Postpartum Care Notes

Flashcards about postpartum care and physiological changes

What is the postpartum period?

The period from birth to the return of reproductive organs to a non-pregnant state, also known as the 'Fourth Trimester' or Puerperium, typically lasting from the delivery of the placenta to 6 weeks postpartum.

What are the greatest risks during the recovery period (birth - 2 hours) in the postpartum period?

Postpartum hemorrhage (PPH), shock, and infection.

What is involution?

The contraction of smooth muscle to facilitate the uterus returning to its pre-pregnancy size.

How does the fundus descend after delivery?

After the first 24 hours, the fundus descends 1-2 cm every 24 hours.

What is the primary mechanism to prevent postpartum hemorrhage during involution?

Contraction of muscle fibers, catabolism (shrinking of myometrial cells), and regeneration of uterine epithelium.

How can exogenous oxytocin reduce postpartum hemorrhage?

IV administration of exogenous oxytocin reduces postpartum hemorrhage by half.

What nursing actions should be taken regarding afterpains?

Assess for pain frequently, assess the source, provide comfort measures (relaxation, heat, cold, sitz baths, witch hazel pads, peri bottles), administer medications (NSAIDS, narcotics), and organize nursing care to allow for rest/naps when the infant is sleeping.

What factors slow or cause abnormal uterine involution?

Overdistended uterus, long labors, retained placenta, C-sections, and infection.

What interventions facilitate uterine involution?

Administering oxytocin after placental delivery, encouraging early breastfeeding, facilitating bladder emptying, and performing fundal massage with frequent assessments.

What are some nursing interventions to teach patients about regarding pelvic floor/muscle tone?

Kegel exercises, early ambulation, proper body mechanics and posture, and avoiding abdominal exercises after C-section until provider follow-up.

What are the effects of the delivery of the placenta on the endocrine system?

Rapid clearance of placental hormones, reversing the diabetogenic effects and significantly lowering blood sugar levels in the immediate puerperium. Estrogen & Progesterone drop immediately after placenta separates and delivers.

How does the urinary system change postpartum?

Kidney function returns to normal within a month, urinary tract structures return to normal within 2-8 weeks. Diuresis and diaphoresis result in a weight loss of about 5 pounds.

What interventions are appropriate for urinary retention?

Frequently empty bladder, measure 1st 2-3 voids, increase PO fluids and consider catheterization (I&O cath or Foley) if bladder is distended and the patient is unable to void.

What safety measures should be taken before ambulating a postpartum patient?

Check blood pressure first, assess motor function and sensation after epidural/spinal, elevate HOB prior to ambulating, dangle at the side of bed, help client stand and test strength of legs and assess for s/s dizziness, lightheadedness. Stay with the patient for the first ambulation.

What are some GI system nursing interventions to promote bowel function?

Encourage the patient to drink 8 glasses of water per day, ambulate, consume fiber, and assess bowel sounds.

What cardiovascular system changes occur postpartum?

Postpartum diaphoresis and diuresis due to elimination of excess fluid. Stroke volume increases for at least 48 hours, cardiac output remains high in the recovery period, returns to pre-labor values at 24-48 hours then gradually returns to normal by 6-8 weeks.

When should a postpartum temperature elevation raise suspicion for infection?

An elevation of temperature after 24 hours OR that persists >2 days

What are the components of the postpartum physical assessment?

B - breasts, U - uterus, B - bowel, B - bladder, L – lochia, E – episiotomy, laceration or incision, E – extremities (edema), E – epidural site, E- emotional status

What hormones affect milk production and ejection?

Prolactin produces breastmilk and oxytocin stimulates milk ejection (letdown).

What are the stages of breastmilk development?

Colostrum (Lactogenesis I), Transitional Milk, and Mature Milk (Lactogenesis II).

How often should a newborn latch?

Every 2-3 hours for 20-40 minutes totaling 8-12 times in 24 hours.

What are the S/S's of mastitis?

Chills, fever, malaise and local breast tenderness. Also, pain, swelling, redness and axillary adenopathy.

What are the S/S's of engorgement?

Breasts appear tight and full, tender, and warm.

What are some nursing interventions for non-nursing mothers to suppress lactation?

Tight-fitting, supportive bra 24/7, no breast/nipple stimulation, ice packs (15 on, 45 off, repeat) or cabbage leaves, and mild analgesics or anti-inflammatory meds.

What are the key factors to assess when examining the uterus postpartum?

Fundal height (location in relation to the umbilicus), Placement (midline, deviated), and Consistency (firm, boggy)

What is the recommended teaching for bowel function postpartum?

fiber/fluids/ambulation, peribottle for cleansing

What is the recommended teaching for bladder function postpartum?

diuresis, peribottle (for cleansing and to stimulate stream)

What is lochia?

Post birth uterine discharge.

What are the classifications of lochia stages?

Rubra, serosa, and alba.

What REEDA stand for in Episiotomy assessment?

Redness, Edema, Ecchymosis, Discharge, Approximation

During assessment of patient lacerations, what should you avoid with 3rd and 4th degree?

NO rectal suppositories

What are the risk factors venous thromboembolism (VTE)?

Pregnancy, Prolonged immobility (bedrest, c-section), Obesity, Smoking, Multiple gestation, Age, Hx of thromboembolism

What are the key elements of postpartum hemorrhage interventions?

Massage, Empty bladder, VS q5min, O2, EKG, IV x2, Oxytocin, Labs

What are the risk factors for reproductive tract infections postpartum?

Cesarean Section, PROM, Multiple vaginal exams, Compromised health status, Internal monitors, Trauma, Chorioamnionitis, vaginal infections, Operative vaginal delivery, Manual extraction of placenta

What are the S/S wound infection?

Wound warmth, Erythema, Tenderness, Pain, Edema, Seropurulent drainage, Wound dehiscence, Evisceration, Temp >100.4 X 2 consec days

What are the steps of Family Adaptation?

Taking in, Taking hold, and Letting go

What are some nursing actions to facilitate Family bonding?

Skin to skin, Newborn facing position, Observe similarities in features, Rooming in, Quiet and private environment, Teach about newborn care

What postpartum mood disorder symptoms include auditor or visual hallucinations and poor impulse control which may increase patient suicide risk?

Postpartum Psychosis

When should the TDAP vaccine be given?

At discharge or at 1st PP visit

What immunization needs maternal consent postpartum?

Rubella