NURS 370 Exam 1 - The Postpartum Period

NSVD

normal spontaneous vaginal delivery

LTCS

low transverse cesarean section

VBAC

vaginal birth after cesarean section

R-LTCS

Repeat low transverse cesarean section

FAVD

forceps assisted vaginal delivery

VAVD

vacuum assisted vaginal delivery

TOLAC

trial of labor after cesarean

antipartum

before birth

intrapartum

during birth

postpartum

after childbirth

intermediate

6 week checkup to resume activities

recovery window

two hours post-birth of placenta

multigravida

pregnant 2+ times

multipara

completed two or more pregnancies at 20wks gestation or greater

primipara

first child after the age of viability (24wks)

primigravida

pregnant for the first time or has never delivered a child at viability

nulligravida

never been pregnant

gravida

number of times someone has been pregnant

para

number of births at or after 20wks gestation

GTPAL

gravida, term (greater than 37.0 weeks gestation), preterm (less than 37wks but greater than 19.6wks), abortions, living children

CBC/plts

needed for blood loss quantification and for epidural - anesthesia needs platelet count

type and screen

blood type and Rh factor. drawn at first prenatal visit and during labor at hospital.

RhoGAM

Used to prevent an immune response to Rh positive blood in people with an Rh negative blood type for future pregnancies... given at 28wks and required before 72 hours post-birth.

RhoGAM fetal cell screen

done to see if maternal-fetal blood mixing occurred and if additional doses are required. Kleihauer Betke test may be done to measure fetal hemoglobin transferred from fetus to parent's bloodstream

Hepatitis B

baby will need vax if mother is positive

Rubella

if non-immune, mother must get booster and should not get pregnant within 4wks as this is a live virus and can cause miscarriage or congenital malformation in early pregnancy.

RPR/VDRL/Syphilis

if positive, baby needs antibiotics for 10 days. done at first prenatal and upon hospital admission.

HIV

cocktail for mother and baby if positive

chlamydia and gonorrhea

baby will likely need antibiotics

GBS (Group Beta Strep)

normal vaginal flora that can travel up and infect mother during pregnancy. screen is done at 36 and 38 weeks and if positive, will be treated during labor.

cesarean section

an emergent mode of birth that can be due to maternal issues (HTN, active HSV, HIV, DM), fetal issues (malpresentation, cephalopelvic disproportion), or placental issues (previa, multiple gestation, cord prolapse). incision may be classical/vertical, or low transverse

placenta previa

implantation of the placenta over the cervical opening or in the lower region of the uterus

quantification of maternal blood loss

always done at each birth with blood soaked items for about 2-4 hours or until bleeding is stable. priority assessment is bleeding for birthing person and respiratory for baby

ID and security

always ensure right patients by checking bands, note HUGS and KISSES tags

what should you do before the postpartum assessment

introduce self and wash hands, safety and ID, ensure patient has voided, explain what will be happening, vitals and pain, HS, LS, BS

breasts + nipples

size, shape, tenderness, temperature, color, everted, flat, inverted, red, blistered, cracked, bleeding

breastfeeding

recommend hydration, massage, frequent feeds (2-3 hrs on demand), hot packs before and cold packs after, 500 extra cals

not breastfeeding

tight-fitting bra, avoiding heat, using cold packs and NSAIDs, bottle feed every 3-4 hours. milk takes 2-3 weeks to try up

engorgement

all women will experience ? as mature milk comes in

mastitis

inflammation of the breast - risk can be reduced by releasing all milk if possible, washing with only water and taking care of sore or cracked nipples

uterus

fundal check supine with empty bladder. will be centered between umbilicus and symphysis pubis right after birth, then 6-12 hours will be at level of umbilicus. will descend 1cm a day.

uterine deviation

usually due to distended bladder

what contributes to involution?

oxytocin / contractions

uterine involution

In a week, the uterus will be half the size it was just after giving birth. After two weeks, it will be back inside the pelvis. By about four weeks, it should be close to its pre-pregnancy size. This process is called involution of the uterus.

uterine inversion

uterine fundus collapses into the endometrial cavity, turning the uterus partially or completely inside out.

