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43 Cards in this Set
- Front
- Back
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postpartum period and changes
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-Birth to approximately 6 weeks after delivery
-body returning to pregnancy state -physiologic changes -emotional changes |
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Breast changes
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-decrease in estrogen
-decrease in progesterone -colostrum(thin yellowish fluid)-packed with anitbodies |
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breast continued
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Oxytocin released by nipples stimulation..causes prolactin to be released
-prolactin caused milk production - milk can take 2-3 days to come in. |
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breats continue
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estrogen and progesterone increased during pregnancy
-dont want baby to lose more then 10% of their weight -Want baby to feed from breast every 2-3 hours - baby maintains glucose to milk comes in, milk comes in quicker with 2nd 3rd and 4th babies. |
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assess breasts for
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-signs of engorgement/red/hot/painful/edematous/mastitis(infection actually gets into tissue/nipple condition (blistering-make sure baby is latching on properly)?
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What do we do if mother is not breastfeeding?
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-encourage tight fit bra-dont stimulate nipples-cabbage leaves-ice packs- dont heat
-may take 5to7 daysfor milk to stop Ibuprofen and vicodin safe for breast feeding |
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uterus/involution
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-begines right after the delivery of the placenta( comes down to pelvic area begins when placenta is out
-exfoliation- sloughing off of dead tissue at the site of the placenta - leaves the site smooth and without scar tissue for further implantations |
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uterus
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immediately begins to descend down
-is midline -by 1 hour after delivery is at umbilicus -descends by approximately 1cm per day -becomes completely non palpable by 10 days post-partum -make sure mom has voided before assessing the fundus(mom has voided lay her flat as tolerated to assess) |
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after pains
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-intermittent contractions
-normal -caused by release of oxytocin -usually last 2 days -more painful for multiparas |
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after pains part 2
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-uterus contracts back to somewhat size mom who is breastfeeding experiences contractions do to oxytocin made through nipple stimulation
-natural way to get uterus back is breastfeeding -more painful in multi-paras do to the uterus being stretched out more then once |
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What could impede involution?
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macrosomic baby- five pregnancys and the last one ten pounds
-twins/triplets -retained placenta and blood clots -alot of pregnancies |
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post-partum hemorrhage
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firm fundus but constant drip(was there a vaginal rip)
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Bladder
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- should void 6-8 hours after delivery
-should have a minimum of 150ml void -Less than that can be related to urinary retention related to decreased bladder tone( maybe bladder got beat up) -assess for signs of UTI -drinks lots of fluids-2000ml/day drink throughout the day,stock with water avoid caffeine pop they dehydrate |
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What are the signs of a UTI?
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painful urination
burning frequency odor |
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bowel
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-important especially after c-section
-assess bowel sounds -needs to be passing flatus -may not stool for 2-3 days after delivery -may need stool softeners (not required to stool before leaving the hospital;) |
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lochia =flow (shedding of epithelium)
3 types -lochia rubra (bright red) -lochia serosa (pink to brown) lochia alba(yellow to white |
bleeding flow
bright red- 1to3 days pink to brown 3 plus days - yellow to white discharge usuallyy occurs by ten days moms by six week check uphas usually stopped all discharge |
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abnormal Lochia
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-saturating one pad in less than a hour
- large clots - significant lochia despite firm fundus... could indicate vaginal tear - foul smelling ( infection ) Is the flow getting less /whats goin on/ how was the baby delivered |
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cervix
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initially appears edematous and bruised
- completely closed by two weeks |
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perineum
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area between the posterior portion of the labia majora and the anus
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type of lacerations
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-first- superficial layers of the skin
-second-extend through the perineal muscle -third- extend through the anal sphincter muscle -fourth- extend through anterior rectal wall and can be damaging to the perineum(moms could need colostomy) |
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Episiotomy
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Red
Echymosis or bruising edema discharge approximated (how are we healing? how does wound look. is the wound foul smelling ?) |
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What could impede involution?
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macrosomic baby- five pregnancys and the last one ten pounds
-twins/triplets -retained placenta and blood clots -alot of pregnancies |
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post-partum hemorrhage
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firm fundus but constant drip(was there a vaginal rip)
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Bladder
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- should void 6-8 hours after delivery
-should have a minimum of 150ml void -Less than that can be related to urinary retention related to decreased bladder tone( maybe bladder got beat up) -assess for signs of UTI -drinks lots of fluids-2000ml/day drink throughout the day,stock with water avoid caffeine pop they dehydrate |
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What are the signs of a UTI?
