Postpartum Period Study Notes

Comp 3: Postpartum Period

Learning Objectives

  • Explain the pathophysiology and physiological adaptations for clients who have an uncomplicated postpartum period.

  • Explore the nursing care of clients with an uncomplicated postpartum course.

  • Apply the nursing process, using clinical judgment, while providing care to clients with an uncomplicated postpartum period.

Expected Maternal Physiological Adaptations

  • Vital Signs

  • Neurological System

  • Endocrine System

    • Placental Hormones

    • Pituitary Hormones

    • Thyroid

  • Pancreas/Liver

    • Insulin

    • Glucose

  • Cardiovascular System

    • Cardiac Output

    • Varicosities

  • Hematological Systems

    • Blood Volume

    • Hemoglobin & Hematocrit

  • Pulmonary/Respiratory Systems

    • Pulmonary Function

  • Gastrointestinal System

    • Peristalsis, Constipation

    • Hemorrhoids

    • Anal Incontinence

  • Renal System

    • Kidney Function

    • Postpartum Diuresis

    • Bladder function: Voiding, Distention, Urinary Incontinence

Reproductive System Adaptations

  • Involution of the Uterus

  • Lochia

    • Lochia rubra: Dark red, lasts for the first 3-4 days postpartum.

    • Lochia serosa: Pink to brown, occurs from days 4 to 10 postpartum.

    • Lochia alba: White or yellow, lasting from days 10 to 14 postpartum.

  • Cervix

  • Ovaries

  • Vagina

  • Perineum & Pelvic Musculature

  • Breasts

    • Colostrum

    • Hyperlactation

    • Hypolactation

Musculoskeletal System Adaptations

  • Muscle Tone

  • Joint Hypermobility

Integumentary System Adaptations

  • Chloasma/Melasma

  • Hyperpigmentation of Areola

  • Linea Nigra

  • Striae Gravidarum

  • Hair Loss

Nursing Care of Postpartum Clients

Physical Assessment

  • Vital Signs:

    • Blood Pressure:

    • Increased: Consider Pre-eclampsia.

    • Decreased: Consider Hemorrhage.

    • Temperature:

    • Increased: Over 38°C – Consider Infection.

    • Heart Rate:

    • Increased: Consider Hemorrhage.

    • Respiratory Rate:

    • Increased: Consider Anxiety or Compromised Respiratory Status.

    • Decreased: Consider Use of Opioid Pain Medications.

Breasts & Nipples Assessment

  • Breasts:

    • Inspection & Palpation

    • Primary Engorgement

    • Secondary Engorgement

  • Nipples:

    • Inspection

    • Breastfeeding & Latching

Uterine Tone Assessment
Lochia Assessment
Perineal Assessment

  • Check for lacerations, episiotomy, rectal area (including hemorrhoids).

Urinary Elimination Assessment
Abdomen Assessment
Lower Extremities Assessment
Types of Lacerations

  • First Degree: Involves only the vaginal mucosa.

  • Second Degree: Involves vaginal mucosa and underlying muscle.

  • Third Degree: Involves vaginal mucosa, muscle, and anal sphincter.

  • Fourth Degree: Extends through the anal sphincter and rectum.

Assessment of Energy Level and Pain Management

  • Address afterpain, perineal pain, and pain related to Cesarean birth.

  • Ensure effective communication with the client.

Psychosocial Aspects

  • Impact of Birth Experience: Affects client & family dynamics.

    • Maternal/Paternal Stress

    • Evaluate Positive Birth Experience

    • Assess Parent-Newborn Interaction

    • Adapting to Parenthood

    • Cultural Beliefs and Practices

Mental Health Disorders Postpartum

Postpartum Blues

  • Symptoms include:

    • Sadness

    • Lack of appetite

    • Sleep disturbance

    • Feelings of inadequacies

    • Crying

    • Restlessness, insomnia, fatigue

    • Headaches

    • Anxiety

    • Anger

Postpartum Depression

  • Symptoms include:

    • Guilt and feelings of inadequacies

    • Irritability

    • Severe anxiety, panic attacks

    • Extreme fatigue

    • Feelings of loss

    • Lack of appetite and weight loss

    • Persistent sadness

    • Mood swings

    • Sleep disturbance

    • Thoughts of harming the infant

Postpartum Psychosis

  • Symptoms include:

    • Pronounced sadness

    • Disorientation

    • Confusion

    • Paranoia, hallucinations, delusions

    • Rapid mood swings

    • Thoughts of harming oneself or the infant.

Nursing Care for Mental Health Disorders

  • Client Education

  • Medications

Managing Physical Needs and Treatments

  • Pain Management Strategies:

    • Sitz Bath

    • Medications (Acetaminophen, Ibuprofen, Oxycodone)

    • Topical treatments (Benzocaine topical, Dermoplast)

    • Cold Therapy

    • Strengthening Muscles

Immunizations

  • Recommended Immunizations:

    • Rubella

    • Varicella

    • Tetanus-Diphtheria-Acellular Pertussis

    • Rh Immune Globulin

Complications During the Postpartum Period

Learning Objectives

  • Examine the conditions and care for clients experiencing postpartum complications such as:

    • Postpartum Hemorrhage

    • Postpartum Shock

    • Deep Vein Thrombosis (DVT)

    • Postpartum Infections

    • Postpartum Coagulopathies

Postpartum Hemorrhage

  • Uterine Atony

    • Etiology, Clinical Manifestations, Nursing Interventions, Client Education

  • Four Ts of Postpartum Hemorrhage:

    • Tone: uterine atony, distended bladder

    • Tissue: retained placenta and clots

    • Trauma: vaginal, cervical, perineum, or uterine injury or hematoma

    • Thrombin: coagulopathy

  • Management Strategies:

    • Non-pharmacologic Intervention (Bimanual Uterine Massage)

    • Pharmacologic Interventions (Uterotonics, Tocolytics, Blood Products)

    • Surgical Interventions (Tamponade)

Retained Placenta

  • Etiology, Clinical Manifestations, Nursing Interventions, Medical Management

Inversion of the Uterus

  • Etiology, Clinical Manifestations, Nursing Interventions, Medical Management

Subinvolution of the Uterus

  • Etiology, Clinical Manifestations, Nursing Interventions, Medical Management

Genital Tract Lacerations

  • Etiology, Clinical Manifestations, Nursing Interventions, Medical Management

Hematomas

  • Etiology, Clinical Manifestations, Nursing Interventions, Medical Management

Postpartum Shock

  • Etiology, Clinical Manifestations, Nursing Interventions, Medical Management

Deep Vein Thrombosis (DVT)

  • Etiology, Clinical Manifestations, Nursing Interventions, Medical Management

Postpartum Infections

  • Etiology, Clinical Manifestations, Nursing Interventions, Medical Management

Postpartum Coagulopathies

  • Gestational Thrombocytopenia and Idiopathic Thrombocytopenic Purpura (ITP)

  • Medications: Magnesium Sulfate, Oxytocin, Misoprostol, Carboprost Tromethamine, Methylergonovine, Dinoprostone (Prostaglandin E2), Tranexamic Acid, Nitroglycerin, Terbutaline, Low Molecular Weight Heparins, Rho(D) Immune Globulin

Questions

  • Open the floor for any questions regarding the topics covered and provide clarification where necessary.