bladder

measure for first 24 hours. empty bladder every 2-4 hours with 300mL per void. should be able to void 6-8 hours after birth. drink fluids and practice kegels

bowel

last BM, use of laxatives and fluids, fiber

what hormone causes slowing of bowels in pregnancy?

progesterone

lochia

vaginal

lochia rubra

days 1-3 Bright red, fleshy odor, small blood clots, scant to moderate amount, flow increases with standing or breastfeeding

lochia serosa

days 4-10, pink or brown and scant, increased with activity

lochia alba

day 10+, yellow or white and scant

episiotomy

check in sims or side lying to assess, check REEDA and hemorrhoids. encourage ice for 24 hours then heat, peri-bottles and witch hazel/tucks pads, nothing in the vagina until follow up at 6 weeks.

REEDA

redness, edema, ecchymosis, drainage, approximation

1st degree laceration

Extends through skin of perineum

2nd degree laceration

extends through muscles of perineal body

3rd degree laceration

Extends through skin, muscle, perineum, and extends through anal sphincter muscles

4th degree laceration

Extends through skin, muscle, anal sphincter, and anterior rectal wall

extremities

assess IV sites, edema, DVT - encourage early ambulation and compressive devices, avoiding leg crossing

transient anemia postpartum

this is normal, HGB may be 10 and patient is okay

emotion and attachment

look for eye contact and touch, encourage rest and sleep and nutrition, having a support system. tell difference between postpartum depression and baby blues (can last 2 weeks)

geriatric pregnancy

pregnancy after the age of 35

postpartum intravascular fluid shift

5th day

heme/metabolic changes

changes of blood volume, insulin needs reduced, increased prolactin, increased WBCs, increased fibrinogen

neuro changes

altered sleep, fatigue, HA, spinal HA in epidural

renal changes

fluid electrolyte shift, diuresis postpartum, GFR changes

respiratory changes

quickly returns to pre-pregnancy state

cardiac changes

increased cardiac output and stroke volume due to hemodynamic changes, diuresis, fluid shift

integumentary changes

striae gravidarum, laceration, episiotomy

immune changes

increased WBCs, RhoGAM, MMR, Rubella

reproductive changes

ovulation returns quicker for those bottle feeding than breastfeeding (menses at 7-9 weeks and ovulation around 10 weeks). uterine involution takes 3 weeks

gastrointestinal changes

straining r/t constipation and sutures, abdominal distension. use laxatives or stool softeners

muscular changes

relax! muscle fatigue and diastasis recti

postpartum recovery and self care

ambulation, sleep when baby is asleep, nutrition and extra 500 cals for breastfeeding, lots of water, keep bladder empty, ice packs for 24 hours for perineum, pad changes, peri bottles, pat dry, hand hygiene

postpartum drugs

NSAIDS (ibuprofen, tordol for c sec), Acetaminophen, opioids (norco, morphine dilaudid), tucks, witch hazel, prep H, stool softeners (colace, dulcolax, metamucil), vaccines (MMR, flu), RhoGAM, PNV

6 week visit

modified physical exam of breasts, perineum, incisions, SVE for cervix and PAP, screening for depression and IPV, resumption of intercourse and exercise

Previas

pregnancy condition where the placenta attaches low in the uterus and covers all or part of the cervix

accreta spectrum disorder

serious pregnancy condition where the placenta attaches too deeply into the wall of the uterus and cannot separate normally

cord prolapse

a rare and critical obstetric emergency where the umbilical cord slips down through the cervix ahead of or alongside the baby after the amniotic sac ruptures (cuts off the baby’s oxygen and blood supply)

Proper involution

natural postpartum process where the uterus shrinks and returns to its normal, pre-pregnancy size and condition- assess during fundal check

Post partum hemorrhage (PPH)

cumulative blood loss of 1000 mL or greater accompanied by s+s of HYPOvolemia within the first 6 weeks of giving birth

Vaginal Birth

QBL <500mL

C-section birth

QBL <1000mL

QBL

precise measurement of blood lost by a patient during and after childbirth

Abnormal Lochia

foul odor, saturated pad, bleeding beyond 6 weeks

MMR

What vaccine do you need to educate pt to use protection for 28 days after vaccine

S. aureus

What organism causes mastitis