NURS 371: CH 21

Typical hospital stay is

◦1 to 2 days after vaginal birth; 3-4 days after a c-section

Information for report

  Name, age, OB, GP/TPAL, anestia if have (spinal, epidural, natural, general), bleeding postatpial, delivery type- ,

Tears/episotmy- sutured, LABS (Prenatal- CBC, arrivial H/H, GBS status, HIV, RUBELLA-IMMUNE/aquired/implicable, blood type and RH factor, GC/CT, HEPT B), meds received, baby info- boy girl, how feeding, peditricin info

◦Newborns’ and Mothers’ Health Protection Act of 1996

The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. The attending provider and the mother together can decide on an earlier discharge

◦Advantages and disadvantages of early postpartum discharge

-advantages: decrease infection rate, decrease cost, promote better bonding, establish a home routine, comfort at own home

-disadvatages: increase readmission rates, postpartum preeclampsia, missed clinical support, incraese parental anxiety/stress

Ongoing Assessment

BP, Vital signs, Breast, Fundus, Lochia, I/O, perineum, bladder/bowel, psychosocial

PP Bleeding

Need to accurately asses blood loss CAREFULLY

1 ml = 1 gram if weighing pads

Maintenance of uterine tone

◦Gentle massage of fundus

◦Administration of medication

Time

How long has it been, which day postapartum is she

Bladder-

Incomplete emptying and over distention of the bladder can lead to urinary tract infection. Over distention of the bladder displaces the uterus and prevents contraction of the uterine muscle, thus leading to postpartum hemorrhage.

Nursing Interventions when voiding-

•Pouring water over the perineum may stimulate voiding. It is easy, noninvasive, and should be tried first.

•The oil of peppermint releases vapors that may relax the necessary muscles. It, too, is easy, noninvasive, and should be tried early on.

•If the woman is anticipating pain from voiding, then pain medications may be helpful.

•Other nonmedical means should be tried first, but medications still come before the insertion of a catheter.

Prevention of bladder distention

◦** Bladder distention can cause uterine atony

6-8 hr to go void (increase fluids, warm water in peri bottle)

Nursing Interventions for postpartum care-

1.) Heating pad, ice pack, anesthetic spray, sitz bath- all can help

2.) Promote walking-  2 people, sit up first (not dizzy or light headed), bring legs over side of bed, then stand up, step in place while bed behind you, then walk to bathroom

3.) Voiding?

     Bowels?  

4.) Medical Clearance by PCP

5.) Nutrition-  increase calories (1800-2200 calories a day, breastfeeding add 500 calories to that), eat a well balanced diet, drink plenty of water

◦Rubella vaccination

if immune do nothing, if not immune ask if want vaccine to prevent MMR

A live vaccine- cant get pregnant for 28 days

◦Tetanus-diphtheria-acellular pertussis (Tdap) vaccine

not live vaccine

protect baby from wooping cough (good for 10 years)

Rh Immunoglobulin- What patients get this?

Pregnancy- Rh negative mothers get a 28 weeks of pregnancy, receive 72 hr after birth if baby is Rh positive- prevent sensitation to prevent antibodies getting made which can affect future pregnancy.