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23 Cards in this Set
- Front
- Back
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What is Puerperium?
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Period of time following delivery until uterus returns to a pre-pregnancy state(usually 3-6 weeks)
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What is Involution?
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Process in which the uterus contracts back down to its pre-pregnancy state.
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Fundus levels: End of 3rd stage of labor; 12 hr. pp; each week until it is back to its pre-pregnancy size and position.
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End of 3rd stage: midline, 2 cm. below umbilicus
12 hr. pp - midline, 1 cm above umbilicus descends 1-2 cm./day after that *If the fundus is not midline, think - full bladder |
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Components of History
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1. Type of delivery (SVD, LFD, VAD, VBAC, C-S)
2. Compications/ significant history 3. Blood type 4. Rubella status 5. Perineal Care 6. Other incisions 7. Breast/ Bootle feeding 8. PP Hct value 9. Misc: IV/ Foley/ Voiding Status |
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General PP assessment
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1. LOC
2. Anxiety/ Pain/ Fatigue 3. Coping skills 4. Relationships: significant other/ family members 5. Bonding with infant |
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Questions to ask postpartum (9)
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1. How do you feel?
2. Pain 3. How is breastfeeding going? 4. How do your nipples/ breasts feel? 5. Are you having any cramping? 6. Stitches (episiotomy)? 7. Gas or BM since delivery? 8. Any pain in legs? 9. Are the medications helping? |
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What are the guidelines for VS post delivery?
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q15min. x 1 hr. then q 30 min. X 2 hr. then unit protocol
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Measures of perineal care
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1. warm water
2. Ice pack - 1st 24 hrs. for edema 3. anesthetic foam, sprays - front to back 4. Inflatable ring - can increase swelling because the perineum hangs down 5. sitz bath - hyperemia |
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Postpartum CVS
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- EBL = 200-400cc. (vaginal); 500-1000cc. (c/s)
- fatigue, lethargy, fainting, thirst, pallor - encourage hydration and nutrition - compare pre- and post- Hct/ Hgb. |
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PP specific assessment - Breasts
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- are they soft, filling, lactating, engorged?
- Nipples - intact/ cracked/ blistered - Breastfeeding/ Bottle feeding |
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Patient education for the breastfeeding mother
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1. Colostrum production - thick, creamy (full of antibodies) provides passive immunity
2. Milk production will begin within 48-72 hours and is the consistency of thin skim milk - infant will not starve before it comes 3. Breast consistency will change from soft to firm when it becomes engorged 4. Engorgement process can be painful |
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Patient education for the bottle feeding mother
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1. Bind the breast tightly - (very important) pre-pregnancy sports bra; will limit milk production
2. Do no stimulate the breast - turn back to hot shower, avoid mechanical stimulation 3. Apply ice packs - frozen cabbage or frozen newborn diapers |
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PP specific assessment - Fundus
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Should be midline, firm
1. Height - measured in relation to umbilicus in cm. or fingerbreadths 2. Tone - firm; boggy is concern 3. Deviation - right or left indicates bladder retention (#1 cause of a boggy uterus) *When palpating the fundus, support the lower segment to prevent inversion of the uterus (immediate emergency surgery) |
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PP specific assessment - Bladder
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1. Distention
2. Suprapubic tenderness 3. Presence of Foley - d/c Foley asap |
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PP specific assessment - Perineum
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Yes look at it. Yes, palpate it
1. Midline Lateral Episiotomy/ laceration (approximate edges of episiotomy) 2. Hemeroohoids - result of pushing - inverted rectum 3. Hematoma - redness, tender, bleeding under skin |
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PP specific assessment - Lochia
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Bleeding after birth
lochia rubra (red); days 1-3 lochia serosa (pink-brown); days 3-10 lochia alba (white, yellow); days 10-21 |
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What to know before assessing a c-section patient
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1. Anesthesia - epidural, spinal. general anesthesia
2. Pain management - epidural/ PCA/ PO 3. Breath sounds - listen for atelectasis 4. Bowel sounds 5. IV 6. Foley 7. Abdominal dressing/ wound assessment |
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BUBBLE
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Breasts
Uterus Bladder Bowels Lochia Episitomy |
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What to know about assessing a vaginal delivery patient
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1. Episiotomy/ Lacerations - crowning of fetal head can cause swelling (lubrication, stretching, support to minimize; lacerations can still occur - 1st or 2nd degree)
2. Unassisted spontaneous birth - laceration common - 1st, 2nd, 3rd, 4th degree |
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Degrees of laceration: 1st, 2nd, 3rd, & 4th
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1st Degree - limited to skin and superficial structures
2nd Degree - reaches into perineal muscle 3rd Degree - extends into anal sphincter 4th Degree - involves the anterior rectal wall (vaginal c-section) |
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Risk Factors for Postpartum hemorrhage
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1. Multigravid patient
2. Prolonged use of Pitocin 3. Over-distended uterus 4. Clotting disorder 5. Full bladder - uterus is not midline 6. Uterine Atony 7. Red hair 8. Retained placental fragments 9. Vaginal/ Cervical lacerations |
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What is Uterine Atony?
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A boggy uterus. Caused by:
1. Full bladder (most common cause) 2. bleeding from the placental site |
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What causes retention of placental pieces?
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1. Subincolution
2. Ineffective contractions |
