varicella

live vaccines, cannot get pregnant for 1 month after injection

Tdap

all care providers need to get it

attachment and bonding

assess for healthy behaviors, promote bonding, teach soothing techniques, encourage accepting help, taking breaks when overwhelmed

transition to parenthood factors

educate parents about new realities, consider the new family dynamics, mixed emotions are normal but should be monitor for patterns that may suggest pp depression or maladaptation, resuming sexual activity after birth 

when should parents resume sexual activity after birth

2 to 4 weeks or if bleeding stops and perineum heals

culturally responsive care

asking, listening, supporting and educating without judging, cultural traditions influences, facilitate family involvement, ask open ended questions