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painful urination
burning frequency odor |
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bowel
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-important especially after c-section
-assess bowel sounds -needs to be passing flatus -may not stool for 2-3 days after delivery -may need stool softeners (not required to stool before leaving the hospital;) |
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episiotomy/Lacterations- offer mom frozen peri-pad, they can do cold for the first 24 hours (apply every 2 to 3 hours
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- excessive edema can impair wound healing
-some redness is normal but significant pain present warrants further investigation |
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perineum: edema
-ibuprofen- good for pain and inflammation |
cold for 1st 24 hours> frozen peri-pads are in utility room/kitchen freezer
-can apply every 2-3hours -Heat after the first 24 hours- sitzbath -Meds -tucks-witch hazel-comfort -dermoplast spray-comfort |
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Rectal Area:
-hemorrhoids -swollen blood vessels *Nupercainal Ointment |
Generaly
-if no hemorrhoids before PG then go away -if hemorhoids before PG just get worse |
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DVT- assesing for signs and symptomsof Deep Vein thrombosis
* what are the signs and symptoms of DVT? *Pedal edema normal for a few days after delivery last edema is not *encourage patient to ambulate *avoid crossing legs *elevate legs |
-any pain with dorsiflexion ask them to do it
-look at legs pedal edema - feel legs getting them to ambulate helps with venous return |
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post partum- what normal emotions would you expect?
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happy-excited-assume care-bonding time-attentive to infants cues- claiming/ labeling
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psychological adaptation to PG danger signs
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- avoids eye ontact with the baby
-Negative verbalization to or about the baby -Identifies baby with negative characteristics -Unrealistic expectations of the infant -bothered by infants cry ( high risk for shaken baby syndrome, identify and report to social worker) |
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Baby Blues
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-tearfulness
-irritabuility -insomnia--related to;hormonal fluctuations -physical ehaustion - Maternal role adjustment |
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baby blues is a normal occurence during the postpartum period
-should not last more than a few weeks |
may experience more then crying
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postpartum depression
-no specific criteria -occurs within 9 months of birth - becomes non-functional -with drawn - decreased appeitite - expresses desire to harm herself -expresses desire to harm the infant - May have somatic symptoms (induced by some sort of anxiety - headache -diarrhea -anxiety -not themselves |
at risk for post partum depression
-if mom has hx of postpartum then puts mom at higher risk. - mom previously depressed puts her at a greater risk - baby may come ot not crying with no respiratory distress |
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siblings
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- if close in age baby dont usually phase them ie. 9 months
- how old is child - is new marriage or partnership -starting a new family -get them involved with naything if possible -give present to siblings when at the hospital |
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other important things
-respirations -blood pressure -temperature - slight elevation in termp related to dehydration -epidural-(hypotensive) -bradycardia normal immedietly after delivery -tachycardic - hemorrhage -infection |
35-60 baby 12-20 mom
100-130/60-80 baby temp above 97.8 if hypovalemic may have increased hear rate |
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pain-assess for pain with every assessment
-pharmacologic -non- pharmacologic cold packs sitz bath heat ambulation give c/s moms pillow to cough |
-have mom rate on scale
- baby rate with face scale --fill out scoring system -what is baby doing? pharm- motrin vicodin tylenol |
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fundal check why is it important?
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-trying to avoid postpartum hemorrhage
-greater then 500 ml after vaginal delivery -greater than 1000ml after c-section |
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postpartum hemorrhage=
refers to>500 ml after vaginal delivery refers to>1000ml after c section -early pph occurs within the first 24 hours after birth -late pph>24hrs after birth |
hypovalemic shock
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risk factors for pph
-instrumentation -forceps/vacuum c-section transitional cut |
- if mom was placenta previa or placenta abruptio
-placenta left behind -hypertension if mom was on magnesium -quick delivery -too long of labor -using pitocin puts at risk for pph -lots of pregnancies -big babies -twins/trips/multiple babies |
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signs of shock
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tachycardic
-cool pail cold clammy -increased respiratory rate -loc changes - decreased blood pressure late sign -anxious -hemoglobin changes |
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rubella vaccine- not contagious
- if chart states immune means that the titer is greater than 1:8 - if less than 1:8 not immune> needs vaccine - vaccine has an egg base so if allergic to neomycin, eggs should not receive |
it is alive virus recommend do not get pregnant 4-6 weeks
- should not give vaccine if allergic - give it for the future pregnancys sub q- redness at site rash infection |
